Objective To systematically review the effectiveness and safety of coronary artery bypass grafting (CABG) versus percutaneous coronary stent implantation (PCI) in the treatment of patients with unprotected left main coronary artery disease (ULMCA). Methods Databases including The Cochrane Library (Issue 2, 2012), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP were electronically searched from inception to September 2012 for randomized controlled trials on the effectiveness and safety of coronary artery bypass grafting (CABG) versus percutaneous coronary stent implantation (PCI) for ULMCA; References of the included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then, meta-analysis was performed using RevMan 5.0. Results Four studies were included involving 1 611 cases, of which, 802 cases are in the CABG group, while 809 cases were in the PCI group. The results of meta-analysis showed that: comparing with PCI, CABG significantly reduced the postoperative repeat revascularization rate (OR=0.45, 95%CI 0.31 to 0.66, Plt;0.000 1), but there was no significant difference between the two groups in reducing the myocardial infarction incidence (OR=1.28, 95%CI 0.47 to 3.48, P=0.63), mortality rate (OR=1.36, 95%CI 0.80 to 2.34, P=0.26), and the incidence of major adverse cardio-cerebral vascular events (OR=0.92, 95%CI 0.66 to 1.28, P=0.61). Conclusion This study indicates that CABG is superior to PCI in reducing postoperative rate of target vessel revascularization. But CABG and PCI are alike in reducing myocardial infarction incidence, mortality rate, and the incidence of major adverse cardio-cerebral vascular events. Due to the limited quantity and quality of the included studies, the above conclusion needs to be verified by more high quality RCTs.
目的:探讨黄芪颗粒对紫癜性肾炎的临床疗效,为本病的后续治疗提供更多的药物选择。方法:对我院2003年至2008年收治的51例紫癜性肾炎患儿进行出院后的后续治疗并作随访对照观察。对照组根据病情酌情使用双嘧达莫、泼尼松、中药及对症等。治疗组加服黄芪颗粒,6个月～3岁:每次1/2袋,3～6岁每次2/3袋,6～13岁每次1袋,一天两次,疗程2～3个月。结果:治疗组尿常规异常2例(2/26),对照组8例(8/25),差异有统计学意义(χ2=478,Plt;005);治疗组肾炎复发1例(1/26),对照组5例(5/25),差异有统计学意义(χ2=1543,Plt;001)。结论:黄芪颗粒在紫癜性肾炎后续治疗中有肾脏保护作用,可以明显减少尿常规异常和肾炎复发。
目的：研究吗替麦考酚酯（MMF）和环孢素A（CsA）对大鼠慢性移植肾病中细胞保护基因A20、HO-1、Bcl-2和Bcl-XL表达的影响。方法：分别采用雄性SD大鼠和Wistar大鼠作为供受体建立强化缺血/再灌注损伤慢性移植肾病模型。对受者依据所采用的免疫抑制剂方案分组：对照组、CsA组、MMF组。在移植术后的相同时间点处死大鼠，切取移植肾脏。采用荧光定量RTPCR和免疫组织化学方法检测A20、HO-1、Bcl2和BclXL的表达及其在移植肾中的定位情况。结果：在大鼠慢性移植肾病模型中，能够检测到所有上述四种细胞保护基因的表达。A20主要表达于血管内皮细胞和浸润之淋巴细胞。HO-1主要表达于浸润之淋巴细胞，但在肾小管上皮细胞也有表达。Bcl2和BclXL则主要表达于肾小管上皮细胞。MMF组A20的表达显著高于CsA组和对照组（Plt;0.01）。HO1，Bcl2和BclXL的表达在MMF组和CsA组间无显著性差异（Pgt;0.05）。结论：MMF对A20表达的增强可能与MMF减轻大鼠慢性移植肾病病变的机制有关。
目的：替扎尼定是具有解痉作用的α２肾上腺能受体激动剂，并具有一定的胃肠道保护作用，适用于单一治疗或与非甾体消炎药（NSAIDs）联合治疗急性痉挛性疼痛。通过替扎尼定和非甾体类抗炎药物的联合应用，临床观察和评估联合用药能否增强疗效和增加安全性。方法：急性痉挛性疼痛70例，随机分为两组，一组服用替扎尼定2mg,bid+双氯芬酸50 mg,bid，一组服用双氯芬酸50 mg,bid+安慰剂2mg,bid。观察药物疗效和不良反应。结果：联用组的总有效率为70％，胃肠道不良反应发生率为12%,中枢神经系统不良反应发生率为18％；单用组的总有效率为56％，胃肠道不良反应发生率为32％，中枢神经系统不良反应发生率为10％。结论：替扎尼定和非甾体类药物联用具有更好的疗效以及更高的药物耐受性。
Objective To explore the significance of parathyroid micro vascular anatomy in thyroid lobectomy with capsular technique. Methods The pertinent literatures in recent thirty years were screened with key words “parathyroid micro vascular anatomy， capsular technique， and protection”and reviewed. Results There were many types of number， origin， and length of parathyroid vascular， and specific measurements should be taken in thyroid lobectomy with capsular technique. Conclusion Fully awareness of parathyroid micro vascular anatomy will benefit to ensure preservation of their function during thyroid lobectomy with capsular technique.
Twenty six cases with carotid body tumours (27 tumors) were operaterated on from November,1988 to October, 1997. Eleven of the 26 cases were misdiagnosed in other hospital. Twenty six cases experienced B-mode ultrasonic scanning and 18 carotid arteriography. Seventeen cases underwent general hypothermic anesthesia (30℃-32℃) and 9 general carotid-internal carotid shunt. Eight cases (9 tumors) experienced simple excision of tumor, 3 resection of the tumor with external carotid, 11 excision of the tumor with internal, external and general carotid and carotid-reconstructing. Two cases underwent anestomosis of general carotid with internal carotid and 2 ligation of the internal carotid. All patients showed good results but one complicated with hemiplegia. The authors consider that misdiagnosis can be avoided with careful physical examination, Bmode ultrasonic scanning and arteriography, and hypothermic general anesthesia and intraoperative general carotid internal carotid shunt were important measures for the protection of brain.
Abstract： Objective To explore clinical outcomes of nitroglycerin perfusion via the aortic root before heart re-beating for patients undergoing heart valve replacement. Methods A total of 254 patients with valvular heart diseases underwent heart valve replacement in Beijing Anzhen Hospital from January 2008 to December 2011. According to whether or not they received nitroglycerin perfusion via the aortic root before heart re-beating during cardiopulmonary bypass （CPB）， all the 254 patients were randomly divided into two groups， the nitroglycerin group and the control group. There were 134 patients in the nitroglycerin group including 57 males and 77 females with their average age of 58.47±12.34 years. They received aortic root perfusion of 5 mg nitroglycerin diluted into 20 ml after full de-airing of the heart， and repeated aspiration was performed 8 to 10 times before heart re-beating during CPB. Aortic cross-clamp was released after the heart showed signs of automatic re-beating， and the aortic root was squeezed in high frequency by hand to make sure that the aorta was squeezed to close each time. In the control group， there were 120 patients including 64 males and 56 females with their average age of 61.85±11.97 years. Patients in the control group received routine procedures of CPB except nitroglycerin perfusion before heart re-beating. Automatic heart re-beating rate， CPB supporting time after heart re-beating， postoperative usage of inotropic drugs， mechanical ventilation time， perioperative morbidity and length of hospital stay were compared between the 2 groups， and patients were followed up and further evaluated. Results There was no in-hospital death. CPB supporting time after heart re-beating（12.32±9.76 min vs. 23.43±10.33 min， t=-1.233， P=0.000）， dopamine usage［3.45±2.33 μg/ （kg?min） vs. 5.67±3.12 μg/ （kg?min） ， t=-0.943 ， P=0.034］ and epinephrine usage ［0.026±0.013 μg/ （kg?min） vs. 0.056±0.021 μg/ （kg?min） ， t=-0.822 ， P=0.027］ of the nitroglycerin group were significantly shorter or lower than those of the control group. Automatic heart re-beating rate of the nitroglycerin group was significantly higher than that of the control group ［97.01% vs. 66.67 % ， χ 2 =-2.115 ， P=0.000］. A total of 121 patients in the nitroglycerin group were followed up for 2-36 months， and 13 patients were lost during follow-up. There was no death during follow-up. Conclusion For patients undergoing heart valve replacement， some myocardial protection strategies including nitroglycerin perfusion via the aortic root before heart re-beating， use of norepinephrine， and aortic root squeezing in high frequency by hand can significantly increase the automatic heart re-beating rate， shorten the CPB supporting time after heart re-beating， and improve postoperative clinical outcomes.
Abstract： Objective To observe myocardial protective effect of sevoflurane used in the whole process of cardiopulmonary bypass（CPB）. Methods A total of 150 patients older than 18 years who underwent cardiac surgery under CPB in Fu wai Hospital from January 2010 to November 2011 were enrolled in this double-blind and randomized controlled study. All the patients were randomly divided into three groups：Sevoflurane pretreatment group （Group A，n=50），whole-process Sevoflurane group （Group B，n=50），and whole-process intravenous anesthesia group （Group C，n=50）. Radial artery pressure and other hemodynamic parameters were continuously measured for all the patients. At following time points: CPB beginning （T1），aortic declamping （T2），3 hours after aortic declamping （T3），and 24 hours after aortic declamping （T4），serum concentrations of cardiac troponin I （cTnI） and other parameters were measured by enzyme-linked immunosorbent assay （ELISA）. Results There were 31 males and 19 females at age of 60.43±3.24 years in group A，28 males and 22 females at age of 59.88±4.12 years in group B，31 males and 19 females at age of 58.76±3.87 years. There was no statistical difference in mean arterial pressure （MAP），central venous pressure （CVP），pulmonary artery wedge pressure （PAWP） and heart rate （HR） at respective time points among the 3 groups （P＞0.05）. At T1 and T2，there was no statistical difference in cardiac index （CI） among the 3 groups （P＞0.05）. At T3，there was no statistical difference in CI between Group A and Group C（F=3.382，P=0.845），but CI of Group B was significantly higher than that of Group A and C（F=3.382，3.382； P=0.033，0.020）. At T4，CI of Group B was significantly higher than that of Group A and C （F=13.324，13.324； P=0.005，P=0.000），and CI of Group A was significantly higher than that of Group C （F=13.324，P=0.024）. At T1 and T2，there was no statistical difference in serum concentrations of creatinine kinase MB （CK-MB），cTnI，interleukin-6 （IL-6） and tumor necrosis factor alpha （TNF-α） among the 3 groups （P＞0.05）. At T3 and T4，serum concentrations of CK-MB，TNF-α，IL-6 and cTnI of Group C were significantly higher than those of Group A，and serum concentrations of CK-MB，TNF-α，IL-6 and cTnI of Group A were significantly higher than those of Group B （F=531.616，5.410，3.5813，3.160，1.126，4.702，7.819，5.424，all P=0.000）. Conclusion Sevoflurane used in the whole process of CPB has definite myocardial protective effect which is ber than that of Sevoflurane pretreatment.