After completing the producing of the televised teaching material of TCM Bone-setting Skills,which was sponsored by Scientific and Teaching Section of Ministry of Health,and applying it to the teaching process in classroom for undergraduate students in Southern Medical University,The students were asked to fill out a questionnaire so as to preliminarily explore the applying methods and assess its teaching value under the circumstances of multimedia teaching.

Objective To introduce the clinical experience of Bentall procedure with composite tissue valve conduit. Methods Five patients were diagnosed as severe aortic regurgitation with dilatation of Valsava sinus and sinotubular junction and ascending aorta. Mean age of patients was (55.8?9.4) years (range 47～67). After median sternotomy , cardiopulmonary bypass was established using a single two-stage venous cannula. Temperature was brought to 28℃. After the ascending aorta was occluded, an aortotomy was made and aortic valve was excised. Aorta was removed from sinuses of Valsalva except for generous buttons around coronary ostia. After sizing the aortic annulus, an appropriate-size tissue valve and woven dacron conduit (3 mm greater in diameter than the tissue valve) were chosen to build a composite conduit. It was attached to annulus of aortic valve with pledget-reinforced horizontal mattress stitches to replace the aortic valve and ascending aorta as an en bloc procedure (Bentall procedure). In 2 cases, Coronary artery bypass grafting was performed with greater saphenous vein anastomosed distally to left anterior descending artery and proximately to conduit. Results All cases recovered uneventfully and they were discharged without any postoperative complications. Echocardiography was repeated before discharge. Mean aortic pressure gradient was (18.3?7.6) mmHg. Left ventricular dimension was significantly reduced [(58.8?6.3)mm vs. (43.7?3.1)mm]after operations(P0.05). Follow-up was 2 to 8 months. Conclusion With composite tissue valve conduit, Bentall procedure to replace the aortic valve and ascending aorta as an en bloc procedure is feasible and safe for the elderly patients. A long-term follow-up for the function and structure of tissue valve is needed.

0.05). Accordingly, statistics shows that the mean value of PI is 2.56?2.35. Conclusion: The referential range of PI for Chinese CABG patients is 2.56?2.35.

To introduce the experience in application of intra aortic balloon pump (IABP) in coronary artery bypass grafting (CABG), 506 consecutive CABG performed from March 1997 to October 2001 including 19 cases who needed IABP support were retrospectively studied. IABP was inserted through femoral artery when blood circulation failed to maintain normal even though cardiopulmonary bypass had been weaned off and inotropic agents administered. The overall rate of using IABP was 2 4%. IABP was not needed in off pump CABG. Sixteen patients smoothly resuscitated from low output syndrome, but two died of perioperative myocardial infarction (PMI) and one of allergic shock to protamine, resulting in a mortality rate of 15 8%. Two patients (10 5%) were respectively insulted by external iliac artery rupture and thromboembolism of dorsal pedis artery but cured completely. The complication rate was 10 5%. The mean duration of using IABP was 25 3?5 6 hours. The authors hold that IABP should be used without hesitation when indicated and good early outcome and low incidence of complication can always be obtained.

ObjectiveTo determine the primary control factors of nucleotides metabolisms on insulin secretion.MethodsNMRI mice isolated islets were used to investigate the amount of insulin secretion and the changes of ATP,ADP,GTP,GDP and UTP in islets when the activity of K+ATP channel was eliminated by diazoxide.ResultsThe above assays demonstrated that insulin secretion increased with the rise of glucose concentration.In the same time,ratio of ATP/ADP,GTP/GDP and level of UTP increased,too.All three indexes correlated with the insulin secretion very well respectively,but only ratio of ATP/ADP can control insulin secretion directly in common influence.ConclusionOur findings suggest that there is the second control site in islets when glucose induces insulin secretion and ATP/ADP ratio is only key factor in this mechanism.

In the study of T2DM(n=30),IGR(n=26) and NGT(n=30) cases in Guangxi Province,T2DM had higher resistin and PAI-1 levels than did the groups of IGR and NGT(P<0.05).IGR had higher levels of PAI-1 and leptin than NGT(P<0.05).Leptin level of T2DM was higher than that of NGT(P<0.05).Insulin resistance index was positively correlated with leptin,TG and PAI-1 levels(P<0.05).

Objective To study the effects of supra-physiologic glucose on the expression of PDX-1 and insulin secretion. Methods Islet cells isolated from SD rats were incubated in medium containing 5.6 mmol/L or 33 mmol/L glucose respectively for 3 days. Basic and glucose-induced insulin levels in supernate and in islet cells were detected. The PDX-1 mRNA and protein were detected. Results (1) Islet cells exposed to 33 mmol/L vs 5.6 mmol/L glucose for 3 days showed significant decrease in the basic and glucose-induced insulin release, and in cell insulin content and PDX-1 protein. (2) Prolonging incubation of islet cells in 33 mmol/L glucose aggravated the inhibitive effect on PDX-1 expression and insulin secretion. (3)Recovery to normal concentration of glucose in 3 days could partly improve PDX-1 expression and insulin secretion. Conclusions Inhibition of PDX-1 is one of the mechanism of glucotoxicity, and recovery to normal concentration of glucose in 3 days can partly improve PDX-1 expression and insulin secretion.

Objective To introduce the strategy of perioperative blood glucose control and the early outcome in diabetic and non-diabetic patients undergone coronary artery bypass grafting (CABG). Methods A total of 1019 CABG were performed and the patients were divided into diabetic and non-diabetic groups (n=211, 808, respectively). The demography was comparable between the two groups with the exception that the percentage of preoperative myocardial infarction was significantly higher in diabetic group than that in non-diabetic group. Off-pump and conventional CABG were routinely performed and the left internal mammary artery (IMA) and great saphenous vein (GSV) were used as conduit. Perioperative blood glucose was controlled according to the close supervision. The aim of preoperative 6mmol/L and postoperative 8mmol/L was achieved by means of oral medication or subcutaneous injection of insulin, which was complimented by continuous pump infusion of regular insulin to optimize the glucose level. Results 99.2% patients were discharged. The overall perioperative mortality was 0.8% and the percentage was 1.4% and 0.6% respectively in diabetic and non-diabetic group with significant difference(P0.05), respectively. Cerebral infarction occurred in 1.4% diabetic patients and in 0.5% non-diabetic patients(P

Objective To introduce experience of harvesting great saphenous vein (GSV) and surgical techniques to avoid infectious complication in coronary artery bypass grafting (CABG). Methods One thousand and one hundred twenty CABG, including 523 conventional CABG (CCABG) and 597 off-pump coronary artery bypass grafting (OPCAB), were performed by the same surgical team. One thousand and fifty GSV were used as the conduit. Left internal mammary artery was routinely anastomosed to left anterior descending artery(LAD), and GSV and/or radial artery to the other target vessels. Preoperative selection of GSV, operative procedure of harvesting, meticulous postoperative supervision and appropriate treatment of the incision, and the control of risk factors as diabetes mellitus, which composed an integral part of periopertive strategies, are critical to avoid infectious complication. Results No infection occurred. Recovery of two patients with diabetes mellitus was complicated by delayed healing of incision. In ten patients there was a slight exudation from the incision, and they healed without infection after the addition of 2~3 interrupted sutures. Healing was not delayed. Swelling of the involved legs occurred in the majority of patients, and numbness along the incision was also documented in some patients, and it usually recovered to normal three months after operation, after being followed-up for 3 months to 2 years. Conclusion Infection can be completely avoided after the planned procedure of harvesting GSV and meticulous perioperative care.

Objective To summarize the operative techniques and clinical outcome of 582 patients undergoing off-pump coronary artery bypass grafting (OPCAB). Methods 582 patients who underwent off-bump coronary artery bypass were retrospectively studied. Results One patient was re-explored for bleeding. The other patients experienced a good recovery without complications. The mean mechanical ventilation time was 3.2?1.2h, and the mean hospital stay time was 7?1.6d. All the patients were free from angina after the operation. 2 patients died of arrhythmia. Conclusions OPCAB can reduce the time of postoperative recovery and decrease the incidence of complication and mortality. OPCAB is a good choice for high-risk patients.