Objective To investigate the effects of puerarin on renal advanced glycosylation end products (AGEs), expression of transforming growth factor-?1 (TGF-?1) and pathomorphism in diabetic rats. Methods Rats were randomly divided into following groups:normal control rats (Group CN), diabetic rats (Group DM) and diabetic rats treated with puerarin (Group DP). After Puerarin was given to STZ-induced diabetic rats for 10 weeks, blood glucose, urine protein, glomerular basement membrance thickness (GBMT) and profile of kidney hypertrophy in diabetic rats were measured and analysed. The renal pathologic changes were observed by light microscopy and electron microscopy. Renal AGEs content was determined by expose time of fluorescence microscopy. The expression of TGF-?1 was examined by immunohistochemical methods. Results Urine protein, GBMT and profile of kidney hypertrophy were significantly increased in diabetic rats as compared with control animals (P

There are lots of contents in the clinical teaching of cardiothoracic surgery , but the teaching time is short .What should be concerned by every cardiothoracic surgery teacher is how to make full use of the limited time to make students grasp the main contents of cardiothoracic surgery .It is crucial to develop new models of education and assessment .We discuss efforts in our teaching , including new teaching paradigms , teaching tools and multimedia teaching .The combination of varieties of teaching methods , clinical and basic teaching , theory teaching and clinical practice may improve the quality of clinical teaching in cardiothoracic surgery .

Purpose To investigate the prognosis and influencing factor of hematoma complicated from ultrasonography-guided EnCor vacuum-assisted breast biopsy system in minimally invasive surgery for breast lesions, and to provide reference for clinical treatment. Materials and Methods 280 female patients with 486 benign breast lesions underwent minimally invasive excision using a ultrasonography-guided EnCor vacuum-assisted device, occurrence and the inlfuence factors of hematoma complicated from the operation was observed. Results All the 486 lesions were completely excised with EnCor system, hematoma (≥1cm) were found in 47 cases after 24 hours and almost disappeared in 6 months. After analysis of the occurrence of hematoma, it was found that the following situations would lead to a higher incidence of hematoma, which included lumps ≥ 2.5 cm, more than two lesions removed at one time, lumps locating deep inside the areola or the edge of breasts, bigger and less dense breasts, operation in menstrual period, pressure bandaging after operation less than 12 hours and operation without using adrenaline (P<0.05 or P<0.01). Conclusion Benign lesions breast can be effectively excised using ultrasonography-guided EnCor vacuum device, and the factors listed below could affect the occurance of hematoma complicated from the surgery, including the size, location and number of the resected nodules, breast shape, surgery during menstrual period, postoperative pressure bandaging and the use of hemostatics.

[Abstract ] Objective The aim of the study was to investigate the effects of recombinant human erythoropoietin (EPO) and bone marrow mesenchymal stem cell (BMSC) transplantation on renal inflammatory response following cardiopulmonary bypass (CPB). Methods Forty sprague-Dawley male rats were randomly divided into five groups (n=8):shame operation group, CPB group, EPO group, BMSC group and EPO +BMSC group.CPB model was built in shame operation group without CPB .The other four groups un-derwent CPB, following by jugular vein infusion of 1.5 ×106 BMSCs after an hour′s 100 L/kg/min bypass .Jugular vein infusion of 3000 IU/kg EPO was done in EPO group , while the combination of EPO with BMSCs was infused in EPO +BMSC group.The same volume of isotonic saline solution was infused via jugular vein in CPB group and shame operation group respectively .Rats were sacrificed at 24 hours after CPB termination .Blood samples were collected for the determi-nation of creatinine(Cr) and urea nitro(BUN) levels.HE staining was applied in the examination of renal tissues .ELISA was used in the determination of serum interleukin 6 (IL-6) and interleukin 10 (IL-10) levels and western blot was taken to test the expressions of tumor necrosis factor (TNF-α) and insulin-like growth factor 1 (IGF-1). Results In CPB group, the levels of Cr, BUN, IL-6 and the expression of TNF-αwere increased, while IL-10 level and of IGF-1 expression were decreased(P<0.05).TNF-αexpression was increased while IGF-1 expression was decreased in renal tissue (P<0.05).HE staining results showed the renal injury in EPO +BM-SC group was significantly lower than those in EPO group , BMSC group and CPB group , along with the decrease in the levels of Cr , BUN, IL-6, the increase in IL-10 level(P<0.05), as well as the decline of TNF-αexpression and the rise of IGF-1 expression(P<0.05). Conclusion The combination of EPO and BMSCs which reduces renal inflammatory response following CPB has protective effects on renal injury following CPB in rats , which is better than single application of EPO or BMSCs .

Objective To study the action of puerarin on Caspase-3 and Bcl-2 expression of hippocampal CA1 neurons in ovariectomized rats, and explore its mechanism. Methods SD female rats were randomly assigned into sham operation group, model group, premarin group and puerarin groups (120, 60, 30 mg/kg). The model group and sham operation group were injected NS intraperitoneally, other groups were treated with corresping drugs for 30 d. Immunohistochemistry and RT-PCR were used to determine Caspase-3 and Bcl-2 expression of hippocampal CA1 neurons. Results Caspase-3 expression of hippocampal CA1 neurons was significantly decreased in high-dose puerarin group (P <0.05). Bcl-2 expression of hippocampal CA1 neurons was significantly increased in high- and medium-dose puerarin groups (P<0.05, P<0.01). Bcl-2 mRNA level of hippocampal CA1 neurons in high-dose puerarin group was significantly increased (P<0.05). Conclusion Puerarin can decrease Caspase-3expression and increase Bcl-2 expression of hippocampal CA1 neurons in ovariectomized rats, and has protective effect on neuronal structure.

Objectives: To study the correlation between plasma matrix metalloproteinase 9(MMP 9) concentration and acute lung injury following cardiopulmonary bypass(CPB). Methods: Human plasma was obtained after informed consent from twenty patients undergoing CPB. Plasma was collected at the beginning of CPB, 5 minutes after the initiation of CPB, at the termination of CPB, 1 hour after the termination of CPB and 6 hours after the termination of CPB. All samples were analyzed by standard enzyme linked immunosorbent assay (ELISA). A aDO 2 and respiratory index (RI) was measured at the termination, 1 hour and 6 hours after termination of CPB. The cross clamp times, CPB times and the time to extubation was recorded. Data were expressed as means ?SE and assessed by analysis of variance (ANOVA).The regression analysis was utilized to define the correlations of variables measured( A aDO 2 ,RI, cross clamp times, CPB times and the time to extubation ) at the end of CPB. Results: Plasma MMP 9 concentration was significantly increased at the end of CPB (430.6?50)?g/L( P

In almost one century, cardiovascular surgery has considerably evolved. Heart valve innovation has been one of the most important component during the evolution of cardiovascular surgery. The evolution of heart valve prostheses, including mechanical heart valves, biological heart valves, transcatheter heart valve, and tissue engineered heart valve, influence the development and the future direction of cardiovascular surgery technology. The early period of prosthetic valve development provided much information that is still of value today. We can learn more the good, the failure experiences from the pioneers of the valve innovation. In this ever evolving landscape, looking back into history will pave the way to the future.

Objective The present study aims to summarize the clinical experience and methods of nervous system protection in the treatment of DeBakey type Ⅰ aortic dissection with hybrid procedure.Methods From Jan 2009 to Jun 2011,56 patients suffering from DeBakey Ⅰ aortic dissection underwent hybrid procedure.The ascending aorta part were replaced under conventional cardiopulmonary bypass,and the0 aortic arch branch vessels were reconstructed,and then a stent graft was implanted to cover the aortic arch and part of the descending aorta.The unilateral antegrade cerebral perfusion(UACP) and/or bilateral antegrade cerebral perfusion (BACP) combined with femoral artery perfusion was used,and the left subclavian arteries were selectively reconstructed according to cerebral arteries and aorta computed tomography angiography scan.Results All the patients went through the procedure successfully.BACP combined with femoral artery perfusion was applied in 16 patients,UACP combined with femoral artery perfusion in 33 patients,and 7 were perfused with only femoral artery cannulation.Of all the patients,19 underwent the innominate artery and left common carotid artery reconstruction and the other 37 patients underwent the innominate artery,the left common carotid artery and the left subclavian artery reconstruction.The cardiopulmonary time was 44 -95 min,mean (65 ±24) min; aortic clamping time was 32 -71 min,mean (48 ±29)min; the cerebral perfusion time was 24 -44 min,mean (32 ± 13) min.One ( 1.8％ ) patient,who was perfused with only femoral artery cannulation,suffered from permanent neurological dysfunction,and 5 (8.9％) had transient neurological dysfunction.One patient died from severe infection,1 patient was given up because of permanent neurological dysfunction,and the rest 54 patients recovered and discharged.The patients were followed up 1 to 25 months,and there was no newly occurred neurological dysfunc tion.The CTA examination 3 months post-operative revealed that the branch bypass vessels were unobstructed.There was no subclavain steal symptom occurred in the 19 patients whose left subclavian arteries were not reconstructed.The left upper limb strength was slightly lessened in 3 patients and recovered 6 - 12 months later.Conclusion In the treatment of DeBakey type Ⅰ aortic dissection with hybrid procedure,the selective use UACP and/or BACP combined with femoral artery perfusion can avoid deep hypothermic and circulatory arrest and provide the continuous cerebral and spinal perfusion.This perfusion strategy in hybrid procedure can decrease the morbidity of post-operative nervous system disorders with satisfactory nervous system protection effect.

Objective To review the clinical experience in the surgical treatment of infective endocarditis,and to summarize the key points of how to elevate therapeutic effect.Methods From Jan 2001 to Dec 2010,106 patients with infective endocarditis who underwent operative therapy were retrospectively analyzed.All patients underwent cardiac operation in conventional hypothermic cardiopulmonary bypass.Vegetations and suspicious infective focus were thoroughly cleaned.Endocardium was swabbed with normal sodium repeatedly and with high concentration antibiotic solution.Combined anomalies were rectified and the affected valves were replaced.Artificial valves were preconditioned with antibiotics before implantation.All patients were treated with full dose of sensitive antibiotics for 6-8 weeks after operation.Results Two patients(1.8％) died perioperatively,1 died of severe pulmonary infection 5 days post operation,and 1 died of multisystem organ failure.Other 104 patients recovered smoothly,95 of whom were followed up for 6 months to 10 years.One patient died,and the other patients recovered with Ⅰ-Ⅱ grade heart function(NYHA).Three patients had anticoagulation related complications.There was no relapse of endocarditis occurred during the period of follow-up.Conclusion Early diagnosis and timely operation on infective endocarditis can achieve satisfactory effect.The thorough sterilization,prosthetic valves precondition and post operative regular antibiotics therapy were the key points of successful surgical treatment.

OBJECTIVETo investigate the result of surgical treatment of active infective endocarditis in patients with recent cerebrovascular events, and to evaluate the optimal indication and timing of surgical intervention.

METHODSThe clinical data of 26 patients with cerebrovascular complications before surgery Between December 2007 and December 2013 were analyzed retrospectively. There were 17 male and 9 female patients, aged (42±14) years. Types of disease included single aortic valvular disease (n=8), single mitral valvular disease (n=12), multiple valvular disease (n=5), and aortic valvular disease with ventricular septal defect (n=1). Type of cerebrovascular complication included cerebral infarction (n=25) and cerebral hemorrhage (n=1). Thirty-one valves were involved in 26 patients, mechanical prosthetic valve replacement (n=25), bioprosthetic valve replacement (n=4), and mitral valve repair (n=2).

RESULTSThe interval between onset of cerebrovascular event and surgical intervention was less than 14 days (n=3), 14 to 21 days (n=13), over 21 days (n=10), and the mean was (20±4) days. There were 33 vegetations found intraoperatively. The mean size of vegetations was (10±4) mm and 19 were found in mitral valve. Two patients died in hospital. One case relapsed after 1 year and underwent reoperation for prosthetic valve endocarditis. The remaining patients recovered with cardiac function of New York Heart Association class I to II after the period of 3 months to 5 years follow-up.

CONCLUSIONSAppropriate surgery may effectively improve the outcome of IE patients with cerebrovascular complications. The surgical indications and risks of further neurologic deterioration after cardiac surgery should be assessed comprehensively before surgical intervention.

Adult ; Aortic Valve ; Cerebral Hemorrhage ; etiology ; Endocarditis ; Endocarditis, Bacterial ; complications ; surgery ; Female ; Heart Defects, Congenital ; Heart Septal Defects, Ventricular ; Heart Valve Diseases ; Humans ; Male ; Middle Aged ; Mitral Valve ; Postoperative Complications ; Reoperation ; Retrospective Studies ; Time Factors