Objective To report the experience of first 100 cases of off-pump coronary artery bypass(OPCAB) grafting by a training cardiac surgeon,and to discuss the feasibility of the training method.Methods The trainee,who had no previous experience of coronary surgery,received an OPCAB training program under the guidance by a director who had completed more than 2000 cases OPCAB.After 28 months of training,the trainee began to be an independent operator.The data of the first consecutive 100 cases of OPCAB by the trainee(Training Group) were collected for comparison with the director's 100 cases of OPCAB surgery(Control Group).Results There were 5 cases of conversion to on-pump surgery in the Training Group.The number of distal anastmosis in the Training Group(2.9?0.6) was smaller than that in the Control Group(3.5?0.7)(t=-6.508,P=0.001).Compared with the Control Group,there were less circumflex grafts(67/100 vs 88/100;?~2=12.645,P=0.000) and sequential grafts(3/100 vs 27/100;?~2=22.588,P=0.000) in the Training Group.There was no significant difference in mortality between the Training Group(3%,3 cases) and the Control Group(1%,1 case)(?~2=0.255,P=0.614).No significant difference was observed between the two groups in other postoperative severe complications.Conclusions The first 100 cases of OPCAB surgery performed by the trainee give favorable results,indicating a stable transition from training period to independent performance.It also testifies the feasibility of this training program.

SUMMARY A 61-year-old male patient, with the history of premier myocardial infarction and CABG surgery, experienced recurrent unstable angina. Angiography showed triple vessel disease and vein grafts obstruction. The patient underwent a re-do OPCAB + TMLR + bone marrow mononuclear cell (BM-MNCs) transplantation on Nov. 8, 2004. BM-MNCs were isolated with standard gravity gradient method and the final implanted cell number was 12.06?108. Peri-operative data were similar to those of single OPCAB or re-CABG. The patient recovered promptly without recurrence of angina or infarction. Six-minute walking distance increased significantly (366 m to 493 m). Several imaging examinations reveal improved left cardiac function (LVEF improved from 23.75% to 52% in MRI) and diminished MI area. The results reveal that bone marrow cell transplantation, combined with TMLR and OPCAB is safe and might be effective in improving heart function for patients with IHD.

The cause of dilated cardiomyopthy (DCM) has not been elucidated yet .The poor prognosis and lack of specific and effective treatment became a serious health problem .Therefore to establish animal models of DCM to study the pathogenesis and treatment is necessary and urgent .At present the molding method of DCM mainly includes drug induction, immunological induction and molecular biology , etc.This article reviews the mature and commonly used establishing methods and mechanism of DCM models .

Objective To discuss the clinical application and features of coronary artery bypass grafting(CABG) through left intercostal thoracotomy approach. Methods A total of 36 cases of CABG were performed through left intercostal thoracotomy approach from September 1996 to August 2005 in this hospital.The patients fell into four categories: ①single vessel disease in the left anterior descending artery(LAD);②re-operation of CABG with a patent LIMA(left internal mammary artery)-LAD bypass;③severe calcified ascending aorta;and ④concurrent other procedures that required left thoracotomy.There were 26 cases of single vessel disease,3 cases of double vessel disease,and 7 cases of triple vessel disease.Five cases had a history of percutaneous coronary interventions(PCIs) and 6 cases had a history of CABGs.The left ventricular ejection fraction was 0.562?0.107. Results Off pump CABG with 1~4 distal anastomosis was successfully accomplished in all the 36 cases,with an operation time of 190.4?44.1 min.Concurrent procedures included 2 cases of transmyocardial laser revascularization(TMLR),1 case of lung cancer resection,and 1 case of esophageal cancer resection.There was no in-hospital mortality.Two fatal cases were seen in long-term follow-up observations.Recurrent angina developed in 2 cases 1 year after operation,and was cured with a PCI in 1 case and with a re-operation of CABG in 1 case. Conclusions The left intercostal thoracotomy is a safe and feasible approach for CABG surgery in patients with some special types of coronary heart disease.The procedure can be performed under beating heart.

Adolescent ; Adult ; Atropine ; therapeutic use ; Female ; Foodborne Diseases ; drug therapy ; Humans ; Insecticides ; poisoning ; Male ; Muscarinic Antagonists ; therapeutic use ; Organophosphorus Compounds ; Pesticide Residues ; poisoning ; Pesticides ; poisoning ; Treatment Outcome

Objective To discuss the clinical features of dystonia manifested as Parkinsonism ( PKS) . Methods Clinical materials of a patient with dystonia manifested as PKS were analyzed retrospectively. Results The onset age of the young women was 31 years old, who was started asymmetrically with symptoms of claudication and tremor of the right foot. Levodopa had a short-term effect. The results of dopamine transporter ( DAT) PET showed that DAT in retrolentiform part were decreased significantly. Atypical Parkinson's disease was considered and she was treated as PKS long-termly. Subsequently, heterozygous mutation of c. 268-4T>A (NM_018105) in DYT6 gene was found through the next-generation sequencing, which was a kind of splicing mutation and confirmed by the first-generation sequencing. Conclusions Patients with dystonia might share similar clinical manifestations with PKS. Particularly, they should be differentiated with young-onset Parkinson's disease combined with focal dystonia. Clinical observation and genetic testing are important approaches to differentiate them.

Objective To explore the value of endoscopic mini-incision greater saphenous vein harvesting for coronary artery bypass operation. Methods A total of 411 patients scheduled for coronary artery bypass operation were given either endoscopic vein harvesting(EVH Group,n=136) or open vein harvesting(OVH Group,n=275),based on patient's willingness.The operation outcomes and incision complications were compared between the two groups. Results The incidence of various incision complications was significantly lower in the EVH Group(18.4%,25/136) than in the OVH Group(36.7%,101/275)(?~2=14.406,P=0.000).As compared with the OVH Group,the EVH Group had lower incidences of edema(1.5% vs 35.3%;?~2=56.861,P=0.000),paraesthesia(7.4% vs 33.8%;?~2=33.937,P=0.000),hematoma(16.2% vs 27.3%;?~2=6.214,P=0.013),and incisional liquefaction(0.7% vs 8.7%;?~2=10.174,P=0.001) of the lower extemity.The total operation time were 226.3?28.5 min in the EVH Group and 224.7?19.2 min in the OVH Group,without significant difference between the two groups(t=0.673,P=0.502).Early graft failure happened in 1 case in each of the groups,without significant difference between the two groups(?~2=0.000,P=1.000).The numbers of distal coronary anastomoses were 3.6?0.8 in the EVH Group and 3.3?1.0 in the OVH Group,with significant difference(t=3.049,P=0.002). Conclusions Endoscopic greater saphenous vein harvesting can significantly reduce the morbidity associated with incision complications,whereas does not prolong the operative time,increase the incidence of early graft failure,and decrease the number of distal coronary anastomoses.

Objective To investigate the protective effect of the new type of Tongxinluo (TXL) on blood-brain barrier impairment after cerebral ischemic/reperfusion injury in rats.Methods 78 male Sprague-Dawley rats were randomly divided into sham-operated group (n=6), operated group (n=36) and TXL-treated group (n=36), the latter two groups were divided into 0.5 h, 2 h, 6 h, 12 h, 24 h and 48 h groups (n=6, each) according to the time after cerebral ischemic/reperfusion for 2 h. The rats were pretreated with normal saline or TXL for 7 d. The middle cerebral artery occlusion/reperfusion (MCAO/R) rat model was established by the Longa occlusion method;The serum S100? protein concentrations of different point time were determined by ELISA method and infarct volumes were determined by 2,3,5-triphenyltetrazolium Chloride (TTC) staining method. Results (1) The serum S100? protein level in TXL-treated groups were significantly decreased compared with operated groups at 0.5 h, 2 h, 6 h,12 h and 24 h after MCAO/R (P

Objective: To summarize and analyze the early outcomes and clinical experience in 1198 patients undergone off-pump coronary artery bypass (OPCAB). Methods: This multi-center report covers 15 different institutes in China from October 1996 to May 2002. The ratio of OPCAB to conventional coronary artery bypass grafting (cCABG) was 85.2%. The mean age was (61.6?9.0) years. 77.3% patients were male and 22.7% were female. There were 34.6% patients with myocardial infarction, 58.2% with unstable angina pectoris, 18.7% with left main lesion, 76.9% with triple-vessel disease, 1.5% was redo surgery, and 9.9% emergent or urgent surgery. The mean left ventricular ejection fraction was 0.56?0.17. Results: The number of distal anastomosis was 3.1?0.9. IMA was used in 65.6% patients and radial artery was used in 18.0%. 13.5% OPCAB was combined with TMLR. IABP was used in 5.2% patients. The hospital mortality was 1.2%. The morbidity included 0.4% peri-operative myocardial infarction, 0.3% heart failure, 1.2% fatal arrhythmia, 2.0% pulmonary complications, 1.2% neurotic disorder, 0.7% renal dysfunction, 1.0% reopen for bleeding, and 0.6% delayed wound healing. Conclusion: OPCAB surgery is a safe and feasible procedure with good early results. Its late outcomes need further follow-up. OPCAB requires certain special skills and methods in practice so a specific training course should be designed.

[Objective] To investigate the characteristics of senile diabetic hip fracture in the peri-operation stage and to summarize the experience for its treatment. [Methods] A retrospective study was conducted in 21 cases of senile hip fracture complicated with diabetic mellitus which had received operation. [Results] No case was dead and no case was infected after operation; the incision was healed well and the patients went through the peri-operation stage safely. [Conclusion] On the basis of effectively controlling the blood sugar level, operation can be taken into consideration and pre-operative and post-operative treatment should also be emphasized.