Objective Evaluate the clinical outcomes of redo coronary revascularization performed with CABG techniques. Methods During the past 10 years, 51 patients (2.5% in the patients who underwent CABG and OPCABG) received redo coronary revascularization in our hospital. The period between the first and the redo surgeries was ( 15.1±5.8)years. Two different procedures were performed with or without cardiopulmonary bypass for the redo CABG: off-pump procedure (OPCABG) in 10 patients and on-pump procedure (CABG) in 41 patients. Two types of surgical approaches were used: me-dian sternotomy in 43 patients and left thoracotomy in 8 patients. Results Respiratory failure requiring mechanical ventilation occurred in 3 of the 51 patients after the operation, as compared with none in the patients who underwent OPCABG. The mean duration treated in the ICU was (2.2±0.7 ) days and that of hospital admission was( 9.2±2.4) days. Two patients (3.9%)died in hospital, one ease was in the off-pump group and the other was in the on-pump group. The causes of death were thought to be acute myocardial infarction with low output syndrome in 1 case and severe respiratory failure in the other. Complications occurred in 11 patients, including re-thoracotomy for hemostasis in 1 patient, respiratory failure in 3 patients and other complications 7. Postoperative EF was 0.60±0. 06. Complete revascularization was achieved in 44 patients, 6 patients in the offpump group and 38 patients in the on-pump group. Partial revascularization was observed in the additional 7 patients. Conclusion Redo CABG performed with or without cardiopuimonary bypass may provide favorable effects with acceptable safety profile and complete revascularization is achievable.

Objective Comparatively studying the method,efficiency and anti-hypoxia ability of cardiomyocytes which are directionally induced from human embryonic stem cells and mouse embryonic stem cells in vitro so as to provide an experimental basis for further study of inducing the differentiation of embryonic stem cells into cardiomyocytes in vitro.Methods Human embryonic stem cells are induced into cardiomyocytes by suspension method which dosen't using inducersand adherence method which using inducers respectively.Mouse embryonic stem cells are induced into cardiomyocytes by hanging drop method which dosent using inducers and using inducer respectively.Staining the specific marker cTnT of cardiomyocytes by immunofluorescence.Comparing the time,percentage and beating frequency of cardiomyocytes by counting under the microscope.Using apoptosis-hoechst staining kit to detect the apoptosis ratio of beating cardiomyocytes which have been treated by hypoxia with 24 h.Results The group of hESC without inducers results in that the mean time days of appearing beating cardiomyocytes is (13.9 ± 0.9) days,the percentage is 20.8 ％ and the average frequency of beating is (63.8 ± 5.6) times/min.The group of hESC with inducers results in that the mean time days of appearing beating cardiomyocytes is (13.0 ± 1.1) days,the percentage is 66.7％ and the average frequency of beating is (63.0 ± 7.0) times/min.The group of mESC without inducers results in that the mean time days of appearing beating cardiomyocytes is (14.3 ± 1.0) days,the percentage is 12.5％ and the average frequency of beating is (80.2 ± 3.9) times/min.The group of mESC with inducers results in that the mean time days of appearing beating cardiomyocytes is (12.2 ± 1.2) days,the percentage is 81.3％ and the average frequency of beating is (79.9 ±7.7) times/min.Beating cardiomyocytes of each group are positive to cTnT staining.Different apoptosis ratio are detected of beating cardiomyocytes of each group.Conclusion The four methods can all successfully induce the differentiation of embryonic stem cells into myocardiocytes,and the adherent method of hESC induced with activin A + BMP4 is the first successful induction in China.The groups adding inducers improve the differentiation efficiency more significantly than the groups without adding inducers.Inducing mouse embryonic stem cells into cardiomyocytes is more simple and efficient compared with human embryonic stem cells.Without the presence of other protective factor,anti-hypoxia ability of cardiomyocytes induced from human embryonic stem cells is stronger and the beating time are longer in vitro compared with mouse embryonic stem cells.

Objective To study the effect of polymer material on adhesion , proliferation and differentiation of mouse in-duced pluripotent stem cells via co-culturing in vitro, to find a suitable polymeric biomaterials for miPSCs attachment , prolifera-tion and differentiation , forming myocardial patches as a new repair method for myocardial infarction .Methods miPSCs were recovered, passaged and cultured with PHBHHx two-dimension films and PHBHHx three-dimension films together.The mor-phology of miPSCs attached on the films was visualized under scanning electron microscope ( SEM) .The mouse induced pluri-potent stem cells were induced by differentiation medium that containing vitamin C .Control group did not add any inducer.The survival and differentiation of miPSCs were observed through immunofluorescence and flow cytometry .Results MiPSCs can grow, proliferate and differentiate on PHBHHx films both two-dimension and three-dimension.Vitamin C, as a favourable in-ducer, can markedly improve the efficiency of miPSCs differentiation of cardiomyocytes on PHBHHx films .Immunofluorescence results demonstrated positive cTnT expression.Flow cytometry measured cTnT expression: Vitamin C inducer group(47.54 ± 1.46)%>without any inducer group(7.02 ±0.95)%(P<0.05).In the process of miPSCs differentiating into myocardial cell, after adding Vitamin C, the expression quantity of cTnT:PHBHHx three-dimensional films(60.32 ±1.76)%>PHBHHx two-dimensional films(53.31 ±1.41)%>traditional cell culture(47.54 ±1.46)%(P<0.05).Conclusion iPSCs can ad-here, survive and differentiate on the PHBHHx film.Vitamin C, as a favourable inducer, can markedly improve the efficiency of miPSCs differentiation of cardiomyocytes .Relative to PHBHHx two-dimensional film culture and traditional culture , the three-dimensional PHBHHx film culture has a great advantage in the process of miPSCs differentiating into myocardial cells .

Objective To evaluate the medium-and long-term efficacy of loading statins after coronary artery bypass grafting surgery by comparing patients undergoing coronary artery bypass grafting surgery(CABG) using a loading dose statins or a regular dose of statins.Methods Cochrane Library, WanFang database etc database web were searched for the efficacy of a loading dose of statins after CABG in randomized controlled trials(RCTs).The quality of included studies was evaluated according to the Newcastle-Ottawa Scale(NOS).The statistical results of treatment were represented by weighted mean difference (WMD) , the odds ratio(OR) and 95％ confidence intervals(CI).Revman 5.2 software was used for data processing and analysis.Results There are eight studies including 8 676 cases, 4 352 cases are in group using a loading dose of statins, 4 324 cases are in group using a regular dose of statins.Meta-analysis showed the level of low-density lipoprotein(LDL-C) in patients who took a loading dose of statins after CABG(WMD =-42.15,95％ CI:-44.45～-39.84, P ＜0.00001);the number of death caused by myocardial infarction (OR =0.74, 95 ％ CI: 0.60～ 0.91, P =0.005);the number of patients occurred myocardial infarction (OR =0.78, 95 ％ CI: 0.66～ 0.92, P =0.004);the number of patients undergoing secondary CABG (OR =0.72, 95％ CI: 0.63～ 0.82, P ＜ 0.00001);the number of patients occurred drug side effects(OR =1.43, 95％ CI: 1.06～ 1.93, P =0.02);the number of patients occurred grafts restenosis by intravascular ultrasound(IVUS) (OR =0.59, 95％ CI: 0.50～0.70, P ＜0.0001).The data above reached statistically significant difference.Conclusion Comparing patients who used a loading dose of statins and those who used a regular dose of statins after CABG.The medium-and long-term efficacy of a loading dose of statins showed significantly reduction of LDL-C;reduction of the occurrence to cardiac events, such as death caused by myocardial infarction, myocardial infarction and secondary CABG;reduction of grafts restenosis.The incidence of drug side effects was a little higher in a loading dose of statin group.But the majority of patients did not show serious drug side effects after using a loading dose of statins.In summary, the medium-and long-term efficacy of a loading dose of statins after CABG is better than that of a regular dose of statins.

Connexin43 has been shown to play a pivotal role in wound healing process. Wound repair is enhanced by acute downregulation of connexin43, by increasing proliferation and migration of keratinocyte and fibroblast. Angiogenesis is also a central feature of wound repair, but little is known about the effects of connexin43 modulation on functions of endothelial cells. We used connexin43 specific small interference RNA (siRNA) to reduce the expression of connexin43 in human umbilical vein endothelial cell (HUVEC), and investigated the effects of connexin43 downregulation on intercellular communication, viability, proliferation, migration and angiogenic activity of HUVEC. Treatment of siRNA markedly reduced the expression of connexin43 by -80% in HUVEC (P < 0.05), and decreased the intercellular communication by -65% (P < 0.05). The viability, proliferation, migration and angiogenic activity of HUVEC decreased significantly (P < 0.05), compared with that of the normal cells. The results suggest that temporally downregulation of connexin43 expression at early stage of wound to inhibit the abnormal angiogenesis characterized with leaky and inflamed blood vessels, maybe a prerequisite for coordinated normal healing process.

Objective We aimed to recent experience at our hospital in the diagnosis and treatment of pericardial effusion after cardiac surgery and to identify risk factors for its development.Methods We searched our hospital for patient who had cardiac surgery with cardiopulmonary bypass from January 2002 through December 2010.For patient with pericardial effusion,medical records were reviewed to evaluate its manifestations and management.To identify risk factors for effusion,patients with effusions were compared with patients without effusions.All patients had routine postoperative echocardiographic examination.Results Of 22462 patients identified,509 (2.3％) had pericardial effusion.Compared with patients without pericardial effusion,ages,sex,cardiac function and so on were no significant( P ＞ 0.05 ).Body,valve cardiac diseases,and cardiopulmonary bypass time and so on were significant ( P ＜ 0.05 ).Among 509 patients with pericardial effusion,262 patients (51.4％) of whom had specific symptoms.Clinical features of tamponade were documented in 51 patients( 10.1％ ).Pericardial effusions were evacuated by echocardilgraphy-guided pericardiocentesis ( n =27,10.3％ ) or surgical drainage ( n =15,5.7％ ).Pericardial effusion resolved after left thoracocentesis for pleural effusion in 5 patients ( 1.9％ ) ; The Other patients with pericardial effusion were treated conservatively.Indeperdent risk factors for pericardial effusion were large body,valve cardiac operations,and prolonged cardiopulmonsry bypass.Conclusion In our study,pericardial effusion occurred in 2.3％ of patients,and symptoms were nonspecific.Several factors,mainly related to preoperative characteristics and type of operation,predispose patients to effusion,echocardiography-guided pericardiocentesis is effective and safe in these patients with pericardial effusion.

Objective: To investigate the clinical efficacy of reduced port laparoscopic radical resection on colorectal cancer. Methods: Clinical data of 46 patients with colorectal cancer undergoing reduced port laparoscopic radical resection were retrospectively analyzed. Results: All of 46 patients underwent laparoscopic surgery, with an average operation time of 206 minutes, an average intraoperative bleeding of 56 ml, an average number of lymph nodes removement of 12/case (ranged from 6 to 21). One case had incision infection, 2 cases had anastomotic leakage, and they all recovered and discharged after treatment. Conclusions Reduced port laparoscopic radical resection of colorectal cancer is safe and feasible, reduces labor costs, and has a good clinical efficacy, which is worthy of clinical promotion.

Microenvironment has a major impact on stem-cell differentiation. Stem-cell differentiation achieved by controlling the microenvironment is more similar to physiological characteristic than the traditional chemical induction, which will undoubtedly have a broader clinical application prospect. The impact of microenvironment on stem cell to cardiomyocyte differentiation is reviewed in this paper.

Objective:To investigate the possible mechanism of DiI labeled bone marrow mesenchymal stem cells (BMSCs) in contact co-cultured with neonatal rat cardiomyocytes (CMs) on polycaprolactone (PCL) film to make myocardial patch.Methods:BMSCs from Sprague Dawley rats (aged 5-6 weeks) were isolated, cultured, and characterized for surface marker expression using flow cytometry. CMs from 15 neonatal rats were isolated and cultured. After cultured for 3 generations, BMSCs were labeled with DiI dye. On PCL film, DiI labeled BMSCs were co-cultured with CMs as the experimental group, and CMs were replaced with the same amount of unlabeled BMSCs in the control group. After 24 h of co-culture, the cell growth was observed under fluorescence microscope and the co-culture was observed under scanning electron microscope. Immunofluorescence staining was performed after 7 days to detect myocardial markers, including cardiac troponin T (cTnT) and α-actinin. BMSC differentiation on the PCL film was observed under a fluorescence microscope. The differentiation efficiency of BMSCs into cardiomyoid cells was analyzed by flow cytometry on days 1 and 7 of co-culture. Intercellular dye transfer was observed by staining CMs with calcein and co-culturing them with DiI-labeled BMSCs on PCL film. The cells were stained with immunofluorescence to detect the expression of connexin 43 (Cx43) and observe the relationship between gap junction and contact co-culture.Results:Flow cytometry showed strong positivity for CD90 and CD44 and negativity for CD11b/c and CD45 on BMSCs. After 24 h of co-culture, DiI labeled BMSCs glowed red on the PCL film, while unlabeled CMs did not; the number of cells on PCL film was large and cell morphology appeared normal under scanning electron microscope. On the 7th day of co-culture, some DiI labeled BMSCs expressed cTnT and α-actinin. Flow cytometry showed a higher differentiation rate of stem cells in the experimental group on day 7 compared to the control group ((20.12±0.15)% vs. (3.49±0.20)%, P<0.05). From the second day of co-culture, some BMSCs exhibited green dot fluorescence in Cx43 immunofluorescence staining; and by the third day, dye transfer test showed green fluorescence emission from some BMSCs. Conclusion:Contact co-culture of DiI labeled BMSCs and CMs on PCL film can make myocardial patch. The mechanism of contact co-culture promoting the differentiation and formation of myocardial patch may be associated with gap junctions and intercellular signal pathways mediated by gap junctions.