Valve replacement is the primary means of treatment of valvular disease. With the further research of artificial valve, Prosthesis-patient mismatch is becoming a hot research hotspot. This paper reviews research status of Prosthesis-patient mismatch.

Objective To explore the feasibility of laparoscopic surgery for esophageal hiatus hernia and reflux esophagitis complicated with cholecystolithiasis.Methods Five trocars were used for the patients to perform laparoscopic hiatal hernia repair,followed by fundoplication(Nissen fundoplication in 21 cases and Toupet fundoplication in 6),and then LC.Results The procedures were completed in all of the 27 cases.The postoperative mean esophageal pressure of the patients was significantly higher than that before the operations [(19.32?4.11) mm Hg vs(7.30?1.36) mm Hg,t=-16.407,P=0.000],while the 24-hour pH value were decreased markedly(9.20?2.15 vs 160.16?50.30,t=16.387,P=0.000).No hemorrhage,intra-abdominal infection,biliary leakage occurred in this series.The patients were followed up for 1 to 24 months(1-6 months in 7 cases,and 7-24 months in 20 cases),during which no esophageal stenosis or incisional hernia were detected.Conclusions It is feasible to perform primary laparoscopic surgery for patients suffering from esophageal hiatus hernia and reflux esophagitis complicated with simultaneous cholecystolithiasis,if no contraindications.

ObjectiveTo detect five periodontal pathogenic bacteria in coronary atherosclerotic plaques.MethodsAtherosclerotic plaque specimens were obtained from 101 patients who scheduled for coronary artery bypass graft surgery.The bacteria DNA was obtained from coronary atherosclerotic plaques using the chelex-100 method.The extracted DNA were examined by PCR.ResultsWithin the 101 pieces of atherosclerotic plaque samples Porphyromonas gingivalis( Pg,31％ ),Tannerella forsythensis(Tf,42％ ),Prevotella intermedia( Pi,26％ ),Fusobacterium nucleatum( Fn,21％ ),Actinobacillus actinomycetemcomitans( Aa,23％ ).PCR products were sequenced and were compared with GenBank sequences,the homology was 99％-100％.ConclusionPeriodontitis might affect the development of atherosclerosis and there is a correlation between coronary heart disease and chronic periodontitis.

Objective To study the expression of LI-cadherin in gastric cancer, gastric stromal tumor, chronic gastritis and intestinal metaplasia. Methods Two hundred and forty four specimens were collected, including normal epithelia (n=28), chronic superficial gastritis (n=30), chronic atrophic gastritis(n=42), intestinal metaplasia (n=58), gastric adenocarcinoma (n=46), paracancerous gastric tissues (n=30), gastric stromal tumor (n=10). The expression of LI-cadherin was detected by S-P immunohischemistry with purified goat polyclonal antibody. Results The expression of LI-cadherin in normal epithelia and chronic gastritis are all negative, the positive rates of LI-cadherin expression in intestinal metaplasia and gastric adenocarcinoma is 83% (48/58) and 65% (30/46) respectively. By Laurien classification, the positive rate of LI-cadherin expression in intestinal type was higher(78% ) than those in the diffuse type (35%) (P<0.05). LI-cadherin was in positive correlation with lymph node metastasis and staging. Paracancerous tissues and gastric stromal tumor did not express LI-cadherin. Conclusions The abnormal expression of LI-cadherin was correlated with intestinal metaplasia and gastric adenocarcinoma. GCs with high LI-cadherin index have more lymph node metastasis. High expression rate of LI-cadherin in gastric cancer tissues may predict poor prognosis.

Objective To investigate whether the bilateral nipple discharge with the background of hypothyroidism and pituitary tumor causes intraductal neoplasm. Methods Clinical data of 222 bilateral nipple discharge patients with hypothyroidism or pituitary tumor undergoing mammary ductoseopy (MDS) examination were analyzed. Those diagnosed as intraductal papilloma received surgery and pathological exam. 158 cases with inflammatory comedomastitis diagnosed by MDS received milk duct washing with gentamycin, dexamethasone and corresponding medical treatment. Results Among the 222 cases, 158 cases(71.17%) were diagnosed as inflammatory comedomastitis by MDS, 64 cases (28.83%) were diagnosed as intraduetal papilloma (64/222) by MDS and received operation,59 cases were pathologically diagnosed as intraductal papilloma,the other 5 cases were pathologically diagnosed as mammary duct ectasia. The pathological coincidence was 92.2% and no breast cancer was observed. 68.10% of inflammatory comedomastitis cases suffered from breast pain. There were no significant difference in the disease distribution of the ethnic groups. During pre-menopause period, the incidence of period neoplasia is higher in pituitary tumor than hypothyroidism; However, during the post-menopause the situation was vice versa. The color of niplle discharge is mostly milk-like in patients with pituitary tumor, while serous in patients with hypothyroidism. 71.19% of duct papilloma locate at the branch of the main duct. Conclusion The bilateral nipple discharge with hypothyroidism or pituitary are usually concomitant with intraduetal lesions. Mammary ductosopy is helpful to discover intraduetal neoplasia.

Objective To summarize the experiences of 5-year relative living kidney transplantation in the minorities. Methods The clinical data of HLA matching, rejection, survival and causes of death were retrospectively analyzed from 2004 to July 2009. There were 97 blood relative donations, including 1 case of father → son, 1 case of daughter → father, 1 case of mother → son, 24 cases of donation between brother and sister, 2 cases of non-blood relative donors (husband and wife),1 case of inter-ethnics, and the remaining were collateral relative donors. All the donations were voluntary, and all the recipients were minorities and all donors were their blood relatives. There were no mismatch of gene matching of 6 antigenic sites (0 MM) in 1 patient, 1 mismatch point (1 MM) in 2 patients, 2 mismatch points (2 MM) in 5 patients, 3 mismatch points (3 MM) in 10 patients, 4 mismatch points (4 MM) in 21 patients, 5 mismatch points (5 MM) in 39 patients and complete mismatch in 22 patients. Results All donors were discharged after 1 week and followed up for 3-6 months. Blood creatinine was normal and urine protein was negative. Up to July 2009, the conditions of the recipients were as follows: (1) Ninety-one receptors survived after transplantation. The longest survival time was up to 5 years. Among 9 deaths, 1 case died from myocardial infarction, 1 case from hemorrhagic shock and the others from respiratory failure (7 %) ; (2) Two renal grafts lost their functions and the patients restarted dialysis, in whom the preoperative panel reactive antibodies (PRA) of 1 patient was high and the patient had postoperative acute rejection, and the other patient stopped immunosuppressive agents on his own, leading to renal function loss; (3) After transplantation 10 patients had acute rejection, of which 2 cases received methylprednisolone plus OKT3, and the remaining 9 patients were treated with methylprednisolone. All rejections were reversed; (4) Urethral fistula occurred in one case and was improved after 45 days. Three patients had vesicoureteral anastomotic stenosis and were cured surgically. lyrnph leakage occurred in one case and was improved after 2 months. Fourteen patients had lung infection, including 7 mild lung infections which were improved after treatment, and 7 severe lung infections which died from respiratory failure.Other complications included secondary diabetes mellitus (4 cases), urinary tract infection (2 cases),acute renal failure (2 cases), deep venous thrombosis (3 cases), drug-induced liver damage (5 cases),polycythemia (5 cases), hepatitis C (3 cases), chronic allograft nephropathy (3 cases), and all were improved after treatment. Conclusion Comprehensive assessments of the donors and receptors before transplantation are guarantee to successful living kidney transplantation from relative donors; Living kidney transplantation from relative donors has the advantages of good matching, short ischemia period of donated kidney, less rejections and high survival rate of transplanted kidneys.

Objective: To compare metabolic syndrome(MS)with Framingham risk score as predictors of cardiovascular disease(CVD)among Kazakhs population. Methods: The participants were the residents who had been followed up for more than 5 years in representative areas of Kazakhs in Xinjiang. We assigned MS a continuous risk score for predicting the development of CVD based on the weights of MS components. MS and Framingham risk score were compared in terms of their ability in predicting years in representative areas of Kazakhs in Xinjiang. We assigned MS a continuous risk score for predicting the development of CVD based on the weights of MS components. MS and Framingham risk score were compared in terms of their ability in predicting development of CVD using Cox regression and receiver operating characteristic curve. Results: The incidence of CVD was 13.87%. The incidence of CVD was higher in the MS group than it in the non-MS group(21.59% vs 11.10%, P<0.001). The area under the receiver operating characteristic(ROC)curve of MS risk score was significantly larger than that of MS classification(0.727 vs 0.585, P<0.001); the area under the curve of MS risk score was close to that of Framingham risk score(0.732 vs 0.727, P=0.673). The association between CVD and each quintile of MS risk score was more significant than that between Framingham risk score and CVD under the same exposed condition(4.61, 9.33, 14.15, 22.29 vs 3.69, 6.36, 8.47, 16.99). Conclusion MS risk score that included age may be a better predictor of CVD among Kazakhs population.

Objective: To construct and confirm a predictive model for the risks of cardiovascular diseases (CVD) with metabolic syndrome (MS) and its factors in Xinjiang Kazakh population. Methods: A total of 2 286 Kazakh individuals were followed for 5 years from 2010 to 2012 as baseline survey. They were recruited in Xinyuan county, Yili city, Xinjiang. CVD cases were identified via medical records of the local hospitals in 2013, 2016 and 2017, respectively. Factor analysis was performed on 706 MS patients at baseline, and main factors, age, and sex were extracted from 18 medical examination indexs to construct a predictive model of CVD risk. After excluding the subjects with CVD at baseline and incomplete data, 2007 were used as internal validation, and 219 Kazakhs in Halabra Township were used as external validation. Logistic regression discriminations were used for internal validation and external validation, as well as to calculate the probability of CVD for each participant and receiver operating characteristic curves. Results: The prevalence of MS in Kazakh was 30.88%. Seven main factors were extracted from the Kazakh MS population, namely obesity factor, blood lipid and blood glucose factor, liver function factor, blood lipid factor, renal metabolic factor, blood pressure factor, and liver enzyme factor. The area under the curve (AUC) for predicting CVD in the internal validation was 0.773 (95%CI 0.754-0.792). In the external validation, the AUC for predicting CVD was 0.858 (95%CI 0.805-0.901). Conclusions The CVD risk prediction model constructed by 7 main factors extracted from Kazakh MS patients has high validation efficiency and can be used for risk assessment of CVD in Xinjiang Kazakh population.