Ligament of Marshall(LOM) is a bunch of epicardial structural deterioration.Because of its complex histological structure and electrophysiological properties, LOM plays an important role in the occurrence and maintenances of atrial fibrillation(AF).In addition, more and more studies indicated that ablation of LOM could effect the clinical result of AF treatment.We reviews on the anatomy, electrophysiological characteristics of LOM and the interrelationship between LOM and AF.

This paper is to analyze the clinical features of infective endocarditis (IE) and summarize the experience of surgical treatment. The retrospective review was based on 65 consecutive patients, who fulfilled the Duck criteria of the diagnosis of endocarditis, admitted from Jan 1997 to Jun 2002. There were 44 males and 21 females, with age ranged from 9 to 68 years. Pre operative blood cultures were positive in 20 out of 55 patients(45%), with Streptococcus in 8 (45%). Staphylococcus in 9 (40%), and other bacteria in 3 (15%). Echo cardiography revealed vegetations in 62 cases, involving the mitral valve in 19 cases, aortic valve in 31 case, pulmonary valve in 5 cases, tricuspid valve in 5 cases, and valsalva sinus in 2 cases. Among 65 patients, aortic valve replacement was performed in 22, mitral valve replacement in 13, combined aortic and mitral valve replacements in 5, mitral valve plasty in 3, repair of atrial septal defect in 2, ventricular septal defects in 14, rupture of Valsalva sinus in 3, correction of tetralogy of Fallot in 1, patent ductus arteriosus in 2. Four patients died in hospital. 56 patients (91%) were followed up for 6 months to 69 months. Two patients with replacement of aortic valve died 1 and 3 years later due to congestive heart failure and sepsis. In the other 54 patient, no recurrent infection was found. One year, 3 year, and 5 year survival rates were 96 6%, 90 1%,90 1%, respectively. The results suggest that urgent early diagnosis and optimal surgical intervention play key role in successful treatment of infective endocarditis.

In the recent years,many studies have confirmed that vascular endothelial progenitor cells(EPC)can migrate,proliferate and differentiate into mature endothelial cells.They participate in the angiogenesis not only during the process of embryonic development but also during the growth and metachoresis of tumor.Therefore,further studies on EPC are important for the understanding of the formation and treatment of tumor.This review summarizes the research progress in this field.

Objective To understand the cognition of nursing undergraduate innovative talents of college nursing graduates,provide the basis for training and evaluation of nursing undergraduate innovative talents and establishing evaluation system.Methods Using the method of qualitative research,in-depth interviews were carried out in 13 nurses who had received full-time undergraduate nursing education from a comprehensive hospital.The acquired data were collected and analyzed,and the topics were put forward.Results The demands of clinical post for undergraduate nursing talents were many-sided.The explicit achievements such as specific topic submission,articles printed,patented invention,etc.were the most intuitionistic evaluation for innovative talents.Most of the nursing students during the learning period could not understand the importance of innovation ability in nursing work,and were lack of motivation to obtain related knowledge.Many undergraduate nurses chose self-development after work simply for professional title promotion,lacking the simplicity for innovation or for solving practical problems.Conclusions For cultivation of innovative talents,school should take students as the starting point,and the different competency as orientation,perfect cultivation mode of innovative talents.The hospital should provide learning,studying abroad opportunities for nurses,construct the innovation team of department.In addition to explicit results,internal innovation consciousness and innovation spirit should also be concerned in evaluation.

The experiences of surgical treatment of valvular heart diseases in children were reported. Cardiac valve operations were performed in 87 children including 58 males and 29 females between the age of 4 to 14 years ( mean 10 2 years) . Of the 87 patients, 36 underwent mitral valve replacement, 13 aortic valves replacement, 6 mitral and aortic valves replacement, 13 aortic valvuloplasty, and 29 mitral valvuloplasty. Associated cardiac lesions were simultaneously managed. Postoperative complications included low cardiac output syndromes in 7 patients, respiratory failure in 3, and arrhythmia in 5 patients. The operative mortality was 4 60% (4 patients). Follow up was 0 5 to 14 5 years (mean 6 51 years). Late mortality was 3 61% (3 patients). The valvuloplasty operations were first choice for cardiac valve operations in children. It was advisable to use cardiac valve prosthesis of larger size(adult) for valve replacement in children.Anticoagulation with Warfarin was routinely used and the treatment of rheumatic fever should be emphasized postoperatively.

The experiences of coronary artery bypass grafting (CABG ) surgery and perioperative management for critical patients are reported. Forty-five critical CAD patients aged from 41 to 78 years old with 32 male and 13 female underwent CABG.The critical conditions included coronary artery disease complicated with left ventricular dysfunction (LVEF less than 30%) in 7 patients, heart valve disease in 13, postinfarction giant LV aneurysm in 6, aged 75 years or older patients with hypertension, diabetes, and renal or severe lung dysfunction in 8, and emergent CABG because of insufficient blood supply from left coronary artery during cardiac valve replacement or ascending aortic aneurysm operation in 5. Among all the patients, pure CABG was performed in 20, and CABG with other simultaneous procedures in 25. Each of 45 patients received l to 4 bypass grafts with a mean of 2 9. During the early stage of postoperation,there were low cardiac output syndrome in 6 patients, renal failure in 3, pulmonary failure in 2, and MOSF in 1.With the application of IABP, 5 from 6 LCDS patients recovered.Three patients were complicated with renal failure, and they also recovered with the use of peritoneal or blood dialysis postoperatively. During the early stage of postoperation,two patients (4 4%) died of LCOS and MOSF, respectively. One died of arrhythmia 15 months later after operation .The experiences suggest that control of hypertension,heart rate and diabetes before operation, perfect revascularization of ischemic myocardium and effective myocardial protection during operation,prevention of LCOS and renal failure after operation could improve the results of CAD patients undergoing CABG.

To study the ischemia/reperfusion-induced dynamic changes in PLA 2 in cardiomyocytes and its effect on phospholipids of cardiomyocyte membrane during cardiopulmonary bypass (CPB), and to evaluate the protective effects of two kinds of cardioplegia. The results showed that there was an increase in PLA 2 activity during CPB followed by decreases in the contents of total phospholipids, phosphatidylcholine and phosphatidylethanolamine. During the 6o-min aorta occlusion beriod,there were no obvious changes in the activity of PLA 2 and the contents of total phospholipids, phosphatidylethanolamine and phosphatidylcholine when cardioplegia was used. During early reperfusion, there were a rapid increase in PLA 2 activity accompanied by a rapid decrease in contents of phospholipids.However,after 30~60min reperfusion, the contents of phospholipids for group C, D began to increase and the PLA 2 activity began to decrease. The changes in the contents of phospholipids and the PLA 2 activity in extracorporeal circulation with warm blood cardioplegia group were smaller in magnitude. These results suggested that the myocardial membrane injury was dependent on PLA 2 activation. Warm blood cardioplegia could provide better myocardial protection, and warrant further improvements.

To investigate the effect of transfection of adenovirus mediated vascular endothelial growth factor B (VEGF B) gene transfer on the proliferation of endothelial cells. We constructed a replication deficient recombinant adenovirus vector coding for human VEGF B, and detected its gene transcription and expression in Ad. VEGF B infected rat arotic endothelial cells (RAECs) with RT PCR and western blat. The effect of Ad.VEGF B on RAECs prolifeation was examined by MTT assay on days 1, 2, 3, 5, 7 after infection. RAECs were successfully infected with high efficiency and expressed a special protein that is immunoreactive to anti VEGF B monoclonal antibody. This protein could be detected in the culture medium. The proliferation assay of RAECs infected with VEGF B expressing adenovirus revealed a significant increase in cell number over control. These results implied that the use of VEGF B expressing recombinant adenovirus may induce angiogenesis, which might be potential in vivo gene therapy for ischemic heart disease.