Objective To explore a method to culture human aortic valvular interstitial cells and identify the phenotypes,to establish the cell model which would be used to study aortic valve diseases in vitro.Methods Normal aortic valves of the patient with acute Stanford A aortic dissection in Peking Union Medical College Hospital were preserved during the surgical operation.Human aortic valvular interstitial cells were isolated and amplified in vitro by modified collagenase digestion method.The cell phenotype was identified by the immunofluorescent staining.Results Human aortic valvular interstitial cells could be successfully isolated and amplified in vitro by modified collagenase digestion method,identified by positive staining of Vimention and α-SMA.Conclusions The cell model of human aortic valvular interstitial ceils could be successfully established in vitro by modified collagenase digestion method.The cell phenotype identification proved to meet the experimental requirements.So it could provide cellular foundations for the study of pathogenesis of degenerative aortic valve disease.

Objective To assess the left atrial early function in pilots with essential hypertension by strian rate imaging (SRI). Methods Twenty-five hypertensive pilots without left ventricular hypertrophy and expansion (LVN) were selected. Twenty-ifve healthy pilots were included as control group. At the left ventricular apical four-chamber view, three-chamber view, two-chamber view, the systolic, early and late diastolic peak strain rate (SRs, SRe, SRa) curves were acquired by SRI in the basal section, the middle section and the upper section of the wall of left atrium. The average strain rate (mSRs, mSRe, mSRa) was calculated. The LA maximal, minimal and pre-systolic volume (LAVmax , LAVmin and LAVp), LA passive ejection fraction (LAPEF), LA active ejection fraction (LAAEF) , left atrial stroke volume (LASV), E/A and E/E′ were calculated. Results The LAPEF, LAAEF, LASV, E/A, E/E′were (38.96±6.43)%, (61.11±5.86)%, (14.74±5.33)mm, 1.23±0.08, 8.63±1.77 in the control group, and were (34.18±5.72)%, (63.23±6.89)%, (10.12±3.23)mm, 1.04±0.26, 7.16±0.84 in the study group. Compared with the control group, signiifcant difference was detect in LAPEF, LAAEF, LASV, E/E′(t=4.840, 2.690, 4.801, 2.950, all P<0.05). No signiifcant difference was found in E/A between the study and control group (t=-1.424, P=0.178). There was signiifcant positive correlation between SRa and E/E′(r=0.632, P<0.05). Conclusion SRI could be applied in the evaluation of early left atrial function. In pilots with essential hypertension, the changes of strain rate in left atrial wall, which is prior to the modeling geometry of left ventricular, could be detected by SRI.

Objective:To investigate the characteristics of nosocomial infection and relative risk factors, and provide the basis for the management and control of nosocomial infection.Methods:A cross-sectional survey was conducted on all inpatients with nosocomial infection in the First Affiliated Hospital of Shandong First Medical University from 0:00 to 24:00 on September 18, 2018.Results:There were 2 766 inpatients in the survey day, and the detection rate was 100%. The number of nosocomial infections was 57, with a current incidence rate of 2.06% (57/2 766), and the number of infections was 60, with a secondary incidence rate of 2.17% (60/2 766). The departments with the highest infection rates were neurosurgery department and intensive care units (ICU), which were 9.92% (13/131) and 9.38% (6/64) respectively. The lower respiratory tract at the infected site was the first, accounting for 50.00% (30/60). The main pathogens of nosocomial infection were gram-negative bacteria. The incidence of nosocomial infection was higher in patients with age ≥60 years ( χ2 value was 18.22 , P<0.001), ventilator( χ2 value was 37.84 , P<0.001), urinary tract intubation ( χ2 value was 180.57 , P<0.001), diabetic nephropathy ( χ2 value was 34.71 , P<0.001), and hemodialysis ( χ2 value was 368.60 , P<0.001) with statistically significant differences (all P<0.05). Conclusions:The focus should be on the prevention and treatment of lower respiratory tract infection inpatients in the intensive care unit of neurosurgery, and medic should develop preventive measures to avoid the occurrence of nosocomial infection according to the risk factors of patients with age ≥60 years, ventilator, urinary tract intubation, diabetic nephropathy, and hemodialysis to shorten hospital stay and costs.

Objective To analyze the outcome of applying venous flow-through flap in replantation of complex severed finger.Methods From March,2011 to August,2012,15 cases of complex severed fingers were repaired by flow-through flap with two sets of venous system of forearm vein and one stage repair of wound.The time from injury to operation was 1.5-5.5 h (mean 2.5 h).Vascular defect length ranged from 1.5 to 11.0 cm (mean 3.6 cm);and soft tissue defect of 1.5 cm × 3.0 cm to 11.0 cm × 11.0 cm.All digits had severe soft tissue defect and segmental defect of blood vessels.All the finger blood circulation was disorder.Results All flaps and replanted fingers survived completely,except 1 case of postoperative venous crisis occurred which was remission after the vascular transplantation,and 1 case of skin flap necrosis at the distal part which was healed after skin grafting; Fourteen cases were followed-up from 7 to 20 months.At the final followed-up the flaps were of good consistency and appearance.Function of the finger was graded excellent in 7 cases,good in 5 cases,and poor in 2 cases.All flaps and replanted fingers survived completely over a period of 12 to 30 months follow-up.The flaps were of good consistency and appearance.Function of the finger was graded excellent in 7 cases and good in 5 cases.Conclusion With less injury at donor site,and good repair results,venous flow-through flap is well indicated in complex finger replantation with soft tissue defect and vascule defect.

BACKGROUND:Several reports have demonstrated that metabolic disorders and physiopathologic changes accompany with urinary diversion.But these metabolic disorders caused by bladder reconstruction using intestinal tract are related to type and length of intestinal canal.OBJECTIVE:To investigate the histological change of reservoir mucosa and to assess effects on metabolic state in patients with a Roux-y sigmoid neobladder.DESIGN,TIME AND SETTING:A retrospective case analysis was performed at the Department of Urinary Surgery,the 184 Hospital of Chinese PLA between June 2000 and November 2008.PARTICIPANTS:The experimental group comprised 33 bladder carcinoma patients,21 males and 12 females,averaging 64 years of age.The control group consisted of 25 subjects who had no sigmoid colon diseases confirmed by gastroenterological endoscopy.METHODS:Patients with bladder carcinoma received radical cystectomy and bladder reconstruction using Roux-y sigmoid neobladder which controlled urination with anal sphincter.Prior to and after neobladder drainage tube removal,serum levels of electrolyte,creatinine,and urea nitrogen were detected.Before and 36 months after surgery,reservoir mucosa from 13 patients with bladder carcinoma was pathologically examined.For the control group,the thickness of sigmoid colon mucosa and the numbers of intestinal glands were determined.MAIN OUTCOME MEASURES:Electrolyte,renal function,acid-base balance,mucosal layer thickness,numbers of intestinal glands prior to and after surgery,as well as prior to and after drainage tube extraction.RESULTS:After surgery,electrolyte,creatinine,and urea nitrogen were all normal in 30 patients.There was no significant difference in serum electrolyte,creatinine,and urea nitrogen between prior to and after surgery.Mild acid poisoning was found in 3 patients.Microscopic observation results revealed that sigmoid colon mucosa in the control group did not change significantly after surgery,and it basically kept the normal tissue structure;in the experimental group,sigmoid colon mucosa that was(577.6±169.4)μm prior to surgery was thinned(412.5±114.7)μm(P＜0.05),intestinal glands were loosely arranged,interstitial substance became less,and the number of intestinal glands per high-fold visual field that was(26.4±3.5)/high-fold visual field prior to surgery was decreased(15.2±2.7)/high-fold visual field(P＜0.05),after surgery.In addition,intestinal villus in the neobladder was gradually atrophied,and no enterocyte proliferation and malignant changes were found after surgery.CONCLUSION:After Roux-y sigmoid neobladder application,colon mucosa was gradually thinned,intestinal glands were loosely arranged,interstitial substance became less,the number of glands per high-fold visual field was decreased,and body metabolism produced no changes.

Objective To assess metabolic state in patients with Roux-y sigmoid neobladder.Methods The study comprised 33 patients(21 men and 12 women) with Roux-y sigmoid neobladder after oneological sur-gery.All enrolled patients were treated by the same protocol.Before and after withdrawing the catheter , serum e-lectrolytes, ereatinine and urea were analysed and used to assess the effect.Results All 33 patients were evalu-able.Before and after withdrawing the catheter , serum electrolytes, creatinine and urea were normal values and there was no signifcant difference(P >0.05).Three patients developed mild metabolic acidosis.Conclusions The Roux-y sigmoid neobladder is a feasible , safe and effective method for continent urinary diversion.This surgi-cal technique had no signifcant effect on metabolic state.

Objective To investigate the expression and clinical significance of pro-inflammation S100A9 protein in intestinal type gastric cancer.Methods We retrospectively analyzed the clinicopathological materials of the 278 patients who were diagnosed as Lauren classification intestinal gastric cancer and underwent surgical treatment between January and December 2008 at the Department of General Surgery,Zhongshan Hospital Fudan University.Immunohistochemistry was used to analyze the expression of S100A9 protein in tumor tissues and para-tumor tissues.Results High expression of S100A9 protein was associated with the depth of tumor invasion (P =0.013),lymph node metastasis (81.4％,53.9％,47.3％ vs.84.7％,69.3％,60.7％,x2 =4.220,P =0.041) and TNM stage (P =0.010).The overall survival rate of these patients with high expression of S100A9 protein was significantly lower than those with low expression of S100A9 protein.In stage Ⅲ/Ⅳ patients,the overall survival rate of these patients with high expression of S100A9 protein was significantly lower than those with low expression of S100A9 protein.Moreover,for those patients who received postoperative chemotherapy,the prognosis of the patients with high expression of S100A9 protein was poorer than those with low expression.By multivariable analysis,the expression of S100A9 protein was not an independent risk factor for the prognosis of intestinal gastric cancer patients.Conclusions High expression of S100A9 protein in intestinal gastric cancer was associated with poor prognosis.

Objective To investigate the prognostic factors of radical gastrectomy for stage Ⅲ gastric cancer and predictive value of metastatic lymph node ratio for prognosis.Methods The retrospective case-control study was conducted.The clinicopathological data of 995 patients with stage Ⅲ gastric cancer who were admitted to the Zhongshan Hospital of Fudan University between January 2003 and December 2014 were collected.There were 690 males and 305 females,aged from 20 to 75 years,with an average age of 61 years.After clinical staging according to results of preoperative accessory examinations,patients with early gastric cancer underwent D1+ lymphadenectomy,patients with advanced gastric cancer underwent D2 lymphadenectomy and patients with serosa invasion underwent D2+ lymphadenectomy.Observation indicators:(1) treatment situations;(2) follow-up and survival situations;(3) prognostic factors analysis after operation;(4) stratified analysis:① stratified analysis of tumor pathological N staging;② stratified analysis of number of lymph node dissected;③ stratified analysis of tumor pathological TNM staging;(5) receiver operating characteristic (ROC) curve.Patients were followed up using outpatient examination and telephone interview to detect postoperative survival up to January 2016.The overall survival time was from the operation data to last follow-up or time of death.Measurement data with normal distribution were represented as Mean±SD.The survival rate and curve were respectively calculated and drawn by the Kaplan-Meier method and Log-rank test was used for survival analysis.The COX proportional hazard model was used for univariate and multivariate analysis.The ROC curve and area under curve (AUC) were used to check the accuracy of number of positive lymph nodes and metastatic lymph node ratio for prognosis.Comparison of the AUC was analyzed by the Z test.Results (1) Treatment situations:of 995 patients underging gastrectomy,677 underwent distal gastrectomy,85 underwent proximal gastrectomy,233 underwent total gastrectomy.There were 117 undergoing D1+ lymphadenectomy and 878 undergoing D2 lymphadenectomy or D2+ lymphadenectomy.The number of lymph node dissected,number of positive lymph nodes,metastatic lymph node ratio were 27± 12,10± 9 and 0.41±0.28,respectively.(2) Follow-up and survival situations:995 patients were followed up for (35± 32)months.During the follow-up,the 1-,3-,5-year overall survival rates were 77.9％,47.8％,36.2％.(3) Prognostic factors analysis after operation:results of univariate analysis showed that sex,tumor histological type,vascular embolus,degree of tumor invasion,tumor pathological N staging,number of lymph node dissected,metastatic lymph node ratio,tumor pathological TNM staging were related factors affecting prognosis of radical gastrectomy for stage Ⅲ gasteric cancer (hazard ratio =0.817,1.486,1.268,2.173,1.957,1.737,3.357,2.169,95％ confidence interval:0.686-0.973,1.059-2.086,1.074-1.497,1.195-3.954,1.480-2.588,1.390-2.170,2.476-4.602,1.740-2.704,P＜0.05).Results of multivariate analysis showed that sex,tumor histological type,tumor pathological N staging,number of lymph node dissected,metastatic lymph node ratio,tumor pathological TNM staging were independent factors affecting prognosis of radical gastrectomy for stage Ⅲ gastric cancer (hazard ratio =0.805,1.476,0.237,1.475,3.811,3.600,95％ confidence interval:0.673-0.963,1.049-2.087,0.083-0.678,1.140-1.909,2.259-6.428,1.317-9.839,P＜0.05).(4) Stratified analysis:of the 995 patients,the postoperative l-,3-,5-year overall survival rates were 93.7％,69.6％,60.5％ in the patients with metastatic lymph node ratio ≤ 0.1,86.9％,60.6％,44.3％ in the patients with 0.1 ＜ metastatic lymph node ratio ≤0.4 and 64.3％,28.9％,21.0％ in the patients with metastatic lymph node ratio ＞ 0.4,showing a statistically significant difference (x2 =121.300,P＜0.05).There were statistically significant differences between patients with metastatic lymph node ratio ≤0.1 and patients with 0.1＜ metastatic lymph node ratio ≤0.4,between patients with metastatic lymph node ratio ≤0.1 and patients with metastatic lymph node ratio ＞0.4 (x2=7.580,65.320,P＜0.05).There was a statistically significant difference between patients with 0.1 ＜ metastatic lymph node ratio ≤0.4 and patients with metastatic lymph node ratio＞0.4 (x2 =80.806,P＜0.05).① Stratified analysis of tumor pathological N staging:the average metastatic lymph node ratio was 0.09 in the 132 stage N1 patients,who were divided into the patients with metastatic lymph node ratio ≤ 0.1 and ＞ 0.1.The postoperative 1-,3-,5-year overall survival rates were 92.2％,68.6％,59.1％ in the 108 patients with metastatic lymph node ratio ≤ 0.1 and 79.2％,32.8％,21.9％ in the 24 patients with metastatic lymph node ratio ＞0.1,respectively,showing a statistically significant difference (x2 =14.499,P＜0.05).The average metastatic lymph node ratio was 0.23 in the 265 stage N2 patients,who were divided into the patients with metastatic lymph node ratio ≤0.2 and ＞0.2.The postoperative 1-,3-,5-year overall survival rates were 92.3％,73.8％,61.0％ in the 138 patients with metastatic lymph node ratio ≤0.2 and 76.5％,40.1％,22.2％ in the 127 patients with metastatic lymph node ratio ＞0.2,respectively,showing a statistically significant difference (x2 =42.536,P＜0.05).The average metastatic lymph node ratio was 0.56 in the 598 stage N3 patients,who were divided into the patients with metastatic lymph node ratio ≤0.4 and ＞0.4.The postoperative 1-,3-,5-year overall survival rates were 88.5％,62.8％,47.0％ in the 194 patients with metastatic lymph node ratio ≤ 0.4 and 64.3％,29.8％,21.0％ in the 404 patients with metastatic lymph node ratio ＞0.4,respectively,showing a statistically significant difference (x2 =51.860,P＜ 0.05).② Stratified analysis of number of lymph node dissected:7 of 117 patients with the number of lymph node dissected ＜ 15 had metastatic lymph node ratio ≤0.1,who were divided into patients with metastatic lymph node ratio ≤0.4 and ＞0.4.The postoperative 1-,3-,5-year overall survival rates were 78.2％,40.0％,28.6％ in the 44 patients with metastatic lymph node ratio ≤0.4 and 78.1％,18.7％,12.9％ in the 73 patients with metastatic lymph node ratio＞0.4,respectively,showing a statistically significant difference (x2 =4.727,P＜0.05).③ Stratified analysis of tumor pathological TNM staging:of 262 patients with stage Ⅲa gastric cancer,the postoperative 1-,3-,5-year overall survival rates were 88.5％,65.0％,54.3％ in the 230 patients with metastatic lymph node ratio ≤0.4 and 77.5％,35.4％,29.5％ in the 32 patients with metastatic lymph node ratio ＞0.4,respectively,showing a statistically significant difference (x2 =6.132,P＜0.05).Of 296 patients with stage Ⅲb gastric cancer,the postoperative 1-,3-,5-year overall survival rates were 84.4％,60.7％,42.7％ in the 200 patients with metastatic lymph node ratio ≤ 0.4 and 59.9％,26.8％,21.7％ in the 96 patients with metastatic lymph node ratio ＞0.4,respectively,showing a statistically significant difference (x2 =23.699,P＜0.05).Of 437 patients with stage Ⅲ c gastric cancer,the postoperative 1-,3-,5-year overall survival rates were 84.7％,59.9％,38.7％ in the 133 patients with metastatic lymph node ratio ≤0.4 and 64.0％,27.9％,18.3％ in the 304 patients with metastatic lymph node ratio ＞0.4,respectively,showing a statistically significant difference (x2=36.215,P＜ 0.05).(5) ROC curve:ROC curves of postoperative overall survival rates in patients with stage Ⅲ gastric cancer were drawn using the number of positive lymph nodes and metastatic lymph node ratio,of which AUC were 0.619 (95％ confidence interval:O.588-0.649) and 0.706 (95％ confidence interval:0.677-0.734),showing a statistically significant difference (Z=8.842,P＜0.05).Conclusions Sex,tumor histological type,tumor pathological N staging,number of lymph node dissected,metastatic lymph node ratio,tumor pathological TNM staging are independent factors affecting prognosis of radical gastrectomy for stage Ⅲ gastric cancer.There is different prognosis of patients with different metastatic lymph node ratios in the subgroup of the same tumor pathological TNM staging,number of lymph node dissected,tumor pathological TNM staging.Compared with tumor pathological N staging,metastatic lymph node ratio has a more accurate predictive value for prognosis.

Objective:To investigate the clinical effect of supermicrosurgery combined with modified anterograde replantation in Yamano Ⅰ zone.Methods:To retrospect and analysis the data of replantation of amputated finger in Yamano Ⅰ in Xuzhou Renci Hospital from March 2016 to October 2019. All patients were treated by supermicrosurgery combined with modified anterograde replantation method. The modified anterograde replantation method was according to proportional anastomosis of arteries and veins, the proceed was artery and nerve → fixation of bone → anastomosis of subcutaneous vein → suturing of skin wound. In the procedure of anastomosis of arteries and nerves, the position of injured finger replantation was modified, the customary horizontal position was altered to vertical position, the severed finger was flipped to the palmar side which was taken as the rotation axis, and the anastomosis was performed through the dorsal approach. Both the proximal and distal sections was completely exposed in the position, so that the visual angle of the surgeon was changed from squint to direct vision, and which suitable for the observation and operation. Follow-up was performed in outpatient department and WeChat after surgery, and functional evaluation was recorded according to the trial standard for functional evaluation of replantation of severed finger of Hand Surgery Society of Chinese Medical Association.Results:All of 38 patients were involved, including 23 males and 15 females. The mean age was 27.3 years (ranged from 1 to 58 years). All of injured fingers were completely severed in Yamano Ⅰ zone by single finger. The causes of injuries included chainsaw injury( n=6), knife cutting injury ( n=5), crush injury ( n=19), and avulsion injury ( n=8). According to the classification of Yamano Ⅰ zone, there were 4 cases of type Ⅰ, 14 cases of type Ⅱ, 11 cases of type Ⅲ, 6 cases of type Ⅳ and 3 cases of type Ⅴ. There were 12 cases of thumb, 9 cases of index finger, 6 cases of middle finger, 7 cases of ring finger and 4 cases of little finger. The ischemia time was 1-12 h. The survival rate was 94.7% (36/38). Thirty-three patients were followed up for 6-12 months. The length and shape of the fingers were similar to the contralateral finger, the nail was intact, and the two-point discrimination was 3-5 mm. The hand function returned to normal. Conclusions:The supermicrosurgery combined with modified anterograde replantation in Yamano Ⅰ zone can be used for the replantation of fingertip with arterial and venous anastomosis. The replantation fingertip has a high survival rate, satisfactory function and appearance. It is an ideal choice for the treatment of amputated finger in Yamano Ⅰ.

Objective:To investigate the clinical effect of supermicrosurgery combined with modified anterograde replantation in Yamano Ⅰ zone.Methods:To retrospect and analysis the data of replantation of amputated finger in Yamano Ⅰ in Xuzhou Renci Hospital from March 2016 to October 2019. All patients were treated by supermicrosurgery combined with modified anterograde replantation method. The modified anterograde replantation method was according to proportional anastomosis of arteries and veins, the proceed was artery and nerve → fixation of bone → anastomosis of subcutaneous vein → suturing of skin wound. In the procedure of anastomosis of arteries and nerves, the position of injured finger replantation was modified, the customary horizontal position was altered to vertical position, the severed finger was flipped to the palmar side which was taken as the rotation axis, and the anastomosis was performed through the dorsal approach. Both the proximal and distal sections was completely exposed in the position, so that the visual angle of the surgeon was changed from squint to direct vision, and which suitable for the observation and operation. Follow-up was performed in outpatient department and WeChat after surgery, and functional evaluation was recorded according to the trial standard for functional evaluation of replantation of severed finger of Hand Surgery Society of Chinese Medical Association.Results:All of 38 patients were involved, including 23 males and 15 females. The mean age was 27.3 years (ranged from 1 to 58 years). All of injured fingers were completely severed in Yamano Ⅰ zone by single finger. The causes of injuries included chainsaw injury( n=6), knife cutting injury ( n=5), crush injury ( n=19), and avulsion injury ( n=8). According to the classification of Yamano Ⅰ zone, there were 4 cases of type Ⅰ, 14 cases of type Ⅱ, 11 cases of type Ⅲ, 6 cases of type Ⅳ and 3 cases of type Ⅴ. There were 12 cases of thumb, 9 cases of index finger, 6 cases of middle finger, 7 cases of ring finger and 4 cases of little finger. The ischemia time was 1-12 h. The survival rate was 94.7% (36/38). Thirty-three patients were followed up for 6-12 months. The length and shape of the fingers were similar to the contralateral finger, the nail was intact, and the two-point discrimination was 3-5 mm. The hand function returned to normal. Conclusions:The supermicrosurgery combined with modified anterograde replantation in Yamano Ⅰ zone can be used for the replantation of fingertip with arterial and venous anastomosis. The replantation fingertip has a high survival rate, satisfactory function and appearance. It is an ideal choice for the treatment of amputated finger in Yamano Ⅰ.