Quercetin and praziquantel were used to treat mice with hepatic fibrosis due to Schistosoma japonicum infection.Quercetin treatment obviously relieved the degree of hepatic fibrosis,significantly reduced the expression of immediate early gene,tissue inhibitor of metalloproteinase 1(TIMP 1),typesⅠ and Ⅲ collagen compared to the control.The expression of c-jun mRNA,typeⅠ and type Ⅲ collagen were reduced significantly compared to the group treated with praziquantel,whereas no difference in the expression of c-fos mRNA and TIMP1 between the two groups,indicating that quercetin may have better effect on schistosomal liver fibrosis than praziquantel in the long term.

Objective To analyze the influence of left atrial dimension (LAD) on the effectiveness of heart valve replacement combined with dipolar radiofrequency ablation in atrial fibrillation (AF). Methods Eighty-one patients with permanent AF and heart valve diseases having undergone surgical treatment were selected. The patients were divided into two groups according to the size of LAD:groupⅠ (45 patients with LAD<60 mm) and group Ⅱ (36 patients with LAD ≥60 mm). All the patients underwent heart valve replacement and douching dipolar radiofrequency ablation, and were given amiodarone therapy after operation. The ultrasonic cardiogram and electrocardiogram after operation were inspected periodically. The changes of cardiac function and electrophysiology activity were observed. The patients were followed up for 12 months. Results The early-stage mortality after operation was 3.7% (3/81), and all of death was caused by postoperative low cardiac output syndrome. Two cases appeared third-degree atrioventricular block after surgery, and they were installed permanent pacemaker. During the follow-up, 1 case died because of sudden cerebrovascular accident. Two cases were loss to follow-up. There was no statistical difference in rate of maintaining sinus rhythm at discharge from hospital between group Ⅰ and group Ⅱ: 75.0% (33/44) vs. 73.5% (25/34), P=0.88. But the rates of maintaining sinus rhythm at 3 and 12 months after operation in groupⅠwere significantly higher than those in groupⅡ:81.4% (35/43) vs. 58.8% (20/34) and 88.1% 37/42) vs. 60.6% (20/33), and there were statistical differences ( P=0.029 and 0.006). Conclusions For the patients in permanent AF and heart valves diseases with LAD <60 mm, the dipolar radiofrequency ablation during heart valve replacement has considerably beneficial effects on rate of maintaining sinus rhythm. But for the patients with LAD≥60 mm, the result is not optimistic and has a lower postoperative sinus rhythm restoration rate.

Objective To analyze the medium and long-term results of tricuspid valve replacement (TVR)and summarize the operative experience for tricuspid valve disease.Methods Clinical data of 27 patients with severe tricuspid valve disease from September 2005 to May 2010 were retrospectively reviewed.Biological valve prosthesis was replaced in 23 patients,while mechanical valve prosthesis was replaced in 4 patients.Accompanying procedures included mitral valve replacement in 8 cases,mitral valve replacement and aortic valve replacement in 4 cases,and repair of atrial septal defect in 4 cases.Results The operative mortality was 11.1％(3/27),among these patients,2 cases died of serious low cardiac output syndrome,1case died of muhiorgan failure on the 7th day after operation,1 case who underwent reoperation for hemorrhage postoperative was improved after treatment.During follow-up,1 patient died of biological valve prosthesis dysfuncion 3 years after operation,1 patient died of cerebral embolism 19 months after operation.Six cases were in New York Heart Association(NYHA)class Ⅰ,and 14 cases in NYHA class Ⅱ during the period of follow-up.Conclusions Because operative and follow-up mortality is high,TVR is the last selection for the treatment of tricuspid valve disease.Appropriate operative technique and perioperative therapy are the key for clinical success.For those older than 50 years,follow-up inconvenience and reproductive-age female patients,biological valve prosthesis should be recommended as a preferential choice.

Objective To discuss the pathological and clinical features, diagnosis and treatment of prostatic duct adenocareinoma. Methods The clinical data of nine cases of prostatic duct adeno-carcinoma were retrospectively analyzed, with the average age of 76 (59-106) years. Six cases were presented with dysuresia and/or nocturia, and two of them had the painless gross hematuria. Two pa-tients presented painless gross hematuria as the first symptom. One case was detected the elevated ser-um PSA in a routine healthy examination. Radical prostatectomy (RP) was performed in 1 case;RP and bilateral orchidectomy and external beam radiotherapy (EBRT) were performed in 1 case;5 cases underwent transurethral resection of the prostate (TURP) combined with photoselective vaporization of the prostate (PVP) by green laser and bilateral orchidectomy;1 case underwent TURP combined with PVP;1 case underwent bilateral orchidectomy combined with EBRT. Eight cases took flutamide for 3-45 months. All patients were followed-up according to the scheduled time. Results The op-erations were successfully performed in all 9 patients. The papillary or cauliflower-like tumors infiltra-ted colli culus seminalis and prostate duct nearby. The glands were coated with tall pseudostratified columnar cells. The nuclei were large, dark stained with more frequent mitoses. The positive rates of immunolabelling antibody PSA, AR, PAP were found to be 89%(8/9), 100%(5/5), 100%(5/5) re-spectively. The distribution of Gleason score was 6-7(3 cases), and≥8(6 cases), and a coexisting acinar carcinoma component was identified in 5 cases of the group. Nine cases had a mean follow up for 20(3-48) months. Five cases have developed biochemical recurrence, of whom 3 died of bone metas-tasis and multiple organ failure, and 1 developed lung and bone metastasis. Three cases remained alive without recurrence. The remaining 1 case survives during the follow-up survey for 6 months until now, without examinations due to the old age. Conclusions Duct adenocarcinoma of the prostate presents the low incidence and lacks of typical symptoms in the early stage. Diagnosis was confirmed mainly on the basis of pathology. The tumors tend to have a more advanced stage and a very short term survival rate. The treatment options and management are similar to that of high-grade adenocar-cinoma of the prostate;meanwhile, close follow-up survey should be performed.

Objective To explore the value of video-assisted thoracoscopic thymectomy in the treatment of thymoma accompanied by myasthenia gravis.Methods In this study,forty-two patients who were preoperatively con-firmed to be thymoma accompanied by myasthenia gravis from 2008.1 to 2012.12 were treated using VATS,including typeⅠin 23 cases,typeⅡa in 11 cases,typeⅡb in 7 cases,and type Ⅲ in 1 case.Thymectomy and dissection of all fatty tissue anterior to the pericardium were performed in all cases.The operation time,blood loss,chest drainage time,hospital stay and outcomes were recorded and compared.Results In this group,one patient showed myasthenic crisis after surgery and recovery well after treated by ventilatory support.the patients had fewer blood loss(<35mL) , shorter operation and postoperative drainage time, and shorter postoperative hospital stay.Conclusion Extended thymectomy by VATS is safe and feasible with the advantage of less invasion,less surgical trauma and pain,lower rate of complication,and good curative effect.

Objective To observe the mid-term changes of pulmonary function and quality of life in the patients with emphysema who have undergone lung volume reduction surgery.Methods 44 subjects with severe emphysema underwent single or double lung volume reduction surgery through thoracoscope.There were 33 male and 11 female in the population analyzed with an age range of 46 to 70 years old.The mean age of the patients was (65.2-± 6.0) years.The pulmonary function and quality of life evaluation were determined over 3 time periods:prior to surgery,12 months postsurgery,and 24 months postsurgery Pulmonary function measurement project including the forced expiratory volume in 1 second (FEV 1),FEV 1％ of predicted value,residual volume (RV),RV ％ of predicted value,partial pressure of oxygen(PO2),partial pressure of carbon dioxide (PCO2),life quality evaluation performed in the form of questionnaire,including whether under anhelation,satisfactory sleep,living by self-care,participating in household duties,taking part in social work,whether to have a good mental state and have a hobby.Results There was 1 death of 44 patients from respiratory failure.43 patients recovered smoothly.4 cases were lost to follow-up.In 39.patients with follow-up,1 patient succumbed to cerebrovascular at 13 months after surgery.The other 38 cases compared with the preoperative at 12 and 24 months postsurgery,postoperative forced expiratory volume in 1 second (FEV1) increased,P ＜ 0.05,residual gas volume (RV) decreased,P ＜ 0.05,partial pressure of oxygen (PO2) increased,P ＜ 0.05,partial pressure of carbon dioxide (PCO2) decreased,P ＜ 0.05,meanwhile,the quality of life has improved significantly.Conclusion Lung volume reduction surgery in patients with severe obstructive emphysema can improve pulmonary function and quality of life.And its effect would not disappeared in the short term.

ObjectiveTo investigate the myocardial protection on cardiac valve replacement surgery with creatine phosphate of myocardial GIK (GIK) in order to reduce the surgical risk and improving the efficacy.Methods126 cases were unergone surgical treatment of heart valve disease,whose cardiac function on admission wereⅢor Ⅳ. 126 patients were randomly divided into two groups. Cardiopulmonary bypass time, aortic cross clamp time, postoperative myocardial injury markers ( CK-MB, cTNI) changes, arrhythmias, heart function recovery, length of stay and mortality rate and other indicators were compared between the two groups. ResultsThe age, gender, body mass,heart disease and surgery combined data were not statistically significant between the two groups( all P ＞0. 05). The cardiopulmonary bypass time, aortic cross clamp time and mortality had no significant differences between the two groups( all P ＞ 0.05 ). The CK-MB( 21.36± 9.21 ) U/L and cTNI(0.83 ± 0. 35 ) ng/ml of creatine phosphate group were significantly lower than those of the control group. The incidence of arrhythmia in phosphocreatine group (37. 1％ ) was significantly lower than ordinary group (57.8 ％ ) ( X2 ＝ 5. 418, P ＜ 0. 05 ). ConclusionThe application of creatine phosphate GIK before valve replacement surgery could effectively reduce reperfusion injury after myocardial ischemia,myocardial protection,and significantly reduce the incidence of arrhythmia and improve heart function in patients.

Objective To summarize the results of valve re-operative cases after cardiac valve replacement, to find the better re-operative time, and to estimate the re-operative methods and influencing factors of the operation. Methods Thirteen valve re-operative cases after cardiac valve replacement from October 2008 to February 2010 were retrospectively studied. According to NYHA classification, 9 cases belonged to class Ⅳ, and only 4 cases belonged to class Ⅲ preoperatively. Mitral valve replacement (MVR)was performed in 7 cases, aortic valve replacement (AVR) in 3 cases, MVR + AVR in 3 cases. Results The early-stage postoperative mortality was 7.7%( 1/13),and the reason was low cardiac output syndrome. Two cases who underwent re-operation and re-intubation respectively after operation for hemorrhage were improved after treatment. Twelve cases were discharged in 3-6 weeks after heart valve surgery and all were followed up for 6-15 months. The cardiac function of all the discharged patients recovered well and no death occurred during follow-up. Conclusion The key factors to reduce the death of re-operation are improving preoperative heart function,setting up extracorporeal circulation as soon as possible,consummating myocardial preservation,perfecting operating skills,correcting low cardiac output syndrome in time and preventing complications.

ObjectiveTo explore the surgical treatment of congenital heart disease combined with severe pulmonary hypertension.MethodsThirty-two patients of congenital heart disease combined with severe pulmonary hypertension were included in the study.The saturation of arterial oxygen ranged from 0.84 to 0.94 and echocardiography showed left to right slow velocity shunt in 20 eases,double direction shunt in 10 cases and no shunt in 2 cases.The pulmonary arterial pressure was 65-120 (82 ± 14) mm Hg ( 1 mm Hg =0.133 kPa).All patients received surgical repairs under cardiopulmonary bypass and were treated preoperatively with oxygen inhalation therapy,oral intake of beraprost sodium or silaenafil respectively according to the degree of pulmonary hypertension.During cardiopulmonary bypass,pulmonary artery perfusion was performed with protective solution containing ulinastatin for lung protection.Vasoactive drugs were routinely administrated postoperatively.Results Thirty-two cases underwent the surgical treatment successfully with their postoperative pulmonary arterial pressure decreased 20 -40 mm Hg and 2 cases died of severe low cardiac output syndrome and fatal arrhythmia.The mortality was 6.25％(2/32).ConclusionComprehensive perioperative management followed by radical operation can achieve a good clinical result on congenital heart disease combined with pulmonary hypertension.

Objective To discuss the clinicopathologic features, diagnosis and treatment of pri-mary prostatic signet ring cell carcinoma (PPSRCC). Methods Clinical data of 23 PPSRCC cases were retrospectively reviewed. The mean age was 74 years and majority of them had aggravated dysu-ria. The mean serum PSA was 45.3 ng/ml (7.4-126.8 ng/ml). To exclude the metastasis from stomach and colon SRCC, upper gastric tract endoscopy and barium enema were carried out. Seven pa-tients received radical prostatectomies and 2 patients who had positive margins received hormonal and radiation therapy. The rest of patients received maximal androgen blockade therapy. Photoselective vaporization of the prostate was performed on 11 patients who had lower urinary tract symptoms. All cases were investigated by routine pathological, immunohistochemical studies. Results Seventeen cases of PPSRCC were associated with concurrent high-grade prostatic carcinoma, only 6 cases were pure SRCC. Immunohistochemical stains were positive in all cases for PSA and PAP. Stains were ne-gative for AB/PAS (23/23) and CEA (21/23). The clinical TNM stages were 7 of Ⅱ , 10 of Ⅲ and 6 of Ⅳ. Follow-up was available on 20 cases with a mean 24 months and 3 cases were lost during follow up. Eight cases died of metastasis. Five cases had evidence of recurrence 12-21 months from presen-tation. Conclusions The diagnosis of PPSRCC depends on pathological and immunohistochemical studys after metastasis from stomach and colon SRCC is excluded. Early diagnosis and combination treatment for PPSRCC might improve its prognosis.