Objective To compare the mortality,valve-related morbidity and reoperation rate between mechanical prostheses and bioprostheses in patients aged 60 to 70 years.Methods The pre-operative characteristics of 119 patients who received mechanical prostheses and 181 those with bioprosthesis implantation in our department between January 2006 and December 2014 were analyzed,and their mortality,valve-related morbidity and reoperation rate were compared.Results Followup revealed mechanical prostheses had a lower all-cause mortality after mitral valve replacement than bioprostheses at 6 years after the operation (P=0.033),but there was no statistical difference in valve-related mortality (P=0.277).The complications after mechanical prosthesis replacement had embolism (8.4％) and bleeding (5.0％),bioprosthesis' those consisted of structural valvular deterioration (2.2％),nonstructural dysfunction (1.1％),thrombosis (2.8％),embolism (5.0％),bleeding (0.6％) and operated valvular endocarditis (1.1％).There was no statistically significant difference in total complication rate between the two groups (P=0.318).Biological group had 3 patients receiving reoperation in 8 years,while there was no reoperation in the mechanical group,but without statistical group difference.Conclusion Patients aged 60-70 years old could have a similar valve-related mortality,morbidity and reoperation rate after mitral valve replacement between mechanical and biological valves.

Calcific aortic valve disease(CAVD) is the most common valvular disorder.There is no medical treatment to prevent and/or reverse the progression of CAVD and the etiology still requires further study.CAVD has long been described as a degenerative disease related to aging.In the past few years,our comprehension of the etiology and mechanisms leading to CAVD has progressed at a fast pace.In this article,we review the latest discoveries of CAVD,from aspects of lipid retention,inflammation,calcification,osteogenic transition and their basic molecular processes.

Objective: It is difficult to repair large-area Ⅲ?burn wound in children.Here we introduce the advantages of the back skin donor site in repairing Ⅲ?burn wound in children.Methods: This clinical study included 15 children with Ⅲ?burn,ranging in age from 18 months to 11 years(mean 7.6 years),with the Ⅲ?burn wound area averaging at 12.6% of the total body surface.The back skin donor site was used to repair the wound.The functional site,such as the joint,was preferentially considered if the skin graft was not enough for all the wounds.Results: Most of the skin grafts survived and the donor sites on the back healed very well.The patients were followed up for six months to three years,which revealed that the skin grafts remained soft without dysfunction and the scar hyperplasia was mild on the donor site.Conclusion: The back donor site supplies larger-area skin with good quality.The donor site heals fast.After healing,patients could sleep on back and compress the scar so as to prevent scar hyperplasia,and the scar does not affect the patient's appearance.With all these advantages,the back donor site is a good choice for repairing Ⅲ?burn wound in children.

Objective: Breast augmentation by polyacrylamide hydrogel(PAHG) injection has resulted in a series of adverse events in many female patients.This article summarizes the authors' experience in the diagnosis and treatment of lactational infection after breast augmentation by PAHG injection and discusses related preventive measures.Methods: This study included 2 patients who had developed infection during lactation 5 years after breast augmentation with PAHG.We identified the exact position of the PAHG and vomica by color Doppler,computerized tomography and magnetic resonance.We made incisions in the submammary fold or mammary areola to take out the PAHG,drain the pus and place the vacuum pressure tube,followed by application of pressure bandages.Results: One of the patients healed without any complication,while the other developed latex leak in both breasts,but finally cured after milk regurgitation and repeated changing of dressings.Conclusion: Lactational infection after breast augmentation by PAHG injection is detrimental to female patients.Preventive measures should be taken as early as possible.For patients with this infection,operation should be performed to take out the PAHG and drain the pus.Sufficient draining and milk regurgitation are necessary to avoid latex leak.

Objective:To study the positive expression rate of M2 subtype of macrophage cell surface molecules and the inflammatory factors of PPS in IL-4-induced M2 macrophage.Methods:The experiment was divided into 5 groups:blank control group, Model group,PPS groups(50 μg/ml,100 μg/ml and 200 μg/ml).The expression of CD206 and CD23 was used as bio-maker to confirm IL-4 induced macrophages by treating RAW264.7 with 20ng/ml of IL-4.IL-4 induced RAW264.7 cells were treated with PPS of 50μg/ml,100μg/ml and 200μg/ml for 24 h.Then the expression of CD206,CD16/32 and CD40 were analyzed by flow cytometry, and the mRNA expression of IL-1β,TNF-α,IL-10 and iNOS were detect by qRT-PCR.Results: After treated with IL-4,the positive rate of CD206 of RAW264.7 were high.After treated with PPS ,the rate of CD16/32 and CD40 in IL-4 induced RAW264.7 cells were high ,the expression of CD206 decreased,and the mRNA level of IL-1βand TNF-αincreased.Conclusion:RAW264.7 cells can be polarlized to M2 subtype macrophage by using 20 ng/ml IL-4.PPS enhances the mRNA of IL-1β,TNF-αand the expression of CD40, CD16/32 in IL-4-induced RAW264.7 cells .These results indicate that PPS can induce the M2 subtype to become M1 macrophages, can improve immune function of macrophages.

Objective:To investigate the distribution and evolution of immunocytes in infantile hemangioma(IH).Methods:Fifty-two infantile hemangioma samples were investigate.The distribution of CD3+T cells,CD8+T cells and S-100+dendritic cell(DC) in IH was observed with.Results:CD3+T cell was not found among the earliest IH.In the middle proliferating stage,the number of CD3+T cells increased;But the CD8+T cells were still scare.In the late proliferating stage,there were many CD3+T cells and the number of CD8+T cells also increased.In the early involuting stage,there were still a number of CD3+ and CD8+ T cells around the microvessels.In the middle involuting and involuted stage,only a few of CD3+T cells and CD8+ T cells existed.In the early proliferating stage,there were some DC in IH.During the middle and late proliferating stage,the number of DC increased significantly.Since the early involuting stage,the DCs decreased rapidly and disappeared.Conclusion:The distribution of T cells and its subsets and DC have close relationship with the pathologic evolution of infantile hemangioma.

Objective To analyze the related risk factors for delayed gastric emptying ( DGE) after pancreaticoduodenectomy .Methods Clinical data on 308 patients who underwent pancreaticoduodenectomy at Ningbo Lihuili hospital from January 2009 to December 2014 were retrospectively analyzed , and patients were divided into DGE group and non-DGE group.Univariate analysis and multivariate logistic regression analysis were used to study the risk factors associated with DGE during perioperative period .Results DGE occurred in 55 patients (17.9%).The incidences of grade A, grade B and grade C DGE were 7.1%(22/308), 6.2%(19/308) and 4.5%(14/308), respectively.The univariate analysis showed the method of pancreatic digestive tract reconstruction ( pancreaticogastrostomy or pancreaticojejunostomy ) , postoperative pancreatic fistula, postoperative biliary fistula and postoperative intraabdominal infection were risk factors for DGE after surgery. Multivariate analysis indicated that the method of pancreatic digestive tract reconstruction (OR=1.19, P=0.046), postoperative pancreatic fistula ( OR=1.33, P=0.014), postoperative biliary fistula (OR=1.43, P=0.047) and postoperative intraabdominal infection (OR=1.51, P=0.001) were independently associated with DGE . Postoperative pancreatic fistula (OR=3.692, P=0.021) and intraabdominal infection (OR=3.725,P=0.003)were also the independent risk factors for Grade B and Grade C DGE. Conclusions DGE after pancreaticoduodenectomy was strongly related to the postoperative complications .Postoperative pancreatic fistula , biliary fistula and intraabdominal infection were associated with increased risk of DGE , while pancreaticogastrostomy reduced the incidence of DGE by decreasing the incidence of pancreatic or biliary fistula .

Objective To screen potential genes associated with drug resistance and multidrug resistance. Methods Microarray with 8000 genes was used to detect the different expression of 5-8F cells and 6-10B cells. Subsquently, genes of drug resistance and multidrug resistance were screened by MILANO online programme. Semiquantitative RT-PCR was utilized to confirmed the reliability of differentially expressed genes. Results 283 genes were identified the differential expression. Of these, 85 genes were shown to be upregulated and 98 downregulated. After the analysis of MILANO, 4 genes including UGT1A9 (15.85 folds),MVP(6.77 folds), CAV1(2.49 folds) and HIF1A(2.67 folds) with higher expression in 5-8F cells were found to be likely associated with drug resistance and multidrug resistance. Subsquently, semiquantitative RT-PCR confirmed the reliability of differential expression of these 4 genes. Conclusion Differentially expressed genes shown in NPC 5-8F cells compared to 6-10B cells with the identification of online MILANO program analysis are likely associated with drug resistance and mnltidrug resistance of NPC cells with the ability of metastasis.

Objective To investigated the protective ways of intensity modulated radiotherapy (IMRT)for submandibular gland function in patients with nasopharyngeal carcinoma.Methods From March 2010 to November 2012,101 patients with nasopharyngeal carcinoma were enrolled into study.They were treated with IMRT and evaluated by face to face dry mouth questionnaire during the follow-up of 3,6,12,18,24 and more than 24 months,meanwhile,their dose volume histogram of submandibular gland were taken into consideration.Results The average contralateral median dose and that of ipsilateral submandibular gland were (45.69±7.22) Gy and (51.64±8.20) Gy,respectively,and the V35,V40,V45,V50 were 95.82 ％,69.99 ％,46.90 ％,25.50 ％,and 100 ％,96.50 ％,82.24 ％,60.98 ％,respectively.There were positive relationship between the xerostomia grading of 3,6,and 12 months after radiotherapy and the average dose of submandibular gland or the V35,V40,V45,V50.After 6 month,the xerostomia in 77.2 ％ (78/101) was significantly improved,and after 12 months,less than 5 ％ of patient complained about G3 or more grade of xerostomia.Conclusions When using IMRT in nasopharyngeal carcinoma,it' s necessary to reduce the irradiated volume and the dose of submandibular gland.It is confined that the median dose of contralateral submandibular gland should be less than 40-45 Gy,and V40 or V45 ≤66.7 ％ or ≤50 ％,which can effectively protect the function of salivary gland.

Objective To investigate the plasma levels of glutamate (Glu) andγ-aminobutyric acid (GABA) in Par?kinson’s disease patients with depression (PDD) and their clinical significance. Methods Plasma levels of Glu and GA?BA were measured in 88 PD patients including 43 PDD patients and 45 PD patients without depression, and 68 healthy controls by using high performance liquid chromatography (HPLC-RF). Depression was assessed in enrolled subjects by using the Hamilton Depression Scale (HAMD). The plasma levels of Glu and GABA were compared among different groups and their associations with HAMD scores were subsequently evaluated by correlation analysis. Results The plas?ma levels of Glu and GABA were significantly lower in PD group(49.81±22.79,249.17±62.57)than in normal control group(149.59±50.08,276.66±85.43)(all P<0.05). In addition, PD patients with depression exhibited significantly low?er plasma levels of Glu and GABA(40.34±15.77 and 233.63±53.56)compared to PD patients without depression(58.86± 24.87 and 264.02±67.39)and healthy controls (all P<0.05). Correlation analysis indicated that HAMD scores were nega?tively associated with plasma levels of Glu ( r=-0.366,P=0.000 ) and GABA ( r=-0.217,P=0.043 ). Conclusion The decrease in plasma levels of Glu and GABA may be implicated in the pathogenesis of depression in PD patients.