BACKGROUND: Current studies have shown that bone marrow mesenchymal stem cells from normal or young people usual y serve as a source of transplanted cells in stem cel transplantation treatment of myocardial infarction. OBJECTIVE: To compare the therapeutic effects of bone marrow mesenchymal stem cells from diabetic and normal rats on myocardial infarction. METHODS: Under sterile conditions, bone marrow mesenchymal stem cells from normal and diabetic rats were harvested. Then, rat models of myocardial infarction were established and randomly divided into three groups:100 μL cellsuspension containing 105-106 bone marrow mesenchymal stem cells from F2 normal or diabetic rats was injected into myocardial infarction lesions, and 100 μL Dulbecco’s modified Eagle’s medium containing 20%fetal bovine serum was injected serving as blank control. After 1 month, hematoxylin-eosin staining for myocardial infarction lesions was performed for histomorphological observation. Bcl-2 expression was detected by immunohistochemistry method. RESULTS AND CONCLUSION: Based on cel morphology observation and flow cytometry identification, high-purity bone marrow mesenchymal stem cells could be obtained using rat femoral bone marrow adherent culture. Cel growth curve showed that normal rat bone marrow mesenchymal stem cells grew faster than those from diabetic rats. At 1 month after transplantation, histomorphological improvement was seen in the infarcted area after transplantation of normal rat bone marrow mesenchymal stem cells as compared with the other two groups. In addition, the Bcl-2 expression in the infarcted area was higher in the normal rat cel group than the the other two groups. These findings indicate that bone marrow mesenchymal stem cells from normal rats grow faster than those from diabetic rats, and the cells from normal rats have better therapeutic effects on myocardial infarction.

Objective To review the experience of treatment of atrial fibrillation (AF) after coronary artery bypass grafting (CABG), and to analyze its risk factors. Methods 110 patients were subjected to CABG. AF occurred in 26 of them after surgery. All these patients were treated with drugs or direct current. AF group and non-AF group were studied retrospectively, with an analysis of risk factors of AF. Results The incidence of AF after CABG was 23.6%. 19 patients were treated with Amiodarone, and 17 of them had sinus rhythm restored to normal (84.2%). In 3 of 4 patients, who were treated with Esmolol, sinus rhythm restored to normal (75%). All 3 patients who were treated with direct current had their sinus rhythm restored. The occurrence of AF was related to age, volume of left atrium, pathological change in proximal-median segment of right coronary artery, and the administration of ?-receptor blockade before surgery. It was indicated by logistic regression multiple factors analysis that both advanced age and abstinence of administration of ?-receptor blockade before surgery were individual risk factors for AF. Conclusion Ventricular rhythm should be controlled positively when AF occurred after CABG. Amiodarone, Esmolol and direct current were safe and effective treatment modalities. Patients with advanced age, large left atrium and pathological change in proximal-median segment of right coronary artery, should be treated with ?-receptor blockade to prevent AF.

Objective To investigate the localization and expression of endothelial nitric oxide synthase (eNOS) within the wall of the human internal mammary arteries (LMA), radial arteries (RA) and the great saphenous veins (SV) using immunohistochemistry method. Methods Specimens were harvested from 20 patients undergoing coronary artery bypass grafting and submitted to light microscope analysis using immunohistochemistry method. Results The expression of eNOS was evident in the intima of LIMA, RA and SV and in the media of muscular LIMA and RA. No eNOS expression was found in the media of great saphenous veins. Semiquantitative and the imaging analysis indicated by gray level values revealed a higher eNOS expression in the wall of internal mammary artery, particularly at the level of the media. Conclusion Different expression of eNOS in the intima and media of LIMA, RA and SV may provide a histological explanation for the better results of the LIMA when used for coronary artery bypass grafting.

Objective To observe functional changes of the right ventricle (RV) during off-pump coronary bypass grafting (OPCABG) by using a continuous cardiac output (CCO) monitoring. Methods The study included 178 patients with 2~3 vessel disease requiring a coronary bypass grafting. Preoperative cardiac functions were classified as New York Heart Association (NYHA) class Ⅱ in 72 patients, class Ⅲ in 84 patients and class Ⅳ in 22. The ejection fraction of the left ventricle was 0.35~0.82. The mean number of bypassed vessel was 3.3. A Swan-Ganz catheter was inserted for continuous monitoring of cardiac output by thermodilution. Parameters measured were heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), mean pulmonary artery pressure (MPAP), right atrial pressure (RAP), pulmonary capillary wedge pressure (PCWP), cardiac output (CO), cardiac index (CI), stroke volume index (SVI), systemic vascular resistance index (SVRI), pulmonary vascular resistance index (PVRI), mixed venous saturation value (SvO_2), right ventricular ejection fraction (RVEF), right ventricular end-systolic volume (RVESV), right ventricular end-diastolic volume (RVEDV), right ventricular end-systolic volume index (RVESVI), and right ventricular end-diastolic volume index (RVEDVI). The hemodynamic parameters were measured at time-points when a stable hemodynamics was obtained after the induction of general anesthesia and before the heart would be moved (T1), when the anterior descending branch would be anastomosed (T2), when the circumflex branch or the diagonal branch would be anastomosed (T3), when the right coronary artery or the posterior descending branch would be anastomosed (T4), and when the heart had been repositioned before the thoracic cavity would be closed (T5), respectively. Results There were 4 fatal cases: 2 patients received an emergency surgery for acute myocardial infarction and died with severe low cardiac output syndrome 3 days after the surgery, 1 patient ended with severe respiratory failure 7 days after the surgery, and 1 succumbed to acute pulmonary embolism 4 days after the surgery. As compared with the time-point of T1: the MPAP, PCWP, RAP and PVRI were significantly elevated and the SvO_2 was significantly reduced at the time-point of T2; the MPAP, PCWP, RAP, PVRI and SVRI were significantly elevated and the SvO_2, CI, SVI and RVEF were significantly depressed at the time-point of T3; the HR and RAP significantly went up and the SvO_2 significantly dropped at the time-point of T4; the parameters didn’t recover to normal levels at the time-point of T5. Conclusions When the obtuse marginal (OM) branch is anastomosed, right ventricular functions may decrease, particularly in CI and RVEF levels, while when the left anterior descending branch or right coronary artery is anastomosed, hemodynamics of the right ventricle vary within narrow limits. Therefore, a monitoring of right ventricular functions during OPCABG is of great significance, especially for those with right ventricular insufficiency.

Objective To evaluate the effects of different interventions on and influencing factors of picky eaters aged 1 to 5 years old.Methods Two hundred and forty-seven individuals were randomly assigned to the Identification and Management of Feeding Difficulties (IMFeD) group (n =147) and the control group (n =100).The IMFeD group received comprehensive guidance once a month,3 times in total;while the control group had traditional eating guidance.Scores of the IMFeD group were compared with the control group.Multivariate method was used for data analysis.Results Behavior scores of the IMFeD group were 4.7 ± 1.1 at baseline and 9.5 ± 2.6 after the intervention ; although behavior scores of the control group were 4.9 ± 1.1 at baseline and 6.6 ± 2.3 following the routine guidance (F =32.99,P ＜ 0.001).Univariate analysis showed that those two interventions significantly affected the outcomes of intervention (x2 =52.76,P ＜0.05).Regression analyses revealed an odds ratio (OR) of 6.171 (95％ confidence interval (CI) 3.652-10.428) or 0.448 (95％ CI:0.264-0.761) for intervention strategy and time with parents during their 1 year.Conclusion Family-based periodicity intervention may play an important role in eating behavior change and should be widely conducted in child health care.

The status of breastfeeding and in-hospital health education during pregnancy was surveyed in 32 maternity and children health care hospitals at provincial and municipal levels.A total of 1105 cases were assigned into hospital health education (A,n =872) and control (B,n =233) groups according to whether the women received the hospital health education of breastfeeding during pregnancy.Their differences in breastfeeding knowledge,attitudes and early feeding behavior were compared and analyzed by x2 test and binary logistic regression.Mothers in the group A were at higher levels of breastfeeding knowledge and had a higher proportion of breastfeeding at Day 1 (82.3％).The rate of exclusive breastfeeding in-hospital was significantly higher in group A than that in group B (51.1％ vs.32.3％).After adjusting for in-hospital health education,health education during pregnancy had significant effects on breastfeeding in the first days for group A:breastfeeding in the first 24 hour (OR =2.076,95％CI:1.474-2.924) and exclusive in-hospital breastfeeding (OR =2.105,95％ CI:1.529-2.898).

BACKGROUND:The artificial heart valve used in clinical application can be divided into stented and stentless. Stented valve is convenient for operations, with a low possibility of incompetency after transplantation. However stented valve cannot stimulate natural valve. OBJECTIVE:To reduce valve implantation time and improve valve properties, this study was designed to develop a new stentless porcine aortic valve for single-layer suture and implantation based on the design of valve in pig aortic root geometry optimization, and to further evaluate its performance by in vitro test. METHODS:(1) Stentless porcine aortic valve for single-layer suture was prepared. (2) The in vitro valve implantation experiment was performed with monolayer suture method. (3) The valve was detected by in vitro fluid mechanics test and fatigue test. RESULTS AND CONCLUSION:Stentless valve for single-layer suture has removed the valve hard, which contributes to reduce the damaged caused by blood flow on the valve leaflet, at the same time removal of the hard valve ring can widen the diameter of implanted valve and improve hemodynamics, even the implantation time of valve is shorter than traditional double-layer suture. The in vitro fluid mechanics test and fatigue test results are satisfactory. The future research lies in a complete elucidation of long operation time, postoperative long-term clinical efficacy and durability of stentless valve implantation.

BACKGROUND:Artificial valve replacement for valvular disease has good biocompatibility and hemodynamic characteristics, but there are stil many factors that affect its therapeutic effects. OBJECTIVE:To detect the level of serum Apelin-12 in the perioperative period of valve replacement in valvular disease patients with atrial fibrilation. METHODS: Sixty-two patients with valvular heart disease scheduled for artificial valve replacement were selected, including 30 patients with persistent atrial fibrilation (atrial fibrilation group) and 32 patients with sinus rhythm (sinus rhythm group). There were 33 males and 29 females, with a mean age of (55±11) years. Levels of serum Apelin-12 and makers related to inflammation and oxidative stress were detected in two groups at admission. Furthermore, the sinus rhythm group was sub-divided into postoperative atrial fibrilation (POAF) group (n=8) and non-POAF group (n=24) after valve replacement, and the above-mentioned indicators were detected and compared between these two subgroups. RESULTS AND CONCLUSION:Compared with the sinus rhythm group, the serum level of Apelin-12 was significantly lower in the atrial fibrilation group, while the levels of high-sensitivity C-reactive protein and interleukin-6 and total antioxidant capacity were significantly higher in the atrial fibrilation group (P <0.05). Correlation analysis showed that the serum level of Apelin-12 was negatively correlated with high-sensitivity C-reactive protein level and total antioxidant capacity (r=-0.265,P=0.045;r=-0.960,P <0.001), but not correlated with the interleukin-6 level (r=-0.155,P=0.230). Compared with the non-POAF group, the serum level of Apelin-12 was significantly lower in the POAF group (P< 0.05), but the left atrial diameter, high-sensitivity C-reactive protein level were higher in the POAF group (P < 0.05). Apelin-12 may take part in the occurrence and maintenance of atrial fibrilation through the regulation of inflammations and oxidative stresses. The testing of serum Apelin-12 has a certain value in predicting the occurrence of postoperative atrial fibrilation.

Objective To assess and compare the the results of tricuspid annuloplasty performed with the Edwards MC3 and Kay methode.Methods From January 2010 to May 2014, 759 patients with function tricuspid regurgitation(FTR) secondary to left-sided valve disease received tricuspid annuloplasty.Cardiac ultrasound Heartbeat diagram were made to confirm the degree of tricuspid regurgitation, the diameter of tricuspid annulus, the pressure of pulmonary artery and the heart function both in the left and the right, and so on.Of them, 355 cases of male, female 404 cases, at the mean age of(54.1 ± 8.3) years old, with the heart function classical(NYHA) : Ⅰ 13, Ⅱ 177, Ⅲ 400, Ⅳ 169, the mean left ventricles ejection fraction(LVEF) was 0.53 ±0.04, the mean pulmonary artery pressure was(62.5 ± 17.6) mmHg(1 mmHg =0.133 kPa).The diagnosis include rheumatic heart disease 517 cases, degenerative disease 209 cases and infective endocarditis 33 cases.The operation include mitral annuloplasty 132 case, mitral replacement 295 cases, mitral annuloplasty and aortic replacement 20 cases, mitral and aortic replacement 388 cases, CABG 86 cases and Maze Ⅲ methode 23 cases.The degree of tricuspid regurgitation before the operation were class Ⅰ 88, Ⅱ 189, Ⅲ 352 and V 130.From January 2010 to May 2012, 447 cases received Kay' s methods and 312 cases received MC3 annuloplasty ring during May 2012 to May 2014.In the MC3, We use the rings in 28mm size were 79 cases, 30 mm 155 cases, 32 mm 66 cases and 34 mm 12 cases.Results There were no death, reoperation and adverse events in both groups.There were no diffent in the aorta block time, the circulation bypass time, the time of mechanical ventilation, stay in ICU and in the hospital(P ＞ 0.05).All the patient were followed up regularity.The rat of follow up was 90.4％ (686/759), and the mean time of follow up was(39.9 ± 7.7) month.The patients' s EF increased, inner diameter of the right ventricle decreased in both group.There were no severe TR in the patients in the Kay group within 3 months, and 1 case of severe TR 1 year later, as 5 cases at 2 years and 12 cases after 2 years.The regurgitation volume of tricuspid was (3.4 ± 1.4) ml at the moment of 3 month, (6.5 ± 2.1) ml at 1 year, (7.9 ± 2.5) ml at 2 years and (12.4 ± 4.7)ml 2 years later.In the MC3 group, there were no severe TR in the patients during all the stage of fellow-up.There were on regurgitation in the patient within 3 months, 1 case of Class Ⅲ of TR at 1 year and 3 cases of Class Ⅲ at 2 years, without worse TR happen.At the same stage as in MC3 group, the regurgitation volume was(2.9 ±0.9) ml,(3.5 ±1.3) ml and(3.4 ±2.1) ml.The result in MC3 group was similar with Kay group(P ＞0.05) in short term, but much better in the long-term(P ＜ 0.05).Conclusion The Kay methode has good early result, but not the same good in the long-term, which can be applied in the elder persons or the patient without long Life expectancy.And the MC3 ring can correct the FTR enduringly and effectually, specifically the size in small one which behaves perfectly.The MC3 ring should be used in the young patient or the patient wants more.

ObjectiveTo study the pulmonary arterial development over five years in patients underwent extracardiac total cavopulmonary connection (ETCPC).Methods43 survived patients,who had undergone ETCPC were examined with pulmonary perfusion at one month and five year following the operation.Central venous pressure (CVP) and arterial oxygenation saturation (SatO2 ％ ) were measured by right cardiac catheter,pulmonary arterial index (PAI) and pulmonary vascular resistance (PVR) were calculated.Pulmonary blood distribution were measured and calculated by 99m Tc-MAA perfusion imaging.ResultsThe PAI and PVR of the follow-up group reduced significantly ( t =2.41,P ＜ 0.05 ; t =2.08,P ＜ 0.05 ),CVP also reduced significantly ( t =2.69,P ＜ 0.05 ),but SatO2 ％ did not changed significantly.Total radionuclide counts and the ratio of rightorleft pulmonary perfusion did not change significantly.( t =0.38,P ＞ 0.05 ;t =1.12,P ＞ 0.05 ),but the ratio of the superior and inferior lobe decreased significantly( t =2.54,P ＜ 0.05 ).ConclusionThe weak pulsation and low dynamic of Fontan circulation also can promote pulmonary vascular development.However,the improvement of hemodynamic in pulmonary circulation at mid-term follow will not lead to an increased amount of pulmonary perfusion or oxygen supply,which is probably due to the massive opening of the arteriovenous shunt and increased futile circulation.