[Summary] The paper reported perioperative respiratory nursing experience of 31 patients with emphysema complicating pneumothorax treated with lung volume reduction surgery under video-assisted thoracoscopy .The thoracoscopic surgery was completed in 27 patients and conventional thoracotomy were required in 4 patients because of severe pleural cavity adhesions .No severe respiratory complications occurred in all the patients .We deemed that positive preoperative mental nursing , respiratory preparation and exercises, proper physical training , intraoperative prevention of hazardous inhalation , postoperative effective analgesia , and careful management of closed thoracic drainage are key points of perioperative nursing .

Mammalian target of rapamycin( mTOR) is a key reg-ulator of aging and aging-related diseases. Rapamycin ( RAPA) induces and promotes the process of cell autophagy through in-hibiting mTOR pathway. Autophagy exerts a crucial role in main-taining the cellular meostasis, which provides essential materials for cell reconstruction, regeneration and repair via degradating the redundant, damaged, or senescent proteins and organelles. Hutchinson Gilford progeria syndrome ( HGPS ) patients are al-ways accompanied with abnormally accumulated progerin in cells. Similar to HGPS, abnormal protein accumulation is the common pathological feature of neurodegenerative diseases, in-cluding Huntington′s disease, Parkinson′s disease, Alzheimer′s disease and so on. Degradation of these abnormal proteins pre-dominantly depends on cell autophagy. Thus, rapamycin is a po-tential anti-aging drug for HGPS and aging-related diseases thera-py. This view focuses on the effects of rapamycin on cell autoph-agy and clinical application in HGPS and neurodegenerative dis-eases.

Objective To investigate the mecbanism of safflor injection treating myocardial contusion following thoracic impact.Methods Thirty healthy Japan big-ear rabbits were randomly assigned to the myocardial contusion control group (control group,n =15) and safflor injection group (safflor group,n =15).The rabbits with severe myocardial contusion were induced by BIM-Ⅱ Horizontal Bioimpact Machine.Blood samples were taken from common carotid artery of both groups to measure the levels of plasma thromboxance A2 (TXA2) and prostaglandin I2 ( PGI2 ) at 10 minutes before impact and at t0 minutes,30 minutes,1,3,6,12 and 24 hours after impact.Rabbits were dissected to observe the gross and micropathological changes of the hern at 24 hours after impact.Results The control group showed a distinct falling of plasma PGI2 concentration and a significant increase of plasma TXA2 concentration in the early period after severe myocardial contusion.The morphological observation revealed severe myocardial tissue injury as well.However,the safflor group showed insignificant variation pertaining to the reduction of plasma PGI2 concentration and increase of plasma TXA2 concentration,but obvious alleviation of myocardial tissue injury,as compared with the control group.Meanwhile,the ratio of TXB2 to 6- Ketoprostaglandin Fla (6-Keto-PGFla) in the safflor group was lower than that of the control group (P ＜0.05).Conclusion Safflor injection has therapeutic effect on myocardial contusion by elevating the concentration of plasma PGI2 and decreasing the concentration of plasma TXA2 in the early period after severe myocardial contusion.

Objective To evaluate the left ventricular diastolic dysfunction by tissue Doppler imaging (TDI)in a suprarenal abdominal aortic coarctation model of Lewis rats. Methods Thirty male Lewis rats at age of 8 weeks were used. Myocardial hypertrophy model was obtained by suprarenal abdominal aorta banding with ligation. Mitral annular velocity measurement by TDI and regular two-dimensional echocardiography with M mode were examined at baseline and at 10-,20-,30-and 40-day post banding.Results Compared with baseline,the left ventricular end diastolic and end systolic wall thickness and ventricular dimension were progressively increased,while ejection fraction(EF)and fraction shortening(FS)were decreased(P＜0.0 1).The left ventricle demonstrated centrifugal myocardial hypertrophy.Peak myocardial systolic velocity(Sa)at the mitral annulus did not change significantly throughout this study and there was no significant correlation with EF(r=0.216,P=0.071),and peak myocardial early diastolic (Ea),late diastolic(Aa)at the mitral annulus and Ea/Aa indices also were not stable after aortic banding and there were no significant difference in repeated measures at different time(P＞0.05).But the E/Ea wasincreased and the index had a statistically significant difference(P＜0.001).Conclusions The left ventricleshowed centrifugal myocardial hypertrophy in Lewis rats with abdominal aortic banding.E/Ea radio was a sensitive and stable index to evaluate left ventricular diastolic dysfunction.

Objective: To explore the clinical, pathological and echocardiographic characteristics of rare primary non-mucinous cardiac tumor (PNCT) and to investigate the diagnostic value of echocardiography in benign and malignant PNCT with various pathological classiifcations. Methods: We retrospectively studied 32 PNCT patients including 21 benign and 11 malignant patients treated in our hospital from 2003-01 to 2013-02. There were 23 male and 9 female from 0.5 to 66 (36.92 ± 20.17) years of age. We analyzed the clinical information of echocardiography, CT, MRI and operation, and the ifndings were conifrmed by pathology. Results: Statistic analysis presented that there were more male PNCT patients than female, the ratio of male/female in benign patients was 16/5, in malignant patients was 7/4, P<0.05, the age was similar between 2 groups, (38.06 ± 21.68) years vs (35.72 ± 13.55) years,P>0.05, and either infant or adult could suffer from PNCT. Benign PNCT was more in left heart and malignant PNCT was more in right heart. Compared with benign PNCT, malignant lesions were usually no base, with irregular shape, pericardial effusion and surrounding tissue adhesion. Conclusion: Echocardiography was sensitive for diagnosing the patients with PNCT, it could preliminarily identify benign and malignant lesions with different ultrasonographic manifestation.

Objective: To explore the occurrence rate of permanent pacemaker implantation (PPI) with relevant risk factors in patients after mechanical aortic valve replacement. Methods: A total of 1986 consecutive patients with mechanical aortic valve replacement were enrolled in this study. According to PPI conduction caused by severe arrhythmia , the patients were divided into 2 groups: PPI group,n=61 including 27 male with the average age of (53.6 ± 9.03) years and Non-PPI group,n=1925. The median follow-up time was (4.47 ± 4.36) years after valve replacement. Results: The patients in PPI group were with the elder age and higher ratio of pre-existing atrial ifbrillation (AF) than those in Non-PPI group,P<0.05. The overall PPI occurrence rate was 3.07% after valve replacement and the short term incidence rate (within 30 days) was 0.55%, midterm (from 30 day to 1 year) was 0.03%, long term (>1 year) was 2.22%. For PPI indications, there were 70.5% patients with high degree A-V block including 30 of AF combining long intervals, 12 of high degree A-V block, 1 of complete left bundle branch block (LBBB) and 14.8% patients with sick sinus syndrome/sinus arrest/ sinus bradycardia. Conclusion: PPI incidence was at a relative low level, the long term occurrence rate was higher than both short term and midterm; elder age, pre-existing AF could be the high risk factors for PPI requirement, and the major PPI indication was high degree AV block in clinical practice.

ObjectiveTo explore the value of conventional echocardiography and transthoracic real-time three-dimensional echocardiography (RT3DE) in diagnosis of Ebstein anomaly.MethodsWe investigated the morphology and function of right ventricle (RV) as well as the structure, morphology and regurgitation of tricuspid valve in 61 adult patients with Ebstein anomaly before surgery by using conventional echocardiography and transthoracic RT3DE. Twenty normal adults were enrolled as control group. ResultsThe surface of the tricuspid leaflets, the morphology of the tricuspid annulus as well as the three-dimensional structure of the tricuspid valve were displayed stereoscopically by RT3DE. Complete RV volume data could be acquired in 32 patients of Ebstein anomaly. The apex or part of RV could not be contained in the remaining 29 patients. Thirty-four (55.7%) patients with Ebstein anomaly had severe tricuspid regurgitation,
16 (26.2%) patients had moderate to severe regurgitation, and 11 (18.1%) patients had moderate regurgitation. Compared with the normal adults, patients of Ebstein anomaly showed higher RV end-diastolic volume (EDV), end-systolic volume (ESV), end-diastolic volume index (EDVI), end-systolic volume index (ESVI), stroke volume (SV), RV anterior-posterior diameter (RV), tricuspid valve annular transverse diameter (TV-R), and lower RV ejection fraction(EF) [(273.5±77.7) mlvs (74.3±15.9) ml, (187.1±96.8) mlvs (31.1±9.2) ml, (177.4±53.6) ml/m2vs (43.4±8.2) ml/m2, (121.7±65.5) ml/m2vs (18.4±5.1) ml/m2, (95.9±20.2) ml vs (43.6±8.8) ml, (48.1±13.3) ml/m2vs (19.0±1.9) ml/m2, (56.4±8.9) ml/m2vs (28.5±4.3) ml/m2, (38.3±12.8) %vs (59.3±5.1) %, allP<0.05). The tricuspid regurgitant orifice flow cross-sectional area (EROA) were correlated positively with RV anterior-posterior diameter (r=0.691), ratio of RV and LV anterior-posterior diameter (RV/LV) (r=0.6471).ConclusionTransthoracic RT3DE is a feasible method in addition to conventional two-dimensional echocardiography in evaluation of tricuspid valve mophology and function, as well as RV volume and EF in adult patients with Ebstein anomaly.

Objective To study the characteristics of heterotopic heart transplantation by echocardiographyand evaluate the heart function and acute rejection.Methods Five male 49-61 years old patients with heterotopic heart transplantation were studied using echocardiography pre-,intra-,post～operation and at follow-up.The anastomoses of great vessels of recipient with donor heart,chamber size,left ventricular wall thickness with wallmotion.left ventricular ejection fraction(LVEF),valvular function,pulmonary artery pressure,pericardial and pleural effusion were observed.Results All patients were end-stage coronary artery disease with NYHA class of received heterotopic heart transplantation with coronary artery bypass grafting.Some patients received mitral valvuloplasty,ventricular aneurysmectomy and stem cell transplantation simultaneously.During the operation,intra-operation transesophageal echocardiography was used to monitor and evaluate the surgical procedure with chamber sizes,anastomoses,native with donor heart ventricular and valvular function,and air bubble in chambers.The cardiac functions of donor heart backed to normal post operation,while the functions of recipient heart were increased gradually.All patients survived in 6 months and one year follow-up,with significantly improved functions of heart in situ[LVEF(44.0±15.6)%].The main reject reaction was small pericardial perfusion and pleural effusion.Conclusions Heterotopic heart transplantation has distinctive characteristics with echocardiography study,which is also an important technique in evaluation at pre-,intra-,post-operation and also at follow-up.

Objective: To retrospectively analyze the ascending aortic diameter (AAD) changes in patients after mechanical aortic valve replacement (AVR).
Methods: The medical records and echocardiography reports in patients who received AVR or bivalve valve replacement (BVR) in our hospital from 2000-01 to 2001-12 were retrieved, the retrieval conditions were as aortic valve structure must be mechanical and the follow-up echocardiography examination should be more than 9 years. The clinical information, pre- and post-operative 2-dimentional transthoracic echocardiography reports were collected, the follow-up echocardiography periods were ≤3-year, 3-year<-≤6-year, 6-year<-≤9-year and >9-year. AAD changes at different periods were compared. According to baseline AAD, the patients were divided into AAD<35 mm group and AAD≥35 mm group in order to observe the ascending aortic events.
Results: A total of 141 patients were enrolled form 595 echocardiography reports which included 75 male, the patients were at the mean age of (45.5 ± 11.2) years with mean follow-up time of (7.59 ± 3.38) years. Compared with baseline level, the follow-up AAD was similar between ≤3-year and 3-year<-≤6-year patients,P>0.05; while the follow-up AAD was different between 6-year<-≤9-year and >9-year patients,P<0.05. The patients with second operation in AAD≥35 mm group were much higher than those in AAD<35 mm group (24.0% vs 12.9%). There were 5 (20%) patients suffered from ascending aortic events in AAD≥35 mm group.
Conclusion: AAD dilatation were gradually occurring after mechanical AVR, the patients with AAD≥35 mm had the higher risk for ascending aortic events, therefore special attention should be taken in patients with aortic valve disease combining AAD dilatation during surgical treatment.

OBJECTIVE To improve methods for the sterilization of skin in injection site of myelosuppression(BMD) patients,to raise the effect of sterilization and to prevent the infection of skin and soft tissue.METHODS A hundred and eighty-six myelosuppression patients were randomized to divide into two groups,an experiment group and a control group.The modified methods were adopted in the experiment group while the conventional methods were adopted in the control group.RESULTS The incidence rate of infection of skin and soft tissue in the experiment group was 9.4%,obviously lower than that of the control group,which was 35.6 %(P