AIM: To study the changes in anterior chamber angle after phacoemulsification and foldable IOL implantation with ultrasound biomicroscopy.METHODS: Small-incision phacoemulsification and foldable IOL implantation were performed in 50 eyes of 46 senior patients, and the changes of anterior chamber angle were determined quantitatively by using ultrasound biomicroscopy before and one month after the surgery.RESULTS: In all patients, the angle was widened significantly one month after the surgery (P＜0.01). The measurements of TIA500 ( trabecular-iris angle at 500μm from the scleral spur) , AOD250 (angle-opening distance at 250μm from the scleral spur) and AOD500 (angle-opening distance at 500μm from the scleral spur) increased significantly after the operation ( P＜ 0.01). The mean post/pre-operative TIA500ratio, AOD250 ratio and AOD500 ratio were 1.65 (1.12-4.91),1.81 (1.06-2.67) and 1.65 (1.01-2.76), respectively. A significant negative correlation existed between preoperative and postoperative data.CONCLUSION: Small-incision cataract surgery deepens the anterior chamber and widens anterior chamber angle significantly in senior patients. The narrower the preoperative angle, the higher ratio of post/preoperative ratio found.

OBJECTIVETo study the effect of Qinghuang Powder (QHP) combined Chinese herbs for Pi-strengthening and Shen-reinforcing (CHPSSR) on hypoxia-inducible factor 1alpha (HIF-1alpha) in bone marrow mononuclear cells of myelodysplastic syndrome (MDS) patients.

METHODSChanges of HIF-1alpha in bone marrow mononuclear cells of MDS patients were detected in 25 MDS patients treated by QHP combined CHPSSR using flow cytometry. Meanwhile, 13 healthy subjects were recruited as the control group. Changes HIF-1alpha levels in various serial bone marrow mononuclear cells were detected.

RESULTS(1) Among the 25 patients in the treatment group, there were 19 patients effective and 6 patients ineffective, with the total effective rate being 76%. (2) Compared with before treatment, levels of peripheral blood WBC, Hb, PLT, and ANC significantly increased in the treatment group after treatment, showing statistical difference (P < 0.05, P < 0.01). (3) Compared with before treatment, the HIF-1alpha mean fluorescence intensity was enhanced in bone marrow lymphocytes, monocytes, granulocytes, and nucleated red blood cells of the treatment group after treatment (P < 0.05, P < 0.01). Compared with the control group, the HIF-1alpha mean fluorescence intensity was weakened in bone marrow lymphocytes, monocytes, and nucleated red blood cells of the treatment group before treatment; while it was obviously enhanced in granulocytes (P < 0.01). But after treatment the HIF-1alpha mean fluorescence intensity increased more in the granulocytes of the treatment group than in those of the control group (P < 0.01), but there was no statistical difference in bone marrow lymphocytes, monocytes, or nucleated red blood cells.

CONCLUSIONQHP combined CHPSSR could improve HIF-1alpha levels in bone marrow lymphocytes, monocytes, granulocytes, and nucleated red blood cells of MDS patients, thus improving Hb levels of MDS patients, and improving their anemia and correlated symptoms.

Adolescent ; Adult ; Aged ; Arsenicals ; therapeutic use ; Bone Marrow ; Bone Marrow Cells ; drug effects ; metabolism ; Case-Control Studies ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Hypoxia-Inducible Factor 1, alpha Subunit ; metabolism ; Male ; Middle Aged ; Monocytes ; drug effects ; metabolism ; Myelodysplastic Syndromes ; drug therapy ; metabolism ; Phytotherapy ; Young Adult

Objective To Summary the first 40 cases underwent robotic atrial septal defect (ASD) closure or atrial septal defect closure combined bicuspid valve plasty (TVP) using da Vinci S surgical System on beating heart. Methods 40 cases of atrial septal defect or combined sever tricuspid valve regurgitation were repaired using da Vinic S surgical system on beating heart from March 2009 to December 2010 in cardiovascular department of PLA general hospital. The average age was (38 ± 13) yeas old. 23 cases were female and 17 cases were male. All patients were ostium atrial septal defect with or without pulmonary hypertension. The atrial defect diameter was 1.5 -3.5 cm, and the mean diameter was(2. 8 ±1.3)cm. 9 patients had sever tricuspid valve regurgitation. Without sternotomy, the extracorporeal circulation was established through groin artery,groin vein and internal jugular vein cannulation with the guidance of transeophageal echocardiography. 3 ports of 8 mm and 1 working port of 2 cm were made in the right chest wall. After da Vinci S syetem was set up, with the assistant of bed-side surgeon, the surgeon completed the atrial septal defect closure or combined tricuspid valve plasty in the surgeon console with three dimensions visualization. During the operation, without cardioplegia administrated and aortic occlusion, the procedure was completed through right atriotomy. The pleural space was insufflated with carbon dioxide to avoid the air embolism. The direct suturing was used in 22 cases and pericardial patch were used in 18 cases. 9 patients accepted concurrent De Vega tricuspid valve plasty. The transesophageal echocardiography were used to evaluate the result of atrial defect closure or tricuspid valve repair. The operation time, robotic using time and cardiopulmonary time were compared with totally robotic atrial defect repair in arrested heart. Results All cases were accomplished successfully without complication. There was no residual shunt and air embolism. The operation time, robotic using time and cardiopulmonary time were less than the arrested group. Conclusion Robotic atrial septal defect closure or combined tricuspid valve repair on beating heart can avoid aortic ocllusion and can be utilized effectively and safely.

Objective The aim of this study is to address learning curve and clinical outcomes of totally robotic atrial septal defect repair on the basis of a single - center experience.Methods 54 cases of atrial septal defect (ASD) were repaired using “da Vinic S surgical system on arrested ( group Ⅰ,54 cases) or beating heart ( group Ⅱ,40 cases) from January 2007 to December 2010.Learning curves were assessed by means of regression analysis with logarithmic curve fit.The effect of operative variables on clinical outcome was analyzed by linear by regression using the Spearman's rho coefficient.Results All cases were accomplished successfully without complications.No residual shunt was detected at intraoperative or postoperative echocardiography.Significant learning curves were noted for corss clamp time in group Ⅰ:y (min) =68.741 -8.283 (n) (x)( r2 =0.489 ; P ＜ 0.01 ) ; the operation time in group Ⅱ:y (min) =355.51 - 56.29 (n) (x) ( r2 =0.581 ; P ＜ 0.01 ).No correlation was detected between operation time,cardiopulmonary bypass time,or cross clamp time and intubation time,intensive care unit stay,or total length of stay.Conclusion The robotic atrial septal defect repair can be performed safely.The learning curves is steep and the longer cardiopulmonary bypass times,operation time or cross clamp time had no negative impact on intraoperative and postoperative outcome.

Objective To explore the relationship of the severity of coronary-artery stenosis with plasma levels of brain natriuretic peptide (BNP) and Meprin-α.Methods Totally 237 patients in our hospital were divided into control group (CON group), stable angina group (SA group) and acute coronary syndrome group (ACS group), according to coronary artery angiography.Patients with acute coronary syndrome were divided into 3 subgroups: unstable angina (UA) group, non-ST segment elevation myocardial infarction (NSTEMI) group and ST segment elevation myocardial infarction (STEMI) group.Patients with coronary artery disease (CAD) were divided into 3 subgroups: low-score, medium-score and high-score groups, according to coronary angiography and Syntax score.BNP and Meprin-α levels were determined in patients with coronary artery disease, and the degree of coronary artery stenosis was evaluated.The differences in above indexes were analyzed and compared among the three groups.Results Plasma levels of BNP and Meprin-α were higher in ACS group than in CON group [(233.16± 78.22)ng/L vs.(33.48 ± 13.71)ng/L, (26.89 ± 6.45) nmol/L vs.(12.83±0.66)nmol/L, both P＜0.05].Compared with UA group, plasma levels of BNP and Meprin-α were increased in NSTEMI and STEMI groups (all P＜0.05).Compared with the control group, plasma levels of BNP and Meprin-α in the Syntax scores-divided subgroups were increased (all P＜ 0.05).The plasma levels of BNP and Meprin-α in CAD patients were significantly increased along with the increase of Syntax Score.Spearman correlation analysis showed that low density lipoprotein cholesterol, glucose, BNP and Meprin-α levels had positive correlations with the occurrence of coronary heart disease, while high density lipoprotein level was negatively correlated with the occurrence of coronary heart disease (all P＜0.05).Conclusions BNP and Meprin-α levels in peripheral blood are significantly elevated in patients with coronary heart disease, and they are correlated with Syntax score.The risk of ACS is increased along with the increased BNP and Meprinα levels.

Objective To investigate the effect of selenium on proliferation and apoptosis of chondrocytes of articular cartilage cultured in vitro in Kaschin-Beck disease(KBD) patients and normal person, to explore the role of selenium in control of KBD, and to provide evidence for selenium's effect on the growth of normal cartilage cells. Methods The articular cartilage samples of grade Ⅱ and Ⅲ KBD patients were selected according to the national "Clinical Diagnosis of KBD" (GB 16003-1995). Chondrocytes of 5 KBD and 5 non-endemic normal accidentswere separated and cultured in vitro. KBD group and control group were given different doses of selenium (0,0.0125,0.0250,0.0500,0.1000,0.2500,0.5000,1.0000 mg/L, respectively). Methyl thiazolyl tetrazolium (MTT),flow cytometric analysis, and immunocytochemical staining were used to observe the effect of selenium on cell growth and apoptosis in KBD and normal persons. Results MTT results showed that the cell proliferation rate in each dosage group of the control group at the 6th day(0.086 ± 0.025,0.077 ± 0.012,0.073 ± 0.027,0.071 ± 0.017,0.058 ± 0.028,0.052 ± 0.028 and 0.046 ± 0.037) was significantly lower than that of 0 mg/L group(0.138 ± 0.026,all P ＜ 0.05);the average cell proliferation rate was negative( - 0.001 ± 0.001, - 0.003 ± 0.000, - 0.003 ± 0.001and - 0.004 ± 0.001 ) in 0.1000 - 1.0000 mg/L dose group, which was significantly lower than that of the 0 mg/L group(0.025 ± 0.003, all P ＜ 0.05);compared with 0 mg/L group(0. 115 ± 0.011), the KBD 0.2500 mg/L dose group promoted cell proliferation(0.128 ± 0.037, P ＜ 0.05), the KBD 1.0000 mg/L dose group inhibited cell growth (0.071 ± 0.019, P ＜ 0.05). The apoptotic rate of 0.0500 - 1.0000 mg/L dose control group [ (18.88 ± 0.02)%,(17.58 ± 0.01)%, (17.09 ± 0.04)%, (56.00 ± 0.02)%, (57.85 ± 0.03)% ] were higher than that of the 0 mg/L group[(13.51 ± 0.01)%, all P ＜ 0.05];compared with 0 mg/L group[(25.84 ± 0.02)%], the apoptotic rate in KBD 0.0250 - 0.2500 mg/L dose group [ ( 13.69 ± 0.02) %, ( 15.96 ± 0.03 ) %, ( 16.68 ± 0.03 ) %, ( 16.67 ± 0.02) % ]were lower, and the apoptotic rate in 0.5000, 1.0000 mg/L dose group [ (59.58 ± 0.03)%, (73.48 ± 0.04)% ] were significantly higher(all P ＜ 0.05). The Fas expression in KBD 0.0500 - 0.2500 mg/L dose groups[ (41.2 ± 1.5)%,(40.3 ± 2.0)%, (50.2 ± 2.5)%] were lower than those of the same dose control group with selenium intervention [(52.4 ± 1.0)%, (67.2 ± 4.0)%, (75.1 ± 5.0)%, all P ＜ 0.05], the caspase-3 expression in KBD 0.0500,0.1000 mg/L dose groups[ (40.8 ± 1.1 )%, (45.1 ± 2.1 )%] were lower than those of the same dose control group with selenium intervention[ (68.0 ± 3.0)%, (70.6 ± 3.5)%, all P ＜ 0.05 ]. Conclusions Appropriate dose of selenium supplementation (0.1000 - 0.2500 mg/L) could promote the growth of KBD chondrocyte, decrease cell apoptosis,but have a damage when the dose of selenium ＞ 0.5000 mg/L;doses of selenium that could promote the growth of KBD chondrocyte does not mean to promote the growth of normal cartilage cells in vivo.

Background Though nitric oxide (NO) and NO synthase (NOS) have a critical role in angiogenesis,their effects on corneal neovascularization (CNV) and mechanism need to be further explored.Objective The aim of this study was to explore the effects of NOS and its antagonist,Nw-nitro-L-arginine methyl ester (L-NAME) on experimental CNV in mice,and investigate the influence of NOS and L-NAME on the tube formation of human retinal endothelial cells (RECs) in vitro.Methods The CNV models were established in the left eyes of 36 male BALB/c mice aged 7-8 weeks by application of the filter paper with NaOH in the center of corneas.The mice were randomized into two groups.L-NAME of 10 g/L (0.5 ml) was intraperitoneally injected 1 week before induction of CNV three times a week for three weeks in the mice of the L-NAME injection,and PBS was used in the same way in the control group.CNV was examined under the slit lamp biomicroscope 2,4,7,14 days after NaOH burn.The expression of CD31 in the CNV was assayed to calculate the ratio of CNV area and total corneal area using whole mount technique.The expression of NOS mRNA in the corneal tissue was detected by reverse transcriptase polymerase chain reaction (PCR),and VEGF expression in the human RECs was assayed by Western blot.The vessel formation number of cultured human RECs with or without L-NAME was performed by matrigel in vitro.Grouped t test was used to compare the differences of the parameters between the two groups.Results CNV developed and peaked 2 weeks after the application of NaOH on the mice corneas,and the CNV was obviously less in the L-NAME group compared with the control group.The expression of NOS mRNA in the corneas (NOS mRNA/ GAPDH mRNA)was significantly lower in the L-NAME group than that of the control group 2,4,7 days after CNV induction (t =19.481,t=22.059,t=10.961,all at P＜0.01).The ratio of the CD31 positive area in whole corneal area was 0.59± 0.01 in the L-NAME group,and that of the control group was 0.78±0.10,showing a significant difference between the two groups (t =3.078,P＜0.05).Western blot assay showed that the relative expression of VEGF protein in human RECs was declined in the L-NAME group compared with the control group 0,2,4,7 days,with statistically significant differences in 4 days and 7 days after NaOH burn(t=7.696,t=17.953,both at P＜0.01).The number of vessel network was 46.33±1.86 in the L-NAME group and 64.00±4.51 in the control group,with a significant difference between them (t =3.623,P＜0.05).Conclusions NOS participated in the pathogenesis and aggravation of CNV induced by NaOH.L-NAME arrests CNV formation and human RECs tube formation through down regulating the VEGF expression and NOS activity.

Objective To study the expression and change of neuropeptide substance P (SP) during the wound healing of deep partial thickness scalding in diabetic rats. Methods Eighty-four Wistar rats were randomly divided into diabetes mellitus group (n=42) and control group (n=42). Diabetic rat models were established by intraperitoneal injection of streptozotocin (STZ) in diabetes mellitus group, and those in control group were intraperitoneally injected with aseptic citrate buffer solution. Deep partial thickness scalding with diameter of 2 cm on the back were prepared in all the rats. The pre-scalding and post-scalding wound specimens of different time points were obtained, and the percentages of wound closure were calculated. The wound specimens were also obtained for immunohistological staining to compare the areas with positive staining of SP, and ELISA was employed to detect the expression of SP in the wound tissues. Results The percentage of wound closure was significantly lower in diabetes mellitus group than that in control group from 7 days post-scalding (P< 0.01). The areas with positive staining of SP in diabetes mellitus group were much smaller than those in control group at different time points, which was most significant on the seventh day post-scalding[(1 350.93±99.28) μm2 vs(1 715.86± 103.41) μm2](P < 0.01). The expression of SP in the wound tissues was significantly lower in diabetes mellitus group than that in control group at different time points, which was most significant on the seventh day post-scalding[(114.04±9.96) vs(143.39±8.94)](P<0.01). Conclusion The significantly lower expression of SP in wound site may be one of the causes of delayed wound healing in diabetic rats.

Objective To determine the safety and efficacy of robotic mitral valvereplacement using da Vinci S system.Methods From August 2008 to April 2011, over 400 cases of robotic cardiac surgery have been completed in Chinese PLA general hospital, in which 20 patients with isolated mitral valve stenosis underwent robotic mitral replacement, including 7 male and 13 female patients with a mean age of (44.7 ±9.8) years (ranging from 32 to 65 years). 16 patients had a NYHA class Ⅰ～Ⅱ heart function and 4 patients were NYHA class Ⅲ. Fifteen patients were concomitant with atiral fibrillation. Surgery approach was achieved through 4 right chest ports with femoral perfusion and Chitwood aortic occlusion. Antegrade cold blood cardioplegia was administered directly via chest for myocardial protection. The transesophageal echocardiography was used intraoperatively to estimate the surgical results. Results All patients had successful valve replacement including mechanical and tissue valve replacement. There was no conversion to a median sternotomy. The mean cardiopulmonary bypass and arrested heart time were(137.1 ±21.9) minutes and (99.3 ±17.4) minutes. Echocardiographic follow-up in all patients revealed no complications. Conclusion Robotic mitral valve replacement is safe and efficacious in the patients with isolated mitral valve disease.

Objective To delineate the utility and results of intraoperative transesophageal echocardiography (TEE) in the evaluation of patients undergoing robot-assisted cardiac surgery. Methods Intraoperative TEE was performed in 193 patients undergoing robot-assisted procedures in cardiac surgery over a period of 4 years. (1) Before CPB, a comprehensive TEE was performed to document the lesions and their precise localization. ( 2 ) During establishment of peripheral CPB, a arterial cannula was placed percutaneously into the right internal jugular vein and passed into the superior vena cava; a venous cannula was inserted into the right common femoral vein and passing it into the inferior vena cava with its tip just inferior to the inferior vena cava-right atrium junction; a arterial perfusion cannula was passed into the ascending aorta with its tip approximately 3 cm from the aortic valve under TEE guidance. (3) After weaning from CPB, TEE was performed to evaluate the efficiency of the procedure. Results (1) The concordance with surgical findings concerning the lesions and precise localization was 100% and 98. 8% among all the patients, respectively. (2) All cannulae were located in the correct position. (3) TEE confirmed successful procedures with no concomitant complication in all the patients. Conclusion Intraoperative TEE is a valuable adjunct in the assessment of robot-assisted cardiac surgery.