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.

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 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.

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.

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 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.

BACKGROUND:At present, there are stil differences in the studies of total-etch, self-etch and self-bonding resin cement effect on the coronal microleakage and bonding strength of fiber posts.
OBJECTIVE:To evaluate the coronal microleakage and the bonding strength of fiber posts treated with three kinds of resin cements.
METHODS:Total y 32 upper incisors were randomly divided into five groups, including three experimental groups and two control groups. After the root canal preparation, three kinds of resin cements (EMBRACE WetBond, LuxaCore, Medental Multi-cure) were used to fiber posts with the bond diameter of 1.4 mm. Stereomicroscope was used to observe the microleakage. Then, the specimens were cut into 2 mm wafer along the axis of tooth, and universal testing machine for push-out test was used to observe the failure mode. In the positive control group, no root canal preparation was done, the root was coated with nail polish, and the crown was directly exposed to the dye. In the negative control group, no root canal preparation was done, the root canal orifice was covered with the resin, the tooth was overal coated with nail polish and then embedded 1 mm below the section.
RESULTS AND CONCLUSION:The microleakage was observed in al the three resin cements, Medental Multi-cure showed the least microleakage and LuxaCore showed the largest microleakage, and there was significantly different among the three kinds of resin cements (P<0.05). The bonding strength of three cements had significant differences (P<0.05), and ranked from high to low:Mdental Multi-cure, LuxaCore, and EMBRACE WetBond. The main fracture modes were binder/fiber post fracture and mixed failure. The results suggest that the total-etch resin cement binds tightly with the dentin, and owns a superiority in the microleakage and bonding property as compared with the self-etch resin cements and self-bonding resin cements.

Objective To explore the importance of intraoperatlVe transesophageal echocardlography(TEE) in totally endoscopic atrial septal defect(ASD)repair.Methods Twenty four patients underwent repair of ASD by a totally endoscopic approach，utilizing the da Vinci S robotic system.After induction of general anesthesia and a left-sided double-lumen endotracheal tube was positioned，a TEE probe was inserted.①Before cardiopulmonary bypass(CPB)，TEE examination was conducted to document the types and size of ASD.The procedures were predetermined by the operator according to the TEE diagnosis.②CPB was achieved peripherally.With TEE guidance，a 19-or 21-Fr.femoral venous cannula was inserted into the right common femoral vein and passing it into the inferior vena cava(IVC)，with its tip just inferior to the IVC-right atrium junction；a 15-or 17-Fr.femoral arterial eannula was placed percutaneously into the right internal jugular vein and passed into the superior vena cava(SVC).The bypass circuit was completed by inserting a 14G arterial perfusion cannula into the ascending aorta(AAO)，with its distal tip passing over the center of the AAO，approximately 3 cm from the aortic valve.③ After weaning from CPB，TEE examination was performed again.Results①Surgical confirmation was obtained in all the patients and no operative procedures were changed.②All venous，arterial and arterial perfusion cannula were located in correct position.③In all patients，TEE after weaned from CPB confirmed successful repair.Conclusions Intraoperative TEE is essential for totally endoscopic ASD repair.

Objective To explore the utility of intraoperative transesophageal echocardiography (TEE) in robotic mitral valve repair (MVR) with the da Vinci system. Methods Intraoperative TEE was performed in 24 patients undergoing robotic MVR for severe degenerative mitral regurgitation (MR)between September 2007 and February 2010. Before cardiopulmonary bypass (CPB) ,TEE was performed to document the mechanism and location of degenerative MR. During establishment of peripheral CPB, TEE was used to guide placement of the cannulae in the inferior vena cava (IVC),superior vena cava (SVC),and ascending aorta (AAO). After weaning from CPB, TEE was performed to evaluate the effect of the procedure. Results Accuracy of TEE was 93.1% for the mechanism of degenerative MR, and 98.6% for the localization of the prolapsed leaflets. All the cannulae in the SVC,IVC and AAO were located in correct position. In all patients, TEE confirmed successful repair with no residual insufficiency and no procedurerelated complications. Conclusions In robotic MVR, TEE have important roles as follows: providing the reliable diagnostic information before CPB, guiding placement of the cannulae in the IVC, SVC, and AAO correctly during establishment of peripheral CPB determining the competency of MVR immediately after CPB. TEE is important for robotic MVR.