From January 1954 to December 1991, 348 cases of chest trauma caused by traffic accident were treated, with multiple injury in 219 cases. There were 8 deaths and the mortality was 2.6%. Injury Severity Score (ISS) and a lethal dose for 50% of the patients (LD_(50)) were used to analyse the correlation between total injury severity and mortality. The clinical characteristics and some problems in diagnosis and treatment of these patients were discussed. The authors stressed that (1) to shorten the time elapsed from admission to the efficient freatment started was the key of decreasing mortality, (2) ISS and LD_(50) were useful tools in retrospective study of the correlation between injury severity and mortality, But further researches were needed.

Objective: To study the mechanisms and treatment of ischemia/reperfusion injury. Expression of E selectin was measured and the effect on suppression of E selectin by the Pyrrolidine Dithiocarbamate was investigated. Methods: Endothelial cells were exposed to hypoxia, then returned to reoxygenation condition. ELISA methods were used to detect expression of E selectin. Results: E selectin expression on hypoxia/reoxygenation stimulated endothelial cells increased, PDTC could suppress translation of E selectin effectively. Conclusion: It seems that E selectin may act as a critical factor. PDTC may prove beneficial in the treatment of ischemia/reperfusion injury.

Objective To compare the clinical features and severity of penetrating thoracoabdominal combined injuries (TACI) and thoracoabdominal multiple injuries (TAMI) so as to guide the diagnosis and management of trauma. Methods A total of 251 cases of penetrating chest trauma complicated by abdominal trauma were reviewed and divided into 2 groups. Group TACI (177 cases) was associated with diaphragmatic rupture but Group TAMI (74 cases) not. The injury features and the clinical characteristics of both groups were analyzed and the trauma severity of 2 groups evaluated by trauma score system. Results The pre-hospital time and the revised trauma score (RTS1) on admission were (1.86?2.27) hours and 6.45?1.64 respectively in the Group TACI, and (2.81?3.98) hours and 6.97?1.18 respectively in the Group TAMI ( P 0.05 ). TACI was easily complicated by injuries of vital organs such as the heart, the thoracic or the abdominal great vessel, the liver and the spleen. TACI was usually very serious and developed quickly. The overall mortality was 7.2% (18/251) of all the cases. The mortality was significantly higher in Group TACI (9.0%, 16/177) than that in Group TAMI (2.7%, 2/74) ( P

Twenty patients who suffered from RHD and CHF were randomly divided into the test group (n=12) and the control group (n = 8). Captopril was given orally before and after operation only in the test group. The results showed that the plasma level of ANF declined obviously in the test group. This may illustrate that the therapeutic effect of the captopril on the failing heart can be exerted by suppressing the secretion of ANF. The data also suggest that captopril might have some inhibitory effect on the reactions to the in-traoperative stress.

Objective Recent.studies have found a strong association of insulin resistance, which might occur during ischemia reperfusion in vitro in the experimental dogs, with disturbed function of cardiomyocytes. Obvious acute insulin resistance, along with glucose dysmetabolism in the reperfused cardiomyocytes, was furher observed in the study performed with ischemia-reperfused ventric- ular myocytes of rats. We tried to investigate preliminarily the molecular mechanisms of insulin resistance in the cardiomyocytes after ischemia reperfusion. Methods An experimental model of insulin-stimulated ischemia reperfusion (SI/R) was created by isolating cardiomyocytes from adult rats. Glucose uptake of the cardiomyoctyes was evaluated with isotope-labeling technique. Glucose trans- porter 4 (GLUT4) translocation induced by insulin was investigated with Western blot analysis, and the intracellular level of free Ca2+ ([Ca2+]I) was measured quantitatively with Ca2+ indicator Fura-2. Results Insulin can stimulated glucose uptake by cardiomyo- cytes, indicating that these cells were insulin-sensitive. Cardiomyocytes were demonstrated notable acute insulin resistmce during reperfusion. Insulin-stimulated GLUT4 translocation in the cardiomyocytes 15 minutes after reperfusion was 72.2% of that in the con- trol group(P<0.05), in which the GLUT4 content in plasma membrane remained unchanged. The finding suggested that a disturbed GLUT4 translocation might happen in the cardiomyocytes during insulin-stimulated ischemia-reperfusion. Calcium overload was identi- fied in the cardiomyocytes with ischemia reperfusion. At 15 minutes of reperfusion, [Ca2+]I was significantly higher in the reperfused cardiomyocytes than that in the control cardiomyocytes[(318.66±23.06)vs(130.70±0.82) nmol/L, P<0.05], and kept at a higher level [(177.79±17.46) nmol/L] at 60 minutes of reperfusion (P<0.05, vs control). Partial correlation analysis revealed a negative correlation of[Ca2+]I with insulin-induced ghcose uptake in the cardiomyoctyes (r = -0.557,P=0.006). Conclusion Disturbed GLUT4 translocation and decreased intrinsic activity may be important molecular mechanisms for the development of insulin resistance in the cardiomyocytes of rat during insulin-simulated ischemia reperfusion,. [Ca2+]I overload may account for the de- creased intrinsic activity d GLUT4.

Objective To evaluate the method of low-intensity anticoagulation therapy in the pregnant women who had received mechanical heart valve replacemant, and the effects of warfarin on the pregnant women and their fetus. Methods This retrospective study involved 56 pregnant women( 61 pregnancies)who had received mechanical heart valve replacement.Their pregnant status, delivery, and anticoagulation therapy were observed and followed-up between May 1986 and November 2009 at West China Hospital of Sichuan University. Results All patients took oral anticoagulant (warfarin) throughout pregnancy. The dose of domestic warfarin was ( 3.02 ± 0.85 ) mg/d ( in 42 cases), and the dose of imported warfarin was (2.84 ± 0.57 )mg/d (in 14 cases). The mean INR value of 401 samples from patients was 1.67 ±0.58. No thromboembolism or major hemorrhagic complications occurred. Minor bleeding occurred in 11 pregnancies. Forty-seven patients had term delivery, 7 had premature birth, 6 had spontaneous abortion, and 1 had intrauterine fetal death. Six newborns were born with low birth weight (2.3 ± 0. 5 ) kg, and no abnormal fetus was observed. Conclusion The low-intensity anticoagulation therapy with warfarin (at a dose of less than 5 mg/d) and a INR target of 1.5 to 2.0 was safe and convenient for the pregnant women,who had received mechanical heart valve replacement. The abnormalities rate of fetus was low.

Objiective To evaluate the effect of pearventricular device closure of non-muscular ventricular defercts(VSDs) in infants.Methods From April 2007 to February 2008,39 patients with non-muscular VSDs were received off pump surgical treatment,perventricular device closure were for all the patients.There were 16 males and 23 females with mean age of(14.5±7.8) months(12 to 36 months and mean weight of(12.4±2.3)kg(8.5 to 18.0 kg).There were 34 perimembranous and 5 subateria VSD.The diameter of defects were 3.0 to 11 mm[mean(6.1±2.0)mm].Results Thirty-seven(94.9%)VSDs ere successfully closed,while two were repaired under cardiopulmonary bypass(CPB)instead of device closure because of the complication of moderat aortic reurgitation.The diameter of occluders were 4 to 12mm[mean(8.2±2.0)mm].The tricuspid regurgitations decareasded after operation in 3 patients with perimenmbranous VSDs,while the closure caused new mild or trace tricuspid regurgitations in 8 patients.Six patients with perimembranours VSDs acquired the incomplete right bundle branch blocks affter device closure.The length of hospital stay was 3 to 5 days[mean(3.4±0.4)]after operation and no petient had blood transfusion.Conclustion Perventricular device closure is probably an effective and safe treatment for non-muscular VSDs in unfants.

0.05,vs control).Insulin stimulated glucose transport into cardiomyocytes in a dose-dependent fashion.Glucose uptake stimulated by insulin into cardiomyocytes was both decreased significantly in 15 mins reperfusian group and in 60 mins reperfusion group (P

Valve replacement represents the most common surgical therapy for valvular heart diseases. However, the long-term results of the valve protheses in clinical use are not satisfying. Recently, with the development of tissue engineering, more and more studies are focusing on creating ideal valve substitutes through seeding autologous cells on biodegradable scaffold. This article describes the definition of valvular tissue engineering, the choice of scaffold biomaterials, the methods of cell culture and seeding, and the evaluation of tissue-engineered heart valves. Furthermore, the problems which should be resolved in the future are also presented in the article.
Animals ; Bioartificial Organs ; Biocompatible Materials ; Biodegradation, Environmental ; Cells, Cultured ; Heart Valve Prosthesis ; Polymers ; Tissue Engineering

This study was intended to enhance the resistance of cultured endothelial cells (EC) to fluid shear stress and clarify the possible mechanism.A modified parallel plate flow apparatus was used to compare the strength between the grafts and the endothelial cells under shear stress condition and static condition. The dynamic change of cytoskeletal actin filaments and the effects of different adhesive proteins coated on the strength of EC adhesion to the glass were studied. The results showed that the number of cells retention of the shear stress-conditioned group was significantly larger than that of the static group. Precoated fibronectin and laminin significantly promoted the adherence of the EC cultured in a steady environment but seemed to have no effect on the EC cultured under flow condition. The results suggest that the vascular endothelial cell cytoskeleton, stress fiber and the shape of EC reorganize in response to long term fluid-imposed shear stress, and the endothelial cells become tightly adherent to the grafts.