Objective To investigate the clinical significance of thoracoscopy combined with beating-heart technique to provide a certain reference for selecting clinical operation mode.Methods Forty patients with chronic rheumatic mitral stenosis receiving thoracoscopic mitral valve replacement surgery in the cardiothoracic surgery department of our hospital from September 2012 to September 2015 were included in this study and divided into the experimental group(beating-heart group,20 cases) and control group(arrested heart group,20 cases).The operative time,CPB time,enzymology indicators,RI and operative complications were analyzed and compared between the two groups.Results One case in each group died of postoperative low cardiac output syndrome.Other cases successfully completed the operation without serious operative complications such as low cardiac output syndrome,serious cardiac arrhythmia and air embolism.Two groups had no statistically significant difference in the operation time and time of CPB (P＞0.05),but the ICU staying duration had statistical difference between the two groups(P＜0.05).The levels of CK-MB,cTnI,LDH,TNF-α,IL-6,IL-8 and RI were significantly increased in two groups(P＜0.05),while the levels in the experimental group were significantly lower than those in the control group(P＜0.05).Conclusion Thoracoscopic mitral valve replacement operation with beating-heart may have better protection effect on heart and lung than thoracoscopic arrested-heart mitral valve replacement operation.

BACKGROUND:The treatment of severe rigid idiopathic scoliosis is the difficulty of clinical treatment. The studies in recent years have shown that the three-stage correction is a safe and effective treatment method. OBJECTIVE:To explore the efficacy of three-stage correction in the treatment of severe rigid scoliosis. METHODS:Retrospective analysis was performed on 10 severe rigid scoliosis patients undergoing three-stage correction, the mean age of the patients was 12 years. The average Cobb angle in the coronal plane was 140° (ranged 110°-180°), the average Cobb angle in the sagittal plane was 75° (ranged 50°-100°). The treatment was divided three stages:anterior release, Halo-plevic traction and third step with posterior osteotomy and fixation. RESULTS AND CONCLUSION:Al of the patients underwent the surgery safely without severe complications. After anterior release and Halo-plevic traction, the Cobb angle in the coronal plane was 90°, and the mean correction rate was 35.7%;the Cobb angle in the sagittal plane was 50° with correction rate of 33.3%. The mean Cobb angle in the coronal plane was 40° with the correction rate of 71.4%after osteotomy, and the Cobb angle in the sagittal plane was 35° with the correction rate of 53.3%. The results show that three-stage correction is a safe and effective method for the treatment of severe rigid scoliosis.

OBJECTIVE To investigate the develop mental toxicity of muscone to embryos. METHODS With zebrafish embryos as a model,The 3 h post fertilization (hpf)embryos were exposed to muscone at 5,10,20,40,80 and 160 μmol·L -1 culture solutions for 96 h and inspected daily with mi-croscopy for larval morphology.The drug solution was replaced every 24 h.Spontaneous move ments were checked at 24 hpf.Heart rate at 48 hpf,hatching rate,e mbryo deformity rate and mortality rate were evaluated.The expression of sepn1 was determined with real-ti me quantitative PCR technique at 96 hpf.RESULTS The 24 hpf spontaneous move ments showed no significant difference.At 48 hpf, spine curvature,pericardial ede ma,yolk sac ede ma,and abnormal swi mming were observed.In addition, the 48 hpf heart beats(10 s)was decreased fro m 26.5 ±1 .0 to 18.0 ±1 .9(P <0.01 ).At 48 hpf , hatching rate of 5 ~40 μmol·L -1 decreased(P <0.05),while of 160 μmol·L -1 increased (P <0.05) co mpared with muscone 0 μmol·L -1 .Muscone had little effect on hatching rate at other ti me points;Mal-formation rate and mortality rate at higher concentrations were up to 100%.The sepn1 gene expression at 96 hpf in the exposure groups decreased co mpared with that of control group(P <0.01 ).CONCLU-SION Muscone had toxic effects on the develop ment of zebrafish embryos,including spine curvature, abnormal swi mming,and pericardial ede ma.These effects may be related to the inhibition of sepn1 gene expression by muscone.

Objective To explore a simple and effective operative procedure for treatment of pa-tellar fractures.Methods The clinical data of 108 patients (including 76 males and 32 females) with patellar fractures were analyzed.The age of the patients ranged from 18 years to 82 years.There were 67 patellar fractures on the right extremities and 41 on the left.Fracture types included transfractures in 43 patients, comminuted fractures in 54, torn fractures in eight and longitudinal fractures in three.Period from injury to operation ranged from 3 hours to 10 days.During operation, the broken patella was exposed for reduction and temporary pliers fixation;then, a five-pointed star woven with two absorbable sutures was placed on the broken patella, two semi-circular sutures around the patellar edge were made with su-tures which were through five points of the five-pointed star.When two sutures were pulled and knotted,the five-pointed star was also stretched to fix the patellar fractures firmly.Models of transverse patellar fractures were made in 20 knee joints of catties, which were divided into two groups randomly.Patellar fractures in Group A were fixed with five-pointed star lattice sutures and those in Group B with AO inten-sion bands.Loading test was performed on quadriceps femoris with materials test system for measuring the width of each fractured patella after the test.Results All patients were followed up for 6-60 months (mean 20 months) , which showed that all patellar fractures were healed.According to Bostman scoring system, the efficacy was excellent in 76 patients and good in 32.The experiment showed no statistical difference in the fracture disjunction distance between two methods (P > 0.05).Conclusion For treatment of patellar fractures, five-pointed star lattice sutures have the advantages of simple operation,reliable fixation, early postoperative exercise, fast recovery, satisfactory outcome and free need of reoper-ation for removing internal fixation.

Objective To establish an animal model of SM by equal toxicity dose(1LD50)-induced acute pulmonary injury in rats and compare the differences of inflammatory factor and protein expression. Methods Rats were randomly divided into five groups. ELISA and immunohistochemical methods were measured. Results Serum INF-γ and IL-23 levels in the intraperitoneal SM group were increased compared with the tracheal SM group;there were also significant differences in serum IL-4 levels between the two groups. In the alveolar septum , the positive expression ratios of NF-Kβ1,NF-Kβp65,ERK,JNK,and p38MAPK in the intraperitoneal SM group were increased compared with the tracheal SM group. Conclusion Using SM (1LD50),There are significantly higher serum inflammatory factor levels and protein-related expression in the alveolar septum of rats intraperitoneally injected with SM compared with those administered SM by intratracheal instillation. The results suggest that pulmonary inflammatory reactions associated with SM are dependent on the route of exposure.