Objective Background Predicting risk factors for valve replacements is important both for informed consent of patients and objective review of surgical outcomes. Development of reliable prediction rules requires large data sets with ap-propriate risk factors that are available before surgery. Methods Data were from Belling Anzhen Institute of heart, pulmonary and vascular diseases in the period of January 1993 to December 2004. 4482 heart valve replacement patients were analyzed.There. were 848 aortic valve replacements, 2202 mitral valve replacements and 1387 double valve replacements. Logistic regres-sion was used to examine the relationship between risk factors and in-hospital mortality. Results In the multivariable analysis,5 variables in the aortic model (older age, body area, NYHA class IV, creatin, CPB time) , 8 variables in the mitral model ( NYHA class Ⅳ, congestive heart failure, cardiac/thoracic ratio, FS, etiology, LVESD, CPB time, use of IABP) and 7 var-iables in the double valve model (older age, NYHA class Ⅳ, previous myocarditis, diabetes, CPB time, weight index, previ-ous percutaneous mitral balloon valvotomy ) remained independent predictors of the outcome. The mathematical models were highly significant predictors of the in-hospital mortality, and the results were in general agreement with those of others. The area uoder the receiver operating characteristic curve for the aortic model was 0. 921 [ 95% confidence interval ( CI ), 0. 874 to 0. 967 ], for the mitral model was 0. 859 ( 95% CI, 0. 813 to 0. 905 ) aod for dnuhle model was 0. 868 ( 95% CI, 0. 827 to 0.908). The goodness-of-fit statistic for the aortic model was χ~2 = 1.463, P=0.993, for the mitral model was χ~2 = 8.720,P = 0. 366 and for the double valve model was χ~2 = 8 . 134, P = 0. 420. Conclusion We print results and methods for use in day-to-day practice to calculate patient-specific in-hospital mortality after aortic and mitral valve surgery, by the logistic e-quation for each model or a simple scoring system with a look-up table for mortality rate.

Objective To explore the prognostic value of blood aspartate aminotransferase to platelet ratio index(APRI)in patients with hepatocellular carcinoma(HCC)after radical surgical resection. Methods A retro-spective cohort study was conducted to analyze 228 patients with HCC who underwent radical surgical resection. Patients were divided into low APRI group(APRI<1.62)and high APRI group(APRI≥1.62). Patients′clinical and demographic data and overall survival(OS)were statistically analyzed and multivariate analysis was performed to identify prognostic factors. Results APRI was closely related to preoperative serum ALT level,PLT level,the positivity of HBsAg,liver cirrhosis and portal vein tumor thrombus. OS of patients in low APRI group was signifi-cantly better when compared to those with an elevated APRI(P<0.01). Multivariate analysis indicated that preop-erative APRI,maximum size of tumor,number of tumor nodules,portal vein tumor thrombus,TNM and differenti-ation of tumors were independent prognostic factors for HCC(P<0.05). Conclusions Preoperative APRI≥1.62 is an independent prognostic factor of OS for patients with HCC after radical surgical resection.

AIM:To compare the biological characteristics , surface markers and multi-differentiation potential of the mesenchymal stem cells (MSCs) derived from the umbilical cord and bone marrow in the green fluorescent protein (GFP) transgenic mice.METHODS:Umbilical cord MSCs (UCMSCs) were isolated by collagen type II enzymatic diges-tion and bone marrow MSCs ( BMSCs) were isolated by density gradient centrifugation .The growth of the 2 types of MSCs was observed under inverted microscope .The cell proliferation was detected by determining the growth curve and MTT as-say.The Trypan blue method was performed to analyze the cell viability rate .The cell cycle and cell surface markers were measured by flow cytometry .The differentiation potentials of the 2 types of MSCs were tested by the differentiation kits to-ward adipocytes and osteoblasts .RESULTS:The UCMSCs attached to the culture surface 1 d after the isolation , and the cells showed spiral shape with notable growth and proliferation after 2 d of culture.After 3 d, the cell arrived sub-confluent and was ready for passage .BMSCs still showed circular shape and started to attach to the surface 4 d after culture .They formed the small colony shape only after 5 d with obvious proliferative potential .The cells became confluent 7 d after the culture.The original generation of cultivating UCMSCs growth curve was shown typically an “S” shape.But the BMSCs growth was slower than the UCMSCs .The cell proliferation was obvious for UC-MSCs in 3~5 d.BMSCs proliferated signif-icantly only after 7 d.The viability rate arrived more than 96%for both types of MSCs .The cell cycle of both MSCs did not show significant difference (G0/G1 phases were above 85%, P>0.05).Both MSCs positively expressed CD44, CD90 and CD105 (60.7%±2.3%) but the expression of CD45, CD19, CD14 and CD79 was negative (less than 25.6%±4.8%, P>0.05).More than 90%of the MSCs from the umbilical cord and bone marrow differentiated towards the adipocytes and osteoblasts without significant difference (P<0.05).CONCLUSION:UCMSCs have stronger ability of proliferation and multi-directional differentiation potentials .UCMSCs in GFP transgenic mice as a high-quality tracer can serve for tracking the stem cells in vivo.

Objective To analysis of risk factors for left atrial thrombosis in patients with rheumatic mitral stenosis.Methods From January 2001 to December 2008, 2277 patients with rheumatic mitral stenosis underwent operations in our hospital. There were 737 males and 1540 female, the age ranged from 19 to 84 years [average (50.9 ±10.2) years]. Left atrial thrombosis group (554 cases) and no thrombosis group (1723 cases) were divided, retrospectively collected data were analyzed with univariate and multivariate Logistic regression. Results 12 bvariables, including age, mitral valve orifice area, left atrial diameter, left ventricular diastole diameter, CRP, gender , degree of mitral stenosis, or regurgitation, degree of bicuspid regurgitation, degree of pulmonary hypertension, atrial fibrillation and heart function had statistic difference between two groups. With multivariate Logistic regression for these 12 factors, age, mitral valve orifice area, left atrial diameter, degree of mitral regurgitation and atrial fibrillation were found to be the affecting factors for left atrial thrombosis in patients with rheumatic mitral stenosis. Conclusion For patients with rheumatic mitral stenosis, age, mitral valve orifice area, left atrial diameter and atrial fibrillation are the risk factors for left atrial thrombosis. Mitral regurgitation is a protective factor for left atrial thrombosis.

Objective The optimal treatment for chronic type B dissection remains controversial. The purpose of this study was to report early and mid-term results of thoracic endovascular aortic repair (TEVAR) of chronic type B aortic dissection. Methods Methods From June 2001 to September 2007, 84 patients with chronic type B aortic dissection received TEVAR. The time between onset of dissection and TEVAR was (13.9 ± 22.0) months (ranged 1 - 120 months). All patients were followed for 6 - 86 months [mean (33.2 ± 19.2) months]. Results The entry tear was completely sealed in 77 cases ( 91.7% ) during TEVAR. The incidence of incomplete seal was 8.3%. One-month mortality was 1. 2%. One patient had retrograde type A dissection 1 month after operation. Four patients received a second TEVAR during follow-up :3 for endoleaking and 1 for newly formed intima tear. Seven patients (8.3%) died during follow-up: 3 thoracic aorta rupture due to endoleaking, 1 abdominal aorta rupture caused by continuous dilation of the abdominal aorta, unrelated to aortic dissection deaths in 2 and 1 died of unknown cause. The Kaplan Meier actuarial survival curve showed a 7-year survival rate of 84.4%. Conclusion Early and mid-term results showed that TEVAR was effective in treating chronic type B aortic dissection. Endoleak was the main cause of death during follow-up. With increasing of physician's experience and refinement of the stent-graft, results are likely to improve in the future.

Objective To evaluate the treatment effect and security of transcatheter arterial chemoembolization(TACE)combined with sorafinib for intermediate-advanced hepatocellular carcinoma.Methods From July 2008 to November 2010,the treatment effects of two groups of patients with advanced hepatocellular carcinoma were retrospectively analyzed and compared,including 44 patients treated by sorafenib combined with TACE(test group)and the other 44 patients treated only with TACE(control group).To assess the treatment effect based on mRECIST,the time for patients' tumor progression(TTP),overall survival(OS)time and adverse events were recorded.Survival rate were analyzed using KaplanMeier method and Log-rank analysis in SPSS 18.0.Results Till January 2011,24 patients(54.5％)survived and 20 patients(include patients lost to visit)died(45.5％)among the test group,13 patients survived(29.5 ％)and 31 patients(include patients lost to visit)died(70.5 ％)among the control group.No complete remission condition was observed in all patients.Among the test group,1 patient got partial remission,24 ones remain stable and 19 patients got progression.While among the control group,conditions remained stable in 21 patients and progressed in rest 23 ones.The disease control rate(DCR)in the test group and control group were 56.8％(25/44)and 47.7％(21/44)respectively,with no statistical significance(x2 =0.729,P =0.393).The median overall survival time(mOS)of test group and control group were 21.0(95 ％ CI:14.9-27.1)months and 10.0(95 ％ CI:6.4-13.6)months respectively,and the difference reached statistical significance(x2 =7.436,P =0.006).The median time to tumor progression(mTTP)of test group and control group was 1 1.0(95％ CI:8.7-13.3)and 6.0(95％ CI:3.9-8.1)months respectively,and the difference had statistical significance(x2 =10.437,P =0.001).The adverse events of test group mainly included hand-foot skin reaction,loss of appetite,fever,fatigue and diarrhea.The adverse events of control group mainly included fever,loss of appetite,nausea,vomiting and fatigue.The incidences of hand-foot skin reaction,baldness,diarrhea were significantly higher in test group than those in the control group(P ＜0.05).In most patients,these side effects were mild-to-moderate,and alleviated remarkablely after symptomatic treatment.Conclusions Compared with TACE alone,TACE combined with sorafenib can prolong the OS and TTP significantly for the patients with intermediate-advanced hepatocellular carcinoma.However,the DCR of the two groups has no statistical significance.

Objective:To prepare nanosilver-hybridized polylactic acid-glycolic acid copolymer (PLGA) microspheres loaded with simvastatin (SIM), and to evaluate its sustained release effect in vitro. Methods:The emulsification-solvent evaporation method was used to prepare SIM-loaded PLGA microspheres. Silk fibroin (SF) was used to modify the surface of SIM-loaded PLGA microspheres by hydrophobic interaction. Then, the microspheres were continually modified by electrostatic adsorption to chitosan (CTS) and nano-silver (AgNPs) to prepare SF-AgNPs-CTS-SF-SIM-PLGA microspheres. Scanning electron microscope, Fourier transform infrared spectrometer, energy spectrometer, Zeta potential meter were used to analyze the SIM-loaded microspheres. The external release properties of the SIM-loaded microspheres were also investigated.Results:The average diameter of the prepared PLGA microspheres was about 9.67 μm. The results of Fourier transform infrared spectroscopy and energy spectroscopy showed that the AgNPs-CTS-SF-SIM-PLGA microspheres have been successfully constructed. The Zeta potential results indicated that the SIM-loaded microspheres were all in a stable state. The in vitro release results showed that the SF-AgNPs-CTS-SF-SIM-PLGA microspheres had a good in vitro release effect, could delay the drug release rate and prolong the drug release time. Conclusions:The SF-AgNPs-CTS-SF-SIM-PLGA microspheres have antibacterial and osteogenic effects, and exhibit a good in vitro release effect. They can be used for local sustained-release administration in the oral cavity, which make makes them potentially useful in the treatment of periodontitis.