Chest wall resection and reconstruction remains a severe challenge for reconstructive surgeons,which often leads to conservative treatment regimens in clinical practice,consequently resulting in poor outcomes(high morbidity and mortality).In recent 20 years,advances in muscle flap surgery and availability of chest reconstructive prosthesis have encouraged the surgeons to take an active attitude toward chest wall resection;many "unresectable" lesions now have a chance to be resected and cured.This article reviews the problems concerning the principles for chest wall resection,reconstruction,prosthesis selection,etc.in chest wall reconstruction.

The deepening of our understanding on the cardiac electrophysiology mechanism and the progress on cell transplantation technique have expanded our view in treating various kinds of cardiac diseases. Over the past few years literatures have reported many kinds of cell transplantation techniques for treating various types of bradyarrhythmias, such as complete heart block and sinoatrial node dysfunction, and impressive achievements have been made by far. This review discusses the advantages and flaws of the existing strategies and the future of biological pacemakers.

Valvular disease is a commonly seen heart disorder,valve replacement is an effective approach to treat valve disorders.Both the mechanic valves and bioprosthesis used now have their own defects,making it important for the cardio surgery field to develop some kind of ideal valves.With the development of tissue engineering techniques,the tissue engineering valves are thought to have great potential and bright clinical future,and now it has become a hot point in cardiac surgery.This article is to evaluate the frame materials,resource of tissue cells and implantation, in vitro pre adaptation testing and in vivo animal experiment results,and the existing problems are pointed out in the present study.

Objective To investigate the long-term morphologic and functional changes of the tricuspid valve after mitral valve replacement. Methods The tricuspid valve function was evaluated by Doppler echocardiography in 903 patients who underwent mitral valve replacement during recent 10 years. Tricuspid regurgitation and annular dilatation in various degrees were found in all patients preoperatively. 686 patients underwent Kay annuloplasty or DeVega annuloplasty, 106 patients underwent tricuspid ring annuloplasty, and 201 untreated. Results Among 201 patients who did not undergo tricuspid annuloplasty, severe tricuspid regurgitation developed in 46 during 2 to 3 years follow-up. One out of 16 patients who underwent tricuspid ring annuloplasty developed moderate tricuspid regurgitation 2 years after operation. Of 686 patients who underwent Kay annuloplasty or DeVega annuloplasty, 150 developed moderate or severe tricuspid regurgitation during 3~5 years after operation. Conclusion Tricuspid annular dilatation, right heart impairment and severe pulmonary hypertension are responsible for the development of late tricuspid regurgitation after mitral valve replacement. For the patient who underwent mitral valve replacement ,tricuspid annuloplasty should be performed when annular dilatation was found, even without tricuspid regurgitation and tricuspid ring annuloplasty should be performed in patient with severe tricuspid regurgitation and obvious tricuspid annular dilatation.

Objective To investigate the effect of penehyclidine hydrochloride combined with low tidal volume ventilation on lung function in patients with lower abdominal operation.Methods Sixty elderly patients who underwent elective lower abdominal operation were divided into three groups by random digits table method:the conventional tidal volume group (group A),penehyclidine hydrochloride combined with conventional tidal volume group (group B) and penehyclidine hydrochloride combined with low tidal volume group (group C),20 cases in each group.The patients in group B and group C were given penehyclidine hydrochloride 0.01 mg/kg before induction of anesthesia.The patients in group A were given equal volume of saline.After induction of anesthesia and mechanical ventilation modes:the patients in group A and group B were given tidal volume 10 ml/kg,the patients in group C were given tidal volume 6 ml/kg.After mechanical ventilation in anesthetized (T1),1 h after anesthesia (T2),2 h after anesthesia (T3),8 h after anesthesia (T4),24 h after anesthesia (T5),the level of tumor necrosis factor alpha (TNF-α),interleukin-6 (IL-6),pH,arterial partial pressure of oxygen (PaO2),arterial partial pressure of carbon dioxide (PaCO2),the calculation of oxygenation index (PaO2/FiO2) were measured and compared.The pulmonary complications after operation 1 day were recorded.Results The level of TNF-α,IL-6 in three patients at T1 had no significant difference (P ＞ 0.05).The level of TNF-α,IL-6 at T2-5 in group C were significantly lower than those in group A and group B (P ＜ 0.05).Compared with group A and group B,the level of PaO2 and PaO2/FiO2 at T2-5 were increased in group C (P ＜ 0.05).None pulmonary complications were occurred in three groups.Conclusions Penehyclidine hydrochloride combined with low tidal volume ventilation may improve arterial oxygen in patients with lower abdominal operation,reduce the lung injury induced by mechanical ventilation,protective effect on lung function.

Objective To describe the mastery of knowledge about antihypertensive drugs of clinical nurses in one tertiary comprehensive hospital of Beijing.Methods Purposive sampling was used to recruit 195 clinical nurses who were working in one tertiary comprehensive hospital in Beijing.The demographic questionnaire,knowledge of antihypertensive drugs questionnaire were filled.Results The score of knowledge of antihypertensive drugs Questionnaire was (45.63 ± 3.79) points;different education,wishes to take part in hypertension related knowledge training had significant differences (t =2.007,2.049,P ＜ 0.05).Conclusion Knowledge of antihypertensive drugs of clinical nurses in Beijing was at medium level.Those who indicated that it was not matter whether to attend hypertension related knowledge training and had low level of education had more problems in knowledge of antihypertensive drugs.

Objective To design and prepare a new prosthesis of chest wall by selecting and integrating the appropriate biodegradable materials,and to evaluate the efficiency and safety of the prepared prosthesis in order to explore the feasibility of reconstruction of an extensive chest wall defect.Methods Three types of chest wall prostheses,polydioxanone(PDO)mesh,chitin fiber reinforced polycaprolactone(CFRP)plate and CFRP strip,were designed and prepared to fulfill the function of chest wall.A canine model of the chest wall resection and reconstruction was reproduced to evaluate these porstheses.15 adult mongrel dogs were subjected to extensive resection of anterior-lateral chest wall and reconstruction with chest wall prosthesis.Chest wall stability,the degradative process of the prosthetic materials and regeneration of the chest wall tissue postoperatively were recorded dynamically by macroscopic inspection and histopathologic examinations,so as to provide valuable scientific data for improving chest wall prosthesis.Results The implanted PDO mesh was well integrated with autogenous connective tissue 8 weeks after operation,degraded gradually and reabsorbed completely within 24 weeks.It provided adequate support to the chest wall and achieved satisfy cosmetic and functional repair.CFRP plate was the best in chest wall stabilization among the three groups,and paradoxical respiratory movement was efficiently relieved with CFRP rib,and it had a better biological compatibility.There was no obvious morphological change in the CFRP material after it was implanted for 24 weeks.Conclusion The synthetic prostheses developed here showed excellent biocompatibility,and they fulfilled the function in providing chest wall stabilization.Each prosthesis has its respective favorable properties in chest wall reconstruction,and all of them are valuable in clinic application in the management of complicated chest wall defects.

Surgical outcome of 188 patients with coronary artery disease was analized. 132 of them were male and 56 female (mean age 60 3 yrs).Fifty six patients had acute or post MI, 46 diabetes, 14 renal dysfunction, 26 stroke, 21 valve disease, 7 left ventricular aneurysm, and 1 type I dissecting aneurysm. Cardioplegia was used in 104 patients, intermittent aortic cross clamping in 59, OPCAB in 25, average number of graftings was 2 7 per patient. Concomitant procedures included 8 MVR or MVP, 4 AVR, 9 DVR and 1 Bentall′s procedure. Total early mortality was 5 9%, but the mortality decreased to 3 2% in 124 patients undergone CABG since Jan, 2000. Late death occurred in 2, recurrence of chest pain in 4 patients in 2 to 5 yrs postoperatively. Improved surgical techniques and perioperative management were the main factors reducing early mortality. Timing of operation, respiratory management, prevention of digestive track bleeding, and postoperative rehabilitation, should be emphasized.

With the development of tissue engineering technology .tissue engineering of heart valve by seeding cells and scaffolds has become a hot issue in valve surgery. In this article we reviewed the selection of scaffold. acquirement and culture of seeding cells, in vitro pre-condition and in vivo experiment. The questions need to be resolved in the future study is also put forward.

Objective To elucidate the effect of ischemic preconditioning(IPC)on regional fluidity of myocardial cell membrane during cardiopulmonary bypass (CPB). Methods Seventy-five felines were randomized into three groups: Group A (CPB group,n =25),in which CPB was conducted without aortic cross-clamping (ACC);Group B (IR group,n =25),with 60min ACC followed by 60min reperfusion,and cardioplegia used during period of ACC;Group C (IPC group,n =25),with protocol similar to that of group B except for three-cycle IPC applied before ACC. Electron spin resonance (ESR) technique was employed to monitor membrane regional fluidity of cardiomyocyte during CPB in all groups. Results Regional fluidity of myocardial cell membrane kept unchanged in CPB group and markedly decreased during ACC and reperfusion periods in IR group. Though the regional fluidity of myocardial cell membrane during ACC and reperfusion periods in IPC group was slightly decreased compared to CPB group,it was significantly higher than that in IR group. Conlusion IPC can protect myocardial cells from ischemia and reperfusion injury by maintaining the fluidity of myocardial membrane during CPB.