0.05).Right Group had lower incidence of pigeon chest compared with that of Median Group [0 vs.1.6%,?2=413.041,P=0.000].The scores of TACQOL questionnaire of Right Group were higher than that of Median Group in the domains "Physical Complaints" [(29.6?2.8) vs.(28.1?3.0),t=4.843,P=0.000],"Motor Functioning" [(31.2?1.1) vs.(30.5?1.6),t=5.139,P=0.000] and "Cognitive Functioning" [(29.9?3.2) vs.(26.9?4.2),t=7.902,P=0.000].Conclusions The repair surgery of ventricular septal defects through a shorter right lateral thoracotomy can provide superior early and late outcomes and better health-related quality of life for pediatric patients.

Objective:To explore the clinical effect of different surgical methods combined with Neoadjuvant chemotherapy in treating patients with breast cancer.Methods:80 patients treated and diagnosed in our hospital from January,2012 to January,2014 were enrolled in the present study.According to the willingness,physical condition and financial situation,they were divided them into group A (23 cases) and group B (57 cases).Neoadjuvant chemotherapy of EC regimens (epirubicin+cyclophosphamide) was applied to both groups,on the basis of which,group A received breast-conserving surgery,group B received modified radical mastectomy.The clinical effect,breast cosmetic result,life quality,psychological states were compared in both groups.Results:The operation time,extubation time were significantly shorter than those of group B (p ＜0.05),the amount of bleeding,AMA,HRSD score,occurrence rate of complications in group A were significantly lower than those of group B (p＜0.05),the breast cosmetic result of group A was obviously better than that of group B (p＜0.05),and the QLQ-BR23 score in group A was significantly higher than that of group B (p＜0.05).The 2-year survival rate and 2 year recurrence rate showed no statistical difference between the two groups (p ＞0.05).Conclusion:Breast-conserving surgery combined with epirubicin neoadjuvant chemotherapy was effective in treating breast cancer,which could decrease the complications,improve the breast cosmetic result and quality of life.

ObjectiveAnalyze the results of distal aortic reoperation in Marfan syndrome patients after proximal aortic surgery.MethodsBetween January 2000 and January 2010, 28 Marfan patients underwent surgical repair of distal aortic disease after aortic root surgery at our institution.There were 20 males and 8 females.Age ranged from 23 to 52 years [ mean (38.5 ± 8.7) years ].First time operations were Bentall procedure in 24, David procedure in 4.There were 8 cases of Stanford A dissection and 20 cases of aortic root aneurysm.The second time operations included 1 partial aortic arch replacement, 2 total arch replacements, 7 total arch replacements combined with stent elephant trunk, 6 descending thoracic aorta replacements,10 thoracoabdominal aorta replacements and 2 total aorta replacements.The interval between the lst and 2nd operation was 1 to 12 years [mean (6.43 ±3.07) years].The surgical technique used for distal procedures was dependent on the pathology of the aorta.Median repeat sternotomy was used for surgical exposure in 10 patients, who required an arch/proximal descending aortic procedure.Cardiopulmonary bypass (CPB) was established through the right axillary perfusion and right femoral venous drainage in all of these patients.16 patients were operated on through a left-sided incision, namely, a posterolateral thoracotomy, or a thoracoabdominal incision, depending on the distal extent of aortic replacement.For such patients, the left femoral vessels were cannulated for CPB in 14 patients and the rest 2 patients were operated on without CPB.Two patients with total aorta replacement were operated on through a median sternotomy combined with thoracoabdominal incision.22 patients underwent deep hypothermic circulatory arrest because of the replacement of anrtic arch or the extensive aneurismal arch.Reconstruction of intercostal arteries (T8-L1) was performed in 16 patients for the protection of spinal cord.ResultsTwo patients (7.1％) died postoperatively.Neurological morbidity included 1 patient with stroke, 1 paraplegia and 2 temporary paraparesisThree patients required temporary tracheotomy for prolonged weaning form the respirator.All patients were followed up for 10-118 months [mean (40.8 ±29.5) months].Two patients died during follow-up.The survival rate was (94.5 ± 1.3)％,(90.6 ± 1.4) ％ at 1-and 5-year, respectively.ConclusionDistal aortic reoperation in Marfan patients can be performed with good short-and long-term results.Complete aortic arch replacement with elephant trunk technique, if safely performed,should be considered for Marfan patients presenting with type A dissection.

Objective To investigate the effects of sevoflurane postconditioning on myocardial ischemiareperfusion(I/R)injury in patients undergoing coronary artery bypass grafting(CABG)with cardiopulmonary bypass(CPB).Methods Forty NYHA Ⅰ -Ⅲ patients of both sexes,aged 55-64 yr,with BMI ＜ 30 kg/m2,scheduled for CABG under CPB,were randomly divided into 2 groups(n = 20): control group(group C)and sevoflurane postconditioning group(group S).Anesthesia was induced with midazolam and/or etomidate,fentanyl and rocuronium.Patients were tracheal intubated and mechanically ventilated.Anesthesia was maintained with iv infusion of propefol and intermittent iv injection of fentanyl and pipecuronium.In group S,2% sevoflurane was inhaled continuously for 15 min immediately after aortic unclamping.After anesthesia induction,before CPB,10 min after the end of CPB,at the end of operation,and 6 and 24 h after operation,MAP,HR,CVP,mean pulmonary arterial pressure,pulmonary arterial wedge pressure,CO and S(v)O2 were recorded,and CI,SVI,systemic vascular resistance index and pulmonary vascular resistance index were calculated.Blood samples were taken from central vein before aortic clamping,at 6 h of reperfusion and 24 h after operation for determination of plasma creatine kinase(CK),creatine kinase isoenzyme(CK- M B)and lactate dehydrogenase(LDH)activities and tropenin I(TnI)concentrations.Myocardial tissues were obtained from right auricle before aortic clamping and at the end of CPB for observation of the ultrastructure and the severity of myocardial injury was assessed.Results There was no significant difference in hemodynamics and parameters of cardiac function between the two groups(P ＞ 0.05).Compared with group C,plasma CK-MB and LDH activities at 6 h of reperfusion and plasma CK activity and TnI concentrations at 24 h after operation were significantly decreased and the myocardial injury was significantly reduced after the end of CPB in group S(P ＜ 0.05).Conclusion Sevoflurane postconditioning can protect myocardium against I/R injury induced by CPB in patients undergoing CABG.

Objective To investigate the effects of chemotherapeutic drugs on ER-α expression and methylation in breast cancer cells.Methods Human breast cancer cells MCF-7(ER+,Luminal A) were induced by paclitaxel(PTX) and epirubicin(EPI) for more than 6 months,with an incremental dose,respectively.The expression and methylation status of ER-α in MCF-7 cells were detected before and after drug treatment.miRNAs with consistent expression changes in MCF-7 cells after two drugs' treatment were screened by microarray,and verified by quantitative PCR (qPCR).Targets of the most significantly down-regulated miRNA were analyzed by bioinformatics.miRNA inhibitor was transfected into MCF-7 cells,miRNA mimic was transfected into MCF-7/PTX and MCF-7/EPI cells,then ER-α and DNA methyltransferase 1 (DNMT1) expression were detected by Western blot,and ER-α methylation was detected by quantitative methylation-specific PCR (qMSP).Results PTX resistant MCF-7/PTX cell line and EPI resistant MCF-7/EPI cell line were established.Both drug treatments caused a decrease in ER-α protein expression and an increase in methylation levels,with up-regulation of DNMT1 and his tone deacetylase 1 (HDAC 1) expression.miRNAs with consistent expression changes in MCF-7 cells after drug treatments were screened and verified by qPCR,the most significant down-regulation among which was miR-148b.Bioinformatics analysis,and further confirmed by luciferase reporter gene assay (Luciferas) that DNMT1 was a direct target of miR-148b.miR-148b inhibitor induced decreased expression of ER-α and increased methylation level in MCF-7 cells,accompanied by increased expression of DNMT1;whereas miR-148b mimic caused an increased expression of ER-α and decreased methylation level in MCF-7/PTX and MCF-7/EPI cells,with a decreased expression of DNMT1.Conclusion Chemotherapeutic drugs (represented by PTX and EPI) induce aberrant miRNA expression in breast cancer MCF-7 cells,and down-regulate miR-148b further to attenuate the inhibition of DNMT1 expression,which promote,hypermethylation and down-regulation of ER-α.

Objective To study the relationship between serum uric acid (UA) level and metabolic syndrome (MS) in elderly essential hypertensive (EH) patients.Methods Two hundred and one elderly EH patients were divided into hyperuricemia group (n=47) and normal UA group (n=154).Hyperuricemia was defined in males with their serum UA level ＞ 420 μmol/L and in females with their serum UA level ＞ 360 μmol/L.Relationship between serum UA level and MS in elderly EH patients was analyzed by Pearson correlation analysis and logistic regression analysis respectively.Results The age was significantly older,the waist circumference was significantly longer,the BMI and serum SCr,FPG,TG level and the incidence of MS,central obesity,high blood glucose and high TG were significantly higher while the serum HDL-C level was significantly lower in hyperuricemia group than in normal UA group.Pearson correlation analysis showed that waist circumference,BMI,serum FPG and TG level were positively related with serum UA level while serum HDL-C level was negatively related with serum UA level (P＜0.05,P＜0.01).Logistic regression analysis showed that waist circumference and serum TG level were the independent risk factors for elevated serum UA level in elderly EH patients (OR=1.080,95％ CI:1.035-1.127,P=0.000;OR=1.472,95％CI:1.021-2.122,P=0.038).Conclusion Serum UA level is closely related with MS and its components while waist circumference and serum TG level are the independent risk factors for hyperuricemia in elderly EH patients.

Objective To summarize the experience of surgical treatment of Kommerell diverticulum and related aortic arch and descending thoracic aneurysm. Methods From November 2012 to January 2018,6 patients(5 males,and 1 fe-male),with median age of 46(from 14 to 63)years old,underwent graft replacement of involved aortic segment in our institu-tion . All the patients had symptom including persistent backache(3 patients),hoarseness( 1 patient),recurrent pneumonia( 1 patient)and hemoptysis( 1 patient). All the patients had right-sided aortic arch and aberrant left subclavian artery. True aneu-rysm occurred in 5 patients and pseudoaneurysm occurred in 1 patients. The median diameter of the aneurysms was 65mm(53- 80 mm). Two kinds of approaches were used:left posterior thoracotomy(2 patients)and median sternotomy plus right poste-rior thoracotomy(4 patients). The left posterior thoracotomy was achieved through the fourth and seventh intercostal space with excellent exposure of the whole descending thoracic aneurysm. For each patient,the aneurysm was resected with the proximal and distal aortic segment were clamped and the ligamentum arteriosum were divided. A branched woven polyester graft was used to reconstruct the descending thoracic aneurysm. 1 or 2 subclavian arteries were replaced with 10mm collagen-impregnated pol-yester grafts. One patient received total arch and partial descending thoracic aorta replacement with reconstruction of 3 supra-arch vessels. Results There was no operative mortality. The median clamping time of descending aorta was 28(22 - 61)mi-nutes,the median mechanical ventilation time was 33. 5(6 - 485)hours,the median ICU stay was 4( 1 - 31)days. One pa-tient died from central respiratory and circulatory failure due to acute brain stem infarction on the 31st day after operation. One patient suffered from reentry to ICU due to hyoxemia and recovered through expectant treatment. One patient had critical illness polyneuropathy after operation and received mechanical ventilation therapy for 485 hours,he recovered through neurotrophic drug treatment. The median follow-up time is 5( 1 - 46)months. 5 patients lived with no discomfort and the CT scans during follow-up time showed good morphology and patency of graft and branches. There was no anastomotic leakage and pseudoaneu-rysm. Conclusion Surgical treatment of Kommerell diverticulum is safe and effective. Subclavian artery should be reconstruc-ted.

Objective To summarize the experience and strategy of surgical treatment of Kommerell diverticulum and related aortic dissection aneurysm.Methods From November 2012 to January 2018,4 patients(all males),with median age of 44 (from 40 to 49) years old,underwent surgical treatment in our institution.All the patients had fight-sided aortic arch and aberrant left subclavian artery.One patient had type A aortic dissection and other 3 had type B aortic dissection(one had chronic type B dissection).The patient with type A aortic dissection had Bentall procedure plus total arch replacement and frozen elephant trunk implantation.One patient with chronic type B aortic dissection received type 2 hybrid aortic arch repair.One patient with acute type B aortic dissection had ascending aorta and total arch replacement plus frozen elephant trunk implantation followed by TEVAR.The last patient underwent graft replacement of aorta,total arch and descending thoracic aorta.Results There was no operative mortality.The median mechanical ventilation time was 229 (from 13 to 485) hours,the median ICU stay was 12 (from 2 to 27) days.One patient died from respiratory and circulatory failure due to compression of left main bronchus on the 17th day after operation.One patient had irritating cough due to mild compression of bifucation of trachea and the symptom resolved spontaneously before discharge.One patient had critical illness polyneuropathy after operation and received mechanical ventilation therapy for 485 hours.He recovered through neurotrophic drug treatment.The median follow-up time is 15 (from 4 to 36) months.The patients with type A dissection had delayed dilation of descending thoracic aorta beyond the frozen elephant trunk and received TEVAR 6 months later.The CT scans of the other two patients during follow-up time showed good morphology and patency of graft and branches.There was no anastomotic leakage and pseudoaneurysm.Conclusion The decision making of treatment of Kommerell diverticulum and related aortic dissection should be on the basis of classification of aortic dissection.Operation combined with TEVAR is safe and effective.

Aged ; Female ; Herpesvirus 8, Human ; isolation & purification ; Humans ; Immunosuppressive Agents ; adverse effects ; Pemphigoid, Bullous ; complications ; Sarcoma, Kaposi ; virology