There are lots of contents in the clinical teaching of cardiothoracic surgery , but the teaching time is short .What should be concerned by every cardiothoracic surgery teacher is how to make full use of the limited time to make students grasp the main contents of cardiothoracic surgery .It is crucial to develop new models of education and assessment .We discuss efforts in our teaching , including new teaching paradigms , teaching tools and multimedia teaching .The combination of varieties of teaching methods , clinical and basic teaching , theory teaching and clinical practice may improve the quality of clinical teaching in cardiothoracic surgery .

Objective To investigate the expression of RCAS1 in the tissues of normal cervix,cervical intraepithelial neoplasia(CIN)and cervical cancer,and to explore their role in the pathogenesis of cervical carcinoma.Methods The expression of RCAS1 protein was analyzed by immunohistochemical S-P method in 89 cases of cervical carcinoma,82 cases of CIN,and 24 cases of normal cervical specimens.Results Immunohistochemistry showed that the expression rate of RCAS1 in normal cervix,CINⅠ,CINⅡ-Ⅲ and cervical cancer were 0.00,0.314,0.447 and 0.775,respectively.RCAS1 expression tended to increase along with tumor progression.The expression of RCAS1 in cervical cancer was significantly related to the histological grade,the tumor in different sizes(≥4cm or 0.05)betwan patients' age,clinical stage and histological classification.Conclusions The data suggested that RCAS1 might play an important role in the pathoqenesis and development of cervical carcinoma.Over expressed RCAS1 could be regard as an important parameter in malignant degree and poor prognosis of cervical cancer.

OBJECTIVE To study the efficacyof the lateral vocal fold injection of autogenous fat for vocal fold insufficiency. METHODS Twenty nine patients with vocal fold insufficiency were treated in our department with fat injection. Deep lateral vocal fold injection was performed through direct laryngoscope under general anesthesia. Fat was injected into the lateral aspect of the vocal fold (paraglottic space) using a special high pressure Brunning injector. The perceptual acoustic,phonatory function,and video laryngostroboscopy were evaluated before and after operation. RESULTS All the patients were followed up for 10 to 18 months. There were 24 patients with excellent results,2 patients with improvement, and 3 patients with no improvement. Phonatory function showed significant improvement(P

This paper is to evaluate the biocompatibility and cytotoxicity of a new Ni-free Zr-based bulk metallic glass (BMG), Zr60.14 Cu22.31 Fe4.85 Al9.7 Ag3, by comparing it with conventional Ti6Al4V alloy. According to ISO 10993-5: 1999 and GB/T 16886.5-1997 standards, Zr60.14 Cu22.31 Fe4.85 Al9.7 Ag3, pure Zr and Ti6Al4V materials were extracted with surface area of sample/volume of medium ratio being 1 cm2/mL and 0.5 cm2/mL, respectively. The viabilities of MG-63 cells (Human osteosarcoma cell line) cultured in the BMG medium extracts for 1, 3 and 5 days were determined by CCK-8 assay. The cellular morphology of MG-63 cells cultured on the surface of samples for 3 days was tested through laser scanning confocal microscopy (LSCM) and scanning electron microscopy (SEM). The relative growth rate (RGR) of MG-63 cells cultured in Zr60.14 Cu22.31 Fe4.85 Al9.7 Ag3 and pure Zr were both more than 85%, indicating that the cytotoxicity of BMG was relatively low and met the national biomedical material eligibility standard. There was insignificant difference in the morphology of MG-63 cells cultured in the BMG medium extracts and the control group through LSCM and SEM, which showed the BMG had excellent biological compatibility. The Zr-based bulk metallic glass Zr60.14 Cu22.31 Fe4.85 Al9.7 Ag3 and the conventional Ti6Al4V alloy both had no obvious cytotoxicity to MG-63 cells. These results provided evidence that the new Zr-based bulk metallic glass could be potential replacement material for the orthopedic surgical implant.
Alloys ; Biocompatible Materials ; Cell Line ; Glass ; Humans ; Microscopy, Electron, Scanning ; Nickel ; Titanium ; Zirconium

Objective To prepare recombinant human epidermal growth factor (rhEGF) sustained-release microspheres and evaluate their morphology, rhEGF releasing activities and cell proliferation activity in vitro and compare difference of rhEGF sustained-release microspheres and rhEGF in facilitaring ulcer healing in diabetic rats. Methods (1) rhEGF sustained-release microspheres were prepared by the modified double emulsion method. Morphology of the microspheres was detected by transmission electron microscope and size distribution measured by laser granularity meter/Zeta electric potential meter. ELISA assays were applied to determine rhEGF releasing. (2)Proliferation of mouse fibroblasts was analyzed by MTr method. (3) Diabetic rat models were prepared and divided into four groups, ie, rhEGF sustained-release mierospheres group (Group A), rhEGF stock solution group (Group B), blank sustainedrelease mierospheres group (Group C) and PBS meustruum control group (Group D), which were given drug once a day. The wound healing rate was calculated by taking photographs at days 3,7,14 and 21. Skin specimens from the wound edge were harvested partially for observation of hydroxyproline (HYP) contents. Immunohistochemistry was employed to detect integrin 131 and keratin-19 and measure their positive staining area ratio. Results (1) The particle diameter of rhEGF sustained-release microspheres was 193.5 nm, with relative uniform particle diameter distribution. There showed no conglutination among rhEGF susrained-release microspheres, with good dispersibility. Releasing drug lasted for 24 hours and accorded with Higuchi release kinetic model. (2) Different concentrations of rhEGF sustained-release microspheres could promote the proliferation of mouse fibroblast, especially the concentration of 10 μg/L (P <0.05, compared with the control). (3) From the 7th day after treatment, Group A had the fastest wound healing rate, with statistical difference compared with other three groups (P < 0.05). Group A had higher HYP contents and positive area ratio of integrin β1 and keratin-19 than Group B. Conclusions rhEGF sustained-release microspheres prepared by the modified double emulsion method have uniform particle size and can last release for 24 hours. Compared with rhEGF stock solution, rhEGF sustained-release microspheres have faster and better ulcer healing and higher healing quality in diabetic rats.

OBJECTIVE The aim of our study was to evaluate the significance of the frequency of microsatellite instability (MSI) and its relationship to mismatch repair gene (MMR) in laryngeal squamous cell carcinoma.METHODS We investigated the expression frequency and clinical significance of MSI and MMR in 50 laryngeal squamous cell carcinoma (LSCC) patients from Beijing Tongren Hospital. The status of MSI was evaluated using microdissection - polymerase chain reaction (PCR) - single strand length polymorphism (SSLP) - silver staining.Five markers on chromosomes 1p, 3p, 5q, 9p, 17p, which were adjacent to BCAR3 (breast cancer anti-estrogen resistance 3), FHIT, APC, CDKN2A (p16), TP53 respectively, were used. Two of the six components of MMR -hMLH1 and hMSH2- were investigated by an immunohistochemical approach because of the high frequency of their downregulation in head and neck tumors. RESULTS The informative case number of the five markers (D17S796, D3S3544, D5S656, D1S375, D9S162) were 44, 42, 45, 44 and 40 respectively. The incidence of MSI was lower than the frequency of loss of heterozygosity (LOH). The incidence of MSI on D17S796 (TP53)was 20.5% (9/44),on D3S3544 (FHIT) was 14.3 % (6/42), on D5S656 (APC) was 31.1% (14/45), on D1S375 (BCAR3) was 20.5 % (9/44), and on D9S162 (CDKN2A) was 15.0 % (6/40). Though there was no relationship between MSI status and age, gender, smoke history, tumor location, tumor differentiation and T stage (P＞0.05),there was a strong correlation between MSI and relapse condition (P＜0.01). Also, MSI status correlated with MMR expression to some degree (P＜0.01), but it was common for negative and positive staining of MMR to coexist on the same slide. CONCLUSION Microsatellite instability and abnormal mismatch repair may contribute to the carcinogenesis of a subset of laryngeal squamous cell carcinoma. Microsatellite instability may be a characteristic signal of tumor recurrence.

other trauma.The diagnosis of blunt cardiac rupture is difficult and the mortality rate is high .The experience of rapid and accurate di-agnosis and operation on 16 cases of blunt cardiac rupture was summarized in this article . Methods The clinical data of 16 cases of blunt cardiac rupture in Nanjing General Hospital of Nanjing Military Region from July 2006 to June 2013 were retrospectively re-viewed.All of the 16 patients were diagnosed by physical examination , chest CT and cardiac ultrasound accurately in the emergency room.The treatment of emergency chest operation was conducted to repair the broken sites of heart .One case with left ventricular rup-ture was treated with emergency repair through cardiopulmonary bypass .The remaining 15 cases were repaired without cardiopulmonary bypass.Nine cases suffered rupture of right ventricle were treated with interrupted mattress sutures , 1 case suffered accompanying inju-ry of the right coronary artery was treated with emergency right coronary artery bypass grafting , 4 cases suffered rupture of right atrium were treated with direct sutures , 2 cases suffered rupture of the opening of pulmonary vein were treated with interrupted mattress su -tures.Two cases combining rupture of mitral chordae tendineae did not receive any special treatmen simultaneously and two cases combining with splenic rupture received laparotomy and splenectomy after cardiosurgery .Thoracic drainage tube , ECG monitoring , ventila-tor assisted breathing and so on were used in all patients . Results
One case with left ventricular rupture died of low cardiac output after operation , the rest 15 cases recovered successfully .Two cases combining with mitral chordae tendineae received mitral valve replacement because of mitral severe insufficiency after 1 year. Conclusion Rapid and accurate diagnosis and timely and reasonable operation were the key treatments of blunt cardiac rupture .

OBJECTIVE To evaluate the value of Epworth sleepiness scale(ESS) combined with home-based portable monitoring(PM) in the diagnosis of patients with obstructive sleep apnea syndrome(OSAS). METHODS Adult OSAS patients who visited Beijing Tongren Hospital and complained of snoring were included in this study. The overnight polysomnography(PSG) and the ESS were completed at the sleep center and the portable multi-channel monitoring was completed within one week. Subjects were divided into two groups according to their apnea hypopnea index(AHI) of PSG: simple snoring or mild OSAS group(AHI<15/h) and moderate-severe group(AHI≥15/h). The ESS score, respiratory disturbance index(RDI) of PM and other parameters were compared and the correlation of AHI with ESS scores, RDI were analyzed. The sensitivity and specificity of ESS score≥9 points, RDI≥15/h in the diagnosis of moderate-severe OSAS were calculated. RESULTS A total of 51 subjects were included in this study with 42 males(82.4％) and 9 females(17.6％). Mean age was(43.8±10.8) years, and the mean body mass index was(27.9±4.5)kg/m2; ESS scored 1-24 points and mean(8.6±5.0) points, 18 cases with ESS score ≥9 points; AHI ranged between 2.5 and 99.8/h with a mean of(37.4±29.8)/h. There were 19(37.3％) and 32(62.7％) patients in snoring-mild group and moderate-severe group, respectively. There was significant difference for ESS scores between the two groups(9.9±5.1 vs 6.6±4.2 points, P<0.05),RDI in moderate-severe OSAS group was significantly higher than that in snoring-mild group[(49.4±23.1)/h vs (6.8±4.5)/h, P<0.001)]. There was a positive correlation between the ESS score and PSG derived AHI(r =0.435, P =0.002); the PM derived RDI were significantly correlated with PSG derived AHI in snoring-mild group(r =0.706, P=0.001), moderate-severe group(r =0.873, P=0.000) and patients with ESS score ≥9 points(r =0.967, P=0.000). At a PSG threshold AHI=15/h, the sensitivity and specificity for ESS score ≥9 points were 45.2％ and 78.9％; the PM derived RDI≥15/h had a sensitivity and specificity of 84.4％ and 84.2％, respectively; the sensitivity and specificity for each individual screening tool along with the combination of ESS and PM were 100.0％ and 100.0％. CONCLUSION ESS combined with PM diagnostic method is a valuable measure for the diagnosis of moderate and severe OSAS patients.

ObjectiveTo investigate the influence of cobalt chloride ( CoCl2 )-mimetic hypoxia on theproliferation,apoptosis and migration of human pancreatic cancer cell fine PANC1.MethodsPANC1 cells were treated with 0(control),100,200,400,800 μmol/L CoCl2 respectively for 24 h.Real-time RT-PCR and Western blot were used to determine hypoxia induced factor ( HIF)-1o mRNA and protein expression respectively,and cell counting kit-8(CCK-8) assays,flow cytometry and cell scratch test were used to examine the proliferation,apoptosis and migration of PANC1 cells,respectively.ResultsIn the control group and 100,200,400 and 800 μmol/L CoCl-2 groups,the expressions of HIF-1t mRNA were 1,1.08 ±0.12,1.12 ± 0.09,1.04±0.11,0.66 ±0.07,and the expressions of VEGF mRNA were 1,2.69±0.35,4.81 ±0.54,2.19 ± 0.21,0.79 ± 0.08,while the expressions of HIF-1 α protein were 0.23 ± 0.03,0.36 ± 0.04,1.15 ± 0.11,1.08 ± 0.09,0.44 ± 0.04; and the expressions of VEGF protein were 0.14 ± 0.02,0.12 ± 0.01,0.95 ±0.09,0.87 ±0.09,0.55 ±0.06; and cell viability rates were 100％,(98.43 ±2.88)％,(76.15 ± 0.70)％,(53.87 ±0.77)％,(35.23 ±0.67)％ ; while cell apoptotic rates were (5.2 ±1.12)％,(5.74 ± 1.07)％,(6.82 ± 1.85)％,(12.09 ±3.53)％,(31.88 ±6.95)％ ; the cell migration distance of PANC1 cells were (43.24 ±3.67)％,(59.46 ±5.39)％,(80.56 ±8.05)％,(63.89 ±5.96)％,(9.09 ± 1.59 ) ％.Compared with those of control group,the expressions of VEGF mRNA,VEGF and HIF-1 α protein,cell migration distance showed a two-way variation ( ascending first and descending later) (P ＜0.05 ),and the expression of HIF-1α mRNA and cell proliferation rate was decreased in a dose-dependent manner,while the cell apoptosis was increased in a dose-dependent manner.Conclusions CoCl2 significantly inhibits the proliferation and promotes apoptosis of PANC1 cells at certain level.CoCl2 has a two-way effect on the migration of PANC1 cells,and it may be related to the direct injury of high concentration of CoCl2 on cells.

[Abstract ] Objective The aim of the study was to investigate the effects of recombinant human erythoropoietin (EPO) and bone marrow mesenchymal stem cell (BMSC) transplantation on renal inflammatory response following cardiopulmonary bypass (CPB). Methods Forty sprague-Dawley male rats were randomly divided into five groups (n=8):shame operation group, CPB group, EPO group, BMSC group and EPO +BMSC group.CPB model was built in shame operation group without CPB .The other four groups un-derwent CPB, following by jugular vein infusion of 1.5 ×106 BMSCs after an hour′s 100 L/kg/min bypass .Jugular vein infusion of 3000 IU/kg EPO was done in EPO group , while the combination of EPO with BMSCs was infused in EPO +BMSC group.The same volume of isotonic saline solution was infused via jugular vein in CPB group and shame operation group respectively .Rats were sacrificed at 24 hours after CPB termination .Blood samples were collected for the determi-nation of creatinine(Cr) and urea nitro(BUN) levels.HE staining was applied in the examination of renal tissues .ELISA was used in the determination of serum interleukin 6 (IL-6) and interleukin 10 (IL-10) levels and western blot was taken to test the expressions of tumor necrosis factor (TNF-α) and insulin-like growth factor 1 (IGF-1). Results In CPB group, the levels of Cr, BUN, IL-6 and the expression of TNF-αwere increased, while IL-10 level and of IGF-1 expression were decreased(P<0.05).TNF-αexpression was increased while IGF-1 expression was decreased in renal tissue (P<0.05).HE staining results showed the renal injury in EPO +BM-SC group was significantly lower than those in EPO group , BMSC group and CPB group , along with the decrease in the levels of Cr , BUN, IL-6, the increase in IL-10 level(P<0.05), as well as the decline of TNF-αexpression and the rise of IGF-1 expression(P<0.05). Conclusion The combination of EPO and BMSCs which reduces renal inflammatory response following CPB has protective effects on renal injury following CPB in rats , which is better than single application of EPO or BMSCs .