Objective To study a minimally invasive surgical procedure for coronary artery bypass grafting (GABG). Methods 23 patients, aged from 45 to 73 years old, undervent off-pump coronary artery bypass grafting (OPCABG) according to Octopus procedure from December 1999 to Auguest 2001. In the present study , more than 3 vessels were involved in 19 patients; 2 vessels involved in 3 cases and 1 vessel involved in one case. The grafted arteries included left anterior descending branch (LAD)(23); circumflex(CX)(15); right coronary artery(RCA)(14); ramus intermedius(RUM)(8); and posterior descending artery(PDA) (8). The types of grafts were left internal mammary artery (LIMA)(20) and saphenous vein grafts(SVG)(48). Results None of the patients was managed by means of cardiopulmonary bypass. All survived without angina pectoris. MRI showed that all the conduits were patent postoperatively. Conclusions OPCABG by Octopus procedure can be used in multiple vessel coronary bypass including CX and PDA. The patency rate is similar to that of the conventional technique. The mortality rate and occurrence of complications is low compared with those of the conventional technique . In addition, medical cost is lower. So This procedure is both safe and cost-effective, and is of value in clinical practice.

Objective To study the clinical characteristics of epidemic Japanese encephalitis in 4 adult patients and to improve the level of diagnosis.Methods The clinical characteristics, laboratory results and MRI features of 4 adult patients with epidemic Japanese encephalitis hospitalized in our hospital between 2007 and 2008 was retrospectively reviewed and analyzed.Results All patients were sporadic.Two were female and others were male with the age from 34 to 68 years old and onset in summer and autumn.One patient had diarrhea at onset while others had fever and headache at onset.All patients had high fever and psychiatric symptoms.Two patients had respiratory failure.Obvious elevation of white cells in cerebrospinal fluid was seen in all patients and Japanese viral antibody of IgM was all positive whereas the image of MRI was abnormal only in one patient.Two patients had neurological sequelae.Conclusions The clinical manifestations of epidemic Japanese encephalitis in adults are severe and untypical and the respiratory failure is likely to occur.

Objective To explore the differential diagnostic value of color-Doppler technique in acute and chronic thrombosis of leg arteries. Methods The two-dimensional and color Doppler ultrasonographic characteristics were analyzed in acute thrombostic event in 80 leg arteries and chronic thrombostic events in 244 leg arteries. And some parameters (history, the vessel wall structures, hemodynamic of inlet and outlet at the lesion) were compared, too. Results There existed a significant difference in history, vessel wall structure and the establishment of collaterals between the acute and chronic groups. And there were also significant difference in maximum blood velocity proximal and distal to the lesion and proximal resistant index between two groups(P

Two hundred and thirty-five patients of both sexes (123 male,112 female) aged 18-54 yr,weighing 35-62 kg underwent repair of tetralogy of Fallot from January 1996 to July 2009 in Fuwai hospital.Direct BP, ECG,CVP,SpO2,naso-pharyngeal temperature and TEE were continuously monitored during operation.Anesthesia was induced with midazolam and/or etomidate, fentanyl and pipecuronium and maintained with isoflurane/sevoflurane inhalation and intermittent iv boluses of fentanyl and pipecuronium. The total amount of fentanyl administered ranged from 30-50 μg/kg. Cardiac function was supported and hemodynamic stability was maintained with vasoactive and inotropic drugs. Measures were taken to strengthen blood conservation and respiratory function support.Seven patients(2.9%) needed urgent CPB during operation because of serious cyanotic spells. Perfusion-induced lung injury occurred in 18 patients (7.6%). Circulation was assisted by ECMO in 2 patients (0.9%). Three patients (1.3%) died of serious low cardiac output and perfusion-induced lung injury.

Objective: To compare the effects of ultra-fast track anesthesia and traditional anesthesia on blood levels of high sensitivity C-reactive protein (Hs-CRP), C-reactive protein (CRP) and procalcitonin (PCT) in patients after pediatric cardiac surgery.
Methods: A total of 101 patients received pediatric cardiovascular surgery by a same anesthesiologist in our hospital from 2013-09 to 2014-05 were retrospectively reviewed. The patients were studied in 2 anesthesia groups:Ultra-fast track group, in which the extubation was conducted in operating room, n=40 and Traditional group, n=44. Blood levels of Hs-CRP, CRP and PCT at pre-operation (T0), 1st day post-operation (T1) and 2nd day post-operation (T2) were compared.
Results: ①Hs-CRP levels were higher at T1 and T2 than T0 in both groups, all P<0.05;Hs-CRP level in Ultra-fast track group was lower than Traditional group at T1 time point, P<0.05. ②CRP levels were similar among 3 time points in Ultra-fast track group;while in Traditional group, CRP level at T2 was higher than T1, P<0.05; CRP level was higher in Traditional group than Ultra-fast track group at T2, P<0.05.③PCT levels at 3 time points were similar in the same group;while PCT level in Ultra-fast track group was lower than Traditional group at T1 time point, P<0.05.
Conclusion: Compared With traditional anesthesia, ultra-fast track anesthesia could decrease the post-operative elevations of Hs-CRP, CRP and PCT in patients after pediatric cardiac surgery.

Objective: To seek the optimum technology of drying and to solve the problem of powder sticking clump. Methods : On the basis of major drying condition, such as duration of drying, temperature of drying, evaluating different drying technology; On the basis of the quantity of the powder sticking on the wall and the hygroscopicity of one, investigating different excipients how to affect the spray drying. Seeking the optimum kinds and quantity of excipients. Results : The best properties of the granules are from the spray drying process. ?-cyclodextrin and lactose have the effects on solving the powder sticking on the wall. Conclusion : The spray drying process is the optimum one. Adding 3～5 percent of ?-cyclodextrin has an effect on improving the phenomenon of powder sticking on the wall in process of the spray drying.

Objective To investigate the impacts of the left ventricular size for infants with total anomalous pulmonary venous connection(TAPVC) on the early results of anatomical correction.Methods From Jan 2010 to Jun 2013,103 cases of TAPVC children under 1 year of age received biventricular correction in our hospital,including 65 males and 38 females with the mean body weight of(5.3 ± 1.3) kg.Taking left ventricular end-diastolic volume index(LVEDVI) of 20 ml/m2 as a boundary,all the children were divided into two groups:Small LV group and the Near normal LVgroup.Various factors including age,body weight,pathological type,pulmonary venous obstruction and restricted atrial septal defect were compared between the two groups.The Z value were introduced to demonstrate the small extent of the left atrium and left ventricle of TAPVC patients in comparison with the normal children.TAPVC correction surgery were performed with conventional median sternotomy,moderate hypothermic cardiopulmonary bypass and combined malformations were treated simultaneously.Results 45 patients were classified to Small LV group and 58 patients were classified toNear normal LV group.71.1％ of all Small LV patients was diagnosed as the obstruction type of TAPVC,the ratio was significantly higher than that of theNear normal LV group.The Z value of left ventricular end-diastolic diameter in theSmall LV group was significantly lower than that of the Near normal LV group.The mean CPB and aortic clamping time of all patients were (96.6 ± 34.4) min and (58.0 ±21.1) min respectively.There were 4 early postoperative death and the overall mortality was 3.9％.No patient was dead of low cardiac output.The duration of postoperative mechanical ventilation,ICU stay and vasoactive drugs application in Small LV group was significantly longer than that of Near normal LV group.Conclusion TheSmall LV,which should be viewed as relative dysplasia of left ventricle ,is more common in obstructive type of TAPVC.As long as the sizes of mitral valve and aortic valve were not significantly reduced,anatomic correction can be implemented and need not to concern the reducing degree of left ventricle.Nevertheless,the prevention and treatment of low cardiac output in the operation and early postoperative period were still key points for small LV patients to achieve good surgical results.

Objective To investigate the use of laryngeal mask airway (LMA) ProSeal for airway management during open heart surgery performed under CPB in children. Methods Seventy-six ASA Ⅱ and NYHA class Ⅰ or Ⅱ patients aged 3 months-8 yr, weighing 3.3-34.5 kg undergoing open heart surgery under CPB were randomly divided into 2 groups ( n = 38 each): tracheal intubation group (group T) and ProSeal LMA group (group P1). Tracheal tube and LMA were inserted after induction of anesthesia with 8% sevoflurane. The rate of successfultracheal intubation and LMA placement, placement time, peak airway pressure and side effects during and after surgery including hypoxemia, tachycardia, bradycardia, hypotension and hypertension, laryngesl edema, dysphagia, bucking, dyspnea and hoarseness were recorded. Results There were no significant differences in the rate of successftl tracheal intubation and LMA placement, peak airway pressure, bucking, dyspnea and hoarse voice between the two groups (P＞ 0.05). The LMA placement time was significantly shorter than tracheal intubation time and the incidence of laryngeal edema and dysphagia lower in group P than in group T ( P ＜ 0.05). Conclusion The LMA ProSeal can provide adequate ventilation during operation with less complications and can be used effectively for cardiac surgery performed under CPB in children.

Objective: Compared with ketamine anesthesia, to investigate sevoflurane inhalation combining laryngeal mask airway for anesthesia induction in pediatric cardiac surgery.
Methods:A total of 40 pediatric patients with congenital heart diseases received elective cardiac surgery in our hospital from 2013-08 to 2014-01 were studied. The children were from 6 months to 2 years of age and randomly divided into 2 groups, n=20 in each group. Sevolfurane group, the children inhaled the mixture of 8%sevolfurane and 100%O2, laryngeal mask airway was used upon losing consciousness for mechanical ventilation, the anesthesia was maintained by (3-4)% sevolfurane inhalation to facilitate central venous catheter placement. Ketamine group, the children received intramuscular injection of ketamine (7 mg/kg)+atropine (0.01 mg/kg). The peripheral venous line was established upon losing consciousness, the intravenous midazolam (0.1 mg/kg), pipecuronium (0.10 mg/kg), fentanyl (5 μg/kg) were applied, then tracheal intubation was performed for mechanical ventilation and the anesthesia was maintained by (0.5-1)%sevolfurane to facilitate central venous catheter placement.
Results: Sevoflurane group had the shorter time for losing the consciousness than that in Ketamine group (48.90 ± 3.93) s vs (577.85 ± 116.41) s, P<0.05 and the shorter time for ifnishing the central venous catheter placement (11.15 ± 2.48) min vs (24.15 ± 4.02) min, P<0.05. The average blood pressure and heart rate were similar between 2 groups after laryngeal mask or tracheal intubation, P>0.05. The arterial PH value, PaCO2, BE and lactatein were similar between 2 groups, P>0.05.
Conclusion: Sevoflurane inhalation combining laryngeal mask airway could shortening anesthesia preparation time with simple management. It provided an important anesthesia option in pediatric cardiac surgery.

Objective To detect the expression levels of miR-7-5p and POLE4 in non-small cell lung cancer cells and their effect on cells proliferation, migration and invasion. Methods qRT-PCR was used to detect the relative expression levels of miR-7-5p and POLE4 mRNA in NSCLC tissues, adjacent tissues, tumor cells and human normal bronchial epithelial cells. Luciferase reporter gene was used for analyzing of the targeting relation between POLE4 and miR-7-5p in NSCLC cells. si-NC and si-POLE4 were transfected into SPC-A-1 cells as the si-NC group and si-POLE4 group, and the control group was set at the same time. MTT method, scratch test and Transwell test were used to detect cell proliferation, migration and invasion. Results The expression levels of miR-7-5p in NSCLC tissues and cells were reduced, and the expression levels of POLE4 were increased. miR-7-5p could target to combine with POLE4. After 72 hours of culture, the OD value in si-POLE4 group was significantly lower than those in the control group and si-NC group (P < 0.05). The migration rate and the number of transmembrane cells in the si-POLE4 group cultured for 48 hours were lower than those in the control group and the si-NC group (P < 0.05). Conclusion miR-7-5p may inhibit the proliferation, migration and invasion of non-small cell lung cancer cells by targeting POLE4.