Objective The aim of this study was to assess the value of △Np63α in predicting tumor recurrence after curative resection in esophageal squamous cell carcinoma (ESCC) patients.Methods We analyzed △Np63α protein cxpression in 304 clinicopathologically characterized ESCC cases by immunohistochemistry.Results We found △Np63α expression was positive in 122 (40％) of 304 cases.△Np63α expression was higher in the cancer tissue than in non-tumorous control tissue at protein level(P =0.034).There was a significant difference of △Np63α expression in patients categorized according to invasive depth (P =0.001),tumor position (P =0.001) and lymph nodes metastasis condition (P =0.001).Multivariate analyses showed that △Np63α was an independent prognostic marker for ESCC recurrence.Conclusion △Np63α is associated with outcome of ESCC and can be a novel predictor for poor prognosis of ESCC patients after curative resection.

In this paper, an improved back-projection algorithm of dynamic electrical impedance tomography (EIT) was described. The improved back-projection algorithm modified the computing method of back-projection matrix B. Dynamic reconstruction image was obtained by the improved algorithm, and it was compared to the image obtained by the traditional method of equi-potential back-projection. The results showed that the improved algorithm of equi-potential back-projection could locate the object's position in the field with higher precision, and its speed was very fast. It also could improve the resolution of the reconstructed image in some extent.
Algorithms ; Diagnostic Imaging ; methods ; Electric Impedance ; Humans ; Image Processing, Computer-Assisted ; methods ; Models, Biological ; Tomography ; methods

Objective To investigate the surgical technique and clinical outcomes of reconstruction of the annulus and the intervalvular fibrous body during valve replacements. Methods Fifty-nine patients underwent reconstruction of the annulus or the intervalvular fibrous body during the valve replacement. Indications for the operation were small aortic annulus which may cause patient/prosthesis mismatch in 43, active infective endocarditis with the abscess in the periannulus tissue in 13, extensive calcification of the aortic annulus in 2 and an active bleeding complication of the aortic root after aortic and mitral valve replacement in 1. The reconstruction was done with fresh autologous pericardium. Results The aortic clamping time in reconstruction of the intervalvular fibrous body with double valve replacement was longer than that of the regular double valve replacement. Four patients died in the perioperative period, giving an overall in- hospital mortality of 6.7%. Postoperative complication were: re-sternotomy for bleeding in 2, Ⅲ degree A-V block in 2, respiratory dysfunction in 2, and acute renal failure in 2. Patients were followed up for 6 months by echocardiography study, and no periannular leakage was found. Conclusion Reconstruction of the annulus is an effective technique for patients with a small aortic annulus, extensive calcification of the interventricular fibrous body and active infective endocarditis with abscess. Although the operative procedure is challenging and taking more time, the technique is safe and reproducible.

Objective To validate the value of Cleveland Clinical Score in predicting acute renal injury requiring renal replacement therapy(RRT-AKI) after cardiac valve surgery in Chinese adult patients.Methods An analysis was conducted for all the adult patients who underwent cardiac valve surgery from January 2010 to December 2014 in Changhai Hospital,Shanghai.A total of 3 230 adult patients were included.Based on Cleveland Clinical Score,the patients were divided into 3 risk stages:0 to 2 point,3 to 5 point,and 6 to 8 point.The incidence of RRT-AKI were compared between different stages.And the predictive value of the Cleveland Clinical Score model was assessed by area under the receiver operating characteristic curve(AUC-ROC) and the model calibration was assessed using the Hosmer-Lemeshow test.The patients were also divided into two groups:Non-RRT group and RRT-AKI group.The mortality were compared between these two groups.Results The incidence of RRT-AKI was 1.67％ vs the predicted ratio of RRT-AKI 1.70％ (x2 =0.018,P =0.892).Among the stage 1,2,and 3,the actual incidence of RRT-AKI,was 1.23％,2.66％,and 16.7％ vs the predicted incidence 0.40％,1.80％,and 9.50％,respectively.The AUC-ROC for Cleveland Clinical Score predicting RRT-AKI was 0.64 [95 ％ CI(0.57,0.71),P ＜0.01].Compared with Non-RRT group,the RRT-AKI group got a higher mortality(87.00％ vs 1.50％,x2 =1 330,P ＜0.01).Conclusion The Cleveland Clinical score had no real predictive value for RRT-AKI in Chinese adult patients after cardiac valve surgery.The incidence of RRT-AKI of the whole population and the stage 3 patients could be predicted by the model.And the patients with a high Cleveland score got a higher mortality than that of patients with a low Cleveland score.

Objective To validate the value of Simplified Renal Index Score(SRI) in predicting acute renal injury requiring renal replacement therapy(RRT-AKI) after cardiac valve surgery in Chinese adult patients.Methods An analysis was conducted for all the adult patients who underwent cardiac valve surgery from January 2010 to December 2014 in Changhai Hospital,Shanghai.A total of 3 183 adult patients were included.Based on SRI Score,the patients were divided into 3 risk stages:0 to 1 point,2 to 3 point,and 4 to 8 point.The incidence of RRT-AKI was compared between different stages.And the prediction value of the SRI model was assessed by area under the receiver operating characteristic curve (AU-ROC) and the model calibration was assessed with the Hosmer-Lemeshow (H-L) test.Results After surgery 52 (1.6％) patients developed acute kidney impairment and subsequently underwent renal replacement therapy.Patients with low values of simplified renal index (0-1),medium(2-3) and high values (4 and more) were found to have increasingly higher risk for renal replacement therapy of 0.8％ (95％ CI:0.005-0.012) 、3.8％ (95％ CI:0.026-0.052) 、20％ (95％ CI:0.010-0.720),respectively.TheAU-ROCwas0.68(95％ CI:0.610-0.760,P＜0.01).The H-L test was x2 =2.45,P=0.29.Conclusion SRI model gives a certain clinical significance,suggesting that high-values patients may occur RRT-AKI with a significantly higher risk than low-values patients.However,SRI model cannot give an accurate prediction value for RRT-AKI in Chinese adult patients after cardiac valve surgery.Direct clinical use of the model should be considered cautiously.

OBJECTIVE: To observe the effects of Xuefu Zhuyu Capsule (XFZYC), a compound traditional Chinese herbal medicine, on endothelin-1 (ET-1) release in myocardium and vascular endothelium and nitric oxide (NO)/nitric oxide synthase (NOS) system of swines after acute myocardial infarction (AMI) and reperfusion, and to explore the action mechanisms of XFZYC in improving the endothelium function. METHODS: Forty-five Yorkshire swines were randomized into 3 groups: sham-operated group, untreated group and XFZYC-treated group. A Yorkshire swine model of reperfusion in AMI was established by ligation of left anterior descending coronary artery for 90 min followed by 2 h relaxation. The content of serum ET-1 and NO was measured by radioimmunoassay before and after AMI and after reperfusion, respectively. Twenty-four hours after operation, all Yorkshire swines underwent diagnostic coronary angiography to delineate coronary arteries. The expressions of ET-1 and endothelial nitric oxide synthase (eNOS) in myocardial tissue of ischemic area were quantified with Western blotting. Microvessel density of the implanting sites was assessed by using HE staining. RESULTS: Compared with the untreated group, the levels of serum ET-1 after AMI and reperfusion were significantly decreased in XFZYC-treated group (P<0.01), while the NO levels after AMI and reperfusion in XFZYC-treated group were significantly increased (P<0.01). There was no significant difference in diagnostic coronary angiography between XFZYC-treated group and untreated group (P=0.253). Western blotting showed that the level of ET-1 in ischemic area in XFZYC-treated group was lower than that in the untreated group (P<0.01), while the eNOS protein expression in XFZYC-treated group was higher than that in the untreated group (P<0.01). The results of HE staining and microvessel density analysis of the implanting sites all showed that the degree of telangiectasis was reduced, the cardiac muscle damage was improved, and the density of capillaries was increased obviously in XFZYC-treated group as compared with the untreated group. CONCLUSION: The endothelium injury may be one of the important mechanisms for no-reflow phenomenon. XFZYC may reduce the no-reflow by protecting endothelium cells.

Objective To explore and conclude the influence factors of long-term outcomes of mitral valve repair for moderate and severe mitral regurgitation due to myxomatous degeneration.Methods To review the in-patient data and followup outcomes of 261 patients after mitral valve repair for moderate and severe mitral regurgitation due to myxomatous degeneration from Jan 1993 to Jan 2008 in Changhai Hospital of Second Military Medical University.Results There were 7 perioperative deaths and 254 survivors who obtained satisfactory perioperative outcomes.During the follow-up,24 patients were lost and 230 patients were followed up from 36 months to 174 months (77.3 ±30.3) months and follow-up rate was 90.6％.Multivariate Cox regression shows age ≥ 60 years old,left ventricular ejection fraction ＜ 0.50,undergoing combined coronary artery bypass grafting were the independent risk factors for long-term death after operations and left ventricular ejection fraction ＜ 0.50,New York Heart Association functional classification Ⅲ-Ⅳ,anterior leaflet prolapse were the independent risk factors for long-term recurrent moderate or severe mitral regurgitation after operations and prosthetic ring or band annulopasty was a protective factor.Conclusion The age ≥60 years old,left ventricular ejection fraction ＜ 0.50,undergoing combined coronary artery bypass grafting,New York Heart Association functional classification Ⅲ - Ⅳ,anterior leaflet prolapse,and prosthetic ring or band annulopasty were closely related with long-term adverse events after operations.

Objective During last decades,mechanical ventilation has been an important support in the postoperative management of patients undergoing cardiac surgery.However,a considerable number of patients need mechanical ventilation for a prolonged period after cardiac surgery,and this is associated with increased mortality and morbidity.The study was designed to determine the pre-and perioperative predictors of prolonged mechanical ventilation (PMV) in adult patients undergoing double valve surgery.Methods The retrospective study considered of 2026 adult patients who underwent double valve replacement surgery at Changhai Heart Center from January 1990 to December 2010.PMV is considered as mechanical ventilation period of ＞ 48 hours at postoperative hospital stay here.Results PMV occurred in 11.35 ％ of patients.The total hospital mortality was 4％.The hospital mortality of patients who had undergone double valve replacement surgery required PMV was significantly higher than control (33.5％ vs 0.2％,P ＜ 0.01).And so as comorbidities.Age more than 60 years (OR =1.943),diabetes(OR =1.757),preoperative active endocarditis (OR =3.167),New York Heart Association class higher than 3 (OR =2.464),preoperative critical state(OR =2.556),ejection fraction less than 0.50 (OR =2.026),creatinine greater than 110 μmol/L (OR =2.740),cardiopulmonary bypass time longer than 180 min (OR =3.529) and perioperative intra-aortic balloon pump(OR =18.350) were independent predictors of PMV in our patients.Conclusion PMV is associated with significant comorbidities and increased hospital mortality.Strategies to delineate the patients at risk and to modify these risk factors by prophylactic measures should probably lead to a lower incidence of prolonged mechanical ventilation for adult patients undergoing double valve replacement surgery.

Objective To establish a surgical risk prediction model for in-hospital mortality of adult rheumatic heart disease.Methods The study sample comprised of 3 889 patients with adult (is, or older than 18 years) rheumatic heart valve surgery only.All patients were divided into three subgroups according to the surgery site of left atrioventricular valve: mitral valve surgery group;aortic valve surgery group;and mitral and aortic valve surgery group.The data was splited into development(60％) and validation(40％) data sets, and then the risk model was developed by using a logistic regression model according to the data in development data set.Model calibration was analyzed by Hosmer-Lemeshow goodness-of-fit statistic, and model discrimination was tested by calculating the area under the receiver operating characteristic(ROC) curve.Risk score was finally set up according to the coefficient β and rank of variables in logistic regression model.Results The general in-hospital mortality of the whole group is 4.2％ (165/3 889).We established a risk prediction model and found seven risk factors: heart function in NYHA functional class ≥ Ⅱ grade (OR =3.36, 95％ CI: 2.42-4.67) , preoperative creatinine ＞ 110 mmoL/L (OR =2.69, 95％ CI: 1.51-4.79) , history of previous chest pain(OR =2.33, 95％ CI: 1.07-5.11) , surgical status(OR =2.32, 95 ％ CI: 0.94-5.73) , previous history of hypertension (OR =2.24, 95 ％ CI: 1.19-4.23), preoperative critical state (OR =2.14, 95％ CI: 1.27-3.60) and age ＞ 50 years (OR =1.57, 95 ％ CI: 1.18-2.09).Our risk model showed good calibration and discriminative power for the development data set, validation data set, and three subgroup in which Hosmer-Leme-show test' s P value were greater than 0.05 and the area under the ROC curve were greater than 0.70.Scoring methods: age 51-60years: 1 point, age 61-70 yeas: 2 points, age ＞70 years: 3 points;history of hypertension: 1 point;creatinine ＞ 110 umol/L: 4 points;NYHA class stage Ⅱ : 2 points, NYHA class stage Ⅲ: 4 points;NYHA class stage Ⅳ: 6 points;history of previous chest pain: 1point;preoperative critical condition: 2 points;urgent surgery: 2 points: emergency surgery: 4 points.Conclusion We have created a new risk prediction model and risk score, which can accurately predicts outcomes in patients undergoing heart valve surgery for our center.Furthermore, our risk model can also enable benchmarking and comparisons between multicenter in a meaningful way in the future.

AIM To study the effects of Biejiajian Pills (Colla Carapacis Trionycis,Asini Corii Colla,Nidus Vespae,etc.) on NF-κB,p65,p50 and IκB in NF-κB signaling pathway and target gene expression in HSC-T6 cells of rats.METHODS HSC-T6 cells were cultured with Biejiajian Pills drug serum for 24 hours,the expressions of p65,p50,VEGF and TIMP-1 mRNA were determined by qPCR;the expression of p65 was measured by immunofluorescence;the expressions of IκBα,IκBβ and α-SMA were determined by Western blot.RESULTS The Biejiajian Pills middle-,high-dose and positive control groups showed significantly lower expressions of p65,VEGF and TIMP-1 mRNA as compared with the blank control group and negative control group,the expressions of p50 mRNA among various groups showed no significant differences.But immunofluorescence showed that the expression of p65 in cytoplasm was decreased.Meanwhile,Biejiajian Pills showed significantly higher IκBα protein expression and obvious down-regulation of α-SMA expression in a dose-dependent manner,but had no significant influence on the expression of IκBβ.CONCLUSION Biejiajian Pills' therapeutic effects on hepatic fibrosis may be related to influencing NF-κB signaling pathway and inhibiting the expression of down-stream target gene.