Objective to summarize the clinical experience and results of 50 cases of mitral valve surgery via right anterolateral mini-thoracotomy technique. Methods Patients of mitral valve diseases who accepted such less invasive technique with cap lamp between October 2008 and February 2010 were reviewed.Out of a total 50 cases,38 rheumatic cases underwent mitral valve replacement,12 degenerative cases underwent mitral valvuloplasty,22 cases underwent associated tricuspid valvuloplasty.Preoperative transthoracic echocardiography(TTE) manifest mean left ventricular ejection fraction(LVEF) was 57.3±6.0%.According to NYHA classification,32 patients were in NYHA class II while the other 18 in class III. Diagnosis was identified according to history, physical examination, ECG as well as TTE. There was no statistical difference with regard to age, body weight, cradiothoracic ratio,size of left atrium,size of left ventricle and LVEF comparing with homochronous mitral valve surgeries via median sternotomy.All the patients adopted single lumen trachea cannula and were positioned on his/her back with a 20-30 elevation of the right side, the right arm was suspended over the head. Cardiopulmonary bypass was established between the femoral artery and bicaval venous cannulation. A 6-8cm incision was created in the right submammary fold and the right chest cavity was entered through the fourth intercostalspace.In addition,two other ports were necessary with one positioned at the cross-point of right medioclavicular line and second intercostalspace for placing long myocardial perfusion needles and superior vena cava blocking belt and the other positioned at the cross-point of right midaxillary line and fourth intercostalspace for placing special aortic clamp as well as inferior vena cava blocking belt. Surgeons should wearing headlamps to obtain a clear operation field. The procedures were then performed through an interatrial septum or interatrial groove incision.Result None of the 50 patients turned into median sternotomy during surgeries, there was no case of prolonged intubation, failure of important organs, hemoglobinuria or death,4 cases appeared hypoxemia during surgeries because of high-frequency ventilation with low tidal volume and all Improved after being treated. One case was complicated by active bleeding of intercostal arteries and recovered uneventfully after secondary hemostasis. Comparing with a group made up of 50 patients of the same period who underwent traditional mitral valve surgery through median sternotomy, there was no statistical difference regarding total operation time(130-206,152.0±42.6min:120-190,145.6±50.4min),the mean bypass time(58-147,75.1±20.3min:56-140,72.0±19.3min),the cross-clamp time (29-71,42.9±16.5min: 27-66,41.7±14.7min),mean parallel cycle time(18-60,28.5±12.8min:21-50,29.5±12.0min)(P>0.05). Tracheal intubation time was similar for both groups.(3.5-12,5.2±2.8h:4-14,5.5±2.6h)(P>0.05).The drainage volume of the mini-invasive group was significantly less when comparing with traditional group and all removed their chest tubes on 1st postoperative day.The mean volume were 40-600(105±40)ml and 150-1000 (300±80) ml, respectively(P<0.05). Volume of blood transfusion was also significantly less than traditional group(200±50ml:300±100ml)(P<0.05).TTE before discharged manifest all mitral valve prosthesis had good function, no paravalvular leak was detected, mitral regurgitation and tricuspid regurgitation following valvuloplasty was mild.Conclusion On-pump mini-invasive mitral valve surgery via right submammary thoracotomy which entered the right chest cavity through the fourth intercostalspace together with the using of headlamps can provide a clear operation field. The operating procedure is simple, more important, it is less invasive, less draining and has shorter mean hospital stay and hidden incision. The operation is safety and early postoperative result of this new procedure is satisfactory.

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.

Objective:To study the effect of increased expression of Fas on the killing of ? cells Methods:The level of Fas expression and apoptosis of human ? cells strain (NIT) were detected by FACS Results:There is no Fas expression on NIT But Fas expression can detected by culturing NIT with IFN ? and/or TNF ? The apoptosis of NIT induced by sFasL and anti Fas correlates with the level of Fas expression Conclusion:Fas expression induced by cytokine may represent a factor for the initiation of ? cells destruction

Objective:To explore the mechanism of anti CD4 antibodies effect on SEB induced proliferation of the peripheral blood mononuclear cells (PBMC) Methods:Using MTT method to observe anti CD4 antibodies effect on PBMC proliferation in different conditions Using morphologic, biochemistry and flow cytometer methods to detect CD4 +T cells apoptosis induced by anti CD4 antibodies Results:Both anti CD4 human/murine chimeric antibodies and murine McAbs could inhibit the SEB induced PBMC proliferation Anti CD4 chimeric antibodies could specially induced CD4 +T cells apoptosis Conclusion:Most important inhibitory effects of the anti CD4 antibody appear to direct at TCR induced early activation signals, and their inhibitory effect of anti CD4 chimeric antibodies is close related to the monocytes The further cross linking of anti CD4 antibodies is important for inducing CD4 +T cells apoptosis

The relationship between bone mineral density (BMD) and Zn, Cu, Ca levels in the meal and hair of urban and rural elderly people were studied. 470 subjects above 60 years old (urban 205 and rural 265), 178 males with an average age of 65.70 +/- 3.48 and 292 females with an average age of 65.90 +/- 4.02, were inquired. The BMD and Zn, Cu, Ca levels in the meal and hair were measured. The detected BMD in urban and rural female old people was significantly lower than that of the males; The contents of Ca and Zn in the meal of the urban females were significantly lower than those of the urban males; The Ca, Zn in the meal and Zn in the hair of the rural females were significantly lower than those of rural males (P < 0.05 or 0.01). The BMD, Ca intakes, Ca and Zn in the hair of the rural old people were significantly lower than those of the urban old people (P < 0.05 or 0.01). There was a correlation between BMD with the Ca, Zn of the hair and dietary Ca, Zn, Cu or between dietary Zn with Ca, Zn in the hair and Ca, Cu intakes. The Zn, Cu and Ca levels in the meal nutrients were correlated with BMD to some degrees. Lack of Ca and Zn in the meal can cause the reduction of BMD.
Bone Density ; Cadmium/*analysis ; Copper/*analysis ; Diet Surveys ; Hair/*chemistry ; Nutritional Status ; Osteoporosis/prevention & control ; Rural Health ; Zinc/*analysis

Objectives To construct a small interfering RNA (siRNA) targeting vascular endothelial growth factor (VEGF) in eukaryotic expression vector, and to assess effects of this vector on proliferation and apoptosis of malignant melanoma cell line A375. Methods pU-VEGF-siRNA plasmid was transfected into A375 cells by electroporation. VEGF mRNA and protein were detected by reverse transcription polymerse chain reaction (RT-PCR) and ELISA, respectively, in A375 cells after gene transfer. Proliferation of A375 cells was assessed by cell counting. Human umbilical vein endothelial cells (ECV-304) were cultured in medium containing supernatants of treated and untreated A375 cells, and their viability was tested by cell counting. Apoptosis of A375 cells was observed by flow cytometry (FCM). Results VEGF mRNA and protein were significantly decreased in the experimental group, compared to those in the controls (P

Objective To analyze the abnormal detectable rates of different kinds of blood test indexes before and after treatment in the patients with snake bite and to probe into the change condition of these indexes after different snake bite .Methods The inpa‐tients with clearly diagnosed what kind of snake bite in the past two years were selected as the research subjects .The multiple blood test indexes were determined before and after treatment in these patients .The abnormal detectable rates of these indexes were ana‐lyzed and compared among various snake bite patients .Results The different kinds of snake bite all could cause the different de‐grees of changes in some detection indexes among partial patients .Specially ,the detectable rates of WBC ,PT ,APTT ,TT ,D‐D ,CK , CK‐MB ,LDH ,Urea ,Cr and Cys‐C increase and PLT and Fbg decrease caused by viper bite were apparently higher than those caused by other kinds of snake bites (P<0 .05) .The detectable rates of CO2 increase and K+ decrease in the coral snake bite were apparently higher than those in trimeresurus gramineus ,cobra and viper bite (P<0 .05) .Conclusion Because the snake species and toxicities are different in the various snake bites ,so the caused changes and the abnormal detectable rates of blood test indexes also are different .

Objective To explore the change regulation of blood coagulation function before and after treatment of snake bite pa‐tients .Methods A total of 226 hospitalized patients with clear diagnosis belong to what kind of snakes in the past two years were selected in this study ,39 cases were bit by coral ,76 cases were bit by trimeresurus stejnegeri ,47 cases were bit by cobra ,24 cases bit by king cobra ,40 cases were bit by adder .Five blood coagulation indexes were determined before and after treatment various pe‐riods for these patients .The tested results were made to statistical analysis according to kind of snakes ,periods and disease condi‐tion .Results D‐D level obvious .rise before treatment for the severe cases patients of coral snake bite (P<0 .05) .Plasma prothrom‐bin time (PT) ,activated partial clotting enzyme live time (APTT) ,thrombin time (TT)and D‐D level rise and Fib level reduced be‐fore treatment for the severe cases patients of trimeresurus stejnegeri bite ,and Fib and D‐D level before and after treatment had sta‐tistical significant difference with the mild patients (P<0 .05) .Every index for the cobra and king cobra had no statistical signifi‐cant differences (P>0 .05) before and after treatment ,only D‐D level of the severe cases had statistical significance before treat‐ment in contrast to the mild cases of cobra bite (P< 0 .05) .The changes of 5 item blood coagulation indexes were all very large whether mild or severe for viper bite patients ,a number of comparisons had statistical significance difference (P<0 .05) whether before or after treatment and whether mild or severe for viper bite patients .Conclusion The bite of coral snake ,cobra and king co‐bra affect little for the blood coagulation function .The severe cases patients of trimeresurus stejnegeri bite might lead to more seri‐ous blood coagulation function abnormality but the recovery is faster after treatment .The viper bite might lead to maximum blood coagulation function abnormality and the recovery is slow after treatment .

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.

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.