Objective To study the early clinical outcome of patients undergone minimally invasive direct coronary bypass(MIDCAB) surgery,and the mid-term patency of left internal mammary artery(LIMA)-left anterior descending(LAD) anastomosis.Methods From Jannuary 2007 to May 2014,47 cases underwent MIDCAB surgery in our department,with 35 males and 12 females,aged 48-76 years,with the average of (62.9 ± 8.1) years old.Types of LAD lesions were as followed:1 case was ostial total obstruction,28 severe stenosis at proximal segment,10 long and severe stenosis,3 calcified lesion with severe stenosis,5 myocardial bridge.All patients had symptomatic angina,typical myocardial ischemia could be detected by electrocardiogram for all patients with myocardial bridge.Comorbidities included:hypertension 38 cases,27 diabetes mellitus,3 COPD and 3 chronic kidney disease.Results All surgery went well without transfer to mid-sternotomy.LIMA harvest time was 38-53 minutes,mean LIMA flow rate was(22 ± 6) ml/min after anastomosis.Surgery duration was 117-143 minutes,blood loss was less than 100 ml for each operation.No blood transfusion was required.Tracheal intubation time was 4-16 hours,ICU stay time was 22-45 hours,hospital stay time was 6-10 days.There was no peri-operative death,either no myocardial infarction or cerebral vessel accident.During follow-up,all LIMA-LAD appeared to be patent by coronary CT angiography.Conclusion High patency rate of LIMA-LAD anastomosis could also be obtained during MIDCAB surgery.It was reserved as a safe and effective surgery for well-selected patients.

BACKGROUND:The technique of vacuum sealing drainage, initialy used for better wound healing, has been widely applied to al kinds of refractory wounds. OBJECTIVE:To summarize the research progress in vacuum sealing drainage for treatment of severe soft tissue injury. METHODS: An electronic retrieve was performed in Wanfang database, VIP database and PubMed database from January 1989 to August 2014 was performed for papers regarding the vacuum sealing drainage technology with the key words of “vacuum sealing drainage technology; injury; gentamicin; hyperbaric oxygen; nerve growth factor; chymotrypsin” in Chinese or English. Finaly 48 articles were involved in the final analysis according to the inclusion criteria. RESULTS AND CONCLUSION:Vacuum sealing drainage is a highly effective treatment technique to promote wound healing which can promote wound blood circulation, reduce sweling, inhibit bacterial growth, stimulate growth of granulation tissue by mechanical stress, inhibit cel apoptosis, thereby helping wound healing. Compared to conventional open-dressings, vacuum sealing drainage has a faster wound healing speed, lower infection rate, and fewer dressing change frequency. With recent advances in medicine, vacuum sealing drainagetechnology cannot be simply used for treatment of skin soft tissue damage, but in combination with gentamicin, hyperbaric oxygen, nerve growth factor and chymotrypsin to achieve better therapeutic effects.

Background The retina ischemia reperfusion injury (RIRI) can lead to apoptosis,which is associated with many genes.It is very significant to explore the protection of drugs on RIRI-induced apoptosis.Objective This study was to explore the relationship between the expression of Nogo-A and the cell apoptosis as well as the therapeutic effect of NEP1-40 in RIRI retina.Methods The device of raising intraocular pressure (IOP)was used to elevate the IOP for 60 minutes and then restore the IOP to normal for the establishment of RIRI models.Seventy-eight SD rats were randomized to the normal group,RIRI group and NEP1-40 group.PBS of 5 ml/(kg · d)was injected intraperitoneally in the rats of the RIRI group,and NEP1-40 of 8 mg/(L · kg) was used in the same way in the NEP1-40 group.The rats were sacrificed in overdose anesthesia at 6 hours,12 hours and 1 day,2,3,7 days after RIRI to prepare the retinal specimens.The ultrastructure of rat retinas was examined under the transmission electron microscope.Cell apoptosis was assessed by the TUNEL method,and the apoptotic index (AI) was calculated.The expressions of Nogo-A protein and mRNA in rat retinas were detected by immunohistochemistry and semiquantitative reverse transcription PCR (RT-PCR).Results The ultrastructure of retinal cells were normal in the normal group.Retinal cell organelle dissolution,mitochondria swelling,cavitation,chromatin edge heterochromatin and apoptotic body were seen in the rats of the RIRI group from 12 hours through 7 days after injection.However,only the slight loose of outer membranous disk,inner and outer nuclear layer and retinal ganglion cells,the nucleus gap broadening,shortness of some mitochondrial cristae in the NEP1-40 group.TUNEL-positive cells appeared 6 hours after RIRI and reached peak in 1 day,and gradually declined after that in the RIRI group.A similar pattern was seen in the rats of the NEP1-40 group with a more mild manifestation.Significant differences were seen in the AI values among the different groups at various time points (Fgroup =100.850,P =0.000 ; Ftime =34.309,P =0.000),and the AI values were significantly higher in the RIRI group and NEP1-40 group compared with normal group;while the AI values in the NEP1-40 group was lower than those of the RIRI group (all at P＜0.05).The expressions of Nogo-A protein and mRNA showed a coincident pattern with apoptosis procedure,with a gradually elevated level from 6 hours through 7 days after RIRI and a peak in 2 days,and those in the NEP1-40 group were weaker in comparison with the RIRI group in various time points.Significant differences were detected in the expression of Nogo-A protein and the expression of Nogo-A mRNA among different groups and various time points(protein:Fgroup =164.139,P =0.000;Ftime =21.772,P =0.000.mRNA:Fgroup =93.889,P =0.000 ; Ftime =6.349,P =0.000).Conclusions Nogo-A probably plays an important role in RIRI.NEP1-40 can protect retinal cells from apoptosis following RIRI through down-regulating the expression of Nogo-A.

This paper introduced the design and application of the performance appraisal scheme for the interventional operation platform.The comparison of interventional operations before and after the means of performance management in place, presented the effective role of performance management in interventional operation platform, and analyzed the motivation effect of performance management on the enthusiasm of interventional operators.The authors recommend performance appraisal and incentive compensation mechanism to motivate the clinical use of the platform, and greater application of such a common platform, for perfection of surgery performance management.

Objective To evaluate the outcomes achieved by using left internal mammary artery(LIMA) to radial artery (RA) total arterial composite grafts in minimally invasive direct coronary artery bypass grafting (MIDCAB) for patients with multiple vessel disease.Methods From January 2009 to September 2015, 39 patients(24 males) with multiple vessel disease underwent MIDCAB with LIMA-RA total arterial composite grafts without cardiopulmonary bypass in our hospital .MIDCAB was performed through a left anterior minithoracotomy .Results All patients successfully underwent MIDCAB with LIMA-RA total arterial composite grafts.No patient required to convert to strenotomy during the surgery.Mean operation time was(176.1 ± 14.1)min.Revascularization was performed for 2 target vessels in 11 cases, 3 target vessels in 25 cases and 4 target vessels in 3 cases.Mean postoperative ventilation time was(21.9 ±27.9) h.Mean ICU time was(2.8 ±2.1) days, and mean postoper-ative inhosptial time was(11.2 ±3.3)days.There was no early death in perioperation.At a follow-up of 6 to 86 months[aver-age(27.5 ±18.0) months], one patient died.The overall survival at 2 years postoperatively was(96.0 ±3.9)%.The paten-cy rate of LIMA was 100%.The overall patency rate of RA grafts at 2 years postoperatively was(91.8 ±4.0)%.Conclusion MIDCAB with LIMA-RA total arterial composite grafts is a safe and effective procedure with favorable early and mid-term out-comes for patients with multiple vessel disease .

Objective Objectives: To introduce the technique of performing minimally invasive concomitant Cox Maze Ⅳ ablation procedure entirely by bipolar clamp through right lateral minithoracotomy for patients with atrial fibrillation(AF) associated with mitral valve diseases.Methods Sixty nine patients with mitral valve disease and long-standing persistent AF received minimally invasive Cox Maze Ⅳ ablation procedure combined with mitral valve surgery from June 2012 to January 2015.The etiology of mitral valve disease was rheumatic(41 cases) and degenerative(28 cases).Age at operation ranged from 52 to 71 years.There were 43 males and 26 females.AF duration ranged from 1.5 years to 13 years.Diameter of the left atrium ranged from 42 to 60 mm.Diameter of the left ventricle ranged from 43 to 66 mm.Left ventricle ejection fraction (LVEF) ranged from 0.45 to 0.67.Concomitant Maze Ⅳ ablation procedure was performed through right lateral minithoracotomy entirely by bipolar radiofrequency clamp.Results All patients successfully underwent this minimally invasive concomitant Maze Ⅳ ablation procedure and mitral valve surgery.The mean cardiopulmonary bypass time was(130.3 ± 17.7) minutes.The mean aortic crossclamp time was(91.8 ± 12.7) minutes.No patient needed conversion to sternotomy during the surgery.There was no early death or pacemaker implantation in the perioperation.The average length of hospital stay was(9.8 ± 3.3) days.At discharge, 65 patients(65/69, 94.2％) maintained sinus rhythm.At a mean follow-up time of(21.0 ± 8.6) months, sinus rhythm was restored in 62 patients(62/69, 89.9％).Cumulative maintenance of normal sinus rhythm without AF recurrence at 2 years postoperatively was(85.1 ± 5.8)％.Conclusion The minimally invasive concomitant Maze Ⅳ ablation procedure performed entirely by bipolar clamp through right lateral minithoracotomy was a safe, feasible, and effective technique for patients with AF associated with mitral valve diseases.

Objective The aim is to observe the role and mechanism of estradiol ( E2 ) on the proliferation of rat hippocampal neural stem cells ( NSCs ) .Methods Twenty hippocampi from embryonic 17-day ( E17 ) SD rats were dissociated and plated into culture flasks with NSCs specific medium containing different concentrations of estradiol .The proliferation and the vitality of NSCs were detected by immunofluorescence against BrdU and MTT assay .The expression of estrogen receptors ( ERαand ERβ) was measured by immunofluorescence staining combined with Nestin double labeling . Results BrdU and MTT assay results showed that the cell number increased when the concentration of estradiol increased from 10 -10 to 10 -8 mol/L.The number of cell proliferation and the viability of cells were best at the concentration of 10 -8 mol/L compared to the other groups .However, when the estradiol concentration was increased from 10-8 to 10 -6 mol/L, the cell proliferative capacity declined gradually .Double immunofluorescence labeling showed that the two types of estrogen receptors ( ERαand ERβ) were expressed in the cultured hippocampal NSCs .Conclusion Estradiol promotes the proliferation of hippocampal NSCs in a certain concentration range , and ERαand ERβmay be involved in the estradiol-induced proliferation .

Objective To sunomanize the experience of consecutive 353 patients and mean 2-years follow-up following Mei mini maze procedure for atrial fibrillation.Methods Between June 2010 and May 2015,353 patients(240 males, 113 females) of atrial fibrillation received this therapy.The age of these patients were(59.7 ± 8.5) years.Among them, 186 were with paroxysmal and 167 were with non-paroxysmal.The procedure, through three ports on left chest wall, included pulmonary vein isolation and ablations of the roof and posterior wall of left atrium which were achieved by bipolar radiofrequency ablation.Ganglionic plexus ablation was made by the ablation pen.Left atrial appendage was excluded.Results Durations of their procedures were(92.3 ± 19.1) mins.No conversion to sternotomy or pacemaker implantation occurred and none of the patients died.The hospital stay was(8.5 ± 2.1) days.The mean follow-up duration was (25.0 ± 15.1) months.308 (90.1％) patients were in sinus rhythm.34 patients could not maintain sinus rhythm.Stroke, thrombus in the left atrium and stenosis of pulmonary vein were not found after their procedures.Conclusion Mei mini maze procedure is a safe, effective, and appropiiate treatment for AF, which restores sinus rhythm and may be associated with the prevention of AF-related stroke.It deserved to be promoted in future.

Objective To summarize the experience of hybrid repair performed in high risk patients with dissection involving the aortic arch.Methods From Sep.2007 to Mar.2015,hybrid repair was performed in 33 high risk patients with dissection involving the aortic arch including acute (n =8),subacute (n =15),or chronic (n =10) cases.Descripitive statistics were computed for continuous and categorical variables.Results There were 22 male and 11 female patients with a mean age of(69 ± 10) years,and ASA Physical Status Ⅲ-Ⅳ.Simultaneous (n =27) and staged (n =5,mean interval 5.0 ± 1.3 days)endovascular repair were performed via femoral artery.The technical success rate was 100％.The average hospital stay was (16 ±6) days.One case died of cerebral infraction.There were two with strokes,one with pneumonia and two with renal failure as complications.Median follow-up was 47 months (3-66 months).There were four deaths with two were related to aortic artery.Endoleak was found in 3 during follow-up.One type Ⅰ endoleak was cured after remedy hybrid repair.Conclusions Hybrid repair performed in patients at high risk with dissection involving the aortic arch is less invasive with favorable medium and long-term outcomes.

Objective To establish a suitable evaluation index system to track implementation effect of clinical research program.Methods Delphi method was used to creat the evaluation index system.The weighted average method was adopted to determine the weight of each index.Results After two rounds of expert consultation,twenty seven evaluation indices were selected,including three first-class indices,eight second-class indices and sixteen third-class indices,and the weight of each index was determined.Conclusions The evaluation index system reflects the purpose of tracking clinical research to a certain extent.This index system is simple and easy to be used.