Objective To discuss the effectiveness of heart operation through subaxillary minithoracotomy.Methods Subaxillary minithoracotomy heart operation was carried out in 378 cases between March 1995 and October 2004.The operation was performed under beating heart and without the occlusion of the ascending aorta in 81 cases of atrial septal defect, 32 cases of ventricular septal defect,and 16 cases of other diseases.The operation was completed under low temperature and extracorporeal circulation in other 249 cases.Results The operation was accomplished smoothly in all the cases.The operation time was 167?2.0 min,and the extracorporeal circulation time was 28.1?16.6 min.Postoperatively,1 patient with double-chamber anormaly of the right ventricle was given a tracheotomy because of an acute laryngeal edema,1 patient with tetralogy of Fallot died of low cardiac output syndrome,1 patient had a cerebral embolism,2 patients experienced an incision fat liquefaction,and the remaining patients recovered uneventfully.A follow-up for 2 months ~ 10 years(mean,5.1 years) in 366 patients revealed a full range of physical activities.One case of ventricular septal defect with residual shunt and 1 case of cerebral embolism were fully recovered.Conclusions Subaxillary minithoracotomy open heart operation has advantages of minimal invasion,quick recovery,simplicity of performance,and good cosmetic results.

Objective To explore the effects of liraglutide on cardiovascular in obese men without diabetes mellitus.Methods Ten obese men without diabetes mellitus (body mass index (BMI) ＞ 25 kg/m2)were enrolled in this study.All subjects received 6 months treatments of liraglutide.Cardiovascular risk factors were measured at 0 and 6 months after treatment.Results Compared to the baseline,BMI and blood pressure didn't change(P＞0.05).The waist-hip ratio and hemoglobin A1c (HbA1c) in base line were 0.98±0.04,(5.96± 0.4) 6％,significant different from those after treatment (0.94 ± 0.04,(5.45 ± 0.25) ％;t =2.391,4.115;P＜0.05).The high density lipoprotein cholesterol and superoxide dismutase after treatment were (1.24 ±0.15) mmol/L and (92.6±6.1) U/ml,higher than those before treatment ((1.08±0.16) mmol/L,(83.2 ± ±9.2) U/ml;t =2.843,2.490;P ＜ 0.05).Conclusion Liraglutide improve body fat distribution and cardiovascular risk factors in obese men.

Objective:To investigate the roles of donor alveolar maerophages and the recipient circulating neutrophils in early-stage reperfusion injury of lung allograft,and to study the interaction between the 2 kinds of cells.Methods:Twenty pairs of size-and weight-matched adult mongrel dogs were randomly assigned to 4 groups:C(control),D(leukocyte-depleted blood reperfusion),M(maerophage inhibition)and DM(leukocyte-depleted plus macropbage inhibition).The 20 cases of left lung transplantations were performed by the same surgeon.All procedures were identical,except that the donors in Group M and DM received the macrophage inhibitor gadolinium chloride(14 mg/kg)intravenously 24 h before operation,and that the recipients in Group D and DM underwent initial 10 min reperfusion with leukocyte-depleted blood collected from donors'inferior vena cava. All lung allografts were reperfused for 2 h.Results:Compared with Group D and C,macrophage inhibition ameliorated PO_2/FiO_2 and mean pulmonary arterial pressure(mPAP)consistently after 30 min reperfusion in Group M and DM;the parameters of lung reperfusion injury(malonaldehyde activity,wet/dry ratio)at 120 min after reperfusion were also significantly improved(P

Objective To investigate the clinical features and management of pancreatic disease- associated portal hypertension.Methods A retrospective analysis was carried out in patients with portal hypertension complicating with pancreatic diseases in our hospital from January 1986 to April 2005. Medical records of these patients were reviewed,including data of demographics,etiologies,venous involvement,clinical presentation,laboratory tests,imaging studies,therapeutic modalities and out- comes.Results There were 59 cases of portal hypertension resulted from pancreatic diseases in our hos- pital,accounting for 4% of all portal hypertension in 19 years.The underlying pancreatic diseases were chronic pancreatitis(21 cases,35.6%),pancreatic carcinoma(20 cases,33.9%),acute pancreatitis (8 cases,13.6%),pancreatic pseudocyst(3 cases,5.1%).Of the 40 patients whose venous involve ment was identified,splenic vein obstruction occurred in 27 cases(67.5%),followed by portal vein obstruction(16 cases,40.0%).Mild or moderate splenomegaly was present in 48 cases(81.4%),with leukocytopenia as the most common manifestation of the 31 cases(52.5%)of concomitant hyper- splenism.Forty-five patients(76.3%)developed gastroesophageal varices(including 35 isolated gastric varices),among them,19 had bled(32.2%).Conservative treatment was effective in controlling acute bleeding,but could not prevent re-bleeding.Splenectomy was performed in 18 patients,mainly because of gastrointestinal hemorrhage.No postoperative bleeding occurred in the period of follow-up from 8 months to 9 years.Conclusions Pancreatic diseases may compromise portal vein and its tributaries, leading to generalized or regional portal hypertension.Pharmacological therapy can effectively control acute variceal bleeding,while surgical treatment is the appropriate procedure of choice in case of hemor- rhage recurrence.

Metastasis is the essential character of biological behaviors in malignancies,which is also the main reason for the death of patients with tumor. So it is very important to research the metastasis for the pre-vention and treatment of carcinomas. Rectal cancer is one of the most common gastrointestinal cancer,and its prognosis is bad. lymphatic metastasis is one important factor in the determination of colon cancer' s progno-sis. More than 50% patients are found lymphatic metastasis when taking operation. The ralationship of lym-phatic metastasis and prognosis is more important than the original tumor's invasiving. So it is meaningful to study the mechanism of tumor metastasis, and to provide a scientific approach to the prediction of tumor me-tastasis, the precise assessment of prognosis and the treatment of tumor metastasis.

Objective To summarize the techniques of anatomical liver resection for the treatment of hepatocellular carcinoma(HCC).Methods The clinical data of 125 patients with solitary HCC who underwent anatomical liver resection at the Zhongshan Hospital from January 2005 to December 2006 were retrospectively analysed.The inflow and outflow of hepatic segments to be resected were selectively clamped,then the main branches of portal vein and hepatic artery were ligated,and the ischemic hepatic segments were resected en bloc.Kelly forceps were used to crash and clamp the liver cut surface.The stumps of left and right hepatic ducts were continuously sutured with Prolene sutures.For tumors with the size above 10 cm in diameter,hepatectomy with anterior approach and liver hanging maneuver were adopted.Bile leakage was checked by injecting methylene blue or covering a gauze on the liver cut surface.Results The mean blood loss of all patients was 250 ml(100-6000 ml),and 32 of them needed blood transfusion.The morbidity was 23%(29/125).No patient died within 30 days after the operation,and 6%(5/83)of patients were found with residual tumor by postoperative arteriography.Conclusion Anatomical liver resection may improve the safety of operation,prevent the injury of great vessels and thus improve the efficacy.

Objective To construct a cDNA expression library from unfed female tick Haemaphysalis longicornis for screening and cloning potential antigenic genes.Methods Total RNA was isolated from unfed female ticks,mRNA was purified and a library of oligo(dT)-primed cDNA with added directional EcoR Ⅰ/Hind Ⅲ linkers was constructed from the purified mRNA.The constructed cDNA was ligated to the EcoRⅠ/HindⅢ arms of the ?SCREEN vector.Pure phage stocks were harvested by plaque purification and converted to plasmid subclones by plating phage on host strain BM25.8.Recombinant plasmids that were subcloned to E.coli BM25.8 were isolated and transformed into E.coli JM109.Recombinant plasmids abstracted from JM109 were identified by PCR and sequencing.Rusults The recombinant phage DNA was packaged by using phage-marker packaging extracts,resulting in a primary cDNA library with a size of 1.8?106 pfu.Data showed 100% of the library were recombinant and the titer of the amplified library was 2.4?109 pfu/ml.Forty-two clones of encoding immunodominant antigens were obtained from the cDNA library.Sequence analysis revealed 12 unique cDNA sequences and the encoded putative proteins showed similarities to H.longicornis tropomyosin mRNA,Rhipicephalus annulatus unknown larval protein mRNA,chromosome 2R of Drosophila melanogaster,mitochondrial DNA of H.flava,clones HqL09 unkown mRNA and Hq05 mRNA of H.qinghaiensis,and myosin alkali light chain protein mRNA.Conclusion The cDNA expression library from unfed female H.longicornis was successfully constructed and screening of protective genes may provide candidate antigens of the tick.

Objective To compare the dosimetric results of postoperative intensity modulated radiation therapy (IMRT) using single-energy or mixed-energy photons in invasive thymoma patients.Methods Simulation CT images were acquired and clinical target volume (CTV),planning target volume (PTV) and organs at risk (OARs) were defined.Three sets of fixed-field IMRT planning were generated using 6 MV,10 MV and mixed 6/10 MV photons for each case.Monitor Units (MUs) for each plan were recorded after optimization,and parameters of PTV such as conformity index (CI),homogeneity index (HI) and dose to OARs were evaluated on dose-volume histograms.Results Near-Maximal dose (D2％) received by PTV was better in mixed-energy IMRT as compared with 6 MV(t =3.107,P ＜0.05).HI was better in mixed-energy than in 6 MV(t =2.924,P ＜0.05).There were statistically significant differences in CI among three IMRT plans.MU was higher in 6 MV than in both 10 MV and mixed-energy IMRT.The percentages of lung volumes receiving 5 Gy (V5),10 Gy(V10),20 Gy (V20),30 Gy (V30) and the mean lung dose (D) were also significantly different in most plans.V30 and V40 of the heart were comparable between 6 MV and mixed energy plans but better than in 10 MV plan.Conclusions If the reasonable choice of beam angles and number,and capability of energy selection according to beam directions,with combined advantages of low and high energy photons,mixed IMRT plans can improve the quality of IMRT plans in general and has clinical potential for postoperative radiotherapy of invasive thymomas.

OBJECTIVETo observe the effects of tetrandrine (Tet) on the pulmonary capillary permeability in rats with acute lung injury induced by intravenous injection of lipopolysaccharide (LPS).

METHODSThirty-two healthy male Wistar rats were randomly divided into 4 groups: the model group, the normal group, the Tet prevention group and the Tet treatment group, 8 in each group. All rats except those in the normal group, were established into acute lung injury model by intravenous injection of LPS. Intravenous injection of Tet (20 mg/ kg) were given to the Tet prevention group 30 min before and to the Tet treatment group 30 min after modeling respectively, and equal volume of normal saline was given to the other two groups instead. Arterial blood samples were collected to determine PaO2 and PaCO2 at the time points of immediately after modeling (0 h), 0.5 h, 2 h, 4 h, 6 h. The animals were sacrificed by the end of the experiment, the wet/dry weight ratio of lung (W/ D), neutrophil percentage in bronchoalveolar lavage fluid (BALF), concentration of TNF-a in peripheral blood and BALF by ELISA, and content of malonaldehyde (MDA) in lobus inferior pulmonis homogenate by thio barbituric acid colorimetric method were determined. Pathological change of the upper lobe of lung was examined and lung injury was scored as well.

RESULTSAs compared with that in the model group, the level of PaO2 was higher in Tet prevention group at 0.5 h, 2 h, 4 h, 6 h and in the Tet treatment group at 2 h, 4 h, 6 h (P< 0.05); and the content of TNF-alpha, MDA and neutrophil percentage in BALF, as well as W/D and lung injury score were lower in the Tet prevention group and the Tet treatment group (P <0.05). Pathological changes of lung in the two Tet groups were all better than those in the model group.

CONCLUSIONEarly intervention with tetrandrine shows a protectiv effect on rats against acute lung injury induced by intravenous injection of LPS.

Acute Lung Injury ; chemically induced ; pathology ; physiopathology ; Animals ; Benzylisoquinolines ; pharmacology ; Capillary Permeability ; drug effects ; Drugs, Chinese Herbal ; pharmacology ; Female ; Lipopolysaccharides ; Lung ; blood supply ; Male ; Random Allocation ; Rats ; Rats, Wistar

Objective To analyze indications,complications and outcomes of amputation.Methods A total of 15 patients undergone amputation in field or at tent hospital were collected for analy-zing injury severity,place where amputation was done,whether open or closed amputation and stitch re-moval time. Results There were 9 males and 6 females.at an average age of 32 years(11-51years).There were 16 amputations including Gustilo IIIB in 2 patients, Gustilo IIIC in 9 and Tscheme Ⅲin 5 according to Gustiln classification or Tscheme classification.Four patients who received amputation in field or at tent hospital developed infection and had to receive amputation again at a higher level on the limb and drainage of open wounds because of a higher infection rate due to the amputation location.Ten patients received first amputation at higher levels with open wound at station hospital but only 2 manifested infected incision.High level amputation with one stage closure was done in 1 patient who was infected and suppurated after operation and even developed bacteremia. Conclusions Infection rate following am-putation 4n field and tent clinics is rather higher,so secondary open amputations should be performed at a higher level as soon as possible.One-time and high-level open amputation plays an important role in treat-ment of severe lower limb injuries following earthquake.