Objective To investigate the feasibility of minimal access valve surgery. Methods The authors performed minimal access valve surgery from January 1997 to January 2003 in 72 cases: 36 cases of mitral valve operations and 9 cases of tricuspid valve operations were performed through right anterolateral thoracotomy; 5 cases of aortic valve operations through mini-sternotomy approach; 5 cases of aortic valve operations and 2 cases of mitral valve operations through para-sternotomy approach; 15 cases of mitral valve operations through “reversed L” mini-sternotomy access. Results In the early course following the surgery (within 1 postoperative month ) 71 patients survived and 1 patient died of acute hepatic and renal failure.Complete follow-up in 64 patients for 6～60 months(mean, 13 months) revealed that all the patients responded symptomatically, with New York Heart Association (NYHA) Class Ⅱ status in 56 patients and Class Ⅲ in 8 patients. Color ultrasonocardiogram revealed normal status of mechanical or biological valves. All the patients were satisfied with cosmetic results. Conclusions Minimal access valve surgery is feasible, and is also associated with a better outcome in terms of sternal stability and postoperative recovery.

Objective To investigate the effects of different analgesia protocols on immune function in patients undergoing surgery for ovarian neoplasms after neoadjuvant chemotherapy.Methods Forty ovarian neoplasms patients ageing from 31 to 62 years undergoing neoadjuvant chemotherapy were randomly divided into 2groups:epidural analgesia group (group E,n =20) and intravenous analgesia group (group Ⅰ,n =20).All patients underwent surgery under total intravenous general anesthesia.Patients in group E were given 2 mg morphine in epidural space at half an hour before abdomen was closed,then epidural analgesia pump was installed,with ropivacaine composite morphine in the pump.Analgesia time was 48 h.Patients in group Ⅰ were given sufentanil 0.1 μg/kg intravenously at half an hour before abdomen was closed,then analgesia pump was installed,with sufentanil compound flurbiprofen ester in the pump.Analgesia time was 48 h.The cervical venous blood samples were obtained from the patients at 30 min before surgery(T0),immediately(T1),12 h(T2),24 h(T3) and 48 h (T4) after the end of operation for determination of the expression of CD3 +,CD4 +,CD8 + on T cells and natural killer cell.Visual analogue scales (VAS)and adverse reaction at T2-4 were recorded.Results No statistical difference was found between group E and group Ⅰ in VAS and adverse reaction.Compared with T0,CD3 +,CD4 + T-lymphocytes,CD4 +/CD8 +,and NK cell decreased.Compared with group E,CD8 + increased at T1-2in both groups and at T3-4 in group Ⅰ.CD3 +,CD4+ T-lymphocytes,CD4+/CD8 + and NK cell decreased while CD8 + increased at T2-4 in group Ⅰ.Conclusion Epidural analgesia may be better to promote the immunologic function of ovarian neoplasms patients undergoing surgery after neoadjuvant chemotherapy.

Objective To evaluate the role of mammalian target of rapamycin (mTOR ) in reduction of oxygen-glucose deprivation and restoration (OGD/R )-induced injury to isolated cardiomyocytes by hypoxic preconditioning (HPC) in neonatal rats .Methods Primary cardiomyocytes were obtained from neonatal Sprague-Dawley rats (1-3 days after birth ) ,and seeded in 96-well plates at the density of 1 × 105 cells/ml (200μl/well ) . The cells were randomly divided into 6 groups ( n=6 each ) using a random number table:control group (group C) ,rapamycin group (group R) ,group OGD/R ,rapamycin+OGD/R group (group R+OGD/R);group HPC+OGD/R ,and rapamycin+HPC+OGD/R group (group R+HPC+OGD/R) .Rapamycin (final concentration 20 nmol/L) was added to the culture media and the cells were then incubated for 1 h in group R .In R+OGD/R group ,rapamycin (final concentration 20 nmol/L ) was added to the culture media ,the cells were then incubated for 1 h ,and then OGD/R was performed .In HPC+OGD/R group ,OGD/R was performed immediately after HPC was completed .In R+HPC+OGD/R group ,rapamycin (final concentration 20 nmol/L) was added to the culture media ,the cells were then incubated for 1 h , and then HPC and OGD/R were performed . All the cells were subjected to OGD for 2 h followed by restoration of O2-glucose supply for 3 h to induce OGD/R .HPC was induced by 3 cycles of 10 min hypoxia followed by 30 min reoxygenation .The cell viability (using MTT assay ) and lactic dehydrogenase (LDH) activity in the culture medium were determined .Results Compared with group C ,the cell viability was significantly decreased , and LDH activities in the culture medium were increased in OGD/R , R+OGD/R ,HPC+OGD/R and R+ HPC+OGD/R groups ( P<0.05 ) ,while no significant change was found in the cell viability and LDH activities in R group ( P>0.05) .The cell viability was significantly higher ,and LDH activity in the culture medium were lower in HPC+OGD/R group than in OGD/R group ,and in R+HPC+OGD/R group than in HPC + OGD/R group ( P< 0.05 ) .Conclusion mTOR is involved in HPC-induced attenuation of OGD/R injury to isolated cardiomyocytes in neonatal rats .

OBJECTIVETo investigate the effects of total flavonoids of propolis (TFP) on apoptosis of myocardial cells of chronic heart failure and its possible mechanism in rats.

METHODSSix male SD rats were randomly selected as normal control group, the remaining rats were made as chronic heart failure (CHF) model by intraperitoneal injection of adriamycin. The rats in the successful model were randomly divided into five groups (n = 6): CHF group, total flavonoids of propolis low dose group (LD group), total flavonoids of propolis middle dose group (MD group), total flavonoids of propolis high dose group (HD group), digoxin group (DIG group). After six week treatment, cardiac function indexes of rats were recorded by signal acquisition system; brain natriuretic peptide (BNP), cardiac troponin I (cTnI), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) content in plasma were detected; Myocardial morphological changes and collagen fiber hyperplasia by HE and Masson staining were observed; Myocardial apoptosis was detected with TUNEL method and protein connexin 43(P-Cx43) expression was detected by Western blot method.

RESULTSCompared with NC group, left ventricular systolic pressure(LVSP) and maximal rise/fall velocity of left ventriculad pressure (± dP/dt(max)) absolute value in CHF group were significantly lowered (P < 0.01) while left ventricular end diastolic pressure (LVEDP) was increased significantly (P < 0.01); Contents of plasma BNP, cTnI, TNF-α and IL-6 in the CHF group were significantly improved (P < 0.01). Compared with CHF group, LVSP, ± dP/dt(max) absolute value in MD and HD groups were increased (P < 0.05), and LVEDP was significantly lowered (P < 0.01); LVEDP in LD group was significantly lowered (P < 0.01), changes in LVSP and ± dp/dt(max) absolue value were not obvious (P > 0.05). BNP, cTnI, TNF-α and IL-6 contents in MD and HD groups were significantly reduced (P < 0.01), but those plasma indicator changes were not obvious in LD group (P > 0.05). Western blot showed that P-Cx43 expression in CHF group was significantly higher than that in NC group (P < 0.01) and that in all TFP treatment groups it was decreased compared with CHF group (P < 0.05, P < 0.01), among which pairwise comparisons also showed differences (P < 0.05), myocardial apoptosis index (%)(22.62 ± 3.39) in CHF group was higher than that in NC group( 1.12 ± 0.24) (P < 0.01); compared with CHF group, the apoptosis index of myocardial cells (%) in LD,MD and HD groups, (15.79 + 2.8), (9.28 + 2.1) and (4.73 + 1.14) respectively, were significantly lower than those in the CHF group( P < 0.01). The expression level of P-Cx43 positively correlated with the apoptotic index (r = 0. 861, P < 0.01).

CONCLUSIONTotal flavonaids of propolis have inhibitory effect on apoptosis of myocardial cells of chronic heart failure induced by adriamycin in rats, and the mechanism may be closely related to the regulation of Cx43 expression, especially the regulatory phosphorylation status.

Animals ; Apoptosis ; Chronic Disease ; Connexin 43 ; metabolism ; Disease Models, Animal ; Doxorubicin ; adverse effects ; Flavonoids ; pharmacology ; Heart Failure ; drug therapy ; Interleukin-6 ; blood ; Male ; Myocardium ; pathology ; Myocytes, Cardiac ; drug effects ; Natriuretic Peptide, Brain ; blood ; Phosphorylation ; Propolis ; chemistry ; Rats ; Rats, Sprague-Dawley ; Troponin I ; blood ; Tumor Necrosis Factor-alpha ; blood

Objective To compare the bilateral symmetry characters of corneal topography in patients with different refraction, age and gender.Design Retrospective case series.Participants 1000 eyes of 500 patients who were going to undergo corneal refractive surgery with myopia from 18 to 47 years old.Methods Bilateral corneal topography was obtained using TOMEY Version 3.30.Contact lenses had not been worn for more than a week before the examination,and patients with dry eye or other ocular and systemic diseases were excluded.Main Outcome Measures Symmetry and symmetric rates of corneal topography.Results Bilateral symmetry of loca- tion of the cone apex and refraction:uniform 3.4%;almost symmetry 1.8%;approximately symmetry 79.0%;asymmetry 15.8%.The rates of bilateral symmetry in patients with different refraction:0.05).Conclusions 80% of patients with myopia have bi- lateral symmetric corneal topography patterns.The rates of bilateral symmetry of corneal topography increase with the increase of spher- ical refraction(

Objective:To investigate frequencies of microsatellite instability(MSI)and loss of heterozygosity(LOH)in renal ceil carcinoma(RCC),and to discuss the relationship of clinicopathological characteristics of RCC with MSI and LOH. Methods:Twelve microsatellite markers located at chromosomes 3p,9p and 14q were selected to investigate microsatellite alterations(MSI and LOH)in 31 RCC specimens and their paired metastasis specimens by polymerase chain reaction- polyacrylamide gel elect rophoresis-ethylene dibromide(PCR-PAGE-EB)staining and sequencing.Results:The frequency of MSI could reached 61.3% and that of LOH could reach 54.8%.The highest frequency of MSI was at locus of D9S168(32.3%);the highest frequency of LOH was at locus of D3S1289(21.4%).No correlation was found between MSI or LOH and the patients' age,sex,pathology type and metastastis,except that MSI was correlated with TNM stage of RCC(P

OBJECTIVETo explore the clinical effects of combined slower plasma exchange (PE) and continuous veno-venous hemofiltration (CVVH) with a parallel circuit in the treatment of chronic severe viral hepatitis B patients.

METHODS104 patients with chronic severe viral hepatitis B were divided into three groups: 44 patients were treated with a parallel circuit of combined slower plasma exchange and continuous veno-venous hemofiltration (group A), 30 patients were treated with plasma exchange (group B), and 30 patients received routine treatment (group C). Efficacy of treatment and survival rate in three groups were investigated. The levels of cytokine, plasma sodium concentration and pH value were examined before and after artificial liver support system treatment.

RESULTSIn group A, 7 of 9 patients in coma regained normal consciousness, 6 of 9 patients with hepatorenal syndrome restored renal function, hyponatremia was improved, the balance of pH value was corrected, tumor necrosis factor (TNF)-alpha level was decreased, and the total survival rate was 56.82%. In group B, 2 of 7 patients in coma regained normal consciousness, 1 of 5 patients with hepatorenal syndrome restored renal function. Hyponatremia, pH value and TNF-alpha level were not changed; the total survival rate was 33.33%. Both IL-1 and IL-6 levels were significantly decreased after treatment in group A. IL-10 level was increased in both group A and group B. In group C, 1 of 6 patients regained normal consciousness from coma, none of them restored renal function, and the total survival rate was 16.67%.

CONCLUSIONSCombined slower PE and CVVH with a parallel circuit is a new, safe and effective non-biological artificial liver in the treatment for chronic severe viral hepatitis B patients.

Hemofiltration ; Humans ; Interleukin-10 ; blood ; Interleukin-6 ; blood ; Plasma Exchange ; Tumor Necrosis Factor-alpha

Acute appendicitis is the most common operative disease in general surgery, but it is not also rate disease to see in other clinical department such as Internal Medicine and Obstetric and Gynecology, because it reqnires to differenciate from many other diseases which have similar symptoms. Expecially, because the clipical aymptoms of acute appendicitis are not typieal in children, elderly, and women, it is hard to be diagnosed as acute appendicitis and it is often misdiagnosed as other disease. We performed colonoscopy due to be interpretated aa one of the colon diseases rather than acute appendicitis. But in colonoscopic findings, there were hyperemie and edematous change on the appendiceal orifice of cecum(cherry or acorn shape). So we report 5 cases of acute appendicitis diagnosed br colonoscopy.
Aged ; Appendicitis* ; Child ; Colon ; Colonoscopy* ; Female ; Gynecology ; Humans ; Internal Medicine

OBJECTIVETo investigate the placement of a long tube into the small intestine under fluoroscopic guidance and to evaluate its decompression effect on early postoperative small bowel obstruction (EPSBO).

METHODSFifty-four patients with EPSBO requiring decompression between April 2010 and July 2014 were enrolled in the study. Insertion of a long tube was guided by fluoroscopy. We first used the guide wire to pass the pylorus and then used the 10 Fr feeding tube as an exchangeable tube to put the superstiff wire into the duodenum. Finally the long tube could be passed over the guide wire through the pylorus into the intestine. The total procedure time, the radiation exposure time, and the incidence of complications were evaluated.

RESULTSThe long tubes passed into the jejunum on initial insertion for all patients, so the success rate of this technique was 100%. The long tube was inserted into ileum in 18 patients. The mean total procedure time was 34.4 ± 8.6 minutes, and the mean radiation exposure time 18.9 ± 6.8 minutes. A total of 47 patients (87%) experienced full recovery following long-tube decompression and without the need for surgical intervention.

CONCLUSIONSUsing the wire-exchange technique, it is easy to place a long tube into the small bowel under fluoroscopic guidance. This decompression method is safe and effective for management of EPSBO.

Adult ; Aged ; Decompression, Surgical ; methods ; Female ; Fluoroscopy ; Humans ; Intestinal Obstruction ; surgery ; Male ; Middle Aged ; Postoperative Complications ; surgery ; Retrospective Studies