Objective:To summarize the experience of surgical treatment of valvular heart disease with enlarged or small left ventricles. Methods:Valvular operations were performed in 473 patients,including 38 with enlarged left ventricles(group Ⅰ)and 40 with small left ventricles(group Ⅱ),from April 1998 to June 2005.Postoperative complications between two groups were com- pared and analyzed statistically. Results:The postoperative eomplications were ventricular arrhythmia,low output syndrome,lung infection,renal failure and brain embolism.Low output syndrome tended to occur in group Ⅱ(20%),whereas there was a higher incidence of ventricular ar- rhythmia in group Ⅰ(65.79%).The difference between groups was significant(P＜0.05). Conclusion:To improve the successful operative rate in patients with enlarged or small left ventricles,we should take effec- tive measures to manage the post-procedural complications,such as ventricular arrhythmia(mainly in group Ⅰ)and low output syndrome(mainly in group Ⅱ).

Objective To explore the influence of diabetes on the protective effect of ischemic preconditioning(IPC) on ischemic-reperfused(IR) myocardium of rat.Methods Sixty male SD rats(30 with diabetes and 30 without diabetes) were divided into six groups(10 each): non-diabetic rats control group(group A),non-diabetic rats IR group(group B),non-diabetic rats IPC group(group C),diabetic rats control group(group D),diabetic rats IR group(group E) and diabetic rats IPC group(group F).The isolated heart perfusion Langendorff models were established after rats were sacrificed.Isolated hearts of the two control groups were undergone a 90min perfusion without any other intervention;those of the two IR groups were undergone a 30min equilibration period,a 30min ischemia and a 30min reperfusion;those of the two IPC groups were undergone a 10min equilibration,then elicited by two cycles of 5min ischemia interspersed with 5min reperfusion prior to 30min ischemia and a 30min reperfusion.The recovery rates of the left ventricular function,such as cardiac output(CO) and left ventricular developed pressure(LVDP),and the maximum upstroke and decay velocities of left ventricular pressure(?dp/dtmax) were recorded.The activity of creatine kinase(CK) in coronary outflow,contents of malonyldialdehyde(MDA) and superoxide dismutase(SOD) in myocardium were detected,and myocardial water ratio were assessed.Results In non-diabetic rats IPC group,the activity of CK,content of MDA and water ratio of myocardium declined significantly,while the content of SOD increased and the recovery rates of CO,LVDP and ?dp/dtmax rose significantly compared with that in non-diabetic rats IR group(P0.05).Conclusion Diabetes may inhibit the protective effect of ischemic preconditioning on ischemic reperfused rat heart.

BACKGROUND:Artificial valve replacement for valvular disease has good biocompatibility and hemodynamic characteristics, but there are stil many factors that affect its therapeutic effects. OBJECTIVE:To detect the level of serum Apelin-12 in the perioperative period of valve replacement in valvular disease patients with atrial fibrilation. METHODS: Sixty-two patients with valvular heart disease scheduled for artificial valve replacement were selected, including 30 patients with persistent atrial fibrilation (atrial fibrilation group) and 32 patients with sinus rhythm (sinus rhythm group). There were 33 males and 29 females, with a mean age of (55±11) years. Levels of serum Apelin-12 and makers related to inflammation and oxidative stress were detected in two groups at admission. Furthermore, the sinus rhythm group was sub-divided into postoperative atrial fibrilation (POAF) group (n=8) and non-POAF group (n=24) after valve replacement, and the above-mentioned indicators were detected and compared between these two subgroups. RESULTS AND CONCLUSION:Compared with the sinus rhythm group, the serum level of Apelin-12 was significantly lower in the atrial fibrilation group, while the levels of high-sensitivity C-reactive protein and interleukin-6 and total antioxidant capacity were significantly higher in the atrial fibrilation group (P <0.05). Correlation analysis showed that the serum level of Apelin-12 was negatively correlated with high-sensitivity C-reactive protein level and total antioxidant capacity (r=-0.265,P=0.045;r=-0.960,P <0.001), but not correlated with the interleukin-6 level (r=-0.155,P=0.230). Compared with the non-POAF group, the serum level of Apelin-12 was significantly lower in the POAF group (P< 0.05), but the left atrial diameter, high-sensitivity C-reactive protein level were higher in the POAF group (P < 0.05). Apelin-12 may take part in the occurrence and maintenance of atrial fibrilation through the regulation of inflammations and oxidative stresses. The testing of serum Apelin-12 has a certain value in predicting the occurrence of postoperative atrial fibrilation.

0.05).In the 35 patient who had unitary incontinence before the operation,the symptom disappeared in 6(17.1%) patients,and deteriorated in 2(5.7%).While in the 38 patients without urinary incontinence before the operation,9(23.7%) showed the symptom postoperation.Totally,urinary incontinence was developed in 11 patients after the operation.Conclusions The patients with moderate-to-severe pelvic organ prolapse treated by traditional surgical procedures have a low rate of objective cure and a high rate of recurrent cystocele.It is important to repair the anterior pelvic floor during the operation.And the surgeons should be alert to the possibility of urinary incontinence.

Objective To compare the costs of laparoscopy and laparotomy in the operative treatment of ovarian cysts. Methods Patients with ovarian cysts who were operated on by laparoscopy (83) or by laparotomy (65) in the Peking University Third Hospital from June 2000 to August 2001 were retrospectively analyed.Patients' hospital stay,time taken for the patients to return to work,hospital charges,costs because of inability to work and total costs (including the direct medical costs,direct non-medical costs and indirect costs) were compared between the two groups. Results The mean hospital stay and the mean time taken for the patients to return to work were statistically shorter in the laparoscopy group than those in the laparotomy group.The mean hospital charges were significantly higher and the mean costs of without work were significantly lower in the laparoscopy group.The total costs in the two groups were similar (no significant difference). Conclusions According to the mean income of the people in Beijing,the costs of laparoscopy in the operative of the ovarian cysts are not higher than that of lapatomy.

0.05).The pregnancy rate was 41.5%(17/41) in the(Non-cystectomy) Group,33.3%(23/69) in the Laparoscopic Group,and 25.5%(14/55) in the Open Group,respectively,without significant differences(?~2=2.754,P=0.252).A total of 86 patients(90 cycles) were given a unilateral cystectomy,including 37 cycles in the Open Group and 53 cycles in the Laparoscopic Group.In the 37 cycles of the Open Group,the number of dominant follicles was less in affected ovary(4.41?4.02) than in contralateral one(6.14?4.37)(t=-2.364,P=0.024),whereas in the 53 cycles of the Laparoscopic Group,the number of dominant follicles was significantly less in affected ovary(3.33?3.50) than in contralateral ovary(6.40?3.61)(t=-5.358,P=0.000).Conclusions Both laparoscopic and open cystectomy of ovarian endometrioma may cause damage to ovarian response of COH.

Objective To summarize the clinical characteristics of recurrent endometrial carcinoma.Methods A total of 22 cases of recurrent endometrial carcinoma from January 2006 to December 2015 were enrolled.Primary diagnosis of endometrial carcinoma were made in our hospital,with complete clinical data and standard NCCN staging operation.The recurrence of endometrial cancer was confirmed by pathological diagnosis after second surgery or biopsy.Clinical data were retrospectively analyzed.Results The median age of primary diagnosis was 52 years old (rang,44-63 years old).And the most common clinical symptom was postmenopausal vaginal bleeding (54.5％,12/22).There were 18 cases (81.8％) of endometrial adenocarcinoma,3 cases (13.6％) of serous adenocarcinoma,and 1 case (4.5％) of clear cell carcinoma.As to the muscular layer infiltration,there were 14 cases (63.6％) ＜ 1/2,7 cases (31.8％) ＞ 1/2 and 1 case (4.5％) involving the whole layer.There were 4 cases (18.2％) of positive pelvic lymph node and no para-aortic lymph nodes metastasis.As to the postoperative clinical pathologic stage,there were 12 cases (54.5％) of FIGO Ⅰ A,5 cases (22.7％) of FIGO Ⅰ B,1 case (4.5％) of FIGO Ⅱ,and4 cases (18.2％) of FIGO ⅢC1.The median recurrent time was 4 years (rang,1.5-7 years),without obvious self-conscious symptoms,including serum CA125 elevated in 12 cases (54.5％) and positive ultrasound,CT or X-ray examination findings in 10 cases (45.5％).As to the recurrence location,14 cases (63.6％) were in the pelvic cavity,6 cases (27.3％) of retroperitoneal lymph nodes,1 case (4.5％) of anterior abdominal wall accompaning lung metastasis,and 1 case (4.5％) of lung metastasis.Three patients accept Lynch syndrome screening,of which 2 cases were positive.Conclusions Muscular layer infiltration is common in recurrence of endometrial cancer,with no obvious clinical symptoms.Pelvic cavity is the most common location of recurrence.

Objective:To analyze the effect of glucocorticoid on the biological function of lens epithelial cells (LECs) by bioinformatics and predict related microRNA (miRNA).Methods:GSE3040 database was downloaded and the human LECs line (HLE-B3) cells in the experimental group were treated with 1 μmol/L dexamethasone, and HLE-B3 cells in the control group were treated with 1 μmol/L dimethyl sulfoxide(DMSO).GEO2R was used to analyze the differentially expressed genes between the two groups.Metascape website was employed to analyze the functional enrichment of differentially expressed genes, and EdU cell proliferation assay was performed to detect the difference in cell proliferation between the two groups.STRING website and cytoscape software were used to construct protein-protein interaction network.Hub genes were calculated by cytohubba app, and quantitative real-time PCR was performed to detect the expression levels of hub genes between the two groups.MirCode website was used to predict the related miRNAs.Results:A total of 341 differentially expressed genes were detected between the experimental group and the control group, among which there were 300 up-regulated genes and 41 down-regulated genes. SLC12A1, MED13L, ALDH5A1, SLC15A3 and WWC1 were the top five down-regulated genes and SCNN1A, ANKRD36, FKBP5, PYY and ADH1B were the top five up-regulated genes.The top 20 terms of functional enrichment were listed, and the negative regulation of HLE-B3 cells proliferation showed the most enrichment.Cell proliferation rate in the experimental group was (8.09±0.20)%, which was significantly lower than (39.63±0.80)% in the control group ( t=38.43, P<0.01).The top ten hub genes were SST, CXCL8, GRM1, GNRH1, CXCL5, PPBP, CX3CR1, PYY, EDNRA and GRK5, and quantitative real time PCR confirmed that the expression levels of SST, CXCL8, GRM1, PYY, EDNRA and GRK5 mRNA were statistically different (all at P<0.05).The top six miRNAs which might be associated with hub genes were miR-15abc, miR-214, miR-23abc, miR-129-5p, miR-132 and miR-24. Conclusions:The 1 μmol/L glucocorticoid can negatively regulate the proliferation of HLE-B3 cells. SST, CXCL8, GRM1, PYY, EDNRA and GRK5 may be hub genes and miR-15abc, miR-214, miR-23abc, miR-129-5p, miR-132, miR-24 are most likely to relate to them.

Objective To summarize the experience of application of artificial chordae transplantation in mitral valve repair.Methods One hundred and five patients with mitral regurgitation due to mitral degeneration,underwent mitral valve repair with artificial chordae transplantation.Operative technique included simple Gore-Tex artificial chordae transplantation in 25 cases,artificial chordae transplantation plus quadrangular resection of the posterior leaflet in 67 cases,artificial chordae transplantation plus quadrangular resection of the posterior leaflet and Sliding technique in 13 cases.Results No early death occurred after operation.The postoperative complications were caused in 30 patients including sinus bradycardia in 8 cases,supraventricular tachycardia in 20 cases,late cardiac tamponade in onecase,pacemarker implantation in one case.Hospital time was 9-21 (14 ±4) d.Follow-up was done to 96 patients for 3 months to 5 years with a follow-up rate of 91.4％(96/105).Among 96 cases,one died of cerebral infarction after 13 months,one died from accident while the remaining were alive,74 cases were with cardiac function (NYHA) of grade Ⅰ and 20 cases with grade Ⅱ.No regurgitation was found in 92 cases,mild regurgitation in 2 cases.There were no artificial chordae ruptures.Conclusions The key to improve the early and midterm results of artificial chordae transplantation are to choose patients strictly,to grasp proper surgical skills,to do a good job in intraoperative shaping effect evaluation and the myocardial protection during extracorporeal circulation.

BACKGROUND:Artificial chordae transplantation and saddle ring annuloplasty are the key steps in mitral valvuloplasty. However, there are no large-size studies addressing the safety, validity and efficacy of these treatments in China.
OBJECTIVE:To summarize the efficacy and safety of artificial chordae transplantation and saddle ring annuloplasty in the treatment of degenerative mitral regurgitation.
METHODS:Eighty-five patients with degenerative mitral regurgitation underwent mitral valve repair with artificial chordae (Gore-Tex sutures) transplantation and saddle ring (SJMTM rigid saddle-shaped) annuloplasty from January 2009 to May 2013 in General Hospital of Shenyang Area Military Command, China. Operative technique included simple artificial chordae transplantation in 41 cases, artificial chordae transplantation plus quadrangular resection of the posterior leaflet in 22 cases, artificial chordae transplantation plus quadrangular resection of the posterior leaflet and sliding technique in 23 cases. Al cases received saddle ring annuloplasty.
RESULTS AND CONCLUSION:Fol ow-up after treatment was done among 78 patients for 6 months to 4 years, with a fol ow-up rate of 91.7%(78/85). Among the 78 cases, one case died of cerebral infarction after 13 months, one died from accident, and the remaining 76 were alive. According to the evaluation of cardiac function (NYHA), 59 cases were in grade I and 17 cases were in grade II. Color ultrasound displayed that, no regurgitation was found in 67 cases, and mild regurgitation in 9 cases. The echocardiography showed that postoperative left atrium diameter (P<0.05 or P<0.01), left ventricular end-diastolic diameter (P<0.05 or P<0.01), left ventricular end-systolic diameter (P<0.05 or P<0.01), and the ratio of regurgitation beam area and left atrial area (P<0.05 or P<0.01), mean pulmonary artery pressure (P<0.05 or P<0.01) were significantly decreased compared with that before operation. Ejection fraction was significantly increased after operation (P<0.05 or P<0.01). No systolic anterior motion occurred. The postoperative complications included sinus bradycardia in 12 cases and paroxysmal supraventricular tachycardia in 25 cases, late cardiac tamponade in 1 case at 1 week postoperatively, and pacemarker implantation in 1 case (who exhibited bradycardia-tachycardia syndrome before operation). There was no ring rupture, ring avulsion, hemolysis, left ventricular outflow tract infarction and artificial chordae rupture or splitting. No cases needed reoperation on valve replacement. Application of artificial chordae transplantation and saddle ring annuloplasty is a safe and effective means for treating degenerative mitral regurgitation, with excellent midterm outcomes.