Objective: To summarize and analyze the early outcomes and clinical experience in 1198 patients undergone off-pump coronary artery bypass (OPCAB). Methods: This multi-center report covers 15 different institutes in China from October 1996 to May 2002. The ratio of OPCAB to conventional coronary artery bypass grafting (cCABG) was 85.2%. The mean age was (61.6?9.0) years. 77.3% patients were male and 22.7% were female. There were 34.6% patients with myocardial infarction, 58.2% with unstable angina pectoris, 18.7% with left main lesion, 76.9% with triple-vessel disease, 1.5% was redo surgery, and 9.9% emergent or urgent surgery. The mean left ventricular ejection fraction was 0.56?0.17. Results: The number of distal anastomosis was 3.1?0.9. IMA was used in 65.6% patients and radial artery was used in 18.0%. 13.5% OPCAB was combined with TMLR. IABP was used in 5.2% patients. The hospital mortality was 1.2%. The morbidity included 0.4% peri-operative myocardial infarction, 0.3% heart failure, 1.2% fatal arrhythmia, 2.0% pulmonary complications, 1.2% neurotic disorder, 0.7% renal dysfunction, 1.0% reopen for bleeding, and 0.6% delayed wound healing. Conclusion: OPCAB surgery is a safe and feasible procedure with good early results. Its late outcomes need further follow-up. OPCAB requires certain special skills and methods in practice so a specific training course should be designed.

Objective To investigate expression changes of Tau protein in retinal ganglion cells (RGCs) and oligodendrocytes (Ols) after stretch injury in rats and explore the relationship of Tau protein with pathological changes after axonal injury. Methods Morphological changes of optic nerves, RGCs and OLs after stretch injury were examined under light microscope in control group, stretch only group, heat stress only group and heat stress pretreatment plus stretch group. The expressions of Tau protein in RGCs and OLs after heat stress and/or stretch injury were observed by using immunohistechemical stai-ning. Results Pathological changes of axons, RGCs and OLs were identified morphologically or quan-titatively after stretch injury to the optic nerves, which was significantly ameliorated through pretreatment with heat stress plus stretch injury. The expressions of Tau protein in RGCs and OLs were increased in stretch only group. There was no significant expression change of Tau protein in heat stress only group. Expression of Tan protein was obviously decreased in heat stress pretreatment plus stretch group. Con-clusions Both neurons and glial cells are involved in pathological process after axonal injury. The ex-pression changes of Tau protein are probably related to delayed axotomy and neuron apoptosis. Heat stress can relieve the impairment of cystoskeleton through decreasing and delaying the expression of Tau protein.

Objective:To introduce a new style of platysma myocutaneous flap and to evaluate its application value in the restoration of oral-maxiofacial defects.Methods:Platysma myocutaneous flap with apron incision was used for the restoration of oral-maxiofacial defects after oral lesion ablation in 15 cases from January,2014 to September,2015.The platysma muocutaneous flap was harvested with a U shaped apron incision.The skin above the flap pedicle was preserved.The platysma pedicle was widened to ensure the flap survival.All the patients were followed up form 4 to 33 months.Results:Of the 15 platysma myocutaneous flaps,12 survived completely and 3 had partial flap necrosis.The total survival rate of the flaps at the recipient site of buccal mucosa,tongue and alveolar was 8/9,1/3 and 3/3 respectively.Additionally,there were 2 cases of disturbed wound healing in the neck.Except for 1 case of carcinoma of gingiva which had apparent cervical scar and 1 case of tongue carcinoma which had limited tongue mobility,the other cases showed a satisfactory recovery of oral-maxillofacial contour and fucnction.Conclusion:Compared with the traditional platysma myocutaneous flap,the platysma myocutaneous flap with apron incision can provide a larger skin paddle,and is suitable for the restoration of small and medium sized buccal mucosa and alveloar defects,but not for tongue defect.

Objective To investigate the role of the QQ group follow up of nursing education on patients with nasopharyngeal carcinoma after radiotherapy in patients after they discharged. Methods Thirty patients with nasopharyngeal carcinoma hospitalized from January to December 2013 in our department were set as control group and another 30 patients with NPC hospitalized from January to December 2014 in our department were assined to in the experiment group. Patients of two group received health education before discharge . The controls were followed up on phone and the experimental group received QQ group follow up of education for one year, besides phone follow-up. The two groups were compared in terms of incidence of adverse reactions one year after discharge. Results One year after discharge , the incidences of side effects in the experiment group were lowered than those in the control group , and the differences were siguificant difference ( all P < 0 . 05 ) . Conclusion The QQ group follow up of nursing education can reduce the incidence of adverse reactions by radiotherapy after discharge.

Objective Total aortic arch replacement and stented elephant trunk surgery is an important surgical method for acute type A aortic dissection, and the short, middle, long term curative effect has been recognized by more and more experts at home and abroad.Circulatory arrest was an independent risk factor for postoperative complications and mortality in patients with type A aortic dissection.The aim of this article is to observed the effection of a new technology to block aortic arch, whicn can shorten the circulatory arrest time to 2 minutes and avoid harm of circulatory arrest on patients.Methods From May 2016 to February 2017, 68 patients with acute type A aortic dissection were divided into the conventional group and the modified group.All the patients underwent total arch replacement and stented elephant trunk surgery.The rectal temperature of the conventional group was 25℃ and circulatory arrest time was 20 min.While the rectal temperature of the modified group was 28℃ and and circulatory arrest time was 2 min.Results In the conventional operation group, 3 patients died after operation while all the patients in the modified group were cured and discharged.There are no differences between the two groups in the time of cardiopulmonary bypass(CPB) and heart arrest time(P>0.05).There are Significant differences in CPB time, circulatory arrest time, postoperative awake time, intubation time, amount of blood used, the amount of drainage during the first two days after operation, the time staying in ICU and the postoperative time in hospital.And the modified group was much better.(P<0.05)Conclusion The results of new technology blocking aortic arch in the patients with acute type A aortic dissection are better than the conventional surgical approach during the perioperative period.This technology is simple and effective.It is worth promoting.

Objective To study the differentiation and proliferation ability of the spinal neural stem cells (NSCs) at different gestational ages in fetal rats. Methods Sprague-Dawley fetal rats were divided into group A (12 days of pregnancy), group B (14 days of pregnancy) and group C (16 days of pregnancy). NSCs were separated with enzyme-assisted microdissection. The diameter and numbers of NSCs balls were measured at different time. The cell growth curve was drawn with CCK8 colorimeter. NSCs were identified with BrdU/Nestin immunohistochemical staining. They were induced with 10% fetal bovine serum for 10 days, and the expression of β-tubulinⅢ and glial fibrillary acidic protein was detected with immunocytochemistry. Results There were cells expressed BrdU, Nestin, β-tubulinⅢ and GFAP in all the group. The most cells (22.74±0.79%) expressed β-tubulinⅢ in the group B, but no significant difference between group B and group C. The cell vitality on the 5th day of third-generation neural stem cells was the most in group B. Conclusion For enzyme-assisted microdissection, it may obtain more neurons to isolate the neural stem cells from 14 days of pregnancy pregnant rats.

Objective To investigate the endoscopic and ultrasonic endoscopic features of colorectal carcinoid and the indications of endoscopic treatment. Methods The clinical data of 22 patients with colorectal carcinoid who had been admitted to our hospital from 2002 to 2007 were collected. The endoscopic and ultrasonic endoscopic features and the relationship between the features and invasion depth of colorectal carcinoid were analyzed. Results Under the endoscope, early carcinoid presented submucosa tumor with 1.5cm in diameter, and yellow or white smooth surface; advanced carcinoid presented submucosa tumor with 0.8-3.0cm in diameter, and yellow or white little nodus or ulcerative surface. The ultrasonic endoscopic feature of the colorectal carcinoid was orbicular-ovate low level echo tumor with punctiform slightly high-level echo and an unsharpness edge. Sixteen mucosal layer-cancers and submucosal layer-cancers were removed by endoscopic mucosal resection, and 10 of them were additional treated by argon plasma coagulation. After a follow-up period of 4-36 months, no recurrence was observed. Conclusions Endoscopy and endoscopic ultrasonography are effective methods to diagnose colorectal carcinoid and its invasion depth. Endoscopic treatment is a simple, safe and effective means to treat the early colorectal carcinoid tumors.

Objective: To study the antitumor effects of transmembrane TNF-? and secretory TNF-? in vivo. Methods: Three types of TNF-? cDNA plasmids (wild type TNF-?; transmembrane TNF-? mutant; secretory TNF-? mutant) were directly injected into tumor-tearing mice. Results: The three types of TNF-? could be expressed by tumor cells and all of them could inhibit evidently the rate of tumor growth. The tumor regression after treatment with transmembrane TNF-? mutant at the early stage was more significant than that with the other two types of TNF-?( P

Objective To investigate the clinical features of malignant conversion of oral submucous fibrosis (OSF) and the application value of polyflaps perforator flaps in its surgical treatment.Methodis Ten patients who suffered from malignant conversion of OSF underwent simultaneous multiple defects reconstruction using polyflaps perforator flaps after radical tumor resection from August 2012 to October 2014.The fibrous bands leading to severe trismus near the pterygomandibular ligament as well as other intraoral lesions with malignant tendency were also resected besides from the known carcinoma.Patients with synchronous multiple primary cancers underwent radical resection and neck dissection of all other malignant lesions.The flaps were cut and tailored between adjacent perforators according to the amount and size of defects,forming several independent paddles for each defect reconstruction.Results Twenty-two defects were formed in 10 patients with malignant conversion of OSF.All of them were repaired with polyflaps anterolateral thigh (ALT) perforator flaps,including 8 cases of bipaddled ALT flaps and 2 cases of tripaddled ALT flaps.The total size of the flaps ranges from 3 cm ～ 8 cm × 6 cm ～ 24 cm,and the pedicle length ranges from 5 ～ 12 (9.7 ± 2.1)cm.Thirty-five perforator vessels were dissected,and each paddle included 1.6 perforators on average.All flaps survived after transplantation,and only 1 patient had infection of the neck incision.Post-operative adjuvant radio-chemotherapy was applied in 2 patients.All patients showed satisfactory accepting-site morphology with good speech function and swallowing recovery,and their trismus was improved during 6 to 30 (11.6 ± 3.7) months.One patient died from lung metastasis 10 months after the surgery while local recurrent or metastasis did not occur in others.The donor sites were closed primarily without skin-grafting,leaving no obvious surgical donor-site complications.Conclusions Polyflaps perforator flaps can reconstruct multiple and sizable complicate defects,increase month opening by one stage operation.They are worth being applied in surgical treatment of malignant conversion of OSF.

Background Behcet's disease is a refractory panuveitis with high blindness rate.Multifocal electroretinography (mfERG) is a useful tool for the evaluation of the function of the posterior retina.ObjectiveThe aim of this study is to assess the characteristics of Behcet's disease using the mfERG.Methods mfERG was recorded in 68 eyes of 39 cases with active stage of Behcet's disease.All of the patients were diagnosed based on the Standard of International Study Group for Behcet's Disease and assigned to the cystoid macular edema (CME) group and the diffuse macular edema (DME) group after assessment by fundus fluorescein angiography (FFA).Seventeen normal subjects were used as controls.Oral informed consent was obtained from all of the subjects prior to this trial.mfERG recording followed the ISCEV Guidelines for Clinical Multifocal Electroretinography (2007 edition).The response density and latency of P1 and N1 waves in 6 rings were analyzed and compared.Results The amplitudes of N_1 waves from rings 1 through 6 and N1 wave from rings 1 through 5 were significantly declined in patients with Behcet's disease compared with normal control (P＜0.01).All of the latencies of P_1 waves from rings 1 through 6 were insignificantly shortened in patients with Behcet's disease compared with normal control (P＞0.05).The amplitudes of P_1 and N_1 waves from rings 1 through 6 in diffuse macular edema group were considerably lower than those in the cystoid macular edema group (P＜0.05,P＜0.01).A test of visual acuity showed a negative correlation to the amplitude and latency of N_1 wave (r=-0.36,-0.37,P＜0.05 ) and a positive correlation with the amplitude of N1 wave (r=0.43,P＜0.05) in the DME group.In the CME group,a test of visual acuity presented a negative correlation to the amplitude and latency of N1 wave and latency of P1 (r=-0.41,-0.35,-0.40,P＜0.05 ) and a positive correlation with the amplitude of P1 wave (r=0.48,P＜0.05).Conclusion mfEGR demonstrates that retinal electro-activity is abnormal in eyes with Behcet's disease.The distinct functional disorder is situated around the fovea.