Objective To sum up the experience of perioperative management of patients with heart transplantation.Methods In recent 3 years 24 cases of dilated cardiomyopathy,4 cases of(serious) valve disease,1 case of serious ischemic cardiomyopathy and 1 case of bi-ventricular assist(received) heart transplantation surgery.The mean by pass time was 75?24 min and the mean aortic clamp time was 72?8 min.Cyclosporine,MMF and prenisodone were adopted as anti-immune(response) strategy and the dose of cyclosporine was adjusted according to the serum concentration.(Intramyocardial) electrograms and tissue Doppler ultrasound technique were used to monitor the(immune) response situation.The myocardial biopsy was performed in case of the suspect of acute(rejection).Results In 5 postoperative deaths,3 cases died of low cardiac output,1 died of infection-(induced) multiple organ failure and 1 case died of serious bleeding.The postoperative complications(included) right heart failure in 6 cases,renal failure in 13 cases,and acute rejection in 4 cases.(Conclusion) The effective prevention and management of complications is the key point of success of heart transplantation.Application of comprehensive monitoring techniques is beneficial to the management of the immune rejection after transplantation.

Objective To study some sensitive electrophysiological parameters in surveillance of allograft rejection.Methods Forty rats underwent heterotopic heart transplantations.IMEG was re- corded by an epicardiac unipolar pacing lead fixed at the right ventricular outflow tract.QRS amplitude and heart rate were determed daily in 10 syngeneic and 30 allogeneic transplants.Syngeneic transplants were killed at 7 th postoperative day,and allogeneic transplants killed at 3 rd,5 th and 7 th postopera- tive day.Histopathologie studies were performed at every transplanted heart.Results In syngeneic group,QRS amplitude kept constant after the transplantation while no significant differences were ob- served at the 3 rd,5 th and 7 th postoperative day.QRS amplitude was dropped obviously in allogeneic group after the first two postoperative days whereas significant differences were observed at the rejec- ting and non-rejecting hearts.Conclusions IMEG is a valid method to monitor acute allograft rejec- tion.QRS amplitude is a more sensitive electrophysiological parameter to diagnose severe rejections than heart rate,while mild rejections were not detected by this method.

Objective To evaluate the application value of virtual touch tissue quantification(VTQ) in the differential diagnosis of small breast lesions.Methods Fifty-six patients with sixty-nine small breast lesions whose largest diameter were less than or equal to 1 cm were evaluated with VTQ.The shear wave velocity (SWV) of the lesions and normal breast tissue were measured to analyze the diversity of different pathological types lesions of SWV and to find the optimal cut-off points using ROC curve to predict small breast cancer.Resuits The mean SWV(Vm) and the ratio (mean of lesions and normal tissue) of SWV (Vm1/Vm2) in benign group was (2.93 ± 1.32)m/s,1.79 ± 0.63,respectively,and that in malignant group was (5.65 ± 2.63) m/s,3.61 ± 1.35,respectively,there were statistically significant differences between benign group and malignant group (t test,P ＜0.05).The cut-off point of Vm was determined as 4.43 m/ s,the sensitivity,specificity and accuracy of diagnosing breast cancer were 80.5％,89.3％,92.8％,respectively.The cut-off point of Vm1/Vm2 was determined as 2.37,the sensitivity,specificity and accuracy of diagnosing breast cancer were 76.9％,81.2％,89.9％,respectively.Conclusions VTQ technique can provide helpful information in the differential diagnosis of small breast lesions.

Objective To evaluate the applicative value of ultrasound elastography in diagnosis of focal lesions in the parotid and submandibular glands.Methods 30 patients(30 lesions) were scanned by real-time ultrasound elastography and were analyzed in elastography evaluated criteria (5 score method).All the results were compared with the pathological types.Results The elastographic grades of most benign nodules were 1 - 3,while most of malignancy were 4 - 5.The elastographic grades of benign and malignant lesions were of significant difference statistically( P ＜0.01 ).If elastographic grade 4 or 5 were diagnosed as malignancies,the sensitivity,specificity and accuracy for diagnosing malignant l(e)sions in the parotid and submandibular glands were 72.73 ％,84.21 ％,80.00 ％,respectively.Conclusions Ultrasound elastography is useful in the differential diagnosis of focal lesions in the parotid and submandibular glands.

ObjectiveTo analyze the perioperative risk factors of right heart failure (RHF) in human heart transplantation, and to summarize the efficacy of targeted agent especially on pulmonary hypertension.Methods Patients underwent heart transplantation were selected by exclusion criteria : (1) acute heart or other organ failure, or supported by mechanical assist device ; (2) the difference between the body weight of donor and recipient was ＞ 20％ ; (3) the ischemic time of donor was＞ 6 h; (4) acute rejection episode after transplantation; (5) perioperative death.The clinical data of 96 patients were collected, including gender, age, body weight, protopathy, history of heart failure, preoperative systolic pulmonary arterial pressure (SPAP), left ventricle end diastolic diameter (LVEDD), preoperative ejection fraction(LVEF), preoperative blood creatinine, donor ischemic time and preoperative application of 5-PDEs.The diagnosis standard of RHF was established.The risk factors were analyzed through Logistic Regression.Patients were divided into two groups according to the systolic pulmonary arterial pressure (SPAP).In group A, SPAP was ＜40 mm Hg, and in group B with SPAP≥40 mm Hg.The correlation between two groups was tested byχ2 test.ResultsIn the multivariable analysis, age, history of valve disease, length of heart failure,and preoperative SPAP were the risk factors of RHF with the coefficient of 1.051, 1.351, 1.712 and 6.725, respectively.SPAP seems to be the most important risk factor.Coronary artery disease and preoperative application of 5-PDEs-I were the favorable factors with the coefficient of 0.056 and 0.034, respectively.Parameters regarding age, history of valve disease, length of heart failure between the two groups were significantly different.There were no significant differences in gender, body weight, diagnosed as dilated cardiomyopathy or coronary artery disease and other etiologies, preoperative LVEDD, preoperative EF, preoperative blood creatinine, isehemic time and RHF, though the incidence of RHF in group B was higher than in group A (67.6％ vs 45.8％).There was also no statistic difference in using of ECMO and the mortality rate between two groups.ConclusionPreoperative PAP was the main risk factor of the RHF after heart transplantation.Although there was no statistic difference, the incidence of RHF in patients with SPAP≥40 mm Hg was higher than in patients with SPAP ＜40 mm Hg .The application of targeted agent therapy and ECMO may be helpful in treating RHF after heart transplantation.

Objective To conclude the results of electrophysiological (EP) mapping and ganglianated plexis (GPs) ablation during the minimally invasive atrial fibrillation (AF) surgery.Methods During the period of Sep 2007 to May 2010 to-tally 185 paroxysmal atrial fibrillation cases were recruited receiving the minimally invasive AF surgery with video assistance.The EP mapping was used to test the dual direction block after ablation and the distribution of GPs was recorded.The sinus rhythm rate was followed up after surgery.Results All the minimally invasive surgery were performed successfully withoutdeath in the hospital.There was no permanent pacemaker implant and other serious complications.EP mapping results showed92％ pulmonary vein (PV) potential to the left atrium (LA) could be isolated with the dual direction block for the paroxysmal atrial fibrillation cases.And there were 89％ GPs positive,higher rate than the persistent AF.There were more GPs positive in the right PV area than the left and 86％ GPs lied at the LA domain,not the PV orifice.At least 5 or 6 ablation lesions were needed to get the dual direction block and denervation of the GPs.The sinus rhythm rate after surgery after 3,6,12 and 24months is 83.7％,82.4％,85.4％ and 83.9％.The 12 months follow up data showed the cases with more GPs positive (＞6) had 81.3％ sinus rate and the less GPs positive (≤2) group with 52.6％.Conclusion The EP mapping and GPsablation techniques during the minimally invasive AF ablation surgery could get good sinus rhythm rate during the long term follow up.

Objective: To investigate the changes of osteoprotegerin ( OPG) and receptor activator of nuclear factor kappa B ligand ( RANKL) level in perio-implant crevicular fluid ( PICF) and to monitor the development of the stability of Straumann ? tissue-level implants by resonance frequency analysis ( RFA) during the early phases of healing .Methods: A total of 35 implants ( length 10 mm ) were placed.PICF samples were collected with filter paper strips at baseline , 1, 2, 3, 4, 6, 8, and 12 weeks post-surgery, respectively.The OPG, RANKL levels were determined by ELISA method .At the same time points, the implant stability quotient (ISQ) values were determined with Osstell TM mentor.Results:During healing , PICF-OPG levels increased significantly 2 weeks after surgery when compared with the 4th-, 6th-, 8th-and 12th-week reevaluation (P<0.05).The OPG/RANKL ratio in PICF was significantly higher ( P<0 .05 ) than that in gingival crevicular fluid at 1 week post-surgery .ISQ slightly fluctuated within the first 4 weeks after installation .Following this, the ISQ values increased steadily for all the implants and up to 12 weeks.Significant differences were noted between the mean ISQ values at the 12th-week and other observation time points .Conclusion: The PICF-OPG levels may be effective in monito-ring the process of osseointegration .All the ISQ values indicated the stability of Straumann ? implants over a 12-week healing period .RFA is a reliable and effective assistant to monitor implant stability .

Objective To optimize and establish the methodology for culturing and inducing differentiation of mouse preadipocytes 3T3-L1. Methods The mouse cells 3T3-L1 were incubated in DMEM medium contained with 10%FBS, during which the incubation medium was refreshed every 2 to 3 days. Two methods were used to introduce differentiation, including three-drug combination group and four-drug combination group. The protocol of mediumⅠin three-drug combination group including insulin 10 mg/L, IBMX 0.5 mmol/L and DEX 1.0μmol/L. The protocol of mediumⅠin four-drug combination group including indometacin 0.1 mmol/L based on those of three-drug combination group. Both of them were incubated for 2 days and continuous for 2 times. And medium Ⅱ included insulin 10 mg/L for 2-day culturing and continuous for 2 times. Oil red O staining was used to observe the morphological changes of two groups of cells before and after treatment under inverted microscope. Results Mouse preadipocytes 3T3-L1 appeared in good conditions and grew in a paving stone fashion. These cells covered homogeneously the bottom of incubators, the culture medium refreshed every 2 days. The results of four-drug combination group were better than those of three-drug combination group. After three-drug combination induced differentiation, there was no significant change in cell morphology. Comparing with three-drug combination induced differentiation, four-drug combination was successfully achieved in over 90% of the cell inducing, which were round-shaped, with jacinth ester droplets by oil-red O staining. Conclusion We have optimized the method for culturing and inducing differentiation of mouse preadipocytes 3T3-L1 by adding indometacin on the basis of the three-drug combination induced differentiation.

Objective The aim of the present study was to monitor the plasma levels of atrial natriuretic peptide(ANP) in patients accepting minimally invasive ablation.Methods The demographic and clinical data were collected from 26 consecutive patients with paroxysmal atrial fibrillation.Two milliliter of peripheral blood was harvested before operation,7 days and 3 months post-operation followed by ANP assay using ELISA kit.The repeated measurements were performed for each sample and One-way ANOVA was used for statistical analysis.Results Before operation,the ANP levels in plasma was (2.86 ± 1.47) pg/ml.No significant changes of this ANP levels were observed 7 days and 3 months after operation,which were(2.83 ± 1.08) pg/ml and(2.75 ±0.87) pg/ml,respectively.The Pvalue of sphericity Mauchly test was 0.008 for repeated measurements and for correction coefficient,P =0.801.Conclusion These findings suggest that the minimally invasive ablation and left appendage excision in patients with atrial fibrillation has no significant effect on atrial ANP secretion.

Objective To investigate the mitral annular three dimensional configuration changes after application of two dimensional mitral annuloplasty.Methods Includes criteria:serious mitral prolapse without other cardiac disorders,with age ranged from 18 to 60 years old.Three dimensional echocardiography was performed before the surgery in the operation room.The mitral annular three dimensional configuration,the mitral prolapse and regurgitation grades were examined.And same procedure was done after the mitral repair.All the measure results were expressed as x ± s and the statistical analysis was performed using SPSS 19.0 software.Results Totally 42 cases were enrolled,including 28 posterior prolapse and 14 anterior prolapse cases.All the mitral repair got satisfied none or mild regurgitation.The mitral annulus moved consistently as saddle shape during the whole cardiac cycle,the lowest annulus part was at the commissure and the highest part was at the anterior and posterior annulus centers.During the systolic phase the non-planer angel between anterior and posterior annuls was bigger than in diastolic phase.The annulus circumference,transverse,longitudinal diameters decreased compared with before the surgery.Preoperative mitral transverse diameter and longitudinal diameter values are almost the equal size,indicating the mitral annulus was in nearly round shape.However the longitudinal/transverse ratio reached 0.88 after surgery which implied the annulus configuration recovery after annuloplasty.After the mitral annuloplasty the annular height decreased from (8.4 ± 0.6) mm to (3.2 ±0.1) mm while the annular height/transverse diameter ratio decreased from 0.24 to 0.15,which may be affected by the application of the two dimensional rigid artificial annulus.Non-planar angle between the anterior and posterior mitral annuls increased from(136 ± 13)degrees to(145 ± 14) degrees after mitral repair.Conclusion The mitral annulus configuration may have planarization changes due 1o the apply of two dimentional artificial annulus.