ObjectiveTo retrospectively analyze clinical data of patients who has left-side valvular disease combined with severe tricuspid regurgitation and evaluate the effect of our modified tricuspid annuloplasty with enforcement of artificial felt strip.Methods76 patients who had left-side valvular disease combined with severe tricuspid regurgitation received operations between Jan.2008 and Jun.2010.The average age of the patients was 53.5 years old (32 male and 44 female).Besides the severe tricuspid regurgitation, other combined cardiac impairments included mitral valvar disease (52 cases), aortic valvar disease(5 cases), double valvar disease(19 cases) and left atrial thrombosis(22 cases).6 patients had grade II cardiac function according to the NYHA criteria, while 47 and 23 were in grade III and IV, respectively.Other signs included cyanosis(5cases), jaundice(11 cases), neck vein engorgement(48 cases) , ascites(22 cases), hepatomegaly(41 cases) and pitting edema in the lower limbs(68 cases).The concomitant operative procedures included mitral valve replacement in 52 patients,aortic valve replacement in 5 patients, double valve replacement in 19 patients, removal of left atrial thrombus in 22 patients,left atrium folding in 21 patients and left atrium appendage suture in 68 patients.Left-sided valve disease were corrected first,TAP was performed on the beating heart after the heart had been defibrillated.The anteroseptal commissure was plicated first.A double-armed 3-0 pledgeted suture was taken through the base of the septal leaflet, 5-6 mm from the commissure, extending along the annulus, and out from the point in the anterior annulus 10-12 mm from the anteroseptal commissure.Both ends of the suture was tied until the two Teflon pledgets approximated each other near the commissure.Then a semicircular De Vega type of plicating with a 3-0 prolene was taken, starting just from the anterior annulus near the anteroposterior commissure, and extending clockwise to a point just cephalad to the posteroseptal commissure.The suture was tied with positioning a 27-29 mm valve siser across the tricuspid valve.At last, a 3-5 mm width felt strip was prepared and was sutured to the plicated posterior annulus region with interrupted mattress sutures of 2 to 3 2-0 prolene.A favorable result was considered when TR was not marked by saline injection.Echocardiography was routinely examined one week postoperatively and patients were followed up 6 month after discharge.ResultsThere is no death in all patients.The CVP diminished significantly from 16mmHg preoperatively to 8mmHg postoperatively (P = 0.0021).The systomic pulmonary pressure diminished from 59 mmHg preoperatively to 41 mmHg postoperatively (P = 0.038).Echo one week postoperative showed no tricuspid regurgitation in 56 patients and mild in 18 patients, while 2 had moderate tricuspid regurgitation.The diameter of right atrium diminished significantly postoperatively, too.The ejection fraction was improved even though there was not significant difference as compared with preoperative data.The cardiac function of all patients improved and the signs of right heart failure were alleviated or disappeared.Follow up 1 to 36 months showed no change of the regurgitation except for one become moderate from mild when discharged.No hepatic congestion or edema was observed in all patients.ConclusionThese new modifications make the technique more selective in the remodeling of the tricuspid annulus.It could achieve better coaptation of the anterior leaflet with the others, successful annular reduction, better maintenance of the contractile property of the tricuspid ring, better distribution of pursing force in the more dilated region.It could prevent the tear of the endocardium in the posteroseptal region in the long period of time postoperatively.

Objective To develop an ideal cultural method to amplify embryonic hepatic stem cells and inhibit their differentiation in vitro. Methods Suspension of ED 14 Fischer (F) 344 rat em-bryonic hepatic stem cells was prepared by collagenase digestion and mechanical disaggregation. Then cells were divided into two groups randomly. The cells in group 1 were seeded into type I collagen-coated plates by adherent culture while those in group 2 were seeded into soft agar medium by suspen-sion culture. After culture for 2 weeks, the morphology and ultrastructure of cells in both groups were observed and compared by inverted microscope and transmission electron microscope, respectivley.The expression of CD90. 1 and CD49F, the two specific stem cell surface markers, was tested by flow cytometry to manifest the establishment of embryonic hepatic stem cells. Alkaline phosphatase stai-ning was used to detect stem cell differentiation. Result Embryonic hepatic stem cells in group 2 were characterized by higher nucleus-cytoplasm ratio and less cell organelles, higher expression of CD90. 1 and CD49F, and stronger positive reaction for alkaline phosphatase staining compared with those in group 1. Moreover, the cells in group 1 showed significant differentiation features. Conclusion Em-bryonic hepatic stem cells cultured suspendedly in soft agar medium experience less differentiation than those adherently cultured in serum-added culture medium, and can proliferate and form clone ball with a specific stem cell feature.

Objective To compare the efficacy of insulin aspart and human soluble insulin on postprandial glucose control and blood glucose excursion in type 2 diabetic patients managed with insulin pump therapy. Methods All of 345 hospitalized type 2 diabetic patients were randomized divided into two groups. One group underwent insulin pump therapy with insulin aspart (aspart group, 173 cases),another group with human soluble insulin (humulin R group, 172 cases). Capillary glucose concentrations were measured at 9 time points,including preprandial,2 hours postprandial,bedtime (22:00),midnight(0:00) and 3:00 every day during the treatment. The change of blood glucose at each time point and the variation of postprandial blood glucose excursion was compared between the two groups. The frequency of hypoglycemia was also evaluated. Results After treatment, fasting blood glucose and post breakfast and post dinner blood glucose levels were decreased more significantly in the aspart group than those in the humulin R group. And a significantly smaller postprandial blood glucose excursion was shown in the aspart group compared with that in the humulin R group (P< 0.05). The time to achieve good glycemic control in the aspart group was (4.40 ± 2.16) d, significantly shorter than that in the humulin R group[(5.68 ± 2.29) d](P< 0.05). The incidence of hypoglycemia was significantly lower in the aspart group (P <0.05). Conclusion Insulin aspart results in better control of blood glucose and less glycemic variability compare with human soluble insulin in type 2 diabetic patients during delivery by continuous subcutaneous insulin infusion.

Objective To investigate the relationship between serum pregnancy associated plasma protein A (PAAA‐A) ex‐pression and gene polymorphism with the severity of coronary lesions in the patients with coronary heart disease (CHD) .Methods Ninety‐eight patients with CHD in the Nanyang Municipal Central Hospital were selected as the observation group and divided into single vessel lesion group and multiple vessel lesion group according to coronary angiographic results .Ninety‐eight individuals un‐dergoing healthy physical examination were selected as the control group .The venous blood was collected at the visiting hospital in the observation group and at the physical examination in the control group for detecting the serum PAPP‐A protein level by ELISA .PAPP‐A gene and IVS6+ 95 polymorphism were analyzed by adopting polymerase chain reaction restriction fragment length polymorphism(PCR‐RELP) .Results Compared with the control group ,peripheral blood PAPP‐A protein level in the obser‐vation group was significantly increased(P<0 .05) ,moreover the PAPP‐A protein level in the multiple vessel lesion group was sig‐nificantly higher than that of the single vessel lesion group (P<0 .05) .The peripheral blood PAPP‐A level was positively correlated with the severity of CHD .Three genotypes existed in PAPP‐A gene IVS6+95 locus ,including CG heterozygous ,homozygous CC and GG homozygous type .The CC homozygous allele frequency in the patients with multiple vessel lesion was higher than that in the patients with single vessel lesion (P<0 .05) .Conclusion The PAPP‐A protein level and IVS6+95 polymorphism have a close relation with the severity of coronary lesions in patients with CHD .CC genotype may be one of genetic susceptibility gene markers in the patients with CHD .

Objective To analyze the failure ratio and the causes of the inoculation failure of hepatitis B virus(HBV)-vaccine in children and relevant the remedial measures. Methods One thousand three hundred and sixty cases treated in Suzhou Wuzhong people′s hospital during Jan.2007 to Jul.2008 were chosen,of whom 286 children from 1-5 years old to be anti-HBs negative or anti-HBs titre to be 0-10 IU/L were screened,and specific failure reasons for the vaccination were analyzed,also the timely treatment measures were taken.Then 286 children were divided into 5 groups randomly.Apart from one group was set up as blank control,the other 4 groups were arranged to accept different immunization methods with 0,1,2 month schedule,group A simply got revaccinated with HB vaccine(10 ?g) 3 times;group B revaccinated with double dosage of HB vaccine(20 ?g) 3 times;group C besides being revaccinated 3 times,the immune regulatory agent was jointly used;group D revaccinated 3 times with genetically engineered CHO hepatitis B vaccine. Results The ratio of failure of HBV-vaccine was 21.03%,what caused failure of hepatitis B vaccine included immunologic inadequacy 218(76.22%),repeated respiratory infection 192 cases(67.13%),abuse hormone 140 cases(48.95%),zinc deficiency 129 cases(45.10%),anaemia 108 cases(37.76%),passive smoking 80 cases(27.97%),the mother being chronic parenchymatous nephritis or HBV carrier 63 cases(22.03%),premature 54 cases(18.88%),adiposity 38 cases(13.29%),dystrophy 29 cases(10.14%).There were 4 methods of revaccination,the positive rate for group A,B,C,D were 90.00%,96.47%,99.08%,95.83%,respectively.Group C had the highest positive rate,compared with the other 3 groups,which were statistically significant(P a

OBJECTIVETo assess the therapeutic effects of Chinese medicine (CM) treatment mainly by Modified Shenqi Dihuang Decoction (MSDD) in delaying the progress of chronic renal failure (CRF).

METHODSA prospective cohort method was employed. CRF patients with serum creatinine (SCr) ranging between 133 and 442 micromol/L were recruited. Those in the CM treatment group (61 cases) were treated with MSDD as well as basic treatment of Western medicine, while those in the control group (57 cases) were treated with basic treatment of Western medicine alone. A 2-year follow-up study was carried out. The effects on postponing the progression of CRF were observed mainly from the levels of hemoglobin (HB), plasma albumin (ALB), SCr, estimated glomerular filtration rate (eGFR), reciprocal slope of serum creatinine (b value), and endpoint events, etc.

RESULTS(1) The progression of the renal function: After 24 months of treatment, better therapeutic effects were shown in the CM treatment group than in the control group (P < 0.05), which could be illustrated by decreased SCr levels, increased eGFR levels, and the positive reciprocal slope of SCr (1/SCr) to the time linear regression slope (b value). There were 40 cases (65.57%) with a reciprocal slope of SCr (b value) > or = 0 (34.43%) and 21 cases with b < 0 in the CM treatment group. However, there were 7 cases (12.28%) with b > or = 0 and 50 cases (87.72%) with b < 0 in the control group. The difference was statistically significant (P < 0.05). (2) There was no significant difference in HB or ALB between the two groups after 12 months and 24 months of treatment (P > 0.05). (3) Twenty-four months later, there were 6 endpoint events (9.84%) in the CM treatment group and 9 (15.79%) in the control group, with insignificant difference (P > 0.05).

CONCLUSIONMSDD plus basic treatment of Western medicine could delay the progression of CRF patients.

Adult ; Aged ; Drugs, Chinese Herbal ; administration & dosage ; therapeutic use ; Female ; Humans ; Kidney Failure, Chronic ; drug therapy ; Male ; Middle Aged ; Phytotherapy ; Prospective Studies

Objective To construct and apply a cell line screening Mycobacterium tuberculosis (Mtb)-specific tetramers of CD4+α/β T cell receptor(TCR). Methods The β chains of HLA class Ⅱ (DR) were amplified from tuberculosis patients by PCR. The pMT-HLA-DRB expression vectors that carries the HLA-DR 13 chain and pMT-HLA-DRA-P expression vectors which carries the genes of HLA-DR α chain loaded with Mtb antigen were transfected into S2 cells with the method of calcium phosphate transfection. The expressed Mtb peptide/HLA-DR complexes were primarily identified by the method of cell immunohistochemistry. The cell lines expressing Mtb peptide/HLA-DR complexes were used to screen tetramers of CD4+ TCR by flow cytometry. Results S2 cell lines expressing Mtb peptide/HLA-DR complexes on the cell surface were obtained, two kinds of Mtb specific tetramers of CD4+α/β TCR were screened. Conclusion S2 cell lines expressing Mtb peptide/HLA-DR complexes on the cell surface provide the solid basis of the further research on the TCR tetramers and are helpful for exploring new diagnostic study methods about tuberculosis and developing new vaccines.

Objectives To establish a cost-effective and reproducible procedure for induction of chronic left ventricular aneurysm (LVA) in rabbits. Methods Acute myocardial infarction (AMI) was induced in 35 rabbits via concomitant ligation of the left anterior descending (LAD) coronary artery and the circumflex (Cx) branch at the middle portion. Development of AMI was co n-firmed by ST segment elevation and akinesis of the occluded area. Echocardiography, pathological evaluation, and agar i n-tra-chamber casting were utilized to validate the formation of LVA four weeks after the surgery. Left ventricular end systolic pressure (LVESP) and diastolic pressure (LVEDP) were measured before, immediately after and four weeks after ligation. D i-mensions of the ventricular chamber, thickness of the interventricular septum (IVS) and the left ventricular posterior wall (LVPW) left ventricular end diastolic volume (LVEDV) and systolic volume (LVESV), and ejection fraction (EF) were recorded by echo-cardiography. Results Thirty one (88.6%) rabbits survived myocardial infarction and 26 of them developed aneurysm (83.9%). The mean area of aneurysm was 33.4% ± 2.4% of the left ventricle. LVEF markedly decreased after LVA formation, whereas LVEDV, LVESV and the thickness of IVS as well as the dimension of ventricular chamber from apex to mitral valve annulus significantly increased. LVESP immediately dropped after ligation and recovered to a small extent after LVA formation. LVEDP progressively increased after ligation till LVA formation. Areas in the left ventricle (LV) that underwent fibrosis included the apex, anterior wall and lateral wall but not IVS. Agar intra-chamber cast showed that the bulging of LV wall was prominent in the area of aneurysm. Conclusions Ligation of LAD and Cx at the middle portion could induce develo pment of LVA at a mean area ratio of 33.4%±2.4%which involves the apex, anterior wall and lateral wall of the LV.

Objective To study the strategy of psychological care when victims’transshipment after the earthquake in Sichuan province.Methods 52 victims who were transferred by our medical team were divided into four groups by age.Each group received the pertinent psychological care.Then the effects were observed.Results After the effective sychological care,52 patients’psychological status turned for the better when arrived at The base hospitals.and they were full of confidence for rehabilitation.Conclusions Effective and timely psychological care can make victims relax,reduce stress and decrease the complications during transshipment.

Objective To develop a magnetic resonance imaging (MRI) system for pelagic definitive treatment platforms, large support ships and ocean vessels.Methods The system was designed based on normal electromagnetic MRI technology, which was composed of six parts of gradient system, magnet system, coil system, radiofrequency system, spectrum control system and imaging system.The magnet system was developed with C-shaped open magnet,five systems were designed such as a super-stability excitation system, a super-sensitivity signal detection system, a magnetic filed dissipation precision control system, a shipborne sensitive equipment vibration control system and a software system, and a set of technical detection standards was proposed.Results The developed MRI system realized mobile imaging,gained advantages in imaging velocity,resolution,magnetic field dissipation control,ship bump resistance and environmental suitability,and thus could be used in marine mobile conditions. Conclusion The developed MRI system meets the requirements of pelagic medical treatment, and contributes to improving pelagic medical support ability of Chinese navy.