Objective The early causes of death were analyze in 2349 patients who had undergone heart valve replacement.Methods Methods From January 1995 to December 2007,2349 patients with heart valve diseases received heart valve replacement.1109 cases were male and 1240 were female.The mean age of the patients was(41±19)years old.1962 cases had rheumatic heart valve disease,308 had congenital heart valve disease,39 had infective endocarditis,29 underwent reintervention by heart valve replacement,11 had Marfan syndrome.34 cases with coronary heart disease underwent heart valve prosthesis implantation and coronary artery bypass grafting.Mitral valve replacement(MVR)was performed in 1333 patients,aortic valve replacement(AVR)in 271,double valves replacement(DVR)in 736 and tricuspid valve replacement(TVR)in 9.There were 3075 mechanical valves and 10 bioprosthetic valves.Results From 1995 to 1999,death occurred in 16 of the 235 cases,early mortality rate was 6.81%.From 2000 to 2004,death occurred in 35 of the 1087 cases,early mortality rate was 3.22%.From 2005 to 2007,there were 29 deaths among 1027 cases,with an early mortality rate of 2.82%.Overall early mortality rate was 3.40%.The early mortality rate was 2.32%(31 in 1333 cases)in patients who underwent MVR,3.32% (9 in 271)in patients who underwent AVR,5.24%(40 in 736)in patients who underwent DVR,5.50%(7 in 127)with LVEDD≥70 mm,4.60%(14 in 304)with LVEF<0.40,2.14%(9 in 419)with NYHA class II,2.42%(37 in 1529)with NYHA class Ⅲ,and 8.48%(34 in 401)with NYHA class IV.The causes of 80 deaths were low cardiac output syndrome in 31 cases(38.8%),renal failure in 14 cases(17.5%),arrhythmia in 10 cases(12.5%),pulmonary infections in 8 cases (10.0%).cerebrovascular accidentin 5(6.3%),left ventricular rupture in 5(6.3%),multisystem and organ failure in 5(6.3%),and other cause in 2 cases(2.5%).Conclusion The causes of early death after heart valve replacement are low cardiac output syndrome,renal failure,arrhythmia,pulmonary infection,cerebrovascular accident,left ventricular rupture and multisystem and organ failure.

ObjectiveTo study the situation of neural invasion in pancreatic cancer and investigate its related clinical factors. Methods The neural invasion in 73 cases of pancreatic cancer patients was retrospective analysed. The correlation between neural invasion and clinicopathological parameters,and survival rate was investigated.Results In 73 cases of pancreatic cancer,neural invasion occurred in 38(52.1％) patients,among whom intra-pancreatic neural invasion rate was 15.8％ (n =6) ; and both intrapancreatic and external pancreatic plexus invasion rate was 84.2％ ( n =32).Neural invasion was not related with gender,age,and pathological type,degree of differentiation,tumor size and lymph node metastasis (P ＞ 0.05 ).But the presence of abdominal pain,vascular invasion,the expression of EGFR and VEGF in tumor tissue was significantly related with neural invasion (P ＜0.01 ).The median survival of patients in neural invasion group was 8 months,which were significantly shorter than that of in patients without neural invasion (13 months,x2 =4.69,P =0.030).Conclusions Neural invasion has a high incidence in pancreatic cancer,and it can cause obvious abdominal pain.And it is related with vascular invasion and the expression of EGFR and VEGF in tumor tissue.Neural invasion is one of the factors affecting the survival rate.

Objective To investigate the characteristic of MRS in patients suffered diffuse axonal injury (DAI)in acute and suba-cute stage,and the correlation between MRS changes and the severity of disease.Methods We reported MRI and proton magnetic resonance spectroscopy studies of 3 6 head-inj ured patients in acute and subacute stage.Proton magnetic resonance spectra were ac-quired from the white matter and gray matter of bibateral frontal lobe that on conventional MRI appeared normal by using 2D MRSI at 3.0T MRI .30 volunteers as contronl were studied at the same time.Results In patient group,N-acetylaspartate/creatine ratios were (2.14±0.15)and (1.71±0.08)choline/creatine ratios were(1.35±0.13)and (1.03±0.08)for the white matter and the gray matter,respectivily.The brain N-acetylaspartate/creatine ratio was reduced and the choline/creatine ratio was increased in pa-tient group compared with the controls.The increase in the choline/creatine ratio was significant even in the moderate and severe in-j ured groups.Furthermore,there was a significantly correlation between the severity of head inj ury and the N-acetylaspartate/cho-line ratio,and changes in patients with metabolite ratios of the GCS score had a strong correlation.Conclusion We conclude that DAI patients with normal conventional imaging manifestations of the frontal lobe appear metabolite ratio change,suggesting the existence of local cerebral inj ury,and it has a strong correlation between the prognosis and MRS changes.MRS may provide an useful method that can tell us the severity of the brain inj ury in patients with DAI .

Objective To evaluate left intra-ventricular diastolic blood flow patterns and fluid dynamics in pre diabetics using vector flow mapping(VFM),and to explore the value of left intra-ventricular hydromechanics characteristics assessment of intracardiac flow by VFM with more sensitive indexes.Methods Forty four patients with type 2 diabetes,twenty-eight pre-diabetes patients and thirty-three normal volunteers underwent VFM to determine the left ventricular(LV) diastolic blood flow patterns and fluid dynamics.The two-dimensional color Doppler flow images data were acquired in standerd apical fourchamber view during 3 complete cardiac cycles.These images were analyzed using a dedicated off-line workstation.At different level (mitral annulus,papillary muscl and apex level),the diastole blood flow parameters of LV including flow velocity and volume,velocity gradients (△V),pressure gradients (△P),diastole flow volume,vortex intensity ( Ⅵ),vortex area ( VA),vortex radius (VA) were derived.Thedifferences of the above parameters were compared among the three groups.The correlationship between diastolic function parameters and LV hydromechanics indexes were analyzed.Results ① Compared to normal group and pre-diabetics group,the LV diastolic function parameters E/A and e/a in diabetics group were lower( P ＜0.01),with no differences for E/e( P ＞0.05).There were no significant diffrences of these indices between diabetics group and pre-diabetics group( P ＞0.05).②)Compared to normal group,the intraventricular peak flow velocity at basal level,△V and △P in diabetics group and pre-diabetics group were lower( P ＜0.01),but there were no significant differences of these indices between diabetics group and prediabetics group( P ＞ 0.05).③Compared to normal group,the diastolic positive volume at basal level in diabetics group and pre-diabetics group was lower ( P ＜0.01 ),but there was no significant differences of these indices between diabetics group and pre-diabetics group ( P ＞ 0.05).④ Compared to the normal group,the Ⅵ in diabetics and pre-diabetics group was decreased,but there were no significant differences ofthese indices between diabetics group and pre-diabetics group( P ＞0.05).The VA and VR in diabetics and pre-diabetics group were increased,but there were no significant differences of these indices between diabetics group and pre-diabetics group ( P ＞ 0.05).⑤ There were no correlationship between diastolic function parameters and LV hydromechanics indexes.Conclusions There is the same LV diastolic blood flow patterns and fluid dynamics existed in pre-diabetics as diabetics.VFM could be used as a new methods to demonstrate the early left intra-ventricular fluid dynamics damages in pre-diabetics patients.

ObjectiveStudy the effects of mitral valve replacement using video-assisted thorascoscopy compared with median sternotomy mitral valve replacement.MethodsBetween October 2003 and October 2011,72 cases suffer from mitral valve disease underwent video-assisted thorascoscopic mitral valve replacement,74 cases underwent median sternotomy procedure.CPB time,cross clamp time,ventilation time,drainage,ICU stay time and hospital stay time of the two groups were compared.Results It was longer that CPB time and cross clamp time in video-assisted thoracospic group than those of median sternotomy group.There was statistically significant difference.However there was no statistically significant differentce in ventilation time and ICU stay time between two groups.Drainage of video-assisted thoracospic group was less than median sternotomy group.And there was statistically significant difference.ConclusionAs long as strictly a good indication,mitral valve surgery can routinely be performed with video-assisted thoracospic.

The safe-care practiced by the Second Xiangya Hospital of Central South University is designed to make continued improvements of the quality of care and enhance hospital management.The paper first explained the concept of the model as upholding Xiangya spirit,standardized management,good clinical service pattern,enhanced continuing education and training,enhanced doctor-patient communication,risk prevention beforehand,enhanced team spirit,and enhanced information system.It went on to describe the measures taken by the hospital in implementing the mode,significance and steps for each measure taken,and initial outcomes achieved by the mode for both the hospital and patients in the end.

Objective To define the mechanical features of mitral annulus at various sites,and to investigate the specific mechanics characterization at different mitral annulus sites in evaluation consequences of left ventricular function by dual pulse-wave Doppler (DPW) technology.Methods The DPW spectrums were obtained at lateral and aboral interval,anterior and inferior and posterior mitral annular from 112 normal adults.The peak systolic velocity (Sm),peak early diastolic velocity (Em),peak late diastolic velocity (Am),the beginning time of the peak and the time to peak were measured,and E/A,Em/Am,E/Em,left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) were computed.Results 1)Sm,Em,Am and Em/Am measured in the free wall annulus were significantly greater than measured in the interval annulus of mitral annular sites.However,E/Em was opposited (P ＜ 0.05).Sm of the posterior wall mitral annulus accelerated frist and experienced shortest duration in all the mitral annular sites (P ＜ 0.01).There were no significant differences of Em time parameters among different mitral annulus sites.Am of the beginning time and peak time in the free wall annulus were significantly longer than that in the interval annulus of anterior mitral annular sites.However,the acceleration time was opposited(P ＜0.05).2) Sm was correlated with LVEF and LVFS (r =0.243 and r =0.227,P ＜0.01) only at the posterior mitral annular site,Em/Am of anterior and posterior wall mitral annulus had the highest correlations with mitral orifice flow E/A(r =0.545 and 0.545 respectively,P ＜ 0.01).Conclusions There are significant differences among the mechanics patterns at different mitral annulus sites in normal adults.The mechanics characterization at different mitral annulus sites have different conclusions of left ventricular function.

With introduction of current main methods for heart fluid mechanics researches, we studied the characteristics and weakness for three primary analysis methods based on magnetic resonance imaging, color Doppler ultrasound and grayscale ultrasound image, respectively. It is pointed out that particle image velocity (PIV), speckle tracking and block match have the same nature, and three algorithms all adopt block correlation. The further analysis shows that, with the development of information technology and sensor, the research for cardiac function and fluid mechanics will focus on energy transfer process of heart fluid, characteristics of Chamber wall related to blood fluid and Fluid-structure interaction in the future heart fluid mechanics fields.
Algorithms ; Biomechanical Phenomena ; Heart ; physiology ; Humans ; Image Interpretation, Computer-Assisted ; Magnetic Resonance Imaging ; Ultrasonography, Doppler

Chronic obstructive pulmonary disease (COPD) is an incompletely reversible chronic airway disease that can be prevented and cured.There is a tendency toward increasing the morbidity and mortality for COPD.Establishment of an animal model for COPD is an important step to explore the pathogenesis of this disease.Presently,a well-recognized COPD animal model is not available.The key points for establishing the COPD animal models,such as selection of animal species,parameters for model evaluation,are constantly updated.

Objective To compare the efficacy and safety of levofloxacin 750 mg for 5 days versus 500 mg for 7‐14 days intravenous (IV ) infusion in the treatment of community‐acquired pneumonia (CAP ) . Methods This study was a multi‐center , randomized , open‐label , non‐inferiority , controlled clinical trial .The CAP patients were randomized to receive levofloxacin 750 mg IV daily for 5 days or levofloxacin 500 mg IV daily for 7‐14 days .The clinical symptoms , laboratory tests , imaging results and microbiology data were collected and compared between the two treatment groups in terms of efficacy and safety .Results A total of 241 patients were enrolled in this clinical trial from 10 study centers .Among these patients ,223 were eligible for full analysis set (FAS) analysis ,including 111 in 750 mg group and 112 in 500 mg group .Of the 223 patients in FAS ,211 were eligible for per‐protocol set (PPS) analysis ,including 107 in 750 mg group and 104 in 500 mg group .Two hundred and forty‐one patients were included in safety set (SS) ,including 121 patients in 750 mg group and 120 in 500 mg group .The median treatment duration was 5 .0 days in 750 mg and 9 .0 days in 500 mg group .The median total dose was 3 750 mg in 750 mg group and 4 500 mg in 500 mg group .The overall efficacy rate was 86 .2% in 750 mg group and 84 .7% in 500 mg group in terms of FAS at visit 4 ,which suggested that the efficacy of 750 mg group was non‐inferior to 500 mg group .Of the 111 FAS patients in 750 mg group ,40 were bacteriological evaluable ,and 41 strains of pathogens were isolated .Forty‐nine of the 112 FAS patients in 500 mg group were bacteriological evaluable ,and 51 bacterial strains were obtained .The bacterial eradication rate was 100% in both groups .The clinical treatment efficacy rate for atypical pathogens was 100% in both groups .In 750 mg group ,the most common clinical adverse drug reactions (ADRs) were injection site adverse reactions including injection site pruritus ,pain and hyperemia .The other common ADRs were insomnia ,nausea ,skin rash .The most common drug‐related laboratory abnormalities were neutrophil percentage decreased , decreased white blood cell (WBC ) count , alanine aminotransferase (ALT) and aspartate aminotransferase (AST) elevation .Most of the ADRs were mild in severity and well‐tolerated .The safety profile of the two treatments was comparable in terms of the drug‐related treatment discontinuation and the incidence of ADRs .Conclusions The short‐course regimen of levofloxacin 750 mg IV for 5 days is at least as effective and well tolerated as the long‐course regimen of 500 mg IV for 7‐14 days in treatment of CAP .