BACKGROUNDRepair of anterior mitral leaflet (AML) prolapse is still a technical challenge for cardiac surgeons. It is an important issue to find a way to repair the AML prolapse with a reliable and reproducible technique.

METHODSBetween January 2002 and June 2009, the operation of chordal transfer based on the "edge-to-edge" technique was performed in 21 patients with serious mitral valve regurgitation because of prolapse of the anterior leaflet. After the operation, echocardiography was performed in each patient before discharge and at the time of follow-up.

RESULTSAll patients survived the operation. One patient required mitral valve replacement because of anterior leaflet perforation 3 days after the operation. The other patients were free from reoperation. At the time of follow-up, all these patients were in New York Heart Association (NYHA) functional class I. In all these patients, pre-discharge and follow-up echocardiography showed neither stenosis nor significant regurgitation of the mitral valve: the cross-sectional area of the mitral valve was 3.3 - 4.8 cm(2) (mean (3.78 ± 0.52) cm(2)), the mean regurgitation area was (0.45 ± 0.22) cm(2). At the same time, both dimension of left atrium and left ventricle reduced significantly (left atrium diameter: pre-operation (48.26 ± 11.12) mm, post-operation (37.57 ± 9.56) mm, P < 0.05; the end-diastolic diameter of the left ventricle: pre-operation (61.43 ± 8.24) mm, post-operation (42.35 ± 10.79) mm, P < 0.01).

CONCLUSION"Edge-to-edge" chordal transfer technique is a simple, reliable, and reproducible technique that can provide good results for repair of anterior leaflet prolapse of mitral valve.

Adolescent ; Adult ; Aged ; Chordae Tendineae ; surgery ; Echocardiography ; Female ; Humans ; Male ; Middle Aged ; Mitral Valve ; surgery ; Mitral Valve Prolapse ; diagnostic imaging ; surgery ; Suture Techniques

Ureteropelvic junction obstruction (UPJO) is characterized by decreased flow of urine down the ureter and increased fluid pressure inside the kidney. Open pyeloplasty had been regarded as the standard management of UPJO for a long time. Laparoscopic pyeloplasty reports high success rates, for both retroperitoneal and transperitoneal approaches, which are comparable to those of open pyeloplasty. However, open and laparoscopic pyeloplasty have yielded disappointing failure rates of 2.5%-10%. The main causes for recurrent UPJO are severe peripelvic and periureteric fibrosis due to urinary extravasation, ureteral ischemia, and inadequate hemostasis. In addition, failing to diagnose lower pole crossing vessels before or during the primary procedure is also responsible for recurrent UPJO. In addition, poor preoperative split renal function, hydronephrosis, presence of renal stones, patient age, diabetes, prior endopyelotomy history, and retrograde pyelography history were considered as predictors of pyeloplasty failure. The failure is usually defined by persistent pain, persistent radiographic obstruction (infection or stones), continued decline in split renal function, or a combination of the above. And the failure of pye-loplasty often occurs in the first 2 years after the surgery. The available options for managing recurrent UPJO with a salvageable renal unit include endopyelotomy, re-do pyeloplasty, stent implantation, percutaneous nephrostomy, ureterocalicostomy, and nephrectomy. Re-do pyeloplasty has such merits as high successful rates and rare complications, compared with endopyelotomy or ureterocalicostomy. And some investigators think that re-do pyeloplasty should be regarded as the gold standard for secondary therapy if feasible. Open pyeloplasty can enlarge the operating field, facilitate the exposure of the ureteropelvic junction, reduce the difficulty of operation, and thus reduce the occurrence of complications. There are no significant differences among the success rates of re-do pyeloplasty under open approach, traditional laparoscopy and robot-assisted laparoscopy, according to previous reports. However, traditional laparoscopic and robot-assisted pyeloplasty give advantages of cosmetology, small trauma, less postoperative pain, speedy recovery and shorter hospitalization, fewer complications and lower recurrent rates. If the primary pyeloplasty is an open operation in retroperitoneal approach, the traditional laparoscopic and robotic operation with retroperitoneal approach should be considered for secondary repair. The cause of recurrent UPJO should be evaluated before surgery and identified intraoperatively to minimize the possibility of recurrence.
Humans ; Hydronephrosis ; Kidney Pelvis ; Laparoscopy ; Ureter ; Ureteral Obstruction/surgery* ; Urologic Surgical Procedures

Acute Disease ; Adult ; DNA, Viral ; blood ; Female ; Genotype ; Hepatitis B virus ; genetics ; Humans ; Male

Adult ; Female ; Hepatitis B ; immunology ; Humans ; Interferon-gamma ; blood ; Interleukin-12 ; blood ; Male ; Middle Aged ; Tumor Necrosis Factor-alpha ; analysis

OBJECTIVETo evaluate the clinical application of a computer aided design and computer aided manufacture (CAD/CAM) veneer system.

METHODSSixty-five CAD/CAM veneers were made for 23 patients and 105 porcelain veneers were made for 25 patients. After three years, the clinical performance of two veneer systems were evaluated and compared according to modified California Dental Association/Ryge criteria. The clinical success rate and patient satisfactory rate were calculated.

RESULTSThe success rates of porcelain veneer and CAD/CAM veneer were 96.2% and 93.8%, respectively. The patient satisfactory rates were 92.4% and 90.8%. There was no significant difference between two veneer systems in color match, marginal discoloration and marginal fit. But the surface texture of CAD/CAM veneers was better than that of porcelain veneers.

CONCLUSIONSCAD/CAM veneer system was a successful approach for veneer restorations.

Adolescent ; Adult ; Computer-Aided Design ; Dental Prosthesis Design ; Dental Veneers ; Female ; Humans ; Male ; Metal Ceramic Alloys ; Young Adult

OBJECTIVETo evaluate the long-term effects of delayed hyperbaric oxygen (HBO) therapy on neonatal rats with hypoxic-ischemic brain injury (HIBD).

METHODPostnatal 7 days newborn rats (n = 52) were randomly set to three groups: control (n = 18, sham operation), HIBD (n = 17), or HBO (n = 17). Pups in the HBO group were subjected to hyperbaric oxygen treatment with 2 atmosphaera absolutus, 5 x 30 min at a 24 h intervals since 48-72 h after the HIBD model. All the animals were tested for the spatial learning and memory ability in the Morris water maze from postnatal days 37 to 41. At day-42, rats were decapitated and the brains were analyzed for morphological and histological changes, including brain shapes and weights, survival neurons, percentage of AchE positive area and NOS positive neurons in hippocampal CA1 region.

RESULTSRats in HBO and HIBD groups displayed significant morphological and histological damages, as well as severe spatial learning and memory disability. The average escape latency of Morris water maze in HBO group [(56 +/- 23) s] and HIBD group [(56 +/- 22) s] were longer than the control [(23 +/- 16) s] (P < 0.05). The swimming time in HBO group [(30 +/- 5) s] and HIBD group [(29 +/- 6) s] were shorter than the control [(51 +/- 5) s] (P < 0.05). The swimming length in HBO group [(572 +/- 92) cm] and HIBD group [(548 +/- 92) cm] were shorter than the control [(989 +/- 101) cm] (P < 0.05). The weight of left brains in HBO group [(598 +/- 46) mg] and HIBD group [(601 +/- 59) mg] were lighter than the control [(984 +/- 18) mg] (P < 0.05). The survival neurons of hippocamal CA1 region in HBO group [(97 +/- 27)/mm] and HIBD group [(100 +/- 27)/mm] were less than the control [(183 +/- 8)/mm] (P < 0.05). The percentage of AchE-positive fibers in HBO group [(18.4 +/- 2.2)%] and HIBD group [(18.5 +/- 2.2)%] were less than the control [(27.5 +/- 2.2)%,] (P < 0.05). NOS-positive neurons in HBO group [(21 +/- 5)/mm(2)] and HIBD group [(19 +/- 4)/mm(2)] were also less than the control [(34 +/- 6)/mm(2)] (P < 0.05).

CONCLUSIONDelayed HBO therapy resulted in no protection against either HIBD-induced brain morphological and histological deficits or spatial learning and memory disability.

Acetylcholinesterase ; analysis ; Animals ; Animals, Newborn ; Brain ; pathology ; Female ; Hippocampus ; pathology ; Hyperbaric Oxygenation ; Hypoxia-Ischemia, Brain ; drug therapy ; pathology ; Male ; Maze Learning ; Nitric Oxide Synthase ; analysis ; Rats ; Time

Objective To evaluate the clinical efficacy of Yang Xue Rou Gan (blood-nourishing and liver-soothing) needling method in treating post-stroke depression. Method A total of 150 patients with post-stroke depression were divided into an observation group and a control group by using the random number table, 75 cases each. In addition to the same basic treatment, the control group was intervened by Fluoxetine hydrochloride, while the observation group received Yang Xue Rou Gan needling method, twice every day, 6 d as a course at 1-day interval, for 4 weeks in total. Before and after the intervention, 24-item Hamilton Depression Scale (HAMD), Modified Edinburgh-Scandinavian Stroke Scale (MESSS), and activities of daily living [ADL, Barthel Index (BI)] were evaluated. Result After the intervention, HAMD, MESSS, and BI scores were significantly changed in both groups (P<0.05), indicating that the two groups both had improvements in depression symptoms and signs; there were significant differences between the two groups (P<0.01), suggesting that the observation group had a more significant efficacy in treating depression. Conclusion Yang Xue Rou Gan needling method can notably improve the depression and neural deficit level in post-stroke depression patients.

BACKGROUND:To date,no single material can completely meet the clinical requirements.However,the composite materials characterized by good biodegradability,biocompatibility and osteoconductivity have become a highlight of the artificial bone materials.OBJECTIVE:To synthesize the basic fibroblast growth factor (bFGF)-poly(lactic-co-glycolic acid) (PLGA) microspheres/hydroxyapatite (HA)/poly(I-lactic acid) (PLLA) porous bone scaffolds,and to observe the physicochemical properties and biocompatibility of the composite material.METHODS:The bFGF-PLGA microspheres were prepared by double emulsion method,and then six kinds of materials were made including PLLA,PLLNHA,PLLAJPLGA,PLLNHNPLGA,PLLNHA/bFGF,and bFGF-PLGA microspheres/PLLA/HA.The characterization of the materials were observed by particle size analyzer,transmission electron microscopy,X-ray diffraction,Fourier transform infrared spectrometer,microcomputer differential thermal balance,and scanning electron microscope.Toxicity of these materials and proliferation of bone marrow mesechymal stem cells seeded onto these materials were analyzed and compared.RESULTS AND CONCLUSION:The average particle size of bFGF-PLGA microspheres was about 250 nm,the average drug-loading capacity was (26.03±0.17)％,and the entrapment percentage was (90.65±2.68)％.The prepared bFGF-PLGA microspheres were spherical and had good dispersibility.In addition,all the six kinds of materials had a porous structure with similar pore diameter,in which the microspheres and particles exhibited a rational distribution.The toxic level of bFGF-PLGA microspheres/PLLNHA,bFGF/HNPLLA and HAP/PLLA was graded as 1 (with a relative survival rate ≥ 80％),indicating no obvious toxicity or slight toxicity.All these six kinds of composite materials can promote the proliferation of bone marrow mesenchymal stem cells,and the bFGF-PLGA microspheres/PLLNHA shows the best effects on cell proliferation and has good biocompatibility.

·AIM: To investigate the role of small interference RNA interference targeted Integrin-linked kinase (ILK SiRNA) on the proliferation and apoptosis of human Tenon fibroblasts (HTFs) induced by transforming growth factor-β2(TGF-β2). · METHODS: The HTFs were identified by immunofluorescence analysis with Vimentin and keratin. HTFs with no other addiction was as normal control;H+T group:HTFs+5μ g/L TGF-β2;H+T+NC SiRNA group:HTFs+5μ g/L TGF-β2+50nmol/L negtive SiRNA; H+T+ILK SiRNA group:HTFs+5μ g/L TGF-β2+50nmol/L ILK SiRNA. The ILK SiRNA were transfected into HTFs by lipofectamine 2000, then the cells were stimulated with 5μ g/L TGF - β2. The protein expression of ILK were analyzed by Western Blot. The proliferation levels of HTFs were analyzed by CCK-8, the apoptosis of HTFs were analyzed by Hoechst 33342/PI double staining. ·RESULTS: The protein ILK were expressed in both TGF-β2treated and control groups, and TGF- β2up-regulated the expression of ILK, ILK SiRNA inhibited the protein expression of ILK(P< 0. 05). CCK- 8 analysis showed that compared with the normal control group,the cell proliferation rate of HTFs in TGF-β2treated group increased, and in ILK SiRNA group the cell proliferation rate was suppressed after exposured to ILK SiRNA for 48h (P<0.05). Hoechst 33342/PI double staining showed that there was no change on the apoptosis of TGF - β2 stimulated group (P>0.05), compared with the normal control group, however in the ILK SiRNA group, we found lots of apoptosis cells and a few of necrotic cells (P<0.05). ·CONCLUSION: The ILK SiRNA attenuates the abnormal proliferation of HTFs induced by TGF - β2, thereby enhancing the apoptosis of HTFs.

OBJECTIVETo evaluate the use of clinical nutritional support in critical SARS patients, and the relationship between blood glucose levels/insulin administration amount and outcome.

METHODSTwenty-one SARS patients who reached the standard of Ministry of Health's "critical level" were transferred into our ICU in an average of 11 days after onset and enrolled in this clinical trial. All patients underwent respiratory support and clinical nutrition support as scheduled. For about 60 kg patient per day 3347.2 kJ(800 kcal), 36 g protein, and 125 g carbohydrate was given intravenously; 4184 kJ(1000 kcal), 38 g protein, and 125 g carbohydrate was provided by enteral route. MCT/LCT as fat resource shared 50% calories intake. All patients received similar doses of intravenous Methylprednisolone(about 200 mg/d). Blood glucose, serum albumin, blood lymphocyte counts, and serum alanine transminase (ALT) were checked on the first admission day in ICU and on the 12th day after nutrition therapy was started. Insulin was started to pump in to maintain the blood glucose levels between 4.44-7.78 mmol/L (80-140 mg/dl) when the levels exceeded normal range.

RESULTSUpon admission into ICU, all patients had poor nutrients intake for an average of 11 days and 16 patients (76.2%) were diagnosed as malnutrition. Parenteral and enteral nutrition therapy were then offered for an average of 12 days. On the 12th day, the serum albumin increased [(28.5 +/- 2.2)] g/L vs (37.0 +/- 4.1) g/L] (P = 0.0001) and so did the lymphocytes count [(0.74 +/- 0.47)] x 10(9)/L vs (1.22 +/- 0.73) x 10(9)/L] (P = 0.02). The blood glucose maintained at lower level in the surviving patients when compared with those who died [(9.5 +/- 2.3) mmol/L vs (6.3 +/- 1.8) mmol/L] [(196 +/- 70) mg/dl vs (110 +/- 21) mg/dl] (P = 0.0002), and the abnormally high ALT levels presented in some of the patients decreased but not significantly (81.0% vs 57.1%) (P = 0.18). In order to keep blood glucose within the range 4.44-7.78 mmol/L (80-140 mg/dl), only 18.8% of the surviving patients needed insulin intervention as opposed to 80.0% of those who died (P = 0.03). The amount of insulin used in the surviving group was significant lower than that in the group who died [(24 +/- 2) IU/d vs (72 +/- 9) IU/d] (P = 0.01).

CONCLUSIONSEleven days after SARS onset, most of the critical patients presented with malnutrition. Some improved nutrition related parameters may be associated with clinical nutritional support. The surviving patients required less insulin when compared to those who died. 80.0% of the patients who died need insulin versus only 18.8% of the surviving patients. Due to the difficulty of SARS management, this study was not a randomized controlled clinical trial. More clinical trials will be needed for checking the results of this investigation.

Adult ; Blood Glucose ; metabolism ; Enteral Nutrition ; Female ; Humans ; Insulin ; administration & dosage ; Male ; Malnutrition ; blood ; etiology ; therapy ; Middle Aged ; Nutritional Support ; Parenteral Nutrition ; Severe Acute Respiratory Syndrome ; blood ; complications ; therapy ; Treatment Outcome