Objective The aim of the study was to compare the mid-and long-term results between mitral valve repair and mitral valve replacement in mitral regurgitation due to infective endocarditis.Methods From January 2005 to December 2014, 225 patients with mitral regurgitation due to infective endocarditis underwent surgical treatment at our institution.159 patients(70.7%) were male, and the mean age was(42±15) years(13-76 years).Among them, mitral valve repair was performed in 89 patients(repair group) and mitral valve replacement in 136 patients(replacement group).Preoperative clinical profiles, perioperative details and follow-up data were reviewed retrospectively.Results There was no operative death in both groups.Compared to replacement group, patients undergoing mitral valve repair suffered significantly less embolism events(9.0% vs.22.8%, P<0.05) and central nerve complications(6.7% vs.17.6%, P<0.05).Patients with mitral valve vegetation were significantly less in repair group as well(59.6% vs.89.0%, P<0.05).The mean cardiopulmonary bypass time[(87±30) min vs.(86±33) min, P>0.05] and aorta clamp time[(52±21) min vs.(51±23) min, P>0.05]were similar between repair group and replacement group.Intensive care stay was significantly shorter in repair group[(1.4±0.7)days vs.(1.9±1.3)days, P<0.05] and hospital stay was shorter in repair group as well[(8.3±4.5)days vs.(9.5±5.3)days, P=0.09].Perioperative cerebral hemorrhage was observed in no patient in repair group and 2 patients(1.5%) in replacement.There was no in-hospital death in repair group.2 in-hospital(1.5%) deaths occurred in replacement group and the causes of death were cerebral hemorrhage and low cardiac output syndrome.The mean follow-up time was(40±35) months(3-134 months), and follow-up was complete in 85% patients.10 years over follow-up, freedom from heart related adverse events was 88% in repair group and 86% in replacement group(P>0.05).Conclusion Mitral valve repair was safe and feasible in mitral regurgitation due to infective endocarditis, with good mid-and long-term outcomes.Thorough excision of infective tissue and vegetation was necessary to perform mitral valve repair.Yet mitral valve replacement was a viable option in patients for whom repair was infeasible due to severe damage of valve.

Objective Investigating activity variance of PKC.AchE and HSP70 in different tissues of rabbits caused by dying from suspension of anterior limbs.in order to study how factors above contribute in the mechanism of death.Methods Suspend rabbit by its anterior limbs until it dies.and coilect tissue from its diaphragmatic muscle,intercostal muscle,myocardium,gastrocnemius,cerebrum,brain stem,liver,kidney and lung.In the control groups,collect same tissues of rabbits dying from strangulation,craniocerebral injury and diseases as contrast.Detect activity of PKC,AchE and HSP70 in tissues of those groups mentioned above by SP stain of immunohistochemistry.and statistically analyze result of detection by rank SUm test of independent samples of multi-groups.Results Compared with data from other control groups,there are more obvious expressions in following tissues of group of suspension:PKC in disphragmatic muscle,intercostal muscles and cerebrum(P＜0.05);AchE in disphragmatic muscles,intercostal muscles,myocardium,cerebrum,liver and nerve tract ofmuscles(P＜0.05);HSP70 in cerebrum,myocardium and lung(P＜0.05).Conclusion Through different mechanisms,PKC,AchE and HSP70 could take some certain contributions in death pmcess of suspension by anterior limbs,and the results above could offer some experimental evidences for related studies and medicolegal investigations.

Objective To explore the CT features of infantile hepatic hemangioendothelioma (IHH).Methods CT imaging features of 16 IHH patients confirmed by surgical pathology and clinical diagnosis were retrospectively reviewed.Results Of 16 patients,there were single lesion in 10 cases and multiple lesions in 6 cases.All the lesions were rich in blood supply,and the arterial phase showed obviously rings enhanced.Some linear enhancement towards to the center below the annular enhancement of solitary lesions were found.There were patchy enhancement in annular enhancement center area,and the area of enhancement obvious increasing in venous phase and delayed phase in 4 cases with multiple lesions,enhancement mode was similar to single lesion in 1 case with multiple lesions.The lesions of IHH Ⅱ were small and multiple,and showed intermittent line shaped edge enhancement;some lesions below the linear enhancement showed small nodular enhancement and the area of nodular enhancement enlarged in venous phase,the range of linear enhancement was not obvious.Conclusion CT manifestations of IHH have some characteristics,and the enhancement of CT is more important in the diagnosis of this disease.

Aim To investigate whether the effect of Aβ25-35 on Bcl-2 and Bax gene transcription through DNA methylation in SH-SY5Y cell.Methods Differ-ent concentrations of Aβ25-35 (0, 25, 50 μmol? L-1 ) were treated with SH-SY5Y cells for 48 h or 72 h in vitro.The optimal concentration and time of Aβ25-35 in-duced SH-SY5 Y apoptosis were determined by MTT method.Protein expression levels of Bcl-2 and Bax of Aβ25-35-treated groups were determined by Western blot.Real time PCR was used to detect the mRNA lev-els of DNA methyltransferase including DNMT 1 , DN-MT3a, DMT3b, MeCP2. Methylation specific PCR ( MSP) was used to analyze the effect of Aβ25-35 media-ted Bcl-2 and Bax gene promoter methylation .Results 25 μmol? L-1 Aβ25-35 was exposed to SH-SY5Y cells for 72 h, MTT assay showed that cell viability was (68.49 ±9.83 )%, which was significantly reduced compared with the control group ( P <0.05 ) , indica-ting AD cell apoptosis model was successfully estab-lished.Bcl-2 expression of Aβ25-35-treated group was significantly reduced compared with the control group , on the contrary , the expression of Bax was significantly increased .Real-time PCR results showed that com-pared with the control group , DNMT1, DNMT3a, DMT3b, MeCP2 mRNA levels of the Aβ25-35-treated groups had no significant difference ( P>0.05 ); MSP results showed that Bcl-2 and Bax unmethylated ampli-fication was positive , methylated amplification was neg-ative in control group , Bcl-2 and Bax unmethylated amplification was positive and methylated amplification was negative in Aβ25-35-treated group.Conclusion DNA methylation of Bcl-2 and Bax gene promoter are not affected during Aβ25-35 induced SH-SY5Y cell ap-optosis .

Objective This article aims to explore the role of HSP70 in the developing mechanism of SMDS(sudden manhood death syndrome,SMDS)and to investigate the value of it in the early diagnosis of SMDS.Methods By way of immunohistochemieal staining of left,right ventricular musles,sino atrial node and atrioventricular node from 30 cases of SMDS group and 20 cases of control group,we observed and measured the expression of HSP70 and its variance of intensity with graphical analysis software.Results Compared with the control group cases,in cardiac conduction system tissue of SMDS victims.we saw an obviously higher expression and intensity of HSP70(P<0.05).Conclusion As a kind of mediator in stress reaction,HSP70 is involved in the process of protecting the heart from impairment in SMDS,and it can be considerated as a reference index to identify the SMDS.

Objective:To compare the osteogenesis ability between human umbilical cord Wharton's Jelly-derived mesenchymal stem cells(hUCWJMSCs) and human periodontal ligament mesenchymal stem cells (hPDLSCs) in vitro.Methods:hUCWJMSCs and hPDLSCs were in vitro cultured.The cell proliferation capacity was examined by MTT assay.After osteogenesis induction culture,ALP activity of the cells was determined,minerialization was observed by alizarin red staining,OPN and Runx2 mRNA expression was analyzed by Real-time PCR.Results:hUCWJMSCs grew faster than hPDLSCs.After osteogenic differentiation induction,hPDLSCs group showed higher ALP level,more mineralized nodule formation and higher Runx2 expression compared with hUCWJMSCs group (P ＜ 0.05);while the OPN expressed higher in hUCWJMSCs than in hPDLSCs (P ＜ 0.05).Conclusion:hUCWJMSCs and hPDLSCs have osteogenesis differentiation potential,hPDLSCs are more osteogenetic.

Objective To analyze the acoustic features of patients with Parkinson's disease (PD),and to explore the correlation between the acoustic features and the severity and course of disease.Methods Fifty-two patients with PD from the Tongji Hospital Affiliated to Tongji Medical University and the Ninth People's Hospital Affiliated to the Medical College of Shanghai Jiaotong University from August to December 2015 were enrolled into this study.Thirty-two age-matched healthy people served as control group.PD patients were tested with Unified Parkinson's Disease Rating Scale (UPDRS) and Hoehn-Yahr (H-Y) staging.And all the patients were tested with Mini-Mental State Examiantion (MMSE) and Voice Handicap Index (VHI).The voice samples of all subjects were collected and the frequency perturbation (jitter),amplitude perturbation (shimmer),and harmonic-to-noise ratio (NHR) were analyzed using a vocal assessment.Fundamental frequency (F0),standard deviation of fundamental frequency (SDF0) and formant ratio (F2i/F2u) were analyzed using a real-time speech measuring instrument.The acoustic parameters of the two groups were compared and the correlation between the parameters of the patients and the disease and course of disease was analyzed.Results Subjective assessment using VHI showed a total of 24 VHI abnormalities (46％) in the PD group,including 13 males (54％),11 females (46％).No VHI abnormalities were found in the control group.Among the parameters analyzed by objective acoustic method,compared with the control group (female/a/1.43(1.19,1.92),/i/3.39(1.49,9.85),/u/1.46(1.23,3.85);male/a/1.06(0.92,1.89),/u/1.30(1.07,1.64)),the SDF0 of the three vowels of the female patients in the PD group (/a/2.99(1.81,4.12),Z=5.429,P＜0.01;/i/10.89(5.47,22.20),Z=8.487,P＜0.01;/u/5.16(3.75,7.80),Z=7.138,P＜0.01) and /a/ and /u/ of the male patients in the PD group (/a/2.16(1.73,2.94),Z=4.858,P=0.002;/u/3.70(2.41,5.43),Z=7.664,P＜0.01) were significantly increased,and the F2i/F2u in the PD group (male 1.96±0.84,female 1.81± 1.14) was lower than that in the control group (male 3.48±0.70,female 4.14± 1.08),and the difference was statistically significant (t=-6.669,-6.844,P＜0.01).There were no statistically significant differences in frequency perturbation,amplitude perturbation,harmonic noise ratio and fundamental frequency.Only the fundamental frequency standard deviation of the sound parameters used in the study was correlated with the disease course of PD patients.After the severity of the disease was assessed by H-Y staging,the frequency perturbation (jitter),amplitude perturbation (shimmer) in the middle and late stage patients were higher than those in the early stage patients,and the difference of frequency perturbation in the three vowels was statistically significant,and the difference of amplitude perturbation in the vowels/i/and/u/was statistically significant.No correlation was found between the acoustic parameters and UPDRS score.Conclusions Consonance disorders are common in PD patients,and the changes in acoustic parameters are mainly manifested as the increase in the SDF0 and the decrease in the F2i/F2u.Acoustic parameters can be used as an effective indicator to evaluate the condition and course of PD patients,and further language tasks need to be added to clarify.

Objective The aim of the study was to compare the early and mid-term outcomes of isolate mitral valve repair through minimal invasive and median sternotomy approach .Methods From July 2009 to December 2015, 329 patients under-went minimal invasive isolated mitral valve repair through right thoracic approach at our institution .The mean age was(48 ±14) years(15-78 years), 202 patients(61.4％) were male and 137 patients(41.6％) were in NYHA class Ⅲ-Ⅳ.570 patients underwent isolate mitral valve repair through median sternotomy in the same period .Propensity score matching identify 248 pa-tient pairs with similar preoperative characteristics .Early and mid-term outcomes were compared between propensity-matched groups.Results After propensity matching, the mean cardiopulmonary bypass time[(91 ±27)min vs.(76 ±27)min, P<0.05] and aorta cross clamp time[(52 ±18)min vs.(43 ±15)min, P<0.05] were significantly longer in minimal invasive group.24 hours drainage volume was significantly less[(353 ±329)ml vs.(446 ±356)ml, P <0.05] and patients need transfusion was significantly fewer(22.2％ vs 31.5％, P<0.05) in minimal invasive group.Incidence of stroke, poor wound healing, renal failure requiring hemodialysis and tracheotomy were similar between the two groups(P>0.05).There were two in-hospital death in minimal invasive group(respiratory failure) and median sternotomy group(low cardiac output syndrome), respectively.Follow-up was 91％ complete and the mean follow-up time was(28 ±21) months(3-89 months).At 7 year after surgery, overall survival were 99％and 100％(P>0.05) in minimal invasive group and median sternotomy group, respective-ly.Freedom from reoperation were 100％ and 95％(P>0.05) and freedom from recurrent mitral regurgitation were 95％ and 90％(P>0.05).Conclusion Minimal invasive mitral valve repair was safe, effective and provide equivalent mid-term out-comes compared to median sternotomy approach .Minimal invasive surgery provided cosmetic benefits , decreased postoperative trauma.As the accumulation of clinical experience, complex repair is feasible through minimal invasive surgery.Adoption of minimal invasive surgery will increase the acceptance of early intervention strategy among asymptomatic MR patients and thus improve late outcomes and life quality .

Objective The aim of the study is to evaluate the early and long-term outcomes of mitral valve repair for degenerative mitral regurgitation.Methods From January 2003 to December 2015,clinical profiles of 1 903 patients with degenerative mitral regurgitation who underwent mitral valve repair at our institution were analyzed retrospectively.There were 1 312 males (68.9 ％) and 591 females (31.1％) the mean age was (54.2 ± 13.1) years.Early and long-term outcomes were summarized and risk factors for adverse events were assessed.Results There were 35 in-hospital deaths(1.8％) and in-hospital mortality for isolated mitral valve repair was 0.9％ (10/1 163).Perioperative complications included central nerve system complications(0.7％),respiratory failure requiring tracheotomy(1.8％),acute renal injury requiring hemodialysis(1.2％) and reoperation for bleeding(0.7 ％).NYHA function class Ⅲ-Ⅳ (OR =3.65),atrial fibrillation (OR =2.85) and ejection fraction ＜0.6(OR =2.34) were identified as independent risk factors for in-hospital mortality.12 years over follow-up,overall survival,freedom from reoperation for mitral valve and freedom from recurrent moderate/severe regurgitation were 85％ 、91％ and 75％,respectively.Age ＞ 60 years(HR =7.43),preoperative stroke(HR =6.51),ejection fraction ＜ 0.6 (HR =3.87),left ventricular end-systolic dimension ＞ 40 mm (HR =3.98) and pulmonary systolic pressure ＞ 50 mmHg (1 mmHg =0.133 kPa) (HR =2.85) were independent predictive factors for late death.Ejection fraction ＜ 0.6 (HR =4.01),left ventricular end-diastolic dimension ＞ 60 mm(HR =1.88),leaflet lesion involving anterior leaflet (HR =2.40) and residue mild regurgitation(HR =4.17) were independent predictors for late recurrent regurgitation.Leaflet lesion involving anterior leaflet(HR =2.40) and residue mild regurgitation (HR =3.35) were independent predictor for late reoperation for mitral valve.Conclusion Mitral valve repair is safe and effective in degenerative mitral regurgitation.Early surgical intervention for asymptomatic patients with preserved left ventricular function before onset of atrial fibrillation and pulmonary artery hypertension is associated with decreased incidence of adverse events and improved long-term outcomes.Early surgical intervention should be restricted in experienced high-volume centers.