[Objective] To study the apoptosis after long time of heart preservation,and the barrier of caspase (Ac-DEVD-CHO) in prolonged heart transplantation.To improve the techniques on the preservation of donor heart.[Methods] Donor rat hearts were subjected to group A (non-Ac-DEVD-CHO-treated),group B (Ac-DEVD-CHO-treated) of hypothermic storage,after 9 hours of heart preservation,then performed heterotopic heart transplantation,followed by 60 min of normothermic reperfusion (n ＝ 6 in each group).[Results] After 60 min reperfusion,compared with group A,① a significant improvement in the percent recovery of HR was observed in group B (P ＜ 0.05);② Caspase-3 activity was decreased in group B (P ＜ 0.01);③ an apparent decline in the expression of infarct area was observed in group B (P ＜ 0.01);④ an apparent decline in the expression of TUNEL-positive cardiomyocyte was observed in group B (P ＜ 0.01);⑤ Group B shows the least disease.[Conclusion] ① After preservation and reperfusion,cardiomyocyte apoptosis was observe evidently,which led to irreversible heart dysfunction.② The administration of caspase-3 inhibition after reperfusion attenuates ischemia-reperfusion injury by suppressing apoptosis in heart transplantation.Furthermore,the use of caspase inhibition was investigated as a strategy for the preservation donor heart in transplantation.③ The relationship of dose-response and time-effect is still unknown.

To explore the molecular pathological mechanism of severe brain injury, the brain diffuse axon injury (DAI) model and Mamarou free drop model were produced in rats. Sagittal sections of the brain were processed by immunohistochemical ABC method using the mouse serum against NF68 subunit and HSP70. The medulla oblongata was observed under the microscope and electron microscope. Left parietal lobe of the free drop model was examined with HE and HSP70 immunohistochemistry. At 30 min post injury, the axons in medulla oblongata were seen to be crooked, swollen,and deranged. The myelin sheath became slightly separated, and the NFs in axoplasma were abnormal . At 2~24 h post injury,obvious axonal swelling, disconnection and formation of axonal retraction balls were seen. Obvious separation of myelin sheaths, local disconnection, vacuolization,peripheral aggregation of mitochondria and partial dissolution of axoplasma were seen. The NF68 positive axons increased gradually in staining intensity. HSP 70 positive cells of the two groups were detected at 3h after brain injury, reached the peak at 24h, and decreased at 72h. The HSP expression of the two groups were in accord. The research indicated that DAI could lead to a derangement in structure of NFs. Ischemia and anoxia may aggravate the brain injury.

Objective To establish an HPLC method for the content determination of sodium Danshensu inBawei Qidan Capsule.Methods HPLC was applied and the determination was performed on Shim-pack CLC-ODS C18 column (250 mm×4.6 mm, 5μm) with methanol-water- acetic acid (7∶92∶1, V/V/V) solution at a flow rate of 1.0 mL/min and detection wavelength at 281 nm. The column temperature was 30℃, and injection volume was 10μL.Results Through methodological study, the linear range of sodium Danshensu was 0.494 4-4.944μg (r=0.9996), the average recovery was 97.20%, RSD=1.13%.Conclusion The HPLC method for the content determination of sodium Danshensu inBawei QidanCapsule was user-friendly, accurate and reliable, with good repeatability and stability, which can be used for quality control ofBawei Qidan Capsule.

Objective To evaluate safety and validity of 3D video-assisted thoracoscopic technology in cardiac surgery.Methods Between October 2013 and July 2014,50 patients underwent 3 D Video-assisted thoracoscopic cardiac surgery including:5 atrial septal defect closure,1 ventricular septal defect closure,repairment of 1 unroofed coronary sinus,1 partial atrioventricular septal defect and 1 cor triatriatum,28 mitral valve replacement (1 re-MVR),1 tricuspid valve replacement,9 mitral valvuloplasty,2 left atrial myoxoma resection,and 1 left internal mammary artery harvest + minimally invasive direct coronary artery bypass.All procedures were performed under extracorporeal circulation,using 30° thoracoscope and 3D high resolution monitor.Results There was no perioperative death.One patient was converted to median sternotomy because of pericardial adhesions.Mean operative time was(232.8 ± 54.7) min,mean cardiopulmonary bypass time was(128.0 ±42.5) min,mean aortic cross-clamp time was (74.7 ± 25.1) min.Mean ICU stay was (30.4 ± 22.0) h,mean duration of mechanical ventilation was(13.7 ± 11.9) h.Mean postoperative drainage time was (3.34 ± 1.91) d,mean hospital stay was (6.52 ± 3.06) days.There were 11 (22％) operative complications,including 4 intrathoracic bleeding,1 wound infection,3 hemothorax,1 brachial plexus injury,1 intractable hiccup and 1 mild paravalvular leakage.Compared with 20 mitral valve replacement by 2D thoracoscopy,the 3 D group was slightly less time consuming(P ＞ 0.05).Conclusion 3 D video-assisted thoracoscopic cardiac surgery is feasible and safe,and it' s worthwhile to promote this promising technology.

Objective To evaluate the limitation of image-based classification and delineation of cervical nodes proposed in 1999. Methods 259 consecutive nasopharyngeal carcinoma patients received contrast-enhanced transverse CT scan from July to November in 2003, the scanning range extended from the skull base to the inferior border of the clavicle, with thickness set at 5?mm per slice from the skull base to the oropharynx, and 1?cm per slice from the oropharynx to the clavicle. Interpretation of the images and assessment of the involved nodes distribution were performed by both radiation oncologists together with diagnostic radiologists according to 1999 image-based classification and delineation of the neck. Then we evaluated whether this classification could fully cover all the lymphatic drainage areas of the neck. Results 218 cases had nodal involvements. Nodal distributions were 0 in levelⅠA, 6 in levelⅠB, 136 in level ⅡA, 171 in level ⅡB, 78 in level Ⅲ, 20 in level Ⅳ, 33 in level VA, 27 in level VB,0 in level Ⅵ and Ⅶ, 5 in supraclavicle and 102 in retropharyngeal space, respectively. Among another 57 cases who belonged to none of the above levels, 2 cases had lesions in the preauricular area, the rest 55 medial to the border of internal carotid artery, 2?cm from inferior to the skull base to the hyoid bone. Conclusions The 1999 image-based classification of the neck nodes,being essentially rational, did not fully cover the retropharyngeal space. It would be better to shift the inferior boundary of the retropharyngeal space to the level of the hyoid bone.

Objective Background and objective The Cox maze Ⅲ procedure has been considered the gold standard for the surgical treatment of atrial fibrillation (AF) and the modified Cox maze use bipolar radiofrequency ablation instead of the cut-and-sew technique,while also reducing the connecting lines in left atrium.This study was to understand whether completely isolation the posterior left atrium by increasing left atrium ablation lines can enhance the survival after modified Cox maze procedure.Methods From Jan 2009 to Dec 2009,all the patients underwent the Cox maze procedure,following the same examination,were divided into two groups (case-control): box lesion group (n =60),which is means the right and lefi pulmonary vein lesions were connected inferiorly by adding ablation lines,thereby completely isolating the posterior left atrium and the non-box lesion group (n =60).Similar interventions were given during the perioperative periods.Comparing the risk factors before surgeries,then follow-up was 100％ complete,and the mean follow-up was 9 ± 8.4 months.Results Except the box lesion had long time of extracorporeal circulation,the characteristics of the 2 groups were similar because there were no differences in age,AF duration,left atrial diameter,left ventricular ejection fraction or homochronous operation between the groups and there was no operative death.No patient was lost to follow-up.In the mean follow-up duration,a patient was died of intracerebral hemorrhage at 2 months postoperationly in the box lesion group and a patient suffered from stroke at 12 months postoperationly in the non-box lesion.The overall freedom from AF recurrence was higher in the box lesion group at 1 (70％ vs 51.2％,P =0.039) and 3 (78.3％ vs 60％,P =0.030) months.While it was 80％ vs 71.7％ (P =0.286) at 6 months.Eight patients wrere readmitted because of the recurrence of AF,4 and 2 patients underwent catheter ablation in box and non-box group respectively,one patient in each group underwent electrical conversion.After treatment,all of the patients were recovered to sinus rhythm and continued to take cordarone.Conclusion Compared to the single connecting between right and left pulmonary vein,isolating the entire posterior left atrium by creating a box lesion showed higher freedom from AF in the earlier months (1-3months).However,half a year after the surgery,there were no significant differences between the two groups.

Objective To examine whether the minimally invasive video-assisted thoracoscopic surgery(VATS) in atrial septal defect(ASD) closure yields better clinical outcome equivalent to those of more established procedures,such as median sternotomy,moreover,to provide our own clinical experience in ASD Closure.Methods From January 2012 to January 2013,100 ASD patients were treated,50 patients received traditional open heart surgery (OHS group),17 males and 33 females,aged(23.3 ± 7.5) years,weighted (47.5 ± 16.5) kg; 50 patients underwent video-assisted thoracoscopic surgery (VATS group),20 males and 30 females,(22.6 ± 8.2) years old and (49.6 ± 17.2) kg weight.Collected and analyzed the clinical date of intraoperation and postoperation.Results All patients survived after surgery without serious complications like death.Clinical date of both group(OHS group vs.VATS group)include:Total operating room time (121.3 ± 20.5) min vs.(105.3±17.5) min (P＜0.05); tracheal intubation time in ICU (210.0±36.5) min vs.(100.0 ±47.5) min(P＜0.05) ; volume of thoracic drainage after operation (350.3 ± 50.8) ml vs.(47.0 ± 10.9) ml (P ＜ 0.005) ; postoperative length of hospital stay (6.2 ± 1.7) days vs.(4.4 ± 1.5) days (P ＜ 0.005).Rate of return to work in 3 weeks of postoperation 0 vs.78.4％ (P ＜ 0.005).Conclusion Completed VATS in ASD closure is less invasive,accelerates recovery and maintains overall surgical efficacy,which brings good economic and social benefits.For the appropriate patients,and for the experienced and skilled surgeon,completed VATS is the best method of choice of ASD closure in our department.

Purpose: The aim of this retrospective study was to evaluate the relationship between admission base excess and clinical outcomes in postoperative patients with aortic dissection. Methods: Clinical data were extracted from the MIMIC-IV (Medical Information Mart for Intensive Care IV) database. The association between admission base excess and mortality in postoperative patients with aortic dissection was assessed using multivariate Cox regression and Kaplan-Meier survival analysis. Subgroup analysis and receiver operating characteristic (ROC) curve analysis were employed to evaluate the predictive performance of base excess for in-hospital, 30-day, 90-day, and 1-year mortality. Results: A total of 196 patients were categorized into the normal base excess (–3 to +3 mmol/L) group and abnormal base excess (<–3 or >+3 mmol/L) group. Multivariate Cox regression analysis revealed that arterial base excess was a significant predictor of all-cause mortality across all periods. Subgroup analyses showed no significant interaction effects.The area under the ROC curve for base excess ranged from 0.640 to 0.745, indicating comparable predictive performance to existing scoring tools. Conclusion Arterial base excess measured at admission is an effective and accessible predictor of mortality in patients with aortic dissection following surgical treatment.

Purpose: The aim of this retrospective study was to evaluate the relationship between admission base excess and clinical outcomes in postoperative patients with aortic dissection. Methods: Clinical data were extracted from the MIMIC-IV (Medical Information Mart for Intensive Care IV) database. The association between admission base excess and mortality in postoperative patients with aortic dissection was assessed using multivariate Cox regression and Kaplan-Meier survival analysis. Subgroup analysis and receiver operating characteristic (ROC) curve analysis were employed to evaluate the predictive performance of base excess for in-hospital, 30-day, 90-day, and 1-year mortality. Results: A total of 196 patients were categorized into the normal base excess (–3 to +3 mmol/L) group and abnormal base excess (<–3 or >+3 mmol/L) group. Multivariate Cox regression analysis revealed that arterial base excess was a significant predictor of all-cause mortality across all periods. Subgroup analyses showed no significant interaction effects.The area under the ROC curve for base excess ranged from 0.640 to 0.745, indicating comparable predictive performance to existing scoring tools. Conclusion Arterial base excess measured at admission is an effective and accessible predictor of mortality in patients with aortic dissection following surgical treatment.

Purpose: The aim of this retrospective study was to evaluate the relationship between admission base excess and clinical outcomes in postoperative patients with aortic dissection. Methods: Clinical data were extracted from the MIMIC-IV (Medical Information Mart for Intensive Care IV) database. The association between admission base excess and mortality in postoperative patients with aortic dissection was assessed using multivariate Cox regression and Kaplan-Meier survival analysis. Subgroup analysis and receiver operating characteristic (ROC) curve analysis were employed to evaluate the predictive performance of base excess for in-hospital, 30-day, 90-day, and 1-year mortality. Results: A total of 196 patients were categorized into the normal base excess (–3 to +3 mmol/L) group and abnormal base excess (<–3 or >+3 mmol/L) group. Multivariate Cox regression analysis revealed that arterial base excess was a significant predictor of all-cause mortality across all periods. Subgroup analyses showed no significant interaction effects.The area under the ROC curve for base excess ranged from 0.640 to 0.745, indicating comparable predictive performance to existing scoring tools. Conclusion Arterial base excess measured at admission is an effective and accessible predictor of mortality in patients with aortic dissection following surgical treatment.