Objective To summarize the experience of great saphenous vein (GSV) harvesting using multiple interrupted cutaneous incisions and retrospectively compare the clinical results with those using traditional single long incision. Methods One hundred and forty-nine patients for initial elective coronary artery bypass grafting underwent GSV harvesting by either interrupted incisions (Group A, n=108) between August 2004 to October 2005 or traditional technique (Group B, n=41) between February 2004 and July 2004, respectively. The Length of GSV harvested, total incision length, time of harvesting, and complication rate were compared between the two groups. Results There were no statistical differences in the age, sex, length of GSV harvested, and macroscopic GSV quality between the two groups. Short- or long-term complications relating to the quality of venous grafts occurred in neither groups. As compared with the Group B, the Group A presented significantly longer time for GSV harvesting (49.3?6.6 min vs 29.1?5.4 min; t=17.490, P=0.000), shorter incision length (17.8?3.2 cm vs 43.1?4.9 cm; t=-36.878, P=0.000), and lower wound-related complication rate [9.3% (10/108) vs 22.0% (9/41); ?2=4.303, P=0.038]. The time for donor site manipulation was slightly increased in the Group A (62.4?8.7 min vs 59.8?6.9 min; t=1.718, P=0.088). Conclusions GSV harvesting using multiple interrupted incisions requires more complicated and difficult techniques than using a single long incision, but it is less invasive and produces superior patient satisfaction and better cosmetic outcomes.

With the development of molecular imaging technology, incorporate multiple modes of medical imaging imaging techniques of SPECT/CT and PET/CT technology with a certain degree of development. But compared to SPECT/CT and PET/CT technologies, SPECT/CT far earlier than PET/CT technology to clinical applications, due to a variety of factors influence SPECT/CT far PET/CT clinical applications to grow faster. This article highlights the progress and problems of SPECT/CT technology.
Diagnostic Imaging ; Positron-Emission Tomography ; Tomography, Emission-Computed, Single-Photon ; Tomography, X-Ray Computed

Objective To explore a method to culture human aortic valvular interstitial cells and identify the phenotypes,to establish the cell model which would be used to study aortic valve diseases in vitro.Methods Normal aortic valves of the patient with acute Stanford A aortic dissection in Peking Union Medical College Hospital were preserved during the surgical operation.Human aortic valvular interstitial cells were isolated and amplified in vitro by modified collagenase digestion method.The cell phenotype was identified by the immunofluorescent staining.Results Human aortic valvular interstitial cells could be successfully isolated and amplified in vitro by modified collagenase digestion method,identified by positive staining of Vimention and α-SMA.Conclusions The cell model of human aortic valvular interstitial ceils could be successfully established in vitro by modified collagenase digestion method.The cell phenotype identification proved to meet the experimental requirements.So it could provide cellular foundations for the study of pathogenesis of degenerative aortic valve disease.

Background Laser assisted in situ keratomileusis (LASIK) for myopia will change corneal asphericity and further affect the quality of vision.However,how operating parameters such as ablation depth and optic zone diameter affect corneal asphericity is still rarely reported.Objective Aim of this study was to investigate the influence of corneal ablation depth and optic zone diameter on corneal asphericity after LASIK for myopia.Methods This prospective study comprised 175 eyes of 89 patients with the spherical equivalent of (-5.93± 1.98)D and the best corrected visual acuity (BCVA) ≥ 1.0.The flap creation with the femtosecond laser combine iris recognize guided LASIK was performed on the patients who were available for the evaluation at postoperative 6 months.Corneal aspherical index (Q value) at the central corneal 6.0 mm were measured with Orbscan IIz-corneal topography before and 6 months after operation.Corneal ablation depth and optic zone diameter were recorded in operation.The changes of visual acuity and spherical equivalent before and after surgery were compared by self-control method,and the correlations between corneal ablation depth or optic zone diameter with alteration of Q value (AQ) after LASIK were assessed using multiple regression analysis.Results The mean spherical power,cylinder diopter and spherical equivalent were (-5.57 ± 1.89) D,(-0.71 ±0.55) D and (-5.93 ± 1.98) D before surgery,and those after surgery were (-0.25 ±0.30),(-0.14±0.22)D and (-0.32±0.37)D,showing significant differences between before and 6 months after LASIK (t=-32.39,-23.91,-35.18,all at P＜0.01).The Q values at the central corneal 6.0 mm were -0.13 ± 0.09 (-0.47-0.08) in preoperation and 1.09 ± 0.54 (0.22-2.51) in postoperation,with a significant increase in postoperation (t=29.37,P＜0.01).Corneal ablation depth was (95±28) μm and optic zone diameter was (6.32±0.26)mm.Ablation depth appeared to be positive correlation with AQ (β =0.803),and optic zone diameter showed a negative correlation with AQ (β =-0.149),with a multiple regression formula AQ =1.517+0.015×ablation depth-0.3 ×optic zone diameter.Conclusions LASIK for myopia increase corneal Q value.The increase of corneal ablation depth and decrease of optic zone diameter contribute to enlargement of corneal Q value.

Abstract： Arsenic and arsenic compounds have been listed as one of the toxic and harmful environment pollutants, and drinking, seafood intake, use of skincare products and inhalation of tobacco smoke are main routes of exposure to human arsenic exposure. The adverse effects of arsenic on pregnant outcomes have been paid much attention. Prenatal exposure to high-level arsenic has been found to increase the risk of spontaneous abortion among pregnant women. Based on national and international epidemiological studies on the correlation between arsenic exposure and spontaneous abortion during the period between 1992 and 2020, we review the association between arsenic exposure and spontaneous abortion and describe the mechanisms underlying spontaneous abortion caused by arsenic exposure, so as to provide insights into early prevention of spontaneous abortion.

Objective To systemically assess impact on postoperative outcomes after red blood cell transfusion(RBCT) in coronary artery bypass graft surgey.Methods A meta-analysis was performed on the comparison and synthesis of findings from included studies published from January 1980 to January 2014.Pooled odds ratio(OR) and 95 ％ confidence interval(CI) were calculated using RevManS.3 software.Sensitivity analysis was conducted and possible publication bias was tested as well.Results Seven retrospective studies including 71 228 patients(33 872 RBCT cases,37 356 control cases) were eligible for inclusion.The pooled analysis revealed difference in the 30-day mortality OR =1.85 (95％ CI:1.35-2.54),1-year mortality OR =2.02 (95 ％ CI:1.44-2.84),shock OR =2.92 (95 ％ CI:1.96-4.35),renal dysfunction OR =7.67 (95 ％ CI:1.44-40.94),mediastinitis OR =2.26 (95 ％ CI:1.72-2.97),and myocardial infarction OR =3.53 (95 ％ CI:2.89-4.29).Conclusion Perioperative RBCT can incresase the risk of postoperative mortality and complications in coronary artery bypass graft surgey.High-quality randomized case cohort studies are still needed for the further proof of the risk.

Inferior vena caval (IVC) tumor thrombus with cardiac extension is a very rare phenomenon,which proliferates fast and could be very challenging to the surgery.This paper was designed to investigate the clinical value of transesophageal echocardiography (TEE) for the surgical resection of IVC tumor thrombus extending into right cardiac cavities.Six cases from our medical institute,preoperatively diagnosed as IVC tumor thrombus with cardiac extension and scheduled for the surgical resection,were retrospectively analyzed.In addition to real-time and dynamic monitoring,comprehensive TEE exams were performed for all the patients respectively after anesthesia induction,namely before tumor resection and after tumor resection.Cardiac extension was defined by the preoperative finding of cardiac mass originated from IVC tumor thrombus by transthoracic echocardiography,computerized tomography or CT angiography.In all the cases,intraoperative TEE provided an accurate and excellent view of the IVC tumor thrombus.For case three,the IVC tumor thrombus was found at the IVC entrance to right atrium without further cardiac extension; for case five,the IVC tumor thrombus proliferated into right atrium but the extended cardiac mass was very slim and flexible and the tricuspid valve was untouched; for case four,the IVC tumor thrombus extended into right atrium and even cross the tricuspid valve but the extended cardiac mass was also very slim and flexible.Based on the TEE-provided information,the originally scheduled surgical decision was modified and the surgical resection was performed without cardiopulmonary bypass (CPB).For the other three cases,the intraoperative TEE showed similar results to preoperative findings.The huge IVC tumor thrombus extended into the right heart,presented almost no flexibility and dramatically compromised the intracardiac blood flow.For the three cases,CPB support was indispensable for the tumor resection.The full TEE exam after tumor resection in all the six patients displayed clear surgical resection without tumor residuals,but in those three patients suffered with severely compromised cardiac extension,severe tricuspid regurgitation was noticed.All the six patients were closely monitored until discharged,and no TEE-related complications were observed.This paper reports about TEE' s utilization in a series of consecutive patients undergoing surgical resection of IVC tumor thrombus with cardiac extension.In addition to its safety and effectiveness,TEE can provide valuable information for surgical decision making,surgical intervention assessment and anesthesiamanagement strategies.

Objective Renal tumor and gynecological tumor invading into inferior vena cava and extending to the right cardiac cavities is quite uncommon,we report the experience of diagnosis and surgical treatment of intravenous tumor embolus extending through inferior vena cava into the right cardiac cavities.Methods From Junuary 2001 to May 2008,4 patients with intravenous tumor embolus extending through inferior vena cava into right cardiac cavity were treated in PUMC Hospital.Three cases were leiomyomatosis.Two patients' operation was performed by stages,firstly removed tumer in the right cardiac cavities using cardiopulmonary bypass under mid-hypothermia,and,postoperatively 3～4 weeks,total abdominal hysterectomy with bilateral salpingo-oophorectomy including the tumor mass was performed.The other patient's tumor was resected at one time.One case is renal clear cell carcinoma,The urologist performed abdominal nephrectomy and then cardiac surgeon resected tumor embolus using cardiopulmonary bypass under deep hypothermic total circulatory.Results The four patients were uneventful recovery,there was no death or any serious perioperative complications.Following up of 3 months to 4 years showed no tumor recurrence after the operation.Conclusion Confirmed diagnosis,the tumor embolus extending through inferior vena cava into the right cardiac cavities should be suspected among patients with renal cell carcinoma and multiple hysteromyoma are all critical for the treatment.Successful therapy for intravenous tumor embolus is dependent on totalone or two-stage surgical excision of the tumor and multi-department cooperation and combined therapy.

ObjectiveTo research the relationship between the plasma levels of myeloperoxidase (MPO) and the onset and progress of acute coronary syndrome (ACS) and the severity of coronary lesions in patients with ACS.MethodsSeventy-eight patients hospitalized with chest pain were enrolled,including 41 patients with ACS (ACS group),17 patients with stable angina pectoris(SAP,SAP group) and 20 patients serving as control (control group).Forty-one patients undergoing coronary angiography were divided into single vessel lesions group (7 patients),double vessel lesions group (7 patients),multiple vessel lesions group ( 12 patients) and no vessel lesions group ( 15 patients) based on the vessel lesions of the left anterior descending,left circumflex artery and right coronary artery.According to the diameter stenosis of major coronary artery,there were 15 patients in no vascular stenosis group,2 patients in mild vascular stenosis group,6 patients in moderate vascular stenosis group and 18 patients in severe vascular stenosis group.The levels of MPO were measured by enzyme-linked immunosorbent assays(ELISA).ResultsThe levels of MPO in ACS group [( 252.10 ± 27.07 ) μ g/L]were higher than those in SAP group[( 185.81 ± 17.85 ) μ g/L]and control group [( 140.42 ± 71.40) μ g/L](P ＜ 0.05 ),the levels of MPO in SAP group were higher than those in control group(P＜ 0.05 ).The levels of MPO in single vessel lesions group and multiple vessel lesions group were higher than those in no vessel lesions group (P ＜ 0.05 ),but there was no significant difference among single vessel lesions group,double vessel lesions group and multiple vessel lesions group (P ＞ 0.05 ).The levels of MPO in mild vascular stenosis group,moderate vascular stenosis group and severe vascular stenosis group were higher than those in no vascular stenosis group (P ＜ 0.05),but there was no significant differenceamong mild vascular stenosis group,moderate vascular stenosis group and severe vascular stenosis group(P ＞ 0.05 ).A positive correlation was observed between the levels of MPO and neutrophils (r =0.288,P=0.018 ),creatine kinase isoenzyme-MB(r =0.469,P=0.043 ),subject groups( r =0.757,P=0.000),vessel lesions (r =0.584,P=0.000) and the degree of vascular stenosis (r =0.491,P=0.001).Conclusion MPO may predict ACS and reflect the severity of coronary lesions in ACS as a novel inflammatory marker.

Objective To investigate the mRNA-based anticancer gene transfer in MSCs-mediated cytotox-icity of glioma cells. Methods TRAIL mRNA and PTEN mRNA were synthesized in vitro. Immunoblotting assay was used to detect the expression of TRAIL and PTEN in the transfected MSCs.Transwell co-culture was perform to detect the migration ability of MSCs after gene transfection. The bioluminescence,live/dead staining and real time cell analyzer were used to analyze the viability of DBTRG cells. Results Compared with non-transfected MSCs, an enhanced migration rate was observed in MSCs with two kind of mRNA transfection.TRAIL-and PTEN-mRNA-induced cytotoxicity in DBTRG glioma cell was correlated with the ratio of the conditioned medium of the transfect-ed MSCs. A synergistic action was observed in TRAIL and PTEN in the transwell co-culture model. Conclusion The present study reveals the effect of synthesized mRNA-based gene transfer on mesenchymal stem cell-mediated cytotoxicity of glioma cells(DBTRG).