Objective The purpose of this study was to evaluate the safety and clinical oulcomes of aortic valve replacement (AVR) performed with minimally invasive technique.Methods From June 2010 to October 2011,20 cases of minimally invasive AVR were performed.The mean age was (47.60±12.28) ;12 males and 8 females.All patients are ventilated with a double-lumen endotracheal tube,through the 3nd anterior intercostals space with a 5 -6cmskin incision,right femoral artery and vein cannulation are used to establish CPB,direct aortic cross-clamped by Chitwood sliding clamp through the right 4th intercostals space,and completed the aortic valve replacement.Results Mean length of incision was (4.73±0.54)cm.Mean duration of cardiopulmonary bypass was (124±39.83)min,crossclamp time was (97.21±33.17) min.Median intubation time was (13.55±3.87)hours.Median duration of intensive care and postoperative hospital stay was (16.34±3.82)hours and (6.63±1.45) days,respectively.Hospital mortality was 0.There was no perivalvular leakage,Conclusion Minimally invasive aortic replacement with a modified Port-Access approach is feasible,small incisions,more cosmetic,shorter length of bospital stay and less need for blood transfusion are attainable.

Objective To evaluated the early-term results of the right or left anterolateral minithoracotomy used for the repair of various congenital heart defects.Methods All the patients with congenital heart defects who were operated with this incision between April 2010 and December 2012 were reviewed.There were 63 patients (41 females,22 males) underwent openheart surgery through right or left anterolateral minithoracotomy.Ages ranged from 12 to 69 years,mean (30.63 ± 11.74) years.Corrected defects included atrial septal defect(ASD) closure in 38,closure of ventricular septal defect(VSD) in 19,correction of partial atrioventricular canal defect (PECD) in 3,correction of partial anomalous pulmonary venous connection (PAPVC) in 1,correction of Ebstein's anomalyin 1,and repair of ruptured aneurysm of the sinus of Valsalva in 1.Results In all patients,length of incision was (4.76 ± 0.95) cm.There was no early or late death.No patient required conversion to full sternotomy.The median CPB and aortic clamp times were (76.38 ± 29.97) and (33.49 ± 31.50) minutes,respectively.Median intubation time was (10.53 ± 6.13) hours.Median duration of intensive care and postoperative hospital stay was (14.93 ± 7.65) hours and (5.42 ± 1.98) days,respectively.Only 9 patients(14.3％) received blood transfusion.Follow-up echo showed no residual defect.All patients have gratifying cosmetic results and are in excellent condition after a median follow-up of (13.75 ± 8.91)months.Conclusion The small anterolateral thoracotomy in congenital cardiac surgery is a safe and feasible approach,and with a excellent cosmetic results.

Objective Discuss the different between minimally invasive and conventional thoracotomy mitral valve replacement surgery.Methods Select 141 cases from February 2009 to December 2012 in our hospital suffer mitral valve replacement surgery.69 cases minimally invasive surgery and the 72 cases conventional thoracotomy mitral valve replacement surgery,mechanical valve 90 cases,the bioprosthesis 51 cases.The establishment of cardiopulmonary bypass is through the femoral artery and vein and the right jugular vein with cannulation.Under the guide of transesophageal echocardiography (TEE) and adjust the the intubation position to the inferior vena cava and superior vena cava junction.Double-lumen endotracheal intubation in trachea.Transthoracic approach through the right side of the stemum 4 intercostal,the left lung unilateral breathing and fight lung collapse.Open the pericardium with minimally invasive surgical instruments away 2 cm from the phrenic nerve.Transthoracic chitwood clamp blocking the ascending aorta,HTK or crystalloid cardioplegia aortic root perfusion.Arrest heart minimally invasive mitral valve replacement surgery.After CPB,unplug the femoral artery and vein catheter,6-0 prolene suture femoral artery reconstruction pathway.Results Minimally invasive compared to the conventional median thoracotomy mitral valve replacement surgery have no significant difference in operative time,cardiopulmonary bypass time,aortic clamping timeand the intensive care unit (ICU) time.Conclusion Overcome the learning curve,minimally invasive mitral valve surgery have many advantages than the conventional median thoracotomy surgery is a safe,effective,and easy to spread surgery.

Objective To review and analyze minimally invasive right thoracotomy and peripheral cannulation as an alternative strategy in redo heart surgery.Methods From June 2012 to December 2016, 23 reoperative heart procedures were performed through a right lateral thoracotomy with about 5 cm in the third or fourth intercostal space,according to the different diagnosis with the corresponding operations.Results We performed 23 redo heart surgeries,there were 10 female and 13 male patients with a mean age of 41.43 years(range,20 to 69 years).4 mitral perivalvular leakage, 1 prosthetic valve dysfunction, 3 mitral insufficiency after mitral valvuloplasty, 1 aortic insufficiency after ventricular septal defect and aortic repair, 1 mitral insufficiency after ventricular and atrial septal defect repair, 3 residual fistula after surgery repair of ventricular septal defect, 1 tricuspid insufficiency after mitral and aortic valve replacement, 1 tricuspid insufficiency after left atrial myxoma removal,1 tricuspid insufficiency after Bentall surgery, 2 tricuspid insufficiency after mitral valve replacement, 1 mitral insufficiency after ventricular septal defect and mitral valvuloplasty, 2 tricuspid insufficiency after the repair of Ebstein abnormality.We respectively carried out repair of valve leakage, mitral valve replacement, aortic valve replacement, mitral valve repair, tricuspid valvuloplasty, postoperative repair of residual shunt of ventricular septal defect, redo repair of Ebstein abnormality.The effect of the whole group operation of operation was satisfactory, no death during operation and severe complications.All patients were under cardiopulmonary bypass,three patients' ascending aortas were bloked, and nine patients were with cardiopulmonary bypass.It indicated tha the operation was possible at operation time,total blood loss and the frequency of blood transfusion.Conclusion The application of closed thoracic cardiopulmonary bypass and minimally invasive right thoracotomy in redo or multiple cardiac surgery,can avoid reoperative sternotomy risk such as hemorrhage, tissue damage and so on.It shortened the operation time, reduced the risk of surgery and blood transfusion rate, can be used in some of the heart surgery patients again and repeatedly.

Objective The aim of this study is to evaluate the early and midterm results of reconstructive new tricuspid valvar annulus technique and prosthetic ring in the anatomic correction of Ebstein's anomaly.Methods 60 operations for Ebstein's anomaly were performed by the reconstructive new tricuspid valvar annulus technique,prosthetic ring was used to reinforce the new tricuspid valvar annulus,the plastic effect of tricuspid valve was observed real-time by trans-esophagus echocardiography during operation.The follow-up results of the plastic effect of tricuspid valve were studied after operation.Results Mean operation time was (3.1 ± 2.3) h,mean cardiopulmonary bypass time was (148.8 ± 44.6) min,mean aortic cross-clamp time was(112.6 ± 34.1) min.3 patients had tricuspid valve replacement because of bad plastic effect;1 patient had bidirectional shunt Glenn procedure because of right sided heart failure.Hospital mortality was 1.When the patients were discharged,tricuspid regurgitation severe 1,medium 5,mild or no 50;53 being of heart functional class Ⅰ and class Ⅱ,3 of classⅢ.45 patients (80.3 ％) were followed-up out-hospital from 6 months to 7 years,mean (24.4 ± 21.4) months.Tricuspid regurgitation severe 1,medium 6,mild or no 38.And the nice stability of tricuspid valve was found during the follow-up period,41 patients being of heart functional class Ⅰ or Ⅱ (NYHA),4 of class Ⅲ.1 need reoperation.Conclusion The reconstructive new tricuspid valvar annulus technique can maintain farthest the dimension and geometric configuration of functional right ventricle,longitudinal plication of the atrialized right ventricle can restore a large ventricular cavity,improve it's pump function,and make valvuloplasty perfect,which widen obviously the indication of tricuspid valvuloplasty for Ebstein's anomaly.The research concluded that this technique can correct anatomically Ebstein's anomaly effectively,and it can get the stable effect of tricuspid valvuloplasty obviously if use prosthetic ring to reinforce the new tricuspid valvar annulus.

Objective To investigate the effect of berberine on insulin resistance induced by free fatty acid in 3T3-L1 adipocytes and the possible molecular mechanism.Methods 3T3-L1 adipocytes were treated with 0.5 mmol/L palmitic acid to induce insulin resistance.Berberine was used for treatment and aspirin for positive control.Glucose oxidase method was employed for measuring the glucose consumption in the medium and 2-deoxy- [~3H]-D-glucose method was used for the determination of glucose uptake.Western blot was used for the determination of IKB kinase(IKK)?SerlS1 phosphorylation,insulin receptor substrance-1(IRS-1)Ser307 phosphorylation,the protein expression of IKK?,IRS-1,phosphatidylinositol 3-kinase(PI-3K)p85 and glucose transporter 4(Glut4).Results After the treatment with 0. 5 mmol/L of palmitic acid for 24 h,glucose consumption by 3T3-L1 adipocytes was decreased by 41%,insulin-stimulated glucose transport was inhibited by 67%,IRS-1 and PI-3K p85 proteins were reduced, and phosphorylations of IKK?Ser181 and IRS-1 Ser307 were induced.The above results were reversed by adding berberine or aspirin.But Glut4 and IKK?protein abundance was not changed during this study.Conclusion Berberine significantly improves insulin resistance induced by free fatty acid in 3T3-L1 adipocytes via inhibiting IKK?serine phosphorylation.

AlM:To evaluate the efficacy of combined pranoprofen eye drops and artificial tears on the treatment of mild to moderate dry eye syndrome after trabbeculectomy.METHODS:This prospective case control study included 63 cases (63 eyes) of patients with mild to moderate dry eye syndrome after trabbeculectomy in our hospital from November 2013 to June 2013. All subjects were randomly divided into two groups. Observation group was treated with combined pranoprofen eye drops and artificial tears and control group received simple artificial tears marking the eyes at 1, 2, 4wk. The patient's symptoms, signs, BUT, S▏t, and FL were observed before treatment and 1, 2, 4wk after treatment.RESULTS: After 2wk, the symptoms of observation group were improved, there was statistically significant difference (P<0. 05). FL difference of each group was statistically significant ( P<0. 05 ); After 4wk, symptoms and signs were improved. There was statistically significant difference ( P < 0. 05 ). The BUT of the observation group and corneal FL scores of two groups showed significant differences (P<0. 05). CONCLUSlON: Artificial tears joint pranoprofen eye drops has good curative effect in the treatment of mild to moderate dry eye syndrome after trabbeculectomy.

OBJECTIVETo study the expressions of MMP-2 and TIMP-2 mRNA on cultured rat mesangial cells (MsC) and in human diseased glomeruli, and to explore their significance in the development of glomerulosclerosis.

METHODSThe expressions of MMP-2, TIMP-2, and Col IV mRNA on cultured rat MsC stimulated by IL-1 or/and TGF-beta1 were investigated through Northern blot analysis. The levels of MMP-2 and TIMP-2 mRNA expressions and immunoreactivity of PCNA and Col IV in human diseased glomeruli from renal biopsies of lupus nephritis (LN) patients were examined by in situ hybridization and immunohistochemistry, respectively.

RESULTSThe levels of MMP-2, TIMP-2, and Col IV mRNA expressions were markedly increased on cultured rat MsC stimulated by IL-1 or/and TGF-beta1. Meanwhile, upregulation of MMP-2 and TIMP-2 mRNA expressions was confirmed in diseased glomeruli from patients with various subtypes of LN, and was closely related to the positive cell number of PCNA presentation and deposition of Col IV in glomeruli.

CONCLUSIONThe results suggest that the over-expressions of MMP-2 and TIMP-2 mRNA on glomerular cells might play a critical role in the development of glomerulosclerosis.

Animals ; Cells, Cultured ; Collagen Type IV ; biosynthesis ; genetics ; Glomerular Mesangium ; metabolism ; Humans ; Kidney Glomerulus ; metabolism ; Lupus Nephritis ; metabolism ; pathology ; Matrix Metalloproteinase 2 ; biosynthesis ; genetics ; Proliferating Cell Nuclear Antigen ; biosynthesis ; genetics ; RNA, Messenger ; biosynthesis ; genetics ; Rats ; Tissue Inhibitor of Metalloproteinase-2 ; biosynthesis ; genetics ; Up-Regulation

OBJECTIVESTo introduce the method and experience of three-piece inflatable penile prosthesis for treatment of erectile dysfunction (ED).

METHODSBoth AMS700CX/CXM and MENTOR ALPHA I three-piece inflatable prosthesis were used for 48 cases of ED.

RESULTSThere were no rejection, mechanical problems, urethral injury and penile skin necrosis after surgery. All patients had satisfaction of sexual life. Only one case had trauma of tunica albuginea (2.08%) and the implantation had to be cancelled. There were 2 cases of post-operative infection (4.17%), 10 cases of prepuce edema(20.8%), 8 cases of penile pain(16.67%). The effective rate was 97.9% and satisfaction rate was almost 100%.

CONCLUSIONSThree-piece inflatable penile prosthesis was more compatible to human physiology. It is natural, easy to hide and use, and it caused little trauma in surgery with high rate of successful implantation and patient satisfaction. It was indicated for all kinds of ED, especially suitable for refractory and drug incurable ED patients.

Adolescent ; Adult ; Aged ; Erectile Dysfunction ; therapy ; Humans ; Male ; Middle Aged ; Penile Implantation ; Penile Prosthesis

Objective To optimize the extraction technology for Yangxin Anshen Granules. Methods With yield of volatile oil as index, single factor tests were adopted to investigate effects of water, soaking time and distillation time on extraction technology of volatile oil. Using water amount, extraction time and extraction times as factors, the contents of paeoniflorin and total solid as indexes, orthogonal test was employed to optimize the extraction technology of Yangxin Anshen Granules. Results The optimical extraction technology conditions were as follows:Cinnamomi Ramulus, Saposhkoviae Radix, and Citri Sarcodactylis Fructus were extracted to get volatile oil with eight-folds amount water of herbs for 6 hours; other herbs were boiled with eight-folds amount water of herbs and extrancted for two times, 1 h each time. Conclusion This extraction process is reasonable and practical, and can well guarantee the quality of preparation.