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 study the objectivity and reliability of needle electromyography and nerve conduction for detection of musculus extensor digitorum brevis strength, which may provide a basis for establishing a quantitative detection of muscle strength in forensic clinical study. METHODS: Forty-four healthy people were enrolled as the subjects, and during toe dorsiflexion, the following items including needle electromyography indexes, motor unit potential (MUP) amplitude, MUP count, recruitment reaction type, and nerve conduction detection indexes, compound muscle action potential (CMAP) amplitude, CMAP latent period and motor nerve conduction velocity (MNCV), were simultaneously detected under the cooperation and disguise condition. RESULTS: Under the cooperation condition, regardless of the same operator or different operators, there were good test-retest reliabilities in MUP amplitude, CMAP amplitude, CMAP latent period and MNCV, while there were normal test-retest reliabilities in MUP count and recruitment reaction type and the repeatability of the same operator was slightly better than the repeatability between different operators. Under the disguise condition, test-retest reliabilities of MUP amplitude, CMAP amplitude, CMAP latent period and MNCV were relatively high, while test-retest reliabilities of MUP count and recruitment reaction type were relatively low. CONCLUSION There are good test-retest reliabilities in MUP amplitude, CMAP amplitude, CMAP latent period and MNCV, which can be conducive to comparison between different operators and results at various times; MUP count and recruitment reaction type, which can be easily affected by subjectivity of operators and examinees, can be used to differentiate whether an examinee disguises or not. The indexes used to objectively judge muscle strength remain to be further investigated.
Electrodes, Implanted ; Electromyography ; Humans ; Muscle Strength/physiology* ; Muscle, Skeletal/innervation* ; Neural Conduction/physiology* ; Reproducibility of Results ; Toes

Objectives To clarify the basic data such as prevalent range,regiohal characteristics and the population at risk of drinking brick-tea type fluorosis in China.Methods Comprehensive survey for basic information was conducted in the provinces and autonomous regions where drinking brick-tea type fluorosis Wag prevalent,ineluding Inner Mongolia Autonomous Region,Tibet Autonomous Region, Sichuan Province,Xinjiang Autonomous Region, Qinghai Province,Gansu Province,Ningxia Autonomous Region and Yunan Province.The survey included the number ot counties(cifies)and townships(towns)where the people were accustomed to drinking brick-tea,pepulation,ethnic minority composition,the production and living style,sales and the kinds of brick-tea aIn so on.Results Two hundred and forty-one counties and 3246 townships were found to haye the habit 0f drinking brick-tea,among which 87.46%(2839/3246)had the habit for more than 30 years.There were 31 684 administrative vilages(residents' committees),15 047 elementary schools and 2873 temples surveyed,coveting a total population of 31 052 398 and 122 739 monks.Fifty-three ethnic minorities were involved.Han accounted for 44.86%(12 902 710/31 052 398), Uighur ethnic for 20.98%(7 416 474/31 052 398),Tibetan ethnic for 13.34%(4 323 272/31 052 398),Muslim ethnicfor 8.15%(2 767 603/31 052 398),Mongolian ethnic for 4.61%(1 400 206/31 052 398),Kazak ethnicfor 3.45% (1 218 272/31 052 398),of the population of drinking brick-tea,farmer population accounted for 64.13%(19 912 833/ 31 052 398),herdsman population for 8.79%(2 728 418/31 052 398),farmer-herdsman population for 12.53%(3 889 678/ 31 052 398)and town population for 14.56%(4 521 169/31 052 398).There Was 3926.74 tons of brick-tea sold per year in the investigated regions,mainly of Fu brick-tea,Green brick-tea and Black brick-tea.Areas with high brick- tea consumption distributed mainly in farmer region and farmer-herdsman region.Annual per capita consumption of brick-tea for farmers was 3.77 kg,and for farmer-herdsman population was 2.05 kg.Conclusions Begions with the habit of drinking brick-tea distributes extensively in western China and cover a huge population,and the herdsmen and farmer-herdsman are the main risk population.Drinking brick-tea type fluorosis is a seriolls public health issue in western China.

Child ; Child, Preschool ; China ; epidemiology ; Female ; Hand, Foot and Mouth Disease ; epidemiology ; Humans ; Infant ; Male ; Seasons

To study the effect of Siwu decoction on the function and expression of P-glycoprotein (P-gp) in Caco-2 cells. The Real-time quantitative poly-merase chain reaction (Q-PCR) was used to analyze the mRNA expression of MDR1 gene in Caco-2 cells. Flow cytometer was used to study the effect of Siwu decoction on the uptake of Rhodamine 123 in Caco-2 cells, in order to evaluate the efflux function of P-gp. Western blotting method was used to detect the effect of Siwu decoction on the P-gp protein expression of Caco-2 cells. Compared with the blank control group, after Caco-2 incubation with Siwu decoction at concentrations of 3.3, 5.0, 10.0 g x L(-1) for 24, 48, 72 h, the mRNA expression of MDR1 was up-regulated, suggesting the effect of Siwu decoction in inducing the expression of MDR1. After the administration with Siwu decoction in Caco-2 cells for 48 h, the uptake of Rhodamine 123 in Caco-2 cells decreased by respectively 16.6%, 22.1% (P < 0.05) and 45.4% (P < 0.01), indicating that the long-term administration of Siwu decoction can enhance the P-gp efflux function of Caco-2 cells. After the incubation of Caco-2 cells with Siwu decoction for 48 h, the P-gp protein expression on Caco-2 cell emebranes, demonstrating the effect of Siwu decoction in inducing the protein expression of P-gp.
ATP Binding Cassette Transporter, Sub-Family B ; genetics ; metabolism ; ATP-Binding Cassette, Sub-Family B, Member 1 ; genetics ; metabolism ; Caco-2 Cells ; Drugs, Chinese Herbal ; pharmacology ; Humans ; Up-Regulation ; drug effects

Objective To investigate the different pathogeneses of asymptomatic lacunar infaction and symptomatic nonlacunar infaction by investigating their risk factors.Methods A total of 1989 people more than 50 years old,performed physical examination were chosen with the results showing 48 patients with asymptomatic lacunar infaction (group A) and 51 patients with symptomatic nonlacunar infaction (group B).Another 1862 controls without cerebrovascular disease were also chosen.Single factor analysis and logistic regression analysis were used to analyze the risk factors.Each risk factor and amount of risk factors for the two diseases was compared between group A and group B.Results Age,hypertension and smoking were the independent predictors of asymptomatic lacunar infaction (P＜0.05).Age,sex,diabetes mellitus,drinking,family history of stroke and stenosis of intracrianial artery were the independent predictors of the symptomatic nonlacunar infaction (P＜0.05).Both rates of diabetes mellitus and stenosis of intracrianial artery in group B were higher than those in group A (diabetes mellitus:x2=17.603,P=0.008; stenosis of intracrianial artery:x2=19.319,P=0.005).The amount of risk factors in patients from group B was significantly more than that in patients from group A (Z=2598,P=0.009).Conclusion The risk factors and vascular mechanism in patients with symptomatic nonlacunar infaction and asymptomatic lacunar infaction are different.Diabetes mellitus and stenosis of intracrianial artery are more often noted in patients with symptomatic nonlacunar infarction.

OBJECTIVE: To explore the application value of needle electromyography (EMG) and nerve conduction study (NCS) in the forensic appraisal; to provide scientific basis for establishing normative and unified assessment methods of the peripheral nerve study in forensic medicine. METHODS: One hundred and sixty-four samples with injured peripheral nerve (injury group) and 138 samples with normal peripheral nerve (control group) were collected and tested with methods of EMG and NCS respectively. The relevance rate of two methods were compared and statistical analysis was performed. RESULTS: In the injury group, there was no statistical difference on the relevance rate between the application of EMG and that of NCS (P > 0.05). In the control group, there was no statistical difference on the negative rate between the two methods (P > 0.05). The false negative rate of the injury group and the false positive rate of the control group were both 0% when using the two methods together. CONCLUSION When the injured peripheral nerve in forensic appraisal is in doubt, application of both EMG and NCS could disclose truth from falsehood. The accuracy and credibility of identification results could be enhanced.
Action Potentials ; Adolescent ; Adult ; Case-Control Studies ; Electromyography/methods* ; Female ; Forensic Medicine/methods* ; Humans ; Lower Extremity/injuries* ; Male ; Middle Aged ; Muscle, Skeletal/physiopathology* ; Needles ; Neural Conduction/physiology* ; Peripheral Nerve Injuries/physiopathology* ; Trauma Severity Indices ; Upper Extremity/injuries* ; Young Adult

OBJECTIVETo investigate the regional spread of micrometastatic nodules in the mesorectum from low rectal cancer, and provide further pathological evidence to optimize radical resection procedure for rectal cancer.

METHODSA total of 62 patients with low rectal cancer underwent low anterior resection and total mesorectal excision (TME) was included in this study. Surgical specimens were sliced transversely and serial embedded blocks were made at 2.5 mm interval, and paraffin sections were stained with hematoxylin and eosin. The mesorectum on whole-mount sections was divided into three regions: outer region of mesorectum (ORM), middle region of mesorectum (MRM) and inner region of mesorectum (IRM). Microscopic spread were examined microscopically on the sections for the distribution in different mesorectal regions, frequency, types, involvement of lymphatic system and correlation with the primary tumor.

RESULTSMicroscopic spread of the tumor in mesorectum and ORM was observed in 38.7% (24/62) and 25.8% (16/62) of the patients, respectively. Circumferential resection margin (CRM) involved by microscopic tumor foci occurred in 6.5% (4/62) of the patients, and distal mesorectum (DMR) involvement was recorded in 6.5% (4/62) with a spread extent within 3 cm of distal border of the main lesions. Most (20/24) of the patients with microscopic spread in mesorectum were in TNM stage III.

CONCLUSIONResults of the present study support that complete excision of mesorectum without destruction of the ORM is essential for surgical management of low rectal cancer, and an optimal DMR clearance resection margin should not be less than 4 cm.

Adenocarcinoma ; pathology ; surgery ; Adult ; Aged ; Female ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Mesentery ; pathology ; surgery ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Staging ; Neoplasm, Residual ; Neoplastic Cells, Circulating ; pathology ; Peritoneal Neoplasms ; pathology ; surgery ; Rectal Neoplasms ; pathology ; surgery ; Rectum ; surgery