Chest wall resection and reconstruction remains a severe challenge for reconstructive surgeons,which often leads to conservative treatment regimens in clinical practice,consequently resulting in poor outcomes(high morbidity and mortality).In recent 20 years,advances in muscle flap surgery and availability of chest reconstructive prosthesis have encouraged the surgeons to take an active attitude toward chest wall resection;many "unresectable" lesions now have a chance to be resected and cured.This article reviews the problems concerning the principles for chest wall resection,reconstruction,prosthesis selection,etc.in chest wall reconstruction.

The deepening of our understanding on the cardiac electrophysiology mechanism and the progress on cell transplantation technique have expanded our view in treating various kinds of cardiac diseases. Over the past few years literatures have reported many kinds of cell transplantation techniques for treating various types of bradyarrhythmias, such as complete heart block and sinoatrial node dysfunction, and impressive achievements have been made by far. This review discusses the advantages and flaws of the existing strategies and the future of biological pacemakers.

Valvular disease is a commonly seen heart disorder,valve replacement is an effective approach to treat valve disorders.Both the mechanic valves and bioprosthesis used now have their own defects,making it important for the cardio surgery field to develop some kind of ideal valves.With the development of tissue engineering techniques,the tissue engineering valves are thought to have great potential and bright clinical future,and now it has become a hot point in cardiac surgery.This article is to evaluate the frame materials,resource of tissue cells and implantation, in vitro pre adaptation testing and in vivo animal experiment results,and the existing problems are pointed out in the present study.

Objective To investigate the long-term morphologic and functional changes of the tricuspid valve after mitral valve replacement. Methods The tricuspid valve function was evaluated by Doppler echocardiography in 903 patients who underwent mitral valve replacement during recent 10 years. Tricuspid regurgitation and annular dilatation in various degrees were found in all patients preoperatively. 686 patients underwent Kay annuloplasty or DeVega annuloplasty, 106 patients underwent tricuspid ring annuloplasty, and 201 untreated. Results Among 201 patients who did not undergo tricuspid annuloplasty, severe tricuspid regurgitation developed in 46 during 2 to 3 years follow-up. One out of 16 patients who underwent tricuspid ring annuloplasty developed moderate tricuspid regurgitation 2 years after operation. Of 686 patients who underwent Kay annuloplasty or DeVega annuloplasty, 150 developed moderate or severe tricuspid regurgitation during 3~5 years after operation. Conclusion Tricuspid annular dilatation, right heart impairment and severe pulmonary hypertension are responsible for the development of late tricuspid regurgitation after mitral valve replacement. For the patient who underwent mitral valve replacement ,tricuspid annuloplasty should be performed when annular dilatation was found, even without tricuspid regurgitation and tricuspid ring annuloplasty should be performed in patient with severe tricuspid regurgitation and obvious tricuspid annular dilatation.

Objective To design and prepare a new prosthesis of chest wall by selecting and integrating the appropriate biodegradable materials,and to evaluate the efficiency and safety of the prepared prosthesis in order to explore the feasibility of reconstruction of an extensive chest wall defect.Methods Three types of chest wall prostheses,polydioxanone(PDO)mesh,chitin fiber reinforced polycaprolactone(CFRP)plate and CFRP strip,were designed and prepared to fulfill the function of chest wall.A canine model of the chest wall resection and reconstruction was reproduced to evaluate these porstheses.15 adult mongrel dogs were subjected to extensive resection of anterior-lateral chest wall and reconstruction with chest wall prosthesis.Chest wall stability,the degradative process of the prosthetic materials and regeneration of the chest wall tissue postoperatively were recorded dynamically by macroscopic inspection and histopathologic examinations,so as to provide valuable scientific data for improving chest wall prosthesis.Results The implanted PDO mesh was well integrated with autogenous connective tissue 8 weeks after operation,degraded gradually and reabsorbed completely within 24 weeks.It provided adequate support to the chest wall and achieved satisfy cosmetic and functional repair.CFRP plate was the best in chest wall stabilization among the three groups,and paradoxical respiratory movement was efficiently relieved with CFRP rib,and it had a better biological compatibility.There was no obvious morphological change in the CFRP material after it was implanted for 24 weeks.Conclusion The synthetic prostheses developed here showed excellent biocompatibility,and they fulfilled the function in providing chest wall stabilization.Each prosthesis has its respective favorable properties in chest wall reconstruction,and all of them are valuable in clinic application in the management of complicated chest wall defects.

Objective To evaluate the therapeutic efficacy of peritoneal dialysis(PD) for acute renal failure(ARF) subsequent to cardiac surgical procedures in adults.Method Clinical data of 125 consecutive adult patients,admitted from Feb.1997 to Nov.2007,with ARF subsequent to cardiac surgery and undergone PD,were analyzed retrospectively.The levels of creatinine(Cr),blood urea nitrogen(BUN),albumin and kalium ion([K+]) were compared before and after PD.Results Of 8451 consecutive adult patients undergone operations on heart,358 cases(4.2%) experienced ARF,and 125 cases(1.5%) required PD.In 117 patients performed PD,[K+] declined to normal level within one day,BUN and Cr were 10.5?3.6mmol/L and 129.3?41.6?mol/L at the third day after PD respectively,significantly lower than those before PD(P

Objective To investigate the feasibility of minimal access valve surgery. Methods The authors performed minimal access valve surgery from January 1997 to January 2003 in 72 cases: 36 cases of mitral valve operations and 9 cases of tricuspid valve operations were performed through right anterolateral thoracotomy; 5 cases of aortic valve operations through mini-sternotomy approach; 5 cases of aortic valve operations and 2 cases of mitral valve operations through para-sternotomy approach; 15 cases of mitral valve operations through “reversed L” mini-sternotomy access. Results In the early course following the surgery (within 1 postoperative month ) 71 patients survived and 1 patient died of acute hepatic and renal failure.Complete follow-up in 64 patients for 6～60 months(mean, 13 months) revealed that all the patients responded symptomatically, with New York Heart Association (NYHA) Class Ⅱ status in 56 patients and Class Ⅲ in 8 patients. Color ultrasonocardiogram revealed normal status of mechanical or biological valves. All the patients were satisfied with cosmetic results. Conclusions Minimal access valve surgery is feasible, and is also associated with a better outcome in terms of sternal stability and postoperative recovery.

Objective: To determine whether paroxetine would be effective in the treatment of patients with chronic insomnia and to compare efficacy of paroxetine and estazolam on chronic insomnia. Methods: 74 patients with chronic insomnia were divided into 2 groups, receiving treatments of paroxetine and estazolam respectively. All of the subjects were assessed with Pittsburgh Sleep Quality Index (PSQI) and sleep diary. Results: 1. On the eighth day of treatment, estazolam group showed improvement, all the indexes of sleep were better than those before treatment and those of paroxetine group; 2. On the fifteenth day of treatment, paroxetine group showed improvement, all the indexes of sleep were better than those before treatment and those of estazolam group, while the indexes of the estazolam group returned to pre-treatment level. 3. At the end of treatments and 3 months' follow up, paroxetine group still showed better effect in sleep indexes than estazolam group and the pre-treatment level. Conclusion: paroxetine is effective in the treatment of chronic insomnia and shows long-term effect.

Surgical outcome of 188 patients with coronary artery disease was analized. 132 of them were male and 56 female (mean age 60 3 yrs).Fifty six patients had acute or post MI, 46 diabetes, 14 renal dysfunction, 26 stroke, 21 valve disease, 7 left ventricular aneurysm, and 1 type I dissecting aneurysm. Cardioplegia was used in 104 patients, intermittent aortic cross clamping in 59, OPCAB in 25, average number of graftings was 2 7 per patient. Concomitant procedures included 8 MVR or MVP, 4 AVR, 9 DVR and 1 Bentall′s procedure. Total early mortality was 5 9%, but the mortality decreased to 3 2% in 124 patients undergone CABG since Jan, 2000. Late death occurred in 2, recurrence of chest pain in 4 patients in 2 to 5 yrs postoperatively. Improved surgical techniques and perioperative management were the main factors reducing early mortality. Timing of operation, respiratory management, prevention of digestive track bleeding, and postoperative rehabilitation, should be emphasized.

With the development of tissue engineering technology .tissue engineering of heart valve by seeding cells and scaffolds has become a hot issue in valve surgery. In this article we reviewed the selection of scaffold. acquirement and culture of seeding cells, in vitro pre-condition and in vivo experiment. The questions need to be resolved in the future study is also put forward.