Objective Valve replacement is a conventional therapy for the mitral insufficiency caused by IE. Mitral valve repair as an optional procedure for the disease has become feasible in recent years. However, concerns from surgeons about the recurrence of endocarditis after mitral valve repair remained. in this study we evaluated the long-term clinical outcomes of patients treated with surgery for the mitral insufficiency caused by infective endocarditis (IE). Methods Between July 1990 and July 2007, 83 consecutive patients (male 62, female 21) with mitral valve IE were enrolled in this study. Forty-one (49.4% )patients received mitral valve repair ( MVP,group A) and 42(50. 6% ) patients received mitral valve replacement ( MVR, group B). Thirty-seven cases had concomitant aortic valve replacement; 1 patient had aortic valve repair; 4 cases had ventricular septal defect repair; 1 case had atrial septal defect repair, 12 cases had bicuspid valve repair; 2 cases had coronary artery bypass graft and 1 case had femoral artery thrombus. Intraoperative transesophageal echocardiography were performed in 18 cases for the evaluation of mitral valve regurgitation. Mean cardiopulmonary bypass time, aortic clamping time and postoperative ventilation time were recorded and analyzed. Mid- and long-term clinical and echocardiographic outcomes were assessed.Results Preoperative left ventricular end systolic diameter, left ventricular ejection fraction and the classification of New York Heart Association in group A were significantly lower than those in group B (P ＜ 0. 05), but no difference was observed between the 2 groups in the cardiopulmonary bypass time and the crossclamping time. However, the intubation time and ICU time were shorter in group A than those in group B ( P ＜ 0.05 ). More vegetations were seen in the MVR group than in the MVP group. Three (3.6% ) patients died after the operation in group B. All patients were assessed as in NYHA Ⅰ-Ⅱ at discharge.A follow-up was done between 1 to 165 months (mean 39 months) with a mean follow-up rate of 95%. In the MVR group, peri-valvular leakage happened in 1 case, cerebral hemorrhage happened in 2 cases and repetitive pleura! effusion in 1 case. One death happened in the MVR group and none in the MVP group. The 10-year survival rate (100% ) in group A was nonsignificantly higher in group A than that (75% ) in group B(P =0.081). Conclusion Mitral valve repair is feasible for treating mitral valve lesions caused by endocarditis, and may provide an optimistic long-term outcome to the patients. The indication for mitral valve repair is mild to moderate mitral valve lesion. Experienced cardiac surgeons, use of antibiotics before and after the operations based on drug-sensitivity test and blood test, as well as follow-up the patients yearly, are important factors for the favorite outcomes.

Objective To investigate the application of CUSUM (cumulative sum control chart) curve in cardiac clinical teaching of resident surgeon education.Methods We chose a surgeon of 10years work experience of attending the preparation operation of internal mammary artery as control reference (standard group,28 patients) and a resident engaged in professional clinical cardiac work no more than 5 years as group 1,a professional training physician engaged in cardiac surgery clinical work more than 5 years as group 2 and took 40 patients' data respectively from the two groups' preparation of internal mammary artery operation.And then we recorded the postoperative mammary artery flow,internal mammary artery preparation time and adverse events data and made statistics analysis with SPSS 19.0,and CUSUM curve with Matlab R2012b polynomial curve.Results When the density of operate interval and the operate numbers came to about 25 cases,the polynomial eurve's slope rate went up to 0,regardless the surgeons' experience,CUSUM value was accumulated from 66 to 76,and overcame the learning curve successfully.However,when the density of operate interval did no reach the standard,the surgeon's CUSUM ploynomial cmwe slope rate never reached to 0,and can't overcome the learning curve.Conclusion CUSUM curve gives a clear quantitative indicator to the cultivation of clinical physician,and makes teaching teachers can understand the young physicians' learning process,so as to change the teaching plan,help young physicians cross the learning curve as soon as possible.

Objective To evaluate the operative results of 542 patients underwent mitral valve repair and the results of 20-years follow-up.Methods A total of 542 patients [306 males,236 females;mean age (38.75?19.38) years) underwent mitral valve re- pair between 1985 and 2006.Mean follow-up was (41.03?40.40) months (1～240 months),and follow-up was 90.8% complete. Results The post-operative mortality was 3.7 %,and 96.3 % of patients were in NYHA class Ⅰ and Ⅱ after surgery.During fol- low-up,there were 20 deaths and 23 reoperations.Survival at 7-year,10-year and 15-year was 91%,88% and 70%,respectively. Freedom from reoperation at 7-year and 10-year was 94% and 86%,respectively.Conclusion Valve repair in mitral leaflet disease is a standard technique,with a good operative results.

Objective To investigate the alleviative effects of lidocaine postconditioning on pulmonary injury following ischemia reperfusion. Methods Seventy-two adult SD rats were randomized to 4 groups; sham group, ischemia-reperfusion (I-R) group, ischemic postconditioning(IPC) group and lidocaine postconditioning group. The pulmonary ischemia-reperfusion model was established by occlusion of the left hilum of lung for 45 min and the reperfusion was taken by removing the clamp for 2 h. At the moment of reperfusion, lidocaine 4 mg/kg was injected as a priming dose following a continuous rate of 4 mg/(kg · h). PaO_2, TNF-α, W/D of left lung, the level of MDA of left lung tissue were measured. At the end of reperfusion left lung was removed for microscopy. Results After reperfusion PaO_2 of lidocaine group was much higher than that of I-R group (P<0.05). Lidocaine postconditioning induced a significant decrease in the level of MDA of lung tissue[(7. 03±1.17) μmol/L] compared with ischemia reperfusion group [(8.77±1.42) μmol/L] (P<0.05). Lidocaine postconditioning resulted in a lower level of TNF-α [(1. 69±0.34) μg/L] than that of I-R group [(2. 52±0. 54) μg/L] (P < 0. 05). Microscopic examination showed that lidocaine postconditioning could decrease the level of edema of left lung and accumulation of neutro-phils. Conclusion Lidocaine postconditioning exerts a protective effect on pulmonary ischemia-reperfusion injury administered in the beginning of reperfusion. The effect may be explained by to the antioxidant effect and the suppression of expression of TNF-α.

Objective To investigate the alleviative effects of lidocaine postconditioning on pulmonary injury following ischemia reperfusion.Methods Seventy-two adult SD rats were randomized to 4 groups:sham group,ischemia-reperfusion(I-R) group,ischemic postconditioning(IPC) group and lidocaine postconditioning group. The pulmonary ischemia-reperfusion model was established by occlusion of the left hilum of lung for 45 min and the reperfusion was taken by removing the clamp for 2 h. At the moment of reperfusion,lidocaine 4 mg/kg was injected as a priming dose following a continuous rate of 4 mg/(kg?h). PaO2,TNF-?,W/D of left lung,the level of MDA of left lung tissue were measured. At the end of reperfusion left lung was removed for microscopy. Results After reperfusion PaO2 of lidocaine group was much higher than that of I-R group(P

Adolescent ; Adult ; Female ; Histiocytic Necrotizing Lymphadenitis ; diagnosis ; therapy ; Humans ; Lymph Nodes ; Male ; Middle Aged ; Neck ; Young Adult

Objective To investigate the surgical approach for adult patients with presacral cystic teratoma.Methods In this study,16 female patients,aged at 26-45 years,with presacral cystic teratoma underwent surgical resection between March 2007 and August 2012.Tumor was primary in 9 cases and recurrent in 7 cases,Rectal examination revealed retrorectal tough semi-circular poorly movable massess with intact rectal mucosa.MR examination showed cystic or solid mass in the anterior sacral,clear boundary,rectum and or vagina compressed.Tumors were completely removed in all cases.Results All patients were cured by surgery,13 cases were cured by one stage resection and 1 was cured by two stage resection.Two cases suffered from recurrence and was cured by reoperation.There were no injury to rectum,anal sphincter,cauda equina,presacral vein.Pathological diagnosis was cystic teratoma.Conclusions By sacrococcygeal surgical resection of presacral cystic teratoma was safe and effective ; complete resection of the tumor capsule is the key to successful operation.

Objective The aim of this study is to summarize primarily the application range and the clinical effect of the minimally invasive direct cardiac surgery (MIDCS).Methods From April 2010 to August 2011,108 operations had been performed in our centre using MIDCS,among of which 44 males and 64 females,mean age (44.3 ± 16.4 ) years old,mean weight (60.0 ± 12.0 ) kg.These operations included 29 MVR operations (replacement with mechanical valve 19,with tissue valve 10),17 AVR operations( replacement with mechanical valve 11,with tissue valve 6 ),5 MVP operations,6 MVR + AVR operations (replacement with mechanical valve 5,with tissue valve 1 ),12 VSD repair operations and 23 ASD repair operations,9 MIDCAB operations,1 MVR + CABG oparation,2 PECD correction,1 repair of ruptruec chordae tendineae of tricuspid septum and 1 Ebstein deformity correction operation.Concomitant procedures included 19 TVP operations and 11 radiofrequency ablation operations.Except MIDCAB operations,other operations are performed with closed type extracorporeal circulation.Conversion to median sternotomy was necessary in only two patients ( 1.9％ ).Results Mean cardiopulnonary bypass time and aortic eross-clamp time were ( 104.4 ± 59.3 ) minutes and ( 66.7 ± 52.8 ) minutes respectively,74 patients ( 92.5 ％ ) recover to beat automatically after heart ceased operation.Median mechanical ventilation time was ( 14.5 ± 11.9 ) hours,Median intensive care unit stay was ( 18.8 ± 15.3 ) hours,median hospital stay post operative was (6.9 ± 2.9) days.Median incision length was (5.3 ± 1.2 )cm.Median draining volume was( 337.6 ± 240.9 )ml in the first day after operation,No transfusion occurred in 72 patients(66.7％ ).Hospital mortality was 0.No re-exploration for bleeding and sternal wound infection.When leaving hospital,94 being of heart functional class Ⅰ,8 of class Ⅱ,6 of class Ⅲ.Conclusion MIDCS was associated with good operative effect in the near future,superior safety and broad application range.Furthermore MIDCS has minimally invasive,less postoperative bleeding,fewer blood transfusions,good cosmesis,as well as the absence of sternal wound infection.It may be safely performed on selected patients with low postoperative mortality and morbidity.

Urokinase plasminogen activator receptor (uPAR) is a membrane protein which is attached to the cellular external membrane. The uPAR expression can be observed both in tumor cells and in tumor-associated stromal cells. Thus, in the present study, the human amino-terminal fragment (hATF), as a targeting element to uPAR, is used to conjugate to the surface of superparamagnetic iron nanoparticle (SPIO). Flowcytometry was used to examine the uPAR expression in different tumor cell lines. The specificity of hATF-SPIO was verified by Prussian blue stain and cell phantom test. The imaging properties of hATF-SPIO were confirmed in vivo magnetic resonance imaging (MRI) of uPAR-elevated colon tumor. Finally, the distribution of hATF-SPIO in tumor tissue was confirmed by pathological staining. Results showed that the three cells in which we screened, presented different expression characteristics, i. e., Hela cells strongly expressed uPAR, HT29 cells moderately expressed uPAR, but Lovo cells didn't express uPAR. In vitro, after incubating with Hela cells, hATF-SPIO could specifically combined to and be subsequently internalized by uPAR positive cells, which could be observed via Prussian blue staining. Meanwhile T2WI signal intensity of Hela cells, after incubation with targeted probe, significantly decreased, and otherwise no obvious changes in Lovo cells both by Prussian blue staining and MRI scans. In vivo, hATF-SPIO could be systematically delivered to HT29 xenograft and accumulated in the tumor tissue which was confirmed by Prussian Blue stain compared to Lovo xenografts. Twenty-four hours after injection of targeting probe, the signal intensity of HT29 xenografts was lower than Lovo ones which was statistically significant. This targeting nanoparticles enabled not only in vitro specifically combining to uPAR positive cells but also in vivo imaging of uPAR moderately elevated colon cancer lesions.
Cell Line, Tumor ; Colonic Neoplasms ; diagnosis ; Ferric Compounds ; Humans ; Magnetic Resonance Imaging ; Magnetite Nanoparticles ; chemistry ; Molecular Imaging ; methods ; Receptors, Urokinase Plasminogen Activator ; chemistry ; Staining and Labeling

Objective To investigate liver regeneration after transplantation of microencapsulated hepatocytes in rats with acute liver failure (ALF). Methods ALF rat model was established by intraperitoneal injection of D-galactosamine (D-GalN). After 18 h, rats were randomized into control group ( Ⅰ ), free hepatoeyte transplantation group ( Ⅱ ) and the microencapsulated hepatecyte transplantation group (Ⅲ). Six rats for each group were randomly selected and sacrificed at 6, 12, 24, 36, 48, 72, 120, 168 and 240 h after ALF induced and blood samples from inferior vena cava were collected. Liver functions were tested in blood samples, and the expression of proliferating cell nuclear antigen (PCNA) was detected by immunohistochemistry. Results Ten-day survival rates of 3 groups were 26.7% (4/15), 40.0% (6/15) and 73. 3% (11/15), respectively (x2 = 9. 349,P = 0. 009). Survival rate of group Ⅲ was significantly higher than that of group Ⅰ and Ⅱ. Levels of ALT and AST in each group increased significantly at 6 h after ALF induced, and peaked between 48 ～ 72 h. Levels of ALT and AST in group Ⅱ and Ⅲ declined from 36 h, which was more significant in group Ⅲ. Tbil levels in group Ⅰ gradually increased after ALF induced and peaked at 72 h. Tbil in group Ⅱ and Ⅲ declined from 48 h, which was more markedly in group Ⅲ. In normal rats, the expression of PCNA protein was almost negative, but it was strongly expressed in ALF rats and peaked at 48 h. The number of positive cells in group Ⅲ was higher than that in group Ⅰ and Ⅱ, and the differences were of statistical signifieance. Conclusion The transplantation of microencapsulated hepatocytes can promote the regeneration of liver, and it can improve the liver function and prognosis in rats with ALF.