Objective The prosthesis used for aortic valve replacement (AVR) can be too small in relation to body size,thus causing valve prosthesis-patient mismatch (PPM).The aim of this article was to summarize the preventive strategy of PPM during AVR.Methods A total of 357 patients [203 males,154 females; mean age (54.9 ± 18.7 ) years ] underwent AVR between February.2010 and December 2011.The weight and body surface area (BSA) of the group is( 60.1 ± 11.4 )kg and (1.67 ± 0.21 )m2 respectively.The aortic valve prosthesis effective orifice area (EOA) was divided by body surface area (BSA) to obtain the EOA index (EOAI).PPM was then defined as none or mild if EOAI was ＞ 0.85 cm2/m2,as moderate for (0.65 - 0.85 ) cm2/m2 and as severe for ＜ 0.65 cm2/m2.To avoid PPM,a simple three-step algorithm was applied:Step 1,Calculate the patient's BSA from weight and height;Step 2,Calculate the minimal valve EOA required based on the BSA to ensure an EOAI ＞0.85 cm2/m2 ; Step 3,Select the type and size of prosthesis that has reference values for EOA greater or equal to the minimal EOA value obtained in step 2.For patients with a small aortic root,the following three methods was used:( 1 ) Replace aortic valve with simple interrupted suture technique ; (2) Apply new type and high-performance prosthetic valves such as St.Jude Medical Regent mechanical valve ; (3) Enlarge the narrowed aortic root when necessary.Results Of all 357 patients,272 patients received mechanical AVR and 85 bioprosthetic AVR.Among the 49 patients who received AVR with simple interrupted suture technique.St.Jude Medical Regent mechanical valve was implanted in 38 patients and the aortic root enlargement was performed in 11 patients.The total prevalence of PPM was 6.4％ and there was no severe PPM.The prevalence of PPM with mechanical AVR and bioprosthetic AVR was 1.8％ and 21.2％ respectively.There were 4 deaths during early period of operation,and the operative mortality was 1.1％.Conclusion Prosthesis-patient mismatch can be effectively prevented at the time of AVR with appropriate measurement.

Cardiac surgery carried out on cardiopulmonary bypass(CPB) in a pregnant woman is associated with poor neonatal outcomes although maternal outcomes are similar to cardiac surgery in non-pregnant women.Most adverse maternal and fetal outcomes from cardiac surgery during pregnancy are attributed to effects of CPB.The CPB is associated with utero-placental hypoperfusion due to a number of factors,which may translate into low fetal cardiac output,hypoxia and even death.Better maternal and fetal outcomes may be achieved by early pre-operative optimization of maternal cardiovascular status,use of perioperative fetal monitoring,optimization of CPB,delivery of a viable fetus before the operation and scheduling cardiac surgery on an elective basis during the second trimester.

Objective To investigate the clinical and renal pathological features in the new rat model induced by anti-human podocyte-protein antibody. Methods The rat model was induced by once intravenous injection of rabbit anti-human podocyte-protein antiserum which was prepared at first. Male Sprague-Dawley rats (n=36) were randomly divided into six groups (6rats in each group): control group (CG), the time points of day 7 group (D7), day 14 group (D14),day 21 group (D21) and day 28 (D28) group after antiserum injection, and day 28 group after the normal rabbit serum injection (NRG). The level of 24 hour proteinuria, the clearance of creatinine,albumin, blood urea nitrogen, triglyceride, cholesterol and serum creatinine were measured. The renal morphology was detected under the light microscope, immunofluorescence microscope, and electron microscope. Results 24-hour proteinuria (mg) was gradually increased, and the level of proteinuria in D28 (48.56±13.80) was significantly higher than that in CG (5.34±2.77, P＜0.01)and NRG (11.32±4.90, P＜0.01). The clearance of creatinine (ml/min) and serum creatinine (μmol/L) in D28 (0.90±0.47, 33.48±9.94) were significantly different from CG (1.68±0.54, P＜0.05;26.03±2.67, P＜0.05), but showed no difference with NRG (1.34±0.87, P＞0.05; 27.40±4.73, P＞0.05). The level of albumin (g/L) was lower in D7, D14, D21, D28 (28.20±0.87, 27.80±1.97,27.42±1.66, 27.77±1.95) than CG (29.98±0.76, P＜0.05). But there was no difference in the level of albumin among the groups after antiserum injection and NRG (28.68±1.18, P＞0.05). The level of blood urea nitrogen, triglyceride, cholesterol showed no difference among the groups (P＞0.05). The renal morphology showed no obvious changes between CG and NRG. Among the groups after antiserum injection, the renal pathological changes under the light microscope were some spikes formation in D28. Immunostained for rabbit IgG in rat glomeruli progressively decreased over the 28 days, while rat IgG progressively increased. The renal section deposition for rat complement 3 reached a maximum at day 21 then decreased afterward. Under the electron microscope, there were immune complexes and foot process fusion at day 14. Conclusions The new rat model induced by anti-human podocyte-protein antibody showing typically clinical and pathological changes of the membranous nephropathy is successfully established.

Background: Percutaneous radiofrequency ablation (RFA) is a first-line treatment for very-early-stage hepatocellular carcinoma (HCC), whereas the efficacy of percutaneous microwave ablation (MWA) for very-early-stage HCC remains unclear. The purpose of this study was to clarify this issue by comparing the safety and efficacy of percutaneous MWA with percutaneous RFA in treating very-early-stage HCC. Methods: Clinical data of 460 patients who were diagnosed with very-early-stage HCC and treated with percutane-ous MWA or RFA between January 2007 and July 2012 at the Eastern Hepatobiliary Surgery Hospital, The Second Mili-tary Medical University, in Shanghai, China were retrospectively analyzed. Of these 460 patients, 159 received RFA, 301 received MWA. Overall survival (OS), recurrence-free survival (RFS), local tumor progression (LTP), complete ablation, and complication occurrence rates were compared between the two groups, and the prognostic factors associated with survival were analyzed. Results: No significant differences were observed between the two groups in terms of the 1-, 3-, or 5-year OS rates (99.3%, 90.4%, and 78.3% for MWA vs. 98.7%, 86.8%, and 73.3% for RFA, respectively;P= 0.331). Furthermore, no signif-icant differences were observed between the two groups in terms of the corresponding RFS rates (94.4%, 71.8%, and 46.9% for MWA vs. 89.9%, 67.3%, and 54.9% for RFA, respectively;P= 0.309), the LTP rates (9.6% vs. 10.1%,P= 0.883), the complete ablation rates (98.3% vs. 98.1%,P= 0.860), or the occurrence rates of major complications (0.7% vs. 0.6%,P= 0.691). By multivariate analysis, LTP, antiviral therapy, and treatment of recurrence were independent risk fac-tors for OS (P < 0.001), and the alpha-fetoprotein level was an independent prognostic factor for RFS (P= 0.002). Conclusions: MWA is as safe and effective as RFA in treating very-early-stage HCC, supporting MWA as a first-line treatment option for this disease.

Objective To introduce the experience and analyze the clinical outcome of applica- tion of reinforced bar-ring hybrid external fixator combined with limited internal fixation for complex frac- turcs of tibia plateau in patients.Methods From Aug.2002 to Feb.2005,21 patients with complex fractures of tibial plateau were treated with reinforced bar-ring hybrid external fixatar combined with lim- ited internal fixation.According to Schatzker classification,there were 13 patients with typeⅤfracture and 8 with typeⅥfracture.Voluntary and non-weight beating knee joint motion to partially weight bear- ing was taken one week after operation.Progressive loading was taken continuously until there was clinical evidence of fracture stability and then full weight bearing was done.Results The mean follow-up peri- od was 15.9 months (10-24 months).All the fractures got united and the mean union time was 4.2 months(3-8 months).All the injured knees could extend to less than 5 degrees and flex to more than 90 degrees after rehabilitation.Evaluated by Merchant score system for knee joint,81% of patients achieved excellent healing (7 cases) and good healing (10 cases).Conclusion Operation by using reinforced bar-ring hybrid external fixator combined with limited internal fixation can reduce complications and avoid stiffness of the knee joint.It is an effective method for complex fractures of tibial plateau.

Objective To evaluate the efficacy of the treatment of hilar biliary malignant obstruc tion with multiple stent drainage.Methods One hundred and twenty-seven patients with malignant biliary hilar obstruction were enrolled.The obstructions at the common hepatic duct within less than 1 cm to the junction of the left and the right hepatic duct were found in 66 cases,at the proximal common hepatic duct and the left and the right hepatic ducts in 45 cases,at the right hepatic duct in 5 cases and at the both left and right hepatic duets in 11 cases.Sixty-six patients received stent placement through the right biliary ducts and the common bile duct by puncturing the right mid-axillary line.The other 37 patients received 2 stents placement (disposed"Y"style) through the left and the right hepatic duct punc turing routway.Seven patients received 2 stents placement (disposed"┌"style) through the right hepatic duct and the common bile duct with a stent placed between the left and the right hepatic duct.Three patients had right hepatic duct stent placed first,followed by right hepatic duct and common hepatic duct stent. Twelve patients had stents placed in the right hepatic duct with external drainage from the left hepatic duct. Two patients had multiple strictures at the right hepatic duct,who got multiple external drainages.The total serum bilirubin levels were measured pre-and post-operatively.Results One hundred and twenty-seven patients with bi[iary obstraction had internal stents placed for drainage.The average total bilirubin levels among 121 patients were (283.4?175.4 )?mol/L pre-operation and (63.2?11.8)?mol/L post-operation (P

Laboratory animals and animal experiments are foundations and important support conditions for life sciences, especially for medical research. The animal experiments have drawn extensive attention from the society because of the ethical issue. This paper takes Wenzhou Medical University as an example to give a brief introduction to the ethical review about laboratory animals in the university so as to further draw attention and concerns from the public about the ethical issue of laboratory animals. We successively introduce its scientific projects, nurturing environment and ethical review of laboratory animals.
Animal Experimentation ; ethics ; Animals ; Animals, Laboratory ; Universities

Objective To analyze the early outcomes of the Sun' s procedure,which is an approach integrating total arch replacement using a 4-branched graft with implantation of a special stented graft in the descending aorta,and observe the mortality,morbidity and mid-term clinical results of postoperative in patients with acute type A aortic dissection (AAAD).Methods Clinical data of 61 consecutive AAAD patients undergoing the Sun' s procedure were analyzed.There were 53 male and 8 female,aged (54 ± 12) years.61 patients had postoperative follow-up and the clinical effect of Sun' s procedure were retrospectively analyzed.Results Cardiopulmonary bypass time was (229 ± 46) min,aortic clamping time was (147 ± 37) min and unilateral selective cerebral perfusion time was (35 ± 9) min.Reoperation for excessive bleeding in 5 cases (8.2％),acute renal failure in 3(4.9％),tracheotomy patients for pulmonary infection in 3(4.9％),and spinal cord injury in 2 (3.3％),delayed thoracic incision healing in 1 (1.6％),and osteofascial compartment syndrome of the right lower limb in 1 (1.6％).The 30 day mortality is 8.2％,and the leading causes was low cardiac output syndrome in 2(3.3％),multi-organ failure in 1 (1.6％),pulmonary infection in 1 (1.6％) and ruptured of abdominal aortic dissection in 1 (1.6％).The average follow-up time is(5.1 ± 0.7) years.Postoperative 1 year survival rate was 91.8％,5 year survival rate was 83.6％.Conclusion The Sun' s procedure has generated a relatively lower mortality rate in 61 patients with AAAD.Postoperative survival rate is high,and the reoperation rate is low.

OBJECTIVETo study the pathological changes of blood glucose, serum lipid, insulin resistance, liver function, liver cell denaturalization of total glucosides of paeony on nonalcoholic fatty liver rats caused by insulin resistance and discuss the acting mechanism.

METHODAdult SD rats were maintained on high-fat-sugar-salt diet for 56 days. In the 57th day, their fasting blood glucose (FBG) and 2-hours blood glucose after oral glucose tolerance test (OGTT-2 hBG) were mensurated, according to which and the weight the rats were divided randomly into nonalcoholic fatty liver model group, metformin group (0.2 g x kg(-1)) and total glucosides of paeony group (high dosage 0.15 g x kg(-1), low dosage 0.05 g x kg(-1)). All the rats were still administered the same diet and given different drugs by intragastric administration for 28 days. In the 29th day, all of them were killed and the blood was sampled to measure the levels of blood glucose [FBG, OGTT-2 hBG, fasting insulin (Fins)] and serum lipid [free fatty acids (FFA), triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C)], then the HOMA insulin resistance index (HOMA-IRI, fasting glucosexinsulin) and insulin sensitivity index (ISI) were counted. The activities of aspartate aminotransferase (AST), alanine aminotransferase (ALT), cholinesterase (ChE), superoxide dismutase (SOD) and the contents of malondialdehyde (MDA) were measured also. Livers were weighed and collected to be observed the pathological changes.

RESULTCompared with normal group, in nonalcoholic fatty liver model group the levels of Fins and IRI were increased obviously (P < 0.01), ISI were decreased (P < 0.01), FFA, TG, TC, LDL-C were increased (P < 0.01), HDL-C were decreased (P < 0.05); the content of MDA were increased (P < 0.05), the activities of SOD were decreased (P < 0.01); AST, ALT and ChE were increased (P < 0.05, or P < 0.01), the pathological changes of liver fat were severe (P < 0.01). In glucosides of paeony group and metformin group, hyperinsulinaemia and insulin resistence were resisted (P < 0.05, or P < 0.01); the levels of FFA, TG, TC, LDL-C were decreased and HDL-C were increased (P < 0.05, or P < 0.01); the activities of AST, ALT, ChE were decreased (P < 0.05, or P < 0.01) and SOD were increased (P < 0.01). The contents of MDA were decreased (P < 0.05). The levels of FBG and 2 hBG in metformin group were decreased but in total glucosides of paeony group were not decreased obviously.

CONCLUSIONTotal glucosides of paeony may protect liver function and modulate serum lipid for the fatty liver rats caused by insulin resistance, and its action mechanism may be concerned with enhancing insulin sensitivity and antioxidative ability, decreasing serum lipid.

Alanine Transaminase ; metabolism ; Animals ; Aspartate Aminotransferases ; metabolism ; Blood Glucose ; drug effects ; Cholesterol, LDL ; blood ; Cholinesterases ; metabolism ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Enzyme Activation ; drug effects ; Fatty Liver ; drug therapy ; prevention & control ; Female ; Glucose Tolerance Test ; Glucosides ; chemistry ; pharmacology ; therapeutic use ; Insulin Resistance ; Lipids ; blood ; Liver ; drug effects ; metabolism ; pathology ; Male ; Malondialdehyde ; metabolism ; Paeonia ; chemistry ; Rats ; Rats, Sprague-Dawley ; Superoxide Dismutase ; metabolism