Objective To investigate effects of penehyclidine hydrochloride (PHC)protects a-gainst acute lung injury (ALI)in heart valve replacement patients with cardiopulmonary bypass (CPB).Methods Thirty rheumatic heart disease patients,eighteen males and twelve females with NYHA Ⅱ or Ⅲ,with cardiac valve replacement undergoing CPB were enrolled in the study.All pa-tients were randomly divided into group P and group C (fifteen in each group).Patients in group P re-ceived an intravenous injection of 0.03 mg/kg PHC before anesthesia induction and those in group C received the same volume of normal saline.Blood samples were collected to monitor the concentrations of IL-6,TNF-αand NF-κB at the following time points:before anesthesia induction (T0 ),the end of the operation (T1 ),6 hours (T2 ),12 hours (T3 )and 24 hours(T4 )postoperatively,arterial blood gas analyses were detected and oxygenation index (OI)was calculated at the time of T0 ,T1 and T4 , as well as lung dynamic compliance of patients adopt at the time of soon after anesthesia induction and the end of the operation.The outcomes included duration of intubation (DOI),length of intensive care unit stay (LOI)and length of hospital stay after the surgery (LOH).Results The DOI,LOI and LOH in group P were shorter than those in group C,but there was no statistical significance between groups.The plasma levels of IL-6,TNF-α and NF-κB were higher at T1-T4 than T0 in both groups (P <0.05),and those in group P were statistically lower than group C at T1-T4 (P <0.05).The val-ues of OI at T0 and T1 were obviously lower than T4 in both groups (P <0.05),and that in group P was slightly higher than group C at T4 but without statistical significance.The lung dynamic compli-ance of patients in group P at the end of operation was obviously higher than that in group C (P <0.05).Conclusion PHC inhibits systemic inflammatory response,improves lung compliance,amel-iorates tissue oxygen supply and encourages postoperative rehabilitation in valve heart replacement pa-tients with CPB,and its mechanisms is relevant to the regulation of NF-κB signal way on the produc-tion of such proinflammatory cytokines as IL-6 and TNF-α.

Objective: To investigate the clinical efifcacy of thoracic endovascular aortic repair (TEVAR) for treating the patients with complicated thoracic aortic dissection and to report the relevant clinical experiences. Methods: We retrospectively analyzed the records of 56 patients with complicated thoracic aortic dissection who received the operation of TEVAR in our hospital from 2011-02 to 2015-10 in order to analyze their operation methods with reasons. Results: There were 21 patients with complex anatomic conditions for aortic arch, 7 of them received TEVAR and 14 received TEVAR with covered left subclavian artery; 16 patients with complex shape of aortic dissection, 5 of them received TEVAR and 11 received TEVAR with covered left subclavian artery; 19 patients with aortic dissection involving aortic arch, 17 of them received hybrid procedures of aortic arch branch bypass surgery + TEVAR and 2 received TEVAR with fenestrated stent grafts. All operations were successful and no severe complications occurred. Conclusion: TEVAR is a fast and effective method for treating complicated thoracic aortic dissection, which may expand the application ranges as covering left subclavian artery, branch vessel bypass and modiifed stent grafting.

Objective This study aims to analysis in the clinical features of Stanford type B thoracic aortic dissection with multiple tears,and to explore the clinical methods of thoracic endovascular aortic repair (TEVAR) treating this disease.Methods From February 2011 to May 2015,the cases that diagnosed with multiple tears (≥ two tears) Stanford type B thoracic aortic dissection and accepted operations with TEVAR at department of Thoracic Cardiovascular Surgery,Wuhan General Hospital of Guangzhou Command,were retrospective analyzed their clinical data.Except the first tear of proximal,cases were named for the treatment group whom used surgical methods treating distal aortic dissection tears.Otherwise,the cases were named non-treatment group.We compared the incidence of chest and back pain,the progress of distal aortic dissection,the changes of false lumen with aortic dissection,and the benefit of distal tears in two groups after 6 months after TEVAR.Results A total of 67 cases were recruited this retrospective study,successful operations with TEVAR were conducted in all patients,and no serious complications occurred postoperatively in all patients.7 cases with treatment group,60 cases with non-treatment group,no deaths within two groups in 6 months after TEVAR.There were no significance statistically in complained of the incidence of chest and back pain,and the rate of progress with distal aortic dissection (P ＞ 0.05).There was statistically significant in the rate of changes with false lumen with aortic dissection false lumen (P ＜ 0.05).Some cases with abdominal visceral artery blood flow from the distal tears of aortic dissection in the non-treatment (n =19).Conclusions TEVAR is an effective method for treating multiple tears Stanford type B thoracic aortic dissection.Distal tears should be individualized treatment according to the characteristics of Stanford type B thoracic aortic dissection or try not to deal with.

Objective To evaluate the effects of ulinastatin on hemorrhagic shock and resuscitation ( HS∕R)?induced acute lung injury in rats. Methods Fifteen SPF adult Sprague?Dawley rats, aged 2-3 months, weighing 300-400 g, were divided into 3 groups ( n=5 each) using a random number table:sham operation group ( group S ) , HS∕R group and ulinastatin group ( group U ) . Carotid arteries were cannulated for blood pressure monitoring and blood?letting. HS∕R was induced by blood?letting and maintained for 1 h, followed by resuscitation with autologous blood transfusion and infusion of normal saline. After cannulation of carotid arteries ( T0 ) , at 5 min after hemorrhagic shock ( T1 ) , before resuscitation ( T2 ) , at 5 min after the expected blood pressure was achieved following resuscitation ( T3 ) , and at 30 min, 1?5 h and 2?5 h after resuscitation ( T4?6 ) , arterial blood samples were collected for determination of interleukin?6 ( IL?6 ) and tumor necrosis factor?α ( TNF?α) concentrations ( by enzyme?linked immunosorbent assay) . Arterial blood samples were collected at T0 , T2 and T6 for blood gas analysis. The pH value, partial pressure of arterial carbon dioxide ( PaCO2 ) , HCO-3 and base excess ( BE) value were recorded, and oxygenation index ( PaO2∕FiO2 ) was calculated. Lungs were removed at T6 , and pulmonary specimens were obtained for examination of pathological changes which were scored, and nucleus was extracted for determination of nuclear factor?kappa B ( NF?κB ) p65 expression by enzyme?linked immunosorbent assay. Results Compared with group S, the pH values, HCO-3 , BE values and OI were significantly decreased, and PaCO2 , plasma IL?6 and TNF?α concentrations, expression of NF?κB p65 in lung tissues, and pathological scores were increased in U and HS∕R groups. Compared with group HS∕R, the plasma concentrations of IL?6 and TNF?α, expression of NF?κB p65 in lung tissues, and pathological scores were significantly decreased, and no significant changes were found in parameters of blood gas analysis in group U. Conclusion Although ulinastatin can alleviate HS∕R?induced acute lung injury, it is insufficient to improve lung oxygenation in rats.

OBJECTIVE:To investigate the effect of clinical pharmacist intervention on prophylactic application of antibiotics in cardiothoracic surgery. METHODS:Medical records of patients underwent cardiothoracic surgery were collected from our hospi-tal during Mar. to Apr. in 2014 (before intervention) and during Jun. to Jul. in 2014 (after intervention). Those were divided into pre-intervention group(n=115)and post-intervention group(n=119). The prophylactic application effect of antibiotics was com-pared before and after intervention. RESULTS:After intervention,the rates of prophylactic application were decreased significantly from 96.5% to 72.3%;the rationality rate of antibiotics selection was improved significantly from 27.9% to 94.2%;The course of prophylactic medication decreased significantly from(5.4±2.8)days to(2.3±1.8)days;the difference had statistical significance before and after intervention(P<0.01). The postoperative infection rate was decreased from 13.0% to 5.9%,the difference had no statistical significance(P=0.074). The average hospitalization time,average drug costs,and average hospitalization expenses were decreased significantly,the difference had statistical significance(P<0.05 or P<0.01). CONCLUSIONS:Clinical pharmacist inter-vention to prophylactic application of antibiotics in cardiothoracic surgery can control the infection effective and guarantee reason-able and safe use of drugs during perioperative period.

Objective: To investigate the feasibility for reconstructing an aortic arch by a new integrated two-branched stent graft releasing in experimental canine thoracic aorta simulation system.
Methods: A new type of integrated two-branched stent graft was developed and placed in the canine thoracic aorta, the stent graft releasing in a simulated system was conducted under X-ray guidance to monitor the operating process and to explore the feasibility for invitro sent graft releasing.
Results: The new two-branched stent graft was successfully deployed in canine thoracic aorta simulation system. The releasing process was smooth, two small stent grafts were well landing, and all stent grafts were fully expanded and properly positioned.
Conclusion: Our new two-branched stent graft could successfully reconstruct the aortic arch in experimental canine. The thoracic aorta releasing system may better and truly simulate the whole process of endovascular aortic repairing, which provides a good foundation for further animal experiments.

Objective To evaluated clinical effects and effectiveness of dual-port video-assisted thoracic surgery(VATS)for secondary spontaneous pneumothorax.Methods The clinical data of 48 pa-tients with secondary spontaneous pneumothorax who underwent open thoracotomy(n =18)or dual-port VATS(n =30)were reviewed retrospectively.Mean operation time,mean postoperative drainage period and mean postoperative hospital stay between the two groups were compared.Results All surgeries were suc-cessfully performed without reoperation and severe complications.No patient was converted to thoracotomy in the VATS group.There were significant differences in mean operation time [(67.9 ±7.2)min vs (73.3 ±6.4)min],mean postoperative drainage period [(3.2 ±0.9)d vs(5.0 ±1.3)d],and mean postoperative hospital stay [(7.2 ±1.4)d vs(8.7 ±1.5)d]between the dual-port VATS and open thora-cotomy(P <0.05 ).Conclusion Dual-port video-assisted thoracic surgery can reduce postoperative drainage period and postoperative hospital stay and increase satisfaction.It has little influence on upper limb movement and improves postoperative recovery.

Objective To investigate clinical diagnosis value in complex heart disease of 320-slice computerized tomography.Methods Twenty-seven patients' imaging data of 320-slice computerized tomography and transthoracic heart echocardiography were taken retrospective analysis,all patients were diagnosed with complex heart disease on cardiothoracic surgery.And the authors compared the diagnostic accuracy of imaging diagnosis and operation diagnosis.Results The diagnostic of 27 patients with 89 cardiac anomalies with 320-slice computerized tomography and were diagnosed 83 cardiac anomalies with transthoracic heart echocardiography.However,92 cardiac anomalies were found on cardiothoracic surgery.The diagnostic accuracy of 27 patients had a statistical difference between 320-slice computerized tomography and transthoracic heart echocardiography with complex heart deformity disease (P ＜ 0.05).Conclusions Compared with transthoracic heart echocardiography,320-slice computerized tomography improved the diagnosis accuracy of the complex heart deformity disease.

Thoracic aortic dissection was a catastrophic disease with change quickly,and the characteristic of thoracic aortic dissection was acute onset,complex,progress rapidly,difficult to diagnosis,and highly misdiagnosis rate.So the fatality rate of thoracic aortic dissection was high,which easy caused medical disputes.Even so,the cause of the formation of thoracic aortic dissection in detail is not clear,and many risk factors associated with the occurrence of thoracic aortic dissection.These including high blood pressure,gender (male),aortic normal aging,drug using,atherosclerosis,genetic disease and inflammatory diseases,etc.

Adolescent ; Breast Neoplasms ; diagnosis ; Female ; Fibroadenoma ; diagnosis ; Humans