Meta-analysis of Clinical Effects of Topical Administration of Phenytoin on Wound Healing / 中国药师

Objective:To evaluate the clinical effects of topical administration of phenytoin ( PHT) on wound healing. Methods:The clinical trials on PHT topically used for wound healing were collected from Cocharne Library and PubMed ( from database establish-ment to May, 2016. Meta-analysis was performed using RevMan 5. 0 software and Stata 12. 0 software. Results:A total of 15 stud-ies involving 1 048 patients were included. Topical PHT treatment was significantly associated with complete healing rate (OR=3. 28, 95%CI:1. 23-8. 75, P=0. 02), production rate of health granulation tissue (OR=2. 18,95%CI:1. 33-3. 59, P=0. 002) and aver-age percentage reduction of wound surface size (SMD=1. 77, 95%CI:0. 53-3. 02, P<0. 000 01). However, heterogeneity existed in complete healing rate and average percentage reduction of wound surface size among the studies. Meta-regression analysis showed that wound types (P=0. 02) and treatment periods(P=0. 08) were associated with the heterogeneity of complete healing rate outcomes, and mean age was associated with the heterogeneity of average percentage reduction of wound surface size(P=0. 07). Conclusion:Meta-analysis suggests that topical PHT treatment has significant positive clinical effect on wound healing. There is heterogeneity among the studies, so topical PHT treatment still should be applied in clinical practice prudently.

Clinical research of the treatment on cervical esophagus fistula with low negative pressure suction by double caping pipe / 中国综合临床

Objective to investigate the clinical effect of negative pressure suction by double caping pipe on cervical esophagus fistula after esophageal carcinoma surgery,and search for the effective treatment of cervical anastomotic fistula after esophageal carcinoma surgery.Methods The clinical data of 140 patients with cervical esophagus fistula after esophageal carcinoma surgery in Nanjing General Hospital of Nanjing Command from September 2004 to September 2015 were retrospective analyzed.Among them,85 cases were treated with low negative pressure suction by double caping pipe as experimental group,55 cases were treated with conventional drainage and dressing as the control group.The length of hospital stay,healing time,dressing frequency,neck bleeding risk,anastomotic stenosis and mortality rate between two groups were analyzed and compared.Results The length of hospital stay,the time of wound healing,the frequency of wound change dressing,the rate of neck bleeding in experimental group were (15.94± 1.57)d,(8.00± 1.55)d,(6.22± 1.52)times,1.18％ respectively,significantly lower than that of control group ((23.64 ± 2.36) d,(15.64 ± 2.08) d,(27.56±3.58) times,12.24％;P=0.000,0.000,0.000,0.029).While the rate of anastomotic stenosis after half a year in experimental group was 17.65％,lower than that of the control group (23.64％),the difference was no significant(P=0.387).Conclusion The treatment on cervical esophagus fistula with low negative pressure suction by double caping pipe has superiorities on hospitalization and healing time,dressing frequency,neck bleeding risk,mortality,and does not increase the incidence of anastomotic stenosis,and it can achieve a better therapeutic effect compare with the conventional drainage and dressing.

Effect of Sanhuang Decoction on glucose and lipid metabolism in 3 T3-L1 adipocytes / 中国药理学通报

Aim ToobservetheeffectofSanHuang Decoction (SHD )on glucose and lipid metabolism in insulin resistance(IR)3T3-L1 adipocytes.Methods TheIRmodelof3T3-L1adipocyteswasinducedby high glucose and hyperinsulinism cultivation(also con-taining dexamethasone ).The adipocytes were treated with rosiglitazone(Ros)and different concentrations of SHD(2. 5,5,10,20,40 g·L-1 )for 24 h.The content of glucose disappeared from the culture medium was determined as glucose consumption of the cells. The transport of glucose was observed by 2-deoxidation-[3 H]-glucose uptake method.The efflux of nonesteri-fied fatty acids(NEFA)from adipocytes was observed by the concentration of NEFA in the culture medium. The mRNA expression of glucose transporter-4 (GLUT-4)was measured by real-time polymerase chain reac-tion (real-time PCR).The protein expression of GLUT-4wasdetectedbyWesternblot.Results Compared with the Con group,SHD(5,10,20,40 g·L-1 ) could significantly induce the glucose consumption and transportion(P0.05).Conclusion SHDcanin-crease insulin sensitivity by increasing glucose trans-portation and consumption in the 3T3-L1 adipocytes as well as decreasing the NEFA efflux from the cells.

Efficacy of Cetuximab Combined with Chemotherapeutics versus Chemotherapeutics alone in the Treatment of Metastatic Colorectal Cancer:A Meta-analysis / 中国药房

OBJECTIVE:To systematically review the efficacy of cetuximab combined with chemotherapeutics versus chemo-therapeutics alone in the treatment of metastatic colorectal cancer,and provide evidenced-based reference for clinical treatment. METHODS:Retrieved from Medline,PubMed,EMBase,CJFD,VIP,WanFang database and Cochrane Library,randomized con-trolled trials(RCT)about the efficacy of cetuximab combined with chemotherapeutics(test group)versus chemotherapeutics alone (control group) in the treatment of colorectal cancer were collected. Meta-analysis was performed by using Rev Man 5.2 software after data extract and quality assessment. RESULTS:A total of 12 RCTs were included,involving 8 514 patients. Results of Me-ta-analysis showed progression free survival in test group was significantly longer than control group,the difference was statistical-ly significant [HR=0.87,95%CI(0.79,0.95),P=0.002];compared with control group,there were no significant differences in the disease control rate[OR=1.06,95%CI(0.88,1.27),P=0.54] and overall survival[HR=0.92,95%CI(0.85,1.00),P=0.05] in test group. Results of subgroup analysis showed cetuximeb could significantly prolong the progression free survival of KRAS wild-type patients,the difference was statistically significant[HR=0.80,95%CI(0.66,0.98),P=0.03]. CONCLUSIONS:Compared with che-motherapeutics alone,chemotherapeutics combined with cetuximab can significantly prolong the progression free survival of pa-tients with metastatic colorectal cancer. Due to the limits of quality and sample size,more strict designed,long-term follow-up of large scale RCTs are needed for the further verification of the conclusion.

Participation Experience of Clinical Pharmacist in the Treatment of One Patient with Multidrug Resistant Acinetobacter baurnannii Infection / 中国药师

Objective:To discuss the experience accumulation and thinking tralning of clinical pharmacist in the pharmaceutical consultation with SOAP model. Methods:Clinical pharmacist performed the condition evaluation for one patient with Acinetobacter bau-rnannii infection after esophagus cancer surgery and was invited to the consultation for three times. Clinical pharmacist also provided the references for the drug treatment and monitored the whole process. Clinical pharmacist actively followed and pald return visits for the prognosis of the patient for one month. Results: After identifying the pathogen, the experiential therapy was given and the condi-tions of the patient were improved. According to the changes of the conditions, the treatment was adjusted in time with the most suitable drugs for the conditions and infection degree. Finally, the infection was controlled effectively, and the patient was discharged after the 35-day postoperative treatment. Conclusion:During the consultation, clinical pharmacist should correctly judge the conditions of pa-tients, summarize and evaluate the earlier therapy results, and then choose suitable drugs according to the property of PK/PD. Clinical pharmacist also should track the therapy results to assess the conditions of patients and individualize the treatment.

Surgical management of infective endocarditis with cerebrovascular complications / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the result of surgical treatment of active infective endocarditis in patients with recent cerebrovascular events, and to evaluate the optimal indication and timing of surgical intervention.</p><p><b>METHODS</b>The clinical data of 26 patients with cerebrovascular complications before surgery Between December 2007 and December 2013 were analyzed retrospectively. There were 17 male and 9 female patients, aged (42±14) years. Types of disease included single aortic valvular disease (n=8), single mitral valvular disease (n=12), multiple valvular disease (n=5), and aortic valvular disease with ventricular septal defect (n=1). Type of cerebrovascular complication included cerebral infarction (n=25) and cerebral hemorrhage (n=1). Thirty-one valves were involved in 26 patients, mechanical prosthetic valve replacement (n=25), bioprosthetic valve replacement (n=4), and mitral valve repair (n=2).</p><p><b>RESULTS</b>The interval between onset of cerebrovascular event and surgical intervention was less than 14 days (n=3), 14 to 21 days (n=13), over 21 days (n=10), and the mean was (20±4) days. There were 33 vegetations found intraoperatively. The mean size of vegetations was (10±4) mm and 19 were found in mitral valve. Two patients died in hospital. One case relapsed after 1 year and underwent reoperation for prosthetic valve endocarditis. The remaining patients recovered with cardiac function of New York Heart Association class I to II after the period of 3 months to 5 years follow-up.</p><p><b>CONCLUSIONS</b>Appropriate surgery may effectively improve the outcome of IE patients with cerebrovascular complications. The surgical indications and risks of further neurologic deterioration after cardiac surgery should be assessed comprehensively before surgical intervention.</p>

Diagnostic and treatment value of CT-guided coil localization followed by real-time DSA-guided accurate resection of solitary pulmonary nodules with video-assisted thracoscopic surgery / 医学研究生学报

Objective The localization of pulmonary nodules in surgery remains a clinical challenge .In this study we dis-cussed the diagnostic and treatment value of CT-guided coil localization followed by real-time digital subtraction angiography ( DSA)-guided accurate resection of solitary pulmonary nodules (SPN) with video-assisted thracoscopic surgery (VATS). Methods This study involved 82 cases of SPN treated in the Department of Cardiothoracic Surgery of Jinling Hospital from September 2011 to May 2014 .The SPNs were preoperatively positioned by placing a metal coil close to the lesion under CT guidance on the same day of surger -y.Then VATS wedge resection of the SPNs was performed under the guidance of real -time DSA and further procedures followed in ac-cordance with the results of intraoperative pathology . Results The success rate of coil localization was 100%, the mean time of po-sitioning was (15.3 ±3.2) min, and the mean time of VATS wedge resection was (24.2 ±12.1) min.Pathological results revealed 45 cases of malignancy and 37 cases of benign lesions . Conclusion Preoperative CT-guided coil localization of SPNs showed a high accuracy and no serious complications , and by real-time DSA-guided VATS that immediately followed , the nodules could be precisely removed with the cutting edge 2 cm above the lesion , which achieved both the purposes of diagnosis and treatment of SPNs .

Nervous system protection in the treatment of DeBakey type Ⅰ aortic dissection with hybrid procedure / 中华胸心血管外科杂志

Objective The present study aims to summarize the clinical experience and methods of nervous system protection in the treatment of DeBakey type Ⅰ aortic dissection with hybrid procedure.Methods From Jan 2009 to Jun 2011,56 patients suffering from DeBakey Ⅰ aortic dissection underwent hybrid procedure.The ascending aorta part were replaced under conventional cardiopulmonary bypass,and the0 aortic arch branch vessels were reconstructed,and then a stent graft was implanted to cover the aortic arch and part of the descending aorta.The unilateral antegrade cerebral perfusion(UACP) and/or bilateral antegrade cerebral perfusion (BACP) combined with femoral artery perfusion was used,and the left subclavian arteries were selectively reconstructed according to cerebral arteries and aorta computed tomography angiography scan.Results All the patients went through the procedure successfully.BACP combined with femoral artery perfusion was applied in 16 patients,UACP combined with femoral artery perfusion in 33 patients,and 7 were perfused with only femoral artery cannulation.Of all the patients,19 underwent the innominate artery and left common carotid artery reconstruction and the other 37 patients underwent the innominate artery,the left common carotid artery and the left subclavian artery reconstruction.The cardiopulmonary time was 44 -95 min,mean (65 ±24) min; aortic clamping time was 32 -71 min,mean (48 ±29)min; the cerebral perfusion time was 24 -44 min,mean (32 ± 13) min.One ( 1.8％ ) patient,who was perfused with only femoral artery cannulation,suffered from permanent neurological dysfunction,and 5 (8.9％) had transient neurological dysfunction.One patient died from severe infection,1 patient was given up because of permanent neurological dysfunction,and the rest 54 patients recovered and discharged.The patients were followed up 1 to 25 months,and there was no newly occurred neurological dysfunc tion.The CTA examination 3 months post-operative revealed that the branch bypass vessels were unobstructed.There was no subclavain steal symptom occurred in the 19 patients whose left subclavian arteries were not reconstructed.The left upper limb strength was slightly lessened in 3 patients and recovered 6 - 12 months later.Conclusion In the treatment of DeBakey type Ⅰ aortic dissection with hybrid procedure,the selective use UACP and/or BACP combined with femoral artery perfusion can avoid deep hypothermic and circulatory arrest and provide the continuous cerebral and spinal perfusion.This perfusion strategy in hybrid procedure can decrease the morbidity of post-operative nervous system disorders with satisfactory nervous system protection effect.

Key points in the surgical treatment of infective endocarditis : a report of 106 cases / 中华胸心血管外科杂志

Objective To review the clinical experience in the surgical treatment of infective endocarditis,and to summarize the key points of how to elevate therapeutic effect.Methods From Jan 2001 to Dec 2010,106 patients with infective endocarditis who underwent operative therapy were retrospectively analyzed.All patients underwent cardiac operation in conventional hypothermic cardiopulmonary bypass.Vegetations and suspicious infective focus were thoroughly cleaned.Endocardium was swabbed with normal sodium repeatedly and with high concentration antibiotic solution.Combined anomalies were rectified and the affected valves were replaced.Artificial valves were preconditioned with antibiotics before implantation.All patients were treated with full dose of sensitive antibiotics for 6-8 weeks after operation.Results Two patients(1.8％) died perioperatively,1 died of severe pulmonary infection 5 days post operation,and 1 died of multisystem organ failure.Other 104 patients recovered smoothly,95 of whom were followed up for 6 months to 10 years.One patient died,and the other patients recovered with Ⅰ-Ⅱ grade heart function(NYHA).Three patients had anticoagulation related complications.There was no relapse of endocarditis occurred during the period of follow-up.Conclusion Early diagnosis and timely operation on infective endocarditis can achieve satisfactory effect.The thorough sterilization,prosthetic valves precondition and post operative regular antibiotics therapy were the key points of successful surgical treatment.

Clinical experience in 36 cases of T4 esophageal carcinoma radical surgery combined with descending thoracic aortic segment replacement / 中国综合临床

Objective To summary the experience of T4 esophageal carcinoma surgery and to explore the methods and operating skills on descending thoracic aortic resection with prosthetic vascular graft replacement in patients with T4 locally advanced esophageal carcinoma invading descending thoracic aorta.Methods From Jan.2001 to Dec.2010,36 patients with esophageal carcinoma underwent esophagectomy and descending aortic replacement simultaneously in our hospital.The clinical data were retrospectively reviewed.All patients had a left posterior lateral incision via the 6th intercostal space.The vascular adventitia of the descending thoracic aorta in the left side was incised,and the aorta was clamped in the proximal and distal side of the invaded segment.Then the invaded segment was resected and replaced with artificial vessels.Esophageal carcinoma was radically resceted,and left cervical esophageal-gastro anastomosis was performed in all patients.Results Radical resection of esophageal carcinoma was achieved in all patients.There was no perioperative death,or severe complications such as paraplegina,acute renal failure and intestinal dysfunction occurred.Two patients had chylous hydrothorax,and one had late stage anastomotic stoma fistula.The post-operative hospital stay was 10-42 d,mean (15.5 ± 7.2 )d.The pathological examination revealed that all the patients had squamous cell carcinoma.The aortic tunica adventitia was invaded in all the patients,9(25％ ) had tunica media invasion,and there was no tunica intima invasion observed.The 1-,3-,and 5-year survival rate was 80.6％,46.2％ and 20.0％ respectively.Conclusion Combined esophagectomy and descending aortic replacement for locally advanced T4 esophageal carcinoma invading aorta can be considered as radical operation for selected patients,and it can improve the survival rate and life quality of the patients.

Hybrid procedure without deep hypothermic circulatory arrest for DeBakey type Ⅰ aortic dissection / 中华胸心血管外科杂志

Objective Some major procedures for DeBakey type Ⅰ aortic dissection used to be performed with deep hypothermic circulatory arrest, which had been associated with more complications than seen with standard extracorporeal circulation. We reviewed the cases who received the treatment for DeBakey type Ⅰ aortic dissection by hybrid procedure without deep hypothermic circulatory arrest. The procedure consisted of ascending aorta replacement, ascending aorta-aortic arch branch vascular bypass reconstruction and endovascular graft exclusion. Methods From January 2009 to June 2010, 39 patients [mean age (55 ±16) years] who had DeBakey Ⅰ aortic dissection underwent hybrid procedure without deep hypothermic circulatory arrest. The femoral artery and right axillary artery were cannulated for perfusion. The ascending aorta and/or aortic valves were replaced under conventional extracorporeal circulation with Bentall procedure or Wheat procedure. The aortic arch branch vessels were dissected and the proximal part was sealed. Then the ascending aorta-aortic arch branch vascular bypasses were constructed with 4-bifurcation vascular grafts, Y-shape bifurcated vascular grafts or artificial vessels. Finally the endovascular grafts were deployed via the femoral incisions monitored dynamically with DSA, or via the ascending aortic bifurcated vessels monitored with transesophageal echocardiography. Results The operation succeeded in all 39 patients. Eight patients underwent ascending aorta replacement without aortic valve replacement or prosthesis, 20 patients underwent Bentall procedure ( Carbrol procedure were used in 11 cases), and 11 underwent Wheat procedure. For ascending aorta-aortic branch vascular bypass reconstruction, sequential anastomoses were performed in 8, Y-shaped bifurcated grafts were used in 15, and 4-bifurcated grafts were employed in 16 patients. The endovascular stent grafts were deployed via the former femoral incisions in 36 patients and via ascending aortic bifurcated vessels in 3. The cardiopulmonary bypass time was (61 ±22) minutes, the aortic crossclamp time was (48 ±18) minutes, and the post-operative intubation time was (30 ±9) hours. The thoracic drainage from each patient was less than 300 ml in 24 hours. No complication, such as hemiplegia, paraplegia, severe infections, renal failure or coagulation disorder, was observed. The duration of hospitalization was (21 ±6) days. No hospital death occurred. Follow-up was performed 1 to 15 months [mean (8.4 ±7.2) months] postoperatively. All patients survived without any organ dysfunction at follow up. The CTA examination 3 months after operation revealed that the false lumens had been closed in 91.2% of the patients. Conclusion Our findings indicated that the hybrid procedure, which combining ascending aorta replacement,ascending aorta-aortic arch branch vascular bypass reconstruction and endovascular graft exclusion under conventional extracorporeal circulation, may be an option for avoiding the possible complications associated with profound hypothermic circulatory arrest. The novel hybrid operation may improve the surgical outcomes and provide a simplified surgical approach for the treatment of DeBakey Ⅰ aortic dissection.

Impact of unilateral and bilateral antegrade selective cerebral perfusion on neurological function in patients undergoing a hybrid approach for DeBakey type Ⅰ aortic dissection A prospective randomized controlled study / 国际脑血管病杂志

Objective To compare the effect of brain unilateral and bilateral antegrade selective cerebral perfusion (ASCP) during a hybrid approach to DeBakey type Ⅰ aortic dissection and to provide the clinical evidence for the selection of cerebral perfusion methods of aortic dissection surgery.Methods Among the 56 patients undergoing a hybrid approach to DeBakey type Ⅰ aortic dissection from January 2009 to June 2011,24 were enrolled in the study.They were randomly divided into a unilateral ASCP group (n =11) and a bilateral ASCP group (n =13).The patients in both groups underwent cognitive ability test,brain CT scan,cerebrovascular and aortic CTA examinations before and after procedure.The general information,intraoperative conditions and neurological function in the patients of both groups were compared.Results There was no difference in the general data between the unilateral and bilateral ASCP groups.There were no significant differences among the intraoperative cardiopulmonary bypass time (125.2 ± 34.4 min vs.132.1 ± 45.4 min; t =- 0.278,P =0.784),aortic cross-clamping time (54.5 ± 23.6 min vs.61.6 ± 27.5 min; t =-0.149,P =0.883),cerebral perfusion time (30.9 ± 13.2 min vs.31.7 ± 14.5 min; t =- 1.283,P =0.213),right radial artery pressure (57.6 ± 15.5 mm Hg vs.60.7 ± 14.3 mm Hg; t =0.758,P =0.457),and arterial oxygen pressure (465.6 ± 62.4 mm Hg vs.488.4 ± 72.5 mm Hg; t =- 1.894,P =0.071 ).There were no surgery and recent death in both groups.There were no significant differences among the mechanical ventilation time (33.5 ± 14.6 h vs.37.8 ± 12.3; t =- 1.009,P =0.162),time awake after surgery (5.2 ± 2.4 h vs.5.5 ± 3.1 h; t =0.876,P =0.195),and intensive care unit stay time (7.5 ± 3.1 d vs.8.2 ± 3.5 d; t =-0.186,P =0.427).There was no new permanent neurological dysfunction in both groups.One patient had transient neurological impairment in each group.The cognitive function scores after surgery in the unilateral ASCP group (50.1 ± 14.8 vs.47.3 ± 15.2; t =1.005,P =0.126) and in the bilateral ASCP group (52.1 ± 13.7 vs.48.6 ± 16.5; t =0.576,P =0.254) were slightly lower than those before procedure,however,there was no significant difference; there was also no significant difference in the unilateral and bilateral ASCP groups before (t =-0.887,P =0.385) and after procedure (t =-0.953,P =0.351).Conclusions Under the circumstance of complete circle of Willis,the brain protective effect of the unilateral and bilateral ASCP in patients undergoing a hybrid approach for DeBakey type Ⅰ aortic dissection had no significant difference,and more simple and convenient unilateral ASCP can be used.

Effects of n-3 fatty acids on cardiac allograft vasculopathy / 中国组织工程研究

BACKGROUND: Fish oil is one of mainly natural resources of n-3 fatty acids, which can inhibit cardiac allograft vasculopathy (CAV) and prolong the survival of cardiac allograft. But, the mechanism is unclear. Recent in vitro data suggested that n-3 fatty acids could inhibit the release of inflammatory transmitter by the activation of peroxisome proliferator-activated receptor-y (PPARy). OBJECTIVE: To test the hypothesis that n-3 fatty acids from fish oil ameliorates CAV development via activating PPARy. METHODS: A total of 6 Lewis rats and 18 Fisher344 rats were randomly selected as heart donors. An additional 24 Lewis rats were randomly and equally divided into 4 groups. In isograft group, heart transplantation was performed among Lewis rats, without any drug. In low-dose fish oil-treated group, F344→Lewis transplantation was performed. At 1 day following surgery, 0.03 mL/kg fish oil was treated by gavage for 8 weeks. In high-dose fish oil-treated group, F344→Lewis transplantation was conducted. At 1 day following surgery, 0.06 mL/kg fish oil was treated by gavage for 8 weeks. In control group, F344→Lawis transplantation was conducted. Cyclosporine A was administrated by gavage for 8 weeks. In the low-dose and high-dose fish oil-treated groups, cyclosporine A (1.5 mg/kg) was given daily by intramuscular injection for 2 weeks following surgery. CAV was evaluated by histological examination. Activity of nuclear factor (NF) k-B and PPARy was assessed in homogenate. Contents of monocyte chemoattractant protein-1 and interferon-inducible protein 10 were measured by enzyme-labeled immunosorbent assay (ELISA). Chemokine receptor CCR2 and CXCR3 expression was determined by real-time quantitative reverse transcription-polymerase chain reaction (RT-PCR). RESULTS AND CONCLUSION: All 24 receptor Lewis rats were survived following surgery. The donor heart could regularly beat at 8 weeks following transplantation. Compared with the isograft group, severe CAV was detected in the control group al 8 weeks. Compared with the control group, CAV was significantly relieved, the activity of PPARy was significantly elevated, the activity of NF k-B was significantly decreased, levels of intragraft monocyte chemoattractant protein-1 and interferon-inducible protein-10 were significantly reduced in the low-dose and high-dose fish oil-treated groups (P < 0.001, P < 0.05), especially in the high-dose fish oil-treated group (P < 0.05). There was no significant difference in expression of chemokine receptors CXCR3 in the low-dose and high-dose fish oil-treated groups and control group. Our results demonstrated that n-3 fatty acids from fish oil can attenuate CAV development, possibly through activating PPARy and subsequently inhibiting the NF-kB activation, the chemokines secretion and its receptor expression in a dose-dependent fashion in rat models.

Study on the Bioavailability of 2 Kinds of Cyclosporin A in Human Body / 中国药房

0.05)except that the tmax of the testing preparation was faster than that of the control drug.The relative bioavailability of the testing drug was(93.83?15.21)%.CONCLUSION:The AUC0～24,AUC0～∞and Cmax of 2 preparations are similar,but there is a significant difference in tmax.

Stem cell and repair of traumatic myocardium / 医学研究生学报

Recent work has revealed that large numbers of mitotic figures are present in adult hearts,which has implied that there should be some mechanism about nature repair of the adult heart.But the levels of natural repair are not high enough to retrieval the traumatic myocardium.As a new approach to improving the cardiac repair,stem-cell therapy provides an exciting and powerful treatment.We describe the background of natural repair,and summarize the current strategies in the application of stem-cell therapy to repair the traumatic myocardium.

Surgical treatment of thoracic aortic dissecting aneurysm: A report of 115 cases / 医学研究生学报

Objective: The present study aims to summarize the clinical experience in the surgical treatment of thoracic aortic dissecting aneurysm.Methods: We retrospectively analyzed the clinical data of 115 cases of thoracic aortic dissecting aneurysm treated by surgery from December 1995 to December 2006.Thirty-eight of them were DeBakey type I aortic dissection,18 type Ⅱ,and 59 type Ⅲ.Of the 38 DeBakey type I patients,30 underwent ascending aorta with total aortic arch replacement(2 cases of total thoracic aortic artificial vessel replacement,25 Wheat procedure and 3 aortic valvuloplasty) and the other 8 received ascending aorta with semi-aortic arch replacement.Of the 59 DeBakey type Ⅲ patients,36 underwent descending aortic aneurysm resection with artificial vessel replacement via left posterolateral thoracic incision by left heart bypass or aorta to artery bypass(using Cott tubes),while the other 23 received endovascular stent-graft exclusion in descending aorta via the femoral artery.Results: All the patients were successfully treated except 5 that died during the perioperative period.The survivors were followed up for 3-118 months,among whom 2 died long-term death after the operation and the others were living healthy.Conclusion: Surgical treatment improves the clinical outcome of thoracic aortic dissecting aneurysm.Bilateral perfusion via the carotid artery in aortic arch replacement has a definite cerebral protective effect.Surgical procedures can be simplified by using the modified elephant trunk technique.Endovascular stent-graft exclusion is safe and effective in the treatment of DeBakey type Ⅲ aortic dissection.

Clinical application of emergency extracorporeal circulation / 医学研究生学报

Objectives: To evaluate the clinical application of emergency extracorporeal circulation(ECC) in cardiac surgery. Methods: Emergency open heart surgery was performed in 24 ECC cases. Warm blood left heart bypass was performed in 3, hypothermic cardiopulmonary bypass in 21. The vena cava-aorta extracorporeal circulation was built in 16,vena cava-femoral in 4, left atrium-femoral in 3 and femoro-femoral in 1. Retrograde or antegrade perfusion through aortic root were applied to protect the heart. Results: There were 2 hospital deaths, the hospital mortality rate was 8.3%. The cardiopulmonary bypass was established in 10 to 15 minutes with an average duration of cardiopulmonary bypass of 78～132 minutes. Twenty-two patients were discharged from the hospital and have resumed a normal and active life style. Conclusions: Emergency cardiopulmonary bypass support is a powerful resuscitative tool that may stabilize the condition of patients with cardiogenic shock and mutiorgan dysfunction to allow for definitive intervention. The femoro-femoral cannulation is the first choice for emergency. The time to establish extracorporeal circulation should be as short as possible.

Heart valve replacement for giant left ventricle: Clinical analysis of 138 cases / 医学研究生学报

Objective: Giant left ventricle is one of the important dangerous factors impacting the results of valve replacement operation.In order to improve the efficiency of operation,we summarized our experience in valve replacement surgery for patients with giant left ventricle(LVEDD ≥ 7.0 cm).Methods: We retrospectively analyzed the clinical data of 138 cases of giant left ventricle treated by valve replacement operation in our hospital from June 1996 to April 2008.The preoperative left ventricular end diastolic dimension(LVEDD),left ventricle end systolic dimension(LVESD),left ventricular ejection fraction(LVEF) and left ventricular fractional shortening(LVFS) were 7.38-10.51 cm(mean 7.98?0.39),5.20-7.93(mean 5.88 ? 1.03),0.21-0.66(mean 0.43 ? 0.11) and 0.10-0.45(mean 0.25 ? 0.07),respectively.Eighty-nine of the patients had the heart function(NYHA) of class Ⅲ,and the other 49 class Ⅳ.Mitral valve replacement(MVR) was performed for 57 cases,aortic valve replacement(AVR) for 26,double valves replacement(DVR) for 40,and Bentall operation for the other 15.Meanwhile,78 of them underwent tricuspid valve plasty(TVP),and another 17(LVEDD ≥8.5 cm and LVEF ≤ 25%) partial left ventriculectomy(PLV).Results: The early postoperative mortality rate was 5.8%,mainly due to postoperative multiple organ failure,severe low cardiac output syndrome and ventricular fibrillation.Compared with the preoperative data,postoperative echocardiography showed that LVEDD and LVESD were decreased slowly at 2 weeks,and LVEF and LVFS significantly improved at 6 months.In the 17 patients who underwent PLV,LVEDD and LVESD were significantly reduced at 2 weeks,and LVEF and LVFS markedly improved.Conclusion:The key to the efficiency of valve replacement for giant left ventricle was proper choice of the blood containing stop-beating fluid during the operation,preserving the posterior valve of the mitral valve and the structure beneath it,shortening aortic cross-clamping time as much as possible,and perioperative prevention and management of arrhythmia.The short-term effect of valve replacement with simultaneous PLV is satisfactory,while its long-term effect is yet to be further investigated.

The effect of matrix metalloproteinase-9 in acute lung injury following cardiopulmonary bypass / 医学研究生学报

Objectives: To study the correlation between plasma matrix metalloproteinase 9(MMP 9) concentration and acute lung injury following cardiopulmonary bypass(CPB). Methods: Human plasma was obtained after informed consent from twenty patients undergoing CPB. Plasma was collected at the beginning of CPB, 5 minutes after the initiation of CPB, at the termination of CPB, 1 hour after the termination of CPB and 6 hours after the termination of CPB. All samples were analyzed by standard enzyme linked immunosorbent assay (ELISA). A aDO 2 and respiratory index (RI) was measured at the termination, 1 hour and 6 hours after termination of CPB. The cross clamp times, CPB times and the time to extubation was recorded. Data were expressed as means ?SE and assessed by analysis of variance (ANOVA).The regression analysis was utilized to define the correlations of variables measured( A aDO 2 ,RI, cross clamp times, CPB times and the time to extubation ) at the end of CPB. Results: Plasma MMP 9 concentration was significantly increased at the end of CPB (430.6?50)?g/L( P

Expression and Clinical Significance of Survivin in Acute Leukemia / 中国医师杂志

Objective To study the expression and clinical significance of survivin in acute leukemia. Methods By using semi-quantitative RT-PCR technique, survivin gene expression was detected in 43 acute leukemia(AL). Results Survivin gene expression rate in the cells of AL patients at diagnosis was 69.77%(30/43). Survivin mRNA expression rate in both 18 acute lymphocytic leukemia (ALL) and 25 acute nonlymphocytic leukemia(ANLL) (72.22% and 68.0% respectively) was signficantly higher than that in control group (33.33%,P0.05). Conclusions Survivin gene was highly expressed in AL patients and could be a potential target for treatment of AL.