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体外循环与非体外循环冠状动脉旁路移植术临床分析

目的 比较体外循环冠状动脉旁路移植术（on—pump CABG，on—pump）和非体外循环冠状动脉旁路移植术（off—pump CABG，off—pump）的临床应用效果。方法 回顾2003年12月-2005年1月间我院行冠状动脉旁路移植术（CABG）195例的临床资料，依据术中采用不同的手术方式分为on—pump组和off—pump组。并对两组患者的术前、术后临床资料、术后并发症发生情况进行分析。结果 两组患者术前一般临床资料比较差别无统计学意义；术后off—pump组发生并发症17例，on—pump组26例（P=0．000）；off-pump组住院死亡2例，on—pump组死亡6例（P=0．025）。结论 在多支左主干病变中，off—pump和on—pump在再血管化的应用上无差别；off—pump后的心电图改变、死亡率和并发症发生率比on—pump患者低，但是合并瓣膜病或严重的3支血管病变、左主干病变、室壁瘤形成的患者更适宜采用on—pump，off—pump不能取代on—pump。

二尖瓣置换术后三尖瓣关闭不全的外科治疗

目的总结二尖瓣置换术后三尖瓣关闭不全患者的外科治疗经验。方法14例心脏瓣膜疾病患者行二尖瓣置换术后发生中度或重度三尖瓣关闭不全,其中相对性关闭不全12例,器质性关闭不全2例。行三尖瓣成形术4例,均使用人工瓣环成形;行三尖瓣置换术10例,其中置换生物瓣6例,双叶机械瓣4例。在心脏不停跳下手术4例,常规心脏停搏手术10例。结果全组无手术死亡,术后发生低心排血量综合征3例,用升压药维持循环,患者均顺利出院。术后复查超声心动图,右心房、室均明显缩小,右心室前后径(22.5±5.6mm)较术前(31.9±5.9mm)明显减小(Plt;0.001)。随访14例,随访时间1.8±1.3年,心功能级2例、级9例,级2例,1例于术后4年因心力衰竭死亡。结论二尖瓣置换术后远期三尖瓣关闭不全的患者经外科矫治后疗效满意,合理掌握手术指征、手术时机和良好的围术期治疗是手术成功的关键。

延伸入右心房内肿瘤的外科治疗

目的　总结膈下肿瘤蔓延至右心房的外科治疗经验。　方法　自 1991年 5月～ 2 0 0 2年 11月外科治疗膈下肿瘤蔓延至右心房 6例 ,病变来源于子宫平滑肌瘤 3例 ,子宫间质肉瘤 1例 ,下腔静脉粘液肉瘤 1例 ,肾平滑肌肉瘤 1例。 5例完整切除右心房和下腔静脉内肿瘤 ,1例部分切除。　结果　无手术死亡 ,1例粘液肉瘤患者部分切除肿瘤术后 5个月死亡 ,其余患者随诊 5个月～ 3年 ,下腔静脉内无肿瘤复发 ,无明显症状。　结论　膈下肿瘤蔓延至右心房应积极手术治疗 ,手术尽量完整切除肿瘤 ,中期疗效良好。

主动脉瓣四叶畸形合并肾移植术后行主动脉瓣置换术一例

主动脉瓣下狭窄老年患者一例

冠状动脉CT血管造影诊断冠状动脉左前降支左心室瘘一例

Vitamin C Promoting Embryonic Stem Cells Co-cultured on Poly 3-Hydroxybutyrate-co-4-Hydroxybutyrate to Differentiating into Myocardiocytes

ObjectiveTo assess the suitability of P (3HB-co-4HB) combined with embryonic stem cells (ESCs) for myocardial patch formation and whether adding vitamin C would improve inductivity or not. Method We extracted mouse embryonic fibrous cell from three clean female white Kunming mouses at a mean body weight of 37.5 grams. We recovered and cultured mouse ESCs. Those mouse embryonic stem cells were obtained from Shanghai Institutes of Biological Sciences. We took pendant-drop method to form embryonic bodies (EBs) and co-cultured them with myocardial patch. The experimental group were cultured in the substate with vitamin C while the control group were cultured in the substate without vitamin C. We immunostained the myocardial patch and observed them by scanning electron microscope. We calculated the differentiation efficiency and mapped the distribution curve of induction time. ResultsThe scattergram showed that the differentiation efficiency increased gradually. The differentiation efficiency of the group with vitamin C was 71.1% and the group without vitamin C was 17.8%. There was a statistical difference between the two groups (P < 0.05). ConclusionOn the biological patch of P (3HB-co-4HB), ESCs could grow, proliferate, and differentiate into myocardial cell and adding vitamin C into it could improve the differentiation efficiency.

Experimental Research of Small Molecule Compound XAV939 Inducing Mouse Embryonic Stem Cell into Cardiac Myocyte

ObjectiveTo investigate the feasibility of small molecule compound XAV939 to induce mouse embryonic stem cells (mESC) to differentiate into cardiac myocytes. MethodsWe revived and cultured undifferentiated mESC growing confluently on trophoderm made of mouse embryonic inoblast cell. The mESCs were digested by trypsin to form embryoid bodies (EBs) by handing drop method. After plated, EBs were induced by XAV939 to differentiate into cardiac myocytes. We observed the cardiac myocytes with lightmicroscopy and identified it with immunofluorescence method. Result The XAV939 can effectively induce mESC into cardiac myocytes with the mean efficiency rate of 71.85%±1.05%. The differentiated cardiac myocytes shrinked spanteously and rhythmicly. The cardiac troponin T as the special marker of cardiac myocyte was positive. ConclusionThe small molecule compound XAV939 could effectively induce mES cells into cardiac myocytes.

Experimental Study on PHBHHx Co-culturing with Mouse Induced Pluripotent Stem Cells outside Body

ObjectiveTo study the external biocompatibility bewteen the mouse induced pluripotent stem cells (miPSCs) and poly-3-hydroxybutyrate-co-3-hydroxyhexanoate (PHBHHx). MethodsAfter we recovered and subcultured miPSCs, we divided them into two groups. There was one group cultured with material of PHBHHx films outside the body. We observed the adhesive pattern of miPSCs on film by fluorescence of 4, 6-diamidino-2-phenylindole (DAPI) staining. The cell vitality was detected by cell counting kit-8 (CCK-8). The morphology of miPSCs attached on the film was visualized under scanning electron microscope (SEM). We used the traditional petri dish to culture miPSCs and detect the cell activity by CCK-8. ResultsMiPSCs can adhere and proliferate on PHBHHx films. The result of cell vitality which detected by CCK-8 showed that there was a statistical difference in OD value between culturing on PHBHHx films and traditional cultivation (0.617±0.019 vs. 0.312±0.004, P < 0.05). ConclusionThere are adhesion and proliferation on the surface of cells patch made by miPSCs co-culturing with PHBHHx film. Compared with traditional culturing in the cell culture dish, culturing in PHBHHx films have great advantages in the process of adhesion and proliferation. PHBHHx can be used as one of the scaffold for stem cells treating various disease.

Hypoxic three-dimensional culture microenvironment promotes proliferation of bone marrow mesenchymal stem cells through HIF-1α signaling pathway

ObjectiveTo investigate the effects of hypoxic three-dimensional culture microenvironment on the proliferation of bone marrow mesenchymal stem cells and its mechanism. MethodsP5 generation mouse bone marrow mesenchymal stem cells and P (3HB-co-4HB) were co-cultured under normoxic three-dimensional (20%) and hypoxic three-dimensional microenvironment (4%) respectively. After 24 hours, the proliferation of the two groups was determined by CCK-8 method. The expression of HIF-1α gene was detected by real-time quantitative PCR after 12 hours. Western blotting was used to detect the expression of HIF-1α protein after 24 hours. ResultsAfter 24 hours, the CCK-8 method showed that the OD value of the hypoxia group was significantly higher than that of the normoxia group (0.455±0.027 vs. 0.352±0.090, n=12, P<0.05). After 12 hours of hypoxic culture, the expression level of HIF-1α mRNA in the hypoxia group was significantly higher than that in the normoxia group (P<0.05). Compared with the normoxia group (0.47± 0.05), the relative expression level of HIF-1α protein in the hypoxia group (0.63±0.06) significantly increased in the Western blotting after 24 hours (n=3, P<0.05). ConclusionThe hypoxic three-dimensional microenvironment can promote the proliferation of bone marrow mesenchymal stem cells, which may be related to the activation of HIF-1α signaling pathway.