We aimed to investigate the improving measures of the training of research ability in cardiothoracic surgical resident. We analyzed the current training status of researching ability in residents by reviewing relevant literatures and combing with the actual situations. There are still some aspects of the training program for research ability in cardiothoracic surgical resident needing further improvements, such as training system, assessment system. Scientific research ability is one of the basic abilities for cardiothoracic surgical resident. Strengthening the training of research ability for cardiothoracic surgical resident is propitious to the long-term development of the doctors' career.
Objective To compare and evaluate the short-term outcomes of 3 different tricuspid valve plasty for functional tricuspid regurgitation (TR) in patients with rheumatic heart disease. Methods Between October 2010 and June 2011, 148 patients with rheumatic heart disease undergoing left heart valve replacement and tricuspid valve plasty for functional TR were enrolled in the study. There were 32 males and 116 females with an average age of 47.5 years (range, 15-66 years). The patients were divided into 3 groups depending on tricuspid valve plasty: Cosgrove-Edwards annuloplasty ring group (annuloplasty ring group, 58 cases), Kay annuloplasty group (Kay group, 61 cases), and DeVega annuloplasty group (DeVaga group, 29 cases). There was no significant difference in general data among groups (P gt; 0.05), except more severe TR degree, higher atrial fibrillation, and higher radiofrequency ablation in annuloplasty ring group (P lt; 0.05). Perioperative data were recorded. The heart function was evaluated according to the standard of New York Heart Association (NYHA). Echocardiography (ECG) was used to record the TR class during perioperative period and follow-up. Results After operation, 1 case in Kay group and 1 case in annuloplasty ring group were dead because of low cardiac output syndrome. Pneumonia happened in 2 cases of Kay group and in 1 case of annuloplasty ring group; re-operation was performed in 1 case of annuloplasty ring group because of sternal dehiscence. There was no significant difference in perioperative complication among 3 groups (P=0.840). The TR degree was significantly improved at discharge when compared with preoperative degree in 3 groups (P lt; 0.001). A total of 146 patients were followed up 6-12 months (mean, 7.3 months). The NYHA grade of 3 groups at last follow-up was improved when compared with preoperative grade (P lt; 0.001), but no significant difference among 3 groups (χ2=0.120, P=0.942). The TR degree at last follow-up was all improved in 3 groups when compared with preoperative degree (P lt; 0.001); the improved efficiency showed significant difference among 3 groups (χ2=26.827, P=0.000), it was significantly better in annuloplasty ring group than in the other 2 groups (P lt; 0.001), but no significant difference between DeVega group and Kay group (Z=1.467, P=0.142). Conclusion The early improved efficiency of TR after Cosgrove-Edwards annuloplasty is superior to that of Kay annuloplasty and DeVega annuloplasty.
Objective To investigate the effect of a new suturing method called two-layer closure and to compare this with the traditional four-layer suturing method. Methods A randomized controlled trial was conducted in patients admitted from January to April 2008. A total of 124 eligible patients were divided into 2 groups. Sixty-one patients in the trial group received two-layer closure, while 63 in the control group received four-layer closure. The baseline conditions before the operation, incision parameters, and the recovery of the body and incision after the operation were compared between the 2 treatment groups. Results The baseline characteristics of the groups were similar. No significant differences were observed in terms of the length of hospital stay, time to food intake, time to ground activity, and time to first passage of gas by anus (Pgt;0.05). However, the incidence of fever after the operation was significantly lower in the trial group compared with the control group (P=0.014). The healing level of the incisions was comparable between the 2 groups (Pgt;0.05). As for complications after the operation, no cases of incision infection or incision granuloma or sinus tract were reported. However, 3 cases of active hemorrhage and 2 cases of incision split occurred in the control group. Moreover, the incidence of incision liquefaction in the trial group was significantly lower than that in the control group (P=0.03). Conclusion For abdominal median incision, two-layer closure is associated with smaller incision trauma, less stimulation from extraneous materials, as well as more accurate anatomic replacement compared with the traditional four-layer closure. However, further studies need to be conducted to determine whether the new suturing method of twolayer closure is effective and safe for other kinds of incision.
ObjectiveTo investigate the effect and mechanism of ulinastatin to ventilator induced lung injury (VILI). MethodsTotal 24 SD rats were randomly divided into a control group, a VILI group, and a VILI+ ulinastatin group. High mobility group box-1 (HMGB-1), tumor necrosis factor (TNF)-α and interleukin (IL)-6 in bronchoalveolar lavage fluid, toll like receptor-4, dry/wet ratio and pathological scores of lung tissue were detected in the three groups. ResultsHMGB-1, TNF-α, and IL-6 in bronchoalveolar lavage fluid, toll like receptor-4, dry/wet ratio and pathological scores of lung tissue were significantly higher in the VILI group than those in the control group with statistical differences (P<0.05). While HMGB-1, TNF-α, and IL-6 in bronchoalveolar lavage fluid, toll like receptor-4, dry/wet ratio and pathological scores of lung tissue were reduced in the VILI+ ulinastatin group compared with those in the VILI group. ConclusionUlinastatin may protect ventilator induced lung injury by reducing inflammation level in lung through HMGB-1-TLR4 pathway.
ObjectiveTo analyze the reason of 45 patients with cardiac valve reoperation and to evaluate the safety of redo heart valve replacement. MethodsWe retrospectively analyzed the clinical data of 45 patients in our hospital between January 2010 and January 2015. There were 45 patients with 14 males and 31 females at an average age of 51.21± 8.36 years. ResultsThree of 45 patients (6.67%) were died after surgery. Mean follow-up was 36 (4-68) months. A total of 42 patients were alive and without reoperation again. The main reasons of heart valve reoperation included lesions of untreated valve, paravalvular leakage, thrombosis associated with valvular dysfunction, bioprosthesis degeneration, endocarditis, valvular lesions after angioplasty. ConclusionTricuspid regurgitation should be treated aggressively when the mitral valve involved in the first operation. Patients received the secondary heart valve replacement is safe and effective. Strict follow-up system should be established and surgical intervention should be taken timely and appropriately.