[Efficacy of compound pholcodine syrup and compound codeine phosphate oral solution on lung cancer-related cough].

Objective: To assess the clinical efficacy of compound pholcodine syrup and compound codeine phosphate oral solution on lung cancer-related cough. Methods: A total of 60 patients diagnosed with middle-advanced stage lung cancer and had lung cancer-related cough in the Department of Geriatric Oncology of Chongqing University Cancer Hospital from January to May 2022 were prospectively enrolled. According to the random number table method, the patients were divided into two groups: observation group and control group. The observation group [n=30, with 21 males and 9 females, and aged (62.3±10.4) years] received compound pholcodine syrup treatment, while the control group [n=30, with 21 males and 9 females, and aged (62.0±8.1) years] received compound codeine phosphate oral solution treatment. The dosage of the two drugs was 15 ml each time, 3 times a day, and the treatment course was 5 days. The antitussive effectiveness, cough severity and quality of life (Leicester Cough Questionnaire in Mandarin-Chinese scale) were observed and compared between the two groups 3 days and 5 days after the treatment. Results: All 60 patients completed the study. Both regimens were effective in controlling lung cancer-related cough. After 3 days treatment, the antitussive effective rate of the observation group and the control group was 83.3% (25/30) and 73.3% (22/30), respectively, with no statistically significant difference (P=0.347). Likewise, after 5 days treatment, the antitussive effective rate of observation group and control group was 90.0% (27/30) and 86.6% (26/30), respectively, with no statistically significant difference (P=0.687). There was no statistically significant difference in the cough severity between observation group [moderate and severe cough: 56.7% (17/30)] and control group [moderate and severe cough: 67.7% (20/30)] (P=0.414). After 3 days treatment, cough symptoms were relieved in both groups. Patients with mild cough accounted for 73.3% (22/30) in the observation group and 56.7% (17/30) in the control group, and the difference was not statistically significant (P=0.331). Moreover, after 5 days treatment, there was also no significant difference in mild cough between observation group [86.7% (26/30)] and control group [66.7% (20/30)] (P=0.067). Meanwhile, there were no significant differences in the physiological score, psychological score, social score and total score of the Leicester Cough Questionnaire in Mandarin-Chinese scale before the treatment, after 3 days and 5 days treatment between the two groups (all P>0.05). The incidence of both xerostomia and constipation in the observation group was 0, which was lower than those of the control group [20.0% (6/30) and 20.0% (6/30)] (both P<0.05). Conclusions: Both compound pholcodine syrup and compound codeine phosphate oral solution are effective in treating lung cancer-related cough with similar antitussive effectiveness. Compound pholcodine syrup has a lower incidence of xerostomia and constipation than control group, with a better safety profile.

[Efficacy of early interdisciplinary palliative care based on WARM model in non-small-cell lung cancer].

Objective: To assess the therapeutic effect of the early interdisciplinary palliative care based on WARM model (whole, assessment, revaluation, management) on the quality of life, psychological state, pain and nutritional status in patients with non-small-cell lung cancer (NSCLC). Methods: A total of 60 patients from Chongqing University Cancer Hospital with newly diagnosed advanced NSCLC from Oct 15, 2019 to Jun 12, 2020 were enrolled. According to the method of random number table, the patients were divided into two groups: standard oncologic care group (SC, n=30) and early palliative care group (EPC, n=30). SC group only received standard oncological care, while EPC group received standard oncological care and additional comprehensive treatment from a MDT consisted of medical oncologists, palliative care nurses, dietitians and psychologists. The quality of life [functional assessment of cancer therapy-lung (FACT-L) scale], psychological state [hospital anxiety and depression scale (HADS) and patient health questionnaire-9 (PHQ-9)], nutritional status [patient-generated subjective global assessment (PG-SGA)], and cancer pain status [numerical rating scale (NRS)] were observed and compared between the two groups before and after the 6 months treatment, respectively. Results: A total of 45 patients completed 6 months treatment, including 24 males and 21 females, aged 38-82 (60.5±1.7), with 23 patients in the EPC group and 22 patients in the SC group. Patients assigned to EPC group had a better quality of life than those assigned to SC group [FACT-L scale: (122.3±1.6) vs (111.8±2.1), P<0.001]. Fewer patients had anxiety and depressive symptoms in the EPC group than those in the SC group [HADS anxiety subscale: (1.1±0.3) vs (2.9±0.4), P<0.001; HADS depression subscale: (0.7±0.3) vs (3.6±0.4), P<0.001]. The PHQ-9 results showed that 100.0% (23/23) patients were free of depression in the EPC group, while 45.5% (10/22) patients were free of depression in SC group (P<0.001). Furthermore, patients in the EPC group had a better nutritional status [moderate malnutrition: 60.9% (14/23); no malnutrition: 39.1% (9/23)] than those in the SC group [severe malnutrition: 40.9% (9/22); moderate malnutrition: 50.0% (11/22); no malnutrition: 9.1% (2/22)] (P<0.001). There was no significant difference in NRS score between EPC group and SC group (P=0.140). Conclusion: Early interdisciplinary palliative care based on WARM model can improve the quality of life, psychological state and nutritional status in NSCLC patients.

Vasoactive intestinal peptide is required in the maintenance of immune regulatory competency of immune regulatory monocytes.

Dysfunction of the immune regulatory system plays an important role in the pathogenesis of rheumatoid arthritis (RA). Vasoactive intestinal peptide (VIP) has multiple bioactivities. This study aims to investigate the role of VIP in the maintenance of the immune regulatory capacity of monocytes (Mos). Human peripheral blood samples were collected from RA patients and healthy control (HC) subjects. Mos and CD14+ CD71- CD73+ CD25+ regulatory Mos (RegMos) were isolated from the blood samples and characterized by flow cytometry. A rat RA model was developed to test the role of VIP in the maintenance of the immune regulatory function of Mos. The results showed that RegMos of HC subjects had immune suppressive functions. RegMos of RA patients expressed less interleukin (IL)-10 and showed an incompetent immune regulatory capacity. Serum levels of VIP were lower in RA patients, which were positively correlated with the expression of IL-10 in RegMos. In-vitro experiments showed that the IL-10 mRNA decayed spontaneously in RegMos, which could be prevented by the presence of VIP in the culture. VIP suppressed the effects of tristetraprolin (TTP) on inducing IL-10 mRNA decay in RegMos. Administration of VIP inhibited experimental RA in rats through restoring the IL-10 expression in RegMos. RegMos have immune suppressive functions. VIP is required in maintaining IL-10 expression in RegMos. The data suggest that VIP has translational potential in the treatment of immune disorders such as RA.

Rosuvastatin inhibits inflammatory response and resists fibrosis after myocardial infarction.

OBJECTIVE: To study the effect of rosuvastatin on myocardial infarction in rats and its mechanism of action. MATERIALS AND METHODS: 24 Sprague-Dawley (SD) rats were randomly divided into 3 groups: intensive statin group (n=8), myocardial infarction control group (n=8) and sham-operation group (n=8). The left anterior descending coronary artery was ligated to establish myocardial infarction models. Rats in intensive statin group were treated with gavage via rosuvastatin (1 mg × kg) and 1.5 mL distilled water suspension at 3 d before operation, while rats in the other two groups received gavage via the same amount of distilled water till 4 weeks after operation. Venous blood was collected using capillary glass tubes at 3 d before operation (before medication) and the last day in the 4th week after operation. Interleukin-6 (IL-6) was detected via chemiluminescence assay, and tumor necrosis factor-α (TNF-α) was detected via immunofluorescence assay. Hematoxylin and eosin (HE) staining and Masson staining were performed for myocardium to detect the inflammation and fibrosis. Finally, the expressions of inflammatory protein p65, peroxisome proliferator-activated receptor (PPAR) and fibrin were detected via Western blotting, and the Snail expression was detected by immunohistochemical assay. RESULTS: The survival rate and cardiac function of rats in intensive statin group were superior to those in control group. HE staining and detection of blood IL-6 and TNF-α, and p65 and PPAR protein expressions revealed that the inflammatory levels in the body and myocardium of rats in intensive statin group were decreased compared with those in control group. Masson staining and detection of fibrin level showed that the myocardial fibrosis level of rats in intensive statin group was reduced compared with that in control group. CONCLUSIONS: Rosuvastatin can reduce the level of myocardial fibrosis through alleviating the inflammatory response in rats with myocardial infarction.

Conscious sedation with midazolam and dezocine for diagnostic flexible bronchoscopy.

OBJECTIVE: This study aimed to assess the benefits and risks of conscious sedation with midazolam and dezocine in diagnostic flexible bronchoscopy (FB). PATIENTS AND METHODS: This prospective case control study enrolled 40 non-sedated and 40 sedated subjects who underwent diagnostic FB. All received the standard upper airway preparation, while sedated subjects received midazolam and dezocine for conscious sedation. Subject discomforts during FB were assessed using the verbal analogue score (VAS, 0-10 scale). Willingness to return was assessed as five scales to monitor subject's satisfaction level. Safety profiles throughout the procedures were also assessed. RESULTS: Anterograde amnesia existed in 75.0% sedated subjects. Compared to non-sedated subjects, sedated ones expressed less discomfort, with lower VAS scores regarding scope insertion (4 [0-10] vs. 0 [0-4], p < 0.001), cough (5.5 [0-10] vs. 0 [0-4], p < 0.001), dyspnea (3.5 [0-10] vs. 0 [0-4], p<0.001), pain (3 [0-10] vs. 0 [0-5], p < 0.001), and global tolerance of the procedures (5.5 [1-10] vs. 0 [0-5], p < 0.001). More sedated subjects expressed willingness to return (90.0% vs. 30.0%, p < 0.001). Sedated subjects had no more hypoxemic episodes during the procedure (7.5% vs. 5.0%, p > 0.99), which were all transient and not life-threatening. CONCLUSIONS: Conscious sedation with midazolam and dezocine reduces discomforts, improves satisfaction level, and carries no significantly risks in subjects undergoing diagnostic FB.

First Report of Tomato zonate spot virus in Iris tectorum in China.

Iris tectorum Maxim, a very popular Chinese traditional medicinal perennial herb belonging to the Iridaceae family, is widely grown as a year-round ornamental in China. During May to August 2014, as part of a survey for tospoviruses (family Bunyaviridae) in flue-cured tobacco, symptoms suspected to be caused by tospoviruses were observed on I. tectorum around farmers' fields in Kunming, Yunnan province. Symptoms were chlorotic spots on younger leaves and necrosis on older leaves. Since Tomato spotted wilt virus (TSWV) and Tomato zonate spot virus (TZSV) are two common tospoviruses in flue-cured tobacco fields in Yunnan, ELISA with monoclonal TSWV antibody (provided by J. X. Wu, Zhejiang University, China) and polyclonal TZSV antiserum (provided by J. H. Dong, Yunnan Academy of Agriculture Science, China) was performed to identify the presence of virus. Positive extinction values (ODλ405nm 0.835 ± 0.121 and 1.024 ± 0.193, as compared with the negative 0.153 ± 0.076 and the positive control 0.510 ± 0.109 at a confidence interval of P ≤ 0.05) were obtained from two symptomatic samples with TZSV antibody but not with TSWV. The absence of TSWV was confirmed with a commercially available immune-strip (Agdia, Elkhart, IN), following the manufacturer's instructions. To further verify the causal agent of these symptoms, total RNA was isolated from two symptomatic and one asymptomatic samples and reverse transcribed using degenerate primer J13 (1). These cDNAs were then used as a template in a universal PCR assay using specific primers TZSVNF (5'-ATGTCTAACGTCCGGAGTTTAACAC-3') and TZSVNR (5'-TTAAAAAGACAGATCATTGCTG-3'), which amplify the complete nucleocapsid (N) protein. The PCR was carried out for denaturation at 94°C for 3 min, and subsequently 30 cycles were carried out, with each cycle consisting of 94°C for 45 s, 55°C for 45 s, and 72°C for 1 min, followed by a final extension step at 72°C for 10 min. An 0.8-Kb DNA fragment was amplified from symptomatic samples and cloned into a pGEM-T Easy (Promega, Madison, WI) vector. Three clones of each sample were selected and sequenced. BLAST analysis of the obtained sequences (Accession Nos. KM452916 and KM452917) revealed that the N sequences of these isolates have 96 to 99% nucleotide identity and 99 to 100% amino acid identity with the deposit TZSV sequence in NCBI from Yunnan (JN116580 to JN116583 and EF552433) (2). These combined results provide further confirmation of TZSV infection. It is known that perennial herb or ornamental plants may act as reservoirs for tospoviruses that can infect cultivated crops because tospoviruses have a very broad host range. Therefore, elaborate inspections for tospoviruses and appropriate management strategies to limit virus spread are necessary for production of crops. To our knowledge, this is the first report of TZSV in I. tectorum Maxim. References: (1) I. Cortez et al. Arch Virol. 146:265, 2001. (2) J. Dong et al. Arch Virol. 153:855, 2008.

Quantitative proteomic analysis of dexamethasone-induced effects on osteoblast differentiation, proliferation, and apoptosis in MC3T3-E1 cells using SILAC.

SUMMARY: The impairment of osteoblast differentiation is one cause of the glucocorticoid-induced osteoporosis (GCOP). The quantitative proteomic analysis of the dexamethasone (DEX)-induced effects of osteoblast differentiation, proliferation, and apoptosis using stable-isotope labeling by amino acids in cell culture (SILAC) demonstrated drastic changes of some key proteins in MC3T3-E1 cells. INTRODUCTION: The impairment of osteoblast differentiation is one of the main explanations of GCOP. SILAC enables accurate quantitative proteomic analysis of protein changes in cells to explore the underlying mechanism of GCOP. METHODS: Osteoprogenitor MC3T3-E1 cells were treated with or without 10(−6) M DEX for 7 days, and the differentiation ability, proliferation, and apoptosis of the cells were measured. The protein level changes were analyzed using SILAC and liquid chromatography-coupled tandem mass spectrometry. RESULTS: In this study, 10(−6) M DEX inhibited both osteoblast differentiation and proliferation but induced apoptosis in osteoprogenitor MC3T3-E1 cells on day 7. We found that 10(−6) M DEX increased the levels of tubulins (TUBA1A, TUBB2B, and TUBB5), IQGAP1, S100 proteins (S100A11, S100A6, S100A4, and S100A10), myosin proteins (MYH9 and MYH11), and apoptosis and stress proteins, while inhibited the protein levels of ATP synthases (ATP5O, ATP5H, ATP5A1, and ATP5F1), G3BP-1, and Ras-related proteins (Rab-1A, Rab-2A, and Rab-7) in MC3T3-E1 cells. CONCLUSIONS: Several members of the ATP synthases, myosin proteins, small GTPase superfamily, and S100 proteins may participate in functional inhibition of osteoblast progenitor cells by GCs. Such protein expression changes may be of pathological significance in coping with GCOP.

Phylogenetic relationships among the species of Elymus sensu lato in Triticeae (Poaceae) based on nuclear rDNA ITS sequences.

The genus Elymus L. sensu lato includes Roegneria, Elymus, Hystrix, Sitanion and Kengyilia, and they are very important group in the tribe Triticeae. However, the phylogenetic relationships and taxonomic status of them are still in dispute. The ITS sequences were obtained and analyzed for their phylogenetic relationships by using Maximum Parsimony (MP) and Bayesian Inference (BI) methods. The main results were as follows: (1) Most species in Roegneria, Elymus and Sitanion were clustered in the St clade with diploid St genome species, and it was difficult to distinguish the species in Roegneria and Elymus; (2) The polyploid species with St genomes in the St clade were divided into three groups, which suggests that there exists differentiation of St genome in polyploids; (3) Most species of Kengyilia have only P-type of clone and clustered with diploid Agropyron species, which may suggest that Kengyilia is a valid genus; (4) Hy. patula, the type species of Hystrix was clustered with species of Elymus, while Hy. duthiei ssp. duthiei, Hy. duthiei ssp. longearistata, Hy. coreana and Hy. komarovii were grouped with diploid Psathyrostachys species. It indicated that Hy. patula is distinct related to other Hystrix species, and it is reasonable to treat Hystrix patula as Elymus hystrix and other species in Hystrix should be transferred to Leymus; (5) The "clones bias" in ITS sequences are widespread in the allopolyploid species.

A combination of grape seed-derived procyanidins and gypenosides alleviates insulin resistance in mice and HepG2 cells.

This study investigated the effects of grape seed-derived procyanidins (GSP), gypenosides (GPE), and combination procyanidins/gypenosides on insulin resistance in mice and HepG2 cells. ICR mice were randomly divided into 2 control and 4 treatment groups. The control mice were to receive either normal diet (ND) or high-fat diet (HFD), and the treatment groups were fed high-fat diet with either 80 mg/kg of GSP (GSP80), GPE (GPE80), GSP + GPE (1: 1, GSP40 + GPE40), or 500 mg/kg of metformin for a 6-wk period. All the groups of mice except the normal control were on high-fat diet along with fructose (15%) administered in drinking water throughout the period of treatment. An insulin-resistant HepG2 cell model was developed after 24 h of 5 x 10(-7) mol/L insulin incubation. The treatment of GPE80 could significantly reduce the index of insulin resistance (HOMA-IR) and increase hepatic glycogen concentration, compared with HFD group (P < 0.05). When GSP and GPE were administered simultaneously, synergic effects were observed in decreasing the HOMA-IR index and serum total cholesterol (TC) level and enhancing glucose tolerance. All treatment groups showed considerable raise of hepatic glucokinase activity (P < 0.05 compared with HFD group). GSP application increased the consumption of extracellular glucose in HepG2 cells. Our data suggest that the combination of GSP and GPE may have functional efficacy in consumers with insulin resistance.

Treatment of coke-plant wastewater by biofilm systems for removal of organic compounds and nitrogen.

Coke-plant wastewater was treated by an anaerobic-anoxic-aerobic (A(1)-A(2)-O) biofilm system and an anoxic-aerobic (A/O) biofilm system, respectively. At same or similar levels of hydraulic retention time (HRT), the two systems had almost identical chemical oxygen demand (COD) and NH(3) removals, but a different organic-N removal. Set-up of an acidogenic stage benefited for the removal of organic-N and the A(1)-A(2)-O system was more useful for total nitrogen removal than the A-O system. HRT did not have a substantial effect on the COD and NH(3)-N removal efficiencies, but considerably influenced the organic-N removal and distribution of oxidized nitrogen in the final effluent. The GC/MS analysis demonstrated that some refractory compounds were decomposed at the acidogenic stage and resulted in the production of some intermediates, which were more readily degraded in the subsequent aerobic stage. Hence, the A(1)-A(2)-O system had better effluent quality than the A-O system in terms of effluent composition.

Inhibition by chromium and cadmium of anaerobic acidogenesis.

The effects of chromium (III) and cadmium on the anaerobic acidogenesis of a simulated dairy waste were examined using serum vials. At Cd dosages less than 20 mg/l, the acidogenesis process was enhanced by the dosage, resulting in a higher degree of acidification, protein conversion, and hydrogen production than the control. At dosages over 20-mg/l, Cd inhibited the acidogenesis. The Cr (III) dosage of 5 mg/l reduced overall volatile fatty acid and alcohol generation, degree of acidification, conversions of lactose, lipid and protein, and total biogas production, with the exception of accumulation of hydrogen and propionate. At dosages exceeding 5 mg/l, Cr (III) had a severe inhibition on the acidogenesis. The Cd concentrations which caused a 50% reduction in total volatile fatty acid and alcohol production, degree of acidification and cumulative gas production were higher than the corresponding values caused by Cr (III), suggesting that Cr (III) was more toxic to acidogenic bacteria than Cd.

Enhanced sludge granulation in upflow anaerobic sludge blanket (UASB) reactors by aluminum chloride.

Two upflow anaerobic sludge blanket (UASB) reactors were concurrently operated for 146 days to examine the effects of aluminum chloride (AlCl3) on the sludge granulation process during start-up. Sludge granulation (defined as that over 10% of granules were larger than 2.0 mm) was achieved in the control reactor (R1) in approximate three months. Introduction of Al3+ at a concentration of 300 mg/l reduced the sludge granulation time by approximate one month. Throughout the experiment the AlCl3-added reactor (R2) had a higher biomass concentration, e.g., 13.8 g-MLVSS/l versus 12.8 g-MLVSS/l on Day 146. Granules became visible earlier in R2 compared with R1 (35 days versus 65 days). The average size of granules from R2 was larger than that from R1. The results demonstrated that AlCl3 enhanced the sludge granulation process in the UASB reactors.

[Analysis of the influence factors on the resection and prognosis of thymic tumors].

One hundred eleven thymic tumors were intervened surgically, including 92 thymoma, 8 thymic carcinoid, and 10 thymic carcinoma. In this series 50.9% of the cases were complicated with various syndrome, 44.5% with myasthenia gravis (MG), more frequently in the epithelial cell type. Pure red cell aplasia often associated with the spindle-cell thymoma. Of the thymic carcinoid 50% had ectopic ACTH syndrome. Resection rate correlated with the size and invasion of the tumor. There were significant difference in resection rate among thymoma, thymic carcinoid, and thymic carcinoma. The degree of invasion undoubtedly influenced on resection. The 3-, 5-, and 10-year survival rates of the thymoma were 82.7%, 68.1% and 40.0% respectively. The prognosis depended on the pathological classification and the severity of neighbouring invasion, but MG had no significant effect on prognosis. Recurrence and metastasis of the tumor remained to be the main cause of late death.

Rearrangements of the retinoic acid receptor alpha and promyelocytic leukemia zinc finger genes resulting from t(11;17)(q23;q21) in a patient with acute promyelocytic leukemia.

Cytogenetic study of a patient with acute promyelocytic leukemia (APL) showed an unusual karyotype 46,xy,t(11;17) (q23;21) without apparent rearrangement of chromosome 15. Molecular studies showed rearrangements of the retinoic acid receptor alpha (RAR alpha) gene but no rearrangement of the promyelocytic leukemia gene consistent with the cytogenetic data. Similar to t(15;17) APL, all-trans retinoic acid treatment in this patient produced an early leukocytosis which was followed by a myeloid maturation, but the patient died too early to achieve remission. Further molecular analysis of this patient showed a rearrangement between the RAR alpha gene and a newly discovered zinc finger gene named PLZF (promyelocytic leukemia zinc finger). The fusion PLZF-RAR alpha gene found in this case, was not found in DNA obtained from the bone marrow of normals, APL with t(15;17) and in one patient with AML-M2 with a t(11;17). Fluorescence in situ hybridization using a PLZF specific probe localized the PLZF gene to chromosomal band 11q23.1. Partial exon/intron structure of the PLZF gene flanking the break point on chromosome 11 was also established and the breakpoint within the RAR alpha gene was mapped approximately 2 kb downstream of the exon encoding the 5' untranslated region and the unique A2 domain of the RAR alpha 2 isoform.

[Heart surgery in normothermia and aerobiosis: apropos of 530 patients]. / Chirurgie cardiaque en normothermie et aéorobiose: à propos de 530 patients.

Between February and October 1991, 530 consecutive patients underwent myocardial revascularization or valvular surgery with warm continuous antegrade and retrograde cardioplegia (37 degrees C). Three hundred and thirty three patients had isolated myocardial revascularization, 159 valvular surgery alone and 25 had combined valvular and coronary bypass. The global mortality was 5.1%, 3.7% for coronary bypass, 7.5% for valvular surgery and 8% for combined valvular and coronary surgery. A multivariate analysis identified the "reperfusion time" as the only predictive factor of hospital mortality (p < 0.001). Intraortic balloon counterpulsation was required postoperatively in 3.2% of cases, 5.2% of coronary bypass and 0.8% of the valvular patients. Inotropic drugs were used to come off cardiopulmonary bypass in 16.5% of coronary and 37.5% of valvular patients. There were 0.9% perioperative infarctions: 1.2% in the coronary bypass cases and 0.6% in the valvular cases. Spontaneous return to sinus rythm was observed in 87.9% of cases. The average "reperfusion time" was 20.48 +/- 0.7 mn. Analysis of the influence of aortic cross clamp time on cardiac morbidity in two groups of coronary patients (Group I: short cross clamp time less than 60 mn; Group II: long cross clamp time, 60 to 33 mn) showed that the hospital mortality, the prevalence of the use of inotropic drugs and balloon counterpulsation the postoperative cardiac index, the rate of spontaneous de fibrillation and the reperfusion time did not depend on the aortic cross clamp time. Cardiac morbidity.

Beyond cold cardioplegia.

One hundred fifteen consecutive patients were operated on for myocardial revascularization or valvular disease or both with continuous antegrade and retrograde aerobic warm (37 degrees C) blood cardioplegia. Mean cross-clamp time was 56.3 +/- 21 minutes (+/- standard deviation). Mean reperfusion time was 18.4 +/- 11.8 minutes (range, 5 to 81 minutes). Five patients (4.3%) died, and 15 (13%) needed inotropic support. Two (1.7%) required intraaortic balloon support. Two patients (1.7%) had evidence of perioperative myocardial infarction, and 98 (85%) returned spontaneously to normal sinus rhythm. Sixteen patients had a cross-clamp time greater than 80 minutes. All 16 of them had an uneventful postoperative course except for 1 patient who required inotropic drugs. This method of myocardial protection is now used for all open heart procedures in our institution.