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@#Objective Toinvestigatethepreoperativeriskfactorsofpostoperativeatrialfibrillation(POAF)inpatients undergoingoff-pumpcoronaryarterybypassgrafting(CABG). Methods Atotalof1888patientsunderwentoff-pump CABGinourhospitalweredividedintonewonsetatrialfibrillationgroup(POAFgroup, n=389)andnonAFgroup(NPOAF group, n=1 499). Univariate analysis was used to compare general clinical data, preoperative biochemical indicators, preoperativeechocardiography,coronaryarterydiseaseandpreoperativemedicationbetweentwogroups.Theindicatorswith statisticallysignificantdifferenceswerefurtheranalyzedbyLogisticsregressionanalysis. Results TheincidenceofPOAF was20.60%(389/1888).Thedataofage,chronicobstructivepulmonarydisease(COPD)history,myocardialinfarction history, preoperative urea nitrogen (BUN) level, left atrial diameter (LAD) and left ventricular end diastolic diameter (LVEDD)werehigherinPOAFgroupthanthoseofNPOAFgroup,andthepreoperativeHYHAgradingwaslowerinPOAF groupthanthatofNPOAFgroup（P＜0.05).Theproportionofpreoperativeuseofbetablockerswassignificantlylowerin POAFgroupthanthatofNPOAFgroup(P＜0.01).LogisticregressionanalysisshowedthatincreasedageandLADwere independentpreoperativeriskfactorsforPOAF.PreoperativebetablockerapplicationwasaprotectivefactorforPOAF. Conclusion Itsuggeststhatage,LADandpreoperativebetablockerapplicationarerelatedtotheoccurrenceofPOAFin patientsunderwentoff-pumpCABG.
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Objective To summarize the clinical experience and the clinical therapeutic effect of minimally invasive surgery for congenital heart disease under thoracoscope. Methods A total of 154 patients of congenital heart disease treated by minimally invasive surgery through thoracoscopic surgery were divided into two groups,adult group(n=112)and minor group (n=42). Through the right chest intercostal incision, thoracoscopic assisted exposure of the surgical field of visual, superior vena cava and femoral vein catheterization, cardiopulmonary bypass were established. The principle of operation was the same as that of thoracotomy.Data of operation time,extraeorporeal circulation time,cross-clamping time, ICU time, length of hospital stay, amount of drainage and the complications were observed in two groups of patients. Results Operations were successful and all patients recovered well.There were no significant differences in operation time, extraeorporeal circulation time,cross-clamping time,ICU time and length of hospital stay between two groups of patients.In adult group, the amount of drainage was significantly increased than that in minor group (P<0.05). In adult group, there were 4 cases with complications (3.6%), 1 case was changed to median thoracotomy surgery, 1 case was undergone reoperation for bleeding, 1 case had delayed pleural effusion,and 1 case had pneumothorax.In minor group,there were 2 cases with complications(4.8%),1 case had injury of femoral artery and had bypass operation immediately and 1 case had delayed pleural effusion.There was no significant difference in complications between 2 groups(P>0.05).There was neither serious complication nor death in both adult and minor groups. Conclusion Minimally invasive thoracoscopic surgery for congenital heart disease is safe and reliable for both adults and minors.It has the advantages of small trauma,less bleeding, less serious complications and quick recovery after operation.However,it takes surgeons some time to grasp the operative skill skillfully,and the operative indication should be controlled strictly.
ABSTRACT
<p><b>OBJECTIVE</b>To analyze expression characteristics of human skin epidermal stem cell at different developmental stages, and to explore its biological significance.</p><p><b>METHODS</b>Health skin samples from 28-32 w fetuses (F group), 4-12 y children (C group), and 35-55 y adult (A group) were harvested, with 10 cases in each group. Epidermis were separated using trypsin digestion and EDTA, and human epidermal stem cells were isolated and purified with type IV collagen attachment method. The monoclonal antibody of integrin beta1 and keratin 19 were used for detection and identification of epidermal stem cells by immunohistochemical staining. Total RNA was extracted from above cells by Trizol one-step method, and were detected by formaldehyde denaturing agarose gel electrophoresis. Probes were prepared and hybridized into cDNA microarray for scanning fluorescent signals and analysis of images, with two-fold differential expression value for screening. Significantly up/down-regulated genes were selected for verification by real time RT-PCR.</p><p><b>RESULTS</b>By comparing expression profile between A and C groups, a total of 1808 genes with differential expression were detected, including 1089 up-regulated genes and 719 down-regulated genes, and they were classified into 128 categories. Among them, 1462 genes were known (found in GeneBank), 346 genes were unknown. A total of 4534 genes with differential expression were detected between C and F groups, in which 1783 genes were up-regulated and 2751 genes were down-regulated, and they were classified into 216 categories. Among them, 3577 genes were known (found in GeneBank), and 957 genes were unknown. There were 1104 genes with differential expression consistently detected in F, C and A groups, which were classified into 32 categories according to gene function. Among them, 94 genes were consistently up-regulated and 75 genes consistently down-regulated. Test results of real time RT-PCR were in accordance with above-mentioned results.</p><p><b>CONCLUSIONS</b>Gene expression profiles of epidermal stem cells cultured in vitro, harvested from fetuses, children, and adult, exhibit obvious difference. This may be closely related to different stages of proliferation and differentiation of human epidermal stem cell and self-repair ability of wound at different developmental stages.</p>