Improved leg wound healing with endoscopic saphenous vein harvest in coronary artery bypass graft surgery: a prospective randomized study in Asian population.

OBJECTIVE: Conventional open saphenous vein harvest (OVH) for coronary artery bypass graft surgery is often associated with significant pain and morbidity. This study aims to determine whether endoscopic saphenous vein harvest (EVH) reduces leg wound morbidity and improves patient satisfaction as compared to OVH in Asian population. METHODS: Between March 2005 and June 2006, 120 patients who underwent isolated CABG were prospectively randomized into EVH (n = 60) and OVH (n = 60) groups. VirtuoSaph (Terumo Cardiovascular Corp., Ann Arbor, MI, USA) harvesting system was used for EVH. We analyzed leg wound complications (ASEPSIS score), postoperative pain, satisfaction, and clinical outcomes. Fisher's exact test and Mann-Whitney U test were used for categorical and continuous variables analysis respectively. RESULTS: Six patients in the EVH group required conversion to open technique. Both groups had matched demographic characteristics and risk factors. Mean numbers of grafts performed were 3.2 +/- 0.6 (EVH n = 54) and 3.0 +/- 0.7 (OVH n = 60) (p = 0.03). ASEPSIS scores at postoperation days three, seven, and 21 were significantly lower in the EVH group than the OVH group (p = 0.02, p = 0.002 and p = 0.01, respectively). Wound pain scores at postoperative days three, seven, and 21 were significantly lower in the EVH group (p = 0.000, p = 0.001 and p = 0.000 respectively). Wound numbness was found in 5.7% of the EVH group and 33.3% of the OVH group patients (p = 0.01). [Six patients required conversion to open technique.] There was one hospital mortality (OVH group) and major postoperative complications were not significantly different between the groups. CONCLUSION: EVH system is a safe and effective alternative to OVH with better wound healing, reduced postoperative pain, and wound numbness. However, the higher conversion rate to OVH in Asian patients requires further evaluation.

[Effects of acupuncture combined with medicine on expression of matrix metalloproteinase-2 in the rat of endometriosis].

OBJECTIVE: To probe into an effective method for treatment of endometriosis (EMs) and the mechanism. METHODS: Rat EMs model was established and they were randomly divided into a model group, an acup-moxibustion group, a TCM group, an acupuncture and medicine group, with a control group set. The acup-moxibustion group were treated with electroacupuncture at "Xuehai (SP 10)", "Sanyinjiao (SP 6)" and moxibustion at "Guanyuan (CV 4)"; the TCM group were treated with stomach perfusion of modified Mojie Tablet in normal saline; the acupuncture and medicine group were treated with the above two methods; both the control group and the model group were bound and treated with stomach perfusion of saline. After treatment of 35 days, the greatest diameter of the ectopic tissue was measured in the rats, pathological observation of the ectopic tissue was made and matrix metalloproteinase-2 (MMP-2) expression in the ectopic tissue was determined. RESULTS: The greatest diameter of ectopic tissue and MMP-2 expression in the ectopic tissue in the acupuncture and medicine group were significantly lower than those in the model group, the acup-moxibustion group and the TCM group (P < 0.05); and the ectopic endometrium trended to atrophy, and with necrosis of some epithelial cells. CONCLUSION: Combination of acupuncture with medicine has a better therapeutic effect on endometriosis and down-regulates the abnormal increase of MMP-2 level to inhibit the invasion of ectopic tissue to extracellular matrix, so as to reduce the ectopic tissue, hence cure of endometriosis.

Clinicopathologic significance of mitotic arrest defective protein 2 overexpression in hepatocellular carcinoma.

Mitotic arrest defective protein 2 (MAD2) gene plays a central role in the mitotic checkpoint. Elevated MAD2 expression was observed in a number of human malignancies; its role in the development of hepatocellular carcinoma is still not understood and is controversial. The purpose of this study was to investigate the clinicopathologic significance of MAD2 expression in hepatocellular carcinoma. The MAD2 protein and its messenger RNA levels were measured in hepatocellular carcinomas, high-grade dysplastic nodules, and their paired nontumorous liver tissues by quantitative real-time polymerase chain reaction, Western blot, and immunohistochemistry. The results showed that MAD2 at both messenger RNA and protein levels was overexpressed in 8 of 9 high-grade dysplastic nodules and in 51 of 58 hepatocellular carcinomas, including 12 of 14 unifocal small hepatocellular carcinomas. There was a tendency for MAD2 expression to increase in the process of this multistep carcinogenesis. A significantly high tumor MAD2 immunostaining was associated with the progression of histologic grade and the overall low survival. In conclusion, MAD2 is overexpressed frequently in hepatocellular carcinoma, including high-grade dysplastic nodules and early-stage small hepatocellular carcinoma, indicating that overexpression of MAD2 plays a role in the development and progression of hepatocellular carcinoma. It may be an early event in hepatocarcinogenesis and could be used as a potential prognostic indicator.

[Micro-Raman spectra for gastritis and gastric ulcer tissues].

Micro-Raman spectroscopy was employed to identify gastritis tissues and gastric ulcer tissues. The primary spectral differences between the two types of samples include, for gastric ulcer tissues, (1) the intensity of the peak at 781 cm(-1) ascribed to cytosine decreases, while the peaks ascribed to adenine and thymine respectively at 793 and 823 cm(-1) become stronger; (2) the bands of amide I and amide III at 1654 and 1320-1270 cm(-1) respectively, characteristic of alpha-helix structural protein, lose their intensities, and the tryptophan band at 1332 cm(-1) and phenylalanine band at 1003 cm(-1) reduced significantly, while the tryptophan marker at 1554 cm(-1) up shiftes to 1556 cm(-1) with increasing intensity; (3) a blue shift of 1073 cm(-1) line, the characteristic Raman band of lipid, and a reduction in the ratio of 1303 cm(-1) assigned to in-phase CH2 twisting motion to 1268 cm(-1) from =CH in-plane deformation were observed; (4) statistic analysis shows that the ratio of Raman intensities at bands 1449 cm(-1) originating from CH2 group to 1660 cm(-1) from amide I provides a promising standard to distinguish the two tissues.

Pneumatic pump reduces leg wound complications in cardiac patients.

Leg wound complications at the site of vein harvest for coronary artery bypass graft, although infrequent, cause significant morbidity. Pneumatic pressure therapy is valuable in venous and lymphatic diseases, but its usefulness after leg vein harvest has not been determined. A prospective randomized controlled trial was conducted on 200 patients, half of whom had sequential pneumatic leg pump therapy postoperatively. Wound healing, extent of lower limb edema, patient satisfaction, and the financial implications of pneumatic pressure therapy were assessed. In the study group, 71 patients had satisfactory wound healing vs. 23 in the control group. The leg wound infection rate in the study group was 3% vs. 15% in the control group ( p = 0.003). Lower limb edema was significantly reduced in the study group in the early postoperative period ( p < 0.05), and the mean postoperative length of hospital stay was reduced by 2.6 days in patients given pneumatic pressure therapy ( p = 0.003). The sequential pneumatic leg pump is an effective, inexpensive, and convenient device that reduces leg wound complications after coronary artery bypass grafting.

Biatrial pacing to prevent atrial fibrillation after coronary artery bypass.

Between October 1999 and December 2000, 52 patients (37 male) undergoing coronary artery bypass surgery were selected for overdrive biatrial pacing to determine its effectiveness in reducing atrial fibrillation. A pacing wire was attached to the right atrial appendage and another to the roof of the left atrium behind the aorta. The atria were paced continuously in AAI mode at a rate of 90 pulses per minute or 10 pulses above the underlying rate (maximum rate < 140/min) for 3 days. The endpoint was the onset of atrial fibrillation during hospital stay. Results were compared with those of a control group of 52 matched patients. There were no significant differences in the occurrence of atrial fibrillation (30% in the paced group vs. 25% in the control group), morbidity, or length of hospital stay. Continuous biatrial pacing after coronary bypass surgery was safe and well tolerated, however, it did not prevent or lower the incidence of atrial fibrillation.