62岁男性患者，发现右心室肿物1天。既往有骨肉瘤病史。超声心动图示右心室心腔内及右心室壁占位性病变。2019年2月在全麻低温体外循环下行右心室肿物切除术＋三尖瓣生物瓣膜置换术＋心外膜临时起搏导线缝置术。术后病理检查示间叶源性恶性肿瘤，考虑心脏转移性骨肉瘤。术后随访1年，患者心功能良好，心腔内未见肿瘤复发，右心室壁占位无明显变化。

Aim The aim of this study was to investigate the effect of the modified extracorporeal circulation perfusion method during surgery for acute Stanford type A aortic dissection in patients who underwent stented elephant trunk implantation and arch replacement. Method A total of 69 patients with acute Stanford type A aortic dissection who underwent stented elephant trunk implantation and arch replacement were retrospectively analysed from 2017 to 2018. According to the perfusion method of extracorporeal circulation, patients were divided into a routine perfusion (RP) group and a modified perfusion (MP) group. Clinical data were collected, including the time of extracorporeal circulation and deep hypothermic circulatory arrest, incidence of acute kidney injury and neurological complications, and comparisons between the two groups were conducted by using independent sample t-tests for normally distributed qualitative data, the Mann-Whitney U-test for skewed qualitative data, and the chi square test or Fisher's exact test for categorical data. Results There were 55 (80%) males and 14 (20%) females in the entire cohort, and the mean +/- standard deviation age was 50.4+/-9.0 years. Atotal of 53 (77%) patients were included in the RP group, and 16 (23%) were included in the MP group. Patients in the MP group were older (55.5+/-7.8 vs 48.8+/-8.9 years), and the difference was significant (p=0.008). Compared with the RP group, the time of extracorporeal circulation (218.0 [44.7] vs 246.0 [58.0] min; p=0.005) and deep hypothermic circulatory arrest (4.0 [2.0] vs 25.0 [10.0] min; p<0.001) was shorter, and the incidence of postoperative acute kidney injury (n=6 [37.5%] vs n=36 [67.9%]; p=0.029) was lower in the MP group; the differences were significant. Six (6) patients died in the RP group; no patients died in the MP group. The total in-hospital mortality rate was 8.7%. Conclusions The modified extracorporeal circulation perfusion method is feasible, with satisfactory results.

Internal serpentine ribbed coolant channel with low aspect ratio (AR) has been widely employed to provide excellent thermal protection for advanced first-stage turbine blades. Various height differences ( ΔH s) of adjacent passages along pressure side can be generated under the restriction of actual blade profile. The present work made an attempt to acquire detailed influences of ΔH on the time-averaged and transient secondary motions near sharp bends of low-AR coolant channels. An actual blade ribbed three-pass coolant channel with two ΔH s was chosen as experimental model. Planar time-resolved particle image velocimetry technique was applied to capture the transient flow fields in 21 typical cross sections. Time-averaged results were validated by standard PIV measurements and flow visualizations. Snapshot proper orthogonal decomposition was employed to extract the dominant flow structures and identify the underlying small-scale flow patterns in time-resolved velocity fields. The experimental results indicated the low-AR channel with real blade profile induces a new type of the secondary-vortex superposition downstream of bends, in comparison with the large-AR channels in open literature. The crucial reason is the ΔH along pressure side leads to an intensive impingement on the bend wall, which weakens the effects of bend, rib and curvature of suction side. Another new discovery is the effect of ΔH on unsteady internal flow. In the small ΔH case, the oscillatory frequency of the secondary vortices is nearly similar with the counter-rotating Dean-vortices; however, in the large ΔH case, the oscillatory frequency is much lower, and the rotating direction of vortices is same and unchanged in a period. Increasing inlet Reynolds number can significantly change the underlying small-scale flow patterns and improve the oscillatory frequency of large-scale structures, although the basic time-averaged flow patterns are nearly same. Effect of injection from auxiliary-hole (AH) on unsteady internal flow is obvious and the optimum mass flow ratio of AH-to-inlet is 5%.

The present study aimed to clarify the influence of long non-coding RNA small nuclear host gene 16 (lncRNA SNHG16) on cardiomyocyte proliferation following ischemia/reperfusion injury (IRI) and the potential mechanism. An IRI model in mice was established by performing ligation of the anterior descending coronary artery (LAD). Primary cardiomyocytes were isolated from newborn mice and subjected to H2O2 treatment to mimic in vitro IRI. Relative levels of SNHG16 and miRNA-770-5p in both in vivo and in vitro IRI models were examined. The regulatory effects of SNHG16 and miRNA-770-5p on the proliferative ability of H2O2-treated cardiomyocytes were assessed by Cell Counting Kit-8 (CCK-8) and 5-ethynyl-2'-deoxyuridine (EdU) assay. The binding relationship between SNHG16 and miRNA-770-5p was verified through dual-luciferase reporter gene assay. It is found that SNHG16 was time-dependently downregulated in the IRI models. Overexpression of SNHG16 enhanced the proliferative ability of the cardiomyocytes. miRNA-770-5p was found to be a direct target of SNHG16. Moreover, SNHG16 was able to negatively regulate the miRNA-770-5p level. Overexpression of miRNA-770-5p partially reversed the role of SNHG16 on accelerating cardiomyocyte proliferation. Collectively, SNHG16 accelerates the proliferative ability of cardiomyocytes following IRI by negatively regulating miRNA-770-5p.

目的 探讨体外循环下心脏瓣膜置换术后心包及纵膈引流液量的变化规律.方法 选取青岛大学附属医院2018年1月至2019年4月收治的85例心脏瓣膜病患者为研究对象,首先给予患者入院常规用药,安排行体外循环下心脏瓣膜置换术治疗.术后给予常规用药,并密切监测引流液变化以及引流液中红细胞计数(RBC)、血红蛋白(Hb)、血细胞压积(HCT)变化.结果 85例患者中,术后心包、纵膈引流液量显著的持续下降,差异有统计学意义(P<0.05);术后1～2?h引流液量的下降最为显著,术后6?h后,引流液量的下降逐渐趋于平缓.术后6～8?h引流血RBC、Hb、HCT水平显著低于术后3?h引流血(P<0.05),术后6～8?h循环血RBC、Hb、HCT水平均高于同期引流血(P<0.05).结论 体外循环下心脏瓣膜置换术后1～2?h的心包及纵膈引流液量最高,是术后出血的高发时期,随后引流液量逐渐减少,术后6?h后出血风险随之减小,表明术后应当加强1～2?h出血风险的监测,做好预防性诊断,避免引起严重后果.

For modern investment-casting turbine blades, auxiliary holes (AHs) are unavoidable to be generated near internal coolant channels; however, the additional effect of AH is usually ignored. In this work, the AH-injection influence on the flow characteristics in a round bend was studied, using a planar Time-resolved Particle Image Velocimetry (TRPIV) system. The main feature of this experiment was the application of a ribbed channel with the real blade geometry as the specimen. At first, in the real bend, different flow phenomena from those in the simplified models reported in the past literature can be observed, i.e. asymmetrical mainstream near two sides of blade and a superposition of secondary vortices downstream of bend. Subsequently, the AH influences on the special flow mentioned above were discussed at an inlet Reynolds number (Re-in) of 21,500 and five AH-to-inlet mass flow ratios (MFRS = 0-10%). The conditions at MFR larger than 5% can obviously change the original flow at MFR = 0 and due to the real blade geometry, the various influences can be observed in different planes. In general, the sizes of separation bubble and corner vortex can be suppressed by the AH-injection; however, the AH-injection effects on the flow impingement are complex, i.e. enhancement on suction side but reduction on pressure side. Finally, through the increase of Re-in from 21,500 to 39,000, it can be found that at a given MFR, the flow impingement and turbulent kinetic energy can be simultaneously enhanced by Re-in.

This paper presents an experimental investigation on the flow characteristics within an entire coolant channel of a 2nd stage high pressure (HP) static turbine blade using TRPIV (Time-Resolution Particle Image Velocimetry) technique. The serpentine channel with three passages connected by a sharp bend, a round bend, 2 tip exits, 8 tailing exits and 40 film-holes staggered arranged on pressure side (PS) of the third pass is chosen as specimen, whose cross sections are manufactured to keep the real blade-shape. Ribs with a fixed spacing-to-height of 7 and an angle of 60° to the flow direction are applied on two opposite walls. The experiment is carried out at a fixed inlet Reynolds number of Rein = 23508. The variation process of secondary vortices and the main flow patterns in typical planes of the realistic coolant channel are successfully captured by TRPIV technique. The effects of rib, bend, cross-sectional shape, layout of passages, ejection ratio on the flow characteristics are analyzed and discussed. The following five new phenomena can be obtained. Namely, 1) near the two bend-regions, the rib can reduce the size of separation bubble and generate a new flow-acceleration downstream of the rib. 2) The rib-vortices combined with the mixing vortex caused by the bend and layout of channels, which leads to a new pair of vortices downstream of the bend, and further downstream, in the pair of vortices, the larger vortex presses the smaller vortex to form a new large vortex. This phenomenon has not been captured up to now in simplified ribbed two-pass channels and smooth realistic channels. 3)The development process of the secondary vortices and asymmetric behavior of main flow structure are similar in the regions of the sharp and round bends. 4)The coolant ejection from the tip exit in the sharp bend can decrease the mixing speed of the secondary vortices downstream of the bend. 5)The tip ejection from the trailing edge exits and film holes can reduce of the size of the secondary vortices downstream of the bend.

Objective To investigate the results of the surgical treatment in the patients with Stanford type A aortic dissection.Methods Aretrospective study was performed on 88 cases of patients who were admitted and underwent surgery of the Stanford type A aortic dissection from January 2011 to March 2016.The preoperative data,in vitro circulation data,perioperative blood transfusion volume,mechanical ventilation time,ICU hospitalization time,total hospitalization time and postoperative complications were analyzed.Results In the total 88 cases,16 cases were operated by the means of the none-total arch replacement without the deep hypothermic circulatory arrest (7 cases with the ascending aorta replacement and Bentall surgery in 9 cases),and the rest of the 72 cases were operated by the total arch replacement (ascending aorta replacement + Sun's surgery in 40 cases,Bentall + Sun's surgery in 31 cases,David + Sun's surgery in 1 case).Compared with the patients of non-total arch replacement group,patients of total arch replacement group were with low intraoperative nasopharyngeal temperature and anal temperature,long time of extracorporeal circulation and the ascending aorta blocking,large amount of intraoperative red blood cells,plasma and platelet transfusion,long time of the breathing machine ventilation and ICU length of hospital stay,large amount of postoperative red blood cells,plasma and platelet transfusion,high incidence rate of postoperative neurological complications,and the differences were statistically significant(P ＜ 0.05).The autologous blood transfusion volume,the total length of hospital stay,postoperative acute kidney injury,hypoxemia,the application of continuous renal replacement therapy and secondary tracheal intubation and tracheostomy and mortality rate in the total arch replacement group were higher than those in the non-total arch replacement group,there was no statistically significant difference between the two groups(P ＞ 0.05).During the follow-up,2 patients(12.5％) were re-operated by the means of total arch replacement and descending aorta stent implantation because of the aortic dissection in the aortic arch in the none-total arch replacement group,there was no secondary surgery in the total arch replacement group,and the difference was statistically significant (P ＜ 0.05).Conclusion The surgical treatment effect of the Stanford A type aortic dissection is satisfactory although the disease is complicated,the condition is severe,the operation risk is large and the in-hospital mortality is high.Intraoperative brain protection is of particular importance,and selection of surgical methods should be considered.

体外膜肺氧合( extracorporeal membrane oxygenation,EC-MO)是指通过胸腔外血管插管进行的长时间体外心肺支持。ECMO可以对呼吸功能衰竭或心功能衰竭的危重患者进行有效的呼吸或循环支持。1972年,Hill等[1]首先报道了此技术的临床应用。 ECMO技术不仅应用于心胸外科的心肺支持、心肺移植过渡、呼吸窘迫综合征的救治,还用于新生儿胎粪吸入,气管内异物吸入、婴幼儿的室上性心动过速、重症心脏介入手术、先天性膈疝、严重心肺外伤、烧伤科患者的吸入性肺损伤、不同原因的严重肺炎及多器官功能衰竭等多种病症,并逐渐成为一个跨学科的新技术。在我国,ECMO仍处在起步阶段,对有关装置的认识及使用、临床适应证的选择、各种参数的控制及撤离ECMO的指征等,均是目前体外循环及心外科值得探讨的问题[2]。现结合青岛大学医学院附属医院心血管外科收治的l例缺血性心肌病患者,行冠脉搭桥加室壁瘤切除术后顽固性心力衰竭,应用ECMO 技术心肺辅助成功救治,对有关应用ECMO的情况进行回顾性分析。现报道如下。

Objective To compare the mid-long-term efficacy in the treatment of permanent atrial fibrillation (AF) in rheumatic heart disease using monopolar vs.biopolar radiofrequency ablation during the cardiac valve replacement surgery.Methods 151 patients with rheumatic heart disease and permanent atrial fibrillation underwent modified maze procedure using monopolar or biopolar radiofrequency ablation concomitant the cardiac valve replacement in the affiliated hospital of Qingdao university form January 2007 to December 2010.Seventy-nine of them were given the monopolar radiofrequency ablation (monopolar group),and remaining 72 the biopolar radiofrequency ablation (biopolar group).We collected the perioperative data of the patients,and collected the 12-lead electrocardiogram (ECG) or the dynamic electrocardiogram (24 h Holter),the echocardiography data immediately after the operation,at the time of discharge from hospital,3rd month,6th month,and 1 st year postoperatively,and every year after the operation.We also collected the related complications,the recovery of their cardiac function and life quality and some other useful information.We compared the related indexes including the eliminating rate of the atrial fibrillation (including sinus rhythm and nodal rhythm),operation time,postoperative drainage volume,hospital stay after operation,severe postoperative complications,and the mortality in the two groups.Results The radiofrequency ablation time in the biopolar group was longer than in the monopolar group [(31.5 ±3.9) min vs.(17.1 ±2.5) min,P ＜0.01].There was no significant difference in the ascending aorta clamping time [(61.4 ± 20.1) min vs.(57.0 ± 21.6) min,P ＞ 0.05] and the cardiopulmonary bypass time [(104.1 ±27.1) min vs.(93.9 ±37.9) min,P ＞0.05] between the two groups.In terms of the severe perioperative complications such as the renal insufficiency undergoing hemodialysis (2/77 vs.1/71,P ＞ 0.05),the refractory ventricular arrhythmias (1/78 vs.0/72,P ＞ 0.05),the exploratory thoracotomy for bleeding (5/74 vs.4/68,P ＞ 0.05),and the mortality (1/71 vs.1/78,P ＞ 0.05),the difference between the two groups had no statistical significance,suggesting the safety of the two groups was similar.The postoperative hospital stay [(13.6 ± 4.7) days vs.(15.7 ± 10.9) days,P ＞ 0.05] showed no statistically significant difference.The elimination rate of the atrial fibrillation in the bipolar group was significantly higher than in the monopolar group (27/45 vs.36/43,x2 =4.342,P ＜ 0.05).Conclusion The mid-long-term efficacy in the treatment of the permanent atrial fibrillation in rheumatic heart disease using the biopolar radiofrequency ablation during the cardiac valve replacement surgery is better than the using of the monopolar radiofrequency ablation.

BACKGROUND AND OBJECTIVEHuman major histocompatibility complex class I-related gene A (MICA) is reportedly associated with poor transplant outcomes and a high risk of acute and chronic rejection in solid organ transplantation. However, studies on these risks have found conflicting results. In the present study, we investigate the MICA expression and serum MICA (sMICA) as well as the MICA antibodies (anti-MICA) in serum of recipients during acute rejection (AR) in a rat-to-mouse cardiac transplantation model.METHODSConstruct rat-to-mouse concordant cardiac transplantation models, histological examination of the heart in recipients during AR at 2-6 hours time point was done. We then studied the MICA gene expression of the heart in recipients during AR at 2-6 hours time point by western blot and RT-PCR assay. We latter studied the anti-MICA and sMICA levels in serum of recipients during AR at 2-6 hours time point by Flow cytometry and ELISA measurement.RESULTSWe found that Lewis rat hearts transplanted into BALB/c mice developed typical AR in 6 days. The level of severity of xenograft rejection from 2 d to 6 d was increased in a time-dependant way. MICA protein and MICA mRNA was also increased in time-dependant way and reached the highest value at 6 h. The prevalence of anti-MICA was significantly higher among those with severe acute rejection. However, sMICA was significantly increased during AR at 2 hours, then gradually decreased, and reached the lowest value at 6 h.CONCLUSIONSMICA expression in recipients' heart and anti-MICA antibodies in recipients' sera may associated with high risk of AR in rat-to-mouse transplantation. sMICA showed a negative association with acute rejection and may be a good predictor of heart transplant outcomes.

Objective To discuss the effect of aortic aneurysmal sac-right atrial shunt in the operation of aorta. Methods The records of 45 aortic operations done in our hospital,from 07-2005 to 08-2009,were analyzed retrospectively,of which,the aortic aneurysmal sac-right atrial shunt procedure was applied in 18 cases.The operation time,blockage time of the aorta,postoperative drainage volume,postoperative blood transfusion and re-thoracotomy rate were summarized. Results Compared with those underwent surgery not using the shunt technique,the shunt technique showed the advantages of shorter operation time,less drainage volume,and less postoperative blood transfusion,the differences between the two groups being significant,except the time of aorta blocking and re-thoracotomy(t=1.96-3.74,P<0.05). Conclusion The aortic aneurysmal sac-right atrial shunt can effectively reduce blood loss after surgery,shorten the operation time,and decrease blood transfusion;the incidence of re-thoracotomy is low.The shunt procedure is simple to perform and worth clinical generalization.

AIM To isolate and culture human aortic valve interstitial cells and to identify their morphology,subtype and membrane molecules distribution.METHODS The endothelial cell layers on the dissected valves were removed and the remaining interstitial layers were minced and digested with collagenase I.Cells were then seeded and maintained on culture dishes.Cells were observed under light microscopy and cellular α-smooth muscle actin was detected with confocal staining microscopy.The expressed interferon(IFN)-γ and tumor necrosis factior(TNF)-α receptors were analyzed by flow cytometry with their corresponding monoclonal antibodies.RESULTS The isolated valves interstitial cells were proved to be myofibroblast.More IFN-γ receptors and TNF-α receptors were expressed on rheumatic aortic valves interstitial cells than on non-rheumatic cells and their expression was patients' sera dependent.CONCLUSION The valves interstitial cells culture system has been established successfully and the membrane molecules differ according to their origins.

AIM:To identify the distribution of tenascin-C(TN-C)in sera and heart valves of patients with rheumatic heart diseases and its significance.METHODS:The sera of normal subjects,patients with congenital valves malformation and patients with rheumatic heart diseases were collected and the TN-C concentrations were measured with ELISA.The heart valves were obtained surgically from patients with congenital malformation or rheumatic heart diseases.The valves were embedded in paraffin and then TN-C distribution pattern was identified by immunohistochemistry.RESULTS:Compared with normal subjects or patients with congenital valves malformation,the sera concentration of larger variants TN-C was significantly higher than that in patients with rheumatic heart diseases.TN-C was mainly distributed on the basement membrane beneath the endothelial cells in the malformed valves,and universally distributed in the rheumatic valves.CONCLUSION:To some extents,TN-C could be taken as biomarker of rheumatic heart diseases and TN-C may be involved in pathogenesis of rheumatic heart valves diseases.

病人男,22岁.左前胸刀刺伤22 d.活动后心悸、气促7 d.查体:贫血貌,平卧位颈静脉充盈.左胸第5肋间胸骨旁3 cm处可见一长约1 cm的刀伤瘢痕,心率94次/min,律齐,血压117/64 mm Hg(1 mm Hg=0.133 kPa),胸骨左缘3、4肋间闻及3/VI级喷射样收缩期杂音,心尖部闻及3/VI级吹风样收缩期杂音,P2亢进,肝肋下1.0 cm.心电图示完全性右束支传导阻滞,II、III、avF、V4～V6T波倒置.X线胸片示心影增大,心胸比率0.55,双肺纹理增强;彩色超声示肌部室间隔回声中断0.4 cm,其上缘距三尖瓣隔叶瓣环1.2 cm,二尖瓣前叶距瓣根约0.5 cm处见0.4 cm的穿孔,收缩期见大量血液过孔反流,肺动脉收缩压43 mm Hg。