Objective: To summarize the experience of valve replacement for multiple valve insufficiency in patients with giant left ventricle and the operative indication. Methods: Multiple valvular operations were performed in 62 patients with giant left ventricle between 1991 and 2002. Combined mitral and aortic valve replacement was performed in 56, tricuspid valve annuloplasty in 43, left atrium placation surgery in 12, and mitral valve replacement in 5. Results: The early postoperative complication and mortality rate were 45.2% and 17.7%, respectively .The late mortality rate was 6.5%. The main factors influencing the early surgical results were preoperative severe left ventricular enlargement (ESD ≥6.0cmand EDD ≥8.0cm) and systolic dysfunction (EF ≤0 40 and FS ≤0 25), perioperative ventricular fibrillation, postoperative low cardiac output and multiple organal failure. The main factors affecting long term survival were postoperative severe ventricular arrhythmia and left ventricular enlargement with depressed systolic performance. Conclusion: The keys to improve the early and late results of multiple valve replacement in these patients with giant left ventricle are the choice of optimum surgical timing, the proper management of the high risk factors mentioned above during perioperative and follow up periods.

Objective To study the expression of vesicular GABA transporter and vesicular glutamate transporter 1 in de‐pression .Methods Mice was divided into control group and defeat group stochastically .By social defeat model and social avoidance , the defeat group was divided into two groups:susceptible group and unsusceptible group .Synaptic proteins were extracted respec‐tively from the 3 groups .We detected the expression abundance of VGAT and VGLUT1 by Western blot .Results Compared with the control group ,in susceptible group ,the residence time in the contact area was significantly reduced ,and the residence time in the corner area was significantly increased ,with statistical difference(P<0 .05) .In the prefrontal cortex and hippocampus ,Com‐pared with the control group and the unsusceptible group ,the expression levels of VGLUT1 and VGAT were increased in the sus‐ceptible group(P<0 .05) .there were no statistically significant in VGLUT1 and VGAT leveles between control group and the un‐susceptible group(P>0 .05) .In the striatum ,although the expression levels of VGAT and VGLUT1 were increased in susceptible group ,but in unsusceptible group ,the expression of these proteins also increased significantly .Conclusion The prefrontal cortex and hippo‐campus excitability and inhibitory vesicle transport were changed in depression ,which may relate to the transcription disorder .

Objective To explore glycogen synthase kinase -3β( GSK-3β) activity and Toll-like receptor 4 ( TLR4 ) proteins expression of microglia were tested in vitro experiments, and the possible mechanism of postoperative cognitive dysfunction(POCD).Methods The cell morphology of primary culture microglia was observed by inverted microscope;microglia were identified by glial fibrillary acidic protein ( GFAP ) immunofluorescence;the best POCD modeling conditions of microglia injury induced by lipopolysaccharides( LPS) were screened ; microglia vigor was assayed by MTT ; the proteins expressions of GSK-3βand TLR4 of microglia were detected by Western blot.Results GFAP immunofluorescence showed a positive result that primary culture of rat microglia was successful;MTT result showed that the best PODC modeling conditions of microglia injury induced by LPS (100 ng/mL) was 7h; Western blot results showed that the preotein expressions of GSK-3βand TLR4 of microglial cells were up-regulated by LPS compared with the control group,and there were significantly differences (P<0.01).Conclusion PODC pathogenesis may be associated with LPS that could up-regulat the protein expression of GSK-3βand TLR4 in microglial cells.

Migraine is a common neurological disease.It involves complex neurological abnormalities.Recent advances in the neurophysiology of migraine have enabled us to explain some of the symptomatic problems and have contributed to the development of new targeted treatments that may change the way migraine treated in the future.Migraine treatment is individualized,in which preventive drug therapy also plays an important role.This article will discuss the new progress in the treatment of migraine,with emphasis on the new treatment of calcitonin gene-related peptide pathway.

BACKGROUNDTo evaluate the preoperative right ventricular ejection fraction (RVEF) as a predictor of postoperative complications after lung resection.

METHODSRVEF was consecutively assessed in 254 patients before pulmonary resection by echocardiography. According to preoperative right ventricular function, the patients were divided into: group Ia (n=82, RVEF≥45%), group Ib (n=92,RVEF < 45%), group Ic (n=42, RVEF < 40%),and group Id (n=38, RVEF≤35%). Postoperative RVEF was detected again in 122 patients 3 weeks later after lung resection.

RESULTSPreoperative RVEF of patients with postoperative complications was significantly higher than that of patitents without postoperative complications (P < 0.001). Among group Ia, Ib, Ic, and Id, there were significant differences in postoperative morbidities (P < 0.005). Patients with a preoperative RVEF less than 40% had a higher incidence of complications than those with RVEF over 40% (P < 0.005). Of the 122 patients, postoperative RVEF was remarkably lower than preoperative RVEF (P < 0.01).

CONCLUSIONSThe preoperative RVEF may be a predictor of postoperative complications for lung resection. RVEF higher than 40% is considered as a safe range for pneumonectomy.

Objective To investigate the interference of hyperlipidemia and hyperbilirubinaemia to HbA1c measurements by ion‐exchange high‐performance liquid chromatography(IE‐HPLC) method .Methods Fresh whole‐blood samples collected with EDTA‐K2 anticoagulant tubes were divided into four groups :control group(HbA1c<6 .2% ) ,diabetes group(HbA1c≥6 .2% ) ,hyperlipi‐demia group(TG 3 -20 mmol/L);hyperbilirubinaemis group (TBIL 21 -549 μmol/L) .HbA1c of these samples were measured with affinity chromatography(AC‐HPLC) and IE‐HPLC respectively .Results When HbA1c≤18 .7% ,r=0 .993 ;95% confidence interval(CI) of HbA1c results by using IE‐HPLC method was -0 .71 -0 .89 ;coefficient of variation was -5 .8% -6 .8% ;P=0 .198 and the difference was not statistically significant .When HbA1c< 16 .3% ,r= 0 .997;95% CI of HbA1c results with IE‐HPLC method is -0 .31-0 .67;coefficient of variation was -5 .8% -4 .3% .P=0 .000 and the difference was statistically signifi‐cant .No interference was detectded with the results ;When HbA1c was 16 .3% -18 .7% ,positive bias was observed with the re‐sults .When TG≤20 .78 mmol/L ,r=0 .995;95% CI of HbA1c results with IE‐HPLC method was -0 .26-0 .50 ;coefficient of var‐iation was -5 .5% -5 .8% .P=0 .000 and the difference was statistically significant .No interference was detectded with the re‐sults;When TBIL≤549 .3 μmol/L ,r=0 .990 ;95% CI of HbA1c results with IE‐HPLC method was -0 .08 -0 .63;coefficient of variation was -14% -4 .1% .P=0 .000 and the difference was statistically significant .When TBIL≤342 .1 μmol/L ,r= 0 .994 ;95% CI of HbA1c results with IE‐HPLC method was -0 .09-0 .50;coefficient of variation was -5 .5% -4 .1% .No interference was detectded with the results .When TBIL was 380 .7-549 .3 μmol/L ,negative bias was observed with the results .Conclusion Our data indicated that HbA1c measurement with IE‐HPLC method could resist the interference of hyperlipidemia;When TBIL≤380 .7 μmol/L and HbA1c<16 .3% ,the results could meet the needs of general clinical detection .Clinical staff should choose more specific HbA1c measurement method according to the patient's condition .

Objective:To explore the clinical significance of prealbumin(PA) and γ-glutamyltranspeptidase (γ-GT) detection in evaluation of hyperbilirubinemia in neonates at different stages.Methods:From August 2017 to August 2018, 300 full-term delivery patients with neonatal hyperbilirubinemia were selected, including 210 early-stage neonates and 90 late-stage neonates.According to the severity of bilirubinemia, the patients were classified into mild group (50 cases), moderate group (150 cases), and severe group (100 cases). The blood levels of PA and γ-GT of each group were detected.Results:The levels of PA and γ-GT in late neonates were (95.81±4.58)mg/L, (44.97±5.21)IU/L, respectively, which were significantly higher than those in early neonates [(94.77±6.32)mg/L, (53.88±6.32)IU/L]( t=1.410, 11.767, P=0.160, 0.000). With the increase of bilirubin level, the blood PA level was gradually decreased( P<0.05). The blood γ-GT level of moderate and severe patients were significantly higher than that of mild ones ( t=2.222, 2.020, P=0.027, 0.046). The blood levels of γ-GT and PA had no statistically significant differences between moderate patients and severe patients ( t=0.712, 1.741; P=0.477, 0.083). The blood PA level of moderate and severe patients were significantly lower than that of mild patients ( t=2.357, 3.277, P=0.019, 0.001). The serum PA levels had no statistically significant difference between severe patients and moderate patients ( t=0.719, P=0.474); and the serum PA levels of severe and moderate patients were lower than that of mild patients ( t=3.234, 2.117, P=0.001, 0.043). The serum γ-GT levels among the three groups had no statistically significant differences (severe vs.moderate: t=0.297, P=0.767; severe vs.mild: t=0.269, P=0.788; moderate vs.mild: t=0.013, P=0.989). Conclusion:By detecting the levels of PA and γ-GT in neonatal hyperbilirubinemia in different periods, it can provide a reference for clinical judgment of the condition of the children, thus guiding clinical rational treatment.

Objective To investigate the Influence of beta-thalassemia minor on four different HbA1c detection systems.Methods All 65 blood samples from March 2014 to August 2014 were collected from Zhongshan Hospital of Sun Yat-sen University , and divided to normal control group ( 40 cases ) , no diabetic group(20 cases) and diabetic group (5 cases) combining with beta-thalassemia minor.The fresh mixed whole-blood samples were used for transferring value-assignment in order to improve the comparability of Bio-Rad variant ⅡTurbo, Primus Ultra2 ,Roche Modular PPI to Bio-Rad Variant Ⅱwhich was NGSP Ⅰlaboratory certificated.The whole-blood concentration of HbA 1c were measured by four detection systems . Differences between normal control group and no diabetic group were compared using the Independent Samples T Test.Then Taking the Primus Ultra 2 as comparable system and others as experimental system ,the HbA1c results from no diabetic group and diabetic group were compared by the standardization NGSP Ⅰlaboratory and statistical techniques of consistency test .Results Compared with Variant Ⅱ detection system, after transferring value-assignment, deviations of Variant Ⅱ, Modular PPI and Variant Ⅱ Turbo were -6%to +6%.The HbA1c testing results from normal control group and no diabetic group had no statistical significance (P>0.05).Linear regression analysis demonstrated that the correlation coefficient of Primus Ultra2 with Variant Ⅱ, Modular PPI, VariantⅡTurbo were 0.995, 0.999 and 0.995, respectively (P<0.01).The percentage deviation of the reference system and experimental system was -6.0% to+6.0%.Conclusion There was no obviously significant influence of beta-thalassemia minor on Bio-Rad Variant Ⅱ,Bio-Rad variant ⅡTurbo,Primus Ultra2,Roche Modular PPI detection systems.