Objective The modified Blalock-Taussig shunt (MBTS) is considered a low-risk management option for palliation in patients with severely cyanotic heart anomalies in advanced heart centers in western countries.But the morbidity and mortality associated with MBTS remains challenge in developing countries.Methods 106 patients with severely cyanotic complex heart anomalies underwent 110 modified Blalock-Taussig shunts(B-T shunts) between October 2000 and August 2012.The mean age was (3.8 ± 1.1) months (1 day-37.2 months).The mean weight of the babies was (5.0 ± 2.1) kg (2.3 kg-12.0 k g).The cardiac anatomy was as follows:pulmonary atresia with intact ventricular septum in 25,pulmonary atresia with ventricular septum defects in 45,tricuspid atresia in 11,tetralogy of Fallot in 7,complex single ventricle physiology in 18.All patients were deeply cyanotic,and preoperative prostaglandin E1 was needed in 78 patients to ensure ductus patent and maintain oxygen saturations prior to the shunt operation.The shunts were accomplished with 3.0 mm polytetrafluoroethylene grafts in 8 patients,3.5 mm in 11,4 mm in 65,5mm in 26.Results The duration of mechanical ventilation was 4 hours-7 days,cardiac intensive care unit stay was 1-12 days,hospital stay after operation was 1-18 days.There were 3 deaths (2.6％),immediate post-operative shunt block in 1,severe hypoxidosis in 1 and heart failure in 1.Oxygen saturation increased from 68.5％ preoperatively to 79.2％ postoperatively.Four patients had shunt block,additional shunt was created respectively.There was 2 late death.Follow-up of 94 patients revealed satisfactory systemic oxygen saturation of 0.81 ± 0.10 (0.63-0.92).86 cases received further operations,including 7 in TOF radical operation,31 in Rastelli,25 in Glenn,18 in Fontan.Conclusion With an encouraging early shunt patent rate and oxygen saturation increasing,we can now adopt MBTS as an alternative in patients with severely cyanotic heart anomalies.Modified B-T shunt is a good palliation for patients with cyanoti cheart anomalies,which can increase pulmonary blood flow.Excellent surgical skills and perioperative treatment contribute to good operation results,and to low morbidity and low mortality.

Objective To evaluate the methods of standard patient (SP)combined with case-based learning (CBL ) in humanistic quality cultivation for interns in the department of thoracic surgery. Methods Medical interns in the department of thoracic surgery were divided randomly into experimental(n=30)and control group(n=30)respectively. In experimental group,SP combined with CBL was used while in control group traditional teaching was used. At the end of the study,teaching effect was assessed by the final examination and questionnaires and the data were processed by t test andX2 test. P<0.05 signifies statistical differences. Results There was no significant difference in test scores between the two groups (P>0.05). Scores of history-taking,medical check-up,paper writing quality in the final examination in experimental group were significantly higher than those in control group(P<0.01). Satisfaction degrees of doctor-patient communication,responsibility and service attitude in experimental group were better than those of control group(X2=16.484,10.335,20.376,32.851,P<0.01). Conclusions SP combined with CBL teaching method can stimulate the students' interests in thoracic surgery practice,improve the doctor-patient relationship and strengthen the ability of human-istic concern. It is a better clinical thoracic practice teaching method and it is beneficial to cultivating medical students with humanistic concern.

Objective To study the promotive effect of chitosan liquid on wound healing.Methods Wound model was established on the back of 60 rats,which were classified into 3 groups to be treated with topical chitosan liquid (group A),basic fibroblast growth factor (group B),and sodium chloride physiological solution (group C),respectively.The time required for the healing of wound was recorded.Regenerated tissues were resected from the rats on day 3,7 and 14 after the establishment of wound model,and observed with light microscopy.Results The time required for the healing of wound was 17.3 ± 1.35 days in group A,18.2 ± 1.15 days in group B,and 24.0 ± 1.37 days in group C.For the time required for the healing of wound,no significant difference was observed between the group A and B (P ＞ 0.05),but group C significantly differed from group A and B (both P ＜ 0.05).Chitosan liquid accelerated the generation of capillary sprouts and vascular endothelial cells at the early stage of wound healing,promoted the production of fibroblasts and collagen fibers at the middle stage,and improved the organization of collagen fibers at the late stage.Conclusion Chitosan liquid exerts a promising promotive effect on wound healing.

BACKGROUND:Nowadays,liver grafts for transplantation are clinically sourced from non-heart-beating donors.Moreover,there is still no uniform determination of safe time limit points for non-heart-beating donor liver in warm ischemia and cold preservation.OBJECTIVE:To evaluate the application safety and curative effects of warm ischemia liver graft affected by varied cold ischemia time (CIT) in liver transplantation.DESIGN,TIME AND SETTING:A randomized controlled observation was performed in the Organ Transplantation Center,First Affiliated Hospital of Sun Yat-sen University between January 2006 and December 2007.PARTICIPANTS:154 cases who underwent non-heart-beating liver transplantation were included in this study.All liver graftsinvolved had a warm ischemia time(WIT) less than 10 minutes.METHODS:All cases were assigned into 3 groups according to CIT:group Ⅰ (CIT＜8 hours,n=58),group Ⅱ (CIT 8-12hours,n=62),and group Ⅲ (CIT 13-16 hours,n=34).The liver grafts were randomly allocated for the patients.Following liver transplantation,the same immunosuppression protocol was employed for each group.MAIN OUTCOME MEASURES:Following surgery,peak level of alanine aminotransferase (ALT),primary graft dysfunction (PGD) after liver transplantation,acute rejection response,biliary complications,vessel complications,perioperative infections,graft and recipient survival rate were compared among 3 groups.RESULTS:Follow-up time was 8-32 months.No PGD was detected in all 154 cases.Group Ⅱ showed postoperative ALT peak levels significantly higher than group Ⅰ (P＜ 0.05).There was no significant difference between groups Ⅰ and Ⅱin terms of acute cellular rejection,perioperative infection,biliary complication,vessel complication,graft survival rate,and recipient survival rate (P＞0.05).Compared with group Ⅰ,the group Ⅲ exhibited significantly increased postoperative ALT peak level,biliary complications,and perioperative infections,and significantly decreased graft and recipient survival rate (P＜0.05).CONCLUSION:Non-heat-beating-liver grafts with less than 10 minutes of warm ischemia can tolerance 12 hours of cold ischemia.More than 12 hours,postoperative liver transplantation complications ascend and,contradictorily,graft and recipient survival rate descend.

To explore the effect of PluronicF-127 and Vascular endthelial growth factor(VEGF) delivery system on the survival of the grafted fat, we divided fat harvest under the same condition into 4 groups. One group served as blank control; the other 3 groups served for experiments with respective to DMEM containing 20 ng/ml VEGF; DMEM containing 30% Pluronic F-127; DMEM containing 20 ng/ml VEGF and 30% Pluronic F-127, and then we transplanted the 4 groups of fat, subcutaneously, on the back of 3 groups of BALB/c nude mice (8 mice per group; injecting 4 points per mouse; 0.2 ml per point). At 3 weeks, 6 weeks and 12 weeks, we dissected the fat grafts, measured their weight retention, and put them in histopathologic examination with the use of HE and CD34 staining. And we compared the weight retention and microvessel density (MVD) of each experiment group versus those of control group. The relation between adipose cell and PluronicF-127 was observed through electron microscope. The results reveal that the MVD and weight of pluronicF-127 and VEGF of the experiment groups are significantly greater than those of other groups. The PluronicF-127 and VEGF composite delivery system can significantly improve the blood circulation for fat transplantation, and increase the survival rate of grafted fat.
Adipose Tissue ; cytology ; transplantation ; Animals ; Drug Delivery Systems ; Female ; Graft Survival ; drug effects ; Male ; Mice ; Mice, Inbred BALB C ; Mice, Nude ; Poloxamer ; administration & dosage ; Random Allocation ; Vascular Endothelial Growth Factor A ; administration & dosage

Objective:To retrospectively analyze the efficacy of arterial switch operation in infants with transposition of the great arteries and to explore the prognostic related factors.Methods:The clinical data of 381 children with transposition of the great arteries from October 2001 to December 2017 were collected, including anatomical diagnosis, age of surgery, preoperative status, coronary artery malformation, aortic arch disease, etc. The relevant factors of postoperative mortality and reintervention were analyzed.Results:The overall mortality rate is about 4.5%, and the reintervention rate is about 3.7%. The postoperative mortality of every 100 cases droped significantly ( P<0.05), early surgery did not increase the risk of surgical death, but the mortality rate in the emergency surgery group was higher than that in the non-emergency surgery group. The mortality in the combined coronary artery abnormality group was significantly higher than that in the normal coronary artery group. Patients with Taussig-Bing anomaly and abnormal aortic arch were significantly more likely to get worse outcomes than those without aortic arch abnormality. In the whole group, 14 patients were re-intervened due to pulmonary valve or supra-valvular stenosis, aortic arch constriction, left ventricular outflow obstruction, and new aortic valve regurgitation. One patient died after operation. There was no coronary reintervention in the middle and long-term follow-up. Conclusion:The clinical outcome of early diagnosis and treatment of transposition of great arteries was good, preoperative status affects the outcome of surgery, coronary artery malformation, Taussig-Bing combined with aortic arch abnormalities were associated with increased operative mortality.

Objective Modified upper abdominal cluster transplantation (MCT), which was inspired by the classical cluster transplant technique, has been proven more effective and feasible in the treatment of patients with end stage liver diseases associated with insulin-dependent diabetes mellitus (DM) than orthotopic liver transplantation (OLT) alone. In this study, we summarized our experience with MCT in 5 consecutive patients suffering from end stage liver diseases associated with insulin-dependent type 2 DM in our single center.Methods Five patients with hepatitis B-related chronic liver cirrhosis and insulin dependent type 2 DM received MCT in our single center. The biliary and exocrine pancreatic drainage reconstructions were achieved by a Roux-en-Y duodenojejunostomy or a side-to-side duodenojejunostomy. A quadruple immunosuppressive regimen based on tacrolimus including Basiliximab induction, mycophenolate mofetil (MMF) and steroids was used in the early stage post-transplant, and then converted to tacrolimus monotherapy.Results All of the patients experienced an uneventful post-operative recovery. They were rendered independent from insulin therapy shortly after transplantation. The fasting glucose and glycosylated hemoglobin levels were within normal range. In addition, the fasting C-peptide value was increased from much lower than the normal range pre-transplant to within normal range post-transplant and maintained stable since then. However, the third patient suffered from graft verse host disease (GVHD) 20 days post-operatively and died from severe infection on the post-operative 47 days. The other 4 patients had returned to work and a normal lifestyle over 22, 15, 5 and 4 months of follow-up.Conclusion MCT is an effective method in treating patients suffering from end stage liver diseases combined with insulin-dependent type 2 DM. Whether a cluster graft would increase the risk of GVHD needs further investigation.

Madelung′s disease is a rare lipid metabolic disorder with unclear mechanism, characterized by the formation of diffuse uncapsulated lipomas in face, neck, shoulder and other body areas. This disease mainly affect middle-aged male, and is related to alcohol abuse. The treatment nowadays is only palliative surgery with a high recurrence rate, including lipectomy and liposuction. Both of them have advantages and disadvantages.

Objective:To explore the efficacy and safety of laparoscopic colon cancer surgery for patients with end-stage renal disease .Methods:Thirty-one end-stage renal disease patients (continuous hemodialysis) underwent laparoscopic colon cancer surgery from Jan 2014 to May 2019 in Tianjin First Central Hospital compared to 35 colon cancer patients with normal renal function.Result:Compared with the control group, the operation time in laparoscopic group was longer[(187±20) min vs. (174±21) min, t=2.381, P=0.020], the intraoperative blood loss was more[90 (80-110) ml vs. 50(40-60) ml, Z=-6.580, P<0.001], the postoperative drainage volume was more[(417±89) ml vs.(208±67) ml, t=10.858, P<0.001], the postoperative hospitalization time was longer[(13.68±2.10) d vs.(9.09±1.65) d, t=9.918. P<0.001], and the total hospitalization costs were higher[9.2 (8.8-9.6) ten thousand yuan vs. 6.1 (5.8-6.5) ten thousand yuan, Z=-6.976, P<0.001]. There was no significant difference in overall morbidity between the two group (23% vs. 9%, P=0.170). Sixty-one patients (92%) were followed up for a median time of 6 months. One case of liver metastasis was found in each group. Conclusion:Laparoscopic colon cancer surgery can be a safe and effective procedure in patients with end-stage renal disease .

Objective:To explore the efficacy and safety of laparoscopy for acute appendicitis (AA)in kidney transplant(KT)recipients.Methods:From May 2016 to December 2022, retrospective review is conducted for 99 AA patients operated at Tianjin First Central Hospital.They are assigned into two groups of observation(kidney transplant recipients, 33 cases)and control(normal renal function patients, 66 cases). Laparoscopic perioperative data of white blood cell(WBC), neutrocyte percentage(NEUT%), C-reactive protein(CRP), procalcitonin(PCT), operative duration, intraoperative blood loss, postoperative drainage volume, postoperative hospitalization length, total hospitalization expense and morbidity of postoperative complications are compared.Results:After propensity score matching, no statistically significant inter-group difference existed in clinical profiles.WBC and NEUT% pre-operation are lower in observation group than those in control group[11.85(9.54~13.99)×10 9/L vs 13.74(12.42~14.66)×10 9/L, Z=-3.908, P<0.01; 85.00(73.65~89.60)% vs 88.20(83.85~90.20)%, Z=-2.522, P=0.012]. No significant inter-group difference existed in preoperative CRP/PCT(all P>0.05). No significant inter-group differences existed in WBC, NEUT, CRP or PCT at Day 3 post-operation(all P>0.05). No significant difference existed in creatinine level in observation group before and after operation( P>0.05). As compared with control group, operative duration was longer[86(74~99)vs 62(57~68)min, Z=-6.290, P=0.020], intraoperative blood loss greater[25(20~33)vs 15(15~20)ml, Z=-6.104, P<0.01], postoperative drainage volume larger[75(65~85)vs 35(25~36)ml, Z=-8.103, P<0.01], postoperative hospitalization time longer[7(6~9)d vs 5(4~5)d, Z=-7.064, P<0.01]and total hospitalization expense higher[(1.98±0.22)vs (1.73±0.22)ten thousand yuan, t=5.401, P<0.01]. No significant inter-group differences existed in time of postoperative passage of flatus( P=0.669). No significant inter-group difference existed in morbidity of postoperative complications( P=0.893). Conclusions:The efficacy of laparoscopic appendectomy in patients post-KT is basically comparable to that in counterparts with normal renal function.