Objective To observe the effect of local mild hypothermia and Naloxone in the treatment of acute intracerebral hemorrhage. Methods Forty-five patients with acute intracerebral hemorrhage were randomly divided into 4 groups:a control group(12 patients),a hypothermia group(11 patients),a Naloxone group(11 patients)and a hypothemrmia plus Naloxone group(11 patients).The patients in the control group were managed with conventional interventions including the administration of 6-aminocaproic acid within 24 hours and dehydrant when intracranial pressure was high.Those in the hypothermia and Naloxone groups were treated with local hypothermia at 33～34 ℃ for 3 days or intravenous transfusion of Naloxone at 4 mg/d in addition to the conventional intervention.Those in the combination group were treated with local hypothermia and intravenous Naloxone in addition to the conventional intervention.Immediately after admission and 2 weeks after treatment,head CT scans were conducted to observe the volume of cerebral hematoma and edema.The patients' neurological function was scored according to the European Stroke Standards(ESS)before and after treatment. Results There was no significant difference among the 4 groups in terms of the volume of hematoma and edema or in their ESS scores before treatment.After treatment,any differences among the 4 groups with regard to hematoma volume were not significant.The volume of edema in the hypothermia group was similar to that in the combination group and significantly lower than that in the Naloxone andcontrol groups.Hematoma volume in the Naloxone group was significantly lower than that in the control group.After treatment,the ESS scores were significantly higher in the combination group than that in hypothermia group,and scores in the hypothermia group were significantly higher than in the Naloxone group.ESS scores in the Naloxone group were significantly higher that in the control group. Conclusion Local mild hypothermia and Naloxone treatment can inhibit cerebral edema and enhance recovery of neurological function in patients with intracerebral hemorrhage.Local mild hypothermia has advantages over Naloxone in inhibiting the development of cerebral edema and in promoting recovery of neurological function.Local mild hypothermia in combination with Naloxone further inhibits edema,and it can enhance neurological function to a greater extent.

Objective To observe characteristics of the activity in resting brain of asymptomatic reflux esophagitis (RE) patients,and explore the role of default network in the pathogenesis of asymptomatic RE.Methods Functional magnetic resonance imaging (fMRI) was performed to scan the brains of 15 asymptomatic RE patients,15 symptomatic RE patients and 15 healthy volunteers under no-mission-stimulation state.With fractional amplitude of low frequency fluctuation (fALFF),characteristics of the strengthened and weakened regions of asymptomatic RE patients,symptomatic RE patients and healthy individuals were compared and analyzed.SPM 5 was applied for data preprocessing.Single-sample t test was performed to observe the noticeable active regions of each group under resting state,and then double-sample t test was used to compare the characteristics of active regions of the entire brain between asymptomatic RE patients and symptomatic RE patients or healthy individuals.Results Under resting state,the active brain regions of asymptomatic RE patients,symptomatic RE patients and healthy individuals were similar.The activity of only small part of brain regions in visceral sensory processing relevant networks changed.There was no significant difference in the active regions of default network under resting state between asymptomatic RE patients and healthy individuals.Compared with symptomatic RE patients,fALEF decreased at right central sulcus cover,right superior temporal gyrus,right insula,right transverse temporal gyrus,right postcentral gyrus,superior temporal gyrus and temporal pole (X=50,Y=-6,Z=12,t=2.7874,P＜0.01).Conclusion The difference in characteristics of activity in default network under resting state may play an important role in the pathogenesis of asymptomatic RE.

Objective To investigate the signaling mechanisms underlying up-regulation of nontypeable Haemophilus influenzae(NTHi)-induced MUC5AC mucin expression. Methods The expression of MUC 5AC at mRNA level was measured by reverse transcriptase-polymerase chain reaction (RT-PCR)and real-time fluorescent quantitative PCR.Immunoprecipitation and Western blot were performed tO examine the phosphorylation of p38 mitogen-activated protein kinase(p38MAPK)and epidermal growth factor receptor(EGFR)or the effect of dominant negative mutant of EGFR on the phosphorylation of p38MAPK in HM3 cells treated with NTHi.Luciferase assay was also performed to examine the effect of p38MAPK and EGFR inhibitors or dominant negative mutant of EGFR on NTHi-induced MUC5AC expression at transcription level.Results NTHi induced MUC5AC mucin expression at both mRNA and transcription levels.Phosphorylation of p38MAPK and EGFR were observed in HM3 cells treated with NTHi.Either SB203580,a specific inhibitor for p38MAPK or AGl478,a specific inhibitor for EGFR.inhibited NTHi-induced MUC5AC up-regulation at transcription level. Furthermore,Overexpressing dominant negative mutant of EGFR also inhibited NTHi-induced MUC5AC upregulation at transcription 1evel in a dos-dependent manner.EGFR inhibitor reduced NTHi-induced p38MAPK phosphorylation in HM3 cells.Conclusion Bacterium NTHi up-regulates MUC5AC mucin transcription via EGFR-p38MAPK signaling pathway.

Objective To report the clinical features and inwardly rectifying potassium channel 18 (KCNJ18) gene mutation in a group of patients with thyrotoxic periodic paralysis (TTP).Methods Fiftyseven TTP cases (55 male and 2 female) were collected in our clinic from July 2002 to October 2011.The KCNJ18 gene was directly sequenced in 57 TTP patients and 50 health Chinese controls through the nested PCR.According to the results of gene screening,the clinical features of KCNJ18 patients and non-KCNJ18 patients were retrospectively summarized and analyzed.Results In 4 male patients with TPP,we found 3 novel heterogeneous mutations (p.Q126X,p.K360T,p.E388K) and 1 reported mutation (p.A200P) in the KCNJ18 gene.The age of onset was 19-25 years old,and the duration ranged from 2 to 8 hours.The 4 patients all presented severe muscle weakness.The attacks of muscle weakness preceded overt symptoms of hyperthyroidism in the 4 patients. Three patients showed recurrent weakness during the 13-28 months follow-up,while the episodic weakness never appeared when patients got euthyroid. Conclusions The mutations in the KCNJ18 gene are responsible for a part of Chinese patients with TPP.The patients with KCNJ18 mutations have a shorter disease course,severer manifestation,and higher prevalence of recurrence as compared with those TPP patients without KCNJ18 mutations.

Objective To study the methodology and effect of auricle reconstruction with prefabricated expanded fascial flap in temporal and parietal area and skin flap in mastoid area, covered on the Medpor support. Methods Thirty cases of congenital vestigial auricle were involved in this study. The operations were divided into two stages: in the stage I,the temporal and parietal superficial fascia flap was cut with a vascular pedicle in the parietal and temporal superficial area, which was implanted under the skin of mastoid, and then both layers of those were expanded at the same time; in the stage II, this fascial skin flap was cut down and covered on the whole Medpor support to rebuild the man-made auricle. Results Thirty cases were successful after following-up for 6 months to 3 years. Their auricle shapes were vivid; their skin color was normal, and it had no any difference from all around skins, or no any appearance of the support. Conclusions With best understanding the biological characteristics of the Medpor support and choosing the suitable procedures and using the prefabricated expanded support, we could minimize the surgical complications in this operation. The results show that this procedure is satisfactory, without any necrosis of flap, swelling of contour, or appearance of the support. The combination of two flaps is the best method for the auricle reconstruction.

Objective To investigate the efficacy and safety of percutaneous induced thrombosis closure on small patent ductus arteriosus (PDA) solely under echocardiography guidance.Methods From June 2013 to September 2016,276 PDA patients were treated by femoral artery retrograde approach under echocardiography guidance.Twenty-five patients (14 boys,11 girls) among them with small PDA received percutaneous induced thrombosis closure because the delivery sheath could not pass PDA,with mean age (3.7 ± 1.6) years,mean body weight (16.6 ±5.4) kg and the mean diameter of the most narrow PDA was (1.3 ± 0.4) mm.All patients were assessed by transthoracic echocardiography,chest radiography and electrocardiography preoperatively.The intraoperative and postoperative effects were evaluated by echocardiography.Outpatient assessment was performed at 1,3,6 and 12 months after operation with electrocardiography and echocardiography,and yearly thereafter.Results Twenty-five patients were successfully treated with percutaneous induced thrombosis closure solely under echocardiography guidance.The mean operation time was (35.2 ± 6.1) minutes.The immediate residual shunt rates and 24 hours after operation were 28.0％ (7/25 cases) and 16.0％ (4/25 cases),respectively.All patients recovered and were discharged from hospital.The average hospitalization stay was (3.0 ± 0.6) days.The mean follow-up was (16.8 ± 12.3) months,residual shunt was observed in 2 patients (8.0％),and it decreased from 1.5 mm and 2.0 mm preoperatively to 0.8 mm and 1.0 mm postoperatively,respectively.All patients survived without peripheral vascular injury,cardiac perforation,PDA rupture or thrombembolia.Conclusions Percutaneous induced thrombosis closure of small PDA solely under echocardiography guidance is safe and effective.It can avoid occluder implantation and radiation injury.However,the residual shunt after operation needs following up closely.

Objective:To retrospectively analyze the results and mid-term outcomes of 107 patients with corrected congenital transposition of great arteries(CCTGA)who underwent surgical treatment.Methods:A total of 107 CCTGA patients with surgical treatment from January 1996 to October 2005 in our hospital were studied.There were 72 male and 35 female,with the mean age of 11.5±8.4years and mean body weight of 31.6±4.7kg. Among the cohort,81 were levocardia,23 dextrocardia,and 3 medocardia.Initial surgical procedure included single ventricle repair in 14 cases,conventional biventricular repair in 75 and biventricular anatomical repair in 18 cases. 99(93%)patients were followed up with the mean time of 47.8 months.Results:The early operative mortality rate was 4.76% in different procedures.The death rate with single ventricle repair was 0%,conventional biventricular repair 4%,atrial-arterial double switch 0%,atrial-ventricular double switch 40%. The risk factors for operative mortality were lesions with double outlet left ventricle combined with pulmonary stenosis(P<0.01)and Rastelli procedure(P<0.05). 12 patients(12.6%)died during the follow up period,among them,10(83.3%)were in conventional repair group,2(16.7%)in single ventricle repair group,and no death in double switch group. The risk of death during the follow up period of time were conventional biventricular repair,Rastelli procedure and tricuspid regurgitation.Conclusion:Conventional biventricular repair had a disappointing outcome in both operation and in long-term of follow up time. Patients suitable for single ventricular repair had fair short-and mid-term outcomes. Atrial-arterial double switch procedure had good operation and long-term results.

Objective: To evaluate the changes of left and right ventricular function in patients after percutaneous pulmonary valve implantation (PPVI). Methods: A total of 8 patients with successful PPVI in our hospital from 2014-05-27 to 2015-03-25 were studied. The patients received pre-operative evaluation including clinical symptoms, plasma BNP levels, ECG, chest X-ray, echocardiography, CT and MRI examinations. Post-operative follow-up study was conducted at 6 months after PPVI to compare the ventricular functional changes. Results: The average age in 8 patients was 14-42 (25.4±8.1) years including 7 with tetralogy of Fallot correction and 1 with pulmonary stenosis plasty for 24 years. Echocardiography found that 3 patients with mid to large pulmonary regurgitation and 5 with large regurgitation. Compared with pre-operation, at 6 months after PPIV, all patients had decreased right ventricular end-diastolic diameter (RVEDD) as (44.0±4.8) mm vs (33.6±7.1) mm, right ventricular end-diastolic volume index (RVEDVI) (150.1±25.7) ml/m2 vs (111.4±39.1) ml/m2, RVESVI (107.8±21.5) ml/m2 vs (80.7±22.2) ml/m2 and right ventricular cardiac output (RV-CO) (6.8±1.3) L/min vs (4.9±0.8) L/min, but right ventricular ejection fraction (RVEF) was similar (40.5±6.2) % vs (39.5±9.9) %, P>0.05; while
increased LVEDD (42.9±4.4) mm vs (46.1±3.0) mm, P<0.05, but LVEDVI (61.8±15.0) ml/m2 vs (72.4±17.6) ml/m2, LVESVI (47.8±12.4) ml/m2 vs (41.0±10.4) ml/m2, LVEF (50.9±5.5) % vs (52.8±6.7) % and LV-CO (3.7±1.0) L/min vs (4.2±1.0) L/min were similar, allP>0.05. Conclusion: PPVI may decrease right ventricular preload, improve its reverse remodeling and maintain systolic function at normal level in relevant patients; while the impacts on left ventricular function and geometry should be further studied.

Objective: To assess the application value of CT scanning in percutaneous pulmonary valve implantation (PPVI). Methods: A total of 19 patients with severe pulmonary regurgitation planed to receive PPVI in our hospital from 2014-05 to 2016-07 were studied. CT scan and transthoracic echocardiography (TTE) were conducted to collect the data of pulmonary root anatomy and to compare the difference of pulmonary annulus size measured by CT and TTE. The accuracy of pre-operative measurement was evaluated by the follow-up study at (1-26) months after the operation. Results: In all 19 patients, the mean anatomic measurements by CT were as follows: diameter of pulmonary annulus (24.3±3.5) mm, diameter of pulmonary sinotubular junction (25.4±4.0) mm, diameter at distal of main pulmonary artery (27.5±4.8) mm, diameter of right ventricular outflow tract (36.8±7.3) mm, length of main pulmonary artery (45.5±7.0) mm, diameter of left pulmonary artery (17.9±1.5) mm and diameter of right pulmonary artery (18.5±3.6) mm. The diameter of pulmonary annulus measured by CT was larger than TTE, P<0.05. During (1-26) months follow-up period, no patients suffered from stent fracture or translocation, peri-pulmonary valve regurgitation, obvious pulmonary regurgitation or coronary stenosis; 1 patient had increased flow rate at right pulmonary artery opening by stent blocking and 2 patients had residue mild stenosis of pulmonary valve. Conclusion: Pulmonary annulus size measured by CT and TTE was different; CT may precisely assess the morphology of pulmonary root with adjacent area which is important for pre-operative evaluation in PPVI patients.

Objective This study was designed to examine the clinical characteristics of bloodstream infections (BSI) caused by Staphylococcus aureus in a teaching hospital and the risk factors for 30-day mortality.Methods A single center retrospective cohort study was conducted for all the patients with BSI caused by S.aureus between 2008 and 2015.The data of clinical features,microbiology,and 30-day mortality were collected from the database of electronic medical records.Results A total of 121 patients with S.aureus BSI were identified.The prevalence of methicillin-resistant S.aureus (MRSA) was 17.4％ (21/121).MRSA BSIs were significantly associated with old age (≥65 years) (P=0.026),hospital acquired infection (P=0.035),respiratory tract infection (P=0.001),polyinfection (P=0.005) and inappropriate initial antibiotic therapy (P=0.001) than methicillin-sensitive S.aureus (MS SA) BSIs.The 30-day mortality was 18.2％ (22/121).Both univariate and multivariate analysis suggested that solid tumor (OR,8.932,P=0.004) and septic shock (OR,56.721,P＜0.001) were independently associated with the 30-day mortality.Conclusions The present study confirms that solid tumor and septic shock are more important risk factors than MRSA in mortality of patients with S.aureus BSI.