Objective To summarize the experience of 11 orthotopic allogeneic heart transplantations for patients suffering from terminal heart disease, and to discuss how to improve the selection of donor and recipient, protection for the donated heart, postoperative treatment and immune surveillance suitable for our country. Methods 1.All the donated hearts were protected by perfusing cold modified St.Thomas cardioplegia and cold oxygenated blood. 2. Orthotopic heart transplantation was performed with the standard technique of medium low temperature extracorporeal circulation. 3. FK506, mycophenolate mofetil(MMF) and steroid were given to prevent rejection. 4. Troponin I, ? 1 and ? 2 microglobulin, C reactive protein (CRP), interleukins, lymphocyte subgroups and mixed lymphocyte reaction (MLR) were employed to monitor the immune rejection reactions. Furthermore, myocardial biopsy and coronary arteriography were conducted periodically. Results Three patients died of systemic failure and infection due to hepatic failure and mental disorder after operation. All the others survived with no complications. Conclusion Strictness in selection of the recipient, high quality of donor heart, correct early postoperative treatment and sound use of immunosurppressant are key to achieving successful cardiac transplantation.

Objective To evaluate clinical effects of combined use of hysteroscopy and laparoscopy in the diagnosis and treatment of infertility with uterine septum,and to analyze the relationship between infertility and uterine septum. Methods Surgery using hysteroscopy combined with laparoscopy was performed in 110 patients with infertility accompanying uterine septum,including primary infertility in 78 patients and secondary infertility in 32 patients.The relative infertility factors and post-operative pregnancy prognoses were analyzed. Results Unexplained infertility accounted for 40% of patients(44/110).As of March 2006,a total of 82 patients were successfully followed.The total post-operative pregnancy rate was 45.1%(37/82),consisting of 46.6% in patients with primary infertility(27/58) and 41.7% in patients with secondary infertility(10/24),without significant difference between the two groups(?~2=0.164,P=0.686).The post-operative pregnancy rates in patients with unexplained infertility and etiologically-clarified infertility were 51.2%(22/43) and 38.5%(15/39),respectively,without significant difference(?~2=1.332,P=0.248).In patients with unexplained infertility,the post-operative pregnancy rate for primary infertility was 56.7%(17/30) and for secondary infertility,38.5%(5/13). Conclusions Combined use of hysteroscopy and laparoscopy for infertility with uterine septum can improve the post-operative pregnancy rate.The presence of uterine septum bears some relationship to the incidence of infertility.

Objective To study the effect of Atorvastatin on the level of serum high-sensitivity C-reactive protein(hs-CRP) and nitric oxide(NO) in patients with acute cerebral infartion(ACI). Methods 60 patients with ACI were randomly divided into the Atorvastatin therapy group (n=30) and the conventional therapy group (n=30). At the basic of conventional therapy, the Atorvastatin therapy group was treated with Atorvastatin 20 mg/d. Both groups were treated for 14 consecutive days. The levels of serum hs-CRP and NO were measured and the scores of neurological deficit (NDS) were evaluated before and after treatment. Results The levels of serum hs-CRP in both two groups after 14 d treatment were significantly lower than those before treatment ( all P

Objective To explore the association of anti-mullerian hormone(AMH)in seminal plasma and serum with sperm counts and energy for male.Methods For 215 cases of healthy male selected from our reproductive clinic,with women′s reason for infertility,seminal plasma and serum AMH were detected,as semen parameters(sperm density,living rate,vitality and malformation rate),6 items of serum sex hormone.In seminal plasma and serum AMH respectively as the dependent variable,using multiple line-ar regression model to explore its quantitative relation with semen parameters and sex hormone levels.Results 215 cases were en-rolled,aged 34.28±5.70 years,while the median of the seminal plasma AMH was 0.47,quartile 0.05-3.09 pmol/ejaculation.The median of the serum AMH was 53.07,quartile 32.32 -72.20 pmol/L.Through multiple linear regression analysis,after adjusted by age and BMI,the seminal plasma of AMH and total number of sperm,sperm concentration,dynamic motility,total sperm activi-ty,serum inhibin B were positively correlated(P <0.05);The correlation between sperm morphology and other serum sex hormone had no statistical significance(P >0.05);Serum AMH negatively correlated with serum FSH,with serum inhibin B positively(P <0.05);Seminal plasma in various parameters and other related serum sex hormone had no statistical significance(P >0.05).Conclu-sion The seminal plasma of AMH were positively correlated with sperm concentration,sperm counts,sperm vitality,with the asso-ciation for serum AMH not yet found.

Objective To explore the short-term and long-term effects ofapplication of Percutaneous Transhepatic Cholangioscopic Lithotripsy on the treatment of hepatolithiasis. Methods Eighty-threecases of hepatolithiasis were treated with the PTCSL and the other 87cases were treated with the Laparoscopic exploration lithotomy.The general clinical parameters , curative effect in the near future and long-term curative effect were anlyzed. Results No significant differences were found between the two groups in the general clinical parameters (P>0.05). The operation time,intraoperative blood transfusion volume and intraoperatve blood soss in group A were significantly shorter than those in group B(P<0.05, respectively). The original calculi residual rate was 2.4%, the eventually calculi residual rate was 4.8%and the recurrent cholangitis was4.8%in the model of PTCSL (Group A). The original calculi residual rate was 18.4%, the eventually calculi residual rate was 23.0% and the recurrent cholangitis was 23.0%in the model of Laparoscopic exploration lithotomy (Group B), with significant difference between these two groups (P<0.05). The calculi recurrence rate of group A was 12.0%,the calculi recurrence rate of group B was 22.9%,withno significant difference between these two group (P>0.05). No patients died in each group. The results of complications showed thatthe incidence of residual calculi of group A was significantly lower than that of group B (P<0.01). Conclusions Compared with the model of Laparoscopic exploration lithotomy, the PTCSL was more safe, minimally invasive and effective. The short-term efficacy of the model of PTCSL was better than that of the model of Laparoscopic exploration lithotomy.

ObjectiveTo investigate the correlation between the chromosomal abnormalities and prognosis of the myelodysplastic syndrome(MDS)patients, and analyze the effects of treatment. Methods Karyotype analysis of 122 patients according to the international human cytogenetics(ISCN) criteria.Treatment of RA and RAS were mainly dependent on agents to induce differentiation of hematopoietic cells and drugs based.RAEB,RAEB-t,CMML treatment were dependent on low-dose chemotherapy and low-dose combination chemotherapy regimens.The treatments of 64 MDS patients with abnormal karyotype were analyzed and compared with control group, and 58 normal karyotype MDS patients were hospitalized in the same period.ResultsAfter treatments,17 cases gained complete remission among 64 patients with abnormal karyotype MDS patients.The CR rate was 26.6 ％.While in control group,30 gained CR in 58 MDS patients with normal karyotype. The CR rate was 51.7 ％. Comparing with the CR patients of normal karyotype, the number of patients with abnormal karyotype of CR was significantly lower (x 2 =8.1 3,P ＜ 0.05).Conclusion Karyotype analysis shows important significance in the diagnosis and prognosis of MDS.Karyotype transformation demonstrates differently in the risk of leukemia progress.

Objective To explore the diagnosis and treatment strategy of mammary duct ectasia.Methods The clinical data of 59 cases with mammary duct ectasia from January 2006 to December 2013 were analyzed retrospectively.Results The main clinical manifestations of mammary duct ectasia were mammary inflammatory mass in 46 cases,nipple discharge in 21 cases,nipple retraction in 18 cases,mammary abscess and mammary fistula in 8 cases.Definite diagnosis of mammary duct ectasia depended on pathology.All the patients were treated by operation,followed up for 3 months to 6 years,and none of them had recurrence.Conclusions Operation is the main method of curing mammary duct ectasia.To select proper operation time and method according to disease type,lesion size,location and scope.Thorough resection,repeat rinsing,wound clearance and immediate breast shape can not only cure disease,but also reserve breast configuration as possible.Therapeutic effect is satisfactory.

Objective To systematically compare the clinical efficacy of hepatectomy via anterior approach and the conventional approach for the treatment of giant liver cancer.Methods The database including Cochrane library,PubMed,Web of Knowledge,EMBASE,China National Knowledge Infrastructure (CNKI),Chinese Medical Current Contents(CMCC),Wanfang database were searched with the key words of原发性肝癌,转移性肝癌,手术,肝切除术,前入路,绕肝提拉法,传统入路,hepatocellular carcinoma,metastatic liver cancer,HCC,surgery,liver resection,hepatectomy,hepatic resection,anterior approach,conventional approach and liver hanging maneuver between the database establishment and December 2013.Chinese and English literatures on major hepatectomy via anterior approach and conventional approach for the treatment of giant liver cancer were retrieved,and data were analyzed by 2 independent researchers.Meta analysis was carried out using the software of Review Manager 5.1.2.The count data were analyzed using the odds ratio (OR).The quantitative data were analyzed by the weighted mean difference (WMD),and were presented by 95％ confidence interval (95％ CI).Results Thirteen literatures with 1 287 giant liver cancer patients were retrieved,including 603 patients receiving hepatectomy via anterior approach and 684 via conventional approach.Three literatures were enrolled in the randomly controlled studies,one had high risk of bias and the other 2 had low risk of bias.Ten literatures were enrolled in the non-randomly controlled studies with the mean score of 7 (range,5-9).The results of Meta analysis showed that hepatectomy via anterior approach could reduce the volume of intraoperative blood loss (MD =-349.39,95％ CI:-636.90--61.81,P ＜ 0.05),the blood transmission rate (OR =0.41,95％ CI:0.24-0.72,P ＜ 0.05),the operation time (MD =-40.81,95 ％ CI:-57.81--23.80,P ＜ 0.05),the mean time of hospital stay (MD =-4.52,95 ％ CI:-8.36--0.69,P ＜ 0.05) and the postoperative mortality and incidence of postoperative complications (OR =0.32,0.68,95 ％ CI:0.16-0.62,0.53-0.88,P ＜ 0.05) when compared with the conventional approach,further more,hepatectomy via the anterior approach could reduce the postoperative recurrence of giant liver cancer and had higher overall 1-and 3-year survival rates (OR =0.45,2.72,4.47,95％ CI:0.29-0.69,1.59-4.66,2.61-7.63,P ＜ 0.05).Conclusion The safety of hepatectomy via anterior approach is similar to that of the conventional approach,while the short-and long-term efficacy are superior to those of the conventional approach.

Objective To develop an accurate 2D dose reconstruction model using electronic portal imaging device (EPID).2D dosimetric verifications of volumetric intensity-modulated arc therapy (VIMAT)were done using the model.And the results were compared to other dosimeters.Methods The EPID-based dose reconstruction model was using convolve,deconvolve and correction function.The dose profiles which were obtained by the ion chamber were used to determine the model parameters.A total of 12 VIMAT plans for the treatment of anatomical sites of various complexities were chosen.The results obtained from EPID were compared to other dosimeters and treatment planning system (TPS).The ion chamber was used to measure the central point absolute doses.Other dosimeters were used to measure the plane dose distributions.All dosimeters measured the dose at 10 cm depth.The results were analyzed using γevaluation method.Results Regarding absolute central point doses,the ion chamber results were within 1.5％ of the EPID results.For the comparison to Seven29 and Matrixx,the average γ pass rates with 2％and 2 mm criteria were 98.9％ and 99.8％ respectively.For the dose distributions measured by EPID and calculated by TPS,the γ pass rates with 3％ and 3 mm criteria were 99.9％.Conclusions The presented results which were obtained from the comparison of measured and calculated doses show the reliability of our EPID-based dose reconstruction model.With the model,EPID can be a reliable and fast tool for IMRT plan dosimetric verification.The model expanded to the 3D dosimetric verification in the uniform phantom will be considered as the next work.

Objective To define individualized internal target volume (ITV) for hepatocellular car-cinoma using four-dimensional (4D) CT, and to compare the differences in target volume definition and dose distribution among 3D, 4D and respiratory-gated plans. Methods 4DCT scanning was obtained for 12 pa-tients with hepatoceUular. Gross tumor volume (GTV), clnical target volume (CTV) and normal tissues were contoured on all 10 respiratory phases of 4DCT images. The 3D, 4D and gated treatment plans were prepared for each patient using three different planning target volumes (PTVs): 1) PTV3D was derived from a single CTV plus conventional margins;2) PTV4D was derived from ITV4D, which encompassed all 10 CTVs plus setup margins (SMs);3) PTV_(Gating) was derived from ITV_(Gating), which encompassed 3 CTVs within ga-ting-window at end-expiration plus SMs. The PTV volume and dose distribution were compared among differ-ent plans. Results The PTV3D was the largest in all 12 patients, but still missed partial target volume in 5 patients when comparing with PTV4D. Both the 4D plans and the gated plans spared more normal tissues than the 3D plans, especially the hver. Without increasing normal tissue dose, the 4D plans allowed for increas-ing the calculated dose from (50.8±2.0) Gy (3D plans) to (54.7±3.3) Gy, and the gated plans could further increase the dose to (58.0±3.9) Gy. Conclusions The 4DCT-based plans can ensure optimal tar-get coverage with less irradiation of normal tissues and allow dose escalation when compared with 3D plans.Respiratory gated radiotherapy can further reduce the target volumes to spare more surrounding tissues, espe-cially for patients with large extent of respiratory mobility.