ObjectiveTo analyze the perioperative risk factors of right heart failure (RHF) in human heart transplantation, and to summarize the efficacy of targeted agent especially on pulmonary hypertension.Methods Patients underwent heart transplantation were selected by exclusion criteria : (1) acute heart or other organ failure, or supported by mechanical assist device ; (2) the difference between the body weight of donor and recipient was ＞ 20％ ; (3) the ischemic time of donor was＞ 6 h; (4) acute rejection episode after transplantation; (5) perioperative death.The clinical data of 96 patients were collected, including gender, age, body weight, protopathy, history of heart failure, preoperative systolic pulmonary arterial pressure (SPAP), left ventricle end diastolic diameter (LVEDD), preoperative ejection fraction(LVEF), preoperative blood creatinine, donor ischemic time and preoperative application of 5-PDEs.The diagnosis standard of RHF was established.The risk factors were analyzed through Logistic Regression.Patients were divided into two groups according to the systolic pulmonary arterial pressure (SPAP).In group A, SPAP was ＜40 mm Hg, and in group B with SPAP≥40 mm Hg.The correlation between two groups was tested byχ2 test.ResultsIn the multivariable analysis, age, history of valve disease, length of heart failure,and preoperative SPAP were the risk factors of RHF with the coefficient of 1.051, 1.351, 1.712 and 6.725, respectively.SPAP seems to be the most important risk factor.Coronary artery disease and preoperative application of 5-PDEs-I were the favorable factors with the coefficient of 0.056 and 0.034, respectively.Parameters regarding age, history of valve disease, length of heart failure between the two groups were significantly different.There were no significant differences in gender, body weight, diagnosed as dilated cardiomyopathy or coronary artery disease and other etiologies, preoperative LVEDD, preoperative EF, preoperative blood creatinine, isehemic time and RHF, though the incidence of RHF in group B was higher than in group A (67.6％ vs 45.8％).There was also no statistic difference in using of ECMO and the mortality rate between two groups.ConclusionPreoperative PAP was the main risk factor of the RHF after heart transplantation.Although there was no statistic difference, the incidence of RHF in patients with SPAP≥40 mm Hg was higher than in patients with SPAP ＜40 mm Hg .The application of targeted agent therapy and ECMO may be helpful in treating RHF after heart transplantation.

ObjectiveTo investigate the effect of ulinastatin on perioperative renal function in patients undergoing orthotopic liver transplantation.MethodsSixty ASA Ⅱ or Ⅲ patients of both sexes aged 35-64 yr weighing 50-75 kg with normal blood urea nitrogen (BUN) and creatinine (Cr) before operation undergoing orthotopic liver transplantation were randomly divided into 2 groups ( n ＝ 30 each):control group (group C) and ulinastatin group ( group U).Anesthesia was induced with midazolam,fentanyl,etomidate and vecuronium and maintained with isoflurane inhalation,propofol TCI,continuous remifentanil infusion and intermittent iv boluses of fentanyl and vecuronium.The patients were tracheally intubated and mechanically ventilated.PET CO2 was maintained at 30-35 mm Hg.Ulinastatin 400 000 IU in normal saline 20 ml was infused iv after induction of anesthesia.Ulinastatin 200 000 IU was then infused every 4 h until 48 h after operation.Urine volume and the amount of furosemide administered were recorded before anhepatic phase,and during anhepatic and neohepatic phase.Venous blood samples and urine were collected before induction of anesthesia (T1),at 15 min of anhepatic phase ( T2 ),at 15min of neohepatic phase (T3),at the end of operation (T4) and 48 h after operation (T5) for determination of serum concentrations of BUN,Cr and creatinine clearance rate and urinary N-acetyl-beta-D-glucosaminidase (NAG)activity and microalbumin concentration.ResultsCompared with group C,ulinastatin significantly decreased the amount of furosemide administered and increased urine volume during anhepatic and neohepatic phase,decreased serum Cr concentration,increased creatinine clearance rate at T2.5,decreased urinary NAG activity and microalbumin concentration at T4.5 and serum BUN concentration at T3-s.ConclusionUlinastatin has protective effect on rehal function during perioperative period in patients undergoing orthotopic liver transplantation.

The paper uses computer multimedia technology to collect and switch audio and video signals, constructs the remote High Definition ( HD) surgery demonstration system which supports live broadcast, recorded broadcast, rebroadcast and video-on-demand depending on the network communication routing technology.It introduces functions, design scheme and composition of the system and points out that the system can realize HD video transmission and video talkback between the surgery scene and the classroom.Thus, tech-nical level of clinical surgery teaching can be enhanced.

Protease activated receptor-2(PAR-2)is a G-protein-coupled receptor.Recent studies indicate that PAR-2 is mainly expressed in leukocytes and activated by pancreatin and(or)tryptase,which subsequently induces inflammation through degranulation of leukocytes.Activation of PAR-2 in leukocytes is possibly involved in the pathogenesis of rheumatoid arthritis.

Objective To investigate the clinical results of extracorporeal membrane oxygenation (ECMO) technique during the peri-operative heart transplantation. Methods The clinical data of heart transplantations supported by the ECMO were retrospectively analyzed, including during the bridge to transplant, working as routine bypass in the operation room, and supporting the heart failure after surgery. Results Three 3 cases were supported with ECMO to extend the waiting time: 2cases died of multi organ failure during the waiting, and the third one received the heart transplant and the ECMO was successfully removed. Totally 12 cases of heart transplantation received the modified open style ECMO techniques replacing the routine bypass. The ECMO was removed after assistance for (38 ± 14) h. All the recipients except one death recovered well without right ventricular failure or obvious tricuspid regurgitation which was common after heart transplantation. Ten cases received ECMO support for the heart failure after the transplant. The initial application time ranged from 2 h to 2 days and lasted 43～176 h. One died of infection and two died of multi organ failure nothing to do with ECMO application and other 7 discharged with NYHA Ⅰ/Ⅱ cardiac function. Conclusion Early use of ECMO could safely bridge the heart failure patients to the transplant. Replacing the routine with ECMO techniques in the heart transplantation could get good myocardial protection results even with long cold ischemic time and improve the cardiac function recovery. For the heart failure patients after the surgery the ECMO could afford good support effect.

Objective To construct the micro-invasive immune rejection monitoring methods with peripher-al blood mononuclear cell gene expression detection and evaluate the clinic rejection estimation value. Methods The SYBR Green Ⅰ was used as fluorescent dye and the GAPDH as house keeping gene control in the quantitatiun RT-PCR technique to observe the 16 immune rejection relative genes expression features after heart transplantation. results were also compared with that of the normal people. Results The 16 immune rejection relative genes expres-sion were no different between normal people and the transplantation recipients before surgery (P>0.05). After heart transplantation the expression of ITGA4, FKB, ILI R-2 up regulated and the level of PF4、ITGAM、TGFβ1、 RHOU down regulated. The results were similar with the clinic observation that the immune rejection often occurs in the first 3 months after heart transplantation. It implied that these 7 genes may play an important role in the acute im-mune rejection after transplantation. Conclusion The real time quantitation RT-PCR methods were constructed suc-cessfully to detect the multiple immune relative genes expression and is of chnic applicable.

Objective This study aimed to evaluate the reliability of Tslew in survelliance of allograft rejection after heart transplantations in rats. Methods Forty rats underwent modified Ono's heterotopic heart transplantation. The autonomous IMEG and VER were recorded with epicardiac pacing leads fixed at right ventricular outflow tracts, left ventricular apex and free wall. Tslews were detected daily in these 10 syngeneic and 30 allogeneic transplants. Syngeneic transplants were sacrificed on 7th postoperative day and allogeneic transplants were sacrificed on 3rd, 5th and 7th postoperative days, respectively.Histopathologic studies were performed at the same time. Results On the 3rd ,5th and 7th postoperative days Tslews depressed gradually in the allogeneic group. The depressions between 3rd and 5th, 3rd and 7th were obvious( P ＜0.05 ). No significant differences were observed in the syngeneic group. Tslews differed between the two groups at 5th and 7th postoperative days ( P ＜0.05 ). The Depression correlated with histopathologic results. Area under ROC( receiver operating characteristic) curve (AUC) of Tslew was 0.9474 and the 95% confidence interval(CI) was (0. 8753 -1. 0000 ). At the cutoff point of 92% ( ≤92% considered positive), Tslew had a sensitivity (Se) 100%, specificity (Sp) 63.64%, positive predictive value (PV + )82.61%, negative predictive value (PV-) 100%, respectively. At the cutoff point 85%, Sp 90.91%, Se 78.95%, PV +93.75 %, PV- 71. 43%. At the best cutoff point 90%, Tslew had a Se 94.74%, Sp 81. 82%, PV + 82.61%, PV- 90%.Whereas QRS had a Se 68.42%, Sp 90.91%, PV + 92.86%, PV- 62.50% at the best cutoff point of 72.3%. Conclusion Tslew of VER are reliable indexs to monitor acute allograft rejection after heart transplantations in rats. Having great diagnostic value, Tslew may be used as a replacement for EMB at the best cutoff point when EMB can' t be performed. At cutoff point of 92%, Tslew may be used as a screening index.

Objective To investigate the reliability of intramyocardial electrogram (IMEG) in monitoring acute rejection after human heart transplantation. Methods From June 2004 to March 2009, 32 patients underwent orthotopic heart transplantations. During the operation telemetric pacemakers were placed under the skin of the body with connected bipolar electrodes implanted into epimyocardium. Postoperative IMEGs, including the autonomous IMEG and ventricular evoked response (VER) were recorded routinely. The endomyocardium biopsy (EMB) was taken routinely and performed once again when positive IMEG results or other positive signs were observed. Results Totally 523 IMEGs has been produced, 41 of VERs were recorded together with autonomous IMEGs and EMBs, in which 17 EMB specimens were confirmed positive and 24 negative. AUC of QRS was 0.7537, Se was 88.24%, Sp was 62. 50%; AUC of Tslew was 0. 9081, Se was 94. 12%, Sp was 87. 50%. QRS and Tslew had significant difference in AUC of ROC, with x2 = 4. 22, P＜0. 05; AUC of combined diagnostic index (positive when either QRS or Tslew is positive and negative when both values are negative) was 0. 7917, Se was 100.00%, Sp was 58. 33%. Conclusion QRS amplitude of the autonomous IMEGs, Tslew of VERs and combined diagnostic index are reliable indexes for monitoring acute allograft rejection after human heart transplantation. Furthermore, Tslew has a better prognostic value than QRS.

Objective To compare the mid-term results of video-assisted pulmonary veins isolation and box-lesion for lone atrial fibrillation.Methods Between June 2010 to November 2012,80 lone atrial fibrillation(LAF) patients underwent minimally invasive surgical ablation in Beijing Anzhen Hospital,and all of them received left atrial appendage excision and Marshall ligament break in the surgery.Among them,37 cases were performed two epicardial ablation lines in order to created box-lesion based on PVI(14 paroxysmal AF and 23 persistent AF).Follow-up was finished after discharge.Results Mean follow-up was(18.8 ± 7.4) months,and 2 patients were died with non-cardiac disease.The success rate is 78.8％ (Paroxysmal AF 87.9％;Persistent AF 72.3％).In the paroxysmal AF patients,the success rate for PVI and Box lesion treatment was 84.6％ (11/13) and 92.9％ (13/14),P =0.45;in the persistent AF patients,the success rate for PVI and Box-lesion was 58.3％ (14/24) and 87.5％ (14/16),P =0.04.Conclusion Addition of epicedial ablation lines might increase the cure rate for lone AF therapy,especially for persistent AF.

ObjectiveTo explore the effect and safety of three non-invasive immune rejection monitor techniques including intramyocardial electrogram (IMEG),tissue Doppler imaging (TDI) and multiple rejection relative genes expression detection in the peripheral blood.MethodsTotally 103 well recovered heart transplant cases were recruited The IMEG,TDI and gene expression detection techniques were used to monitor the rejection.The endomyocardial biopsy (EMB) was performed routinely after 1,3,and 12 months,or with clinic severe symptom,or with obvious abnormal noninvasive monitoring results,The patients were divided into different groups and were subjected to the test of TDI and quantitative real-time fluorescent quantitative reverse transcription-polymerase chain reaction(RT-PCR) technique test to observe the expression patterns of 16 immune rejection relative genes after heart transplantation.Results were also compared with those of the normal people.Results The sensitivity of IMEG was 92.9％,the specificity was 99.2％,positive predictive rate was 70.0％,and negative predictable rate was 99.8％.The routine echo can only detect the abnormality in the severe cardiac function impair.The TDI parameters in the grade Ⅰ or Ⅱ rejection group were decreased as compared with the controls (P＜0.05).The parameters Em,Sm and Tem were significantly reduced in grade ≥Ⅱ group as compared with the grade 0 or Ⅰ rejection group (P＜0.05).On the onset of acute rejection,the expression of ITGA4,FKB and IL1R2 was up-regulated,and that of PF4,ITGAM,TGF-β1and RHOU was down-regulated.ConclusionThe high negative prediction of the IMEG could be used as a non-invasive,convenient and safe monitoring technique for rejection reaction without any biopsies.It has a better correlation to use TDI and the Em,Am,Tem,Sm and Tsm could be used as the early sensentive parameters to detect the immune rejection.The real time quantitation RT-PCR methods were constructed successfully to detect the multiple immune relative genes expression and had clinic application value.