Objective To summarize successful experience in three of orthotopic homoplastic heart transplantation,to explore some problems for donor myocardial protection,the application of immunosuppressive drugs,anti-infection and prevent acute rejection.Methods From 2000.11.to 2001.3,we performed successful three cases orthotopic homoplastic heart transplantation;one case of hypertrophic myocardosis in terminal phase, one case of dilatanay myocardosis and one case of geneogenous tricuspic valve atresia.Postoperation,cyclosporin A,methylprednisolone,prednisolone and other immunosuppressive drugs have been used.Results Three patients have survived for three and six months with normal heart function and a good life quality.Conclusion Successful keys of heart transplantation are donor myocardial protection,technology of anastomosis and treatment of peroperation.

OBJECTIVE:To study the cytotoxicity of the graft polymer after polyethyleneimine (PEI) had been modified by polyoxyethylene stearate (POES) and the property of the carrier,grafted-polymer/DNA complexes. METHODS: To modify PEI by conjugating PEI to POES with succinimidyl carbonate method. Structural analysis of synthesized polymer was performed by using 1H-NMR. Agarose gel electrophoresis (AGE) behavior of the graft polymer/DNA complexes was observed with particle size and zeta potential measured. The cytotoxicity of the graft polymer was evaluated by MTT method. The pGL3-lus served as a reporter gene,and the luciferase activity was determined to evaluate the transfection efficiency of grafted-polymer/DNA on Hela cells. RESULTS: 1H-NMR showed that the graft polymer had high purity. AGE showed that the DNA-wrapping ability of the graft polymer were increased with the increase of N/P ratios,and decreased with the increase of the POES graft number. The size of complexes was below 300 nm,and the zeta potential of the complexes increased with the increase of N/P ratios. The graft polymer showed significantly lower cytotoxicity than PEI. The graft polymer with lower POES graft number had higher transfection efficiency. CONCLUSIONS: The POES-modified PEI can be used as an effective non-viral genetic carrier.

Objective To estimate the effect of glycoprotein (transmembrane) nonmetastatic melanoma protein B (GPNMB) on the proliferation and migration of as well as melanogenesis in melanoma cells.Methods The expression of GPNMB was detected by immunofluorescence assay in two melanoma cell lines M14 and G-361,as well as in primary human melanocytes.Then,the three kinds of cells each were classified into three groups:experimental group treated with small interfering RNA targeting GPNMB (GPNMB-siRNA),negative control group treated with the negative control siRNA,blank control group remaining untreated.Methyl thiazolyl tetrazolium (MTT) assay,transwell invasion assay and spectrophotometry were performed to evaluate cell proliferation activity,invasion potential and melanin levels,respectively.Statistical analysis was done using Student's t test.Results GPNMB was expressed in both melanoma cells and melanocytes.The transfection with GPNMB-siRNA down-regulated the mRNA and protein expressions of GPNMB in,and markedly suppressed the proliferation and migration of,melanoma cells.In detail,the proliferative activity (expressed as the absorbence value at 570 nm) of M14 and G361 cells was reduced by 35％ and 40％ respectively,the migration activity of M14 and G361 cells by 49％ and 51％ respectively,and the melanin levels in melanocytes,M14 cells and G361 cells by 73％,82％ and 69％ respectively,in the experiment group compared with those in the blank control group.Conclusions The siRNA-mediated silencing of GPNMB could effectively inhibit the proliferation of,invasion of and melanogenesis in melanoma cells,which suggests that GPNMB plays critical roles in the initiation and progression of melanoma.

AIM: To determine multifocal visual evoked potential (mVEP) in the prediction of postoperative visual acuity in cataract. METHODS: We examined 30 normal eyes as control and 60 eyes of 52 cataract patients, senile cataract in 27 cases 30 eyes, cataract with glaucoma in 25 cases 30 eyes by mVEP examination. All patients underwent phacoemulsifi-cation (Phaco) and intraocular lens (IOL) implantation. After surgery,best corrected visual acuity (BCVA) was examined at 1 week, 1 month, and 3 months respectively.RESULTS: The mean amplitude and latency in mVEP responses between normal control group were 183±11nV, 95±8ms, and in senile cataract group were 177±10nV, 96± 8ms respectively, there were no significant difference between two groups (P>0.05). The mean amplitude and latency of cataract with glaucoma 138±7nV, 99±6ms were significantly different comparing to both control and senile cataract group (P<0.05). After surgery, the am-plitude and latency were 276±11nV and 93±8ms respec-tively, which did not change significantly comparing to the normal eyes (P<0.05), their visual function got no obvious damage and visual recovery were better (BCVA≥0.8). While those with central amplitude 221±6nV and latency 105±7ms that were significantly deviated from control group (P<0.05), and their visual function were seriously damaged and visual recovery were much poorer (BCVA<0.3).CONCLUSION: mVEP waveform might enable us to evaluate objective visual function detection before cataract surgery. A subject with visual function damage, their mVEP responses to stimulation were severely changed when it compared to controls.

Adolescent ; Adult ; Aged ; Humans ; Middle Aged ; Pupil Disorders ; diagnosis ; etiology ; Refraction, Ocular ; Retina ; physiopathology ; Retinal Detachment ; surgery ; Scleral Buckling ; Visual Acuity ; Vitreoretinopathy, Proliferative ; surgery

Objective To investigate the prognostic factors and the clinical outcome of locally recurrent rectal cancer after radical resection. Methods From April 2000 to April 2004, 105 patients with locally recurrent rectal cancer after radical resection were re-treated in Tianjin cancer hospital. Thirty-four patients were re-treated with surgery combined with adjuvant chemoradiotherapy (group 1), 35 with surgery alone (group 2), and 36 with chemoradiotherapy (group 3). The impact of 17 clinicopathological factors and treatment modalities on the survival was analyzed. Results The follow-up rate was 95. 2%. The median survival time was 23 months. The 1-, 3-and 5-year survival rates of patients with locally recurrent rectal cancer were 63% ,34% and 19%, respectively. The 1-, 3-and 5-year survival rates were 79%, 55% and 32% in group 1 ; 68%, 40% and 14% in group 2; and 64%, 36% and 11% in group 3; respectively (χ~2 =7. 96,P =0. 019). The univariate analysis showed that the degree of differentiation, depth of tumor invasion, number of metastatic lymph nodes, initial TNM stage, recurrent location, time to recurrence, and surgery combined with adjuvant therapy were significant prognostic factors, with the last 4 being the independent prognostic factors. Conclusions Surgery combined with chemoradiotherapy may improve the survival of patients with locally recurrent rectal cancer.

Objective The aim of this study is to evaluate the early and midterm results of reconstructive new tricuspid valvar annulus technique and prosthetic ring in the anatomic correction of Ebstein's anomaly.Methods 60 operations for Ebstein's anomaly were performed by the reconstructive new tricuspid valvar annulus technique,prosthetic ring was used to reinforce the new tricuspid valvar annulus,the plastic effect of tricuspid valve was observed real-time by trans-esophagus echocardiography during operation.The follow-up results of the plastic effect of tricuspid valve were studied after operation.Results Mean operation time was (3.1 ± 2.3) h,mean cardiopulmonary bypass time was (148.8 ± 44.6) min,mean aortic cross-clamp time was(112.6 ± 34.1) min.3 patients had tricuspid valve replacement because of bad plastic effect;1 patient had bidirectional shunt Glenn procedure because of right sided heart failure.Hospital mortality was 1.When the patients were discharged,tricuspid regurgitation severe 1,medium 5,mild or no 50;53 being of heart functional class Ⅰ and class Ⅱ,3 of classⅢ.45 patients (80.3 ％) were followed-up out-hospital from 6 months to 7 years,mean (24.4 ± 21.4) months.Tricuspid regurgitation severe 1,medium 6,mild or no 38.And the nice stability of tricuspid valve was found during the follow-up period,41 patients being of heart functional class Ⅰ or Ⅱ (NYHA),4 of class Ⅲ.1 need reoperation.Conclusion The reconstructive new tricuspid valvar annulus technique can maintain farthest the dimension and geometric configuration of functional right ventricle,longitudinal plication of the atrialized right ventricle can restore a large ventricular cavity,improve it's pump function,and make valvuloplasty perfect,which widen obviously the indication of tricuspid valvuloplasty for Ebstein's anomaly.The research concluded that this technique can correct anatomically Ebstein's anomaly effectively,and it can get the stable effect of tricuspid valvuloplasty obviously if use prosthetic ring to reinforce the new tricuspid valvar annulus.

Objective To summarize the short-term therapeutic results of valve-sparing reimplantation procedure (David Ⅰ procedure) using Valsalva conduit in patients with aortic valve insufficiency due to aortic root disease.Methods From January 2008 to May 2011,David Ⅰ procedure was performed using Valsalva conduit in 15 patients with aortic insufficiency caused by aortic root disease,of which 14 males and 1 female,mean age was (49.5 ± 10.3) years old (from 33 to 67 years old).The evaluation of pre-operative heart functional and aortic valve regurgitation:11 in class Ⅰ,4 in class Ⅱ ; 9 with moderate and 6 with severe aortic insuffciency.Concomitant procedures included 4 CABG operations,9 aortic arch replacements,1 mitral annuloplasty and tricuspid annuloplasty,and 1 ASD repair operation.Results There was two intra-operative deaths occurred,one died of pulmonary infection,another one died of hemategenous septic shock and multiple organ failure.The mean extracorporeal circulation time was (230.0 ± 54.4) min,the aortic cross clamp time was (181.2 ± 30.6) min.One week after operation,the heart functional of all patients changed into class Ⅰ ; 8 patients had no aortic regurgitation,6 had gentle aortic regurgitation and 1 had moderate aortic regurgitation.After leaving hospital,13 patients were followed-up by (8.8 ± 5.9)months (ranged 3 to 24 months),3 were no and 9 with gentle (3 of which showed no aortic regurgitation in half past year)and 1 with moderate aortic regurgitation (this patient showed gentle aortic regurgitation in 3 months later).Conclusion David Ⅰ procedure using Valsalva conduit was a good option for patients with aortic valve insufficiency with approximate normal aortic leaflets and valvular ring,which could provide a good short-term operative effect.

Objective To observe the clinical results of the valve-sparing root reimplantation procedure(David Ⅰ procedure) in patients with aortic valve insufficiency due to aortic root disease.Methods From august 2005 to May 2011,aortic valve-sparing root reimplantation was performed in 24 patients with aortic insufficiency due to aortic root disease,21 males and 3 females; mean age (47.0 ± 12.3) years old (from 24years to 69years) ; 20 being of heart functional class Ⅰ,3 of class Ⅱ,and 1 of class Ⅲ; 13 with moderate and 11 with severe aortic insufficiency ; The tubular graft was used in 9 patients and valsalva conduit was used in15 patients in David Ⅰ procedure.Concomitant procedures included 6 CABG operations,11 aortic arch replacement operations,1 mitral annuloplasty and tricuspid annuloplasty,1 VSD repair and 1 ASD repair operation.Conversion to Bentall procedure was necessary in only one patient because transesophageal echocardiography (TEE) showed moderate aortic insufficiency due to aortic valve prolapse.Post-operative aortic valve regurgitation and heart function were followed up.Results There were two peri-operative deathes(one died of pulmonary infection in the 22th day postopertatively,another one died of haemategenous septic shock and multiple organ failure in the 9th day postopertatively),one late death other than operation-related reasons(died of pulmonary infection in the 54th day postopertatively).The mean extracorporeal circulation time was (235.9 ± 58.5) min,the aortic crossclamp time was(182.7 ± 35.8) min.11 patients had no aortic regurgitation,11 gentle and 1 moderate regurgitation postopertatively ; The heart functional of all patients changed into class Ⅰ one week post-operatively.20 patients were followed-up 3 to 74 months,of which 3 with no and 15 with gentle (3 of which showed no aortic regurgitation in half year later) and 2 with moderate aortic regurgitation (1 patient with Marfan syndrome used tubular graft showed severe postopertative aortic regurgitation 55 months later).Conclusion David Ⅰ procedure is a good option for patients with aortic valve insufficiency due to aortic root disease,and with more or less normal aortic leaflets and valvular ring normal.Furthermore using Valsalva conduit in David Ⅰ procedure could provide a more stable mid and long-term effect.

ObjectiveTo evaluate the primary effect of granulocyte-monocyte colony stimulating factor (GM-CSF) as an immunotherapy option for treatment of residual disease after alloHSCT.Methods Immunotherapy was performed on two patients with blood malignancy to treat residual disease after allo-HSCT. The patient one,who was diagnosed as having MDS-RAEB Ⅱ,showed bone marrow displasis and incomplete chimerism 6 months after unrelated donor HSCT.Immunosuppressive drug was withdrawn without induction of graft-versus-host disease (GVHD).The patient two B-ALL demonstrated a residual disease at molecular level 30 days post-transplantation.Both of them were given GMCSF (300 μg) subcutaneously once every two days for totally three weeks.During the whole period,skin itch and rash,liver function,subgroups of lymphocytes,and MDSCs and DCs in peripheral blood were investigated.Results In case one,grade Ⅰskin acute GVHD (aGVHD) appeared as early as one week after GM-CSF administration,as well as grade Ⅱ (skin and liver) by the end of the third weeks,and GM-CSF injection was withdrawn.One month later since the start of GM-CSF,the patient showed normal bone marrow morphology and full donor type chimerism. Cyclosporine A (CsA), mycophenolate mofetil and methylprednisolone were administered for two weeks to control GVHD.In the other case,grade Ⅰ aGVHD occurred 9 days after GMCSF administration,and whole blood CsA maintained at 0.134-0.472 μmol/L.Prednisone (30mg per day for 5 days) was used to control grade Ⅱ GVHD from the 11th day after GM-CSF,and grade Ⅰ GVHD continued without any intervention.On the 30th day after GM-CSF treatment,bone marrow aspiration showed complete molecular remission.In both of the two cases,no differences in lymphocytic subtypes were revealed before and after GM-CSF administration,while there were trends of increased DC number and decreased MDSCs in peripheral blood.ConclusionThe administration of GM-CSF as an immunotherapy option for blood malignancy may contribute to the clearance of residual disease after Allo-HSCT.