TGF ? plays a crucial role in the renal fibrosis and Smads mediate the intracellular signal transduction of TGF ?.Overexpression of Smad7,which can mediate TGF ? by the feedback action,is able to change the physiopathology equilibrium between the R Smads response and the I Smads inhibition to the fibrosis induced by TGF ?.It may help to understand the mechanism of renal fibrosis and Smads TGF ? signaling transduction, and it may also provide a new approach to the renal fibrosis.

Objective To analyze the prevalence of hospital acquired infection and the associated risk factors.Methods Nine hundred and three hospitalized preterm infants in our neonatal intensive care unit from August 2006 to October 2010 were retrospectively studied.Risk factors of hospital acquired infection were analyzed by single factor analysis and logistic regression analysis method.Site and pathogen of infection were also analyzed.Results One hundred and ten preterm infants developed 123 times of hospital acquired infection.The incidence of hospital acquired infection was 12.2％,and hospital acquired infection patient-day rates was 7.3‰.The mortality was 2.7％.Gestational age less than 32 weeks,birth weight less than 1500 gram,non-invasive ventilation,tracheal intubation,umbilical vein catheter(UVC),peripherally inserted central catheter(PICC),parenteral nutrition were the risk factors of hospital acquired infection.Logistic regression analysis showed mechanical ventilation,UVC and PICC were the main risk factors.The main sites of infection were sepsis(45.5％),low respiratory infection and conjunctivitis.Seventy positive culture samples were obtained.Bacteria were the main pathogen.Fifty percent was gram-staining positive,while 46％ was gram-staining negative.Conclusion It is very important to identify the high risk factors for hospital acquired infection.Standardized management of preterm infants,standardized usage of umbilical vein catheter and peripherally inserted central catheter,minimized usage of intubation would be conductive to reduce the incidence of hospital acquired infection.

Objective To investigate the effects of dexmedetomidine on the end-tidal concentration of sevoflurane during recovery from breast cancer surgery under general anaesthesia. Methods A total of 120 patients undergoing unilateral breast cancer radical operation were randomly divided into four groups:group C (infusion of saline, n=30), group D0.5 [infusion of dexmedetomidine 0.5μg/(kg·h) during operation, n=30], group D0.6 [dexmedetomidine 0.6μg/(kg·h), n=30] and group D0.7 [dexmedetomidine 0.7 μg/(kg · h), n=30]. The end-tidal concentrations of sevoflurane during surgery and postoperation were observed. The end-tidal concentration of sevoflurane on palinesthesia was recorded. The time from stopping administration of anesthetic drug to palinesthesia and the operation time were recorded. The palinesthesia of patients from general anaesthesia and the degree of emergence agitation of the patient were measured using Riker ’s sedation-agitation scale. The operation time, anesthesia time, intraoperative remifentanil dosage, intraoperative auditory evoked potential index (AAI), sevoflurane inhalation concentration and the corresponding time were recorded. Results There were no significant differences in clinical data, remifentanil dosage, operation time and AAI between four groups. The anesthesia time was longer in group D0.7 than that in the other three groups (P<0.05). Compared to group C, the end-tidal concentration of sevoflurane during surgery, postoperation and palinesthesia were lower and the time of palinesthesia was delayed in groups D0.5, D0.6 and D0.7 (P<0.05). And the time of palinesthesia was delayed in group D0.7 than that of group D0.5 and group D0.6. Compared with group C, the ratio of Riker’s sedation-agitation scale>7 was lower in groups D0.5, D0.6 and D0.7 (P<0.05). The ratio of Riker’s sedation-agitation scale>4 was significantly higher in group D0.6 and group D0.7 than that in group C and group D0.5, but the ratio of score>6 was lower (P<0.05). The ratio of score>3 was higher in group D0.7 than that of other three groups (P<0.05). Intraoperative cardiac tachycardia was found in group D0.6 and group D0.7 (4 cases, 13%and 8cases, 7%). Conclusion Sevoflurane inhalation anesthesia and intravenous infusion of dexmedetomidine 0.6μg/(kg·h) can effectively reduce intraoperative sevoflurane dosage, the end-tidal concentration of sevoflurane during recovery, and the occurrence of agitation in patients undergoing general anesthesia.

OBJECTIVE: To observe the correlation between traditional Chinese medicine (TCM) syndromes ("deficiency of qi and yin" and "deficiency of liver yin and kidney yin") and A267G in 5'-untranslated region within exonal of megsin gene, and to search the substantial genetic basis for micro-differentiation of TCM syndromes in primary immunoglobulin A nephropathy (IgAN). METHODS: A total of 120 IgAN cases meeting the diagnostic criteria were enrolled. The sequence of single nucleotide polymorphism (SNP) of A267G in 5'-untranslated region within exonal of megsin gene was tested. The correlation between SNP and TCM syndromes was observed. RESULTS: There were 83 cases carrying GG genotype, 34 cases carrying GA genotype and 3 cases carrying AA genotype in 120 cases of primary IgAN. There was a high proportion of "deficiency of liver yin and kidney yin" in IgAN cases with AA and GA genotypes, and a high proportion of "deficiency of qi and yin" in IgAN cases with GG genotype (P<0.01). Odds ratio in TCM syndrome distribution between GG genotype and GA plus AA genotype was 9.800, and 95% confidence interval was 3.969-24.199. The discrepancy also resided in IgAN patients with different genders and ages. CONCLUSION: A267G in 5'-untranslated region within exonal of the megsin gene may be one of the substantial genetic basis for differentiating "deficiency of liver yin and kidney yin" syndrome and "deficiency of qi and yin" syndrome in primary IgAN.

Objective: To evaluate the feasibility ofin vitro balloon dilatation for treating aortic coarctation infants younger than 6 months. Methods: A total of 13 aortic coarctation infants treated in our hospital from 2011-01 to 2015-12 were summarized. The patients were at the mean age of 3.4 months (from 20 days to 6 months), with the mean body weight of 4.8 kg (from 3.6 kg to 6.2 kg) including 9 male. Aortic coarctation segments were resected during the operation and the resected segments were expanded by percutaneous transluminal angioplasty (PTA) via (2-4) times diameter balloon dilatation. The diameters of resected aortic segments were recorded before and after expansion; the change of vascular middle smooth muscle layer was observed by HE staining. Results: There were 8 cases with non-restricted ventricular septal defect (VSD) and 3 of them received staging operation, 2 with atrial septal defect (ASD), 3 with bicuspid aortic valve, 3 with patent ductus arteriosus (PDA) and 1 with pericardial effusion. The resected aortic segments presented that 9 patients had diaphragm type narrow and 4 had tube type narrow. After PTA, the diameters of resected aortic segments were slightly increased for the mean of 0.2 mm and no obvious change was observed; HE staining showed that the vascular inner mucosa was shed, while the middle smooth muscle layer was intact. Conclusion: Balloon dilatation had the poor effect for treating aortic coarctation infants younger than 6 months; surgical procedure could be applied for treating the relevant patients.

Objective To discuss one-stage surgical repair of interrupted aortic arch ( IAA) in neonates and young in-fants, summarize follow-up results and subsequent treatments.Methods From September 2010 to December 2014, a series of 38 consecutive neonates and young infants ( M/F =26/12 ) with IAA were admitted in our surgical group to receive surgical treatment, with a median age of 11 days(1 day to 5 months) and a median body weight of 4.1 kg(1.8 to 5.8 kg).IAA was type A in 24 cases, type B in 13 cases and type C in 1 case.Associated cadiovascular anomalies were common except 2 cases, including atrial septal defect(n=23), ventricular septal defect(n=36), left ventricular outlet tract obstruction(LVOTO)(n=7), anomalous left pulmonary artery from aorta(n=1), truncus arteriosus(n=1).There were 5 cases of airway stenosis in 28 cases of CT angiography and 3D airway reconstruction.All the 38 cases were admitted with differential cyanosis.36 cases were recieved one-stage surgical repair except 2 cases died before operation.35 cases of IAA associated with intracardiac anom-alies were repaired through a median sernotomy.Cardiopulmonary bypass(CPB) was performed with two canulations in ascend-ing aorta and main pulmonary artery.Selective cerebral perfusion(n=21) or circulatory arrest(n =14) was carried out with body temperature of 18℃-23℃.After the patent ductus arteriosus tissue was completely resected , a continuous end-to-end or end-to-side suturing with 7/0(8/0) prolene was performed.In 1 type B cases with expected excessive anastomotic tension, the left subclavian artery was cut off to release the aortic arch .The associated anomalies were repaired during the cooling or re-warming period.Chest close was delayed to carry out no more than 24-72 h postoperatively in 16 cases.The other one type A IAA case without intracardiac anomaly was repaired through a standard left posterior lateral incision .Patients were strictly fol-lowed up with a standard protocol.Complications such as aortic arch restenosis, new LVOTO, new airway stenosis, and so on, were specialy focused on during the follow-up period.If needed, reoperation or transcatheter intervention was applied to treat the complications.Results Two cases died before operation and another 2 died in the early period postoperatively because of pulmonary hypertension crisis and severe tracheal stenosis, respectively.Sudden death was in 1 case during the follow-up peri-od.Median CPB time was 138 min(105-208 min) and median selective cerebral perfusion or circulatory arrest time was 24 min(16-35 min) .Mechanical ventilation time was 2-25 days.Blood pressure difference between the upper and lower limbs was less than 20 mmHg in all the patients before discharge.29 cases(85.29%) was followed up for 28 months(9 -60 months).3 cases were received reoperation in 5 cases of newly detected LVOTO.One case received reoperation in the 7 preop-erative LVOTO cases because of newly detected LVOTO(blood pressure gradient more than 40 mmHg).Two cases with aortic arch restenosis received percutaneous transcatheter ballon dilation .One case with new left main bronchus stenosis after opera-tion was strictly followed up.Conclusion IAA is a rare and severe congenital heart disease.Positive surgical repair should be performed after definite diagnosis being made .Although satisfactory results can be obtained with one-stage primary operation , IAA is a kind of progressive chronic disease.New postoperative LVOTO should be focused on becasue it will need reoperation or even the third operation .

Objective To understand the prevalence and epidemiological features of clonorchiasis sinensis based on inpa-tients in Zhongshan City. Methods All of the 23 town hospitals in Zhongshan City were selected as the surveillance hospitals in 2016. Among the inpatients from those hospitals,those lived in the city longer than 6 months were selected as the surveillance subjects. The stool specimens of the subjects were collected and examined by the modified Kato-Katz thick smear method for the eggs of Clonorchis sinensis. The crude infection rates of C. sinensis of the subjects were standardized according to the age and sex compositions of the population in Zhongshan City,2016. Meanwhile,the infection rates of the subjects from different towns and those combined with related clinical diseases were analyzed. Results A total of 2667 people were included in the surveil-lance,among which 219 were tested as positives,with a crude infection rate of 8.21％. For the positives,the male accounted for 81.74％(179/219),and their age ranged from 4 to 89 years with the mean value of(62.20±13.80)years. After standardization by age and sex composition,the infection rate was 3.62％for the whole population,the rates of the male and the female were 5.46％and 1.53％,respectively,and the former was 3.57 times as high as the latter. Both the infection rates of the male and the female rose as the age increasing(χ2 male=99.91,χ2 female=16.51,both P<0.01). The standardized infection rates among the subjects in different towns ranged from 0 to 10.40％,and the rates in the north towns were higher than those in the south towns. The standardized rate was 9.22％for the subjects combined with gallstone,3.40％for those not combined with gallstone,and the former was 2.71 times as high as that of the latter. Conclusion The people aged 30 years and above,with gallstone or living in towns with high C. sinensis infection rates are the key population for prevention and control of clonorchiasis in Zhongshan City.

Objective To observe the availability and safety of ventricular septal defect (VSD) occluder in infants and young children with large patent ductus arteriosus (PDA) associated with severe pulmonary hypertension.Methods Five patients (1 male and 4 fomale) of large PDA aged 5 months to 3 years,weighted from 5.1 to 15 kg,body surface area (BSA) 0.37-0.58 m2 underwent transcathter intervention with concentric VSD occluders from June 2008 to May 2009.Arterial ducta were tube-like and their diameters were 5.7 to 8.5 mm,with ulmonary vascular resistance from 4.8 to 5.7 Wood Unit,Qp/Qs 3.4-4.6.Three patients were given Bosentan after intervention.Results The large PDAs were successfully closed with VSD occluders,including 1 concentric perimembranous VSD occluder and 4 muscular VSD occluders.They all discharged 4 to 5 days with hidrosis and weight improved.Echocardiogram indicated VSD occluder was stable,no residue shunt and no stricture of left pulmonary artery and descending aorta were found.According to tricuspid and pulmonary regurgitation,pulmonary arterial pressure decreased differently and returned to normal after 6 months follow-up.Conclusion VSD occluder is available and effective to close large PDA associated with severe pulmonary hypertension in inrants and young children,but more cases and long-term follow-up are necessary.

Objective: To summarize the experience for treating pulmonary venous obstruction in patients after total anomalous pulmonary venous connection (TAPVC) operation. Methods: A total of 16 patients with post-TAPVC pulmonary venous obstruction in our hospital from 2011-01 to 2015-12 were retrospectively analyzed including10 male. All patients received echocardiography, electrocardiogram and chest X-ray examinations at pre-discharge, 1, 3, 6, 12 and 24 months post-operation. Pulmonary venous obstruction was diagnosed by echocardiography measured pulmonary vein (PV) lfow speed>2m/s. The time of re-operation was determined by clinical manifestations as recurrent heart failure and growth retardation; sutureless technique and conventional patch enlarge technique were used in the second operation. Results: No one lost contact in all 16 patients. There were 7/16 patients with anastomotic stenosis (1 mixed type, 3 infracardiac type, 2 supracardiac type and 1 cardiac type), 7 patients with one PV stenosis, 2 with two PV stenosis and nobody with three or more PV stenosis. Based on per-operative Darling classiifcation, there were 2 patients with mixed type, 5 with infracardiac type, 5 with supracardiac type and 4 with cardiac type. Most post-operative PV stenosis occurred at 3-6 months after the surgery. There were 5 patients receive re-operation, 4 with sutureless technique, 1 with conventional patch enlarge technique and all of them suffered from anastomotic stenosis. 2 patients died and 3 were followed-up. Conclusion: Post-operative anastomotic stenosis was the main indication for re-operation in patients after TAPVC; early operation could better improve the clinical condition.