OBJECTIVE:To observe clinical efficacy and safety of milrinone in the treatment of persistent pulmonary hyperten-sion of newborn. METHODS:52 newborns with persistent pulmonary hypertension were divided into control group and observa-tion group according to random number table,with 26 cases in each group. The control group were given mechanical ventilation and intravenous prostaglandin therapy. Observation group was treated with Milrinone injection at loading dose of 50 μg/kg,10 min intravenous injection,maintenance dose of 0.75 μg/(kg·min). Both groups received treatment for 48 h. Clinical efficacies of 2 groups were compared as well as SpO2,PaO2,OI,PAP,PAMP and SV before and after treatment. The occurrence of ADR was compared between 2 groups. RESULTS:Total effective rate of observation group was 92.31%,which was significantly higher than 80.77% of control group,with statistical significance (P<0.05). Before treatment,there was no statistical significance in SpO2,PaO2,OI,PAP,PAMP and SV levels between 2 groups(P>0.05). After treatment,above indexes of 2 groups were im-proved significantly;SpO2,PaO2,OI and SV levels of observation group were significantly higher than those of control group, while PAP and PAMP levels were significantly lower than those of control group,with statistical significance(P<0.05). No obvi-ous ADR was found in 2 groups. CONCLUSIONS:Milrinone shows significant therapeutic efficacy in the treatment of persistent pulmonary hypertension of newborn,and can significantly improve persistent pulmonary hypertension and increased oxygen con-tent of blood with good safety.

Objective To construct a phage antibody Fab library of human antinuclear antibody. Methods Total RNA was extracted from peripheral blood lymphocytes of 4 patients suffering from autoallergic disease, with antinuclear IgG antibody titers in the serum higher than 1∶10 000 as estimated by indirect immunofluorescence technique. Taking oligo-dT as the primers, human immunoglobulin light chains ?/? genes as well as heavy chains Fd genes were reversely transcribed to cDNA by PCR. The ?/? light chains were initially cloned into pComb3Hss vector to construct a human recombinant light chain library, and the heavy chain genes were subsequently inserted into the corresponding sites of ?/?-pComb3Hss plasmid to generate a recombinant ?/?-Fd-pComb3Hss plasmid. The plasmid was then transformed into E. coli XL1-Blue, which was subsequently infected by the helper phage M13KO7. A random recombinant antibody library was expressed on the surface of filamentous phage. Results Human immunoglobulin ?/? light chain and heavy chain Fd genes (660bp) were amplified successfully. The light chain library with the capacity size of 2?104, and the human recombinant Fab antibody library with the capacity size of 4?104 were also successfully obtained. Finally, the phage antibody library of the Fab fragment of human antinuclear antibody, containing 2?109 CFU/ml phage, was constructed. Conclusion A phage antibody library of Fab fragment of human antinuclear antibody is constructed successfully. This research lays a foundation for the preparation for phage library of Fab fragment of human antinuclear antibody, and also paves the way for the advanced assessment for its effect on the immuno-targeting therapy of tumors.

Objective To assess the efficacy and safety of interventional combine with surgical therapy of symptomatic portal vein thrombosis (PVT). Methods Seven patients with PVT were treated by surgical thrombectomy, regional medical thrombolysis, and angioplasty or stenting. Resection of part of the small intestine was performed in 2 cases due to enteric necrosis and in 1 case because of enteric stenosis. Results The procedure was successful in all the 7 patients. The preoperative symptoms (abdominal pain, distention, and ascites) were alleviated apparently. Follow-up observations for 3~24 months (mean, 16 months) showed no death. No alimentary tract hemorrhage occurred. Re-examinations with Doppler ultrasonography revealed patent blood flow in the portal vein. Conclusions Interventional combined with surgical therapy is safe and effective in the treatment of symptomatic portal venous thrombosis.

Objective To explore the value of phase-contrast magnetic resonance imaging (PC-MR) in diagnosis of secundum atrial septal defect (ASD) in pediatric patients. Methods Totally 42 patients (aged from 9 months to 15 years) with secundum ASD proved with tansthoric echocardiographic (TTE) were evaluated with PC-MRI. Images of the flow through ASD were obtained with PC-MRI. The distances of ASD rim to superior vena cava (SVC), inferior vena cava (IVC), atrioventricular valves (AVV) and right upper pulmonary vein (RUPV), as well as the entrances of the vena cava and right upper pulmonary vein (RUPV) were assessed. Results The sizes of ASD and distances of ASD rim to the adjacent structures (SVC, RVC, AVV and RUPV) at PC-MRI were well consistent with those of TTE in 42 patients (P<0.001). PC-MRI results in 26 patients correlated well with surgical results (P<0.001). With different velocity encoding, compared with surgical results, measurements of ASD's sizes were more accurate when setting velocity from 50 to 70 cm/s than 90 cm/s. Conclusion The shape of ASD can be virtually depicted with PC-MRI. PC-MRI can accurately assess the defect size, number, rim distances to adjacent structures, therefore providing a new method for depiction of congenital heart anomaly.

ObjectiveTo explore the causes of recurrence of Budd Chiari syndrome after radical resection and the key points of second surgery. Methods Venography was performed in 11 relapsing cases. The diseased IVC segment was resected and replaced with artificial vascular graft in 4 cases, membranectomy and thrombectomy were performed in 2 cases. Thrombectomy with artificial vascular patch cavoplasty in 4 cases, incision of the stenotic IVC and right hepatic venoplasty and IVC venoplasty with artificial vascular patch repairing was performed in 1 case. Result The mortality rate was zero. Acute heart failure occurred in 2 cases and thoracic hemorrhea in 2 cases. Symptoms disappeared or improved in all cases. Patients were followed up from 6 to 68 months, with excellent results in 9 cases and fair in 2 cases. Conclusion There were some factors influcing the long term results of the surgery including distal free length from diseased IVC, thrombus clearance, material and size of the patch used for venoplasty.

Objective To evaluate the surgical and interventional therapy in patients with acute superior mesenteric vein thrombosis.Methods In this series,31 acute superior mesenteric vein thrombosis(SMVT) cases were reviewed from Oct 2006 to Feb 2012.According to varied clinical presence,patients received superior mesenteric vein thrombectomy with necrotic bowel resection or indirected catheter thrombolysis through superior mesenteric artery.Results 6 of 9 cases undergoing surgery were cured and other 3 still complained abdominal distension when discharged for not being able to bear anticoagulation and thrombolysis after operation due to alimentary tract hemorrhage,and residual thrombus was shown in superior veins by venography.17 of 22 treated by interventional therapy gained obvious relief within 72 hours after intervention,others gained symptomatic relief in 5-7 days.Indirected catheter thrombolysis were interrupted in 2 due to alimentary tract hemorrhage.One patient was shifted to surgery 48 hours after catheter thrombolysis due to deterioration.Mean duration of follow-up after hospital discharge was (19 ± 5) months in 25 cases,20 had no abdominal distension and pain,3 with postcibal abdominal distension.Conclusions Indirected thrombolytic therapy by way of the superior mesenteric artery is a technically simple,safe and effective therapy for patients with acute SMVT.

ObjectiveTo evaluate interventional therapy for Buddi-Chiari syndrome with occlusive hepatic veins.MethodsIn this study,37 Budd-Chiari syndrome cases with occlusive hepatic vein undergoing abdominal ultrasonography, CT scan, and liver vascular reconstruction before operation.Interventional procedures included recanalization of occlusive hepatic veins through transjugular,transfemoral vein or both. ResultsProcedures were successful in 34 patients (success rate 34/37,92％ ),with 38 hepatic veins opened. After hepatic vein was opened,nine patients were treated with PTA alone.27 stents were placed in 25 patients,with 2 cases receiving stent placement in both the right hepatic vein and accessory hepatic vein.7 home-made Z-stent were placed after the opening of occluded inferior vena cara.After the procedures hepatic vein pressure dropped from ( 36.0 ± 3.4) cm to ( 21.0 ± 2.3 ) cm H20.Recurrence of stenosis or oclusion was found in 4 out of 9 receiving PTA only after a follow-up of (23.0 ± 2.0) months.In the other 23 patients with stent implantation there were 6 eases of restenosis or occlusion (6/23,26％ ). ConclusionsAccording to the hepatic vein and intrahepatic collateral venous occlusion conditions,correct selection of interventional methods can significantly decrease the hepatic and portal vein pressure,improve clinical symptoms.

Objective To analyze the clinical features of takayasu's arteritis in elderly patients for improving their general management.Methods Twenty-six patients,aged over 60 years,with takayasu's arteritis were enrolled.The clinical manifestations and medical records were collected in detail and analyzed retrospectively.Results The mean age of the patients in our study was 64.0±3.8 years,four males and twenty-two females.Of all patients,nine were accompanied by coronary heart disease,seven by primary hypertension,four by diabetes mellitus,two by arrhythmia and one by subacute infective endocarditis.The frequent clinical manifestations were hypertension (n = 21,81%),dizzy (n=12.46%),chest pain (n=9,35%),pulselessness or weak pulse (n=7,27%).The clinical classification of this group showed brachiocephalic artery type (n = 8,30%),abdominal aorta type (n=4,15%),extensive type (n=11,58%) and pulmonary artery type (n=3,12%).Ten patients had elevated ESR level,six had elevated CRP level and fourteen had elevated ASO level.Two patients with diabetes mellitus died of serious complications.Conclusions Takayasu's arteritis in the elderly is usually accompanied by other cardiovascular diseases and risk factors.It is important to enhance the comprehensive treatment of these patients.

Objective To discuss a new method of interventional and surgical therapy for the lower extremity postthrombotic syndrome (PTS). Methods 35 PTS cases were enrolled in our group. Dilation and stent placement in stenosis of iliac veins were performed in all cases, then temporary femoral arteriovenous fistula was established. After two weeks, 15 cases with varicosity underwent high ligation of the great saphenous vein and stripping, 5 cases with leg ulcers (ulcers diameter>3 cm) underwent skingrafting. After operation, patients took warfarin orally for 6 months and wear elastic compression stockings. Results Procedures were successful in all cases. Thrombectomy extracted only a few old thrombus. Before discharge, limb swelling subsided in 26 cases while 4 remain light swelling and 5 had no obviously relief. Twenty-six cases were followed-up for 3～24 monthes. Limb swelling subsided in 22 cases but still exist in 4. Limb ulcers were healed in 11 cases and the area of pigmentation were diminished. Limb ulcer recurred 12 months after skingrafting and healed finaly after perforator veins clipping with second skingrafting. Color Doppler was used in follow-up to check the potency of affected deep veins, good outcome was found in 20 cases and rough intima with stenosis of iliac veins was found in 2, no flow signal in 4. Conclusions Stenosis of iliac veins in PTS are common, the pathological changes could be treated by interveional method combined with temporary arteriovenous fistula. The degree of recanalization of femoral-popliteal veins determined the results.

Objective To evaluate the prevention and management for the complications in interventional therapy for the lower extremity arteriosclerosis obliterans (ASO). Methods In this study 207 ASO cases received interventional therapy. The relationship between complication rates and different TASC type and the influence of diabetes mellitus (DM) with coronary heart disease (CHD) on critical organs complication rates was analyzed. Results The intervention succeeded in 190 cases. There was 17 failures, including 13 procedure failures and 4 deaths due to postoperative critical organ complications. Among the complications there were puncture site hemorrhage in 12, pseudoaneurysm in 4, alimentary tract hemorrhage in 2, arteriorrhexis in 6, cerebral infarction in 8, acute heart failure in 9, respiratory failure in 13, renal failure in 6, thrombosis in 5 and blue-toe syndrome in 1. The intraoperative complication rate of femoral-political type (39.84%, 51/128) was high than that of aorta-iliac type (18.99%, 15/79) (P< 0.05). Those critical organ complication rates of patients with DM and patients with DM&CHD were 27.66% (13/47)and 24.49% (12/49)respectively, they were higher than that of patients without (5%, 2/40) (P<0.05). Conclusions The high complication rates during interventional therapy of ASO were because of misoperation and complicated pathological type and together with DM and CHD. These rates could be decreased when we treated DM and CHD before operation and chosen a reasonable method and shorten the duration of operation.