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 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.

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 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.

Objective To evaluate balloon angioplasty and stenting of the hepatic veins for the treatment of Budd-Chiari syndrome with long segmental inferior vena cava (IVC).Methods The hepatic veins were evaluated by colour Doppler,CT or MR.Epidiaphragmatic inferior vena cavography was performed to locate the stenused opening of the hepatic veins,in case of membrane occlusion of the hepatic veins,a puncture was attempted with Rups100 needle and then balloon dilation of the hepatic veins and stents implantation was carried out.Results In 40 cases of long segmental inferior vena cava ( IVC ) occlusive Budd-Chiari syndrome,membranous obstruction of the hepatic veins was found in 5 cases and short-segmental occlusion in 24 cases.28 cases were successfully treated with balloon dilation and stents implantation,including percutaneous transluminal angioplasty(PTA) of hepatic vein in 5 cases,and stent implantation in 23 cases,puncture procedure was failed in 1 case.Postoperative follow-up was made in 26 cases from 6 to 62 months ( mean,24.0 ± 1.3 months ).Symptoms recurred in 6 cases.Hepatic vein restenosis or occlusion were observed using color Doppler ultrasound in 6 cases.Conclusions Most lesions in hepatic veins were membranous obstruction or short-segmental occlusion among patients with long-segmental occlusion of IVC.Balloon angioplasty and stenting of hepatic veins for long segmental IVC occlusive Budd-Chiari syndrome through jugular vein can relieve hepatic venous obstruction and relieve portal hypertension.

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 observe the effect of costimulatory molecule B7-1 on cytoskeleton rearrangement in mouse podocytes induced by angiotensin Ⅱ (Ang Ⅱ),and to study the underlying molecular mechanism of B7-1 in the pathological changes of podocytes.Methods All cultivation of conditionally immortalized mouse podocytes (MPC) in vitro were divided into the following groups:normal control group,CTLA-4 group,Ang Ⅱ group (10-6 mmol/L 12 h,24 h;10-8 mmol/L 12 h,24 h) and CTLA-4 with Ang Ⅱ group.Transfect B7-1 RNA interference fragment (siRNA) to the mature podocytes,and then restimulated by Ang Ⅱ (10-6 mmol/L 12 h),the change of podocyte cytoskeleton after Ang Ⅱ stimulation were observed.The expression of B7-1 in each group was assayed by flow cytometry and Western blotting.The nephrin and p-nephrin protein levels in the four groups were also analyzed by Western blotting.At the same time,the podocyte cytoskeleton distribution as indicated by F-actin was observed by fluorescence microscopy.Results Flow cytometry and Western blotting showed that B7-1 was not expressed in the normal control group.Ang Ⅱ showed a concentration and time dependent induction of B7-1 expression in mouse podocytes (P ＜ 0.05).Western blotting indicated that Ang Ⅱ induced B7-1 protein expression (P ＜ 0.05).Expression of nephrin and p-nephrin was significantly down-regulated by Ang Ⅱ (P ＜ 0.05).Compared with the normal control group,the expression of podocyte protein nephrin and p-nephrin in Ang Ⅱ stimulation group was significantly reduced (P ＜ 0.05).Using FITC phalloidin fluorescence staining showed that CTLA-4+Ang Ⅱ stimulation group cytoskeleton rearrangement was improved significantly and F-actin recombinant score (mCFS) decreased compared with Ang Ⅱ group (P ＜ 0.05),suggesting that Ang Ⅱ led to the disorder of the podocytes cytoskeleton and the destruction of the cytoskeleton of podocytes by Ang Ⅱ could be improved after B7-1 blocking.Compared with the Ang Ⅱ stimulation,transfection of B7-1 siRNA + Ang Ⅱ stimulation group improved F-actin cytoskeletal rearrangement,and mCFS also decreased significantly (P ＜ 0.05),suggesting that transfection of B7-1 siRNA might improve the damage of Ang Ⅱ on podocytes cytoskeleton.Conclusions B7-1 participates in the process of cytoskeleton reconstruction and plays an important role in the pathological changes of podocytes.