Objective To investigate the effect of different doses of dexmedetomidine on myocardial injury (in perioperative peri‐od) on cardiopulmonary bypass (CPB) in patients with rheumatic heart valve replacement surgery .Methods Patients undertook rheumatic heart valve replacement surgery with mitral stenosis were divided into three groups (n=20) in randomized and double‐blind method :control group (group C) ,dexmedetomidine 0 .3 μg/kg group (DEX1 group) ,dexmedetomidine 0 .6 μg/kg group (DEX2 group) .Central venous blood was drawn respectively before anesthesia induction (T0 ) ,2h after CPB (T1 ) ,24 h after CPB (T2 ) ,48 h after CPB (T3 ) ,72 h after CPB (T4 ) .Plasma muscle calcium protein I (cTnI) and creatine kinase (CreatineKinase MB , CK‐MB) were measured and mean arterial pressure and heart rate were recorded at each time point .Furthermore ,extubation time , ICU stay ,postoperative inotropic score 24 h after operation ,drainage 24 h after operation ,cardio auto‐resuscitation rates and ad‐verse cardiovascular events were recorded .Results Compared with T0 ,HR was significantly lower in the T1 time point in DEX2 group .Compared with group C ,HR ,plasma CK‐MB ,inotropic score 24 h after operation and cardiovascular adverse events was sig‐nificantly reduced in the T1 time points in DEX1 group (P<0 .05) ,but the heart auto‐resuscitation rate did not significantly im‐proved .HR at T1 ,plasma CK‐MB values at T1 and T2 ,and plasma cTnI values at T2 -T4 were significantly reduced ;the heart re‐suscitation significantly increased ,myocardial contraction power ratings 24 h after operation and the incidence of cardiovascular e‐vents was significantly lower in DEX2 group (P<0 .05) .The extubation time ,ICU stay time and drainage 24 h after operation did not change significantly in both groups .Conclusion Dexmedetomidine has a protective effect on perioperative myocardial injury in patients with rheumatic heart valve replacement surgery ,and the effect would be better when the dexmedetomidine was infused at 0 .6 μg · kg -1 · h-1 after a loading dose of 0 .6 μg/Kg continuously .

Objective To identify homogenous clones of S.flexneri 2a, using gene distribution polymorphism of Shigella enterotoxinl and Shigella enterotoxin2 in a shigellosis outbreak by S.flexneri 2a. Methods 93 strains of S.flexneri 2a isolated from different areas, at different time were detected by Shigella enterotoxin1 and Shigella enterotoxin2 gene polymerase chain reaction to identify genetic type of S.flexneri 2a. Results The 93 strains of S.flexneri 2a were divided into 4 clones: ShET1(-)/ShET2(+)for 12 strains,ShET1(+)/ShET2(-)for 14 strains,ShET1(+)/ShET2(-)for 59 strains, ShET1(-)/ShET2(-)for 8 strains. Conclusions It is believed that Shigella enterotoxin1 and Shigella enterotoxin2 gene PCR analysis is a simple method for the primary screening of S.flexneri 2a.

Objective To summarize the outcomes and clinical experience of orthotopic heart transplantations in Shanghai Zhongshan Hospital.Methods From May 2000 through October 2005,141 patients,101 males and 40 females,diagnosed as having dilated cardiomyopathy in 118,hypertrophic cardiomyopathy in 2,restrictive cardiomyopathy in 2,end-stage ischemic heart disease in 9, primary malignant cardiac tumor in 4,valvular heart disease in 3 and others in 3,underwent orthotopic heart(transplantations) at our center.The operative procedures included 120 bicaval anastomotic cardiac transplantations,19 conventional Stanford orthotopic cardiac transplantations and 2 total heart transplantations.The immunosuppressive therapy strategies included Cyclosporine A or tacrolimus,corticosteroids and mycophenolate mofetil.For the latest 28 patients,induction therapy with Daclizumab was applied.Results There were 3 operative deaths with an operative survival of 97.9 %.During the follow-up from 1 month to 65 months,the actuarial survival rate was 90.8 % after 1 year,84.6 % after 3 year and 81.4 % after 5 year.Acute rejection,infections,graft failure and metastasis of primary cardiac tumor were the main causes of death in the 1st postoperative year,while acute rejection and graft coronary vasculopathy were the leading causes of death thereafter.Postoperative complications included acute rejection,infections,renal dysfunction and graft failure.Conclusions Orthotopic heart transplantation was proved to be a reliable choice for endstage heart disease with excellent outcomes.More attention should be paid to surveillance and management of acute rejection, infections and graft coronary vasculopathy in the long-term follow-up.

[Objective]To evaluate the clinical results of the patients with severe kyphosis and paraplegia in differnt spine segment due to tuberculosis of thoracic and lumbar which had been treated by different surgical procedure. [Methods]There were a total of 23 patients, 16 male and 7 female in this stuady. The average age were 25 years, ranging from 12~56 years old. Tuberculosis lesion were located in different spine segment(T1~4)four cases, (T5~10)four cases, (T11~L2) nine cases,(L3~5) six cases, two vertebral bodies were involved in 8 patients and three vertebralbodies involved in 12 patients. Surgical procedure:four patients treated through modified anterior cervico-thoracic approach.Five patients treated through one stageposterior total vertebral osteotomy, other patients combined with anterior-posterior approach, according to the patient's surgical situation, twelve patients accepted anterior and posterior combined operation, two patients were treated by two stages.The period of bone grafting fusion, kyphosis deformity correction degree ,and neurological function recovery record were investigated postoperatively.[Results]All patients got solid fusion in a average of seven months. The kyphosis deformity was corrected 49? in average, which was maintained well within follow-up period. Patients neurological function deficiency achieved completely recovery, the longest time being within 10 months. All patients were cured thoroughly and there was no seroius complication.[Conclusion]Different surgical procedure should be selected, according to different spine segments due to tuberculosis of thoracic and lumbar vertebrae with the extent of severe kyphosis and paraplegia, it can achieve thoroughly debridement of tubereulosis, solid interbody fusion, good correction of deformity and forever stability of spine with anterior or posterior internal fixation.It could get successful rehablitation for patient’s neurological function and improve the patient’s life quality.

Nervous system develops from multipotential stem cells of the embryonic neural tube.The discovery of cells of stem-like properties in the adult central nervous system(CNS)has provoked an intense search for ways to utilize their potential for treatments of multiple neurological disorders.Expansion and recruitment of endogenous progenitors may be limited in treating widespread cell loss in the adult CNS.Transplantation of neural stem cells(NSCs)or more restricted progenitors to replace cells lost to injury or disease may facilitate functional recovery in a spectrum of neurological disorders.A major challenge to the development of effective NSCs therapies is to direct the fate of the newly generated cells to specifically replace those lost to disease.The key to the effective treatment of NSCs is molecular regulation of the differentiation of NSCs and their progeny in areas of injury to the adult CNS,the fate of transplanted stem cells is also important.

Objective To investigate the value of dual-source CT perfusion imaging in evaluation of liver fibrosis stage.Methods Liver fibrosis models were established with 35 rabbits (experimental group)which were intraperitoneally injected with carbon tetra-chloride.Meanwhile,other 5 rabbits were regarded as control group which were intraperitoneally inj eced with physiological saline.7 rabbits of experimental group and 1 of control group were undergone dual-source CT perfusion scan at 4,6,8,10,12 weeks respec-tively.Arterial liver perfusion (ALP),portal venous perfusion (PVP),total hepatic perfusion (THP),hepatic perfusion index (HPI)were recorded,and staging of liver fibrosis were assessed by pathological method.Results With the increase of liver fibrosis degree,HPI showed an upward trend,whereas PVP was opposite.HPIs of S2,S3 and S4 stage were significantly different com-pared to that of control group respectively.The differences of HPI between S3,S4 stage to S0 and S1 stage were significant.PVP between S2,S3,S4 stage to S0 stage and S1 stage were also significant different.Conclusion HPI and PVP can reflect the perfu-sion changes of liver fibrosis stages.Combination of HPI and PVP may help the diagnosis of S2,S3 or S4 stage of liver fibrosis.

Objective To determine whether strain and strain rate derived from velocity vector imaging ( VVI) allowed assessment of regional and global right ventricular ( RV) dysfunction and intra‐and inter‐ventricular dyssynchrony in patients with pulmonary hypertension ( PHTN) . Methods Ninety‐nine patients were enrolled , including 35 controls and 64 PHTN patients . All participants underwent echocardiography examinations and off line strain/strain rate analysis . Bi‐ventricular regional peak systolic strain ,strain rate ,and the time‐to‐peak systolic variables were measured at the RV free wall ,inter‐ventricular septum ,and LV lateral wall in apical four chamber views . Standard deviations of the time‐to‐peak systolic strain (SD‐Ts) and strain rate (SD‐Tsr) at six RV and three left ventricular (LV) segments were calculated to define intra‐and inter‐ventricular dyssynchrony . Results Compared with the controls , segmental and global peak systolic strain and strain rate decreased in the PHTN patients . And intra‐right ventricular dyssynchrony was present in the PHTN patients [SD‐Ts:(28 ± 20)ms in controls vs (61 ± 62) ms in patients , P = 0 .003 ] . The difference between the time‐to‐peak systolic strain rate at the basal segment of RV free wall and LV lateral wall indicated earlier RV free wall contraction in PHTN patients , relativetoLVlateralwall,particularlyinthoseseverePHTNpatients[(13±13)msincontrolsvs( -49± 14) ms in patients , P < 0 .01] . Conclusions PHTN impairs RV myocardial contraction and induces to ventricular mechanical dyssynchrony .VVI could monitor RV function during the treatment of PHTN .

Objective To explore the adverse effect of arsenic trioxide (As2O3) on liver,kidney and heart function during treating children patients with acute promyelocytic leukemia (APL) at therapeutic dose.Methods Sixty-five APL cases received As2O3 by intravenous drip and organic toxicity were selected as our subjects.The indices of liver,heart and kidney were measured.Results Of all subjects,19 cases(29.2％) occurred liver damage,including 15 cases(23.1％) mild and 4 cases(6.2％) moderate toxicity.The levels of alanine aminotransferase of patients before treatment was (19.9 ±9.5) U/L,and (24.3 ± 11.8) U/L,(25.0 ± 14.4) U/L at 1 st and 2nd weeks after treatment,higher than those before the treatment (P ＜ 0.05).However,level of alanine aminotransferase was back to normal at 3th weeks after treatment.Meanwhile the levels of aspartate aminotransferase at 1st,2nd and 3th weeks after treatment were (38.3 ± 16.5),(39.1 ± 15.5),(35.3 ± 20.6) U/L respectively,higher than that before treatment((28.5 ± 8.8) U/L,P ＜ 0.05 or 0.01),and it was back to normal at 4th weeks.(2) The levels of urinary cystatin C were (2.51 ± 1.45) mg/L,(3.05 ± 1.13) mg/L,(2.46 ± 1.21) mg/L at 2nd,3th,4th weeks after treatment,significantly higher than that before treatment ((1.98 ±0.68) mg/L,P ＜0.05 or 0.01).And the levels of urinary β2 microglobulin at 2nd,3th,4th weeks after treatment were significantly higher than that before treatment (P ＜0.05 or 0.01) and back to normal at 5 weeks after treatment.(3) Nine cases at remission stage showed the symptoms of palpitation,precordial discomfort and increased heart rate,and all those symptoms were mild.And the symptoms disappear at the 3th week after the treatment.Creatine kinase at the 2nd weeks after treatment was (90.2 ± 32.5) U/L,higher than that before treatment ((78.5 ± 22.3) U/L).The levels of creatine kinase isoenzyme at 2nd,3th weeks after treatment were (8.3 ± 4.8) U/L,(8.5 ± 5.6) U/L,higher than that before treatment ((6.3 ± 3.5) U/L).The serum creatine kinase mass at 4th weeks((3.9 ±2.0) g/L) was significantly higher than that before treatment ((2.8 ± 1.9) g/L),and then gradually be back to normal.Conclusion The routine dose As2O3 in treatment of APL children show less toxicity in liver,kidney,and heart Those adverse effects are transient,reversible and they occurred at 1-3 week after As2O3 treatment.Serum alanine aminotransferase,aspartate aminotransferase and urinary cystine protease inhibitors,β2 micro ring protein and serum creatine kinase MB mass might be served as sensitive indicators of organ damage.

Objective To discuss the effect of comprehensive mental intervention on mental health and sleep quality among the crew members during the Escort Mission in the Gulf of Aden.Methods The same batch of two escort ships was divided into study group and control group.The study group was intervened by comprehensive psychological intervention methods involving diversified forms of psychological training, counseling, behavioral intervention and cooperation between various departments.A psychological survey was conducted with Symptom Checklist 90( SCL-90) , Self-rating Anxiety Scale (SAS), Self-rating Depression Scale(SDS) and Pittsburgh Sleep Scale(PSQI) before and 3 months after intervention. Results There was no significant difference between the two groups before intervention (P>0.05).After intervention,the score of SCL-90 of study group was significantly better than that of the control group in somatization,obsessive compulsive disorder,interpersonal relationship,depression, anxiety,bigotry and hostility (P<0.05), while the score of SAS and SDS was lower(P <0.05).Sleep quality, the time taken to fall asleep, sleep time, dyssomnia,sleep efficiency,daytime dysfunction factor and the total score of PSQI were significantly more desirable than in control group (P<0.01).Conclu-sion Comprehensive intervention can effectively improve mental health and sleep quality of the crew members in the escort mission in the Gulf of Aden.It is worthy of popularization and application.

By using the high resolution mass spectrometer TripleTOF 5600 , three kinds of standard proteins including bovine serum albumin ( BSA) , ovalbumin ( OVA) and lysozyme C( LYZC) were analyzed, and the correlationship between the ion intensity of mass spectrometry and the relative content of protein sample was investigated. The protein samples were digested by trypsion and diluted to 1-1024 fmol in 7 μL. The ion counts per second ( cps) were used to stand for the amounts of proteins and peptides. Then the correlation between sum of ion intensity ( cps) of all the peptides, number of peptides detected and the amount of proteins was investigated. By comparing the change of values of the same sample in three parallel experiments, a linear relationship between these indexes and the amount of proteins within 1-1024 fmol was found when the cps was more than 1000. Usually, the maximal ion intensity was no more than 1. 5 times of the minimum value for same peptide in triplicate experiments, which suggested that the 3 times or more change of ion intensity was the minimum threshold to determine the differences of proteins amounts in different samples. This study provides a relative quantitative analysis method using qualitative data of high resolution and high scan speed mass spectrometry, which can quickly and easily provide reference for biological and medical research.