The technology of artificial intelligence and the diagnosis of medical laboratory are combined to design a prototype of medical laboratory expert system.Adopting the present successful production rule to express the method as knowledge and using inaccurate inference engine,this prototype designs and realizes six major function module,such as "laboratory project meaning analysis",etc.It can be used as a clinical tool.

Objective To observe functional changes of the right ventricle (RV) during off-pump coronary bypass grafting (OPCABG) by using a continuous cardiac output (CCO) monitoring. Methods The study included 178 patients with 2~3 vessel disease requiring a coronary bypass grafting. Preoperative cardiac functions were classified as New York Heart Association (NYHA) class Ⅱ in 72 patients, class Ⅲ in 84 patients and class Ⅳ in 22. The ejection fraction of the left ventricle was 0.35~0.82. The mean number of bypassed vessel was 3.3. A Swan-Ganz catheter was inserted for continuous monitoring of cardiac output by thermodilution. Parameters measured were heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), mean pulmonary artery pressure (MPAP), right atrial pressure (RAP), pulmonary capillary wedge pressure (PCWP), cardiac output (CO), cardiac index (CI), stroke volume index (SVI), systemic vascular resistance index (SVRI), pulmonary vascular resistance index (PVRI), mixed venous saturation value (SvO_2), right ventricular ejection fraction (RVEF), right ventricular end-systolic volume (RVESV), right ventricular end-diastolic volume (RVEDV), right ventricular end-systolic volume index (RVESVI), and right ventricular end-diastolic volume index (RVEDVI). The hemodynamic parameters were measured at time-points when a stable hemodynamics was obtained after the induction of general anesthesia and before the heart would be moved (T1), when the anterior descending branch would be anastomosed (T2), when the circumflex branch or the diagonal branch would be anastomosed (T3), when the right coronary artery or the posterior descending branch would be anastomosed (T4), and when the heart had been repositioned before the thoracic cavity would be closed (T5), respectively. Results There were 4 fatal cases: 2 patients received an emergency surgery for acute myocardial infarction and died with severe low cardiac output syndrome 3 days after the surgery, 1 patient ended with severe respiratory failure 7 days after the surgery, and 1 succumbed to acute pulmonary embolism 4 days after the surgery. As compared with the time-point of T1: the MPAP, PCWP, RAP and PVRI were significantly elevated and the SvO_2 was significantly reduced at the time-point of T2; the MPAP, PCWP, RAP, PVRI and SVRI were significantly elevated and the SvO_2, CI, SVI and RVEF were significantly depressed at the time-point of T3; the HR and RAP significantly went up and the SvO_2 significantly dropped at the time-point of T4; the parameters didn’t recover to normal levels at the time-point of T5. Conclusions When the obtuse marginal (OM) branch is anastomosed, right ventricular functions may decrease, particularly in CI and RVEF levels, while when the left anterior descending branch or right coronary artery is anastomosed, hemodynamics of the right ventricle vary within narrow limits. Therefore, a monitoring of right ventricular functions during OPCABG is of great significance, especially for those with right ventricular insufficiency.

Objective: To summarize the experience of corrective surgery for Ebstein's anomaly. Methods: 139 patients with Ebstein's anomaly were operated on from June, 1980 to January, 2000. Among them, 111 cases received atrialized ventricle plication, tricuspid valve plasty and Devega tricuspid annuloplasty, 27 cases undergoing tricuspid valve replacement. One case of right ventricular hypoplasia received extra total cavopulmonary connection (ETCPC). Results: In the whole group, there were 12 operative deaths, with mortality rate of 8.6%. While in the later 10 years, operative mortality rate was reduced to 3.3%. In the group of plastive operation, 10 cases were re-operated with valve replacement and all were survived. Conclusion: Operative method of Ebstein's anomaly should be decided according to the pathologicoanatomic feature. For mild type, tricuspid valve plasty should be chosen. For medium A type, plastic operation should be performed. For medium B type, plasty or valve replacement should be cautiously selected. For severe type, valve replacement should be considered.

Objective: To summarize the experience of clinical application of extracardiac valved tubes in complex congenital heart disease. Methods: From September 1979 to December 2001, 131 patients with complex congenital heart disease underwent surgical treatment by using extracardiac valved tubes, including 22 cases of aortic valved homografts, 73 cases of swine pulmonary valved tubes and 36 cases of extracardiac tubes with anti-calcified swine pericardium valve. Results: The overall mortality rate was 17.5%. The mortality rate has decreased to 10.7% in the late 10 years, and 4.5% in recent 5 years, respectively. Conclusion: It was suggested that aortic and pulmonary valved homograft preserved by liquid nitrogen is the first choice for extracardiac valved tubes. Extracardiac tubes with anti-calcified swine pericardium valve can also be used and they easily available. A better postoperative haemodynamic effect can be achieved by proper placement of the tubes, choice of suitable size and positioning in good geometrical figure.

Objective To explore the influence of diabetes on the protective effect of ischemic preconditioning(IPC) on ischemic-reperfused(IR) myocardium of rat.Methods Sixty male SD rats(30 with diabetes and 30 without diabetes) were divided into six groups(10 each): non-diabetic rats control group(group A),non-diabetic rats IR group(group B),non-diabetic rats IPC group(group C),diabetic rats control group(group D),diabetic rats IR group(group E) and diabetic rats IPC group(group F).The isolated heart perfusion Langendorff models were established after rats were sacrificed.Isolated hearts of the two control groups were undergone a 90min perfusion without any other intervention;those of the two IR groups were undergone a 30min equilibration period,a 30min ischemia and a 30min reperfusion;those of the two IPC groups were undergone a 10min equilibration,then elicited by two cycles of 5min ischemia interspersed with 5min reperfusion prior to 30min ischemia and a 30min reperfusion.The recovery rates of the left ventricular function,such as cardiac output(CO) and left ventricular developed pressure(LVDP),and the maximum upstroke and decay velocities of left ventricular pressure(?dp/dtmax) were recorded.The activity of creatine kinase(CK) in coronary outflow,contents of malonyldialdehyde(MDA) and superoxide dismutase(SOD) in myocardium were detected,and myocardial water ratio were assessed.Results In non-diabetic rats IPC group,the activity of CK,content of MDA and water ratio of myocardium declined significantly,while the content of SOD increased and the recovery rates of CO,LVDP and ?dp/dtmax rose significantly compared with that in non-diabetic rats IR group(P0.05).Conclusion Diabetes may inhibit the protective effect of ischemic preconditioning on ischemic reperfused rat heart.

Objective To evaluate the effects of inhaled nitric oxide in the early period after extracardiac total cavopulmonary connection (ETCPC). Methods 32 patients after ETCPC were evaluated,of them 16 patients (experimental group) were administered with inhaled nitric oxide in the early postoperative period. Another 16 patients were as control. The cardiac index (CI), pulmonary vascular resistance(PVR), respiratory index(RI), pulmonary-left atrium pressure gradient(PLG), duration of ventilation, intensive care time, hydrothorax drainage and hospital stay were recorded. Results In experimental group, after inhaled NO, RI decreased from 2.61?0.32 to 1.41?0.21 (t=2.35,P

Objective To evaluate the experiences of complete repair of tetralogy of Fallot with pulmonary atresia (TOF-PA). Methods From June1984 to December 2003, 24 patients with TOF-PA underwent complete surgical repair. There were ten males and fourteen females. The age ranged from 6 months to 9 years. 14 patients were in type I TOF-PA, type II 8, type III and type IV 1 each. Through a standard median sternotomy incision, all patients were operated on under moderate hypothermia and cardiopulmonary bypass. An artificial vessel patch with a monocuspid valve was applied to enlarged the outlet of right ventricle in typeIpatients and a conduit with valves from right ventricle to pulmonary artery was applied in typeII patients. Midline one-stage complete unifocalization and repair of ventricular septal defect and major aortopulmonary collaterals were used in patients with type III and IV. Results Early mortality was 13.3% (4 patients). The causes of death were severe low cardiac output (2 patients), respiratory function failure (1 patient) and multiorgan function failure (1 patient). There was no late death. 18 patients were followed up from one month to 15.5 years. Postoperative heart function (NYHA) was class I or II in 16 patients and class III or IV in 2. Conclusion Surgical repair of patients with TOF-PA can be achieved with acceptable mortality and good results. In selected patients one stage surgical correction can be done through a midline sternotomy approach.

Objective To discuss the surgical technique in correction of tetralogy of Fallot with complete atrioventricular septal defect (TOF-AVSD). Methods 16 patients aged 2-16 years underwent correction of TOF-AVSD. The atrioventricular septal defect was closed through a right atriotomy and longitudinal right ventriculotomy in each case. The three-patch technique was used for the first 7 cases and two-patch technique for the later 9 cases. The commissure between the superior and inferior bridging leaflets of the left portion of the common atrioventricular valve was closed in each patient. RVOT obstruction was relieved by a transannular patch. Results Results There were 4 deaths in the early postoperative period, 3 deaths in the first 7 cases compared to 1 death in the later 9 cases (P

Objective To report the outcomes of double switch operation as the primary approach for congenital corrected transposition of great arteries (cTGA) with heart anomaly. Methods From April 2002 to June 2004, seven patients ranged 4 to 15 years with cTGA underwent double switch operation. Six patients were situs solitus (SLL segmental anatomy) while one patient was situs inversus (IDD segmental anatomy). The heart defects included ventricular septal defect in 6 cases, secondary atrial septal defect in, double outlet of right ventricle in 1, pulmonary stenosis in 6, dextrocardia in 3 and levocardia in 1. The operative procedures comprised of 4 modified Senning+Rastelli, Mustard +Rastelli +bidirectional Glenn, 1 Senning +Rastelli, 1 modified Senning+switch. Results There was one early operative death after modified Senning+switch operation. The cause of death was left ventricular failure. The postoperative complications included severe low cardiac output syndrome in 1, temporary atrioventricular block in 1, pleurisy and low plasma protein in 2. The survivors were followed up from 2 to 24 months, all of them were in sinus cardiac rhythm except one case with junction cardiac rhythm. All were in NYHA I class. Conclusion Anatomic correction of cGTA by double switch operation can be performed with lower operative mortality and good medial-term outcome. In the SLL cases, modified Senning operation may yield better outcomes than Mustard operation.

Objective To assess the damage of secondary focal segmental glomerulosclerosis(sFSGS) in IgA nephropathy (IgAN). Methods Clinical and pathological data on 182 patients with IgAN were analysed quantitatively ,who had pathological damage of sFSGS.The clinical data included gender,age,blood pressure,urine protein,serum creatinine (Scr),blood urea nitrogen (Bun),uric acid (UA),blood cholesterol (Ch),triglycerides (TG),serum total protein (TP),albumin (Alb) and creatinine clearance rate (Ccr).The data of pathology included quantitive integration in focal and segmental glomerulosclerosis,cellular proliferation,mesangial proliferation,crescent,inflammatory cell infiltration,interstitial fibrosis,tubule atrophy and angio-lesion.The multivariate over univariate statistical analyses had been done,finding the correlation among the factors.Results The most common clinical type of 182 patients' was asymtomatic urine abnormality(50.55%),then were hypertension with/no chronic renal function failure and mass proteinura/nephrotic syndrome.The quantitive value of urine protein,Scr,Bun and UA increased as exacerbation of sFSGS' degree.It showed that inflammatory cell infiltration,interstitial fibrosis,tubule atrophy and angio-lesion had intimate correlation with sFSGS(r_1=0.377,r_2=0.169,r_3=0.412,r_4=0.331,P