Objective To evaluate the outcomes of cardiac surgery in neonates weighing less than 2500g and premature infants. Methods From January 2000 through March 2005, 36 consecutive critically symptomatic neonates (26 males, 10 females) weighing less than 2500g underwent cardiac surgery at our center. Median gestational age was 34 weeks with 24 (70.6%) premature (≤37 weeks). Median age at operation was 15.5 days (from 4 days to 68 days). Median weight was 2120g (from 700g to 2500g). Indications for surgery were: persistent ductus arteriosus (PDA, n=15), coarctation of the aorta (CoA, n=3), transposition of great arteries with severely hypoplastic aortic arch (TGA/HAA, n=1), ventricular septal defect (VSD, n=10), pulmonary atresia with intact ventricular septum (PA/IVS, n=5), total abnormal pulmonary venous return (TAPVR, n=2). The heart functions of all patients were assessed in NYHA class IV and 7 patients (19.4%) were intubated pre-operatively. 18 cases (50%) needed extracorporeal circulation and deep hypothermia with circulatory arrest was used in 6 patients. Results The overall mortality was 11.1%. The causes of death were left heart failure in 1 patient and multiorgan failure in 2 and hypoxmia in 1. Mean extracorporeal circulation time was 92 min (from 72 min to 198 min). Mean aortic cross-clamping time was 76 min (from 46 min to 158 min). Mean deep hypothermia with circulatory arrest Peritoneum dialysis was carried out in 5 cases. Mean follow-up period was 22. 3 months (from 2 months to 46 months). 2 patients underwent reoperation and catheter intervention respectively. The heart functions of 26 patients (81.4%) were in NYHA class I at the latest clinical examination. Conclusion This study suggests that complete repair of simple and complex congenital heart diseases can be performed effectively in low birth weight neonates with acceptable mortality and morbidity. Low weight alone should not be considered as a contraindication to surgery in these patients. It is recommended that such neonates undergo early surgical correction rather than prolonged conservative palliation.

Biomarkers ; blood ; metabolism ; Diabetes Mellitus, Type 2 ; blood ; diagnosis ; genetics ; metabolism ; Humans ; MicroRNAs ; genetics ; Polymorphism, Single Nucleotide ; genetics ; Precision Medicine ; methods

Objective The feasibility of constructing endothelialized vascular graft by using cryopreserved HUVCs was studies. Methods Forty-two human umbilical cords were used in this study. HUVECs were isolated by means of filling umbilical veins with digestive enzyme solution. HUVECs were then cultured and observed. Endothelial cells were identified by von Willebrand factor immunofluorescence staining and scanning electron microscope examination. Endothelial cells were suspended in cryopreserving solution which contains 10% DMSO and 10% fetal bovine serum in M199 and cryopreserved in liquid nitrogen. Post-thawed cells and non-frozen cells proliferation was evaluated by measuring the metabolic activity of tetrazolium compound. The endothelial cell growth characteristics were determined by daily observation using phase contrast microscope. Post-thawed endothelial cells viability was determined by trypan blue staining test. Flow cytometry were applied to determine the apoptosis rate of post-thawed cells. Cryopreserved endothelial cells morphological examinations such as hematoxylin and eosins staining and scanning electron microscope examination were carried out in this study. After cell culture and amplification, cryopreserved HUVCs were seeded on the inner surface of Gore-Tex graft to construct tissue engineered vascular graft. Results Extreme high-purified endothelial cells could be isolated by infusing digestive solutions to the lumen of human umbilical veins. Compared with non-frozen endothelial cells, Post-thawed endothelial cells showed 95% of vitality. Post-thawed HUVEC growth curve was similar to non-frozen ones'. Post-thawed HUVEC apoptosis rate (5.85? 0.56) % was higher than non-frozen ones (5.34?0.49)%; however, the difference was not statistically different. Endothelialization of vascular graft was carried out successfully. Cryopreserved cells on Gore-Tex surface showed a good growth trend. Conclusion Cryopreserved HUVCs may be taken as a cell choice for tissue engineering. Enough high pure endothelial cells could be isolated by digestive solutions infusion of human umbilical veins. Post-thawed endothelial cells are proved to have high vitality and growth potential on Gore-Tex surface in vitro.

ObjectiveTo investigate the dosage of protamine to counteract heparin in patients with different pH values of after - surgery plasma of congenital heart defect.MethodsThe clinical data of 108 patients during March 2011 to April 2011 with congenital heart diseases who underwent cardiopulmonary bypass(CPB) surgery were reviewed.The volumes of chest tube drainage were analyzed to investigate the dosage of protamine in patients with different pH values in plasma.ResultsThe dosages of protamine and the volumes of chest tube drainage[ ( 136.8 ± 22.8 ) ml] in patients with an acidic environmental plasma were higher than the patients in another group [ ( 112.6 ± 22.7 ) ml ] ( P＜ 0.01 ).In patients with non-acidic environments,the mean ratio of dosage of protamine to heparin was 1.23:1 ; meanwhile in patients with pH＜7.30 or base excess (BE) ＜ -6,the mean ratio was 1.86:1.It suggested the dosage of protamine increased significantly in patients with an acidic environmental plasma.ConclusionsDifferent plasma pH values could change the dosage of protamine after cardiopulmonary bypass,and the acidic environment would increase the dosage of protamine and increase the volume of chest tube drainage after surgery.When pH ＜ 7.30 or BE ＜ - 6 at the end of CPB,to correct acid-base balance first and then calculate the dose of protamine was recommended.

Objective To construct the eukaryotic expressing plasmid of tumor necrosis factor-related apoptosis-inducing ligand(TRAIL),and study its inhibitory effect on hepatic tumor which implanted subcutaneously in nude BALB/c mice.Methods Total RNA of U937 cell was extracted, and its extracellular domain (114-281aa) was amplified by RT-PCR, then signal peptide was ligated. The recombinant secreting plasmid for TRAIL was constructed successfully which was confirmed by enzyme cleavage identification and sequencing identification. Liver cancer cell (strain No.7402) was implanted subcutaneously in 32 nude BALB/c mice. These mice were randomly divided into two groups: study group and control group. The mice in study group received muscular injection of plasmids for transfection, and the mice in control group received the injection of normal saline at the same time. The size of implanted tumors were measured continuously till the day of sacrificing, tumor cell apoptosis effect was examined by TUNEL method. Results In study group,tumor volume was smaller than that in control group and the blue-purple apoptosis cells were observed under microscope. Conclusion TRAIL plasmid can induce apoptosis of liver cancer cell and can inhibit the growth of liver tumor.

Objective　To investigate the prognosis in risk of ventricular arrhythmia in coronary heart disease with heart rate variability (H RV), left ventricular ejection fraction (LVEF) and other clinical background dat a. Methods　A total of 81 patients were divided into ventricular premature beats (VPBs)≥30/h group and VPBs<30/h group. Their LVEF, HRV and cli nical data were studied and analyzed. Results　The age and blood pressure between 2 groups had no significant difference. LVEF, standard deviati on of all normal RR intervals (SDNN), SD of the average of NN interval (SDANN) a nd HRV triangular index (HRVI) were significant less in VPBs≥30/h group than in VPBs<30/h group (43.29±15.38 vs 67.33±11.47，P＜0.01；90.05±22.2 9 vs 117.90±30.32，P＜0.05；77.43±17.78 vs 105.69±28.79，P＜0.05 ；24.54±8.70 vs 32.70±10.87，P＜0.05, respectively). Incidence of myo cardial infarction (MI) was larger in VPBs≥30/h group than VPBs<30/h group. LVE F was the independent predictable factor in risk of ventricular arrhythmia with multinomial regression logistic analysis（B=0.119, P=0.032）. Co nclusion 　Our findings indicate that LVEF is an independent predictable factor i n risk of ventricular arrhythmia in coronary heart disease. Although HRV and MI history can not be used to predict VPB, significant difference is found between 2 groups. High-risk patients could be selected successfully when these data are considered in combination.

Objective A retrospective study was undertaken to evaluate the outcomes of the newborns with pulmonary atresia with intact ventricular septum(PAIVS),in order to delineate strategies for the optimal management of PAIVS. Methods From July 2003 to July 2008,17 neonates with PAIVS underwent surgical treatment.The mean age at operation was(1 5.6±8.6)d and the mean weight was(3.54±0.44)kg.Initial surgical treatment included:Blalock-Taussig shunt (BT shunt)in 2 cases,closed pulmonary valvotomy and BT shunt in 1 case,right ventricular outlet tract reconstruction(RVOTR)in 2 cases,RVOTR and BT shunt in 11 cases. Results The mean duration of mechanical ventilation and intensive care unit stay were(35.5±35.1)h and(8.7±5.9)d,respectively.Two early deaths were reported inside the hospital(2/17,11.8%).Multivariable analysis demonstrated that mechanical ventilation before surgery was the risk factor for in-hospital mortality(r=1.02,P<0.01).The rest 15 cases were followed up with the average time of 19 months(2 months to 5 years)and no death was reported. Conclusions Neonates with PAIVS should be operated early.Individualized treatment strategy and regular follow-up are helpful to achieve better short-term outcome.

Objective To evaluate early and mid-term results in infants,weighing less than 2 500 g,who underwent early cardiac surgery on cardiopulmonary bypass (CPB).Method Since November 2003 to December 2007,28 consecutive infants of less than 2 500 g underwent early cardiac surgery on CPB in Children's Hospital Affiliated to Fudan University.Sixteen infants were male,and 12 infants were female.The mean pregnancy period was 34 weeks (30 to 41 weeks) ,and 14 patients were premature,and the mean birth weight was 2 010 g(1 370-2 500 g).Mean age at operation was 27.46 d (range 1～61 d),and mean weight was 2 391 g (range 1 500～2 500 g).Deep hypothermia circulatory arrest was used in 9.Indications for surgery were:ventricular septal defect (10 infants),transposition of great arteries (6 iofants),totally anomalous pulmonary venom return (5 infants),pulmonary atresia with intact ventricular septum(2 infants),coarctation of aorta (1 infants) ,interrupted aortic arch (1 infants),cortriatriatum(1 infants),abnormal original of fight pulmonary artery (1 infants).Resuits Two (7.14%) infants died after operation at early phase.Mean duration of mechanical ventilation and intensive care unit stay were 113.9 h and 14.4 d,respectively.During follow-up (mean 16.87 months),one died.Two patients needed reintervention.About 84.4% infants didn' t need reintervention at the end of 12-month followup.Conclusions If medicine is aseless,infants woth low birth weight and congenital heart defect can obtain satisfactory outcome after CPB.Perioperative proration for virtual organs should be payed attention to.

Objective To assess the radiofrequency ablation (RFA) lesions in canine prostate with real-time harmonic gray-scale contrast-enhanced ultrasonography and investigate the feasibility to predict these lesions.Methods A total of 5 male beagle dogs took RFA of the prostate.Radiofrequency (RF) was delivered under transrectal ultrasound (TRUS) guidance.A lesion was created in the right and left lateral lobes of canine prostate,respectively.The examination of conventional gray-scale ultrasonography,power Doppler ultrasonography,real-time harmonic gray-scale contrast-enhanced ultrasonography were performed immediately after RF procedure.All animals were subsequently sacrificed and the prostates were harvested for pathologic analysis.Thermal lesion volume was calculated based on expected shape of ellipsoid using equation.The volumes of the calculated thermal lesion on contrast-enhanced ultrasonography in dogs were compared with the volumes obtained from the pathological specimens.Results The RFA lesions could not be imaged accurately with real-time conventional gray-scale or power Doppler ultrasonography.However,contrast-enhanced low MI perfusion imaging was able to have real-time monitoring for the lesion (no blood flow).The volume of lesions was measured with contrast-enhanced ultrasonography without significant difference with those of pathologic results.Ultrasonic imaging(conventional gray-scale or power Doppler sonography)of the ablation areas also had its own characteristics.Conclusion The real-time harmonic gray-scale contrast-enhanced ultrasonography appears to be an accurate modality for assessment of RFA lesions.Conventional gray-scale and power Doppler sonography had their own characteristics to evaluate the RFA lesion.

Corneal endothelial cell(CEC)is the most critical part for the cornea, of which activity can influence the postoperative vision.It is very important for the clinical cornea preservation considering the function and its self-purification of donor cornea.There are a variety of classical methods, which can significantly prolong the saving time of donor cornea with its good quality of CEC.We reviewed the published papers about present preservation methods of cornea, which can give us many suggestions for the clinical cornea preservation.