Objective To summarize the clinical data of cardiac transplantation in 28 patients of our hospital,and study the effectiveness of operation and the methods of immunosuppressive regime.Methods From January 2000 to May 2005,in our center,28 patients were subjected to orthotopic cardiac transplantation.In early stage(before 2003) ciclosporin A and mycophenolate mofetil were used for immunosuppression.In late stage(after 2003) Daclizumab and mycophenolate mofetil were used for immunosuppression.Results Orthotopic cardiac transplantations were done successfully in 28 patients.There was no haemorrhage,twist and right heart insufficiency postoperatively.In the patients before 2003,the complications of hepatic-renal inadequacy to varying degrees occurred in 6 cases and infection in 3 cases respectively.In the patients after 2003,there were no complications of hepatic-renal inadequacy and infection.Conclusions Cardiac transplantion is an effective way for end stage cardiomyopathy.Immunosuppressive effect of Daclizumab and mycophenolate mofetil is satisfactory.

Objective To evaluate the curative effects and complications of synthetic dural substitute (Neuro-Patch) in the surgical treatment of Chiari type I malformation (CMI) complicated with syringomyelia (SM). Methods .Forty patients suffered from CMI with SM were given foramen magnum decompression and duraplasty between June 2002 and June 2004. The duraplasty was performed using either synthetic dural substitute (Neuro-Patch Group, n=20) or autologous fascia lata (Autologous Group, n= 20). Results .Symptoms were improved in 17 patients in both of groups (85.0%) at 6 months postoperatively, and no deterioration of symptoms was seen. Postoperative pyrexia occurred in 12 patients in the Neuro-Patch Group (60.0%) and 9 patients in the Autologous Group (45.0%), without significant differences (?2=0.902,P=0.342). No statistically significant differences were observed between the Neuro-Patch Group and the Autologous Group in the operating time (3.6?0.7 h vs. 3.4?0.4 h; t=1.109,P=0.274), the time to the onset of postoperative pyrexia (7.3?3.4 d vs. 9.4?2.5 d;t=-1.560,P=0.135), the length of duration of postoperative pyrexia (range, 1~19 d vs. 1~8 d, median, 4.5 d vs. 2 d;z=-1.643,P=0.100), the drainage time (1.3?0.5 d vs. 1.2?0.4 d; t=0.230, P=0.820), the drainage volume (range, 15~300 ml vs. 20~250 ml, median, 80 ml vs. 37.5 ml; z=-1.359,P=0.174), the duration of antibiotic administration (15.8?4.8 d vs. 13.7?1.5 d;t=1.260,P=0.223), and the assessment outcomes of curative effects. The length of duration of hormone requirement was longer in the Neuro-Patch Group (12.8?4.1 d) than in the Autologous Group (7.8?3.1 d) (t=3.055, P=0.007). On MRI examinations at 6 postoperative months, no posterior cranial fossa effusion was detected in both of groups. Follow-up checkups for 9 months ~ 2 years in the 40 patients showed delayed infectious granuloma on the wound in 1 patient in the Autologous Group, which was cured by debridement. Conclusions .The Neuro-Patch is a reliable dural substitute for repairing of dural defects in the treatment of CMI associated with syringomyelia.

Objective To discuss the diagnosis and treatment of brain abscesses. Methods A total of 20 patients with brain abscesses from January 1996 to June 2004 were studied.All the patients received a CT scanning,and 8 patients were given an MRI examination(two of them underwent a magnetic resonance spectroscopy).An administration of ceftriaxone in combination with metronidazole was given for 1~9 weeks(mean,3.7 weeks).Surgery was conducted in 8 patients under the guidance of CT scanning or B-ultrasonography,including 3 cases of abscess resection and 5 cases of aspiration and drainage. Results One patient died of ventricle involvement,16 patients were cured without after-effects,and 3 patients were improved but the hemiplegia was left behind.No surgery-related deaths were encountered in the 8 surgical cases.Among 8 patients who complicated with diabetes mellitus,tuberculosis,HIV infection,or kidney transplantation,4 patients were cured;all the remaining 12 patients without co-morbidities were cured.Among 9 patients with lesions closely near the ventricle,5 were cured,while the rest of 11 patients with superficial abscesses were all cured.All the 5 patients with multiple abscesses were cured,and 11 out of 15 patients with solitary lesion were cured. Conclusions Most brain abscesses can be cured by early diagnosis and early drug administration.The magnetic resonance is an important means for early diagnosis,and the stereotactic operation is a favorable surgical treatment.

Objective To investigate the diagnosis and treatment of multiple spinal intradural extramedullary tumors.Methods Totally 15 patients(11 men and 4 women) with multiple spinal intradural extramedullary tumors were enrolled in this study.The patients aged from 16 to 81 years with a mean of(51.0?21.2) years.The mean course of the disease was(11.0?7.6) months(range:2-27 months).In the patients,no skin neurofibroma or coffee spots were detected;brain MR showed no abnormalities.Enhanced MR revealed totally 46 spinal intradural extramedullary tumors,35 of which ≥0.5 cm in diameter,involving the cervical segment in 1 case,the thoracic segment in 5,and lumbar and sacrum segments in 12.All the patients received tumorectomy via the posterior midline approach.If the tumor was less than 1 cm,hemilaminectomy was performed under a microscope;the tumor was removed completely,while crucial nerves supplying the tumor were conserved as much as possible.When it is difficult to separate the nerves,we freed the roots of the nerves at our best ability,so that to carry out anastomosis of the roots after removing the tumor.Antibiotics and hormone therapy were administered after the operation,and the patients were required to wear neck/waist support brace for 2 months,and practice the back and waist muscles at the meantime.Results Among the 15 cases,total resection of the spinal tumors was performed on 12 patients(33 tumors were removed),of which one patient received anastomosis of the nerve roots.In the other three patients,two were diagnosed as having scattered multiple small neurofibroma or Schwannoma(

Objective To study the experience of cricohiodoepiglottopexy(CHEP) in the cases with glottic cancer. Methods A retrospective analysis has been carried out in 36 cases with glottic cancer. All cases treated in our hospital with supracricoid laryngectomy with CHEP. Results All 36 cases kept the normal airway, swallowing and speech. Conclusion CHEP is a useful technique for laryngeal cancer, particularly for glottic cancer.

Objective To investigate the correlation between the-1562 C/T polymorphism of matrix metalloproteinase-9 (MMP-9) and the risk of ischemic stroke.Methods All the relevant literatures published were searched from PubMed,Embase,MEDLINE,Web of Science as well as CBMdisc and CNKI before May 2013.After extracting data,a meta-analysis of the studies meeting the requirements was conducted by using Review Manager Version 5.0 and Stata 11.0 software.The effect size was pooled and odds ratio (OR) and 95％ confidence interval (CI) were calculated.Results Six studies were enrolled,including 1115 patients and 979 controls.The ORs after pooled analysis (95％ CIs) were C/T vs.C/C:1.10 (0.71-1.71) and T/T vs.C/C:1.78 (0.89-3.57) of the codominant genetic model,respectively; C/T + T/T vs.C/C:1.13 (0.76-1.67) of the dominant genetic model; T/T vs.C/T + C/C:1.79 (0.90-3.57) of the recessive genetic model,which suggested that there was no significant correlation between the-1562 C/T polymorphism of MMP-9 gene and the risk of ischemic stroke.The analysis of 5 studies in Chinese populations showed that the ORs (95％ CIs) of the above 4 genetic models were 1.24 (0.76-2.04),1.43 (0.52-3.92),1.25 (0.80-1.97),and 1.33 (0.49-3.62),respectively.There were also no significant differences.Conclusions According to the analysis of the available literatures,there was no significant correlation between the-1562 C/T polymorphism of MMP-9 gene and the risk of ischemic stroke.

Objective To investigate the association between podocytes and proteinuria in children with Alport syndrome. Methods Twenty-one children including 13 boys and 8 girls with Alport syndrome were divided into 3 groups according to 24-hour urinary protein, ＜30 mg/kgas the mild proteinuria group (10 patients), 30 to 50 mg/kg as the moderate proteinuria group (4 patients) and ＞50 wg/kg as the heavy proteinuria group (7 patients). The correlation between foot process width and the degree of proteinuria was analyzed. By immunoperoxidase staining on renal tissue, the key slit diaphragm molecules nephrin, podocin and podocyte cytoskeleton-associated molecule synaptopodin were studied. Results The foot process width (420-2270 nm) in patients with Alport syndrome was positively correlated with proteinuria significantly (r=0.765, P＜0.01).Foot process width was significantly lower in patients with mild proteinuria [475 (420-900) nm)compared with that in patients with heavy proteinuria [1520 (480-2270) nm] (P＜0.05). In Alport syndrome children with heavy proteinuria, the distribution of nephrin and podocin changed dramatically. In two children with shorter proteinuria period (1 year), dramatic distribution change of nephrin and podocin occurred, however, the foot process along with synaptopodin preserved.Conclusions Podocyte foot process effacement and injury of slit diaphragm participate in the mechanism of proteinuria in Alport syndrome. The injury of slit diaphragm seems to be an early event in the development of foot process effacement in Alport syndrome, which may guarantee early treatment.

Objective:To analyze the curative effect of discectomy under Quadrant expandable channel associated with annulus repair for the treatment of adolescent lumbar disc herniation (ALDH).Methods:10 ALDH patients received discectomy under Quadrant expandable channel associated with annulus repair (annulus repair group) and 12 patients received discectomy (control group) in Clinical Medical College of Yangzhou University from January 2013 to December 2017 were retrospectively collected. The length of skin incision, amount of intraoperative bleeding, operation time and duration of hospitalization were compared. The degree of pain was assessed by visual analogue scale (VAS) before operation, 24 h, 1 week and 1 year after operation, and the lumbar function was assessed by Oswestry disability index (ODI) before operation, 1 week and 1 year after operation. At the last follow-up, the curative effect was evaluated by MacNab Scale, and the recurrence of lumbar disc herniation during the follow-up was recorded.Results:There were no significant differences in the amount of intraoperative bleeding, operation time and duration of hospitalization between the two groups ( P>0.05). The skin incision length of the annulus repair group was less than that of control group ( P<0.05). The postoperative VAS score and ODI score at each follow up time point in both groups were significantly improved when compared with the preoperative ones ( P<0.05). There were no statistically significant difference between the two groups in the VAS score and ODI score 1 week postoperative and 1 year postoperative ( P>0.05). According to the MacNab criteria, there was no statistically significant difference between the two groups in the excellent and good rate (annulus repair group: 9/10, control group: 10/12; P>0.05). There was no recurrence case in the annulus repair group, but two cases of recurrence (one recovered by conservative treatment, the other needed second operation) in the control group ( P<0.05). Conclusions:Discectomy under Quadrant expandable channel associated with annulus repair can achieve early satisfied outcome, reduce surgery related trauma, pain in the early period postoperative and recurrence rate after operation in the treatment of ALDH.

We retrospectively analyzed the clinical manifestations,treatments and prognosis of infective endocarditis (IE)associated with renal lesions in children.There were 23 confirmed IE cases who were admitted to the Capital Institutes of Pediatrics from 1992 to 2012.There were 6 cases (26％) with renal lesions.Renal lesions included asymptonatic microscopic hematuria(1 case),asymptomatic proteinuria (1 case) and acute nephritic syndrome (4 cases).There were 3 cases of acute renal injury (AKI) resulted from nephritis accompanied with acute heart failure.The serum level of C3 was lower in patients with renal lesions than patients without renal lesions (P ＜ 0.05),but the clinical manifestations,physical signs and other laboratory findings were the same.Patients of both groups were treated with antibiotics.All patients were recovered and discharged.The average hospital days were (39.2-± 15.2)days for patients with renal lesions and (34.9-± 19.2) days for patients without renal lesions (P ＞ 0.05).Renal lesions secondary to IE are relatively common in IE patients in children.Most of renal lesions can be improved by effective antibiotics.Prognosis of those patients accompanying with AKI is bad.