Objective To explore the application of high-frequency oscillatory ventilation(HFOV)postoperatively after open heart surgery in children with congenital heart disease.Methods From Jun.2007 to Jun.2008,a total of 1 957 cases were operated in pediatric center of Fuwai cardiovascular hospital.Thirteen cases of 1 957 were given HFOV.Among these 13 patients,8 were male and 5 were female;Age was(13.4?15.4)months.The range of weight was 4.2-12.5 kg.Four cases were tetralogy of Fallot,3 cases were transposition of the great arteries(1 case was corrective transposition of the great arteries),2 cases were total anomalous pulmonary venous connection,2 cases were total endocardial cushion defects,2 cases were pulmonary artery atresia,all patients were under cardiopulmonary bypass repaired operation except 1 patient with PAA under Blalock-Taussig procedure.All patients were mechanical ventilated after surgery.Results The duration of switching general mechanical ventilation to HFOV was(15.70?20.33)days and patients continued to be on HFOV about(10.0?7.5)days.In short term,the lung function of ventilation and gas exchange were be improved by HFOV,but the long-term result was not sa-tisfactory due to a high mortality.There were 5 survived(38.4%)in this group.Six cases of the patients succumbed to consolidation of lung.The commonest complication was pneumothorax(7 cases).Conclusions Short term of HFOV in children with congenital heart disease was satisfactory postoperatively.But there was a high mortality.HFOV can be regarded as a transition method for unsatisfactory long-term.

Objective To analyze the relationship between CT characteristics of chronic subdural hematoma (CSDH) and its recurrence, as well as relevant pathological mechanism. Methods The study involved 178 patients with CSDH who underwent surgery, of whom 38 patients (40 lesions) experienced recurrence of CSDH. Univariate and multivariate logistic analyses were performed to assess the correlation among CT characteristics ( including side, density, width, subtype and midline shift of the hematoma) and CSDH recurrence. Results ( 1 ) The width of hematoma, midline shift, type of hematoma were found to be correlated with the recurrence of CSDH in the univariate analysis. The odds ratio (OR)and 95% confidence interval (CI) value of patients with hematoma width ＞30 mm, midline shift ＞10 mm and the separated type were 18. 400 (2.024-167. 301 ), 4. 643 ( 1. 815-11. 877 ) and 14. 385 (3. 601-57.467 ), respectively. (2) The midline shift and type of hematoma were found to be correlated with the recurrence of CSDH in the multivariate analysis, when the OR and 95% CI value of patients with hematoma midline shift ＞ 10 mm and separated type were 5. 280 ( 1. 339-20. 823) and 19. 125 (4. 175-87.619), the OR and 95% CI value of patients with hematoma width ＞30 mm was 14. 838 ( 1. 353-162.698). Conclusions Type of hematoma and midline shift are found to be independently correlated with the recurrence of CSDH, and the width of hematoma is also related with its recurrence.

AIM:To observe the effects of prostaglandin E2 on transforming growth factor-?1(TGF-?1)triggered human lung fetus fibroblast(HLF)transdifferentiation and connective tissue growth factor(CTGF),collagen type I(COLⅠ)expression.METHODS:HLFs were treated with TGF-?1,the cells underwent phenotypic change to myofibroblast.The marker of myofibroblast-?-smooth muscle actin(?-SMA)was detected by immunofluorescence.The ?-SMA content was measured by Western blotting.The changes in CTGF and COL Ⅰ at transcription levels were estimated by RT-PCR method.CTGF protein expression was evaluated by immunocytochemical.Cell culture medium hydroxyproline amount was measured by colormetric assay.RESULTS:PGE2 blocked TGF-?1 induced ?-SMA positive myofibroblast transformation(P

Objective To explore clinical feasibility of liver transplant from child of brain death to adult, to summarize the clinical experiences that a child of brain death transplants liver to an adult. Methods The recipient was a 39-year-old woman patient with primary hepatic carcinoma and posthepatitis cirrhosis (decompensation stage); while the donor was a 8-old-year child of brain death because of brain neoplasms. Donated liver was gained by the method of en bloc multivisceral procurement in a short time; the operative method was classic orthotopic liver transplantation. The postoperative managements included immunosuppression, prevention of infection, hepatic protection, and other relevant supports etc. Results The transplantation operative duration was 6 hours, after which not only did the recipient survive but also her body functioned well including the liver part, with no severe postoperative complications. Conclusions The technology of transplanting livers from children to adults is feasible. The key to ensure the success of transplant operation is systematic preoperative evaluation, excellent operative technique, and perfect postoperative treatment.

A 32-year old male who had liver cirrhosis accompanying with chronic renal insufficiency (uremia) was suffered from homochronous allograft transplantation of liver-kidney. The blood and other tissue typing were in concord between the donor and recipient. The liver transplantation took typical orthotopic transplantation technique while the kidney transplantation took general operation method to place the transplanted kidney at the recipient's right lilac fossa. Daclizumab was taken for the immunity induction treatment before transplantation while the trigeminy of tacrolimus+mycophemocate mofeil+methylprednisolone were taken as immunosuppressant after transplantation. The transplanted liver and kidney recovered well which could work at once without any serious complications after transplantation, suggesting that combined liver-kidney transplantation was an effective treatment method for homochronous function failure of liver and kidney characterizing by perfect tissue typing, excellent operation skill, reasonable usage of immunosuppresant being the key point of success for transplantation.

Objective To characterize the spinal motion of 6 degrees of freedom (6DOF) under the fulcrum bending in Lenke type 1 adolescent idiopathic scoliosis (AIS) patients using 3D image volume fusion technique.Methods Ten volunteers with Lenke type 1 AIS were examined by the Gemstone Spectral Imaging to obtain their T1-S1 vertebral morphological data in the supine position and fulcrum bending position.With the computer software,images of 2 different positions were fused with the 3D image to obtain in vivo kinematics data of each vertebral body in the target area.Results In the apical vertebrae (AV) region,the main range of motion in the fulcrum bending position ranged from-2.57°± 0.95° to-1.37°± 0.65°,showing significant differences between segments (P ＜ 0.05);along the vertical axis the coupling rotation ranged from-2.71° ± 0.48° to-1.27° ± 0.49°;along the coronal axis,the coupling flexion and extension ranged from 0.19° ± 0.85° to 1.51° ± 0.42°.In the upper end vertebrae (UEV) area,the main ROM ranged from-2.20° ± 1.13° to-1.91° ± 0.76°,showing no significant differences between the 3 segments (P ＞ 0.05);along the vertical axis,coupling rotation ranged from 0.18°±0.47° to 1.35°±0.52°;along the coronal axis,coupling flexion and extension ranged from 1.62° ± 0.41° to 2.07° ± 0.37°.In the lower end vertebrae (LEV) region,the main movement ranged from-0.79°± 0.63° to 0.73°± 1.09°,showing significant differences between the 3 segments (P ＜ 0.05);along the vertical axis,the coupling rotation ranged from-1.62°± 1.05° to-0.60°± 0.60°;along the coronal axis,the coupling flexion extension ranged from -1.41° ± 0.87° to-0.75° ± 0.66°.Conclusionts In the fulcrum bending position,Lenke type 1 AIS shows a unique motion and coupling mechanism in the spine.The coupling rotational movement in the UEV region is at the same side as the lateral flexion movement.The coupling rotational motion in the AV and LEV regions is opposite the lateral flexion movement.

Objective: To explore the role of angiotensin receptor type I (AT1)-calcineurin (CaN) signaling pathway in transient outward potassium ion channel (Ito) remolding in hypertrophic atrial myocytes of neonatal rats. Methods: 1 day old neonatal rats’ atrial myocytes were isolated and the cells were divided into 4 groups:①Control group, normal cells were cultured for 24 h,②Stretching group, the cells were cultured for 24 h with mechanical stretching to induce hypertrophy,③Telmisartan group, the cells were treated by telmisartan at 1 μmol/L for 1 h, then cultured for 24 h and ④Cyclosporin-A (CsA) group, the cells were treated by CsA at 0.25 μg/ml for 1 h, then cultured for 24 h. The ratios of protein/DNA in myocytes were compared between Control group and Stretching group, cell hypertrophy was deifned by mRNA expression of atrial natriuretic peptide (ANP). Ito changes were detected by whole-cell patch clamping technique, proteins expressions of Kv4.3 and CaN A subunit were examined by Western blot analysis. Results: Compared with Control group, Stretching group showed obviously decreased Ito density and Kv4.3 protein expression, while increased CaN A protein expression; Compared with Stretching group, the above effects were reduced in Telmisartan group and CsA group. Conclusion: AT1-CaN signaling pathway was involved in the regulation of Ito channel remodeling in hypertrophic atrial myocytes of neonatal rats.

Objective The Rex shunt has been used to treat children with extrahepatic portal hypertension by creating a venous bypass between the superior mesenteric vein and the left portal vein to circumvent the extrahepatic portal venous obstruction.This retrospective study aimed to analyse our results in the use of this novel approach.Methods 52 patients with cavernous transformation and obstructed main portal veins were treated by Rex shunts.Results The age of children was 1.4 ～ 12 year,the mean age was 3.7 years.The patients were followed up from 1.5 to 5 years.In 48 patients,there was no recurrence of gastrointestinal bleeding after surgery making an efficacy rate of 92.3％.In the recurrence group,the postoperative venous pressure in the superior mesenteric vein was (27.6 ± 3.2) cmH2O (1 cmH2O =0.098kPa) which was significantly higher than the non-recurrence group (23.5 ± 3.1)cmH2O.The difference between the pre-and post-Rex shunting was significantly lower in the recurrence group (5.7 ± 1.8)cmH2O than the non-recurrence group (11.7 ± 3.3) cmH2 O,P ＜ 0.05.Thus,a low reduction in postoperative pressure was an early manifestation of poor prognosis.Conclusions The Rex shunt was safe and efficacious.The degree of reduction in postoperative venous pressure in the superior mesenteric vein could be used to predict recurrence of gastrointestinal bleeding.

Objective To quantify sjTREC using a modified method in patients who underwent allogeneic hematopoietic stem transplantation (all-HSCT),and determine the level of thymic output function and analyse the influencing factors in post-allo-HSCT patients.Methods Real time quantitative PCR was used to detect sjTREC levels from the peripheral blood DNA of pre-transplantation,14 d,28 d,3 m,6 m,9 m,1 y,1.5 y,2 y,2.5 y,and above 2.5 y after HSCT,and analyse thymic output function and related factors after HSCT.sjTREC levels in 24 normal individuals were also determined to use as the normal range.Results The mean of Log (sjTREC copies/ml) in normal individuals was 3.74±0.26.Negative correlation existed between thte Log sjTREC and the age (r =-0.65,P ＜ 0.01).There was no clear association between the TREC and the gender.Log sjTREC in pre-transplantation patients was 3.09±0.52,and the levels of sjTREC in 14 d,28 d,6 m,1 y after HSCT were 1.18±0.22,2.16±0.31,1.31±0.2,1.83±0.31,respectively.There was no significant difference between normal individuals and patients 1.5 years after HSCT.The post-transplantation level of sjTREC was not related to the age,but was negatively correlated to the acute graft versus host disease (aGVHD) 1 year after HSCT.There was no difference between patients with or without aGVHD 1.5 years post-HSCT.Conclusion The modified method for detecting sjTREC is applicable to allo-HSCT.The recovery of thymic output function after allo-HSCT is slow,in which aGVHD may have a negative effect.

OBJECTIVETo investigate the feasibility of using percutaneous K-wires fixation after manipulative reduction combining with gypsum or splint fixation for treatment of the Barton fracture of aged people.

METHODSFrom June 2011 to May 2013, 91 patients with closed and fresh Barton fracture were analyzed retrospectively which information was complete. According to different methods these patients were divided into three groups: 33 patients in group A were treated by simplex fixation of gypsum or splint after manipulative reduction, including 20 males and 13 females with an average age of (63.27 ± 5.83) years old; 35 patients in group B were treated by percutaneous K-wires fixation after manipulative reduction combining with gypsum or splint fixation, including 23 males and 12 females with an average age of (64.25 ± 4.53) years old; 23 patients in group C were treated by open reduction and internal fixation including 15 males and 8 females with an average age of (64.04 ± 4.83) years old.

RESULTSAll the patients were followed up for 10 to 16 months with an average of 12 months by the method of recheckging in outpatient clinic. According Dienst scoring system: in group A, the result was excellent in 15 cases, good in 7 cases, fair in 11 cases; in group B, excellent in 25 cases, good in 6 cases, fair in 4 cases; in group C, excellent in 16 cases, good in 5 cases, fair in 2 cases. The excellent and good rate of group C was better than that of group B and A, further more group B is better than group A. According to X- ray standard, in group A, 26 patients were acceptable, 7 patients were unacceptable; in group B,28 patients were acceptable, 7 patients were uacceptable; in group C, 19 patients were acceptable,4 patients were unacceptable; there were no statistical significant difference (P > 0.05). There were 18 patients with emerging recrispation in group A, 10 patients in group B, 6 patients in group C, the result of group B and C was better than that of group A, and there was no statistically significant between group B and C (P > 0.05).

CONCLUSIONUsing percutaneous K-wires fixation after manipulative reduction combining with gypsum or splint fixation for treatment of the Barton fracture of aged people is an effective method, it has advantages of micro-invasived, reliable fixation, less complication, not need to fix wrist joint and early functional exercise.

Aged ; Bone Wires ; Female ; Humans ; Male ; Manipulation, Orthopedic ; methods ; Middle Aged ; Radius Fractures ; therapy ; Retrospective Studies ; Splints