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 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.

[ABSTRACT]AIM:Toinvestigatetheeffectsofmechanicalstretchontransientoutwardpotassiumcurrent(Ito), inward rectifier potassium current ( IK1 ) and action potential duration ( APD) of cultured neonatal rat atrial myocytes . METHODS:Neonatal rat atrial myocytes were isolated and cultured on silicone sheeting with or without stretch for 24 h. The silicone membrane area was increased by 12%in stretched group.The cells without stretch served as control .Ito, IK1 and APD were recorded by the technique of whole-cell patch clamp.RESULTS:Compared with control group, Ito density in stretched myocytes was significantly reduced [(1.6 ±0.4) pA/pF vs (12.1 ±2.9) pA/pF, P<0.01], whereas IK1 density was increased [(-10.8 ±0.8) pA/pF vs (-8.8 ±0.9) pA/pF, P<0.01].The APDs at 50%and 90%levels of repolarization ( APD50 and APD90 ) in the stretched cells were obviously decreased than those in non-stretched cells [(10.5 ±1.4) ms vs (15.5 ±2.4) ms, (30.0 ±2.8) ms vs (56.3 ±3.6) ms, P<0.01].CONCLUSION: Stretch stimulation leads to the reduction of Ito density, the increase in IK1 density and the shortness of APD in cultured rat atrial neonatal myocytes , which may contribute to atrial electrical remodeling induced by pressure overload .

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.

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 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.

Objective To decrease the incidence of acute rejection in renal allograft recipients by monitoring of cyclosporine A (CsA) concentration at 2-hour after dosing(C2). Methods The CsA C2 and CsA trough concentration(C0) were assayed in renal allograft recipients.All patients were followed up for at least 1 year.The correlation of C0 and C2 monitoring with clinical outcomes was analyzed. Results At 1 week and 1 month post-transplantation,the incidence of acute rejection in patients with C2 in target level was 4.41% and 10.29%, respectively,but the incidence of acute rejection in patients with C2 in lower level was 42.37% and 36.20%,respectively. ConclusionBy reflecting the drug exposure of CsA more accurately,C2 monitoring is beneficial for decreasing the incidence of acute rejection after renal allograft transplantation.