Objective To sum up the experience of perioperative management of patients with heart transplantation.Methods In recent 3 years 24 cases of dilated cardiomyopathy,4 cases of(serious) valve disease,1 case of serious ischemic cardiomyopathy and 1 case of bi-ventricular assist(received) heart transplantation surgery.The mean by pass time was 75?24 min and the mean aortic clamp time was 72?8 min.Cyclosporine,MMF and prenisodone were adopted as anti-immune(response) strategy and the dose of cyclosporine was adjusted according to the serum concentration.(Intramyocardial) electrograms and tissue Doppler ultrasound technique were used to monitor the(immune) response situation.The myocardial biopsy was performed in case of the suspect of acute(rejection).Results In 5 postoperative deaths,3 cases died of low cardiac output,1 died of infection-(induced) multiple organ failure and 1 case died of serious bleeding.The postoperative complications(included) right heart failure in 6 cases,renal failure in 13 cases,and acute rejection in 4 cases.(Conclusion) The effective prevention and management of complications is the key point of success of heart transplantation.Application of comprehensive monitoring techniques is beneficial to the management of the immune rejection after transplantation.

Objective To study some sensitive electrophysiological parameters in surveillance of allograft rejection.Methods Forty rats underwent heterotopic heart transplantations.IMEG was re- corded by an epicardiac unipolar pacing lead fixed at the right ventricular outflow tract.QRS amplitude and heart rate were determed daily in 10 syngeneic and 30 allogeneic transplants.Syngeneic transplants were killed at 7 th postoperative day,and allogeneic transplants killed at 3 rd,5 th and 7 th postopera- tive day.Histopathologie studies were performed at every transplanted heart.Results In syngeneic group,QRS amplitude kept constant after the transplantation while no significant differences were ob- served at the 3 rd,5 th and 7 th postoperative day.QRS amplitude was dropped obviously in allogeneic group after the first two postoperative days whereas significant differences were observed at the rejec- ting and non-rejecting hearts.Conclusions IMEG is a valid method to monitor acute allograft rejec- tion.QRS amplitude is a more sensitive electrophysiological parameter to diagnose severe rejections than heart rate,while mild rejections were not detected by this method.

Objective To investigate the dynamic changes of Th 17 ,NK and IFN-γ,IL-17 in periop-erative patients with lung cancer .Methods Twenty cases of patients with lung cancer surgery were chosen ran-domly.Ten cases of healthy were used as control .We detected the express of Th17,NK,IFN-γand IL-17.Re-sults Compared with the control group , the levels of Th17 and IL -17 increased significantly in lung cancer group(P<0.05);Compared with the pre -operation,the levels of Th17 and IL-17 increased significantly after 1st day of lung cancer surgery .However,the levels of NK and IFN -γdecreased significantly .The expression of Th17 and IL-17 decreased obviously after 5 days of lung cancer surgery .However,the levels of IFN -γin-creased significantly(P<0.05).The correlation analysis showed that there was a positive correlation between Th17 and IL-17A,NK and IFN-γof peripheral blood with lung cancer patients (P<0.01),negative correla-tion between Th17 and NK,IFN-γof peripheral blood with lung cancer patients (P<0.05).Conclusion The immune suppress before activating at perioperative ,it is important for lung cancer patients to detect the levels of Th17,IL-17,NK,IFN-γin peripheral blood .

Objective To study the changes of CD4 +/CD8 +T cells ratio and TGF -β,IL-4,IL-6 levels in lung cancer patients during the perioperative period and to analyze the clinical significance .Methods Flow cytometer and Elisa were used to analyze the CD 4 +/CD8 +T cells ratio and TGF-β,IL-4,IL-6 levels in peripheral blood sapmles from 20 patients with lung cancer during the perioperative period and 10 healthy con-trolsR. esults Before operation ,the ratios of CD4 +T and CD8 +T cells from 20 patients with lung cancer were (46.26 ±4.26)%and(43.15 ±5.18)%, respectively.On the fifth day after operation ,the ratios of CD4 +T and CD8 +T cells were(44.30 ±4.25)%and(39.80 ±2.53)%.TGF-β,IL-4 and IL-6 levels in 20lung cancer patients were(240.51 ±46.37)pg/mL,(19.85 ±2.52)pg/mL,and(129.28 ±33.06)pg/mL,respectively.On the fifth day after operation,TGF-β,IL-4 and IL-6 levels were(210.79 ±36.94)pg/mL,(17.37 ±2.57) pg/mL,and(107.28 ±27.83) pg/mL.The differences of above parameters between the preoperative period and the fifth day after operation were statistically significant ( P<0.05) . Conclusion The immune suppression oc-curs before its recovery during perioperative period ,the changes of CD4 +/CD8 +T cells ratio and TGF-β,IL-4 and IL-6 levels have significance on monitoring the progress and prognosis of patients with tumor .

Objective To explore the relationship between cholelithiasis and the function of sphincter of Oddi (SO). Methods To identify the existence of calculi, choledochoscopy was performed in patients 6 weeks after exploration of the common bile duct (CBD) and T tube drainage, in which 71 were patients with stones in gall bladder, CBD or intra-hepatic bile duct, and 9 with trauma of pancreas or liver.Biliary manometry was performed after choledochoscopy, and an additional manometry was applied after calculus removal if calculi were detected. The indices measured included SO basal pressure ( SOBP), amplitude of SO contractions (SOCA), frequency of SO contractions (SOF) and CBD pressure (CBDP). The patients with cholelithiasis were classified into cholecystolithiasis group, choledocholithiasis group, and hepatolithiasis group according to the position of calculi. Patients with trauma were assigned as the control group.Results All variables in 50 patients with choledocholithiasis were similar before and after the procedure.The variables in patients with cholecystolithiasis and choledocholithiasis had no difference from those of the control (P ＞ 0. 05 ). The SOBP and SOCA of patients in hepatolithiasis group were lower than those of the control group ( P ＜ 0. 05 ), while no difference in SOF was detected (P ＞ 0. 05 ). Conclusion The function of SO in patients with hepatolithiasis is abnormal ( decrease in SOBP and SOCA). Biliary manometry cannot be the reliable evidence for the existence of calculi in bile duct.

ObjectiveTo analyze the perioperative risk factors of right heart failure (RHF) in human heart transplantation, and to summarize the efficacy of targeted agent especially on pulmonary hypertension.Methods Patients underwent heart transplantation were selected by exclusion criteria : (1) acute heart or other organ failure, or supported by mechanical assist device ; (2) the difference between the body weight of donor and recipient was ＞ 20％ ; (3) the ischemic time of donor was＞ 6 h; (4) acute rejection episode after transplantation; (5) perioperative death.The clinical data of 96 patients were collected, including gender, age, body weight, protopathy, history of heart failure, preoperative systolic pulmonary arterial pressure (SPAP), left ventricle end diastolic diameter (LVEDD), preoperative ejection fraction(LVEF), preoperative blood creatinine, donor ischemic time and preoperative application of 5-PDEs.The diagnosis standard of RHF was established.The risk factors were analyzed through Logistic Regression.Patients were divided into two groups according to the systolic pulmonary arterial pressure (SPAP).In group A, SPAP was ＜40 mm Hg, and in group B with SPAP≥40 mm Hg.The correlation between two groups was tested byχ2 test.ResultsIn the multivariable analysis, age, history of valve disease, length of heart failure,and preoperative SPAP were the risk factors of RHF with the coefficient of 1.051, 1.351, 1.712 and 6.725, respectively.SPAP seems to be the most important risk factor.Coronary artery disease and preoperative application of 5-PDEs-I were the favorable factors with the coefficient of 0.056 and 0.034, respectively.Parameters regarding age, history of valve disease, length of heart failure between the two groups were significantly different.There were no significant differences in gender, body weight, diagnosed as dilated cardiomyopathy or coronary artery disease and other etiologies, preoperative LVEDD, preoperative EF, preoperative blood creatinine, isehemic time and RHF, though the incidence of RHF in group B was higher than in group A (67.6％ vs 45.8％).There was also no statistic difference in using of ECMO and the mortality rate between two groups.ConclusionPreoperative PAP was the main risk factor of the RHF after heart transplantation.Although there was no statistic difference, the incidence of RHF in patients with SPAP≥40 mm Hg was higher than in patients with SPAP ＜40 mm Hg .The application of targeted agent therapy and ECMO may be helpful in treating RHF after heart transplantation.

BACKGROUND:Researches about sub-health status in general community population are rare,especially in minor nationalities.OBJECTIVE:To explore the sub-health status and its risk factors with logistic regression model and negative binomial regression model in Tibetan people.DESIGN,TIME AND SETTING:A cross-sectional study was performed among subjects selected from Songpan county in the Aba Tibetan and Qiang Autonomous Prefecture of Sichuan Province on September 2007.PARTICIPANTS:A total of 1791 Tibetan subjects from were recruited from Songpan county in the Aba Tibetan and Qiang Autonomous Prefecture of Sichuan Province and were involved in this study,among which 1763 subjects completed the sub-health questionnaire.Their average age was 27 years,ranging from 10 to 80.There were 731 male subjects (41.5%)and 1032 female ones (58.5%).All subjects were informed of the survey regimen.METHODS:The sub-health rating scale framed by Chen Qingshan et al was used to assess the sub-health status of subjects with stratified and cluster sampling,including the prevalence rate of sub-health status,the number of sub-health symptoms and various dimensional prevalence.MAIN OUTCOME MEASURES:Risk factors of sub-health status with logistic regression model and negative binomial regression model.RESULTS:There were 1038 subjects suffering from one or more sub-health symptoms,and they were considered as being in the sub-health status with the prevalence of sub-health 58.9%.The split-half reliability and internal consistency of the scale were separately 0.7658 and 0.8154.Logistic regression results indicated that the seniors (P=0.0004),female (P＜0.0001),marriage status (P=0.0008),mental labor (P=0.0021)and smoking (P＜0.0001)were main contributing factors of sub-health status.However,marriage status (P=0.0689)and occupation (P=0.1398)weren't statistically significant in negative binomial regression analyses.CONCLUSION:Tibetan populations living in high altitude are also suffering from sub-health status and should be given more attention.Further more negative binomial regression model could be popularized to analyze sub-health and its influencing factors.

Objective To sum up the experience of diagnosis and treatment of paraduodenal hernia. Methods The clinical data of 18 cases of paraduodenal hernia treated by surgery were analyzed retrospectively. Results The average age of the patients was 34 years old.There were 15 cases with left paraduodenal hernia and 3 cases with right paraduodenal hernia.Ten patients usually had no clinical symptoms,while acute abdominal pain occurred after full food in 7 cases,and after vigorous movement in 10 cases respectively.Abdominal X-ray revealed complete or incomplete intestinal obstruction in 16 cases,while abdominal CT revealed abnormal cystic loops of small intestine between the pancreas and the stomach in 10 cases.All 18 cases underwent surgical operation,recovered 10-15 days after operation.After 2-8 years follow-up,there was no hernia recurrence.Conclusion Paraduodenal her-nia is difficult to diagnosis before operation,and the key to correct diagnosis and treatment is to explore the positive exploratory laparotomy.

Objective To explore the changes of the pressure of sphincter of Oddi(SO)in postoperative patients with cholangiolithiasis.Methods Sixty cases with multiple biliary calculi operation (recurrent cholangiolithiasis group),80 cases with biliary calculi operation at first time(cholangiolithiasis group)and 9 cases with external injuries of pancreas or liver(control group),who were examined in order to identify common bile duct pressure(CBDP),SO basal pressure(SOBP),amplitude of SO contractions (SOCA),frequency of SO contractions(SOF),then comparing the difference of statistics among the three groups.Results CBDP,SOBP,SOCA,SOF in recurrent cholangiolithiasis group and cholangiolithiasis group were significantly higher than those in control group[(13.78 ±9.91),(12.65 ±7.64)mm Hg(1mm Hg =0.133 kPa)vs.(12.54 ± 2.35)mm Hg,(15.27 ± 9.15),(14.89 ± 7.87)mm Hg vs.(13.63 ± 3.27)mm Hg,(106.30 ± 54.70),(98.39 ±38.29)mm Hg vs.(87.65 ±56.38)mm Hg,(6.91 ± 1.92),(6.25 ±2.17)times/min vs.(5.26 ± 2.11)times/min](P ＜ 0.05),but there was no significant difference between recurrent cholangiolithiasis group and cholangiolithiasis group(P ＞ 0.05).Conclusion SO dysfunction resides in the postoperative patients with cholangiolithiasis,and it is possible related with the formation and/or recurrence of cholangiolithiasis.

A method based on gas chromatography-mass spectrometry (GC-MS) was established to analyze the changes of intracellular metabolites and study the toxic mechanisms of different concentrations of particulate matter (PM2.5) effecting the lung tissues in mice.Nasal drip experiments of PM2.5 suspensions (0, 7.5, 20.0, 37.5 g/L) for mice were carried out, and the intracellular metabolites in lung tissues were extracted, pretreated and analyzed.Principal component analysis (PCA) and partial least-squares discriminant analysis (PLS-DA) were employed for pattern recognition, and an obvious distinction among different conditions was found.According to the PLS-DA loading diagram and variable important factor (VIP) value, 7 kinds of potential biomarkers, alanine, valine, leucine, ornithine, fumaric acid, citric acid and purine (p<0.01), were determined with significant differences between four different concentrations of PM2.5.Metabolic pathway analysis indicated that the oxidative stress reactions were enhanced, and the TCA cycle and the purine metabolism in lung cells were restrained after dripping PM2.5 to the lung tissues in mice.This study could provide a new perspective and theoretical basis for the further analysis on toxic mechanisms by PM2.5.