Objective To evaluate the safety and effectiveness of immunosuppression regimens,postoperative complications,dead causes and risk factors of lung transplantation (LTx).Methods The immunosuppression regimens and clinical data of 100 patients with end-stage lung diseases receiving LTx in our hospital were retrospectively analyzed between Sept.2002 to Dec.2010.There were 72 patients subject to single LTx and 28 patients to bilateral LTx,amongst them 61 patients received LTx under circulation support,including 5 cases of cardopulmonary bypass (CPB) support and 56 cases of extracorporeal membrane oxygenation (ECMO) support.The immunosuppression regimens including Cyclosporin,mycophemolate Mofeil and corticosteroids were utilized in 53 recipients before the year of 2007,and Cyclosporin was switched to Tacrolimus in 47 patients after 2007.All the patients received Daclizumab or Basiliximab as immunosuppression induction regimens.Results The 1-,2-,3-and 5-year survival rate after LTx was 73.3％,61.6％,53.5％ and 40.7％ respectively.The mean survival time post-transplant in the patients who received Cyclosporin-based regimens and Tacrolimus-based regimens were (36.57 ± 3.44) months and (35.00 ± 2.33) months,repectively,with no significant differences (P＞0.05).The main causes of mortality included primary graft dysfunction (PGD),acute rejection (AR),bronchiolitis obliterans (BOS) and sepsis.The incidence of AR and BOS in Tacrolimus group was significantly lower than that in Cyclosporin grou (P ＜0.05),but the incidence of diabetes mellitus was significantly higher in Tacrolimus group.Analysis of Spearman rank correlation revealed that there was a direct correlation between the incidence of AR and BOS (r =0.340,P＜0.01).The use of circulation support,diagnosis of IPF,postoperative complications such as AR,BOS and infection were associated with decreased survival time postoperatively,in both univariate and multivariate proportional hazards regression models (P＜0.05).Conclusion Cyclosporin-and Tacrolimus-based regimens were both effective immunosuppression strategies postoperatively,Consummate follow-up surveillance and prompt treatment of complications were the key points in prolongation of survival time and improving quality of life after LTx.

Objective To evaluate the diagnostic value of ultrasonography on thyroid microcarcinoma ,and to find out its sono-graphic characteristics .Methods Ultrasound performance of 206 thyroid microcarcinoma nodules in 150 patients confirmed by sur-gery and pathology were retrospectively analyzed ,nodules internal echo ,boundary ,the shape ,the blood flow and internal calcifica-tion and calcification size ,distribution and type were observed and compared with 82 benign nodules(diameter ≤1 cm) .Results In terms of solid low echo ,minicalcification ,aspect ratio≥1 ,rich blood flow and neck lymph node enlargement ,thyroid microcarcinoma were significantly higher than that of thyroid benign nodules (P<0 .05) .Ultrasonographic performance of thyroid microcarcinoma often presented as solid low echo ,irregular form ,aspect ratio ≥1 ,internal mostly small calcification ,edge blur and the surrounding small burrs .Color doppler blood flow showed that ,blood supply was rich in patients with strong nodules ,distribution was irregular , smaller nodules blood flow was not rich .Conclusion The two-dimensional and color doppler flow imaging(cdfi) might be has a im-portand value on thyroid microcarcinoma diagnosis .

Objective To explore the role of remote ischemic preconditioning(RIPC)in prevention of contrast -induced nephropathy(CIN)in elderly patients undergoing coronary artery angiography(CAA).Methods 106 elderly patients were enrolled in this randomized control trial.According to random number table,the patients were randomized into control group (n =53)and RIPC group(n =53).All of the patients received 1 000mL of 0.9% sodium chloride injection before CAA.The RIPC group patients underwent RIPC in their right arms with sphygmomanometer cuff infla-tion for 5 minutes prior to the CAA,three cycles were repeated.Serum creatinine was detected before and 48 hours after CAA.Results CIN was reported in 10 cases in the control group and 3 cases in the RIPC group(χ2 =4.30, P =0.04).The levels of serum creatinine were increased[(96.38 ±9.50)μmol/L vs (88.87 ±10.24)μmol/L] after CAA in the control group(t =2.28,P =0.03),and there was no difference in the RIPC group(t =1.17,P =0.24).Conclusion RIPC has a protective effect on CIN in elderly patients in our study.Since this method is harm-less and cost effective,further studies is required to popularize PIPC to our clinical practice for prevention of CIN.

ObjectiveTo compare the performance of color Doppler utrasonography (CDUS) alone,magnetic resonance imagine (MRI) alone, and the combination of the two in the diagnosis of thyroid carcinona (TC). MethodsCDUS and MRI results of 54 focuses of carcinoma in 45 cases diagnosed as TC by postoperative pathological results were reviewed. The sensitivity of CDUS, MRI, and the combination of the two in the diagnosis of TC was compared. ResultsThe sensitivity of CDUS and MRI was 77.78％ (42/54)and 81.48％(44/54) respectively. The difference had no statistical significance (P ＞ 0.05 ). The specificity of CDUS and MRI was 88.17％ and 92.47％ respectively, the positive predictive value was 79.25％ and 86.27％ respectively,and the negative predictive value was 87.23％ and 89.58％ respectively. The sensitivity of the combination of CDUS and MRI was 94.44％ (51/54). The difference between the combination and CDUS or MRI alone had statistical significance( P ＜0.05). ConclusionsCDUS has higher detection rate than MRI in microcalcification of TC focus. However, MRI can show more clearly of the peripheral invasion and cervical lymph node metastasis.The combination of the two can improve the accuracy of TC diagnosis.

Objective To investigate the significance of sonographic patterns of thyroid calcification in diagnosis of thyroid nodule.Methods 235 patients with 355 thyroid nodules were retrospectively analyzed.Nodule calcification size,distribution and pattern were observed.Results The incidence of calcification in benign and malignant nodules was 30.3％ (89/294)and 73.7％ (45/61) respectively.The difference had statistical significance(x2 =24.3,P ＜0.01).The rate of microcalcification in cancer was 47.5％ (29/61),higher than that in benign one 3.1％ (9/294)(x2 =99.1,P ＜ 0.01).Coarse calcification in benign nodules and malignant lesion was 27.2％ (80/294)and 26.2％ (16/61)respectively.The difference had no statistical significance(x2 =0.42,P ＞0.05).Conclusions Microcalcification of thyroid nodules is a specific index for thyroid carcinoma.Any type of sonographically detected calcification represents risk of malignancy.Not only microcalcification,these cases should raise the suspicion of malignancy in coarse calcification,especially involving a solitary nodule and irregular shape.

Objective To investigate the effectiveness and safety of bilateral lobar lung transplantations (LLTx) in thoracic cavity size mismatching patients with end-stage lung diseases and analyze its prognosis.Method Clinical data of 34 patients receiving LLTx in our hospital were retrospectively analyzed between Sept.2002 to Dec.2012.LLTx were performed on 14 male and 20 female patients,with a mean age of 37.0 ± 6.3 years (ranging from 15 to 56 years).Indications for LLTx were idiopathic pulmonary fibrosis (n =24),idiopathic pulmonary hypertension (n =2),Eisenmenger syndrome (n =3),bronchiectasis (n =2) and lymphangiomyomatosis (n =3).Amongst them 26 patients received LLTx under extracorporeal membrane oxygenation (ECMO) support and 3 on ECMO as a bridge to transplantation.Twenty-four middle/lower right lobes with left lower LLT,4 bilateral lower LLT,2 bilateral superior LLT and 4 split left lung LLT were performed.Ischemic time was 4.4± 1.2 h for the first lobe and 6.3 ± 1.4 h for the second.Result The mortality in postoperative prophase (30 days) was 23.5％.The 1-,2-,3-and 5-year survival rate after LLTx was 70.9％,60.8％,50.6％ and 36.2％ respectively.The main causes of mortality included primary graft dysfunction,acute rejection,multiple organ failure,bronchiolitis obliterans and sepsis.Lung function test was performed on 23 cases after transplantation and forced expiratory volume in first second,maximal voluntary ventilation accounting for the predicted value was (74.23 ± 4.86)％ and (72.0 ± 3.64)％,respectively.Conclusion This study demonstrates that for thoracic cavity size mismatching patients,LLTx are safe and effective in the treatment of end-stage lung diseases,which can ameliorate the lung function and prognosis.

Objective To estimate the indications, operative technique, perioperative treatment, postoperative complications and the outcome of lung transplantation (LTx) for end-stage pulmonary diseases. Methods The clinical data of 100 patients with end-stage lung diseases receiving LTx in our hospital were retrospectively analyzed. The main indications for LTx were as follows:idiopatic pulmonary fibrosis (IPF, 47/100), chronic obstructive pulmonary disease (COPD, 33/100),silicosis (5/100 ), bronchiectasis ( 5/100 ), Eisenmenger syndrome (4/100 ), secondary lung tuberculosis (2/100), idiopathic pulmonary hypertension ( 2/100 ), lung lymphangioleiomyomatosis ( 1/100), primary alveolar cell carcicoma (1/100). There were 72 patients receiving single LTx and 28 patients receiving bilateral LTx. Sixty-one patients received lTx under circulation support, including 5 cases of cardiopulmonary bypass (CPB) support and 56 cases of extracorporeal membrane oxygenation (ECMO) support. All the patients were followed up when they discharged from our hospital. The issues including postoperative complications and prognosis were observed. Results The perioperative survival rate was 82. 0 % (82/100). There were 18 deaths in early stage (30 days) after LTx: 10 due to pulmonary infection, 6 due to primary graft dysfunction (PGD), 1 due to acute rejection (AR) and 1 due to pulmonary infarction. The common complications included lung infection (11 cases), PGD (10 cases), AR (3 cases), tracheostenosis (10 cases), stoma fistula (3 cases),hemorrhage (3 cases), pulmonary embolism (3 cases), pulmonary artery stenosis (one case) and thrombus in the deep veins of lower limb (one case). During long-term follow-up period, 15 patients developed obliterative bronchiolitis, and one patient suffered from lung cancer in his contralateral native lung. The 1-, 2-, 3- and 5-year survival rate after LTx was 73.3 %, 61.6 %, 53.5 % and 40. 7 % respectively. Conclusion LTx is an effective therapy for various end-stage pulmonary diseases. Perioperative mortality is especially high in patients undergoing LTx. Consummate perioperative management is the key to increase survival rate.

Objective To explore the value of color Doppler ultrasonography(CDU)as preoperative diagnosing and postoperative monitoring in patients with stenosis of subclavian or innominate artery(SIA)before and after percutaneous transluminal angioplasty and stent(PTAS).Methods A total of 45 patients with stenosis of SIA were selected.Their extracranial vertebral artery and subclavian artery were observed with CDU.In 36 patients with one-sided stenosis of SIA.blood flow direction and spectrum of extracranial vertebraI artery were analyzed.Subclavian steal grade confirmed by spectrum change of vertebral artery was compared with the stenosis grade on quantitative angiography(QA).Among 45 patients with stenosis of SIA,PTAS was performed successfully in 36 patients(36 stents implanted).After stents implanted, hemodynamie parameters such as peak systolic velocity(PSV)in stent, follow-up velocity ratio in stem(VR)were measured.Restenosis in stent were observed.Results In 36 patients with one-sided stenosis of SIA,the ultrasonographic steal grade correlated with the QA stenosis grade significantly(r=0.752,P<0.01).Among 36 patients with stent implanted,follow up 8-12 months, 4 patients with restenosis in stent were found.Compared with the patients without restenosis in stent,PSV and VR in stent increased significantly(P<0.01).Conclusions As a fast and non-invasive imaging technique,CDU could allow diagnosis of stenosis of SIA before PTAS,and detection of restenosis after PTAS.

ObjectiveTo evaluate the security and effectiveness of raffinose-low potassium dextran solution (RLPDs) for donor lung preservation.MethodsFrom Sep.2002 to Dec.2011,131patients underwent lung transplantation in our institution,including 81cases of single lung transplantation and 50 cases of bilateral lung transplantation.There were 95 males and 36 females.A total of 129 donors were used for organ harvest.Two donors denoted their lungs to four patients receiving single lung transplantation. All the donors were flushed, perfused antegradely and retrogradely,and preserved with hypothermal RLPDs.The repeated reperfusion was necessary when the cold ischemic time was fairly long and the function of donor was poor.During operation,the blood gas analysis,mean pulmonary artery pressure (mPAP) and breathing mechanics were monitored.Postoperatively,all the recipients received re-examination of cardiac ultrasonography,pulmonary function,blood gas analysis and chest imaging.ResultsAll lung transplantations were performed successfully,with a mean cold ischemic time of (193±21) min (range,65-630 min).There was a significant relationship between postoperative pneumonedema and donor lung cold ischernic time (P＜0.05),which was also observed between postoperative pneumonedema and primary graft dysfunction (P＜0.01). The blood gas analysis and oxygenation index were significantly improved postoperatively,with the mPAP and parameters of breathing mechanics being descended to a normal level.There were 24 early deaths in the first month post-transplant,with a mortality of 18.3％ (24/131),including 11cases of sepsis,7 cases of primary graft dysfunction,3 cases of heart failure,1case of bronchial stomal leak,1case of acute rejection,and 1case of pulmonary infarction.The pulmonary function was improved significantly 3 months postoperatively.Conclusion RLPDs is efficient in the preservation of donor lung,with the ability to alleviate ischemic reperfusion injury and improve pulmonary function.

Objective To summarize the clinical experience ot harvesting and using the lungs from donation after brain death (DBD) and donation after cardiac death (DCD,Maastricht category Ⅳ) in China.Methods Eleven potential DBDs and DCDs were evaluated by our transplant group preoperatively,including 6 cases of DCDs and 5 cases of DBDs,and all of them received the tests of sputum culture bedside bronchoscopy,chest X rays,and blood gas analysis.After clear evaluation,1 case of DCD and 2 cases of DBD were discharged from the group for bilateral inflammatory infiltration and poor oxygenation index,and one case of DCD was precluded due to long warm ischemic time (＞60min).The donor lungs from remaining 7 cases were harvested successfully after the declaration of brain death or cardiac death.The preoperative lymphocytotoxic cross match test was negative,ABO blood types were compatible,and the donors were all suitable for the transplant procedure.Results Seven lung transplants were performed successfully under ECMO support,including 5 cases of bilateral lung transplantation and 2 cases of single lung transplantation.One patient was complicated with severe infection and died of sepsis on postoperative day (POD) 39,and one was succumbed to multiple organ failure.Two patients suffered of acute rejection on POD 30 and POD 19,respectively,and obtained improvements by bolus steroid therapy.The remaining 3 patients all recovered uneventfully.During a follow up period,all the patients lived an active life style with high quality of life.The mean survival time was 23.3 months (3-51 months).Conclusion The DCD and DBD may be one of the available donor resources for lung transplantation after efficient management of the potential donors and detailed preoperative evaluation in China.