Objective Compare and analyze the serum proteomics data of healthy human and patients with bronchial asthma(both before and after ICS treatment).Then explore the possible pathogenesis and therapeutic targets.MethodsSelect 102 patients with chronic persistent asthma who were diagnosed and treated in our hospital during December 2015 to December 2016, and recruit 102 cases of healthy volunteers over the same period.The patients were treated with conventional ICS, after 8 weeks of treatment, compare and analyzethe serum proteomics data of healthy people and both patients with bronchial asthma (both before and after treatment).ResultsAfter treatment, patients with asthma still got poorer lung function than normal ones (P<0.05);at the same time, all of the serum HSP70, Eotaxin, MMP-9 of pre-treatment patients were higher than healthy individuals (P<0.05), although they had declined after treatment (P<0.05), but still higher than normal people(P<0.05).ConclusionHuman serum HSP70, Eotaxin, MMP-9 may not only be involved in the pathogenesis progress of asthma, but the mechanisms of treating asthma with ICS.

To observed the Clinical effect of ropivacaine (Rop) of different concentration used for analgesia of labor, and ex plore the ideal concentration and dosage. Methods: 45 case s of ASA Ⅰ-Ⅱ primiparae nearing labor were vandomly divided three groups rand omly (0.16% Rop group, 0.2% Rop group were assigned 15 cases). The analgesia, in which the cervical os had opened up to 2-3cm; the controlled group was not giv en the analgesia of labor. BP, SpO2, EKG, PETCO2, cerrical contraction , fetal cardiac sounds were monitored continuously in the perinatal analgesia pe riod. The analgesia effects were determined by giving a mark for pain by VAPS, motor nerve blockings were given amark by Bromage scale; Apgar scale were conduc ted 1-5 min after neonates were labored out. Results: The vital signs of three groups were stable in perinatal; the VAPS scale was lower s ignificantly in observed group than in controlled group; while the blocking freq uency and extent of motor nerve were highest from 0.2% Rop, which had light inhi bitory effect to cervical contraction, causing the dosage of oxytocin to increas e relatively; the NACS scale 24 h after labor was more increased significantly in observed group than controlled group. Conclusion: The un ique blockings to sense and motor were obviously separate, having no obvious eff ect to blood stream of uterus and placenta, being benificial to analgesia in per inatal. The 0.16% Rop was a more ideal local anaesthesia agent than 0.2% Rop .

AIM: To study the role of peroxisome proliferator-activated receptor-α (PPAR-α) signal transduction pathway in cardiac hypertrophy induced by high glucose and insulin (HGI). METHODS: The cultured neonatal rat cardiomyocytes were used to observe the effect of fenofibrate (FF), a selective PPAR-α agonist, on cardiomyocyte hypertrophy induced by HGI (glucose at concentration of 25.5 mmol/L and insulin at 0.1 μmol/L). The cardiomyocyte hypertrophic responses were assayed by measuring the cell surface area, protein content, and mRNA expression of atrial natriuretic factor (ANF). The expressions of mRNA and protein were assayed by real -time PCR and Western blotting. RESULTS: In cultured cardiomyocytes, HGI induced profound change of hypertrophic morphology, the significant increase in cell surface area, protein content and ANF mRNA expression compared to those in vehicle control (P<0.01), but the expressions of PPAR-α mRNA and protein decreased significantly (P<0.05). At the same time, the expression of cyclooxygenase 2 (COX-2), one of the PPAR-α downstream effectors was obviously elevated (P<0.05). However, FF (0.1, 0.3 and 1 μmol/L) inhibited the cardiomyocyte hypertrophy induced by HGI in a concentration-dependent manner (P<0.01). FF at concentration of 0.3 μmol/L increased the expressions of PPAR-α in both mRNA and protein levels (P<0.05) and inhibited the expressions of COX-2 (P<0.05), which were abolished by MK 886 (0.3 μmol/L), a selective PPAR-α antagonist (P<0.05). CONCLUSION: PPAR-α signal transduction pathway and its downstream effector COX-2 might involve in the cardiomyocyte hypertrophy induced by HGI.

AIM:To study the role of peroxisome proliferator-activated receptor-? (PPAR-?) signal transduction pathway in cardiac hypertrophy induced by high glucose and insulin (HGI). METHODS:The cultured neonatal rat cardiomyocytes were used to observe the effect of fenofibrate (FF),a selective PPAR-? agonist,on cardiomyocyte hypertrophy induced by HGI (glucose at concentration of 25.5 mmol/L and insulin at 0.1 ?mol/L). The cardiomyocyte hypertrophic responses were assayed by measuring the cell surface area,protein content,and mRNA expression of atrial natriuretic factor (ANF). The expressions of mRNA and protein were assayed by real -time PCR and Western blotting. RESULTS:In cultured cardiomyocytes,HGI induced profound change of hypertrophic morphology,the significant increase in cell surface area,protein content and ANF mRNA expression compared to those in vehicle control (P

Clinical ophthalmic surgery is a special branch of general surgery,the microsurgery of ophthalmology has properties of high-precision,high-risk and longer learning curve.The ophthalmology department of Tongji University Hospital has explored a set of step-by-step and efficacious postgraduate student education method,including theoretical basis,in vitro stimulation and in vivo practice.The intervention of quality control and incentive mechanism were also included.

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 clinical effect of lung transplantation for pediatric pulmonary artery hypertension (PAH).Methods The recepter 1 and 2 with idiopathic pulmonary artery hypertension (IPAH) were diagnosed by right catheterization.The heart fuction was NYHA IV.The pulmonary artery pressure and mean pulmonary artery pressure were 110/70mmHg and 148/72 mmHg respectively.They underwent bilateral sequential lung transplantation with extracorporeal membrane oxygenation (ECMO) support.During operation,the ECMO support time was 550 min and 450 min and the blood loss was 3000 ml and 1200 ml respectively.The recepter 3 with end-stage congenital ventricular septal defect with Eisenmenger syndrome (ES) who had received open heart exploration underwent right single lung transplantation and ventricular septal defect repair under cardiopulmoanry bypass(CPB).There were ventricular septal defect and bidirectional shunt through UCG assessment The pulmonary artery pressure and mean pulmonary artery pressure were 110/60 mmHg.CPB time was 244 min.The three recepters had the same ABO blood group and the similar body type with the three donors.Results The recepter 1 and 2 was sustained by ECMO after operation for 16 h and 13h respectively.But unstable hemadynamics and acute left heart failure occured on 3rd and 4th day after the operation respectively.We treated them with ventilate support and tracheotomy on 3rd and 6th day respectively.They were also treated with cardiotonic; dieresis and the patients were weaned away from the ventilation on 33rd and 12ed day after the operation respectively.The transplanted lung of the receptor 3 had pneumochysis in the first 3 days.The patient was treated with ventilate support and tracheotomy on 7th day and was weaned from the ventilation on 12ed day after the operation.An acute rejection episode occurred on 14th day.The cordioform and heart function of the three cases improved and especially the receptor 3 had intact repaired of ventricular septal defect.They were discharged from the hospital on 93rd,32ed and 62ed day afer the operation.The heart function all reached NYHA I and the pulmonary artery pressure and mean pulmonary artery pressure was reduced to 54/32 mmHg,60/36 mmHg and 53/39 mmHg respectively.The three cases have been followed up for 41 months,21 months,and 82 months.They are having an excellent quality life.Conclusion Lung transplantation is effective to improve the quality of life for end-stage pediatric pulmonary artery hypertension even with slight right ventricular dysfunction with satisfying short-term results.

Objective To investigate the effectiveness and safety of bilateral lung transplantation with simultaneous lung volume reduction surgery in the treatment on end-stage lung disease and analysis its prognosis.Methods Clinical data of 79 patients with end-stage 1ung diseases receiving BLTx in our hospital were retrospectively analyzed between Sept.2002 to Dec.2012.Bilateral lung transplantations were performed on 48 male and 31 female patients, with a mean age of(57.0 ± 6.3) years (ranging from 15 to 75 years).Amongst them 56 patients received LTx under circulation support,including 1 cases of cardiopulmonary bypass(CPB) support and 55 cases of extracorporeal membrane oxygenation(ECMO) support.34 patients accepted lung volume reduction surgery, other 45 patients receive standard BLTx.The Patients were divided into lung volume reduction group(group Ⅰ)and control group(group Ⅱ).Differences in various clinical parameters such as Pulmonary function, postoperative complications, and prognosis between the two groups were compared.Results The 1、2、3 and 5-year survival rate after LTx was 80.5％ 、71.4％ 、58.2％ and 43.5％.The mean survival time post-transplant in size reduction group and control group were(38.54 ±4.72) months and(42.19 ±6.64) months repectively.The main causes of mortality included primary graft dysfunction(PGD) ,acute rejection(AR) , multiple organ failure(MOF) , bronchiolitis obliterans(BOS) and sepsis.No tendency of increase in mechanical ventilation, chest tube drainage time, volume of chest drainage were observed.Compared clinical parameters between the two groups, none had significant differences(P ＞0.05).Lung function test was performed on 63 cases after transplantation.There was no significant difference in FEV1 improvement after lung transplantation between the two groups[(74.23 ±4.86)％, (72.0 ±3.64)％, P ＞0.05].Conclusion This study demonstrates that BLTx with simultaneous lung volume reduction surgery is safe and effective, which have the same outcome and prognosis compare with standardbilateral lung transplantation.

Objective To determine the changes of heart structure and function in early stage after lung transplant and to study the relationship between decreased pulmonary artery pressure and changes of heart structure and function.Methods 45 cases of lung transplant recipients were included in the study,their preoperative and postoperative echocardiography data were reviewed,and the postoperative early changes of cardiac structure and function were analysed.Then,the Pearson correlation analysis was used to compare the relationships between the decrease of pulmonary artery pressure and the changes of cardiac structure and function.Results After lung transplant,pulmonary artery systolic pressure(PASP) decreased significantly [(62.3 ± 27.2) vs (36.20 ± 7.8)mm Hg,P ＜0.01],and right ventricular dimensions zoomed down,tricuspid valve and pulmonary valve regurgitation reduced,left atrial diameter (LAD) and left ventricular end-diastolic diameter (LVDD) were enlarged,stroke volume (SV) increased [(43.85 ± 14.78) vs (58.68 ± 13.85)],but left ventricular ejection fraction (LVEF) was decreased [(69.31 ± 7.50)％ vs (62.82 ± 8.12) ％],those differences above were statistically significant (P ＜ 0.05) compared with preoperative echocardiography date.Pearson linear correlation analysis show that after lung transplantation the more decreased PASP,the more increased LAD and LVDD,and the more decreased LVEF (P ＜0.05).Conclusions In early stage after lung transplant,the structure of right ventricular was quickly normalized,the function of right ventricular improved,LAD enlarged,SV increased,but left ventricular function reduced,there were a linear correlation between those changes and PASP reduced.Echocardiography has good reference value for early lung transplant patient.

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.