Objective To investigate the effect of tumor necrosis factor receptor 1 (TNFR1) in angiogenesis and neurogenesis during cerebral ischemia in mice.Methods Twenty-four wild-type and 24 TNFR1 knockout mice were randomly divided into either a sham operation group or a focal cerebral ischemia group (n =12 in each group).5-bromodeoxyuridine (BrdU) was injected intraperitoneally at day 3 after cerebral ischemia and sham operation.At day 7 and 28 after cerebral ischemia,the double-label immunofluorescence staining of glucose transporter-1(Glut-1)/BrdU was used to evaluate the angiogenesis surrounding the areas of infarction.A labeled BrdU was used to detect the neural stem cell proliferation in the subventricular zone.Double-labeled doublecortin (DCX)/BrdU and neuronal nuclei antigen (NeuN)/BrdU were used to detect the migration and survival of neural stem cells,respectively.Results Under the normal condition,there was no significant difference in angiogenesis and the number of BrdU-positive cells in the subependymal zone (SVZ) between the wild-type (418.000 ± 28.404) and TNFR1 knockout (528.000 ± 60.597) mice (t =-1.644,P =0.131).At day 7 after cerebral ischemia,the number of Glut-1/BrdU-positive cells in the TNFR1 knockout mice was significantly less than that in the wild-type mice (14.833 ± 2.182 vs.27.5 ± 4.209) (t =2.672,P =0.023),and the number of DCX/B3rdU-positive cells was also significantly less than that in the wild-type mice (163.000 ± 11.106 vs.257.168 ± 12.213) (t =5.705,P =0.000).At day 28 after cerebral ischemia,the number of NeuN/BrdU-positive cells in the TNFR1 knockout mice was significantly less than that in the wildtype mice (6.000 ± 0.577 vs.11.000± 1.571) (t=2.988,P=0.014).Conclusions TNFR1 may play a promoting role in the neurovascular reggeneration in late cerebral ischemia.

Objective To explore the application value of invasive intracranial pressure (ICP) monitoring in children with severe traumatic brain injur (sTBI).Methods A total of 158 children with sTBI in our hospital from January 2012 to March 2015 were collected and retrospectively analysed.According to whether the child recieved invasive ICP monitoring or not,they were divided into the monitoring group (80 cases) and the control group (78 cases).Children in the monitoring group were embed of invasive ICP monitoring device within first 24 h after surgery,and were treated with appropriate measures according to the ICP level.In the control group,the determination of whether needing to recieve head CT and adjusting the treatment program was made based on the clinical symptoms and surgeon′s experiences.The prognosis of children in the two groups were evaluated by Glasgow coma scale (GOS) and compared at 3 months after injury.At the same time,the prognosis of children in the monitoring group with different ICP levels were compared.Results The favorable prognosis rates in the monitoring group and control group were 61.2% and 41.0% respectively,and there was statistically significant difference between the two groups(P<0.05).The mortality rates of children in the monitoring group had statistical difference among different ICP levels(P<0.05).Conclusion For children with sTBI,the invasive ICP monitoring is contribute to dynamically observing the changes in ICP,early detecting changes of conditions,guiding clinical treatment,and improving the prognosis.

Objective To investigate the effect of health literacy on stroke education in patients with ischemic cerebrovascular disease and their family members.Methods Health literacy questionnaire was used to conduct the health literacy questionnaire survey for patients with ischemic cerebrovascular disease and their family members.The respondents received stroke education randomly through neurologists' explanation or self-reading.The corresponding questionnaire was used to evaluate the mastering of the content of stroke education for the respondents.Results The complete data of 42 patients with ischemic cerebrovascular disease (34 ischemic stroke and 8 transient ischemic attack) and 57 family members of the patients with ischemic cerebrovascular disease were collected and enrolled in the analysis.The good health literacy score group (＜ 10) and the poor health literacy score group (≥ 10) were 61 and 38 subjects respectively.The proportions of younger age (x2 =16.410,P ＜0.001) and high school or above (68.85％ vs.23.68％ ;x2 =19.25,P ＜ 0.001) of the former were higher than those of the latter,and the proportion of patients (32.79％vs.57.89％;x2 =6.043,P=0.014) was significantly lower than that of the latter,but there was no significant difference in the proportion of the males between the two groups (55.74％ vs.44.74％ ;x2 =1.134,P =0.287).Multivariate logistic regression analysis showed that health literacy was independently associated with the age of respondents (≤40 years:odds ratio [OR] 7.753,95％ confidence interval [CI]1.208-49.740; P=0.031) and the level of education (high school and above:OR,3.993,95％ CI 1.305-12.218; P=0.015),and it was not correlated with gender and role.Those with good stroke education score (≥7)and poor stroke education score (＜7) were 57 and 42,respectively.The proportions of younger age (x2 =17.095,P ＜0.001),high school and above (70.00％ vs.23.08％ ;x2 =20.836,P ＜ 0.001),and good health literacy score (88.33％ vs.20.51％;x2 =45.968,P＜0.001) were significantly higher than those of the latter,while there were no significant differences in the proportions of gender,role,and stroke education.Multivariatelogistic regression analysis showed that only the good health literacy was independently associated with the stroke education score (OR 20.147,95％ CI6.089-66.655; P＜0.001).Conclusions Health literacy can significantly affected the effect of the stroke education in patients with ischemic cerebrovascular disease and their family members.In the development of individualized stroke education program,it should be considered.

Objective To investigate the effects of electroacupuncture (EA) on expression of phosphatase and tensin homology deleted on chromosome ten (PTEN) protein and growth associated protein-43 (GAP-43) in rats with Barrel cortex focal ischemia. Methods 24 adult male Sprague-Dawley rats were divided into sham group (n=8), model group (n=8) and EA group (n=8). The EA group accepted EA at Baihui (DU20) and Fengfu (DU16) acupoints 3 days after modeling, 30 min a time, once a day. They were assessed with Corner Test 1 day before modeling, and 3 days, 7 days and 14 days after medication. The expression of GAP-43 and PTEN around infarct zone were detect with Western blotting 14 days after medication. Results The frequence of turn-right decreased in the EA group compared with that in the model group (P<0.001) 14 days after modeling. The expression of GAP-43 increased in the model group compared with that in the sham group (P<0.05), and increased more in the EA group than in the model group (P<0.05). There was no significantly difference in PTEN expression between the model group and the sham group (P=0.460), and significantly decreased in the EA group (P<0.001). Conclusion EA may inhibit expression of PTEN protein and increase expression of GAP-43, which may be involved in nerve regeneration and functional recovery.

Objective In patients with pulmonary atresia and intact ventricular septum ( PAIVS) without right ventricular-dependent coronaries, catheter techniques including the use of a sniff wire, lasers, and radiofrequency have been the most widely used initial therapy. However, percutaneous perforation and balloon valvuloplasty were associated with higher rate of procedural failure and serious complications. Methods We report our experience with a hybrid approach for pulmonary atresia with intact ventricular septum, combining surgery and interventional catheterization techniques. Between March 2005 and March 2010, hybrid procedure was carried out successfully in 30 newboms and infants with favorable anatomy. The age ranged from 1 day to 48 months with a mean of (4.59 ±3.21) months. The heart was exposed through median sternotomy. A pursestring suture was placed in the right ventricular outflow tract 2 cm away from the pulmonary trunk. Then a 16-gauge intravenous catheter was punctured through the right ventrical and perforated the atretic PV with the guidance of echocardiography. A guide wire was then inserted into the sheath and used to guide the balloon across the PV. Sequential dilations were performed until a full opening of the PV with the guidance of epicardial echocardiography. In patients ＜ 3 months PDA ligation was performed followed by modified Blalock-Taussig (B-T) shunt. In patients ＞ 3 months PDA ligation was not performed. A modified B-T shunt was inserted if severe systemic oxygen desaturation occurred after PDA ligation. Bidirectional Glenn shunt was performed for severe hypoplasia. Hybrid procedure was achieved in all patients. The simultaneous procedures included 25 cases of PDA ligation. 6 newborns underwent modified B-T shunt placement (3.5 to 5 mm) after pulmonary valvuloplasty and PDA ligation, and 2 patients ＞ 1 month underwent modified B-T shunt. Another 2 patients were selected for univentricular palliative surgery because of a diminutive monopartite right ventricle and bidirectional Glenn procedure was performed. No pericardial effusion or cardiac tamponade was observed in all patients. Another case without PDA ligation underwent a modified B-T shunt because of hypoxemia three days after hybrid procedure, and the rest patients were discharged without any further surgical intervention.During the follow-up period of 1.5 to 62.0 months, 5 patients died. 25 (83.3%) survived and were all in New York Heart Association functional class 1. Peripheral oxygen saturation increased from 0.73 ± 0.08 to 0.94 ± 0.04 (P ＜ 0.05). One patient remains in a single-ventricle pathway, whereas 24 patients achieved a two-ventricle circulation. Results Conclusion Perventricular balloon pulmonary valvuloplasty using a hybrid approach is a safe and feasible procedure for patients with PAIVS.

With the changes of the disease spectrum of liver transplantation and organ allocation system, more and more patients complicated with cardiovascular complications have entered the waiting list for liver transplantation. However, surgical stress, severe infection and adverse reactions of immunosuppressive drugs will significantly increase the risk of postoperative cardiac complications and affect the short-and long-term survival of the recipients. Therefore, comprehensive evaluation of cardiac structure and function of the recipients before liver transplantation is of significance for improving clinical prognosis of the recipients. In this article, the main causes for the increased risk of heart disease during the perioperative period of liver transplantation, the time and methods of heart disease risk assessment for liver transplant recipients were reviewed, and existing assessment approaches for common heart diseases before liver transplantation were illustrated, aiming to provide reference for further reducing the incidence of heart complications after liver transplantation, improving the survival rates of grafts and recipients and enhancing clinical prognosis.

Objective To study the expression of chemokine receptor 5 (CCR5) in breast cancer and metastatic axillary nodes and the frequency of polymorphism CCR5-△32,and its effect on breast cancer metastasis.Methods Specimens were collected from Aug.2008 to Jun.2009 in Department of Breast and Thyroid Surgery,Liaocheng People's Hospital.The relative expression quantity of CCR5 mRNA was detected by real-time fluorescence quantitative PCR (RT-PCR),and polymorphism CCR5-△32 was tested by DNA electrophoresis.The data was processed by SPSS software.Results 1.The relative expression quantity of CCR5 mRNA was significantly higher in breast cancer tissues than in paracarcinoma tissues(P ＜ 0.01)and breast fibroadenoma tissues (P ＜ 0.05).The difference of relative expression quantity of CCR5 mRNA had statistical significance between breast cancer tissues in stage Ⅱ and Ⅲ(P ＜ 0.05 ),but not between breast fibroadenoma tissues and paracarcinoma tissues(P ＞0.05).2.The relative expression quantity of CCR5 mRNA was significantly higher in metastatic axillary nodes than in nonmetastatic nodes (P ＜ 0.05 ).3.Polymorphism CCR5-△32 wasn't found in any specimen.4.The relative expression of CCR5 mRNA had connection with breast oncogene C-erbB-2 and whether there was axillary lymph node metastasis,but no connection with other immunological and biochemical indicators.Conclusions CCR5 mRNA is significantly higher expressed in breast cancer and metastatic axillary nodes.The interaction between CCR5 and its ligands promotes the progress of breast cancer and axillary lymph node metastasis.CCR5 can be taken as a molecular indicator to predict axillary lymph node metastasis in breast cancer and provides new targert for clinical therapy.

Objective To explore rationale and clinical application of simplified modified radical thyroideetomy for differentiated thyroid carcinoma.Methods From Jan.2007 to Jun.2010,349 cases of differentiated thyroid carcinoma received simplified operative procedure based on standard modified radical thyroidectomy.The simplified procedure took a low small collar incision(about 10-12 cm).In separating upper and lower skin flaps,subcutaneous tissues covering posterior triangle of neck and posterior edge of sternoeleidomastoid muscle were spared to protect sensory nerves.Subtotal thyroidectomy Was performed to resect the affected lobe,isthmus,and the majority of opposite lobe without considering the size of primary tumor or whether metastasis to the neck lymph nodes happened.Soft tissues of the mainly metastatic areas(Ⅱ a、Ⅲ、Ⅳ、Ⅴb)were cleared.The accessory nerve was not exposed routinely to avoid stimulation.Lymph nodes metastasis in different areas was recorded respectively.Complications in different operative modes were compared.Results Compared with standard modified radical thyroidectomy,the simplified mode had shorter scar-and no limit of neck mobility.Because of muscles and nerves pemervation,movement dysfunction and abnormal sensation of neck and shoulder decreased obviously.The operation duration was shortened.Cervical lymph node status Was evaluated,which provided basis for prognosis judgment and comprehensive treatment.Conclusions The simplified modified radical procedure has the benefit of decreased trauma while maintains the similar recurrence rate compared to modified radical thyroidectomy.It improvs the life quality of patients.This procedure fits the principle of functional radical neck dissection better.

Objective To review the early-and mid-term results of anatomic repair or Fontan pathway for congenitally corrected transposition of the great arteries(ccTGA) in a single institution of China.Methods Hospital records over a 9-year period(2009-2017) were reviewed to identify patients with ccTGA who underwent anatomic repair or Fontan pathway.Pa-tient-and procedure-related variables were reviewed.Results We identified 37 patients.Group 1 consisted of 10 anatomic re-pairs, of which 4 required prior pulmonary artery banding.Median age at anatomic repair was 1.0 years( range: 0.3 -7.8 years).There was one early death, and one patients experienced ECMO support.The mean follow-up was(3.0 ±2.8)years (range:0.7-8.4 years).Five(55.5％) patients showed arrhythmias, and one required permanent pacemaker implantation during follow-up.Group 2(27 patients) underwent Fontan palliation, of which 23(85.2％) underwent prior bidirectional Glenn shunt.Median age at Fontan completion was 3.8years(range:2.2-14.3 years).there was one early death with a mor-tality of 3.7％.The mean follow-up was(2.8 ±1.6) years(range:0.8-8.2 years).There was 4(15.4％) cases of arrhyth-mias, but none required reintervention.The arrhythmias incidence in Fontan group was significantly lower than the anatomic re-pair group.The early-and mid-term survival rate were 90.0％ and 96.3％in the two groups.The difference was not statistical-ly significant(P=0.458).Conclusion Patients with ccTGA do well with both anatomic repair and the Fontan pathway in the medium term.Pulmonary artery banding can be used effectively for morphological left ventricular retraining , and extenuate tri-cuspid regurgitation.Excellent outcomes with reduced early complication and arrhythmias incidence can be achieved for this co-hort of patients when a strategy of avoiding complex anatomic repair in favor of the Fontan pathway is used .

Objective: To examine the early- and midterm outcomes of pulmonary artery banding as an initial palliation in patients with single ventricle associated with unrestricted pulmonary blood flow. Methods: Between January 2008 and December 2017, 49 patients with single ventricle and unrestricted pulmonary blood flow underwent pulmonary artery banding at Department of Cardiac Surgery, Guangzhou Women and Children′s Medical Center, Guangzhou Medical University. There were 29 males and 20 females. The age at the time of surgery was 5.6 (11.5) months (M(Q_R)), and the weight was 5.2 (3.9) kg. The medical records and results after pulmonary artery banding (death/reoperation, transition to the Glenn procedure) and subsequently after the Glenn procedure (death, transition to the Fontan procedure) were reviewed retrospectively. Actuarial survivals were estimated by the Kaplan-Meier curve. Relative factors for affecting outcomes were analyzed using the Cox regression hazard model. Results: There were 8 early deaths, with a mortality of 16.3%, including 4 cases who received simultaneous arch repair. There were 5 late deaths. During the follow-up of 47(62) (M(Q_R)) months, 11 patients (22.4%) underwent pulmonary artery banding adjustment, 29 patients (59.2%) underwent the Glenn procedure, 21 patients (42.8%) underwent the Fontan procedure. The survival of patients after the initial pulmonary artery banding were 77.4% (95%CI: 65.6% to 89.2%) and 72.6% (95%CI: 59.9% to 85.3%) at 1 year and 5 years, respectively. Multivariate Cox regression analysis revealed that systemic ventricular outflow tract obstruction (HR=4.25, 95%CI: 1.50 to 12.03, P=0.006) and total anomalous pulmonary venous connection (HR=6.49, 95%CI: 3.24 to 12.98, P=0.000) were relative factors for death. Conclusions The early and midterm outcomes of pulmonary artery banding as an initial palliative strategy is not satisfactory. Systemic ventricular outflow tract obstruction and total anomalous pulmonary venous connection are associated with high mortality.