Objective To investigate the operative procedure for complicated patent ductus arteriosus.Methods 87 cases of complicated patent ductus arteriosus who received operation from Oct 1993 to Aug 2001 were studied retrospectively.Results Operations supported by cardiopulmonary bypass for closure of complicated patent ductus arteriosus and other concomitant cardiothoracic procedures were performed on the all patients at the same time. There were 5 cases of deaths, with dead rate of 5 7%, which mainly caused by heart failure. 82 survivals were followed up at mean period of 3 years and 7 months, and no operative complications occurred.Conclusions Closure for complicated patent ductus arteriosus with correction of concomitant cardiothoracic malformation supported by cardiopulmonary bypasss is a effective treatment of complicated patent ductus arteriosus.

Objective To characterize the CT features of primary mediastinal seninoma. Methods CT scans of 10 cases with pathologically proved primary mediastinal seminoma were retrospectively reviewed.Results 9 of the 10 cases with the maximal dimension of 6. 5 ～ 18.2 cm( mean = 12. 3 cm) were located in the anterior mediastinum and 1 tumor was located in the middle mediastinum. All of the 10 tumors were solid masses and none of cavity, loculus, fat, calcification or fluid was detected. Areas of low density in the center of tumors were seen in 9 cases. Tumors encircling macrovascular or pericardium were seen in 7 cases. Chest wall invasion was detected in 2 cases. Enlarged lymph nodes in supraclavicular or mediastinum were identified in 4 cases. Lung diseases were found in 5 cases. Bilateral pulmonary metastasis was seen in 1 case. Pleural effusions were detected in 4 cases. Pericardial effusions were evident in 5 cases. Conclusion Most of the primary mediastinal seminomas are solid and large mass without calcification or fat. The tumors are usually located in the anterior mediastinum and areas of low density are usually seen in the center of tumors. Some tumors involve in adjacent structures. Seminoma has some features on CT.

Objective To assess the clinical value of multi-slice helical CT perfusion on the post-operative follow-up of glioma.Methods CT perfusion image was applied to 32 patients with glioma after operation.Various perfusion parameters,include cerebral blood volume(CBV),permeability surface(PS),relative cerebral blood volume(rCBV)and relative permeability surface(rPS)were measured on recurrent area,nonrecurrent area and normal cerebral area respectively.SPSS 12.0 statistical software was used.Independent t test was used to compare the differences.Results In the recurrent group(16 cases),the value of CBV in creased in 12 cases and was normal in the other 4 cases.The value of PS increased in all the cases of recurrent group.The value of rCBV exceeded 2.6 in 10 cases,among which the biggest value of rCBV was 4.01.The mean value of rCBV was 2.67 and the mean value of rPS was 6.32;In the non-recurrent group(16 cases),the value of CBV was nearly normal in 7 cases,increased in 2 cases and decreased in the remaining 7 cases.The value of PS was nearly normal in 11 case,decreased in 3 cases and increased in the remaining 2 cases.The values of rCBV were all less than 2.6 and the biggest value of rCBV was 2.14.The mean value of rCBV was 0.99 and the mean value of rPS was 1.42.The statistic significance was obtained for all the parameters when compared the recurrent group with the non-recurrent group(P＜0.01)and with the normal cerebral area(P＜0.01).When compared the non-recurrent group with the normal cerebral area,none of the parameters had statistic significance(P＞0.05);The statistic significance was obtained for rCBV and rPS when compared the recurrent group with the non-recurrent group(P＜0.01).Conclusion CT perfusion image is valuable in determining glioma recurrence after operation.

Objective Background and objective Bioinformatics technology found the TCF21 gene has difference expression in non-small cell lung cancer (NSCLC) and benign lung tissue.To explore TCF21 mRNA and protein expression in nonsmall cell lung cancer and its methylation of the promoter region is the aim of this study.Methods Use RT-PCR,Western blot and Pyrosequencing detected TCF21 gene mRNA,protein and the methylation of the promoter region respectively in 97 cases of non-small cell lung cancer and 21 cases of benign lung tissue.Results TCF21 gene mRNA-positive expression were detected 23 cases (23.71％) and 14 cases (66.67％) in 97 cases of NSCLC cancer tissue and 21 cases of benign lung tissue,the average gray value of TCF21 protein expression levels in NSCLC cancer tissue is 0.49 ± 1.78,while it is 1.48 ± 1.58 in benign lung tissue,the TCF21 gene promoter region have varying degrees methylation in NSCLC cancer tissue and benign lung tissue,and the significant of methylation frequency was found statistically significant between NSCLC cancer tissue and benign lung tissue,also it has higher frequency of 49.04％ and 51.37％ respectively at point 1 and 5 in NSCLC cancer organizations.Conclusion TCF21 gene mRNA and protein expression were statistically significant in NSCLC cancer tissue and benign lung tissue,the TCF21 gene promoter region average methylation frequency was significantly higher than that in benign lung tissue cells.

ObjectiveTo introduce a new technique to create a pulmonary valve biorifice for reconstruction of right ventricular outflow tract in tetralogy of Fallot (TOF),and to summarize its initial clinical experience and therapeutic effect.MethodsThe new technique regarding reconstruction of right ventricular outflow tract with a pulmonary valve biorifice was used in a total of 53 TOF cases (the observation group).The conventional technique regarding reconstruction of right ventricular outflow tract was used in other 50 TOF cases (the control group).The clinical dates of all cases were reviewed retrospectively.ResultsThe ages,weights,cardiopulmonary bypass time,cardiac arrest time,as well as the post operation ventilation support time were not different significantly between two groups.Compared with the contrul group,patients from the observation group had shorter duration of ICU stay.After operation,in the observation group,only 2 cases had large amount of pleural effusion,1 case meddle,and 8 cases little amount of pleural effusion; whereas,in the control group,the corresponding numbers were 1,5 and 17,respectively.At the time point of 1 week after operation,all patients were rechecked by echocardiography,no pulmonary valve stenosis was found.Moderate pulmonary valve regurgitation was found in 8 cases,mild regurgitation in 15 cases from the observation group; and severe regurgitation in 3 cases,moderate regurgitation in 17 cases,and mild regurgitation in 16 cases from the control group.A total of 33 cases from the observation group were rechecked at the time point of half year after operation,and moderate - mild pulmonary regurgitation were found in 3 cases.A total of 18 cases of them were rechecked 1 - year latter,no pulmonary regurgitation was found.ConclusionsThe new technique to create pulmonary valve biorifice can reduce the pulmonary valve regurgitation and postoperative pleural effusion,and improve the early outcomc.

Objective To study the feasibility and safety of limb remote ischemic preconditioning (RIPC) in infants and explore the protective effect on myecardium ischemia reperfusion injury for infants undergoing cardiac operation under cardiopulmonary bypass. Methods 60 infants weight less than 7 kilograms with ventricular septal defect were enrolled into the study. 30 of them (RIPC group) were ischemic preconditioned two times (24 hours and 1 hour preoperatively) by three cycles of iscbemia (5 minutes for each) and reperfusion on the left upper arm using a blood pressure cuff. Serum lactate dehydrogenase (LDH), creatine kinase (CK) and its isoenzyme (CK-MB), and tro-ponin I (TnI) ; malondialdehyde (MDA) and superoxide dismutase (SOD) was preoperatively detected. The expression of heat shock pro-tein 70 (HSP 70) in cardiomyocytes was determined by western blot analysis. The surgical outcome including limb movement and sensory function was also recorded. Results No limb disability or sensory disturbance or no other surgical complications was found in all infants. LDH, CK, TnI at the beginning of operation in RIPC group was higher than those in control group. After operation, leakage of heart enzymes were attenuated in RIPC group, and the serum concentration of enzymes were lower than those in the control group. The RIPC group had low coronary sinus venous concentration of MDA but high SOD. The expression of HSP70 was upregulated in cardiomyocytes of RIPC group. Conclusion The limb RIPC can be done easily and safety in infants, and BIPC can reduce the leakage of myocardial enzymes and upregu-late the expression of HSP, which possess protective effect on myocardial IRI.

ObjectiveTo observe the clinical efficacy of external application of sihuang-honey for aseptic inflammation after total knee arthroplasty.Methods 30 cases of total knee arthroplasty patients were recruited into two groups,of 15 cases in each group.The treatment group was treated with sihuang-honey (made of rhubarb,scutellaria,phellodendron,coptis according to the same proportion of powder with honey ),which was placed on a sterile plastic sheet,0.5 cm thickness.The sheet was applied on the knee of the highest skin temperature for 6 hours,removed it for 2 hours interval,and reapplied on it,for altogether 24 hours before changing another sheet.The control group were treated by continued covering ice on the knee every day,with the ice completely surrounded the knee.Both groups were treated for 2 weeks.Clinical efficacy was observed before the treatment,and 3 d,7 d,14 d after the treatment.ResultsAfter the treatment,compared with the control group,the treatment group was effective in terms of VAS score (4.12± 1.08) points in 3d,(3.34±0.61)points in the first 7 days; skin temperature (37.56±0.40) ℃,activity (98.56±3.24) ° in 3d,and the difference was statistically significant (P＜0.05).The degree of swelling in 3 d (5.80±2.00) ％,7 d (9.33±2.55)％,14 d (12.13 ± 2.70)％ in the treatment group were better than the control group (P＜0.05); The rate of pain relief of treatment group was 93.33％ and satisfaction was 66.67％,although better than 86.67％ and 46.67％ of the control group,the difference was not statistically significant (x2 were 1.33,3.04,P＞0.05).Conclusion Sihuang-honey was effective for the treatment of aseptic inflammation after the surgery of total knee arthroplasty.

Objective To investigate the sonographic characteristic of hepatic lymphoma. Methods Fifteen patients with pathological proven hepatic lymphomas (4 primary and 11 secondary hepatic lymphomas) were included in this retrospective study. All the 15 patients underwent conventional B-mode ultrasound examinations. Two patients (one with primary lymphoma and another with secondary lymphoma) underwent contrast enhanced ultrasonography (CEUS). Results In the conventional ultrasonography, hepatic masses were detected in 9 patients (4 primary and 5 secondary lymphomas). No hepatic mass was detected in the remaining 6 patients with pathological proven secondary lymphomas. For the 4 patients with detectable primary masses, 2 had a single mass and 2 had multiple masses. All primary hepatic lymphomas were hypoechoic. For the 5 patients with detectable secondary masses, 2 had a single mass and 3 had multiple masses. The hypoechoic lymphomas were found in 3 patients, while hyperechoic and isoechoic lymphomas were found in the other 2 patients. In the 4 patients with primary hepatic lymphomas, 3 had hepatomegaly, while none of the 4 patients had splenomegaly. In the 5 patients with detectable secondary masses, hepatomegaly was found in 3 patients in whom 2 had splenomegaly and 1 had a plate-shaped hypoechoic region within spleen. For the 6 patients without detectable secondary masses, splenomegaly was found in all 6 patients and hepatomegaly was found in 4 patients. In the spleen of one patient, a plate-shaped hypoechoic region was detected in the B-mode ultrasonography. In the CEUS, the primary lymphoma presented a thick ring region with slight enhancement peripheral to the mass during the hepatic artery phase;while the secondary lymphoma presented the uneven enhancement pattern with a small plate-shaped region unenhanced in its center during the hepatic artery phase. Conclusions In ultrasonography, the patients with hepatic lymphomas commonly present a single or multiple hypoechoic well-deifned hepatic masses, poor blood lfow and uneven enhancement peripheral to the mass during the hepatic artery phase of CEUS. Other sonographic characteristic include hepatomegaly and splenomegaly. No mass is detected in ultrasonography can not exclude the diagnosis of hepatic lymphoma.

OBJECTIVE:To investigate the effectiveness and economics of 10 mg/d rosuvastatin and 20 mg/d atorvastatin in the treatment of hyperlipidemia (HLP). METHODS:The information of 180 HLP patients selected from Tianmen Municipal First People's Hospital during Mar. 2015-Feb. 2016 were divided into group A and B according to medication regimen,with 90 cases in each group. Group A was given Atorvastatin calcium tablet 20 mg,qd;group B was given Rosuvastatin calcium tablet 10 mg,qd. Treatment course of 2 groups lasted for 8 weeks. Blood lipid indexes before and after treatment,lipid-lowering efficacy,the rate of qualified blood lipid and the occurrence of ADR after treatment were compared between 2 groups. Cost-effectiveness analysis was adopted for economic evaluation. RESULTS:Before treatment,there was no statistical significance in the levels of blood lipid in-dexes between 2 groups (P>0.05). After treatment,TC and LDL-C levels of 2 groups were significantly lower than before treat-ment,and those of group B were significantly lower than those of group A,with statistical significance(P<0.05). Total response rate of lipid-lowering in group B(97.78％)was significantly higher than group A(86.67％),and the rate of qualified blood lipid (66.67％)was also significantly higher than group A(51.11％),with statistical significance(P<0.05). There was no statistical significance in the incidence of ADR between 2 groups (P>0.05). The costs of group A and B were 488.32,436.24 yuan,and cost-effectiveness ratios were 5.63,4.46;incremental cost-effectiveness ratio was -4.69. The plan of group B had cost-effective-ness advantage. The results of cost-effectiveness analysis were supported by sensitivity analysis. CONCLUSIONS:In the view of short-term efficacy,10 mg/d rosuvastatin plan is better than 20 mg/d atorvastatin plan in lowering lipid and has cost-effectiveness advantage,and both have similar safety.

Objective To analyze the changes of portal venous velocity (PVV) ratio (PVVR) in different degrees of portal vein stenosis (PVS) following 70％ partial hepatectomy (PH) in rats.Methods According to different surgical methods,102 SD rats were randomly subjected into sham operation rats group (n=6),non PVS group,mild,moderate and severe PVS group (each group n=24).Models of 70％ PH without PV ligation were established in non-PVS group,while in PVS groups were produced with partially ligating PV in different degrees following 70％ PH.PVV was measured 1,3,7 and 14 days after operation,and PVVR was calculated in PVS groups.Combined with mitotic index (MI) 3 days after operation and liver regeneration degree (LRD) 7 days after operation,the changes of PVVR in different groups were analyzed.Results MI of non-PVS and moderate PVS groups were significantly higher than that of mild PVS group (both P＜0.05),while of severe PVS group was significantly lower than that of moderate PVS group (P＜0.05).LRD of severe PVS group was significantly lower than that of non PVS and moderate PVS groups (both P＜0.05).In non-PVS group,PVV decelerated to the lowest 3 days after operation,and recovered 7 and 14 days.In PVS groups,PVVR decelerated to the lowest 7 days after operation,and recovered until 14 days.PVVR of severe PVS group was significantly higher than that of mild and moderate PVS groups 1 and 3 days after operation (all P＜0.05),while there was no statistical differences among PVS groups 7 and 14 days after operation (all P＞0.05).Conclusion Ultrasound can well demonstrate blood flow changes of PVS following 70％ PH in rats.Changes of PVVR may relate to pathological changes in hepatocytes,the nuclear division and the volume of regenerated liver in rats.