To analyze the risk factors for peri-operative mortality in patients with total anomalous pulmonary venous connection (TAPVC). Methods: A total of 563 TAPVD patients including atrial septal defect, ventricular septal defect and patent ductus arteriosus treated in our hospital from 1996-10 to 2012-12 were retrospectively investigated. There were 219 (38.9%) male, the mean age of patients was (4.6±9.0) years and the mean body weight was (13.2±14.6) kg. The patients were divided into 2 groups: Death group, n=34 and Survival group, n=529. Risk factors for peri-operative mortality were studied by single and multi Logistic regression analysis. Results: The overall peri-operative mortality was 6.0% (34/563). Compared with Survival group, Death group had more patients≤1 year of age (P=0.008), the higher ratio of elective surgery (P=0.002), the longer cardiopulmonary bypass time (P=0.000) and longer aorta clamping time (P=0.001). Multi Logistic regression analysis presented that the age≤1 year was the independent risk factor for TAPVC peri-operative death (OR=3.802, P=0.013) and elective surgery was the protective factor for TAPVC peri-operative death (OR=0.234, P=0.027). Conclusion: The patient's age≤1 year was the independent risk factor for TAPVC peri-operative death, while elective surgery was the protective factor for TAPVC peri-operative death.

OBJECTIVETo analyze the efficacy and safety of bicyclol combined with thymosin in treatment of chronic viral hepatitis B (CHB).

METHODSA total of 135 patients with CHB were randomized into experimental group and control group. The patients in the experimental group received bicyclol orally 75 mg daily and thymosin 20 mg intramuscular injection once every 2 days for 24 weeks and those in control group received bicyclol orally 75 mg daily alone for 24 weeks. The levels of serum aminotransferase (ALT/AST), HBV-DNA, HBeAg /antiHBe were observed.

RESULTSCompared with pre-treatment levels, the serum aminotransferase levels decreased significantly in both groups, but there were no statistically significant differences between them. HBeAg negative conversion rate was significantly higher in the experimental group than in the control group (35.3 percent vs.19.4 percent, P less than 0.05). HBV DNA negative conversion rate was significantly higher in the experimental group than in the control group (36.7 percent vs. 20.9 percent, P less than 0.05). No obvious adverse events which were probably related to the drugs were observed in this study.

CONCLUSIONThe combination of bicyclol with thymosin had better effect in treatment of chronic hepatitis B ias compared with bicyvlol alone.

Adolescent ; Adult ; Biphenyl Compounds ; administration & dosage ; adverse effects ; Drug Therapy, Combination ; Female ; Hepatitis B, Chronic ; drug therapy ; Humans ; Male ; Middle Aged ; Thymosin ; administration & dosage ; adverse effects

OBJECTIVETo construct the folic acid deficient model in zebrafish and observe the abnormal cardiac phenotypes, to find the optimal period for supplementing folic acid that can most effectively prevent the heart malformation induced by folic acid deficiency, and to investigate the possible mechanisms by which folic acid deficiency induces malformations of heart.

METHODThe folic acid deficient zebrafish model was constructed by using both the folic acid antagonist methotrexate (MTX) and knocking-down dhfr (dihydrofolate reductase gene). Exogenous tetrahydrofolic acid rescue experiment was performed. Folic acid was given to folic acid deficient groups in different periods. The percent of cardiac malformation, the cardiac phenotypes, the heart rate and the ventricular shortening fraction (VSF) were recorded. The out flow tract (OFT) was observed by using fluorescein micro-angiography. Whole-mount in situ hybridization and real-time PCR were performed to detect vmhc, amhc, tbx5 and nppa expressions.

RESULTAbout (78.00 ± 3.74)% embryos in MTX treated group and (68.00 ± 6.32)% embryos in dhfr knocking-down group had heart malformations, including the abnormal cardiac shapes, the hypogenesis of OFT and the reduced heart rate and VSF. Giving exogenous tetrahydrofolic acid rescued the above abnormalities. Given the folic acid on 8 - 12 hours post-fertilization (hpf), both the MTX treated group (20.20% ± 3.77%) and dhfr knocking-down group (43.40% ± 4.51%) showed the most significantly reduced percent of cardiac malformation and the most obviously improved cardiac development. In folic acid deficient group, the expressions of tbx5 and nppa were reduced while the expressions of vmhc and amhc appeared normal. After being given folic acid to MTX treated group and dhfr knocking-down group, the expressions of tbx5 and nppa were increased.

CONCLUSIONSThe synthesis of tetrahydrofolic acid was decreased in our folic acid deficient model. Giving folic acid in the middle period, which is the early developmental stage, can best prevent the abnormal developments of hearts induced by folic acid deficiency. Folic acid deficiency did not disrupt the differentiations of myosins in ventricle and atrium. The cardiac malformations caused by folic acid deficiency were related with the reduced expressions of tbx5 and nppa.

Animals ; Atrial Natriuretic Factor ; metabolism ; Cell Differentiation ; drug effects ; Folic Acid ; metabolism ; Folic Acid Deficiency ; genetics ; metabolism ; Gene Knockdown Techniques ; Heart ; drug effects ; embryology ; growth & development ; T-Box Domain Proteins ; metabolism ; Zebrafish ; embryology ; genetics

Objective To discuss the clinic characters of clear cell papillary renal cell carcinoma ( CCPRCC) and the efficacy of related laparoscopic surgery.Methods From October 2013 to December 2015, 4 cases were treated as CCPRCC including 3 male and 1 female.Their age ranged from 34 to 67 years old ( mean 53 years old) .The duration of illness ranged from 7 days to 3 months, which the average duration was 1.5 months.The location of tumor included left side in 2 cases and right side in other 2 cases.All tumors were found incidentally, without symptoms or positive sign.Ultrasound showed that 2 cases were solid, and the other 2 cases were cystic solid with low, high or mixed echo and rich blood flow signals.The tumors were enhanced in CT arterial phase, and calcification showed in one case.MRI showed heterogeneous signal.The mean size of tumor was 3.0 cm,ranging 2.3 to 4.5 cm.After preoperative examination, all cases underwent retroperitoneal laparoscopic partial nephrectomy.During the operation, 2 cases were confirmed as cystic solid tumors, and the other 2 cases were solid tumors.Renal artery and renal mass were dissociated , then the artery was blocked.The tumor was complete resected, and kidney was sutured. Results All surgery was performed successfully without conversion.The operation time was 137-191 min (average 157 min).The blood loss was 10-100 ml (average 45 ml) without blood transfusion.The warm ischemia time was 15-35 min ( mean 22 min) .The postoperative hospitalization time stay 6-8 d ( average 7 d).Pathologic report was CCPRCC, including 3 cases of WHO/ISUP grade 1, and 1 case of WHO/ISUP grade 2.2 cases were cystic solid tumor, and other 2 cases were solid tumor.Bland-appearing tubules and occasional small papillae, and uniform small nuclei are arranged in a linear manner away from the basal aspect of the tubules in microscope.Immunohistochemistry showed that CA IX, CK7, 34 E12 were positive, but CD10 , P504S and CD117 were negative.The mean duration of postoperative follow-up was 14 months, ranging 4 to 30 months.No recurrence was found in those patients.Patients were followed up for 4-30 months ( average 14 months) without recurrence or metastasis.Conclusions CCPRCC is a rare subtype of renal tumor, which mainly diagnosed by pathological diagnosis . Retroperitoneal laparoscopic partial nephrectomy is an effective method for the treatment with good prognosis.

Non-governmental organizations ( NGOs) are playing an increasingly significant role in global health governance. This study selected ten key NGOs that play an important role in global health affairs and summarized the tools employed by NGOs participating in global health governance, including nine dimensions:“Generating informa-tion and evidence/intelligence”, “Cooperation ( Partnerships )”, “Participation”, “Consultation”, “Transparen-cy”,“Organizational adequacy/system design”, “Formulating policy / strategic direction”, “Responsibility” and“Regulation”. Four types of NGOs including Operational, Supportive, Advocacy and Integrated ones presented com-monness and their priorities in the selection of tools to participate in global health governance. Meanwhile, China should strive to nurture local NGOs, which should pay attention to“Transparency”,“Participation” and“Cooperation ( Partnerships)”.

AIMTo determine the effect of lysophosphatidylcholine (LPC) on the expression of vascular endothelial growth factor (VEGF) in human umbilical veins endothelial cell line (ECV304) and the inhibitory effect of 2, 3, 5, 4'-tetrahydroxystilbene-2-O-beta-D-glucoside (ST I) in vitro.

METHODSExposure to 2.5 mg x L(-1) LPC or LPC + ST I for 24 hours, VEGF protein was determined by enzyme-linked immunosorbent assay (ELISA). Meanwhile, VEGF mRNA expression in ECV304 was examined by in situ hybridization. VEGF165 mRNA was examined by RT-PCR and Realtime RT-PCR.

RESULTSLPC upregulated VEGF protein and VEGF mRNA expression in the ECV304 cells. ST I was shown to markedly inhibit the LPC-induced increase of VEGF protein and VEGF165 mRNA (P < 0.001).

CONCLUSIONLPC can induce a strong expression of VEGF in ECV304 cells and ST I can inhibit it.

Cells, Cultured ; Endothelial Cells ; metabolism ; Glucosides ; isolation & purification ; pharmacology ; Humans ; Lysophosphatidylcholines ; antagonists & inhibitors ; Plants, Medicinal ; chemistry ; Polygonum ; chemistry ; RNA, Messenger ; biosynthesis ; genetics ; Stilbenes ; isolation & purification ; pharmacology ; Umbilical Veins ; cytology ; Vascular Endothelial Growth Factor A ; biosynthesis ; genetics

OBJECTIVETo study the effect of methotrexate (MTX), a folic acid antagonist which can lead to folic acid deficient, on the cardiac development and on the expressions of BMP2b and HAS2 in zebrafish.

METHODSThe zebrafish embryos at 6-48 hrs post fertilization (hpf) were treated with various concentrations of MTX (0.5 x 10(-3), 1.0 x 10(-3) and 2.0 x 10(-3) M). At 48 hpf, the percentage of cardiac malformation and heart rate were recorded. The zebrafish embryos at 6-10 hpf treated with 1.5 x 10(-3) M MTX were used as the MTX treatment group. At 24 and 48 hpf the cardiac morphology was observed under a microscope. The expressions of BMP2b and HAS2 in zebrafish were detected by in situ antisense RNA hybridization and real-time PCR.

RESULTS6-12 hpf, the early embryonic developmental stage, was a sensitive period that MTX affected cardiac formation of zebrafish. The retardant cardiac development and the evidently abnormal cardiac morphology was found in the MTX treatment group. The results of in situ antisense RNA hybridization showed that the expressions of BMP2b and HAS2 in the zebrafish heart were reduced in the MTX treatment group at 36 and 48 hpf. The real-time PCR results demonstrated that the BMP2b expression decreased at 12, 24, 36 and 48 hpf, and that the HAS2 expression decreased at 24, 36 and 48 hpf in the treatment group compared with the control group without MTX treatment.

CONCLUSIONSThe inhibition of folic acid function may affect cardiac development of early embryos, resulting in a retardant development and a morphological abnormality of the heart in zebrafish, possibly by down-regulating the expressions of BMP2b and HAS2.

Abnormalities, Drug-Induced ; etiology ; Animals ; Bone Morphogenetic Protein 2 ; Bone Morphogenetic Proteins ; genetics ; Down-Regulation ; Folic Acid Antagonists ; toxicity ; Gene Expression Regulation ; drug effects ; Glucuronosyltransferase ; genetics ; Heart Defects, Congenital ; chemically induced ; Hyaluronan Synthases ; Methotrexate ; toxicity ; Polymerase Chain Reaction ; Zebrafish ; Zebrafish Proteins ; genetics

BACKGROUNDFolic acid is very important for embryonic development and dihydrofolate reductase is one of the key enzymes in the process of folic acid performing its biological function. Therefore, the dysfunction of dihydrofolate reductase can inhibit the function of folic acid and finally cause the developmental malformations. In this study, we observed the abnormal cardiac phenotypes in dihydrofolate reductase (DHFR) gene knock-down zebrafish embryos, investigated the effect of DHFR on the expression of heart and neural crest derivatives expressed transcript 2 (HAND2) and explored the possible mechanism of DHFR knock-down inducing zebrafish cardiac malformations.

METHODSMorpholino oligonucleotides were microinjected into fertilized eggs to knock down the functions of DHFR or HAND2. Full length of HAND2 mRNA which was transcribed in vitro was microinjected into fertilized eggs to overexpress HAND2. The cardiac morphologies, the heart rates and the ventricular shortening fraction were observed and recorded under the microscope at 48 hours post fertilization. Whole-mount in situ hybridization and real-time PCR were performed to detect HAND2 expression.

RESULTSDHFR or HAND2 knock-down caused the cardiac malformation in zebrafish. The expression of HAND2 was obviously reduced in DHFR knock-down embryos (P < 0.05). Microinjecting HAND2 mRNA into fertilized eggs can induce HAND2 overexpression. HAND2 overexpression rescued the cardiac malformation phenotypes of DHFR knock-down embryos.

CONCLUSIONSDHFR plays a crucial role in cardiac development. The down-regulation of HAND2 caused by DHFR knock-down is the possible mechanism of DHFR knock-down inducing the cardiac malformation.

Animals ; Basic Helix-Loop-Helix Transcription Factors ; genetics ; physiology ; Female ; Heart ; embryology ; Heart Defects, Congenital ; etiology ; Tetrahydrofolate Dehydrogenase ; genetics ; physiology ; Zebrafish ; Zebrafish Proteins ; genetics ; physiology

BACKGROUNDReal-time perfusion imaging (RTPI) using ultrasound contrast agents has shown good "accuracy" in detecting myocardial infarction, however its accuracy in the assessment of peri-infarct ischemia and stress echocardiography are not known. The aim of this study was to determine the accuracy of RTPI in assessment of peri-infarct ischemia during dobutamine and adenosine stress.

METHODSWe employed the RTPI modality (Agilent and ATL Philips) in a canine model (18 dogs) of distal coronary occlusion and proximal coronary stenosis. Using coronary flow probe recordings, the physiologic significance of proximal coronary stenosis was established by confirming abolition of the coronary reserve. The contrast agent Optison was given as a slow bolus injection at baseline, during prolonged distal coronary occlusion, during adenosine bolus stress and during dobutamine stress. Triphenyltetrazolium chloride (TTC) staining was used to verify a distal infarction. RTPI recordings at baseline, the distal coronary occlusion and stress protocols were randomly mixed and reviewed blindly.

RESULTSIn all but one dog, RTPI detected a distal infarct as small as 9% of the left ventricle. The sensitivity, specificity and overall diagnostic accuracy of RTPI in the detection of distal infarcts were: 94%, 89% and 92%, respectively. The sensitivity, specificity, and overall diagnostic accuracy of RTPI in the assessment of peri-infarction ischemia were 83%, 92% and 88% for adenosine stress and 95%, 86% and 91% for dobutamine stress, respectively.

CONCLUSIONSEven small distal infarcts can be detected by RTPI; peri-infarct ischemia can be accurately recognized by RTPI during stress; adenosine and dobutamine stress appear equally reliable in the RTPI evaluation of peri-infarct ischemia.

Adenosine ; toxicity ; Animals ; Coronary Circulation ; drug effects ; Dobutamine ; toxicity ; Dogs ; Echocardiography ; methods ; Female ; Hemodynamics ; drug effects ; Male ; Myocardial Infarction ; diagnostic imaging