Objective To summarize successful experience in three of orthotopic homoplastic heart transplantation,to explore some problems for donor myocardial protection,the application of immunosuppressive drugs,anti-infection and prevent acute rejection.Methods From 2000.11.to 2001.3,we performed successful three cases orthotopic homoplastic heart transplantation;one case of hypertrophic myocardosis in terminal phase, one case of dilatanay myocardosis and one case of geneogenous tricuspic valve atresia.Postoperation,cyclosporin A,methylprednisolone,prednisolone and other immunosuppressive drugs have been used.Results Three patients have survived for three and six months with normal heart function and a good life quality.Conclusion Successful keys of heart transplantation are donor myocardial protection,technology of anastomosis and treatment of peroperation.

AIM: To determine multifocal visual evoked potential (mVEP) in the prediction of postoperative visual acuity in cataract. METHODS: We examined 30 normal eyes as control and 60 eyes of 52 cataract patients, senile cataract in 27 cases 30 eyes, cataract with glaucoma in 25 cases 30 eyes by mVEP examination. All patients underwent phacoemulsifi-cation (Phaco) and intraocular lens (IOL) implantation. After surgery,best corrected visual acuity (BCVA) was examined at 1 week, 1 month, and 3 months respectively.RESULTS: The mean amplitude and latency in mVEP responses between normal control group were 183±11nV, 95±8ms, and in senile cataract group were 177±10nV, 96± 8ms respectively, there were no significant difference between two groups (P>0.05). The mean amplitude and latency of cataract with glaucoma 138±7nV, 99±6ms were significantly different comparing to both control and senile cataract group (P<0.05). After surgery, the am-plitude and latency were 276±11nV and 93±8ms respec-tively, which did not change significantly comparing to the normal eyes (P<0.05), their visual function got no obvious damage and visual recovery were better (BCVA≥0.8). While those with central amplitude 221±6nV and latency 105±7ms that were significantly deviated from control group (P<0.05), and their visual function were seriously damaged and visual recovery were much poorer (BCVA<0.3).CONCLUSION: mVEP waveform might enable us to evaluate objective visual function detection before cataract surgery. A subject with visual function damage, their mVEP responses to stimulation were severely changed when it compared to controls.

Adolescent ; Adult ; Aged ; Humans ; Middle Aged ; Pupil Disorders ; diagnosis ; etiology ; Refraction, Ocular ; Retina ; physiopathology ; Retinal Detachment ; surgery ; Scleral Buckling ; Visual Acuity ; Vitreoretinopathy, Proliferative ; surgery

Objective To estimate the effect of glycoprotein (transmembrane) nonmetastatic melanoma protein B (GPNMB) on the proliferation and migration of as well as melanogenesis in melanoma cells.Methods The expression of GPNMB was detected by immunofluorescence assay in two melanoma cell lines M14 and G-361,as well as in primary human melanocytes.Then,the three kinds of cells each were classified into three groups:experimental group treated with small interfering RNA targeting GPNMB (GPNMB-siRNA),negative control group treated with the negative control siRNA,blank control group remaining untreated.Methyl thiazolyl tetrazolium (MTT) assay,transwell invasion assay and spectrophotometry were performed to evaluate cell proliferation activity,invasion potential and melanin levels,respectively.Statistical analysis was done using Student's t test.Results GPNMB was expressed in both melanoma cells and melanocytes.The transfection with GPNMB-siRNA down-regulated the mRNA and protein expressions of GPNMB in,and markedly suppressed the proliferation and migration of,melanoma cells.In detail,the proliferative activity (expressed as the absorbence value at 570 nm) of M14 and G361 cells was reduced by 35％ and 40％ respectively,the migration activity of M14 and G361 cells by 49％ and 51％ respectively,and the melanin levels in melanocytes,M14 cells and G361 cells by 73％,82％ and 69％ respectively,in the experiment group compared with those in the blank control group.Conclusions The siRNA-mediated silencing of GPNMB could effectively inhibit the proliferation of,invasion of and melanogenesis in melanoma cells,which suggests that GPNMB plays critical roles in the initiation and progression of melanoma.

OBJECTIVE:To study the cytotoxicity of the graft polymer after polyethyleneimine (PEI) had been modified by polyoxyethylene stearate (POES) and the property of the carrier,grafted-polymer/DNA complexes. METHODS: To modify PEI by conjugating PEI to POES with succinimidyl carbonate method. Structural analysis of synthesized polymer was performed by using 1H-NMR. Agarose gel electrophoresis (AGE) behavior of the graft polymer/DNA complexes was observed with particle size and zeta potential measured. The cytotoxicity of the graft polymer was evaluated by MTT method. The pGL3-lus served as a reporter gene,and the luciferase activity was determined to evaluate the transfection efficiency of grafted-polymer/DNA on Hela cells. RESULTS: 1H-NMR showed that the graft polymer had high purity. AGE showed that the DNA-wrapping ability of the graft polymer were increased with the increase of N/P ratios,and decreased with the increase of the POES graft number. The size of complexes was below 300 nm,and the zeta potential of the complexes increased with the increase of N/P ratios. The graft polymer showed significantly lower cytotoxicity than PEI. The graft polymer with lower POES graft number had higher transfection efficiency. CONCLUSIONS: The POES-modified PEI can be used as an effective non-viral genetic carrier.

Objective To investigate the prognostic factors and the clinical outcome of locally recurrent rectal cancer after radical resection. Methods From April 2000 to April 2004, 105 patients with locally recurrent rectal cancer after radical resection were re-treated in Tianjin cancer hospital. Thirty-four patients were re-treated with surgery combined with adjuvant chemoradiotherapy (group 1), 35 with surgery alone (group 2), and 36 with chemoradiotherapy (group 3). The impact of 17 clinicopathological factors and treatment modalities on the survival was analyzed. Results The follow-up rate was 95. 2%. The median survival time was 23 months. The 1-, 3-and 5-year survival rates of patients with locally recurrent rectal cancer were 63% ,34% and 19%, respectively. The 1-, 3-and 5-year survival rates were 79%, 55% and 32% in group 1 ; 68%, 40% and 14% in group 2; and 64%, 36% and 11% in group 3; respectively (χ~2 =7. 96,P =0. 019). The univariate analysis showed that the degree of differentiation, depth of tumor invasion, number of metastatic lymph nodes, initial TNM stage, recurrent location, time to recurrence, and surgery combined with adjuvant therapy were significant prognostic factors, with the last 4 being the independent prognostic factors. Conclusions Surgery combined with chemoradiotherapy may improve the survival of patients with locally recurrent rectal cancer.

Objective The purpose of this study was to evaluate the safety and clinical oulcomes of aortic valve replacement (AVR) performed with minimally invasive technique.Methods From June 2010 to October 2011,20 cases of minimally invasive AVR were performed.The mean age was (47.60±12.28) ;12 males and 8 females.All patients are ventilated with a double-lumen endotracheal tube,through the 3nd anterior intercostals space with a 5 -6cmskin incision,right femoral artery and vein cannulation are used to establish CPB,direct aortic cross-clamped by Chitwood sliding clamp through the right 4th intercostals space,and completed the aortic valve replacement.Results Mean length of incision was (4.73±0.54)cm.Mean duration of cardiopulmonary bypass was (124±39.83)min,crossclamp time was (97.21±33.17) min.Median intubation time was (13.55±3.87)hours.Median duration of intensive care and postoperative hospital stay was (16.34±3.82)hours and (6.63±1.45) days,respectively.Hospital mortality was 0.There was no perivalvular leakage,Conclusion Minimally invasive aortic replacement with a modified Port-Access approach is feasible,small incisions,more cosmetic,shorter length of bospital stay and less need for blood transfusion are attainable.

ObjectiveDouble-outlet right ventricle,which often associated with total anomalous pulmonary venous connection and complete endocardial cushion defects,has been considered a risk factor for biventricular repair procedure.To reviewed cases treated by biventricular repair for endocardial cushion defects with double outlet right ventricle.MethodsFrom July to November of 2009,6 patients (3 males and 3 females) aged from 7 to 24 (16.17±5.98) years and with endocardial cushion defects and double outlet right ventricle underwent operation of biventricular repair The duration of follow-up ranged from 10 days to 2 years(median,16 months).Endocardial cushion defects were repaired with a 2-patch technique.The artificial vascular patch was implanted to connect the ventricular septal defects and the aorta for draining the blood stream from the left ventricle to the aorta.The other patch was used to repair the ostium primum atrial septal defects.Right ventricular outflow tract obstructions was released and reconstructed by transplanting a bovine pericardium patch.If the size of pulmonary valve annulus was far more below the normal,a transannular pericardial patch was used.Rastelli procedure with a valved conduit between the right ventricle and the pulmonary artery would be performed if the obstruction in the right ventricular outfolw tract was severe.ResultsOne death occurred 2 days after the operation,resulting in a mortality rate of 16.6%.The case,a boy of 7 years old,had a mirror-image dextrocardia,complete endocardial cushion defect ( C type),anomalous pulmonary venous drainage and single atrium.In this case,the operation lasted for 8 hours,acute renal failure happened next day to the operation,the effect of CRRT was unsatisfied,and eventually cardiac arrest occurred as a result of hyperkalemia.The remaining cases had survived.Follow-up examinations showed that the systolic pressure gradients across the pulmonary valves decreased,with a range of 14 to 40 mm Hg,(23.9 ± 11.03) mm Hg.Mild mitral and tricuspid regurgiration were identified in 4 cases and moderate mitral regurgitation was identified in one case.The cardiac function in all patients was classified as NYHA class Ⅰ/Ⅱ,Conclusion Endocardial cushion defects with double outlet right ventricle can be corrected by means of biventricular repair procedure.The procedure was associated with a low mortality,The interim life quality of patients may be improved.The longterm outcomes should be further studied.

ObjectiveTo evaluate the primary effect of granulocyte-monocyte colony stimulating factor (GM-CSF) as an immunotherapy option for treatment of residual disease after alloHSCT.Methods Immunotherapy was performed on two patients with blood malignancy to treat residual disease after allo-HSCT. The patient one,who was diagnosed as having MDS-RAEB Ⅱ,showed bone marrow displasis and incomplete chimerism 6 months after unrelated donor HSCT.Immunosuppressive drug was withdrawn without induction of graft-versus-host disease (GVHD).The patient two B-ALL demonstrated a residual disease at molecular level 30 days post-transplantation.Both of them were given GMCSF (300 μg) subcutaneously once every two days for totally three weeks.During the whole period,skin itch and rash,liver function,subgroups of lymphocytes,and MDSCs and DCs in peripheral blood were investigated.Results In case one,grade Ⅰskin acute GVHD (aGVHD) appeared as early as one week after GM-CSF administration,as well as grade Ⅱ (skin and liver) by the end of the third weeks,and GM-CSF injection was withdrawn.One month later since the start of GM-CSF,the patient showed normal bone marrow morphology and full donor type chimerism. Cyclosporine A (CsA), mycophenolate mofetil and methylprednisolone were administered for two weeks to control GVHD.In the other case,grade Ⅰ aGVHD occurred 9 days after GMCSF administration,and whole blood CsA maintained at 0.134-0.472 μmol/L.Prednisone (30mg per day for 5 days) was used to control grade Ⅱ GVHD from the 11th day after GM-CSF,and grade Ⅰ GVHD continued without any intervention.On the 30th day after GM-CSF treatment,bone marrow aspiration showed complete molecular remission.In both of the two cases,no differences in lymphocytic subtypes were revealed before and after GM-CSF administration,while there were trends of increased DC number and decreased MDSCs in peripheral blood.ConclusionThe administration of GM-CSF as an immunotherapy option for blood malignancy may contribute to the clearance of residual disease after Allo-HSCT.

To investigate the therapeutic effects and associated complications of allogeneic peripheral blood stem cell transplantation (allo-PBSCT). 40 patients with various malignant hematopoietic diseases received allo-PBSCT. The preparative regimens were based on BUCY2 or modified BUCY2. The acute graft-versus host disease (aGVHD) was prevented by cyclosporin A and short-term MTX regimen in all patients. Two patients from donors with one fully mismatched HLA on DRB1 locus and 4 from unrelated donor also administered Zenapox (CD25 MAb) at dosage of 1 mg/kg every day on the day before transplantation and day 4 after transplantation. These 6 patients were also treated with mycophenolate mofetil (MMF). Transfusion of the donor cells: The median of the transfused nucleated cells was 5.38 x 10(8)/kg and that of the CD34+ cells was 7.8 x 10(6)/kg respectively. All the patients gained hematopoietic reconstruction except one who died of infection before engraftment. Seven patients got II degrees-IV degrees aGVHI) and the incidence was 17.5%. Fourteen patients got cGVHD and the incidence was 53.8% in the patients who survived over 6 months. Twenty-eight patients had fever or other characteristics of infection. The median follow-up time was 13.8 months. The incidence of transplantation related mortality (TRM) was 17.5% and 2 patients relapsed (5.0%). It was concluded that allo-PBSCT can reconstruct hematopoiesis quickly and is a favorable therapeutic method for leukemia.
China/epidemiology ; Cyclosporine/*therapeutic use ; Follow-Up Studies ; Graft vs Host Disease/*prevention & control ; Leukemia/*therapy ; Leukemia, Lymphoid/therapy ; Leukemia, Myeloid, Acute/therapy ; *Peripheral Blood Stem Cell Transplantation/adverse effects ; Sepsis/epidemiology ; Sepsis/etiology