Objective To investigate the risk factors associated with early mortality of the rapid two-stage arerial switch operation, which has a significantly higher overall mortality than that of ASO procedure for D-TGA with a intact ventricular septun. Methods The data we reviewed involving patients who underwent rapid two-stage switch operations from September,2002 to September, 2007 in our center, 13 patients were male and 8 were female, their age at operation ranged from 29 to 250 days afer birth, and the body weight was 3.5 to 7 kg. Chi-squared test and multivariant logistic regression methods were used for the analysis of demographic data, pre-diagnosis information, operation data, interval data combined with the operation time,left ventricle training condition, and the early post-operative outcomes. Results The operative mortality was high at initial stage, and then decreased gradually. The logistic multivariant regression analysis indicated that the mortality of left ventricular training operation was associated with the diameters of BT shunt ( P =0.003 ); the mortality of two-stage switch was associated with feminie ( P = 0.006 ) and pre-operative p. LV/RV ( P ＜ 0.001 ). Conclusion Patients with transposition of the great arteries and intact ventricular septum who missed the optimal time for switch operation should receive rapid two-stage switch operations, which provide an opportunity for the correction of the deformity. The key factor associated with the success for operation was good in heart function after left ventricular training.

Objective To study the effects of B cells from lupus prone Triple congenic (TC) mouse model on the differentiation and development of T cell subsets. Methods The spleen size and B cell numbers were measured, and surface CD40, CD86 and Ⅰ-Ab molecules on B cells as well as CD4+T cell subsets were detected using flow cytometry when the spontaneous systemic lupus erythematosus (SLE) model TC mice and control B6 mice were 6 months old. In addition, the chimera of TC B cells and B6 CD4+T cells or chimera of B6 B cells and B6 CD4+ T cells were transferred into B6.Rag-/- mice via intravenous injection. Then, T cell subsets in the spleen of recipient B6.Rag-/-mice were observed 7 days after cell transplantation. Results TC mice had significantly bigger spleen [(5337±934) mg] and more CD19+B cell number [(276.0±48.7)×107] than control B6 mice [spleen weight: (91±4) mg; B cell number: (6.4±0.3)×107](P<0.01). TC mice showed markedly increased CD40 [MFI (63.6±3.1)], CD86 [(MFI (18.96±0.44)] and Ⅰ-Ab [MFI (637±41) on spleen B cells compared with that of B6 mice [CD40 MFI: (36.6 ±2.0); CD86 MFI: (14.26 ±0.19); Ⅰ-Ab MFI: (307 ±23)] (P<0.01). In addition, TC mice revealed notably more Th1 subset [(36.54 ±4.22)%] in spleen than B6 mice [Th1 subset: (19.90±0.10)%] [P<0.01], but both strains had equivalent percentages of Th17 and IL-21+CD4+T cell populations (P>0.05). The recipient B6.Rag-/-mice transplanted with TC B cells had significantly more Th1 subset [(54.1±2.8)%] and IL-21+CD4+T cell population [(14.3±1.0)%], but less Th17 subset [(2.05±0.09)%] in spleen than the recipient B6.Rag-/-mice administered by B6 B cells [Th1 subset: (39.5±1.1)%; IL-21+CD4+T cell population:(7.5±1.2)%;Th17 subset:(6.45±1.10)%](P<0.01). Conclusion The B cells of lupus-prone TC mice exhibit a markedly hyper-activation in spleen, and promote CD4+T cells differentiation preferentially into Th1 subset and IL-21+CD4+T cell population, which may further contribute to SLE pathogenesis.

Adaptive response is a topic of general interest in medical research. Utilization of adaptive response has become a new treatment strategy for some diseases, the core of which is to stimulate the mechanisms of body internal protection, to improve the adaptive and anti-injury capability, and to maintain the homeostasis of the body. The existence of adaptive response indicates that the body internal protection can be induced and its key mechanism is the inducement of internal protective factors (internal protective proteins). In this article, some connections between adaptive response and the theory of traditional Chinese medicine (TCM) were discussed, which indicated that adaptive response is much beneficial for explaining some theories of TCM such as correspondence between human and nature, strengthening healthy qi to consolidate constitution, acupuncture theory, adaptogen herbs, and treating disease before its onset, etc. Thus the adaptive response is of great significance for explaining scientifically the connotative meaning of the theories of TCM and for promoting the integration of TCM and western medicine.

Objective To describe the clinical characteristics of 9 cases of idiopathic pulmonary alveolar proteinosis (iPAP) with secondary infections. Method The clinical and radiological data of 9 patients with iPAP and secondary infections admitted into Peking Union Medical College Hospital from 1 st January 1990 to 1st January 2010 were retrospectively analyzed. Results In that period, there were 97 patients of iPAP were admitted in our hospital. There were 9 patients of iPAP with secondary infections,aged (46.4±14.6)y. There were 5 males and 4 females. Among them, 6 patients were misdiagnosed as interstitial pneumonia and corticosteroids were given to them. When the infection appeared, corticosteroids were still given to 3 patients, and the other 3 patients had stopped corticosteroids for 3 to 15 and a half months. Five patients had accepted mono-lung or whole lung lavage before 1,2, 9, 14,24 months. The clinical manifestations were fever(8 cases) ,cough(9 cases) , expectoration(8 cases) ,hemoptysis(2 cases),chest pain(1 case) and moist rales(1 case). Glass-ground opacities (9 cases) and cavitations(4 case)were the main manifestations of chest radiology. Pleural effusions(1 case) was not common. The locations of infection was limited in chest:9 cases had pulmonary infection and one case was associated with pleurisy.The infectious pathogens were the acid-fast tubercle bacillus (4 cases), fungus (3 cases, candida albicans,penicillium and aspergillus fumigatus for each one) and norcardia (2 cases, one case was associated with cytomegalovirus infection). Follow-up: 6 patients were cured, 1 patient was improved and 2 patients were died. Conclusions For patients with iPAP, especially when they had been receiving corticosteroids, if they had fever and/or recently exaggerated dyspnea, especially whose chest radiology showed nodules and cavitations, the clinicians should be aware of infections diseases for them. Further specific microbiological studies and sufficient therapy should be obtained as quickly as possible.

Objective To observe the clinical effect and side-effect of low molecular weight beparin (LMWH) and simvastatin on patients with acute myocardial infarction(AMI). Methods 80 cases of AMI were randomly divided into simvastatin with low-molecular-weight heparin treatment (joint group) 40 cases and nitrates drug treatment( conventional group) 40 cases Au the patiants were observed before and after treatment for serum inflammatory factor,quantitative gated tomography,Holter and analysis of the effectbefore and after treatment. Results The conventional group and joint group after the treatment of TC, TG, LDL, HDL-C, hs-CRPs, CD40L levels were decreased than before treatment (t=2. 131, t = 2. 211, t = 2. 235, t = 2. 211, t = 2. 115, t = 2. 274, both P＜0. 05 ) ; the joint group after treatment bs-CRP, sCD40L significantly declined than conventional group (t = 2. 231, t = 2. 245, both P＜0. 05 ) ;conventional group of IMT dropped 1.1% lower than the 3.4% of the joint group ( X2 = 4. 01,P＜0. 05 ) ; conventional treatment group plaque score 11.5% higher than the combined group plaque score decreased 16. 9% (X2 =4. 25 ,P＜0. 05) ;joint group after treatment,a few soft spots(7. 7 %) lower than before treatment(28.2%) (X2 = 6. 78,P＜0. 01) ;the joint group of EDV,ESV,EF after treatment decreased significantly than before treatment (t =2. 221 ,t =2. 342 ,t = 2. 245, P＜0. 05) ; conventional treatment group and joint group after the number of ischemic attack, ST above the largest decrease, ST segment depression was significantly lower than the time before treatment(t=2. 731 ,t=2. 781, t=2. 785,t=2. 781, t=2. 815, t=2. 874, both P＜0. 01);joint total effective rate 90. 0% higher than the conventional group 67.4% (X2=4. 25,P＜0. 05 ). Conclusion Simvastatin combined with LMWH have good effect in the treatment of acute myocardial infarction.

Objective　To probe into roles of hCKLF-1 in the development of systemic lupus erythematosus in BXSB mice in vivo.Methods　The recombinant eukaryotic expression plasmid for hCKLF-1 (pCDI-hCKLF-1) was transferred and expressed in lupus-prone BXSB mice with the technique of muscle-mediated transgene by electric pulse;the levels of serum IgM and IgG anti-DNA antibodies as well as serum BUN and urine protein were detected.Results　hCKLF-1 expression in vivo did not make any effects on the levels of IgM and IgG anti-DNA antibodies in female and male BXSB mice,but markedly enabled abnormal elevation of urine protein in male BXSB mice in short time,suggesting its ability for accelerating glomerulonephritis.Conclusion　hCKLF-1 may be one of inflammation mediators,playing an important role in the lupus glomerulonephritis of male BXSB mice,and its target cells may be monocyte and macrophage.

Objective To review and sum up experience of surgical repair of single ventricle. Methods Since January 1973 to December 1999, 47 patients with single ventricle have been repaired. Right ventricle type was 17 patients, left ventricle type was 14, and unrecorded type was 16. Surgical procedure consisted of pulmonary banding 1, Fontan operation 23, and bidirection superior cavopulmonary anastomosis 23. Results Seven patients died. The motality was 15%. There was no death in bidirection superior cavopulmonary anastomosis patients. Conclusion For the single ventricle, early surgical intervention is required to prevent pulmonary congestion and severe cyanosis. The bidirection superior cavopulmonary anastomosis can improve single ventricle function secondary to pressure and volume load to decrease surgical mortality and to minimize the risk factors for subsequent Fontan operation.

Objective To probe into the role of apoptotic cells in the disease development of systemic lupus erythematosus.Methods Apoptotic thymocytes injected intraperitoneally into syngeneic normal C57 mice and lupus prone BXSB mice,and then the level of anti dsDNA and anti ssDNA antibodies of IgM and IgG classes,and the concentration of urine protein and immune complex of IgG class deposited in kidney were detected.Results The apoptotic thymocytes induced the production of anti dsDNA and anti ssDNA antibody of IgG class in C57 mice,and their levels were higher in female BXSB mice than in male ones.The concentration of urine protein of male BXSB mice injected with apoptotic thymocytes was noticeably higher than that of the control male BXSB mice.Conclusion Apoptotic cells have immunogenicity,and may be the major source of autoantigens in lupus BXSB mice.Lupus genetic factors and Yaa gene can potentiate the immunogenicity of apoptotic cells or accelerate their inducing the lupus nephritis.

[Objective] To investigate the relationship of thyroid hormones with excess-heat syndrome and deficiency-heat syndrome. [Methods] Serum levels of thyroid hormones and thyroid-stimulating hormone (TSH) in 30 healthy volunteers (Group A) , 27 cases of excess-heat syndrome (Group B) and 35 cases of deficiency-heat syndrome (Group C) were detected by radioimmunoassay. [Results] Serum levels of triiodothyronine (T3) and thyroxine (T4) were higher and reverse T3 (rT3) lower in Group C than those in Group A (P 0.05). [Conclusion] Serum thyroid hormones level in deficiency-heat syndrome is different from that of excess-heat syndrome may be related to the hypothalamus-pituitary-thyroid function.

15 mm) should be used in patients over the age of 4 and later reoperation might be avoided. For D-TGA without long segment of LVOTO, we can choose arterial switch plus pulmonary valvotomy or Konno procedure to relief the LVOTO. To prevent postoperative functional mitral regurgitation, in C-TGA-VSD-PS patients the best surgical procedure is double switch operation.