Objective To assess the correlation between pre-operative N-terminal-pro-brain natriuretic levels and early survival rate among heart transplantion (HT) recipients in a single Chinese center.Methods According to the pre-operative NT-proBNP level of 284 HT recipients,the recipients were divided into two distinctive groups,≤5000 nmol/L group (237 cases) and ＞5000 nmol/L group (47 cases).The baseline characteristics and mortality for recipients with different primary cardiac diseases and on extracorporeal membrane oxygenation (ECMO) support were compared.Kaplan Meier method was used to calculate the 1-year survival rate of the two groups.Results The pre-operative NT-proBNP ＞5000 nmol/L group had an average pulmonary capillary wedge pressure of (25.1 ± 7.4)mmHg,noticeably higher than in ≤5000 nmol/L group [(21.4 ± 9.2) mmHg,P＜0.05].At the same time,the cardiac index (CI) in ＞5000 nmol/L group was (1.8 ± 0.5) L·min-1·m-2,significantly lower than in ≤5000 nmol/L group [(2.1 ± 0.6) L·min-1 ·m-2,P＜0.05].14.9％(7/47) of recipients in ＞5000 nmol/L group used ECMO support,and the corresponding ECMO-related morbidity was 71.4％ (5/7) and 1-year survival rate was 91.3％.6.8％ (16/237) of recipients in ≤ 5000 nmol/L group used ECMO support and the corresponding ECMO-related morbidity was 12.5％ (2/16) and 1-year overall survival rate was 96.9％.There was statistically significant difference in the ECMO usage,ECMO-related mortality rate and 1-year survival rate between the two groups (P＜0.05).Conclusion Recipients with pre-operative NT-proBNP ＞5000nmol/L have higher peri-operative ECMO-related morbidity and 1-year death rate.So determination of pre-operative NT-proBNP level may be beneficial to the timing of cardiac transplantation.

ObjectiveTo evaluate the clinical effect and reliability of basiliximab as immune inducer combined with classic triad resisting immune rejection scheme in preventing immune rejection after heart transplant.MethodsWe continuously collected the clinical information of 214 patients undergoing heart transplantation from June 2004 to January 2011.Basiliximab was used at 1st h before heart transplant and 4 days after the operation by 20 mg each time.Triad resisting immune rejection scheme included methylprednisone,cyclosporine A and mycophenolate mofetil.The endocardial biopsy was done to diagnose rejection postoperatively,and the severity of acute rejection was graded according to the standardized criteria of the International Society for Heart and Lung Transplantation (ISHLT).The recipients were followed up for 1year after the surgery,the data of the endocardial biopsy and rejection were collected,and the postoperative complications and deaths were observed.Results The first time of recipients to accept the endocardial biopsy was 20.1±7.3 days postoperatively,including 63 (29.4％) cases of Grade Ⅰ A,8 (3.7％) cases of grade Ⅰ B,and 12 (5.6％) cases of grade Ⅱ.One year after operation,143 recipients accepted the endocardial biopsy,including 29 (20.3％) cases of grade Ⅰ A,1(0.7％) case of grade Ⅰ B,12 (7.7％) cases of grade Ⅱ.During hospitalization,5 recipients died,including 3 cases due to transplant heart failure,1case due to multiple organ failure and 1due to sudden death.One year after discharge,there were 2 deaths,including one case of serious rejection and 1case of multiple organ failure One month after operation,infection occurred in 7 cases (3.3％),and acute renal insufficiency in 11cases (5.1％).ConclusionCombined use of Basiliximab with triad resisting immune rejection scheme was a kind of safe and effective therapy to prevent early acute rejection after heart transplantation.

Objective To determine the incidence and independent risk factors of new onset posttransplantation diabetes mellitus (PTDM) and its prognostic value in medium term survival rate in heart transplant recipients.Method We performed a retrospective study on all heart transplant recipients in a single center from June 2004 to May 2012,and selected 226 patients without DM in pretransplant period with median 41-month follow-up.According to the diagnostic criteria of the American Diabetes Association (ADA) 2006 revised edition of PTDM,the selected patients were divided into PTDM (group 1) and NPTDM (group 2).Univariate analysis and logistic regression analysis were used to determine preoperative and postoperative risk factors responsible for PTDM.Kaplan-Meier method and Log rank test were used for survival analysis.Result Of the 226 patients,53 case developed DM (23.5 ％).The multivariate analysis identified the following as predictive factors for the development of PTDM:age ([OR]:1.05,95％ CI:1.01 ～2.30,P =0.012),and first-degree relatives of family history of DM ([OR]:1.90,95％ CI:1.04～4.10,P =0.032).The 1-,3-and 5-year survival rate in PTDM patients post-transplantation was 100.0％,98.0％ and 89.8％,and that in NPTDM patients was 98.2％,94.2％ and 92.4％,respectively.Log Rank test displayed no significant difference between two survival curves (P＞0.05).Conclusion PTDM is a frequent comorbidity after HT.Age and first-degree relatives of family history of DM were significant and independent risk factors for the development of PTDM during the follow-up period.By appropriate treatment,the medium-term survival rate of patients with PTDM was unaffected.

Objective To study the significance of No12 lymphadenectomy in patients of advanced distal gastric cancer undergoing D2 distal or total gastrectomy.Methods Clinical and pathological data of 193 distal gastric cancer cases undergoing D2 gastrectomy and No12 lymphadenectomy during Jan 2012 and Jan 2013 were analyzed retrospectively.Results In Borrmann Ⅲ,Ⅳ No.12a LN metastasis was significantly higher than that in Borrmann Ⅰ,Ⅱ (x2 =4.841,P =0.028).In cases of multiple cancer 12a LN metastasis was significantly higher than that in gastric angle,gastric antrum (11.1％ 、9.7％ 、30.4％).High-differentiated cancer was lower in LN metastasis than that of low differentiated both in No.12a group (x2 =4.292,P =0.038),and in No.12b group (x2 =4.079,P =0.043).In cases with serosal invasion LN metastasis was higher than that without infiltration both in No.12a group (x2 =8.107,P =0.004),and in 12b group (x2 =3.836,P =0.050).In cases of N 0 ～ 1 the LN metastasis was lower than that in N 2 ～ 3 in 12a group (x2 =10.960,P=0.001),12b group (x2 =4.989,P =0.026),and in 12p group (x2 =4.433,P =0.035 respectively).In cases of tumor diameter ＜3 cm,3 ～5 cm and ＞5 cm,the 12a lymph node metastasis rate was 4.2％,10.0％,and 29.2％,respectively.Tumor size ＞ 5 cm has higher metastasis rate in No.12a group (x2 =6.464,P =0.011).Conclusions No.12 lymphadenectomy should be included routinely in D2 gastrectomy in patients of distal gastric carcinoma.

Objective:To compare the pain control efficiency of continuous adductor canal block (ACB) and femoral nerve block (FNB) in total knee arthroplasty.Methods:From April to September 2016,patients with severe knee osteoarthritis undergoing primary unilateral total knee arthroplasty (TKA) were prospectively observed,and all the patients were randomized received ultrasound-guided continuous ACB or FNB after surgery.Numeric pain rating scales (NPRS)pain scores in rest and activity 2,6,12,24 and 48 h after surgery were collected,and the preoperative and postoperative quadriceps strength at 24 and 48 h were analyzed.Opioids consumption and anesthesia related adverse effects were also recorded.Results:In the study,40 patients were enrolled,with 20 patients in each group,male ∶female =7 ∶ 33,the age:(63.8 ± 10.1) years,and the body mass index (BMI):(28.5 ± 3.5) kg/ m2.The general conditions were comparable between the two groups.Though the rest pain 2 h after surgery [ACB =0.0(0,6),FNB =3.0(0,5),P=0.004] and activity pain 12 h post operation [ACB =3.0(3,0),FNB =5.5(0,10),P =0.004] were lower in ACB group compared with FNB group,there was no statistical difference in the other pain checking points between the two groups.The quadriceps strength 24 h and 48 h after surgery were (85.3-± 27.6) N and (80.0 ± 30.1) N in ACB group,(69.0 ± 29.4) N and (64.4 ± 32.0) N in FNB group,both of them were declined by time.The exact data were higher in ACB group,however,there was no statistical difference between the two group by repeated measurements variance analysis(F =2.703,P =0.108).Four patients in ACB group and five in FNB acquired additional use of dolantin once (100 mg/per time) within 24 h.And among them,three patients acquired once dolantin in ACB,two in FNB,from 24 to 48 h postoperation.There were five patients who suffered nausea postoperation in ACB group,and one who reported xerostomia.Four patients in FNB had nausea with vomiting,and three experienced xerostomia.Deep vein thrombosis appeared in 2 patients in FNB group,but no one in ACB group.Conclusion:Continuous ACB is not superior in pain control after TKA compared with FNB,and the quadriceps strength could be reserved more by this method,which performed early benefits in fast rehabilitation.

Objective: To analyze the basic thyroid hormone level on long term prognosis and peri-operative recovery in patients after heart transplantation (HT) at the terminal stage of heart failure (HF).
Methods: A total of 270 consecutive patients who received HT at the terminal stage of HF in our hospital from 2009-09 to 2014-07 were retrospectively studied. According to serum levels of thyroid stimulating hormone (TSH), the patients were divided into 3 groups: TSH < 0.55 mIU/L group, TSH (0.55-2.5) mIU/L group and TSH > 2.5 mIU/L group. The peri-operative recovery condition and long term prognosis were observed and compared among 3 groups.
Result: The average age of patients was at (44.58 ± 13.30) years including 228 (84.4%) male and 42 (15.6%) female. The average post-operative follow-up period was (31.88 ± 17.48) months with 100% follow-up rate. There were 41.8% of patients with hypothyroidism, and 46 (17.0%) patients with low T3 syndrome, 56 (20.7%) with subclinical hypothyroidism and 11 (4.1%) with clinical hypothyroidism. The ratio of low level thyroid hormone in HT patients was much higher than general population. For peri-operative recovery, the ICU stay time and mechanical ventilation time were similar among 3 groups,P>0.05, while TSH (0.55-2.50) mIU/L group had the shortest times and TSH > 2.50 mIU/L group had longest times. For long term prognosis, no matter uni-/multi- aviate regression analysis or Kaplan-Meier surviving curve all suggested that TSH > 2.50 mIU/L was the independent risk factor inlfuencing the prognosis of HT patients at the terminal stage of HF. Upon TSH increasing, the patients would have worse prognosis accordingly.
Conclusion: Serum level of TSH > 2.50 mIU/L was the independent risk factor in HT patients at the terminal stage of HF.

Objective To study the effect of Exendin-4 on oxidative stress and neural apoptosis following spinal cord injury (SCI). Methods Adult male SD rats, with weight between 200-250 g, were randomly divided into three groups (12 in each group):Sham group, SCI group and Exendin-4 group (Ex-4 group). Rats in Sham group achieved spinal cord exposure. SCI group and Ex-4 group were induced according to Allen′s test (using a weight-drop device). Rats in Ex-4 group were ad?ministrated with Exendin-4 (10 μg/rat) through intraperitoneal injection immediately after establishment of SCI models. Rats in Sham group and SCI group were given the same volume of normal saline solution instead. Level of malondialdehyde (MDA) and the activity of catalase (CAT) were assessed in spinal cord tissues 24 hour after drug administrations. Neural apoptosis was detected by TUNEL staining and the expression levels of caspase-9 and AIF were determined using Western blot. Results Compared with Sham group, the levels of MDA, caspase-9 and AIF as well as neuronal apoptosis rate in?creased obviously, while activity of CAT decreased markedly in SCI group(P<0.01). Compared with SCI group, the levels of MDA, caspase-9 and AIF as well as the neuronal apoptosis rate decreased obviously, while activity of CAT increased re?markably in Exendin-4 group(P < 0.01). Conclusion Exendin-4 restrain neural apoptosis following spinal cord injury through relieving oxidative damage.

Objective To investigate the effects of hydrogen sulfide on autophagy and the apoptosis after acute spinal cord injury in rats. Methods Thirty-six adult male SD rats (250-300 g) were randomly divided into three groups (n=12 for each group):sham operation group (Sham group), spinal cord injury group (Model group) and hydrogen sulfide pre-treatment group (H2S group). Allen’s method was used to establish the rat model of spinal cord injury. Rats of sham operation group re?ceived only laminectomy. Rats of H2S group received sodium hydrosulphide injection intraperitoneally (50μmol/kg) 1h after spinal cord injury, and Model group was given the same amount of saline solution. Rats in the three groups were sacrificed 24 h after spinal cord injury, then the spinal cord was removed. The expressions of LC3, p70S6K and Cleaved caspase-3 were detected by Western blot assay. The expression of LC3 was also detected by immunofluorescence. The cell apoptosis was as?sessed by TUNEL stain. Results Compared with Sham group, the expression levels of LC3Ⅱ/LC3Ⅰand Cleaved caspase-3 were increased in Model group, but the expression of p70S6K decreased and cell apoptosis increased in Model group (P<0.01). Compared with Model group, the expression levels of LC3Ⅱ/LC3Ⅰand Cleaved caspase-3 were decreased significant?ly, while the expression of p70S6K increased and cell apoptosis decreased significantly in H2S group (P < 0.01). Conclu?sion Hydrogen sulfide can inhibit autophagy and reduce cell apoptosis after acute spinal cord injury in rats.

Objective To investigate the protective effect of Ebselen on mitochondrial damage and its influence to Cytochrome C expression and the neuronal apoptosis after spinal cord injury in rats. Methods Sixty adult SD rats were ran-domly divided into 5 groups (12 each group). Spinal cord injury model was made using Allen's method. Sham operation group received only laminectomy;SCI group received laminectomy and spinal trauma;Saline group received saline injection intraperitoneally (0.1%DMSO) after injury;methylprednisolone group received 30 mg/kg methylprednisolone injection intra-peritoneally, ebselen group received 10 mg/kg ebselen injection intraperitoneally. The malonaldehyde (MDA) and glutathi-one (GSH)level at the injured sites of the spinal cord were detected 24 hours after trauma, and the expression level of Cyto-chrome C was also observed. Finally, neuronal apoptosis was identified by TUNEL staining. Results MDA level in the Eb-selen group was significantly lower than that in the SCI group, and GSH level was significantly elevated in the Ebselen group compared with SCI group (P<0.01). Expression of Cytochrome C in Ebselen group was lower than that in SCI group shown by Western blot, and the neuronal apoptosis in Ebselen group reduced significantly too compared with SCI group (P<0.01). Conclusion Ebselen can alleviate peroxidation,prohibit expression of Cytochrome C and inhibit neuronal apoptosis,thus it shows a protective effect to experimental acute SCI.

Objective To study the effect of de novo donor-specific antigen (DSA) on transplant heart function and recipient survival after heart transplantation.Methods 195 recipients went through heart transplantion from March 2013 to January 2016 in our center,13 patients with preoperative panel reactive antibody (PRA) and 10 patients suffered from in-hospital death were exclude from this study,and the actual number of patients enrolled in this study was 172.By detecting HLA typing and DSA,recipients were divided into DSA positive group,anti-HLA antigen positive but DSA negative group (DSA negative group) and anti-HLA negative group.Cardiac dysfunction,coronary heart disease and cardiovascular death were recorded as cardiac events during the follow-up period.By analyzing the cardiac events rate among 3 groups,the relationship between DSA and cardiac events was acknowledged.Results The mean follow-up period of all patients was (1.3 ± 0.8) years.Among 172 patients,6 were positive for DSA (3.4％).In the DSA positive group,66％ of DSA were directed at HLA Ⅱ,mainly against HLA-DQ,1 developed only anti-HLA I antibody,1 developed both anti-HLA Ⅰ and Ⅱ antibody.The median developing time of DSA was (256 ± 125) days,and the distribution was centralized in the first half year.84％ of patients in DSA positive group were witnessed cardiac events.One patient was diagnosed as coronary heart disease and received PCI at 145th days after DSA was developed.Four out of 6 patients experienced cardiac dysfunction with median developing time of (54 ± 13) days,and the cardiac function restored after treatment with immunosuppression modification,high-dose glucocorticoid and IVIG.In the DSA negative PRA positive group,the incidence of cardiac events was 13％.There was one cardiovascular death,and 2 cases of cardiac dysfunction.In the HLA antigen negative group,the incidence of cardiac events was 4％.Cox regression analysis revealed that DSA could be seen as an independent risk factor in leading to cardiac events and affecting mid-long term survival of recipients (P =0.02).Significant difference was observed in Kaplan-Meier analysis among 3 groups (P＜0.001).Conclusion DSA has strong impact on outcome after heart transplantation.Routine surveillance and appropriate treatment should be attached to DSA.