Objective To summarize the sonographic characteristics of high frequency ultrasound and elastography of thyroid microcarcinoma(TMC),and to analyze the causes of misdiagnosis.Methods The preoperative ultrasonic data of 245 suspicious TMCs in 202 patients,as confirmed by operation pathology,were retrospectively analyzed.Results Preoperative ultrasonography accurately diagnosed 221 TMCs,the diagnosis rate was 90.2％,and the misdiagnosis rate was 9.8％.Among the missed diagnosed lesions,18 lesions were nodular goiter,others were 3 nodular goiter with focal papillary hyperplasia of follicular epithelium,2 nodular goiter with adenomatous hyperplasia,1 focal lymphocytic thyroiditis,respectively.The thyroid lesions≤0.5 cm in diameter were more easily to misdiagnose.According to the importance of the ultrasonographic features of TMC,the order were aspect ratio (A/T) ≥ 1,irregular-shape,microcalcifications,low or very-low echo.Based on the above corresponding characteristics and considering other features together,the diagnostic accuracy rate were 94.1 ％,93.9％,92.4％ and 90.5％,respectively.Less blood supply and ill-defined boundary were the secondary sonographic signs of TMC.The elastographic scores of TMC were most showed 4 to 5 points.Diagnosis of TMC relied on elastography alone is less effective,but when elastograph diagnosis based on high frequency ultrasound,the diagnostic accuracy is much higher,especially when there is no calcification in the lesions.Conclusions High-frequency ultrasound has a very important value in the diagnosis of TMC,while elastography has certain assistant value on the basis of high-frequency ultrasonic diagnosis.

Objective To induce the immune tolerance of heart grafts with infusion of isogeneic bone marrow mesenchymal stem cells (BMSCs) in heart transplant rats.Method Donor Wistar rats and recipient F344 rats were randomly divided into 4 groups:acute rejection group (group A),Wistar rats as the donors and F344 rats as the recipients for heart transplantation; low dose cyclosporin A(CsA) group (group B),recipient F344 rats given low dose CsA; BMSCs group (group C),recipient F344 rats given isogeneic BMSCs; BMSC and low dose CsA group (group D),the recipient F344 rats given isogeneic BMSCs and low dose CsA.The serum cytokine levels were determined,and the donor heart pathological changes and survival were observed postoperatively.The relative level of Foxp3 mRNA expression in the spleen of the recipient F344 rats was also observed.Result The blood levels of interleukin-2 (IL-2) and interferon-γ(INF-γ) were significantly reduced,but IL-4 and IL-10 levels were increased (P＜0.05),and the survival time of donor heart was significantly prolonged in group D as compared with groups A,B and C (P＜0.05 for all).Heart pathological examination revealed a mild acute rejection in group D,moderate acute rejection in groups B and C group,and severe acute rejection in group A respectively.The expression of Foxp3 mRNA was significantly lower in group A than in groups B,C and D (P＜0.05 for all),and that in group D was significantly higher than in groups B and C (P＜0.05 for both),but there was no significant difference between between groups B and C (P＞0.05).Conclusion Intravenous administration of BMSCs can alleviate immunorejection in heterotopic rat heart transplantation.Low-dose CsA acts synergistically with BMSCs to significantly inhibit acute rejection after heart transplantation.The partial mechanisms involve the suppressive effect of BMSCs on the expression of Foxp3 mRNA and modulation on cytokine.

Objective To evaluate the reconstruction of right ventricle outflow tract (RVOT) with BalMedic pulmonary valved conduit in multiple medical center.Methods Since January 2007,50 patients age (4.90 ± 7.63) years (range 6 month to 39 years),weight (16.20 ± 13.69) kg (range 4.50 to 65.0 kg),had been corrected by reconstruction of RVOT.There were 22 patients with pulmonary atresia and ventricular septal defect (PA/VSD) ; 10 patients with corrected transposition of the great arteries and pulmonary stenosis (C-TGA/PS) ; 7 patients with truncus; 4 patients with double outlet of right ventricle and pulmonary stenosis (DORV/PS) ; 3 patients with tetralogy of Fallot (TOF) ; 2 patients with complete transposition of the great arteries and pulmonary stenosis (TGA/PS) ; and each 1 with aortic stenosis (AS) and pulmonary stenosis (PS).Fifty BalMedic pulmonary valved conduits were implanted between pulmonary and RVOT underwent cardiopulmonary bypass.There were different diameter of pulmonary valved conduit included 10 mm to 24 mm depend on the patients weight and pulmonary size.All patients were followed up after operation on 1 month,3-6 months and more than 12 months.Results There was no death.Three patients were lost followed up after 12 months and one late death.There were no pulmonary valve stenosis about 91.1％,moderate pulmonary regurgitation 16.0％,no RVOT obstruction 95.6％,no main pulmonary artery stenosis 80.0％,and no right and left pulmonary artery stenosis 73.0％.Conclusion These results demonstrated that the BalMedic pulmonary valved conduit is reliable and effective in surgical procedure,but the long-term results should be followed up continually.

Objective To compare the clinical efficacy of BalMedic bovine jugular vein conduit (BalMedic) with homograft in right ventricular outflow tract reconstruction.Methods Totally 10 patients were implanted homograft to reconstruct right ventricular outflow tract,while 14 patients were implanted BalMedic from January 2003 to July 2009,and the function of the implanted conduit was evaluated by Doppler echocardiography one year after operation.Results 9 patients in group Homograft were cured,while 1 patient died of multiple organ failuie caused by infective endocarditis,which was confirmed associated to the conduit.13 patients in group BalMedic were cured,while 1 patient died of heart failure 2 days after operation,which no independent with the conduit.No stenosis of the pulmonary valve and further stoma had been found in both two groups,and they were no significant different( P ＞0.05 ).There were no thrombus aud aneurysm in both two groups.Two patients in group Homograft had low-grade regurgitation with pulmonary valve,while one had middle-grade regurgitation.And 4 patients in group BalMedic had low-grade regurgitation with pulmonary valve,no else became worse.Conclusion Both homograft and BalMedic can be used in reconstruction of right ventricular outflow tract.BalMedic may have better prospect.

Objective To retrospectively analyze the clinical management and follow-up of 13 recipients with survival of over ten years after cardiac transplantation. Methods Thirteen male recipients underwent orthotopic heart transplantation between August 1995 and June 2001 in our center and received standard immunosuppressive therapy protocols (8 cases) or induction therapy protocols (5 cases). Cyclosporine, azathioprine or mycophenolate mofetil, and prednisolone were applied as maintenance immunosuppressive regimens. Six recipients switched from azathioprine to mycophenolate mofetil when mycophenolate mofetil was available. Perioperative complications were prevented and treated. After operation, the recipients were followed up regularly to set up personnel long-term follow-up files. The incidence of acute rejection (AR) and (cardiac allograft vasculopathy (CAV) was monitored. Results The 13 survived recipients accounted for 48. 1 % of the total number in the corresponding period (13/27). All survivals recovered well and had a good quality of life. The recent (1 year) complications included acute allograft rejection (3 cases), infection (4 cases), renal insufficiency (3 cases), allograft right ventricular dysfunction (5 cases), post-transplant diabetes (2 cases) and liver dysfunction (5 cases). The long-term (1 year later) complications included acute allograft rejection (2 cases), CAV (2 cases), hypercholesterolemia (5 cases), hypertension (4 cases), hyperuricemia (10 cases) and chronic renal impairment (3 cases). One hepatitis B virus carrier died of liver cancer 13 years after transplantation. Conclusion The long-term survival of cardiac allograft recipients is closely associated with psychological state, financial condition, compliance and follow-up medical system, while the sociological and environmental factors may play important roles.

Objective To investigate living quality of patients after orthotopic cardiac transplantation and to provide scientific evidence for specific strategy of therapy and improvement of living quality of patients with cardiac transplantation. Methods SF-36 and the social support questionnaire were used to analyze living quality of 79 patients who received orthotopic cardiac transplantation in the Department of Cardiovascular surgery of Affiliated Union Hospital of Fujian Medical University. The mode of SF-36 was from the investigative numerical value of residents in Sichuan province. Description, t-test and Spearman correlation analysis were used to study the related factors. Results Compared with a reference general population, the heart transplant recipients showed a significantly worse living quality score on all domains of the SF-36 scales (P＜0. 05), except the domain of somatic pain. Among the patients after cardiac transplantation, living quality was more significantly improved in ＞2-year survival group than that in ＜one-year survival group (P＜0. 05),except the domain of somatic pain. The relationships between the social support and living quality were analyzed,and it was found that as compared with a reference general population, the heart transplant recipients showed significantly lower scores on all domains of the social support questionnaire (P＜0. 01 ). The total social support scores were positively related to mental health related living quality (P＜0.05, r = 0.223 - 0.710), except the domain of somatic pain. Conclusion Compared with a general population, heart transplant recipients demonstrated a significantly worsened living quality. But evidence showed the living quality can be improved gradually with the prolongation of the survival time after heart transplantation. Social support was related to the living quality of heart transplantation patients. Improvement of availability on social support will probably improve living quality.

OBJECTIVE: To investigate the effect of cardiomyopeptidin for injection on energy metabolism in isolated hearts of young rats after ischemia-reperfusion injury. METHODS: Fifty young healthy SD rats(aged 20 +/- 3 days and weighing 50-70 g) were randomly divided into 5 groups: a normal control group (NC group, n = 10 ): the isolated hearts were stable for 20 min, and then 150 min continuous perfusion; a normal + cardiomyopeptidin group (NCMP group, n = 10): the same as the normal control group, but K-H buffer solution was added with 50 mg/L cardiomyopeptidin, and 3 ischemia-reperfusion injury model groups, including a model control group (n = 10): the isolated rat hearts were perfused with K-H buffer and then arrested with cardioplegic solution; a CMP1 group (n = 10): the ST.Thomas'II cardioplegic solution was added with 100 mg/L cardiomyopeptidin; CMP2 group (n=10): K-H buffer and ST.Thomas'II cardioplegic solution was added with 50 mg/L and 100 mg/L cardiomyopeptidin respectively. The cardiac functional indexes were monitored, including heart rate, myocardial contractility and diastolic function, peak systolic and diastole myocardial velocities and coronary flow. In the 3 ischemia-reperfusion injury model groups, myocardial ultrastructure was observed through transmission electron microscopy; the creatine kinase isoenzyme (CK-MB) concentration was measured in the fluid outflow of coronary; the content of Na+-K+ ATPase, Ca2+-Mg2+ ATPase, total ATPase, superoxide dismutase (SOD), malondialdehyde (MDA), nitric oxide(NO), total nitric oxide synthase (TNOS), inducible nitric oxide synthase (iNOS) and aldosereductase were measured in the myocardium tissue; the relative expression levels of iNOS, eNOS, and Akr1b4 mRNA in the myocardial tissue were also detected by real-time fluorescence quantitative PCR. RESULTS: In the NC group, after prolonged perfusion, the cardiac function of isolated hearts had no significant change. Cardiomyopeptidin for injection had no significant effect on normal isolated hearts. Compared with the model control group, the cardiac function indexes and coronary flow in the groups treated with cardiomyopeptidin decreased much less. Cardiac myofibrillar fragmentation and mitochondrial swelling were observed in the control group, while in the CMP groups, the myocardial structure was nearly complete, and only mild mitochondria swelling and degeneration could be seen. After the reperfusion, the content of CK-MB was increased in the control group. Compared with the model control group, the CK-MB content was lower in the CMP1 and CMP2 groups. There was a slight decline in the contents of Na+-K+ ATPase, Ca2+-Mg2+ ATPase, and Total ATPase in the CMP1 and CMP2 groups, and an increase in SOD activity (P < 0.01 or P < 0.05). The concentration of NO and MDA produced after the ischemia-reperfusion injury was much lower in the CMP1 and CMP2 groups. The activity of iNOS and aldosereductase was inhibited, the expression levels of iNOS, and Akr1b4 mRNA were significantly down-regulated in the CMP1 and CMP2 groups. These changes were more prominent in the CMP2 group (P < 0.01 or P < 0.05). The eNOS mRNA levels in the CMP2 group was up-regulated (P < 0.05). CONCLUSION Cardiomyopeptidin for injection may improve the energy metabolism, improve coronary blood flow and cardiac function after the reperfusion, thus protecting immature myocardial against ischemia-reperfusion injury in young rats. Administration of it in both K-H buffer and ST.Thomas'II cardioplegic solution is better than adding it in cardioplegic solution alone. The mechanism may be associated with the inhibition the mRNA expression of iNOS and Akr1b4 in cardiomyocytes, the inhibition activity of iNOS and aldosereductase, and the decrease of NO production.
Aldehyde Reductase ; genetics ; metabolism ; Animals ; Energy Metabolism ; drug effects ; Female ; In Vitro Techniques ; Male ; Myocardial Reperfusion Injury ; metabolism ; Myocardium ; metabolism ; ultrastructure ; Nitric Oxide ; biosynthesis ; Nitric Oxide Synthase Type II ; genetics ; metabolism ; Peptides ; pharmacology ; Random Allocation ; Rats ; Rats, Sprague-Dawley

Objective To explore the effects of P85,microbubbles and ultrasound on plasmid DNA skeletal muscle gene transduction of mice in vivo. Methods Plasmid encoding green fluorescent protein (GFP) ,which conjugated with 0.05% P85 and/or microbubbles, 10% Optison,was injected into the tibialis anterior(TA) muscle of mice with or without ultrasound irradiation (1 MHz, 1 W/cm2 2 min,20% duty cycle). Mice were killed 1 week after injection. The TA muscles were removed and snap-frozen immediately in isopentane cooled by liquid nitrogen and sections 7 μm thick were cut at intervals. One set of sections mounted with DAPI were used to assess the transfection efficiency by counting the number of GFP-positive fibers under fluorescence microscopy,and the other set of sections were stained with haematoxylin and eosin to assess the tissue damage area. Results The P85 and Optison significantly enhanced the plasmid DNA skeletal muscle gene delivery in vivo separately (P<0.01, P<0.05).Ultrasound exposure could significantly enhance the efficiency of P85 induced gene delivery(P<0.01) but not of Option(P>0.05).The gene delivery efficiency induced by P85 was higher than that by Optison no matter with or without ultrasound irradiation(P<0.01). When the P85 conjugated with Optison, they could further significantly enhance gene delivery efficiency with ultrasound exposure (P<0.01). Meanwhile, ultrasound exposure could increase the muscle damage areas in the groups with microbubbles (P<0.01). Conclusions The P85,microbubbles and ultrasound exposure display synergistic effect to enhance plasmid DNA transduction in skeletal muscle of mice in vivo.

Objective To observe the effect of hepatocyte growth factor on preserving isolated heart of rats. Methods Forty rats were random divided into two groups: Control group(n=20)which rat hearts were isolated and preserved in 4℃HTK solution, and experimental group(n=20)which rat hearts were isolated and preserved in 4℃ HTK+rh-HGF(100μg/L)solution. Before operation and rat hearts were subjected to 8 hours(groupA,C)or 12 hours(group B,D)hypothermic storage followed by 5 minutes of normothermic reperfusion onmodifiedLangendorff-Neely model. The recovery rate of cardiac function after myocardial preservation, such as LVSP and LVDP and±dp/dt max and the changes of CK,LDH,NO and ET were measured. Cell apoptosis was detected by TUNEL staining and the expression of c-met was analyzed by immunohistochemical method. The expression change of bcl-2 mRNA was examined by RT-PCR. Results Compared with control group, experimental group showed that a significantly higher recovery rate of LVSP,LVDP and±dp/dt max(P＜0.01) and lower rate of TUNEL positive cardiomyocytes(P＜0.01) after reperfusion. The leakage of CK and LDH was significant lower than that of control group(P＜0.01). Immunohistochemical analysis revealed that c-met receptor expression was stronger in the HGF-treated myocardium than that in the non HGF-treated myocardium after storage, and this was associated with a stronger expression of bcl-2 mRNA. Conclusion The administration of rh-HGF before storage improved cardiac function after prolonged myocardial preservation by preventing apoptosis and enhancing expression of bcl-2 mRNA. Thus, the addition of rh-HGF in the storage solution may be a promising strategy for prolonged heart graft preservation.

The value of color Doppler flow imaging (CDFI) and intravenous contrast-enhanced ultrasound (CEUS) for assessing the transplanted liver and early diagnosing complications by examining hemodynamic changes was discussed. Seventy-five patients with orthotopic liver transplantation (OLT) underwent CDFI. The following parameters were measured: peak systolic velocity (PS), resistance index (RI) and Doppler perfusion index (DPI) of the hepatic artery (HA), time average velocity (TAV) of portal vein (PV) and velocity of hepatic vein (HV) in different stages postoperation. And 11 patients of them received CEUS. Thirty healthy subjects were enrolled as controls. The results showed that: (1) In 23 patients without obvious complications, TAV of PV within 15 days post-operation was significantly higher than in controls (P<0.05), PS and DPI of HA within 7 days postoperation were lower, but RI was higher than in controls (P<0.05); (2) When the hepatic artery thrombosis (HAT) occurred, PS and DPI of HA were obviously decreased, but TAV of PV significantly increased like a high saw-tooth wave; (3) While rejection occurred, both TAV of PV and PS of HA were decreased with the increase in RI of HA, and the triphasic wave of HV disappeared and displayed as saw-tooth wave; (4) The incidence of biliary complications in liver transplantation was increased when DPI was reduced; (5) Seven cases of hepatic carcinoma relapse after OLT demonstrated hyperecho in the arterial phase and hypoecho in the portal and later phase on CEUS; (6) In 2 cases of HA thrombus, there was no visualized enhancement in arterial phase of CEUS, but enhancement during the portal vein and parenchymal phase. It was concluded that the hemodynamic changes of PV, HA and HV in the transplanted liver are valuable for assessing the transplanted liver and early diagnosing complications on CDFI and CEUS.
Bile Ducts/pathology ; Contrast Media/*administration & dosage ; Hemodynamics ; Hepatic Artery/pathology ; Infusions, Intravenous/*methods ; Liver Transplantation/*adverse effects ; Liver Transplantation/*methods ; Liver Transplantation/ultrasonography ; Perfusion ; Postoperative Complications ; Ultrasonography/*methods ; Ultrasonography, Doppler/*methods