Objective: To compare patent foramen ovale (PFO) detected by transesophageal echocardiography (TEE) between patients with PFO complicated paradoxical cerebral embolism (PCE) and those PFO without symptom.Methods: A total of 132 PFO+PCE patients from our hospital were regarded as PFO+PCE group, another 80 patients with asymptomatic PFO identified by physical examination were collected as asymptomatic PFO group.Both groups received esophageal multi-faceted echocardiography at rest and during Valsalva manoeuvre and right ventricular acoustics angiography.PFO size, shunt degree, presence of atrial septal aneurysm.Eustachian valve and PFO tunnel length were recorded.Results: Compared with asymptomatic PFO group, there were significant rise in PFO size [(1.2±1.2)mm vs.(3.8±1.3)mm], PFO tunnel length [(11.2±5.6) mm vs.(13.0±5.8) mm], proportions of large shunt (2.5% vs.41.7%), atrial septal aneurysm (16.3% vs.47.7%) and Eustachian valve (13.8% vs.46.2%) in PFO+ PCE group, P<0.05 or <0.01.Conclusion: The foramen ovale of PFO+PCE patients is usually bigger, typically complicated with large shunt, atrial septal aneurysm and Eustachian valve, and foramen ovale tunnel is longer.These morphological characteristics may be meaningful for paradoxical cerebral embolism.

Objective: To study the correlation between serum N terminal pro brain natriuretic peptide (NT-proBNP) concentration and mean pulmonary arterial pressure (mPAP) in patients with congenital heart disease (CHD). Methods: According to mPAP level, a total of 62 CHD patients undergoing transcatheter closure were divided into non- pulmonary artery hypertension （PAH）CHD group (n=26), CHD + mild PAH group (n=17), CHD + moderate PAH group (n=12) and CHD + severe PAH group (n=7). Another 20 healthy subjects in the same period were selected as healthy control group. The changes of serum NT-proBNP concentration was compared among all groups before, 24h and three months after operation. Correlation between NT-proBNP concentration and mPAP was analyzed before transcatheter closure. Results: Compared with healthy control group, there was significant rise in serum NT-proBNP level in all CHD groups before operation, and it significantly elevated along with mPAP increased [healthy control group (34.0±16.8) pg/ml vs. CHD non-PAH group (68.0±20.2) pg/ml vs. mild PAH group (116.7±43.5) pg/ml vs. moderate PAH group (273.1±64.2) pg/ml vs. severe PAH group (326.5±50.2) pg/ml, P<0.01? all]; linear correlation analysis indicated that serum NT-proBNP concentration before operation was positively correlated with mPAP in 62 CHD patients (r=0.604, P=0.002). On 24h after transcatheter closure, NT-proBNP concentration was significantly higher than before operation in all groups, but it possessed significant difference only in non-PAH CHD group [(98.9±22.1) pg/ml vs. (68.0±20.2) pg/ml, P<0.05]. NT-proBNP concentration was significantly lower than before operation in all CHD groups after three months (P<0.01? all). Conclusion: Serum NT-proBNP level rises along with pulmonary arterial pressure increased in patients with congenital heart disease, which could be used as an index judging severity of pulmonary artery hypertension and prognosis in these patients.

BACKGROUND:At present,the use of a locking bone plate combined with steel wire or steel cable for the treatment of periprosthetic femoral fracture often adopts monocortical fixation,which is not stable and the proximal end of the bone cannot be achieved anatomically fitted by plate.The customized anatomical plate system can effectively solve this problem. OBJECTIVE:To explore the biomechanical strength of a customized anatomical plate system in fixation of Vancouver BI periprosthetic femoral fracture. METHODS:CT thin layer scanning data of normal femurs of 1 006 cases were selected and input into the MIMICS 21.0 software to establish the three-dimensional reconstruction model of the femur,which was set as the three-dimensional reconstruction group.56 complete human femoral specimens were selected as the femoral specimen group.The measured results of the two groups for femoral anatomical appearance were compared.If there was no significant difference between the two groups,the approximate appearance of a customized anatomical plate system was designed based on the measurement results in MIMICS 21.0 software and NX11.0 software.The customized anatomical plate system was designed and prepared according to the above measurement results.Eight pairs of frozen human femurs were selected to make Vancouver BI periprosthetic femoral fracture,which of the left were thin layer scanned by dual-source CT to obtain data.The data were transferred to determine the customized anatomical plate system model by the above design software.Eight sets of customized anatomical plate systems were ultimately produced,relying on the instrument company.The eight pairs of models were numbered 1-8.The left side was fixed with the customized anatomical plate system(customized anatomical plate system group);the right side was fixed with a metal locking plate system-large locking plate(claw plate group).L1-L4 and R1-R4 were subjected to vertical short-cycle loading test and vertical loading test.L5-L8 and R5-R8 were subjected to horizontal short-cycle loading test and four-point bending test.The vertical loading test and four-point bending test were used to collect bending load,bending displacement,and bending strain.Two short cycle loading tests were used to collect strain displacement to compare the maximum load,maximum displacement,bending stiffness,and short-period displacement resistance of the two kinds of bone plates. RESULTS AND CONCLUSION:(1)There were no significant differences in all indexes between the three-dimensional reconstruction group and the femoral specimen group(P>0.05).Individual customized anatomical plate system was designed based on the measurement results combined with digital software.(2)In the vertical loading test,the maximum load was higher(P=0.015),the maximum bending displacement was smaller(P=0.014),and the bending stiffness was higher(P=0.005)in the customized anatomical plate system group compared with the claw plate group.(3)In the four-point bending test,the maximum load was higher(P=0.023),the bending stiffness was higher(P=0.005),and the maximum bending displacement was not significant(P=0.216>0.05)in the customized anatomical plate system group compared with the claw plate group.(4)In the vertical short-cycle loading test,the average level of bending displacement in the customized anatomical plate system group(0.23±0.10 mm)was significantly lower than that in the claw plate group(0.44±0.02 mm)(P<0.05).(5)There was no significant difference in the average level of bending displacement between the two groups in the horizontal short cycle loading test(P>0.05).(6)It is concluded that the customized anatomical plate system has personalized anatomical characteristics,and the fixation of Vancouver BI periprosthetic femoral fracture is more stable,which has certain significance for clinical treatment.