Objective To summarize the echocardiographic characteristics and clinical signiifcance of prenatal diagnosis of coronary artery ifstula (CAF). Methods Images and follow-up results of ifve fetuses with CAF diagnosed by fetal echocardiography between January, 2011 and December, 2012 in our department were reviewed. Results Echocardiographic characteristics of CAF were a dilated coronary artery in the four chamber view and the left ventricular outlfow tract view. Track the course of the dilated coronary artery can conifrm the oriifce of the ifstula. Among the ifve cases, the oriifce of the ifstula included the aortic root of left ventricular outlfow tract, right atrium side of interatrial septum, the entrance of superior vena cava to right atrium, right ventricular apex and right ventricle cone. The colour Doppler lfow imaging showed turbulence in the dilated coronary artery. The spectral Doppler with the sampling gate in coronary artery showed the characteristic bidirectional lfow pattern. One case was associated with other complex intracardiac abnormalities and one case with persistent left superior vena cava. Among the ifve cases of CAF diagnosed by fetal echocardiography, one case was missed and four cases were conifrmed by postnatal echocardiography. Conclusion Coronary artery ifstula has special fetal echocardiographic characteristics. The fetal echocardiography plays an important role in early detection, diagnosis and treatment of CAF.

Objective To determine the protective effect of osteoprotegerin (OPG), receptor activator of nuclear factor kappa-B (RANK) and RANK ligand (RANKL) on avascular necrosis femoral head.Methods Necrotic tissue or corresponding normal tissues were collected from 29 avascular necrosis femoral head patients.Quantitative Real TimePCR ( qPCR ) is used to evaluate mRNA expression of OPG , RANK and RANKL.OPG and RANKL protein levels were estimated by Western blot.Results The results of qPCR showed that the expression of OPG in the necrotic tissue was significantly higher than that in the normal tissue (4.56 ±0.37) (3.39 ±0.52) (P<0.05).The expression levels of RANKL mRNA in necrotic tissues and normal tissues were (0.86 ±0.11) and (0.31 ±0.08), respectively,the difference was statistically significant (P<0.05).The expression levels of RANK mRNA in necrotic tissues and normal tissmes were(0.87 ±0.12), (0.56 ±0.13) respectively,the difference was statistically significant (P<0.05).The ratio of RANKL/OPG and RANK/OPG in normal tissues were 0.69 and 0.52, respectively.In the necrotic tissues, RANKL/OPG and RANK/OPG ratios were 1.35 and 0.61, respectively.Results of Western blot showed that the expression of OPG in necrotic tissues was consistent with that in normal tissues.The expression of RANKL protein was detected in all samples , and the expression of RANKL protein in necrotic tissue and normal tissue was almost the same.RANK protein expression was not detected in all samples.Conclusion OPG, RANK and RANKL play important roles in progress of bone remodeling in necrotic area and in disturbance of bone homeostasis and might have an effect on bone destruction and subsequent collapse of hip joint.

Objective To evaluate the value of 16-slice spiral computed tomography angiography(16SCTA) and reconstruction technique in the diagnosis of vascular diseases. Methods Using 0.75 mm collimation,1mm slice thickness and 0.5mm repitition,16SCTA was performed in 100 patients with suspected vascular diseases.Reconstruction methods were multiple planar reconstruction(MPR),maximum intensity projection(MIP) and volume rendering technique(VRT). Results 65 patients were proved by pathology or DSA in 100 vascular diseases,which included cerebral aneurysm(n=8),brain arteriovenous malformation(AVM,n=2),pulmonary AVM(n=6),pulmonary artery embolism with thrombus of the lower limb vein(n=9),pulmonary sequestration(n=4),coronary artery soft plaque and / or calcification(n=20),aortic aneurysm(n=12),renal artery stenosis(n=3),superior mesenteric artery thrombus(n=2),femoral artery stenosis(n=1),soft tissue hemangioma(n=33).Three reconstruction techniques showed the size,shape and extent of the lesion and displayed the lesion in any directions.VRT could display three-dimensionally the lesion.MPR and MIP could show the thrombus of lesion,MIP and VRT could display the calcification of lesion. Conclusion Application of every 16 SCTA reconstruction technique can display clearly lesion and replace DSA in diagnosis of vascular diseases,and provides another reliable diagnostic method for patients and has clinical importance for treatment.

Objective To evaluate the efficacy and safety of HLA identical and haploidentical related allogeneic hematopoietic stem cell trans?plantation in the treatment of acute myeloid leukemia(AML)and myelodysplastic syndrome(MDS). Methods A total of 21 patients with AML and 8 patients with MDS who underwent allogeneic hematopoietic stem cell transplantation in our hospital from April 2011 to April 2016 were ana?lyzed retrospectively,including 16 cases of HLA?identical allogeneic HSCT,10 cases of haploidentical allogeneic HSCT,and 3 cases of syngeneic HSCT. BUCY2 or TBI plus CY ± chemotherapeutic agents was the regular conditioning regimen. No graft versus host disease(GVHD)prophylax?is was required for syngeneic HSCT,but cyclosporine in combination with methotraxate was essential for allogeneic HSCT,cyclosporine,methotrax?ate,antithymocyte globulin,mycophenolate mofetil and glucosteroids for haploidentical HSCT. Results All patients achieved fully donor?originat?ed hematopoiesis. Two patients died of severe acute GVHD within 100 days post HSCT. Acute GVHD with gradeⅡ?Ⅳoccurred in 23.1%(6/26) patients,chronic GVHD in 50%patients,therapy and relapse?relevant mortality was 4/29(13.8%)and 6/29(20.7%)cases within a median follow?up of 23(1?60)months,respectively. Two?year overall survival and leukemia free survival rates are 68.09%( 95%CI:45.77%?82.78%)and 60.22%(95%CI:38.19%?76.55%),respectively. High risk AML is still the main challenge to long?term leukemia free survival. Conclusion HLA identical and haploidentical allogeneic HSCT for AML and MDS is safe ,effective and feasible. Minimal residual disease monitoring and pre?ventative as well as preemptive intervention is necessary for improving prognosis of high risk AML.

Objective To investigate the echocardiographic features and clinical significance of prenatal diagnosis of fetal double aortic arch (DAA). Methods Totally 21 596 fetuses underwent fetal echocardiography in Nanjing Medical University Afifliated Suzhou Hospital and ifve cases were diagnosed as DAA by echocardiography. Echocardiographic characteristics, types and outcomes of these ifve cases were summarized retrospectively. Results Five fetal cases were diagnosed as DAA by fetal echocardiography. 1. Prenatal echocardiographic features:In three-vessel and trachea view, the normal“V”-shaped conlfuence formed by the aortic arch and ductal arch was absent. However, the ascending aorta bifurcated into the left and right aortic arch and these two arches encircled the trachea. Annular lfow signal around trachea was seen on color Doppler imaging. 2. Types:Among these ifve fetuses, three cases were called right arch predominant type, whose diameters of right arches were larger than those of left arches. The other two were balanced type, whose diameters of right arches were almost equal to those of left arches. 3. Accompanied malformations:Case 2 was accompanied with membranous ventricular septal defect and permanent left superior vena cava. Case 4 was associated by hemivertebrae. The other three cases had no other abnormalities. 4. Follow-up:These five cases were all arranged for MRI subsequently and all were confirmed by follow-up till to the induction of labor or three months after birth. Conclusions Double aortic arch is a kind of severe congenital heart disease. Echocardiography is the ifrst choice to diagnose DAA prenatally and three-vessel and trachea view are the effective cross sections in the diagnosis of double aortic arch.

Objective To investigate the application value of the transesophageal echocardiography TEE in patients with nonvalvular atrial fibrillation about the size lobes morphology and function of left atrial appendage LAA Methods One hundred and forty-two patients underwent TEE were divided into nonvalvular atrial fibrillation group 98 cases and non atrial fibrillation group 44 cases The orifice diameter depth volume peak emptying velocity PEV of the LAA and the 1 eft atrial dimension LAD were measured The form and lobes of LAA thrombus and spontaneous echo contrast SEC in LAA were observed Results The LAA orifice diameter depth volume and LAD of patients with atrial fibrillation were significantly higher than those in the group without atrial fibrillation which showed statistical significance P < 0 05 Forty-one cases in atrial fibrillation group were found with the SEC and the number with thrombus in LAA was 22 The differences of PEV between chicken wings and non-chicken wings were statistically significant P <0 05 The SEC in LAA and the lobe number of LAA had no relevance Conclusions It was reliable to analyze the size morphologies lobes and hemodynamic parameters of LAA in patients with atrial fibrillation by TEE which provided reference for percutaneous LAA occlusion and anticoagulation therapy for the patients with atrial fibrillation.

Objective To study the role of pulmonary angiography with 16-detector row spiral CT in the diagnosis of pulmonary embolism (PE).Methods Forty-nine patients suspected of having pulmonary embolism were examined prospectively with 16-detector row spiral CT pulmonary angiography.Contrast enhanced 3-mm section thickness was used to scan the entire chest and the raw data were used to perform the reconstruction with 1-mm section thickness and multiplanar reformation (MPR).The axial images of 3-mm,1-mm section thickness,and MPR were compared.Results PE were diagnosed in 42 of 49 patients,and 352 branches were detected,including 8 left or right main pulmonary arteries,96 lobar arteries,132 segmental vessels,and 116 subsegmental arteries.For displaying the emboli in main pulmonary arteries and lobar arteries,the results of the images with 3-mm,1-mm section thicknesses and MPR were identical.But 1-mm-thick section yielded higher rate of detecting emboli in segmental and subsegmental pulmonary arteries compared with 3-mm-thick sections,and there was significant difference statistically (P0.05).Conclusion 16-detector row spiral CT pulmonary angiography is non-invasive,fast,and highly sensitive for PE,and it should be the modality of choice for the diagnosis of PE.

Objective To evaluate the clinical effect of protecting the saphenous nerve with the suture anchor on repairing the medial collateral ligament injury of the knee joint. Methods From June 2014 to June 2016, 48 cases of medial collateral ligament injuries of the knee joint were repaired with suture anchors of the saphenous nerve in the 107th Hospital of PLA. Results All patients were followed up for 12-18 months, with an average of 14.6 months. All the patients were followed up with good stability of the knee joint. The 30 degree flexion stress test of the knee joint showed that 2 cases were positive forⅠdegree, and the stress test of the extension position was negative. The X-ray examination showed that the internal and external articular space of the knee joint was symmetrical and good, and the anchors did not loose or move in the bone. The average knee flexion before operation was (43.19 ± 2.60)°, and 1 year after operation was (135.62 ± 3.68) °. And the flexion of knee 1 year after operation was higher than that before operation (t=5.37, P<0.01). The Lysholm score was (43.19 ± 2.60) points before operation, and 1 year after operation was (93.69 ± 5.39) points, and the postoperative score was higher than that before operation (t=4.85, P<0.01). The grade of efficacy was excellent in 42 cases, good in 4 cases, fair in 2 cases, and the excellent and good rate was 95.8％(46/48). Conclusions The repair of medial collateral ligament injury with suture anchors under the protection of the hidden nerve can effectively prevent the symptoms of numbness in the medial area of the knee joint. It is simple, fixed and can be repaired under direct vision. It is reliable to restore the strength of the ligament and maintain the stability of the medial knee joint. It is worthy of clinical push and wide application.

Inflammation plays an important role in the pathophysiological process of ischemic stroke. Experimental results have shown that the lipocalin-2 (LCN2) produced by astrocytes is involved in the inflammatory mechanism of ischemic stroke and aggravates the ischemic brain damage. Clinical studies have shown that the increased LCN2 in peripheral blood of patients with ischemic stroke is associated with the poor outcomes and risk of death. Further research is needed to reveal the specific mechanism of LCN2 in cerebral ischemia-reperfusion injury, especially the signaling pathway mediated by LCN2, and look for possible treatments targeting LCN2.

Objective To investigate the expression and role of the Sonic Hedgehog (Shh) signaling pathway in intestinal mucosal barrier injury in rats with severe acute pancreatitis (SAP). Methods A total of 48 Sprague-Dawley rats were divided into sham-operation group (Sham group), SAP model group (SAP group), SAP+Shh signaling pathway-specific agonist purmorphamine group (PUR+SAP group), and SAP+Shh signaling pathway-specific antagonist cyclopamine group (CYC+SAP group) using a random number table, with 12 rats in each group, and each group was further divided into 12-hour and 24-hour subgroups, with 6 rats in each subgroup. Rats were given retrograde injection of 5% sodium taurocholate into the pancreatic and bile ducts to establish a model of SAP, and rats in the intervention groups were given intraperitoneal injection of 0.69 mg/kg purmorphamine and 0.69 mg/kg cyclopamine before modeling. Related samples were collected at 12 and 24 hours after modeling. HE staining was used to observe the pathological changes of the pancreas and the ileum; ELISA was used to measure the serum levels of amylase, lipase, diamine oxidase (DAO), and endotoxin-core antibody (EndoCAb); the TUNEL method was used to observe the apoptosis of intestinal epithelial cells; Western blot was used to measure the expression levels of Shh, Ptch1, and Gli1 in ileal tissue. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the least significant difference t -test was used for further comparison between two groups; the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups and further comparison between two groups. Results Compared with the Sham group, the SAP group had significant increases in the pathological scores of pancreatic and ileum tissue, the serum levels of lipase, amylase, DAO, and EndoCAb, the apoptosis of intestinal epithelial cells, and the protein expression levels of Shh, Ptch1, and Gli1 in ileal tissue (all P < 0.05). Compared with the SAP group, the PUR+SAP group had significantly alleviated pathological injury and dysfunction of the pancreas and intestine, a significant reduction in the apoptosis of intestinal epithelial cells, and significant increases in the protein expression levels of Shh, Ptch1, and Gli1 in ileal tissue (all P < 0.05). Compared with the SAP group, the CYC+SAP group had significant aggravation of the pathological injury and dysfunction of the pancreas and intestine, a significant increase in the apoptosis of intestinal epithelial cells, and significant reductions in the protein expression levels of Shh, Ptch1, and Gli1 in ileal tissue (all P < 0.05). Conclusion The Shh signaling pathway may be involved in intestinal mucosal barrier injury in SAP and exerts a protective effect.