Objective In order to meet the quantitative measurement of soft tissues balance required in the TKR,a new soft tissues balance navigation system have been developed and used experimentally in adjusting the soft tissue release of medial collateral ligament(MCL)and quantitative measurement of the force change in extension gap or flexion gap after various kinds of MCL release during TKA.Methods Six precise load sensors have been embedded in the front measure device,which is inserted into the cutting gaps of the 5 knee joints of cadavers to measure the force of MCL before or after various types of releases.The device has the function of changing distance between its upper and lower plates by the mechanical structure for the adjustment of different bone cutting space.The reading of the sensors representing the force are displayed in three or two-dimensional manner in real-time with accuracy of better than 0.098 N per bit.Results The preliminary test shows that the measurement system can accomplish the force measurement and the distance adjustment in the knee joint,and its application for measuring the force of medial collateral ligament shows a quantitative force change in MCL in different knee position and different way of release.Release of the posterior portion of MCL mainly produces laxity of MCL at full extension with 33.61% reduction rate of tensional force in value.Complete medial collateral ligament release causes laxity of MCL both at full extension and 90? flexion with reduction rate of 44.96% or 41.30% respectively.Conclusion The soft tissues balance measurement device are capable of clinical use for navigation of soft tissue balance in TKA and performing knee dynamics research.It has been proved quantitatively that the posterior portion of MCL plays an important role in stability for extended knee while the anterior portion of MCL mainly stabilizes the knee in flexion.

ObjectiveTo evaluate regional and global systolic function of left ventricle (LV) after mitral valve replacement(MVR) of different methods by 2-dimensional strain (2DS).MethodsAccording to the operational method whether preserve the posterior leaflet and its subvalvular apparatus,48 patients who underwent MVR were divided into two groups,the preservation group (group A) and the resection group (group B).Echocardiography was examinated before and after MVR and the apical four-chamber view,two-chamber view and long-axis view of LV were acquired.Regional peak strain (Sp) and global strain (GS) of LV longitudinal movement were analysed by 2DS software.Results①Compared to preoperation,the Sp in basal segment of posterior septum and inferior wall and middle segment of lateral wall in group A increased significantly ( P ＜0.01 or P ＜0.05).The Sp of group B were improved in both basal and middle segments of posterior septum ( P ＜0.05),while declined in middle segment of lateral wall and anterior wall,basal segment of lateral wall and apical segment of anterior wall significantly (P ＜0.01 or P ＜0.05).②Compared with group A,subtractions between preoperative and postoperative Sp of group B decreased in middle segment and apical segment of anterior wall,middle segment of lateral wall and middle segment of inferior wall significantly ( P ＜0.01 or P ＜0.05).③The GS of group A increased significantly ( P ＜0.05),while that in group B tended to reduce with no statistical significance ( P ＞0.05).Compared with group A,subtractions between preoperative and postoperative GS of group B droped significantly (P ＜ 0.05).ConclusionsAppropriate preservation of the posterior leaflet and its subvalvular apparatus has morebeneficial effect in improving the early regional and global function of LV after surgery,which would be recommended in MVR.Early regional and global systolic function of LV after MVR could be accurately evaluated by 2DS relatively,which has the application value of guiding clinical treatment and estimating prognosis.

Objective To evaluate the capability of strain rate imaging(SRI)for monitoring regional systolic deformation and synchronicity of left ventricle after coronary artery bypass graft(CABG)and for evaluating effect of surgery and predicting restenosis.Methods The values of systolic strain rate(SRsys),systolic strain(Ssys)and post systolic strain index(PSI)in 5 segments supplied by left anterior descending coronary artery were measured in study group(60 patients with coronary artery disease)at 1 day before and 10 days,1 month,3 months and 6 months after CABG.Forty healthy participants served as a baseline control group.The regional myocardial function before and after CABG was compared and analyzed.Results The peak values of SRsys and Ssys decreased before CABG in study group.In 52 of the 60 patients,SRsys and Ssys in the graft segments increased gradually and showed statistical significance in most studied segments at 3 and 6 months after surgery.In the above 52 patients,value of PSI increased before CABG and reduced significantly in all analyzed segments at 6 months after surgery.The restenosis of graft artery was suspected in 8 patients by SRI and the positive predictive value was 75%.The diagnosis sensitivity of SRI parameter method was higher than that of 2-dimensional echocardiography and the sensitivity of Ssys was higher than that of SRsys.Conclusions SRI can be used to quantitatively assess the regionsl systolic deformation and synchronicity and monitor the improvement of myocardial function after CABG and determine the effect of surgery and predict restenosis of graft artery.

Objective To summarize the characteristics of low echo lesions by ultrasound findings in fat-ty liver,using real -time contrast -enhanced ultrasonography ( CEUS) for differential diagnosis .Methods The study was examed in 128 cases low echo lesions of fatty liver by using CEUS ,the malignant and the highly suspec-ted malignant and part of the benign lesions (in all the 52 cases)were punctured by ultrasound guided biopsy ,the rest of the 76 cases was confirmed benign by clinical comprehensive diagnosis ,were compared to the characteris-tics about ultrasound and contrast -enhanced ultrasound image and reviewed regular follow -up.We calculated the sensitivity,specificity,youden index and the area under the ROC curve by contrast -enhanced ultrasonography and ultrasound and apply for Kappa test for reliability analysis to contrast -enhanced ultrasonography and ultra-sound.Results There were 23 malignant lesions and 105 benign lesions in total of 128 patients.The sensitivity, specificity,youden index and the area under the ROC curve by contrast -enhanced ultrasonography and ultra-sound were 95.65%,98.10%,93.75% and 87.00%,91.43%,84.43%respectively.Compared contrast -en-hanced ultrasound examination diagnosis of low echo lesions in fatty liver with the clinical diagnosis performed good reliability(Kappa=0.922,P=0.045).Conclusion We should pay attention to low echo lesions in the fatty liver.contrast-enhanced ultrasound can effectively identify low echo lesions in the fatty liver ,and identify benign and malignant lesions in the liver ,and improve obviously the accuracy of diagnosis ,and reduce the misdi-agnosis rate.

Objective To analyze the characteristic of trauma in 246 fatal falls. Methods We collect 246 cases of fatal falls from Pudong district of Shanghai from 2005 to 2014, and then analyze the characteristics of trauma by using different parameters. Results The height in suicides by fall is higher than accidents by fall (25.7m:13.98m). In all fatal falls, head has a higher possibility in suffering trauma than other body regions (75.2%), while neck has a lower possibility (6.5%). The possibility of head trauma in accidents by fall is higher than suicides by fall (89.4%:75.2%). Conclusion Comparing with suicides by fall, victims in accidents by fall have lack of protection from limbs. Besides, the low rate of ifnding neck trauma suggests legal physicians should be more careful in examining this area.

Objective To study the role of call stimulate in arousal of coma patients after severe craniocerebral injury.Methods Twenty patients with severe craniocerebral trauma coma,admitted to our hospital from June 2014 to June 2015,were randomly divided into stimulation group (n=13) and control group (n=7).In addition to the regular relatives call stimulation,other treatments in stimulation group were the same as the control group.One,2,and 4 weeks after call stimulation,Glasgow Coma Scale (GCS) scores,blood flow velocity changes of internal carotid artery (ICA) and middle cerebral artery (MCA),and neurotransmitter contents of5-hydroxytryptamine (5-HT),dopamine (DA),norepinephrine (NE) and acetylcholine (Ach) in the cerebrospinal fluid (CSF) were detected.Results The consciousness was significantly improved in the stimulation group since the second week;at the 4th week,the GCS scores (11.85±2.58) were significantly higher than those in the control group (9.14±2.85,P＜0.05).ICA and MCA blood flow velocity of both groups reached peak level in the first week,and then,gradually decreased till the end of the observation;ICA velocity value in the stimulation group (72.85± 7.45) was lower than that in the control group (82.14±11.61).The DA,Ach and NE content in the stimulation group were significantly increased at the 4th week as compared with those in the control group (P＜0.05);but no significant difference was noted between the two groups in the content of 5-TH (P＞0.05).Conclusion The call stimulus has certain awaking effect on coma patients,whose mechanism may be related to call induced changes of cerebral blood flow velocity and related neurotransmitter release.

Objective To assess the influence of different interventional injection routes of raltitrexed on the liver function, histology and pharmacokinetics in experimental rabbits, and to discuss the feasibility, safety and advantages of local application of raltitrexed. Methods A total of 25 New Zealand white rabbits were randomly and equally divided into 5 groups with 5 rabbits in each group: group A (using peripheral intravenous injection), group B (employing hepatic arterial infusion), group C (adopting hepatic artery embolization with Lipiodol), group D (hepatic artery embolization with gelfoam particles), and group E (direct puncture of liver and injection). Clinical equivalent dose (0. 17 mg/kg) raltitrexed injection was given to each experimental rabbit. At 5, 15, 30, 60, 120 and 180 min after the treatment, venous blood sample was collected for pharmacokinetic analysis. At 6 h and one week after administration of drug, liver functions were tested, and histological specimens of liver tissues were made at the same time. Results The peripheral blood drug concentrations at 5 and 60 min in group A were 0. 91 μg/mL and 0 μg/mL respectively, at 5 and 180 min in group B were 1. 73 μg/mL and 0. 37 μg/mL respectively, at 5 and 180 min in group C were 0. 82 μg/mL and 0. 08 μg/mL respectively, at 5 and 180 min in group D were 0. 94 μg/mL and 0. 08 μg/mL, and at 5 and 60 min in group E were 0. 39 μg/mL and 0. 13 μg/mL respectively. Six hours after administration of drug, the serum levels of AST, ALT in group C, group D and group E were significantly increased (P＜0. 0l), which returned to normal levels in one week after the treatment. The severity of liver tissue degeneration and necrosis detected in each group varied, in a severity - decreasing order, from group E, group C, group D, group B and group A. In group E, the surrounding normal liver tissue had no obvious necrosis. Conclusion The rabbit' s liver has no significant first pass elimination effect to raltitrexed. The equivalent dose of raltitrexed administered through the hepatic artery can cause obvious hepatocellular injury. Direct puncture and injection produce limited liver injury. Clinically, the dose of raltitrexed can be adjusted based on the degree of super selective catheterization condition and tumor size. (J Intervent Radiol, 2018, 27:247-251)

Objective: To investigate the prevalence of bifid mandibular canals (BMC), and to measure their diameter and angle. Methods : CBCT images of 500 patients were used for this study. The incidence and types of bifid mandibular canals were recorded according to a modified classification of Naitoh: Ⅰ, retromolar canal; Ⅱ, dental canal; Ⅲ, forward canal; Ⅳ buccolingual canal. The diameter and angle between the accessory canal and the main mandibular canal were recorded. Results: Bifid mandibular canals were found in 32.2% of the 1 000 hemi- mandibles, with the incidence rate of 52.17%, 36.02%, 6.21%, 5.59% in TypeⅠ, Ⅱ, Ⅲ, Ⅳ respectively. There are 90 cases of the mandibular branch with a diameter greater than or equal to the backbone 1/2, and 100 cases that are less than 1/2 of the backbone. The angle between the mandibular branch and the trunk Ⅰ, Ⅱ and Ⅲ were 50.21° ± 22.25°、28.81° ± 11.5° and 13.50° ± 2.39° respectively. Conclusion Bifid mandibular canals were observed at a relatively high incidence using CBCT, and the most common type was the retromolar canal. It is suggested CBCT should be taken before mandibular surgery to give an accurate evaluation of bifid mandibular canals.