A 34-year-old woman who was suffering from aortitis syndrome with annuloaortic ectasia (AAE) and severe aortic regurgitation (AR) from 18 years of age was admitted for an aortic root replacement. She has been on 5mg predonine daily. Aortography, CT and echocardiography examinations revealed dilated aortic annulus (D=30mm) and valsalva sinuses (D=43mm) and overstretched aortic valve leaflets. The ascending aorta was aneurysmal (D=50mm). Because of the patient's strong desire to have children, a Freestyle bioprosthesis was chosen for replacement. A collagen impregnated tube graft was interposed between the Freestyle and the proximal end of the transverse aorta. In order to reconstruct the coronary arteries, the Cabrol technique was utilized because of severe inflammatory adhesion of the aortic root. The patient had an uneventful postoperative course. This case shows that an aortic root replacement with Freestyle bioprosthesis offers a great benefit to those patients who are not suitable to receive postoperative anti-coagulation therapy to enable future pregnancy and child delivery.

Objective To study the clin ic al application of 64-slices spiral CT in coronary artery. Methods Twenty-six patients were performed 64-slices spiral CT in coronary artery, 15 of the 26 patients underwent selective coronary artery angiography. Results The main branches and part of the sub-branches o f the coronary artery were clearly displayed. 38 coronary artery branches of 16 patients were found stenosis. In 15 cases with conventional angiography, all mai n branches and parts of sub-branches of coronary artery were displayed clearly. All patients demonstrated coronary artery stenosis. The diagnostic accuracy of 64-slices spiral CT was 94.12%. Conclusion As a minimall y invasive examination, 64-slices spiral CT is a valuable method to detect and diagnose the diseases of coronary artery.

Objective To investigate the effect of treatment and restoration of residual dental root and crown in the elderly. Methods A total of 68 elderly patients with 202 residual roots and 47 residual crowns was treated.Radiography was taken to find out the length of residual roots and the status of treatment. A comprehensive treatment plan was made for each case, including restoration, extraction and endodontic treatment, etc. The restoration and the periodontal health of abutment teeth were followed up for 1 5 to 3 years consecutively. Results In endodontically treated teeth, the success rates of anterior 109, bicuspid 74, molar 26, were 92 3% 94 5%. In 87 post core crowns, 1 root cracked, 7 teeth mobility was 2 0 3 0 , all of which were the abutment teeth of removable dentures and single tooth. Maybe it was the impact of load heavy and occlusal trauma. In 64 post core fixed bridges, 6 ceramic broken was the impact of occlusal trauma. The function of restorations was good, with no root caries. Periodontitis was mainly in the abutment teeth and single tooth. Failure rate of restorative was 5 5% 7 7%. Conclusions Comprehensive treatments and restorations for residual root and crowns in the elderly would improve periodontal health and chewing function.

Objective To evaluate percutaneous endoscopic gastrostomy (PEC) in long-term coma patients at different phases who received trans-nasal feeding in Department of Neurosurgery. Methods A total of 51 patients who received trans-nasal feeding because of long-term coma were randomly divided into 2 groups to undergo PEG at 25-39 days after coma (n =24) or at 40-60 days (n = 27) , respectively. The rates of upper gastrointestinal bleeding, average episodes of bleeding, average hemostatic time, the rates of aspiration and aspiration pneumonia were compared between the 2 groups. Results The rates of upper gastrointestinal bleeding, aspiration and aspiration pneumonia in post-PEG patients were significantly lower than those in pre-PEG patients (P < 0.05). Before the procedure of PEG, the rates of upper gastrointestinal hemorrhage,average episodes of bleeding, rates of aspiration and aspiration pneumonia in 25-39-day group were significantly lower than those in 40-60-day group (P < 0.05). There was no significant difference between 2 groups, in regarding of either hemostatic time, or rates of upper gastrointestinal bleeding, aspiration and aspiration pneumonia after PEG (P > 0. 05). Conclusion PEG may decrease the rates of upper gastrointestinal bleeding, aspiration and aspiration pneumonia in neurosurgical patients receiving trans-nasal feeding because of long-term coma. PEG is preferably performed on 25-39 days of onset to 40-60 days. If there is no contraindication, 25-39 days after coma is likely to be the optimal time for PEG.

This study was designed to evaluate the optimal surgical treatment strategy for abdominal aortic aneurysm (AAA) coexisting with coronary artery disease (CAD). Twenty-six patients (21 men and 5 women with a mean age of 72.6±3.7 years old) who required surgical treatment of both conditions were examined. Eleven patients underwent a one-stage operation. Four of them had on-pump CABG and 7, including 3 high-risk-patients, underwent off-pump CABG. There were no operative mortalities, but 3 patients had severe morbidity (respiratory failure, acute renal failure, pneumonia). Fifteen patients underwent a two-stage operation. None of them had rupture of the AAA during the interval between the two operations, but 2 patients with large AAA (more than 6cm in diameter) required emergency operation due to impending rupture of the AAA. There was no operative mortality, but one patient suffered acute renal failure. One-stage operation for low-risk patients seems to be a safe and reasonable strategy. One-stage operation for high-risk patients should be performed cautiously, and off-pump CABG is especially useful in such patients.

Objective To explore the prevalence of self reposed mania/hypomania symptoms of depressive disorders and the difference between the two self-rating symptoms questionnaires in setting of psychiatric clinic of a general hospital.Methods 102 outpatients who were diagnosed with depressive disorders by ICD-10 in department of psychiatry of Tongji Hospital of Tongji University were continuously investigated and fulfilled the Chinese Version mood disorder questionnaire(CV-MDQ)and the Chinese Version 32 items hypomania check list(CVHCL-32).The positive mania symptoms were elevated with at least seven positive mania items reported by the CVMDQ.The positive hypomania symptoms were elevated with at least fourteen positive hypomania items reported by the CV-HCL-32.Results The internal consistency(Cronbach alpha)of the CV-MDQ was 0.808(95% CI=0.767～0.845,P<0.01).The internal consistency(Cmnbach alpha) of the CV-HCL-32 was 0.916(95% CI=0.898～0.930,P<0.01).11 patients(10.8%) reported positive mania symptoms by the CV-MDQ.14 patients (13.7%)had been reported positive hypomania symptoms through the CV-HCL-32.The ability of discriminating mania or hypomania between the two scales was significantly different(Kappa=0.227,P<0.05).Compared to the patients who were reported negative hypomania symptoms by the CV-HCL-32.the 11 patients with positive hypomania symptoms by the CV-HCL-32 had much earlier age in first episode(35.0 vs 50.5,z=-2.065,P<0.05),much longer months in total disease course(60.0 vs 22.0,z=-2.102,P<0.05)and present episode (12.0 vs 6.0,z=-2.180,P<0.05),and much higher frequency of relapse(2.5 vs 1.0,z=-2.168,P<0.05),but no significant differences at age,gender and education.No significant differences appeared between CV-MDQ positive and negative group.Conclusion Mania or hypomania symptoms may be screened by CV-MDQ and CV-HCL-32 from the outpatients with depressive disorders who are diagnosed by ICD-10 in general hospital.whether CV-HCL-32 is superior to CV-MDQ when screening bipolar Ⅱ disorder is worthly further study.

Objective:To investigate the feasibility and safety of perimembranous ventricular septal defects (PmVSD) closure solely by femoral vein approach under transesophageal echocardiography (TEE) guidance.Methods:From January 1,2014 to May 31,2016,26 patients with PmVSD in Second Xiangya Hospital were selected,with age at 3.2-6.0 (4.3±0.7) years old and body weight at 15.0-19.5 (16.7±1.4) kg.The diameter of VSD was 3.5-4.8 (4.1±0.3) mm.All patients were treated by percutaneous PmVSD closure solely by femoral vein approach under TEE guidance.The effect of the procedure was evaluated by TEE and transthoracic echocardiography (TTE).The clinical follow-up study was conducted by TTE at 1,3,6 and 12 month (s) after the procedure.Results:Twenty cases were successfully treated with percutaneous PmVSD closure solely by femoral vein approach under TEE guidance,and the success rate was 76.9％.Six patients were converted to perventricular closure under TEE guidance because the guide wire in two cases or catheter in other cases could not pass through PmVSD.The diameter of symmetrical VSD occluder was 6.0-7.0 (6.2±0.4) mm.The procedural time was 12.0-64.0 (26.8±6.3) min.The residence time at ICU was 1.8-2.4 (26.8±6.3) h.The in-hospital time was 4.0-5.0 (4.4±0.5) d.There were 3 patients with immediate post-operative trivial residual shunt and incomplete right bundle branch block (IRBBB).All patients survived with no peripheral vascular injury or complications such as tricuspid regurgitation,pericardial tamponade and pulmonary infection.The residual shunt disappeared in 3 patients and IRBBB became normal rhythm in 3 patients at 1 month follow-up time point.No patients suffered from occluder malposition,residual shunt,pericardial effusion,arrhythmia (atrio-ventricular block),aortic valve regurgitation and tricuspid regurgitation.Conclusion:TEE-guided percutaneous PmVSD closureby femoral vein approach is safe and effective.

0.05). The bone graft rate was 13% in senile group and 9% in non-senile group( P

Objective To investigate the effect of sinomenine on the purinergic receptors A2A and P2X7 in endotoxemia mouse model and RAW264.7 macrophage model stimulated by lipopolysaccharide(LPS). Methods BALB/c mice were randomly divided into blank control group, model group and sinomenine group. Thirty minutes after the rats of sinomenine group were pretreated with intraperitoneal injection of sinomenine (40, 80, 160 mg/kg), the mice were given intraperitoneal injection of 15 mg/kg LPS to induce endotoxemia model. The serum levels of tumor necrosis factor-alpha(TNF-α) and interleukin-6(IL-6) were measured by enzyme-linked immunosorbent assay (ELISA). The expression levels of purinergic receptor A2A and P2X7 in the liver and spleen were detected by reverse transcription-polymerase chain reaction(RT-PCR). RAW264.7 macrophages were divided into blank control group, LPS group and sinomenine group. Sinomenine group was firstly treated with sinomenine(300μmol/L) for 2 h, and then LPS group and sinomenine group were treated with LPS (100 ng/mL) for another 8 hours. TNF-α in the cell supernatant was measured by ELISA, and the expression levels of A2A and P2X7 in RAW264.7 cells were detected by RT-PCR. Results Stimulation with LPS could induce the increase of the mouse serum levels of TNF-α and IL-6 as well as the expression of A2A and P2X7 in mouse liver and spleen, and sinomenine had a counteraction on the above indexes(P<0.05) . In-vitro stimulation with LPS could induce the increase of the content of TNF-α and the expression of A2A and P2X7 in RAW264.7 cells , and sinomenine decreased TNF-α content and P2X7 expression (P<0.05) , but had an effect on enhancing A2A expression. Conclusion Sinomenine suppresses the expression of purinergic receptor P2X7 in mouse spleen and liver as well as in RAW264.7 macrophages, but its effect on the expression of A2A in various tissues and cells varies, whose related mechanism is needed further study.

Objective To evaluate the role of myricetin in the metastasis of human renal cancer ACHN cells both in vitro and in vivo.Methods With different concentration of myricetin (25, 50, 100 μmol/L) acting on ACHN cells, the cell viability, migration and invasion were respectively measured with CCK-8 assay, wound healing migration assay and Transwell invasion assay in vitro.A lung metastatic model for human renal cell carcinoma was developed by tail vein injection with ACHN cells.The effect of myricetin on the metastasis of renal cell carcinoma was explored by intraperitoneal injection of myricetin in vivo.After 6 weeks, the micro metastases of the lungs in nude mice was examined.Results Compared to the control group, CCK-8 assay showed that the cell viability was significantly lower in the myricetin group at the concentration of 50 μmol/L for 24 h (P=0.019).The inhibitory effect became more significant with the increase in drug concentration or action time.In addition, myricetin also inhibits the migration and invasion of ACHN cells in a dose dependent manner.Intraperitoneal injection of myricetin significantly reduced the number of the micro metastases of renal cell carcinoma in the lungs of nude mice.Conclusion Myricetin effectively inhibits the cell viability, migration and invasion of human renal cancer ACHN cells.It has the potential therapeutic value in the treatment of renal cell carcinoma.