Objective To explore and evaluate the value of transcatheter closure procedure in con-genital heart diseases. Methods Transcatheter closure was performed in 12 patients with congenital heart diseases including 6 ventricular spetal defect (VSD), 4 atrial septal defect (ASD), 2 patent ductus arteriosus (PDA), by the Amplaztzer occlusion device under local or general anesthesia. Results The procedure was successful in all patients outcoming with the disappearance of cardiac murmur. All of them could get out of the bed within 6 to 12 hours postoperatively, and were discharged from hospital after 4 to 6 days.Conclusions Transcatheter treatment of congenital cardiac defects by Amplatzer occlusion device is less traumatic, with good effect, simul taneously.

Objective To study the values of HMRS and DTI technology for detecting brain damage in heroin-dependent patients.Methods The routine MRI,HMRS and DTI were performed in 7 heroin abuser8 and 8 healthy volunteers without the history of drug abuse.The regions of interest(ROI) were selected in the gray matter and white matter of prefrontal lobe in HMRS exam,and the ratio of NAA/ Cr、Cho/Cr and Cho/NAA were measured respectively.For the DTI,six ROIs were selected,and the values of fractional anisotropy(FA)and ADC were calculated respectively.The independent samples t test was used for the statistics.Results No abnormality was found in the routine MRI.The ratio of NAA/Cr decreased in the prefrontal lobe.the values were 1.40±0.16 in gray matter and 1.72±0.41 in white matter 0f the drug group.1.57±0.09 and 2.08±0.21 in the control group on HMRS examiation.The differenee between the two groups had statistical significance(t=2.183,2.190,P<0.05)On DTI examination,the values of FA decreased in GCC,SCC and AIC,each was 0.70±0.04,0.76±0.41,0.55±0.03 in drug group,and 0.76±0.03,0.82±0.03,0.64±0.03 in controlgroup.The difference betweenthetwo groups had statistical significance(t=3.830,3.713,5.555,P<0.05).The value8 of ADC increased in SCC,PIC and EC in drug group,each Was(8.18±0.48)×10-4,(7.54±0.22)×10-4,(7.72±0.30)× 10-4and(7.50±0.26)×10-4,(7.154-0.20)×10-4,(7.19±0.39)×10-4mm2/s in control group respectively.The difference between tlle two groups had statistical significance(t=3.477,3.507,2.895, P<0.05).Conclusion The early abnormalities of the brain in heroin-induced patients can be found combining HMRS and DRI.

Objective To verify the accuracy of blood oxygenation level dependent (BOLD)-based activation using electrocortical stimulation mapping (ESM) and explore the value of language fMRI in the navigating operation of neurosurgery. Methods In 8 cases with brain tumors,BOLD-fMRI examinations were done before the operations. Under the state of awake anesthesia,the patients were aroused and ESM was conducted. Point-to-point comparison between the BOLD signal activations and the ESM was carried out under the surveillance of the neuro-navigation technology. In order to observe the sensibility and specificity of BOLD activations, the location of BOLD activations and the point of ESM was compared to calculate the stimulating positive points inside the regions of BOLD signals(real positive), outside BOLD regions(pseudo-negative), the stimulating negative points inside the regions of BOLD signals(pseudo-positive), and outside BOLD region(real negative). Two kinds of criteria for assessment were used. One was that the positive stimulating points were located in BOLD regions, and the other was that the positive stimulating points were located within 1 cm around the range of BOLD regions. Removal of the lesions were conducted with the tissue 1 cm around the language region preserved, and the cortex inside 0.5-1.0 cm distance from the positive points were retained. Results Of the 8 cases, only 6 finished the tasks. Among them, 3 cases were with astrocytoma of grade 2,2 were with astrocytoma of grade 3, and one with glioblastoma. The total number of stimulating points was 48, among which the positive points were 11. When the first criteria was applied, the sensitivity was 72.7% (8/11), and the specificity was 81.8% (30/37). When the second criteria was applied, the sensitivity was 82.0% (9/11),and the specificity was 75.6% (28/37). Follow-up after operation showed no aphasia occurred. Conclusions BOLD-fMRI had a high sensitivity and specificity in displaying the language regions. But due to the great variation of brain language area among the people, we need more studies of large sample to obtain enough experience before it can be used clinically.

Objective To investigate the underlying mechanism of motor recovery of the hemiplegic lower extremity in stroke patients. Methods The brain activation pattern during sequential extension-flexion of the affect-ed knee of 7 stroke patients and 8 healthy subjects was observed by blood-oxygen- level-dependent fMRI (BOLD-fM-RI) and analyzed by microsoft SPM5. Results When executing unilateral knee flexion-extension, contralateral paracentral lobe and contralateral supplementary motor area and right temporal gyms and inferior parietal lobes of both sides were significantly activated in all the healthy subjects, while the ipsilateral parietal lobe BA7 and BA5 were sig-nificantly activated in 6 of the 7 stroke patients. Conclusions Sequential extension-flexion of the affected knee of stroke patients was probably dependent on the activation of BA7 and BA5 in the intact side. Compensatory activation of the intact hemisphere might be one of the main mechanisms for the paretic lower extremity motor recovery in stroke patients.

Objective To compare the clinical efficacy and angiographic outcomes of balloon dilation angioplasty,balloon-expandable stent implantation and self-expanding stent implantation in the treatment of intracranial arterial stenosis.Methods The patients with intracranial arterial stenosis who met the indications of surgical intervention treated with balloon dilatation angioplasty and stent placement were selected from Nanjing Stroke Registry Program.According to the different interventional procedures,the patients were divided into the balloon expandable stenting goup,the self-expanding stents group and the balloon dilatation angioplasty group.The success rate of surgery,the perioperative complication rate and the significant residual stenosis rate were compared among the three groups.The clinical and angiographic assessments were performed through 1-,3-,6-,12- and 24-month regular outpatient or inpatient follow-up after procedure.The incidences of ischemic stroke and/or death and restenosis within 2 years were compared.Multivariate Cox proportional hazards analysis was used to analyze the risk factors for recurrent ischemic stroke and/or death and restenosis.Results A total of 183 patients with 192 stenoses performed balloon dilatation angioplasty or stenting,in which 92 were in the balloon expandable stenting goup,42 were in the self-expanding stents goup and 49 in the balloon dilatation angioplasty group.Their preoperative stenosis rates were 80.2 ±12.8％ 、76.3 ± 11.9％ and 89.7 ± 10.2％,respectively (F =15.863,P =0.000).There were no significant differences in other baseline data.The success rates of surgery in the balloon expandable stenting group,self-expanding stents group and balloon dilatation angioplasty group were 96.7％,95.2％ and 91.8％,respectively (x2 =1.646,P =0.439).The perioperative complication rates were 6.5％,14.3％ and 10.2％,respectively (Fisher exact test,P=0.334).The imaging follow-up showed that the restenosis rate in the balloon dilatation angioplasty group was 48.5％.Although it was high than 27.7％ in the balloon expandable stenting group and 34.8％ in the self-expanding stents group,there were no significant differences (x2 =4.176,P =0.124).Multivariate Cox proportional hazards analysis showed that balloon dilatation angioplasty was an independent risk factor for restenosis after procedure (hazard ratio 2.490,95％ confidence interval 1.247- 4.969,P=0.010).Conclusions Compared to the balloon expandable stenting,the balloon dilatation angioplasty is more likely to have restenosis,but it is not associated with the risks of postoperative recurrent ischemic stroke and/or death.

Objective To evaluate the prognostic value of hyperintense vessel (HV) in patients with acute middle cerebral artery (MCA) occlusion.Methods Seventy-four consecutive patients with first ever stroke(48 male and 26 female,the mean age was (60.7 ± 15.3) years) in the territory of MCA,retrieved from Nanjing Stroke Registry Program between May 2009 and February 2011,were enrolled assubjects.All subjects completed brain MRI,and MRA or DSA indicated proximal MCA occlusion.According to the location and extent of HV,all subjects were classified into 3 groups:without HV,proximal HV and distal HV.Clinical data were obtained and compared among patients with different grades of HV.Logistic regression analysis was employed to confirm the relevant factors of prognosis 90 days after index stroke.Results HV was observed in 49 (66.2％ ) of the 74 enrolled patients.Among patients with HV,7 (9.4％ ) were classified as proximal HV and 42 ( 56.8％ ) as distal HV.Initial NIHSS score ( 11 ( 1 -22) ),10-day NIHSS score ( 13.5(4-25) ),infarction size ( ＞2/3:5 cases(6.8％ ) ),and 90-day mRSscore (3-6 scores:12 cases( 16.2％ )) were significantly lower in patients with distal HV than those without (15(6-25),Z=-3.544;7(0-22),Z=-4.461;20 cases(27.0％),x2 =20.916;27 cases (36.5％),x2 =22.689;all P＜0.01).The NIHSS score decreased from baseline to that on 10 days and the mRS score decreased from 10 days to that on 90 days in patients with distal HV was more than that in patients without distal HV. Multivariate analysis revealed that patients with older age ( OR =1.111,95％ CI 1.036-1.191,P=0.003),high infarction size (OR=3.679,95％ CI 1.35-10.025,P=0.011) worsened outcome,whereas distal HV (P =0.012,OR =0.131,95％ CI 0.027-0.638)improved outcome.Conclusion Distal HV on FLAIR may predict a favorable outcome in patients with acute middle cerebral artery occlusion.

Objective To explore the effect of the DNA methyltransferase 5-aza-2'-deoxycytidine (5-aza-CdR)on human esophageal squamous cancer Ecal09 cells.nethods Human esophageal squamous cell cancer(ESCC)Eca109 cells were treated by 5-aza-CdR with 10-7,10-6,1O-5,10-4,0 mol/L. Respectively.Consequently,the growth rate of the cells was detected by MTT assay and morphological structure Was observed.Meanwhile,cell apoptosis and cell cycle were analyzed by flow cytometry method. (FCM).ResulIs The proliferation of Eea109 cells Was inhibited by 5-aza-CdR from 10-7 to 10-4 mol/L Moreover,the inhibition rate showed time-and-concentration-dependent manner(24～96 h,F=160.06,P=0.000,10-7～10-4 mol/L,F:60.95,P:0.000).The maximum rate of inhibitory was reached up to(15.70±0.75)% in the group treated by 10-4 mol/L 5-aza-CdR after 96 hours.An apoptosis peak appeared before diploid peak.The proportion of Go/G1 phase cells Was significantly increased(F=6479.46, P=0.000),especially up to(89.70±0.91)% in the group treated by 10-4 mo/L 5-aza-CdR after 96 h. However,the proportion of S phase cells Was obviously decreased(F=4222.26,P=0.000),especially down to(9.10±0.48)% in the group treated bv 10-4mol/L 5-aza-CdR after 96 h.Conclusions The proliferation of Eca109 cells is inhibited bv 5-aza-CdR in a time-and-concentration-dependent manner.Moreover,the 5-aza-CdR can inhibit cell growth by regulation of DNA cycle and apoptosis.

OBJECTIVETo study the expression of tumorigenesis-related stem cell markers Lgr5 and CD44 in different pathological types of intestinal polyps and their clinical significance in predicting tumorigenesis.

METHODSA total of 145 cases of colorectal polyps, adenomas and cancer tissues were obtained by colonoscopy biopsy. Immunohistochemistry was employed to detect the expression of Lgr5 and CD44 to analyze their relationship with the occurrence and prognosis of colon and rectal cancer.

RESULTSThe expression of CD44 in colon cancer tissue was 95.65%, significantly higher than that in normal mucosa (5%), inflammatory hyperplastic polyps (22.58%), tubular adenomatous polyps (55.26%) and villous polyps (75.76%) (P<0.05). The expression of Lgr5 in colorectal cancer was up to 95.65% while negative in normal colorectal tissue and was 16.12% in inflammatory hyperplastic tissues (P<0.05). The expression rate of Lgr5 was 86.84% in tubular adenoma and 93.94% in villous polyps, both comparable with that in colon cancer (P>0.05). Correlation analysis indicated that the expression of CD44 and Lgr5 were positively correlated with the progression of intestinal polyp tumorigenesis (rs=0.69377, P<0.0001; rs=0.81637, P<0.0001).

CONCLUSIONLgr5 and CD44 are highly expressed in colorectal cancer tissues in close correlation with the clinical and pathological features. The expression profiles of Lgr5 and CD44 represent a distinct feature to differentiate colorectal cancer from normal intestinal mucosa. Lgr5 is more closely correlated with tumor progression of polyps than CD44. This means detecting of the expression of Lgr 5 together with CD44 is important and necessary in clinical diagnosis of patients with early stage colorectal diseases such as polyps and their canceration.

Adult ; Aged ; Colorectal Neoplasms ; metabolism ; pathology ; Female ; Humans ; Hyaluronan Receptors ; metabolism ; Intestinal Polyps ; metabolism ; pathology ; Male ; Middle Aged ; Prognosis ; Receptors, G-Protein-Coupled ; metabolism ; Young Adult