Objective To explore the value of phase-contrast magnetic resonance imaging (PC-MR) in diagnosis of secundum atrial septal defect (ASD) in pediatric patients. Methods Totally 42 patients (aged from 9 months to 15 years) with secundum ASD proved with tansthoric echocardiographic (TTE) were evaluated with PC-MRI. Images of the flow through ASD were obtained with PC-MRI. The distances of ASD rim to superior vena cava (SVC), inferior vena cava (IVC), atrioventricular valves (AVV) and right upper pulmonary vein (RUPV), as well as the entrances of the vena cava and right upper pulmonary vein (RUPV) were assessed. Results The sizes of ASD and distances of ASD rim to the adjacent structures (SVC, RVC, AVV and RUPV) at PC-MRI were well consistent with those of TTE in 42 patients (P<0.001). PC-MRI results in 26 patients correlated well with surgical results (P<0.001). With different velocity encoding, compared with surgical results, measurements of ASD's sizes were more accurate when setting velocity from 50 to 70 cm/s than 90 cm/s. Conclusion The shape of ASD can be virtually depicted with PC-MRI. PC-MRI can accurately assess the defect size, number, rim distances to adjacent structures, therefore providing a new method for depiction of congenital heart anomaly.

Objective:To evaluate the clinical effect of retroperitoneoscopic renal pedicle lymphatic disconnection via extra-adipose capsule in the management of chyluria and to discuss the management of its complications.Methods:From August 2013 to June 2008,five patients with chyluria were admitted. All the patients were female,aged from 26 to 73 years,and disease course from 1 to 10 years.All the five patients had complained of intermittently voiding milky urine with varying degrees of weight loss,and fa-tigue,of whom two presented with flank pain and one with anemia.Their urine chyle tests were con-firmed to be positive.Preoperative cystoscopy found that chyluria was from the left side in 3 cases,and from the right side in 2 cases.Their proteinuria ranged from +to ++++.All the cases had been treated with the modified procedure by which lymphatic ligation was performed to hilar vessels and proximalureter via extra-adiposecapsule without disconnection of perirenal fat tissues.The operation time,intraoperative blood loss,postoperative intestinal function recovery,catheter time,drainage tube removal time and com-plications during operation were collected.Results:All the five cases were performed successfully.The operation time ranged from 75 to 170 minutes,mean (126.0 ±39.6)minutes,with the intraoperative blood loss 20 to 60 mL,mean (38.0 ±16.4)mL,and the postoperative intestinal function recovery time 1 to 3 days,mean (1.9 ±0.4)days.The catheter time was 1 to 4 days,mean (2.1 ±0.3)days and the drainage tube removal time ranged from 3 to 15 days,mean (9.3 ±1.8)days.Postoperatively lym-phorrhagia was found in two cases.No renal vessels injury occurred during operation.Chyluria of all the patients disappeared on the operation day with negative chyluria test after surgery.Furthermore,urine test revealed that proteinuria was totally negative.No recurrence was detected in our patients in the 9 to 31 months’follow-up.Conclusion:This modified procedure does not have to disconnect perirenal fat tissues and nephropexy during operation.It was characterized with shorter operation time,definitive effect and fewer complications.

Objective To report a ileal ureteric replacement surgery for bilateral long segment ureter injury.Methods Data from a patient suffered bilateral long segment uretercic stenosis was reviewed.A 32-year-old female,who underwent radical surgery of cervical cancer and postoperative radiotherapy 1 year ago,complained intermittent low back pain for 11 months and was found renal function abnormality for 3 months.Ultrasound showed bilateral hydronephrosis,and the CT urography showed bilateral middle-lower ureteral stenosis.Preoperative diagnosis was bilateral hydronephrosis with bilateral ureteral obstruction.The patient underwent bilateral ileal ureteric replacement under general anesthesia.Results The surgical procedure was successful and the postoperative recovery was favorable.The operation time was 180 min,and blood loss was 100 ml.The abdominal cavity drainage tube was removed 8 days and the urinary catheter was removed 9 days postoperatively.During 8 months' follow up,the patient showed resolved flank pain with stable serum creatinine.No complication was reported.The CTU 2 months postoperatively showed the hydronephrosis was relieved with normal functioning kidneys.Conclusion Bilateral ileal ureteric replacement surgery might be an effective procedure and viable option for bilateral long segment ureteric injuries.

Objective To investigate the action of chondrogenesis differentiation of bone marrow stromal cells (BMSCs) transfected with adeno-hTGF-β1. Methods In the experiment group, replication-deficient a denoviruses carrying human hTGF-β1 complementary DNA (adeno-hTGF-β1 was constructed and applied to transfect to the first generation BMSCs. As a control, each BMSCs was transduced with 200 pfu of adeno-LacZ gene. One day after transfer, BMSCs were trypsinized, counted, and 5×105 cells aliuots were spun down at 500 rpm per minute in 15 ml polypropylene conical tubes and then cultured in a defined medium in an incubator at 37℃ for 21 days. The aggregates were harvested at time points to 21 days and assessed by gross observation, histological analyses and immunohistochemical localization of type Ⅱ collagen. Results When harvested at 21 days, each pellet shrinked to spheroid tissue with apearly opalescence in gross morphology and found to be relatively firm. H.E staining showed elongate dlining cells appeared as perichon drium-like cells at the surface. Some nests of cartilage were observed at the substrate of the tissue. Mature chon drocytes were embeded in the lacuna in the experiment group. In addition, Safranin'O staining confirmed the presence of sulfated proteoglycans in the ECM of chondrogenesis region. Immunohistochemical staining revealed the presence of type Ⅱ collagen in chondrogenesis region. By contrast, HE staining showed no evidence of cartilage formation in the control group. They were fibrous tissue with no architectural feature. Safranin'O staining and Immunohistochemical staining showed no evidence of sulfated proteoglycans or typeⅡ collagen expression. Conclusion BMSCs transfected with adeno-hTGF-β1 could induce its chondro-genesis when aggregate cultured in a defined medium in vitro, laying a foundation for the application of hTGFβ1 gene-transfected BMSCs in cartilage tissue engineering.

ObjectiveTo investigate the diagnosis and treatment of adrenocorticotropin-independent macronodular adrenal hyperplasia (AIMAH). MethodsThe clinical data of 14 cases of AIMAH from August 1972 to July 2010 were retrospectively analyzed.The cases included 5 males and 9 females with a mean age of 45 (range 26 to 58 ) years.Ten patients demonstrated typical Cushing's syndrome (CS) and 4 patients presented with weight gain,hypertension or diabetes mellitus without any signs of CS.The circadian rhythm of serum cortisol was abnormal.Low and high dose dexamethasone suppression tests failed to suppress cortisol secretion.CT scan showed bilateral enlargement of the adrenal glands with multiple macronodules.All patients underwent open surgery,including 5 cases of unilateral adrenalectomy,6 cases of adrenalectomy combined with contralateral subtotal adrenalectomy and 3 cases of bilateral adrenalectomy.ResultsIt was established by pathological examination that all patients had bilateral adrenal macronodular or adenomatoid hyperplasia.During the mean follow-up of 69 months (range 12 to 120 months),the clinical symptoms of CS disappeared after surgery in all cases.The 5 patients who received unilateral adrenalectomy had urinary free cortisol and serum cortisol within normal ranges and no further enlargement of the contralateral gland was noticed.Among the 3 patients who received bilateral adrenalectomy,1 case died of adrenal crisis on day seven post-operation.The remaining 2 cases presented with adrenal insufficiency but returned to normal after glucocorticoid replacement therapy.Nelson's syndrome was not observed in the other patients.ConclusionsAIMAH has unique endocrinological and pathological features,presenting as an independent etiology of CS.Unilateral adrenalectomy appears to be an effective and safe alternative treatment for AIMAH and long-term remission can be achieved.Bilateral adrenalectomy or unilateral adrenalectomy combined with contralateral subtotal adrenalectomy may be performed if the symptoms have not improved or recurred after unilateral adrenalectomy.

Objective To investigate the diagnosis and treatment of extra-adrenal pheochromocytoma(EAP). Methods The clinicsl data of 37 cases of EAP from April 2003 to April 2010 were retrospectively analyzed.Hypertension was observed in 31 cases.The typical triad of headache,palpitation and sweating was observed in 12 cases.The positive rate of plasma-free MNs and 24-hour urinary CA in diagnosing EAP was 96.8%(30/31) and 86.5% (32/37) respectively.The main localization diagnosis included ultrasonography,CT,MRI and 131I-MIBG,with positive rates of 91.7% (33/36),97.0%(32/33),90%(9/10) and 82.6%(19/23) respectively.Two patients underwent radiotherapy, and the remaining 35 cases underwent surgical treatment. Results Among the total of 37 cases,32 cases were single tumor,and five were multiple tumors.The anatomic locations of the single tumors were as follows: 14 wre adjacent to the abdominal aorta,seven in the bladder,four adjacent to the inferior vena cava,four adjacent to the renal hilum,two adjacent to the lilac blood vessel and one in the upper pole of the right kidney.Thirty cases underwent complete tumor resection,three cases underwent tumor resection plus right nephrectomy and two cases underwent partial cystectomy.Twenty-four cases were diagnosed benign and 11 cases were diagnosed malignant by pathological examination.Among 31 cases with preoperative hypertension,postoperative blood pressure returned to normal in 23 patients,blood pressure descended mildly in six cases and blood pressure was still hypertensive in two cases.Thirty-four patients were followed up for five months to seven years,during which five cases had tumor recurrence or metastases and five cases died postoperatively. Conclusions EAP is a rare neuroendocrine tumor and its accurate diagnosis is rather difficult.Plasma-free MNs and 24-hour urinary CA are important qualitative examinations.Ultrasonography,CT,MRI and 131I-MIBG scintigraphy are important methods for the localization of the tumor.Transperitoneal resection of the tumor is the preferred choice of management and adequate perioperative preparation is the key to a successful operation,including bringing down blood pressure,expanding blood volume and correcting arrhythmia.Patients with malignant EAP may be treated with 131I-MIBG after surgical therapy.

Objective To investigate the immediate brain effect of acupuncture at Fengchi using amplitude of low-frequency fluctuation(ALFF)and functional connectivity by the resting-state functional magnetic resonance imaging(rs-fMRI)in patients with posterior circulation ischemia vertigo(PCIV).Methods Twenty patients with PCIV were enrolled.The dizziness handicap inventory(DHI)was used to evaluate the severity of vertigo.The patients were randomly divided into acupuncture group and sham acupoint acupuncture group.Rs-fMRI scan was performed before and after acupuncture.MATLAB-based DPABI 6.1 software was used to analyze rs-fMRI data.Correlation analysis was used between the altered ALFF values and DHI scores.The regions of altered ALFF were taken as seeds to analyze functional connectivity.Results Compared with the sham acupoint acupuncture group,the increased ALFF values were mainly located on the left precuneus,left superior frontal gyrus and left caudate nucleus after acupuncture in the acupuncture group;the decreased ALFF values were mainly located on the left cerebellum and right inferior occipital gyrus.The ALFF value of the left superior frontal gyrus was negatively correlated with the DHI score(P=0.04).The increased functional connectivity was mainly found between left precuneus and the right middle frontal gyrus,the right superior frontal gyrus,the decreased functional connectivity was mainly found between left precuneus and the bilateral paracentral lobule and right cerebellum.Conclusion The ALFF value and functional connectivity are different before and after acupuncture,indicating that the vestibular network,visual and motor brain regions functional activities are changed after needling at Fengchi,which may be the brain functional basis of Fengchi for vertigo in PCIV.

Objective:To systematically evaluate the clinical efficacy of melatonin for neonatal hypoxic-ischemic encephalopathy (HIE).Methods:From the inception of the databases to December 1, 2022, randomized controlled trials (RCTs) and cohort studies on the use of melatonin for HIE were searched in the following databases: PubMed, Web of Science, Cochrane library, Embase, Chinese Medical Journal Full-text Database, CNKI, Wanfang Database and VIP Database. Meta-analysis, literature risk assessment and sensitivity analysis were conducted using R4.2.2 software and RevMan5.4 software.Results:A total of 4 eligible RCTs were found, including 155 patients. Meta-analysis showed that melatonin could reduce the mortality rate ( RR=0.336, 95% CI0.157-0.718, P=0.005) and white blood cell count in HIE infants ( MD=-1.74, 95% CI -3.404--0.079, P=0.040). Sensitivity analysis showed that the Meta-analysis results were generally stable after excluding the studies one by one. Conclusions:Current evidence shows that melatonin can reduce mortality in HIE infants. However, the included studies have high risk of bias and small sample sizes. More high-quality studies are still needed.

Artificial tracheal grafts are required when repairing extensive tracheal defects that exceed 50％ of total length in adults and 30％ in infants.Alternative options for trachea replacement now are being developed,including autografts,allografts,and prosthetics,or a combination of these,but they have limitations including inflammation,infection.With the advancements made in tissue engineering (TE) in recent years,researchers are focusing their attention on using a tracheal scaffold made from a synthetic polymer or a cadaveric allotransplant.Considering the critical role of epithelium in the trachea,the repithelialization of tracheal grafts has gradually become the focus of tissue engineering tracheal reconstruction.This article will make a summary of the researches on the correlation of tissue-engineered tracheal re-epithelialization.

Objective To assess the gender-related differences of upper tract urothelial carcinoma and analyze the causes of the gender-related differences.Methods We retrospectively studied 942 patients underwent radical nephroureterectomy for upper tract urothelial carcinoma between January 2000 and December 2014 in our hospital.The mean age of the entire cohort was 64.5 years,with 424 males (45.0％)and518 females (55.0％).Compared with male patients,female patients tended to had a history of aristolochic acids exposure (5.2％ vs.11.1％,P =0.001),infrequent smoking (29.7％ vs.5.2％,P ＜0.001) and showed poorer renal function (P =0.023).We reviewed clinicopathologic data from these patients and used univariate analysis to determine the gender-related differences.The Kaplan-Meier method was adopted to investigate the gender differences of cancer specific survival,bladder recurrence-free survival and contralateral upper tract recurrence-free survival of patients.Results When compared with males,females were less likely to have high-stage disease (33.7％ vs.24.9％,P =0.003).The mean follow-up for the entire cohort was 70.2 months (4-193 months).The cancer specific survival rate (x2 =14.116,P ＜0.001)and the contralateral upper urinary tract recurrence rate(x2 =7.362,P =0.007)in females were both higher than those in males.The 5-year cancer specific survival rates were 72.0％ in the males and 83.5％ in females,respectively.In addition,the 5-year contralateral UTUC-free survival rates were 98.6％ in the males and 92.9％ in females.Conclusions Female patients in our cohort were more common and they were more likely to be exposed to aristolochic acids.Females were less likely to have high-stage disease but had significantly worse contralateral upper tract recurrence-free survival.