Objective To quantitatively assess the geometry configuration of mitral valve and annulus in the ischemic mitral regurgitation(IMR) and non-ischemic mitral regurgitation(NIMR) by real-time threedimensional transesophageal echocardiography (RT-3D-TEE),and provide a basis for surgical cardiac surgery.Methods 98 patients undergone RT-3D-TEE examination were enrolled in this study,and were divided into three groups:IMR group (n =43),NIMR group (n =33),and no mitral regurgitation group (control group,n =22).Full-volume 3D dynamic images of mitral annulus and valve were obtained.The images were off-line analyzed using Qlab 7.0 MVQ workstation,and the geometry indexes:area of leaflets (A3DE),area of anterior leaflet (A3DE Ant),area of posterior leaflet (A3DE Post),perimeter of annulus (C3D),anterolateral to posteromedial diameter of annulus (DAlPm),anterior to posterior diameter of annulus (DAP),annulus height (H),maximal prolapse height (HProl),maximal tenting height (HTent),volume of leaflet prolapse (Vprol),volume of the leaflets tent (Vtent),Aortic orifice to mitral plane angle (θ),angle of anterior leaflet (θAnt),non-planar angle of leaflets (θNPA),angle of posterior leaflet (θPost)and other mitral valve leaflets and annulus,were derived and statistically analyzed.Results Compared with the control group,significant increases of A3DE,A3DE Ant,DAP and θPost,and decreases of θ and θNPA were demonstrated in IMR group,the differences were statistically significant (P ＜ 0.05).Significant increases of A3DE,A3DE Ant,DAP,HProl,Vprol and θNPA,and decreases of θ,θAnt and θPost were explored in NIMR group,the differences were statistically significant (P ＜0.05).Compared with NIMR group,a reduction of A3DE,A3DE Ant,DAP,HProl and θNPA,and increases of θAnt and θPost were found in IMR group and the differences were statistically significant (P ＜0.05).Conclusions Both IMR group and NIMR group could lead to mitral annulus dilatation,leaflets area increase,and mitral annulus geometry change,the overall mitral annulus tends to flatten were more obvious in the NIMR group than those in IMR group.The prolapse is more prominent in NIMR group than those in IMR Group.The difference of mitral annulus geometry between IMR group and NIMR group indicates that the damage of the mitral leaflets and annulus might be more serious in NIMR group.

Objective:To investigate the skin positioning error in total breast radiotherapy after breast cancer surgery through image analysis.Methods:The study period was from January 2019 to June 2019. A total of 80 patients who received breast-conserving breast cancer surgery and adjuvant radiotherapy during this period in Zhejiang Cancer Hospital were selected. The CT positioning image for each patient in the treatment plan was created and the relevant cone beam computed tomography verification film after the patient positioning setting was obtained during radiotherapy, and the positioning map and the verification film to each patient through image processing software skin surface location were overlapped. The isocenter deviation of the nipple-lung ( X) and cranial tail ( Y) directions and the deviation of the X and Y axis rotation angle of the superimposed image were measured. Results:In the 80 patients, the system error ( μ, Σ) and random error ( σ) were calculated based on the X-axis and Y-axis deviation and the rotation angle deviation. The μ value of X-axis, Y-axis and rotation angle were (0.01 ± 0.01) mm, (-1.35 ± 0.14) mm and (0.06 ± 0.01)°. The Σ value of X-axis, Y-axis and rotation angle were (1.76 ± 0.72) mm, (1.49 ± 0.58)mm and (0.90 ± 0.12)°. The σ value of X-axis, Y-axis and rotation angle were (1.34 ± 0.96) mm, (1.93 ± 1.02) mm and (1.0 ± 0.2)°. The average value of the total vector error in the left and right patients were (3.02 ± 1.26), (2.88 ± 1.03) and (3.25 ± 1.38) mm, which had no clinical significance. Conclusions:In the routine breast radiotherapy after breast-conserving surgery, the smallest position error of the skin can be obtained by using the skin surface position combined with image processing software.

Objective To analyze the risk factors of respiratory depression occurring during recovery period in patients after having undergone general anesthesia and laparoscopic operation.Methods A total of 374 patients after general anesthesia and laparoscopic surgery admitted to the First Affiliated Hospital of Wenzhou Medical University from June 2015 to June 2016 were enrolled, they were divided into with or without the incidence of respiratory depression two groups by whether or not respiratorydepression, with the incidence of respiratory depression group 52 cases, without the incidence of respiratory depression group 322 cases. The patients' gender, age, body mass index (BMI), operation time, anesthesia maintenance mode, artificial airway mode, operative type and medication used in operation, intra-operative hypotension presence or absence, and type of operation were recorded. Univariate and multivariate logistic regression analyses were used to evaluate the risk factors of respiratory depression occurring in the recovery period after general anesthesia; receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of age, intraoperative medication, and age combine with intraoperative medication respectively in the occurrence of respiratory depression during recovery period after general anesthesia and lapatoscopic operation.Results Univariate analyses showed that there were no statistical significant differences in gender, BMI, operation time, anesthesia maintenance mode, artificial airway mode, intra-operative hypotension presence or absence, type of operation, etc. compared between patients with and without the incidence of respiratory depression groups (allP > 0.05); while the differences were statistically significant in age and drug used in the operation (dezocine, flurbiprofen, dexmedetomidine or dezocine combined with dexmedetomidine, allP < 0.05). Multivariate analyses showed that age and medication used in operation were the independent risk factors for the occurrence of respiratory depression during the anesthesia recovery stage (P values being 0.000, 0.002 respectively). ROC curve showed that age, intra-operative medication and age combine with intraoperative medication respectively had certain predictive value for the occurrence of respiratory depression during the recovery period after general anesthesia and laparoscopic surgery, the area under the ROC curve (AUC) of age combine with intraoperative medicationfor prediction of occurrence of respiratory depression during recovery period after anesthesia and laparoscopic surgery was significantly larger than that of single age or single intraoperative medication (0.826 vs. 0.668, 0.750,P < 0.01), 95% confidence interval (95%CI) of age, intraoperative medication and age combined with intraoperative medication were 0.598-0.738, 0.670-0.830, 0.764-0.888, the sensitivity, specificity and accuracy rate of age combine with intraoperative medication were 53.8%, 94.4% and 88.8%, respectively.Conclusion Elderly patients undergoing general anesthesia and laparoscopic operation and dezocine, dexmedetomidine or dezocine combined with dexmedetomidine being applied in the laparoscopic operation are more easily associated with incidence of respiratory depression during recovery period of anesthesia.

Objective To study the experiences of severe acute pancreatitis (SAP) treated by combmation of traditional Chinese and western medicine.Methods Two hundred and forty patients with SAP were divided into A and B groups randomly,140 patients of group B were treated by combination of traditional Chinese and western medicine;100 patients of group A were treated by western medicine.Results After treatment in group B, the serum and urine amylase, and c-reactive protein,signiflcantly decreased.The complication rate of group A and group B was 55.00 % and 12.86 %(P

The changes of serum malondialdehyde, myeloperoxidase, total antioxidant capacity, superoxide dismutase activity, and glutathione peroxidase were observed in patients with Graves′ disease. The myeloperoxidase level increased in patients with Graves′ disease. The balance between oxidation and antioxidative defense was disrupted in patients with newly-onset Graves′ disease. Oxidative stress seems to be related to hyperthyroidism.

OBJECTIVE ToinvestigatethepossibleprotectiveeffectofTripterygiumwilfordiipolyg-lycoside (TWP ) on experi mental diabetic nephropathy (D N ) rats and its possible mechanis m. METHODS Thediabeticmodelwasinducedbyasingleintraperitonealinjectionofstreptozotocin (STZ)65 mg·kg -1 .Three weeks after modeling,TWP 4.5,9.0 and 1 8.0 mg·kg -1 was ig given to rats,once daily,for 8 consecutive weeks.During the experiment,the changes of body mass,hair, mental health of rats were observed.Two days before the end of the experi ment,the rats were placed into metabolic cages to collect 24 h urine in order to detect 24 h urinary albu min excretion rate (UAER). The rats were given TWP for 8 weeks and anesthetized with 1 0%chloral hydrate.The blood was collect-ed fro m the heart and centrifuged,seru m creatinine and urine creatinine were measured,and creatinine clearance (Clcr)was calculated.Blood urea nitrogen (BUN)and the serum catalase (CAT)activity were tested by optical method while the level of seru m superoxide oxygen anion(O2÷)was tested by col-orimetry.The level of malondialdehyde(MDA)was determined by thiobarbituric acid condensation,and glutathione peroxidase (GSH-Px)activity was tested by colorimetry.The right kidney was HE stained to observepathologicalchanges.RESULTS Comparedwithnormalcontrolgroup,theratsinmodel control group developed polydipsia,polyuria,polyphagia,body mass loss,unresponsiveness,brown hair,pale tail and apathy clammy.Besides,blood glucose,BUN and 24 h UAER were significantly higher (P<0.01 ),but Clcr was lower (P<0.01 ).The activity of serum CAT and GSH-Px in renal tissue was significantly lower(P<0.01 ),while the level of serum O2÷ and MDA in the renal tissue was significantly higher(P<0.01 ).Compared with model control group,TWP 9.0 and 18.0 mg·kg -1 could improve the general condition of rats.BUN and 24 h UAER were obviously reduced(P<0.01 ),Clcr and serum CAT were increased obviously(P<0.01 ),the level of MDA and O2÷ were reduced obviously(P<0.01 ),and GSH-Px level was increased(P<0.01 ).TWP 9.0 and 18.0 mg·kg -1 could significantly im-prove the renal histopathological changes of rats.TWP 4.5 mg·kg -1 had no significant effect on the aboveindicators.CONCLUSION TWPhasprotectiveeffectontherenalfunctionofexperimentalDN rats.The mechanis m may be related to inhibition of the oxidative stress and enhance ment of the body antioxidant capacity.

ObjectiveTo evaluate the long-term outcomes of carotid endarterectomy versus carotid artery stenting for carotid stenosis.MethodsPubMed, EMBASE, and the Cochrane databases were retrieved.The randomized controlled trials of comparing CEA with CAS in patients with carotid artery stenosis were enrolled.The data such as the research basic characteristics and the long-term outcomes including stroke or death combined endpoints, any stroke or any death were extracted.The Stata software was used to conduct statistical analysis.ResultsA total of 7 randomized controlled trials and 8 210 patients were included.The median follow-up time was 2-7.4 years.The overall quality of the included studies was high and the risk of bias was low.The meta-analysis showed that the risks of the combined endpoint of stroke or death (hazard risk [HR] 1.21, 95% confidence interval [CI] 1.04-1.39), any stroke (HR 1.32, 95% CI 1.15-1.51) and ipsilateral stroke (HR 1.26, 95% CI 1.02-1.55) in the CAS group were significantly higher than those in the CEA group;the risks of death (HR 1.06, 95% CI 0.95-1.18), disabling stroke (HR 1.23, 95% CI 0.95-1.60), non-ipsilateral stroke (HR 1.12,95% CI 0.81-1.55) and restenosis (HR 1.18,95% CI 0.91-1.52) were not significantly different between between the CAS group and the CEA group.Conclusions CAS and CEA are associated with similar risks of long-term death, disabling stroke, non-ipsilateral stroke and restenosis.The risks of long-term combined endpoint of stroke or death, any stroke and ipsilateral stroke significantly higher with CAS.These results suggest that CEA remains the treatment of choice for carotid stenosis.

Objective To investigate the effects of human amniotic membrane on the survival of the crossboundary perforator flap in rats through distal subcutaneous implantation.Methods From February,2016 to December,2016,38 SD rats weighing 270-300 g were randomly divided into experimental group and control group (n=19).A three-territory perforator flap (3 cm× 10 cm) with the iliac artery as the pedicel elevated on the right dorsum of the rats.Experiment group,a section of amnion was sutured to the distal subcutaneous of the flap and then the flap was sutured back to its donor site.Control group,after the flap elevated,directly sutured back to its donor site.The blood flow of the pedicel were detected by laser Doppler flowmetry at the day before surgery,1 day after surgery,3 and 7 days after surgery,with 3 rats in every group.When the rats were anesthetized,biopsies were taken from the choke area Ⅱ at the day before surgery,3 and 7 days after surgery,with 9 rats in every group.When the rats were anesthetized,HE was used to compare the diameter size of the artery and vein at the same site.At day 7,measure the survival area of the flap,and 3 of them observe the vessel of the flap by lead oxide-gelatine technique.Results The survival rate of the experimental group and the control group after 7 days were (89.09±4.23)％ and (74.56-±5.59)％ respectively,the experimental group was significantly higher than that of the control group (t=5.48,P=0.00).X-ray showed that 7 days after operation,the pedicel of iliac artery in the experimental group was bigger than that in the control group.The blood flow detection showed that the blood flow of the experimental group was higher than that of the control group (t=2.39,3.06;P=0.03,0.00,respectively) at day 1 and day 3 after surgery.Hematoxylin eosin staining showed that arteriovenous tube diameter at the Choke Ⅱ were gradually increased on the day3 and day7 after surgery in both group,but the experimental group diameter expanded multiple was higher than that of control group (t=3.52,3.50;P=0.02,0.02,respectively).Conclusion Human Amnion subcutaneous embedding may improve the blood flow of the vascular pedicle,expand the microvascular at Choke area Ⅱ,improve microcirculation,as a result to promote the survival of cross perforator flap,while the mechanism is needed to understanding.

Objective To compare the therapeutic effects of 3 operative options with selective high level ligation of spermatic veins, transinguinal canal and renovated Potomo's laparoscopic manage-ment of varicocele. Methods From January 1990 to November 2006, 1075 primary varicocele above grade Ⅱ patients accepted the operations, of them, 685 patients had follow up data and were recruited into this study. These patients were divided into 3 groups according to the operative methods:group A (n=369) was treated with open selective high level ligation of spermatic veins, group B (n=218) was treated with open transinguinal canal operation, and group C (n=98) was treated by renovated Polo-mo's laparoscopic management of varicocele. The complications of the 3 operative methods were com-pared, such as recurrence rate, testicular atrophy rate, scrotal edema rate and semen analysis. The therapeutic effects of these 3 methods were evaluated. Results The recurrence rates of the 3 groups were 3.3%, 7.3% and 5.1%, respectively. Group A had significantly lower recurrence rate than group B, P<0.05. The testicular atrophy rates of 3 groups were 0.5%, 17.9% and 9.2%, respec-tively. There were significant differences among the 3 groups (P<0.05). The scrotal edema rates of the 3 groups were 1.4%, 17.4% and 16.3%, respectively. Group B and C had higher risk of scrotal edema than group A, P<0.05. For patients with ages younger than 30, the improved semen quality rate in group A was higher than in group B and C. The improved semen quality rate in each group of patients younger than 30 was higher than patients with age over 30. Conclusion The open selective high level ligation of spermatic veins is the best choice in the treatment for patients with primary sper-matic varicocele.

Objective To investigate the effects of the wound isolation in prevention of abdominal wound infection. Methods 2549 patients who bearded abdominal operation in 3 years in our hospital were randomly divid-ed into wound isolation group (n=1300) and control group(n=1249). The wound infection rates were summarized by operation ways and major influencing factors. Results The overall wound infection rate of control group and wound isolation group was 5.9% (76/1300) and 2.6% (32/1249). The infection rate was 13.4% (40/300) and 3.1% (9/280) in gallbladder resection, 14.7 % (24/165) and 3.5 % (6/159) in radical operation for carcinoma of colon, 13.6% (15/108) and 3.2% (13/114) in intestine block operation, 9.6% (18/187) and 1.8% (3/169) in stomach resection (P<0.01);The infection rate was 9.3% (13/145)and 2.9% (4/153)in biliary exploration, 14.6% (8/55) and 1.8% (1/56) in WHIPPLE, 10.6% (9/85) and 2.3% (2/88) in cholecystectomy (P<0.05);The infection rate was 6.3% (6/95) and 2.3% (2/86) in liver resection, 5.3% (5/95) and 1.2% (1/87) in spleen resection, 4.6% (3/65) and 1.8% (1/57) in porto-azygos venous disconnection (P>0.05). The wound infection rate of type Ⅰ resection of control group and wound isolation group was 2.0% (6/305) and 1.4% (4/280) (P> 0.05);The infection rate of type Ⅱ and Ⅲ resection was 7.0% (70/995) and 2.9% (28/969), for old man (≥60) was 12.6% (36/286) and 3.6% (10/279), the emergency operation was 10.0% (38/381) and 2.8% (10/362), the operation time ≥3 h was 9.0% (39/435) and 2.8% (12/426), with diabetes was 14.5% (21/145) and 4.9% (6/123), with obesity was 12.3% (40/325) and 3.9% (12/310), with malnutrition was 8.5% (39/458) and 3.2% (14/433), with cancer was 8.6% (40/465) and 3.0% (15/496) (P<0.01).;undergoing unemergency operation was 4.1% (38/919) and 2.5% (22/887),for yong persons (<60) was 3.9% (40/1014) and 2.3% (22/970), with operation time<3 h was (37/865) and 2.4% (20/823), without diabetes was 3.9% (45/1155) and 2.3 % (26/1126), without obesity was 3.7 % (36/975) and 2.1% (20/939), without malnutrition was 4.4% (37/842) and 2.2% (18/816)and without cancer was 4.3% (36/835) and 2.3% (17/753) (P<0.05). Conclu-sions The wound isolation can decrease the wound infection rates by reducing the chance of bacterial contamina-tion.