Objective To discuss difficulties and techniques of standard video-assisted thoracoscopic or laparoscopic surgery(SVATS or SVALS) for spine internal fixation.Methods Between July 2004 and September 2005,6 cases of vertebral lesions located in the T_5～L_1 segment(including 2 cases of vertebral tuberculosis) were given SVATS under single-lung ventilation for resection of diseased vertebral body,reconstruction with autograft or titanium mesh cage,and fixation with the Z-plate system or the CD-Horizon system.Other 2 cases of vertebral tuberculosis located in the L_2～L_3 segment underwent retroperitoneal gasless SVALS for lesion debridement,reconstruction with autograft,and fixation with the Z-plate system.For cases of vertebral tuberculosis,(anti-tuberculosis) drugs were administrated preoperatively for 3 weeks and postoperatively for 6 months.Results The lesion debridement and anterior decompression was completed in all the 8 cases,including internal fixation with the Z-Plate system in 7 cases and with the CD-Horizon system in 1 case.There were 5 cases of iliac autografting and 3 cases of titanium mesh cage reconstruction.The operative time was 6.5~12.6 h(mean,8.7 h) and the blood loss during surgery was 250~1 800 ml(mean,950 ml).The correction of the Cobb angle was 5?~18?(mean,12?).During a follow-up period for 2~13 months(mean,7.4 months) in the 8 cases,nerve functions recovered by 1~2 Frankel grade in 5 cases,and the Cobb angle lost by 4? at 6 months postoperatively in 1 case of metastatic adenocarcinoma at the T_7 segment.Conclusions Spine internal fixation of T_5～L_3 segment can be conducted successfully with SVATS or SVALS.The key to the question is accurate orientation of the port site,proper hemostasis of the segment blood vessel,and careful resection of the anterior wall of the vertebral canal.

[Objective]To compare the reliability and value of clinical signs,MRI imaging and arthroscopy in management of meniscal tears in order to increase the diagnostic rate.[Method]A retrospective study was done on 176 cases undergoing MRI examination and arthroscopic treatment,and being diagnosed as meniscal injuries in knee joint by any one of the three clinical,MRI or arthroscopic examinations.Using arthroscopic diagnosis as the standard,the sensitivity,specificity.and overall accuracy of clinical diagnosis and MRI were then calculated respectively.Significant differences between arthroscopic diagnosis and clinical diagnosis or MRI diagnosis were analyzed using statistical method of Chi-square test.[Result]The sensitivity,specificity and accuracy of clinical diagnosis were 79.3%,26.3% and 73.8% respectively.There was statistically significant difference between arthroscopic diagnosis and clinical diagnosis.The sensitivity,specificity and accuracy of MRI diagnosis were 94.1%,92.9% and 93.4% respectively.The difference between arthroscopic diagnosis and MRI diagnosis had no statistically significance and can be used as an important examination before knee arthroscopy.[Conclusion]MRI is a reliable,noninvasive diagnostic tool for meniscal tears and can be used as an important examination before knee arthros copy with MRI examination combining with the clinical signs,diagnotic rate of meniscal tears can be increased.Unnecessary arthroscopic therapy could be avoided.

Objective To investigate regional ventricular long-axis velocity and adjacent intraventricular flow velocity using dual-pulse wave(PW) Doppler echocardiography synchronously,and to analyze the coupling relationship between regional ventricular long-axis strain and adjacent intraventricular pressure gradients in normal cases using dual-PW Doppler echocardiography.Methods Eighty-six normal subjects aged 19～66 years [mean age (37.49 ± 11.97)years] underwent routine echocardiography and dualPW Doppler echocardiographic exam.Total 18 segments were sampled using dual-PW Doppler (PW/TDI mode) images at basal,mid and apical levels on three standard apical views,and electrocardiogram was recorded simultaneously.Peak early diastolic velocity (emax),peak late diastolic velocity (amax),peak early mitral diastolic inflow velocity (Emax),regional peak early diastolic velocity (Em),regional peak late diastolic velocity (Am) and regional peak early diastolic inflow velocity (E) were measured simultaneously in the same one cardiac cycle.Myocardial variations of left ventricular segments were observed.Em,Am and E of different levels from different ventricular wall were analyzed.The co-relationship between regional ventricular long-axis strain and adjacent intraventricular pressure gradients were calculated and analyzed.Results ①Regional myocardial velocity and regional peak early diastolic inflow velocity in normal subjects declined from basal to apical segments gradually at the same ventricular wall (P ＜ 0.01).② Emax was correlated with emax(r =0.418,P ＜0.001),and E was correlated with Em (posterior septum,r =0.610,P ＜0.001 ；anterior wall,r =0.499,P ＜0.001).③There was a medium correlation between normal longaxis strain in segments and adjacent intraventricular pressure gradients (the global,r =0.412,P ＜0.001 ；posterior septum,r =0.319,P ＜0.005).Conclusions The acquirement of E and Em by dual-PW Doppler showed downtrend of segmental wall movement and regional blood flow from basal segment to apex.Emax is correlated with e E is correlated with Em,and long-axis strain at segments is correlated with adjacent intraventricular pressure gradients partly.Dual-PW Doppler might provide a potential method for the more precise evaluation of left ventricular fluid-solid coupling during diastole.

Epilepsy with mental retardation limited to females (EFMR) is a syndrome characterized by early onset heat-sensitive epilepsy of infancy or early childhood and generally limited to females,which previously reported that the cadherin gene superfamily subtype protocadherin 19 (PCDH19)gene is its pathogenic gene.We retrospectively analyzed the clinical data for 2 cases of EFMR patients with PCDH19 mutation diagnosed by Department of Pediatric Neurology of Xiangya Hospital,Central South University in 2015.Literature on PubMed,OMIM and HGMD relevant to this syndrome was reviewed,and the clinical characteristics were summarized accordingly.The 2 cases are consistent with the typical clinical manifestations of EFMR caused by PCDH19 mutations.Their seizures are heat sensitive,with or without screaming,and expressed in various forms.Cognitive impairment or autism-like performance were often identified in these patients,hematuria metabolic diseases screening was normal,no abnormal MRI imaging of the head,and de novo PCDH19 gene mutations were found in their epilepsy gene chip sequencing.It is noteworthy that this disease is very similar to the clinical manifestations of the Dravet syndrome due to the mutations of the neurotype sodium channel αl subunit SCN1A.Therefore,in female patients whose clinical manifestations resemble to Dravet syndrome but SCN1A gene test were negative,EFMR with PCDH19 mutation should be taken into consideration.Early PCDH19 gene testingis of great significance because it not only helps clinicians to understand and analyze the prognosis of this disease,but also offers genetic counseling to the parents.

Objective To apply the big data on medical equipment quality inspection to scientific management of medical equipment.Methods The big data on medical equipment metrological verification and quality control were analyzed,and medical equipment performance curve was drawn based on the function on data standard deviation and time.Results The big data provided support for medical equipment bidding and purchase,preventive maintenance and precision benefit analysis.Conclusion Medical equipment big data is of great significance to enhance medical support ability,and contributes to the management of medical equipment and strategic equipment.

Objective To explore changes in circulating endothelial cells(CECs)numbers in neonatal hypoxemia and its clinical significance.Methods Hladovec method was used to measure the quantity of CECs in 40 cases of neonatus with different degree of hypoxemia(hypoxemia group),and 20 matched healthy newborns were enrolled as control group.Results The numbers of CECs in hypoxemia group were much more than those in control group,and the difference was statistically significant.Meanwhile,there were significant differences in CECs numbers between moderate group and mild group(t =13.43,P <0.05),as well as moderate group and severe group(t=7.698,P <0.05).Conclusion The quantity of circulating ECEs in hypoxic neonatus is correlated with the hy-poxic severity,which may be used as early diagnostic indicator for hypoxemia,and could provide new scientific evidences for early diagnosis,illness judgment and curative effect evaluation.

As the major member of serine/threonine protein ki-nases family, glycogen synthase kinase 3β ( GSK-3β) has well characterized roles in the development of a variety of diseases. However, it is noticed that modulation of GSK-3β in tumor pro-gress is two-faced. Once the activity of GSK-3βas a“pro-onco-genic factor” is inhibited, opposing role as a“tumor suppressor”can also be disrupted, which will trigger the consequent side effect on activation of Wnt/β-catenin signaling pathway. The is-sue has placed a major obstacle to anti-GSK-3β in cancer treat-ment. In fact, functional compartmentalization of a large number of intracellular signaling events cross-talked with GSK-3β can prevent their mutual interference and determine the cell fate. Therefore, understanding the specific mechanisms of GSK-3β in regulation of diverse signaling systems or refinement of a sub-strate competitive inhibitor may have great significance to exploit approaches selectively target GSK-3β in tumor treatment.

Objective To explore the clinical efficacy and outcomes of thrombus aspiration in ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PPCI). Methods A total of 664 cases of STEMI patients undergoing PPCI from Tianjin Chest Hospital from January 2013 to March 2015 were retrospectively analyzed. Patients were divided into two groups:primary PCI after thrombus aspiration group and conventional primary PCI without thromobus aspiration group. The base-line clinical characteristics, and the procedure of percutaneous coronary intervention were similar between two groups. The TIMI flow, LVEF, one-month outcomes and 12-month outcomes were compared between two groups. Results There were significant higher TIMI flow, LVEF in primary PCI after thrombus aspiration group than those of conventional primary PCI without thromobus aspiration group (P<0.05). At one-month follow-up, there were no significant differences in major adverse cardiac events (MACE) between the two groups. At 12-month follow- up, there were no significant differences in cardiovascular death, recurrent myocardial infarction and new hospitalization between two groups. The incidence of recurrent angina was significantly higher in non-aspiration group than that in aspiration group (P<0.05). There were the better survival functions without MACE in aspiration group than that of control group. Conclusion Thrombus aspiration, as an adjunctive method to primary PCI for STEMI, may improve TIMI flow, have beneficial effects on LVEF and reduce the incidence of recurrent angina at 12-month follow up.

Objective To investigate the implementation of the system of older pregnant women prenatal ultrasound screening for the diagnosis and clinioal significance.Methods Clinical data from March 2004 to April 2009 a total of 10 630 cases of pregnant women receiving prenatal ultrasound examination of fetal malformation data,of which 712 cases of advanced maternal age( expected date of birth aged≥35 years) to implement the system of prenatal ultrasound screening and follow-up of all maternal age pregnancy outcome,the final post-natal diagnosis of fetal malformations in the standard,both young women screened as a control group for comparison to assess the value of prenatal ultrasound diagnosis.Results 712 cases of advanced maternal age,prenatal ultrasound diagnosis of fetal malformations in 32 cases,abnormalities occur in approximately 4.49％,single abnormal in 15 cases,complex deformity in 17 cases,missed 4 cases of malformation detection rate was 88.88％ (36/32).Control group,9918 cases of prenatal ultrasound diagnosis of fetal malformations 243 cases,2.45％ incidence of deformity (243/9 918 ).Conclusion Older pregnant women,prenatal ultrasound screening for malformations occur in approximately 4.49％,higher than the detection rate with screening younger women 2.45％,of older pregnant women according to the results of prenatal diagnostic screening could be effective in reducing the birth rate of deformed children and the rate of misdiagnosis.

Aim To discuss the impact of important ac-tive ingredient of garlic diallyl sulfide———DATS on platelet activating factor (PAF ) mediated melanoma metastasis and its mechanisms.Methods ①MTT was used to test the effect of different concentrations of DATS on B16F10 and A375 melanoma cell growth number;②Scratch test and transwell were employed to test the effect of different concentrations of DATS on B16F10 and A375 melanoma cell migration;③ West-ern blot was used to test the effect of DATS on expres-sion of MMP-2,ERK,p38 induced by PFA;④Intrave-nous injection of tumor metastasis model was used to check the inhibition of DATS in PAF-mediated melano-ma metastasis.Results B16F10 cells relative growth rate fell to 73.21% and 48.78%,respectively,when DATS concentration reached 50 and 100 μmol·L-1 . DATS inhibited the levels of PAF-induced migration of melanoma cells B16F10 and vertical migration signifi-cantly,and inhibited B16F10 cells migration induced by PAF through inhibiting the expression of MMP-2, paxillin protein,FAK and other proteins.Conclusion DATS can significantly inhibit PAF-induced tumor metastasis, which is related to the inactivation of MAPKs.