Objective To describe the echocardiographic and clinical findings of patients with accessory mitral valve(AMV).Methods Four adult patients were diagnosed to have AMV by Doppler echocardiography.Results All the four patients had cardiac murmur but 2 were asymptomatic.Echocardiogram showed that two cases had isolated AMV with significant left ventricular outflow tract (LVOT)obstruction.Another patient was complicated by idiopathic hypertrophic subaortic stenosis and his systolic pressure gradient across the LVOT reduced to normal after taking negative inotropic drugs.The fourth patient was associated with complex congenital cardiac anomalies but without LVOT obstruction.Conclusions AMV may not be very rare as previously reported.An echocardiographic examination Can detect AMV and difierentiate it from other causes of LVOT obstruction.

Objective: To explore the therapeutic effects of immediate breast reconstruction after modified radical mastectomy of breast cancer with nipple-areolar complex preservation and partial skin-sparing. Meth- ods- We studied 24 eady stage breast cancer patients who received immediate breast reconstruction after modified radical mastectomy with nipple-areolar complex preservation and partial skin-sparing. Nine patients had silicone prosthesis, 3 patients had transverse rectus abdominis myocutaneous flap (TRAM), and 12 pa-tients had silicone prosthesis combined with part of latissmus dorsi-myocutaneous flap (LDMF). The effects of breast reconstruction were evaluated according to objective and subjective criteria after surgery. Results: All of the 24 patients obtained successful breast reconstruction. The appearance of the reconstructed breast was perfect and the two sides seemed symmetrical. The aesthetic outcome was good in 23 patients and satisfacto-ry rate was up to 95.83%, and the subjective evaluation was up to 100%. Necrosis of part of the nipple was found in only one case. Hematoma appeared in one patient and vanished after 3 months. All patients received adjuvant chemotherapy after surgery. No local recurrence and distant metastasis occurred during the follow up period (5～48 months). One patient died of primary hepatic carcinoma at 2 years after surgery. Conclusion:Immediate breast reconstruction after modified radical mastectomy of breast cancer with preservation of nip-ple-areolar complex and partial skin-sparing is safe and effective for early stage breast cancer patients. The reconstructed breast is satisfactory. Breast reconstruction surgery is economical and can reduce patients' psy-chological pressure due to loss of the breast, and improve quality of life. Immediate breast reconstruction does not affect postoperative adjuvant therapy and long-term therapeutic effect. Breast reconstruction surgery has been gradually accepted by more and more eady stage breast cancer patients.

Objective To evaluate the effect of open reduction and multi-dimensional several pin fixation of Gartland type Ⅲ supracondylar fractures with late callus formation in children.Methods The study involved 37 children of Gartland type m supracondylar fractures with late callus formation undergone posteromedial elbow incision,open reduction via bilateral triceps sparing approach,several K-wire internal fixation and early functional rehabilitation from May 2009 to May 2011.There were 23 males and 14 females at 3-13 years of age (mean,7 years).Postoperative results were evaluated according to Flynn standard.Mean 9.5 months of follow-up was made.Results The results were excellent in 28 cases,good in five,fair in two and poor in two.No serious complications occurred after operation.Conclusion Open reduction and multi-dimensional several K-wire fixation is an effective treatment for Gartland type Ⅲ supracondylar fractures with late callus formation in children and hence provides a choice for clinical use.

Objective To evaluate the left ventricular(LV) torsion and rotation in normal subjects using vector velocity imaging.Methods LV basal and apical short-axis images were captured in 10 healthy individuals to estimate LV torsion and rotation using routine 2-dimensional echocardiography and vector velocity imaging. Results As viewed from LV apex,the systolic basal rotation was clockwise (negative value),and apical rotation was counterclockwise (positive Value). The apical peak systolic rotational velocity was significantly higher than the basal [endo:(150±62)°/s vs (114±65)°/s;epi:(81±40)°/s vs (55±28)°s,respectively,P＜0.01]. The peak systolic endocardial rotational velocity and rotation was significantly higher than epicardial rotational velocity and rotation[basal:(-114±65)°/s vs (-55±28)°/s,(-12±6)°vs (-4±1)°;apical:(150±62)°s vs (81±40)°s,(10±4)°vs(6±2)°,respectivelv,P＜0.05]. There were no significant differences in the time to peak systolic rotational velocity/rotation between basal endocardium/epicardium and apical endocardium/epicardium. Conclusions Vector velocity imaging can assess LV torsion and rotation non-invasively,and normal LV has a kind of characteristic motion of torsion.

Identiifcation of tissues/body lfuids in forensic science is important for criminal cases investigation such as crime scene reconstruction, conclude the character of crime. Recently, many researches of Epigenetic shows that tissue speciifc differentially methylated regions(tDMRs) have the ability to as a biomarker for identiifcation of tissues/body lfuids. In this paper, we reviewed the study progress and summarized the probability, advantage and disadvantage as well as application value and the development direction of the application of DNA methylation in the aspect of identifying the tissues/ body lfuids source, aiming at providing a reference for the related research and application.

Objective To evaluate the therapeutic effects of Shenfu injection (a Chinese herbal preparation of Aconitum and Ginseng) for the treatment of patients with post-resuscitation syndrome (PCAS) and to investigate its mechanism as well.Methods The data of 80 patients with restoration of spontaneous circulation (ROSC) after cardiac arrest were collected,and the patients were randomly divided into the experimental group and the control group.The patients in experimental group received Shenfu injection in addition to conventional treatment,and the patients in control group just had the conventional treatment.The cerebral performance classification (CPC) scores,Glasgow Coma Scales cores and sequential organ failure assessment (SOFA) scores before treatment and on the 3rd,7th,14th and 28th days after treatment in the patients of two groups were monitored and compared.The length of ventilation time,total expenses and mortality of the patients were calculated and compared between two groups.Results The data of 3 patients were excluded from those of total 80 patients,because the information of those patients was not complete.Finally,there were 37 cases in experimental group and 40 patients in control group.The CPC scores of smrvived cases in experimental group were lower than those in control group on the 3rd,7th,14th and 28th days after treatment (P ＜ 0.05).The Glasgow Coma Scale scores in experimental group were higher than those in control group on the 14th and 28th days after treatment (P ＜ 0.05).The SOFA scores in experimental group were lower than those in control group on the 3rd,7th and 14th days after treatment (P ＜ 0.05).There were no significant differences in length of ventilation time and total expenses between two groups on the 3rd,7th,14th and 28th days after treatment (P ＞ 0.05).The mortality of the experimental group was lower than that in control group at the 28 th day after treatment (P ＜ 0.05).Conclusions The Shenfu injection could improve the prognosis of patients with post cardiac arrest syndrome.

Objective To identify the clinical and imaging characteristics in neonatal refractory purulent meningitis. Methods Clinical data of 70 cases of neonatal purulent meningitis admitted to the neonatal intensive care unit at Children's Hospital of Fudan University from January, 2009 to December, 2014 were reviewed retrospectively. The patients were divided into refractory group (n=28) and non-refractory group (n=42) according to the course of antimicrobial therapy.The clinical and brain MRI characteristics of neonatal refractory purulent meningitis were analyzed. Parameters were compared between the two groups using Chi-square or Fisher's exact tests, and Wilcoxon tests where appropriate. Risk factors of neonatal refractory purulent meningitis were investigated by univariate and multivariate Logistic regression analysis. Results Among the 70 cases, 31(44.3%) were positive for cerebrospinal fluid (CSF)/blood culture. The positive rate was higher in the refractory group than in the non-refractory group [75.0%(21/28) vs 23.8%(10/42),χ2=17.843, P<0.01]. The most common pathogenic bacteria isolated in the refractory group were Escherichia coli [8 cases (38.1%)] and group B streptococci [5 cases (23.8%)]. Compared to the non-refractory group, patients in the refractory group were more likely to have seizure, higher CSF white blood cell count, higher CSF protein concentration and lower CSF glucose concentration [53.6%(15/28) vs 7.1% (3/42), 965.0 (463.0-2 200.0)×106/L vs 116.5 (61.0-327.5)×106/L, 3 221.1(2 354.3-4 633.5) mg/L vs 1 487.6(988.2-1 924.1) mg/L, and 0.2 (0.1-0.8) mmol/L vs 1.5 (1.2-1.8) mmol/L; all P<0.01]. Multivariate Logistic regression analysis showed that seizure, low CSF glucose concentration on admission, and a positive CSF/blood culture result neonatal refractory purulent meningitis (OR=9.6, 95%CI: 1.2-76.0; OR=15.0, 95%CI: 5.6-63.3; and OR=7.3, 95%CI: 1.5-36.0, respectively). Abnormal brain MRI findings, including intracranial extracerebral space abnormality, ventricular dilatation and periventricular white matter injury, were more common in the refractory group [100.0%(28/28) vs 61.9%(26/42), χ2=13.827 totally; 64.3%(18/28) vs 21.4%(9/42), χ2=13.023 for intracranial extracerebral space abnormality; 60.7%(17/28) vs 19.0%(8/42), χ2=12.704 for ventricular dilation and 28.6%(8/28) vs 2.4%(1/42) for periventricular white matter injury; all P <0.01]. Compared with the non-refractory group, the refractory group had a longer hospital stay [(48.0±17.4) d vs (26.0±10.2) d, t=6.016, P<0.01] and more adverse events [67.9%(19/28) vs 31.0%(13/42), χ2=9.220, P=0.002], including hearing impairment and requirement of neurosurgical intervention [14/18 ears vs 10/46 ears (21.7%), χ2=4.292, P=0.038]. There was no death in both groups during hospitalization. Conclusions Neonates with seizure, low CSF glucose concentration and positive CSF/blood culture results are more likely to have refractory purulent meningitis. Brain MRI abnormalities are more common in neonatal refractory purulent meningitis.

_ Objective_ To evaluate the efficacy of unilateral subtotal adrenalectomy in the treatment of bilateral adrenal solitary neoplasma causing Cushing's syndrome and to elaborate the therapeutic principle. Methods From 2007 to 2013, a total of ten patients were diagnosed with Cushing's syndrome caused by bilateral solitary adrenal neoplasma. We compared patients'clinical symptoms, hormone profiles, biochemical and metabolic parameters, and imaging data before and after the surgery. Five of them chose the optimal neoplasma based on the lateralization ratio of adrenal venous sampling result and the other 5 patients chose the optimal neoplasma based on the diameter of the mass reflected by the computed tomography result and were then operated. Results After the unilateral subtotal adrenalectomy,the24-hour urinary free cortisol decreased significantly(P<0.05)and the midnight serum cortisol level also significantly reduced(P<0. 01). Plasma adrenocorticotropic hormone level increased significantly(P<0. 01). Nine patients of them did not need contralateral adrenalectomy and one patient received contralateral adrelectomy because of the remnant of Cushingnoid symptoms. Conclusion Unilateral subtotal adrenalectomy is an effective and safe way to treat Cushing's syndrome caused by bilateral solitary neoplasma.

Objective To evaluate left ventricular wall motion changes after successful pereutaneous coronary artery intervention (PCI) in patients with acute myocardial infarction (MI) by velocity vector imaging (VVI). Methods Twenty patients with acute MI, 16 anterior MI and 4 inferior MI,were studied by VVI within 3 days before PCI, 1 week and 3 months after PCI. The VVI parameters included peak systolic myocardial velocity (Vsys), peak systolic strain (εsys), maximal strain (εmax), peak systolic strain rate ( SRsys), isovolumic relaxation strain rate(SRivr),segmental ejection fraction (sEF), time to peak of velocity (TPKvel),and time to peak of strain (TPKε). Results Compared with that before PCI,εsys, SRsys, sEF, PSI, SRivr/SRsys, and TPKε were improved one week after PCI,and were further significantly improved at 3 months follow-up. Conclusions The VVI parameters can be used to evaluate the effectiveness of PCI shortly after the procedure and during long-term follow-up.

Objective Kunming strain(KM) mice were used as animal models. Nontoxic dextran conjugated with tetramethylrhodamine(TMR)and fluorecein isothiocyante(FITC)was microinjected to two of the 2-cell blastomere as molecular probe to trace the development fate of the blastomere ,in order to figure out the mechanisms of the formation of Em-Ab axis. Methods FITC- dextran was injected to zygote in order to make sure if it is noxious. Two blastomeres of 2-cell embryo were injected FITC- dextran and TMR- dextran respectively. Results When labeled embryo develeped to blastocyst, distribution of progeny of 2-cell embryo blastomeres can be detected.Conclusion The cells of blastomere randomly distributed either embryonic parts or extraembryonic parts of blastocyst.