Objective To detect the normal values of the fetal coronary sinus(CS) in length(L) .diameter (D) and diameter-to-length ratio(D/L) using fetal echocardiography and assess the clinical significance of dilated CS. Methods Fetal echocardiography were performed in 218 normal fetuses from the 20th to the 40th week of gestation. The L,D and D/L of CS were measured and the standard values of the normal fetal CS were established. A second group of 8 fetuses with dilated CS were assessed compared to the values of normal fetuses. Results The L and D of normal fetal CS correlated well with the gestational weeks (Linear regression equation is L= - 0. 94 + 0. 4 weeks, r = 0. 661, P<0. 0001 ;D= - 0. 07 + 0. 08 weeks, r = 0. 433, P <0. 0001). And the D/L did not vary significantly throughout pregnancy(D/L = 0. 21 0.04, r = 0. 115, P = 0.08). Therefore, the D value of normal fetal CS is less than 3.9 mm and D/L is less than 0.3 throughout pregnancy (20-40 gestational weeks). Conclusions The values of D and D/L of fetal CS in prenatal echocardiography might be useful and important parameters for fetal cardiac or extracardiac anomaly.

Objective To compare success and complication rate of cordocentesis (CC) with intrahepatic umbilical vein sampling (IUVS) under the guidance of ultrasonography in ovine fetus. Methods Twenty near-term singleton pregnant ewes were randomly divided into CC group and IUVS group (each n=10). All of the ewes underwent CC or IUVS in ovine fetus guided with ultrasonography. Success and complication rate of CC and IUVS were calculated. Results Success rates of IUVS on the first, less than 3 times and 5 times attempt was 32.00%, 68.00% and 84.00%, respectively, higher than that of CC (15.00%, 40.00% and 75.00%, respectively, P<0.05). Sever complication rates of IUVS in comparison with CC was not statistically different (P>0.05). Conclusion Fetal IUVS may be a reasonable option to obtain fetal intravascular access and facilitate therapeutic intervention.

Objective To study the indications,feasibility and efficacy of rigid choledochoscopy via biliary fistula tracts to remove bile duct stones.Methods A retrospective analysis was performed on the clinical data of 86 patients with bile duct stones treated with rigid choledochoscopy via biliary fistula tracts at our hospital between November 2011 and July 2016.Patients with bile duct stones were divided into the percutaneous transhepatic cholangio drainage (PTCD) group and the T tube tract group.There were 40 patients who underwent lithotomy using rigid choledochoscopy via the PTCD tract and 46 patients who underwent choledocholithotomy using rigid choledochoscopy via the T-tube tract.A comparison was conducted to compare the duration of the procedures,the amount of perioperative bleeding,the postoperative complication rates and residual stone rates between the two groups.Results In the PTCD group,the average operation time was (77.0 ± 36.5) min,the amount of perioperative bleeding was (26.5 ± 54.1) ml,and the postoperative complication rate was 37.5 ％ (15/40).Complete lithotomy in one-stage was successful in 33 patients,and in two-stages in 1 patient.The residual stone rate was 15.0％ (6/40).In the T tube tract group,the average operation time was (82.5 ± 44.1) min,the amount of perioperative bleeding was (14.8 ± 21.0) ml,and the postoperative complication rate was 32.6％ (15/46).Complete lithotomy in one-stage was successful in 34 patients,and two-stages in 2 patients.The residual stone rate was 21.7％ (10/46).There were no significant differences in the residual stone rates,complication rates and operation time between the two groups (P ＞ 0.05).The amount of operative bleeding was significantly better in the T tube tract group than the PTCD group,(P ＜ 0.05).Conclusions There was no significant differences in the clinical efficacy in the treatment of bile duct stones using choledochoscopy either via the PTCD tract or the T tube tract group.Both approaches can be used for bile duct stones.

Objective To prospectively study the clinical significance of the MELD scoring system in surgical treatment of obstructive jaundice.Methods 112 patients with obstructive jaundice who were admitted into our hospital from January 2009 to December 2013 were divided into two groups:group A (Stage Ⅰ PTCD and stage Ⅱ open operation,n =53) and group B (1 stage open surgery,n =59).The amount of intraoperative bleeding blood loss,operation time,postoperative complications,duration of hospitalization,mortality rate,and the changes in liver function after surgery were compared between the two groups.Results The differences in the liver function index of the two groups on the same postoperative date were significantly different (P ＜ 0.05).The liver function of group A recovered faster than group B.Patients in group A with a MELD ＜ 10 points stayed in hospital significantly longer when compared with patients in group B.For patients in group A with MELD ＞ 10 points,the operation time,bleeding volume,postoperative complications and hospitalization were significantly less than the patients in group B (P ＜ 0.05).There were 3 patients (group B) who died with MELD ≥ 20 points after operation.Conclusions In patients with obstructive jaundice with a MELD score greater than 10 points,especially those with a score equal to or greater than 20,PTCD should be performed first to relieve biliary tract obstruction,followed by a stage Ⅱ open surgical operation after the liver function had improved.MELD had important clinical significance in the evaluation of operation risk in patients with obstructive jaundice.

ObjectiveTo evaluate the clinical value of the rate of fetal urine production rate (UPR) in fetus with twin-to-twin transfusion syndrome(TTTS).Methods 22 continuative normal monochorionic diamniotic(MCDA) twin fetuses were selected as controll group.Eight fetuses with TTTS were selected as disease group,and UPR was measured by three-dimensional ultrasound virtual organ computer-aided analysis (VOCAL) and the rate of UPR in twin was calculated.Results1)The rate of UPR of twin fetuses in MCDA did not vary significantly throughout pregnancy (0.97 ± 0.28).The correlation coefficient between the rate of UPR and gestational age was 0.13,without obvious correlation.2)The rate of UPR-recipient/UPR-donor in TTTS fetuses increased significantly compared with MCDA twin fetus (7.83 ± 2.61,t =6.19,P ＜0.05).ConclusionsThe rate of UPR may be an important index in the assessment of TTTS.

Objective To establish normal reference indexes of aorta during gestation and cut-points for detection of fetuses with coarctation of aorta.Methods From long-axis views of the aortic arch,the internal diameter of the aortic root,ascending aorta,transverse aortic arch,aortic isthmus,descending aorta,anonyma,left common carotid artery,left subclavian artery were measured in 234 normal fetuses at different time ranging from 14 to 41 weeks during gestation.Reference values of each aortic segment were constructed by linear regression analysis.The ratio of each aortic segment to the ascending aorta were calculated.ResultsThe internal diameter in each aortic segments increased as pregnancy progressed (P<0.01).In the prenatal diagnosis of fetus with coarctation of the aorta,the ratio of the aortic isthmus to the ascending aorta and descending aorta to the ascending aorta were significantly lower than the normal fetuses(all P<0.01).Conclusions The ratio of the aortic isthmus to the ascending aorta and ratio of descending aorta to the ascending aorta detected by echocardiography may be helpful in the prenatal diagnosis of coarctation of aorta.

Objective To investigate the the effects of chronic intrauterine hypoxia on intimal-media thickening(IMT) and strain rate(SR) in abdominal aorta of male offspring rabbits during adult age.Methods Sixten New-Zealand rabbits were assigned randomly to 2 groups: chronic intrauterine hypoxia group (CIH, 12% O_2, n = 8) and normal oxygen group (NO,21%O_2, n = 8).After delivery,2 male offspring rabbits per litter were selected and breast-fed for 3 months, randomly divided into high-fat diet and normal diet groups.Finally, there were 4 groups in this experiment:chronic intrauterine hypoxia with high fat diet (CIH + HFD, n = 8) ,non-chronic intrauterine hypoxia with high fat diet (NCIH + HFD, n = 8),chronic intrauterine hypoxia with normal diet (CIH + ND, n = 8) and normal control (NC, n = 8).At sixth months of age, Serum levels of total cholesterol(TC) and triglyceride(TG) were assayed.SR in the abdominal aorta of male offspring rabbits was evaluated by ultrasonography.Then, abdominal aorta was taken out and observed by electron microscope and IMT was measured.Results CIH increased the levels of TC and TG (P < 0.01), thickened the IMT (P<0.05) and decreased the SR(P<0.05) of abdominal aorta of male offspring rabbits during adult age.There were relevant pathological changes in different groups.All these above-mentioned profiles were aggravated significantly after feeding high fat diet (P<0.05 or P<0.01).Conclusions CIH increased the IMT and decreased the SR of abdominal aorta of male offspring rabbits during adult age.

Objective To investigate the relation between type 2 diabetic nephropathy and blood lipid levels with insulin resistance.Methods The study included 50 patients with type 2 diabetes mellitus without nephropathy,45 patients with early stage diabetic nephropathy,52 patients with diabetic nephropathy and overt proteinuria,43 patients with end-stage diabetic nephropathy.Serum level of their lipid,blood sugar,HbA1c,insulin,and albumin-to-creatinine ratio(ACR)were monitored.Results(1)The lever of serum TG、TC、LDL-C、 ApoB were increased in the three groups of diabetic nephropathy,there was significant difference between the group of diabetes mellitus without nephropathy and the three groups with diabetic nephropathy(P

Objective To evaluate the clinical effect of Kangai injection combined with transcatheter arterial chemoembolization (TACE) in the treatment of hepatic cancer.Methods We searched CBM,CNKI,WanFang and VIP,clinical studies of Kangai injection combined with TACE in the treatment of hepatic cancer were included and compared.The methodological quality of included studies was assessed and Meta analysis was performed by Rev Man 5.2 software.Results 9 studies involving 595 patients were included.Meta analysis results indicated that the difference of effective rate was significant [RR =1.32,95 ％ CI(1.10,1.58),P =0.003] ; The quality of life improvement rate also had significant difference[RR =1.85,95％ CI(1.42,2.41),P ＜ 0.000 01].Conclusion Kangai injection combined with TACE in the treatment of hepatic cancer can get extra benefits compared with TACE alone.It can improve the curative effect,significantly improve the quality of life.

BACKGROUND: A skull defect is inevitable after decompression treatment for traumatic brain injury. Titanium mesh as the most recognized skull repair material has good biocompatibility and has been widely used in clinical practice. However, the timing for skull repair after brain injury is still in dispute.OBJECTIVE: To compare the changes of brain perfusion and the recovery of neurological function in patients with skull defects before and after early and late-stage titanium mesh repair based on CT perfusion technique.METHODS: This was a single-center, prospective, observational clinical trial that was completed at the Taihe Hospital,Hubei University of Medicine in Hubei Province, China. Eighty-six patients with craniocerebral injury who had undergone decompression with removal of bone flap from January 2013 to January 2016 were recruited and subjected to skull repair using titanium mesh. All the patients were randomized into two groups: test group (n=40) with early skull repair within 1-3 months after decompression and control group (n=46) with late-stage skull repair within 6-12 months after decompression. CT perfusion technology was used to observe changes of brain perfusion at 3 days operatively and at 10 days postoperatively. The Barthel index was evaluated at 30 days postoperatively. The trial was registered with ClinicalTrial.gov (identifier: NCT03222297) on July 12th, 2017. The study protocol was approved by the Ethics Committee of Taihe Hospital with the approval No. 2012 (08), and performed in accordance with the Declaration of Helsinki,formulated by the World Health Organization and the hospital's ethical requirements for human research. All the patients and their families were voluntary to participate in the trial, were fully informed of the trial process, and then signed the informed consent prior to the initialization of the trial.RESULTS AND CONCLUSION: The postoperative cerebral blood volume and cerebral blood flow at the parietal cortex on the side of skull defect and at the cortex in the defect region were significantly higher in the two group than the baseline (P < 0.05), while the time to peak was lower than the baseline (P < 0.05). Compared with the control group,significantly higher cerebral blood volume and cerebral blood flow as well as shorter time to peak were observed in the test group (P < 0.05). The Barthel index of the test group was also significantly higher than that of the control group at 30 days postoepratively (P < 0.05). Overall, early skull repair with titanium mesh is helpful to improve the cerebral blood perfusion at the affected side and the recovery of neurological function. In addition, CT perfusion technology is a safe and effective method to monitor hemodynamic changes in the brain.