37.5?m),showing light,scattered and small granules and gamma motoneurons(diameter

Objective: To compare patent foramen ovale (PFO) detected by transesophageal echocardiography (TEE) between patients with PFO complicated paradoxical cerebral embolism (PCE) and those PFO without symptom.Methods: A total of 132 PFO+PCE patients from our hospital were regarded as PFO+PCE group, another 80 patients with asymptomatic PFO identified by physical examination were collected as asymptomatic PFO group.Both groups received esophageal multi-faceted echocardiography at rest and during Valsalva manoeuvre and right ventricular acoustics angiography.PFO size, shunt degree, presence of atrial septal aneurysm.Eustachian valve and PFO tunnel length were recorded.Results: Compared with asymptomatic PFO group, there were significant rise in PFO size [(1.2±1.2)mm vs.(3.8±1.3)mm], PFO tunnel length [(11.2±5.6) mm vs.(13.0±5.8) mm], proportions of large shunt (2.5% vs.41.7%), atrial septal aneurysm (16.3% vs.47.7%) and Eustachian valve (13.8% vs.46.2%) in PFO+ PCE group, P<0.05 or <0.01.Conclusion: The foramen ovale of PFO+PCE patients is usually bigger, typically complicated with large shunt, atrial septal aneurysm and Eustachian valve, and foramen ovale tunnel is longer.These morphological characteristics may be meaningful for paradoxical cerebral embolism.

Objective: To study the correlation between serum N terminal pro brain natriuretic peptide (NT-proBNP) concentration and mean pulmonary arterial pressure (mPAP) in patients with congenital heart disease (CHD). Methods: According to mPAP level, a total of 62 CHD patients undergoing transcatheter closure were divided into non- pulmonary artery hypertension （PAH）CHD group (n=26), CHD + mild PAH group (n=17), CHD + moderate PAH group (n=12) and CHD + severe PAH group (n=7). Another 20 healthy subjects in the same period were selected as healthy control group. The changes of serum NT-proBNP concentration was compared among all groups before, 24h and three months after operation. Correlation between NT-proBNP concentration and mPAP was analyzed before transcatheter closure. Results: Compared with healthy control group, there was significant rise in serum NT-proBNP level in all CHD groups before operation, and it significantly elevated along with mPAP increased [healthy control group (34.0±16.8) pg/ml vs. CHD non-PAH group (68.0±20.2) pg/ml vs. mild PAH group (116.7±43.5) pg/ml vs. moderate PAH group (273.1±64.2) pg/ml vs. severe PAH group (326.5±50.2) pg/ml, P<0.01? all]; linear correlation analysis indicated that serum NT-proBNP concentration before operation was positively correlated with mPAP in 62 CHD patients (r=0.604, P=0.002). On 24h after transcatheter closure, NT-proBNP concentration was significantly higher than before operation in all groups, but it possessed significant difference only in non-PAH CHD group [(98.9±22.1) pg/ml vs. (68.0±20.2) pg/ml, P<0.05]. NT-proBNP concentration was significantly lower than before operation in all CHD groups after three months (P<0.01? all). Conclusion: Serum NT-proBNP level rises along with pulmonary arterial pressure increased in patients with congenital heart disease, which could be used as an index judging severity of pulmonary artery hypertension and prognosis in these patients.

Objective To investigate the changes and clinical correlation of IL-4 in patients with HBV infection.Methods Sixty cases with chronic asymptomatic HBV carriers,60 cases with chronic hepatitis B,60 cases with liver cirrhosis,60 cases with hepato-cellular carcinoma and 50 healthy controls were collected for serum.ELISA was used for detection of cytokine IL-4 levels;The a-mount of HBV DNA was measured by fluorescence quantitative PCR;Liver function was tested by automatic biochemical analyzer. Results Compared with the healthy controls[(1.64±0.17)ng/mL],IL-4 levels of patients with CHB,LC and HCC were signifi-cantly increased[(4.18±0.48),(4.71±0.42),(3.62±0.31)ng/mL,P <0.05].LC group have the highest IL-4 levels,while ASC was the lowest.Compared with the ASC group,IL-4 levels of patients with CHB,LC and HCC were significantly increased(P <0.05).Compared with the HCC group,IL-4 levels of patients with LC were significantly increased(P <0.05).IL-4 level was posi-tively correlated with TBIL levels in LC patients(r=0.529,P <0.01),while the IL-4 level was positively correlated with ALT and TBIL level in HCC patients(r=0.263,0.323,P <0.05).Conclusion IL-4 may play an important role in chronic HBV infection, the levels of IL-4 can be used as an important indicator to assess the severity of chronic hepatitis B.

BACKGROUND:Considering the risk of lack of bone in revision and the bone coverage of component,it is advisable to use bone grafting to increase bone stock in patients with adult Crowe type Ⅲ developmental dysplasia of the hip (DDH) in the first total hip arthroplasty (THA).OBJECTIVE:To investigate the effectiveness of impaction bone grafting with morselized bone and bone paste for acetabular defects of adult Crowe type Ⅲ DDH in THA.METHODS:Forty cases (45 hips) of Crowe type Ⅲ DDH were enrolled,including 8 males and 32 females,aged 31-68 years.All the components were reconstructed at the anatomic acetabulum combined with deepening acetabulum and putting the centre of rotation medially and distally during THA procedures.The patients were all followed up and evaluated with Harris score,limp length,displacement of the centre of rotation,cup coverage,and postoperative complications.RESULTS AND CONCLUSION:The average follow-up was 32.7 months.Acetabular rotation centers of all the cases were recovered (near) to normal.The incisions healed by first intention and there was no complication such as infection,dislocation,prosthesis loosening.The acetabular cup prosthesis did not displace and was covered well by bone at the last follow-up,the grafted bone particles got radiological osseointegration and the bone sclerosis zone disappeared.No radiolucent lines and screw fracture were detected.The Harris scores of affected hips at the last follow-up were significantly higher than those before surgery(P=0).The average leg length was increased (2.31 ±0.18) cm.The mean cup coverage was 78.1％.The postoperative horizontal and vertical distance of the hip center were shorter than those before surgery (P=0).Reconstructing the acetabulum with autogenous morselized bone graft impaction can effectively restore the acetabular coverage,maintain the stability of acetabular cup and provide better relative bone stock in THA for Crowe type Ⅲ DDH in adult,and moreover,the short-term effect is satisfactory.

Objective:To explore the predictive value of single high-sensitivity cardiac troponin I (hs-cTnI) concentration of 30-day cardiovascular adverse events in patients with suspected acute coronary syndrome (ACS).Methods:This is a multicenter, prospective and observational clinical study. Patients with suspected ACS who were admitted into the emergency department of Fuwai Hospital, the First Affiliated Hospital of Sun Yat-sen University and Nanjing First Hospital from January 2017 to September 2020 were enrolled. hs-cTnI result at the time of visit was obtained from patients with suspected ACS. Patients were followed up for 30 days and patients were divided into no events group and events group according to the presence or absence of 30-day cardiovascular adverse events (acute myocardial infarction (including index), unplanned revascularization and cardiovascular death). The predictive value of single Hs-cTnI at different concentration thresholds on the adverse event was evaluated in terms of sensitivity, negative predictive value (NPV) and 95% confidence interval ( CI). The best threshold was defined as: missed diagnosis rate <2% and NPV >99%. Patients were sub-grouped according to the confounders of hs-cTnI (sex, age, chest pain duration, estimated glomerular filtration rate), and Chi-square test was used to compare sensitivity and NPV among various subgroups. Results:A total of 1 461 patients were included. Among them, 387 patients (26.5%) had 30-day adverse cardiovascular events and 1 074 patients (73.5%) had no adverse cardiovascular events. Mean age was (62±12) years old and 905 were males (61.9%). When the concentration of hs-cTnI was less than 2 ng/L (limit of detection), the missed diagnosis rate of 30-day cardiovascular adverse events was 0.8% (3/387), the sensitivity was 99.2% (95% CI 97.6%-99.8%), and NPV was 98.7% (95% CI 96.0%-99.7%). When hs-cTnI concentration was less than 6 ng/L, the missed diagnosis rate was 1.8%, the sensitivity was 98.2% (95% CI 96.1%-99.2%), and NPV was 99.0% (95% CI 97.9%-99.6%). Subgroup analysis showed that the sensitivity and NPV of single hs-cTnI concentration <6 ng/L for 30-day cardiovascular adverse events were lower in patients with chest pain less than 3 h than those with chest pain time>3 hours ( P<0.05). Conclusions:Single hs-cTnI concentration less than 6 ng/L can predict the risk of 30-day cardiovascular adverse events in suspected ACS patients, but continuous monitoring is recommended for patients with chest pain onset≤3 hours.