Animals ; Aortic Valve ; surgery ; Aortic Valve Stenosis ; congenital ; therapy ; Balloon Valvuloplasty ; methods ; Cardiac Surgical Procedures ; adverse effects ; methods ; Catheterization ; adverse effects ; methods ; Female ; Fetal Diseases ; therapy ; Fetal Heart ; surgery ; Heart Defects, Congenital ; therapy ; Humans ; Postoperative Complications ; epidemiology ; Pregnancy ; Pregnancy Trimester, Second ; Ultrasonography, Interventional ; methods

Objective To study the importance of radial height restoration in the type C distal radial fractures and selection of therapeutic method.Methods Sixty-one cases of type C distal radial fractures in the department of joint orthopedics and traumatic orthopedics of affiliated traumatic and orthopedic hospital of Guangzhou university of Chinese medicine from June 2013 to September 2015 were retrospectively analyzed, including 34 cases of C1 type,14 cases of C2 type and 13 cases of C3 type according to the AO/ASIF fracture classification, the cases were divided into the manual reduction and splint external fixation group (27 cases), external fixator group (18 cases) and plate screw internal fixation group (16 cases).The radial height, palm inclination angle, ulnar inclination angle and Gartland-Werley (G-W) score after treatment were compared among various groups.Results Fifty-eight cases were followed up.The radial height, ulnar inclination angle and G-W score had statistical difference among 3 groups (P<0.05), while the palm inclination angle had no statistical difference among 3 groups (P>0.05);the difference of radial height and ulnar inclination angle between the external fixator group and plate screw internal fixation group had no statistical significance (P>0.05), but there were statistically significant differences when these two groups were compared with the manual reduction and splint external fixation group respectively (P<0.05).The G-W score had no statistical difference between the manual reduction splint fixation group and the external fixator group (P>0.05) , but there were statistically significant differences when these two groups were compared with the the plate screw internal fixation group respectively (P<0.05).Conclusion The radial height restoration may better recovery ulnar inclination angle and improve the joint function.

Objective To investigate the changes of plasma adrenodullin(ADM) and C-type natriuretic peptide(CNP) level in children with chronic heart failure(CHF) and its clinical implications.Methods Forty-two children with CHF were collected.The patients suffered from dilated cardiomyopathy,congenital heart defects,and other heart diseases.According to a modified scoring system described by Ross and Reithman,16 patients were classified as class Ⅱ,14 as class Ⅲ,and 12 as class Ⅳ.Plasma levels of ADM and CNP were measured by radioimmunoassay assay in these patients and 11 healthy children.Echocardiography was performed to measure left ventricular function and the ratio of E/A.Results Plasma ADM and CNP levels of CHF patients were significantly elevated as compared with those of the control subjects [(218.27?106.53) ng/L vs(74.39?53.99) ng/L,P=0;(190.27?108.38) ng/L vs(92.59?(59.46) ng/L),P0.05).ADM levels were elevated with the advancing severity of CHF determined by a modified scoring system described by Ross.However,the plasma CNP levels in the normal state wasn′t significantly different from those observed in class Ⅱ.Likewise,the plasma CNP level in the class Ⅲ was not significantly different from that observed in class Ⅱ.Conclusions ADM and CNP might play a compensatory and defensive roles in the pathophysiology of the pediatric CHF.ADM may be a biochemical marker for evaluation the severity of the chronic heart failure in children,but also a new prognostic indicator of this syndrome.

Objective To investigate the combination of color Doppler flow imaging (CDFI) and transcranial Doppler (TCD) in the assessment of the hemodynamic changes of vertebral artery occlusion disease and their clinical value. Methods A total of 101 patients with vertebral artery occlusion detected by the combination of CDFI and TCD and confirmed by DSA were enrolled from January 2005 to January 2009. Taking the result of digital subtraction angiography (DSA) as a golden standard, The differences between the different types of the side of vertebral artery occlusion and contralateral vertebral artery on the extra- and intracranial segments were compared and analyzed in peak systolic velocity (PSV), end diastolic velocity (EDV), resistive indices (RI), pulsatility index (PI), spectrum morphology, and hemodynamics. Results No blood flow signals were detected by CDFI and TCD in patients of complete occlusion of the vertebral artery; the weak blood flow signals were detected by CDFI in patients of the occlusion in the intracranial segment of the vertebral artery. 3he blood flow signals after the establishment of collateral circulation in patients of the segmental occlusion were detected in the extraeranial segment or intraeranial segment of the vertebral artery. The PSV on the occluded sides of the extraeranial segments were decreased more significantly than that on the unoccluded sides (27.39 ± 12.44 cm/s vs. 62.61 ± 13.22 cm/s, P = 0.000); RI was significantly higher than the unoccluded sides (0. 99 ± 0. 21 vs. 0. 62 ± 0.07, P = 0. 000). When a vertebral artery had the segmental occlusion and the collateral circulation was established, the PSV, EDV, and PI of the intracranial segment of the vertebral artery on the occluded sides were decreased more significantly than those on the unoccluded sides, PSV were 37. 81 ± 12.28 cm/s and 73.17±30. 99 cm/s, respectively (P =0. 000), EDV were 17.58 ± 7.10 cm/s and 29.31 ± 12.94 cm/s, respectively (P = 0. 000), PI were 0.84 ± 0.22 and 1.01 ±0. 18, respectively (P=0. 000). The compard DSA showed that the sites of vertebral artery occlusion were different, There was significant difference in the Doppler flow velocity spectrum between the CDFI and TCD. Conclusions PSV, EDV, RI, and PI are the hemodynamic parameters of accurately assessing vertebral artery occlusion, and the combination of CDFI and TCD has significant value for the hemodynamie changes of different types of vertebral artery occlusion and the clinical comprehensive assessment.

ObjectiveTo explore the relationship between chronic kidney disease (CKD) and cerebral small vessel disease (SVD) in elderly patients. MethodsOne hundred and fifty-two elderly male CKD patients for experimental group and 158 elderly male for control group were recruited. Demographic data and vascular risk factors were recorded. White matter lesion (WML) was semi-quantitatively assessed by cerebral magnetic resonance imaging (MRI), and lacunar infarction (LI) was also calculated. Results(1) The prevalenees of hypertentsion and diabetes mellitus were higher in elderly CKD patients than those in control group (30. 9% vs. 19.0%, 23.7%vs. 14.6%;both P～0. 05). (2) The percentages of grade 2 and grade 3 WMLs were higher in elderly CKD patients than those in control group (34.9% vs. 24.1%, 25.7% vs. 16.5%;both P<0.05). Prevalence of LI was higher in elderly CKD patients than that in control group (45.4% vs.25.3% ,X2= 13. 70, P<0. 05). The similar Resultswere also obtained except for control subjects with hypertension and diabetes mellitus. (3) The logistic regression analysis showed that age, hypertension and low glomerular filtration rate (GFR) were closely associated with SVD in elderly CKD patients. ConclusionsHypertention and diabetes mellitus are risk factors for CKD in elderly patients. SVD is associated with CKD, and age, hypertension and low GFR may be risk factors for SVD in elderly CKD patients.

Objective To investigate the CT features of inflammatory myofibroblastic tumor in children. Methods Eighteen patients with inflammatory myofibroblastic tumor proven by surgery and pathology were examined with plain and contrast medium enhancement CT scan. Results Of 18 cases,16 had isolated lesions located at lung (n =4), mesentery (n =3), kidney (n =2) and trachea (n = 1 ),left main bronchus ( n = 1 ), right thoracic cavity ( n = 1 ), peritoneum cavity ( n = 1 ), pancreas ( n = 1 ),left thigh ( n = 1 ), prostate ( n = 1 ), superclvicle soft t tissue ( n = 1 ) , bladder ( n = 1 ). The other 2 cases were with multiple lesions on omentum and mesentery, and in intraperitoneal and side of split of right hepatic lobe, respectively. The CT findings of 18 cases included 16 solid mass with calcifications in 3 of them, and 2 solid-cystic mass. After contrast enhancement, moderate or marked homogeneous or heterogeneous enhancement were shown in all the solid parts of tumor on dynamic CT. Mass can compress surround great vessel and tube-like structure. On pathological examination, the tumor was mainly composed of spindleshaped fibrous cells and inflammatory cells, and the immunohistochemically staining for SMA was observed positively. Conclusion CT can provide specific information for diagnosis of inflammatory myofibroblastic tumor, yet definite diagnosis relies on pathology.

Objective To investigate the evaluation value of anterior communicating artery patency for patients with severe carotid artery stenosis treated by carotid endarterectomy (CEA )with transcranial color Doppler ultrasonography. Methods From June 2014 to June 2015,89 consecutive inpatients with unilateral symptomatic severe carotid stenosis treated with CEA at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were enrolled retrospectively. They were divided into either a patent group (n=45)or a non-patent group (n=44)according to whether the anterior communicating artery was patent or not (DSA findings). Whether the anterior communicating artery was patent or not diagnosed by the transcranial color Doppler ultrasonography was compared with the consistency of the digital subtraction angiography (DSA)results. The differences of intraoperatively implemented temporary shunt rate and the differences of hemodynamic parameters including peak velocity (PSV),end-diastolic velocity (EDV),and pulsatility index (PI)of the preoperative and postoperative bilateral middle cerebral artery and anterior cerebral artery (ACA)of both groups were analyzed. Results Compared with the results of DSA, the sensitivity and specificity of transcranial color Doppler ultrasonography for preoperative evaluation of the patency of anterior communicating artery were 91. 1%(41/45)and 97. 7%(43/44)respectively,the total accordance rate was 94. 4%(84/89)(Kappa=0. 888,P<0. 01). The temporary shunt rate (2. 2%[1/45])of patients in CEA of the anterior communicating artery patent group was significantly lower than that of the non-patent group (20. 5%[9/44]). There was significant difference between the 2 groups (χ2 =5. 700,P =0. 017). PSV,EDV,and PI of the ipsilateral middle cerebral artery after procedure in both groups were higher than those before procedure. There were significant differences (the patent group:128 ± 41 cm/s vs. 77 ± 24 cm/s,55 ± 18 cm/s vs. 41 ± 13 cm/s,and 0. 92 ± 0. 14 vs. 0. 67 ± 0. 14;the non-patent group:139 ± 44 cm/s vs. 86 ± 31 cm/s,59 ± 22 cm/s vs. 44 ± 16 cm/s,and 0. 94 ± 0. 15 vs. 0.71 ± 0. 16;all P<0. 01). PSV and EDV of the contralateral ACA of the patent group were decreased after procedure. There were significant differences (125 ± 42 cm/s vs. 157 ± 57 cm/s,55 ± 24 cm/s vs. 72 ± 34 cm/s,all P<0. 01). There was no significant difference in PI of contralateral ACA before and after procedure (P >0.05). There were no significant differences in PSV,EDV and PI of the contralateral ACA in the non-patent group between after procedure and before procedure (all P>0. 05). Conclusions Transcranial color Doppler ultrasonography can accurately and objectively evaluate whether the anterior communicating artery is patent or not in patients with unilateral severe carotid stenosis. It has an important clinical significance for selective shunt in CEA and improving the success rate of CEA.

Objective To evaluate the correlation between the types of vertebral artery occlusion and their compensatory hemodynamic changes and posterior circulation ischemia using color Doppler flow imaging combined with transcranial color-coded sonography.Methods From June 2015 to June 2016,A total of 108 patients with vertebral artery occlusion confirmed by vascular sonography,digital subtraction angiography (DSA) or CT angiography (CTA) were enrolled retrospectively.According to the magnetic resonance imaging (MRI)-diffusion weighted imaging (DWI) findings,they were divided into posterior circulation infarction (n=78 in infarction group) and non-posterior circulation infarction (n=30 in TIA group).Color Doppler flow imaging and transcranial color Doppler ultrasonography were used to examine the contralateral vertebral artery extracranial diameter, peak systolic velocity(PSV) and end diastolic velocity(EDV) of bilateral extracranial and intracranial vertebral arteries.The differences of the vertebral artery occlusion types,establishment of collateral circulation and hemodynamic changes of the contralateral vertebral artery were compared between the two groups.Results The patients with single vertebral artery occlusion in the infarction group and TIA group were 69 (88.5%) and 26 (86.7%) respectively;those with bilateral vertebral artery occlusion were 9 (11.5%) and 4 (13.3%) respectively.There was no significant difference in the number of vertebral artery occlusion between the two groups (χ2=0.000,P=1.000).The proportion of patients with vertebral artery occlusion in intracranial segment in the infarction group was higher than that in the TIA group (70.5% [55/78] vs.36.7% (11/30);χ2=10.444,P=0.001).The proportion of patients with the establishment of collateral circulation in the infarction group was lower than that in the TIA group (14.1% [11/78] vs.43.3% (13/30);χ2=10.711,P=0.001).The peak systolic velocity (PSV) and the end diastolic velocity (EDV) of contralateral extracranial vertebral artery in patients with single vertebral artery occlusion in the TIA group were higher than those in the infarction group (65±21 cm/s vs.57±15 cm/s,25±8 cm/s vs.20±7 cm/s,t=2.043 and 2.606 respectively,all P<0.05).Conclusion The establishment of collateral circulation and hemodynamic compensation of the contralateral vertebral artery after vertebral artery occlusion were closely associated with the occurrence of posterior circulation ischemia.

Objective To evaluate the short-term and long-term effects in patients of carotid artery subtotal or complete occlusion after carotid endarterectomy ( CEA) using vascular ultrasound. Methods A total of 107 consecutive patients were diagnosed as carotid artery occlusive disease with DSA and treated with CEA at Beijing Xuanwu Hospital,Capital Medical University from January 2005 to January 2014 were enrolled retrospectively. Sixty-three of them had subtotal occlusion ( the carotid artery stenosis rate 95% to 99%) and 44 had complete occlusion. The occurrence of perioperative complications of all patients was documented. The follow-up study used outpatient follow-up and telephone tracking. The patients of surgical recanalization were followed up with ultrasound at 1 week, 3, 6, 12, and 24 months after procedure. The clinical prognosis, restenosis, vascular structure and hemodynamic changes of the patients after CEA were documented. Results (1) Of the 107 patients,86 (80. 4%) achieved recanalization after procedure and 21 (19. 6%) did not. The incidence of stroke and death was 4. 7% (5 cases) within 30 days after procedure,among them the incidence of subtotal occlusion group was 4. 8% ( n=3 cases) and the complete occlusion group was 4. 5% (2 cases). (2) Within one week after procedure,the peak systolic velocity ( PSV) ,end diastolic velocity ( EDV) ,and pulsatility index ( PI) of the ipsilateral middle cerebral artery in the recanalization patients increased significantly (120 ± 39 cm/s vs 60 ± 17 cm/s,50 ± 18 cm/s vs 33±11cm/s,and0.96±0.20vs0.67±0.14,respectively).Thereweresignificantdifferences(allP<0. 01). Carotid artery ultrasound showed that the local vessel diameters of the original lesions in the recanalization patients were widened as compared with preoperation (4. 4 ± 1. 1 and 3. 6 ± 1. 0 mm). There was significant difference (P<0. 01). (3) Sixty-nine patients with recanalization were followed up for 1 to 60 months( the median time was 12 months) . One to six months after procedure,the patency rate of the patients was 95. 6%(n=66),>6 to 12 months was 94. 2%(n=65),>12 to 24 months was 94. 2%(n=65),and more than 2 years was 91. 3%(n=63). Conclusion Vascular ultrasound can conduct short-term and long-term follow-up for carotid artery occlusive disease after CEA. The degree of blood flow improvement should be identified and restenosis should be found in time after procedure.