Objective To explore the mechanism of therapeutic action of needle knife “regulating sinews and treating bones” on knee osteoarthritis (KOA) by observing the effect of needle knife intervention on KOA rabbit behaviors, mechanical characteristics of patellar ligament (PL), and expressions of interleukin-4 (IL-4), matrix metalloproteinase-3 (MMP-3) and aggrecan in knee cartilages.Methods Forty New Zealand rabbits were randomly allocated to blank, model, needle knife and electroacupuncture groups, 10 rabbits each. A rabbit model of KOA was made by the modified Videman method of immobilization in extension position. After model making, the needle knife and electroacupuncture groups received needle knife and electroacupuncture treatments, respectively. A behavioral assessment was made using the modified Lequesne MG knee grade evaluation method in every group after model making and treatment. The samples were taken after treatment. PL tension, stress relaxation and creep state were tested using a Bose Electro Force 3300 protracted test machine. Cartilage cell IL-4 expression was examined by ELISA. MMP-3 mRNA and aggrecan mRNA expressions were detected by real-time PCR.Results After model making, there was a statistically significant difference in the Lequesne MG score between the model and blank groups (P<0.01); there was no statistically significant difference in the Lequesne MG score between the needle knife or electroacupuncture group and the model group (P>0.05). There was a statistically significant post-treatment difference in the Lequesne MG score between the needle knife or electroacupuncture group and the model group (P<0.01,P<0.05) and between the needle knife and electroacupuncture groups (P<0.05). There were statistically significant post-treatment differences in PL maximum stress, maximum displacement, elastic modulus, stress relaxation rate and creep rate between the model and blank groups (P<0.01,P<0.05). There were statistically significant post-treatment post-treatment differences in PL maximum stress, maximum displacement, elastic modulus, stress relaxation rate and creep rate between the needle knife and model groups (P<0.01,P<0.05). There was a statistically significant post-treatment difference in elastic modulus between the electroacupuncture and model groups (P<0.01). The IL-4 content and aggrecan mRNA expression decreased significantly and MMP-3 mRNA expression increased significantly in the model group after model making and there were statistically significant differences compared with the blank group (P<0.01,P<0.05). After treatment, the IL-4 content increased significantly in the needle knife and electroacupuncture groups compared with the model group (P<0.01,P<0.05) and aggrecan mRNA expression tended to increase in the two groups. The regulation of aggrecan mRNA and MMP-3 mRNA expressions was better in the needle knife group than in the electroacupuncture groups, but there was no statistically significant difference compared with the model group (P>0.05).Conclusion The mechanism of action of needle knife treatment on KOA may be that it improves ligament mechanical characteristics, regulates intra-articular stress environment, and modulates aggrecan mRNA and MMP-3 mRNA expressions and inhibits cartilage degeneration through IL-4 mechanical signal pathway, to produce the therapeutic effect of “regulating sinews and treating bones”.

The development and present situation of high power and luminous flux LED is introduced. The feasibility of high luminous flux LED in the field surgery illumination is analyzed in detail. Then the realizable plans are discussed separately from device, driving circuit, optical system and mechanical system.

One strain of Pseudoalteromonas sp. E18 was isolated from the sea mud of Ningbo, Zhejiang. It can produce indigo pigment. The morphological, cultural and biochemical characteristics of the bacterium were studied. The indigo pigment was also extracted. The results showed that the maximum absorption peak of the pigment was at 579nm. The pigment was stable to UV, Na_2SO_3,It was also stable at pH 3～9. The pigment was unstable to the sunlight and high concentration H_2O_2. Temperature of 60℃～80℃ could increase the hue while temperature higher than 90℃ could reduce the hue.

Objective To investigate the changes of thyroid hormones in patients with peripartum car-diomyopathy. Methods Seventy-two patients with peripartum cardiomyopathy were consecutively enrolled and 72 healthy women who had normal delivery were regarded as control. Among all the subjects , free triiodothyronine (FT3), free thyroxine (FT4) and thyroid-stimulating hormone (TSH) in the serum and high sensitive C-reactive protein (hs-CRP), interferon-gamma (IFN-γ) and interleukin-4 (IL-4) in the plasma were measured. Results The levels of serum FT3 and FT4 in peripartum cardiomyopathy group were significantly higher than those in control group (P < 0.05). And the level of serum TSH in peripartum cardiomyopathy group was significantly low-er than that in control group (P < 0.05). There were 24 cases with hyperthyroidism in peripartum cardiomyopa-thy group while no patient in the control group had hyperthyroidism (P < 0.05). The levels of plasma hs-CRP and IFN-γ in peripartum cardiomyopathy group were significantly higher than those in the control group (P <0.05). And the level of IL-4 in peripartum cardiomyopathy group was significantly lower than that in the control group (P < 0.05). Conclusions Serum thyroid hormones elevated in patients with peripartum cardiomyopathy and its mechanism might be related to abnormal immune reaction.

OBJECTIVE:To prepare Hyaluronic acid-methyl collagen-terpolymer (HEMA-MMA-MAA)/Doxorubicin com-pound membranes-loaded tantalum stent,and to optimize the formulation. METHODS:Electrostatic self-assembly reaction was ad-opted to prepare compound membranes using metal tantalum stent as carrier,hyaluronic acid,methyl collagen and terpolymer as ex-cipients. With 1 and 30 d accumulative release rate as index,orthogonal test was used to optimize mass concentrations of hyaluron-ic acid,methyl collagen and terpolymer,and validated. The drug release behavior in vitro were investigated. RESULTS:The opti-mal formulation was as hyaluronic acid 1 mg/ml,methyl collagen 4.5 mg/ml and terpolymer 100 mg/ml. 1 and 30 d accumulative release rates of prepared tantalum stent were 7.57%(RSD=2.3%,n=3) and 84.14%(RSD=2.1%,n=3),respectively. 20 d later,dissolution rate approximated to zero level rate of drug release. CONCLUSIONS:Hyaluronic acid-methyl collagen-terpoly-mer/Doxorubicin compound membranes-loaded tantalum stent with sustained-release property is prepared successfully.

ObjectiveTo explore the diagnosis and treatment of acute mesenteric ischemia.MethodsClinical data of 12 cases with acute mesenteric ischemia diagnosed by both operation and pathology were analyzed retrospectively.ResultsThe cases were mainly aged patients accompanied by cardiovascular disease and easily developed to strangulative intestinal obstruction. The mortality rate of this disease was very high.ConclusionThe early diagnosis with suitable techniques and prompt treatment are the keys to the management of this disease.

Objective The aim of this study was to evaluate the feasibility,safety and efficacy of peratrial device closure of ventricular septal defect (VSD) through a right parasternal approach.Methods Between May 2011 and July 2012,47 patients (peratrial group),aged 7 months to 37 years,underwent peratrial device closure of VSD through a right parasternal approach.According to the same inclusion criteria,47 patients who underwent perventricular device closure of VSD were randomly chosen as the control group (perventricular group).In the peratrial group,a 1.5 to 2.0 cm parasternal incision was made in the right fourth or third intercostal space.The pericardium was incised and cradled.Two parallel pursestring sutures were placed at the right atrium near the atrioventricular groove.After puncture,a specially designed hollow probe was inserted into the right atrium.The probe was passed through the tricuspid valve into the right ventricle.Under transesophageal echocardiographic guidance,the tip of the probe was adjusted to point to or cross the defect.A flexible guidewire was rapidly inserted into the left ventricle through the channel of the probe to establish a delivery pathway,and the delivery sheath was introduced through the defect over the wire.Then the device was deployed to close the defect.Results Successful implantation of the device was achieved in both groups of patients (100％).In the peratrial group,the entrance and the exit diameter of the VSD were (7.4 ±4.1) mm (range,2.0 to 20.0 mm) and (3.4 ± 1.2)mm (range,2.0 to 7.0 mm),respectively.The mean device size was (6.3 ± 1.5)mm (range,4.0 to 12.0 mm).The mean intracardiac manipulation time is longer in the peratrial group [(15 ± 13) min] than in the perventricular group[(8 ± 5)min],P ＜ 0.01.But the procedure time is shorter in the peratrial group[(56 ± 24) min] than in the perventricular group [(72 ± 16) min],P ＜ 0.01.During the follow-up period of 1 to 12 months,no device-related complications were found.Conclusion The peratrial device closure of VSD is feasible,safe,and efficacious.It has the advantages of less invasiveness,better cosmetic results,and a shorter procedure time.

Objective This study is to evaluate the advantages between percutaneous and peratrial device closure of secundum atrial septal defects(ASD) under single transesophageal echocardiographic (TEE) guidance.Methods From December 2010 to December 2012,53 patients with the ASD of≤25 mm in diameter underwent percutaneous device closure under simple TEE guidance(the percutaneous group).The device was implanted through the femoral vascular access.Fifty patients with similar age and similar-sized ASD to the percutaneous group,were selected from 350 consecutive patients who underwent peratrial device closure of ASD and assigned to the peratrial group.The ASDs were occluded through a right minithoracotomy approach.The success rate,intracardiac manipulation time,procedural time,postoperative stay and the follow-up results were recorded.Results When the maximum diameter of ASD was ＜ 20 mm,the success rate of both groups was 100％.When the ASD diameter was 20 mm but 25 mm,the success rate was 84％ in the percutaneous group and 100％ in the peratrial group.Three patients failed in the percutaneous group with the ASD diameter of 20 mm and the aortic rim of 3 mm.They were successfully converted to peratrial device closure.The average intrcardiac manipulation time was(20±7) minutes in the percutaneous group and (5 ± 6) minutes in the peratrial group(P ＜ 0.05).The average procedure time was(24 ± 7) minutes in the percutaneous group and (39 ± 6) minutes in the peratrial group(P ＜ 0.05).The postoperative hospital stay was (3.0 ± 0.8) days in the percutaneous group and(4.7 ± 1.5) days in the peratrial group(P ＜ 0.05).Conclusion The percutaneous device closure of ASD under simple TEE guidance is feasible,safe,and efficacious in patients with the ASD diameter of ≤25 mm.It has the advantages of less trauma,less procedural time,shorter hospital stay and better cosmetic results.However,when the ASD diameter was 20 mm and the aortic rim was 3 mm,the peratrial approach may be a better choice.

INTRODUCTIONBicuspid aortic valve (BAV) is the most common form of adult congenital heart disease. When compared to patients with a normal trileaflet aortic valve, dilatation of the aortic root and the ascending aorta (Asc Ao) are the common findings in patients with BAV, with consequent higher risk of developing aortic aneurysm, aortic dissection and rupture. We aim to determine the site of the Asc Ao where maximum dilatation occurs in Asian adult patients with BAV.

MATERIALS AND METHODSAll subjects underwent full echocardiography examination. The diameter of the Asc Ao was measured at 3 cm, 4 cm, 5 cm, 6 cm and 7 cm from the level of aortic annulus to the Asc Ao in 2D from the parasternal long-axis view.

RESULTSA total of 80 patients (male/female: 45/35; mean age: 45.3 ± 16.2 years) with congenital BAV and 30 normal control group (male/female: 16/14; mean age: 45.9 ± 15.1 years) were enrolled. The indexed diameters of the Asc Ao were significantly larger than the control group. In patients with BAV, maximum dilatation of Asc Ao occurred around 6 cm distal to the aortic annulus.

CONCLUSIONIn patients with BAV, dilatation of Asc Ao is maximal at the mid Asc Ao region around 6 cm distal to the aorta annulus.

Adult ; Aneurysm, Dissecting ; epidemiology ; Aorta ; diagnostic imaging ; Aortic Aneurysm ; epidemiology ; Aortic Diseases ; diagnostic imaging ; epidemiology ; Aortic Rupture ; epidemiology ; Aortic Valve ; abnormalities ; diagnostic imaging ; Case-Control Studies ; Comorbidity ; Dilatation, Pathologic ; diagnostic imaging ; epidemiology ; Echocardiography ; Female ; Heart Valve Diseases ; diagnostic imaging ; epidemiology ; Humans ; Male ; Middle Aged ; Risk Factors ; Singapore ; epidemiology

Objective To evaluate the feasibility,safety and efficacy of perventricular device closure of supracristal or intracristal ventricular septal defects (VSD) using a minimally invasive technique through a parasternal approach.Methods 49 patients,aged 4 months to 53 years [median 4.8 years],were enrolled in this study.A 1.5 to 3 cm parasternal incision was made in the left second or third intercostal space.The pericardium was incised and cradled without entering the pleural space.Two parallel pursestring sutures were placed at the right ventricular outflow tract.After puncture,the specially designed delivery sheath loaded with the device was inserted into the right ventricle.Under transesophageal echocardiographic guidance,the sheath was advanced through the defect into the left ventricle.Then the device was deployed to close the defect.Results Successful implantation of the device was achieved in 47 patients (96％),including 26 in intracristal group and 21 in supracristal group.The concentric,eccentric,and muscular occluders were used in 17,28 and 2 patients,respectively.The mean diameter of VSD was (4.4 ± 1.7)mm in the intracristal group and (2.7 ± 0.9) mm in the supracristal group.The mean device size was (7.0 ± 2.3) mm and (4.8 ± 1.1)mm in the intralcristal and supracristal group,respectively.The mean intracardiac manipulation time was (17 ± 16) min.During the follow-up period of 3 to 24 months,no device-related complications were found.Conclusion The perventricular device closure of small-sized supracristal or under medium-sized intracristal VSD is feasible,safe,and efficacious through a left parasternal approach.