Objective To evaluate the value of color Doppler flow imaging(CDFI) in the diagnosis of congenital coronary artery fistula (CAF).Methods Thirteen consecutive patients ranging in age from 8 to 68 years underwent conventional transthoracic echocardiography,which depicts their origin, course, and drainage site. Results Right CAFs were detected in 8 patients: four of them had drainages to the left ventricle, two to the main pulmonary artery, one to the right ventricle(RV) and the other to the right atrium(RA). CAFs arising from the left coronary artery were noted in five patients: three of them had drainages to the main pulmonary, and the other two to the RA and RV respectively. The origin and the course were precisely defined and the drainage site was clearly depicted in all thinteen patients. The diagnosis of the thirteen patients was confirmed by coronary angiography, and eight of them received surgical treatment. Conclusions CDFI offers a simple, useful and reliable technique in diagnosis of CAF.

Objective Currently, the effect of hydrogen peroxide solution( H2 O2 ) flush on the recovery of peripheral nerve injury are still undetermined. This study aims to explore the effects of different H2 O2 flushing time course on recovery of peripheral nerve injury during surgical debridement. Methods 18 New Zealand male white rabbits were randomly divided into isotonic saline group( isotonic saline flush) , H2 O21 min group ( hydrogen peroxide solution flush 1 min + isotonic saline flush) , H2 O23 min group ( H2 O2 flush 3 min + isotonic saline flush. Each group has 6 rabbits. We established rabbit sciatic nerve injury model. After 12 weeks, we executed the animals, drew materials at the suture nerve, detected motor nerve conduction velocity and observed pathological HE staining, as well as measuring the sciatic nerve function indexes( SFI) of rabbits at the 8th and 12th week, respectively. Results Nerve conduction velocity in H2O21min group and isotonic saline group[(25.89±1.42), (26.46±1.67) m/s] were higher than that in the H2O23min group[(23.80±2.91)m/s](P<0.05). Pathological section shows that the isotonic saline group has a better sheathstructure, nerve fibers structure damage is not obvious and myelin degeneration degree is mild in H2 O21 min group. blurred sheath structure and myelin axons obvious deformation in H2 O23 min group. 8 weeks and 12 weeks after operation, SFI in isotonic saline group [(-43.00±0.82), (-39.17±0.91) m/s] was significant higher than H2O21 min group [ (-49.79±1.47), (-46.60±0.79) m/s] and H2O23min group [(-51.66±1.27), (-46.39±0.94) m/s], thedifference was statistically significant (P<0.05). SFI in group of H2O21min [(-49.79±1.47)m/s] was higher than group og H2O23 min [(-51.66±1.27) m/s][P<0.05]. Conclusion H2O2 solution has side effect on the recovery of damaged peripheral nerve inju-ry and with prolonging the H2 O2 flushing time, the damage of peripheral nerve can be aggravated. So in the process of clinical surgical debridement, under the premise of guaranteed sterilization the time of H2 O2 flush should be shortened as far as possible.

Quorum sensing is defined as the cell density-dependent regulation of gene expression, and the involved system is the quorum sensing system, in which N-acyl homoserine lactone is known as the signal molecules of most gram-negative organisms. It can regulate diverse physiological functions. This paper reviewed the quorum sensing systems and the recent advances which play a major role in the formation of the symbiosis between the rhizobia and their host plants.

The government and general public has paid unprecedented attention to the public health after the outbreak of SARS in 2003. Based on the first and the second round of Three-year Action Plan for Public Health System Construction, the public health system in Shanghai has been gradually improved. The city's public health security has been increasingly consolidated and people's main health status and indicators have been constantly improved. Nowadays, the third round of Three-year Action Plan will be started. This paper will review the development of public health system in Shanghai in recent ten years, analyze the possible problems and challenges in the future and put forward the development direction and strategy of the system.

Objective To further elaborate the clinical characteristics,diagnosis,treatment and prognosis of primary cutaneous invasive epidermo-tropic CD8 positive cytotoxicity T-cell lymphoma.Methods The clinical characteristics,diagnosis and treatment of a patient with primary cutaneous invasive epidermotropic CD8 positive cytotoxicity T-cell lymphoma were summarized,and diagnosis and treatment of the disease from published literature were reviewed.Results After one year long,recurrence of exudative maculopapule on his body and limbs,a middle-aged male patient visited our hospital.Then,the patient was diagnosed as T2N0M0 Ⅰ phase of primary cutaneous invasive epidermo-tropic CD8 positive cytotoxicity T-cell lymphoma based on results of skin biopsy,immunohistochemistry,T-cell gene rearrangement and PET-CT.Through integrative medicine treatment (combination of bruceolic oil emulsion and chemotherapy with GDP regimen),the patient achieved complete remission (CR).The treatment and follow-up continues till now and his condition was stable.Conclusions Clinical occurrence of primary cutaneous invasive epidermo-tropic CD8 positive cytotoxicity T-cell lymphoma is rare and early diagnosis is difficult.It could be diagnosed with histopathology combined with T-cell gene rearrangement.In order to avoid misdiagnosis,great caution should be taken during disease history inquiry and physical examination,should be early lesion for delayed healing of recurrent lesions,biopsy should be conducted as soon as possible and immunohistochemistry should be performed simultaneously,which will provide a good basis for further treatment.

Objective To investigate the echocardiographic features in patients with right atrial myxoma and thus evaluate the value of echocardiog?raphy in the diagnosis of right atrial myxoma. Methods The echocardiographic findings of 20 patients with right atrial myxomas were retrospectively analyzed,and the echocardiographic features of these patients were summarized. Results The main clinical symptoms of right atrial myxoma includ?ed chest tightness,shortness of breath,lower limb edema,and syncope. Of these 20 patients,the echocardiography showed that the average size of the right atrial myxomas was 3.11 cm × 2.90 cm to 7.44 cm × 4.52 cm. The myxomas were round or oval shape in 15 patients(75%)and lobulated shape in 5(25%). The myxomas were attached to the atrial septum in 15 patients(75%)and to right atrial free wall in 25%of the patients. The aver?age width of the basement was 1.62±0.30 cm,and the width was greater than 1 cm in 80%of the patients had the width over 1 cm. Some myxomas had internal areas of calcification and anechoic cystic areas. The percentages of patients with the blocking of right atrium,tricuspid and pulmonary hy?pertension were 70%,50%,and 10%,respectively. Conclusion The echocardiographic features of right atrial myxoma were specific. Echocardiog?raphy can accurately assess the tumor and identify the secondary changes in cardiac structure and hemodynamics and thus provide evidence for time?ly and accurate diagnosis of right atrial myxoma.

Objective To analyze subclinical changes of left ventricular deformation by using two-dimensional (2-D) speckle tracking imaging (STI) in primary mitral regurgitation (MR) and to identify sensitive parameters of left ventricular deformation that reflect reduction of left ventricu-lar function after mitral valve repair.Methods We evaluated patients with primary MR who underwent mitral valve repair between May 2013 and June 2015.According to the reduction in ejection fraction (EF),the MR patients were divided into MR1 (EF reduction of ≤10％) and MR2 groups (EF reduction of ＞10％).The parameters of left ventricular deformation were measured by using 2-D STI.Results Compared with the MR1 group,the MR2 group had increased global longitudinal strain (GLS;P ＜ 0.05).A positive correlation was found between postoperative EF reduction and left ventricular intemal dimension at end-diastole,left ventricular internal dimension at end-systole,end-diastohc volume,left ventricular mass index,regurgitant volume,and GLS (P ＜ 0.05).GLS showed a diagnostic value in predicting EF reductions of ＞ 10％.Conclusion STI is useful for evaluating the postoperative reduction of left ventricular function in primary MR patients and thus is helpful for optimizing surgical timing.

Objective To explore the value of free anterolateral thigh flaps in the reconstruction of maxillofacial defects after resection.Methods Patients were recruited from January,2008 to March,2016 in the Department of Oral and Maxillofacial Surgery of Nanjing University.All patients sunder when reconstructive surgery employing anterolateral thigh myocutaneous flaps follow-up of 3 months to 84 months after operation.Results Among 422 cases,survived completely with satisfied configuration,the survival rate was 98.6％.Postoerative vessel thrombosis occurred in flaps,21 patients required operative exploration in the perioperative period including 10 flaps with thrombotic events and 11 flaps with venous thrombosis were complete survival after the salvages,and 6 flaps were failure.The mean follow-up was 36.5 months (range:3 to 84 months).Conclusion The free anterolateral thigh flap is an ideal choice for reconstruction of maxillofacial defects,as it has many advantages such as abundance volume,easily molding and adjusting the thickness,possessing,long vascular pedicle,composition need to be adjusted according to defects,easily concealed donor site,and little donor site complications and malformation.

Bile Duct Neoplasms ; diagnosis ; surgery ; Bile Ducts, Intrahepatic ; Cholangiocarcinoma ; diagnosis ; surgery ; Hepatectomy ; Humans ; Liver Transplantation ; Prognosis

Objective To investigate the distribution pattern of the ADAS-Cog scores among the elderly in Beijing and to evaluate the application of ADAS-Cog in distinguishing patients with mild Alzheimer's disease (AD) and healthy elderly. Methods In total, 1616 healthy elderly (NC), 125 elderly patients with non-AD disorders (ND), and 310 patients with probable AD including 201 patients with mild AD and 109 patients with moderate AD (by NINCDS-ADRDA criteria) were recruited in the study and their cognitive performance was measured by the ADAS-Cog.Results In NC group, those older than 80 years and those with less than 5 years schooling scored highest. There was statistically significant correlation between the total scores of the ADAS-Cog and age and duration of schooling in NC group (F=14.34, 113.27,both P<0.01). No correlation was suggested in the mild AD group. The total score of ADAS-Cog was significantly associated with duration of schooling in both moderate AD and ND groups (F=4.18, 8.72, both P<0.05). The total score of ADAS-Cog differentiated the patients with mild AD from NC healthy elderly with AUC ranging from 0.69 to 0.82 in each subgroup by age, and from 0.75 to 0.88 in subgroups by durations of schooling with the highest AUC of 0.88 in the subgroup having more than 15 years of schooling education. Conclusions The ADAS-Cog score in the healthy elderly is significantly associated with age and duration of schooling education. The ADAS-Cog can be applied in the cognitive assessment of Chinese AD patients. The total score of ADAS-Cog could efficiently differentiate patients with mild AD from healthy elderly, especially in subjects with higher education level.