Objective To evaluate the safety and efficacy of the valve sparing aortic reimplantation in selected patients with acute type A aortic dissection(AAAD).Methods From October 2012 to March 2014, 65 AAAD patients with entry tear located in the sinus of Valsalva and/or genetic: syndrome underwent emergent operation.Of them, 34 patients had valve sparing aortic reimplantation(David Ⅰ group) , and 31 patients underwent aortic composite replacement(Bentall group).Results No operative mortality was observed in this study.In-hospital mortality(8.8％ vs.9.7％ , P ＞ 0.05) and morbidity (25.4％ vs.27.9％, P ＞0.05) were comparable between two groups.All the patients underwent arch replacement and stented elephant trunk implantation concomitantly.Mean cross-clamp time [(149 ± 23) min v s.(124 ± 21) min, P ＜ 0.05] was longer for David Ⅰ group, while mean cardiopulmonary bypass time[(186 ± 77) min vs.(193 ± 89) min, P ＞0.05] and mean operation time [(341 ± 137) min vs.(378 ± 174) min, P ＞ 0.05] had no significant difference between two groups.The blood transfusion was significantly reduced in David Ⅰ group than that in Bentall group[(1 180 ±490) ml vs.(1 790 ±560) ml, P ＜0.05].The mean follow-up was(17.6 ± 5.4) months(range, 8-26 months).In David Ⅰ group, one patient with genetic syndrome died of ruptured abdominal aortic aneurysm 18 months postoperatively.Two late deaths occurred in Bentall group due to intracranial hemorrhage after 9 months and ruptured infective pseudoaneurysm after 13 months respectively.In David Ⅰ group, average grade of aortic regurgitation 6 months postoperatively was 0.6 ± 0.4.At the latest visit, no pseudoaneurysm on anastomosis was observed.Besides two patients from Bentall group were in NYHA class Ⅱ , all the other patients presented in NYHA class Ⅰ.Conclusion David Ⅰ aortic root reimplantation can be performed safely and obtain excellent short-term results in selected patients with AAAD.Long-term results need continuing follow-up.

Multi-stage membranes processes, including ultrafiltration and nanofiltration are used in concentration of Biyankang extracts at room temperature, and the concentrations of main active ingredient in retentions after membrane processes were determined by HPLC. The results showed that the removal rate of water is about 45%, and the cost is only one fourth of the vacuum heating method. The retention rates of buddleoside and ephedrine hydrochloride are above 80% and 90% respectively, which meet the efficient concentration and energy-saving needs. The concentration method of Biyankang with multi-stage membranes processes provides some instructive theories and experimental foundations.
Drugs, Chinese Herbal ; chemistry ; economics ; isolation & purification ; Filtration ; economics ; methods ; Membranes, Artificial ; Ultrafiltration ; methods

OBJECTIVETo identify the genetic defects in patients with congenital atrial septal defects (ASD).

METHODSThe clinical data and blood samples from 180 unrelated subjects with congenital ASD were collected and evaluated. Two hundred healthy individuals served as controls. The coding exons and the flanking introns of GATA4 gene were amplified by polymerase chain reaction and sequenced using the di-deoxynucleotide chain termination approach. The acquired sequences were aligned with the sequences publicized in GenBank by the aid of programme BLAST to identify the sequence variations. Clustal W software was applied for analysis of the conservation of altered amino acids.

RESULTSTwo novel heterozygous missense GATA4 mutations were identified in 2 out of 180 ASD patients. Namely, the triplet substitutions of GTC for GGC at codon 21 and TCG for CCG at codon 87 were detected, predicting the conversions of glycine into valine at amino acid residue 21 (G21V) and proline into serine at amino acid residue 87 (P87S). None of the two mutations were detected in 200 healthy controls. Across-species alignment of GATA4 encoded protein sequences displayed that the mutated amino acids were highly conserved evolutionarily. Additionally, a single nucleotide polymorphism c.99G>T was observed. However, the polymorphic frequency distribution in ASD cases was similar with that in healthy controls (for genotype GT, χ(2) = 0.7556, P = 0.3847; for allele T, χ(2) = 0.7235, P = 0.3950).

CONCLUSIONSTwo novel mutations of GATA4 gene are identified in two unrelated ASD patients. This finding provides new insight into the molecular etiology responsible for ASD.

Case-Control Studies ; Child, Preschool ; DNA Mutational Analysis ; GATA4 Transcription Factor ; genetics ; Genome ; Heart Septal Defects, Atrial ; genetics ; Humans ; Mutation

OBJECTIVETo study the anatomy of angular nerve (AN), so as to provide safe approach for the denervation surgery of corrugator supercilii, depressor supercilii and procerus.

METHODS10 fresh cadaver (20 sides)were perfused and fixed with formalin. Dissection was performed in the 10 x operating microscope. The plexus of the zygomatic branch and the buccal branch were detected to confirm the AN. The relationship of AN with the surrounding blood vessels was observed. We tracked AN until it entered corrugator supercilii, depressor supercilii and procerus.

RESULTS(1) AN was classified into I, II, III type according to its formation pattern. Type I (20%, 4/20 sides) AN is single, which is mainly from the plexus of buccal branch plus the zygomatic branch from the orbicularis oculi muscle. In type II (20%, 4/20 sides), the single AN was formed by buccal branch plexus and zygomatic branch plexus in the "Four Muscle Gap". In type III (60%, 12/20 sides), the AN had two branches in the "Four Muscle Gap". (2) The three types AN passed inferior to the support ligament at the suborbital part, and then transversed medial to the support ligament at the medial canthus, along the vessels of medial canthus. (3) The branch of AN enters the depressor supercilii or procerus 2.19 to 4.28 mm above the medial canthus ligament. The backward branch enters the levator labii superioris alaeque nasi 6.89 to 9.38 mm below the medial canthus ligament.

CONCLUSIONSThe approach of denervation surgery for AN should be performed medial to the support ligation, between 2.19 mm above the medial canthus and 6.89 mm below the medial canthus.

Adult ; Cadaver ; Denervation ; Facial Muscles ; innervation ; Facial Nerve ; anatomy & histology ; surgery ; Female ; Humans ; Male

OBJECTIVETo explore the features of proton magnetic resonance spectroscopy (1H-MRS) of the hippocampus in schizophrenia patients before and after stereotactic neurosurgery.

METHODS1H-MRS was performed to determine NAA/Cr and CHO/Cr ratios on the bilateral hippocampal regions before and after stereotactic neurosurgery in 20 schizophrenia patients, with 20 healthy individuals as the controls.

RESULTSThe NAA/Cr ratio in the hippocampal regions was significantly lower and the CHO/Cr ratio significantly higher in schizophrenia patients before the surgery than in the healthy controls (P<0.01). The NAA/Cr and CHO/Cr ratios in the hippocampal regions underwent no significant changes in the patients after the surgeries (P>0.05).

CONCLUSIONNeuronal and cell membrane metabolism impairment is present in the hippocampus of schizophrenia patients, and stereotactic neurosurgery does not produce obvious adverse effects on the cell membrane metabolism in the hippocampus of the patients.

Adolescent ; Adult ; Aspartic Acid ; analogs & derivatives ; metabolism ; Case-Control Studies ; Choline ; metabolism ; Creatine ; metabolism ; Female ; Hippocampus ; metabolism ; pathology ; Humans ; Magnetic Resonance Spectroscopy ; methods ; Male ; Protons ; Schizophrenia ; metabolism ; pathology ; surgery ; Stereotaxic Techniques ; Young Adult

OBJECTIVETo investigate the effect of plant growth regulators on the growth and quality of Angelica dahurica var. formosana.

METHODFive plant growth regulators: chlormequat chloride (CCC), Mepiquat chloride (PIX), Gibberellic acid (GA3), Paclobutrazol (PP333) and Maleic Hydrazide (MH) were sprayed in rosette stage, the effects of these plant growth regulators (PGRs) on the growth, yield and quality of A. dahurica var. formosanaw were observed. The biological traits were first measured and then imperatorin and isoimperatorin contents in roots were determined by HPLC.

RESULTLow concentration GA3 increased the yield while not influenced the premature bolting rate and the coumarin content.

CONCLUSIONSpraying of GA3 (30 mg x L(-1)) could guarantee the growth and development of A. dahurica var. formosana to have a higher yield and maintain the active ingredients content in the root as well.

Angelica ; drug effects ; growth & development ; Chlormequat ; pharmacology ; Gibberellins ; pharmacology ; Maleic Hydrazide ; pharmacology ; Piperidines ; pharmacology ; Plant Growth Regulators ; pharmacology ; Triazoles ; pharmacology

Objective:This study aimed to investigate the effect of differentiation osteogenic bone marrow mesenchymal stem cells (De-BMSCs) transplantation on the promotion of bone formation at the tendon-bone interface after anterior cruciate ligament reconstruction (ACLR), and further explored the molecular mechanism of the enhanced osteogenic effect of De-BMSCs.Methods:BMSCs from femur and tibia of New Zealand White rabbit were subjected to osteogenic induction and then cultured in no osteogenic factor medium; the obtained cell population was termed De-BMSCs. De-BMSCs were induced into osteo-, chondro-and adipo-differentiation in vitro to examine the characteristics of primitive stem cells. ACLR model with a semitendinosus tendon were performed in 48 adult rabbits, three groups were established: control group with alginate gel injectionat the tendon-bone interface, BMSCs group with the injection of alginate gel containing BMSCs, De-BMSCs group with the injection of alginate gel containing De-BMSCs. At 4 and 12 weeks after surgery, rabbits in each group were sacrificed to evaluate tendon-bone healing by histologic staining, micro-CT examination, and biomechanical test. During osteogenic differentiation of De-BMSCs, si-RNA of nuclear factor of activated T cells 2 (NFATc2) si-RNA of nuclear factor of activated T cells 1 (NFATc1) were used to verify the molecular mechanism of enhanced osteogenic effect of De-BMSCs.Results:De-BMSCs exhibited some properties similar to BMSCs including multiple differentiation potential and cell surface marker. At 4 weeks after surgery, the BV/TV value of the De-BMSCs group 0.36±0.01 was significantly higher than that of the control group 0.24±0.03 and BMSCs group 0.30±0.02 (all P<0.05), and the maximum load 40.34±1.19 N and stiffness 20.67±2.14 N/mm were significantly higher than those in the control group 14.88±2.74N, 8.67±2.19 N/mm and the BMSCs group 26.31±1.76 N, 13.81±2.14 N/mm (all P<0.05). At 12 weeks after surgery, the BV/TV value of the De-BMSCs transplantation group 0.47±0.02 was significantly higher than that of the control group 0.30±0.02 and the BMSCs group 0.35±0.03 (all P<0.05), and the maximum load 64.46±6.69 N and stiffness 25.18±3.11 N/mm were significantly higher than those in the control group 41.01±6.12 N, 11.59±2.54 N/mm and the BMSCs group 48.21±4.12 N, 15.89±2.94 N/mm (all P<0.05). During the osteogenic differentiation of De-BMSCs, the expressions of Nanog and NFATc1 were synergistically increased which promoted interaction of NFATc1 and Osterix ( P< 0.05), resulting in the increased expression of osteoblast marker genessuch as COL1A, OCN, OPN (all P< 0.05). Conclusion:De-BMSCs transplantation could promote bone formation at the tendon-bone interface after ACLR,Nanog/NFATc1/Osterix signaling pathway mediated the enhancement of the osteogenic differentiation effect of De-BMSCs.

BACKGROUNDEchinococcosis is still endemic in many countries, including China, where it is especially prevalent in the northwest. The aim of this study was to enrich the international literature about the treatment of intracranial hydatid cysts.

METHODSWe retrospectively reviewed the clinical features, radiological manifestations, and surgical outcome of 97 patients with intracranial hydatid cysts, who received surgical treatment at the Neurosurgical Department of First Affiliated Hospital of Xinjiang Medical University from 1985 to 2010 and followed up the patient via sending a questionnaire or telephone contact. Clinical outcome was evaluated using the Karnofsky Performance Scale Index.

RESULTSHeadache and vomiting were the most common initial symptoms in our patients. Neurological deficits caused by the mass effect of the cysts were seen in 82 cases. On the X-ray, significant bone erosion was seen in only two cases with epidural hydatid cysts. Round-shaped and thin-walled homogeneous low-density cystic lesions without surrounding edema and enhancement were the main findings on computerized tomography (CT) in 95 patients with intraparenchymal hydatid cysts, while two cases with epidural hydatid cysts presented as a heterodensity lesions. On magnetic resonance imaging (MRI), hydatid cyst presented as a round-shaped low signal lesion in T1-weighted images and high signal lesion in T2-weighted images, without enhancement after contrast media injection, while the two cases with epidural cysts presented as mixed signal masses. Surgical removal of cyst was performed in all cases. Total removal was achieved in 93 cases without rupturing the cyst wall. Only two cysts ruptured during the dissection, resulting in two surgery-related mortalities. There was no other additional neurological deficit caused directly by surgery. In 97.2% of the patients, the Karnofsky Performance Scale score was 80 to 90 at the last follow-up.

CONCLUSIONSIntracranial hydatid cyst is still a main cause of increased intracranial pressure among the patients in endemic areas for echinococcosis. CT and MRI are the best diagnostic methods and surgery is the treatment of choice for intracranial hydatid cysts.

Adult ; Brain Diseases ; diagnostic imaging ; pathology ; surgery ; Child ; Echinococcosis ; diagnostic imaging ; pathology ; surgery ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Retrospective Studies ; Tomography, X-Ray Computed

Objective To analyze the clinical and imaging features of a family(3 patients)with familial hemangioblastoma,and their diagnosis and prognosis.Methods The detailed data about clinical and imaging features of all patients diagnosed as familial hemangioblastoma,admitted to our hospital from October 2004 to May 2010,were analyzed,and the lesions of other regions,besides the tumor lesion,were observed.Results No lesions of other regions were noted in these 3 patients.Cranial MRI showed that 2 had cystic and solid tumor and 1 had solid tumor;,total removal was performed on these patients under microscope; regular follow-up was given and no recurrence was noted.Conclusion Familiar hemangioblastoma is serious hereditary disease; and MRI is the most important detective method; microsurgical operation is the most important therapy.Early diagnosis and treatment should be given to the patients with familiar hemangioblastoma due to its high recunence rate,having difficulty in operation and its trend to combining with other lesions of the other parts.

OBJECTIVETo report an X-linked dominant Charcot-Marie-Tooth disease (CMTX) Chinese family with vocal cord paresis and to identify the mutation of gap junction protein beta 1 gene (GJB1).

METHODSPart of the family members with dysphagia, dysphonia and lethal respiratory failure were studied through flexible laryngoscope, clinical, brain MRI and electrophysiological examinations. After excluding large fragment tandem duplication containing peripheral myelin protein 22 gene (PMP22), direct sequencing was performed to analyze the mutation of the GJB1 gene in 5 patients including the proband, 5 unaffected family members and 50 unrelated healthy individuals.

RESULTSEight members spanning 3 generations in this family were affected with CMTX characterized by progressive atrophy and weakness of the anterior tibial and peroneal muscles, especially in the proband. Vocal cord paresis was observed through flexible laryngoscope in total of 4 affected members with dysarthria and dysphagia, 2 of them died of severe respiratory failure due to complete bilateral vocal cord involvement. Normal brain MRI was observed in the proband. The electrophysiological data showed predominant demyelization involving the motor and sensory nerves in the proband. DNA sequencing revealed a de novo c.186 C>G missense mutation in exon 2 of the GJB1 gene, the mutation cosegregated with phenotype.

CONCLUSIONRespiratory failure associated with vocal cord involvement may be a rare and severe symptom in CMTX. The present report provides further evidence for clinical and genetic heterogeneity in the X-linked Charcot-Marie-Tooth disease.

Adolescent ; Adult ; Asian Continental Ancestry Group ; genetics ; Base Sequence ; Case-Control Studies ; Charcot-Marie-Tooth Disease ; genetics ; Connexins ; genetics ; Female ; Humans ; Male ; Molecular Sequence Data ; Mutation, Missense ; Myelin Proteins ; genetics ; Pedigree ; Vocal Cord Paralysis ; genetics ; Young Adult