Epidemiological studies have shown that the incidence of patent foramen ovale (PFO) in patients with cryptogenic stroke is significantly higher than general population.The close association between cryptogenic stroke and PFO supports the hypothesis that paradoxical embolism is a cause of stroke.However,the detection of PFO alone does not establish the diagnosis of paradoxical embolism in patients with cryptogenic stroke. The risk of ischemic stroke will increase significantly when PFO and other factors coexist.Some studies tave shown that there is significant difference between the MRI lesion patterns in patients with cryptogenic stroke and PFO in those without cryptogenic stroke,particularly in multiple ischemic lesions.Therefore,it does not support the theory of paradoxical embolism as a cause of stroke in patients with PFO.The PFO detection methods include transthoracic echocardiography,transesophageal echocardiography (TEE) and transcranial Doppler (TCD).TCD and TEE have a good consistency.Accordingly,TCD should be recommended as a simple,noninvasive,and reliable technique,while TEE should be only restricted to the selected patients.The treatment options of PFO include antiplatelet drugs,anticoagulant drugs,percutaneous vascular closure,and thoracotomy.Percutaneous vascular closure should only be considered the recurrent events during the medical treatment,the contraindications of medical treatment,and PFO with some anatomical high risks for patients with cryptogenic stroke with PFO before the completion of several large randomized controlled trials.

ObjectiveTo systemically review the effects of timing of initiation of renal replacement therapy (RRT) on prognosis in septic patients with acute kidney injury (AKI).Methods A systematic search for randomized controlled trials (RCTs) and other clinical studies focused on comparing varied timing of initiation of RRT in septic AKI patients was performed in English or Chinese from PubMed, Web of Science, EMBASE, CNKI, Wanfang data, VIP from January 2000 to July 2014. Data screened were extracted with Cochrane systemically review method, and enrolled literature was collected for Meta analysis with RevMan 5.2 software. Total mortality, 28-day mortality, the total length of hospital stay and intensive care unit (ICU) stay in septic AKI patients with early or late initiation of RRT was analyzed. Funnel plots were drawn to detect publication bias.Results Five retrospective comparative studies with a total of 885 patients were enrolled. Random effect model in Meta analysis showed that there was no significant difference in total mortality between early RRT group and late RRT group [65.7% (226/344) vs. 68.7% (239/348), odds ratio (OR) = 0.71, 95% confidence interval (95%CI) = 0.38-1.31,P = 0.27]. The funnel plot demonstrated publication bias. Fixed effect model showed that there was significant difference in 28-day mortality between early RRT group and late RRT group [43.4% (66/152) vs. 55.3% (94/170),OR = 0.59, 95%CI = 0.36-0.94,P= 0.03]. The funnel plot demonstrated publication bias too. The data of total length of hospital stay and ICU stay could not be Meta-analyzed because of different data distribution, but no differences in total length of hospital stay and ICU stay between early and late RRT groups for septic AKI patients were found.ConclusionEarly RRT could reduce the 28-day mortality in patients with septic AKI compared with late RRT, but it did not lower the total mortality.

Objective:To improve the method for isolating platelet-rich plasma (PRP). Methods:Whole blood was collected from 8 healthy donors and then PRP was separated by both the tube method and the syringe method respectively. Samples were activated to get serum rich-in growth factors (SRGF).Platelets in the SRGF were counted and the level of TGF-?1 was assayed by enzyme-linked immunosorbent assay (ELISA).Results:The end product of syringe method has both a higher platelet count in PRP (P=0.003) and a higher level of TGF-?1 in SRGF(P=0.041) than that of tube method.Conclusion:The syringe method is an effective method in preparation of PRP.

The present study shows that mushroom juice exhibits a significanteffect on growth of L. acidophilus in reconstituted skim milk. When 5% - 10% mushroom juice was added in skim milk, they shorten generation time and the rate of lactic acid production was accelerated. After 10h incubation at 37℃ cell counts of L. acidophilus in test groups were much more than in control group, were up to 108/mL.

Objective To explore the diagnosis and treatment of the congenital membrane atresia of duodenum(CMAD). Methods The clinical data of 32 cases of CMAD admitted from 1980 to 1996 were analysed retrospectively.Results Of the 32 cases,28 cases had single membrane in the duodenum,4 two membranes;and 6 accompanied with intestinal malrotation, 2 circular pancrease and 1 anal atresia. 24 patients were treated with membrane resection only,2 underwent membrane resection and gastrojejunostomy,6 underwent membrane resection plus Ladd's operation.28 cases were cured,4 cases died.Among the 28 cases discharged,20 cases were followed-up for the period from five months to three years,their sympotoms disappeared, nutrition and development were good.Conclusions Patients with CMAD have vomit, and containing bile in most cases;abdominal erect plain film shows "double bubble sign",and gastrointestinal series can help make the diagnosis.Membrane resection is the best way of therapy,but we should pay attention to correct the double membranes and other deformity,and should strengthen perioperative period management.

Objective:To explore the effect of siRNA targeting myeloid cell leukemia-1(Mcl-1)on the biological behavior of salivary adenoid cystic carcinoma cells.Methods:The chemically synthesized Mcl-1-siRNA was transfected into salivary adenoid cystic carci-noma SACC-2 cells.The expression levels of Mcl-1-mRNA and Mcl-1protein were examined by Real-time PCR and western blotting respectively.MTT assay,transwell chamber and flow cytometry were used to determine the effect of Mcl-1-siRNA on SACC-2 cell pro-liferation,migration and apoptosis.Results:Compared with the control group,liposome group and NC-siRNA group,SACC-2 cell proliferation rate of Mcl-1-siRNA group was obviously slowed down.48 h after transfection,the migration of SACC-2 cells in Mcl-1-siRNA group(39 ±9.0)were lower than that in control group(69 ±6.0).The apoptosis rate of Mcl-1-siRNA group(8.6%)was sig-nificantly higher than that in control group(1.9%).Conclusion:Silence Mcl-1 can inhibit cell proliferation and migration and pro-mote apoptosis of salivary adenoid cystic carcinoma cells.

BACKGROUND:To ensure the catheter position is very important for interventional catheters. In emergency, rapid and accurate catheter insertion is required. Ultrasound can real-time track the movement of catheters in vivo. It is safe to patient, which has exhibited a bright future in catheter placement. OBJECTIVE: To compare the current methods for improving ultrasonic localization methods and to prospect the future development and improvement of real-time ultrasonic localization of catheters in vivo. METHODS: Literature search was carried out based on PubMed (1990-01/2015-04) and Espacenet with the key words of catheter, ultrasonic guidance, ultrasound localization, enhanced localization for the initial retrieval of relevant articles. RESULTS AND CONCLUSION:To improve the image quality and increase the accuracy of catheter placement by ultrasound, recent efforts have been focused on two paths. One is to improve the resolution of ultrasonic images by enhancing ultrasound equipment or ultrasonic guidance system. The other is to modify catheter itself to obtain high acoustic impedance differential and improve its echogenicity. The latter approach can be potentialy applied in al kinds of catheters and is more economical and practical. Therefore, in future researches, innovation and design of catheter materials for catheter fabricating wil play an important role in promoting the real-time ultrasonic localization of catheters.

Objective:To explore the effects of cysteine-rich 6 1 (Cyr6 1 )on biological behavior of human adenoid cystic carcinoma ACC-LM and ACC2 cells.Methods:The chemically synthesized Cyr6 1-siRNA was transfected into ACC-LM and ACC2 cells.Cell proliferation was measured by the MTT method,the invasive ability was evaluated by Transwell chamber assay,and cell apoptosis was analyzed using flow cytometry by double staining with Annexin V and propidium iodide.Results:Cyr61-siRNA significantly down-regu-lated Cyr61 protein expression in ACC-LMand ACC2 cells.Cyr61-siRNA markedly inhibited the proliferation and invasion of the cells, however,there was no significant difference in cell apoptosis between Cyr6 1-siRNA and control groups.Conclusion:Cyr6 1 promote the proliferation and invasion of adenoid cystic cancer cells.

Objective To discuss the predictable factors for the occurrence of intraoperative aneurysm rupture(IAR) of anterior circulation aneurysm treated by clipping.Methods The clinical data of 96 patients with 115 aneurysms treated by clipping were retrospectively analyzed.The univariate analysis and Logistic regression analysis was performed for the risk factors of IAR such as history of hypertension,pre-operative Hunt-Hess scale,aneurysm location,aneurysm sac,aneurysm dome/neck ratio,aneurysm direction,and operation time.Results Twenty-one patients occurred IAR [18.3 ％ (21/115) of aneurysms,21.9％ (21/96) of patients] during the operation,2 patients died and 94 patients were estimated by Rank scale:0 score was for 66 patients,2 scores was for 10 patients,3 scores was for 6 patients,4 scores was for 4 patients,5 scores was for 6 patients and 6 scores was for 2 patients at 6 months after surgery.Statistic analysis revealed that history of hypertension (P =0.037),pre-operative Hunt-Hess scale (P =0.040),aneurysm direction (P =0.009),aneurysm sac (P =0.010),operation time (P =0.001) and aneurysm dome/neck ratio (P =0.029) were the predictable factors for the occurrence of IAR,while aneurysm location was not included (P =0.198).Conclusion The history of hypertension,pre-operative Hunt-Hess scale,aneurysm direction,aneurysm sac,operation time and aneurysm dome/neck ratio 1.78-2.89 are the predictable factors for the occurrence of IAR and the combination of various factors lead to the occurrence of IAR.

Objective To study the risk factors of prolonged postoperative recovery after the total cavopulmonary connection(TCPC) in the current era.Methods Data on all patients admitted to the cardiac intensive care unit (CICU) after a TCPC between January 2013 and March 2014 were retrospectively analyzed.We excluded all patients who died and required TCPC takedown.The study cohort was further divided into a prolonged recovery group that included patients with 75％ ile for duration of mechanical ventilation or pleural drainage,and a standard recovery group which included all other patients.A multivariable logistic regression model was used to compare demographic,anatomic,and physiological variables between the prolonged and standard recovery groups.Then,the cohort was separated into a high volume resuscitation group and a low volume resuscitation based on the 75％ ile for volume resuscitation(ml/kg) administered on the first three days after the TCPC.Results Totally 118 TCPC operations were performed.Of the study population (n =118),the median age was 3.8 years (3.1 to 4.8 years) and median weight was 14.8 kg(13.3 to 17.1 kg).The most common diagnosis was double outlet of right ventricle (n =47,39.8％).The extracardiac conduit fenestrated TCPC was the most common surgery(n =79,66.9％).Within the study population,43 (39.8％) patients met criteria for prolonged recovery.Univariate risk factors for prolonged recovery included higher preoperative mPAP(P =0.022),atrioventricular valve regurgitation (P =0.000),longer total bypass time (P =0.044),higher postoperative central venous pressure (P =0.000),AST (P =0.001),ALT (P =0.010),NT-proBNP (P =0.000),SaO2 (P =0.012),I n-otropic score (P =0.001),higher incidence of arrhythmia (P =0.000),low cardiac output syndrome (P =0.000),need for peritoneal dialysis (P =0.000),and requirement for greater volume resuscitation during the 72 postoperative hours(75％ for the entire group,P =0.000).In a multivariable Logistic model,need for greater volume resuscitation (OR 10.860,95 ％ CI 2.681,43.987) and the higher postoperative central venous pressure (OR 1.446,95 ％ C I 1.113,1.879) were the only two independent risk factors for prolonged outcome after the TCPC.Conclusion The need for high volume expansion and higher central venous pressure were the risk factors of mediate prolonged recovery.