PurposeTo investigate clinical significance of echocardiography combined with Flash CT in diagnosis of partial anomalous pulmonary venous connection (PAPVC). Materials and Methods Twenty-eight cases of PAPVC were recruited in the study. All the subjects underwent both preoperative echocardiography and coarse pitch Flash CT scanning. Imaging findings were compared with the results of surgery, including the type of PAPVC, size of atrial septal defect (ASD), and other combined malformations. Results Among 28 patients, 16 cases and 5 suspicious cases (4 cases of PAPVC and 1 case of pulmonary vein embolism) were diagnosed by echocardiography. Six cases were missed, and 1 case was misdiagnosed. CT misdiagnosed 1 case. The accurate diagnosis rate of echocardiography (71.4%, 20/28) was lower than that of Flash CT (96.4%, 27/28) (P<0.05). There were 44 combined malformations in 28 cases, 43 lesions were diagnosed by echocardiography, and 34 lesions were diagnosed by Flash CT. The accurate diagnosis rate of echocardiography (97.7%, 43/44) was higher than that of Flash CT (77.3%, 34/44) (P<0.05). The average DLP was (15.5±3.2) mGy·cm and average effective dose (ED) was (0.354±0.058) mSv.Conclusion Flash CT has a higher diagnosis accuracy of PAPVC but a lower diagnostic accuracy of combined malformations when compared with echocardiography. Moreover, echocardiography can make comprehensive evaluation in valve disease, pulmonary artery pressure and cardiac function. Flash CT combined with echocardiography may improve preoperative diagnosis.

Objective To explore clinical value of optimizing the contrast medium injection protocol for dual-source CT high-pitch spiral acquisition in children with complex congenital heart disease.Methods Sixty patients with complex congenital heart disease were prospectively recruited and randomly divided into group A and group B by the random number table method.Patients in group A received a conventional contrast medium injection protocol,i.e.a diluted contrast material with fast and slow rate respectively,and then a flush with normal saline.The volume of contrast medium was 2.0 ml/kg.Patients in group B received an optimized injection protocol,i.e.a four-phase diluted contrast material with contrast/ saline ratio of 8:2,6:4,4:6,2:8 respectively.The volume of contrast medium was 1.0-1.5 ml/kg.Attenuation and noise were measured in superior vena cava,right atrium,right ventricle,the main pulmonary artery,left atrium,left ventricle,ascending and the descending aorta in the two groups and compared by t test.The image uniformity was assessed by t test.Subjective image quality and artifacts of superior vena cava were analyzed by the Mann-Whitney U test.Diagnostic accuracy was evaluated by x2 test.All the patients undergone the surgical treatment and demonstrated 121 abnormalities (22 species) of internal and external heart structure,i.e.56 in group A and 65 in group B.Results There was no significant difference in diagnostic accuracy between group A and group B (A:96.9％,52/56,vs.B:96.4％,62/65;x2=0.28,P=0.59).While,significant difference was found in the amount of consumed iodine between the two groups [A:(15.7±6.5) ml vs.B:(10.4±2.4) ml;t=4.14,P＜0.01].Furthermore,the image uniformity in group B was statistically higher than that in group A[A:(36.5± 18.0)HU vs.B:(272.0± 124.5)HU;t=10.30,P＜0.01].As for subjective image quality,no significant difference were observed (A:3.3±0.5 vs.B:3.5±0.5;Z=396.00,P=0.39);while significant difference was found in artifacts of superior vena cava (A:3.2±0.9 vs.B:3.7 ± 0.7;Z=300.50,P=0.02).Conclusion The optimized contrast medium injection protocol for children with complex congenital heart disease could eliminate the image artifacts of superior vena cava and improve the image quality.

AIM:To identify and quantify the expression of IL-1βand IL-17 in mast cells ( MCs) in different types of human pericapical diseases using double immunofluorescence staining .METHODS: The specimens ( n=102 ) , including healthy control ( n=35 ) , periapical cyst ( n=35 ) and periapical granuloma ( n=32 ) , were involved in the present study .The tissue samples were fixed in 10% buffered formalin for at least 48 h and then embedded in paraffin . Serial 5-μm-thick sections were deposited onto SuperFrost/Plus microscope glasses .Routine staining of the sections using hematoxylin&eosin ( HE) was performed for morphological evaluation .The number of IL-1βand IL-17 positive MCs was identified by double immunofluorescence staining .RESULTS:Compared with the healthy controls , the inflammation score of periapical lesions was significantly increased in the periapical patients (P<0.01).The density of IL-1βand IL-17 posi-tive MCs in the periapical lesions were obviously higher than that in the healthy controls (P<0.01).However, no signifi-cant difference between periapical cyst and periapical granuloma was observed .The Pearson correlation analysis showed that there was a positive correlation between the density of IL-1βand IL-17 double positive MCs and inflammation score in dif-ferent groups of specimens (P<0.01).CONCLUSION:There is significantly increased number of MCs , along with in-creased density of IL-1βand IL-17 positive MCs in human periapical lesions .The increased density of IL-1βand IL-17 positive MCs has the similar tendency as the severity of tissue inflammation in human periapical lesions , suggesting that IL-1βand IL-17 positive MCs may play an important role in the pathogenesis of human periapical diseases .

Objective To explore the effect of silver needle thermo-conduction on cervical spondylosis of vertebral artery type (CSA). Methods 82 patients with CSA were randomly divided into control group (n=41) and treatment group (n=41). The control group was treated with cervical traction combined with microwave diathermy, and the treatment group was treated with silver needle thermo-conduction combined with cervical traction. Both groups were evaluated with Evaluation Scale for Cervical Vertigo (ESCV) and transcranial Doppler before and 1 course after treatment. Results The ESCV score, the peak blood flow velocity of period of contraction of left vertebral artery, right vertebral artery and basilar artery in both groups were significantly higher after treatment than before (P<0.01), the treatment group was better than the control group after treatment (P<0.01). Conclusion Silver needle thermo-conduction combined with cervical traction therapy can accelerate the blood flow of patients with CSA and improve their clinical symptoms

Objective To evaluate the relationship between the change of the aortomitral angle (AMA) with left ventricular systolic function in patients with ischemic cardiomyopathy (ICM) by echocardiography.Methods Thirty-one patients were enrolled in the ICM group,and 59 healthy subjects were selected as the control group.On the parasternal left ventricular long axis plane,AMA were measured at the R wave apex (R-AMA),J-point(J-AMA),ST-segment midpoint(ST-AMA),T-final wave (T-AMA)and P-final wave (P-AMA).The angle difference(⊿ θ) =AMAmax-AMAmin,the angle changing rate =⊿ θ/AMAmax.The global left ventricular longitudinal strain (GLS) and global circumferential strain (GCS) were obtained by 2D-speckle tracking echocardiography.Left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV) and left ventricular end-systolic volume(LVESV) were measured using Simpson biplane method.Results The J-AMA was the largest in the control group,while the ST-AMA was the largest in the ICM group.The levels of LVEDV,LVESV and AMA in ICM group were significantly higher than those in control group,while LVEF,GLS,GCS,⊿ θ/AMAmax and ⊿ θ were decreased (P ＜0.05).In the control group,there was a correlation between T-AMA and LVEF (r =-0.349,P =0.007),and ⊿ θ was negatively correlated with GLS (r =-0.372,P =0.004).In the ICM group,⊿1 θ/AMAmax and ⊿ θ were correlated with LVEF (r =0.424,P =0.018;r =0.490,P =0.005).Conclusions AMA in ICM patients is significantly increased.The angle difference and the rate of its change are closely related to the LVEF,which is a manifestation of three-dimensional structure change of the myocardial.

Objective To explore the surgical management in patients with Bismuth Ⅳ hilar cholangiocarcinoma.Methods Retrospective study was used to analyze the clinical data with operative and pathologic diagnosis of Bismuth Ⅳ hilar cholangiocarcinoma in the recent five years.Results Of the 22 patients,there were 13 males and 9 females,with M∶F=1.4∶1.In the group of non-liver transplantation(NLTX),5 cases(31.3%) underwent resection(radical resection in 2 cases;palliative resection in 3 cases),and 11 cases had nonresectional internal or external drainage.In the liver transplantation group(LTX),the resection rate was 100 %(6/6).Five LTX cases survived for 28,19,17,12 and 9 months respectively,and one died from chronic rejection in 11 months after operation.In the NLTX group,the 1-and 2-yr survival rate was 32.1 % and 0% respectively.The 1-and 2-yr survival rate of LTX was 80.0 %(4/5)and 50.0 %(1/2)respectively.There was significant difference between the two groups in average survival rate(P=0.041).Conclusions Aggressive surgical treatment should be adopted for Bismuth Ⅳ hilar cholangiocarcinoma,and radical resection is crucial to enhance survival rate.LTX is a good choice for the patients with unresectable Bismuth Ⅳ hilar cholangiocarcinoma and the prognosis is satisfactory.

OBJECTIVEThis study aimed to induce carcinogenesis of lingual mucosa in C57BL/6 mice by feeding them 4-nitroquinoline 1-oxide (4NQO) solution.

METHODSA total of 85 C57BL/6 mice were randomly divided into distilled water control group (DD group, n=5), 1,2-propylene glycol control group (PG group, n=5), and experimental group (EP group, n= 75). The mice in the experimental group were medially fed in 15 cages. By contrast, the mice in DD, EP, and PG groups were watered with distilled water, 50 mg.L-1 4NQO solution, and 1,2-propylene glycol solution. The mice in EP group were executed every two weeks from week 0, and the mice in the control groups were sacrificed at the 28th week. The mice were weighed. Mucosal lesions were measured by macroscopic observation and histopathologic detection.

RESULTSOne mouse in EP group died of unknown reason. The weight of the mice in EP group presented weight loss compared with the mice in DD and PG groups after the 24th week. Seventy-nine macroscopic lesions were observed in the lingual mucosa, oral floor, and upper palatal and buccal mucosa. A total of 70 macroscopic lesions (88.6%) were located in the lingual mucosa. Mucosal lesions changed from simple hyperplasia to squamous cell carcinomas. Well-differentiated squamous cell carcinomas were observed in all mice of EP group by pathological section at the 28th week. No lesion was found in the mice of DD and PG groups.

CONCLUSIONThe animal model of lingual squamous cell carcinomas was successfully established. The periods from 12th to 16th week and 20th to 28th week were the ideal times for the research on pathogenesis of early and medial-advanced stage during carcinogenesis of squamous cell carcinomas.

Objective To explore the application value of real time three-dimensional echocardiography (RT-3DE) on right ventricular systolic function in patients with moderate and severe pulmonary hypertension (PH).Methods Twenty-five patients with moderate PH (group Ⅱ) and 25 patients with severe PH(group Ⅲ) were selected,30 normal cases were selected to be control group(group Ⅰ).Tricuspid annular systolic peak velocity (S'),right ventricular Tei index(RIMP),tricuspid annular planet systolic excursion(TAPSE) and right ventricular fractional area change(RVFAC) were measured by conventional ultrasound echocardiography.Right ventricular end diastolic volume (RVEDV),right ventricular end systolic volume (RVESV),right ventricular stroke volume (RVSV) and right ventricular ejection fraction (RVEF) were measured by RT-3DE.The correlation between all the parameters and pulmonary artery systolic blood pressure (PASP),and the correlation between RVEF and S',RIMP,TAPSE,RVFAC were analyzed respectively.Results The differences of RVEDV,RVESV,TAPSE,RVFAC in each group were all statistically significant (all P ＜0.01);RIMP,RVEF between group Ⅰ and group Ⅱ,as well as between group Ⅰ and group Ⅲ were statistically significant (all P ＜0.01);S',RVSV only between group Ⅰ and group Ⅲ was statistically significant (P ＜0.01).The correlation coefficients of RVEF and RIMP,S',TAPSE,RVFAC were-0.707,0.402,0.574,0.763,respectively (all P ＜ 0.01).The best parameters associated with RVEF in each group were RVFAC,RIMP,RVFAC,which correlation coefficients were 0.787,-0.679,0.744,respectively (all P ＜0.01).Conclusions RT-3DE is a objective and accurate method to evaluate the right ventricular volume and RVEF in patients with moderate and severe PH,and it can select out the sensitive indicators to evaluate those patients' right ventricular systolic function from conventional echocardiographic parameters,provide important reference value for clinical.

Objective To evaluate the aortomitral angle(AMA)changes in primary hypertension patients with left ventricular normal configuration (LVN) by echocardiography,and explore the correlation with left ventricular systolic function.Methods LVN group included 54 patients,control group included 79 healthy subjects.All subjects were examined by conventional echocardiography,the 2-dimensional gray-scale dynamic images of 5 consecutive cardiac cycles were collected by routine echocardiography;from parasternal left ventricular long axis,the related AMA at the starting isovolumic contraction time (S-IVCT),S-wave peak(SP),starting isovolumic relaxation time(S-IVRT),and starting-end diastole(SD) were measured respectively based on the tissue Doppler imaging,calculating the angle difference(⊿θ) as well as the rate of the angle change.The global systolic longitudinal strain(GLS) and circumferential strain (GCS) of left ventricle were measured by 2-dimensional speckle tracking and quantitative analysis software.Left ventricular ejection fraction (LVEF) was measured by Simpson′s biplane method.Results Compared with control group,the ⊿θ and AMA of each phases in cardiac cycles of LVN group were increased (P<0.05);Compared with control group,the GCS of the left ventricular was increased in LVN group (P<0.05).There was a correlation between AMA of the S-IVCT and that of GLS or GCS,and the LVEF of the left ventricular in the control group (r=-0.18,P=0.04;r=-0.17,P=0.04;r=-0.19,P=0.03).Conclusions AMA angle in patients with LVN is significantly greater than the normal population value,which may be to maintain effective left ventricular systolic function and could be used as an quantitative indicator to assess the left ventricular remodeling in patients with LVN.

OBJECTIVE To explore the expression of long non-coding RNA (LncRNA) HOTAIR, enhancer of Zeste homolog 2 (EZH2) and vascular endothelial growth factor (VEGF) in nasopharyngeal carcinoma (NPC) and their relationship between HOTAIR and prognosis. METHODS We examined the expression of HOTAIR, EZH2 and VEGF in NPC tissues, and analyzed the clinical significance of HOTAIR expression in patients with NPC. RESULTS We found that the expression of HOTAIR, EZH2 and VEGF in the NPC tissues were significantly higher than those in the chronic nasopharyngitis tissues in the gene and protein levels (U=955,P<0.05). The HOTAIR was positively correlated with VEGF (r=0.599,P<0.001), VEGF was positively correlated with EZH2 (r=0.369, P=0.012), and HOTAIR had no significant correlation with EZH2 (r=0.139,P=0.357). Moreover, HOTAIR expression levels increased with clinical stage progression. CONCLUSION The expression of HOTAIR, EZH2 and VEGF were significantly increased in the NPC tissues, and the expression of HOTAIR was related with the TNM stage, the clinical stage and the short term therapeutic effect of the NPC patients, which indicated that the HOTAIR might be used as a biological indicator to determine the prognosis of the NPC.