0.05).Compared with those in Sham group,LVWI,the typeⅠCVF,type Ⅲ CVF andⅠ/Ⅲ ratio in NIZ were increased significantly in MI group.Compared with those in MI group,the LVWI,the type ⅠCVF,type Ⅲ CVF andⅠ/Ⅲ ratio in NIZ were decreased significantly in Sim groups(but higher than those in Sham group).Compared with MI groups,left ventricular function in rats treated with simvastatin was also obviously improved.(2) Contrasted to those in MI group,the expressions of TGF-?1 and Smad3 were down-regulated in simvastatin treatment groups(but higher than those in Sham group).Conclusions Sim can ameliorate ventricular remodeling and ventricular function in rats induced by MI,and the mechanisms can be independent of its lipid-lowering and associated with inhibition of TGF-?1/Smad3 signal transduction.

Objective To investigate the beneficial effects of simvastatin on ventricular remodeling in rats after myocardial infarction and the possible mechanisms involved.Methods The myocardial infarction rat model was reproduced.Twenty-four hours after infarction,the survived rats were randomly divided into myocardial infarction group(MI group,n=9),simvastatin 10mg group [10mg/(kg?d),Sim1 group;n=8],simvastatin 20mg group [20mg/(kg?d),Sim2 group;n=10] and simvastatin 40mg group [40mg/(kg?d),Sim4 group;n=9].A sham-operated group(Sham group;n=10) served as control.Four weeks later,the serum lipid level,hemodynamic indexes and left ventricular weight index(LVWI) were measured.The changes in rats' myocardial tissue were observed with HE staining;the cross-sectional area of myocardial cells was calculated.The expressions of transforming growth factor ?1(TGF-?1) and TGF-?-activated kinase 1(TAK1) in non-infarction area were determined by Western blotting and reverse transcription polymerase chain reaction(RT-PCR).Results The hemodynamic indexes,LVWI,cross-sectional area of myocardial cells and the pathological changes were improved,and mRNA and protein expressions of TGF-?1 and TAK1 were down-regulated significantly in the 3 Sim-treated groups compared with that in MI group.The indices mentioned above were significantly different in Sim2 and Sim4 group compared with Sim4 group(P0.05).Conclusion The inhibitory effect of simvastatin on ventricular remodeling after acute myocardial infarction is independent of its lipid-regulating effect,but possibly attributed to its action in inhibiting the TGF-?1/AK1 signal transduction.Within the concentration of 20mg/(kg?d),the therapeutic efficacy of simvastatin may be more obvious with an increase in its dosage.

Objective To investigate the clinical results of minimally invasive fixation of the sacroiliac triangle for vertically unstable pelvic posterior ring injury. Methods A retrospective study was conducted of 20 patients who had been treated for vertically unstable pelvic posterior ring from January 2014 to August 2016. They were 12 males and 8 females, aged from 20 to 58 years ( average, 35 years ) . According to Tile classification for pelvic fractures, there were 4 cases of type C1. 1, 6 cases of type C1. 2, 7 cases of type C1. 3 and 3 cases of type C2. Their posterior rings were treated by fixation through posterior paraspinal approach with S1-iliac pedicle screws plus percutaneous sacroiliac screws, and their anterior rings by closed reduction and internal fixation with cannulated screws, Infix or plate following open reduction. The incision length, operation time and intraoperative blood loss were recorded. Postoperative reduction quality was assessed by Matta radio-logical criteria and pelvic function by Majeed criteria at the final follow-ups. Results Altogether 20 fixation systems of S1-iliac pedicle screws and 37 sacroiliac joint screws were inserted in this series. The length of incision ranged from 5. 5 to 7. 6 cm ( average, 6. 2 cm ) , the operation time from 89 to 130 minutes ( average, 98 minutes) and the intraoperative blood loss from 110 to 320 mL (average, 195 mL). According to Matta ra-diological criteria, reduction was excellent in 13, good in 5 and fair in 2 cases, with an excellent and good rate of 90％. The follow-up time for the 20 patients ranged from 6 to 15 months ( average, 9 months ) . The healing time ranged from 10 to 14 weeks ( average, 12. 5 weeks ) . At the final follow-ups, X-ray and CT three-dimensional reconstruction showed fine fracture union. By the Majeed criteria, the pelvic function was excellent in 11 cases, good in 5, fair in 3, and poor in one, with an excellent and good rate of 80％. No loosening, breakage or pull-out of pedicle screws or sacroiliac screws happened. Conclusion Minimally invasive fixation of the sacroiliac triangle for vertically unstable pelvic posterior ring injury can lead to precise placement, quick recovery, small incision and good functional outcome.

Objective To evaluate the clinical efficacy of our self-made minimally invasive pelvic channel instrument in the treatment of pelvic ring fracture-dislocation.Methods A retrospective study was conducted of the 35 patients who had been treated for pelvic ring fracture-dislocation from December 2015 to November 2017 and fully followed up at Department I of Orthopaedis,Beijing Chaoyang Emergency Rescue Center.They were 25 males and 10 females,aged from 20 to 73 years (average,41.3 years).According to the Tile classification for pelvic fractures,there were 26 cases of type B (type B1 in 8,type B2 in 12 and type B3 in 6) and 9 cases of type C(type C1 in 5,type C2 in 3 and type C3 in 1).Infix or anterior plate combined with percutaneous internal fixation with sacroiliac cannulated screws was used in 11 patients,sacroiliac triangle fixation combined with percutaneous internal fixation with anterior ring cannulated screws in 5 ones,and internal fixation with cannulated screws for anterior and posterior rings in 19 ones.All the channels were established using our self-made minimally invasive pelvic channel instrument for internal fixation with cannulated screws.The time for each screw placement and the number of X-ray projection were recorded.Postoperative reduction,pelvic function at the final follows-ups and complications were recorded.Results A total of 84 cannulated screws were inserted in the 35 patients.The time for each cannulated screw placement ranged from 5 to 13 minutes (average,8.1 minutes);the number of X-ray projection for each screw placement ranged from 7 to 15 times (average,10.3 times).Postoperative CT showed that all the cannulated screws were located in the preset channels.According to the Matta radiological criteria,postoperative reduction quality was excellent in 29,good in 4 and fair in 2,giving a good to excellent rate of 94.3％.The follow-up time for the 35 patients ranged from 6 to 15 months (average,12.3 months).At the final follow-ups,all the patients showed fine fracture union.There was no loosening or breakage of screws in all but one patient in whom one sacroiliac screw became loose 3 months after surgery.By the Majeed criteria,the pelvic function was excellent in 27 cases,good in 5,fair in 3 and poor in one,giving a good to excellent rate of 91.4％.Conclusion Our self-made minimally invasive pelvic channel instrument can be used to establish pelvic channels,leading to more accurate placement,shorter operative time and less X-ray projection.

Objective To investigate the remodeling of atrial fibrosis in rheumatic heart disease (RHD) patients with atrial fibrillation and its possible mechanism.Methods The clinical data and right atrial tissue specimens were obtained from patients who had undergone mitral valve replacement for rheumatic valvular disease or who had undergone thoracotomy for congenital heart disease in the Second People's Hospital of Yibin from Oct.2013 to Oct.2015.According to the heart rhythm characteristics,the specimens obtained from these patients were divided into sinus rhythm group (RHD-SR group,18 cases),paroxysmal atrial fibrillation group (RHD-pAF group,21 cases) and persistent atrial fibrillation group (RHD-cAF group,42 cases).The right atrial tissue specimens obtained from those who had undergone thoracotomy for congenital heart disease with sinus rhythm were taken as the control group(CHD-SR group,21 cases).The structures of atrial tissues were observed under a light microscope.The picric acidsirius red staining was used to detect collagen volume fraction (CVF) of type Ⅰ and Ⅲ collagen and the type Ⅰ /Ⅲ collagen CVF ratio.The expressions of TGF-β1 protein and mRNA were detected by using Western blot and reverse transcription polymerase chain reaction (RT-PCR).Results The left atrial diameter (LAd) in the RHD-cAF group was significantly higher than that in the RHDSR group (P＜0.05),but no statistically significant difference was found in other clinical data among these groups (P＞0.05).The results of picric acid-sirius red staining demonstrated that the volume fraction of type Ⅰ and type Ⅲ1 collagen and the ratio of type Ⅰ /Ⅲ collagen were increased in CHD-SR group,RHD-SR group,RHD-pAF group and RHD-cAF group,gradually,there were statistically significant differences (P＜0.05),The expression levels of TGF-β1 protein and mRNA were increased gradually in CHD-SR,RHD-SR,RHD-pAF and RHD-cAF groups (P＜0.05).Conclusion Atrial fibrosis remodeling is an important mechanism of atrial fibrillation in patients with RHD.High expression of TGF-β1 may be involved in the remodeling of atrial fibrosis.

Objective To investigate the value of pelvic CT sagittal reconstruction for percutaneous insertion of iliosacral screws.Methods Data of 32 patients who had been treated for pelvic posterior ring injury from June 2015 to March 2017 were retrospectively analyzed.There were 21 males and 7 females,aged from 21 to 75 years (average,43.2 years).According to Tile classification for pelvic fractures,there were 23 cases of type B (type BI in 4,type B2 in 13 and type B3 in 6),and 9 cases type C (type C1 in 6,type C2 in 2 and type C3 in 1).The pelvic CT three-dimensional reconstruction was performed before operation,and the reconstructed layer of CT sagittal position was overlapped,and preset S1,S2 sacroiliac joint hollow.Insert the screws according to the preset needle point and passage under the perspective of C-arm X-ray machine during the operation.In 32 cases of patients,3 cases of type C1,1 case of type C2 and 1 case of type C3 fractures in sacroiliac joint hollow combined with S1-ilium pedicle screw internal fixation,and the rest of 27 patients were treated by iliosacral screws.The time for each screw placement and the times of X-ray projection were recorded.The position of cannulated screw was observed by CT scan and compared with the preset channel after the operation.Postoperative reduction quality was assessed using Matta radiological criteria and Majeed criteria was used at the final follow-ups to evaluate the pelvic function.Results The operations time was ranged from 40 to 240 min (average,130 min);and the blood loss was ranged from 20 to 150 ml (average,80 ml).Altogether 58 iliosacral screws were inserted in 32 patients.The time for each screw placement was ranged from 5 to 15 min (average,9.5 min);and the number for each screw X-ray projection was ranged from 7 to 15 times (average,10.2 times).Postoperative CT scan and vascular ultrasound showed that all the iliosacral screws did not penetrate the cortical bone or damaged the vascular nerves,and the error of the preset channel was from 0 to 5 mm (average,2.2 mm).All fractures healed successfully,and the healing time was 12 to 18 weeks (average,14.2 weeks).According to Matta radiological criteria,reduction was excellent in 26,good in 3 and fair in 3,with an excellent to good rate of 90.6％ (29/32).The follow-up time for the 32 patients was ranged from 6 to 15 months (average,11.3 months).At the latest follow-ups,Xray and CT examination showed fine fracture union and no loosening or breakage of screws in all.By the Majeed criteria,the pelvic function was excellent in 21 cases,good in 8 cases,fair in 3 cases,with a good to excellent rate of 90.6％ (29/32).Conclusion Preoperative pelvic CT sagittal reconstruction for preset of iliosacral screw insertion point,angle and length can achieve more accurate placement,shorter operative time and less time of X-ray projections.

Achalasia is a primary esophageal motility disorder manifested by dysphagia and chest pain that impair patients’ quality of life, and it also leads to chronic esophageal inflammation by food retention and increases the risk of esophageal cancer. Although achalasia has long been reported, the epidemiology, diagnosis and treatment of achalasia are not fully understood. The current clinical dilemma of achalasia is mainly due to its unclear pathogenesis. In this paper, epidemiology, diagnosis treatment, as well as possible pathogenesis of achalasia will be reviewed and summarized. The proposed hypothesis on the pathogenesis of achalasia is that genetically susceptible populations potentially have a higher risk of infection with viruses, triggering autoimmune and inflammation responses to inhibitory neurons in lower esophageal sphincter.

Objective To compare the efficacy and safety of turning holmium laser enucleation of the prostate (THoLEP) and transurethral holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH).Methods A retrospective analysis of 532 patients with BPH surgery from January 2016 to December 2017 was performed,including 289 cases of transurethral resection of holmium laser enucleation (THoLEP) and 43 cases of transurethral holmium laser enucleation (HoLEP).Cases with incomplete data were excluded.Finally,100 patients were enrolled and divided into THoLEP group and HoLEP.The mean ages of patients in the THoLEP group and the HoLEP group were (74.6 ± 8.2) years and (75.3 ± 7.7) years,respectively.The prostate weights were (52.3 ± 23.1) g and (52.6 ± 22.7) g,respectively.International prostate symptom scores (IPSS) were (22.8 ± 1.3) and (23.1 ± 1.6),and the quality of life score (QOL) scores were (4.4 ± 0.5) and (4.3 ± 0.8),respectively.The rate of mximum flow rate (Qmax) was (5.9 ± 2.7) ml/s and (6.3 ± 2.8) mL/s,respectively.The residual urine volume was (149.3 ± 8.7) ml and (145.3 ± 9.7) ml,respectively.There was no significant difference between the two groups (P ＞ 0.05).Results Compared with HoLEP group,THoLEP group showed shorter operation time [(44 ± 13) min vs.(61 ± 15) min,P ＜ 0.05] and less intraoperative bleeding [(101.6 ± 13.2) ml vs.(119.9 ± 18.0) ml,P ＜ 0.05].The weight of the resected tissue in the THoLEP group was slightly larger than that in the HoLEP group,however the difference was not statistically significant [(30.5 ± 9.5) g vs.(28.7 ± 8.5) g] (P ＞ 0.05).The incidence of transient urinary incontinence in THoLEP group was less than that in HoLEP group [2 and 4 cases,P ＜ 0.05].There were no cases of urinary incontinence in both groups after 3 months,and no permanent urinary incontinence in both groups.THoLEP was slightly better than HoLEP group,but the difference was not statistically significant (P ＞0.05).Conclusions Compared with HoLEP,THoLEP has similar short-term results,and has more advantages in shortening the operation time,reducing intraoperative bleeding and transient urinary incontinence.It is a safer and effective method for the treatment of benign prostatic hyperplasia.

Objective:To evaluate the effects of modified peroral endoscopic myotomy (POEM) on esophageal dynamics and clinical efficacy in achalasia (AC) patients.Methods:From January 2013 to December 2014, 51 patients diagnosed with AC and received modified POEM at The First Affiliated Hospital of Sun Yat-sen University were retrospectively enrolled. AC patients were classified as type Ⅰ, type Ⅱ and type Ⅲ according to Chicago classification. The changes of esophageal dynamics before and after the modified POEM were compared by high resolution manometry (HRM). The reflux after the operation was evaluated by 24-hour esophageal impedance-pH monitoring. The clinical symptoms and the quality of life of AC patients were assessed by impaction dysphagia questionnaire (IDQ), Eckardt scale and short-form 36 item health survey (SF-36). Paired t test, independent sample t test, Wilcoxon rank sum test and Pearson correlation analysis were used for statistical analysis. Results:At three months and one year after operation, lower esophageal sphincter pressure (LESP) and integrated relaxation pressure (IRP) were all lower than those before operation ((23.89±12.68) and (23.44±12.56) mmHg (1 mmHg=0.133 kPa) vs. (39.29±16.14) mmHg; (16.13±9.43) and (15.37±8.36) mmHg vs. (30.57±11.31) mmHg), and the differences were statistically significant ( t=7.520, 7.866, 7.641 and 8.909, all P<0.05). There were no statistically significant differences in LESP and IRP during the same period between patients with type Ⅰ AC and type Ⅱ AC (all P>0.05). The LESP of patients with partial esophageal peristalsis function recovered one year after operation was lower than that of patients with unrecovered esophageal peristalsis function ((15.38±4.54) mmHg vs. (25.65±13.19) mmHg), and the difference was statistically significant ( t=0.039, P<0.05). The proportions of pathologic acid reflux of AC patients at three months and one year after operation were 7.8%(4/51) and 2.0%(1/51), respectively. The IDQ and Eckardt scores of patients with AC at three months and one year after operation were both lower than those before operation (4 points, 0 points to 10 points and 4 points, 0 points to 11 points vs. 23 points, 18 points to 30 points; 2 points, 1 points to 3 points and 1 points, 0 points to 1 points vs. 5 points, 4 points to 5 points), and the differences were statistically significant ( Z=-6.036, -6.104, -5.971 and -6.209, all P<0.01). According to Eckardt score, the proportions of clinical remission at three months and one year after operation were higher than that before operation (98.0%, 50/51 and 100.0%, 51/51 vs. 19.6%, 10/51), and the differences were statistically significant ( χ2=64.76 and 68.56, both P<0.05). The SF-36 general health and social function scores at three months and one year after operation were both higher than those before operation (0.55 points, 0.45 points to 0.70 points and 0.55 points, 0.45 points to 0.70 points vs. 0.45 points, 0.30 points to 0.55 points; 0.88 points, 0.75 points to 1.00 points and 0.88 points, 0.75 points to 1.12 points vs. 0.75 points, 0.75 points to 1.00 points); and the differences were statistically significant ( Z=-4.439, -4.225, -2.123 and -2.320, all P<0.05); and the health change scores were lower than those before operation (3.00 points, 2.00 points to 3.00 points and 2.00 points, 1.00 points to 3.00 points vs. 4.00 points, 3.00 points to 4.00 points), and the differences were statistically significant ( Z=-4.827 and -4.841, both P<0.05). Before and after modified POEM, the changes of LESP were positively correlated with the changes of IRP ( r=0.624 and 0.592, both P<0.01). Conclusion:Modified POEM can significantly improve the symptoms and LES relaxation function of AC patients, with a low incidence of post-operative reflux.

Virtual monochromatic images (VMI) that reconstructed on dual-energy computed tomography (DECT) have further application prospects in radiotherapy, and there is still a lack of clinical dose verification. In this study, GE Revolution CT scanner was used to perform conventional imaging and gemstone spectral imaging on the simulated head and body phantom. The CT images were imported to radiotherapy treatment planning system (TPS), and the same treatment plans were transplanted to compare the CT value and the dose distribution. The results show that the VMI can be imported into TPS for CT value-relative electron density conversion and dose calculation. Compared to conventional images, the VMI varies from 70 to 140 keV, has little difference in dose distribution of 6 MV photon treatment plan.
Electrons ; Phantoms, Imaging ; Tomography Scanners, X-Ray Computed ; Tomography, X-Ray Computed