[Objective]To study the perioperative management and effect of total hip arthroplasty (THA) in elder patients with developmental dysplasia of the hip (DDH). [Methods]THA was applied in 24 patients (32 hips) who sufferring osteoarthritis and femoral head necrosis due to developmental dysplasia of the hip. The patients ranged from 70 to 82 years old with an average age of 74.3,and they all had metabolic diseases or more than one organ dysfunctions. The patients fulfilled the conditions of the surgery after sufficient perioperative period preparation.[Results]The follow-up time was from 2 to 8 years (averaged 3 years).Cardiopulmonary function was improved in all patients and the artificial joints were stable. And the patients could walk stably and powerfully without pain and deformity of the hip. The average Harris score after the operation was 87.2 points,and it was higher than 38.5 points before the operation.[Conclusion]For the reason of osteoarthritis and femoral head necrosis due to DDH,the patient's activity decreased,and so with their organ functions. And these patients always had metabolic diseases.All these can affect the safety and the outcome of THA. Therefore,sufficient perioperative management is as important as the surgery technique to obtain a stable,painless and functional joint in these patients.

BACKGROUND:Whether adipose-derived mesenchymal stem cells are able to exert immunomodulatory effects in the treatment of myocardial infarction, as wel as the best time, is less reported.
OBJECTIVE:To observe the effect of adipose-derived mesenchymal stem cells on inflammatory reaction and ventricular remodeling after myocardial infarction, and to explore the possible mechanisms of adipose-derived mesenchymal stem cells for the treatment of myocardial infarction.
METHODS:Enzyme digestion method was employed to isolate and culture rat adipose-derived mesenchymal stem cells. By ligation of the left anterior descending coronary artery, we established animal models of myocardial infarction in 40 rats. The rats were randomly divided into four groups:sham group, control group (injected high-glucose Dulbecco’s modified Eagle’s medium), 3-hour transplantation group (transplanted adipose-derived mesenchymal stem cells after 3 hours of myocardial infarction), 7-day transplantation group (transplanted adipose-derived mesenchymal stem cells after 7 days of myocardial infarction). After 14 days of operation, the levels of tumor necrosis factor-αand interleukin-10 in the plasma were detected by enzyme linked immunosorbent assay. After 28 days of operation, the left ventricular end diastolic diameter, left ventricular end systolic diameter, left ventricular ejection fraction and left ventricular fractional shortening were measured by echocardiography.
RESULTS AND CONCLUSION:Compared with the control group, in the 3-hour transplantation group and 7-day transplantation group, the levels of tumor necrosis factor-αwere significantly lower (P<0.01), and the levels of interleukin-10 were significantly higher (P<0.01) at postoperative 14 days;the left ventricular end diastolic diameter and left ventricular end systolic diameter in the two transplantation groups were also significantly smal er (P<0.05), but left ventricular ejection fraction and left ventricular fractional shortening were significantly elevated (P<0.05), which was more apparent in the 3-hour transplantation group than the 7-day transplantation group. Adipose-derived mesenchymal stem cells transplantation in acute phase of myocardial infarction can suppress the inflammatory response, regulate the cytokine network equilibrium, and thus delay ventricular remodeling and improve cardiac function.

Objective To investigate the value of contrast enhancement T1 mapping in detection of diffuse myocardial fibrosis in cardiomyopathy, and the relationship between myocardial fibrosis and cardiac function. Methods From September 2013 to September 2014, 76 cases of cardiomyopathy patients (including myocarditis) and 33 cases of healthy controls were enrolled in our study. All the subjects underwent cardiac MR (CMR) examination. Scan sequences included cine MR, pre-contrast and post-contrast T1 mapping and late gadolinium enhancement (LGE) imaging. The pre-/post-contrast left ventricle average T1 value and cardiac function of patients and controls were measured and compared by using independent-samples t test. According to the LGE imaging, all the subjects were subsequently divided into LGE positive group, LGE negative group and control group. The myocardial average T1 value and cardiac function among the three sub-groups were compared by using one-way ANOVA, and the relationship among them were analyzed by using Pearson correlation. Results Among the 76 cases of non-ischemia cardiomyopathy patients, 51 cases (67.1%) had LGE. Compared with controls, cardiomyopathy patients presented with higher pre-contrast T1 value [(1 306.4 ± 84.6)ms vs. (1 266.6 ± 57.3)ms, t=2.10, P<0.05] and lower post-contrast T1 value [(483.6 ± 112.0)ms vs. (534.1 ± 92.7)ms,t=-0.27, P<0.05]. Pre-contrast and post-contrast average T1 value of LGE positive patients were (1 322.2 ± 85.8) and (459.7 ± 132.2)ms respectively;pre-contrast and post-contrast average T1 value of LGE negative patients were (1 267.0 ± 68.5) ms and (521.0±95.2)ms, there were statistical significant differences of T1 value between LGE positive and LGE negative patients (P<0.01), however, there were no statistical significant differences of T1 value between LGE negative patients and controls (P>0.05). There were correlation between pre-/post-contrast left ventricle T1 value and ejection fraction (EF) in cardiomyopathy patients (r=-0.252,-0.217, P<0.01), however no statistical correlation with other cardiac function parameters (P>0.05). Conclusions The average pre-/post-contrast T1 value in left ventricle myocardium are helpful for detection of diffuse fibrosis in cardiomyopathy patients. The LGE positive is a sign that can greatly change the T1 value of the myocardial tissue, meanwhile, myocardial fibrosis is negative correlated with ejection fraction in cardiomyopathy patients.

Aim To determine whether AngⅡin para-ventricular nucleus (PVN)was involved in the chronic intermittent hypoxia (CIH ) induced-hypertension in rats.Methods Male Sprague-Dawley rats were ran-domly divided into Sham and CIH groups,the Sham rats were exposed to continuous normoxia,while the CIH rats were submitted to CIH (8 h per day for 15 days).The conscious noninvasive method with tail cuff was performed in rats to record the systolic blood pres-sure during establishing the model of CIH induced hy-pertension.Mean arterial pressure (MAP)and heart rate (HR)were recorded in vivo on a PowerLab data acquisition system after CIH.Rats were fixed on the stereotaxic instrument to conduct microinjection in the PVN.We used Western blot to measure Ang Ⅱ level and AngⅡtype 1 receptor (AT1 R)protein expression in PVN.Results The level of PVN Ang Ⅱin CIH rats was significantly higher than that in Sham rats,a-long with increased AT1 R protein expression.Microin-jection of Ang Ⅱ(0.03,0.3,3 nmol)in bilateral PVN dose-dependently increased MAP in both CIH and Sham rats,and this response was significantly augmen-ted in CIH rats.Losartan (50 nmol),AT1 R antago-nist,had no effect on MAP in Sham rats,but caused significant MAP decreases in CIH rats,and prevented Ang Ⅱ-induced increases in MAP in both CIH and Sham rats.Conclusion The results suggest that the increased AngⅡrelease and enhanced AT1 R activation in the PVN contribute to CIH induced-hypertension in rats.

PurposeTo determine the feasibility and accuracy of dual source CT (DSCT) in assessing myocardial delayed-enhancement and left ventricular wall thickness of hypertrophic cardiomyopathy (HCM) in comparison with cardiac magnetic resonance (CMR).Materials and MethodsEighty patients with HCM confirmed by clinical diagnosis were enrolled in the study. DSCT images and CMR images were acquired at the arterial and lag phases. According to 17-segment model provided by American Heart Association, the left ventricular wall thickness and location of delayed-enhancement were verified, and the correlation of these two methods were analyzed in terms of the diagnosis of myocardial delayed enhancement (MDE).Results1360 myocardial segments for 80 patients were assessed. The left ventricular wall thickness determined by DSCT was significantly correlated with MR results (r=0.88,P<0.01). DSCT and MDE showed substantial agreement on per-patient (n=74,Kappa=0.751,P<0.05) and per-segment (n=1238, Kappa=0.746,P<0.01) levels. For dense myocardial delayed enhancement, CT findings were significantly correlated with those of CMR (r=0.89, P<0.01), but CT scan slightly underestimated the lesion scope of fibrosis. Bland-Altman analysis showed that CT and MRI were different in measuring the lesion volume of myocardial delayed enhancement (mean standard deviation was 2.71%).ConclusionThe cardiac CT examination provides comprehensive information in coronary artery and myocardial assessment, and MDE-DSCT is also effective in the diagnosis of myocardial fibrosis in HCM since it can be used in assessing myocardial fibrosis.

Aim To study the effect of pectin-adriamy-cin conjugate ( PAC) on cardiac toxicity .Methods 50 female SD rats were randomly divided into 5 groups with 10 animals in each group .Adriamycin ( ADM ) group received 3 mg? kg -1 , ip, every other day for 6 times.PAC group received ADM equivalent 1.5,3 and 6 mg? kg -1 , ip, every other day for 6 times.Control group received normal saline parallel to ADM .Rats were sacrificed and the echocardiogram , cardiac en-zymes , the oxidative stress levels in myocardial cells and histopathological changes after 48 h administration were detected.S180 ascites tumor bearing mice models were established to investigate the antitumor activity of PAC.Results The survival rate of ADM group was 50% and that of PAC each group was 100%.PAC could significantly increase body weight ,heart index and immune index and increase HR ,EF,FS,reduce LVIDd, LVIDs.PAC could also significantly increase the AST , LDH, CK, CK-MB level in serum .GSH-Px and SOD activities of PAC group were significantly increased and MDA contents were reduced , and histopathological changes decreased .PAC could effectively inhibit the growth of tumor cells and extend the survival period of mice.Conclusion PAC induces a significant reduc-tion in cardiotoxicity by increasing survival rate , im-mune and cardiac function , improving cardiac en-zymes ,oxidative stress and myocardial cell injury , and also PAC has obvious antitumor effect .

Objective To investigate the application of low-dose adaptive sequence scan of dual-source CT coronary angiography in patients with high heart rate and evaluate the image quality.Methods Seventy-two patients who underwent coronary CT angiography with heart rate> 70 bpm were divided into 2 groups.Group A was adaptive sequence scan, and Group B was retrospective ECG-gating helical scan.Examinations were performed on a dual-source CT scanner (Somatom Definition) .All images were transferred to a workstation for further processing and analysis.The image quality was evaluated using same criteria.The image quality of coronary artery segments was compared in two groups using rank sum test, and the radiation dose was compared using t test Results A total of 501 coronary artery segments were evaluated in group A and 400 segments in group B.The mean ranks in image quality of coronary artery segments in group A was 475.42, whereas 420.41 in group B.There was a statistical difference in image quality between the two groups (Z= - 3.509,P=0.000).The effective dose was on average (6.2±0.9) mSv in group A, whereas on average (14.7±1.9) mSv in group B, there was a statistical difference between the two groups(t= - 27.011, P=0.000).Conclusions Adaptive sequence scan in dual-source CT coronary angiography is feasible in patients with high heart rates.This scan mode can substantially reduce radiation dose and maintain the diagnostic image quality.

Objective To compare the curative effect of internal fixation treatment between reconstruction-type intramedullary nailing and long anatomic proximal femoral locking plate for patients with ipsilateral femoral proximal and shaft fractures. Methods Twenty-six patients with ipsilateral femoral proximal and shaft fractures were selected, among whom 12 patients were treated with reconstruction-type intramedullary nailing internal fixation treatment (group A), and 14 patients were treated with long anatomic proximal femoral locking plate internal fixation treatment (group B). The fracture to operation time, operation time, intraoperative blood loss, fracture healing time and hip joint function according to Majeed function score were compared between 2 groups. Results The fracture to operation time, operation time, intraoperative blood loss, proximal femoral fracture healing time, femoral shaft fracture healing time and Majeed function score in group A were (6.65 ± 4.11) d, (131.08 ± 20.70) min, (470.83 ± 96.43) ml, (17.83 ± 2.70) weeks, (20.08 ± 3.97) weeks and (83.83 ± 8.13) scores, and those in group B were (7.13 ± 4.56) d, (141.86 ± 27.30) min, (553.57 ± 127.80) ml, (18.29 ± 5.12) weeks, (21.55 ± 4.19) weeks and (83.21 ± 9.58) scores, and there were no statistical differences (P>0.05). According to Majeed function score, in group A excellent was in 7 cases, good in 4 cases, and general in 1 case; in group B excellent was in 9 cases, good in 3 cases, and general in 2 cases. Conclusions A fixation device fixes two fracture is preferred. Both treatment methods used in the present study could achieve satisfactory curative effect, and should be chosen according to the fracture type of the patients and the surgeon′s familiarity for the methods of internal fixation chosen. The proximal femoral fracture should preferably be reduced and stabilized first. A delay of 5 - 6 d would not affect the ultimate curative effect.

Objective To explore the clinical application value of left atrial function with feature tracking cardiac magnetic resonance imaging (FT-CMR) by evaluating preliminarily left atrial strain and strain rate in patients with atrial fibrillation. Methods Thirty patients with paroxysmal atrial fibrillation, thirty patients with persistent atrial fibrillation and twenty-two healthy subjects were enrolled. All the subjects underwent cardiac magnetic resonance imaging with the real steady-state free precession(SSFP) sequence. FT-CMR parameters included left atrial strain and strain rate parameters, left atrial volume and function parameters were detected by using offline cardiovascular analysis software, respectively. Left atrial strain and strain rate parameters included left atrial total strain(Εs), passive strain(Εe), active strain(Εa), peak positive strain rate(SRs), peak early negative strain rate(SRe)and peak late negative strain rate(SRa). Volume and function parameters included maximum of left atrial volume(LAVmax), minimum of left atrial volume(LAVmin), total left atrial emptying fraction(LATEF), passive left atrial emptying fraction(LAPEF)and active left atrial emptying fraction(LAAEF). The differences in the general data among the paroxysmal atrial fibrillation group, the persistent atrial fibrillation group and the control group were compared by usingχ2 test or ANOVA analysis. The differences in all parameters between the atrial fibrillation group and the control group, the paroxysmal atrial fibrillation group and the persistent atrial fibrillation group were compared by using independent t test. Left atrial strain and strain rate parameters on an intra-observer and inter-observer were determined by intraclass correlation coefficient(ICC)analyses. Results Compared to control group, LAVmax and LAVmin in atrial fibrillation group were significantly increased(t=9.737,7.889,P<0.001);The LATEF and LAPEF had no significant difference, the LAAEF in two groups had statistically significant difference(t=-4.762,P<0.001).The absolute value of Es, Ee, Ea, SRs, SRe, SRa in atrial fibrillation group were significantly reduced than in control group(t=-7.732,-6.610,-6.493,-7.546, 6.864, 5.917,P<0.001). Compared with paroxysmal atrial fibrillation group, LAVmax and LAVmin in persistent atrial fibrillation group were increased obviously, LATEF and LAPEF were significantly decreased, and the differences were statistically significant(t=-4.575,-5.524, 4.002, 4.028,P<0.001).The LAAEF in two groups had no statistically significant difference. Compared with strain and strain rate in two groups, absolute value of Es, Ee, Ea, SRs, SRe, SRa in persistent atrial fibrillation group significantly decreased than in paroxysmal atrial fibrillation(t=4.310, 3.128, 4.465, 5.496,-3.290,-3.863,P<0.001). The intra-group and inter-group had well correlation coefficients between the observers in the left atrial strain and strain rate parameters of the subjects(ICC=0.85—0.94,0.81—0.90). Conclusions FT-CMR technique can be used to assess the left atrial strain and strain rate in patients with atrial fibrillation;Left atrial reservoir, conduit and booster-pump functions in patients with atrial fibrillation were impaired. Patients with persistent atrial fibrillation had worse left atrial function throughout the entire cardiac cycle compared with those with paroxysmal atrial fibrillation.

Objective To evaluate the diffuse myocardial fibrosis of the left ventricle (LV) in patients with atrial fibrillation (AF) by cardiac MR (CMR) T1 mapping methods.Methods Totally 60 subjects (30 paroxysmal AF patients and 30 persistent AF patients) and 59 normal control underwent MR cardiac cine,late gadolinium enhancement,and LV T1 mapping.For T1 mapping,modified Look-Locker inversion recovery sequence was used.Compared with control,pre-contrast ventricular T1 times were quantified and extracellular volume (ECV) was calculated.Results All subjects completed the CMR exam,no myocardial delay enhanced lesion was found.Pre-contrast ventricular T1 time in healthy controls was lower than that in patients with persistent and paroxysmal AF,and the pre-comrast ventricular T1 time in persistent AF patients was higher than that of paroxysmal AF patients (all P＜0.05).The mean LV myocardial ECV had no statistical difference between healthy controls and paroxysmal AF patients (P＞ 0.05),while lower than persistent AF patients (P ＜ 0.05).The mean LV myocardial ECV in patients with persistent AF was larger than that in patients with paroxysmal AF (P＜0.05).LV functional indexes were positive correlated with pre-contrast ventricular T1 time and ECV in patients with AF (all P＜0.05).Conclusion There is LV myocardial fibrosis in patients with AF,and the degree in patients with persistent AF is more severe than that in patients with paroxysmal AF.