Objective To evaluate the value of transesophageal echocardiography (TEE) in transthoracic minimally invasive device closure of ventricular septal defect(VSD).Methods A total of 164 cases of VSD were recruited as candidates to receive transthoracic minimally invasive device closure between January 2007 and October 2010,including 138 perimembranous VSDs,3 muscular VSDs and 23 supracristal VSDs.Among these groups,85 male patients were included.Four-champer view,five-champer view,left ventricular long-axis view,short-axis view and right ventricular inflow view were detected to evaluate the availability of device closure.Results A total of 152 cases(92.7%)were successfully closed with a device.All the patients were followed up more than 3 months arranged with a standard protocol.No complete atrioventricular block (CAVB) or associated valvular complications were observed.Three of the five cases with traced residual shunt after device closure closed spontaneously.Conclusion TEE plays an important role in transthoracic minimally invasive device closure of ventricular septal defect,which has been proved by the good follow-up results without CAVB and associated valvular complications.

Objective To investigate the effects of tetramethylprazine (TMP) on left ventricular hypertrophy and the regulation of nicotinamide-adenine dinucleotide(NADPH) oxidases in renovascular hypertension of rat.Methods Hypertensive rats were obtained by using two-kidney-two-clip (2K2C) method.Rats were classified into sham-operated group,model group,low,high dose experimental groups (TMP,30,60 mg · kg-1 · d-1) and control group (candesartan,10 mg · kg-1 · d-1).The drugs were continuously administered for 2 weeks.Left ventricular (LV) hemodynamic parameters,serum superoxide ismutase (SOD),dmalondialdehyde (MDA) and hydrogen peroxide(H2O2)levels were measured.The ratio of LV weight to body weight (LVW/BW) was calculated.Hematoxylin-eosin(HE) staining was used for morphological analysis.RT-polymerase chain reaction and Western-blot were performed to investigate the protein expressions of brain natriuretic peptide (BNP),β-myosin heavy chain(β-MHC) and NADPH oxidases(Nox2,Nox4 and P47phox).Results Compared with model group,aortic systolic pressure (AoSP),aortic diastolic pressure (AoDP),LV end-systolic pressure (LVESP),LV end-diastolic pressure(LVEDP) significantly decreased in low,high dose experimental groups with siginificanly (all P ＜ 0.05) while (+ dp/dtmax) and (-dp/dtmax) increased in low,high dose experimental groups with siginificanly (P ＜ 0.05).Compared with model group on LVW/BW (2.8 ± 0.3) mg · g-1,LVW/BW of (1.9 ± 0.2),(1.7 ± 0.4) mg · g-1 in low,high dose experimental groups significantly decreased (P ＜ 0.05).Compared with model group SOD significantly increased while MDA and H2O2 decreased in low,high dose experimental groups with significandy (all P ＜ 0.05).The protein expressions of Nox2 in low,high experimental groups and model group were 0.82 ± 0.08,0.57 ± 0.05,0.30 ± 0.13;the protein expressions of Nox4 in above three groups were 1.00±0.10,0.79 ± 0.07,1.32 ± 0.15 and the protein expressions of P47phox in above three groups were 0.88 ± 0.08,0.65 ± 0.06,1.23 ± 0.15,compared with model group,the protein expression significantly decreased in low,high dose experimental groups with significantly (all P ＜ 0.05).Conclusion TMP attenuated cardiac hypertrophy possibly through decreasing NADPH oxidases (Nox2,Nox4,P47phox) expressions and oxidative stress in renovascular hypertensive rats.

Objective To summarize the clinical features of extraorbital inflammatory myofibroblastic tumor (IMT) of the head and neck.Methods Fourteen cases of extraorbital IMT treated in recent 20 years were analyzed retrospectively.Results Of the 14 patients,9 cases with limited lesion in maxilla (n =5),mandible (n =2) or neck (n =2) underwent local resection,and no recurrences were found after 1.5 to 20.0 years; 3 cases diagnosed as maxillary IMT involved in orbit,hard palate or pterygopalatine fossa received conservative therapy (prednisone,prednisone plus radiotherapy or prednisone plus chemotherapy),and no disease progression was found after 6,9 or 2 years respectively; and 1 case diagnosed as maxillary IMT involved in orbit and pterygopalatine fossa was confirmed with cervical metastases after two operations and died of brain invasion within 17 months.One patient with localized lesion around the common carotid artery was treated with prednisone and had no disease progression with a 2-year follow-up.Conelusions Extraorbital IMT of the head and neck is a rare clinical entity.Pathology examination is required for final diagnosis.Corticosteroid administration may be a choice of treatments,and radical resection should be taken selectively for limited lesions.

Neurotoxicity is one common adverse effect caused by many drugs or compounds.In the early phase of new drug development,it is necessary to screen for neurotoxicants.Neurotoxicity studies in nonhuman primates (NHP) are used to evaluate the neurotoxicity of small-molecule drugs or vaccines that may affect the nervous system across the blood-brain barrier during preclinical safety assessment.Toxicologic pathological evaluation or neuropathological examination is the "gold standard" for the evaluation of drug neurotoxicity in preclinical drug safety studies.In this paper,the majory factors influencing the quality of neuropathology evaluation in toxicology,including the general strategy of neuropathology evaluation,the optimal timing of evaluation,the specific blood-brain barrier in the nervous system,the method of sampling in the histopathology of nerve tissue,and the interference of artificial artifacts in diagnosis of neuropathology,were detailly analyzed in order to provide a reference for setting guidelines of neurotoxicity risk assessment in China and pathologists and toxicologists engaged in nonclinical neurotoxicity studies.

Objective To analyze the status of quality indicators(QI) on specimen acceptability and establish preliminary qual ity specification.Methods Web based External Quality Assessment system was used to collect data of laboratories partici pated in "Medical quality control indicators in clinical laboratory" from 2015 to 2017,including once in 2015 and 2017 and twice in 2016.Rate and sigma scales were used to evaluate incorrect sample type,incorrect sample container,incorrect fill level and anticoagulant sample clotted.The 25th percentile (P25) and 75th percentile (P75) of the distribution of each QI were employed to establish the high,medium and low specification.Results 5 346,7 593,5 950 and 6 874 laboratories sub mitted the survey results respectively.The P50 of biochemistry (except incorrect fill level),immunology and microbiology reach to 6σ.The P50 of clinical laboratory is 4 to 6σ except for incorrect sample container.There is no significant change of the continuous survey results.Based on results in 2017 to establish the quality specification,the P25 and P75 of the four QIs is 0 and 0.084 4 ％,0 and 0.047 6 ％,0 and 0.114 2 ％,0 and 0.078 4 ％,respectively.Conclusion According to the results of the survey,most laboratories had a faire performance in biochemistry,immunology and microbiology,and clinical laboratory needs to be strengthened.Laboratories should strengthen the laboratory information system construction to ensure the actual and reliable data collection,and make a long time monitoring to achieve a better quality.