In this paper, we propose an image-based key frame gating method to reduce motion artifacts in intravascular ultrasound (IVUS) longitudinal cuts. The artifacts are mainly caused by the periodic relative displacement between blood vessels and the IVUS catheter due to cardiac motion. The method is achieved in four steps as following. Firstly, we convert IVUS image sequences to polar coordinates to cut down the amount of calculation. Secondly, we extracted a one-dimensional signal cluster reflecting cardiac motion by spectral analysis and filtering techniques. Thirdly, we designed a Butterworth band-pass filter for filtering the one-dimensional signal clusters. Fourthly, we retrieved the extremes of the filtered signal clusters to seek key frames to compose key-frames gated sequences. Experimental results showed that our algorithm was fast and the average frame processing time was 17ms. Observing the longitudinal viewpictures, we found that comparing to the original ones, the gated sequences had similar trend, less saw tooth shape, and good continuity. We selected 12 groups of clinical IVUS sequences [images (876 +/- 65 frames), coronary segments length (14.61 +/- 1.08 mm)] to calculate vessel volume, lumen volume, mean plaque burden of the original and gated sequences. Statistical results showed that, on one hand, both vessel volume and lumen volume measured of the gated sequences were significantly smaller than those of the original ones, and there was no significant difference on mean plaque burden between original and gated sequences, which met the need of the clinical diagnosis and treatment. On the other hand, variances of vessel area and lumen area of the gated sequences were significantly smaller than those of the original sequences, indicating that the gated sequences would be more stable than the original ones.
Algorithms ; Artifacts ; Heart ; Humans ; Motion ; Ultrasonography, Interventional

Objective:To examine the occurrence of seizures and perioperative risk factors in children after obtaining cardiopulmonary bypass (CPB).Methods:Electroencephalograph (EEG) and cerebral oxygen saturation (ScO 2) were monitored in 87 patients (aged 3 days-110 months, with the median at 4.4 months) and they were admitted to the Cardiac Intensive Care Unit (CICU) from May 2018 to April 2019, with 77 patients for 72 h after CPB and 10 cases with clinical seizures after CICU discharge for 8-180 h. Clinical data were recorded every 4 hours, including blood pressure, central venous pressure (CVP), temperature, arterial blood gases, lactate, doses of Dopamine, Milrinone, and Adrenalin, and daily C-reaction protein (CRP) and N-terminal pro-brain natriuretic peptide(NT-proBNP). Demographic data, the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery(STAT) mortality classification and clinical outcomes (duration of mechanical ventilation, CICU and hospital stay, and death) were recorded. Results:Seizures occurred in 24 patients (27.6%) within 48 h after CPB.EEG seizures appeared in 7 patients, both EEG and clinical seizures in 7 patients, and clinical seizures in 10 patients.Three patients developed epilepsy.There were 2 hospital deaths and both had EEG seizures.Patients with seizures had higher STAT categories, longer operative time and worse clinical outcomes (all P<0.05). Univariate regression revealed that the occurrence of seizures was positively related to adrenalin, temperature, lactate level (all P<0.01), blood pressure, CVP (all P<0.05) and CRP ( P<0.1), and negatively correlated with arterial carbon dioxide tension[ pa(CO 2)], ScO 2 and dose of Milrinone (all P<0.05). In multivariate regression, only dose of Adrenalin ( P<0.001) and lactate level ( P<0.01) remained significant. Conclusions:The incidence of seizures was high in children after CPB.Numerous perioperative factors that were related to seizures were identified.The most significant risk factors were higher dose of adrenaline and lactate level.Studies on neurological injury after CPB are urgently needed in China in order to reduce brain injury and improve neurodevelopmental outcomes.

Objective To analyze the value of diffusion weighted imaging ( DWI) in assessing the effect of neoadjuvant chemotherapy of uterine cervix cancer .Methods Thirty one patients with LACC confirmed by pa-thology received conventional magnetic resonance imaging and DWI before and after neoadjuvant chemotherapy . The variation of DWI image and ADC was evaluated before and after chemotherapy .Results The correlation be-tween maximum diameter of the tumor before treatment (37.10 ±11.23) and pretreatment ADC value (0.83 ± 0.12)was not statistically significant(correlation coefficient r=-0.1746,P=0.3475);the correlation between the maximum diameter of the tumor(24.03 ±5.65)and ADC value(1.10 ±0.16)after treatment was not statisti-cally significant(correlation coefficient r=-0.2077,P=0 2621.);the degree of tumor size before and after the treatment was correlated with the degree of ADC increase (P<0.05);Effective chemotherapy group of 20 cases, invalid group of 11 cases,ADC value of effective treatment group after treatment (0.95 ±0.13) was significantly higher than ADC value before chemotherapy (0.80 ±0.12),the change was statistically significant (P<0.05), while the difference between former ADC value(0.88 ±0.10)and ADC value after treatment(0.95 ±0.13)of in-effective group therapy was not statistically significant (P>0.05).Conclusion DWI sequence may be useful for early prediction and evaluation of curative effect to neoadjuvant chemotherapy for uterine cervical cancer .

Objective To evaluated the early and mid-term results of arterial switch operation (ASO) for patients with intramural coronary artery.Methods From September 2008 to March 2012,75 patients underwent ASO at Guangzhou Women and Children Medical Center for repair of transposition of the great arteries and Taussig-Bing anomaly.Among these patients,7patients (9.3％) had an intramural coronary artery.Mean age at operation was 2.4 months (2 days to 1 year) and mean body weight was(4.3 ±2.2) kg.The TGA and VSD in 3 cases,TGA/IVS in 2,and Taussig-Bing anomaly in 2.Among them 3 patients had an aortic arch anomaly,interruption of the aortic arch in 1 and coarctation of the aorta in 1.The individual coronary button technique was used in coronary transfer in 7 patients,of whom one patient required to unroof the intramural segment,an-other one required to unroof the intramural segment and enlarge with autologous pericardium the because of myocardial ischemia.There was 1 operative death because of low cardiac output syndrome.This patient underwent a coronary transfer combining aortic arch repair but without unroofing the stenotic intramural segment.The mortality was 14.2％.In the same period the mortality for 68 patients without an intramural coronary artery was 4.4％ (3/68).There was no statistical difference in mortalitv between the patients with and without an intramural coronary artery (P ＞ 0.05).Results 6 patients follow-up 4 to 47months.There was no late death.No intramural coronary artery obstruction was identified by cardiac computerize temography.All patients had normal ventricular function and were in NYHA class Ⅰ during follow-up.The intramural coronary artery is well known as a risk factor of ASO.Conclusion The technique of coronary transfer should be individually adapted to each anatomical situation.Individual technique for coronary transfer has excellent results.

Insolinoma is a rare disease,but with an increased incidence in recent years.From March 2003 to October 2010,16 patients with insulinoma had been admitted to the Nanfang Hospital,and the results of imaging investigation were compared with histopathological examination after operation.All cases had typical Whipple's triad,low plasma glucose and high plasma insulin concentrations. Sixteen tumors were found in total.The detection rate of ultrasonography was 44％ (7/16),and the detection rate of enhanced computed tomography (CT)and magnetic resonance imaging (MRI) were 67％ (8/16) and 75％ (6/8) respectively.The detection rate reached 88％ by combination of CT and MRI.Two patients had no abnormal findings in ultrasonography,CT and MRI,while positive results were found in the arterial stimulation procedure with venous sampiing (ASVS) in both patients.CT or MRI is the preferred approach for localization diagnosis of insulinoma. The ASVS achieves a distinct advantage in localization of insulinoma.

Objective:To evaluate the relationship between changes in Golgi apparatus morphological structure and endotoxin-induced acute lung injury (ALI) in mice.Methods:Twenty healthy male C57BL/6J mice, weighing 18-20 g, aged 6-8 weeks, were divided into 2 groups ( n=10 each) using a random number table method: sham operation group (group Sham) and endotoxin-induced ALI group (group ALI). Lipopolysaccharide (LPS) 10 mg/kg was injected intravenously in group ALI, while the equal volume of normal saline 0.5 ml was given instead in group Sham.The animals were sacrificed at 12 h after LPS injection and the lung tissues were taken for detection of the content of reactive oxygen species (ROS) and wet to dry weight ratio (W/D ratio), for observation of the pathological changes (using HE staining) and Golgi apparatus morphological structure (with a transmission electron microscope) and for determination of expression of Golgi matrix protein 130 (GM130), Golgin97 and mannosidase alpha class II member 1 (MAN2A1) and its mRNA (by Western blot and quantitative polymerase chain reaction). Results:Compared with group Sham, ROS content and the W/D ratio in lung tissues were significantly increased, GM130, MAN2A1, Golgin97 protein and its mRNA expression were down-regulate ( P<0.01), the pathological changes of lung tissues were accentuated, the Golgi cisternae was swollen, and Golgi fragments were dispersed in the cytoplasm in group ALI. Conclusion:The mechanism of endotoxin-induced ALI may be related to the changes in Golgi apparatus morphological structure.

Objective Experience with high-frequency oscillatory ventilation (HFOV) after congenital cardiac surgery is limited.The aim of the present study was to investigate the effect and safety of high frequency oscillation ventilation for patients with serious pulmonary hemorrhaege after surgical repair of congenital heart disease (CHD).Methods The patients with serious pulmonary hemorrhaege after surgical repair of CHD using conventional mechanical ventilation or high frequency oscillation ventilation were retrospectively analyzed.From January 2010 to July 2012,there were fourteen patients suffered from serious pulmonary hemorrhaege after surgical repair of congenital heart disease in our hospital and all involved in this study.The mean age was (6.5 ± 5.9) months(ranged from 1 to 24 months) and the mean body weight was (5.8 ± 1.7) kg(ranged from 3.7 to 10 kg).Before May 2011 patients with serious pulmonary hemorrhaege after surgical repair of congenital heart disease were treated with conventional mechanical ventilation(CMV group,n =6),and after May 2011 high frequency oscillation ventilation (HFOV group,n =8) instead.The diagnoses were pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries 7 cases,tetralogy of Fallot with imbalance pulmonary arterial development 5 cases,and total anomalous pulmonary venous connection 2 cases.Heart rate,arterial blood pressure,central venous pressure(CVP),inostmpic score,the blood gas analysis,the oxygenation index(OI),the outcomes and complications during both mechanical ventilations were all recorded.Results The PaO2,OI and systolic blood pressure of patients in HFOV group were significant higher than those in CMV group after 2 hours ventilation.There was no statistical difference in PCO2,diastolic blood pressure and inostropic score after 1,2,4,8,24 hours ventilation.All cases had no significant changes in hemodynamics.CVP of patients in HFOV group increased slightly(P ＜0.05),but there was no statistical difference in arterial blood pressure.Four patients died in CMV group.The mortality of CMV group and HFOV group was 66.7％ (4/6) and 37.5％ (3/8,one with pulmonary venous obstrution,one with tracheobronchial blocked,the other with re-hemorrhaege) respectively.The mortality of HFOV group was no significantly different from that of CMV group.Conclusion Compared to CMV,using HFOV achieved greater oxygenation function in patients with serious pulmonary hemorrhaege after surgical repair of CHD rapidly,had no significant changes in hemodynamics and rare serious complications.HFOV was effective and safe for patients with serious pulmonary hemorrhaege after surgical repair of congenital heart disease.

Objective To discuss the relationship between cardio-vocal syndrome and pulmonary arterial hypertension in infants with congenital heart disease(CHD).Methods Based on the electronic bronchoscopy results,257 less than one-year-old infants with congenital heart disease were selected and divided into vocal cord paralysis positive group (31 cases) and negative group(226 cases).Factors including age,sex,body weight,pulmonary arterial hypertension degree and PA/AO value were compared between the two groups.The risk factors of left vocal cord paralysis were analyzed using logistic regression method.Results There were no significant differences in age and weight between left vocal cord paralysis positive group and negative group(P ＞0.05).While incidence of pulmonary arterial hypertension and PA/AO value of the positive group were significantly higher than those of the negative group (P ＜ 0.01).The incidence of left vocal cord paralysis in no,mild-moderate and severe pulmonary arterial hypertension groups were 1.39％,10.6％ and 22.0％ (P ＜ 0.05) respectively.Left vocal cord paralysis was positively correlated with the degree of pulmonary arterial hypertension (r =0.179,P ＜ 0.01) and PA/AO value (r =0.169,P ＜ 0.01).Pulmonary arterial hypertension was an independent risk factor of left vocal cord paralysis (P =0.005,OR =1.689).Conclusion Left vocal cord paralysis was significantly correlated with pulmonary arterial hypertension and pulmonary artery dilatation.So pulmonary arterial hypertension should be one of the possible causes of cardio-vocal syndrome in infants with CHD.

Objective To review the outcomes of atrioventricular valve replacement in patients with functional single ventricle and evaluate risk factors for mortality.Methods Retrospectively reviewed our experience with atrioventricular valve (AVV replacement) in patients with functional single ventricle from January 2008 to December 2014.Outcome included mortality and valve-related complications.Results Thirteen patients required AVV replacement.Prosthetic valve type was St.Jude bileaflet mechanical mitral valve.Valve size ranged from 27 to 31 mm,including 27 mm in 2,29 mm in 7,and 31 mm in 4 patients.Median age at valve replacement was 4.5 years(range:1.2 years to 18.0 years).Concomitant procedures included bidirectional Glenn shunt in 3,pulmonary artery banding in 1,and repair of pulmonary vein stenosis in 1 patient.There were four early deaths with a perioperative mortality of 30.8％.Complications after AAV replacement included complete atrioventricuiar block in 1,intracerebral hemorrhage in 1 patient due to valve-related anticoagulation.No patient had perivalvular leakage.There was one late death during a mean follow-up of 3 years (range:0.5-5.0 years).Five-year Kaplan-Meier survival was 61.5％.Fisher exact probability test showed that lower weight(＜ 10 kg) at operation and prosthetic size/weight ratio ＞ 2.0 were risk factors for overall mortality.Of the survival patients,functional status is NYHA class Ⅰ in 3,class Ⅱ in 5.No patient developed valve-related complications.Conclusion Atrioventricular valve replacement can be performed in patients with functional single ventricle with acceptable mortality.Lower weight and increased prosthetic size/weight ratio at operation were significantly associated with worse survival.

Objective To investigate the mechanism of tumor necrosis factor-α (TNF)-α inhibiting osteo blastdifferentiation of mesenchymal stem cells (BMMSCs) in the pathogenesis of osteoporosis in the mouse model of systemic lupus erythematosus (MRL/lpr). Methods The femurs of MRL / lpr and C3He/HeJ mice were isolated, the bone structure were examined by hematoxylin-eosin (HE) staining. The proteins of TNF-α, NF-κB P50, bone morphogenetic protein -2 (BMP-2) and PSmad1/5/8 were measured by immunohistochemical stain. Bone marrow mesenchymal stem cells (BMMSCs) were isolated. After BMMSCs grew on the cover slips, the proteins on top of it were evaluated by immunohistochemistry stain. Moreover, the alkaline phosphatase (ALP) staining was employed for the measurement of the early osteogenic differentiation. BMMSCs together with hydroxyapatite were embedded subcutaneously in the nude mice and eight weeks later, the ectopic bone formation was evaluated. The recombinant human tumor necrosis factor receptor type Ⅱantibody fusion protein (etanercept) or normal saline was subcutaneous injected to the mice with lupus. After four weeks, the expression of these proteins was observed and the ectopic bone formation was investigated. Image-Pro plus 6.0 software was employed for imagine analysis, and Studentˊs t-test was used to test the differences between 2 independent groups. Results MRL/lpr mice showed decreased volume of cortex and the percentage of cortex to the volume of bone of MRL/lpr mice was significantly lower compared to control groups and with C3He/HeJ mice (13.96±0.25 vs 23.61±0.71, n=3, P<0.01). The protein levels of both TNF-αand NF-κB P50 on the femur of MRL/lprl mice were higher than those of the control group (0.643±0.051 vs 0.405±0.022, 0.917±0.023 vs 0.650±0.032, n=3, P<0.01). The expressions of BMP-2 on the femur of MRL/lpr mice were lower than those of the C3He/HeJ mice (0.52 ±0.03 vs 0.72 ±0.03, n=3, P<0.01). There was no difference in the expression of PSmad1/5/8 on the femur between the two groups by immunohistochemistry detection (1.264 ±0.021 vs 1.301± 0.044, n=3, P>0.05). The expressions of TNF-α and NF-κB P50 in BMMSCs of MRL/lprl mice were higher than those of the C3He/HeJ (0.184±0.021 vs 0.136±0.013, 0.132±0.021 vs 0.097± 0.014, n=3, P<0.01), while BMP-2 and PSmad were lower than those of the control group (0.128±0.013 vs 0.216±0.221, 0.115±0.023 vs 0.196±0.034, n=3, P<0.01). After 7 days of BMP-2 stimulation, the activities of ALP of BMMSCs from MRL/lprl mice were reduced detected by ALP staining and the osteoblast differentiation of these cells were decreased than BMMSCs from the control mice by HE and Masson staining. The percentage of the cortex to the volume of bone of the etanercept injection MRL/lpr mice was higher than that of the control group (21.8±1.0 vs 14.3 ±0.6, n=3, P<0.01). Moreover, the proteins of TNF-α and NF-κB P50 on the femurs of such injected mice were lower than those of the control group (0.540±0.024 vs 0.682±0.031, 0.857±0.023 vs 1.098±0.044, n=3, P<0.05), while the expressions of BMP-2 were higher than the control group (0.99±0.04 vs 0.85±0.04, n=3, P<0.05). There was no difference in the PSmad1/5/8 expression on the bone of the two group of lupus mice (0.88 ±0.08 vs 0.84 ±0.04, n=3, P>0.05). The ectopic bone formation of BMMSCs of the etanercept injected MRL/lpr mice was higher than that of the normal saline injected mice, however, it was lower than that of the C3He/HeJ mice. Conclusion TNF-α inhibits osteoblast differentiation of mesenchymal stem cells by depressing Smad signaling which may contribute to the osteoporosis of the lupus mice.