Objective To determine the usefulness of real time three-dimensional transesophageal echocardiography(RT-3D TEE) in the preoperative assessment of mitral valve (MV) pathology by comparing images with surgical findings and to evaluate the function of MV postoperatively. Methods Nineteen consecutive adult patients with established diagnosis of mitral regurgitation(MR) scheduled for surgical correction were enrolled. Intraoperative 2D and 3D transesophageal echocardiography(TEE) were performed. All the 3D images were compared with findings obtained from direct surgical inspection. Postoperative RT-3D TEE was performed immediately to evaluate outcomes of mitral annuloplasty. Results Superb 3D-TEE en face views of the MV were obtained in all patients. Correct diagnoses of MV pathology in agreement with the surgical findings were made in 16 of 19 patients (84. 2%), however in the remaining 3 patients, the diagnoses were incorrect despite good image quality. In one, RT-3D TEE diagnosed prolapse of A2 segment and P2 scallop,which was not confirmed at surgery, but MV degeneration and annular dilatation were observed. In another one, RT-3D TEE revealed prolapse of P3 scallop, while at surgery prolapse involved P2 and P3 with ruptured chordae. In the rest one,surgically detected prolapse of P2 was missed by RT-3D TEE. On the other hand with 2D TEE,the diagnoses correlated poorly with surgical findings,only 10 patients were accurately diagnosed (52.6%). In some patients,2D TEE was able to identify the MVP, but it had difficulty in defining the exact location of the prolapsed segment or scallop. The severity of MR decreased significantly after surgery. MV repair was successful in all patients except one(5.1%), in whom moderate to severe MR was still present and MV replacement was conducted subsequently as an alternative.Conclusions RT-3D TEE provides excellent imaging of MV components, including the anterior and posterior leaflets, as well as annulus and subvalvular structures, which can be especially helpful in planning the most appropriate surgery strategy. RT-3D TEE offers exact anatomic characteristics of mitral annuloplasty rings and bands, providing additional information for the evaluation of surgical outcomes.

Objective To investigate the effect of erythropoietin(EPO)on the proliferation of neural stem cells(NSCs)derived from central canal of adult rat spinal cord in vitro ,so as to provide a theoretical basis for clinical treatment of spinal cord injury by autotransplanting or allograft transplanting of adult spinal cord NSCs. Method NSCs were isolated from the central canal of the adult rats spinal cord by microsurgical method,and Nestin(nestin)and Sox2 immunofluorescence stain were used to identify the cells. After cells were treated with different dose of EPO,5,10,20 and 40 U/mL,respectively,the optical treatment concentration and time were determined by CCK8 assay. The effect of EPO on the cell count and the expression of Cyclin D1 in NSCs were detected at the treatment time 96 h. Result The NSCs derived from the central canal of adult SD rats spinal cord could stably express protein Nestin and transcription factor Sox2. As the results of CCK8 test,cell counts and real-time quantitative PCR showed the optimal treatment of concentration and time maybe 20 U/mL and 96 h. Conclusions This study shows that EPO can promote the proliferation of NSCs derived from central canal of adult rat spinal cord,and the optimal treatment of concentration and time for proliferation might be 20 U/mL and 96 h.

Objective To investigate the value of synchronous recording of Doppler blood flow spectrum of fetal pulmonary artery and vein in quantitative measurement of fetal heart conduction time. Methods A total of 221 fetuses aged 16-41 weeks were enrolled in this study.Each fetus was measured by pulsed Doppler (PD),tissue Doppler (DTI) and pulmonary arteriovenous synchrony (PA-PV). Atrioventricular conduction time (AV) and the time period from ventricular contraction began to shrink to the next cardiac atrial contractions (VA) were recorded for comparing the consistency of three measure methods.Results ①The AV and VA obtained by three different measurement methods have no significant difference after any comparison( P >0.05). ②There was a significant positive correlation between AV and gestational age (r= 0.825, P = 0.000). There was a weak correlation between VA and gestational age (r=0.216,P =0.000). ③AV was negatively related to heart rate ( r = -0.236,P =0.000);VA was negatively related to heart rate( r = -0.860,P =0.000). ④There was a positive correlation between AV and biparietal diameter ( r = 0.188, P = 0.005). There was no significant correlation between VA and biparietal diameter ( r = 0.054, P = 0.428). ⑤ AV and VA in different gestational weeks fetuses were analyzed by ANOVA. The differences in AV among PD,DTI and PA-PV groups were statistically significant ( P =0.014),AV > 36 weeks was the longest,and there was no significant difference in VA among PD,DTI and PA-PV groups ( P =0.941). ⑥ According to different biparietal diameter grouping, the differences in AV among PD,DTI and PA-PV groups were statistically significant ( P = 0.004),and biparietal diameter was 8~9 cm.There was no significant difference in VA among PD,DTI and PA-PV groups ( P = 0.829). Conclusions PA-PV method,PD method and DTI determination of fetal heart conduction time have the same clinical value,the measured data can be used as a clinical reference value, quantitative analysis of fetal arrhythmia has important clinical potential value.

Objective:To analyze the correlation between left and right atrial diameters and fetal biological growth parameters of normal fetuses in middle and late trimester, and to establish normal reference and Z-score model for left and right atria.Methods:Three hundred and ninety-two fetuses in middle and late trimester were prospectively selected from July 2022 to October 2022 in Sir Run Run Shaw Hospital.Non-cardiac biometric parameters included biparietal diameter (BPD), femoral length (FL), and gestational age (GA) based on menstrual age were assessed.Left and right atrial widths (LAW, RAW) and atrial lengths (LAL, RAL) at end-systole, left and right atrial areas (LAA, RAA) at end-systole and the heart area (HA) at end-diastole were measured in standard apical four-chamber or basal four-chamber view. The ratio of RA and LA transverse diameters (RAW/LAW), the ratio of RA and LA length diameters (RAL/LAL), ratio of RA and LA area (RAA/LAA), spherical index of the ratio of RA and LA length to transverse diameter (RASI, LASI), ratio of LA and RA area to heart area (LAA/HA, RAA/HA) were calculated. The best regression equation was established using GA, BPD and FL as independent variables and LAL, LAW, LAA, RAL, RAW, RAA as dependent variable. The correlation between the standard deviation (SD) and the independent variables GA, BPD and FL was analyzed, and then the above statistics were used to calculate the corresponding Z-score for each variable of RA and LA using the regression equation.Results:①Significant positive correlations were found between LAW, RAW, LAL, RAL, LAA and RAA with the increase of GA, BPD and FL, and the highest degree of correlation between RAA, LAA and GA was denoted ( r=0.927, 0.920, all P<0.001). ②Taking GA as an example, there was no significant correlation between RAL/LAL, RAW/LAW and GA ( r=-0.064, 0.077; all P>0.05). RAA/LAA showed a very weak positive correlation with GA ( r=0.106, P=0.037), with normal reference values of 1.002±0.091, 1.091±0.093, 1.059±0.090, respectively. Interestingly RAL/LAL was found close to 1, while RAW/LAW and RAA/LAA were always >1. No significant correlations were found between LAA/HA, RAA/HA and GA ( r=0.003, 0.056; all P>0.05), with normal reference values of 0.155±0.026, 0.163±0.026, respectively, and RAA/HA was found larger than LAA/HA. LASI showed a very weak positive correlation with GA ( r=0.112, P=0.027), while there was no significant correlation between RASI and GA ( r=0.003, P>0.05), the normal reference values were 1.068±0.113, 0.980±0.105, respectively. ③The SD of LAL, LAW, etc.showed a simple linear relationship with the independent variables. Taking RAA and GA as examples, the linear regression equation for RAA was Y=-1.690+ 0.107 0GA ( r=0.927, P<0.001) and the linear regression equation for RAA-SD was Y=-0.107+ 0.010 4GA ( r=0.320, P<0.001). The Z-scores for LAL, LAW, LAA, RAL, RAW and RAA were relatively constant with the growth of GA, BPD and FL, with the corresponding Z-scores for GA were -1.817~3.631( r=0.000 3), -1.605~2.995( r<-0.000 1), -1.700~3.107( r<0.000 1), -1.617~3.466( r=0.000 1), -1.491~3.025( r<-0.000 1), -1.566~3.104( r=0.000 2), respectively. Conclusions:This study preliminarily establish the reference value ranges and Z-score of atrial diameters in normal fetuses during middle and late trimester, providing a reference basis for accurate quantitative evaluation of fetal atrial development and analysis of fetal congenital heart abnormalities, and contributing to the early detection of pathological conditions leading to abnormal atrial size.