Objective To explore the application of echocardiography to guide interatrial septal puncture and evaluate the clinical effect in PBMV. Methods One hundren and sixty two patients were categorized into two groups according to whether echocardiography was applied in atrial septal puncture and real time monitoring. X-ray fluoroscopy guidence was used during atrial septal puncture in group 1 and in group 2, X-ray as well as echocardiography were used. The clinical outcomes were analyzed and contrasted between the 2 group. Results (1) The mean mitral pressure gradient dropped obviously in group 2 immediately after PBMV compared with group 1 (6.4?2.6 mm?Hg vs 10.2?3.7 mm?Hg,P

Objective To investigate the effect of emulsified isoflurane preconditioning on postsynaptic density protein 95 (PSD95) activation in brain during focal cerebral ischemia-reperfusion (I/R)injury in rats.Methods Thirty-two pathogen-free male SD rats weighing 280-300 g were randomly divided into 4 groups (n =8each): sham operation group(group S),group I/R,emulsified isoflurane group(group EI) and lipid emulsion group(group LE).Focal cerebral I/R was induced by middle cerebral artery occlusion for 2 h followed by reperfusion.8％ emulsified isoflurane 10.5 ml/mg or 30％ lipid emulsion 10.5 ml/mg was injected intraperitoneally at 24h before I/R in groups EI and LE respectively.The neurologic deficit score (NDS) was evaluated at 6 h of reperfusion and then 4 rats were sacrificed,and brains were removed for determination of phosphorylatied PSD95 (pPSD95) expression in ischemia cortex and hippocampus by Western blot.Four rats were sacrificed at 24 h of reperfusion and then their brains were removed for determination of infarct volume percentage.Results NDS,infarct volume percentage and pPSD95 expression in ischemia cortex and hippocampus were higher in groups I/R,EI and LE than in group S( P ＜ 0.01 ).NDS,infarct volume percentage and pPSD95 expression in ischemia cortex and hippocampus were lower in group EI than in group I/R( P ＜ 0.05).There was no significant difference in NDS,infarct volume percentage and pPSD95 expression between groups I/R and LE(P ＞ 0.05).Conclusion Emulsified isoflurane preconditioning can attenuate focal cerebral I/R injury in rats by inhibiting PSD95 activation in brain.

ObjectiveTo investigate the effects of emulsified isoflurane preconditioning on the expression of platelet-activating factor (PAF) and PAF receptor during focal cerebral ischemia-reperfusion (I/R) in rats.MethodsThirty-two healthy adult male SD rats weighing 250-300 g were randomly divided into 4 groups ( n =8each):group sham operation (group S); group I/R; group emulsified isoflurane preconditioning( group EI) and group lipid emulsion (group LE).Focal cerebral I/R was induced by 2 h occlusion of middle cerebral artery followed by reperfusion in groups I/R,EI and LE.8％ emulsified isoflurane 10.5 ml/kg and 30％ lipid emulsion 10.5 ml/kg were injected intraperitoneally at 24 h before cerebral ischemia in groups EI and LE respectively.The neurologic deficit score (NDS) (0 =no deficit,4 =unable to control) was evaluated at 12 h of reperfusion.Venous blood samples were collected for measurement of plasma PAF concentration.The animals were then sacrificed and their brains removed for determination of infarct size (by TTC staining) and PAF receptor expression in hippocampus and cerebral cortex (by Western blot).ResultsFocal cerebral I/R significantly increased NDS,the infarct size,plasma PAF concentration and PAF receptor expression in cerebral cortex and hippocampus in group I/R as compared with group S.Emulsified isoflurane preconditioning significantly attenuated the focal cerebral I/R induced above changes in group EI as compared with group I/R,but there was no significant difference between groups I/R and LE.ConclusionEmulsified isoflurane preconditioning can attenuate focal cerebral I/R injury by inhibiting PAF and PAF receptor expression.

Ion chromatography(IC)can make up the deficiency of LC or GC for the analysis of ionic drugs because of the unique separation mechanism,so IC is more and more widely applied in the field of drug analysis. In the paper,the application of IC is reviewed in the quality control of chemical drugs.

Objective To preliminary formulated 2017 Chinese rare disease survey list by experts consensus.Methods By using checklist methods,we selected studied diseases from five available rare disease data sources in China.By summarizing,proofreading,removing of duplicate data,the primary survey list with 344 diseases was formulated.By organizing two rounds of consensus conferences,experts voted and revised the survey list,then ultimately formulated 2017 Chinese rare disease survey list.Results According to the poll,in selected 344 rare diseases which were discussed in consensus conferences,54 diseases were suggested to be deleted,9 pairs of diseases were suggested to be incorporated.For Chinese and English names of these rare diseases,306/344 diseases conform to nomenclature by discussion.According to the experts' tips and advice,we revised the primary survey list and ultimately formulated 2017 Chinese rare disease survey list including 281 diseases.Conclusions Experts consensus combines the scientificity of methodology and clinical experience of experts.In the background of medical big data and targeted poverty alleviation,the early stage of study is in accordance with the main stream of thought for the national survey of rate disease in China.

Objective To evaluate the value of endoscopic ultrasonography ( EUS) combined with conventional endoscopy for prediction of invasion depth of early gastric cancer and its therapeutic decision-making. Methods Patients with biopsy-proven gastric cancer underwent EUS and conventional endoscopy from July 2011 to January 2018 in Ningbo No. 2 Hospital. A total of 129 patients with early gastric cancer confirmed by postoperative pathology were enrolled in the study. The sensitivity, specificity, positive predictive value, negative predictive value, consistency ( the value of Kappa ) and area under receiver operating characteristic curve ( AUC) of EUS, conventional endoscopy and combination of two methods to assess the accuracy of tumor infiltration depth were analyzed. The accuracy of therapeutic decision-making based on the EUS, conventional endoscopy and combination of two methods were assessed. Results In intramucosal cancer, the sensitivity, specificity, positive predictive value, negative predictive value, the value of Kappa and AUC of EUS were 75. 00％, 82. 22％, 88. 73％, 63. 79％, 0. 536 and 0. 797, respectively, and for conventional endoscopy, these statistical values were 61. 9％, 93. 33％, 94. 55％, 56. 76％, 0. 481, and 0. 801, respectively. For the combination of two methods, these statistical values were 85. 71％, 82. 22％, 90. 00％, 75. 51％, 0. 666 and 0. 850, respectively. In submucosal cancer, the sensitivity, specificity, positive predictive value, negative predictive value, the value of Kappa and AUC of EUS were 51. 11％, 86. 91％, 67. 65％, 76. 84％, 0. 403 and 0. 697, respectively, and for conventional endoscopy, these statistical values were 57. 78％, 73. 81％, 54. 17％, 76. 54％, 0. 311 and 0. 678, respectively. For the combination of two methods, these statistical values were 71. 11％, 90. 48％, 80. 00％, 85. 39％, 0. 632 and 0. 817, respectively. The accuracies of therapeutic decision-making of EUS, conventional endoscopy and the combination of two methods were 83. 72％, 68. 22％ and 92. 25％, respectively. Conclusion Patients who are diagnosed as intramucosal caner by conventional endoscopy should not be recommended to undergo EUS. For those whose invasion depth is unclear, or diagnosed as submucosal cancer or deeper by conventional endoscopy, EUS should be performed for reassessment. The combination of two methods can improve the accuracy of distinguishing intramucosal and submucosal caners and therapeutic decision-making. Trial registration Chinese Clinical Trial Registry, ChiCTR-DDT-13003299.

Objective To evaluate the performance of an artificial intelligence ( AI ) assisted diagnosis system for diabetic retinopathy ( DR) based on deep learning theory. Methods Diagnostic performance of a robot assisted diagnosis system called SongYue for DR was trained by using 25297 retinal images tagged by fundus doctors from multiple hospitals in China. Four types of DR detection model consisting of abnormal DR,referable DR,severe non-proliferative and proliferative DR as well as proliferative DR according to fundus leisions identification were established. The ability of the system to distinguish DR was determined by using receiver operator characteristic (ROC) analysis,sensitivity and specificity of the system. Results SongYue system achieved an area under the ROC curve ( AUC) of 0. 920 for successfully distinguishing normal images from those DR with a sensitivity of 96. 0％at a specificity of 87. 9％. The AUC of SongYue for referable DR was 0. 925,sensitivity was 90. 4％,and specificity was 95. 2％. For severe non-proliferative and proliferative DR,AUC was 0. 845,sensitivity was 72. 7％,and specificity was 96. 2％. For proliferative DR, AUC was 0. 855, sensitivity was 73. 5％, and specificity was 97. 3％. Conclusions SongYue robot assisted diagnosis system has high AUC,sensitivity and specificity for identifying DR, showing good clinical applicable benefits.

Objective: To analyz the current situation of the diagnosis, treatment and prevention of methylmalonic acidemia, the phenotypes, biochemical features and genotypes of the patients in the mainland of China, were investigated. Methods: Tottally 1 003 patients of methylmalonic acidemia from 26 provinces and municipalities of the mainland of China were enrolled. The clinical data, biochemical features and gene mutations were studied. Blood aminoacids and acylcarnitines, urine organic acids, and plasma total homocysteine were determined for the biochemical diagnosis. Gene analyses were performed for the genetic study of 661 patients. The patients were treated with individual intervention and long-term follow up. Prenatal diagnoses were carried out for 165 fetuses of the families. Results: Among 1 003 patients (580 boys and 423 girls), 296 cases (29.5%) had isolated methylmalonic acidemia; 707 cases (70.5%) had combined homocysteinemia; 59 patients (5.9%) were detected by newborn screening; 944 patients (94.1%) had the onset at the ages from several minutes after birth to 25 years and diagnosed at 3 days to 25 years of age. The main clinical presentations were psychomotor retardation and metabolic crisis. Multi-organ damage, including hematological abnormalities, pulmonary hypertension, kidney damage, were found. MMACHC, MUT, MMAA, MMAB, HCFC1, SUCLG1, SUCLA2 mutations were found in 631 patients (96.6%) out of 661 patients who accepted gene analysis. MMACHC mutations were detected in 460 patients (94.7%) out of 486 cases of methylmalonic acidemia combined with homocysteinemia. MUT mutations were found in 158 (90.3%) out of 169 cases of isolated methylmalonic acidemia. The development of 59 patients detected by newborn screening were normal; 918 cases (97.2%) were diagnosed after onset accepted the treatment. Forty-five of them completely recovered with normal development. Twenty-six patients (2.7%) died; 873 (92.5%) patients had mild to severe psychomotor retardation. Methylmalonic acidemia were found in 35 out of 165 fetuses by metabolites assay of amniotic fluid and amniocytes gene analysis. Conclusion Combined methylmalonic acidemia and homocysteinemia is the common type of methylmalonic acidemia in the mainland of China. CblC defect due to MMACHC mutations is the most common type of methylmalonic acidemia combined with homocysteinemia. MUT gene mutations are frequent in the patients with isolated methylmalonic acidemia. Newborn screening is key for the early diagnosis and the better outcome. Combined diagnosis of biochemical assays and gene analysis are reliable for the prenatal diagnosis of methylmalonic acidemia.