Objective To assess the changes of structure and function of the moderate mitral valvular regurgitation before and after percutaneous coronary intervention ( PCI ) by real-time 3-dimensional transthoracic echocardiography ( RT 3D-TTE) . Methods Thirty-two patients with acute myocardial infarction( AMI) and moderate mitral regurgitation were enrolled in the study ,while 30 healthy subjects were selected as the control group . All patients accepted RT 3D-TTE ,the imaging was analyzed offline with TomTec 4D MV-Assessment software . The mitral valve structure and function parameters were measured . All AMI patients were performed RT 3D-TTE at 12 hours before PCI ,1 week and 3 months after PCI . According to whether improved at 3 months after PCI ,patients with moderate mitral regurgitation were dividedintotwogroups:improvementgroupandnoimprovementgroup.Results ①Comparedwiththe control group ,anterior-posterior ( AP) diameter ,anterolateral-posteromedial ( AL-PM ) diameter ,annular circumference(AC) ,commissural diameter(CD) ,three-dimensional annular area(AA3D) ,tenting volume (TV) ,tenting height(TH) ,nonplanarity angle(NPA)of mitral regurgitation group were larger( P <0 .05) , annular height ( AH ) and maximum annular displacement ( ADMax ) ,and maximum annular displacement velocity( ADVMax ) of mitral regurgitation group were smaller( P <0 .05) . ②At three months after PCI ,20 patients with moderate mitral regurgitation were improved ( effective regurgitant orific area < 0 .2 cm2 ) , twelve patients with moderate mitral regurgitation were not improved . Compared with mitral valve parameters before PCI and at one week after PCI ,AP ,AL-PM ,AC ,CD ,AA3D ,and TV in improvement group were discreased at three months after PCI( P < 0 .05) ,AH was increased ( P < 0 .05) . Compared with mitral valve parameters before PCI ,mitral valve structure and function parameters after PCI were not improved ,compared with those in no improvement group ,AP ,AL-PM ,AC ,CD ,and AA3D in improvement group were smaller( P < 0 .05) . ③ By analysis of ROC curves AP ,AL-PM ,AC ,and CD for diagnosing mitral regurgitation had good test effectiveness . Conclusions In patients with acute myocardial infarction and moderate mitral regurgitation ,the mitral annular is not only presented as the size enlargement but also the flattening of its geometric shape and the decrease of its dynamic ,while structure and function parameters of the mitral valve before PCI can predict improvement of mitral regurgitation and provide a reference for the development of clinical programs .

Objective: To investigate the clinical manifestations and pathological changes of salivary duct carcinoma (SDC) and the relationship between them, so as to provide reference for the diagnosis of SDC. Methods: In this retrospective analysis 40 cases of SDC diagnosed from January 2012 to August 2018 in the Department of Pathology of the First Affiliated Hospital of Zhengzhou University were enrolled and the clinical and pathological characteristics were analyzed, 29 were male and 11 were female, the ratio of male to female was 2.64∶1, the median age was 59.0 years, the average course of disease was 3.5 years. The reported cases of SDC were reviewed and compared with patients of this study. Results: Among the 40 patients, 24 cases occurred in parotid gland, 9 cases in submandibular gland and 7 cases in small salivary glands; 24 cases had cancer cell infiltration and invasion of adjacent tissues, 11 cases had lymph node metastasis and 9 cases had distant metastasis at the time of diagnosis. Pathological results showed that 27 cases belonged to primary salivary duct carcinoma, 13 cases belonged to malignant transformation of pleomorphic adenoma; 10 cases invaded local nerve, 22 cases invaded glandular lobules and ducts. Immunohistochemical results showed that 33 cases were positive for androgen receptor, 27 cases were positive for cytokeratin-7, 22 cases were positive for human epidermal growth factor receptor-2, 8 cases were positive for gross cyst disease fluid protein 15. The proliferation index of nuclear antigen Ki-67 ranged from 10% to 90%. Among them 18 cases were over 50% and 22 cases were below 50%. Conclusions Salivary duct carcinoma is a rare and highly malignant tumor of the salivary gland. Accurate pathological diagnosis is helpful to inhibit the early local recurrence, distant metastasis and improve survival rate of salivary duct carcinoma.