Objective To evaluate the feasibility, safety and efficacy of a new homemade device for percutaneous closure of secundum atrial septal defects (ASDs) Methods Percutaneous closure of surgically created fossa ovalis ASD was attempted in 8 piglets The device was braided from Nitinol wires in the shape of two flat discs with a short connecting waist with a diameter corresponding to that of the defect to be closed Polyethylene filling was implanted to enhance thrombogenicity Pulmonary arteriography with levo phase was obtained before closure and immediately after closure Transthoracic echocardiography with color Doppler was used in all animals during closure and in follow up examinations The animals were killed at various intervals up to 6 months after occlusion for microscopic examination Results Successful placement of the device was achieved in all the 8 animals All ASDs were completely occluded in 1 month, observed by transthoracic echocardiography Postmortem gross and microscopic examination of the 8 specimens 1 to 6 months after placement showed complete or near complete fibrous neoendocardium coverage of both the right and left atrial discs Conclusion These observations show the feasibility of occlusion of secundum ASDs by the homemade device with the advantages of easy placement and repositionability in piglets

Objective To investigate the relationship between angiotensinogen(AGT)gene M235T polymorphism and the onset of chronic heart failure(CHF).Methods Polymerase chain reaction combined with restrictive fragment length polymorphism was used to detect the M235T variants of AGT gene in 111 CHF cases,accompanied with 110 healthy controls.Results Three kinds of AGT genotypes were detected,which were MM、MT and TT genotype separately.The frequencis of TT genotpye were higher in CHF cases than in healthy controls,and there was statistical significance in old aged group(P =0.042).The odds ratio(OR)with CHF of TT genotype was 3.367 compared with non-TT genotypes in old aged group.Conclusion The M235T polymorphism of AGT gene is associated with the occurrence of CHF in old aged group and TT genotype might be one of the genetic risk factors of CHF in such place of old aged population.

Objective To explore the Application value of hand acupuncture holographic method in endosco -py.Methods According to randomized controlled holographic method ,200 patients who underwent endoscopy were divided into the hand acupuncture holographic group (68 cases),the hand acupuncture group (65 cases) and the con-trol group(67 cases).The hand acupuncture holographic group pushed the needle sticking and made use of press and hand acupuncture combination of both methods ,and the hand acupuncture group was taken hand-hole method ,and the control group was taken normal gastroscopy operation .A questionnaire survey ( after checking the content of what dis-comfort,fear,are you willing to accept gastroscopy retest ) was taken and observed the patient's discomfort after the op-eration that nausea,vomiting,abdominal distension and pain,salivation volume,mirror smooth interpolation degree. Results The subjective feelings of the hand acupuncture holographic group were better than those of the hand acu -puncture group and the control group (all P<0.05);The adverse reactions of the hand acupuncture holographic group were lower than those of the hand acupuncture group and the control group before and during the endoscopy ( all P<0.05).Conclusion The hand acupuncture holographic therapy is a combination method of hand side of the second metacarpal holographic acupuncture massage gastroscopy which can reduce pain and fear of the patients ,and its side effects is small ,and it is inexpensive ,the risk factor is small ,and it is easy to operate easy to spread .

Objective To evaluate the prospective electrocardiograph (ECG)-gated 128-slice spiral CT angiography in the diagnosis of complex congenital heart disease and airway abnormality in children.Methods Eighty children with congenital heart disease received prospective (n =40) or retrospective ECG-gated 128-slice spiral CT angiography (n =40).All of the patients underwent ultrasound cardiogram (UCG) within one week before CTA exmination.The image quality and the effective radiation dose were statistically analyzed using independent samples t test and x2 test.The surgical results were taken as the diagnostic standards,and the preoperative prospective and retrospective CT angiography data were compared with UCG results using x2 test.Results The effective dose of prospective ECG-gated CT angiography[(1.00 ± 0.26)mSv] was reduced by 86％ as compared with the retrospective ECG-gated CT angiography[(7.37 ± 0.52) mSv] (t =69.296,P ＜ 0.01).Image quality was graded 0 in none patients,graded 1 in 2 patients who underwent prospective ECG-gated CT angiography,graded 2 in 8 and 1 patient who received prospective and retrospective ECG-gated CT angiography respectively,and graded 3 in 30 and 39 patients who underwent prospective and retrospective ECG-gated CT angiography,respectively.There was no significant difference in image quality between prospective and retrospective ECG-gated CT angiography (x2 =0.044,P ＞ 0.05).The definitive diagnosis of extracardiac vascular anomalies was made in 98.3％(59/60) of patients by using prospective and retrospective ECG-gated CT angiography,which were significantly superior to UCG results[(76.7％ (46/60),76.7％ (45/59),respectively] (x2 =13.144,12.644,P ＜ 0.01),and there was no significant difference in the definitive diagnosis between prospective and retrospective ECG-gated CT angiography (x2 =0.001,P ＞ 0.05).The definitive diagnosis of the cardiac/large-vessel malformations was made in 100％ of the patients by both prospective and retrospective ECG-gated CT angiography,and there was no significant difference between 128-slice spiral CT angiography results and UCG results [97.2％ (35/36),97.3％ (36/37),respectively] (x2 =1.014,0.001,P ＞0.05).In the cardiac malformations,the definitive diagnosis by prospective and retrospective ECG-gated CT angiography was 88.7 ％ (47/53) and 92.5 ％ (49/53),and there was no significant difference between 128-slice spiral CT angiography results and UCG results [98.1％ (52/53),98.1％ (52/53),respectively](x2 =3.824,1.889,P ＞ 0.05),and no significant difference in the definitive diagnosis was observed between prospective and retrospective ECG-gated CT angiography (x2 =0.442,P ＞ 0.05).In addition,the 128-slice spiral CT angiography detected airway abnormality in 9 cases who underwent prospective or retrospective ECG-gated CT angiography.Conclusion The prospective ECG-gated 128-slice spiral CT angiography exhibits great application value in the preoperative diagnosis of complex congenital heart disease,which helps to develop surgical program and evaluate surgical risks.

Objective To study the clinical experience of extracorporeal circulation management in modified total arch replacement combined with stented elephant trunk.Methods Fifty-eight patients with Stanford A aortic dissection underwent modified total arch replacement combined with stented elephant trunk.With the modified surgical technique,the technology of extracorporeal circulation was also modified with bilateral antegrade cerebral perfusion,the management of the temperature and blood protection.Results All patients were operated successfully.The operative time was 248-485 (396 ± 67) min,extracorporeal circulation time was 175-260 (181 ± 33) min,cross clamp time was 64-104 (85 ± 12) min,stop circulation time was 22-48 (32 ± 5) min,and selective cerebral perfusion time was 26-54 (39 ± 7) min.The ventilator assisted breathing time was 5.0-35.5 (23.0 ± 4.5) h,and ICU monitoring time was 24-140 (88 ± 12) h.Postoperative complications included transient neurologic deficit in 3 cases (5.2％,3/58),renal dysfunction in 5 case (8.6％,5/58),and pulmonary infection in 4 cases (6.9％,4/58).Conclusion To modified total arch replacement combined with stented elephant trunk,the modified management of extracorporeal circulation with bilateral antegrade cerebral perfusion,the management of temperature and blood protection,has a low prevalence of morbidity and mortality.

Corticotropin-releasing hormone(CRH) is the key regulator during stress reaction which integrates endocrine,autonomic,immune and behavioral responses to stressors.Receptors mediating the action of CRH have been identified as CRH-R1,CRH-R2 and CRH-R3.In the process of stress reaction,CRH mainly interacts with CRH-R1 and CRH-R2,producing multiple physiological and pathological effects.In recent years,by employing transgenic animals,selective CRH-receptor antagonists and special CRH-receptor agonists,the effect of CRH receptors on stress reaction and its mechainisms have been deeply realized.

Child ; Humans ; Vascular Calcification ; diagnosis

Objective To investigate the changes of the cervical spinal cord in patients with relapsing-remitting multiple sclerosis (RRMS) and relapsing neuromyelitis optica (RNMO) using diffusion tensor imaging (DTI) and to analyze its correlations with clinical disability scores.Methods Thirty patients with MS (MS group),28 patients with NMO (NMO group) and 20 healthy volunteers were imaged using DTI on a 3.0 Tesla scanner.DTI indices of cervical spinal cord from all participants were measured,including mean diffusivity (MD) and fractional anisotropy (FA),and the correlations between the DTI metrics and the expanded disability status scale (EDSS) scores were assessed.One-way ANOVA,Dunnett-t test and Spearman correlation analysis were used for statistics.Results (1) The values of MD among three groups were different at C3 level for left lateral and dorsal columns,C4 level for the central gray substance and dorsal columns,and C5-C6 level for all structures.There were significant differences among them (F =4.006-36.814,P ＜ 0.05).The values of FA were significantly different at all levels (F =5.561-98.128,P ＜0.05).(2) Compared with the control group,the values of MD were increased and FA were decreased for both MS and NMO groups,there were significant differences among them (t =-0.320-3.138,P ＜0.05).In MS and NMO groups,there were no significant differences of MD (t =-1.183-0.069,P ＞0.05),while the FA at C4-C6 levels (including the central gray substance,dorsal columns,right lateral columns and left lateral columns) for NMO group were 0.57 ± 0.09,0.56 ± 0.11,0.54 ±0.10,0.57±0.09,0.55 ±0.11,0.52 ±0.13,0.55 ±0.11,0.54 ±0.13,0.54±0.10,0.54±0.11,0.53 ±0.13,0.52 ±0.11 ;and for MS group were 0.67 ±0.10,0.68 ±0.10,0.68 ±0.10,0.70 ±0.12,0.68 ±0.11,0.69±0.10,0.68 ±0.11,0.69 ±0.12,0.67 ±0.14,0.68 ±0.15,0.69 ±0.14,0.69 ±0.16,and there were significant differences between two groups (t =-0.011-0.169,P ＜ 0.05).(3)Univariate correlations between DTI measures and the average EDSS scores were assessed.The MD at all levels showed significant positive correlations with disability scores (r =0.324-0.541,P ＜ 0.05),and FA significant negative correlated with disability scores (r =-0.632--0.294,P ＜ 0.05),except C4 level for lateral columns and C2 level.Conclusions DTI metrics are sensitive to cervical spinal cord damage in demyelinating diseases,providing an important way of distinguishing MS from NMO,and can be potentially useful quantitative biomarkers for monitoring the evolution of demyelinating diseases.

Objective To look for a reliable and convenient judgement criteria for the screening of cytomegalovirus pneumonia in order to reduce misdiagnosis and resulted mistherapy.Methods Process collected data on fifty-six cytomegalovirus pneumonia and forty-two common viruses induced asthmatic bronchitis cases by use of discriminant analysis to construct prediction model of diagnosis result.Results Only three indexes including age,lymph count and platelet count were selected into the model via sift.The performance of the established screening model showed as follows:sensitivity was 80.36％,specificity was 80.95％,misdiagnosis rate was 19.05％,false negative rate was 19.64％,diagnostic accordance rate was 80.61％.Conclusion Being concise and of strong maneuverability and high accuracy in prediction,cytomegalovirus pneumonia diagnosis model constructed through discriminant analysis can provide powerful screening means for medical staff.

[ ABSTRACT] AIM:To investigate the characteristics of the intestinal microbial flora in the pregnant women with congenital heart disease fetus ( PW group) and normal pregnant women ( NW group) .METHODS: Stool samples were collected from 15 NW and 17 PW cases.The bacterial genomic DNA was extracted.The 16S rDNA was amplified by PCR, and the second generation of Illumina sequencing was conducted.RESULTS: We obtained 2 696 276 ( NW group) and 2 445 530 ( PW group) optimized sequences.The coverage was greater than 97%.We obtained 77 243 operational taxono-mic units ( OTUs) in NW group and 75 600 OTUs in PW group after a 97%similarity merge.In NW group, the Chao 1 in-dex and the Shannon index were greater than those in PW group.The diversity analysis of microbial population indicated that they were mainly composed of Firmicutes, Proteobacteria and Actinobacteria.In family, the Bifidobacteriaceae and Cori-obacteriaceae were significantly different through analysis of variance.CONCLUSION: The Bifidobacteriaceae and Cori-obacteriaceae may play an important role in the occurrence of congenital heart disease.