BACKGROUND:The development and evolution of atlas are complex,and there are a few research reports. CT imaging can show the normal development process,anatomical structure,developmental variation and deformity of the axis. It has important clinical value to clarify the time of occurrence of ossification center of axis and closure of epiphyseal plate and its evolution process and law.OBJECTIVE:To present the anatomical structure of the normal development and variation of children's axis based on CT images.METHODS:CT images obtained from 732 children aged 0 to 15 years who underwent neck scans between June 2016 and November 2019 were retrospectively analyzed. The observation indicators encompassed the axis odontoid,bilateral pedicle,vertebral ossification center,secondary ossification center at the tip of odontoid,pedicle,base of odontoid,and posterior median epiphyseal plate,as well as any variations or deformities in axis development. The changes in these indicators were analyzed and compared across different age groups. SPSS 17.0 statistical software package was utilized for data classification and statistical analysis. RESULTS AND CONCLUSION:(1) A total of 732 subjects were examined,comprising 718 cases (98.1％) with normal development of the axis and 14 cases (1.9％) exhibiting deformity or dysplasia. (2) The axis demonstrated the presence of five ossification centers,including those of the bilateral pedicles,odontoid process,and vertebral body,which were observed at birth. The median age for the secondary ossification center located at the tip of the odontoid process was determined to be 5.7 years,with an interquartile range of 4.1 to 7 years. The earliest recorded occurrence was observed at 8 months and 22 days,while the latest occurrence was noted at 12 years and 10 months. (3) The median age at which fusion took place was 6 years,with an interquartile range of 5-8 years. The maximum age at which non-fusion was observed was 8 years and 9 months,while the minimum age at which fusion occurred was 4 years and 3 months. (4) The median age at which bilateral epiphyseal plate closure occurred was approximately 3.8 years,with an interquartile range of about 2.9-4.6years. The earliest observed closure was at 2 years and 3 months,while the latest observed unclosure was at 6 years old. (5) The median age at which odontoid base epiphyseal plate closure occurred was 5.2 years,with an interquartile range of 3.5-6.8 years. The minimum age for closure was 2 years and 6 months,and the latest age for non-closure was 9 years and 6 months. (6) The posterior median epiphyseal plate typically closed at a median age of 1.5 years,with an interquartile range of 1.0-2.1 years. However,two cases exhibited delayed closure,occurring at ages 2 years and 5 months,and 14 years,respectively. Theearliest closure observed was at 6 months and 20 days. (7) Axis malformation or developmental abnormalities,including 7 cases of accessory ossification center and accessory epiphyseal plate,3 cases of free ossified small bones in the axis,2 cases of posterior median epiphyseal plate failure,2 cases of secondary ossification centers in the absence of the apex of odontosis,and 1 case of absence at ossification center in the odontoid of the armature vertebrae. (8) It is concluded that the utilization of multi-slice spiral CT scanning in conjunction with the multi-plane reconstruction technique enables comprehensive visualization of the anatomical structure of the axis,facilitating precise assessment of both its typical developmental variations and deformities.

Objective To investigate the protective effects and potential mechanisms of tetrahydrocurcumin(THC)on thoracic aortic aneurysm and dissection(TAAD)in mice.Methods TAAD was induced in 3-week-old C57BL/6J mice by oral administration of β-aminopropionitrile(BAPN)(diluted in drinking water,1 g/(kg·d)).Eighty mice were divided randomly into Con,BAPN,BAPN+THC,and BAPN+THC+3-TYP(SIRT3 inhibitor)groups(n=20 mice per group).The survival rate of mice in each group was recorded after 4 weeks.The maximum diameter of the aorta was measured and the histomorphology and aortic wall elastin integrity were evaluated by hematoxylin and eosin and elastin van Gieson staining.Macrophage infiltration was detected by immunohistochemical staining and α-smooth muscle actin(α-SMA)and osteopontin(OPN)expression were detected by immunofluorescence staining.The production of reactive oxygen species(ROS)was measured by dihydroethidium staining and superoxide dismutase(SOD)activity and malondialdehyde(MDA)levels were determined using kits.Protein expression levels of matrix metalloproteinase(MMP)2,MMP9,interleukin(IL)-6,tumor necrosis factor(TNF)-α,nuclear factor erythroid 2-related factor 2(NRF2),NADPH oxidase 2(NOX2),α-SMA,OPN,sirtuin 3(SIRT3),Ac-SOD2,and SOD2 were measured by Western Blot.Results Mice in the BAPN+THC group showed significantly higher survival and a lower incidence of TAAD compared with the BAPN group and the degree of aortic dilatation and morphology and structure were improved(P＜0.05).Infiltration of CD68-positive macrophages and MMP2,MMP9,IL-6,and TNF-α expression levels were lower(P＜0.05),ROS generation,MDA content,and NOX2 expression in aortic tissue were also significantly decreased,while SOD activity and NRF2 expression were increased(P＜0.05).α-SMA expression was also increased,while OPN expression was reduced(P＜0.05).SIRT3 expression was increased while the Ac-SOD2/SOD2 ratio was decreased(P＜0.01).Treatment with the SIRT3-specific inhibitor and silencing of SIRT3 counteracted the ability of THC to resist TAAD via the SIRT3 signaling pathway(all P＜0.05).Conclusions THC alleviated inflammation and oxidative stress in aortic tissues by activating the SIRT3 signaling pathway,thus inhibiting the phenotypic transformation of vascular smooth muscle cells and resisting the formation of TAAD in mice.

BACKGROUND:The development and evolution of atlas are complex,and there are a few research reports. CT imaging can show the normal development process,anatomical structure,developmental variation and deformity of the axis. It has important clinical value to clarify the time of occurrence of ossification center of axis and closure of epiphyseal plate and its evolution process and law.OBJECTIVE:To present the anatomical structure of the normal development and variation of children's axis based on CT images.METHODS:CT images obtained from 732 children aged 0 to 15 years who underwent neck scans between June 2016 and November 2019 were retrospectively analyzed. The observation indicators encompassed the axis odontoid,bilateral pedicle,vertebral ossification center,secondary ossification center at the tip of odontoid,pedicle,base of odontoid,and posterior median epiphyseal plate,as well as any variations or deformities in axis development. The changes in these indicators were analyzed and compared across different age groups. SPSS 17.0 statistical software package was utilized for data classification and statistical analysis. RESULTS AND CONCLUSION:(1) A total of 732 subjects were examined,comprising 718 cases (98.1％) with normal development of the axis and 14 cases (1.9％) exhibiting deformity or dysplasia. (2) The axis demonstrated the presence of five ossification centers,including those of the bilateral pedicles,odontoid process,and vertebral body,which were observed at birth. The median age for the secondary ossification center located at the tip of the odontoid process was determined to be 5.7 years,with an interquartile range of 4.1 to 7 years. The earliest recorded occurrence was observed at 8 months and 22 days,while the latest occurrence was noted at 12 years and 10 months. (3) The median age at which fusion took place was 6 years,with an interquartile range of 5-8 years. The maximum age at which non-fusion was observed was 8 years and 9 months,while the minimum age at which fusion occurred was 4 years and 3 months. (4) The median age at which bilateral epiphyseal plate closure occurred was approximately 3.8 years,with an interquartile range of about 2.9-4.6years. The earliest observed closure was at 2 years and 3 months,while the latest observed unclosure was at 6 years old. (5) The median age at which odontoid base epiphyseal plate closure occurred was 5.2 years,with an interquartile range of 3.5-6.8 years. The minimum age for closure was 2 years and 6 months,and the latest age for non-closure was 9 years and 6 months. (6) The posterior median epiphyseal plate typically closed at a median age of 1.5 years,with an interquartile range of 1.0-2.1 years. However,two cases exhibited delayed closure,occurring at ages 2 years and 5 months,and 14 years,respectively. Theearliest closure observed was at 6 months and 20 days. (7) Axis malformation or developmental abnormalities,including 7 cases of accessory ossification center and accessory epiphyseal plate,3 cases of free ossified small bones in the axis,2 cases of posterior median epiphyseal plate failure,2 cases of secondary ossification centers in the absence of the apex of odontosis,and 1 case of absence at ossification center in the odontoid of the armature vertebrae. (8) It is concluded that the utilization of multi-slice spiral CT scanning in conjunction with the multi-plane reconstruction technique enables comprehensive visualization of the anatomical structure of the axis,facilitating precise assessment of both its typical developmental variations and deformities.

Objective To investigate the protective effects and potential mechanisms of tetrahydrocurcumin(THC)on thoracic aortic aneurysm and dissection(TAAD)in mice.Methods TAAD was induced in 3-week-old C57BL/6J mice by oral administration of β-aminopropionitrile(BAPN)(diluted in drinking water,1 g/(kg·d)).Eighty mice were divided randomly into Con,BAPN,BAPN+THC,and BAPN+THC+3-TYP(SIRT3 inhibitor)groups(n=20 mice per group).The survival rate of mice in each group was recorded after 4 weeks.The maximum diameter of the aorta was measured and the histomorphology and aortic wall elastin integrity were evaluated by hematoxylin and eosin and elastin van Gieson staining.Macrophage infiltration was detected by immunohistochemical staining and α-smooth muscle actin(α-SMA)and osteopontin(OPN)expression were detected by immunofluorescence staining.The production of reactive oxygen species(ROS)was measured by dihydroethidium staining and superoxide dismutase(SOD)activity and malondialdehyde(MDA)levels were determined using kits.Protein expression levels of matrix metalloproteinase(MMP)2,MMP9,interleukin(IL)-6,tumor necrosis factor(TNF)-α,nuclear factor erythroid 2-related factor 2(NRF2),NADPH oxidase 2(NOX2),α-SMA,OPN,sirtuin 3(SIRT3),Ac-SOD2,and SOD2 were measured by Western Blot.Results Mice in the BAPN+THC group showed significantly higher survival and a lower incidence of TAAD compared with the BAPN group and the degree of aortic dilatation and morphology and structure were improved(P＜0.05).Infiltration of CD68-positive macrophages and MMP2,MMP9,IL-6,and TNF-α expression levels were lower(P＜0.05),ROS generation,MDA content,and NOX2 expression in aortic tissue were also significantly decreased,while SOD activity and NRF2 expression were increased(P＜0.05).α-SMA expression was also increased,while OPN expression was reduced(P＜0.05).SIRT3 expression was increased while the Ac-SOD2/SOD2 ratio was decreased(P＜0.01).Treatment with the SIRT3-specific inhibitor and silencing of SIRT3 counteracted the ability of THC to resist TAAD via the SIRT3 signaling pathway(all P＜0.05).Conclusions THC alleviated inflammation and oxidative stress in aortic tissues by activating the SIRT3 signaling pathway,thus inhibiting the phenotypic transformation of vascular smooth muscle cells and resisting the formation of TAAD in mice.

Objective:To research and design a negative pressure environment that can be applied in container type of biological isolation shelter,so as to meet the stable negative pressure environment and dynamic intelligent regulation of pressure difference in the container during multimodal transportation,especially under air freight conditions.Methods:The design specifications and research achievements of pressure differences of negative pressure isolation equipment for infectious diseases at home and abroad were comprehensively analyzed.And then,one kind of power-distributed ventilation system without air duct was designed to achieve.The preseted pressure redundancy,real-time monitoring of sensors and dynamic follow-up of pressure were used to realize stable and intelligent regulation of negative pressure within the container during air freight.Results:After testing,the pressure differences of each region of the"three regions and two channels"included clean region,buffer region,contamination region,medical staff passage and patient passage within container type of biological isolation shelter under the negative pressure environment could meet the preseted requirements.The values of pressure differences at the outside of room of clean region,the toilet of clean region,the toilet of clean region of the second dressing room of the buffer region,the contamination region of the first dressing room of the buffer region,the toilet of contamination region and the outside of the room of contamination region were respectively 34.2,38.8,-8.0,-31.7,-15.1 and-44.6.The conditions of the pressure differences within each region of container,which dynamically met the requirements of Biosafety Level-Ⅲ(BSL-3)laboratory,were tested through the sensors,and intelligent display and control equipment that deployed inside of container.Conclusion:The stable negative pressure environment and intelligent regulation for pressure difference in each region of the container can take container to have more high biosafety characteristics,which can effectively ensure the safe transportation of whole region for patients with severe infectious diseases,and the transport and treatment under air freight condition.

Objective To obtain the range of anatomical parameters of healthy knee joints in Chinese males and validate a statistical shape model(SSM)based on the geometric shape of a healthy knee to provide references for the design of knee SSM-based prostheses.Methods Computed tomography(CT)images of knee joints from 112 healthy males were acquired to build three-dimensional(3D)knee joint models.Each model was the target model separately,and the remaining models were used as the training set for principal component analysis(PCA).The obtained knee SSM was fitted to the target model to predict the SSM.The exact anatomical measurement points were marked on the sample and SSM prediction models,and 17 linear and 3 angular parameters were derived.The values of the anatomical parameters were statistically tested using an independent samples t-test and Mann-Whitney U-test,and the validity of the SSM in terms of geometric shape was demonstrated if the resulting P-values were all greater than 0.05.Results Qualitative and quantitative comparative analyses of anatomical parameters showed that the mean deviation of linear parameters was less than 6 mm,and that of angular parameters was less than 2.5°.The results of statistical tests showed P＞0.05 for all anatomical parameters,proving that the knee SSM prediction model was not statistically different from the true healthy model in terms of geometric shape.Conclusions This study derived a reference range of anatomical parameters for a healthy knee and demonstrated that the knee SSM model was consistent with the real healthy model in terms of shape.The results provide a reference for the design of knee SSM-based prostheses.

Objective:To systematically compare the safety and reliability of remodeling and reimplantation in aortic root valve preservation surgery for acute Stanford type A aortic dissection.Methods:We searched the databases of CNKI, VIP, Wanfang, CBM, Pubmed, EMBASE, Cochrane Central Register of Controlled Trials ( CENTRAL ) to find the clinical controlled research literature on acute type A aortic dissection remodeling and replantation. The relevant outcome indicators were analyzed by Review Manager 5.3 combined with Stata15.0 statistical software.Results:Seven studies involving 356 patients were included. Remodeling surgery versus replantation surgery. There was a higher incidence of postoperative grade Ⅱ or Ⅲ aortic regurgitation( OR=5.56, 95% CI: 1.89-16.41, P<0.05 ), higher 5-year reoperation rate ( OR=7.50, 95% CI: 2.11-26.65, P<0.05 ), shorter cardiopulmonary bypass time ( MD=-20.81, 95% CI: -35.08-6.54, P< 0.05 ), and longer aortic occlusion time ( MD=35.23, 95% CI: 21.21-49.26, P<0.05 ). The 30-day/in-hospital mortality( OR=1.09, 95% CI: 0.56-2.13, P>0.05) , postoperateive secondary thoracotomy for hemostasis( OR=2.91, 95% CI: 0.34-24.99, P>0.05), the rate of reoperation 1 year after surgery( OR=1.22, 95% CI: 0.20-7.56, P> 0.05) and 5-year mortality( OR=7.50, 95% CI: 2.11-26.65, P>0.05), were no significant difference between remodeling surgery group and replantation surgery group. Conclusion:Compared with replantation surgery, remodeling surgery in patients with acute type A aortic dissection has a higher incidence of grade Ⅱ or Ⅲ aortic insufficiency, a higher rate of reoperation 5 years after surgery, a shorter duration of cardiopulmonary bypass, and a longer duration of aortic occlusion. There were no statistically significant differences in postoperative hospitalization/30-day mortality, postoperative secondary thoracotomy, reoperation rate 1 year after surgery, and late mortality using remodeling and replantation techniques, which could be selected according to the actual situation of the aortic root and the experience of the surgeon.

Objective:To compare the early and mid-term results of hybrid coronary revascularization (HCR) and minimally invasive multivessel coronary artery bypass grafting (MICS-CABG) in coronary artery disease patients with low left ventricular ejection fraction and non diabetes mellitus, and to explore the indication of HCR and MICS-CABG.Methods:A retrospective cohort analysis of HCR and MICS-CABG cases with preoperative left ventricular ejection fraction less than 0.40, and without diabetes mellitus were conducted in Xijing Hospital from January 2015 to December 2019. 36 cases in HCR group and 17 cases in MICS group were included in this study. For HCR procedure, minimally invasive left internal mammary artery(LIMA) to the left anterior descending artery (LAD) bypass surgery were performed, and followed by percutaneous coronary intervention (PCI) to treat non LAD lesion 1 to 4 weeks later. MICS-CABG procedure was performed through left anterior small thoracotomy minimally invasive direct coronary artery bypass grafting for multiple diseased vessels.Results:The preoperative SYNTAX score in MICS group was significantly higher than that in HCR group ( P<0.05). There was no perioperative death in both groups. Troponin I, postoperative drainage volume, blood transfusion volume and ventilator ventilation time in MICS group were significantly higher than those in HCR group ( P<0.05). After 12 months follow-up, no patient died in both groups. Furthermore, all LIMA grafts were patency. The stenosis rate of drug-eluting stents in HCR group was similar to that of great saphenous vein grafts in MICS group. LVEF and left ventricular end diastolic diameter of both groups were significantly improved 12 months after operation ( P<0.05). Conclusion:HCR and MICS-CABG are minimally invasive and safe treatment for multivessel coronary artery disease patients with low ejection fraction and non diabetese mellitus. The early and mid-term therapeutic effects are satisfactory. If coronary artery lesions other than LAD are suitable for PCI, HCR should be the preferred treatment.

Objective    To investigate the therapeutic effect, safety and effectiveness of multiple valvular surgery through right anterolateral intercostal thoracotomy, as well as the mid-term follow-up results and surgeon's learning curve. Methods    The clinical data of 154 patients with multiple valvular disease were performed minimally invasive cardiac surgery in the Department of Cardiovascular Surgery, The First Affiliated Hospital of Air Force Medical University, from 2015 to 2019 were retrospectively analyzed. There were 103 males and 51 females, aged 23-68 years. Closed cardiopulmonary bypass was established through femoral artery and femoral vein, and the thoracic cavity was entered through a 6 cm transverse incision in the fourth intercostal space on the right side of sternum. Baseline and perioperative characteristics and postoperative outcomes were reviewed. Results    There was no perioperative death. The average cardiopulmonary bypass time was 159.3±39.4 min, and the aortic clamping time was 102.3±20.3 min. One patient underwent thoracotomy during the operation, and two patients underwent second thoracotomy for hemostasis. During the follow-up period of 10-55 months, 1 patient died, 2 patients developed mild perivalvular regurgitation, 6 patients developed moderate tricuspid regurgitation, and no serious cardiovascular events occurred in the rest of the patients. Conclusion    Our findings demonstrate that multiple valvular surgery through right anterolateral intercostal thoracotomy is safe, and in an acceptable risk of complication. The early and middle follow-up results are satisfactory. The minimally invasive cardiac surgery can also meet the requirements of cosmetology, and is conducive to the recovery of patients' mental and physical health. This method is worthy of application in medical centers with rich experience in routine cardiac surgery.

Objective    To evaluate the prognosis of interventional treatment with covered stent graft for retrograde Stanford type A aortic dissection and intramural hematoma by single-arm meta-analysis. Methods    Related studies on treating retrograde Stanford type A aortic dissection and intramural hematoma with covered stent graft were retrieved from the databases by computer, including PubMed, EMbase, The Cochrane Library, Wanfang Data, VIP, CNKI and CBM, from inception to January 2020. Literatures were screened by researchers step by step according to the predefined inclusion and exclusion criteria. Quality of the enrolled literatures was evaluated, and data were extracted from the included studies. Afterwards, single-arm meta-analysis was carried out by the R3.6.3 software. Results    A total of 12 English and 5 Chinese studies were included, which were all case series, and the quality of all literatures was moderate evaluated by Newcastle-Ottawa Scale (NOS). After analyzing the clinical prognosis of 260 patients, the 30-day mortality was 6% (95%CI 0.04 to 0.11, P=0.97), the late mortality was 8% (95%CI 0.05 to 0.14, P=0.78), the incidence of endoleak was 21% (95%CI 0.16 to 0.29, P=0.06), the incidence of stroke was 5% (95%CI 0.03 to 0.09, P=0.99), the incidence of new aortic dissection was 7% (95%CI 0.04 to 0.11, P=0.96), the incidence of dissection progression was 10% (95%CI 0.07 to 0.16, P=0.24), and the absorption rate of intramural hematoma was 84% (95%CI 0.37 to 1.00, P<0.01). Conclusion    Interventional treatment with covered stent graft for retrograde Stanford type A aortic dissection and intramural hematoma can obtain good early treatment results for some patients, and can be used as a safe and effective treatment for aged patient with high risk who cannot tolerate surgery. Endoleak, stroke and new aortic dissection are the early serious complications of this method.