Transcranial magneto-acoustic electrical stimulation (TMAES) is a novel method of brain nerve regulation and research, which uses induction current generated by the coupling of ultrasound and magnetic field to regulate neural electrical activity in different brain regions. As the second special envoy of nerve signal, calcium plays a key role in nerve signal transmission. In order to investigate the effect of TMAES on prefrontal cortex electrical activity, 15 mice were divided into control group, ultrasound stimulation (TUS) group and TMAES group. The TMAES group received 2.6 W/cm ² and 0.3 T of magnetic induction intensity, the TUS group received only ultrasound stimulation, and the control group received no ultrasound and magnetic field for one week. The calcium ion concentration in the prefrontal cortex of mice was recorded in real time by optical fiber photometric detection technology. The new object recognition experiment was conducted to compare the behavioral differences and the time-frequency distribution of calcium signal in each group. The results showed that the mean value of calcium transient signal in the TMAES group was (4.84 ± 0.11)% within 10 s after the stimulation, which was higher than that in the TUS group (4.40 ± 0.10)% and the control group (4.22 ± 0.08)%, and the waveform of calcium transient signal was slower, suggesting that calcium metabolism was faster. The main energy band of the TMAES group was 0-20 Hz, that of the TUS group was 0-12 Hz and that of the control group was 0-8 Hz. The cognitive index was 0.71 in the TMAES group, 0.63 in the TUS group, and 0.58 in the control group, indicating that both ultrasonic and magneto-acoustic stimulation could improve the cognitive ability of mice, but the effect of the TMAES group was better than that of the TUS group. These results suggest that TMAES can change the calcium homeostasis of prefrontal cortex nerve clusters, regulate the discharge activity of prefrontal nerve clusters, and promote cognitive function. The results of this study provide data support and reference for further exploration of the deep neural mechanism of TMAES.
Acoustics ; Animals ; Brain ; Calcium ; Electric Stimulation ; Mice ; Prefrontal Cortex ; Transcranial Direct Current Stimulation ; Transcranial Magnetic Stimulation

Objective:Analyze the effect of intracardiac method and upturning method in the treatment of infracardiac total anomalous pulmonary venous connection(TAPVC), to explore the surgical method of infracardiac TAPVC.Methods:From July 2011 to August 2019, 20 patients with infracardiac TAPVC were treated, including 12 cases with upturning method and 8 cases with intracardiac method. The cardiopulmonary bypass time, aortic cross-clamp time, delayed thoracic closure, ICU time, mechanical ventilation time, postoperative days and anastomotic flow rate were compared between the two groups.Results:There was no significant difference in cardiopulmonary bypass time, aortic cross-clamp time, delayed thoracic closure, ICU time and mechanical ventilation time between the two groups. The postoperative hospital stay in upturning group was significantly lower than that in intracardiac group [(14.7±2.9)days vs.(16.1±6.2)days, P<0.05], and the postoperative anastomotic velocity > 120 cm/s in intracardiac group was significantly less than that in upturning group(1 case vs. 7 cases, P<0.05). Two patients died in upturning group, but there was no significant difference compared with the intracardiac group. Conclusion:There is no significant difference between the two methods in the treatment of subcardiac TAPVC. The authors think that the exposure of the upturning methods is difficult, and the distortion of the anastomosis may be hidden trouble. The in situ anastomosis of the intracardiac method is not easy to make mistakes.

Objective:To explore the treatments and outcomes of heart and kidney transplantation(HKTx)and summarize its management experiences.Methods:From October 2016 to October 2020, clinical data, treatment strategies and prognosis of 11 patients received HKTx were analyzed retrospectively.In 11HKTx cases, the ratio of male-to-female was 10∶1, the age(50.6±12.9)years and the preoperative body mass index(26.72±3.29)kg/m 2.The preoperative cardiac function was class Ⅳ and the preoperative left ventricular ejection fraction(29.40±4.48)%.All patients were in uremic state pre-operation and underwent regular dialysis.The mean duration of dialysis was 2.5(0.5-7.0)years, preoperative creatinine 753.5(434-1144)μmol/L and preoperative predictive glomerular filtration rate 5.59(3.93-17.23)ml/(min preop 2). Non-staged transplant was performed and donor heart and kidney were from the same donor.The median time of cold cardiac ischemia 2.75(2.5, 4.0)hours, the median time of cold renal ischemia 9(8.5, 15.0)hours and the median time from the end of heart transplantation to the beginning of kidney transplantation 2(1.0, 3.5)hours.The immunosuppressive regimen was a combination of tacrolimus, mycophenolate mofetil and methylprednisolone. Results:Normal cardiac function and renal function normalized in 9 cases.At Month 6 post-operation, the postoperative left ventricular ejection fraction was(57.55±2.51)%, creatinine 107.7(85-132)μmol/L and urine volume in 24h 1988(1800-2200)ml.The long-term survival time was 6-62 months.No such complications as infection or rejection occurred in 9 patients.The cardiac function was class Ⅰ at Month 6 post-operation.One patient died from pulmonary mucor infection at Month 4 post-operation.Another death was due to gastrointestinal fungal infection at Month 1 after HKTx.Conclusions:HKTx is an effective treatment for end-stage heart disease with renal failure.

Objective:To explore the therapeutic strategy and result of adult total anomalous pulmonary venous connection(TAPVC).Methods:From November 2011 to November 2019, 6 adult patients with TAPVC underwent surgical correction. The Darling types include 4 cases of supracardiac , 1 case of intracardiac and 1 case of mixed type. There were 1 male and 5 female. The mean age was(28.6±4.8) years old and the mean weight was(47.3±3.67) kg. Preoperative oxygen saturation was 0.91±0.05.Results:All patients underwent primary repair successfully without perioperative death and complications. The average cardiopulmonary bypass time was(122.0±35.9) min, and the aortic cross-clamp time was(78.2±20.4) min. The mean postoperative hospitalization was(9.7±2.9) days, and the mean intensive care unit time was(3.5±1.4) days.The mean mechanical ventilation was(17.1±2.9) h. There were no later left heart dysfunction and pulmonary vein obstruction during the follow-up of 6-100 months.no pulmonary artery hypertension was identifed.Conclusion:TAPVC can be repaired savely in adult and satisfied result can be anticipated.

Objective:To summarize the experience of surgical treatment of anomalous aortic origin of the coronary artery arising from the inappropriate sinus(AAOCA) in children.Methods:Between April 2016 and November 2019, the clinical data of 9 patients with AAOCA in Anzhen Hospital were retrospectively analyzed, including 5 males and 4 females; aged from 5 month to 15 years old, with an average(11.7±5.1) years old. The clinical symptoms, auxiliary examination, treatment methods and prognosis of AAOCA patients were analyzed retrospectively.Results:The diagnosis of AAOCA was confirmed by echocardiography and coronary computed tomography angiography in all 9 cases. Left coronary arteries originated from the right coronary sinus in 4 cases, and right coronary arteries originated from the left coronary sinus in 5 cases. Two cases had a history of sudden cardiac death, and 1 case had a history of acute myocardial infarction; except for one asymptomatic case, other children had chest tightness, chest pain, syncope and other symptoms. Surgery was successfully completed in all children, included 7 cases of unroofing surgery, 1 case of coronary translocation and pulmonary translocation, and 1 case of inter-aortic release. There were no death in-hospital and serious complications. The postoperative follow-up period ranged from 3 months to 4 years. During the follow-up period, no patient died with normal heart function; 2 cases had nonspecific chest tightness and chest pain, and there was no evidence of myocardial ischemia.Conclusion:Younger AAOCA patients have a high rate of sudden cardiac death. Once diagnosed, early surgical treatment is needed. Coronary unroofing procedures and coronary translocation are recommended for AAOCA children with safe and reliable.

Objective: To compare the clinical results between arthroscopic anchor suture bridge and Ethibond suture bone tunnel for anterior cruciate ligament (ACL) tibial avulsion fractures. Methods: A retrospective case control study was conducted to analyze the clinical data of 18 patients with ACL tibial avulsion fracture admitted to Wenzhou Central Hospital from June 2012 to June 2017. There were 14 males and four females, aged 12-57 years, with an average age of 31.4 years. According to the Meyers-McKeever classification, there were six patients with type II and 12 patients with type III. Seven patients underwent anchor suture bridge fixation (anchor group), and 11 patients underwent Ethibond suture bone tunnel fixation (Ethibond suture group). The operation time, range of motion (ROM) of knee joint, Lysholm knee score and International Knee Documentation Committee (IKDC) knee score of the two groups were compared before operation and 3, 6 and 12 months after operation. Results: All patients were followed up for 12-36 months, with an average of 20.18 months. The operation time of anchor group [(87.14±8.59)minutes]was longer than that of Ethibond suture group [(71.1±11.5)minutes](P<0.05). The ROM of anchor group and Ethibond suture group was (127.1±8.6)° and (124.1±7.4)° respectively at 3 months after surgery, showing no statistical difference between the two groups (P>0.05). But the functional knee scores (Lysholm score and the IKDC score) revealed better clinical results in anchor group [(91.9±3.0)points, (85.6±4.1) points respectively] than Ethibond suture group [(88.6±3.3)points, (79.9±4.9)points respectively] at 3 months after surgery (P<0.05). There were significant differences between before and after operation within two groups regarding the knee function scores including ROM, Lysholm knee score and IKDC score (P<0.05). Three months after operation, there were significant differences between the two groups in terms of the Lysholm score and IKDC score (P<0.05), but there were no statistical differences between two groups at 6 months and 12 months after surgery (P>0.05). Conclusions Both arthroscopic anchor and Ethibond suture can achieve plane fixation of fracture, but there is no significant difference in the long-term effect of improving knee joint mobility and restoring knee joint function between the two approaches. However, the anchor group can achieve early recovery of knee joint function.

Objective To observe the expression of indoleamine 2,3-dioxy-genase(IDO) in hippocampus of rats with posttraumatic stress disorder (PTSD) and the protective effect of IDO inhibitor on neurons,and to explore the role of IDO in the pathogenesis of PTSD.Methods Adult male Wistar rats were randomly divided into the normal control group,PTSD model group and IDO inhibitor treatment group.The expression of IDO was detected by immunohistochemistry,RT-PCR and Western-blot.The apoptosis of rat hippocampal neurons was assayed by Tunel staining.Tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were detected by ELISA.Moreover behavioral evaluation was performed,including central residence time,percentage of open arm residence time and stage latency.Results Comparing with the control group,PTSD rats showed decreased central residence time ((22.65± 1.54)s),decreased percentage of open arm residence time((10.55± 1.96) ％),prolonged stage latency ((56.38±4.21) s) (P＜0.05),increased TNF-α ((8.58±0.6) pg/ml),IL-6 ((15.72±1.42) pg/ml) and IDO mRNA (0.8278±0.0796),increased IDO protein (1.2329±0.1148) expression and apoptosis rate ((81.47± 6.86) ％) in hippocampus (P＜ 0.05) (P＜ 0.05).However,rats treated with IDO inhibitor showed increased central residence time((30.78±3.20) s),increased percentage of open arm residence time ((10.55± 1.96)％),shortened stage latency ((56.38 4.21) s),meanwhile reduced expression of TNF-α((3.69±0.41) pg/ml),IL-6((7.45±0.58) pg/ml),IDO mRNA(0.2236 ±0.0387) and IDO protein(0.4235±0.0411) was detected in hippocampus(P＜0.05).Apoptosis rate ((42.54± 3.98)％) was also decreased in hippocampus(P＜0.05).Conclusion The content of TNF-α,IL-6 and IDO are increased significantly in the hippocampus of PTSD rats.IDO may participate in the pathogenesis of PTSD,and the IDO inhibitor may play a neuroprotective role in hippocampus of PTSD.

Objective To compare clinical efficacy of open radical mastoidectomy (ORM) and complete bi-style radical mastoid surgery (CRMS) and open radical mastoidectomy-mastoid tamponade(ORM-MT) treatment of cholesteatoma otitis media (COM), and explore treatment measures for cholesteatoma recurrence after surgery. Methods The 130 cases of COM patients were randomly divided into ORM group(46 cases), CRMS group (38 cases) and ORM-MT group (46 cases). The values of average air conduction hearing threshold value and Air-bone difference and recurrence rate during fol-low-up were compared. Results The values of average air conduction hearing threshold value and Air-bone difference in CRMS group after three months were significantly lower than ORM group (q=12.055, 7.761, P<0.01), the values of average air conduction hearing threshold value and Air-bone difference in CRMS group after three months were signifi-cantly lower than ORM group (q=8.764, 11.443, P<0.01). But CRMS group and ORM-MT group had no significant dif-ference (q=1.170, 0.575, P>0.05). Recurrence rate of ORM, CRMS and ORM-MT group was 5 ears (10.9%), 9 ears (23.7%) and 4 ears (8.7%), respectively. Recurrence rate of CRMS group was significantly higher than ORM group and ORM-MT group (χ2=6.640, 9.072, P<0.05). Conclusion CRMS and ORM-MT technique is superior in improving hear-ing function, but CRMS has a higher recurrence rate. Face higher neural crest and poor drainage patients should be performed radical mastoid surgery again.

Objective To study the safety and efficacy of damage control using percutaneous transhepatic biliary drainage (PTBD) in acute cholangitis of severe type (ACST) secondary to intrahepatic choledocholithiasis.Methods The clinical data of 8 patients who received PTBD after hospital admission followed by conventional surgery for ACST when their general condition improved were retrospectively studied.Results All patients received PTBD successfully and the amount of bile drained was 100-400 ml in the first day.The general condition of these 8 patients became better after 24 h and the total bilirubin decreased for about 25-100 mmol/L after 48 h.Three patients with a platelet count of less than 20 × 109/L showed an improved count to more than 50 × 109/L 72 h after PTBD.All patients were operated at different times after the PTBD:2 received T-tube drainage,3 T-tube drainage combined with left hepatectomy,and 3 choledochojejunostomy.Seven patients recovered uneventfully,but 1 developed hepatic failure with the total billurubin rose to more than 200 μmol/L.He was discharged home with the PTBD tube.During the waiting time of 7 days to 3 months before surgery,the tubes were kept patent and no mortality or morbidity such as bleeding,bile leakage,and peritonitis occurred.Conclusions PTBD was a safe and efficacious procedure for patients who were in a serious condition with ACST secondary to intrahepatic choledocholithiasis.It was more likely to be successful as it is minimally invasive and therefore well-tolerented.It reduced the biliary pressure,relieved the ongoing sepsis,and was a good preparatory procedure before any conventional surgery.

Objective To review our experiences of diagnostic methods and surgical treatment of the left superior vena cava (LSVC) draining into the left atrium.Methods Nineteen patients with LSVC draining into the left atrium were diagnosed and treated surgically from February 1998 to January 2012.All the cases were combined with other congenital heart diseases including patent ductus arteriosus,ventricular septal defect,atrial septal defect,single atrium,triatriatum,partial endocardial cushion defect,anomalous pulmonary venous drainage,right ventricle outflow stenosis,pulmonary valve stenosis,tetralogy of Fallot,double outlet right ventricle,complete endocardial cushion defect,tricuspid atresia.The patients were diagnosed through different methods including echocartiographic examination,cardiac catheterization,computer tomography,and explored during the operation,even postoperatively.All were treated surgically with four techniques including simple ligation to the LSVC,including ligation during a redo procedure; intra atrial rerouting to drainage the flow from the LSVC to the right atrium,atrial septum reconstruction to make the outlet of the LSVC lying in the right side of the patched atrial septal,and bidirectional Glenn shunt to get a physiological result.Results No mortality postoperatively.All the cases were uneventful postoperatively.And the main postoperative course was related only to the main diagnosis of congenital heart disease,not to the left superior vena cava draining into the left atrium.The echo examination result was satisfied before the discharge.The early and long term follow-up(1-11 years) results are excellent,no arrhythmia,no cardiac deficits after echo examination,including stenosis obstruction and residual shunt.No death.Conclusion The diagnostic methods of the LSVC draining into the left atrium are difficult,the only way to make the diagnosis clearly enough before the operation is depending on improving of more and more comprehending to this rare cardiac anomaly,by the pediatric cardiologists,the sinologist,the intensive care unit,and the pediatric cardiae surgeons.The choice of different surgical treatment is depending on the diagnosis and the findings during the operations,and the results are excellent after a suitable choice made.