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Objective: To discuss the surgical strategy for difficult-reducible atlantoaxial dislocation. Methods: Clinical data of 82 patients with difficult-reducible atlantoaxial dislocation underwent surgical treatment in the Department of Neurosurgery, Xuanwu Hospital from January 2018 to February 2019 were retrospectively reviewed. Total of 32 men and 50 women were included, with a mean age of (41.8±12.9) years. Most cases ( n =80) were treated with one-staged posterior atlantoaxial joint distraction and cage implantation, a few ( n =2) underwent ventral decompression. All cases were followed up, postoperative improvement of clinical symptoms and radiology parameters were analyzed. Results: Of the patients, 80 cases (97.6%) received one-staged posterior atlantoaxial joint distraction and cage implantation; lateral facet joint bony fusion was found in 4 patients and was cut off with an osteotome. Transoral odontoidectomy was performed in 2 cases (2.4%) with fused atlanto-odontoid joint. All the patients were followed-up for (18.6±7.3) months. Postoperative CT showed complete reduction of ADI was achieved in 60 patients (75.0%). The ADI decreased significantly after the operation [(2.1±1.4) mm vs (5.0±1.5) mm, P <0.05]. The postoperative vertical distance between odontoid process and the Chamberlain line decreased significantly when compared with that before the operation [(3.9±3.8) mm vs (10.2±5.2) mm, P <0.05]. The mean JOA score at 6 months post operation improved significantly than that before the operation (13.7±1.5 vs 11.2±1.7, P <0.05). Seventy-five patients (93.8%) had atlantoaxial intra-articular bony fusion at 1 year follow-up. Conclusion: Most difficult-reducible atlantoaxial dislocations can be managed well by posterior one-staged atlantoaxial joint distraction and Cage implantation.

Objective: To examine the short-term outcomes of minimally invasive reoperation for severe tricuspid regurgitation after left-sided valve surgery. Methods: From January 2015 to December 2018, a total of 89 patients with severe tricuspid regurgitation after left-sided valve surgery received reoperation in Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University were included in this study. There were 21 males and 68 females, aging of (56.4±7.9) years (range: 41 to 74 years). The interval between previous left-sided valve surgery and tricuspid reoperation was (14.1±6.1) years (range: 4 to 33 years). A combination of multiple minimally invasive techniques were adopted, including endoscopy-assist right minithoracotomy approach, peripheral cannulation strategy with the vacuum-assist single venous drainage technique, heart beating technique, and temporary percutaneous pacemaker implantation, with a concomitant enhancement in preoperative right cardiac function optimization. Results: All patients received minimally invasive isolated tricuspid valve replacement ( n= 81) or tricuspid valve repair ( n= 8). After the application of multiple minimally invasive techniques, the operative mortality rate was only 3.4% (3/89). The causes of death were progressive right heart failure with multiorgan failure ( n= 1) and low cardiac output associated with postoperative bleeding ( n= 2). Regarding to the perioperative complications, renal replacement therapy rate was 5.6% (5/89), permanent pacemaker implantation rate was 1.1% (1/89), and the incidence of stroke was 0. Mechanical ventilation time was 24(24) hours, ICU stay time was 2.5 (3.0) days ( M ( Q(R) )). During the short-term follow-up, there were no case of severe tricuspid regurgitation, 2 cases of moderate regurgitation, 4 cases of mild-to-moderate regurgitation. Conclusions: For severe tricuspid regurgitation after left-sided valve surgery, the advanced minimally invasive techniques can significantly reduce the operative mortality and morbidity. Minimally invasive bioprosthetic tricuspid valve replacement is a reliable alternative for severe tricuspid regurgitation after left-sided valve surgery.

Late tricuspid regurgitation after left-sided valve surgery can negatively affect long-term prognosis. The surgical timing and strategy of tricuspid valve reoperation will have important impact on the surgical outcomes. However, there is no clear recommendations of the surgical timing for this condition in the current guidelines. Generally, tricuspid valve reoperation should be performed before irreversible right heart failure occurs. Although tricuspid valve repair is the first choice for tricuspid regurgitation, bioprosthetic tricuspid valve replacement might be a reliable alternative when tricuspid leaflets have severe rheumatic damage or right ventricle and tricuspid annulus significantly dilate. Combined minimally invasive surgical techniques, including right minithoracotomy approach, accessing the right atrium directly through the pericardium with limited dissection, peripheral cannulation strategy with the vacuum-assist single venous drainage technique and heart beating technique, can significantly decrease the operative mortality and postoperative bleeding. With development of interventional therapy, transcatheter tricuspid valve repair or replacement may become alternatives for tricuspid regurgitation after left-sided valve surgery in the future.

Objective: To report on the two years outcome of Chinese multi-center study of the treatment of high risk non-calcified pure aortic regurgitation with transcatheter heart valve replacement (TAVR) using domestic made J-Valve™ system. Methods: The national multi-center clinical study of the treatment of high risk non-calcified pure aortic regurgitation with transcatheter heart valve replacement using domestic made J-Valve™ system was conducted during the period from April 2014 to July 2015. The follow-up time was up to 2 years. Forty-three cases with predominant aortic valve regurgitation were enrolled for transapical implantation of the J-Valve™ system from 3 Chinese centers, including 16 patients from Zhongshan Hospital, Fudan University, 23 patients from West China Hospital, Sichuan University, and 4 patients from Fuwai Cardiovascular Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. There were 30 males and 13 females in this cohort. The age of the patients was (74±6) years (range: 61 to 84 years). The patiens were all sympotmatic preoperatively. All patients were considered at prohibitive or high risk for surgical valve replacement (Logistic European System for Cardiac Operative Risk Evaluation of (25.5±5.3)%, range: 20.0% to 44.4%) after evaluation by an interdisciplinary heart team. Comprehensive clinical and echocardiographic assessments were scheduled before discharge and at 30 days, 12 months, and 24 months after the procedure. Results: One patients was converted to surgical aortic valve replacement (SAVR) due to valve embolism into the arch. The other 42 cases had J-Valve™ systems implanted successfully. One patient died from multi-organ disorder due to paravalvular leak (PVL) during perioperative period. There was no acute myocardial infarction, stroke or coronary obstruction during the perioperative period. The median follow-up time was 725 days (range: 6 to 1 082 days). There were 5 patients died during the 2 years, follow-up, 2 patients had stroke, 2 patients had permanent pacemaker implanted. Three patients had valve related reinterventions: One for intraoperative valve embolism into the aortic arch followed by a conversion to SAVR which was mentioned above. One patient underwent SAVR on the postoperative day 6 due to moderate PVL and ventricular dysfunction. One patient underwent SAVR 6 months after primary procedure due to prosthesis thrombosis and severe aortic valve stenosis.Thirty-six patients with J-valve™ implanted survived to the latest echocardiogram follow-up, 25 patients had trivial or less PVL, 9 patients had mild PVL, and the transvalvular gradient after valve implantation was favorable at (9.8±5.8) mmHg (1 mmHg=0.133 kPa). Conclusions: Transapical implantation of domestic made J-Valve™ transcatheter heart valve system for patients with predominant aortic regurgitation has a excellent early outcome. This novel technology is safe and effective.

Objective: To compare the characteristics of X-ray, CT and MRI of Brucella spondylitis and tuberculous spondylitis and its significance for differential diagnosis. Methods: A total of 10 cases of Brucella spondylitis and 20 cases of tuberculous spondylitis confirmed from the clinical, laboratory or pathological department were enrolled between January 2014 and August 2017 in the Fifth Affiliated Hospital of Sun Yat-sen University and the Third Affiliated Hospital of Southern Medical University. The CT, MRI findings were retrospectively analyzed to improve the differential diagnosis of these two diseases. Results: Of the 10 cases of Brucella spondylitis, 8 were located only in the lumbosacral vertebrae, 1 in the thoracic vertebrae only, 1 in the cervical and thoracic vertebrae, 8 with invasive bone destruction, and 8 with narrowed intervertebral space. In 9 cases of intervertebral disc destruction, 7 cases developed paravertebral abscesses, 3 cases had sclerotic edges, all cases had no vertebral body flattening, 5 cases invaded the accessory, 4 cases formed sequestrum, and 6 cases invaded the spinal canal. There were 3 cases showing invasion of surrounding muscles. In 20 cases of tuberculous spondylitis, 12 cases were located in the lumbosacral vertebrae, 6 cases in the thoracic vertebrae only, 1 involved the thoracic vertebrae and lumbosacral vertebrae, 1 involved the neck, chest, and lumbosacral vertebrae. Bone destruction of bone, 19 cases of intervertebral space narrowing, 20 cases of intervertebral disc destruction, 18 cases of paraspinal abscess formation, 10 cases of sclerotic edge formation, 6 cases of vertebral body flattened, 16 cases of invading attachment. There were 17 cases of sequestrum formation, 13 cases of invasion of the spinal canal, and 12 cases of violation of surrounding muscles. There were statistical differences between the two types of imaging signs such as the type of vertebral destruction and the presence or absence of sequestrum. Conclusion: The type of vertebral destruction and the presence or absence of imaging features such as sequestrumwill facilitate the differential diagnosis of Brucella spondylitis and tuberculous spondylitis.

Objective: To investigate the impact of TGF-β3 on the chondrogenesis of bone marrow mesenchymal stem cells (BM-MSCs) under hypoxia environment. Methods: BM-MSCs were obtained from SD rat tibias and femora and cultured with whole bone marrow adherent method. Cell surface antigens were analyzed by flow cytometry and the multiple-directional differentiation capabilities were detected with special differentiation agents to affirm the reality of BM-MSCs. Under normoxia or hypoxia condition, BM-MSCs were induced with TGF-β3 or not. Then, alcian blue and immunofluorescence staining were performed to evaluate the expression level of aggrecan, collagen Ⅱ. qRT-PCR analysis were performed to analyze the expression of aggrecan, collagen Ⅱ and collagen Ⅹ. qRT-PCR and Western blot analysis was performed to detect the mRNA and protein level of HIF-1α, collagenⅡ and β-catenin. Results: BM-MSCs were fibroblast-like shape and had ablities of osteogeic, adipogenic and chondrogenic differentiation, with the expression of CD(29, )CD(44) and CD(90) but not CD(45). Alcian blue and immunofluorescence staining showed that BM-MSCs strongly expressed the aggrecan and collagen Ⅱ with the presence of TGF-β3 under hypoxia condition. qRT-PCR analysis showed the mRNA expression levels of collagen Ⅱ, aggrecan and collagen Ⅹ were up-regulated at 2.46, 2.20 and 1.80 folds, comparing with control group (all P <0.05). Western blot analysis showed that the protein levels of HIF-1α, collagenⅡ in BM-MSCs were up-regulated with the presence of TGF-β3 under hypoxia condition, but β-catenin level was down-regulated. Conclusion: TGF-β3 promotes the chondrogenic differentiation ability of BM-MSCs under hypoxia condition, which may be relative with the inhibition of Wnt/β-catenin signaling pathway.

Objective: To observe and analyze the difference of serum immunoglobulin IgA, IgG, IgM, β2-microglobulin and transferrin in pre-eclampsia (PE) and pregnancies complicated with chronic kidney disease. Methods: Totally 46(40.0%) pregnancies with PE (PE group), 36(31.3%) pregnancies with chronic kidney disease (chronic kidney disease group) and 33(28.7%) normal pregnancies with normal blood pressure and proteinuria without any complication (control group) delivered in Renji Hospital were recruicted in this study from February 2017 to July 2017. Serum IgA, IgG, IgM, β2-microglobulin and transferrin levels were detected. Correlation tests were conducted between these indicators and blood pressure, 24 hours proteinuria value and delivery weeks. Results: (1) Comparison of general situation of pregnancies in the 3 groups: there were no significant difference in the age and child bearing history between the 3 groups (all P> 0.05), while there was a significant difference in the blood pressure and deliver week (all P< 0.01). There was no significant difference in 24 hours proteinuria values between PE group and chronic kidney disease group ( Z =-0.187, P= 0.852). (2) Comparison of serum immunoglobulin, β2-microglobulin and transferrin levels in pregnant women with three groups: serum IgA level in chronic kidney disease group was significantly higher than those in PE and control groups [(2.4±0.9) vs (1.8±0.9) vs (1.6±0.6) g/L; F =9.959, P< 0.01]. The serum IgG and IgM values had no significant difference between the 3 groups (all P> 0.05). Serum β2-microglobulin in chronic kidney disease group was significantly higher than those in PE and control groups [(4.0±2.6) vs (2.7±0.7) vs (2.0±0.5) mg/L; F =15.892, P< 0.01]. Serum transferrin in chronic kidney disease group was significantly lower than those in PE and control groups [(3.0±0.8) vs (3.7±1.1) vs (3.6±0.6) g/L; F =6.284, P< 0.01]. (3) The correlation between serum immunoglobulin, β2-microglobulin, transferrin and blood pressure, proteinuria value and delivery weeks in PE group: the blood pressure level was not correlated with serum IgA, β2-microglobulin and transferrin values in PE group (all P> 0.05). So, 24 hours proteinuria value was positively correlated with β2-microglobulin ( r= 0.557, P< 0.01), which was negatively correlated with transferrin ( r=- 0.442, P< 0.01) and was not correlated with IgA( r= 0.089, P= 0.556). There was a negative correlation between delivery weeks and β2-microglobulin ( r=- 0.328, P= 0.026), and positive correlation with transferrin ( r= 0.315, P= 0.035) and no correlation with IgA ( r=- 0.169, P= 0.260). (4) The correlation between serum immunoglobulin, β2-microglobulin, transferrin and blood pressure, proteinuria value and delivery weeks in chronic kidney disease group: the blood pressure level was positively correlated with β2- microglobulin (systolic pressure: r= 0.598, P< 0.01; diastolic pressure: r= 0.557, P< 0.01), which was not correlated with IgA and transferrin in chronic kidney disease group (all P> 0.05). So, 24 hours proteinuria value was positively correlated with β2-microglobulin and IgA ( r= 0.568, r= 0.330, both P< 0.05), and not correlated with transferrin ( r= 0.255, P= 0.133). Delivery weeks had a negative correlation with β2-microglobulin ( r=- 0.574, P< 0.01), while it had a positive correlation with transferrin ( r= 0.369, P= 0.027). No correlation was found between delivery weeks and IgA values ( r=- 0.257, P= 0.131). Conclusion: The serum levels of IgA, β2-microglobulin and transferrin in PE and pregnancies with chronic kidney disease are significantly different, which may provide clinical value for the diagnosis of PE and pregnancies with chronic kidney disease in future.

Objective: To investigate the features of apparent diffusion coefficient (ADC) histogram parameters based on entire tumor volume data in high resolution diffusion weighted imaging of nasopharyngeal carcinoma (NPC) and to evaluate its correlations with cancer stages. Methods: This retrospective study included 154 cases of NPC patients[102 males and 52 females, mean age (48±11) years]who had received readout segmentation of long variable echo trains of MRI scan before radiation therapy. The area of tumor was delineated on each section of axial ADC maps to generate ADC histogram by using Image J. ADC histogram of entire tumor along with the histogram parameters-the tumor voxels, ADC(mean), ADC(25%), ADC(50%), ADC(75%), skewness and kurtosis were obtained by merging all sections with SPSS 22.0 software. Intra-observer repeatability was assessed by using intra-class correlation coefficients (ICC). The patients were subdivided into two groups according to cancer volume: small cancer group (<305 voxels, about 2 cm(3)) and large cancer group (≥2 cm(3)). The correlation between ADC histogram parameters and cancer stages was evaluated with Spearman test. Results: The ICC of measuring ADC histogram parameters of tumor voxels, ADC(mean), ADC(25%), ADC(50%), ADC(75%), skewness, kurtosis was 0.938, 0.861, 0.885, 0.838, 0.836, 0.358 and 0.456, respectively. The tumor voxels was positively correlated with T staging ( r =0.368, P <0.05). There were significant differences in tumor voxels among patients with different T stages ( K =22.306, P <0.05). There were significant differences in the ADC(mean), ADC(25%), ADC(50%) among patients with different T stages in the small cancer group( K =8.409, 8.187, 8.699, all P <0.05), and the up-mentioned three indices were positively correlated with T staging ( r =0.221, 0.209, 0.235, all P <0.05). Skewness and kurtosis differed significantly between the groups with different cancer volume( t =-2.987, Z =-3.770, both P <0.05). Conclusion: The tumor volume, tissue uniformity of NPC are important factors affecting ADC and cancer stages, parameters of ADC histogram (ADC(mean), ADC(25%), ADC(50%)) increases with T staging in NPC smaller than 2 cm(3).

Objective: To evaluate the characteristics of high resolution diffusion-weighted imaging(DWI) using readout segmentation of long variable echo trains (RESOLVE ) for nasopharyngeal carcinoma (NPC). Methods: A total of 131 with newly diagnosed NPC patients from the 5th Affiliated Hospital of Sun Yat-sen University were included in this study from October 2013 to April 2016.DWI using RESOLVE technique was performed. The signal intensity (SI(lesion)), and mean(ADC(mean)), maximum(ADC(max)), minimum (ADC(min))ADCs of NPC were calculated. The signal intensity (SI(normal))and ADC (ADC(normal))of normal nasopharyngeal tissue were calculated. These quantitative parameters of NPC and normal nasopharyngeal tissue were compared.Statistical difference of ADC(mean), ADC(max) and ADC(min) between the clinical tumor stages were assessed. Results: On the DWI, all NPCs were clearly shown as high signal intensity relative to the surrounding normal nasopharyngeal structure( F =70.019, P =0.000). The ADC(mean)( F =20.442, P =0.000), ADC(max)( F =35.374, P =0.000), ADC(min)( F =61.534, P =0.000) in the carcinoma were significantly lower compared with that of normal nasopharyngeal structure. There was no statistically significant difference of ADC(mean), ADC(max) and ADC(min) ( P >0.05)in different clinical stages of NPC. Conclusion: NPC can be clearly detected by RESOLVE-DWI, but the ADC(mean), ADC(max) and ADC(min) can not be used for differentiating the clinical stage of NPC.

Objective: To gain a clear idea on the resources and pharmacognostic identification of medicinal plant Xanthium in China., Method: Identification of botanical origin, analysis of fruit shapes and properties, microscopic characteristics, TLC and UV., Result: Identification criteria have been worked out for Xanthium and its confused species., Conclusion: The resources of medicinal plant Xanthium may be appropriately expanded.