Abstract:As the "gold standard" treatment for carotid artery stenosis to prevent ischemic stroke, carotid endarterectomy (CEA) has been widely accepted in the western countries; but was developing rapidly only within the past years in China. We noticed that many surgeons in China can master the surgical skills, but there is still much room for improvement in their concept understanding, surgical procedure selections, technical concepts, complication management and other aspects. Many surgeons are still puzzled by the following questions during their clinical practices, such as "Is it the plaque or intima that should be resected in CEA?" "How to resect?" "How to select the resecting site?" "To what extent should it be resected?", and "Whether to perform additional vascular cutting and anastomotic plasty?". Hereby, we summarize the above four controversies of CEA in the real world, including concept doubt, surgical tangle, conceptual differences and technical confusion. We also put forward our thinkings on the issues and shared the latest developments in this field.

Abstract:Demyelinating diseases are a group of nervous system disorders characterized by myelin sheath damage. Demyelinating diseases can seriously affect the quality of life of its victims and still lack satisfying therapeutic options. Oligodendrocyte precursor cells (OPCs) are progenitor cells exist in the central nervous system (CNS), with migration and proliferation capacities and potential to differentiate into oligodendrocytes (OLs), which are myelinated cells in the CNS, indicating that OPCs are closely related to myelination and post-injury regeneration in CNS. Recently, with the improved understanding of the mechanisms of OPCs development and lineage specification, the approaches to gain functional OPCs through directed differentiation from pluripotent stem cells or lineage reprogramming from somatic cells have been greatly promoted. Based on these achievements, OPCs transplantation becomes a promising therapeutic option for the treatment of demyelinating diseases of CNS. In this review, we summarized the latest research progress in this field.

Abstract:Objective To study the effects of low-dose histamine and serotonin on bladder function of overactive bladder (OAB) rats. Methods OAB model of female SD rat was successfully established by partial bladder outlet obstruction (PBOO) to simulate clinical OAB urodynamic changes. Forty OAB rats were randomly divided into four groups: PBOO+histamine group (2 μg histamine), PBOO+serotonin group (1.1 μg serotonin), PBOO+combination group (combined treatment of 2 μg histamine and 1.1 μg serotonin) and PBOO+normal saline (NS) group. Ten SD rats undergoing sham PBOO and receiving normal saline served as sham group. All subcutaneous injections began at 10 days after PBOO surgery (twice daily for one week). The urodynamic indexes of rats were recorded under conscious state by bladder pressure measurement during urinary storage and micturition, and then bladder tissues were collected, weighted and stained with Masson's trichrome for histological assessment. The quantitative data of groups were compared and analyzed using one-way ANOVA followed by a Tukey's post hoc test. Results Compared with sham group, the other four groups had significantly increased frequency and amplitude of non-voiding contraction, maximum bladder capacity, interval of micturition contraction, residual urine volume and bladder weight (P<0.05). Compared with PBOO+NS group, the amplitude of micturition contraction was significantly increased, the frequency of non-voiding contraction and residual urine volume were significantly reduced in PBOO+combination group (P<0.05). Moreover, histological analysis showed that detrusor arrangement was continuous and close in PBOO+combination and PBOO+histamine groups. Conclusion Combined use of low-dose histamine and serotonin can improve the stability of bladder function during urinary storage and increase the empty efficiency of bladder, which may provide a new way for clinical treatment of OAB.

Abstract:Objective To know about the two-week prevalence of the elderly people living in Shanghai and its influencing factors, so as to provide evidence for the health management of the elderly. Methods The data were extracted from the fifth national health services survey of Shanghai, and the data of 11 103 elderly people from 17 districts in Shanghai were investigated by multi-stage stratified cluster sampling, including the basic situation, healthy physical examination within a year and two-week prevalence. Univariate analysis was performed by Wilcoxon rank sum test and Kruskal-Wallis H test, and multivariate analysis was performed by logistic regression to explore the factors influencing the number of two-week prevalence of the elderly people aged 60 years and above in Shanghai. Results The total number of the two-week prevalence of the elderly people was 8 943, and the two-week prevalence rate was 805.458‰. The highest frequencies of two-week diseases were hypertensive and diabetes, accounting for 59.4% (5 314/8 943) and 14.9% (1 332/8 943), respectively. Results of univariate analysis and multivariate analysis showed that the main influencing factors of two-week prevalence were age, employment status, type of occupation, and physical examination within one year. Conclusion The two-week prevalence of elderly people in Shanghai is higher than the national average. Health guidance should be given to the factors influencing of the two-week prevalence in order to achieve a healthy aging.

Abstract:Objective To compare the circulating fibroblast growth factor-23 (FGF23) levels between patients undergoing in-center nocturnal hemodialysis (INHD) and conventional hemodialysis (CHD), and to explore the factors influencing the level of circulating FGF23. Methods Limosis vein blood were collected from 44 patients undergoing INHD and 64 patients undergoing CHD in Changzheng Hospital, Second Military Medical University. Serum calcium, phosphate, intact parathyroid hormone (iPTH), urea clear index (Kt/V), 25-hydroxy vitamin D, ferritin, hemoglobin, blood lipid, and FGF23 were measured and compared between the two groups. All the influencing factors of FGF23 were analyzed by multivariate regression analysis. The correlations between FGF23 and serum calcium, phosphate, calcium-phosphate product, iPTH, 25-hydroxy vitamin D and Kt/V were analyzed by Pearson correlation analysis. Results The levels of serum phosphate and FGF23 in patients undergoing INHD were significantly lower than that in patients undergoing CHD (P<0.05). The dialysis adequacy of INHD was significantly higher than that of CHD (P<0.05). Serum FGF23 was related to serum calcium, serum phosphate, and calcium-phosphate product (all P<0.01), but not to iPTH or Kt/V. Conclusion INHD is more effective than CHD in improving the chronic kidney disease-mineral and parameters of bone abnormalities (CKD-MBD). Calcium-phosphate product is an independent influencing factor of serum FGF23 in patients undergoing IHND. Reducing the serum FGF23 by decreasing calcium-phosphate product may be a mechanism of INHD to improve the clinical prognosis of patients.

Abstract:Objective To analyze the blood glucose levels and related data of inpatients of different clinical departments, so as to provide a basis for normalized management of blood glucose in hospital. Methods Medical records of 1 726 discharged patients from 9 different clinical departments of Changhai Hospital in November 2014 were retrospectively analyzed using medical record inquiry system. The data included admission blood glucose, metabolic indexes, hospital stay and hospitalization expenses. The abnormal blood glucose and related factors were analyzed. Results We found that 99.19% (1 712) of the 1 726 inpatients had their blood glucose monitored once at least. According to their past medical history and blood glucose levels on admission or during hospitalization, 42.76% (738) patients had pathoglycemia. Endocrinology department (73.79%,76/103), geriatrics department (54.17%, 13/24) and pancreatic surgical department (50.54%, 93/184) had more pathoglycemia patients than other departments. The patients with newly discovered pathoglycemia (393) accounted for 22.77% of the inpatients, and the hospital stay and hospitalization expenses in these patients were significantly higher than patients with diabetes and impaired glucose regulation (IGR) and those with normal blood glucose (P<0.01). The levels of serum triglyceride (TG) and blood urea (BUN) of diabetic and IGR inpatients were significantly higher than patients with newly discovered high glucose and normal glucose (P<0.01); the levels of high density lipoprotein cholesterol (HDL-C) in diabetic and IGR inpatients and those with newly discovered pathoglycemia were significantly lower than that in those with normal blood glucose (P<0.01), but there was no significant difference between the former two groups. Conclusion Newly discovered hyperglycemia during hospitalization should not be overlooked. The blood glucose monitoring of high risk population should be reinforced on admission and during hospitalization, and a standard management of hyperglycemia should be established.

Abstract:Objective To prepare a novel collagen scaffold material using Basa fish (Pangasisus haniltoa) skin as the ingredient and to analyze the structural characteristics, physical properties and degradability of the prepared material, so as to explore whether Basa fish can replace terrestrial mammals for preparing a novel collagen scaffold material. Methods Basa fish skins were lyophilized to obtain the membrane material after repeated degreasing, decolorization and dedoping. Crude protein content was determined by the Kjeldahl method. Structure of the materials and its pore size and distribution were analyzed by scanning electron microscopy (SEM). Porosity was measured by the liquid displacement technique, and tensile strength was tested using universal testing machine. The changes of viscosity with temperatures were detected to determine the denaturation temperature of the material.The material was immersed in the phosphate-buffered solution (0.1 mol/L, pH 7.4), which was placed in a constant temperature shaker at 37℃, and the water absorption and weight loss rates of the material were detected. Results The crude protein content of the collagen scaffold material was 95.2%, with visually uniform thickness. SEM photographs showed that one side of the material had a rough surface and porous structure, on which varying sizes of pores distributed uniformly; the other side was smooth with dense pores. The porosity of the material was (55.50±1.94)%, thickness was (0.66±0.10) mm and tensile strength was (18.82±0.94) MPa. The denaturation temperature of the material was 34℃ before thermo-crosslinking and 36℃ after thermo-crosslinking. The water absorption of the material was (379.77±77.81)% at 48 h. At 28 d after thermo-crosslinking, the degradation rate was (80.22±2.49)%, and the pH value of buffer was 6.67±0.05. Conclusion The collagen scaffold material from Basa fish skin can be made into the biological membrane with uniform thickness, and the membrane comprises double structures: dense layer and loose layer. This material exhibits excellent mechanical strength and appropriate denaturation temperature, but its degradation is fast, which needs further improvement.

Abstract:Objective To study the behaviors and characteristics of memory updating ability in postmenopausal women with highly active physical activity, so as to provide evidence for slowing down memory loss and preventing injury in postmenopausal women. Methods The Chinese version of International Physical Activity Questionnaire (IPAQ-short volume) was used to evaluate the long-term physical activity levels of postmenopausal women, and the involved postmenopausal participants were divided into 2 groups: highly active physical activity group (n=20) and normal control group (n=20). We collected the behavioral responses and electroencephalograph (EEG) data of postmenopausal women with different levels of physical activity during the memory updating task using event-related brain potentials and behavioral monitoring techniques. Results In the graph matching n-Back task, the reaction speed and accuracy of behavior in the high and low load task in highly active physical activity group were higher than those in the control group. In the process of coding, matching, refreshing and short-time storage of information, the amplitudes of P3 in two groups were decreased with the increase of the memory load. The latent period of 3-Back-P3 was significantly shorter than that of 1-Back in control group, indicating that postmenopausal women in control group were more sensitive to cognitive load. In highly active physical activity group, the P3 peak of 3-Back, 1-Back and the D-N450 amplitude of frontal, central and parietal area in highly active physical activity group were higher than those in the control group, indicating that the cognitive load had less effect on postmenopausal women in highly active physical activity group, who had a strong ability of mobilization, allocation and application for cognitive resources. Conclusion Postmenopausal women with long-term highly active physical activity have stronger memory updating ability, including better ability to respond to movements, stronger adaptability for perceptual requirements of different cognitive loads, and more flexible and efficient cognitive processing capacity for coding, matching, refreshing and short-time memory storage.

Abstract:Objective To explore the effect of heat shock protein-27 (HSP27) in lipopolysaccharide (LPS)-induced renoprotection against ischemia-reperfusion (IR) injury in mice. Methods Male C57BL/6 mice were used for establishing renal IR injury model and the animals were divided into 4 groups: sham group, LPS+sham group, IR group, and LPS+IR group; each group was further divided into quercetin (200 mg/kg) subgroup and vehicle control subgroup. Renal IR model was established by right nephrectomy + clamping the left renal pedicle for 25 min. Mice were intraperitoneally injected with LPS (3 mg/kg body weight) 3 days prior to renal IR, and the expression of HSP27 was inhibited by quercetin (200 mg/kg), an inhibitor of HSP27 synthesis. 24 h after reperfusion, the extent of IR injury was evaluated by serum creatinine (Cr) and blood urea nitrogen (BUN) levels in abdominal aorta, and the degree of inflammatory reaction, expression of HSP27 protein and activity of apoptosis protein caspase-3 were evaluated in the left kidney. Results LPS pretreatment significantly reduced the levels of Cr and BUN in the serum, improved the expression level of HSP27, and reduced the degree of renal IR injury after renal IR (P<0.05). It was found that quercetin significantly inhibited the expression of HSP27 in the kidney (P<0.05). Quercetin could significantly weaken the alleviating effect of LPS on renal IR by elevating Cr and BUN levels and causing more severe inflammation reaction (P<0.05). In addition, LPS significantly reduced the activity of caspase-3 after renal IR, which could be significantly weakened by quercetin. Conclusion LPS pretreatment can relieve the renal IR injury in mice by up-regulating the expression of HSP27.

Abstract:Objective To design and prepare an absorbable transthoracic left atrial appendage (LAA) reverse occluder and delivery system and to evaluate the feasibility of absorbable transthoracic LAA reverse occlusion by in vitro experiment. Methods A double-disk-shaped absorbable transthoracic LAA occluder was designed using polydioxanone (PDO), poly-L-lactic acid (PLA), and polyglycolic acid (PGA). Compression properties, elastic recovery properties and ultimate sustainable effective delivery times of the tail thread riveting were tested by in vitro water bath. Six isolated dog hearts were punctured at the center of the upper 1/3 axis of left atrial appendage under direct vision,and 14F sheath with scale was used to complete the in vitro experiment of occlusion. The location and effect of the occluder were observed by anatomizing the hearts after closure. Results Absorbable LAA occluder was smoothly delivered by 14F sheath, and instantly released and restored to 96% of original size after placed for 15 min in the sheath. Tail thread riveting could tolerate (5.20±0.75) times effective delivery. Six heart specimens successfully underwent the occluding tests in vitro. We found that the occluder was well located, with the opening disk of the left atrial appendage porting into the opening a little, and the opening was in an over distraction state. There was no influence on blood flow of pulmonary vein and function of the mitral valve. Conclusion The absorbable transthoracic LAA reverse occluder is well-designed and matches the anatomy of the left atrial appendage of canine. Further animal experiment is needed to evaluate the feasibility, safety and efficacy of the absorbable transthoracic LAA reverse occluder.

Abstract:Objective To observe whether the changes of electrocardiogram (ECG) is earlier than the morphological changes of ultrasonic cardiogram (UCG) during the development of cardiac pressure over-load left ventricular hypertrophy (LVH) in rabbits, so as to discuss the value of ECG in the early diagnosis of hypertensive LVH. Methods Forty male Japanese rabbits were randomly divided into experimental group (n=25) and control group (n=15). Rabbits in the experimental group were used to establish cardiac pressure over-load LVH model by subtotal ligation of suprarenal abdominal aorta. The control group received the same treatment as that in the experimental group except for the coarctation of abdominal aorta. Before operation and the 2^nd, 4^th, 6^th, and 8^th week after operation, 12-lead ECG were recorded to measure R-wave and QRS complex wave amplitude, heart electric axis, QRS duration and QTc period; UCG was performed to detect the thickness of left ventricular inferior wall (LVIW), posterior wall (LVPW) and interventricular septum (IVS), left ventricular end diastolic diameter (LVDd), left ventricular end systolic diameter (LVDs), E/A ratio and left ventricular ejection fraction (LVEF). Before operation and the 8^th week after operation, chest X-ray examination was performed to detect cardiothoracic ratio. Then all the rabbits were sacrificed. Left ventricular mass indices (LVMI) were measured and cardiac pathological examination was performed. Results The blood pressure of rabbits increased gradually after operation in the experimental group, the cardiothoracic ratio and LVMI aggrandized, and the cardiomyocytes hypertrophy, denaturalization or necrosis were observed under microscope in the experimental group. The thickness of LVIW, LVPW and IVS of rabbits in the experimental group increased gradually, and the E/A ratio decreased gradually, showing significant difference when compared to those of the control group at the 4^th week (P<0.05). LVDd and LVDs of rabbits in the experimental group increased from the 4^th week, and were significantly larger than that of the control group after the 6^th week (P<0.05). LVEF of rabbits in the experimental group decreased gradually, showing significant difference when compared with the control group at the 8^th week (P<0.05). R-wave and QRS complex wave amplitudes in Ⅱ, Ⅲ, aVF and chest leads in ECG of the experimental group increased gradually, and became significantly higher than those of the control group at the 2^th week (P<0.05). QRS duration and QTc increased gradually after operation, showing significant difference compared to that of the control group at the 4^th week (P<0.05). The above mentioned indices had no significant change before or after operation in control group (P>0.05). Conclusion During the development of cardiac pressure over-load LVH of rabbits, the electrical changes of ECG are earlier than the morphologic changes of UCG, which indicates that ECG may has a value for early diagnosis of the hypertensive LVH.

Abstract:Objective To search for the potential plasma biomarkers for patients with psoriasis vulgaris by metabonomics technology based on nuclear magnetic resonance ¹H spectroscopy (¹HNMR), and to explore the related metabolic pathway. Methods ¹HNMR technique was applied to examine the plasma samples from 10 patients with psoriasis vulgaris and 12 healthy volunteers. The data were analyzed for pattern recognition using principal component analysis (PCA) and orthogonal partial least squares discriminant analysis (OPLS-DA). The differential metabolites in plasma between patients psoriasis vulgaris and healthy volunteers were analyzed, and the metabolic pathways were constructed according to the changes of the differential metabolites. Results Pattern recognition analysis had a satisfactory discriminating and predicting performance. Compared with healthy volunteers, the levels of very low density lipoprotein (VLDL), low density lipoprotein (LDL), lipids, leucine, isoleucine, valine, β-hydroxybutyrate, lactate, alanine, arginine, N-acetylglycoproteins, acetoacetate, glutamate, pyruvate, glutamine, citrate, creatine, creatinine, glucose, aspartate and phenylalanine in plasma of patients with psoriasis vulgaris were greatly increased. Conclusion Our results suggest that patients with psoriasis vulgaris have disorders of lipid metabolism, glucose metabolism and amino acid metabolism, accompanied by inflammation and functional damage to the liver and kidney, which may improve our understanding of the pathogenesis of psoriasis vulgaris.

Abstract:Objective To investigate the characteristics of hyaluronic acid-uricase multivesicular liposomes (UHMVLs) in vitro and the pharmacodynamics of UHMVLs in rats. Methods UHMVLs was prepared by multiple emulsion method. The entrapment efficiency and physicochemical properties were detected. Twelve healthy male SD rats were enrolled in this study. The rat model of hyperuricemia was established with hypoxanthine and oteracil potassium, while the normal rats (n=3) were set as controls. Intravenous UHMVLs, uricase (UC) and nothing were given to the rats of UHMVLs group (n=3), UC group (n=3) and hyperuricemia model group (n=3), respectively; the levels of serum uric acid (UA) were detected in rats of the 4 groups. Results The average entrapment efficiency of UHMVLs was (62.48±3.87)%. The optimum temperatures of UHMVLs and UC were 40℃, while the optimum pH values of UHMVLs and free UC were 8.0 and 8.5, respectively. The activity of UC in UHMVLs was significantly higher than that in free UC at the same temperature (20-70℃) and pH value (6.5-9.5) (P<0.05). UHMVLs was more effective than free UC in decreasing serum UA in rats with hyperuricemia at all time points (P<0.05), except for 1 h, 36 h and 48 h. Conclusion Under the same condition, UHMVLs can improve not only the activity, but also the stability of UC. UHMVLs is more effective in decreasing serum uric acid in rats compared with free UC, which may pave a way for clinical application of UC.

Abstract:Prostate cancer is a malignant tumor with insidious onset, and it usually gets into a terminal stage when discovered and has limited therapy measures. Hence, novel and more effective diagnostic and therapeutic approaches of prostate cancer are greatly needed. Exosomes are one subtype of extracellular vesicles (30-100 nm) secreted by various living cells. Tumor-associated exosomes have been identified in various body fluids from cancer patients and playing important roles in promoting tumor growth, invasion, metastasis and drug resistance. Furthermore, exosomes have multiple advantages when applied in cancer therapy, including the ability to overcome natural barriers, intrinsic cell targeting properties and stability in the circulation, which implies an enormous potential for treatment of prostate cancer. In this review, we summarized the characteristics and functions of exosomes, and discussed the potential value of exosomes as biomarkers and therapeutic tools for prostate cancer.

Abstract:Oculomotor nerve plays an important role in regulating the function of eyeball by controlling levator palpebrae superioris muscle, superior rectus muscle, inferior rectus muscle, medial rectus muscle, inferior oblique muscle, sphincter pupillae muscle and ciliary muscle. Oculomotor nerve palsy is a common clinical symptom characterized by diplopia, ptosis, ophthalmoplegia or pupillary dysfunction. The etiologies of oculomotor nerve palsy are complicated, including intracranial aneurysm, cerebral infarction and hemorrhage, diabetes, intracranial inflammation, craniocerebral trauma, congenital disease and so on. Palsy caused by different etiologies has corresponding clinical features. In this review, we summarized the common causes of oculomotor nerve palsy, and their corresponding pathogenesis, clinical manifestations, signs, treatments and prognosis, hoping to provide help for rapid identification of etiology and effective treatment of the oculomotor nerve palsy.

Abstract:Presenilin (PS) is a transmembrane protein identified in familial early-onset Alzheimer disease, and it is mainly expressed in cell membranes and organelle membranes. As an important catalytic core of the γ-secretase multimeric enzyme complex, PS has been implicated in regulating various proteins. Recent researches have shown that mutations in PS are identified in the familial dilated cardiomyopathy, and the PS gene plays an important role in cardiac formation and regulation of calcium homeostasis in myocardial cells. In this review, we summarized the function of PS in heart and the mechanisms underlying the effects of PS on calcium homeostasis, such as amyloid β protein (Aβ), 1,4,5-inositol trisphosphate receptors, ryanodine receptors and PS as endoplasmic reticulum (ER) Ca²⁺ leak channels, hoping to provide a theoretical basis for the therapy of dilated cardiomyopathy.

Abstract:Objective To analyze the difference in sustained attention and vigilance level between male and female crews during long-term sailing, so as to provide reference for reasonable assignment of operators on duty and improving the comprehensive management ability of warships. Methods A self-made demographic survey questionnaire was adapted with continuous performance test (CPT) on computers to investigate the attention and vigilance abilities of 95 crews (70 males and 25 females), and the obtained data were analyzed statistically. Results The response ability and accuracy rate of the 95 crews were decreased at the beginning stage and then increased, with the lowest points seen at the mid-term stage. The average response time of the male crews was significantly longer than those of the female crews at the beginning and late stage of the sailing, while it was significantly shorter at the mid-term stage(P<0.05). The response accuracy rate of male crews was significantly lower than that of the female crews at the beginning and later stages of sailing while it was significantly higher at the mid-term stage (P<0.05). Conclusion There is difference between male and female crews in the sustained attention and vigilance level during long-term sailing. The attention stability of male crews is better than that of the female crews, while the attention level of female crews is superior, but it is easier to be affected by negative factors.

Abstract:Objective To investigate the characteristics of craniocerebral injuries in the Beagle dogs caused by explosion shock wave and quasi-static pressure by simulating the condition of multiple cabins explosion in warship. Methods A total of 24 Beagle dogs were randomly divided into 2 groups, with 12 in each group, and the Beagle dogs of 2 groups were tested in the multiple cabins with the same size of the real warship. A 0.65 kg TNT equivalent bare explosion was blasted in the cabins, which was defined as the target cabin (Ⅰgroup), and the neighboring one was defined as the adjacent cabin (Ⅱgroup). Parameters of shock waves were measured using pressure transducers. The survival status of dogs, basic vital signs, neurological function scores and the gross and morphological changes of the brains were observed after the explosion. Results There were two reflected shock waves after the explosion in the cabins, and the peak pressure of the shock wave in the adjacent cabin was about 0.39 times of that of the target cabin. Seven Beagle dogs died instantly after the explosion, and four died within 24 h. The mortality rate of the dogs was 45.83% (11/24), with that in the target cabin being 66.67% (8/12) and that in the adjacent cabin being 25.0% (3/12). The basic vital signs and neurological function of the survival dogs underwent great changes immediately after the explosion, which basically recovered after 24 h. The brain tissues of the dogs that immediately died after explosion had obvious contusions, and cerebral hemorrhage and cerebral edema were found in the dogs died within 24 h after explosion. Abnormal morphological structures and neuronal structures were also found in the brain tissues of survival Beagle dogs under light microscope, with some neurons showing nuclei condensation and deep staining, nuclear dissolution or disappearance of nucleus, and the cell borders being blurred. Conclusion In multiple cabin explosion, the peak pressure of the shock wave in the target cabin is significantly higher than that in the adjacent cabin. There are two reflected shock waves in the cabins, which increases the damage to the dogs. The mortality rate of the Beagle dogs in the target cabin is higher than that in the adjacent cabin; and the acute injuries of Beagle dogs immediately after the explosion are the most serious ones, with obvious pathological changes of the brain tissues.

Abstract:Objective To review the relationship between CDKAL1 gene rs7756992 A>G polymorphism and the susceptibility to type 2 diabetes mellitus (T2DM). Methods Electronic databases including China National Knowledge Infrastructure (CNKI), Wanfang database, EMBASE, PubMed and ScienceDirect were searched. Case-control studies on the relationship between CDKAL1 gene rs7756992 A>G polymorphism and the susceptibility to T2DM were selected based on the inclusion and exclusion criteria of original document. The pooled odds ratio (OR) with 95% confidence interval (CI) of the relationship between CDKAL1 gene rs7756992 polymorphism and the susceptibility to T2DM were calculated using different genetic models. Subgroup analysis based on the population of different ethnicities and sensitivity analysis were performed. Results Fourteen studies including 24 315 participants in T2DM group and 35 132 in control group were identified in this analysis. Meta analysis showed that CDKAL1 gene rs7756992 A>G polymorphism was associated with the susceptibility to T2DM under different genetic models (allele [G vs A]: OR=1.171, 95%CI: 1.122-1.223, P<0.001; co-dominant [GG vs AA]: OR=1.380, 95%CI: 1.258-1.515, P<0.001; co-dominant [AG vs AA]: OR=1.131, 95%CI: 1.089-1.176, P<0.001; dominant [AG+GG vs AA]: OR=1.168, 95%CI: 1.101-1.240, P<0.001; recessive [GG vs AA+AG]: OR=1.343, 95%CI: 1.282-1.405, P<0.001). Results of subgroup analysis showed that CDKAL1 gene rs7756992 G allele significantly increased the risk of T2DM in both Asian and Caucasian populations (P<0.05), but there was no significant difference in African population. Conclusion The mutations of A>G allele of rs7756992 locus in CDKAL1 gene may be a risk factor for T2DM in Asian and Caucasian population.

Abstract:Objective To summarize the clinical experiences of surgical treatment of tetralogy of Fallot (TOF) in infants, and to evaluate its short- and mid-term efficacy. Methods The clinical data of 142 infants with TOF preoperatively diagnosed by cardiac color Doppler ultrasound and/or cardiac CT angiography were retrospectively reviewed. There were 79 males and 63 females with a mean age of (6.4±2.7) months (range 1-12 months) and a mean body weight of (6.7±1.4) kg (range 3.0-12.0 kg). The mean McGoon index was 1.59±0.34 (range 0.80-2.47), and the left ventricular end diastolic volume index was 25.5±5.9 (range 14.0-36.3). One-stage radical operation was performed in 138 cases under moderate hypothermic cardiopulmonary bypass, and staging radical operation was performed in 4 cases. Results The mean time of cardiopulmonary bypass, arrest of the ascending aorta, post-operative ventilation, and ICU stay were (95.0±21.7) min, (54.3±15.1) min, (40.2±30.5) h, and (5.0±3.5) d, respectively. Two cases died in the early postoperative period, with the mortality being 1.4%. Reoperation in the early postoperative period was performed in 4 cases (2.8%). The incidence rate of postoperative complications was 7.0% (10/142), including low cardiac output syndrome, pulmonary infection, acute renal failure and so on. Medium term clinical follow-up was achieved in 127 (89.4%) cases. The mean follow-up time ranged from 11 to 62 months (median 37 months). There was no death or reoperation during the follow-up period. The cardiac function NYHA classⅠwas found in 117 cases, and class Ⅱ in 10 cases. During the follow-up period, all patients had normal right ventricular ejection fraction, and various degrees of pulmonary regurgitation (PR), including trace or mild PR in 113 cases (89.0%) and moderate PR in 14 cases (11.0%). Conclusion Radical operation of TOF in infants is safe and effective, with satisfactory short- and medium-term outcomes. Optimizing operation method and strengthening the perioperative management are the keys to improve the successful rate of operation in TOF infants, with satisfactory early- and mid-term curative effect.

Abstract:Objective To investigate the incidence rates of different fetal variations of inferior vena cava, and to compare the diameters and peak velocity of blood in the inferior vena cava between the normal and changed inferior vena cava. Methods Prenatal ultrasound data of 37 448 fetuses were retrospectively analyzed. We screened out the cases with variation of inferior vena cava,and calculated related incidence. Then the diameters and S-wave peak velocity of the inferior vena cava in fetuses of the two groups were measured and compared. Results We found 54 (1.44‰) cases of left inferior vena cava and 14 (0.37‰) cases of double inferior vena cava. The diameter of normal fetal inferior vena cava was (2.71±0.42) mm and the peak velocity was (36.25±6.30) cm/s, the diameter of the left inferior vena cava was (2.70±0.45) mm and the peak velocity was (36.55±7.53) cm/s, both showing no significant difference when compared with the normal group (t=6.78, P>0.05; t=3.56, P>0.05). The diameter of double inferior vena cava was (2.72±0.50) mm and the peak velocity was (36.18±7.49) cm/s, showing no significant difference when compared with the normal group (t=10.43, P>0.05; t=7.01, P>0.05). Conclusion The incidence rates of left inferior vena cava and double inferior vena cava in fetuses have been found to be 1.44‰ and 0.37‰, respectively, and they have similar diameters and velocity with normal inferior vena cava.

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