Objective：To preliminarily verify the cross talk between tissue factor/active coagulation factor Ⅶ (TF/FⅦa) and epidermal growth factor receptor (EGFR) pathways in human colon cancer cells in culture. Methods: FⅦa was treated to HT-29 (KRAS-wild type) and LoVo (KRAS-mutant) colon cancer cells to activate TF/FⅦa pathway, qRT-PCR and Western blot were used to detect the expressions of amphiregulin (AREG) and epiregulin (EREG), ligands of EGFR on mRNA and protein levels, respectively. After knocking down expression of TF by TF-targeted siRNA transfection, FⅦa was treated and mRNA expressions of AREG and EREG were detected to see whether the FⅦa-induced effects were dependent on TF. Expressions of mRNA of TF and FⅦ were detected by qRT-PCR following the activation of EGFR pathway by treatment with epidermal growth factor (EGF) to HT-29 and LoVo cells. Results: After TF/FⅦa pathway was activated, for HT-29 cells, expressions of AREG (on mRNA level) and EREG (both on mRNA and protein level) were significantly down-regulated versus those of control group, gene expressions of AREG and EREG were 0.55±0.09 vs.0.99±0.09, 0.67±0.10 vs.1.02±0.02, protein expressions of EREG were 0.54±0.09 vs.1.04±0.13, all P＜0.05. For LoVo cells, expressions of AREG (both on mRNA and protein level) and EREG (on protein level) were significantly up-regulated versus those of control group, gene expression of AREG were 1.87±0.39 vs. 0.93±0.23, protein expressions of AREG and EREG were 3.09±0.73 vs.1.11±0.21, 1.53±0.19 vs.0.97±0.23, all P＜0.05. The regulating effect of AREG and EREG mRNA expression by FⅦa in HT-29 and LoVo cells could both be partly blocked by knocking down TF expression. For HT-29 cells, activation of EGFR pathway induced no significant TF mRNA expression, FⅦ mRNA expression was not detected. However，for LoVo cells, activation of EGFR pathway induced significantly higher mRNA expressions of both TF and FⅦ, expressions were 1.53±0.23 vs.1.00±0.23, 53.20±6.08 vs.1.00±0.15, all P＜0.05. Conclusion: In colon cancer cell LoVo, when activated, TF/FⅦa pathway and EGFR pathway could interact through upregulating the other pathway’s effectors, and mutant KRAS might play a critical role in the two pathways’cross talk.

Objective： Vacuolar ATPase (V-ATPase) was found within the membranes and internal organelles of a vast array of eukaryotic cells, and was related to various kinds of highly metastatic tumors. LASS2/TMSG1 gene was a novel tumor metastasis suppressor gene cloned from human prostate cancer cell line PC--3M in 1999 by our laboratory. It was found out that protein encoded by LASS2/TMSG1 could interact with the c subunit of V-ATPase (ATP6V0C). In this study, To use RNA interference to suppress the expression of ATP6V0C and try to further investigate the molecular mechanism of ATP6V0C in tumor metastasis and its relationship with LASS2/TMSG1 gene. Methods and Results: The expression level of ATP6V0C mRNA and protein in high metastatic potential prostate cancer cell lines (PC-3M-1E8 and PC-3M) was significantly higher than that in low metastatic potential prostate cancer cell lines (PC-3M-2B4 and PC-3), the expression level in PC-3M-1E8 being the highest. Follow-up tests selected PC-3M-1E8 cells for gene silencing. The expression and secretion of MMP-2 and the expression of MMP-9 in ATP6V0C siRNA transfected PC-3M-1E8 cells displayed no obvious change, but the activity of secreted MMP-9 was abated noticeably compared with the controls (P<0.05). Extracellular hydrogen ion concentration and V-ATPase activity in interference group were both reduced significantly compared with the controls (P<0.05). The migration and invasion capacity of ATP6V0C siRNA interfered cells in vitro were diminished significantly compared with the controls (P<0.05). Furthermore, a dramatic reduction of LASS2/TMSG1 mRNA and protein level after transfection of siRNA in PC-3M-1E8 cells was discovered (P<0.05). Confocal immunofluorescence showed a vast co-localization of ATP6V0C protein and LASS2/TMSG1 protein in plasma and membrane. The co-localization signals of control group were much stronger than those of interference group. Conclusion: Specific siRNA silencing of ATP6V0C gene inhi-bits the invasion of human prostate cancer cells in vitro by mechanism of inhibiting V-ATPase activity and then reducing the extracellular hydrogen ion concentration, inhibiting MMP-9 activation and affecting ECM degradation and reconstruction. Meanwhile, ATP6V0C and LASS2/TMSG1 have interaction and it is likely that ATP6V0C functions as a feedback regulator of LASS2/TMSG1.

Objective： To investigate the expression of immunoglobulin A (IgA) in human mesangial cells (HMCs). Methods: The HMCs were cultured. The subcellular location of IgA was detected by immunofluorescence staining; the transcripts of Ig α，Ig κ and Ig λ constant region were detected by reverse transcriptionpolymerase chain reaction (RT-PCR) and further analyzed by DNA sequencing. The expressions of Ig α and Ig λ were detected at transcription level by Western blot after the cytoplasmic protein extraction. The culture supernatant was collected to explore whether IgA could be secreted out of the cell and the protein was further analyzed by mass spectrometry after being purified by affinity chromato-graphy with jacalin-sepharose. The results of DNA sequencing and mass spectrometry were aligned with the mRNA and amino acid sequences in the National Center of Biotechnology Information (NCBI) database. Results: By immunofluorescence staining, we detected the presence of IgA heavy chain Ig α, light chain, both Ig κ and Ig λ in expressions of transcripts of Ig α1, Ig α2, Ig κ and Ig λ in the HMCs and the alignment of the sequences of the RT-PCR products with those of the Ig Cα1, Ig Cα2, Ig κ and Ig λ mRNA in the NCBI database exhibited that the similarities were 99%, 97%, 98% and 97%, respectively. Western blot showed Ig α and Ig λ expressions in the cell lysate and secretion of Ig α1 and Ig α2 heavy chains in cell culture supernatant. To further explore the protein that secreted into the supernatant, after supernatant affinity chromatography with jacalin-sepharose, the proteins were separated by sodium dodecyl sulfonate-polyacrylamide gel electrophoresis (SDS-PAGE) and the band approximating to 65 000 was cut and sent to mass spectrometry. The results were aligned with the amino acid sequences of Ig α1 and Ig α2 constant region in NCBI database, showing that amino acids between No.52 and No.104, amino acids between No.154 and No.221, amino acids between No.276 and No.327 from Ig Cα1 and amino acids between No.52 and No.113, amino acids between No.151 and No.204, amino acids between No.251 and No.314 from Ig Cα2 were the same with those derived from B cells. Conclusion: Our fin-dings suggested that HMCs could synthesize and secret IgA.

Objective： To explore the effect of high glucose-based peritoneal dialysis fluids on NLRP3-IL-1β in human peritoneal mesothelial cells. Methods: HMrSV5 cells (SV40 immortalized human peritoneal mesothelial cell line) were grown in type Ⅰ collagen-coated dishes in DMEM/F12 containing 10% fetal calf serum (FCS). All experiments on HMrSV5 cells were performed between passages 5 and 10-The cells were divided into 7 groups: control, 1-5% dextrose, 2-5% dextrose, 425% dextrose, rotenone, thenoyltrifluoroacetone (TTFA), and antimycin A-Immunoblotting was used to evaluate the expression of IL-1β-Small interfering RNA (siRNA) targeting NLRP3 was used to downregulate the expression of NLRP3 and Western blot was used to evaluate the expression of IL-1β in human peritoneal mesothelial cells exposed to 4-25% dextrose- In the meanwhile, resveratrol （RSV） was used to induce autophagy, 3-methyladenine (3-MA) and siRNA against Beclin 1 or ATG5 were used to block auto-phagy, flow cytometric was used to analyze the respiring (mitotracker deep red), total (mitotracker green) and reactive oxygen species (ROS)generating mitochondria (mitoSOX); Western blot was used to evaluate the expression of IL-1β- Results: The IL-1β relative expressions were 0, 0-175±0-082, 0-418±0-163, 2-357±0-288, 2-642±0-358, 3-271±0-462, and 0-123±0-091, indicating that the cells exposed to high glucose-based peritoneal dialysis fluids and cells treated with mitochondria respiratory chain key enzyme complex Ⅰ, and complex Ⅲ inhibitors increased the IL-1β expression- And we found that NLRP3 knock-down significantly blocked the upregulation of IL-1β- In addition, the fluorescence intensity of total mitochondria and ROS-generating mitochondria in the following groups: control, negative control, RSV, 3-MA, ATG5 siRNA, Beclin1 siRNA were 1-76±0-42, 1-83±0-55, 1-85±0-62, 7-36±0-92, 5-35±0-77, 5-06±0-62 and 821-68±95-12, 868-15±102-82, 723-39±92-56, 1 660-08±113-65, 1 433-01±107-24, 1 562-36±112-88 respectively- The increased concentrations of mitochondrial ROS and IL-1β upregulation were confirmed in the inhibition but not the induction of auto-phagy-We also found that downregulation of ATG5 and Beclin1 sensitized cells for the release of IL-1β induced by MSU (monosodium urate) or nigericin which was the NLRP3 inflammasome activator- RSV treatment attentuated this effect- Conclusion: Long-term application of high glucose-based peritoneal dialysis fluids can trigger the consistent activation of NLRP3-IL-1β in peritoneal mesothelial cells-Timely initiation of autophagy may block the NLRP3-IL-1β activation and provide a basis for the further development of a potential therapeutic strategy for delay of chronic inflammation and peritoneal fibrosis associated with peritoneal dialysis.

Objective： To investigate serum IgG4 levels in different diseases and the changes of serum IgG4 levels in post  treatment of IgG4 related disease. Methods: Clinical data of 620 patients who received investigation of serum IgG4 in Peking University People’s Hospital from January 1, 2015 to March 31, 2016 were collected retrospectively. According to the difference of the diseases ,they were divided into common group of diseases, autoimmune diseases and IgG4 related diseases; pancreatic disease patients were divided into autoimmune pancreatitis and pancreatic cancer group; According to different treatment stages of the disease, the patients with IgG4 related diseases were divided into pretreatment group and post treatment  group. And  the expressions of the patients’ serum IgG4 levels in different groups were analyzed. Results: The median serum IgG4 level in the group of the patients with common diseases was 0.480（0.005， 50.400） g/L, in the group of autoimmune disease was 0.406 （0.003， 18.700） g/L , in the group of IgG4 related diseases was 5.200（0.046， 46.000）g/L, which was significantly higher in the group of IgG4 related diseases than the other two groups, and there was obvious statistical significance in serum IgG4 levels between the group of IgG4 related diseases and  the other two groups (P<0.01); There was no obvious difference in serum IgG4 levels between the common disease group and the autoimmune disease group, and there was no obvious statistical difference in serum IgG4 levels between the two groups (P>0.05)．In the patients with IgG4 related diseases, the median serum IgG4 level in the group of pretreatment  patients was 6.540 （1.330， 34.100） g/L , and 3.735 （0.063， 46.000） g/L in the post treatment patients.   Serum IgG4 levels decreased in post treatment group, significantly lower than in pretreatment, there was obvious statistical difference in serum IgG4 levels between the two groups (P<0.01)．The median serum IgG4 level in the group of patients with autoimmune pancreatitis was 3.735 （0.063， 46.000） g/L ,and 0.438 （0.056， 1.130） g/L in the group of patients with pancreatic cancer，which was significantly higher in the group of patients with autoimmune pancreatitis than the others, and there was obvious statistical difference in serum IgG4 levels between the two groups (P<0.01). Conclusion: Serum IgG4 levels in patients with different diseases were different, and were significantly higher in patients with autoimmune pancreatitis and IgG4 related diseases, so serum IgG4 levels can provide the basis for the differential diagnosis of different diseases; Serum IgG4 levels in patients with IgG4 related diseases decrease significantly after treatment, so it can be used as an important index to evaluate the curative effect of IgG4 related diseases.

Objective： To study the spatial expression of trophectoderm cells in human embryonic preantral blastocysts. Methods: The study used Gardner score 5AA blastocysts harvested on day 6 after fertilization from assisted reproductive technology. Microcapsules were used to separate trophectoderm cells from the epidermal cells. Single-cell sequencing was performed. P ＜ 0.05 was calculated by unpaired t test, and the difference was 2 times. Here we determined, for the first time, global gene expression patterns in the polar/mural trophectoderm isolated from human blastocysts. Unsupervised hierarchical clustering analysis and gene ontology (GO) functional classification were performed using bioinformatics software. Differentially expressed genes were annotated by the Database for Annotation, Visualization and Integrated Discovery. Functions of differentially expressed genes were further annotated using encyclopedia of genes and genomes. Results: The results showed that there were up to 306 genes in the trophoblast cells and up to 75 genes in the trophoblast cells. Unsupervised cluster analysis of polar trophoblast cells and mural trophoblast cells were divided into two groups, belonging to different types and biological functions. Differences in gene function indicated that the biological functions of GO gene uptake genes were mainly transcription, energy metabolism, protein synthesis, transport, oxidative stress, ion transport, protein synthesis and transport, cell cycle regulation, actin growth, etc. They were mainly involved in ubiquitin-mediated protein hydrolysis, oxidative phosphorylation, Wnt signaling pathway, estrogen androgen metabolism and other signal pathways; wall trophoblast cells up-regulated gene GO biological function, which was mainly proteolytic metabolism, cell cycle arrest, apoptosis, activation of MAPK, carbohydrate transport, synaptic regulation, cell growth, calcium channel activation, positive B cell differentiation, T cell apoptosis and other biological functions, which were mainly involved in B cell receptor, T cell receptor, white blood cells crossendothelial transplantation, VEGF expression, gap connection, GnRH secretion, apoptosis and other signaling pathways. Conclusion: The gene expression of blastocysts trophectoderm is revealed from the spatial dimension, indicating that differentiation of polar and mural trophectoderm of blastocysts is accompanied by differences between the two cell lineages, and the polar and mural trophectoderms are coordinated with each other and the blastocyst hatching and embryo implantation processes are finely adjusted. Further data analysis is expected to find the endogenous molecular specificity of the regulation of embryo implantation.

Objective： Preliminary study on therapeutic effects of adipose tissue derived stem cells (ADSCs) on MRL/lpr mice and the effect on imbalance of Th17/Treg. Methods: Fifteen 12-week-old MRL/lpr mice were randomly divided into 3 groups by using random number table, including ADSCs group, control group and cyclophosphamide (CTX) group, with 5 in each group. ADSCs group and control group were injected with 1×106 ADSCs or phosphate buffered solution (PBS) via tail vein respectively, once a week, a total of eight times. CTX group was injected CTX at a dose of 15 mg/kg body weight, once a week for 2 weeks, and then repeated after 2 weeks’ rest, a total of four times. The 24-hour proteinuria was measured before and after treatment. All the mice were sacrificed after treatment for 8 weeks. Th17 cells and Treg cells in splenic were examined by flow cytometry. Results: (1) The 24-hour proteinuria in the three groups had no significant difference before treatment (P>0.05). After therapy for 4 weeks, the 24-hour proteinuria in the ADSCs and CTX groups was much lower than those in control group, and the difference was significant ［(5.02±1.61) g/L vs. (7.10±1.63) g/L, (4.90±0.71) g/L vs. (7.10±1.63) g/L, P<0.05］, and the longer the duration of treatment (8 weeks), the more obvious effect ［(2.24±0.73) g/L vs. (10.36±1.64) g/L, (3.80±1.45) g/L vs. (10.36±1.64) g/L, P<0.01］. There was no significant difference in 24-hour proteinuria between ADSCs group and CTX group (P>0.05). (2) Percentage of Treg cells /CD4+T cells in the spleen lymphocytes: The percentages in ADSCs and CTX groups were higher than that in control group. The levels were 13.62%±187%, 14.14%±1.29%, 10.71%±1.23%, respectively, but there was no significant difference (P>0.05). (3) Percentage of Th17 cells /CD4+T cells in the spleen lymphocytes: The percentages in ADSCs and CTX groups were significantly lower than that in control group. The levels were 1.43%±020%, 1.63%±0.65%, 6.37%±1.64%, respectively, with statistical significance (P<0.01). Conclusion: Transplantation of ADSCs can reduce the 24-hour proteinuria in MRL/lpr mice. To prolong the time of treatment, the effect is more significant. Transplantation of ADSCs can up-regulate Treg cells and down-regulate Th17 cells. ADSCs have the ability to regulate the immune balance of Th17/Treg in MRL/lpr mice, suggesting that ADSCs play the role of antiinflammatory and immune regulation by regulating the Treg and Th17 cells.

Objective： To evaluate the ability of 2015 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria to diagnose gout compared with the widely used 1977 American Rheumatism Association (ARA) criteria and other criteria in clinical practice in Chinese patients, and to compare the sensitivity and specificity of different classification criteria for gout in early and established diseases. Methods: The patients who had ankle arthritis and visited the Department of Rheumatology and Clinical Immunology, Peking University First Hospital between February 2012 and February 2016 were screened. The patients who had been already diagnosed with gout or pyrophosphate deposition disease through arthrocentesis or tissue aspiration and those who had been diagnosed with rheumatoid arthritis, spondyloarthritis, and osteoarthritis were excluded. The patients were diagnosed by two experienced rheumatologists and all of them were followed up for at least one year. Early disease was defined as symptom onset of no more than 2 years; established disease was defined as symptom duration of more than 2 years. The 2015 ACR classification criteria were divided into clinical form with clinical parameters included and complete form with not only clinical parameters but also synovial fluids tests, imaging findings and monosodium urate (MSU) included. The two forms above were short for “clinical form (incorporating clinical parameters)” and “complete form (incorporating imaging and MSU data)” respectively. Results: In this study, 284 patients suffering from ankle arthritis were included in the study, 219 of them were classified as gout and 65 of them had alternative diagnoses. The sensitivity and specificity of 2015 ACR complete form (incorporating imaging and MSU data) for diagnosing gout were 88.13% and 95.38%, respectively. The area under the curves (AUC) of 2015 ACR “complete form (incorporating imaging and MSU data)”, 2015 ACR “clinical form (incorporating clinical parameters)”, 2010 Netherlands criteria and 1977 ARA criteria were 0.982, 0.983, 0.963, and 0.928, respectively. For the 94 early gout patients, the AUC of the above criteria were 0.973, 0.968, 0.916, and 0.910, respectively. For the established gout patients, the AUC were 0.987, 0.991, 0.982, and 0.936, respectively. For the patients with disease duration within two years, the odd ratio (OR) for sensitivity of 2015 ACR “complete form (incorporating imaging and MSU data)”, 2015 ACR “clinical form (incorporating clinical parameters)”, 2010 Netherlands criteria and 1977 ARA criteria were 1.562 (1.003-2.435), 1.500 (1.001-2.346), and 1.812 (1.177-2.791), nevertheless, for the patients with established gout, the OR were 1.702 (1.300-2.229), 1.607 (1.224-2.110), and 1.821 (1.396-2.377), respectively. Conclusion: The 2015 ACR/EULAR criteria are more accurate in gout diagnosis compared with the 1977 ARA criteria by elevating the sensitivity and specificity, in respective of the disease duration. The 2015 ACR/EULAR criteria may serve as new diagnostic tools in daily clinical practice in Chinese patients.

Objective： To describe the endocrine abnormalities in patients with POEMS syndrome in order to identify more patients with POEMS syndrome among those who have endocrine dysfunctions. Methods: We searched the inpatient medical record system of Peking University People’s Hospital with “POEMS syndrome”. Finally the data from 23 patients were analyzed. Epidata 3.0 was used for data entering and SPSS 19.0 was used for statistical analysis. Results: The median age of all the 23 patients was 47 years. The ratio of male to female was 1.88 ∶1. Polyneuropathy was the most common initial symptom which accounted for 56.5% in the 23 patients. The median duration from the initial symptoms to diagnosis as POEMS syndrome was 30 months. Among all the departments, the number of confirmed cases was highest in the department of neurology. The median duration from the onset of initial symptoms (6 months) to the diagnosis made in neurology department was also significantly shorter than in other departments. Among all the 23 patients, 100.0% of them had polyneuropathy, 82.6% had organomegaly, 95.7% had endocrinopathy, 52.2% were M protein positive, 91.3% had skin changes, 45.5% had papilledema, 43.5% had extravascular volume overload, 43.5% had platelet elevation and 17.4% had Castleman disease. Among all the patients with endocrinopathy, the incidence of hyperprolactinemia was 60.0% which was the highest one followed by thyroid dysfunction and adrenal dysfunction. Among the patients who had endocrine system dysfunctions, most of them had two target endocrine glands involved (36.5%). Conclusion: Endocrinopathy is an important component of POEMS syndrome and it is of great importance to pay more attention to POEMS syndrome in patients with thyroid dysfunction, adrenal dysfunction, gonadal dysfunction, parathyroid dysfunction, hyperprolactinemia and glucose intolerance, especially in patients with two or more target gland dysfunctions. Symptoms and signs of polyneuropathy should be assessed carefully to reduce misdiagnosis of POEMS syndrome. Evaluation of the endocrine system should also be done in patients diagnosed with POEMS syndrome in order to treat the patients properly.

Objective： To investigate the clinical biological characteristics of EVI1 positive acute myeloid leukemia (AML) and its effect on early chemotherapy. Methods: The clinical and biological cha-racteristics of 33 AML patients with EVI1 positive were retrospectively analyzed in 361 AML patients who were diagnosed and treated in our institute from March 2015 to July 2016, and the clinical and biological features, and rates of the induced remission were compared between the intermediate risk and poor risk with EVI1 positive AML, moreover, the influential factors on complete remission (CR) were analyzed. The expression of EVI1/ABL was tested in 32 healthy donors to confirm the abnormal threshold of EVI1 expression. Results: The definition of EVI1 positive was that the quantitative expression of EVI1/ABL was more than 8.0%. The 33 AML patients with EVI1 positive were found in 361 newly diagnosed AML patients, in which the female and male patients were 17 and 16 respectively, the median age was 45 (18-67) years, with a median followup of 6.6 (0.7-13.2) months. Intermediate karyotype was found in 17 patients(including 9 patients with normal karyotypes,1 patient with +8);unfavorable karyotype was found in 14 patients ［including 7 patients with -7/7q-,4 patients with t (v;11q23)，3 patients with inv(3)/t(3;3)， and 2 patients without mitotic figures］. The rate of CR in the first induction chemotherapy was 42.4%, and the rate of total CR was 60.6%. According to the NCCN, 16 intermediate risk patients and poor risk patients were divided, without favorable risk patients. The rate of CR in the first induction chemotherapy were 68.8% and 17.6% (P=0.005) in the intermediate risk and poor risk respectively, that of total CR were 81.3% and 41.2%（P=0.032）, and the rates of relapse were 7.7% and 14.3%.Univariable analysis revealed that unfavorable karyotype could affect the rate of CR in the first reduction chemotherapy and that of total CR (P=0.004, 0.029). The poor risk patients had higher mortality (41.2% vs. 6.3%, P=0.039) and lower overall survival (OS)(P=0.012). Conclusion: EVI1 may be not an independent prognostic factor for the AML patients considering the appearance in the intermediate and poor risk patients. It predicts poor outcome in the EVI1 positive AML patients who have unfavorable karyocytes, such as -7/7q-, t(v;11q23), and inv(3)/t(3;3), and also a low rate of both CR in the first induction chemotherapy and total CR. It also has a low rate of longterm survival and high mortality in the AML patients with EVI1 positive, who may benefit from allogeneic bone marrow transplantation as soon as possible.

Objective： To evaluate the efficiency of thoracic endovascular aortic repair (TEVAR) in dealing with abdominal aortic branch malperfusion based on the analysis of aortic computed tomography angiography (CTA) images in pre-and postTEVAR. Methods: Retrospective analysis from September 2015 to March 2016 in single institution to 32 patients, diagnosed as Stanford B aortic dissection with abdominal aortic branch malperfusion, CTA images in pre- and postTEVAR were collected. Based on the aortic branch malperfusion pattern redefined by Nagamine, we identified and characterized branch malperfusion pattern for four abdominal aortic branches (celiac trunk, superior mesenteric artery, bilate-ral renal artery) in statistical analysis. Results: In the four abdominal aortic branches (total 128 branches), 86 branches (67.2%) expressed with Class Ⅰ patterns, in which subtype Ⅰ-b presented with 0.8%, subtype Ⅰ-c with 5.5%; 14 branches (10.9%) expressed with Class Ⅱ patterns, in which subtype Ⅱ-b-1 with 3.9%, subtype Ⅱ-b-2 with 3.1%; 16 branches (12.5%) expressed with Class Ⅲ patterns, all with subtype Ⅲ-a, no subtype Ⅲ-b and Ⅲ-c presented. The remaining 12 branches were normal. The 100% successful rate of TEVAR obtained in 32 patients performed. The mean followingup was 4 months. Aortic CTA showed that among the 14 “high-risk” abdominal aortic branch malperfusion, 13 (92.9%) with obvious branch malperfusion in post-TEVAR were observed to improve, and the remaining one branch malperfusion (7.1%) was observed to change from subtype Ⅰ-b to Ⅰ-c. Conclusion: Few ratios in abdominal aortic branches suffered with obvious malperfusion complicated by Stanford B aortic dissection. For branches with “highrisk” malperfusion pattern, optimal changes were observed in abdominal aortic branch without revascularization in postTEVAR, as well other branches with non-“highrisk” pattern perfusion were mostly stable in post-TEVAR. It could be of profound benefit to extend branch malperfusion patterns redefined by Nagamine in clinical practice to assess aortic dissection and in further guide for revascularization or not.

Objective： To evaluate the functional outcome and the complication rate after open reduction and internal fixation of proximal humeral fractures with a “timeangle measurement” reduction evaluation technique, to assess the acceptance of the fracture reduction and to estimate the result of the sur-gery. Methods: Forty-six patients ［mean age: （66.2±14.9） years］ with an acute proximal humeral fracture were managed with open reduction and internal fixation with this reduction evaluation technique from January 2012 to December 2013. According to the Neer classification, there were 6 two-part fractures, 25 three-part fractures and 15 four-part fractures. The functional outcome was evaluated for each patient using the Constant-Murley score; radiographic evaluation was also conducted and complications were recorded. The postoperative shoulder function recovery and imaging findings were followed up to evaluate the guiding significance of this reduction evaluation technique in the clinical treatment of this kind of fracture. Results: In the study, 46 patients had been followed up for 13-36 months, and the average follow-up time was (23.5±7.3) months. All the patients achieved fracture healing 3 months after operation. The average head-shaft angle was (124±3.5) degrees. According to the Constant scoring system, 29 patients (63%) had excellent, 14 patients (30%) had good, and 3 patients (7%) had  poor results. The most common complications were pain (7/65) and restricted movement of the shoulder (5/46). There were no cases of screw penetration, necrosis of humeral head, deep tissue infection, nonunion of fracture and axillary nerve injury after operation. Conclusion: For appropriate cases of displaced proximal humeral fractures, surgical treatment with application of “time-angle measurement” reduction evaluation technique that was introduced in the present study can lead to a good functional outcome, and the technique of reduction assessment should be regarded as a reasonable reference standard in the treatment of displaced proximal humerus fracture.

Objective： To investigate the effect of general or regional anesthesia on postoperative cardiopulmonary complications and inpatient mortality after hip fracture surgery in elderly patients. Me-thods: A retrospective analysis was conducted according to the medical records of 572 elderly patients with hip fractures admitted to our hospital from January 1, 2005 to December 31, 2014. The age, gender, preoperative comorbidities, length of preoperative bedridden time, mechanism of injury, surgical types, anesthetic methods, major postoperative complications and inpatient mortality were recorded. Multivariate Logistic regression analysis was applied to analyze the impact of different anesthetic methods on inpatient mortality in these patients. Results: Of the 572 patients, 392 (68.5%) received regional anesthesia. Inpatient death occurred in 8 (8/572, mortality: 1.4%), including 5 cases of RA group (5/392, mortality: 1.3%) and 3 cases of GA group (3/180, mortality: 1.7%). There was no statistically significant difference between the two groups in inpatient mortality (P>0.05). Multiple Logistic regression analysis showed that gender (odds ratio: 0.18, 95% CI: 0.03-1.05, P=0.057), age (odds ratio: 1.22, 95% CI: 1.07-1.38, P=0.002), preoperative pulmonary comorbidities (odds ratio: 12.09, 95% CI: 2.28-64.12, P=0.003) and surgical types (odds ratio: 9.36, 95% CI: 1.34-64.26, P=0.024) were risk factors for inpatient mortality. Postoperative cardiovascular complications occurred in 36 patients (36/572, morbidity: 6.3%), with 19 patients in RA group (19/392, morbidity: 4.8%)，and 17 patients in GA group (17/180, morbidity: 9.4%). Multiple Logistic regression analysis showed that age (odds ratio: 1.13, 95% CI: 1.07-1.19, P<0.001), hypertension (odds ratio: 2.72, 95% CI: 1.24-5.96, P=0.012) and preoperative cerebral comorbidities (odds ratio: 2.11, 95% CI: 0.99-4.52, P=0.054) were risk factors for postoperative cardiovascular complications. Postoperative pulmonary complications occurred in 56 patients (56/572, morbidity: 9.8%), with 19 patients in RA group (19/392, morbidity: 4.8%), and 37 patients in GA group (37/180, morbidity: 20.6%). Multiple Logistic regression analysis showed that age (odds ratio: 1.13, 95% CI: 1.07-1.19, P<0.001), preoperative pulmonary comorbidities (odds ratio: 2.89, 95% CI: 1.28-7.05, P=0.020), length of preoperative bedridden time (odds ratio: 1.11, 95% CI: 1.04-1.18, P=0.003) and anesthetic methods (odds ratio: 5.86, 95% CI: 2.98-11.53, P<0.001) were risk factors for postoperative pulmonary complications. Conclusion: General anesthesia may not affect the inpatient mortality after hip fracture surgery in elderly patients. Regional anesthesia is associated with a lower risk of pulmonary complications after surgical procedure compared with general anesthesia.

Objective： To explore the value of ultrasound in the diagnosis of anterosuperior acetabular labral tear. Methods: A total of 102 patients ［(42 males and 60 females, age from 13 to 60 years, average age was (35.14±9.16) years］ with suspected anterosuperior acetabular labral tear were included in this study, including 44 left hip joints and 58 right hip joints. All the patients received hip joint ultrasound and magnetic resonance imaging (MRI) evaluation before arthroscopy surgery. Using arthroscopy as golden standard, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy between ultrasound and MRI were calculated and compared. Results: There were 91 antero-superior acetabular labral tears of 102 patients which were confirmed during arthroscopy surgery. Sixty-nine patients were diagnosed correctly by ultrasound, including 60 anterosuperior acetabular labral tears and 9 with no acetabular labral tears, whereas 2 were false-positive and 31 were found to be false-negative. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy by ultrasound were respectively 65.93%, 81.82%, 96.77%, 22.50% and 67.65%. In contrast, seventy-seven patients were diagnosed correctly by MRI, including 70 anterosuperior acetabular labral tears and 7 with no acetabular labral tears, whereas 4 were false-positive and 21 were found to be falsenegative. For MRI, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were respectively 76.92%, 63.64%, 94.59%, 25.00% and 75.49%. The results of ultrasound and MRI were in accordance in 68 of the 102 patients. There were 51 anterosuperior acetabular labral tears of the 68 patients who were diagnosed by both ultrasound and MRI, whereas there were 17 with no acetabular labral tears of the 68 patients who were diagnosed by both ultrasound and MRI. The results of ultrasound and MRI were inconsistent in 34 of the 102 patients. In 11 of the 34 patients, in which case ultrasound diagnosed anterosuperior acetabular labral tear, MRI found no acetabular labral tear. Whereas, in 23 of the 34 patients, in which case MRI diagnosed anterosuperior acetabular labral tear, ultrasound found no acetabular labral tear. As compared with MRI findings, ultrasound had a lower accuracy for anterosuperior acetabular labral tear than MRI, there was statistical difference on the accuracy for anterosuperior acetabular labral tear (P<0.01). Conclusion: Although ultrasound had a slightly lower sensitivity for anterosuperior acetabular labral tear, it had a higher specificity than MRI. Dynamic evaluation of anterosuperior acetabular labral tear is an advantage of ultrasound. Ultrasound could be used as a feasible me-thod to evaluate anterosuperior acetabular labral tear.

Objective： To assess the midterm clinical and radiological outcomes of internal fixation and fusion for the treatment of Hirayama disease and to evaluate the clinical significance and value of this procedure. Methods: In the study, 36 patients were treated with anterior cervical internal fixation and fusion. The clinical outcomes including muscle strength and atrophy were recorded. The radiological outcomes including range of motion of cervical spine and the cross-sectional area of spinal cord at each level on MRI scan were measured before and at 3 month, 1 year and 2 years follow-up time points after sur-gery. Results: (1) Clinical outcomes: all the patients showed no further progression of symptoms except one patient with mild progression of muscular weakness and atrophy. As the time passed by, the ratio of the patients with muscle strength and atrophy improvement increased. There were 26.5% of patients in 3 months, 36.0% in 1 year and 85.7% in 2 years who experienced muscle strength improvement. 8.8% of patients in 3 months, 24.0% in 1 year and 35.8% in 2 years felt muscle atrophy improvement. And 12 of the 14 patients showed improved muscle strength and atrophy at the end of 2 years period follow-up. (2) Radiological outcomes: the range of motion (ROM) of C2-C7 was significantly decreased after the operation. The ROM of preoperation was 62.25°±2.10° and that of 2 years postoperation was 13.67°±7.51°(P<0.01). The spinal cord was of no compression on flexion MRI. The cross-section area of spinal cord on MRI was significantly increased only at C6 level (P<0.05) at the end of three months follow-up. The level of increased cross-section area rose to C4-C5-C6 levels (P<0.01) in 1 year and to C4-C5C6-C7 levels at the end of 2 years follow-up (P<0.05). The cross-section area increased 15.60% at C4, 19.08% at C5, 21.60% at C6 and 23.91% at C7 with significant difference (P<0.05) 2 years after the operation. Conclusion: Anterior cervical internal fixation and fusion is an effective surgical treatment for Hirayama disease and may provide preferable midterm clinical and radiological outcomes. This procedure has clinical significance and value in terms of control of the progression and outcome of this disease.

Objective： To evaluate the relationship between large artery elastic function and coronary heart disease (CHD) or lower extremity arterial disease (LEAD) in patients with carotid plaque. Me-thods: A total of 491 patients with carotid plaque were enrolled into the study with complete data of arterial stiffness detection and blood test ［male: 208 and female: 283, and mean age: (61.66±11.60) years］. All the subjects were divided into 2 groups according to CHD or LEAD, namely non-CHD&LEAD group (neither CHD nor LEAD) and CHD/LEAD group (either CHD or LEAD). Accor-ding to the mean age level (age<61.66 years or age>61.66 years), the independent association was analyzed between higher large arterial stiffness (carotid-femoral pulse wave velocity, CF-PWV, CF-PWV>9 m/s) and CHD/LEAD. Results: In the present research population, the mean level of arterial stiff-ness was high (the mean CF-PWV was 10.71 m/s), and 76.6% of them had arteriosclerosis, and 36.9% CHD/LEAD. The age, male and smoking proportion, systolic blood pressure (SBP), glycosyla-ted hemoglobin (HbA1c), homocysteine (Hcy), creatinine (Cr), CF-PWV, prevalence rate of hypertension and diabetes mellitus, medication on hypertension, diabetes and hyperlipidemia were higher in CHD/LEAD group, and total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), and low density lipoprotein cholesterol (LDL-C) were lower in CHD/LEAD group than in non-CHD&LEAD group (all P<0.05).In multivariate Logistic regression analysis, the results showed that in the patients with age below 61.66 years, large artery stiffness (CF-PWV>9 m/s) was an independent risk factor of CHD/LEAD (OR=3.229, 95%CI 1.156-9.022, P<0.05); In the patients with age above 61.66 years, there was no independent association between large artery stiffness and CHD/LEAD (P>0.05). Conclusion: The large artery elasticity function in the patients with carotid plaque was poor. In the patients with carotid plaque and higher large artery stiffness below 61.66 years, the risk of the prevalence of CHD/LEAD was increased significantly than with normal arterial stiffness. In the patients with carotid plaque below or above 61.66 years, the independent influencing factors on the prevalence of CHD/LEAD were different.

Objective： To explore the surgical strategies for the treatment of T1b gallbladder cancer patients diagnosed intraoperatively or postoperatively. Methods: A retrospective analysis of 42 patients with T1b gallbladder cancers was performed. There were 14 patients diagnosed intraoperatively and 28 patients diagnosed postoperatively. The reevaluations of T stages were conducted in the 28 T1b gallbladder cancer patients diagnosed postoperatively by the professional pathologist. After T stage reevaluation, 25 confirmed T1b patients with complete follow-up data were divided into simple cholecystectomy group and ra-dical resection group, and the clinicopathologic characteristics between the two groups were analyzed. Results: Only 2 of the 14 T1b gallbladder cancer patients diagnosed by the intraoperative frozen specimen proved to be T1b on postoperative paraffin pathology, and for the remaining 13 patients, T2 was in 11 patients, and T3 in one patient. The rate of misdiagnosis was 85.7% by the intraoperative frozen specimens, postoperative T stages were equal or higher than intraoperative T stages. Two of the 28 postoperatively diagnosed T1b patients were proved to be T2 after reevaluation, the rate of misdiagnosis was 7.1%, the reevaluated T stages were equal to or higher than the previous stages. Twenty-five confirmed T1b gallbladder cancer patients had complete follow-up data, 11 of whom underwent simple cholecystectomy and the remaining 14 radical resections. No patient had vessel or perineural invasion on pathology in the 25 confirmed T1b patients. Metastasis was absent in all the 30 lymph nodes examined, which achieved from 14 patients with radical resection. The survival rate after simple cholecystectomy was comparable to that after radical resection (P=0.361). Only one patient with radical resection had abdominal cavity implantation relapse, who received gallbladder compression during operation and 2 years later died from metastasis. Conclusion: Intraoperatively diagnosed T1b gallbladder cancer should receive radical resection. Reevaluation of the T stage is necessary and the initial step for postoperative diagnosed T1b gallbladder cancer patients. The pros and cons of radical surgery for definitive T1b patients should be carefully evaluated, and systemic chemotherapy is recommended for those with bile spillover.

Objective： To understand the cognition and behavior of drug safety in Beijing middle school students and provide advice for relevant education. Methods: A cross-sectional survey using paper questionnaires was carried out on the student body of nine Beijing middle schools. Multi-stage proportionate stratified cluster sampling was adopted to enroll participants. In addition to demographic questions, the questionnaire included 17 questions assessing the cognition and behavior of safe drug use, prioritizing questions that aligned with the health education guideline for primary and secondary school students from Chinese Ministry of Education. Descriptive statistical methods were applied using the SAS 9.2 software. Results: Of the 4 220 students investigated, 2 097(49.7%) were males and 2 123(50.3%) were females. The average age was (14.3±1.7) years. 2 030(48.1%) students were from downtown areas, 1 511(35.8%) were from urban-rural linking areas and 679(16.1%) were from rural areas. Half (51.5%) of the respondents were junior high school students, and the others were from senior high schools (34.2%) and vocational high schools (14.3%). Most of the students (89.6%) lived off campus. The awareness rate of drug safety knowledge was 74.4%, the median score of drug safety behavior was 4 points (full score was 5 points) and there was a statistically positive correlation between the two (Spearman’s correlation coefficient was 0.156, P<0.001). Both the awareness rates and the drug safety behavior scores were statistically different among the students in different regions, different school types and different residence types (P<0.001). Multiple factors analysis demonstrated the correlation between the cognition degrees of both drug safety knowledge, behavior and the above factors. Of all the students, 80.4% agreed that any drug could have adverse drug reactions; 40.5% were aware that antibiotics couldn't kill viruses; as many as 49.6% mistook aspirin as antibiotic; 97.4% would read drug instructions before taking them; Only 42.4% put expired drugs into special recycling bins; 49.8% would deviate from the suggested dosage and frequency of their medication when they were sick with common diseases. Conclusion: Overall, the cognition of drug safety in Beijing middle school students is good, but problems still exist in medication adherence, the management of expired drugs and the antibiotics cognition, which need to be fixed through specific, pointed way of education. And more efforts should be made to improve the cognition in rural regions, vocational high schools and on campus students.

Objective： To evaluate whether midazolam with propofol target controlled infusion (TCI) intravenous sedation during the mandibular third molar extraction influences patients’ perioperative anxiety. Methods: The subjects were patients who planned to undergo the mandibular third molar extraction in Peking University School and Hospital of Stomatology, whose state anxiety inventory (SAI) scores were≥38 at the initial visit. They were divided into intravenous sedation group (IVS) and local anesthesia group (LA) on the basis of the planned intravenous sedation. Each group was divided into two subgroups according to the overall SAI scores at the initial visit: IVS-Ⅰ, LA-Ⅰ(SAI: 38-50) and IVS-Ⅱ, LA-Ⅱ (SAI: 51-80). The anxiety before and after the surgery was evaluated by the SAI scores at the initial visit (T1), before surgery (T2) and 7 days after surgery (T3). The anxiety during the surgery was evaluated by the heart rate, blood pressure and visual analogue scale (VAS) scores. Results: There were no significant differences on SAI at T1, T2, and T3 in the two groups (P>0.05). The heart rate, blood pressure and VAS pain scores of IVS group were significantly lower than those of LA group during the surgery (P<0.001). Conclusion: Intravenous sedation with midazolam and propofol TCI was effective on the patients’ anxiety during the third molar extraction, which successfully made the patients more comfortable and their heart rate, blood pressure and oxygen saturation more stable during the surgery. But there were no significant differences on the patients’ anxiety at the initial visit (T1), before surgery (T2) and 7 days after surgery (T3) according to the SAI scores in the two groups.

Objective： To investigate the cervical lymphatic metastasis rates of clinically negative neck lymph node (cN0) maxillary malignant tumors, to compare the cervical lymphatic metastasis rates of the various pathological types, and to provide the reference for the treatment of the neck of the patients with cN0 maxillary malignant tumor. Methods: The clinical data of 277 cases with cN0 maxillary malignant tumor, treated in the department of oral and maxillofacial surgery of Peking University School and Hospital of Stomatology from 1990 to 2010, were reviewed. The cervical lymph node metastasis and the related clinical information were recorded. The clinical information including histopathology type of the tumors, tumor grade, primary site and TNM staging, as well as other demographic and clinical data, were retrieved from the electronic medical record system (EMRS) of the hospital. The pathogenesis of cervical lymph node metastasis in maxillary malignant tumors of different histopathological types, and the factors related to lymph node metastasis of upper cervical malignancy were analyzed by SPSS 19.0 statistical software. Results: The overall cervical lymph node metastasis rate of the 277 patients with cN0 maxillary malignant tumor was 15.5% (43/277). Maxillary squamous cell carcinoma (SCC) had a strong cervical lymph node metastasis tendency and the rate was 33.0%. The overall metastatic rate of adenocarcinoma was 7.6% lower than that of SCC, and the occurrence of cervical lymph node metastasis time was relatively late, but the metastasis rate of highly malignant grade salivary gland carcinoma was significantly higher than that of intermediate and low grade carcinoma (P=0.037). The metastatic rates of some highly malignant cN0 salivary gland carcinomas including adenocarcinoma, not other specified, high-grade mucoepidermoid carcinoma (MEC), and salivary duct carcinoma were exceeded 15%, while the metastasis rates of adenoid cystic carcinoma and myoepithelial carcinoma were lower. The metastasis rate of the sarcomas was very low with the rate of 4.9%. Conclusion: Selective neck dissection (SND) is recommended for cN0 maxillary SCC and feasible for some highly malignant cN0 salivary gland carcinomas including adenocarcinoma, not other specified, highgrade MEC, salivary duct carcinoma. The neck can be closely observed for the patients with maxillary sarcoma.

Objective：To evaluate the bonding ability of one representative self-etch adhesive system by applying the micro-shear bond strength test method with different concentrations of carbodiimide ［1-ethyl-3-(3-dimethylaminopropyl) carbodiimide, EDC］ ethanol solution pretreatment. Methods:Extracted sound human third molars were collected from patients ranging 18 to 40 years. In the study, 80 molars were first sectioned to prepare a flat middle coronal dentin surface and then were randomly divided into 5 groups (n=16) according to without/with different surface treatments ［blank control; 80% (volume fraction) ethanol control; EDC ethanol solution of three concentrations (0.01 mol/L, 0.3 mol/L and 0.5 mol/L）］. Each specimen underwent a micro-shear bond strength test and failure mode observation. The data collected were subjected to statistical analysis using one-way ANOVA and post hoc Tukey’s test to analyze the difference of the microshear bond strength, and chi-square test/Fisher’s exact test for the failure mode frequency of the micro-shear bond strength test specimens at a significance level of P=0.05. Results: The micro-shear bond strength of the three concentration EDC treatments were (35.29±8.97) MPa (0.01 mol/L EDC treatment group), (40.24±9.68) MPa (0.3 mol/L EDC treatment group), (37.38±9.66) MPa (0.5 mol/L EDC treatment group) separately; and that of the 80% ethanol group was (37.49±7.76) MPa. All micro-shear bond strength value of the above four groups was statistically higher than that of the blank control group ［(33.81±7.98) MPa］. The immediate micro-shear bond strength and failure mode was of no statistically significant difference among all the groups. It was noticed that the immediate micro-shear bond strength of 0.3 mol/L was higher than that of all the other groups, especially higher than that of the 80% ethanol pretreatment group despite that there was no significant difference among all the groups. And the test of failure mode indicated that the cohesive failure was more common, while the frequency of adhesive failure was rare in each experimental group. Conclusion:EDC pretreatment had no adverse effect on the immediate microshear bond strengths of Clearfil SE Bond. Meanwhile, EDC treatment did not cause more adhesive failure in immediate micro-shear test, which had further denoted what was said above. However, it needs more research to illustrate the anti-enzymatic role of EDC in dentin bonding.

Objective： The hydrogen sulfide (H2S) role in pathogenesis of various diseases were wildly addressed in recent decade. The circulatory (plasma or serum) and biological fluid H2S measurement is still an enormous issues due to the technical limitation. This paper aimed to develop a novel measurement method based on fluorescence probe. Methods: Firstly, 20 μL ethanol was used to dissolve 100 pmol fluorescence probe, then added in a 96-well plate. An equal volume of ethanol was also added to the blank well of the plate. The plate was placed in a dark room for about 1 h until the fluorescence probe was evenly coated in the 96-well microplate and dried. The plate was frozen at -20 ℃ for later use. Secondly, the plasma or serum sample was added with saturated ammonium sulfate buffer (pH 7.8) and then centrifuged to remove the proteins. The equal volume supernatant liquid was added to the probe-coated well and the probe-uncoated well. The plate was incubated in a dark environment at 37 ℃ for 2 h. Finally, after incubation, the fluorescence density was acquired at λEx/λEm 340/445 nm in a microplate reader. The differences of the  fluorescence density values between the probe-coated well and probe-uncoated well were counted and H2S concentration of plasma/serum was calculated by standard curve with NaHS. Results: The method had high sensitivity (from 0.3 to 100 μmol/L) and specificity for measuring H2S as compared with other biologically relevant reactive sulfur species and sulfur-containing amino acid. Serum H2S concentrations were assayed in 188 health volunteers using this method ［(12.1±3.5) μmol/L， 95%CI: 4.6-19.8 μmol/L］, and the frequency distribution showed a normal tendency(one-sample Kolmogorov-Smirnov test, P>0.1). The serum H2S concentrations in 30 hypertension patients were decreased compared with 22 age-and gender-matched health individuals (paired-samples t test, t=9.937, P<0.001). There were no differences of H2S concentration in serum ［(19.66±2.32) μmol/L］ or plasma ［(18.67±2.07） μmol/L］, between the samples acquired from artery ［(19.34±0.51) μmol/L］ or vein ［(18.99±0.50) μmol/L］ of male Wistar rats (repeated measurement of ANOVA, P=0.38). One week frozen samples did not affect the detection. The values of the repeated measurement did not differ (two-way ANOVA, P>0.05). Conclusion: The present method is easily performed with high sensitivity, specificity and repeatability for circulatory H2S. It is also quick and may apply for large samples.

Objective： To compare the safety and effectiveness of two minimally invasive approaches for multi-vessel coronary revascularization. Methods: From August 2014 to February 2017, 70 consecutive patients who underwent minimally invasive coronary artery bypass grafting in Peking University Third Hospital were randomly divided into two groups. In one group, 40 patients underwent staged-hybrid coronary revascularization (staged-HCR) treatment; in the other group, 30 patients underwent minimally invasive total arterial revascularization with bilateral internal thoracic artery (BITA). In staged-HCR group, the patients underwent minimally invasive direct coronary artery bypass grafting (MIDCAB) and percutaneous coronary intervention (PCI) procedure for treatment of multi-vessel disease. In BITA group, the patients underwent total arterial coronary artery bypass grafting with composite “Y” BITA graft. Preoperative and postoperative data of the two groups, including postoperative blood usage, mechanical ventilation time, domiciling duration in intensive care unit (ICU), major adverse cerebral and cardiovascular event (MACCE), and postoperative coronary angiography results were compared, in order to evaluate the safety and effectiveness of these surgical approaches. Results: The preoperative characteristics of 70 patients in the two groups showed no significant difference. All the patients underwent successfully, elective minimally invasive multi-vessel coronary artery bypass grafting as scheduled preoperatively. Postoperative result showed the patients in staged-HCR group took advantages in less postoperative mechanical ventilation time ［Staged-HCR group (11.2±8.7) h vs. BITA group (18.3±9.1) h, P=0.013］, shorter domiciling duration in ICU ［StagedHCR group (26.29±4.05) h vs. BITA group (44.74±28.75) h, P=0.022］, and less total drainage ［Staged-HCR group (695.57±250.46) mL vs. BITA group (1 103.26±547.44) mL, P=0.03］ than the patients in the group of minimally invasive total arterial revascularization with BITA. Postoperative in hospital coronary angiography showed satisfactory graft patency rates in both groups ［97.5% in Staged-HCR group vs. 97.8% in BITA group］. No MACCE occurred in both groups during hospitalization. Conclusion: Staged-HCR is a feasible method for the treatment of multi-vessel revascularization involving right coronary artery. Minimally coronary revascularization with BITA is associated with superior long-term graft patency and it’s recommended for patients who could not tolerate dual-antiplatelet therapy. This study shows that both minimally invasive surgical approaches are safe and effective for treatment of patients with multi-vessel coronary artery disease.

Objective： Contrast enhanced ultrasound (CEUS) is an innovative technique that employs microbubble contrast agents to demonstrate parenchymal perfusion. Ultrasound contrast agent was reported to be directly used in human internal lumen to improve the observation capacity of ultrasound. However, CEUS has never been reported to be used in the guidance of percutaneous renal access in percutaneous nephrolithotomy (PCNL). This study aimed to assess the efficacy of CEUS-guided renal access in PCNL. Methods: In this retrospective study, percutaneous renal access was performed under real-time monitoring of CEUS during PCNL in a cohort of 20 patients with renal stones at Peking University First Hospital. Data regarding patients’ demographic and clinical characteristics, therapeutic regimens, and postoperative information were collected from a comprehensive database containing comprehensive medical records of the patients undergoing PCNL. Briefly, the procedure was as follows. With the patient under general anesthesia, renal access was established by the guidance of CEUS. Afterwords, holmium laser, pneumatic or ultrasonic lithotripsy was used by the same urologist. The patient demographics, stone characteristics and procedure details were noted. Finally, appropriate statistical analyses were performed to evaluate the effectiveness and safety of the CEUS-guided percutaneous renal access in PCNL. Results: All the 20 patients underwent PCNL successfully with the help of CEUS guidance for tract creation. The collecting system was successfully accessed in all the patients, and only one patient underwent re-puncture. All the patients approached through a middle-pole percutaneous access. The median puncture time was 3.9 (2.9-4.6) min, and the median operating time was 112 (98.5-134.5) min. The preliminary stone-free rate of PCNL was 95.0% (19/20) as shown by the kidney, ureter, and bladder (KUB) radiographs 48 h postoperation, and the median decline in hemoglobin level was 10 (5.5-14.5) g/L. Two patients had transient postoperative fever and responded well to antibiotics. In addition, no other major complications were observed. Conclusion: CEUS is a safe and effective alternative way of guidance for percutaneous renal access for PCNL beginners. It makes this procedure more visualized and simpler, and produces clearer images than common ultrasonic ones. PCNL beginners might benefit from this method to shorten the learning curve of PCNL, while it warrants further comparative studies to clarify.

Pulmonary adenofibroma is an extremely rare benign primary tumor of the lung, with cha-racteristic bi-phasic differential pattern. They are usually sub-pleural solid pulmonary nodules with clear margins. The tumor is composed of glands and peri-gland stroma. The glands are often quite simple, forming long and narrow tubules, with uniformly monolayer lining cells. Combined papillary or phyllodes structures were reported in some cases. The stromal cells are spindleshaped and look mild, mixed with the collagen bands. Up till now, only a few cases of pulmonary adenofibroma have been reported all over the world. And because of the limited recognition, this tumor is easily misinterpreted as malignancy in frozen section or biopsy specimens. We reported a new case of pulmonary adenofibroma. The mass peripherally located in the left lobe of the lung, found by chance in a 74-year-old woman. The patient underwent a wedge resection of the left lung by the thoracoscope, because of the slowly gradual enlargement of the mass annually. An oval grayish-white nodule was sub-pleural located in the specimen, with solid and rubbery texture, but without a distinct capsule. Two distinct components of simple glands and mild spindle cell stroma were found to mix together uniformly under the microscope. Collagen bands of various widths evenly surrounded each stromal cell. A few small coarse papillae or phyllodes structures were randomly distributed in some area. The immunohistochemical staining pattern of the glandular cells was accordant with typeⅡalveolar epithelium. Stromal cells were positive with CD34, B-cell lymphoma-2 (Bcl-2), CD99 and estrogen receptor (ER), while S-100, smooth muscle actin (SMA) and all the mesothe-lium markers were negative. The patient was disease free after the surgery, although the follow-up time was only one year. Besides the new case above, we also reviewed all the reported cases, and tentatively discussed the probable histological origin of pulmonary adenofibroma.

The patient, a 43-year-old man, had paroxysmal headache three months ago, and he had complained the left occipital sharp pain, which could be alleviated by itself, with alalia and the right side of the upper limb numbness. Head computed tomography (CT) revealed a left temporal lobe intraparenchymal hemorrhage with the left side of the subarachnoid hemorrhage in small quantities. Digital subtraction angiography (DSA) revealed a suspicious aneurysm on the left internal carotid artery siphon. He had intermittent fever 1 month ago, with maximum body temperature 39 ℃. He suffered headache again 20 days ago, with pain nature, duration and the way of easing up similar to the earlier onset. General examination demonstrated 2/6 grade blowing systolic murmurs at apex area. Neurological examination revealed that Babinski’s sign was positive on the right side. Echocardiographic found an anterior mitral valve ve-getation on the 4th day in hospital. So his clinical diagnosis was infective endocarditis with cerebral embolism. He received vancomycin treatment immediately. His three blood cultures remained negative in hospital. His blood specimens were sent to Chinese Center for Disease Control and Prevention, indirect immunofluorescence method (IFA) IgG antibody detection revealed that the Bartonella henselae IgG antibody was positive. Therefore the clinical diagnosis was Bartonella endocarditis complicated with subarachnoid hemorrhage and cerebral embolism. Bartonella, an intracellular fastidious, gram-negative bacilli, was first documented as a cause of endocarditis in 1993 and since then has been increasingly recognized as an important etiology of infective culture-negative endocarditis. In cases of documented Bartonella endocarditis, the Infectious Diseases Society of America (IDSA) guidelines recommended 2 weeks of gentamicin plus 6 weeks of doxycycline treatment, to achieve a higher cure rate.

Sj-gren’s syndrome is a systemic autoimmune disease which is characterized by xerosis, and multiple organs can be affected, causing interstitial lung disease, renal tubular acidosis, blood system involvement, peripheral neuropathy, and liver damage, but cardiac involvement is rare. Here we report a case of Sj-gren’s syndrome with prominent aortic valve involvement. A 66-year-old woman was admitted for exertional dyspnea, and the ultrasonic cardiogram showed severe aortic stenosis with moderate regurgitation. Preoperative examination for valve replacement found that the patient had elevated erythrocyte sedimentation rate and positive rheumatoid factor, so she was referred to the rheumatology outpatient department for further examination and treatment. Further questions about medical history found that the patient had dry eyes and dry mouth for more than ten years, and had obvious caries. Further laboratory examination showed elevated serum immunoglobulin levels and positive anti-nuclear antibody. The fin-dings of ophthalmologic examination and labial gland biopsy also supported the diagnosis of Sj-gren’s syndrome. After treatment of glucocorticoids and hydroxychloroquine for ten months, her dyspnea symptoms were obviously improved in the patient, and the rheumatoid factor had become negative while her erythrocyte sedimentation rate normal. Repeated ultrasonic cardiogram examination showed that her aortic stenosis was also improved. The patient has been followed up for four years, and her condition kept stable. Cardiac involvement in Sjgren’s syndrome can affect all parts of the heart, but valve involvement is relatively rare. The specific relationship between cardiac involvement and Sj-gren’s syndrome and the mechanisms behind these associations both need further research.

Perioperative stroke is cerebral infarction occurring in the perioperative period. The incidence of perioperative stroke in non-cardiac, and non-neurologic surgery is about 0.7%, but the mortality can be as high as 26% to 40%. The outcome of the patients with perioperative stroke can be disastrous. Here we report a case of perioperative ischemic stroke that occurred after surgery of lumbar decompression and pedical screw fixation. A 76-year-old female admitted to our hospital because of lumbar spinal stenosis. Her medical history included hypertension and diabetes for ten years. Her personal history included a smoking history of 60 years by 2 cigarettes per day, not quitting. Her carotid artery ultrasound showed multiple low echo plaques on the right side and multiple high echo plaques on the left side of the carotid artery, but without distinct stenosis. Other examinations and tests showed no distinct abnormality. She went on a lumbar decompression and pedical screw fixation uneventfully. The blood loss was 400 mL and autologous blood transfusion 150 mL. The arterial blood pressure (ABP) maintained during 100-130 mmHg/60-80 mmHg (1 mmHg=0.133 kPa). Sixty minutes after she recovered from general anesthesia, the patient developed symptoms of slurred speech and right limbs weakness. The anesthesio-logist evaluated the patient immediately with National Institute of Health Stroke Scale (NIHSS). The NIHSS score was 11 and a stroke was highly suspected. The acute stroke team was therefore initiated and fast responded. Within 4 h, digital subtraction angiography (DSA) was proceeded, which showed the M1 segment of the left middle cerebral artery was occluded and the local stenosis of her right middle cerebral artery was up to 80%. After the successful embolectomy by Solitaire stent, the left middle cerebral artery reflowed and the forward blood flow was thrombolysis in myocardial infarction (TIMI) grade 3. The patient was discharged after 33 days after the surgery with a NIHSS of 9. Our case provides an example that an acute stroke team that included the department of anesthesiology can be beneficial to the patients’ perioperative strokes. During the perioperative period, anesthesiologists should be included into the acute stroke team, because anesthesiologists and anesthesia nurses might be first observers of those early onset strokes. Our case also put forward this thought that a standard perioperative stroke evaluation tool, like NIHSS, should be discussed and applied to facilitate and accelerate the initiation of perioperative acute stroke team.

Meckel’s diverticulum is the most common congenital anomaly of the gastrointestinal tract, affecting approximately 2% of the population. It is a true diverticulum occurring on the anti-mesenteric border of the distalileum, typically within 100 cm of the ileo-caecal valve. Neoplasms arising in Meckel’s diverticula are uncommon, and those reported in the literature are mainly carcinoid tumors, followed by gastrointestinal stromal tumors (GIST) and benign leiomyomas. Adenocarcinomas are extremely rare. Tumors in Meckel’s present non-specifically with gastrointestinal complaints, such as bleeding, obstruction, inflammation or perforation. The suspicion of a Meckel’s tumor is often not thought of at the initial. In this article we describe a 57-year-old woman who presented with massive rectal bleeding and severe anemia, later found to be caused by a adenocarcinoma arising from Meckel’s diverticulum. The tumor was unfortunately highly aggressive. Multiple liver metastases had already existed when we discovered the primary mass. Later we performed a partial resection of the ileumto cease the bleeding. Meckel’s diverticulum and the tumor were resected simultaneously. The pathological diagnosis confirmed adenocarcinoma arising from the Meckel’s diverticulum. The final stage was pT4NxM1, stage Ⅳ according to the Union for International Cancer Control (UICC) classification. After operation we gave the patient first-line, mFOLFOX6 chemotherapy, but it turned out to be not effective. Rapid progress of the liver metastases and suspicion of multiple lung metastasis in short time after therapy indicated a bad outcome. We believe this is the first case of adenocarcinoma in a Meckel’s diverticulum to be reported in domestic literature. The diagnosis of Meckel’s tumor should be considered as inpatients’ acute gastrointestinal complaints; when found incidentally at laparotomy, it should be carefully examined for any gross abnormality and resection should be considered.

Bisphosphonate-related osteonecrosis of the jaw (BRONJ), as one serious side-effect of bisphosphonate therapy, has been known for more than ten years since it was first reported in 2003. In the majority of the cases, BRONJ occurs more commonly in the mandible. Those involving the maxilla are relatively few. This paper reported a case that a patient with multiple myeloma developed bilateral maxillary BRONJ after tooth extraction. The patient had used bisphosphonates for more than three years, meanwhile with uncontrolled diabetes mellitus. The patient recovered completely after surgical treatment, in combination with diabetes disease control and antibiotics application. Two key factors to ensure the success of surgical treatment are as follows: sufficient removal of infected and necrotic tissue, and good blood-supply for the local flap to help completely close the wound. The literature was reviewed to analyze the reasons why bone necrosis related to bisphosphonates was most likely to occur in the jaw, especially in the mandible, according to the pathogenesis of this disease. Furthermore, the related risk factors of BRONJ presented in this case were discussed, such as tooth extraction, oral infection and diabetes mellitus, etc. We summarized adjuvant prophylaxes for prevention of BRONJ after tooth extraction, for example, drug holiday that could be used in the dental clinic. This case report reminds us that it’s of great importance to establish the awareness that the osteonecrosis of the jaw may be related to the use of some bone-stabilizers. As for patients with a history of exposure to antiresorptive or antiangiogenic agents, dentists are supposed to be cautious. It’s recommended to take appropriate measures in perioperative period of oral surgical treatment to prevent BRONJ.