AIM： To estabish a HPLC assay for the determination of pirarubicin（Pir） in plasma.METHODS： Daunomycin（DM） was used as the internal standard.Plasma samples were extracted with CHCl3∶ CH3OH（2∶ 1） .0.4M NH4Cl buffer（pH=9.0） solution： CH2OH（1∶ 9） and the internal standard were added.Separation was carried out on a 250mm× 4.6mm（5μ m） phenomenex column with 0.04M KH2PO4（pH=3.0） ∶ CH3CN（68∶ 32） as mobile phase.Fluorescent detector was set at an excitation wavelength of 480nm and an emission wavelength of 550nm.RESULTS： The calibration curves for serum Pir was linear over the range of 5～1 000ng/ml（r=0.9 997） .The recovery of Pir was 95.3％ .The within-day and between-day variations were less than 5％ .T1/2β ， CLs， Vd and AUC of Pir were（12.8± 5.9） h， （128.3± 52.6） L/（m2· h） ， （1 754.3± 478.2） L/m2 and （428.7± 137.2） ng/（h· ml） ， respectively.CONCLUSION： The method is suited for monitoring blood concentration and pharmacokinetic study of Pir.

Objective To explore the effect of radio frequency ablation (RFA) combined with transcatherterarterial chemo embolization (TACE) and percutaneous puncture hydrochloric acid injection(PHI) for hepatic tumors unable to resection. Methods The clinical data of 40 cases of patients with unable resection liver cancer (URLC) treated by RFA combined with TACE and PEI were analyzed retrospectively.Results There were 30 cases of primary hepatic tumor(PHT) and 10 cases of metastasis hepatic tumor(MPT) , in this series. Examination of ultrasound, CT and MRI showed the tumors shrink or steady in 39 patients.Among 30 patients with damage by ethanol, 18 cases were AFP positive before treatment and 16 cases of them AFP decreased to normal level after operation. No severe complication was seen in the series. Conclusion RFA combined with TACE and PEI is a safe, well tolerable and effective method for hepatic cancer, and may improve the treatment efficacy of URLC.

Objective:To explore the clinical features of Stewart-Treves syndrome in postoperative patients of breast cancer.Methods:The clinical data of 11 patients with Stewart-Treves syndrome after breast cancer surgery in Beijing Shijitan Hospital from Aug 2008 to Sep 2016 were retrospectively analyzed.Results:All the 11 patients were female , age ranging from 44 to 78 years.The main clinical manifestations included multiple skin and subcutaneous nodules , scattered red or purplish red rashes in the lymphedematous upper limbs, and sometimes in the chest wall. MRI showed multiple short T2 signal soft tissue nodules in skin and subcutaneous soft tissue. Histopathology showed heterogeneous endothelial cell-derived malignant tumor. Immunohistochemical staining showed positive CD31, CD34 and D2-40. These 11 patients had skin and subcutaneous tumor excision and biopsy, 4 had shoulder amputation, 4 received postoperative adjuvant chemo plus or radiotherapy. As of Feb 2020, 1 patient was alive, 9 died and 1 lost follow-up.Conclusions:Stewart-Treves syndrome is a rare complication of breast cancer, with poor prognosis and high mortality.

Objective To explore the risk and treatment of laparoscopic cholecystectomy(LC) in patients with liver cirrhosis and cholelithiasis.Methods To summarize the clinical data of 28 patients with liver cirrhosis and cholelithiasis.The patients were repeated right upper quadrant pain,including 4 cases of gallbladder neck stones incarcerated,gallbladder effusion.Among them,there were 20 cases of hepatitis B cirrhosis,5 cases of schistosomiasis cirrhosis,3 cases of alcohol.Results There were 6 patients with hemorrhage during operation.Among them,5 patients were treated with gelatin sponge,hemostatic gauze and bio-glue spray to stop bleeding,1 case was transferred to open surgery because of bleeding.The remaining 27 cases of LC were successful.Complications occurred in 8 patients,3 cases of increased liver function abnormalities,1 case of upper gastrointestinal bleeding,1 case of mild hepatic encephalopathy,2 cases of significant ascites formation,1 patient underwent subtotal resection of the gallbladder with Hartmanns bag,and bile was found in the ascites after surgery,but the bile disappeared after five days.All patients with complications after symptomatic treatment were cured,no death,no major bleeding and liver failure,bile duct injury,severe biliary fistula and other serious complications.Conclusion Although the risk of LC in patients with liver cirrhosis is higher than that in the general population,with the help of current high-tech surgical instruments,we can safely accomplish this with an improved surgical procedure.As these patients require high technical requirements of surgery,surgeons must have a wealth of experience and familiar laparoscopic liver and gallbladder anatomy.

Objective To explore the prognostic factors of intensive care unit (ICU) patients. Methods A retrospective cohort study was conducted. The clinical data of patients admitted to ICU of Beijing Geriatric Hospital from January 2005 to December 2016 were collected. According to the prognosis, the patients were divided into death group and survival group, and the mortality trend with time and age was observed. Survival and death were treated as dependent variables, while the gender, age, reason of ICU admission, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, whether undergoing invasive mechanical ventilation (MV), invasive MV reason, duration of invasive MV, whether successful weaning, whether ICU nosocomial infection, hospital acquired pneumonia (HAP), central line-associated bloodstream infection (CLABSI), acute kidney injury (AKI) occurred, whether undergoing continuous blood purification (CBP), whether septic shock occurred, whether undergoing invasive hemodynamic monitoring or blood transfusion and length of ICU stay were used as the independent variables. First, the clinical data was analyzed by univariate analysis. Second, the independent variables influencing the dependent variable were analyzed by logistic regression analysis to screen out prognostic factors of ICU patients. Results During the study period, 1325 patients were treated, 26 patients with missing data, 1299 patients in final group, 865 patients in survival group, and 434 in death group. The proportion of men in the patients was larger (67.7%), and the age span was larger (16-105 years old). The mortality rate in different years showed no significant difference (χ2 = 16.712, P = 0.117), and with the increase of age, the mortality rate of ICU showed an upward trend (χ2 = 16.399, P = 0.022). The univariate analysis showed that ICU deaths were unrelated to gender, but associated with age, APACHE Ⅱ score, invasive MV, invasive MV reason, duration of invasive MV, successful weaning, ICU nosocomial infection, HAP, CLABSI, AKI, septic shock, whether CBP or invasive hemodynamic monitoring, blood transfusion, the reason of ICU admission and the length of ICU stay (all P < 0.05). The relevant factors with statistical difference found in univariate analysis were analyzed in logistic regression analysis, which showed that whether successful weaning [odds ratio (OR) = 0.016, 95% confidence interval (95%CI) = 0.010-0.025], and whether AKI (OR = 3.917, 95%CI = 2.331-6.582) or septic shock occurred (OR = 2.808, 95%CI = 1.604-4.915) were the dependent variables of death or survival (all P = 0.000). Regression coefficient (β value) of successful weaning was -4.155, suggesting that unsuccessful weaning patients were likely to die. The β value of AKI and septic shock was 1.365 and 1.033, suggesting that the patients with AKI or septic shock were more likely to die. Conclusions Whether the success of weaning, whether the occurrence of AKI or septic shock are independent prognostic factors for the prognosis of ICU patients. Measures for the prevention of the above three aspects could improve the prognosis of ICU patients.

Objective: To evaluate the safety and feasibility of hybrid thoracoscopic surgery and catheter ablation in treating the patients of long-standing persistent atrial fibrillation (AF) with preliminary experience. Methods: A total of 15 consecutive relevant patients treated in our hospital by hybrid thoracoscopic surgery and catheter ablation from 2014-04 to 2016-03 were studied. The average AF time was (4.0±3.9) years including 13 male. All patients received thoracoscopic surgical ablation including pulmonary vein isolation, left atrial (LA) posterior wall isolation, Waterston's groove Ganglionated plexi ablation by bipolar radiofrequency ablation clamp and LA appendage removal, Marshall ligament dividing. Then establishing LA 3D-modeling, based on LA 3D voltage mapping, catheter ablation was conducted to reinforce surgical ablation or modification in order to confirm bidirectional blocking. Meanwhile, LA ridge and mitral isthmus ablation was performed, some patients received LA anterior wall and tricuspid isthmus ablation. The patients were followed-up at 3, 6 and 12 months after the procedure. Results: 13 patients were restored to sinus rhythm after the procedure and no operative complications occurred. The average follow-up time was (12.1±11.5) months. 2 patients with recovered sinus rhythm had re-catheter ablation since atrial flutter at 3 months post-procedure and sinus rhythm was restored. The overall success rate was 86.7% (13/15), no patient had anti-arrhgthmia medication. Conclusion: Hybrid thoracoscopic ablation and catheter ablation have been a minimally invasive, safe and effective method in treating the patients of long-standing persistent AF.

Objective: To study the clinical effects of liposuction combined with lymphatico-venous anastomosis for treatment of secondary lymphedema of the lower limbs. Methods: A retrospective analysis was performed for 49 patients who had undergone liposuction combined with lymphatico-venous anastomosis to treat secondary lymphedema of the lower limbs at Department of Lymph Surgery, Beijing Shijitan Hospital from November 2013 to February 2015.All patients were female aging from 31 to 70 years with median age of (52±10)years.All patients had history of pelvic surgery.There were 32 cases with cervical carcinoma, 11 cases with endometrial cancer, 1 case with ovarian cancer who accepted radical hysterectomy, 2 cases with benign tumor who accepted resection, 2 cases accepted inguinal lymph node dissection, 1 case with rectal cancer accepted radical resection.There were 30 cases with history of radiation therapy and 23 cases with history of erysipelas recurrent((2.1±3.9)/year). The limb swelling degree in preoperative and postoperative patients was explored using one-way analysis of variance with replicate measures and paired sample t-test. Meanwhile the incidence of lymphogenous infection was used as an evaluation of operation efficacy. Results: The mean lower limb circumference difference at 7 days, 6 months and 12 months was (0.17±1.36)cm, (1.25±1.62)cm and(1.58±1.56)cm, respectively, which was significantly decreased compared with preoperative((4.92±2.16)cm) (t=-5.712, -5.777, -5.765; all P<0.01). The mean lower limb volume difference at 7 days, 6 months and 12 months was (522±799)ml, (726±973)ml and (889±895)ml, respectively, which was significantly decreased compared with preoperative((2 729±1 335) ml)(t=-5.905, -6.093, -5.777; all P<0.01). The incidence of erysipelas was 0.0(0.0, 0.0)/6 months within 6 months after operation and 0.0(0.0, 0.0)/6 months within 6-12 months after operation, which was significantly lower than that before operation(0.0(0.0, 2.0)/year). The feeling of tightness and heaviness of the limb was significantly improved compared with preoperative. Conclusion Liposuction combined with lymphatico-venous anastomosis is an effective method for the treatment of secondary lymphedema of the lower limbs.

Objective: To investigate outcome and clinical value of liposuction in primary lymphedema of lower extremities. Methods: Thirty patients with primary lymphedema in unilateral lower extremity were recruited in this study from July 2016 to August 2017 in Beijing Shijitan Hospital. There were 13 male and 17 female patients, with the average age of (36±16.3) years. All the patients were underwent liposuction. The volume of hemorrhage and lipid, operation time and the volume changes of affected extremity were recorded. The subjective evaluation of the patients were also proceed. The patients were divided into different groups according to gender, stage and erysipelas history. Results: Total lipid volume is 900-3 900 ml. The hemorrhage volume is 160-1 100 ml during liposuction. The ipsilateral-contralateral percent volume of lower extremity was decreased immediately after surgery (6.6%±10.0%, t=7.050, P=0.000), and 3 months postoperatively (12.2%±10.7%, t=5.365, P=0.000), when compared with preoperative (31.4%±16.4%). However, the percent volume was increased 3 months after surgery, compared to immediately postoperative measurements (t=-2.088, P=0.041). Female patients had more lipid volume and higher liposuction rate than males, whereas male patients show more affected extremities volume before, after and in 3-month follow-up. The hemorrhage volume was also higher in male than female patients. Patients with erysipelas had higher volume of hemorrhage, with lower lipid volume and liposuction rate. Stage Ⅱpatients show higher lipid volume and liposuction rate than stage Ⅲ patients in operation, with lower hemorrhage and affected extremity volume changes in before, after and 3-month follow-up. In subjective assessment, the experienced heaviness and fatigue was alleviated in all patients, while the pain and tightness was increased. Conclusions Liposuction is an effective therapy for primary lymphedema in lower extremity. It is necessary to combine with other therapies to improve lymph circulation. Patients′ gender, stage and the history of erysipelas are the main influencing factors of operation difficulty and prognosis.

Objective:To study the clinical effect of liposuction combined with lymphatico-venous anastomosis for treatment of breast cancer-related lymphedema(BCRL).Methods:From Nov 2015 to Nov 2017, 111 patients with BCRL admitted to the Department of Lymphatic Surgery at Beijing Shijitan Hospital were enrolled. The rank-sum test was used for statistical analysis. The frequencies of erysipelas episodes before and after combined surgeries were compared.Results:The mean upper limb circumference significantly decreased at 7 days[0.2 cm (-0.8, 1.1)], at follow-up[0.2 cm(-0.4, 1.0)]compared with that of preoperation[5.0 cm(4.1, 6.9)]( P<0.05). The mean upper limb volume significantly decreased at day 7[26 ml(-120, 155)], at follow-up[37 ml(-66, 165)]compared with preoperation[786 ml(632, 1 200)]( P<0.05). The incidence of erysipelas of the affected limbs significantly decreased after treatment. Furthermore, the softness and the feeling of heaviness of the affected limbs significantly improved after the combined procedures(all P<0.05). Conclusion:Liposuction combined with lymphatico-venous anastomosis is an effective method for the treatment of breast cancer-related lymphedema.

Objective: To investigate the imaging features and etiology of lymphatic trunk in primary facial lymphedema. Methods: 26 patients with primary facial lymphedema patients (F/M, 13/13, ages 21.8 ± 13.9 years old) were recruited from January 2015 to October 2017 in this study, with 32 sides facial lymphedema reported, including 6 right facial lymphedema, 14 left facial lymphedema, and 6 bilateral facial lymphedema. And all the patient data and imaging were retrospective analysis to summarize the MR imaging features of thoracic duct and right lymphatic duct, meanwhile compared with surgical results. Results: For all 26 patients, MR imaging result in thoracic duct manifests 32 lymphatic duct, including 20 thoracic duct and 12 right lymphatic duct. The imaging features demonstrate two typical findings: dilated(13 cases) and slim(7 cases) demonstrations. While for right lymphatic duct, the MR result included three types: dilated(6 cases), slim(4 cases) and no sign of manifestations(2 cases). In surgery, the thoracic duct in cervical segment demonstrated abnormal structures, including capsulated by fibrous tissues in peripheral area(30 sides), surrounded by internal jugular vein sheath(11 sides), external pressed by venae cervicalis transversa(5 sides) and lymphatic trunk dysplasia(2 sides). Conclusions MR thoracic duct and right lymphatic duct imaging can be used as an effective diagnostic imaging method for primary facial lymphedema, and the structural anomaly of the upper cervical catheter and the right lymphatic catheter may be one of the pathogenic factors of primary facial lymphedema.