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 analyze the immunophenotypic characteristics of the patients with minimal residual disease (MRD) positive acute B lymphocytic leukemia (B-ALL). Methods The leukemia-associated immunophenotype (LAIP) of 106 cases with MRD positive B-ALL from Department of Hematology, Tianjin KingMed Diagnois Center between June 2014 and January 2016 were retrospectively analyzed. CD10, CD13/CD33, CD19, CD38, CD58, CD45 and other antibodies were used to analyze the MRD of B-ALL. Results All the patients were positive for CD19. CD34 was negatively or weakly positive expressed in 27 cases (25.4％). CD10 was negatively or weakly positive expressed in 23 cases (21.7％). CD10 was strongly positive in 24 cases (22.6％). Totally, CD10 was weakly or strongly expressed in 47 cases (44.3％). CD58 was strongly positive in 98 cases (92.5％). CD13/CD33 was positively or weakly positive expressed in 64 cases (60.4％). CD38 was negative or weakly expressed in 33 cases (31.1％). CD45 was negative in 21 cases (19.8％). 15 cases (14.1％) were positive for 6 types of LAIP; 30 (28.3％) cases were positive for 5 types of LAIP; 42 (39.6％) cases were positive for 4 types of LAIP; 13 (12.3％) cases were positive for 3 types of LAIP;5 cases (4.7％) were positive for 2 types of LAIP; only one case (0.9％) was positive for 1 type of LAIP. Conclusion The combination of CD58, CD13/CD33, CD10, CD38 and CD34 antibodies can distinguish the neoplastic blast/immature B lymphocytes from progenitor B cells. This strategy has a high accuracy for the judgement of MRD in B-ALL.

Objective:To investigate the clinical features of primary intestinal lymphangiectasia (PIL).Methods:This study was a retrospective case series study. Fifty consecutive patients diagnosed with PIL in Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University from March 2019 to March 2021 were included and their clinical data was retrospectively reviewed. There were 20 males and 30 females included, with an age of ( M(IQR)) 14 (40) years (range:0 to 67 years). No patient had the family history. There were 26 children, including 9 males and 17 females, aged 0 (7) years (range:0 to 14 years). There were 24 adults, including 11 males and 13 females, aged 40 (26) years (range:20 to 67 years). The clinical manifestations and the results of laboratory examinations, gastrointestinal endoscopy, 99Tc m-labeled human albumin ( 99Tc m-HSA) scintigraphy, 99Tc m-DX scintigraphy, direct lymphangiography (DLG), histopathology, diet treatment, surgical intervention, and clinical symptom remission at discharge were collected. Comparisons between groups were performed using independent samples t-test, Mann-Whitney U test, or χ2 test. Results:Among the 50 cases of PIL, the main manifestations were edema (86.0%), diarrhea (76.0%), and abdominal effusion (48.0%). Lymphedema (36.0%) and chylous ascites (18.0%) were not rare in PIL patients. In 99Tc m-HAS scintigraphy, 95.9% (47/49) cases showed signs of intestinal protein loss, and 91.7% (44/48) ceses showed positive findings in 99Tc m-DX scintigraphy. In DLG, 97.8% (45/46) cases showed signs of thoracic duct obstruction, 82.6% (38/46) cases showed retroperitoneal lymphatic hyperplasia, and 23.9% (11/46) cases showed backflow of contrast agent into intestine. No significant difference was seen in gender, course of disease, clinical manifestation, serum level of albumin or globulin, lymphocyte count, positive rate of fecal occult blood and prevalence of lymphedema between adults and children (all P>0.05). Conclusions:The clinical presentations of PIL between children and adults had no significant difference. The diagnosis of PIL should be made according to clinical manifestation, 99Tc m-HAS scintigraphy, 99Tc m-DX scintigraphy, DLG, gastrointestinal endoscopy and pathological findings.