Objective To evaluate the effectiveness of using the anterolateral thigh flap and splitthickness skin grafting to repair large skin defect secondary to the excision of massive penoscrotal Paget's disease.Methods Clinical data of 6 patients with massive penoscrotal Paget's disease were retrospectively reviewed.The patients were admitted to our institute from Feb.2005 to Oct.2010 with mean age of 64 (55-68) years.No other neoplasm and enlarged inguinal lymph node were detected on physical examination,ultrasonography and CT scan.All cases underwent wide local excision of skin lesion which was taken 2 cm beyond the boundary under epidural anesthesia.An anterolateral thigh flap was used to reconstruct the scrotum,and the skin defect of penis was repaired by split-thickness skin grafting.Results Operation was uneventful for the 6 patients,with mean skin defect of 185 (150-210) cm2.The mean operative duration was 270 (210-300) min,and the mean blood loss was 75 (35-150) ml.Negative surgical margins were confirmed on postoperative pathology.Five patients recovered smoothly with satisfying cosmetic appearance,and one patient demonstrated partial necrosis of the flap which was repaired on secondary surgery.The mean follow-up was 37 (10-60) months,and no relapse was found.Conclusions It is an effective method to use anterolateral thigh flap and split-thickness skin grafting to repair large skin defect secondary to excision of massive penoscrotal Paget's disease.

Objective To investigate the influence of cervical vagosympathetic trunk or ganglionated plexi stimulation to the inducibility of atrial fibrillation(AF) in dogs.Methods In 16 anesthetized dogs,right cervical vagosympathetic trunk(VST) were dissected.A right thoracotomy was used to expose fat pad(FP) containing the ganglionated plexi(GP) at the caudal end of the sinus node.An electrode catheter was attached along the right superior pulmonary vein to allow programmed atrial pacing.At 2?,4? and 10? threshold atrial refractory periods(ARPs) were determined with and without VST or GP stimulation.At each pacing threshold AF inducibility was measured from the window of vulnerability(WOV).A cumulative WOV sum made of all WOVs was calculated in each group.Results In the baseline state the heart rate(HR) averaged 153?22 beats/min.Slowing of the HR by VST stimulation(79?44 beats/min) was not significantly different than with GP induced slowing(87?99 beats/min,P=NS).Furthermore,there were no significant differences between the lowest ARPs with VST stimulation and GP stimulation,accounting to 90?17 ms and 91?13 ms respectively(P=NS),but both are shorter than that in the baseline state,which was 101?20 ms(P

10 minutes).The average cycle length(CL) at the RAA was 30.6?4.6 msec vs.105.2?32.0 msec at other atrial sites(P

Objective To investigate electrophysiologic characteristics,the original site of atrial tachycardia(AT)and the results of radiofrequency catheter ablation(RFCA)in children without structural heart disease.Methods Electrophysiologic study and RFCA were performed in 46 children with AT.The site of origin of AT was mapped by using activation mapping during tachycardia.Magnetic electroanatomical mapping(CARTO system)for ablation of atrial tachycardia was performed in 4 patients.Preselecting a temperature of 50~60 ℃ was selected for ablation.Results Electrophysiologic study verified that the mechanism of all the tachycardias in 46 children was focal AT,which might be short paroxysmal,paroxysmal or persistent.1 child also had atrioventricular nodal reentrant tachycardia.ATs were successfully ablated in 41 children(89%),in which 39 had one original site(27 foci in right atrium and 12 foci in left atrium),2 had at least two original sites.Conclusion The success rate of RFCA in ATs of children without structural heart disease was relatively high.Atrial taclycardia could be eliminated by radiofrequency current with safety and efficacy.

Objective To estimate whether a change in the polarity of low atrial electrograms recorded near the ablation line is an accurate indicator of complete isthmus block in the radiofrequency ablation of typical atrial flutter. Methods Radiofrequency ablation was performed in 10 patients with typical atrial flutter. Electrograms were recorded around the tricuspid annulus using a duodecapolar halo catheter and the distal electrode of halo catheter positioned just near the ablation line. The electrogram polarity of the distal electrode pair (H potential) was analyzed during atrial flutter and during coronary sinus pacing before and after ablation. Results Radiofrequency ablation was performed during coronary sinus pacing in 8 patients and performed during atrial flutter in 2 patients. Complete isthmus block was achieved in all patients. Before ablation, the initial polarity of H potential was predominantly positive during coronary sinus pacing and predominantly negative during atrial flutter. After complete isthmus block was achieved, the initial polarity of H potential was predominantly negative during coronary sinus pacing in all the patients. Conclusion The change of the electrogram polarity recorded just near the ablation line during coronary sinus pacing after ablation of typical atrial flutter is a simple, quick and accurate indicator of complete isthmus block.

Objective To investigate the efficacy and safety of the segmental electrical isolation of pulmonary veins (PVs) in patients with paroxysmal atrial fibrillation (PAF). Methods Thirty-nine patients (28 males, 11 females) with recurrent documented symptomatic PAF were included. In order to avoid the risk of cardiac tamponand, we adopted one transseptal procedure and obtained unselective angiography of all PVs and left atrial appendage using pigtail catheter. Lasso mapping catheter and ablation catheter were put into target pulmonary vein ostium through the same site of atrial septum. We routinely mapped the right inferior PV lest any pulmonary vein potential (PVP) that triggered PAF should be omitted. RF ablation was applied at the PVP breakthrough and slightly right and left by moving the RF catheter. Results Eighty-five PVs were targeted for segmental RF ablation. Eight-one were isolated completely. Immediate successful rate was 95%. There was not any complication associated with the procedure. Conclusion It is suggested that the method of segmental PV isolation has a higher cure rate and a shorter procedure time compared with other traditional methods. It can minimize the lesion of pulmonary veins and avoid PV stenosis.

0 05 There was 1 case of cardiac tamponand and 1 case of 60% stenosis of the left superior PV associated with the procedure Conclusion ERAF after segmental PV isolation is common, occurring in approximately 39% of patients with paroxysmal AF However, approximately 35% of ERAF patients without early repeat ablation have no further AF during long term follow up It is suggested that temporary antiarrhymic drug therapy may be more appropriate than early repeat ablation in patients with ERAF

Objective To analyze the electrophysiological characteristics of atrioventricular nodal reentrant tachycardia(AVNRT) requiring ablation at the mitral annulus.Methods Ablation was carried out at the mitral annulus by mapping the slow pathway with resetting method in order to acquire the electrophysiological parameters needed for successful ablation of AVNRT.Results Three cases with AVNRT who had prior failed ablation were successfully ablated by targeting the slow pathway located at the mitral annulus.The location of the left-sided slow pathway was selected by a positive resetting response and verified by junctional automaticity elicited by radiofrequency application and elimination of tachycardia.Conclusion AVNRT refractory to ablation of slow pathway at the posteroseptal area may require ablation at the mitral annulus.Resetting response may help to locate the slow pathway along the mitral annulus.

In order to explore the significance of enterovirus environmental surveillance of sewage,two sewage treatment plants in Fuzhou City were selected as sentinel surveillance sites.One sewage sample was collected from entrance of each plant every month,and total 48 samples were studied from 2013 to 2014 in Fuzhou City.Using the RD,L20B and Hep-2 cell lines to isolate the viruses,44 of the 48 sewage samples (91.67％) were positive,268 strains were isolated which covered at least 22 enterovirus serotypes.The peak season of virus isolation from sewage was in February and July which was two months earlier than patient surveillance.Eehovirus type 7 (Echo 7) was the predominant serotype in 2013 with 58 isolations (43.61％),and in 2014 echovirus type 6 (ECHO 6) became the predominant serotype with 85 isolates (62.96％),among the strains isolated from sewage sample.Phylogenetic analysis found that the predominant serotype Echo 6 and Echo 7 isolated from sewage were more diversified than that from clinical cases during the same period,and were high homology with isolates form patients which belong to same branch in phylogenetic tree.In conclusion,enterovirus environmental sewage surveillance is an effective approach,and could be more sensitive than patient surveillance.

AIM: To study the effects of vitamins on vascular activity elements in rabbits with atherosclerosis risk factors to determine whether vitamins have a role in preventing atherosclerosis. METHODS: 26 male Chinese rabbits were randomly divided into 3 groups. The first group was fed with normal feed as control group (n=6) .The other two groups were fed with normal feed plus cholesterol, lard and methionine as model group (n=10) and vitamin treatment group (n=10) respectively. In addition, the vitamin group was given multi-vitamin daily by gastrogavage. The experiment lasted for 8 wk. The vascular activity elements of the three groups were detected by radioimmunoassay and nitrate reductase respectively ,and the aorta pathological sample was prepared. RESULTS: In model group, the levels of plasma endothelin and thromboxane B 2/6-keto-prostaglandin F l? were significantly increased compared with control group, but serum nitric oxide showed no obvious changes between both groups. In vitamin group, the levels of plasma endothelin and thromboxane B 2 were significantly decreased, and the levels of 6-keto-prostaglandin F1? and nitric oxide were significantly increased compared with model group. In model group, there were significant pathological lesions, but the lesion was decreased by vitamin treatment. CONCLUTION: The vitamins supplement can alleviate or block the impairment of vascular endothelia caused by atherosclerosis risk factors, and help adjust the equilibrium of vascular activity elements. Therefore vitamins may play a positive role in preventing atherosclerosis.