Objective To evaluate the combination use of transcatheter arterial chemoembolization (TACE), portal vein embolization (PVE) and high intensity focused ultrasound (HIFU) in treating portal vein tumor thrombus(PVTT). Methods A total of 85 patients with primary hepatocellular carcinoma complicated by PVTT, who were encountered during the period from Jan. 2011 to Feb. 2012 at authors’ hospital, were enrolled in this study. The patients were divided into the study group (n=47) and the control group (n=38). TACE, PVE and HIFU were performed in the patients of the study group, while only TACE and PVE were carried out in the patients of the control group. The therapeutic process was as follows: PVE was carried out 2 weeks after TACE was performed, and for the patients of the study group additional HIFU was conducted about 10 days after PVE procedure. Results The short-term effective rate in the study group and the control group was 89.4% (42/47) and 39.5% (15/38) respectively, and the difference between the two groups was statistically significant (P< 0.05). The 6-month, one-year, and two-year survival rate in the study group were 87.2%(41/47), 66.0%(31/47) and 27.7%(13/47) respectively; the median survival time was 15.4 months. In the control group, the 6-month, one-year, and two-year survival rate were 55.3% (21/38), 39.5% (15/38) and 10.5%(4/38) respectively;the median survival time was 10.3 months. The differences between the two groups were statistically significant (P< 0.05). Conclusion For the treatment of primary hepatocellular carcinoma associated with portal vein tumor thrombus, transcatheter arterial chemoembolization, portal vein embolization together with high intensity focused ultrasound is an safe and effective therapy as it can significantly improve the therapeutic effect and prolong the survival time.

Objective To investigate the knowledge level of the caregivers about pressure ulcer in patients with high risk of pressure ulcer in rural community,and to provide the scientific basis for the prevention and treatment of pressure ulcer.Methods 216 caregivers for patients with high risk of pressure ulcer in rural community were chosen from Mar.2012 to May 2013.The investigation on the awareness of pressure ulcer was performed by using questionnaire survey.Results The awareness rate of pressure ulcer in caregivers was 41.5 ％.The caregivers had gender difference (174females and 42 males).Most of the caregivers were 41 to 50 years old (124 cases,57.4％).Most caregivers had 1 ～ 2 years work experience (94 cases,43.5％).Most of them had low level of education (170 cases,78.7％) and non-professional training (178 cases,82.4％).The questionnaire score was higher in young caregivers than in the olders(F=2.483,P＜0.05).The questionnaire score was higher in caregivers having a long working lifetime(F=3.624,P＜0.05),higher educationalbackground (F=5.139,P＜ 0.01) and discipline training (t=7.346,P＜ 0.01) than in caregivers not having them.Conclusions The awareness rate of the knowledge about pressure ulcer is low in caregivers for patient with high risk of pressure ulcer in rural community.It is necessary to strengthen the guidance and training in caregivers to reduce the incidence of pressure ulcers and the medical cost,and improve the quality of life in patients with high risk of pressure ulcer in rural community.

ObjectiveTo investigate the pathologic characteristics of the sural nerve in amyotrophic lateral sclerosis. MethodsClinical, electrophysiologic, laboratory data and sural nerve biopsy of 11 patients were reviewed. The clinical and laboratory data were compatible with the diagnosis of ALS. The sural nerve was removed and immediately fixed in 10% formalin and phosphate-buffered 2.5% glutaraldehyde and processed according to the procedure used in our laboratory for light and ultrastructural examination.Results4 groups were distinguished based on pathologic changes: normal; with mild axon degeneration and demyelination; with mild loss of the myelinated nerve, axon degeneration and demyelination; with severe loss of the myelinated nerve, axon degeneration and demyelination.ConclusionPredominantly axonal neuropathies are common and occur early in ALS. Axon degeneration of the nerve fibers is predominant, and demyelination also can be performed in patients with ALS.

OBJECTIVETo study the transdermal absorbability of gentiopicroside, naringin and protosappanin B contained in Xuanbi gel plaster.

METHODThe Franz diffusing cells method was adopted for the in vitro model of rat belly skins. Three indexes, gentiopicroside, naringin and protosappanin B, residued in the accept liquid, skins and plaster were determined by HPLC.

RESULTThe penetration rates of gentiopicroside, naringin and protosappanin B were respectively 3.47, 1.59, 2.13 microg x cm(-2) x h(-1). After 24 h, their penetration rates were 25.42%, 11.73%, 17.78%, respectively. The residual quantities of gentiopieroside, naringin and protosappanin B in skin were 0.231, 0.593, 0.568 microg x cm(-2), ith the retention rates of 0.027%, 0.227%, 0.475%, respectively. The amount of residue of gentiopicroside, naringin and protosappanin B in plaster were 2179, 674, 278 microg, with the retention rates of 81.36%, 81.92%, 73.83%, respectively.

CONCLUSIONThe in vitro transdermal behavior of Xuanbi gel plaster is close to a zero-order process. The residual quantity the retention rate in skins is much lower than the penetration rate and the residual rate in plaster.

Administration, Cutaneous ; Animals ; Flavanones ; metabolism ; Gels ; chemistry ; Iridoid Glucosides ; metabolism ; Male ; Phenols ; metabolism ; Rats ; Rats, Sprague-Dawley ; Skin Absorption

Objective To analyze abnormal characteristics of mitral valve (MV) caused by rheumatic and degenerative mitral valvedisease in virtue of the real-time three-dimensional transesophageal echocardiography(RT3DTEE) and quantitative analysis software.Methods Sixty patients underwent RT3DTEE study:21 patients with rheumatic valvular disease(RHD) studied intraoperatively(9 severe mitral stenosis,6 severe mitral regurgitation,6 severe mitral stenosis couple with regurgitation ) and 20 patients with normal MV who were used as controlsubjects(NS).TomTec-Arena 1.0-4D MV-Assessment 2.3 software was used to measure parameters of annular dimensions and geometry,[eafletsurface area and so on.Results Compared with NS,the diameter between anterior and posterior(AP) of RIID increased,however,the commissural width (CW)didn't change.Parameters of AP,CW,annulus circumference(AC) and annulus area(AA) of degenerative mitral valve disease(DMVD) increased obviously,the spherical index instead didn't change,the original "saddle" shapebecame flat.The impact on mitral valve leaflets is difference between RHD and DMVD.The anterior instead of posterior leaflet arena and length became larger of the group MS and MS&MI.However,the group of DMVD has increased leaflet area of anterior as well as posterior.Posterior leaflet angle is significantly increased in the group of MS&MI.The angle,between the DAP and plane of aortic valve annular (Angle AAo-AP),were magnified in both RHD and DMVD.From the automatic dynamic analysis,the parameters of annular displacement(max),annulus area fraction(2D)decreased considerably in RHD group.Conclusion RHD has relatively mild impact on annular of MV,but the lesions of mitral valve leaflet and chordae tendineae limit the movement of bicuspid valve an nular.The dilated and flattened annular of DMVD still has the "saddle" shape.

Objective To explore the clinic results of our new designed transcatheter valve in valve for the mitral biopro-thesis deterioration.Methods Mitral bioprothesis deterioration patients with high risk for the routine bypass surgery got con-sent.After general anesthesia in the hybrid operation the left ventricle apical puncture was performed with guidance of 3D echo and X-ray.The retro-preset J Valve system was guided into the left atrium and the mitral bioprothesis with the beating heart . Results There were total 9 cases between Jan 2019 to Mar 2019 which had STS score above 6-8.The mitral bioprothesis in-cluded Hancock valve 3 cases, Perimount valve 3 cases, Epic valve 2 cases, Baxiter valve 1 case.The mitral bioprosthesis size included 27 for 6 cases and 25 for 3 cases.The successful implant rate was 100％, mortality rate 0, and all the patients recov-ered well without any main complications.The mean tran-valular pressure was only(8 ±2) mmHg (1 mmHg=0.133 kPa). Conclusion This innovative mitral valve in valve technique with retro-preset J Valve system got very good clinic results and worthy of deep research.

Objective To evaluate the clinical value of ankle arthroscopy in diagnosis and treatment of Danis-Weber type B ankle fracture associated with injury to the distal tibiofibular syndesmosis.Methods A retrospective study was conducted of the 35 patients who had been treated at Department of Orthopaedics,Ruijin Hospital North for Danis-Weber type B ankle fracture from February 2014 to December 2016.They were 23 males and 12 females,with an average age of 43.1 years (from 18 to 65 years).Each of them underwent 4 examinations to detect whether injury to the distal tibiofibular syndesmosis was complicated or not:preoperative CT and MRI,C-ann roentgenography and ankle arthroscopy before and after internal fixation of the ankle.The diagnostic rates of the complicated injury by the 4 examinations were compared.The patients complicated with injury to the distal tibiofibular syndesmosis received surgical repair of the injury using TightRope in addition to internal fixation of the ankle,and injury to the deltoid ligament was repaired simultaneously using 3.5 mm anchor nails in case the injury was concomitant.The repair and stability of the distal tibiofibular syndesmosis were observed using ankle arthroscopy again.Results The Cotton and external rotation tests under C-arm roentgenography before surgery and after internal fixation of the ankle demonstrated that 13 cases were complicated with injury to the distal tibiofibular syndesmosis.Of the other 22 patients who had not been diagnosed with the injury by C-arm roentgenography,6,13 and 11 were diagnosed with the injury respectively by CT,MRI and ankle arthroscopy.The diagnostic rates of Danis-Weber type B ankle fracture associated with injury to the distal tibiofibular syndesmosis were 37.1％ (13/35),54.3％ (19/35),74.3％ (26/35) and 68.6％ (24/35) respectively by C-arm roentgenography,CT,MRI and ankle arthroscopy.In the sensitivity to the injury,MRI ＞ ankle arthroscopy ＞ CT ＞ C-arm roentgenography,with significant differences between them (P ＜ 0.05).The ankle arthroscopy confirmed the repair efficacy in the 24 patients complicated with injury to the distal tibiofibular syndesmosis and negative results of Cotton and external rotation tests in them.Additionally,ankle arthroscopy revealed 16 cases of injury to the deltoid ligament at the medial ankle.Conclusions Ankle arthroscopy can provide evidence for correct diagnosis and treatment of Type B ankle fracture complicated with injury to the distal tibiofibular syndesmosis,because it allows direct observation of the medial deltoid ligament of the ankle and the distal tibiofibular syndesmosis.It can be also used to assess the stability of the tibiofibular syndesmosis after repair of the injury.

Objective:To investigate the safety and efficacy of J-valve transapical catheter aortic Valve replacement(TA-TAVI) in the early treatment of aortic stenosis with low coronary ostium.Methods:From January 2020 to April 2022, 20 patients with aortic stenosis with coronary opening height ≤10 mm who underwent TA-TAVI treatment in the Valve Surgery Center of Beijing Anzhen Hospital Affiliated to Capital Medical University were enrolled retrospectively. All patients underwent preoperative imaging screening, and 5 patients underwent preoperative coronary artery protection: The height of coronary artery opening was less than 5 mm in 3 cases. 2 cases had stent stenosis & LT after coronary artery stenting 50%, and the position of the coronary artery opening was less than 8mm. The postoperative complications, mortality and cardiac function prognosis of TA-TAVI were analyzed.Results:There were 5 males and 15 females. The average age of the whole group was(73.00±6.20) years. Transthoracic echocardiography showed that all patients had severe aortic valve stenosis, and 85% of the patients had NYHA grade Ⅲ-Ⅳ, and 80% of the patients had aortic valve stenosis with insufficiency. The mean height of left coronary artery opening was(9.07±3.70) mm. RCA(11.39±3.00) mm; The opening height of coronary artery was ≤5 mm in 3 cases(left 7.5%), 5-8 mm in 5 cases(12.5%), and 8-10mm in 16 cases(40.0%). Mean aortic sinus(valsalva) diameter: Left(30.06±5.90) mm; Right(28.50±5.68) mm; Non(29.96±6.15) mm. J-valve Valve was successfully implanted through apical catheter in all patients, most of whom were size 23. CPB was performed in 2 patients at the same time, permanent pacemaker was inserted in 2 patients, and moderate or above perivalvular leakage was found in 0 patients. All patients had TNI( P=0.12) and MYO( P=0.03) before and 24 hours after operation. None of the 5 patients underwent coronary artery stenting. None of the 5 patients died within 30 days after the operation. Ta-tavi is effective 30 days after operation, with low complication rate and good prognosis of cardiac function. Conclusion:J-valve transapical catheter aortic Valve replacement is safe and effective in the treatment of aortic stenosis with low coronary ostium.

Genome miniaturization drives key evolutionary innovations of adaptive traits in verte-brates,such as the flight evolution of birds.However,whether similar evolutionary processes exist in invertebrates remains poorly understood.Derived from the second-largest animal phylum,scallops are a special group of bivalve molluscs and acquire the evolutionary novelty of the swimming lifestyle,providing excellent models for investigating the coordinated genome and lifestyle evolution.Here,we show for the first time that genome sizes of scallops exhibit a generally negative correlation with loco-motion activity.To elucidate the co-evolution of genome size and swimming lifestyle,we focus on the Asian moon scallop(Amusium pleuronectes)that possesses the smallest known scallop genome while being among scallops with the highest swimming activity.Whole-genome sequencing of A.pleuronectes reveals highly conserved chromosomal macrosynteny and microsynteny,suggestive of a highly con-tracted but not degenerated genome.Genome reduction of A.pleuronectes is facilitated by significant inactivation of transposable elements,leading to reduced gene length,elevated expression of genes involved in energy-producing pathways,and decreased copy numbers and expression levels of biomineralization-related genes.Similar evolutionary changes of relevant pathways are also observed for bird genome reduction with flight evolution.The striking mimicry of genome miniaturization underlying the evolution of bird flight and scallop swimming unveils the potentially common,pivotal role of genome size fluctuation in the evolution of novel lifestyles in the animal kingdom.

Bivalves are species-rich mollusks with prominent protective roles in coastal ecosystems.Across these ancient lineages,colony-founding larvae anchor themselves either by byssus produc-tion or by cemented attachment.The latter mode of sessile life is strongly molded by left-right shell asymmetry during larval development of Ostreoida oysters such as Crassostrea hongkongensis.Here,we sequenced the genome of C.hongkongensis in high resolution and compared it to reference bivalve genomes to unveil genomic determinants driving cemented attachment and shell asymmetry.Importantly,loss of the homeobox gene Antennapedia(Antp)and broad expansion of lineage-specific extracellular gene families are implicated in a shift from byssal to cemented attachment in bivalves.Comparative transcriptomic analysis shows a conspicuous divergence between left-right asymmetrical C.hongkongensis and symmetrical Pinctada fucata in their expression profiles.Especially,a couple of orthologous transcription factor genes and lineage-specific shell-related gene families including that encoding tyrosinases are elevated,and may cooperatively govern asymmet-rical shell formation in Ostreoida oysters.