Objective To provide the anatomical basis for detecting distal outflow tract in late atherosclerosis obliteration in lower extremities.Methods Ten lower extremities that were amputated above knees because of late atherosclerosis obliteration were used in this experiment.The blood vessels in the residual bodies were perfused to run blood vessel cast mould to observe the anatomical and pathological change of the popliteal artery,the anterior and posterior tibial arteries and their collateral vessels.The number and distribution of those collateral vessels were also observed.Results The popliteal artery,anterior and posterior tibial arteries were all occluded due to atherosclerosis.However,there were three types of those collateral arteries:① Atheromatous plaque in bole stretched into collateral arteries and led to occlusion.② Obliteration was only observed at the initial segment,with no obstruction at the distal end but extenuated.③ The collateral arteries originated from the bole artery symmetrically,keeping communicative with each other through punctiform interspaces.The last two types were mainly distributed at the inferior segment of popliteal artery,the superior segment of anterior and posterior tibial arteries,forming vascular anastomosing network in the whole cnemis muscle group.Conclusion Un-obstructed collateral arteries in certain places can be still found,though atherosclerosis obliteration is formed in popliteal artery,anterior and posterior tibial arteries in lower extremities.Therefore,it may be possible to construct collateral outflow tracts if endo-membrane stripping operation is performed.

AIM: To summarize the effect of femoral popliteal arterial graft operation and the influence of construction of bypass circuit outflow tract.METHODS: A retrospective study was performed in 15 cases of femoral popliteal arterial bypass.RESULTS: A femoral popliteal embolism occurred in one patient undergoing simple femoral-popliteal arterial bypass in the early postoperative period and in 2 patients in the long-term followed up.However,the effects of constructing bypass circuit in the same time were very well,and only one patient had chill on the limbs.CONCLUSION: The operative results are better when the construction of bypass circuit is performed in the femoral-popliteal arterial graft operation,further more,a new method is provided for construction of distal end outflow tract.

Objective To study the academic level of randomized control trials(RCTs)published from 2004 to 2009 in Chinese Journal of Hepatobiliary Surgery.Methods Published work about RCTs in 72 issues of Chinese Journal of Hepatobiliary Surgery was searched by finding relevant articles published during 2004-2009.Correlated indexes including literature received time, literature publishing time, the total number of citations, number of citations in Chinese, number of citations in English, research funding situations, the number of authors, article affiliations in all RCTs, together with single(or multiple)center study situation, positive conclusions, the starting time, the end time,and number of patients recruited in clinical RCTs were extracted for aggregate analysis.Results During the past six years, a total of 135 articles of RCT were published in Chinese Journal of Hepatobiliary Surgery, accounting for 8.7% in all clinical studies.The average number of RCTs in each issue was 1.88.The average time for publishing time delay was 450 days.The total number of citations in RCTs was 1252 and the average number of RCTs for citations was 9.3.53 RCT studies were financed, accounting for 39% of the total number of research papers.Beijing Friendship Hospital attached to the Capital University of Medical Sciences had published 8 papers of RCT and it is the institution of publishing the largest number of such papers in the journal.The number of multi-center study for RCTs was one and all RCT studies had significant conclusions.The average research duraton in RCTs was 45 months.The total number of patients in 33 clinical RCTs was 2705 and the average number of patients recruited in each RCT was 82.Conclusion Chinese Journal of Hepatobiliary Surgery put emphasis on the strongest evidence and the most valuable RCT researches that have great significance in the field of domestic hepatobiliary surgery for clinical treatment and experimental research.

ObjectiveTo investigate the diagnosis and treatment of purple urine bag syndrome following transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).Methods Clinical data of 13 patients who developed purple urine bag syndrome out of 117 patients undergoing TACE for HCC in the Sixth Afifliated Hospital of Sun Yat-sen University between January 2012 and May 2014 were retrospectively studied. Among the 13 patients, 4 were males and 9 were females with the age ranging from 35 to 68 years old and the median of 53 years old. The tumor diameter was≤5 cm in 8 cases and was > 5 cm in 5 cases. The operative duration of TACE was≤30 min in 6 cases and was >30 min in 7 cases. The informed consents of all patients were obtained and the local ethical committee approval had been received. The diagnostic criteria was pink to purple urine in the urine bag after TACE and no blood urine detected by urine routine test.ResultsThe incidence of purple urine bag syndrome following TACE was 11.1% (13/117). After purple urine bag syndrome was confirmed, the patients were given the comprehensive therapy of urine acidification, rehydration, regular change of urinary catheter and urine bag, and gastrointestinal function improvement. No anti-infective therapy was given. The average indwelling time of urinary catheter was (12±3) d.ConclusionsIt is not a rare case for purple urine bag syndrome following TACE for HCC, thus it should be taken seriously. The treatment mainly includes urine acidiifcation, rehydration and gastrointestinal function improvement.

OBJECTIVETo evaluate the efficacy and feasibility of the Chinese drugs for supplementing Qi and activating blood circulation in preventing DVT after big operations in orthopaedics and traumatology and observe the change of D-dimer before and after treatment.

METHODSeventy patients ranging in age from 39 to 94 years who were treated by big operations in orthopaedics and traumatology were divided into two groups randomly. Traditional Chinese medinine (TCM) group (group A) and western medicine group (group B). On the 2rd day after operation d-dimer was tested from both groups and the patients in group A were given one dose of TCM every day and the patients in group B were subcutaneously injected low-molecular-weight heparins calcium (LMWH). On the 8th after operation d-dimer was tested again from both groups. The parameters, such as the incidence of DVT and pulmonary thromboembolism, bleeding condition, were evaluated respectively.

RESULTThe D-dimer decreased in group A and had significant difference (P < 0.05), group B had no significant difference, there was also no significant difference between two groups. DVT was found in 1 patient in group B (1/35). Petechiae were found in 10 patients in group A (10/35) and in 26 patients in group A (26/35), which had significant difference (P < 0.05).

CONCLUSIONBoth the Chinese drugs and anti-coagulation drug can prevent the incidence of DVT effectively, and Chinese herbs are feasible in the prevention of DVT.

Adult ; Aged ; Aged, 80 and over ; Anticoagulants ; administration & dosage ; Blood Circulation ; drug effects ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Heparin, Low-Molecular-Weight ; administration & dosage ; Humans ; Male ; Middle Aged ; Orthopedic Procedures ; Orthopedics ; Postoperative Complications ; drug therapy ; prevention & control ; Qi ; Traumatology ; Venous Thrombosis ; drug therapy ; prevention & control

Objective:To investigate the effect of instantaneous flow rate on the consistency of diagnostic accuracy of severe degenerative mitral regurgitation (DMR) using proximal isovelocity surface area (PISA).Methods:From June 2019 to June 2021, 75 patients with DMR who underwent echocardiography in Department of Echocardiography of Zhongshan Hospital, Fudan University were prospectively enrolled. The instantaneous flow rate of DMR during the systolic phase was calculated using M-mode PISA(PISA M-mode), and a time-integrated curve was plotted. Regurgitant volume (RVol) and effective regurgitant orifice area (EROA) were calculated by traditional PISA (PISA max), pair PISA (PISA pair), and PISA M-mode, respectively. RVol acquired from cardiac magnetic resonance (CMR) volumetric method in 22 patients of the enrolled patients. The correlation and consistency of RVol acquired between the three PISA methods and CMR were compared. Agreement of diagnostic accuracy of severe mitral regurgitation (sMR) acquired between the three PISA methods and multi-parameter algorithm by American Society of Echocardiography (ASE) was analyzed using Cohen′s Kappa analysis. Results:The curve of instantaneous flow rate of DMR showed unimodal pattern with the peak at mid-late systolic phase. The correlation of RVol acquired between PISA methods and CMR was moderate for PISA max and PISA pair ( r=0.77, 0.80, both P<0.001), whereas PISA M-mode presented strong correlation with CMR ( r=0.87, P<0.001). RVol acquired from PISA max was larger than that of CMR[(69.1±37.1) ml vs (49.0±29.0)ml, P=0.002]. Both PISA max and PISA pair were shown moderate agreement of diagnostic accuracy of sMR with ASE multi-parameters algorithm (RVol: κ=0.496, 0.525, both P<0.001; EROA: κ=0.570, 0.578, both P<0.001), while PISA M-mode presented strong agreement (RVol: κ=0.867 and EROA: κ=0.802, both P<0.001). Conclusions:Based on the unimodal pattern of instantaneous flow rate in patients with DMR, PISA max may significantly overestimate RVol, exposing a significant proportion of patients with DMR to unnecessary MR surgery. PISA M-mode presents better correlation and consistency with CMR on the quantification of RVol compared with PISA max and PISA pair, and may improve the diagnostic accuracy of quantification of sMR using PISA.

Objective:To explore the effects of the LAmbre device and mitral annulus(MA), as well as left atrium(LA) in patients with non-valvular atrial fibrillation(NVAF) after left atrial appendage closure (LAAC) using real-time-three-dimensional transesophageal echocardiography (3D TEE).Methods:Fity-six consecutive patients who underwent LAAC with the LAmbre device in Zhongshan Hospital of Fudan University from June 2019 to March 2023 were retrospectively enrolled, with no or less than moderate mitral regurgitation (MR). All patients underwent pre-operative and follow-up two-and three-dimensional transesophageal echocardiography (2D TEE, 3D TEE) at 60 days after the operation. The quantitative parameters of MA and LA were obtained by offline analysis using QLab 13.0 (Philips Healthcare, Andover, MA). Importantly, mitral annular measurements were made at seven time points throughout the cardiac cycle: early diastole, mid-diastole, late diastole, mitral valve closure, early systole, mid-systole, and late systole, which facilitates constructing the dynamic model of MA to assess the annular morphology and dynamics.Results:The values of AP diameter (APD), AL-PM diameter (ALPMD), 3D annulus circumference (3DAC), 3D annulus area (3DAA) decreased significantly compared with pre-operative values at all time points of the cardiac cycle (all P<0.05), while non-planar angle (NPA) and AH/CD were not apparently changed (all P>0.05 ). Throughout the cardiac cycle, MA showed regular changes, gradually increased in systole with the saddle shape deepened, and gradually decreased in diastole with the saddle shape shallowed.During systole, there was an increase in the rate of change of AP in MA [pre-operative (3.01±2.64)%, post-operative (3.81±3.51)%, P=0.037] after LAAC, with no significant difference in the rate of change of ALPM, 3DAC, and 3DAA.Meanwhile, we observed an evident reduction in LA minimal volume (LAVmin) [pre-operative (78.36±25.16)ml, post-operative (70.73±22.78)ml, P=0.004] and an obvious increase in LA ejection function [pre-operative (22.88±10.09)%, post-operative (31.41±12.28)%, P<0.05] during follow-up. Conclusions:3D TEE can accurately assess the impact of LAAC on the MA and LA. The LAmbre device can affect the morphology of MA, as well as the structure and function of LA, while the change of the dynamics of MA is not so prominent.

Objective To investigate the clinical efifcacy of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) in treatment of liver metastasis of colon cancer. Methods A total of 68 patients with liver metastasis of colon cancer in the Sixth Affiliated Hospital of Sun Yat-sen University from June 2007 to May 2011 were enrolled in this prospective study. The informed consents of all patients were obtained and local ethical committee approval had been received. There were 43 males and 25 females with a mean age of (59±4) years old. The patients were divided into RFA group and Control group with 34 cases in each group according to random number table method. Patients in both groups underwent TACE ifrstly and patients in RFA group underwent RFA 3 weeks after TACE treatment. Cluster of differentiation (CD) 3+, CD4+, CD8+positive cell percentage and CD4+/CD8+ratio were deifned by flow cytometry before and after treatments in two groups. The tumor diameter after treatments and general efifcacy were observed. The patients were followed up and the tumor recurrence and survival of the patients were observed. The comparisons of tumor diameter and immune function between two groups were conducted using t test. The comparison of efifcacy between two groups was conducted using rank sum test. The survival analysis was conducted using Log-rank test and Z test. Results The CD4+, CD8+percentage and CD4+/CD8+ratio were (42±4)%, (13±3)%, 2.9±0.9 in RFA group after treatment and were (33±4)%, (17±3)%, 2.3±0.9 in Control group, where signiifcant differences were observed (t=5.483,-6.488, 9.321;P<0.05). The tumor diameter in RFA group after treatment [(0.9±0.1) cm] was significantly smaller than that in Control group [(1.9±0.2) cm] (t=-4.573, P<0.05). The total effective rate in RFA group was 62%(21/34) and was 35%(12/34) in Control group. The treatment efifcacy of RFA group was better than that of Control group (Z=4.769, P<0.05). The 2-, 3-year survival rates in RFA group (38.2%, 23.5%) were significantly higher than those in Control group (14.7%, 5.9%) (Z=4.836, 4.221; P<0.05). Conclusions TACE combined with RFA is a safe and effective regimen in treating liver metastasis of colon cancer. The efifcacy may be associated with the improvement of the body’s immune function.

Transcatheter tricuspid valve intervention is the new frontier of interventional cardiology. The LuX-Valve is a radial force-independent orthotopic tricuspid valve replacement device developed in China. The LuX-Valve Plus transcatheter tricuspid valve replacement (TTVR) system is changed from the trans-atrial to the transjugular approach, which further reduces trauma and pulmonary complications compared with the first generation LuX-Valve. The first-in-human study has been completed at Zhongshan Hospital, Fudan University and an exploratory multicentre clinical study is underway. Echocardiography plays an important role in pre-TTVR screening, intraoperative guidance and postoperative evaluation and follow-up, especially two-dimensional transoesophageal echocardiography (2D-TEE) and three-dimensional transoesophageal echocardiography (3D-TEE). However, there is a lack of appropriate intraoperative guidance and assessment protocols. In this study, we briefly described the protocols and imaging considerations for intraoperative 2D-TEE and 3D-TEE to ensure the successful implantation of TTVR.