The shape and position of the central fibrous body (CFB) and the relation between the CFB and the conduction system were observed in 30 human hearts (children: 25 cases, adult: 5 cases) in serial sections.The shape of the CFB was wedge-shaped. The CFB of each child was horizontal in position, but the CFB of each adult was nearly sagittal in position.A-V node was a long sagittal flat structure. Its left surface contacted with the CFB and the left surface of A-V node often extended processes into the CFB in the children. The processes were called archipelagos. About 80 percent of the children with superficial archipelagos, and 16 percent with deep archipelagos. The superficial archipelagos in the adults was only found in one case, but the deep archipelagos were not seen.His bundle more permanently penetrated into the right inferior part of the CFB.

Using the angiography and the corrosion methods we studied the arterial distribution of the papillary muscles of the left ventricle in llo dog hearts, according to the peculiarities of vasculature, disscused the influence of obstruction of coronary artery upon the papillary muscle.The anterior and posterior papillary muscles in dog all are tethered type. The average length and width of anterior papillary muscle are 1.96 cm. and 1.10cm, respectively, while those in the posterior papillary muscle are 2.04 cm. and 1.20 cm. respectively.The origins of arterial blood supply of anterior papillary muscle may be classiffied into 4 types, type Ⅰ, in which the arterial branehes are from the anterior descending artery, is in leading position(71%); type Ⅱ, in which branches are both from the anterior descending and left circumflex arteries, is in the next place(18%). Origins of arterial branches of posterior papillary muscle are classed under 2 types: type Ⅰ, in which all arterial branches are from the left circumflex artery, is the most, 91%, among them 65% from the posterior branch of the left ventricle.The peculiarities of arterial distribution in papillary muscles are as follows: 1. All artery branch entering the papillary muscle are of Class B. 2. All are segmental distribution in papillary muscles. Each muscle recieyes 2-9 branches, mostly 5 or 6 branches. 3. Each half of one papillary muscle recieves several branches symmetrically. 4. The arrangement of hrauches may be classiffied into several types; mixed type is the most, then comes the transverse type. 5. The branches anastomose each other to form the subendocardial plexus, which is most evident in the middle and upper third of the papillary muscle.

This thesis is the study of the morphology and arterial supply of the papillary musclcs of the left ventricle of 104 human hearts. The maim me-thod used is angiography and corrosion. The commonest number of the anteri-or and posterior papillary muscles is one. In 72 hearts there are musculartrabeculae by which the papillary muscle is attached to the wall of the leftventricle. The projection of the auterior papillary muscle of the left ven-tricle on the heart surface lies most frequently on the middle third regionof a supposed "#"-form region. There are three types of attachment of thepapillary muscle: the free, the attached and the intermidiate, among whichthe largest number is the first type. The arteries supplying the anteriorpapillary muscle are the branches of the anterior descending artery, theleft circumflex artery or these two. Each of the three types amounts to30% or so; the posterior papillary muscle is mostly supplied by the leftventricular posterior branches of the right circumflex artery 9.6 % ). The blood vessels in the papillary muscle belong to class B, each of the papillarymuscles containing 1--3 major vessels measured 0. 1--1 mm in diameter.The three vascular distribution types in the papillary muscle are of axis,segment and mixtnre, and the axial type is most commonly seen of all. Thevascular distribution type j? of certain relation to the attachment type ofthe papillary muscle. The axial distribution is frequently found in the freetype of the papillary muscle. The arteries distributes on either side of thepapillary muscle.

The morphology and position of the AV node and AV bundle were observed in 13 human hearts with serial sections. 1.the AV node is a long sagittal flatt ened structure, its transverse section is triangular in shape with a right convex surface, sometimes the cross section is fusiform or half oval in shape. Its size is 3.5x3.3x1.1 mm in adult. In 5 cases the endocardium lying on the right surface of the AV node is elevated.2.The AV node is situated in the upper border of the atrioventricular septum (between the levels of the attachment lines of the mitral and tricuspid valves). The adult AV node is 1.8-5.8 mm anterior to the coronary sinus orifice, 0.3-0.7 mm from the endocardium of the right atrium, 3.3-7.5 mm above the upper border of the septal leaflet of the tricuspid valve. The left surface of the AV node contacts with the central fibrous body.3.The AV node can be divided in 2 parts: superficial and deep, the fibers of the super ficial part are longitudinal in sections and end in the lower border of the AV node. In one case, the deep part is subdivided in an upper part and a lower part. In the specimens in which the right atrial endocardium lying on the right surface of the AV node is elevated, the overlaying fibers end in the endocardium. At the upper border, right surface, and posterior margin of the AV node, there are atrial fibers ending to the AV node. 4. The adult AV bundle is 5.7-7.9 mm long, 1.1-1.5 mm in diameter. Its anterior part is on top of the muscular interventricular septum in 7 specimens, on its left surface in 3 specimens, and in the substance of the muscular interventricular septum in 2 specimens. In one case its course is very special, at first on the top of muscular interventricular septum, then at its left surface, finally in the substance of the right part of the muscular interventricular septum.

Objective To investigate the relationship between renal vascular resistance index( RI) and serum Apelin level in type 2 diabetic mellitus ( T2DM )?Methods Seventeen cases newly diagnosed T2DM patients with RI increased but without microalbuminuraia in Minhang Hospital Affiliated to Fudan University from December 2011 to December 2014 were selected as observation group,17 newly diagnosed T2DM patients with RI normal during the same period were selected as control group?Fasting plasma glucose(FPG),glycosylated hemoglobin A1C(HbAlC),blood lipids and fasting insulin(FINS),hepatic functional and renal function were tested in all the subjects?Serum Apelin level was detected by enzyme?linked immunosorbent assay?Results Compared with control group,serum Apelin level was significantly higher in observation group((179?2±122?4)μg/L vs?(56?7±50?6) μg/L,t=3?814,P<0?05)?Partial correlation analysis showed that the RI was positive correlated with Apelin ( r= 0?364, P= 0?040 )?Conclusion The serum Apelin levels elevated in newly diagnosed T2DM patients with RI increased, and RI is positively correlated with Apelin, which indicate that Apelin play an important role in the pathophysiology of early renal damage in patients with TsDM.

Objective To investigate characteristics of cage migration after transforaminal lumbar interbody fusion (TLIF) and related risk factors.Methods A retrospective study was conducted to review cage migration in 512 patients who had undergone TLIF procedure from January 2010 to June 2011 in 5 spinal research centers.There were 255 males and 257 females,aged from 37 to 77 years (average,54.7 years).All patients were followed up at 3,6,12 months after operation.The clinical outcomes were evaluated using the visual analogue scores (VAS) and Oswestry disability index (ODI).X-rays and 3D CT scans were used to analyze the incidence and related risks factors of cage migration in these patients.Results Cage migration was found in 6 of 512 patients,the total incidence was 1.17％.Significant difference was found between each center.Cages with different shapes had different incidence.The analysis showed that the incidence of migration of rectangular-shaped cage (3.11％,5/161) was significantly higher than that of kidney-shaped cage (0.28％,1/351).The cage in double-segment TLIF (5.75％,5/87) was easier to migrate than that in monosegment TLIF (0.24％,1/425); furthermore,linear type endplate(3.50％,5/143) was remarkably easier to migrate than concave-concave one (0.27％,1/369).Conclusion Difference in operative skills,cage shape,number of fused segments,adjacent endplate shape,and lumbar spondylolisthesis might be risk factors for cage migration after TLIF.

Objective To investigate the safety and efficacy of radiofrequency ablation (RFA) combined with extracting blood from hemangiomas guided with CEUS for treating hepatic cavernous hemangiomas (HCH).Methods Data of 55 patients with 77 lesions of HCH underwent CEUS guided RFA combined with extracting blood from hemangiomas during January 2010 to December 2016 were retrospectively analyzed.Conventional ultrasound and CEUS were performed before therapy,in order to obtain the size and blood supply information of lesions,also performed immediately after treatment and 3 months later to calculate the volume of hemangiomas and the rate of hemangiomas after the treatment,as well as the rate of non-blood supply 3 months after the treatment.Then statistical analysis was done.Results The mean operation time was (31.53±15.89)min,and the blood extracting from hemangiomas was (135.36± 68.13)ml.There was positive correlation between the volume of hemangiomas before treatment and the blood extracting from hemangiomas (r=0.722,P＜0.05).No serious complication occurred among 55 cases,while mild complications happened in 9 cases (9/55,16.36 ％).The volume of hemangiomas decreased immediately and 3 months after treatment (both P＜0.05),and the rate of hemangiomas reducing was (48.76±32.58) ％ and (22.37±35.73) ％,respectively.The rate of non-blood supply 3 months after treatment was 96.10％ (74/77).Conclusion CEUS-guided RFA combined with extracting blood from hemangiomas is an effective and safe method,which has potential to become a first-line therapy.

Objective TostudythevalueofordinarycolorDopplerflowimaging(CDFI)inthe diagnosis of hepatic artery thrombosis (HAT)in early stage after pediatric liver transplantation (PLT).Methods Clinicaldataof55childrenundergoingPLTintheGeneralHospitalofChinesePeople'sArmed Police Forces from April 2005 to May 2014 were analyzed retrospectively. Conventional hemodynamic monitoring was performed in all cases in the early stage after operation by CDFI. No intrahepatic arterial blood flow signal was observed by CDFI multi-angle examination and HAT was suspected. Computed tomography angiography (CTA)and surgical exploration were performed in the suspected HAT patients. The sensitivity and specificityofordinaryCDFIindiagnosingHATwerecalculatedbyChissstatisticalsoftware.Results Among the 55 PLT recipients,3 cases were suspected as HAT by CDFI,including 2 cases of HAT in the main hepatic artery,1 cases of HAT in the right hepatic artery. All cases were confirmed by CTA or surgical exploration.The incidence of HAT was 5% (3/55 ). The sensitivity and the specificity of CDFI in diagnosing HAT after PLTwereboth1.0,andfalsepositiveratewas0.Conclusions OrdinaryCDFIisthepreferredandmain method for hemodynamic examination after PLT. The experienced sonographer for transplantation can improve the accuracy in diagnosing HAT.

Objective To assess the effects of the risk factors of grafts from donors after cardiac death (DCD) on the prognosis of liver transplantation (LT).Methods In this retrospectively study,215 cases of LT using DCD donor grafts were performed at our institution from September 2013 to January 2017.Due to the loss to follow-up in 4 cases,211 cases were enrolled in the study.The following DCD donor data were collected:gender,age,primary disease,ABO blood type,body mass index (BMI),medical history (fatty liver,hypertension),ICU hospitalization time,mechanical ventilation time,warm ischemia time,cold ischemia time,and indexes of routine laboratory test before donation.Statistical analyses using the Kaplan-Meier method,log-rank test,multivariate step-wise Cox regression were performed.Results Of the 211 donors,univariate analysis showed that the overall 6-month,1-,and 3-year survival rate after DCD LT was 88％,84％,and 82％,respectively.Univariate analysis showed that donor serum sodium level ＜136 mmol/L (P =0.018) and cold ischemia time ＞9 h (P =0.013) were all significant risk factors affecting overall survival after DCD LT.Additionally,donor BMI ＞30 kg/m2 (P =0.011) and donor age ＞60 years (P =0.025) were significantly associated with postoperative complications.Multivariate analysis showed that donor serum sodium level (P=0.025) was an independent risk factor of survival after DCD LT.Conclusion To select suitable DCD liver allografts and control risk factors of donor can help to improve outcomes of recipients.

Objective To evaluate the role of preoperative serological indexes in predicting long-term survival and tumor recurrence of hepatocellular carcinoma (HCC) patients after liver transplantation, aiming to explore its significance in expanding the Milan criteria. Methods Clinical data of 669 recipients undergoing liver transplantation for HCC were retrospectively analyzed. The optimal cut-off value was calculated by the receiver operating characteristic (ROC) curve. The risk factors affecting the overall survival and recurrence-free survival rates of HCC patients after liver transplantation were identified by univariate and multivariate regression analyses. The correlation between preoperative serum liver enzymes and pathological characteristics in HCC patients was analyzed. The predictive values of alpha-fetoprotein (AFP) combined with γ -glutamyl transferase (GGT) and different liver transplant criteria for the survival and recurrence of HCC patients after liver transplantation were compared. Results Exceeded Milan criteria, total tumor diameter (TTD) > 8 cm, AFP > 200 ng/mL and GGT > 84 U/L were the independent risk factors for the overall survival and recurrence-free survival rates of HCC patients after liver transplantation (all P < 0.05). Correlation analysis showed that preoperative serum GGT level was correlated with TTD, number of tumor, venous invasion, microsatellite lesions, capsular invasion, tumor, node, metastasis (TNM) stage, Child-Pugh score and exceeded Milan criteria (all P < 0.05). Milan-AFP-GGT-TTD (M-AGT) criteria were proposed by combining Milan criteria, TTD with serum liver enzyme indexes (AFP and GGT). The 5-year overall survival and recurrence-free survival rates of HCC recipients who met the M-AGT criteria (111 cases of exceeded Milan criteria) were significantly higher than those who met Hangzhou criteria (both P < 0.05), whereas had no significant difference from their counterparts who met the University of California at San Francisco (UCSF) criteria (both P > 0.05). Conclusions Preoperative serological indexes of AFP and GGT could effectively predict the long-term survival and tumor recurrence of HCC patients after liver transplantation. Establishing the M-AGT criteria based on serological indexes contributes to expanding the Milan criteria, which is convenient and feasible.