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 summarize the mid-term effect of modified extended Morrow procedure in patients with hypertrophic obstructive cardiomyopathy (HOCM) combining sub aortic valve obstruction and mid left ventricular obstruction. Methods: We studied 34 consecutive HOCM patients with sub aortic and midventricular obstruction who received modiifed extended Morrow procedure with extracorporeal circulation in our hospital from 1996-11 to 2015-01. Transthoracic echocardiography was conducted at pre-, post-operation and follow-up period to evaluate the changes of mid-ventricular gradient, subarctic gradient and each heart valve function. Results: The average follow-up time was (25.7 ± 14.9) months, 2 patients lost contact and no death occurred. In rest 32 patients, the mid ventricular gradient decreased from (60.3 ± 29.4) mmHg to (21.0 ± 19.8) mmHg, subaortic valve gradient decreased from (77.9 ± 26.2) mmHg to (11.6 ± 6.5) mmHg, the maximum ventricular septal thickness dropped from (25.2 ± 4.9) mm to (17.9 ± 7.2) mm, left atrial diameter reduced from (41.1 ± 7.8) mm to (37.6 ± 6.4) mm, left ventricular end-diastolic diameter increased from (39.8 ± 5.1) mm to (42.2 ± 4.3) mm, allP<0.05; there were 5 patients without obviously improved mid ventricular gradient because of insufifcient resection of septal myocardium in mid-ventricle. The post-operative NYHA classiifcation was improved,P<0.01, mitral valve regurgitation degree was decreased,P<0.01 and SAM phenomenon was disappeared. Complications included 3 (8.8%) patients of III atrio-ventricular block, 1 (2.9%) patient of re-admission due to poorly healed sternum combining pneumonia Conclusion: Modified extended Morrow procedure may relieve sub aortic valve and mid ventricular obstruction, therefore improve left ventricular diastolic function and prognosis in relevant patients.

Tear trough deformity is a complex feature of facial aging, which includes lacrimal groove deformity and skin aging. To correct this deformity, we need to fill in the lacrimal groove and improve the skin quality. Nanofat and its derivatives are fine and equal fillings with adipose derived stem cells, and their advantages in precise injection and skin’ s improvement perfectly fit the needs of tear trough deformity. The applications of nanofat and its derivatives are also promoting and varying constantly, from single injection to the combination with structural fat grafting or surgery. In this review, the research progress of nanofat and its derivatives in the treatment of tear trough deformity was described.

Tear trough deformity is a complex feature of facial aging, which includes lacrimal groove deformity and skin aging. To correct this deformity, we need to fill in the lacrimal groove and improve the skin quality. Nanofat and its derivatives are fine and equal fillings with adipose derived stem cells, and their advantages in precise injection and skin’ s improvement perfectly fit the needs of tear trough deformity. The applications of nanofat and its derivatives are also promoting and varying constantly, from single injection to the combination with structural fat grafting or surgery. In this review, the research progress of nanofat and its derivatives in the treatment of tear trough deformity was described.

Tear trough deformity is a complex feature of facial aging, which includes lacrimal groove deformity and skin aging. To correct this deformity, it is necessary to increase the volume of the underlying depression and improve the skin quality. Nanofat and its derivatives are fine and equal fillings with adipose derived stem cells, and their advantages in precise injection and skin improvement perfectly fit the needs of tear trough deformity. The applications of nanofat and its derivatives are also promoting and varying constantly, from single injection to the combination with structural fat grafting or surgery. In this review, the research progress of nanofat and its derivatives in the treatment of tear trough deformity was described.

Objective:To explore the anatomical levels and injection approaches of the major temporal fat compartments through cadaveric head dissection and to analyze the efficacy of high-volume fat transplantation of the temporal region in a clinical retrospective research.Methods:To clarify the safe and stable levels of high-volume filling of the temporal fat compartment by dissecting the temporal fat compartment of 5 fresh cadaveric heads (10 sides, 25-50 years old, 2 males, 3 females). We retrospectively analyzed the data of patients with temporal fat transplantation admitted to the Second Xiangya Hospital of Central South University and Changsha Mylike Medical Cosmetic Hospital from January 2020 to January 2021. According to the levels and volume of fat filling injection, the patients were divided into large-volume group and conventional group. In the large-volume group the patients were filled with at least three fat compartments with a filling volume of more than 15 ml, while in the conventional group only with 1 to 2 layers, which were the subcutaneous fat and the middle temporal fascia, and the filling volume was generally less than 15 ml. Fat injections were performed with a needle entry within the frontal hairline, targeting the main fat compartments. We compared and studied the mean injection volume per side, postoperative surgeon’s Likert scale score, patient satisfaction and other indicators in the two groups of cases. Stromal vascular fraction-gel(SVF-gel), which was made from surplus fat during the initial operation, was used to locally fine-tune the effect at the 3-month follow-up evaluation.Results:The anatomical study revealed the existence of three main fat compartments in the temporal region: subcutaneous fat layer, superficial and deep temporal fat pad. In the elderly cadavers, the subcutaneous fat was thin, the superficial temporal fat pad and deep temporal fat pad atrophied obviously, and the supporting effect on temporal superficial soft tissue was significantly weakened. The deep temporal fat pad showed obvious atrophy with a certain degree of downward movement. A total of 50 women who underwent bilateral temporal fat transplantation were enrolled in the clinical study, with 25 in the conventional group and 25 in the large-volume group. The age of the patients in the conventional group was (32.7±7.1) years, and the body mass index (BMI) was (20.2±1.9) kg/m 2. In the large-volume group, the age was (32.5±8.3) years, and the BMI was (19.8±2.0) kg/m 2. There were no significant differences in age and BMI between the two groups (all P>0.05). The filling volume was (19.66±4.61) ml/side in the large-volume group, with a Likert scale score of (4.32±0.63) and the patient satisfaction was 92.0%(23/25); the filling volume was (11.06±2.62) ml/side in the conventional group, with a Likert scale score of (3.32±0.80) and the patient satisfaction was 68.0%(17/25). There were statistical differences between the two groups (all P<0.05), suggesting that the large-volume group had better efficacy and patients were more satisfied. No severe complications such as infection, liquefaction, embolism, and nerve injury occurred in all patients during the follow-up period. Conclusion:Anatomical studies have proved that the main three-layer fat compartments filling in the temporal region have a clear approach, especially the feasibility of the puncture approach of the deep temporal fat pad, which provides the basis and feasibility for temporal fat filling with large volume. Compared with the conventional fat filling, multi-level and large-volume filling can significantly improve the surgical effect and patient satisfaction.

Tear trough deformity is a complex feature of facial aging, which includes lacrimal groove deformity and skin aging. To correct this deformity, it is necessary to increase the volume of the underlying depression and improve the skin quality. Nanofat and its derivatives are fine and equal fillings with adipose derived stem cells, and their advantages in precise injection and skin improvement perfectly fit the needs of tear trough deformity. The applications of nanofat and its derivatives are also promoting and varying constantly, from single injection to the combination with structural fat grafting or surgery. In this review, the research progress of nanofat and its derivatives in the treatment of tear trough deformity was described.

Objective:To explore the anatomical levels and injection approaches of the major temporal fat compartments through cadaveric head dissection and to analyze the efficacy of high-volume fat transplantation of the temporal region in a clinical retrospective research.Methods:To clarify the safe and stable levels of high-volume filling of the temporal fat compartment by dissecting the temporal fat compartment of 5 fresh cadaveric heads (10 sides, 25-50 years old, 2 males, 3 females). We retrospectively analyzed the data of patients with temporal fat transplantation admitted to the Second Xiangya Hospital of Central South University and Changsha Mylike Medical Cosmetic Hospital from January 2020 to January 2021. According to the levels and volume of fat filling injection, the patients were divided into large-volume group and conventional group. In the large-volume group the patients were filled with at least three fat compartments with a filling volume of more than 15 ml, while in the conventional group only with 1 to 2 layers, which were the subcutaneous fat and the middle temporal fascia, and the filling volume was generally less than 15 ml. Fat injections were performed with a needle entry within the frontal hairline, targeting the main fat compartments. We compared and studied the mean injection volume per side, postoperative surgeon’s Likert scale score, patient satisfaction and other indicators in the two groups of cases. Stromal vascular fraction-gel(SVF-gel), which was made from surplus fat during the initial operation, was used to locally fine-tune the effect at the 3-month follow-up evaluation.Results:The anatomical study revealed the existence of three main fat compartments in the temporal region: subcutaneous fat layer, superficial and deep temporal fat pad. In the elderly cadavers, the subcutaneous fat was thin, the superficial temporal fat pad and deep temporal fat pad atrophied obviously, and the supporting effect on temporal superficial soft tissue was significantly weakened. The deep temporal fat pad showed obvious atrophy with a certain degree of downward movement. A total of 50 women who underwent bilateral temporal fat transplantation were enrolled in the clinical study, with 25 in the conventional group and 25 in the large-volume group. The age of the patients in the conventional group was (32.7±7.1) years, and the body mass index (BMI) was (20.2±1.9) kg/m 2. In the large-volume group, the age was (32.5±8.3) years, and the BMI was (19.8±2.0) kg/m 2. There were no significant differences in age and BMI between the two groups (all P>0.05). The filling volume was (19.66±4.61) ml/side in the large-volume group, with a Likert scale score of (4.32±0.63) and the patient satisfaction was 92.0%(23/25); the filling volume was (11.06±2.62) ml/side in the conventional group, with a Likert scale score of (3.32±0.80) and the patient satisfaction was 68.0%(17/25). There were statistical differences between the two groups (all P<0.05), suggesting that the large-volume group had better efficacy and patients were more satisfied. No severe complications such as infection, liquefaction, embolism, and nerve injury occurred in all patients during the follow-up period. Conclusion:Anatomical studies have proved that the main three-layer fat compartments filling in the temporal region have a clear approach, especially the feasibility of the puncture approach of the deep temporal fat pad, which provides the basis and feasibility for temporal fat filling with large volume. Compared with the conventional fat filling, multi-level and large-volume filling can significantly improve the surgical effect and patient satisfaction.

Objective This study aimed to evaluate the safety and efficacy of video-assisted thoracoscopic bipolar radio-frequency ablation in the treatment of isolated paroxysmal atrial fibrillation.Methods From September 2010 to December 2016,Seventy-two consecutive patients with paroxysmal atrial fibrillation underwent video-assisted thoracoscopic bipolar radio-frequency ablation at Fuwai Hospital.There were 50 males and 22 females with an average age of(56.5 ± 10.5) years and duration of atrial fibrillation with (6.5 ± 4.8) years.45 patients had previous catheter ablation.The patients were followed up at postoperative 3 months,6 months,1 year and annually.Success of ablation was defined as sinus rhythm and no duration of &ge;30 s for rapid atrial arrhythmias,including atrial fibrillation,atrial flutter or atrial tachycardia in 24 h Holter examination.Univariate and multivariate logistic regression models were used to analyze the risk factors for atrial fibrillation recurrence.Results One patient converted to sternotomy due to bleeding on operation.All patients were successfully discharged.69 patients completed follow-up,with an average follow-up of(28 ± 18)months(3-60 months).The overall success rate was 73.9％,and the success rate without antiarrhythmic drug was 62.3％.Subgroup analysis showed that the success rate was 80％ when left atrial anterior and posterior diameter(LAD) ≤40 mm,and 57.9％ when LAD ＞ 40 mm (P =0.035).Multivariate logistic regression analysis showed that LAD ＞40 mm was an independent risk factor for postoperative recurrence of atrial fibrillation.Conclusion Video-assisted thoracoscopic bipolar radiofrequency ablation is a safe and effective method for the treatment of paroxysmal atrial fibrillation,especially in patients with LAD≤40 mm.

Objective To evaluate the influence of diabetes on coronary artery bypass graft (CABG) surgery using bilateral internal mammary artery (BIMA). Methods From December 2015 to August 2017, 182 patients (153 males, 29 females, age of 56.5±6.8 years) underwent CABG using BIMA. The propensity score was used to create matched diabetes (n=66) and non-diabetes (n=66) cohorts. The operative data, post-operative outcomes and coronary computed tomographic angiography (CTA) of the diabetes group (53 males, 13 females, age of 57.8±7.2 years) and the non-diabetes group (56 males, 10 females, age of 56.3±6.0 years) were analyzed retrospectively. Results There was no peri-operative mortality. There was no difference in operative sternal wound complication (P=0.466), or graft patency (P=0.730 for internal mammary arteries and 0.684 for saphenous vein grafts) between the matched diabetes and the non-diabetes groups. However, patients with elevated glycated hemoglobin (HbA1c) (n=54) had more sternal wound complications (P=0.006). The level of Hb1Ac of the patients with sternal wound complication was significantly higher than that of the patients without sternal wound complication. Conclusion BIMA grafting may be performed routinely even in diabetic patients, without increased complications. However, elevated HbA1c level should be avoided to reduce sternal wound complication.