Objective To investigate the effectiveness and safety of transcatheter radiofrequency ablation guided by a three-dimensional mapping system (Ensite or Carto) for the treatment of complex cardiac arrhythmias. Methods A cohort of 123 consecutive hospitalized inpatients during the period from February 2006 to December 2008 were selected for this study. These patients suffered from various arrhythmias, including paroxysmal atrial fibrillation (n=58). Persistent or permanent atrial fibrillation (n=10), atrial flutter (n=13), atrial tachycardia (n=12) and ventricular tachycardia or frequent ventricular premature beats (n=30). Transcatheter radiofrequency ablation for arrhythmias was performed under the guidance of an EnSite3 000/NavX or Array mapping system in 80 cases, and under the guidance of a CARTO mapping system in the remaining 43 cases. Results Successful ablation of arrhythmias was obtained by single operation in 106 cases(86.18%). Including 59 cases with atrial fibriUation,11 cases with atrial flutter, 10 cases with atrial tachycardia, and 26 cases with ventricular tachycardia or premature ventricular beat. Ablation procedure was carried out and was successful in 10 cases with a successful rate of 94.31%, including 5 cases with atrial fibrillation. 1 case with recurred atrial flutter, 1 case with recurrent atrial tachycardia, and 3 cases with ventricular tachycardia or premature ventricular beat. After operation, complications occurred in 6 cases, including cardiac tamponade in 4 cases, distal embolism of the left anterior descending coronary artery in 1 case, and pulmonary embolism in 1 case. Conclusion Three-dimensional mapping system can clearly and stereoscopically display the cardiac structures. Therefore, this technique is of great value in guiding the transcatheter radiofrequency ablation for complex arrhythmias, in improving the success rate of ablation and in increasing the safety of the procedure.

Objective:To compare the effects of patellar position on the balance of soft tissue during the operation and the postoperative outcomes in minimally invasive total knee arthroplasty via a midvastus approach.Methods:From December 2018 to February 2019, a total of 55 patients were enrolled for primary total knee arthroplasty via a midvastus approach. All patients were randomly divided into 2 groups by random number table. During the operation, the gap balance technique was used with patella reduced or subluxated to complete the osteotomy and balance of soft tissue. The changes of gap and varus-valgus angle were compared between the patellar reduction group and the patellar subluxation group in both extension and flexion position. These data were also compared before and after reducing patellar in the patellar subluxation group. Furthermore, the differences of femoral prosthesis rotation, mechanical femoral axis to tibial axis angle, Knee Society score (KSS), visual analogue scale (VAS) and range of motion (ROM) were compared between the two groups.Results:All patients finished 6 months follow-up, including 27 patients in the patellar reduction group and 28 patients in the patellar subluxation group. After osteotomy and soft tissue balance during the operation, there was no significant difference in gap and varus-valgus angle between two groups in either extension or flexion position. While in the patellar subluxation group, the flexion gap was 10.5±0.3 mm with patella subluxated, less than 11.0 ± 0.3 mm after reducing the patella. The varus-valgus angle was 1.5±0.3 with patella subluxated, less than 2.3±0.4 degree after reducing the patella. The difference was statistically significant ( t=4.180, P<0.001; t=7.642, P<0.001). There was no significant difference in extension gap and varus-valgus angle before and after patella reduction in the patellar subluxation group ( P>0.05). The rotation angle of the femoral component in the patellar subluxation group was -0.49°±1.2°, and the external rotation angle was smaller than that in the patellar reduction group (0.24°±1.3°). The difference was statistically significant ( t=2.116, P=0.039). At one month after operation, ROM of the patellar reduction group was 109.6°±8.5° which was higher than that of the patellar subluxation group (104.9°±8.6°, t=2.048, P=0.046). There was no significant difference in ROM between the two groups at 3 and 6 months ( P>0.05). Moreover, there was no significant difference in KSS and VAS at 1, 3 and 6 months after operation ( P>0.05). Conclusion:In the minimally invasive total knee arthroplasty, it is suggested to balance the soft tissue as much as possible with the patellar reduced. Otherwise, the consequence of increased flexion space, increased varus and increased internal rotation of femoral prosthesis should be considered. The patients undergoing soft tissue balance with patella reduced have better ROM in the early stage postoperatively.

Objective:To evaluate the preliminary effectiveness and safety of surgical peripheral iridectomy (SPI) combined with goniosynechilysis (GSL) and goniotomy (GT) in the treatment of advanced primary angle-closure glaucoma (PACG).Methods:A multicenter observational case series study was performed.Thirty-five eyes of 27 patients with advanced PACG, who underwent SPI+ GSL+ GT with a follow-up of at least 6 months, were included from August 2021 to January 2022 at Zhongshan Ophthalmic Center, Handan City Eye Hospital, Shijiazhuang People's Hospital, West China Hospital of Sichuan University, and the Third Affiliated Hospital of Chongqing Medical University.The mean follow-up time was 9(7, 10) months.Pre- and post-operative best corrected visual acuity (BCVA) and intraocular pressure (IOP) were measured with an ETDRS chart and a Goldmann applanation tonometer, respectively.The number of anti-glaucoma medications applied before and after surgery was recorded, and the complications after surgery were analyzed.Success rate of surgery was calculated.Complete surgical success was defined as an IOP of 5-18 mmHg (1 mmHg=0.133 kPa) and 20% reduction from baseline without anti-glaucoma medication or reoperation.Qualified success was defined as achieving criterion of complete success under anti-glaucoma medications.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Zhongshan Ophthalmic Center, Sun Yat-sen University (No.2021KYPJ177). Written informed consent was obtained from each subject.Results:The mean preoperative IOP was (30.83±8.87)mmHg, which was significantly decreased to (15.69±3.70)mmHg at 6 months after the surgery ( t=8.588, P<0.001), with a 44.00% (34.78%, 60.00%) decline of 13.00(8.00, 21.00)mmHg.The median number of anti-glaucoma medications was significantly reduced from 2(0, 3) preoperatively to 0 (0, 1) postoperatively ( Z=-3.659, P<0.001). The mean preoperative and postoperative 6-month BCVA were 0.80(0.63, 1.00) and 0.80(0.60, 1.00), respectively, showing no significant difference ( Z=-0.283, P=0.777). Complete surgical success rate was 62.86%(22/35), and the qualified success rate was 91.43%(32/35). Surgical complications mainly included hyphema (6/35), IOP spike (3/35), and shallow anterior chamber (4/35). There was no vision-threatening complication. Conclusions:SPI+ GSL+ GT is preliminarily effective and safe in the treatment of advanced PACG, which provides a new option for PACG.

Objective:To explore the therapeutic characteristics of population with gout achieving treat-to-target (T2T) indicators through real-world research and evaluate their safety.Methods:A total of 3 287 patients diagnosed with gout by rheumatologists in 21 first-class tertiary hospitals in 10 provinces, municipalities, and autonomous regions in China from January 2015 to December 2021 were included in this polycentric cross-sectional study. The database included patients′ general information, disease characteristics, and clinical application of traditional Chinese and Western medicine treatment measures. SPSS and Excel software were used for data analysis. Frequency analysis, cluster analysis, and factor analysis were used to summarize the characteristics and rules of treatment measures for patients with gout who achieved the target after treatment. The occurrence of adverse events (AE) was recorded during treatment.Results:After treatment, 691 visits (7%) achieved the serum urate (SUA) target, and the most frequent use of urate-lowering therapy (ULT) was febuxostat, followed by benzbromarone. The most common treatment options were following: GroupⅠ: traditional Chinese medicine (TCM) decoction-TCM external treatment-physical exercise-proprietary Chinese medicine; GroupⅡ: ferulic acid-nonsteroidal anti-inflammatory drugs (NSAIDs); Group Ⅲ: allopurinol-sodium bicarbonate-benzbromarone; Group Ⅳ: glucocorticoid-colchicine; Group Ⅴ: febuxostat. A total of 5 898 visits (60%) chieved manifestations of joint pain VAS scores target, and the most frequently used drug to control joint symptoms was NSAIDs. The frequency of use of drugs to control joint symptoms were 2 118 times (usage rate reached 35.9%), while the frequency of ULT were 2 504 times (usage rate reached 42.5%), which was higher than the joint symptom control drug. The most common treatment options were following: Group Ⅰ: proprietary Chinese medicine-TCM decoction-TCM external treatment-physical exercise; Group Ⅱ: NSAIDs-colchicine hormones; Group Ⅲ: allopurinol, Group Ⅳ: benzbromarone; Group Ⅴ: febuxostat. A total of 59 adverse events occurred during treatment.Conclusion:The proportions of gout patients who reach target serum urate level & good control of joint symptoms are both very low, and ULT and anti-inflammatory prescription patterns are very different from international guidelines, so it is necessary to strengthen the standardized management of gout patients. At the same time, life intervention measures account for a certain proportion of the treatment plans for the T2T population, and further exploration is needed.