Objective To review and summarize the experiences of mitral valve replacement in the children aged less than five years.Methods Twelve patients with moderate to severe mitral valve regurgitation (MR) or/and severe mitral valve stenosis (MS) were retrospectively study from January 2008 to December 2011,all of them suffered from severe heart failure and underwent mechanical mitral valve replacement.There were 9 males and 3 females.They aged from 4 to 58 months [mean (26.2 ± 18.1) months] and weighted from 5.6 to 13.0 kg [mean (9.6 ± 3.8) kg].Three patients underwent unsuccessful mitral valve repair before mitral valve replacement.17 to 23 mm aortic bileaflet mechanical prosthesis were reverse directional implanted in nine patients and 25 to 27 mm mitral bileaflet mechanical prosthesis were implanted in three patients.Results One patient died,the operative mortality rate was 8.3％.2 patients were complicated by cardiac arrhythmia and 2 patients complicated by mild hemolysis,all recovered after symptomatic treatment.The heart function of servived 11 patients improved significantly,none of them were complicated by haemorrhage or thromboembolic.Conclusion Severe mitral valve lesion injure heart function significantly for the young children and timely surgical intervention is the only option.Mitral valve replacement is the ultimate option for the patients failed in mitral valve annuloplasty.The introduction of aortic bileaflet mechanical prosthesis which smaller size is available and reverse directional implantation resolve the difficulty of prosthesis-patient mismatch essentially,most children with a small prosthesis has to redo mitral valve replacement with a larger size prosthesis.The compliance of permanent anticoagulation of young children is favourable and more intensively follow-up is essential to avoid the incidence of bleeding and thromboembolic.

Objective To analyze the epidemiology and clinical features of the critical congenital heart diseases in neonates,and to summarize the main points on pre-operative treatments.Methods We retrospectively analyzed all critical congenital heart disease in newborns admitted to CICU from June 2014to June 2015.Depict entity distribution,the main symptoms,and the key points on their treatments,also the indi-cation of intubation and their operation time were summarized.Results In totally 96cases,transposition of the great artery,with and without the intact ventricle septum,was the biggest category and counts for 49%in our group.Severe cyanosis was the main symptom for 62.5% of all cases.Another key symptom was the heart failure(33.3%).Eight-seven cases were intubated during their treatments,in which 41were intubated as soon as they were admitted and 40cases were done in the first 24hours after their admission.One case died before treatment due to interrupted aortic arch.All the rest received operations during their hospital stay. Conclusion Transposition of great artery is the dominating entity in critical congenital heart diseases in new-borns;severe cyanosis is the main symptom.Treatment should be based on each characteristic anatomy and hemodynamics features.Rigorous and dynamic monitoring on the homeostasis and metabolic index determines the indication of intubation and surgery time.

Objective To analyze clinical and pathological features of dermatomyositis with panniculitis as a skin manifestation.Methods Clinical data were collected from 9 cases of dermatomyositis with panniculitis as a skin manifestation in Department of Dermatology of Zhongshan Hospital affiliated to Fudan University from October 2012 to July 2016,and their clinical and pathological features were analyzed.Results Of the 9 cases,6 were female and 3 were male,and the age ranged from 28 to 73 years.Panniculitis lesions of the 9 patients all manifested as painful indurated plaques or nodules on the buttock,thigh,waist,back,abdomen,upper extremities and cheeks.These lesions occurred before,after or simultaneously with the onset of characteristic skin and muscle lesions of dermatomyositis,especially preceded the onset of characteristic lesions of dermatomyositis by 30 years in 1 case.Histopathological examination of lesions showed liquefaction degeneration of basal cells,inflammatory infiltration of lymphocytes and plasma cells around blood vessels,in the fat lobules as well as between the lobules and septa in the dermis.The necrosis and calcification of lipocytes,lipomembranous changes,fibrinoid necrosis of damaged vessel walls and microvascular occlusion were observed in some cases.Because panniculitis preceded the onset of characteristic lesions of dermatomyositis,2 patients were misdiagnosed with lupus panniculitis and morphea profunda for several times.Most patients had good response to systemic glucocorticoids combined with immunosuppressive agents,while the patients with lipomembranous fat necrosis had poor response to the combination therapy.Conclusions Panniculitis lesions of dermatomyositis are histologically characteristic,and may do not coincide with the onset of characteristic lesions of dermatomyositis.If panniculitis lesions precede characteristic lesions of dermatomyositis,patients will be easily misdiagnosed.Thus,persistent follow-up visit will be of great importance for the diagnosis.

Objective To explore risk factors of cardiac surgery in neonates with low body weight.Methods Retrospective analysis was made in neonates weighing less than 3 kg at surgery(n =192;group 1) and 3 to 6 kg(n =517;group 2),who had undergone open cardiac repairs from January 2006 to December 2015 at our institution.Patients were grouped according to the primary procedure performed and analyzed according to their weight at the time of surgical intervention.Patients were also analyzed according to preoperative risk scores.Univariate versus multivariate risk analysis was performed.Results Hospital early mortality in group 1 was 25.0％ (n =48) versus 14.5 ％ (n =75) in group 2 (P =0.001).Compared with group 2,neonates in group 1 had a significantly higher mortality for simple arterial switch procedure.Lower body weight remained strongly associated with mortality risk after stratifying the population by preoperative risk scores category levels 2.Within group 1,age,weight at surgery,preoperative risk score and type of procedure were not associated with significant differences in early mortality.Cardio-pulmonary bypass time,aortic cross-clamp time and the presence of a surgical complication were independent risk factors for early mortality in group 1.Conclusion Among neonates weighing less than 3.0kg who underwent open cardiac surgery,perioperative hemodynamic status,reflected by bypass time,cross-clamp time,and surgical complications,strongly influenced early mortality.In contrast,low body weight itself was not associated with early mortality.

Objective To investigate the feasibility and clinical efficacy of laparoscopic disc hand assisted laparoscopic splenectomy(LDHALS) for patients with ruptured spleen.Methods LDHALS was performed in 14 patients with ruptured spleen,and among them,8 cases were combined with other visceral trauma.Results All cases were performed successfully by using LDHALS.The median operation time was 70 min(45～100 min).The average hospital stay was 7 days in 6 cases with only spleen trauma and 13.5 days in 8 cases combined with other injuries.No major operative complications and mortality occurred.Conclusion The LDHALS is safe,effective,simple and flexible performed for patients with ruptured spleen.

Aim To establish a simple, rapid and accurate electroanalytical method for water soluble porphyrin meso-tetrakis-(4-sulfonatophenyl) porphyrin (TPPS4);to clarify the reaction between water soluble porphyrins and bovine serum albumin (BSA);and to determine the interaction of TPPS4 with BSA in the absence of presence of cyclodextrins (CDs) , separately. Methods Three methods including LSV,UV spectroscopy and fluorescence spectroscopy bad been employed to the relevant experiments. The way of employing three methods at the same time could make the experiment results more reliable. Results In the supporting electrolyte of NaH2 PO4-Na2 HPO4 ( pH 7. 18 ), a sensitive reduction peak of TPPS4 was found by linear sweep voltammetry (LSV), the peak potential (Ep) was-0. 70 V (vs SCE). The relationship between the second derivative peak of LSV (ip") and the concentration of TPPS4 was linear from 1.0 × 10-7mol·L-1 to 1.0 × 10-5mol· L-1,the square of correlation coefficients (r2) were 0. 998 3 and 0. 999 3, respectively. The relative standard deviation (RSD) was 0. 56% ( n = 5 ). The mean recovery of TPPS4 was 99.59％. In NH4C1-NH3· H2O buffers (pH 9.05), it was proved that BSA and TPPS4 could interact with each other and form 1:1 TPPS4-BSA supramolecular system. Moreover, the interaction between TPPS4 and BSA had been investigated by adding cyclodextrins (CDs). The interaction of TPPS4 with BSA was facilitated both by hydroxypropyl-β-CD (HP-3-CD) and sulforbutylether-β-CD (SBE-3-CD). Conclusion An electroanalytical method for TPPS4 has been established by LSV. The porphyrin drugs included by CDs could react with protein existing inside the human body easier. The consequences of this article also show that CDs will play important role in controlling and releasing the porphyrin drugs.

Objective To firstly report 4 cases of dermatomyositis characterized by painful palmar eruptions complicated by fatal rapidly progressive interstitial lung disease (RP-ILD) in China.Methods Four patients with dermatomyositis with painful palmar eruptions complicated by fatal RP-ILD were enrolled from the Department of Dermatology,Zhongshan Hospital,Fudan University between December 2014 and April 2017,and their clinical and pathological features were analyzed.Results Among these patients,3 were female and 1 was male.Their age ranged from 47 to 59 years.Of the 4 patients,3 had no muscular involvement.All of the 4 patients had multiple solid red papules or nodules on the bilateral palms,palmar and lateral surfaces of fingers,which preceded,followed or concurred with the onset of other skin lesions of dermatomyositis.The occurrence of type Ⅰ respiratory failure was preceded by 3 weeks to 5 months of painful palmar eruptions in the 4 patients.Early-stage palmar eruptions were easily misdiagnosed as contact dermatitis,eczema or erythema multiforme.Histopathological examination of the skin lesions on the finger palmar surface showed perivascular infiltration of a few lymphocytes in the dermis,and deposition of varying amounts of mucin-like substances around blood vessels and appendages.Of the 4 patients,3 showed positive staining for anti-melanoma differentiation-associated gene 5 antibody.Although the 4 patients received anti-inflammatory and immunosuppressive therapies,they all finally died of respiratory failure.Conclusions Dermatomyositis with painful palmar eruptions may indicate the occurrence of fatal RP-ILD,and early biopsy of skin lesions is needed to help to identify the disease.Immunosuppressive treatment should be performed timely to improve the prognosis in these patients.

Objective To study the dose volume histogram ( DVH ) difference of target and organs at risk in intensity-modulated radiation therapy ( IMRT ) planning of cervical cancer based on the interquartile range. Methods A total of 22 cervical cancer patients′ IMRT plans were retrospectively analyzed. Five groups of DVH curves of PTV and OARs ( bladder, rectum, left and right femoral heads) were derived from the Pinnacle3 planning system. The mean DVH curves and interquartile range of volume ( IQRvol ) as a function of dose were calculated from each group′s DVH curve. Results The maximum volume variation for PTV reached at IQRvol(54. 03 Gy) =6. 95%, the volume of the target reached by the prescription dose was ( 96. 43 ± 1. 63 )%. The maximum volume variation for bladder reached at IQRvol (17. 24 Gy) = 14. 62%. V40 and V30 for bladder were ( 32. 79 ± 7. 06 )% and ( 56. 47 ± 9. 94 )%, respectively. Rectal DVH showed the largest difference at 35. 92 Gy, with the quartile of 19. 94%, the V40 and V30 for rectum were (30. 17 ± 10. 80)% and (58. 16 ± 11. 99)%, respectively. The difference in the bladder and the rectum was statistically significant (z = -6. 59, P < 0. 05). The maximum volume variation of left femoral head reached at IQRvol(16. 06 Gy) =31. 47%. The maximum volume variation of right femoral head was reached at IQRvol (17. 47 Gy) =32. 82%. There was no significant difference in IQRvol between right and left femoral head (P>0. 05). Conclusions Quartile range curve of DVHs can be used to analyze the deviations of DVH curves of PTV and OARs, and provide guidance for automatic planning optimization parameter setting.

Objective To explore the CTV to PTV external expansion boundary and the effect of the dose of normal lung tissue under different fixed modes by a comparative analysis of combined body position and thermoplastic film fixed set-up error of radiation therapy for lung cancer. Methods From October 2016 to March 2018, the patients who received chest radiology at the Tangshan people's hospital were enrolled as subjects retrospectively divided into two groups, including 50 patients with lung cancer radiotherapy with combined body position fixation, and 40 patients with lung cancer with thermoplastic film fixation. The two groups of patients drew the target areas in accordance with the unified standard, and the set-up error of left and right, up and down, front and rear ( x, y, z axis) were recorded respectively after 1 time/week cone CT( CBCT) matched with the planned CT image and analyzed by t test. According to the MPTV =2. 5Σ+0. 7δ, CTV to PTV external expansion boundary in the combined body position group were calculated. And the V5、V20 and V30 of two groups of patients were calculated and analyzed by TPS system. Results The set-up error of the combined body position group and thermoplastic film group were respectively (1. 00 ± 0. 58) mm and (3. 28 ± 0. 43) mm on the x axis, (1. 42 ± 0. 28) mm on the y axis and (4. 03 ± 0. 41) mm, (1. 06 ± 0. 44) mm and (3. 18 ± 0. 34) mm on the z axis. The set-up errors of the two groups were statistically significant on x, y and z axis( t= -20. 740, -35. 596, -25. 015,P<0. 05). There was no significant difference in set-up errors between the central and peripheral lung cancer patients and between left and right lung cancer patients(P>0. 05). Through the MPTV =2. 5Σ+0. 7δ, CTV to PTV external expansion boundary in the combined body position fixation group was 2. 906 , 3. 746 and 2. 958 mm on x, y and z axis respectively. The comparison between group A and B showed that the mean values of V5 , V20 and V30 in group B were reduced by 1. 5％, 3. 1％ and 4. 8％ respectively compared with group A. Conclusions The combined body position technique can improve the accuracy of lung cancer patients after radiation therapy,and further reduce the boundary of CTV to PTV, which is of certain value to reduce the occurrence of radiation pneumonitis.

OBJECTIVE To provide a reference for standardizing the conduct of positron-emitting radiopharmaceuticals’ phase 0 clinical trials （hereinafter referred to as “phase 0 clinical trials”） and advancing the development of innovative drug by medical institutions. METHODS Initiated by the First Affiliated Hospital of Jinan University， a panel of experts consisting of pharmacy， clinical medicine and medical ethics from multiple institutions was established to investigate the current landscape， and discuss the necessary conditions， procedures， and other aspects for conducting phase 0 clinical trials in medical institutions by integrating relevant national policies， regulations and expert consensus. Finally， an agreement was reached to formulate this consensus. RESULTS & CONCLUSIONS Currently， most medical institutions have deficiencies in pharmaceutical care during the management of radiopharmaceuticals and the phase 0 clinical trials. In conjunction with the Expert Consensus on the Establishment of Nuclear Pharmacist Positions， this consensus explicitly defines the responsibilities of nuclear pharmacists in the phase 0 clinical trials on the basis of the Expert Consensus for the Application of Positron Emission Tomography Radioligands for Translational Study in the Phase 0 Clinical Trials （2020 edition）， providing a guidance for high-quality participation of nuclear pharmacists from medical institutions in China in phase 0 clinical research. Additionally， in consideration of some constraints imposed by current relevant regulations， this consensus also proposes strategic recommendations， such as encouraging medical institutions to form a consortium， leading to the establishment of dedicated bases or industrial parks， holding significant implications to strengthen institutional capacity for advancing radiopharmaceutical innovation through phase 0 clinical trials.