Objective To explore the image quality of 3.0 T Magnetic Resonance foot and ankle array coil on Achilles tendon ab-normalities for the clinical application.Methods 26 patients (with Achilles tendon symptoms)and 5 volunteers underwent MR exam-ination.The scanning sequences were used:T1 WI、PDWI、T2 WI-FS and STIR.Image diagnoses and clinical data of all patients were obtained and analyzed.Subjective scores on image quality were used.Degrees of comfort in coil were evaluated.Results 10 patients had Achilles tendon inj ury,6 patients with Achilles tendonitis,3 patients with part Achilles tendon rupture,1 patient with tendon xanthoma,and 6 patients were normal.Image scores in patients with T1 WI、PDWI and T2 WI-FS sequences were higher,the anatom-ic structures,lesions of whole Achilles tendon were clear.On the contrary,the lower scores were in STIR sequences.In the heel, images were distorted,the level of organization was disappeared and signal intensity was increased.The volunteers felt a slight dis-comfort at the coil entrance and support point of the heel.Conclusion Patients using 3.0T foot and ankle array coil for the Achilles tendon scanning could get high image quality and degrees of comfort.

Objective To evaluate the treatment effect and security of transcatheter arterial chemoembolization(TACE)combined with sorafinib for intermediate-advanced hepatocellular carcinoma.Methods From July 2008 to November 2010,the treatment effects of two groups of patients with advanced hepatocellular carcinoma were retrospectively analyzed and compared,including 44 patients treated by sorafenib combined with TACE(test group)and the other 44 patients treated only with TACE(control group).To assess the treatment effect based on mRECIST,the time for patients' tumor progression(TTP),overall survival(OS)time and adverse events were recorded.Survival rate were analyzed using KaplanMeier method and Log-rank analysis in SPSS 18.0.Results Till January 2011,24 patients(54.5％)survived and 20 patients(include patients lost to visit)died(45.5％)among the test group,13 patients survived(29.5 ％)and 31 patients(include patients lost to visit)died(70.5 ％)among the control group.No complete remission condition was observed in all patients.Among the test group,1 patient got partial remission,24 ones remain stable and 19 patients got progression.While among the control group,conditions remained stable in 21 patients and progressed in rest 23 ones.The disease control rate(DCR)in the test group and control group were 56.8％(25/44)and 47.7％(21/44)respectively,with no statistical significance(x2 =0.729,P =0.393).The median overall survival time(mOS)of test group and control group were 21.0(95 ％ CI:14.9-27.1)months and 10.0(95 ％ CI:6.4-13.6)months respectively,and the difference reached statistical significance(x2 =7.436,P =0.006).The median time to tumor progression(mTTP)of test group and control group was 1 1.0(95％ CI:8.7-13.3)and 6.0(95％ CI:3.9-8.1)months respectively,and the difference had statistical significance(x2 =10.437,P =0.001).The adverse events of test group mainly included hand-foot skin reaction,loss of appetite,fever,fatigue and diarrhea.The adverse events of control group mainly included fever,loss of appetite,nausea,vomiting and fatigue.The incidences of hand-foot skin reaction,baldness,diarrhea were significantly higher in test group than those in the control group(P ＜0.05).In most patients,these side effects were mild-to-moderate,and alleviated remarkablely after symptomatic treatment.Conclusions Compared with TACE alone,TACE combined with sorafenib can prolong the OS and TTP significantly for the patients with intermediate-advanced hepatocellular carcinoma.However,the DCR of the two groups has no statistical significance.

Objective:To observe the expression of CD36 in hepatocellular carcinoma tissues and cell lines, and to investigate the effects of CD36 on the proliferation and migration abilities of human hepatocellular carcinoma cell lines and human hepatocellular carcinoma cell xenograft models in nude mice.Methods:Differences in the expression levels of CD36 transcripts in 371 hepatocellular carcinoma and paracancerous tissues were analyzed based on information from The Cancer Genome Atlas (TCGA) database. Cancer tissues and corresponding paracancerous tissues of 48 hepatocellular carcinoma patients who were diagnosed and underwent surgical treatment at the Affiliated Hospital of Yangzhou University from January 2019 to February 2021 were prospectively collected, and the levels of CD36 mRNA in the tissues were detected by real-time fluorescence quantitative polymerase chain reaction (qRT-PCR) method. Western blotting was used to detect CD36 protein levels in human hepatocellular carcinoma cell lines Huh7 and HCCLM3 and human normal liver cell line LO2. Plasmids containing CD36 interfering sequences and empty plasmids were transfected into Huh7 cells or HCCLM3 cells for sh-CD36 group and control group, respectively. The CCK-8 assay was used to detect the proliferation ability (expressed as absorbance value) of cells in each group at 0, 12, 24, 36, 48 and 60 h of culture, and the scratch healing assay and Transwell assay were used to detect the migration ability of cells in each group. The Huh7 cells of sh-CD36 group or control group were injected into the axillary subcutis of BALB/c nude mice, with 4 mice in each group, to construct nude mice models of human hepatocellular carcinoma xenografts; the long and short diameters of tumor were measured weekly after 1 week of inoculation, and the tumor volume was calculated. The nude mice were put to death after 5 weeks of inoculation, and the tumor specimens were collected and weighed; the tumor cell morphology was observed under the microscope, and the expressions of CD36 and Ki-67 proteins in the tumor tissues was detected by immunohistochemistry (IHC).Results:Analysis of the data from the TCGA database showed that the level of CD36 transcripts was higher in hepatocellular carcinoma tissues compared with that in paracancerous tissues (4.2±1.8 vs. 3.2±1.5, t = 2.28, P = 0.035). Tissues detection using qRT-PCR in 48 patients with hepatocellular carcinoma showed that the relative expression of CD36 mRNA in hepatocellular carcinoma tissues was higher than that in paracancerous tissues (0.76±0.26 vs. 0.48±0.23, t = 3.52, P < 0.001). Western blotting assay showed that CD36 protein level in Huh7 and HCCLM3 cells was higher than that in LO2 cells, which were (1.42±0.11) times and (1.68±0.16) times higher than LO2 cells, respectively (both P < 0.001). At the mRNA and protein levels, the CD36 of Huh7 and HCCLM3 cells in the sh-CD36 group was lower than that in the corresponding control group (both P < 0.001). CCK-8 assay showed that the proliferative ability of Huh7 cells and HCCLM3 cells in the sh-CD36 group was lower than that in the corresponding control group after 36 and 24 h of culture (both P < 0.01). Scratch healing assay showed that the scratch healing rates of Huh7 cells [(12±3)% vs. (30±5)%, t = 4.01, P < 0.001] and HCCLM3 cells [(15±4)% vs. (29±5)%, t = 4.16, P < 0.001] in the sh-CD36 group were lower than those in the corresponding control group at 48 h of culture; Transwell assay showed that the number of Huh7 cells [(46±6) cells/field of view vs. (88± 6) cells/field of view, t = 5.56, P < 0.001] and HCCLM3 cells [(42±5) cells/field of view vs. (82±7) cells/field of view, t = 5.34, P < 0.001] penetrating into the membrane in 24 h in the sh-CD36 group was less than that in the corresponding control group. Five weeks after subcutaneous injection, the tumor volume [(682±268) mm 3vs. (1 375±512) mm 3, t = 4.73, P = 0.006] and tumor mass [(432±95) mg/mouse vs. (871±109) mg/mouse, t = 6.57, P < 0.001] of nude mice injected with Huh7 cells of the sh-CD36 group were lower than those of nude mice injected with Huh7 cells of the control group; under the microscope, the density of tumor cells in transplanted tumor specimens of nude mice injected with Huh7 cells of the sh-CD36 group was lower than that in nude mice injected with Huh7 cells of the control group, and the expression levels of both CD36 and Ki-67 proteins were also low. Conclusions:CD36 expression is up-regulated in cancer tissues of hepatocellular carcinoma patients and human hepatocellular carcinoma cell lines Huh7 and HCCLM3, and it may associate with cell proliferation and migration of hepatocellular carcinoma. Knockdown of CD36 expression significantly inhibits the proliferation and migration abilities of hepatocellular carcinoma cells in vitro, and inhibits the tumors of human hepatocellular carcinoma cell xenograft models in nude mice.

Objective:To explore the early surgical outcomes of Thoracoscopic Transmitral Myectomy(TTM) on patients with hypertrophic obstructive cardiomyopathy(HOCM).Methods:Preoperative echocardiography and cardiac magnetic resonance were used to evaluate the patient's hypertrophy extent, mitral valve morphology and function. Myocardial resection was performed via the trans-mitral approach under total thoracoscopy, and the surgical methods and early results were analyzed.Results:From April 2019 to October 2019, a total of 15 cases of TTM were performed by a single surgeon in our ward. Preoperative imaging evaluation revealed that 6 patients(40.0%) had predominantly hypertrophic basal septum while another 9 patients(60.0%) had concomitant midventricular septal hypertrophy. Two(13.3%) patients were interrogated ruptured posterior mitral chord by preoperative echocardiogram. After myocardial resection, the mitral valve was treated as follows: 11 patients(73.3%) underwent anterior leaflet enlargement, and 3(20.0%) were directly reattached to mitral valve annulus, and 1(6.7%) underwent bioprosthetic mitral replacement. There was no case of perioperative death, ventricular septal perforation, residual left ventricular outflow tract obstruction and complete atrioventricular block. Median aortic crossclamp time, cardiopulmonary bypass time, postoperative ventilator use time, ICU stay time, and postoperative hospital stay were 129.0min(116.0, 147.0), 184.0 min(158.0, 227.0), 22.0 h(9.0, 26.0), 3 days(2, 7) and 9 days(7, 14) respectively. No patient lost to follow up, the median follow-up time was 4 months(2, 5). One patient(6.7%) underwent mitral angioplasty three months after surgery due to a tear in the A3 area; the ventricular septal thickness and left ventricular outflow tract pressure decreased significantly(preoperative vs follow-up), and were(19.3±3.3)mm vs. (8.9±4.4) mm( P=0.001), (90.8±23.2)mmHg vs. (8.9±4.4) mmHg(1 mmHg = 0.133kPa)( P<0.001) respectively; no residual SAM was observed during follow-up. Patients with moderate-to severe mitral regurgitation were decreased from 12(80.0%) before surgery to 1(6.7%) during follow up( P<0.001). Conclusion:TTM is a safe and effective procedure for HOCM patients with appropriate surgical indications, providing better exposure to septum from basal to apical area, eliminating left ventricular outflow tract obstruction and SAM-related mitral regurgitation. The anterior mitral valve leaflet should be carefully treated during surgery to reduce the occurrence of residual mitral regurgitation resulted in inappropriate selection of patch size and suturing technique.

Objective:To evaluate the clinical effectiveness of thoracoscopic extended septal myectomy in elderly patients diagnosed with hypertrophic obstructive cardiomyopathy(HOCA).Methods:From April 2019 to August 2021, 36 elderly patients with HOCM who underwent septal myectomy were retrospectively analyzed, including 20 patients under thoracoscopy and 16 patients under median sternotomy.The surgical outcomes, echocardiography and follow-up results were compared between the two groups.Results:The number of intracardiac incisions in the Thoracoscopy group was significantly lower than that in the median thoracotomy group( P=0.001).Additionally, the ventilation time of ≤24 hours was higher in the thoracoscopy group compared to the median thoracotomy group(75.0% vs 31.2%, P=0.017).It is noteworthy that there were no deaths in the thoracoscopic group.However, one patient experienced left ventricular rupture during mitral valve replacement and had to be converted to median sternotomy.This patient also developed low cardiac output syndrome after the operation but was discharged smoothly.In the median sternotomy group, one patient died in the hospital, two patients developed low cardiac output syndrome, and one patient underwent re-sternotomy due to bleeding.Importantly, neither group experienced ventricular septal perforation or complete atrioventricular block.The number of intracardiac incisions in the thoracoscopy postoperative interventricular septal thickness was significantly reduced in both groups.In the thoracoscopic group, the interventricular septal thickness was(19.2±3.5)mm and(11.3±2.2)mm, with a t-value of 8.531 and a p-value of <0.001.In the median sternotomy group, the interventricular septal thickness was(19.9±3.9)mm and(13.1±2.6)mm, with a t-value of 5.664 and a p-value of <0.001.This reduction effectively relieved left ventricular outflow tract obstruction.In the thoracoscopic group, the left ventricular outflow tract obstruction decreased from(96.2±32.9)mmHg to(8.2±3.4)mmHg, with a t-value of 11.894 and a p-value of <0.001.In the median sternotomy group, the left ventricular outflow tract obstruction decreased from(83.2±40.9)mmHg to(13.3±19.3)mmHg, with a t-value of 5.997 and a p-value of <0.001.The patients in the thoracoscopic group were followed up for an average of(13.5±8.8)months, and no complications occurred.The patients in the median sternotomy group were followed up for an average of(15.8±9.4)months.One patient in this group underwent alcohol septal ablation for residual obstruction and developed complete atrioventricular block. Conclusions:Thoracoscopic extended myectomy in elderly patients with(HOCM)can achieve comparable therapeutic effectiveness and safety compared to the median sternotomy approach.This minimally invasive procedure is associated with shorter ventilation time and can also minimize the need for additional intracardiac incisions, especially when simultaneous mitral valve treatment is necessary.

Background and Objectives: There is no dedicated occlusive device for closing coronary artery fistulas (CAFs), and specific efficacy and safety data of various off-label occlusive devices for CAFs closure are scarce. Methods: Patients undergoing transcatheter closure of CAFs from January 2011 to December 2022 were included in the single-center retrospective study. The study population was divided into 2 groups: coils group (n=35) and patent ductus arteriosus (PDA) occluders group (n=66). Results: No significant intergroup differences were observed in demographic characteristics except age. The presence of multiple CAF origins (54.3% vs. 4.5%, p<0.001) and multiple draining sites (51.4% vs. 3.0%, p<0.001) were more common in the coils group. In contrast, the presence of aneurysm (72.7% vs. 14.3%, p<0.001), and large fistula (75.8% vs. 37.1%, p<0.001) were more prevalent in the PDA occluders group. The acute procedural success rate of the PDA occluders group was higher compared to that of the coils group (87.9% vs.62.9%, adjusted odds ratio [OR], 7.20; 95% confidence interval, 1.59–32.64; p=0.01).In addition, no significant intergroup differences were noted in both the recanalization rate (7.8% vs. 20%, p=0.107) and the reintervention rate (3.1% vs. 8.6%, p=0.342). Conclusions Transcatheter closure of CAFs using PDA occluders was associated with significantly higher acute procedural success rates compared to coil embolization with comparable late outcomes.

Background and Objectives: There is no dedicated occlusive device for closing coronary artery fistulas (CAFs), and specific efficacy and safety data of various off-label occlusive devices for CAFs closure are scarce. Methods: Patients undergoing transcatheter closure of CAFs from January 2011 to December 2022 were included in the single-center retrospective study. The study population was divided into 2 groups: coils group (n=35) and patent ductus arteriosus (PDA) occluders group (n=66). Results: No significant intergroup differences were observed in demographic characteristics except age. The presence of multiple CAF origins (54.3% vs. 4.5%, p<0.001) and multiple draining sites (51.4% vs. 3.0%, p<0.001) were more common in the coils group. In contrast, the presence of aneurysm (72.7% vs. 14.3%, p<0.001), and large fistula (75.8% vs. 37.1%, p<0.001) were more prevalent in the PDA occluders group. The acute procedural success rate of the PDA occluders group was higher compared to that of the coils group (87.9% vs.62.9%, adjusted odds ratio [OR], 7.20; 95% confidence interval, 1.59–32.64; p=0.01).In addition, no significant intergroup differences were noted in both the recanalization rate (7.8% vs. 20%, p=0.107) and the reintervention rate (3.1% vs. 8.6%, p=0.342). Conclusions Transcatheter closure of CAFs using PDA occluders was associated with significantly higher acute procedural success rates compared to coil embolization with comparable late outcomes.

Background and Objectives: There is no dedicated occlusive device for closing coronary artery fistulas (CAFs), and specific efficacy and safety data of various off-label occlusive devices for CAFs closure are scarce. Methods: Patients undergoing transcatheter closure of CAFs from January 2011 to December 2022 were included in the single-center retrospective study. The study population was divided into 2 groups: coils group (n=35) and patent ductus arteriosus (PDA) occluders group (n=66). Results: No significant intergroup differences were observed in demographic characteristics except age. The presence of multiple CAF origins (54.3% vs. 4.5%, p<0.001) and multiple draining sites (51.4% vs. 3.0%, p<0.001) were more common in the coils group. In contrast, the presence of aneurysm (72.7% vs. 14.3%, p<0.001), and large fistula (75.8% vs. 37.1%, p<0.001) were more prevalent in the PDA occluders group. The acute procedural success rate of the PDA occluders group was higher compared to that of the coils group (87.9% vs.62.9%, adjusted odds ratio [OR], 7.20; 95% confidence interval, 1.59–32.64; p=0.01).In addition, no significant intergroup differences were noted in both the recanalization rate (7.8% vs. 20%, p=0.107) and the reintervention rate (3.1% vs. 8.6%, p=0.342). Conclusions Transcatheter closure of CAFs using PDA occluders was associated with significantly higher acute procedural success rates compared to coil embolization with comparable late outcomes.

Background and Objectives: There is no dedicated occlusive device for closing coronary artery fistulas (CAFs), and specific efficacy and safety data of various off-label occlusive devices for CAFs closure are scarce. Methods: Patients undergoing transcatheter closure of CAFs from January 2011 to December 2022 were included in the single-center retrospective study. The study population was divided into 2 groups: coils group (n=35) and patent ductus arteriosus (PDA) occluders group (n=66). Results: No significant intergroup differences were observed in demographic characteristics except age. The presence of multiple CAF origins (54.3% vs. 4.5%, p<0.001) and multiple draining sites (51.4% vs. 3.0%, p<0.001) were more common in the coils group. In contrast, the presence of aneurysm (72.7% vs. 14.3%, p<0.001), and large fistula (75.8% vs. 37.1%, p<0.001) were more prevalent in the PDA occluders group. The acute procedural success rate of the PDA occluders group was higher compared to that of the coils group (87.9% vs.62.9%, adjusted odds ratio [OR], 7.20; 95% confidence interval, 1.59–32.64; p=0.01).In addition, no significant intergroup differences were noted in both the recanalization rate (7.8% vs. 20%, p=0.107) and the reintervention rate (3.1% vs. 8.6%, p=0.342). Conclusions Transcatheter closure of CAFs using PDA occluders was associated with significantly higher acute procedural success rates compared to coil embolization with comparable late outcomes.

After nearly two decades of application and development, the clinical efficacy of transcatheter aortic valve replacement (TAVR) has been continuously improved and demonstrated. Due to the expansion of indications of TAVR, the frequency of encountering patients with mixed valvular diseases increases greatly, particularly the moderate to severe mitral regurgitation combined with aortic stenosis. Multiple registry studies suggest that the incidence of significant mitral regurgitation is approximately 13% to 74% in patients who undergo TAVR. Some studies have reported that moderate to severe MR is associated with higher mortality, while simultaneous aortic and mitral valve surgery is associated with significantly higher surgical risk. Therefore, the optimal treatment strategy for this special patient group remains uncertain. With the further development of transcatheter therapy, staged surgery may be a feasible solution. However, there is currently a lack of evidence-based support such as randomized clinical trials. This review aims to report and evaluate relevant existing research data to help clinicians make optimal treatment decisions for this specific patient populations.