Objective To investigate the changes of right ventricular(RV) volume and function in patients with atrial septal de-fect(ASD) .Methods 31 patients with ASD-type secundum(ASD group) and 30 age-matched controls(control group) were includ-ed .Single beat real-time three dimensional echocardiography (sbRT3DE) were performed in all to evaluate right ventricular volume and function ,then right venrtricular cardiac output(RVCO) were calculated with heart rate .Further correlative analysis was calcu-lated between right ventricular volume and function parameters of the ASD group and ASD size and the patient′s age .Results Right ventricular end-systolic volume(RVESV) ,right ventricular end-diastolic volume(RVEDV) ,right ventricular stroke volume (RVSV) ,right ventricular ejection fraction(RVEF) ,RVCO of the ASD group were significantly higher than that of control group (P<0 .001) .The maximum diameter of ASD had positive relation with RVESV ,RVEDV ,RVSV ,RVCO(r=0 .55 ,P<0 .01 ;r=0 .61 ,P<0 .01 ;r=0 .63 ,P<0 .01;r=0 .61 ,P<0 .01 ,respectively ) ,and was best correlation with RVSV .But ,there was no signifi-cant correlation between the maximum diameter of ASD and RVEF (r=0 .00 ,P>0 .05) .The patients′age had positive relation with RVESV ,RVEDV ,RVSV(r=0 .53 ,P<0 .01 ;r=0 .48 ,P<0 .01 ;r=0 .41 ,P<0 .01 ,respectively) ,had negtive relation with RVEF (r= -0 .44 ,P<0 .05) ,while there was no significant correlation between the patient′s age and RVCO(r=0 .26 ,P>0 .05) .Conclu-sion sbRT3DE is a fast and accurate new technology in evaluating RV volume and function .Atrial level left-to-right shunt leading to an increase in RV volume ,RV enlargement produces myocardial contractility .RV volume increases with ASD size ,then RV func-tion was enhanced .RV volume increases with patient′s age ,RV function is relatively lower .

Objective To evaluate the changes of right ventricular (RV) volume and function by using single beat real-time three dimensional (3-D) echocardiography in patients with atrial septal defect (ASD) before and after percutaneous closure. Methods During the period from July 2011 to Oct. 2013, a total of 45 patients with pure ostium secundum defect were admitted to authors’ hospital to receive percutaneous transcatheter closer. The patients were divided into ASD without pulmonary hypertension (PH) group (group A, n = 28) and ASD with PH group (group B, n = 17). By using 3-D echocardiography and right cardiac catheterization, the right ventricular end-diastolic volume (RVEDV), right ventricular end-systolic volume (RVESV), right ventricular stroke volume (RVSV), right ventricular ejection fraction (RVEF), right ventricular cardiac output (RVCO), pulmonary artery systolic pressure (PASP) and the mean pulmonary artery pressure (mPAP) were determined before and after the percutaneous transcatheter closer. The results were compared between the two groups. Results After the treatment a statistically significant reduction in RVEDV, RVESV, RVSV and RVCO were seen in all patients (P < 0.05). In group A, RVEF decreased significantly after ASD closure when compared with that determined before transcatheter closer (P < 0.05), while no significant reduction in RVEF was seen in group B (P > 0.05). Pulmonary artery pressure (PAP) decreased significantly in group B after ASD closure when compared with that obtained before Objective To evaluate the changes of right ventricular (RV) volume and function by using single beat real-time three dimensional (3-D) echocardiography in patients with atrial septal defect (ASD) before and after percutaneous closure. Methods During the period from July 2011 to Oct. 2013, a total of 45 patients with pure ostium secundum defect were admitted to authors’ hospital to receive percutaneous transcatheter closer. The patients were divided into ASD without pulmonary hypertension (PH) group (group A, n = 28) and ASD with PH group (group B, n = 17). By using 3-D echocardiography and right cardiac catheterization, the right ventricular end-diastolic volume (RVEDV), right ventricular end-systolic volume (RVESV), right ventricular stroke volume (RVSV), right ventricular ejection fraction (RVEF), right ventricular cardiac output (RVCO), pulmonary artery systolic pressure (PASP) and the mean pulmonary artery pressure (mPAP) were determined before and after the percutaneous transcatheter closer. The results were compared between the two groups. Results After the treatment a statistically significant reduction in RVEDV, RVESV, RVSV and RVCO were seen in all patients (P < 0.05). In group A, RVEF decreased significantly after ASD closure when compared with that determined before transcatheter closer (P < 0.05), while no significant reduction in RVEF was seen in group B (P > 0.05). Pulmonary artery pressure (PAP) decreased significantly in group B after ASD closure when compared with that obtained before transcatheter closer (P < 0.05). Conclusion Single beat real-time 3-D echocardiography is a newly-developed technique. This technique can quickly and accurately assess the right ventricular volume and function. Right ventricular volume will decrease after ASD closer. In ASD patients without PH the right ventricular function will decrease after ASD closer, while in ASD patients with PH the right ventricular function shows no changes after ASD closer although their PAP will decrease.

Objective: To compare the cost changes of total knee arthroplasty (TKA) before and after the cancellation of medical consumables addition, so as to provide reference for the national medical reform policy. Methods: The patients treated with TKA between September 2018 and February 2019 were admitted as objects of study, and 372 of them met the selection criteria and were finally included in the study. According to the time node of cancelling the medical consumables addition (December 24, 2018), all patients were allocated to pre-cancelling and post-cancelling groups ( n=186). The clinical data of patients (gender, age, length of stay, disease classification), and various treatment costs (the costs of diagnosis and treatment, examination, laboratory, material, anesthesia, bed, nursing, operation, drug, and others) were collected. And the changes of various costs and proportions before and after cancelling the medical consumables addition were compared. Results: There was no significant difference in gender, age, and disease classification between the two groups ( P>0.05); the length of stay after cancelling the medical consumables addition was significantly longer than that before cancelling ( t=2.114, P=0.035). There was no significant difference in the total cost of TKA before and after cancelling the medical consumables addition ( t=0.214, P=0.831). Compared with that before cancelling the medical consumables addition, the cost of material was significantly reduced, and the costs of diagnosis and treatment, anesthesia, nursing, and operation were significantly increased ( P<0.05); the costs of examination, laboratory , bed, drug, and others were basically stable, and the differences were not significant ( P>0.05). Conclusion: The total cost of TKA is stable, the proportion of material cost is significantly reduced, the proportion of diagnosis and treatment cost reflecting the technical content of medical staff is significantly increased, which is in line with the expectation of the national policy of cancelling the medical consumables addition.

Objective To evaluate the efficacy and safety of consolidation chemotherapy after thoracic radical concurrent chemoradiotherapy for patients with oligometastatic non?small cell lung cancer ( NSCLC) . Methods Sixty?six NSCLC patients with more than five metastases from 2008 to 2013 were enrolled, and image?guided radiotherapy with conventionally fractionated or hypofractionated doses were performed for these patients. Platinum?based doublets chemotherapy was applied for both concurrent chemoradiotherapy and consolidation chemotherapy. Short?term outcome, adverse reactions, and survival rate were assessed for the patients after treatment. Results Sixty?four patients completed the treatment. The median biologically equivalent dose for planning target volume of thoracic primary tumor lesions was 72 Gy, with a median number of chemotherapy cycles of 4. The objective response rate for thoracic lesions was 70%. The follow?up rate was 97%. The 1?, 2?, and 3?year overall survival ( OS) rates were 72%, 53%, and 31%, respectively, with a median OS time of 25 months;the 1?, 2?, and 3?year progression?free survival ( PFS) rates were 56%, 26%, and 7%, respectively, with a median PFS time of 14 months. The incidence of grade 2?3 acute radiation pneumonitis and radiation esophagitis was 1% and 17%, respectively, and the incidence of grade 3?4 decreases in leukocytes, hemoglobin, and platelet count was 39%, 11%, and 16%, respectively. Conclusions Radical radiotherapy combined with concurrent and consolidation chemotherapy for oligometastatic NSCLC can achieve good short?term outcome and long?term survival, with tolerable adverse effects.

Objective:To discussed the diagnostic value of magnetic resonance cholangiopancreatography (MRCP), and the use of laparoscopic surgery in management of patients with choledochal cyst with extrahepatic bile duct anomaly.Methods:Of 330 consecutive patients who underwent laparoscopic choledochectomy at Guangzhou Women and Children's Medical Center from January 2010 to September 2018, there were 23 patients with extrahepatic bile duct anomaly. The data of these patients were retrospectively analyzed. There were 4 males and 19 females, with an average age of 3.2 (range 0.3~9.0) years. According to whether the extrahepatic bile duct anomaly was diagnosed by preoperative MRCP, these patients were divided into the preoperative MRCP diagnosis group and the preoperative MRCP undiagnosed group. The impact of MRCP in diagnosing bile duct anomaly to prevent bile duct injury, on operation time, hospital stay and the types of extrahepatic bile duct anomaly on outcomes of laparoscopic treatment were analyzed.Results:All the 23 patients with choledochal cysts complicated by extrahepatic bile duct anomaly were confirmed at surgery. The incidence of extrahepatic bile duct anomaly was 6.97% (23/330). There were 47.8% of type II AHD (11/23); 36.8% of type III AHD (7/23); 4.3% of type IV AHD (1/23); 17.4% (4/23) of the type with communication with accessory bile duct (CABD). The preoperative MRCP diagnosis group consisted of 14 patients, while the preoperative MRCP non-diagnosis group consisted of 9 patients, including 2 patients without MRCP. The diagnostic rate of MRCP in preoperative diagnosis of extrahepatic bile duct anomaly was 66.7%(14/21). The preoperative MRCP undiagnosed group, when compared with the preoperatives MRCP undiagnosed group, had a significantly higher bile duct injury rate [preoperative MRCP diagnosis group 7.1%(1/14), preoperative MRCP non-diagnosis group 55.6%(5/9)], and a significantly longer operation time [preoperative MRCP diagnosis group(232.6±10.0) min, preoperative MRCP undiagnosed group (278.9±22.45)min], (all P<0.05). Laparoscopic surgery was completed in 22 of 23 patients. One patient was converted to open surgery. AHD reconstruction was needed in 11 patients with type II AHD and 1 patient with type IV AHD. Seven patients with type III AHD did not require any surgical intervention for the anomaly. The 4 patients with CABD underwent simple ligation. Postoperative chyloperitoneum developed in 1 patient, who successfully responded to conservative treatment. Postoperative recovery was uneventful in the remaining patients. At a median follow-up of 2 years (range 1 to 5 years), no further complications, including intrahepatic bile duct dilatation and hepatic atrophy were detected. Conclusions:MRCP was effective in preoperative diagnosis of choledochal cysts with extrahepatic bile duct anomaly. It helped to decrease intraoperation injuries to bile duct anomalies. MRCP was also useful in classifying patients with extrahepatic bile duct anomaly to better preoperatively planning of surgical treatment strategies. Laparoscopic surgery could be completed in the majority of these patients with good postoperative results.

Objective:To systematically investigate the short-term efficacy of total knee arthroplasty in the treatment of osteoarthritis coupled with fixed patellar dislocation.Methods:A retrospective analysis was conducted on a cohort of 11 patients diagnosed with knee osteoarthritis and fixed patellar dislocation who underwent total knee arthroplasty at Panzhihua Central Hospital from January 2018 to October 2021. The cohort comprised 4 males and 7 females, aged 63.45±4.76 years (range, 56-70 years), all of whom underwent unilateral surgery. There were 5 left and 6 right knees, with a body mass index of 23.20±2.02 kg/m 2 (range, 20.8-27.6 kg/m 2) and a disease course of 12.63±4.81 years. According to the American Society of Anesthesiologists classification, 9 cases were categorized as grade II, and 2 cases as grade III. Recovery of patellar trajectory during total knee arthroplasty, using medial synovial flap transposition to repair lateral joint capsule. Preoperative and postoperative assessments included knee joint range of motion, Knee Society score (KSS), University of California Los Angeles (UCLA) score, and visual analogue scale (VAS). Results:All 11 patients were followed up for a period of 28.64±4.01 months (range, 24-36 months). Two patients exhibited subcutaneous fat liquefaction locally after surgery, which resolved following dressing changes. All wounds achieved primary healing. Two of them developed intramuscular vein thrombosis after surgery and were cured after anticoagulant treatment. The range of motion of the knee joint increased from 63.18°±17.07° before surgery to 104.55°±16.80° at the last follow-up, with a statistically significant difference ( t=14.041, P<0.001). The KSS score increased from 38.00±6.78 points to 80.91±5.65 points, with a statistically significant difference ( t=16.472, P<0.001). The UCLA score increased from 3.18±1.17 to 6.73±1.35, with a statistically significant difference ( t=9.694, P<0.001). The VAS decreased from 6.09±0.94 points to 2.32±0.64 points, with a statistically significant difference ( t=16.600, P<0.001). At the last follow-up, imaging examinations showed no cases of patellar subluxation or dislocation, no tearing or breakage of the knee extension device, and no infection or loosening around the prosthesis. Conclusion:Utilizing medial synovial flap transposition for repairing the lateral joint capsule proves to be an effective technique for key capsule repair. Total knee arthroplasty for osteoarthritis combined with fixed patellar dislocation demonstrates satisfactory early clinical outcomes.

Objective:To study the clinical outcomes of children with extrahepatic portal venous obstruction who underwent balloon venoplasties for anastomotic stenosis after Meso-Rex bypass.Methods:The data of 60 patients who underwent Meso-Rex bypass at Guangzhou Women and Children’s Medical Center between October 2014 and November 2018 were retrospectively analyzed. Four patients were shown by transhepatic portal venography to have graft stenosis in the left portal vein anastomosis. There were 2 males and 2 famales, the age of patients were 11 years, 5 years, 5 years and 8 years. Four patients underwent balloon dilation. The pressure, anastomotic diameter and blood flow velocity of the anterior portal vein were compared before and after balloon dilation. The patients were followed-up on the postoperative status.Results:Three of 4 patients who had anastomotic stenosis were successfully treated by balloon venoplasties. On postoperative follow-up for 6 months, the bridging vessels remained unobtrusive and there was no gastrointestinal bleeding. The pressures of the anterior hepatic portal vein before balloon dilation were 19, 15 and 25 mmHg (1 mmHg=0.133 kPa). They were 8, 11 and 20 mmHg after balloon dilation. The preoperative anastomotic diameters were 2.6, 3.0 and 3.0 cm. They were 6.0, 4.5 and 5.5 cm, respectively 6 months after surgery. The preoperative anastomotic blood flow velocities were 138, 107 and 94 cm/s. They were 96, 91 and 90 cm/s, respectively 6 months after surgery. The preoperative three-dimensional CT reconstruction of spleen volumes were 793.24, 192.25, and 318.05 cm 3, respectively. They were 681.84, 190.30, and 310.65 cm 3, respectively 6 months after surgery. In the remaining patient, balloon dilation failed because of the small diameter of the anastomotic stenosis segment. Conclusion:Balloon venoplasties is an optional procedure for patients with anastomotic stenosis after Meso-Rex bypass.

Objective This study was conducted to evaluate treatment-related toxicities,the patterns of failure,overall survival(OS)and progression-free survival(PFS)by comparing IFI with ENI in combination with chemotherapy. Methods Eligible patients were treated with concurrent chemoradiotherapy and randomized into either an IFI or ENI arm. The primary end points wereacute treatment-related toxicities. The secondary end points were patterns of failure,OS and PFS. Kaplan?Meier survival rate of the method for calculating the Logrank test difference method. Results Between April 2012 and October 2016,a total of 228 patients were enrolled from nine centers in china. Grade≥3,Grade≥2 radiation esophagitis and pneumonitis in the IFI arm were significantly lower than that of the ENI arm(P=0.018,0.027).No significant differences were observed in overall failure rates,loco-regional failure,distant failure rates,in-field and out-field lymph node failure between the two arms(P=0.401,0.561,0.510,0.561,0.681).The 1-,2-, 3-,4-yearand median OS in the ENI arm and IFI arm were 84.1%,57.3%,39.4%,31.6%,28 months and 83.6%,62.1%,44.5%,31.5%,32 months(P=0.654),respectively. The 1-,2-,3-yearand median PFS in the ENI arm and IFI arm were 71.9%,42.3%,32.7%,20 months and 70.1%,45.0%,35.9%,22 months (P=0.885),respectively. Conclusions Compared to ENI,IFI resulted in decreased radiation pneumonitis and esophagitis without sacrificing loco-regional lymph nodal control,PFS and OS in thoracic ESCC. Clinical Trial Registry Chinese Clinical trail registry,registration number:NCT01551589.

Objective: To study the diagnosis and management of choledochal cyst in children with accessory hepatic ducts (AHD). Methods: From November 2013 to June 2018, 14 patients with choledochal cyst with AHD were treated in Guangzhou Women and Children's Medical Center. The patients included 2 males and 12 females, and age ranged from 4 months to 3 years (median 2 years). All patients underwent MRCP before operation, and 2 underwent operative cholangiography through the AHD. Results: Seven patients with choledochal cyst and AHD were demonstrated by preoperative MRCP and intraoperative exploration. One patient was suspected by preoperative MRCP to have AHD which was confirmed by surgical exploration. Preoperative MRCP failed to diagnose, but operative exploration revealed AHD in 6 patients. Anastomosis of the AHD to jejunum was performed laparoscopically in 8 patients and by open surgery in 1 patient. Six patients had the common hepatic duct and the AHD joined together to create a common channel which was then implanted as a single duct into a Roux loop, Three patients had the common hepatic duct and the AHD anastomosed separately to a Roux loop. All the patients recovered well after operation and they were discharged home without any complication. A follow-up which ranged from 0.5 to 5 years showed no jaundice, liver atrophy or liver abscess. Conclusions MRCP was important in the preoperative diagnosis of choledochal cyst with accessory hepatic duct in children. MRCP was difficult in diagnosing type II accessory hepatic ducts. In suspected or undiagnosed cases of AHD, surgical exploration helped to improve the diagnostic accuracy, avoided injury and guided correct surgical decisions. Reconstruction of AHD required joining the AHD to the common hepatic duct, or as a separate duct to jejunal anastomosis to a Roux-y-loop.

ObjectiveTo investigate the efficacy of Bushen Shengxue prescription and Yiqi Yangxue prescription in the treatment of chronic aplastic anemia and the effect on T cell subsets and the expression of T-box expressed in T cells （T-bet） and GATA binding protein 3 （GATA3）. MethodA total of 585 patients with chronic aplastic anemia who were treated in 19 hospitals in China from May 2018 to June 2021 were enrolled. With the prospective， double-blind and randomized control methods， the patients were randomized into three groups： kidney deficiency group， Qi and blood deficiency group， and control group. The three groups were respectively treated with Bushen Shengxue prescription granule， Yiqi Yangxue prescription granule， and Placebo （half the dose of Bushen Shengxue formula granules）. In addition， all of them were given oral cyclosporin and androgen. The treatment lasted 6 months， with 3 months as a course. The blood routine indexes， T cell subsets， and fusion genes T-bet and GATA3 before and after treatment were analyzed， and the safety indexes were monitored. ResultDuring the observation， a total of 75 cases dropped out and 18 were rejected. Finally， 161 cases in the kidney deficiency group， 164 in the Qi and blood deficiency group， and 167 in the control group were included. After 6 months of treatment， the total effective rate was 98.8% （159/161） in the kidney deficiency group， which was higher than the 79.9% （131/164） in the Qi and blood deficiency group （χ²=30.135， P<0.01） and the 61.7% （103/167） in the control group （χ²=70.126， P<0.01）. The total effective rate was higher in the Qi and blood deficiency group than in the control group （χ²=13.232， P<0.01）. After treatment， the hemoglobin （HGB） content increased significantly in three groups （P<0.05） as compared with that before treatment， particularly the kidney deficiency group （P<0.01）. After treatment， the white blood cell （WBC） count and platelet （PLT） count in the kidney deficiency group and the control group increased compared with those in the Qi and blood deficiency group （P<0.01）. There was no specific difference in neutrophils （ANC） after treatment among the three groups. At the same time point， the level of T helper type 1 （Th1） cells， Th1/Th2 ratio （P<0.05）， level of CD4⁺， and CD4⁺/CD8⁺ ratio （P<0.05） were significantly low in the kidney deficiency group among three groups. There was no significant difference in CD19^-， HLA/DR⁺， and CD25⁺ between the kidney deficiency group and the other two groups， but the T-bet of the kidney deficiency group and the control group was lower than that of the Qi and blood deficiency group （P<0.05）. ConclusionBushen Shengxue prescription exerts therapeutic effect on the aplastic anemia by improving the immunoregulatory mechanism， inhibiting the activity of immune system， modulating T cell subsets， suppressing Th1 and CD4⁺， and promoting bone marrow hematopoiesis. Moreover， it is safe with little side effects， which is worthy of further promotion.