In order to maintain and develop the overall advantages and distinguishing features of medicine in Shanghai, the citys health system implemented the program of constructing centers for clinical medicine. The program involved not only the optimization and integration of health resources in the whole city but also the structural readjustment and resources regrouping within the citys health system and each individual hospital. After more than two years construction, 33 centers for clinical medicine have been set up in the city, resulting in primary achievements in expertise improvement, effect of scale, and quality benefits. By analyzing the hardware and software construction process, it can be seen that the centers for clinical medicine have made primary achievements in such aspects as ideological construction, work efficiency, interdisciplinary cooperation, academic status enhancement, medical quality improvement, and reform in the system of personnel distribution.

Objective To evaluate the accuracy of fatsuppressed fast spoiled gradient echo(FSPGR) T_1WI in detection of pancreaticdisease using the receiver operating characteristic curve(ROC).Methods The pancreas were evaluated in 92 subject investigated(57normal and 35 with pancreatic disease) with fat saturation FSPGR T_1WI.The signal intensity(SI) ratio of pancreas relative to liver and spleen was quantitatively measured using regions of interest(ROIs),then qualitatively assessed by one independent observers.Results The mean values of pancreas-liver ratios and pancreas-spleen ratios between a normal and an abnormal pancreas were significantlydifferent.Thearea under ROC curve of the pancreas-liver SI ratio and the pancreas-spleen SI ratio was 0.92?0.03 and 0.91?0.04,respectively.There was no statistically significant difference between quantitative and qualitative analysis for the diagnosis of pancreatic disease when using liver as comparable standard.The sensitivity of qualitative pancreas in comparison with liver was 86.7%,while specificity was 91.2%.Conclusion When the SI ratio of pancreas-liver is used to distinguish normal from abnormal pancreas,qualitative analysis by observers is as accuracy as quantitative measurement.

Objective To investigate MR imaging characteristics of MELAS syndrome.Methods The clinical data and MRI features of 13 cases with MELAS syndrome were retrospectively analyzed.Results Multiple hypointense on T1WI and hyperintense on T2WI lesions were showed predominantly in the gray matter of the temporal, parietal and occipital lobes. The lesions crossed vascular boundaries. No stenosis and occlusion of main artery were displayed by MRA.Basal ganglia calcifications and cerebral atrophy with widening of ventricles were also frequent found. Increased ADC value of the leison on DWI and appearance of Lac peak on1H-MRS were useful in diagnosis.Conclusion There are some characteristics of MRI in patients with MELAS syndrome.Combined clinical informations with neuroimaging and muscle biopsy, the diagnosis of MELAS syndrome can be made correctly.

Objective:To study the effects of doxycycline on the proliferation and invasion of adenoid cystic carcinoma cells.Methods:MTT assay was applied to study the effects of doxycycline on proliferation of SAcc83 cells. Activity of type IV collagenase was detected by the method of gelatin incorporated SDS PAGE electrophoresis.Monolayer cell organ culture was carried out to study the invasion of the cells.Results:Doxycycline at 5～50 ?g/ml inhibited the proliferation of adenoid cystic carcinoma cell in a dose and time dependant manner. 10 ?g/ml of the drug inhibited type Ⅳ collagenase and decreased the invasion of adenoid cystic carcinoma cells by 48%.Conclusion:Doxycycline can inhibit proliferation and invasion of SAcc83 cells.

Objective To examine whether the minimally invasive video-assisted thoracoscopic surgery(VATS) in atrial septal defect(ASD) closure yields better clinical outcome equivalent to those of more established procedures,such as median sternotomy,moreover,to provide our own clinical experience in ASD Closure.Methods From January 2012 to January 2013,100 ASD patients were treated,50 patients received traditional open heart surgery (OHS group),17 males and 33 females,aged(23.3 ± 7.5) years,weighted (47.5 ± 16.5) kg; 50 patients underwent video-assisted thoracoscopic surgery (VATS group),20 males and 30 females,(22.6 ± 8.2) years old and (49.6 ± 17.2) kg weight.Collected and analyzed the clinical date of intraoperation and postoperation.Results All patients survived after surgery without serious complications like death.Clinical date of both group(OHS group vs.VATS group)include:Total operating room time (121.3 ± 20.5) min vs.(105.3±17.5) min (P＜0.05); tracheal intubation time in ICU (210.0±36.5) min vs.(100.0 ±47.5) min(P＜0.05) ; volume of thoracic drainage after operation (350.3 ± 50.8) ml vs.(47.0 ± 10.9) ml (P ＜ 0.005) ; postoperative length of hospital stay (6.2 ± 1.7) days vs.(4.4 ± 1.5) days (P ＜ 0.005).Rate of return to work in 3 weeks of postoperation 0 vs.78.4％ (P ＜ 0.005).Conclusion Completed VATS in ASD closure is less invasive,accelerates recovery and maintains overall surgical efficacy,which brings good economic and social benefits.For the appropriate patients,and for the experienced and skilled surgeon,completed VATS is the best method of choice of ASD closure in our department.

Objective To determine if in vivo detection of choline by1H-magnetic resonance spectroscopy(1H-MRS) could differentiate between benign and malignant bone and soft tissue tumors.Methods MR spectroscopy was performed in 28 cases, including 5 healthy subjects and 23 cases of extremital tumors. Examination was performed by using a point-resolved spectroscopic sequence with echo times of 35,144 and 288 ms.Results 1H-MRS spectrum was different among normal tissue, benign and malignant tumor.Conclusion Choline can be reliable detected in malignant tumor of bone and soft tissue by using1H-MRS.1H-MRS can help differentiate malignant tumor from benign tumor.

Objective    To investigate the perioperative results and safety of minimally invasive direct coronary artery bypass grafting (MIDCAB) treatment of anterior descending artery disease through a small left thoracic incision assisted by thoracoscopy. Methods    The clinical data of 92 patients who received MIDCAB in our hospital from May 2014 to October 2018 were retrospectively analyzed, including 72 (78.26%) males aged 42-78 (61.2±7.48) years, and 20 (21.74%) females aged 30-80 (61.30±12.26) years. The perioperative complications, blood product use, left heart function changes, ventilator use time, ICU stay, hospital stay and other indicators were analyzed. Results    Two (2.17%) patients were transferred to thoracotomy, 5 (5.43%) patients received blood products during the operation, 2 (2.17%) were subjected to secondary thoracotomy to stop bleeding, 4 (4.34%) had postoperative hypoxemia and 1 (1.08%) was reintubated. The ventilator use time was 3-227 (22.35±35.39) hours, the ICU stay was 16-777 (78.85±108.62) hours, and the postoperative hospital stay was 2-36 (8.86±6.05) days. One (1.08%) patient died in hospital. Conclusion    MIDCAB for anterior descending artery disease has good perioperative results, especially for solitary anterior descending artery disease, which can reduce the use of blood products, and shorten the time of ventilator use after operation, ICU stay and hospital stay.

Objective    To evaluate the efficacy of a combination of beating-heart minimally invasive approach and leaflets augmentation technique treating severe tricuspid regurgitation (TR) after cardiac surgery. Methods    From January 2015 to August 2017, patients undergoing reoperative tricuspid valve repair (TVP) with minimally invasive approach and leaflets augmentation were enrolled. Cardiopulmonary bypass (CPB) was established via femoral vessels and the procedures were performed on beating heart with normothermic CPB. A bovine pericardial patch was sutured to leaflets to augment the native anterior and posterior leaflets. Other repair techniques, such as ring implantation and leaflet mobilization, were also applied as needed. Results    A total of 28 patients (mean age 55.6±10.1 years, 5 males, 23 females) were enrolled. One patient was converted to median sternotomy due to pleural cavity adhesion. Twenty-seven patients underwent totally endoscopic TVP with leaflets augmentation. No patients was transferred to tricuspid valve replacement. Two patients died in hospital. All patients were followed up for 7.4±5.0 months and there was no late death and reoperation. Regurgitation area was converted from 20.7±10.1 cm2 to 3.3±3.3 cm2 after TVP according to the latest echocardiography (P<0.001). Conclusion    Minimally TVP with leaflets augmentation is effective in treating severe isolated TR after primary cardiac surgery. It can significantly increase success rate of tricuspid valvuloplasty and decrease the surgical trauma.

Objective To investigate the relationship between two-lung ventilation (TLV) with single-lumen endotracheal tube (SLT), one-lung ventilation (OLV) with double-lumen endotracheal tube (DLT) and postoperative pulmonary complications (PPCs) after total thoracoscopic cardiac surgery. Methods The clinical data of patients who underwent totally thoracoscopic cardiac surgeries in the Guangdong Provincial People’s Hospital from October 2019 to October 2021 were retrospectively analyzed. The patients were divided into 2 group according to the type of endotracheal tube, including a SLT group and a DLT group. Baseline data, surgical variables and PPCs were compared. The influencing factors of PPCs in the two groups were analyzed by binary logistic regression analysis. Results Finally 349 patients were enrolled, including 180 males and 169 females with an average age of (50.0±14.8) years. There were 219 patients in the SLT group and 130 patients in the DLT group. There was no statistical difference in baseline data, surgical variables or PPCs between the two groups (P＞0.05). Binary logistic regression analysis showed that PPCs were related to body mass index in the SLT group (OR=0.778, 95%CI 0.637 to 0.951, P=0.014) and preoperative smoking history in the DLT group (OR=0.058, 95%CI 0.004 to 0.903, P=0.042). Conclusion For the patients who undergo totally thoracoscopic cardiac surgery, TLV with SLT and OLV with DLT show no significant association with PPCs. At the same time, PPCs are associated with body mass index in the SLT group, while associated with preoperative smoking history in the DLT group.

Magnetic anchoring and traction technique is one of the core technologies of magnetic surgery. With the "non-contact" traction force of the outer magnet on the inner magnet, we can drive the inner magnet and the gripper to multiple directions, and pull tissue or organ to required position in operations, so as to get a clearer surgical field of view. On the basis of the previous animal experiments, we applied magnetic anchoring and traction device in 3 human (males aged 63-71 years) thoracoscopic esophagectomies. Using the magnetic anchoring device, we could pull the esophagus dorsally or ventrally to assist in exposing the anatomical plane without special equipment or pleural puncture for retraction of the esophagus. The interference between operating instruments reduced. The mean blood loss in operation was 83 mL, the mean total operation time was 253 min and the mean length of hospital stay was 10 d. Postoperative follow-up showed that all 3 patients had good short-term prognosis. There was no swellling or pain in magnetic anchoring zone of chest wall.