Objective To study the effect of case-based learning(CBL) combined with virtual reality simulator in peripheral vascular intervention training for refresher doctors.Methods Total 30 peripheral vascular refresher doctors were selected in department of vascular surgery,Xuanwu Hospital of Capital Medical University and were randomly divided into the observation group(n=15) and control group(n=15).Doctors in observation group were trained by CBL combined with virtual reality simulator while those in control group were taught by traditional teaching method.Theory examination,skill examination in real environment were performed after the training and achievement differences were compared between 2 groups.Questionnaires were given to the simulator CBL group,to learn refresher doctors' recognition of the teaching method and groups were compared using independent samples t test.Results Theory examination average score was (84.5 ± 7.7) in observation group,higher than the score(72.6 ± 8.7) in control group(P=0.024).Skill examination average score was(85.3 ± 9.3) in observation group,higher than the score(70.2 ± 10.2) in control group(P=0.013).Compared with control group,the mean performance errors in training group,the contrast volume,the mean angiography procedure time,the time of X-ray exposure,the total volume of X-ray exposure and the total volume of X-ray exposure every square meter all decreased significantly and the difference was statistically significant.P value＜0.05.100％ (15/15) simulator CBL group refresher doctors recognized CBL combined with vascular interventional simulator teaching method.Conclusions Teaching method of CBL combined with virtual reality simulator can stimulate the refresher doctors' interest in learning and help them master peripheral vascular interventional techniques.

BACKGROUND:Establishment of high-quality finite element model is an important basis of biomechanical analysis. The reports on three-dimensional finite element model of complete adolescent idiopathic scoliosis are less. OBJECTIVE:To set up three-dimensional finite element model of PUMCIId1 adolescent idiopathic scoliosis for building ideal digitization platform for further biomechanical study. METHODS:A 14-year-old female patient with PUMCIId1 adolescent idiopathic scoliosis was included as volunteer for the current study. CT images obtained from CT transverse scanning from T 1 to sacrococcyx were imported into Mimics 16.0 software to form qualified three-dimensional geometric model, including thoracic cage, which was further delivered to Geomagic Studio 11.0 software to build three-dimensional finite element model by a series of modules and optimization of cleaning. The geometric model was imported to ANSYS 14.0 software to build complete three-dimensional finite element adolescent idiopathic scoliosis model by adding ligaments, setting unit type, and defining material properties. RESULTS AND CONCLUSION:A complete three-dimensional finite element model of PUMCIId1 adolescent idiopathic scoliosis was built successful y, consisting of 522 887 tetrahedron elements and 730 rod elements, a total of 523 617 units and 159 008 nodes. Three-dimensional finite element model of PUMCIId1 adolescent idiopathic scoliosis was lifelike, and can be used as the reliable digital model for further biomechanical analysis.

Objective To investigate the expression of monocyte subsets and their chemokine,i.e.,monocyte chemoattractant protein (MCP-1) and fractalkine (FKN),in patients with acute coronary svndrome (ACS),and to analyze their correlation.Methods Patients with the syndrome of pectoralgia and to be inspected with coronary angiography (CAG) in our hospital from Sep.to Dec.,2016 were included.Patients' venous blood was collected on the operation day before operation,the level and proportion of monocyte (Mon) subsets,which was namely CD14 + CD16-Mon (Mon1),CD14+CD16 + Mon (Mon2) and CD14-CD16 + Mon (Mon3) according to the expression of cluster differentiation-14 (CD14) and CD16,were detected by flow cytometry (FCM).Patients' venous blood was collected on the operation day before operation and one day after operation,the concentrations of MCP-1 and FKN in plasma were measured by ELISA.We compared the expression levels of MCP-1-Mon1 and FKN-Mon3,and analyzed their relationship between each other respectively in different groups.Results Diagnosed according to the clinical symptoms,myocardial markers,electrocardiogram and CAG results,70 individuals were analyzed,including 30 patients with acute myocardial infarction (AMI group),25 patients with unstable angina pectoris (UAP group) and 15 patients with the chest pain symptoms and normal CAG results (control group).The percentage of Mon1 in the AMI group was higher than that in the other groups (P＜0.05);no difference was observed for Mon3 among the groups (P＞0.05).The Mon3/Mon1 ratio in the AMI group was lower than that in the control group (P＜0.05).Moreover,the levels of FKN and MCP-1 in the ACS group were greater than those in the control group.The level of red blood cell distribution width (RDW) was significantly increased in the AMI and UAP group than that in the control group (P＜0.05).There was a significant correlation between FKN and Mon3 (P＜0.05,R=0.650 2).Conclusions The monocyte subset of Mon1 and Mon3 increased in the early stage of ACS,with their chemokine (FKN and MCP-1) increasing at the same time.There is a significant correlation between FKN and Mon3,which indicates MCP-1-Mon1 and FKN-Mon3 may participate in the pathophysiological process of early ACS in patients.

Objective To compare the long term outcome between traditional arterial bypass and interventional therapy for chronic lower limb ischemia according to the TASC classification. Method A retrospective study was undertaken on 201 cases receiving graft bypass or interventional therapy for CLI (chronic limb ischemia) from December 2005 to December 2008. Result The patency rate at 6 month. 12 month and 24 month after operation by femoral artery stent angioplasty in therapy group (100%, 89.8%, 75%) is higher than that of angioplasty group(82.4%, 62.5%, 35.7%), P <0.05. The 2nd term patency rate(88%) of operation group (24 months after operation) is higher than that of interventional group (70.7%), P<0.05. Conclusion Arterial bypass has higher long term patency rate and is applicable for femoral artery long segment obliterate classified as TASC C, D, while for the short segment femoral artery obliterate classified as TASC A, B interventional therapy especially stenting is an alternative despite of low patency rate.

Objective To compare the clinical curative effects of PTA and simple pharmacotherapy for intrapopliteal artery ischemic disease.Methods Seventy-three patients with intrapopliteal artery ischemic disease were divided into PTA group (n=37) and pharmacotherapy group (n=36).Their ABI,claudication distance,vascular patency,rest pain and amputation rate were recorded and analyzed with SPSS 22.0 at months 1,3,6,12,18 and 24 respectively before and after treat ment.The vascular patency and amputation rate were analyzed according to the Kaplan-Meier curve.Results The ABI was higher in PTA group than in pharmacotherapy group during the 1-24 months following up period after treatment,and was still higher in PTA group than in pharmacotherapy group at month 24 after treatment (0.640±0.238 vs 0.500±0.152,P=0.038).The claudication distance was shorter and the rest pain was milder in PTA group than in pharmacotherapy group at months 1 and 3,and at months 1-18 respectively (P＜0.05,P＜0.01).No significant difference was found in amputation-free survival curves between the two groups (Plogrank =0.618).Conclusion The symptom improvement of PTA is better than that of pharmacotherapy for patients with severe rest pain or severe intermittent claudication.

Objective To compare the difference between sperm floating plate and density gradient centrifugation combined with swim-up in human sperm preparation.Methods The semen samples were obtained from 50 infertile men in the clinic of Reproductive Medi-cine of Northwest Women's and Children's Hospital excluding azoospermia,severe oligoasthenozoospermia and semen volume less than 2 mL.After semen liquefaction,the differences of sperm concentration,total progressively motile sperm count(TMSC),percentages of progressively motile sperm and normal morphology sperm,recovery rate and DNA fragmentation index(DFI)were measured by both the methods of sperm floating plate and density gradient centrifugation combined with swim-up,and the results were compared.Results Compared with the pre-sorting samples,sperm concentrations[(16.08±13.39)x 106/mL,(8.88±8.06)x 106/mL vs(60.05± 27.21)×106/mL],TMSC[(7.41±6.14)×106,(3.98±3.57)×106vs(22.24±13.74)×106]and DFI[(2.20±3.44)％,(5.20± 10.79)％vs(26.38±13.92)％]in the sorting groups by sperm floating plate and density gradient centrifugation combined with swim-up were decreased significantly,and the percentages of progressive motile sperm[(91.67±4.75)％,(87.86±7.90)％vs(40.21± 16.83)％]and normal morphology sperm[(9.58±5.08)％,(7.72±4.01)％vs(3.58±2.06)％]were increased significantly.Com-pared with the density gradient centrifugation combined with swim-up,the results of sperm floating plate were higher in sperm concen-tration,percentages of progressively motile sperm and normal morphology sperm,TMSC and sperm recovery rate[(30.74±13.70)％vs(17.09±9.20)％],but DFI was lower,time-consuming was shorter[(32.38±1.01)min vs(60.08±2.06)min],and the difference between the two groups was statistically significant(P＜0.05).Conclusion The sperm floating plate may have certain clinical applica-tion prospects in the future due to better parameters of sperm preparation than those of density gradient centrifugation combined with swim-up in simple operation and shorter time-consuming.

Objective:To understand the characteristics of brucellosis in adults and the abnormality of blood lipid profile, and to analyze the related factors of dyslipidemia in brucellosis patients, so as to provide reference for preventing and controlling the potential risk of dyslipidemia in brucellosis patients.Methods:The clinical data of all hospitalized patients with brucellosis diagnosed in Liaoning Provincial Hospital of Infectious Diseases from January 1, 2015 to December 31, 2016 were collected. Patients' general demographic characteristics, exposure history, clinical stage and course of disease, concomitant chronic diseases and other basic conditions and dyslipidemia were analyzed; single factor and multivariate unconditional logistic regression models were used to analyze the related factors of dyslipidemia in patients with brucellosis.Results:A total of 562 cases with brucellosis were collected, aged (48.59 ± 12.26) years old, ranging from 18 to 76 years old, and the male to female ratio was 2.5∶1.0 (402∶160); among them, 193 cases (34.3%) had a history of contact with cattle and 331 cases (58.9%) had a history of contact with sheep. Among the 562 cases of brucellosis, 314 cases (55.9%) were accompanied with dyslipidemia, 48 (8.5%), 152 (27.0%), 60 (10.7%) and 217 (38.6%) with abnormal total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C), respectively. The results of logistic regression analysis showed that diabetes [odds ratio ( OR) = 4.201, 95% confidence interval ( CI): 1.361-12.971], elevated neutrophils ( OR = 2.314, 95% CI: 1.981-5.462), elevated alanine transferase ( OR = 2.188, 95% CI: 1.379-3.473), increased procalcitonin ( OR = 1.707, 95% CI: 1.515-2.532), history of contact with cattle ( OR = 2.170, 95% CI: 1.464-3.125) were risk factors of dyslipidemia in patients with brucellosis; and neutropenia ( OR = 0.458, 95% CI: 0.232-0.904) was a protective factor. Conclusions:The incidence of dyslipidemia in brucellosis patients is high. Diabetes, inflammation, abnormal liver function, and history contact with cattle are related factors for dyslipidemia in patients with brucellosis. Targeted measures should be taken to intervene and control the potential risk of dyslipidemia in patients with brucellosis, so as to reduce the burden of brucellosis and non-infectious chronic diseases.

Objective:To explore the optimal monochromatic level for the observation of coronary in-stent lumen by dual-layer spectral CT (DLCT).Methods:Forty-nine patients with 74 stents after percutaneous coronary intervention (PCI) who underwent coronary CTA (CCTA) examinations by a DLCT between January 2016 and September 2017 were retrospectively enrolled. A total of 12 groups of images including 60-120 keV (kilo electron voltage) images with 10 keV interval, 140-200 keV images with 20 keV interval and conventional images. In-stent lumen diameter of proximal, mid and distal portion was measured. Difference of CT values between in-stent lumen and ascending aorta was used to describe as blooming artifact, and noise of in-stent lumen as image noise. Then Likert 5-point scale was performed to evaluate images noise, enhancement of in-stent lumen, blooming artifact and diagnostic confidence. Differences of objective and subjective parameters among conventional and various monochromatic images were compared by Friedman test.Results:In the diameter measurement of the proximal, middle and distal segments of the stent, the difference between the images of each group was statistically significant (χ 2 = 427.270, 426.375, 400.981, P< 0.001). The diameter of the lumen measured by 120-200 keV single-level image was larger than that measured by 60-100 keV single-level image, and the difference was statistically significant ( P< 0.05). In the comparison of CT difference between the stent lumen and ascending aorta, the difference between the images of each group was statistically significant (χ 2 = 242.193, P< 0.001), and 100-200 keV single-level images were lower than the conventional images, the difference was statistically significant ( P< 0.05). In the comparison of noise values, the difference between the images of each group was statistically significant (χ 2 = 420.161, P< 0.001), and the difference was statistically significant ( P< 0.05). In the subjective scores of noise, enhancement, halo artifact and diagnostic confidence, there were statistically significant differences among the groups (χ2= 333.827, 455.989, 276.824, 399.497, P< 0.001). The noise score of 100-200 keV single-level image was higher than that of conventional image, the difference was statistically significant ( P< 0.05). The enhancement score of 60 keV was significantly higher than that of other images ( P< 0.05). The halo artifact score of 100-200 keV single level image was higher than that of 60-90 keV image, the difference was statistically significant ( P<0.05). The scores of 90-120 keV single-level images were higher than those of other single-level images, and the difference was statistically significant ( P< 0.05). Conclusions:CCTA examinations can be effectively performed by DLCT in patients after PCI in clinical settings, and 120 keV is recommended as the optimal monochromatic image for the observation of in-stent lumen.

Objective To investigate the clinical outcome of drug-coated balloon ( DCB) treated atherosclerosis obliterans ( ASO) in lower extremity. Methods Data of 28 patients were retrospectively an-alyzed to determine the effectiveness and characteristics of DCB treatment. Results All the 28 patients were successfully treated with endovascular intervention therapy. Lesions mainly located in the superficial femoral arteries were divided into Groups A, B, C, and D according to TransAtlantic InterSociety Consensus (TASC) Ⅱ classification. Follow-up at 6, 9, and 12 months showed 100％, 84. 6％ and 76. 9％ patency rate in treated artery. After 9 months of endovascular intervention therapy, the combined artery patency rates in Groups A and B was 92. 8％, which was significantly better than 66. 7％ in Groups C and D ( P <0. 05 ) . DCB angioplasty had an artery patency rate of 86. 7％, while DCB angioplasty plus stenting had the patency rate of 85. 7％ (P>0. 05). Artery patency rate of Simple DCB angioplasty in ten patients (Exclu-ding patients with in-stent restenosis ) was 80％ and of Atherectomy plus DCB angioplasty in 5 patients was 100％ (P<0. 05). Conclusions DCB angioplasty has superiority over conventional intervention therapy. Combined debulky and DCB angioplasty appear to be the best choice in current treatment of ASO in lower extremity.

Objective: To compare the results of invasive dual mitral and aortic valve replacement(DVR) through anterolateral minithoracotomy(RT) and partial upper hemistemotomy(PS) approaches. Methods: This was a retrospective, observational, cohort study of collected data on 30 patients undergoing dual mitral and aortic valve replacement between July 2009 and March 2018 at Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University. There were 10 male and 20 female patients, aging from 15 to 65 years with a mean age of(45.67±12.25) years. Of these, 8 were performed through right RT and 22 through PS. SPSS 23.0 was used to analysis gender, age, left ventricle ejection fraction, New York Heart Association class, perioperative complications, total operative duration, cardiopulmonary bypass duration, aortic cross clamp time, ICU monitoring time and postoperative hospital stay of the two groups. Results: Both groups successfully completed minimally invasive double-valve replacement surgery, without middle-opening thoracic surgery. Compared with PS group, patients in the RT group had longer aortic cross clamp time[(109.00±27.80)min vs.(81.23±14.10)min, P=0.026], cardiopulmonary bypass duration[(152.13±27.15)min vs.(129.55±26.36)min, P=0.049]and total operative duration[(4.81±0.77)h vs.(4.15±0.44)h, P=0.006]. In addition, the ICU monitoring time and postoperative hospital stay of patients in RT group were shorter than PS group[(24.63±11.55)h vs.(30.55±13.21)h; (5.50±0.93)day vs.(6.59±3.88)day] but there were no statistically significant(P=0.273; P=0.442). Conclusion Minimally invasive dual mitral and aortic valve replacement via RT and PS are both safe and effective. The incision of RT group is more concealed than the PS group as well as retaining sternal integrity. However, the total operative duration, cardiopulmonary bypass duration and aortic cross clamp time were longer than PS group and the requirements of the surgeon are higher. The PS group has a shorter operation time and does not change the habit of the surgeon. It is more suitable for the heart center that proposed to launch the minimally invasive dual mitral and aortic valve replacement.