Objective To investigate the effects ofTiaogan Lipi Huaji Prescription combined with high intensity focused ultrasound (HIFU) for the treatment of locally advanced pancreatic cancer.Methods Randomized, parallel controlled study was designed to select 60 patients with locally advanced pancreatic cancer, which were divided into treatment group and control group by random number table method, 30 cases in each group. The treatment group was givenTiaogan Lipi Huaji Prescription, one dose per day, twice a day, orally, 28 d as a treatment course, 6 courses in total; at the same time, HIFU was given to the treatment group, 30–60 min each time, once every other day, 2–3 times each week, and the tumor was completely covered for 2 times. The control group was given gemcitabine 1000 mg/m2, intravenous infusion, 1st, 8th d, 21–28 d for a cycle, a total of 6 cycles. The clinical benefit response, QOL-C30 score, survival status, progression-free survival (PFS), CA199 and CEA levels were observed.Results Clinical benefit rates of treatment group and control group were: the treatment group 1, 3, 6 months clinical benefit rate was 64.29%, 63.16%, and 50.00%, respectively; control group clinical benefit rate was 48.15%, 40.00%, and 44.44%, respectively, with statistical significance (P<0.05). The difference of QOL-C30 score between the two groups at the same time wasstatistically significant (P<0.05). During the treatment 1 to 6 months, CA199 in the two groups showed a downward trend, without statistical significance (P>0.05). CEA levels in the treatment group were lower than those in the control group at the same time with statistical significance (P<0.05), except for 2 and 6 months. The survival rates of treatment of 3, 6, and 12 months in the treatment group were 82.14%, 46.42% and 32.14%, respectively, and were 96.67%, 59.32% and 37.04%, respectively in the control group, without statistical significance (P>0.05). The survival time of the treatment group was (253.90±18.06)d in the control group and (246.77±17.31)d in the control group, without statistical significance (P>0.05). PFS was (136.73±16.22)d in the treatment group and (145.77±19.74)d in the control group, without statistical significance (P>0.05).ConclusionTiaogan Lipi Huaji Prescription combined with HIFU for the treatment of locally advanced pancreatic cancer has certain clinical efficacy, which can improve patients' life quality.

Objective:To investigate the clinical significance of detecting Epstein Barr virus (EBV) infection in evaluating recent curative and long-term effects in patients with extranodal natural killer (NK)/T-cell lymphoma. Methods:The EBV-DNA copies in the plasma of 109 patients, who were pathologically and immunohistochemically diagnosed with extranodal natural killer/T-cell lymphoma in the First Affiliated Hospital of Zhengzhou University between January 2011 and April 2014, were monitored via quantitative re-al-time polymerase chain reaction. Subsequently, the difference in recent curative and long-term effects between EBV positive and EBV negative patients was compared. Results:Among the 109 patients with extranodal NK/T-cell lymphoma, 34 (64.2%) cases of EBV posi-tive patients were at the advanced stage (Ⅲ~Ⅳ stages), and 22 (39.3%) cases of EBV negative patients were at the terminal stage (Ⅲ~Ⅳstages). EBV positive patients who accompanied by B symptoms were 33 (62.3%) , and there were 21 (37.5%) cases with B symptoms in EBV negative patients, the differences between stages and B symptoms were statistically significant. The attained objec-tive response rate of the EBV-DNA negative patients (34, 60.7%) was significantly higher than that of the EBV-DNA positive patients (22, 41.5%) (P<0.05). Similarly, the 2-year progression-free survival (PFS) rate of EBV negative patients was better than that of EBV positive patients (P<0.05). Conclusion:Detecting EBV in plasma has clinical significance in evaluating the recent curative effect and the 2-year PFS rate in patients diagnosed with extranodal NK/T-cell lymphoma.

Objective To investigate the influencing factors of quality of shear wave elastography (SWE) image and the reproducibility of using SWE for focal liver lesions .Methods A total number of 289 consecutive patients with 305 lesions (the lesions could be detected on baseline ultrasound with intercostals approach ,and the depth of lesion was less than 10 cm) were undergone SWE examination .The SWE values of both lesion and adjacent liver parenchyma were measured .The quality of images was classified into three grades:“Good” ,“Common” ,and “Poor” .The depth of lesion ,the distance from body surface to liver capsule ,diameter and location of lesion were compared among three groups .Twenty consecutive patients with 20 lesions were performed SWE by two operators and another 20 consecutive patients with 20 lesions were performed SWE by one operator at different time .Intra‐class correlation coefficient was used to evaluate the reproducibility of inter‐ and intra‐ observer .Results A total number of 179 lesions were“Good” ,107“Common” and 19 “Poor” .The distance from body surface to liver capsule was significantly different among three groups [(Good (1 3.4 ± 0 3.5)cm ,Common (1 6.3 ± 0 3.6)cm ,Poor (1 8.7 ± 0 3.9)cm , P < 0 0.01] .No significant difference was found for the depth ,diameter and location of lesions among three groups .For all parameters of SWE both lesion and adjacent parenchyma ,intra‐class correlation coefficient of inter‐and intra‐observer were higher than 0 7.5 .The reproducibility of max SWE value was best of four elasticity parameters for lesion ,which intra‐class correlation coefficient of inter‐and intra‐observer was 0 9.0 and 0 9.6 ,respectively .Conclusions For focal liver lesions which could be detected on baseline ultrasound and the depth of lesions was less than 10 cm ,SWE could be used to evaluate elasticity characteristics with good feasibility and reproducibility .

Objective To investigate the value of shear wave elastography (SWE) and quasi-static elastography in the evaluation of radiofrequency ablation of pork.Methods Twelve pieces of fresh pork were underwent radiofrequency ablation (RFA) with different target temperatures.Before and after RFA,conventional ultrasound (US),SWE and quasi-static elastography were conducted to visualize the boundaries of RFA zones.The size of ablation zones obtained from conventional ultrasound,SWE and quasi-static elastography measurement were observed and detected the correlativity with pathology findings.Moreover,the Young's modulus and stain ratio of ablated zone were recorded.Results Most ablated boundaries were clearly delineated by both elastography techniques,except one with a low target temperature of 70 ℃.The sizes of ablated zones measured by SWE and quasi-static elastography were closely correlated with pathological findings.However,no ablated zones could be visualized by conventional US.Before and after RFA,the mean,minimum and maximum values of Young's modulus were (24.2 ± 3.8) kPa vs (97.6 ± 29.1) kPa,(9.2 ± 0.7)kPa vs (44.5 ± 7.7)kPa and (29.9 ± 3.8)kPa vs (181.5 ± 36.7)kPa,respectively (all P ＜0.001).With the increase of target temperature of RFA,the Young's modulus values and the mean strain ratio were significantly increased (all P ＜ 0.01).Conclusions Both SWE and quasi-static elastography are useful tools for evaluating the ablation,which are superior to conventional US.Moreover,SWE can be used to monitor the procedure of ablation.

Objective: To examine the short-term outcomes of minimally invasive reoperation for severe tricuspid regurgitation after left-sided valve surgery. Methods: From January 2015 to December 2018, a total of 89 patients with severe tricuspid regurgitation after left-sided valve surgery received reoperation in Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University were included in this study. There were 21 males and 68 females, aging of (56.4±7.9) years (range: 41 to 74 years). The interval between previous left-sided valve surgery and tricuspid reoperation was (14.1±6.1) years (range: 4 to 33 years). A combination of multiple minimally invasive techniques were adopted, including endoscopy-assist right minithoracotomy approach, peripheral cannulation strategy with the vacuum-assist single venous drainage technique, heart beating technique, and temporary percutaneous pacemaker implantation, with a concomitant enhancement in preoperative right cardiac function optimization. Results: All patients received minimally invasive isolated tricuspid valve replacement (n=81) or tricuspid valve repair (n=8). After the application of multiple minimally invasive techniques, the operative mortality rate was only 3.4% (3/89). The causes of death were progressive right heart failure with multiorgan failure (n=1) and low cardiac output associated with postoperative bleeding (n=2). Regarding to the perioperative complications, renal replacement therapy rate was 5.6% (5/89), permanent pacemaker implantation rate was 1.1% (1/89), and the incidence of stroke was 0. Mechanical ventilation time was 24(24) hours, ICU stay time was 2.5 (3.0) days (M(Q_R)). During the short-term follow-up, there were no case of severe tricuspid regurgitation, 2 cases of moderate regurgitation, 4 cases of mild-to-moderate regurgitation. Conclusions For severe tricuspid regurgitation after left-sided valve surgery, the advanced minimally invasive techniques can significantly reduce the operative mortality and morbidity. Minimally invasive bioprosthetic tricuspid valve replacement is a reliable alternative for severe tricuspid regurgitation after left-sided valve surgery.

Late tricuspid regurgitation after left-sided valve surgery can negatively affect long-term prognosis. The surgical timing and strategy of tricuspid valve reoperation will have important impact on the surgical outcomes. However, there is no clear recommendations of the surgical timing for this condition in the current guidelines. Generally, tricuspid valve reoperation should be performed before irreversible right heart failure occurs. Although tricuspid valve repair is the first choice for tricuspid regurgitation, bioprosthetic tricuspid valve replacement might be a reliable alternative when tricuspid leaflets have severe rheumatic damage or right ventricle and tricuspid annulus significantly dilate. Combined minimally invasive surgical techniques, including right minithoracotomy approach, accessing the right atrium directly through the pericardium with limited dissection, peripheral cannulation strategy with the vacuum-assist single venous drainage technique and heart beating technique, can significantly decrease the operative mortality and postoperative bleeding. With development of interventional therapy, transcatheter tricuspid valve repair or replacement may become alternatives for tricuspid regurgitation after left-sided valve surgery in the future.

Objective To investigate the influencing factors of quality in contrast-enhanced ultrasound (CEUS) perfusion analysis for hepatocellular carcinoma (HCC) and the reproducibility of using CEUS perfusion analysis on HCC.Methods A total of 136 HCC lesions were undergone CEUS perfusion analysis.Maximum intensity (Imax),rise time (RT),time to peak (TTP),mean transit time (mTF) and quality of fit (QOF) of HCC lesion,top-enhanced region inside HCC lesion and adjacent liver parenchyma were measured.The quality of perfusion analysis was classified into three grades " Good" (QOF ＞ 75％),"Common" [QOF (50％-75％)],and " Poor" (QOF ＜ 75％).Ultrasound machine,patients' age,tumor depth,tumor size and tumor location were recorded and compared among the three groups.20 consecutive patients with 20 HCC lesions were received CEUS perfusion analysis by two operators and another 20 consecutive HCC lesions were received CEUS perfusion analysis by one operator at different time.Intra-class correlation coefficient (ICC) was used to evaluate the reproducibility of inter-and intra-observer.Results Fifty-six HCC lesions were classified as " Good",39 as " Common" and 39 as " Poor",respectively.Tumor size (P =0.015) and tumor location (P =0.041) were significantly different among the three groups.Tumor size ＞ 3.0 cm and tumor located in S3,S4b,S5,S6 were apt to gain a better QOF.No significant difference was found for the different ultrasound machine,tumor depth and patients' age.For all CEUS perfusion analysis parameters of both lesion and adjacent parenchyma,intra-class correlation coefficient of inter-and intra-observer were higher than 0.90,the reproducibility of CEUS perfusion analysis was good.For Imax,RT and TTP in top-enhanced region inside HCC lesion,ICC of inter-and intra-observer was all higher than 0.90 (good).For mITT in highest enhanced area inside HCC lesion,ICC of inter-and intra-observer were 0.459 (poor),0.609 (common),respectively.Conclusions The parameters of HCC quantitative perfusion analysis were reproducible in peripheral liver parenchyma and tumor,but the mTT repeatability was poor in the highest enhancement area of the tumor.The size and location of the lesion were the factors affecting quantitative analysis.The quantitative analysis of ＞ 3.0 cm and the tumor located in S3,S4b,S5,S6 in the liver were satisfactory.

The development of human organ transplantation technology has brought the hope of rebirth to countless patients with organ failure. Human organ donation and transplantation need the joint efforts of various levels of Red Cross societies, human organ procurement organizations, medical institutions, etc. Medical social workers, as new forces, are gradually playing their own role. By summarizing the professional advantages of medical social work in organ donation after citizen’s death, this paper proposed that medical social workers can provide professional services for donors and their families through practical work, such as clarifying their willingness to donate and providing crisis intervention services to their families, assisting them in completing donation matters and holding farewell ceremonies, and following up and carrying out grief counseling activities. Regarding the problems encountered in practice process, suggestions were proposed to expand the scale of medical social workers and improve their management, increase social awareness of medical social work, and provide all-round support for the implementation of later service.

Medicine is essentially an anthropology, and the patient role is characterized by integrity and subjectivity. With the progress of science and technology and social development, the contemporary patient role has become alienated. The specific manifestations of patient role alienation were analyzed from four aspects, including the objectification of the patient role and the blurring of the patient boundaries in sociology, the objectification of the patient role and the indexing of patients’ pain in technology, the challenge of patient life and health rights and the alienation of informed consent rights in law, and the instrumentalization of patient role and the fragility of patient subjectivity in economics. This paper proposed that the coordination of technology and humanities, the return to the nature of patients, and the concern for the needs of patients are essential in the development of modern medicine.

Objective    To discuss the feasibility of establishment of animal model of "functional" bicuspid aortic valve with swine and observe its effect on the wall shear stress inside the aorta. Methods    Four common Shanghai White Swine with body weight between 50 kg to 55 kg were selected. Under general anesthesia and cardiopulmonary bypass, the aortic transverse incision approach was used, continuous suture with 6-0 polypropylene to align the left and right coronary valve leaflets to create a bicuspid valve morphology. After the operation, echocardiography was used to observe the aortic valve morphology and the hemodynamic changes of the aortic valve orifice. The effect on the wall shear stress inside the aorta was studied with 4D-Flow magnetic resonance imaging (MRI). Results    A total of 4 swine "functional" bicuspid aortic valve models were established, with a success rate of 100.0%. Echocardiography showed that the blood flow velocity of the aortic valve orifice was faster than that before the operation (0.96 m/s vs. 1.80 m/s). 4D-Flow MRI showed abnormally increased wall shear stress and blood flow velocity in the aorta of the animal models. After the surgery, in model animals, the maximal wall shear stress inside the ascending aorta was greater than 1.36 Pa, and the maximum blood flow velocity was greater than 1.4 m/s. Conclusion    Establishment of the animal model of "functional" bicuspid aortic valve in swine is feasible, scientific and reliable. It can be used in researches on evaluating the pathophysiological changes.