Objective:Analyze the effect of intracardiac method and upturning method in the treatment of infracardiac total anomalous pulmonary venous connection(TAPVC), to explore the surgical method of infracardiac TAPVC.Methods:From July 2011 to August 2019, 20 patients with infracardiac TAPVC were treated, including 12 cases with upturning method and 8 cases with intracardiac method. The cardiopulmonary bypass time, aortic cross-clamp time, delayed thoracic closure, ICU time, mechanical ventilation time, postoperative days and anastomotic flow rate were compared between the two groups.Results:There was no significant difference in cardiopulmonary bypass time, aortic cross-clamp time, delayed thoracic closure, ICU time and mechanical ventilation time between the two groups. The postoperative hospital stay in upturning group was significantly lower than that in intracardiac group [(14.7±2.9)days vs.(16.1±6.2)days, P<0.05], and the postoperative anastomotic velocity > 120 cm/s in intracardiac group was significantly less than that in upturning group(1 case vs. 7 cases, P<0.05). Two patients died in upturning group, but there was no significant difference compared with the intracardiac group. Conclusion:There is no significant difference between the two methods in the treatment of subcardiac TAPVC. The authors think that the exposure of the upturning methods is difficult, and the distortion of the anastomosis may be hidden trouble. The in situ anastomosis of the intracardiac method is not easy to make mistakes.

Objective:To explore the therapeutic strategy and result of adult total anomalous pulmonary venous connection(TAPVC).Methods:From November 2011 to November 2019, 6 adult patients with TAPVC underwent surgical correction. The Darling types include 4 cases of supracardiac , 1 case of intracardiac and 1 case of mixed type. There were 1 male and 5 female. The mean age was(28.6±4.8) years old and the mean weight was(47.3±3.67) kg. Preoperative oxygen saturation was 0.91±0.05.Results:All patients underwent primary repair successfully without perioperative death and complications. The average cardiopulmonary bypass time was(122.0±35.9) min, and the aortic cross-clamp time was(78.2±20.4) min. The mean postoperative hospitalization was(9.7±2.9) days, and the mean intensive care unit time was(3.5±1.4) days.The mean mechanical ventilation was(17.1±2.9) h. There were no later left heart dysfunction and pulmonary vein obstruction during the follow-up of 6-100 months.no pulmonary artery hypertension was identifed.Conclusion:TAPVC can be repaired savely in adult and satisfied result can be anticipated.

Objective:To compare the surgical and long-term follow-up results of partial anomalous pulmonary vein connection treated by double-patch method or Warden Technique.Methods:There were 33 cases of right pulmonary vein connected with the superior vena cava from May 2010 to May 2019 in our center treated by double-patch method or Warden technique. 21 cases were treated by double-patch method and 12 cases by Warden technique. Echocardiography and electrocardiogram were followed up regularly to observe the occurrence of arrhythmia, superior vena cava stenosis and pulmonary vein stenosis postoperatively.Results:All patients were discharged uneventfully, and were followed up for 1~8 years. In double-patch group, 2 cases with arrhythmia, 1 of whom was junctional arrhythmia which was automatically converted to sinus rhythm 1 day after surgery. The other had an early second degree atrioventricular block after surgery, and sinus rhythm was restored 3 days later with temporary pacemaker. 1 case had superior vena cava stenosis by echocardiography(PD 8 mmHg). No arrhythmia was found in long-term follow-up in Warden group. 2 cases had superior vena cava stenosis by echocardiography(PD 6 mmHg). Right pulmonary vein stenosis(PD 8 mmHg) was found in 1 case by echocardiography, no obvious aggravation was found in long-term follow-up.Conclusion:The double-patch method and Warden Technique are both safe and effective in the treatment of partial anomalous pulmonary venous connection.

The authors attempted to use information technology in hierarchical management on clinician′s surgical authority. By means of a hierarchical surgery catalogue database, clinicians′ surgical authority is subject to by-level IT-based approval, and such authorities as clinician′s surgical medical advice, application for surgery, and approval of special surgeries are regulated. Thanks to multi-dimensional objective data, clinicians′surgical competence is subject to a dynamic evaluation, hierarchical authorization and reauthorization. These measures further standardize the behavior of the surgeons, and rule out unauthorized operations, thus improving fine management of surgeries and ensuring patient safety.

Objective To evaluate the clinical effect and safety of oxycodone hydrochloride in the anesthesia for percutaneous radiofrequency ablation (PRFA) in hepatocellular carcinoma.Methods Between March and December 2015,60 cases of hepatocellular carcinoma patients undergoing percutaneous radiofrequency ablation surgery in Peking University Cancer Hospital were randomly divided into three groups:oxycodone group (group Q),fentanyl group (group F) and dezocine group (group D),20 cases in each group.Respectively intravenously injection oxycodone 0.1 mg/kg,fentanyl 0.001 mg/kg,dezocine 0.1 mg/kg before surgery.After the surgeon completed puncture administer propofol to maintain anesthesia.Recorded mean arterial pressure (MAP),heart rate (HR),respiratory rate (RR),oxygen saturation (SpO2) changes in each group at entrance,beginning of radiofrequency ablation (T1),radiofrequency ablation began after 10 minutes (T2),the end of the surgical and awake.Observe the analgesia effect,respiratory depression,nausea,vomit and other complications.Postoperative pain scores were recorded.Using ANOVA,repeated measure variance analysis,SNK test,x2 test and other tests to evaluate the anesthetic effect indexes.Results The observation completed in all patients.Patients of three groups had no significant differences in general information.No significant difference between MAP,HR and SpO2 at each time points among the three groups.At the T1 time point (group Q:(11.7 ± 1.6)/min,group D:(12.1 ±l.7)/min,group F:(10.3 ±2.3)/min,F=5.068,P =0.009) and T2 time point (group Q:(11.9±1.3)/min,group D:(12.2±1.4)/min,group F:(1O.7±.1.3)/min,F=7.024,P=0.O02),RR in group F were lower than in group Q and group D.Pain visual analogue scores after waking (group Q:0.2 ±0.7,group D:O.3 ±0.7,group F:1.7 ± 1.5,F=12.981,P =0.000) and postoperative pain score of 1 hour (group Q:2.0 ± 0.9,group D:1.8 ± O.8,group F:4.3 ± 0.9,F =42.362,P =0.000) in the group Q and group D were significantly lower than in group F.The body movements in group Q and group D were significantly less than in group F (3 cases,3 cases,9 cases,x2 =6.400,P =0.041).Intraoperative respiratory depression in group Q and group D were lower than group F (3 cases,2 cases,9 cases,x2 =8.012,P =0.018).Conclusions Oxycodone hydrochloride can be used safely and effectively for radiofrequency ablation.It has favorable hemodynamic stability,lower incidence of respiratory depression,and advantage in terms of postoperative pain.

Objective To evaluate the clinical effect and safety of oxycodone hydrochloride in the anesthesia for percutaneous radiofrequency ablation (PRFA) in hepatocellular carcinoma.Methods Between March and December 2015,60 cases of hepatocellular carcinoma patients undergoing percutaneous radiofrequency ablation surgery in Peking University Cancer Hospital were randomly divided into three groups:oxycodone group (group Q),fentanyl group (group F) and dezocine group (group D),20 cases in each group.Respectively intravenously injection oxycodone 0.1 mg/kg,fentanyl 0.001 mg/kg,dezocine 0.1 mg/kg before surgery.After the surgeon completed puncture administer propofol to maintain anesthesia.Recorded mean arterial pressure (MAP),heart rate (HR),respiratory rate (RR),oxygen saturation (SpO2) changes in each group at entrance,beginning of radiofrequency ablation (T1),radiofrequency ablation began after 10 minutes (T2),the end of the surgical and awake.Observe the analgesia effect,respiratory depression,nausea,vomit and other complications.Postoperative pain scores were recorded.Using ANOVA,repeated measure variance analysis,SNK test,x2 test and other tests to evaluate the anesthetic effect indexes.Results The observation completed in all patients.Patients of three groups had no significant differences in general information.No significant difference between MAP,HR and SpO2 at each time points among the three groups.At the T1 time point (group Q:(11.7 ± 1.6)/min,group D:(12.1 ±l.7)/min,group F:(10.3 ±2.3)/min,F=5.068,P =0.009) and T2 time point (group Q:(11.9±1.3)/min,group D:(12.2±1.4)/min,group F:(1O.7±.1.3)/min,F=7.024,P=0.O02),RR in group F were lower than in group Q and group D.Pain visual analogue scores after waking (group Q:0.2 ±0.7,group D:O.3 ±0.7,group F:1.7 ± 1.5,F=12.981,P =0.000) and postoperative pain score of 1 hour (group Q:2.0 ± 0.9,group D:1.8 ± O.8,group F:4.3 ± 0.9,F =42.362,P =0.000) in the group Q and group D were significantly lower than in group F.The body movements in group Q and group D were significantly less than in group F (3 cases,3 cases,9 cases,x2 =6.400,P =0.041).Intraoperative respiratory depression in group Q and group D were lower than group F (3 cases,2 cases,9 cases,x2 =8.012,P =0.018).Conclusions Oxycodone hydrochloride can be used safely and effectively for radiofrequency ablation.It has favorable hemodynamic stability,lower incidence of respiratory depression,and advantage in terms of postoperative pain.

OBJECTIVETo analyze and summarize the clinical features and experience in surgical treatment of deep sternal infection (DSWI).

METHODSThis was a retrospective study. From January 2008 to December 2013, 189 patients with secondary DSWI after cardiac surgery underwent the pectoralis major muscle flap transposition in our department. There were 116 male and 73 female patients. The mean age was (54 ± 21) years, the body mass index was (26. 1 ± 1. 3) kg/m2. The incidence of postoperation DSWI were after isolated coronary artery bypass grafting (CABG) in 93 patients, after other heart surgery plus CABG in 13 patients, after valve surgery in 47 patients, after thoracic aortic surgery in 16 patients, after congenital heart disease in 18 patients, and after cardiac injury in 2 patients. Clean patients' wound and extract secretions, clear the infection thoroughly by surgery and select antibiotics based on susceptibility results, and then repair the wound with appropriate muscle flap, place drain tube with negative pressure. Of all the 189 patients, 184 used isolate pectoralis, 1 used isolate rectus, and 4 used pectoralis plus rectus.

RESULTSThe operative wounds of 179 patients were primary healing (94. 7%). Hospital discharge was postponed by 1 week for 7 patients, due to subcutaneous wound infection. Subcutaneous wound infection occurred again in 8 patients 1 week after hospital discharge, and their wounds healed after wound dressing. Nine patients (4. 7%) did not recover, due to residue of the sequestrum and costal chondritis, whom were later cured by undergoing a second treatment of debridement and pectoralis major muscle flap transposition. Eight patients died, in which 2 died of respiratory failure, 2 died of bacterial endocarditis with septicemia, 2 died of renal failure, 1 died of intraoperative bleeding leading to brain death and the 1 died of heart failure. The mortality rate was 4. 2% . The average length of postoperative hospital stay was (14 ± 5) days. The longest postoperative follow-up period was 40 months, the median time was 26 months, the follow-up rate was 83. 9% . Totally 179 patients were no-reinfected, 2 patients were reinfected because of artificial vascular rejection.

CONCLUSIONTo perform surgical debridement and then reconstruct the sternal defect with pectoralis major muscle flap actively for the patient is an effective measure to improve patient's survival rate.

Adult ; Aged ; Cardiac Surgical Procedures ; adverse effects ; Coronary Artery Bypass ; Debridement ; Female ; Heart Defects, Congenital ; Humans ; Incidence ; Length of Stay ; Male ; Middle Aged ; Pectoralis Muscles ; transplantation ; Postoperative Complications ; Postoperative Period ; Retrospective Studies ; Sternum ; surgery ; Surgical Flaps ; Surgical Wound Infection ; surgery ; Wound Healing

Objective To explore the clinical value of expression levels of serum COX-2 in patients with advanced NSCLC before and after EGFR-TKI treatment. Methods The serum was collected from 58 cases. Before and after targeted therapy , the serum COX-2 level was examined by ELISA. Meanwhile , CT scan was exercised to evaluate the treatment. Follow-up interview was done. The relationship among the change in expression level of serum COX-2 , efficacy and PFS was analyzed. Results The serum COX-2 level significantly decreased in the response group (t = 11.258, P = 0.000) and increased in the PD group (t = -7.759, P =0.000) after EGFR-TKI treatment, and not significantly changed in the SD group (t = 1.424, P = 0.170). Before treatment, the baseline serum COX-2 level in the response group was significantly higher than that in the SD group and the PD group (F = 20.852, P = 0.000 ). Before the targeted therapy, the higher the level of serum COX-2 was, the longer PFS patients would enjoy. Conclusion Detection of the serum COX-2 contributes to the judgment of therapeutic effect of EGFR-TKI and can be used as a prediction of EGFR-TKI drugs outcomes for patients with advanced NSCLC.

This article was aimed to study the relevance between traditional Chinese medicine ( TCM ) syndromes and the treatment of chemotherapy and targeted therapy , in order to provide theoretical support for TCM syndromes of lung cancer in the clinical application . Uniform TCM syndromes questionnaire was used in the TCM syndrome differentiation among lung cancer patients from the Oncology Department of Longhua Hospital, Shanghai University of Traditional Chinese Medicine and TCM Department of Shanghai Pulmonary Hospital. The analysis was made on correlation between distribution rules of TCM syndromes and chemotherapy and targeted therapy . The results showed that among primary lung cancer patients , the most TCM syndromes were syndrome of lung-yin deficiency , lung-q i deficiency , blood stasis in lung collaterals , spleen-q i deficiency , lung-yin deficiency with fire excess . There were certain correlation in TCM syndromes and different TCM therapeutic methods , in which targeted therapy had great significant effect on syndrome of lung-yin deficiency ( P < 0 . 05 ) , after targeted therapy syndrome of lung-yin deficiency increased obviously . It was concluded that there were some regulations in TCM syndromes of lung cancer which take syndrome of lung-yin deficiency, lung-qi deficiency, blood stasis in lung collaterals, spleen-qi deficiency, lung-yin deficiency with fire excess. There were certain correlation in TCM syndromes and different TCM therapeutic methods , after targeted therapy syndrome of lung-yin deficiency increased obviously .

Obj ective In the body of stereotactic radiotherapy ( SBRT ) , using Cone Beam is the matc-hing precision of soft tissue and bone anatomy ,translation between evaluation organization and internal organiza-tion in the rotation of the lung cancer patients with tumor location error ,location correction .Methods Applica-tion varian companies in the United States has the airborne imaging system clinac -ix linear accelerator apparatus treatment of 8 cases of lung cancer patients .By CBCT and SBRT comparison before and after the treatment for each patient and evaluate internal instant translation and rotation of the body of the patients with SBRT postures , tumor location and tumor center of baseline shift score changes .Results Based on the difference between of the anatomy of the bone and soft tissue match position is 3.0 mm(0~8.3 mm).The patient′s tumor location in 3-d median change is 1.4 mm(0~12.2 mm)and 12.2 mm(0~13.2 mm).The median baseline offset between 3 d score is 2.2 mm(0~4.7 mm).The rest of the system error and random error about 1 °.Conclusion In Lung cancer SBRT transformation to improve treatment of lung tumor process , change the position of tumor center is mainly affected by the body′s internal organization instant translation and rotation .