Pulmonary electrical impedance tomography (EIT), a noninvasive, continuous, dynamic, and radiation-free bedside imaging technique for monitoring pulmonary ventilation, is now widely utilized in the diagnosis and management of critically ill patients. Beyond ventilation monitoring, hypertonic saline contrast-enhanced EIT for bedside pulmonary perfusion assessment has recently garnered significant attention. This article describes the application of hypertonic saline contrast-enhanced EIT to evaluate pulmonary perfusion in two patients following pulmonary endarterectomy, providing a reference for its perioperative application in such patients.

Oral mucosal melanoma (OMM), a subtype of melanoma which is commonly found in the eastern Asian populations, progresses with unclear pathogenesis, high malignancy and poor prognosis. Constructing different types of preclinical models for OMM, which simulate clinical characteristics such as tumor invasion and metastasis, assists screening and efficacy-evaluation of drugs. This would promote personalized treatments for patients with OMM. However, lack of preclinical models makes one of the critical obstacles that hinder the recognition of mucosal melanoma and block the treatment breakthrough in mucosal melanoma. In recent years, certain progress has been made in the construction and application of OMM preclinical models. Various OMM preclinical models have been successfully constructed and carried out for further research, assisting in excavating personalized treatment strategies. In this review, we will summarize the latest progress in the researches on OMM preclinical models.

As the national key discipline and the initiator of oral and maxillofacial deformity group, the Department of Oral and Maxillofacial Surgery persisted in teaching, designed a novel teaching form combining theoretical knowledge and online software practice according to the characteristics of our discipline and carried out "cloud training" via the National Oral Telemedicine Education Platform. Ten lecturers, 325 theoretical students and 50 practical students were investigated by questionnaire in the present study with questions focusing on the geographical distribution and composition of personnel, etc. The results showed that the online course covered a wide range of students and achieved high acceptance and satisfaction rate. The first online software operation course was conducted in an orderly manner, with timely interaction between teachers and students. The students were able to master the design process skillfully. This "cloud training" has achieved good results, but there are still a series of problems that have yet to be resolved, such as network stalls and protection of intellectual property rights. Under the new form, the exploration and analysis of the new mode of online telemedicine specialist education will provide some practical reference for the National Clinical Research Center for Oral Diseases to carry out online telemedicine teaching in the future.

Objective To study the clinical features of intraductal papillary mucinous neoplasm of the biliary tract (BT-IPMN) and to analyse the diagnostic and surgical patterns.Method The data of 19 patients with BT-IPMN admitted from Jun.2012 to Jul.2016 were retrospectively analyzed.Results These 19 (2.3％) patients with BT-IPMN came from 815 patients with biliary tract tumors who were treated in our institution.There were 9 males and 10 females.The male to female ratio was 1.0∶ 1.1.The mean age was 60.6 ± 12.9 years with a range from 25 to 78 years.Jaundice (in 10 patients) and abdominal discomfort (in 6 patients) were the most common presenting symptoms.Bile duct dilatation and intraluminal mass were typical preoperative imaging findings.All these 19 patients were diagnosed to have BT-IPMN histopathologically.18 patients underwent surgery in our hospital.Left lateral hepatic sectionectomy or left hepatectomy was performed in 8 patients,pancreaticoduodenectomy in 6,local excision of bile duct and cholangiojejunostomy in 3 and central hepatectomy in 1.The average operating time was 280 minutes and the average amount of intra-operative bleeding was 515 ml.Fourteen patients underwent regional lymph node dissection and 3 positive lymph nodes were detected out of 94 resected lymph nodes.Sixteen patients were followed up from 1 to 51 months with a mean of (25.7 ± 19.5) months.Fourteen of these patients were still surviving.Two patients died 3 and 17 months after operation due to the tumor.Conclusions Intraductal papillary mucinous neoplasm of the biliary tract was very rare.Early diagnosis was not easy.There was a low percentage of lymphatic metastasis.Surgery was the first choice of treatment and complete resection of BT-IPMN was associated with good long-term survival.

Objective To summarize the treatment of 10 aortic coarctation cases ,who receive the surgery from ascending aorta to thoracic descending aorta with the prosthetic graft, discuss the valuable and appliable of this method. Methods Cardiac surgery, Chinese Acdemy of Medical Sciences, Peking Union Medical College Hospital department treated 10 patients who got the aortic coarctation from Jan. 2006 to Dec. 2015 Seven male patients and 3 cases of female patients consist of the sample, aged from 14 to 35 years old, the median age was 27. One cases consolidated aortic valve deformity and aortic root expansion, the others were simple aortic coarctation. Their upper limbs blood pressure was 20 mmHg higher compared with the low limb. Meanwhile, there was no sign of surgery contraindication. Ten cases received this operation under cardiopulmonary bypass situation. And the patient who consolidate aortic valve deformity and aortic root expansion receive the Bentall surgery at the same time. Results There was no death during perioperative time, no spinal cord ischemic and other serious complications. Those patients went back to outpatient department after discharging from hospital 3 to 6 months. The differential pressure between upperlimbs and low limbs were less than 20 mmHg, and the CTA results indicated no aneurysms. Conclusion Using artificial blood vessels to make a graft from the ascending aorta to the descending aorta is an effective method for treatment of thoracic aorta.

Objective To establish an assay for detecting α2-macroglobulin activity in Cohn fraction Ⅳ.Methodsα2-M reacted with trypsin to form α2-M-trypsin complex.After the chromogenic substrate Na-benzoyl-DL-arginine 4-nitroanilide hydrochloride ( BAPNA) was added, absorption at 410 nm was detected with the microplate reader .α2-M activity in Cohn fractionⅣwas quantitatively detected according to the established standard curve of plasma α2-M activity. Result Several critical parameters in this assay were optimized .A standard curve of plasma α2-M activity was established . According to this standard curve ,α2-M activity in Cohn fraction Ⅳsample was detected to be 1.578 PU/ml.Conclusion Using normal human plasma as the reference material , theα2-M activity in Cohn fractionⅣcan be detected through chro-mogenic substrate assay.This study provides a simple method to detect α2-M activity during the purification process of α2-M from Cohn fraction Ⅳ.

Objective To systemically assess impact on postoperative outcomes after red blood cell transfusion(RBCT) in coronary artery bypass graft surgey.Methods A meta-analysis was performed on the comparison and synthesis of findings from included studies published from January 1980 to January 2014.Pooled odds ratio(OR) and 95 ％ confidence interval(CI) were calculated using RevManS.3 software.Sensitivity analysis was conducted and possible publication bias was tested as well.Results Seven retrospective studies including 71 228 patients(33 872 RBCT cases,37 356 control cases) were eligible for inclusion.The pooled analysis revealed difference in the 30-day mortality OR =1.85 (95％ CI:1.35-2.54),1-year mortality OR =2.02 (95 ％ CI:1.44-2.84),shock OR =2.92 (95 ％ CI:1.96-4.35),renal dysfunction OR =7.67 (95 ％ CI:1.44-40.94),mediastinitis OR =2.26 (95 ％ CI:1.72-2.97),and myocardial infarction OR =3.53 (95 ％ CI:2.89-4.29).Conclusion Perioperative RBCT can incresase the risk of postoperative mortality and complications in coronary artery bypass graft surgey.High-quality randomized case cohort studies are still needed for the further proof of the risk.

Objective To explore a method to culture human aortic valvular interstitial cells and identify the phenotypes,to establish the cell model which would be used to study aortic valve diseases in vitro.Methods Normal aortic valves of the patient with acute Stanford A aortic dissection in Peking Union Medical College Hospital were preserved during the surgical operation.Human aortic valvular interstitial cells were isolated and amplified in vitro by modified collagenase digestion method.The cell phenotype was identified by the immunofluorescent staining.Results Human aortic valvular interstitial cells could be successfully isolated and amplified in vitro by modified collagenase digestion method,identified by positive staining of Vimention and α-SMA.Conclusions The cell model of human aortic valvular interstitial ceils could be successfully established in vitro by modified collagenase digestion method.The cell phenotype identification proved to meet the experimental requirements.So it could provide cellular foundations for the study of pathogenesis of degenerative aortic valve disease.

Inferior vena caval (IVC) tumor thrombus with cardiac extension is a very rare phenomenon,which proliferates fast and could be very challenging to the surgery.This paper was designed to investigate the clinical value of transesophageal echocardiography (TEE) for the surgical resection of IVC tumor thrombus extending into right cardiac cavities.Six cases from our medical institute,preoperatively diagnosed as IVC tumor thrombus with cardiac extension and scheduled for the surgical resection,were retrospectively analyzed.In addition to real-time and dynamic monitoring,comprehensive TEE exams were performed for all the patients respectively after anesthesia induction,namely before tumor resection and after tumor resection.Cardiac extension was defined by the preoperative finding of cardiac mass originated from IVC tumor thrombus by transthoracic echocardiography,computerized tomography or CT angiography.In all the cases,intraoperative TEE provided an accurate and excellent view of the IVC tumor thrombus.For case three,the IVC tumor thrombus was found at the IVC entrance to right atrium without further cardiac extension; for case five,the IVC tumor thrombus proliferated into right atrium but the extended cardiac mass was very slim and flexible and the tricuspid valve was untouched; for case four,the IVC tumor thrombus extended into right atrium and even cross the tricuspid valve but the extended cardiac mass was also very slim and flexible.Based on the TEE-provided information,the originally scheduled surgical decision was modified and the surgical resection was performed without cardiopulmonary bypass (CPB).For the other three cases,the intraoperative TEE showed similar results to preoperative findings.The huge IVC tumor thrombus extended into the right heart,presented almost no flexibility and dramatically compromised the intracardiac blood flow.For the three cases,CPB support was indispensable for the tumor resection.The full TEE exam after tumor resection in all the six patients displayed clear surgical resection without tumor residuals,but in those three patients suffered with severely compromised cardiac extension,severe tricuspid regurgitation was noticed.All the six patients were closely monitored until discharged,and no TEE-related complications were observed.This paper reports about TEE' s utilization in a series of consecutive patients undergoing surgical resection of IVC tumor thrombus with cardiac extension.In addition to its safety and effectiveness,TEE can provide valuable information for surgical decision making,surgical intervention assessment and anesthesiamanagement strategies.

Objective To investigate the feasibility of treating ischemic heart disease with transplantation of marrow mesenchymal stem cells.Methods Marrow mesenchymal stem cells were collected from New Zealand rabbit's sternum and cultured.A myocardial infarction model was created by ligation of the distal left anterior descending artery in New Zealand rabbit.MSCs were injected into the region of myocardial infarction.The size of the myocardial infarction area was measured by PET and the cardiac function was assessed by measuring the pressure change of left ventricle(dp/dt).Results The size of the myocardial infarction area diminished and the cardiac function was improved after the transplantation of marrow mesenchymal stem cells.Conclusion Transplantation marrow mesenchymal stem cells may improve cardiac function of ischemic heart disease in animal model of New Zealand rabbit.