In February, 2019, a patient with a defect of open dorsal cartilage and bone in the first metatarsal head, including the defects of soft tissue, tendon and joint capsule, was treated in our department. After multiple debridement, the vascularised medial femoral condyle osteochondral chimeric tissue flap was transferred to repair the composite tissue defect in the metatarsal head at the second stage. After 18 months of follow-up, the patient felt no pain in the foot and walking, and there was no sign of lameness and discomfort at donor sites. The postoperative functional recovery was satisfactory.

Objective    To summarize the experience of totally thoracoscopic cardiac surgery for ventricular septal defect. Methods    Clinical data of 449 patients undergoing totally thoracoscopic cardiac surgery for ventricular septal defect from May 2008 to December 2018 in Shanghai Yodak Cardiothoracic Hospital were analyzed retrospectively. There were 232 male and 217 female patients, aged from 3 to 55 years with a mean age of 17.3±11.2 years. Results    All the operations were completed successfully. Mean operative time was 2.4±0.3 h. The mean extracorporeal circulation time and aortic cross-clamp time was 64.2±11.6 min and 28.4±10.7 min, respectively. Mechanical ventilation time and intensive care unit stay was 6.9±3.8 h and 20.5±5.6 h, respectively. Postoperation drainage quantity was 213.1±117.2 mL. The hospital stay was 6.9±1.3 d. Intraoperative and postoperative complications occurred in 11 patients (2.4%), including 1 patient of intraoperative reoperation, 3 patients of reoperation for bleeding, 3 patients of the incision infection, 2 patients of small residual shunt, 1 patient of right femoral artery incision stenosis complicated by thromboembolism and 1 patient of right pleural cavity pneumothorax. The mean follow-up time was 72.2±33.9 months. During the period, there was no reoperation, but 2 patients of ventricular septal defect small residual shunt, 1 patient of mild-moderate mitral valve and 1 patient of mild-moderate aortic valve incompetence, respectively. During the period, heart function of the patients was NYHAⅠ-Ⅱ. Conclusion    Totally thoracoscopic cardiac surgery for ventricular septal defect is a safe and effective treatment, with few serious complications, fast recovery for patients and good short to medium-term outcomes.

Objective    To summarize the experience of totally thoracoscopic cardiac surgery (TTCS) for atrial septal defect. Methods    Clinical data of 442 patients undergoing TTCS for atrial septal defect from May 2008 to December 2018 in Shanghai Yodak Cardiothoracic Hospital was analyzed retrospectively. There were 149 male and 293 female patients, aged 3-74 (29.1±14.3) years. Surgical procedures were performed through 3 ports at the right chest wall. Results    All the operations were completed successfully. Mean operative time was 1.5-4.6 (2.2±0.3) h. The mean extracorporeal circulation and aortic cross-clamp time was 28-118 (55.9±13.3) min and 8-78 (21.5±10.2) min, respectively. Mechanical ventilation and intensive care unit stay time was 3.5-122.0 (8.1±7.4) h and 13-141 (20.7±10.2) h, respectively. Postoperation drainage volume was 70-1 280 (251.8±131.5) mL. The hospital stay was 4-16 (7.1±1.4) d. Intraoperative and postoperative complications occurred in 15 patients (3.3%). The mean follow-up time was 1-128 (67.6±33.3) months, and during the period, there were 25 patients of atrial fibrillation, 25 patients of mild-moderate tricuspid valve incompetence, 1 patient of moderate tricuspid valve incompetence. There was no reoperation or residual shunt during the period of follow-up. And the heart function was improved. Conclusion    TTCS is a feasible, safe and minimal invasive approach for patients with atrial septal defect and has good short to medium-term outcomes.

Objective To summarize the clinical outcome of totally thoracoscopic cardiac surgery for mitral valve replacement.Methods Clinical data of 634 cases undergoing totally thoracoscopic cardiac surgery for mitral valve replacement from May 2004 to February 2016 in Department of Thoracoscopic Cardiacsurgery,Shanghai Yodak Cardiothoracic Hospital was analyzed retrospectively.There were 292 male and 342 female patients,aged from 17 to 68 years with a mean of(45±13)years.All the 634 patients had moderate-severe mitral valve stenosis and(or)incompetence,263 patients had moderate-severe tricuspid valve incompetence,356 patients had atrial fibrillation,46 patients had left atrium thrombosis.Cardiopulmonary bypass was established with right femoral artery and a single 2 stage venus cannula in the right atrium.The ascending aorta was cross-clamped and the myocardium was protected by coronary perfusion with cold crystalloid cardioplegia.Totally thoracoscopic mitral valve replacement were performed.Results Thirteen cases had incision expanded and 8 cases had conversions to sternotomy.Cardiopulmonary bypass and aortic cross-clamp time were(89±18)minutes and(51±12)minutes,respectively.Operation time was(3.1±1.2)hours.Mechanical ventilation time and intensive care unit stay were(17±6)hours and(27±8)hours,respectively.Postoperation drainage quantity was(390±70)ml.The hospital days was(9.2±2.1)days.There were 5 cases in-hospital deaths.Postoperative complications occurred in 42 cases(6.6％),including 18 cases of right hemoneumothorax,12 cases of reoperation for bleeding,3 cases of perivalvular leakage(reoperation was done in 1 patient),3 cases of low cardiac output syndrome,2 cases of acute renal failure,2 cases of inferior vena cava injury,1 case of right femoral artery thrombosis and liver injury,respectively.The mean duration of follow-up was(58±9)months in 608 cases,with a follow-up rate of 96.7％(608/629).Three patients had died during the period of follow-up caused by congestive heart failure(2 patients)and stroke(1 patient).Late complication among 605 survivors were 37 cases,including 32 cases of moderate tricuspid valve insufficiency,3 cases of stroke,1 case of perivalvular leakage and infective endocarditis,respectively.There was no reoperation during the period of follow-up.Conclusion Totally thoracoscopic cardiac surgery for mitral valve replacement is safe and effective,with unique superiority and clinical feasible.

Objective To summarize the clinical outcome of totally thoracoscopic cardiac surgery for mitral valve replacement.Methods Clinical data of 634 cases undergoing totally thoracoscopic cardiac surgery for mitral valve replacement from May 2004 to February 2016 in Department of Thoracoscopic Cardiacsurgery,Shanghai Yodak Cardiothoracic Hospital was analyzed retrospectively.There were 292 male and 342 female patients,aged from 17 to 68 years with a mean of(45±13)years.All the 634 patients had moderate-severe mitral valve stenosis and(or)incompetence,263 patients had moderate-severe tricuspid valve incompetence,356 patients had atrial fibrillation,46 patients had left atrium thrombosis.Cardiopulmonary bypass was established with right femoral artery and a single 2 stage venus cannula in the right atrium.The ascending aorta was cross-clamped and the myocardium was protected by coronary perfusion with cold crystalloid cardioplegia.Totally thoracoscopic mitral valve replacement were performed.Results Thirteen cases had incision expanded and 8 cases had conversions to sternotomy.Cardiopulmonary bypass and aortic cross-clamp time were(89±18)minutes and(51±12)minutes,respectively.Operation time was(3.1±1.2)hours.Mechanical ventilation time and intensive care unit stay were(17±6)hours and(27±8)hours,respectively.Postoperation drainage quantity was(390±70)ml.The hospital days was(9.2±2.1)days.There were 5 cases in-hospital deaths.Postoperative complications occurred in 42 cases(6.6％),including 18 cases of right hemoneumothorax,12 cases of reoperation for bleeding,3 cases of perivalvular leakage(reoperation was done in 1 patient),3 cases of low cardiac output syndrome,2 cases of acute renal failure,2 cases of inferior vena cava injury,1 case of right femoral artery thrombosis and liver injury,respectively.The mean duration of follow-up was(58±9)months in 608 cases,with a follow-up rate of 96.7％(608/629).Three patients had died during the period of follow-up caused by congestive heart failure(2 patients)and stroke(1 patient).Late complication among 605 survivors were 37 cases,including 32 cases of moderate tricuspid valve insufficiency,3 cases of stroke,1 case of perivalvular leakage and infective endocarditis,respectively.There was no reoperation during the period of follow-up.Conclusion Totally thoracoscopic cardiac surgery for mitral valve replacement is safe and effective,with unique superiority and clinical feasible.

In subclinical diabetic nephropathy with glomerular hyperfiltration,the renal size parameters are increased significantly,and this change sets in as early as before the appearance of microalbuminuria.The average kidney length discriminator value for glomerular hyperfiltration by receiver operating characteristic (ROC) curve analysis is 10.53 cm,with the best sensitivity,higher specificity and total coincidence rate,and can be a clinical indicator for screening early diabetic nephropathy with glomerular hyperfiltration.

ObjectiveThis paper reported our experience with thoracoscopic management of isolated atrial fibrillation to define the efficacy and safety of this approach.MethodsThirtytwo patients ( 17 mem,15 women) with isolated atrial fibrillation underwent thoracoscopic surgery.All procedures were finished under 3 port incisions on left posterior chest.Among them 18 cases are paroxysmal and 8 persistent.ResultsThere was no operative death or major perioperative complications.One case was converted to limited thoracotomy because of bleeding.Operation time was 87 - 238 min.Paroxysmal atrial fibrillation occurred in 9 cases in hospital and all the cases were sinus rhythm after discharge.Followup 4 to 20 months,One persistent case was converted paroxysmal.ConclusionPatients with isolated atrial fibrillation can benefited by Videoassisted thoracoscopic left posterior approach with better exposure of left atrial and resection of the left atrial appendage,with decreased operative trauma and better results.

ObjectiveTo summarize the clinical results of totally thoracoscopic cardiac surgery for mitral valve diseases.MethodsFrom May 2004 to October 2011,272 patients underwent totally thoracoscopic cardiac surgery for mitral valve diseases through three ports.Summarize the indication and contraindication are used and for the operation date.Results There was 1 case in-hospital deaths.The time of operations was 2.1 ～ 3.9 (3.0 ± 1.2 ) h.Time of cardiopulmonary bypass and aortic cross-clamp was 76 ～ 158 (98 ± 22) minites and 38 ～ 78 (52 ± 13 ) minites.Time of mechanical ventilation and intensive care unit stay was 5.8 ～ 34.5 ( 11.2 ± 3.6 ) hours and 14 ～ 67 ( 28.2 ± 7.6 ) hours.The volume of drainage was 20 ～ 1200(370 ± 80) ml.The hospital days were 7 ～ 18 ( 10.2 ± 2.1 ) days.The postoperative complications occurred in 14 cases.ConclusionTotally thoracoscopic cardiac surgery for mitral valve diseases is technically feasible and safe with less drainage and shortened hospital stay.

AIM:To put forward three-level design(Box-Behnken design)for fitting response surfaces to optimize the extraction technology of total flavonoids from Hypericum ascyron L.METHODS:Four factors,including temperature,reflux time,concentration of ethanol,ratio of solvent to raw material were used to examine the yield of total flavonoids.Prediction was carried out through comparing the observed and predicted values.RESULTS:The results suggested that ethanol concentration and extraction temperature were two statistically significant factors.The optimum conditions of extraction process consisted of the ratio(mL:g)of solvent to material(13.3:1),ethanol concentration(53.2%),extraction temperature(78.7℃)and extraction time(2.3h).Regression coefficient of binomial fitting complex model was as high as 0.984 6.Bias between observed and predicted values was-4.01%.CONCLUSION:Box-Behnken design is success in optimizing the extaction in close agreement with the predicted values of the mathematic model.

Objective To summarize surgical experience of eight patients with pentalogy of Cantrell. Methods Six male and two female patients with pentalogy of Cantrell,aged from 4 months to 26 years old, average 7.35 years old, underwent surgical therapy for intracardiac anomalies and extracardiac anomalies from July 2007 to June 2009. Eight case with intracardiac anomalies include one case with only VSD, one case with only ASD, two cases with DORV, four cases with VSD and ASD or PTO. Experts majoring in cardiovascular surgery cooperated with doctors majoring in thoracic surgery and general surgery for satisfactory correction of intracardiac anomalies and extracardiac anomalies and repositioning heart to thoracic cavity. Results Ectopic heart of the first patient was simply repositioned into thoracic cavity following surgery of double outlet of right ventricle in another hospital two years before. Correction of introcardiac anomaly and reposition of ectopic heart finished at one time in 7 cases. Eight patients got full recovery except that residual shunt occurred in the second case which also got full recovery after transcatheter therapy. Ventricular diverticulum was removed in the fourth case because of difficult reposition of ectopic heart.With the help of general surgeon and thoracic surgeon, partial coronary ligament of liver and falciform ligament of liver in the left was cut in the first case and the left half lobe of liver was pushed downward. Bilateral pleural and marginal costal costochondral was cut and make thoracic wall upward so that ectopic heart can reset into thoracic cavity. And then, defect of diaphragm and abdominal wall were repaired with Proceed patch. In the other seven cases, bilateral pericardium and mediastinal pleura was cut and the 7th and 8th cartilage was transected and bilateral costal arch was closed so for complete thoracic angioplasty.Left ventricular dysfunction occurred in the fifth case with DORV and also got full recovery after symptomatic treatment. Full recovery was got in all cases after followingup from 1 to 23 months. No adverse complications occurred and every case live a wonderful life. Conclusion Pentalogy of Cantrell can be cured at one time by accurate correction of cardiac anomalies, cutting of bilateral pleural and marginal costal costochondral to make thoracic wall upward and enlarge thoracic space for repositinning of ectopic heart and using artificial patch to repair defect of diaphragm when necessary.