The technology of three-dimensional(3D)printing emerged in the late 1970s and has since undergone considerable development to find numerous applications in mechanical engineering,industrial design,and biomedicine.In biomedical science,several studies have initially found that 3D printing technology can play an important role in the treatment of diseases in hepatopancreatobiliary surgery.For example,3D printing technology has been applied to create detailed anatomical models of disease organs for preoperative personalized surgical strategies,surgical simulation,intraoperative navigation,medical training,and patient education.Moreover,cancer models have been created using 3D printing technology for the research and selection of chemotherapy drugs.With the aim to clarify the development and application of 3D printing technology in hepatopancreatobiliary surgery,we introduce seven common types of 3D printing technology and review the status of research and application of 3D printing technology in the field of hepatopancreatobiliary surgery.

Objective:To prepare IL-12 modified with polyethylene glycol derivatives and determine its modification sites,and to evaluate it in vitro in terms of stability,hemogram recovery,anti-tumor effects and other aspects.Methods:IL-12 was modified with polyethylene glycol propionaldehyde and maleimide imide derivatives,and modified sites of two different derivatives were deter-mined by ultra performance liquid chromatography(UPLC).Recombinant human IL-12 and PEG-IL-12 were used to stimulate NK92 cells,activity and cytotoxicity of IFN-γ were evaluated by kits.CD34+was stimulated to evaluate its blood picture recovery potential.NK cell killing was stimulated to evaluate its effectiveness in improving immunity and anti-tumor effects.Results:Compared with recombinant human IL-12,PEG-IL-12 had higher stability,blood picture recovery potential and anti-tumor effects.Conclusion:PEG-IL-12 can effectively overcome many drawbacks of recombinant human IL-12,greatly improving possibility of its widespread applica-tion in clinical trials.

Metaphorical narrative, as a kind of image, has a remarkable effect on the research of children’s psychological intervention. It is an important way of human cognition of the world, and its essence is the cross-domain mapping between the source domain and the target domain. Taking intractable diseases in children as an example, this paper illustrated the importance of metaphorical narrative in children’s diseases narrative, life and health education, disease science popularization, diseases notification, as well as the treatment communication. This paper aimed to arouse more researchers’ attention to the metaphorical narrative, actively apply metaphorical narrative to clinical practice, guide disease subjects to eliminate fear, accept diseases, so as to achieve the doctor-patients’ vision fusion and positively cooperate with clinical treatment. Not only can an appropriate metaphor help people get out of psychological difficulties, but it can renew a healthy life story.

OBJECTIVES: To evaluate the response to cardiac resynchronization therapy (CRT) and the correlation between CRT and pulmonary artery hemodynamic parameters. METHODS: The patients with chronic heart failure indicator for CRT were enrolled. The left ventricular end-systolic volume (LVESV) was measured by echocardiography and New York Heart Association (NYHA) classification was evaluated between one week before and six months after CRT. Mean pulmonary artery pressure (mPAP), pulmonary artery systolic pressure (PASP) and pulmonary vascular resistance (PVR) were measured by right heart catheterization. Left ventricular reverse remodeling (LVRR) is defined as a decrease of 15% or more in LVESV at the 6th month after CRT; Clinical response is defined as a decrease of NYHA classification at or above grade 1 at the 6th month after CRT. Pulmonary hypertension (PH) was defined as mPAP≥25 mmHg. According to the response, patients were divided into 3 groups: group A (LVRR+clinical response), group B (no LVRR+clinical response) and group C (no LVRR+no clinical response). The changes of NYHA classification, echocardiographic and pulmonary hemodynamic parameters were observed in the 3 groups. The Kaplan-Meier survival curve was used to analyze the differences in all-cause mortality, combined end-point events of death or re-hospitalization due to heart failure among different groups. RESULTS: A total of 45 patients with CRT implantation [aged (63.27±9.55) years, 36 males] were included. The average follow-up period was (33.76±11.50) months. Thirty-one patients (68.89%) were in group A, 9 of whom with PH. Eight patients (17.78%) were in group B, 7 of whom with PH. Six patients were in group C, all with PH. Cardiac function including NYHA classification, echocardiographic and pulmonary hemodynamic parameters had been significantly improved in group A after CRT implantation (<0.05). In group B, NYHA classification and pulmonary hemodynamic parameters were decreased significantly (<0.05), but echocardiographic parameters did not change obviously (>0.05). There were no significant changes in NYHA classification, echocardiographic and pulmonary hemodynamic parameters in group C (>0.05). Compared with group C, group A and group B had lower all-cause mortality (=0.005) and lower incidence of composite endpoint events (=0.001). CONCLUSIONS Patients with LVRR and clinical response after CRT have a good prognosis. Patients with clinical response but without LVRR have a better prognosis than those without clinical response and LVRR, which may be related to the decrease of pulmonary hemodynamic parameters such as mPAP and TPG.
Aged ; Cardiac Resynchronization Therapy ; Heart Failure ; therapy ; Hemodynamics ; Humans ; Male ; Middle Aged ; Pulmonary Artery ; Treatment Outcome ; Ventricular Remodeling

To explore the safety and efficacy for radiofrequency ablation of paroxysmal supraventricular tachycardia (PSVT) guided by Carto Univu three-dimensional mapping system.
 Methods: A total of 99 patients with PSVT underwent radiofrequency catheter ablation (RFCA) were assigned to a Carto Univu group (51 patients) and a two-dimensional X-ray group (48 patients) according to the mapping method. The operation time, X-ray exposure time, X-ray exposure dose, dose area product (DAP), operation success rate and complication rate were compared between the two groups.
 Results: The Carto Univu group and the two-dimensional X-ray group were not significant difference in the operation time, the X-ray exposure time of placing catheter, the X-ray DAP of placing catheter, the number of discharge, the discharge power, and the total discharge time (P>0.05). The mapping and ablation time, total exposure time, mapping and ablation DAP and total DAP in the Carto Univu group were significantly lower than those in the two-dimensional X-ray group (P<0.01). In the right accessory pathway cases, the mapping and ablation DAP and the total DAP in the Carto Univu group decreased compared with X-ray group (P<0.05), but it decreased more profound (P<0.01) in the left accessory pathway cases and the dual atrioventricular nodal pathways cases. Seven cases in the Carto Univu group achieved "zero X-ray", including 5 cases of the dual atrioventricular nodal pathways and 2 cases of the left accessory pathway. The immediate success rate for the two groups was 100%. After 3-12 months of follow-up, there was no recurrence in the Carto Univu group but 3 suspected recurrences in the two-dimensional X-ray group. In addition, no complications occurred in the two groups. 
 Conclusion: Carto Univu electroanatomic mapping system can guide PSVT safely and effectively during radiofrequency ablation and reduce radiation exposure to both doctors and patients. It is especially suitable for dual atrioventricular nodal pathways, which may even achieve "zero X-ray". Perhaps Carto Univu will be the first choice for RFCA of dual atrioventricular nodal pathways.
Catheter Ablation ; instrumentation ; methods ; Humans ; Imaging, Three-Dimensional ; instrumentation ; methods ; Operative Time ; Radiation Exposure ; prevention & control ; statistics & numerical data ; Radiography ; statistics & numerical data ; Recurrence ; Tachycardia, Supraventricular ; diagnostic imaging ; surgery ; Treatment Outcome

Objective Various factors may affect the effects of cardiac resynchronization therapy or cardiac resynchronization and implantable cardioverter-defibrilator ( CRT/CRTD) in chronic heart failure patients ( CHF) .The aim of our study was to explore the correlation of age and gender with the effects of CRT/CRTD in chronic heart failure patients. Methods This study included 136 CHF patients, 92 males and 44 females, treated by CRT/CRTD from January 2005 to March 2015.We divided the patients into three age groups:≥70 yr (n=29), 50-70 yr (n=77), and <50 yr (n=30), and compared the baseline characteristics, CRT respon-ding rate and all-cause mortality among different groups.The CRT response was defined as the decrease of NYHA cardiac function≥1 grade and left ventricular ejection fraction ( LVEF) improvement ≥5%. Results In the 136 CHF patients, there were 72 CRT responders (53%), 52%in the≥70 yr group, 55%in the 50-70 yr group, and 50%in the <50 yr group, with no statistically sig-nificant differences among the three groups (P>0.05).However, the CRT responding rate was remarkably higher in the female than in the male patients (66%vs 47%, P=0.027).Cox multivariate and Kaplan-Meier analyses revealed no significant differences in all-cause mortality between different genders or age groups.Multivariate logistic regression analysis showed that the left ventricular diastolic diameter and base QRS duration were independent factors of the CRT response. Conclusion Age does not affect the CRT response in chronic heart failure patients, while female patients have a higher CRT respon-ding rate than male patients.

OBJECTIVE: To study the effects of cardiac resynchronization therapy (CRT) with different pacing rates and modes on MTWA.
 METHODS: From March, 2012 to October, 2014, 43 patients who received CRT or CRT-D implantation in the first affiliated hospital, Nanjing Medical University were studied. Time-domain MTWA test were assessed following CRT implantation. MTWA was measured at 90 min(-1) and 110 min(-1) by treadmill exercise test with GE CASE 8000 during CRT-on (BIV biventricular) and CRT-off (RA right atrial) pacing modes. The comparsion of MTWA values between different pacing mode and pacing rates were analyzed. According to the heart function classification the patients were divided into 3 groups. The correlation between MTWA and cardiac function was analyzed.
 RESULTS: MTWA-AAI was significantly increased compared to MTWA-BIV at the pacing rate of 90 min(-1) [(11.27±9.94) µV vs (7.09±7.16) µV, P=0.001]. The value of MTWA at pacing rate of 110 min(-1) was nonsignificantly higher than MTWA during AAI pacing [(16.91±12.51) µV vs (15.58± 10.97) µV, P=0.517]. The value of MTWA at pacing rate of 110 min(-1) was higher than MTWA at pacing rate of 90 min(-1) during AAI or BIV (P<0.05). MTWA-AAI and MTWA-BIV in group of NYHA IV were higher than those in group of NYHA II (P<0.05).
 CONCLUSION Biventricular pacing mode at lower pacing rates can significantly attenuate MTWA. The value of MTWA is associated with the severity of CHF.
Arrhythmias, Cardiac ; therapy ; Cardiac Resynchronization Therapy ; Exercise Test ; Heart Failure ; therapy ; Humans

Objective To observe the long-term outcome of implantable cardioverter-defibrillator (ICD) implantation in Brugada syndrome patients and to explore how to reduce the frequency of ICD inappropriate schocks.Methods This study included 14 symptomatic patients (mean age (44.3 ± 8.3)years old;all males) with Brugada syndrome implanted with ICD in our hospital between 1998 and 2012,and these patients were followed up routinely every 6 months.The initial ICD parameters were set according to conventional experience.The ventricular tachycardia (VT) zone was programmed to ventricular rate 150-188 bpm/cycle length (CL) 400-320 ms and the ventricular fibrillation (VF) zone was programmed to ventricular rate≥ 188 bpm/CL≤320 ms.The total events were recorded by ICD.The ICD parameters revision was made by electrophysiological (EP) experts in case of inappropriate shocks.Results Patients were followed up for mean (43.0 ± 28.3) months.A total of 297 VF/VT events were recorded by ICD.Electrophysiological experts found that 90％ (178/198) episodes were true VF (CL 130-250 ms) among of 198 VF episodes and 147 VF episodes were terminated by one shock and 21 VF events were terminated by two or more shocks,and the rest 10 VF terminated spontaneously.Only 9％ (9/99) VT events were true VT (CL 320-360 ms) among of 99 VT episodes.Eight VT episodes were converted by antitachycardia pacing therapy (ATP) and the other one terminated spontaneously.The rest 90 VT episodes (91％) were supraventricular arrhythmias (SVT,CL 340-390 ms).About 90％ inappropriate shocks can be reduced by Wavelet discrimination function and optimal programming (VF zone ventricular rate ≥222 bpm/CL ≤ 270 ms and/or VT zone ventricular rate 167-222 bpm/CL 270-360 ms) according to the characteristics of arrhythmia of individual patient.Conclusion ICD can effectively prevent sudden cardiac death and syncope in high-risk patients with Brugada syndrome.The most common complication is inappropriate shock due to SVT.Optimal ICD programming with Wavelet discrimination function can effectively reduce the frequency of inappropriate shock rate.

Aim To investigate the effects of β1-ad-renergic receptor (β1-AR ) on rapid component of the delayed rectifier potassium current ( IKr ) in ventricular
myocytes of guinea pigs with chronic heart failure ( CHF) . Methods The CHF model of guinea pigs was established by descending thoracic aortic banding .
Whole-cell patch-clamp technique was used to record IKr in ventricular myocytes. The effects ofβ1-AR on IKr in CHF ventricular myocytes were detected and its mechanisms were studied by pretreatment with protein kinase A ( PKA ) inhibitor and calmodulin kinase II( CaMK II) inhibitor. Results In CHF ventricular myocytes, xamoterol, the selectiveβ1-AR agonist, de-creased IKr by (52±8)% and prolonged action poten-tial duration. These effects were completely abolished by pretreatment of myocytes with CGP20712A, a selec-tive β1-AR antagonist. íamoterol only decreased IKr
by (28±3)% by pretreatment of CHF myocytes with specific PKA inhibitor KT5720 . KN93 , an inhibitor of CaMKII, did not attenuate the inhibitory effect on CHF ventricular myocytes. Conclusion IKr is inhibi-ted by β1-AR activation in CHF ventricular myocytes. PKA, but not CaMKII signaling pathway is involved in, at least in part, the inhibitory effect ofβ1-AR acti-vation on IKr.

Objective To compare the effect of retroperitoneoscopic ureterolithotomy (RPUL) and ureteroscopic lithotripsy (URL) for upper ureteral calculi.Methods One hundred and twenty cases treated by RPUL and 108 cases by URL from January 2002 to October 2012 were reviewed.In RPUL and URL group,the diameter of stone was (1.56 ± 0.52) cm vs (1.44 ± 0.46) cm,ipsilateral hydronephrosis was (2.85 ± 0.86) cm vs (2.76 ± 0.82) cm,body mass index was (23.65 ± 2.80) kg/m2 vs (22.54 ± 2.68) kg/m2.There were no signficant differences.Data on the operation time,the hospital stay after operation,the operation,successsful rate,complication incidence and stone-free rate were compared between the 2 groups.Results Comparisons between RPUL group and URL group included the following:the operation time was (75.5 ± 25.8) min vs (62.5 ± 15.3) min,the hospital stay after operation was (6.2 ± 1.2) d vs (4.0 ± 0.8) d.There were significant differences.The operation successful rate was 95.0％ (114/120) in RPUL group and 85.2％ (92/108) in URL group.The complications incidence rate was 3.5％ (4/114) in RPUL group and 17.4％ (16/92) in URL group.The stone-free rate was 100.0％ (114/114) in RPUL group and 89.1％ (82/92) in URL group.The differences were significant (P ＜ 0.05).Conclusions RPUL and URL had the advantages of less trauma and blood loss and rapid recovery.RPUL had fewer complication and higher success rate than URL,and could be a minimally invasive option for the treatment of ureteral calculi.