Objective:To investigate the current situation of the use of transjugular intrahepatic portosystemic shunt (TIPS) for portal hypertension, which should aid the development of TIPS in China.Methods:The China Portal Hypertension Alliance (CHESS) initiated this study that comprehensively investigated the basic situation of TIPS for portal hypertension in China through network research. The survey included the following: the number of surgical cases, main indications, the development of Early-TIPS, TIPS for portal vein cavernous transformation, collateral circulation embolization, intraoperative portal pressure gradient measurement, commonly used stent types, conventional anticoagulation and time, postoperative follow-up, obstacles, and the application of domestic instruments.Results:According to the survey, a total of 13 527 TIPS operations were carried out in 545 hospitals participating in the survey in 2021, and 94.1% of the hospital had the habit of routine follow-up after TIPS. Most hospitals believed that the main indications of TIPS were the control of acute bleeding (42.6%) and the prevention of rebleeding (40.7%). 48.1% of the teams carried out early or priority TIPS, 53.0% of the teams carried out TIPS for the cavernous transformation of the portal vein, and 81.0% chose routine embolization of collateral circulation during operation. Most of them used coils and biological glue as embolic materials, and 78.5% of the team routinely performed intraoperative portal pressure gradient measurements. In selecting TIPS stents, 57.1% of the hospitals woulel choose Viator-specific stents, 57.2% woulel choose conventional anticoagulation after TIPS, and the duration of anticoagulation was between 3-6 months (55.4%). The limitation of TIPS surgery was mainly due to cost (72.3%) and insufficient understanding of doctors in related departments (77.4%). Most teams accepted the domestic instruments used in TIPS (92.7%).Conclusions:This survey shows that TIPS treatment is an essential part of treating portal hypertension in China. The total number of TIPS cases is far from that of patients with portal hypertension. In the future, it is still necessary to popularize TIPS technology and further standardize surgical indications, routine operations, and instrument application.

Objective:To explore the treatment of thoracoabdominal combined injury in a child with heart rupture caused by sheep horns under limited medical conditions.Methods:To summarize the diagnosis and treatment of a child with thoracoabdominal combined injury and cardiac rupture who were treated with epidural anesthesia and having spontaneous breath, and even more there was no oxygen supply and perioperative monitoring during operation.Results:After the complete of thoracoabdominal exploration, the repair of heart, stomach and diaphragm, postoperative anti-infection, nutritional support and symptomatic treatment, the little patient recovered successfully.Conclusions:Thoracoabdominal injuries combined cardiac rupture requires rapid judgment of the patient’s condition, control of bleeding, discharge cardiac tamponade and cardiac repair as soon as possible. In order to save life, unconventional measures can be used when it is necessary.

Objective:To retrospectively analyze the failure patterns and outcomes of patients with locally advanced hypopharyngeal squamous cell carcinoma (HPSCC) after undergoing induction chemotherapy (IC) followed by definitive radiotherapy.Methods:For patients with locally advanced HPSCC who were treated with IC and definitive radiotherapy from August 2008 to December 2019, their data were collected from the medical records system, and their clinical characteristics, failure patterns, and survival were retrospectively analyzed.Results:A total of 116 eligible patient with squamous cell carcinoma were included in this study. with a median age of 59 (39-79), and 3, 3, 60, and 50 of them had stage Ⅱ, Ⅲ, Ⅳ A, and Ⅳ B HPSCC, respectively. Among these patients, 81 received 1~2 cycles of IC, and 35 received 3-4 cycles of IC. After treatment with IC, 54, 13, and 49 patients received concurrent chemoradiotherapy, radiotherapy combined with targeted therapy, and radiotherapy alone, respectively. The median follow-up was 34.6 months (95% CI: 28.7-40.5 months). The 3-year local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), metastasis-free survival (MFS), progression-free survival (PFS), and overall survival (OS) of all the patients were 63.5%, 82.8%, 75.2%, 47.3%, and 43.1%, respectively. Median PFS and OS were 26.1 and 28.0 months, respectively. Treatment failure was reported in 59 patients, of whom 22, 5, 12, 10, 3, 6 and 1 experienced local, regional, distant only, local-regional, regional-distant, local-distant, and local-regional-distant failure, respectively. The objective response rate (CR+ PR) of patients after IC was 55.2% (64/116). The LRFS, RRFS, PFS, and OS of IC responders (CR+ PR) were better than those of IC non-responders (SD+ PD) ( χ2 = 12.52, 5.16, 13.19, 11.72, all P< 0.05). Conclusions:IC combined with radical radiotherapy has efficacy to a certain extent in the treatment of locally advanced HPSCC, and locoregional recurrence predominates the failure patterns. The prognosis of IC responders is significantly better than that of IC non-responders.

Objective:The investigation and research on the application status of Hepatic Venous Pressure Gradient (HVPG) is very important to understand the real situation and future development of this technology in China.Methods:This study comprehensively investigated the basic situation of HVPG technology in China, including hospital distribution, hospital level, annual number of cases, catheters used, average cost, indications and existing problems.Results:According to the survey, there were 70 hospitals in China carrying out HVPG technology in 2021, distributed in 28 provinces (autonomous regions and municipalities directly under the central Government). A total of 4 398 cases of HVPG were performed in all the surveyed hospitals in 2021, of which 2 291 cases (52.1%) were tested by HVPG alone. The average cost of HVPG detection was (5 617.2±2 079.4) yuan. 96.3% of the teams completed HVPG detection with balloon method, and most of the teams used thrombectomy balloon catheter (80.3%).Conclusion:Through this investigation, the status of domestic clinical application of HVPG has been clarified, and it has been confirmed that many domestic medical institutions have mastered this technology, but it still needs to continue to promote and popularize HVPG technology in the future.

Objective:To detect IgG and neutralizing antibodies response to SARS-CoV-2 vaccine by comparing enzyme-linked immunosorbent assay (ELISA), commercial magnetic particle chemiluminescence assay(CLIA) and neutralization test(NT).Methods:ELISA, CLIA and NT were used to detect 143 healthy people before and after 28 days immunization with 2 doses of SARS-CoV-2 vaccine, and calculate the positive conversion rate, quantitative results and analysis the consistency of the three methods.Results:The positive conversion rate of SARS-CoV-2 vaccine antibody detected by ELISA, CLIA and NT were respectively 97.9%, 98.6% and 85.3%. The geometric mean of the highest dilution of the serum quantitatively detected by ELISA was 586.6; The mean of CLIA S/CO value was 11.26; The geometric mean titer of the NT was 7.6. The correlation coefficient between ELISA, CLIA and NT were respectively 0.69( P<0.01) and 0.65( P<0.01), and the correlation coefficient between ELISA and CLIA was 0.79( P<0.01). Conclusions:The three methods all detected high levels of antibodies response to SARS-CoV-2 vaccine immunization. ELISA and CLIA are more consistent to detect IgG antibody, and have a good correlation with the quantitative detection results of the NT.

Objective: To observe the effect of medical instant hemostasis gauze combined with filament speed instant gauze on the drainage and flap healing after modified radical mastectomy. Methods: From August 2015 to August 2016, a total of 80 patients with modified radical mastectomy for breast cancer admitted to Huanxing Tumor Hospital, Chaoyang District, Beijing were selected.According to the random number table method, 80 patients who were ready for modified radical mastectomy for breast cancer were randomly divided into study group (40 cases) and control group (40 cases). Two kinds of hemostatic materials (medical hemolytic hemostatic gauze combined with fibril quick hemostatic gauze) were applied to the surgical wounds in the study group during the operation, while no medical hemostatic materials were used in the control group during the operation, and the other treatment was the same as that in the study group.Total drainage volume and drainage tube removal time were compared between the two groups 1 to 5 days after operation. Results: There were no statistically significant differences in the age, body mass index, and effusion production between the two groups (all P>0.05). The total drainage volume of the study group was (289.23±5.36) ml, and the total drainage volume of the control group was (492.15±8.56) ml.The difference between the two groups was statistically significant (t=8.543, P<0.05). The drainage time of the study group was (6.24±1.23) days, and the extraction time of the control group was (10.12±2.21) days.The difference between the two groups was statistically significant (t=6.203, P<0.05). Conclusion In addition to hemostatic function, using absorbable hemostatic gauze combined with surgicel fibrillar during the surgical process can significantly reduce postoperative subcutaneous fluid accumulation.

Objective     To investigate activated toll-like receptor-4 (TLR4) signaling pathway involved in pathophysiological mechanisms of type A aortic dissection (TAAD). Methods     Specimens of full-thickness ascending aorta wall from the TAAD patients (n=12) and the controlled donors (n=12) were collected. Western blotting was used to examine the associated proteins' expression of TLR4 signaling pathway. Blood samples from TAAD (n=43) and controlled patients (n=50) were examined by enzyme-linked immunosorbent assay (ELISA) to detect the circulating plasma cytokines levels of interleukin-1β (L-1β). Results     In the aortic wall of TAAD, expression levels of TLR4 and protein expression of major molecule significantly elevated, and activated macrophages increased. Furthermore, elevated IL-1β levels were observed in the TAAD patients’ plasma compared with the control plasma. Multiple logistic regression analysis and receiver operating characteristic (ROC) curve showed that elevated IL-1β could be a novel and promising biomarker with important diagnostic and predictive value in the identification of TAAD. Conclusion     Activated TLR4/NF-κB signaling pathway regulates inflammatory response to involve in pathophysiological mechanisms of type A aortic dissection and its regulated inflammatory products have important predictive value for patients with TAAD.

Objective To analyze retrospectively the results of single-patch with elevation of the left-sided atrioventricular valve repair for complete atrioventricular septal defect(CAVSD) in therapeutic effects and safety.Methods Fourteen consecutive patients (2 males and 12 females) with CAVSD were enrolled in the study from April 2012 to December 2017.All patients underwent single-patch with the elevation of left-sided atrioventricular valve repair for CAVSD by regular sternotomy.The median age at operation was 12.5 months(range,11.7 months to 63 months) and the duration of follow-up was(3.27 ± 2.02)years.Echocardiography and electrocardiogram were used during follow-up according to the protocol.Results Compared with pulmonary arterial pressure(PAP) during pre-and post-operation (65.92 ± 6.91 and 62.97 ± 17.29) mmHg (1 mmHg =0.133 kPa),PAP(53.29 ± 20.99) mmHg decreased significantly during follow-up period.There were significant difference during post-operation and follow-up for LAVVR and RAVVR.The extent of regurgitation of atrioventricular valve statistically decreased during follow-up period.None of patients suffered from atrioventricular block and reoperation during follow-up.Conclusion Single-patch with elevation of the left-sided atrioventricular valve repair for CAVSD yields good outcomes,without occurrence of severe LAVVR,during early and mid-term follow-up period.

Objective To investigate retrospectively the therapeutic effect and safety of minimally invasive transthoracic device closure of isolated perimembranous ventricular septal defect (PVSD).Methods Eight hundred and ninety-one consecutive patients with PVSD from December 2008 to October 2014 in our hospital were enrolled,which performed minimally invasive transthoracic device closure of ventricular septal defect (VSD),with a 4 ～ 5 cm incision made on the inferior sternum.Under the guide of transthoracic echocardiography (TEE),right ventricular free wall was punctured followed by a delivery sheath threaded into the VSD and the occluder was released thereafter.Whether were there residual shunt and the occluder anchored firmly or not,the position of occluder and the influence on heart valve were re-evaluated intraoperatively by TEE.All patients were followed up prudently post-operation.Echocardiography and electrocardiogram were scheduled according to the protocol.Results Eight hundred and thirty-four cases were successfully occluded.Fifty-seven cases were performed VSD repair operation with cardiopulmonary bypass.The amounts of concentric occluder and eccentric occluder were 703 and 133,respectively.The patients performed minimally invasive transthoracic device closure of VSD had no severe complications after operation.Conclusions Although the short-term and mid-term therapeutic effect of minimally invasive transthoracic device closure of PVSD seem plausible to be definitive,with a favorable prospective application,the long-term follow-up remains to be studied.

Objective To analyze retrospectively the therapeutic effect and safety of minimally invasive transthoracic device closure of perimembranous ventricular septal defect (PVSD).Methods One hundred and twenty-nine patients with PVSD from January 2011 to December 2011 in our hospital were selected and a 3 to 5 cm incision was made in the inferior sternum,which performed minimally invasive transthoracic device closure of ventricular septal defect (VSD).Right ventricular free wall was punctured and guided by transthoracic echocardiography (TEE),and then the occluder was released after a delivery sheath passed through the VSD.Location of occluder,effect on heart valve,fastness and residual shunt were evaluated by TEE instantly during operation.All patients were followed up intimately after operation,echocardiogram and electrocardiogram were rechecked regularly.Results One hundred and fourteen cases were successfully occluded.Fifteen cases were performed VSD repair operation with cardiopulmonary bypass.The amounts of concentric occluder and eccentric occluder were 96 and 20,respectively.The patients performed minimally invasive transthoracic device closure of VSD had no severe complications after operation.Conclusion Although the short-term therapeutic effect of minimally invasive transthoracic device closure of PVSD is definitely and has favourable prospect of application,the long-term follow-up remains to be studied.