Background::Ebstein’s anomaly (EA) is a rare and complex congenital heart anomaly, and the effect of surgical treatment is not ideal. This study aims to introduce our experience in management strategies, surgical techniques, and operative indications for patients with Ebstein’s anomaly.Methods::A retrospective study of 258 operations was performed in 253 patients by the same cardiac surgeon in The First Hospital of Tsinghua University between March 2004 and January 2020. 32 patients had previously received cardiac surgery in other hospitals. The clinical data including diagnosis, operative indications, techniques, pathological changes, and survival rates were collected and analyzed.Results::Anatomical correction was performed in 203 (78.7%) operations, 1? ventricle repair in 38 (14.7%) operations, tricuspid valve repair only in four operations (1.6%), tricuspid valve replacement in ten (3.9%), total cavopulmonary connection (TCPC) in two (0.8%), and Glenn operation in one operation (0.4%). Reoperation was performed in five patients (2.0%) during hospitalization. Among them, tricuspid valve replacement was performed in one patient, 1? ventricle repair in two patients, and tricuspid valve annulus reinforcement in two patients. Five patients died with an early mortality rate of 2.0%. Complete atrioventricular conduction block was complicated in one patient (0.4%). A total of 244 patients was followed up (four in the 253 patients lost) with a duration of 3.0-168.0 (87.6 ± 38.4) months. Cardiac function of 244 patients improved significantly with mean New York Heart Association (NYHA) functional class recovery from 3.5 to 1.1. The mean grade of tricuspid valve regurgitation improved from 3.6 to 1.5. Three late deaths (1.2%) occurred. The survival rates at five and ten years after surgery were 98.6% and 98.2%, respectively. Reoperation was performed in five patients (2.0%) during the follow-up period.Conclusion::Based on our management strategies and operative principles and techniques, anatomical correction of EA is capable of achieving excellent long-term results, and low rates of TCPC, 1? ventricle repair and valvular replacement.

Since the utilization of anthracyclines in cancer therapy, severe cardiotoxicity has become a major obstacle. The major challenge in treating cancer patients with anthracyclines is minimizing cardiotoxicity without compromising antitumor efficacy. Herein, histone deacetylase SIRT6 expression was reduced in plasma of patients treated with anthracyclines-based chemotherapy regimens. Furthermore, overexpression of SIRT6 alleviated doxorubicin-induced cytotoxicity in cardiomyocytes, and potentiated cytotoxicity of doxorubicin in multiple cancer cell lines. Moreover, SIRT6 overexpression ameliorated doxorubicin-induced cardiotoxicity and potentiated antitumor efficacy of doxorubicin in mice, suggesting that SIRT6 overexpression could be an adjunctive therapeutic strategy during doxorubicin treatment. Mechanistically, doxorubicin-impaired mitochondria led to decreased mitochondrial respiration and ATP production. And SIRT6 enhanced mitochondrial biogenesis and mitophagy by deacetylating and inhibiting Sgk1. Thus, SIRT6 overexpression coordinated metabolic remodeling from glycolysis to mitochondrial respiration during doxorubicin treatment, which was more conducive to cardiomyocyte metabolism, thus protecting cardiomyocytes but not cancer cells against doxorubicin-induced energy deficiency. In addition, ellagic acid, a natural compound that activates SIRT6, alleviated doxorubicin-induced cardiotoxicity and enhanced doxorubicin-mediated tumor regression in tumor-bearing mice. These findings provide a preclinical rationale for preventing cardiotoxicity by activating SIRT6 in cancer patients undergoing chemotherapy, but also advancing the understanding of the crucial role of SIRT6 in mitochondrial homeostasis.

Objective:To explore the application value of dual contrast-enhanced ultrasound in the differential diagnosis of renal cystic lesions.Methods:Eighty-four cases with renal cysts who were diagnosed by routine ultrasound in Zhejiang Cancer Hospital and Zhejiang Xiaoshan Hospital from January 2019 to October 2020 were included in the study. Intravenous contrast-enhanced ultrasound and enhanced MRI were performed to differentiate benign and malignant cysts. Patients with benign cysts underuent intravenous pyelography and intracapsular contrast-enhanced ultrasound. Before sclerotheraphy to exclude renal pelvic cysts. The diagnostic results of dual radiography were compared with MRI and intravenous pyelography.Results:Among 84 patients with suspected renal cysts, the diagnostic accuracy of enhanced MRI for cystic renal cancer was 97.62%, and the sensitivity was 97.62%. The diagnostic accuracy of intravenous contrast-enhanced ultrasound was 98.81, the sensitivity was 100%, and the specificity was 98.73%. There was no statistically significant difference between the two groups (all P>0.05). 77 cases were diagnosed as benign renal cysts, the detection rate of intravenous pyelography was 9.1% (7/77), the detection rate of renal pelvic cysts by intracystic ultrasonography was 6.5% (5/77). With intravenous pyelography as the gold standard, the diagnostic accuracy of intracapsular contrast-enhanced ultrasound was 97.4% (75/77), the sensitivity was 71.4% (5/7), and the specificity was 100% (70/70). Conclusions:Compared with enhanced magnetic resonance and intravenous pyelography before renal cyst sclerosing therapy, there is no difference in diagnostic efficiency of double contrast ultrasound for benign and malignant cysts. The diagnostic efficiency of renal pelvic cysts is high, and the operation is convenient. It can identify cystic renal cancer and cysts from the renal pelvis and improve the safety of sclerotherapy.

Objective To investigate the diagnostic value of ultrasound elastography hardness score and area ratio to identify benign and malignant lesions.Methods 90 patients with breast lumps were selected and divided into the malignant and non -malignant group according to surgical pathology diagnosis,they were 40 cases (a total of 45 tumors)and 50 cases (a total of 57 tumors),two groups of patients were detected in ultrasound elastography,anal-ysis of imaging hardness ratings and area ratio and other information,to investigate the clinical diagnostic value. Results The ultrasound elastography of 50 cases with benign tumor were 0 -2 point,7 cases were 3 -4 point, 7 cases with malignant tumors were 0 -2 point,38 cases were 3 -4 point,the difference between the two groups were statistically significant (χ2 =28.55,P <0.05);The average area ratio of benign tumor was (1.01 ±0.27),malignant tumors was (2.28 ±1.68),the difference between the two groups was statistically significant(t =9.22,P =0.001);the sensitivity,specificity,accuracy of elastography hardness rating in diagnosis of malignant breast tumors were 87.72%,84.44%,86.27%,the area ratio method were 85.96%,86.67%,86.27%,joint inspection of the two groups were 96.49%,95.55%,96.08%,joint inspection had obvious advantages,the difference was statistically sig-nificant(χ2 =16.24,13.58,P <0.05).Conclusion Ultrasound elastography hardness rating combined area ratio has a higher accuracy rate for differentiating benign and malignant breast tumors.

Aim To determine whether AngⅡin para-ventricular nucleus (PVN)was involved in the chronic intermittent hypoxia (CIH ) induced-hypertension in rats.Methods Male Sprague-Dawley rats were ran-domly divided into Sham and CIH groups,the Sham rats were exposed to continuous normoxia,while the CIH rats were submitted to CIH (8 h per day for 15 days).The conscious noninvasive method with tail cuff was performed in rats to record the systolic blood pres-sure during establishing the model of CIH induced hy-pertension.Mean arterial pressure (MAP)and heart rate (HR)were recorded in vivo on a PowerLab data acquisition system after CIH.Rats were fixed on the stereotaxic instrument to conduct microinjection in the PVN.We used Western blot to measure Ang Ⅱ level and AngⅡtype 1 receptor (AT1 R)protein expression in PVN.Results The level of PVN Ang Ⅱin CIH rats was significantly higher than that in Sham rats,a-long with increased AT1 R protein expression.Microin-jection of Ang Ⅱ(0.03,0.3,3 nmol)in bilateral PVN dose-dependently increased MAP in both CIH and Sham rats,and this response was significantly augmen-ted in CIH rats.Losartan (50 nmol),AT1 R antago-nist,had no effect on MAP in Sham rats,but caused significant MAP decreases in CIH rats,and prevented Ang Ⅱ-induced increases in MAP in both CIH and Sham rats.Conclusion The results suggest that the increased AngⅡrelease and enhanced AT1 R activation in the PVN contribute to CIH induced-hypertension in rats.

Objective To investigate the value of Color Doppler ultrasound in hemodynamic changes of non-alcoholic fatty liver disease.Methods 120 cases with non -alcoholic fatty liver disease were selected and divided into the mild group,moderate group and severe group.According to the degree of fatty infiltration of the liver taxono-my,40 cases in each group,hemodynamic changes of each group were detected in Color Doppler ultrasound equip-ment.Results Hepatic venous pulse waveform analysis and comparison constituted of the three groups and control group,the difference was statistically significant (χ2 =25.343,P <0.05).PPVV,MPVV,HARI of the three groups and control group were compared,the difference was statistically significant(F =34.67,51.03,31.06,all P <0.05).Conclusion Color Doppler ultrasound which is used to detect hemodynamic changes in non -alcoholic fatty liver disease had good clinical value,can assess disease progression in patients,can provide the basis for clinical treat-ment.

Objective To investigate the oxidative stress status and cardiac myocyte apoptosis in rats with propylthiouracil-induced hypothyroidism and to examine the effect of levothyroxine ( LT4 ),vitamin E ( VitE ),and both supplementation on this experimental model.Methods Male Sprague Dawley rats were divided into normal control group( NC),propylthiouracil group( PTU ),LT4 treatment group( PTU + LT4 ),VitE treatment group ( PTU +VitE),LT4 and VitE combination therapy group (PTU + LT4 + VitE).Serum T3,T4,TSH levels,serum and myocardial superoxide dismutase ( SOD ) activity and malondialdehyde ( MDA ) content were determined.Cardiac myocyte apoptotic index was made with TUNEL.Results ( 1 ) Compared with NC group,T3 and T4 levels were significantly lower and TSH level was significantly higher in PTU group and PTU+VitE groups( P＜0.05 ).Compared with PTU group,T3 and T4 levels were significantly higher and TSH level was significantly lower in PTU + LT4 group and PTU + LT4 + VitE group( P＜0.05 ).There were no statistical differences in T3,T4,and TSH levels between PTU group and PTU + VitE group( P＞0.05 ).( 2 ) Compared to NC group,serum and myocardial MDA levels in PTU group increased significantly( P＜0.05 ),serum SOD activity decreased significantly ( P＜0.05 ),while myocardial SOD activity showed no significant difference( P＞0.05 ).( 3 ) Compared with NC group,myocardial apoptosis index was significantly higher in PTU and PTU + VitE groups( P＜0.05 ).Compared with PTU group,myocardial apoptosis index was significantly lower in PTU + LT4 group and PTU + LT4 + VitE group( P＜0.05 ).Conclusion LT4,VitE,and their combined treatment of hypothyroidism in rats reduce the myocardial cells apoptosis,which may be related to the improvement of thyroid function and amelioration of oxidative stress.

In April 10, 2010, an earthquake measuring magnitude 7.1 shocked Yushu County,Qinghai province. For medical rescue, the National Earthquake Disaster Emergency Rescue Team was sent to Yushu right away. Rescue work in Yushu was faced with such difficulties as short preparative time, heavy workload, high exposure to various acute high altitude diseases (AHAD), and a number of other diseases frequently found on the cold plateau. To ensure the rescue work a success, the team took a series of measures including efficient preparative procedure, scientific and logical procedure in the emergency medical aid operations, reliable and effective handling of AHADs, along with sufficient self protection for team members.

Objective To investigate the relationship between apoptcsis, expressions of VEGF and clinicopathological characteris- tics, and prognosis in esophageal squamous cell carcinoma (ESCC). Methods Sixty-one surgical specimens of primary esophageal squa- mous cell carcinomas were examined for VEGF by immunohistochemical staining (S-P). Apoptcsis was determined by TUNEL (TdT media- ting dUTP-biotin nick end-labeling) method. Clinicopathologic features were examined by histopathology. The prognostic impacts of these pa- rameters were analyzed by univariate and survival analysis. Results AI and VEGF were well correlated with differentiation, TNM stage. Lower tumor differentiation and higher TNM stage were related to decreasing AI and VEGF. In addition, VEGF in the groups of invasion be- yond muscularis and lymph node metastasis is significant higher than that in invasion reaching muacularis and no lymph node metastasis (P <0.01). But there were no significant correlation between AI and invasion( P>0.05). The simple-factor analysis results showed that the decrease of AI, VEGF, lymph node metastases, lower tumor differentiation, and invasion reaching muscularis were related to decrease of sur- vival rate. However, multivariate Cox analysis demonstrated that only AI and VEGF were the significant prognostic factors. Conclusions Apoptosis and angiagenesis participate in ESCC and promote its growth. VEGF is related to angiogenesis of ESCC. The increase of VEGF may promote invasion and lymph node metastasis. AI and VEGF are significant prognostic factors in ESCC.

The instability of elbow is common among patients who suffered f ro m acute fracture or dislocation or from chronic strain. It is crucial to correct ly deal with the acute injury of the elbow, otherwise it would become chronic in stability of the elbow which is difficult to treat. This paper reviews the liter ature about the clinical representation, diagnosis and treatment of elbow instab ility. The surgical principle is to convert a complex fracture-dislocation patt ern into a simple dislocation pattern. Surgery should try to restore the anatomi c structure of the elbow, including articular surfaces and soft tissues. In inju ries to the ulnohumeral joint, reconstruction of the lateral tissues is the key to restoring joint stability. The premier treatment of recurrent instability of elbow is surgical treatment.