Objective    To compare the long-term durability of valved homograft conduit (VHC) in patients with Ross and non-Ross right ventricular outflow tract (RVOT) reconstruction. Methods    Patients who underwent RVOT reconstruction using VHC in Fuwai Hospital from January 2008 to October 2020 were retrospectively included. Patients who received Ross RVOT reconstruction were allocated to a Ross group and patients who received non-Ross RVOT reconstruction were allocated to a non-Ross group. The survival and reintervention-free rates of the two groups were evaluated with the Kaplan-Meier survival curve and log-rank test. The propensity score matching analysis was performed on the patients who completed ultrasound follow-up in the two groups, and the VHC dysfunction-free rate was compared between the two groups. Results    A total of 243 patients were enrolled, including 142 males and 101 females, with a median age of 6 years (4 months to 56 years). There were 77 patients in the ROSS group and 166 patients (168 operations) in the non-ROSS group. The cardiopulmonary bypass time in the Ross group was shorter than that in the non-Ross group (175.4±45.6 min vs. 200.1±83.5 min, P=0.003). Five patients in the non-Ross group died early after the operation. The follow-up was available in 231 patients (93.1%), with the average follow-up time of 61.7±44.4 months. During the follow-up, 5 patients in the non-Ross group died. The 12-year survival rate was 100.0% in the Ross group and 93.2% in the non-Ross group (log-rank, P=0.026). In addition, 1 patient in the Ross group and 7 patients in the non-Ross group received VHC reintervention. There was no significant difference in the reintervention-free rate between the two groups (log-rank, P=0.096). Among the 73 patients in the Ross group and 147 patients in non-Ross group who were followed up by ultrasound after discharge, 45 patients (20.5%) developed VHC dysfunction. Before matching, the long-term durability of VHC in the Ross group was better than that in non-Ross group (10-year VHC dysfunction-free rate: 66.6% vs. 37.1%, log-rank, P=0.025). After the propensity score matching, 64 patients included in each group, and there was no statistical difference in the long-term durability of VHC between the two groups (10-year VHC dysfunction-free rate: 76.3% vs. 43.0%, log-rank, P=0.065). In the subgroup analysis, the 10-year VHC dysfunction-free rate in the Ross group was higher than that in the non-Ross group (71.0% vs. 20.0%, log-rank, P=0.032) among patients aged<6 years at surgery. However, there was no significant difference in the 10-year VHC dysfunction-free rate between the two groups (53.7% vs. 56.7%, log-rank, P=0.218) among patients aged ≥6 years at surgery. Conclusion    After the propensity score matching analysis, the long-term durability of VHC has no significant difference between the Ross group and non-Ross group. The long-term durability of VHC after Ross surgery is superior to that of non-Ross surgery in patients aged<6 years at surgery.

Objective    To evaluate the clinical outcome of valved homograft conduits (VHC) used for right ventricular outflow tract (RVOT) reconstruction in Fuwai Hospital in recent 13 years, and explore the factors influencing the long-term durability of VHC. Methods    Clinical data of patients using VHC for RVOT reconstruction in Fuwai Hospital from November 2007 to October 2020 were retrospectively analyzed. The Kaplan-Meier survival curve was used to evaluate survival, VHC reintervention and VHC dysfunction. Cox proportional risk regression model was used to analyze the risk factors for VHC dysfunction. Results    Finally 251 patients were enrolled, including 145 males and 106 females. The median age at surgery was 6.0 (0.3-67.0) years. Early death occurred in 5 (2.0%) patients. The follow-up was available for 239 (95.2%) patients, with the follow-up time of 0.3-160.0 (61.3±45.4) months. Five patients died during the follow-up, and the 1-year, 6-year, and 13-year survival rates were 96.6%, 95.5% and 95.5%, respectively. Eight patients received VHC reintervention during the follow-up, and freedom rates from VHC reintervention were 100.0%, 97.1% and 82.4% at 1 year, 6 years and 13 years, respectively. A total of 226 patients were followed up by echocardiography after discharge, with the follow-up time of 0.2-138.0 (48.5±40.5) months. During the follow-up, 46 (20.4%) patients developed VHC dysfunction, and freedom rates from VHC dysfunction at 1 year, 5 years, and 10 years were 92.6%, 79.6% and 59.3%, respectively. Univariate Cox regression analysis showed that age<6 years and VHC diameter<19 mm were risk factors for VHC dysfunction (P=0.029, 0.026), but multivariate regression analysis only indicated that age<6 years was an independent risk factor for VHC dysfunction (P=0.034). Conclusion    The early and late outcomes of VHC used for RVOT reconstruction are satisfactory, and the long-term durability of VHC is also optimal. In addition, age<6 years is an independent risk factor for VHC dysfunction.

Objective To investigate the influence of low-tube current in combination with simultaneous iterative reconstruction algorithm on bone mineral density (BMD) of T12 and image quality with a chest phantom.Methods An adult male chest phantom was selected.CT scan of the chest was performed at tube voltage of 120 kV and five different tube currents (20,30,40,50,60 mAs) in combination with filtered back projection (FBP),iDose4 (Level 4) and iterative model reconstruction (IMR,Level 2),respectively.BMD of T12 in chest phantom and objective evaluation results on different tube currents and simultaneous iterative reconstruction techniques were compared.The subjective scoring of mediastinum and lung window imaging qualities at tube current of 20 mAs with IMR and tube current of 60 mAs with FBP were compared.The consistency between two observers was evaluated.Results There was no significant difference between BMD values nor CT values on different tube currents and simultaneous iterative reconstruction techniques of chest phantom (all P＞ 0.05),but the differences between SD values were statistically significant (P＜ 0.001).SD values obtained with IMR were lower than those of iDose4 and FBP at same tube currents (all P＜0.001).At tube current of 60 mAs with FBP,the consistency of two observers in mediastinum window was the best (Kappa=1,P＜0.001),while in lung window was medium (Kappa=0.64,P=0.002).At tube current of 20 mAs with IMR,the consistency of two observers in mediastinum window was medium (Kappa=0.64,P=0.002),while in lung window was the best (Kappa=1.00,P＜0.001).Conclusion Low-tube current in combination with simultaneous iterative reconstruction algorithm can reduce radiation dose without affecting the accuracy of BMD.

Objective To investigate the reproducibility and accuracy of spinal BMD (bone mineral density) by low mA using adaptive statistic iterative reconstruction based on phantom model.Methods European spine phantom (ESP) was scanned with 5 different tube currents (40,60,80,100 and 120 mA) on the GE Revolution prototype.All data were transferred to the quantitative CT (QCT) PRO workstation for measuring the bone mineral density (BMD).And all data were reconstructed using different adaptive statistical iterative reconstruction veo (ASiR-V) weighting percentages from ASiR-V 0 filtered back projection(FBP) to ASiR-V 100％,at interval of 20％.Quantitative measurements of CT value,noise,and contrast noise ratio (CNR) of L1,L2 and L3 were measured in each group.The singlefactor analysis of variance (ANOVA) was used to compare the bone mineral density values of different mA and ASiR-V weighting percentages.Results Volume CT dose index(CTDIvol) and dose length product (DLP) were positively correlated with tube current(r =1).The BMD of ESP phantoms had no statistically significant differences among the multi-center lumbar spines L1,L2 and L3 at different doses under the same ASiR-V weighting percentages (P ＞ 0.05),as well as at the same dose under different ASiR-V weighting percentages(P ＞ 0.05).The error of bone density accuracy was within 6％.Conclusions Low dosage of 120 kV and 40 mA using ASiR-V without affecting the accuracy of BMD has the potential effect to reduce radiation dose without compromising image quality.

BACKGROUNDDrug eluting stents (DESs) made with biodegradable polymer have been developed in an attempt to improve clinical outcomes. However, the impact of biodegradable polymers on clinical events and stent thrombosis (ST) remains controversial.

METHODSWe searched Medline, the Cochrane Library and other internet sources, without language or date restrictions for articles comparing clinical outcomes between biodegradable polymer DES and durable polymer DES. Safety endpoints were ST (definite, definite/probable), mortality, and myocardial infarction (MI). Efficacy endpoints were major adverse cardiac event (MACE) and target lesion revascularization (TLR).

RESULTSWe identified 15 randomized controlled trials (n = 17 068) with a weighted mean follow-up of 20.6 months. There was no statistical difference in the incidence of definite/probable ST between durable polymer- and biodegradable polymer- DES; relative risk (RR) 0.83; 95% confidence interval (CI) 0.62-1.11; P = 0.22. Biodegradable polymer DES had similar rates of definite ST (RR 0.94, 95% CI 0.66-1.33, P = 0.72), mortality (RR 0.94, 95% CI 0.82-1.09, P = 0.43), MI (RR 1.08, 95% CI 0.92-1.26. P = 0.35), MACE (RR 0.99, 95% CI 0.91-1.09, P = 0.85), and TLR (RR, 0.94, 95% CI 0.83-1.06, P = 0.30) compared with durable polymer DES. Based on the stratified analysis of the included trials, the treatment effect on definite ST was different at different follow-up times: ≤ 1 year favoring durable polymer DES and >1 year favoring biodegradable polymer DES.

CONCLUSIONSBiodegradable polymer DES has similar safety and efficacy for treating patients with coronary artery disease compared with durable polymer DES. Further data with longer term follow-up are warranted to confirm the potential benefits of biodegradable polymer DES.

Objective To deal with measurements of the relative convexity, to observe the morphological characteristics of zygoma and zygomatic arch, and to provide references for anthropology and medical science. Methods 108 dry skulls (62 male and 46 female) from Wuhan University Medical School were used, the zygomatic relative convexity of both sides were measured, and the morphological characteristics were observed in this study. Results Zygomatic process point lied in the middle of zygoma in horizontal direction, and situated 15-20 mm below the external middle 1/3 of infra-orbital margin. The zygomatic arch was anterolateral convexity, and face width in male was bigger than that in female. Conclusion The relative convexity and morphological characteristics of zygoma and zygomatic arch provide

Objective The main goals of orthognathic surgery are to achieve funetional occlusion and improve patient's profile.The unintended nasal change in association with anterior maxillary osteotomy is always a challenging.The purpose of this study was to improve the anterior maxillary segmental osteotomy resulting in less post-operative unintended nasal change.Methods Thirty-two patients with maxillary protrusion underwent modified anterior subapical maxillary osteotomy.The design of the modified approach was based on the anterior mandibular subapical osteotomy.The horizontal osteotomy connecting the vertical osteotomy lines on both right and left sides was performed inferior to the piriform aperture and 3 mm over the apex.The integrity of piriform aperture was maximally preserved.Lateral cephalograms,lateral and frontal photographs taken pre-and post-operatively were analyzed.All the patients were followed up for at least 6 months.Results All thirty-two patients were satisfied with esthetic outcome.The upper lip protrusions and tooth exposure improved significantly.Cephalometric and photograph analysis showed that the ratio of upper lip to maxillary ineisor retractionwas 0.64:1.00,and the nasolabial angle and philtrum length were significantly increased(P＜0.05)while vermilion length was decreased.The height of nasal tip and nasal width(alarbase to alarbase)were not significantly changed.Conclusion The modified anterior subapical maxillary osteotomy is a simple procedure leading to no significant postoperative nasal change.It provides a promising alternative in the treatment of maxillary protrusion.

Objective To explore the effect of combined application of improved microencapsulation and intravenous injection of donor liver cells and spleen cells on pancreatic islet xenografts. Methods New born male pigs and SD rats were selected as donors and recipients respectively, and pig pancreatic islet cells were microencapsulated by static electricity improvement microencapsulation. Islet transplantation was performed after injection of donor liver cells and spleen cells via tail vein. The changes in blood glucose and serum C-peptide, the function-possessed days of islet xenografts and diabetes rats living period were observed. Results In combined application group, the function-possessed days of islet xenografts and diabetes rats living period were significantly prolonged (P

Objective To generalize a valuable classification of mandibular condyle fractures and explore proper measures for such kind of fractures so as to provide reference for clinical treatment. Methods The data of 304 cases with 358 mandibular condyle fractures were analyzed retrospectively. After one year of the initial treatment, X-ray inspection was employed to get the information including mouth opening, pattern of mouth opening, occlusion, facial symmetry and healing condition of mandibular condyles. Results According to classification of position,displacement and age (PDA), 180 mandibular condyle fractures belonged to type Ⅰ, 96 to type Ⅱ and 82 to type Ⅲ, which coincided with the different fractures treated surgically or nonsurgically. All surgical and nonsurgical treatments got satisfactory outcome. Conclusion The classification of PDA is effective in guiding the treatment choice for mandibular condyle fractures. Both surgical and nonsurgical treatment can obtain effective results for corresponding case.

Objective Developmental mandibular asymmetry is a common deformity in the human craniofacial skeleton and the treatment is not easy to get satisfactory results. A retrospective study was performed to investigate the clinical results and stability after treatment of developmental mandibular asymmetry by using combination of orthognathic surgery with orthodontics. Methods 58 cases of developmental mandibular asymmetry were treated by preoperative orthodontics-orthognathic surgery -postoperative orthodontics procedure. 82 times of operation, such as mandibular osteotomy, bimaxillary osteotomy, jaw plastic surgery, genioplasty, and distraction osteogenesis were performed according to different type of asymmetry. The facial appearance and occlusion relationship were evaluated with 1～4 years of follow-up. Results Satisfactory results were achieved in 53 cases (91.4 %). Primary satisfactory results were obtained in 4 cases (6.9 %). 1 case (1.7 %) with unsatisfactory result obtained aesthetic effect and ideal occlusion after operation again. Conclusions It is essential to use both of orthodontics and orthognathic surgery in order to ameliorate facial appearance, resume occlusal function, achieve good corrective result and prevent the recurrence of the developmental mandibular asymmetry.