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.

OBJECTIVE: To review targeted muscle reinnervation (TMR) surgery for the construction of intelligent prosthetic human-machine interface, thus providing a new clinical intervention paradigm for the functional reconstruction of residual limbs in amputees. METHODS: Extensively consulted relevant literature domestically and abroad and systematically expounded the surgical requirements of intelligent prosthetics, TMR operation plan, target population, prognosis, as well as the development and future of TMR. RESULTS: TMR facilitates intuitive control of intelligent prostheses in amputees by reconstructing the "brain-spinal cord-peripheral nerve-skeletal muscle" neurotransmission pathway and increasing the surface electromyographic signals required for pattern recognition. TMR surgery for different purposes is suitable for different target populations. CONCLUSION TMR surgery has been certified abroad as a transformative technology for improving prosthetic manipulation, and is expected to become a new clinical paradigm for 2 million amputees in China.
Humans ; Artificial Limbs ; Muscle, Skeletal ; Neurosurgical Procedures ; Plastic Surgery Procedures ; Prosthesis Implantation

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 explore the value of ultrasound gray scale ratio (UGSR) in the diagnosis and differential diagnosis of papillary thyroid carcinoma(PTC) with different sizes.Methods A retrospective study was made in 702 patients with 1107 nodules which were confirmed by surgery in the Department of Oncology or fineneedle aspiration of HangZhou First people's Hospital,Zhejiang University of medical school from Jan.2016 to Oct.2017.All the thyroid nodules were divided into three groups:D≤ 1 cm group,1＜D≤2 cm group and ＞2 cm group according to their sizes.The UGSR of the PTC and NG were obtained through the RAD info system.Their differences were analyzed and ROC was established to confirm the optimal threshold in the differential diagnosis between PTC and NG among the groups.Results There were 483 PTC and 624 NG in this study.The UGSR of D≤ 1 cm group,1＜D≤2 cm group and ＞2 cm group of PTC and NG were (0.48±0.12) vs (0.76±0.22)(t=33.21,P=0.00);(0.52±0.17) vs(0.80±0.21)(t=1.30,P=0.00) and (0.63±0.20) vs(0.89±0.24)(t=3.58,P=0.00) respectively.The area under the ROC of UGSR in the differentiation of PTC and NG in the three groups were 0.873,0.840 and 0.811 respectively.The Youden indexes were greatest (0.631,0.536 and 0.535 respectively),when the cut-offs of the UGSR were 0.682,0.652 and 0.831 respectively.The sensitivity and specificity to diagnose PTC were 94.8％ and 68.0％,75.0％ and 78.6％,80.3％ and 73.2％ respectively in the three groups.Conclusions The best UGSR value of PTC was variant in thyroid nodule with different size.Recognition of these differences accurately could improve the pre-operative diagnostic accuracy of PTC.Also the method is simple to operate and easy to apply.

Objective To investigate the diagnostic value of computed tomography (CT) histogram analysis for thyroid malignant solitary coarse calcification nodules (MSCN).Methods A total of 89 thyroid solitary coarse calcification nodules (coarse calcification ≥5 mm,no definite soft tissue around calcification) confirmed either by surgery or histopathological examination in 86 patients enrolled in this study from Jan.2009 to Dec.2015 were evaluated,including 33 MSCN from 32 patients and 56 benign solitary coarse calcification nodules (BSCN) from 56 patients.Overall,27 cut-off values were calculated by N (4 ≤ N ≤ 30) times of 50 Hounsfield units (HU) in the range of 200 HU to 1500 HU,and each cut-off value and the differences in the corresponding area percentages in the CT histogram were recorded for MSCN and BSCN.The optimal cut-off value and the corresponding area percentage were established by receiver operating characteristic (ROC) curve analysis.Results In the 24 groups with an ROC area under the curve (AUC) of more than 0.7,at a cut-off value of 1150 HU and at an area percentage of no less than 98.4％,the ROC AUC reached a maximum of 0.86,and the accuracy,sensitivity,and specificity were 70.8％,93.9％,and 57.1％,respectively.At a cut-off value of 450 HU and at an area percentage of no less than 46.3％,the accuracy,sensitivity,and specificity were 76.4％,48.5％,and 92.9％,respectively.At a cut-off value of 550 HU and at an area percentage of no less than 81.5％,the accuracy,sensitivity,and specificity were 75.3％,33.3％,and 100％,respectively.Conclusions In comparison with the cut-off value of 1150 HU with an area percentage of no less than 98.4％,the sensitivities for the cut-off value of 450 HU with an area percentage of no less than 46.3％ and for the cut-off value of 550 HU with an area percentage of no less than 81.5％ were lower;however,the specificities increased significantly,providing an important basis for reducing the misdiagnosis of MSCN.

Objective: To evaluate the differential diagnosis of idiopathic granulomatous mastitis (IGM) and invasive ductal carcinoma. Methods: The ultrasonographic data of 37 IGM patients and 50 cases of IDC were analyzed retrospectively. The shape, growth direction, margin, internal echo, posterior echo, calcification, Adler blood flow classification, PSV(peak sestolic velocity), RI (resistance index)and elasticity scores were analyzed by χ² test and independent sample t test. The optimal cutoff values of age, PSV and RI were calculated by receiver operating characteristic (ROC) curve. Logistic regression analysis was used to calculate the odds ratio (OR) of ultrasonic variates in the diagnosis of both diseases. Results: There were no significant differences in the shape, margin, internal echo and blood flow grading between the two groups. The age, lesion growth direction, posterior echo, calcification, PSV, RI and elasticity were statistically different. The cut-of value of Age, PSV and RI were 38.5 years old, 13.20 cm/s, and 0.655. Logistic regression multi-variated analysis revealed that elastic score (OR=9.806) had the best value of the differential diagnosis, as well as calcification (OR=6.937), posterior echo decay (OR=4.613), RI (OR=3.257), lesion growth orientation (OR=3.198), and PSV (OR=1.202). Lesion shape, margin, internal echo, and Adler blood flow classification did not help in differential diagnosis. Conclusion Ultrasound multi-parameter analysis has high value in IGM and IDC differential diagnosis.

Objective: To evaluate the early and long-term outcomes cardiac surgery of patients with Ebstein anomaly. Methods: The clinic data of 237 patients with Ebstein anomaly received surgical procedures from March 2004 to December 2017 at Department of Cardiac Surgery, First Hospital of Tsinghua University was analyzed retrospectively. There were 105 male and 132 female patients with age of (19.4±16.7) years (ranging from 3 months to 64 years). The surgical procedures include anatomical repair in 188 patients, one and a half ventricle repair in 37 patients, tricuspid valve repair in 4 patients, tricuspid valve replacement in 10 patients, and Fontan procedure in 3 patients (total cavopulmonary connection in 2 patients; Glenn procedure in 1 patient). Results: The early mortality was 2.1% (n=5). One case of atrioventricular (0.4%) newly occurred. There were 228 patients available to follow-up. The range of follow-up duration was 3 to 168 months. Late survival was 99.1% (2 cases of late death) at 10 years. Three patients received reoperation (1.3%), including tricuspid valve repair of 1 patient and one and a half ventricle repair of 2 patients). Indication of tricuspid valve regurgitation improved from 3.6±0.3 to 1.5±0.4. Survival rate at 5 and 10 years was 98.6% and 98.2%, respectively. Conclusions The principle of the techniques is to reconstruct the tricuspid valve and right ventricle anatomically. For most cases, the anatomical repair was demonstrated with low mortality, less complications and excellent durability at long-term follow-up. If the tricuspid valve is severely hypoplastic, one and a half ventricle repair and valve replacement may be alternatie.

Objective To investigate the changes of serum C reactive protein (CRP),D-two polymer (D-D) and calcitonin (PCT) in patients with severe chronic obstructive pulmonary disease ( COPD) and its clinical value. Methods A retrospective analysis was conducted in 146 patients with severe COPD at acute attack in Tongji Huangzhou Hospital of Huazhong University of Science and Technology from December 2015 to December 2017.In addition,146 cases of COPD at remission stage (remission group) and 80 healthy subjects (control group) who were admitted to the hospital during the same period were selected.The serum levels of D -D,hs-CRP and PCT were compared among the three groups.At the same time,the levels of serum D-D,hs-CRP and PCT in patients with no bacterial infection or different pulmonary function classification were compared .Results The serum levels of D-D, hs-CRP and PCT in the acute group [(1 927.4 ±83.4) μg/L,(39.3 ±3.2) mg/L,(5.8 ±1.7) ng/mL] were significantly higher than those in the remission group [(314.2 ±69.2)μg/L,(16.4 ±3.4)mg/L,(1.8 ±0.7)ng/mL], which in the remission group were also significantly higher than the control group [(231.7 ±58.5) μg/L,(3.8 ± 1.5)mg/L,(0.4 ±0.1)ng/mL],the differences were statistically significant (F＝35.487,11.266,6.752,P＝ 0.001,0.005,0.000).The serum levels of hs -CRP and PCT in the acute phase combined with bacterial infection group[(41.4 ±1.7) mg/L,(6.4 ±1.4) ng/mL] were higher than those in the non bacterial infection group [(36.3 ±1.2)mg/L,(5.0 ±1.0)ng/mL](F＝16.541,4.467,P＝0.000,0.011),but there was no statistically significant difference in D -D level ( P ＞0.05).There were statistically significant differences in serum D -D, hs-CRP and PCT levels among patients with different pulmonary function classification [serum D-D:(2 083.5 ± 88.3)μg/L vs.(1 727.3 ±71.3)μg/L vs.(1 523.5 ±67.3)μg/L;hs-CRP:(63.8 ±19.5)mg/L vs.(29.5 ± 10.4)mg/L vs.(10.6 ±3.2) mg/L;PCT:(6.2 ±1.3) ng/mL vs.(3.4 ±0.9) ng/mL vs.(1.3 ±0.4) ng/mL] (F＝34.493,15.488,6.567,P＝0.000,0.001,0.018),and the higher the pulmonary function classification ,the higher the above indicators(all P＜0.05).Conclusion The levels of serum CRP,D-D and PCT in patients with severe COPD at acute attack are significantly increased ,and the increase of the patients with bacterial infection is more obvious,and the index level is positively correlated with the classification of lung function ,which can provide a reference for clinical practice.

Objective To analyze the influencing factors of hematoma complicated from ultrasound-guided minimally invasive surgery for benign breast masses.Methods Retrospective analysis was performed in 412 patients with a total of 516 masses underwent the ultrasound-guided minimally invasive surgery for benign breast masses from January 2011 to December 2015 in Xiaoshan Hospital. Theχ2 test was used to univariately analyze risk factors of hematoma formation after ultrasound-guided minimally invasive surgery for benign breast masses. Logistic regression analysis was used to multivariately analyze risk factors of hematoma formation.Results All masses were resected completely, however, hematomas with long diameter≥1.0 cm were formed in 43 masses one week after surgery, and all hematomas were completely absorbed after six months. There were significant differences in the incidence of hematoma between the groups of different needle sizes, numbers of needle cutting, masses sizes, blood flow grades, depth, resection numbers and effective compression time of postoperative bandages (χ2=16.917, 14.548, 39.971, 23.333, 29.137, 36.819 and 39.864, respectively, allP<0.001). The needle sizes, the numbers of needle cutting, the masses sizes, blood flow grades, depth, resection numbers and the effective compression time constituted the risk factors of hematoma formation after the minimally invasive surgery.Conclusions The risk factors of the hematoma formation after ultrasound-guided minimally invasive surgery for benign breast masses included the different size of the needle, the number of different cutting needles, different size of the masses, the grade of blood flow, the number of resection and the different effective compression time of postoperative bandages. We could prevent the occurrence of hematoma in advance by screening patients and take corresponding measures.