Congratulations to the publication of CJIIT

It is my great pleasure and honor to give my congratulations to the publication of Chinese Journal of Interventional Imaging and Therapy. I have always been greatly impressed by the recent rapid progress in the economy of China. The role of the Chinese Government in the political world has become greater and greater. There is no doubt that China will become one of the most influential nations in the medical world also, in particular in the field of interventional imaging and therapy. My personal interest is how the traditional Chinese medicine becomes harmonized with the modern western medicine.     

Tetralogy of Fallot: to patch or not to patch?

Angiograms of 11 patients with Tetralogy of Fallot were reviewed before and after total repair, and analyzed with respect to growth of the pulmonary valve annulus. At the operation none of the patients was more than 5-years-old, none received a transannular patch and all were asymptomatic at the last visit. The radiologic diameter of the pulmonary valve annulus was compared to the descending thoracic aorta at the level of the diaphragm. Preoperative ratio averaged 1.09 +/- 0.22 and increased postoperatively to 1.35 +/- 0.20 (p less than 0.02). A "catch-up" growth of small annuli could be demonstrated.     

Obliterations of the proximal subclavian artery: to bypass or to anastomose?

A clinical series has been analysed to determine which of two similar, extrathoracic "extraanatomic" methods of treating proximal blocks of the subclavian artery is the superior option. From 1975 until 1988 direct carotid-subclavian anastomosis was used in 32 patients and carotid-subclavian bypass in 19. There were no statistically significant differences for the probability of postoperative survival (p less than 0.877 Breslow; p less than 0.774 Mantel), intraoperative blood loss or the duration of anaesthesia. Those patients who had undergone subclavian artery repair had a significantly longer survival than those following carotid bifurcation endarterectomy (p less than 0.002 Breslow, p less than 0.0002 Mantel). As patients with subclavian lesions have a reasonable life-expectancy, they may possibly experience late complications of their vascular repair. Therefore it seems important to select the most durable operation, and direct carotid subclavian anastomosis has a significantly greater patency rate than bypass (p less than 0.006 Breslow, p less than 0.006 Mantel). Patients with preoperative symptoms of cerebrovascular insufficiency had a lower probability of survival than those with upper extremity claudication, although this did not reach statistical significance (p less than 0.205 Breslow; p less than 0.198 Mantel).     

The foreword to the Chinese Journal of Traumatology

Today marks the birthday of Chinese Journal of Trau-matology(English Edition),which is the first English lan-guage publication on trauma in China.This is an occasionfor trauma researchers to celebrate.     

Projections of the Impact to Arthroplasty Surgeons With Changes to the 2021 Medicare Physician Fee Schedule—A Looming Crisis of Access to Care?

BackgroundThe Centers for Medicare and Medicaid Services 2021 Physician Fee Schedule (PFS) includes increases in office reimbursement but decreases in the valuation of total hip arthroplasty and total knee arthroplasty and the conversion factor. The purpose of this study was to determine the financial impact of these changes on arthroplasty surgeons.MethodsWe queried data for 35 arthroplasty surgeons within our practice from 10/2019 to 10/2020 and captured all office and arthroplasty-related surgical procedure codes. We compared the difference in both work relative value units (RVUs) and Medicare reimbursement by surgeon based on the current 2020 PFS to the 2021 changes. We also estimated the impact of several proposals to include office increases to the global surgical package for each code.ResultsWhile the mean per surgeon RVU amount for primary arthroplasty procedures will decrease (6267 vs 6,088, P = .78), the mean office work RVU (2755 vs 3,220, P = .16) will increase in 2021. However, the reduction in surgical reimbursement ($530,076 in 2020 to $464,414 in 2021) far exceeds the gains from the office ($99,456 vs $107,374), leading to an overall decrease in reimbursement ($629,532 vs $571,788), a reduction of 9%. The passage of the coronavirus disease 2019 relief bill delays many of the PFS cuts and will result in an overall reduction in reimbursement of 2.4% ($629,532 vs $612,475, P = .61).ConclusionArthroplasty surgeons are projected to lose 2.4% of Medicare reimbursement in 2021 with the changes in the Centers for Medicare and Medicaid Services PFS. Further study is needed to determine whether these cuts will limit access to care for Medicare patients.     

Response of prostate cancer to addition of dutasteride after progression on abiraterone

Dear Editor,Abiraterone has achieved great success in clinic by targeting cytochrome P45017A1(CYP17A)for prostate cancer therapy.1,2 However,drug resistance is inevitable and novel strategy is urgently required.Our previous work unveils a steroidal metabolic pathway for abiraterone in patients.3,4 Steroidogenic enzyme 3β-hydroxysteroid dehydrogenase 1(3βHSD1)catalyzes abiraterone toΔ4-abiraterone(D4A),which is further catalyzed to 5α-abiraterone(5α-Abi)by steroid-5α-reductase(SRD5A).The metabolite 5α-Abi binds to androgen receptor(AR)directly and activates AR signaling.     

The centennial of the Department of Microbiology Iaşi--tribute to predecessors

1892-1913 Bacteriological investigations conducted in Ia?i's hospitals. * 1896 Up to date lectures featuring chapters on microbiology. 1899-1911 The first interim of the Department. 1 februarie 1912 Bacteriology Department de iure et facto: Alexandru Sl?tineanu. * 1938-39 Second intermediate period. * 1939-1942 Romanian inframicrobiology first started in Ia?i : Stefan S. Nicolau. 1942-1946 Third intermediate period. * 1946 The Bacteriology Department redivivus: Professor Petru Condrea * 1953 The Discipline of Virology: Professor Mihai Duca.     

Analysis of 78 cases of prehospital death due to traffic accident injury

Objective The cause and time of prehospital death for the injured patients caused by traffic accidents were studied in order to improve traffic management and clinical treatment,and reduce mortality.Methods The characteristics of the injury,the rescue procedure,the status of the injury leading to death were analyzed based on the retrospective data of 78 cases died before admission.Results The main causes of prehospital death in the traffic accidents included:1.head injury,2.bleeding,3.chest and heart wound,4.spinal cord injury at upper cervix.Death happened immediately after injury was in 17 cases.Death happened from the accident site to our hospital was in 47 cases.Death happened within half an hour after reaching emergency room was in 14 cases.In all of the cases,the death on the transfer took up 62.5%.Conclusions Findings from analysis of the data will be presented on a wide range of traffic safety issues.These include enhancing education of traffic safety and administration of drivers and motor vehicles,establishing a perfect emergency medical service system and a well-trained team of first aid,and popularizing first aid knowledge to all people.     

How to alter surgical practice? The use of guidelines to encourage day-case haemorrhoidectomy

BACKGROUND: Day case haemorrhoidectomy has been shown to be safe and acceptable to patients. The best way to introduce such evidence into clinical practice remains unclear: The aim is to assess the effectiveness of guidelines on the introduction of day-case haemorrhoidectomy in a general surgical unit. METHODS: Prospective audit of day-case haemorrhoidectomy and retrospective review of in-patient procedures. The effectiveness of guidelines in encouraging day-case haemorrhoidectomy is assessed by analysis of avoidable admissions. RESULTS: In the year prior to introduction of the guidelines 75 patients had elective haemorrhoidectomy, none as day-cases. In the year following the introduction of the guidelines 80 patients had elective haemorrhoidectomy, 35 (44%) as day cases. There were no complications or re-admissions. Of the 45 in-patients 31 (69%) were eligible for day surgery. CONCLUSIONS: The establishment of clear guidelines and their dissemination results in significant changes in practice. However, audit has demonstrated that alternative strategies are needed to encourage changes in clinical practice.     

“Anatomy Lesson of Frederik Ruysch” of 1670: A Tribute to Ruysch’s Contributions to Lymphatic Anatomy

Background

Frederick Ruysch was one of the most prominent Dutch physicians of the seventeenth and eighteenth centuries. For more than 65 years, he was the Praelector Anatomiae (Lecturer of Anatomy) of the Amsterdam Guild of Surgeons. During his career, he conducted many dissections at the guild’s theatre to teach anatomy. Ruysch was internationally renowned for his great dissection skills and his innovative techniques for preserving anatomical specimens. The “Anatomy Lesson of Dr. Frederik Ruysch” painted in 1670, is thought to be a group portrait undertaken to commemorate the officials of the Guild of Surgeons. Ruysch was portrayed performing an anatomical dissection of inguinal lymph nodes on the corpse of an executed criminal. This portrait is one of the earliest paintings focusing on the “lymphatic system.”

Methods

We investigated the medical background of the painting by revisiting Ruysch’s original work from the mid-seventeenth century. His contributions to the early history of “lymphatic anatomy” are assessed and interpreted from the perspective of the renewed interest in “lymphatic imaging” today.

Results and conclusions

Frederik Ruysch should be considered one of the pioneers contributing to the early knowledge of the lymphatic system. He succeeded in dissecting the lymphatic vessels and valves with the aid of his innovative dissection and preservation techniques. The famous group portrait of the Amsterdam Guild of Surgeons with Ruysch demonstrating the lymph nodes pays tribute to his work on which we still rely today.