Objective To analyze the long-term outcome of modified Morrow surgery (interventricular septal cardiomyectomy) in the treatment of hypertrophic obstructive cardiomyopathy (HOCM) in children. Methods The clinical data of the children with HOCM (aged≤14 years) who underwent modified Morrow surgery from January 2010 to August 2022 in Guangdong Provincial People's Hospital were retrospectively analyzed, including changes in hospitalization status, perioperative period, and long-term 15-lead electrocardiogram and echocardiography. Results A total of 29 patients were collected, including 22 males and 7 females, aged 10.00 (5.00, 12.00) years. Five (17.9%) patients had New York Heart Association (NYHA) heart function grade Ⅲ or Ⅳ. Ventricular septal cardiomyectomy was performed in all patients. All 29 patients survived and their cardiac function recovered after operation. Before discharge, right bundle branch block was observed in 2 patients and left bundle branch block in 6 patients. After surgery, in the left ventricular septal cardiomyectomy, the left atrial diameter decreased (P＜0.001), left ventricular end-systolic diameter increased (P=0.009), the peak pressure gradient of left ventricular outflow tract decreased (P＜0.001), and the thickness of ventricular septum decreased (P＜0.001). The systolic anterior motion of mitral valve disappeared and mitral regurgitent jet area decreased (P＜0.001). The flow velocity and peak pressure gradient of right ventricular outflow tract also decreased in the patients who underwent right ventricular septal cardiomyectomy. The average follow-up of the patients was 69.03±10.60 months. All the patients survived with their NYHA cardiac function grading Ⅰ or Ⅱ. No new-onset arrythmia event was found. Echocardiography indicated that the peak pressure gradient of the left ventricular outflow tract remained low (P<0.001). Moderate mitral regurgitation occurred in 2 patients, and left ventricular outflow tract obstruction with moderate mitral regurgitation occurred in 1 patient after simple right ventricular septal cardiomyectomy. Conclusion Right ventricular or biventricular obstruction is frequent in the children with HOCM and they usually have more symptoms before surgery. Modified Morrow surgery can effectively relieve outflow tract obstruction and improve their cardiac function. The long-term outcome is satisfactory. However, the posterior wall of the left ventricle remains hypertrophic. Also, there is an increased risk of a conduction block.

Objective To explore the impact of SARS-CoV-2-positive donors on the prognosis of heart transplant recipients. Methods The Medline, EMbase, CENTRAL, CNKI, Wanfang Data, VIP and China Biology Medicine from inception to May 2023 were searched by computer for studies about impact of SARS-CoV-2-positive donors on the prognosis of heart transplant recipients. The data were extracted from all the relevant literatures, and the quality of the data was assessed using the Newcastle-Ottawa Scale (NOS). All statistical analyses were conducted by the Stata 11.0 software. Results A total of 10 studies (NOS score ranging from 5 to 9 points) involving 643 patients were enrolled. The pooled results demonstrated that the pooled mortality of heart transplant recipients from SARS-CoV-2-positive donors was 4% (95%CI 2% to 5%). And the incidence of composite outcome, regarding graft failure, rejection and death as poor prognosis, was 7% (95%CI 5% to 9%). Besides, compared with recipients from SARS-CoV-2-negative donors, the pooled odds ratio (OR) value of death of SARS-CoV-2-positive donors was 0.68 (95%CI 0.38 to 1.22, Z=1.28, P=0.200). The pooled OR value of rejection rate was 0.41 (95%CI 0.27 to 0.64, Z=3.97, P<0.005). For the composite outcome, the pooled OR value was 0.50 (95%CI 0.37 to 0.69, Z=4.30, P<0.005). In addition, there was no statistical difference in the length of hospital stay between heart transplant recipients from SARS-CoV-2-positive donors and negative donors (SMD=–0.03, 95%CI –0.22 to 0.15, Z=0.36, P=0.720). Conclusion The application of heart from SARS-CoV-2-positive donor for transplantation is safe and feasible. However, further prospective studies with longer follow-up are still needed to verify its impact on long-term outcomes.

Objective To investigate expression levels and clinical significance of annexin A2 and S100 calcium binding protein A10 (S100A10) in cerebrospinal fluid of patients with secondary intracranial infection after craniocerebral surgery. Methods A total of 120 patients with secondary intracranial infection after craniocerebral surgery were selected as test group, while 120 patients with no infection after craniocerebral surgery in the same period were selected as control group. The levels of Annexin A2 and S100A10 in cerebrospinal fluid were detected by enzyme-linked immunosorbent assay(ELISA). Pearson correlation analysis was applied to analyze the correlations of Annexin A2 and S100A10 with clinical indicators. Logistic regression analysis was applied to analyze the influencing factors of secondary intracranial infection after craniocerebral surgery. Receiver operator characteristic (ROC) curve was applied to analyze the predictive value of Annexin A2 and S100A10 levels for the occurrence of secondary intracranial infection after craniocerebral surgery. Results The proportions of diabetes and cerebrospinal fluid leakages, blood l actate dehydrogenase (LDH), cerebrospinal fluid Annexin A2 and S100A10 levels in the test group were higher than those in the control group (P < 0.05). Annexin A2 in cerebrospinal fluid of patients with intracranial infection was positively correlated with S100A10, LDH, and S100A10 level was positively correlated with LDH (P < 0.05). Multivariate Logistic regression analysis showed that diabetes, cerebrospinal fluid leakage, blood LDH, Annexin A2 and S100A10 in cerebrospinal fluid were independent influencing factors for secondary intracranial infection after craniocerebral surgery (P < 0.05). ROC results showed that the AUCs of Annexin A2 level or S100A10 level alone in cerebrospinal fluid and their combined prediction for secondary intracranial infection after craniocerebral surgery was 0.788, 0.768 and 0.865 respectively, the AUC of combined prediction was larger than that of the single prediction (P < 0.05). Conclusion The expression levels of Annexin A2 and S100A10 are increased in cerebrospinal fluid of patients with secondary intracranial infection after craniocerebral surgery, which are independent influencing factors for secondary intracranial infection after craniocerebral surgery. Their combination has higher predictive value for secondary intracranial infection after craniocerebral surgery.

OBJECTIVE: The purpose of this study was to prospectively investigate the value of the myocardial extracellular volume fraction (ECV) in predicting myocardial functional outcome after revascularization of coronary chronic total occlusion (CTO). MATERIALS AND METHODS: Thirty patients with CTO underwent cardiovascular magnetic resonance (CMR) before and 6 months after revascularization. Three baseline markers of functional outcome were evaluated in the dysfunctional segments assigned to the CTO vessels: ECV, transmural extent of infarction (TEI), and unenhanced rim thickness (RIM). At the global level, the ECV values of the whole myocardium with and without a hyperenhanced region (global and remote ECV) were respectively measured. RESULTS: In per-segment analysis, ECV was superior to TEI and RIM in predicting functional recovery (area under receiver operating characteristic curve [AUC]: 0.86 vs. 0.75 and 0.73, all p values < 0.010), and it emerged as the only independent predictor of regional functional outcome (odds ratio [OR] = 0.83, 95% confidence interval [CI]: 0.77–0.89; p < 0.001) independent of collateral circulation. In per-patient analysis, global baseline ECV was indicative of ejection fraction (EF) at the follow-up examination (β = −0.61, p < 0.001) and changes in EF (β = −0.57, p = 0.001) in multivariate regression analysis. A patient with global baseline ECV less than 30.0% (AUC, 0.93; sensitivity 94%, specificity 80%) was more likely to demonstrate significant EF improvement (OR: 0.38; 95% CI: 0.17–0.85; p = 0.019). CONCLUSION: Extracellular volume fraction obtained by CMR may provide incremental value for the prediction of functional recovery both at the segmental and global levels in CTO patients, and may facilitate the identification of patients who can benefit from revascularization.
Collateral Circulation ; Coronary Vessels* ; Follow-Up Studies ; Humans ; Infarction ; Magnetic Resonance Imaging* ; Myocardial Infarction ; Myocardial Ischemia ; Myocardium ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity

Objective To investigate the value of muhiple inflammatory cells and clinical score in early diagnosis and prognosis assessment of trauma sepsis risks.Methods This retrospective control study enrolled 209 severe trauma patients admitted from January 2010 and May 2016.White blood cell count,lymphocyte count and percentage,monocyte count and percentage,neutrophil count and percentage,ratio of neutrophil to lymphocyte count (N/L),acute physiology and chronic health evaluation (APACHE) Ⅱ score,sequential organ failure assessment (SOFA),improved early warning score (MEWS),Glasgow coma score (GCS),multiple organ dysfunction syndrome (MODS) score and lactic acid (LAC) were collected on the day of admission and 3,5,7 days after trauma.These data were applied to construct weighted and biological score models for early diagnosis and prognosis of traumatic sepsis.Receiver operating characteristic curve (ROC) was performed and area under the curve (AUC) was calculated to measure the value of the two models in early diagnosis and prognosis of sepsis.Results AUC of the weighted model combined by APACHE Ⅱ score,SOFA score and MEWS was 0.729 on the day of admission.AUC of the weighted model combined by inflammatory cells was 0.680 and AUC of the biological score model was 0.800 3 days after trauma (P ＜ 0.05).AUC of the weighted models combined by inflammatory cells was 0.798 and AUC of the biological score model was 0.812 5 days after trauma (P ＜ 0.05).AUC of the weighted models combined by inflammatory cells was 0.706 and AUC of the biological score model was 0.713 7 days after trauma (P ＞ 0.05).AUC of the biological score model had significant difference 3 days and 5 days after trauma (P ＜ 0.05).Of the weighted model combined by APACHE Ⅱ score,MODS score,GCS and LAC to evaluate the prognosis of sepsis,the AUC showed significant difference on the day of admission (0.838),3 days after trauma (0.878),5 days after trauma (0.947) and 7 days after trauma (0.936) (P ＜ 0.05).Conclusions Biological score possesses better effect on early diagnosis of sepsis 3 days after trauma.Weighted model combined by APACHE Ⅱ score,MODS score,GCS and LAC can effectively predict the prognosis of sepsis 5 days after trauma.

Objective:To evaluate influence of electroacupuncture combined point massage on aptients with cartid ar- tery arteriosclerosiss.Methods:A total of 106 patients with carotid atherosclerosis were randomly divided into rou- tine group (n=54,received health education based on routine therapy)and electroacupuncture+ massage group (n=52,received additional electroacupuncture and point massage based on routine group).Both groups were treated for two courses,20 times/course, 1 time/d.Carotid intima-media thickness (IMT)and thickness of carotid plaques were measured and compared between two groups before and after treatment.Results:There were no sig- nificant difference in thickness of carotid plaques and IMT between two groups before treatment,P>0.05 all. Compared with before treatment,after treatment,there were significant reductions in thickness of carotid plaques [left:(0.104±0.103)mm vs.(0.044±0.031)mm,right:(0.111±0.093)mm vs.(0.055±0.046)mm]in elec- troacupuncture + massage group,and they were significantly thinner than those of routine group [left:(0.190± 0.175)mm,right:(0.223±0.183)mm],P<0.01 all;significant reductions in carotid IMT [left:(0.096±0.021) mm vs.(0.086±0.019)mm,right:(0.091±0.019)mm vs.(0.087±0.018)]in electroacupuncture + massage group,and they were significantly thinner than those of routine group [left:(0.105±0.016)mm,right:(0.103± 0.020)mm],P<0.05 or <0.01.Conclusion:Electroacupuncture combined point massage can effectively reduce thickness of carotid plaques and carotid intima-media thickness.

Objective To discuss the nursing points for patients with malignant obstructive jaundice who are receiving biliary stenting combined with linear 125I seeds strand implantation. Methods A total of 41 patients with malignant obstructive jaundice were enrolled in this study. Biliary stenting combined with linear 125I seeds strand implantation was performed in all the 41 patients. Sufficient preoperative preparation and psychological intervention were carefully implemented. During the operation, active cooperation with the surgical procedures and close observation of patient’s vital signs as well as adverse reactions such as nausea and vomiting were strictly carried out. After the treatment the management of PTCD drainage tube, the protection of radiation and the early detection of complications were further emphasized. Results The technical success rate of biliary stenting together with linear 125I seeds strand implantation was 100%. The serum total bilirubin levels, determined at one week, one and 3 months after the treatment, were significantly decreased when compared with the preoperative data. Clinically, the jaundice basically subsided. Bile-cardiac reflex occurred in one case and displacement of PTCD drainage tube in 2 cases. Twelve patients developed chills and fever after operation. Acute renal insufficiency occurred in one patient, which was relieved after effective management. The median survival time was 10.9 months. Conclusion Careful and comprehensive preoperative preparation can ensure a successful operation. Intraoperative close observation of patient’s condition and skilled cooperation with the operator, and high quality postoperative nursing measures and close observation for early signs of complications are essential nursing points to ensure that the patients can safely get over the rehabilitation period.

Objective To discuss the method, safety and clinical value of biliary stenting combined with 125I seed implantation intracavitary irradiation in treating malignant obstructive jaundice. Methods A total of 36 patients with malignant obstructive jaundice were enrolled in this study. PTCD was carried out in all patients, which was followed by biliary stenting combined with 125I seed implantation intracavitary irradiation treatment. The results were analyzed. Results During the interventional management, displacement of the stent and 125I seeds were observed in two cases, and the displaced stent and 125I seeds were replaced to the right position with the help of biliary biopsy forceps. The technical success rate was 100%, and the remission rate of the jaundice was 100%. All the patients were followed up for 1-23 months. No radioactive particles leaking or complications such as radiation enteritis occurred. No in-stent obstruction due to tumor recurrence was observed although slight dilatation of intrahepatic bile duct was detected in 25%of patients, which was resulted from intimal hyperplasia at the stent mesh and/or biliary stone formation. The median survival time was 10.9 months. Conclusion For the treatment of malignant obstructive jaundice, biliary stenting combined with 125I seed implantation intracavitary irradiation is safe, reliable and effective. This technique can prolong stent patency time as well as the patient’s survival time.

[Objective] To explore the role of endothelin-3 (ET-3) on epithelial-to-mesenchymal transition in a malignant melanoma cell line A375.[Methods] A375 cells were cultured in vitro and classified into 3 groups to be treated with ET-3 at 100 nmol/L (ET-3 group),co-cultured with ET-3 at 100 nmol/L and endothelin receptor B (ETRB) antagonist BQ788 at 100 μmo1/L (ETRB antagonist group),or to remain untreated (blank control group).After additional 24-hour culture,Transwell chamber assay was used to detect the invasive capability of A375 cells,real time-PCR to measure the mRNA expressions of Twist and Slug,and Western blot to determine the protein expression of E-cadherin,vimentin,Twist and Slug.The changes in the morphology of A375 cells were observed.Data were assessed by analysis of variance and Scheffe's method.[Results] In the Transwell assay,the number of A431 cells permeating through the basement membrane was 4.200 ± 0.837,9.400 ± 0.548 and 3.400 ± 0.894 respectively in the blank control group,ET-3 group and ETRB antagonist group (F =88.44,P ＜ 0.01 ),suggesting that ET-3 could promote the metastasis of A375 ceils,while BQ788 could block the promotive effect of ET-3.The epithelial-to-mesenehymal transition was obvious in cells treated with ET-3 alone,but was inapparent in cells treated with ET-3 and BQ788.The ET-3 at 100 nmol/Lsignificantly decreased the protein expression of E-cadhefin from 0.33 ± 0.002 (blank control group) to 0.28 ±0.007,but increased that of vimentin from 0.83 ± 0.014 (blank control group) to 1.16 ± 0.003,while BQ788upregulated the E-cadherin expression to 0.42 ± 0.008 and downregulated the vimentin expression to 0.75 ±0.030,and significant differences were observed in the E-cadherin expression and vimentin expression among the ET-3 group,ETRB antagonist group and blank control group (F =329.98,262.94,respectively,both P ＜ 0.01 ).A significant increase was observed in the mRNA and protein expression of Slug (F=376.94,288.87,both P＜ 0.01 )and Twist (F=215.62,156.96,P＜ 0.01 and 0.05) in A375 cells after treatment with ET-3.[Conclusion] ET3/ETRB axis may promote the epithelial-to-mesenchymal transition in A375 cells likely by regulating the expression of E-cadherin,vimentin and two important transcription factors Twist and Slug.

Objective To explore the effects of long-term Tai Ji exercise on risk factors of cardiovascular diseases and incidence of chronic diseases. Methods The elderly involved were divided into control group (n=62) and Tai Ji group (n=63). Both of them received 2-years health education. The Tai Ji group exercised with the frequency of 30~40 minutes each time, 3 times a week, while the control group didn't change their daily behavior. They were observed 2 and 6 years later. Results 2 years later, the blood pressure, weight and waistline decreased in Tai Ji group compared with the control group (P<0.05). After 6 years followed, 1 people died and 4 people occured cardiovascular diseases in Tai Ji group, while 2 people died and 12 people occured cardiovascular diseases in the control group. The incidence of chronic diseases was lower in Tai Ji group (9.52%) than in the control group (33.87%) (P<0.01). And the blood pressure, waistline, and hipline in Tai Ji group decreased significantly compared with the control group (P<0.001). Conclusion Long-term Tai Ji Exercise can ameliorate the risk factors of cardiovascular diseases and reduce the incidence of chronic diseases.