Objective To review retrospectively the experience of surgical treatment of Ebstein anomaly in 45 adult patients.Methods Between January 2008 and December 2011,45 adult patients underwent surgery for Ebstein anomaly.There were 14 male and 31 female patients aged 18 to 61 years (mean,39 years).The main symptoms included chest tightness,shortness of breath,palpitation.25 patients had cyanosis,while 6 patients with Wolff-Parkinson-White syndrome.Preoperative echocardiography: The septal downward from 2.5 cm to 7.5 cm,average 4.2 cm; the posterior leaflet downward 3.0 cm to 8.0cm,average 5.1 cm.Tricuspid incompetence was moderate in 6 patients and severe in 29.According to Carpentier classification,5 cases of type A,30 type B,type C in 6 cases.Preoperative New York Heart Association(NYHA) functional class Ⅱin 14 cases,Ⅲ 30 cases,Ⅳ in 1 cases.Surgical procedures included modified Danielson's in 15 patients,modified Carpentier's in 23,and 7 patients underwent tricuspid valve replacement(incloud 4 secondary operations).The ratio of tricuspid valve repair was 84.4％.Autologous pericardium patch was used to reconstruct the septal and posterior leaflets in 5 cases.Intraoperative use of annuloplasty rings in 21 cases.Results There were 2 hospital deaths with a postoperative mortality of 4.4％.The main causes of death were low cardiac output and right heart failure.Operation to discharge time was (8.0 ± 3.8)days.The follow up time was 2 to 46 months.Echocardiography examination: Within the 32 patients of severe tricuspid regurgitation before tricuspid valve plasty,16 patients’ tricuspid regurgitation disappeared,13 patients with mild regurgitation,3 moderate regurgitation.Within 5 patients of moderate tricuspid regurgitation before tricuspid valve plasty,4 cases tricuspid regurgitation disappeared after operation,1 case tricuspid valve mild regurgitation.Tricuspid valve leaflets were at normal levels,the atrialized portion of the ventricular disappeared.The heart function improved to be NYHA class Ⅰ to Ⅱ in 95 ％ of the survived patients.Conclusion Operative method of Ebstein anomaly sould be selected according to the type of pathoanatomies.Tricuspid valve repair should be performed to the best of our ability.

Objective:To observe the multimodal imaging features of retinal diseases associated with COVID-19.Methods:A retrospective case study. Sixteen patients (30 eyes) of retinal diseases associated with COVID-19 admitted to the Ophthalmology Department of the Second People's Hospital of Zhengzhou in December 2022 were included in the study. There were 5 males and 11 females, with the mean age of (26.69±9.88) years; 14 patients were bilateral and 2 patients were unilateral. The time of ocular symptoms after the diagnosis of COVID-19 was (2.63±0.89) days. All patients underwent the examinations of best corrtected visual acuity (BCVA), fundus color photography (FP), infrared fundus photography (IR), optical coherence tomography (OCT). Fluorescein fundus angiography (FFA) was performed in 2 patients (4 eyes). There were 20 eyes with acute macular neuroretinopathy (AMN), including 6 eyes with cotton wool spots; 10 eyes with Purtscher-like retinopathy (PLR). The BCVA of the patients was 0.1-1.0. No obvious abnormality was found in anterior segment examination. The features of FP, IR and OCT were analyzed retrospectively.Results:In 20 eyes of AMN, irregular reddish brown lesions in the central or paracentral area of the macula in 14 eyes; FP showed no obvious abnormality in 6 eyes; IR showed irregular map like low reflection in the central or paracentral area of macular in all eyes; OCT showed hyperreflectivity in outer plexiform layer and outer nuclear layer, hyporeflectivity in the ellipsoid zone and photoreceptor layers in all eyes; no abnormal fluorecence was observed in 2 eyes examined by FFA. In 10 eyes with PLR, cotton wool spots and retinal hemorrhage were observed in the posterior pole and/or peripapillary area, and the peripheral retina was generally normal, Purtscher spot was found in 5 eyes and macular edema in 4 eyes; OCT showed strong reflex signal in neuroepithelial layers, edema in neuroepithelial layers in 6 eyes; in the 2 eyes examined by FFA, fluorescein leakage from the retinal vein wall was observed, the posterior pole and peripapillary area retinal arteriole occlusions showed patchy hypofluorescence, the fluorescence was obscured by retinal hemorrhage below at inferior retina.Conclusions:For AMN associated with COVID-19, IR can show the lesion contour, OCT shows lesions in the outer retina. PLR associated with COVID-19 are usually at the posterior pole and/or peripapillary area in FP, OCT shows neurocortical edema.

Objective: To investigate the current status of the occupational hazards of welding fume, manganese, and manganese compounds in the welding environment of a large container manufacturing enterprise, as well as the status of occupational health examination of workers, and to provide a basis for improving the welding environment of this enterprise. Methods: In August 2016, July 2017, and August 2018, convenience sampling was used to perform an on-site occupational hygiene survey of the welding workshop for three consecutive years, and welding fume, manganese and, manganese compounds (counted as manganese dioxide) were measured for their workplace exposure concentrations and exposure levels in workers. A comprehensive analysis was performed for the results of occupational health examination. Results: Welding fume, manganese, and manganese compounds in the welding environment gradually increased from 2016 to 2018 (χ²_trend=5.14 and 5.54, P<0.05). The maximum over-standard rate of concentration-short term exposure limit was 43.3% (13/30) for welding fume and 40.0% (12/30) for manganese and its compounds, and the maximum over-standard rate of time-weighted average concentration was 26.7% (8/30) for welding fume and 23.3% (7/30) for manganese and its compounds. Abnormalities were observed in the occupational health examination of welding workers in 2016-2018, among which respiratory system abnormalities (cough, expectoration, and wheezing), nervous system abnormalities (dizziness, fatigue, sleep disorders, amnesia, hyperhidrosis, and palpitations), and electrocardiogram abnormalities (bundle conduction block) had an incidence rate of above 10.0%, and the incidence rate of abnormalities on posterior-anterior X-ray high-kV chest radiograph was close to 8.9% (30/336) . Conclusion There is severe exposure to welding fume, manganese, and manganese compounds among workers in this enterprise, which cause great hazards to the health of workers. It is necessary to strengthen occupational health management, take measures to improve the welding environment, and enhance occupational disease prevention.