ObjectiveTo assess the characteristics of left ventrlcular ( LV) systolic syncnrony before and 6 days after percutaneous transluminal septal myocardial ablation(PTSMA)in patients with hypertrophic obstructive cardiomyopathy (HOCM) using two dimensional speckle tracking imaging(2DSTI),and to investigate correlation between the LV systolic synchrony and LV outflow-trace gradient (LVOTG).MethodsLVOTG were measured before and 6 days after PTSMA in 21 patients with HOCM.The two dimensional loop-cinec were obtained in three levels of the short axis views of LV (mitral valve,papillary muscle and cardiac apex).The time from the onset of QRS complexes to systolic peak strain from the radial vectors (TRs) was recorded using 2D-STI.The standard deviation of the TRS of 18 segments (TRsSD) were calculated as indicator of LV systolic synchrony.Results Six days after PTSMA,LVOTG decreased significantly from (84.3 ± 19.1)mm Hg to (40.6 ± 8.3)mm Hg( P ＜0.01).TRS of the base and middle segments of anteroseptal were prolonged dramatically( P ＜0.05) 6 days after PTSMA compared with that before.There were no significantly differences in TRs-SD of LV between before and 6 days after PTSMA ( t =1.03,P ＞ 0.05).Decreased LVOTG correlated moderately to prolonged TRS of the base segments of anteroseptal ( r =0.657,P ＜0.05).Conclusions2D-STI can detect exactly the characteristics of LV systolic synchrony before and 6 days after PTSMA in patients with HOCM.

Objective This study was conducted to investigate the clinical outcomes and safety of percutaneous coronary intervention (PCI) to the single-opened vessel lesion among patients with severe left ventricular systolic dysfunction. Methods Twenty-seven patients with severe left ventricular systolic dysfunction (ejection fraction≤35%) undergoing PCI were included. All the patients received PCI only to the single-opened vessel lesion under the conditions of: (1) There were limitations to open chronic total occlusion (CTO);(2) Single-opened vessel lesion was not calcified and tortuous. Clinical outcomes, including success rate of PCI, changes of symptoms in-hospital, brain natriuretic peptide (BNP) and left ventricular ejection fraction (LVEF) pre-and one week post-PCI, the major adverse cardiac events (MACE, including death, myocardial infarction and target vessel revascularization) at 30-days after discharged were observed. Results The success rate of PCI was obtained in all 27 patients(100%), and all the patients received drug eluting stent implantation. The symptoms improvement occurred in all patients and the NYHA class improved from grade Ⅳto grade Ⅲin 22 patients(81.5%) in-hospital. Significant differences were noted in the mean BNP and LVEF between pre-PCI and one week post-PCI, BNP[(2699.6±1104.7) pg/ml vs. (737.0 ± 261.7) pg/ml, P<0.05],LVEF[(26.9±5.7)%vs. (36.0±3.41)%, P<0.05)]. No MACE happened in-hospital and at 30-days follow up. Conclusions PCI only to the single-opened vessel lesion among patients with severe left ventricular systolic dysfunction under the condition of limitations to open CTO is safe and can significantly improve clinical outcomes in-hospital and at 30-days follow up, but it must be emphasized that single-opened vessel lesion not with obvious calcification and tortuosity.

Objective To evaluate the application value of real-time three-dimensional echocardiography (RT-3D TEE) in nonvalvular atrial fibrillation patients after transcatheter left atrial appendage closure (LAAC) with the Amplatzer Cardiac Plug (ACP).Methods The two-dimensional transesophageal echocardiography (2D TEE) and RT-3D TEE were performed in selected patients to measure the diameter of left atrial appendage ostium and landing zone,to observe left atrial appendage morphology and lobular distribution.These were also performed to guide the whole process of transcatheter LAAC with ACP,which included the atrial septal puncture,sheathing canal cruise,occluder device implantation,and verifying the stability of occluder device and releasing the device.It involved observing ACP occluder morphology,location,stability,surrounding residual shunt,whether influencing the mitral valve and left superior pulmonary vein flow,and pericardial effusion.Results A total of 15 patients (100％) successfully underwent LAAC with the ACP.The maximum diameter of left atrial appendage ostium by 2D-TEE measurement during operation was (20.5 ± 2.9)mm,located at 135°.The diameter of left atrial appendage landing zone was (17.1 ± 2.8) mm,located at 45°;(18.0 ± 4.0) mm,located at 90°;(22.1 ± 4.7)mm,located at 135°,respectively.The left atrial appendage morphology:2 had one leaf and 13 had two leaves or more,including 2 cases of bifoliate short neck shape.In 15 patients,6 cases of cauliflower type,2 cases of wind sock type,3 cases of chicken wing type,2 cases of cactus type and 2 cases of complex type.The proximal left atrial appendage morphology:3 cases of boot type,2 cases of wide mouth type,6 cases of narrow mouth type,2 cases of straight tube type,and 2 cases of bifoliate short neck type.There was no obvious residual shunt in all the patients at immediately post-operation.Conclusions In the transcatheter LAAC with the ACP,RT-3D TEE has important application value in the preoperative selection of patients,the choice of appropriate occluder,guidance of full-process monitoring during operation,the postoperative effect evaluation and so on.

Objective: To understand physical fitness among primary and middle school students in Henan Province, so as to provide theoretical basis for physical fitness promotion among primary and middle school students. Methods: Based on data of National Survey on Student Physical Fitness and Health in Henan Province in 2019, a total of 42 734 students were investigated. The Z value of each physical fitness index were calculated by Z method, physical fitness index (PFI) was obtained to reflect the physical fitness condition synthetically. Physical fitness of different groups were compared, and associated factors of PFI were analyzed by multiple linear regression. Results: Lung capacity, grip strength, standing long jump, 50 m run, 50 m×8 shuttle run and PFI in boys were [(2 552.1±1 226.5)mL, (26.0±13.9)N, (171.0±43.7)cm, (9.3±1.8)s, (132.1±22.6)s, (1.4±3.6)], respectively, which were significantly higher than that of girls [(1 965.2±765.3)mL, (19.1±8.2)N, (142.4±26.6)cm, (10.5±1.4)s, (136.9±21.1)s, (-1.4±3.2)]( t =59.35,62.66,81.87,-74.92,-16.72,85.96, P <0.01). The seated forward flexion of boys [(7.0±7.5)cm] was significantly lower than that of girls[(11.8±7.1)cm], the difference was statistically significant ( t =-68.57， P <0.01). Significant sex differences were observed in physical fitness at different age ( P <0.01). There was a certain gap between urban boys and rural boys in terms of strength quality, endurance quality and flexibility quality, and the physical quality of urban girls was better than that of rural girls as a whole. The detection rates of poor eyesight, malnutrition, overweight and obesity, anemia and high blood pressure of primary and middle school students were 68.0%, 5.4%, 26.0%, 15.9% and 18.0%, respectively. Region, sex, age and nutritional status(malnutrition,overweight and obesity) were the influencing factors of PFI( β =-0.23,-2.92,-0.11,-1.19, -0.78 , P <0.05). Conclusion Physical fitness among primary and middle school students varies in gender, age group, region and disease condition in Henan Province. Scientific intervention should be administered, especially for rural, female students, senior students, undernourished and overweight and obese students, to improve health awareness and physical fitness.

Objective To study the effect of diosgenin(Dio) from Dioscorea nipponica on the proliferation in mouse spleen T lymphocytes and expressions of IL-2 and IFN-γmRNA,in order to investigate the immunity regulatory mechanism of Dio.Methods T lymphocytes stimulated by different concentrations of Dio and concanavalin A(ConA) were co-cultured.CCK-8 was used to detect the Dio effects on T lymphocyte proliferation.The RT-PCR method was adopted to detect the effect of Dio on expression of IL-2 and IFN-γmRNA.Results The Dio concentration in the range of 0.937 5-15.000 0 μg/mL had the inhibiting effect on T lymphocyte proliferation,Dio concentration in the range of 3.750 0-15.000 0μg/mL had the inhibiting effect on IFN-γ and IL-2 expression in T lymphocytes.With the Dio concentration increase,the inhibition effect was enhanced(P＜0.05).7.500 0 μg/mL was the best inhibition concentration.The inhibition effect was decreased when the concentration exceeding 7.500 0 μg/mL.Conclusion Dio has the inhibiting effect on T lymphocyte proliferation and expressions of IL-2 and IFN-γ mRNA.

Objective To assess left atrial (LA) function by two dimensional speckle tracking echocardiography (2DSTE) in patients with hypertrophic obstructive cardiomyopathy (HOCM) before and one year after percutaneous transluminal septal myocardial ablation (PTSMA).Methods The study included 31 patients with HOCM who underwent PTSMA performed between November 2012 and December 2014 in Sir Run Run Shaw Hospital.Mean age was 51 ± 13 years,and 13 patients were men,18 patients were women.New York Heart Association class was 2.6± 0.7 at baseline.If the target region was correctly marked by the injection of the echo contrast agent,ethanol was slowly (0.5 ml/min) injected to a maximum of 3 ml.Ten minutes after the injection of ethanol,the balloon was deflated.A successful procedure was defined as a ≥ 50％ reduction in the LV outflow tract peak systolic gradient compared to baseline level.Each patient with HOCM had a complete two-dimensional transthoracic echocardiography assessment before and one year after the PTSMA.The measurements included basal septal thickness,left ventricular outflow tract (LVOT) gradient,mitral regurgitation (MR) grade,left atrial dimensions,left ventricular (LV) ejection fraction and tissue Doppler parameters of lateral mitral annular e'and septal mitral annular e'.The LA wall was tracked on a frame-by-frame basis using 2D-STE,and LA volume waveforms were generated.The maximum LA volume (LAVmax),minimal LA volume (LAVmin),and the LA volume before atrial contraction (LAVpre-a) were measured.The LA reservoir function was calculated as left atrial expansion index (LAEI) and left atrial diastolic emptying index (LADEI).The LA conduit function was calculated as the passive emptying percentage of total emptying (PE) and the passive emptying index (PEI).The LA booster function was calculated as the active emptying percentage of total emptying (AE) and the active emptying index (AEI).The comparisons between patient New York Heart Association class,echocardiography and LA function parameter before and after PTSMA were conducted by paired t test.Results Compared with pre-operative values,LVOTG,MR grade,LA end-diastolic size,E/lateral e'ratio,septal mitral annular e'decreased in patients one year after the PTSMA [(35±26) mmHg vs (74135) mmHg,0.9310.35 vs 2.27±0.73,(40±6) mm vs (45±6) mm,12.6±3.8 vs 14.6±4.6,(4.3± 1.1) cm/s vs (5.0± 1.3) cm/s],whereas New York Heart Association class,Lateral mitral annular e',E/septal e'ratio [1.4±0.5 vs 2.6±0.7,(6.9±2.3) cm/s vs (5.8± 1.7) cm/s,20.2±7.1 vs 17.0±5.2] increased (t=6.55,4.78,2.60,2.84,2.59,-3.32,-2.67,-2.93,all P ＜ 0.05).Compared with pre-operative values,LAVImax,LAVImin,LAVIpre-a,AE,AEI(％) decreased in patients one year after the PTSMA [(32.7±7.1) ml/m2 vs (38.9±9.3) ml/m2,(16.3±4.4) ml/m2 vs (20.7±5.5) ml/m2,(23.1±5.7) ml/m2 vs (30.5±7.0) ml/m2,(41.5±8.7)％ vs (53.8± 10.4)％,(29.4±3.9)％ vs (32.1±4.6)％],(t=3.65,3.11,3.38,3.92,2.17,all P ＜ 0.05);whereas the LAEI(％),LADEI(％),PE(％),PEI(％) [(100.1 ± 19.3)％ vs (87.9± 14.7)％,(50.2±9.8)％ vs (46.7±9.1) ％,(58.5± 11.8) ％ vs (46.1 ±9.1) ％,(26.9±5.2)％ vs (21.6±4.8)％] increased (t=-2.82,-2.33,-3.89,-2.74,all P ＜ 0.05).Conclusions The study showed the improvement in LA reservoir and conduit function,while the reduction in LA booster pump function in patients one year after PTSMA.

Objective:To explore the morbidity features and therapeutic outcomes of rejections in pediatric kidney transplantation (KT) recipients.Methods:Between January 2013 and June 2022, 360 children undergoing KT were recruited.The relevant clinical data were collected for examining the morbidity features and therapeutic outcomes of rejections.The serum levels of creatinine were compared among groups by non-parametric rank test.And Kaplan-Meier and Log-rank methods were employed for examining the incidence of rejection and comparing mortality-censored graft survival rates among patients with different times of rejection.Results:A total of 58 recipients had 82 incidents of rejection with a cumulative incidence of 6.3%, 9.2% and 11.3% at 3/6/12 months respectively.Among 50 incidents of biopsy-proved rejections, the types were T cell-mediated rejection [TCMR, 42.0%(21/50)], antibody-mediated rejection [20.0%(10/50), ABMR] and mixed rejection [38.0%(19/50)].Among 58 incidents of initial rejection, 69% had maintained graft function (MGF) and 31% impaired graft function (IGF) after anti-rejection regimens.Among 80.8%, 85.7% and 75% of recipients with clinical rejection, ABMR or borderline rejection while 36.4% in TCMR patients had MGF.Fifteen kidney allografts lost function in 58 recipients with rejection.Five-year death-censored graft survival was significantly lower in patients with two or more incidents of rejection (30.5%, 95% CI: 12.3%-75.4%) than in those without rejection (92.9%, 95% CI: 89.3%-96.6%) ( P<0.000 1) or with only one rejection (82.9%, 95% CI: 65.9%-100%)( P<0.001). Conclusions:The rejection rate remains high in KT children and it affects graft survival.And TCMR is more likely to cause impaired graft function.Recurrent rejections have a more pronounced impact upon graft survival.

Objective:To investigate the value of net water uptake (NWU) in predicting malignant edema (ME) in large hemispheric infarction (LHI).Methods:Fifty-six patients suffering from LHI in the General Hospital of Northern Theater Command from September 2017 to July 2018 were retrospectively analyzed, and their NWU was calculated separately. Patients were divided into two groups according to the occurrence of ME, which was defined as space-occupying infarct requiring decompressive craniectomy or death resulting from cerebral hernia in seven days from onset. The clinical characteristics were analyzed, and receiver operating characteristic (ROC) curve and respective area under curve (AUC) were used to assess the value of NWU and other factors.Results:After adjusting for atrial fibrillation, National Institutes of Health Stroke Scale scores at admission, and time from onset to imaging, multivariable analysis showed that NWU was an independent predictor of ME ( OR=1.226，95% CI 1.040-1.446, P=0.015). According to the ROC curve, NWU≥13.08% identified ME with great predictive power (AUC=0.813;sensitivity 0.64, specificity 0.94). Conclusions:NWU is an important predictor of ME in patients with LHI. It can help identify patients at risk of ME.

OBJECTIVE It's known that post-retrieval extinction but not extinction alone could erase fear memory.However,whether the coding pattern of original fear engrams is remod-eled or inhibited remains largely unclear.Here we try to investigate whether the coding pattern of memory engrams is altered during post-retrieval extinction induced memory updating.METHODS To answer the question,by using activity-depen-dent neuronal-tagging technology,neuronal trac-ing technique combined with optogenetic manipu-lation and in vivo calcium imaging,we identified the fear and extinction cells in PrL and BLA and investigated the dynamic encoding of memory engram ensembles in the PrL and BLA during CS versus US initiated memory updating.RESULTS We found increased reactivation of engram cells in the prelimbic cortex and basolat-eral amygdala during memory updating.More-over,conditioned stimulus and unconditioned stimulu sinitiated memory updating depend on the engram cells reactivation in the prelimbic cor-tex or basolateral amygdala respectively.Finally,we found memory updating causes increased overlapping between fear and extinction cells and the original fear engrams encoding was altered during memory updating.CONCLUSION Our data provide the first evidence to show the overlapping ensembles between fear and extinc-tion cells and functional reorganization of original engrams underlying conditioned stimulus and unconditioned stimulus initiated memory updating.

Objective:To explore the clinical characteristics and outcomes of pediatric kidney transplantations at a single center and discuss the related clinical issues.Methods:From January 1990 to October 2019, clinical data were analyzed retrospectively for 244 pediatric renal transplants. The youngest recipient was aged 1.8 years and the median age of pediatric recipients was 12.2 years. The major disease was primary or hereditary glomerulonephritis ( n=160, 69.0%), congenital anomalies of kidney and urinary tract (CAKUT), cystic renopathy and other hereditary nephropathies ( n=55, 23.7%). The donor sources included traditional deceased donor ( n=42, 17.2%), living-related donor ( n=19, 7.8%) and organ donation ( n=183, 75.0%). The median age of donors was 2 years (0-51) and the median weight 12.0(2.7-72.0) kg. From January 2013 to October 2019, 170 cases), the major induction immunosuppression regimen was anti-thymocyte globulin (ATG) ( n=110, 64.7%) or basiliximab ( n=58, 34.1%). The maintenance regimen was tacrolimus + mycophenolic acid (MPA) + glucocorticosteroids. Finally the outcomes and the complications were analyzed. Results:The survival rates of 244 kidney allograft recipients were 98.1%, 94.5% and 93.4% and the graft survival rates 92.6%, 84.2% and 82.0% at 1/3/5 years respectively. Ten recipients died of accident ( n=2, 20.0%), pneumonia after transplantation ( n=2, 20.0%) and intracranial hemorrhage ( n=2, 20.0%). Thirty-three recipients lost their allografts mainly due to intravascular thrombosis in graft ( n=5, 14.3%), acute rejection ( n=5, 14.3%) and death ( n=9, 25.7%). Besides, among 109 deceased donor allograft recipients, the postoperative outcomes were delayed graft function recovery (DGF) ( n=27, 24.8%), arterial thrombosis ( n=6, 5.5%), venous thrombosis ( n=1, 0.9%), graft perirenal hematoma ( n=6, 5.5%), raft artery stenosis ( n=10, 9.2%) and graft ureteral fistula ( n=1, 0.9%). The incidence of acute rejection was 17.5% and 23.2% at 1/3 year respectively. The recurrent rate of primary disease was 6.9%, including primary FSGS ( n=3, 42.9%) and IgA nephropathy ( n=2, 28.6%). At 1/3 year post-operation, the incidence of pulmonary infection was 16.9% and 22.4% and the incidence of urinary tract infection 26.9% and 31.7%. Excluding recipients with graft failure, the estimated glomerular filtration rate (eGFR) at 1/2/3 year postoperatively was (80.3±25.2), (81.4±27.8) and (71.8±27.6) ml/(min·1.73 m 2)respectively. Conclusions:The outcomes of pediatric renal transplantations are excellent at our center. Future efforts shall be devoted to optimizing the strategies of donor kidney selection and strengthening preoperative evaluations, perioperative and postoperative managements for improving the long-term outcomes of pediatric renal transplantations.