PurposeTo determine the feasibility and accuracy of dual source CT (DSCT) in assessing myocardial delayed-enhancement and left ventricular wall thickness of hypertrophic cardiomyopathy (HCM) in comparison with cardiac magnetic resonance (CMR).Materials and MethodsEighty patients with HCM confirmed by clinical diagnosis were enrolled in the study. DSCT images and CMR images were acquired at the arterial and lag phases. According to 17-segment model provided by American Heart Association, the left ventricular wall thickness and location of delayed-enhancement were verified, and the correlation of these two methods were analyzed in terms of the diagnosis of myocardial delayed enhancement (MDE).Results1360 myocardial segments for 80 patients were assessed. The left ventricular wall thickness determined by DSCT was significantly correlated with MR results (r=0.88,P<0.01). DSCT and MDE showed substantial agreement on per-patient (n=74,Kappa=0.751,P<0.05) and per-segment (n=1238, Kappa=0.746,P<0.01) levels. For dense myocardial delayed enhancement, CT findings were significantly correlated with those of CMR (r=0.89, P<0.01), but CT scan slightly underestimated the lesion scope of fibrosis. Bland-Altman analysis showed that CT and MRI were different in measuring the lesion volume of myocardial delayed enhancement (mean standard deviation was 2.71%).ConclusionThe cardiac CT examination provides comprehensive information in coronary artery and myocardial assessment, and MDE-DSCT is also effective in the diagnosis of myocardial fibrosis in HCM since it can be used in assessing myocardial fibrosis.

Objective: To observe the hemodynamic change characteristics of left ventricle and evaluate left ventricular systolic function in patients with chronic heart failure (CHF) via vector flow mapping(VFM). Methods: Sixty-two patients with CHF(CHF group) were selected as case group and were divided into three groups (B, C, D) according to the American College of Cardiology Foundation and the American Heart Association (ACC/AHA ) recommended stages.Sixty healthy volunteers were selected as control group. The left ventricular circulation parameters (vortex quantity, vortex area, circulation) and energy loss (EL) of the apex, mid, and basal segments in different groups were compared in all the systolic phases. Left ventricular ejection fraction (LVEF) was calculated by biplane Simpson method, and the correlation was analyzed with the parameters of circulation and EL. Results: ①In the phase of isovolumetric contraction (IVC) and slow ejection (SE), compared with the control group, the levels of EL were increased in mid and basal segments (P<0.01 or P<0.05) in CHF group. The vortex area and circulation during IVC and rapid ejection (RE) were higher in CHF group than those in the control group (P<0.01 or P<0.05). As for SE, only vortex quantity was higher in CHF group than that in the control group (P<0.05). ②In CHF group, EL were increased at stage B and stage C than those in the control group (P<0.05), and EL were decreased at stage D than those in the control group ( P<0.05). Meanwhile, there was decreased tendency of EL in CHF group with the increase of ACC/AHA stages. ③The circulation during IVC of phase D was higher in CHF group than that in the control group (P<0.05), the vortex area during RE was greater in CHF group than that of the control group and stage B (P<0.05). ④EL was positively correlated with LVEF at basal segment of IVC(r=0.615, P<0.001). The vortex area during RE, circulation during IVC and RE were negtively correlated with LVEF (r=-0.598, -0.594, -0.623; all P<0.001). Conclusions VFM technology can quantify the left ventricular hemodynamic changes of patients with CHF in the systolic phase, and shows its relationship with left ventricular systolic function, to provide objective basis for grading of CHF and also provide objective quantitative indicators for clinical treatment and curative effect evaluation.

Objective:To investigate the epidermal growth factor receptor (EGFR) mutation rate, mutation characteristics and distribution characteristics of different mutation types in patients with non-small cell lung cancer (NSCLC) in Fuyang of Yunnan province, to provide the clinical individualized targeted therapy of NSCLC in this region.Methods:A total of 328 NSCLC patients whose native place were Fuyuan and who underwent EGFR test in Fuyuan County People's Hospital in Yunnan Province from January 2018 to August 2020 were selected, and their clinical data such as gender, age, ethnicity, pathological type and the results of EGFR test were collected for statistical analysis.Results:The EGFR mutation rate of NSCLC patients was 40.55% (133/328). The EGFR mutation rate of female patients was higher than that of males ( P < 0.01). The EGFR mutation rate showed a downward trend with age, the EGFR mutation rate of patients ≤ 60 years old was higher than that of patients > 60 years old ( P = 0.014). The EGFR mutation rate in ethnic minority was not statistically different from Han nationality ( P = 0.789). The EGFR mutation rate of patients without smoking history was higher than that of patients with smoking history ( P<0.01). Patients with adenocarcinoma had a higher EGFR mutation rate than squamous cell carcinoma ( P = 0.002). The EGFR mutation rate in patients with stage Ⅰ-Ⅱwere higher than that in patents with stage Ⅲ-Ⅳ ( P = 0.013). The EGFR mutation rate in tissue samples were higher than that in peripheral blood samples ( P = 0.009). In 328 patients the EGFR single-point mutation rate was 24.70% (81/328), and the compound mutation rate was 15.85% (52/328); the common mutation rate was 17.07% (56/328), and the rare mutation rate was 23.48% (77/328). The top 5 mutation types were L858R (10.06%), G719X+S768I (7.32%), 19-Del (7.01%), G719X+L861Q (6.40%), and G719X (4.21%). In 133 patients with EGFR mutation, the proportion of patients with rare mutation [57.89% (77/133)] was higher than the proportion of patients with common mutation [42.11% (56/133)]. Conclusion:The EGFR mutation rates of female, adenocarcinoma, non-smoking and young NSCLC patients in Fuyuan area are high, and the rare mutation rate is high.

Objective:To evaluate the effect of age factors on the pharmacodynamics of intranasal dexmedetomidine for sedation in the pediatric patients undergoing transthoracic echocardiography(TTE).Methods:American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ pediatric patients, aged 1-24 months, undergoing TTE from August 2019 to May 2022, were selected. This trial was performed in two parts. Part Ⅰ Pediatric patients were divided into 4 age groups: 1-6 month group, 7-12 month group, 13-18 month group and 19-24 month group. The initial dose of dexmedetomidine was 2.0 μg/kg in 0.1 μg/kg increment/decrement. The dose of dexmedetomidine was determined by using modified Dixon′s up-and-down method. The ED 50 and 95% confidence interval of intranasally administered dexmedetomidine for sedation were calculated by the Dexon-Massey method. Part Ⅱ One hundred patients were divided into 4 age groups ( n= 25 each): 1-6 month group, 7-12 month group, 13-18 month group and 19-24 month group. The 4 groups were further divided into 5 subgroups ( n=5 each) according to the dose of dexmedetomidine: 2.1 μg/kg subgroup, 2.2 μg/kg subgroup, 2.3 μg/kg subgroup, 2.4 μg/kg subgroup, and 2.5 μg/kg subgroup. Part Ⅰ and part Ⅱ trials were combined, and the ED 95 and 95% confidence interval of intranasally administered dexmedetomidine for sedation were calculated using the probit method. Results:A total of 220 pediatric patients were enrolled. There was no significant difference in ED 50 and ED 95 of dexmedetomidine intranasally administered for sedation among groups ( P>0.05). Conclusions:The pharmacodynamics of intranasal dexmedetomidine for sedation shows no significant difference in age in the pediatric patients aged 1-24 months undergoing TTE.

Objective:To explore the feasibility and safety of long-distance urological nephrotomy with the support of 5G communication technology by using the domestic robot.Methods:Clinical data of the patients with remote robot-assisted laparoscopic nephrectomy, which were completed from March to April 2021 by the Affiliated Hospital of Qingdao University (as the host hospital where the main operating system located) were retrospectively analyzed. There were 3 patients, including 2 males and 1 female.The average age was 61 (49-73) years, and the average body mass index was 23.73 (20.00-27.76) kg/m 2. One patient had a ASA classification of grade 2, and the other 2 patients had grade 3. All patients met the surgical criteria for non-functional nephrectomy. The chief surgeon who performing the telesurgery was located at the Affiliated Hospital of Qingdao University. The surgeon remotely controlled the bedside operating system (slave system) in 3 local hospitals located in other cities in Shandong Province (network communication distances of 82.5, 141 and 229 km, respectively) by manipulating the master system located in Qingdao. Images and operating instructions during surgery were transmitted using 5G wireless communication technology. Intraoperative network conditions, robot operation, and patient perioperative data were summarized. Results:All 3 tele-nephrectomies were successfully completed. The average network signal latency time was 27.3 (23-30) ms, with no packet loss, and the average total latency time was 177.3(173-180) ms. The mean resection time was 79.3 (52-111) min, and the average intraoperative blood loss was 31.1 (15.6-41.9) ml. There were no network related adverse events occurred during the operation, and the robot-related adverse events occured 3 times, all three of which were characterized by inconsistent master and slave movements of the manipulator arm and the bedside robotic arm. None of these adverse events affected the successful performance of the telesurgery. The mean postoperative exhaust time was 60.5 (38.5-78.0) h. The mean postoperative VAS score at 24 hours was 3.7 (3-4). The Clavien-Dindo classification were all grade I. No significant abnormality was found on the 30th day after surgery, and the patients recovered well at the follow-up until 6 months postoperatively.Conclusions:It is safe and feasible to perform remote robot-assisted laparoscopic nephrectomy based on 5G communication technology with no serious adverse events or surgical complications.However, the conclusion needs to be further verified by large sample and multi-center prospective study.

OBJECTIVE： To study the mechanism of wound healing promotion of Panax notoginseng-Bletilla striata gum sponge on diabetic foot ulcer （DFU） model rats. METHODS： Healthy SD rats were selected and given high-lipid and high-glucose diet， intraperitoneal injection of streptozotocin once to establish diabetes model. Neodymium-iron-boron magnet was used to press the back of rats to make ulcer wound then established DFU model. Totally 60 DFU model rats were randomly divided into group A（blank group， i.e. normal saline gauze group）， group B（vaseline gauze group），group C （gelatin sponge group） and group D （P. notoginseng-B. striata gum sponge group）， with 15 rats in each group. The rats were given corresponding gauze/sponge to cover the wound for intervention treatment， changing dressing once every 1-2 days. On the 3rd and 7th day after intervention， the wound healing of rats in each group was observed with naked eyes， and the wound healing rate was calculated. The wound margin tissue was collected to obtain HE staining section， and histopathological observation was conducted under microscope. mRNA expression of β-catenin， GSK-3β and Rspo3 in wound tissue were determined by RT-PCR. RESULTS： On the 3rd and 7th day after intervention， compared with group A， B， C， healing rate of group D was increased significantly （P＜0.05）； inflammatory cell infiltration， collagen deposition， capillary and granulation tissue growth in wound tissue increased significantly. The mRNA expression levels of β-catenin and Rspo3 all increased， and those of GSK-3β all decreased； except for the difference of β-catenin at the 3rd day and GSK-3β at the 7th day after intervention between group D and group C were not significant， the difference of other indicators was statistically significant （P＜0.05）. CONCLUSIONS： P. notoginseng-B. striata gum sponge can effectively promote the wound healing in DFU model rats， the mechanism of which may be associated with up-regulating the expression of β-catenin and Rspo3 mRNA and down-regulating the expression of GSK-3β mRNA.