Objective:To explore the clinical features and risk factors of systemic inflammatory responses syndrome (SIRS) after flexible ureteroscopic lithotripsy (FURL) with upper urinary tract stones.Methods:A retrospective of 157 patients with upper urinary calculi treated by FURL who were admitted to Suzhou First People′s Hospital from January 2018 to October 2020 were selected to analyze the treatment results and complications of the patients. Patients were divided into SIRS group ( n=31) and non-SIRS group ( n=126) according to whether they were complicated by SIRS. The clinical data between the two groups were analyzed by a single factor, and the factors with statistical significance were included in the LASSO-Logistic regression analysis. Visualize the model through the Nomogram, and verify and evaluate the discrimination and accuracy of the model. Results:The results of univariate analysis showed that gender( P=0.010), average stone size ( P<0.05), preoperative urine white blood cell count ( P<0.05), operation time ( P<0.05) and postoperative stone bacterial culture ( P<0.05) were different between the two groups and the differences were statistically significant. The LASSO-Logistic regression analysis results show that the above factors were all independent risk factors for patients with SIRS. The Nomogram complicated SIRS risk prediction model constructed based on the above risk factors has good discrimination and high consistency with actual observations. Conclusion:Females, large stones, high preoperative white blood cell counts, longer operation time, and positive bacterial culture of postoperative stones are independent risk factors for SIRS after FURL in patients with upper urinary calculi.

Objective To discuss the application value of transesophageal echocardiography (TEE) in occluding procedure with cardiopulmonary bypass (CPB) for children muscular ventricular septal defects (mVSD).Methods Forty-nine mVSD patients for occluding procedure with CPB were performed guided and monitored by TEE,9 cases were simple mVSD,40 were mVSD combined with other cardiac malformations.The location,size,number,scope and the surrounding anatomy of mVSD were carefully observed before going into cardiac arrest,preparing the operator to choose appropriate occluder devices.The procedure was evaluated after the recovery of heart beat using TEE.Results In all of the 49 patients underwent occluding procedure,44 cases were implanted into one occluder,5 implanted into two occluders.The results of TEE after operation showed that the positions of all occluders were not shifted,2 had trace residual shunt,there were no complications worsening,such as mitral and aortic regurgitation,etc.One patient abandoned treatment for serious infection,the other patients' occluders were all in normal position followed up at 6 months to 2 years after operation,there were no tiny residual shunt and valves regurgitation except 1 patient.Conclusions The technique that TEE guiding and monitoring in occluding procedure with cardiopulmonary bypass for children muscular ventricular septal defects can shorten the time of cardiopulmonary bypass,significantly reducing complications and risks of the surgery,improving the successful rate.

Objective To observe the effect of electroacupuncture of Siguan on contents of hippocampal monoamine neurotransmitter NE, DA and 5-HT in post-stroke depression rats, and throught it to probe the possible mechanism of anti-depressive.Methods 60 rats were divided into five groups randomly, as the normal group, MCAO group, PSD group, Siguan group, and fluoxetine group. Except the normal group, the rats of other groups were used to establish left side of the MCAO models by modified Longa filament method. PSD model was prepared by living alone in combination with mild stimulation by chronic unpredictable after stroke model success 7 days. The Siguan group was received electroacupuncture at Siguan point, and the fluoxetine group was gastrically perfused with fluoxetine, and all rats were received sugar consumption experiment in different period of treatment. After continuous treatment for 21 days, contents of NE, DA and 5-HT in hippocampal tissue were measured with RP-HPLC-fluorescent method. Results At the seventh day, compared with PSD group, the ratio of sugar water consumption(51.09%± 3.68%vs. 38.97%± 4.07%)has a significant increase in the Siguan group(P<0.01), while no significant changes in the fluoxetine group. At the fourteenth day, the ratio of sugar water consumption(68.25%± 4.69%vs. 39.64%± 4.49%)continued to rise in the Siguan group, the fluoxetine group also had significantly increased compared with the PSD group, the two groups were significantly higher than those in the PSD group (P<0.01), but the Siguan group was higher than that of the fluoxetine group(P<0.01).At the twenty-first day, the ratio of sugar water consumption (41.56%± 2.12%vs. 41.56%± 2.12%)increased further in the Siguan group and the fluoxetine group, which was significantly higher than those in the PSD group (P<0.01), but the Siguan group and fluoxetine group had no obvious difference(P>0.05). Compared with the PSD group,the contents of NE(244.93 ± 44.57 ng/g vs. 129.27 ± 11.68 ng/g), DA(86.80 ± 14.64 ng/g vs.44.22 ± 7.60 ng/g), 5-HT(526.31 ± 54.41 ng/g vs.221.56 ± 39.57 ng/g) in the hippocampus tissues were significantly higher than many in the Siguan group and fluoxetine group(P<0.01), but the difference between the two groups was not obvious(P>0.05). Conclusion The symptoms of PSD rats pleasure disappeared can be improved by electroacupuncture atSiguan. Its mechanism may be related with the increased contents of monoamine neurotransmitters in the hippocampus of rats.

Objective To compare the safety and efficacy of direct and remedial rotational atherectomy in the treatment of heavily calcified coronary artery lesions.Methods We retrospectively reviewed 58 patients admitted in the Shanghai Chest Hospital and Liaocheng People Hospital from May 2012 to July 2015 who had received stent implantation and rotational atherectomy.The 58 patients were divided into two groups which were the direct atherectomy group (n =27) and the remedial atherectomy group (n =31).General clinical date,lesion and procedural characteristics,intraoperative complications,in-hospital and follow-up MACCE were compared between the two groups.Results There were no differences between the two groups in general clinical date intraoperative complications,amount of contrast agent used,proceduraltime,rates of in-hospital and follow-up MACCE.Nevertheless,compared with the direct artherectomy group,the remedial group had more number of balloon dilations during procedure [3 (1,5) vs.2 (1,2),P ＜ 0.001] and higher peak cardiac troponin levels [1.1 (0.3,3.0) μg/L vs.0.5 (0.1,2.3) μg/L,P =0.032].Conclusions Remedial rotational atherectomy with drug-eluting stent had the same safety and efficacy as direct atheretomy with drug-eluting stent in treating patients with heavily calcified coronary lesions.It is reasonable and safe to transform routine PCI to remedial rotational atherectomy when the 2.0 mm semi compliant balloon or/and 2.5 mm non-compliant balloon cannot pass through or dilate the lesions.

Anomalous aortic origin of the coronary artery(AAOCA) refers to the abnormal initiation, route, or distribution of coronary arteries, which is generally believed to be caused by abnormal or incomplete development of embryonic coronary arteries, and is a rare congenital cardiovascular malformation. It can exist independently without other congenital heart disease. With the development of medical science and people's understanding of AAOCA, more and more AAOCA has been detected, and its clinical significance has attracted more and more attention. Based on abnormal coronary artery opening, malignant or potential contorts can cause long-term blood flow dynamic change, appear abnormal blood vessel hardening of the arteries, at the same time due to walk in the pulmonary artery and the ascending aorta between two vessels, vulnerable to the extrusion of large blood vessels, which caused a temporary blood flow in coronary artery interruption, can cause acute angina pectoris, myocardial infarction, arrhythmia, exercise-induced cardiac syncope. This review focuses on the anatomy, diagnosis and treatment of coronary artery abnormalities arising from aorta.

Objective:To compare the efficacy and safety of drug-coated balloons (DCB) combined with bare metal stents (BMS) and BMS only for superficial femoral atherosclerosis obliterans.Methods:The clinical and follow-up data of 80 patients (82 limbs) who received combined treatment or BMS implantation at Cardiovascular Surgery Department of China Japan Friendship Hospital from Jan 2017 to Aug 2022 were retrospectively analyzed.Results:43 patients (43 limbs) were included in combined treatment group. 37 patients (39 limbs) were in BMS only. The average lesion length of combined group was longer than BMS group (19.54±7.04 cm vs. 16.25±6.43 cm, P=0.031). The primary patency rate of combined group at 36 months was not statistically different with BMS only group (56.9% vs. 38.5%, P=0.171). The subgroup analysis of superficial femoral artery TASC C/D (Trans-Atlantic Inter-Society Consensus) and CTO (chronic total occlusion) lesions indicated that efficacy of the combined group was superior to BMS only group. The patency rates of the combined group compared with the BMS group at 36 months were 57.6% vs. 23.8%, P=0.046, 60.2% vs. 31.4%, P=0.028, respectively. There was no significant difference in the FCD-TLR (free from clinical driven target lesion revascularization) between the two groups at 36 months (72.6% vs. 66.5%, P=0.706). There was no significant difference in major adverse events between the two groups ( P>0.05). Conclusion:Paclitaxel drug-coated balloon combined with bare metal stent is a safe and effective treatment for superficial femoral atherosclerosis obliterans, which is superior to bare metal stent, especially in TASC C/D and chronic total occlusive lesions.

Objective To investigate chromosomal abnormalities in fetuses with conotruncal defects(CTD).Methods From January 2013 to February 2017,107 fetuses (singleton pregnancy) prenatally diagnosed as CTD in Beijing Anzhen Hospital were enrolled.Umbilical cord specimens of these fetuses were collected after termination of pregnancy and analyzed by low coverage whole gene sequencing to detect chromosomal aneuploidy and copy number variations.Types of chromosomal abnormalities in these cases were analyzed.Chi-square test was used for statistical analysis.Results Twenty-two cases (21％,22/107) were identified with chromosomal abnormalities.The most common seen chromosomal abnormalities were found in those with interrupted aortic arch (2/2),followed by those with tetralogy of Fallot and pulmonary atresia/stenosis accompanied with ventricular septal defect (28％,12/43).No chromosomal abnormalities were detected in fetuses with aortopulmonary septal defect (0/2).Differences were shown in the detection rates of chromosomal abnormalities among different types of CTD (x2=12.744,P=0.026).Among the 22 fetuses with chromosomal abnormalities,there were seven with abnormal aneuploidy (three trisomy-13s,two trisomy-18s,one trisomy-21 and one 45,X) and 15 with pathogenic copy number variations [11 cases with 22q11.2 microdeletion syndrome,two with 17p12p11.2 microdeletion (Smith-Magenis syndrome),one with 8p23.3p21.3 microduplication and one with 2p23.1p25.2 microdeletion].Of the 15 cases with pathogenic copy number variations,12 segments of microdeletion/microduplications were de novo and one was paternally inherited,while the causes of the other two were not clear because their parents refused chromosomal testing.Conclusions Fetal CTD are likely to be accompanied with aneuploidy abnormalities and chromosome microdeletions/microduplications and the detection rate of chromosomal abnormalities varied with the type of CTD.Microdeletion and microduplication,especially de novo microdeletions/duplications,are the common chromosomal abnormalities.Chromosome analysis is recommended for fetuses prenatally diagnosed with CTD.