Objective To evaluate the value of echocardiography in investigation the failure of interventional therapy of VSDs and to increase the successful rate. Methods 15 cases with failure of VSD closure through interventional approach were undertaken measurement of major parameters of the defect on left ventriculography and then followed by Philips 5500 color Doppler US for repeated multi-direction tangential measuring of the size, morphologic change, relation with peripheral structure and individual valvular regurgitation. Results (1) Marginal membranous VSD 10 cases; membranance aneurysm 8 cases, ≥2 outlets 6 cases. Width of basal part of membranous aneurysm was 8 ～ 18 (10 ?2) mm with depth of 3 ～ 10 (6 ? 2) mm, distance from aortic valve was 0 ～ 6 (2 ? 1) mm and from tricuspid valve was 2 ～ 5 (2 ?1) mm; associated with slight tricuspid valvular regurgitation. Aortic valvular regurgitation 5 cases showed slight to mild amount and without membranous aneurysm occurred in 2 cases. (2) Intracristal VSD 5 cases showed the size of defect as 6 ～ 10 (7 ? 1) mm, with distances of 2 ～ 3 (1 ? 0.8) mm from pulmonary valve and 1 ～ 2 (1 ? 0.6) mm from aortic valve associated with slight regurgitation in 4 cases, slight tricuspid valvular regurgitation in 5 cases and aortic valvular prolapse in 4 cases. Conclusions Many factors can influence the direction tangential continuous scanning should be taken for accurate localization and measurement of VSD in order to select the very sight occludor providing high successful rate of occlusion and long term efficacy.

Objective:To investigate the clinical characteristics of elderly patients with coronavirus disease 2019(COVID-19), in order to provide scientific evidence for the diagnosis and treatment of COVID-19 in elderly patients.Methods:Clinical data of 102 patients with COVID-19 admitted to the B11 East Ward of the Zhongfaxincheng campus and the E1-3 ward of the Guanggu Campus of Tongji Hospital affiliated to Huazhong University of Science and Technology in Wuhan from 1 February 2020 to 28 February 2020 were retrospectively collected and analyzed.Patients were categorized into 2 groups: the elderly group(≥60 years old)and the young and middle-aged group(<60 years old). Differences in epidemiological features, demographics, clinical symptoms, laboratory results and imaging findings between the two groups were retrospectively analyzed.Results:Among 102 patients with COVID-19, 58 were in the elderly group(≥60 years old), with a median age of 67.0(63.8, 71.0)years old, and 44 in the young and middle-aged group(<60 years old), with a median age of 47.5(38.0, 51.8)years old.There was no significant difference in gender ratio between the two groups( χ2=0.033, P=0.855). Of 102 patients, 42.0%(21/50)had close contact with an infected person, 14.0%(7/50)were from infection clusters, and 18.0%(9/50)had suspected hospital-acquired infections.Fever and cough remained the most common symptoms, but gastrointestinal symptoms such as nausea, poor appetite, diarrhea and muscle cramps were also warning signs.Fatigue and cough were the most common presenting symptoms in elderly male patients.Bilateral patchy infiltrates(57.9%, 22/38)and ground-glass opacities(42.1%, 16/38)were the main imaging features and 42.1%(16/38)patients had multiple areas of the lungs involved.Over 50% patients had increased levels of blood glucose, D-dimer, fibrinogen, C-reactive protein, procalcitonin, multiple cytokines and neutrophil-to-lymphocyte ratio, as well as decreased levels of albumin, hemoglobin, hematocrit, lymphocytes and serum calcium.Compared with the young and middle-aged group, the elderly group had higher rates of abnormality in levels of D-dimer and serum calcium( χ2=7.067 and 4.166, P=0.008 and 0.041). Conclusions:Fever and cough are the most common symptoms in elderly patients with COVID-19.Elderly patients with COVID-19 have multiple abnormalities in clinical laboratory test results, which show a certain level of specificity compared with young and middle-aged patients.

Objective To investigate the clinical characteristics,treatment and prognosis of tuberculosis in patients with autoimmune diseases after tumor necrosis factor-αinhibitors.Methods Clinical data of 33 patients with TB after biologics(tumor necrosis factor-α inhibitors)treated in Guangzhou Chest Hospital from January 2019 to March 2023 were collected,including 25 males and 8 females,with a median age of 32 years.The clinical symptoms,laboratory results,imaging and tracheoscopic features,pathological features,treatment and outcome were analyzed retrospectively.Results The common clinical manifestations were cough(26/33),sputum(23/33)and fever(17/33).The most common cases were pulmonary tuberculosis(32/33),bronchial tuberculosis(15/33),mediastinum and hilar lymph node tuberculosis(11/33).Bilateral lung spread of tuberculosis(21/33),intrapulmonary spread of tuberculosis(bronchus,mediastinal hilar lymph nodes,pleura)(19/33),extrapulmonary tuberculosis(18/33),pulmonary tuberculosis with intrapulmonary or extrapulmonary tuberculosis(26/33).Blood CD4+T lymphocyte test was normal(23/33),and blood IGRA test was positive(27/33).Pulmonary imaging miliary nodules(8/33).The histopathology of the lymph nodes showed atypical granulomatous nodules.The duration of anti-tuberculosis treatment is 8-32 months.1 case of death.Conclusion Patients with autoimmune diseases complicated with tuberculosis after the application of tumor necrosis fact-α inhibitor are more likely to have double lung lesions,which are easy to spread to lung tissues and multiple organs of the body,and have decreased immune function.Most of them need to extend the treatment course,and the prognosis is generally good after comprehensive treatment.

Objective:To analyze the changes of gray matter volume and resting-state functional connectivity in children with attention deficit hyperactivity disorder (ADHD) comorbid with oppositional defiant disorder (ODD).Methods:A total of 22 ADHD comorbid with ODD children (ADHD-ODD group, n=22) were selected from a public-assess resting-state fMRI ADHD cohort, namely, ADHD-200.Meanwhile, 22 age- and sex- matched ADHD children without ODD (ADHD group, n=22) and 22 healthy children(control group, n=22) were also included.T1-weighted MRI and resting-state fMRI scans were performed on all of the participants.The voxel-based morphometric (VBM) method was used to compare the volume of gray matter in three groups.The gray matter with aberrant volume was set as the region of interest(ROI) for mapping the functional connectivity of the whole brain.For comparison of gray matter volumes, one-way ANOVA and two-sample t-test analysis were applied, while two-sample t-test analysis was used for comparison of functional connectivity. Results:Compared with the control group, ADHD-ODD group showed decreased gray matter volume in the left cerebellum anterior lobe (MNI coordinate: x, y, z=-19.5, -42, -18) and right cerebellum anterior lobe (MNI coordinate: x, y, z=19.5, -39, -21). The left cerebellum anterior lobe showed increased functional connectivity with left superior frontal gyrus, left middle frontal gyrus (MNI coordinate: x, y, z=-24, 19, 43), right superior frontal gyrus, right middle frontal gyrus (MNI coordinate: x, y, z=30, 9, 45) and bilateral precuneus, posterior cingulate gyrus(MNI coordinate: x, y, z=-6, -35, 24). Compared with the ADHD group, ADHD-ODD group showed decreased gray matter volume in the right cerebellum anterior lobe (MNI coordinate: x, y, z=19.5, -37.5, -22.5). The right cerebellum anterior lobe showed increased functional connectivity with bilateral superior frontal gyrus, bilateral middle frontal gyrus, bilateral medial frontal gyrus, anterior cingulate gyrus and posterior cingulate gyrus(MNI coordinate: x, y, z=18, -12, 42), bilateral cuneus, bilateral lingual gyrus(MNI coordinate: x, y, z=9, -87, 27).Conclusion:ADHD comorbid with ODD children show decreased cerebellum volume and excessive functional connectivity with several brain regions of the cerebral hemispheres, which may be one of the neuropathological bases of cognitive, emotional, and behavioral disorders.

Bladder cancer(BC) ranks the first of genitourinary tumor in China and is one of the most common urological malignancies, in which 25%-30% of patients were diagnosed with muscle-invasive bladder cancer. Radical cystectomy combined with pelvic lymph node dissection is the standard procedure for treatment, which can effectively avoid tumor recurrence or distant metastasis as well as improve the prognosis of patients. However, some patients may not tolerate or refuse to undergo radical bladder surgery due to worry about high complication rate, high morbidity and poor postoperative quality of life. With the increasing understanding of bladder cancer heterogeneity and biological behavior, the treatment of bladder cancer has changed from a surgery-based treatment model to an individualized and comprehensive treatment model by multidisciplinary collaboration. The bladder-preserving treatment can achieve the same oncological prognosis as that of radical bladder surgery with a better quality of life of the patients, which has become a hot topic and focus of research in muscle-invasive bladder cancer treatment. This article reviewed the progress of research related to the comprehensive treatment of muscle-invasive bladder cancer with preservation of the bladder.

Depression has become one of the most important causes of disability worldwide. Although traditional treatment methods such as drug therapy, physical therapy and psychological intervention have positive effects, they still have limitations such as high treatment cost, high drug side effects, high recurrence rate and poor compliance. Exercise therapy, as a treatment recommended by many guidelines, has many advantages such as simple and convenient, few side effects, and strong persistence. Studies have shown that exercise can relieve depression through a variety of mechanisms, but there is still a lack of effective targets for the treatment of depression. Microglia is an innate immune cell in the central nervous system. In recent years, the role of microglia in neuroinflammation in depression and other mental diseases has attracted more and more attention. Thus, microglia may be a key target for exercise to alleviate depression. This article discusses the relationship between exercise and microglia phenotypes as well as depression, and proposes future research directions on microglia-mediated exercise to improve depression, in order to provide new ideas and directions for the clinical treatment of depression.

Objective To observe the value of B1 corrected T1 mapping for distinguishing pathological types and differentiation degrees of lung cancers.Methods A total of 74 lesions in 65 patients with lung cancers were prospectively enrolled,including 49 poorly differentiated lesions and 25 moderately or well differentiated ones,i.e.42 adenocarcinomas,14 squamous cell carcinomas and 18 small cell lung cancers(all poorly differentiated).B1 corrected T1 mapping was performed,ROI(ROI1 and ROI2)were delineated using 2 methods,and T1 values of different pathological types and differentiation degrees lung cancers were compared.The receiver operating characteristic(ROC)curves were drawn,and the areas under the curve(AUC)were calculated.Results Significant differences of T1 values were found among different pathological types of lung cancer(all P＜0.05),as well as between small cell lung cancer and the rest 2 types of lung cancer(both P＜0.05).There were significant differences of T1 values between poorly differentiated and moderately well differentiated lung cancer(squamous cell carcinoma+adenocarcinoma)(both P＜0.05).Taken ROI1 T1 value=1 524.21 ms as the cut-off value,the AUC of T1 value for distinguishing poorly differentiated and moderately well differentiated lung cancer(squamous cell carcinoma+adenocarcinoma)was 0.698,with sensitivity of 64.50％and specificity of 76.00％.Taken ROI2 T1 value=1 630.68 ms as the cut-off value,the AUC of T1 value was 0.676,with sensitivity of 54.80％and specificity of 80.00％.Conclusion B1 corrected T1 mapping was helpful for distinguishing pathological types and differentiation degrees of lung cancers.

In the past ten years, the research and application of microbiome has continued to increase. The microbiome has gradually become the research focus in the fields of life science, environmental science, and medicine. Meanwhile, many countries and organizations around the world are launching their own microbiome projects and conducting a multi-faceted layout, striving to gain a strategic position in this promising field. In addition, whether it is scientific research or industrial applications, there has been a climax of research and a wave of investment and financing, accordingly, products and services related to the microbiome are constantly emerging. However, due to the rapid development of microbiome sequencing and analysis related technologies and methods, the research and application from various countries have not yet unified on the standards of technology, programs, and data. Domestic industry participants also have insufficient understanding of the microbiome. New methods, technologies, and theories have not yet been fully accepted and used. In addition, some of the existing standards and guidelines are too general with poor practicality. This not only causes obstacles in the integration of scientific research data and waste of resources, but also gives related companies unfair competition opportunity. More importantly, China still lacks national standards related to the microbiome, and the national microbiome project is still in the process of preparation. In this context, the experts and practitioners of the microbiome worked together and developed the consensus of experts. It can not only guide domestic scientific research and industrial institutions to regulate the production, learning and research of the microbiome, the application can also provide reference technical basis for the relevant national functional departments, protect the scale and standardized corporate company's interests, strengthen industry self-discipline, avoid unregulated enterprises from disrupting the market, and ultimately promote the benign development of microbiome-related industries.
China ; Consensus ; Humans ; Industry ; Microbiota