OBJECTIVES: To investigate the application of transesophageal echocar-diography assessment for mitral valve in patients with atrial septal defects undergoing repair surgery. METHODS: The study group comprised of thirty-two adult patients with atrial septal defect who underwent thoracoscopic repair surgery at the First Affiliated Hospital of the Air Force Medical University from March to September 2022. Two-dimensional and real-time three-dimensional transesophageal ultrasonography of the mitral valve were performed after anesthesia. The parameters of the mitral valve structure at the late diastolic and late systolic stages were recorded, including anteroposterior and left-right annular diameters, anterior and posterior valves lengths, the vertical distance from the coaptation point of leaflet zone 2 during systole to the annular plane (mitral valve coaptation depth) and mitral valve coaptation length. Data from 32 patients with normal intracardiac structure and no mitral valve regurgitation (control group) were also collected and compared with those of the study group. Concurrent mitral valvoplasty was performed during the atrial septal defect repair surgery for 7 patients with significant mitral valve structural abnormalities and 2 patients with significantly increased mitral regurgitation after cardiac resuscitation. The study group was followed up with transthoracic echocardiography for 2 years postoperatively. RESULTS: In the study group, 26 (81.3%) patients had varying degrees of mitral valve morphological abnormalities. Among them, 10 (31.3%) patients had short mitral valve coaptation length or depth, 12 (37.5%) patients had closure point malposition, and 4 (12.5%) patients had different bulge of anterior and posterior leaflets. Compared with the control group, the study group had significantly smaller systolic and diastolic mitral left-right annular diameter, mitral posterior valves lengths, mitral coaptation length or depth (all P<0.05), a higher pulmonary systemic flow ratio (P<0.01), and a lower maximum blood flow velocity across the mitral valve (P<0.05). After 2 years of follow-up, among the 9 patients who underwent concurrent mitral valvoplasty, the mitral valve maintained no or little regurgitation, and the average mitral valve pressure difference was less than 5 mmHg (1 mmHg=0.133 kPa). Among the 23 patients without concurrent mitral valvoplasty, 2 patients had moderate regurgitation 1 year after surgery, with a pulmonary/systemic flow ratio larger than 2.8. CONCLUSIONS Patients with large atrial septal defects often have abnormal mitral valve structure. Therefore transesophageal echocardiography is recommended for mitral valve assessment during the surgery. If significant mitral valve structural abnormalities are detected, concurrent mitral valvoplasty is recommended.
Humans ; Heart Septal Defects, Atrial/diagnostic imaging* ; Echocardiography, Transesophageal/methods* ; Mitral Valve/surgery* ; Adult ; Female ; Male ; Middle Aged ; Mitral Valve Insufficiency/diagnostic imaging*

BACKGROUND: Meningeal metastasis (MM) is a form of malignant metastasis where tumor cells spread from the primary site to the pia mater, dura mater, arachnoid, subarachnoid space, and other cerebrospinal fluid compartments. Lung cancer is one of the most common malignant tumor types with MM. MM not only signifies that the lung cancer has progressed to an advanced stage but also leads to a range of severe clinical symptoms due to meningeal involvement. Currently, the risk factors associated with the development of MM are not fully elucidated. The aim of this study was to investigate the risk factors for MM in patients with lung adenocarcinoma (LUAD) who underwent non-surgical interventions, in order to identify LUAD patients at high risk for MM. METHODS: This retrospective study analyzed the clinical data of patients diagnosed with LUAD at the First Affiliated Hospital of Zhengzhou University from January 2020 to July 2024. Missing data were imputed using multiple imputation methods, and risk factors were identified through LASSO, univariate, and multivariate Logistic regression analyses. RESULTS: A total of 170 patients with LUAD were included in this study and divided into two groups: 87 patients with MM and 83 patients without MM. Univariate and multivariate Logistic regression analyses revealed that younger age at diagnosis (P=0.004), presence of the epidermal growth factor receptor (EGFR) L858R gene mutation (P=0.008), and concurrent liver metastasis at baseline (P=0.004) were independent risk factors for developing MM in LUAD patients who did not undergo surgical intervention. Conversely, higher baseline globulin levels (P=0.039) and the presence of the anaplastic lymphoma kinase (ALK) gene mutation (P=0.040) were associated with a reduced risk of MM development. CONCLUSIONS Age at diagnosis, EGFR L858R mutation status, ALK gene mutation status, concurrent liver metastasis, globulin levels at baseline were significantly associated with the risk of developing MM in patients with LUAD patients who did not undergo surgical intervention. For patients diagnosed at a younger age, carrying the EGFR L858R mutation, or presenting with baseline liver metastasis, early implementation of tertiary prevention strategies for MM is crucial. Regular monitoring of MM status should be conducted in these high-risk groups.
Humans ; Male ; Adenocarcinoma of Lung/therapy* ; Female ; Middle Aged ; Risk Factors ; Lung Neoplasms/therapy* ; Retrospective Studies ; Aged ; Meningeal Neoplasms/genetics* ; Adult

Objective:To investigate associations of serum nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3), apoptosis-associated speck like protein containing a caspase recruitment domain (ASC), caspase-1 with the outcome in patients with hypertensive intracerebral hemorrhage (HICH) after minimally invasive neuroendoscopic surgery.Methods:Patients with HICH underwent minimally invasive neuroendoscopic surgery at the Affiliated Hospital of Noncommissioned Officer School, Army Medical University between June 2022 and June 2024 were included prospectively. According to the Glasgow Outcome Scale score at 3 months after surgery, the patients were divided into a good outcome group (4-5) and a poor outcome group (1-3). The clinical data and peripheral blood levels of NLRP3, ASC, caspase-1, interleukin (IL)-18, and IL-1β between the two groups were compared. Multivariate logistic regression analysis was used to determine assocations of serum NLRP3, ASC, caspase-1 with the postoperative outcome. Results:A total of 121 patients with HICH were enrolled, including 71 males (58.68), aged 56.11±4.96 years. At 3 months after surgery, 70 patients (57.9%) had good outcome, 51 (42.1%) had poor outcome, and 3 died. Onset to admission time, onset to first CT scan time, onset to surgery time, baseline serum NLRP3, ASC, caspase-1, baseline hematoma volume, and the proportion of patients with hematoma rupture into the ventricles and midline shift in the poor outcome group were significantly higher than those in the good outcome group, while baseline Glasgow Coma Scale (GCS) score and hematoma clearance rate were significantly lower than those in the good outcome group ( P<0.05). Multivariate logistic regression analysis showed that after adjusting for other factors such as onset to surgery time, baseline GCS score, hematoma rupture into the ventricles, and hematoma clearance rate, baseline serum NLRP3 (odds ratio [ OR] 2.018, 95% confidence interval [ CI] 1.502-2.711; P<0.001), ASC [ OR 1.764, 95% CI 1.418-2.195; P<0.001], caspase-1 [ OR 1.901, 95% CI 1.476-2.449; P<0.001]) were significantly independently associated with the poor outcome. Conclusion:The serum levels of NLRP3, ASC, and caspase-1 are significantly higher in HICH patients with poor outcome, and are independently associated with the poor outcome after minimally invasive neuroendoscopic surgery.

Objective:To investigate the predictive value of D-dimer (DD)/platelet count (PLT) ratio (DPR) and fibrinogen (Fg)/C-reactive protein (CRP) ratio for lower extremity deep venous thrombosis (LEDVT) in patients with spontaneous intracerebral hemorrhage (ICH).Methods:Consecutive patients with ICH admitted to the Department of Neurosurgery, the Affiliated Hospital of Noncommissioned Officer School, Army Medical University from February 2023 to November 2024 were included retrospectively. The baseline clinical data and laboratory test results between the LEDVT group and the non-LEDVT group were compared. Multivariate logistic regression analysis was used to evaluate the independent influencing factors of LEDVT. Receiver operating characteristic (ROC) curves were used to evaluate the predictive efficacy of influencing factors for patients with ICH complicated with LEDVT. Results:A total of 156 patients with ICH were enrolled, including 67 males (42.9%), aged 61.54±7.91 years; 47 patients (30.1%) experienced LEDVT during hospitalization. Univariate analysis showed that DD, PLT, DPR, Fg, and CRP in the LEDVT group were significantly higher than those in the non-LEDVT group, while the Fg/CRP ratio was significantly lower than that in the non-LEDVT group (all P<0.05). Multivariate logistic regression analysis showed that DD (odds ratio [ OR] 5.499, 95% confidence interval [ CI] 2.909-10.395; P<0.001), PLT ( OR 1.044, 95% CI 1.026-1.062; P<0.001), Fg ( OR 2.119, 95% CI 1.482-3.031; P<0.001), DPR ( OR 5.924, 95% CI 3.058-11.475; P<0.001), and Fg/CRP ratio ( OR 0.614, 95% CI 0.505-0.746; P<0.001) were the independent influencing factor for the occurrence of LEDVT in patients with ICH. ROC curve analysis showed that the areas under the curves of DD, PLT, Fg, DPR and the Fg/CRP ratio for predicting LEDVT in patients with ICH were 0.784 (95% CI 0.711-0.846), 0.772 (95% CI 0.699-0.836), 0.711 (95% CI 0.633-0.781), 0.782 (95% CI 0.709-0.844), and 0.778 (95% CI 0.705-0.841), respectively. The area under the curve for the combined prediction of DD+PLT+Fg was 0.878 (95% CI 0.816-0.924), and the area under the curve for the combined prediction of DPR+Fg/CRP ratio was 0.921 (95% CI 0.867-0.958). The latter showed a higher predictive value. Conclusion:The combined detection of DPR and Fg/CRP ratio has higher predictive value for LEDVT in patients with ICH.

Objective:To explore the application value of arthroscopic tunnel pulling and suturing methods in West type Ⅱ and Ⅲ lateral meniscus posterior root injuries.Methods:A total of 184 patients with West Ⅱ ( n=92) and Ⅲ ( n=92) lateral meniscus posterior root injuries who underwent surgical treatment in Second Affiliated Hospital of Xi′an Jiaotong University from May 2022 to June 2023 were selected as the study subjects, by adopting a retrospective controlled study method. Using a random number table method, West Ⅱ and Ⅲ patients were divided into a tunnel method group and a suture method group, with 46 patients in each group. There were 23 male and 23 female patients in the West Ⅱ tunnel method group, with an age of (48.36±2.52) years. There were 25 male and 21 female patients in the suture method group, with an age of (48.61±2.21) years. There were 24 male and 22 female patients in the West Ⅲ tunnel method group, with an age of (48.53±2.36) years. There were 24 male and 22 female patients in the suture method group, with an age of (46.38±2.67) years. The tunnel method group used arthroscopic tibial tunnel cable fixation method, while the suture method group used arthroscopic full internal meniscus suture method. Compared the surgical time, length of hospital stay, and first postoperative time of getting out of bed between the tunnel method group and the suture method group of patients with different subtypes. Compared the knee joint function scores (Lysholm, Tegner, IKDC, VAS) before and after surgery. Used MRI to examine the compression of the patient′s lateral meniscus. Compared the incidence of adverse reactions. Measurement data with normal distribution were represented as mean ± standard deviation( ± s), and the comparison between groups was conducted using the t-test; the comparison of count data were represented as [ n(%)] and was conducted by chi-square test or Fisher exact probability. The skewness data were expressed by M( Q1, Q3), and rank-sum test was used for inter-group comparison. Results:There was no significant difference in surgical time, length of hospital stay, and first postoperative bed time between the West type Ⅱ, Ⅲ tunel method group and the suture method group ( P>0.05). At 12 months after surgery, there was no statistically significant difference in the Lysholm score, Tegner score, IKDC score, and VAS score between the West Ⅱ type patients in the tunnel method group and the suture method group ( P>0.05). However, the Lysholm score and IKDC score in the West Ⅲ type tunnel method group were significantly higher than those in the suture method group, and the difference was statistically significant( P<0.05). However, there was no statistically significant difference in the Tegner score and VAS score ( P>0.05). At the 12th months after surgery, there was no statistically significant difference in the overall width of the meniscus between the tunnel method group and the suture method group for patients with different West classifications( P>0.05). However, the relative percentage of meniscus compression in the tunnel method group was significantly lower than that in the suture method group, and the difference was statistically significant ( P<0.05). There was no statistically significant difference in the incidence of postoperative complications between the tunnel method group and the suture method group in patients with different West subtypes ( P>0.05). Conclusions:The arthroscopic tibial tunnel wire fixation method is effective, safe, and reliable in treating patients with West Ⅱ and West Ⅲ lateral meniscus posterior root injuries promoting kneejoint function recovery. It is expected to become a high-quality treatment plan for patients with West Ⅱ and West Ⅲ meniscus injuries.

ObjectiveTo investigate the application value of liver/spleen CT value （CT_L/S）， controlled attenuation parameter （CAP）， and magnetic resonance imaging-proton density fat fraction （MRI-PDFF） in chronic hepatitis B （CHB） patients with hepatic steatosis. MethodsA retrospective analysis was performed for the clinical data of 213 CHB patients who underwent liver CT， CAP， and MRI-PDFF examinations in Affiliated Hospital of Yan’an University from October 2018 to December 2022. According to MRI-PDFF， the 213 patients were divided into CHB group with 111 patients （MRI-PDFF<5%） and CHB+hepatic steatosis group with 102 patients （MRI-PDFF≥5%）， among whom there were 69 patients with mild hepatic steatosis and 33 patients with moderate to severe hepatic steatosis. The independent-samples t test was used for comparison of normally distributed continuous data between groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups. The Bland-Altman plot was used to evaluate the consistency in MRI-PDFF measurement between two physicians. The Spearman’s correlation coefficient was used to analyze the correlation between CT_L/S and MRI-PDFF and between CAP and MRI-PDFF. The receiver operating characteristic （ROC） curve was plotted and the area under the ROC curve （AUC） was calculated to investigate the value of CT_L/S and CAP in the diagnosis of different degrees of hepatic steatosis， and the DeLong test was used to compare the AUCs of the two radiological examinations. ResultsMRI-PDFF had relatively high repeatability and stability in CHB patients. There is a significant negative correlation between CT_L/S and MRI-PDFF （r=-0.800， P<0.001） and a significant positive correlation between CAP and MRI-PDFF （r=0.692， P<0.001）. Both CT_L/S and CAP had a relatively high accuracy in the diagnosis of hepatic steatosis in CHB patients， with an AUC of 0.951 and 0.902， respectively， and CT_L/S had a better accuracy than CAP （P<0.05）. In the diagnosis of mild and moderate-to-severe hepatic steatosis， CT_L/S had an AUC of 0.921 and 0.895， respectively， and CAP had an AUC of 0.859 and 0.825， respectively， suggesting that CT_L/S had a slightly higher diagnostic efficiency than CAP. ConclusionMRI-PDFF has high repeatability and stability in CHB patients， and CT_L/S and CAP have a high diagnostic value for different degrees of hepatic steatosis in CHB patients.