BACKGROUND: Coronary artery disease (CAD) is the commonest cause of heart failure (HF), whereas pulmonary hypertension (PH) has not been established or reported in this patient population. Therefore, we assessed the prevalence, risk factors, and survival in CAD-associated HF (CAD-HF) complicated with PH. METHODS: Symptomatic CAD-HF patients were continuously enrolled in this prospective, multicenter registry study. Echocardiography, coronary arteriography, left and right heart catheterization (RHC), and other baseline clinical data were recorded. Patients were followed up and their survival was recorded. RESULTS: One hundred and eighty-two CAD-HF patients were enrolled, including 142 with HF with a preserved ejection fraction (heart failure with preserved ejection fraction [HFpEF]; left ventricular ejection fraction [LVEF] ≥50%) and 40 with a reduced ejection fraction (heart failure with reduced ejection fraction [HFrEF]; LVEF < 50%). PH was diagnosed with RHC in 77.5% of patients. Patients with PH showed worse hemodynamic parameters and higher mortality. HFrEF-PH patients had worse survival than HFpEF-PH patients. CAD-HF patients with an enlarged left ventricular end-diastolic diameter and reduced hemoglobin were at higher risk of PH. Nitrate treatment reduced the risk of PH. Elevated creatinine and mean pulmonary arterial pressure (mPAP), diastolic pressure gradient (DPG) ≥7 mmHg, and previous myocardial infarction (MI) entailed a higher risk of mortality in CAD-HF patients with PH. CONCLUSIONS: PH is common in CAD-HF and worsens the hemodynamics and survival in these patients. Left ventricle enlargement and anemia increase the risk of PH in CAD-HF. Patients may benefit from nitrate medications. Renal impairment, elevated mPAP, DPG ≥7 mmHg, and previous MI are strong predictors of mortality in CAD-HF-PH patients. TRIAL REGISTRATION ClinicalTrials.gov, NCT02164526.
Coronary Artery Disease/epidemiology* ; Creatinine ; Heart Failure/complications* ; Humans ; Hypertension, Pulmonary/complications* ; Nitrates ; Prevalence ; Prognosis ; Prospective Studies ; Registries ; Risk Factors ; Stroke Volume ; Ventricular Function, Left

Objective: To analyze the characteristics of individuals positive for SARS-CoV-2 nucleic acid in a centralized isolation site for people entering China in Huzhou City of Zhejiang Province from December 18, 2021 to January 12, 2022, so as to provide insights into the prevention and control of overseas imported COVID-19. Methods: The basic characteristics, nucleic acid detection and epidemiological investigations were collected from individuals positive for SARS-CoV-2 nucleic acid in a centralized isolation site for people entering China from December 18, 2021 to January 12, 2022, and the temporal distribution, population distribution, source of importation, and virus typing were descriptively analyzed. Results : From December 18, 2021 to January 12, 2022, a total of 2 974 individuals in 19 flights were recorded in this centralized isolation site, and 33 cases were tested positive for SARS-CoV-2 nucleic acid, including 21 confirmed cases with common type, 9 confirmed cases with mild type, and 3 cases with asymptomatic infections. There were 11 cases with Omicron infections ( 33.33% ), 5 cases with Delta infections ( 15.15% ), and 17 cases with infection of unidentified types ( 51.52% ). The median interval ( interquartile range ) from the time of entry to the time of a positive test was 4.0 ( 7.0 ) days among all positive cases, 0 ( 4.0 ) day among cases with Omicron infections and 4.5 ( 8.5 ) days among cases with infections of Delta and unidentified types. The positive cases had a mean age of ( 36.97±8.58 ) years, and included 27 men (81.82%). There were 30 cases ( 90.91% ) receiving two and more doses of COVID-19 vaccines, and 7 cases ( 21.21% ) with a previous history of SARS-CoV-2 infections. There were 19 cases ( 57.58% ) from African countries, and 7 of 11 cases with Omicron infections were imported from African countries. Conclusion Omicron infection was predominant among individuals positive for SARS-CoV-2 nucleic acid in this centralized isolation site for people entering China from December 18, 2021 to January 12, 2022, with no severe cases detected, and most positive cases were imported from African countries.

Closed-loop hospital management can effectivly cope with the COVID-19 pandemic. In order to ensure the continuity of treatments for hemodialysis patients under closed-loop management and minimize possible medical and infection risks, Huashan Hospital affiliated to Fudan University and 9 hospitals in Shanghai established a hemodialysis alliance in January 2021.The alliance optimized hemodialysis resources within the region through overall planning by preparing sites, materials and personnel shifts in advance, and establishing management systems and work processes to ensure that patients could be quickly and orderly diverted to other blood dialysis centers for uninterrupted high-quality hemodialysis services, in case that some hemodialysis centers in the alliance under closed-loop management.From November 2021 to April 2022, 317 of 1 459 hemodialysis patients in the alliance were diverted to other centers for treatment, accumulating 1 215 times/cases of treatments without obvious adverse reactions. The practice could provide a reference for medical institutions to quickly establish mutual support mode under major public health events.

In this study, self-discriminating hybrid nanocrystals was utilized to explore the biological fate of quercetin hybrid nanocrystals (QT-HNCs) with diameter around 280 nm (QT-HNCs-280) and 550 nm (QT-HNCs-550) following oral and intravenous administration and the contribution of integral nanocrystals to oral bioavailability enhancement of QT was estimated by comparing the absolute exposure of integral QT-HNCs and total QT in the liver. Results showed that QT-HNCs could reside

Objective:To investigate the safety and clinical effect of single-stage separation of 4-finger with contiguous gull wing flaps and preserving the dorsal metacarpal vein in Poland syndrome.Methods:From June 2013 to January 2018, 17 children with Poland syndrome were treated by contiguous gull wing flaps. Postoperative follow-up was conducted to observe the incidence of skin flap necrosis and finger vascular crisis. Morphology of the fingers web was evaluated by modified Withey score and Swanson hand function score. Paired t-test was used for intra group comparison. Results:The operation was successfully completed and there were no early complications such as vascular crisis and skin necrosis. All patients were followed up for 12-41 months, with an average of 23.1 months. All patients had a reconstruction depth of digital webbed at nearly 1/3 of the proximal phalanx. Both the appearance and function were satisfactory without conspicuous scar. The depth, width and slope of the webbed are normal without conspicuous scar. Withey score was 0-1, with an average score of 0.17. There was significant differences of Swanson hand function score between preoperative(16.3±1.4)% and postoperative(3.6±1.3)%( t=16.469, P<0.01). Conclusions:It is safe to treat the syndactyly deformity of Poland syndrome with single-stage separation of 4-finger with contiguous gull wing flaps and preserving the dorsal metacarpal vein. The clinical efficacy is reliable.

Objective:To investigate the effectiveness of cross flap in reconstruction of the web space in congenital toe syndactyly.Methods:From January 2019 to September 2019, 11 patients with congenital toe syndactyly were treated for web space reconstruction with dorsal cross flap. There were 7 boys and 4 girls with the average age of 5.6 years old. There were 6 cases of congenital toe syndactyly located at left foot and 5 cases located at right foot.During follow up, the web space appearance, web space depth, and web space gradient were observed to evaluate the effectiveness.Results:In all cases, there were no skin grafts on the web, root and side of the toe. The incisions were primary healing without infection or necrosis. After 5-14 months follow-up, the depth, width and gradient of the web were normal, and 2 cases had slight cicatricial hyperplasia.Conclusions:The cross flap is easy to design. It has advantages of reliable blood supply, high utilization of skin on the dorsum of toe, without skin grafting and reconstruction of normal toe web.

Objective:To investigate the safety and clinical effect of single-stage separation of 4-finger with contiguous gull wing flaps and preserving the dorsal metacarpal vein in Poland syndrome.Methods:From June 2013 to January 2018, 17 children with Poland syndrome were treated by contiguous gull wing flaps. Postoperative follow-up was conducted to observe the incidence of skin flap necrosis and finger vascular crisis. Morphology of the fingers web was evaluated by modified Withey score and Swanson hand function score. Paired t-test was used for intra group comparison. Results:The operation was successfully completed and there were no early complications such as vascular crisis and skin necrosis. All patients were followed up for 12-41 months, with an average of 23.1 months. All patients had a reconstruction depth of digital webbed at nearly 1/3 of the proximal phalanx. Both the appearance and function were satisfactory without conspicuous scar. The depth, width and slope of the webbed are normal without conspicuous scar. Withey score was 0-1, with an average score of 0.17. There was significant differences of Swanson hand function score between preoperative(16.3±1.4)% and postoperative(3.6±1.3)%( t=16.469, P<0.01). Conclusions:It is safe to treat the syndactyly deformity of Poland syndrome with single-stage separation of 4-finger with contiguous gull wing flaps and preserving the dorsal metacarpal vein. The clinical efficacy is reliable.

Objective:To investigate the effectiveness of cross flap in reconstruction of the web space in congenital toe syndactyly.Methods:From January 2019 to September 2019, 11 patients with congenital toe syndactyly were treated for web space reconstruction with dorsal cross flap. There were 7 boys and 4 girls with the average age of 5.6 years old. There were 6 cases of congenital toe syndactyly located at left foot and 5 cases located at right foot.During follow up, the web space appearance, web space depth, and web space gradient were observed to evaluate the effectiveness.Results:In all cases, there were no skin grafts on the web, root and side of the toe. The incisions were primary healing without infection or necrosis. After 5-14 months follow-up, the depth, width and gradient of the web were normal, and 2 cases had slight cicatricial hyperplasia.Conclusions:The cross flap is easy to design. It has advantages of reliable blood supply, high utilization of skin on the dorsum of toe, without skin grafting and reconstruction of normal toe web.

Objective:To introduce the clinical experience and treatment effect of congenital radial longitudinal deficiency in children with one-stage bilobed flap combined with centralization by circular external fixation.Methods:Analysis and statistics from 14 children with radial longitudinal deficiency were summarized in our hospital from January 2006 to December 2018, 8 males and 6 females; aged 3 to 17 years, average 9.7 years. 3 patients on the left side, 10 patients on the right side, 1 case bilateral.1 case was type Ⅱ, 7 cases were type Ⅲ, 6 cases were type Ⅳ.2 cases were with scoliosis. The radial angulation of 30°- 90°(average 67.3°) before operation. In the first phase, bilobed flaps were used to completely release soft tissue and restore dynamic balance. After the centralization, it was fixed with a circular external fixation. Three cases underwent ulnar osteotomy and forearm extension at the same time. Follow-up indicators: Observe the flap survival in the short term, and follow up on the radial deviation of the wrist and the degree of wrist mobility for a long time.Results:In one patient, the distal part of the dorsal wrist flap was necrotic, the necrotic part was removed and directly sutured 12 days later, and the rest all survived. During a follow-up period of 2 to 8 years (average 3.6 years), the average radial angulation was 9.3° (2°to 17°), the average flexion of the wrist was 46.7°(25°to 70°), and the average extension was 14.7° (5°to 20°). One case which forearm extension had a fractured nonunion and bone graft with internal fixation was performed in 9th after surgery, and ulna healed in 3 months after bone grafting. The forearm radial deflection was significantly improved in all patients, and functional recovery was satisfactory.Conclusions:Treatment of radial longitudinal deficiency in children in one-stage bilobed flap combined with centralization by circular external fixation is an effective clinical treatment method. It can reduce the number of operations, obtain satisfactory appearance and receive good functional recovery.

Objective:To explore the effect of using fascial flap and shoe type neurovascular island flap with nail fold in Wassel Ⅳ-D thumb duplication reconstruction.Methods:According to the ratio of the width of the nail fold on both sides of the finger, 30 cases were treated with shoe type neurovascular island flap with nail fold(the ratio<1/2) and 16 cases with fascial flap(the ratio>1/2) between November 2014 to February 2018. The Aesthetic Scoring System (ASS) were proposed and parents’satisfaction scores were recorded to assess Wassel Ⅳ-D thumb duplication reconstruction’s cosmetic results.Results:All flaps survived. The average follow-up was 19.3 months (range, 10 to 37 months). Nail fold symmetry was improved in all cases. Nail width and circumference were close to the normal side. 38 cases were excellent and 8 cases were good based on the ASS. Parents’ satisfaction scores range from 4 to 5, averaging 4.83 points.Conclusions:The shoe type neurovascular island flap with nail fold and the fascial flap was a safe and effective approach to recovery the nail fold symmetry and reach the aesthetic improvement in Wassel Ⅳ-D thumb duplication reconstruction.