Objective:To investigate the effect of extracorporeal membrane oxygenation (ECMO) in assisting neonates with complex congenital heart diseases (CHD) and the survival rate of the patients.Methods:A retrospective case-control study was made on 22 newborns with complex CHD assisted by ECMO during the perioperative period in Fuwai Central China Cardiovascular Hospital from January 2018 to June 2024.There were 19 males and 3 females in the newborns included, with an average age of (10.4±8.7) days (range: 1-26 days) and an average weight of (3.1±0.3) kg.Complex CHD included total anomalous pulmonary venous connection in 9 cases (40.9%), interrupted aortic arch and coarctation in 8 cases (36.4%), transposition of great arteries in 3 cases (13.6%), double outlet right ventricle in 1 case (4.5%) and cardiac tumor in 1 case (4.5%).The patients were divided into the <5 d group, 5-12 d group, and >12 d group according to the duration of ECMO support.Data were compared using the t-test or χ2 test. Results:There were 8 cases (36.4%) successfully weaned from ECMO support and 6 cases (27.3%) survived.ECMO support was used routinely in 15 cases (68.2%), and for extracorporeal cardiopulmonary resuscitation in 7 cases (31.8%).The duration of ECMO support was (5.9±3.7) days.There were no statistically differences in age, weight, gender, disease composition, operation time, cardiopulmonary bypass time, cross-clamp time, assistant time, blood routine, liver and kidney function and other biochemical indicators, preoperative cardiac ejection fraction value, procalcitonin, C-reactive protein and other infection indicators between the death group and the survival group (all P>0.05).The highest lactate values 24 hours before [(8.1±5.4) mmol/L] and after ECMO support [(10.5±7.1) mmol/L] in the survival group were significantly lower than those in the death group [(18.7±9.2) mmol/L, (21.3±8.6) mmol/L] ( t=2.606, P=0.018; t=2.729, P=0.013).It was found that the survival rate was 0/9 (0) in the <5 d group, 6/12 (50.0%) in the 5-12 d group, and 0/1 (0) in the >12 d group.The survival rate of the 5-12 d group was the highest, which was significantly higher than that of the <5 d group ( χ2=6.300, P=0.012). Conclusions:ECMO support is an effective treatment for severe circulatory failure in neonates with complex CHD in the perioperative period.The highest lactate levels 24 hours before and after ECMO support affect the survival rate.Patients receiving 5-12 d ECMO support can achieve the highest survival rate.

Background and Aims:Spontaneous isolated superior mesenteric artery dissection(SISMAD)is a relatively common type of visceral artery dissection,typically presenting with acute abdominal pain.In severe cases,it may lead to intestinal ischemia or even necrosis.With the widespread use of imaging techniques such as CT angiography(CTA),the detection rate of SISMAD has significantly increased.However,there is still controversy regarding its optimal treatment strategy,especially in choosing between conservative management and endovascular intervention,as no unified standard currently exists.This study aimed to compare the short-and medium-term outcomes of the two treatment modalities by retrospectively analyzing the clinical data of SISMAD patients treated at our center in order to provide evidence for individualized treatment decisions.Methods:A retrospective analysis was conducted on 174 patients diagnosed with SISMAD at Ningbo Second Hospital between January 2018 and December 2023.Among them,30 patients received conservative treatment,and 144 underwent endovascular intervention(including stent implantation alone or in combination with coil embolization of the false lumen).All patients were diagnosed using CTA or superior mesenteric artery angiography and classified accordingly.Patients were followed up at 1 month and 1 year after treatment to assess clinical symptom relief and radiological outcomes,including dissection remodeling and stent patency.Results:In the conservative group,the symptom relief rate was 90.0%at 1 month and 92.8%at 1 year;in the interventional group,the corresponding rates were 99.3%and 98.6%.The difference in symptom relief at 1 month was statistically significant(P=0.016),while the difference at 1 year was not(P>0.05).Subgroup analysis by classification showed that the interventional group generally had higher symptom relief rates than the conservative group across all types.However,none of the differences reached statistical significance(all P>0.05).The conservative group showed poorer symptom control in type Ⅲpatients,including one death.The technical success rate of endovascular treatment was 99.3%,with no cases of stent displacement or occlusion within 1 year.The complete remodeling rate was 86.8%,and the stent patency rate was 100.0%.Some patients had minor mural thrombus formation within the stent without evidence of flow obstruction.Conclusion:Endovascular intervention offers a high technical success rate and favorable short-and medium-term efficacy in SISMAD patients,particularly for type Ⅱ and Ⅲ cases with compromised true lumen perfusion.Treatment strategies should be tailored based on the dissection type and the degree of true lumen compression to improve clinical outcomes and reduce associated risks.

Objective:To explore the effect of ultrasound-guided stellate ganglion block (SGB) combined with cognitive behavioral therapy for insomnia (CBT-I) in the treatment of chronic insomnia.Methods:A total of 69 patients with chronic insomnia admitted to the Nanjing First Hospital from January 2023 to February 2024 were selected and randomly divided into the CBT-I alone group (simple group, 34 cases) and the SGB combined with CBT-I group (combined group, 35 cases) using a random number table. Both groups received treatment for 8 weeks. The simple group was treated with CBT-I twice a week, 1 hour each time. The combined group, on the basis of the simple group, received ultrasound-guided SGB with 4 ml of 1% lidocaine, which was performed once a day, alternately on the left and right sides, for 7 consecutive days each time, with a total of 14 injections in the 1st and 5th weeks. One week before treatment and 8 weeks after treatment, the Pittsburgh Sleep Quality Index (PSQI) and sleep diary were used to record patients′ subjective sleep quality; Actigraph was used to record objective sleep status; the Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were used to assess patients′ emotional status. Adverse reactions such as hoarseness, pneumothorax, bleeding, and infection were recorded.Results:After 8 weeks of treatment, the effective rate was 76.5%(26/34) in the simple group and 94.3%(33/35) in the combined group, with a statistically significant difference (χ 2=8.433, P<0.05). Before treatment, there was no significant difference in PSQI scores between the two groups ( P>0.05). After 8 weeks of treatment, the PSQI scores of both groups were lower than those before treatment, and the PSQI score of the combined group was lower than that of the simple group, with a statistically significant difference ( P<0.05). Before treatment, there were no significant differences in sleep parameters from sleep diaries and Actigraph between the two groups (all P>0.05). Compared with before treatment, after treatment, the total sleep time and time in bed were prolonged, and sleep efficiency, the proportion of deep sleep, and the proportion of rapid eye movement sleep were increased in both groups; these indicators in the combined group were better than those in the simple group, with statistically significant differences (all P<0.05). Compared with before treatment, the sleep onset latency was shortened and the number of awakenings was reduced in both groups after treatment, and the combined group was better than the simple group, with statistically significant differences (all P<0.05). Before treatment, there were no significant differences in SAS and SDS scores between the two groups (all P>0.05). After treatment, the SAS and SDS scores of both groups were lower than those before treatment, and the SAS and SDS scores of the combined group were lower than those of the simple group, with statistically significant differences (all P<0.05). During treatment, 2 cases in the combined group developed hoarseness, which relieved spontaneously after 2 hours, and no other complications occurred. Conclusions:Ultrasound-guided SGB combined with CBT-I can significantly improve the nighttime sleep quality of patients with chronic insomnia.

Background and Aims:Spontaneous isolated superior mesenteric artery dissection(SISMAD)is a relatively common type of visceral artery dissection,typically presenting with acute abdominal pain.In severe cases,it may lead to intestinal ischemia or even necrosis.With the widespread use of imaging techniques such as CT angiography(CTA),the detection rate of SISMAD has significantly increased.However,there is still controversy regarding its optimal treatment strategy,especially in choosing between conservative management and endovascular intervention,as no unified standard currently exists.This study aimed to compare the short-and medium-term outcomes of the two treatment modalities by retrospectively analyzing the clinical data of SISMAD patients treated at our center in order to provide evidence for individualized treatment decisions.Methods:A retrospective analysis was conducted on 174 patients diagnosed with SISMAD at Ningbo Second Hospital between January 2018 and December 2023.Among them,30 patients received conservative treatment,and 144 underwent endovascular intervention(including stent implantation alone or in combination with coil embolization of the false lumen).All patients were diagnosed using CTA or superior mesenteric artery angiography and classified accordingly.Patients were followed up at 1 month and 1 year after treatment to assess clinical symptom relief and radiological outcomes,including dissection remodeling and stent patency.Results:In the conservative group,the symptom relief rate was 90.0%at 1 month and 92.8%at 1 year;in the interventional group,the corresponding rates were 99.3%and 98.6%.The difference in symptom relief at 1 month was statistically significant(P=0.016),while the difference at 1 year was not(P>0.05).Subgroup analysis by classification showed that the interventional group generally had higher symptom relief rates than the conservative group across all types.However,none of the differences reached statistical significance(all P>0.05).The conservative group showed poorer symptom control in type Ⅲpatients,including one death.The technical success rate of endovascular treatment was 99.3%,with no cases of stent displacement or occlusion within 1 year.The complete remodeling rate was 86.8%,and the stent patency rate was 100.0%.Some patients had minor mural thrombus formation within the stent without evidence of flow obstruction.Conclusion:Endovascular intervention offers a high technical success rate and favorable short-and medium-term efficacy in SISMAD patients,particularly for type Ⅱ and Ⅲ cases with compromised true lumen perfusion.Treatment strategies should be tailored based on the dissection type and the degree of true lumen compression to improve clinical outcomes and reduce associated risks.

Objective:To investigate the effect of extracorporeal membrane oxygenation (ECMO) in assisting neonates with complex congenital heart diseases (CHD) and the survival rate of the patients.Methods:A retrospective case-control study was made on 22 newborns with complex CHD assisted by ECMO during the perioperative period in Fuwai Central China Cardiovascular Hospital from January 2018 to June 2024.There were 19 males and 3 females in the newborns included, with an average age of (10.4±8.7) days (range: 1-26 days) and an average weight of (3.1±0.3) kg.Complex CHD included total anomalous pulmonary venous connection in 9 cases (40.9%), interrupted aortic arch and coarctation in 8 cases (36.4%), transposition of great arteries in 3 cases (13.6%), double outlet right ventricle in 1 case (4.5%) and cardiac tumor in 1 case (4.5%).The patients were divided into the <5 d group, 5-12 d group, and >12 d group according to the duration of ECMO support.Data were compared using the t-test or χ2 test. Results:There were 8 cases (36.4%) successfully weaned from ECMO support and 6 cases (27.3%) survived.ECMO support was used routinely in 15 cases (68.2%), and for extracorporeal cardiopulmonary resuscitation in 7 cases (31.8%).The duration of ECMO support was (5.9±3.7) days.There were no statistically differences in age, weight, gender, disease composition, operation time, cardiopulmonary bypass time, cross-clamp time, assistant time, blood routine, liver and kidney function and other biochemical indicators, preoperative cardiac ejection fraction value, procalcitonin, C-reactive protein and other infection indicators between the death group and the survival group (all P>0.05).The highest lactate values 24 hours before [(8.1±5.4) mmol/L] and after ECMO support [(10.5±7.1) mmol/L] in the survival group were significantly lower than those in the death group [(18.7±9.2) mmol/L, (21.3±8.6) mmol/L] ( t=2.606, P=0.018; t=2.729, P=0.013).It was found that the survival rate was 0/9 (0) in the <5 d group, 6/12 (50.0%) in the 5-12 d group, and 0/1 (0) in the >12 d group.The survival rate of the 5-12 d group was the highest, which was significantly higher than that of the <5 d group ( χ2=6.300, P=0.012). Conclusions:ECMO support is an effective treatment for severe circulatory failure in neonates with complex CHD in the perioperative period.The highest lactate levels 24 hours before and after ECMO support affect the survival rate.Patients receiving 5-12 d ECMO support can achieve the highest survival rate.

Objective:To explore the effect of ultrasound-guided stellate ganglion block (SGB) combined with cognitive behavioral therapy for insomnia (CBT-I) in the treatment of chronic insomnia.Methods:A total of 69 patients with chronic insomnia admitted to the Nanjing First Hospital from January 2023 to February 2024 were selected and randomly divided into the CBT-I alone group (simple group, 34 cases) and the SGB combined with CBT-I group (combined group, 35 cases) using a random number table. Both groups received treatment for 8 weeks. The simple group was treated with CBT-I twice a week, 1 hour each time. The combined group, on the basis of the simple group, received ultrasound-guided SGB with 4 ml of 1% lidocaine, which was performed once a day, alternately on the left and right sides, for 7 consecutive days each time, with a total of 14 injections in the 1st and 5th weeks. One week before treatment and 8 weeks after treatment, the Pittsburgh Sleep Quality Index (PSQI) and sleep diary were used to record patients′ subjective sleep quality; Actigraph was used to record objective sleep status; the Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were used to assess patients′ emotional status. Adverse reactions such as hoarseness, pneumothorax, bleeding, and infection were recorded.Results:After 8 weeks of treatment, the effective rate was 76.5%(26/34) in the simple group and 94.3%(33/35) in the combined group, with a statistically significant difference (χ 2=8.433, P<0.05). Before treatment, there was no significant difference in PSQI scores between the two groups ( P>0.05). After 8 weeks of treatment, the PSQI scores of both groups were lower than those before treatment, and the PSQI score of the combined group was lower than that of the simple group, with a statistically significant difference ( P<0.05). Before treatment, there were no significant differences in sleep parameters from sleep diaries and Actigraph between the two groups (all P>0.05). Compared with before treatment, after treatment, the total sleep time and time in bed were prolonged, and sleep efficiency, the proportion of deep sleep, and the proportion of rapid eye movement sleep were increased in both groups; these indicators in the combined group were better than those in the simple group, with statistically significant differences (all P<0.05). Compared with before treatment, the sleep onset latency was shortened and the number of awakenings was reduced in both groups after treatment, and the combined group was better than the simple group, with statistically significant differences (all P<0.05). Before treatment, there were no significant differences in SAS and SDS scores between the two groups (all P>0.05). After treatment, the SAS and SDS scores of both groups were lower than those before treatment, and the SAS and SDS scores of the combined group were lower than those of the simple group, with statistically significant differences (all P<0.05). During treatment, 2 cases in the combined group developed hoarseness, which relieved spontaneously after 2 hours, and no other complications occurred. Conclusions:Ultrasound-guided SGB combined with CBT-I can significantly improve the nighttime sleep quality of patients with chronic insomnia.

AIM:To investigate the effect of spermidine(SPD)on pressure overload-induced cardiac hyper-trophy and heart failure model in mice and its underlying mechanisms.METHODS:(1)Eight-week-old male C57BL/6J mice were randomly divided into 4 groups:sham group,sham+SPD group,transverse aortic constriction(TAC)group,and TAC+SPD group.After TAC,the mice in sham+SPD group and TAC+SPD group were fed with 3 mmol/L SPD via drinking water,and the mice in other groups were fed with normal water.Western blot was used to detect the protein ex-pression levels of silent information regulator 6(SIRT6),peroxisome proliferator-activated receptor γ coactivator-1(PGC-1)and mitofusin 2(MFN2).Adult mouse cardiomyocytes were isolated to detect cell length and width.Wheat germ agglu-tinin staining was used to detect the cardiac cell size.Masson staining was used to detect the extent of fibrosis.Echocar-diography was used to detect cardiac function and myocardial hypertrophy.Transmission electron microscopy was used to analyze mitochondrial morphology.Oxygraph-2k high-resolution respirometer was used to detect cardiac mitochondrial oxy-gen consumption.(2)In vitro,primary rat ventricular cardiomyocytes were cultured and treated with angiotensin II(Ang II;1 μmol/L)to construct a hypertrophy model of cardiomyocytes.These cardiomyocytes were divided into control(Con)group,Con+SPD(1 mmol/L)group,Ang II group,Ang II+SPD group and Ang II+SPD+SIRT6 siRNA(siSIRT6)group.Confocal microscopy was used to detect cardiomyocytes area and mitochondrial.RESULTS:(1)Compared with sham group,cardiac function of the mice in TAC group was significantly decreased(P＜0.05),the degree of myocardial hyper-trophy was significantly increased(P＜0.05),and the expression levels of SIRT6,PGC-1 and MFN2 in the myocardial tis-sue were significantly decreased(P＜0.05).Compared with TAC group,the expression levels of SIRT6,PGC-1 and MFN2 in mouse myocardial tissues of TAC+SPD group were significantly increased(P＜0.05),pathological myocardial hy-pertrophy was reduced(P＜0.05),the numbers of mitochondria and mitochondrial cristae were increased(P＜0.05),mito-chondrial function was restored(P＜0.05),myocardial fibrosis was alleviated(P＜0.05),and cardiac function was im-proved(P＜0.05).(2)In vitro,compared with Con group,the expression levels of SIRT6,PGC-1 and MFN2 in cardio-myocytes of Ang II group were decreased(P＜0.05),and the degree of cardiomyocyte hypertrophy was significantly in-creased(P＜0.05).Treatment with SPD increased the expression levels of SIRT6,PGC-1 and MFN2 in cardiomyocytes of Ang II group(P＜0.05),reversed myocardial hypertrophy and improved mitochondrial dynamics(P＜0.05).Compared with Ang II group,the expression levels of SIRT6,PGC-1 and MFN2 in Ang II+SPD+siSIRT6 group showed no significant changes,and the degree of cardiomyocyte hypertrophy and mitochondrial dynamics also had no statistically significant changes.CONCLUSION:Spermidine promotes the expression of SIRT6,PGC-1 and MFN2,thus improving mitochon-drial function,reducing myocardial hypertrophy and alleviating heart failure in mice with pressure overload.

Objective:To investigate the current status of endoscopic treatment for gastroesophageal varices in portal hypertension in China, and to provide supporting data and reference for the development of endoscopic treatment.Methods:In this study, initiated by the Liver Health Consortium in China (CHESS), a questionnaire was designed and distributed online to investigate the basic condition of endoscopic treatment for gastroesophageal varices in portal hypertension in 2022 in China. Questions included annual number and indication of endoscopic procedures, adherence to guideline for preventing esophagogastric variceal bleeding (EGVB), management and timing of emergent EGVB, management of gastric and isolated varices, and improvement of endoscopic treatment. Proportions of hospitals concerning therapeutic choices to all participant hospitals were calculated. Guideline adherence between secondary and tertiary hospitals were compared by using Chi-square test.Results:A total of 836 hospitals from 31 provinces (anotomous regions and municipalities) participated in the survey. According to the survey, the control of acute EGVB (49.3%, 412/836) and the prevention of recurrent bleeding (38.3%, 320/836) were major indications of endoscopic treatment. For primary [non-selective β-blocker (NSBB) or endoscopic therapies] and secondary prophylaxis (NSBB and endoscopic therapies) of EGVB, adherence to domestic guideline was 72.5% (606/836) and 39.2% (328/836), respectively. There were significant differences in the adherence between secondary and tertiary hospitals in primary prophylaxis of EGVB [71.0% (495/697) VS 79.9% (111/139), χ2=4.11, P=0.033] and secondary prophylaxis of EGVB [41.6% (290/697) VS 27.3% (38/139), χ2=9.31, P=0.002]. A total of 78.2% (654/836) hospitals preferred endoscopic therapies treating acute EGVB, and endoscopic therapy was more likely to be the first choice for treating acute EGVB in tertiary hospitals (82.6%, 576/697) than secondary hospitals [56.1% (78/139), χ2=46.33, P<0.001]. The optimal timing was usually within 12 hours (48.5%, 317/654) and 12-24 hours (36.9%, 241/654) after the bleeding. Regarding the management of gastroesophageal varices type 2 and isolated gastric varices type 1, most hospitals used cyanoacrylate injection in combination with sclerotherapy [48.2% (403/836) and 29.9% (250/836), respectively], but substantial proportions of hospitals preferred clip-assisted therapies [12.4% (104/836) and 26.4% (221/836), respectively]. Improving the skills of endoscopic doctors (84.2%, 704/836), and enhancing the precision of pre-procedure evaluation and quality of multidisciplinary team (78.9%, 660/836) were considered urgent needs in the development of endoscopic treatment. Conclusion:A variety of endoscopic treatments for gastroesophageal varices in portal hypertension are implemented nationwide. Participant hospitals are active to perform emergent endoscopy for acute EGVB, but are inadequate in following recommendations regarding primary and secondary prophylaxis of EGVB. Moreover, the selection of endoscopic procedures for gastric varices differs greatly among hospitals.

Objective To explore the CT imaging features and independent risk factors for cystic pulmonary nodules and establish a malignant probability prediction model. Methods The patients with cystic pulmonary nodules admitted to the Department of Thoracic Surgery of the First People's Hospital of Neijiang from January 2017 to February 2022 were retrospectively enrolled. They were divided into a malignant group and a benign group according to the pathological results. The clinical data and preoperative chest CT imaging features of the two groups were collected, and the independent risk factors for malignant cystic pulmonary nodules were screened out by logistic regression analysis, so as to establish a prediction model for benign and malignant cystic pulmonary nodules. Results A total of 107 patients were enrolled. There were 76 patients in the malignant group, including 36 males and 40 females, with an average age of 59.65±11.74 years. There were 31 patients in the benign group, including 16 males and 15 females, with an average age of 58.96±13.91 years. Multivariate logistic analysis showed that the special CT imaging features such as cystic wall nodules [OR=3.538, 95%CI (1.231, 10.164), P=0.019], short burrs [OR=4.106, 95%CI (1.454, 11.598), P=0.008], cystic wall morphology [OR=6.978, 95%CI (2.374, 20.505), P<0.001], and the number of cysts [OR=4.179, 95%CI (1.438, 12.146), P=0.009] were independent risk factors for cystic lung cancer. A prediction model was established: P=ex/(1+ex), X=–2.453+1.264×cystic wall nodules+1.412×short burrs+1.943×cystic wall morphology+1.430×the number of cysts. The area under the receiver operating charateristic curve was 0.830, the sensitivity was 82.9%, and the specificity was 74.2%. Conclusion Cystic wall nodules, short burrs, cystic wall morphology, and the number of cysts are the independent risk factors for cystic lung cancer, and the established prediction model can be used as a screening method for cystic pulmonary nodules.