Objective:To explore the effect of arrhythmia in early and intermediate postoperative stages of the Fontan procedure.Methods:Patients undergoing Fontan procedure at Shanghai Children's Medical Center within 2015 to 2018 were included.Identified data obtained from retrospective，observational dataset including demographic information，patient diagnoses，baseline characteristics，operation details，ECG data，ultrasound cardiograph data，in-hospital medical intervention，in-hospital mortality，out-patient medical intervention，readmission，and complications.Results:Among the 277 children，early arrhythmia occurred in 173 cases（62.5%），medium- and long-term arrhythmia occurred in 35 cases（12.6%），and 69 cases（24.91%）had no arrhythmia，of which only 55 cases（19.9%）needed early intervention with drugs.Malignant arrhythmia was an independent predictor of poor prognosis（ OR 5.835 95% CI 1.738-19.596, P=0.004）.Among all arrhythmia，atrioventricular junction arrhythmia had the highest incidence.During the follow-up，we found that most of the arrhythmia that had occurred in the early postoperative period could return to normal in three months after the operation，while the rhythm gradually stabilized at four years after the operation，the persistent arrhythmia almost no longer returned to normal，and the normal rhythm basically did not recur.For patients who did not develop arrhythmia in the early postoperative period，the peak of new arrhythmia occurred within one year after surgery，and most of them were persistent arrhythmia. Conclusion:The development of an arrhythmia is associated with a heightened risk of subsequent failure of the Fontan circulation，especially malignant arrhythmia.However，the incidence of malignant arrhythmia is not high.In addition，most of the arrhythmias that had occurred in the early postoperative period could return to normal in three months after surgery，and the rhythm gradually stabilized in four years after surgery.While no arrhythmia in the early postoperative period，the peak of new arrhythmia occur within one year after surgery，and most of them are persistent arrhythmia.

Objective:To explore the effect of arrhythmia in early and intermediate postoperative stages of the Fontan procedure.Methods:Patients undergoing Fontan procedure at Shanghai Children's Medical Center within 2015 to 2018 were included.Identified data obtained from retrospective，observational dataset including demographic information，patient diagnoses，baseline characteristics，operation details，ECG data，ultrasound cardiograph data，in-hospital medical intervention，in-hospital mortality，out-patient medical intervention，readmission，and complications.Results:Among the 277 children，early arrhythmia occurred in 173 cases（62.5%），medium- and long-term arrhythmia occurred in 35 cases（12.6%），and 69 cases（24.91%）had no arrhythmia，of which only 55 cases（19.9%）needed early intervention with drugs.Malignant arrhythmia was an independent predictor of poor prognosis（ OR 5.835 95% CI 1.738-19.596, P=0.004）.Among all arrhythmia，atrioventricular junction arrhythmia had the highest incidence.During the follow-up，we found that most of the arrhythmia that had occurred in the early postoperative period could return to normal in three months after the operation，while the rhythm gradually stabilized at four years after the operation，the persistent arrhythmia almost no longer returned to normal，and the normal rhythm basically did not recur.For patients who did not develop arrhythmia in the early postoperative period，the peak of new arrhythmia occurred within one year after surgery，and most of them were persistent arrhythmia. Conclusion:The development of an arrhythmia is associated with a heightened risk of subsequent failure of the Fontan circulation，especially malignant arrhythmia.However，the incidence of malignant arrhythmia is not high.In addition，most of the arrhythmias that had occurred in the early postoperative period could return to normal in three months after surgery，and the rhythm gradually stabilized in four years after surgery.While no arrhythmia in the early postoperative period，the peak of new arrhythmia occur within one year after surgery，and most of them are persistent arrhythmia.

Objective:To prevent postoperative myocardial oedema or other causes of acute heart failure in congenital cardiac disease,anticipating delay sternal closure may reduce the number of children requiring cardiopulmonary resuscitation after surgery.The aim of this study was to describe the rate of delay sternal closure after surgery for congenital cardiac disease and to analyse the risk factors that may be associated with it.Methods:We retrospectively reviewed all surgeries with extracorporeal circulation in the cardiothoracic surgery intensive care unit of Shanghai Children's Medical Center in the past five years,from September 2014 to December 2018.The study cohort was divided into the delay sternal closure group (n=418) and the control group (routine chest closure,n=12 188) according to whether a delay sternal closure was applicated.Risk factors associated with delay sternal closure were identified by multivariate Logistic regression analysis.Results:A total of 12 606 cases were eligible,of which 418 (3.32%) were in the delayed sternal closure group.The most common cardiac diagnosis in the delayed sternal group was transposition of the great arteries (26.8%,112/418),whereas the most common cardiac diagnosis in the control group was ventricular septal defect (45.9%,5 599/12 188).All-cause mortality in children in the delayed sternal closure group was 3.3% (14/418) compared with 0.4% (46/12 188) in the control group,with a statistically significant difference ( P<0.05).Multivariate Logistic regression analysis showed that the need for delayed sternal closure were associated with age ( OR 0.164,95% CI 0.079-0.338, P<0.001),positive intropic support before surgery ( OR 0.42,95% CI 0.252-0.699, P=0.001),sex（ OR 0.742，95% CI 0.648-1.098， P<0.05），mean body weight（ OR 1.192，95% CI 1.078-1.318， P<0.001），positive intropic support before surgery（ OR 0.370，95% CI 0.252-0.699， P<0.001），complicated surgery ( OR 0.241,95% CI 0.159-0.367, P<0.001) and extracorporeal circulation diversion time ( OR 6.412,95% CI 4.339-9.475, P<0.001). Conclusion:Delayed sternal closure is an important management strategy for congenital cardiac surgery in infants and children.Delayed sternal closure is associated with age，sex,mean body weight at the time of surgery,positive intropic support before surgery，complicated surgery and extracorporeal circulation diversion time.

Cardiac arrest (CA) is a serious cardiac event, which has a high incidence and low survival rate at home and abroad. In order to predict the risk of CA in advance, a large number of studies have been conducted by relevant researchers. This paper mainly summarizes the characteristics and research status of the existing analysis and prediction of CA from three aspects: the risk prediction factors of CA, the evaluation index of risk prediction of CA and the early warning scoring system of CA. We hope it can help medical staff to understand the current progress in this field, and provide new ways and methods for predicting the risk of CA.

Objective To evaluate the testing capabilities of laboratories,analyze existing issues,and improve testing quality,through carrying out the external quality assessment(EQA)of clinical laboratories for human papillomavirus(HPV)type 6 and 11 nucleic acid detection.Methods EQA plan was carried out twice a year.Each panel contains 4 positive samples,including one strong positive sample and one weak positive sample of HPV6 and HPV11,made from cervical secretions from patients with clinical manifestations of condyloma acuminata(CA)and positive for HPV6 or HPV11(from Shanghai First Maternity and Infant Hospital).One negative sample was cultured from the C-33A cell line(from Chinese Academy of Sciences).Samples were sent to participating laboratories by cold chain,and laboratories were required to detect test samples and upload their results within the specified time.Shanghai Center for Clinical Laboratory(SCCL)calculated the scores of each laboratory based on the return results.Results A total of 163 sample panels were sent out in the 6 rounds of EQA plan and 140 valid reports were received.The laboratory qualification rate was 96.43%(135/140)and the sample compliance rate was 97.86%(685/700).There were 13 false negative results and 2 false positive results,with weakly positive samples accounting for 76.92%(10/13)of the false negative results.Conclusion The detection accuracy of HPV6/11 nucleic acid in each laboratory was relatively high,and the detection ability of weak positive samples in individual laboratories may need to be improved.The laboratory could discover problems and improve its quality management by participating in EQA.

BACKGROUND:Alzheimer's disease is a degenerative neurological disorder characterized primarily by cognitive impairment.Acupuncture is a kind of traditional Chinese medicine therapy for treating Alzheimer's disease,but its mechanism is not yet clear. OBJECTIVE:To observe the effects of electroacupuncture with"Zhi San Zhen"on the Notch signaling pathway,β-amyloid protein(Aβ)and synaptic plasticity in 5xFAD mice. METHODS:Sixteen male,6-month-old 5xFAD mice,SPF-grade,were randomly divided into the electroacupuncture with"Zhi San Zhen"group(electroacupuncture group)and the model group,with eight mice in each group.Eight SPF-grade,male,6-month-old C57BL/6 mice were used as the wild control(wild)group.The electroacupuncture group received electroacupuncture with"Zhi San Zhen"intervention,5 times a week for 4 consecutive weeks.The model group and the wild group did not receive electroacupuncture intervention.The Morris water maze was used to preliminarily assess their learning and memory abilities.Thioflavin S staining was performed to detect Aβ plaque deposition.Western blot and real-time quantitative polymerase chain reaction(RT-qPCR)were used to measure the expression levels of transmembrane receptor protein Notch-1,Notch 1 intracellular domain(NICD),hairy and enhancer of split 1(Hes 1),hairy and enhancer of split 5(Hes 5),synaptophysin(SYN),postsynaptic density protein-95(PSD-95),and Aβ. RESULTS AND CONCLUSION:Compared with the model group,the wild group and the electroacupuncture group showed shortened escape latency,increased platform crossing times,and longer target quadrant dwell time(P<0.05).Compared with the wild group,the model group had significantly increased deposition of Aβ plaques,while electroacupuncture with"Zhi San Zhen"inhibited the deposition of Aβ plaques in the hippocampus of 5xFAD mice(P<0.05).Compared with the wild group,the model group had decreased mRNA levels of SYN,PSD-95,Notch 1,NICD,Hes 1,and Hes 5 in the hippocampal tissue of mice,and increased mRNA levels of Aβ(P<0.05).Electroacupuncture with"Zhi San Zhen"increased the mRNA levels of SYN,PSD-95,Notch 1,NICD,Hes 1,and Hes 5 in the hippocampal tissue,and decreased the mRNA level of Aβ(P<0.05).Compared with the Wild group,the model group had decreased protein expression levels of SYN,PSD-95,Notch 1,NICD,Hes 1,and Hes 5 in the hippocampal tissue of mice,and increased protein expression levels of Aβ(P<0.05).Electroacupuncture with"Zhi San Zhen"upregulated the protein expression levels of SYN,PSD-95,Notch 1,NICD,Hes 1,and Hes 5,and inhibited the protein expression of Aβ(P<0.05).To conclude,electroacupuncture with"Zhi San Zhen"can improve the learning and memory abilities of 5xFAD mice,possibly by inhibiting the deposition of Aβ protein and activating the Notch signaling pathway in the hippocampus to enhance synaptic plasticity.

OBJECTIVE To investigate the role of solute carrier family 1 member 4(SLC1A4) in platinum-based chemotherapy resistance in ovarian cancer. METHODS The expression of SLC1A4 in ovarian cancer or platinum-resistant ovarian cancer was analyzed by GEO and TCGA database analysis tools. The expression of SLC1A4 in platinum-treated ovarian cancer cell lines was analyzed by GEO database. The relation of SLC1A4 expression and overall survival(OS) or progression free survival(PFS) in ovarian cancer patients were analyzed by Kaplan Meier-plotter. Correlation between SLC1A4 gene effect and sensitivity to chemotherapeutic agents in ovarian cancer was analyzed through DepMap platform. Low expression of SLC1A4 mediates cisplatin resistance in ovarian cancer cells as verified by flow cytometry and tumor cell clone colony formation assays; prediction of microRNAs(miRNA) targeting SLC1A4 was conducted using TargetScan then validated their correlation in TCGA ovarian cancer samples. Used COREMINE tool to analyze the biological processes of SLC1A4 mediating chemoresistance in ovarian cancer. RESULTS SLC1A4 was significantly reduced in ovarian cancer patients and platinum-resistant ovarian cancer(P<0.05) and significantly correlated with OS and PFS in ovarian cancer patients(P<0.05). SLC1A4 expression was increased in ovarian cancer cells with platinum treatment. The genetic effect of SLC1A4 on ovarian cancer was positively correlated with platinum drug sensitivity. Overexpression of SLC1A4 increased cisplatin-induced apoptosis and reduced tumor cell colony formation in ovarian cancer cells. Hsa-let-7c-5p was targeted to SLC1A4 and significantly negatively correlated in samples from drug-resistant ovarian cancer patients. CONCLUSION Low expression of SLC1A4 mediates platinum drug resistance in ovarian cancer and is potentially associated with hsa-let-7c-5p regulation.

Objective:To analyze the cognitive changes and alterations in the topological properties of functional and structural brain networks in elderly women with mild cognitive impairment (MCI), and explore the relationship between brain network and cognitive function, and find the neuroimaging mechanism of cognitive decline in female patients with MCI.Methods:A cross-sectional study was conducted, collecting clinical data from 38 elderly women with MCI, aged 60-79, recruited between October 1, 2019 and May 31, 2021, through community visits, online advertisements, free consultations by experts at the First Hospital of China Medical University and outpatient promotions. A matched control group of 37 healthy women of similar age was also recruited. Both groups underwent comprehensive neuropsychological assessments and MRI data collection, Brain functional and structural networks were constructed, and the corresponding global and nodal topological metrics were calculated. Differences in general demographic data, cognitive function scores, and network topology attribute indexes were compared. Pearson correlation analysis was used to explore the relationship between the altered topological properties of brain networks and cognitive function differences.Results:Cognitive function assessments showed that compared to the healthy control group, elderly women with MCI scored lower on the Rey Auditory Verbal Learning Test-N5 (AVLT-N5), Digit Span Test (DST), Clock Drawing Test (CDT), and Verbal Fluency Test (VFT) (1.95±1.02 vs 6.42±1.63, t=14.85; 7.14±1.58 vs 8.08±1.29, t=2.93; 3.30±1.12 vs 3.73±0.55, t=2.20; 15.49±3.87 vs 18.53±3.80, t=3.60; all P<0.05). The results of brain functional and structural network nodal topological properties indicated that the left inferior parietal angular gyri, left supramarginal gyrus, right orbital inferior frontal gyrus, and right insula showed incomplete white matter network structure or reduced efficiency in brain network functional transmission ( P<0.05). Conversely, regions such as the left cuneus, left superior frontal gyrus orbital part, left middle occipital gyrus, left precuneus, right superior parietal gyrus, and left paracentral lobule showed enhanced structural integrity of white matter network or increased efficiency in brain network functional transmission ( P<0.05). Correlation analysis suggested that abnormal nodal topological attributes were associated with language function (VFT), short-term memory (AVLT-N5), and visuospatial ability (CDT) in patients with MCI(All P<0.05). Conclusion:Elderly women with MCI exhibit declines in short-term memory, linguistic function, attention, and visuospatial abilities. Changes in the topological properties of brain function and structural networks occur in regions such as the orbital superior frontal gyrus, middle occipital gyrus, and cuneus in the elderly women.

Background: ChatGPT is a large language model (LLM) based on artificial intelligence (AI) capable of responding in multiple languages and generating nuanced and highly complex responses. While ChatGPT holds promising applications in medical education, its limitations and potential risks cannot be ignored. Methods: A scoping review was conducted for English articles discussing ChatGPT in the context of medical education published after 2022. A literature search was performed using PubMed/MEDLINE, Embase, and Web of Science databases, and information was extracted from the relevant studies that were ultimately included. Results: ChatGPT exhibits various potential applications in medical education, such as providing personalized learning plans and materials, creating clinical practice simulation scenarios, and assisting in writing articles. However, challenges associated with academic integrity, data accuracy, and potential harm to learning were also highlighted in the literature. The paper emphasizes certain recommendations for using ChatGPT, including the establishment of guidelines. Based on the review, 3 key research areas were proposed: cultivating the ability of medical students to use ChatGPT correctly, integrating ChatGPT into teaching activities and processes, and proposing standards for the use of AI by medical students. Conclusion ChatGPT has the potential to transform medical education, but careful consideration is required for its full integration. To harness the full potential of ChatGPT in medical education, attention should not only be given to the capabilities of AI but also to its impact on students and teachers.