Objective To compare the mid- and long-term clinical results of mitral valve plasty (MVP) and mitral valve replacement (MVR) in the treatment of functional mitral regurgitation (FMR). Methods Patients with FMR who underwent surgical treatment in the Department of Cardiovascular Surgery of the General Hospital of Northern Theater Command from 2012 to 2021 were collected. The patients who underwent MVP were divided into a MVP group, and those who underwent MVR into a MVR group. The clinical data and mid-term follow-up efficacy of two groups were compared. Results Finally 236 patients were included. There were 100 patients in the MVP group, including 53 males and 47 females, with an average age of (61.80±8.03) years. There were 136 patients in the MVR group, including 72 males and 64 females, with an average age of (61.29±8.97) years. There was no statistical difference in baseline data between the two groups (P＞0.05). There was no statistical difference between the two groups in the extracorporeal circulation time, aortic occlusion time, postoperative hospital and ICU stay, intraoperative blood loss, or hospitalization death (P＞0.05), but the time of mechanical ventilation in the MVP group was significantly shorter than that in the MVR group (P=0.022). The total follow-up rate was 100.0%, the longest follow-up was 10 years, and the average follow-up time was (3.60±2.55) years. There were statistical differences in the left atrial diameter, left ventricular end-diastolic diameter, left ventricular end-systolic diameter and cardiac function between the two groups compared with those before surgery (P<0.05). The postoperative left ventricular ejection fraction in the MVP group was statistically higher than that before surgery (P=0.002), but there was no statistical difference in the MVR group before and after surgery (P=0.658). The left atrial diameter in the MVP group was reduced compared with the MVR group (P=0.026). The recurrence rate of mitral regurgitation in the MVP group was higher than that in the MVR group, and the difference was statistically significant (10.0% vs. 1.5%, P=0.003). There were 14 deaths in the MVP group and 19 in the MVR group. The cumulative survival rate (P=0.605) and cardiovascular events-free survival rate (P=0.875) were not statistically significant between the two groups by Kaplan-Meier survival analysis. Conclusion The safety, and mid- and long-term clinical efficacy of MVP in the treatment of FMR patients are better than MVR, and the left atrial and left ventricular diameters are statistically reduced, and cardiac function is statistically improved. However, the surgeon needs to be well aware of the indications for the MVP procedure to reduce the rate of mitral regurgitation recurrence.

ObjectiveTo study the correlations between traditional Chinese medicine （TCM） syndromes and lipid metabolism in children with Wilson disease （WD）. MethodsClinical data and lipid metabolism indicators ［total cholesterol （TC）， triglycerides （TG）， low-density lipoprotein cholesterol （LDL-C）， high-density lipoprotein cholesterol （HDL-C）， apolipoprotein A1 （ApoA1）， apolipoprotein B （ApoB）， and lipoprotein a （Lpa）］ were retrospectively collected from 341 children with WD. The clinical data were compared among WD children with different syndromes， and the correlations between TCM syndromes and lipid metabolism in children with WD were analyzed. Least absolute shrinkage and selection operator （LASSO） regression was used for variable screening， and unordered multinomial Logistic regression was employed to analyze the effects of lipid metabolism indicators on TCM syndromes. ResultsThe 341 children with WD included 121 （35.5%） children with the dampness-heat accumulation syndrome， 103 （30.2%） children with the liver-kidney Yin deficiency syndrome， 68 children with the combined phlegm and stasis syndrome， 29 children with the spleen-kidney Yang deficiency syndrome， and 20 children with the liver qi stagnation syndrome. The liver-kidney Yin deficiency syndrome， combined phlegm and stasis syndrome， and spleen-kidney Yang deficiency syndrome had correlations with the levels of lipid metabolism indicators （P<0.05）. Lipid metabolism abnormalities occurred in 232 （68.0%） children， including hypertriglyceridemia （108）， hypercholesterolemia （23）， mixed hyperlipidemia （67）， lipoprotein a-hyperlipoproteinemia （12）， and hypo-HDL-cholesterolemia （22）. The percentages of hypertriglyceridemia and hypo-HDL-cholesterolemia varied among children with different TCM syndromes （P<0.05）. Correlations existed for the liver-kidney Yin deficiency syndrome with TG， TC， and HDL-C， the combined phlegm and stasis syndrome with TG， the spleen-kidney Yang deficiency syndrome with TG， TC， and LDL-C， and the liver Qi stagnation syndrome with TC and LDL-C （P<0.05， P<0.01）. ConclusionThe TCM syndromes of children with WD are dominated by the dampness-heat accumulation syndrome and the liver-kidney Yin deficiency syndrome， and dyslipidemia in the children with WD is dominated by hypertriglyceridemia and mixed hyperlipidemia. There are different correlations between TCM syndromes and lipid metabolism indicators， among which TG， TC， LDL-C， and HDL-C could assist in identifying TCM syndromes in children with WD.

Background::Hypothermia therapy has been suggested to attenuate myocardial necrosis; however, the clinical implementation as a valid therapeutic strategy has failed, and new approaches are needed to translate into clinical applications. This study aimed to assess the feasibility, safety, and efficacy of a novel selective intracoronary hypothermia (SICH) device in mitigating myocardial reperfusion injury.Methods::This study comprised two phases. The first phase of the SICH was performed in a normal porcine model for 30 minutes ( n = 5) to evaluate its feasibility. The second phase was conducted in a porcine myocardial infarction (MI) model of myocardial ischemia/reperfusion which was performed by balloon occlusion of the left anterior descending coronary artery for 60 minutes and maintained for 42 days. Pigs in the hypothermia group ( n = 8) received hypothermia intervention onset reperfusion for 30 minutes and controls ( n = 8) received no intervention. All animals were followed for 42 days. Cardiac magnetic resonance analysis (five and 42 days post-MI) and a series of biomarkers/histological studies were performed. Results::The average time to lower temperatures to a steady state was 4.8 ± 0.8 s. SICH had no impact on blood pressure or heart rate and was safely performed without complications by using a 3.9 F catheter. Interleukin-6 (IL-6), tumor necrosis factor-α, C-reactive protein (CRP), and brain natriuretic peptide (BNP) were lower at 60 min post perfusion in pigs that underwent SICH as compared with the control group. On day 5 post MI/R, edema, intramyocardial hemorrhage, and microvascular obstruction were reduced in the hypothermia group. On day 42 post MI/R, the infarct size, IL-6, CRP, BNP, and matrix metalloproteinase-9 were reduced, and the ejection fraction was improved in pigs that underwent SICH.Conclusions::The SICH device safely and effectively reduced the infarct size and improved heart function in a pig model of MI/R. These beneficial effects indicate the clinical potential of SICH for treatment of myocardial reperfusion injury.

Objective To explore the efficiency of artificial intelligence and radiomics-assisted X-ray in diagnosis of lumbar osteoporotic vertebral compression fractures(OVCF).Methods The clinical data of 455 patients diagnosed as lumbar OVCF by MRI in our hospital were selected.The patients were divided into the training group(n=364)and the validation group(n=91),X-ray films were extracted,the image delineation,feature extraction and data analysis were carried out,and the artificial intelligence radiomics deep learning was applied to establish a diagnostic model for OVCF.After verifying the effectiveness of the model by receiver operating characteristic(ROC)curve,area under the curve(AUC),calibration curve,and decision curve analysis(DCA),the efficiencies of manual reading,model reading,and model-assisted manual reading of X-ray in the early diagnosis of OVCF were compared.Results The ROC curve,AUC and calibration curve proved that the model had good discrimination and calibration,and excellent diagnostic performance.DCA demonstrated that the model had a higher clinical net benefit.The diagnostic efficiency of the manual reading group:the accuracy rate was 0.89,the recall rate was 0.62.The diagnostic efficiency of the model reading group:the accuracy rate was 0.93,the recall rate was 0.86,the model diagnosis showed good predictive performance,which was significantly better than the manual reading group.The diagnostic efficiency of the model-assisted manual reading group:the accuracy rate was 0.92,the recall rate was 0.72,and the recall rate of the model-assisted manual reading group was higher than that of the manual reading group,but lower than that of the model reading group,indicating the superiority of the model diagnosis.Conclusion The diagnostic model established based on artificial intelligence and radiomics in this study has reached an ideal level of efficacy,with better diagnostic efficacy compared with manual reading,and can be used to assist X-ray in the early diagnosis of OVCF.

Objective To develop a clinical prediction model for predicting risk factors for prolonged hospital stay after anterior cervical discectomy and fusion(ACDF).Methods The clinical data of 914 patients underwent ACDF treatment for cervical spondylotic myelopathy(CSM)were retrospectively analyzed.According to the screening criteria,800 eligible patients were eventually included,and the patients were divided into the development cohort(n=560)and the validation cohort(n=240).LASSO regression was used to screen variables,and multivariate Logistic regression analysis was used to establish a prediction model.The prediction model was evaluated from three aspects:differentiation,calibration and clinical effectiveness.The performance of the model was evaluated by area under the curve(AUC)and Hosmer-Lemeshow test.Decision curve analysis(DCA)was used to evaluate the clinical effectiveness of the model.Results In this study,the five factors that were significantly associated with prolonged hospital stay were male,abnormal BMI,mild-to-moderate anemia,stage of surgery(morning,afternoon,evening),and alcohol consumption history.The AUC of the development cohort was 0.778(95%CI:0.740 to 0.816),with a cutoff value of 0.337,and that of the validation cohort was 0.748(95%CI:0.687 to 0.809),with a cutoff value of 0.169,indicating that the prediction model had good differentiation.At the same time,the Hosmer-Lemeshow test showed that the model had a good calibration degree,and the DCA proved that it was effective in clinical application.Conclusion The prediction model established in this study has excellent comprehensive performance,which can better predict the risk of prolonged hospital stay,and can guide clinical intervention as soon as possible,so as to minimize the postoperative hospital stay and reduce the cost of hospitalization.

Objective To explore the risk factors for surgical site infection(SSI)after transforaminal lumbar interbody fusion(TLIF)for the treatment of lumbar degenerative diseases.Methods A total of 1 000 patients who underwent TLIF for lumbar degenerative diseases in our hospital were included and divided into the infection group(n=23)and the non-infection group(n=977)according to whether the surgical incision was infected.General data,surgical and laboratory indicators of patients were collected,and potential risk factors of SSI were screened by univariate analysis and multivariate regression analysis,a nomogram model was established,and its predictive efficiency was validated by the receive operating characteristic(ROC)curve.Results The incidence of SSI in patients after TLIF was 2.3％.The results of univariate analysis showed that age,operative time,intraoperative blood loss,preoperative C-reactive protein(CRP),smoking,and diabetes mellitus were the significant risk factors for the occurrence of SSI.Multivariate regression analysis showed that older age,longer operation time,more intraoperative blood loss,smoking and diabetes mellitus were the independent risk factors for postoperative SSI.ROC curve showed that the nomogram model established in this study has good predictive efficiency.Conclusion Older age,longer operation time,more intraoperative blood loss,smoking,and diabetes mellitus were independent risk factors for postoperative SSI.For patients with these high risk factors,corresponding intervention measures should be taken before operation to reduce the incidence of SSI.

To analyze the biological characteristics of Pasteurella multocida in bovine respiratory tract and its prevalence in large-scale cattle farms,bacterial isolation,culture,and morphological observation were conducted on the lungs and liver samples of dead cows suffering from respiratory diseases in Hohhot,Inner Mongolia.The isolated strains were studied through biochemical testing,16S rRNA gene sequencing,specific primer PCR identification,capsule serotyping,pathogenicity testing,virulence gene testing,drug sensitivity testing,and drug resistance gene detection methods.The results showed that six strains of Pasteurella multocida serotype A were isolated and identi-fied from the lungs of diseased and dead cows.After sequencing the 16S rRNA sequence of the bac-teria,it was found that the six strains of Pasteurella multocida had the closest genetic relationship with the Chongqing isolate CQ2(CP033599.1).The results of mouse pathogenicity test and viru-lence gene detection showed that all isolates were pathogenic and carried at least 16 or more related virulence genes such as exbB,nanB,sodC,oma 87,etc.,but no hsf1 and toxA were detected.The results of drug sensitivity tests and resistance gene detection showed that the isolated strains were sensitive to different degrees of antibiotics such as ciprofloxacin,ofloxacin,and cefotaxime.They were resistant to streptomycin,clindamycin,and lincomycin,and resistance genes of str A,strB,and tet(H)were detected.The results indicate that there is a certain correlation between the pathoge-nicity and virulence genes,drug resistance phenotype,and drug resistance genes of Pasteurellamultocida type A in cattle.It is recommended to use quinolones(such as ciprofloxacin)and cepha-losporins(such as cefotaxime)antibacterial drugs in clinical practice,which can provide scientific basis and prevention and control plans for the prevention and treatment of respiratory diseases caused by Pasteurella multocida in cattle farms,and lay a foundation for the epidemiological mo-nitoring of bovine respiratory multocida pasteurellosis.

Objective This study utilizes bioinformatics methods to analyze differentially expressed genes(DEGs)between Alzheimer's disease(AD)and vascular dementia(VD)compared to normal controls.The aim is to identify key genes and validate their relevance to both types of dementia.Methods Gene chip dataset GSE122063 were obtained from the Gene Expression Omnibus(GEO)database.Using the GEO2R tool,DEGs in AD,VD,and normal control group were screened.We constructed a protein-protein interaction network using the STRING database and identified key genes through Cytoscape.Subsequently,DAVID database were used to analyze gene ontology(GO)enrichment and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathways associated with interconnected DEGs,predicting their biological functions.Finally,diagnostic performance were validated and assessed by using receiver operating characteristic curves.Results In the AD and VD groups,we identified 1099 and 505 DEGs,respectively,with 69 genes showing associations in the protein-protein interaction network.GO analysis revealed that DEGs are primarily located in the extracellular matrix,cell surface,and plasma membrane.They influence biological processes such as signal transduction and inflammatory responses,with functions related to receptor binding and signal receptor activity,collectively contributing to dementia development.KEGG analysis indicated significant enrichment of DEGs in immune-related signaling pathways,including microbial infections,rheumatoid arthritis,systemic lupus erythematosus,and inflammatory bowel disease.Four key genes—CCR5,CCL2,FCGR2A,and ITGB2—with significantly elevated expression in both AD and VD groups were indentifiied.The area under the curve suggests their potential diagnostic value for dementia.Conclusion Through bioinformatics analysis of AD and VD,the enriched signaling pathways and key genes associated with immunity and inflammation were discovered.These findings may play a crucial role in dementia progression and provide new insights for early diagnosis.

Objective To investigate the incidence rate,clinical characteristics,and prognosis of neonatal stroke in Shenzhen,China.Methods Led by Shenzhen Children's Hospital,the Shenzhen Neonatal Data Collaboration Network organized 21 institutions to collect 36 cases of neonatal stroke from January 2020 to December 2022.The incidence,clinical characteristics,treatment,and prognosis of neonatal stroke in Shenzhen were analyzed.Results The incidence rate of neonatal stroke in 21 hospitals from 2020 to 2022 was 1/15 137,1/6 060,and 1/7 704,respectively.Ischemic stroke accounted for 75％(27/36);boys accounted for 64％(23/36).Among the 36 neonates,31(86％)had disease onset within 3 days after birth,and 19(53％)had convulsion as the initial presentation.Cerebral MRI showed that 22 neonates(61％)had left cerebral infarction and 13(36％)had basal ganglia infarction.Magnetic resonance angiography was performed for 12 neonates,among whom 9(75％)had involvement of the middle cerebral artery.Electroencephalography was performed for 29 neonates,with sharp waves in 21 neonates(72％)and seizures in 10 neonates(34％).Symptomatic/supportive treatment varied across different hospitals.Neonatal Behavioral Neurological Assessment was performed for 12 neonates(33％,12/36),with a mean score of(32±4)points.The prognosis of 27 neonates was followed up to around 12 months of age,with 44％(12/27)of the neonates having a good prognosis.Conclusions Ischemic stroke is the main type of neonatal stroke,often with convulsions as the initial presentation,involvement of the middle cerebral artery,sharp waves on electroencephalography,and a relatively low neurodevelopment score.Symptomatic/supportive treatment is the main treatment method,and some neonates tend to have a poor prognosis.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.