Objective:To assess the prognostic value of cerebrospinal fluid (CSF) neuron specific enolase (NSE) combined with protein content in predicting poor prognosis in patients with intraventricular hemorrhage after external ventricular drainage (EVD).Methods:The clinical data of 73 intraventricular hemorrhage patients underwent EVD in the Second Affiliated Hospital of Wenzhou Medical University from February 2019 to January 2022 were retrospectively analyzed. After 90 d of surgery, 37 patients (good prognosis group) had a modified Rankin score of 0 to 2, while 36 cases (poor prognosis group) had a score of 3 to 5. The baseline characteristics including gender, age, hypertension, diabetes and Glasgow coma score (GCS) upon admission were recorded. The peripheral blood samples were collected within 24 h of admission to measure C-reactive protein, white blood cell and blood potassium. The CSF samples were obtained within 24 h after EVD to measure NSE, protein content, white blood cell and red blood cell. Binary Logistic regression analysis was used to analyze the independent risk factors of poor prognosis in patients with intraventricular hemorrhage after EVD. The efficacy of CSF NSE combined with protein content in predicting the poor prognosis in patients with intraventricular hemorrhage after EVD was evaluated by the receiver operating characteristics (ROC) curve.Results:There were no statistical differences in gender distribution, age, hypertension, diabetes, blood C-reactive protein, white blood cell and blood potassium between two groups ( P>0.05); the GCS upon admission in poor prognosis group was significantly lower than that in good prognosis group: (5.83 ± 0.20) scores vs. (9.54 ± 0.43) scores, the CSF NSE, protein content, white blood cell and red blood cell were significantly higher than those in good prognosis group: (377.94 ± 21.91) μg/L vs. (86.43 ± 11.96) μg/L, (16.70 ± 2.07) g/L vs. (2.92 ± 0.74) g/L, (731.61 ± 141.36) × 10 6/L vs. (302.16 ± 90.99) × 10 6/L and (410 332 ± 88 584) × 10 6/L vs. (156 075 ± 61 387) × 10 6/L, and there were statistical differences ( P<0.01 or <0.05). Binary Logistic regression analysis result showed that elevated CFS NSE and higher CSF protein content were independent risk factors of poor prognosis in patients with intraventricular hemorrhage after EVD ( OR = 1.053 and 1.270, 95% CI 1.005 to 1.103 and 1.020 to 1.581, P<0.05). ROC curve analysis result showed that the area under the curve of CFS NSE combined with protein content detection to predict the poor prognosis in patients with intraventricular hemorrhage after EVD was larger than that of CFS NSE and protein content alone detection (0.982 vs. 0.971 and 0.903), and the optimal cutoff values of CSF NSE and protein content were 233.090 μg/L and 1.425 g/L, respectively. Conclusions:CSF NSE and protein content are significantly elevated in patients with intraventricular hemorrhage after EVD. The combined detection of CSF NSE and protein content provides valuable prognostic information for prognosis in patients with intraventricular hemorrhage after EVD, and it can provide important basis for prognosis evaluation.

Objective    To assess mid- and long-term outcomes and share our clinical method of reduction ascending aortoplasty (RAA) in adult patients undergoing aortic valve replacement (AVR). Methods    We retrospectively analyzed clinical data of 41 adult patients with aortic valve disease and ascending aortic dilatation before and after operation of RAA+AVR in Fuwai Hospital from January 2010 to July 2017. There were 28 male and 13 female patients aged 28-76 (53.34±12.06) years. Twenty-three patients received AVR+RAA using the sandwich technique (a sandwich technique group), while other 18 patients received AVR+ascending aorta wrap (a wrapping technique group). Ascending aorta diameter (AAD) was measured by echocardiography or CT scan preoperatively and postoperatively. Results    There was no perioperative death. The mean preoperative AAD in the sandwich technique group and the wrapping technique group (47.04±3.44 mm vs. 46.67±2.83 mm, P=0.709) was not statistically different. The mean postoperative AAD (35.87±3.81 mm vs. 35.50±5.67 mm, P=0.804), and the mean AAD at the end of follow-up (41.26±6.54 mm vs. 38.28±4.79 mm, P=0.113) were also not statistically different between the two groups. There were statistical differences in AAD before, after operation and at follow-up in each group. All 41 patients were followed up for 23-108 (57.07±28.60) months, with a median follow-up of 51.00 months. Compared with that before discharge, the AAD growth rate at the last follow-up was –1.50-6.78 mm/year, with a median growth rate of 0.70 mm/year, and only 3 patients had an annual growth rate of above 3 mm/year. Conclusion    Mid- and long-term outcomes of RAA in adult patients undergoing AVR with both methods are satisfying and encouraging.

Objective:To evaluate the trauma center model in general hospitals for patients with severe trauma.Methods:The data of 1,248 patients with severe trauma (ISS≥16) were retrospectively analyzed who had been admitted to the trauma centers in 6 Chinese general hospitals from January 2019 through June 2020. They were 987 males and 261 females with an age of 50.4 years ± 15.4 years. Their injuries were caused by a traffic accident in 622 cases, falling from a height in 357 cases, a knife in 62 cases, and others (like a heavy object and fall) in 207 cases. Upon admission, their injury severity scores (ISS) were 24.9±8.5 and their Glasgow coma scores (GCS) 12.6±3.6. They were all treated in a scientific and standard manner by a multidisciplinary team at the trauma center of their specific general hospital. Recorded were deaths within 30 days after admission, 30-day mortality and causes of death.Results:All the patients were treated effectively. 101 deaths occurred within 30 days after admission, yielding a 30-day mortality of 8.1%. The main causes of death were severe craniocerebral injury in 56 cases, hemorrhagic shock in 26 cases, multi-organ failure in 11 cases and others in 8 cases.Conclusions:Establishment of trauma centers in China can make up for the disadvantage of over-division of clinical specialties in large general hospitals which has led to insufficient care for patients with severe trauma and multiple injuries. The trauma centers in general hospitals may be a feasible model to be popularized in treatment of patients with severe trauma and multiple injuries.

Objective    To evaluate the long-term clinical effect and risk factors of tricuspid valve replacement (TVR) as a relief treatment for adult patients with congenitally corrected transposition of the great artery (CCTGA). Method     We retrospectively analyzed the clinical data of 47 adult patients with CCTGA who underwent tricuspid valve replacement in Fuwai Hospital between 2000 and 2017 year. There were 27 males and 20 females with operation age of 14–62 (38.8±13.5) years. Preoperative echocardiography showed moderate or more tricuspid regurgitation in all patients. The basic data of patients before and during operation were recorded. Survival was followed up by telephone and ultrasound report. Results    The average follow-up time was 6.5±3.7 years. The 1-year, 5-year and 10-year survival rate or the incidence of heart transplant-free was 94.6%, 90.5% and 61.7%, respectively. During the follow-up period, the long-term right ventricular ejection fraction of most patients (>90%) was still greater than or equal to 40%. Increased preoperative right ventricular end diastolic diameter (RVEDD) was a risk factor for death or heart transplantation (risk ratio 1∶11, P=0.04). The survival rate of patients with RVEDD (>60 mm) before operation was significantly reduced (P=0.032). Conclusion    TVP is a feasible treatment for adult patients with CCTGA. The increase of preoperative RVEDD is a risk factor for long-term mortality.

Objective    To explore our novel strategy of surgical treatment for ventricular septal rupture (VSR) and the long-term outcomes. Methods    All the patients referred to the Center of Adult Surgery, Fuwai Hospital were treated with integration treatment of vasoactive agents, intra-aortic balloon pump, or left ventricular assist device. The timing of surgical treatment was individually customized. One hundred and five consecutive patients with VSR (63 males, 42 females ) presented at the mean age of 63 (range, 41 to 80) years. We retrospectively analyzed the results and followed up patients who survived the surgical procedure. Results     They were divided into a hemodynamics stable group (25 patients, 2 received emergent operation and 23 received selective operation) and a hemodynamics unstable group (80 patients, 34 received vasoactive agents and selective operation, 4 received vasoactive agents and emergent operation, 20 received vasoactive agent, intra-aortic balloon counterpulsation (IABP), and selective operation, 16 received vasoactive agents, IABP, and emergent operation, 2 received vasoactive agents, IABP, ventilator support, and selective operation, 2 received vasoactive agents, IABP, and ventilator support and emergent operation, 2 received vasoactive agents, ventilator support, and selective operation). There were 3 in-hospital deaths. Ninety-nine patients were followed up, with a follow-up rate of 97.1%. The mean follow-up time was 76.56±47.78 months. There were 2 late deaths during follow-up. Conclusion    The timing of surgical treatment for ventricular septal rupture should be individually customized. The long-term outcomes of ventricular septal rupture patients who survived the surgery are satisfactory.

Thirty nine patients with pathologically confirmed parotid tumors,including 18 cases of pleomorphic adenomas,12 cases of papillary cystadenoma lymphomatosum and 9 cases of malignant tumors,were enrolled in the study.Characteristics on routine MR image,diffusion weighted imaging (DWI),timesignal intensity curve (TIC) and apparent diffusion coefficient (ADC) value in different types of tumors were evaluated.There were significant differences in imaging features between benign and malignant tumors (P ＜ 0.01).The TIC types were A,B and C for pleomorphic adenomas,papillary cystadenoma lymphomatosum and malignant tumors,respectively.The mean ADC value of pleomorphic adenomas was significantly higher than that of papillary cystadenoma lymphomatosum and malignant tumors (P ＜ 0.01).No significant difference in ADC values between papillary cystadenoma lymphomatosum and malignant tumors was detected (P =0.73).The study indicates that MR plain scan combined with dynamic contrast enhanced MRI and DWI may be helpful in pre-operative differentiation of common parotid tumors.

Objective To investigate whether diffusion kurtosis imaging(DKI)can be predictive in high-aggressive prostate cancer (PCa).Methods 51 patients with pathologically confirmed PCa underwent preoperative DK-MR imaging(b of 0,700,1 400 and 2 100 s/mm2).Data was post-processed by mono-exponential and non-Gauss DK model,respectively,for quantitation of apparent diffusion coefficient(ADC),apparent non-Gaussian diffusion coefficient(Dapp)and apparent non-Gauss kurtosis coefficient(Kapp). The ability of Dapp,Kapp and ADC for predicting high-aggressive(Gleason score>4+3)PCa was analyzed by ROC regression.Results There were 29 low-aggressive and 33 high-aggressive PCa on pathologic findings.High-aggressive PCa had significantly lower ADC[(0.764 ± 0.114)×10-3mm2/s vs(0.825 ± 0.116)×10-3mm2/s,P=0.004],lower Dapp[(1.212 ± 0.194)×10-3mm2/s vs (1.472 ± 0.297)×10-3mm2/s,P< 0.001],while higher Kapp(1.114 ± 0.177 vs 0.835 ± 0.192,P<0.001)than that for low-aggressive PCa.Dapp and Kapp had significantly higher sensitivity(Dapp:75.3%;Kapp:74.1%),specificity(Dapp:85.4%;Kapp:86.7%)and area under curve(AUC)(Dapp:0.889;Kapp:0.894)than that for ADC(64.1%;76.4%;0.738;P<0.01)in differentiating low-aggressive from high-aggressive PCa.Conclusion DKI can be a reliable way for predicting high-aggressive PCa.

Objective     To evaluate a score system to allow stratification of complexity in degenerative mitral valve repair. Methods     We retrospectively reviewed the clinical data of 312 consecutive patients who underwent surgery for mitral valve repair and whose preoperative echocardiography was referable in our hospital from January 2012 to December 2013. A scoring system for surgical complexity was used based mainly on the preoperative echocardiography findings. Complexity of mitral valve repair was scored as 1 to 9, and patients were categorized into 3 groups based on the score for surgical complexity: a simple group (1 point), an intermediate group (2-4 points) and a complex group (≥5 points). There were 86 males and 35 females in the simple group (n=121) with an average age of 51.6±12.6 years, 105 males and 53 females in the intermediate group (n=158) with an average age of 51.1±12.8 years and 25 males and 8 females in the complex group (n=33) with an average age of 49.3±13.0 years. Results     There was significant difference in surgical complexity in different groups. In the simple, intermediate and complex groups, the mean cardiopulmonary bypass time was 111.7±45.5 min, 117.7±40.4 min and 153.4±74.2 min (P<0.001), the mean cross-clamping time was 77.5±33.8 min, 83.2±29.9 min and 108.8±56.2 min (P<0.001), and the mean number of repair techniques utilized was 2.1±0.4, 2.4±0.6 and 2.8±0.8 (P<0.001). However, there was no significant difference in the early and late outcomes in different groups. Conclusion     It is feasible to use echocardiography to quantitatively evaluate the difficulty of mitral valvuloplasty.

Objective To analyze the epidemiological characteristics and spatial distribution of human brucellosis in Fujian province during 2011-2016,and provide evidence for the prevention and control of the disease.Methods The surveillance data of human brucellosis in Fujian during 2011-2016 was analyzed with software R 3.3.1,ArcGIS 10.3.1,GeoDa 1.8.8 and SaTScan 9.4.3.Results During 2011-2016,a total of 319 human brucellosis cases were reported,the incidence increased year by year (F=11.838,P=0.026) with the annual incidence of 0.14/100 000.The male to female rate ratio of the incidence was 2.50 ∶ 1.Farmers and herdsmen accounted for 57.37％.The incidence was 0.40/100 000 in Zhangzhou and 0.32/100 000 in Nanping,which were higher than other areas.The number of affected counties (district) increased from 12 in 2011 to 28 in 2016,showing a significant increase (F=13.447,P=0.021).The Moran' s I of brucellosis in Fujian between January 2011 and December 2016 was 0.045,indicating the presence of a high value or low value clustering areas.Local spatial autocorrelation analysis showed that,high-high clustering area (hot spots) were distributed in Zhangpu,Longhai,Longwen,etc,while high-low clustering areas were distributed in Nan' an and Jiaocheng,etc.Temporal scanning showed that there were three clustering areas in areas with high incidence,the most possible clustering,occurring during January 1,2013-December 31,2015,covered 6 counties,including Yunxiao,Pinghe,Longhai,etc,and Zhangpu was the center,(RR =7.96,LLR=92.62,P＜0.001).Conclusions The epidemic of human brucellosis in Fujian is becoming serious,and has spread to general population and non-epidemic areas.It is necessary to strengthen the prevention and control of human brucellosis in areas at high risk.

In this study,we analyzed the data of hemorrhagic fever with renal syndrome (HFRS) and host animals monitoring in Zhangzhou City,Fujian Province,China,2006-2015,in order to find out the epidemic situation and risk factors,and provide a scientific basis for the prevention and control strategy.A total of 171 HFRS cases,including 1 death,were reported in Zhangzhou in this decade.The incidence rate of 0.352/105 showed an upward trend (xtrend2 =58.60,P＜0.01).And 70 villages and towns in 11 counties have affected,accounting for 56.00％ of the counties in Zhangzhou City.The cases were mainly reported in some towns of Huaan,Nanjing and Zhaoan countries.The cases mainly occurred in countryside,which reported 142 cases.The cases in farmers accounted for the highest proportion (79.58 ％),and pig farming staff accounting for 23.01％ in farmer cases.Most cases were reported in municipal hospitals (86.55 ％).The common clinical manifestations of those cases were fever,nausea,vomiting,backache,headache,pain,oliguria or anuria,eyelid edema and so on,with 72.67％ of thrombocytopenia and of 83.09 ％ proteinuria positive.Compared with the proportion (80.49 ％) of mice in patients' house from 2006 to 2010,that (45.83％) from 2011 to 2015 decreased obviously;however,the proportion of mice or mice droppings in workplaces were rising from 60.98％ to 73.33％.Mean rodent density was 6.40％ and total infection rate in rats was 7.42％.The main kind of rats with virus infection was Rattus norvegicus,carrying Seoul virus Ⅱ.Results of this study indicate that Zhangzhou is one of the foci of HFRS rodent,and the epidemic is rising in recent years,the overall in the highly distributed,while some counties showed a rising trend year by year.Thus,monitoring and control efforts in prone areas should be increased,and to carry out clinics training of HFRS in primary health care institutions.