Objective:To investigate the feasibility and clinical effects of ultra early enteral nutrition (≤24 h) in critically ill children supported by extracorporeal membrane oxygenation (ECMO).Methods:A retrospective cohort study was conducted. Clinical data of 43 critically ill children who received ECMO support in the pediatric intensive care unit (PICU) of Shanghai Children′s Hospital from January 2016 to December 2023 were collected, including general information, nutritional support modalities, and enteral nutrition tolerance. Based on the timing of enteral nutrition initiation, patients were divided into the within 24 h enteral nutrition group and the after 24 h enteral nutrition group. Nutritive indicators, nutritional intake, duration of ECMO support, duration of mechanical ventilation duration, and mortality rates were compared between the 2 groups using the two independent sample t test, Mann-Whitney U test, χ2 test and Fisher′s exact test. Results:Among the 43 children, 25 were male and 18 were female, with an age of 47 (18, 97) months. There were no statistically significant differences between the within 24 h enteral nutrition group (21 cases) and the after 24 h enteral nutrition group (22 cases) in terms of age, body mass index Z score, total protein, albumin, hemoglobin levels before ECMO support, duration of ECMO support, duration of mechanical ventilation, length of PICU stay, number of enteral nutrition intolerance events, number of enteral nutrition interruption, or mortality rate (all P>0.05). The protein intake adequacy rate during ECMO support was higher in the within 24 h enteral nutrition group than in the after 24 h enteral nutrition group (0 (0, 21%) vs. 0 (0, 0), U=175.00, P<0.05). Conclusions:Ultra early enteral nutrition is safe for children supported by ECMO. Initiating enteral nutrition within 24 h can increase the proportion of days with adequate protein intake in ECMO children without increasing the occurance of enteral nutrition intolerance or interruptions.

Objective:To investigate the feasibility and clinical effects of ultra early enteral nutrition (≤24 h) in critically ill children supported by extracorporeal membrane oxygenation (ECMO).Methods:A retrospective cohort study was conducted. Clinical data of 43 critically ill children who received ECMO support in the pediatric intensive care unit (PICU) of Shanghai Children′s Hospital from January 2016 to December 2023 were collected, including general information, nutritional support modalities, and enteral nutrition tolerance. Based on the timing of enteral nutrition initiation, patients were divided into the within 24 h enteral nutrition group and the after 24 h enteral nutrition group. Nutritive indicators, nutritional intake, duration of ECMO support, duration of mechanical ventilation duration, and mortality rates were compared between the 2 groups using the two independent sample t test, Mann-Whitney U test, χ2 test and Fisher′s exact test. Results:Among the 43 children, 25 were male and 18 were female, with an age of 47 (18, 97) months. There were no statistically significant differences between the within 24 h enteral nutrition group (21 cases) and the after 24 h enteral nutrition group (22 cases) in terms of age, body mass index Z score, total protein, albumin, hemoglobin levels before ECMO support, duration of ECMO support, duration of mechanical ventilation, length of PICU stay, number of enteral nutrition intolerance events, number of enteral nutrition interruption, or mortality rate (all P>0.05). The protein intake adequacy rate during ECMO support was higher in the within 24 h enteral nutrition group than in the after 24 h enteral nutrition group (0 (0, 21%) vs. 0 (0, 0), U=175.00, P<0.05). Conclusions:Ultra early enteral nutrition is safe for children supported by ECMO. Initiating enteral nutrition within 24 h can increase the proportion of days with adequate protein intake in ECMO children without increasing the occurance of enteral nutrition intolerance or interruptions.

Recently,small nucleolar RNAs(snoRNAs)have transcended the genomic"noise"to emerge as pivotal molecular markers due to their essential roles in tumor progression.Substantial evidence indicates a strong association between snoRNAs and critical clinical features such as tumor pathology and drug resistance.Historically,snoRNA research has concentrated on two classical mechanisms:2'-O-ribose methylation and pseudouridylation.This review specifically summarizes the novel regulatory mecha-nisms and functional patterns of snoRNAs in tumors,encompassing transcriptional,post-transcriptional,and post-translational regulation.We further discuss the synergistic effect between snoRNA host genes(SNHGs)and snoRNAs in tumor progression.More importantly,snoRNAs extensively contribute to the development of tumor cell resistance as oncogenes or tumor suppressor genes.Accordingly,we provide a comprehensive review of the clinical diagnosis and treatment associated with snoRNAs and explore their significant potential as novel drug targets.

Recently, small nucleolar RNAs (snoRNAs) have transcended the genomic "noise" to emerge as pivotal molecular markers due to their essential roles in tumor progression. Substantial evidence indicates a strong association between snoRNAs and critical clinical features such as tumor pathology and drug resistance. Historically, snoRNA research has concentrated on two classical mechanisms: 2'-O-ribose methylation and pseudouridylation. This review specifically summarizes the novel regulatory mechanisms and functional patterns of snoRNAs in tumors, encompassing transcriptional, post-transcriptional, and post-translational regulation. We further discuss the synergistic effect between snoRNA host genes (SNHGs) and snoRNAs in tumor progression. More importantly, snoRNAs extensively contribute to the development of tumor cell resistance as oncogenes or tumor suppressor genes. Accordingly, we provide a comprehensive review of the clinical diagnosis and treatment associated with snoRNAs and explore their significant potential as novel drug targets.

Objective:To investigate the value of T 1ρ mapping in the assessment of myocardial fibrosis in patients with hypertrophic cardiomyopathy (HCM). Methods:Forty HCM patients and 16 healthy volunteers who underwent CMR examination between December 2021 and May 2022 were prospectively enrolled. T 1ρ mapping, pre-and post-contrast T 1 mapping, and gadolinium contrast-enhanced delayed enhancement (LGE) imaging were performed in HCM patients, while T 1ρ mapping and T 1 mapping were performed in volunteers. HCM patients were further divided into LGE-positive (LGE+) and LGE-negative (LGE-) groups based on the presence or absence of LGE. The T 1ρ and pre-contrast T 1 values of the left ventricular myocardium of HCM patients and volunteers were measured, and the extracellular volume fraction (ECV) of the left ventricular myocardium of HCM patients was measured using pre-and post-contrast T 1 mapping. One-way ANOVA was used to compare the T 1ρ and pre-contrast T 1 values among the LGE+, LGE-, and volunteer groups, and pairwise comparisons were further corrected using the Bonferroni method. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic performance of pre-contrast T 1 and T 1ρ values in distinguishing LGE+ and LGE- patients from volunteers. The chi-square test or Fisher′s exact probability test was used for categorical variable comparisons. Pearson correlation coefficient was used to evaluate the correlation between T 1ρ and pre-contrast T 1, and ECV. Results:There were no significant differences in age, gender, and body surface area among the LGE+, LGE-, and healthy control groups ( P>0.05). Compared to the HC group, both the T 1ρ value ( t=5.74, P<0.001) and the pre-contrast T 1 value ( t=3.99, P<0.001) increased in LGE positive group, as well as in the LGE negative group (T 1ρ: t=4.19, P<0.001; T 1: t=2.06, P<0.044). ROC analysis showed that the area under the curve (AUC) of T 1ρ and pre-contrast T 1 in distinguishing LGE+patients from healthy controls were 0.93 (sensitivity 84.0%, specificity 93.8%) and 0.87 (sensitivity 84.0%, specificity 87.5%), respectively. The AUC of T 1ρ and pre-contrast T 1 in distinguishing LGE-patients from healthy controls were 0.84 (sensitivity 86.7%, specificity 68.8%) and 0.68 (sensitivity 60%, specificity 68.8%), respectively. The correlation analysis showed that the T 1ρ value of the left ventricular myocardium was positively correlated with the pre-contrast T 1 value ( r=0.31, P=0.02) and ECV value ( r=0.38, P=0.02). Conclusion:Without the use of contrast agents, T 1ρ mapping shows good performance for myocardial replacement fibrosis and diffuse fibrosis in HCM patients.

Objective:To investigate the effects of total-body PET/CT imaging with short acquisition time on image quality and lesion detectability in lungs and parenchymal organs.Methods:Sixty patients (31 males, 29 females, age (61.1±11.8) years) with pulmonary nodules (PN) and 53 patients (29 males, 24 females, age (56.7±17.2) years) with parenchymal organ lesions (POL) who underwent total-body PET/CT imaging in the First Affiliated Hospital of Shandong First Medical University between October 2021 and April 2022 were retrospectively analyzed. The acquisition time with PET was 600 s, and the reconstructed images were divided into 6 groups based on different duration (30, 60, 120, 180, 300 and 600 s), namely G30, G60, G120, G180, G300 and G600 groups. The subjective analysis was carried out with the 5-point Likert scale in 3 aspects: the overall impression of image quality, noise, and lesion conspicuity. The objective analysis indicators included the SUV mean of the mediastinal blood pool (MBP); the SUV mean, standard deviation (SD) and signal-to-noise ratio (SNR) of the liver; SUV max and target-to-background ratio (TBR) of the lesions. Differences of the indicators among 6 groups were analyzed by Friedman test with Bonferroni correction. G600 served as the reference for the other 5 groups to test their lesion detectability. Results:The subjective image quality of different groups for PN and that of G120, G180, G300 groups for POL could meet the needs of clinical diagnosis in terms of the overall image quality, noise, and lesion conspicuity (all scores>3). There was no significant difference in the SUV mean of MBP among different time groups (median for PN: 1.52-1.56, median for POL: 1.35-1.47; χ2 values: 10.23, 11.02, both P>0.05). Difference was not found in SUV mean of the liver either (median for PN: 2.51-2.56, median for POL: 2.33-2.40; χ2 values: 8.35, 8.93, both P>0.05). The liver SD significantly increased along with the shortened acquisition time ( χ2 values: 400.99, 400.00, both P<0.001; z values: from -16.90 to -3.15, all P<0.003). The SNR significantly decreased along with the shortened acquisition time ( χ2 values: 397.32, 400.00, both P<0.001; z values: 2.98-16.90, all P<0.003). The SUV max (median for PN: 3.55-4.01, median for POL: 5.77-6.08; χ2 values: 8.58, 3.02, both P>0.05) and TBR (median for PN: 2.42-2.81, median for POL: 2.36-2.45; χ2 values: 9.83, 3.69, both P>0.05) of lesion were not significantly different among 6 groups. Taking G600 group as a reference, the lesion detection rates were 100% in G30 group and other 4 groups for PN (81/81) and in G120, G180, G300 groups for POL (80/80). Conclusion:Total-body PET/CT imaging with acquisition time of 30 s for lungs and that with acquisition time of 120 s for parenchymal organs are feasible for clinical use, with the PET image quality and lesion detectability maintained.

OBJECTIVE: Segmented cardiac cine magnetic resonance imaging (MRI) is the gold standard for cardiac ventricular volumetric assessment. In patients with difficulty in breath-holding or arrhythmia, this technique may generate images with inadequate quality for diagnosis. Real-time cardiac cine MRI has been developed to address this limitation. We aimed to assess the performance of retrospective electrocardiography-gated real-time cine MRI at 3T for left ventricular (LV) volume and mass measurement. MATERIALS AND METHODS: Fifty-one patients were consecutively enrolled. A series of short-axis cine images covering the entire left ventricle using both segmented and real-time balanced steady-state free precession cardiac cine MRI were obtained. End-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), and LV mass were measured. The agreement and correlation of the parameters were assessed. Additionally, image quality was evaluated using European CMR Registry (Euro-CMR) score and structure visibility rating. RESULTS: In patients without difficulty in breath-holding or arrhythmia, no significant difference was found in Euro-CMR score between the two techniques (0.3 ± 0.7 vs. 0.3 ± 0.5, p > 0.05). Good agreements and correlations were found between the techniques for measuring EDV, ESV, EF, SV, and LV mass. In patients with difficulty in breath-holding or arrhythmia, segmented cine MRI had a significant higher Euro-CMR score (2.3 ± 1.2 vs. 0.4 ± 0.5, p < 0.001). CONCLUSION: Real-time cine MRI at 3T allowed the assessment of LV volume with high accuracy and showed a significantly better image quality compared to that of segmented cine MRI in patients with difficulty in breath-holding and arrhythmia.
Arrhythmias, Cardiac ; Diagnosis ; Heart Ventricles ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Imaging, Cine* ; Retrospective Studies* ; Stroke Volume

Objective: To investigate the feasibility and consistency of four-dimensional flow (4D flow) quantification of pulmonary regurgitation in patients with repaired Tetralogy of Fallot (ToF) by comparing with conventional two-dimensional flow (2D flow) and echocardiography. Methods: Both the 4D flow and 2D flow imaging were acquired with repaired ToF (a total of 21 patients) consecutively on 3.0 T MR scanner from May 2018 to August 2018. Pulmonary flow and regurgitant fraction were measured by a commercial post processing software Circle CVI42. All patients underwent echocardiography within one week after or before MR examination. The inter/intra-observer variability by 2D/4D f1ow and agreement between the two methods were investigated by interclass correlation coefficients (ICC) and Bland-Altman analyses. The agreement between MR and echocardiography were analyzed by weighted Kappa coefficient. The correlation between pulmonary regurgitation and cardiac function was also investigated by Pearson analysis. Results: All patients were included and completed the examinations successfully. Both inter-observer and intra-observer agreement by 4D flow for total forward volume (ICC=0.993, 0.996, respectively, P<0.001), total backward volume (ICC=0.994, 0.997, respectively, P<0.001) and regurgitant fraction (ICC=0.968, 0.985, respectively, P<0.001) were good. The total forward volume, total backward volume and regurgitant fraction measured by 2D flow and 4D flow reached a good agreement (ICC=0.954, 0.913,0.721,respectively,P<0.001). The consistency was good for severity of regurgitation measured by 2D flow (weighted Kappa=0.897, P<0.001) and 4D flow (weighted Kappa=0.710, P=0.001) compared with echocardiography. Significant correlation was found among right ventricular cardiac index(r=0.600, P<0.05), right ventricular end-diastolic volume index(r=0.788, P<0.05), right ventricular end-systolic volume index(r=0.683, P<0.05) and left ventricular end-diastolic volume index(r=0.578, P<0.05), left ventricular end-systolic volume index(r=0.687, P<0.05) with regurgitant fraction measured by 2D flow. Regurgitant fraction measured by 4D flow had a significant correlation with right ventricular cardiac index(r=0.606, P<0.05), right ventricular end-diastolic volume index(r=0.685,P<0.05), right ventricular end-systolic volume index(r=0.534, P<0.05) and left ventricular end-diastolic volume index(r=0.459, P<0.05), left ventricular mass index(r=0.633, P<0.05). Conclusion 4D flow MRI provides highly reproducible measurements of pulmonary flow on morphology and haemodynamics in patients with repaired ToF compared with 2D flow MRI and echocardiography.

Objective: To compare the imaging characteristics and long-term prognosis in hypertrophic cardiomyopathy(HCM) patients with or without left ventricular apical aneurysm(LVAA). Methods: Retrospectively analyzed the clinical data from 18 patients diagnosed as HCM complicating with LVAA(HCM-LVAA group), hospitalized and underwent cardiac magentic resonance (CMR) examination in Fuwai Hospital between December 2012 and December 2016. Eighteen age and gender matched patients with HCM diagnosed by CMR served as control(HCM group). Outpatient and in-hospital clinical data as well as follow up results were compared. The major adverse cardiovascular events were defined as malignant arrhythmia events (including sudden cardiac death, ventricular flutter/ventricular fibrillation) and heart failure events (including heart transplantation, progressive heart failure). Results: Compared with HCM group, patients in HCM-LVAA group had a more positive family history of HCM(P=0.04), higher incidence of ST-T segment changes and abnormal Q wave in electrocardiograms (both P<0.01), the CMR derived left ventricular end-diastolic transverse diameter and end-diastolic volume index were also significantly higher (both P<0.05), and delayed enhancement was more significant ((25.26±10.60)% vs. (15.78±7.33)%, t=3.12, P=0.004) in HCM-LVAA group. Moreover, the left ventricular ejection fraction ((54.4±10.6)% vs. (67.5±7.6)%, t=-4.28, P<0.000 1) and the thickness of the apical wall ((3.11±1.05) mm vs. (5.46±1.94) mm, t=-4.49, P<0.000 1) were significantly lower in HCM-LVAA group than in HCM group. The mean follow-up duration was (3.46±1.64) years, 4 patients in HCM-LVAA group (22.2%) developed 4 cardiovascular events, including 1 sudden cardiac death, 3 progressive heart failures. One patient in HCM group developed progressive heart failure. Conclusion The prognosis of the HCM complicating with LVAA patients is worse than that of HCM patients without LVAA, and the amount of late gadolinium enhancement is higher than that of HCM patients without LVAA.

Objective To detect retinoid X receptor α (RXRα) mRNA expression in blood of subjects exposed to different concentrations of arsenic via drinking water, to analyze the relationship between RXRα mRNA expression and skin lesion caused by arsenic,and further to explore the skin lesion mechanism of arsenic. Methods Study sites were selected by molecular epidemiology method from high arsenic drinking water area of Bayannur City. Two hundred and thirty-five subjects who had been lived in high arsenic area for more than 10 years were selected;blood samples and water samples were collected from the subjects; according to arsenic concentration in drinking water,they were divided into four groups,<10 μg/L(control group),10-<100 μg/L(low dose group),100- <200 μg/L (middle dose group), and ≥200 μg/L (high dose group). Skin hyperkeratosis and pigment abnormity examination were conducted. The RXRα mRNA expression level in blood samples was detected by real-time quantitative PCR, and then the relationship between expression of RXRα mRNA and different levels of arsenic exposure,and skin lesion induced by arsenic were analyzed. Results ①The results showed that there was a dose-effect relationship between the prevalence of hyperkeratosis, pigment abnormity and arsenic exposure (χ2= 14.597, 12.825, P < 0.05); ②With increasing of arsenic exposure, RXRα mRNA expression in blood decreased firstly and then increased (F = 8.312, P < 0.05), which were significantly different statistically from those of control [(1.20 ±0.53)×10-3]and low dose groups[(0.92 ± 0.49)×10-3,P<0.05];RXRα expression was significantly higher in high dose group[(1.40 ± 0.45)×10-3]than those of middle and low dose groups [(1.12 ± 0.58,0.92 ± 0.49)×10-3,P<0.05]; ③The RXRα mRNA expression in people with different level of skin damage (hyper keratosis and pigment abnormity)were statistically significant(F=4.206,4.389, P< 0.05); degree Ⅲ[(1.98 ± 0.38) × 10-3] hyperkeratosis patients compared with degree Ⅰ [(1.11 ± 0.52) × 10-3] and degree Ⅱ [(1.13 ± 0.42) × 10-3], RXRα mRNA expression was significantly different (P < 0.05), degree Ⅱ and higher degrees [(1.61 ± 0.54) × 10 -3] pigment abnormity patients compared with control [(1.15 ± 0.52)×10-3],RXRα mRNA expression was significantly different (P < 0.05). Conclusions Chronic arsenic exposure has an effect on RXRα mRNA expression in blood. There is a relationship between abnormal expression of RXRα mRNA and skin lesion induced by arsenic.