Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. As a critical component of surgical repair, reconstruction of the right ventricular outflow tract (RVOT) serves as a primary determinant of postoperative hemodynamics and long-term prognosis. With advancements in surgical techniques, early postoperative survival rates for TOF have significantly improved, shifting clinical focus toward addressing long-term complications such as right ventricular dysfunction and reduced exercise tolerance. However, challenges persist regarding optimal timing of surgery in relation to adverse long-term outcomes, balancing RVOT reconstruction strategies, and selecting appropriate repair materials for RVOT reconstruction, with a lack of unified high-level evidence-based guidelines. To address these issues and standardize the application of radical corrective surgery for TOF to better serve patients, the National Society for Congenital Heart Diseases has systematically reviewed existing high-level evidence. Consequently, we have registered and formulated the "Protocol for Chinese expert consensus on right ventricular outflow tract reconstruction in tetralogy of Fallot (2026 edition)", which details the methodology and development process of this upcoming consensus.

Objective To investigate the efficacy of leaflet augmentation technique to repair the recurrent mitral valve (MV) regurgitation after mitral repair in children. Methods A retrospective analysis was conducted on the clinical data of children who underwent redo MV repair for recurrent regurgitation after initial MV repair, using a leaflet augmentation technique combined with a standardized repair strategy at Fuwai Hospital, Chinese Academy of Medical Sciences, from 2018 to 2022. The pathological features of the MV, key intraoperative procedures, and short- to mid-term follow-up outcomes were analyzed. Results A total of 24 patients (12 male, 12 female) were included, with a median age of 37.6 (range, 16.5–120.0) months. The mean interval from the initial surgery was (24.9±17.0) months. All children had severe mitral regurgitation preoperatively. The cardiopulmonary bypass time was (150.1±49.5) min, and the aortic cross-clamp time was (94.0±24.2) min. There were no early postoperative deaths. During a mean follow-up of (20.3±9.1) months, 3 (12.5%) patients developed moderate or severe mitral regurgitation (2 severe, 1 moderate). One (4.2%) patient died during follow-up, and one (4.2%) patient underwent a second MV reoperation. The left ventricular end-diastolic diameter was significantly reduced postoperatively compared to preoperatively [ (43.5±8.6) mm vs. (35.8±7.8)mm, P<0.001]. Conclusion The leaflet augmentation technique combined with a standardized repair strategy can achieve satisfactory short- to mid-term outcomes for the redo mitral repair after previous MV repair. It can be considered a safe and feasible technical option for cases with complex valvular lesions and severe pathological changes.

ObjectiveTo investigate the expression of serum Aldo-keto reductase family 1 member B10 （AKR1B10） in patients with hepatocellular carcinoma （HCC） in northern China， and to provide a new and valuable biomarker for the clinical diagnosis of HCC. MethodsThis study was conducted among 102 patients with HCC， 119 patients with benign liver disease， and 132 patients with other malignant tumors who attended The Affiliated Hospital of Chengde Medical University and 148 healthy individuals who underwent physical examination from May 2020 to May 2024. ELISA and chemiluminescence were used to measure the serum levels of AKR1B10 and alpha-fetoprotein （AFP）. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups， and the Kruskal-Wallis H test was used for comparison between three groups and further comparison between two groups； the chi-square test was used for comparison of categorical data between groups. The area under the ROC curve （AUC） was used to assess diagnostic efficiency. ResultsThe expression level of AKR1B10 was 3 053.79 （1 475.67‍ ‍—‍ ‍4 605.86） pg/mL in the HCC group， 1 324.42 （659.68‍ ‍—‍ ‍2 023.88） pg/mL in the benign liver disease group， 660.68 （377.56‍ ‍—‍ ‍2 087.77） pg/mL in the other malignant tumor group， and 318.30 （82.73‍ ‍—‍ ‍478.82） pg/mL in the healthy group， with a significant difference between the four groups （H=240.86， P<0.001）， and further comparison between two groups showed that the HCC group had a significantly higher level than the other three groups （all P<0.001）. The ROC curve analysis of the HCC group and the other three groups showed that serum AKR1B10 had an optimal cut-off value of 1 584.97 pg/mL in the diagnosis of HCC， with an AUC of 0.86 （95% confidence interval ［CI］： 0.82‍ ‍—‍ ‍0.90）， a sensitivity of 74.3%， and a specificity of 85.2%. Compared with each indicator alone， a combination of AKR1B10 and AFP could improve the sensitivity （81.8%） and specificity （91.4%） of HCC diagnosis. AKR1B10 had an AUC of 0.84 （95%CI： 0.78‍ ‍—‍ ‍0.90） in the diagnosis of patients with early- or middle-stage HCC， with a sensitivity of 76.2% and a specificity of 81.2%. AKR1B10 had an AUC of 0.85 （95%CI： 0.77‍ ‍—‍ ‍0.92） in the diagnosis of patients with AFP-negative HCC， with a sensitivity of 81.6% and a specificity of 79.9%. ConclusionAKR1B10 is a promising serological marker for the diagnosis of HCC， and a combination of AKR1B10 and AFP can improve the detection rate of HCC patients in northern China， especially those with early- or middle-stage HCC and AFP-negative HCC.

Objective To establish a new model for predicting cardiac function in patients with type 2 diabetes mellitus(T2DM)by using biochemical indicators,in order to find the intrinsic factors affecting cardiac function in T2DM patients.Methods A total of 361 patients with T2DM admitted to the Department of Endocrinology of The First Affiliated Hospital of Zhengzhou University from January 2023 to January 2024 were retrospectively selected.They were divided into T2DM group(n=117)and decreased ventricular diastolic function group(n=244)according to cardiac function.General characteristics and biochemical indicators were collected in the two groups,as well as echocardiography.Logistic regression was used to construct a new prediction model.The area under the receiver operating characteristic(ROC)curve(AUC)was used to evaluate the accuracy of the model,and the Hosmer-Lemeshow goodness-of-fit test was used to evaluate the calibration of the model.Results Age,DM duration,TC,urea,serum creatinine(Scr),25(OH)D3 and HDL-C were higher,while TG,triglyceride and glucose product index,serum uric acid(SUA)and glomerular filtration rate(eGFR)were lower in the ventricular diastolic function decline group than in the T2DM group(P<0.05).Logistic regression analysis showed that the duration of DM,urea,Scr,SUA and eGFR were the influencing factors for cardiac diastolic function decline inpatients with T2DM,and the prediction model was constructed as follows:y=7.054+0.097×ln DM duration+0.209×ln urea-0.203×ln Scr-0.003×ln SUA-0.052×ln eGFR,AUC was 0.832,sensitivity was 0.713,specificity was 0.803,cut-off value was 0.69,and the model fitted well and had certain predictive value.Conclusions The decline of cardiac diastolic function in patients with T2DM is related to DM duration,urea,SUA,Scr and eGFR.The new model has a good predictive effect on cardiac function in patients with T2DM and provides clinical value.

Objective To establish a new model for predicting cardiac function in patients with type 2 diabetes mellitus(T2DM)by using biochemical indicators,in order to find the intrinsic factors affecting cardiac function in T2DM patients.Methods A total of 361 patients with T2DM admitted to the Department of Endocrinology of The First Affiliated Hospital of Zhengzhou University from January 2023 to January 2024 were retrospectively selected.They were divided into T2DM group(n=117)and decreased ventricular diastolic function group(n=244)according to cardiac function.General characteristics and biochemical indicators were collected in the two groups,as well as echocardiography.Logistic regression was used to construct a new prediction model.The area under the receiver operating characteristic(ROC)curve(AUC)was used to evaluate the accuracy of the model,and the Hosmer-Lemeshow goodness-of-fit test was used to evaluate the calibration of the model.Results Age,DM duration,TC,urea,serum creatinine(Scr),25(OH)D3 and HDL-C were higher,while TG,triglyceride and glucose product index,serum uric acid(SUA)and glomerular filtration rate(eGFR)were lower in the ventricular diastolic function decline group than in the T2DM group(P<0.05).Logistic regression analysis showed that the duration of DM,urea,Scr,SUA and eGFR were the influencing factors for cardiac diastolic function decline inpatients with T2DM,and the prediction model was constructed as follows:y=7.054+0.097×ln DM duration+0.209×ln urea-0.203×ln Scr-0.003×ln SUA-0.052×ln eGFR,AUC was 0.832,sensitivity was 0.713,specificity was 0.803,cut-off value was 0.69,and the model fitted well and had certain predictive value.Conclusions The decline of cardiac diastolic function in patients with T2DM is related to DM duration,urea,SUA,Scr and eGFR.The new model has a good predictive effect on cardiac function in patients with T2DM and provides clinical value.

Objective To investigate the influencing factors of ERCP stent implantation for patients with malignant obstructive jaundice.Methods 130 patients with malignant obstructive jaundice who received ERCP stent implantation in our hospital from January 2017 to January 2024 were retrospectively included,and grouped according to the jaundice control effect 4 weeks after surgery.Univariate and multivariate analysis of the efficacy of ERCP stent placement in malignant obstructive jaundice after 4 weeks.Construction of a predictive model for the efficacy of ERCP stent placement in malignant obstructive jaundice after 4 weeks and clinical efficacy analysis.Results There were 64 cases for jaundice resolved in 4 weeks after surgery among all 130 patients with the regression rate for 49.23％.The results of univariate analysis showed that the type of biliary obstruction,stent type,and preoperative Child Pugh grading may all be related to the efficacy of ERCP stent placement in malignant obstructive jaundice after 4 weeks(P＜0.05).The results of Logistic multivariate analysis showed that the type of biliary obstruction,stent type,and preoperative Child Pugh grade were all independent influencing factors on the efficacy of ERCP stent placement for malignant obstructive jaundice at 4 weeks(P＜0.05).Using the independent influencing factors and P-value prediction probability of Logistic regression model to predict the prognosis of patients,the ROC curve was used,with areas under the curve of 0.713,0.823,0.907,and 0.971,respectively.Conclusion The clinical effects of ERCP stent implantation in malignant obstructive jaundice was closely related to the type of biliary obstruction,stent type and preoperative Child-Pugh grade.The data model constructed using the above three factors has shown good performance in predicting the prognosis of patients.

Objective To investigate the influencing factors of ERCP stent implantation for patients with malignant obstructive jaundice.Methods 130 patients with malignant obstructive jaundice who received ERCP stent implantation in our hospital from January 2017 to January 2024 were retrospectively included,and grouped according to the jaundice control effect 4 weeks after surgery.Univariate and multivariate analysis of the efficacy of ERCP stent placement in malignant obstructive jaundice after 4 weeks.Construction of a predictive model for the efficacy of ERCP stent placement in malignant obstructive jaundice after 4 weeks and clinical efficacy analysis.Results There were 64 cases for jaundice resolved in 4 weeks after surgery among all 130 patients with the regression rate for 49.23％.The results of univariate analysis showed that the type of biliary obstruction,stent type,and preoperative Child Pugh grading may all be related to the efficacy of ERCP stent placement in malignant obstructive jaundice after 4 weeks(P＜0.05).The results of Logistic multivariate analysis showed that the type of biliary obstruction,stent type,and preoperative Child Pugh grade were all independent influencing factors on the efficacy of ERCP stent placement for malignant obstructive jaundice at 4 weeks(P＜0.05).Using the independent influencing factors and P-value prediction probability of Logistic regression model to predict the prognosis of patients,the ROC curve was used,with areas under the curve of 0.713,0.823,0.907,and 0.971,respectively.Conclusion The clinical effects of ERCP stent implantation in malignant obstructive jaundice was closely related to the type of biliary obstruction,stent type and preoperative Child-Pugh grade.The data model constructed using the above three factors has shown good performance in predicting the prognosis of patients.

The etiology of rhabdomyolysis in adults is multifaceted,with one cause being physical exertion,termed exertional rhabdomyolysis(ERM).Characterized primarily by the destruction of muscle cells,ERM results in the release of intracellular contents into the bloodstream,leading to a spectrum of symptoms,including myalgia,dark urine,weakness,and marked elevations in serum creatine kinase(CK)and myoglobin levels.Some patients experience recurrent symptoms,persistently high serum CK levels(exceeding 50 times the normal upper limit),or unexplained severe manifestations.Despite this,the underlying pathogenesis remains elusive in numerous cases.Recent studies have implicated mutations in the RYR1 gene as a potential cause of exercise-induced ERM.This report describes a patient presenting with ERM and a heterozygous RYR1 gene missense mutation.Following treatment with fluid resuscitation,metabolic optimization,and antioxidant therapy,the patient exhibited clinical and biochemical improvement.

Two pediatric heart failure patients were treated with pulmonary artery banding(PAB)at Fuwai Hospital,from December 2021 to January 2022.In the first case,an 8-month-old patient presented with left ventricular non-compaction cardiomyopathy(LVNC),left ventricular systolic dysfunction,ventricular septal defect,and atrial septal defect.The second case was a 4-month-old patient with LVNC,left ventricular systolic dysfunction,and coarctation of the aorta.After PAB,the left ventricular function and shape of both patients were significantly improved,without serious surgery-related complications.In these individual cases of pediatric heart failure,pulmonary artery banding exhibited a more satisfactory efficacy and safety compared to pharmacological treatment,especially for those with unsatisfactory medication results.Future clinical data are needed to promote the rational and broader application of this therapeutic option for indicated patients.

[Purpose]To analyze the compliance rates and influencing factors for gastroscopy and colonoscopy in gastrointestinal cancer screening,and to provide evidence and management recom-mendations for gastrointestinal cancer screening programs.[Methods]The study was based on the joint gastrointestinal cancer screening program conducted in Fenghua District of Ningbo City in 2023.The target population underwent risk assessments,following which high-risk individuals were mobilized for gastroscopy and colonoscopy screenings.The x2 test was used to compare the positive rates of gastrointestinal cancer risk assessments and the compliance rates of clinical screenings among populations with different characteristics.Multivariable Logistic regression models were applied to analyze the factors associated with compliance rates of clinical gastroscopy and colonoscopy screenings among high-risk individuals.[Results]A total of 48 587 individuals were included in the analysis,with an average age of(63.95±7.48)years old.Among them,39.45％(19 166 individuals)were male.The positive rates of risk assessment for upper gastrointestinal cancer and colorectal cancer were 39.00％(18 949 individuals)and 16.02％(7 782 individuals),respectively.The compliance rates for gastroscopy and colonoscopy were 59.51％(11 227/18 949)and 50.85％(3 957/7 782),respectively.Multivariable Logistic regression analysis revealed that unmarried in-dividuals and those with an assessment interval of more than 14 d had lower compliance with gas-troscopy(both P＜0.05).High-risk individuals for upper gastrointestinal cancer with BMI≥24 kg/m2,gastrointestinal symptoms,history of upper gastrointestinal diseases,family history of cancers,history of gastroscopy,lower intake of fresh vegetables and fruits,and higher intake of processed meats had higher compliance with gastroscopy(all P＜0.05).High educational levels and an assess-ment interval of more than 14 d were associated with lower compliance with colonoscopy(both P＜0.05).Among individuals at high risk for colorectal cancer,those with gastrointestinal symptoms,history of upper gastrointestinal diseases,higher intake of processed meats and fried or grilled foods,and a positive risk assessment for upper gastrointestinal cancer had higher compliance with colonoscopy(all P＜0.05).[Conclusion]Participants in the joint gastrointestinal cancer screening program exhibit high compliance with both gastroscopy and colonoscopy.Compliance with gas-troscopy and colonoscopy is associated with individual lifestyle,health conditions,disease history,medical history,and family history of cancers.