Objective To investigate the feasibility of a "pericardial lining" modified Bentall procedure for the treatment of patients with aortic root aneurysm. Methods This was a retrospective study that consecutively enrolled patients treated at the Affiliated Suzhou Hospital of Nanjing Medical University, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, and the First People's Hospital of Guangyuan from January 2023 to February 2024. Preoperative clinical data, imaging findings (including echocardiography and CT scans of the aortic root and the entire aorta), details of coronary artery management, surgical outcomes, and postoperative follow-up results were collected. All patients underwent the "pericardial lining" modified Bentall procedure: the aortic valve was replaced, and an autologous pericardial patch was divided into three equal leaflets based on the circumference of the aortic annulus measured by a valve sizer. These leaflets were then sutured to the aortic annulus. Fenestrations were created in two of the pericardial leaflets for anastomosis with the left and right coronary ostia. The pericardial leaflets were sutured to the wall of the aortic sinuses to form an integrated structure, thereby narrowing the sinus portion. A prosthetic vascular graft was anastomosed to the proximal and distal aorta, and no aortic root-to-right atrium shunt was created. Results A total of 5 patients, aged 37 to 68 years, were included. The preoperative Society of Thoracic Surgeons (STS) risk scores ranged from 2.8% to 3.9%. The diameter of the ascending aorta was 40-73 mm, the left ventricular end-diastolic diameter (LVEDD) was 45-71 mm, and the left ventricular ejection fraction (LVEF) was 47%-64%. Intraoperatively, the aortic cross-clamp time ranged from 85 to 180 min, and the cardiopulmonary bypass time ranged from 110 to 302 min. Postoperative follow-up echocardiography revealed that the ascending aortic diameter was 27-35 mm, LVEDD was 39-57 mm, and LVEF was 43%-61%. All surgeries were completed successfully with satisfactory immediate outcomes and no intraoperative complications. During the follow-up period, there was no mortality or reoperation. Conclusion For patients with aortic root aneurysm, the "pericardial lining" modified Bentall procedure yields satisfactory preliminary results, and the technique is demonstrated to be feasible.

Objective To compare the clinical efficacies among three surgical approaches of small inci-sion in the lower segment of the sternum,small incision in the right axilla and thoracoscopic 3 incisions for re-pairing adult giant atrial septal defects(ASD).Methods The medical records of 112 patients with giant ASD undergoing surgical repair in this hospital from January 2018 to January 2024 were retrospectively analyzed.According to the different surgical approaches,the patients were divided into the group A(n=35,small inci-sion in the lower part of the sternum),group B(n=37,small incision in the right axilla)and group C(n=40,thoracoscopic 3 incisions).The general data,operation time,cardiopulmonary bypass time,blood transfusion volume,incision length,postoperative VAS score,postoperative mechanical ventilation time,ICU stay time,postoperative hospitalization duration,hospitalization cost and postoperative complications occurrence rates were compared among the various groups.Results There were no statistically significant differences in the operation time,cardiopulmonary bypass time,blood transfusion volume,postoperative mechanical ventilation time,ICU stay time and postoperative hospitalization duration among 3 groups(P＞0.05).The hospitalization cost in the group C was higher than that in the groups A and group B,the postoperative VAS score in the group B was higher than that in the group A and C,the incision size in the group C was shorter than that in the group A and group B,and the differences were statistically significant(P＜0.05).All patients were suc-cessfully repaired.The incidence rate of postoperative pulmonary infection in the group A and group C was lower than that in the group B,and the difference was statistically significant(P＜0.05).Conclusion All three surgical approaches could safely and effectively repair adult giant ASD.Different surgical approaches should be selected based on the specific conditions of the patients.

Objective To investigate the associations of immune cells,CD8+and CD4+T cells,and high-sensitivity C-reactive protein(hs-CRP)with cognitive function,and to explore the relation-ships among immunity,chronic inflammation,and Alzheimer's disease-related cognitive impair-ment.Methods A cross-sectional study was conducted on 101 patients with primary complaints of memory decline who visited the Alzheimer's Disease Clinic of Dongzhimen Hospital from June to December 2024.Mini-Mental State Examination(MMSE)and Delayed Story Recall Task(DSR)were performed to assess their cognitive function,and according to the results,they were divided into observation group(cognitively impaired,60 cases)and control group(cognitively normal,41 cases).Peripheral blood levels of CD8+T cells,CD4+T cells,and hs-CRP were compared between the two groups.Results The observation group exhibited significantly lower total scores and scores of different dimensions of MMSE and DSR scores,but notably higher activities of daily liv-ing scores than the control group(P＜0.05,P＜0.01).Serum hs-CRP level was obviously elevated in the observation group than the control group(P＜0.05).Binary logistic regression analysis revealed that CD8+T cells(OR=0.998,95％CI:0.996-1.000,P=0.038)and body mass index(OR=0.843,95％CI:0.719-0.990,P=0.037)were protective factors,while hs-CRP(OR=2.004,95％CI:1.215-3.306,P=0.006)was an independent risk factor for cognitive impairment.Spearman's rank correlation analysis showed a significant positive correlation between hs-CRP and CD4+T cells(P=0.011),but no significant association with CD8+T cells(P＞0.05).Conclusion Chronic inflammation and immune dysregulation synergistically contribute to cogni-tive decline.Hs-CRP may serve as a potential screening biomarker for cognitive impairment in pri-mary care settings.

Objective To investigate the associations of immune cells,CD8+and CD4+T cells,and high-sensitivity C-reactive protein(hs-CRP)with cognitive function,and to explore the relation-ships among immunity,chronic inflammation,and Alzheimer's disease-related cognitive impair-ment.Methods A cross-sectional study was conducted on 101 patients with primary complaints of memory decline who visited the Alzheimer's Disease Clinic of Dongzhimen Hospital from June to December 2024.Mini-Mental State Examination(MMSE)and Delayed Story Recall Task(DSR)were performed to assess their cognitive function,and according to the results,they were divided into observation group(cognitively impaired,60 cases)and control group(cognitively normal,41 cases).Peripheral blood levels of CD8+T cells,CD4+T cells,and hs-CRP were compared between the two groups.Results The observation group exhibited significantly lower total scores and scores of different dimensions of MMSE and DSR scores,but notably higher activities of daily liv-ing scores than the control group(P＜0.05,P＜0.01).Serum hs-CRP level was obviously elevated in the observation group than the control group(P＜0.05).Binary logistic regression analysis revealed that CD8+T cells(OR=0.998,95％CI:0.996-1.000,P=0.038)and body mass index(OR=0.843,95％CI:0.719-0.990,P=0.037)were protective factors,while hs-CRP(OR=2.004,95％CI:1.215-3.306,P=0.006)was an independent risk factor for cognitive impairment.Spearman's rank correlation analysis showed a significant positive correlation between hs-CRP and CD4+T cells(P=0.011),but no significant association with CD8+T cells(P＞0.05).Conclusion Chronic inflammation and immune dysregulation synergistically contribute to cogni-tive decline.Hs-CRP may serve as a potential screening biomarker for cognitive impairment in pri-mary care settings.

Objective To analyze the treatment effects of extracorporeal cardiopulmonary resuscitation(ECPR)in 3 patients with cardiac arrest due to cardiac causes in a mountain area hospital,providing a reference for clinical diagnosis and treatment.Methods The combined treatment process of 3 patients with cardiogenic cardiac arrest admitted to Wufeng Tujia Autonomous County People's Hospital from January to December 2023 was retrospectively analyzed,and the treatment experience was summarized.Results All 3 patients underwent continuous cardiopulmonary resuscitation and defibrillation while urgently initiating the ECPR combined rescue process.First,a central venous catheter(CVC)was established under ultrasound guidance to create access for extracorporeal membrane oxygenation(ECMO).Once the ECMO equipment from a higher-level hospital arrived,the circuit was replaced,significantly reducing the time required for subsequent patient treatment.Finally,two patients with acute myocardial infarction underwent emergency coronary angiography and percutaneous coronary intervention(PCI)under ECMO support,resulting in the restoration of spontaneous cardiac rhythm and gradual stabilization of vital signs.The last patient was discharged after recovery following transfer to a higher-level hospital,while another patient received rehabilitation treatment after hemodynamic stability was achieved.The third patient,who experienced cardiac arrest due to hypertrophic cardiomyopathy,regained spontaneous rhythm after ECMO,but due to poor neurological recovery after transfer to a higher-level hospital,the family chose to withdraw treatment.Conclusions ECPR is a rapid extracorporeal membrane oxygenation-assisted cardiopulmonary resuscitation method for patients who cannot regain spontaneous rhythm or experience recurrent cardiac arrest.It aims to improve patient survival rates.In grassroots medical centers lacking the necessary conditions,early assistance from regional advanced medical centers can ensure rapid transfer and surgery under ECMO support,providing a guarantee for favorable patient outcomes.

This article reports one case of adult COVID-19-associated acute necrotizing encephalopathy(ANEC).The patient developed disturbance of consciousness and seizure on the 12th day after SARS-CoV-2 infection.Imaging showed significant swelling and signal changes in the bilateral thalamus,brainstem,cerebral hemisphere and cerebellar hemisphere,which were consistent with the characteristic images of Acute necrotizing encephalitis(ANE).Although methylprednisolone shock therapy and high-dose human immunoglobulin therapy were given early,the patient died.ANEC often starts quickly and progresses rapidly,unconsciousness and seizure are the main manifestations.Imaging features of thalamic and subtentorial symmetry and multifocal lesions are specific for diagnosis,but the treatment and prognosis still face challenges and need further study.

Objective:To explore the role of serum cholinesterase (CHE) levels in the prognosis of patients with acute decompensated heart failure (ADHF).Methods:Total of 244 consecutive patients with ADHF who were admitted to the emergency department and were successfully discharged were prospectively enrolled from January 2018 to June 2020. Patients were divided into groups according to the first and third quartile of CHE level and the clinical data, laboratory tests and other nutritional indices were recorded after discharge, and then were followed up. The primary end points were the composites of cardiovascular death and hospitalization for worsening HF (composite end points). The secondary end points were all-cause mortality and cardiovascular death. Cox proportional risk analysis, time-dependent Cox regression model or stratified cox regression were used to identify the risk of primary and secondary endpoints. Clinical, biomarker and the compound models of clinical and biomarker were constructed. Kaplan-Meier method was used to plot the survival curves of different groups and compare their differences. Receiver Operating characteristics (ROC) curves were used to compare the area under the curve for CHE levels and other nutritional or prognostic indicators to identify composite end-point events.Results:During a follow-up period of 350(100,683) days, 158 patients reached the composite end points. In the multivariable Cox analysis, cholinesterase level was significantly associated with the composite end points after adjustment for major confounders. Cox proportional risk analysis or time-dependent Cox regression model showed that CHE level was significantly associated with the composite end points, all-cause mortality and cardiovascular mortality in both clinical, biomarker and composite models (all P< 0.05). A Kaplan–Meier analysis revealed that patients with low cholinesterase levels had significantly greater risk of reaching the composite end points than those with middle or high cholinesterase levels (78.1% vs 66.7% vs. 46.7%, P<0.001); Cholinesterase level showed the largest area under the receiver operating characteristic curve (AUROC) of 0.736 (95% CI, 0.664-0.888) for prediction of the composite end points among other nutritional indices. The AUROC of the Global Meta-Analysis Group Chronic Heart Failure (MAGGIC) Risk Score for prediction of the composite end points was increased from 0.704 to 0.762 ( P=0.038), when cholinesterase level was added. Conclusions:Cholinesterase may serve as a simple and effective prognostic marker for predicting adverse outcomes in ADHF patients.

Objective To analyze the treatment effects of extracorporeal cardiopulmonary resuscitation(ECPR)in 3 patients with cardiac arrest due to cardiac causes in a mountain area hospital,providing a reference for clinical diagnosis and treatment.Methods The combined treatment process of 3 patients with cardiogenic cardiac arrest admitted to Wufeng Tujia Autonomous County People's Hospital from January to December 2023 was retrospectively analyzed,and the treatment experience was summarized.Results All 3 patients underwent continuous cardiopulmonary resuscitation and defibrillation while urgently initiating the ECPR combined rescue process.First,a central venous catheter(CVC)was established under ultrasound guidance to create access for extracorporeal membrane oxygenation(ECMO).Once the ECMO equipment from a higher-level hospital arrived,the circuit was replaced,significantly reducing the time required for subsequent patient treatment.Finally,two patients with acute myocardial infarction underwent emergency coronary angiography and percutaneous coronary intervention(PCI)under ECMO support,resulting in the restoration of spontaneous cardiac rhythm and gradual stabilization of vital signs.The last patient was discharged after recovery following transfer to a higher-level hospital,while another patient received rehabilitation treatment after hemodynamic stability was achieved.The third patient,who experienced cardiac arrest due to hypertrophic cardiomyopathy,regained spontaneous rhythm after ECMO,but due to poor neurological recovery after transfer to a higher-level hospital,the family chose to withdraw treatment.Conclusions ECPR is a rapid extracorporeal membrane oxygenation-assisted cardiopulmonary resuscitation method for patients who cannot regain spontaneous rhythm or experience recurrent cardiac arrest.It aims to improve patient survival rates.In grassroots medical centers lacking the necessary conditions,early assistance from regional advanced medical centers can ensure rapid transfer and surgery under ECMO support,providing a guarantee for favorable patient outcomes.

Objective:To evaluate the effects of intensive intervention on negative spouses in sero-discordant couples.Methods:From December 2019 to December 2020, all HIV sero-discordant couples in seven townships in Butuo County of Liangshan were enrolled and divided into intensive intervention group and routine intervention group. Both intensive intervention and routine intervention were conducted for one year. Baseline survey and follow-up were conducted respectively with a questionnaire survey and a serological testing in HIV sero-discordant couples in the two groups at 6 th month before and after the interventions. Multivariable Cox proportional hazards model and difference-in-difference model were used to evaluate the effect of the intensive intervention. Results:A total of 899 sero-discordant couples were enrolled (393 of intensive intervention group and 506 of routine intervention group), in whom 806 completed the follow up survey (349 of intensive intervention group and 457 of routine intervention group). Compared with routine intervention, intensive intervention had no effect to improve the correct answer rate of an AIDS related question in negative spouses ( P>0.05), but could improve their awareness of AIDS related knowledge ( β=1.40, P=0.008). Compared with routine intervention, intensive intervention could reduce the frequency of sex between HIV sero-discordant couples ( β=-0.73, P=0.021), and increase the frequency of condom use ( β=0.19, P=0.007), but had no effect to decrease the positive conversion rate in negative spouses ( β=-0.61, OR=0.55,95% CI:0.18-1.66, P=0.294). Conclusions:The intensive interventions could improve the awareness of AIDS related knowledge in negative spouses in sero-disordant couples and promote their safe sexual behavior, but had no effect to decrease the positive conversion in negative spouses. It is necessary to continue the intensive intervention and follow up to evaluate the effects of the intervention.

OBJECTIVE: The current fertilization methods for Chinese yam are uneconomic and unfriend to environment. A rational one is very important to achieve desired balance of high yield of Chinese yam, economic and friend to environment. Here, we studied the effects of nitrogen (N), phosphorus (P), and potassium (K) fertilizers on the yield of 'Qinfeng' Chinese yam in shallow-groove directional cultivation. METHODS: The experiments were conducted in Dehua County, Fujian Province, China using a "3414" optimal design. Overall, three fertilizer factors (N, P, and K) were evaluated at the following four levels: 0, no fertilizer; 1, 0.5-fold the typical rate; 2, typical fertilization rate; and 3, 1.5-fold the typical rate. There were 14 different fertilization treatments. RESULTS: Treatment 6 (N₂P₂K₂) produced the longest (75.6 cm) and thickest tubers (4.9 cm) with the highest tuber fresh weight (1311.9 g) and yield (41 015.9 kg/hm²), whereas, treatment 1 produced the shortest (65.6 cm) and thinnest tubers (3.9 cm) with the lowest fresh weight (953.4 g) and yield (28 532.8 kg/hm²) among the 14 fertilizer combinations. The experimental data could be fitted to single-variable quadratic and binary quadratic models but not to a ternary quadratic polynomial model. Appropriate N, P, and K fertilizer application rates increased Chinese yam yield. However, excessive fertilization lowered the yield. Chinese yam yield was significantly and strongly correlated with the amounts of N, P, and K fertilizer applied. CONCLUSION Based on the single variable quadratic and binary quadratic models, we propose that the quantities of N, P, and K fertilizer used to grow 1 hm² 'Qinfeng' Chinese yam should be 360-388.3, 90-100.95, and 416.3-675 kg, respectively.