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.

Background and Objectives: The Fractional Flow Reserve and Intravascular UltrasoundGuided Intervention Strategy for Clinical Outcomes in Patients with Intermediate Stenosis (FLAVOUR) trial demonstrated non-inferiority of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) compared with intravascular ultrasound (IVUS)-guided PCI. We sought to investigate the cost-effectiveness of FFR-guided PCI compared to IVUS-guided PCI in Korea. Methods: A 2-part cost-effectiveness model, composed of a short-term decision tree model and a long-term Markov model, was developed for patients who underwent PCI to treat intermediate stenosis (40% to 70% stenosis by visual estimation on coronary angiography).The lifetime healthcare costs and quality-adjusted life-years (QALYs) were estimated from the healthcare system perspective. Transition probabilities were mainly referred from the FLAVOUR trial, and healthcare costs were mainly obtained through analysis of Korean National Health Insurance claims data. Health utilities were mainly obtained from the Seattle Angina Questionnaire responses of FLAVOUR trial participants mapped to EQ-5D. Results: From the Korean healthcare system perspective, the base-case analysis showed that FFR-guided PCI was 2,451 U.S. dollar lower in lifetime healthcare costs and 0.178 higher in QALYs compared to IVUS-guided PCI. FFR-guided PCI remained more likely to be cost-effective over a wide range of willingness-to-pay thresholds in the probabilistic sensitivity analysis. Conclusions Based on the results from the FLAVOUR trial, FFR-guided PCI is projected to decrease lifetime healthcare costs and increase QALYs compared with IVUS-guided PCI in intermediate coronary lesion, and it is a dominant strategy in Korea.

Objective To explore and analyze the application effect of the digital information management mode of nurs-ing"teaching-training-clinical"work in operating room teaching.Methods 100 nursing students who interned in the operating room of Gaozhou Hospital of Traditional Chinese Medicine from April 2023 to February 2024 were selected as the research sub-jects.They were divided into an observation group(digital information management mode of"teaching-training-clinical"work)and a control group(traditional teaching mode)by random number table method,with 50 students in each group.The teaching effects of the two groups were compared.Results The theoretical and practical scores and core competency scores of the obser-vation group after teaching were significantly higher than those of the control group.The observation group had higher satisfaction with the teaching plan,teaching content,teaching methods,teaching achievements,and teaching ability,and the comparison was statistically significant(P＜0.05).The long-term teaching results of the observation group,including theoretical and practical assessment results and core competency assessment results,were higher than those of the control group(P＜0.05).Conclusion The digital information management mode of"teaching-training-clinical"work can improve the teaching quality of operating room teaching and enhance the working ability of nursing students.

Objective:To investigate the current status and influencing factors of decision anxiety in guardians of children with acute appendicitis under Endoscopic retrograde appendicitis therapy (ERAT) background, and to provide reference for the development of targeted intervention programs for decision anxiety.Methods:Convenient sampling method was used to select 254 guardians of children with acute appendicitis treated in the Department of Pediatrics, Second Affiliated Hospital of PLA Air Force Medical University from February 2023 to April 2024. A cross-sectional survey was conducted using the General Data Questionnaire, the State-Trait Anxiety Inventory Form Y-State anxiety subscale and the Preparation for Decision Making Scale. Multiple linear regression was used to analyze the influencing factors in guardians of children with acute appendicitis.Results:Among the guardians of 254 children with acute appendicitis, 156 were males and 98 were females, aged (37.44 ± 3.63) years old. The decision anxiety score of guardians of children with acute appendicitis was (52.49 ± 6.54). The results of multiple linear regression showed that age of children, gender of guardian, education level of guardian, per capita monthly income of family, decision making tendency and decision preparation were the main influencing factors of decision anxiety in guardians of children with acute appendicitis ( t values were -7.07-3.58, all P<0.05), which could explain 64.4% of the total variation. Conclusions:The decision anxiety in guardians of children with acute appendicitis is at a high level. Medical staff should provide targeted decision guidance, improve decision assistance programs and provide more effective decision support for guardians of children with acute appendicitis.

Objective To investigate the correlation between skeletal muscle mass index(ASMI)and islet β cell reserve function in patients with newly diagnosed type 2 diabetes mellitus(T2DM).Methods A total of 100 patients with newly diagnosed T2DM were included in this study.All the patients were admitted to the Department of Endocrinology in the First People's Hospital of Yinchuan between June 2022 and November 2023.They were divided into two groups according to their skeletal muscle mass index(ASMI):patients with T2DM accompanied by sarcopenia(Sar,n=50)group,and patients with simple T2DM(T2DM,n=50)group.Additionally,a control(NC)group consisting of 50 healthy participants was selected.Fasting C-peptide levels,liver and kidney function,blood lipid profiles,and other indicators were assessed in all the individuals.The correlation between ASMI and other indicators was analyzed,and the influencing factors for ASMI and T2DM combined with sarcopenia were analyzed respectively.Results The levels of HbA1c,FPG,and TG were higher,while FC-P and Scr levels were lower in the T2DM group and Sar group compared with the NC group(P<0.05).FPG was higher,while ASMI,FC-P,BMI were lower in the Sar group than in the T2DM group(P<0.05).Spearman correlation analysis revealed a negative correlation between ASMI and FPG and HbA1c(P<0.05),whereas a positive correlation was observed with BMI,ALT,Scr,SUA and FC-P(P<0.05).Multiple linear regression analysis indicated that BMI,HbA1c and FC-P were influencing factors for ASMI(P<0.05).Furthermore,logistic regression analysis demonstrated that BMI,HbA1c,FC-P were influencing factors for T2DM with sarcopenia(P<0.05).Conclusions The level of ASMI may be related to the reserve function of islet β cells.

Objective:To analyze and explore the selection of secondary intervention strategies for residual issues following congenital aortic valve disease surgery in children, as well as to evaluate their prognostic efficacy.Methods:A retrospective analysis was conducted on the clinical data of 41 children with residual issues after congenital aortic valve disease surgery, who were treated at the Department of Cardiovascular and Thoracic Surgery, Shanghai Children's Medical Center, between January 2013 and August 2024. Among them, 25 were male and 16 were female, with a mean age of(116.8±45.1)months and a mean weight of(40.0±20.2)kg. The mean interval for secondary intervention was(60.0±36.4)months. The residual issues included aortic valve insufficiency(20 cases), aortic valve stenosis(11 cases), and combined aortic valve insufficiency and stenosis(10 cases).Results:Secondary interventions included aortic valve repair(7 cases), mechanical valve replacement(20 cases), Ross procedure(13 cases), and Ozaki procedure(1 case). Additionally, 5 cases with left ventricular outflow tract stenosis underwent concomitant Konno surgery.One case of early postoperative in-hospital death occurred, with a mortality rate of 2.4%, primarily due to acute left heart failure and multiple organ dysfunction. The average follow-up period for surviving children was( 64.6±34.5) months(5-147 months), with no mid- to long-term mortality. Follow-up results showed that In surviving children, the left heart showed significant reduction in size postoperatively, with the LVEDD Z-score decreasing from 1.24±2.23 before surgery to -0.97±1.48( P=0.001). Postoperative LVEF 0.66±0.06 showed no significant difference compared to pre-reintervention 0.68±0.10( P=0.140). In aortic stenosis(AS) patients, the peak transvalvular pressure gradient decreased from(69.5±19.8) mmHg(1 mmHg=0.133 kPa) preoperatively to(25.1±10.9) mmHg postoperatively( P=0.003). In aortic insufficiency(AI) patients, the width of the aortic regurgitation jet decreased from(5.8±1.1) mm preoperatively to(2.7±1.1) mm postoperatively( P=0.012). 97.5% of children maintained mild-to-moderate aortic regurgitation(jet width <4 mm), with only 1 case of moderate regurgitation(jet width 4.4 mm)remaining under close observation.Two children underwent reoperation on the aortic valve, with a tertiary intervention rate of 5.0%. One case underwent redo commissurotomy 21 months after aortic valve repair due to recurrent stenosis, and the other underwent mechanical valve replacement 34 months after the Ozaki procedure due to leaflet calcification and infective endocarditis. Mid-term follow-up revealed good cardiac function recovery in surviving children, with 87.5% achieving NYHA functional class Ⅰ/Ⅱ. Conclusion:Due to the demands of growth and development and the degenerative nature of valve tissue, residual issues are inevitable in the mid- to long-term following congenital aortic valve disease surgery in children, often necessitating secondary intervention. Given the lack of suitable autologous valve tissue, the use of aortic valve replacement has significantly increased in secondary interventions. The Ross procedure, as an ideal secondary intervention, demonstrates satisfactory mid-term follow-up outcomes. For children with high-risk factors for the Ross procedure, mechanical valve replacement also yields favorable prognoses.

Objective To investigate the expression of ferritinophagy-related gene ELAV-like RNA binding protein 1(ELAVL1)in multiple myeloma(MM)and elucidate its diagnostic and prognostic value for MM.Methods First,we analyzed ELAVL1 expression level in healthy controls and MM patients using data from the GEO and TCGA databases.Subsequently,bone marrow specimens were collected from 28 newly diagnosed MM patients and 20 healthy controls,and qRT-PCR was employed to validate ELAVL1 expression.The diagnostic and prognostic potential of ELAVL1 was assessed using ROC curve analysis and Kaplan-Meier survival curves.Additionally,univariate and multivariate COX regression analyses were performed to identify independent risk factors for MM prognosis.Finally,KEGG and GO enrichment analyses were performed using the DAVID online platform.Results The level of ELAVL1 expression was significantly higher in newly diagnosed MM patients and refractory/relapsed MM patients than in the healthy controls(P＜0.001).Moreover,ELAVL1 expression was positively correlated with the International Staging System(ISS)stage of MM(P＜0.01).Furthermore,qRT-PCR validation confirmed that ELAVL1 expression was elevated in the 28 newly diagnosed MM patients compared to the 20 healthy controls(P＜0.001).ROC curve analysis demonstrated that ELAVL1 could effectively differentiate between newly diagnosed MM patients,healthy controls,and MGUS patients(P＜0.001 and P=0.000 2,respectively).Survival analysis revealed that high ELAVL1 expression was associated with shorter progression-free survival(P=0.0141)and overall survival(P=0.008 0).Univariate and multivariate COX regression analyses identified high ELAVL1 expression as an independent risk factor for poor MM prognosis(P=0.005 0).KEGG analysis suggested that ELAVL1 might be involved in the Hippo and MAPK signaling pathways.Conclusion High ELAVL1 expression in MM may serve as a biomarker for diagnosis and poor prognosis.ELAVL1 may promote MM initiation and progression via the Hippo and MAPK signaling pathways.

Objective To investigate the protective effect and mechanism of RhoE overexpression in angiotensin Ⅱ-induced myo-cardial fibrosis.Methods Primary cardiomyocytes were cultured in vitro using angiotensin Ⅱ-induced myocardial fibrosis model,and transfected with M-RhoE-carrying overexpressing adenovirus and overexpressing RhoE according to subgroup.α-SMA and Smad3 ex-pression distribution in primary cardiomyocytes were detected by immunofluorescence.The protein expression levels of RhoE,GAPDH,α-SMA,Smad3 and p-Smad3 in primary cells were detected by Western blotting.Results Ang Ⅱ interferes with primary cardiomyo-cytes.Western-blot analysis showed that compared with the control group,the expression levels of p-Smad3 and α-SMA in Ang Ⅱgroup were increased,while the expression levels of RhoE were decreased(P＜0.05).After transfection of RhoE overexpressing adenovi-rus,Western blot results showed that the α-SMA expression level in Ang Ⅱ group was increased compared with that in the control group(P＜0.05).Compared with Ang Ⅱ group α-SMA expression level in Ang Ⅱ+Ad-RhoE group was significantly decreased(P＜0.05).Immunofluorescence detection showed that the α-SMA fluorescence intensity in Ang Ⅱ group was increased compared with that in control group(P＜0.05).Compared with Ang Ⅱ group α-SMA fluorescence intensity in Ang Ⅱ+Ad-RhoE group was significantly decreased(P＜0.05).Effects of overexpression of RhoE gene on TGF-β1/Smad3 pathway.Western blot results showed that compared with the control group,the p-Smad3/Smad3 ratio in Ang Ⅱ group was increased(P＜0.05).Compared with Ang Ⅱ group,the p-Smad3/Smad3 ratio in Ang Ⅱ+Ad-RhoE group was significantly decreased(P＜0.05).Immunofluorescence nuclear translocation showed that compared with the control group,the red fluorescence in myocardial nucleus of Ang Ⅱ group was significantly increased(P＜0.05).Compared with Ang Ⅱ group,the red fluorescence in myocardial nucleus of Ang Ⅱ+Ad-RhoE group was significantly decreased(P＜0.05).Conclusion The process of Ang Ⅱ-induced myocardial fibrosis is accompanied by the activation of TGF-β1/Smad3 sig-naling pathway,and RhoE can inhibit Ang Ⅱ-induced myocardial fibrosis by inhibiting TGF-β1/Smad3 signaling pathway.

Objective:To analyze and explore the selection of secondary intervention strategies for residual issues following congenital aortic valve disease surgery in children, as well as to evaluate their prognostic efficacy.Methods:A retrospective analysis was conducted on the clinical data of 41 children with residual issues after congenital aortic valve disease surgery, who were treated at the Department of Cardiovascular and Thoracic Surgery, Shanghai Children's Medical Center, between January 2013 and August 2024. Among them, 25 were male and 16 were female, with a mean age of(116.8±45.1)months and a mean weight of(40.0±20.2)kg. The mean interval for secondary intervention was(60.0±36.4)months. The residual issues included aortic valve insufficiency(20 cases), aortic valve stenosis(11 cases), and combined aortic valve insufficiency and stenosis(10 cases).Results:Secondary interventions included aortic valve repair(7 cases), mechanical valve replacement(20 cases), Ross procedure(13 cases), and Ozaki procedure(1 case). Additionally, 5 cases with left ventricular outflow tract stenosis underwent concomitant Konno surgery.One case of early postoperative in-hospital death occurred, with a mortality rate of 2.4%, primarily due to acute left heart failure and multiple organ dysfunction. The average follow-up period for surviving children was( 64.6±34.5) months(5-147 months), with no mid- to long-term mortality. Follow-up results showed that In surviving children, the left heart showed significant reduction in size postoperatively, with the LVEDD Z-score decreasing from 1.24±2.23 before surgery to -0.97±1.48( P=0.001). Postoperative LVEF 0.66±0.06 showed no significant difference compared to pre-reintervention 0.68±0.10( P=0.140). In aortic stenosis(AS) patients, the peak transvalvular pressure gradient decreased from(69.5±19.8) mmHg(1 mmHg=0.133 kPa) preoperatively to(25.1±10.9) mmHg postoperatively( P=0.003). In aortic insufficiency(AI) patients, the width of the aortic regurgitation jet decreased from(5.8±1.1) mm preoperatively to(2.7±1.1) mm postoperatively( P=0.012). 97.5% of children maintained mild-to-moderate aortic regurgitation(jet width <4 mm), with only 1 case of moderate regurgitation(jet width 4.4 mm)remaining under close observation.Two children underwent reoperation on the aortic valve, with a tertiary intervention rate of 5.0%. One case underwent redo commissurotomy 21 months after aortic valve repair due to recurrent stenosis, and the other underwent mechanical valve replacement 34 months after the Ozaki procedure due to leaflet calcification and infective endocarditis. Mid-term follow-up revealed good cardiac function recovery in surviving children, with 87.5% achieving NYHA functional class Ⅰ/Ⅱ. Conclusion:Due to the demands of growth and development and the degenerative nature of valve tissue, residual issues are inevitable in the mid- to long-term following congenital aortic valve disease surgery in children, often necessitating secondary intervention. Given the lack of suitable autologous valve tissue, the use of aortic valve replacement has significantly increased in secondary interventions. The Ross procedure, as an ideal secondary intervention, demonstrates satisfactory mid-term follow-up outcomes. For children with high-risk factors for the Ross procedure, mechanical valve replacement also yields favorable prognoses.

Objective To develop an innovative minimally invasive rotary-cutting surgical system for axillary osmidrosis,and conduct clinical validation.Methods The design concept,technical principles and system composition of the innovative minimally invasive rotary-cutting surgical system for axillary osmidrosis were introduced.A total of 73 patients(146 axillae)with axillary osmidrosis were enrolled as subjects,and underwent surgery using the newly developed surgical system.Clinical validation of the system was performed by evaluating postoperative scarring,odor elimination rate,postoperative complication incidence,and patient satisfaction.Results The study demonstrated favorable clinical outcomes in the following aspects:postoperative scarring,odor elimination rate,postoperative complication incidence,and patient satisfaction.Conclusion The minimally invasive rotary-cutting surgical system for axillary osmidrosis is rationally designed.The rotary-cutting puncture device is safe,effective,minimally invasive,and convenient for axillary osmidrosis surgery,warranting further clinical validation and widespread application.