Objective:To quantitatively evaluate the effects of left bundle branch block（LBBB）on left ventricular structure，function and myocardial perfusion using left ventricular pressure-strain loop and single photon emission computed tomography（SPECT），and to investigate the relationship between myocardial work，myocardial perfusion and pathological changes of left ventricular remodeling in left bundle branch block induced cardiomyopathy（LBBB-CM）.Methods:Fourteen male beagle dogs were selected，and the main trunk of the left bundle branch was ablated to create an LBBB dog model. Electrocardiogram（ECG），transesophageal echocardiography and arterial blood pressure data of LBBB dogs were collected before and 12 months after the ablation of left bundle branch trunk. Global and segmental myocardial work parameters were obtained by left ventricular pressure-strain loop. The differences of above parameters between baseline and 12 months after the ablation of left bundle branch were compared. SPECT was performed in LBBB dogs 12 months after the creation of LBBB. The hearts were harvested for anatomy observation and histopathological analysis in LBBB dogs and another 7 male beagle dogs（normal control group）matched by age and weight. The correlation between myocardial perfusion（percentage of regional tracer uptake）and myocardial work parameters，myocardial fibrosis in LBBB dogs were analyzed.Results:Compared with baseline，the left ventricular end-diastolic volume of 12 months after the ablation increased［（20.78 ± 5.32）ml vs（26.71 ± 7.94）ml， P = 0.003］，left ventricular ejection fraction decreased［（59.17 ± 5.67）% vs（47.69 ± 5.45）%， P<0.001］；left ventricular global/segmental longitudinal strain，global/segmental constructive work and global/segmental work efficiency decreased（all P<0.05），left ventricular global/segmental wasted work increased（all P<0.001）. Heterogenous perfusion defect was observed in LBBB dogs by SPECT，compared with lateral wall segments，the percentage of regional tracer uptake of septum was decreased（all P<0.05）. Gross anatomical and myocardial pathological changes were manifested as cardiomegaly，flaky or focal grayish thickening of endocardium，cardiomyocyte degeneration and fibrosis. Compared with normal control group，the collagen fiber volume fraction（CVF）in all segmental endocardium and partial segmental myocardium of LBBB dogs were significantly increased（all P<0.05）. Percentage of regional tracer uptake was positively correlated with segmental myocardial work（SMW）and segmental myocardial efficiency（SWE）（ r s = 0.49，0.31；both P<0.001），and negatively correlated with CVF and segmental wasted work（SWW）（ r s = -0.51，-0.49；both P<0.001）. Conclusions:Isolated LBBB is not benign，which can result in left ventricular remodeling，decreased cardiac constructive function，abnormal myocardial perfusion，endocardial fibrosis and myocardial fibrosis.The parameters of myocardial work assecsed by echocardiograpgy and myocardial perfusion，as non-invasive examination，can to some extent reflect the degree of left ventricular remodeling in LBBB-CM.

Objective:To quantitatively evaluate the effects of left bundle branch block（LBBB）on left ventricular structure，function and myocardial perfusion using left ventricular pressure-strain loop and single photon emission computed tomography（SPECT），and to investigate the relationship between myocardial work，myocardial perfusion and pathological changes of left ventricular remodeling in left bundle branch block induced cardiomyopathy（LBBB-CM）.Methods:Fourteen male beagle dogs were selected，and the main trunk of the left bundle branch was ablated to create an LBBB dog model. Electrocardiogram（ECG），transesophageal echocardiography and arterial blood pressure data of LBBB dogs were collected before and 12 months after the ablation of left bundle branch trunk. Global and segmental myocardial work parameters were obtained by left ventricular pressure-strain loop. The differences of above parameters between baseline and 12 months after the ablation of left bundle branch were compared. SPECT was performed in LBBB dogs 12 months after the creation of LBBB. The hearts were harvested for anatomy observation and histopathological analysis in LBBB dogs and another 7 male beagle dogs（normal control group）matched by age and weight. The correlation between myocardial perfusion（percentage of regional tracer uptake）and myocardial work parameters，myocardial fibrosis in LBBB dogs were analyzed.Results:Compared with baseline，the left ventricular end-diastolic volume of 12 months after the ablation increased［（20.78 ± 5.32）ml vs（26.71 ± 7.94）ml， P = 0.003］，left ventricular ejection fraction decreased［（59.17 ± 5.67）% vs（47.69 ± 5.45）%， P<0.001］；left ventricular global/segmental longitudinal strain，global/segmental constructive work and global/segmental work efficiency decreased（all P<0.05），left ventricular global/segmental wasted work increased（all P<0.001）. Heterogenous perfusion defect was observed in LBBB dogs by SPECT，compared with lateral wall segments，the percentage of regional tracer uptake of septum was decreased（all P<0.05）. Gross anatomical and myocardial pathological changes were manifested as cardiomegaly，flaky or focal grayish thickening of endocardium，cardiomyocyte degeneration and fibrosis. Compared with normal control group，the collagen fiber volume fraction（CVF）in all segmental endocardium and partial segmental myocardium of LBBB dogs were significantly increased（all P<0.05）. Percentage of regional tracer uptake was positively correlated with segmental myocardial work（SMW）and segmental myocardial efficiency（SWE）（ r s = 0.49，0.31；both P<0.001），and negatively correlated with CVF and segmental wasted work（SWW）（ r s = -0.51，-0.49；both P<0.001）. Conclusions:Isolated LBBB is not benign，which can result in left ventricular remodeling，decreased cardiac constructive function，abnormal myocardial perfusion，endocardial fibrosis and myocardial fibrosis.The parameters of myocardial work assecsed by echocardiograpgy and myocardial perfusion，as non-invasive examination，can to some extent reflect the degree of left ventricular remodeling in LBBB-CM.

Objective　To analyze the epidemiological characteristics, trends, risk factors, and pathogenic spectrum of adult diarrheal diseases in Xuhui District, Shanghai from 2017 to 2023, so as to provide scientific reference for pathogen monitoring and disease prevention and control of diarrheal diseases. Methods Samples of adult patients with diarrhea in sentinel hospitals of Xuhui District from 2017 to 2023 were collected, and nucleic acid detection of intestinal pathogens was conducted using real-time quantitative PCR. Thirty specimens were subjected to shotgun metagenomic next-generation sequencing (mNGS), with species identified as metagenomic positive pathogens at the level of genus or species by a threshold that at least one read per million of total reads identified by METAMIC. Pathogenic spectrum detected by qPCR and mNGS was listed and compared. Results A total of 1 265 adult diarrheal specimens were collected, showing a significant upward trend in pathogen positivity rates (χ2=23.493, P<0.05), peaking in 2023 at 64.9% (100/154). A higher incidence was found among males (52.9%, 669/1 265), with the primary affected age group being 26-45 years (51.8%, 655/1 265), and summer and autumn being peak seasons for infection (67.7%, 857/1 265). Most patients (72.3%, 914/1 265) sought medical attention within one day of onset. Before onset, 67.8% (858/1 265) of patients had eaten suspicious meat, eggs, dairy, or seafood products. qPCR results revealed the top three dominant pathogens as Norovirus GII (22.6%, 132/584), Campylobacter jejuni (20.0%, 117/584 ), and enterotoxigenic Escherichia coli (13.0%, 76/584). There were significant differences in pathogenic spectrum across different years (χ2=79.578, P<0.05), with enteroaggregative E. coli, Campylobacter jejuni, and Norovirus GII showing the most variation in prevalence. The difference in pathogenic spectrum detected by mNGS and qPCR was also significant (P<0.05), with the top three most abundant pathogens being Rotavirus (93.3%, 28/30), Vesiculovirus (83.3%, 25/30), and Herpesvirus (80.0%, 24/30). Factor analysis indicated that age, suspicious food, and fever were statistically significant related factors to the detection rates (P<0.05). Conclusions From 2017 to 2023, the overall positive rate of adults with diarrhea in Xuhui District exhibited an increasing trend. Summer and autumn were the peak infection seasons, with viruses predominantly detected in summer and bacteria in both summer and autumn. In addition, mNGS could be used as a complementary technology for conventional detection techniques to provide a scientific basis for the effective prevention and control of diarrhea.

Objective To analyze the main factors affecting early using enteral nutrition and the effect of enteral nutrition within 72 h after burning on outcomes by presenting a retrospective cohort study of 11 years of hospitalization data,to provide evidence for enteral nutrition regimens for severe burn patients.Methods A retrospective study analyzed adult extensive burn patients between January 2009 and December 2020.Patients enrolled in this study who admitted to the burn department within 24 h after burning and with a burned area of more than 30%.Univariate and multiple regression were used to analyze the main factors affecting early using enteral nutrition in patients with severe burn.Non parametric Mann-Whitney U test was used to compare the main influencing factors of enteral nutrition implementation within or after 72 h,as well as the impact on the treatment outcomes such as 28-day survival rate and in hospital survival rate.Results The univariate analysis found that total burn area,full-thickness burn area,burn type,and inhalation injury were the main factors of the time to initation of enteral nutrition in patients with severe burn(P<0.05).Incorporating the above single factors into multiple regression analysis,we found that the main factors affecting enteral nutrition using in patients with severe burn were full-thickness burn area(P=0.017)and inhalation injury(P=0.001).To analysis whether enteral nutrition was started within 72 h after burning,we found that inhalation injury and larger area of full-thickness burn area in patients was the main factors for initiating enteral nutrition.After matching injury situation with pre-injury situation,we found that using enteral nutrition within or after 72 h after injury were no significant differences in the survival rate,28-day survival rate,and positive blood culture rate(P>0.05),but was associated with the lower incidence of bacteria positive in intravenous catheters(P=0.001)and the lower rate of parenteral nutrition treatment used within 7 d after burning(P= 0.001).Conclusions The main factor for influencing early implement enteral nutrition in patients with severe burn were large area of full-thickness burn and inhalation injury.Enteral nutrition using within 72 h after burning reduces the incidence of catheter infection and the use of parenteral nutrition,thereby reducing the risk of treatment in patients with severe burn.

Objective:To investigate the alteration of right ventricular function after catheter ablation in patients with persistent atrial fibrillation(PAF) and concomitant heart failure with preserved ejection fraction (HFpEF).Methods:The prospective observational study was performed in patients with HFpEF-PAF and undergoing first-time radiofrequency ablation procedures in the First Affiliated Hospital of Nanjing University between May to December 2019. Right ventricular functional parameters were measured before and 5 days, 1, 3, 6 and 12 months after the ablation by transthoracic echocardiography, respectively, including the right ventricular fractional area change (RVFAC), tricuspid annular plane systolic excursion(TAPSE), tricuspid annular diameter (TVAD), tricuspid annular peak systolic speed(TDI-S′) and longitudinal strain of right ventricular free wall (RVFLS). Meanwhile, routine ECG and Holter recordings were performed at each follow-up time point.Results:In this study, atrial fibrillation (AF) recurrence occurred in 4 patients at the 3rd month after ablation, and 7 patients failed to follow up due to the Covid-19. Finally, 19 patients were followed up for the evaluation of cardiac function after catheter ablation. Compared with pre-ablation, right ventricular structural and functional paramters(RVFAC, TAPSE, TVAD, TDI-S′, RVFLS) improved significantly at all stages of follow-up( all P<0.05). Patients with atrial fibrillation recurrence had lower RVFLS and TDI-S′ at the baseline( P=0.039, P=0.019). Conclusions:Right ventricular function could improve in HFpEF-PAF patients who maintain sinus rhythm after radiofrequency ablation.

Objective:To analyze the incidence and risk factors of non-acute symptomatic portal vein thrombosis (PVT) after endoscopic gastric variceal injection (GVI) in the treatment of liver cirrhosis with gastric variceal bleeding (GVB).Methods:66 patients with GVB who were treated with GVI for the first time from July 2017 to October 2019 in Minhang Hospital Affiliated to Fudan University were retrospectively analyzed. The data of gender, age, preoperative Child-Pugh grade, preoperative platelet count, preoperative plasma D-dimer concentration, preoperative splenic length, preoperative portal vein velocity, preoperative splenic vein velocity, preoperative portal vein diameter, preoperative splenic vein diameter, treatment times, total number of injection points, total dose of sclerosing agent and tissue adhesive agent were collected. The patients were divided into PVT group and non-PVT group according to the occurrence of non-acute symptomatic PVT within one year after GVI. Univariate analysis was performed first, and then the factors with P<0.2 were included in the binary logistic regression model to screen the risk factors of PVT after GVI. Results:There were 25 cases (37.88%) in PVT group and 41 cases (62.12%) in non-PVT group. There were significant differences in D-dimer concentration, spleen length, Child-Pugh grade and total dose of sclerosing agent between the two groups ( P<0.05). The D-dimer concentration ( OR=2.319, 95% CI:1.359-3.956), spleen length ( OR=1.044, 95% CI:1.007-1.081) and total dose of sclerosing agent ( OR=1.075, 95% CI:1.004-1.152) were independent risk factors for PVT ( P<0.05). Conclusions:Preoperative D-dimer concentration, spleen length and total dose of sclerosing agent can predict the risk of PVT after GVI. In order to reduce the risk of PVT after GVI, the dose of sclerosing agent should be reduced as much as possible.

Objective To evaluate prenatal diagnosis value of echocardiography in pathological types,differential diagnosis and accompanied malformations of fetal persistent truncus arteriosus(PTA).MethodsTwenty-four cases of PTA selected from 1 392 cases were analysed,who were definitely diagnosed to be suffered from cardiovascular malformation by fetal echocardiography.The ultrasound findings,pathological results and followed up were analysed.According to Van Praagh classification,the type IV PTA was excluded in this study which was classified into pulmonary artery atresia.Results The total PTA were 24 cases,in which 10 cases of A1 type,3 cases of A2 type,9 cases of A3 type,and 2 cases of A4 type.Nine cases of PTA accompanied other cardiac anomalies,and 1 case of PTA accompanied both cardiac anomalies and extracardial malformations.Two PTA cases were born,one was A1 type underwent surgical intervention,and the other was died due to multiple organ-failure.Fourteen PTA cases were termination and 7 cases were confirmed by pathology.Seven women pregnant again,of which 5 cases were born while only one was diagnosed atrial septal defect after birth,2 pregnant women were still during follow-up.Eight PTA cases follow-up were lost.Conclusions A1 type and A3 type of PTA have high incidence in fetus.Accompanied cardiac anomalies is certainly related to different types.Combination of multiple ultrosund techniques can diagnose PTA prenatally,make accurate classification and detect accompanying malformations,which is of great significance to offer proper pregnancy counselling and postpartum treatment.

Objective:The recent therapeutic effects and safety profile of pemetrexed plus cisplatin as first-line chemotherapy in advanced lung adenocarcinoma were evaluated. Methods:A total of 41 chemotherapy-naive locally advanced or metastatic non-small cell lung cancer patients, who were diagnosed with adenocarcinoma by pathological examination, were included. All patients received 500 mg/m2 pemetrexed on day 1. A total dose of 75 mg/m2 cisplatin was divided into three daily doses administered over 3 d. Treat-ments were repeated every three weeks. The therapeutic efficiency and safety profile were evaluated every two treatment cycles. Re-sults:All 41 patients were eligible for the evaluation of therapeutic efficiency. Seventeen patients showed partial response, 20 patients showed stable disease, and four patients showed disease progression. The overall response rate (ORR) was 41.5%and the disease con-trol rate (DCR) was 90.3%. Subgroup analysis showed that the ORR in males was significantly higher than that in females (63.1%vs. 22.7%, P=0.009). The median progression-free survival of all patients was 11.0 months, whereas the median overall survival was 12.6 months. The intracranial lesions of six patients with brain metastases were well controlled after chemotherapy and palliative whole brain radiotherapy. The ORR and DCR for these patients were 83.3%and 100.0%, respectively. In terms of safety, only 4.8%of the pa-tients showed gradesⅢandⅣneutropenia, nausea, or vomiting. Conclusion:Pemetrexed plus cisplatin is an effective and well-tolerat-ed regimen as first-line therapy for patients with lung adenocarcinoma. According to subgroup analysis, efficacy in males was signifi-cantly better than that in females. Good efficacy was observed in patients with brain metastases treated with chemotherapy and pallia-tive whole brain radiotherapy. No additional adverse effects were observed.

Treatment of gynaeeological cancer frequently results in the loss of ovarian function and menopausal syndrome.The most effective treatment is hormone replacement therapy (HRT).According to the current studies,HRT does not increase the risk of recurrence or death in patients with early stage endometrial cancer and uterine leiomyosarcomas. The safety of HRT in ovarian cancer patients is inconclusive. Cervical squamous cell carcinoma, vaginal cancer and vulvar cancer are not contraindications for HRT. Estrogen replacement therapy (ERT) is contraindicated for low-grade endometrial stromal sarcomas. Therefore,after integrated risk assessment and discussion,patients with severe menopausal symptoms can be treated with HRT to improve the quality of life.

Objective To express and purify recombinant Tp0136 epitope fragment, and study the immunity activity. Methods The Tp0136 selective fragment(Tp0136B) gene was devised by the surface property analysis, solvent-accessible suface calculateions, secondary structure function region analysis, and was inserted between the sites of Nde Ⅰ and Not Ⅰ in pET22b ( + ) . The recombinant plasmid was expressed in E. coli BI21. After nickel ion metal affinity chromatography, the antigenic and immune reactivity of rTp0136B was confirmed. Then indirect ELISA with the rTp0136B as coating antigen was performed to detect the anti-Tp0136 antibody in sera from 100 normal human controls and 131 primary syphilis patients. Results The rTp0136B was soluble expressed with a molecular weight of about 28 000 and was obtained with a purity of ＞98% by chromatography. Western blot proved that the rTp0136B could specifically react with anti-Tp0136 polyclonal antibody. Specific humoral response was elicited by the recombinant protein in Japan negative. The positive detection rate in sera from primary syphilis patients was 85.5%. Conclusion This result suggested that the recombinant Tp0136 epitope fragments have a satisfactory immunocompetence,which may have applications in the serodiagnosis of primary syphilis.