Objective     To summarize the characteristics of children diagnosed with secondary subaortic stenosis after the surgical closure for ventricular septal defect and explore its potential mechanism. Methods     We retrospectively collected patients aged from 0 to 18 years, who underwent ventricular septal defect closure and developed secondary subaortic stenosis, and subsequently received surgical repair from 2008 to 2019 in Fuwai Hospital. Their surgical details, morphological features of the subaortic stenosis, and the follow-up information were analyzed. Results     Six patients, including 2 females and 4 males, underwent the primary ventricular septal defect closure at the median age of 9 months (ranging from 1 month to 3 years). After the first surgery, patients were diagnosed with secondary subaortic stenosis after 2.9 years (ranging from 1 to 137 months). Among them, 2 patients underwent the second surgery immediately after diagnosis, and the other 4 patients waited 1.2 years (ranging from 6 to 45 months) for the second surgery. The most common type of the secondary subaortic stenosis after ventricular septal defect closure was discrete membrane, which located underneath the aortic valve and circles as a ring. In some patients, subaortic membrane grew along with the ventricular septal defect closure patch. During the median follow-up of 8.1 years (ranging from 7.3 to 8.9 years) after the sencond surgery, all patients recovered well without any recurrence of left ventricular outflow tract obstruction. Conclusion     Regular and persistent follow-up after ventricular septal defect closure combining with or without other cardiac malformation is the best way to diagnose left ventricular outflow tract obstruction in an early stage and stop the progression of aortic valve regurgitation.

Objective:To explore the correlation between the number of sentinel regional lymph node (SALN) and non-sentinel regional lymph node (NSALN) metastasis in patients with early breast cancer after sentinel regional lymph node (SALN) biopsy.Methods:Retrospectively selected 400 female patients with early breast cancer who underwent SALN biopsy at the Department of Thyroid and Breast Surgery, Yijishan Hospital of Wannan Medical College from January 2016 to July 2021, and summarized and analyzed their clinical case data. The Chi-square test or Fisher exact probability method was used to compare the count data between groups. Perform single-factor analysis on the research indicators, then screen out indicators with statistically significant differences, then perform multi-factor Logistic regression analysis, draw a receiver operating characteristic curve, and combine the area under the curve to establish a predictive model.Results:SALN biopsy was performed in 400 patients with early breast cancer. A total of 1 504 lymph nodes were detected in 320 cases of total mastectomy, with an average of 4.7, 47 cases of macrometastasis, and 2 cases of postoperative macrometastasis. The false negative rate was 4.3%. Among 400 cases, 67 cases were positive for SALN, and the positive rate was 16.75% (67/400). The results of univariate analysis showed that the number of tumor thrombus in the vessel, the number of positive SALN and the metastasis of NSALN were closely related ( χ2=8.775, 16.53, P=0.003). The results of multivariate Logistic regression analysis showed that the number of tumor thrombi and SLN-positive ≥3 in the vessel were independent predictive risk factors for NSLN metastasis ( OR=16.149, 95% CI: 3.016-86.473, P<0.001; OR=31.76, 95% CI: 5.242-192.43, P<0.001). SALN positive was closely related to NSALN metastasis, but as the number of SALN detected increases (more than 6) and when only 1 to 2 SALN was positive, the probability of NSALN metastasis was significantly reduced ( P<0.05). Conclusions:The positive number of SALN and intravascular tumor thrombolus were closely related to NALN metastasis. SALN positive number ≥3 was the most important independent predictor of NSALN metastasis. The recurrence risk of sentinel lymph node can be reduced by increasing the number of SALN detected, when 1-2 positive sentinel lymph node are detected and the number of sentinel lymph node detected >6, axillary lymph node dissection can be exempted as appropriate.

Objective    To explore the clinical effect of mitral valvuloplasty on children with Barlow disease combined with moderate to severe or severe mitral regurgitation. Methods    The clinical data of 10 patients with Barlow disease combined with moderate to severe or severe mitral regurgitation in Fuwai Hospital from January 2014 to August 2019 were analyzed retrospectively, including 3 males and 7 females, with a mean age of 8.7±7.9 years. Echocardiography before and during the operation confirmed that the mitral valve leaflets were long and swinging, the valve leaflets and the opposite edge protruded into the left atrium and were higher than the level of the mitral valve rings, the mitral valve rings were dilated, the papillary muscles and tendons were long, and the pathological changes after the operation showed mucoid degenertion of the valve leaflets and tendons, and some fibrous foci hyperplasia. Mitral valve repair included implantation of artificial valve ring, implantation of artificial tendon, posterior leaflets sliding, partial resection of posterior leaflets (excluding sliding), valve leaflets folding, tendon folding, papillary muscle splitting and annular valve contraction (excluding artificial valve ring implantation). The technique of mitral valve repair, early clinical results and follow-up echocardiographic data were analyzed. Results    All the patients successfully completed the mitral valve repair. The mean time of aortic occlusion was 73.2±17.4 min, and cardiopulmonary bypass time was 99.5±19.8 min. At the same time, 4 patients received tricuspid valve repair and 1 funnel chest correction. There was no reoperation in perioperative period. The 1-year and 5-year survival rates were 100.0% and 100.0%, respectively. The incidence of below moderate mitral regurgitation was 90.0% at postoperative 1 year and 72.0% at postoperative 5 years. Conclusion    For the young children who have Barlow disease and mitral regurgitation, considering the characteristics of heavy lesions, small operation space, and the need to meet the growth and development of valve, it is suggested to adopt the surgical techniques different from those of older children, such as valve ring retraction and tendon folding, if necessary, to adopt "edge to edge" suture, which can shorten aortic occlusion time and achieve good early effects, and its long-term effects still need further follow-up observation. Mitral valvuloplasty technique for Barlow disease similar to that of adults can be used in older children, including implantation of artificial valve ring and implantation of artificial tendon, etc.

Objective    To investigate the best anatomical classification, surgical timing, procedure and clinical outcomes of congenital vascular ring. Methods    The clinical data of 58 patients who underwent congenital vascular ring surgery in Pediatric Surgery Center, Fuwai Hospital between 2014 and 2019 were retrospectively analyzed. There were 32 (55.2%) males and 26 (44.8%) females with a median age of 16.5 (2-73) months. Preoperative symptoms, imaging examinations, anatomical classifications, surgical procedures and postoperative recovery were assessed. Results    There were 20 (34.5%) patients of double aortic arch, 22 (37.9%) patients of right aortic arch with left arterial duct or ligament, 15 (25.9%) patients of left aortic arch with aberrant right subclavian artery, and 1 (1.7%) patient of circumflex aorta with cervical aorta arch. The median ventilator supporting time was 6.0 (0-648) h, and the median hospital stay time was 14.5 (7-104) d. One patient with coarctation of aorta died of severe pulmonary infection during perioperative period, and the others survived without symptoms and reoperation after discharge. The median follow-up time was 7.0 (1-62) months. Conclusion    For children with unexplained dyspnea and dysphagia, or with right aortic arch, preoperative imaging examinations such as computed tomography or magnetic resonance imaging are required to confirm the diagnosis of vascular ring. Surgical correction of congenital vascular ring is safe and reliable, and can effectively relieve symptoms. The mortality rate and reoperation rate are low, and the follow-up results are satisfactory.

A 12-year-old girl with double outlet of right ventricle, complete atrioventricular septal defect, pulmonary valve stenosis, single atrium, inferior vena cava-hemiazygos vein drainage and left isomerism, who had undergone surgical left superior vena cava-pulmonary artery connection was referred to our hospital. Echocardiography revealed thickening, crimping and malalignment of common atrioventricular valve, moderate-to-severe regurgitation mainly from the left side and the main pulmonary artery was poorly developed. We preserved the autologous valve and used the 31# mechanical mitral valve which was sutured to mitral annulus. After the main pulmonary artery was transected, proximal end was sutured and a 20# Gore-tex artificial vessel was anastomosed to the distal end of the main pulmonary artery. We excised hepatic vein from the right atrium which was then anastomosed to another artificial vessel. Postoperative oxygen saturation was 95%-100%. Echocardiography and CT showed that the function of mechanical valve and heart was good before discharge. Common atrioventricular valvuloplasty is the preferred choice of the management of impaired valve. However, when dysfunction of valve is too severe and valvuloplasty is more likely to fail, the risk of barely performing a valvuloplasty will increase dramatically. On this condition, the mechanical valve replacement should be performed.

Objective    To summarize the experience of surgical treatment of transposition of the great arteries with intact ventricular septal (TGA-IVS) after left ventricular regression by comparing the characteristics of rapid and long-term two-stage arterial switch operation (ASO). Methods    Forty-one patients who were mainly diagnosed with TGA-IVS from January 2007 to January 2019 and underwent two-stage ASO were included. They were divided into a rapid two-stage ASO group (19 patients) and a long-term two-stage ASO group (22 patients) according to the interval of left ventricular training surgery and ASO. The clinical effectiveness of the two groups was compared. Results    There was a statistical difference in age, body weight, blood oxygen saturation before ASO, end diastolic diameter of left ventricle before training, and thickness of posterior left ventricular wall before ASO (P<0.05). Children older than 1 year was an independent risk factor for long-term two-stage ASO. Conclusion    Long-term two-stage ASO is suitable for children who are older than 1 year and who have severe left ventricular regression.

With the development of stem cell transplantation technology, anti-aging treatment or treatment of degenerative diseases through the input of stem cells has become a research hotspot. Human umbilical cord mesenchymal stem cells (HUCMSCs) are unique precursor cells which are derived from Wharton’s jelly and the perivascular tissue of umbilical cord. They have been identified to be self-renewal and multi-differentiation potential. Currently, a large number of scientific studies have shown that HUCMSCs can achieve anti-aging effects by regenerating and repairing senescent cells, tissues and organs. This article reviews the research advances in biological characteristics, tissue regeneration and repair mechanisms, and anti-aging treatment mechanisms of HUCMSCs in detail. Besides, the current status of preclinical research on HUCMSCs is summarized, suggesting that HUCMSCs is a type of stem cell therapy with good potential and value.

With the development of stem cell transplantation technology, anti-aging treatment or treatment of degenerative diseases through the input of stem cells has become a research hotspot. Human umbilical cord mesenchymal stem cells (HUCMSCs) are unique precursor cells which are derived from Wharton’s jelly and the perivascular tissue of umbilical cord. They have been identified to be self-renewal and multi-differentiation potential. Currently, a large number of scientific studies have shown that HUCMSCs can achieve anti-aging effects by regenerating and repairing senescent cells, tissues and organs. This article reviews the research advances in biological characteristics, tissue regeneration and repair mechanisms, and anti-aging treatment mechanisms of HUCMSCs in detail. Besides, the current status of preclinical research on HUCMSCs is summarized, suggesting that HUCMSCs is a type of stem cell therapy with good potential and value.

OBJECTIVE: To explore the association of workplace loneliness, job burnout and conscientiousness in teachers of special education. METHODS: A total of 344 teachers of special education from Guangxi Zhuang Autonomous Region were selected as study subjects by judgment sampling method. The questionnaires of Workplace Loneliness Scale, Maslach Burnout Inventory and Conscientiousness Scale of Big Five Inventory were used to conduct the survey. The mediating role of job burnout in workplace loneliness and conscientiousness was analyzed. RESULTS: The total score of workplace loneliness was 32.6±8.3. The median total score of job burnout and conscientiousness was 31.0 and 30.6 respectively. Partial correlation analysis showed that the dimensions of job burnout were positively correlated with the total score of workplace loneliness and all its dimension scores, and negatively correlated with conscientiousness score(P<0.01). The degree of explanation for the change of workplace loneliness and job burnout on conscientiousness were 9.0% and 17.0% respectively. CONCLUSION: Job burnout plays a partial mediating role in workplace loneliness and conscientiousness in teachers of special education. Reducing workplace loneliness and job burnout can help improve the conscientiousness of teachers of special education.

Mechanical stress plays an important role in bone growth and bone remodeling. It causes stretch stress and fluid shear stress (FSS), which can be sensed by mechanosensory cells, e.g. osteocytes and osteoblasts, and further induce changes of gene expression in those cells. The FSS is thought to be the main cause in this process. However, up to now, it is still not clear what signals are triggered in the mechanosensory cells cultured in vitro and how the FSS exactly affects the expression of specific proteins. Evidences have shown that Ca2+ signaling pathway, Cyclooxygenase-prostaglandin E2 pathway, protein kinase A/protein kinase C (PKA/PKC) pathway, and drosophila mothers against decapentaplegic (Smad) protein pathway may be the key players in osteoblast differentiation by FSS. The precise mechanism involved in mechanotransduction and signal transduction remains to be elucidated. The present review gives a brief summary on the effects of these signaling pathways on the differentiation of osteoblasts cultured in vitro under FSS, to get the message of the present situation of the research on the stress transmission and signal transduction influencing osteoblast molecular activity, and to provide reference for further study on its specific mechanism.
Animals ; Calcium Signaling ; physiology ; Cell Differentiation ; physiology ; Cells, Cultured ; Dinoprostone ; metabolism ; Humans ; Osteoblasts ; cytology ; physiology ; Prostaglandin-Endoperoxide Synthases ; metabolism ; Shear Strength ; physiology ; Signal Transduction ; physiology