Objective:Investigate the impact of calcification on the long-term outcomes of patients with coronary chronic total occlusion (CTO) after percutaneous coronary intervention (PCI).Methods:A retrospective cohort study was conducted. Patients who underwent PCI and had at least one CTO lesion at Fuwai Hospital between January 2010 and December 2013 were consecutively enrolled. Calcification was evaluated by coronary angiography, and patients were divided into two groups: moderate/severe calcification group and non/mild calcification group. Clinical follow-up was completed up to 5 years. Incidence of PCI-related complications and immediate procedural outcomes were compared between two groups, and the primary endpoint was the target lesion failure (TLF) at 5 years after PCI. Clinical follow-up endpoint events were analyzed using Kaplan-Meier survival analysis with log-rank test, and Cox multivariate regression model was used to evaluate the relationship between calcification and TLF.Results:The study included 2 659 CTO patients with an age of (57.2±10.5) years, of whom 442 (16.6%) were female, and among whom 13.5% (360/2 659) had moderate/severe calcification. Compared with the non/mild calcification group, the moderate/severe calcification group had a higher incidence of PCI-related complications (43.2% (156/361) vs. 32.5% (772/2 374), P<0.001) and procedural failure (34.3% (124/361) vs. 24.3% (577/2 374), P<0.001). Additionally, the moderate/severe calcification group showed a higher risk of the primary endpoint event (TLF) during the 5-year follow-up (19.8% vs. 15.3%, log-rank P=0.028). Higher incidence of cardiac death was observed in moderate/severe calcification group (5.7% vs. 2.7%, log-rank P=0.003). Cox multivariate regression analysis revealed that moderate/severe calcified plaques remained an independent risk factor for 5-year TLF after CTO-PCI ( HR=1.34, 95% CI: 1.01-1.79, P=0.043). Conclusion:Compared with CTO patients with non/mild calcification, those with moderate/severe calcification have higher procedural failure and complication rates, as well as poorer long-term prognosis, mainly due to an increase in cardiac death.

Objective:Investigate the impact of calcification on the long-term outcomes of patients with coronary chronic total occlusion (CTO) after percutaneous coronary intervention (PCI).Methods:A retrospective cohort study was conducted. Patients who underwent PCI and had at least one CTO lesion at Fuwai Hospital between January 2010 and December 2013 were consecutively enrolled. Calcification was evaluated by coronary angiography, and patients were divided into two groups: moderate/severe calcification group and non/mild calcification group. Clinical follow-up was completed up to 5 years. Incidence of PCI-related complications and immediate procedural outcomes were compared between two groups, and the primary endpoint was the target lesion failure (TLF) at 5 years after PCI. Clinical follow-up endpoint events were analyzed using Kaplan-Meier survival analysis with log-rank test, and Cox multivariate regression model was used to evaluate the relationship between calcification and TLF.Results:The study included 2 659 CTO patients with an age of (57.2±10.5) years, of whom 442 (16.6%) were female, and among whom 13.5% (360/2 659) had moderate/severe calcification. Compared with the non/mild calcification group, the moderate/severe calcification group had a higher incidence of PCI-related complications (43.2% (156/361) vs. 32.5% (772/2 374), P<0.001) and procedural failure (34.3% (124/361) vs. 24.3% (577/2 374), P<0.001). Additionally, the moderate/severe calcification group showed a higher risk of the primary endpoint event (TLF) during the 5-year follow-up (19.8% vs. 15.3%, log-rank P=0.028). Higher incidence of cardiac death was observed in moderate/severe calcification group (5.7% vs. 2.7%, log-rank P=0.003). Cox multivariate regression analysis revealed that moderate/severe calcified plaques remained an independent risk factor for 5-year TLF after CTO-PCI ( HR=1.34, 95% CI: 1.01-1.79, P=0.043). Conclusion:Compared with CTO patients with non/mild calcification, those with moderate/severe calcification have higher procedural failure and complication rates, as well as poorer long-term prognosis, mainly due to an increase in cardiac death.

Objective To analyze the epidemic characteristics of influenza in children in Jinshan District of Shanghai，so as to provide scientific basis for prevention and control of influenza in children. Methods We analyzed the surveillance data as well as the results of virus isolation and identification in children with influenza-like illness （ILI） in Jinshan District of Shanghai from January 2010 to December 2019. Results There were two annual epidemic peaks in 2010， 2016， 2017 and 2018， one annual epidemic peak in winter and spring in 2011 and 2013， and two annual epidemic peaks in 2012， 2014， 2015 and 2019. A total of 3 859 ILI cases were collected in the past 10 years， and 848 positive virus strains were isolated， with a positive rate of 21.97%. Among them， 371 were seasonal H3N2， 163 were new H1N1， 314 were type B（among them， 226 were yamagata and 88 were victoria）. The positive rates of influenza virus in different children groups were 0.88% in scattered children， 6.76% in kindergarten children， and 14.33% in students， respectively （P= 0.001）. Conclusion From January 2010 to December 2019， seasonal H3N2 was the predominant virus strain in children influenza epidemic in Jinshan District of Shanghai. The influenza epidemic shows a strong seasonal feature with double peaks in winter/spring， summer or autumn. The positive rate of influenza virus in middle school students is the highest in different age groups， followed by kindergarten children.

Objective To investigate the prevalence and epidemiological characteristics of enuresis in children aged 5-13 years old in Jinshan District, Shanghai, and analyze the relevant pathogenic factors, so as to provide a reference for clinical prevention and treatment of enuresis in children and related psychological diseases. Methods Using the medical history collection table (CMT checklist) of ICCS (International Association for Urinary Control of Children) as a guidance, a random cluster sampling was performed on 1 000 preschool and school-age children from 9 representative schools with a relatively concentrated population in Jinshan District. Results Excluding the missing and invalid questionnaires, a total of 785 cases were included in the study, and the total prevalence of enulists in 5-13 children was 7.77% (61 cases), among which 42 cases were 5-7 years old (68.85%), 12 cases were 8-10 years old (19.67%), and 7 cases were 11-13 years old (11.48%). There were statistically significant differences among the age groups (χ²=52.87，P=0.001)). Among the affected children, 3.31% (26 cases) were in urban areas and 4.46% (35 cases) in rural areas (P<0.05). The prevalence of boys (38 cases) and the prevalence of girls (23 cases) were statistically significant (P<0.05). The characteristics of enuresis, organic diseases, and attention were analyzed in 61 children diagnosed with enuresis. Children with enuresis ≥7 times/week were the highest (33 cases), accounting for 54.10%; children with 3-6times/week (19 cases) accounted for 31.15%; 2 times/week (9 cases) accounted for 14.75%. Physical examination abnormalities (including urinary routine abnormalities: urinary tract infection, hematuria, high urinary calcium or phimosis) were found in 18 cases, accounting for 29.51%. Four patients (6.56%) had a family history of enuresis. Fifty-two (85.25%) of the affected children had psychologically related problems: introverted personality, impulsiveness, inferiority, lack of concentration, medium or inferior academic performance. Conclusion The prevalence of enuresis in 5-13 children was 7.77%. There were significant differences between urban and rural areas, different age groups and genders as well. Most sick children developed organic diseases and some degree of psychological problems. A timely diagnosis and treatment of enuresis in children in combination with psychological guidance and behavioral intervention is necessary for the prevention of the occurrence of enuresis related psychological problems.

Objective:To compare the efficacy and safety of ultrasound-guided percutaneous translumial septal myocardial ablation in dogs using laser and radiofrequency.Methods:Twelve healthy adult Beagle dogs (males or females) were randomly divided into two groups, namely, group laser and group radiofrequency (6 dogs each group). Under ultrasound guidance, laser fiber or radiofrequency ablation needle was respectively inserted into the basal and middle segments of the interventricular septa via the percutaneous transapical approach to perform ablation. The Beagle dogs received radiologic examination, laboratory tests and pathological detection before ablation, immediately after ablation, at 1 week after ablation, and at 1 month after ablation, respectively. The efficacy and safety of the two ablation procedures were compared.Results:All dogs survived after ablation. The peak gradient of LVOT decreased immediately after ablation using either laser or radiofrequency ( P<0.05), but it increased at 1 week after ablation than before ( P<0.05). At 1 month after ablation, no significant differences were found in the peak gradient of LVOT compared with that before surgery ( P<0.05). The interventricular septum thickness was increased immediately after ablation using either laser or radiofrequency than before ( P<0.05), but it decreased at 1 week and at 1 month after surgery than before ( P<0.05). The ablation zone using radiofrequency was slightly larger than that of using laser[(372.50±69.06)mm 3 vs (116.65±20.15)mm 3, P<0.001], and the surgical time of the former was significantly shorter than that of using laser [(56.00±3.22)s vs (260.00±65.39)s, P<0.05)]. Conclusions:Ultrasound-guided percutaneous translumial septal myocardial ablation is feasible, safe and effective using either laser or radiofrequency. Comparatively speaking, radiofrequency ablation is more simple and convenient.

Objective:To prepare ultrasound-responsive nanodroplets with block polymer PEG-PCL as shell and perfluoropentane (PFP) as core, and study the effects of mechanical index (MI) on contrast-enhanced imaging properties of nanodroplet.Methods:PEG-PCL micelles were first prepared by dialysis, and then the micelles were mixed with PFP for emulsification to obtain nanodroplets. The particle size and zeta potential of nanodroplets were measured, and the morphology of nanodroplets were observed using transmission electron microscope (TEM). The stability of nanodroplets after storage at 25 ℃ and 37 ℃ was investigated. The phase transition and contrast-enhanced imaging of nanodroplets in vitro under a series of mechanical index (MI) were studied using an ultrasound diagnostic instrument.Results:The particle size of the nanodroplets was (356.6±5.6)nm, and the zeta potential was -(7.30±0.14)mV. The nanodroplets were close to spherical under TEM and had a clear core-shell structure. The particle size and dispersion of the nanodroplets increased after storage at 37 ℃ and 25 ℃. For imaging in vitro, no acoustic signal were observed at 25 ℃ when the MI varied from 0.08 to 1.0. At 37 ℃, acoustic signals were observed when MI≥0.4, and the intensity was stronger for higher MIs.Conclusions:The contrast-enhanced imaging of nanodroplets are closely related to the MI, and a higher MI could induce the phase transition of more nanodroplets and produce stronger contrast enhancement. This study could provide basis for the application of polymeric nanodroplets in ultrasound diagnosis and targeted therapy.

Objective: To evaluate the prognostic value of the thrombolysis in myocardial infarction (TIMI) and global registry of acute coronary events (GRACE) risk scores for in-hospital mortality in Chinese non-ST-segment elevation myocardial infarction (NSTEMI) patients. Methods: Data of present study derived from the prospective, multi-center registry trial of Chinese AMI (CAMI). Among 31 provinces, municipalities or autonomous districts in China, at least one tertiary and secondary hospital was selected. From January 2013 to September 2014, 5 896 consecutive non-ST-segment elevation myocardial infarction patients who were admitted to 107 hospitals within 7 days of symptom onset were enrolled. For each patient, TIMI and GRACE risk scores were calculated using specific variables collected at admission. Their prognostic value was evaluated by the endpoint of in-hospital mortality. Results: Among 5 896 NSTEMI patients (age was (65.4±12.1) years old), 68.2% (n=4 020) were males. The in-hospital mortality was 6.0% (n=353) and the median length of hospital stay was 10.0 (7.0, 13.0) days. The incidence of pre-hospital cardiac arrest was 3.6% (n=213) among 5 896 NSTEMI patients. Six hundreds and forty five patients (10.9%) received primary percutaneous coronary intervention, and 6 patients underwent emergent coronary artery bypass grafting surgery (0.1%), and the median time of reperfusion was 529.5 (256.0, 1 065.0) minutes. The prescription percentage of statins, β-blocker, angiotensin converting enzyme inhibitors or angiotensin Ⅱ receptor blockers, and aldosterone antagonists were 94.8% (n=5 587), 71.7% (n=4 228), 65.5% (n=3 864) and 26.0% (n=1 533) respectively. The area under the curve of GRACE risk score for in-hospital mortality (0.7930 (95%CI 0.767-0.818)) was better than that of TIMI risk score (0.5588 (95%CI 0.532-0.586), P<0.001). Conclusion GRACE risk score demonstrates better predictive accuracy than TIMI risk score for in-hospital mortality in NSTEMI patients in this patient cohort.

Objective: To compare predictive value of the current 7 scoring systems and CADILLAC-plus scoring system for risk of short-term deathin patients with acute myocardial infarction complicating cardiogenic shock. Methods: A total of 126 acute myocardial infarction patients complicating cardiogenic shock hospitalized in Fuwai hospital from June 2014 to January 2018 were enrolled in this study, the clinical data were retrospectively analyzed. The patients were divided into survival group(49 cases) and death group(77 cases) according to survival or not at 28 days after diagnosis of cardiogenic shock.The scores of APACHE Ⅱ,APACHE Ⅲ,SAPS Ⅱ,PAMI, TIMI-STEMI,TIMI-NSTEMI,and CADILLAC were calculated within 24 hours in coronary care unit (CCU),and scores of CADILLAC-plus, which is an improved score derived from CADILLAC, was also calculated. The predictive value of the different scoring systems for 28 day smortality of acute myocardial infarction patients complicating cardiogenic shock were compared in this patient cohort. Results: Scores of APACHEⅡ,APACHEⅢ,SAPSⅡ,PAMI,TIMI-STEMI, TIMI-NSTEMI,CADILLAC,and CADILLAC-plus were all significantly higher in death group than in survival group: (28.9±10.2 vs. 21.8±8.3,94.0 (57.0,114.0) vs. 57.0 (45.4,81.5) ,62.0 (46.0,81.0) vs. 47.0 (41.5,60.5) ,7.0 (6.0,9.0) vs. 6.0 (6.0,7.5) ,10.0 (9.0,11.0) vs. 9.0 (8.0,10.0) ,4.0 (3.0,5.0) vs. 3.0 (3.0,4.0) ,10.0 (7.0,12.0) vs. 7.0 (5.0,9.0) ,and 10.0 (8.0,14.0) vs. 7.0 (5.0,10.0) , respectively, all P<0.01).The area under the curve(AUC) of receiver operating characteristic(ROC) curve for predicting 28 days death of APACHE Ⅱ,APACHE Ⅲ,SAPS Ⅱ,PAMI, TIMI-STEMI,TIMI-NSTEMI,and CADILLAC scoring systems were 0.820,0.797,0.785,0.667,0.657,0.711,and 0.821,respectively and cut-off value was 27.5,79.5,66.0,8.5,10.5,3.5,and 8.5, respectively and the sensitivity was 0.766,0.844,0.649,0.494,0.494,0.740,and 0.753, respectively and specificity was 0.816,0.755,0.837,0.204,0.796,0.571,and 0.755,respectively.The AUC of ROC of CADILLAC-plus scoring system was 0.885,cut-off value was 9.5, sensitivity was 0.896,and specificity was 0.735. The predicting efficacy of CADILLAC-plus scoring system was superior to other scoring systems. Conclusion The 7 current scoring systems are all suitable for predicting theshort-term death in acute myocardial infarction patients complicating cardiogenic shock, and the predicting efficacy of the improved CADILLAC-plus score is superior to other scoring systems in this patient cohort.

Objective: To investigate the impact of aortic root morphology on the implantation depth of aortic valve prosthesis during trans-catheter aortic valve replacement (TAVR) in bicuspid aortic valve patients. Methods: Clinical data of 40 patients with native bicuspid aortic valve stenosis who underwent TAVR using the self-expandable prosthesis (the Venus A-valve) from 2014 to 2017 in Fuwai Hospital was retrospectively analyzed. The patients were divided into non-deep implantation group (implant depth ≤10 mm by instant angiogram after implantation,29 cases) and deep implantation group (implant depth> 10 mm by instant angiogram after implantation,11 cases).Pre-procedural aortic root characteristics (e.g. calcification, angle and dimensions) were assessed by CT. The impact of aortic root morphology on the implantation depth and clinical outcomes were also evaluated. Results: The age was (75.1±5.9) years with equal representation from the raphe-type and non-raphe type (52.5%(21/40) and 47.5%(19/40)).The bigger aorta angle ((56.5±4.5)° vs. (47.4±9.4)°, P=0.004),more frequent mild-calcification (HU850, <200 mm³) or severe-calcification(HU850, >1 000 mm³) of aortic leaflets (7/11 vs. 4/29, P=0.006), as well as higher ratio of left ventricular outflow tract perimeter to annulus perimeter ((109.2±7.5)% vs. (101.5±6.5)%, P=0.004) were found in the deep implantation group compared to the non-deep implantation group. The new in-hospital onset of bundle-branchheart-block or atrioventricular block conduction disturbance rate was higher in the deep implantation group than in the non-deep implantation group (6/11 vs. 2/29, P=0.030).Left ventricular ejection fraction was similar between deep implantation group and non-deep implantation group at baseline((49.9±8.9)% vs. (55.8±10.4)%, P=0.117), and was significantly lower in the deep implantation group than in the non-deep implantation group at 30 days after implantation ((51.6±12.8)% vs. (60.9±8.1)%, P=0.020). Conclusion Aortic root morphology of bicuspid aortic valve patients is associated with implantation depth of the prosthesis during TAVR, which affects the conduction system and left ventricular function during and post TAVR.

Objective: To investigate the current status of application of intra-aortic balloon pump(IABP) and analyze the factors which might impact the application of IABP in patients with acute myocardial infarction complicated with cardiac shock in China. Methods: In China Acute Myocardial Infarction (CAMI) Registry,a nationwide, multicenter(107 hospitals), prospective study, 26 592 patients with acute myocardial infarction were enrolled consecutively between January 1, 2013 and September 30, 2014. After excluding of 30 cases due to missing important data,26 562 cases were analyzed.The application status of IABP was analyzed and multivariate logistic regression analysis was performed to determine the factors related to IABP application. Results: A total of 785(3.0%) patients with acute myocardial infarction received IABP implantation, and 381(49.9%) patients belonged to preventive application of IABP before primary percutaneous coronary intervention,and 6(0.8%) patients were complicated with mechanical complications.There were 118(15.0%) patients with cardiac shock received IABP implantation, which accounted for 12.0%(118/984) of all patients with cardiac shock.Multivariate logistic regression analysis showed that the clinical independent factors of the decision of IABP insertion included dyslipidemia (OR=2.858, 95%CI 1.397-5.846, P=0.004),left ventricular ejection fraction (OR=0.977, 95%CI 0.961-0.994, P=0.009),usage of dopamine (OR=2.817, 95%CI 1.495-5.308, P=0.001), left main disease (OR=2.817, 95%CI 1.495-5.308, P=0.001), GRACE score (OR=1.006, 95%CI 1.000-1.011, P=0.034), receiving primary percutaneous coronary intervention (OR=4.508, 95%CI 1.673-12.146, P=0.003), teritiary hospitals (OR=2.562, 95%CI 1.498-4.384, P=0.001), and higher education of the patients (OR=2.183, 95%CI 1.056-4.509, P=0.016). Conclusions Among the Chinese acute myocardial infarction patients who received IABP implantation, nearly half application of IABP are preventive implantation before primary percutaneous coronary intervention. Only a few patients complicated with cardiac shock received IABP insertion. The clinical conditions, grade of hospitals, degree of education impact the decision of IABP insertion for the patients with acute myocardial infarction. Clinical Trial Registry National Institutes of Health, NCT018746.