Objective:To summarize the clinical treatment of complete left bundle branch block (CLBBB) after the transcatheter closure of ventricular septal defect (VSD).Methods:A case series study was conducted on the treatments and outcomes of 25 children with CLBBB after transcatheter VSD closure in Guangdong Provincial People′s Hospital from January 2010 to December 2023.Paired sample t test was used to evaluate the effect of occlude removal. Results:Among the 25 patients, 12 were males (48%), and 13 were females (52%).The age at surgery was 3.18 (2.51-3.86) years, the height before surgery was 95.0 (90.0-97.5) cm, and the weight before surgery was 13 (12-15) kg.Fourteen children were early-onset cases (≤ 1 month), while the other 11 were late-onset cases (> 1 month).The mean follow-up time was (6.63±3.93) years.Of the 14 early-onset cases, 6 children underwent occluder removal within 1 month and restored normal heart rhythm or incomplete right bundle branch block; 4 children underwent occluder removal after 1 month, of whom 2 recovered, 1 remained CLBBB, and 1 had complete atrioventricular block (CAVB); the other 4 children received drug treatment, of whom 2 had normal heart rhythm, 1 had left anterior fascicular block, and 1 died of cardiac shock and heart failure.All the 11 late-onset cases were first treated by drugs, of whom 3 recovered, and the other 8 remained CLBBB.One of the 8 cases received occluder removal at 8 months after surgery and recovered, 1 had CAVB, and the other 6 remained CLBBB.Conclusions:For patients with CLBBB after transcatheter closure of VSD, drug therapy is not always effective, and CLBBB is easy to recur.Therefore, occluder removal is recommended to be done immediately after CLBBB is discovered.Patients with persistent CLBBB should be followed up regularly, and pacemaker implantation may be performed if necessary.

Objective This study aims to explore effective ways to enhance patient experience by analyzing relevant indi-cators before and after the implementation of a new admission model at a large public tertiary hospital.Methods A retrospective analysis and a questionnaire survey were conducted to assess changes in hospital admission convenience,timeliness,and patient satisfaction before and after the implementation of the new admission model.Results After the new admission model was imple-mented,the bed occupancy rate for waiting patients significantly increased,while the waiting time decreased.The time required for completing admission procedures was notably shortened,bed utilization rates improved,and the average pre-operative hospital stay decreased.Additionally,the volume of admitted critically ill patients increased,and indicators such as the proportion of level IV surgeries and inpatient satisfaction improved.Conclusion The implementation of the new admission model has enhanced serv-ice efficiency and quality,improved patient experience,and increased patient satisfaction,making it a model worth promoting.

Purpose: Radiation-induced dermatitis (RD) is a common side-effect of therapeutic ionizing radiation that can severely affect patient quality of life. This study aimed to develop a risk prediction model for the occurrence of RD in patients with cervical carcinoma undergoing chemoradiotherapy using electronic medical records (EMRs). Methods: Using EMRs, the clinical data of patients who underwent simultaneous radiotherapy and chemotherapy at a tertiary cancer hospital between 2017 and 2022 were retrospectively collected, and the patients were divided into two groups: a training group and a validation group. A predictive model was constructed to predict the development of RD in patients who underwent concurrent radiotherapy and chemotherapy for cervical cancer. Finally, the model's efficacy was validated using a receiver operating characteristic curve. Results: The incidence of radiation dermatitis was 89.5% (560/626) in the entire cohort, 88.6% (388/438) in the training group, and 91.5% (172/188) in the experimental group. The nomogram was established based on the following factors: age, the days between the beginning and conclusion of radiotherapy, the serum albumin after chemoradiotherapy, the use of single or multiple drugs for concurrent chemotherapy, and the total dose of afterloading radiotherapy. Internal and external verification indicated that the model had good discriminatory ability. Overall, the model achieved an area under the receiver operating characteristic curve of .66. Conclusions The risk of RD in patients with cervical carcinoma undergoing chemoradiotherapy is high. A risk prediction model can be developed for RD in cervical carcinoma patients undergoing chemoradiotherapy, based on over 5 years of EMR data from a tertiary cancer hospital.

New threats posed by the emerging circulating variants of SARS-CoV-2 highlight the need to find conserved neutralizing epitopes for therapeutic antibodies and efficient vaccine design. Here, we identified a receptor-binding domain (RBD)-binding antibody, XG014, which potently neutralizes β-coronavirus lineage B (β-CoV-B), including SARS-CoV-2, its circulating variants, SARS-CoV and bat SARSr-CoV WIV1. Interestingly, antibody family members competing with XG014 binding show reduced levels of cross-reactivity and induce antibody-dependent SARS-CoV-2 spike (S) protein-mediated cell-cell fusion, suggesting a unique mode of recognition by XG014. Structural analyses reveal that XG014 recognizes a conserved epitope outside the ACE2 binding site and completely locks RBD in the non-functional "down" conformation, while its family member XG005 directly competes with ACE2 binding and position the RBD "up". Single administration of XG014 is effective in protection against and therapy of SARS-CoV-2 infection in vivo. Our findings suggest the potential to develop XG014 as pan-β-CoV-B therapeutics and the importance of the XG014 conserved antigenic epitope for designing broadly protective vaccines against β-CoV-B and newly emerging SARS-CoV-2 variants of concern.
Angiotensin-Converting Enzyme 2 ; Antibodies, Neutralizing ; Antibodies, Viral ; COVID-19 ; Epitopes ; Humans ; SARS-CoV-2/genetics* ; Spike Glycoprotein, Coronavirus/genetics*

Objective:To explore the research trends and hot spots of atrial fibrillation and cognitive impairment.Methods:Research papers and review articles related to atrial fibrillation and cognitive impairment was retrieved from the Web of Science core collection database from inception to November 17, 2021. The bibliometric and visualization analysis on the publishing times,journals and countries,related disciplines and key words was conducted with Excel and VOSviewer software.Results:A total of 1 496 articles were collected,showing a parabolic rise in the number of published articles in recent years. During this period,journal Stroke published more high quality articles in the field than others. The academic areas with the most publications were neurology, cardiovascular research, peripheral vascular disease and geriatrics. "Stroke" and "risk factors" were the keywords with the highest frequency. The research hot spots of atrial fibrillation and cognitive impairment mainly focused on anticoagulant drugs, mechanism research, epidemiology catheter ablation and status quo investigation. Conclusion:Through visualization, the development trend and research hot spots on atrial fibrillation and cognitive dysfunction are displayed intuitively, to provide reference for future studies.

Objective:To analysis the clinical features of patients with acute myocardial infarction (AMI) presenting de Winter pattern on electrocardiogram.Methods:A total of 1 287 patients with AMI admitted to Beijing Luhe Hospital between June 2017 and January 2019 were enrolled in the study. Electrocardiogram and clinical features of 13 patients with AMI presenting de Winter pattern on electrocardiogram were analyzed and compared with anterior wall ST-segment elevation myocardial infarction(STEMI, n=206). Results:Among the 13 patients, 12 were males, aged (52.23±12.55) years old. Compared to patients with anterior wall STEMI, the age in the de Winter group was younger [(52.23±12.55)years vs. (59.79±12.46)years; t=-2.12, P=0.03], and the time from onset to appearing a typical ECG was shorter [109.0 (71.5, 152.0)min vs. 200.5 (120.0, 397.5)min; Z=-3.38, P<0.01]. Three cases showed a shifting between de Winter pattern and typical STEMI ECG: the de Winter ECG pattern progressed to STEMI in 2 cases, 1 case changed from STEMI to de Winter,then converted to STEMI again. The emergency angiography was performed in all 13 patients, angiography showed that proximal left anterior descending branch (LAD) was involved in 11 cases, mid LAD was involved in 1 case, and diffuse spasm occurred in all vessels in 1 case. The de Winter ECG pattern vanished in all patients after primary percutaneous coronary intervention or emergency angiography. Conclusions:The de Winter ECG pattern suggests an acute proximal or mid LAD artery occlusion, and the de Winter ECG pattern can be alternated with STEMI. The de Winter pattern should be recognized and revascularization should be given early.

Dehydration-responsive element binding proteins (DREBs) are an important class of transcription factors related to plant stress tolerance. Ammopiptanthus mongolicus is an evergreen broadleaf shrub endemic to desert areas of northwest China, and it has a very high tolerance to harsh environments. In order to reveal the functions and mechanisms of the AmDREB1F gene from this species in enduring abiotic stresses, we performed subcellular localization test, expression pattern analysis, and stress tolerance evaluation of transgenic Arabidopsis harboring this gene. The protein encoded by AmDREB1F was localized in the nucleus. In laboratory-cultured A. mongolicus seedlings, the expression of AmDREB1F was induced significantly by cold and drought but very slightly by salt and heat stresses, and undetectable upon ABA treatment. In leaves of naturally growing shrubs in the wild, the expression levels of the AmDREB1F gene were much higher during the late autumn, winter and early spring than in other seasons. Moreover, the expression was abundant in roots and immature pods rather than other organs of the shrubs. Constitutive expression of AmDREB1F in Arabidopsis induced the expression of several DREB-regulated stress-responsive genes and improved the tolerance of transgenic lines to drought, high salinity and low temperature as well as oxidative stress. The constitutive expression also caused growth retardation of the transgenics, which could be eliminated by the application of gibberellin 3. Stress-inducible expression of AmDREB1F also enhanced the tolerance of transgenic Arabidopsis to all of the four stresses mentioned above, without affecting its growth and development. These results suggest that AmDREB1F gene may play positive regulatory roles in response to abiotic stresses through the ABA-independent signaling pathways.
Arabidopsis/metabolism* ; Droughts ; Ectopic Gene Expression ; Fabaceae/genetics* ; Gene Expression Regulation, Plant ; Plant Proteins/metabolism* ; Plants, Genetically Modified/genetics* ; Stress, Physiological/genetics*

Objective:To investigate the cause of missed diagnosis by transthoracic echocardiography (TTE) based on the characteristics of partial anomalous pulmonary venous connection (PAPVC), and to improve the ultrasonic diagnostic accuracy of PAPVC in children.Methods:The TTE results of 252 children under 12 years old who were confirmed with PAPVC at Guangdong Provincial People′s Hospital from January 2011 to June 2019 were reviewed retrospectively.The types of PAPVC and the associated atrial septal defects (ASD) as well as the confirmed and missed cases by TTE were analyzed.Results:PAPVC was right-sided in 238 patients (94.4%), left-sided in 8 patients (3.2%), and bilateral in 6 patients (2.4%). There were 177 cases (70.2%) whose pulmonary veins were abnorma-lly connected to the right atrium(RA), 37 cases (14.7%) to the junction of the RA and the superior vena cava (SVC), 27 cases (10.7%) to the distal SVC, and 6 cases (2.4%) to the inferior vena cava.Besides, pulmonary veins of 5 cases (2.0%) flew back to the RA through the coronary sinus.One hundred and ninety PAPVC cases were combined with sinus venous defects (SVD) and 53 cases combined with secondum ASD.Two hundred and twenty-one cases were accurately diagnosed while 31 cases were underestimated by TTE.The omission diagnostic rates of right superior pulmonary veins connecting to the distal SVC, 1 or 2 right pulmonary veins connecting to the RA or the junction of the RA and SVC, and left-sided PAPVC were 8 out of 18 (44.4%), 22 out of 215 (10.2%) and 1 out of 8 (12.5%), respectively.Among 54 cases with right superior pulmonary veins anomalously connected to the RA or the junction of the RA and SVC, 88.9% of them (48/54 cases) were combined with superior SVD.Among 161 cases with the right inferior pulmonary veins or 2 right pulmonary veins connected to the RA, 78.2% of them (126/161 cases) were combined with inferior SVD.There were statistically significant differences in ASD types between the 2 right-sided PAPVC groups.Conclusions:SVD is often associated with 1 or 2 right pulmonary veins connected to the RA or the junction of the RA and SVC.The cases with right superior pulmonary veins connected to the distal SVC are prone to be underestimated by TTE.Whether there is abnormal blood flowing into SVC should be noticed during superior sternal fossa examinations.Each pulmonary vein should be examined in detail in the TTE test and accurate diagnosis of PAPVC can be made in most cases.

Objective To explore the effects of hospital-community-family ternary linkage nursing model in continuing care among epileptic children. Methods From June 2017 to January 2019, we selected 260 epileptic children in First People's Hospital of Shangqiu. The total of 260 children were randomly divided into observation group and control group based on the random number table by computer, 130 cases in each group. Control group carried out routine health education, while observation group implemented the hospital-community-family ternary linkage nursing. The intervention of two groups lasted for two months. We compare the scores of the Self-Designed Family Health Knowledge Questionnaire and Quality of Life in Children with Epilepsy (QOLCE), disease control effects and nursing satisfaction between two groups before and after intervention. Results After intervention, the scores of health knowledge and QOLCE of observation group were higher than those in control group with statistical differences (P＜0.05). The disease control of observation group was better than that of control group with a statistical difference (P＜0.05). Nursing satisfaction of observation group was higher than that of control group with a statistical difference (P＜0.05). Conclusions Application of hospital-community-family ternary linkage nursing model in continuing care among epileptic children can improve health knowledge of children's parents, quality of life, disease control effects and nursing satisfaction.

Objective To explore the value of time-invariant CTA in assessing collateral circulation of patients with acute ischemic stroke and assisting clinicians in predicting clinical outcomes.Methods The score of collateral circulation was compared between single-phase and time-invariant CTA.NIHSS score was calculated at admission and two weeks after admission.A 50% or greater decrease in NIHSS score over two weeks was considered as major neurologic improvement,which showed good clinical outcome;otherwise,it indicated bad outcome.The predictive ability of time-invariant CTA for clinical outcomes was assessed based on ROC curves.Results Compared with single-phase CTA,more collateral vessels could be viewed on time-invariant CTA.The average score of collateral circulation on time-invariant and single-phase CTA was 1.50±0.69 and 1.15±0.49 respectively (P=0.006<0.05 ).Time-invariant CTA had the moderate predictive ability for clinical outcomes in patients with acute ischemic stroke (AUC=0.810;P=0.032<0.05). Conclusion The time-invariant CTA showed potential value in assessing collateral circulation of patients with acute ischemic stroke and assisting clinicians in predicting clinical outcomes.