Objective To analyze the outcomes of catheter ablation for persistent atrial fibrillation(AF)and the independent risk factors for its recurrence in the elderly.Methods A total of 194 patients with persistent AF who underwent catheter ablation at our department from January 2019 to December 2021 were enrolled in this study.They were divided into elderly group(≥60 years old,99 cases)and non-elderly group(＜60 years old,95 cases).Their surgical characteris-tics,postoperative complications and recurrence were compared between the two groups,and the independent risk factors for postoperative recurrence were analyzed in the elderly group.Results Advanced age,higher B-type natriuretic peptide,larger proportions of hypertension and coronary heart disease,and increased CHA2DS2-VASc and HAS-BLED scores,while lower male ratio and estimated glomerular filtration rate were observed in the elderly group than the non-elderly group(P＜0.05,P＜0.01).The elderly group had a higher proportion of left atrial fibrosis than the non-elderly group(30.3％vs 8.4％,P=0.001).Postoperative complications in the elderly group in-cluded 1 case of pericardial effusion and 2 cases of hematoma at the puncture site,and all of these were improved after treatment.There were no significant differences in the 1-year success rate(71.7％vs 69.5％,P=0.763)or recurrence rate during blanking period(21.2％vs 21.1％,P=0.981)between the elderly and non-elderly groups.AF duration(HR=1.020,95％CI:1.007-1.032,P=0.002)and recurrence during blanking period(HR=6.781,95％CI:3.078-14.935,P=0.001)were independent risk factors for postoperative recurrence in the elderly group.Conclu-sion Catheter ablation is safe and effective in the treatment of persistent AF in the elderly.The elderly patients with long duration of AF and recurrences during blanking period are more likely to experience recurrences within 1 year after ablation.

Objective To develop an intelligent model for differential diagnosis of atrioventricular nodal re-entrant tachycardia(AVNRT)and atrioventricular re-entrant tachycardia(AVRT)using 12-lead wearable electrocardiogram devices.Methods A total of 356 samples of 12-lead supraventricular tachycardia(SVT)electrocardiograms recorded by wearable devices were randomly divided into training and validation sets using 5-fold cross validation to establish the intelligent classification model,and 101 patients with the diagnosis of SVT undergoing electrophysiological studies and radiofrequency ablation from October,2021 to March,2023 were selected as the testing set.The changes in electrocardiogram parameters before and during induced tachycardia were compared.Based on multiscale deep neural network,an intelligent diagnosis model for classifying SVT mechanisms was constructed and validated.The 3-lead electrocardiogram signals from Ⅱ,Ⅲ,and V1 were extracted to build new classification models,whose diagnostic efficacy was compared with that of the 12-lead model.Results Of the 101 patients with SVT in the testing set,68 were diagnosed with AVNRT and 33 were diagnosed with AVRT by electrophysiological study.The pre-trained model achieved a high area under the precision-recall curve(0.9492)and F1 score(0.8195)for identifying AVNRT in the validation set.The total F1 scores of the lead Ⅱ,Ⅲ,V1,3-lead and 12-lead intelligent diagnostic models in the testing set were 0.5597,0.6061,0.3419,0.6003 and 0.6136,respectively.Compared with the 12-lead classification model,the lead-Ⅲ model had a net reclassification index improvement of-0.029(P=0.878)and an integrated discrimination index improvement of-0.005(P=0.965).Conclusion The intelligent diagnostic model based on multiscale deep neural network using wearable electrocardiogram devices has an acceptable accuracy for classifying SVT mechanisms.

Objective To develop an intelligent model for differential diagnosis of atrioventricular nodal re-entrant tachycardia(AVNRT)and atrioventricular re-entrant tachycardia(AVRT)using 12-lead wearable electrocardiogram devices.Methods A total of 356 samples of 12-lead supraventricular tachycardia(SVT)electrocardiograms recorded by wearable devices were randomly divided into training and validation sets using 5-fold cross validation to establish the intelligent classification model,and 101 patients with the diagnosis of SVT undergoing electrophysiological studies and radiofrequency ablation from October,2021 to March,2023 were selected as the testing set.The changes in electrocardiogram parameters before and during induced tachycardia were compared.Based on multiscale deep neural network,an intelligent diagnosis model for classifying SVT mechanisms was constructed and validated.The 3-lead electrocardiogram signals from Ⅱ,Ⅲ,and V1 were extracted to build new classification models,whose diagnostic efficacy was compared with that of the 12-lead model.Results Of the 101 patients with SVT in the testing set,68 were diagnosed with AVNRT and 33 were diagnosed with AVRT by electrophysiological study.The pre-trained model achieved a high area under the precision-recall curve(0.9492)and F1 score(0.8195)for identifying AVNRT in the validation set.The total F1 scores of the lead Ⅱ,Ⅲ,V1,3-lead and 12-lead intelligent diagnostic models in the testing set were 0.5597,0.6061,0.3419,0.6003 and 0.6136,respectively.Compared with the 12-lead classification model,the lead-Ⅲ model had a net reclassification index improvement of-0.029(P=0.878)and an integrated discrimination index improvement of-0.005(P=0.965).Conclusion The intelligent diagnostic model based on multiscale deep neural network using wearable electrocardiogram devices has an acceptable accuracy for classifying SVT mechanisms.

Adenoid cystic carcinoma usually occurs in the salivary glands of the head and neck. It is a malignant tumor with a high degree of malignancy, resistance to radiotherapy and chemotherapy and poor prognosis. The clinical course of adenoid cystic carcinoma is slow and easy to be misdiagnosed. The main diagnosis and treatment means are individualized and precise treatment under the multi-disciplinary consultation mode, that is, surgical treatment and radiotherapy and chemotherapy. Adenoid cystic carcinoma is prone to relapse and hematologic metastasis, and the traditional radiotherapy and chemotherapy based therapies have not achieved satisfactory efficacy in the past three decades. How to detect, diagnose and treat early is an urgent task faced by clinicians.
Humans ; Carcinoma, Adenoid Cystic/pathology* ; Neoplasm Recurrence, Local ; Neck/pathology* ; Oropharynx/pathology* ; Diagnostic Errors

Objective:To evaluate the efficacy of 1-year subcutaneous immunotherapy (SCIT) with dust mites in polysensitized allergic rhinitis (AR) patients and to analyze the serological markers associated with clinical response.Methods:A retrospective analysis of data from 69 polysensitized AR patients who completed 1-year SCIT with dust mites from Oct 2020 to Mar 2022 in Shandong Provincial ENT Hospital was conducted. The median patient age was 21 years, including 41 males and 28 females. The changes in symptoms and serum IgE, IgG4 assessed before and after treatment were evaluated. The differences in serological markers between effective and ineffective groups were analyzed. Multivariate regression analysis was used to investigate the predictors of clinical response. SPSS 22.0 software was used for data processing.Results:After immunotherapy, there was a significant reduction in symptom scores and a substantial improvement in the quality of life of polysensitized AR patients (all P<0.001). Dust mite specific IgG4 (sIgG4) significantly increased and dust mite specific IgE (sIgE)/sIgG4 significantly decreased (all P<0.05). sIgE, total IgE (tIgE), sIgE/tIgE and sIgE/sIgG4 were significantly lower in ineffective group than those in effective group (all P<0.05). The clinical response of SCIT related only to dust mite sIgE ( r=0.29, P=0.036), and sIgE≥53.86 kU/L had the best sensitivity (77.78%) and specificity (57.89%) to predict effective SCIT in polysensitized AR patients. Conclusions:One-year dust mite SCIT is effective for polysensitized AR patients. Pre-treatment serum dust mite sIgE≥53.86 kU/L may play a role in predicting clinical response of dust mite SCIT in polysensitized AR patients.

Objective:To explore the prognostic value of lymphocyte subsets in adult hemophagocytic syndrome (HPS).Methods:A total of 172 adult HPS patients diagnosed in 8 medical centers from January 2013 to August 2020 were selected for the study, of whom 87 were male (50.6%, 87/172), and 85 were female (49.4%, 85/172), with 68 survivors and 104 deaths. The clinical data were summarized, and variables such as lymphocyte subsets, immunoglobulin characteristics and fibrinogen were retrospectively analyzed, and the correlation between the mentioned variables and patient prognosis was analyzed. The optimal cut-off values of continuous variables were calculated by MaxStat, and the prognostic factors of HPS patients were screened based on the Cox proportional hazard regression model.Results:The median age of HPS patients was 56 (42, 66) years old, and the 5-year cumulative survival rate was 37.4% (37.4/100). The median age, platelet and albumin were 48 (27, 63) years, 84×10 9/L and 32.3 g/L in the survival group, and 59 years, 45.5×10 9/L, and 27.3 g/L in the death group, respectively. The differences between the two groups was statistically significant ( Z=?3.368, P=0.001; Z=?3.156, P=0.002; Z=?3.431, P=0.001). Patients with differentiated cluster 8+(CD8+)<11.1%, CD3+<64.9%, CD4+>51%, and CD4/CD8 ratio>2.18 had poor prognosis (χ 2=7.498, P=0.023; χ 2=4.169, P=0.041; χ 2=4.316, P=0.038; χ 2=9.372, P=0.002). Multivariable analysis showed that CD4/CD8 ratio, age, fibrinogen and hemoglobin were independent prognostic factors in HPS patients ( HR=2.435, P=0.027; HR=5.790, P<0.001; HR=0.432, P=0.018; HR=0.427, P=0.018). Conclusion:Peripheral blood lymphocyte subsets can be used to evaluate the prognosis of patients with HPS; CD4/CD8 ratio, age, fibrinogen, and hemoglobin are independent prognostic factors in HPS patients.

Objective To explore the role of electrocardiogram (ECG) in predicting cardiac resynchronization therapy (CRT) response.Methods This study retrospectively analyzed ECG of 92 CRT patients,who received CRT therapy from 2001 to 2013 in our center and were followed up for 6 months.The patients were divided into responder group (n =64) and non-responder group (n =28).The baseline and 6-month data including QRS width,heart rhythm and axis variation were analyzed.The definition of responder is left ventricular end systolic volume (LVESV) reduction ≥ 15％ within 6 months after CRT.After CRT therapy,the ventricular activation was changed as left to right (frontal plane),posterior to anterior and axis changed in a clockwise direction.The change in more than two directions was defined as prominent axis change.Logistic analysis was performed to analyze the role of ECG in predicting CRT response.Results (1) Baseline parameter comparison between the two groups:the proportion of female and LBBB is significantly higher (P ＜ 0.01;P =0.04),while the proportion of atrial fibrillation/flutter (Af/AF) is significantly lower (P ＜ 0.01) in responder group than in non-responder group.The pre-CRT average QRS duration is much wider in responder group than in non-responder group (P =0.01).(2) Comparison of follow-up with baseline results in two groups:NYHA heart function level,6 minutes walking distance,QRS duration,LVEF,LVESV improved significantly (P ＜0.01) post-CRT in responder group.In non-responder group,the QRS duration and LVESV deteriorated significantly (P =0.02,P ＜ 0.01),while post-CRT NYHA heart function level improved significantly.In responder group,pre-CRT ECG axis of 53 patients (82.8％) pointed to left and 58 patients (90.6％) pointed to posterior;post-CRT ECG axis of 49 patients (76.6％) pointed to right and 30 patients (40.6％) pointed to anterior.In non-responder group,pre-CRT ECG axis of 25 patients (89.3％) pointed to left and 24 patients (85.7％) pointed to posterior;post-CRT ECG axis of 17 patients (60.7％) pointed to right and 12 patients (42.9％) pointed to anterior.Post-CRT,the proportion of ECG axis prominent change was significantly higher in responder than in non-responder group (62.5％ (40/64) vs.32.1％ (9/28),P =0.007).(3) Predicting value:pre-CRT QRS width ≥140 ms (OR =4.97,95 ％ CI 1.53 to 16.13,P =0.008) and post-CRT prominent axis change (OR =5.1,95 ％CI 1.67 to 15.5,P =0.004) were found to be independent predictors of CRT responders.Af/AF pre-CRT was associated with reduced CRT response (OR =0.25,95 ％ CI0.08 to 0.80,P =0.02).Conclusions ECG may play a role in predicting CRT response.QRS width and Af/AF before CRT and ECG axis change post-CRT could be used to predict CRT response.

Objective To investigate the impact of cardiac resynchronization therapy (CRT) on left ventricular systolic function evaluated by velocity vector imaging (VVI) in refractory heart failure patients and the predictive value of VVI on CRT responses.Methods This study included 38 patients with medically refractory heart failure (HF) patients underwent CRT in our department from May 2007 to April 2011.Left ventricular long axis dyssynchrony indexes including time to peak of systolic velocity (Ts max-min),standard deviation of the time to peak of systolic velocity (Ts-SD) before and at 3-6 months post CRT.CRT response was defined as 15％ decrease in left ventricular end-systolic volume.ROC curve and the area under the curve (AUC) were calculated.Results Twenty-four patients were defined as responder.No significant difference was observed between responders and non-responders in medical therapy.When using Ts max-min to predict response,the AUC of ROC curves was 0.76 ± 0.07.The sensitivity and specifity was 70.8％ and 77.8％ respectively with Ts max-min≥124.0 ms.When using Ts-SD to predict response,the AUC of ROC curves was 0.82 ±0.07.The sensitivity and specifity was 79.2％ and 71.2％ respectively with Ts-SD≥40.5.Conclusion Ts-SD is a useful index to predict CRT response in refractory HF patients.

AIM: To determine the effect of exogenous phosphocreatine (PCr) at different concentrations on transient outward potassium (Ito) current in rat ischemic ventricular mid-myocardial (M) cells and to explore the antiarrhythmia mechanism in the treatment of ischemic heart disease. METHODS: M cells were isolated enzymatically from left ventricular mid-myocardium of rats. Peak Ito current was recorded by patch-clamp technique in the whole-cell configuration when M cells were superfused with normal Tyrode solution,simple ischemic solution,and simulated ischemic solution containing PCr at concentrations of 5,10,20 and 30 mmol/L for 10 min. RESULTS: Peak Ito current density of M cells superfused with simple simulated ischemic solution was significantly reduced by (76.1±6.3)% (P<0.05) compared with M cells superfused with Tyrode solution. Ischemic solution containing 5,10,20 and 30 mmol/L PCr reduced peak Ito current density by (57.1±9.6)% (P<0.05),(40.3±10.3)% (P<0.05),(34.3±9.6)% (P<0.05) and (32.1±10.6)% (P<0.05),respectively. There was statistical difference among ischemic solution without PCr and containing PCr at concentrations of 5 and 10 mmol/L groups (P<0.05). No statistical difference among groups of 10,20 and 30 mmol/L PCr was observed (P>0.05). CONCLUSION: PCr reverses the inhibition of Ito current under ischemic condition in M cells,which may be the mechanism responsible for arrhythmia prevention in ischemic heart disease. PCr at concentrations of 0～10 mmol/L exerts significant dose-effect relationship.

BACKGROUND: The occurrence and severity of acute high-altitude disease(AHAD) are determined by the speed entering the highland, the altitude of highland and seasons. The association between obesity and AHAD has not been fully investigated.OBJECTIVE: To investigate the association between obesity and acute high-altitude in people exposed rapidly to the highland.DESIGN: Comparative observation.SETTING: Department of Cardiology, General Hospital of Chinese PLA and Department of Cardiology, Tibetan General Hospital of Chinese PLA.PARTICIPANTS: The experiment was conducted at the Department of Cardiology, General Hospital of Tibetan Military Area Command of Chinese PLA in August 2006. Totally 82 Henan subjects aged 28-45 years were selected from the male workers constructing the Qinghai-Tibet Railway and their managers with acute high-altitude exposure. They had never been to the highland before, and all agreed to the detection.METHODS: ①Every subject completed the AHAD self-report questionnaire at sea level and 12 hours and 24 hours after ascending high-altitude. The items in the questionnaire included symptoms of headache, gastrointestinal symptoms,fatigue or weakness, dizziness, and insomnia. Each symptom was graded from 0-3 with 0 as no symptoms, 1 as mild symptoms, 2 as moderate symptoms, and 3 as severe symptoms and a total score of 15. A score of 4 or more could by identified as AHAD. ②The height and body mass were measured to calculate the body mass (BMI). Those with BMI≥28 kg/m2 served as the obesity group [n =39, mean age (35±8) years], and those with BMI of 18.5-23.9 kg/m2 as the normal body mass group [n =43, mean age (35±8) years]. ③Arterial blood was taken to evaluate arterial oxygen saturation (SO2), arterial oxygen pressure (PaO2) and arterial carbon dioxide pressure (PaCO2) at baseline and 24 hours after ascending high-altitude. ④The measurement data was compared by t test.MAIN OUTCOME MEASURES: BMI, vital capacity of lungs, SO2, PaO2 and PaCO2 levels of obese and normal people.RESULTS: Totally 39 obese people and 43 normal people were involved in the result analysis. ①AHAD score: No symptom was reported at sea level in all participants (scored 0), but the AHAD scores in the obesity group were significantly higher than those in normal group 12-hour and 24-hour after ascending high-altitude. ②Blood gas analysis:At sea level, there were no statistical differences in the levels of SO2, PaO2, and PaCO2 between two groups (P ＞ 0.05).But 24 hours after ascending high-altitude, SO2 and PaO2 of the obesity group were much lower than in the normal group (P＜ 0.01), and PaCO2 was significantly higher than in the normal group (P＜ 0.01).CONCLUSION: Obese men are more vulnerable to high-altitude hypoxia than people with normal body mass. Obesity is an important risk factor for the development of acute high-altitude disease.