ObjectiveTo analyze the research hotspots and frontier trends in the field of early screening tools of autism spectrum disorder (ASD) over the past two decades. MethodsThe literature on early screening tools for ASD was searched in Web of Science core collection database from 2002 to 2022. CiteSpace was used for cluster analysis of keywords, to draw knowledge mapping. Research disciplines were analyzed and comprehensively interpreted. ResultsA total of 115 articles were included. The number of researches on early screening tools for ASD had been increasing over the past two decades. The research disciplines with higher publication volume included pediatrics, neurology and neuroscience, and psychology. A total of 191 keywords were identified, and the LLR keyword clustering analysis yielded eleven clusters. ConclusionModified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F) and Brief Infant-Toddler Social and Emotional Assessment (BITSEA) have been subjected to large-scale sample screening and follow-up observation for validity, demonstrating good psychometric properties and high clinical diagnostic value. The development of new early screening tools for ASD, validation of the reliability and validity of different language versions of the M-CHAT-R/F, and research on digital and networked M-CHAT-R/F are current research hotspots. Cultural adaptation of early screening tools for ASD and their application within the developmental monitoring framework may represent frontier research trends.

Objective    To summarize the experience of right ventricular outflow tract reconstruction with self-made single-valve conduit for the treatment of complex congenital heart disease, and to explore the key points of operation, and to evaluate the short-term and medium-term results of the treatment. Methods    We retrospectively analyzed the clinical data of 65 patients with complex congenital heart disease treated by self-made single-valve conduit from January 2006 to June 2018. There were 42 males and 23 females aged 5-23 (9.9±4.2) years with weight 15-65 (26.2±9.9) kg. There were 19 patients with single valve artificial blood vessel (an artificial vascular group), and 46 patients with single valve bovine pericardium tube (a bovine pericardial tube group). There were 48 patients of ventricular septal defect (VSD) with pulmonary atresia (PA), 10 patients of corrective transposition of great artery with pulmonary artery stenosis, 5 patients of tetralogy of Fallot with single coronary artery malformation, 2 patients of double outlet of right ventricle with pulmonary artery stenosis and single coronary artery malformation. Results    Two patients died early after operation, both of them were VSD/PA patients who underwent radical treatment of extravascular prosthesis. The right ventricular outflow tract pressure difference was 13-37 (25.2±4.9) mm Hg in the artificial vascular group and 5-23 (10.5±3.3) mm Hg in the bovine pericardial tube group. No obvious reflux was found at discharge. The patients were followed up for 8 months to 13 years. One patient was lost. During the follow-up period, there were 5 patients of moderate tricuspid regurgitation, 32 patients of moderate intraductal regurgitation, 7 patients of severe right ventricular outflow  tract obstruction, 11 patients of moderate obstruction and 25 patients of mild obstruction. There was no late death. Heart function classification of all patients was in New York Heart Association classⅠtoⅡ. Conclusion    The self-made single-valve conduit used to reconstruct right ventricular outflow tract shows good clinical effect. Using bovine pericardium tube has less pressure difference of outflow tract in comparison with artificial blood vessel. Bovine pericardium tube is more recommended for young and low weight patients.

Objective    To investigate the results of emergent aortic arch replacement using moderate hypothermic circulatory arrest and unilateral antegrade cerebral perfusion (MHCA+UACP). Methods    We retrospectively analyzed the clinical data of 146 patients who underwent emergent aortic arch replacement using MHCA+UACP in our institution from January 2008 to June 2018. There were 111 males and 35 females aged 60.3±7.2 years. According to different surgical approaches, patients were divided into two groups: a total arch replacement (TAR) group (n=104) and a semi arch replacement (SAR) group (n=42). Right axillary artery was cannulated for cardiopulmonary bypass (CPB) and cerebral perfusion. Core temperature at the onset of MHCA was 23.4±1.4 ℃. UACP was initiated at 18-22 ℃ with the flow of 5-10 ml/(kg·min). Flow was adjusted to maintain cerebral perfusion pressure of 50–60 mm Hg. Results    CPB time was 235.0±42.0 min. Aortic clamp time was 154.0±29.0 min. Circulatory arrest (CA) time was 48.1±13.0 min. The CPB time and CA time of the TAR group were longer than those of SAR group. Overall mortality rate was 9.6%. Complications included permanent neurological dysfunction (PND), temporary neurological dysfunction (TND), acute kidney injury (AKI) requiring dialysis and delayed extubation (mechanical ventilation time > 72 hours). Overall incidence of PND and TND was 2.7% and 6.8%, respectively. The incidence of AKI requiring dialysis was 4.1%. The incidence of delayed extubation was 21.9%. No difference of mortality rate or incidence of complications was found between the two groups. The average follow-up was 63.0±33.1 months. The 5-year survival rate was 72.6% in the TAR group and 85.5% in the SAR group. Conclusion    Emergent aortic arch replacement using MHCA+UACP can be accomplished with excellent results.

Objective To explore the application and effectiveness of one-staged or two-staged hybrid minimally invasive surgical and transcatheter ablation for long-standing persistent atrial fibrillation(LSPAF).Methods From Jun 2015 to Dec 2017,a cohort of 56 patients[18 female,mean age of(59.1 ±6.9) years] with long-standing persistent atrial fibrillation underwent one-staged(30 cases) or two-staged(26 cases) hybrid minimally invasive surgical and transcatheter ablation.Mean AF duration was(5.9 ± 3.0) years.Mean left atrial diameter was(45.4 ± 4.2) mm.Mean CHA2DS2-VASc score was 2.3 ± 1.2.Fourteen cases had a history of prior catheter ablation.All patients underwent continuous 24-hour or 48-hour holter monitoring at 3 months,6 months,1 year and yearly thereafter.Results All patients successfully underwent one-staged or two-staged hybrid minimally invasive surgical and transcatheter ablation.During ablation,LSPAF was terminated in 80.0％ (24/30) with one-staged hybrid ablation and 84.6％ (22/26) with two-staged hybrid ablation.At a mean follow-up of(20.3 ± 8.2) months,89.3％ (50/56) patients maintained sinus rhythm.Among them,86.7％ (26/30) patients with one-staged hybrid ablation maintained sinus rhythm,and 92.3％ (50/56) patients with two-staged hybrid ablation maintained sinus rhythm.Six patients with recurrent AF continued to receive warfarin and amiodarone drug therapy.No death or cerebrovascular events occurred.No patient required permanent pacemaker implantation.Conclusion One-staged or two-staged hybrid minimally invasive surgical and transcatheter ablation could be safely and effectively applied to the treatment of LSPAF.The early and midterm outcomes were satisfactory.

Objective    To investigate the perioperative change and the predictive value of myoglobin, creatine kinase-MB (CK-MB), and cardiac troponin I (cTnI) in non-coronary cardiac surgery. Methods    The clinical data of 77 patients undergoing cardiac surgery for non-coronary lesions in the Shanghai Xinhua Hospital from March 2016 to November 2016 were retrospectively reviewed, including 37 males and 40 females with a median age of 2 years. There were simple congenital heart diseases in 45 patients, complicated congenital heart diseases in 10, and heart valve diseases in 22. The levels of myoglobin, CK-MB and cTnI were collected at the first postoperative day. The ventilation duration and the length of ICU stay were recorded. The recovery condition was accessed by senior surgeons. Results    The myoglobin, CK-MB and cTnI concentrations increased at the first postoperative day, and cTnI increased most significantly. The multivariate linear regression analysis indicated that these changes were only related to cardiopulmonary bypass time and aortic cross-clamping time (P<0.001). The high cTnI level was associated with prolonged ventilation duration and length of ICU stay. Fourteen patients (18.2%) did not recovered well, and their cTnI level was significantly higher than that of well-recovered patients (16.8±16.7 ng/ml vs. 5.1±4.4 ng/ml, P<0.001). The cTnI cutoff value of 5.33 ng/ml could predict whether patients had good postoperative recovery (area under the receiver operating characteristic  curve=0.862, P<0.001), and the predictive value of cTnI was superior to that of myoglobin and CK-MB. Conclusion    The increase levels of myoglobin, CK-MB and cTnI post non-coronary cardiac surgery are associated with prolonged cardiopulmonary bypass time and aortic cross-clamping time. cTnI on postoperative 24 h may predict good recovery, and it is a useful biomarker.

Objective    To analyze the mid-term results of surgical treatment for prosthetic valve endocarditis (PVE). Methods    We retrospectively analyzed the clinical data of 22 PVE patients operated in our institution from January 2006 to June 2016. There were 14 males and 8 females, aged 31-62 (49.6±11.8) years. PVE occurred following single valve replacements in 20 patients, including aortic valve replacements in 12 and mitral valve replacements in 8. Two patients suffered PVE after multi-valve replacement, which was aortic and mitral valves. Mechanical valves were used in all patients. Early PVE (<1 year after valve implantation) was detected in 10 patients, and late PVE (>1 year after valve implantation) in 12 patients. Blood culture was negative in 6 patients. Fifteen patients underwent emergent or urgent surgery (within one week after definite diagnosis) and 7 elective surgery. Paravalvular abscess was detected in 12 patients and repaired bovine pericardium. Results    Three patients (13.6%) died postoperatively in hospital, among whom two died of multiple systemic organ failure, and the other died of cerebral hemorrhage. Main postoperative complications included low cardiac output syndrome in 5 patients (22.7%), renal dysfunction in 6 (27.3%), respiratory failure in 5 (22.7%) and pulmonary infection in 4 (18.2%). During the follow-up of 6-120 (53.6±20.8) months, 2 deaths were observed in the middle term, including one sudden death and the other of cerebral infarction. No recurrent infection or valve-related surgery was observed during the follow-up. The survival rate was 86.4% in 1 year and 70.4% in 5 years. Conclusion    PVE is a very severe disease with high mortality. Early surgical treatment and complete removal of infectious tissues have preferable early- and mid-term results.

In this paper, water extract of Nauclea officinalis was absorbed by AB-8 macroporous resin and subsequently gradient-eluted with alcoholic solution of different proportion to prepare pumiloside monomer of high purity. The metabolites in urine, feces and bile of rats with gavage administration were analyzed by UPLC-QTOF/MS. Accurate MS/MS data of all components were collected with full scan mode, and analyzed by MetaboLynx software. Results showed that the monomer of high-purity pumiloside was prepared and four metabolites in rats were identified.

Objective To construct and evaluate a nomogram for predicting the risk of peri-operative complications after radical retro-pubic prostatectomy (RRP) with standard classification criteria.Methods The peri-operative complications and clinicopathological data of 240 patients (50-82 years old) who had undergone RRP for prostate cancer from June 2006 to June 2011 were retrospectively collected.Gleason score:95 cases ＜ 7; 145 patients ≥ 7;Clinical staging:cT1 is 1 case (0.4％),T2a 5 cases (2.1％),T2b 7 cases (2.9％),T2c 162 cases (67.5％),T3a 26 cases (10.8％),T3b 39 cases (16.3％).The peri-operative complications (in 30 days after surgery) were classified by Clavien-Dindo Classification system (the occurrence rates are as follows:rectum injury 1.6％,wound infection 2.0％,deep venous thrombosis 1.2％,urinary leak 5.0％,lymphocele 4.5％,myocardial infarction 5.8％,second look operation 1.6％),and a logistic regression model was used to construct the nomogram.Results BMI,N staging and Blood loss more than 200ml during surgery were independent prognostic factors of RRP morbidity in multivariate logistic regression.The nomogram predicting the risk of peri-operative complications showed relative good concordance index (0.633) and good calibration. Conclusions Based on the clinicopathological factors,a nomogram to predict the probability of peri-operative complications in patients undergone RRP was constructed.This statistical tool may be beneficial in judging operation risk and help consulting with patient before or after surgery.

Objective To summarize the preliminary experience of early anticoagulant therapy after endovascular stent graft exclusion for Stanford B type aortic dissection.Methods From June 2006 to June 2011,75 patients[ 65 males,10 fe males,mean age (59.1±13.5) years,range 22 -81 years ] under went endovascular stent-graft exclusion for Stafford B type aortic dissection in Shanghai Xinhua Hospital.Computed tomography angiography (CTA) was used to evaluate the lesions of aortic dissection before endovascular stent-graft exchusion.The descending thoracic aortic diameters were 22 mm to 42 mm [ mean (30.3±4.0) mm ].The distance from the breakage of dissection to the left vertebral artery(LSA)was longer than 1.5 mm in 29 cases,and shorter than 1.5cmin 46 cases.During the operation,left subclavian artery revascularization was per formed to patient,whose left vertebral artery was advantage and needs to be fully or partially covered From the second day after operation,asprin was given to patint,whose left subclavian artery was fully or partially coverd by endovascular stent-graft(no endoleak and residual distal tear).Early anticoagulant therapy lasted 3 months.The symptoms or signs about nervous system were observed in the early stage of postoperation,and the CTA was examined at postoperative 3 months.Results The operation succeeded in 75 patients.The diameters of aortic stent were 26mm to 46rmm[ mean(34.3±4.0) mm ].Left subclavian ar tery revascularization was carried out for 2 cases of all patients.The left subclavian artery was fully or partially coverd in 58 patients(fully covered in 19 cases,2/3 covered in 15 cases,1/2 covered in 24 cases),and 56 patints(no endoleak and residualdistal tear) were given anticoagulant therapy to prevent vertebral artery thrombosis.2 patients(2.7％)died in the early stage after operation.1 patient died of renal failure,1 patient died of dissection rupture,The duration of hospitalization was 4 to 19 days [ mean (7.9±3.5)days ].No neurological complications occurred in hospital.The follow-up period was 6 to 66 months.1 patient died during the follow-up,1 patient had recurrence of Stanford A type aortic dissection and was cured by ascending aorta and aortic arch replacement,1 patient had recurrence of Stanford B type aortic dissection and was cured by second endovascular stent-graft exclusion.All patients had no neurological complications,such as cerebral infarction and paraplegia.Concluslon Early anticoagulant therapy could safely and effectively prevent the neurological complications (such as cerebral infarction and paraplegia) related to vertebral artery thrombosis for Stanford B type aortic dissection patients whose left subclavian artery was fully or partially coverd by endovascular stent-graft.