Cardiovascular surgery is still the preferred treatment for some congenital or acquired cardiovascular diseases.With the aging of China's population and the prevalence of unhealthy lifestyles brought about by the improvement of living standards,the burden of cardiovascular diseases is still steadily increasing and the volume of cardiovascular surgery continues to be at a high level,which puts forward a new demand for the prevention and treatment strategy of cardiovascular diseases and the allocation of medical resources.Cardiovascular surgery has many perioperative complications and high risk of mortality,a scientific surgical complexity scoring system can help clinicians fully assess the difficulty of surgery,stratify the risk of patient surgery,and formulate targeted and personalized diagnosis and treatment plans;meanwhile,it can help the health management department accurately grasp the overall diagnosis and treatment level of China's cardiovascular surgery,monitor the quality of medical care and provide a reference for the formulation and implementation of relevant medical policies.In this study,we systematically review the current status of evidence-based research on different cardiovascular surgical complexity assessment systems and summarize the application of machine learning in cardiovascular surgical assessment,with a view to contributing to the establishment of a cardiovascular surgical complexity assessment system applicable to the Chinese population.

Objective    To summarize the clinical characteristics and the long-term results of pulmonary thromboendarterectomy (PTE) in the chronic thromboembolic pulmonary hypertension (CTEPH) patients with unilateral main pulmonary artery occlusion. Methods    We retrospectively analyzed the clinical data of 15 CTEPH patients with unilateral main pulmonary artery occlusion in Fuwai Hospital between 2004 and 2018. There were 11 males and 4 females aged 34.1±12.0 years at operation. Results    The mean circulatory arrest was 31.1±12.1 minutes. The ICU stay was 5 (2-29) d. The hospital stay was 15 (8-29) d. There was no hospital death. There was a decline in systolic pulmonary artery pressures (sPAP, 69.9±27.9 mm Hg to 35.1±9.7 mm Hg, P=0.020) after surgery. On postoperative V/Q scan, only 6 patients (40.0%) had significant improvement in reperfusion (≥75% estimated) of the occluded lung. There was no death during the median observation period of 49 months follow-up, while 2 patients had recurrence of pulmonary embolism. Conclusion    CTEPH patients with unilateral main pulmonary artery occlusion represent a challenging cohort. PTE is a curative resolution in both early- and long- term results, although there is a high requirement of perioperative management and a high risk of postoperative complications and rethrombosis.

Mutations in the triggering receptor expressed in myeloid 2 (TREM2) gene have recently been found to be closely related to the development of Alzheimer's disease (AD) and other neurodegenerative diseases. However, the detailed mechanism underlying TREM2's participation in the pathogenesis of AD and other diseases has yet to be fully elucidated. In this review, we discuss current understanding on the structure and function of TREM2, the relevance between TREM2 and AD, and the possible causes of AD by TREM2 mutations.

Objective This study aimed to evaluate the safety and efficacy of video-assisted thoracoscopic bipolar radio-frequency ablation in the treatment of isolated paroxysmal atrial fibrillation.Methods From September 2010 to December 2016,Seventy-two consecutive patients with paroxysmal atrial fibrillation underwent video-assisted thoracoscopic bipolar radio-frequency ablation at Fuwai Hospital.There were 50 males and 22 females with an average age of(56.5 ± 10.5) years and duration of atrial fibrillation with (6.5 ± 4.8) years.45 patients had previous catheter ablation.The patients were followed up at postoperative 3 months,6 months,1 year and annually.Success of ablation was defined as sinus rhythm and no duration of ≥30 s for rapid atrial arrhythmias,including atrial fibrillation,atrial flutter or atrial tachycardia in 24 h Holter examination.Univariate and multivariate logistic regression models were used to analyze the risk factors for atrial fibrillation recurrence.Results One patient converted to sternotomy due to bleeding on operation.All patients were successfully discharged.69 patients completed follow-up,with an average follow-up of(28 ± 18)months(3-60 months).The overall success rate was 73.9％,and the success rate without antiarrhythmic drug was 62.3％.Subgroup analysis showed that the success rate was 80％ when left atrial anterior and posterior diameter(LAD) ≤40 mm,and 57.9％ when LAD ＞ 40 mm (P =0.035).Multivariate logistic regression analysis showed that LAD ＞40 mm was an independent risk factor for postoperative recurrence of atrial fibrillation.Conclusion Video-assisted thoracoscopic bipolar radiofrequency ablation is a safe and effective method for the treatment of paroxysmal atrial fibrillation,especially in patients with LAD≤40 mm.

Objective     To evaluate a score system to allow stratification of complexity in degenerative mitral valve repair. Methods     We retrospectively reviewed the clinical data of 312 consecutive patients who underwent surgery for mitral valve repair and whose preoperative echocardiography was referable in our hospital from January 2012 to December 2013. A scoring system for surgical complexity was used based mainly on the preoperative echocardiography findings. Complexity of mitral valve repair was scored as 1 to 9, and patients were categorized into 3 groups based on the score for surgical complexity: a simple group (1 point), an intermediate group (2-4 points) and a complex group (≥5 points). There were 86 males and 35 females in the simple group (n=121) with an average age of 51.6±12.6 years, 105 males and 53 females in the intermediate group (n=158) with an average age of 51.1±12.8 years and 25 males and 8 females in the complex group (n=33) with an average age of 49.3±13.0 years. Results     There was significant difference in surgical complexity in different groups. In the simple, intermediate and complex groups, the mean cardiopulmonary bypass time was 111.7±45.5 min, 117.7±40.4 min and 153.4±74.2 min (P<0.001), the mean cross-clamping time was 77.5±33.8 min, 83.2±29.9 min and 108.8±56.2 min (P<0.001), and the mean number of repair techniques utilized was 2.1±0.4, 2.4±0.6 and 2.8±0.8 (P<0.001). However, there was no significant difference in the early and late outcomes in different groups. Conclusion     It is feasible to use echocardiography to quantitatively evaluate the difficulty of mitral valvuloplasty.

Objective To investigate the predictive value of plasma gelsolin in the prognosis of patients with ST-sgement elevation myocardial infarction ( STEMI ) and undergone primary percutaneous coronary intervention ( PCI ) .Methods The study included 206 patients with STEMI and undergone primary PCI, 148 patients with stable angina pectoris and received elective PCI and 80 healthy volunteer as the health population (NP) control.Blood samples were taken at admission on day 1, 3, 5, 7 and 9 to determine the plasma gelsolin level .Patients′baseline clinical characteristics , blood biochemistry tests results , details of operation and their cardiovascular risk factors were recorded .Major adverse cardiovascular events (MACE) within one year were recorded.Results (1) Compared to the stable angina group and the NP group, the level of plasma gelsolin of STEMI patients were obviously decreased at various time points ( all P<0.05 ) .There were no statistical differences between the stable angina group and the NP group .( 2 ) Patients with STEMI were catagorized into MACE group (n=78) and non-MACE group (n=128) according their follow up record in 1 year.The level of plasma gelsolin in patients with MACE were lower than the non-MACE group ( P <0.05 ) with the minimum value detected on day 7.Among patients complicated with MACE (n=78), they were further devided into the deceased group (n=18) and the survival group (n=60).Plasma gelsolin levels were lower in the deceased group with satistical differences found on day 5, 7 and 9.(3) Single factor Logistic regression analysis showed that the level of plasma gelsolin on day 7 was independent risk factor of MACE within one year ( P =0.014 ) .( 4 ) Setting the cutoff value of plasma gelsolin on day 7 as 21.7 mg/L,the sensitivity and speciticity for the MACE in STEMI patients treated with primary PCI within one year were 82.1%and 81.4%respectively , with the area under the receiver operator characteristic curve ( ROC ) was 0.854 ( 95% confidence interval 0.732 -0.961 , P <0.01 ) . Conclusions Plasma gelsolin levels are correlated with the severity of STEMI lesions and plasma gelsolin can be used as predicting factor of prognosis .

Objective To study and analyze the long-term video electroencephalography (VEEG) and clinical characteristics of children with Rolandic discharge.Methods Twenty-seven children with Rolandic discharge,admitted to our hospital from October 2009 to June 2013,were chosen in our study; theit clinical characteristics,VEEG results,imaging results,treatments and prognosis were retrospectively analyzed.Results In these 27 patients,19 had benign epilepsy with centrotemporal spikes (BECT),low-dose antiepileptic drug oxcarbazepine could obtain good efficacy in 15 patients and the other 4 did not give drug because of few seizures,and generally the prognosis was good; 2 had variants of BECT (therapy of antiepileptic drugs and corticosteroids had efficacy); 3 had symptomatic epilepsy (one was infantile autism,the other was encephalitis sequela,the last one was focal cortical dysplasia; therapy of antiepileptic drugs was combined,the result of the first one was good,the second one was not good,and the third was cured by surgery); and one had benign childhood occipital epilepsy and two had Tourette's syndrome.The VEEG of all 27 children showed numerous or single spikes on one side or both sides in Rolandic areas during wake-up and sleep; a few of them presented electrical status epilepticus during slow wave sleep.Conclusions Rolandic discharges in children are mostly seen in BECT,and secondly in symptomatic epilepsy and the variants of BECT,and sometimes in childhood occipital epilepsy and non-epilepsy children.VEEG monitoring can help the diagnosis and estimate the prognosis and instruct the therapy.

Objective To investigate the role of soluble cytotoxic T-lymphocyte associated antigen-4 (sCTLA-4) in the pathogenesis of myasthenia gravis (MG) in Fujian province.Methods A total of 80 patients with MG and 80 sex-and age-matched healthy controls were enrolled in the study .MG patients were divided into non-glucocorticoid treatment group and glucocorticoid treatment group , and the latter was further divided into immunosuppressive therapy group and thymusectomy group .Concentrations of sCTLA-4 in ser-ums from above mentioned groups were measured by enzyme-linked immunosorbent assay (ELISA).Results The concentrations of sCTLA-4 in both non-glucocorticoid treatment group and glucocorticoid treatment group were significantly higher than those in the healthy control group (6.03 ng/ml±3.58 ng/ml, 3.44 ng/ml± 2.36 ng/ml vs.0.49 ng/ml±0.95 ng/ml) (χ2=100.67, P<0.001), but sCTLA-4 concentrations in glu-cocorticoid treatment group were lower than those in non-glucocorticoid treatment group (Z=-3.37,P=0.001).With the treatment of glucocorticoid, the sCTLA-4 concentrations were reduced (6.03 ng/ml± 3.58 ng/ml vs.4.56 ng/ml±2.08 ng/ml;t=3.10, P=0.005), and the concentrations of sCTLA-4 were also decreased after thymusectomy therapy (3.86 ng/ml±2.53 ng/ml vs.2.59 ng/ml±2.37 ng/ml; Z=-2.21, P=0.04).However, there was no significant difference in the concentrations of sCTLA-4 before and after immunosuppressive drugs treatment (Z=-1.26,P=0.21).Conclusion The concentration of sCTLA-4 was increased in patients with MG , but with the treatment of glucocorticoid or thymusectomy it could be reduced .

Eight cases of hypothyroid myopthy admitted in Zhanshan Hospital Xiamen University from 1995 to 2011 were retrospectivrely analyzed.The main clinical features were proximal muscle weakness,susceptibility to fatigue,and elevation of muscle enzymes.Electromyography revealed no specific findings.All patients obtained clinical recovery after thyoid hormone replacement.Hypothyroid myopathy should be considered in cases of muscle weakness and elevation of muscle enzymes.

Objective： To study the application of DSA in the diagnosis and treatment of ENT diseases. Methods： The diagnostic and therapeutic roles of DSA in ENT patients admitted from November 1995 to December 1999 were retrospectively studied. Results： Therapeutic vascular embolization using DSA was performed in 9/10 patients with severe epistaxis. The treatment was successful in 8/9 patients with a successful rate of 88.89%; embolization of tumor supplying vessels using DSA as a preoperative measure for reducing operative blood loss in 3 patients with nasopharyngeal fibrohemangioma obtained a total success; diagnosis was clarified in 2 patients using DSA. No patients were with severe complications. Conclusion： DSA is not only a safe and effective measure for diagnosis and therapy, but also effective in differential diagnosis of space occupying lesions. Preoperative selective embolization of tumor supplying arteries can reduce operative blood loss.