Objective To investigate the effects of probiotics combined with sacubitril valsartan and amiodarone on short-term and long-term efficacy of patients with atrial fibrillation after radiofrequency ablation. Methods A total of 90 patients with atrial fibrillation after radiofrequency ablation in the First Hospital of Zhangjiakou City from June 2021 to June 2022 were selected and randomly divided into three groups, with 30 cases in each group. Control group was treated with amiodarone, sacubitril valsartan group was treated with amiodarone and sacubitril valsartan, and probiotics group was treated with probiotics, amiodarone and sacubitril valsartan. The recurrence situation, atrial structure indexes[left atrial diameter (LAD), left ventricular ejection fraction (LVEF), left ventricular end systolic volume index (LVESVI), left atrial volume (LAV), left ventricular end diastolic volume index (LVEDVI)], myocardial fibrosis indexes[galactin-3 (Gal-3), soluble growth stimulation expression gene 2 protein (sST2)], inflammatory response indexes[intercellular adhesion molecule-1 (ICAM-1), C reactive protein (CRP), interleukin-6 (IL-6)], neuroendocrine hormone indexes[aldosterone, norepinephrine (NE), angiotensin Ⅱ (AngⅡ)], metabolites of gut microbiota[total bile acids, trimethylamine oxide (TMAO)] and incidence of adverse events were compared among the three groups. Results At 12 months after treatment, the recurrence rate of the probiotics group was significantly lower than that of the sacubitril valsartan group and the control group (P < 0.05); after 3, 6 and 12 months of treatment, the LAD, LAV, LVESVI, LVEDVI, sST2 and Gal-3 in the probiotics group were significantly lower than those in the sacubitril valsartan group and the control group (P < 0.05), and these indexes in the sacubitril valsartan group were also significantly lower than those in the control group (P < 0.05); after 3, 6 and 12 months of treatment, the LVEF of the probiotics group was significantly higher than that of the sacubitril valsartan group and the control group (P < 0.05), and the LVEF of the sacubitril valsartan group was also significantly higher than that of the control group (P < 0.05); after 3, 6 and 12 months of treatment, the CRP, IL-6, ICAM-1, NE, aldosterone and AngⅡ in the probiotics group were significantly lower than those in the sacubitril valsartan group and the control group, and these indexes in the sacubitril valsartan group were also significantly lower than those in the control group (P < 0.05); after 3, 6 and 12 months of treatment, the TMAO and total bile acids in the probiotics group were significantly lower than those in the control group and the sacubitril valsartan group (P < 0.05); there was no significant difference in the incidence of adverse events among the three groups (P>0.05). Conclusion Probiotics combined with sacubitril valsartan and amiodarone can improve atrial structure after radiofrequency ablation of atrial fibrillation, inhibit myocardial fibrosis, reduce inflammatory response, regulate neuroendocrine hormones and metabolites of gut microbiota, prevent long-term recurrence of atrial fibrillation, and have a high safety.

The development of genetic testing technology has allowed the increasing diagnosis of inherited metabolic diseases. The principle of treatment of inherited metabolic diseases is to limit the intake of the substrates of a reaction that is impaired, reduce the accumulation of harmful metabolites, and replenish insufficient metabolites. Common inherited metabolic diseases include amino acid and peptide metabolism disorders, lipid and lipoprotein metabolism disorders, fatty acid and ketone metabolism disorders, carbohydrate metabolism disorders, and other metabolic disorders. Therefore, fine modification on the ratios of nutrients is required in the clinical nutrition treatment for such diseases. The commonly used approach is diet intervention. Here we report a case of a child with glucose transporter type 1 deficiency syndrome, who received the whole course nutritional management with dietary nutrient ratio modification, and discuss the role of ketogenic diet in this disease and its implementation. We aim to explore the significance of individualized dietary therapy in improving the prognosis and quality of life in children with inherited metabolic diseases.

Objective:To analyze the paradigm and changes of enteral nutrition support for hospitalized children in Shanghai Children's Medical Center affiliated to School of Medicine of Shanghai, Jiao Tong University in last ten years, so as to provide guidance for nutritionists and dietitians on the application and management of enteral nutrition.Method:Relevant data were collected and analyzed from 2011 to 2020 in the Clinical Nutrition Department of Shanghai Children's Medical Center, including the implementation status of parenteral and enteral nutrition as well as the types and distribution of different enteral nutrition formulas and diet.Results:The Clinical Nutrition Department of our hospital provided seventy-five types of diet for hospitalized children. The utilization of ordinary diets and specialized diets has been stable at about 76,000 cases per year. In the past decade, twenty-one ordinary formulas and special formulas were provided every year by the Clinical Nutrition Department in our hospital and the utilization has been stable at 46,000 cases per year. The total consumption of ordinary formulas and the proportion of ordinary formulas users showed a descending trend. The proportion of specialized formulas users among discharged patients remained at 10%, with an upward trend in the proportion of high-calorie formulas and extensively-hydrolyzed formulas.Conclusions:The enteral nutrition formulas and inpatient diets are important components of nutritional treatment. The evolution of its clinical application to some extent reflects the changes of disease spectrum and the development of clinical disciplines. In short, the dietitians play a significant role in the nutrition support team.

【Objective】 To compare and analyze clinical efficacy and safety of subxiphoid vs. intercostal video-assisted thoracoscopic surgery (VATS) thymic tumor resection. 【Methods】 We selected 124 patients from January 2015 to March 2019, who received VATS thymic tumor resection in the Thoracic Department of The First Affiliated Hospital of Xi'an Jiaotong University. We divided them into the subxiphoid VATS group with 47 cases and intercostal VATS group with 77 cases to analyze clinical characteristics, postoperation outcomes, complications, pain score, and short-term quality of life. 【Results】 There were no significant differences in operation time, blood loss, the rate of postoperative pneumonia, arrhythmia, phrenic nerve paralysis or myasthenia crisis between the two groups (P>0.05). Average hospital stay: It was shorter in subxiphoid VATS group than intercostal VATS group (P<0.05). Pain score: It was lower the first day and the third day after operation in subxiphoid VATS group than in intercostal VATS group (P<0.05). SF-36 health scale score: 3-month and 12-month postoperation score was higher in subxiphoid VATS group than in intercostal VATS group (P<0.05). 【Conclusion】 Subxiphoid VATS thymic tumor resection is safe and feasible; compared with intercostal approach, it can significantly reduce wound pain and improve short-term quality of life.

Objective    To compare and analyze the short-term efficacy of different surgical methods for Siewert type Ⅰ and type Ⅱ esophagogastric junction carcinoma. Methods    We selected 82 patients who accepted radical resection of esophagogastric junction carcinoma from March 2015 to March 2018 in our department, including 53 males and 29 females, aged 48-72 (61±6) years. The patients were divided into four groups according to the surgical method: a left thoracotomy group (n=14), a laparoscopic left small thoracotomy group (n=33), a thoracoscopic Ivor-Lewis group (n=17), and a thoracoscopic McKeown group (n=18). Their clinical characteristics, operative situations, postoperative complications and survival rate were analyzed. Results    Among the four groups, the left thoracotomy group cost the shortest operation time, followed by laparoscopic left small thoracotomy group, thoracoscopic McKeown group and thoracoscopic Ivor-Lewis group. The thoracoscopic McKeown group/laparoscopic left small thoracotomy group had the least bleeding. The fewest lymph nodes were dissected in the left thoracotomy group and the most in the thoracoscopic McKeown group. The laparoscopic left small thoracotomy group had the lowest total complication rate and the incidence of pneumonia and arrhythmia among the four groups (P<0.05). There was no significant difference in survival rate among the four groups (P>0.05). Conclusion    For Siewert type Ⅰ and type Ⅱ esophagogastric junction carcinoma, thoracoscopy combined with laparoscopic radical resection is safe and reliable. Laparoscopic left small thoracotomy has the advantages of minimal invasiveness and complete lymph node dissection, especially for the patients with poor cardiopulmonary function, which will significantly shorten operation time and reduce postoperative complications, so it is worth to be popularized.

Objective:This study aims to survey the changes of the nutritional status of the children with primary acute lymphoblastic leukemia (ALL) using L-asparaginase (L-Asp) and evaluate the effect of Oral nutritional supplements (ONS) added high protein and medium-chain triglyceride (MCT)(FSMP) improving their nutritional status and clinical outcome.Methods:121 ALL patients receiving the L-Asp chemotherapy were randomized administered conventional low-fat formula (control group, 63 cases) and high protein and MCT FSMP (intervention group, 58 cases). We recorded the one-week diet and performed dietary analysis. The changes of body weight and albumin were recorded on admission and discharge, and the body composition was determined, the nutritional status, number of hospitalization days, and medical costs were assessed.Results:ALL patients had lower intake than the guideline′s recommended value during chemotherapy. The control group was significantly lower in calorie intake and nutrients intake than the intervention group. Weight changes during chemotherapy were positivelycorrelated with calorie intake ( P=0.009), protein intake( P=0.014), and carbohydrate intake( P=0.003). Conclusions:ALL children have different degrees of weight loss and protein level decline during chemotherapy, and their nutritional status was closely related to nutritional intake.ONS is an important nutritional therapy. The appropriate addition of high protein and MCT FSMP can alleviate the loss of thin body weight and the decline of albumin in ALL children.

AIM: To detect the effects of resveratrol (RSV) on the expression of microRNA-21 (miR-21) in primarily cultured neonatal rat atrial myocytes with electric remodeling induced by rapid electrical stimulation (RES).Furthermore, to find out the possible mechanism of miR-21 regulating electrical remodeling.METHODS: The neonatal rat atrial myocytes were isolated by double-enzyme (trypsin and collagenase I) digestion and differential adhesion method.The atrial fibrillation (AF) model was induced by RES.Atrial myocytes were randomly divided into 4 groups: control group, RSV group, RES group, and RSV+RES group.To further detect whether RSV regulated electric remodeling by miR-21, except the 4 groups, we add miR-21 over-expression group and miR-21 inhibitor group: RES+negative control (NC) group, RES+miR-21 mimics group, RES+miR-21 mimics+RSV group, RES+miR-21 inhibitor group, and RES+miR-21 inhibitor+RSV group.The optimal concentration and pretreatment time of resveratrol were determined by CCK-8 assay.The expression of miR-21 and the mRNA expression of L-type calcium channels CACNA1C and CACNB2 in atrial myocytes were detected by qPCR.The protein expression of L-type calcium channels Cav1.2 and Cavβ2 in the atrial myocytes was analyzed by Western blot.RESULTS: The expression of miR-21 in RES group was significantly increased compared with control group, while preconditioning with RSV decreased the expression of miR-21.Compared with RES+miR-21 mimics group, the expression of miR-21 in RES+miR-21 mimics+RSV group was significantly decreased.Meanwhile, the mRNA expression of CACNA1C and CACNB2, and the protein levels of Cav1.2 and Cavβ2 were increased (P<0.05).Compared with RES group, the expression of miR-21 in RES+miR-21 inhibitor group and RES+miR-21 inhibitor+RSV group was decreased, while the mRNA expression of CACNA1C and CACNB2, and the protein levels of Cav1.2 and Cavβ2 were increased.However, no difference of the expression of miR-21, the mRNA expression of CACNA1C and CACNB2, and the protein levels of Cav1.2 and Cavβ2 among RSV+RES, RES+miR-21 inhibitor and RES+miR-21 inhibitor+RSV groups was observed (P<0.05).CONCLUSION: In AF model induced by RES, RSV may reduce electric remodeling by inhibiting the expression of miR-21 and regulating the downstream target genes.

Objective    To evaluate the clinical role of video-assisted mediastinoscopy and its safety and effectiveness in the diagnosis of thoracic disease. Methods    We reviewed the clinical data of consecutive 40 patients (25 males and 15 females with an average age of 54.6 years) who received video-assisted mediastinoscopic surgery in our department of thoracic surgery from December 2011 to November 2016, including mediastinal lymph node biopsy in 27 patients, mediastinal primary lesions biopsy in 8, bronchial cystectomy in 3 and esophageal dissection in 2. Results    The histological results were positive in 20 patients (73.1%) in mediastinal lymph node biopsy, including granulomatous mediastinitis in 14 and metastasis in 6 (non-small cell lung cancer in 4, Ewing sacoma in 1 and small cell lung cancer in 1) and reactive proliferation in 7 (26.9%). In mediastinal primary lesions biopsy, the accuracy rate of diagnosis was 100.0%. The pathologic results were malignant in all patients, including small cell lung cancer in 5, adenoid cystic carcinoma in 1, squamous carcinoma in 1 and adenocarcinoma in 1. In patients who received the bronchial cystectomy, no recurrence was found during at least 2 years follow-up. There was one patient with severe complication (innominate artery injury). Two patients suffered transient laryngeal recurrent nerve palsy with hoarseness and two patients incision secretion. Conclusion    Video-assisted mediastinoscopic surgery is effective and safe and dissection should be careful in granulomatous mediastinitis to avoid the great vessel injures.

In recent years, premature birth rate has increased due to the development of medical technology and the change of socioeconomic environment.In order to reduce the possibilities of extrauterine growth retardation and neural development retardation among premature infants, nutrition support should be fully paid attention to in clinical settings.Currently, nutritional intervention for premature infants mainly adopts enteral or parenteral nutrition.Parenteral nutrition is prescribed according to the recommended value in China Neonatal Nutrition Support Application Guide, individualized for premature infants.Enteral nutrition commonly uses breast milk, milk supplements, premature infant formula milk, hydrolyzed protein milk and formula milk after discharge.In this review, we summarized the clinical application of nutritional intervention in premature infants.

Objective To explore the change of dietary intake and nutritional status before and after hematopoietic stem cell transplantation (HSCT) in pediatric patients to assess the importance of nutritional interventions.Methods In this observational cohort study,65 children undergoing HSCT between January 2012 and November 2012 in the Department of Hematology and Oncology,Shanghai Children's Medical Center were enrolled.The data collected before preconditioning were considered as the baseline data.We also collected data twice a week between preconditioning and 30 days after HSCT,and once a week from 30 days to 100 days after HSCT.Dietary analysis and urea nitrogen analysis were conducted in parallel.Results The baseline level of energy intake was (5 844.9 ±2 490.4) kJ/d,protein intake was (56.4 ±28.6) g/d,fat intake was (49.7 ±38.9) g/d,and carbohydrate intake was (190.9 ± 91.1) g/d.With the hematopoietic reconstruction,the oral nutrients intake significantly decreased compared with the baseline levels (all P =0.000).During the recovery period after HSCT,the energy intake showed no significant difference when compared with the baseline level in the 6th postoperative week,protein in the 13th week,carbohydrate in the 4th week,and fat in the 6th week.The urine nitrogen was (3.9 ± 2.4) g/d before HSCT,which increased to (16.7 ± 11.0) g/d after preconditioning (P=0.000).In the 1st postoperative week,the weight (P =0.000),triceps skin fold thickness (P =0.003),mid-upper arm circumference (P =0.000),serum albumin (P =0.000) and prealbumin (P =0.000) of the patients all significantly decreased compared with the baseline levels.In the 9th postoperative week,the fat-free body weight percentage (P =0.010),muscle percentage (P =0.001) and protein percentage (P =0.000) were significantly lower than the baseline levels,while the body fat percentage was higher than the baseline level (P =0.002).Conclusions Children undergoing HSCT exhibit a marked reduction in nutrient intakes at the early stage of HSCT,which may gradually return normal during the recovery period.This process may be slow,especially for the protein,and therefore may affect the serum protein level in these pediatric patients.Thus,more careful nutrition guidance is necessary during HSCT for pediatric patients,emphasizing oral nutrients intakes,and high protein dietary or formula may be helpful.