Objective To investigate the expression of pepsin in vocal cord polyps and vocal cord cancer,and to compare the difference of pepsin expression.Methods From May 2020 to December 2021,27 patients with vocal cord polyp,27 patients with vocal cord cancer and 23 healthy volunteers were selected.RSI and RFS scoring scales were used for scoring,pepsin detection kit was used for saliva pepsin detection,and immunohistochemical methods were used to detect the expression of pepsin in vocal cord tissues of patients with vocal cord polyps and vocal cord cancer.Results The RSI score,RFS score and pepsin test kit results of vocal cord polyp group and vocal cord canc-er group were higher than those of non-vocal cord disease group,and the differences of the three indexes were statis-tically significant(P＜0.05).RSI score,pepsin detection kit results and pepsin immunohistochemistry results of vocal cord polyp group showed no significant difference compared with vocal cord cancer group(P＞0.05).The RFS score of vocal cord polyp group was significantly different from that of vocal cord cancer group(P＜0.05).Conclusion Pepsin may be an important pathogenic factor of vocal cord polyp and vocal cord cancer,and play an im-portant role in the occurrence of these two diseases.The difference of pepsin expression in vocal cord polyp and vo-cal cord cancer suggests that pepsin may have different pathogenesis.

Abdominal surgery as a common type of clinical surgery, postoperative treat-ment and rehabilitation has always been the focus of surgeons. Somatostatin drugs are commonly used for postoperative bleeding, portal hypertension bleeding, and prophylactic treatment of com-plications such as acute pancreatitis. However, the standardized application of somatostatin still faces numerous challenges in clinical practice. The famous experts and their teams in the field of digestive surgery, medical insurance expert and lawyer, combined with the experience of their respective centers, under the new national medical insurance policy, explore the significance of treatment and rehabilitation after abdominal surgery and the application strategy of somatostatin drugs from different angles. Professor Zhang Taiping succinctly explained the incidence and harm of gastro-intestinal fistula, pointing out that "how to heal the fistula in a short time" is the main rehabilitation goal and the treatment is mainly comprehensive treatment. Professor Chen Chaowu comprehen-sively introduces diagnostic and treatment processes for several representative cases encountered in clinical practice while sharing his team′s rich clinical experience and posing reflective questions. Professor Li Fei starts with practical cases, focusing on duodenal fistula, including fistula caused by complications after endoscopic retrograde cholangiopancreatography, with special emphasis on Stanford classification and different types of treatment. Ms. Zhang Qun interprets national medical insurance policies. She emphasizes the significance of supervising medical insurance funds and shares experiences related to issues regarding autonomous management by healthcare institutions. Lawyer Li Hongqi provides comprehensive suggestions on rational use of drug based on policy guidance and practical cases.

Objective Using healthy female reproductive-age rhesus macaques as the research subjects,we explored the correlation between menstrual cycle abnormalities and gut microbiota composition by using 16S rRNA metagenomic sequencing.Methods Twenty-seven healthy female rhesus macaques were divided into regular menstrual and irregular menstrual groups.Fecal samples were collected at follicular phase(FP),ovulation phase(OP)and luteal phase(LP)of the two groups.The structure and diversity of bacterial flora in different physiological periods were analyzed and compared between the two groups.Results At the phylum level,Firmicutes,Bacteroidetes,and Proteobacteria dominated the sample flora in the follicular,luteal,and ovulatory phases of the rhesus macaques in both the regular and irregular groups,with a combined percentage of more than 98% .At the genus level,the genus Prevotella_9,Ruminococcaceae_UCG-002,Lactobacillus,Prevotella_2,Phascolarctobacterium,Ruminococcaceae_UCG-005,Streptococcus,Blautia,Prevotellaceae_NK3B31_group,Rikenellaceae_RC9_gut_group were dominant.In the luteal phase the percentage of Firmicutes was higher in the regular group than in the irregular group,while the opposite was true for Bacteroidetes.Spirochaetes were higher in the regular group than in the irregular group at all 3 stages(P＜0.05).Conclusion There were some differences in intestinal microbial composition between the two groups of macaques with regular and irregular menstrual cycles,which provided some reference for the study of intestinal bacteria and ovulation disorders.

Objective    To explore the safety and effectiveness of different interventional approaches for the treatment of patent ductus arteriosus (PDA) in children. Methods    The children (≤7 years) who underwent interventional treatment for PDA from 2019 to 2020 in our hospital were retrospectively included. The patients were divided into 3 groups according to the procedures: a conventional arteriovenous approach group, a simple venous approach group, and a retrograde femoral artery approach group. The clinical efficacy of the patients was compared. Results     A total of 220 patients were included. There were 78 males and 142 females, with an average age of 3.21±1.73 years, weight of 14.99±5.35 kg, and height of 96.19±15.77 cm. The average diameter of the PDA was 3.35±1.34 mm. A total of 85 patients received a conventional arteriovenous approach, 104 patients received a simple venous approach, and 31 patients received a retrograde femoral artery approach. The diameter of PDA in the retrograde femoral artery group was smaller than that in the other two groups (3.44±1.43 mm vs. 1.99±0.55 mm; 3.69±1.17 mm vs. 1.99±0.55 mm, P<0.001); the contrast medium usage [40 (30, 50) mL vs. 20 (20, 30) mL; 35 (25, 50) mL vs. 20 (20, 30) mL, P≤0.001] and operation time [32 (26, 44) min vs. 25 (23, 30) min; 29 (25, 38) min vs. 25 (23, 30) min, P<0.05] in the simple venous approach group were significantly less or shorter than those in the other two groups; the length of hospital stay of the conventional arteriovenous group was longer than that in the other two groups [3 (3, 5) d vs. 4 (3, 6) d; 4 (3, 5) d vs. 4 (3, 6) d, P<0.05]. There was no significant difference in postoperative complications. Conclusion    It is safe and effective to close PDA through simple venous approach. The retrograde femoral artery approach has the advantage of simplifying the surgical procedure for PDA with small diameters.

Objective:To explore the feasibility of three-dimensional CT axial sequence assisted volumetric measurement (CTAS) in evaluating atrial septal defect (ASD).Methods:The patients with single secundum ASD who successfully underwent interventional therapy in Fuwai Hospital from January 2016 to December 2019 were retrospectively collected. The patients underwent coronary CT angiography (CTA) before and on the second day after closures, and DSA examinations during operation. A total of 52 cases met the inclusion conditions, among them, there were 37 patients with large defects which had deficient inferior rims ≤3 mm, and 15 patients with severe pulmonary arterial hypertension that occluded with fenestrated ASD occluder. The CT data of patients before and after operation were reconstructed by CTAS. Then the anatomical structure of ASD before the operation was evaluated, including the long diameter and short diameter of ASD, and the CT three-dimensional volume diameter of ASD was calculated by using the equivalent circle conversion formula of ellipse. The waist diameter of occluder and rims of the ASD were measured after occlusion on postoperative CT three-dimensional volume reconstruction images. Meanwhile, the deployed occluder waist dimension was measured in DSA examination during the operation by simulating the balloon measurement of ASD. Lastly, paired t-test and consistency analysis were carried out among the values of parameters. Results:Before operation, the equivalent circle diameter of ASD was (32.3±5.4) mm measured by CTAS. After ASD occlusion, the size of the waist dimension measured by DSA and CTAS were (32.5±4.9) mm and (32.6±4.9) mm. There were no significant differences between them ( P>0.05). There were also no significant differences for each rims of the ASD pre and post operation on CTAS except for the inferior rims and the total length of atrial septum in superior-inferior direction ( P>0.05). Conclusion:As an alternative to balloon sizing, CTAS can be used as a reference standard to conduct ASD interventional treatment.

Objective:To investigate the value of 18F-fluorodeoxyglucose (FDG) PET imaging in evaluating the 18F-FDG influx rate of lungs and its relationship with parameters of pulmonary hemodynamics in patients with pulmonary arterial hypertension related to congenital heart disease (PAH-CHD). Methods:From January 2018 to June 2019, a total of 16 PAH-CHD patients (6 males, 10 females, age (29.2±10.6) years) and 22 health controls who received physical examinations (8 males, 14 females, age (45.4±3.8) years) in Fuwai Hospital were respectively enrolled. All cases underwent dynamic 18F-FDG PET imaging for whole lung 18F-FDG influx rate (presented as Ki). Right heart catheterization was performed to evaluate pulmonary hemodynamic parameters such as pulmonary vascular resistance (PVR), mean pulmonary vascular pressure (mPAP) in PAH-CHD patients after imaging within one week. Independent-sample t test was used to compare Ki of 2 groups, and Pearson correlation analysis was used to analyze the relationship between Ki and PVR, mPAP in PAH-CHD patients. Results:Ki of the lungs was significantly higher in PAH-CHD patients than that in controls ((0.000 6±0.000 3) vs (0.000 4±0.000 3) ml·g -1·min -1; t=2.15, P=0.038). Ki was not correlated with PVR ((10.86±4.45) Wood units) or mPAP ((69.75±18.93) mmHg; 1 mmHg=0.133 kPa) in PAH-CHD patients ( r values: 0.202 and 0.006, both P>0.05). Conclusions:Pulmonary vascular remodeling can lead the increasing lung 18F-FDG uptake in patients with PAH-CHD. 18F-FDG PET may have the ability in monitoring and evaluating pulmonary vascular remodeling in PAH-CHD.

Objectives To discuss the characteristics of late gadolinium enhancement (LGE) magnetic resonance (MR) imaging in patients with hypertrophic cardiomyopathy (HCM) and left ventricular apical aneurysm (LVAA) and its related prognostic value. Methods Thirty HCM patients with LVAA were collected from August 2004 to August 2013. All cases with coronary artery diseases were ruled out, and all patients underwent LGE derived by cardiac MR (CMR). Five cases of LVAA were pathological confirmed. Atrial and ventricular diameters, apical aneurysm diameters and left ventricular ejection fraction were measured, and apical aneurysm LGE was evaluated. All patients were then followed up. Comparisons in continuous parameters between patients with or without LGE were performed by independent t test. A Cox proportional hazard model was used to estimate the hazard rate for adverse cardiovascular events. Results LGE was identified in 21 LVAAs and non-LGE in 9 LVAAs. Between two groups, there was no significant difference in the size of LVAA [(16.4 ± 11.5) mm vs. (20.3 ± 9.8) mm, P=0.63]. In particular, the complete transition from non-LGE to LGE LVAA was recorded during follow-up in one patient. Pathological findings confirmed that LGE indicated fibrous tissue in LVAA, and LVAA without LGE indicated viable myocardium. The follow-up suggested that the patterns and the size of LVAA were associated with the adverse events in these patients (LGE of LVAA, HR=7.94, P=0.064; the size of LVAA, HR=1.08, P=0.009). Conclusions LGE-MR had important clinical significance in HCM patients with LVAA. LGE in LVAA corresponded with the fibrous tissue and was associated with the prognosis.

Objective: To explore the short and mid-term efficacy of device closure of patent foramen ovale (PFO) for treating the patients with PFO combining cryptogenic stroke (CS) and transient ischemic attack (TIA). Methods: A total of 56 PFO patients with CS and TIA receiving device closure in our hospital from 2009-05 to 2015-12 were retrospectively studied. Transthoracic echocardiography (TTE), electrocardiogram (ECG), chest X-ray were examined at 24h, 1 month, 3 and 6 months after theoperation; telephone visit was conducted every 6 months thereafter. Results: There were 54/56 PFO patients combining CS and 2 combining TIA; 53 (94.6%)patients received PFO occluder from Starway medical technology. Aspirin was used for 6 months after the operation. The patients were followed-up for the average of (34.67±23.24) months. No body suffered from post-operative stroke and TIA; no residual shunt was observed. Conclusion: The short and mid-term efficacy of device closure has been satisfactory for treating the patients with PFO combining CS and TIA; its overall clinical value should be further investigated in large population and long-term study.

Objective To assess the feasibility and efficacy of Amplatzer duct occluder Ⅱ (ADOⅡ) in occlusion of aortopulmonary collateral arteries. Methods Seven patients,6 males and 1 female, with aortopulmonary collateral circulation diagnosed previously by cardiac Computed Tomograpy or cardioangiography from Mar 2014 to Apr 2015 were enrolled. All of them were treated with ADO Ⅱ. Results The age of the patients ranged between 5 - 71 months old and weight 4. 2 - 22. 0 kg. Successful hybrid approach was achieved in 6 of 7 patients. One patient failed the occlusion because of severe hypoxemia and mild-moderate residual shunt after catheter intervention. Total 15 aortopulmonary collateral vessels were embolized by 7 ADO-Ⅱ, 22 non-detachable coils ( Cook corp. ) and 2 detachable micro-coils ( Boston Scientific corp. ). Complete embolization was achieved in 2 patients,4 patients had mild residual shunt and 1 patient had mild-moderate residual shunt after the embolisation. No interventional complications recorded. Conclusions ADO Ⅱ has high controllability and suitable for application through small delivery catheter for minimally-invasive procedures to the vessels. It is a preferable alternative in treating pediatric patients with large and tortuous aortopulmonary collateral arteries.

Objective: To analyze the clinical features in patients with hypertrophic cardiomyopathy (HCM) combining left ventricular apical aneurysm (LVAA) . Methods: A total of 1194 HCM patients treated in our hospital from 2007-01 to 2013-01 were studied. There were 23 (1.93%) patients combining with LVAA including 19 male and 4 female; coronary artery disease (CAD) was excluded and the patients received echocardiography and coronary angiography (CAG) examinations. Results: There were 21/23 LVAA patients having left mid-ventricular obstruction and 7 of them combining simultaneous left ventricular outflow obstruction.The average pressure gradient in those 21 patients was (56.8 ± 12.9) mmHg and the rest 2 patients suffered from apical hypertrophic cardiomyopathy.The mean maximum thickness of left ventricular wall was (21.8 ± 6.3) mm and the dimension of left ventricle was (39.4 ± 5.2) mm. Electrocardiography showed that 3 patients had paroxysmal ventricular tachycardia;CAG indicated that 6 patients combined with coronary artery muscular bridge at left anterior descending (LAD) artery. The patients were followed-up for (2.7 ± 1.3) years and adverse cardiovascular events occurred in 5 patients during that period. Conclusion: HCM combining LVAA was most frequently happened in patients with left mid-ventricular hypertrophic cardiomyopathy, some of them combining simultaneous left ventricular outflow obstruction and had the higher occurrence rate of adverse cardiovascular events. Early and accurate diagnosis is very important for guiding clinical treatment.