Objective To observe the echocardiographic manifestations of infective endocarditis(IE)complicated with valve damage in children.Methods Totally 104 children with IE were retrospectively enrolled and divided into non-damage group(n=34),mild damage group(n=39)and dysfunction group(n=31)according to whether complicated with valve damage and damage's degree.The general and echocardiographic data were compared among groups,and the echocardiographic characteristics of IE complicated with valve damage in children were analyzed.Results Significant difference of the proportion of combining with other congenital heart diseases(excluding bicuspid aortic malformations),the incidence of embolization events during hospital stay,also of endocarditis of left cardiac system were found among groups(all P＜0.05).Pairwise comparison showed that in non-damage group,the proportion of combining with other congenital heart diseases was higher,while the incidence of endocarditis of left cardiac system was lower than those in both mild damage group and dysfunction group(all P＜0.05).The incidence of embolization events during hospital stay in non-damage group was lower than that in dysfunction group(P＜0.05).Among 70 cases of IE complicated with valve damage,mitral valve(30/70,42.86％)was the most common involved valve,mostly presented as valve stenosis(63/70,90.00％).No significant difference of valve involvement site,valve structural lesions nor the incidence of valve stenosis was found between mild damage group and dysfunction group(all P＞0.05).Conclusion IE complicated with valve damage in children mostly involved left cardiac system,and the risk of embolization events was higher than that of IE children without valve damage.Echocardiography could be used as an important method for evaluating the site of valve involvement and the degree of damage.

Objective To observe the manifestations of isolated bicuspid aortic valve(i-BAV)in children using echocardiography.Methods Echocardiographic data of 79 children with i-BAV were retrospectively analyzed,and classification of i-BAV was performed.The patients were divided into complication group(n=50)and non-complication group(n=29)according to the existence of valve and/or aortic involvement or not,and echocardiographic parameters were compared between groups.Results After adjusting body surface area(BSA),in complication group,left ventricular end-systolic diameter/BSA was lower,while left ventricular myocardial mass index group was higher than those in non-complication group(both P＜0.05).Type 0 i-BAV was found in 22 cases,with lat subtype as the most common ones(18/22,81.82％),while Type Ⅰ was observed in 57 cases with L-R subtype as the most common ones(39/57,68.42％).The most common subtype in complication group was also Type Ⅰ L-R(31/50,62.00％),with incidence of valve involvement of 90.00％(45/50),mainly including mild aortic stenosis and/or incompetence(37/45,82.22％),and incidence of aorta involvement of 24.00％(12/50),all with type Ⅰ or Ⅱ aortic widening.Conclusion The most common subtype of i-BAV in children was type Ⅰ L-R,with mild valve damage as the main complication and possibility of left ventricular myocardial remodeling.

Objective To establish a prognostic model for lung adenocarcinoma (LUAD) based on genes associated with the disulfidptosis (DS) pathway, and to elucidate its potential biological mechanisms. Methods LUAD-related gene sequencing and clinical information were sourced from public databases.The correlation between results of gene set variation analysis (GSVA) and mRNA expression in The Cancer Genome Atlas (TCGA) dataset was used to screen genes that were significantly active in the disulfur death (DS) pathway.The Least Absolute Shrinkage and Selection Operator (LASSO) analysis and Random Forest (RF) algorithm were employed to screen out DS pathway prognosis-related genes (DPRGs) and multivariate Cox regression analysis was used to construct risk score (RS) model, which was validated using external GEO datasets.The samples were divided into high and low-risk groups based on the median score of RS.A protein-protein interaction (PPI) network corresponding to 7 DPRGs was established, with LDHA identified as the protein with the most interactions, thereby further investigating its function and expression patterns. Results In this study, 7 DPRGs were screened, including SLC2A1, LDHA, SNAI2 and ACO2, FGF12, ANP32B and ST13.The prognostic model constructed based on these genes exhibited high validation efficiency.Kaplan-Meier survival analysis revealed significant differences in overall survival of patients between high-risk group and low-risk group in four datasets.Differential expression gene enrichment analysis between the high-risk and low-risk groups showed that these genes were enriched in pathways such as the p53 signaling pathway and cell cycle. Results of real-time quantitative polymerase chain reaction (qRT-PCR) and immunohistochemistry indicated that LDHA expression levels were elevated in LUAD tissue compared to normal tissues. Conclusion The LUAD model established based on DPRGs can effectively predict patients'prognosis, potentially offering insights into the treatment and prognosis of LUAD patients.

Objective:To evaluate the clinical value of the New England spinal metastasis score (NESMS) in predicting the prognosis of patients with spinal metastases by retrospectively analyzing the medical records of multicenter spinal metastases in China.Methods:The data of 179 patients with spinal metastases from January 2008 to December 2018 were retrospectively collected. There were 108 males (60.3%) and 71 females (39.7%) with an average age of 59.79±10.88 years old (range 27-84 years). The patient demographic characteristics, primary tumor type, spinal metastases and segments, vertebral pathological fractures, neurological Frankel classification, physical function status, Karnofsky performance scale (KPS), visual analogue score (VAS), the spinal instability neoplastic score (SINS), modified Bauer score, NESMS score, Tomita score and modified Tokuhashi score were collected. The clinical value of NESMS score, Tomita score and modified Tokuhashi score in predicting the survival of patients with spinal metastases were compared. The independent factors affecting survival in these patients were analyzed by Cox proportional hazards regression model.Results:Among the 179 patients, the peak incidence of spinal metastases was in the age group of 61-75 years (45.3%, 81/179) of all patients. Lung cancer was the most common primary tumor (46.9%, 84/179). 40.8% (73/179) of patients had multi-segment metastasisand thoracic spine was the most common site with single-site metastasis (26.3%, 47/179). 28.5% (51/179) of the patients had visceral metastases and 52.0% (93/179) of the patients had extraspinal bone metastases. 31.3% (56/179) of the patients had pathological fractures of the involved vertebral bodies.114 patients received surgical treatment (63.4%). The mortality rates in 3-months, 6-months and 1-year were 22.4% (40/179), 51.4% (92/179) and 77.1% (138/179), respectively. The median survival time of patients with NESMS score of 0-3 was 3, 4, 8, and 10 months respectively with the mean survival time was 3.60±2.10, 6.77±3.39, 9.69±5.71 and 10.53±6.25 months. The 1-year mortality rates were 100% (13/13), 87.5% (42/48), 71.6% (63/88) and 66.7% (20/30) respectively. The consistency of NESMS score, Tomita score and modified Tokuhashi score in predicting survival of all patients was 0.63, 0.58 and 0.55, respectively. For patients with spinal metastases, the NESMS score was better than the Tomita score and modified Tokuhashi score in predicting survival at 3-months (AUC=1.00, 0.63, 0.42) and 6-months (AUC=0.71, 0.63, 0.45). But the accuracy of Tomita score was best in predicting survival at 1-year (AUC=0.66, 0.61, 0.38). Multivariate Cox proportional hazards regression model analysis showed that growth rate of primary tumor, neurological function Frankel score, albumin level and surgical treatment were independent factors affecting the survival time of patients with spinal metastases ( P<0.05). Conclusion:The consistency and accuracy of NESMS score in predicting survival of patients with spinal metastases are better than Tomita score and modified Tokuhashi score, especially in predicting 3- and 6-month survival. The growth rate of primary tumor, Frankel classification, albumin level and surgical treatment were independent factors affecting the survival time of patients with spinal metastases.

Objective:To retrospectively analyze the patients with spinal metastases who received surgical intervention and summarize the evolution of their clinical and pathological characteristics and surgical methods.Methods:The data of 703 patients with spinal metastases from January 2007 to December 2018 were collected retrospectively. There were 395 males (56.19%, 395/703) and 308 females (43.81%, 308/703) with an average age of 58.14±11.46 years (range 13-84 years). According to the degree of invasion and thoroughness of tumor resection, the surgical methods could be divided into minimally invasive surgery, decompression surgery, separation surgery, piecemeal resection and total en-bloc spondylectomy surgery. The operative methods were minimally invasive surgery in 89 cases (12.66%), decompression surgery in 96 cases (13.66%), separation surgery in 303 cases (43.10%), piecemeal resection in 182 cases (25.89%) and total en-bloc spondylectomy in 33 cases (4.69%). To analyze the trend of the clinical, pathological types and surgical treatment of patients with spinal metastases over the years, and determine the relevant factors affecting the decision-making of surgical methods by multivariate logistic regression.Results:The ratio of male to female was 1.28:1. 39.54% (278/703) of patients with single-segment involvement in 703 patients, 24.04% (169/703) of patients with double-segment metastasis and 36.42% (256/703) of patients with multi-segment metastasis. The most common type of primary tumor was lung cancer (34.57%, 243/703), followed by breast cancer (8.25%, 58/703), myeloma (8.11%, 57/703), gastrointestinal tumor (6.82%, 48/703) and renal malignant tumor (6.40%, 45/703). From 2007 to 2018, there was no significant difference in the percentage change of different age, gender and primary tumor source composition (age: χ 2=14.01, P=0.233; gender: χ 2=35.73, P=0.341; primary tumor: χ 2=120.09, P=0.074). The percentage of patients with sacrococcygeal metastasis decreased from 20.00% in 2008 to 1.89% in 2017 and the difference was statistically significant (χ 2=8.09, P=0.005). The percentage of patients with multi-level metastasis increased from 26.67% in 2008 to 52.83% in 2017, and the difference was statistically significant (χ 2=7.23, P=0.007). The percentage of patients with minimally invasive surgery decreased from 25.00% in 2007 to 5.88% in 2018, and the percentage of patients with segmented resection decreased from 53.33% in 2008 to 10.29% in 2018. The proportion of the two surgical methods showed a significant downward trend, and the differences were statistically significant (minimally invasive surgery: χ 2=1.46, P=0.026; segmented resection surgery: χ 2=19.56, P<0.001). The percentage of patients undergoing separation surgery increased from 13.33% in 2008 to 64.71% in 2018, and the proportion of patients undergoing total en-bloc spondylectomy increased from 0 in 2007 to 10.29% in 2018. Both surgical methods showed a significant growth trend and the differences were statistically significant (separation surgery: χ 2=27.09, P<0.001; χ 2=4.16, P=0.042). Multivariate Logistic regression analysis showed that age, metastatic site, number of metastatic segments, pathological vertebral fractures, Frankel grade, SINS score and VAS score were independent factors influencing surgical decision-making ( P<0.05). Conclusion:With different time and age, the invasiveness and thoroughness of surgery are increasing, which shows that the percentage of patients who underwent separation surgery and to-tal en-bloc spondylectomy is significantly increasing. Age, metastatic site, number of metastatic segments, pathological vertebral fractures, Frankel grade, SINS score and VAS score are independent factors affecting surgical decision-making.

Objective:To explore the performance characteristics of the digital clock-drawing test(dCDT) for amnestic mild cognitive impairment(aMCI), and its diagnostic value for aMCI patients compared with the traditional clock-drawing test (tCDT).Methods:Total 81 middle-aged and elderly outpatients in Affiliated Hospital to Shanxi Medical University from November 2020 to May 2021 were selected, including 42 cognitively normal people (control group) and 39 aMCI patients (aMCI group). The dCDT developed by our team was used to collect drawing process parameters (such as stroke length, time and speed). The Cognitive Domain Indexs of Montreal Cognitive Assessment (MoCA) were calculated using the CDIS scoring method, and the correlation between dCDT parameters and MoCA indexs were analyzed.Logistic regression analysis was used to construct the predictive model, and the sensitivity and specificity of different methods for the diagnosis of aMCI patients were compared by the area under the ROC curve.Results:(1) The total time(51.25(38.80, 63.75)s vs 42.42(33.64, 51.91)s) and time in air(36.34(26.81, 47.25)s vs 28.47(22.37, 33.98)s) of the aMCI group were significantly higher than those of the control group, and the minute hand/hour hand ratio(1.23±0.35 vs 1.39±0.34), strokes per minute((31.31±10.44) vs (41.05±9.48))and tCDT score(3.0(3.0, 4.0), 4.0(3.0, 4.0))were significantly lower than those of the control group, and the differences were statistically significant (all P<0.05). Other dCDT parameters were not statistically significant between the two groups ( Z=-1.835--0.440, P>0.05). (2) Correlation analysis showed that the total time was negatively correlated with MoCA MIS( r=-0.224, P=0.049), LIS( r=-0.237, P=0.037)and AIS( r=-0.236, P=0.038); time in air was negatively correlated with MoCA MIS( r=-0.268, P=0.018), LIS( r=-0.271, P=0.016), AIS( r=-0.259, P=0.022)and OISA( r=-0.267, P=0.018); the minute hand/hour hand ratio was positively correlated with MoCA EIS( r=0.259, P=0.022)and VIS( r=0.309, P=0.006); the strokes per minute was positively correlated with MoCA MIS( r=0.376, P=0.001), EIS( r=0.290, P=0.010), VIS( r=0.294, P=0.009), AIS( r=0.238, P=0.036)and OISA( r=0.301, P=0.007). (3)dCDT model composed of the pre-second hand latency, the ratio of minute hand/hour hand, and the strokes per minute can correctly classify 77.8% of aMCI, with a sensitivity of 74.36% and a specificity of 80.95%.Its diagnostic power for aMCI was significantly higher than the tCDT scoring( Z=2.335, P=0.02). Conclusion:The cognitive impairment in aMCI can be detected by dCDT, and different dCDT parameters can reflect the impairment of different cognitive domains.Compared with tCDT scoring, dCDT can improve the diagnostic efficacy of aMCI patients.

Objective:To investigate the precise reconstruction method of anterior maxillary defect with fibula musculocutaneous flap assisted by digital surgical technology.Methods:The clinical data of the patients with anterior maxillary defect repaired by fibular free flap from January 2014 to January 2020 in Nanjing Stomatological Hospital were analyzed retrospectively. Mimics 23.0 software was used to perform computer virtual surgery using preoperative CT data of patients. Then the design of the focal osteotomy guide plate, fibular plastic guide plate and fibular reduction guide plate as well as the surgical plan was completed. The navigation registration point was designed by the Accunavi-A navigation system. The surgical guide plates were 3D printed. During the operation, the fibular musculocutaneous flap was harvested to cover the defect after resection of the anterior maxillary lesion with the assistance of the surgical guide plate and navigation technology. The facial appearance and function were followed up after operation.Results:A total of 12 cases, 9 males and 3 females, aged from 33 to 56 years, were included. There were 5 cases of gingival carcinoma, 4 cases of ameloblastoma, 1 case of chondrosarcoma, 1 case of mucoepidermoid carcinoma and 1 case of odontogenic myxoma. The size of the defect after resection was 5 cm×4 cm-6 cm×5 cm. In 12 patients, the focal osteotomy guide plate and fibula plastic guide plate were designed accurately, and the fibular reduction guide plate was successfully placed with accurate navigation and no displacement during the operation. The position of transplanted fibula was consistent with the normal maxillary position. The length of fibula was 8 -10 cm, and the size of the fibular free flap was 5 cm× 4 cm-6 cm×5 cm. All fibular musculocutaneous flaps survived. The patients were followed up for 1 to 72 months, with an average of 24.5 months. The patients had clear pronunciation, no oral and nasal reflux during diets, and presented in good facial appearance. No tumor recurrence occurred in 12 patients during follow-up.Conclusions:It is an accurate and feasible method to repair the anterior maxilla defect with fibula free flap assisted by digital surgical technology. The function of oral and nasal closure and speech was well maintained. A satisfactory facial appearance was obtained.

Objective:To investigate the precise reconstruction method of anterior maxillary defect with fibula musculocutaneous flap assisted by digital surgical technology.Methods:The clinical data of the patients with anterior maxillary defect repaired by fibular free flap from January 2014 to January 2020 in Nanjing Stomatological Hospital were analyzed retrospectively. Mimics 23.0 software was used to perform computer virtual surgery using preoperative CT data of patients. Then the design of the focal osteotomy guide plate, fibular plastic guide plate and fibular reduction guide plate as well as the surgical plan was completed. The navigation registration point was designed by the Accunavi-A navigation system. The surgical guide plates were 3D printed. During the operation, the fibular musculocutaneous flap was harvested to cover the defect after resection of the anterior maxillary lesion with the assistance of the surgical guide plate and navigation technology. The facial appearance and function were followed up after operation.Results:A total of 12 cases, 9 males and 3 females, aged from 33 to 56 years, were included. There were 5 cases of gingival carcinoma, 4 cases of ameloblastoma, 1 case of chondrosarcoma, 1 case of mucoepidermoid carcinoma and 1 case of odontogenic myxoma. The size of the defect after resection was 5 cm×4 cm-6 cm×5 cm. In 12 patients, the focal osteotomy guide plate and fibula plastic guide plate were designed accurately, and the fibular reduction guide plate was successfully placed with accurate navigation and no displacement during the operation. The position of transplanted fibula was consistent with the normal maxillary position. The length of fibula was 8 -10 cm, and the size of the fibular free flap was 5 cm× 4 cm-6 cm×5 cm. All fibular musculocutaneous flaps survived. The patients were followed up for 1 to 72 months, with an average of 24.5 months. The patients had clear pronunciation, no oral and nasal reflux during diets, and presented in good facial appearance. No tumor recurrence occurred in 12 patients during follow-up.Conclusions:It is an accurate and feasible method to repair the anterior maxilla defect with fibula free flap assisted by digital surgical technology. The function of oral and nasal closure and speech was well maintained. A satisfactory facial appearance was obtained.

Objective To improve the quality control standard of the hospital preparation Kechuan Liuwei oral liquid in Longhua Hospital.Methods TLC was used for qualitative identification of Scutellaria baicalensis Georgi and Asarum sieboldi Mig in the Kechuan Liuwei oral liquid.Ephedrine and Baicalin content in ephedra and Scutellaria were determined by HPLC with Welch-C18column (4.6mm×250mm, 5μm).Acetonitrile-0.1％phosphoric acid solution (4∶96) and methanol-0.1％phosphoric acid solution (47∶53) were used as mobile phase.The detection wavelengths were 206nm and 278nm respectively.The flow rate was 1.0ml/min.Results The TLC spots of Scutellaria baicalensis Georgi and asarum were clear without interference of the negative control.The linear range of Ephedrine hydrochloride was within 12.04-301.00μg/ml (r=0.999 9).The average recovery was 101.7％ (RSD=1.5％).The linear range of Pseudoephedrine hydrochloride was within 7.98-199.40μg/ml (r=0.999 9).The average recovery was 101.6％ (RSD=2.4％).The linear range of Baicalin was within 5.18-129.50μg/ml (r=0.999 9).The average recovery was 101.0％ (RSD=0.3％).Conclusion The qualitative identification and the active ingredient assay method established in this experiment were simple and feasible.Those methods can be used as the quality control standard for Kechuan Liuwei oral liquid.

Objective To investigate the value of echocardiography in assessing the right heart function of patients with chronic obstructive pulmonary disease (COPD). Methods Forty-four COPD patients who were treated in Beijing Anzhen Hospital of Capital Medical University, from April 2016 to April 2017, were selected as COPD group; and 12 healthy physical examiners were included in healthy control group during the same period. Patients were divided into COPD with pulmonary hypertension (PH) group and COPD without PH group. All subjects were routinely examined by transthoracic echocardiography. The parameters of right heart function of all subjects were measured by echocardiography according to 2010 guideline of American Society of Echocardiography (ASE). Independent sample t test was used to compare echocardiographic routine parameters and recommended parameters of ASE guideline between COPD group and healthy control group. One-way analysis of variance was used to compare the routine parameters of echocardiography and the recommended parameters of the ASE guide in the patients of COPD with PH group and COPD without PH group and the healthy control group. SNK-q test was used for comparison between groups. Results The right ventricle diameter (RVD) in group COPD was wider than that in healthy control group [(20.68±4.21) mm vs (18.17±1.75) mm], and the difference was statistically significant (t=2.92, P=0.005). There was no significant difference in the right ventricular outflow tract (RVOT), main pulmonary artery diameter (MPAD), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD) and left ventricular ejection fraction (LVEF) between the COPD group and the healthy control group. Compared with the healthy control group, the diameter of right ventricle basal segment in the COPD group increased [(35.92±8.12) mm vs (27.75±3.17) mm], tricuspid annular plane systolic excursion (TAPSE) decreased [(19.61±4.08) mm vs (22.67±2.67) mm], right ventricular index of myocardial performance (RIMP) increased [(0.52±0.10) cm/s vs (0.43±0.04) cm/s)], and the differences were statistically significant (t=3.39, P=0.001; t=-2.44, P=0.019; t=4.31, P ＜ 0.001). There was no significant difference in right atrium area, E/A, E/E' and S' between COPD group and healthy control group. There was no significant difference in RVOT, RVD, MPAD, LVEDD, LVESD and LVEF in the patients of COPD with PH group and COPD without PH group and in the healthy control group. There was no significant difference in the right atrium area, E/A, E/E', TAPSE and S'. The right ventricular basal segment diameter and RIMP of COPD with PH group and COPD without PH group were higher than those of healthy control group [(37.99±9.66) mm, (34.47±6.70) mm vs (27.75±3.17) mm; (0.54±0.13) cm/s, (0.51±0.08) cm/s vs (0.43±0.04) cm/s]. The differences were statistically significant (q=6.960, 4.905, 5.796, 4.348, all P＜0.05). However, there was no significant difference in right ventricular basal segment diameter and RIMP between COPD with PH group and COPD without PH group. The RVWT of COPD with PH group was higher than that of COPD without PH group [(5.29±0.69) mm vs (4.54±0.70) mm], and the difference was statistically significant (t=3.313, P=0.002). Conclusions The method recommended in the ASE guidelines for this study was more sensitive than conventional methods for the detection of changes in the structure of the right heart. The change of the right ventricular structure was the first manifestation of right heart involvement in COPD patients, and then the systolic function of the right ventricle diminished. The long-term effect of pulmonary hypertension was thickening of the right ventricular wall at the early stage and then enlargement of the right ventricle.