Objective:Interruption of aortic arch(IAA)is a rare congenital heart disease.This study aims to investigate echocardiographic features and pathological ultrastructural characteristics of fetal IAA and to further analyze its pathological evolution. Methods:A retrospective analysis was conducted on prenatal echocardiographic,post-surgical,or autopsy findings of fetuses prenatally diagnosed with IAA.Prenatal echocardiographic tracking was used to observe the internal diameters and Z-scores of different segments of the aortic arch and the changes in the narrowed section.These observations were combined with autopsy and pathological findings to explore the potential intrauterine evolution of IAA and its cytological basis. Results:The study included 34 fetuses with IAA,with 3,3,and 28 fetuses prenatally diagnosed with aortic arch dysplasia(AAD),coarctation of aorta(CoA),and IAA,respectively.The 3 AAD and 3 CoA fetuses chose termination of pregnancy 1 to 2 weeks after prenatal ultrasound diagnosis,and autopsy confirmed IAA.Among the 28 fetuses prenatally diagnosed with IAA,6 cases of CoA progressively worsened,eventually evolving into type A IAA as observed through echocardiographic follow-up.The remaining 22 cases were diagnosed as IAA on the first prenatal ultrasound.Postnatal surgery corrected 3 cases,while 27 cases opted for pregnancy termination,and 4 cases resulted in intrauterine death.Echocardiographic features of the fetal IAA included a significantly smaller left ventricle compared with the right or negligible difference on the four-chamber view,a significantly smaller aorta than the pulmonary artery on the three-vessel view,and a lack of connection between the aorta and the descending aorta on the three-vessel-trachea and aortic arch views.The aortic arch appears less curved and more rigid,losing the normal"V"shape between the aorta,ductus arteriosus,and descending aorta.Color Doppler ultrasound showed no continuous blood flow signal at the interruption site,with reversed blood flow visible in the ductus arteriosus.Transmission electron microscopy of 7 IAA fetuses revealed numerous disorganized smooth muscle cells between the elastic membranes near the aortic arch interruption site,significantly increased in number compared with the proximal ascending aorta.The elastic membranes were thicker and more twisted near the interruption site.The interruption area lacked normal endothelial cells and lumen,with only remnants of necrotic endothelial cells,disorganized short and thick elastic membranes,and randomly arranged smooth muscle cells. Conclusion:Prenatal echocardiography is the primary diagnostic tool for fetal IAA.Post-surgical follow-up and autopsy help identify complications and disease characteristics,enhancing diagnostic accuracy.Some fetal IAA may evolve from AAD or CoA,with potential pathogenesis related to ischemia,hypoxia,and migration of ductal constrictive components.

Early distinction of bipolar disorder (BD) from major depressive disorder (MDD) is difficult since no tools are available to estimate the risk of BD. In this study, we aimed to develop and validate a model of oxidative stress injury for predicting BD. Data were collected from 1252 BD and 1359 MDD patients, including 64 MDD patients identified as converting to BD from 2009 through 2018. 30 variables from a randomly-selected subsample of 1827 (70%) patients were used to develop the model, including age, sex, oxidative stress markers (uric acid, bilirubin, albumin, and prealbumin), sex hormones, cytokines, thyroid and liver function, and glycolipid metabolism. Univariate analyses and the Least Absolute Shrinkage and Selection Operator were applied for data dimension reduction and variable selection. Multivariable logistic regression was used to construct a model for predicting bipolar disorder by oxidative stress biomarkers (BIOS) on a nomogram. Internal validation was assessed in the remaining 784 patients (30%), and independent external validation was done with data from 3797 matched patients from five other hospitals in China. 10 predictors, mainly oxidative stress markers, were shown on the nomogram. The BIOS model showed good discrimination in the training sample, with an AUC of 75.1% (95% CI: 72.9%-77.3%), sensitivity of 0.66, and specificity of 0.73. The discrimination was good both in internal validation (AUC 72.1%, 68.6%-75.6%) and external validation (AUC 65.7%, 63.9%-67.5%). In this study, we developed a nomogram centered on oxidative stress injury, which could help in the individualized prediction of BD. For better real-world practice, a set of measurements, especially on oxidative stress markers, should be emphasized using big data in psychiatry.
Biomarkers/metabolism* ; Bipolar Disorder/metabolism* ; Depressive Disorder, Major/diagnosis* ; Early Diagnosis ; Humans ; Oxidative Stress

Objective:To investigate the effect of L-carnitine on myocardial ischemia-reperfusion injury in patients undergoing coronary artery bypass grafting (CABG) operation.Methods:The clinical data of 60 patients who had underwent CABG under extracorporeal circulation in Department of Cardiovascular Surgery, the First Affiliated Hospital of Medical College of Xi′an Jiaotong University from January 2015 to December 2017 was retrospectively analyzed. L-carnitine was infused into the patients in the observation group while the equal amount of normal saline was given to the patients in the control group during perioperative period. Venous blood was collected from each patient 1 hour before the surgery and at 2, 6, 24 and 72 hours after unclamping the aorta, then serum levels of aspartate aminotransferase (AST), lactic acid dehydrogenase (LDH), creatine kinase (CK), and creatine kinase-MB isozyme (CK-MB) were detected. Additionally, cardiac function indices including stroke volume (SV), left ventricular diastolic diameter (LVDD), cardiac output (CO), Left ventricular ejection fraction (lVEF) were compared between the two group patients before the surgery and 6 days after operation.Results:Compared with before the operation, the levels of serum enzymes were all significantly increased after unclamping the aorta. The levels of serum AST, LDH and CK reached their peak at 24 hours after unclamping the aorta. Notably, the levels of serum AST, LDH and CK in the experimental group were lower than that in the control group at each time point after unclamping the aorta ( P<0.05). For serum CK-MB, the level in the experimental group reached its peak at 6 hours after unclamping the aorta, while the peak value was observed at 24 hours after unclamping the aorta in the control group. The level of CK-MB in the experimental group was significantly decreased compared with the control group at each time point after unclamping the aorta ( P<0.05). Moreover, there were no significant differences in cardiac function indices between the 2 groups before the operation ( P>0.05). The levels of SV, CO and LVEF in the experimental group were significantly increased while the level of LVDD was obviously decreased compared to that in the control group after the operation ( P<0.05). Conclusions:L-carnitine has protective effects on myocardial ischemia-reperfusion injury in patients undergoing CABG operation under cardiopulmonary bypass, with reducing serum levels of myocardial enzyme in these patients.

Objective:To explore the key influencing factors of public protective action from the angle of risk perception, protective cognition and authority trust so as to build the public protective action decision model in city with COVID-19.Methods:From 2ed February, 2020 to 6th February, 2020, we carried out cross-sectional investigation among 1 201 publics selected by convenience sampling with the "Wen Juan Xing" electronic questionnaire collection system. The investigation tool included the general information questionnaire and the COVID-19 public protective decision-making scale. SPSS 22.0 was used to data statistics and AMOS 23.0 was applied to explore correlations among four variables, risk perception, protective cognition, authority trust and protective action, so as to build the COVID-19 public protective action decision model.Results:The structural equation model had a high level of goodness-of-fit, the direct effect of risk perception on protective action was 0.410; the direct effect of protective cognition on protective action was 0.070; the total effect of authority trust on protective action was 0.377.Conclusions:In China, the public have good compliance of protective action. The model can effectively forecast the protective action of COVID-19 among city publics.

Objective To investigate the effect of intravenous drip of levocarnitine during perioperative period on serum cytokines and cardiac troponin (cTn) I in patients undergoing coronary artery bypass grafting (CABG) under extracorporeal circulation. Methods The clinical data of 70 patients who had underwent CABG under extracorporeal circulation in Department of Cardiovascular Surgery, the First Affiliated Hospital of Medical College of Xi′an Jiaotong University from January 2015 to December 2017 were retrospectively analyzed. Among them, 35 cases were treated with intravenous infusion of levocarnitine (experiment group), and 35 cases were not treated with intravenous infusion of levocarnitine (control group). The serum levels of cTnI, tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-8 and IL-10 1 h before operation and 2, 6, 24, 72 h after aorta open were detected; the postoperative recovery and complication were recorded. Results There were no statistical differences in TNF-α, IL-6, IL-8, IL-10 and cTnI before operation between 2 groups (P＞0.05); the indexes 2, 6, 24 and 72 h after aorta open were significantly higher than those before operation, and there were statistical differences (P＜0.05). The TNF-α, IL-6 and cTnI 2, 6, 24 and 72 h after aorta open in experiment group were significantly lower than those in control group, and the IL-10 was significantly higher than that in control group; the IL-8 2, 6 and 24 h after aorta open in experiment group were significantly lower than that in control group, and there were statistical differences (P＜0.05). The ICU monitoring time, electrocardio-monitoring time, duration of antibiotic treatment, duration of drainage tube, mechanical ventilation time and length of hospital stay in experiment group were significantly shorter than those in control group: (2.9 ± 0.5) d vs. (3.5 ± 0.8) d, (5.7 ± 1.8) d vs. (7.6 ± 3.2) d, (6.7 ± 1.5) d vs. (9.8 ± 2.2) d, (3.1 ± 0.8) d vs. (3.9 ± 1.4) d, (3.3 ± 2.1) d vs. (5.1 ± 2.3) d and (8.1 ± 2.2) d vs. (12.8 ± 2.6) d, and there were statistical differences (P＜0.01). Moreover, there were no severe perioperative complications such as myocardial infarction and pulmonary infection in 2 groups. Conclusions Intravenous drip of levocarnitine during perioperative period could effectively control postoperative inflammatory response and myocardial injury in patients undergoing CABG under extracorporeal circulation. The effect of levocarnitine may be related to its ability to balance the levels between proinflammatory cytokines and anti-inflammatory cytokines.

Objective To investigate the difference of curative effects and prognosis between coronary artery bypass grafting with and without cardiopulmonary bypass.Methods 152 patients who were operated using off-pump coronary artery bypass grafting (OPCABG) and 107 patients who were performed with on-pump coronary artery bypass grafting (CABG) in the authors'department during the period from October 2013 to October 2017 were included in the study.The differences of postoperative recovery and major complications between the two groups were analyzed.Results Compared with CABG group,patients in OPCABG group had shorter intensive care unit (ICU) monitoring time,electrocardio-monitoring time,duration of antibiotic treatment,time of drainage tube intubation,mechanical ventilation time,arterial piezometer tube monitoring time and length of hospital stay (P ＜ 0.05).And postoperative draining fluid volume in patients of OPCABG group was also less than that in CABG group (P ＜ 0.05).Additionally,there was no difference between the two groups in postoperative parameters including renal insufficiency,using intra-aortic balloon pump (IABP) machine,perioperative myocardial infarction,second operation for hemorrhage,the occurrence of postoperative arrhythmias and cerebrovascular accident (P ＞ 0.05).However,the incidence of postoperative pulmonary infection was significantly higher in patients of CABG group than that in OPCABG group (P ＜ 0.05).Conclusions The incidence of postoperative pulmonary infection was significantly decreased in OPCABG group compared with that in CABG group.And the postoperative recovery of patients undergoing off-pump coronary artery bypass grafting was superior to that of patients undergoing onpump coronary artery bypass grafting.

Objective: To investigate the effect of Calcium dibutyryladenosine cyclophosphate on myocardial ischemia-reperfusion injury in patients undergoing coronary artery bypass grafting (CABG) operation. Methods: The clinical data of 62cases were retrospectively analyzed. These patients were performed coronary artery bypass graft (CABG) operation under cardiopulmonary bypass (CPB) in the First Affiliated Hospital of Medical College of Xi′an Jiaotong University from January 2013 to January 2016. According to the use calcium dibutyryladenosine cyclophosphate, 62 patients were divided into the control group and the experimental group. Thirty-one cases in the experimental group were given an intravenous drip of calcium dibutyryladenosine cyclophosphate, while other 31 cases in the control group were not given to calcium dibutyryladenosine cyclophosphate during perioperative period. Venous blood was collected from each patient 1 h before the surgery and 2, 6, 24 and 72 h after unclamping the aorta, then serum levels of aspartate aminotransferase (AST), lactic acid dehydrogenase (LDH), creatine kinase (CK), and creatine kinase-MB isozyme (CK-MB) were detected. Additionally, cardiac function indices including SV, LVDD, CO, LVEF in these patients were recorded before the operation and 6 days after operation. Results: Compared with those before the operation, the levels of serum enzymes were all significantly increased after unclamping the aorta. The levels of serum AST, LDH and CK reached their peak 24 h after unclamping the aorta. Notably, the levels of serum AST, LDH and CK in the experimental group were lower than those in the control group at each time point after unclamping the aorta (P < 0.05). For serum CK-MB, the level in both the two groups reached its peak 6 h after unclamping the aorta. The level of CK-MB in the experimental group was significantly decreased compared with that in the control group 6, 24 and 72 h after unclamping the aorta (P < 0.05). Moreover, there were no significant differences in cardiac function indices between the 2 groups before the operation (P > 0.05). The levels of SV, CO and LVEF in the experimental group were significantly increased while the level of LVDD was obviously decreased compared to that in the control group after the operation, SV: (70.93 ± 9.72) ml vs. (65.07 ± 6.81) ml, CO: (5.32 ± 0.98) L vs. (4.29 ± 0.91) L, LVEF: (57.87 ± 8.92)% vs. (52.68 ± 7.31)% and LVDD: (55.67 ± 4.12) mm vs. (62.85 ± 5.71) mm, and there were statistical differences (P < 0.05). Conclusions Calcium dibutyryladenosine cyclophosphate has protective effects on myocardial ischemia-reperfusion injury and cardiac function in patients undergoing CABG operation under CPB, by reducing serum levels of myocardial enzymes in these patients.

Objective To investigate the abnormal change of gray matter volume in patients with euthymic bipolar disorder Ⅰ (BD-Ⅰ),and to elucidate the relationship between the use of different mood stabilizers and brain structure variations.Methods Voxel-based morphometry (VBM) was used to analyze the volume of local gray matter in 35 patients with BD-Ⅰ and 30 healthy controls(HC).The patients were divided into BD-Ⅰ with lithium group and BD-Ⅰ with valproate group according to different mood stabilizers.The volume differences of gray matter of the three groups were compared by one-way ANOVA.Results Compared with HC,BD-Ⅰ patients showed significantly reduced gray matter volume in the medial frontal cortex (MNI (x,y,z):2,34,-18),orbital frontal cortex (MNI(x,y,z):-32,22,-4),frontal operculum (MNI(x,y,z):38,18,4) and insula cortex (MNI(x,y,z):-32,22,-4) (P＜0.05).There was no significant difference in thevolume of gray matter between BD-Ⅰ with lithium group and BD-Ⅰ with valproate group(P＞0.05).Conclusion Emotional disturbance in patients with BD-Ⅰ may be associated with reduced gray matter volume in the medial frontal cortex,orbital frontal cortex,frontal operculum and insula cortex.There are not significant difference about the effects of lithium carbonate and valproate on cerebral gray matter volume in patients with BD-Ⅰ.

Objective To study the, influencing factors of suicide-committing risks among hospitalized depressive patients. Methods Based on qualitative diagnoses, 102 patients were divided into non-suicide and suicide group.The two groups were compared in terms of general information, score by the Beck hopelessness scale (BHS) and the suicide subscale of the Chinese version of mini-international neuropsychiatric interview (MINI). Logistic regression was applied to analyze the related factors of suicide-committing risk in depressive patients. Results Among the 102 patients, 70 cases had tendency to commit suicide, accounting 68.6% , and 32 did not, accounting for 31.4%. Multivariate logistic regression suggested that the score of the suicide subscale of MINI could effectively predict the suicide tendency (P＜0.001). Conclusions The suicide-committing risk is high in the depressive patients. The MINI suicide risk is the influencing factor of suicide-committing risk and can be used to predict suicide tendency in hospitalized depression patients. More attention should be paid to patients at high risk and relevant nursing countermeasures should be taken for effective intervention.