Objective To evaluate early outcomes of transthoracic pulmonary valve implantation for the treatment of moderate and severe pulmonary regurgitation by using homemade self-expanding valve (SalusTM). Methods Patients with severe pulmonary regurgitation who underwent transthoracic pulmonary valve implantation in Guangdong Provincial People’s Hospital from September 2, 2021 to November 25, 2022 were prospectively enrolled. The early postoperative complications and improvement of valve and heart function were summarized and analyzed. Results A total of 25 patients were enrolled, including 16 males and 9 females, with an average age of 24.5±1.5 years and an average weight of 57.0±3.0 kg. The mean systolic diameters of the bifurcation near the main pulmonary artery, the stenosis of the middle segment of the aorta and near the valve of the right ventricular outflow tract of the patients were 31.8±7.4 mm, 30.6±5.9 mm and 38.4±8.0 mm, respectively. All patients were successfully implanted with valves, and there were no serious complications such as death, coronary compression, stent fracture, valve displacement and infective endocarditis in the early postoperative period. The indexed left atrial longitudinal diameter, indexed right atrial longitudinal diameter, and indexed right ventricular outflow tract anteroposterior diameter decreased significantly after the operation. The degree of tricuspid and pulmonary valve regurgitation and the indexed regurgitation area decreased significantly. The above differences were statistically significant (P<0.05). Conclusion The early outcomes of transthoracic pulmonary valve implantation with homemade self-expanding pulmonary valve (SalusTM) in the treatment of severe pulmonary regurgitation is relatively good, and the long-term outcomes need to be verified by the long-term follow-up studies with large samples.

Objective    To investigate the predictive value of right atrial myocardial fibrosis in the prognosis of isolated tricuspid regurgitation surgery after left heart valve surgery. Methods    The patients who underwent tricuspid valvuloplasty by the same operator in Guangdong Provincial People's Hospital from April 2016 to August 2021 due to long-term isolated severe tricuspid regurgitation after left heart valve surgery were included in the study. According to the degree of right atrial myocardial fibrosis, the patients were divided into three groups: a mild group, a moderate group, and a severe group. The clinical data of these patients were compared and analyzed. Results    A total of 75 patients were enrolled, including 16 males and 59 females with an average age of 57.0±8.4 years. There were 30 patients in the mild group, 29 patients in the moderate group and 16 patients in the severe group. In terms of the preoperative data, there were statistical differences in cardiac function grade, right atrial diameter, tricuspid incompetence area among the three groups (P<0.05). In terms of the postoperative data, there were statistical differences among the three groups in the cardiopulmonary bypass time, mechanical ventilation time, ICU monitoring time, complication rate and mortality (P<0.05). Further pairwise comparison showed that, compared with the mild group, the severe group had longer mechanical ventilation time (P=0.024), longer ICU monitoring time (P=0.003) and higher incidence of postoperative complications (P=0.024), while the moderate group had no statistical difference in all aspects (P>0.05); compared with the moderate group, the severe group had longer ICU monitoring time (P=0.021) and higher incidence of complications (P=0.006). Conclusion    The early outcome of tricuspid valvuloplasty in patients with isolated tricuspid regurgitation after left heart valve surgery with severe right atrial myocardial fibrosis is worse than that in the patients with mild and moderate fibrosis, suggesting that the degree of myocardial fibrosis in the right atrium can be a predictor of the effect of tricuspid regurgitation surgery and a judgement indicator of the surgery timing.

Objective:To evaluate the anesthetic efficacy of remiazolam combined with alfentanil in the patients undergoing painless gastroscopy.Methods:A total of 400 patients of both sexes, aged 20-64 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, scheduled for elective painless gastroscopy, were divided into 2 groups ( n=200 each) using the computer-generated random numbers: remimazolam combined with alfentanil group (group RA) and propofol combined with alfentanil group (group PA).All subjects inhaled oxygen and were denitrogenated by deep inhalation.Alfentanil 7 μg/kg and remimazolam 0.2 mg/kg were intravenously injected in group RA, and alfentanil 7 μg/kg and propofol 1.5 mg/kg were intravenously injected in group PA.When body movement occurred during operation, remimazolam 2.5 mg was intravenously injected in group RA, propofol 0.5 mg/kg was intravenously injected in group PA, and anesthesia was defined as failure when there was still body movement after 3 times of additional injection within 15 min.The success of anesthesia, effective time of sedatives, time of gastroscopy, emergence time, perioperative adverse reactions, and satisfaction score of endoscopic surgeons-anesthesiologists-patients were assessed using visual analog scale score. Results:Compared with group PA, the incidence of hypotension (6.2%/14.0%), bradycardia (6.2%/19.0%), respiratory depression (3.1%/8.0%), injection pain (2.1%/30.0%), postoperative nausea (6.3%/25.0%), fatigue (7.8%/14.0%) was significantly decreased, and the incidence of hiccup (8.3%/1.0%) and patient′ s satisfaction score were increased in group RA ( P<0.05).There was no significant difference between the two groups in the success rate of sedation, effective time of sedatives, time of gastroscopic examination, emergence time, satisfaction scores of anesthesiologists-endoscopic surgeons, and incidence of postoperative vomiting, dizziness, and lethargy ( P>0.05). Conclusions:Compared with conventional anesthesia for painless gastroscopy, remiazolam (0.2 mg/kg) combined with alfentanil (7 μg/kg) has a certain optimization effect in anesthesia for gastroscopy.

Objective:To investigate the changes of inflammatory factors and immune function in bronchial asthma children with Mycoplasma pneumoniae infection.Methods:From March 2019 to March 2020, 78 children with bronchial asthma and Mycoplasma pneumoniae infection in Wenling Maternal and Child Health Hospital were selected as observation group, and 50 bronchial asthma children without Mycoplasma pneumoniae infection during the same period were selected as control group.The levels of inflammatory factors, including tumor necrosis factor-α(TNF-α), interleukin-8(IL-8) and interleukin-13(IL-13), immunoglobulin A(IgA), immunoglobulin G(IgG) and immunoglobulin M(IgM) were measured by enzyme-linked immunosorbent assay, and the changes of T lymphocyte subsets in peripheral blood were measured by flow cytometry.Results:The serum levels of TNF-α[(76.42±16.51)ng/L], IL-8 [(130.92±25.45)ng/L] and IL-13 [(172.35±28.39)ng/L] in the observation group were higher than those in the control group [(58.93±13.24)ng/L, (89.65±17.42)ng/L and (108.47±21.42)ng/L] ( t=6.708, 11.025, 14.665, all P<0.05). The serum levels of IgA [(0.64±0.16)g/L] and IgG [(7.31±1.26)g/L] in the observation group were lower than those in the control group [(1.04±0.19)g/L and (8.64±1.35)g/L], while the serum level of IgM [(1.29±0.24)g/L] was higher than that in the control group [(0.97±0.18)g/L] ( t=12.587, 5.864, 8.714, all P<0.05). The CD 3+ [(62.08±3.87)%], CD 4+ [(38.98±3.31)%] and CD 4+ /CD 8+ (1.29±0.13) in the observation group were lower than those in the control group [(71.38±4.35)%, (45.37±3.18)% and (1.87±0.25)] ( t=12.549, 11.103, 15.512, all P<0.05). Conclusion:Children with bronchial asthma and Mycoplasma pneumoniae infection have obvious inflammatory reaction and low immune function.

Objective To analyze the relationship between ferritin, carbohydrate antigen (CA)125, CA153, lactic dehydrogenase (LDH), albumin and progression and prognosis of Sj?gren's syndrome with inter-stitial pneumonitis (pSS-IP). Methods Five hundred and twenty-seven primary pSS patients from 2011 to 2017 were analyzed retro-spectively. According to the lung imaging and clinical features, they were divided into groups. The differences of ferritin, CA125, CA153, LDH and albumin (ALB) levels in each group were analyzed by Mann-Whitney U test. Logistic regression was used to analyze the risk factors of pSS complicated with interstitial pneumonitis. Results ① Among the 527 pSS patients, 206 (39.1％) were diagnosed with IP. Compared with 321 patients without interstitial pneumonitis (pSS-N-IP), ferritin, CA125, CA153 and LDH in pSS-IP were relatively higher [189(116, 380) ng/ml vs 138(75, 258) ng/ml, Z=-3.777, P<0.05;19(12, 36) U/ml vs 12(9, 19) U/ml, Z=-5.974, P<0.05;22(12, 34) U/ml vs 9(6, 14) U/ml, Z=-4.582, P<0.05;206(165, 258) U/L vs 161(139, 195) U/L, Z=-8.770, P<0.05], while albumin was lower [34(31, 37) g/L vs 36(34, 39) g/L, Z=5.210, P<0.05]. ② pSS-IP were divided into pSS-IP progression group (46 cases) and pSS-IP stable group (60 cases) according to their lung imaging characteristics. Compared with pSS-IP stabilization group, pSS-IP progression group had higher ferritin [254(129, 693) ng/ml vs 161(104, 259) ng/ml, Z=-2.437, P<0.05]. ③ Logistic regres-sion analysis showed that there was correlation between ferritin and the progress of pSS-IP (OR=1.002). Conclusion Ferritin, CA125, CA153, LDH, albumin are related to pSS-IP. Ferritin isrelated to the progress of pSS-IP, and is a risk factor for the progress of pSS-IP.

Objective To get well-informed of the current status of emergency training in primary hospitals in Sichuan Province and to find weaknesses in the system in order to provide scientific basis for emergency knowledge and skills training.Methods A stratified random cluster sampling method as adopted and an anonymous questionnaire survey method was conducted to investigate the basic circumstances of the current training and the training needs of 1 000 emergency medical staff in 9 regions throughout Sichuan Province.Results The scope of the survey covered emergency doctors,nurses and technicians in hospitals of Grade Ⅱ,Grade Ⅲ and below.A total of 1 000 surveys were sent out and 983 were recovered.The questionnaire completion rate was 98.3％.The respondents mainly worked for more than 10 years,most of which with Bachelor degree,junior and intermediate titles.Results of the survey showed,63.1％ Most respondents have only one or two training opportunities per year.The training methods are mainly continuing education (59.0％,580 trips),training organized within the unit (58.5％,575 trips),and training organized by health administrative units (39.3％,386 trips).The main contents of the training are:basic professional skills learning (66.7％,655 trips),basic professional theoretical study (59.2％,582 trips),and new emergency technology (42.5％,418 trips),only 32.0％ of the respondents believe that these methods meet the practical needs.The main factors that influence participation in the training were:not be arranged by employer (36.2％,356 trips);the training was different from actual work (31.6％,311 trips);no replacement for work so they couldn't join training (29.8％,293 trips).The survey showed that the most desirable way of training is:practical application (60.1％,591 trips) and the most desirable training content is:emergency first aid knowledge (73.7％,724 trips).There were significant differences in case discussion,technical observation,academic lectures,special study trainingand learning methods in hospitals of different levels (P＜0.05),but there was no significant difference in the choice of professional practice methods (P＞0.05),and the selection of training contents was in emergency first aid knowledge,general medical knowledge and prevention and treatment of chronic diseases.There was no statistical difference in the selection of training contents of knowledge,infectious disease knowledge and department management knowledge (P＞0.05).There were significant differences in the choice of nursing knowledge training (P＜0.05).Conclusion The current situation showed a lack of first-aid knowledge and skills training for emergency personnel in Sichuan Province.The present situation of skill training can't satisfy the need of their desire to participate in training.It is urgent to develop a standardized,systematic and scientific training mode to improve the emergency first aid ability of primary medical and emergency personnel.

Objective To investigate the influence of age on recovery from neuromuscular blocking after continuous infusion of rocuronium bromide.Methods A total of 60 patients receiving general anesthesia were assigned to one of four groups according to age:≤44 years old group (n=12),45-59 years old group (n=18),60-74 years old group (n=15),and ≥75 years old group (n=15).Total intravenous anesthesia was used for both induction and maintenance of anesthesia.The train-of four (TOF) was applied for measuring acceleromyography.The induction of anesthesia was conducted with 0.6 mg/kg rocuronium bromide,and 0.3-0.6 mg · kg-1 · h-1 rocuronium bromide was continuously intravenouoly infused until 30 minutes before the end of operation by a micro-pump to maintain T1 between 10-20％.Recovery index (RI),recovery time of TOFr 70％ and TOFr 90％,and the average infusion rate of the four groups were collected.Results The RI,TOFr 70％ recovery time,and TOFr 90％ recovery time in the ≥75 years old group [28.9±10.0,(59.8±12.1) min,(38.6±10.6) min] were higher than those in the other three groups [≤44 years old group:21.4±7.0,(40.2±11.0) min,(27.610.0) min;the 45-59 years old group:22.8±7.0,(42.4±11.8) min,(28.7±9.2) min;the 60-74 years old group:21.1±7.9,(41.0±9.8) min,(26.1±6.7) min] (all P ＜0.05 or 0.01).The average infusion rate for the ≤44 years old group (0.41±0.1) mg·kg-1·h-1was higher than that for the 60-74 years old group (0.33±0.06) mg·kg-1·h-1(P＜0.01);The rate for the ≥75 years old group (0.32±0.06) mg·kg-1 ·h-1 was lower than that for the ≤44 years old group and that for the 45-59 years old group (0.38±0.08) mg·kg-1 ·h-1 (P＜0.05 or ＜0.01)Conclusions After continuous infusion of rocuronium bromide,patients aged 75 or over need more time to recover their myodynamia than younger people do.The myodynamia recovery time is longer after continuous bromide infusion than after a single dose injection of rocuronium bromide,but it still follows a similar pattern.For the same level of muscle relaxation in the elderly,a lower dose of rocuronium bromide is required.

Objective To explore the efficacy of mycophenolate mofetil (MMF), which is a kind of immuno-suppressant drugs, on the treatment of Connective tissue diseases-pulmonary arterial hypertension (CTD-PAH). Methods Medical charts of eleven cases of hospitalized patients who were diagnosed as CTD-PAH and treated by MMF in Beijing Chaoyang Hospital affiliated to the Capital Medical University, from January 2014 to June 2016 were collected and analyzed. Results In the 11 cases of CTD-PAH, the systemic lupus erythematosus (SLE) related pulmonary hypertension (SLE-PAH) were 7, while the systemic sclero-derma associated pulmonary hypertension (SSc-PAH) were 2, and rheumatoid arthritis related pulmonary hy-pertension (RA-PAH) was 1, and the mixed connective tissue disease related pulmonary hypertension (MCTD-PAH) was 1. All patients were women, and the average age was (40 ±14) years, and the average duration of PAH was (34 ±35) months. The combination therapy of corticosteriods and MMF was applied to 7 cases, meanwhile the therapy of corticosteriods, MMF and bosentan was used in 1 case, corticosteriods, MMF and sildenafil was prescribed for 3 cases, and symptoms of the patients alleviated. Except for one case having been followed up for 7 months and one for 6 months, 9 patients completed the 1-year follow-up, and the survival rate was 100%(9/9). Notably, one patient, who had been alleviated for 111 months with therapy of corticosteriods and MMF, adopted the combination therapy of corticosteriods, MMF and bosentan for aggravated chest distress, and became stable eventually. Conclusion MMF may have therapeutic effects on inducing and even maintaining the stabilization of CTD-PAH.

The present paper presents the design of a remote monitoring system based on smartphone and mobile internet. The system can realize functions such as multi-physiological parameter collection, micromation of collecting equipment, real-time monitoring, remote data transmission, automatic alarm, physiological parameter analyze and Global Position System (GPS) location of patient's position. Besides acting as a receiver and transmission platform, smartphone can also process and analyze the physiological parameters, such as detection of the apnea from electrocardiogram (ECG). The system contains technologies of MCU, Bluetooth transmission, Android and Wed development, wavelet transform, mobile communication as a whole. It propels further developments of the remote mobile medical based on smartphone.
Cell Phone ; Electrocardiography ; Geographic Information Systems ; Humans ; Internet ; Monitoring, Ambulatory

Objective To detect the expression of stem-cell related factors Nanog and CD44 in spheroid body-form?ing cells of gastric cancer cell line MKN-45. Methods The gastric cancer cell line MKN-45 was used to culture spheroid bodies in non-adherent condition in a serum-free medium supplemented with epidermal growth factor (EGF) and basic fibro?blast growth factor (bFGF). Using Western blot analysis, immunofluorescence staining and quantitative real time polymerase chain reaction(qRT-PCR), the expression levels of stem cell-related genes Nanog and CD44 were studied. Results In this study, we observed that MKN45 cells formed spheroid bodies in non-adherent condition in a serum-free medium, and the levels of Nanog and CD44 mRNA expression in spheroid body-forming cells were 2.34 ± 0.22 and 1.18 ± 0.04,respectively, which were higher than those in parental cells (1.00±0.00 and 1.00±0.05). The levels of Nanog and CD44 protein expression in spheroid body-forming cells were 0.18±0.02 and 0.24±0.04, respectively, which were significantly higher than those in pa?rental cells (0.07±0.02 and 0.18±0.01, P<0.05). Nanog protein was positively stained within the perinuclear and cytoplasm of the spheroid body-forming cells, and CD44 was positively stained mainly in the membrane. Dual staining of Nanog/CD44 indicated that the embryonal protein Nanog was co-localized with CD44 in the spheroid body-forming cells. Conclusion Spheroid body-forming cells developed from human gastric cancer cell line MKN-45 in serum-free medium supplemented with EGF and bFGF show characteristics of cancer stem cell (CSC). The cells co-expressed of CD44 and Nanog maybe a phe?notype of gastric CSCs.