Objective     To evaluate the clinical effectiveness of valve-sparing aortic root replacement (VSARR) in the treatment of patients with dilated aortic root after operation for tetralogy of Fallot (TOF). Methods     A retrospective analysis was conducted on clinical data of TOF patients with aortic root dilation who underwent VSARR in our hospital from 2016 to 2022. Results     Finally 14 patients were collected, including 8 males and 6 females, with a median age of 22 years ranging from 12-48 years. Among them, 5 patients had severe aortic valve regurgitation, 4 moderate regurgitation, and 5 mild or no regurgitation. Six patients had sinus of valsalva dilation, and 8 significant dilation of the ascending aorta. One patient had residual shunt due to ventricular septal defect, and 9 severe pulmonary valve regurgitation. The David procedure was performed in 10 patients, Yacoub procedure in 2 patients, and Florida sleeve in 2 patients. There was no perioperative mortality in the group. The median follow-up time was 2.9 years (ranging from 0.4 to 6.0 years). One patient had mild aortic valve regurgitation, and the rest had minimal or no regurgitation. One patient had mild stenosis of the left ventricular outflow tract, and the rest patients had no obvious stenosis. Conclusion     VSARR is a satisfactory treatment for aortic root dilation in patients with TOF, with no significant increase in the incidence of left ventricular outflow tract stenosis or aortic regurgitation during mid-term follow-up.

Objective To investigate the safety and efficacy of transesophageal echocardiography assisted thoracoscopic left atrial appendage clipping in atrial fibrillation patients with high risk of stroke and bleeding.Methods Clinical data of 14 atrial fibrillation patients with high risk of stroke and bleeding from November 2021 to May 2023 was retrospectively analyzed.All the patients had suffered from cerebral infarction.The CHA2DS2-VASc score was 3-7(mean,5.0±1.4)and the HAS-BLED score was 3-4(mean,3.3±0.5).The thoracoscopic surgery was performed with two ports.The left atrial appendage clipping was performed by using a domestically produced E-Clip left atrial appendage closure system,assisted by transesophageal echocardiography.Results All the operations were successfully performed.The mean operation time was(39.6±7.7)min,the mean drainage volume after operation was(80.4±37.1)ml,and the drainage tube was removed at(26.0±2.5)h after operation.All the 14 patients were followed up for 3-21 months,with a median of 8 months.Complete closure of the left atrial appendage without residual leakage and no thrombosis in the left atrium were confirmed by transthoracic echocardiography.No new cerebral infarction or bleeding lesions in the brain was detected by CT scanning.The electrocardiogram showed that 2 patients converted to sinus rhythm and 12 patients still maintained atrial fibrillation rhythm.Conclusions Transesophageal echocardiography assisted thoracoscopic left atrial appendage clipping can completely closure left atrial appendage and avoid new onset of stroke in atrial fibrillation patients with high risk of stroke and bleeding.It can also play a role in electrical isolation of left atrial appendage so as to cure atrial fibrillation in few patients.

Cardiopulmonary exercise test(CPET) is the most commonly used non-invasive tool in the world to objectively evaluate cardiopulmonary reserve function and exercise tolerance. CPET play an important role in diagnosis, risk stratification, prognosis evaluation and therapeutic planning in heart failure(HF) patients. In recent years, due to the increasing number of advanced HF patients and the paucity of heart donors, left ventricular assist device(LVAD) has represented a valid alternative to heart transplantation(HT) from bridge to transplantation indication to destination therapy. This article summarizes several topical issues regarding the current use of CPET in assessing the prognosis of HF patients, implantation and withdrawal of LVAD, postoperative right ventricular failure, and the effects of exercise rehabilitation in LVAD patients.

Collagen is a macromolecular protein constituting the extracellular matrix of animal connective tissue, which has been widely used and developed in fields of biomedicine, tissue engineering, food, and cosmetics. Due to its advantages such as abundant sources and good biocompatibility, low immunogenicity, and degradability, collagen can be used as a dressing or tissue engineering scaffold for wound repair. According to the source of materials, collagen can be divided into natural collagen and recombinant collagen. Natural collagen is mainly extracted directly from mammals and fish; recombinant collagen is obtained based on genetic engineering technology, and its sources include recombinant expression systems of microorganisms, animals, and plants. This paper summarizes the sources of collagen, and the roles, advantages, and disadvantages of different sources of collagen in wound repair, the particularity and superiority of collagen combined with three-dimensional printing technology in wound repair, the impact of market norms of China's collagen industry on the field of wound repair, and explains the precautions for the development of collagen-related products, aiming to provide new ideas for selecting a suitable source of collagen for wound repair.
Animals ; Collagen/metabolism* ; Wound Healing ; Tissue Engineering ; Tissue Scaffolds ; Cosmetics ; Mammals/metabolism*

Liver transplantation is one of the main treatments of early hepatocellular carcinoma (HCC). The recurrence of HCC after liver transplantation severely affects the long-term survival rate of the recipients. Targeted therapy and immunotherapy play a critical role in HCC downstaging, preventing disease progression, reducing recurrence rate, prolonging the survival and improving the quality of life. However, no consensus has been reached on the application of targeted therapy and immunotherapy in recipients undergoing liver transplantation for HCC, including indications, timing and dosage. In this article, clinical research progresses on the indications and timing of targeted therapy and immunotherapy before and after liver transplantation for HCC were reviewed, aiming to provide reference for prolonging the survival of recipients after liver transplantation for HCC.

Aim:Pertussis is a respiratory tract infection,the vaccine for which was introduced in the Expanded Programme on Immunization (EPI) in Guizhou Province of China (hereafter referred as Guizhou) in the 1980s.This vaccine rapidly decreased incidence rates of pertussis in the province,however,despite the wide high coverage of the diphtheria,tetanus and acellular pertussis (DTaP) combined vaccine,there has been a resurgence of pertussis since 2014.Even with this recent increase in disease transmission,risk factors for pertussis infection have not been evaluated in Guizhou.We aimed to provide information on pertussis risk factors and insight on designing targeted pertussis control policies and measures through this study.Methods:A 1∶2 matched retrospective case-control study was conducted between 2016 and 2017,involving infants and children younger than 6 years old and parents of the participants.The enrolled cases included clinical and laboratory confirmed pertussis cases according to the WHO-recommended pertussis definition.Controls were selected from children in the same neighborhood who were not diagnosed with pertussis prior to our investigation and did not exhibit any clinical manifestations of pertussis.Results:The household size[Matched odds ratio (ORm) =1.4,95％ confidence interval (CI):1.1-1.7]and house-hold members with antecedent cough (ORm =3.6,95％ CI:1.8-7.2) were significantly associated with their child's pertussis onset.The parents' occupations were significantly associated with their child's pertussis onset(ORm =9.4,95％ CI:1.6-54.8,for mother side;ORm =4.5,95％ CI:1.2-16.5,for father side),when they worked in the business and/or service industry.Having family members with a history of cough was an independent risk factor for pertussis[Adjusted odds ratio (AOR) =43.6,95％ CI:2.7-694.0].Besides,the parents' demographic characteristics and DTaP doses were not found to be independent factors.Conclusion:Household exposure is an important risk factor for pertussis infection in infants and young children and should therefore be considered as a major factor during formulation of pertussis control policies and measures.

Objective:To investigate the safety and efficacy of ultrasound-guided percutaneous radiofrequency ablation (RFA) for caudate lobe hepatocellular carcinoma (HCC) and the failure factors of incomplete tumor ablation.Methods:Twenty-four cases with caudate lobe hepatocellular carcinoma who underwent ultrasound-guided percutaneous RFA in the Affiliated Tumor Hospital of Zhengzhou University from January 2017 to October 2019 were enrolled. The ablation effect and complications conditions were recorded, and the primary technical effectiveness and local tumor progression (LTP) were evaluated.Results:Among 24 cases, 20 cases had complete ablation at one session, 4 cases had incomplete ablation, and after supplementary radiofrequency ablation all cases had achieved complete ablation. There was no evidence of local tumor progression in 24 cases after one-month postoperative evaluation. The primary technical effectiveness rate was 100%. The postoperative follow-up was 2 to 29 months (median follow-up time was 18 months). Of the 24 cases after ablation, LTP were detected in 11 cases, of which only 3 cases had distant intrahepatic recurrence, 1 case had distant intrahepatic recurrence and distant metastasis, and 5 cases had only distant metastasis, 2 cases died, and 4 cases had SIR grade B complications related to ablation.Conclusion:Ultrasound-guided percutaneous radiofrequency ablation was safe and effective for caudate lobe hepatocellular carcinoma. In addition, the distance between the tumor and the inferior vena cava < 0.5cm is a suspected risk factor for incomplete ablation of caudate lobe hepatocellular carcinoma ( P < 0.05).

Objective:To study the safety and efficacy of liquid isolation assisted technology in ultrasound-guided percutaneous radiofrequency ablation for hepatocellular carcinoma adjacent to liver surfaces.Methods:A retrospective study was conducted on 246 patients with hepatocellular carcinoma near liver surfaces treated by radiofrequency ablation from November 2016 to November 2019 at the Department of Hepatobiliary and Pancreatic Surgery, Affiliated Tumor Hospital of Zhengzhou University. There were 182 males and 64 females, aged (56.7±9.2) years. The patients were divided into the liquid isolation group with liquid isolation assisted technology for radiofrequency ablation ( n=131) and the conventional treatment group with conventional radiofrequency ablation ( n=115). The complication, one-time complete ablation and progression-free survival rates were compared between the two groups. Results:The incidence of intraoperative complications in the liquid isolation group was 21.4% (28/131), versus 20.9% (24/115) in the conventional treatment group. There was no significant difference between the two groups ( P>0.05). The incidence of postoperative complications in the liquid isolation group was 20.6% (27/131), which was significantly lower than that in the conventional treatment group 33.9% (39/115) ( P<0.05). The incidence of postoperative pain in the liquid isolation group was 6.1% (8/131), which was significantly lower than that in the conventional treatment group 15.7% (18/115) ( P<0.05). For the 131 patients in the liquid isolation group, there were 183 tumors near to liver surfaces. For the 115 patients in the conventional treatment group, there were 142 lesions near to liver surfaces. The one-time complete ablation rate in the liquid isolation group was 94.0% (172/183), which was significantly higher than the 75.4% (107/142) in the conventional treatment group ( P<0.05). The progression-free survival rate in the liquid isolation group was significantly better than that in the conventional treatment group ( P<0.05). Conclusion:The liquid isolation technique increased the one-time complete ablation rate of liver cancer adjacent to liver surfaces, reduced the incidence of postoperative complications and improved prognosis.

Objective:To examine the safety and effectiveness of ultrasound-guided percutaneous radiofrequency ablation in the treatment of liver malignant tumor under subcardiac.Methods:The clinical data of 26 patients (31 tumors) with subcardiac liver malignant tumors who underwent ultrasound-guided percutaneous radiofrequency ablation from January 2017 to October 2019 at the Affiliated Tumor Hospital of Zhengzhou University were retrospectively analyzed. There were 21 males and 5 females. The age was 55 years old (range: 40 to 77 years old) .There were 14 cases of primary liver cancer and 12 cases of metastatic liver cancer. The maximum diameter of tumor was (2.3±1.0) cm (range: 1.0 to 4.2 cm) .According to the maximum diameter of the tumor, 1∶1 match was made between 27 non-subcardiac patients admitted at the same time and a total of 36 liver malignant tumors. subcardiac tumor is defined as tumor ≤1 cm from pericardium in sagittal or coronal imaging. The ablation effect and complications were recorded, and the one-time complete ablation rate, main technical efficiency and complications were evaluated. The preoperative baseline characteristics, ablation effect and complications of the two groups of patients were collected and counted. Single factor analysis and Logistic regression analysis were used to analyze the independent risk factors that affect the ablation effect of ultrasound-guided percutaneous radiofrequency ablation for liver malignant tumors under subcardiac.Results:The one-time complete ablation rate of tumor after radiofrequency ablation was 80.8% (21/26) in the subcardiac group and 92.6% (25/27) in the non-subcardiac group. There was no significant difference between the two groups ( P>0.05) . No evidence of local tumor progression was found in the follow-up evaluation of the two groups one month after radiofrequency ablation, and the main technical effective rate was 100%.Ablation-related complications occurred in 2 patients in the subcardiac group. Multivariate analysis both showed that the distance between tumor margin and pericardium ≤5 mm was an independent risk factor affecting radiofrequency ablation ( OR=0.020, 95 %CI: 0.001 to 0.454, P=0.014) . Conclusions:Ultrasound-guided percutaneous radiofrequency ablation can safely and effectively treat liver malignant tumor under subcardiac. When there is a tumor near the patient′s heart (the distance between the edge of the tumor and pericardium is ≤5 mm) , special attention should be paid to formulate a detailed and reasonable ablation plan to minimize tumor residue.

Objective:To examine the safety and effectiveness of ultrasound-guided percutaneous radiofrequency ablation in the treatment of liver malignant tumor under subcardiac.Methods:The clinical data of 26 patients (31 tumors) with subcardiac liver malignant tumors who underwent ultrasound-guided percutaneous radiofrequency ablation from January 2017 to October 2019 at the Affiliated Tumor Hospital of Zhengzhou University were retrospectively analyzed. There were 21 males and 5 females. The age was 55 years old (range: 40 to 77 years old) .There were 14 cases of primary liver cancer and 12 cases of metastatic liver cancer. The maximum diameter of tumor was (2.3±1.0) cm (range: 1.0 to 4.2 cm) .According to the maximum diameter of the tumor, 1∶1 match was made between 27 non-subcardiac patients admitted at the same time and a total of 36 liver malignant tumors. subcardiac tumor is defined as tumor ≤1 cm from pericardium in sagittal or coronal imaging. The ablation effect and complications were recorded, and the one-time complete ablation rate, main technical efficiency and complications were evaluated. The preoperative baseline characteristics, ablation effect and complications of the two groups of patients were collected and counted. Single factor analysis and Logistic regression analysis were used to analyze the independent risk factors that affect the ablation effect of ultrasound-guided percutaneous radiofrequency ablation for liver malignant tumors under subcardiac.Results:The one-time complete ablation rate of tumor after radiofrequency ablation was 80.8% (21/26) in the subcardiac group and 92.6% (25/27) in the non-subcardiac group. There was no significant difference between the two groups ( P>0.05) . No evidence of local tumor progression was found in the follow-up evaluation of the two groups one month after radiofrequency ablation, and the main technical effective rate was 100%.Ablation-related complications occurred in 2 patients in the subcardiac group. Multivariate analysis both showed that the distance between tumor margin and pericardium ≤5 mm was an independent risk factor affecting radiofrequency ablation ( OR=0.020, 95 %CI: 0.001 to 0.454, P=0.014) . Conclusions:Ultrasound-guided percutaneous radiofrequency ablation can safely and effectively treat liver malignant tumor under subcardiac. When there is a tumor near the patient′s heart (the distance between the edge of the tumor and pericardium is ≤5 mm) , special attention should be paid to formulate a detailed and reasonable ablation plan to minimize tumor residue.