Objective:To compare the surgical efficacy of pericardial soft ring tricuspid valvuloplasty with DeVega and artificial valvuloplasty.Methods:227 patients undergoing tricuspid valvuloplasty due to rheumatic heart disease complicated with functional tricuspid valve insufficiency were retrospectively analyzed and divided into 3 groups according to tricuspid valvuloplasty dynamic cohort(pericardial ring group, 89 cases; the artificial flap ring group, 61 cases, and the DeVega group, 77 cases) were matched 1∶1 for propensity score(match A: pericardial ring group and artificial flap ring group; match B: pericardial ring group and DeVega group), the successful matching was included in follow-up and data collection, and cases with incomplete case data during follow-up were removed from the study cohort in pairs according to matching conditions. The results of follow-up 1 month, 6 months and 24 months after surgery were compared.Results:1 month after operation: the tricuspid valve regurgitant in all groups was significantly reduced or even disappeared compared with that before operation, and the right atrium and right ventricle were also smaller than that before operation, with statistical significance( P<0.05). 6 months after surgery: There was no statistical significance in the area of tricuspid regurgitation and right atrial/indoor diameter between all groups compared with the results one month after surgery( P>0.05), and there was no statistical significance in the recurrence rate of tricuspid regurgitation between all groups( P>0.05). 24 months after surgery: There were no significant differences in the recurrence rate of tricuspid regurgitation, area of tricuspid regurgitation and right atrial/indoor diameter between the two groups in matching A( P>0.05). There was no statistical significance in the right atrial/indoor diameter between the matched pericardial ring group and the Devega group, but the tricuspid valve regurgentation area of the Devega group at 24 months after surgery was higher than that of the Devega group at 1 month after surgery, and the difference was statistically significant( P<0.05). The regurgitation area and recurrence rate of tricuspid valve were significantly higher than those of pericardium-TVP group( P<0.05). Conclusion:Pericardial soft ring tricuspid valvuloplasty can effectively correct functional tricuspid valvuloplasty and reverse right heart remodeling, which is an effective tricuspid valvuloplasty.

Objective:To explore the clinical characteristics of patients with pulmonary sarcoidosis complicated by pulmonary cryptococcosis, thereby enhancing the understanding of this clinical scenario.Methods:We report a case of pulmonary sarcoidosis complicated by pulmonary cryptococcosis treated at Beijing Hospital.The patient was diagnosed with stage Ⅱ pulmonary sarcoidosis via CT-guided percutaneous fine needle aspiration lung biopsy.However, during treatment with oral prednisone, a chest CT scan revealed newly developed multiple nodules in the right lower lobe.By considering the patient's medical history, imaging results, cryptococcal antigen(CrAg)levels, and treatment response, a diagnosis of pulmonary sarcoidosis complicated by pulmonary cryptococcosis was established.Additionally, we systematically reviewed the literature on pulmonary sarcoidosis complicated by pulmonary cryptococcosis published before April 2024, focusing on epidemiological characteristics, clinical manifestations, diagnosis, treatment, and prognosis.Results:A total of seven articles were obtained, and nine cases were reviewed in conjunction with this case.Among these, 55.6%(5/9)of the patients were male, with an average age of 51 years, and one-third of the patients were categorized as elderly.The stages of pulmonary sarcoidosis identified were stage Ⅰ and stage Ⅱ.Eight patients(88.9%, 8/9)were receiving glucocorticoids or other immunosuppressants at the time of cryptococcosis diagnosis.In the cases that specified the diagnostic method for cryptococcosis, serum cryptococcal antigen(CrAg)was found to be positive, including in three elderly patients.One patient did not receive antifungal treatment due to the rapid deterioration of his condition.During a follow-up period of at least six months, all patients remained clinically stable, with fluconazole being the most chosen antifungal agent.Conclusions:Although cases of pulmonary sarcoidosis complicated by cryptococcal infection are rare, clinicians should remain vigilant to this possibility.The two conditions may exhibit overlapping clinical manifestations, yet their treatment strategies can be contradictory.Misdiagnosis and delayed diagnosis could result in serious clinical consequences.Serum CrAg testing is particularly useful for diagnosis, especially in elderly patients.

Objective:To explore the average age at onset of endometrial cancer (EC) and the differences between domestic and international factors.Methods:Pubmed, Wanfang Database, VIP Information Resource System, and China National Knowledge Infrastructure (CNKI) were selected to extract clinical research data related to EC. Through data mining methods such as frequency analysis and cluster analysis, we compared the differences in the average age of onset of EC between domestic and foreign countries.Results:A total of 280 articles that met the inclusion criteria were selected, and frequency analysis found that the average age of onset of EC in the Chinese population was mostly concentrated under 57 years old, while in European and American countries, it was mainly concentrated above 57 years old. Through cluster analysis, it was found that the average age of onset in China was clustered in one category with most Asian countries, while European and American countries and Australian countries were clustered in another category. Through analysis of domestic and foreign articles, it was found that the average age of onset of EC did not show a significant upward or downward trend with years.Conclusions:There are differences in the average onset age of EC among different countries and regions. The onset age of EC in Asian populations is significantly earlier than that in European and American populations. The average onset age of EC in Chinese populations is 54 years old, and there is no trend towards a younger onset of EC.

Objective:To investigate the distribution of human papillomavirus (HPV) subtypes in patients with cervical invasive cancer.Methods:Retrospective selection was conducted on hospitalized patients diagnosed with cervical invasive cancer by pathology at the Third Affiliated Hospital of Sun Yat-sen University from January 2016 to December 2020, with complete relevant information. The age, histological classification, specific HPV infection types at the time of diagnosis of cervical cancer were recorded, and differences in HPV types and single and multiple infections in the squamous cell carcinoma and adenocarcinoma populations were analyzed. The coverage rate of bivalent, tetravalent, and ninvalent HPV vaccines in the cervical cancer population was analyzed.Results:A total of 231 cases of cervical invasive cancer that met the criteria were included, including 183 cases of squamous cell carcinoma, 43 cases of adenocarcinoma, and 5 cases of other histological types. The positive rates of HPV infection in cervical cancer, squamous cell carcinoma, and adenocarcinoma populations were 89.18%(206/231), 92.35%(169/183), and 74.42%(32/43), respectively. The top five types of HPV infection in cervical cancer patients were 16, 18, 58, 52, 31, and 33, respectively; The top five types of infection rate in squamous cell carcinoma patients were HPV16, 18, 58, 52, 31, and 33, respectively; Adenocarcinoma patients only detected 5 types of HPV, with the main types being HPV16 and 18. The infection rates of single HPV type in patients with cervical cancer, squamous cell carcinoma, and adenocarcinoma were 77.49%(179/231), 79.23%(145/183), and 67.44%(29/43), respectively. The multiple infection rates were 11.69%(27/231), 13.11%(24/183), and 6.98%(3/43), respectively. The positive rate of HPV was higher in all age groups of cervical cancer. The coverage rates of bivalent, tetravalent, and ninvalent HPV vaccines covering different types of infections in cervical cancer populations were 66.67% to 74.03%, 67.53% to 74.89%, and 81.39% to 87.44%, respectively.Conclusions:The cervical cancer population is mainly affected by high-risk HPV single infection, mainly including HPV16, 18, 58, 52, 31, 33; The HPV infection rate in the squamous cell carcinoma population is higher than that in the adenocarcinoma group, with the main type being HPV16, while in the adenocarcinoma population, the main types are HPV16 and 18.

Objective:To explore the perception and demand of children's parents on Internet children's hospital, and provide reference for improving the service model of Internet children's hospitals.Methods:This is a qualitative study. Totally 11 parents of children who visited the outpatient services of Guangzhou Women and Children's Medical Center from November to December 2021 were selected by convenience sampling, and a semi-structured interview was conducted with them based on a self-made outline. The Colaizzi phenomenological 7-step analysis method was used to analyze the data and refine the themes.Results:A total of four themes were extracted, namely, the high degree of parental recognition of the Internet children's hospital service model, the need for convenient, timely and safe information acquisition, the need for professional, reliable and friendly diagnosis and treatment services, and the need for reasonable and transparent fees.Conclusions:The online diagnosis and treatment services of Internet children's hospitals meet the needs of parents for medical treatment and have good prospects. At the same time, the service model of Internet children's hospitals should pay more attention to the convenience, professionalism, safety and economy of users, so as to promote its healthy development.

Objective:To study the value of ventilation/perfusion single-photon emission computed tomography(SPECT)in combination with a low-dose CT scan(SPECT/CT)in diagnosing pulmonary embolism(PE)in elderly patients.Methods:In this retrospective study, data were collected from 279 patients with suspected PE and undergone SPECT/CT between January 2015 and December 2019 at Beijing Hospital, with 163 aged ≥65(the elderly group)and 116 aged <65(the control group). Based on diagnosis confirmed during follow-up as the final diagnosis, the diagnostic efficacy of ventilation/perfusion SPECT/CT in the two age groups was examined.The diagnostic efficacy of ventilation/perfusion SPECT/CT and age-adjusted D-dimer in the elderly group was also compared.The diagnostic efficacy of ventilation/perfusion SPECT/CT and CT pulmonary angiography(CTPA)was compared in 43 elderly patients who had undergone both ventilation/perfusion SPECT/CT and CTPA.Results:The sensitivity, specificity and accuracy of ventilation/perfusion SPECT/CT in the elderly group were 96.10%(74/77), 91.86%(79/86)and 93.87%(153/163)in the elderly group and 96.43%(27/28), 94.31%(83/88)and 94.83%(110/116)in the control group, respectively, with no statistically significant difference between the two groups( χ2=0.000, 0.409, 0.116, P=1.000, 0.522, 0.733). The sensitivity, specificity and accuracy of age-adjusted D-dimer were 84.42%(65/77), 63.95%(55/86)and 73.62%(120/163), and were significantly different from those of ventilation/perfusion SPECT/CT(all P<0.05). Among 43 elderly patients undergone ventilation/perfusion SPECT/CT and CTPA, 1 was excluded because the diagnosis based on CTPA was uncertain.The diagnostic sensitivity, specificity and accuracy of ventilation/perfusion SPECT/CT were 96.55%(28/29), 92.31%(12/13)and 95.24%(40/42)and those of CTPA were 65.52%(19/29), 92.31%(12/13)and 73.81%(31/42). They had the same specificity, but there were significant differences in sensitivity and accuracy( P=0.012, 0.022). Conclusions:Ventilation/perfusion SPECT/CT has higher accuracy in the diagnosis of PE in elderly patients, compared with CTPA and age-adjusted D-dimer.

Objective:To investigate the changes in clinical signs and laboratory testing results and their risk-tiring diagnostic effectiveness in elderly patients with pulmonary embolization (PE) with different risk levels.Methods:A retrospective analysis was conducted on the clinical data of elderly hospitalized PE patients in Beijing Hospital and other coordinated hospital from 2012 to 2020.Differences in 43 clinical signs and detection indicators between patients with four different risk levels were compared.The univariate and multivariate regression models were used to analyze differences between high-risk and non-high-risk PE and between intermediate-risk and low-risk PE with ROC analysis.Results:In the multi-group comparison, there are 33 clinical tests having significant differences between four risk groups, 29 clinical tests having significant differences between three risk groups(high, intermediate and low groups), and 21 clinical tests having significant differences between two groups(high and non-high groups). In the ROC analysis of risk stratification in high-risk and non-high-risk groups, it was found that the range of area under the curves(AUC)of 14 significantly changed clinical tests were 0.611 to 0.802 in the univariate regression analysis.The AUC of the model of systolic blood pressure(SBP)combined with white blood cell count(WBC)and aspartate aminotransferase(AST)was 0.8593(95% CI: 0.795-0.924)in the multivariate regression analysis.While in the ROC analysis between intermediate-risk and low-risk, the range of AUC of 12 significantly changed clinical tests were 0.592 to 0.835 in the univariate regression analysis.The B-type natriuretic peptide(BNP)and N-terminal B-type natriuretic peptide(NT-proBNP)can assist the risk stratification in intermediate-risk and low-risk PE groups.No efficient combined diagnosis model was found. Conclusions:The basic vital signs and multiple clinical laboratory tests were significantly different among four risk levels of elderly PE patients, such as blood gas analysis, coagulative function, liver and kidney function and myocardial markers.The combination of SBP, WBC, and AST can effectively assist the risk stratification in high-risk and non-high-risk PE groups.

Objective:To establish the method for detecting lower respiratory infections (LRIs) bacterialpathogens using nanopore sequencing, and evaluate the feasibility of this method.Methods:Bronchoalveolar lavage fluid (BALF) samples from 33 patients with LRIs who visited the Department of Respiratory and Critical Care Medicine of Beijing Hospital from July 2019 to September 2020 were collected.Nanopore 16S amplicon sequencing were performed on these samples. In order to evaluate the clinical value of the nanopore sequencing, χ 2 test was used to analyze the pathogen differences between the detection rate and pathogen types results found with using the nanopore 16S sequencing and the results found with bacterial culture. Results:The process and method of nanopore sequencing used in the detection of the LRIs pathogens were established. The pathogen detection rate of the 16S sequencing was higher than that of the traditional bacterial culture (75.8% [25/33], 45.5% [15/33], χ2=5.140, P<0.05). From the 25 positive samples found with nanopore 16S sequencing, 16 pathogens were detected, including Haemophilus parainfluenzae, Haemophilus influenzae, Streptococcus pneumoniae, Streptomonas maltophilia, Acinetobacter baumannii, and Acinetobacter junii, Staphylococcus aureus, Klebsiella pneumoniae, Enterococcus faecalis, Enterococcus gallinarum, Corynebacterium striatum, Mycobacterium paraintracellulare, Serratia marcescens, Achromobacter insuavis, Citrobacter murliniae and Mycoplasma pneumoniae. More than 6 pathogens were tested in clinical culture, including Haemophilus parainfluenzae, Acinetobacter baumannii, Pseudomonas aeruginosa, Staphylococcus aureus, Klebsiella pneumoniae and Streptomonas maltophilia (χ2=7.949, P<0.05). 16S sequencing aligned to species level sequences accounted for 80.0 (60.0, 86.0)% of the genus level. The results obtained by using16S sequencing and bacterial culture were consistent in 11 (33.3%) samples. Conclusions:Nanopore 16S amplicon sequencing can quickly identify pathogenic bacteria from BALF in LRIs patients. Nanopore 16S amplicon sequencing has a high detection rate, it can detect more pathogens than traditional bacterial culture, and it can also identify most bacteria to the species level. This technology is a very promising platform with broad application prospects.

OBJECTIVE: To investigate the effect of dexmedetomidine combined with pulmonary protective ventilation against lung injury in patients undergoing surgeries for esophageal cancer with one-lung ventilation (OLV). METHODS: Forty patients with undergoing surgery for esophageal cancer with OLV were randomly divided into pulmonary protective ventilation strategy group (F group) and dexmedetomidine combined with protective ventilation strategy group (DF group; =20). In F group, lung protective ventilation strategy during anesthesia was adopte, and in DF group, the patients received intravenous infusion of dexmedetomidine hydrochloride (0.3 μg · kg ·h) during the surgery starting at 10 min before anesthesia induction in addition to protective ventilation strategy. Brachial artery blood was sampled before ventilation (T), at 30 and 90 min after the start of OLV (T and T, respectively) and at the end of the surgery (T) for analysis of superoxide dismutase (SOD), malondialdehyde (MDA), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), arterial oxygenation pressure (PaO), oxygenation index (OI) and lung compliance (CL). RESULTS: At the time points of T, T and T, SOD level was significantly higher and IL-6 level was significantly lower in the DF group than in F group ( < 0.05). The patients in DF group showed significantly higher PaO, OI and CL index than those in F group at all the 3 time points. CONCLUSIONS Dexmedetomidine combined with pulmonary protective ventilation strategy can reduce perioperative lung injury in patients undergoing surgery for esophageal cancer with OLV by suppressing inflammation and oxidative stress to improve lung function and reduce adverse effects of the surgery.
Analgesics, Non-Narcotic ; pharmacology ; therapeutic use ; Dexmedetomidine ; pharmacology ; therapeutic use ; Esophageal Neoplasms ; drug therapy ; surgery ; Humans ; Lung ; drug effects ; surgery ; One-Lung Ventilation ; Oxidative Stress ; drug effects ; Treatment Outcome

OBJECTIVE: To investigate the effect of dexmedetomidine combined with pulmonary protective ventilation against lung injury in patients undergoing surgeries for esophageal cancer with one-lung ventilation (OLV). METHODS: Forty patients with undergoing surgery for esophageal cancer with OLV were randomly divided into pulmonary protective ventilation strategy group (F group) and dexmedetomidine combined with protective ventilation strategy group (DF group; =20). In F group, lung protective ventilation strategy during anesthesia was adopte, and in DF group, the patients received intravenous infusion of dexmedetomidine hydrochloride (0.3 μg · kg ·h) during the surgery starting at 10 min before anesthesia induction in addition to protective ventilation strategy. Brachial artery blood was sampled before ventilation (T), at 30 and 90 min after the start of OLV (T and T, respectively) and at the end of the surgery (T) for analysis of superoxide dismutase (SOD), malondialdehyde (MDA), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), arterial oxygenation pressure (PaO), oxygenation index (OI) and lung compliance (CL). RESULTS: At the time points of T, T and T, SOD level was significantly higher and IL-6 level was significantly lower in the DF group than in F group ( < 0.05). The patients in DF group showed significantly higher PaO, OI and CL index than those in F group at all the 3 time points. CONCLUSIONS Dexmedetomidine combined with pulmonary protective ventilation strategy can reduce perioperative lung injury in patients undergoing surgery for esophageal cancer with OLV by suppressing inflammation and oxidative stress to improve lung function and reduce adverse effects of the surgery.
Dexmedetomidine ; Esophageal Neoplasms ; therapy ; Humans ; Lung ; Malondialdehyde ; One-Lung Ventilation