Objective To investigate the effect of percutaneous balloon mitral valvuloplasty under echocardiographic guidance for patients with moderate to severe mitral stenosis during pregnancy. Methods A retrospective observational study was conducted to include pregnant women who were diagnosed with moderate to severe mitral stenosis and underwent percutaneous balloon mitral valvuloplasty under echocardiographic guidance in Fuwai Hospital from August 2018 to June 2022, and their baseline characteristics, surgical outcomes, echocardiographic results, and follow-up results were analyzed. Results A total of 3 pregnant women aged 30-35 years, with gestational age of 19-26 weeks, and New York Heart Association (NYHA) function class Ⅲ were included. All the procedures were successfully performed. The mitral valve orifice area increased from 0.9 cm2 preoperatively to 2.1 cm2 postoperatively. The mean transvalvular pressure gradient decreased from 15.0 mm Hg preoperatively to 6.7 mm Hg postoperatively. No perioperative adverse events occurred. The follow-up time ranged from 3 to 48 months. All patients delivered uneventfully and returned to normal life, with maternal-fetal safety. Conclusion Percutaneous balloon mitral valvuloplasty under echocardiographic guidance is a feasible and effective procedure for the treatment of patients with moderate to severe mitral stenosis in pregnancy, with satisfactory maternal-fetal outcomes.

Objective:To evaluate the medium-term clinical and hemodynamic outcomes of percutaneous pulmonary valve implantation (PPVI) using a domestic Venus-P self-expanding valve in the treatment of severe pulmonary regurgitation after Tetralogy of Fallot (TOF).Methods:Retrospective study.From December 2017 to December 2020, 13 TOF patients with (17.8±4.7) years old and (50.2±12.3) kg underwent PPVI using the Venus-P self-expanding valve in the Department of Children′s Heart Center, Zhengzhou University People′s Hospital were recruited.The mean valve size was (31.9±3.1) mm.All patients received the transannular patch surgery and developed severe pulmonary regurgitation.After PPVI, 13 patients were followed up for at least 12 months.The operation-related complications, improvement of valve and heart function and the durability and reintervention of the Venus-P self-expanding valve were analyzed.The right ventricular end-diastolic volume index (RVEDVi) before and after operation was compared by the paired t-test, and the New York Heart Association (NYHA) class was compared by the paired Wilcoxon signed rank sum test. Results:PPVI was successfully performed in all 13 patients without death.At 6 months post-PPVI, cardiac magnetic resonance imaging findings showed that RVEDVi was significantly reduced[(145.7±9.6) mL/m 2vs.(100.2±12.2) mL/m 2, P<0.05], and the NYHA class was significantly improved ( P<0.05). One patient presented moderate pulmonary valve regurgitation at 12 months postoperatively.No vegetation was found on echocardiography, and blood culture was negative in this case.Six patients did not have postoperative pulmonary valve regurgitation, and the remaining presented mild or less pulmonary regurgitation.One patient had sudden ventricular tachycardia on the 6 th day postoperatively, which was converted to sinus rhythm after synchronous electrocardiography.Only one case underwent appendectomy 7 months after operation due to acute appendicitis, and the remaining did not require valve-related reintervention after implantation.During the follow-up for (22.8±8.0) months, no patients had perivalve leakage, stent migration and rupture.Complications like embolization and coronary artery compression were not reported. Conclusions:PPVI using the Venus-P self-expanding valve is safe and effective in patients with severe pulmonary valve regurgitation after TOF surgery, showing an acceptable medium-term follow-up outcome.Studies with a large sample size and long follow-up period are still needed to validate our findings.

Background: Currently available guidelines contain conflicting recommendations on the management of blood pressure (BP) in patients with diabetes mellitus (DM). Therefore, it is necessary to appraise the guidelines and summarize the agreements and differences among recommendations. Methods: Four databases and the websites of guideline organizations were searched for guidelines regarding BP targets and thresholds for pharmacologic therapy in DM patients, and the included guidelines were appraised with the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Results: In 6,498 records identified, 20 guidelines met our inclusion criteria with 64.0% AGREE II scores (interquartile range, 48.5% to 72.0%). The scores of the European and American guidelines were superior to those of the Asian guidelines (both adjusted P<0.001). Most of the guidelines advocated systolic BP targets <130 mm Hg (12 guidelines, 60%) and diastolic BP targets <80 mm Hg (14 guidelines, 70%) in DM patients. Approximately half of the guidelines supported systolic BP thresholds >140 mm Hg (10 guidelines, 50%) and diastolic BP thresholds >90 mm Hg (nine guidelines, 45%). The tiny minority of the guidelines provided the relevant recommendations regarding the lower limit of official BP targets and the ambulatory BP monitoring (ABPM)/home BP monitoring (HBPM) targets and thresholds in DM patients. Conclusion The lower official BP targets (<130/80 mm Hg) in patients with DM are advocated by most of the guidelines, but they contain conflicting recommendations on the official BP thresholds. Moreover, the gaps regarding the lower limit of official BP targets and the ABPM/HBPM targets and thresholds need to be considered by future study.

Background: Currently available guidelines contain conflicting recommendations on the management of blood pressure (BP) in patients with diabetes mellitus (DM). Therefore, it is necessary to appraise the guidelines and summarize the agreements and differences among recommendations. Methods: Four databases and the websites of guideline organizations were searched for guidelines regarding BP targets and thresholds for pharmacologic therapy in DM patients, and the included guidelines were appraised with the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Results: In 6,498 records identified, 20 guidelines met our inclusion criteria with 64.0% AGREE II scores (interquartile range, 48.5% to 72.0%). The scores of the European and American guidelines were superior to those of the Asian guidelines (both adjusted P<0.001). Most of the guidelines advocated systolic BP targets <130 mm Hg (12 guidelines, 60%) and diastolic BP targets <80 mm Hg (14 guidelines, 70%) in DM patients. Approximately half of the guidelines supported systolic BP thresholds >140 mm Hg (10 guidelines, 50%) and diastolic BP thresholds >90 mm Hg (nine guidelines, 45%). The tiny minority of the guidelines provided the relevant recommendations regarding the lower limit of official BP targets and the ambulatory BP monitoring (ABPM)/home BP monitoring (HBPM) targets and thresholds in DM patients. Conclusion The lower official BP targets (<130/80 mm Hg) in patients with DM are advocated by most of the guidelines, but they contain conflicting recommendations on the official BP thresholds. Moreover, the gaps regarding the lower limit of official BP targets and the ABPM/HBPM targets and thresholds need to be considered by future study.

Objective:To evaluate the effects of modified peroral endoscopic myotomy (POEM) on esophageal dynamics and clinical efficacy in achalasia (AC) patients.Methods:From January 2013 to December 2014, 51 patients diagnosed with AC and received modified POEM at The First Affiliated Hospital of Sun Yat-sen University were retrospectively enrolled. AC patients were classified as type Ⅰ, type Ⅱ and type Ⅲ according to Chicago classification. The changes of esophageal dynamics before and after the modified POEM were compared by high resolution manometry (HRM). The reflux after the operation was evaluated by 24-hour esophageal impedance-pH monitoring. The clinical symptoms and the quality of life of AC patients were assessed by impaction dysphagia questionnaire (IDQ), Eckardt scale and short-form 36 item health survey (SF-36). Paired t test, independent sample t test, Wilcoxon rank sum test and Pearson correlation analysis were used for statistical analysis. Results:At three months and one year after operation, lower esophageal sphincter pressure (LESP) and integrated relaxation pressure (IRP) were all lower than those before operation ((23.89±12.68) and (23.44±12.56) mmHg (1 mmHg=0.133 kPa) vs. (39.29±16.14) mmHg; (16.13±9.43) and (15.37±8.36) mmHg vs. (30.57±11.31) mmHg), and the differences were statistically significant ( t=7.520, 7.866, 7.641 and 8.909, all P<0.05). There were no statistically significant differences in LESP and IRP during the same period between patients with type Ⅰ AC and type Ⅱ AC (all P>0.05). The LESP of patients with partial esophageal peristalsis function recovered one year after operation was lower than that of patients with unrecovered esophageal peristalsis function ((15.38±4.54) mmHg vs. (25.65±13.19) mmHg), and the difference was statistically significant ( t=0.039, P<0.05). The proportions of pathologic acid reflux of AC patients at three months and one year after operation were 7.8%(4/51) and 2.0%(1/51), respectively. The IDQ and Eckardt scores of patients with AC at three months and one year after operation were both lower than those before operation (4 points, 0 points to 10 points and 4 points, 0 points to 11 points vs. 23 points, 18 points to 30 points; 2 points, 1 points to 3 points and 1 points, 0 points to 1 points vs. 5 points, 4 points to 5 points), and the differences were statistically significant ( Z=-6.036, -6.104, -5.971 and -6.209, all P<0.01). According to Eckardt score, the proportions of clinical remission at three months and one year after operation were higher than that before operation (98.0%, 50/51 and 100.0%, 51/51 vs. 19.6%, 10/51), and the differences were statistically significant ( χ2=64.76 and 68.56, both P<0.05). The SF-36 general health and social function scores at three months and one year after operation were both higher than those before operation (0.55 points, 0.45 points to 0.70 points and 0.55 points, 0.45 points to 0.70 points vs. 0.45 points, 0.30 points to 0.55 points; 0.88 points, 0.75 points to 1.00 points and 0.88 points, 0.75 points to 1.12 points vs. 0.75 points, 0.75 points to 1.00 points); and the differences were statistically significant ( Z=-4.439, -4.225, -2.123 and -2.320, all P<0.05); and the health change scores were lower than those before operation (3.00 points, 2.00 points to 3.00 points and 2.00 points, 1.00 points to 3.00 points vs. 4.00 points, 3.00 points to 4.00 points), and the differences were statistically significant ( Z=-4.827 and -4.841, both P<0.05). Before and after modified POEM, the changes of LESP were positively correlated with the changes of IRP ( r=0.624 and 0.592, both P<0.01). Conclusion:Modified POEM can significantly improve the symptoms and LES relaxation function of AC patients, with a low incidence of post-operative reflux.

Objective To investigate the effects of same calorie intake of different enteral nutrition (EN) on blood glucose in patients with mechanical ventilation.Methods A total of 60 critically ill patients who were admitted to the Department of Intensive Care Unit (ICU) of Taizhou Combined Traditional Chinese and Western Medicine Hospital and received mechanical ventilation from January 2015 to January 2017 were selected. According to the random number table method, the patients were divided into a control group and a study group, 30cases in each group. The patients in the control group were given EN suspension (nutrison fibre), patients in the study group received EN emulsion (fresubin diabetes), on the first day, 1/3 standard calorie was supplied, if the patient had no any discomfort, on the second day 1/2 standard heat was given, from the third day to the tenth day they took the full amount and achieved complete EN (TEN).The fasting blood glucose (FBG), 2 hours postprandial blood glucose (2 h PBG) and glycated hemoglobin (HbA1) level before and after the EN for 10 days were observed, the gastrointestinal tolerance, dosage of insulin, inflammation related indexes, the incidence of ventilator associated pneumonia (VAP) and fatality were analyzed in the two groups.Results Compared with those before EN support, the FBG and 2 h PBG were decreased after the support for 10 days in both groups, the dosage of insulin used was decreased, and the degrees of decrease were more marked in the study group than those in the control group [FBG (mmol/L): 8.03±1.69 vs. 8.87±1.75, 2 h PBG (mmol/L): 8.25±1.98 vs. 10.43±2.34, dosage of insulin (U/d): 38.02±3.24 vs. 40.87±3.48, allP < 0.05], but there was no statistical significant difference in HbA1 level between the two groups [(7.36±1.53)% vs. (7.37±1.29)%,P > 0.05]. The incidence of gastrointestinal intolerance was lower in study group than that in control group [6.67% (2/30) vs. 10.0% (3/30)], but there was no statistical significant difference between the two groups (P > 0.05). Compared with those before EN support, the levels of γ-interferon (IFN-γ) were significantly increased (P < 0.05), while the tumor necrosis factor-α (TNF-α), interleukins (IL-6 and IL-8) levels were significantly decreased after 10 days of EN support, but no statistical significant differences were found (allP > 0.05) between the two groups. During the treatment in the two groups, the incidence of VAP and mortality were relatively low, and there were no statistical significant differences were seen between the two groups (bothP > 0.05).Conclusions The blood glucose control of fresubin diabetes in patients with mechanical ventilation is superior to that of nutrison fibre, fresubin diabetes can reduce the dosage of insulin, decrease the levels of inflammatory factors and conducive to the prognosis of the patients.

Objective To study the homology characteristics of clinicaly isolated and colonized linezolid(LZD)-resistant Enterococcus faecalis (E.faecalis) strains from a patient.Methods Ten E.faecalis strains (2 were isolated from urine specimens and 8 were from stool specimens) isolated from a patient with pulmonary infection were performed antimicrobial susceptibility testing, homology of E.faecalis was determined by pulsed-field gel electrophoresis (PFGE).Results Before and after patients received LZD therapy, 2 E.faecalis strains isolated form urine specimens were both resistant to LZD (MICs: 8 mg/mL, 16 mg/mL, respectively), among 8 strains from stool specimens (6 were isolated before therapy, and 2 were isolated after therapy), LZD susceptible, intermediate, and resistant strains were 4, 2, and 2 respectively(MICs: 0.25-12 mg/mL).10 strains of E.faecalis were homologous by PFGE typing.Conclusion In this case, the detection of E.faecalis from urinary tract and intestinal tract is homologous, which suggested that LZD-resistant Enterococcus may be colonized in vivo for a long time, and may be shift to cause bacterial infection.

Objective To study the preventive effects of prevention monitoring form for reducing enteral nutrition complications. Methods From January 2013 to December 2013, 58 patients were divided into control group which were used traditional nursing method. From January 2014 to December 2014, 61 cases were in intervention group undergoing prevention monitoring nursing method based on traditional nursing. We compared the differences between these two groups in body quality, C-reactive protein, albumin, prealbumin, complications and patient satisfaction before and after 10 d surgery. Results There were no differences between body quality, C-reactive protein, albumin, prealbumin in these two groups before surgery (P > 0. 05). Compared with the 10th day after surgery, there were significantly higher level of body quality, albumin, prealbumin in the intervention group than those of the control group (P<0. 05), while higher level C-reactive protein in the control group (P<0. 05). The incidences of abdominal pain, diarrhea, nausea, vomiting, gastric retention, reflux, aspiration and aspiration pneumonia, the proportion of blocking pipe were lower in the intervention group than the control group. Patient′s satisfaction rates were 98. 4% and 81. 0% in the intervention group and control group (P<0. 05). Conclusions Prevention monitoring form can decrease the rate of enteral nutrition complications, and improve nutrition, biochemical indexes and patients satisfaction.

BACKGROUND:Knee joint is the most complicated structure of human body, and X-ray is often used to reflect the stenosis of knee compartment. However, radiographs are two-dimensional projection of three-dimensional joint structure. Thus, different joint shooting locations can impact the outcomes of measurement, and it is difficult to ensure the accuracy of repeated measurements. OBJECTIVE:To build three-dimensional model of knee compartment, measure the distance and volume, and provide the basis for subsequent models, biomechanics and relevant clinical studies. METHODS:Based on the principle of reverse engineering, using CT images of the knee joint and the software of Mimics, three-dimensional model of medial compartment knee structure was reconstructed. After the model was imported and smoothed, the medial and lateral compartment volumes were finaly calculated by the software of Geomagic Studio. RESULTS AND CONCLUSION: Three-dimensional model of the knee compartment, including femur, tibia and fibula, was successfuly structured by CT images. The models of knee and knee compartment could be observed at any angle or observed individualy, and could be measured. It was discovered that the volume of medial and lateral compartments of knee is close, although the joint space width of them is different, which ilustrates that the procedure can accurately reflect the degree of knee joint space width in the round by calculating the volume of medial and lateral compartments of knee joint through computer.

Objective Explore the reversibility and potential molecular mechanisms of pulmonary hypertension in pa-tients with complete transposition of the great arteries (cTGA) combined with ventricular septal defect (VSD) in comparison with those with simple VSD. Methods Twenty-four patients with pulmonary hypertension (mean pulmonary arterial pressure was greater than 30 mmHg) were enrolled in our study, in which 10 patients suffered from cTGA with VSD, and the rest 14 pa-tients suffered from simple VSD. Lung specimens were taken from the right middle lobe of lung before cardiopulmonary bypass. The extent of pulmonary hypertension was then graded according to the Heath-Edwards classification. ELISA was used to exam-ine the expression of eNOS, iNOS, ET-1, ET-AR, ET-BR, MMP-2, MMP-9 and TIMP in all the specimens. Results No statistically significant differences in age, height, weight, the size of VSD, and the pulmonary artery pressure before operation were found between the groups. The level of hemoglobin, aortic and pulmonary arterial oxygen saturation, and the reduction value of pulmonary arterial pressure after surgery were significantly higher in the cTGA patients than that in the simple VSD pa-tients (P < 0.05). All patients had grade 0 - Ⅱ Heath-Edwards changes in their lung biopsy samples. The expression of eNOS and MMP-2 was significantly lower in the TGA group than that in the simple VSD group [eNOS: (280.13 ± 101.92) ng/mg vs. (488.41±249.6) ng/mg, P<0.05; MMP-2:(31.68±15.36)ng/mg vs. (69.28±49.12)ng/mg, P<0.05]. There were no statistically significant differences between the two groups regarding the expression of iNOS, ET-1, ET-AR, ET-BR,MMP-9 or TIMP. Conclusion The imbalance of the NOS/ET system and the MMP/TIMP system involves in the development of pulmonary hypertension in patients with TGA combined with VCD. In patients with cTGA, the high oxygenation state in pul-monary circulation may decrease the expression of MMP2 and eNOS, and may affect the progress of pulmonary hypertension to a certain extent.