Objective To compare the benefits and drawbacks of primary patch expansion versus pericardial tube right ventricular-pulmonary artery connection in patients diagnosed with pulmonary atresia with ventricular septal defect (PA/VSD). Methods A retrospective study was conducted on patients diagnosed with PA/VSD who underwent primary right ventricular-pulmonary artery connection surgery at our center between 2010 and 2020. Patients were categorized into two groups based on the type of right ventricular-pulmonary artery connection: a pericardial tube group and a patch expansion group. Clinical data and imaging findings were compared between the two groups. Results A total of 51 patients were included in the study, comprising 31 males and 20 females, with a median age of 12.57 (4.57, 49.67) months. The pericardial tube group included 19 patients with a median age of 17.17 (7.33, 49.67) months, while the patch expansion group consisted of 32 patients with a median age of 8.58 (3.57, 52.72) months. In both groups, the diameter of pulmonary artery, McGoon index, and Nakata index significantly increased after treatment (P<0.001). However, the pericardial tube group exhibited a longer extracorporeal circulation time (P<0.001). The reoperation rate was notably high, with 74.51% of patients requiring further surgical intervention, including 26 (81.25%) patients in the patch expansion group and 12 (63.16%) patients in the pericardial tube group. No statistical differences were observed in long-term cure rates or mortality between the two groups (P＞0.005). Conclusion In patients with PA/VSD, both patch expansion and pericardial tube right ventricular-pulmonary artery connection serve as effective initial palliative treatment strategies that promote pulmonary vessel development and provide a favorable foundation for subsequent radical operations. However, compared to the pericardial tube approach, the patch expansion technique is simpler to perform and preserves some intrinsic potential for pulmonary artery development, making it the preferred procedure.

Objective To confirm the changes of pulmonary artery pressure, neo pulmonary artery stenosis and reoperation in children with unilateral absence of pulmonary artery (UAPA) undergoing pulmonary artery reconstruction. Methods The clinical data of the infants with UAPA undergoing pulmonary artery reconstruction in our hospital from February 19, 2019 to April 15, 2021 were analyzed. Changes in pulmonary artery pressure, neo pulmonary artery stenosis and reoperation were followed up. Results Finally 5 patients were collected, including 4 males and 1 female. The operation age ranged from 13 days to 2.7 years. Cardiac contrast-enhanced CT scans were performed in all children, and 2 patients underwent pulmonary vein wedge angiography to confirm the diagnosis and preoperative evaluation. Preoperative transthoracic echocardiography and intraoperative direct pulmonary arterial pressure measurement indicated that all 5 children had pulmonary hypertension, with a mean pulmonary arterial pressure of 31.3±16.0 mm Hg. Pulmonary arterial pressure decreased immediately after pulmonary artery reconstruction to 16.8±4.2 mm Hg. The mean follow-up time was 18.9±4.7 months. All 5 patients survived during the follow-up period, and 1 patient had neo pulmonary artery stenosis or even occlusion and was re-operated. Conclusion Pulmonary artery reconstruction can effectively alleviate the pulmonary hypertension in children with UAPA. The patency of the neo pulmonary artery should be closely followed up after surgery, and re-pulmonary angioplasty should be performed if necessary.

Objective To observe the effects of octreotide on fecal characteristics and humoral immunity in neonates with necrotizing enterocolitis(NEC).Methods A retrospective study was conducted on 60 newly born NEC patients at Hebei PetroChina Central Hospital from March 2022 to September 2023.The patients were separated into the observation group(30 cases)and the routine group(30 cases)based on treatment methods.The conventional group was treated with total parenteral nutrition and gastrointestinal decompression plus piperacillin sodium and tazobactam sodium for 7 days.The observation group was treated with octreotide in addition to the routine group for 5 days.The treatment efficacy,general clinical data,degree of intestinal microbiota disorder,expression levels of intestinal microbiota markers and immune indicators were compared between the two groups.Results The total effective rate of the observation group was higher than that of the routine group(P＜0.05).After treatment,body weight of the observation group was higher than that of the routine group.The hospitalization time,vomiting relief time,abdominal distension relief time,diarrhea relief time and complete recovery time of fecal characteristics were lower in the observation group than those in the routine group.Compared with before treatment,the degree of intestinal microbiota disorder and high mobility group box protein 1(HMGB1)were reduced in both groups after treatment,and expression levels of human β defensin 2(HBD2),autoinducer-2(AI-2)and serum immunoglobulin(Ig)A,IgG and IgM were increased(P＜0.05).After treatment,HMGB1 was lower in the observation group than that in the routine group,while HBD2,AI-2 and serum IgA,IgG and IgM were higher than those in the routine group(P＜0.05).Conclusion Octreotide can effectively treat children with NEC,improve stool characteristics,and enhance immunity.

Objective:To analyze the expression levels of urinary interleukin-6 (IL-6), signal transducer and activator of transcription 3 (STAT3) and heparin-binding protein (HBP) in urinary tract infection and its correlation with infection prognosis.Methods:The clinical data of 100 patients with urinary tract infection (urinary tract infection group) from January 2021 to December 2022 in the Affiliated Hospital of Jining Medical College were retrospectively analyzed. Among them, simple urinary tract infection was in 62 cases, and complex urinary tract infection was in 38 cases; after treatment, 25 cases were not cured, and 75 cases were cured. Another 50 healthy examinees were selected as the health control group. The level of urine IL-6 was detected by luminescence assay method, the level of urine STAT3 was detected by enzyme-linked immunosorbent assay method, and the level of urine HBP was detected by fluorescence immunochromatography method. The blood routine was detected by fully automated blood cell analyzer, and the blood cell count was recorded. The levels of serum C-reactive protein (CRP) and procalcitonin (PCT) were detected by radioimmunoassay. The correlation between urine IL-6, STAT3, HBP and blood routine inflammatory response markers was analyzed by Pearson method. The receiver operating characteristic (ROC) curve was used to evaluate the predictive effectiveness of urine IL-6, STAT3, HBP and blood routine inflammatory response markers in infection prognosis.Results:The urine IL-6, STAT3, HBP, and blood CRP, PCT, white blood cell count in urinary tract infection group were significantly higher than those in healthy control group: (33.19 ± 11.02) μg/L vs. (16.84 ± 3.57) μg/L, (66.77 ± 19.58) μg/L vs. (38.69 ± 11.04) μg/L, (151.98 ± 42.00) μg/L vs. (28.55 ± 9.16) μg/L, (12.57 ± 4.19) mg/L vs. (5.23 ± 1.80) mg/L, (0.58 ± 0.19) μg/L vs. (0.22 ± 0.07) μg/L and (9.86 ± 3.20) × 10 9/L vs. (6.44 ± 2.13) ×10 9/L, and there were statistical differences ( P<0.01). The urine IL-6, STAT3, HBP, and blood CRP, PCT, white blood cell count in patients with complex urinary tract infection were significantly higher than those in patients with simple urinary tract infection: (40.25 ± 10.34) μg/L vs. (28.87 ± 8.55) μg/L, (79.50 ± 17.92) μg/L vs. (58.96 ± 13.43) μg/L, (186.51 ± 35.92) μg/L vs. (130.82 ± 39.74) μg/L, (14.09 ± 4.18) mg/L vs. (11.64 ± 3.55) mg/L, (0.64 ± 0.20) μg/L vs. (0.55 ± 0.13) μg/L and (11.27 ± 3.08) × 10 9/L vs. (8.99 ± 2.36) × 10 9/L, and there were statistical differences ( P<0.01). The urine IL-6, STAT3, HBP, and blood CRP, PCT, white blood cell count in patients with untreated urinary tract infection were significantly higher than those in patients with cured urinary tract infection: (42.97 ± 11.51) μg/L vs. (29.93 ± 8.66) μg/L, (86.81 ± 20.35) μg/L vs. (60.09 ± 17.43) μg/L, (264.27 ± 28.76) μg/L vs. (114.55 ± 21.38) μg/L, (19.11 ± 3.28) mg/L vs. (10.39 ± 2.40) mg/L, (0.85 ± 0.14) μg/L vs. (0.49 ± 0.11) μg/L and (12.26 ± 2.77) × 10 9/L vs. (9.06 ± 2.34) ×10 9/L, and there were statistical differences ( P<0.01). Pearson correlation analysis result showed that urine IL-6, STAT3, HBP were positively correlated with blood CRP, PCT, white blood cell count ( P<0.01). The ROC curve analysis result showed that the area under curve (AUC) of urine IL-6, STAT3 and HBP in predicting the infection prognosis in patients with urinary tract infection was greater than that of blood CRP, PCT and white blood cell count; moreover, the AUC and sensitivity of the combined of urine IL-6, STAT3 and HBP in predicting the infection prognosis in patients with urinary tract infection were significantly higher than the combined of blood CRP, PCT and white blood cell count (0.937 vs. 0.898 and 96.00% vs. 76.00%), but with lower specificity (81.33% vs. 98.67%). Conclusions:Urinary tract infections can cause elevated urine IL-6, STAT3 and HBP, and the degree of elevation is related to the types of simple or complicated infection and the infection prognosis. The combined detection of the urine IL-6, STAT3 and HBP is expected to be a method to predict the infection prognosis, and it provides reference information for clinical diagnosis and treatment.

ObjectiveTo develop basic training courses for family doctor teams for people with disabilities. MethodsUtilizing the methods and theories of the World Health Organization (WHO) rehabilitation competency framework (RCF), and referring to the WHO universal health coverage global competency framework, the rehabilitation competency characteristics of family doctor teams for people with disabilities in community settings were analyzed, and a basic training course system for these teams based on the RCF was developed. Results and ConclusionBased on RCF, a competency framework for family doctor teams serving people with disabilities has been constructed. The objectives, content and training course system for basic rehabilitation training has been established.

Objective:To investigate the diagnostic method and value of echocardiography in screening right patent ductus arteriosus(PDA) of infants.Methods:This was a prospective study.Thirty-one infants with right PDA diagnosed by ultrasound and confirmed by prenatal ultrasonography, electronic computed tomography angiography, angiocardiography and/or surgery in Hebei Children′s Hospital from April 2014 to May 2022 were collected as research subjects, and the association of right ductus arteriosus with aortic arch anomalies and complex cardiac malformations were summarized. The diagnostic method and value of ultrasonic screening were summed up.Results:Of the 31 cases, 30 cases were correctly diagnosed by ultrasound and 1 case was misdiagnosed, who was a left aortic arch descending to the right, a crossover variation of the right and left pulmonary arteries, and a rightward displacement of the ductus arteriosus. Among these cases diagnosed correctly, 27 cases (including 24 cases with right aortic arch and 3 cases with left aortic arch) presented that ductus arteriosus was open and its ostium of pulmonary artery end was located in the proximal right pulmonary artery in views of parasternal short-axis view of great vessels at cardiac base with the combination of two dimensions and color Doppler flow imaging. Other 3 cases of right aortic arch were all single ventricle with transposition of the great artery. Due to the parallel relationship of the two great arteries, the standard parasternal short-axis view of great vessels could not be obtained, and the right ductus arteriosus was found in the high parasternal views.In all of the 27 cases with right aortic arch and right ductus arteriosus, high parasternal views showed that one end of the ductus arteriosus was connected to the right aortic arch isthmus and the other end was connected to the right pulmonary artery. In all of the 3 cases with left aortic arch and right ductus arteriosus, the high parasternal views showed that one end of the ductus arteriosus was connected to the right subclavian artery and the other end was connected to the right pulmonary artery. Among the 27 cases with right aortic arch, 16 cases were accompanied with mirror image branches, 9 cases of which had complex cardiac malformations; 10 cases were associated with aberrant left subclavian artery, 1 case of which had complex cardiac malformations; 1 case was with isolated left subclavian artery, and without complex cardiac malformations. All 3 cases of left aortic arch were accompanied with isolated right subclavian artery and none of them were associated with complex cardiac malformations. Clinical outcomes of 30 cases with right PDA: 14 cases underwent ductus arteriosus ligation due to thick ductus or other heart malformations. In other 16 cases, 4 cases were closed spontaneously, 9 cases had persistent small ductus arteriosus, and 3 cases were lost to follow-up.Conclusions:Right ductus arteriosus is mostly related to the right aortic arch, and those with mirror image branches are prone to complex cardiac malformations; cases of left aortic arch with right ductus arteriosus are tend to accompany isolated right subclavian artery. Ultrasound has an important application in the screening and diagnosis of right PDA.

ObjectiveTo observe the effects of Wendantang on the expression of inflammatory cytokines， autophagy markers， and key molecules of phosphatidylinositol-3-kinase/protein kinase B/mammalian target of rapamycin （PI3K/Akt/mTOR） signaling pathway in the adipocytes of the rat model of obesity （syndrome of phlegm-dampness） and to explore the material basis of inflammation in obesity （syndrome of phlegm-dampness） and the underlying mechanism of Wendantang intervention. MethodA total of 126 SD rats were randomized into 2 groups： 16 rats in the blank group and 110 rats in the modeling group. The blank group was fed with a basic diet while the modeling group with a high-fat diet to establish the animal model of obesity （syndrome of phlegm-dampness） for 8 weeks. After successful modeling， 48 obese rats were selected according to their body mass and randomized into a model control group， an orlistat （ORLI， 32.40 mg·kg^-1） group， a rapamycin （RAPA， 2 mg·kg^-1） group， and low-， medium-， and high-dose （4.45， 8.90， 17.80 g·kg^-1， respectively） Wendantang groups， with 8 rats in each group. In addition， 8 rats were randomly selected from the blank group to be set as the normal control group. The corresponding agents in each group were administrated by gavage and the model and control groups were administrated with equal amounts of distilled water once daily for 6 weeks. The body mass， Lee's index， body fat ratio， and obesity rate were measured or calculated. The expression of UNC51-like kinase-1 （ULK1）， Beclin1， human autophagy-related protein 5 （Atg5）， p62， and microtubule-associated protein 1 light chain 3 （LC3） Ⅰ/Ⅱ （markers of autophagy in adipocytes） was detected by the immunohistochemical two-step method. Enzyme-linked immunosorbent assay （ELISA） was employed to determine the expression of tumor necrosis factor （TNF）-α， interleukin-6 （IL-6）， IL-1β， monocyte chemotactic protein-1 （MCP-1）， IL-4， IL-10， IL-13， and transforming growth factor （TGF）-β in adipocytes. Western blot was employed to measure the protein levels of classⅠ-PI3K， phosphatidylinositol triphosphate （PIP3）， Akt， mTORC1， ULK1， TSC1， and TSC2 in adipocytes. ResultCompared with the blank group， the modeling group showed increased body mass and Lee's index （P<0.01）， the obesity rate >20%， and phlegm-dampness syndrome manifestations such as physical obesity， decreased mobility， decreased appetite， lusterless and tight fur， loose stools， decreased responsiveness to the outside world， and decreased water intake. Compared with the normal control group， the model control group showed increased body mass， Lee's index， body fat ratio， adipocyte autophagy marker expression， pro- and anti-inflammatory cytokine levels （P<0.05， P<0.01）， down-regulated protein levels of classⅠ-PI3K， PIP3， Akt， mTORC1， TSC1， and TSC2 （P<0.01）， and up-regulated protein level of ULK1 （P<0.01）. The intervention groups showed lower body mass， body fat ratio， adipocyte autophagy marker protein expression， and protein levels of TNF-α， IL-6， IL-1β， MCP-1， IL-4， and IL-13 than the model control group （P<0.05， P<0.01）. Moreover， the RAPA and Wendantang （medium and high dose） groups showed lowered levels of IL-10 and TGF-β （P<0.01）， and the ORLI group showed down-regulated expression of TGF-β （P<0.01）. The expression of key molecules of the signaling pathway was up-regulated （P<0.05， P<0.01） while that of ULK1 was down-regulated （P<0.01） in all the intervention groups. Compared with the RAPA group， the Wendantang groups showed up-regulated expression of all autophagy marker proteins in adipocytes （P<0.01）. In addition， the low-dose Wendantang group showed elevated levels of inflammatory cytokines （except TNF-α） （P<0.05， P<0.01） and down-regulated expression of all key molecules of the signaling pathway （P<0.05， P<0.01）. The levels of inflammatory cytokines （except IL-16， MCP-1， and IL-10） were elevated in the medium-dose Wendantang group （P<0.05， P<0.01）. The expression of key molecules except PI3K of the signaling pathway was down-regulated in the medium- and high-dose Wendantang groups （P<0.05， P<0.01）. Compared with the ORLI group， low- and medium-dose Wendantang groups showed up-regulated expression of autophagy markers in adipocytes （P<0.01）， and the low-dose group showed elevated levels of inflammatory cytokines （IL-6， IL-4， and TGF-β） （P<0.01） and down-regulated expression of all key molecules of the signaling pathway （P<0.01）. The medium-dose Wendantang group showed up-regulated expression of IL-4 （P<0.01） and down-regulated expression of key molecules except PI3K of the signaling pathway （P<0.05， P<0.01）. The high-dose Wendantang group showed increased body mass， up-regulated expression levels of autophagy markers （ULK1， LC3 Ⅰ/Ⅱ） （P<0.05， P<0.01）， down-regulated expression of PIP3， mTORC1， and TSC1 （P<0.05， P<0.01）， and lowered levels of Beclin1， Atg5， TNF-α， and IL-13 （P<0.05， P<0.01）. ConclusionThe inflammation in obesity （syndrome of phlegm-dampness） is closely associated with the PI3K/Akt/mTOR pathway-mediated adipocyte autophagy. Wendantang can treat the chronic inflammation in obese rats with the syndrome of phlegm-dampness by regulating this signaling pathway and thus improve adipocyte autophagy.

Background and purpose: Long non-coding RNA small nucleolar RNA host gene 5 (lncRNA SNHG5) plays a cancer-promoting role in many cancers, however its effect on colorectal cancer (CRC) and its regulatory mechanism are not clear. This study aimed to explore the mechanism of lncRNA SNHG5/miR-26a-5p/metadherin (MTDH) signal axis promoting metastasis of CRC. Methods: The data of The Cancer Genome Atlas (TCGA) database was analyzed, the abnormal expression of lncRNA in CRC was explored and analyzed the survival. Samples of CRC, paracancerous tissues and complete clinical data of patients who underwent surgical resection from October 2020 to October 2021 were collected. The expression levels of SNHG5 and miR-26a-5p in lncRNA were detected by real-time fluorescence quantitative polymerase chain reaction (RTFQ-PCR), and the expression level of MTDH was detected by immunohistochemistry. The relationship between the relative expression level of lncRNA SNHG5 in CRC and clinicopathological features and survival time was analyzed. The effects of lncRNA SNHG5 on the proliferation, migration and invasion of CRC cells were detected by cell counting kit-8 (CCK-8), clone formation, scratching assays, transwell test and in vivo xenotransplantation. The relationship between CRC cell metastasis, the expression level of epithelial-mesenchymal transition related molecules and lncRNA SNHG5 expression level by Western blot and immunohistochemical detection were explored. The physical interaction between SNHG5 and miR-26a-5p, MTDH and miR-26a-5p was studied by RNA pull-down test, double luciferase reporter gene detection and RNA co-immunoprecipitation. The functional relationship among the three was verified by CCK-8, EdU and transwell experiments. The effect of SNHG5, miR-26a-5p and MTDH expression on migration and invasion related molecules was analyzed by Western blot. Results: The results of TCGA database analysis showed that lncRNA SNHG5 was significantly upregulated in CRC. The results of RTFQ-PCR and immunohistochemistry showed that the levels of lncRNA SNHG5 and MTDH in CRC tissues were significantly upregulated (P＜0.05), the level of miR-26a-5p was decreased (P＜0.05), and the level of MTDH in samples with high expression of SNHG5 was also increased. The expression of lncRNA SNHG5 in CRC tissues with serosa and extraserosal invasion, distant metastasis, lymph node metastasis and TNM stage Ⅲ was significantly higher compared with subserosal invasion, no distant metastasis and lymph node metastasis and TNM stage Ⅰ-Ⅱ (P＜0.05). The results of survival analysis showed that the high expression of lncRNA SNHG5 was significantly correlated with overall survival rate (P＜0.05). Overexpression of lncRNA SNHG5 could enhance the proliferation, clone formation, migration and invasion of CRC cells, promote the growth and lung metastasis of transplanted tumor, increase the relative expression level of Ki-67 proliferation index and vimentin (P＜0.05), and decrease the relative expression level of E-cadherin (P＜0.05). However, the development of CRC cells was inhibited after inhibition of lncRNA SNHG5 expression. RNA pull-down test, double luciferase reporter gene detection and RNA co-immunoprecipitation confirmed the physical interaction between SNHG5 and miR-26a-5p, MTDH and miR-26a-5p. Upregulation of miR-26a-5p or downregulation of MTDH expression in lncRNA SNHG5 overexpressed cells partially reversed the effects of lncRNA SNHG5 on proliferation, migration, invasion and expression of related molecules in CRC cells. Conclusion: LncRNA SNHG5 is upregulated in CRC tissues and cells, and its high expression is related to tumor progression and poor survival. It can be used as a molecular sponge of miR-26a-5p to regulate the expression of MTDH to promote the proliferation and metastasis of SW620 cells.

Objective:To explore the echocardiographic characteristics of isolated brachiocephalic artery branches, and to analyze the reason of missed diagnosis and misdiagnosis in order to improve the diagnostic accuracy.Methods:Echocardiographic features of isolated subclavian artery and brachibrachial trunk confirmed by operation or CT angiography (CTA) or digital subtraction angiography (DSA) were retrospectively analyzed in Hebei Children′s Hospital from May 2017 to July 2021. Related literatures of other rare types of isolated brachiocephalic artery branches retrieved in PubMed were reviewed, and the echocardiographic characteristics of such vascular malformations were summarized.Results:A total of 4 children with isolated brachiocephalic artery branches were included. Echocardiography correctly diagnosed isolated brachiocebrachial trunk in 1 case and missed or misdiagnosis in 3 cases, including isolated subclavian artery was missed in 1 case, isolated subclavian artery was misdiagnosed as aberrant subclavian artery in 1 case and patent ductus arteriosus in 1 case. A total of 105 cases of isolated brachiocephalic artery branches were reviewed, including isolated brachiocephalic artery in 31 cases (53.3%), isolated common carotid artery in 15 cases (29.5%), isolated common carotid artery in 15 cases (14.3%) and isolated internal carotid artery in 3 cases (2.9%). The characteristic of echocardiography was that the brachiocephalic branch of the aortic arch was disconnected from the aortic arch, often via the ductus arteriosus or directly connected to the bifurcation of the pulmonary artery.Conclusions:Isolated brachiocephalic artery branches have certain characteristic echocardiographic features and these kinds of vascular malformations are accompanied by different degrees of stealing blood phenomenon. Careful tracing of the origin of brachiocephalic artery branches and combined with cervical vascular ultrasound when necessary can improve the diagnosis rate of isolated brachiocephalic artery branch lesions.

Objective:To investigate the effect of treatment of spinal meningioma with microsurgical procedures.Methods:From January 2003 to March 2022, there were 120 patients who had spinal meningioma and treated in the Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University. Their clinical data were retrospectively analysed. Of the 120 patients, there were 90 females and 30 males, aged from 14 to 85 (average, 54) years old. According to McCormick Classification, 29 cases were in grade I, 59 cases were in grade II, 25 cases were in grade III, and 7 cases were in grade IV. They were all underwent microsurgery. Patients were followed up by outpatient service within 3 months after surgery, then reviewed by outpatient visits and telephone interviews. McCormick's classification method and MRI examination were used to analyse the neurological and imaging changes of the patients before and after the surgery.Results:A total of 113 patients had complete resection and 7 had the resection of most part of the spinal meningioma. No infection, cerebrospinal fluid leakage, other complications and death occurred. Three months after surgery, 95 patients achieved the improvement or even completely disappearance of symptoms (such as numbness, pain, limited movement, etc.). There were 23 patients who had the symptoms unchanged as what before the surgery. Two patients had the symptoms worsened after the surgery. At 3 months after surgery, 95 cases (79.2%) improved, 23 cases (19.2%) were stable, and 2 cases (1.6%) aggravated. According to McCormick classification method, 92 cases were in grade Ⅰ, 15 cases were in gradeⅡ, 10 cases were in grade Ⅲ, and 3 cases were in grade Ⅳ. MRI scans showed that the dural sac were well refluxed, and no recurrence was found.Conclusion:Microsurgery is safe and effective for removal of spinal meningioma, with significant improvement in symptoms with fewer complications.