Objective To develop a novel transcatheter tricuspid valve replacement device and test its performance. Methods The transcatheter tricuspid valve stent consisted of double-layer self-expanding nitinol stent, biotissue-derived bovine pericardial leaflets, and PTFE woven. The delivery system, mainly consisting of a handle control unit and a delivery sheath, was sent to the correct position via right atrium or jugular vein. The sheath had a visualization feature, and the handle control unit could realize the functions of stable release and partial recovery of the interventional valve. In addition, this study performed animal survival experiments on the basis of in vitro experiments. A large-white pig was used as the experimental animal. Cardiopulmonary bypass was established through median thoracotomy, then the right atrium was opened, and the interventional valve was released under direct vision without cardiac arrest. Approximately 1 month after interventional valve implantation, the maneuverability and stability of the interventional tricuspid device were evaluated by autopsy. Results Through the animal experiment, the interventional valve was successfully released, and the anchoring was satisfactory. Postoperative transthoracic echocardiography showed that the interventional valve opened and closed well, the flow rate of tricuspid valve was 0.6 m/s, and there was no obvious tricuspid regurgitation. One month after the operation, we dissected the large-white pig and found the interventional valve was not deformed or displaced, the leaflets were well aligned, and there was thrombus attachment in the groove between the inner and outer layers of the interventional valve. Conclusion Animal experiment shows that the novel device can stably and firmly attach to the tricuspid annulus, with good anchoring effect, and effectively reduce paravalvular leakage.

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 understand the status of anemia among rural children aged 3-6 in central China and its relationship with dietary behavior, and to provide reference for prevention and intervention of anemia in rural children. Methods: From April to June 2021, stratified cluster sampling was used to select 1 246 preschool children aged 3 to 6 years old in rural areas in central China. Peripheral blood of the ring finger was collected. Dietary behaviors regarding consumption of cereals and potatoes, fruits, vegetables, soy products, milk, animal foods, food diversity, and drinking water were investigated. Logistic regression analysis was used to analyze the association between anemia and dietary behaviors. Results: The detection rate of anemia in rural children aged 3-6 in central China was 13.88%. The anemia detection rate of left behind children (19.00%) was higher than that of non left behind children (11.27%), and the difference was statistically significant ( χ 2=13.93, P <0.01). Logistic regression analysis showed that the proportion of left behind children ( OR=1.28, 95%CI =1.16-1.56) with anemia was higher than that of non left behind children ( P <0.01). Consumption of animal food intake ≥3 times/week ( OR=0.82, 95%CI =0.69-0.91), and ≥2 kinds of vegetables ( OR= 0.86, 95%CI =0.71-0.93) were associated with lower rate of anemia ( P <0.05). Conclusion The detection rate of anemia in rural children aged 3-6 years in central China is relatively high, especially in left behind children. Dietary literacy of caregivers should be further improved regarding increased intake of animal foods and vegetables to reduce the risk for anemia in preschoolers.

Objective:To investigate the surgical method and clinical value of free medial sural artery perforator (MSAP) flap for repairing the wound of toe.Methods:The patients with isolated toe skin defects admitted to the Department of Trauma Microsurgery of No.988 Hospital of Joint Logistics Support Force were treated with MSAP flap for wound repair from June 2014 to December 2018. All the donor site were closed primarily. After the operation, the appearance, texture, hair growth and functional recovery of donor and recipient sites were observed through regular follow-up in outpatient or WeChat.Results:A total of 11 cases were enrolled, including 7 males and 4 females, aged from 19 to 44 years, with an average of 31.3 years. The wound sites were located at the first toe in 8 cases, the second toe in 2 cases, and the fourth toe in 1 case. The size of the skin defects was from 2.2 cm×1.8 cm to 5.7 cm×3.8 cm, the primary repair was performed in 4 cases and secondary repair in 7 cases, and the flaps ranged from 2.6 cm×2.1 cm-6.1 cm×4.2 cm. Ten cases survived successfully, and the wounds healed primarily. One case had local necrosis at the distal end of the flap, the wound healed after secondary repair surgery. All patients were followed-up from 6 to 18 months. The appearance of flaps was good in 9 cases and slightly swollen in 2 cases. All flaps had good texture, no discomfort of wearing shoes, no obvious influence on walking, and linear scar remained in the donor area. Three cases were treated with laser hair removal because of the flap hair growth.Conclusions:The method of using a free MSAP flap to repair the small toe wound can restore its appearance to satisfaction and achieve a good aesthetic repair effect.

Objective:To investigate the surgical method and clinical value of free medial sural artery perforator (MSAP) flap for repairing the wound of toe.Methods:The patients with isolated toe skin defects admitted to the Department of Trauma Microsurgery of No.988 Hospital of Joint Logistics Support Force were treated with MSAP flap for wound repair from June 2014 to December 2018. All the donor site were closed primarily. After the operation, the appearance, texture, hair growth and functional recovery of donor and recipient sites were observed through regular follow-up in outpatient or WeChat.Results:A total of 11 cases were enrolled, including 7 males and 4 females, aged from 19 to 44 years, with an average of 31.3 years. The wound sites were located at the first toe in 8 cases, the second toe in 2 cases, and the fourth toe in 1 case. The size of the skin defects was from 2.2 cm×1.8 cm to 5.7 cm×3.8 cm, the primary repair was performed in 4 cases and secondary repair in 7 cases, and the flaps ranged from 2.6 cm×2.1 cm-6.1 cm×4.2 cm. Ten cases survived successfully, and the wounds healed primarily. One case had local necrosis at the distal end of the flap, the wound healed after secondary repair surgery. All patients were followed-up from 6 to 18 months. The appearance of flaps was good in 9 cases and slightly swollen in 2 cases. All flaps had good texture, no discomfort of wearing shoes, no obvious influence on walking, and linear scar remained in the donor area. Three cases were treated with laser hair removal because of the flap hair growth.Conclusions:The method of using a free MSAP flap to repair the small toe wound can restore its appearance to satisfaction and achieve a good aesthetic repair effect.

Objective:To investigate the efficacy of tacrolimus combined with irbesartan in treating female patients with lupus nephritis and its effect on serum levels of high mobility protein B1(HMGB1) and receptor for advanced glycation products(RAGE).Methods:Sixty female patients with lupus nephritis admitted to the First People's Hospital of Wenling from January 2018 to May 2019 were included and divided into control group and observation group according to the random number table method, with 30 cases in each group.The control group received tacrolimus.The observation group was treated with irbesartan on the basis of the control group.After 6 months of continuous treatment, the renal function, scores of lupus nephritis activity index(SLE-DAI) and chronic disease index(SLE-CI), the efficacy, and serum levels of HMGB1 and RAGE were compared between the two groups.Results:Compared with the control group, the serum levels of creatinine(SCr)[(76.46±9.09)μmol/L], urea nitrogen(BUN)[(6.71±0.88)mmol/L], 24h urinary protein quantification[(1.38±0.21)g/24h], scores of SLE-DAI[(9.09±1.41)points] and SLE-CI[(1.17±0.17)points] were significantly reduced in the observation group after treatment, and the plasma albumin(Alb)[(35.08±5.11)g/L] and estimated glomerular filtration rate(eGFR)[(57.79±6.94)mL/min] were significantly increased (all P<0.01). The total effective rates of the observation group and the control group were 90.00% and 63.33%, respectively, and the difference between the two groups was statistically significant(χ 2=4.565, P<0.05). Compared with the control group, the serum levels of HMGB1[(52.31±7.13)μg/L] and RAGE[(1.11±0.18)μg/L] in the observation group were significantly reduced after treatment(all P<0.01). Conclusion:The efficacy of tacrolimus combined with irbesartan in the treatment of female patients with lupus nephritis is significant, and it can inhibit serum levels of HMGB1 and RAGE.

Objective    To compare the efficacy and safety of mitral valvuloplasty via minimally invasive approach with those of mitral valvuloplasty via traditional median sternotomy. Methods    A total of 1 221 patients undergoing mitral valvuloplasty from January 2015 to August 2018 in Guangdong Provincial People's Hospital were analyzed retrospectively, including 721 males and 500 females, with an average age of 47.2±15.1 years. According to the different surgical methods, they were divided into a study group (n=654), who received mitral valvuloplasty via the totally thoracoscopic approach, and a control group (n=567), who received mitral valvuloplasty via traditional median sternotomy. Clinical data, surgical results, and perioperative outcomes of the two groups were compared. Results    There was no significant difference in preoperative general data between the two groups (P>0.05). Compared with the control group, the study group had longer cardiopulmonary bypass time and aortic cross-clamping time (146.7±42.4 min vs. 122.7±30.6 min, 96.2±32.7 min vs. 78.3±23.8 min, both P=0.000), and shorter total operation time (227.4±55.3 min vs. 238.1±56.4 min, P=0.001). There was no significant difference in the incidence of secondary cross-clamping and mitral valve replacement between the two groups (3.7% vs. 2.6%, P=0.312; 1.7% vs. 1.4%, P=0.690). The blood transfusion rate and the incidence of respiratory tract infection and postoperative poor wound healing were lower (13.0% vs. 24.5%, 2.1%vs. 18.0%, 1.5% vs. 5.3%, all P=0.000) and the postoperative hospital stay was shorter (6.2±4.4 d vs. 11.5±8.8 d, P=0.000) in the study group. There was no significant difference in hospitalization expense between the two groups (95 847.9±31 322.0 yuan vs. 99 673.1±47 930.3 yuan, P=0.149). Within 30 d after surgery, 1 patient died in the study group and 4 patients died in the control group. Before discharge, there were 4 and 5 patients with severe mitral valve regurgitation in the study group and the control group, respectively. Conclusion    Compared with mitral valvuloplasty via traditional median sternotomy, minimally invasive mitral valvuloplasty is superior in shortening operation time and postoperative hospital stay, lowering blood transfusion rate, and reducing postoperative complications, which can achieve better clinical outcomes.

Objectives: To evaluate the efficacy of minimally invasive surgery in patients with late severe tricuspid regurgitation after cardiac surgery, and to evaluate the role of leaflets augmentation technique in tricuspid valvuloplasty. Methods: From January 2015 to June 2019, 85 patients undergoing tricuspid valve repair procedure with minimally invasive approach at Department of Cardiovascular Surgery, Guangdong provincial People′s Hospital were enrolled. There were 22 males and 63 females, aging of (53.6±12.4) years (range: 15 to 75 years). The interval between the prior and current operations was (16.0±7.3) years (range: 0.2 to 35.0 years). The diameter of right atrium and right ventricle was (77.3±17.2) mm and (61.0±8.4) mm, respectively. Tricuspid regurgitation was severe or extremely severe, the tricuspid regurgitation area was (19.0±10.3) cm². All patients underwent minimally invasive tricuspid valvuloplasty or tricuspid valve replacement on beating-heart with totally endoscopic technique and port-access approach through right chest wall. The operations included tricuspid valve replacement and tricuspid valvuloplasty, the technique of tricuspid valvuloplasty including leaflets augmentation with patch, ring implantation, chordae tendineaes reconstruction, release of papillary muscle, edge to edge method, etc. Postoperative hospitalization days, the time of ICU stay, blood transfusion rate, ventilator time and the results of echocardiography were recorded. Follow-up was completed regularly by WeChat, telephone and outpatient visit. Results: Sixty-five patients underwent tricuspid valve repair, and 20 patients underwent tricuspid valve replacement because of prosthetic failure and plasty failure. Five patients died during hospitalization, with mortality rate 5.9%. One patient was transferred to local hospital for anti-infection treatment, the other 79 patients were discharged from hospital in well condition and followed-up. The postoperative hospitalization time was 7.0 (5.5) days (M(Q_R)) days, the mean ventilator time was 18.0 (16.2) hours, and the mean ICU stay time was 68.0 (75.5) hours. There were 35 patients without blood conduction transfusion, the transfusion rate was only 58.9% (50/85). Four cases of severe, 9 cases of moderate and 67 cases of mild to zero tricuspid regurgitation were examined before being discharged, with tricuspid regurgitation area of (2.8±3.5) cm² (range: 0 to 19.1 cm²). The follow-up time was 1 to 38 months. Two patients died during follow-up, one patient died from infective endocarditis and mitral perivalvular leakage, the other one died of intractable right heart failure. One patient was implanted with permanent pacemaker due to Ⅲ atrioventricular block. Valvular re-replacement was performed in 2 patients who were re-admitted for the artificial valve infection and mechanical valve obstruction. No re-operation of tricuspid valve. Conclusions Totally endoscopic minimally invasive technique provided satisfactory surgical outcomes for critically sick patients with severe tricuspid regurgitation following cardiac surgery. The application of leaflets augmentation technique achieved ideal repair effect for previously unrepairable lesions.

Objective To investigate the clinical effect of lateral supramalleolar perforator flap with the rotation point down on the repair of forefoot soft tissue defect.Methods From January,2016 to June,2017,23 cases (15 males and 8 females) of forefoot soft tissue defect were repaired by lateral supramalleolar perforator flap with the rotation point down.The age ranged from 8 to 67 (mean,42.9) years.The soft tissue defects were located far from the tarsometatarsal joint of the foot and the areas were 4.0 cm×4.0 cm-8.0 cm×12.0 cm.The areas of flap stitched directly or take blade thick skin repair on the thigh.All cases were followed-up by telephone or Internet,outpatient visit and home visit.Results Twenty-one cases survived successfully.Small area necrosis occurred at the distal end of the flap in 1 case,and healed after changing treatment.In the other cases,tension blister appeared at the distal end of the flap.After cut off some surgical stitches,the flap survived.All cases were followed-up from 6 to 12 months.The shape of flaps were not bloated and had good textures.The walking of affected limbs had no significant effect,and the functional recovery was satisfactory.Conclusion The lateral supramalleolar perforator flap is easy to cut and the perforator of flap is constant,which is a appropriate flap to repair the soft tissue defect of the forefoot.

To explore the method and effect of repairing the soft tissue defect of the lateral heel with the retrograde lateral supramalleolar flap pedicled with the end perforator of peroneal artery. Methods From May, 2015 to February, 2018, 16 cases of lateral calcaneal soft tissue defect were repaired with the retrograde lateral supramalleolar flap pedicled with the end perforator of peroneal artery.All wounds were treated with one-stage dilata-tion and VSD to control infection. In cases of chronic calcaneal bone infection, the bone defect formed after extensive resection of infected bone was temporarily filled with antibiotic bone cement. The area of soft tissue defect on the lat-eral heel was 3.0 cm×2.0 cm-8.0 cm×5.0 cm, and the area of flaps was 3.5 cm×2.5 cm-8.5 cm×5.5 cm. The small donor area of the flap was sutured directly, and the larger area was repaired by skin grafting. Patients with chronic calcaneal bone infection underwent bone cement removal and autogenous bone transplantation after inducing mem-brane formation 6 to 8 weeks after flap transplantation. All cases were followed-up, including 7 cases outpatient fol-low-up and 9 telephone follow-up. Results All the 16 flaps survived smoothly. The donor and recipient areas of the flaps healed primarily. All cases were followed-up for 3 to 13 months. The flaps had good shape, no swelling, similar color to heel skin and no pigmentation.Ankle flexion and extension were not restricted.Four cases with chron-ic osteomyelitis of calcaneus healed well after second-stage bone grafting, with an average healing time of 8.5 months. Conclusion The retrograde lateral supramalleolar flap with the end perforator of peroneal artery is an ideal method for repairing the soft tissue defect on the lateral heel with simple operation and reliable blood supply.