Objective To investigate the relationship between two-lung ventilation (TLV) with single-lumen endotracheal tube (SLT), one-lung ventilation (OLV) with double-lumen endotracheal tube (DLT) and postoperative pulmonary complications (PPCs) after total thoracoscopic cardiac surgery. Methods The clinical data of patients who underwent totally thoracoscopic cardiac surgeries in the Guangdong Provincial People’s Hospital from October 2019 to October 2021 were retrospectively analyzed. The patients were divided into 2 group according to the type of endotracheal tube, including a SLT group and a DLT group. Baseline data, surgical variables and PPCs were compared. The influencing factors of PPCs in the two groups were analyzed by binary logistic regression analysis. Results Finally 349 patients were enrolled, including 180 males and 169 females with an average age of (50.0±14.8) years. There were 219 patients in the SLT group and 130 patients in the DLT group. There was no statistical difference in baseline data, surgical variables or PPCs between the two groups (P＞0.05). Binary logistic regression analysis showed that PPCs were related to body mass index in the SLT group (OR=0.778, 95%CI 0.637 to 0.951, P=0.014) and preoperative smoking history in the DLT group (OR=0.058, 95%CI 0.004 to 0.903, P=0.042). Conclusion For the patients who undergo totally thoracoscopic cardiac surgery, TLV with SLT and OLV with DLT show no significant association with PPCs. At the same time, PPCs are associated with body mass index in the SLT group, while associated with preoperative smoking history in the DLT group.

Objective To explore the clinical features,imaging and pathological characteristics of the patients with congenital liver fibrosis(CHF).Methods The medical case data of 6 patients with pathological-ly diagnosed CHF in this hospital from January 2011 to June 2021 were retrospectively analyzed,and the clini-cal menifastations,laboratory indicators,imaging characteristics,pathological manifestations,treatment and outcomes were summarized.Results The clinical classification in 6 cases of CHF was mainly portal hyperten-sion(66.67％),and the most common clinical manifestations and signs were hepatosplenomegaly(83.33％),melena(50.00％)and abdominal distension(33.33％).Total bil irubin was normal,and only 2 cases(33.33％)were mildly elevated.The prothrombin time was in the normal range in 4 cases(66.67％),and mild abnormality in 2 cases(33.33％).Imaging showed abnormal liver morphology in 6 cases,spleen enlarge-ment in 5 cases(83.33％),portal vein widening in 3 cases(50.00％),diffuse dilatation of intrahepatic bile ducts in 2 cases(33.33％),and complicating Caroli disease in 1 case(16.67％).The pathological manifesta-tions were normal liver parenchymal cells,periportal fibrosis,and manifold-manifold bridging-like fibrosis.Six cases received the conventional liver protection therapy,3 cases underwent splenectomy+pericardia vascular dissection,the median follow-up time was 68.2 months,1 case died due to liver failure,and 5 cases were rela-tively stable.Conclusion The patients with hepatic disease whose portal hypertension is inconsistent to the degree of hepatic function damage,especially those complicating polycystic kidney disease should perfect the liver puncture pathological examination and genetic testing to clarify the diagnosis,and conduct the genetic counseling and intervention treatment as soon as possible.

Objective:To explore the efficacy and safety of sirolimus in the treatment of diazoxide unresponsive congenital hyperinsulinism(CHI) and summarize the single-center experience.Methods:A retrospective analysis was conducted on the clinical data of 5 cases of CHI treated with sirolimus after ineffective treatment with diazoxide, admitted to the Children′s Hospital Affiliated to Zhengzhou University from January 2017 to December 2022. The efficacy and safety of sirolimus in the treatment of CHI were evaluated.Results:The study included 5 patients, 3 males and 2 females. The age of onset ranged from 1 to 90 days. Initial symptoms included poor mental state(2/5) and convulsions(3/5). Blood glucose levels were 1.1 to 2.3 mmol/L, and insulin levels ranged from 13.52 to 70.53 μIU/mL. Two cases were classified as diffuse type, and the histological type of 3 cases was unknown. Genetic testing confirmed the diagnosis, with whole-exome sequencing revealing an unreported novel mutation in 1 case(ABCC8 exon 25_28del). Of the five patients, three patients were treated with sirolimus after diazoxide and octreotide failed, one patient was treated after unresponsive diazoxide, and the other one was treated after diazoxide, octreotide, and even near-total pancreatectomy failed. The onset age of sirolimus therapy ranged from 1 to 20 months. The maximum dosage of sirolimus was 1.2-3.2 mg·m -2·d -1, and the duration of medication ranged from 2 to 12 months. One patient was fully responsive to sirolimus, and the other four patients were partially responsive. All patients achieved euglycemia with sirolimus alone or in combination with standard CHI treatment. During follow-up, non-infectious diarrhea, elevated carcinoembryonic antigen, elevated triglycerides, and elevated liver enzymes were observed. Conclusion:This study indicates that sirolimus has a certain degree of efficacy in CHI patients for whom diazoxide treatment is ineffective. However, the long-term efficacy and safety warrant further multicenter trials.

OBJECTIVE：To screen the main effective components of Compound Agrimonia pilosula enteritis capsules and targets of enteritis. METHODS ：UHPLC-MS/MS，MWDB database and relevant literature analysis were used to identify main chemical components in methanol extract of Compound A. pilosula enteritis capsules. TCMSP ，PubChem and UniProt database were adopted to predict and screen the active ingredients and their potential targets. GeneCards and OMIM database were used to predict and screen enteritis related targets ；common targets were screened by R language 4.0.2. The chemical components corresponding to the common targets were matched with the chemical components in the methanol extract of the preparation to obtain the main effective components of the preparation. With the help of STRING database and Cytoscape 3.7.1 software，the protein-protein interaction network was constructed ，and the key targets of the preparation were screened by degree. RESULTS ： A total of 48 compounds were identified ，including 13 phenolic acids ，10 alkaloids，8 flavonoids，6 terpenoids，6 other compounds，3 lipids，1 tannin and 1 organic acid. Compared with the network pharmacology data ，apigenin，luteolin，quercetin （3，7-di-O-methylquercetin，Quercetin-3-O-β-D-galactoside，Quercetin-7-O-glucoside，Quercetin-3-O-β-D-glucoside），palmatine， protocatechuic acid- 4-glucoside and 3，4-dimethoxycinnamic acid were the main effective components. The key targets for the treatment of enteritis included RELA ，APP，CCND1，EGFR，INS，ESR1，IL6，NCOA1，CASP8，FOS. CONCLUSIONS ：A total of 9 main effective components （including apigenin ，luteolin，quercetin，etc.）and 10 key targets for enteritis （including RELA，APP，CCND1，etc.）of Compound A. pilosula enteritis capsules are found.

Objective:To investigate the efficacy and safety of cortical-sparing adrenalectomy (CSA) in the treatment of bilateral pheochromocytoma.Methods:The clinical data of 20 patients with bilateral pheochromocytoma treated in Xiangya Hospital of Central South University from January 2004 to December 2019 were analyzed retrospectively, including 10 males and 10 females. The average age of onset was 32.5 (8-51) years. 3 cases had a family history of pheochromocytoma. There were 14 and 6 patients with bilateral synchronous and metachronous onset, respectively. The mean value of vanilmandelic acid (VMA) in 20 cases was (106.4 ± 60.0) μ mol/24h. Preoperative enhanced CT showed a soft tissue mass with uneven enhancement in the adrenal region, with low-density necrosis, which suggested the diagnosis of Pheochromocytoma. All 20 cases underwent CSA under general anesthesia. In 14 cases of bilateral synchronous disease, 9 cases underwent simultaneous operation and 5 cases underwent staged operation; 6 patients with metachronous disease underwent bilateral tumor resection successively. Laparoscopic surgery was performed in 18 cases and open surgery in 2 cases. Through the abdominal or retroperitoneal approach, open the fat capsule around the upper pole of the kidney, free the medial edge of the upper pole of the kidney, expose the adrenal gland and tumor, completely remove the tumor and capsule, ensure that the adrenal tissue is 3-5 mm away from the cutting edge of the tumor, and the reserved cortical size is at least 1 / 3 of the ipsilateral adrenal gland. The central adrenal vein was preserved as much as possible to reduce the damage to the adrenal vascular bed. The operation related data, intraoperative monitoring records, postoperative complications and long-term follow-up results were recorded.Results:All the 20 cases were successfully completed without tumor rupture. The operation time of simultaneous operation and staged operation were (242.3 ± 61.0) min and (137.9 ± 60.3) min, respectively. The number of patients admitted to ICU after operation was 7 and 2, respectively ( P<0.05); The intraoperative bleeding volume was (528.6 ± 355.7) ml and (277.8 ± 264.7) ml, the number of blood transfusion cases were 5 and 2 cases, and the average hospital stay was (7.4 ± 2.0) d and (7.8 ± 3.3) d, respectively ( P>0.05). 20 cases took glucocorticoid orally (prednisone 5 mg, once every 12 hours) after operation. There was no obvious manifestation of adrenocortical dysfunction and Addison's crisis. The hormone was stopped gradually from 2 weeks to 1 month after operation. The average follow-up was 5.4 (1.0-16.0) years. There were 3 cases of recurrence and no metastasis. Gene detection was performed in 10 cases after operation, and 7 cases carried pheochromocytoma RET and VHL pathogenic gene mutations (RET in 2 cases and VHL in 5 cases). Conclusion:Although CSA has a certain risk of recurrence, it avoids hormone replacement and does not increase the risk of metastasis and death. It is recommended for the treatment of hereditary pheochromocytoma, especially bilateral pheochromocytoma.

Objective To investigate the efficacy and safety of 6-month and 12-month oral dual-antiplatelet therapy This work was supported by the National Key Technology Research and Development Program in the Twelfth Five-year Plan of China (2011BAIl1B07) and the Military Clinical Key Technology and Development Program (2010gxjs001)(DAPT) on patients implanted with biodegradable polymer-coated and drug-eluted long stents (BP-DES).Methods In the I-LOVE-IT 2 trial,574 patients implanted with biodegradable polymer-coated and sirolimus-eluted long stent (BP-SES) (total stent length ≥50mm) were randomized to accepting either 6-month (n=270) or 12-month (n=304) DAPT.The primary endpoint of present study was 12-month target lesion failure (TLF),including cardiac death,target vessel myocardial infarction and clinically indicated target lesion revascularization (CI-TLR).The major secondary endpoint was 12-month net adverse clinical events (NACE),including all-causes of death,myocardial infarction,stroke,all revascularization (CI-TLR plus clinically indicated nontarget lesion revascularization) and bleeding.Results For the patients implanted with BP-SES of total stent length≥ 50mm,the total stent length was 73.0 ± 22.5mm and 69.8 ± 19.4mm in the 6-month DAPT group and 12-month group,respectively (P=0.07).No significant difference existed in the incidence of 12-month TLF between 6-month DAPT group and 12-month DAPT group (11.1％ vs.9.2％,P=0.47).The incidence of NACE was similar between the 2 groups (21.9％ vs.19.7％,P=0.57).The incidence of revascularization was lower in 12-month DAPT group (5.6％) than in 6-month DAPT group (11.1％,P=0.01).Furthermore,6-month landmark analysis showed that 12-month DAPT was associated with significantly lower risk of TLF (2.6％ vs.6.3％,P=0.03) at a cost of slightly increased risk of all bleeding events (1.6％ vs.0.7％,Log-rank P=0.32) between 6 and 12-months compared to 6-month DAPT.Conclusions In patients treated with BP-SES of total stent length ≥ 50mm,12-month DAPT have similar impacts on 12-month clinical outcomes except for all revascularization.However,12 months DAPT decreased the incidence of TLF and total revascularization between 6 months to 12 months after PCI.

Objective To observe the effects of dietary nursing based on macroscopic and microscopic syndrome differentiation on the compliance, clinical efficacy and quality of life (QOL) of ulcerative colitis patients with damp-heat in large intestine. Methods One hundred and ten cases meeting the diagnostic criteria of ulcerative colitis patients with damp-heat in large intestine were divided into routine group and observation group, 55 cases in each group. Both groups were given oral use of Sulfasalazine Tablets, and routine health education and dietary nursing for ulcerative colitis patients with damp-heat in large intestine. Additionally, the observation group was given dietary nursing based on macroscopic syndrome differentiation and colonoscopic microscopic syndrome differentiation. One month constituted a treatment course. After 6 courses of treatment, the compliance, clinical efficacy and QOL of the two groups were compared. Results (1) The incidence of medication missing or suspension in the routine group was 14.55%, while the incidence of diet missing or suspension in the observation group was 1.82%, the difference between the two groups being statistically significant (P < 0.01). (2) In the routine group, the cure rate was 5.5% and the total effective rate was 81.8%; in the observation group, the cure rate was 12.7% and the total effective rate was 92.7%. The differences between the two groups were statistically significant(P<0.05).(3) The scores of each dimension of QOL scale in the observation group were higher than those of the routine group (P < 0.05) , indicating that the improvement of QOL in the observation group was superior to that of the routine group. Conclusion The compliance, clinical efficacy and QOL of ulcerative colitis patients with damp-heat in large intestine are enhanced after treatment with dietary nursing based onmacroscopic and microscopic syndrome differentiation.

Objective To establish a simple scoring system for the diagnosis of liver fibrosis in chronic hepatitis B (CHB), and to observe its sensitivity and specificity. Methods Two hundred and thirty-three patients diagnosed as CHB by liver biopsy were divided into model group (N = 154) and validation group (N = 79). The general information, biochemical parameters and imaging data of all patients were observed. With hepatic fibrosis being obvious or not as the end point of primary study in the model group, we established a simple scoring system for the diagnosis. The cut-off, sensitivity and specificity of the system were tested in the model group by ROC curve, and its diagnostic efficacy was tested in the validation group. Results(1) A simple scoring system for the diagnosis of liver fibrosis called MDFS was established in the model group, and the dimensions of the system included sex, HBV-DNA, Fibroscan (FS) value and splenomegaly. In MDFS, male, HBV-DNA≥ 107 U/mL,FS value≥7.3 kPa, and splenomegaly were assigned 1 point, -2 points, 3 points, and 2 points respectively. (2) The best cut-off value in MDFS was 2 points.(3) ROC curve of the model group indicated that the specificity and sensitivity were 92.86% and 54.76% respectively, the area under curve(AUC) was 0.790, and the Youden index was 0.4762. In the validation group, the diagnostic cut-off value was over 2 points, and the sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 52.17%, 82.35%, 2.96, and 0.58 respectively. (4) The scoring results of MDFS for different traditional Chinese medical syndromes of CHB showed that the scores of blood stasis blocking collaterals > damp-heat accumulation > deficiency of spleen and kidney yang> liver depression and spleen deficiency = stagnation of liver Qi. Conclusion The MDFS diagnostic scoring system has medium efficiency. The specificity of MDFS is relatively high and MDFs has a relatively low misdiagnosis rate for the diagnosis of obvious hepatic fibrosis in CHB. The MDFS is expected to be a noninvasive and simple diagnosing way for hepatic fibrosis in CHB.

Objective: To explore the clinical value of adenosine triphosphate (ATP) stress99mTc-methoxyisobutylisonitrile (99mTc-MIBI) gated myocardial perfusion imaging (G-MPI) for evaluating the severity and region of myocardial ischemia and left ventricular function in patients with myocardial bridge. Methods: A total of 58 patients with CAG or CTA confirmed diagnosis of myocardial bridge received ATP stress99mTc-MIBI G-MPI examination in our hospital. The short and vertical long-axis image of left ventricular myocardium were divided into 13 segments and the radionuclide distribution was semi-quantitatively evaluated into 4 classes by 0-3 scores visually (0: normal, 1: mild reduction, 2: moderate reduction, 3: severe reduction). The summed stress score (SSS) of left ventricular myocardium was calculated, the severity and region of myocardial ischemia were judged and compared with the severity of myocardial bridge. The LVEF obtained by ATP stress 99mTc-MIBI G-MPI was compared with LVEF obtained by cardiac color ultrasound (UCG).Results: The detection rate of myocardial ischemia by ATP Stress 99mTc-MIBI G-MPI and by 24h dynamic ECGwere 82.76% vs 56.10%, P <0.05. ATP Stress 99mTc-MIBI G-MPI presented abnormal radionuclide distribution in258 segments (63.55%) of LAD supplied territory, 82 (47.13%) of LCX supplied territory and 74 (42.53%) of RCAsupplied territory; the ischemic segments in LAD supplied territory were more than those in LCX and RCA suppliedterritories, P <0.0125. The resting LVEF obtained by ATP Stress 99mTc-MIBI G-MPI and by UCG were (69.59 ± 4.13)% vs (63.22 ± 4.12) %, P >0.05 and they had positive correlation (r =0.555, P <0.05).Conclusion: ATP stress 99mTc-MIBI G-MPI could accurately and intuitively evaluate the severity and region ofmyocardial ischemia and left ventricular function in patients with myocardial bridge, it has certain guiding value inclinical practice.

Objective To evaluate the influence of renal insufficiency (RI) on long-term major adverse cardiac events (MACE) of patients with acute myocardial infarction (AMI) plus metabolic syndrome (MetS) and received percutaneous coronary intervention (PCI). Methods This was a retrospective study. From February, 2011 to Octorber, 2013 , we consecutivly enrolled 223 AMI patients with MetS in the First Affiliated Hospital of China Medical University. There were 88 patients with RI in group A, and 135 patients as the control group (group B). Patients were followed up for major adverse cardiac events (MACE) for 1 year. Results Compared with group B, the incidence of 1-year MACE of patients in group A was increased (36.4% vs. 18.5%, P= 0.003). Result of Cox proportional hazard regression analysis showed that RI was a predictive factor for 1-year MACE (HR = 3.56,95%CI 1.004 ~ 4.170, P = 0.002). Conclusion The incidence of 1-year MACE for AMI patients with RI and MetS post-PCI was high. RI was a risk factor for poor prognosis of AMI patients with MetS.