COMBINED IMAGING DIAGNOSIS OF PAROTID MASSES

Computed tomography (CT), ultrasonography, sialography, and 99mTc scintigraphy were applied before operation to 108 patients with parotid masses. The results of each technique and the combined study of them were compared with the pathological diagnosis. Ultrasonography was found to be a very effective diagnostic aid in determining the presence of space-occupying lesion in the parotid. CT was the best technique to provide adequately reliable informations regarding the location of the tumor and the relationship between tumor and surrounding tissues. For diagnosing the nature of tumors, ultrasonography combined with sialography was reliable. 99mTc scintigraphy was better than other techniques in diagnosis of adenolymphoma. The diagnostic accuracy of combined diagnosis (90.7%) was higher than those of ultrasonography (83%), CT (80.5%), sialography (79%), and 99mTc scintigraphy (13.9%) alone. The advantage of combined diagnosis was particularly obvious for the diagnosis of low-grade malignant tumors.

Multimodal cardiac imaging assisted tumor characterization and surgical planning of a patient with rare primary cardiac paraganglioma

Paragangliomas,also known as pheochromocytomas(1–9 cases per million),arise in the paraganglia.[1]Pheochromocytomas occur in the adrenal glands,while paragangliomas occur elsewhere.[2]Paragangliomas originate from paraganglion cells,which are derived from the neural ectoderm of the nerves and migrate along both sides of the median axis from the base of the skull to the pelvis during embryonic development.

Clinical characteristics of testicular torsion and factors influencing testicular salvage in children:A 12-year study in tertiary center

BACKGROUND Testicular torsion is the most common acute scrotum worldwide and mainly occurs in children and adolescents.Studies have demonstrated that the duration of symptoms and torsion grade lead to different outcomes in children diagnosed with testicular torsion.AIM To predict the possibility of testicular salvage(TS)in patients with testicular torsion in a tertiary center.METHODS We reviewed the charts of 75 pediatric patients with acute testicular torsion during a 12-year period from November 2011 to July 2023 at the Suzhou Hospital of Anhui Medical University.Univariate and multivariate logistic regression analyses were used to determine independent predictors of testicular torsion.The data included clinical findings,physical examinations,laboratory data,color Doppler ultrasound findings,operating results,age,presenting institution status,and follow-up results.RESULTS Our study included 75 patients.TS was possible in 57.3%of all patients;testicular torsion occurred mostly in winter,and teenagers aged 11-15 years old accounted for 60%.Univariate logistic regression analyses revealed that younger age(P=0.09),body mass index(P=0.004),torsion angle(P=0.013),red blood cell count(P=0.03),neutrophil-to-lymphocyte ratio(P=0.009),and initial presenting institution(P<0.001)were associated with orchiectomy.In multivariate analysis,only the initial presenting institution predicted TS(P<0.05).CONCLUSION The initial presenting institution has a predictive value for predicting TS in patients with testicular torsion.Children with scrotal pain should be admitted to a tertiary hospital as soon as possible.

QUANTITATIVE ASSESSMENT OF MYOCARDIAL PERFUSION DEFECTS WITH REAL-TIME THREE-DIMENSIONAL MYOCARDIAL CONTRAST ECHOCARDIOGRAPHY

Objective To evaluate the feasibility and accuracy of measurement of myocardial perfusion defects with intravenous contrast-enhanced real-time three-dimensional echocardiography (CE-RT3DE). Methods RT3DE was performed in 21 open-chest mongrel dogs undergoing acute ligation of the left anterior descending artery (LAD, n=14) or distal branch of the left circumflex artery (LCX, n=7). A perfluorocarbon microbubble contrast agent was injected intravenously to assess the resulting myocardial perfusion defects with Philips Sonos-7500 ultrasound system. Evans blue dye was injected into the occluded coronary artery for subsequent anatomic identification of underperfused myocardium. In vitro anatomic measurement of myocardial mass after removal of the animal’s heart was regarded as the control. Blinded off-line calculation of left ventricular mass and perfusion defect mass from RT3DE images were performed using an interactive aided-manual tracing technique.Results Total left ventricular (LV) myocardial mass ranged from 38.9 to 78.5 (mean±SD: 60.0±10.1) g. The mass of perfusion defect ranged from 0 to 21.4 (mean±SD: 12.0±5.0) g or 0 to 27% of total LV mass (mean±SD: 19%±6%). The RT3DE estimation of total LV mass (mean±SD: 59.8±9.9 g) strongly correlated with the anatomic measurement (r=0.98; y=2.01+0.96x). The CE-RT3DE calculation of the mass of underperfused myocardium (mean±SD: 12.3±5.3 g) also strongly correlated with the anatomic measurement (r=0.96; y=-0.10+1.04x) and when expressed as percentage of total LV mass (r=0.95; y=-0.20+1.04x). Conclusions RT3DE with myocardial contrast opacification could accurately estimate underperfused myocardial mass in dogs of acute coronary occlusion and would play an important role in quantitative assessment of myocardial perfusion defects in patients with coronary artery disease.

Effect of bilateral supraclavicular postoperative radiotherapy in middle and lower thoracic esophageal carcinoma

AIM: To evaluate whether postoperative radiotherapy is an alternative to neck lymph node surgery and if it provides a survival benefit for those receiving two-field, chest and abdomen, lymphadenectomy.

Tiaozhi Tongmai Granules reduce atherogenesis and promote the expression of ATP-binding cassette transporter A1 in rabbit atherosclerotic plaque macrophages and the liver

Objective:ATP-binding cassette transporter A1(ABCA1)is an integral membrane protein that plays a key role in cellular lipid metabolism,preventing the accumulation of lipids that contribute to the initiation and progression of atherosclerosis.Tiaozhi Tongmai Granules are a Chinese herbal compound that is capable of treating atherosclerosis.This study was designed to explore the potential pharmacological mechanism by which Tiaozhi Tongmai Granules protect against atherosclerosis.Methods:Forty-nine male New Zealand rabbits were randomly divided into seven groups:normal control group,normal diet;model groups 1 and 2:balloon injury and high-fat diet for 6 or 12 weeks;statin groups 1 and 2:balloon injury and high-fat diet plus atorvastatin for 6 or 12 weeks;and Chinese herb groups 1 and 2:balloon injury and high-fat diet plus Tiaozhi Tongmai Granules for 6 or12 weeks.The granules were administered at a dose of 1.14 g/kg/d,with atorvastatin(1.14 mg/kg/d)serving as positive control.Serum lipid profiles and liver function indices were measured.Atherogenesis was viewed after H&E staining and quantified by thickened intimal area percentage and maximal intimal thickness percentage.The ABCA1 protein expression in atherosclerotic plaque macrophages of the common carotid arteries(CCA),thoracic aortae(TA),and liver tissues were observed by immunohistochemical staining and evaluated using mean optical density(OD)value in macrophages and ABCA1-positive hepatocyte number.Results:Compared with model group 1 at week 6,Chinese herb group 1 and statin group 1 displayed significant reductions in total cholesterol(TC)(PZ0.027,0.012)and low-density lipoprotein cholesterol(LDL-C)(PZ0.039,0.028)levels,as well as marked increases in ABCA1-positive hepatocyte numbers(P all<0.001),and only statin group 1 displayed a markedly reducedmaximal intimal thickness percentage in the CCA(P Z 0.018).Compared with model group 2 at week 12,Chinese herb group 2 and statin group 2 all presented significant reductions in TC(P Z 0.011,0.003),LDL-C(P Z 0.017,0.010)and thickened intimal area percentage in the CCA(P Z 0.001,0.022),as well as prominent increases in the ABCA1 OD value of both the CCA(P Z 0.001,0.039)and TA(P Z 0.001,0.025)and positive hepatocyte number(P all<0.001).Chinese herb group 2 had a markedly reduced maximal intimal thickness percentage compared with model group 2(P Z 0.006)and a higher positive hepatocytes number than statin group 2(P Z 0.001).Conclusions:Tiaozhi Tongmai Granules appear to have an anti-atherogenic effect that is most likely mediated by simultaneously upregulating the protein expression of ABCA1 in rabbit atherosclerotic plaque macrophages and in the liver.

Cohort profile: design and methods of the Chinese colorectal, breast, lung, liver, and stomach cancer screening trial(C-BLAST)

Given the rapid changes in social structure(urbanization),economic structure(industrialization),and demographic structure(population aging)in China,cancer has become a major public health problem1.Extensive evidence has indicated that screening can decrease cancer mortality,particularly among high-risk groups,and several representative national and regional cancer screening programs have been launched in China to cope with the increasing burden of cancer.

Comparison of Anticoagulant Effects on Vein Grafts between Human TFPI Gene Transfection and Aspirin Oral Administration

To develop a more efficient antithrombotic way after coronary artery bypass grafting （CABG）, the anticoagulant effects were compared of human tissue factor pathway inhibitor （TFPI） gene transfection and aspirin oral administration （traditional method） on vein grafts. An eukaryotic expression plasmid pCMV-（Kozak） TFPI was prepared. Animal model of carotid artery bypass grafting was constructed. In operation, endothelial cells of vein grafts in TFPI group and empty plasmid control group were transfected with pCMV-（Kozak） TFPI and empty plasmid pCMV respectively, while no transfection was conducted in aspirin control group. After operation, aspirin （2 mg·kg^-1·d^-1） was administered （i.g.） in aspirin control group. Three days later, grafts （n=10） were harvested for RT-PCR, Western blotting and immunohistochemical analyses of exogenous gene expression and for pathological, scanning electron microscopic observation of thrombus. Thirty days later, the patency rates of remnant grafts （n= 10） were recorded by vessel Doppler ultrasonography. Human TFPI gene products were detected in gene transferred vein grafts. Three days later, thrombi were found in 7 animals of aspirin control group and in 8 animals of empty plasmid control group, but in only 1 of TFPI group （P〈0.01）. Thirty days later, 5 grafts were occluded in empty plasmid control group, but none of grafts was occluded in the other groups （P〈0.05）. The endothelial surfaces of grafts in both of the control groups were covered with aggregated erythrocytes and platelets, and it were not seen in TFPI group. It was suggested that the anticoagulant effects on vein grafts of human TFPI gene transfection are better than those of aspirin.

Effects of Bisoprolol on the ventricular function and hemodynamics in patients with atrial fibrillation and chronic heart failure

Background: Recent data suggest that beta-blockers can be beneficial in patients with chronic heart failure (CHF). Atrial fibrillation (AF) is present in a significant number of patients with CHF and is associateing with significant morbidity and increasing mortality rates. Thus it is necessary to establish therapy to improve the poor prognosis in this high-risk population, but a specific benefit of beta-blockers to the subset with concomitant AF and CHF has been little demonstrated. Objective: To examine the effects of Bisoprolol (6 months treatment) on the ventricular function and hemodynamics in patients with AF and CHF. Methods: 84 patients with stable CHF (NYHA≤Ⅲ class) and AF were assigned to Treated Group( n = 37) or Control group Ⅰ ( n = 22, 24-hour heart mean rate < 70/min) or Control Group Ⅱ ( n = 25, 24-hour heart mean rate ≥ 70/min) . All patients were given the basic therapy for CHF, and Treated Group received Bisopolol. Clinical and echocardiographic variables were measured in 3 groups at baseline and after 6 months, and the results were compared . Results: After 6 months of treatment with Bisoprolol, left ventricular ejection fraction (LVEF) and NYHA class had significandy improved (P < 0.05), and a trend towards a reduction in combined end point of death or CHF hospitalization was also observed (P < 0.20) in Treated Group; The increase of LVEF in Treated Group were associated with a reduction in mitral regurgitation degree and left atrial volume; The heart rate in mean 24-hour and at peak exercise decreased in Treated Group, but were similar to that in Control Group Ⅰ. Conclusion: 6 months of Bisoprolol therapy resulted in an improvement in the NYHA class and LVEF, and also showed a trend towards a reduction in hospitalization or death. The beneficial effects of Bisoprolol on patients with AF and CHF may be partly mediated by improvement of ventricular diastolic function.

Predicting depression in patients with heart failure based on a stacking model

BACKGROUND There is a lack of literature discussing the utilization of the stacking ensemble algorithm for predicting depression in patients with heart failure(HF).AIM To create a stacking model for predicting depression in patients with HF.METHODS This study analyzed data on 1084 HF patients from the National Health and Nutrition Examination Survey database spanning from 2005 to 2018.Through univariate analysis and the use of an artificial neural network algorithm,predictors significantly linked to depression were identified.These predictors were utilized to create a stacking model employing tree-based learners.The performances of both the individual models and the stacking model were assessed by using the test dataset.Furthermore,the SHapley additive exPlanations(SHAP)model was applied to interpret the stacking model.RESULTS The models included five predictors.Among these models,the stacking model demonstrated the highest performance,achieving an area under the curve of 0.77(95%CI:0.71-0.84),a sensitivity of 0.71,and a specificity of 0.68.The calibration curve supported the reliability of the models,and decision curve analysis confirmed their clinical value.The SHAP plot demonstrated that age had the most significant impact on the stacking model's output.CONCLUSION The stacking model demonstrated strong predictive performance.Clinicians can utilize this model to identify highrisk depression patients with HF,thus enabling early provision of psychological interventions.

Reference values of carotid intima-media thickness and arterial stiffness in Chinese adults based on ultrasound radio frequency signal:A nationwide,multicenter study

Background:Carotid intima-media thickness(IMT)and diameter,stiffness,and wave reflections,are independent and important clinical biomarkers and risk predictors for cardiovascular diseases.The purpose of the present study was to establish nationwide reference values of carotid properties for healthy Chinese adults and to explore potential clinical determinants.Methods:A total of 3053 healthy Han Chinese adults(1922 women)aged 18-79 years were enrolled at 28 collaborating tertiary centers throughout China between April 2021 and July 2022.The real-time tracking of common carotid artery walls was achieved by the radio frequency(RF)ultrasound system.The IMT,diameter,compliance coefficient,βstiffness,local pulse wave velocity(PWV),local systolic blood pressure,augmented pressure(AP),and augmentation index(AIx)were then automatically measured and reported.Data were stratified by age groups and sex.The relationships between age and carotid property parameters were analyzed by Jonckheere-Terpstra test and simple linear regressions.The major clinical determinants of carotid properties were identified by Pearson’s correlation,multiple linear regression,and analyses of covariance.Results:All the parameters of carotid properties demonstrated significantly age-related trajectories.Women showed thinner IMT,smaller carotid diameter,larger AP,and AIx than men.Theβstiffness and PWV were significantly higher in men than women before forties,but the differences reversed after that.The increase rate of carotid IMT(5.5µm/year in women and 5.8µm/year in men)and diameter(0.03 mm/year in both men and women)were similar between men and women.For the stiffness and wave reflections,women showed significantly larger age-related variations than men as demonstrated by steeper regression slopes(all P for age by sex interaction<0.05).The blood pressures,body mass index(BMI),and triglyceride levels were identified as major clinical determinants of carotid properties with adjustment of age and sex.Conclusions:The age-and sex-specific reference values of carotid properties measured by RF ultrasound for healthy Chinese adults were established.The blood pressures,BMI,and triglyceride levels should be considered for clinical application of corresponding reference values.

Retroperitoneoscopic approach for partial nephrectomy in children with duplex kidney: A case report

BACKGROUND Renal duplication is a common deformity of the urinary system,with an incidence of approximately 1/125 in children.Symptomatic patients with hydronephrosis,vesicoureteral reflux,or incontinence may require surgical interventions.Laparoscopy and retroperitoneoscopy are the two main accesses for partial nephrectomy.CASE SUMMARY A 9-year-old child was admitted to the hospital for hydronephrosis of the left kidney.Ultrasonography showed that the left kidney was larger,approximately 12.6 cm×6.3 cm×5.5 cm in size,with visible separation of the pelvis and an obviously separated lower portion.The upper segment of the left ureter was dilated(approximately 2.6 cm in width),and no significant dilation was observed in the middle and upper segments.The right kidney and ureter were normal.Primary diagnosis was left renal duplication malformation and hydronephrosis.Retroperitoneal laparoscopic nephrectomy and ureterectomy were performed.Intraoperative exploration revealed a dilated pelvis and thin renal parenchyma at the lower pole of the left kidney.The upper left kidney was smaller than normal,and the pelvis and ureter were larger than normal.The renal artery was blocked for 40 min.A hemolock was used to clamp down the kidney ureter,and a drainage tube was retained in the retroperitoneal cavity.The operation was uneventful,and the estimated amount of blood loss was 100 mL.Total abdominal drainage amount was 116 mL.The drainage tube was removed on postoperative day(POD)3 and the patient was discharged on POD6.The pathological diagnosis confirmed the atrophy of the renal parenchyma,the dilation of the renal pelvis,hydronephrosis,and ureteral cystic dilation.CONCLUSION The retroperitoneoscopic approach for partial nephrectomy is feasible and effective in selective pediatric patients with a duplex kidney.

Autophagosome activity in macrophage for atherosclerotic plaques in ApoE^-/-mice enhanced by Tiaozhi Tongmai Granules

Objective:Atherosclerosis is the fundamental pathophysiologic component of cardiovascular disease,and Tiaozhi Tongmai Granules show great efficiency in the treatment of the disease.However,the mechanism of Tiaozhi Tongmai Granules is still unclear.In this study,we have combined experiments with network pharmacology to explore the antiatherosclerosis mechanism of Tiaozhi Tongmai Granules.Method:120 male ApoE
/
mice were randomly divided into three groups:the model group,Chinese herb group and Atorvastatin group.The model group,Atorvastatin group and Chinese herb group were fed with a high-fat diet,a high-fat diet plus atorvastatin(5.1 mg/kg/d)and a high-fat diet plus Tiaozhi Tongmai Granules(16.5 g/kg/d)for 16 weeks,respectively.Atherogenesis was identified by H&E staining.The colocalization of neutral lipid stain BODIPY and microtubule-associated protein 1 light chain 3(LC3)and the colocalization of BODIPY and lysosomal-associated membrane protein 1(LAMP1)within ApoE
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mice aortic plaques were tested using fluorescence confocal microscopy and the Pearson’s coefficients were calculated.To further explore the anti-atherosclerosis mechanism of Tiaozhi Tongmai Granules,the network pharmacology was used to construct the herb-compound-target network.Results:The size of the aortic lipid plaque in the Chinese herb group and Atorvastatin group were smaller compared with the model group on the 16th week.Compared with the model group on the 16th week,the BODIPY and LC3 colocalization rate,the BODIPY and LAMP1 colocalization rate of the Chinese herb group and Atorvastatin group all presented significant increase in the aortic plaque(P<.001),showing that Tiaozhi Tongmai Granules could enhance autophagosome activity in the macrophage.In the herb-compound-target network,17 active compounds and 27 targets were obtained through literature searching and using LHRI&DAVID Bioinformatics.It was found that 23 targets were correlated with the macrophage.Some of them participated in macrophage inflammatory response,and the other targets could promote/inhibit phagocytosis of the macrophage.It was hypothesized that the active compounds of Tiaozhi Tongmai Granules were acting on these targets and having y the biological effects.Conclusions:In the progression stage of atherosclerosis,Tiaozhi Tongmai Granules can still make the macrophage have higher autophagosome activity,and play a role of anti-atherogenesis.

Correlation between ductus venosus spectrum and right ventricular diastolic function in isolated single-umbilical-artery foetus and normal foetus in third trimester

BACKGROUND Single umbilical artery(SUA)is the most common umbilical cord malformation in prenatal diagnosis.The presence of an SUA can cause blood circulation disorder in the foetus and functional changes of the foetal heart,affecting foetal circulation.The right ventricular diastolic functions in foetuses with isolated SUA and in normal foetuses in the third trimester were evaluated using the spectral Doppler of blood flow in the foetal ductus venosus(DV).AIM To evaluate the right ventricular diastolic functions in foetuses with isolated SUA and in normal foetuses in the third trimester.METHODS Colour Doppler was used to measure the spectrum of foetal DV and tricuspid orifice in 34 foetuses with isolated SUA aged 28-39 wk and in age-matched healthy controls.The DV flow velocities and velocity ratios were measured.The early passive/late active(E/A)ratio at the tricuspid orifice and tissue Doppler Tei index of the foetal right ventricular in the two groups were also measured.RESULTS During the third trimester,the isolated SUA group showed a lower‘a’-wave peak velocity in the DV than the control group(P<0.05).The correlations between the velocity ratios and E/A ratio at the tricuspid orifice in the two groups were analysed,and the correlation between the ventricular late diastolic velocity/ventricular diastolic peak flow velocity and E/A ratios was the best(R^2of the isolated SUA group:0.520;R2 of the control group:0.358).The correlations between the velocity ratios and tissue Doppler Tei index of foetal right ventricular in the two groups were analysed,and the correlation between the pulsatility index for veins(PIV)and tissue Doppler Tei index ratios was the best(R2 of the isolated SUA group:0.865;R2 of the control group:0.627).CONCLUSION In the isolated SUA group,the atrial systolic peak velocity‘a’decreased,and this finding might be related to the changes in foetal cardiac functions.The ratio of ventricular late diastolic velocity to ventricular diastolic peak flow velocity was closely related to the E/A ratio at the tricuspid valve and can be used to identify changes in the right ventricular diastolic functions of isolated SUA and healthy foetuses.PIV was closely related to the tissue Doppler Tei index of the foetal right ventricular and can be used to identify the right ventricular overall functions of isolated SUA and healthy foetuses.

A minimally invasive alternative for the treatment of nutcracker syndrome using individualized three-dimensional printed extravascular titanium stents

Background: This study was designed to evaluate the clinical and radiographic outcomes of patients with nutcracker syndrome (NCS) who were treated with three-dimensional printing (3DP) extravascular titanium stents (EVTSs). The 3DP EVTS was expected to release the hypertension of the left renal vein (LRV) produced by its compression between the superior mesenteric artery (SMA) and the aorta without causing any complications. Method: The pre-operative kidney model of each patient was printed out to enable surgical planning. After that, the EVTS was designed based on the LRV’s primitive physiologic structure using computer-aided design software, and each stent was printed out with a precision setting of 20 μm. Seventeen patients who had been suffering from NCS underwent laparoscopic 3DP EVTS placement. The surgical procedure was designed for the placement of EVTS, taking great care in positioning and fixing the stent. Surgical data, which included patient demographic characteristics as well as pre- and post-operative test results, were collected and analyzed. Results: The mean duration of surgery was 75 ± 9 min, and the mean blood loss was 20 ± 5 mL. Computed tomography examinations revealed that the pre- and post-operative angle between the SMA and the aorta ranged from 18.7°± 4.3° to 48.0°± 8.8°(P < 0.05);in patients with left varicocele, the mean diameter of the left spermatic vein ranged from 3.7 ± 0.5 to 1.3 ± 0.2 mm (P < 0.05). Moreover, Doppler ultrasound examinations showed that the peak velocity of blood flow at the hilar area ranged from 12.4 ± 3.3 to 18.5 ± 3.4 cm/s (P < 0.05). No side effects were observed in the 24 to 42 months following surgery. Conclusion: The findings after 2 years of follow-up suggest that the 3DP EVTS is a safe and effective minimally invasive alternative for the treatment of NCS.

Study of endorectal ultrasonography in the staging of rectal cancer

Background There is no consensus regarding the performance for endorectal ultrasonography （ERUS） at every stage of rectal cancer. Thus, the purpose of our study was to further assess the value of ERUS in the preoperative staging of rectal cancer. Methods A retrospective study was performed with 44 consecutive patients （mean age： （63.3±10.2） years） who underwent surgical treatment for endorectal carcinoma and were preoperatively evaluated using Biplane ERUS between September 2008 and December 2010. We compared the ERUS staging with the pathological findings based on surgical specimens. Results ERUS staging agreed with the histologic staging in 39 of the 44 （88.6%） patients： the agreement on the depth of transmural invasion was good （k= 0.73; 95% CI： 0.60-0.86, P =0.000）. The detection sensitivities of rectal cancer with ERUS were as follows： T1 85.7%, T2 87.5%, T3 88.9%, and T4 100.0% with specificity values of T1 97.3%, T2 92.9%, T3 96.2%, and T4 97.6%. ERUS correctly staged patients with T1 95.5%, T2 90.9%, T3 70.5 %, and T4 97.7%. The positive predictive value of ERUS was lowest for T4 （75%）, but highest for T3 （94.1%） followed by T2 （87.5%） and T1 （85.7%）; the negative predictive values of ERUS from high to low were ordered as T4 （100%）, T1 （97.3%）, T2 （92.9%）, and T3 （92.6%）. The percentage of total over-staged cases was 4.5% and the under-staged cases was 6.8%. The extent of perirectal lymph node metastases was determined with a sensitivity of 68.4% （13/19）, specificity of 80.0% （20/25）, and diagnostic accuracy of 75.0% （33/44）.

Analysis and comparison of failure causes of minimally invasive surgical closure of ventricular septal defects in children

Objectives The aims of the present study were to explore the causes of minimally invasive surgical ventricular septal defect(VSD)closure failure under transesophageal echocardiography guidance and thus to improve the success rate of surgical VSD closure.Methods From January 2015 to December 2019,522 children with VSD underwent minimally invasive surgical closure.Nineteen procedures(3.64%)were unsuccessful.The failure causes,VSD locations and surgical incision approaches were retrospectively analyzed.Results Among the 19 patients(3.64%)with unsuccessful outcomes,18 were switched to cardiopulmonary bypass(CPB)surgery,and 1 was closed successfully using an occlusion device a year later.The causes of failure included occlusion device shedding or shifting(n=6),failure of the guidewire(or the sheath)to pass through a small defect(n=5),device-related valve regurgitation(n=4),significant residual shunt(n=2),ventricular fibrillation(n=1),and continuous sharp blood pressure decreases(n=1).Patients with high VSD had a slightly higher failure rate than those with perimembranous VSD(p=0.049),and its key reason is the high proportion of occlusion device shedding or shifting(p=0.005).No significant difference in the failure rate was found between patients with different surgical incision approaches.Conclusions Minimally invasive surgery has a high success rate for perimembranous VSDs.Occlusion device shedding or shifting is the most common cause of failure.The shedding or shifting risk of eccentric occlusion devices being used only for high VSDs is much greater than that of concentric occlusion devices being used for perimembranous VSDs,which increases the risk of conversion to CPB surgery for high VSDs.

A K-nearest Neighbor Model to Predict Early Recurrence of Hepatocellular Carcinoma After Resection

Background and Aims:Patients with hepatocellular carci-noma(HCC)surgically resected are at risk of recurrence;however,the risk factors of recurrence remain poorly un-derstood.This study intended to establish a novel machine learning model based on clinical data for predicting early re-currence of HCC after resection.Methods:A total of 220 HCC patients who underwent resection were enrolled.Clas-sification machine learning models were developed to predict HCC recurrence.The standard deviation,recall,and preci-sion of the model were used to assess the model’s accura-cy and identify efficiency of the model.Results:Recurrent HCC developed in 89(40.45%)patients at a median time of 14 months from primary resection.In principal compo-nent analysis,tumor size,tumor grade differentiation,por-tal vein tumor thrombus,alpha-fetoprotein,protein induced by vitamin K absence or antagonist-II(PIVKA-II),aspartate aminotransferase,platelet count,white blood cell count,and HBsAg were positive prognostic factors of HCC recurrence and were included in the preoperative model.After compar-ing different machine learning methods,including logistic re-gression,decision tree,naïve Bayes,deep neural networks,and k-nearest neighbor(K-NN),we choose the K-NN model as the optimal prediction model.The accuracy,recall,preci-sion of the K-NN model were 70.6%,51.9%,70.1%,respec-tively.The standard deviation was 0.020.Conclusions:The K-NN classification algorithm model performed better than the other classification models.Estimation of the recurrence rate of early HCC can help to allocate treatment,eventually achieving safe oncological outcomes.

An unusual cause of cyanosis after intra-extra cardiac Fontan procedure: anastomotic leakage between conduit and inferior vena cava

A child aged 7 years was admitted to our hospital nearly 5 years after an intra-extra cardiac Fontan operation due to aggravated cyanosis.He was diagnosed with pulmonary atresia(PA),atrial septal defect,patent ductus arteriosus(PDA)and thickened tricuspid valve with severe regurgitation 1 month after being born,which was considered PA with intact ventricular septum(IVS)with severely hypoplastic right ventricle and was similar to functional single ventricle.

2D/3D echocardiography evaluation of efficacy of transcatheter closure ventricular septal defects with double-umbrella nitinol prosthesis

Background A study group of 268 patients with VSD diagnosed by Echocardiography and left ventriculography underwent transcatheter procedure. We observed that double-umbrella devices were successfully deployed in 262 patients. Methods The concentric devices were deployed in 184 patients, eccentric in 78 patients. After deployment of concentric devices in 3 cases with sac VSD, there was evident residual shunt, and then replaced of eccentric devices, there was no residual shunt. Trivial residual shunt occurred in 12 patients disappeared in 10 after 24 hours follow up. There was no complication occurred in 2 patients with trivial residual one month later after procedure. Results Transcatheter occlusion failed in 6 patients： 3 patients gave up finally because occluders replacement caused aortic regurgitation （AR） during procedure. One occluder in VSD dislocated minutely 2 days after procedure, then removed by operation. One occluder was retrieved by snare 5 days after placement because of residual shunt causing hemolysis. One patient developed serve tricuspid regurgitation （TR） after procedure, and accepted operation 3 days later. Conclusions Transcatheter closure of VSD with double-umbrella nitinol occluder is safe and effective. The best indication must be chosen by echocardiography to ensure VSD occlusion successfully and the better prognostic efficacy.