Effectiveness and Safety of Transcatheter Closure of Various Ventricular Septal Defects Using Second-Generation Amplatzer Duct Occluders

Objective:This study was designed to determine the long-term safety and efficacy of using the Amplatzer Duct Occluder II(ADO II)for the closure of various ventricular septal defects(VSDs).Methods:From January 2011 to December 2019,selected VSD patients were treated through transcatheter intervention using ADO II occluders.The closure results and complications from 188 patients,involving 167 perimembranous ventricular septal defects(pmVSDs),9 intracristal VSDs,11 post surgery residual shunts and 1 post closure residual shunt with the mean outlet diameter3.1±0.8 mm under angiography,were enrolled in this study.Results:The success rate was 98.9%for all procedures.During the median 77-month follow-up period,no cases of complete atrioventricular block(cAVB),infective endocarditis or death occurred.One major adverse event(0.5%)was recorded:cerebrovascular accident occurred 1 day after the procedure in one patient who was transferred to the neurology department.The residual shunt rate was 44.6%,which was the most common minor adverse event.The cardiac conduction block rate was 4.3%.Specifically,one pmVSD patient developed intermittent LBBB during the 28-month follow-up.There were 3 patients(1.6%)with new-onset mild tricuspid insufficiency,and the insufficiency degree was stable during follow-up.There was no new-onset aortic insufficiency that occurred.Conclusions:Transcatheter closure of pmVSDs,some intracristal VSDs,some postsurgery or postclosure residual shunts using ADO II occluders were both safe and effective and yielded excellent long-term results in selected patients.

Follow-up study of hepatitis C virus infection in uremic patients on maintenance hemodialysis for 30 months

INTRODUCTIONA high prevalence of antibodies to hepatitis C virus(HCV)(range from 3.3%-80%)has beenreported in hemodialysis(HD)patients,andworrisome as it often becomes chronic and induceschronic liver disease,therefore thenephrologists face a major challenge of how toprevent it.The main route of HCV transmission

Natural history of chronic hepatitis C in patients on hemodialysis: Case control study with 4-23 years of follow-up

AIM:Hepatitis C virus(HCV)infection is very common among end-stage kidney disease patients on hemodialysis,but its natural history is not known. METHODS:In this study,189 dialysis patients(case) positive for HCV antibodies who were followed up for more than 4 years were compared with twice as many sex/age matched controls with chronic hepatitis C who were diagnosed in the same month as the case and followed up for comparable periods.The longest follow-up was 23 years in dialysis cases. The disease activities were graded into'asymptomatic'if ALT was less than 40(35 in cases)IU/L,'low activities'if ALT was 40(35)-79 IU/L,and'high activities'if ALT was above 80 IU/L during the last or latest 4 year period. RESULTS:All 25 dialysis cases who were followed up for more than 15 years were asymptomatic and 15 of them were negative for HCV RNA.Of the 50 controls followed up for more than 15 years,34 had high activities,and none deared HCV RNA.There were 60 controls who were asymptomatic, but they were all positive for HCV RNA,while 22.3% of asymptomatic dialysis cases were RNA negative.No dialysis patients with chronic hepatitis C progressed to cirrhosis, whereas the disease progressed to cirrhosis in more than one quarter of the controls.These differences were highly significant(P<0.0001). CONCLUSION:Chronic hepatitic C among hemodialysis patients is mild in disease activity,and is not progressive, perhaps due to immunological abnormalities in these patients. Hepatic C virus is frequently cleared in asymptomatic dialysis patients during a long course.A possible mechanism for viral clearance is viral particle destruction on the surface of the dialyzer membrane.

P300 change and cognitive behavioral therapy in subjects with Internet addiction disorder A 3-month follow-up study

Event-related potential studies of cognitive function in addiction behaviors have focused on the P300 event-related potential component. The current study investigated the association between P300 component and Internet addiction disorder. We found that individuals with Internet addiction disorder exhibited significantly longer P300 latencies than controls （N2： P = 0.035; P3a： P = 0.031 P3b： P = 0.043） and similar P300 amplitudes compared to control participants. After 3 months of cognitive behavioral therapy, P300 latencies decreased significantly in the P3a and P3b （P3a： P = 0.045; P3b： P = 0.062）. These results suggest that deficits in cognitive function may be involved in Internet addiction disorder, and that clinical psychological treatment may be effective.

Association of extraintestinal manifestations of inflammatory bowel disease in a province of western Hungary with disease phenotype:Results of a 25-year follow-up study

AIM:IBD is a systemic disease associated with a large number of extraintestinal manifestations (EIMs).Our aim was to determine the prevalence of EIMs in a large IBD cohort in Veszprem Province in a 25-year follow-up study. METHODS:Eight hundred and seventy-three IBD patients were enrolled (ulcerative colitis/UC/:619,m/f:317/302, mean age at presentation:38.3 years,average disease duration:11.2 years;Crohn's disease/CD/:254,m/f:125/129, mean age at presentation:32.5 years,average disease duration:9.2 years).Intestinal,extraintestinal signs and laboratory tests were monitored regularly.Any alteration suggesting an EIMs was investigated by a specialist. RESULTS:A total of 21.3% of patients with IBD had EIM (UC:15.0%,CD:36.6%).Age at presentation did not affect the likelihood of EIM.Prevalence of EIMs was higher in women and in CD,ocular complications and primary sclerosing cholangitis (PSC) were more frequent in UC.In UC there was an increased tendency of EIM in patients with a more extensive disease.Joint complications were more frequent in CD (22.4% vsUC 10.2%,P<0.01).In UC positive family history increased the risk of joint complications (OR:3.63).In CD the frequency of type-1 peripheral arthritis was increased in patients with penetrating disease (P=0.028).PSC was present in 1.6% in UC and 0.8% in CD.Dermatological complications were present in 3.8% in UC and 10.2% in CD,the rate of ocular complications was around 3% in both diseases.Rare complications were glomerulonephritis,autoimmune hemolytic anaemia and celiac disease. CONCLUSION:Prevalence of EIM in Hungarian IBD patients is in concordance with data from Western countries.The high number of EIM supports a role for complex follow-up in these patients.

36-Month Follow-Up Study of Post-Intervention Chronic Heart Failure Patients

Aim: Although numerous studies of disease management and case management of chronic heart failure (CHF) have been carried out, length of effectiveness after program commencement has not been examined, so we examined a follow-up study at 36 months after program commencement. Methods: Participants went for follow-up visits to one Japanese clinic which specializes in internal cardiovascular medicine and they were given diagnoses of CHF. 104 outpatients participated in this study and randomized control trial was implemented. An educational program was implemented for 6 months. The data were collected at baseline, 3, 6, 9, 12 months from both intervention and control groups and at 24 and 36 months from the intervention group. Results: There was significant improvement in New York Heart Association (NYHA) in the intervention group between baseline and 36 months. Improvement in weight monitoring and activities or exercise in the intervention group continued up to 36 months. Meanwhile, sodium restricted diets and quitting smoking and/or drinking depended on individual preference and it was difficult to make improvements in these areas. Conclusions: The educational program showed promise in preventing CHF outpatients from deteriorating significantly on a long-term basis as self-monitoring of activity and weight continued significantly and there were no participants with CHF who deteriorated in the intervention group at 36 months after program commencement, although the program aimed only to provide illness and self-management knowledge. On the other hand, future work will need to compare participants in this program to a control group over an extended period of time with consideration for relieving the burden of the control group.

Survivors of COVID-19 exhibit altered amplitudes of low frequency fluctuation in the brain: a resting-state functional magnetic resonance imaging study at 1-year follow-up

Although some short-term follow-up studies have found that individuals recovering from coronavirus disease 2019(COVID-19)exhibit anxiety,depression,and altered brain microstructure,their long-term physical problems,neuropsychiatric sequelae,and changes in brain function remain unknown.This observational cohort study collected 1-year follow-up data from 22 patients who had been hospitalized with COVID-19(8 males and 11 females,aged 54.2±8.7 years).Fatigue and myalgia were persistent symptoms at the 1-year follow-up.The resting state functional magnetic resonance imaging revealed that compared with 29 healthy controls(7 males and 18 females,aged 50.5±11.6 years),COVID-19 survivors had greatly increased amplitude of low-frequency fluctuation(ALFF)values in the left precentral gyrus,middle frontal gyrus,inferior frontal gyrus of operculum,inferior frontal gyrus of triangle,insula,hippocampus,parahippocampal gyrus,fusiform gyrus,postcentral gyrus,inferior parietal angular gyrus,supramarginal gyrus,angular gyrus,thalamus,middle temporal gyrus,inferior temporal gyrus,caudate,and putamen.ALFF values in the left caudate of the COVID-19 survivors were positively correlated with their Athens Insomnia Scale scores,and those in the left precentral gyrus were positively correlated with neutrophil count during hospitalization.The long-term follow-up results suggest that the ALFF in brain regions related to mood and sleep regulation were altered in COVID-19 survivors.This can help us understand the neurobiological mechanisms of COVID-19-related neuropsychiatric sequelae.This study was approved by the Ethics Committee of the Second Xiangya Hospital of Central South University(approval No.2020 S004)on March 19,2020.

Follow-up Study of Retreatment TB Patients with Sputum Smear and/or Culture Positive Two Years after They were Declared Cured with First-line Anti-TB Drugs in Shandong Province

This study aimed to learn the recurrence rate in the retreatment TB patients with sputum smear and/or culture positive （ss＋ and/or c＋） two years after they were declared cured, and to explore causes of recurrence in order to improve long-time treatment outcome. 5 cities were selected as research locations. Recurrence of TB was judged by chest X-ray examination together with sputum smear and culture examination.

Follow-up study on ThinPrep cytology test-positive patients in tropical regions

BACKGROUND As shown in the statistics from the World Health Organization,it is estimated that approximately 75000 new cases of cervical cancer occur every year in China.In 2008,33000 people died of cervical cancer in China.It is proven that most women are at risk of cervical cancer.The progression from human papillomavirus(HPV)infection to cervical cancer can be several years or decades,which offers a unique opportunity to prevent cancer.AIM To observe the changes in ThinPrep cytology tests(TCT)and HPV infection in patients who were detected to be positive via TCT screening of cervical cancer and further explore the biopsy results.METHODS This paper performed a follow-up study on 206 cervical cancer screening-positive patients of 12231 total cases from our previous research.We conducted an observational study on the TCT results based on the interpretation of The Bethesda System.RESULTS Over a 5-year period,10 cases received consistent follow-up.The proportions of cases in which glandular epithelial lesions were detected increased over the follow-up period.The differences between the years were statistically significant(P<0.01).Over the 5 years,the proportion of patients whose squamous epithelial lesions transformed into glandular epithelial lesions increased yearly.Annual positive rates of HPV infection were:year 1,73%(24/33);year 2,43%(6/14);year 3,36%(9/25);year 4,50%(9/18);and year 5,25%(6/24).The positive detection rate after biopsy over a 9-year period was 29%.CONCLUSION The follow-up study for 5 years to 9 years revealed a tendency to change from squamous epithelial lesions to glandular epithelial lesions and an improvement of the disease(which had not been reported previously).The HPV test indicated a high negative conversion ratio of the viral infection.However,the follow-up cases were not found to have persistent infection of high-risk HPV.Therefore,early intervention of cervical cancer screening is necessary.Low re-examination compliance,patient education,and preventive measures should be enhanced.

Studies on the Construction Parameter of an Artificial Occluded Cell for In-situ Inspection of the Propagation Rate of Localized Corrosion

An artificial localized corrosion system is assembled and some parameters related to the localized corrosion in active dissolution state (i.e., non-passive state) have been studied. The results showed that the developed electrochemical system can satisfactorily imitate a naturally formed localized corrosion and the coupling current can indicate the maximum localized propagating rate. In this artificial system, the anodic dissolution reaction followed the auto-catalytic mechanism. The localized corrosion current density was dependent on the area ratio R of the cathode to the occluded anode. While R was equal to or more than 6, the coupling current reached at a maximum value and did not alter with the increase in R-value. Therefore, R=7 is chosen as one of these optimum parameters used in constructing the system, with which the biggest galvanic current might be obtained. In contrast, the thickness of the polymer filler separating the occluded anode area from the bulk electrolyte solution and the volume of the occluded anode area did not affect the corrosion current obviously. They might affect the response time to approach a steady state.

Follow-Up Study of a Multiple Myeloma Patient Successfully Treated with Clarithromycin (CAM), Low-Dose Lenalidomide and Low-Dose Dexamethasone: Significance and Possible Mechanism of Action of CAM as an Add-On Therapy

Background: Recently, high efficacy of the chemotherapeutic regimen combining clarithromycin (CAM) with lenalidomide (Len) and dexamethasone (Dex) (BiRD) in treating multiple myeloma (MM) patients has been reported. However, the exact mechanism of added CAM has not been fully elucidated. This case report will provide helpful information for understanding the significance and the mechanism of action of CAM as an add-on therapy. Patient: A 78-year-old female patient with IgA-λ type MM was treated with low-dose Len coupled with low-dose Dex (low Rd), and excellent response was achieved for long term, but she later became refractory to this treatment. Then, CAM was added to low Rd (low Rd-CAM, i.e., modified BiRD therapy). This add-on-therapy was found to be effective, but later suspended because of pneumonitis. Then, low-dose Len coupled with CAM (low R-CAM) treatment was applied;but effect of this Dex-free treatment was insufficient. Thus, low Rd-CAM was reapplied and satisfactory reduction of IgA was achieved. This fact suggests that low Rd-CAM is the favorable combination, Dex is requisite and CAM might have enhanced the effect of Dex. In this case, various serum cytokines were examined during the course of illness. Only interleukin-6 showed apparent increase, and tumor necrosis factor-α, transforming growth factor-β, soluble IL-2 receptors and C-reactive protein showed the slight increase during low Rd-CAM treatment. The results seem somewhat conflicting, but it seems that intricate cytokine response due to immune activation might have occurred during low Rd-CAM treatment.

The First Case of Free Radial Forearm Skin Flap:A 40-Year Follow-Up Study

Background The radial forearm skin flap(RFSF)was first introduced by the Chinese scholar Guofan Yang and has since been used for nearly 40 years.The many advantages of RFSF have been investigated in this study.Case presentation In this case,a female patient underwent RFSF surgery in 1979.In 2016 and 2018,two interviews were held to evaluate her subjective postoperative experience.In addition,overall donor site evaluation was conducted based on general health checkups and tests;tests for appearance,tactile sensitivity,muscle strength,and motor function;and CTA.Results The flap survived well,and the donor site recovered without hand necrosis in the 1970s.In 2018,the patient was in good health condition and expressed her satisfaction with the surgery.The patient did not suffer from any postoperative complications such as diminished sensation of the donor site or donor site dysfunction;in the evaluation of hand and finger function,there was no point where functional reduction of the donor site was noted.CTA revealed compensatory blood supply with enlargement in the diameter of the ulnar and interosseous artery.Conclusion After a nearly 40-year follow-up,the patient who underwent the first free radial forearm flap transplantation expressed satisfaction with the operative outcomes.The examination showed good results at the recipient site with little donor site deformities and good compensatory blood supply.

Structural and functional connectivity of the whole brain and subnetworks in individuals with mild traumatic brain injury:predictors of patient prognosis

Patients with mild traumatic brain injury have a diverse clinical presentation,and the underlying pathophysiology remains poorly understood.Magnetic resonance imaging is a non-invasive technique that has been widely utilized to investigate neuro biological markers after mild traumatic brain injury.This approach has emerged as a promising tool for investigating the pathogenesis of mild traumatic brain injury.G raph theory is a quantitative method of analyzing complex networks that has been widely used to study changes in brain structure and function.However,most previous mild traumatic brain injury studies using graph theory have focused on specific populations,with limited exploration of simultaneous abnormalities in structural and functional connectivity.Given that mild traumatic brain injury is the most common type of traumatic brain injury encounte red in clinical practice,further investigation of the patient characteristics and evolution of structural and functional connectivity is critical.In the present study,we explored whether abnormal structural and functional connectivity in the acute phase could serve as indicators of longitudinal changes in imaging data and cognitive function in patients with mild traumatic brain injury.In this longitudinal study,we enrolled 46 patients with mild traumatic brain injury who were assessed within 2 wee ks of injury,as well as 36 healthy controls.Resting-state functional magnetic resonance imaging and diffusion-weighted imaging data were acquired for graph theoretical network analysis.In the acute phase,patients with mild traumatic brain injury demonstrated reduced structural connectivity in the dorsal attention network.More than 3 months of followup data revealed signs of recovery in structural and functional connectivity,as well as cognitive function,in 22 out of the 46 patients.Furthermore,better cognitive function was associated with more efficient networks.Finally,our data indicated that small-worldness in the acute stage could serve as a predictor of longitudinal changes in connectivity in patients with mild traumatic brain injury.These findings highlight the importance of integrating structural and functional connectivity in unde rstanding the occurrence and evolution of mild traumatic brain injury.Additionally,exploratory analysis based on subnetworks could serve a predictive function in the prognosis of patients with mild traumatic brain injury.

心腔内超声指导下的柔腰单铆型卵圆孔未闭封堵器植入实验研究

目的评价新型柔腰单铆型卵圆孔未闭(PFO)封堵器在心腔内超声(intracardiac echocardiography,ICE)指导下行卵圆孔未闭封堵术的可行性、安全性和有效性,为临床研究提供实验依据和操作指导。方法2023年2月至2023年10月期间于长海医院临床研究中心选取10只健康成年犬,在ICE指导下行卵圆孔未闭建立PFO模型并行柔腰单铆型PFO封堵器植入,术后即刻、1个月、3个月、6个月分别通过心脏大体标本、光镜、电镜检查,评价柔腰单铆型卵圆孔未闭封堵器植入后的内皮化过程,观察有无残余分流、血栓形成等并发症。结果10只犬在ICE指导下均成功完成PFO模型建模并成功植入柔腰单铆型PFO封堵器,造模成功率100%,封堵器植入成功率100%,术中无并发症发生,所有实验犬均达到随访终点。10只犬术后即刻、1个月、3个月、6个月分别取出心脏大体标本进行观察,结果显示10只犬封堵器均无移位、合金丝断裂、血栓附着和赘生物,光镜和电镜检查显示封堵器在3月组、6月组内皮化良好。结论新型柔腰单铆型PFO封堵器设计科学,用于犬PFO封堵可行、安全、有效,ICE指导的房间隔穿刺术和PFO封堵术直观、安全、高效。

Low grade gastric mucosa associated lymphoid tissue lymphoma:Treatment strategies based on 10 year follow-up

AIM:To deduce strategic guidelines of gastric mucosa associated lymphoid tissue lymphoma (MALTOMA) by evaluating the long-term outcome of patients in respect to various treatment modalities. METHODS:A total of 55 patients with MALTOMA from May 1992 to August 2002 were retrospectively reviewed. RESULTS:Complete remission was obtained in 24 (82.8%) of 29 patients treated with anti Helicobacter pylori (Hpylori) regimen only.The duration to reach complete remission was 12 months (85 percentile,2-33 months).Five patients showed complete remission with radiation therapy (26-86 months).Two of them were Hpyloritreatment failure cases. CONCLUSION:Hpylorieradication is an effective primary treatment option for low grade MALTOMA and radiation therapy could be considered in patients with no evidence of Hpyloriinfection or who do not respond to Hpylorieradication therapy 12 months after successful eradication.

Heart-shaped anastomosis for Hirschsprung's disease: Operative technique and long-term follow-up

AIM: To study the long-term therapeutic effect of 'heartshaped' anastomosis for Hirschsprung's disease.METHODS: From January 1986 to October 1997, we performed one-stage 'heart-shaped' anastomosis for 193 patients with Hirschsprung's disease (HD). One hundred and fiftytwo patients were followed up patients (follow-up rate 79%).The operative outcome and postoperative complications were retrospectively analyzed.RESULTS: Early complications included urine retention in 2patients, enteritis in 10, anastomotic stricture in 1, and intestinal obstruction in 2. No infection of abdominal cavity or wound and anastomotic leakage or death occurred in any patients. Late complications were present in 22 cases,including adhesive intestinal obstruction in 2, longer anal in 5, incision hernia in 2, enteritis in 6, occasional stool stains in 7 and 6 related with improper diet. No constipation or incontinence occurred in any patient.CONCLUSION: The early and late postoperative complication rates were 7.8% and 11.4% respectively in our 'heartshaped anastomosis' procedure. 'Heart-shaped'anastomosis procedure for Hirschsprung's disease provides a better therapeutic effect compared to classic procedures.

Four-year follow-up of endoscopic gastroplication for the treatment of gastroesophageal reflux disease

AIM:To evaluate the long-term effect of Endocinch treatment for gastroesophageal reflux disease(GERD).METHODS:After unblinding and crossover,50 patients(32 males,18 females; mean age 46 years) with pH-proven chronic GERD were recruited from an initial randomized,placebo-controlled,single-center study,and included in the present prospective open-label follow-up study.Initially,three gastroplications using the Endocinch device were placed under deep sedation in a standardized manner.Optional retreatment was offered in the first year with 1 or 2 extra gastroplications.At baseline,3 mo after(re) treatment and yearly proton pump inhibitor(PPI) use,GERD symptoms,quality of life(QoL) scores,adverse events and treatment failures(defined as:patients using > 50% of their baseline PPI dose or receiving alternative antireflux therapy) were assessed.Intention-to-treat analysis was performed.RESULTS:Median follow-up was 48 mo [interquartile range(IQR):38-52].Three patients were lost to follow-up.In 44% of patients retreatment was done after a median of 4 mo(IQR:3-8).No serious adverse events occurred.At the end of follow-up,symptom scores and4 out of 6 QoL subscales were improved(all P < 0.01compared to baseline).However,80% of patients required PPIs for their GERD symptoms.Ultimately,64% of patients were classified as treatment failures.In 60% a post-procedural endoscopy was carried out,of which in 16% reflux esophagitis was diagnosed.CONCLUSION:In the 4-year follow-up period,the subset of GERD patients that benefit from endoscopic gastroplication kept declining gradually,nearly half opted for retreatment and 80% required PPIs eventually.

Natural history of heartburn:A 10-year population-based study

AIM： To study the natural history and prevalence of heartburn at a 10-year interval, and to study the effect of heartburn on various symptoms and activities. METHODS： A population-based postal study was carried out. Questionnaires were mailed to the same age- and gender-stratified random sample of the Icelandic population （aged 18-75 years） in 1996 and again in 2006. Subjects were classified with heartburn if they reported heartburn in the preceding year and/or week, based on the definition of heartburn. RESULTS： Heartburn in the preceding year was reported in 42.8% （1996） and 44.2% （2006） of subjects, with a strong relationship between those who experienced heartburn in both years. Heartburn in the precedingweek was diagnosed in 20.8%. There was a significant relationship between heartburn, dyspepsia and irritable bowel syndrome. IndMduals with a body mass index （BMI） below or higher than normal weight were more likely to have heartburn. Heartburn caused by food or beverages was reported very often by 20.0% of subjects. CONCLUSION： Heartburn is a common and chronic condition. Subjects with a BMI below or higher than normal weight are more likely to experience heartburn. Heartburn has a great impact on daily activities, sleep and quality of life.

Physical activity,fitness and all-cause mortality:An 18-year follow-up among old people

Background：Little is known about change in physical activity（PA） and its relationship to all-cause mortality among old people.There is even less information about the association between PA,fitness and all-cause mortality among people aged 80 years and above.The objective is to investigate persistence and change in PA over 5 years as a predictor of all-cause mortality,and fitnes as a mediator of this association,among people aged 80 and 85 years at the beginning of an 18-year mortality follow-up period.Methods：Using Evergreen Project data（started in 1989）,4 study groups were formed according to self-reported changes in PA level,over a 5-year period（starting in 1989–1990 and ending in 1994–1995）：remained active（RA,control group）,changed to inactive（CI）,remained inactive（RI）,and changed to active（CA）.Mortality was followed up over the 18-year period（1994–2012）.Cox models with different covariates such as age,sex,use of alcohol,smoking,chronic diseases,and a 10 m walking test were used to analyze the association between change in PA level and mortality.Results：Compared to RA,those who decreased their PA level（CI） between baseline and follow-up had higher all-cause mortality（hazard ratio（HR=2.09;95%CI：1.63–2.69） when adjusted for age,gender,and chronic diseases.RI showed the highest all-cause mortality（HR = 2.16;95%CI：1.59–2.93）.In CA,when compared against RA,the risk of all-cause mortality was not statistically significan（HR=1.51;95%CI：0.95–2.38）.In comparison with RA,when walking speed over 10 m was added as a covariate,all-cause mortality risk was almost statistically significan only in CI（HR=1.37;95%CI：1.00–1.87）.Conclusion：Persistence and change in PA level was associated with mortality.This association was largely explained by fitnes status.Randomized controlled studies are needed to test whether maintaining or increasing PA level could lengthen the life of old people.