Heart failure (HF) is a serious global health issue that demands innovative treatment approaches. In this study, we collected samples from 4 HF patients before and after MSC therapy and performed scRNA-seq. After the MSC therapy, the proportion of CD14(+ ) monocytes decreased significantly in both the treatment response and non-response groups, with a more pronounced decrease in the treatment response group. The therapyresponse and non-response group were clearly separated in the UMAP plot, while the CD14(+ )monocytes in the therapy-response group before and after MSC therapy were very similar, but there were significant differences in the non-response group. By further performing NMF analysis, we identified 11 subsets of CD14(+ ) monocytes. More importantly, we identified a therapy-related CD14(+ ) monocyte subpopulation. The predictive model based on CD14(+ ) monocytes constructed by machine learning algorithms showed good performance. Moreover, genes such as FOS were highly enriched in the therapy-related CD14+ monocytes. The SCENIC analysis revealed potential regulatory factors for this treatment-responsive CD14(+ ) monocytes, and FOS/JUN were identified as potential core indicators/regulators. Finally, HF patients were divided into three groups by NMF analysis, and the therapy-responsive CD14(+ ) monocyte characteristics were differentially activated among the three groups. Together, this study identifies treatment-responsive CD14(+ ) monocytes as a crucial biomarker for assessing the suitability of MSC therapy and determining which HF patients could benefit from it. This provides new clues for further investigating the therapeutic mechanisms of MSC therapy, offering beneficial insights for personalized treatment and improving prognosis in HF patients.

INTRODUCTION:Although venovenous extracorporeal membrane oxygenation (VV ECMO) is a reasonable salvage treatment for acute respiratory distress syndrome (ARDS), it requires sedating the patient. Sevoflurane and propofol have pulmonary protective and immunomodulatory properties. This study aimed to compare the effectiveness of sevoflurane and propofol on rats with induced ARDS undergoing VV ECMO. METHODS:Fifteen sprague-dawley (SD) rats were randomly divided into three groups: Con group, sevoflurane (Sevo) group and propofol (Pro) group. Arterial blood gas tests were performed at time pointsT0 (baseline), T1 (the time to ARDS), and T2 (weaning from ECMO). Oxygenation index (PaO2/FiO2) was calculated, and lung edema assessed by determining the lung wet:dry ratio. The protein concentration in bronchial alveolar lavage fluid (BALF) was determined by using bicinchoninic acid assay. Haematoxylin and eosin staining was used to evaluate the lung pathological scores in each group. IL-1β and TNF-α were also measured in the BALF, serum and lung. RESULTS:Oxygenation index showed improvement in the Sevo group versus Pro group. The wet:dry ratio was reduced in the Sevo group compared with propofol-treated rats. Lung pathological scores were substantially lower in the Sevo group versus the Pro group. Protein concentrations in the BALF and levels of IL-1β and TNF-α in the Sevo group were substantially lower versus Pro group. CONCLUSION:This study demonstrates that compared with propofol, sevoflurane was more efficacious in improving oxygenation and decreasing inflammatory response in rat models with ARDS subject to VV ECMO treatment.

Scoliosis before the age of 5 years is referred to as early-onset scoliosis (EOS). While causes may vary, EOS can potentially affect respiratory function and lung development as children grow. Moreover, scoliosis can lead to thoracic insufficiency syndrome when aggravated or left untreated. Therefore, spinal thoracic deformities often require intervention in early childhood, and solving these problems requires new methods that include the means for both deformity correction and growth maintenance. Therapeutic strategies for preserving the growing spine and thorax include growth rods, vertically expandable titanium artificial ribs, MAGEC rods, braces and casts. The goals of any growth-promoting surgical strategy are to alter the natural history of cardiorespiratory development, limit the progression of underlying spondylarthrosis deformities and minimize negative changes in spondylothorax biomechanics due to the instrumental action of the implant. This review further elucidates EOS in terms of its aetiology, pathogenesis, pathology and treatment.

BackgroundLeft subclavian artery (LSA) revascularization during thoracic endovascular aortic repair (TEVAR) is necessary to reduce postoperative complications in patients with Stanford type B aortic dissection and an insufficient proximal anchoring area. However, the efficacy and safety of different LSA revascularization strategies remain unclear. Here, we compared these strategies to provide a clinical basis for selecting an appropriate LSA revascularization method.MethodsIn this study, we included 105 patients with type B aortic dissection who were treated using TEVAR combined with LSA reconstruction in the Second Hospital of Lanzhou University from March 2013 to 2020. They were divided into four groups according to the method used for LSA reconstruction, namely, carotid subclavian bypass (CSB; n = 41), chimney graft (CG; n = 29), single-branched stent graft (SBSG; n = 21), and physician-made fenestration (PMF; n = 14) groups. Finally, we collected and analyzed the baseline, perioperative, operative, postoperative, and follow-up data of the patients.ResultsThe treatment success rate was 100% in all the groups, and CSB + TEVAR was the most commonly used procedure in emergency settings compared with the other three procedures (P < 0.05). The estimated blood loss, contrast agent volume, fluoroscopic time, operation time, and limb ischemia symptoms during the follow-up were significantly different in the four groups (P < 0.05). Pairwise comparison among groups indicated that the estimated blood loss and operation time in the CSB group were the highest (adjusted P < 0.0083; P < 0.05). The contrast agent volume and fluoroscopy duration were the highest in the SBSG groups, followed by PMF, CG, and CSB groups. The incidence of limb ischemia symptoms was the highest in the PMF group (28.6%) during the follow-up. The incidence of complications (except limb ischemia symptoms) during the perioperative and follow-up periods was similar among the four groups (P > 0.05) The median follow-up time of CSB, CG, SBSG, and PMF groups was significantly different (P < 0.05), and the CSB group had the longest follow-up.ConclusionOur single-center experience suggested that the PMF technique increased the risk of limb ischemia symptoms. The other three strategies effectively and safely restored LSA perfusion in patients with type B aortic dissection and had comparable complications. Overall, different LSA revascularization techniques have their advantages and disadvantages.

INTRODUCTION:Venovenous extracorporeal membrane oxygenation (VV ECMO) is now considered a reasonable option to salvage acute respiratory distress syndrome (ARDS). However, we lack a rodent model for experimental studies. This study was undertaken to establish an animal model of VV ECMO in ARDS rats.METHODS:A total of 18 Sprague-Dawley (SD) rats (350 ± 50 g) were used in this study. Using a rat model of oleic acid (OA)-induced ARDS, VV ECMO was established through cavoatrial cannulation of the right jugular vein for venous drainage and venous reinfusion with a specially designed three-cavity catheter. Continuous arterial pressure monitoring was implemented by using a catheter through cannulation of the right femoral artery. The central temperature was monitored with a rectal probe. Arterial blood gas monitoring was implemented by a blood gas analyzer at three-time points: at baseline, 1-hour (after OA modeling), and 3.5-hour (after VV ECMO support). Lung tissue and bronchoalveolar lavage fluid were harvested respectively for protein concentration and pulmonary histologic evaluation to confirm the alleviation of lung injury during VV ECMO.RESULTS:Following ARDS induced by OA, ten rats were successfully established on VV ECMO without failure and survived the ECMO procedure. VV ECMO alleviated lung injury and restored adequate circulation for the return of lung function and oxygenation. VV ECMO was associated with decreased lung injury score, wet/dry weight ratio, and fluid leakage into airspaces.CONCLUSION:We have established a reliable, economical, and functioning ARDS rat model of VV ECMO.

Objective Although the application of venovenous extracorporeal membrane oxygenation (VV-ECMO) in coronavirus disease 2019 (COVID-19) patients with acute respiratory distress syndrome (ARDS) is accumulating, the feasibility and safety of this therapy remain controversial. We aimed to evaluate the effect of VV-ECMO in the treatment of these patients. Methods A comprehensive literature search was performed using PubMed, Embase, the Cochrane Library, and International Clinical Trials Registry Platform databases through November 2021. According to the inclusion and exclusion criteria, the included studies were screened, and meta-analysis was performed by R software (version 4.0.2). Results Forty-two studies including 2037 COVID-19 patients supported with VV-ECMO due to ARDS were identified. The pooled analysis revealed that 30-, 60-, and 90-day mortality among patients were respectively 46% (95% CI 37%–57%, I 2 = 66%), 46% (95% CI 30%–70%, I 2 = 93%), and 49% (95% CI 43%–58%, I 2 = 52%), and the pooled incidence rate of in-hospital mortality, major bleeding, hemorrhagic stroke, thrombosis, pulmonary embolism, deep venous thrombosis, and renal replacement therapy were respectively 35%, 39%, 11%, 40%, 15%, 21%, and 44%. Conclusion Although COVID-19 patients may have a higher risk of bleeding, hemorrhagic stroke, and acute kidney injury during ECMO therapy, the survival rate was more than half of the cases. Our data may support the application of VV-ECMO in COVID-19 patients.

Objective: Although the application of del Nido cardioplegia solution (DNC) in adult cardiac surgery is accumulating, the feasibility and safety of this myocardial protection strategy in adults remains controversial. We aimed to update our previous meta-analysis to determine the myocardial protective effect of DNC versus conventional cardioplegia (CC) in adult cardiac surgery. Methods: A comprehensive literature search was performed using PubMed, EMBASE, the Cochrane Library, and International Clinical Trials Registry Platform databases through November 2020. Results: Thirty-seven observational studies and four randomized controlled trials (RCTs) including 21,779 patients were identified. The DNC group was associated with decreased postoperative cardiac enzymes [troponin T (cTnT) and creatine kinase-MB (CK-MB)] [standardized mean differences (SMD): −0.59, 95% confidence interval (CI): −0.99 to −0.19, p = 0.004], cardiopulmonary bypass (CPB) time (MD: −9.31, 95% CI: −13.10 to −5.51, p < 0.00001), aortic cross-clamp (ACC) time (MD: −7.20, 95% CI: −10.31 to −4.09, p < 0.00001), and cardioplegia volume (SMD: −1.95, 95% CI: −2.46 to −1.44, p < 0.00001). Intraoperative defibrillation requirement was less in the DNC group [relative risk (RR): 0.50, 95% CI: 0.33 to 0.75, p = 0.0007]. The pooled analysis revealed no significant difference in operative mortality among the patients assigned to DNC and those undergoing CC. Conclusion: In adult cardiac surgery, compared to CC, myocardial protection used with DNC yield similar or better short-term clinical outcomes. More high-quality trials and RCTs reflecting long-term follow-up morbidity and mortality are required in the future to confirm these findings.

Acute respiratory distress syndrome (ARDS) is characterized by disruption of the alveolar–capillary barrier, resulting in severe alveolar edema and inflammation. D-tagatose (TAG) is a low-calorie fructose isomer with diverse biological activities whose role in ARDS has never been explored. We found that TAG protects lung tissues from injury in the oleic acid-induced rat model of ARDS. Seventeen male Sprague–Dawley rats were randomly assigned to 3 groups: Sham (n = 5), ARDS (n = 6), and TAG + ARDS (n = 6). The treatment groups were injected with oleic acid to induce ARDS, and the TAG + ARDS group was given TAG 3 days before the induction. After the treatments, the effect of TAG was evaluated by blood gas analysis and observing the gross and histological structure of the lung. The results showed that TAG significantly improved the oxygenation function, reduced the respiratory acidosis and the inflammatory response. TAG also improved the vascular permeability in ARDS rats and promoted the differentiation of alveolar type II cells, maintaining the stability of the alveolar structure. This protective effect of TAG on the lung may be achieved by activating the PTEN/PI3K/AKT pathway. Thus, TAG protects against oleic acid-induced ARDS in rats, suggesting a new clinical strategy for treating the condition.

Objective:To establish a simple model of rat venovenous extracorporeal membrane oxygenation (VV ECMO).Methods:Totally, 16 healthy male SD rats weighing (350±50) g were selected and divided into sham group ( n=6) and VV ECMO group ( n=10). After 5% sevoflurane induced anesthesia, the rats were intubated with 20G vein detained needle and connected to a small animal ventilator, and anesthesia was maintained with 2% sevoflurane throughout the whole process. The 24G vein detained needle was inserted into the right femoral artery of rats and connected with vital signs monitor for monitoring. A special 5.5 Fr three-cavity tube was inserted on the right jugular vein of rats, with the 20G lumen as the venous drainage end of the VV ECMO loop, the 22G lumen as the fluid supply channel and 22G lumen as the perfusion end of the ECMO loop. The VV ECMO assisted time of rats was 3 h, during which the blood pressure and heart rate of rats were monitored in real time, and blood gas was detected preoperatively, 1 and 2 h intraoperatively and postoperatively. T test was used for measurement data. Results:In the VV ECMO group, one animal died directly under anesthesia due to bleeding and poor venous drainage, and the rest were executed under anesthesia after the experiment. The arterial oxygen pressure (PaO 2) [(243.23±19.12), (226.89±21.32) mmHg (1 mmHg=0.133 kPa)] at 60 min and 120 min with VV ECMO was higher than that before [(104.34±12.13) mmHg], and the difference was statistically significant ( t=14.612, 11.893, P<0.05). Arterial partial pressure of carbon dioxide (PaCO 2) [(34.43±4.21), (35.22±2.31) mmHg], hemoglobin (Hb) [(9.24±0.83), (8.13±1.14) g/dL], and hematocrit (Hct) [(30.62±0.81)%, (29.23±0.71)%] were lower than those before [(42.38±3.18) mmHg, (14.13±0.62) g/dL, (41.11±1.22)%], and the differences were statistically significant ( t=3.893, 4.834, 12.317, 11.642, 18.577, 21.445, P<0.05). Conclusion:The simple rat VV ECMO model established in this study provides a good model basis for the study of related diseases.

One of the possible mechanisms involved in beta-amyloid (Abeta)-induced neuronal damage is blood-cerebrospinal fluid barrier dysfunction. Recently, we have demonstrated that Alzheimer patients have an elevated expression of Abeta in the choroid plexus (CP), where it could impair the physiological functions of CP epithelium. We investigated whether these alterations were mediated by mitochondrial dysfunction, a common early pathomechanism in Alzheimer's disease. Our main observations were: high Abeta levels; increased nitric oxide levels; impairment of the activity and assembly of mitochondrial respiratory chain complexes I and IV; and a significant increase in reactive oxygen species and caspase expression in CP epithelial cells treated with Abeta. Our results also demonstrate a direct relationship between Abeta toxicity, increased expression of matrix metalloproteinase-9, and blood-cerebrospinal fluid barrier disruption. We propose a sequence of pathological steps that link Abeta accumulation in CP epithelium with an enhanced nitric oxide production, mitochondrial dysfunction, and up-regulation of matrix metalloproteinase-9, which ultimately lead to cell death, and probably to CSF barrier dysfunction.

Objective: Neurologic complications seriously affect the survival rate and quality of life in patients with extracorporeal cardiopulmonary resuscitation (ECPR) undergoing cardiac arrest. This study aimed to repurpose selective hypothermic cerebral perfusion (SHCP) as a novel approach to protect the brains of these patients. Methods: Rats were randomly allocated to Sham, ECPR, and SHCP combined ECPR (CP-ECPR) groups. In the ECPR group, circulatory resuscitation was performed at 6 minutes after asphyxial cardiac arrest by extracorporeal membrane oxygenation. The vital signs were monitored for 3 hours, and body and brain temperatures were maintained at the normal level. In the CP-ECPR group, the right carotid artery catheterization serving as cerebral perfusion was connected with the extracorporeal membrane oxygenation device to achieve selective brain cooling (26-28 degrees C). Serum markers of brain injury and pathomorphologic changes in the hippocampus were evaluated. Three biological replicates further received RNA sequencing in ECPR and CP-ECPR groups. Microglia activation and inflammatory fl ammatory cytokines in brain tissues and serum were detected. Results: SHCP rapidly reduced the brain-targeted temperature and significantly fi cantly alleviated nerve injury. This was evident from the reduced brain injury serum biomarker levels, lower pathologic scores, and more surviving neurons in the hippocampus in the CP-ECPR group. Furthermore, more differentially expressed genes for inflammatory fl ammatory responses were clustered functionally according to Kyoto Encyclopedia of Genes and Genomes pathway analysis. And SHCP reduced microglia activation and the release of proinflammatory fl ammatory mediators. Conclusions: Our preliminary data indicate that SHCP may serve as a potential therapy to attenuate brain injury via downregulation of neuroinflammation fl ammation in patients with ECPR. (JTCVS Open 2022;12:221-33)

Myocardial ischemia causes myocardial inflammation. Research indicates that the venoarterial extracorporeal membrane oxygenation (VA ECMO) provides cardiac support; however, the inflammatory response caused by myocardial ischemia remains unresolved. Dexamethasone (Dex), a broad anti-inflammatory agent, exhibits a cardioprotective effect. This study aims to investigate the effect of Dex on a rat model of acute myocardial infarction (AMI) supported by VA ECMO. Male Sprague-Dawley rats (300–350 g) were randomly divided into three groups: Sham group ( n = 5), ECMO group ( n = 6), and ECMO + Dex group ( n = 6). AMI was induced by ligating the left anterior descending (LAD) coronary artery. Sham group only thoracotomy was performed but LAD was not ligated. The ECMO and ECMO + Dex groups were subjected to 1 h of AMI and 2 h of VA ECMO. In the ECMO + Dex group, Dex (0.2 mg/kg) was intravenously injected into the rats after 1 h of AMI. Lastly, myocardial tissue and blood samples were harvested for further evaluation. The ECMO + Dex group significantly reduced infarct size and levels of cTnI, cTnT, and CK-MB. Apoptotic cells and the expression levels of Bax, Caspase3, and Cle-Caspase3 proteins were markedly lower in the ECMO + Dex group than that in the ECMO group. Neutrophil and macrophage infiltration was lower in the ECMO + Dex group than in the ECMO group. A significant reduction was noted in ICAM-1, C5a, MMP-9, IL-1β, IL-6, and TNF-α. In summary, our findings revealed that Dex alleviates myocardial injury in a rat model of AMI supported by VA ECMO.

BACKGROUND:Scoliosis causes changes in the thorax, but it is unclear what type of changes occur in the thoracic profile after scoliosis surgery.OBJECTIVE:To investigate changes in rib cage deviation in the postoperative period after adolescent idiopathic scoliosis (AIS) surgery.METHODS:Forty-four patients with AIS with a main right thoracic curvature underwent posterior surgical fusion (PSF), and radiological parameters of the spine and thorax were evaluated.RESULTS:The correction rates of main thoracic curve (MT)-Cobb angle at immediate after surgery and postoperative follow-up (2 years) were 64% and 66%, respectively. At these two postoperative time points, the correction rates of height of thoracic vertebrae 1 to 12 (T1T12) were 10% and 12%; the correction rates of Rib-vertebra angle difference (RVAD) were 59% and 52%; the correction rates of Apical rib hump prominence (RH) were 58% and 76%; while the correction rates of Apical vertebral body-rib ratio (AVB-R) were 23% and 25%, respectively. Statistical analysis showed that all these radiological parameters at the two postoperative time points were significantly different from the preoperative values (p< 0.001). There were significant correlations between MT-Cobb angle and T1-T12 height (p< 0.001), RVAD (p< 0.001), RH (p< 0.001), and AVB-R (p< 0.001).CONCLUSIONS:Posterior spinal fusion appears to be effective at correcting scoliosis, and the correction of rib cage deviation also plays an important role.

目的 建立一种简便的静脉-动脉体外膜肺氧合(VAECMO)治疗心源性休克(CS)的大鼠模型.方法 25只SD雄性大鼠(350±50)g按随机数字表法分成假手术组(5只),CS组(10只)和VA ECMO组(10只).5％七氟烷诱导麻醉,16 G静脉留置针经口气管插管并连接呼吸机.右侧股动脉置入22G静脉留置针,同侧颈静脉置入自制静脉引流管,分别作为ECMO的动脉灌注端及静脉引流端.术中监测血压心率,并在术前(T0),CS后30 min(T1)及停机时(T2)检测血气,同时检测心肌酶学变化.组间比较采用t检验.结果 VA ECMO组1只死于颈静脉破裂,CS组1只大鼠死于恶性心律失常.停机时Na+[(129.00±2.00)mmol/L]、红细胞比容(Het)[(29.90±1.90)％]和血红蛋白(Hb)[(83.00±1.00)g/L]低于 CS 后[(139.00±3.00)mmol/L、(38.70±1.70)％、(137.00±3.00)g/L)],差异有统计学意义(t =10.625、20.362、11.417,P＜0.05),停机时K+[(5.60±0.30)mmol/L]高于 CS 后[(4.30±0.20)mmol/L],差异有统计学意义(t=10.625,P＜0.05).VA ECMO 组的肌钙蛋白 Ⅰ(cTnⅠ)[(404.50±54.47)pg/ml],肌钙蛋白 T(cTnT)[(411.80±43.04)pg/ml]和肌酸激酶(CK-MB)[(4.72±0.79)ng/ml]均低于 CS 组[(657.40±78.23)pg/ml、(563.40±57.40)pg/ml、(5.72±0.51)ng/ml],差异有统计学意义(2=7.502、5.980、5.154,P＜0.01).结论 本研究成功建立一种简便、稳定的VAECMO治疗CS的大鼠模型,为进一步研究VA ECMO在多种疾病下的作用机制提供了模型基础.

Abstract Currently no proven effective treatment exists for lung ischemia-reperfusion injury (LIRI). Natural compounds represent a source of new drugs for the treatment of different diseases. The present study aims to investigate Rebaudioside B (Reb B) as a potential compound to the treatment of LIRI in vivo and in vitro. The present study includes the human pulmonary alveolar cells line with epithelial type II A549 under oxygen-glucose deprivation/recovery (OGD/R) to high-throughput in vitro cell viability screening to identify the most promising compound tested candidates. Moreover, an in vivo rat model of lung ischemia-reperfusion was used to assess the potential protective effect of Reb B. Reb B was identified as the most promising compound among the natural compounds tested, being identified by high-throughput screening. Reb B enhances cell viability by reducing apoptosis in A549 OGD/R models. In the in vivo model of LIRI, preconditioning with Reb B significantly reduced apoptotic cells, perivascular edema, and neutrophil infiltration in lung tissues. In addition, Reb B inhibits LIRI lung inflammation mainly by increasing IL-10 levels, while decreasing IL-1β and IL-8 levels. The overall results suggest that Reb B has a promising protective effect in LIRI caused by the inhibition of the mitochondrial apoptotic pathway and by decreasing the inflammatory response.

Background: We aimed to evaluate the immediate and mid-term outcomes of transthoracic minimally invasive closure (TMIC) of ruptured sinus of Valsalva aneurysm (RSVA), which is a rare and mostly congenital heart disease. Methods: From January 2014 to November 2020, 19 patients (16 males, 3 females) with RSVA were selected for TMIC and were followed up at our centre. Data were analysed from our prospectively collected database and clinical mid-term follow-up was obtained. Results: Among these 19 cases, transthoracic echocardiography showed rupture of the right coronary sinus to the right atrium in 9 patients, non-coronary sinus rupture to the right atrium in 7 patients, and right coronary sinus rupture to the right ventricle in 3 patients. Most (13/19) cases were New York Heart Association (NYHA) functional class III or IV. The mean diameters of the defect from the aortic end and ruptured site were 8.8 +/- 3.0 and 6.4 +/- 2.6 mm, respectively. TMIC was attempted using ventricular septal defect (VSD)/patent ductus arteriosus (PDA) occluders 2-7 mm larger than the aortic ends of the defects. All patients were successfully treated by TMIC and achieved complete closure at discharge after a mean hospital stay length of 6.2 +/- 2.5 days. Seventeen patients were NYHA class I while 2 patients were NYHA class II. No cases of residual shunts, device embolization, infective endocarditis, or aortic regurgitation were observed during a median follow-up of 36 months (range, 16-84 months). Conclusions: In appropriately selected cases with RSVA, TMIC is an attractive alternative to surgery, with a high technical success rate and encouraging short-term and mid-term outcomes. However, long-term follow-up is needed.

目的 探讨食道超声引导经胸小切口封堵与经皮介入封堵膜周部室间隔缺损(VSD)的疗效.方法 选取自2015年1月至2020年12月兰州大学第二医院收治的184例患者VSD患者为研究对象.患者根据术中操作引导方式分为两组.超声组(n=147)患者采用食道超声引导经胸作小切口封堵,介入组(n=37)患者采用经皮介入封堵.通过倾向性匹配评分匹配两组患者性别、年龄、体质量、VSD大小等基本特征.匹配后,比较封堵成功率、术后心率失常、术后瓣膜反流、封堵器残余分流等指标.结果 经倾向评分匹配后,超声组患者住院时间长于介入组,住院花费多于介入组,差异有统计学意义(P<0.05).超声组患者出院后3个月、6个月残余分流发生率低于介入组,差异有统计学意义(P<0.05).匹配前、后,两组患者术后心律失常、主动脉反流发生率、使用偏心封堵器比例比较,差异无统计学意义(P>0.05).结论 食道超声引导经胸小切口和经皮介入都是微创封堵VSD的安全、有效途径.食道超声引导经胸小切口适用于包括膜周部在内的各种类型VSD,且不需要严格的外周血管条件,可以适用于年龄小、体质量低的患儿.经皮介入封堵VSD的患者住院时间短,花费较少,但术后封堵器残余分流发生率更高.

Purpose Multiple myeloma (MM), a kind of malignant neoplasm of clonal plasma cells in the bone marrow, is a refractory disease. Understanding the metabolism disorders and identification of metabolomics pathways as well as key metabolites will provide new insights for exploring diagnosis and therapeutic targets of MM. Methods We conducted nontargeted metabolomics analysis of MM patients and normal controls (NC) using ultra-high-performance liquid chromatography (UHPLC) combined with quadrupole time-of-flight mass spectrometry (Q-TOF-MS) in 40 cases of cohort 1 subjects. The targeted metabolomics analysis of amino acids using multiple reaction monitoring-mass spectrometry (MRM-MS) was also performed in 30 cases of cohort 1 and 30 cases of cohort 2 participants, to comprehensively investigate the metabolomics disorders of MM. Results The nontargeted metabolomics analysis in cohort 1 indicated that there was a significant metabolic signature change between MM patients and NC. The differential metabolites were mainly enriched in metabolic pathways related to amino acid metabolism, such as protein digestion and absorption, and biosynthesis of amino acids. Further, the targeted metabolomics analysis of amino acids in both cohort 1 and cohort 2 revealed differential metabolic profiling between MM patients and NC. We identified 12 and 14 amino acid metabolites with altered abundance in MM patients compared to NC subjects, in cohort 1 and cohort 2, respectively. Besides, key differential amino acid metabolites, such as choline, creatinine, leucine, tryptophan, and valine, may discriminate MM patients from NC. Moreover, the differential amino acid metabolites were associated with clinical indicators of MM patients. Conclusions Our findings indicate that amino acid metabolism disorders are involved in MM. The differential profiles reveal the potential utility of key amino acid metabolites as diagnostic biomarkers of MM. The alterations in metabolome, especially the amino acid metabolome, may provide more evidences for elucidating the pathogenesis and development of MM.

Abstract Background: Scoliosis can cause deformities of the rib cage. The three-dimensional (3D) shape of the rib-vertebral-sternal complex matches that of the thoracic cavity and is visualized as an elastic structural model that is approximately cubic in shape. This study was performed to evaluate the changes in thoracic torsion by measuring radiological parameters.Methods: Forty-four patients with adolescent idiopathic scoliosis (AIS) with a main right thoracic curvature underwent posterior spinal fusion (PSF), and radiological parameters of the spine and thorax were evaluated. Results: The correction of preoperative, immediately postoperative, and 2-year postoperative MT-Cobb angles were 64% and 66%. The correction of T1–T12 heights were 10% and 12%. The correction of RVAD was 59% immediately postoperatively and 52% at 2 year postoperatively. The correction of RH was 59% immediately postoperatively and 52% at 2 year postoperatively. The correction of AVB-R was 23% immediately postoperatively and 25% at 2 year postoperatively. From the above results, all radiological parameters were significantly different immediately and at 2 year postoperatively compared to preoperatively (p < 0.001). There were significant correlations between MT-Cobb angle and T1–T12 height (p < 0.001), RVAD (p < 0.001), RH (p < 0.001), and AVB-R (p < 0.001).Conclusion: Most cases of mild and moderate scoliosis surgery also includes the correction of thoracic torsion. PSF appears to be effective at correcting scoliosis, and the correction of thoracic torsion also plays an important role.

Penetrating aortic ulcer (PAU) is one of the three subtypes of acute aortic syndrome. PAUs occur at any point throughout the aorta, most commonly in the descending thoracic aorta and less frequently in the aortic arch. Open surgical repair and total/hybrid endovascular repair are currently available to treat aortic arch PAUs. Herein, we present a patient with aortic arch PAU who underwent transthoracic minimally invasive closure, which is a novel method for the treatment of PAU. We describe a 52-year old Asian man who presented with sudden chest and back pain for 8 h. Computed tomography angiography showed that the PAU occurred in the aortic arch and had a diameter of 16 mm and a depth of 6 mm. The opening was successfully closed via transthoracic minimally invasive closure with an atrial septal defect occluder.