Abstract:Objective To explore the application value of echocardiography in evaluating the improvement of cardiac structure and hemodynamic status after rheumatic mitral valve disease surgery.Methods From March 2012 to June 2023,a total of 112 patients with rheumatic mitral stenosis and/or mitral regurgitation who underwent mitral valve replacement or mitral valve repair in Beijing Anzhen Hospital,Capital Medical University and underwent echocardiography review after operation were retrospectively enrolled.The cardiac structure and function indexes before and after operation were compared to evaluate the postoperative clinical efficacy.Results The mean age of 112 patients was(69±3)years,90 patients(80.4％)were female.75 patients(67.0％)underwent mitral valve replacement,37 patients(33.0％)underwent mitral valve repair,and 93 patients(83.0％)underwent tricuspid valve repair at the same time.The median follow-up time was 32(13,62)months.The diameters of bilateral atria and left atrial anteroposterior diameter after operation were significantly smaller than those before operation(all P＜0.001).The amplitude of ventricular septal motion after surgery was significantly smaller than that before surgery,the area of mitral valve orifice was significantly larger than that before surgery,and the area of mitral regurgitation was significantly smaller than that before surgery[(5±2)mm vs(7±2)mm,(2.3±0.4)cm2 vs(1.3±0.5)cm2,2.7(1.9,3.8)cm2 vs 6.0(2.3,10.0)cm2](all P＜0.05).Postoperative pulmonary artery systolic pressure,tricuspid regurgitation pressure gradient,tricuspid regurgitation peak velocity and tricuspid regurgitation area were significantly lower than those before operation(all P＜0.001).Conclusions Mitral valve replacement or repair can significantly improve the cardiac structure and hemodynamic status of patients with rheumatic mitral valve disease.Echocardiography is an important tool to evaluate the effect of surgery.

Abstract:Objective To evaluate the left ventricular reverse remodeling at 1 year after transcatheter edge-to-edge repair(TEER)of moderate to severe mitral regurgitation(MR)in patients with different etiologies.Methods The clinical and echocardiographic data of 91 patients with moderate to severe MR Who underwent TEER treatment in the Interventional Center of Valvular Heart Disease,Beijing Anzhen Hospital,Capital Medical University from June 2021 to November 2023 were retrospectively analyzed.According to the etiology,the patients were divided into degenerative mitral regurgitation(DMR)group(70 cases)and functional mitral regurgitation(FMR)group(21 cases).Clinical baseline data and echocardiographic data before and 1 year after surgery were collected.Left ventricular reverse remodeling and functional changes were compared between the two groups one year after surgery.Results Compared with the DMR group,the effective regurgitation orifice area and effective valve orifice area in the FMR group were smaller,the left ventricular end-diastolic volume(LVEDV)and left ventricular end-systolic volume(LVESV)were larger,and the left ventricular ejection fraction was smaller(all P＜0.05).One year after operation,the left ventricular end-diastolic diameter,left ventricular end-systolic diameter,LVEDV,LVESV and left atrial diameter of the two groups were lower than those before operation,the mean mitral valve pressure gradient was higher than that before operation,and the New York Heart Association heart function classification was significantly improved(all P＜0.05).The proportion of normal left ventricular shape was increased compared with baseline[DMR group:31.4％(22/70)vs 20.0％(14/70),FMR group:61.9％(13/21)vs 33.3％(7/21)],and the proportion of eccentric left ventricular hypertrophy was decreased(all P＜0.05).Conclusions For patients with moderate to severe MR of different etiologies,TEER treatment can effectively improve the degree of MR Regurgitation in the mid-term after operation,improve cardiac function,promote left ventricular reverse remodeling,and restore normal left ventricular morphology in some patients.

Abstract:Objective To observe the analgesic effect of esmketamine in general anesthesia with double-lumen endotracheal intubation for thoracoscopic pneumonectomy.Methods A total of 118 patients who underwent thoracoscopic pneumonectomy in Anhui Chest Hospital from July 1,2022 to June 30,2023 were selected as the research objects.They were divided into the control group and the observation group by simple random method,with 59 cases in each group.The control group was given propofol and remifentanil for anesthesia maintenance after anesthesia induction,and the observation group was added esketamine for combined anesthesia maintenance on the basis of the control group after anesthesia induction.The intraoperative hemodynamics,perioperative opioid consumption,postoperative analgesia and adverse reactions were compared between the two groups.Results There was no significant difference in mean arterial pressure(MAP)and heart rate between the two groups before anesthesia induction(T0)(both P＞0.05).The MAP and heart rate immediately after intubation(T1)and at 5 min after double-lumen tube insertion(T2)were lower than those at T0 in both groups(all P＜0.05).There was no significant difference between 10 min after removal of double-lumen tube(T3)and T0 in the same group(all P＞0.05).The MAP and heart rate of the observation group at T,were higher than those of the control group at the same time point,but there were no statistically significant differences in MAP and heart rate between the two groups at T2 and T3(all P＞0.05).The perioperative doses of remifentanil and sufentanil in the observation group were lower than those in the control group(both P＜0.001).The time of first pressing analgesic pump after surgery in the obser-vation group was later than that in the control group[(80±12)min vs(46±8)min],the actual and effective pressing times within 24 hours and the dosage of ketochromate tromethamine were less than those in the control group[(5.8±3.2)times vs(10.3±4.1)times,(5.9±3.0)times vs(10.3±4.3)times,(304±20)mg vs(712±29)mg](all P＜0.05).However,there was no significant difference in the incidence of visual analogue scale score＞4 between the two groups(P＞0.05).The levels of prostaglandin E2,cortisol and norepinephrine in the two groups at 24 hours after operation were higher than those before operation,but those in the observation group were lower than those in the control group(all P＜0.05).The incidence of nausea and vomiting in the observation group was lower than that in the control group,and the difference was statistically significant(P=0.038).However,there was no significant difference in the incidence of dizziness,respiratory depression,pruritus,restlessness and hallucination between the two groups(all P＞0.05).Conclusion The application of esmketamine in general anesthesia with double-lumen endotracheal intubation in thoracoscopic pneumonectomy can stabilize hemodynamics,reduce the dosage of opioids,and have good analgesic effect.

Abstract:Objective To investigate the effect of glucagon like peptide 1(GLP-1)metabolite GLP-1(28-36)amide on transforming growth factor-β(TGF-β)-mediated proliferation and activation of pulmonary fibroblasts and its possible mechanism.Methods Mouse lung fibroblasts(MLg cells)were divided into control group,TGF-βgroup,TGF-β+liraglutide group,TGF-β+GLP-1(28-36)amide group.The phosphorylation level of Smad homolog 3(SMAD3)in MLg cells was detected by Western blotting.Cell counting kit-8 was used to detect the proliferation of MLg cells.Ligand fishing of MLg cell lysates was performed by biotin-labeled GLP-1(28-36)amide[BIOT(28-36)]and streptomycin agarose.The protein samples obtained from fishing were analyzed by high performance liquid chromatography-tandem mass spectrometry.According to the mass spectrometry data,the top 100 abundant proteins were screened for bioinformatics analysis to further screen the proteins that might interact with GLP-1(28-36)amide.Autodock vina1.5.6 software was used to verify the binding between proteins.Results Compared with the control group,the phosphorylation level of SMAD3 in MLg cells was increased(P＜0.01)and the cell proliferation rate was increased(P＜0.05)in TGF-β group.Compared with TGF-β group,the phosphorylation level of SMAD3 in TGF-β+GLP-1(28-36)amide group was decreased[(0.677±0.046)vs(1.414±0.037)](P＜0.05),and there was no significant difference in proliferation rate(P＞0.05).Bioinformatics analysis showed that mitochondrial protein YME1-like 1atpase(YME1L1),phosphoglycerate mutase 5(PGAM5),mitochondrial translation elongation factor Tu(TUFM),heat shock protein family D member 1(HSPD1),solute carrier family 25 member 5(SLC25A5)may be related to GLP-1(28-36)amides bind to each other.Autodock vina1.5.6 software was used for molecular Docking and Pymol 3.1 software was used for visualization.The docking scores of the above-mentioned proteins with GLP-1(28-36)amide were all＜-4 kcal/mol.Conclusion GLP-1(28-36)amide can inhibit TGF-β-mediated activation of pulmonary fibroblasts,which may act through mitochondrial related pathways.The proteins that can directly bind to GLP-1(28-36)amide may be mitochondrial proteins such as YME1L1,PGAM5,TUFM,HSPD1,and SLC25A5.

Abstract:Objective To investigate the protective effect of dimethyl fumarate(DMF)on acute gouty arthritis in rats and its mechanism.Methods Twenty-one male SD rats were randomly divided into physiological saline group,urate crystal(MSU)group,and MSU+DMF group after one week of feeding in an environment without specific pathogens,with seven rats in each group.In the physiological saline group,no model was made,and physiological saline was administered by gavage;The model of acute gouty arthritis was made by MSU in MSU group and MSU+DMF group,and the rats were gavaged with physiological saline and DMF respectively.The degree of ankle swelling and gait behavior rating were compared between the groups,and the pathological sections of rat ankle synovium were stained with hematoxylin-eosin.The histopathological changes and inflammatory cell infiltration of rats in each group were observed.The protein expressions of scutellarin D,NOD like receptor protein 3(NLRP3)and caspase-1 in synovial tissue of rats in each group were determined by integrated optical density method.The serum levels of interleukin-1 β(IL-1β),IL-6 and tumor necrosis factor α(TNF-α)were determined by enzyme-linked immunosorbent assay.Results The joint swelling degrees of MSU+DMF group and MSU group were greater than those of normal saline group at 4,8,24 and 48 h after treatment,but the joint swelling degrees of MSU+DMF group were less than those of MSU group(all P＜0.05).At 4,8,24,48 h after treatment,the MSU+DMF group and MSU group had significantly higher gait behavior rating than the physiological group,but the MSU+DMF group had significantly lower gait behavior rating than the MSU group(all P＜0.05).The MSU group had a large number of inflammatory cell infiltration and obvious inflammatory response.Compared with the MSU group,the MSU+DMF group had less inflammatory response,less inflammatory cell infiltration,and more uniform distribution of synovial cells.The protein expression of NLRP3,caspase-1,and gasdermin D and the levels of IL-1β,IL-6,and TNF-α in the synovial tissue of the MSU group were significantly higher than those in the physiological saline group,and those in the MSU+DMF group were significantly lower than those in the MSU group[inflammatory factors:(64±7)ng/L vs(106±13)ng/L,(27±4)ng/L vs(59±8)ng/L,(11.3±1.5)ng/L vs(27.8±3.9)ng/L](all P＜0.05).Conclusions DMF has a protective effect on MSU induced acute gouty arthritis in rats,which may be related to the inhibition of NLRP3 inflammasome and NLRP3 inflammatory pathway.

Abstract:Niemann-Pick disease(NPD)is a rare lipid storage disease.Hemophagocytic syndrome(HPS)is a rare and highly inflammatory disease,which can be triggered by infection,malignant tumors,or autoimmune diseases.Due to the limited number of reported cases,the clinical features of NPD with HPS are unknown.A 41-year-old man was admitted to the hospital due to yellow skin,fatigue for 2 months,and chronic liver failure.Bone marrow aspiration revealed a large number of Niemann-Pick cells with erythrocyte phagocytosis.The patient's condition developed rapidly,and his family finally gave up after active diagnosis and treatment,and he died at day 22.This is one of the rare HPS phenomenon associated with NPD found in adult patients.This case is reported in order to improve clinicians'understanding of the disease and avoid misdiagnosis and missed diagnosis.

Abstract:Hippo signaling pathway is a signaling pathway that plays an important role in biological processes,which can regulate cell proliferation,apoptosis and differentiation.Osteoporosis(OP)is a bone metabolic disease characterized by loss of bone mass and destruction of bone microstructure.Hippo signaling pathway can balance the proportion of osteoblasts and osteoclasts,which plays an important role in the regulation of OP.Hippo has multiple regulatory effects on bone development and homeostasis,including the effects on the differentiation of mesenchymal stem cells,the proliferation and maturation of hematopoietic stem cells,the function of fibroblast-like synoviocytes,and the promotion of macrophage differentiation.This article focuses on the mechanism of Hippo signaling pathway in osteoblasts,osteoclasts and mesenchymal stem cells in OP,and focuses on the relationship between OP and Hippo signaling pathway and its treatment prospects,such as targeted regulation of related molecules,the use of exosomes to mediate therapy,the combination of other therapeutic methods,and the application of traditional Chinese medicine.It is expected to provide new ideas for the follow-up research of OP.In addition to summarizing related studies,this review also points out that further studies are needed to explore the role of Hippo signaling pathway in OP-related pathways.Clarifying the precise function of Hippo signaling pathway is of great significance for the development of new therapeutic targets and methods.

Abstract:Primary biliary cholangitis can combine other immune system diseases,when the two diseases appear at the same time,easily to cause complicated complications.This paper reports a case of a 66-year-old female patient with primary biliary cholangitis in the stage of liver cirrhosis who was admitted to the hospital due to unexplained fever and recurrent thrombocytopenia.After excluding infection,tumor,drug and other causes,the final diagnosis was primary biliary cholangitis,systemic lupus erythematosus,infective endocarditis,and the diagnosis and treatment process was analyzed.On the basis of anti-infection treatment,the patient was given avatrobopag maleate to increase platelet.Systemic lupus erythematosus was treated with corticosteroids,cyclosporine and hydroxychloroquine,and the patient's condition improved and was discharged.Half a year later,no aortic valve vegetation was found by echocardiography in the outpatient follow-up,which was good for clinical reference.

Abstract:Objective To investigate the relationship between left atrial appendage emptying velocity(LAAeV)and the risk of ischemic stroke after catheter ablation in patients with persistent atrial fibrillation.Methods Patients with persistent atrial fibrillation who underwent ablation for the first time in Beijing Anzhen Hospital,Capital Medical University from March 2017 to December 2019 were retrospectively enrolled.The clinical and echocardiographic characteristics of the patients were collected.LAAeV was measured by transesophageal echocardiography before operation.Patients were followed up regularly to observe the primary outcome of ischemic stroke.Results A total of 926 patients were enrolled,and LAAeV was(40.1±18.3)cm/s.During a median follow-up of3.0(2.5,3.5)years,28 patients had ischemic stroke.Univariate analysis showed that previous ischemic stroke history(hazard ratio=2.925,95％confidence interval:1.323-6.465,P=0.008),left atrial anteroposterior diameter(hazard ratio=1.092,95％confidence interval:1.016-1.174,P=0.017),and LAAeV(hazard ratio=0.976,95％confidence interval:0.951-1.001,P=0.063)were associated with the incidence of ischemic stroke after atrial fibrillation ablation.Multivariate analysis showed that only the previous history of ischemic stroke(hazard ratio=2.494,95％confidence interval:1.085-5.734,P=0.031)was significantly related to the incidence of ischemic stroke after atrial fibrillation ablation.Conclusions The risk of ischemic stroke after catheter ablation in patients with persistent atrial fibrillation is related to previous ischemic stroke history.There is no significant correlation between the LAAeV and the risk of ischemic stroke in patients after catheter ablation.

Abstract:Objective To investigate the impact of novel coronavirus infection(COVID-19)on new-onset subclinical atrial fibrillation in patients with dual-chamber pacemaker implantation.Methods The clinical data of 420 patients who were implanted with permanent dual-chamber pacemaker for the first time in Beijing Anzhen Hospital,Capital Medical University from January 2016 to June 2023 were retrospectively analyzed.The patients were divided into infection group and non-infection group according to whether they were complicated with COVID-19.The follow-up data and the incidence of subclinical atrial fibrillation were compared between the two groups.Multivariate Logistic regression model was used to analyze the independent risk factors for subclinical atrial fibrillation.Results A total of 395 of 420 patients completed 24.0(6.0,54.0)months of follow-up,including 323 patients in the infection group and 72 patients in the non-infection group.Three patients died during the follow-up,including one with renal failure and the other two with unknown causes,all of whom were complicated with COVID-19.The incidence of subclinical atrial fibrillation in the infection group was significantly higher than that in the non-infection group[16.7％(54/323)vs 6.9％(5/72)](P=0.035).Multivariate Logistic regression analysis showed that COVID-19,longer RR interval(＞2 s)and enlarged left atrial diameter were independent risk factors for subclinical atrial fibrillation(all P＜0.05).Conclusion COVID-19,longer RR interval(＞2 s),and enlarged left atrial diameter are independent risk factors for subclinical atrial fibrillation in patients with permanent dual-chamber pacemaker implantation.

Abstract:Objective To explore the correlation between afternoon blood pressure level and target organ damage in patients with hypertension,and to provide a new clinical basis for blood pressure management.Methods A total of 252 hypertensive patients who received ambulatory blood pressure monitoring were recruited from the hypertension center of Beijing Anzhen Hospital,Capital Medical University from January to December 2022.According to the third level of afternoon systolic blood pressure,the patients were divided into low afternoon blood pressure group,middle afternoon blood pressure group and high afternoon blood pressure group,with 84 cases in each group.Multivariate Logistic regression analysis was used to evaluate the association of afternoon systolic blood pressure with left ventricular hypertrophy,proteinuria and arteriosclerosis.Subgroup analysis was used to verify the interaction effect of this association in patients with different age,gender,smoking and drinking status.Results Multivariate Logistic regression analysis showed that compared with the low afternoon blood pressure group,the high afternoon blood pressure group had more severe left ventricular hypertrophy,proteinuria,and arteriosclerosis damage,which still existed after adjusting for age,gender and other factors(all P＜0.05).Afternoon systolic blood pressure was analyzed as a continuous variable.After adjusting for confounding factors,the degree of left ventricular hypertrophy(odds ratio=1.07,95％confidence interval:1.04-1.11),proteinuria(odds ratio=1.05,95％confidence interval:1.02-1.07)and arteriosclerosis(odds ratio=1.04,95％confidence interval:1.02-1.06)damage increased with the increase of afternoon systolic blood pressure(all P＜0.05).Subgroup analysis showed that the association between afternoon systolic blood pressure and target organ damage was consistent across subgroups of gender,age,smoking and drinking status,and no significant interaction was found(all P＞0.05).Conclusions The afternoon systolic blood pressure level is positively correlated with target organ damage in hypertensive patients,which is consistent in different population subgroups,suggesting that afternoon blood pressure monitoring is of great clinical significance in assessing the risk of target organ damage in hypertensive patients.

Abstract:Prostate cancer is now the most common tumor in the male reproductive system,and its treat-ment has been a research hotspot.MicroRNA is a kind of endogenous non-coding single-stranded RNA.Some studies have shown that it can act as an oncogene or tumor suppressor gene to regulate the occurrence and develop-ment of prostate cancer,which is of extraordinary significance for the diagnosis,treatment and prognosis monitoring of prostate cancer.This article reviews the research on the relationship between microRNA and prostate cancer,and discusses the effect of microRNA related upstream and downstream genes and pathways on prostate cancer.

Abstract:Objective To investigate the clinical characteristics and gender differences in patients with degenerative mitral regurgitation undergoing mitral valve repair.Methods A total of 639 consecutive patients with degenerative mitral regurgitation who underwent mitral valve repair in Beijing Anzhen Hospital,Capital Medical University from January 1,2018 to December 31,2022 were enrolled.The patients were grouped according to gender,and the differences in clinical characteristics and echocardiographic parameters between the two groups were compared.Results Of the 639 enrolled patients,195(30.5％)were female.Compared with male patients,female patients were older[58(47,66)years vs 54(45,62)years]and had higher levels of brain natriuretic peptide and D-dimer before surgery(all P＜0.05).There was no significant difference in the location of valve prolapse and chordae tendineae rupture between male and female patients(all P＞0.05).The left atrial antero-posterior diameter,right atrial diameter,left ventricular end-diastolic diameter and left ventricular end-systolic diameter of female patients were smaller than those of male patients(all P＜0.001).However,after adjusting for body surface area,the above imaging parameters were larger in female than in male,and the corrected left ventricular end-diastolic diameter and corrected left ventricular end-systolic diameter were significantly different(all P＜0.001).Conclusion For female patients with degenerative mitral regurgitation,ultrasound parameters without body surface area correction may underestimate the severity of cardiac compensation caused by valvular regurgitation.

Abstract:Objective To investigate the clinical characteristics and prognosis of patients with hematogenous disseminated tuberculosis(HDTB)admitted to intensive care unit(ICU),and to improve clinicians'understanding of the disease.Methods A total of 130 patients with severe tuberculosis admitted to the tuberculosis ICU of Changsha Central Hospital,Hunan Province from June 2019 to June 2023 were retrospectively analyzed.According to the presence or absence of hematogenous spread and lesion involvement,the patients were divided into HDTB group(42 cases)and local tuberculosis group(88 cases).The clinical characteristics and prognosis of the two groups were compared.Results The proportions of underlying diseases and autoimmune diseases in the HDTB group were higher than those in the local tuberculosis group,while the proportions of cough and expectoration were signif-icantly lower than those in the local tuberculosis group(all P＜0.05).The white blood cell count,hemoglobin and albumin levels of the HDTB group were lower than those of the local tuberculosis group,and the procalcitonin and C-reactive protein levels and the proportions of liver and renal insufficiency were higher than those of the local tuberculosis group(all P＜0.05).The proportion of hematogenous disseminated tuberculosis in the HDTB group was significantly higher than that in the local tuberculosis group,while the proportion of invasive tuberculosis was lower than that in the local tuberculosis group[54.8％(23/42)vs 9.5％(8/84),21.4％(9/42)vs 54.8％(46/84)](both P＜0.05).There was no significant difference in the proportion of cavitary tuberculosis between the two groups(P＞0.05).The positive rate of acid-fast bacilli in HDTB group was significantly lower than that in local tuberculosis group(P＜0.05).The incidences of multiple organ dysfunction syndrome,sepsis and adverse reactions to anti tuberculosis drugs in the HDTB group were significantly higher than those in the local tuberculosis group,and the length of ICU stay and total hospital stay were longer than those in the local tuberculosis group(all P＜0.05).Totally 27 patients(64.3％)in HDTB group were successfully transferred out of ICU after treatment,and 15 patients(35.7％)died in hospital.In the local tuberculosis group,74 patients(84.1％)were discharged from ICU and 14 patients(15.9％)died in hospital.The mortality rate in the HDTB group was significantly higher than that in the local tuberculosis group(P＜0.05).Conclusion HDTB mostly occurs in patients with immunocompromised underlying diseases.The clinical manifestations of HDTB are mainly systemic symptoms,such as lack of specificity,pulmonary imaging is mainly hematogenous disseminated tuberculosis,the positive rate of acid-fast bacilli in sputum is low,the co-infection is more serious,the incidence of multiple organ dysfunction syndrome and sepsis is high,the adverse drug reactions in the process of anti-tuberculosis is easy to occur,the length of hospital stay is long,and the mortality is high.

Abstract:Objective To investigate the efficacy and safety of esketamine combined with sufentanil in patients undergoing liver cancer resection.Methods A total of 108 patients with primary liver cancer who under-went liver cancer resection in Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine,Hebei Province from November 2021 to November 2023 were divided into sufentanil group and combination group by simple random method,with 54 cases in each group.Patients in both groups were treated with patient-controlled intravenous analgesia(PCIA)after operation.The sufentanil group was treated with sufentanil and ondansetron.The combination group was treated with esketamine on the basis of sufentanil group.The perioperative indexes,visual analogue scale(VAS)scores,respiratory and circulatory function indexes at 6,24 and 48 hours after operation were compared between the two groups.The occurrence of adverse reactions was recorded.Results The first ambulation time and the dosage of PCIA in the combined group were shorter/lower than those in the sufentanil group[(33±4)h vs(39±4)h,(56±5)ml vs(79±6)ml](both P＜0.001).The VAS scores of the two groups showed a decreasing trend at 6,24 and 48 hours after operation,and the VAS scores of the combined group were lower than those of the control group at each time point(all P＜0.001).The mean arterial pressure and heart rate of the two groups showed a decreasing trend,and the levels of the combined group were lower than those of the control group at each time point(all P＜0.001).The pulse oxygen saturation of the combined group was higher than that of the sufentanil group at each time point(all P＜0.05).The incidence of adverse reactions in the combined group was lower than that in the sufentanil group(P＜0.05).Conclusion PCIA with esketamine combined with sufentanil has definite analgesic effect in patients undergoing liver cancer resection,can improve perioperative indicators,and has little effect on respiratory and circulatory function of patients,with high safety.

Abstract:Objective Real-time three-dimensional echocardiography(RT-3DE)combined with tissue motion mitral annular displacement automatic tracking technology(TMAD)was used to evaluate relevant indicators and to explore the effect of hyperbilirubinemia on left heart function in newborns.Methods A total of ninety newborns with hyperbilirubinemia admitted to the Department of Neonatology,Inner Mongolia Maternal and Child Health Hospital from June 2022 to June 2023 were selected and divided into mild jaundice group(total bilirubin 221-255 μmol/L),moderate jaundice group(total bilirubin 256-341 μmol/L),and severe jaundice group(total bilirubin≥342 μmol/L)based on total bilirubin levels,with 30 cases in each group.Thirty healthy full-term newborns from the same period were selected as the control group.The left ventricular function of newborns in each group were evaluated by collecting relevant parameters such as RT-3DE and TMAD,and the correlation between each parameter and the left ventricular ejection fraction(LVEF)of the newborns were explored.Results The mitral valve E peak flow velocity,peak E to peak A velocity ratio,LVEF,left ventricular end diastolic volume,mitral annulus interventricular annular displacement(TMAD AP4 MV1),left ventricular sidewall annular displacement(TMAD AP4 MV2),mean midpoint displacement of the mitral annulus line during systole(TMAD Midpt),and mean midpoint displacement rate of the mitral annulus(TMAD Midpt％)in the severe jaundice group were all lower than those in the other groups,while the mitral valve A peak flow velocity and left atrial ejection fraction of the mitral orifice were higher than those in the other groups(all P＜0.05).TMAD AP4 MV1,TMAD AP4 MV2,TMAD Midpt,and TMAD Midpt％were all positively correlated with LVEF(r=0.823,0.758,0.727,0.842,all P=0.001),among which TMAD Midpt％showed the best correlation.Conclusion Hyperbilirubinemia to a certain extent can affect the left heart function of newborns.RT-3DE combined with TMAD can early evaluate left heart function in newborns,and its measurement indicators have a good correlation with LVEF of the newborns.

Abstract:Composite end points are often used for primary endpoints in clinical studies of cardiovascular disease.The traditional composite endpoint is usually based on the time to first event,which ignores the differences in clinical importance of each component and the influence of secondary events,which may lead to the bias of research conclusions and the underutilization of follow-up data.Win ratio is an emerging statistical method that allows more precise analysis of composite endpoints of randomized controlled trials based on clinical priority.This article reviews the concept and basic methods of win ratio,and discusses its potential application value in the field of cardiovascular disease combined with recent clinical studies.

Abstract:Objective The aim of this study is to establish a model to predict the risk of restenosis or reintervention in patients with supravalvular aortic stenosis(SVAS)after surgical repair based on the data of two Chinese heart centers.Methods This study enrolled 291 patients diagnosed with SVAS and underwent surgical repair from two cardiac centers,Fuwai Hospital,Chinese Academy of Medical Sciences and Yunnan Fuwai Cardio-vascular Hospital,from May 2002 to January 2020.The primary end point was restenosis or reintervention(reoperation or intervention)during postoperative follow-up.Cox regression was used to explore the risk factors affecting the primary endpoint and to construct a prediction model.The receiver operating characteristic curve was used to determine the predictive efficacy of the prediction model.Results Among 291 SVAS patients,98 were female(33.7％),and the mediansurgical age was 4.9(2.3,9.9)years old.The medianfollow-up time was 24.0(6.0,54.0)months.Echocardiographic follow-up was completed in 240 patients(82.5％),including 157 males and 83 females.During the follow-up period,no death occurred,restenosis occurred in 33 patients(13.8％),and 8 patients(3.3％)underwent reintervention(including reoperation or interventional therapy).Multivariate Cox regression analysis showed that type Ⅱ SVAS,combined with pulmonary artery stenosis,combined with aortic valve stenosis,sinotubular junction Z score and sinotubular junction pressure gradient were independent risk factors for long-term restenosis or reintervention and were included in the prediction model(all P＜0.05).The area under the curve of the prediction model was 0.846(95％confidence interval:0.763-0.928).Conclusions This study identified key variables that predict the occurrence of restenosis or reintervention after surgical treatment of SVAS.A predictive model is established that can predict the risk of restenosis or reintervention in patients after SVAS surgery,which can be used as a practical method for individualized risk assessment of SVAS patients after surgery.

Abstract:Anastomotic leakage is a common complication after surgical repair of complex congenital heart disease(CHD).When the leakage is small,it may close spontaneously over time,in which case it may be treated conservatively or without treatment.When the leakage is large,it will cause hemodynamic disorder,and in severe cases,it can lead to heart failure or sudden death,requiring surgical intervention.In the past,reoperation was the main treatment for this type of anastomotic leakage.However,surgery often requires reoperation,cardiopulmonary bypass,and general anesthesia,which not only causes great trauma and high risk,but also increases the difficulty of reoperation due to the adhesion of pericardium and surrounding tissues after the first operation.In recent years,with the development of interventional technology for CHD,interventional therapy has gradually become an ideal alternative to secondary surgery due to its advantages of minimally invasive,exact effect,good repeatability and few complications.At present,there are few clinical cases of interventional treatment of anastomotic leakage after surgical repair of complex CHD.This paper reported four cases of successful interventional closure of anastomotic leakage after surgical repair of complex CHD and systematically reviewed the relevant literature,in order to provide new ideas for clinical treatment of this disease.

Abstract:Objective To observe the efficacy and safety of ticagrelor in the treatment of acute coronary syndrome(ACS)patients with severe renal disease.Methods A total of 115 ACS patients with severe kidney disease[estimated glomerular filtration rate＜30 ml/(min·1.73 m2)]admitted to the Department of Cardiology,Peking University International Hospital from July 2018 to March 2023 were retrospectively selected.The patients were divided into ticagrelor group(38 cases)and clopidogrel group(77 cases)according to the type of antiplatelet drugs taken by the patients.Ticagrelor group was treated with aspirin enteric-coated tablets 100 mg/time,once a day combined with ticagrelor 90 mg/time,twice a day oral antiplatelet therapy.Clopidogrel group was treated with aspirin enteric-coated tablets 100 mg/time,once a day combined with clopidogrel 75 mg/time,twice a day oral antiplatelet therapy.Patients were followed up for 1 year after discharge for major adverse cardiovascular events(MACE)and bleeding events.Results The levels of N-terminal pro-brain natriuretic peptide and left atrial anteropos-terior diameter were lower/smaller in ticagrelor group than in clopidogrel group[3 343.0(1 707.0,7 125.5)ng/L vs 11 401.0(4 818.5,31 174.0)ng/L,(41±7)mmvs(44±7)mm],and the incidence of acute myocardial infarc-tion and coronary Gensini score were higher in the clopidogrel group than in the clopidogrel group[89.5％(34/38)vs 57.1％(44/77),(74±43)vs(59±31)](all P＜0.05).There was no significant difference in the incidence of MACE between the two groups at 1 year after discharge(P＞0.05).There was no significant difference in the incidence of bleeding events between the ticagrelor group and the clopidogrel group(P=0.716).However,all four cases fatal bleeding events occurred in the clopidogrel group.Conclusion Ticagrelor-based dual antiplatelet therapy is effective and safe for ACS patients with severe renal disease.