The potential impact of digital economy on energy poverty in the context of Chinese provinces.

This study focused on exploring the impact of the digital economy (DE) on energy poverty (EP) across Chinese provinces from 2004 to 2018, motivated by the critical need to understand how technological advancements in the digital sector influence energy accessibility and sustainability. Conducted against the backdrop of global digital transformation, the research aimed to dissect the nuanced ways in which the DE contributes to mitigating EP, employing dynamic panel threshold and indirect effect models to capture both the direct and nuanced, and intermediate effects of digital progress on energy deprivation. Key findings revealed a significant reduction in EP attributed to the advancements in DE, with the most notable improvements observed in Eastern China where strategic energy policies and management practices enhanced the positive impacts of digitalization. The study highlighted the DE's role in improving energy access, efficiency, and environmental sustainability, although it also pointed out the potential for regressive effects in areas with lower levels of technological advancement. These findings are of substantial value as they offer empirical evidence of the DE's capacity to alleviate EP, underlining the importance of integrating digital strategies into energy policy planning. The research provides critical insights for policymakers, stakeholders in the energy sector, and scholars interested in the synergies between digital innovation and energy security, suggesting that leveraging digital technologies could accelerate efforts towards achieving sustainable energy access and combating energy poverty in China and potentially in other contexts facing similar challenges.

Longer-term Mortality and Kidney Outcomes of Participants in the Combination Antibiotics for Methicillin-Resistant Staphylococcus aureus (CAMERA2) Trial: A Post Hoc Analysis.

Background: The Combination Antibiotic Therapy for Methicillin-Resistant Staphylococcus aureus (CAMERA2) trial ceased recruitment in July 2018, noting that a higher proportion of patients in the intervention arm (combination therapy) developed acute kidney injury (AKI) compared to the standard therapy (monotherapy) arm. We analyzed the long-term outcomes of participants in CAMERA2 to understand the impact of combination antibiotic therapy and AKI. Methods: Trial sites obtained additional follow-up data. The primary outcome was all-cause mortality, censored at death or the date of last known follow-up. Secondary outcomes included kidney failure or a reduction in kidney function (a 40% reduction in estimated glomerular filtration rate to <60 mL/minute/1.73 m2). To determine independent predictors of mortality in this cohort, adjusted hazard ratios were calculated using a Cox proportional hazards regression model. Results: This post hoc analysis included extended follow-up data for 260 patients. Overall, 123 of 260 (47%) of participants died, with a median population survival estimate of 3.4 years (235 deaths per 1000 person-years). Fifty-five patients died within 90 days after CAMERA2 trial randomization; another 68 deaths occurred after day 90. Using univariable Cox proportional hazards regression, mortality was not associated with either the assigned treatment arm in CAMERA2 (hazard ratio [HR], 0.84 [95% confidence interval [CI], .59-1.19]; P = .33) or experiencing an AKI (HR at 1 year, 1.04 [95% CI, .64-1.68]; P = .88). Conclusions: In this cohort of patients hospitalized with methicillin-resistant S aureus bacteremia, we found no association between either treatment arm of the CAMERA2 trial or AKI (using CAMERA2 trial definition) and longer-term mortality.

Early and mid-term results of Fontan operation versus anatomic correction for congenitally corrected transposition of the great arteries: A retrospective cohort study in a single center / 中国胸心血管外科临床杂志

@#Objective     To compare the early and mid-term results between Fontan operation and anatomic correction for congenitally corrected transposition of the great arteries (ccTGA). Methods     The clinical data of 53 patients with ccTGA who underwent anatomic correction and Fontan operation from January 2009 to September 2021 in our hospital were reviewed, including 41 males and 12 females with a mean age of 55.02 (3-168) months. They were divided into an anatomic correction group (16 patients) and a Fontan operation group (37 patients) according to the operation. The hospitalization mortality, survival rate, postoperative complications, and free rate from re-intervention between the two groups were compared. Another 180 healthy children were recruited as a control group, and 14 children were matched with the propensity score matching method as a Fontan control group. The results of cardiopulmonary exercise testing (CPET) between the Fontan operation group and the Fontan control group were compared. Results     There were 2 (12.5%) early deaths and 3 (18.8%) early re-intervention in the anatomic correction group, while 1 death and 2 re-intervention in the Fontan operation group. In addition, there were 9 patients (56.3%) in the anatomic correction group and 6 (16.2%) patients in the Fontan operation group suffering from arrhythmia after operation, respectively. Compared with the anatomic correction group, cardiopulmonary bypass time, aortic cross-clamping time, intubation time and ICU stay were significantly shortened in the Fontan operation group (P<0.05). CPET results showed that, percent predicted max VO2 in the Fontan operation group was lower than that in the Fontan control group (0.84±0.11 vs. 0.99±0.12, P<0.05). The patients were followed up for 0.5-126.0 months. Two patients were lost in the Fontan operation group. There was no death and 1 re-intervention in the anatomic correction group, while no death or re-intervention in the Fontan operation group. The 1-year, 5-year and 10-year transplant-free survival rate of the anatomic correction group and the Fontan operation group was 87.5%, 87.5%, 87.5% and 97.3%, 97.3%, 97.3%, respectively (P>0.05). The 48 patients were classified as grade Ⅰ-Ⅱ in cardiac function in the last follow-up. Conclusion     There is no statistical difference in the transplant-free survival rate between the anatomic correction and the Fontan operation group. The postoperative complications in the Fontan operation group are decreased than those in the anatomic correction group. The Fontan operation is also a good choice, even though the patients with ccTGA meet the condition of the procedure of anatomic correction.

Early and mid-term results of surgical treatment for complete atrioventricular septal defect / 中华胸心血管外科杂志

Objective:To summarize the results of surgical treatment for complete atrioventricular septal defect(CAVSD) in early and middle stages.Methods:147 children with CAVSD in Guangzhou Women and Children’s Medical Center from January 2010 to December 2019 were selected, Males 85, females 62, median age of surgery 5 months(1 months-10 years old), median body mass 5.5 kg(2.4-20.9 kg). Complete atrioventricular septal defect was diagnosed by ultrasonic cardiogram before surgery. All the children underwent atrial ventricular valve formation and underwent simultaneous repair.Outpatient follow-up was planned.Ultrasonic cardiogram and electrocardiogram were performed. SPSS 22 statistical software was used for data analysis.Results:All 147 CAVSD patients underwent one-time surgical correction.Early postoperative death occurred in 7 cases(4.76%). The causes of death were: 3 cases of pulmonary hypertension crisis, 3 cases of severe mitral insufficiency(MI), 1 case of postoperative malignant arrhythmia, and the rest of the children were cured and discharged. Permanent pacemaker was installed in 3 patients due to atrioventricular block(AVB). The follow-up time was 1-10 years old, and 2 patients died in late stage: 1 patient did not seek medical treatment in time due to infection, and 1 patient had unknown cause. Five patients underwent secondary surgery: 4 due to severe mitral/tricuspid insufficiency(MI/TI) and 1 due to delayed AVB. The mid-term follow-up showed 9 cases of severe MI and 4 cases of severe TI. Compared with children with surgical age<3 months and ≥3 months, there were statistically significant differences in postoperative ventilator-assisted ventilation time, severe MI before postoperative discharge and total mortality between the two groups( P<0.05). Mid-term follow-up results showed no difference between the two groups. There were statistically significant differences in surgical age, postoperative CICU stay time and total hospital stay between the children with trisomy 21-syndrome and those without trisomy 21-syndrome( P<0.05), and there was no difference between the two groups in mid-term follow-up results. Residual shunt of 1-3 mm VSD was found in 29 cases, 26 cases were closed during follow-up, and 3 cases had smaller residual shunt. Conclusion:Modified single patch technique treatment of CAVSD has good effect, low mortality and low re-operation rate. But age <3 months group, infant mortality was significantly increased, the duration of postoperative mechanical assisted ventilation was prolonged, and the proportion of early postoperative severe MI was high.Severe MI and TI is easy to occur after CAVSD, which requires long-term follow-up and timely treatment. The children with trisomy 21-syndrome were similar to those with normal chromosome except for longer stay in ICU and total hospital stay.

A novel nomogram based on the nutritional risk screening 2002 score to predict survival in hepatocellular carcinoma treated with transarterial chemoembolization / Un nuevo nomograma basado en el puntaje de detección de riesgo nutricional 2002 para predecir la supervivencia en el carcinoma hepatocelular tratado con quimioembolización transarterial

Objective: transarterial chemoembolization (TACE) is one of the common treatments for hepatocellular carcinoma (HCC). Predicting prognosis for HCC patients who received TACE is challenging because of huge differences in outcome. At present, the Nutritional Risk Screening 2002 (NRS-2002) is widely used to screen nutritional risk in hospitalized patients, which has been confirmed to be related to prognosis. Here, the objective of this research is to construct a prognostic nomogram using the NRS-2002 score for HCC patients receiving TACE. Methods: we enrolled 359 HCC patients who received TACE at the Xingtai People's Hospital between January 2015 and December 2020. According to the preoperative NRS-2002 score, patients were divided into an NRS ≥ 3 group (n = 190; 52.9 %) and an NRS < 3 group (n = 167, 47.1 %). Meanwhile, variables associated with survival were analyzed by univariate and multivariate Cox regression. Beyond that, a nomogram incorporating independent variables was established. The concordance index (C-index) and calibration curves were used to assess the prediction performance of the nomogram. Results: the median survival of the NRS ≥ 3 group was significantly lower than that of the NRS < 3 group. As shown by multivariate analysis, in the Barcelona Clinic Liver Cancer stage an NRS-2002 score ≥ 3, γ-glutamyl transpeptidase, and alpha-fetoprotein were significantly associated with survival in HCC patients after TACE. In addition, the C-index was 0.708 (95 % confidence interval: 0.672-0.743), and the calibration curves showed a good consistency between the observed and predicted survivals at 1, 2, and 3 years, respectively. Conclusions: NRS-2002 ≥ 3 could identify high-risk patients with HCC who received TACE. The NRS-2002-based nomogram model had good prognostic prediction accuracy(AU)

Objetivo: la quimioembolización transarterial (TACE) es uno de los tratamientos comúnmente utilizados para el carcinoma hepatocelular (CHC). La predicción pronóstica en pacientes con CHC sometidos a TACE es un desafío debido a la gran variabilidad del resultado. La “Detección del riesgo nutricional 2002” (NRS-2002) se utiliza ampliamente en la actualidad para evaluar el riesgo nutricional de los pacientes hospitalizados y se ha demostrado que está relacionada con el pronóstico. Aquí, nuestro objetivo fue construir un nomograma pronóstico, utilizando la puntuación NRS-2002, para pacientes con HCC que reciben TACE. Métodos: reclutamos a 359 pacientes con CHC tratados con TACE en el Hospital Popular de Xingtai desde enero de 2015 hasta diciembre de 2020. Los pacientes se dividieron en un grupo NRS ≥ 3 (n = 190; 52,9 %) y un grupo NRS < 3 (n = 167, 47,1 %) según la puntuación NRS-2002 preoperatoria. Las variables asociadas con la supervivencia se analizaron mediante la regresión de Cox univariante y multivariante. Se estableció un nomograma que incorpora variables independientes. El rendimiento predictivo del nomograma se evaluó mediante el índice de concordancia (índice C) y la curva de calibración. Resultados: la mediana de supervivencia del grupo NRS ≥ 3 fue significativamente menor que la del grupo NRS < 3. El análisis multivariante mostró que el estadio del grupo de Clínica de Cáncer de Hígado de Barcelona, una puntuación NRS-2002 ≥ 3, la γ-glutamil transpeptidasa y la alfa-fetoproteína se asociaron significativamente con la supervivencia de los pacientes con CHC después de la TACE. El índice C fue de 0,708 (intervalo de confianza del 95 %: 0,672-0,743) y las curvas de calibración mostraron una buena concordancia entre las supervivencias observadas y las predichas a 1, 2 y 3 años. Conclusiones: la puntuación NRS-2002 ≥ 3 podría identificar a los pacientes con HCC de alto riesgo sometidos a TACE (AU)

Bilateral pulmonary artery banding for neonatal complex congenital heart disease / 中华胸心血管外科杂志

Bilateral pulmonary artery banding was reported to be used for truncas in 1976. With conjunctive duct stenting or Prostaglandin infusion it can improve the surgical outcomes of neonates with several complex congenital heart diseases. This review introduces scenarios that bilateral pulmonary artery banding could be used, how to band the pulmonary artery and complications, prospecting for providing suggestion for surgical treatments of neonatal complex congenital heart diseases.

Study on establishing the reference range of atrial septal excursion index and foramen ovale membrane angle in normal fetuses aged 16-40 weeks / 中华超声影像学杂志

Objective:To establish the normal reference range of atrial septal excursion index (ASEI) and foramen ovale membrane angle in normal fetuses aged 16-40 weeks, and to analyze the correlation between ASEI and foramen ovale membrane angle in normal fetuses.Methods:A total of 378 normal singletons with gestational ages of 16-40 weeks undergoing by fetal echocardiography were selected in the Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, from January to June 2021, and 349 fetuses successfully finished all measurements. After all fetuses completed the systematic fetal echocardiography, fetal foramen ovale diameter and foramen ovale membrane angle were measured on the four chamber view. The maximum distance of foramen ovale valve from the base of atrial septum to the free wall of left atrium and the transverse diameter of left atrium were measured, and ASEI was calculated. The differences of ASEI, foramen ovale membrane angle and foramen ovale diameter of the groups with different gestational weeks were compared. The correlations among ASEI, foramen ovale membrane angle and foramen ovale diameter were analyzed by Pearson correlation analysis.Results:All 349 fetuses were divided into 6 groups according to their gestational weeks, including 17 cases at 16-20 weeks, 46 cases at 21-24 weeks, 114 cases at 25-28 weeks, 105 cases at 29-32 weeks, 31 cases at 33-36 weeks and 36 cases at 37-40 weeks. The ± s of ASEI was 0.492 7±0.059 7, 95% CI was 0.486 4-0.499 0, 95% normal reference value range was 0.375 7-0.609 8. Significant differences were found in ASEI among different groups( P<0.05). The ± s of foramen ovale membrane angle was (44.03±5.48)°, 95% CI was 43.46-44.61°, 95% normal reference value range was 33.29-54.78°. Significant differences were found in the foramen ovale membrane angle among different groups( P<0.05). The ± s of foramen ovale diameter was (4.32±1.30)mm, 95% CI was 4.18-4.45 mm, the differences among different groups were significant( P<0.05) and foramen ovale diameter was found increased with the increase of gestational weeks. There was a significant positive correlation between ASEI and foramen ovale membrane angle ( r=0.558, P<0.05). There was no correlation between foramen ovale diameter and ASEI and foramen ovale membrane angle ( r=-0.166, -0.084; all P>0.05). Conclusions:The normal reference ranges of ASEI and foramen ovale valve angle of normal fetuses aged 16-40 weeks was successfully established. These parameters may be useful for evaluating diastolic cardiac function by assessing foramen ovale.

Early and mid-term results of surgical revascularization of pulmonary artery in unilateral absence of a pulmonary artery / 中华胸心血管外科杂志

Objective:To summarize the early and middle terms of the revascularization of remnant pulmonary artery in unilateral absent intrapericardial pulmonary artery.Methods:We retrospectively analyzed the medical records of 14 patients(7 males and 7 females) with unilateral absent pulmonary artery, in which 10 were right and 4 were left, the median age at surgery was 5 months. The patients received operation from January 2009 to December 2020. 14 patients, 2 cases associated with tetralogy of Fallot, and 1 case with aortopulmonary window. The diagnosis was made by enhanced CT scan or pulmonary vein wedge angiography. The median diameter of the affected hilar pulmonary artery remnants was(3.20±0.94)mm, and the Z value was -3.92±1.64. All the patients received single-stage revascularization: group A: tube graft interposition in 3 patients, autologous pericardial roll in 5; group B: direct anastomosis in 2, unifocalization in one and main pulmonary artery flap angioplasty in the rest 3.Results:No hospital death occurred. There were no difference finds in the age and weight at operation, the cardiopulmonary bypass time, the mechanical ventilation time, and the length of intensive care unit stay between the two groups. All the patients took aspirin for anticoagulation for 6 months after the operation. The follow-up period was 1 month to 68 months. Because the neo-PA stenosis at the anastomosis was found in one patient in group B, transcatheter balloon angioplasty was performed at 41 months after surgery. Nonetheless, the results were encouraging, symptoms have improved in all patients. The diameter and Z value of the latest ipsilateral pulmonary artery was(6.25±0.99)mm and -2.34±1.18 respectively, significantly improved when compared to the preoperative value. Residual pulmonary artery hypertension was not found. The Z value of the affected side of the pulmonary artery in group B was significantly improved than that in group A.Conclusion:Early and aggressive pulmonary artery revascularization is effective at restoring normal antegrade flow to the affected lung, resulting in improved diameter of the PA, and UAPA patient’s symptoms. The use of autologous pulmonary artery tissue angioplasty may reach a more satisfying result. However, transcatheter intervention may diminish the new pulmonary artery stenosis temporarily, reoperation is still needed in the long-term follow-up.

Application of fetal atrial septal excursion index and comprehensive Z-scores of cardiovascular structures in fetuses with redundancy foramen ovale flap / 中华超声影像学杂志

Objective:To investigate the application of fetal atria septal excursion index (ASEI) combining cardiovascular structure Z-scores in fetuses with redundancy foramen ovale flap (RFOF).Methods:Twenty-two fetuses with RFOF diagnosed by fetal echocardiography in Sir Run Run Shaw Hospital from December 2019 to September 2021 were selected as the RFOF group and 62 normal fetuses as the control group. The movement of the foramen ovale valve was observed in the four chamber view, and the maximum distance of the foramen ovale valve bulging, the total length of the atrial septum, the foramen ovale diameter, the diameters of the aortic valve, the pulmonary valve, the ascending aorta, the aortic isthmus, the descending aorta and the left and right ventricular areas were measured. ASEI, foramen ovale diameter, foramen ovale valve excursion distance, the ratio of foramen ovale diameter to total atrial septum length, aortic valvular annular diameter Z-score(AOV Z-score), pulmonary valvular annular diameter Z-score(PV Z-score), ascending aorta diameter Z-score(AOA Z-score), ascending aorta diameter Z-score (AOA Z-score), aortic isthmus Z-score (AOI Z-score), descending aorta diameter Z-score (AOD Z-score), diastolic right ventricular area Z-score (RV area Z-score) and diastolic left ventricular area Z-score(LV area Z-score) were compared between the two groups. RFOF fetuses were followed up to observe the prognosis.Results:There were significant differences in fetal ASEI, foramen ovale diameter, foramen ovale valve excursion distance, the ratio of foramen ovale diameter to total atrial septum length, AOV Z-score, PV Z-score, AOA Z-score, AOI Z-score, AOD Z-score and LV area Z-score between RFOF group and control group (all P<0.05), but there was no significant difference in RV area Z-score ( P>0.05). Postnatal follow-up outcomes in RFOF group indicated that 17 of 22 cases (77.3%) had live birth, five cases (22.7%) were lost at follow-up. Twelve of 17 live birth cases (70.5%) showed structurally normal heart by postnatal echocardiography, 3 cases (17.6%) showed mild coarctation of the aorta with nonsignificant hemodynamics under clinical follow-up, 2 cases (11.8%) were diagnosed with coarctation of the aorta, pulmonary artery dilation and atrial septal defect, and died after operation, of which one case died of infections pneumonia after operation. Another case was born prematurely at 36 + 4 weeks with a birth weight of 2 650 g, and neotal echocardiography showed ventricular septal defect, atrial septal defect and patent ductus arteriosus. Conclusions:ASEI can quantitatively evaluate the behavior of foramen ovale valve mobility and in combination with Z-scores of cardiovascular structures can be used to assess the morphological changes of fetal hearts. Although some fetuses with RFOF demonstrate left and right ventricular disproportion and coarctation of the aorta in fetal echocardiography, most fetuses have a good prognosis.

Results of surgical treatment for 79 patients with aortic coarctation combined with complex anomalies: A retrospective analysis in a single center / 中国胸心血管外科临床杂志

@#Objective    To summarize the results of surgical treatment for 79 patients with coarctation of the aorta (CoA) combined with complex anomalies (CA) in recent years. Methods    The data from 79 patients with CoA combined with CA admitted to Guangzhou Women and Children's Medical Center between January 19, 2010 and September 7, 2017 were collected and analyzed. There were 52 males and 27 females. The median age was 71 days, and the median weight was 4.3 kg. There were 26 patients combined with tracheostenosis and 7 patients with preoperative tracheal intubation. Extended end-to-side anastomosis was used to correct the CoA, and the associated cardiac abnormalities were treated simultaneously by an incision through median sternotomy. All operations were performed by the same group of surgeons. Results    The median deep hypothermic circulatory arrest was 18 (13-28) minutes, the median aorta cross-clamp time was 62 (15-199) minutes, the median cardiopulmonary bypass time was 145 (71-674) minutes, the median ventilation time was 72 (9-960) hours, the median length of ICU stay was 144 (12-1 944) hours, and the median length of hospital stay was 24 (2-93) days. Early death occurred in 9 patients and late death occurred in 5 patients. Reoperation occurred in 28 patients and recoarctation developed in 10 patients. After operation, transcoarctation gradient was reduced, and the transcutaneous oxygen saturation, C-reactive protein (CRP), lactate and creatinine were increased. Compared to the survival group, both preoperative and postoperative transcutaneous oxygen saturation were worse and the postoperative levels of plasma brain natriuretic peptide (BNP) and CRP were higher in the death group. Conclusion    Correcting the CoA and the associated CA simultaneously with extended end-to-side anastomosis by an incision through median sternotomy is effective and safe, and the outcomes of immediate and medial-term are satisfactory. Improving oxygenation and limiting elevation of BNP and CRP levels may reduce the death rate.

Ferroptosis is essential for diabetic cardiomyopathy and is prevented by sulforaphane via AMPK/NRF2 pathways

Herein, we define the role of ferroptosis in the pathogenesis of diabetic cardiomyopathy (DCM) by examining the expression of key regulators of ferroptosis in mice with DCM and a new ex vivo DCM model. Advanced glycation end-products (AGEs), an important pathogenic factor of DCM, were found to induce ferroptosis in engineered cardiac tissues (ECTs), as reflected through increased levels of Ptgs2 and lipid peroxides and decreased ferritin and SLC7A11 levels. Typical morphological changes of ferroptosis in cardiomyocytes were observed using transmission electron microscopy. Inhibition of ferroptosis with ferrostatin-1 and deferoxamine prevented AGE-induced ECT remodeling and dysfunction. Ferroptosis was also evidenced in the heart of type 2 diabetic mice with DCM. Inhibition of ferroptosis by liproxstatin-1 prevented the development of diastolic dysfunction at 3 months after the onset of diabetes. Nuclear factor erythroid 2-related factor 2 (NRF2) activated by sulforaphane inhibited cardiac cell ferroptosis in both AGE-treated ECTs and hearts of DCM mice by upregulating ferritin and SLC7A11 levels. The protective effect of sulforaphane on ferroptosis was AMP-activated protein kinase (AMPK)-dependent. These findings suggest that ferroptosis plays an essential role in the pathogenesis of DCM; sulforaphane prevents ferroptosis and associated pathogenesis via AMPK-mediated NRF2 activation. This suggests a feasible therapeutic approach with sulforaphane to clinically prevent ferroptosis and DCM.

Research Status and hot topics of studies on clinical nutrition in congenital heart disease at home and abroad: visual analysis based on CiteSpace / 中华临床营养杂志

Objective:To analyze the research status and discuss hot topics and development trends of studies on clinical nutrition in congenital heart disease (CHD) at home and abroad, so as to provide reference for Chinese researchers.Method:Studies on clinical nutrition in CHD were retrieved from the databases of CNKI and Web of Science, from the founding of database until 2020. CiteSpace 5.6.R5 was used for visual analysis of authors, countries, institutions, research hotspots and frontiers.Results:A total of 163 Chinese and 1,809 English publications were included. The number of literatures published at home and abroad shows an overall trend of growth. The United States has the largest number of publications, with China in seventh place. Domestic publishing institutions are mainly hospitals, led by Nanjing Children's Hospital affiliated to Nanjing Medical University. Foreign publications are mainly by university institutions, with Harvard University in the United States ranking first. Research teams led by authors including Gu Ying and Ravishankar C. are at the core in this field. The most discussed issues in China are mainly nutritional risk, nutritional support and nutrient research. The main target populations are ICU patients, premature infants, infants and children, etc. The forefront of research includes early enteral nutrition, prognosis and feeding intolerance. In foreign countries, studies mainly focus on epidemiology, nutritional support, malnutrition, risk factors, nutritional treatment, energy metabolism, obesity, clinical outcomes, etc. Main target population is special population, such as neonates with CHD, infants, children, patients after heart transplantation, etc. cohort studies and researches on overweight are at the frontier.Conclusions:The research on nutrition in CHD has attracted more and more attention. There are some differences in research content and hot topics between domestic and foreign studies. Therefore, we should strengthen the cooperation and exchanges among institutions, combine the advantages of CHD nutrition research in China, and strengthen the epidemiological study of CHD nutrition and the nutrition management of CHD key population, so as to further promote research development in this field.

Joinpoint regression analysis of injury tendency among students in Changning District, Shanghai in 2010-2017 / 公共卫生与预防医学

Objective To investigate the current situation and annual trend of injuries among primary and middle school students in Changning District, Shanghai, and to provide scientific evidence for decision-making of prevention and control. Methods The monitoring data of various types of injuries was collected from the “cause of class absence” system during the 2010-2017 school years. The Joinpoint regression analysis was used to estimate the annual percent change and average annual percent change, and to perform the trend test. Results During the 2010-2017 school years in Changning District, a total of 2,286 cases of injuries occurred among primary and middle school students, with an injury rate of about 0.70%. The top three prevalent injury types were falls, traffic accidents, and burn-related injury. The results of Joinpoint trend analysis indicated that the incidence of total injuries in Changning District was generally decreasing, which was mainly due to the effective control of injuries caused by falls, traffic accidents, and burns, and to the decreasing injury incidence among primary school students. Conclusion The overall situation of injuries among primary and middle school students in Changning District has improved significantly, but falls and traffic accidents are still important health threats. More attentions should be paid to certain groups, such as vocational and special education students.

Analysis of the influencing factors of cardiopulmonary bypass with ultra-fast-track anesthesia in pediatric heart surgery / 中华胸心血管外科杂志

Objective:Analyze the perioperative data of children undergoing cardiopulmonary bypass(CPB) for congenital heart disease under the management of ultra-fast track anesthesia(UFTA), the factors of CPB are discussed.Methods:1 034 children who underwent CPB from May 2018 to August 2019 were analyzed retrospectively. According to the success of anesthesia, they were divided into two groups: UFTA group and UFTA failure group. Propensity score matching was used to screen the children with preoperative baseline data matching. Finally 346 cases in each group. The possible CPB factors of the two groups were analyzed by single factor analysis, and the statistically significant factors were analyzed by logistic regression analysis. Results:Univariate analysis showed that the CPB and aortic occlusion time, the lowest temperature and lowest hematocrit in CPB, the dosage of crystalloid and suspended erythrocytes, the second or more times of CPB, and the blood lactate after CPB were the factors influencing the ultra-fast track anesthesia. Logistic regression analysis showed that the time of CPB and aortic occlusion, the value of blood lactate, the dosage of suspended erythrocytes, and the second or more times of CPB were the independent influencing factors of ultra-fast track anesthesia. In the UFTA failure group, the postoperative hospitalization time, the length of stay in the ICU and the hospitalization cost were all higher than those in the ultra-fast track group. Conclusion:CPB time, aortic occlusion time, blood lactate after CPB, the dosage of suspended erythrocytes, secondary or multiple CPB were independent risk factors for UFTA.UFTA is beneficial to shorten the postoperative hospital stay, the ICU stay and the cost of hospitalization.

Analysis of perioperative risk factors for seizures in children with congenital heart disease following cardiopulmonary bypass / 中华实用儿科临床杂志

Objective:To examine the occurrence of seizures and perioperative risk factors in children after obtaining cardiopulmonary bypass (CPB).Methods:Electroencephalograph (EEG) and cerebral oxygen saturation (ScO 2) were monitored in 87 patients (aged 3 days-110 months, with the median at 4.4 months) and they were admitted to the Cardiac Intensive Care Unit (CICU) from May 2018 to April 2019, with 77 patients for 72 h after CPB and 10 cases with clinical seizures after CICU discharge for 8-180 h. Clinical data were recorded every 4 hours, including blood pressure, central venous pressure (CVP), temperature, arterial blood gases, lactate, doses of Dopamine, Milrinone, and Adrenalin, and daily C-reaction protein (CRP) and N-terminal pro-brain natriuretic peptide(NT-proBNP). Demographic data, the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery(STAT) mortality classification and clinical outcomes (duration of mechanical ventilation, CICU and hospital stay, and death) were recorded. Results:Seizures occurred in 24 patients (27.6%) within 48 h after CPB.EEG seizures appeared in 7 patients, both EEG and clinical seizures in 7 patients, and clinical seizures in 10 patients.Three patients developed epilepsy.There were 2 hospital deaths and both had EEG seizures.Patients with seizures had higher STAT categories, longer operative time and worse clinical outcomes (all P<0.05). Univariate regression revealed that the occurrence of seizures was positively related to adrenalin, temperature, lactate level (all P<0.01), blood pressure, CVP (all P<0.05) and CRP ( P<0.1), and negatively correlated with arterial carbon dioxide tension[ pa(CO 2)], ScO 2 and dose of Milrinone (all P<0.05). In multivariate regression, only dose of Adrenalin ( P<0.001) and lactate level ( P<0.01) remained significant. Conclusions:The incidence of seizures was high in children after CPB.Numerous perioperative factors that were related to seizures were identified.The most significant risk factors were higher dose of adrenaline and lactate level.Studies on neurological injury after CPB are urgently needed in China in order to reduce brain injury and improve neurodevelopmental outcomes.

Comparison of severe and non-severe COVID-19 pneumonia: review and meta-analysis

ObjectiveTo compare the difference between severe and non-severe COVID-19 pneumonia and figure out the potential symptoms lead to severity. MethodsArticles from PubMed, Embase, Cochrane database, and google up-to 24 February 2020 were systematically reviewed. Eighteen Literatures were identified with cases of COVID-19 pneumonia. The extracted data includes clinical symptoms, age, gender, sample size and region et al were systematic reviewed and meta analyzed. Results14 eligible studies including 1,424 patients were analyzed. Symptoms like fever (89.2%), cough (67.2%), fatigue (43.6%) were common, dizziness, hemoptysis, abdominal pain and conjunctival congestion/conjunctivitis were rare. Polypnea/dyspnea in severe patients were significantly higher than non-severe (42.7% vs.16.3%, P<0.0001). Fever and diarrhea were higher in severe patients(p=0.0374and0.0267). Further meta-analysis showed incidence of fever(OR1.70,95%CI 1.01-2.87), polypnea/dyspnea(OR3.53, 95%CI 1.95-6.38) and diarrhea(OR1.80,95%CI 1.06-3.03) was higher in severe patients, which meant the severe risk of patients with fever, polypnea/dyspnea, diarrhea were 1.70, 3.53, 1.80 times higher than those with no corresponding symptoms. ConclusionsFever, cough and fatigue are common symptoms in COVID-19 pneumonia. Compared with non-severe patients, the symptoms as fever, polypnea/dyspnea and diarrhea are potential symptoms lead to severity.

Analysis of clinical characteristics of new coronavirus pneumonia patients in secondary epidemic areas / 中华危重病急救医学

Objective:Understand the clinical characteristics of confirmed pneumonia patients infected with new corona virus in secondary epidemic areas and guide the diagnosis and treatment of novel pneumonia in secondary epidemic areas and provide a reference for clinical prevention and control of the epidemic situation.Methods:The clinical data of 33 patients admitted with pneumonia caused by a novel coronavirus in the Second Affiliated Hospital of Wenzhou Medical University from January 15 to February 1, 2020, were retrospectively reviewed. At the onset of the disease, we analyzed the primary symptoms such as fever, cough, fatigue, chest tightness, chest pain and also a significant blood test results of the patients. According to the patient's contact history, it was divided into the direct infection group of the main epidemic area and the indirect contact infection group of the main epidemic areas. The difference between clinical manifestations among the two groups was analyzed.Results:The main clinical symptoms of patients with novel coronavirus pneumonia in the secondary epidemic area were respiratory tract and systemic symptoms. After grouping according to the presence and absence of direct contact in the main epidemic area, there was no significant difference in baseline data between the two groups, and there was no significant difference in symptoms and signs between the two groups ( P < 0.05). Some patients had serum amyloid protein (SAP) increased abnormall. Conclusions:The respiratory tract and systemic symptoms are the primary symptoms of the patients with the new type of coronavirus pneumonia in the secondary epidemic area, which are not typical. The abnormal increase of serum amyloid protein (SAA) may be used as an auxiliary index for diagnosis and treatment.

Analysis of clinical characteristics of new coronavirus pneumonia patients in secondary epidemic areas / 中华危重病急救医学

Objective@#Understand the clinical characteristics of confirmed pneumonia patients infected with new corona virus in secondary epidemic areas and guide the diagnosis and treatment of novel pneumonia in secondary epidemic areas and provide a reference for clinical prevention and control of the epidemic situation.@*Methods@#The clinical data of 33 patients admitted with pneumonia caused by a novel coronavirus in the Second Affiliated Hospital of Wenzhou Medical University from January 15 to February 1, 2020, were retrospectively reviewed. At the onset of the disease, we analyzed the primary symptoms such as fever, cough, fatigue, chest tightness, chest pain and also a significant blood test results of the patients. According to the patient's contact history, it was divided into the direct infection group of the main epidemic area and the indirect contact infection group of the main epidemic areas. The difference between clinical manifestations among the two groups was analyzed.@*Results@#The main clinical symptoms of patients with novel coronavirus pneumonia in the secondary epidemic area were respiratory tract and systemic symptoms. After grouping according to the presence and absence of direct contact in the main epidemic area, there was no significant difference in baseline data between the two groups, and there was no significant difference in symptoms and signs between the two groups (P < 0.05). Some patients had serum amyloid protein (SAP) increased abnormall.@*Conclusions@#The respiratory tract and systemic symptoms are the primary symptoms of the patients with the new type of coronavirus pneumonia in the secondary epidemic area, which are not typical. The abnormal increase of serum amyloid protein (SAA) may be used as an auxiliary index for diagnosis and treatment.

Surgical treatment for patients aged above 5-month with heterotaxy with functional single ventricle and total anomalous pulmonary venous connection / 中华胸心血管外科杂志

Objective:To review the surgical outcomes for patients above 5-month old with heterotaxy syndrome with heterotaxy with functional single ventricle and total anomalous pulmonary venous connection(TAPVC) in a single center.Methods:From September 2008 to December 2018, there were 34 patients with heterotaxy syndrome with heterotaxy with functional single ventricle and TAPVC underwent cardiac operations at Guangzhou Women and Children Medical Center. 29 patients are aged above 5-month. The median age and body weight at surgery were 440 days(159 to 3 718 years) and 8.5 kg(4.9 to 19.2 kg). The type of TAPVC was supracardiac in 29 patients. All patients were diagnosed with complex cardiac anomaly, including complete atrioventricular canal defect 22 cases, tricuspid atresia 1 cases, mitral atresia 1 cases, atrioventricular valve regurgitation ≥moderate 6 cases, pulmonary venous stenosis 5 cases.Results:There were 4 died after initial operation. The causes of dead were pulmonary hypertension and low cardiac output syndrome. The follow-up duration was 11 to 130 months. 3 patients died of low cardiac output syndrome, protein-losing enteropathy and pulmonary venous stenosis respectively. Kaplan- Meier estimated survival at 1 and 5 years were 79.3% and 75.7%, respectively. 13 patients proceeded to a modified Fontan operation. Fontan completion was 44.8%(13/29). The mortality for patients with pulmonary venous stenosis(PVO) was 60%(3/5). Cox multivariate regression analysis indicated that preoperative PVO was the only risk factor for mortality. Conclusion:Delayed surgical treatment outcomes for patients with heterotaxy syndrome and TAPVC have improved significantly. Fontan completion was higher. However, preoperative PVO was the only risk factor for mortality, and outcomes for patients with PVO were still not promising. The outcomes could be better if these patients underwent initial operation at an early time. Early diagnosis and early intervention are still the principle strategy of surgical treatment of congenital heart disease.

Chinese expert consensus on surgical treatment of congenital heart disease (3): pulmonary atresia with ventricular septal defect / 中国胸心血管外科临床杂志

@#Pulmonary atresia with ventricular septal defect (PA/VSD) is a complicated congenital heart defect. The consensus of Chinese experts is developed based on the evidence-based data and expert opinions provided by the literature. Tchervenkov classification (A, B and C, three types) is adopted. Echocardiography is preferred to assess the abnormalities of the heart, physiological function and pulmonary artery development, but it is not absolutely accurate for the evaluation of collateral vessels. Furthermore, multi-row CTA can confirm the development of the native pulmonary artery, the number, origin and morphological characteristics of collateral vessels. Additionally, angiography provides more details of the number, origin and distribution of collateral vessels. Genetic testing is important to understand the genetic etiology and to determine the prognosis. After definite diagnosis, treatment plan is made according to the classification and clinical manifestations. Pulmonary artery flow is arterial duct dependent for Type A and surgical treatment is usually performed within 6 months. But patients with severe hypoxia were treated during neonatal period. The strategy for type B/C is more complex. Severe hypoxemia may occur in infants with type B PA/VSD and decreased pulmonary flow, and systemic to pulmonary artery shunt should be performed during neonatal or early infant period, complete repair following after good pulmonary arterial development. On the other hand, for patients with over circulating pulmonary flow, primary repair is perform with 3~6 months for congestive heart failure. For patients with balanced pulmonary flow and repairable condition, one-stage complete repair can be performed in infancy stage. Otherwise, palliative systemic to pulmonary artery shunt or right ventricle to pulmonary artery shunt should be first, and second-staged complete repair or pulmonary arterial development promotion is adopted according to following assessment. The surgical option for type C PA/VSD should be discreet. Pulmonary arterial flow study is demanded after unifocalization to decide to close the VSD completely or not. Close follow-up after operation is imperative and cardiac catheterization is perform to reveal the pulmonary artery and collateral vessels if necessary and dilates the site of stenosis.