[Similarities and differences of myocardial metabolic characteristics between HFpEF and HFrEF mice based on LC-MS/MS metabolomics].

Objective: To reveal the similarities and differences in myocardial metabolic characteristics between heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) mice using metabolomics. Methods: The experimental mice were divided into 4 groups, including control, HFpEF, sham and HFrEF groups (10 mice in each group). High fat diet and Nω-nitroarginine methyl ester hydrochloride (L-NAME) were applied to construct a"two-hit"HFpEF mouse model. Transverse aortic constriction (TAC) surgery was used to construct the HFrEF mouse model. The differential expression of metabolites in the myocardium of HFpEF and HFrEF mice was detected by untargeted metabolomics (UHPLC-QE-MS). Variable importance in projection>1 and P<0.05 were used as criteria to screen and classify the differentially expressed metabolites between the mice models. KEGG functional enrichment and pathway impact analysis demonstrated significantly altered metabolic pathways in both HFpEF and HFrEF mice. Results: One hundred and nine differentially expressed metabolites were detected in HFpEF mice, and 270 differentially expressed metabolites were detected in HFrEF mice. Compared with the control group, the most significantly changed metabolite in HFpEF mice was glycerophospholipids, while HFrEF mice presented with the largest proportion of carboxylic acids and their derivatives. KEGG enrichment and pathway impact analysis showed that the differentially expressed metabolites in HFpEF mice were mainly enriched in pathways such as biosynthesis of unsaturated fatty acids, ether lipid metabolism, amino sugar and nucleotide sugar metabolism, glycerophospholipid metabolism, arachidonic acid metabolism and arginine and proline metabolism. The differentially expressed metabolites in HFrEF mice were mainly enriched in arginine and proline metabolism, glycine, serine and threonine metabolism, pantothenate and CoA biosynthesis, glycerophospholipid metabolism, nicotinate and nicotinamide metabolism and arachidonic acid metabolism, etc. Conclusions: HFpEF mice have a significantly different myocardial metabolite expression profile compared with HFrEF mice. In addition, biosynthesis of unsaturated fatty acids, arachidonic acid metabolism, glycerophospholipid metabolism and arginine and proline metabolism are significantly altered in both HFpEF and HFrEF mice, suggesting that these metabolic pathways may play an important role in disease progression in both types of heart failure.

CoSe nanoparticles in-situ grown in 3D honeycomb carbon for high-performance lithium storage.

Although transition metal selenides are considered to be extremely promising anode materials for lithium-ion batteries (LIBs), severe volume changes and low electronic conductivity are their huge and unavoidable challenges. To solve these problems, CoSe nanoparticles in-situ grown on the inner surface of every macropore of 3D honeycomb C is successfully synthesized by three simple steps: dense assembling of polystyrene spheres, calcination and gaseous selenylation. The sizes of CoSe and honeycomb pores are 10-15 nm and 190 nm, respectively. The content of CoSe is 72 wt%. This unique architecture guarantees high electrochemical activity, rapid reaction kinetics and excellent structural stability of CoSe, as identified by cycling and rate performance measurements, various electrochemical kinetics analyses and ex-situ characterization of the cycled electrode material. As a result, the CoSe@honeycomb C anode exhibits extraordinary cycling performance (823.5 mAh g-1 after 200 cycles at 0.5 A g-1, 610.1 mAh g-1 after 250 cycles at 2 A g-1, 247 mAh g-1 after 1500 cycles at 5 A g-1) and exceptional rate capability (261.9 mAh g-1 at 10 A g-1, 1491.4 mAh g-1 at 0.1 A g-1), demonstrating that it is a potential anode material for high-performance LIBs.

[Clinical study on the relationship between the exosomes in bronchoalveolar lavage fluid and plasma and the severity of lung injury and outcome in early acute respiratory distress syndrome patients].

Objective: To investigate the relationship between the levels of exosomes in bronchoalveolar lavage fluid (BALF) and plasma and the severity of lung injury and its outcome in patients with acute respiratory distress syndrome (ARDS). Methods: Patients who were admitted to the Department of Critical Care Medicine, Zhongda Hospital Affiliated to Southeast University and received invasive mechanical ventilation were selected from August 2020 to April 2021, and they were divided into ARDS group and non-ARDS group. Finally, 33 ARDS patients were included, including 18 males and 15 females, aged (65.5±15.5) years; 10 non-ARDS patients, 8 males and 2 females, aged (57.2±15.3) years. The BALF and plasma of the two groups of patients were collected within 24 hours after enrollment, and the total exosomes of the samples were collected by ultracentrifugation. Nanoparticle tracking analysis (NTA) was used to detect and compare the differences in exosome content between the two groups. Correlation of content with the severity and prognosis of lung injury in ARDS patients. Results: There was no significant difference in gender and age between ARDS group and non-ARDS group (both P>0.05). The exosome in plasma of ARDS group was significantly higher than that of non-ARDS group [(25.3±1.2)/ml vs (24.2±1.6)/ml, P=0.031], while the exosomes in BALF of ARDS group was also higher than that of non-ARDS group [(26.5±1.6)/ml vs (24.6±1.1)/ml, P=0.001]. The exosomes in BALF of patients with ARDS caused by intrapulmonary causes was higher than that in ARDS group caused by extrapulmonary causes [(26.9±1.5)/ml vs (25.2±0.9)/ml, P=0.01], and the infection caused by bacterial shows that the highest exosome level in BALF. The exosomes in the BALF of the mild ARDS group was significantly lower than that of the severe ARDS group [(25.7±1.3)/ml vs (27.2±1.5)/ml, P=0.038]; the exosomes in BALF of ARDS patients was negatively correlated with P/F ratio (r=-0.38, P=0.03); and it was positively correlated with Murray lung injury score (r=0.47, P=0.01). However, the static compliance levels, length of hospital stay, duration of mechanical ventilation, and 28-day outcome were not associated with the exosomes in BALF. Conclusion: Compared with non-ARDS patients, ARDS patients have significantly higher levels of exosomes in BALF and plasma, there is a certain correlation between exosomes derived from BALF and the severity of lung injury in ARDS.

Vaccination to reduce severe COVID-19 and mortality in COVID-19 patients: a systematic review and meta-analysis.

OBJECTIVE: The outbreak of coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in the death of up to 5 million people worldwide, with a mortality rate of approximately 2%. Wearing masks, maintaining social distance, tracking, and isolating close contacts are not sufficient to control the epidemic. The effectiveness of vaccines is affected by the willingness of people to be vaccinated. Therefore, in this review, we aimed to examine the efficacy of different types of vaccines in reducing hospitalization rates, disease severity, and mortality. MATERIALS AND METHODS: We searched five databases (Embase, PubMed, Cochrane, EBSCO, and CEPS) for related research on September 3, 2021. We used a random-effects model for analysis. RESULTS: Seven studies were identified, involving 1,366,700 participants (689,967 participants in the vaccinated group and 676,733 participants in the non-vaccinated group). There were 292 significant incidents (56 in the vaccinated group and 236 in the non-vaccinated group) with a risk ratio of 0.12 and a 95% confidence interval of 0.040-0.363. Compared with no vaccine, all types of vaccines can effectively prevent the rate of severe illness. CONCLUSIONS: We evaluated whether different brands of vaccines or types of COVID-19 vaccines could prevent the risk of severe illness after diagnosis. The analysis showed that all types of vaccines can effectively prevent severe disease. Implementing epidemic prevention guidelines and obtaining vaccines in different countries can improve vaccine protection and reduce COVID-19-related deaths worldwide.

[An area under curve-based nomogram to predicts vancomycin-associated nephrotoxicity in critically ill patients: a retrospective cohort study].

Objective: To develop an area under curve (AUC)-based nomogram to predict vancomycin-associated nephrotoxicity in critically ill patients. Methods: This retrospective cohort study included adult patients treated with vancomycin in the intensive care unit at a tertiary teaching hospital from January 2015 to December 2017. Baseline clinical characteristics before vancomycin treatment and pharmacokinetic parameters were collected to establish a prediction model of nephrotoxicity. Univariate analysis was used to screen variables, and multivariate logistic regression analysis was used to establish the prediction model and nomogram. Results: A total of 159 patients met the inclusion criteria, sixty-four were included in the final analysis. Sixteen patients (25%, 16/64) developed vancomycin-associated nephrotoxicity. The following variables were incorporated into the prediction model: vancomycin AUC, estimated glomerular filtration rate (GFR), and combined nephrotoxic drugs. The following equation was established to calculate the probability of nephrotoxicity: logit (P)=-4.83+0.009×AUC-2.87×1 (if GFR>60 ml/min)+2.53×1 (if number of combined nephrotoxic drugs≥2). A nomogram was generated based on the equation. The receiver-operating characteristic curve demonstrated that the AUC of the prediction model was 0.927 (95%CI 0.851-1.000). The cut-off value of the probability of nephrotoxicity was 26.48%. The sensitivity and specificity were 87.5% and 87.5% respectively. Conclusion: The incidence of vancomycin-associated nephrotoxicity is high. The AUC-based nomogram can effectively predict vancomycin-associated nephrotoxicity in critically ill patients.

[The implementation of hour-1 bundle for sepsis in medical staff].

To determine the physicians'compliance of hour-1 bundle for sepsis. A management system of hour-1 bundle for sepsis was established. The clinical data of 286 sepsis patients were collected, who were classified into 3 months before the bundle (control group), 9 months during process (observation group) and 3 months after bundle (study group). The compliance of hour-1 bundle implementation was compared in three groups. The results showed that with the application and implementation of the management system, the compliance of hour-1 bundle for sepsis in the control group, observation group and study group was 58.3%(28/48), 69.1%(105/152) and 88.4%(76/86) respectively (χ2=7.053,P=0.029). The 28 day mortality in sepsis patients was 41.7%(20/48), 34.9%(53/152) and 23.3%(20/86) respectively (χ2=5.576,P=0.062).The management system of hour-1 bundle for sepsis can effectively improve the physicians' compliance.

Interrupting TGF-ß1/CCN2/integrin-α5ß1 signaling alleviates high mechanical-stress caused chondrocyte fibrosis.

OBJECTIVE: Mechanical-stress has been reported to trigger cartilage fibrosis, in which transforming growth factor (TGF)-ß and connective tissue growth factor (CCN2) are involved. However, the function of integrin-α5ß1, a cytomembrane receptor, on mechanical-stress related fibrosis has not yet been elucidated. This study aims to reveal the interaction of TGF-ß1/CCN2/integrin-α5ß1 in the mechanical-stress induced chondrocyte (CH) fibrosis. PATIENTS AND METHODS: We used different levels (5% and 10%) of cyclic tension simulation (CTS) to stretch CHs and observed the gene expression of TGF-ß1/CCN2/integrin-α5ß1 as well as the fibrous related genes containing collagen I/II/III, Runx2, MMP13, and ADAMTS-5 by real-time polymerase chain reaction (RT-PCR) or immunofluorescence. We used the siRNA or the corresponding antagonist of TGF-ß1, CCN2, integrin-α5ß1 during the CTS to clear the effect of them in the fibrosis progress. In addition, to verify the crosstalk between TGF-ß1, CCN2, and integrin-α5ß1, we used the recombinant human (rh)-TGF-ß1 and CCN2 to culture CHs without CST. RESULTS: 24 hours-10% CTS was sufficient to induce a decrease of collagen II and increase the collagen I/III, Runx2, MMP13, and ADAMTS-5 gene expression. Under CTS, TGF-ß1 silencing resulted in a decline of CCN2, integrin-α5ß1, and alleviated the CHs fibrosis. Apart from this, blocking CCN2 or integrin-α5ß1 expression also contributed to the suppression of 10% CTS induced CHs fibrosis. Meanwhile, the exogenic protein supplement raised the cellular TGF-ß1 or CCN2 expression and increased the integrin-α5ß1 mRNA level. However, the downregulation of TGF-ß1 or CCN2 did not affect integrin-α5ß1 expression, whether the CTS exited or not. CONCLUSIONS: High mechanical-stress induces CHs fibrosis via the activation of TGF-ß1/CCN2/integrin-α5ß1 signaling, and interrupting the TGF-ß1, CCN2, or integrin-α5ß1 expression can alleviate the fibrous process.

[Preliminary application of postoperative fast track transfer to intensive care unit for the geriatric hip fractures under enhanced recovery after surgery].

Objective: To develop a fast track transfer to intensive care unit (ICU) for the perioperative high-risk elderly patients after hip fracture surgery and analyze the preliminary clinical effect of the application. Methods: From January 2014 to December 2017, before the application of postoperative fast track transfer to ICU, the clinical data of 195 elderly patients with hip fracture were included in a retrospective analysis. Among 195 hip fracture patients, 18 were transferred to ICU post operation (non-fast track group). Multivariate logistic regression analysis was applied to investigate relevant risk factors for transferring to ICU after hip fracture surgery. Based on risk factors acquired from the analysis and clinical experience, the fast track transfer to ICU for the perioperative high-risk elderly patients after hip fracture surgery was constructed according to the preliminary and experiential criteria. From January 2018 to December 2019, the clinical data of 70 patients (fast track group) who were transferred to ICU after hip fracture surgery through the fast track were collected and compared with non-fast track group. Results: Multivariate regression analysis revealed that American Society of Anesthesiologists classification(≥Ⅲ) (OR=4.260, 95%CI:1.157-15.683, P=0.029), pre-hospital stage (≥48 h) (OR=4.301, 95%CI:1.212-15.266, P=0.024), hemoglobin concentration at admission(<90 g/L) (OR=7.979, 95%CI:1.936-32.889, P=0.004), coronary heart disease as one comorbidity(OR=6.063, 95%CI:1.695-21.693, P=0.006) were independent risk factors for transferring to ICU after hip fracture surgery. There were no significant difference in gender, age, fracture type, hemoglobin concentration at admission and time of pre-hospital stage between the non-fast track group and fast track group(all P>0.05). However, the number of comorbidities in the fast track group was significantly higher than that in the non-fast track group (Z=-1.995, P=0.046). The time to surgery, postoperative hospital stay, and length of hospital stay in fast track group were all significantly less than those in non-fast track group (Z=-2.121, -2.726, -3.130, all P<0.05). Also, there were fewer medical consultations needed and fewer patients who stayed in ICU more than or equal to 2 nights in fast track group than that in non-fast track group(all P<0.05). There were no significant difference in the rate of patients who transferred from the general ward to ICU after transferring from ICU to the general ward, the proportion of patients who received more than or equal to 4 departments, operation time, hospitalization expense, mortality during hospitalization, 30-day mortality and 90-day mortality after operation between the two groups(all P>0.05). Conclusions: The fast track constructed in this study can reduce time to surgery, postoperative hospitalization stay and length of hospitalization stay for the perioperative high-risk elderly patients with hip fractures and is a specific clinical application of eras concept based on multidisciplinary team.

[Vertical supraumbilical incision versus left lower oblique incision for specimen retrieval during laparoscopic rectal surgery].

Objective: To compared the short-term surgical outcomes of the vertical supraumbilical incision with the left lower oblique incision for specimen retrieval in laparoscopic resection for rectal cancer. Methods: A retrospective cohort study was performed. Inclusion criteria: (1) rectal cancer confirmed by colonoscopy and pathological examination; (2) undergoing the operation for the first time; (3) laparoscopic rectal surgery performed by the same surgeon team; (4) age of > 18 years and < 76 years old. According to above criteria, clinical data of 178 consecutive patients scheduled for laparoscopic surgery for rectal cancer at Department of Gastrointestinal Surgery of Renji Hospital between March 2015 and December 2017 were collected. Based on incision site of the mini-laparotomy, patients were classified to the vertical supraumbilical incision group (n=75) and the left lower oblique incision group (n=103). There were no significant differences in baseline data, such as age, gender, body mass index (BMI), tumor diameter, preoperative carcinoembryonic antigen (CEA) level, score of American Society of Anesthesiologists, TNM stage, between the two groups (all P>0.05). Perioperative variables and follow-up data were compared between two groups. Results: Between the vertical supraumbilical incision group and the left lower oblique incision group, the operation time [(131.7±3.7) minutes vs. (138.5±3.5) minutes], operative bleeding volume [(138.9±11.5) ml vs. (154.3±10.3) ml], length of auxiliary incision [(4.0±0.1) cm vs. (4.0±0.1) cm], and distance from anastomosis to dentate line [(3.8±0.1) cm vs. (4.2±0.1) cm] were not significantly different (all P>0.05). As compared to the left lower oblique incision group, patients in vertical supraumbilical incision group had earlier flatus [(62.7±2.3) hours vs. (69.2±1.7) hours, t=2.282, P=0.023], earlier ambulation [(41.9±1.8) hours vs. (46.78±1.42) hours, t=2.131, P=0.032], lower pain VAS scores at postoperative 24 hours (2.0±0.1 vs. 2.4±0.1, t=2.172, P=0.032) and 48 hours (2.7±0.1 vs. 3.0±0.1, P<0.05), and lower incidence of postoperative incisional hernia [6.7% (5/75) vs. 9.7% (10/103), χ(2)=3.942, P=0.042]. However, the postoperative fluids intake time, hospitalization days, pain VAS scores at postoperative 12 hours and postoperative complications (wound infection, anastomotic leakage, urinary retention, intestinal obstruction) were not significantly different between the two groups (all P>0.05). Conclusion: The vertical supraumbilical incision in laparoscopic resection for rectal cancer can reduce the degree of postoperative pain, facilitate early recovery of intestinal function and decrease the incidence of incisional hernia.

[Systematic evaluation of neuromuscular blocking agents on prognosis of patients with moderate to severe acute respiratory distress syndrome].

Objective: To evaluate the prognostic impact of neuromuscular blocking agents (NMBA) on patients with acute respiratory distress syndrome (ARDS). Method: Online search of MEDLINE, Embase, Web of Science, CNKI, CBM and other Chinese databases for randomized controlled trials (RCTs) of NMBA in patients with ARDS from January 1994 to June 2019 was done, and literature was selected according to inclusion and exclusion criteria. The patients were divided into NMBA group and non-NMBA group according to whether NMBA was adopted or not. The prognostic indicators (ICU mortality, 28 d mortality, 90 d mortality) and NMBA-related complications (ICU acquired muscle weakness, barometric injury, pneumothorax) of the patients in the two groups were mainly analyzed. Meta-analysis of the data was performed using RevMan 5.0 software. Results: A total of 6 RCTs were included, and 1 502 patients were enrolled, including 761 in the NMBA group and 741 in the no-NMBA group. The 90-day mortality in the NMBA group and no-NMBA group were 38.8% and 42.6%, OR=0.87 (95%CI: 0.70-1.07, P=0.190); the 28-day mortality rates were 32.5% and 36.5%, OR=0.71 (95%CI: 0.45-1.11, P=0.130); ICU mortality rates were 31.8% and 43.8%, OR=0.60 (95%CI: 0.41-0.88, P=0.009). Conclusion: NMBA can reduce the ICU mortality of moderate to severe ARDS patients, but not reduce 28-day and 90-day mortality.

[The influencing factors achieving target vancomycin trough level in critically ill patients].

Objective: To assess the rate achieving the target vancomycin trough level (VTL) and its influencing factors in critically ill patients. Methods: The retrospective observational study recruited adult patients treated with intravenous vancomycin in the intensive care unit (ICU) at Zhongda Hospital from January 2015 to December 2017. Serum VTL was tested at steady state. Patients' demographics, the sites of infection, microbial culture results, the severity of illness, laboratory data and vancomycin regimen were obtained at the baseline. The rate achieving target VTL (15-20 mg/L) was analyzed based on renal function. Linear regression was performed to determine the influencing factors of VTL. Results: A total of 85 patients were enrolled, among whom only 23.5% (20/85) achieved the target VTL. In patients with normal renal function, the achieving rate was only 11.4% (4/35), and 80.0% (28/35) was lower than the target trough level multiple linear regression analysis showed that procalcitonin (PCT), estimated glomerular filtration rate (eGFR) and acute physiology and chronic health disease classification system Ⅱ (APACHE Ⅱ) score were independent factors associated with VTL. Conclusion: Achieving target VTL in critically ill patients is not satisfactory. Further study to optimize the administration is needed to facilitate prompt attainment of target VTL.

[A clinical study of haploidentical hematopoietic stem cell transplantation in the treatment of pediatric patients with acquired severe aplastic anemia: single center experience].

Objective: To investigate the efficacy of haplotype hematopoietic stem cell transplantation in the treatment of acquired severe aplastic anemia (SAA) in children. Methods: The clinical characteristics of 59 pediatric patients with SAA, including 26 cases VSAA, 37males and 22 females, 47 cases typeⅠ and 12 cases typeⅡ, undrerwent haplo-HSCT in our hospital between December 1st, 2011 and December 1st, 2017 were retrospectively analyzed. Among 59 patients, 56 patients with a median age of 4.5 (1.2-14.8) years and median weight of 43 (12-80) kg underwent their first HSCT and 3 patients underwent their second HSCT. All patients received the following conditioning regimen: busulfan, cyclophosphamide, and rabbit ATG or Bu (-, CTX) , fludarabineand rabbit ATG. The prophylaxis of acute graft versus host disease (aGVHD) was cyclosporine (CsA) , MMF and methotrexate. All patients received bone marrow transfusion on day 01 and peripheral stem cell transfusion on day 02 from haploid donor. The median dose of donor mononuclear cell counts was 15.60 (7.74-21.04) ×108/kg of recipient weight and CD34+ cell counts was 4.86 (3.74-7.14) ×106/kg of recipient weight. Results: Neutrophils and platelets of all 59 children were implanted. The median implantation time of granulocytes and platelets were 13 (10-19) d, 19 (9-62) d, respectively. The incidence of grade Ⅰ-Ⅱ aGVHD was 45.76% (27 cases) and grade Ⅲ/Ⅳ 13.56% (8 cases) , The incidence of chronic GVHD was 8.47% (5 cases) , The incidences of CMV and EBV viremia were 59.32% (35 cases) and 28.81% (17 cases) , respectively. The median follow-up was 30 (8-80) months, 57 patients survived with disease free, 2 patients died of GVHD. Both of the estimated 5-year OS and DFS rates were (96.4±2.5) %. Conclusion: Haplo-HSCT could improve the outcomes of SAA children.

RBM5-AS1 participates in fracture healing and inhibits apoptosis of bone cells through the up-regulation of ß-catenin.

OBJECTIVE: The aim of this study was to detect the expression of RBM5-AS1 during fracture healing, and to explore its possible mechanism. MATERIALS AND METHODS: A mice tibia fracture model was constructed in this study. Mice in the control group and experimental group were sham-operated on the left tibia and were operated in the right tibia, respectively. The tibia bones of both groups were obtained at 4 d, 8 d, 12 d, 16 d, 20 d, and 24 d after the operation. Quantitative polymerase chain reaction (qPCR) was used to detect the expression of RBM5-AS1 in tibiae. After interfering with the expression of RBM5-AS1 in bone cells, Cell Counting Kit-8 (CCK-8) was used to detect cell proliferation ability, and flow cytometry was applied to detect apoptosis. Western blot was used to measure the protein expression of beta-catenin and RBM5 after down-regulating RBM5-AS1. Finally, beta-catenin was interfered in osteoblasts to explore the relationship between RBM5-AS1 and beta-catenin. RESULTS: Compared with the control group, the expression of RBM5-AS1 in the experimental group was significantly increased on the 4 d, 8 d, 12 d, and 16 d after fracture surgery. However, no statistical difference was observed on the 20 d and 24 d between the two groups. After interfering with RBM5-AS1, the apoptosis of chondrocytes and osteoblasts was significantly increased in both mouse and human cells, while the expression of beta-catenin was strikingly decreased. Further up-regulation of beta-catenin could reduce the apoptosis of bone cells. The expression of RBM5, which was a natural antisense transcript of RBM5-AS1, was increased after down-regulating RBM5-AS1. CONCLUSIONS: RBM5-AS1 can inhibit the apoptosis of bone cells by promoting the expression of beta-catenin and can be used as a biomarker for fracture healing.

[Echocardiographic diagnosis of infracardiac total anomalous pulmonary venous connection].

OBJECTIVE: To investigate the clinical usefulness of echocardiography in the diagnosis of infracardiac total anomalous pulmonary venous connection (ITAPVC) in neonates and infants. METHODS: Retrospective analysis on 8 patients with ITAPVC was performed using echocardiography between April 2006 and December 2016. There were 4 boys and 4 girls with a mean age of 79.8 days (ranging from 15 to 195 days). A combined scanning via parasternal, subcostal and apical acoustic windows had been employed to diagnose ITAPVC and to trace the course and site of the anomalous pulmonary venous drainage, and to confirm the direction of the inter-atrial shunt and enlargement of right atrium and right ventricle. RESULTS: Of the 8 patients who received echocardiography, ITAPVC was diagnosed in 7 patients. Mis-diagnosis by echocardiography was encountered in one patient. The diagnosis by echocardiography was compatible with the operative findings in 5 patients receiving surgery and with the results of multislice computed tomography in 6 patients. The diagnostic accuracy rate of ITAPVC was 87.5%. The indirect signs obtained from echocardiogram was coexistence of a small malformed, triangle-shaped left atrium and right to left shunting at atrial level with dilatation and tortuousness of portal vein or hepatic vein and abundant blood flow in liver. The direct signs was total pulmonary veins unconnected with left atrium, whose confluence joining into vertical vein drained right-inferiorly to portal vein or hepatic vein through diaphragm. Three parallel vessels including vertical vein, abdominal aorta and inferior vena cava arranged anteriorly, left-posteriorly and right-posteriorly with the opposite flow directions of inferior vena cava and the other two were found on sub-costal view. Sites of the drainage to the infra-diaphragm veins located portal vein in 8 patients. Stenosis of site of vertical vein connecting to portal vein or hepatic veins occurred in 3 patients. CONCLUSION: Echocardiography has significant value in the diagnosis of pediatric ITAPVC and is capable of providing important structural and hemodynamic information for preoperative assessment of surgery. With multiple windows and multiple sections, ITAPVC could be diagnosed accurately by echocardiography. However, it is necessary to differentiate ITAPVC with intrahepatic portosystemic venous shunts or hepatic arteriovenous fistula.

[Efficacy of intra-aortic balloon counterpulsation in patients with acute myocardial infarction according to the type of revascularization: a meta-analysis].

OBJECTIVE: To evaluate the effects of intra-aortic balloon counterpulsation (IABP) on mortality in patients with acute myocardial infarction according to the type of revascularization. METHODS: Recruited randomized controlled trials of IABP compared with no-IABP controls in acute myocardial infarction patients from January 1970 to May 2015 were searched from Medline, Embase and Cochrane Library, according to inclusion criteria and exclusion criteria. These data were analyzed using the methods recommended by the Cochrane Collaboration's software RevMan 5.0. Revascularization included thrombolytic therapy, percutaneous coronary intervention (PCI), or coronary artery bypass grafting. RESULTS: (1) Eleven randomized controlled trials were enrolled for analysis with 1 102 patients in IABP group, 1 123 in no-IABP control group. (2) Compared with no-IABP control group, IABP could not significantly decrease the in-hospital or 30 day mortality (OR=0.84, 95%CI 0.65-1.09, P=0.20). (3)Compared with no-IABP control group, IABP could not significantly decrease the in-hospital or 30 day mortality in thrombolytic patients(OR=0.64, 95%CI 0.25-1.61, P=0.34), in PCI patients (OR=0.89, 95%CI 0.68-1.18, P=0.42), and in coronary artery bypass grafting patients(OR=0.46, 95%CI 0.13-1.63, P=0.23). (4)The difference reached borderline signiicance between no-IABP control group and IABP group in patients using IABP before PCI(OR=0.47, 95%CI 0.22-1.00, P=0.05), but not in case of after PCI(OR=1.33, 95%CI 0.63-2.79, P=0.45). CONCLUSIONS: IABP does not decrease the in-hospital or 30 day mortality of acute myocardial infarction patients who received thrombolytic therapy, PCI, or coronary artery bypass grafting. But IABP might decreases the in-hospital or 30 day mortality in patients when used before PCI.