Artificial intelligence in lung cancer screening: Detection, classification, prediction, and prognosis.

BACKGROUND: The exceptional capabilities of artificial intelligence (AI) in extracting image information and processing complex models have led to its recognition across various medical fields. With the continuous evolution of AI technologies based on deep learning, particularly the advent of convolutional neural networks (CNNs), AI presents an expanded horizon of applications in lung cancer screening, including lung segmentation, nodule detection, false-positive reduction, nodule classification, and prognosis. METHODOLOGY: This review initially analyzes the current status of AI technologies. It then explores the applications of AI in lung cancer screening, including lung segmentation, nodule detection, and classification, and assesses the potential of AI in enhancing the sensitivity of nodule detection and reducing false-positive rates. Finally, it addresses the challenges and future directions of AI in lung cancer screening. RESULTS: AI holds substantial prospects in lung cancer screening. It demonstrates significant potential in improving nodule detection sensitivity, reducing false-positive rates, and classifying nodules, while also showing value in predicting nodule growth and pathological/genetic typing. CONCLUSIONS: AI offers a promising supportive approach to lung cancer screening, presenting considerable potential in enhancing nodule detection sensitivity, reducing false-positive rates, and classifying nodules. However, the universality and interpretability of AI results need further enhancement. Future research should focus on the large-scale validation of new deep learning-based algorithms and multi-center studies to improve the efficacy of AI in lung cancer screening.

Application of computer-aided detection for NCCN-based follow-up recommendation in subsolid nodules: Effect on inter-observer agreement.

RATIONALE AND OBJECTIVES: Computer-aided detection (CAD) of pulmonary nodules reduces the impact of observer variability, improving the reliability and reproducibility of nodule assessments in clinical practice. Therefore, this study aimed to assess the impact of CAD on inter-observer agreement in the follow-up management of subsolid nodules. MATERIALS AND METHODS: A dataset comprising 60 subsolid nodule cases was constructed based on the National Cancer Center lung cancer screening data. Five observers independently assessed all low-dose computed tomography scans and assigned follow-up management strategies to each case according to the National Comprehensive Cancer Network (NCCN) guidelines, using both manual measurements and CAD assistance. The linearly weighted Cohen's kappa test was used to measure agreement between paired observers. Agreement among multiple observers was evaluated using the Fleiss kappa statistic. RESULTS: The agreement of the five observers for NCCN follow-up management categorization was moderate when measured manually, with a Fleiss kappa score of 0.437. Utilizing CAD led to a notable enhancement in agreement, achieving a substantial consensus with a Fleiss kappa value of 0.623. After using CAD, the proportion of major and substantial management discrepancies decreased from 27.5% to 15.8% and 4.8% to 1.5%, respectively (p < 0.01). In 23 lung cancer cases presenting as part-solid nodules, CAD significantly elevates the average sensitivity in detecting lung cancer cases presenting as part-solid nodules (overall sensitivity, 82.6% vs. 92.2%; p < 0.05). CONCLUSION: The application of CAD significantly improves inter-observer agreement in the follow-up management strategy for subsolid nodules. It also demonstrates the potential to reduce substantial management discrepancies and increase detection sensitivity in lung cancer cases presenting as part-solid nodules.

Expression of hsa-miR-422a in hypertrophic scars: a bioinformatics analysis / 中华医学美学美容杂志

Objective:To evaluate the expression level of hsa-miR-422a in hypertrophic scars and to identify the target genes of hsa-miR-422a along with their biological functions using bioinformatics approaches.Methods:From June 2020 to December 2020, tissue samples of 3 hypertrophic scar and 3 normal skin were collected from patients (3 males, 3 females, aged 20-42 years) in Department of Plastic and Reconstructive Surgery, Shanghai Ninth People′s Hospital, Shanghai Jiaotong University School of Medicine. Primary fibroblasts were isolated and cultured. Real-time quantitative PCR was performed to quantify the expression of hsa-miR-422a. To construct a ceRNA network, starbase and Target Scandata bases were utilized to predict genes as well as long noncoding RNAs (lncRNAs) that may sponge hsa-miR-422a. GO and KEGG pathway enrichment analyses were conducted on the target genes of hsa-miR-422a; protein-protein interaction (PPI) networks were constructed to identify the hub genes whose functions were predicted by functional enrichment analyses. The expression of hub genes was validated through real-time quantitative PCR in hypertrophic scars.Results:The expression of hsa-miR-422a was significantly lower in the hypertrophic scar tissue samples and fibroblasts compared to that in the normal skin ( P<0.05). 133 target genes as well as 1033 lncRNAs were predicted by starBase and TargetScandata bases and used to construct an hsa-miR-422a-centered ceRNA network. PPI networks of the target genes revealed 10 hub genes, including MAPK1, GRB2, and IGF1R, which were discovered to be related to protein serine/threonine/tyrosine kinase activity, ubiquitin protein ligase binding, fibroblast growth factor receptor signaling pathway, muscle cell proliferation, and many others; besides, they may be involved in FoxO, mTOR, Toll-like receptor, Ras, MAPK, PI3K-Akt signaling pathways and signaling pathways regulating pluripotency of stem cells. Three hub genes (MAPK1, GRB2, and IGF1R) were significantly upregulated in hypertrophic scars ( P<0.05). Conclusions:hsa-miR-422a is significantly downregulated in the hypertrophic scars and may target hub genes such as MAPK1 in ceRNA networks, ultimately modulating hypertrophic scar formation.

Closing doubly committed ventricular septal defect through a super minimal intercostal incision / 中华胸心血管外科杂志

Objective:Combined with the actual clinical situation, to introduce the application of invasive trans super minimal intercostal device closure in doubly committed ventricular septal defect(DCVSD).Methods:Between January 2017 and July 2020, 82 DCVSD children were recruited. Relevant data such as operation time, length of hospital stay, postoperative complications, etc. were analyzed, and the follow-up of the postoperative period was used to evaluate the effect of the operation.Results:Among them, 2 children’s puncture points were bleeding. Chest closure time was obviously extended. The total operation time of the remaining children was 24-72(47.54±12.06)min, among which the umbrella release time was 5-37(16.16±8.01)min, and the chest opening and closing time was 14-59(31.56±9.58) min. Pericardial effusion occurred in 2 patients after operation, and the discharge time was more than 2 weeks. The remaining children were hospitalized for 3-9(5.79±1.45)days after surgery.Conclusion:Closing DCVSDs through a super minimal intercostal incision under TEE guidance was safe, effective and less trauma.

Analysis of risk factors for surgical treatment of congenital pulmonary venous stenosis combined with congenital heart disease / 中国胸心血管外科临床杂志

@#Objective    To explore risk factors associated with mortality and restenosis after the surgery for congenital pulmonary venous stenosis (CPVS) combined with congenital heart disease. Methods    From May 2007 to August 2019, 58 patients received surgical relief of CPVS combined with congenital heart disease, including 24 males and 34 females, aged 17.2±26.3 months, weighing 8.8±8.2 kg. Endpoints were death and restenosis, and the risk factors were analyzed. A univariate and multivariate risk analyses were performed. Results    Preoperative pulmonary venous stenosis severity score (PVSSS) was 4.5±2.7. Average pulmonary vein counts with CPVS was 1.9±1.0. There were 2 (3.4%) early deaths. The mean follow-up time was 2-145 (49.8±40.0) months. The 1-, 2-, 3- and 5-year overall survival rates were 86.7%, 81.3%, 78.5% and 73.6%, respectively, and the pulmonary venous restenosis-free rates were 79.6%, 68.5%, 68.5% and 68.5%, respectively. Preterm birth was an independent risk factor for mortality. The pulmonary venous peak flow rate ≥ 1.2 m/s at discharge was an independent risk factor for mortality and restenosis. Conclusion    The prognosis of CPVS is still poor. Postoperative residual stenosis at discharge is an independent risk factor for death and restenosis.

Application of transesophageal echocardiography in high ventricular septal defect closure via the small intercostal incision with eccentric occluder in children / 中华超声影像学杂志

Objective@#To explore the value of transesophageal echocardiography (TEE) in high ventricular septal defect (VSD) occlusion via a left parasternal ultra-minimal intercostal incision (≤1 cm) with eccentric occluder in children.@*Methods@#Forty-eight children with high VSD underwent device occlusion via ultraminimal intercostal incision with eccentric occluder. The whole operation, including preoperative evaluation, intraoperative localization and guidance and postoperation evaluation were performed under the guidance of TEE.@*Results@#Forty-six children with high VSD underwent successfully device closure in all 48 cases and the operation success rate was 95.8%. The average size of high VSD was 2.2-6.0 (3.70±0.90)mm and the average size of eccentric occluder was 4-8 (5.48±1.12)mm. The average operation duration was 18-98 (49.80±16.71)min. There were 2 cases of peri-membranous high VSD and 44 cases of outlet-typle VSD, of which 10 cases of mild aortic valve prolapses (AVOP), including 5 cases of aortic valve regurgitation(AR). In addition, there was 1 case of replacement of device, 1 case of having septum below the margin of the defect and 1 case of using a dilator for a small defect. The 46 cases were followed up for 6 to 42 months, and the pericardial effusion occured in 3 cases and disappeared during follow-up. No other abnormal conditions were found.@*Conclusions@#During the surgery of high VSD device occlusion via ultraminimal intercostal incision with eccentric occluder, TEE has an important value in defect assessment, intraoperative localization and guidance, and immediate evaluation of efficacy, and can effectively guide the device occlusion of high VSD.

Application of transesophageal echocardiography in high ventricular septal defect closure via the small intercostal incision with eccentric occluder in children / 中华超声影像学杂志

Objective To explore the value of transesophageal echocardiography ( T EE ) in high ventricular septal defect ( VSD) occlusion via a left parasternal ultra‐minimal intercostal incision ( ≤1 cm ) with eccentric occluder in children . Methods Forty‐eight children with high VSD underwent device occlusion via ultraminimal intercostal incision with eccentric occluder . T he w hole operation , including preoperative evaluation ,intraoperative localization and guidance and postoperation evaluation were performed under the guidance of T EE . Results Forty‐six children with high VSD underwent successfully device closure in all 48 cases and the operation success rate was 95 .8% . T he average size of high VSD was 2 .2－6 .0 ( 3 .70 ± 0 .90) mm and the average size of eccentric occluder was 4－8 ( 5 .48 ± 1 .12) mm . T he average operation duration was 18－98 ( 49 .80 ± 16 .71) min . T here were 2 cases of peri‐membranous high VSD and 44 cases of outlet‐typle VSD ,of w hich 10 cases of mild aortic valve prolapses ( AVOP) ,including 5 cases of aortic valve regurgitation ( AR ) . In addition ,there was 1 case of replacement of device ,1 case of having septum below the margin of the defect and 1 case of using a dilator for a small defect . T he 46 cases were followed up for 6 to 42 months ,and the pericardial effusion occured in 3 cases and disappeared during follow‐up . No other abnormal conditions were found . Conclusions During the surgery of high VSD device occlusion via ultraminimal intercostal incision with eccentric occluder ,T EE has an important value in defect assessment ,intraoperative localization and guidance ,and immediate evaluation of efficacy ,and can effectively guide the device occlusion of high VSD .

Efficacy of staging surgery in pulmonary atresia with intact ventricular septum / 中华外科杂志

Objective@#To assess the feasibility and efficacy of a staged invasive treatment strategy for the treatment of pulmonary atresia with intact ventricular septum, in the first stage using a catheter-based stent placement, second-stage surgery, and three-stage atrial septal occlusion.@*Methods@#Totally 19 children with pulmonary atresia with intact ventricular septum were enrolled at Department of Cardiovascular Surgery, the Children′s Hospital of Zhejiang University School of Medicine from January 2009 to December 2017, including 11 male and 8 female patients. The age was (13.8±7.7) days (ranging from 3 to 35 days). The weight was (3.4±0.5) kg (ranging from 2.8 to 4.1 kg). Among them, there were 13 cases of type Ⅱ and 6 cases of type Ⅲ. Regular follow-up visits for patients with stage Ⅰ arterial duct stenting after 1, 3, and 6 months; and routine follow-ups for 1, 3, and 6 months after stage Ⅱ surgery.The t test was used to compare the oxygen saturation between pre-operation and post-operation.@*Results@#All 19 patients underwent arterial catheterization. The preoperative peripheral oxygen saturation was (64.4±5.3)%, while increased to (86.0±3.0)% after operation (t=16.353, P=0.000). One patient died during follow-up and 2 patients lost follow-up. One patient received stent balloon dilatation due to oxygen saturation decrease.Twelve patients completed the second-stage surgery and 1 case died after surgery. The rest were alive, including 2 cases of double-ventricular correction and 9 cases of semi-ventricular treatment in one room; 2 cases had completed three-stage atrial septal occlusion.@*Conclusions@#Stage Ⅰ arterial duct stent, stage Ⅱ surgery, and stage Ⅲ atrial septal occlusion to treat pulmonary atresia with intact ventricular septum in children is feasible and effective. The method can be used as the important treatment direction for pulmonary atresia with intact ventricular septum.

Surgical treatment and prognosis of Borrmann type IIII( gastric cancer involving the whole stomach / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the surgical treatment and prognosis of Borrmann type IIII( gastric cancer involving the whole stomach.</p><p><b>METHODS</b>Clinicopathological characteristics and survival data of 223 patients with Borrmann type IIII( gastric cancer involving the whole stomach (defined as the tumor infiltrating 3 regions of the stomach) receiving surgical treatment at the Department of Abdominal Surgery of Zhejiang Cancer Hospital between January 2002 and December 2015 were analyzed retrospectively. The survival time of patients with different clinicopathological features and different treatment methods was compared. Cox regression was used to analyze the independent prognostic factors.</p><p><b>RESULTS</b>Two hundred and twenty-three patients with Borrmann type IIII( gastric cancer involving the whole stomach accounted for 24.0% (223/930) of all Borrmann type IIII( gastric cancer cases undergoing surgical resection at the same period. There were 147 males and 76 females with an average age of 57.8 years. All the patients underwent total gastrectomy. Of these patients, radical resection was performed in 149 cases(66.8%) and palliative resection in 74 cases (33.2%). Combined organ resection was performed in 43 patients (19.3%), including 25 splenectomies, 6 pancreatic body and tail plus spleen and transverse colon resections, 2 transverse colon plus spleen resections, 2 right colon resections, 2 transverse colon resections, 2 ovariectomies, 1 partial jejunal resection, 1 pancreatoduodenectomy, 1 pancreatic tail plus transverse colon resection, and 1 partial pancreatectomy. Postoperative complications occurred in 28 patients(12.6%), including 10 patients with combined organ resection. Esophagojejunal fistula was the most frequent complication, accounting for 39.3%(11/28). Perioperative mortality occurred in 3 patients (1.3%). Thirty-nine patients underwent preoperative adjuvant chemotherapy (clinical stage: cT4aN0M0 in 1 patient, cT4bN1-2M0 in 12 patients, cT4aN1-2M0 in 20 patients, and cT4aN3M0 in 6 patients). Among these 39 patients, post-chemotherapeutic degenerative response was detected in 25 postoperative pathological specimens (64.1%), radical resection was performed in 21 patients (53.8%), distant metastasis was observed in 7 patients (17.9%) and peritoneal metastasis was found in 17 patients (43.6%) during operation. The average maximal tumor diameter was 13.2 cm (range from 6 to 22). Histological types included 23 moderate-poorly differentiated adenocarcinomas (10.3%), 146 poorly differentiated adenocarcinomas (65.5%), 41 signet ring cell carcinomas (18.4%), 11 mucinous adenocarcinomas(4.9%), 1 squamous cell carcinoma (0.4%) and 1 undifferentiated carcinoma (0.4%). Tumor-infiltrating duodenum was found in 57 patients (25.6%) and tumor-infiltrating esophagus in 132 patients (59.2%). The positive margin was found in 66 patients (29.6%): upper margin in 35 patients (15.7%), lower margin in 22 patients (9.9%), and both margins in 9 patients(4.0%). Immunohistochemical positive HER2(3+) was detected in 4 patients (1.8%). Tumor infiltrating into serosa(T4a) was found in 197 patients (88.3%) and infiltrating into adjacent organ (T4b) in 26 patients(11.7%). One hundred and forty-three cases (64.1%) had lymphatic or venous invasion, 187 (83.9%) had neural invasion, and 35 (15.7%) had cancer nodules. Of 149 patients undergoing radical resection, 5 patients were stage II(b, 9 patients were III(a, 20 patients were III(b and 115 patients were III(c. Of 145 patients(65.0%) undergoing postoperative chemotherapy, the average cycles of chemotherapy was 3.6 (median 3 cycles) and only 69 patients (47.6%) completed 4 cycles or more. Patients were followed up for 1-102 months (average 17.3 months). The median overall survival time was 13.8 months and the 1-, 3-, and 5-year survival rate was 57.9%, 14.1% and 6.8% respectively. The median survival time of the 149 cases with radical resection was 16.7 months and the 1-, 3- and 5-year survival rate was 67.5%, 16.5% and 8.4% respectively; the median survival time of the 74 cases with palliative resection was 10.3 months and the 1-, 3- and 5-year survival rate was 42.6%, 8.5% and 1.7% respectively, whose differences were statistically significant (all P=0.000). Multivariate analysis showed that tumor staging (P=0.005), radical resection (P=0.009), lymphatic or venous invasion (P=0.017) and postoperative chemotherapy (P=0.001) were independent prognostic factors.</p><p><b>CONCLUSIONS</b>Surgical treatment for Borrmann type IIII( gastric cancer involving the whole stomach is safe. Radical resection can improve the prognosis though the overall survival is poor.</p>

Extracorporeal membrane oxygenation for failure to separate from bypass after arterial switch operation / 中华胸心血管外科杂志

Objective To summary the clinical experience of ECMO for failure to separate from bypass after arterial switch operation of TGA.Methods 8 TGA patients (6 boys and 2 girls,aged 1 day to 3.5 years and weighing 2.7-11.0 kg,3 VSD intact and 5 with VSD,others complicated malformation including COA,left ventricular outtract stenosis) were treated with VA ECMO owing to failure to separate from bypass caused by low output syndrome after ASO between July 2007 and June 2016.We collected the medical records and analyzed the indication,management and complication of ECMO for this patient population.There were two stages of ECMO supporting for low output after ASO,The first stage was to improve tissue perfusion and correct inner environment by high flow supporting,and the second stage was ventricular function training.ECMO was weaned when the blood pressure was more than 60 mmHg and the difference value of systolic pressure and diastolic pressure was 15-20 mmHg under medium dose inotropics supporting.Volume infusion was limited strictly during ECMO.Results The running time were 22-300 h.5 patients were weaned from ECMO successfully and 4 patients discharged to home.The long-term follow-up of echocardiography indicated normal cardiac function in 3 patients.1 older child had left cardiac failure again after weaning from ECMO 12 days later;he was supported by LVAD subsequently.LVAD was weaned after 236h supporting,unfortunately,He died from cardiac failure 50 days after LVAD weaning.3 patients could not wean from ECMO and died.The main complications were bleeding and pericardial tamponade.Conclusion VA ECMO was effective treatment for failure to separate from bypass after switch operation of TGA.The high mortality was seen in patients with intramural coronary arterial.The myocardial structure perhaps changed secondary in older TGA children,ECMO and LVAD can be used as short-term circulatory transition to artificial heart or transplant.Bleeding was the main complication of this population;surgical hemostasis and accurate coagulation management were the guarantee for successful ECMO running.

Efficacy of percutaneous atrial septal defect closure guided by transesophageal echocardiography in children / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To compare the efficacy of percutaneous atrial septal defect (ASD) closure guided by transesophageal echocardiography (TEE) or guided by fluoroscopy in pediatric patients.</p><p><b>METHODS</b>Medical records of patients who underwent percutaneous ASD closure in the Children's Hospital, Zhejiang University School of Medicine from January 2017 to March 2018 were reviewed. There were 120 patients whose procedures were guided by TEE (TEE group), and 125 patients who had their procedures guided by fluoroscopy (fluoroscopy group). The performance of surgery, efficacy and postoperative complications were compared between two groups.</p><p><b>RESULTS</b>Percutaneous ASD closure was successful in all patients. The operation time was shorter in the TEE group than that in fluoroscopy group[(20±14) min vs. (29±11) min, =-7.939, <0.05]. The size of the defect was larger in the TEE group than that of fluoroscopy group[(11±4) mm vs. (9±4) mm, =2.512, <0.05], but there was no significant difference in the sizes of occluder and occluder sheath between two groups (all >0.05). No residual shunt, occluder shedding or displacement, severe arrhythmia or pericardial effusion were observed in either group. The incidence rates of fever, cough and diarrhea were not statistically different between two groups (all >0.05).</p><p><b>CONCLUSIONS</b>There was no significant difference in the outcome of percutaneous ASD closure guided by TEE or by fluoroscopy, but the procedure guided by TEE may reduce the operation time and can evaluate the size of ASD more accurately without involving radiation exposure, contrast agents use and large digital subtraction equipment.</p>

Use of pericardium to repair anastomotic leak after esophageal atresia surgery; experience with one case.

Diverse therapies for the management of anastomotic leakage after esophageal atresia repair have been reported with various outcomes. The surgical management of anastomotic leakage after esophageal atresia repair can be challenging. We present a child with long-gap esophageal atresia and anastomotic leakage repair with pericardium. This article aimed to illustrate that pericardium may be a substitute for esophageal leakage repair.

Perimembranous ventricular septal defect performed super minimally invasive trans intercostal device closure under the guidance of transesophageal echocardiography in children / 中华胸心血管外科杂志

Objective This study was aimed to discuss the safety, feasibility and availability of perimembranous ventricular septal defects(PmVSD) closure via super minimal intercostal incision under transesophageal echocardiography(TEE) guidance in children.Methods There were 81 cases of PmVSD via super minimally invasive transintercostal device closure operation(length of incision ≤ 1cm) from August 2014 to August 2016.TEE was used to guide and monitor the entire procedure.Assessed the effectiveness of device closure by postoperative regular follow-up.Results 80 patients were successfully operated by super minimally invasive transintercostal device closure in all 81 cases.Operation success rate reached 98.77%.The average diameter of ventricular septal defects was(3.72±0.96)mm.The average diameter of amplatzer occluder was(4.88±0.95)mm.Postoperative follow-up time was from 6 months to 24 months.One of 16 cases that with aneurysm of membranous septum had more than two shunts, remained a mild residual shunt beside of the amplatzer occluder but self cured during follow-up.Mild pericardial effusion was found in one patients after the operation and disappeared during follow-up.There were no cases of perioperative death, device deformation or displacement, residual shunt, complete atrioventricular block and valve involvement in the patients whom were successfully operated.One patient transferred to ventricular septal defect repair operation under direct visualization with a cardiopulmonary bypass, because ventricular fibrillation happened when guide wire passed the ventricular septal.Conclusion Super minimally invasive transintercostal device closure of PmVSD in children guided by TEE was safety and availability, that could avoid x-ray radiation and sternotomy, and operate simply, with small incision and low complication.

Nine cases of children with ventricular septal defect performed super minimally invasive trans intercostal device closure / 中国医师杂志

Objective To introduce the super minimally invasive transintercostal device closure of ventricular septal defect (VSD) and summarize it's therapeutic effect.Methods Nine patiens with VSD from August 2014 to December 2014 in our hospital were enrolled,which performed super minimally invasive transintercostal device closure of VSD.All patients were followed up prudently post-operation.Echocardiography was scheduled according to the protocol.Results All cases were successfully occluded.There was no death case in the peri-operation period and severe complications after operation.Conclusions The super minimally invasive transintercostal device closure of VSD is safe and reliable.

An interactive method based on the live wire for segmentation of the breast in mammography images.

In order to improve accuracy of computer-aided diagnosis of breast lumps, the authors introduce an improved interactive segmentation method based on Live Wire. This paper presents the Gabor filters and FCM clustering algorithm is introduced to the Live Wire cost function definition. According to the image FCM analysis for image edge enhancement, we eliminate the interference of weak edge and access external features clear segmentation results of breast lumps through improving Live Wire on two cases of breast segmentation data. Compared with the traditional method of image segmentation, experimental results show that the method achieves more accurate segmentation of breast lumps and provides more accurate objective basis on quantitative and qualitative analysis of breast lumps.

Effects of TSA on Cerebral ischemia/reperfusion injury via JAK/STAT signal pathway in rats / 中华急诊医学杂志

Objective To investigate the protective effect of trichostatin-A (TSA) on cerebral ischemia/reperfusion injury via Janus kinase/signal transducer and activator of transcription (JAK/STAT) signal pathway.Methods 36 male SD rats were randomly (random number) divided into 3 groups:shamoperated group,ischemia/reperfusion (I/R) group and TSA group.Rat model of middle cerebral artery occlusion/reperfusion (MCAO) was established using a modified filament method.No occlusion was applicated to the sham-operated group.TSA group was injected with TSA 0.05 mg/kg via penile vein,20 minutes before operation.Reperfusion was carried out 24 hours after modeling.Longa 5 score was used to assess the neurological function,and TTC staining was applied to calculate the percentage of cerebral infarction area,The expression of JAK2 and p-JAK2 proteins was detected by Elisa.Results The low expression of JAK2 was observed in each group,and there was no statistical difference between groups (P =0.266).Compared with I/R group,TSA group had lower score in cerebral ischemia-reperfusion injury assessment (P=0.019),smaller area of cerebral infarction (P ＜0.01),reduced expression of p-JAK2 (P =0.009),all of which were of significant difference.Condusions TSA can reduce the cerebral ischemia/reperfusion injury via JAK/STAT signal pathway by down regulating p-JAK2 expression.

The effect of diltiazern on patency rate of arteriovenous anastomosis in rat and how it works / 中华胸心血管外科杂志

Objective This study was designed to study the effect of Diltiazem on patency rate of arteriovenous anastomosis in rat and how it works.Methods 24 SD rats were divided into control group and experimental group,12 rats in each group.Experimental group rats were gavaged with Diltiazem after vascular anastomosis.Control group rats were gavaged with water.By comparing the patency rate and the thickness of artery to make sure whether Diltiazem will affect the patency rate.;By comparing the clotting time,prothrombin time,artial thromboplastin time,and serum thromboxane B2 levels to explore the pathway of diltiazem.Results The patency rate was 75％ in the experimental group and 25％ in control group.Compared with the control group,experimental group venous blood vessels in the film segment was significantly thicker,clotting time was prolonged,TXB2 levels in blood was decreased,the differences were statistically significant(P ＜ 0.05).There were no significant difference in prothrombin time and partial thromboplastin between two groups (P ＞ 0.05).Conclusion Diltiazem can inhibit the secretion of TXB2,antagonize the effct of antiplatelet,and increase the patency rate of vascular anastomosis in rats.

Relationship of conotruncal anomalies and chromosome 22q11.2 deletion / 国际儿科学杂志

Congenital cardiovascular anomalies are present in approximately 80％ of children with 22q11.2 deletion syndrome.Three genes in chromosome 22q11.2 ( TBX1,CRKL,and ERK2 ) have been identified whose haploinsufficiency causes anomalies of 22q11.2 deletion.The most common diseases are conotruncal anomalies,which include tetralogy of Fallot ( TOF),pulmonary atresia with ventricular septum defect (PA-VSD),truncus arteriosus,and interrupted aortic arch.In major phenotypes,a high prevalence of the deletion is noted in patients with TOF with pulmonary atresia,TOF associated with pulmonary atresia and major aortopumonary collateral arteries,persistent truncus arteriosus,and type B interruption of aortic arch.In minor phenotypes,right aortic arch,aberrant subclavian artery,and major aortopulmonary collateral arteries are frequently associated with cardiovascular anomalies associated with 22q11.2 deletion.In conclusion,conotruncal anomaly associated with aortic arch and branch anomalies should increase the suspicion of 22q11.2 deletion.

Simultaneous minimally invasive technique for congenital heart disease and pectus excavatum / 中华胸心血管外科杂志

Objective To investigate the safty and feasibility of simultaneous minimally invasive technique for congenital heart disease (CHD) and pectus excavatum (PE).Methods From July 2006 to June 2011,6 children with PE associated with CHD were treated by simultaneous minimally invasive technique.They were 4 boys and 2 girls,aged from 4 years to 6 years 5 months ( average 5 years and 4 month),.The body weight were from 16 kg to 20 kg [ average ( 18.00 ± 1.79kg ].CT Hailer index were 3.9 - 5.0 ( average 4.35 ± 0.43 ).4 patients with ventricular septal defect (VSD) were treated by minimally invasive closure device,including 3 membranous VSD and 1 subaortic VSD.The defect diameter was 4 - 5 mm.2 cases with atrial septal defect (ASD) were treated using the same technique.the diameter of ASD was 12 - 16 mm.After minimally invasive heart surgery,Nuss operation was carried out in all 6 patients for their PE.Results All operations were successful and patients were extubated 5 - 11 h after operation [ mean ( 8.17 ± 2.04) h ].The pericardial mediastinal drainage was removed at 48 h postoperatively.There were no operative mortality and severe postoperative complications.1 patient had delayed wound healing and was successfully discharged.The plate was removed in 3 cases,and they all had satisfactory outcomes.Conclusion Simultaneous minimally invasive technique is a safe and effeictive mothod for treating pectus excavatum and congenital heart disease.

Fresh autologuos pericardium for reconstruction of new pulmonary arterial root in arterial switch operation / 中华胸心血管外科杂志

Objective To evaluate the result of fresh autologuos pericardium for the reconstruction of new pulmonary arterial root in arterial switch operation (ASO). Methods Between January 2004 and June 2010, 63 consecutive infants with congenital heart disease were treated with ASO. A new pulmonary arterial root was reconstructed with a fresh autologuos pericardium which clipped pants-like. The followed up time was 3 months to 6 years after discharge. Patients were reexamined consecutively at 3- and 6-month; 1-, 2- and 6-year. Two-dimensional echocardiography was performed for measuring the pulmonary artery diameter. The pulmonary arterial blood speed was measured by continuous Doppler during systole. The pulmonary flow and the pulmonary artery diameter of healthy children of same age were also measure as control group. Simplified Bernoulli formula was adopted to calculate the pressure gradient through pulmonary artery anastomose for, evaluating whether it had pulmonary stenosis or not. Results Fifty seven infants were cured and discharged. Forty nine patients were finished follow up with a mean duration of( 18 ±4) months. The blood speed in the pulmonary artery anastomosis was 0.70 -2.16 m/s with a mean of (1.31 ±0.40) m/s. No pulmonary stenosis was found with the simplified Bernoulli formula. There was no significant difference regarding the pulmonary diameter and the pulmonary artery flow velocity as compared with the normal children of the same age. Conclusion The fresh autologuos pericardium is reliable for reconstruction of new pulmonary arterial root in ASO.