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Background: The region-specific importance of carcinogenic HPV genotypes is required for optimizing HPV-based screening and promoting appropriate multivalent HPV prophylactic vaccines. This information is lacking for Ningbo, one of the first cities of China's Healthy City Innovation Pilot Program for Cervical Cancer Elimination. Here, we investigated high-risk HPV (HR-HPV) genotype-specific distribution and attribution to biopsy-confirmed cervical intraepithelial neoplasia grade 2 or worse (CIN2+) before mass vaccination in Ningbo, China. Methods: A total of 1393 eligible CIN2+ archived blocks (including 161 CIN2, 1107 CIN3, and 125 invasive cervical cancers [ICC]) were collected from 2017 to 2020 in Ningbo. HR-HPV DNA was genotyped using the SPF10-DEIA-LiPA25 version 1 detection system and the SureX HPV 25X Genotyping Kit. Genotype-specific attribution to CIN2+ was estimated using a fractional contribution approach. Results: Ranking by the attributable proportions, HPV16 remained the most important genotype in both cervical precancers and cancers, accounting for 36.8% of CIN2, 53.2% of CIN3, and 73.3% of ICC cases. Among cervical precancers, HPV52 (17.3% in CIN2, 12.7% in CIN3) and HPV58 (13.9%, 14.9%) ranked second and third, while HPV33 (8.3%, 7.9%) and HPV31 (6.5%, 4.1%) ranked fourth and fifth, respectively. However, among ICCs, HPV18 (5.7%) accounted for the second highest proportion, followed by HPV33 (5.4%), HPV58 (4.0%), and HPV45 (3.2%). HPV18/45 together accounted for 46.8% of adenocarcinomas, which was slightly lower than that of HPV16 (47.7%). The remaining HR-HPV genotypes (HPV35/39/51/56/59/66/68) combined accounted for only 6.7% of CIN2, 2.9% of CIN3, and 4.2% of ICC. Conclusions: With Ningbo's strong medical resources, it will be important to continue HPV16/18 control efforts, and could broaden to HPV31/33/45/52/58 for maximum health benefits. However, different strategies should be proposed for other HR-HPV genotypes based on their lower carcinogenic risks. [ABSTRACT FROM AUTHOR]

This article investigates the influencing factors of China's outward foreign direct investment (OFDI) in RCEP countries across quantiles. We apply a panel quantile regression to seek the factors that influence China's OFDI in RCEP countries with the most and least OFDI from China. Our findings are outlined as follows. First, influencing factors of China's OFDI in RCEP countries have significant heterogeneity across quantiles. More specifically, China's trade exports (EXP) to RCEP countries have the strongest positive impact on promoting China's OFDI in RCEP countries, and the strongest positive impact of trade exports on China's OFDI occurs in RCEP countries with less China's OFDI. Second, The higher the level of political stability (HP) of RCEP countries with more China's OFDI, the more China's OFDI they attract, while in RCEP country with the least China's OFDI and changes in political stability will not have a significant impact on China's OFDI. Third, in RCEP countries with less China's OFDI, a higher level of labour resource endowment (LAB) has a stronger effect on attracting China's OFDI. Overall, our findings provide policymakers more targeted references for tapping the potential of China's OFDI in RCEP countries. [ABSTRACT FROM AUTHOR]

Dynamic mathematics software, such as GeoGebra, is one of the most important teaching and learning media. This kind of software can help teachers teach mathematics, especially geometry, at the elementary school level. However, the use of dynamic mathematics software of elementary school teachers is still very limited so far. This study analyzed the factors influencing elementary school teachers' usage behavior of dynamic mathematics software. Four independent variables, namely performance expectancy (PE), effort expectancy (EE), social influence (SI), and facilitating conditions (FC) from the united theory of acceptance and use of technology (UTAUT), were used to understand elementary school teachers' usage behavior of dynamic mathematics software. A questionnaire survey was conducted in the Hunan and Guangdong provinces of China. Two hundred and sixty-six elementary school mathematics teachers provided valid questionnaire data. The partial least squares structural equation modeling (PLS-SEM) approach was used to analyze the data. The results showed that facilitating conditions and effort expectancy significantly affect elementary school teachers' usage behavior of dynamic mathematics software, and facilitating conditions were the biggest factor that affected user behavior. The moderating effects of gender, major, and training on all relationships in the dynamic mathematics software usage conceptual model were not significant. This study contributes by developing a model and providing new knowledge to elementary school principals and the government about factors that can increase the adoption of dynamic mathematics software. [ABSTRACT FROM AUTHOR]

Summary: Art painting is a very important major in China's education system. Under the background of the new era, the country vigorously promotes the modernization of education and the development of intelligence. Many subjects of teaching have been more mature and carried out intelligent teaching based on virtual reality technology. But throughout the art painting profession, the research on this aspect is almost blank. The main reason is that there are deep academic barriers between art painting and computer science. Therefore, this paper puts forward the application research of multi‐source information art painting fusion interactive 3D dynamic scene virtual reality technology. This paper deeply analyzes the needs of art painting and its teaching reform and believes that the existing virtual reality technology cannot adapt to the teaching environment of art painting. In view of the possible inaccurate calculation and other problems, this paper puts forward the optimization scheme. The core of the scheme is to use the information integration advantages of multi‐source information fusion to provide more comprehensive and complete object information for 3D modeling of virtual reality technology, so as to improve the imaging quality of virtual reality technology. In order to meet the requirement of high precision, the calculation method is optimized, the calculation steps are simplified, and the sensor selection is optimized again. This paper introduces the design principle and operation steps of the optimization method in detail. In order to further verify the actual effect of this method, comparative analysis method is used to test the comprehensive performance. In order to ensure the test quality, the median filtering algorithm and fuzzy algorithm are compared. Through the analysis and comparison of the data, the optimization method in this paper greatly improves the accuracy of calculation and the comprehensive performance is improved. [ABSTRACT FROM AUTHOR]

• The prevalence of IGD symptoms is 1.78 % among Chinese adolescents. • Excessive online gaming not only contributes to psychological distress of adolescents, but also increase the level of aggressive behavior. • Apart from male sex and younger age, severe IGD symptoms and psychological distress are the most important predictors of the development of aggressive behavior. The present study aimed to investigate the current situation of internet gaming disorder (IGD) in Chinese adolescents and explore the impact of IGD-related factors on adolescent aggression. We hypothesized that IGD symptoms in adolescents would be associated with aggressive behavior and that risk factors for IGD symptoms could increase the aggressive tendencies of adolescents. To verify the above hypothesis, a cross-sectional survey of junior and senior high school students from southern, southwestern, central, and eastern China was conducted. A total of 9306 valid questionnaires were collected. The results showed that the prevalence of IGD symptoms was 1.78 % among Chinese adolescents. The adolescents in the disordered gamer group had the most severe IGD symptoms, with the highest levels of psychological distress and aggression. Interestingly, adolescents in the casual gamer group had the lowest psychological distress and aggression scores. Linear regression analysis further showed that higher levels of aggression were significantly associated with male sex, younger age, more severe psychological distress and IGD symptoms, and more violent game exposure. Our results suggested that excessive online gaming not only contributes to psychological distress in adolescents but also increases their levels of aggressive behavior. Apart from male sex and younger age, severe IGD symptoms and psychological distress are the most important predictors of the development of aggressive behavior. [ABSTRACT FROM AUTHOR]

Marine zoning has been widely used to effectively manage the relationship between economic development and marine environmental protection. However, it remains challenging for marine environmental management to integrate land–sea coordination and effectively implement spatially differentiated control under the existing technical framework. This study aims to explore the development and practice of marine zoning in China. This paper discusses the technical framework and key technical methods of marine zoning under the "Three Lines One Permit" policy. The main effectiveness and shortcomings of this strategy are described in the Hainan Free Trade Port case. The Hainan Free Trade Port has 276 marine control units, of which 36% are priority protection units and 6% are priority control units. These marine control units help improve the orderly development and utilization of land and sea resources and promote construction of an ecological security pattern of land–sea coordination. The marine zoning under the "Three Lines One Permit" policy complements and enhances the existing marine zoning system and promotes the potential for integrated coastal zone management. Suggestions are proposed to promote a more efficient marine zoning strategy towards land–sea integration and science-management integration. • Discussed the technical framework of marine zoning based on the land–sea coordination under the "Three Lines One Permit" policy. • First proposed a technical framework of marine zoning using the four-step method of "challenge-goal-zoning-regulation". • Established a quantitative response relationship between pollution discharge and marine environmental quality. [ABSTRACT FROM AUTHOR]

Abstract: Water shortage in China, particularly in the north and northwest of China, is very serious. The region accounts for half of the total area of China, but has less than 20% of total national available water resources. While the water shortage in this region is severe, irrigation water use efficiency is only about 40%, with a typical agricultural water use efficiency of about 0.46kgm−3. Excessive irrigation in Ningxia and Inner Mongolia has had a significant influence on downstream water users along the Yellow River. It is widely believed that an increase in the agricultural water use efficiency is the key to mitigating water shortage and reducing environmental problems. This paper reviews water-saving agricultural systems and approaches to improve agricultural water use efficiency in the arid and semiarid areas of China. The paper will cover biological mechanisms of water-saving agriculture and water-saving irrigation technologies, including low pressure irrigation, furrow irrigation, plastic mulches, drip irrigation under plastic, rainfall harvesting and terracing. In addition, the paper addresses the compensatory effect of limited irrigation and fertilizer supplementation on water use efficiency and highlights the need to breed new varieties for high water use efficiency. Considerable potential for further improvement in agricultural water use efficiency in the region depends on effective conservation of moisture and efficient use of the limited water. [Copyright &y& Elsevier]

Charnockites are Opx-bearing igneous rocks commonly found in high-grade metamorphic terranes. Despite being volumetrically minor, they show a wide range in both bulk geochemistry and intensive parameters. They form a characteristic component of the AMCG (anorthosite–mangerite–charnockite–granite) suite, but their association with typical S-type granites is less well-known. The Darongshan S-type granitic complex (DSGC) in Guangxi Province, southern China, contains granites varying in mafic silicate mineral assemblages from Bt + Crd (Darongshan suite) to Opx + Grt + Bt + Crd (Jiuzhou suite) and Opx + Crd ± Bt (Taima suite), corresponding to a geochemical transition from magnesian calc-alkalic to ferroan calc-alkalic. However, its genesis, even the accurate age of intrusion, remains highly contentious despite intensive research. In order to understand the genesis of charnockite and its genetic relationship with S-type granite; here, we first determined zircon U-Pb ages of each suite using a SIMS on the basis of a detailed petrological study. Zircon U-Pb ages show that all suites of the complex were emplaced contemporaneously at ca. 249 Ma. Monazite apparent U-Pb ages are indistinguishable from zircon U-Pb ages within analytical error. Further in situ zircon Hf-O isotope analyses reveal that the granitic complex was dominantly derived from reduced melting metasedimentary rocks (δ 18 O zircon = ca. 11‰; ε Hf ( t ) zircon = ca. − 10; Δlog FMQ ≤ 0; Mn in apatite oxybarometer) with rare material input from the mantle. The variation in δ 18 O (7.8‰–12.9‰) is more likely a result of hybridization, whereas that in ε Hf ( t ) (− 31.9 to − 1.8) is a result of both hybridization and disequilibrium melting. The variation in mineralogy and geochemistry may be interpreted as a result of entrainment of peritectic garnets from biotite-dehydration melting. Nevertheless, heat input from mantle through basaltic intrusion/underplating is considered to play a major role in high-temperature (> 850 °C) melting at mid-crustal levels (i.e. the cordierite stable field) for generation of the granitic complex. We interpret that the granites were intruded in a back-arc setting and basaltic magmatism was directly associated with slab roll-back and tearing during the latest Permian and early Triassic times. [ABSTRACT FROM AUTHOR]

Abstract: The EIAV (equine infectious anemia virus) multi-species attenuated vaccine EIAVDLV121 successfully prevented the spread of equine infectious anemia (EIA) in China in the 1970s and provided an excellent model for the study of protective immunity to lentiviruses. In this study, we compared immune responses induced by EIAVDLV121 to immunity elicited by the virulent EIAVLN40 strain and correlated immune responses to protection from infection. Horses were randomly grouped and inoculated with either EIAVDLV121 (Vaccinees, Vac) or a sublethal dose of EIAVLN40 (asymptomatic carriers, Car). Car horses became EIAVLN40 carriers without disease symptoms. Two of the four Vac horses were protected against infection and the other two had delayed onset or reduced severity of EIA with a lethal EIAVLN40 challenge 5.5months post initial inoculation. In contrast, all three Car animals developed acute EIA and two succumbed to death. Specific humoral and cellular immune responses in both Vac and Car groups were evaluated for potential correlations with protection. These analyses revealed that although plasma viral loads remained between 103 and 105 copies/ml for both groups before EIAVLN40 challenge, Vac-treated animals developed significantly higher levels of conformational dependent, Env-specific antibody, neutralizing antibody as well as significantly elevated CD4+ T cell proliferation and IFN-γ-secreting CD8+ T cells than those observed in EIAVLN40 asymptomatic carriers. Further analysis of protected and unprotected cases in vaccinated horses identified that cellular response parameters and the reciprocal anti-p26-specific antibody titers closely correlated with protection against infection with the pathogenic EIAVLN40. These data provide a better understanding of protective immunity to lentiviruses. [Copyright &y& Elsevier]

Although the Omicron variant has been associated with greater transmissibility and tropism of the upper respiratory tract, the clinical and pathogenic features of patients infected with the Omicron variant during an outbreak in China have been unclear. Adults with COVID-19 were retrospectively enrolled from seven medical centers in Guangzhou, China, and clinical information and specimens ( BALF, sputum, and throat swabs) from participants were collected. Conventional detection methods, metagenomics next-generation sequencing (mNGS), and other methods were used to detect pathogens in lower respiratory tract samples. From December 2022 to January 2023, we enrolled 836 patients with COVID-19, among which 56.7% patients had severe/critical illness. About 91.4% of patients were infected with the Omicron strain (BA.5.2). The detection rate of possible co-infection pathogens was 53.4% by mNGS, including Klebsiella pneumoniae (16.3%), Aspergillus fumigatus (12.2%), and Pseudomonas aeruginosa (11.8%). The co-infection rate was 19.5%, with common pathogens being Streptococcus pneumoniae (11.5%), Haemophilus influenzae (9.2%), and Adenovirus (6.9%). The superinfection rate was 75.4%, with common pathogens such as Klebsiella pneumoniae (26.1%) and Pseudomonas aeruginosa (19.4%). Klebsiella pneumoniae (27.1%% vs 6.1%, P < 0.001), Aspergillus fumigatus (19.6% vs 5.3%, P = 0.001), Acinetobacter baumannii (18.7% vs 4.4%, P = 0.001), Pseudomonas aeruginosa (16.8% vs 7.0%, P = 0.024), Staphylococcus aureus (14.0% vs 5.3%, P = 0.027), and Streptococcus pneumoniae (0.9% vs 10.5%, P = 0.002) were more common in severe cases. Co-infection and superinfection of bacteria and fungi are common in patients with severe pneumonia associated with Omicron variant infection. Sequencing methods may aid in the diagnosis and differential diagnosis of pathogens., Importance: Our study has analyzed the clinical characteristics and pathogen spectrum of the lower respiratory tract associated with co-infection or superinfection in Guangzhou during the outbreak of the Omicron strain, particularly after the relaxation of the epidemic prevention and control strategy in China. This study will likely prompt further research into the specific issue, which will benefit clinical practice., Competing Interests: The authors declare no conflict of interest.

Background: For patients taking esophagogastroduodenoscopy (EGD), sedation should ideally be used individually based on patients' comfort and tolerance level. However, currently there is no valid predictive tool. We undertook this study to develop and temporally validate a self-assessment tool for predicting discomfort and tolerance in Chinese patients undergoing EGD., Methods: We recruited 1522 patients undergoing routine diagnostic EGD without sedation. We collected candidate predictor variables before endoscopy and evaluated discomfort and tolerance with a 5-point visual analogue scale after the procedure. We developed logistic regression predictive models based on the first 2/3 of participants, and evaluated the calibration and discrimination of the models in the later 1/3 of patients., Results: 30.2% and 23.0% participants reported severe discomfort or poor tolerance to EGD respectively. The predictive factors in the model for discomfort included sex, education, expected level of discomfort, and anxiety before endoscopy. The model for tolerance included income, expected level of discomfort, and anxiety before endoscopy. In the validation population, the established models showed a moderate discriminative ability with a c-index of 0.74 for discomfort and 0.78 for tolerance. Hosmer-Lemeshow test suggested the models had fine calibration ability (discomfort: P = 0.37, tolerance: P = 0.41)., Conclusions: Equations for predicting discomfort and tolerance in Chinese patients undergoing EGD demonstrated moderate discrimination and variable calibration. Further studies are still required to validate these tools in other population., Trial Registration: Chinese Clinical Trial Registry (ChiCTR1800020236)., (© 2022. The Author(s).)

The spatial distribution of fertilization intensity and its influencing factors are significant for the accurate management of fertilization and pollution prevention and control. Previous studies are mostly limited to the discussion of human factors that influences the spatial distribution of fertilization intensity while ignoring natural geographical factors. Based on the chemical fertilizer survey data collected from 23492 sites in Chengdu Plain and combined with Geostatistics analysis and Geographic Information System (GIS) technology, the spatial distribution characteristics and influencing factors of average nitrogen and phosphorus fertilizer application intensity from 2010 to 2015 in this region were explored. The results show that:① the average annual application intensity of nitrogen and phosphorus fertilizer in the study area from 2010 to 2015 is generally in the low and medium risk intensity of 120-360 kg·hm -2 and 60-180 kg·hm -2 . The high risk intensity is mainly distributed in the grain (fruit) and vegetable growing areas such as Pidu, Pengzhou, Shifang, Longquanyi and Jintang, while the relatively low value areas are mostly distributed in the south and northeast. ② the nugget coefficients of nitrogen and phosphorus fertilizer application intensities are 66.17% and 41.60%. Their spatial distribution is determined by structural and random factors, showing a moderate spatial autocorrelation. ③ both human and natural factors have significant effects on the application intensity of nitrogen and phosphorus fertilizer. The crop type (fine classification) can explain the spatial variation of nitrogen fertilizer and phosphorus fertilizer respectively by 12.90% and 25.10%, which is the main controlling factor affecting the spatial distribution of nitrogen and phosphorus application intensity; the importance of soil parent material is second only to the planting crop type, and the independent explanation ability of phosphorus application intensity is about 3.6 times higher than that of nitrogen application intensity. When the type of planting crop plays a decisive role, the soil parent material still deeply restricts and affects the spatial distribution of nitrogen and phosphorus fertilizer application intensity in the study area. Therefore, the comprehensive effects of planting crop types and soil parent materials should be considered in fertilization management and environmental risk analysis, and the effects of soil parent material should also be taken into account in the application of phosphate fertilizer.

Objective: To analyze the results of concurrent hearing and deafness genetic screening and follow up of newborns., Methods: In total 33 911 babies born to 5 designated hospitals in Nanshan District of Shenzhen city from October 2017 to December 2019 were included. All subjects underwent concurrent hearing and deafness genetic screening covering 21 variants of 4 genes including GJB2, SLC26A4, GJB3 and Mt12SrRNA. For those with positive results, Sanger sequencing was carried out for confirmation., Results: 93.32% subjects passed the first-round hearing screening, and 87.01% passed the recheck testing. The overall detection rate was 4.18%. The detection rates for GJB2, SLC26A4, GJB3 and Mt12srRNA variants were 1.98%, 1.58%, 0.37% and 0.25%, respectively. 126 and 84 subjects were found with high risk for delayed-onset and drug-induced hearing loss, respectively. In addition, 4 and 5 subjects were found to harbor homozygous/compound heterozygous variants of the GJB2 and SLC26A4 genes, respectively. Concurrent screening showed that subjects (with heterozygous variants) who did not passed the two round hearing test were as follows: GJB2 with 6.75% in the first round and 2.61% in the second round testing, SLC26A4 (3.3%/1.2%), GJB3 (0.72%/0.14%) and 12SrRNA (0.36%/Nil), respectively. Moreover, the No-pass rate in the subjects with homozygous or compound variants in single gene, heterozygous variant in single gene, heterozygous variant in multiple genes, and homozygous variant in GJB3 gene were significantly higher than the subjects with negative results of genetic screening., Conclusion: Concurrent newborn genetic screening can enhance the effectiveness of hearing screening and enable earlier identification and intervention for children with hearing impairment. Follow-up can improve the diagnostic rate for children who are positive for the concurrent screening. Nevertheless, genetic and hearing screening cannot replace the diagnostic testing. It is necessary to conduct comprehensive analysis for the results of genetic and hearing screening and radiological examinations. Sanger sequencing and next-generation sequencing are critical for ascertain the diagnosis.

Importance: Lymphopenia is common and correlates with poor clinical outcomes in patients with coronavirus disease 2019 (COVID-19)., Objective: To determine whether a therapy that increases peripheral blood leukocyte and lymphocyte cell counts leads to clinical improvement in patients with COVID-19., Design, Setting and Participants: Between February 18 and April 10, 2020, we conducted an open-label, multicenter, randomized clinical trial at 3 participating centers in China. The main eligibility criteria were pneumonia, a blood lymphocyte cell count of 800 per μL (to convert to ×109/L, multiply by 0.001) or lower, and no comorbidities. Severe acute respiratory syndrome coronavirus 2 infection was confirmed with reverse-transcription polymerase chain reaction testing., Exposures: Usual care alone, or usual care plus 3 doses of recombinant human granulocyte colony-stimulating factor (rhG-CSF, 5 μg/kg, subcutaneously at days 0-2)., Main Outcomes and Measures: The primary end point was the time from randomization to improvement of at least 1 point on a 7-category disease severity score., Results: Of 200 participants, 112 (56%) were men and the median (interquartile range [IQR]) age was 45 (40-55) years. There was random assignment of 100 patients (50%) to the rhG-CSF group and 100 (50%) to the usual care group. Time to clinical improvement was similar between groups (rhG-CSF group median of 12 days (IQR, 10-16 days) vs usual care group median of 13 days (IQR, 11-17 days); hazard ratio, 1.28; 95% CI, 0.95-1.71; P = .06). For secondary end points, the proportion of patients progressing to acute respiratory distress syndrome, sepsis, or septic shock was lower in the rhG-CSF group (rhG-CSF group, 2% vs usual care group, 15%; difference, -13%; 95%CI, -21.4% to -5.4%). At 21 days, 2 patients (2%) had died in the rhG-CSF group compared with 10 patients (10%) in the usual care group (hazard ratio, 0.19; 95%CI, 0.04-0.88). At day 5, the lymphocyte cell count was higher in the rhG-CSF group (rhG-CSF group median of 1050/μL vs usual care group median of 620/μL; Hodges-Lehmann estimate of the difference in medians, 440; 95% CI, 380-490). Serious adverse events, such as sepsis or septic shock, respiratory failure, and acute respiratory distress syndrome, occurred in 29 patients (14.5%) in the rhG-CSF group and 42 patients (21%) in the usual care group., Conclusion and Relevance: In preliminary findings from a randomized clinical trial, rhG-CSF treatment for patients with COVID-19 with lymphopenia but no comorbidities did not accelerate clinical improvement, but the number of patients developing critical illness or dying may have been reduced. Larger studies that include a broader range of patients with COVID-19 should be conducted., Trial Registration: Chinese Clinical Trial Registry: ChiCTR2000030007.

Hydroelectric cascade exploitation, one of the major ways for exploiting water resources and developing hydropower, not only satisfies the needs of various national economic sectors, but also promotes the socio-economic sustainable development of river basin. unavoidable anthropogenic impacts on the entire basin ecosystem. Based on the process of hydroelectric cascade exploitation and the ecological characteristics of river basins, this paper reviewed the major impacts of hydroelectric cascade exploitation on dam-area ecosystems, river reservoirs micro-climate, riparian ecosystems, river aquatic ecosystems, wetlands, and river landscapes. Some prospects for future research were offered, e.g., strengthening the research of chain reactions and cumulative effects of ecological factors affected by hydroelectric cascade exploitation, intensifying the study of positive and negative ecological effects under the dam networks and their joint operations, and improving the research of successional development and stability of basin ecosystems at different temporal and spatial scales.

Objective: This study intends to summarize 5 years of intraoperative hybrid procedure (IHP) experience with neonates and young children having congenital heart disease (CHD)., Methods: From March 2003 to March 2009, a total of 152 consecutive patients younger than 2 years old who had undergone IHP were enrolled. In the balloon plasty group (n = 72), transventricular pulmonary valvuloplasty, or transaortic balloon dilatation were performed for pulmonary atresia, pulmonary stenosis, or coactation of the aorta. In the device group (n = 43), transventricular device closure was performed for ventricular septal defect (VSD), or transatrial device closure for atrial septal defect (ASD). In the collateral arteries occlusion group (n = 37), the major aortopulmonary collateral arteries (MPCAs) were occluded with coils for tetralogy of Fallot or other cyanotic CHDs. All procedures were image guided and performed in a specially designed hybrid operation room. All surviving patients were followed up, and the major adverse cardiovascular events that occurred were recorded., Results: In the balloon plasty group, all patients received successful transventricular valvuloplasty or transaortic balloon angioplasty. However, severe right ventricle outflow obstruction was observed in 2 cases. One patient was transferred to regular open-heart surgery immediately, and another underwent regular open-heart procedure after discharge. Furthermore, 1 neonate with pulmonary atresia with intact ventricular septum died from liver failure 6 months after IHP. In the device closure group, the device closure failed to be performed in 3 cases (2 with ASD and 1 with VSD). One young child with VSD died from pneumonia, even after successful device closure. No device malposition was observed in the device closure group during follow-up. All patients who received MPCA occlusion and associated open-heart correction were eventually discharged., Conclusion: IHP could avoid or shorten the application of cardiopulmonary bypass and reduce surgical trauma for selected young children with CHD. Although IHP is feasible and safe, the image outfits, image-guided technology, and IHP-related devices should be developed and improved.

Objective: To identify the disease-causing genetic alteration of split-hand/split-foot malformation (SHFM) in a Chinese family., Methods: Three of the 5 affected individuals from a four-generation Chinese SHFM family were examined physically and radiologically. Peripheral blood samples were collected from Digital photographs of the malformed hands and feet were taken. Peripheral blood samples were collected from 2 affected individuals, and lymphocytes were isolated to undergo high resolution G-banding. Genomic DNA was extracted from the whole blood samples of 4 available family members, including the 3 affected individuals. All 16 exons and their flanking intronic sequences of the TP63 gene were amplified using polymerase chain reaction (PCR) and sequenced directly. Microsatellite markers from the five SHFM loci were analyzed in the available family members by PCR, polyacrylamide gel electrophoresis and silver staining. For semi-quantitative determination of the allele copy number, the polymorphic PCR-amplified fragments representing genetic markers from the SHFM3 locus at chromosome 10q24.3 were sequenced in the affected individuals using normal individuals with identical genotypes as controls., Results: All 3 existing affected individuals showed absence of 3 radial fingers, 2 affected individuals had a deep central cleft and central ray deficiency in the feet, and 1 affected individual had a fibular monodactyli, all limb malformations being bilateral and consistent with the phenotype of typical SHFM. G-banding showed normal karyotypes in the 3 affected individuals and no visible cytogenetic abnormality was found. Moreover, no mutation was identified in the TP63 gene. While no haplotype sharing was observed in the markers from loci SHFM1, SHFM4 and SHFM5, potential haplotype sharing was detected in the markers from two loci, SHFM2 and SHFM3, indicating possible causative mutation at SHFM2 or SHFM3. Furthermore, obviously biased silver density toward the allele fragments shared by the 3 affected individuals was observed in the markers from the SHFM3 locus. Comparative sequencing showed roughly one-fold increase of fluorescent signal of the shared fragments in the affected individuals. These results suggested a large-scale DNA duplication within the SHFM3 locus., Conclusion: A large-scale DNA duplication within the SHFM3 locus at chromosome 10q24.3 has been identified as the pathogenic genetic change in Chinese patients with SHFM.