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Objectives: The "modified single-patch" technique (Nunn's technique) has become more widely adopted, especially in small infants with common atrioventricular septal defect (CAVSD). In this study, we retrospectively reviewed our surgical experiences of the "modified single-patch" technique with CAVSD patients, including newborns and adults, to reveal the early and midterm clinical results.Methods: There were 233 cases diagnosed with CAVSD undergoing biventricular repair in our hospital from June 2009 to 2016. A total of 197 cases (84.5%) with the "modified single-patch" technique were enrolled in the final analysis, including type A in 106 cases (53.8%), type B in 13 cases (6.6%), type C in 15 cases (7.6%), and intermediate type in 63 cases (32%). Major associated cardiovascular malformations included five cases of unroofed coronary sinus syndrome with LSVC (UCS), five cases of coarctation of the aorta and one case of translocation of the great artery. The median age at operation of the studied 197 cases was 44.3 ± 103.3 months (ranging from 18 days to 58 years old), including two newborns. Detailed information on the "modified single-patch" procedure was described previously, and the other cardiac malformations were repaired simultaneously with surgical repair.Results: There were 14 (7.1%) early deaths and 3 (1.5%) late deaths at 3 months and 1 year after the initial operation, respectively. The total mortality rate was 8.1%, and there was no significant difference in mortality among the different age groups (P = .291). Five patients (2.5%) underwent reoperation because of severe mitral insufficiency (MI), and another patient was reoperated for left ventricular outflow tract obstruction 3 years after the initial surgery. Long-term survival in the <3 months group was significantly lower than that in the group of older children (1-18 years old). Of the 180 survivors who were followed up for at least 1 year, the proportion of severe MI began to drop from 26.2% before the operation to 13.8% just 1-week postoperation and continued to decline to the lowest level, 3.4%, at 3 months postoperation. However, MI began to rebound at 3 months and reached 20.8% at 1-year postoperation. The rebound of MI was evident in the (3 months, 6 months) age group and the >18 years age group. However, compared to the preoperation situation, the proportion of severe tricuspid insufficiencies decreased each month from 24.8% to 0.0% until 3 months after the operation and remained at a relatively low level within 1 year after surgery.Conclusions: In our experience, age is not a limitation of the modified single-patch technique, and patients even in adults with surgical indications can apply this technique. In older children and adults, we should pay more attention to atrioventricular valve annuloplasty. Infants may suffer from severe residual left atrioventricular valve regurgitation, especially in the <3 months age group, so we should improve postoperative follow-up work during infancy. [ABSTRACT FROM AUTHOR]

Background: Precisely evaluating the need for transannular patch (TAP) placement is very important in the surgical treatment of tetralogy of Fallot. We hypothesized that the pulmonary annulus area index (PAAI, the pulmonary-to-aortic valve annulus cross-sectional area ratio) could be a useful and accessible predictor for TAP placement.Methods: The medical records of patients who underwent tetralogy of Fallot repair between 1 January 2016 and 31 December 2017 were reviewed retrospectively. A total of 255 patients were included and categorized into two groups: patients who needed TAP placement and patients who did not. Various candidate predictors for TAP placement (PAAI, pulmonary annulus z-score, and velocity across the pulmonary annulus) were compared using receiver operating characteristic curves. The optimal cutoff for each predictor was assessed.Results: Among the 255 patients included, 156 needed TAP placement (156/237, 65.8%). Both the PAAI (0.28 [0.20/0.34] vs 0.14 [0.09/0.19]; P < .0001) and z-score (-1.5 [-2.9, -0.4] vs -3.6 [-5.3/-2.6]; P < .0001) were smaller in the TAP group. The PAAI is a useful predictor of the pulmonary annulus z-score (AUC 0.830 vs 0.811, P = .19). Combination analysis of the PAAI and velocity across the pulmonary annulus (PV vmax ) showed better predictive value than the PAAI and z-score (AUC 0.860, sensitivity 89.7%, specificity 61.7%, P < .0001).Conclusions: Our results suggest that the PAAI is a useful and accessible predictor for TAP placement and can be applied readily and simply in clinical practice. A combination with the velocity across the pulmonary annulus could promote the accuracy of prediction. [ABSTRACT FROM AUTHOR]

Background: The clinical course and predictors of adverse aortic events (AAE) in patients with acute Stanford type B intramural hematoma (IMH) remain controversial. This study aimed to investigate whether 18F-FDG PET/CT can predict risk in patients with acute type B IMH.Methods and Results: This study included 34 patients with acute type B IMH who underwent PET/CT within 14 days from the onset of symptoms. The maximal standardized uptake values (SUVmax) of 18F-FDG uptake was significantly different between patients with or without AAE (4.3 ± 0.6 vs 3.7 ± 1.0, P = 0.020), but not the target to blood ratio (TBR, SUVmax divided by SUV in the superior vena cava) (1.6 ± 0.2 vs 1.5 ± 0.5, P = 0.064). In patients with initial ulcer-like projection (ULP), a blood-filled pouch protruding into the IMH, which was seen in 25 patients(74%), both the SUVmax and TBR were significantly higher in patients who developed AAE, (4.3 ± 0.6 vs 3.3 ± 0.5, P = 0.001; 1.6 ± 0.2 vs 1.4 ± 0.2, P = 0.01); the TBR >1.5, which is determined from receiver-operating-characteristic curve, had a sensitivity of 73% and a specificity of 80% in predicting AAE.Conclusion: Patients with ULP and high 18F-FDG uptake were more likely to develop AAE and may require closer surveillance with serial imaging. [ABSTRACT FROM AUTHOR]

Objective: Data about renal artery stenosis association with left ventricular remodeling in patients coexisting with coronary artery disease are scanty.Methods: Patients with suspected both coronary artery disease and renal artery stenosis undergoing coronary and renal arteriography between October 2013 and December 2015 were prospectively enrolled. Left ventricular remodeling patterns were compared among different severity of renal artery stenosis group. Logistic regression was done to investigate the determinants of the left ventricular morphology.Results: The overall prevalence of left ventricular hypertrophy was 40.5%, the highest in bilateral renal artery stenosis group compared to unilateral or normal ones (65.4% versus 41.8% versus 34.8%, p = 0.012). Significantly lower estimated glomerular filtration rate and higher cystatin C level were found in bilateral renal artery stenosis group than that in other two groups. Multivariate regression analysis showed that bilateral renal artery stenosis was associated with increased left ventricular hypertrophy and concentric hypertrophy with statistical significance (adjusted odds ratio = 2.909 (95%CI: 1.063-7.961), and 3.021 (95%CI: 1.136-8.033)). In addition, estimated glomerular filtration rate level was also related to left ventricular hypertrophy, while there was no significant interaction between renal artery stenosis and coronary artery disease on left ventricular hypertrophy/concentric hypertrophy occurrence.Conclusions: Bilateral renal artery stenosis is significantly associated with increased left ventricular hypertrophy/concentric hypertrophy in patients with suspected concomitant coronary and renal artery disease, while no synergic effect could be found in coronary artery disease. [ABSTRACT FROM AUTHOR]

Soil, air, tree bark, rice, wheat, invertebrates, and chicken tissues around a typical endosulfan-contaminated site were analyzed in each season in each of two years. The total endosulfan (the sum of α-, β-endosulfan and endosulfan sulfate) were significantly different in soil and air samples collected in the four seasons (P < 0.01) and the mean concentrations were 6.53 ng/g dry weight (d.w.) and 2.40 ng/m 3 , respectively, in autumn, 3.32 ng/g d.w. and 2.48 ng/m 3 , respectively, in winter, 2.10 ng/g d.w. and 0.93 ng/m 3 , respectively, in spring, and 1.03 ng/g d.w. and 0.83 ng/m 3 , respectively, in summer. The total endosulfan concentrations in tree bark, rice, wheat, and invertebrates were 23.0–278 (mean 95.5) ng/g d.w., 7.36–35.5 (mean 17.4) ng/g d.w., 34.3–158 (mean 83.1) ng/g d.w., and 401–4354 (mean 2125) ng/g lipid weight, respectively. The total endosulfan concentrations in the chicken gizzard, heart, liver, and meat samples were 552, 212, 699, and 221 ng/g lipid weight, respectively. The endosulfan concentrations in soil, air, and biota around the site were strongly influenced by endosulfan emissions from the site, and the concentrations had decreased to half the initial concentrations six months after endosulfan production stopped. The invertebrate and chicken bioconcentration and biomagnification factors indicated that endosulfan accumulated in the invertebrates and chicken tissues was slightly biomagnified by chickens. [ABSTRACT FROM AUTHOR]

The control of soil pollution in China has become an issue, and in this study, a compound contaminated site was selected and focus on the site and its nearby environment, organochlorine pesticides (OCPs) were investigated in both soil (top and deep soil) and air samples. The main pollutants in top soils at site are dichlorodiphenyltrichloroethane (DDTs, 0.05-104 mg/kg d.w., avg: 14.5 mg/kg d.w.) and hexachlorobenzene (HCB, 0.02-4.85 mg/kg d.w., avg: 0.72 mg/kg d.w.) which is in accordance with its production history. As for the deep soils, ΣOCPs at site were found concentrated at workshops especially the technical pesticide workshop (5.29-22.1 mg/kg d.w., avg: 9.15 mg/kg d.w.) and the history DDTs’ workshop (4.00-64.8 mg/kg d.w., avg: 20.4 mg/kg d.w). Around site, OCPs were mainly concentrated at layers of −20 cm and the −40 cm and decreased with distance being far away, at 5000 m, the ΣOCPs was comparable with normal agriculture soil (22.1−91.4 ng/g d.w., avg: 55.4 ng/g d.w.). ΣOCPs in the air samples ranged 64.6-823 ng/m3 (avg: 459 ng/m3) at site and 9.93-176 ng/m3 (avg: 50.8 ng/m3) around site which are all dominated with DDTs and HCHs. Soil-air exchange fugacity was calculated to judge the transportation of the OCPs and the results showed soils at the site and its nearby areas (within 5000 m) are releasing most of the OCPs into air, and accordingly through evaluation, inhalation was found to be the major source for human health risk, which is a great threat to the workers at site and the nearby residents. [ABSTRACT FROM AUTHOR]

Pilot-scale fermentation is one of the important processes for achieving industrialization of biogenic coalbed methane (CBM), although the mechanism of biogenic CBM remains unknown. In this study, 16 samples of formation water from CBM production wells were collected and enriched for methane production, and the methane content was between 3.1 and 21.4%. The formation water of maximum methane production was used as inoculum source for pilot-scale fermentation. The maximum methane yield of the pilot-scale fermentation with lump anthracite amendment reached 13.66 μmol CH4/mL, suggesting that indigenous microorganisms from formation water degraded coal to produce methane. Illumina high-throughput sequencing analysis revealed that the bacterial and archaeal communities in the formation water sample differed greatly from the methanogic water enrichment culture. The hydrogenotrophic methanogen Methanocalculus dominated the formation water. Acetoclastic methanogens, from the order Methanosarcinales, dominated coal bioconversion. Thus, the biogenic methanogenic pathway ex situ cannot be simply identified according to methanogenic archaea in the original inoculum. Importantly, this study was the first time to successfully simulate methanogenesis in large-capacity fermentors (160 L) with lump anthracite amendment, and the result was also a realistic case for methane generation in pilot-scale ex situ. [ABSTRACT FROM AUTHOR]