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Objective To share our experience of percutaneous or transthoracic closure of atrial septal defect (ASD) and ventricular septal defect (VSD) supported by echocardiography guidance. Methods From December 2010 to September 2019, 54 patients of congenital heart disease (30 cases of isolated atrial septal defect, 24 cases of ventricular septal defect) were treated with surgical operation by occluder under guidance of echocardiography closed without cardiopulmonary bypass. Fourteen cases of ASD were performed device closure through a small right sternal margin thoracotomy incision at the forth intercostal space, 16 cases of ASD underwent percutaneous occlusion surgery, and 24 cases of VSD were closed through small incision under the xiphoid process. Results The operations were successful in the 24 cases of VSD. One of the cases with minimally incision ASD occlusion was displaced 7 hours after operation, the occluder was taken out and ASD was repaired under cardiopulmonary bypass in emergency. There were 13 cases of successful occlusion and 3 cases of failure in percutaneous ASD closure patients. Among three cases, 2 cases underwent ASD closed through transthoracic closure and 1 case underwent open surgery under cardiopulmonary bypass successfully. The 46 cases were followed up for 3-103 months, with an average of (21.3±16.2)months. No occluder displacement, shedding, significant residual shunt were observed. Conclusions Echocardiography-guided percutaneous atrial septal defect and ventricular septal defect is safe and effective without radiation and CPB. Percutaneous closure of atrial septal defect is suitable for children over 3 years. Atrial septal defect and ventricular septal defect occlusion through small thoracic incision is feasible and easy to operate in other healthcare institutions.

The appropriate and adjustable band structure and positive visible-light response enable the halide perovskite MAPbBr3 to be a promising photocatalyst for CO2 reduction. Considering the extremely poor water resistance and severe carrier complexation trends, rational design and control of steam stable MAPbBr3-based heterojunction nanocrystals to exploit their potential for photocatalytic CO2 reduction in steam is important while being a challenging topic. Here, an efficient MAPbBr3/Pb-MOF heterojunction photocatalyst is developed, ensuring in situ growth of Pb-MOF on the surface of the perovskite via a self-sacrificial template method, thus creating tightly connected interfaces to mitigate the sluggish charge transfer due to the discontinuous interfaces. The experimental results confirm that construction of MAPbBr3/Pb-MOF heterojunctions suppresses the recombination of photogenerated carriers. Meanwhile, the prepared MAPbBr3/Pb-MOF exhibits better steam stability, CO2 adsorption capacity, and higher separation efficiency of photogenerated carriers. The heterostructure enables the photocatalytic reduction of CO2 to CO at an excellent rate of 21.5 μmol g−1 under visible light irradiation, which is 4.8 times larger than that of pristine MAPbBr3. [ABSTRACT FROM AUTHOR]

Iron being the second most abundant metal on the surface of the earth (5.1%), size-confined iron-based photocatalysts are of particular importance for solar energy conversion. Herein, a ternary Z-scheme g-C3N4/PPy/Fe2O3 heterostructure photocatalyst with PPy supporting and confining Fe2O3 was designed and fabricated for hydrogen production using a facile method. The small particle size of Fe2O3 (around 5 nm) improved the transport efficiency of charge carriers with the conductive PPy acting as a mediator, and the formation of the g-C3N4–Fe2O3 Z-scheme heterostructure dramatically facilitated the photocatalytic activity. Consequently, the optimal g-C3N4–PPy–Fe2O3 demonstrated an excellent photocatalytic hydrogen evolution activity, which was 120, 6.4 and 4.8 times larger than that of the pristine g-C3N4 and g-C3N4 singly loaded separately with PPy and Fe2O3, respectively, and exhibited considerable H2 and H2O2 production activity even in the absence of a sacrificial agent. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the performance of a novel non-invasive controlled attenuation parameter (CAP) to assess liver steatosis., Methods: This was a multi-center prospective cohort study. Consecutive patients (aged ≥ 18 years) who had undergone percutaneous liver biopsy and CAP measurement were recruited from three Chinese liver centers. Steatosis was categorized as S0: < 5%; S1: 5%-33%; S2: 34%-66%; or S3: ≥ 67%, according to the nonalcoholic fatty liver disease (NAFLD) activity score. The FibroScan(®) 502 equipped with the M probe (Echosens, Paris, France) was used to capture both CAP and liver stiffness measurement values simultaneously. Receiver operating characteristic curves were plotted, and the areas under the curves were calculated to determine the diagnostic efficacy. The accuracy of the CAP values at the optimal thresholds was defined by maximizing the sum of sensitivity and specificity (maximum Youden index)., Results: A total of 152 patients were recruited, including 52 (34.2%) patients with NAFLD and 100 (65.8%) with chronic hepatitis B (CHB) virus infection. After adjustment, the steatosis grade (OR = 37.12; 95%CI: 21.63-52.60, P < 0.001) and body mass index (BMI, OR = 6.20; 95%CI: 2.92-9.48, P < 0.001) were found independently associated with CAP by multivariate linear regression analysis. CAP was not influenced by inflammation, fibrosis or aetiology. The median CAP values and interquartile ranges among patients with S0, S1, S2 and S3 steatosis were 211 (181-240) dB/m, 270 (253-305) dB/m, 330 (302-360) dB/m, and 346 (313-363) dB/m, respectively. The cut-offs for the CAP values in all patients with steatosis ≥ 5%, ≥ 34% and ≥ 67% were 253 dB/m, 285 dB/m and 310 dB/m, respectively. The areas under the curves were 0.92, 0.92 and 0.88 for steatosis ≥ 5%, ≥ 34% and ≥ 67%, respectively. No significant differences were found in the CAP values between the NAFLD group and the CHB group in each steatosis grade., Conclusion: CAP appears to be a promising tool for the non-invasive detection and quantification of hepatic steatosis, but is limited by BMI.

Objective: To investigate the feasibility, advantages and efficacy of implantation of left atrial and ventricular epicardial dual chamber pacemaker to treat pediatric complete atrioventricular block., Method: Eleven children with median age 4.0 years (0.5-7.6 years) diagnosed as complete atrioventricular block resisting to drug therapy received implantations of left atrial and ventricular epicardial dual chamber pacemakers. Six were male and five female. Temporal or permanent right ventricular pacing was used for all of them before implantation of left atrial and ventricular epicardial dual chamber pacemakers. Three cases showed cardiac dysfunction. Left lateral thoracotomy was performed at 4th intercoastal space along anterior axillary line under general anesthesia, the pericardium was incised vertically anterior to the phrenic nerve, two pacing leads were individually located at left atrial appendage and left ventricular lateral wall. After all the parameters were detected to be satisfactory, a pouch was made at left abdomen under coastal margin. Dual chamber pacemaker was connected with pacing leads through subcutaneous tunnels. The sizes of heart chambers, cardiac functions, parameters of pacemaker, sensitivity, pacing status, PR interval and QRS interval were closely followed up post-operatively., Result: Implantations of pacemakers were successful for all of the patients with no complications associated with operations. Preoperative electrocardiograms showed QRS interval (180 ± 33)ms under right ventricular pacing, it decreased to (140 ± 24)ms after implantation of left atrial and ventricular epicardial dual chamber pacemaker, significantly lower than right ventricular pacing (t = 8.8, P < 0.05) . Atrioventricular (AV) interval was set at 90 ms, PR interval (124 ± 4)ms. Echocardiograms performed within 2-3 days after implantation of left atrial and ventricular epicardial dual chamber pacemakers showed that for the 3 cases who were previously under right atrial and right ventricular dual chamber pacing presenting cardiac dysfunction, their left ventricular diastolic diameter (LVDd) decreased from (46.3 ± 12.5) (32.0-55.0) ms to (44.7 ± 12.0) (31.0-53.0) mm and left ventricular ejection fraction (LVEF) increased from 30% ± 15% (18%-47%) to 44% ± 18% (33%-65%). During 2-14 months' follow up, LVEF increased progressively which became significantly higher than before (65% ± 8% vs. 30% ± 15%, t = 5.6, P < 0.05) . Cardiac chamber sizes and left ventricular systolic function for the other 8 patients maintain normal during follow up. Pacing status and sensitivity were satisfactory for all these patients during follow up., Conclusion: Implantation of left atrial and ventricular epicardial pacemaker might be considered for children diagnosed as complete atrioventricular block for whom endocardial pacemaker could not be implanted, due to its utmost protection for cardiac function with minimal injury and its ability to prevent or reverse pacemaker syndrome. Left atrial and left ventricular epicardium should be regarded as the first-choice and routine locations for epicardial pacing.

Objective: To study the chemical constituents of ethnical drug Cissus pteroclada., Methods: Silica gel column chromatography was employed to separate the constituents from EtOAc extraction of Cissus pteroclada and their structures were identified by physicochemical properties as well as spectrum analysis., Results: Five steroidal compounds and 2 triterpenoid constituents were obtained. Their structures were identified as: stigmasterol (1), stigmasterol acetate (2), stigmasta-5, 22-dien-3-O-beta-D-glucopyranoside (3), beta-sitosterol (4), daucousterol (5), taraxerone (6), oleanolic acid (7)., Conclusion: All the compounds are isolated from this plant for the first time except for compound 4 and 5. Compounds 1 - 3 are obtained from this genus for the first time.

Objective: To analyze the surgical strategy and result of one-stage repair for congenital aortic arch disease associated with other cardiac anomalies., Methods: Between April 1993 and November 2009, 25 consecutive patients aged 26 d to 6.5 years underwent one-stage repair for congenital aortic arch disease with other cardiac anomalies. Among them, 6 patients had coarctation of aorta, 6 patients had interrupted aortic arch, and 13 cases had hypoplasia of aortic arch. The surgical techniques include excision of the anterior wall of pulmonary artery, resection of patent ductus arteriosus tissue, aortic arch reconstruction with autologous pulmonary artery wall, reconstruction of the pulmonary artery and repair of the associated defects., Results: Twenty-four patients survived and recovered uneventfully. One patient died of pulmonary hypertension crisis in hospital. The reconstruction of the aorta and the correction of the intracardiac anomalies were proved by postoperative echocardiography and CT scan. There were no neurological or other complications. The follow-up showed that all patients developed normally and there were no restenosis of the aorta arch., Conclusions: With the benefits of growth potential and less tension, autologous pulmonary artery tissue is an optimal choice in aortic arch reconstruction. One-stage repair of congenital aortic arch disease associated with other cardiac anomalies can achieve good results.

Objective: To retrospectively analyze the experiences, indications, technique, and results of coronary artery bypass grafting (CABG) in patients over 70 years old., Methods: Ninety-one patients received coronary artery bypass grafting from March 2004 to March 2008. Ages ranged from 70 to 83 years old, 22 patients over 75 years old. Conventional CABG (CCABG) in 72 patients, off-pump CABG (OPCAB) in 19 patients. Clinical data has no significant differences in two groups. The rate of using left internal mammary artery was 96.7%. The number of grafts in CCABG and OPCAB group were 2 to 5 (3.5 +/- 0.8) and 1 to 4 (2.9 +/- 0.7) respectively., Results: In-hospital death in 2 cases, both were from chronic obstructive pulmonary disease and pulmonary infection. Cerebral infarction in 1 case and pulmonary infection in 2 cases in CCABG group, but no significant difference between two groups, and no difference in intubation, ICU stay, respiratory failure, renal function failure. But number of grafts in CCABG was significantly more than that in OPCAB (P < 0.01). Postoperative follow-up was 3 to 36 months, 1 case with recurrent angina in OPCAB., Conclusions: According to the characteristic of coronary artery disease in elderly, fully revascularization and improving myocardial blood supply, patients over 70 years old with CABG can obtain the same efficacy as younger patients. There were not significant difference between CCABG and OPCAB.

Objective: To review the experience of staged total cavopulmonary connection (TCPC) in complex congenital heart diseases., Methods: From June 1998 to March 2008, 22 patients underwent staged TCPC for complex congenital heart diseases. Among them, 9 were univentricular and pulmonary artery valve stenosis; 3 were univentricular and pulmonary artery atresia; 1 was transposition of great arteries, crisscross heart and pulmonary artery valve stenosis; 1 was complete atrioventricular canal defects, left ventricular hypoplasia, pulmonary artery atresia and atrioventricular valvular regurgitation; 1 was complete atrioventricular canal defects, left ventricular hypoplasia, pulmonary artery valve stenosis and atrioventricular valvular regurgitation after Glenn procedure; 1 was mirror image dextrocardia, single ventricle, pulmonary artery atresia, major aortopulmonary collateral arteries (MAPCAs) and right pulmonary arteriovenous fistula after Glenn procedure; 4 were tricuspid atresia and pulmonary artery valve stenosis; 1 was tricuspid atresia and pulmonary atresia; 1 was mirror image dextrocardia, double-outlet of right ventricle, left ventricular hypoplasia, pulmonary artery valve stenosis, tricuspid incompetence, and MAPCAs. Among them, 5 patients received systemic-to-pulmonary artery shunt, bidirectional Glenn procedure and TCPC. Seventeen patients received bidirectional Glenn procedure, the mean age was (5.9+/-4.4) years old. Pulmonary artery pressure pre-Glenn procedure was 17 to 20 mm Hg (1 mm Hg=0.133 kPa). Atrioventricular valve incompetence in 3 patients. Nakata index was less than 200 mm2/m2 in 4 patients before the first stage operation. The age of TCPC procedure was (9.6+/-4.9) years old, the interval time was (3.7+/-1.2) years., Results: There was one in-hospital death, the mortality was 4.5%. The patient with univentricular and pulmonary atresia, received systemic-to-pulmonary artery shunt, bidirectional Glenn procedure and TCPC and died of pneumorrhagia. Other patients were recovered well, postoperative central venous pressure was 12 to 18 mm Hg, percutaneous oxygen saturation was 90% to 96%. The cardiac function were in NYHA class I to II., Conclusions: The staged TCPC was a good procedure in high-risk Fontan candidates. The results were satisfactory for those patients. This staged strategy may extend the operative indications for the Fontan procedure.

Objective: To report the experience of extracardiac conduit total cavopulmonary connection (ECTCPC) in surgical treatment of complex congenital heart diseases., Methods: From 1998 to 2006, 68 patients underwent ECTCPC for complex congenital heart diseases. Among them, 45 had functional univentricle with transposition of the great artery (TGA) and pulmonary artery valve stenosis, 19 had tricuspid atresia with hypoplasia of right ventricle, 4 had Ebstein's anomaly with hypoplasia of right ventricle. Six had left superior vena cava, 18 had received Bidirectional Glenn operation; Fifty-seven cases were performed under cardiopulmonary bypass with general anesthesia and hypothermia, 11 cases were performed without cardiopulmonary bypass., Results: There were two death, the mortality was 2.9%. All patients were followed up from 1 to 8 years with no clinical symptoms and have been doing well. The arterial oxygen saturation was 90% - 96%, the cardiac function were in NYHA class I - II., Conclusion: The extra cardiac conduit TCPC is a simple procedure and superior to other type of Fontan procedure in most patients.