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Fetal congenital heart disease (CHD) is the most common type of fatal congenital malformation. Fetal four-chamber (FC) view is a significant and easily accessible ultrasound (US) image among fetal echocardiography images. Automatic detection of four fetal heart chambers considerably contributes to the early diagnosis of fetal CHD. Furthermore, robust and discriminative features are essential for detecting crucial visualizing medical images, especially fetal FC views. However, it is an incredibly challenging task due to several key factors, such as numerous speckles in US images, the fetal four chambers with small size and unfixed positions, and category confusion caused by the similarity of cardiac chambers. These factors hinder the process of capturing robust and discriminative features, hence destroying the fetal four chambers' precise detection. Therefore, we propose an intelligent feature learning detection system (FLDS) for FC views to detect the four chambers. A multistage residual hybrid attention module (MRHAM) presented in this paper is incorporated in the FLDS for learning powerful and robust features, helping FLDS accurately locate the four chambers in the fetal FC views. Extensive experiments demonstrate that our proposed FLDS outperforms the current state-of-the-art, including the precision of 0.919, the recall of 0.971, the F1 score of 0.944, the mAP of 0.953, and the frames per second (FPS) of 43. In addition, our proposed FLDS is also validated on other visualizing nature images such as the PASCAL VOC dataset, achieving a higher mAP of 0.878 while input size is 608 * 608.

Background Deafness, autosomal recessive 16 (DFNB16) is caused by compound heterozygous or homozygous variants in STRC and is the second most common form of genetic hearing loss. Due to the nearly identical sequences of STRC and the pseudogene STRCP1, analysis of this region is challenging in clinical testing. Methods We developed a method that accurately identifies the copy number of STRC and STRCP1 using standard short-read genome sequencing. Then, we used whole genome sequencing (WGS) data to investigate the population distribution of STRC copy number in 6813 neonates and the correlation between STRC and STRCP1 copy number. Results The comparison of WGS results with multiplex ligation-dependent probe amplification demonstrated high sensitivity (100%; 95% CI, 97.5%–100%) and specificity (98.8%; 95% CI, 97.7%–99.5%) in detecting heterozygous deletion of STRC from short-read genome sequencing data. The population analysis revealed that 5.22% of the general population has STRC copy number changes, almost half of which (2.33%; 95% CI, 1.99%–2.72%) were clinically significant, including heterozygous and homozygous STRC deletions. There was a strong inverse correlation between STRC and STRCP1 copy number. Conclusions We developed a novel and reliable method to determine STRC copy number based on standard short-read based WGS data. Incorporating this method into analytic pipelines would improve the clinical utility of WGS in the screening and diagnosis of hearing loss. Finally, we provide population-based evidence of pseudogene-mediated gene conversions between STRC and STRCP1.

Fetal congenital heart disease (CHD) is a prevalent and highly complicated fetal deformity. Furthermore, the number of infants with CHD accounts for as high as 6‰–8‰ among all the living newborns in China. For the early diagnosis and screening of the fetal CHD, echocardiography technology plays a vital role in assessing anatomical structures and functions of the fetal heart. However, the prenatal detection rate of CHD is still meager due to the particularity of the fetal cardiac structures and the diversity of the fetal CHD. Hence, we propose a simple yet effective residual learning diagnosis system (RLDS) for diagnosing fetal CHD to improve diagnostic accuracy, which adopts convolutional neural networks to extract discriminative features of the fetal cardiac anatomical structures. To enhance the credibility of the RLDS, we provide a global visualizing explanation for the diagnosis process of our RLDS. Moreover, we visually explain the local feature map of the residual feature learning, making the residual learning more transparent. Extensive experiments demonstrate that our proposed RLDS is very effective in diagnosing fetal CHD. Furthermore, the proposed RLDS achieves a precision of 93% and a recall of 93% on the test set, which significantly improves the prenatal detection rate for the fetal CHD.

Echocardiography is essential for evaluating cardiac anatomy and function during early recognition and screening for congenital heart disease (CHD), a widespread and complex congenital malformation. However, fetal CHD recognition still faces many difficulties due to instinctive fetal movements, artifacts in ultrasound images, and distinctive fetal cardiac structures. These factors hinder capturing robust and discriminative representations from ultrasound images, resulting in CHD's low prenatal detection rate. Hence, we propose a multi-scale gated axial-transformer network (MSGATNet) to capture fetal four-chamber semantic information. Then, we propose a SPReCHD: four-chamber semantic parsing network for recognizing fetal CHD in the clinical treatment of the medical metaverse, integrating MSGATNet to segment and locate four-chamber arbitrary contours, further capturing distinguished representations for the fetal heart. Comprehensive experiments indicate that our SPReCHD is sufficient in recognizing fetal CHD, achieving a precision of 95.92%, a recall of 94%, an accuracy of 95%, and a F

Objective The most serious complication of Kawasaki syndrome (KS) is coronary artery lesions (CAL). About 20%-25% of KS will develop into severe CAL without intervention. Machine learning (ML) is a branch of artificial intelligence (AI), which integrates complex data sets on a large scale and uses huge data to predict future events. Besides, computers can reveal new relationships that doctors may not easy to find. The present study presented a model to predict the risk of CAL in KS children by different algorithms to achieve the early diagnosis of CAL. Methods A total of 158 children were enrolled from Women and Children’s Hospital, Qingdao University and divided into 7 to 3 as the training sets and the test sets for modeling and validation studies. The clinical manifestations and auxiliary examinations were collected as input features in our models based on the latest 6th edition diagnostic guidelines. Prior to applying the algorithm to modeling, the principal component analysis (PCA) was used to achieve dimension reduction for eliminating the high correlation between features and the Synthetic Minority Oversampling Technique (SMOTE) for promoting accuracy. There are several classifiers are constructed for models including the Random Forest (RF), the Logical regression (LG), and the eXtreme Gradient Boosting (XGBoost). Results The sensitivity and specificity of RF were 0.8 and 0.906, and the area under the curve (AUC) was 0.972. For LG, the sensitivity and specificity were 0.6 and 0.976. The XGBoost were 0.2 and 0.953, respectively. Conclusion Models are established through three different algorithms to achieve the best sensitivity and specificity. The RF was superior to other methods, which provides a reference for the prevention of CAL.

Background Hereditary spherocytosis (HS) is a common inherited red blood cell membrane disorder characterized by an abnormal increase of spherocytes in peripheral blood. SPTB gene mutation is one of the most common causes of HS; however, few cases of HS resulting from SPTB mutation in the Chinese population have been reported so far. Case presentation A 3-year-old Chinese girl presented to Qingdao Women and Children’s Hospital, Qingdao University, with atrial septal defect (ASD). Meanwhile, she was clinically diagnosed with HS. Whole genome sequencing (WGS) was performed for the proband and her parents for genetic molecular analysis. A novel SPTB mutation (c.1756delG) was detected by WGS and confirmed by Sanger sequencing in the proband. This mutation results in a frameshift with a premature termination codon in exon 12, leading to a nonsense mutation (p.Ala586Profs*7). Her parents had no similar symptoms, and blood routine and serum biochemical tests showed no significant abnormalities. The patient’s mother did not know of any relatives with HS-like symptoms. Percutaneous transcatheter closure was successfully performed for treating the ASD. Conclusion In this study, we identified a novel SPTB frameshift mutation in a Chinese girl with HS. This finding would expand the spectrum of SPTB mutations, provide a valuable insight into the genotyping of HS in the Chinese population, and contribute to the clinical management and genetic counseling in HS.

Background: It is reported that the adverse impact of nonpharmaceutical interventions (NPIs) on the mental health of children and adolescents may lead to psychologically related disorders during the coronavirus disease 2019 (COVID-19) period. Subject symptoms such as chest pain, chest tightness, and palpitation are closely related to increased stress and anxiety in children and adolescents. The present research aimed to determine the change in pediatric consult of the symptoms onset in children during the COVID-19 period compared with before and after the COVID-19 period.Methods: Children who visited Women and Children's Hospital, Qingdao University between January 23 to April 30, 2019 (pre-COVID-19 period), January 23 to April 30, 2020 (COVID-19 period), and January 23 to April 30, 2021 (post-COVID-19 period) presenting chest pain, chest tightness, and palpitation were recruited. Information to determine gender, ages, department for the initial visit, clinical manifestations, time from the latest onset to the visit, and diagnosis were recorded.Result: A total of 891 patients were enrolled in the present study (514 males; median age: 7.72). 123 patients presented during the pre-COVID-19 period while 130 during the COVID-19 period, nevertheless, the number substantially increased during the post-COVID-19 period (n=638). There was no significant difference among groups in the distribution of organic etiology. The median time from the latest onset to the visit during the pre-COVID-19 period was 7 days compared to 10 days during the COVID-19 period and 3 days during the post-COVID period. Conclusion: The pediatric consult of children with subject symptoms presented increased substantially during the post-COVID-19 period, with a less median time from the latest onset to the visit. The major etiology of subject symptoms was shown in favor of non-organic during the three periods.

Objective The aim is to develop a novel noninvasive prenatal testing (NIPT) method that simultaneously performs fetal aneuploidy screening and the detection of de novo and paternally derived mutations. Methods A total of 68 pregnancies, including 26 normal pregnancies, 7 cases with fetal aneuploidies, 7 cases with fetal achondroplasia or thanatophoric dysplasia, 18 cases with fetal skeletal abnormalities, and 10 cases with β‐thalassemia high risk were recruited. Plasma cell‐free DNA was amplified by Targeted And Genome‐wide simultaneous sequencing (TAGs‐seq) to generate around 99% of total reads covering the whole‐genome region and around 1% covering the target genes. The reads on the whole‐genome region were analyzed for fetal aneuploidy using a binary hypothesis T‐score and the reads on target genes were analyzed for point mutations by calculating the minor allelic frequency of loci on FGFR3 and HBB. TAGs‐seq results were compared with conventional NIPT and diagnostic results. Results In each sample, TAGs‐seq generated 44.7–54 million sequencing reads covering the whole‐genome region of 0.1–3× and the target genes of >1000×depth. All cases of fetal aneuploidy and de novo mutations of achondroplasia/thanatophoric dysplasia were identified with high sensitivities and specificities except for one false‐negative paternal mutation of β‐thalassemia. Conclusions TAGs‐seq is a novel NIPT method that combines the fetal aneuploidy screening and the detection of de novo FGFR3 mutations and paternal HBB mutations., Key Points What's already known about this topic? Recently, the improvement of noninvasive prenatal testing (NIPT) allowed the expanded detection of chromosomal copy number variants (CNVs) and monogenic diseases in fetus. However, the expanded detection of CNVs and monogenic disease usually requires separate experiment procedures such as quantitative polymerase chain reaction (qPCR), digital PCR or haplotype‐assisted approaches, which could not be integrated with the screening of chromosome aneuploidy and lack of laboratory efficiency What does this study add? We developed a novel NIPT method that could simultaneously detect fetal aneuploidies, autosomal dominant diseases, and the paternally inherited mutations of autosomal recessive diseases without additional experiments. We validated this method using the plasma samples of pregnant women carrying fetal achondroplasia, thanatophoric dysplasia, and β‐thalassemia, which showed promising results

Four-chamber (FC) views are the primary ultrasound (US) images that cardiologists diagnose whether the fetus has congenital heart disease (CHD) in prenatal diagnosis and screening. FC views intuitively depict the developmental morphology of the fetal heart. Early diagnosis of fetal CHD has always been the focus and difficulty of prenatal screening. Furthermore, deep learning technology has achieved great success in medical image analysis. Hence, applying deep learning technology in the early screening of fetal CHD helps improve diagnostic accuracy. However, the lack of large-scale and high-quality fetal FC views brings incredible difficulties to deep learning models or cardiologists. Hence, we propose a Pseudo-Siamese Feature Fusion Generative Adversarial Network (PSFFGAN), synthesizing high-quality fetal FC views using FC sketch images. In addition, we propose a novel Triplet Generative Adversarial Loss Function (TGALF), which optimizes PSFFGAN to fully extract the cardiac anatomical structure information provided by FC sketch images to synthesize the corresponding fetal FC views with speckle noises, artifacts, and other ultrasonic characteristics. The experimental results show that the fetal FC views synthesized by our proposed PSFFGAN have the best objective evaluation values: SSIM of 0.4627, MS-SSIM of 0.6224, and FID of 83.92, respectively. More importantly, two professional cardiologists evaluate healthy FC views and CHD FC views synthesized by our PSFFGAN, giving a subjective score that the average qualified rate is 82% and 79%, respectively, which further proves the effectiveness of the PSFFGAN.

Background: Fetal balloon atrial septoplasty (BAS) is performed through the restrictive foramen ovale in fetal cases with established hypoplastic left heart syndrome (HLHS) and an intact or highly restrictive atrial septum (RAS). Methods: In the current report, we present a case of high position BAS in a fetus with HLHS/RAS. Results: Echocardiography confirmed an adequate atrial opening above the foramen ovale and fetal pleural effusion resolved spontaneously 1 day after the procedure. Conclusion: To the best of our knowledge, the creation of a high position hole in the thinner part of the atrial septum, instead of the restrictive tiny hole, has not been reported in fetal cases with HLHS/RAS. Keywords: Congenital heart disease, Fetal balloon atrial septoplasty, Hypoplastic left heart syndrome, Intact or highly restrictive atrial septum

Nano-pore size is the key factor to determine the performance of porous membrane in various applications. The programmable and continuous manipulation of it remains as a great challenge. In this work, nano-porous shape memory polymer (SMP) membrane has been fabricated successfully in ternary blend of PVDF, PBSU and random copolymer (BMG) based on the special interface interaction and complicated phase behaviors among them. On one hand, phase separation takes place, producing bicontinuous structures with the characteristic size of microns including BMG rich phase and PVDF/PBSU mixed phase. The former provides shape memory effect in which cross-linked points and network play the roles of shape fixed phase and recovery phase respectively; on the other hand, exclusion of PBSU during crystallization of PVDF contributes to bicontinuous structures in nanoscale. The removal of PBSU based on double bicontinuous structures results in the interconnected nano-pores. The obtained nano-porous PVDF/BMG composite membranes possess not only shape memory performance, but also the interpenetrated channels. The pore size has been manipulated successfully by means of biaxial tension based on the proportional deformation in macro- and micro-scales. Our results provide a new strategy for the fabrication of nano-porous SMPs and the manipulation of pore size in them.

Syncope belongs to the transient loss of consciousness (TLOC), characterized by a rapid onset, short duration, and spontaneous complete recovery. It is common in children and adolescents, accounting for 1% to 2% of emergency department visits.Recurrent syncope can seriously affect children's physical and mental health, learning ability and quality of life and sometimes cardiac syncope even poses a risk of sudden death. The present guideline for the diagnosis and treatment of syncope in children and adolescents was developed for guiding a better clinical management of pediatric syncope. Based on the globally recent development and the evidence-based data in China, 2018 Chinese Pediatric Cardiology Society (CPCS) guideline for diagnosis and treatment of syncope in children and adolescents was jointly prepared by the Pediatric Cardiology Society, Chinese Pediatric Society, Chinese Medical Association (CMA)/Committee on Pediatric Syncope, Pediatricians Branch, Chinese Medical Doctor Association (CMDA)/Committee on Pediatric Cardiology, Chinese College of Cardiovascular Physicians, Chinese Medical Doctor Association (CMDA)/Pediatric Cardiology Society, Beijing Pediatric Society, Beijing Medical Association (BMA). The present guideline includes the underlying diseases of syncope in children and adolescents, the diagnostic procedures, methodology and clinical significance of standing test and head-up tilt test, the clinical diagnosis vasovagal syncope, postural orthostatic tachycardia syndrome, orthostatic hypotension and orthostatic hypertension, and the treatment of syncope as well as follow-up.

BACKGROUND AND OBJECTIVES: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a newly identified pathogen that mainly spreads by droplets. Most published studies have been focused on adult patients with coronavirus disease 2019 (COVID-19), but data concerning pediatric patients are limited. In this study, we aimed to determine epidemiological characteristics and clinical features of pediatric patients with COVID-19. METHODS: We reviewed and analyzed data on pediatric patients with laboratory-confirmed COVID-19, including basic information, epidemiological history, clinical manifestations, laboratory and radiologic findings, treatment, outcome, and follow-up results. RESULTS: A total of 74 pediatric patients with COVID-19 were included in this study. Of the 68 case patients whose epidemiological data were complete, 65 (65 of 68; 95.59%) were household contacts of adults. Cough (32.43%) and fever (27.03%) were the predominant symptoms of 44 (59.46%) symptomatic patients at onset of the illness. Abnormalities in leukocyte count were found in 23 (31.08%) children, and 10 (13.51%) children presented with abnormal lymphocyte count. Of the 34 (45.95%) patients who had nucleic acid testing results for common respiratory pathogens, 19 (51.35%) showed coinfection with other pathogens other than SARS-CoV-2. Ten (13.51%) children had real-time reverse transcription polymerase chain reaction analysis for fecal specimens, and 8 of them showed prolonged existence of SARS-CoV-2 RNA. CONCLUSIONS: Pediatric patients with COVID-19 presented with distinct epidemiological, clinical, and radiologic characteristics from adult patients. Nearly one-half of the infected children had coinfection with other common respiratory pathogens. It is not uncommon for pediatric patients to have prolonged fecal shedding of SARS-CoV-2 RNA during the convalescent phase.

Objective: To simultaneously detect fetal aneuploidies and single gene diseases using a novel noninvasive prenatal testing (NIPT) method called the Targeted And Genome-wide simultaneous sequencing (TAGs-seq). Design: Comparison of TAGs-seq NIPT results with conventional NIPT and diagnostic results. Setting: Shenzhen People’s Hospital and Chinese PLA General Hospital Population or Sample: 26 normal pregnancies, 7 pregnancies with fetal aneuploidies, 7 pregnancies with fetal achondroplasia (ACH) or thanatophoric dysplasia (TD), 18 pregnancies with ACH/TD-like ultrasound findings, and 10 pregnancies with fetal risk of beta-thalassemia. Methods: Plasma cfDNA was amplified by TAGs-seq to simultaneously obtain the whole-genome sequence of 0.1-3× depth and reads on target genes of >1000× depth. The whole-genome sequence was analyzed for fetal aneuploidy risk using a binary hypothesis T-score, and the reads on target genes were analyzed for single gene diseases by calculating minor allelic frequency of loci on FGFR3 and HBB. Main Outcome Measures: Concordance between the TAGs-seq NIPT, conventional NIPT and diagnostic results. Results: Consistent to conventional NIPT and diagnostic results, all cases of fetal aneuploidies and fetal ACH/TD were correctly identified from 58 pregnancies by TAGs-seq NIPT with high sensitivities and specificities. Two cases of paternal mutations of beta-thalassemia were correctly identified by TAGs-seq NIPT from 10 pregnancies, although one false-negative result was obtained. Conclusions: The TAGs-seq assay demonstrated a good potential to simultaneously detect fetal aneuploidies and single gene diseases as a novel NIPT method.

Idiopathic ventricular tachycardia (IVT) is the major cause of sudden cardiac death. Patients with IVT were usually manifested without structural heart disease. In this present study, we performed family-based whole genome sequencing (WGS) and Sanger sequencing for a 5-year-old Chinese boy with IVT and all the unaffected family members in order to identify the candidate gene and disease-causing mutation underlying the disease phenotype. Results showed that a novel heterozygous single-nucleotide duplication (c.128dup) and a novel heterozygous missense (c.3328A > G) variant in ABCA5 gene were identified in the proband. The single-nucleotide duplication (c.128dupT), inherited from his father and patrilineal grandfather, leads to a frameshift which results into the formation of a truncated ABCA5 protein of 50 (p.Leu43Phefs*8) amino acids. Hence, it is a loss-of-function mutation. The missense (c.3328A > G) variant, inherited from his mother, leads to the replacement of isoleucine by valine at the position of 1110 (p.Ile1110Val) of the ABCA5 protein. Multiple sequence alignment showed that p.Ile1110 is evolutionarily conserved among several species indicating both the structural and functional significance of the p.Ile1110 residue in the wild-type ABCA5 protein. Quantitative RT-PCR showed that the ABCA5 mRNA expression levels were decreased in the proband. These two novel variants of ABCA5 gene were co-segregated well among all the members of this family. Our present study also strongly supports the importance of using family-based whole genome sequencing for identifying novel candidate genes associated with IVT.

Background: With the ongoing outbreak of Coronavirus Disease 2019 (COVID-19), infected patients within and beyond the epidemic area, Wuhan, China, showed different epidemiological and clinical characteristics. Little is known about the pattern of coinfection with other common respiratory pathogens in COVID-19 patients outside of Wuhan. Methods: We conducted a double-centre study recruiting 68 patients with severe acute respiratory coronavirus 2 (SARS-CoV-2) infection confirmed by nucleic acid testing in Qingdao and Wuhan from January 17 to February 16, 2020. Indirect immuno-fluorescence was performed to detect the specific IgM antibody against common respiratory pathogens in collected acute phase serum. Findings: Of the 68 patients with SARS-CoV-2 infection, 30 (44.12%) were from Qingdao. The median age of Qingdao and Wuhan patients were 50 (IQR: 37-59) and 31 (IQR: 28-38) years, respectively, and the majority of patients were female in Qingdao (60.00%) and Wuhan (55.26%). Among COVID-19 patients in Qingdao, 24 (80.00%) of them had IgM antibodies against at least one respiratory pathogen, whereas only one (2.60%) of the patients in Wuhan had positive results for serum IgM antibody detection ( P

A 3-year-old girl was admitted to our hospital for the correction of atrial septal defect (ASD). Open heart operation with cardiopulmonary bypass is dangerous because the patient also had hereditary spherocytosis, which put her at risk for hemolytic anemia. Therefore, percutaneous transcatheter closure for ASD was chosen and performed successfully, which avoided the erythrocyte damage caused by cardiopulmonary bypass. This is the first time such a case has been reported, and we present an alternative approach for ASD with hereditary spherocytosis.

Lung adenocarcinoma (LAC) is the leading cause of cancer-related death worldwide. Aberrant expression of genes expressed preferentially in the lung tumor vasculature may yield clues for prognosis and treatment. Von Willebrand factor (vWF) is a large multifunctional glycoprotein with a well-known function in hemostasis. However, vWF has been reported to exert an anti-tumor effect, independent of its role in hemostasis. We investigated the expression of vWF in LAC through immunohistochemical staining of tumor tissue microarrays (TMAs). We found that vWF was overexpressed preferentially in the tumor vasculature of LAC compared with the adjacent tissue vasculature. Consistently, elevated vWF expression was found in endothelial cells (ECs) of fresh human LAC tissues and transplanted mouse LAC tissues. To understand the mechanism underlying vWF up-regulation in LAC vessels, we established a co-culture system. In this system, conditioned media (CM) collected from A549 cells increased vWF expression in human umbilical vein endothelial cells (HUVECs), suggesting enhanced expression is regulated by the LAC secretome. Subsequent studies revealed that the transcription factor GATA3, but not ERG, a known regulator of vWF transcription in vascular cells, mediated the vWF elevation. Chromatin immunoprecipitation (ChIP) assays validated that GATA3 binds directly to the +220 GATA binding motif on the human vWF promoter and A549 conditioned media significantly increases the binding of GATA3. Taken together, we demonstrate that vWF expression in ECs of LAC is elevated by the cancer cell-derived secretome through enhanced GATA3-mediated transcription.

Background: To assess the relationship between endothelial progenitor cells (EPCs) in peripheral blood and pulmonary hypertension (PH) in children with congenital heart disease (CHD) and explore the possibility of applying EPCs to treatment of PH in children with CHD. Methods: In this study, a total of 173 cases with CHD (from 0 to 6 years old) were collected. According to the right heart catheterization of mean pulmonary arterial pressure (mPAP) results, these cases were divided into PH groups (including high PH group, n=32, and the middle PH group, n=30) and non-PH group (n=111). We took their peripheral blood for flow cytometry, and counted the number of EPCs(CD133+/KDR+ cells). The number of EPCs /μL of peripheral blood was calculated using the following formula: EPCs /μL =WBC /L × lymphocytes % × EPCs % × 10-6. Results: The median EPCs of the non-PH group, middle PH group and high PH group are 1.86/μL, 1.30 /μL and 0.98/μL, respectively. The mPAP decreases steadily as the level of EPCs increases (P0.05). Conclusion: The findings revealed that the EPCs and high PH in CHD patients correlate significantly and EPCs may become an effective treatment for PH in CHD patients.EPCs may be a protective factor of high PH for children with CHD.

Sepsis, the systemic inflammatory responses after infection, remains a serious cause of morbidity and mortality in critically ill patients. The anti-malarial agent dihydroartemisinin (DHA) has been shown to be anti-inflammatory. In this study, we examined the effects of DHA on sepsis-induced acute kidney injury (AKI) and explored the mechanism underlying its mode of action in AKI. In a lipopolysaccharide (LPS)-induced mouse model, we observed that DHA treatment ameliorated glomerular injury, and relieved elevation of the urine albumin to creatinine ratio (UACR) and serum creatinine. At a concentration of 25 μM, DHA had no effect on overall cellular viability or apoptosis in assays with human renal glomerular endothelial cells (HRGECs), but significantly inhibited the tumor necrosis factor-α (TNF-α)-induced hyperpermeability of HRGEC monolayers. We found that TNF-α decreases the expression of the junctional protein occludin in HRGECs, which is reversed by DHA. Taken together, our results demonstrate that DHA decreases permeability of the glomerular endothelium by maintenance of occludin expression. This suggests DHA may have therapeutic utility in sepsis-induced AKI.

Background Surgical repair of doubly committed subarterial ventricular septal defect (VSD) under cardiopulmonary bypass has been the gold standard with full median sternotomy, complicated by skin scarring and potential mortalities and morbidities from cardiopulmonary bypass. Perventricular device closure of muscular and then perimembranous VSD on beating heats with a small subxiphoid or inferior sternotomy has been attempted in the past few years with good results. We have tried perventricular closure of doubly committed subarterial VSD through a left anterior minithoracotomy as an alternative procedure with a modified occluder. Methods Between January 2008 and December 2010, 6 selected patients with doubly committed subarterial VSD were recruited for modified device closure on beating hearts without cardiopulmonary bypass through left anterior minithoracotomy involving a short incision through the third intercostal space. Their ages ranged from 18 to 46 months and their body weights from 11 to 23 kg. A single per-right ventricular "U" like suture under pulmonic annulus was established, and a delivery system was introduced, aided by an 18G trocar, including a guidewire, delivery sheath, and loading sheath. A proper device was selected according to the VSD size established by transesophageal echocardiography (TEE), and then the device was released under real-time monitoring of TEE if no residual shunt, increased aortic prolapse or regurgitation, abnormal atrioventricular valvular motion appeared. Results In 5 of the 6 children, the device was successfully closed through a left minithoracotomy with satisfactory cosmetic effects. In the other child, the procedure was converted to conventional open-heart repair because the relatively larger occluder induced significantly increased aortic regurgitation. There was no operative or late mortality or major morbidity. All children were followed up for 10 to 21 months. No residual shunt, increased aortic prolapse or regurgitation, or serious atrioventricular block was recorded until the most recent follow-up. Conclusions Selected doubly committed subarterial VSD can be safely closed with a proper occluder through left anterior minithoracotomy. The Cosmetic results are highly satisfactory.

Objective: Both surgical and percutaneous device closure of ventricular septal defect (VSD) have drawbacks and limitations in infants. We report our experiences and midterm results of transthoracic device closure of VSDs (TDCVs) without cardiopulmonary bypass (CPB) in infants. Methods: Between September 2007 and September 2009, 32 patients, with a mean age of 7.2 4.7 months, body weight of 6.8 2.8 kg, underwent this procedure. The procedure was performed in the operating room. A small subxiphoid incision was made. A purse-string suture was placed on the right ventricular free wall. The free wall waspunctured usinga trocar, then a guidewire was insertedand advanced to cross the VSD into the left ventricle under transesophageal echocardiographic guidance. A modified delivery sheath was then introduced over the guide wire. Thedevicewasdeliveredanddeployedinpositionalongthesheathtoclosethedefect.Results:Atotalof30cases(94%)weresuccessfullyclosed, and the remaining two cases (6%) were converted to open heart repair. No patients received transfusion. There was no perioperative mortality, or any major complication. The mean size of the devices was 7.6 3.4 mm. The total operative time was less than 60 min, and the mean time for deviceimplantationwas18.3 9.4 min.Allpatientswereextubatedwithin2 h,andweredischargedwithin5daysafteroperation.Thefollow-up period ranged from 6 to 31 months (18.3 9.6 months). There was no late major complication detected. Conclusion: Minimally invasive TDCV without CPB is a safe and effective alternative to the conventional operation in low-body-weight infants. # 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.