Management of acute type A aortic dissection during COVID-19 outbreak: Experience from Anzhen

OBJECTIVES

We seek to report our management protocol and early outcomes of acute type A aortic dissection (ATAAD) repair during the early phase of coronavirus disease 2019 (COVID-19).

METHODS

From January 23 to April 30, 2020, we performed ATAAD repair for 33 patients, including three with pregnancy-related TAADs. Confirmation of COVID-19 depended on the results of two nucleic acid tests and pulmonary computed tomography scan. Based on testing results and hemodynamic stability, patients were triaged to an isolated intensive care unit or negative pressure operating room for emergency surgery.

RESULTS

Mean age 50.2 ± 13.3 years and 20 were male (60.1%) and 8 patients were febrile (>37.3°C; 24.2%) and 17 were lymphopenic (51.5%). No patient was excluded from COVID-19 infection preoperatively. Extensive aortic repair with total arch replacement (TAR) was performed in 24 (72.7%), and limited proximal repair in 9 patients (27.3%). Cardiopulmonary bypass and cross-clamp times averaged 177 ± 34 and 88 ± 20 min for TAR, and 150 ± 30 and 83 ± 18 min for hemiarch, respectively. The mean operation time was 410 ± 68.3 min. Operative mortality was 6.1% (2/33). Complications included reintubation in four (12.1%), acute kidney failure in two (6.1%), and cerebral infarction in one (3.0%). No paraplegia nor re-exploration for bleeding occurred. COVID-19 was excluded in 100% eventually. No nosocomial infection occurred. Nor did any patient/surgical staff develop fever or test positive during the study period.

CONCLUSIONS

The results of this study show that our management protocol based on testing results and hemodynamic stability in patients with ATAAD during the COVID-19 pandemic was effective and achieved favorable early surgical outcomes.

[The clinical observation of external scleral plaque radiotherapy in patients with uveal melanoma]

Objective: To investigate the safety and efficacy of external scleral plaque radiotherapy (PRT) in the treatment of uveal melanoma (UM). Methods: This was a retrospective case series study. The data of 819 patients who underwent ophthalmic PRT from July 2007 to November 2017 at Tongren Hospital Affiliated to Beijing Capital Medical University was collected, including preoperative visual acuity, intraocular pressure and slit lamp microscope, color fundus photography, indirect ophthalmoscopy, color Doppler ultrasound, fundus fluorescein angiography, indocyanine green angiography, orbital nuclear magnetic resonance imaging, PRT times and time, complications, follow-up time, the maximum basal diameter and height of the tumor UM half a year after the applicator was removed, tumor metastasis rate, mortality and visual acuity observed at the last follow-up. The tumor growth was considered when the tumor height increased by 2.0 mm or the extension of any boundary of the tumor was 2.5 mm; otherwise, the treatment was defined as effective. The paired t test and Kaplan-Meier survival curve were used for statistical analysis. Results: There were 408 males and 411 females. The age ranged from 13 to 85 years (mean, 47 years). Nine patients had ciliary body melanoma, 43 patients had choroidal melanoma involving the ciliary body, and 767 patients had choroidal melanoma. In all 819 eyes, the tumor was medium-sized in 697 eyes and large in 110 eyes. All patients were treated with PRT only one time. The average radiotherapy time was 15 days (range, 6 to 50 d). All operations were successfully completed, with no active bleeding, infection, adjacent tissue injury and other related complications. At 6 months after the treatment, the maximum basal diameter of the tumor was (12.41±3.20) mm, which was significantly different from that before treatment (12.82±3.21) mm (t=2.40, P<0.01); the tumor height was (6.18±2.55) mm, which was significantly different from that before treatment (7.21±2.57) mm (t=4.05, P<0.01). The average follow-up time was (34±24) months (range, 1 to 125 months). Twenty-five patients lost follow-up at 2 years after the PRT, and 71 patients underwent enucleation. The effective rate of the PRT treatment was 88.3% (723/819), and the eyeball retention rate was 91.1% (723/794). The visual acuity remained stable in 393 eyes, decreased in 344 eyes, and improved in 82 eyes. Sixty patients had systemic metastasis (liver, bone or breast metastasis). Twenty-two patients died of tumor metastasis. The 5-year metastasis rate was 12.8%; the 5-year mortality rate was 5.8%; the 10-year metastasis rate was 20.6%; the 10-year mortality rate was 5.8%. Conclusions: PRT is safe and effective in the treatment for UM and can preserve some useful visual acuity. PRT can be used as the main treatment for medium-sized UM.(Chin J Ophthalmol, 2020, 56: 670-675).

Different hypothermic and cerebral perfusion strategies in extended arch replacement for acute type a aortic dissection: a retrospective comparative study

BACKGROUND

The optimal hypothermic level in total arch replacement with stented elephant trunk implantation for acute type A aortic dissection (aTAAD) has not been established, and the superiority of unilateral or bilateral cerebral perfusion remains a controversial issue. Therefore, we evaluated the application of moderate hypothermic circulatory arrest (MHCA) with a core temperature of 29 °C and bilateral selective antegrade cerebral perfusion in aTAAD treated by total arch replacement with stented elephant trunk implantation.

METHODS

From July 2019 to January 2020, 25 aTAAD patients underwent total arch replacement with stented elephant trunk implantation via MHCA (29 °C) and bilateral selective antegrade cerebral perfusion (modified group). Thirty-six patients treated by the same procedure with MHCA (25 °C) and unilateral selective antegrade cerebral perfusion during this period were selected as controls.

RESULTS

There were no differences between the two groups of patients in terms of age, sex, incidence of hypertension, malperfusion, and pericardial effusion, although the incidence of cardiac tamponade was higher in the modified group (control 2.8%, modified 20%; P = 0.038). The lowest mean circulatory arrest temperature was 24.6 ± 0.9 °C in the control group, and 29 ± 0.8 °C in the modified group (P <  0.001). In-hospital mortality was 4.9% (3/61) for the entire cohort (control 8.3%, modified 0; P = 0.262). The incidence of permanent neurologic deficit was 4.9% (control 8.3%, modified 0; P = 0.262). There were no significant differences in the occurrence of temporary neurological deficit, renal failure, and paraplegia between groups. The rate of major adverse events in the modified group was lower (30.6% vs. 4%, P = 0.019). A shorter duration of ventilation and ICU stay was identified in the modified group, as well as a reduced volume of drainage within the first 48 h and red blood cell transfusion.

CONCLUSIONS

The early results of MHCA (29 °C) and bilateral selective antegrade cerebral perfusion applied in total arch replacement with stented elephant trunk implantation for aTAAD were acceptable, providing similar inferior cerebral and visceral protection compared with that of the conventional strategy. A higher core temperature may account for the shorter duration of ventilation and ICU stay, as well as a reduced volume of drainage and red blood cell transfusion.

[Probiotics enhance the efficacy of fecal microbiota transplantation in severe acute liver injury]

Objective: To observe the changes of gut flora in mice, and explore the outcome of fecal microbiota transplantation combined with probiotics in the intervention of severe acute liver injury. Methods: Forty male BALB/c mice were selected and randomly divided into blank control group (10 mice), model group (10 mice), ordinary fecal microbiota transplantation group (10 mice), and fecal microbiota + probiotics transplantation group (10 mice). An intraperitoneal injection of d-galactosamine (D-GalN 3.0g/kg) was given to every group except the blank control group to induce severe acute liver injury model. Simultaneously, ordinary fecal microbiota transplantation group and fecal microbiota + probiotics transplantation group and modeling group were given enema solutions (once a day). After 48 hours, fetched serum was taken to detect alanine transaminase, aspartate transaminase and total bilirubin, and liver tissue was taken for pathological detection. The colonic content was used to extract DNA for 16S V3-V4 high-throughput sequencing. The results of sequencing were analyzed by using bioinformatics analysis; including OTU cluster analysis, α diversity analysis, β diversity analysis, and linear discriminant analysis effect size (Lefse) to find the bacteria with different colonic content characteristics in different groups of mice. Differences in clinical biochemical indicators between groups were compared using t-test, and the differences between 16S V3-V4 region sequencing results were compared using Wilcoxon test. Results: Model group mice serum biochemical parameters were higher than the other three groups, and the difference was statistically significant (P < 0.05). HE staining of liver sections showed severe inflammatory changes under the microscope in the model group. Ordinary fecal microbiota transplantation group and fecal microbiota + probiotic microbiota transplantation group had low levels of inflammation than the model group. The analysis results of 16S rRNA high-throughput sequencing showed that there was no statistically significant difference in Shannon's index between the blank control and the other three groups. Observed Species difference was statistically significant, and the gut flora composition varied greatly. Species number in the mice gut flora was increased with fecal microbiota transplantation. The results of β - diversity analysis showed that the difference between the blank control group and the other three groups was greater than that between the disease groups. The difference in the structure of the gut flora of the diseased mice in the fecal microbiota + probiotic transplantation group was mostly butyrate-producing bacteria. Conclusion: Fecal microbiota + probiotics enhance the therapeutic effect of fecal microbiota transplantation, improve liver inflammation, and increase the number of butyrate-producing bacteria in the gut.

[Analysis of treatment response and prognostic factors of T-LBL patients treated with pediatric-like ALL therapy following HSCT]

目的

探讨经急性淋巴细胞白血病（ALL）儿童方案治疗达到完全缓解（CR）和部分缓解（PR）的T淋巴母细胞淋巴瘤（T-LBL）患者应用造血干细胞移植巩固治疗的疗效及预后因素。

方法

收集2013年1月至2017年1月于唐都医院血液病中心接受治疗的T-LBL患者的临床资料，将达到CR或PR的患者纳入研究，进行回顾性分析。

结果

①48例患者接受了ALL儿童方案治疗，经2个疗程的诱导化疗后39例达CR，9例达PR。其中接受自体造血干细胞移植（auto-HSCT）者14例，接受异基因造血干细胞移植（allo-HSCT）者7例，21例患者移植后造血功能均顺利重建。②中位随访时间31（9～16）个月。3年总生存（OS）率为61.0%（95% CI 53.7%～68.3%），3年无进展生存（PFS）率为54.8%（95% CI 47.1%～62.2%）。③移植组和未移植组3年OS率分别为84.7%和42.8%（P＝0.006），两组3年PFS率分别为75.4%和38.9%（P＝0.004）。④auto-HSCT组与allo-HSCT组患者的OS率、PFS率差异均无统计学意义（P值分别为0.320、0.597）。⑤骨髓侵犯、未接受造血干细胞移植是影响患者长期预后的独立危险因素［ HR＝5.804（95% CI 1.140～29.549），P＝0.034；HR＝5.871（95% CI 1.711～20.140），P＝0.005］。

结论

ALL儿童方案化疗序贯造血干细胞移植治疗T-LBL疗效确切，安全性好。auto-HSCT与allo-HSCT患者的OS率及PFS率差异均无统计学意义。骨髓侵犯、未接受造血干细胞移植是影响T-LBL患者长期预后的独立危险因素。

Relationship Between Renal Function and Renal Artery Involvement in Acute Debakey Type I Aortic Dissection

BACKGROUND

The aim of this study was to analyse the differences in renal function among various types of renal artery involvement in acute Debakey Type I aortic dissection.

METHODS

From January 2016 to January 2018, 304 consecutive patients with acute Debakey type I aortic dissection with renal artery involvement were included. According to computed tomography angiography (CTA) findings, renal artery involvement on one side can be classified into four types: type A, in which a large intimal tear is near the renal artery orifice; type B, the orifice of the renal artery originates entirely from the false lumen; type C, the orifice of the renal artery originates entirely from the true lumen; and type D, a renal artery dissection is observed. All patients underwent aortic repair.

RESULTS

The average age was 46.98±10.64 years. The types of bilateral renal artery involvement were as follows: AB type, four patients (1.32%); AC type, 38 patients (12.50%); AD type, three patients (0.99%); BB type, 13 patients (4.28%); BC type, 140 patients (46.05%); BD type, four patients (1.32%); CC type, 76 patients (25.00%); and CD type, 26 patients (8.55%). One-way ANOVA showed that there was no significant difference in serum creatinine (P = .57) and creatinine clearance rate (P = .08) between the groups. A statistically significant difference in age, gender, body mass index, hypertension history and aortic dissection onset time also was not observed (P > .05). The overall incidence of KDIGO acute kidney injury (AKI) was 49.67%. There was no significant difference in AKI incidence between different types of renal artery involvement after aortic surgery (P = .39). For patients needing renal replacement therapy, CTA showed that enhancement of renal cortex in the arterial phase was low and the boundary between the cortex and medulla was unclear in bilateral kidneys.

CONCLUSION

The types of renal artery involvement did not affect renal function in the acute phase.

Is the frozen elephant trunk technique justified for chronic type A aortic dissection in Marfan syndrome?

Background

Chronic type A aortic dissection (cTAAD) in Marfan syndrome (MFS) is rare. Surgical experience is limited and the role of frozen elephant trunk (FET) technique remains undefined. We seek to evaluate the safety and efficacy of the total arch replacement (TAR) and FET technique for cTAAD in MFS.

Methods

The clinical data of sixty-eight patients with MFS undergoing FET and TAR for cTAAD were analyzed.

Results

Mean age was 35.8±9.7 years and thirty-nine were male (57.4%). Operative mortality was 10.3% (7/68). Stroke occurred in one (1.5%), re-exploration for bleeding in five (7.3%), low cardiac output in four (5.9%), and acute renal failure in two (2.9%). Follow-up was complete in 100% (61/61) at mean 7.3±4.0 years. The false lumen was obliterated in 73.5% across FET and 50.0% in unstented descending aorta (DAo). Distal dilation occurred in twenty patients, six of whom underwent thoracoabdominal aortic replacement, one abdominal aortic replacement and one thoracic endovascular aortic repair (TEVAR). Late death occurred in five. At ten years, 59.8% were free from distal aortic dilation, and the incidences were 23.2% for death, 14.4% for distal reoperation, and 62.4% for reoperation-free survival. Predictors for operative mortality were extra-anatomic bypass [odds ratio (OR), 229.592; P=0.036], preoperative maximal size (DMax) of aortic sinuses (mm) (OR, 1.134; P=0.032) and cardiopulmonary bypass (CPB) time (minute) (OR, 1.061; P=0.041). Risk factors for aortic dilatation included patent false lumen at diaphragmatic hiatus [hazard ratio (HR), 5.374; P=0.008], preoperative DMax (mm) of proximal DAo (HR, 1.068; P=0.001) and renal arteries (HR, 1.102; P=0.005) which also predicted distal reoperation (HR, 1.149; P=0.001). The time from onset to operation (day) (HR, 1.002; P=0.004) and CPB time (minute) (HR, 1.032; P=0.036) predicted late death.

Conclusions

This study shows that the TAR and FET technique is a safe and durable approach to cTAAD in patients with MFS. The operation should be performed as early as possible to optimize clinical outcomes.

Clinical characteristics and risk factors for fatal outcome of patients receiving Sun's procedure after previous cardiac surgery

BACKGROUND

Cardiac reoperation has always been a difficult problem in clinical practice. Because of the difficulty of operation, the incidence of complications and mortality rate is high. Secondary aortic surgery, especially the reoperation involving arch, has higher risk and is more difficult for patients with renal failure. Sun's operation (total arch replacement + stent elephant nose) has achieved good results in the treatment of diseases involving aortic arch, and occupies an important position in the treatment of patients with secondary arch lesions after cardiac surgery.

METHODS

A total of 395 patients with a history of cardiac surgery were recorded in our center from January 1, 2009 to December 31, 2017, among whom 118 (30.1%) patients underwent aortic reoperation via the original incision using Sun's aortic procedure owing to postoperative great vessel disease. We analyzed the clinical data and survival time, and used Cox regression to analyze the risk factors for 30-day mortality as well as long term mortality.

RESULTS

The interval between the last operation and the present operation was 0.08-19 years. Sixteen patients died within 30 days after operation and the average mortality rate was 13.6%. During the follow-up period, 28 patients died, with the mortality rate of 23.7%. As of December 31, 2017, the longest survival time was 9.36 years, and the survival time of 70 patients was more than 3.05 years. The main risk factor associated with the 30-day survival was cardiopulmonary bypass (CPB) time. The longer the CPB time was, the greater the risk of death was. The main risk factors associated with the long-term survival were CPB time and 24-h bleeding volume. The longer the CPB time was, the more the 24-h bleeding volume was, the higher long-term mortality rate was.

CONCLUSION

The second Sun's operation, as a surgical treatment after cardiac surgery, showed a high survival rate, with long survival time and good curative effect. CPB is the main risk factor for the 30-day survival state after operation, and CPB time and 24-h bleeding volume are the main risk factors for the long-term survival state after operation.

Repair of Type Ia Endoleaks Involving the Distal Arch Using Left Subclavian Artery-Left Common Carotid Artery Transposition with a Stented Elephant Trunk

BACKGROUND

Type Ia endoleaks are common after thoracic endovascular aortic repair (TEVAR). However, the repair of type Ia endoleaks involving the distal arch is challenging because of the presence of the interventional endografts, potential damage to the aortic arch vessels, and the location and size of the aneurysmal body. We retrospectively reviewed our experience of the surgical treatment of type Ia endoleaks with distal arch involvement using left subclavian artery (LSCA)-left common carotid artery (LCCA) transposition with a stented elephant trunk.

METHODS

Sixteen patients (male = 16; mean age, 47 ± 9 years, range 31-63 years) with type Ia endoleaks involving the distal arch underwent LSCA-LCCA transposition with a stented elephant trunk from July 2010 to July 2018. TEVAR failure occurred in 12 patients, re-TEVAR was performed in two patients, hybrid aortic arch repair in one patient, and the chimney technique in one patient.

RESULTS

There were no in-hospital deaths. Fourteen patients required mechanical ventilation for <24 h and one for <48 h. One patient required reintubation after mechanical ventilation for 19 h and continuous renal replacement therapy because of renal failure. One patient received pericardial drainage, and recurrent laryngeal nerve injury occurred in one patient. Three patients died during follow-up.

CONCLUSIONS

The LSCA-LCCA transposition with a stented elephant trunk can produce satisfactory results in patients with a type Ia endoleak involving the distal arch. Using this technique, it is possible to exclude the aneurysm sac distal to the LCCA origin and seclude the failed interventional endograft. These encouraging outcomes suggested that this technique could be a suitable surgical treatment for this type of lesion.

Spin-structures of the Bose-Einstein condensates with three kinds of spin-1 atoms

We have performed a quantum mechanic calculation (including solving the coupled Gross-Pitaevskii equations to obtain the spatial wave functions, and diagonalizing the spin-dependent Hamiltonian in the spin-space to obtain the total spin state) together with an analytical analysis based on a classical model. Then, according to the relative orientations of the spins S_A, S_B and S_C of the three species, the spin-structures of the ground state can be classified into two types. In Type-I the three spins are either parallel or anti-parallel to each other, while in Type-II they point to different directions but remain to be coplanar. Moreover, according to the magnitudes of S_A, S_B and S_C, the spin-structures can be further classified into four kinds, namely, p + p + p (all atoms of each species are in singlet-pairs), one species in f (fully polarized) and two species in q (a mixture of polarized atoms and singlet-pairs), two in f and one in q, and f + f + f. Other combinations are not allowed. The scopes of the parameters that supports a specific spin-structure have been specified. A number of spin-structure-transitions have been found. For Type-I, the critical values at which a transition takes place are given by simple analytical formulae, therefore these values can be predict.

[Application of three methods in occupational health risk assessment of automobile 4S shop]

Objective: To choose various occupational health risk assessment of the mature methods at home and abroad respectively occupational health risk assessment was carried out on the 4s stores, to explore different risk assessment methods on the 4 s shop the applicability of the occupational health risk assessment. Methods: Chemical was applied on the harmful factors of occupational health risk assessment technology guideline in the composite index method, quantitative cancer risk assessment method using the guidelines for the harmful factors of occupational health risk assessment of chemical technology of composite index method, quantitative cancer risk assessment method, international commission on mining and metals (ICMM) occupational health risk assessment quantitative method and the occupational-disease-inductive operation classification to evaluate chemical factors in 4S store, Combined with on-site occupational health investigation to compare with the result of risk assessment and analysis of international mining and metals (ICMM) committee occupational health risk assessment quantitative method and the occupational-disease-inductive operation classification of 4S store to evaluate chemical factors, combined with on-site occupational health investigation comparison and analysis the result of the risk assessment. Results: Except for 6 times, the results of ICMM matrix method and comprehensive index method were consistent, which were all higher than job classification. The other results were job classification of >of ICMM matrix method >comprehensive index method or job classification of >of ICMM matrix method. Conclusion: When the concentration of occupational-disease-inductive factors is lower than 1/2 limit, the risk assessment results tend to be ICMM quantitative >composite index method >operation classification. When the occupational-disease-inductive factors were involved with triphenyl, the quantitative non-carcinogenic risk assessment method was more likely to reach the conclusion that the occupational health risk was unacceptable.

Differential protein analysis of Heracleum moellendorffii Hance seeds during stratification

Heracleum moellendorffii Hance is a medicinal vegetable species, and the seed dormancy of this species has caused many agricultural problems. One stratification technique involves alternating layers of seeds and substrate to allow post-ripening of dormant seeds under appropriate environmental conditions and to release dormancy. Non-stratified seeds (NS), cotyledon-stage-embryo seeds (CS) and germinated seeds (GS) represent key stages of H. moellendorffii seeds during stratification. To better understand the breaking of dormancy caused by stratification, tandem mass tag (TMT) mass spectrometry (MS)/MS was used to detect proteins among NS, CS and GS. A total of 876 proteins were identified, which were subjected to Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses. The results showed that carbohydrate metabolic processes, responses to stress and ribosome biogenesis were the main biological processes. The changes in protein accumulation were validated by qRT-PCR. The results showed that starch, sucrose, pyruvate and fatty acid metabolism played significant roles and that the contents of stored substances were gradually degraded during stratification. This study provides a theoretical basis in terms of proteomics for exploring the post-ripening and germination of H. moellendorffii seeds.

[Analysis of 18 cases of toxic encephalopathy caused by occupational acute 1, 2-dichloroethane poisoning]

Retrospective analysis of 18 cases of occupational acute 1, 2-dichloroethane (1, 2-DCE) poisoning. The results showed that all patients have the main manifestations such as dizziness, headache, unresponsiveness and other symptoms of nervous system damage; Brain CT showed varying degrees of diffuse white matter lesions. Brain MRI showed extensive involvement of white matter in both cerebral hemispheres. Affected white matter area presented low intensity on T1WI, hyperintensity on T2WI and T2-Flair; Lumbar puncture examination of cerebrospinal fluid (CSF) pressure (262.5±48.39) mm H(2)O; After treatment, the required time for CSF pressure to restore was (161.56±75.27) days (50-280) days. Summary, Occupational acute 1, 2-DCE poisoning caused by toxic encephalopathy can be manifested as persistent abnormalities in CSF pressure, and the CSF pressure drops slowly during treatment; Early head CT and lumbar puncture examination will be helpful for early detection of intracranial pressure in toxic encephalopathy caused by acute 1, 2-DCE poisoning. Dynamic monitoring of CSF provides guidance for acute 1, 2-DCE poisoning with a long time of treatment and various types of dehydrating agents.

[Analysis of common gynecological diseases in 1142 married female workers]

Objective: To understand the prevalence of gynecologic diseases among married female workers. Methods: The data of married female workers who underwent occupational health examination in a physical examination center from January to December 2017 were collected. The relationship between the detection of common gynecological diseases, age and occupational types examined by gynecological routine, TCT, breast B-mode ultrasound, uterus and appendix B-mode ultrasound were analyzed. Results: Among the 1142 female workers, the total detection rate of reproductive tract infections was 67.25% (768/1142), the total detection rate of breast-related diseases was 75.22% (859/1142) ; the total detection rate of gynecological tumors and benign lesions was 14.71% (168/1142). The detection rate of breast hyperplasia was the highest 67.08% (766/1142), followed by vaginitis 51.66% (590/1142). Among the abnormalities detected in breast-related diseases, gynecological tumors and benign lesions, the highest detection rate was found in public institutions (85.66% and 27.13%), and the lowest was found in factory workers (70.24% and 7.89%). With the increase of age, the detection rate of breastrelated diseases (breast hyperplasia, breast cyst), gynecological tumors, benign lesions (uterine myoma), and Nessler's cyst abnormalities in married female workers increased (χ(2)(trend)=7.647、21.653、107.411、53.802, P<0.05), while the detection rate of columnar epithelium of cervix decreased (χ(2)(trend)=7.404, P<0.05). There was no significant difference in the total detection rate of reproductive tract infectious diseases (vaginitis, cervical polyps, cervical hypertrophy) among married famale workers of different ages (P<0.05) . Conclusion: The common gynecological diseases of married female workers are affected by many factors such as age and occupation. Health examination and health education should be carried out regularly to reduce the incidence of gynecological diseases among female workers according to different ages and occupations.

[Survey of Schistosoma japonicum infections in wild animals in hilly transmission-controlled areas of Jiangxi Province]

OBJECTIVE

To understand the situation of Schistosoma japonicum infections in wild animals in transmission-controlled schistosomiasis-endemic areas in Jiangxi Province, so as to provide scientific evidence for implementing precision control interventions and achieving the goal of transmission interruption and elimination of schistosomiasis.

METHODS

Five endemic villages from Ruichang City and Pengze County that were heavily endemic for schistosomiasis in Jiangxi Province, were selected as the study villages. Wild animals like wild mice were captured, and the livers of wild animals were purchased from the snail habitats in the study villages for detection of S. japonicum infections. In the study villages, S. japonicum human infections were screened using indirect hemagglutination assay (IHA) followed by parasitological examinations with miracidial hatching test and Kato-Katz method, and the S. japonicum infection in livestock was tested using a miracidial hatching test with a plastic tube. In addition, snail survey was conducted in the study villages by means of systematic sampling combined with environmental sampling, and the S. japonicum infection in snails was detected using a loop-mediated isothermal amplification (LAMP) assay.

RESULTS

A total of 240 liver specimens were sampled or purchased from 5 species of wild animals in the study villages, including wild mice, weasels, pigs, deer and rabbits. A total of 172 wild mice were captured, with a 2.91% rate of S. japonicum infection, and there was no S. japonicum infection detected in other wild animals. The prevalence of Capillaria hepatica infection was 12.21%, 1.96% and 12.50% in wild mice, deer and pigs, respectively. In addition, there was no S. japonicum infection found in either humans or livestock in the study villages, and the mean snail density varied from 0.13 to 0.80 snails/0.1 m² in the study villages. LAMP assay detected S. japonicum infection in 2 tubes in a study village.

CONCLUSIONS

The role of wild animals in schistosomiasis transmission and their potential risks can not be neglected in hilly schistosomiasis-endemic areas of Jiangsu Province after transmission control. Intensified surveillance and targeted control measures should be implemented to consolidate schistosomiasis control achievements.

P5294Metabolically healthy obese is associated with better left atrial function and lower risk of adverse cardiovascular events including atrial fibrillation

Purpose

Metabolic syndrome (MetS) and obesity are both crucial risk factors for heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF). However, the prognostic value of utilizing left atrial (LA) deformation imaging in metabolically healthy obese (MHO) or metabolically unhealthy normal weight (MUNW) subjects remains largely unexplored.

Methods

Speckle-tracking echocardiography was used to evaluate LA strain and strain rate among 3,915 subjects free from clinical heart failure (mean age: 50.0±10.6 years, 66.2% male) undergoing annual cardiovascular health survey. Metabolically unhealthy was defined by the presence of at least one MetS component or history of cardiovascular disease. Participants were categorized as: metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUNW), metabolically healthy overweight/obese (MHO), metabolically unhealthy overweight/obese (MUO).

Results

Markedly decreased LA strain, early-diastolic LA strain rate and increased LA stiffness were observed with metabolic disorders (all trend p: <0.05). During a median follow-up period of 3.68 years, significantly higher risk of primary endpoints (death, heart failure, major cardiovascular events) was observed in MUO vs. MHO (HR=1.87, p=0.005) and MUNW vs. MHNW (HR=2.82, p=0.004). Similar patterns with incident AF (MUO vs MHO: HR=3.05, p=0.001, MUNW vs MHNW: HR=4.04, p=0.002) were also observed. After multivariate adjustment, risk of AF remained associated with low LA strain (β=−0.07, p<0.001), systolic LA strain rate (β:−0.05, p=0.007) and high LA stiffness (β=0.18, p<0.001).

Comparison between metabolic groups MHNW (N=1107) MUNW (N=255) p (MUNW vs MHNW) MHO (N=1859) MUO (N=694) p (MUO vs MHO) Age 48±10.57 54.29±11.52 <0.001 49±10.02 54.21±10.49 <0.001 LA GLS (%) 40.6±7.68 37.16±7.5 <0.001 36.77±7.66* 33.58±8.01‡ <0.001 LA SRs 1.79±0.41 1.76±0.48 NS 1.63±0.39* 1.55±0.41‡ <0.001 LA SRe 2.11±0.62 1.8±0.63 <0.001 1.68±0.55* 1.48±0.52‡ <0.001 LA stiffness 0.17±0.08 0.22±0.12 <0.001 0.21±0.11* 0.25±0.13‡ <0.001 *p<0.001 for MHO vs MHNW, ‡p<0.001 for MUO vs MUNW. LA GLS = left atrial global longitudinal strain, LA SRs = left atrial systolic strain rate, LA SRe = left atrial early-diastolic strain rate, NS = non-significant.

Kaplan-Meier curves of adverse events

Conclusion

Metabolic abnormality may contribute to certain aspects of mechanistic LA dysfunction tightly linked to clinical events, even with normal lean body mass. Our observations may be insightful for targeted interventions in higher-risk patients with subclinical atrial dysfunction.

[An investigation of an accident of acute mixed gas poisoning]

An accident of mixed acute gas poisoning accident happened in a place in GuangDong in March 2018. To investigates three poisoning workers and related clinical data were summarized., we tested the field air and analyzed the accident reasons. This event due to the staff lack of occupational protection awareness and illegal operation. The working environment must be ventilated before limited space operation, and must be sure that the limited space is safe by toxic gas monitoring. In case of occupational acute gas poisoning, rescuers should help the persons who are poisoned reasonably and meanwhile their own safety.