Transcatheter Closure of Perimembranous Ventricular Septal Defect Using the Amplatzer Duct Occluder II

Objective: To evaluate the efficacy of Amplatzer duct occluder II (ADO II) in the treatment of perimembranous ventricular septal defect (pmVSD) in children. Methods: Between June 2017 and June 2020, 13 patients with pmVSD had attempted transcatheter closure using ADO II, seven of patients were used antegrade approach and six of them were used retrograde approach. Results: There were 8 males and 5 females, age from 1 to 7 years, weight from 10.5 to 31.0 kg, and VSD size from 2.0 to 4.0 mm. Procedure was successful in all cases with the outer diameter of the occluders ranging from 4 to 6 mm. No aortic, tricuspid regurgitation or residual shunt was found in the immediate ultrasound assessment. No arrhythmia was observed in the Holter monitoring 3 days after the intervention. Discharge echocardiography indicated complete shunt closure. No evidence of occluder prolapse, malignant arrhythmia, or intensed valve regurgitation was seen on a median follow-up of 18 months (range, 6 to 36 months). Conclusions: Based on our experience, ADO II showed good efficacy in the early and middle stages of pediatric pmVSD closures.     

Effect of Substrate Plate Heating on the Microstructure and Properties of Selective Laser Melted Al-20Si-5Fe-3Cu-1Mg Alloy

The Al-20Si-5Fe-3Cu-1Mg alloy was fabricated using selective laser melting (SLM). The microstructure and properties of the as-prepared SLM, post-treated SLM, and SLM with substrate plate heating are studied. The as-prepared SLM sample shows a non-uniform microstructure with four different phases: fcc-αAl, eutectic Al-Si, Al₂MgSi, and δ-Al₄FeSi₂. With thermal treatment, the phases become coarser and the δ-Al₄FeSi₂ phase transforms partially to β-Al₅FeSi. The sample produced with SLM substrate plate heating shows a relatively uniform microstructure without a distinct difference between hatch overlaps and track cores. Room temperature compression test results show that an as-prepared SLM sample reaches a maximum strength (862 MPa) compared to the heat-treated (524 MPa) and substrate plate heated samples (474 MPa) due to the presence of fine microstructure and the internal stresses. The reduction in strength of the sample produced with substrate plate heating is due to the coarsening of the microstructure, but the plastic deformation shows an improvement (20%). The present observations suggest that substrate plate heating can be effectively employed not only to minimize the internal stresses (by impacting the cooling rate of the process) but can also be used to modulate the mechanical properties in a controlled fashion.     

Effect of Structural Build-Up on Interlayer Bond Strength of 3D Printed Cement Mortars

Understanding the relationship between the intrinsic characteristics of materials (such as rheological properties and structural build-up) and printability and controlling intrinsic characteristics of materials through additives to achieve excellent printability is vital in digital concrete additive manufacturing. This paper aims at studying the effects of material’s structural build-up on the interlayer bond strength of 3DPC with different time gaps. Structural build-up can indirectly affect the interlayer bond strength by affecting the surface moisture of concrete. Based on the structural build-up of 3DPC, a new parameter, maximum operational time (MOT), is proposed, which can be considered as the limit of time gap to ensure high interlayer bond strength. Slump-retaining polycarboxylate superplasticizer (TS) slightly slows down the physical flocculation rate, but increases the maximum operational time of the cement paste. Nano clay significantly increases the sort-term structural build-up rate and has the function of internal curing and water retaining. Composite with nano-clay and TS can reduce the loss of surface moisture of 3D printed layers, prevent the formation of interface weak layer, and increase the interlayer bond strength between printed layers. This contribution can provide new insight into the design of 3D-printed ink with good extrudability, outstanding buildability, and excellent interlayer bond strength.     

一站式CT能谱灌注成像预测兔腋窝淋巴结性质

目的 探讨一站式CT能谱灌注成像定量参数预测兔腋窝淋巴结性质的应用价值。方法 将60只新西兰纯种雌性大白兔随机分为2组,分别建立兔乳腺癌腋窝转移性淋巴结（转移组）与炎性淋巴结动物模型（炎症组）。于建模后第4周末对实验兔行一站式CT能谱灌注成像扫描,扫描完成后摘取腋窝淋巴结行病理检查,并与CT图像逐一对照。采用两独立样本t检验比较2组能谱参数和灌注参数的差异,以Logistic回归和ROC曲线分析单一参数和联合参数诊断实验兔腋窝淋巴结性质的效能。结果 转移组淋巴结的血流量（BF）、血容量（BV）、动静脉期碘浓度（IC）、标准化碘基值（NIC）和40~70 keV间的能谱曲线斜率（λ）均高于炎症组（P均<0.05）,平均通过时间（MTT）和表面通透性（PS）差异无统计学意义（P均>0.05）。最佳联合参数（BF+动脉期λ+静脉期λ）的AUC为0.942,以0.65为临界值,其诊断实验兔腋窝乳腺癌转移性淋巴结的敏感度、特异度、阳性预测值和阴性预测值分别为79.68%、95.92%、92.91%和82.70%。结论 一站式CT能谱灌注成像定量参数鉴别兔腋窝乳腺癌转移性淋巴结与炎性淋巴结的诊断效能较好,联合参数（BF+动脉期λ+静脉期λ）具有较高诊断价值。     

Implantable cardioverter defibrillator replacement guided by T wave safety margin in a short QT syndrome patient

We report implantable cardioverter defibrillator (ICD) generator replacement guided by T wave safety margin (TWSM) in a short QT syndrome patient with T wave oversensing (TWOS). During the procedure of generator replacement, the feature of ventricular sensing in four different ICDs was compared in the patient. The four ICDs showed different R and T wave amplitudes. Though R/T ratio is not the highest, Vitality ICD showed the highest TWSM and was implanted as replacing generator. During 20‐month follow‐up, the patient has been symptom‐free with no T‐wave oversensing episode. This case illustrates a method to evaluate the risk of TWOS before ICD implantation in patients with high risk of TWOS.     

Psychometric Properties and Factor Structure of the Center for Epidemiologic Studies Depression Scale in a National Sample of Arab Adolescents

Having valid, reliable, and culturally adapted tools to screen for adolescent depression is a crucial concern for mental health care professionals who promote preventive care. To this aim, this study tested the psychometric properties and factor structure of the Center for Epidemiologic Studies Depression (CES-D) Scale among Arab adolescents. A nationally representative sample of 3,292 Jordanian adolescents aged 13–17 completed the CES-D 20-item scale. A principal axis factoring with a varimax rotation was used to identify the factor structure of the scale on a half of the sample (n₁?=?1,655), followed by a confirmatory factor analysis to assess the fitness of the factor structure to the other half of the sample (n₂?=?1,637) on a variety of model-fit indices. Findings did not support the original four-factor structure. The results indicated that two factors provide a reasonably better fit: Factor 1 combined items on depressed affect, somatic complaints and interpersonal problems, and Factor 2 consisted of the remaining four positive affect items. The modified model showed high internal reliability and excellent construct validity. The results revealed that depression construct among Arab adolescents, as measured by the CES-D, differs from that in other ethnic groups. Nurses and other health professionals need to closely examine the different presentation of depressive symptoms across racial and ethnic groups to avoid diagnostic errors, inappropriate management, and poor compliance.     

Efficacy and safety of gemcitabine-oxaliplatin combined with huachansu in patients with advanced gallbladder carcinomaTian-Jie Qin,Xin-Han Zhao,Jun Yun,Ling-Xiao Zhang,Zhi-Ping Ruan,Bo-Rong Pan

AIM:To evaluate the efficacy and safety of gemcitabine-oxaliplatin(GEMOX)cornbined with huachansu(cinobufagin)injection treatment in patients with locally advanced or metastatic gallbladder carcinoma(GBC),and to assess the quality of life(QOL)of such patients.METHODS:Twenty-five patients with locally advanced or metastatic GBC were treated with intravenous gemcitabine(1000 mg/m2)over 30 min on days 1 and 8,2 h infusion of oxaliplatin(120 mg/m2)on day 1,and 2-3 h infusion of huachansu(20 mL/m2)on days-3-11,every 3-4 wk.Treatment was continued until occurrence of unacceptable toxicity or disease progression.QOL of patients was assessed by the EORTC QLQ-C30 at baseline,at the end of the first,third and sixth chemotherapy cycles,and 1 mo after the treatment.RESULTS:Among the 25 patients with a median age of 64 years(range 42-78 years),23 were evaluable in the study.A total of 137 cycles of therapy were performed and the median cycle was 5(range 1-8)per patient.Out of the 23 patients whose response could be evaluated,8 partial responses(PR)were observed(34.8%),while 7 patients(30.4%)demonstrated a stable disease(SD).The disease control rate was 65.2%.Progression of cancer was observed in 8(34.8%)patients.The median progression-free and overall survival time was 5.8 mo(95% CI:4.5-7.1 mo)and 10.5 mo,respectively.The therapy was well tolerated,with moderate myelosuppression as the main toxicity.Anemia grade 2 was seen in 16.0%,neutropenia grade 3 in 8.0% and thrombocytopenia grade 3 in 24.0% of patients,respectively.Non-hematologic toxicity ranged from mild to moderate.No death occurred due to toxicity.The QOL of patients was improved after chemotherapy,and the scores of QOL were increased by 10 t0 20 points.CONCLUSION:GEMOX combined with huachansu(cinobufagin)injection is well tolerated,effective,thus ireproving the QOL of patients with advanced GBC.(C)2008 The WJG Press.All rights reserved.