We report an acute myocardial infarction patient with respiratory cardiac arrest in whom conventional cardiopulmonary resuscitation was invalid and extracorporeal cardiopulmonary resuscitation (ECMO) was performed. During ECMO, bloodstream infections caused septic shock. With the assistance of ultrasound and other techniques, cardiac function and volume status were evaluated, which provided a basis for making rational clinical decision. After shock resuscitation and anti-infection treatment, the patient's condition improved.

Objective

To investigate the incidence， associated characteristics， and postnatal follow-up results of ventricular septal defect （VSD） detected in a national ultrasound screening program for fetal congenital heart defects （CHDs） in China.

Methods

From January 1， 2011 to December 31，2013， a ultrasound screening for CHDs was investigated in 92 hospitals across 31 provinces/municipalities/autonomous regions in China.A total of 759 physicians in these hospitals， who had undergone standardized prenatal ultrasound training and obtained qualiflcations for prenatal diagnosis， participated in this research project.Fetal ultrasound screening was performed in accordance with relevant practice guidelines and hierarchical referral criteria.Data on fetuses with CHDs and their mothers were collected and uploaded using a “data investigation software” system developed by the research group.The incidence， associated characteristics， and follow-up outcomes of VSD was analyzed based on the aggregated data from 92 hospitals during the fetal cardiac screening.

Results

A total of 18 171 fetal CHD cases were identified from 2 452 249 pregnancies.Among these cases， 4345 fetuses were diagnosed with ventricular septal defect（VSD）， accounting for 23.9% of all CHD cases （4345/18 171）.The incidence of VSD was 17.72 per 10 000（4345/2 452 249； 95% confldence interval：17.20-18.25）， which was the highest among the 36 subtypes of CHD.The 31 provinces， municipalities， and autonomous regions in China were divided into six geographical regions.The highest incidence of fetal VSD was found in the eastern region （20.59 per 10 000； 854/414 815），while the lowest incidence occurred in the northwestern region （8.85 per 10 000； 109/123 189）.There was a statistically signiflcant difference in incidence among the six geographical regions （χ² = 166.71， P＜0.01）.Among the 4345 VSD cases， isolated VSD was identifled in 3171 cases （72.98%）， while 1015 cases （23.36%）were associated with extracardiac malformations.The top three extracardiac malformations were central nervous system anomalies （427 cases）， single umbilical artery and umbilical cord cysts （241 cases）， and craniofacial anomalies （219 cases）.A total of 534 VSD fetuses underwent genetic study for chromosomal abnormality， with 142 cases （27%） showing chromosomal abnormalities.The most common abnormalities were trisomy 21 （31 cases） and trisomy 18 （59 cases）.Postnatal follow-up was carried out for the fetal VSD cases， with 2835 fetuses born alive， 674 cases terminated， and 836 cases lost to follow-up.The concordance rate between prenatal screening results and postnatal veriflcation was 89.60% （3144/3509）.

Conclusion

This study provides the incidence of VSD in China， including the regional incidence in the six geographical regions， as well as types of extracardiac malformations associated with VSD， the incidence of chromosomal abnormalities， and the concordance rate between prenatal screening results and postnatal veriflcation.These flndings offer valuable foundational data for further research on fetal VSD.

Ureteral rupture is a rare and severe complication following extracorporeal shock wave lithotripsy（ESWL）.This article reports a case of a male patient who developed a ureteral rupture in the upper segment after undergoing ESWL for an upper ureteral stone.After treating with the placement of a ureteral stent for continuous decompression and drainage，the patient's symptoms were improved，and the rupture site was healed completely.Subsequently，a second session of ESWL successfully fragmented and expelled the stone.This article also discussed the clinical presentation，pathophysiology，and treatment options for this rare complication，in conjunction with a review of the literature.

Objective

Analyze the causes of ureteral stent fracture and retention，explore the treatment of ureteral stent and its complications，improve the vigilance of urological surgeons.

Methods

The data of a patient with ureteral stent fracture in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed and relevant literature was reviewed.

Results

Intraoperatively，fragmented and residual ureteral stent combined with bladder stones and right hydronephrosis were diagnosed.Cystoscopic lithotripsy and laparoscopic right pyeloplasty were performed，and the stent fragments were removed successfully.

Conclusion

The reasons of ureteral stent fracture include material factors of stent，patient factors and iatrogenic factors.Urological surgeons should be cautious about ureteral stent-related operation，choose appropriate treatment methods according to the degree of stent encrustation，stone burden and renal function，and strengthen communication with patients and follow-up visits to prevent the occurrence of stent neglect.

Objective

To investigate the clinical characteristics，treatment and prognosis of primary renal angiosarcoma （PRA）.

Methods

One case of primary renal angiosarcoma complicated with hemorrhage and multiple systemic metastases was retrospectively analysed and relevant literatures were reviewed.

Results

The patient was admitted to our hospital for “acute left abdominal pain for 5 hours”，CT revealed a tumor in his left kidney complicated with hemorrhage，palliative left nephrectomy was performed and pathologic diagnosis confirmed renal angiosarcoma，though chemotherapy，targeted therapy and immunotherapy were carried out.The patient's condition was stable during treatment.After 3 courses of comprehensive treatment，the patient gave up for economic reasons，and dead one-year after operation.

Conclusions

Primary renal angiosarcoma is an exceedingly rare and highly aggressive neoplasm with a poor prognosis，the final diagnosis depends on pathology.Once diagnosed，radical nephrectomy should be performed early，chemotherapy and radiotherapy should be followed after surgery，targeted therapy and immunotherapy may be effective treatments for PRA.