From 1982 till 1999, our department performed a total of 2970 heart valve replacements--92% of which were with mechanical heart valves. During this period, there were 8 patients who came to our department with mechanical heart valve obstruction. All these patients presented with signs of heart failure or compromised haemodynamic. Confirmatory tests included transthoracic or transoesophageal echocardiography and cine fluoroscopy. Seven patients were operated upon urgently. Four of the patients had valve thrombosis. The time interval between the initial implantation and presentation varies from 4 months to 11.3 years. Six of the seven patients who were operated on recovered well from the surgery.
A minimally invasive approach to aortic valve surgery through a transverse incision ("pocket incision") at the right second intercostal space was examined. Sixteen patients with a mean age of 30 years underwent this approach. The third costal cartilage was either excised (n = 5) or dislocated (n = 11). The right internal mammary artery was preserved. Cardiopulmonary bypass (CPB) was established with aortic-right atrial cannulation in all except the first case. Aortic valve replacements (AVR) were performed in 15 patients and one had aortic valve repair with concomitant ventricular septal defect closure. There was no mortality and no major complications. The aortic cross-clamp, CPB and operative times were 72 +/- 19 mins, 105 +/- 26 mins and 3 hrs 00 min +/- 29 mins respectively. The mean time to extubation was 5.7 +/- 4.0 hrs, ICU stay of 27 +/- 9 hrs and postoperative hospital stay of 5.1 +/- 1.2 days. Minimally invasive "pocket incision" aortic valve surgery is technically feasible and safe. It has the advantages of central cannulation for CPB, preservation of the internal mammary artery and avoiding sternotomy. This approach is cosmetically acceptable and allows rapid patient recovery.
Playing mobile MOBA games has become a popular leisure activity among Malaysian youth. However, MOBA games are highly addictive and have negative impacts on adult development. Inadequate local studies investigated the risk factors of excessive MOBA gameplay. The present study examined the (1) predictive role of need frustration on Internet gaming disorder (IGD) and (2) mediating effect of gaming motives. A total of 398 mobile MOBA gamers aged 18 to 29 participated in this cross-sectional online survey study. The findings showed that need frustration positively predicted IGD. Social, escape, competition, coping, and skill motives were significant mediators for the association between need frustration and IGD. However, fantasy and recreation motives were not significant mediators. MOBA players who were frustrated while fulfilling their basic needs may succumb to uncontrollable gaming behavior. Therefore, future prevention and intervention programs should cultivate positive mental strength for youth while meeting their basic needs.
This study analyzed the factors influencing adolescents' non-suicidal self-injury (NSSI) behavior and their interrelationships, and established a total influencing factor model. Through a literature analysis and semi-structured interviews with 87 adolescents and 27 experts in Guangxi Province, China, 13 influencing factors were identified from six aspects: physiological factors, cognitive factors, emotional factors, social support factors, social environment, and NSSI behavior. A system of factors influencing adolescents' NSSI behavior and a model of the factors influencing the comprehensive antagonism multilevel explanatory structure were obtained using a combination of Decision-Making Trial and Evaluation Laboratory technique and Total Adversarial Interpretive Structural Model. In descending order, NSSI, emotional state, self-efficacy, and self-cognition influenced adolescents' NSSI behavior. Social environment, exercise, and recreation had a greater impact on other factors, while NSSI, emotional regulation ability, and emotional state were greatly affected by other factors. Emotion regulation ability, self-cognition, self-efficacy, family support, school support, social support, and sleep were found to be the core factors influencing NSSI behavior of adolescents. These factors could be used to directly intervene in adolescent NSSI behavior. Timely treatment of adolescents' negative emotional states is directly conducive to preventing NSSI behavior and alleviating its severity.
Adolescence is the peak period of non-suicidal self-injury (NSSI) behaviour, and it is also a period when the prevention and intervention in NSSI are frequently required. To explore the relationship between catastrophising and NSSI and its mechanism, the mediating effects of parental support and negative emotions on catastrophising and NSSI were analysed. A questionnaire was administered to 401 middle school students with a history of NSSI behaviour from 12 schools in Guangxi. (1) Adolescents' catastrophising tendencies positively predicted their NSSI status through negative emotions (B = 0.274, P < 0.001). The more severe the adolescents' catastrophising tendency, the more likely they were to have stronger negative emotions and thus show an increased NSSI level. (2) Parental support played a positive moderating role between the tendency to catastrophise and negative emotions (B = -0.101, t = -2.694, P < 0.01), and it had a protective effect on adolescents' NSSI. Catastrophising was less likely to induce the NSSI behaviour by reducing adolescents' negative emotions (B = -0.104, t = -2.313, P < 0.05); however, it should be noted that only parental affective support, informative support, and instrumental support played a significant mediating role. Parental support of adolescents has positive effects on the tendency to catastrophise, negative emotions, and NSSI, and it has some implications for the prevention and intervention of adolescents' NSSI.