Postoperative morbidity and mortality of patients with COVID-19 undergoing cardiovascular surgery: an inverse propensity-weighted study : Postoperative outcomes of patients undergoing cardiovascular surgery during the COVID-19 pandemic.

BACKGROUND: To evaluate the postoperative morbidity and mortality of patients undergoing cardiovascular surgery during the 2022 nationwide Omicron variant infection wave in China. METHODS: This retrospective cohort study included 403 patients who underwent cardiovascular surgery for the first time during the 2022 wave of the pandemic within 1 month. Among them, 328 patients were preoperatively diagnosed with COVID-19 Omicron variant infection during the pandemic, and 75 patients were negative. The association between Omicron variant exposure and postoperative prognosis was explored by comparing patients with and without COVID-19 exposure. The primary outcome was in-hospital death after cardiovascular surgery. The secondary outcomes were major postoperative morbidity, including myocardial infarction (MI), acute kidney injury (AKI), postoperative mechanical ventilation hours, ICU stay hours, and postoperative length of stay. The data were analyzed using inverse probability of treatment weighting (IPTW) to minimize bias. RESULTS: We identified 403 patients who underwent cardiovascular surgery, 328 (81.39%) had Omicron variant infections. In total, 10 patients died in the hospital. Omicron variant infection was associated with a much greater risk of death during cardiovascular surgery after adjustment for IPTW (2.8% vs. 1.3%, adjusted OR 2.185, 95%CI = 1.193 to 10.251, P = 0.041). For major postoperative morbidity, there were no significant differences in terms of myocardial infarction between the two groups (adjusted OR = 0.861, 95%CI = 0.444 to 1.657, P = 0.653), acute kidney injury (adjusted OR = 1.157, 95%CI = 0.287 to 5.155, P = 0.820), postoperative mechanical ventilation hours (B -0.375, 95%CI=-8.438 to 7.808, P = 0.939), ICU stay hours (B 2.452, 95%CI=-13.269 to 8.419, P = 0.660) or postoperative stay (B -1.118, 95%CI=-2.237 to 1.154, P = 0.259) between the two groups. CONCLUSION: Perioperative COVID-19 infection was associated with an increased risk of in-hospital death among patients who underwent cardiovascular surgery during the Omicron variant wave of the pandemic.

Ductility Variation and Improvement of Strain-Hardening Cementitious Composites in Structural Utilization.

Strain-hardening cementitious composite (SHCC) has the obvious advantages of excellent material properties such as its high tensile and compressive strengths, high tensile strain capacity, and excellent durability against multi-cracking performance with very fine crack widths. In particular, the multi-cracking performance of SHCC during structural utilization is obviously reduced compared to that of SHCC in uniaxial tension tests using dumbbell-shaped specimens of small size. The corresponding tensile strain capacity of SHCC during structural utilization is, thus, significantly decreased compared to that of SHCC in uniaxial tension tests. However, the reduction in the ductility of SHCC during structural utilization has not been sufficiently understood, and further study is required. This paper presents an experimental investigation into the ductility variation of flexural-failed and shear-failed SHCC members as well as the ductility improvement of SHCC members with steel reinforcement compared with that of SHCC in uniaxial tension tests using small-sized specimens. This study focuses on not only the decrease in the crack elongation performance of the SHCC material during structural utilization but also the increase in the crack elongation performance of SHCC members with steel reinforcement. The results demonstrate that the crack elongation performance of flexural-failed and shear-failed SHCC members is significantly reduced compared to that of SHCC in the uniaxial tension tests. Moreover, it was confirmed that steel reinforcement can effectively improve the SHCC member, increasing the strain-hardening capacity and multi-cracking performance. The load-carrying capacity of the flexural-failed SHCC member with steel reinforcement seemed to increase linearly with an increase in the reinforcement ratio, accompanied by an increase in the distribution of multiple fine cracks in the flexural-failed SHCC member with steel reinforcement.

Application of 3D Printing Navigation Template Technology in Severe Hallux Valgus Surgery.

OBJECTIVES: To explore the application of 3D printed navigation template technology in severe Hallux valgus surgery. METHODS: Forty-eight patients with severe Hallux valgus were selected. There were 24 cases in the control group underwent hallux valgus osteotomy using traditional methods and fixed with fully threaded hollow screws during the surgery. There were 24 cases in the 3D group who underwent personalized osteotomy using 3D printing navigation template technology. Patients were followed up regularly for six months after surgery. RESULTS: The surgery time of the 3D group was shorter than that of the control group, and the intraoperative bleeding was reduced (P<0.05). Compared with the preoperative data, the HVA and IMA significantly reduced immediately and 1, 3, and 6 months after surgery (P<0.05). The VAS scores decreased significantly, while the AOFAS and SF-36 scores increased (P<0.05). At three months and six months after surgery, the VAS score of the 3D group was lower than that of the control group, while the SF-36 score was higher (P<0.05). During the follow-up period, both groups had no recurrent cases or complications. CONCLUSIONS: The 3D printing navigation template technology improves patients' prognosis, functional recovery, and quality of life.

Measurement and correction of lateral distortion in a Fizeau interferometer based on the self-calibration technique.

The lateral distortion of a surface measuring Fizeau interferometer may cause distorted image features in the lateral direction, as well as the surface form error in the axial direction (which is a source of the retrace error). Traditional method for lateral distortion measurement requires a high-accuracy calibration plate featuring a grid pattern. Such a calibration plate is not always available, especially when the required accuracy of the grid pattern comes to the order of sub-micrometer or even nanometer level. To remove the dependence on the plate accuracy, we propose a self-calibration method for the measurement and correction of lateral distortion in Fizeau interferometer. The self-calibration technique may separate the lateral distortion and the geometric error of the calibration plate. This method is verified using a 108-mm-aperture Fizeau interferometer. The experiments show that the form measurement error of a surface tilted at approximately 5° and 16° can be reduced from 92 nm to 43 nm and from 251 nm to 144 nm (peak-to-valley value), respectively, after the distortion correction.

A modified three-incision approach to treating three-column Lisfranc injuries.

PURPOSE: The most popular surgical approach to manage Lisfranc fracture-dislocations is the double-incision approach, which frequently causes a variety of complications, such as skin necrosis, rotational malreduction of the first tarsometatarsal joint (TMTJ) and lateral column dorsoplantar malreduction of the TMTJ. We introduce a three-incision approach to treat Lisfranc fracture-dislocations with only minor postoperative complications and good foot function. METHODS: We prospectively selected 30 previously healthy patients, ranging from 18 to 60 years of age, but only 23 patients completed the follow-up and thus were finally included, with an average age of 38.1 ± 12.9 years. All patients have sustained Lisfranc fracture-dislocations involving all three-column; 13.0% (3/23) were Myerson classification type A (medial), 47.8% (11/23) were type A (lateral), and 39.1% (9/23) were type C2. All patients were treated via a three-incision approach: a long incision made along the lateral border of the second ray was used as a working incision to visualize and reduce the first three TMTJs, as well as to apply internal fixation instrumentation; a 2 cm medial incision was made at the medial side of the first TMTJ as an inspecting incision, ensuring good reduction of the first TMTJ in medial and plantar view; another 1 cm inspecting incision was made at the dorsal side of the fourth/fifth TMTJ to prevent sagittal subluxation of the lateral column. Mean ± SD was used for quantitative data such as operation time, follow-up time and foot function scores. Postoperative complications were documented, and foot function was evaluated using the American orthopaedic foot & ankle society score, foot function index and Maryland foot score at follow-up. The foot function of the injured foot and contralateral foot of the same patient was at the end of follow-up, and independent sample t-test was used for statistical analysis. RESULTS: The median operation time was 117.9 ± 14.6 min (range 93 - 142 min). All complications occurred within three months after the operation, and included delayed wound healing (17.4%), superficial infection (8.7%), complex regional pain syndrome (4.3%) and neuroma (4.3%). There was no case of postoperative skin necrosis or malreduction. At the end of follow-up of 14.1 ± 1.2 months (range 12-16 months), the median American orthopaedic foot & ankle society score of the operated foot was 89.7 ± 5.7, the median foot function index was 21.7 ± 9.9, and the median Maryland foot score was 88.7 ± 4.8. There were no significant differences between the operated and contralateral sides, in terms of foot function, at the end of followup (p > 0.05). CONCLUSION: The three-incision approach can provide adequate visualization of all TMTJs to ensure anatomical reduction and offer sufficient working space to apply internal fixation instrumentation, which is effective in treating three-column Lisfranc fracture-dislocations with minor soft tissue complications and satisfactory functional recovery.

[Matrine alleviates N-methyl-N'-nitro-N-nitrosoguanidine (MNNG)-induced gastric mucosal damage in rats and its mechanism].

Objective To investigate the effect of matrine on gastric mucosal injury induced by N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) in rats and its mechanism. Methods A total of 75 Wister rats were randomly divided into a control group, a model group and three matrine-treated groups (100, 150 and 200 mg/kg). Except for the control group, the other groups were treated with MNNG to establish the models of gastric mucosal injury in the rats. After the models were successfully established, the rats in the three matrine-treated groups were administrated 100, 150, 200 mg/kg matrine, respectively, for successive 45 days. After the last administration, the body mass, daily intake of drinking water and dietary of rats were measured. And then the tissue samples were collected after the rats were sacrificed. The levels of interleukin 1ß (IL-1ß), IL-4, interferon gamma (IFN-γ), and tumor necrosis factor alpha (TNF-α) were measured by ELISA in gastric mucosa. HE staining was used to observe the pathological changes of gastric mucosa tissue. Immunohistochemical staining was performed to evaluate the expression of vascular endothelial growth factor C (VEGF-C) and vascular endothelial growth factor receptor 3 (VEGFR3) in gastric mucosa. The protein levels of Bcl2, BAX, caspase-3, cytochrome C (Cyt-C), Toll-like receptor 4 (TLR4), myeloid differentiation factor 88 (MyD88) and nuclear factor κB p65 (NF-κB p65) were determined by Western blotting. Results The body mass, daily intake of drinking water and dietary increased in matrine-treated rats in comparison with the model group. In addition, compared with the model group, matrine significantly reduced the expression levels of VEGF-C, VEGFR3, BAX, caspase-3, Cyt-C, TLR4, MyD88 and NF-κB p65, and increase Bcl2 protein level in the gastric mucosa tissues. Conclusion Matrine can reduce gastric mucosal damage induced by MNNG in rats, which is related to the down-regulation of VEGF-C/VEGFR3 and NF-κB/TLR4 signaling pathway.

Management of Sharp-Pointed Esophageal Foreign-Body Impaction With Rigid Endoscopy: A Retrospective Study of 130 Adult Patients.

OBJECTIVES: To propose a management algorithm for adult patients with sharp-pointed esophageal foreign-body impaction (EFBI) who have rigid endoscopy (RE) indications and to conduct a retrospective analysis of their data. METHODS: All adult patients who received RE at the Department of Otorhinolaryngology in Beijing Shijitan Hospital between January 2017 and May 2019 were enrolled. The demographics, clinical characteristics, and management data were collected and analyzed. RESULTS: A total of 130 patients were identified, 56.9% were female with median age 60 years. More than half (56.9%) of patients had foreign-body (FB) ingestion on holidays. The most frequent FBs were jujube pits (66.9%) and bones (23.8%). There is a significant female predominance in ingestion of jujube pits (65.5%, P = .005). The most common symptoms were odynophagia (49.2%) and sore throat (47.7%). The majority (96.8%) of FB founded were lodged at upper esophagus. In all, 74 patients were categorized as having mild complications and 54 having significant complications. Time interval from ingestion to presentation longer than 15 hours was an independent risk factor for significant complications, while esophagogram with barium as a protective factor. CONCLUSIONS: Long-time interval from ingestion to presentation will lead to high risk of significant complications. Computed tomography should be a prioritized imaging method for all patients suspected with EFBI, and multidisciplinary collaboration is recommended. Besides, mass education on eating habits is necessary.

A simple high-precision wide-spectrum interferometric system.

This paper presents a simple system capable of detecting wavefront information in the wavelength range of 488-1064 nm based on an interferometric system consisting of a ball lens and an aspheric collimator. The design is conducive to short-distance Gaussian beam expansion and collimation at multiple wavelengths. The design principles and performance of the system are described in detail; the measurement precision of the system is verified experimentally by measuring the surface profile of a piece of uncoated N-BK7 glass at various test wavelengths with the proposed setup and with a digital 4D FizCam 2000 interferometer. The highly consistent measurement results of the two methods reveal that the proposed system operates precisely and effectively at various wavelengths. Subsequently, the system is applied to measure the transmitted-wavefront error of a solar filter at a wavelength of 808.0 nm; the measurement results show superb repeatability. The proposed technique avoids the shortcomings of conventional single-working-wavelength interferometric systems, which can neither work in a wide spectrum with high precision nor measure the wavefront properties of many optical bandpass elements in one device; this technique also provides technical support for future applications of high-precision and low-cost wavelength-switchable laser interferometers.

Differential expression of immune markers in the patients with obstructive sleep apnea/hypopnea syndrome.

PURPOSE: To evaluate phenotypic changes of various immune cells in the peripheral blood in the patients with sleep apnea/hypopnea syndrome (OSAHS). METHODS: This is a case-control study. The peripheral venous blood was collected. A subset of T cells, B cells, natural killer cells, and dendritic cells was analysed using various markers and flow cytometry. Regression curve analysis was made to examine the correlation between the change of immune cells and aponea hypoxia index (AHI) and oxygen desaturation. RESULTS: The percentage of CD3+/CD4+ T lymphocytes (P < 0.001) and CD19+ B cells (P < 0.001) and the CD4+/CD8+ ratio (P < 0.001) in the OSAHS patients were significantly increased compared with those in the control group without OSAHS, and CD4+/CD8+ ratio positively correlated with aponea hypoxia index (r = 0.37, P < 0.001) but negatively correlated with the lowest SaO2 (r = - 0.2, P < 0.001), whereas a greater reduction in the percentage of CD3+/CD8+ T cells (P < 0.001). Moreover, the ratios of CD3+/CD16+/CD56+ natural killer (NK)-like T cells (P < 0.05) and CD3-/CD16+/CD56+ NKT cells (P < 0.001) were significantly lower in the OSAHS group than those in the control group. However, no significant difference was observed in the percentage of CD3+ total T cells, CD8+/CD28+ T cells, CD8+/CD28- T cells, DC1, DC2, and DC1/DC2 dendritic cells between the OSAHS and control groups. CONCLUSION: Our study showed differential responses of various types of immune cells in the peripheral blood in patients with OSAHS and their correlation with severity of oxygen desaturation.

Single-cell whole-genome sequencing identifies human papillomavirus integration in cervical tumour cells prior to and following radiotherapy.

Single-cell sequencing technology is a promising systematic and comprehensive approach to delineate clonal associations between cells. The present study collected 13 and 12 cervical cells from fresh tumour tissue prior to and following radiotherapy, respectively, from a 46-year-old female patient with exogenous-type cervical carcinoma. Next, single-cell whole-genome sequencing analysis was performed on each cell. Examination revealed that normal cells could be clearly distinguished from tumour cells among the 25 cells. Tumour cells prior to and following radiotherapy almost represented two independent clones, with the main subpopulation prior to radiotherapy being killed and the minor subpopulation prior to radiotherapy becoming the main subpopulation following radiotherapy. A human papillomavirus (HPV) integration site was detected in POU class 5 homeobox 1B (POU5F1B) in tumour cells following radiotherapy, which has been reported to be a frequent HPV integration site in cervical carcinoma. These results indicate that tumour cells with HPV integration in POU5F1B survive radiotherapy, and that tumour cells prior to and following radiotherapy exhibit distinct characteristics.

[Adenoid cystic carcinoma of external auditory canal: a report of 7 cases].

OBJECTIVE: To detect the clinical and pathological features of the adenoid cystic carcinoma of external auditory canal, and to improve its diagnosis and treatment level. METHOD: A retrospective analysis was performed on 7 patients with ACCEAC by their clinical manifestation, the therapy and follow-up results as well as the combination with the review of related literature. RESULT: The period from the appearance of primary symptoms to definite diagnosis averaged 5.7 years. All patients were treated by surgical excision and followed up from 2 years 8 months to 9 years 11 months. Five of them were recurrent after operation, 2 of which died. CONCLUSION: Adenoid cystic carcinoma of external auditory canal, which is rarely seen in clinic, is not easy to exact diagnosis in early stage. It progresses slowly and tends to invade parotid and even intracranial cavity. It also has the tendency of recurrence and pulmonary metastasis. So, its necessary to do both aggressive surgery and postoperative irradiation. The long term follow-up indicates that the tumor has a poor prognosis.