[Risk factors of hyperlactatemia during pulmonary endarterectomy under deep hypothermic circulatory arrest and its influence on prognosis].

Objective: To investigate the incidence, risk factors, and outcomes of hyperlactatemia after pulmonary endarterectomy (PEA) under deep hypothermic circulatory arrest (DHCA). Methods: From December 2016 to January 2022, patients receiving PEA in China-Japan Friendship Hospital were enrolled in the study. Arterial blood samples were analyzed intraoperatively. Multivariate logistic regression analysis was performed to identify the predictors of intraoperative lactate elevation as well as major factors influencing the clinical outcome of the surgery. Results: A total of 110 patients (69 males and 41 females) were enrolled, aged (50.6±12.8) years. Receiver operating characteristic curve yielded an optimal cut-off lactate level of 7 mmol/L for predicting major postoperative complications (re-operation, re-intubation, postoperative renal failure requiring renal replacement therapy, wound infection, stroke, atrial fibrillation, and perioperative extracorporeal membrane oxygenation usage within 48 hours after surgery). Thirty-nine patients (35.5%) had an intraoperative peak arterial lactate level of≥7 mmol/L. According to intraoperative peak arterial lactate level, the patients were divided into two groups (<7 mmol/L and≥7 mmol/L). There were no statistically significant differences in age, sex and body mass index between the two groups (all P>0.05). Intraoperative peak lactate level was associated with prolonged mechanical ventilation time (r=0.262, P=0.008) and intensive care unit length of stay (r=0.304, P=0.002). Multivariate logistic regression analysis identified three key variables associated with lactate level≥7 mmol/L: DHCA duration (OR=1.186, 95%CI: 1.027-1.370, P=0.020), nadir hematocrit (HCT) (OR=0.580, 95%CI: 0.341-0.988, P=0.045) and preoperative pulmonary vascular resistance (PVR) (OR=1.096, 95%CI: 1.020-1.177, P=0.012). Patients with lactate≥7 mmol/L carried a higher rate of major complications (P=0.001). For patients with lactate≥7 mmol/L, 41.0% (16 out of 39 cases) had major complications, while for patients with lactate<7 mmol/L, only 14.1% (10 out of 71) had major complications. There was no statistically significant difference in mortality (8.5% vs 10.3%, P=0.753) between patients with different lactate levels. Moreover, intraoperative peak lactate level was a predictor of postoperative combined morbidity (OR=1.625, 95%CI: 1.176-2.245, P=0.003). Conclusion: High intraoperative lactate levels are associated with higher preoperative PVR, lower nadir HCT, and longer DHCA duration. Intraoperative lactate levels are independently associated with increased combined morbidity.

[Analysis of risk factors for post-polypectomy bleeding and polyp recurrence after colonoscopic polypectomy in children].

Objective: To explore the incidence and the risk factors of post-polypectomy bleeding and polyp recurrence after colonoscopic high-frequency electrocoagulation snare polypectomy. Methods: Clinical data of 1 826 children who underwent colonoscopic high-frequency electrocoagulation snare polypectomy in the Children's Hospital, Zhejiang University School of Medicine from January 2009 to December 2020 was retrospectively analyzed. Demographic characteristics, endoscopic manifestations, pathological features, diagnosis, occurrence of post-polypectomy bleeding and polyp recurrence were collected. The associated risk factors were analyzed by Logistic regression. Results: A total of 1 826 children (1 191 males and 635 females) with 1 967 polypectomies were included. The age was 4.6 (3.2, 6.4) years at initial diagnosis. According to the initial colonoscopy, 1 611 children (88.2%) had solitary polyps, 1 707 children (93.5%) had pedicled polyps, 1 151 children (63.0%) had polyps involving the rectum, and 1 757 children (96.2%) had hamartomatous polyps. Polyposis syndromes were diagnosed in 73 children (4.0%). The post-polypectomy bleeding occurrence was 3.8% (75/1 967). Polyps recurred in 88 children (4.8%). Girls (OR=2.01, 95%CI 1.26-3.23) and sessile polyps (OR=2.28, 95%CI 1.15-4.49) were risk factors for post-polypectomy bleeding (both P<0.05). Multiple polyps (OR=17.49, 95%CI 9.82-31.18), right-colon involvement (OR=3.44, 95%CI 1.89-6.26) and non-hamartoma (OR=2.51, 95%CI 1.04-6.07) were risk factors for polyp recurrence (all P<0.05). Conclusions: Colonoscopic high-frequency electrocoagulation snare polypectomy has low incidence of post-polypectomy bleeding and polyp recurrence. Female patients and sessile polyps have higher risk for post-polypectomy bleeding. Multiple polyps, right-colon involvement and non-hamartoma polyps increase the risk for polyp recurrence.

[Analysis of positive rate of sinusitis in children with head and pituitary MRI].

Objective: To investigate the incidence of asymptomatic sinusitis in children by magnetic resonance imaging. Method: Collected the head MRI of 1-12 years old children. According to the examination site,the MRI group and the pituitary MRI group (both sinus level) were included.The nasal-sinusitis-like changes in the field were used as positive criteria. Statistical analysis was conducted on the test results. Result: In 3 900 children with MRI, the positive rate of sinusitis was 30.21%. The positive rate increased from 2 years old to 3 years old and remained at the age of 11 years.The higher positive rate was slightly decreased at 12 years old; 1 228 cases of pituitary MRI examination, the positive rate of nasal-sinusitis was 38.27%, the positive rate increased significantly from the age of 2, reached the peak at 6 years old, and then fell back, still kept high positive rate, the lowest to 12 years old. The positive rate of total sinusitis was 32.14%. No obvious difference was found between two groups. Conclusion: Children's skull and pituitary MRI imaging suggests that the positive rate of nasal-innocuous sinusitis is related to age, peaking at 3 to 8 years old, and then gradually decreasing.

[Prevalence of alcohol drinking and influencing factors in female adults in China, 2010-2012].

Objective: To understand the prevalence of alcohol drinking and influencing factors in female adults in China. Methods: At the 150 survey sites where 2010-2012 Chinese nutrition and health surveillance was conducted, a face to face questionnaire survey was conducted in female adults selected through multi-stage stratified cluster random sampling. Sample weights was assigned to each participant based on the study design by using national population census data in 2009. The complex sampling and unconditional multivariate logistics regression analysis was conducted to identify the influencing factors for the prevalence of alcohol drinking in the female adults. Results: A total of 75 518 participants were included in this study. The prevalence of drinking in female adults was 13.9% (95%CI: 11.7-16.2) in urban area and 13.3% (95%CI: 9.4-17.2) in rural area. The prevalence of frequent drinking was 13.9% (95%CI: 9.9-17.9) in women in urban area and 14.2% (95%CI: 10.8-17.6) in women in rural area. The prevalence of excessive drinking was 11.1% (95%CI: 7.5-14.8) in women in urban area and 12.8% (95%CI: 9.1-16.4) in women in rural area. The prevalence of wine drinking in women in urban area was significantly higher than in women in rural and had positive correlation with income and education levels. The social and economic factors influencing drinking behavior of the female adults included occupation, drinking behaviors of family members and smoking behavior. Those who were engaged in agriculture, production and transportation (OR=0.72, 95%CI: 0.56-0.94, P=0.016), housework (OR=0.59, 95%CI: 0.44-0.78, P<0.001) and other work (OR=0.61, 95%CI: 0.43-0.85, P=0.004) had lower drinking prevalence. Whereas those whose family members had drinking behavior (OR=2.66, 95%CI: 2.17-3.26, P<0.001) and those who were current smokers (OR=4.32, 95%CI: 2.95-6.34, P<0.01) had higher drinking prevalence. Conclusions: The prevalence of drinking, frequent alcohol drinking and excessive drinking were relatively low in female adults in China. Occupation, drinking behaviors of family members and smoking behavior were the main factors influencing the prevalence drinking behavior in female adults in China.

[Prevalence of alcohol drinking in males aged 20-79 years in China, 2012].

Objective: To understand the prevalence of alcohol drinking in 20-79 years old males with different educational backgrounds and smoking behaviors in different areas of China. Methods: A multi-stage cluster random sampling survey was conducted in 150 surveillance sites in 2010-2012 Chinese nutrition and health surveillance in China. At least 1 000 subjects were selected in each surveillance site. Alcohol drinking prevalence and pattern information were collected by using personal health and food frequency questionnaire in face to face interviews. Results: A total of 60 791 males aged 20-79 years were surveyed. The prevalence of alcohol drinking was 57.8% (58.3% in rural area, 57.3% in urban area). The mean daily alcohol intake level was 32.7 g (33.3 g in rural area, 32.1 g in urban area). The rate of almost drinking every day and daily alcohol intake level were highest among males aged 50-59 years. Mean daily alcohol intake level, rate of almost drinking every day and excessive drinking decreased with the increase of education level. Non-smokers had higher rate of never drinking and lower prevalence of drinking and excessive drinking, lower mean daily alcohol intake level, and lower rate of almost drinking every day compared with current and past smokers. Conclusions: Alcohol drinking was common in males aged 20-79 years in China, and, the difference was not obvious between rural residents and urban residents. The differences in daily intake level of different alcohol drinks among males with different characteristics had certain significance. Significant difference in excessive drinking was found among different age groups, those with different education levels and those with different smoking history.

[X-linked inhibitor of apoptosis deficiency manifested as Crohn's disease: a case report and literature review].

Objective: To analyze the clinical characteristics of X-linked inhibitor of apoptosis (XIAP) deficient patients with clinical manifestation of Crohn's disease. Methods: Clinical manifestations, laboratory investigations, genetic testing and therapeutic interventions of one case of XIAP deficiency who was admitted to Department of Gastroenterology in Children's Hospital, Zhejiang University School of Medicine in May 2016 were summarized. PubMed and Chinese database for articles published from January 2016 to June 2017 were searched using the key words of'Crohn's disease'and'XIAP', and the relevant literature was reviewed. Results: The case we reported was a 6-year-1-month-old boy with recurrent bloody stool for 2 months, and abdominal pain with fever for 2 weeks. The patient had a past history of hemophagocytic lymphohistiocytosis (HLH) and epilepsy in the past one year. Complete blood cell count showed mild anemia (Hb108 g/L). The patient had an elevated high-sensitivity C reactive protein (86 mg/L) and erythrocyte sedimentation rate (46 mm/1h) . White blood cells, pus cells and red blood cells were found on routine stool examination. Biochemical panel showed hypoalbuminemia (25.2 g/L) , elevated transaminase (alanine aminotransferase 175 U/L, aspartate transaminase 229 U/L) , hypertriglyceridemia (4.41 mmol/L) , and hyperferritinemia (>1 650.0 µg/L) . Magnetic resonance enterography revealed the intestinal wall thickening and increased enhancement in parts of illeum and colon. Capsule endoscopy revealed multiple ulcers in jejunum. Colonoscopy showed multiple ulcers in colon and the pathological examination revealed chronic inflammation in mucosa of terminal ileum and colon, which was combined with partial necrosis and ulceration. Some phagocytes were seen in bone marrow smears. The patient was given multiple diagnoses, including hemophagocytic lymphohistiocytosis, Crohn's disease, sepsis, epilepsy, severe malnutrition, and hypoproteinemia. The pediatric Crohn's disease activity index (PCDAI) was 37.5. Genetic testing identified a hemizygotic mutation of c.910G>T chrX:123022501 p.G304X in XIAP. The parents had no such mutation. The patient showed response to infliximab with oral intake of mercaptopurine and corticosteroids, and had remission with PCDAI of 0. There were 9 relevant articles (Chinese 0 English 9), which showed 33.3% XIAP deficient patients manifested with inflammatory bowel disease(IBD), who might have other manifestations such as hemophagocytic lymphohistiocytosis or splenomegaly simultaneously or sequentially. Those patients showed poor response to monotherapy. Conclusion: XIAP deficient patients have various clinical manifestations. Genetic testing is important to those male pediatric IBD patients who have the complicated symptoms or little response to standard therapy.

Hybrid cellular spheroids from hepatocellular carcinoma and insulin-secreting cell lines.

During islet transplantation into the portal vein of the liver, the islet cells are expected to have complex interactions with hepatocytes. However, the mechanism underlying this interaction is not yet understood. Hence, we developed cellular complexes containing a mixture of human hepatocellular carcinoma cell line (Hep-G2) and rat insulin-secreting cell line (RIN-5F) by using a co-culture model and studied the function and morphology of the resultant hybrid cellular spheroids (HCSs). The RIN-5F and Hep-G2 cells were suspension cultured and, within 5 days of culture, the two types of cells aggregated to yield spheroids. The functionality of the thus formed HCSs was evaluated by measuring the levels of insulin and albumin in the culture supernatant. The HCSs retained their insulin- and albumin-secreting ability and their morphology, as revealed by immunohistological staining. The insulin and albumin levels secreted by the HCSs were considerably higher than those secreted by spheroids of single-cell origin. Generally, obtaining complexes from more than two types of cells is difficult. However, we were able to generate HCSs. We believe that this culture method could have various applications such as studying the in vitro cell-cell interactions and developing new cell transplantation models.

Impact of coculture with ischemic preconditioned hepatocellular carcinoma cell line (Hep-G2) cells on insulin secreting function of rat insulin-secreting cell line (RIN-5F) cells.

INTRODUCTION: Although Islet cell isolation and culture have been well developed, there has been little progress to prolong transplanted islet survival. Hepatic ischemia and insufficient neovascularization of islets are considered to be the barriers to long-term survival, Hepatocytes that survive ischemic injury have been reported to protect themeslves and regenerate using the IL-6 interleukin 6 and STAT3 pathways. MATERIALS AND METHODS: The hepatocellular carcinoma (Hep-G2) cell line preconditioned for 0, 2, 4, 6, and 24 hours in a hypoxic chamber, was cocultured with rat insulin-secreting celline (RIN-5F) cells. We measured cell viabilities, insulin secretion, and p-STAT3, IL-6, and NF-κB levels. RESULTS: Cocultured Hep-G2 and RIN-5F cells aggregated to form spheroids. Viabilities of Hep-G2 cells were no different after various ischemic preconditioning times, but insulin secretion increased in a time-dependent fashion with preconditioning. Western blotting showed p-STAT3, NF-κB, and IL-6 levels to increase with preconditioning time. CONCLUSION: The IL-6/STAT3 pathway of Hep-G2 cells after ischemic injury showed beneficial effects on insulin secretion of RIN-5f cells cocultured with themselves.

Long-term viability of transplanted hybrid cellular spheroids within chondrocyte sheets.

Encapsulation of transplanted cells within an immunoisolating membrane may provide a new strategy for protecting these cells from recipient immune responses without the use of immunosuppressive drugs. We have previously reported a novel concept of immunoisolation and immunodelusion using recipient cells instead of traditional artificial materials. We developed a chondrocyte sheeting immunodelusive immunoisolated bioartificial pancreas (CSI-BAP) that would enable transplantation of cells across allogeneic and xenogeneic barriers without the cells being recognized as donor cells and without the need for immunosuppression. Recently, we have constructed hybrid cellular spheroids (HCSs) containing cells from two different cell lines (RIN-5F, an insulin-secreting cell line, and Hep-G2, a hepatocellular carcinoma cell line) to enhance the function and biocompatibility of the HCSs. These HCSs were then encapsulated with multiple layers of chondrocyte sheets obtained from the auricular cartilage of Sprague-Dawley (SD) rats. The in vitro ability of the CSI-BAP to secrete insulin was tested before transplantation. Histological evaluation of CSI-BAP chondrocyte microencapsulated immunoisolated islet morphology and viability of allogeneic or xenogeneic cell lines was performed 100 days after the CSI-BAP was transplanted into SD rats. Morphological evaluations revealed good viability of the islets and progression of islet encapsulation. In vitro insulin secretion from the CSI-BAP was well maintained. Additionally, insulin and albumin secretion from the CSI-BAP was confirmed by in vivo immunohistochemical examination. Moreover, the cell lines transplanted into the subcutaneous space in the form of HCSs within the chondrocyte sheets showed good viability of more than 100 days and sustained insulin and albumin secreting ability.

A novel HLA-DRB1 allele, DRB1*1219, was identified by sequence-based typing in a Chinese leukaemia family.

A novel human leukocyte antigen DRB1 allele, DRB1*1219, has been identified in a Chinese leukaemia patient and his family by polymerase chain reaction sequence-based typing, which has one nucleotide change at position 341 (C-->T) in exon 2 from the closest matching allele DRB1*120201, resulting in an amino acid substitution from Ala-->Val at codon 85.