Changing of haemostatic system in a pig model during different types of hypothermic circulatory arrest.

BACKGROUND: Hypothermic circulatory arrest is usually used in aortic surgery, congenital heart defect repairs and other complex surgeries. It is frequently associated with excessive postoperative bleeding and the transfusion of allogeneic blood products. The physiopathology of hypothermic circulatory arrest-induced coagulopathy has never been systematically studied. The aim of the study was to investigate this phenomenon in a pig model. METHODS: Ten pigs were randomly assigned to 30 min of hypothermic circulatory arrest at either 15 °C (n = 5) or 25 °C (n = 5). Detection of apoptosis and haemostatic system assays were performed in this experiment. Enzyme-linked immunosorbent assays were performed at ten time points in each group to study the changes in the coagulation system in hypothermic circulatory arrest. All of the statistical analyses were performed in SPSS software, version 18.0, and as bilateral tests, and p < 0.05 was considered statistically significant. RESULTS: There was no significant difference in the effect of different types of hypothermic circulatory arrest on routine laboratory tests and tissue sample analysis (p > 0.05, for all). Our results demonstrated that more severe systemic activation of the coagulation system (TAT and F1+2) was applied in the deep hypothermic circulatory arrest group but not in the moderate hypothermic circulatory arrest group (TAT/p = 0.01, F1+2/p = 0.03). However, this activation of the coagulation system (AT III and PC) was not associated with changes in the anticoagulation pathway (AT III/p = 0.24, PC/p = 0.33). In addition, analysis of biomarkers of the haemostatic system revealed that the consumption of coagulation is more concentrated on extrinsic coagulation factors (FVII/p = 0.01). CONCLUSIONS: Moderate hypothermic circulatory arrest is more suitable for patients with coagulation dysfunction. We believe the application of deep hypothermic circulatory arrest should pay more attention to changes in coagulation rather than the anticoagulation pathway. Extrinsic coagulation factor supplementation is more effective after deep hypothermic circulatory arrest.

Effects of the linoleic acid/docosahexaenoic acid ratio and concentration inducing autophagy in Raw264.7 cells against Staphylococcus aureus.

Our study was to understand the autophagy induce by different ratios and concentrations of LA/DHA on Raw264.7 cell, and then to investigate the effect of Raw264.7 autophagy on the clearance of Staphylococcus aureus. Raw264.7 cells was treated by LA/DHA in different concentrations (50/100 µmol/L) and ratios (4:1, 6:1, 8:1, 1:4, 1:6 and 1:8) for 6/12/24 h, cell viability assay was assessed by Cell Counting Kit-8, LC3B, p62, P-mTOR, P-Akt, P-PI3K and BECN 1 were detected by the Western blot. LA/DHA could induce autophagy of Raw264.7 cells through the PI3K-Akt-mTOR signaling pathway, the strong effect on autophagy by the concentration is 100 µmol/L, the ratio is 6:1 of LA/DHA, and the treatment time is 24 h. Compared with the images in the control group obtained by merging red and green fluorescence channels, the treatment of LA, DHA in a ratio of 6:1 at a concentration of 100 µmol/L for 24 h significantly lead to a substantial number of autophagosomes (yellow) as well as autolysosomes (red), enhancing autophagy flux. Autophagy induce by LA/DHA can devour and damage intracellular and extracellular Staphylococcus aureus. These results indicate that LA/DHA cloud induce autophagy and enhance the phagocytosis and killing ability of macrophages to intracellular parasitic bacteria.

Case report of achalasia secondary to a lung carcinoma of the mediastinal type.

Pseudo- or secondary achalasia may mimic primary achalasia upon radiological examination and may be difficult to diagnose. It is usually due to a cancer or metastases involving the gastroesophageal junction. We present the case of a 53-year-old woman with recent onset of dysphagia, and with typical findings suggesting primary achalasia. We found a 4-cm mediastinal tumor invading the lower esophagus, which was proven to be a metastasis from a lung carcinoma. The patient was treated with surgery, chemotherapy and radiotherapy. In patients with a new onset of achalasia symptoms, keeping in mind the possibility of an underlying cancer is important.

The prognostic value of admission D-dimer level in patients with cardiogenic shock after acute myocardial infarction.

Background: Shock is associated with the activation of the coagulation and fibrinolytic system, and D-dimer is the degradation product of cross-linked fibrin. However, the prognostic value of D-dimer in patients with cardiogenic shock (CS) after acute myocardial infarction (AMI) remains unclear. Methods: We retrospectively analyzed the data of consecutive patients with CS complicating AMI. The primary endpoint was 30-day mortality and the secondary endpoint was the major adverse cardiovascular events (MACEs) including 30-day all-cause mortality, ventricular tachycardia/ventricular fibrillation, atrioventricular block, gastrointestinal hemorrhage, and non-fatal stroke. Restricted cubic spline (RCS) analyses were performed to assess the association between admission D-dimer and outcomes. A multivariable Cox regression model was performed to identify independent risk factors. The risk predictive potency with D-dimer added to the traditional risk scores was evaluated by C-statistics and the net reclassification index. Results: Among 218 patients with CS complicating AMI, those who died during the 30-day follow-up presented with worse baseline characteristics and laboratory test results, including a higher level of D-dimer. According to the X-tile program result, the continuous plasma D-dimer level was divided into three gradients. The 30-day all-cause mortality in patients with low, medium, and high levels of D-dimer were 22.4, 53.3, and 86.2%, respectively (p < 0.001 for all). The 30-day incidence of MACEs was 46.3, 77.0, and 89.7%, respectively (p < 0.001). In the multivariable Cox regression model, the trilogy of D-dimer level was an independent risk predictor for 30-day mortality (median D-dimer cohort: HR 1.768, 95% CI 0.982-3.183, p = 0.057; high D-dimer cohort: HR 2.602, 95% CI 1.310-5.168, p = 0.006), a similar result was observed in secondary endpoint events (median D-dimer cohort: HR 2.012, 95% CI 1.329-3.044, p = 0.001; high D-dimer cohort: HR 2.543, 95% CI 1.452-4.453, p = 0.001). The RCS analyses suggested non-linear associations of D-dimer with 30-day mortality. The enrollment of D-dimer improved risk discrimination for all-cause death when combined with the traditional CardShock score (C-index: 0.741 vs. 0.756, p difference = 0.004) and the IABP-SHOCK II score (C-index: 0.732 vs. 0.754, p difference = 0.006), and the GRACE score (C-index: 0.679 vs. 0.715, p difference < 0.001). Similar results were acquired after logarithmic transformed D-dimer was included in the risk score. The improvements in reclassification which were calculated as additional net reclassification index were 7.5, 8.6, and 12.8%, respectively. Conclusion: Admission D-dimer level was independently associated with the short-term outcome in patients with CS complicating AMI and addition of D-dimer brought incremental risk prediction value to traditional risk prediction scores.

Total pelvic floor reconstruction surgery for repair of severe pelvic organ prolapse.

OBJECTIVE: To evaluate clinical effectiveness of total pelvic floor reconstruction surgery for repair of severe pelvic organ prolapse. METHODS: We retrospectively analyzed the clinical data of 21 patients with severe pelvic organ prolapse. The anatomical outcomes were evaluated by Pelvic Organ Prolapse Quantitation, functional effectiveness by Prolapse Quality of Life method, and sexual function and operation-related complications were also analyzed. RESULTS: All surgical operations were accomplished successfully by the same surgeon. No impairment of bladder, urethra, rectum, or great vessels was noted, and no patient required blood transfusion. The mean operation duration was (63±19) minutes, and the mean intra-operative blood loss was (143±72) ml. One patients experienced post-operative urinary retention for 7 days, and the remaining 20 patients were able to micturate spontaneously 1-2 day after surgery. The post-operative morbidity rate was 14.3%. Three patients (14.3%) experienced mesh erosion. Of 12 patients who were sexually active, two patients suffered from algopareunia from dyspareunia, one from de novo overactive bladder, and one from stress urinary incontinence Questionnaire scores showed that the overall post operative quality of life was improved significantly (P=0.000), while quality of sexual life significantly degraded (P=0.044) The anatomic cure rate was 95.2% (20/21), and the patient subjective satisfaction rate was 85.7% (18/21) CONCLUSIONS: The total pelvic floor reconstruction is a safe and effective approach for the repair of severe pelvic organ prolapse, although its functional effectiveness is not as notable as anatomical outcomes However, the complications such as mesh erosion, low urinary tract symptoms, algopareunia, and dyspareunia should be carefully managed.

Effect of transcutaneous electrical acupoint stimulation bracelet at Neiguan acupoint on post-operative nausea and vomiting after thyroidectomy under general anesthesia / 临床麻醉学杂志

Objective To explore the effect of transcutaneous electrical acupoint stimulation bracelet at Neiguan acupoint on the postoperative nausea and vomiting after thyroidectomy under general an-esthesia.Methods Seventy-two female patients underwent thyroidectomy,aged 18-50 years,ASA physical status Ⅰ or Ⅱ,were enrolled.The patients were assigned 1 ∶ 1 to two groups by permuted block randomization:the electrical stimulation group and the control group,36 patients in each group.Before an-esthesia induction,patients in both groups wore domestic transcutaneous electrical acupoint stimulation bracelets,and the electrodes were aimed at Neiguan acupoint.The electrical stimulation group started to stimulate Neiguan acupoint,and adjusted the proper intensity to make the patient feel tingling in the related area of the hand.When the bracelet was fixed firmly,turned it off.At the end of the operation,the bracelet was turned on with the stimulation intensity set before induction for 24 hours.Patients in the control group also wore the bracelet for 24 hours,but it was never turned on.The number of cases of postoperative nausea and vomiting(PONV)and the number of remedial cases of antiemetic drugs were recorded.Results Compared with the control group,the incidence of PONV and postoperative vomiting in the electrical stimula-tion group were significantly reduced within 24 hours after surgery(P＜0.05),and the differences were mainly in 1-6 hours after surgery(P＜0.05).There was no significant difference in the rate of remedial ca-ses of antiemetic drugs between the two groups at different time periods.Conclusion Transcutaneous electri-cal stimulation bracelet at Neiguan acupoint can effectively reduce the incidence of PONV within 24 hours after thyroidectomy.

Effects and mechanism of astilbin on myocardial ischemia-reperfusion injury in rats / 中国药房

OBJECTIVE To investigate the effects of astilbin （AST） on myocardial ischemia-reperfusion injury （MIRI） in rats and its potential mechanism. METHODS SD male rats were randomly divided into sham operation group， model group， positive control group （Compound Salvia miltiorrhiza tablets， 240 mg/kg）， AST low-dose and high-dose groups （30， 90 mg/kg）， and high- dose of AST+hypoxia-inducible factor-1α（HIF-1α） inhibitor group （AST 90 mg/kg+2ME2 15 mg/kg）， with 25 rats in each group. Except for sham operation group， MIRI model was induced in other groups， and then given relevant drug or normal saline intragastrically or intraperitoneally， for consecutive 28 d. Serum contents of cardiac troponin I （cTnI） and creatine kinase isoenzyme （CK-MB） were detected； volume ratio of myocardial infarction was measured； the pathological changes of myocardium， the apoptotic rate of myocardial cells and ultrastructure of mitochondria in myocardial tissue were all observed. The contents of tumor necrosis factor α （TNF-α）， interleukin 6 （IL-6） and malondialdehyde （MDA）， the activity of superoxide dismutase （SOD）， the expressions of HIF-1α， adenovirus E1B interacting protein 3 （BNIP3） and myosin-like Bcl-2 interacting protein （Beclin1） were determined in myocardium. The ratio of microtubule-associated protein light chain 3 （LC3） Ⅱ to Ⅰ （LC3 Ⅱ/Ⅰ） in rat myocardium was calculated. RESULTS Compared with model group， no obvious swelling was found in the myocardial tissue of rats in positive control group， AST low-dose and high-dose groups， and the myocardial fibers were arranged regularly； the volume ratio of myocardial infarction， the contents of cTnI， CK-MB， TNF-α， IL-6 and MDA， the apoptotic rate were decreased significantly （P＜0.05）， while SOD activity， protein expressions of HIF-1α， BNIP3 and Beclin1， LC3Ⅱ/Ⅰ were increased significantly （P＜0.05）. HIF-1α inhibitor could significantly weaken the improvement effect of AST on the above indicators in MIRI model rats （P＜0.05）. CONCLUSIONS AST enhances mitochondrial autophagy by activating HIF-1α/BNIP3 signaling pathway， thereby reducing MIRI in rats.

Detection rate of pulmonary nodules by CT scan at different doses and application value of artificial intelligence assistance / 中国医师进修杂志

Objective:To investigate the detection rate of pulmonary nodules (PN) by CT scan at different doses and the application value of artificial intelligence(AI) system assistance.Methods:From October 2019 to October 2021, 210 patients with PN in Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, were retrospectively selected, and they were divided into the study group (106 cases) and the control group (104 cases) by CT scan at different doses. The control group used the conventional average dose (169 mAs) CT scan, the study group used an average low-dose (54 mAs) CT scan. The PN detection rate of different gender, age, body mass index (BMI) between the two groups were compared. The morphological characteristics, radiation dose, CT image quality between the two groups were compared. The diagnostic efficiency of radiologists and AI system was compared.Results:The detection rate of PN in the study group and the control group had no significant difference: 73.58% (78/106) vs. 80.77%(84/104), χ2 = 1.54, P>0.05. The detection rate of PN with different gender, age group and BMI in the two groups had no significant differences ( P>0.05). The diameter of nodules and the rates of calcification, cavitation, bronchial sign, lobar sign, burr sign and pleural adhesion sign in the two groups had no significant differences ( P>0.05). The mean effective tubular bulb dose, length product of radiation dose, total tubular bulb dose, radiation volume dose index in the study group were higher than those in the control group: (46.15 ± 7.38) mAs vs. (104.39 ± 10.53) mAs, (169.24 ± 19.77) mGy·cm vs. (427.17 ± 43.58) mGy·cm, (972.65 ± 58.34) mAs vs. (2 861.26 ± 181.37) mAs, (3.55 ± 1.16) mGy vs. (8.95 ± 2.07) mGy, there were statistical differences ( P<0.05). The excellent, good, acceptable, poor of 1.0 mm image quality in the study group were 26, 60, 18, 2, and in the control group were 32, 64, 8, 0, there was statistical difference ( u =1.71, P = 0.087). The excellent, good, acceptable, poor of maximum intensity projection (MIP) image quality in the study group were 58, 42, 6, 0 and in the control group were 70, 34, 0, 0, there was statistical difference ( u = 1.81, P = 0.070). The detection rate of PN by AI low-dose CT scan was higher than that of radiologists: 88.68%(94/106) vs. 73.58%(78/106), there was statistical difference ( χ2 = 7.89, P = 0.005). Conclusions:The low-dose CT chest scans for PN, the results of detection rate, morphological characteristics, CT image quality are basically the same as those of conventional-dose CT chest scans, and can greatly reduce the radiation dose, which is more suitable for PN screening, and combined with AI system can significantly improve the detection rate of PN.

Gene cloning and enzymatic activity analysis of phenylalanine ammonia-lyase from Sinopodophyllum hexandrum (Royle) Ying / 生物工程学报

Phenylalanine ammonia-lyase (PAL) is the key entry enzyme of plant phenylpropanoid pathway. It plays an important role in the biosynthesis of podophyllotoxin, an anti-tumor lignan that is currently produced from its main natural source Sinopodophyllum hexandrum (Royle) Ying. In this study, we cloned the gene ShPAL encoding phenylalanine ammonia-lyase by RT-PCR from the root of S. hexandrum ecotype inhabited in the Aba' district, Sichuan, based on its public SRA transcriptome data-package. Bioinformatics analyses showed that the ShPAL-encoded protein is composed of 711 amino acids, contains the conserved domains of PAL, and has the signature motif within the active center of aromatic ammonia-lyases. Moreover, ShPAL protein was predicted to have a secondary structure mainly composed of α-helix and random coil, a typical 'seahorse' shape monomer tertiary structure, and a homologous tetramer three-dimensional structure by Swiss-Modelling. The phylogenetic lineage analysis indicated ShPAL was of the highest sequence identity and the shortest evolutionary distance with the PAL of Epimedium sagittatum from the same Berberidaceae family. Subcellular localization experiments showed that ShPAL protein was mainly distributed in the cytoplasm, despite of a minority on the endoplasmic reticulum membrane. Furthermore, ShPAL protein was recombinantly expressed in Escherichia coli and purified by histidine-tag affinity chromatography. Its enzymatic activity was determined up to 20.91 U/mg, with the optimum temperature of 41 ℃ and pH of 9.0. In contrast, the enzyme activity of its F130H mutant decreased by about 23.6%, yet with the same trends of change with temperature and pH, confirming that phenylalanine at this position does affect the substrate specificity of PAL. Both the wild type and the mutant have relatively poor thermostability, but good pH-stability. These results may help to further investigate the regulatory role of PAL in the process of podophyllotoxin biosynthesis and advance the heterologous synthesis of podophyllotoxin to protect the germplasm resource of S. hexandrum. They also demonstrate that ShPAL has a potential application in biochemical industry and biomedicine.

Establishment and evaluation of risk prediction model for ischemic stroke after coronary artery bypass grafting in elderly patients / 中华胸心血管外科杂志

Objective:To explore the risk factors of ischemic stroke after coronary artery bypass grafting(CABG) in elderly(≥75 years old)patients, establish a risk prediction model and evaluate it.Methods:From January 2015 to September 2021, a total of 1 553 elderly patients with coronary artery disease who were admitted to Beijing Anzhen Hospital for coronary artery bypass grafting were included retrospectively. Among which 1 121(72%) cases were males, with a median age of 77( IQR 75, 78) years. Clinical data were collected and univariate analysis and multiple logistic regression analysis were used to explore the risk factors of ischemic stroke after CABG in elderly patients. After the establishment of risk prediction model, we constructed the nomogram, and tested the discrimination and calibration of the model. Results:All patients underwent CABG, there were 35 patients with ischemic stroke after operation, with an incidence of 2.25%(35/1 553). Multivariate logistic regression analysis showed that diabetes( OR=2.61, 95% CI: 1.31-5.32), old myocardial infarction( OR=3.62, 95% CI: 1.61-7.63), systolic blood pressure( OR=1.03, 95% CI: 1.01-1.04) and vertebral artery stenosis( OR=1.01, 95% CI: 1.00-1.02) were independent risk factors for postoperative cerebral infarction in patients undergoing CABG. The model was presented by a nomogram, and the model discrimination was evaluated by ROC curve. The area under the curve( AUC) was 0.757, indicating a optimal discrimination. Hosmer- Lemeshow test of goodness of fit was performed to evaluate the model calibration( χ2=6.209, P=0.624). Conclusion:Diabetes mellitus, old myocardial infarction, systolic blood pressure and vertebral artery stenosis are independent risk factors for ischemic stroke in elderly patients after CABG. The established risk prediction model has optimal discrimination and calibration.

Carotid stenting in coronary artery bypass grafting patients with asymptomatic severe carotid artery stenosis / 中华胸心血管外科杂志

Objective:To evaluate the perioperative and follow-up data of carotid artery stenting (CAS)+ coronary artery bypass grafting (CABG) and CABG alone, and to assess the safety and efficacy of CAS in the treatment of severe stenosis of the carotid artery in combination with asymptomatic carotid artery stenosis.Methods:A retrospective analysis of 700 CABG patients combined asymptomatic carotid artery severe stenosis at Beijing Anzhen Hospital, Beijing Chaoyang Hospital, and Beijing Tiantan Hospital from January 2018 to December 2022 was performed. According to whether or not underwent CAS treatment, they were divided into the CAS-CABG group(116 cases)and the CABG-only group(584 cases). The mean age of the CAS-CABG group was (64.8±7.3) years, and all of them underwent unilateral CAS surgery only; the mean age of the CABG only group was (65.5±7.6) years. The main results of the patients in the two groups were compared at 30 days after the operation and follow-up period.Results:The early postoperative stroke rate was significantly lower in the CAS-CABG group(2.6% vs. 9.1%, P=0.02), while the combined procedure did not increase the rates of mortality and adverse events during follow-up. Subgroup analysis revealed that there was no significant difference in stroke rates between the two procedures for asymptomatic unilateral carotid artery stenosis, advanced age, history of atrial fibrillation, and history of stroke were independent risk factors for early stroke in CABG for asymptomatic unilateral carotid artery stenosis. Conclusion:CAS-CABG is safe and effective in the treatment of coronary artery disease combined with asymptomatic carotid artery stenosis, and can reduce the incidence of early postoperative stroke in patients. CABG patients with asymptomatic carotid stenosis should be rationally screened for prophylactic CAS to reduce the risk of postoperative stroke in these patients.

Anzhen hospital expert experience on perioperative treatment principles of cardiovascular surgery for patients infected with COVID-19 / 中华胸心血管外科杂志

The end of the COVID-19 infection peak in 2022 prompts a backlog of cardiovascular surgical patients to gradually return to the hospital, resulting in a surge in cardiovascular surgeries. However, against the backdrop of the COVID-19 pandemic, the clinical practice of cardiovascular surgery faces many problems. Therefore, organized by Beijing Anzhen Hospital, experts in cardiovascular surgery and related fields have formulated hospital expert experience on perioperative treatment principles of cardiovascular surgery for patients infected with COVID-19. This article summarizes the clinical decision-making of patients requiring cardiovascular surgery after COVID-19 infection, and advises on the corresponding recommendations according to the existing evidence-based medical evidence as well as the actual clinical practice experience of relevant experts. The main content of the article includes special requirements for cardiovascular surgical treatment indications in patients with COVID-19 infection, selection of surgical timing, special requirements of preoperative, intraoperative and postoperative management, etc., which aims to provide COVID-19-infected patients with guidance on rational decision-making when receiving cardiovascular surgery.

PD-1 inhibitor plus anlotinib for metastatic castration-resistant prostate cancer: a real-world study / 亚洲男科学杂志(英文版)

Management and treatment of terminal metastatic castration-resistant prostate cancer (mCRPC) remains heavily debated. We sought to investigate the efficacy of programmed cell death 1 (PD-1) inhibitor plus anlotinib as a potential solution for terminal mCRPC and further evaluate the association of genomic characteristics with efficacy outcomes. We conducted a retrospective real-world study of 25 mCRPC patients who received PD-1 inhibitor plus anlotinib after the progression to standard treatments. The clinical information was extracted from the electronic medical records and 22 patients had targeted circulating tumor DNA (ctDNA) next-generation sequencing. Statistical analysis showed that 6 (24.0%) patients experienced prostate-specific antigen (PSA) response and 11 (44.0%) patients experienced PSA reduction. The relationship between ctDNA findings and outcomes was also analyzed. DNA-damage repair (DDR) pathways and homologous recombination repair (HRR) pathway defects indicated a comparatively longer PSA-progression-free survival (PSA-PFS; 2.5 months vs 1.2 months, P = 0.027; 3.3 months vs 1.2 months, P = 0.017; respectively). This study introduces the PD-1 inhibitor plus anlotinib as a late-line therapeutic strategy for terminal mCRPC. PD-1 inhibitor plus anlotinib may be a new treatment choice for terminal mCRPC patients with DDR or HRR pathway defects and requires further investigation.

Endoscopic thoracic sympathicotomy in the treatment of primary hyperhidrosis based on ambulatory surgery and enhanced recovery mode: A retrospective cohort study in a single center / 中国胸心血管外科临床杂志

@#Objective    To investigate the safety of endoscopic thoracic sympathicotomy in the treatment of primary hyperhidrosis based on ambulatory surgery mode. Methods    Retrospective analysis was performed on the clinical data of 158 patients with primary hyperhidrosis who received endoscopic thoracic sympathicotomy in the Affiliated Hospital of Zunyi Medical University from January 2019 to March 2021. There were 68 (43.2%) males and 90 (56.8%) females with an average age of 14-33 (20.5±3.1) years. The basic information of the patients, operation time, intraoperative blood loss, postoperative pain score, hospitalization expenses and postoperative complications were observed and recorded. Results    All surgeries were successfully completed and the patients were discharged as planned. The operation time was 41.8±13.9 min, the intraoperative blood loss was 10.5±7.3 mL, the postoperative anesthesia recovery time was 15.0±5.9 min, and the pain score was 3.0±0.9 points. The total length of hospitalization was 1.6±1.0 days. The total postoperative expenses were 9 471.7±1 698.9 yuan. Pneumothorax occurred after the operation in 3 patients. Telephone follow-up on the 30th day after the operation showed no recurrence of sweaty hands, pneumothorax or rapid heart rate, and no serious complications or death related to the day operation within 30 days after the operation. Conclusion    Endoscopic thoracic sympathicotomy based on ambulatory surgery mode is safe and effective in the treatment of primary hyperhidrosis.

Preoperative ascending aorta diameter and prognosis analysis of patients with acute type A aortic dissection / 中华胸心血管外科杂志

Objective:To investigate the preoperative ascending aorta diameter in patients with acute type A aortic dissection in the Chinese population, compares and analyze the differences in preoperative blood biomarkers, and evaluate the impact of the preoperative ascending aorta diameter in this part of patients on the short-term prognosis of patients.Methods:A collection of 641 patients with acute type A aortic dissection who were enrolled in the " Acute Aortic Syndrome High-Risk Early Warning and Intervention Study" project from January 2018 to January 2020 were collected. Divide the patients into two groups (group Ⅰ<55 mm, group Ⅱ≥55 mm) according to the preventive intervention value of ascending aorta diameter recommended by the guideline for studying preoperative ascending aorta diameter difference in blood biomarkers and the influence of ascending aorta diameter on the short-term prognosis of patients. All patients had CT scans to assess the diameter of the ascending aorta before operation.Results:In this study, all patients with acute type A aortic dissection had a mean preoperative ascending aorta diameter of (46.9±9.7)mm. The preoperative ascending aorta diameter of all patients was less than 55 mm, accounted for 84.1%. Male patients were more likely to have aortic dissection than females; most patients' age was less than 60 years old. The preoperative blood inflammatory index counts were higher in the ascending aorta diameter ≥55 mm group. However, the long-term prognosis of patients with different ascending aorta diameters before surgery was not apparent in this study. The preoperative survival rate and short-term survival rate of patients with ascending aorta diameter <55 mm were higher than those of other groups, but the difference was not statistically significant.Conclusion:In patients with acute type A aortic dissection, the diameter of the ascending aorta is usually less than 55 mm. Moreover, the blood inflammatory index counts are high in the preoperative ascending aorta diameter ≥55 mm group. Meanwhile, patients with smaller ascending aorta diameter have better survival rate and short-term prognosis.

Correlation of mRNA expression levels and DNA methylation levels of APTR with HBV infection / 中华临床感染病杂志

Objective:To investigate the correlation of mRNA expression levels and DNA methylation levels of Alu-mediated p21 transcriptional regulator (APTR) with hepatitis B virus infection.Methods:One hundred patients with HBV infection admitted in Affiliated Hospital of Yunnan University during January to December 2019 were enrolled in the study, including 50 patients with chronic hepatitis B (CHB group) and 50 asymptomatic HBV carriers (ASC group); and 50 healthy subjects were also enrolled as the healthy control group. The DNA methylation levels of APTR gene were detected by methylation-sensitive high-resolution melting (MS-HRM); the expression levels of APTR mRNA were detected by fluorescence real-time quantitative PCR (qRT-PCR). Pearson correlation or Spearman rank correlation was used for correlation analysis.Results:There were significant differences in the APTR DNA methylation levels among the CHB, ASC and healthy control groups {[12.02 (9.30, 23.32)]%, [10.02 (8.46, 17.44)]% and [8.86 (7.82, 11.57)]%, χ2=13.360, P<0.01}. The APTR DNA methylation levels were significantly higher in CHB group than those in healthy control group( Z=31.480, P<0.01). There were significant differences in the APTR mRNA expression levels among CHB, ASC and healthy control groups (2.38±1.41, 5.78±2.78 and 5.70±2.66, F=33.720, P<0.01). The APTR mRNA expression levels were significantly lower in CHB group than those in healthy control and ASC groups ( t=7.808 and 7.724, both P<0.01). Correlation analysis showed that the DNA methylation level of APTR gene was negatively correlated with mRNA expression levels ( r=-0.305, P<0.01) in all subjects. The DNA methylation level of APTR gene was positively correlated with HBsAg level ( r=0.231, P=0.022), and the mRNA expression level was negatively correlated with HBsAg level ( r=-0.245, P=0.014) in patients with HBV infection. Conclusion:There are differences in DNA methylation and mRNA expression of APTR gene in different stages of HBV infection, suggesting that APTR gene may be involved in the immune regulation of HBV infection.

A review of international progress in colorectal cancer screening programs / 上海预防医学

Objective:To summarize the international experience in colorectal cancer population screening programs， so as to provide reference for the development and promotion of similar programs in China. Methods:We used “colorectal cancer population screening program” as key words to search the database of CNKI and Web of Science in this study. Results:A total of 18 reports （including 17 programs） were selected from 187 Chinese and 1 256 English literatures. International colorectal cancer screening programs were organized to target asymptomatic 50-74 years old population for fecal immunochemical test every two years and recommend participants with positive result to take further colonoscopy. These programs reduced the incidence of colorectal cancer and adenoma， which were beneficial to early diagnosis and treatment in colorectal cancer patients. They also showed good cost-effectiveness. Conclusion:Based on the domestic and foreign experiences， we suggest to further improve colorectal cancer screening programs in China， including designing evidence-based and feasible strategies， attaching importance to the implementation and management of the programs， and simultaneously implementing project monitoring and effectiveness evaluation.

Improvement Effects of Dantaojin Extract on Oxidative Stress Injury of Liver and Kidney in Chronic Lead Po i- soning Model Mice / 中国药房

OBJECTIVE：To stu dy the improvement effect s of Dantaojin （Salvia miltiorrhiza ，Persicae Semen ，Curcumae Radix）extract on oxidative stress of liver and kidney in chronic lead poisoning model mice. METHODS ：Totally 72 mice were randomly divided into normal control group ，model group ，positive control group （dimercaptosuccinate，70 mg/kg），Dantaojin extract low-dose ，medium-dose and high-dose groups （20，40，60 g/kg），with 12 mice in each group. Except for normal control group，other groups were given intraperitoneal injection of lead acetate solution 20 mg/kg（every other day ，consecutive 20 days） to establish chronic lead poisoning model. After modeling ，administration groups were given relevant medicine intragastrically ， normal control group and model group were given constant volume of water intragastrically ，once a day ，for consecutive 20 days. After last medication ，body weight of mice was weighed ，and organ coefficients （kidney and liver ）were calculated. Serum levels of ALT ，AST，BUN and Scr were determined by automatic biochemical detector. HE staining was used to observe histopathological features of liver and kidney. ELISA method was used to determine the levels of GSH-Px ，SDO and MDA in liver and renal tissue. RESULTS：Compared with normal control group ，body weight （except for high-dose group ），the levels of SOD （except for high-dose group ）and GSH-Px were all decreased significantly in model group and Dantaojin extract groups ，while the renal coefficients（except for high-dose group ），liver coefficients （except for low-dose ，medium-dose and high-dose group ），the levels of BUN （except for high-dose group ），Scr，AST（except for high-dose group ），ALT and MDA were increased significantly （P＜ 0.05 or P＜0.01）. The epithelial cells of glomerulus and renal tubules were atrophied ，the arrang ement of hepatocytes was loose and some cells were necrotic. Compared with model group ，body weight ，the levels of SOD and GSH-Px were increased significantly in positive control group and Dantaojin extract groups，while the renal and liver coefficients ，the levels of BUN，Scr，AST，ALT and M DA were decreased significantly（P＜0.05 or P＜0.01）. Histopathological fea tures of liver and renal tissue were improved significantly in Dantaojin extract medium-dose and high-dose groups. CONCLUSIONS ：Dantaojin extract could improve oxidant stress injury in liver and renal tissue，the mechanism of which may be associated with eliminating reactive oxygen radicals ，inhibiting lipid peroxidation and enhancing antioxidant defense ability.

Prediction model of mid-term fatality risk after radical resection in patients with hepatocellular carcinoma based on ALBI-grade / 浙江大学学报·医学版

OBJECTIVE@#To establish a clinical prediction model of the mid-term fatality risk after radical resection in patients with primary hepatocellular carcinoma (HCC) based on the albumin-bilirubin (ALBI) grade and to assess its prediction value.@*METHODS@#Clinical data of 533 patients who received HCC radical resection in Jinhua Hospital of Zhejiang University, Jinhua People's Hospital, Jinhua Hospital of Traditional Chinese Medicine and Jinhua Guangfu Hospital from January 2010 to August 2016 were retrospectively reviewed. In the training group ( =407), Cox model was used to screen the clinical risk factors of postoperative death, and a predictive model based on ALBI grade was established and then examined in the validation group ( =126). The value of the prediction model was assessed by ROC curve and calibration curve; the prediction results of the model were visualized by the nomogram for the convenience of clinical use.@*RESULTS@#Cox model showed that ALT ≥ 80 U/L, tumor maximum diameter ≥ 5 cm, portal vein tumor thrombus and ALBI grade 2 were independent risk factors for the prognosis of patients with HCC radical resection. The prognosis index (PI) was 0.550×ALT+0.512×ALBI grade+0.872×maximum tumor diameter+1.377×portal vein tumor thrombus. The AUCs for predicting the risk of death in 12, 36 and 60 months were 0.872, 0.814 and 0.810, respectively (all < 0.01), and the goodness of fit ( ) of the established model were 0.953, 0.976 and 0.994. AUC of the established model for predicting risk of death in 36 months after resection was 0.814, which was higher than those of ALBI (AUC=0.683), BCLC (AUC=0.713), CLIP (AUC=0.689), Child-Pugh (AUC=0.645), TNM (AUC=0.612) ( < 0.05 or < 0.01).@*CONCLUSIONS@#ALT ≥ 80 U/L, maximum tumor diameter ≥ 5 cm, portal vein tumor thrombus and ALBI grade 2 are independent risk factors of patients after HCC resection, and ALBI grade-based prediction model is satisfactory in prediction of mid-term death risk of the patients.