Objective:To examine the therapeutic strategy and its impacting factors by analyzing the perioperative outcomes of total thoracoscopic repeat mitral valve surgery under moderate hypothermia-induced ventricular fibrillation with cardiopulmonary bypass.Methods:This study is a retrospective case series. Totally 63 patients who underwent repeat mitral valve surgery by the same surgeon from January 2021 to December 2023 in Department of Cardiovascular Surgery, the First Medical Center of People′s Liberation Army General Hospital were retrospectively enrolled. There were 28 males and 35 females with an age of (58.3±15.9) years (range: 13 to 84 years). Surgery was performed using a totally thoracoscopic approach under moderate hypothermia-induced ventricular fibrillation. Mitral valvuloplasty was completed in 32 cases and mitral valve replacement in 31 cases. Preoperative baseline data and perioperative outcomes of the patients were collected and Logistic regression was used to analyze independent influencing factors of premature ventricular contractions in the early postoperative period.Results:The intraoperative cardiopulmonary bypass time was (191.5±50.9) minutes (range: 95 to 286 minutes), and the hypothermic ventricular fibrillation time was (99.0±39.8) minutes (range: 34 to 203 minutes). The anal temperature before the start of cardiopulmonary bypass was (36.3±0.5) ℃ (range: 35.2 to 38.0 ℃), the lowest intraoperative anal temperature was (27.3±1.3) ℃(range: 23.7 to 30.1 ℃), and the anal temperature at the time of the cessation of cardiopulmonary bypass was (36.3±0.4) ℃ (range: 35.2 to 37.0 ℃), and excessive rewarming was observed in 33 cases. Six cases applied the artificial heart assist device. Seventeen cases developed premature ventricular contractions in the early postoperative period. Two cases developed neurologic complications. Five cases developed respiratory complications. One case developed urological systemic complications. Six cases were mechanically ventilated for more than 3 days, and the duration of ICU stay in 16 cases was more than 3 days and the postoperative discharge time of ( M(IQR)) 8.0 (3.5) days (range: 3 to 26 days). Two cases died or were discharged voluntarily. Logistic regression results showed that persistent preoperative atrial fibrillation ( OR=11.424, 95% CI: 1.477 to 144.564, P=0.033) and excessive rewarming ( OR=15.249, 95% CI: 1.357 to 279.571, P=0.038) were independent risk factors for the appearance of premature ventricular contractions in the early postoperative period. Conclusions:The technique of total thoracoscopic surgery under induced moderate hypothermic ventricular fibrillation with cardiopulmonary bypass could be applied to repeated mitral valve surgeries with less trauma and faster recovery. Persistent preoperative atrial fibrillation and excessive rewarming are independent risk factors for the occurrence of premature ventricular contractions in the early postoperative period.

Objective:To examine the therapeutic strategy and its impacting factors by analyzing the perioperative outcomes of total thoracoscopic repeat mitral valve surgery under moderate hypothermia-induced ventricular fibrillation with cardiopulmonary bypass.Methods:This study is a retrospective case series. Totally 63 patients who underwent repeat mitral valve surgery by the same surgeon from January 2021 to December 2023 in Department of Cardiovascular Surgery, the First Medical Center of People′s Liberation Army General Hospital were retrospectively enrolled. There were 28 males and 35 females with an age of (58.3±15.9) years (range: 13 to 84 years). Surgery was performed using a totally thoracoscopic approach under moderate hypothermia-induced ventricular fibrillation. Mitral valvuloplasty was completed in 32 cases and mitral valve replacement in 31 cases. Preoperative baseline data and perioperative outcomes of the patients were collected and Logistic regression was used to analyze independent influencing factors of premature ventricular contractions in the early postoperative period.Results:The intraoperative cardiopulmonary bypass time was (191.5±50.9) minutes (range: 95 to 286 minutes), and the hypothermic ventricular fibrillation time was (99.0±39.8) minutes (range: 34 to 203 minutes). The anal temperature before the start of cardiopulmonary bypass was (36.3±0.5) ℃ (range: 35.2 to 38.0 ℃), the lowest intraoperative anal temperature was (27.3±1.3) ℃(range: 23.7 to 30.1 ℃), and the anal temperature at the time of the cessation of cardiopulmonary bypass was (36.3±0.4) ℃ (range: 35.2 to 37.0 ℃), and excessive rewarming was observed in 33 cases. Six cases applied the artificial heart assist device. Seventeen cases developed premature ventricular contractions in the early postoperative period. Two cases developed neurologic complications. Five cases developed respiratory complications. One case developed urological systemic complications. Six cases were mechanically ventilated for more than 3 days, and the duration of ICU stay in 16 cases was more than 3 days and the postoperative discharge time of ( M(IQR)) 8.0 (3.5) days (range: 3 to 26 days). Two cases died or were discharged voluntarily. Logistic regression results showed that persistent preoperative atrial fibrillation ( OR=11.424, 95% CI: 1.477 to 144.564, P=0.033) and excessive rewarming ( OR=15.249, 95% CI: 1.357 to 279.571, P=0.038) were independent risk factors for the appearance of premature ventricular contractions in the early postoperative period. Conclusions:The technique of total thoracoscopic surgery under induced moderate hypothermic ventricular fibrillation with cardiopulmonary bypass could be applied to repeated mitral valve surgeries with less trauma and faster recovery. Persistent preoperative atrial fibrillation and excessive rewarming are independent risk factors for the occurrence of premature ventricular contractions in the early postoperative period.

Objective To explore the influence of early high-energy-density milk powder feeding on recovery and nutritional status in infants with congenital heart disease after surgery. Methods A total of 82 infants with congenital heart disease were selected and randomly divided into control group (early routine formula feeding) and study group (early high-energy-density formula feeding), with 41 cases in each group. The recovery outcomes, nutritional status, feeding conditions, and cardiac function were compared between the two groups. Results Mechanical ventilation time, treatment duration in Cardiac Intensive Care Unit (CICU), and hospital stay in the study group were significantly shorter than those in the control group (P < 0.05). Compared with preoperative levels, the levels of prealbumin (PA), retinol-binding protein (RBP), transferrin (TRF) and albumin (ALB) increased significantly in both groups at 3 months after operation (P < 0.05); at 3 months after operation, the levels of PA, RBP, TRF and ALB in the study group were significantly higher than those in the control group (P < 0.05). Compared with preoperative measurements, both groups showed significant improvements in height and body weight at 3 months after operation (P < 0.05); the height and body weight of the study group were significantly higher than those of the control group at 3 months after operation (P < 0.05). Compared with the control group, the study group had a significant lower rate of inadequate feeding and a significant higher rate of appropriate feeding (P < 0.05). Cardiac function of the study group was significantly better than that of the control group (P < 0.05). Conclusion Early high-energy-density milk powder feeding after congenital heart disease surgery in infants can promote faster recovery, improve nutritional status, and result in more appropriate feeding, with a lower incidence of heart failure.

Objective:To observe the clinical and multimodal imaging characteristics of eyes with acute macular neuroretinopathy (AMN) associated with COVID-19.Methods:A retrospective clinical study. From December 18 to 26, 2022, 16 eyes of 8 patients with AMN associated with COVID-19 were included in the study. There were 4 males and 4 females; all cases were bilateral. The age was (31.5±9.6) years old. The time from fever to decreased vision was (3.75±1.04) days. The best corrected visual acuity (BCVA), intraocular pressure, slit lamp microscopy, indirect fundus microscopy, fundus color photography, and optical coherence tomography (OCT) were performed in all patients. Infrared fundus photography (IR), OCT angiography (OCTA) and fluorescein fundus angiography (FFA) were performed in 14, 6 and 4 eyes respectively. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logarithm of the minimum angle of resolution (logMAR) BCVA for statistics. The clinical data, IR, OCT and OCTA imaging features of the patients were retrospectively analyzed.Results:The logMAR BCVA of AMN eyes was 4.21±0.74, intraocular pressure was (14.87±1.50) mm Hg (1 mm Hg=0.133 kPa). Fundus color photography showed that multiple gray-white petal-shaped lesions were arranged around the macular fovea in 2 eyes; no obvious abnormality was found in the macular area in 14 eyes. Of the 14 eyes examined by IR, 6 eyes had irregular weak reflective lesions around the macular fovea. OCT showed strong reflex in the outer nuclear layer and outer plexiform layer of all eyes, including 15 eyes with elliptical zone injury. In 6 eyes examined by OCTA, the blood flow density of the superficial and deep capillary plexus (DCP) of retina decreased, and the blood flow density of DCP decreased significantly. The en-face image of DCP showed the wedge-shaped strong reflective lesion area with the tip pointing to the central fovea in 2 eyes. No abnormal fluorescence was observed in FFA.Conclusions:The characteristic manifestation of AMN associated with COVID-19 is weak reflex focus in IR; OCT shows strong reflection in outer core layer and outer plexiform layer; OCTA showed that retinal DCP blood flow density decreased.

OBJECTIVE：To observe the p rotective effects of resveratrol （Res）on LPS-induced acute lung injury （ALI）model mice，and to explore its possible mechanism based on TLR 4/NF-κB pathway. METHODS：Kunming mice were divided into normal group，model group ，positive control group （dexamethasone，0.5 mg/kg），Res low-dose ，medium-dose and high-dose groups （50， 100，200 mg/kg），with 10 mice in each group. Normal group and model group were given normal saline intragastrically ，once a day，for 7 days；positive control group were intraperitoneally injected with Dexamethasone sodium phosphate injection ，once a day，for 3 days；Res groups were given relevant medicine intragastrically ，once a day ，for 7 days. After last administration ，all the mice except the normal group were dripped LPS （5 mg/kg）into the nose to induce ALI model. The apoptosis of neutrophils in BALF was observed by Hoechst 33242 staining；the apoptosis rate of neutrophils were detected by flow cytometry. The contents of IL- 6 and TNF-α in the plasma were detected by ELISA. After wet mass to dry mass （W/D）ratio of lung was E-mail：492234709@qq.com calculated，the morphological characteristics of lung tissue were observed by HE staining. Western blotting assay was used to detect the expression o f TLR 4 and NF-κ B in lung tissue. RESULTS ：In normal group ，there were few apoptotic neutrophils in the BALF ，and the lung tissue structure was intact ， without edema，hyperemia，exudation，inflammatory cell infiltration or other inflammatory manifestations. In model group ，the number of apoptotic neutrophils in BALF increased ，and the apoptotic rate of neutrophils were enhanced significantly （P＜0.01）； edema and hyperemia of lung tissue were significantly increased ，and the red consolidation area was observed ；the contents of IL- 6 and TNF-α in plasma，the ratio of lung W/D，the relative expression of TLR 4 and NF-κB in lung tissue were significantly increased （P＜0.01）. Compared with model group ，the number of apoptotic neutrophils in BALF were increased ，and the apoptotic rate of neutrophils were enhanced significantly （P＜0.05 or P＜0.01）above symptoms of lung tissue were improved to different extents ； the contents of IL- 6 and TNF-α in plasma，lung W/D ratio as well as relative expression of TLR 4 and NF-κB in lung tissue（except for Res low-dose group ）in administration groups were decreased significantly （P＜0.05 or P＜0.01）. CONCLUSIONS ：Res has a protective effect on ALI model mice ，the mechanism of which may be related to reducing the generation of inflammatory cytokines TNF-α and IL-6 by inhibiting TLR 4/NF-kB expression.

Objective To explore the expression level and significance of the nod-like receptor protein 3 (NLRP3) inflammasome in renal tissue with calcium oxalate stone.Methods 20 kidney specimens were collected as the experimental group from patients with calcium oxalate stone who underwent nephrectomy because of stones in our hospital between January 2008 and December 2014;another 20 renal specimens were get as the control group from patients with renal carcinoma,the renal tissues were obtained 2cm far from the tumor and proved as normal tissue.Immunohistochemical detection was carried out to analyze the expression level of NLRP3,Caspase-1,and IL-1β in the 40 renal samples.Animal experiment:fourteen male SD rats were randomly divided into calcium oxalate stone group and control group.For calcium oxalate stone group we established an ethylene glycol method induced hyperoxaluric rat model featured by crystalline material within tubule lumens;for control group normal feeding was performed.After 6 weeks,all rats were sacrificed,and the kidneys were harvested for further experiments.HE staining and Pizzolato staining were used to detect calcium oxalate crystals within tubule lumens.Western boltting and RT-PCR was applied to detect protein level and mRNA quantity of NLRP3,Caspase-1,and IL-1β from tissue lysates in rat model.Results In renal tissue samples obtained from patients with calcium oxalate stone disease,we demonstrated that the expression level of NLRP3,Caspase-1,and IL-1β were above to the normal renal tissue samples.We established a hyperoxaluric rat model character with crystalline material within tubule lumens examined by renal histology with HE staining and Pizzolato staining.And we detected that the protein and mRNA levels of NLRP3,Caspase-1 and IL-1β were remarkably increased in the lysates from the hyperoxaluric rat model (P ＜ 0.05).Conclusions The NLRP3 inflammasome has overexpression in the renal tissue of patients with calcium oxalate stone as well as in the renal tissue of hyperoxaluric rat,and it provides a new thought to reveal the formation of calcium oxalate stone.

Objective To establish the quality standard for Shengxinfa Capsule. Methods TLC was used to identify Praeparata, Psoraleae Fructus and Gastrodiae Rhizoma in Shengxinfa Capsule, and 2,3,5,4’-the four-stilbene-2-O-β-D-glucoside was identified by HPLC. The column of Agilent TC-C18 (4.6 mm×250 mm, 5 μm) was used. The mobile phase was acetonitrile-water (15∶85). The flow was 1.0 mL/min and column temperature was 30 ℃. UV detecting wavelength was 320 nm. Results Praeparata, Psoraleae Fructus and Gastrodiae Rhizoma could be identified by TLC. The linear range of 2,3,5,4’-the four-stilbene-2-O-β-D-glucoside was in the range of 0.05-0.50 μg. The average recovery was 97.8% (RSD=0.39%). Conclusion The method is feasible and accurate. The quality of Shengxinfa Capsule can be controlled effectively with the established quality standard.

BACKGROUND AND OBJECTIVEThe actual evaluation of immunological function is significant for studing the tumor development and devising a treatment in time. The aim of this study is to evaluate the immunological function of advanced lung cancer patients systematically, and to discuss the clinical significance.

METHODSThe nucleated cell amounts of advanced lung cancer patients and the healthy individuals were counted. The immune cell subsets and the levels of IL-4, INF-gamma, perforin and granzyme in CD8+T cells by the flow cytometry were measured. The proliferation activity and the inhibition ratio of immune cells to several tumor cell lines were evaluated by MTT assay.

RESULTSThe absolute amounts and subsets of T, B, NK cells of advanced lung cancer patients were lower than the healthy individuals (P < 0.05); However, the proportion of regulatory T cells of advanced lung cancer patients (4.00 +/- 1.84)% was lower than the healthy individuals (1.27 +/- 0.78)% (P < 0.05). The positive rates of IFN-gamma perforin, granzyme in CD8+T cells decreased while them in IL-4 did not in the advanced lung cancer patients compared to the healthy control group (P < 0.05). The proliferation activity of immune cells, the positive rate of PPD masculine and the inhibition ratio to tumor cells in the advanced lung cancer patients was lower than the healthy subsets obviously (P < 0.05).

CONCLUSIONThere was a significant immune depression in the advanced lung cancer patients compared to the healthy individuals.

Adult ; Aged ; CD8-Positive T-Lymphocytes ; immunology ; metabolism ; Cell Line, Tumor ; Female ; Flow Cytometry ; Granzymes ; metabolism ; Humans ; Interferon-gamma ; metabolism ; Interleukin-4 ; metabolism ; Lung Neoplasms ; immunology ; pathology ; Male ; Middle Aged ; Perforin ; metabolism

BACKGROUND AND OBJECTIVEThe CIK cell is one of the most important means of the adoptive cellular immunotherapy, and it is a hotspot of which to simplify its culture procedure and to promote its inhibition rate. The aim of this study is to observe the biological function of the CIK cells cultivated by the recombinant human fibronectin (RN) and to establish an effective and simple way of cells expansion.

METHODSWe separated the mononuclear cells (PBMCs) in 50 mL peripheral blood from 10 healthy persons with density gradient centrifugation in the lymphocyte-separating medium, and the PBMCs were divided into two groups, of which were cultivated by RN-introduced and conventional method separately. Then we estimated the proliferation ability, and analyzed the immunologic type, IFN-gamma, IL-4, perforin and granzyme B of them with flow cytometry. Besides that, we tested the inhibition rate of CIKs cells to four kinds of human lung cancer cell lines in vitro by MTT assay.

RESULTSThe RN-induced group had a higher proliferation rate that was 2.0-3.5 times of the conventional group, and there was an obvious statistical difference between the two (P < 0.05). The proliferation rates of CD3+CD16+CD56+T cells in each group were 3 778 and 2 068 times of the initial number, respectively. There was also a higher percentage of CD3+CD8+ T cells in RN-induced group (P < 0.05), while the percentage of CD3+CD4+T cells had no significant statistical difference (P > 0.05). We found a similar inhibition rate of the CIK cells to all this human lung cancer cell lines (P > 0.05). The cells which secreted IFN-gamma increased, while the cells which secreted IL-4 did not. The cells which secreted granzyme B and perforin were positive.

CONCLUSIONIt is an effective and simple way to cultivate the CIK cells with RN, which should be adopted.

CD3 Complex ; metabolism ; CD4-Positive T-Lymphocytes ; immunology ; CD56 Antigen ; metabolism ; Cell Line, Tumor ; Cells, Cultured ; Cytokine-Induced Killer Cells ; drug effects ; metabolism ; Fibronectins ; genetics ; metabolism ; pharmacology ; Flow Cytometry ; Humans ; Immunotherapy, Adoptive ; methods ; Interleukin-4 ; metabolism ; Lung Neoplasms ; therapy ; Receptors, IgG ; metabolism ; Recombinant Proteins ; genetics ; metabolism ; pharmacology ; T-Lymphocytes ; immunology