BACKGROUND:Renal tubular-interstitial lesion and fibrosis induced by peritubular capil ary reduction is a common pathway for various chronic kidney diseases which eventual y develop into end-stage renal failure. How to increase the density of peritubular capil ary network is the key to resolving renal interstitial fibrosis. Netrin-1, as a potent mitogen of vascular endothelial cel s, can promote the migration and proliferation of vascular endothelial cel s and induce angiogenesis. OBJECTIVE:To observe the protective effects of naked netrin-1 plasmid transfer on the remnant renal function of 5/6 nephrectomized rats and the effects of naked netrin-1 plasmid transfer on peritubular capil ary network, and to further discuss the possible mechanism. METHODS:Thirty Sprague-Dawley rats were randomly divided into sham, model and treatment groups. Upper and lower one-third of the rat left kidney was resected in the model and treatment groups, and then the right kidney was resected after 1 week to prepare remnant kidney models in rats. IRES2-EGFP and pCMV6-XL5-Netrin-1-IRES2-EGFP pGenesil-NPs plasmids were intravenously injected into the left renal vein while resecting the right kidney of rats in the model and treatment groups, respectively. RESULTS AND CONCLUSION:Compared with model group, the levels of blood urea nitrogen and serum creatinine decreased, the degree of renal interstitial fibrosis al eviated, the density of peritubular capil aries increased, and the netrin-1 protein expression in renal tubular cytoplasm increased in the treatment group. These findings suggest that the naked netrin-1 plasmid transfer can significantly improve the renal function of the 5/6 nephrectomized rats, reduce the pathological lesion and renal interstitial fibrosis of the remnant kidney, increase the density of peritubular capil aries, and decrease the expression of hypoxia-inducible factor 1α, thereby improving the anoxic condition of renal interstitial tubules.

Background: The occurrence of tumor is closely related to the function of immune system. As an effector cell of innate immunity, the function of γδ T cells is reported to be regulated by co-stimulatory molecules. T-cell immunoglobulin mucin-3 (Tim-3) and programmed death-1 (PD-1), two critical inhibitory co-stimulatory molecules, may affect the immune function of T lymphocytes via binding with their ligands, thus mediating the immune escape of tumor cells. Aims: To investigate the expressions and clinical significance of Tim-3 and PD-1 on γδ T cells in peripheral blood of colon cancer patients. Methods: Peripheral blood samples of 44 colon cancer patients were collected preoperatively at the First Affiliated Hospital of Soochow University from Dec. 2017 to Jun. 2018. Forty healthy volunteers were served as controls. The peripheral blood mononuclear cells (PBMCs) were isolated by density gradient centrifugation. Expressions of Tim-3 and PD-1 on γδ T cells were detected by flow cytometry, and their correlations with tumor clinicopathological characteristics were analyzed. Results: The proportions of Tim-3+, PD-1+ and Tim-3+PD-1+ γδ T cells in peripheral blood of colon cancer patients were significantly higher than those of healthy volunteers (P<0.05), and was positively correlated with the tumor volume and TNM staging (P<0.05). No correlations were found between proportions of Tim-3+, PD-1+ and Tim-3+PD-1+ γδ T cells and the gender, age, tumor location and distant metastasis of colon cancer patients (P>0.05). Conclusions: Tim-3 and PD-1 are highly expressed on γδ T cells in peripheral blood of colon cancer patients and associated with the clinicopathological stage of tumor. Expressions of Tim-3 and PD-1 on peripheral blood γδ T cells might be the promising objective indicators for evaluating the development and progression of colon cancer.

BACKGROUND:The treatment of pulmonary hypertension secondary to congenital heart disease has been a hot topic in the clinical research on cardiac surgery. Although traditional drugs for reducing pulmonary hypertension have excelent effects, there are some defaults, such as difficult monitoring and rebounding phenomenon after drug withdrawal. The traditional heart dacron graft is prone to cause complications, such as deformation, thrombosis, embolism, hemolysis and infection. OBJECTIVE:To investigate the effect of glutaraldehyde-fixed bovine pericardium patch and aerosolized iloprost in patients with pulmonary hypertension secondary to congenital heart disease. METHODS:Ninety patients with pulmonary hypertension due to congenital heart disease underwent a surgery. Glutaraldehyde-treated bovine pericardium patch were used to repair cardiac septal defect, and then aerosolized iloprost was applied after operation, administered for 3 days according to 30 ng/min/kg, every 4 hours in the first 12 hours of a day, and every 6 hours in the resting 12 hours. Mean arterial pressure, mean pulmonary arterial pressure, systemic vascular resistance index, pulmonary vascular resistance index were recorded before inhalation, immediately after inhalation, and 30 minutes after inhalation. The pericardium-associated complications, and cardiac function were also observed at folow-ups. RESULTS AND CONCLUSION: The involved 90 cases were detected by echocardiography. The results showed that, al the flaps were closed, there was no shunting or echo discontinuation of atrial septum. The heart contraction function was normal. No pericardium-associated complications were found. There was no significant difference in the mean arterial pressure and systemic vascular resistance index in al patients at different time points. The mean pulmonary arterial pressure and pulmonary vascular resistance index immediately after inhalation were significantly lower than that before inhalation (P < 0.01). The decrease was also significant 30 minutes after inhalation (P < 0.05). The intervention of glutaraldehyde-fixed bovine pericardium patch and aerosolized iloprost is safe and effective to treat patients with pulmonary hypertension secondary to congenital heart disease.

Objective To analyze the causes and treatment methods of early complications after central systemic-pulmonary shunt in complex cyanotic congenital heart diseases.Methods Two hundred and twelve cases of central systemic-pulmonary shunt in complex cyanotic congenital heart diseases were retro-spectively analyzed in order to explore the early postoperative complications and related treatment measures. Results There were 61 cases(28.77%)of the early postoperative complications,including severe low car-diac output syndrome in 27 cases,acute pulmonary edema in 14 cases,24 h shunt pipe blockage in 12 cases, and supraventricular tachycardia in 8 cases.All patients got followed up,average for(2.49 ±1.21 )years.Af-ter the systemic-to-pulmonary artery shunts,pulmonary vascular had significant growth,8 patients(3.77%) of them who pulmonary hypoplasia were promoted by transcatheter aortopulmonary collateral vessels.At the end of the follow-up,77 patients(36.32%)achieved the standard of radical surgery.Conclusion The factors affecting surgical survival rate include:enhancement of patients cardiac function and strictly handle operation indication before operation a clear operational view;rational surgical methods;treatment of complication with-out delay;strict,intensive care and synthesized treatment.

Objective To explore method of early diagnosis and treatment of adult patients with cerebral ischemic stroke after cardiovascular surgery.Methods The chnical data of 24 adult patients with cerebral ischemic stroke after cardiovascular surgery were retrospectively analyzed.Firstly,CT or MRI should be accomplished to determine the type of cerebral ischemic stroke as soon as patients' condition of circulation and respiration were stable.Secondly,the vital signs should be monitored closely,and the consciousness,pupil,respiratory and hmbs activity of the patients were observed.Thirdly,the patients' temperature of head should be reduced and be given dehydration,anticoagulation,cholesterol-lowering medication,brain nutrition drugs,beta receptor blockers and other drugs.Overall,the balance of fluid,electrolytes and acid-base were maintained in the course of treatment.Results Among the 24 patients,male was 66.7％ (16/24).Early cerebral ischemic stroke occurred in 6 cases,delayed cerebral ischemic stroke occurred in 18 cases.Cerebral ischemic stroke happened in 12 patients who underwent coronary artery bypass grafting surgery,8 patients after cardiac valve replacement surgery,2 cases after artery dissection surgery and 2 patients after other surgery.Two cases were death during hospital stay,the mortality was 8.3％ (2/24).Conclusion Adult patients with clinical manifestation of cerebral ischemic stroke after cardiovascular surgery should be diagnosed early as soon as possible,the treatment key of cerebral ischemic stroke is strict monitoring and comprehensive treatment.

Objective To explore the diagnostic value of digital breast tomosynthesis technique (DBT) in breast suspicious calcified lesions.Methods Clinical data of 135 patients using DBT and FFDM (Full field digital mammography) was respectively analyzed.Results Of the 135 cases,43 cases were malignant,and 92 cases were benign.The diagnostic sensitivity DBT and FFDM were 93.0％ (40/43)and 88.4％ (38/43),specificity were 88.0％ (81/92) and 75.0％ (69/92),accuracy were 89.6％ (121/135) and 79.3％ (107/135),the differences were statistically significant (P ＜0.05).The ROC curve area (AUC) of DBT and FFDM were 0.905 ± 0.026 and 0.817 ± 0.034 (P =0.000 2).In premenopausal,postmenopausal and breast density ACR3-4 cases,DBT accuracy is higher than FFDM (P ＜ 0.05).The BI-RADS classification difference of the benign calcified lesions was statistically significant (x2 =11.740,P =0.038 5).Conclusions Compared with the traditional FFDM,DBT has a higher value in the diagnosis of breast suspicious calcified lesions,especially for benign calcified lesions.

Objective To detect whether patients with gastric cancer had unique serum metabolomic characteristics by liquid chromatography-mass spectrometry (LC-MS) metabolomic analysis,and to screen potential markers for early gastric cancer and to preliminarily explore the related metabolic pathways.Methods At the First Affiliated Hospital of Soochow University,66 patients with gastric cancer and 44 patients with benign gastric disease from July,2017 to January,2018 were enrolled,and 50 healthy subjects served as controls.Twenty-five patients with gastric cancer at stage Ⅰ and Ⅱ and 25 patients with gastric cancer at stage Ⅲ and Ⅳ were selected from the 66 patients with gastric cancer,and 25 subjects were also selected from 50 healthy controls.The plasma small molecule metabolites of patients with gastric cancer and benign gastric disease and healthy controls were detected by LC-MS method.Multivariate logistic regression analysis was used to establish and validate the principal component analysis (PCA) model and partial least squares-discriminant analysis (PLS-DA) model and screen the differential metabolites.The receiver operating characteristic curve analysis was used to evaluated the clinical efficacy of differential metabolites.Results PCA and PLS-DA models showed that gastric cancer had a obviously specific metabolites profile,the profile of benign gastric disease overlapped with that of gastric cancer and healthy controls.The results of multivariate logistic regression analysis confirmed that four metabolites including isoleucine,benzophenone,sphingosine-1-phosphate and galactopyranose set could be used to establish an optimal diagnostic model.The area under the curve (AUC)(95％ confidence interval (CI)) was 0.963 (0.930 to 0.997),and the best cut off value,sensitivity and specificity were 0.871,93.1％ and 94.0％,respectively.Meanwhile,patients with gastric cancer at stage Ⅰ + Ⅱ and stage Ⅲ + Ⅳ had a distinct clustering trend compared with the control group.In the serum of patients with gastric cancer at stage Ⅰ + Ⅱ and stage Ⅲ + Ⅳ,a total of 24 differential metabolites were identified,theconcentration of five of which including lysine,carnitine,benzenesulfonamide,arginine and docosahexaenoic acid ethyl ester,increased along with the progression of gastric cancer.Pipecolic acid and kynurenine might served as biomarkers for early and mid gastric cancer (stage [+ Ⅱ) screening.Conclusions LC-MS metabolomic effectively confirm the unique changes of serum metabolites in patients with gastric cancer.The screened differential metabolites have potential clinical application value for predicting the risk of gastric cancer.

Objective To investigate the effect of lung recruitment maneuver on alveolar collapse after fiber support bronchoscopy,and to evaluate its clinical value.Methods Since April 2014 and April 2017 in underwent deep hypothermia and stop of 60 cases of hypoxemia in patients with postoperative aortic circulation as the research object,according to the random number distribution method.The average score of the two groups,each group with 30 cases in each.The control group was treated with conventional fiber bronchoscopy and end expiratory positive pressure ventilation in the treatment,observation group patients on the basis of the application of lung recruitment method to carry on the treatment.Observation compared two groups of patients with lung recruitment maneuver and respiration and circulation of the parameter variations and mechanical ventilation in time.Results Two groups of patients with treatment of the parameters,the difference was not statistically significant (P ＞0.05);after treatment,observation group of patients with oxygen synthetic index and mechanical ventilation time and the control group was significant difference compared with statistical significance(P ＜ 0.05);and two groups of patients with arterial carbon dioxide into change of pressure and tidal volume before and after the treatment were not significant,no statistical significance(P ＞ 0.05).Two groups of patients with the circulatory system index tends to be stable,no significant change (P ＞0.05).Conclusion The use of bronchoscopy in patients with aortic dissection after the examination of hypoxia,application of lung recruitment maneuver method for treatment,can improve the patient's oxygenation index,reduce the time of mechanical ventilation in patients with.

Objective: To examine the mortality rate and relative factors associate with ventricular septal rupture in myocardial infarction patients. Methods: A total of 51 patients who suffered from myocardial infarction complicating with ventricular septal rupture received operative procedures between January 2005 and December 2018 in Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, were retrospectively analyzed. There were 34 males and 17 females, with an age of (63±8) years (range: 44 to 82 years). The time between ventricular septal rupture and surgical procedure was (44±39) days (range: 3 to 187 days). The t test and χ² test were used for univariate analysis, Logistics regression model was used for multivariate analysis of in-hospital mortality relative factors. Results: There were 8 patients dead in hospital, 43 patients survived, the overall mortality rate was 15.7% in hospital. The post-operation mortality rate was 2/3 of who suffered ventricular septal rupture and underwent operation within 1 week, but it′s markedly decreased to 6.5% if the time over 4 weeks. Univariate analysis showed that renal failure before operation, creatinine before operation, left ventricular ejection fraction, cardiac function (New York Heart Association) grade Ⅳ, severe tricuspid regurgitation, dialysis post-operation, creatinine of the first day of post-operation, the time between and operation more than 4 weeks were in-hospital mortality relative factors. Multivariate analysis reflected that advanced age (OR=1.32, 95%CI: 1.05 to 1.75, P=0.033), cardiac function grade Ⅳ (OR=2.25, 95%CI: 1.62 to 2.82, P=0.003), severe tricuspid regurgitation (OR= 1.82, 95%CI: 1.31 to 2.43, P=0.001), renal failure before operation (OR=1.78, 95%CI: 1.26 to 2.32, P=0.015), the time between ventricular septal rupture and operation less than 1 week (OR=2.50, 95%CI: 1.52 to 2.98, P=0.012), were independent in-hospital mortality relative factors. Conclusions The surgery operation is an effective way to deal with ventricular septal rupture combined with myocardial infarction. The independent relative factors of in-hospital mortality are advanced age, cardiac function grade Ⅳ, renal failure before operation, severe tricuspid regurgitation, the time between ventricular septal rupture and operation less than 1 week.