Objective To summarize the management of cardiopulmonary bypass(CPB) for infants below 10 kilograms with congenital heart diseases.Methods From Jan 2010 to Apr 2011,the clinical datas of 122 infants aged from 1.5 months to 2 years with body weight 3 to 10 kilograms,who underwent open heart surgery under mild or moderate hypothermia CPB were retrospectively analyzed.Results Among all the 122 infants,CPB time was 13 ～ 118 min [(62.69 ± 21.48) min],aortic cross-clamp time was 0 to 86 min [(35.47 ± 19.51) min].All patients were spontaneous resuscitation and successfully weared from the machine,no severe complications associated with CPB occurred,3 infants died (2.46％,3/122) after operation.Conclusion Using membrane oxygenator,circuit tubing and artery filter with less priming,and highflow perfusion during CPB,maintaining hemodynamics stable,holding reasonable hematocrit and colloid osmotic pressure,good myocardial protection and ultrafiltration are the significant elements of the management of CPB in infants with weight less than 10 kilograms.

Objective: To investigate the status of passive smoking among pregnant women in Jinshan District, Shanghai Municipality, so as to provide insights into developing targeted smoking control measures and promoting maternal and infant health. Methods: Pregnant women who had early pregnancy registration at Jinshan District Community Health Service Center from April 2021 to December 2023 were selected as subjects. The basic information, passive smoking and awareness of passive smoking hazards among pregnant women were collected through questionnaire surveys, and passive smoking rate and awareness rate of passive smoking hazards were analyzed. Results: Totally 8 273 questionnaires were allocated, and 8 216 valid questionnaires were recovered, with an effective rate of 99.31%. The mean age of participants was (29.52±4.60) years. There were 4 991 participants with an education of college degree or above, accounting for 60.75%; 3 565 participants with the first pregnancy, accounting for 43.39%; 3 990 primiparas, accounting for 48.56%; 3 193 participants living with smokers, accounting for 38.86%. A total of 3 710 participants passively smoked, with a passive smoking rate of 45.16%. There were 2 817 participants passively smoked in public places, accounting for 75.93%; 2 253 participants passively smoked in workplaces, accounting for 60.73%; 1 563 participants that passively smoked at home, accounting for 42.13%. The awareness rates regarding the hazards of passive smoking to health, causing lung cancer in adults, causing lung diseases in children, causing preterm birth and low birth weight infants, and causing heart diseases in adults were 92.13%, 88.85%, 87.99%, 82.05% and 62.56%, respectively. Conclusion The rate of passive smoking among pregnant women in Jinshan District is comparatively high, while their awareness regarding non-respiratory diseases emanating from passive smoking is comparatively low.

Two patients with typical Gitelman syndrome were diagnosed by gene and their clinical data and endocrine and metabolic status were evaluated.The etiology,clinical manifestation,laboratory findings,genetic diagnosis,and treatment for Gitelman syndrome were reviewed.

Objective To compare the postoperative extubation time and length of PACU retention between patients who had undergone retroperitoneal laparoscopic unilateral adrenal pheochromocytoma resection and other adrenal tumor resection.Methods A retrospective study of 57 hypertensive patients who had undergone retroperitoneal laparoscopic unilateral adrenal tumor resection under the general anesthesia was conducted.Nineteen patients with adrenal pheochromocytoma were assigned to group S,and other 38 patients were assigned to group D.We recorded and compared the gender ratio,ASA grade,age,weight,height,duration of operation and anesthesia,dosage of anes thetics,extubation time,and length of PACU retention between the two groups.Results There were no significant differences in gender ratio,ASA grade,age,weight,height,duration operation and anesthesia,as well as doses of propofol,midazolam,fentanyl and muscle relaxants between the two groups.As to extubation time and length of PACU retention,those of group S were both significantly longer than those of group D [30.0(25.0-42.5)min vs 20.0(15.0-20.0)min;70.0(57.5-82.5)min vs 45.0(33.5-55.0) min,P＜0.05,respectively].Conclusion Retroperitoneal laparoscopic unilateral adrenal pheochromocytoma resection might lead to postoperatively longer extubation time and length of PACU retention.It does not relate to the dosage of anesthetics used perioperatively.

Objective:To analyze the correlation between the volume of irradiated pelvic bone marrow and acute hematologic toxicity (HT), in order to provide clinical data to reduce the risk of acute HT and optimize the radiotherapy plan.Methods:From October 2017 to May 2019, 41 LARC patients who received neoadjuvant concurrent chemoradiotherapy (CCRT) were retrospectively reviewed in our center. All patients were treated with 5-field intensity-modulated radiotherapy (IMRT), and the prescription dose delivered to PTV was 45-50.4 Gy in 25-28 fractions. Capecitabine or 5-fluorouracil (5-FU) wasadministered daily 5 days a week during radiotherapy. Different HTswere recorded according to National Cancer Institute Common Toxicity Criteria Version 5.0 (NCI-CTC.V5.0) based on laboratory tests. The volume of PBM or each site (coxal, sacrum, femoral) receiving more than x Gy refers to as TVx, CVx, SVx, and FVx, respectively. Logistic regression was performed to evaluate the association between the volume of irradiated pelvic bone marrow and different HT. Generalized additive model (GAM) and piecewise regression were used to further analyze the possible nonlinear relationship and threshold effect between them. Results:Multivariate logistic regression analysis showed that low-dose of irradiated total pelvic bone marrow volume ( TV5) and coxal bone marrow volume ( CV5, CV10) were significantly correlated with Grade ≥2 leukopenia( P<0.05). There was a significant negative correlation between the sacrum bone marrow volume ( SV5, SV10) and Grade ≥2 leukopenia ( P<0.05). A thresholdeffect has been observed between CV10 and Grade ≥2 leukopenia by Generalized additive model (GAM) and piecewise linear regression. The threshold between CV10 and Grade ≥2 leukopenia was 575 ml, OR (95% CI) was 1.85 (1.08, 3.16). Conclusions:In neoadjuvant IMRT of rectal cancer, CV is a better predictor of acute HT induced by CCRT than TV. The irradiated volume of CV associated with acute HT was mainly low-dose levels ( CV5, CV10). The thresholds of our study ( CV10= 575 ml) could be a good reference for the optimization of the radiotherapy plan.

Objective:To investigate the correlation between the X-ray cross-complementary gene 1 (XRCC1) rs25487 gene polymorphism and the effect of neoadjuvant chemoradiotherapy for locally advanced rectal cancer (LARC).Methods:This research was a prospective cohort study consisting of 55 patients with LARC who were treated in the Affiliated Hospital, Guizhou Cancer Hospital of Guizhou Medical University from August 2018 to July 2019. The XRCC1 rs25487 genotype was detected, followed by neoadjuvant chemoradiotherapy. The logistic regression with adjusted confounding factors was used to analyze the relationship between down-staging of T-stage and N-stage and XRCC1 rs25487 gene polymorphism. The stratified analysis was used to explore interactions of neutrophil lymphocyte ratio (NLR) based on logistic regression.Results:The frequencies of all genotypes were in accordance with Hardy-Weinberg equilibrium. After adjusting confounding factors, compared to patients with AA genotype, patients with GG genotype had lower rate of down-staging of T-stage after neoadjuvant radiotherapy ( OR=0.1, P<0.05). However, there was no statistically significant difference between GA and AA genotypes ( P>0.05). There was interactions between AA/GA genotypes and NLR, which affected the down-staging of T-stage after radiotherapy. Conclusions:XRCC1 rs25487 gene polymorphism is associated with the efficacy of neoadjuvant radiotherapy and concurrent system chemotherapy in patients with LARC, which may be used as a predictor of the efficacy of neoadjuvant intensive therapy.

Objective: To investigate the clinico-pathological characteristics, outcomes and their predictors in malignant hypertension related kidney injury with and without primary glomerular diseases. Methods: Patients with clinical diagnosis of malignant hypertension, biopsy-proven kidney injury caused by malignant hypertension and complete clinical data from January 2010 to December 2018 were retrospectively analyzed. According to clinical and renal pathology, patients were divided into malignant hypertension related kidney injury without primary nephropathy group and with primary nephropathy group. Clinico-pathological characteristics and outcomes were evaluated and compared between malignant hypertension related kidney injury with and without primary glomerular diseases. Results: Totally 31 biopsy-proven kidney injury patients were analyzed. Among them, there were 18 cases with primary glomerular diseases and 13 cases without primary glomerular diseases, with age of (32.5±6.5) years old and (34.7±8.1) years old, respectively. There were 12 males in both group. The proportion of primary IgA nephropathy was higher (16/18) in the group of malignant hypertension related kidney injury with primary glomerular diseases. Malignant hypertension with primary glomerular diseases patients had lower plasma albunin level [(32.7±6.4) g/L vs (38.5±7.3) g/L, P=0.027], higher 24-hour proteinuria level [(4.03±2.71) g vs (1.45±0.98) g, P=0.002] and higher incidence rates of dysmorphic hematuria (14/18 vs 0, P=0.001) than those without primary glomerular diseases patients. Glomerular sclerosis, mesangial proliferation, tubular atrophy and interstitial fibrosis were more severe in malignant hypertension with primary glomerular diseases patients (all P<0.05), but the ischemic wrinkling of glomerular capillary was more severe in malignant hypertension without primary glomerular diseases (P<0.01). There were no differences of acute or chronic malignant hypertensive injury in small artery and in afferent arterioles between the two groups. Cox regression analysis showed that loss of brush-border with flattening of tubular epithelium was the predictor for renal partial recovery (HR=5.956, 95% CI 1.198-29.614, P=0.029). Kaplan-Meier analysis showed that malignant hypertension patients with primary glomerular diseases had shorter renal survival time than those without primary glomerular diseases [(24.1±9.3) months vs (56.6±12.4) months], and accumulative renal survival rate of malignant hypertension patients with primary glomerular diseases was lower than that without primary glomerular diseases (11.6% vs 53.3%, Log-rank χ²=5.022, P=0.025). Multivariate Cox regression analysis showed that severe tubular atrophy and interstitial fibrosis were independent risk factors for end-stage renal disease in malignant hypertension patients (HR=5.870, 95% CI 1.372-25.112, P=0.017). Conclusions Malignant hypertension with primary glomerular diseases patients have more severe clinico-pathological renal impairment and poorer prognosis of long-term renal survival than those without primary glomerular diseases. Acute renal tubular injury (loss of brush-border with flattening of tubular epithelium) is the only predictor of renal function improvement in patients with malignant hypertension and renal impairment within one year. Tubular atrophy/interstitial fibrosis is a risk factor for end-stage renal disease in patients with malignant hypertension. Renal biopsy is an indispensable tool for predicting short-term and long-term renal outcomes.

Cryoablation (CRA) and microwave ablation (MWA) are two main local treatments for hepatocellular carcinoma (HCC). However, which one is more curative and suitable for combining with immunotherapy is still controversial. Herein, CRA induced higher tumoral PD-L1 expression and more T cells infiltration, but less PD-L1^highCD11b⁺ myeloid cells infiltration than MWA in HCC. Furthermore, CRA had better curative effect than MWA for anti-PD-L1 combination therapy in mouse models. Mechanistically, anti-PD-L1 antibody facilitated infiltration of CD8⁺ T cells by enhancing the secretion of CXCL9 from cDC1 cells after CRA therapy. On the other hand, anti-PD-L1 antibody promoted the infiltration of NK cells to eliminate PD-L1^highCD11b⁺ myeloid cells by antibody-dependent cell-mediated cytotoxicity (ADCC) effect after CRA therapy. Both aspects relieved the immunosuppressive microenvironment after CRA therapy. Notably, the wild-type PD-L1 Avelumab (Bavencio), compared to the mutant PD-L1 atezolizumab (Tecentriq), was better at inducing the ADCC effect to target PD-L1^highCD11b⁺ myeloid cells. Collectively, our study uncovered the novel insights that CRA showed superior curative effect than MWA in combining with anti-PD-L1 antibody by strengthening CTL/NK cell immune responses, which provided a strong rationale for combining CRA and PD-L1 blockade in the clinical treatment for HCC.

OBJECTIVE To establish the HPLC fingerprint of Jianpi huayu decoction， and to determine the contents of 8 components. METHODS Thermo Hypersil Gold C18 column was used with mobile phase consisted of methanol-0.05% phosphoric acid aqueous solution （gradient elution） at the flow rate of 1.0 mL/min. The column temperature was 30 ℃， the injection volume was 5 μL. The detection wavelength of matrine was 211 nm， and the other components’ detection wavelength was 283 nm. The similarity evaluation of HPLC fingerprints for 10 batches of Jianpi huayu decoction was performed by using the Similarity Evaluation System of Chromatographic Fingerprint of Traditional Chinese Medicine （2012 edition）. The contents of chlorogenic acid， vanillic acid， p-coumaric acid， ferulic acid， hesperidin， quercetin， bergapten and matrine in the samples were determined by HPLC. RESULTS HPLC fingerprint of Jianpi huayu decoction was established. A total of 27 common peaks were identified， and 8 components were identified. The similarity between 10 batches of samples and the control map ranged from 0.942-0.999. RSDs of precision， repeatability and stability tests were less than 3% （n＝6）. The average recoveries of chlorogenic acid， vanillic acid， p-coumaric acid， ferulic acid， hesperidin， quercetin， bergapten and matrine were 99.48%， 101.32%， 101.18%， 100.79%， 101.12%， 99.19%， 99.81% and 102.46%， respectively； RSDs were 1.34%， 0.93%， 1.90%， 1.84%， 0.54%， 1.53%， 1.33% and 1.01%， respectively （n＝6）. The contents were 0.021-0.061， 0.025-0.034， 0.116-0.295， 0.006- 0.062， 0.014-0.053， 0.017-0.026， 0.014-0.027 and 14.05-24.11 mg/g， respectively. CONCLUSIONS The established fingerprint and content determination method can provide a reference for the quality control and subsequent preparation development for Jianpi huayu decoction.