Objective Extracorporeal membrane oxygenation (ECMO) provides a treatment for patients with acute heart-lung failure. However, as an invasive procedure, it associated with high incidence of complications. It is important to a-vert and reduce the complications for improving the success rate in critically ill patients. We investigate the complications associated with ECMO after cardiac surgery and their management. Methods Clinical data from 117 postoperative patients[32 male, mean age (48.7 ± 16.5) years]supported with ECMO in the cardiovascular intensive care unit( ICU) from March 2005 to June 2008 were analyzed retrospectively. The cardiac operations they had undergone included coronary artery bypass grafting (n = 20), coronary artery bypass grafting and remodeling of left ventricle(n =9), coronary artery bypass grafting and valvular operation(n =5), repair of ventricular septal perforation following acute myocardial infarction(n =2), valvular operation( n = 46), heart/lung transplantation (n = 20/1), correction of congenital heart defects ( n = 10), and aortic operations ( n = 4). Venoarterial bypass was established in 110 patients by cannulation of the right atrium and femoral artery, and that of the right atrium and ascending aorta in 5 cases. Left atrial drainage to ECMO was added in 2 cases. Venovenous bypass was established in 2 patients with hypoxemia following cardiac surgery. Heparin was infused for maintaining the activated coagulation time (ACT) at 160 to 200 seconds for centrifugal pump(114 cases),and 200 to 250 seconds for roller pump(3 cases) to avoid thrombotic events until decannulation was achieved. Results The mean ECMO duration was 61 hours (range 3 to 225 hours). 48(41.0% ) patients died, 18 of them died of complications after weaning from circulatory assistant successfully. Complications occurred in 74 (63.2% ) patients included reoperation for hemostasis (n = 24), renal failure requiring renal replacement therapy (n =29), nosocomial infections ( n = 32) , ischemia in the extremities(n = 5), plasma leakage of oxygenators ( n = 29), gastroenteral hemorrhage ( n = 14), hemolysis ( n = 7 ), neurological complications ( n = 4) and centrifugal pump failure (n =1). Conclusion Bleeding is an early complication associated with ECMO support. The risk of nosocomial infection, renal failure and plasma leakage of oxygenators increases with the duration of ECMO support.

Objective To analyze the MRI features of central neurocytoma (CNC),and to improve the diagnostic accuracy of this lesion.Methods The MRI findings of 12 patients with CNC confirmed by surgery and pathology were evaluated retrospectively.All patients underwent contrast-enhanced and uncontrast-enhanced MR scan,and 3 patients also received plain CT scan.Results The lesions of 12 cases were all located in the lateral ventricles of septum pellucidum,which were close to the Monro's foramen.5 lesions located in the right lateral ventricle,5 lesions located in both lateral ventricles with 1 case reached the third ventricle,2 lesions located in the left lateral ventricle with 1 case reached the third ventricle.The mean diameter of the CNC lesions was 4.8 cm (ranged from 2.2 to 7.8 cm).11cases (92％) had vavious degrees of cystic change,8 cases (66.7％) had a spongy or soap bubble appearance and 1 case(8.3％) had completely cystic change.3 cases (25％) had a scalloping appearance on sagittal T1-weighted MRI.The solid part of the tumor was similar to the gray matter in signal intensity,with slightly high signal intensity on T2FLAIR.Among 9 cases with DWI,7 cases showed high signal intensity,1 case showed equal signal intensity,and 1 case showed slightly low signal intensity.On enhanced MRI,the solid part of tumors showed slight to medium (83％) or obvious (17％) enhancement.Conclusion CNC should be first considered when a young adult has a lesion located in the lateral ventricles of septum pellucidum,accompainied by varying degrees of cysts,showed slight to medium enhancement in the solid part of the tumor.

Objective To study the MRI features of primary central nervous system lymphoma (PCNSL)to improve its diagnosis. Methods The MRI data of 1 3 patients with PCNSL confirmed by biopsy or surgical pathology were analyzed retrospectively.All patients underwent nonenhanced and contrast-enhanced MRI examinations.Results Multiple lesions in 8 cases and solitary one in 5 cases were found.Five leisons (38.5%)were located in the cerebral hemispheres.Eight(61.5%)were located in deep structures of the brain including periventricular white matter,basal ganglia,thalami and corpus callosum,6 (46.2%)of whom involved in the ependyma including 1 involved in the ependyma of the 4 th ventricle.One leison(7.7%)was located in the cerebellar hemisphere.The tumor showed isointense or mildly hypointense signal on T1WI,mildly hyperintense signal on T2WI and hyperintense signal on DWI.Mild to moderate perilesional edema was noted.The tumors in 13 cases showed remarkable homogeneous enhancement after the contrast agent was injected with the signs of characteristic notch,butterfly and satellite.Focal necrosis occurred in 1 lesions.Conclusion PCNSL shouldbe first considered when a lesion located in the deep central structeres of the brain,multiple and involve ependymal membrane,showed isointensity on T1WI and T2WI,highintensity on DWI in tumoral parenchyma demonstrated,significantly enhancement in the solid part of the tumor.

Objective Based on the Hood Policy Tool perspective on China's DIP policy text mining,word frequen-cy analysis and clustering analysis of the policy content,to explore the actual policy in each pilot region,to further analyze the reasons,to provide a scientific and reference for the subsequent policy adjustment and implementation.Methods Policies were included in this study from platforms such as local healthcare protection bureaus,local health-care commissions,local people's government portals,and NVivo,from which policy documents with a high degree of relevance to DIP were selected.NVivo 20.0 software was used for text coding,word frequency analysis,and analysis based on Hood's policy tool dimensions and regional distribution dimensions to further explore DIP policy specifics.Results A total of 27 policies were included,covering all pilot provinces,with a total of 1,707 policy codes.Authoritative,fiscal,informational,and organizational policy instruments accounted for 54.9％,20.3％,16.9％,and 7.9％,respectively.The percentage of coded reference points in the East,Central,West,and Northeast regions were 23.0％,20.2％,44.5％,and 8.7％,respectively.Conclusion The use of DIP policy tools in the pilot regions focused on authoritative tools and less on organization tools.Among the authoritative policy tools,the sub-tools of mechanism building were mostly used,while the sub-tools of standards and norms were less used.The focus of the policy tools varies among the pilot regions,and the use of policy tools should be tailored to the local context.

Objective:To compare the spermatogenes response of human chorionic gonadotropin(HCG)combined with human menopausal gonadotropin(HMG)in patients with idiopathic hypogonadotropic hypogonadism(IHH)and congenital combined pituitary hormone deficiency(CCPHD), and to explore related factors.Methods:Clinical data of 90 IHH patients and 61 CCPHD patients from January, 2014 to November, 2018 were retrospectively analyzed. Spermatogenesis was compared between the two groups receiving combined gonadotropin therapy. The patients were then divided into two subgroups: spermatogenesis subgroup and nonspermatogenesis subgroup. Related factors of spermatogenesis after the combined gonadotropin therapy were investigated.Results:After the combined treatment of HCG/HMG for 3, 6, and 9 months, the patients with CCPHD revealed lower testicular sizes than those with IHH( P=0.004, 0.021 and 0.032, respectively). Compared with IHH patients, CCPHD patients had larger testicular volume increments( P<0.001), higher spermatogenesis rates( P=0.048), and shorter initial time for sperm appearance( P<0.001)after 24-month treatment. Multivariate logistic regression analysis showed that lower total cholesterol(TC)(IHH group: OR=5.508, 95% CI 1.110-27.326, P=0.037; CCPHD group: OR=4.068, 95% CI 1.077-15.371, P=0.039)was an independent risk factor of poorer spermatogenesis in patients with IHH and CCPHD. Conclusions:The patients with CCPHD demonstrate a better response to combined gonadotropin treatment than those with IHH. Lower TC is an independent risk factor for poor spermatogenesis of combined HCG/HMG therapy in patients with IHH or CCPHD.

Objective To observe changes of spatial learning-memory in rats with chronic hypoxic hypercapnia and the effect of gingkgo biloba extra. Methods After established the rat model of chronic hypoxic hypercapnia,seventy-two rats were randomly divided into four groups normal control (NC),hypoxic-hypercapnia 4-week (4HH),hypoxic-hy-percapnia 4-week+gingkgo biloba extra (EGb)high dose(100 mg/kg)group[4HH+EGb(H)] and hypoxic-hypercapnia 4-week+EGb low dose (50 mg/kg) group[4HH+EGb(L)]. Praxiology in rats was asessed by the Morris water maze and step down test. Results The spatial learning-memory in rats exposed to chronic hypoxic-hypercapnia 4-week(4HH group)were displayed significant impairment in their performance,the longer mean escape latencies and swim path dis tances,the more error times. 4HH+EGb(H) and 4HH+EGb(L)groups shortened the reaction time of leaning, pro longed the latent time of memory, reduced times of mistakes. Conclusions EGb can enhance the capacity of learning-memory in the rats exposed chronic hypoxic hypercapnia.

Objective:To investigate the mediating effect of inflammatory factors in the association between low density lipoprotein-cholesterol(LDL-C) and thyroid associated ophthalmopathy(TAO).Methods:This study was a prospective study, which icluded a total of 86 patients with Graves′ disease who attended the Department of Endocrinology of the First Affiliated Hospital of Zhengzhou University from January 2021 to June 2022. Among them, there were 56 patients with Graves′ disease accompanied by TAO, including 30 cases in the inactive group and 26 in the active group. Additionally, there were 30 cases having Graves′ disease alone. The relationship between LDL-C, inflammatory factors, and the onset and activity of TAO were analyzed using binary logistic regression. Mediation analysis was used to explore the mediating effect of inflammatory factors in the association between LDL-C and TAO onset and activity.Results:Interleukin(IL) -6 was a potential mediator that linking the association between LDL-C and TAO onset: LDL-C had a direct effect on TAO(Total effect value=0.274, 95% CI 0.161-0.386), while IL-6(mediated effect=0.067, 95% CI 0.011-0.123) and IL-17(mediated effect=0.042, 95% CI 0.007-0.077) partially mediated the effect of LDL-C on TAO, accounting for 24.45% and 15.33% of the total effect, respectively. IL-6 was a potential mediator of the association between LDL-C and TAO activity: LDL-C had a direct effect on TAO activity(Total effect value=0.320, 95% CI 0.204-0.435), and IL-6(mediated effect=0.103, 95% CI 0.021-0.185) partially mediated the effect of LDL-C on TAO activity, with a mediation effect of 32.19%. Conclusion:IL-6 plays a partiall mediating role in the association of LDL-C with TAO onset and activity.

Objective:To explore the application and value of metagenomic next-generation sequencing (mNGS) in refractory infection after organ transplantation.Methods:A case report discussed about a patient with lumbar spine infection after kidney transplantation and the relevant literature was reviewed. The recipient was a 63-year-old man with low back pain after kidney transplantation. Lumbar spine magnetic resonance imaging showed lumbar spine infection. Multiple operations plus antibacterial and antituberculosis treatments were ineffective. Before and after treatment, numerous tests of traditional pathogenic microorganisms failed to detect any positive bacteria.Results:The detection of lumbar secretion by mNGS suggested aspergillus infection. The symptoms improved after dosing of voriconazole.Conclusions:The incidence of fungal infection of lumbar spine is low. The imaging manifestations are non-typical so that it is easy to misdiagnose. mNGS helps to timely diagnose and guide treatment. With a review of the literature, mNGS has some application value for some difficult and rare infectious diseases.

Objective To investigate the effect of preoperative serum uric acid level on the incidence of acute kidney in-jury after off-pump coronary artery bypass grafting and to discuss whether serum uric acid level is an independent predictor of postoperative acute kidney injury.Methods A total of 631 patients undergoing off-pump coronary artery bypass grafting in Anzhen Hospital from January 2018 to June 2018 were reviewed.Patients were divided into high uric acid group(higher-than-median)and low uric acid group(lower-than-median) , based on the preoperative serum uric acid level of the patients.The de-mographic variables, comorbidities, the chelsea comorbidity index, preoperative medication, serum creatinine level and glo-merular filtration rate were compared between the two groups.Meanwhile, intraoperative operative time, infusion volume, post-operative acute kidney injury staging and the rate of frozen plasma usage , continuous renal replacement therapy and reoperation rate were observed.Results Among the 631 patients, 83(13.2％, 83/631)cases developed postoperative acute kidney inju-ry, 65(78.3％, 65/83) cases had a higher level of preoperative serum uric acid above the median(OR =3.143, 95％CI:1.850-8.798, P=0.001).After adjustment, multivariate analysis showed that elevated level of serum uric acid and BMI >30 kg/m2, the increase of preoperative serum creatinine level, the decrease of glomerular filtration rate( <60 ml/min) and higher CCI score were associated with postoperative acute kidney injury independently .Intraoperative fluid volume , diabetes and preoperative diuretic administration did not relate to the incidence of acute kidney injury after cardiac surgery .Conclusion Elevated serum uric acid level can be a strong predictor for the incidence of acute kidney injury after off-pump coronary artery bypass grafting.

Objective:To determine the predictive role of combined assessment of vasoactive-inotropic score(VIS) and lactate for the prognosis of patients with postcardiotomy cardiogenic shock(PCS) requiring venoarterial extracorporeal membrane oxygenation(VA-ECMO).Methods:222 adults with PCS requiring VA-ECMO were retrospectively analyzed and divided into four groups according to the cut-off values of VIS and lactate(Lac) at 24 h after ECMO initiation: group 1(59 cases): VIS≤14.5, Lac≤2.45 mmol/L; group 2(17 cases): VIS>14.5, Lac≤2.45 mmol/L; group 3(90 cases): VIS≤14.5, Lac>2.45 mmol/L; group 4(56 cases): VIS>14.5, Lac>2.45 mmol/L. The incidence of in-hospital mortality and other clinical outcomes were analyzed. The associations of VIS and lactate and in-hospital mortality were analyzed using Cox proportional hazards analysis.Results:The in-hospital mortality was 18.6%, 58.8%, 63.3% and 71.4% in the four groups( P<0.001), while the rate of successful weaning off ECMO was 88.1%, 88.2%, 58.9% and 33.9% respectively( P<0.001). The group 1 significantly differed from other three groups with regards to in-hospital mortality and ECMO weaning rate( P<0.05). The groups 1 also showed significantly improved cumulative 60-day survival compared with other three groups( log- rank test, P<0.05). Cox proportional hazards analysis showed age( HR=1.03, 95% CI: 1.01-1.05, P=0.001), female( HR=1.87, 95% CI: 1.27-2.76, P=0.002), VIS at 24 h after ECMO initiation( HR=1.02, 95% CI: 1.00-1.05, P=0.020), and lactate at 24h after ECMO initiation( HR=1.12, 95% CI: 1.08-1.16, P<0.001) were independently predictive of in-hospital mortality. Conclusion:Patients with VIS≤14.5 and Lac≤2.45 within 24 h after ECMO initiation had better in-hospital and 60-day outcomes, suggesting that combined assessment of VIS and lactate may be instructive for determining the prognosis of PCS patients requiring VA-ECMO support.