Objective To establish a surgical risk prediction model for in-hospital mortality of adult rheumatic heart disease.Methods The study sample comprised of 3 889 patients with adult (is, or older than 18 years) rheumatic heart valve surgery only.All patients were divided into three subgroups according to the surgery site of left atrioventricular valve: mitral valve surgery group;aortic valve surgery group;and mitral and aortic valve surgery group.The data was splited into development(60％) and validation(40％) data sets, and then the risk model was developed by using a logistic regression model according to the data in development data set.Model calibration was analyzed by Hosmer-Lemeshow goodness-of-fit statistic, and model discrimination was tested by calculating the area under the receiver operating characteristic(ROC) curve.Risk score was finally set up according to the coefficient β and rank of variables in logistic regression model.Results The general in-hospital mortality of the whole group is 4.2％ (165/3 889).We established a risk prediction model and found seven risk factors: heart function in NYHA functional class ≥ Ⅱ grade (OR =3.36, 95％ CI: 2.42-4.67) , preoperative creatinine ＞ 110 mmoL/L (OR =2.69, 95％ CI: 1.51-4.79) , history of previous chest pain(OR =2.33, 95％ CI: 1.07-5.11) , surgical status(OR =2.32, 95 ％ CI: 0.94-5.73) , previous history of hypertension (OR =2.24, 95 ％ CI: 1.19-4.23), preoperative critical state (OR =2.14, 95％ CI: 1.27-3.60) and age ＞ 50 years (OR =1.57, 95 ％ CI: 1.18-2.09).Our risk model showed good calibration and discriminative power for the development data set, validation data set, and three subgroup in which Hosmer-Leme-show test' s P value were greater than 0.05 and the area under the ROC curve were greater than 0.70.Scoring methods: age 51-60years: 1 point, age 61-70 yeas: 2 points, age ＞70 years: 3 points;history of hypertension: 1 point;creatinine ＞ 110 umol/L: 4 points;NYHA class stage Ⅱ : 2 points, NYHA class stage Ⅲ: 4 points;NYHA class stage Ⅳ: 6 points;history of previous chest pain: 1point;preoperative critical condition: 2 points;urgent surgery: 2 points: emergency surgery: 4 points.Conclusion We have created a new risk prediction model and risk score, which can accurately predicts outcomes in patients undergoing heart valve surgery for our center.Furthermore, our risk model can also enable benchmarking and comparisons between multicenter in a meaningful way in the future.

Objective:To explore the clinical application of NanoString fluorescent barcode technology in the molecular subtyping of diffuse large B-cell lymphoma (DLBCL), and to analyze the correlation between the cell-of-origin subtype and prognosis of patients.Methods:The tumor tissue samples of 12 patients with DLBCL at the Third People's Hospital of Datong of Shanxi Province and 8 patients with DLBCL at Peking University, Health Science Center between January 2014 and December 2019 were collected. According to Hans algorithm, all patients were divided into 1 case of germinal center-derived B-cell (GCB) type and 19 cases of non-GCB type. NanoString platform was used to analyze the expression level differences of 15 genes-related to Lymph2Cx molecular subtyping of all samples at mRNA level. Hierarchical clustering was used to subgroup 20 DLBCL cases and to contrast the prognosis in different subgroups according to the subtyping.Results:NanoString fluorescent barcode technology was used to detect samples of 20 DLBCL cases and hierarchical clustering analysis was performed, and then subtyping results showed that 11 cases were GCB-like type and 9 cases were activated B cell (ABC)-like type. Based on Hans algorithm, 10 GCB-like cases were non-GCB type. According to the survival analysis, GCB-like group had a better overall survival compared with that in ABC-like group ( P=0.019). Conclusion:NanoString fluorescent barcode technology can be successfully applied to the cell-of-origin subtyping of DLBCL, and the molecular subtyping strategy can effectively predict the prognosis of patients.

Objective During last decades,mechanical ventilation has been an important support in the postoperative management of patients undergoing cardiac surgery.However,a considerable number of patients need mechanical ventilation for a prolonged period after cardiac surgery,and this is associated with increased mortality and morbidity.The study was designed to determine the pre-and perioperative predictors of prolonged mechanical ventilation (PMV) in adult patients undergoing double valve surgery.Methods The retrospective study considered of 2026 adult patients who underwent double valve replacement surgery at Changhai Heart Center from January 1990 to December 2010.PMV is considered as mechanical ventilation period of ＞ 48 hours at postoperative hospital stay here.Results PMV occurred in 11.35 ％ of patients.The total hospital mortality was 4％.The hospital mortality of patients who had undergone double valve replacement surgery required PMV was significantly higher than control (33.5％ vs 0.2％,P ＜ 0.01).And so as comorbidities.Age more than 60 years (OR =1.943),diabetes(OR =1.757),preoperative active endocarditis (OR =3.167),New York Heart Association class higher than 3 (OR =2.464),preoperative critical state(OR =2.556),ejection fraction less than 0.50 (OR =2.026),creatinine greater than 110 μmol/L (OR =2.740),cardiopulmonary bypass time longer than 180 min (OR =3.529) and perioperative intra-aortic balloon pump(OR =18.350) were independent predictors of PMV in our patients.Conclusion PMV is associated with significant comorbidities and increased hospital mortality.Strategies to delineate the patients at risk and to modify these risk factors by prophylactic measures should probably lead to a lower incidence of prolonged mechanical ventilation for adult patients undergoing double valve replacement surgery.

Objective: To investigate the effects of exercise combined with dietary intervention on glucose and lipid metabolism, liver and kidney function and cardiovascular function in obese adolescents. Methods: Seventy-one obese adolescents were enrolled in this study. Six weeks of exercise combined with dietary intervention were performed to determine anthropometry, glucose and lipid metabolism, liver and kidney function and cardiovascular function before and after intervention. Results: After 6 weeks of comprehensive intervention, in addition to significant improvement in anthropometry indicators, fasting insulin [(18.76±11.46 vs 11.32±6.54)uU/L], LDL-C [(2.96±0.69 vs 2.22±0.62)mmol/L], TG [(1.57±0.82 vs 0.89±0.37)mmol/L] and TC [(4.52±0.76 vs 3.53±0.62)mmol/L] decreased significantly and insulin resistance improved significantly. AST [(36.1±32.28 vs 22.89±7.27)U/L], ALT [(57.42±61.25 vs 27.86±22.12)U/L], blood urea nitrogen [(4.78±0.89 vs 3.44±0.79)mmol/L] and uric acid [(498.83±120.6 vs 471.07±120.96)mmol/L] were significantly decreased and the detection rates of fatty liver and kidney were significantly decreased(P<0.05), RHI(1.34±0.28 vs 1.69±0.45) and nitric oxide/ endothelin-1 (ET-1) (1.69±0.41 vs 2.67±0.86) significantly increased and atherogenic index (3.06±0.96 vs 2.58±0.80) significantly decreased(P<0.01). Conclusion The comprehensive intervention of exercise combined with diet can effectively improve anthropometry indicators, glycolipid metabolism, liver and kidney function as well as cardiovascular function of obese adolescents.

OBJECTIVETo explore the genetic cause for a child featuring developmental delay and mental retardation.

METHODSThe child was analyzed with G-banded karyotyping and an Illumina Human CytoSNP-12 Beadchip.

RESULTSThe father of the patient had a normal karyotype. The mother had a karyotype of 46, XX, t(12;15)(p13.3;q13). The child had a karyotype of 45, XY, der(12)t(12;15)(p13.3;q13)mat, -15. SNP array analysis showed that the child has deletions in 12p13.31-p13.33 and 15q11.2-q13.2. But no deletion or duplication was detected in his mother.

CONCLUSIONThe unbalanced translocation involving chromosomes 12 and 15 probably accounts for the mental retardation in the child. SNP array is useful for the detection of chromosomal rearrangements and genetic counseling.

Adult ; Child, Preschool ; Chromosome Aberrations ; Chromosome Banding ; Chromosomes, Human, Pair 12 ; genetics ; Chromosomes, Human, Pair 15 ; genetics ; Developmental Disabilities ; genetics ; Female ; Humans ; Intellectual Disability ; genetics ; Karyotyping ; Male ; Translocation, Genetic

There are many problems existing in the basic teaching of traditional surgery, such as much more content, difficult operation, fewer learning hours, more passive acceptance while less active learning and so on. Flipped class based on the WeChat and team-based learning (TBL) is based on the on-line and off-line class. We can use WeChat group and subscription to issue relevant learning materials, learning tasks and test before class. Also, we can summarize and explain incisively by discussion after field operation in class, and answer and test in the way of WeChat discussion after class. Finally, the three-dimensional hybrid teaching will be condensed and sublimated by brand competition based on the basis of surgery, achieving knowledge transfer before class, knowledge internalization in class, knowledge consolida-tion after class and brand competition sublimation, in order to improve the teaching effect of surgical basis.

Xenotransplantation is one of the potential approaches to mitigate the shortage of donor kidneys. With the progress of gene modification techniques and the development of immunosuppressant, significant progress has been made in the preclinical research of genetically modified pig to non-human primate (NHP) xenotransplantation. The longest survival time of recipients exceeds 500 d. However, the number of recipients surviving for over 1 year is extremely low, and most recipients die within postoperative 1-2 months. Therefore, several problems remain to be clarified and resolved. In this article, rejection, refractory coagulation dysfunction, persistent inflammation, the selection of immunosuppressant, the selection of clinical recipients and the risk of cross-infection in genetically modified pig to NHP xenotransplantation were reviewed, and current problems and potential solutions of genetically modified pig to NHP xenotransplantation were summarized, aiming to provide reference for promoting xenotransplantation in clinical settings.

Objective To investigate the effect of right stellate ganglion block(SGB)on postoper-ative shoulder pain in patients receiving laparoscopic cholecystectomy(LC).Methods A total of 104 pa-tients scheduled for LC from April to August 2022,32 males and 72 females,aged 18-64 years,ASA phys-ical status Ⅰ orⅡ,were selected and randomized into two groups:the stellate ganglion block group(group S,n = 51)and the control group(group C,n = 53).Immediately after intubation,0.2%ropivacaine 4 ml was used for ultrasound-guided right SGB in group S,and saline 4 ml was injected at the same site in group C.The number of cases of post-laparoscopic shoulder pain(PLSP)and the duration of PLSP were re-corded within 48 hours after operation.The VAS pain scores of PLSP were recorded to assess the level of PLSP immediately after operation(T1),2 hours after operation(T2),6 hours after operation(T3),12 hours after operation(T4),24 hours after operation(T5),and 48 hours after operation(T6).The number of effective compressions of the PCIA pump and the salvage analgesia were recorded.The adverse reactions such as nausea,vomiting,and abdominal distension were recorded.Results The incidence of PLSP and the rate of patients with PLSP lasting more than 10 hours in group S was significantly lower than those in group C(P＜0.05),and the degree of PLSP in group S was significantly lower than that in group C at T3-T5(P＜0.05).The number of effective compressions of the PCIA pump and the salvage analgesia rate in group S was significantly lower than those in group C(P＜0.05).The incidence of nausea in group S was significantly lower than that in group C(P＜0.05).Conclusion Right stellate ganglion block can reduce the incidence of PLSP in patients receiving LC,relieve the pain degree of PLSP,and reduce the incidence of adverse reactions.

DNA double-strand break (DSB) is the most severe form of DNA damage, which is repaired mainly through high-fidelity homologous recombination (HR) or error-prone non-homologous end joining (NHEJ). Defects in the DNA damage response lead to genomic instability and ultimately predispose organs to cancer. Nicotinamide phosphoribosyltransferase (Nampt), which is involved in nicotinamide adenine dinucleotide metabolism, is overexpressed in a variety of tumors. In this report, we found that Nampt physically associated with CtIP and DNA-PKcs/Ku80, which are key factors in HR and NHEJ, respectively. Depletion of Nampt by small interfering RNA (siRNA) led to defective NHEJ-mediated DSB repair and enhanced HR-mediated repair. Furthermore, the inhibition of Nampt expression promoted proliferation of cancer cells and normal human fibroblasts and decreased β-galactosidase staining, indicating a delay in the onset of cellular senescence in normal human fibroblasts. Taken together, our results suggest that Nampt is a suppressor of HR-mediated DSB repair and an enhancer of NHEJ-mediated DSB repair, contributing to the acceleration of cellular senescence.
Antigen-Antibody Complex ; metabolism ; Antigens, Nuclear ; genetics ; metabolism ; Carrier Proteins ; genetics ; metabolism ; Cell Line ; Cell Proliferation ; Cellular Senescence ; DNA Breaks, Double-Stranded ; DNA End-Joining Repair ; DNA Repair ; DNA-Activated Protein Kinase ; genetics ; metabolism ; DNA-Binding Proteins ; genetics ; metabolism ; Fibroblasts ; cytology ; HeLa Cells ; Homologous Recombination ; genetics ; physiology ; Humans ; Ku Autoantigen ; Nicotinamide Phosphoribosyltransferase ; genetics ; metabolism ; physiology ; Nuclear Proteins ; genetics ; metabolism ; RNA, Small Interfering ; genetics ; beta-Galactosidase ; metabolism

With the increasing use of lower-extremity arterial angioplasty and the clinical use of a variety of vascular preparation devices. Vascular surgeons have more vascular preparation equipment such as cutting balloon, double wire balloon, chocolate balloon, shock wave balloon, AngioJet, Roterax and Acostream. These options can improve clinical outcomes, improve patient experience, and reduce stent placement and associated complications. This article will review the available vascular preparation devices for volume reduction, endovascular lithotripsy, and other special balloons to help clinicians choose the appropriate vascular preparation for their condition to improve perioperative safety and long-term patency.