A 61-year-old female patient was treated with sintilimab (200 mg by intravenous infusion on the first day, 21 days as a cycle) for lung adenocarcinoma and multiple lymph node metastases in the left hilum and mediastinum (10 cycles in total). Headache and dizziness in the patient occurred about 1 month after the last medication. Cerebrospinal fluid examination showed white blood cell count 14×10 6/L, total protein 799.8 mg/L, Pandy′s test (+), immunoglobulin G 70.8 mg/L, and glucose and chloride within the reference value range. The antibodies against N-methyl-D-aspartate receptor in cerebrospinal fluid and serum were all positive. The patient was diagnosed as having sintilimab-induced autoimmune encephalitis. After receiving methylprednisolone sodium succinate by intravenous infusion for 7 days, the patient′s headache and dizziness were alleviated. After that, the methylprednisolone sodium succinate was switched to oral prednisone acetate tablets. At a 2-month follow-up, no symptoms of headache or dizziness recurred in the patient.

A 61-year-old female patient was treated with sintilimab (200 mg by intravenous infusion on the first day, 21 days as a cycle) for lung adenocarcinoma and multiple lymph node metastases in the left hilum and mediastinum (10 cycles in total). Headache and dizziness in the patient occurred about 1 month after the last medication. Cerebrospinal fluid examination showed white blood cell count 14×10 6/L, total protein 799.8 mg/L, Pandy′s test (+), immunoglobulin G 70.8 mg/L, and glucose and chloride within the reference value range. The antibodies against N-methyl-D-aspartate receptor in cerebrospinal fluid and serum were all positive. The patient was diagnosed as having sintilimab-induced autoimmune encephalitis. After receiving methylprednisolone sodium succinate by intravenous infusion for 7 days, the patient′s headache and dizziness were alleviated. After that, the methylprednisolone sodium succinate was switched to oral prednisone acetate tablets. At a 2-month follow-up, no symptoms of headache or dizziness recurred in the patient.

Objective:To investigate the feasibility and clinical efficacy of percutaneous anterior column screwing assisted by blocking screws for pelvic and acetabular fractures.Methods:A retrospective analysis was conducted of the 13 patients who had been admitted from July 2019 to April 2022 for pelvic and acetabular fractures. There were 8 males and 5 females with an age of (49.1±13.3) years, 7 acetabular fractures (6 on one side and 1 on both sides; by the Letournel-Judet classification: 5 anterior column fractures on 6 sides, and 2 transverse and posterior wall fractures on 2 sides), and 6 pelvic fractures (5 complicated with pelvic posterior ring fracture; by the Tile classification: 1 case of type B2, 3 cases of type C1, and 2 cases of type C2). According to the anatomic zones of the anterior column, 5 fractures were at zone Ⅲ, 3 ones at zone Ⅳ, and 6 ones at zone Ⅴ. The time from injury to surgery ranged from 3 to 14 days, averaging (8.2±2.9) days. Anterograde anterior column screwing assisted by blocking screws was performed for all the 13 patients; the posterior ring was fixated with percutaneous sacroiliac joint screws for the 5 patients complicated with pelvic posterior ring fracture. The surgical time, intraoperative fluoroscopy frequency, and intraoperative bleeding volume for insertion of anterior column screws, fracture reduction quality, and hip joint function at the last follow-up were recorded.Results:A total of 14 anterior column screws were inserted percutaneously in the 13 patients. For insertion of anterior column screws, the surgical time was (65.0±10.2) min, the intraoperative fluoroscopy frequency (63.5±14.5) times, and the intraoperative bleeding volume for each screw less than 30 mL. All the incisions healed primarily after surgery, without such complications as iatrogenic neurovascular injury or poor wound healing. All the 13 patients were followed up for (11.1±2.2) months after surgery. In the patient with bilateral acetabular anterior column fractures for which 2 anterior column screws had been inserted, one screw had to be removed due to its displacement at 1 month after surgery; no such complications as loosening of internal fixation or fracture re-displacement was found in the other patients. All fractures healed after (10.2±2.1) months. According to the Matta scoring for quality of fracture reduction, 7 sides were excellent, 5 sides good, and 2 sides poor; according to the Majeed scoring for the 6 patients with pelvic fracture at the last follow-up, the efficacy was rated as excellent in 4 cases and as good in 2 ones; according to the modified Merle d'Aubigné & Postel scoring for the 7 patients with 8 acetabular fractures at the last follow-up, the efficacy was rated as excellent in 4 hips, as good in 3 hips, and as fair in 1 hip.Conclusion:For pelvic and acetabular fractures, minimally invasive percutaneous anterior column screwing assisted by blocking screws can result in fine clinical efficacy, in addition to its easy procedures, safety and reliability.

Objective:To explore the treatments and outcomes of heart and kidney transplantation(HKTx)and summarize its management experiences.Methods:From October 2016 to October 2020, clinical data, treatment strategies and prognosis of 11 patients received HKTx were analyzed retrospectively.In 11HKTx cases, the ratio of male-to-female was 10∶1, the age(50.6±12.9)years and the preoperative body mass index(26.72±3.29)kg/m 2.The preoperative cardiac function was class Ⅳ and the preoperative left ventricular ejection fraction(29.40±4.48)%.All patients were in uremic state pre-operation and underwent regular dialysis.The mean duration of dialysis was 2.5(0.5-7.0)years, preoperative creatinine 753.5(434-1144)μmol/L and preoperative predictive glomerular filtration rate 5.59(3.93-17.23)ml/(min preop 2). Non-staged transplant was performed and donor heart and kidney were from the same donor.The median time of cold cardiac ischemia 2.75(2.5, 4.0)hours, the median time of cold renal ischemia 9(8.5, 15.0)hours and the median time from the end of heart transplantation to the beginning of kidney transplantation 2(1.0, 3.5)hours.The immunosuppressive regimen was a combination of tacrolimus, mycophenolate mofetil and methylprednisolone. Results:Normal cardiac function and renal function normalized in 9 cases.At Month 6 post-operation, the postoperative left ventricular ejection fraction was(57.55±2.51)%, creatinine 107.7(85-132)μmol/L and urine volume in 24h 1988(1800-2200)ml.The long-term survival time was 6-62 months.No such complications as infection or rejection occurred in 9 patients.The cardiac function was class Ⅰ at Month 6 post-operation.One patient died from pulmonary mucor infection at Month 4 post-operation.Another death was due to gastrointestinal fungal infection at Month 1 after HKTx.Conclusions:HKTx is an effective treatment for end-stage heart disease with renal failure.

Objective To summarize the outcomes and clinical experience of combined heart and kidney transplantation.Methods The clinical data of one case of combined heart and kidney transplantation were retrospectively analyzed.The kidney transplant was completed immediately after the heart transplant.The immunosuppressive therapy strategies included tacrolimus,corticosteroids and mycophenolate mofetil.Results For heart transplantation,heart cold ischemia time was 200 min,aorta blocking time was 136 min,and extracorporeal circulation time was 201 min.The kidney was transplanted to the right iliac fossa after heart transplantation.The endotracheal tube was removed 15 h after surgery.The patient was transferred to the general ward on the 8th day after surgery.The patient was discharged from the hospital at 27th day after surgery,the renal function was normal and no activity was restricted.Conclusion Reasonable perioperative management and selection of surgical methods are the keys to the success of combined heart and kidney transplantation.

Objective To summarize the experience of surgical treatment in patients with uremia and severe coronary artery disease, and reduce the perioperative risk thereof. Methods Sixteen chronic renal failure patients who were received haemodialysis and underwent coronary artery bypass grafting (CABG) during the period of February 2009 to December 2016 in Tianjin First Central Hospital were assessed in this retrospective study. Of the 16 patients, 8 patients and 6 patients were treated with off pump and on pump CABG respectively, one patient was treated with CABG and resection of ventricular aneurysm, and one patient was treated with CABG and tricuspid valve replacements. The renal function changes in preoperative and postoperative periods, 2-day and 1-week after surgery were observed. Echocardiography was used to evaluate cardiac function. The improvement of angina was recorded. Results Fourteen patients were successfully withdrawn from ventilator therapy within 24 h after surgery. The tracheal intubation was removed 65-hour after surgery in one patient. One patient died of multiple organ failure on the seventh day after surgery. The average length of ICU staying and in-hospital stay were (125.5 ± 21.6) h and (28.6 ± 7.4) days respectively. The serum creatinine (sCr) and blood urea nitrogen (BUN) were higher in two days after surgery than those before the operation (P < 0.05). Fifteen patients which followed up (the final follow-up date was February 2017) showing cardiac functionⅠ-Ⅱ, ejection fraction (EF)>0.40, and no angina occurred. Conclusion CABG is relatively safe for patients with end-stage renal disease and severe coronary artery disease. CABG can significantly eliminate angina symptoms with satisfactory clinical effect.

The incidence of dextrocardia is lower. The dextrocardia is often associated with congenital anatomical abnormalities. The patient with normal cardiac structure of dextrocardia and severe coronary heart disease that needs coronary artery bypasss is rarer. This article summarizes the perioperative management and surgical experience of dextrocardia with bypass surgery via a clinical case.

Objective To summarize the treatment experiences in patients with cardiac surgery-associated acute kidney injury (CSA-AKI). Methods The clinical data of 9 patients with acute renal injury after orthotopic heart transplantation in our hospital from January 2009 to July 2016 were retrospectively analyzed. Three patients were required the high-dose diuretics (furosemide, >80 mg/d) and six patients were received continuous renal replacement therapy (CRRT). The levels of serum creatinine (Cr) and estimated glomerular filtration rate (eGFR) were compared before and after heart transplantation and after the treatment of AKI. The quality of life was observed in patients in perioperative period. Results After the treatment of diuretics or CRRT, patients showed renal function recovery with significant decreased Cr levels and increased eGFR compared with the postoperation. The patients with diuretic therapy revealed a better eGFR recovery than those with CRRT. Conclusion CSA-AKI should be based on the severity of disease, and comprehensive treatment should be taken to reduce renal damage.

Objective To investigate the risk factors of postoperative atrial fibrillation (POAF) in patients with on-pump coronary artery bypass grafting (ONCAB). Methods The clinical data of 200 patients with ONCAB were retrospectively analyzed. The patients were divided into POAF group (n=52) and non POAF group (n=148) according to the occurrence of POAF after operation. The perioperative data including age and gender of all patients were collected and analyzed. The index of opinion of statistical results was classified by two categories Logistic regression analysis, and the related risk factors of POAF were analyzed. The receiver operating characteristic (ROC) curves of the age, red blood cell (RBC), left atrial diameter (LAD) and left ventricular ejection fraction (LVEF) were analyzed in two groups. Results The incidence rate of POAF was 26%, mostly occurred in the postoperative period from 1 d to 3 d. Compared with non POAF group, the age, the proportion of patients with age≥62.5 years or older, the proportion of patients with LAD≥35 mm, left ventricular end-diastolic diameter and perioperative transfusion of RBC were increased in POAF group, and data of mechanical ventilation time, ICU stay time and hospitalization time were prolonged, but the LVEF level decrease ( P<0.05). Among them, the elderly (≥62.5 years), increased LAD (≥35 mm), the higher perioperative transmission amount of RBC were the independent risk factors of POAF after ONCAB, and the higher LVEF was a protective factor for ONCAB. The optimal thresholds for age, RBC, LAD and LVEF were 62.5 years, 1U, 35.5 mm, and 0.34. Conclusion The occurrence of POAF after ONCAB is related with age (≥62.5 years old),LAD≥35 mm and perioperative transfusion of RBC, which can be used as clinically to predict the occurrence of POAF.

Objective To observe the expression of indoleamine 2,3-dioxy-genase(IDO) in hippocampus of rats with posttraumatic stress disorder (PTSD) and the protective effect of IDO inhibitor on neurons,and to explore the role of IDO in the pathogenesis of PTSD.Methods Adult male Wistar rats were randomly divided into the normal control group,PTSD model group and IDO inhibitor treatment group.The expression of IDO was detected by immunohistochemistry,RT-PCR and Western-blot.The apoptosis of rat hippocampal neurons was assayed by Tunel staining.Tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were detected by ELISA.Moreover behavioral evaluation was performed,including central residence time,percentage of open arm residence time and stage latency.Results Comparing with the control group,PTSD rats showed decreased central residence time ((22.65± 1.54)s),decreased percentage of open arm residence time((10.55± 1.96) ％),prolonged stage latency ((56.38±4.21) s) (P＜0.05),increased TNF-α ((8.58±0.6) pg/ml),IL-6 ((15.72±1.42) pg/ml) and IDO mRNA (0.8278±0.0796),increased IDO protein (1.2329±0.1148) expression and apoptosis rate ((81.47± 6.86) ％) in hippocampus (P＜ 0.05) (P＜ 0.05).However,rats treated with IDO inhibitor showed increased central residence time((30.78±3.20) s),increased percentage of open arm residence time ((10.55± 1.96)％),shortened stage latency ((56.38 4.21) s),meanwhile reduced expression of TNF-α((3.69±0.41) pg/ml),IL-6((7.45±0.58) pg/ml),IDO mRNA(0.2236 ±0.0387) and IDO protein(0.4235±0.0411) was detected in hippocampus(P＜0.05).Apoptosis rate ((42.54± 3.98)％) was also decreased in hippocampus(P＜0.05).Conclusion The content of TNF-α,IL-6 and IDO are increased significantly in the hippocampus of PTSD rats.IDO may participate in the pathogenesis of PTSD,and the IDO inhibitor may play a neuroprotective role in hippocampus of PTSD.