Objective:To detect the abnormal changes of myocardial blood perfusion in patients with hypertrophic cardiomyopathy(HCM) by myocardial contrast echocardiography (MCE) combined with adenosine stress test.Methods:Fifteen adult patients with HCM who were treated in Fuwai Central China Cardiovascular Hospital from May 2021 to March 2022 were prospectively selected as the HCM group, and eighteen healthy volunteers matched by gender, age and body surface area during the same period were chosen as the control group. All subjects underwent routine echocardiography, rest and adenosine stress MCE. The MCE images were analyzed by QLab software to obtain the myocardial perfusion parameters: peak signal intensity (A value), rising slope of the curve (β value) and A×β value, and the differences of above parameters between the two groups were compared.According to whether the end-diastolic wall thickness ≥12 mm, the myocardial segments in the HCM group were divided into hypertrophic segments and non-hypertrophic segments. The differences in myocardial perfusion parameters were compared among control group segments, hypertrophic segments and non-hypertrophic segments of the HCM group. The correlations of stress myocardial blood flow with maximal left ventricular wall thickness (MLVWT), left ventricular mass index (LVMI) and left atrial volume index (LAVI) in the HCM group were analyzed.Results:Compared with the control group, the A value, β value and A×β value of whole myocardium, hypertrophic segments and non-hypertrophic segments in the HCM group were significantly decreased in the rest and adenosine stress state, and the differences were statistically significant (all P<0.05). In the stress state, the A value, β value and A×β value of the hypertrophic segments were significantly lower than those in the non-hypertrophic segments in the HCM group, and the detection rate of abnormal perfusion segments in the HCM group was significantly higher than that in the rest state(all P<0.05). Compared with the control group, the myocardial blood flow reserve of whole myocardium, hypertrophic segments and non-hypertrophic segments in the HCM group were significantly decreased, and the differences were statistically significant(all P<0.05). The stress myocardial blood flow in the HCM group was negatively correlated with MLVWT, LVMI and LAVI ( r=-0.815, -0.805, -0.742; all P<0.05). Conclusions:Myocardial blood perfusion abnormalities can occur in both hypertrophic and non-hypertrophic myocardial segments in patients with HCM, and adenosine stress MCE can significantly improve the sensitivity of detecting myocardial perfusion abnormalities. The stress myocardial blood flow in patients with HCM is negatively correlated with MLVWT, LVMI and LAVI.

[Abstract] Objective: To construct and purify the recombinant bispecific antibody (BsAb) targeting PD-1 and CD19 and evaluate its activity. Methods: With pCAR1 plasmid as the vector, the eukaryotic expression vector of anti-PD-1/CD19 BsAb was constructed by molecular cloning technology, and then transfected into mammalian cell line CHO-S by PEI reagent for transiently expressing antibody. The BsAb was purified by Affinity chromatography and then identified by SDS-PAGE and WB. The blocking activity of BsAb on PD-1/PD-L1 in vitro was detected by Luciferase reporter gene assay. The activity of antibody (BsAb)-dependent cell (PBMC)-mediated cytotoxicity (ADCC) in vitro was evaluated by lactate dehydrogenase (LDH) cytotoxicity assay. Results: The double plasmid eukaryotic expression vector pCAR1-19X3 was successfully constructed, and anti-PD-1/CD19 BsAb was successfully expressed in CHO-S cells, named pCAR1-19X3-TY. pCAR1-19X3-TY could effectively block the binding of PD-1 to its ligand PD-L1 in vitro, and the EC50 based on the dose-response curve was 0.306 μg/ml. ADCC results showed that pCAR1-19X3-TY could mediate the cytotoxicity of PBMC against Raji cells, and the curve showed a linear upward trend; when the effect/target ratio was 50∶1, the target cell lysis rate of pCAR1-19X3-TY was (38.9±0.3)%, which was not significantly different from that of the positive treatment group (46.7±4.9)% (P>0.05), but significantly higher than that of the negative control group (1.2±0.1)% (P<0.05). Conclusion: The recombinant anti-PD-1/CD19 BsAb can effectively block the binding of PD-1 and PD-L1 and activate PBMC mediated cytotoxicity against Raji cells. pCAR1-19X3-TY has the potential application value in the treatment of B-cell malignant tumor.

Objective To evaluate the safety and efficacy of induced hypotension and hypotension in carotid endarterectomy (CEA).Methods Data of 1 486 patients who underwent CEA in multicenters from Aug 2012 to Aug 2018 were retrospectively analyzed.After screening,a total of 1 448 patients met the inclusion criteria.Induced hypertension and hypotension was used in all thees patients.Results 87.8％ of the patients were with severe carotid stenosis.The average operative time was (51.8 ± 6.1) min,and the internal carotid artery clamping time was (11.4 ± 3.1) min.After induced hypertension,the stump pressure were higher than that before,of which 1 438 (99.3％) were greater than 50 mmHg.Monitoring of EEG oxygen saturation showed that the value of ipsilateral rSO2 was significantly lower than that of the contralateral [(56％ ± 3％) vs.(64％ ± 4％),P ＜ 0.05] before induced hypertension.After induced hypertension and clamp removal,the value of ipsilateral rSO2 was lower than that of the contralateral,but there was not significant difference (all P ＞ 0.05).Perioperative cerebral infarction occurred in 2 cases,ipsilateral cerebral hemorrhage in 1 case,contralateral cerebral hemorrhage in 1 case and myocardial infarction in 2 cases.Connclusion The technique of induced hypotension and hypotension play a temporary role in brain protection for patients undergoing CEA.This study demonstrated the safety and effectiveness of induced hypertension and hypotension technique.

Objective To investigate the inflammatory bowel disease (IBD) complicating with pancreatic abnormalities in China.Methods A retrospective analysis for clinical data of 592 IBD cases hospitalized in Changhai hospital from June 2009 to May 2017 were conducted,and the incidence of ulcerative colitis (UC) and Crohn disease (CD) complicating with pancreatic abnormalities was analyzed.Cases were divided into two groups according to whether anti TNF-α bodies therapy for treating IBD was given,and the incidence of acute pancreatitis (AP) in UC and CD patients complicating with pancreatic abnormalities was compared.Results There were 2 patients with pancreatic abnormalities in 310 CD cases including one with AP and pancreatic cystic lesions(PCL),and one with PCL.There were a total of 14 patients with pancreatic abnormalities in 282 UC cases including 4 cases with AP,4 cases with chronic pancreatitis (CP),4 cases with pancreatic cancer (PC),one case with CP and PC and one case with type 2 autoimmune pancreatitis (AIP).The incidence of pancreatic abnormalities in UC was significantly higher than that in CD (P ＜0.01).No AP happened (0/62) in patients receiving anti TNF-α bodies therapy.There were 5 AP cases in patients without anti TNF-α bodies therapy group (5/449),and the difference was not statistical significant.Conclusions UC is more closely associated with pancreatic abnormalities,especially CP and PC.Whether anti TNF-αtherapy could decrease the AP risk in IBD patients has not yet been determined.

Objective To explore the influence of TAC protocol (pirarubicin,cyclophosphamide and docetaxel) and AC-T protocol (pirarubicin,cyclophosphamide and sequential docetaxel) on T lymphocytes cell subsets (included CD3+ T cells,CD3+ CD4+ T cells,CD3+ CD8+ T cells,CD3+ CD4+/CD3 + CD8+),natural killer (NK) cells and part of the quality of life in the peripheral blood of patients.Methods A total of 66 patients with breast cancer included 31 cases for TAC protocol (6 cycles of chemotherapy) and 35 cases for AC-T protocol(8 cycles of chemotherapy).Collected respectively before and after the last chemotherapy of peripheral blood,used flow cytometry technique to detect the proportion of T cell subsets and NK cells in peripheral blood,and compared the change of the part of the quality of life before and after chemotherapy.Results After chemotherapy of total of 66 patients CD3+ T cells,CD3+ CD4+T cells and NK cells of peripheral blood ((68.58± 11.03) ％,(33.53 ± 8.84) ％,(18.27 ± 10.65) ％) significantly lower than before chemotherapy ((74.03±13.04)％,(38.42±9.79)％,(19.83± 10.19)％),the differences were statistically significant(t =4.296,3.387,4.092,P＜ 0.05).Grouping was TAC protocol with AC-T,T cell subsets and NK cells before chemotherapy differences had no statistical significance.But after chemotherapy,CD3+ T cells,CD3+ CD4+T cells,CD3+CD8+ T cells and Karnofky score((64.63±10.01)％,(31.19±7.41)％,(24.66±7.40)％,(68.63± 5.100)％) of peripheral blood on TAC protocol were more decreased than AC-T protocol((72.29± 10.78)％,(35.74± 9.60) ％,(30.15 ± 11.12) ％,(77.29 ± 4.58) ％),the differences were statistically significant (t =2.99,2.15,2.35,2.237,P＜0.05).CD3+ CD4+/CD3+ CD8+ and NK cells were also decreased,but without statistical significance.The body quality of 66 patients was slightly increased after chemotherapy,but without statistical significance.Conclusion The body's immune function and the part of quality of the breast cancer patient's life have declined by chemotherapy drugs in varying degrees.Compared TAC,AC-T protocol has less influence on the immunological function and the part of living quality of patients with breast cancer.

Objective To investigate the influence on biological characteristics in human pancreatic cancer cells after beding transfected by two anti-carcinoma miRNAs at the same time.Methods Pancreatic cancer cells PANC1,SW1990 and normal pancreatic cells AR42J were transfected by miR-34a and(or) miR-let7 by liposome.Cells transfected with negative control miRNA (miR-NC) and untransfected were as controls.The expression of miR-34a and miR-let7 were detected by real-time fluorescent quantitative RT-PCR.The cell proliferation was detected by MTT test and the migration and invasion were evaluated by transwell assay.The apoptosis rate was measured by flow cytometric analysis.Results After being transfected with miRNAs,the expression of miR-34a and miR-let7 in double transfection group (miR-34a and miR-let7 were transfected at the same time),miR-34a transfection group,miR-let7 transfection group was significantly up-regulated than those in miRNA-NC transfection group and untransfected group in PANC1 cells,SW1990 cells and AR42J cells,repectively.The difference which was statistically significant (P ＜0.05)indicating that cells were successfully transfected.The cell proliferation in double transfection group of PANC1 cells and SW1990 cells were (0.665 ± 0.01,0.6375 ± 0.03),which were significantly inhibited compared with (0.974 ± 0.03,0.971 ±0.05) in miR-NC group and (0.8875 ±0.05,0.8625 ±0.06) in miR-let7 group.The difference was statistically significant(P ＜ 0.05).The cell proliferation activity in double transfection group was lower than those in miR-34a group (0.795 ±0.06,0.7925 ±0.06),but did not have statistically significant difference.There was no significant change in AR42J cells.Cell invasion assay showed that the number of PANC1 cells permeating substrate membrane in miR34a group (103.7 ± 3.28) and miR-let7 group (100.7 ± 1.76) were significantly fewer than miR-NC group (231.3 ±2.6) and untransfected group (153.7 ±2.6).The number of cells permeating substrate membrane in double transfection group(61.67 ± 3.18)was fewer than miR-34a group and miR-let7 group,respectively.The difference was statistically significant (P ＜ 0.01).The migration test had consistent results with invasion test.The changes of invasion and migration in SW1990 cells were similar to those in PANC1 cells.The apoptosis rate of PANC1 cells in miR-34a group,miR-let7 group,double transfection group,miR-NC group and untransfected group was (16.66 ± 1.27) ％,(15.46 ± 0.33) ％,(23.35 ± 1.80) ％,(9.33 ± 0.31) ％ and (8.83 ± 0.36) ％ respectively.Single transfection group had higher apoptosis rate than miR-NC group and untransfected group (P ＜0.05).Double transfection group had a significantly higher apoptosis rate than miR-let7 group (P ＜ 0.05),while there was no significant difference between double transfection group and miR-34a group.Conclusions The cell proliferation,invasion and migration in double miRNAs transfected pancreatic cancer cells were significantly down-regulated compared with those in single miRNA transfected cells,while apoptosis rate in double miRNAs transfection group was higher than single miRNA transfection group.Thus,the combination of two anti-cancer miRNAs may exert a more significant synergistic antitumor effect.

Objective To explore the efficacy of constructing the neourethra using a bladder anterior wall for the treatment of female total urethral stricture or atresia.Methods We retrospectively reviewed 11 female patients with total urethral stricture or oblitalition,who were underwent a procedure of reconstructive neourethra using a bladder anterior wall,from January 2009 to November 2015.Of the 11 patients,urethral stricture was associated with vesicovaginal fistula and a severe hydrocolpos in the proximal vagina because of vaginal anterior strictures or atresia in four girls.The mean age was 16 years (ranging 5-48 years) in all patients.The etiology was posttraumatic urethral injuries after pelvic fracture in 9 patients,radical urethral resection because of urethral cancer in 1 patient and congenital bladder exstrophy with an absent urethra in 1 patient.All patients underwent a procedure of neourethral construction under general anesthesia.The bladder anterior wall,which was about 2.0 to 2.5 cm in width and 4.0 ～4.5cm in length,was separated from bladder neck to middle partion of the anterior bladder wall.The bladder flap was tubularized around a 12-14 French catheter using continuous 4-0 polyglycolic acid sutures for the mucosa and interrupted sutures of 3-0 polyglycolic acid for the muscle.The tubularized flap was then flipped caudally to the site of the original external urethral meatus to form a new urethra.4 patients with severe stenosis or oblitalition of the distal vagina underwent a procedure of vaginoplasty at same time,including island vulvar flaps enlarging vaginoplasty in two girls and reconstructive vaginal orifice using the proximal enlargedvagina wall in other two girls.Results There were no serious complications postoperatively.The catheter was removed 3 ～4 weeks after the operation.7 patients were completely continent with excellent voiding,3 patients had stress incontinence.One patient experienced dysuria.And the urethroscopy in this case showed that the mucosal prolapse was present at the 12 to 3 o'clock position on the neck of the bladder,which caused urinary obstruction.Endoscopic resection of the prolapsed mucosa was performed.The patient could easily void without incontinence after the operation.The patients were followed up a median of 38 months,(ranging 6-72 months).2 patients experienced dysuria 3 and 4 months after operation,separatively.Examination showed that the mucosal prolapse was present at the position on the neck of the bladder in one patient and urethral meatal stenosis in another patient.The two patients were separatively underwent a procedure of endoscopic resection of the prolapsed mucosa and meatal urethroplasty,using vulvar flap.All of them could easily void without incontinence after the operation.Of the 3 patients with stress urinary incontinence,one underwent a procedure of TVT-O one year later,and after which continence was achieved with good voiding;the other two cases were awaiting for reoperation.Four cases of postoperative vaginal fluid disappeared with unobstructed micturition.Conclusions Female neo-urethral reconstruction using the bladder anterior wall flap was a reliable technique for the management of complete urethral stricture or obliteration.

OBJECTIVETo investigate the Clinical safety and effectiveness of propofol medium and long chain fat emulsion injection for cesarean section.

METHODSA retrospective analysis was conducted in 88 cesarean section surgeries performed between January, 2014 and June, 2015 with epidural anesthesia in 44 cases (control) and with total anesthesia with propofol/long chain fat emulsion injection in 44 cases (observation group). The maternal mean arterial pressure (MAP), SpO(2), and heart rate and neonatal umbilical dynamic venous blood gas analysis (pH, PO(2), pCO(2)) were compared between the two groups.

RESULTSCompared with the control group, heart rate and MAP significantly increased at skin incision in the observation group. At the other time points, heart rate, MAP, and SpO(2) were all comparable between the two groups. The time from skin incision to newborn delivery was significantly shorter in observation group (P<0.05), but the time from uterine incision to delivery and neonatal Apgar score were equivalent between the two groups (P>0.05); neonatal umbilical arteriovenous blood pH, PO2, and pCO2 were all comparable between the two groups.

CONCLUSIONPropofol medium and long chain fat emulsion injection for general anesthesia induction in cesarean section is characterized by rapid metabolism of the anesthetics, rapid maternal postoperative recovery, and minimal adverse effects on the fetus, and is therefore safe and reliable in clinical use.

Anesthesia, Epidural ; Anesthesia, General ; Anesthetics ; therapeutic use ; Apgar Score ; Blood Gas Analysis ; Blood Pressure ; Cesarean Section ; Emulsions ; chemistry ; therapeutic use ; Fatty Acids ; chemistry ; therapeutic use ; Female ; Fetal Blood ; Fetus ; Heart Rate ; Humans ; Infant, Newborn ; Pregnancy ; Propofol ; therapeutic use ; Retrospective Studies

Objective To investigate the Clinical safety and effectiveness of propofol medium and long chain fat emulsion injection for cesarean section. Methods A retrospective analysis was conducted in 88 cesarean section surgeries performed between January, 2014 and June, 2015 with epidural anesthesia in 44 cases (control) and with total anesthesia with propofol/long chain fat emulsion injection in 44 cases (observation group). The maternal mean arterial pressure (MAP), SpO2, and heart rate and neonatal umbilical dynamic venous blood gas analysis (pH, PO2, pCO2) were compared between the two groups. Results Compared with the control group, heart rate and MAP significantly increased at skin incision in the observation group. At the other time points, heart rate, MAP, and SpO2 were all comparable between the two groups. The time from skin incision to newborn delivery was significantly shorter in observation group (P<0.05), but the time from uterine incision to delivery and neonatal Apgar score were equivalent between the two groups (P>0.05);neonatal umbilical arteriovenous blood pH, PO2, and pCO2 were all comparable between the two groups. Conclusion Propofol medium and long chain fat emulsion injection for general anesthesia induction in cesarean section is characterized by rapid metabolism of the anesthetics, rapid maternal postoperative recovery, and minimal adverse effects on the fetus, and is therefore safe and reliable in clinical use.

Objective To investigate the Clinical safety and effectiveness of propofol medium and long chain fat emulsion injection for cesarean section. Methods A retrospective analysis was conducted in 88 cesarean section surgeries performed between January, 2014 and June, 2015 with epidural anesthesia in 44 cases (control) and with total anesthesia with propofol/long chain fat emulsion injection in 44 cases (observation group). The maternal mean arterial pressure (MAP), SpO2, and heart rate and neonatal umbilical dynamic venous blood gas analysis (pH, PO2, pCO2) were compared between the two groups. Results Compared with the control group, heart rate and MAP significantly increased at skin incision in the observation group. At the other time points, heart rate, MAP, and SpO2 were all comparable between the two groups. The time from skin incision to newborn delivery was significantly shorter in observation group (P<0.05), but the time from uterine incision to delivery and neonatal Apgar score were equivalent between the two groups (P>0.05);neonatal umbilical arteriovenous blood pH, PO2, and pCO2 were all comparable between the two groups. Conclusion Propofol medium and long chain fat emulsion injection for general anesthesia induction in cesarean section is characterized by rapid metabolism of the anesthetics, rapid maternal postoperative recovery, and minimal adverse effects on the fetus, and is therefore safe and reliable in clinical use.