Objective: To characterize perioperative dynamic changes in immune-cell phenotypes and inflammatory cytokines in patients undergoing CPB (cardiopulmonary bypass) cardiac surgery, and to explore their associations with postoperative outcomes. Methods: In this prospective cohort study, 120 adult patients who underwent elective cardiac surgery under CPB at West China Hospital from May 2022 to March 2023 were enrolled. Perioperative immune-cell phenotypes and concentrations of 40 inflammation-related cytokines were measured. The primary outcomes were the sequential organ failure assessment (SOFA) score at 24 h after surgery and ΔSOFA (the peak SOFA score within 48 h after surgery minus the preoperative SOFA score). Secondary outcomes included major adverse cardiovascular events (MACE), acute kidney injury (AKI), respiratory failure, severe liver injury, and infection. Results: The mean age of enrolled patients was 57±10 years. Of these, 52% (62/120) were male and 90% (108/120) underwent valve surgery. During the rewarming to the end of CPB, neutrophil counts rapidly increased (7.39×10 /L vs preoperative 3.07×10 /L, P<0.001), with significant upregulation of CD11b (7.30×10 /L vs preoperative 3.05×10 /L, P<0.001) and CD54 (7.15×10 /L vs preoperative 2.99×10 /L, P<0.001). Lymphocyte counts increased at the end of CPB (1.75×10 /L vs preoperative 1.12×10 /L, P<0.001) but decreased significantly at 24 h after surgery (0.59×10 /L vs preoperative 1.12×10 /L, P<0.001). Plasma analysis showed that multiple pro-inflammatory cytokines increased during CPB and remained elevated up to 24 h after surgery; five chemokines and the anti-inflammatory cytokine IL-10 peaked at the end of CPB. The SOFA score increased from 1 (1, 2) preoperatively to 7 (5, 10) at 24 h after surgery, with a ΔSOFA of 6 (4, 8). Within 30 days after surgery, 48 patients (40.0%) developed AKI, 17 (14.2%) developed infection, 4 (3.3%) developed severe liver injury, 3 (2.5%) developed respiratory failure, and 3 (2.5%) experienced MACE. During the 2-year follow-up, 8 patients (6.7%) experienced MACE and 5 (4.2%) died. Conclusion: Multi-organ dysfunction is common after cardiac surgery under CPB (median ΔSOFA, 6), accompanied by perioperative activation of multiple immune-cell subsets and upregulation of pro-inflammatory, anti-inflammatory, and chemotactic mediators. This study provides data-driven evidence and research clues for further investigation of the associations between CPB-related immune perturbations and postoperative organ dysfunction and clinical outcomes.

Objective To explore the clinical application value of minimally invasive endoscopic visual artificial abortion operation system in Painless abortion. Methods 250 cases early pregnant women who underwent minimally invasive endoscopic visual artificial abortion operation system implementation of Painless abortion from June 2015 to December 2015 were selected as visual painless abortion group,while Two hundred and fifty cases early pregnant women who demanded routine painless abortion during the same period were selected as routine painless abortion group. The operation time, the amount bleeding, the villus integrity, the number of cases of once again clear palace operation , the vaginal bleeding time after operation, and the first menstruation recovery time after operation among the pregnant women in the two groups were analyzed. Results There was statistically significant difference in the operation time, amount bleeding, villus integrity, the number of cases of once again clear palace operation , vaginal bleeding time after operation, and the first menstruation recovery time after operation between the two groups ( P<0. 05) . The Observation index of the pregnant women in visual painless abortion group was Obviously superior of that in routine induced abortion group . Conclusion Minimally invasive endoscopic visual artificial abortion operation system implementation of Painless abortion is worthy to be popularized and applied in clinic.

Objective To collect the demographic,lifestyle and clinical factors of patients with cerebrovascular disease,and analyze the vascular cognitive impairment(VCI) factors and set up high-risk factors model.methods 505 patients with cerebrovascular disease hospitalization in department of geriatrics and neurology in hospital from October 2014 to October 2016 were enrolled.According to the questionaire survey data of demographics,lifestyle and clinical factors,the patients were divided into training set (421 cases) and test set (84 cases),and training set were divided into the non-VCI set (225 cases) and VCI set (196 cases).Analyzed the influence factors of VCI in patients with cerebrovascular disease by decision tree algorithm,and compared it with the Logistic regression analysis and chi-square and established the decision tree model for risk factors of VCI.Result sAccording to the VCI decision tree model,cross validation model recognition accuracy was 73.63%,while test set prediction accuracy was 73.81%.Alcoholism,hobbies,education level,tea drinking,diabetes,hypertension,diet,age,sleep and physical exercise were classification of node variables,while drinking was the root.The probability of VCI had significant difference (P<0.05) in the crowds with different risk factors.According to Result s of Logistic regression analysis,education level,drinking,exercise and diabetes were independent risk factors for VCI,while the model prediction accuracy was 66.98%,and test set prediction accuracy was 53.57%.According to the ROC curve of the decision tree model and the Logistic regression model,the decision tree model AUC was 0.737 (95%CI 0.688 to 0.786),and the Logistic regression model AUC was 0.664 (95%CI 0.612 to 0.717).Conclusion It is suggested that the decision tree model might be superior to logistic regression model in the prediction accuracy for VCI of patients with cerebrovascular disease.The alcoholism,diabetes,high blood pressure,high fat diet and insomnia are risk factors of VCI,while hobbies,high level of education,physical exercise and drinking tea can be the protective factors of the VCI.

Objective To evaluate the association between plasma levels of visfatin and adiponectin with carotid arterial intima-media thickness in patients with type 2 diabetes.Methods A total of 100 elderly patients with type 2 diabetes and 30 healthy elderly controls were recruited from August 2015 to August 2016 at our hospital.Based on carotid arterial intima-media thickness(IMT) assessed via color Doppler ultrasonography,patients with diabetes were further divided into a thickened IMT group (40 cases)and a non-thickened IMT group (60 cases).Plasma levels of visfatin and adiponectin were analyzed and compared,and their associations with carotid arterial IMT were evaluated.Results Compared with the control group,patients in both the thickened IMT group and the non-thickened IMT group had significantly higher serum levels of visfatin(19.1 ± 2.8)μg/L vs.(40.6±3.9)μg/L,(28.9±3.6)μg/L,which was markedly higher in the thickened IMT group than in the non-thickened IMT group(P＜0.05).In addition,compared with the control group,patients in the thickened IMT group and the non-thickened IMT group had significantly lower serum levels of adiponectin(1 590±330)mg/L,(610±170)mg/L,(930±210)mg/L,which was markedly lower in the thickened IMT group than in the non-thickened IMT group (P ＜ 0.05).Furthermore,Pearson's analysis showed that the plasma level of visfatin was positively correlated with carotid arterial IMT(r =0.721,P＜0.05),and the plasma level of adiponectin was negatively correlated with carotid arterial IMT(r=-0.688,P＜0.05).Conclusions Plasma levels of visfatin and adiponectin are closely related to carotid arterial IMT in patients with type 2 diabetes,andmay be used as plasma markers for the prediction of early atherosclerosis.

Objective To investigate the value of Color Doppler ultrasound in hemodynamic changes of non-alcoholic fatty liver disease.Methods 120 cases with non -alcoholic fatty liver disease were selected and divided into the mild group,moderate group and severe group.According to the degree of fatty infiltration of the liver taxono-my,40 cases in each group,hemodynamic changes of each group were detected in Color Doppler ultrasound equip-ment.Results Hepatic venous pulse waveform analysis and comparison constituted of the three groups and control group,the difference was statistically significant (χ2 =25.343,P <0.05).PPVV,MPVV,HARI of the three groups and control group were compared,the difference was statistically significant(F =34.67,51.03,31.06,all P <0.05).Conclusion Color Doppler ultrasound which is used to detect hemodynamic changes in non -alcoholic fatty liver disease had good clinical value,can assess disease progression in patients,can provide the basis for clinical treat-ment.

Objective To investigate the diagnostic value of ultrasound elastography hardness score and area ratio to identify benign and malignant lesions.Methods 90 patients with breast lumps were selected and divided into the malignant and non -malignant group according to surgical pathology diagnosis,they were 40 cases (a total of 45 tumors)and 50 cases (a total of 57 tumors),two groups of patients were detected in ultrasound elastography,anal-ysis of imaging hardness ratings and area ratio and other information,to investigate the clinical diagnostic value. Results The ultrasound elastography of 50 cases with benign tumor were 0 -2 point,7 cases were 3 -4 point, 7 cases with malignant tumors were 0 -2 point,38 cases were 3 -4 point,the difference between the two groups were statistically significant (χ2 =28.55,P <0.05);The average area ratio of benign tumor was (1.01 ±0.27),malignant tumors was (2.28 ±1.68),the difference between the two groups was statistically significant(t =9.22,P =0.001);the sensitivity,specificity,accuracy of elastography hardness rating in diagnosis of malignant breast tumors were 87.72%,84.44%,86.27%,the area ratio method were 85.96%,86.67%,86.27%,joint inspection of the two groups were 96.49%,95.55%,96.08%,joint inspection had obvious advantages,the difference was statistically sig-nificant(χ2 =16.24,13.58,P <0.05).Conclusion Ultrasound elastography hardness rating combined area ratio has a higher accuracy rate for differentiating benign and malignant breast tumors.