Objective To investigate the impact of graft type on perioperative outcomes and long-term prognosis in patients undergoing surgical repair of post-myocardial infarction ventricular septal rupture (VSR) with concurrent coronary artery bypass grafting (CABG). Methods A retrospective analysis was conducted on clinical data from patients who underwent VSR repair and concurrent CABG at Fuwai Hospital between 2005 and 2022. Patients were divided into an arterial graft group and a saphenous vein graft (SVG)-only group based on the type of bypass grafts used. Clinical outcomes were compared between the two groups. Results A total of 92 patients were included, comprising 56 males and 36 females, with a mean age of (62.4±7.9) years. The arterial graft group consisted of 60 patients, and the SVG-only group consisted of 32 patients. There were no statistical differences between the two groups in age, gender, body mass index, past medical history, time interval from myocardial infarction to surgery, or culprit vessel distribution (P>0.05). A higher proportion of patients in the SVG-only group received preoperative intra-aortic balloon pump (IABP) support (56.3% vs. 35.0%, P=0.049). However, cardiopulmonary bypass time, aortic cross-clamp time, and early mortality rates were similar between the two groups (P>0.05). Follow-up data revealed no statistically significant differences in cumulative 10-year survival (82.8% vs. 80.0%, P=0.940) or freedom from major adverse cardiovascular and cerebrovascular events (49.6% vs. 58.6%, P=0.491) between the SVG-only and arterial graft groups. Furthermore, graft type did not significantly affect long-term mortality in patients with a culprit vessel in the left anterior descending artery or those with multivessel disease. Conclusion In patients undergoing delayed repair of VSR with concomitant CABG, the use of arterial or saphenous vein grafts does not significantly impact perioperative outcomes or long-term prognosis. Future research should further explore the benefits of different revascularization strategies to optimize treatment for this population.

This paper summarized Professor PI Chiheng's experience in treating diabetic nephropathy （DN） using the method of warming yang， nourishing yin， and invigorating blood by stages. It is believed that yang deficiency and yin depletion are the key pathological mechanisms of DN， with blood stasis running throughout the disease's progression. The general treatment principle is to warm yang， nourish yin， and invigorate blood， with different emphases at each stage. For early stage， the disease is characterized by spleen qi deficiency and insufficiency of qi and yin， which could be treated by modified Shenqi Dihuang Decoction （参芪地黄汤） to tonify qi and invigorate blood， strengthen yang and consolidate yin； for middle stage， the disease is marked by spleen and kidney yang deficiency with internal dampness accumulation， which could be treated by modified Zhenwu Decoction （真武汤） and Sanren Decoction （三仁汤） warming yang and to resolve dampness and unblock meridians； for the late stage， the disease is characterized by blood stasis and toxin accumulation with deficiency of both yin and yang， which could be treated by modified Jisheng Shenqi Pill （济生肾气丸） to eliminate pathological masses and remove toxins， warm yang and nourish yin. Additionally， traditional Chinese medicine therapies such as rubbing with ointment （Gao Mo therapy） are utilized as adjunct treatments， treating the root and branch simultaneously and combining internal and external approaches.

Objective:To explore the changes of brain excitation/inhibition balance and gray matter volume (GMV) and their correlations with clinical features in benign childhood epilepsy with centrotemporal spikes (BECTS).Methods:A cross-sectional study was performed; 83 BECTS children enrolled from Department of Diagnostic Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University from January 2015 to January 2024 were selected as BECTS group. During the same period, 101 age- and gender-matched healthy children were recruited as healthy control group through advertisements in local primary schools. Data of conventional MRI and resting-state functional MRI (rs-fMRI) of the two groups were collected. Whole brain GMV was analyzed by voxel-based morphometry (VBM), and Hurst index was calculated based on time series data of blood oxygen level dependent (BOLD) signal of rs-fMRI. Correlations of GMV and Hurst index with disease duration and onset age in children with BECTS were explored by Pearson correlation analysis.Results:Compared with the healthy control group, the BECTS group had significantly increased GMV and decreased Hurst index in the bilateral Rolandic region ( P<0.05). Pearson correlation analysis showed that in the BECTS group, GMV in bilateral Rolandic region was negatively correlated with onset age ( r=-0.267, P=0.015) and positively correlated with disease course ( r=0.267, P=0.015); Hurst index in bilateral Rolandic region was positively correlated with onset age ( r=0.323, P=0.003) and negatively correlated with disease course ( r=-0.240, P=0.029); Hurst index was negatively correlated with GMV in bilateral Rolandic region ( r=-0.328, P=0.003). Conclusion:BECTS children have excitation/inhibition imbalance in epilepsy-related regions and cortical structural delay, and both of them are related to onset age and disease course.

The aim of this experiment was to investigate the effects of daidzein(DZ)on mammary gland development in mice during pregnancy.A total of 36 pregnant mice were randomly divided into a control group(treated with sterile PBS),a DZ group(DZ working fluid by intraperitoneal injection)and a E2 group(E2 working fluid by intraperitoneal injection),once daily,for 7 days.Af-ter normal delivery of pregnant mice,6 mice were selected from each group on the 1st and 10th day of the lactation period,then executed after blood sampling,and all mammary gland tissue were taken for the following experiments:1)mammary gland tissue was weighted and the mammary gland index was calculated;preparation of mammary gland tissue sections,HE staining;2)ELISA of estradiol,prolactin and insulin-like growth factor concentrations in serum;3)Western blot and RT-qPCR were used to analyze the expression of cell cyclin proteins and ER-a,ER-β proteins and genes in mammary gland tissues.The results showed that:compared with control group,DZ signif-icantly increased the area ratio of acinar in the mammary gland of mice(P＜0.05),decreased the area ratio of adipose tissue and increased proliferative expansion of adenohypophysis;DZ highly significantly increased serum PRL levels(P＜0.01)and serum IGF-1 content,reduced serum E2 levels;DZ significantly up-regulated the expression of CyclinD1,CyclinD3,PCNA and ER-β pro-teins(P＜0.05),and the mRNA level of ER-β gene was significantly up-regulate(P＜0.01).In conclusion,DZ can promote cell proliferation and division by increasing the expression of cell cycle proteins and proliferation proteins,promotes the proliferation of mammary gland follicles and in-creases mammary gland weight during pregnancy in mice,and at the same time increase the serum levels of IGF-1 and PRL in the female rats,which jointly promote the development of the mamma-ry glands during lactation.

The aim of this experiment was to investigate the effects of daidzein(DZ)on mammary gland development in mice during pregnancy.A total of 36 pregnant mice were randomly divided into a control group(treated with sterile PBS),a DZ group(DZ working fluid by intraperitoneal injection)and a E2 group(E2 working fluid by intraperitoneal injection),once daily,for 7 days.Af-ter normal delivery of pregnant mice,6 mice were selected from each group on the 1st and 10th day of the lactation period,then executed after blood sampling,and all mammary gland tissue were taken for the following experiments:1)mammary gland tissue was weighted and the mammary gland index was calculated;preparation of mammary gland tissue sections,HE staining;2)ELISA of estradiol,prolactin and insulin-like growth factor concentrations in serum;3)Western blot and RT-qPCR were used to analyze the expression of cell cyclin proteins and ER-a,ER-β proteins and genes in mammary gland tissues.The results showed that:compared with control group,DZ signif-icantly increased the area ratio of acinar in the mammary gland of mice(P＜0.05),decreased the area ratio of adipose tissue and increased proliferative expansion of adenohypophysis;DZ highly significantly increased serum PRL levels(P＜0.01)and serum IGF-1 content,reduced serum E2 levels;DZ significantly up-regulated the expression of CyclinD1,CyclinD3,PCNA and ER-β pro-teins(P＜0.05),and the mRNA level of ER-β gene was significantly up-regulate(P＜0.01).In conclusion,DZ can promote cell proliferation and division by increasing the expression of cell cycle proteins and proliferation proteins,promotes the proliferation of mammary gland follicles and in-creases mammary gland weight during pregnancy in mice,and at the same time increase the serum levels of IGF-1 and PRL in the female rats,which jointly promote the development of the mamma-ry glands during lactation.

Objective:To explore the changes of brain excitation/inhibition balance and gray matter volume (GMV) and their correlations with clinical features in benign childhood epilepsy with centrotemporal spikes (BECTS).Methods:A cross-sectional study was performed; 83 BECTS children enrolled from Department of Diagnostic Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University from January 2015 to January 2024 were selected as BECTS group. During the same period, 101 age- and gender-matched healthy children were recruited as healthy control group through advertisements in local primary schools. Data of conventional MRI and resting-state functional MRI (rs-fMRI) of the two groups were collected. Whole brain GMV was analyzed by voxel-based morphometry (VBM), and Hurst index was calculated based on time series data of blood oxygen level dependent (BOLD) signal of rs-fMRI. Correlations of GMV and Hurst index with disease duration and onset age in children with BECTS were explored by Pearson correlation analysis.Results:Compared with the healthy control group, the BECTS group had significantly increased GMV and decreased Hurst index in the bilateral Rolandic region ( P<0.05). Pearson correlation analysis showed that in the BECTS group, GMV in bilateral Rolandic region was negatively correlated with onset age ( r=-0.267, P=0.015) and positively correlated with disease course ( r=0.267, P=0.015); Hurst index in bilateral Rolandic region was positively correlated with onset age ( r=0.323, P=0.003) and negatively correlated with disease course ( r=-0.240, P=0.029); Hurst index was negatively correlated with GMV in bilateral Rolandic region ( r=-0.328, P=0.003). Conclusion:BECTS children have excitation/inhibition imbalance in epilepsy-related regions and cortical structural delay, and both of them are related to onset age and disease course.

Pulmonary alveolar proteinosis (PAP) is a diffuse lung disease characterized by dyspnea due to abnormal deposition of pulmonary surfactant in alveolar macrophages and alveoli, among which autoimmune PAP (aPAP) is the most common clinical type, accounting for about 90%. The abnormal production of anti-granulocyte-macrophage colony stimulating factor antibody (anti-GM-CSF antibody) leads to the dysfunction of alveolar macrophages. We summarize the current state of research on the pathogenesis of aPAP and describe the progress in the diagnosis and treatment of aPAP by discussing the abnormalities of signal pathway, dysfunction of alveolar macrophages and the production of anti-GM-CSF antibody.

Existing antidepressant treatments are generally suboptimal for patients with bipolar disorder(BD).Several studies have explored the efficacy of light therapy(LT)in patients with bipolar depression,along with investigating parameters,devices,and safety aspects of LT.This paper provides a review of these aspects.Numerous meta-analyses and randomized controlled trials have indicated that LT could significantly improve depressive symptoms in BD patients,with both low and high intensity white light having this effect,while the antidepressant effect of blue light remains unclear.LT takes effect rapidly,preferably in the morning,with each session lasting between 30 to 60 minutes,but there is no consensus on the most beneficial LT course for BD patients.The most commonly used device for LT is a lightbox.However further exploration is need regarding the safety of LT glasses.When LT devices that meet safety standards is selected,the overall safety of LT will be high and risk of manic or hypomanic switch will be low for BD patients.In conclusion,LT holds promise for patients with bipolar depression,and further research on LT for BD patients should be conducted to explore LT strategies and develop LT prescriptions.

Objective To explore the related factors for the unilateral flap and bilateral flap by changing the origi-nal operation plan in the extraction of maxillary impacted mesiodens.Methods 81 patients with impacted mesio-dens in the middle of the maxillary were retrospectively analyzed.The primary outcome variables were planned sur-gery (unilateral flap) and unplanned surgery (bilateral flap) .The secondary outcome variables consisted of opera-tion time and postoperative swelling.The predictive variables were as follows:the differential value of the shortest distance from the supernumerary tooth to the labial and palatal bone plates, which was divided into≥1.5 mm group and<1.5 mm group; the ratio of the distance from the adjacent tooth apex to the nasal floor, compared to the length of the supernumerary teeth, was recorded as≥1 and< 1.A statistical software SPSS 20 was used to com-plete the statistical analysis.Results When the differential value was less than 1.5 mm, the possibility of un-planned surgery increased, and the probability of planned surgery was 0.085 times than that of unplanned surgery.With age growing each 1-year, the probability of planned surgery gradually decreased, HR=0.745.The postopera-tive swelling of the palatal approach was only 0.374 times than that of the labial approach.With age increasing, the operation time increased gradually, B=1.213.The ratio of the distance from the adjacent tooth apex to the na-sal floor to the length of the supernumerary teeth did not affect the change of the surgical plan during the operation.Conclusion The shortest distance difference between the supernumerary teeth and the labial and palatal bone plates can be used as a reference for the selection of surgical approach for the extraction of maxillary impacted me-siodens.

ATP is an important cofactor involved in many biocatalytic reactions that require energy input. Polyphosphate kinases (PPK) can provide energy for ATP-consuming reactions due to their cheap and readily available substrate polyphosphate. We selected ChPPK from Cytophaga hutchinsonii for substrate profiling and tolerance analysis. By molecular docking and site-directed mutagenesis, we rationally engineered the dual-substrate channel cavity of polyphosphate kinase to improve the catalytic activity of PPK. Compared with the wild type, the relative enzyme activity of the screened mutant ChPPK_K81H-K103V increased by 326.7%. Meanwhile, the double mutation expanded the substrate utilization range and tolerance of ChPPK, and improved its heat and alkali resistance. Subsequently, we coupled the glutathione bifunctional enzyme GshAB and ChPPK_K81H-K103V based on this ATP regeneration system, and glutathione was produced by cell-free catalysis upon disruption of cells. This system produced (25.4±1.9) mmol/L glutathione in 6 h upon addition of 5 mmol/L ATP. Compared with the system before mutation, glutathione production was increased by 41.9%. After optimizing the buffer, bacterial mass and feeding time of this system, (45.2±1.8) mmol/L glutathione was produced in 6 h and the conversion rate of the substrate l-cysteine was 90.4%. Increasing the ability of ChPPK enzyme to produce ATP can effectively enhance the conversion rate of substrate and reduce the catalytic cost, achieving high yield, high conversion rate and high economic value for glutathione production by cell-free catalysis. This study provides a green and efficient ATP regeneration system that may further power the ATP-consuming biocatalytic reaction platform.
Molecular Docking Simulation ; Catalysis ; Glutathione ; Adenosine Triphosphate