[Objective] To evaluate the efficacy and practicality of autologous platelet-rich plasma (aPRP) in patients undergoing total aortic arch replacement for aortic dissection. [Methods] A retrospective analysis was performed on 483 patients diagnosed with type A aortic dissection who underwent total aortic arch replacement between January 2016 and November 2023. Patients were categorized into two groups based on whether they received aPRP. Baseline characteristics, intraoperative blood product usage and postoperative outcomes were compared between the two groups. [Results] The aPRP group exhibited reduced usage of allogeneic platelets (1.55±1.04 vs 1.60±1.27)U, allogeneic plasma (480.89±432.49 vs 746.50±508.81)mL, allogeneic RBC (red blood cell)(5.95±1.91 vs 6.17±3.52)U, bivalirudin (2.66±1.51 vs 3.31±1.59)U and coagulation factor Ⅶ (0.67±1.03 vs 1.22±1.43)mg compared to the non-aPRP group (P<0.05). The incidence of postoperative hypoxemia was lower in the aPRP group (43.98% vs 48.41%), and the duration of mechanical ventilation was significantly shorter[median 50.91 (interquartile range 18.71, 113.71) vs 83.40 (37.73, 151.98) hours]. There were no significant differences between the two groups in terms of postoperative mortality, continuous bedside hemofiltration, cerebral infarction, cerebral hemorrhage, paraplegia or re-exploration for hemostasis(P>0.05). [Conclusion] The application of aPRP in total aortic arch replacement effectively diminishes intraoperative blood product usage and the incidence of lung injury-related complications. However, it does not demonstrate significant benefits in terms of mortality, cerebral infarction and other complications.

Objective: To investigate an outbreak of acute gastroenteritis at a vocational and technical school in Shaanxi Province in 2024, ao as to provide the reference for the handling of school outbreaks. Methods: The conducted case searches, individual case investigations, and on-site hygienic investigations were established in accordance with the Guidelines on outbreak investigation, prevention and control of Norovirus infection (2015). The potential risk factors were analyzed by case-control study. Anal swab samples from cases and all canteen staff, as well as environmental swab samples were collected to detect common intestinal pathogens. All reserved food samples in canteen were collected to test for common pathogenic bacteria. Results: From October 26 to November 5, 2024, a cumulative total of 53 cases were reported, with an attack rate of 1.47%. The main clinical symptoms included vomiting (83.02%), abdominal pain (56.60%), diarrhea (30.19%), and fever (26.42%). The epidemic curve suggested an intermittent common-source outbreak, with no obvious clustering characteristics in terms of the population and spatial distribution of cases. The case-control analysis revealed that having dinner at the rice-with-dishes-on-top stall on the first floor of the canteen on October 28 was a risk factor for illness (OR=11.025, 95%CI: 2.186-55.601). GⅡ norovirus was detected as positive in anal swab samples from 6 cases and 2 asymptomatic infected canteen staff, as well as in 3 environmental swab samples from the rice-with-dishes-on-top stall. The test results for common pathogenic bacteria in the reserved food samples were all negative. Conclusions This outbreak was caused by an acute gastroenteritis epidemic induced by GⅡ norovirus infection, with a transmission pattern consistent with an intermittent homologous outbreak. The possible source of infection was asymptomatic infected canteen staff mainly through foodborne trasmission, and having meals at the rice-with-dishes-on-top stall was the primary risk factor for this outbreak.

The European Association for Cardio-Thoracic Surgery (EACTS) has recently updated and published the "2024 EACTS guidelines on perioperative medication in adult cardiac surgery". Based on the latest evidence, the guidelines have been updated in multiple aspects including underlying disease management, antithrombotic medication, arrhythmia treatment and other supportive care, etc. This paper aims to summarize and interpret the guidelines, in order to promote clinicians’ understanding and optimize perioperative medical treatment in adult cardiac surgery.

OBJECTIVE To investigate the effects of anlotinib on the malignant phenotype of glioma cells by regulating the nuclear factor-κB （NF-κB） signaling pathway. METHODS Human glioma T98G cells were cultured in vitro， and 5-fluorouracil was used as positive control to investigate the effects of different concentrations of anlotinib （5， 10， 20 μmol/L） on the ability of proliferation， adhesion， migration and invasion， the expressions of epithelial-mesenchymal transition （EMT） related proteins [E-cadherin， N-cadherin， vimentin and fibronectin （FN）]. NF- κB signaling pathway inhibitor （BAY 11-7082） and activator （prostratin） were additionally used to verify the possible mechanism of the above effects of anlotinib. RESULTS Anlotinib with 5， 10， 20 μmol/L could significantly decrease the activity of cell proliferation （except for 5 μmol/L anlotinib group）， migration rate， and the number of adherent cells and invasive cells， could significantly up-regulate the expression of E-cadherin protein while down-regulate the expressions of N-cadherin， vimentin and FN protein （P＜0.05）； the effect of 20 μmol/L anlotinib was similar to that of positive control （P＞0.05）. Compared with 10 μmol/L anlotinib， pathway inhibitor could significantly decrease the ability of proliferation， adhesion， migration and invasion， and the expressions of N-cadherin， vimentin， FN and phosphorylated NF-κB p65 protein， while could significantly up-regulate the expression of E-cadherin protein （P＜0.05）； above indexes were reversed significantly by pathway activator （P＜0.05）. CONCLUSIONS Anlotinib may inhibit the proliferation， adhesion， migration and invasion of human glioma T98G cells， which may be associated with the inhibition of the NF-κB signaling pathway， thus inhibiting cell EMT-like processes.

The research focus of diabetes, a common chronic metabolic disease, has shifted from individual factors to environmental factors at the population level. Epidemiological studies suggest an association between exposure to environmental pollutants and the risk of diabetes. Major environmental pollutants include organochlorine pesticides, polychlorinated biphenyls, phthalates and their metabolites, and arsenics, which primarily enter the human body through the skin, respiratory tract, and digestive system. Long-term exposure to these pollutants can affect the pathology of diabetes through various mechanisms, such as promoting insulin resistance, causing insulin secretion deficiencies, inducing oxidative stress-induced glucose metabolism disorders, and affecting DNA methylation. However, the potential damaging mechanism of the impact of environmental pollutants on diabetes remain unclear. Limitations such as insufficient sample sizes, uncertainties regarding exposure time and dosage, and differences between single and co-exposures. In the future, it is necessary to focus on exploring and analyzing the mechanisms of environmental pollutant exposure on diabetes to develop effective prevention strategies, control and reduce the incidence and development of diabetes, and provide new insights into its diagnosis and treatment.

Objective To summarize the results and clinical experience of transcatheter valve-in-valve implantation using domestic self-expanding valve in patients with aortic degenerated bio-prosthesis. Methods From January 2019 to April 2023, the patients who underwent transcatheter valve-in-valve surgery in the Department of Cardiac Surgery of Tianjin Chest Hospital due to surgical bio-prosthesis failure were included. Characteristics of valves, perioperative complications, and hemodynamic manifestations during the early postoperative and follow-up period were analyzed. Results A total of 24 patients were enrolled, including 14 males and 10 females with an average age of 68.17±7.72 years, and the average interval between the two operations was 10.48±4.09 years. All patients were successfully discharged without complications such as coronary artery obstruction and pacemaker implantation, and the average transvalvular pressure gradient was 16.39±6.52 mm Hg before discharge. During the median follow-up time of 16 months, the left ventricular diastolic inner diameter and ejection fraction were continuously improved. Conclusion Transcatheter valve-in-valve using domestic self-expanding valves is safe and feasible to treat aortic bioprosthetic valve failure. Sound patient selection and surgical strategies are critical to achieve good hemodynamics.

Objective: To study the relationship between sugar sweetened beverages consumption characteristics and insomnia of college students in Yunnan Province, so as to provide evidence for sleep quality improvement of college students. Methods: A cluster random sampling method was used to select 2 515 college students from two universities (Kunming University and Dali Nursing Vocational College) in Kunming and Dali in Yunnan Province for a longitudinal study, including baseline survey (T1, November 2021) and three follow up surveys (T2: June 2022, T3: November 2022, T4: June 2023). Sugar sweetened beverages consumption of college students was collected by Semi quantitative Food Frequency Questionnaire and insomnia was assessed by Insomnia Severity Index Scale. Sugarsweetened beverages consumption was analyzed by Kruskal-Wallis test. The Mann-Whiter U test and Kruskal-Wallis test were used to compare the detection rate of insomnia in college students with different population characteristics, and the generalized estimating equations model was established to analyze the association between sugar sweetened beverages consumption and insomnia. Results: The reported rate of insomnia among college students from T1 to T4 was 21.2%, 23.6%, 30.5 % and 36.0%, respectively. The median of sugar sweetened beverages consumption per week was 5 (1,9) bottles per person, and there were significant differences in sugar sweetened beverages (carbonated beverages, fruit beverages, tea beverages, milk beverages, energy beverages) consumption among college students with different insomnia status ( χ 2=42.91, 23.67, 29.98, 61.70, 30.82, P <0.01). The analysis of the generalized estimating equation model revealed that the consumption of carbonated beverages ( β= 0.04, 95%CI =0.00-0.08) and the consumption of milk beverages among college students ( β=0.04, 95%CI =0.00-0.09) were correlated with insomnia ( P <0.05). The stratified analysis indicated that consumption of carbonated beverages by female college students was associated with insomnia [ β(95%CI )=0.06(0.01-0.11)]; consumption of milk beverages among college students from middle income family was associated with insomnia [ β (95% CI )=0.05(0.00-0.10)], and consumption of carbonated beverages and fruit beverages from college students with high household economic status were both associated with insomnia [ β (95% CI )=0.35(0.23-0.46), 0.12(0.00-0.24)] ( P <0.05). Conclusion Sugar sweetened beverages, especially carbonated beverages, are associated with insomnia among college students in Yunnan Province.

Objective:To establish an animal model of trans-sutural distraction osteogenesis in SD rats.Methods:A self-designed V-shaped distraction device(distractor)was fabricated with the traction force(N)of 0,1.3,2.2,3.0,4.3 and 5.0 corresponding to the distraction length(mm)of 5,4,3,2,1 and 0 respectively,meeting the trans-sutural distraction osteogenesis requirements in skull of 5-week-old SD rats.The distractor was plased into the sagittal suture of 12 SD rats.Continuous sampling was conducted 1,3,5 and 7 days respectively(n=3)after operation.The tissue changes in the trans-sutural distraction area were observed by HE and Masson's trichrome staining.Inflammation levels were determined using Arg-1 immunofluorescence staining.The early angiogenesis was clarified through co-staining with CD31 and EMCN.Results:A stable trans-sutural distraction osteogenesis model was estab-lished,5 mm distraction osteogenesis width was observed completely within 7 days of distraction.Significant new bone formation was observed at 7 days after operation.Arg-1 expression increased and was concentrated at the bone margins,overlapping with the areas of new bone formation.EMCN expression gradually decreased,and by day 7 CD31 was predominant,indicating the basic maturation of blood vessels.Conclusion:This study successfully constructed a stable and effective trans-sutural distraction osteogenesis animal model,and provides an experimental basis for the investigation of its early continuous histological changes.

Objective:Using different machine learning methods to construct and screen the best prediction model for predicting the risk of death within 30 days after surgery in patients with acute type A aortic dissection.Methods:Five hundred and twenty-one patients with acute type A aortic dissection who underwent surgery between 2015 and 2022 were included, after collecting their perioperative date and screening them, 329 patients were retained. two different groups of predictor variables were generated by using Lasso regression and principal component analysis, after that, logistic regression, support vector machine algorithm, random forest algorithm, gradient boosting algorithm, and super learning algorithm were used to develop prediction models for the risk of death within 30 days after surgery. Finally, we compare the models and select the best one. Results:The AUC values for all models rangrd from 0.791-0.959. The model using Lasso regression to determine the predictor variables and built by the super learning algorithm had the best prediction with an AUC value of 0.959. Conclusion:The super learning algorithm better than other algorithms in predicting death within 30 days after acute type A aortic dissection.

Objective To investigate the efficacy of low-dose inhaled nitric oxide (iNO) in the treatment of severe hypoxemia after Sun’s operation. Methods The clinical data of patients undergoing Sun’s operation for acute Type A aortic dissection in our hospital from January 2020 to June 2022 were retrospectively analyzed. Patients who received conventional treatment before November 2021 were enrolled as a control group. After November 2021, iNO was used in our hospital, and the patients who received iNO as an iNO group. The preoperative clinical baseline data, perioperative clinical data and oxygenation index were compared between the two groups. Results A total of 54 patients were included in the control group, including 45 males and 9 females, with an average age of 53.0±10.9 years. A total of 27 patients were included in the iNO group, including 21 males and 6 females, with an average age of 52.0±10.6 years. The preoperative body mass index of the two groups was greater than 25 kg/m2, white blood cell count, C-reactive protein were significantly higher than normal level, but there was no statistical difference between the groups (P＞0.05). There were no statistical differences in intraoperative data between the two groups (P＞0.05). The iNO group had significantly shorter duration of mechanical ventilation, postoperative ICU stay, and postoperative hospital stay than the control group (P<0.001). After 12 h of iNO treatment, hypoxic condition improved obviously, oxygenation indices in 12 h, 24 h, 36 h,48 h, 60 h and 72 h in the iNO group were significantly higher than those in the control group (P<0.05). Conclusion The treatment of severe hypoxemia after Sun’s surgery with low-dose of iNO is safe and effective, can significantly improve oxygenation function, and has significant advantages in shortening ventilator use time, postoperative ICU stay and postoperative hospital stay, but it is not significant in changing postoperative mortality.