Objective To introduce a modified technique of right ventricular outflow tract (RVOT) reconstruction using a handmade bicuspid pulmonary valve crafted from expanded polytetrafluoroethylene (ePTFE) and to summarize the early single-center experience. Methods Patients with complex congenital heart diseases (CHD) who underwent RVOT reconstruction with a handmade ePTFE bicuspid pulmonary valve due to pulmonary regurgitation at Guangdong Provincial People’s Hospital from April 2021 to February 2022 were selected. Postoperative artificial valve function and right heart function indicators were evaluated. Results A total of 17 patients were included, comprising 10 males and 7 females, with a mean age of (18.18±12.14) years and a mean body weight of (40.94±19.45) kg. Sixteen patients underwent reconstruction with a handmade valved conduit, with conduit sizes ranging from 18 to 24 mm. No patients required mechanical circulatory support, and no in-hospital deaths occurred. During a mean follow-up period of 12.89 months, only one patient developed valve dysfunction, and no related complications or adverse events were observed. The degree of pulmonary regurgitation was significantly improved post-RVOT reconstruction and during follow-up compared to preoperative levels (P<0.001). Postoperative right atrial diameter, right ventricular diameter, and tricuspid regurgitation area were all significantly reduced compared to preoperative values (P<0.05). Conclusion The use of a 0.1 mm ePTFE handmade bicuspid pulmonary valve for RVOT reconstruction in complex CHD is a feasible, effective, and safe technique.

Interleukin-17(IL-17)is an important pro-inflammatory cytokine that bridges innate and adaptive immunity,promoting protective immunity against pathogens,but also driving inflamma-tory pathology during infection and autoimmunity.IL-17 has important protective roles in a variety of bacterial zoonoses,but also promotes the development of inflammatory diseases in various organ tissues and is associated with autoimmune diseases induced by bacterial infections.Recent studies have shown that IL-17-secreting CD4+tissue-resident T memory cells play a key role in sustaining adaptive immunity to bacterial infections,and vaccine design strategies targeting IL-17 responses exhibit apparent advantages in improving vaccine efficacy.In this regard,this paper reviews the bio-logical functions of IL-17 and its roles in major bacterial zoonoses and related mechanisms,with the aim of providing a reference for the development of safe and effective IL-17-based immunother-apies.

Innate immunity is the front line of the antiviral immune response and the bridge to a-daptive immunity.Porcine reproductive and respiratory syndrome virus(PRRSV)has evolved mul-tiple strategies to evade the host's innate immunity and thus establish persistent infections,which is one of the biggest obstacles to control PRRSV infection.In antiviral innate immunity,type Ⅰ in-terferons,interferon-stimulated genes(ISGs),and other antiviral proteins are the main perform-ers,cellular autophagy and programmed cell death are important components,noncoding RNAs are key regulators.Studies on evasion mechanisms of innate immune by PRRSV have emerged in re-cent years,greatly expanding our understandings of the PRRSV-host interaction network.In this paper,we outline the latest researches on PRRSV inhibition of type Ⅰ interferon production and its signaling transduction as well as antagonism of ISGs and other antiviral proteins,and focus on summarizing the researches on PRRSV evade the innate immunity through the modulation of cel-lular autophagy,programmed cell death,and non-coding RNAs,with a view to providing ideas for subsequent research and anti-PRRSV vaccine and drug development.

The pathogens were isolated and purified from the stomach,jejunum and rectum tissues of a Yunnan snub-nosed monkey who died of vomiting,oral and nasal chyme,and abdominal dis-tension,and the species and biological characteristics of the pathogens were studied by biochemical identification,PCR identification,drug susceptibility test,pathogenicity test,serotype identifica-tion,and drug resistance gene and virulence gene analysis.The results showed that the pathogens i-solated from stomach,jejunum and rectum were Escherichia coli(E.coli)serotype O127,belong-ing to enteropathogenic E.coli.They were resistant to cefoxitin and sensitive to gentamicin,gati-floxacin and ciprofloxacin.All the three strains carried drug resistance genes blaTEM and blaCTX-M and virulence genes opmA and opmC.This study provides reference and data support for the prevention and control of enteritis caused by E.coli in Yunnan snub-nosed monkey.

This study aimed to investigate the prevalence and clinical characteristics of epilepsy in patients with patent foramen ovale (PFO) and the effect of PFO closure on seizures. Patients diagnosed with PFO were recruited and underwent brain magnetic resonance imaging, electrocardiography, transesophageal echocardiography, and transthoracic echocardiography with right ventriculography. In patients with epilepsy, electroencephalography was performed. A total of 110 patients completed the assessment. A chief complaint of chest tightness or palpitations was proportionately higher in patients aged<18 years, whereas headaches and seizures were higher in patients aged≥18 years ( χ2=4.69 ,P<0.05). Comorbid epilepsy was observed in 20.9% of patients with PFO. The age at admission in the epileptic group (14-66(27±14)years) was significantly lower than that in the non-epileptic group (16-81(38±21)years) and that in patients with headache as the chief complaint (16-68(39±12)years) ( t=3.29, P<0.05). The multivariate analysis found no risk factors related to the prognosis of epilepsy. The incidence of epilepsy was significantly higher in patients with PFO than in the general population.

Objective:To compare the effectiveness and safety of in vitro fenestration and in situ fenestration for reconstruction of the left subclavian artery in patients with aortic arch diseases.Methods:A retrospective analysis was conducted on 80 patients with thoracic aortic dissection, aortic aneurysm, and aortic intramural hematoma involving the left subclavian artery at our center from Jan 2020 to Oct 2023.Results:Thirty-eight patients underwent in vitro fenestration to reconstruct the left subclavian artery, while 42 patients underwent in situ laser fenestration to reconstruct the left subclavian artery. The technical success rates were 97.4% and 97.6% respectively, without statistically significance ( P>0.05). Postoperative CTA examination showed that the primary rupture of the dissection was completely closed, 3 cases had type Ⅱ endoleak in vitro fenestration, and 2 cases had type Ⅱ endoleak in laser in situ fenestration. The blood flow inside the fenestration stent was fluent. During the perioperative period, one patient in the in vitro fenestration group experienced mild cerebral infarction (2.6%), one patient had mild paraplegia, and no related complications occurred in the other patients. Conclusion:For patients with aortic arch diseases, both in situ laser fenestration and in vitro fenestration are safe and effective.

Objective:To analyze the clinical characteristics and medication options of patients with elderly-onset epilepsy and influencing factors for medication efficacy.Methods:A total of 213 patients with elderly-onset epilepsy (age of onset≥65 years) were selected from Epilepsy Outpatient, Department of Neurology, First Medical Center of Chinese PLA General Hospital from February 1999 to March 2023. General data, imaging findings and follow-up results of these patients were collected. Seizure frequencies and types, medication types, and medication efficacy were analyzed retrospectively. According to medication efficacy, these patients were divided into effective anti-seizure medications (ASMs) group and ineffective ASMs group (effective ASMs was defined as having no seizures or seizure reduction>50% at 6 months after medication, and ineffective ASMs as having seizure reduction≤50% or seizure increase. Univariate and multivariate Logistic regression analyses were used to identify the influencing factor for ASMs efficacy.Results:In these 213 patients with elderly-onset epilepsy, 143 (67.1%) were males and 70 (32.9%) were females. Onset age was 70.0 (67.0, 74.5) years, with duration of 12 (4, 32) months. Time from first onset to treatment was 2.0 (1.0, 10.5) months, with that<2 months enjoying the largest proportion ( n=101). MRI/CT in 102 patients indicated potential epileptogenic abnormal structures, such as post-stroke gliosis/encephalomalacia ( n=67) and post-traumatic gliosis/encephalomalacia ( n=13). MRI/CT in 78 patients indicated non-epileptogenic abnormal structures, such as ischemic changes of small and medium vessels ( n=51) and brain atrophy ( n=15). Structural change was the most common cause ( n=160). Sixty-nine patients (32.4%) did not take medicine and 144 (67.6%) took medicine at the visiting; sodium valproate was mostly used ( n=74), followed by levetiracetam ( n=35) and carbamazepine ( n=24). Five patients had sodium valproate combined with levetiracetam, and 4 patients had sodium valproate combined with carbamazepine. Multivariate Logistic regression analysis showed that disease duration and medication combination were independent influencing factors for ASMs efficacy. Conclusion:Structural change is the main cause for elderly-onset epilepsy; medication efficacy is worse in patients with longer disease course and medication combination therapy.

Objective:To analyze the mutation pathogenicity of the novel compound heterozygous mutation in the PKHD1 gene causing autosomal recessive polycystic kidney disease (ARPKD) family, expand the PKHD1 gene mutation database, and explore the genotype-phenotype correlations of PKHD1 gene mutation causing ARPKD. Methods:Clinical data and peripheral blood of a patient with ARPKD caused by the novel compound heterozygous mutation in the PKHD1 gene and their family members were collected. High-throughput sequencing was used to detect pathogenic mutations in the proband, and PCR amplification and Sanger sequencing were used to verify the pathogenic mutations in the family. AlphaFold software was applied to predict changes in protein structure in the present or absent mutations, and the pathogenicity of mutations was analyzed. Results:The patient was a young male who underwent splenectomy due to liver cirrhosis and hypersplenism at age 7. He developed end-stage renal disease at age 22, requiring maintenance peritoneal dialysis, and died of severe pneumonia and septic shock at age 24. Genetic testing revealed three compound heterozygous mutations in the PKHD1 gene inherited from his parents: a missense mutation (c.5935G>A) inherited from the father and a missense mutation (c.1187G>A) and a novel splice mutation (c.6332+1_6332+2insG) from the mother. The single missense mutation allele likely contributed to the prolonged survival. c. 6332+1_ 6332+2insG is a novel splicing mutation that has not been reported in the past, which can lead to early termination of protein translation. This discovery expands the PKHD1 gene mutation database. c. 1187G>A (p.S396N) and c.5935G>A (p.G1979R) occur in the PA14 and G8 domains of the protein, respectively, and are associated with early and severe liver phenotypes in patients. Conclusions:The mutation types and amino acid localization of the PKHD1 gene are associated with the heterogeneity of clinical phenotypes in ARPKD patients. Analyzing structural changes in proteins before and after mutations can help understand the pathogenicity at a molecular level, establishing genotype-phenotype correlations and providing valuable insights for assessing prognosis and identifying high-risk ARPKD patients early.

Objective To explore the key active ingredients and action characteristics of Wenxing Jingjintong Gel Patch in the treatment of rheumatoid arthritis(RA)based on the systematic pharmacology and LC-MS/MS technology.Methods The information of active ingredient from Wenxing Jingjintong Gel Patch was established through LC-MS/MS analysis and literature retrieval.The targets of the active ingredients were predicted using Swiss Target Prediction platform and then mapped with the RA-related targets obtained from GeneCards,DrugBank,and OMIM databases to identify the intersecting targets.The"active ingredients-effective targets"network was constructed through the Cytoscape software.The shared targets were imported into STRING database to construct a protein-protein interaction network.GO function and KEGG pathway enrichment analysis were performed using the Metascape database.Molecular docking studies were conducted using AutoDock software to investigate the interactions between key ingredients and target proteins.Results A total of 142 active ingredients were identified in Wenxing Jingjintong Gel Patch by wsing LC-MS/MS,which were further supplemented to 174 through literature retrieval.There were 175 shared targets between the active ingredients and RA.It was anticipated that Wenxing Jingjintong Gel Patch exerted immune regulation and anti-inflammatory and analgesic effects through the interaction between key active ingredients such as berberine,neobavaisoflavone,and palmatine chloride with key targets,including TNF,IL6,and AKT1 to regulate PI3K/Akt1,JAK/STAT,and MAPK signaling pathways.In 1 152 molecular docking validation,94%of them had binding energies less than-5.0 kcal·mol-1,while 51%of them had binding energies less than-7.0 kcal·mol-1.It was indicated that there was a good binding affinity between the potential active ingredients and core targets.Conclusion This study predicted the active ingredients and action characteristics of Wenxing Jingjintong Gel Patch in the treatment of RA,which provided a theoretical basis for further clinical application and quality control.

Objective:To investigate the predictive value of myocardial perfusion-related parameters measured by echocardiography on the prognosis of patients with coronary artery disease at 90 d after percutaneous coronary intervention (PCI).Methods:Eighty-five patients with coronary artery disease who underwent PCI in Linping Branch of the Second Affiliated Hospital of Zhejiang University from October 2020 to October 2022 were selected retrospectively. Patients were divided into the occurrence myocardial perfusion injury group (40 cases) and the non-occurrence myocardial perfusion injury group (45 cases). The quantitative echocardiographic parameters of left ventricular end-diastolic internal diameter (LVEDD) and left ventricular end-systolic internal diameter (LVESD) were compared between the two groups, and the effects of LVEDD and LVESD on the risk of myocardial perfusion injury after PCI in patients with coronary artery disease were analyzed. Logistic regression was used to analyze the factors influencing the major adverse cardiovascular events (MACE) of patients with coronary artery disease at 90 d after PCI. A line graph model was constructed, the receiver operating characteristic (ROC) curve and decision curve analysis (DCA) were constructed to verify the predictive efficiency of the line graph model.Results:Compared with the day of admission, the levels of LVEDD and LVESD were increased at 2 and 6 h after PCI, and showed an increasing trend at each time point ( P<0.05). The levels of LVEDD and LVESD at 2 and 6 h after PCI in the occurrence myocardial perfusion injury group were higher than those in the non-occurrence myocardial perfusion injury group: (45.56 ± 2.35) mm vs. (43.27 ± 2.12 ) mm, (47.87 ± 3.56) mm vs. (45.73 ± 2.98) mm; (33.49 ± 2.32) mm vs. (31.29 ± 2.29) mm, (35.62 ± 3.03) mm vs. (33.74 ± 2.12) mm, there were statistical differences ( P<0.05). The risk of myocardial perfusion injury was 4.469 and 6.081 times higher in patients with high levels of LVEDD and LVESD than in patients with low levels. The results of Logistic regression analysis showed that coronary multiple lesions, time from onset to balloon dilation, coronary Gensini score and LVEDD, LVESD were independent influencing factors of MACE at 90 d after PCI in patients with coronary artery disease ( P<0.05). Based on the above five independent influencing factors, a column line graph model was established to predict the risk of poor prognosis at 90 d after PCI. According to the column line graph model, the coronary multiple lesions were scored as 5; the corresponding prognostic adverse risk increased with the increase of time from onset to balloon dilation, coronary Gensini score and quantitative echocardiographic parameters LVEDD and LVESD; the internal validation of the column line graph prediction model was performed, and the C-index of the model was 0.978; the calibration curve showed that the model had good differentiation and accuracy in predicting the risk of MACE at 90 d after PCI. The results of ROC curve showed, the area under the curve (AUC) was 0.955 (95% CI 0.952 - 1.000). The DCA showed that when the line graph model was in the high risk threshold range (0 - 0.9), the prediction of the model had clinical practical value and the net benefit of patients was high. Conclusions:The abnormal increase of LVEDD and LVESD determined by echocardiography is associated with myocardial perfusion injury in patients with coronary heart disease after PCI, and a line graph model based on LVEDD and LVESD can predict the occurrence of MACE at 90 d after PCI, so as to guide early risk assessment and prevention.