Objective To investigate differences in postoperative analgesia efficacy,inflammatory response,and recovery between intraplanar(in-plane)and extraplanar(out-of-plane)thoracic paravertebral block(TPVB)techniques under ultrasound guidance in patients undergoing thoracoscopic radical resection for lung cancer,thereby providing evidence for selecting the optimal block technique in clinical practice.Methods Eighty patients undergoing thoracoscopic radical resection for lung cancer between March and September 2022 were randomly assigned to an intraplanar group(n=40)or an extraplanar group(n=40).Before induction of anesthesia,both groups received 10 mL of 0.33％ropivacaine injected into the T4 and T6 paravertebral spaces under ultrasound guidance,using their respective in-plane or out-of-plane techniques.The following parameters were compared between the groups:nerve block procedure duration,onset time of block,visual analogue scale(VAS)pain scores within 48 hours postoperatively,incidence of postoperative nausea and vomiting(PONV),and serum inflammatory and stress markers including C-reactive protein(CRP),interleukin-6(IL-6),cortisol(Cor),and norepinephrine(NE).Results No significant differences were observed between the groups in block procedure duration,onset time,or analgesic duration(P＞0.05).Compared with the extraplanar group,the intraplanar group demonstrated a significantly reduced incidence of PONV(15.0％vs.35.0％,P=0.039)and significantly lower serum levels of CRP,IL-6,and Cor at 24 hours postoperatively(P＜0.05).No pleural punctures occurred in the intraplanar group(0％),whereas the extraplanar group had a 15.0％incidence rate.However,the overall complication rate in both groups showed no statistically significant difference(P=0.060).Conclusion Both ultrasound-guided in-plane and out-of-plane TPVB techniques provide effective postoperative analgesia for thoracoscopic radical lung cancer surgery.However,the in-plane technique significantly reduces the incidence of PONV and postoperative inflammatory responses while demonstrating higher operational safety,making it the preferred clinical choice.

Objective:To explore the feasibility and mid-term efficacy of minimally invasive cardiac surgery coronary artery bypass grafting(MICS CABG) in the treatment of multi-vessel coronary artery disease.Methods:A retrospective analysis was conducted on 440 patients with multi-vessel coronary artery disease at the Minimally Invasive Cardiac Surgery Center of Beijing Anzhen Hospital, Capital Medical University, from January 2018 to December 2022. Among these patients, 145 who underwent MICS CABG were designated as the experimental group(MICS group). And 295 patients who underwent conventional sternotomy off-pump coronary artery bypass grafting(OPCABG) were collected during the same period. Propensity score matching was employed at a 1∶1 ratio to match patients in the OPCABG group, serving as the control group.The clinical data during hospitalization and the results of midterm follow-up were analyzed and compared using rank- sum test, Fisher' s exact test, Kaplan- Meier survival curve, and other methods. Results:After propensity matching, the baseline features were well balanced between the two groups( P>0.05), with 111 patients in each group. Patients who received MICS CABG had significantly reduce blood loss[MICS: 600 ml(500 ml, 900 ml) vs. OPCABG: 800 ml(600 ml, 1 000 ml), P<0.001], transfusion rate(MICS: 1.8% vs. OPCABG: 17.1%, P<0.001), and IABP implantation rate(MICS: 3.1% vs. OPCABG: 17.1%, P=0.001). In addition, patients who received MICS CABG had significantly better postoperative LVEF(MICS: 0.59±0.06 vs. OPCABG: 0.56±0.09, P<0.001) than the control group. The average follow-up time was 2.42 years, and there was no significant difference in the incidence of MACCEs in the mid-term( P=0.748). Conclusion:MICS CABG demonstrates rapid recovery and fewer postoperative complications. For patients with multiple coronary artery lesions, MICS CABG has a similar efficacy in the mid-term as conventional coronary artery bypass surgery.

Objective To investigate differences in postoperative analgesia efficacy,inflammatory response,and recovery between intraplanar(in-plane)and extraplanar(out-of-plane)thoracic paravertebral block(TPVB)techniques under ultrasound guidance in patients undergoing thoracoscopic radical resection for lung cancer,thereby providing evidence for selecting the optimal block technique in clinical practice.Methods Eighty patients undergoing thoracoscopic radical resection for lung cancer between March and September 2022 were randomly assigned to an intraplanar group(n=40)or an extraplanar group(n=40).Before induction of anesthesia,both groups received 10 mL of 0.33％ropivacaine injected into the T4 and T6 paravertebral spaces under ultrasound guidance,using their respective in-plane or out-of-plane techniques.The following parameters were compared between the groups:nerve block procedure duration,onset time of block,visual analogue scale(VAS)pain scores within 48 hours postoperatively,incidence of postoperative nausea and vomiting(PONV),and serum inflammatory and stress markers including C-reactive protein(CRP),interleukin-6(IL-6),cortisol(Cor),and norepinephrine(NE).Results No significant differences were observed between the groups in block procedure duration,onset time,or analgesic duration(P＞0.05).Compared with the extraplanar group,the intraplanar group demonstrated a significantly reduced incidence of PONV(15.0％vs.35.0％,P=0.039)and significantly lower serum levels of CRP,IL-6,and Cor at 24 hours postoperatively(P＜0.05).No pleural punctures occurred in the intraplanar group(0％),whereas the extraplanar group had a 15.0％incidence rate.However,the overall complication rate in both groups showed no statistically significant difference(P=0.060).Conclusion Both ultrasound-guided in-plane and out-of-plane TPVB techniques provide effective postoperative analgesia for thoracoscopic radical lung cancer surgery.However,the in-plane technique significantly reduces the incidence of PONV and postoperative inflammatory responses while demonstrating higher operational safety,making it the preferred clinical choice.

Objective:To explore the feasibility and mid-term efficacy of minimally invasive cardiac surgery coronary artery bypass grafting(MICS CABG) in the treatment of multi-vessel coronary artery disease.Methods:A retrospective analysis was conducted on 440 patients with multi-vessel coronary artery disease at the Minimally Invasive Cardiac Surgery Center of Beijing Anzhen Hospital, Capital Medical University, from January 2018 to December 2022. Among these patients, 145 who underwent MICS CABG were designated as the experimental group(MICS group). And 295 patients who underwent conventional sternotomy off-pump coronary artery bypass grafting(OPCABG) were collected during the same period. Propensity score matching was employed at a 1∶1 ratio to match patients in the OPCABG group, serving as the control group.The clinical data during hospitalization and the results of midterm follow-up were analyzed and compared using rank- sum test, Fisher' s exact test, Kaplan- Meier survival curve, and other methods. Results:After propensity matching, the baseline features were well balanced between the two groups( P>0.05), with 111 patients in each group. Patients who received MICS CABG had significantly reduce blood loss[MICS: 600 ml(500 ml, 900 ml) vs. OPCABG: 800 ml(600 ml, 1 000 ml), P<0.001], transfusion rate(MICS: 1.8% vs. OPCABG: 17.1%, P<0.001), and IABP implantation rate(MICS: 3.1% vs. OPCABG: 17.1%, P=0.001). In addition, patients who received MICS CABG had significantly better postoperative LVEF(MICS: 0.59±0.06 vs. OPCABG: 0.56±0.09, P<0.001) than the control group. The average follow-up time was 2.42 years, and there was no significant difference in the incidence of MACCEs in the mid-term( P=0.748). Conclusion:MICS CABG demonstrates rapid recovery and fewer postoperative complications. For patients with multiple coronary artery lesions, MICS CABG has a similar efficacy in the mid-term as conventional coronary artery bypass surgery.

Due to the insufficient long-term protection and significant efficacy reduction to new variants of current COVID-19 vaccines, the epidemic prevention and control are still challenging. Here, we employ a capsid and antigen structure engineering (CASE) strategy to manufacture an adeno-associated viral serotype 6-based vaccine (S663V-RBD), which expresses trimeric receptor binding domain (RBD) of spike protein fused with a biological adjuvant RS09. Impressively, the engineered S663V-RBD could rapidly induce a satisfactory RBD-specific IgG titer within 2 weeks and maintain the titer for more than 4 months. Compared to the licensed BBIBP-CorV (Sinopharm, China), a single-dose S663V-RBD induced more endurable and robust immune responses in mice and elicited superior neutralizing antibodies against three typical SARS-CoV-2 pseudoviruses including wild type, C.37 (Lambda) and B.1.617.2 (Delta). More interestingly, the intramuscular injection of S663V-RBD could overcome pre-existing immunity against the capsid. Given its effectiveness, the CASE-based S663V-RBD may provide a new solution for the current and next pandemic.

【Objective】 Coronary no-reflow during percutaneous conranary intervention (PCI) often results in the failure of ischemic myocardial reperfusion and major adverse cardiovascular events (MACE). The present study sought to evaluate whether the GRACE risk score can predict coronary no-reflow in STEMI patients undergoing PCI. 【Methods】 We consecutively recruited 1 118 patients with STEMI who were admitted to Gansu Provincial People’s Hospital and The First Affiliated Hospital of Xi’an Jiaotong University from January 2009 to December 2011. Main demographic data, cardiovascular risk factors, blood lipid and other biochemical indicators were recorded. Coronary angiography was performed by a radial artery approach using the standard Judkins technique. Coronary no-reflow was evaluated by at least two independent experienced cardiologists. The GRACE risk score was calculated with a computer program. All the cases were followed up by medical records, face-to-face interviews or telephone calls. Finally, we analyzed the predictive value of the GRACE risk score for coronary non-reflow and MACE in STEMI patients undergoing PCI. 【Results】 During a median period of 36 months, 58 of the 1 118 patients (5.2%) were lost to follow-up. Of the remaining 1 060 patients, 118 (11.1%) had no-reflow and 147 (13.9%) had MACE. The GRACE score was higher in patients with no-reflow than those without no-reflow. Multivariate logistic regression established that the GRACE score was an independent predictor for coronary no-reflow (OR=1.034; P=0.002). And multivariate Cox analysis showed the GRACE score was an independent predictor of MACE. The area under the ROC curve for coronary no-reflow and MACE was 0.719 and 0.697, respectively. Kaplan-Meier analysis showed that the probability of rehospitalization for heart failure, reinfarction, all-cause death and cumulative cardiovascular events increased with the increase of the GRACE risk score. 【Conclusion】 The GRACE risk score is a readily available predictive scoring system for coronary no-reflow and MACE in STEMI patients.

Objective:To investigate the role of Caveolin (Cav-3)/extracellular signal-regulated kinase (ERK) signaling pathway in reduction of myocardial ischemia-reperfusion (I/R) injury by morphine preconditioning in rats with chronic heart failure.Methods:Clean-grade healthy adult male Sprague-Dawley rats, weighing 200-250 g, were used in this study.Chronic heart failure was induced by ligating the left anterior descending coronary artery for 6 weeks.Thirty-six Langendorff-perfused hearts with chronic heart failure were divided into 4 groups ( n=9 each) by a random number table method: myocardial I/R group (group IR), morphine preconditioning group (group MP), morphine preconditioning plus methyl-β-cyclodextrin group (group MP+ MβCD), and methyl-β-cyclodextrin group (group MβCD). Global myocardial I/R was induced by 30 min ischemia followed by 120 min reperfusion.In group MP, after 15 min of equilibration, hearts were subjected to 3 cycles of 5 min perfusion with K-H solution containing 1 μmol/L morphine for preconditioning followed by 5 min perfusion with K-H solution, 30 min in total, and after the end of treatment, hearts were subjected to 30 min ischemia followed by 120 min reperfusion.In group MP+ MβCD, hearts were perfused with K-H solution containing 200 μmol/L methyl-β-cyclodextrin at 10 min before preconditioning with morphine, and the other treatments were similar to those previously described in group MP.In group MβCD, hearts were perfused with K-H solution containing 200 μmol/L methyl-β-cyclodextrin at 40 min before ischemia, and the other treatments were similar to those previously described in group IR.At the end of 15 min of equilibration (T 0) and 5 and 10 min of reperfusion (T 1, 2), coronary outflow was collected for determination of actate dehydrogenase (LDH) activity by chemical colorimetry.Myocardial infarct size (IS) and area at risk (AAR) were measured, and IS/AAR was calculated at the end of 120 min reperfusion.Myocardial tissues of left ventricle were taken to detect the expression of Cav-3, ERK1/2 and phosphorylated ERK1/2 (p-ERK1/2) by Western blot, and p-ERK1/2/ERK1/2 ratio was calculated. Results:Compared with group IR, IS, IS/AAR and LDH activity in coronary outflow were significantly decreased, the expression of Cav-3 was up-regulated, and p-ERK1/2/ERK1/2 ratio was increased in group MP ( P<0.05). Compared with group MP, IS, IS/AAR and LDH activity in coronary outflow were significantly increased, the expression of Cav-3 was down-regulated, and p-ERK1/2/ERK1/2 ratio was decreased in group MP+ MβCD ( P<0.05). Conclusions:The mechanism by which morphine preconditioning reduces I/R injury may be related to activation of Cav-3/ERK signaling pathway in rats with chronic heart failure.

Objective:To evaluate the infection rate and influencing factors of hepatitis E virus (HEV) among key occupational population in Tianjin, so as to help occupational population to carry out HEV prevention and control.Methods:A combination of stratified random sampling and convenience sampling was carried out for the study in Tianjin in June 2019. The livestock and poultry-related farming workers, slaughtering workers, selling workers, doctors, farmers, seafood sellers, sewage pipeline workers as the key occupational population groups (1036 person) , and non key occupational population as the control group (200 person) , cross-sectional surveys were conducted in the groups. Enzyme-linked immunosorbent assay (ELISA) was used to detect the serum IgG and IgM antibodies to HEV, and logistic regression model was used to analyze the influencing factors of HEV infection.Results:The positive rate of anti-HEV IgG in key occupational group was 26.45% (274/1036) , which was higher than that in control group of 14.50% (29/200) (χ 2=13.41, P<0.01) . The occupations with the highest positive rate of anti-HEV IgG were livestock (swine) , breeding and slaughtering workers, all of which reached 33.96% (18/53) . The difference in infection rates between different occupations was statistically significant (χ 2=22.57, P<0.01) . Multivariate logistic regression analysis showed that the longer working years, high frequency of eating out (3-5, ≥6 times/week) , drinking raw water, eating under-cooked pork or pig liver, and low frequency of washing hands were risk factors for HEV infection in occupational population ( P<0.05) . But the high education is a protective factor for HEV infection ( P<0.05) . Conclusion:There is a high positive rate of anti-HEV IgG in key occupational population in Tianjin. It is necessary to strengthen the monitoring, publicity and education of the high-risk population, pay attention to personal and dietary hygiene.

Objective: To describe the epidemiological characteristics of a cluster of COVID-19 cases reported in Baodi district of Tianjin as of 18 February, 2020, which might be associated with the exposure in a local department store, and provide suggestions for prevention and control strategy development. Methods: The basic characteristics, time and area distributions, clinical manifestations, epidemiological history and transmission mode of the COVID-19 cases associated with the department store exposure were analyzed. Results: A total of 40 COVID-19 cases were associated with the department store exposure, accounting for 75.47% of the total confirmed cases (53 cases) reported in Baodi district. The cases were mainly at the age of 60 years or older (35.00%) and farmers (40.00%). The main clinical manifestations included fever (95.00%), cough (35.00%), and diarrhea (15.00%). The proportion of confirmed severe cases was 32.50%. The incidence curve showed that the incidence peak occurred on 31 January, 2020. Among the 40 cases, 6(15.00%) were department store employees, 19(47.50%) were customers and 15(37.50%) were close contacts (secondary cases). The first case occurred on 21 January, 2020, this case was a department store employee who had a purchasing history at whole sale markets in other provinces and cities before the onset, and 3 employees were still on duty after symptom onsets. The median of the incubation period of customer cases was 6 days, and the median of the interval between onset and medical treatment of customer cases was 7 days. Conclusion This was a cluster epidemic of COVID-19, which might be associated with the exposure in the department store. By now, the current prevention and control measures have achieved satisfied effects.

Objective:To evaluate the infection rate and influencing factors of hepatitis E virus (HEV) among key occupational population in Tianjin, so as to help occupational population to carry out HEV prevention and control.Methods:A combination of stratified random sampling and convenience sampling was carried out for the study in Tianjin in June 2019. The livestock and poultry-related farming workers, slaughtering workers, selling workers, doctors, farmers, seafood sellers, sewage pipeline workers as the key occupational population groups (1036 person) , and non key occupational population as the control group (200 person) , cross-sectional surveys were conducted in the groups. Enzyme-linked immunosorbent assay (ELISA) was used to detect the serum IgG and IgM antibodies to HEV, and logistic regression model was used to analyze the influencing factors of HEV infection.Results:The positive rate of anti-HEV IgG in key occupational group was 26.45% (274/1036) , which was higher than that in control group of 14.50% (29/200) (χ 2=13.41, P<0.01) . The occupations with the highest positive rate of anti-HEV IgG were livestock (swine) , breeding and slaughtering workers, all of which reached 33.96% (18/53) . The difference in infection rates between different occupations was statistically significant (χ 2=22.57, P<0.01) . Multivariate logistic regression analysis showed that the longer working years, high frequency of eating out (3-5, ≥6 times/week) , drinking raw water, eating under-cooked pork or pig liver, and low frequency of washing hands were risk factors for HEV infection in occupational population ( P<0.05) . But the high education is a protective factor for HEV infection ( P<0.05) . Conclusion:There is a high positive rate of anti-HEV IgG in key occupational population in Tianjin. It is necessary to strengthen the monitoring, publicity and education of the high-risk population, pay attention to personal and dietary hygiene.