Objective: To retrospectively assess whether a lower hematocrit level (between 18% and 20%) had any impact on the safety of patients undergoing therapeutic plasma exchange (TPE), and to further determine the threshold for red blood cell supplementation prior to TPE. Methods: Clinical data from 181 adult patients who underwent TPE treatment at the Department of Blood Transfusion of our hospital from March 2023 to July 2024 were collected. The patients were divided into a study group of 44 patients (Hct ≥18% and <20%) and a control group of 137 patients (Hct≥20%). In two groups, blood volume-related safety indicators including respiration rate, heart rate, systolic blood pressure, and blood oxygen saturation levels before and after TPE were compared using t-test. Between-group differences in the grading of adverse reactions such as allergies and hypotension were analyzed using chi-square test. Results: A total of 659 TPE treatments were performed on 181 patients, with 169 TPE treatments on 44 patients in the study group (Hct≥18% and <20%) and 490 TPE treatments on 137 patients in the control group (Hct≥20%). There were no statistically significant differences in age, gender, BMI category, and the presence of cardiac insufficiency between the two groups. In the study group, there were no statistically significant differences in safety indicators such as respiration rate, heart rate, systolic blood pressure, and blood oxygen saturation level before and after TPE. In the control group, there were no statistically significant differences in heart rate and systolic blood pressure before and after TPE, but there were statistically significant differences in respiration rate and blood oxygen saturation level (P<0.05). There were no statistically significant differences in the grading of adverse reactions such as allergic reactions and hypotension between the two groups. Conclusion: For adult patients with stable conditions, maintaining a lower hematocrit level (Hct ≥18% and <20%) during TPE is relatively safe. It is feasible to lower the TPE red blood cell supplementation threshold to 18%≤Hct<20%，which may save blood resources while potentially benefit patients by avoiding unnecessary red blood cell transfusion.

Objective:To explore the predictive ability of systemic immune-inflammation index（SII）and prognostic nutrition index（PNI）for early-onset sepsis in preterm infants.Methods:Seventy preterm infants of 28 to 32 weeks，who were born in the Affiliated Hospital of Xuzhou Medical University from January 2019 to December 2022, and transferred to neonatal intensive care unit within 1 h conforming to EOS diagnostic criteria were selected as the EOS group，and 1∶1 matched non-infected preterm infants hospitalized during the same period were selected as control group.Relevant data were collected to compare the differences regarding clinical data，blood routine indicators，C-reactive protein（CRP），serum albumin levels（ALB），SII and PNI between two groups.The ability of SII and PNI to predict EOS was evaluated by Logistic regression analysis and receiver operating characteristic（ROC）curve.Results:Compared with control group,the EOS group had lower 1-minute and 5-minute Apgar scores,higher rates of cesarean section delivery and tracheal intubation,as well as higher rates of suppurative meningitis,bronchopulmonary dysplasia,retinopathy of prematurity and intracranial hemorrhage.The levels of blood routine parameters,ALB,SII and PNI in the EOS group were lower than those in control group,while CRP was increased.The differences were all statistically significant（ P<0.05）.Multivariate Logistic regression analysis showed that tracheal intubation，CRP，SII and PNI were independently influential factors of EOS（ P<0.05）.ROC curve analysis showed that the areas under curve of SII，PNI，CRP and SII combined with PNI were 0.808（95% CI 0.730-0.886），0.792（95% CI 0.718-0.865），0.633（95% CI 0.541-0.725）and 0.866（95% CI 0.803-0.929），the sensitivity were 74.3%，64.3%，42.9%，78.6%，and the specificity were 88.6%，82.9%，81.4%，90.0%,respectively.The cut-off values of SII，PNI and CRP were 221.36，38.65 and 0.80 mg/L,respectively. Conclusion:SII and PNI have a certain predictive value for EOS in preterm infants，and their combined diagnosis efficiency is more stronger.

Radiation therapy is one of the most important treatment methods for malignant tumors. Radiosensitivity is the key factor affecting the therapeutic effect of radiation therapy for tumor patients, which has been a hot topic of research. Alternative splicing is a vital post-transcriptional regulatory step in the process of gene expression. It can produce a variety of different splicing isoforms of pre-mRNA, and then produce various proteins which play a crucial role in maintaining normal life activities of the body. Compared with normal cells, tumor cells have a higher proportion of splicing disorder events, which can lead to the occurrence of pathological processes such as genomic instability and angiogenesis, thus resulting in the progression of diseases. Abnormal splicing events occurring in tumors can be used as new therapeutic targets. In this article, RNA alternative splicing, splicing events affecting radiosensitivity, and the prospects were reviewed.

Objective To probe into the mechanism of Shexiang Baoxin Pill in homo-therapy for heteropathy for type 2 diabetes mellitus （T2DM） and coronary heart disease （CHD） based on network pharmacology. Methods All chemical components and action targets of these seven traditional Chinese medical in Shexiang Baoxin Pill were screened by Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform （TCMSP）, Traditional Chinese Medicines Integrated Database （TCMID）, The Encyclopedia of Traditional Chinese Medicine （ETCM） and BATMAN-TCM platform, and the DisGeNET and GeneCards databases were used to obtain CHD and T2DM-related Disease targets. The “drug-component-target” network map was constructed by Cytoscape 3.8.2 software, the protein-protein interaction （PPI） network map was constructed by STRING database, and the GO biological process analysis and KEGG pathway enrichment analysis were performed on the common targets of Shexiang Baoxin Pill for T2DM and CHD using DAVID online database. Results A total of 101 potential active ingredients for the treatment of T2DM and CHD in Shexiang Baoxin Pill were screened out, corresponding to 229 targets. Network analysis results showed that the common main active ingredients in Shexiang Baoxin Pill for treating T2DM and CHD might be chenodeoxycholic acid, ursodeoxycholic acid, cinnamic aldehyde, bile acids, cinnamic acid, and ginsenosides. The results of pathway enrichment analysis showed that the mechanism of action of Shexiang Baoxin Pill in the treatment of type 2 diabetes and coronary heart disease in treating T2DM and CHD might be related to the inhibition of inflammatory response and oxidative stress. Conclusion Shexiang Baoxin Pill could play a role in treating CHD and T2DM through multiple components, multiple targets and multiple pathways, which provided a certain theoretical basis for the clinical application and further research of Shexiang Baoxin Pill.

【Objective】 To retrospectively analyze the blood transfusion of 322 patients with Stanford type A aortic coarctation in our hospital, and to explore the influencing factors of perioperative blood transfusion in patients and evaluate the effect. 【Methods】 The patients with Stanford A type aortic coarctation who underwent surgical treatment in our hospital from October 2020 to October 2023 were selected to analyze the differences in blood transfusion and the monitoring of blood routine and coagulation function between different surgical modalities, and to evaluate the influencing factors of massive blood transfusion. 【Results】 The intraoperative allogeneic red blood cell transfusion rate was 63.98% and the perioperative allogeneic red blood cell transfusion rate was 85.71% in patients with Stanford type A aortic coarctation. The intraoperative red blood cell, plasma, cryoprecipitates and platelet transfusion volumes for the Bentall procedure were (3.75±3.81) U, (608.13±314.77) mL, (15.25±8.39) U and (1.53±0.78) therapeutic doses, respectively, and had no difference compared with those for Sun′s procedure with the transfusion volume of (3.13±4.04) U, (707.61± 461.21) mL, (15.79±6.59) U and (1.54±0.64) therapeutic doses and those for Bentall&Sun’s procedure with the transfusion volume of (3.04±4.41) U, (813.48±582.02) mL, (18.39±6.43) U and (1.76±0.58) therapeutic doses(P>0.05). Preoperative hemoglobin levels were significantly lower in patients treated with Bentall procedure (127.75±23.17) g/L and in patients treated with Sun′s procedure (126.07±16.14) g/L than in patients treated with Bentall & Sun′s procedure(133.17±18.12) g/L(P<0.05). Postoperative hemoglobin, APTT and platelet counts were not statistically different between groups(P>0.05). Perioperative erythrocyte massive infusion accounted for 53.42%. The length of hospital days(days) in the massive transfusion group (23.83±9.74) was significantly higher than that in the conventional transfusion group (31.71±22.98), and the mortality rate in the massive infusion group 34.88% was significantly higher than that in the conventional transfusion group (5.33%)(P<0.05), and the hemoglobin level (g/L) at discharge in the massive infusion group(95.65±11.58)was lower than that in the conventional transfusion group(101.93±15.77)(P<0.05). 【Conclusion】 Blood transfusion is necessary to ensure the perioperative treatment of patients with acute Stanford type A aortic coarctation. Massive transfusion of red blood cells is accompanied by an increase in mortality rate and prolonged hospital stay. The test of coagulation function is helpful in guiding the use of blood components, and individualized restrictive transfusion strategy can reduce unnecessary blood transfusion and is conductive to patient safety.

Objective:To summarize the clinical outcomes and experience of redo median sternotomy on proximal aortic repair. Investigate the relationship between first operation and reoperation, reoperation indications, cardiopulmonary bypass strategy, intraoperative technical details, early and mid-term postoperative results.Methods:There were 28 patients underwent 29 times of redo median sternotomy on proximal aorta from April 2017 to December 2019. There were 23 males (79.3%) with an average age of (45.1±12.7) years (26-79 years), 15 Marfan syndrome (15/29, 51.7%) and 3 Behcet's disease (3/29, 10.3%). The primary operation included aortic valve or mitral valve replacement, Bentall procedure, ascending aortic replacement, simultaneous abdominal aortic replacement, Sun's procedure and coronary artery bypass grafting. The indications for reoperation were: aortic root aneurysm or coronary artery aneurysm, anastomotic leakage, perivalvular leakage due to inflammatory aortic disease, acute or chronic type A aortic dissection and aortic root abscess, aortic arch aneurysm. The surgical methods were Bentall, Cabrol, wheat, aortic valve sparing root replacement with replantation, anastomotic leakage repair, CABG, total arch replacement + stent elephant trunk implantation (Sun's procedure), ascending aorta to abdominal aorta bypass, abdominal aortic replacement.Results:One patient (3.4%) died in hospital because of severe postoperative pulmonary complications, consolidation of both lungs, ARDS and hypoxia. Postoperative low cardiac output was occurred in 2 cases (6.9%), 1 case was cured by ECMO, and 1 case died half a year after operation during follow up period. Re-exploration for postoperative hemorrhage was occurred in three cases (10.3%). Renal failure requires dialysis was 3 cases (10.3%), and transient paresis was 1 cases (3.4%), respectively. All of them were recovered before discharge. During the follow-up period, one patient died of multiple organ failure due to low cardiac output, and one patient underwent total thoracoabdominal aortic replacement. One patient underwent Cabrol for aneurysm of the coronary artery after Bentall procedure. One year later, type A dissection occurred again and Sun's procedure was performed through a median sternotomy.Conclusion:Reoperation of proximal aorta after cardiac and aortic surgery is safe and effective, with good short-term and medium-term results. Comprehensive preoperative evaluation, successful sternotomy, establishment of cardiopulmonary bypass and effective organ protection are the key to successful operation. Patients with aortic diseases, especially Marfan syndrome, are more likely to undergo reoperation. Close follow-up and timely reoperation are necessary to avoid aortic rupture. Sun's procedure is suitable for redo complex arch operation.

【Objective】 To analyze the blood transfusion strategies in extracorporeal membrane oxygenation (ECMO) recievers in our hospital, so as to explore the clinical application and efficacy of blood transfusion in patients on ECMO. 【Methods】 Data from patients on ECMO treatment in our hospital from October 2017 to October 2021 was collected. The blood transfusion data and coagulation monitoring indexes during different ECMO modes were analyzed, and the efficacy of blood transfusion was evaluated. 【Results】 No difference in the number of blood transfusions was noticed by ECMO treatment modes.The transfusion units of red blood cells, plasma and platelets in VA mode were (28.35±14.60) U, (7 367.78±5 194.33) mL and (7.04±5.10) therapeutic volumes, which were higher than those in VV mode, i. e. (18.67±21.50) U, (4 836.67±6 640.50) mL and (3.60±7.47) therapeutic dose, respectively.In VA-ECMO mode, the Hb level and platelet count before ECMO treatment were (126.44±23.9) g/L and (223.84±67.62) × 10⁹/L, which were significantly higher than those after treatment (91.02±21.48) g/L and (172.86±127.73)×10⁹/L.In VV-ECMO mode, the APTT before ECMO treatment was (35.28±8.73) s, which was shorter than that after treatment (41.96±13.69) s. The levels of fibrinogen, Hb and platelet count were (3.80±1.85) g/L, (123.81±33.77) g/L and (175.72±98.91)×10⁹/L, which were significantly higher than the levels after treatment (2.78±1.08) g/L, (92.31±17.38) g/L and (125.31±98.14)×10⁹/L, respectively. 【Conclusion】 There are differences in the amount of blood transfusion among different modes of ECMO treatment. As blood transfusion is a necessary support to ensure ECMO treatment, the monitoring of coagulation index is conducive to reduce blood transfusion, improve the efficiency of blood transfusion and benefit to patient safety.

Objective:To summarize our clinical experience in the treatment of aortic root aneurysm by aortic valve sparing root replacement.Methods:From May 2017 to October 2019, a total of 20 patients with aortic root aneurysm underwent aortic valve sparing root replacement by reimplantation method. There were 17 males and 3 females, with an average age of(35.6±15.8) years(12-63 years). There were 11 cases of Marfan syndrome, 5 cases of bicuspid aortic valve, and 1 case of redo operation. The preoperative diameter of ascending aorta was(40.6±9.7)mm, the diameter of aortic sinus was(52.2±9.2)mm, and the diameter of aortic valve ring was(27.1±3.6)mm. There were 10 cases of no or mild regurgitation, 5 cases of moderate regurgitation and 5 cases of severe regurgitation. In the whole group of patients, the root replacement of aortic valve was retained by reimplantation, and the artificial graft were selected as: 26, 28 and 30mm straight vessels, 1, 3 and 6 cases, respectively, 26 and 28mm artificial graft with valsalva sinus, 4 and 6 cases, respectively. During the operation, aortic valve cusp repair was performed in 6 cases, such as plication of the free margin( 4 cases), decalcification(1 case) and raphe release(1 case).Results:None of the patients died in hospital or underwent rethoracotomy for hemostasis. During the operation, the duration of CPB time was(171.0±25.6) minutes and the duration of cross-clamp time was(134.0±23.2) minutes. There were 12 cases of aortic valve regurgitation and 8 cases of mild regurgitation. The mean follow-up was(15.1±9.8) months(4-33 months). During the follow-up period, there were 2 cases with moderate aortic regurgitation no need reoperation, while the rest of the patients had no or mild regurgitation. There are no patients undergoing reoperation. During the follow-up, 1 patient suffered coronary artery embolism in left circumflex artery and recovered after medicine treatment.Conclusion:Reimplantation with aortic valve sparing root replacement is safe and effective in the treatment of aortic root aneurysm, and the early and mid-term follow-up results are satisfactory, which can avoid anticoagulation-related complications and is suitable for young patients.

Many human genetic diseases, including Hutchinson-Gilford progeria syndrome (HGPS), are caused by single point mutations. HGPS is a rare disorder that causes premature aging and is usually caused by a de novo point mutation in the LMNA gene. Base editors (BEs) composed of a cytidine deaminase fused to CRISPR/Cas9 nickase are highly efficient at inducing C to T base conversions in a programmable manner and can be used to generate animal disease models with single amino-acid substitutions. Here, we generated the first HGPS monkey model by delivering a BE mRNA and guide RNA (gRNA) targeting the LMNA gene via microinjection into monkey zygotes. Five out of six newborn monkeys carried the mutation specifically at the target site. HGPS monkeys expressed the toxic form of lamin A, progerin, and recapitulated the typical HGPS phenotypes including growth retardation, bone alterations, and vascular abnormalities. Thus, this monkey model genetically and clinically mimics HGPS in humans, demonstrating that the BE system can efficiently and accurately generate patient-specific disease models in non-human primates.
Animals ; Disease Models, Animal ; Female ; Gene Editing ; Humans ; Lamin Type A/metabolism* ; Macaca fascicularis ; Progeria/pathology*

Objective:To investigate the expression and significance of T helper cell 17 (Th17), soluble intercellular adhesion molecule-1 (sICAM-1) and coagulation function in patients with infectious endocarditis(IE).Methods:From December 2016 to December 2018, IE patients in Beijing Anzhen Hospital Affiliated to Capital Medical University who met the inclusion criteria were selected for cardiac surgery to analyze prospectively, 38 IE patients were selected as the observation group, and 30 healthy people were selected as the control group.The concentrations of serum Th17 related factors (IL-1β, IL-6, IL-17 and IL-21), sICAM-1 and coagulation index(P selectin(sP-SLT)) were measured by enzyme-linked immunosorbent assay(ELISA) and the difference between the two groups were statistically analyzed.Results:The concentrations of serum IL-1β, IL-6, IL-17 and IL-21((29.88±6.49), (14.89±3.31), (21.89±3.01), (563.26±67.36) ng/L) in the observation group were significantly higher than those in the control group((16.56±4.11), (7.52±2.34), (12.91±1.01), (423.38±56.49) ng/L)(all P<0.05). The level of serum sICAM-1 and sP-SLT ((1 247.57(581.39, 1 794.66) μg/L, (60.29±6.61) mg/L)in the observation group were significantly higher than those in the control group((837.28(405.68, 954.47) μg/L, (27.37±5.56) mg/L), and the difference was statistically significant( Z=12.37, t=22.30, all P<0.05). The level of serum IL-1β, IL-6, IL-17 and IL-21 in patients with postoperative infective endocarditis((16.19±4.07), (7.73±2.40), (13.83±0.94), (425.33±52.12) ng/L) were significantly lower than those before operation((29.88±6.49), (14.89±2.31), (21.89±3.01), (563.26±67.36) ng/L), and the differences were statistically significant(t values were 11.02, 13.25, 15.76, 9.98, all P<0.05). The levels of sICAM-1 and sP-SLT1 in patients with postoperative infective endocarditis((901.46(472.15, 1276.58) μg/L, (30.70±5.31) mg/L) were significantly lower than those before operation((1 057.26±463.06) μg/L, (60.29±6.61) mg/L)and the differences were statistically significant( Z=11.16, t=21.51, P<0.05). Conclusion:Th17 related factors, sICAM-1 and sP-SLT were highly expressed in IE patients, and the concentrations of these factors decreased after operation, suggesting that the above factors may be used as related factors for the diagnosis and prognosis of IE patients.