Left ventricular assist device (LVAD) has become an important means in the treatment of end-stage heart failure.The incidence of RVF in LVAD recipientsis as high as 10% to 40%, and the mortality rate is as high as 50%.Therefore, it is important to reduce right ventricular dysfunction and improve prognosis if all relevant factors can be monitored and evaluated before operation and timely intervention and perioperative management can be strengthened. This article will review the predictive factors, management strategies and application of devices for RVF after LVAD operation.

Objective: To explore the relationship of sleep quality and emotional regulation difficulties in middle school students, and to analyze its mediating role of daytime dysfunction, social rejection and selfcontrol ability, so as to provide a scientific reference for improving middle school students mental health. Methods: From October to November, 2023, the Pittsburgh Sleep Quality Index, Adolescent Social Rejection Questionnaire, Brief Selfcontrol Scale and Difficulties in Emotion Regulation Scaleshort Form (DERS-16) were used to assess 806 students recruited from four middle schools in Bengbu City by a convenient cluster random sampling method. And model-6 of PROCESS and 5 000 Bootstraps were used to make a chainmediating model analysis. Results: Daytime dysfunction was positively correlated with sleep quality(r=0.57), social rejection(r=0.19), selfcontrol(r=0.29, P＜0.01). Selfcontrol was positively correlated with emotional regulation difficulties(r=0.54, P<0.01).Poor sleep quality showed a significant positive association with on daytime dysfunction, and daytime dysfunction further affected social rejection, selfcontrol ability and emotional regulation difficulties (β=0.86, 0.60, 1.27, 1.56, P<0.05). Meanwhile, daytime dysfunction, social rejection and selfcontrol played a serial mediating role in the relationship between sleep quality and emotional regulation difficulties (Estimate=0.11,95%CI=0.04-0.20,P<0.05). Conclusion The study reveals the complex relationship between sleep quality and emotional regulation difficulties in middle school students and provides a new theoretical basis for adolescent sleep improvement and mental health interventions.

Objective To evaluate the application effect of positive end-expiratory pressure(PEEP)guided by driving pressure on intraoperative oxygenation and postoperative complications in patients undergoing orthotopic liver transplantation(OLT).Methods A total of 118 patients underwent OLT from January 2020 to September 2023,89 males and 29 females,aged 18-70 years,BMI＜28 kg/m2,ASA physical status Ⅲ or Ⅳ.Patients were divided into two groups using the random number table method:drive pressure group(group D)and PEEP group(group P),59 patients in each group.Volume controlled ventilation was used during general anesthesia in two groups,I:E 1:2,VT 6 ml/kg(ideal body weight),RR 10-15 beats/minute.In group D,the PEEP titration test was started after 5 minutes of mechanical ven-tilation,gradually increasing PEEP from 2 to 10 cmH2O,selecting the PEEP that produced the lowest driv-ing pressure,and maintaining this PEEP until the end of the surgery.In group P,the PEEP was maintained at 5 cmH2O during surgery.The amount of intraoperative out put and intake,and the use of vasoactive drugs were recorded.The HR,SBP,DBP,peak airway pressure(Ppeak),airway plateau pressure(Pplat),PEEP,and blood gas analysis results were recorded 5 minutes after intubation(T1),during the anhepatic phase(T2),during the neohepatic phase(T3),and at the end of the operation(T4),and driving pres-sure,dynamic pulmonary compliance(Cdyn),oxygenation index(OI),and dead space fraction(VD/VT)were calculated.The occurrence of postoperative pulmonary complications(PPCs)within 7 days after opera-tion was recorded.Results Compared with group P,the amount of crystalloid and the usage frequencies of norepinephrine,phenylephrine,and epinephrine in group D were significantly increased(P＜0.05).Com-pared with T2,HR was significantly decreased,SBP and DBP were significantly increased at T1,T3,and T4 in the two groups(P＜0.05).Compared with T1,Ppeak,Pplat,driving pressure,and OI were signifi-cantly increased at T2-T4,and Cdyn was significantly decreased at T3 and T4 in the two groups(P＜0.05).Compared with group P,the incidence of PPCs in group D was significantly decreased(P＜0.05).There were no significant differences in other indexes between the two groups.Conclusion The driving pressure guided PEEP ventilation improves intraoperative oxygenation and reduces the incidence of PPCs in patients undergoing OLT,but the use of intraoperative vasoactive drugs increases.

Objective:To compare the clinical efficacy between 3D printing-assisted percutaneous balloon dilatation calcaneal plasty (3D-PCP) and conventional open reduction and internal fixation (ORIF) via the extended lateral L-shaped approach in the treatment of osteoporotic calcaneal fractures of Sanders type Ⅱ or Ⅲ in the elderly patients.Methods:Retrospectively analyzed were the data of 36 elderly patients with osteoporotic calcaneal fracture of Sanders type Ⅱ or Ⅲ who had been surgically treated at Department of Orthopaedics, Yixing People's Hospital from June 2012 to June 2018. According to their treatment methods, the patients were divided into a 3D-PCP group [16 cases, 9 males and 7 females with an age of (73.0 ± 3.4) years] and an ORIF group [20 cases, 8 females and 12 females with an age of (71.4 ± 2.6) years]. The 2 groups were compared in terms of hospital stay, operation time, intraoperative fluoroscopy frequency, suture removal time, weight bearing time, fracture healing time, visual analogue scale (VAS) for the surgical site 2 days and one year after surgery, American Foot and Ankle Surgery Association (AOFAS) ankle-hindfoot score, calcaneal imaging parameters (B?hler angle, Gissane angle, and length, width and height of the calcaneus axis) at 2 days and one year after surgery, and postoperative complications.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P > 0.05). All patients were followed up for 14 to 18 months (mean, 15.6 months). Compared with the ORIF group, the 3D-PCP group had significantly shorter hospital stay, significantly shorter operation time, significantly earlier suture removal, significantly earlier weight-bearing, significantly lower VAS scores at 2 days after surgery, significantly higher AOFAS ankle-hindfoot scores at one month after surgery, but significantly more times of intraoperative fluoroscopy (all P < 0.05). In all patients, the VAS scores at 2 days after surgery were significantly lower than those before surgery, and those at one year after surgery significantly lower than those at 2 days after surgery ( P < 0.05). In all patients, the AOFAS ankle-hindfoot scores at one month after surgery were significantly higher than those before surgery ( P < 0.001). In the ORIF group, the AOFAS ankle-hindfoot scores at one year after surgery were significantly higher than those at one month after surgery ( P < 0.05), but in the 3D-PCP group there was no such a significant difference between one year and one month after surgery ( P > 0.05). There was no significant difference in VAS score, AOFAS score, fracture healing time or postoperative imaging parameters between the 2 groups at one year after surgery ( P > 0.05). There was no significant difference either in the incidence of complications between the 2 groups ( P > 0.05). Conclusion:In the treatment of osteoporotic calcaneal fractures of Sanders type Ⅱ or Ⅲ in the elderly patients, compared with conventional ORIF, 3D-PCP shows advantages of shorter operation time, minimal invasion, quicker incision healing, shorter hospital stay, earlier weight-bearing exercise, and better functional recovery but a disadvantage of increased times of intraoperative fluoroscopy.

【Objective】 To establish an effective method for acquiring bone marrow-derived dendritic cells (DCs) from BALB/C mice in vitro and to establish a reservoir of DC precursor cells. 【Methods】 CD117⁺ hematopoietic stem cells (HSCs) were isolated and purified from bone marrow of BALB/C mice by immunomagnetic beads separation system (MACS), and then amplified in vitro with mouse stem cell factor (SCF) and interleukin-3 (IL-3). HSC was induced to differentiate into DCs by adding granulocyte-macrophage colony-stimulating factor (rmGM-CSF) and IL-4. Different cytokines (tumor necrosis factor-alpha or IL-10) were added to control the maturity of dendritic cells. Then the morphology (electron microscopy), surface molecular markers (FACS method) and cytokine secretion level (ELISA method) were identified. 【Results】 ① The purity of CD117 ⁺ HSC isolated and purified by MACS system was over 95%. ② SCF plus IL-3 could effectively stimulate HSC amplification. ③ The morphology of mature DC (mDC) and immature DC (imDC) was significantly different under light and scanning electron microscopy. ④ In the expressions of surface markers CD40, CD80, CD86, I-A/I-E, there were significant differences between imDC group and mDC group (P<0.01). ⑤ After LPS stimulation, the secretion of IL-12 in imDC group did not change significantly (P=0.064), while the secretion of IL-12 in mDC group increased significantly (P=0.009). LPS and TNF-α had a synergistic effect in stimulating DC maturation. 【Conclusion】 Specific combinations of cytokines can effectively induce the differentiation of bone marrow HSCs into DCs in BALB/C mice, and can control the maturity of DCs. This study makes it possible to use gene modified dendritic cells in GD immunotherapy.

OBJECTIVE:To systematically evaluate therapeutic efficacy of modified Shenqi dihuang decoction in the treatment of chronic glomerular nephritis. METHODS:Retrieved from Wanfang database,CNKI,VIP,CBM,Cochrane Library,Medline, EMBase and PubMed,randomized controlled trials(RCTs)about modified Shenqi dihuang decoction combined with conventional therapy and (or) other Chinese patent medicine (trial group) vs. conventional therapy and (or) other Chinese patent medicine (control group)in the treatment of chronic glomerular nephritis were collected. Meta-analysis was carried out by using Rev Man 5.3 software after literature scanning,data extraction and quality evaluation. Stata 14.0 software was used to conduct Egger test to evaluate publication bias. If publication bias existed,the effect of publication bias on outcome was further evaluated by scissor compensation. TSA v0.9 software was used for trial sequential analysis(TSA)of total efficency. RESULTS:A total of 10 RCTs were included,involving 707 patients. The results of Meta-analysis showed that total response rate of trial group [RR＝1.40,95%CI(1.22, 1.61),P＜0.001] was significantly higher than that of control group; the level of urine protein [SMD＝－1.97,95%CI(－2.92,－1.03),P＜0.001] and Scr [MD＝－28.41,95%CI(－38.95,－17.87),P＜0.001] in trial group were significantly lower than control group,with statistical significance. Publication bias test of total response rate was conducted,and results of it showed that there was publication bias,but bias did not affect the results of this study. TSA analysis showed that the evidence of Meta-analysis was false positive. CONCLUSIONS:Therapeutic efficacy of modified Shenqi dihuang decoction for chronic glomerular nephritis need to be proved by more stringent RCTs.

Objective Discussion the relationship of PALB2 and AR expression in triple negative breast cancer and its clinical pathological features. Methods The SP immunohistochemical staining was adopted to detect the expression of PALB2 and AR in 178 cases of TNBC, PALB2 divided into two groups according to the expression of different, and to analyze the clinical pathological features and prognostic impact of different AR expression status. Results 178 cases of TNBC, that PALB2 missing expression 47 cases (26.4%), AR expression of 60 cases (33.7%), between of them were negatively correlated (-1≤r<1, P<0.05), in PALB2 negative group, AR expression associated with family history, lymph node metastasis, clinical stage and recurrence and metastasis (P<0.05), and 5-year disease-free survival lower than AR negative expression, Log rank = 4.453, P = 0.035. Conclusion PALB2 negative expression while AR positive expression in TNBC have synergistic effect with disease progression, PALB 2 and AR combined detection may provide a new basis for the prognosis of TNBC interpretation, and recommending take further studies to confirm.

Objective To explore the association of NH2-terminal pro-B-type natriuretic peptide ( NT-proBNP) with the risk of type 2 diabetes.Methods One hundred and twenty-six impaired glucose regulation( IGR) participants from Diabetic Identification Center of Tianjin Metabolic Diseases Hospital were included.NT-proBNP was measured in plasma samples collected from participants at baseline condition.Results At baseline, NT-proBNP was inversely associated with body mass index, waist circumference, fasting glucose, insulin and low-density lipoprotein-cholesterol( LDL-C) levels.During a follow-up of 2 years, 51 participants reported a new diagnosis of diabetes from OGTT.Baseline quartiles of NT-proBNP were inversely associated with diabetes risk, even after multivariable adjustment.Theadjustedrelativerisksfordiabeteswere1.0(reference),0.83(95%CI0.74-0.96),0.78(95%CI 0.68-0.90), 0.74 (95%CI 0.64-0.87) for the 1st, 2nd, 3rd, and 4th quartiles of baseline NT-proBNP, respectively ( P<0.01 ) .Conclus ion In IGRpopulation , lowlevels of NT-proBNP were associated with a significantly increased risk of type 2 diabetes.

Background and purpose:Triple-negative breast cancer (TNBC) is currently the focus of breast cancer research. Researches demonstrated that the molecular biological characteristics of different ethnic groups are not the same. This study mainly probed into the expression of endothelial growth factor receptor (EGFR) and vascular endothelial growth factor (VEGF) in Han and Uygur TNBC patients, and the relationship between the expression and prognosis of patients.Methods:From Jan. 2007 to Jan. 2009, 167 patients were admitted. Among those, 121 were Han and 46 were Uygur patients. The expressions of EGFR, and VEGF were detected by PV-9000 immunohistochemical staining, and compared with lymph node metastasis and clinical staging. The results were analyzed by SPSS 18.0 statistical software.Results:Five-year disease-free survival (DFS) of two groups had no indifferent (P>0.05). EGFR and VEGF positive rate of Han patients was lower than that of Uygur patients (P<0.05). Their expressions were correlated with TNM staging and lymph node metastasis (00.05). Uygur TNBC patients might have a different prognostic factor as compared with Han patients. Further studies need to be carried out.

Objective To investigate the clinical significance of BRCA1/ 2 mutation in breast cancer patients with different malignant tumor family history. Methods We studied 98 cases of diagnosed breast cancer patients with malignant tumor family history. BRCA1/2 screening was performed by PCR-DHPLC sequencing method. All mutations were confirmed by using direct DNA sequencing. Results The prevalence of BRCA1/2 germline mutation was 20.41%.The BRCA1/2 mutation was 55.6% in patients with family breast and ovarian cancer, and was 20.0% and 17.9% in patients with family breast and in patients with ovarian cancer, respectively. In correspondence to 2 and 3 and 4 people withof the breast or ovarian cancer in family , the BRCA1/2 mutation was 16.25%、33.3%、66.67% ,respectively. Conclusion The BRCA1/2 mutation rate increased in the patients with breast and ovarian cancer family history, and the detection of BRCA1/2 mutation increased with the number of patients with cancer in a family.