Objective:To examine the efficacy and experience of staged and segmented two hybrid surgeries for total repair of Debakey type Ⅰ aortic dissection (TIAD).Methods:This study was a retrospective case series. The clinic data of 10 patients with acute TIAD who were admitted to the Department of Cardiac Surgery, Second Hospital of Lanzhou University or the First People′s Hospital of Lanzhou, between January 2016 and August 2022, were retrospectively studied. Ten patients underwent hybrid surgeries in two hospitalizations (stages), including 7 males and 3 females with an age of (60±7) years (range: 49 to 71 years). In stage 1, the first type Ⅱ hybrid arch repair was performed to treat the ascending, total arch, and descending thoracic aorta for acute TIAD without circulatory arrest. In stage 2, the second hybrid surgery including infrarenal abdominal aorta replacement, visceral arteries bypass and endovascular thoracoabdominal aortic repair was performed to treat residual thoracoabdominal aortic dissection after the first hybrid operation (segmented). Basic data, preoperative concomitant diseases, high-risk factors, surgical approaches and postoperative complications of all important organs, as well as CT imaging were analyzed.Results:There was no death in the 20 hybrid surgical procedures. In stage 1 type Ⅱ hybrid surgery, 4 cases underwent reconstruction of the aortic sinutubular junction, while Bentall and David surgery was performed for 3 cases, respectively. A patient received coronary artery bypass grafting. Then all patients were sequentially treated with arch debranching and thoracic aortic endovascular repair. Postoperative complications included renal insufficiency (4/10), hemofiltration (1/10), hypoxemia (4/10), neurologic event (1/10) and type Ⅱ endoleak (1/10). Complete false lumen thrombosis occurred in 9/10 of the patients. All complications recovered successfully at discharge and the average hospital stay was (21±4) days (range: 16 to 28 days) in the first hospitalization. At stage 2, the second hybrid surgery was successfully performed in all patients. No paraplegia, hepatic or renal insufficiency, or endoleak occurred. However, branch graft embolism of the left renal artery was found in one patient 3 days after laparotomy, as well as of superior mesenteric artery in another. Superior mesenteric artery occlusion was successfully treated by endovascular recanalization. Complete false lumen thrombosis occurred in all patients. Although all patients had different degrees of intestinal dysfunction, they were gradually relieved at discharge, and the average hospital stay was (19±2)days (range:16 to 21 days) in the second hospitalization. During follow-up, CT angiography showed aortic remodeling in all patients.Conclusion:Staged and segmented two hybrid surgeries are safe and feasible for total repair of Debakey type Ⅰ aortic dissection and are associated with acceptable early and midterm outcomes.

Objective:To explore the clinical features and genetic etiology of a child with Char syndrome.Methods:A child who was presented at the Department of Child Health, Henan Children′s Hospital in February 2022 was selected as the study subject. Clinical data of the child was collected, and peripheral blood samples of the child and her parents were collected for the extraction of genomic DNA. Whole exome sequencing was carried out, and candidate variants were verified by Sanger sequencing and bioinformatic analysis.Results:The child had mainly manifested facial dysmorphism, patent ductus arteriosus, growth retardation, curving of fifth fingers and middle toes. Whole exome sequencing revealed that she has harbored a heterozygous c. 944A>C (p.Glu315Ala) variant of the TFAP2B gene, which was verified to be de novo by Sanger sequencing. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), the variant was rated to be likely pathogenic (PM1+ PM2_Supporting+ PM6+ PP3). Conclusion:The heterozygous c. 944A>C (p.Glu315Ala) variant of the TFAP2B gene probably underlay the Char syndrome in this child. Above finding has expanded the mutational and phenotypic spectra of the TFAP2B gene, which has facilitated early identification and diagnosis of Char syndrome.

Objective:To investigate the factors affecting the change of serum calcium and phosphorus after total parathyroidectomy for secondary hyperparathyroidism(SHPT).Method:Sixty patients with secondary hyperparathyroidism undergoing total parathyroidectomy were selected.Gender, age, hemodialysis time, bone pain time, intravenous calcium supplementation time, blood parathyroid hormone(PTH), parathyroid mass, blood calcium, phosphorus and alkaline phosphatase at admission were tested to compare the correlation between postoperative calcium and phosphorus changes.Result:Blood calcium was: (2.50±0.02), (2.27±0.03), (1.97±0.03), (1.95±0.03), (1.95±0.03), (2.03±0.02) mmol/L at admission, 6 hours after surgery, 1, 2, 3 days after surgery, and when discharged. Blood phosphorus was: (2.32±0.07), (1.95±0.05), (1.65±0.06), (1.44±0.05), (1.35±0.36), (1.14±0.04) mmol/L and when discharged.There are differences between pairwise comparisons ( F=100.979, P<0.05; F=118.910, P<0.05). The blood PTH was (1 791±760) pg/ml, and the postoperative intravenous calcium supplementation time was (7.13±2.34) days. Blood PTH was positively correlated with bone pain time, blood phosphorus and parathyroid mass at admission ( t=-2.199, P<0.05; t=4.718, P<0.05; t=2.507, P<0.05). The time of intravenous calcium supplementation was positively correlated with ALP at admission ( t=3.098, P<0.05). Preoperative serum PTH > 1 430 pg/ml or ALP > 191 mmol/L were prone to hypocalcemia on the first day after surgery. Conclusions:The longer bone pain time, the higher blood phosphorus and the more obvious parathyroid hyperplasia were, the higher PTH was. The higher the ALP, the longer the time of intravenous calcium supplementation. Preoperative serum PTH and ALP values can be used as predictors of hypocalcemia on the first day after surgery.

Objective:To examine the efficacy and experience of staged and segmented two hybrid surgeries for total repair of Debakey type Ⅰ aortic dissection (TIAD).Methods:This study was a retrospective case series. The clinic data of 10 patients with acute TIAD who were admitted to the Department of Cardiac Surgery, Second Hospital of Lanzhou University or the First People′s Hospital of Lanzhou, between January 2016 and August 2022, were retrospectively studied. Ten patients underwent hybrid surgeries in two hospitalizations (stages), including 7 males and 3 females with an age of (60±7) years (range: 49 to 71 years). In stage 1, the first type Ⅱ hybrid arch repair was performed to treat the ascending, total arch, and descending thoracic aorta for acute TIAD without circulatory arrest. In stage 2, the second hybrid surgery including infrarenal abdominal aorta replacement, visceral arteries bypass and endovascular thoracoabdominal aortic repair was performed to treat residual thoracoabdominal aortic dissection after the first hybrid operation (segmented). Basic data, preoperative concomitant diseases, high-risk factors, surgical approaches and postoperative complications of all important organs, as well as CT imaging were analyzed.Results:There was no death in the 20 hybrid surgical procedures. In stage 1 type Ⅱ hybrid surgery, 4 cases underwent reconstruction of the aortic sinutubular junction, while Bentall and David surgery was performed for 3 cases, respectively. A patient received coronary artery bypass grafting. Then all patients were sequentially treated with arch debranching and thoracic aortic endovascular repair. Postoperative complications included renal insufficiency (4/10), hemofiltration (1/10), hypoxemia (4/10), neurologic event (1/10) and type Ⅱ endoleak (1/10). Complete false lumen thrombosis occurred in 9/10 of the patients. All complications recovered successfully at discharge and the average hospital stay was (21±4) days (range: 16 to 28 days) in the first hospitalization. At stage 2, the second hybrid surgery was successfully performed in all patients. No paraplegia, hepatic or renal insufficiency, or endoleak occurred. However, branch graft embolism of the left renal artery was found in one patient 3 days after laparotomy, as well as of superior mesenteric artery in another. Superior mesenteric artery occlusion was successfully treated by endovascular recanalization. Complete false lumen thrombosis occurred in all patients. Although all patients had different degrees of intestinal dysfunction, they were gradually relieved at discharge, and the average hospital stay was (19±2)days (range:16 to 21 days) in the second hospitalization. During follow-up, CT angiography showed aortic remodeling in all patients.Conclusion:Staged and segmented two hybrid surgeries are safe and feasible for total repair of Debakey type Ⅰ aortic dissection and are associated with acceptable early and midterm outcomes.

Open surgery is currently the gold standard for the treatment of thoracoabdominal aortic aneurysm(TAAA), while endovascular aortic repair(EVAR) has also been widely carried out. Because it involves important branches supplying internal organs, the technical system for treating TAAA is particularly complex. However, with the advent of newer, low-cost, flexible stent systems, total endovascular repair techniques have become more feasible and attractive. For young and low-risk patients, the choice of open or endovascular treatment remains controversial. Despite the advantages of a minimally invasive procedure, EVAR carries a greater risk of spinal cord injury and may require secondary endovascular intervention to repair endoleak when its unique complication occurs, and the long-term durability after EVAR is not clear. This article reviews the open and endovascular treatment of TAAA, introduces the development of open surgery and endovascular repair, the advantages and disadvantages of various types of stents, and discusses how to select a more suitable surgical method for patients, providing clinicians with a treatment reference.

With the continuous in-depth study of minimally invasive cardiac surgery(MICS), minimally invasive cardiac surgery in children has also been developed in this period, but there is still a certain gap compared with adults. Because of the large difference in body size and the low tolerance of surgery in children, minimally invasive cardiac surgery in children still has a short board on complex cardiac diseases. This article reviews several commonly used minimally invasive techniques: (1) small incision cardiac surgery; (2) thoracoscopic and robot-assisted cardiac surgery; (3) minimally invasive cardiopulmonary bypass(MiECC) and cardiac surgery to avoid cardiopulmonary bypass; (4) hybrid surgery and enhanced cardiac rehabilitation surgery(ERACS) in pediatric cardiac surgery and their application and research progress.

Objective:To investigate the factors related to recurrent laryngeal nerve invasion in papillary thyroid carcinoma (PTC) with posterior capsular involvment.Methods:The data of 186 PTC patients admitted and operated from Jun 2017 to Jun 2022 were retrospectively analyzed. The invasion of recurrent laryngeal nerve was evaluated on its relation to gender, age, tumor size, Hashimoto's thyroiditis, lymph node metastasis in central region, BRAFV600E gene mutation especially PTC posterior capsular involvement.Results:The recurrent laryngeal nerve was invaded in 30 out of 186 patients. Univariate analysis showed that recurrent laryngeal nerve invasion was related to tumor size, Hashimoto's thyroiditis and cervical lymph node metastasis( χ2=6.964,4.814,6.078, P<0.05). Multivariate regression analysis showed that tumor size and lymph node metastasis in cervical region were independent risk factors for recurrent laryngeal nerve invasion(β=1.020,1.622, P<0.05). Hashimoto's thyroiditis was a protective factor for recurrent laryngeal nerve invasion (β=-1.881, P<0.05). Conclusions:When papillary thyroid carcinoma invaded the capsule, the risk of recurrent laryngeal nerve invasion was higher with larger tumor size and cervical lymph node metastasis, while Hashimoto's thyroiditis was a protective factor for the risk of recurrent nerve invasion.

Objective:To study the role of ethanol extract of Euonymus alatus stems (EAT) and ethanol extract of Euonymus alatus wings (EAW) in anti-hepatic fibrosis induced by carbon tetrachloride in mice, and to explore its preliminary mechanism. Methods:Sixty C57BL/6 mice were selected and randomly divided into healthy control group, carbon tetrachloride model (CTM) group, EAW low dose (EAW-L) group, EAW high dose (EAW-H) group, EAT low dose (EAT-L) group and EAT high dose (EAT-H) group, with 10 mice in each group. Three days before modeling, the mice of EAT-L, EAT-H, EAW-L and EAW-H group were gavaged with EAT or EAW at 2.0 or 8.0 g/kg, respectively, and the mice of healthy control group and CTM group were gavaged with equal volume of pure water, once a day till the 30th day after modeling (total 33 times). Five percent carbon tetrachloride olive oil solution was intraperitoneally injected at 8 mL/kg to establish liver fibrosis model in CTM, EAT-L, EAT-H, EAW-L and EAW-H groups. The mice in the healthy control group were intraperitoneally injected with equal volume of 0.9% sodium chloride solution, twice per week for 30 days, and a total of 9 times of injection. The liver index, serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil) and interleukin-6 (IL-6) were detected. Hematoxylin-eosin and Masson staining were used to observe the pathological changes of mouse liver tissue and calculate the collagen volume fraction. The liver inflammatory response and fibrosis degree were evaluated by histological activity index (HAI) and Ishak system score. The level of α-smooth muscle actin(α-SMA)in liver tissue was both detected by immunohistochemistry and Western blotting. The expression of matrix metalloproteinase 2 (MMP2) and extracellular signal-regulated kinase (ERK) 1/2 at protein and mRNA level was detected by Western blotting and fluorescent quantitative polymerase chain reaction. Analysis of variance, Tukey test and Dunn test were used for statistical analysis.Results:The hepatic indexes of EAW-L, EAW-H and EAT-H groups were lower than that of CTM group(0.06±0.01, 0.05±0.01 and 0.05±0.01 vs. 0.07±0.01), and the differences were statistically significant ( q=5.12, 7.70, 7.11; all P<0.01). The serum ALT and AST levels of EAW-L, EAW-H, EAT-L and EAT-H groups were lower than those of CTM group((601.76±141.38), (283.35±42.32), (734.74±116.06) and (391.60±34.33) U/L vs.(982.45±96.04) U/L, (509.49±152.29), (345.41±67.39), (282.30±65.72) and(243.23±45.20) U/L vs.(766.01±114.49) U/L), and the differences were statistically significant ( qALT =9.88, 20.81, 7.65, 17.58, qAST =5.11, 12.52, 14.92, 15.56; all P<0.001). The serum TBil levels of EAW-H and EAT-H groups were lower than that of CTM group((6.81±0.49) and (7.08±1.78) μmol/L vs.(12.68±3.28) μmol/L), and the differences were statistically significant( q=6.31, 6.01; both P<0.01). The serum IL-6 levels of EAW-L, EAW-H, EAT-L and EAT-H groups were lower than that of CTM group((29.26±5.42), (24.28±4.75), (9.05±1.74) and (8.01±1.24) ng/L vs.(53.21±10.05) ng/L); the serum IL-6 level of EAT-L group was lower than that of EAW-L group; the serum IL-6 level of EAT-H group was lower than that of EAW-H group, and the differences were statistically significant( q=12.20, 14.73, 22.48, 22.11, 10.28, 7.96; all P <0.001). The collagen volume fractions of EAW-L, EAW-H, EAT-L and EAT-H groups were lower than that of CTM group (6.15±1.09, 2.91±0.76, 7.07±1.37 and 5.31±0.80 vs. 12.36±1.96); the collagen volume fraction of EAW-H group was lower than that of EAW-L, EAT-L and EAT-H groups, and the differences were statistically significant( q=11.68, 17.78, 9.94, 13.25; 6.10, 7.84, 4.53; all P <0.05). The HAI and Ishak system scores of EAW-H and EAT-H groups were lower than those of CTM group (6.0 (5.5, 7.5) and 7.0 (6.0, 7.5) vs. 13.0 (12.0, 13.0), 1.0 (1.0, 2.0) and 2.0 (1.0, 2.0) vs. 4.0 (3.0, 4.0)), and the differences were statistically significant( ZHAI=3.38, 3.23, Zlshak=3.22, 3.03; all P<0.05). The result of immunohistochemical analysis showed that the expression levels of α-SMA in the mice liver tissues of EAW-L, EAW-H, EAT-L, EAT-H and CTM groups were 4.76±0.36, 2.75±0.29, 3.72±0.34, 5.20±0.79 and 5.98±0.52, respectively. The result of Western blotting showed that the expression levels of α-SMA in the mice liver tissues of CTM, EAW-L, EAW-H, EAT-L and EAT-H groups were 0.96±0.11, 0.67±0.07, 0.22±0.01, 0.78±0.08 and 0.68±0.07, respectively. Two detection methods both showed that the expression levels of α-SMA of EAW-L, EAW-H and EAT-H groups were lower than that of CTM group; the expression level of α-SMA of EAW-H group was lower than that of EAW-L, EAT-L and EAT-H group, and the differences were statistically significant( qimmunohistochemical =6.06, 15.95, 11.18, 9.92, 12.10 and 4.79, qWestern blotting=7.29, 18.34, 6.84, 11.05, 13.97 and 11.49, all P<0.05). The expression levels of MMP2 and ERK1/2 at protein and mRNA levels in the mice liver tissues of EAW-L, EAW-H, EAT-L, EAT-H and CTM groups were 0.18±0.04, 0.16±0.04, 0.28±0.02, 0.21±0.02 and 0.84±0.02, 0.80±0.02, 0.57±0.08, 0.83±0.03, 0.69±0.02 and 0.91±0.04, 18.74±1.90, 10.73±1.24, 24.99±1.84, 7.19±0.48 and 24.68±1.18, 29.44±4.47, 11.96±0.53, 24.75±4.04, 5.30±0.36 and 35.76±0.85, respectively. The expression levels of MMP2 at protein level in EAW-L, EAW-H, EAT-L and EAT-H groups were lower than that in CTM group; the expression levels of ERK1/2 at protein level in EAW-H and EAT-H groups were lower than that in CTM group; the expression level of ERK1/2 at protein level in EAW-H group was lower than that in EAT-H group; the expression levels of MMP2 and ERK1/2 at mRNA level in EAW-H and EAT-H group were lower than those in CTM group; the expression levels of MMP2 and ERK1/2 at mRNA level in EAW-H group were lower than those in EAW-L group; the expression levels of MMP2 and ERK1/2 at mRNA level in EAT-H group were lower than those in EAT-L and EAW-H groups, and the differences were statistically significant( q=22.15, 22.96, 18.87, 21.31; 13.42, 8.53; 4.90; 18.57, 23.29, 16.49, 21.11; 10.66, 12.12; 23.70, 15.38, 13.48, 16.73; all P<0.05). Conclusions:Both EAT and EAW can alleviate carbon tetrachloride-induced liver injury and liver fibrosis in mice, which may be related with inhibiting the expression of ERK1/2 and IL-6 and then affecting the Ras/ERK-MMP2 signaling pathway.

Immunogenic cell death (ICD) plays a major role in cancer immunotherapy by stimulating specific T cell responses and restoring the antitumor immune system. However, effective type II ICD inducers without biotoxicity are still very limited. Herein, a tentative drug- or photosensitizer-free strategy was developed by employing enzymatic self-assembly of the peptide F-pY-T to induce mitochondrial oxidative stress in cancer cells. Upon dephosphorylation catalyzed by alkaline phosphatase overexpressed on cancer cells, the peptide F-pY-T self-assembled to form nanoparticles, which were subsequently internalized. These affected the morphology of mitochondria and induced serious reactive oxygen species production, causing the ICD characterized by the release of danger-associated molecular patterns (DAMPs). DAMPs enhanced specific immune responses by promoting the maturation of DCs and the intratumoral infiltration of tumor-specific T cells to eradicate tumor cells. The dramatic immunotherapeutic capacity could be enhanced further by combination therapy of F-pY-T and anti-PD-L1 agents without visible biotoxicity in the main organs. Thus, our results revealed an alternative strategy to induce efficient ICD by physically promoting mitochondrial oxidative stress.

As the breakthrough in gene editing, represented by CRISPR/Cas9, gene manipulations now are more maneuverable, economically feasible and time saving. It is possible for China to catch an overtaking in researching and industrializing of downside sections (especially the application of plant gene editing), also the incubation of professional companies in gene editing fields. For this consideration, it is necessary and urgent to find the key demands and potential application for gene editing in China. Questionnaire and statistic analysis were carried out to find the key demands and the most potential application fields of the development for gene editing. Firstly, an ordered multi-classification Logistic regression model was established following with dependent variable analysis. Eight out of 24 questionnaires questions in 4 categories were regarded as independent variables with significance test. Then, regression model based on ordered multi-classification logistic method was established to analyze the specific impact of different options on the development of gene editing. The results showed that most researchers in the field of gene editing take the view that development of potential competitive advantages lies in the field of plant science. The results also showed that major gene editing experts believe more attention should be paid on how to carry out technology industrialization while focusing on basic technology development, as well as the development of potential competitive advantages of gene editing technology in plant field. To promote the development of gene editing in China, not only the participation of scientific research institution was needed, but also the synergy of various forces both universities and governments. It is urgent both properly guiding public opinion on gene editing and establishing a national safety standard system. At the same time, the key point of technology risk avoidance should be put on biological weapons and bioterrorism, gene editing related infectious disease, and the potential risk of species genetic change on the ecological environment, etc.
CRISPR-Cas Systems/genetics* ; China ; Clustered Regularly Interspaced Short Palindromic Repeats ; Gene Editing ; Plants/genetics*