Objective:To analyze the reoperation rate and causes during the early adoption phase of unilateral biportal endoscopy (UBE).Methods:The clinical data of 180 patients who underwent UBE performed by a single surgeon at Beijing Friendship Hospital, Capital Medical University from October 2021 to June 2023 were retrospectively analyzed. Clinical and imaging data of patients who underwent reoperation were collected to analyze the causes of reoperation, and the clinical efficacy of the reoperations was also followed up. Measurement data were expressed as mean ± standard deviation ( ± s), and t-test was used before and after treatment. Results:A total of 180 patients who underwent UBE were included in this study, of which 6 patients underwent reoperation, and the reoperation rate was 3.33%. Among them, 3 cases occurred in the first 90 surgeries and the other 3 occurred in the subsequent 90 surgeries. The causes of reoperation were as follows: recurrent lumbar disc herniation at the same segment postoperatively in 2 cases, insufficient decompression in 2 cases, disc herniation following isolated decompression in 1 case, and immediate postoperative perianal numbness in 1 case. The time between the initial surgery and reoperation ranged from 0 to 187 days, with an average of 63.3 days. The average follow-up time after reoperation was 18.3 months. The visual analogue scale (VAS) and Oswestry disability index (ODI) scores of the patients at the last follow-up were significantly improved compared with those before operation (VAS score of low back pain: 5.2 ± 1.7 before operation, 1.2 ± 0.8 at the last follow-up, P<0.001; VAS score of leg pain: 7.2 ± 1.5 before operation, 1.2 ± 1.2 at the last follow-up, P<0.001; ODI score: 67.3 ± 5.7 before operation, 20.2 ± 8.2 at the last follow-up, P<0.001). The postoperative modified MacNab scores were generally satisfactory (4 cases were rated as excellent, accounting for 66.7%; 2 cases were rated as good, accounting for 33.3%). Except for one patient who experienced dural injury during open revision surgery, there were no serious complications such as nerve damage. Conclusions:In the early stages of UBE surgery, recurrent lumbar disc herniation and inadequate decompression are the primary reasons for reoperation, typically occurring within the first three months postoperatively. Reoperation does not significantly increase the risk of nerve injury. Enhanced early postoperative follow-up is recommended. For symptomatic patients, a second surgery with thorough decompression can yield satisfactory treatment outcomes.

ObjectiveTo investigate the change in the activity of hepatitis B virus （HBV）-specific CD8⁺ T cells after pegylated interferon-α-2b （PEG-IFN-α-2b） therapy in HBeAg-negative patients with chronic HBV infection. MethodsA total of 53 HBeAg-negative patients with chronic HBV infection who attended The First Affiliated Hospital of Xinxiang Medical University and Tangdu Hospital of Air Force Mdical University from April 2020 to June 2022 were enrolled and treated with PEG-IFN-α-2b （180 μg/week， subcutaneous injection） antiviral therapy. The study endpoint was HBsAg clearance （course of treatment<48 weeks） or 48 weeks （course of treatment≥48 weeks）. Peripheral blood mononuclear cells were isolated at baseline and study endpoint， and peripheral blood T cell counts were measured. Enzyme-linked immunospot assay was used to measure the frequency of HBV-specific CD8⁺ T cells secreting perforin， granzyme B， and interferon-γ. A total of 17 HLA-A^*02-restricted patients were selected， and CD8⁺ T cells were purified to establish direct- and indirect-contact co-culture systems for HBV-specific CD8⁺ T cells and HepG2.2.15 cells. The level of lactate dehydrogenase in supernatant was measured to calculate the mortality rate of HepG2.2.15 cells， and the levels of HBV DNA， cytotoxic molecules， and cytokines in supernatant were also measured. Flow cytometry was used to measure the expression of apoptosis ligands， and the cytotoxicity of HBV-specific CD8⁺ T cells was evaluated. The independent samples t-test or the paired t-test was used for comparison of normally distributed continuous data between two groups， and the Mann-Whitney U test or the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between two groups. ResultsThe HBsAg clearance rate at study endpoint was 30.19% （16/53）. There were no significant differences in peripheral blood T cell counts （CD3⁺， CD4⁺， and CD8⁺ T cells） between baseline and study endpoint （P>0.05）. At study endpoint， there was a significant increase in the frequency of HBV-specific CD8⁺ T cells secreting perforin， granzyme B， and interferon-γ （U=177.50， t=11.90， U=186.50， all P<0.001）， and the patients with HBsAg clearance had a significantly higher frequency of such HBV-specific CD8⁺ T cells than those without HBsAg clearance （U=120.50， t=2.73， U=121.50， all P<0.01）. In the direct- and indirect-contact co-culture systems at study endpoint， HBV-specific CD8⁺ T cells induced a significant reduction in HBV DNA in the supernatant of HepG2.2.15 cells （all P<0.001） and significant increases in the secretion of interferon-γ and tumor necrosis factor-α （all P<0.05）； in the direct-contact co-culture system， HBV-specific CD8⁺ T cells induced significant increases in the mortality rate of HepG2.2.15 cells （13.62%±3.27% vs 11.39%±2.40%， t=2.27， P=0.030） and the secretion of perforin and granzyme B （t=72.50， U=52.50， both P<0.05）. In the direct- and indirect-contact co-culture systems， compared with HBV-specific CD8⁺ T cells from the patients without HBsAg clearance， the HBV-specific CD8⁺ T cells from patients with HBsAg clearance had a significantly greater reduction in HBV DNA （P<0.05） and significant increases in the secretion of interferon-γ and tumor necrosis factor-α （P<0.05）. ConclusionPEG-IFN-‍α‍-2b therapy can help to achieve a relatively high HBsAg clearance rate in HBeAg-negative patients with chronic HBV infection， and the activity of HBV-specific CD8⁺ T cells is significantly enhanced， which is closely associated with HBsAg clearance.

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 analyze the efficacy and safety of denosumab(DEN)in the treatment of type 2 diabetes mellius(T2DM)complicated with osteoporosis(OP).Methods The DEN's efficacy on bone metabolism and glucose metabolism in patients with T2DM and OP was retrospectively analyzed through a before-and-after self-controlled design.Forty-one T2DM patients combined with OP who were treated in The First Hospital of Changsha from January 2022 to December 2022 were selected.All patients were observed with subcutaneous injection of DEN 60 mg every 6 months for 12 months.The changes of HbA1c,FPG,bone metabolism indexes,25-hydroxyvitamin D[25(OH)D]and bone mineral density(BMD)of patients before and after DEN treatment were compared.The adverse reactions of DEN were recorded.Results After 12 months of treatment,25(OH)D,the BMD oflumbar vertebra(L1～4),left femoral neck and left hip were higher than before treatment(P<0.05),while the osteocalcin,β-collagen special series,parathyroid hormone and alkaline phosphatase were lower than before treatment(P<0.05),and the adverse reactions were reduced.Conclusions DEN can significantly improve bone metabolism in patients with T2DM and osteoporosis,increase BMD of lumbar spine and whole hip with fewer adverse reactions.

Objective:To investigate the role of miR-34b-5p in formation of atherosclerosis(AS)-associated foam cells and in-flammation,and its possible mechanism.Methods:Expression levels of miR-34b-5p and insulin-like growth factor binding protein-1(IGFBP1)mRNA in serum of 34 AS patients and 20 healthy controls were detected.RAW264.7 macrophages were treated with oxi-dized low-density lipoprotein(ox-LDL)to construct AS foam cell model,and expression levels of miR-34b-5p and IGFBP1 mRNA in foam cells were detected.Interaction between miR-34b-5p and IGFBP1 was verified by dual luciferase reporter gene assay.miR-34b-5p inhibitor(inhibitor),inhibitor negative control(inhibitor-NC),IGFBP1 siRNA plasmid(si-IGFBP1)and siRNA negative control(si-NC)were separately or co-transfected into RAW264.7 macrophages.Lipid deposition ability of foam cells was observed,and levels of intracellular total cholesterol(TC),IL-1β,IL-6 and TNF-α were detected.Results:Compared with healthy controls,miR-34b-5p was highly expressed in serum of AS patients(P<0.05),while expression of IGFBP1 mRNA was lower(P<0.05).ox-LDL treatment significantly increased expression of miR-34b-5p(P<0.05),while significantly reduced expression of IGFBP1 mRNA in RAW264.7 macrophages(P<0.05).Dual luciferase reporter assay showed that IGFBP1 was the target gene of miR-34b-5p.Compared with inhibi-tor-NC group,expression of IGFBP1 protein in RAW264.7 macrophages in inhibitor group was increased significantly(P<0.05).After ox-LDL induction,miR-34b-5p inhibitor inhibited lipid deposition ability of macrophages,and decreased levels of intracellular TC,IL-1β,IL-6 and TNF-α.Interfering expression of IGFBP1 gene could reverse the intervention effect of miR-34b-5p inhibitor on macro-phages by enhance lipid deposition ability of macrophages,and increase levels of intracellular TC,IL-1β,IL-6 and TNF-α.Conclu-sion:Down-regulation of miR-34b-5p expression can inhibit the formation of AS-associated foam cells and inflammatory response,and the mechanism may be realized by targeting up-regulation of IGFBP1 expression.

Objective To analyze the efficacy and safety of denosumab(DEN)in the treatment of type 2 diabetes mellius(T2DM)complicated with osteoporosis(OP).Methods The DEN's efficacy on bone metabolism and glucose metabolism in patients with T2DM and OP was retrospectively analyzed through a before-and-after self-controlled design.Forty-one T2DM patients combined with OP who were treated in The First Hospital of Changsha from January 2022 to December 2022 were selected.All patients were observed with subcutaneous injection of DEN 60 mg every 6 months for 12 months.The changes of HbA1c,FPG,bone metabolism indexes,25-hydroxyvitamin D[25(OH)D]and bone mineral density(BMD)of patients before and after DEN treatment were compared.The adverse reactions of DEN were recorded.Results After 12 months of treatment,25(OH)D,the BMD oflumbar vertebra(L1～4),left femoral neck and left hip were higher than before treatment(P<0.05),while the osteocalcin,β-collagen special series,parathyroid hormone and alkaline phosphatase were lower than before treatment(P<0.05),and the adverse reactions were reduced.Conclusions DEN can significantly improve bone metabolism in patients with T2DM and osteoporosis,increase BMD of lumbar spine and whole hip with fewer adverse reactions.

Objective:To investigate the role of miR-34b-5p in formation of atherosclerosis(AS)-associated foam cells and in-flammation,and its possible mechanism.Methods:Expression levels of miR-34b-5p and insulin-like growth factor binding protein-1(IGFBP1)mRNA in serum of 34 AS patients and 20 healthy controls were detected.RAW264.7 macrophages were treated with oxi-dized low-density lipoprotein(ox-LDL)to construct AS foam cell model,and expression levels of miR-34b-5p and IGFBP1 mRNA in foam cells were detected.Interaction between miR-34b-5p and IGFBP1 was verified by dual luciferase reporter gene assay.miR-34b-5p inhibitor(inhibitor),inhibitor negative control(inhibitor-NC),IGFBP1 siRNA plasmid(si-IGFBP1)and siRNA negative control(si-NC)were separately or co-transfected into RAW264.7 macrophages.Lipid deposition ability of foam cells was observed,and levels of intracellular total cholesterol(TC),IL-1β,IL-6 and TNF-α were detected.Results:Compared with healthy controls,miR-34b-5p was highly expressed in serum of AS patients(P<0.05),while expression of IGFBP1 mRNA was lower(P<0.05).ox-LDL treatment significantly increased expression of miR-34b-5p(P<0.05),while significantly reduced expression of IGFBP1 mRNA in RAW264.7 macrophages(P<0.05).Dual luciferase reporter assay showed that IGFBP1 was the target gene of miR-34b-5p.Compared with inhibi-tor-NC group,expression of IGFBP1 protein in RAW264.7 macrophages in inhibitor group was increased significantly(P<0.05).After ox-LDL induction,miR-34b-5p inhibitor inhibited lipid deposition ability of macrophages,and decreased levels of intracellular TC,IL-1β,IL-6 and TNF-α.Interfering expression of IGFBP1 gene could reverse the intervention effect of miR-34b-5p inhibitor on macro-phages by enhance lipid deposition ability of macrophages,and increase levels of intracellular TC,IL-1β,IL-6 and TNF-α.Conclu-sion:Down-regulation of miR-34b-5p expression can inhibit the formation of AS-associated foam cells and inflammatory response,and the mechanism may be realized by targeting up-regulation of IGFBP1 expression.

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 the efficacy and safety of ivabradine in the treatment of end-stage renal disease patients with chronic heart failure (CHF) during maintenance hemodialysis (MHD).METHODS End-stage renal disease patients with CHF during MHD who were treated in our hospital from May 2021 to September 2023 and met the inclusion criteria were selected as the study subjects.They were randomly divided into control group and observation group,with 60 cases in each group,using a random number table method.Both groups of patients received MHD three times a week for 4 hours each time and were anticoagulated with low-molecular weight heparin sodium.At the same time,they were treated with CHF conventional therapy;based on the above treatment,observation group was orally administered Ivabradine tablets 5 mg,twice a day (if the resting heart rate was above 60 beats/min after 2 weeks,the drug dose was increased to 7.5 mg,twice a day).Both groups of patients were treated continuously for 6 months.The clinical efficacy of 2 groups was compared as well as vital signs,cardiac function,the levels of heart failure-related biomarkers and inflammatory factors before and after treatment,and the incidences of dialysis-related hypotension and adverse drug reactions.RESULTS The effective rate of the observation group (92.45％) was significantly higher than that of the control group (76.47％),and the incidence of dialysis-related hypotension (20.75％) was significantly lower than that of the control group (41.18％) (P<0.05).The heart rate,the levels of left ventricular end-systolic diameter,left ventricular end-diastolic diameter,serum N-terminal pro-B-type natriuretic peptide,cancer antigen 125,tumor necrosis factor-α,interleukin-6,and hypersensitive C-reactive protein in observation group after treatment were significantly lower than those of control group (P<0.05);the left ventricular ejection fraction and cardiac output were significantly higher than those in the control group (P<0.05).There was no statistically significant difference in the diastolic blood pressure,systolic blood pressure,or the total incidence of adverse drug reactions between the two groups after treatment (P>0.05).CONCLUSIONS Ivabradine can significantly improve cardiac function,inhibit ventricular remodeling,down-regulate serum levels of serum N-terminal pro-B-type natriuretic peptide and cancer antigen 125,decrease body inflammation levels and the incidence of dialysis-related hypotension in end-stage renal disease patients with CHF during MHD,with significant clinical effects and good safety.

Objective Our previous studies established that microRNA (miR)-451 from human umbilical cord mesenchymal stem cell-derived exosomes (hUC-MSC-Exos) alleviates acute lung injury (ALI). This study aims to elucidate the mechanisms by which miR-451 in hUC-MSC-Exos reduces ALI by modulating macrophage autophagy. Methods Exosomes were isolated from hUC-MSCs. Severe burn-induced ALI rat models were treated with hUC-MSC-Exos carrying the miR-451 inhibitor. Hematoxylin-eosin staining evaluated inflammatory injury. Enzyme-linked immunosorbnent assay measured lipopolysaccharide (LPS),tumor necrosis factor-α,and interleukin-1β levels. qRT-PCR detected miR-451 and tuberous sclerosis complex 1 (TSC1) expressions. The regulatory role of miR-451 on TSC1 was determined using a dual-luciferase reporter system. Western blotting determined TSC1 and proteins related to the mammalian target of rapamycin (mTOR) pathway and autophagy. Immunofluorescence analysis was conducted to examine exosomes phagocytosis in alveolar macrophages and autophagy level. Results hUC-MSC-Exos with miR-451 inhibitor reduced burn-induced ALI and promoted macrophage autophagy. MiR-451 could be transferred from hUC-MSCs to alveolar macrophages via exosomes and directly targeted TSC1. Inhibiting miR-451 in hUC-MSC-Exos elevated TSC1 expression and inactivated the mTOR pathway in alveolar macrophages. Silencing TSC1 activated mTOR signaling and inhibited autophagy,while TSC1 knockdown reversed the autophagy from the miR-451 inhibitor-induced. Conclusion miR-451 from hUC-MSC exosomes improves ALI by suppressing alveolar macrophage autophagy through modulation of the TSC1/mTOR pathway,providing a potential therapeutic strategy for ALI.