ObjectiveTo investigate the anatomical features of three-dimensional （3D） reconstruction of the hepatic pedicle based on the Laennec’s capsule， as well as its application value in the development of extra-sheath dissection/occlusion clamp and precise hepatectomy. MethodsA retrospective analysis was performed for the abdominal contrast-enhanced CT data of 100 patients without anatomical abnormalities of the hepatic pedicle in The General Hospital of Western Theater Command from January 2021 to June 2024. The Hisense CAS system combined with the 3D U-net deep learning algorithm was used for 3D reconstruction of the hepatic pedicle at the level of Laennec’s capsule， and the hepatic pedicle was measured in terms of the length， outer diameter， and angle of the main trunk and branches. An extra-sheath hepatic pedicle dissection/occlusion clamp was developed based on the above measurements， and a total of 30 patients scheduled for right hemihepatectomy were enrolled and randomly divided into device group and control group， with 15 patients in each group. The two groups were compared in terms of hepatic pedicle handling time， time of operation， intraoperative blood loss， and the incidence rate of bile duct injury. The independent-samples t test was used for comparison of continuous data between two groups， and the Fisher’s exact test was used for comparison of categorical data between two groups. ResultsThe results of 3D reconstruction revealed four variants in the main trunk branches of the hepatic pedicle， with type Ⅰ （left-right branching） accounting for 88% （88/100）， type Ⅱ （trifurcation type） accounting for 5% （5/100）， type Ⅲ （right anterior branching） accounting for 5% （5/100）， and type Ⅳ （special type） accounting for 2% （2/100）. The outer diameter of the main hepatic pedicle was 24.10±6.16 mm， the length of the left main branch was 20.59±6.38 mm， and the length of the right main branch was 21.99±7.98 mm. Compared with the control group， the device group had significantly shorter hepatic pedicle handling time （14.10±1.30 minutes vs 17.50±2.00 minutes， t=-5.620， P=0.001） and time of operation （217.00±28.28 minutes vs 241.87±19.49 minutes， t=-2.804， P=0.009）. The device group had a significantly lower incidence rate of bile duct injury than the control group （0 vs 20%， P=0.031）. Conclusion3D reconstruction based on the Laennec’s capsule can accurately display the anatomical variations of the hepatic pedicle. The extra-sheath hepatic pedicle dissection/occlusion clamp developed based on such data can optimize the process of hepatic pedicle management and improve surgical safety， and therefore， it holds promise for clinical application.

OBJECTIVE To analyze the pathogenic characteristics and clinical features of patients with invasive pul-monary aspergillosis(IPA)and summarize the risk factors for poor prognosis.METHODS The clinical data of 89 patients diagnosed with IPA based on microbial identification of Aspergillus from sputum or bronchoalveolar lav-age fluid cultures and diagnostic criteria,who were admitted to Zhongda Hospital Southeast University from Aug.2022 to Jul.2024 and were queried by electronic case system,were analyzed retrospectively.The distribu-tion of Aspergillus pathogens and clinical features of patients with IPA were analyzed,and the risk factors for poor prognosis were summarized.RESULTS A total of 107 Aspergillus strains were isolated from 89 cases,including 55 strains of Aspergillus fumigatus(51.40％),30 strains of Aspergillus flavus(28.04％)and 10 strains of As-pergillus niger(9.34％).There were 63 m ale patients(70.79％),and 34 cases had poor prognosis.Baseline pe-ripheral blood lymphocyte count(＜0.645×109)(OR=6.653,95％CI:2.013-21.990,P=0.002)and ICU admission(OR=8.303,95％CI:1.283-53.741,P=0.026)were identified as risk factors for poor prognosis in patients with IPA.Receiver operating characteristic curve analysis showed that the cut-off point for baseline pe-ripheral blood lymphocyte count in predicting prognosis in patients with IPA was 0.645 ×109/L,with a sensitivity of 85.22％and a specificity of 69.67％.CONCLUSIONS Baseline peripheral blood lymphocyte count and ICU ad-mission are risk factors for poor prognosis in patients with IPA.The alert value for baseline peripheral blood lym-phocyte count is 0.645 × 109/L,which has good predictive value for the occurrence of poor prognosis.

OBJECTIVE To analyze the pathogenic characteristics and clinical features of patients with invasive pul-monary aspergillosis(IPA)and summarize the risk factors for poor prognosis.METHODS The clinical data of 89 patients diagnosed with IPA based on microbial identification of Aspergillus from sputum or bronchoalveolar lav-age fluid cultures and diagnostic criteria,who were admitted to Zhongda Hospital Southeast University from Aug.2022 to Jul.2024 and were queried by electronic case system,were analyzed retrospectively.The distribu-tion of Aspergillus pathogens and clinical features of patients with IPA were analyzed,and the risk factors for poor prognosis were summarized.RESULTS A total of 107 Aspergillus strains were isolated from 89 cases,including 55 strains of Aspergillus fumigatus(51.40％),30 strains of Aspergillus flavus(28.04％)and 10 strains of As-pergillus niger(9.34％).There were 63 m ale patients(70.79％),and 34 cases had poor prognosis.Baseline pe-ripheral blood lymphocyte count(＜0.645×109)(OR=6.653,95％CI:2.013-21.990,P=0.002)and ICU admission(OR=8.303,95％CI:1.283-53.741,P=0.026)were identified as risk factors for poor prognosis in patients with IPA.Receiver operating characteristic curve analysis showed that the cut-off point for baseline pe-ripheral blood lymphocyte count in predicting prognosis in patients with IPA was 0.645 ×109/L,with a sensitivity of 85.22％and a specificity of 69.67％.CONCLUSIONS Baseline peripheral blood lymphocyte count and ICU ad-mission are risk factors for poor prognosis in patients with IPA.The alert value for baseline peripheral blood lym-phocyte count is 0.645 × 109/L,which has good predictive value for the occurrence of poor prognosis.

Objective To investigate the design of cuffed pediatric tracheal tubes and compare the effects of different tracheal intubation depth placement strategies on the position of the tracheal tube tip and cuff of 5 tracheal tube brands.Methods A total of 180 children who were admitted to Tianjin Children's Hospital from October 2020 to December 2021,with endotracheal intubation under general anesthesia,aged 1-6 years,were enrolled.The length of the subglottic airway was measured by electronic bronchoscopy.Dimensional data from 5 cuffed pediatric tracheal tube brands were recorded,including the length of the tracheal tube cuff,the distance from the tip of the tracheal tube to the upper edge of the cuff,and the tip of the tracheal tube to the lower edge of the tube glottis marker line the distance.Calculation of the required cuffed endotracheal tube internal diameter(ID)for 180 pediatric patients was performed based on the Motoyama formula,the positions of tracheal tube tip and upper cuff border were calculated for each of the 180 tracheas using depth mark to based tracheal tube placement,placement of the tracheal tube tip at 2 cm above the carina,and mid-tracheal tube placement.Results There were differences in the dimensional data of the 5 cuffed pediatric tracheal tube brands.Depth mark-based tracheal tube placement resulted in the incidence rate of tube tip to carina placement less than 1 cm was 3.9%-67.8%,and the highest incidence of bronchial intubation is Ruijing,up to 17.8%.The tracheal tube tip was placed 2 cm above the carina,and no improper placement of the tracheal tube cuff and tube tip was found in all brands.Mid-tracheal tube placement led to 100%subglottic and supraglottic tracheal tube cuff positions,except Weili.Conclusions There are differences in design between different brands of cuffed pediatric tracheal tube,and some of the design deficiencies may lead to the risk of airway complications.The method used to guide the insertion depth and the brand of cuffed tracheal tubes can affect the tracheal tube position.Placement of the tracheal tube tip at 2 cm above the carina allowed safe tracheal tube placement in children aged 1-6 years.

Background::Ebstein’s anomaly (EA) is a rare and complex congenital heart anomaly, and the effect of surgical treatment is not ideal. This study aims to introduce our experience in management strategies, surgical techniques, and operative indications for patients with Ebstein’s anomaly.Methods::A retrospective study of 258 operations was performed in 253 patients by the same cardiac surgeon in The First Hospital of Tsinghua University between March 2004 and January 2020. 32 patients had previously received cardiac surgery in other hospitals. The clinical data including diagnosis, operative indications, techniques, pathological changes, and survival rates were collected and analyzed.Results::Anatomical correction was performed in 203 (78.7%) operations, 1? ventricle repair in 38 (14.7%) operations, tricuspid valve repair only in four operations (1.6%), tricuspid valve replacement in ten (3.9%), total cavopulmonary connection (TCPC) in two (0.8%), and Glenn operation in one operation (0.4%). Reoperation was performed in five patients (2.0%) during hospitalization. Among them, tricuspid valve replacement was performed in one patient, 1? ventricle repair in two patients, and tricuspid valve annulus reinforcement in two patients. Five patients died with an early mortality rate of 2.0%. Complete atrioventricular conduction block was complicated in one patient (0.4%). A total of 244 patients was followed up (four in the 253 patients lost) with a duration of 3.0-168.0 (87.6 ± 38.4) months. Cardiac function of 244 patients improved significantly with mean New York Heart Association (NYHA) functional class recovery from 3.5 to 1.1. The mean grade of tricuspid valve regurgitation improved from 3.6 to 1.5. Three late deaths (1.2%) occurred. The survival rates at five and ten years after surgery were 98.6% and 98.2%, respectively. Reoperation was performed in five patients (2.0%) during the follow-up period.Conclusion::Based on our management strategies and operative principles and techniques, anatomical correction of EA is capable of achieving excellent long-term results, and low rates of TCPC, 1? ventricle repair and valvular replacement.

Objective:To understand the status of human immunodeficiency virus (HIV)infection among blood donors in Beijing from 1994 to 2021, analyze the prevalence characteristics and influencing factors of HIV infection among blood donors, and provide reference for blood donor management and blood safety assurance.Methods:Using descriptive epidemiological method to analyze the situation of HIV enzyme-linked immunosorbent assay (ELISA) combined with nucleic acid detection (NAT), third-party confirmatory laboratory test western blot (WB) result and basic demographic information of infected patients among blood donors.Results:From 1994 to 2021, a total of 6 450 244 person-times participated in blood donation, of which 7 622 were reactive in the primary screening, and 1 553 were positive after the HIV confirmation test, average detection rate is (2.14 per 10 000), the vary of detection rates were statistically significant from year to year( χ2=899.690, P<0.01), with the highest detection rate in 2015 (5.93 per 10 000) and the lowest in 1994 (0). From 2011 to 2021, 3 802 primary screening reactive specimens detected by ELISA combined with NAT were confirmed by WB test, of which 1 191 were positive in the confirmatory test, all of which were ELISA seropositive, of which 682 were NAT (+ ). The gender distribution of the infected population is mainly male (95.30%); the age distribution is mainly 18-30 years old (62.40%); in terms of occupation, the detection rate of infected people is higher among employees, workers and others (including unknown), accounting for 83.26% of the total number of infected persons. The ABO blood group system was dominated by A, B and O (89.7%) and the Rh blood group system was dominated by Rh-positive (99.25%); the detection rate of infection was higher among first-time donors than repeat donors ( χ2=39.587, P<0.01). Conclusions:From 1994 to 2021, the annual number of HIV-infected blood donors in Beijing was greatly affected by the external environment. Although the current screening strategy can reasonably shield HIV-infected people, the detection rate of HIV-infected people in this area is relatively high. In view of the different characteristics of HIV-infected people, follow-up treatment plans should be made to ensure blood safety.

Objective:To evaluate the role of ecto-5′-nucleotidase (CD73) in endogenous protective mechanism of hepatic ischemia-reperfusion (I/R) injury in mice and the relationship with transforming growth factor beta1 (TGF-β 1)/Smad3 signaling pathway. Methods:Twenty-four SPF healthy male C57BL/6 mice, aged 8-10 weeks, weighing 20-23 g, were divided into 3 groups ( n=8 each) by the random number table method: sham operation group (S group), hepatic I/R group (IR group) and hepatic I/R plus CD73 specific inhibitor group (APCP group). The hepatic hilum was only exposed but not occluded in group S. The hepatic portal was occluded for 30 min followed by reperfusion to develop the model of hepatic I/R in anesthetized animals in group IR.CD73-specific inhibitor APCP 40 mg/kg was intraperitoneally injected, and 10 min later hepatic I/R was performed.Orbital venous blood samples were collected at 6 h of reperfusion for determination of serum alanine transaminase (ALT) and aspartate transaminase (AST) concentrations.Then the mice were sacrificed, and liver tissues were obtained for determination of the expression of CD73, TGF-β 1 and phosphorylated Smad3 (p-Smad3) (by Western blot), contents of interleukin-1β (IL-1β) and tumor necrosis factor-alpha (TNF-α) (by enzyme-linked immunosorbent assay), and content of malondialdehyde (MDA) and activity of superoxide dismutase (SOD) (with a visible spectrophotometer) and for microscopic examination of the pathological changes of liver tissues (with a light microscope). Results:Compared with group S, the concentrations of AST and ALT in serum and contents of IL-1β, TNF-α and MDA in liver tissues were significantly increased, the activity of SOD was decreased, and the expression of CD73, TGF-β 1 and p-Smad3 was up-regulated in IR and APCP groups ( P<0.05). Compared with group IR, the concentrations of AST and ALT in serum and contents of IL-1β, TNF-α and MDA in liver tissues were significantly increased, the activity of SOD was decreased, and the expression of CD73, TGF-β 1 and p-Smad3 in liver tissues was down-regulated in group APCP ( P<0.05). The pathological changes of liver tissues were accentuated in group APCP as compared with group IR. Conclusions:CD73 is involved in the process of endogenous protective mechanism of hepatic I/R injury in mice, which may be related to the regulation of TGF-β 1/Smad3 signaling pathway.

Objective:To evaluate the role of microRNA-10a (miRNA-10a) in renal ischemia-reperfusion (I/R) injury in mice and the relationship with transforming growth factor beta1 (TGF-β 1)/Smad2 signaling pathway. Methods:Twenty-four SPF healthy male adult C57BL/6 mice, aged 8-10 weeks, weighing 20-25 g, were divided into 4 groups ( n=6 each) by the random number table method: sham operation group (S group), renal I/R group (IR group), renal I/R plus miRNA-10a antagonist group (I group), and renal I/R+ miRNA-10a agonist group (M group). The mouse model of renal I/R was developed by clamping the left renal pedicle for 45 min followed by reperfusion in anesthetized animals.miRNA-10a antagonist and agonist 20 nmol were injected via the tail vein once every 24 h for 3 consecutive days starting from 72 h before surgery in group M and group I, respectively, while the equal volume of normal saline was given instead in S and IR groups.Blood samples were collected from the orbital vein at 24 h of reperfusion to determine the concentrations of the serum creatinine (Scr) and blood urea nitrogen (BUN). Then the mice were sacrificed, and the kidney tissues were taken for determination of the malondialdehyde (MDA) content and superoxide dismutase (SOD) activity, contents of interleukin-1 beta (IL-β) and tumor necrosis factor-alpha (TNF-α) (by enzyme-linked immunosorbent assay), and expression of TGF-β 1 and phosphorylated Smad2 (p-Smad2) (by Western blot) and for microscopic examination of the pathological changes.The damage to the renal tubules was scored. Results:Compared with group S, the concentrations of Scr and BUN, contents of MDA, IL-1β and TNF-α in renal tissues and renal tubular damage score were significantly increased in IR, I and M groups, and the activity of SOD was significantly decreased, and the expression of TGF-β 1 and p-Smad2 was up-regulated in IR and M groups ( P<0.05). Compared with group IR, the concentrations of Scr and BUN, contents of MDA, IL-1β and TNF-α in renal tissues and renal tubular damage score were significantly decreased, the activity of SOD was increased, and the expression of TGF-β 1 and p-Smad2 was down-regulated in group I, and the concentrations of Scr and BUN, contents of MDA, IL-1β and TNF-α in renal tissues and renal tubular damage score were significantly increased, the activity of SOD was decreased, and the expression of TGF-β 1 and p-Smad2 was up-regulated in group M ( P<0.05). Compared with group I, the concentrations of Scr and BUN, contents of MDA, IL-1β and TNF-α in renal tissues and renal tubular damage score were significantly increased, the activity of SOD was decreased, and the expression of TGF-β 1 and p-Smad2 was up-regulated in group M ( P<0.05). Conclusions:miRNA-10a is involved in the process of renal I/R injury and is related to activation of TGF-β 1/Smad2 signaling pathway in mice.

Objective:To summarise the advantages and disadvantages of applying the method of retrograde replantation with an operative position of foot stepping and knee bending for replantation of rotational avulsed and fractured great toes.Methods:From January 2016 to June 2021, 11 rotational avulsed and fractured great toes were replanted with the method of retrograde replantation in an operative position of foot stepping and knee bending. Of the 11 patients, 10 were males and 1 was female, aged 18 to 50 years old with an average of 32 years old. Causes of injury: 5 of driving belt, 4 of machinery crush and 2 of car accident. Injury sites: 4 on left great toes and 7 on right great toes. All of the injuries were with fracture and exposure of proximal tendons of flexor and extensor. Seven patients had the follow-up reviews by outpatient clinic visiting, 2 over mobile phone and 2 via WeChat.Results:After surgery, 9 great toes completely survived and 2 great toes had necrosis. The survival rate of toe replantation was 81.8%(9/11). The operation time was 2 to 3 hours, with an average of 2.5 hours. Postoperative X-ray film showed that 8 to 12 weeks after the operation, the fracture and joint fusion were healed at first stage in the survived toes. All patients were entered in follow-up for 3 to 18 months with 10.5 months in average. The survived great toes were plump and the toenail grown well. At the final follow-up, the static TPD at the toes was 8-12 mm, with an average of 10 mm. There was no effect shown on either walking or running.Conclusion:The retrograde replantation method with an operative position of foot stepping and knee bending for great toe replantation has the characteristics of a good field of view and convenient in operation under microscope, a short operation time, and a high survival rate of replantation.

Objective:To explore the role of N 6-methyladenosine (m6A) and its regulator METTL3 in the non-coding RNA of endometrial cancer.Methods:The expression levels of m6A and METTL3 were quantified in 20 paired carcinoma and adjacent clinical tissue samples from patients at from Jul. 2016 to Dec. 2020. HEC-1-A cell lines were constructed with METTL3 overexpression and knockdown. Western blot was used to detect the phosphorylation levels of key molecules in METTL3 and Akt/mTOR. The quantitative detection of mRNA levels were used qRT-PCR. The binding level of m6A to its receptor DGCR8 was determined by RNA immunoprecipitation.Results:The results of the m6A RNA methylation quantification kit showed that m6A (1.0±0.15) vs (1.7±0.34) ( P<0.01) and METTL3 levels were elevated in endometrial cancer cells, and METTL3 (1.0±0.13) vs (2.5±0.45) ( P<0.05) levels were elevated in endometrial cancer cells. Western blot and qRT-PCR detection of miR-17-92 cell clusters overexpressing METTL3, METTL3 overexpression significantly increased m6A modification on pri-miR-17-92 ( P<0.05) . Phosphorylation levels of AKT/mTOR pathway-related proteins were upregulated. In addition, RIP test results indicated that the binding of DGCR8 to pri-miR-17-92 was significantly facilitated. Conclusion:METTL3 modification of m6A facilitates the processing of pri-miR-1792 into the miR-17-92 clusters via m6A/DGCR8-dependent mechanism, which in turn activated the AKT/mTOR pathway.