Objective To determine the effects of cardiac resynchronization therapy at different pacing sites on electrocardiogram(ECG),left ventricular(LV)function and adverse events in elderly patients with heart failure(HF).Methods A total of 214 elderly HF patients admitted to our department between July 2021 and July 2024 were retrospectively recruited.According to different pacing sites in cardiac resynchronization therapy,they were divided into His bundle group(102 cases)and left bundle branch group(112 cases).Their grades of New York Heart Association(NYHA)cardiac function,duration of QRS complex,pacing parameters(pacing threshold,pacing perception,pacing resistance),cardiac function indicators,LV function,LV systolic synchrony[standard deviation of time to peak longitudinal strain,to peak radial strain and to peak circumferential strain(Tls-SD,Trs-SD and Tcs-SD)],and incidence of adverse events were compared between the two groups before and at 6 months after cardiac pacemaker implantation.Results In 6 months after surgery the left bundle branch group had significantly lower N-terminal pro-B-type natriuretic peptide level,smaller LV end-diastolic diameter and LV end-systolic diameter,decreased Tls-SD,Trs-SD and Tcs-SD,and shorter duration of QRS complex,but higher LV ejection fraction,cardiac index and cardiac output when compared with the His bundle group(P＜0.01).The incidence of adverse events was obviously lower in the left bundle branch group than the His bundle group(6.25％vs 15.69％,P＜0.05).Conclusion Left bundle branch pacing shows significant improvement for cardiac function in elderly HF patients,and can effectively maintain ECG stability and improve LV function.It is a safe and effective cardiac resynchronization therapy.

Objective:To investigate the expressions of serum cytokines in patients with autoimmune retinopathy (AIR), and their association with disease diagnosis as well as clinical features.Methods:A prospective case-control study was conducted.A total of 90 eyes of 45 AIR patients were consecutively collected in Beijing Tongren Hospital from September 2018 to December 2023.Additionally, age-matched 43 controls (86 eyes) were enrolled, consisting of 21 patients (42 eyes) with retinitis pigmentosa as a disease control group and 22 healthy subjects (44 eyes) as a normal control group.The main clinical outcome measures included best-corrected visual acuity (BCVA), mean deviation (MD) of visual field, central retinal thickness and the maximal response amplitude and implicit time of full-field electroretinography (ff-ERG). A total of 21 serum cytokines were detected by Luminex multiple cytokines assay or ELISA.Differences in serum cytokine concentrations of among groups, the correlation between cytokine levels and clinical outcomes, and the contribution of cytokines to the diagnosis of AIR were analyzed.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Beijing Tongren Hospital (No.TRECKY2018-048). Written informed consent was obtained from each subject.Results:In AIR patients, the expression levels of Th1-type cytokines or receptors (including interferon-γ[IFN-γ], interleukin [IL]-8, C-X-C motif chemokine ligand [CXCL]9, and CXCL10) and Th17-type cytokines (including IL-17 and IL-6) were elevated.There were statistically significant overall differences in pro-inflammatory cytokines/chemokines (IL-6, IL-8, CXCL10, IL-10, IFN-γ, IL-17, C-X3-C motif chemokine ligand 1 [CX3CL]1, CXCL9) among the three groups ( H=10.823, 10.816, 9.633, 10.103, 23.670, 16.493, 9.050, 9.253; all P<0.05). Compared with the disease control group and the healthy control group, the IFN-γ level was significantly increased in the AIR group (both P=0.001). Compared with the healthy control group, the serum levels of IL-6, IL-8, CXCL10, IL-10, IL-17, and CXCL9 in the AIR group were significantly elevated (all P<0.05). The serum level of CX3CL1 was significantly higher in the AIR group than in the disease control group ( P=0.039). The serum level of IFN-γ was significantly higher in the AIR group than in the healthy control and disease control groups, but no association with AIR diagnosis was found ( OR=1.402, 95% CI: 0.710-2.870, P=0.245). Multilevel mixed-effects regression modeling analysis showed that the serum levels of IL-8 and CXCL9 in AIR patients were positively correlated with LogMAR BCVA ( β=0.028, P=0.033; β=0.023, P=0.003). The C-C motif chemokine ligand 11 level was positively correlated with implicit time of ERG a-wave ( β=13.950, P<0.001). The tumor necrosis factor-α level was positively correlated with MD value of visual field ( β=6.310, P=0.002). Granulocyte-macrophage colony-stimulating factor was negatively correlated with the amplitude of ERG a-wave and granulocyte colony-stimulating factor was negatively correlated with ERG b-wave amplitude ( β=-152.700, P<0.001; β=-14.790, P=0.003). Conclusions:Serum Th1 and Th17-type cytokines/chemokines may be involved in the pathogenesis of AIR and are related to disease severity.

Objective To determine the effects of cardiac resynchronization therapy at different pacing sites on electrocardiogram(ECG),left ventricular(LV)function and adverse events in elderly patients with heart failure(HF).Methods A total of 214 elderly HF patients admitted to our department between July 2021 and July 2024 were retrospectively recruited.According to different pacing sites in cardiac resynchronization therapy,they were divided into His bundle group(102 cases)and left bundle branch group(112 cases).Their grades of New York Heart Association(NYHA)cardiac function,duration of QRS complex,pacing parameters(pacing threshold,pacing perception,pacing resistance),cardiac function indicators,LV function,LV systolic synchrony[standard deviation of time to peak longitudinal strain,to peak radial strain and to peak circumferential strain(Tls-SD,Trs-SD and Tcs-SD)],and incidence of adverse events were compared between the two groups before and at 6 months after cardiac pacemaker implantation.Results In 6 months after surgery the left bundle branch group had significantly lower N-terminal pro-B-type natriuretic peptide level,smaller LV end-diastolic diameter and LV end-systolic diameter,decreased Tls-SD,Trs-SD and Tcs-SD,and shorter duration of QRS complex,but higher LV ejection fraction,cardiac index and cardiac output when compared with the His bundle group(P＜0.01).The incidence of adverse events was obviously lower in the left bundle branch group than the His bundle group(6.25％vs 15.69％,P＜0.05).Conclusion Left bundle branch pacing shows significant improvement for cardiac function in elderly HF patients,and can effectively maintain ECG stability and improve LV function.It is a safe and effective cardiac resynchronization therapy.

Objective:To investigate the expressions of serum cytokines in patients with autoimmune retinopathy (AIR), and their association with disease diagnosis as well as clinical features.Methods:A prospective case-control study was conducted.A total of 90 eyes of 45 AIR patients were consecutively collected in Beijing Tongren Hospital from September 2018 to December 2023.Additionally, age-matched 43 controls (86 eyes) were enrolled, consisting of 21 patients (42 eyes) with retinitis pigmentosa as a disease control group and 22 healthy subjects (44 eyes) as a normal control group.The main clinical outcome measures included best-corrected visual acuity (BCVA), mean deviation (MD) of visual field, central retinal thickness and the maximal response amplitude and implicit time of full-field electroretinography (ff-ERG). A total of 21 serum cytokines were detected by Luminex multiple cytokines assay or ELISA.Differences in serum cytokine concentrations of among groups, the correlation between cytokine levels and clinical outcomes, and the contribution of cytokines to the diagnosis of AIR were analyzed.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Beijing Tongren Hospital (No.TRECKY2018-048). Written informed consent was obtained from each subject.Results:In AIR patients, the expression levels of Th1-type cytokines or receptors (including interferon-γ[IFN-γ], interleukin [IL]-8, C-X-C motif chemokine ligand [CXCL]9, and CXCL10) and Th17-type cytokines (including IL-17 and IL-6) were elevated.There were statistically significant overall differences in pro-inflammatory cytokines/chemokines (IL-6, IL-8, CXCL10, IL-10, IFN-γ, IL-17, C-X3-C motif chemokine ligand 1 [CX3CL]1, CXCL9) among the three groups ( H=10.823, 10.816, 9.633, 10.103, 23.670, 16.493, 9.050, 9.253; all P<0.05). Compared with the disease control group and the healthy control group, the IFN-γ level was significantly increased in the AIR group (both P=0.001). Compared with the healthy control group, the serum levels of IL-6, IL-8, CXCL10, IL-10, IL-17, and CXCL9 in the AIR group were significantly elevated (all P<0.05). The serum level of CX3CL1 was significantly higher in the AIR group than in the disease control group ( P=0.039). The serum level of IFN-γ was significantly higher in the AIR group than in the healthy control and disease control groups, but no association with AIR diagnosis was found ( OR=1.402, 95% CI: 0.710-2.870, P=0.245). Multilevel mixed-effects regression modeling analysis showed that the serum levels of IL-8 and CXCL9 in AIR patients were positively correlated with LogMAR BCVA ( β=0.028, P=0.033; β=0.023, P=0.003). The C-C motif chemokine ligand 11 level was positively correlated with implicit time of ERG a-wave ( β=13.950, P<0.001). The tumor necrosis factor-α level was positively correlated with MD value of visual field ( β=6.310, P=0.002). Granulocyte-macrophage colony-stimulating factor was negatively correlated with the amplitude of ERG a-wave and granulocyte colony-stimulating factor was negatively correlated with ERG b-wave amplitude ( β=-152.700, P<0.001; β=-14.790, P=0.003). Conclusions:Serum Th1 and Th17-type cytokines/chemokines may be involved in the pathogenesis of AIR and are related to disease severity.

Objective To investigate the application value of different digestive tract reconstruction methods in laparoscopic distal gastrectomy (LDG).Methods The retrospective cohort study was conducted.The clinicopathological data of 164 with early gastric cancer (GC) who were admitted to the First Affiliated Hospital of Fujian Medical University between June 2010 and April 2015 were collected.Of 164 patients undergoing LDG,45 receiving Billroth Ⅰ (B Ⅰ) anastomosis,39 receiving Billroth Ⅱ (B Ⅱ) anastomosis,44 receiving Roux-en-Y anastomosis and 36 receiving uncut Roux-en-Y anastomosis were allocated into the B Ⅰ group,B Ⅱ group,RY group and uncut RY group,respectively.Observation indicators:(1) surgical and postoperative recovery situations;(2) postoperative short-term complications situations;(3) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative nutriology and long-term complications up to May 2017.Measurement data with normal distribution were represented as x±s.Comparison among groups was analyzed using the ANOVA,and pairwise comparisons were done by the Tukey hsd test.Count data were described as the frequency and percentage,and comparisons among groups were analyzed the chi-square test or Fisher exact probability.Ordinal data were analyzed by the Kruskal Wallis test.Results (1) Surgical and postoperative recovery situations:patients in 4 groups underwent successfully LDG.Cases undergoing total LDG and assisted LDG and digestive tract reconstruction time in the B Ⅰ,B Ⅱ,RY and uncut RRY groups were respectively 0,29,13,15 and 45,10,31,21 and (42±7)minutes,(55±8)minutes,(64±8)minutes,(51±6) minutes,with statistically significant differences among 4 groups (x2 =21.628,F=74.441,P＜0.05).(2)Postoperative short-term complications situations:2,2,3 and 1 patients in the B Ⅰ,B Ⅱ,Roux-en-Y and uncut Roux-en-Y groups had respectively postoperative short-term complications,showing no statistically significant difference among 4 groups (x2 =0.840,P＞0.05).(3) Follow-up situations:all patients were followed up,and follow-up time in the B Ⅰ,B Ⅱ,RY and uncut RY groups were respectively (10.8 ± 3.5) months,(10.9 ±3.4)months,(11.3±3.2) months and (11.2±2.2) months,with no statistically significant difference among 4 groups (F=0.200,P＞0.05).① Comparisons of postoperative 1-year nutritional indexes:rates of changes in body mass index (BMI),hemoglobin (Hb),total protein (TP) and albumin were respectively 93％±7％,91％±7％,90％±7％,90％±9％ and 94％±9％,97％±11％,95％±9％,97％±9％ and 101％±9％,99％±7％,98％±7％,99％±7％ and 101％±10％,103％±7％,100％±10％,103％±9％ in the B Ⅰ,B Ⅱ1,RY and uncut RY groups,showing no statistically significant difference among 4 groups (F=1.182,0.724,1.050,0.971,P＞0.05).②)Of 164 patients within 1 year postoperatively,47 were complicated with gastric retention (27,12,6 and 2 with severity in grade 1,2,3 and 4),87 with residual gastritis (53,24,10 and 0 with severity in grade 1,2,3 and 4),and 38 with bile reflux (severity in grade 1).Of 38 patients with bile reflux,33 were combined with residual gastritis,showing a correlation between residual gastritis and bile reflux (r=0.396,P＜0.05).Cases with gastric retention,residual gastritis and bile reflux within 1 year postoperatively were respectively 16,9,21,1and 35,30,13,9 and 16,18,3,1 in the B Ⅰ,B Ⅱ],RY and uncut RY groups,showing statistically significant differences among 4 groups (x2 =21.261,41.103,30.469,P＜ 0.05).There were statistically significant differences in gastric retention occurrence between uncut RY group and B Ⅰ group or B Ⅱ group or RY group (x2 =12.958,6.675,20.065,P＜0.05),and in residual gastritis occurrence between RY group and B Ⅰ group or B Ⅱ group (x2 =20.831,18.587,P＜0.05) and between uncut RY group and B Ⅰ group or B Ⅱ group (x2 =22.452,20.220,P＜0.05).There were statistically significant differences in bile reflux occurrence between RY group and B Ⅰ group or B Ⅱ group (x2 =10.942,16.926,P＜0.05),and between uncut RY group and B Ⅰ group or B Ⅱ group (x2 =12.958,18.620,P＜0.05).Conclusion Roux-en-Y and uncut Roux-en-Y anastomoses are superior to B Ⅰ and B Ⅱ anastomoses in improving residual gastritis and bile reflux in the postoperative digestive tract reconstruction of LDG,and uncut Roux-en-Y anastomosis can effectively reduce occurrence of postoperative gastric retention.

Background Studies showed that activation of microglia-derived nicotinamide adenine dinucleotide phosphate (NADPH) oxidase plays a key role in the neurodegenerative diseases and neural cell death in central nervous system.The effect of NADPH on cone degeneration have been determined in rd rats,its role in rod degeneration is relatively less studied.Objective This study was to study the expression of NADPH oxidase in the retinal degenerative process in rd mice and further explore its role in the photoreceptor degeneration.Methods rd Mice at postnatal day 8 (P8),P10,P12,P14,P16 and P18 were collected.The mice were sacrificed,and retinal sections,RNAs and proteins were prepared in above-mentioned time points.The expressions of the gp91 phox,a major subunit of NADPH oxidase,in transcript level and protein level in the retinas were semi-quantitatively detected by real-time PCR and Western blot respectively.Expression of gp91phox was localized in the rd retinas as ageing by immunohistochemstry,and the co-expression of gp91phox with CD11b,a specific marker of microglial cells,was assayed by immunofluorescent double labeling.The C57BL/6N mice were served as controls.The use and care of the animals complied with the Guideline of ARVO.Results Real-time PCR showed that gp91phox mRNA was not expressed in the retinas of C57BL/6N mice.Gp91phox mRNA was found to have less expressed in retinas of P8 rd mice.With aging,the expression level of gp91phox mRNA (gp91phox mRNA/β-actin) in rd mouse retinas was gradually increased with the highest level in P14 mice(1.136±0.370).A significant difference was seen in the gp91 phox mRNA expression among various groups of mice (F=17.81,P =0.00),and gp91phox mRNA expression was significantly elevated in P10,P12,P14,P16 and P18 rd mice compared with P8 rd mice(all at P＜0.05).The expression level of gp91phox protein (A value) in the retinas presented with a similar trend in the rd mice,with a significant difference among the various ages of rd mice and C57BL/6N mice (F =354.00,P＜0.01).The expression level of gp91 phox protein was increased in the rd mice in comparison with the C57BL/6N mice (all at P＜0.05).Immunochemistry revealed that the positive response cells for gp91phox increased in the inner layers of retinas in P10 rd mice and peaked in P14 mice.Immunofluorescent double labeling exhibited that gp91phox were seen to present a co-expression with CD11b,showing an orange fluorescence.Conclusions Expression of NADPH oxidase in the rctinas in the rd mice up-regulates and is parallels to the microglial activation and photoreceptor degeneration,suggesting that NADPH oxidase plays a role in the retinal dystrophy associated with microglial activation.