Objective With the widespread of transcatheter aortic valve replacement(TAVR)in patients with severe symptomatic aortic stenosis(AS),the life-cycle management has become a major determinant of prognosis.Methods A total of 408 AS patients who underwent successfully TAVR from June 2021 to August 2023 were consecutively enrolled in Hospital Valve Intervention Center.Patients were assigned to the Usual Care(UC)group between June 2021 and October 2022,while patients were assigned to the Heart Multi-parameter Monitoring(HMM)group between November 2022 and August 2023.The primary endpoint was defined as composite endpoint within 6 months post-TAVR,including all-cause death,cardiovascular death,stroke/transient ischemic attack,conduction block,myocardial infarction,heart failure rehospitalization,and major bleeding events.Secondary endpoints were the time interval(in hours)from event occurrence to medical consultation or advice and patient satisfaction.Statistical analysis was performed using Kaplan-Meier and multivariable Cox proportional hazards models.Results The incidence of primary endpoint in HMM group was significantly lower than that in UC group(8.9％vs.17.7％,P=0.016),the driving event was the rate of diagnosis and recognition of conduction block.The average time intervals from event occurrence to receiving medical advice were 3.02 h in HHM group vs.97.09 h in UC group(P＜0.001).Using cardiac monitoring devices and smart healthcare platforms provided significant improving in patients long-term management(HR 0.439,95％CI 0.244-0.790,P=0.006).Conclusions The utilization of cardiac monitoring devices and smart healthcare platforms effectively alerted clinical events and improved postoperative quality of life during long-term management post TAVR.

OBJECTIVES: To investigate the incidence of extrauterine growth retardation (EUGR) and its risk factors in very preterm infants (VPIs) during hospitalization in China. METHODS: A prospective multicenter study was performed on the medical data of 2 514 VPIs who were hospitalized in the department of neonatology in 28 hospitals from 7 areas of China between September 2019 and December 2020. According to the presence or absence of EUGR based on the evaluation of body weight at the corrected gestational age of 36 weeks or at discharge, the VPIs were classified to two groups: EUGR group (n=1 189) and non-EUGR (n=1 325). The clinical features were compared between the two groups, and the incidence of EUGR and risk factors for EUGR were examined. RESULTS: The incidence of EUGR was 47.30% (1 189/2 514) evaluated by weight. The multivariate logistic regression analysis showed that higher weight growth velocity after regaining birth weight and higher cumulative calorie intake during the first week of hospitalization were protective factors against EUGR (P<0.05), while small-for-gestational-age birth, prolonged time to the initiation of total enteral feeding, prolonged cumulative fasting time, lower breast milk intake before starting human milk fortifiers, prolonged time to the initiation of full fortified feeding, and moderate-to-severe bronchopulmonary dysplasia were risk factors for EUGR (P<0.05). CONCLUSIONS It is crucial to reduce the incidence of EUGR by achieving total enteral feeding as early as possible, strengthening breastfeeding, increasing calorie intake in the first week after birth, improving the velocity of weight gain, and preventing moderate-severe bronchopulmonary dysplasia in VPIs.
Female ; Fetal Growth Retardation ; Gestational Age ; Hospitalization ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Prospective Studies ; Risk Factors

OBJECTIVES: To explore the optimal maintenance dose of caffeine citrate for preterm infants requiring assisted ventilation and caffeine citrate treatment. METHODS: A retrospective analysis was performed on the medical data of 566 preterm infants (gestational age ≤34 weeks) who were treated and required assisted ventilation and caffeine citrate treatment in the neonatal intensive care unit of 30 tertiary hospitals in Jiangsu Province of China between January 1 and December 31, 2019. The 405 preterm infants receiving high-dose (10 mg/kg per day) caffeine citrate after a loading dose of 20 mg/kg within 24 hours after birth were enrolled as the high-dose group. The 161 preterm infants receiving low-dose (5 mg/kg per day) caffeine citrate were enrolled as the low-dose group. RESULTS: Compared with the low-dose group, the high-dose group had significant reductions in the need for high-concentration oxygen during assisted ventilation (P=0.044), the duration of oxygen inhalation after weaning from noninvasive ventilation (P<0.01), total oxygen inhalation time during hospitalization (P<0.01), the proportion of preterm infants requiring noninvasive ventilation again (P<0.01), the rate of use of pulmonary surfactant and budesonide (P<0.05), and the incidence rates of apnea and bronchopulmonary dysplasia (P<0.01), but the high-dose group had a significantly increased incidence rate of feeding intolerance (P=0.032). There were no significant differences between the two groups in the body weight change, the incidence rates of retinopathy of prematurity, intraventricular hemorrhage or necrotizing enterocolitis, the mortality rate, and the duration of caffeine use (P>0.05). CONCLUSIONS This pilot multicenter study shows that the high maintenance dose (10 mg/kg per day) is generally beneficial to preterm infants in China and does not increase the incidence rate of common adverse reactions. For the risk of feeding intolerance, further research is needed to eliminate the interference of confounding factors as far as possible.
Caffeine/therapeutic use* ; Citrates ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Respiration, Artificial ; Retrospective Studies

Animals ; Lung/metabolism* ; Rats ; Silicon Dioxide/toxicity* ; Thioredoxins/metabolism*

The mammalian epididymis not only plays a fundamental role in the maturation of spermatozoa, but also provides protection against various stressors. The foremost among these is the threat posed by oxidative stress, which arises from an imbalance in reactive oxygen species and can elicit damage to cellular lipids, proteins, and nucleic acids. In mice, the risk of oxidative damage to spermatozoa is mitigated through the expression and secretion of glutathione peroxidase 5 (GPX5) as a major luminal scavenger in the proximal caput epididymidal segment. Accordingly, the loss of GPX5-mediated protection leads to impaired DNA integrity in the spermatozoa of aged Gpx5

Adult ; Aged ; Aqueous Humor ; virology ; Female ; Humans ; Immunocompetence ; immunology ; Inflammation ; virology ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

·AIM:To compare the short-term surgical results of 27-gauge ( 27G ) with 25 - gauge ( 25G ) microincision vitrectomy surgery ( MIVS ) for the treatment of vitreoretinal diseases and evaluate the feasibility, safety and effectiveness of 27G MIVS. · METHODS: Two hundred and seventeen eyes with various vitreoretinal diseases underwent 27G or 25G MIVS from April 2016 to October 2017 and were retrospectively reviewed. One hundred and thirty-five eyes underwent 27G vitrectomy and 82 eyes for 25G vitrectomy. The main outcome measurements of the study included surgical time, intraoperative complications, postoperative ocular inflammation reaction, short-term best corrected visual acuity ( BCVA, LogMAR ) recovery and intraocular pressure fluctuation. ·RESULTS: All surgeries were completed successfully, and no eye in 27G group needed conversion to 25G vitrectomy. The mean surgical times in the 25G group was 56. 4±38. 9 min, which was significant longer than that of 27G group (45. 5 ± 26. 1 min, t= 2. 422, P= 0. 016). However, when comparing the surgical time for each category of disease, there were no significant differences observed (P>0. 05). Within the first week postoperatively, the mean cumulative score of conjunctival congestion, anterior chamber flare and aqueous cell in 25G group were 2.4±1.4, 0.7±1 and 0.5±1, which were higher than those in 27G group (2. 1 ± 1. 6, 0. 3 ± 0. 6, and 0. 2 ± 0. 4), with significant differences (P=0. 038, P=0. 011, P=0. 046 respectively). The improvement of BCVA was-0. 4±0. 9 in 25G group, and -0. 2 ± 0. 9 in the 27G groups respectively (t= -1. 636, P = 0. 103 ). The rate of transient ocular hypotony of the 25G vitrectomy was 19. 5% (16 eyes), which was higher than that of the 27G group without significant difference ( 15. 6% , 21 eyes; χ2= 0. 565, P=0. 452). When the eyes injected with silicone oil were excluded, there was no significant difference in intraocular pressure fluctuation between the 25G group (3. 59±0. 69mmHg) and the 27G group (3. 58±0. 47mmHg;t=0. 007, P=0. 995). ·CONCLUSION: The 27G microincision vitrectomy can be used to treat various vitreoretinal diseases. It is a safe and effective surgical procedure with small incision and mild anterior segment inflammatory reaction.

AIM:To compare the clinical effects of 25G+ and 27G+ transconjunctival sutureless vitrectomy in treating idiopathic macular hole.METHODS: We retrospectively reviewed the clinical outcomes of 56 eyes (56 patients) with idiopathic macular hole which were treated with micro-incision vitrectomy from June 2015 to September 2016.Patients were divided into two groups, 28 patients (28 eyes) were treated with 25G+ vitrectomy and the rest (28 eyes) were treated with 27G+ vitrectomy.The operative time and intraoperative complications were recorded and patients were followed up for 3-6mo.During the follow up period, best correct vision acuity (BCVA), intraocular pressure, macular hole healing and postoperative complications were documented and statistically analyzed.RESULTS: BCVA in two groups were significantly improved after surgery(P<0.001) and there was no significant difference between the two groups(P=0.84).No serious complications occurred.No statistically significant difference was found between the two groups in surgical time and healing rate of macular hole (P=0.57, 0.64).The incidence of low intraocular pressure (IOP<10mmHg) in 27G+ group was lower than that in 25G+ group on the first day after surgery(P=0.31).There was no significant difference between preoperative and postoperative intraocular pressure at 1wk after operation in both groups (P=0.72, 0.92).CONCLUSION: Both 25G+ and 27G+ vitrectomy are safe and effective technique in treating idiopathic macular hole.Besides, 27G+ showed better superiority on the maintenance of intraocular pressure and reduce the trauma.

AIM:To evaluate the feasibility and advantages of two-port 27-gauge pars plana vitrectomy for treatment of recurrent retinal detachment in silicone oil dwelling eyes.METHODS:A retrospective study.Two-port 27-gauge pars plana vitrectomy was performed in 7 eyes with recurrent retinal detachment without remove of silicone oil.Proliferative membrane peeling, endolaser treatment, and drainage of subretinal fluid were performed.Scleral bulking was performed if necessary.RESULTS:Sucessful retina re-attachment was accomplishied in all eyes.No visually significant intraoperative complication occurred.All eyes expericend quick recoveray of visual acuity and mild postoperative irritation.One eye developed a recurrent inferior retinal detchment in 20d after the surgery using non-remove technique, and recovered after conventional silicone oil removal and retinal reattachment surgery.CONCLUSION:Two-port 27-gauge pars plana vitrectomy is an efficacious (and potentially cost-efficient) method to treat early stage recurrent retinal detachment in silicone oil dwelling eyes.

Abstract?Since the introduction of 25-gauge/23-gauge ( 25G/23G ) sutureless micro -incision vitrectomy surgery ( MIVS ) at the beginning of the 21 century, we have stepped into an era of micro-incision vitreoretinal surgery more than10a. The current 25/23G MIVS provide numerous advantages over the conventional 20G vitrectomy surgery including simplified surgical procedure, shortened operating time, decreased complications as well as smaller sclerotomy wound.As a result, vitreoretinal surgeons have been shifting gradually from 20-gauge to 25/23-gauge vitrectomy in the past decade. As the 25/23G MIVS adapted worldwide, however, its drawbacks were also increasingly reported. Most criticism regarding to current 25/23G MIVS are focusing on would sealing related complications.Based on stablished notion regarding vitrectomy -“the smaller the better”, researchers and doctors were keeping on exploring the next generation of vitrectomy system. Thanks to the innovation and development in new generation vitrectomy machines, high lumen output light source, more delicate manufacturing technology and clear wild angle fundus view system, Dr.Oshima from Japan launched the first 27-gauge vitrectomy surgery system.It provided us novel surgical experience with smaller sclerotomy wound and faster cut rate. Further development and refinement of vitrectomy with 27-gauge or more are still on its way and will continue in the future. Undoubtedly, MIVS would be heated debated regarding its pro/con, complications, indications and future development.Combined with our own experiences, here we briefly reviewed the 27-gauge vitrectomy surgery.