Objectives:To analyze and summarize the clinical experience of the Y-incision technique in aortic root enlargement surgery.Methods:A retrospective analysis was conducted based on the data of 53 patients who underwent aortic root enlargement using the Y-shaped incision technique by the same surgical team from January to December 2024.The primary endpoint of the study was the efficacy of the technique,as measured by the enlargement size of the valve annulus.The secondary endpoint focused on the safety of the procedure,specifically the incidence of major complications,including re-sternotomy due to bleeding,third-degree atrioventricular block,and major adverse cardiovascular events(MACE).MACE included cardiovascular death,myocardial infarction,stroke,and re-aortic valve intervention.Echocardiography was performed at 3 months after discharge.Root blood flow compliance was analyzed by computer fluid dynamics.Results:Among the 53 patients,30 were male(56.6%),with a mean age of(59.3±13.3)years(range:13-81 years).Five cases(9.4%)were reoperations.Biological valves were replaced in 36 cases(67.9%),and mechanical valves in 17 cases(32.1%).The intraoperatively measured mean native annulus diameter was(20.5±2.2)mm,the post-root enlargement implanted valve size was(25.4±2.5)mm,with a mean enlargement of(4.9±1.5)mm.The mean cardiopulmonary bypass time was(159.9±46.1)minutes,aortic cross-clamp time was(123.3±35.6)minutes,postoperative intensive care unit stay was(2.6±3.0)days,and invasive mechanical ventilation duration was(18.3±29.7)hours.One case(1.9%)required re-exploration for postoperative bleeding.One case(1.9%)developed transient postoperative elevation of cardiac troponin I,and coronary computed tomography angiography(CTA)confirmed asymptomatic compression of the coronary ostium.Follow-up at 1 month showed normal coronary blood flow.No third-degree atrioventricular block or MACE occurred in the entire cohort.Postoperative computer fluid dynamics analysis showed that the high-speed blood flow at the root disappeared after the operation,the blood flow compliance was improved,and no signs of tilt of the prosthetic valve were found.The mean follow-up was(6.2±2.7)months.The follow-up completion rate was 100%,and no death occurred during the follow-up.Both the aortic prosthetic valve and mitral valve functioned well,there was no dysfunction caused by mitral curtain injury.One case of moderate patient-prosthesis mismatch(PPM)occurred in a reoperation patient,there was no severe PPM post surgery.Compared with the preoperative values,left ventricular ejection fraction,peak transaortic valve flow velocity,and the degree of mitral regurgitation all significantly improved at 3 months after discharge(all P<0.001).Conclusions:The Y incision technique is safe and effective for aortic root enlargement,enabling the implantation of larger-diameter prosthetic valves and providing better hemodynamic outcomes.Further follow-up is required to assess its long-term efficacy.

Objectives:To analyze and summarize the clinical experience of the Y-incision technique in aortic root enlargement surgery.Methods:A retrospective analysis was conducted based on the data of 53 patients who underwent aortic root enlargement using the Y-shaped incision technique by the same surgical team from January to December 2024.The primary endpoint of the study was the efficacy of the technique,as measured by the enlargement size of the valve annulus.The secondary endpoint focused on the safety of the procedure,specifically the incidence of major complications,including re-sternotomy due to bleeding,third-degree atrioventricular block,and major adverse cardiovascular events(MACE).MACE included cardiovascular death,myocardial infarction,stroke,and re-aortic valve intervention.Echocardiography was performed at 3 months after discharge.Root blood flow compliance was analyzed by computer fluid dynamics.Results:Among the 53 patients,30 were male(56.6%),with a mean age of(59.3±13.3)years(range:13-81 years).Five cases(9.4%)were reoperations.Biological valves were replaced in 36 cases(67.9%),and mechanical valves in 17 cases(32.1%).The intraoperatively measured mean native annulus diameter was(20.5±2.2)mm,the post-root enlargement implanted valve size was(25.4±2.5)mm,with a mean enlargement of(4.9±1.5)mm.The mean cardiopulmonary bypass time was(159.9±46.1)minutes,aortic cross-clamp time was(123.3±35.6)minutes,postoperative intensive care unit stay was(2.6±3.0)days,and invasive mechanical ventilation duration was(18.3±29.7)hours.One case(1.9%)required re-exploration for postoperative bleeding.One case(1.9%)developed transient postoperative elevation of cardiac troponin I,and coronary computed tomography angiography(CTA)confirmed asymptomatic compression of the coronary ostium.Follow-up at 1 month showed normal coronary blood flow.No third-degree atrioventricular block or MACE occurred in the entire cohort.Postoperative computer fluid dynamics analysis showed that the high-speed blood flow at the root disappeared after the operation,the blood flow compliance was improved,and no signs of tilt of the prosthetic valve were found.The mean follow-up was(6.2±2.7)months.The follow-up completion rate was 100%,and no death occurred during the follow-up.Both the aortic prosthetic valve and mitral valve functioned well,there was no dysfunction caused by mitral curtain injury.One case of moderate patient-prosthesis mismatch(PPM)occurred in a reoperation patient,there was no severe PPM post surgery.Compared with the preoperative values,left ventricular ejection fraction,peak transaortic valve flow velocity,and the degree of mitral regurgitation all significantly improved at 3 months after discharge(all P<0.001).Conclusions:The Y incision technique is safe and effective for aortic root enlargement,enabling the implantation of larger-diameter prosthetic valves and providing better hemodynamic outcomes.Further follow-up is required to assess its long-term efficacy.

Objective:To investigate the role of group 3 innate lymphoid cells (ILC3) in skin wound healing, and to explore the underlying mechanisms.Methods:Twenty-four 5-week-old male C57BL/6 mice were randomly and equally allocated into 3 groups: the skin wound + ILC3 inhibitor group (referred to as ILC3 inhibitor group), the skin wound group, and the control group, with 8 mice in each group. Four days before the establishment of the wound model, mice in the ILC3 inhibitor group were intraperitoneally injected with 1 μg of ILC3 inhibitor every 2 days for a total of 2 doses, mice in the skin wound group were injected with an equal volume of physiological saline solution, and mice in the control group were fed normally. To establish a mouse skin wound model, a full-thickness circular incision with a diameter of 0.6 cm was made around the midpoint of the dorsal midline using a biopsy punch after the intraperitoneal injection of anesthetics, which was histologically confirmed to be a full-thickness injury. The size of the wounds was observed and recorded, photographs of the wounds were taken on days 0, 1, 3, 5, 7, and 9 after wounding, and corresponding wound healing rates were calculated. On day 9 after wounding, tissue samples were collected from the wound edges, and subjected to flow cytometry analysis to quantify ILC3 infiltrating around the skin wound, and hematoxylin and eosin (HE) staining was performed to assess the healing status of the skin wounds. Real-time quantitative polymerase chain reaction (qRT-PCR) was conducted to determine the mRNA expression of vitamin D receptor (VDR), Notch1, tumor necrosis factor-alpha (TNF-α), interleukin (IL) -17A, IL-17F, and IL-22 in the wound-edge tissues, and Western blot analysis to determine their protein expression. Statistical analysis was carried out by using one-way analysis of variance and t test. Results:On day 9 after wounding, the skin wound group showed an increased number of ILC3 in the wound-edge tissues (5.31% ± 1.47% vs. 3.10% ± 0.54%, P < 0.01), increased mRNA and protein expression of TNF-α, IL-22, IL-17A, and IL-17F (all P < 0.05), but decreased mRNA and protein expression of VDR (both P < 0.05) compared with the control group; the protein expression of Notch1 was significantly higher in the skin wound group than in the control group ( P < 0.05), but there was no significant difference in its mRNA expression between the two groups ( P > 0.05). On days 1, 3 and 5, the wound healing rates were significantly higher in the ILC3 inhibitor group (45.17% ± 9.90%, 61.58% ± 11.61%, 75.61% ± 9.12%, respectively) than in the skin wound group (25.87% ± 10.96%, 47.78% ± 13.81%, 64.55% ± 10.29%, respectively, all P < 0.05). On day 9, the ILC3 inhibitor group showed a decreased number of ILC3 around the wound (2.69% ± 0.95%, P < 0.01), decreased mRNA and protein expression of TNF-α, IL-22, IL-17A, and IL-17F in the wound-edge tissues (all P < 0.05), but increased mRNA and protein expression of Notch1 and VDR in the wound-edge tissues (all P < 0.05) compared with the skin wound group. On day 9 after wounding, histopathological examination with HE staining revealed continuous and intact epithelial structure, as well as dense and neatly arranged collagen fibers in the ILC3 inhibitor group, and the structures of hair follicles, blood vessels, and sebaceous glands were similar to those in the control group. Conclusions:Skin ILC3 infiltrated local wounds and were involved in the skin wound healing process through inflammatory factors such as TNF-α, IL-17A, IL-17F, and IL-22. Downregulating the number of ILC3 may promote skin wound healing by activating VDR and Notch1, as well as inhibiting the TNF-α signaling pathway and the expression of downstream inflammatory factors.

Objective:To explore the application value of multimodal MRI imaging in early neurological deterioration (END) and clinical prognosis prediction of acute ischemic stroke (AIS).Methods:A total of 200 AIS patients admitted to the Chengde Central Hospital from October 2019 to October 2022 were selected as the study subjects. Based on whether END occurred within 7 days of enrollment, there were 40 cases in the occurrence group and 160 cases in the non occurrence group. The influencing factors of END occurrence in AIS patients and the predictive value of multimodal magnetic resonance imaging (MRI) parameters on END were analyzed; According to the modified Rankin (mRS) score, patients were divided into good prognosis and poor prognosis groups, and the impact of multimodal MRI imaging parameters on the risk of poor prognosis in AIS patients was analyzed.Results:There were statistically significant differences in the apparent diffusion coefficient (ADC), cerebral blood flow (CBF), and their differences before and after thrombolysis in multimodal MRI imaging parameters between the END group and the non END group, as well as in the National Institutes of Health Stroke Scale (NIHSS) score at admission, age, and time from onset to admission (all P<0.05). The difference between ADC and CBF before and after thrombolysis, time from onset to admission, NIHSS score at admission, and age were all independent influencing factors for the occurrence of END in AIS patients (all P<0.05). The area under the curve (AUC) of the combined prediction of the difference between ADC and CBF before and after thrombolysis for the occurrence of END in AIS patients was 0.924, which was higher than that predicted by a single indicator ( P<0.05). The incidence of poor prognosis in patients with END was significantly higher than that in patients without END ( P<0.05). The risk of poor prognosis in AIS patients with a difference of less than <45.83×10 -9 mm 2/s before and after ADC thrombolysis was 3.136 times higher than that in patients with ≥45.83×10 -6 mm 2/s. The risk of poor prognosis in AIS patients with a difference of less than 10.52 ml/(min·100 g) before and after ADC thrombolysis was 2.640 times higher than that in patients with ≥10.52 ml/(min·100 g). Conclusions:Multimodal MRI imaging can be used for END evaluation in AIS patients and can provide reference for clinical prognosis evaluation.

Type 2 diabetes (T2D) is characterized by the malfunction of pancreatic β cells. Susceptibility and pathogenesis of T2D can be affected by multiple factors, including sex differences. However, the mechanisms underlying sex differences in T2D susceptibility and pathogenesis remain unclear. Using single-cell RNA sequencing (scRNA-seq), we demonstrate the presence of sexually dimorphic transcriptomes in mouse β cells. Using a high-fat diet-induced T2D mouse model, we identified sex-dependent T2D altered genes, suggesting sex-based differences in the pathological mechanisms of T2D. Furthermore, based on islet transplantation experiments, we found that compared to mice with sex-matched islet transplants, sex-mismatched islet transplants in healthy mice showed down-regulation of genes involved in the longevity regulating pathway of β cells. Moreover, the diabetic mice with sex-mismatched islet transplants showed impaired glucose tolerance. These data suggest sexual dimorphism in T2D pathogenicity, indicating that sex should be considered when treating T2D. We hope that our findings could provide new insights for the development of precision medicine in T2D.

OBJECTIVE:To establish the method for content determination of cantharidin in Lytta caraganae,and to use the result as the extract screening evidence of L. caraganae source material. METHODS:Ultrasonic extraction method was used to extract cantharidin from L. caraganae using acetone as solvent. HPLC method was adopted to determine the content of cantharidin. The determination was performed on C18column with mobile phase consisted of methanol-water(23:77)at flow rate of 1.0 mL/min. The detection wavelength was set 230 nm,the column temperature was set at 35 ℃,and sample size was 10 μL. The content of cantharidin in L. caraganae was determined and compared with the results of content determination by the method stated in Chinese Pharmacopeia(using chloroform as extraction solvent). RESULTS:The liner range of cantharidin were 0.2-1.0 mg/mL (r=0.998 8)with average methodology recovery rates of 101.1%(RSD=1.7%,n=6). The average content of cantharidin in L. caraganae was 0.932%(n=3),while the content of cantharidin was 0.793%(n=3)determined by the method stated in Chinese Pharmacopeia. Both were higher than the requirement of Chinese Pharmacopeia that the content of cantharidin in scource material of cantharidin was higher than 0.35%. CONCLUSIONS:Established method is accurate and reliable for the content determination cantharidin in L. caraganae. The content of cantharidin is up to the standard of Chinese Pharmacopeia,and can be used as source material for exacting cantharidin.