Objectives:To investigate the impact of the Micra AV leadless pacemaker on cardiac function.Methods:A total of 76 patients who received the implantation of Micra AV leadless pacemaker due to sick sinus syndrome or atrioventricular block at Ruijin Hospital,Shanghai Jiao Tong University School of Medicine from September 2022 to April 2023 were included in this study.Among them,26 patients(34.2%)had sick sinus syndrome,and 50 patients(65.8%)had atrioventricular block.The patients were followed up for 1 year postoperatively.Cardiac function was evaluated by echocardiography,and the parameters of the pacemaker were collected through the outpatient clinic programming system.Results:After a follow-up of 120(87,181)days,compared with the preoperative state,the left ventricular ejection fraction(LVEF)decreased postoperatively([66.6±5.6]%vs.[63.8±5.2]%,P<0.001),and the cardiac output increased[(4.3±1.2)L/min vs.(5.3±1.5)L/min,P<0.001].There were no statistically significant differences in various cardiac function indexes of patients with sick sinus syndrome between the postoperative and preoperative states(all P>0.05).Compared with the preoperative state,in patients with atrioventricular block,the LVEF decreased postoperatively([67.0±5.1]%vs.[63.4±4.4]%,P<0.001),the cardiac output increased([4.2±1.1]L/min vs.[5.2±1.2]L/min,P<0.001),and the left ventricular end-diastolic diameter decreased[(49.9±5.4)mm vs.(48.6±5.0)mm,P=0.044].Firth's logistic regression analysis indicated that the preoperative LVEF(for every 1%increase,OR=1.56,95%CI:1.12-2.17,P=0.001),stroke volume(for every 1 ml increase,OR=1.15,95%CI:1.04-1.28,P=0.001),body mass index(for every 1 kg/m2 increase,OR=1.49,95%CI:1.02-2.17,P=0.020),and hypertension(OR=12.71,95%CI:1.11-145.13,P=0.039)were independent risk factors for the decrease in LVEF after surgery in patients with atrioventricular block.After the implantation of the MciraTM AV leadless pacemaker,the overall atrioventricular synchrony rate was 81.2%(68.8%,89.0%).The atrioventricular synchrony rates of patients with sick sinus syndrome and those with atrioventricular block were 70.6%(59.5%,83.4%)and 82.4%(74.2%,89.3%)respectively(P<0.05).Firth's logistic regression analysis indicated that sick sinus syndrome(OR=0.26,95%CI:0.07-0.89,P=0.029)and preoperative LVEF(for every 1%increase,OR=1.18,95%CI:1.03-1.35,P=0.015)were independent predictive factors for the atrioventricular synchrony rate>80%.Conclusions:There are differences in the impacts of the Micra AV leadless pacemaker on the LVEF and atrioventricular synchrony rate between patients with sick sinus syndrome and those with atrioventricular block.The preoperative LVEF,stroke volume,body mass index,and hypertension have independent predictive effects on the decrease in postoperative LVEF in patients with atrioventricular block.Sick sinus syndrome and preoperative LVEF are independent predictive factors for the atrioventricular synchrony rate>80%after surgery.

Objectives:To investigate the impact of the Micra AV leadless pacemaker on cardiac function.Methods:A total of 76 patients who received the implantation of Micra AV leadless pacemaker due to sick sinus syndrome or atrioventricular block at Ruijin Hospital,Shanghai Jiao Tong University School of Medicine from September 2022 to April 2023 were included in this study.Among them,26 patients(34.2%)had sick sinus syndrome,and 50 patients(65.8%)had atrioventricular block.The patients were followed up for 1 year postoperatively.Cardiac function was evaluated by echocardiography,and the parameters of the pacemaker were collected through the outpatient clinic programming system.Results:After a follow-up of 120(87,181)days,compared with the preoperative state,the left ventricular ejection fraction(LVEF)decreased postoperatively([66.6±5.6]%vs.[63.8±5.2]%,P<0.001),and the cardiac output increased[(4.3±1.2)L/min vs.(5.3±1.5)L/min,P<0.001].There were no statistically significant differences in various cardiac function indexes of patients with sick sinus syndrome between the postoperative and preoperative states(all P>0.05).Compared with the preoperative state,in patients with atrioventricular block,the LVEF decreased postoperatively([67.0±5.1]%vs.[63.4±4.4]%,P<0.001),the cardiac output increased([4.2±1.1]L/min vs.[5.2±1.2]L/min,P<0.001),and the left ventricular end-diastolic diameter decreased[(49.9±5.4)mm vs.(48.6±5.0)mm,P=0.044].Firth's logistic regression analysis indicated that the preoperative LVEF(for every 1%increase,OR=1.56,95%CI:1.12-2.17,P=0.001),stroke volume(for every 1 ml increase,OR=1.15,95%CI:1.04-1.28,P=0.001),body mass index(for every 1 kg/m2 increase,OR=1.49,95%CI:1.02-2.17,P=0.020),and hypertension(OR=12.71,95%CI:1.11-145.13,P=0.039)were independent risk factors for the decrease in LVEF after surgery in patients with atrioventricular block.After the implantation of the MciraTM AV leadless pacemaker,the overall atrioventricular synchrony rate was 81.2%(68.8%,89.0%).The atrioventricular synchrony rates of patients with sick sinus syndrome and those with atrioventricular block were 70.6%(59.5%,83.4%)and 82.4%(74.2%,89.3%)respectively(P<0.05).Firth's logistic regression analysis indicated that sick sinus syndrome(OR=0.26,95%CI:0.07-0.89,P=0.029)and preoperative LVEF(for every 1%increase,OR=1.18,95%CI:1.03-1.35,P=0.015)were independent predictive factors for the atrioventricular synchrony rate>80%.Conclusions:There are differences in the impacts of the Micra AV leadless pacemaker on the LVEF and atrioventricular synchrony rate between patients with sick sinus syndrome and those with atrioventricular block.The preoperative LVEF,stroke volume,body mass index,and hypertension have independent predictive effects on the decrease in postoperative LVEF in patients with atrioventricular block.Sick sinus syndrome and preoperative LVEF are independent predictive factors for the atrioventricular synchrony rate>80%after surgery.

Objective:To evaluate the efficacy and safety of brentuximab vedotin (BV) combined with rituximab and attenuated chemotherapy in the treatment of children with classic Hodgkin lymphoma (cHL).Methods:A prospective, non-randomized, risk-assigned study. Clinical data (including age, gender, B symptoms, bulky disease, CD30 and Epstein-Barr virus-encoded RNA(EBER) expression, clinical stage, risk stratification, etc.) of 28 intermediate to high-risk cHL children diagnosed and treated at Beijing Children′s Hospital Affiliated to Capital Medical University from October 2022 to May 2024 were collected. Immuno-targeted combined with attenuated chemotherapy was administered based on risk stratification and early treatment response. The patients were followed up until May 1st, 2024. The infusion reactions and adverse reactions after treatment were recorded.Results:In all 28 patients, there were 22 males and 6 females, the age was 12 (5,16) years, 16 cases (57%) presented with bulky disease and 10 cases (36%) with B symptoms. The most common pathological type was nodular sclerosis (14 cases, 50%). There were 7 cases of stage Ⅱ, 14 cases of stage Ⅲ and 7 cases of stage Ⅳ according to the Ann Arbor staging system. There were 5 cases in the intermediate-risk group and 23 cases in the high-risk group. EBER was positive in 20 cases (71%) and negative in 6 cases (21%), and CD30 antigen was expressed in tumor cells of all enrolled children. Treatment duration: 5 cases (18%) received 4 courses of treatment, 21 cases (75%) received 6 courses of treatment, and 2 cases (7%) received 8 courses of treatment, 25 cases (89%) achieved complete metabolism response (CMR) through early assessment after 2 courses of chemotherapy. The CMR rates were 100% in intermediate-risk group and 87% (20/23) in high-risk group, respectively. Four patients (14%) finally received residual field radiotherapy. Toxicities included grade Ⅰ-Ⅱ myelosuppression, early infusion reaction and mild peripheral neuropathy, only one case of grade 3 adverse events was recorded and did not affect sequential treatment. At the end of treatment and 3 months of follow-up, the levels of IgA, IgG and IgM were all decreased compared with the baseline before chemotherapy, and the total B cell count began to be lower than the level before chemotherapy at the early stage of treatment (after 2 courses). The total B cell count monitored during treatment was 50 (0, 101)×10 6/L and was 12 (0, 25)×10 6/L at the end of treatment. The follow-up time was 6 (3, 13) months, all 28 children had event-free survival and all achieved complete remission. At 6 and 9 months of follow-up, IgA, IgG, IgM and total B cell counts returned to pre-chemotherapy baseline levels, respectively. Conclusion:BV combined with rituximab attenuated chemotherapy has demonstrated efficacy and a tolerable safety profile in the treatment of cHL in children, and significantly reduce radiation rate.

Objective:To investigate the clinical effect of ultrasonic root canal intermittent irrigation in endodontic vascular reconstruction.Methods:32 young permanent teeth with pulp and periapical lesions were randomly divided into two groups ( n=32): experimental group was treated with ultrasonic root canal intermittent irrigation and the control group was rinsed with sodium hypochlorite root canal. The changes of periapical lesions and root development were evaluated by preoperative and postoperative clinical symptom observation and radiograph examination, and the clinical effect of endodontic vascular reconstruction was discussed. The time of inflammation control was discussed by analyzing the starting point from the first diagnosis to the date of mineral trioxide aggregate (MTA) coverage. Results:The clinical symptoms of the 16 affected teeth in the experimental group and the control group disappeared, the periapical lesions were eliminated, and the root continued to develop. In the experimental group, root formation was observed in 13 of the affected teeth, with a success rate of 81.25% and a reduction rate of 18.75%. In the control group, root formation was observed in 10 of the affected teeth, with a success rate of 62.5% and a reduction rate of 37.5%. There was no difference in the effective rate between the experimental group and the control group ( P>0.05). The control time of inflammation was (28.44±5.98)days in the experimental group and (34.13±7.17)days in the control group, with statistically significant differences ( P<0.05). Conclusions:Ultrasonic root canal intermittent swabbing applied to pulp revascularization can achieve good clinical effect and shorten the time of inflammation control.

Objective:To investigate the value of contrast-enhanced ultrasound targeting vascular endothelial growth factor receptor-2 (VEGFR-2) in non-invasive monitoring of anti-angiogenesis response in subcutaneous transplantation tumor model of hepatocellular carcinoma in nude mice.Methods:Sixteen nude mice were randomly divided into control group and bevacizumab treatment group (treatment group). Two weeks later, the model of subcutaneous transplanted tumor was established. The mice in the treatment group were intratumorally injected with 0.2 mg bevacizumab, while the control group was given the same amount of saline, three times a week for 2 weeks. Ultrasound microbubbles targeting VEGFR-2 were prepared by biotin avidin method. Ultrasound examinations were performed before treatment, 7 days and 14 days after treatment, and the time intensity curve (TIC) was drawn to quantitatively analyze the differences of parameters with treatment time. The expression of CD31 in tumor tissues was detected by immunohistochemistry.Results:After 14 days of treatment, the volume of tumor tissue in the treatment group and the control group were (0.247±0.019) mm 3 and (0.307±0.031) mm 3, respectively, the difference was statistically significant ( P<0.01). After 7 days of treatment, the rise slope (K 1), time to peak (TTP) and peak intensity (PI) of TIC curve in the treatment group were 3.77±0.62, (3.82±0.21) s and (24.35±3.34) dB, respectively, which were significantly different from 2.93±0.31, (4.47±0.50) s and (30.10±2.35) dB in the control group, respectively ( P<0.05). Immunohistochemistry showed that the PI of contrast enhanced ultrasound was positively correlated with microvessel density ( r2=0.898, P=0.017). Conclusions:The therapeutic effect of bevacizumab on tumor angiogenesis evaluated by contrast-enhanced ultrasound targeting VEGFR-2 is related to the differences of parameters such as K 1, TTP and PI of TIC index. Contrast enhanced ultrasound targeting VEGFR-2 is of great value in non-invasive monitoring of subcutaneous transplanted tumor model of hepatocellular carcinoma in nude mice.

Objective:To investigate the value of contrast-enhanced ultrasound targeting vascular endothelial growth factor receptor-2 (VEGFR-2) in non-invasive monitoring of anti-angiogenesis response in subcutaneous transplantation tumor model of hepatocellular carcinoma in nude mice.Methods:Sixteen nude mice were randomly divided into control group and bevacizumab treatment group (treatment group). Two weeks later, the model of subcutaneous transplanted tumor was established. The mice in the treatment group were intratumorally injected with 0.2 mg bevacizumab, while the control group was given the same amount of saline, three times a week for 2 weeks. Ultrasound microbubbles targeting VEGFR-2 were prepared by biotin avidin method. Ultrasound examinations were performed before treatment, 7 days and 14 days after treatment, and the time intensity curve (TIC) was drawn to quantitatively analyze the differences of parameters with treatment time. The expression of CD31 in tumor tissues was detected by immunohistochemistry.Results:After 14 days of treatment, the volume of tumor tissue in the treatment group and the control group were (0.247±0.019) mm 3 and (0.307±0.031) mm 3, respectively, the difference was statistically significant ( P<0.01). After 7 days of treatment, the rise slope (K 1), time to peak (TTP) and peak intensity (PI) of TIC curve in the treatment group were 3.77±0.62, (3.82±0.21) s and (24.35±3.34) dB, respectively, which were significantly different from 2.93±0.31, (4.47±0.50) s and (30.10±2.35) dB in the control group, respectively ( P<0.05). Immunohistochemistry showed that the PI of contrast enhanced ultrasound was positively correlated with microvessel density ( r2=0.898, P=0.017). Conclusions:The therapeutic effect of bevacizumab on tumor angiogenesis evaluated by contrast-enhanced ultrasound targeting VEGFR-2 is related to the differences of parameters such as K 1, TTP and PI of TIC index. Contrast enhanced ultrasound targeting VEGFR-2 is of great value in non-invasive monitoring of subcutaneous transplanted tumor model of hepatocellular carcinoma in nude mice.

Objective: To study the expression and distribution of filaggrin (FLG) in oral submucous fibrosis (OSF) and to explore the significance of FLG in the occurrence and development of OSF. Methods : Ten cases with a normal oral mucosa (normal buccal mucosa group) and 30 cases of tissues with OSF lesions, including 10 cases each in the early (early OSF group), moderate (middle OSF group) and advanced stages (late OSF group), were selected. FLG was analyzed by immunohistochemistry. The FLG-positive cells were counted to calculate the percentages of cells with FLG-positive expression in each group. Results: FLG expression was negative in most of the normal buccal mucosa group specimens and was positive in the OSF buccal mucosal epithelial specimens. With aggravation of the OSF lesion, the number of FLG-positive cells increased. In the early OSF group, FLG-positive expression was mainly concentrated in the granular and keratinized epithelial layers. In the middle OSF group, the number of FLG-positive epithelial cells increased gradually. In the late OSF group, almost all epithelial cells were FLG-positive in the cytoplasmic nucleus. The percentages of FLG-positive cells in the early, middle and late OSF groups were (24.63 ± 9.06)%, (54.23 ± 10.63)% and (83.97 ± 8.72)%, respectively. The percentage of FLG-positive cells was significantly higher in the OSF group than in the normal mucosa group (P < 0.05). Conclusion FLG was expressed at a higher level in the OSF epithelium than in the normal oral mucosal epithelium and was upregulated in the OSF epithelium with aggravation of the OSF lesions. Abnormal FLG expression may be related to the terminal differentiation disorder of OSF epithelial keratinocytes.

From year 2013 to 2016, the Beijing Municipal Administration of Hospitals has carried out the role exchange campaign at 22 municipal public hospitals.Through this experience, we can increase mutual trust between doctors and patients and enhance the level of hospital management.The campaign adheres to the principles of hospital public welfare, hospital service, patient safety, medical quality management, and continuous improvement, nursing management and quality control, and hospital management.

OBJECTIVETo investigate the trichostain A (TSA)-induced expression of costinmulatory molecules CD80 and CD86 in HL-60, K562 and mononuclear cells (MNC) of bone marrow in AML patients and its clinical significance.

METHODSThe TSA-induced expression of costimulatory molecules CD80, CD86 in HL-60, K562 and BMMNC, and the cell viability were detected by flow cytometry; the mRNA expression of CD80 and CD86 was detected by RT-PCR; after the TSA-induced HL-60 cells and K562 cells were irradiated with 75 Gy, the effect of these cells on proliferation of PBMNC from healthy volunteers was determined with CCK-8 method.

RESULTSThe HL-60 cells and BMMNC in AML patients expressed CD86, not expressed CD80, while the K562 cells not expressed CD86 and CD80. TSA could up-regulate the expression of CD86 in HL-60 cells and BMMNC of AML patients. The TSA-induced HL-60 cells expressing costimulatory molecule CD86 showed the proliferative effect on BMMNC from healthy volunteers.

CONCLUSIONThe TSA can induce the expression of costimulatory molecule CD86 in HL-60 cells and BMMNC in AML patients, and can improve the proliferation of PBMNC in healthy volunteers.

Objective:To evaluate the effects of HIF-1αprotein in the pathogenesis of oral submucous fibrosis(OSF)tissue.Meth-ods:HIF-1αprotein expression in 30 cases of OSF,5 cases of normale control oral mucosa tissue was studied by SP immunohisto-chemistry with HIF-1αrabbit anti-human polyclonal antibody.Results:The negative expression of HIF-1αwas found in normal oral mucoa tissue and possitive in early,intermediate and advanced stage of OSF(P<0.05 ).Conclusion:HIF-1αprotein may play an importent role in the pathogenesis of OSF.