Cardiovascular surgery in China has undergone leapfrog development, from learning and introducing technologies, to independent innovation, and now leading the world in some fields. Currently, the continuous decline in the birth rate, accelerated aging process, and westernization of dietary structure have profoundly reshaped the epidemiological spectrum of cardiovascular diseases, posing a " triple impact" on the development of cardiovascular surgery. This article summarizes their impacts: (1) Congenital heart disease (CHD): The reduction in newborns has led to a decrease in the absolute number of surgeries, but the popularization of prenatal diagnosis and improved treatment capabilities have relatively increased the proportion of complex CHD cases. The population of adult CHD patients is large and their management has become more complex. (2) Acquired heart disease: Aging has driven a significant increase in the volume of surgeries for coronary artery bypass grafting (CABG), valvular heart disease (especially degenerative lesions), atrial fibrillation surgery, and heart failure (heart transplantation and left ventricular assist devices). Patients are characterized by advanced age, critical conditions, and multiple comorbidities. (3) Great vessel diseases: Hypertension, atherosclerosis, and aging have caused a sharp increase in the incidence and surgical volume of aortic aneurysms/aortic dissections, with endovascular treatment becoming an important approach. To address these challenges, future development directions focus on: Technological innovation (minimally invasive surgery, interventional/hybrid techniques, mechanical circulatory support, precision medicine, and regenerative medicine); Transformation of diagnosis and treatment models (establishing full-life-cycle management of CHD, strengthening multidisciplinary heart team decision-making, and promoting enhanced recovery after surgery); Resource optimization (regional collaborative hierarchical diagnosis and treatment, capacity building at the grassroots level, and adaptation to medical insurance payment reforms); Talent training and scientific research innovation (cultivating interdisciplinary talents, strengthening clinical research, and innovating domestic medical devices). Cardiovascular surgery in China needs to actively adapt to changes in population structure and safeguard national heart health through continuous innovation and system optimization.

The activation of the sirtuin1 (SIRT1)/nuclear factor erythroid 2-related factor 2 (Nrf2)/heme oxygenase 1 (HO-1) pathway has been shown to mitigate oxidative stress-induced apoptosis and mitochondrial damage by reducing reactive oxygen species (ROS) levels. Clinical trials have demonstrated that Zhongfeng Xingnao Liquid (ZFXN) ameliorates post-stroke cognitive impairment (PSCI). However, the underlying mechanism, particularly whether it involves protecting mitochondria and inhibiting apoptosis through the SIRT1/Nrf2/HO-1 pathway, remains unclear. This study employed an oxygen-glucose deprivation (OGD) cell model using SH-SY5Y cells and induced PSCI in rats through modified bilateral carotid artery ligation (2VO). The effects of ZFXN on learning and memory, neuroprotective activity, mitochondrial function, oxidative stress, and the SIRT1/Nrf2/HO-1 pathway were evaluated both in vivo and in vitro. Results indicated that ZFXN significantly increased the B-cell lymphoma 2 (Bcl2)/Bcl2-associated X (Bax) ratio, reduced terminal deoxynucleotidyl transferase-mediated dUTP nick-end-labeling (TUNEL)⁺ cells, and markedly improved cognition, synaptic plasticity, and neuronal function in the hippocampus and cortex. Furthermore, ZFXN exhibited potent antioxidant activity, evidenced by decreased ROS and malondialdehyde (MDA) content and increased superoxide dismutase (SOD), catalase (CAT), and glutathione (GSH) levels. ZFXN also demonstrated considerable enhancement of mitochondrial membrane potential (MMP), Tom20 fluorescence intensity, adenosine triphosphate (ATP) and energy charge (EC) levels, and mitochondrial complex I and III activity, thereby inhibiting mitochondrial damage. Additionally, ZFXN significantly increased SIRT1 activity and elevated SIRT1, nuclear Nrf2, and HO-1 levels. Notably, these effects were substantially counteracted when SIRT1 was suppressed by the inhibitor EX-527 in vitro. In conclusion, ZFXN alleviates PSCI by activating the SIRT1/Nrf2/HO-1 pathway and preventing mitochondrial damage.
Sirtuin 1/genetics* ; Animals ; NF-E2-Related Factor 2/genetics* ; Cognitive Dysfunction/genetics* ; Male ; Rats, Sprague-Dawley ; Rats ; Humans ; Signal Transduction/drug effects* ; Drugs, Chinese Herbal/administration & dosage* ; Heme Oxygenase-1/genetics* ; Stroke/complications* ; Oxidative Stress/drug effects* ; Apoptosis/drug effects* ; Mitochondria/metabolism* ; Reactive Oxygen Species/metabolism* ; Neuroprotective Agents

Cardiovascular surgery in China has undergone leapfrog development, from learning and introducing technologies, to independent innovation, and now leading the world in some fields. Currently, the continuous decline in the birth rate, accelerated aging process, and westernization of dietary structure have profoundly reshaped the epidemiological spectrum of cardiovascular diseases, posing a " triple impact" on the development of cardiovascular surgery. This article summarizes their impacts: (1) Congenital heart disease (CHD): The reduction in newborns has led to a decrease in the absolute number of surgeries, but the popularization of prenatal diagnosis and improved treatment capabilities have relatively increased the proportion of complex CHD cases. The population of adult CHD patients is large and their management has become more complex. (2) Acquired heart disease: Aging has driven a significant increase in the volume of surgeries for coronary artery bypass grafting (CABG), valvular heart disease (especially degenerative lesions), atrial fibrillation surgery, and heart failure (heart transplantation and left ventricular assist devices). Patients are characterized by advanced age, critical conditions, and multiple comorbidities. (3) Great vessel diseases: Hypertension, atherosclerosis, and aging have caused a sharp increase in the incidence and surgical volume of aortic aneurysms/aortic dissections, with endovascular treatment becoming an important approach. To address these challenges, future development directions focus on: Technological innovation (minimally invasive surgery, interventional/hybrid techniques, mechanical circulatory support, precision medicine, and regenerative medicine); Transformation of diagnosis and treatment models (establishing full-life-cycle management of CHD, strengthening multidisciplinary heart team decision-making, and promoting enhanced recovery after surgery); Resource optimization (regional collaborative hierarchical diagnosis and treatment, capacity building at the grassroots level, and adaptation to medical insurance payment reforms); Talent training and scientific research innovation (cultivating interdisciplinary talents, strengthening clinical research, and innovating domestic medical devices). Cardiovascular surgery in China needs to actively adapt to changes in population structure and safeguard national heart health through continuous innovation and system optimization.

Objective:To investigate the cognition and learning habits of different types of postgraduates and evaluate learning effect and its potential risk factors on clinical epidemiology in a medical college, so as to provide relevant data for improving the teaching method and learning effect of clinical research methods for postgraduates.Methods:A cross-sectional study design was conducted to enroll all the postgraduates of Grade 2020 in a military medical school. A self-filled questionnaire was adopted to collect data. The discrepancy of cognition and learning habits between different types of postgraduates was evaluated by univariate analysis. Discussion was conducted to clarify the potential risk factors of learning effect. t tests or Mann-Whitney U tests were conducted to test the differences between groups for continuous variables. Chi-squared tests or McNemar tests were applied to evaluate the difference between groups for categorical variables. Results:A total of 652 postgraduate students were enrolled for analysis, including 409 master students (62.7) and 243 doctoral students (37.3). The proportion of doctoral students who have heard of clinical epidemiology ( χ2=19.99, P<0.001), who have learned clinical epidemiology ( χ2=9.20, P=0.002), who are interested in ( χ2=11.41, P=0.001) and think the course is important ( χ2=10.71, P=0.001), who previewed before class( χ2=11.21, P=0.001), reviewed after class ( χ2=3.29, P=0.001) and actively discuss in class ( χ2=11.64, P=0.001) is significantly higher than that of master students, the difference was statistically significance. The average score of all the postgraduates was (5.50±1.62) points before teaching and (7.47±1.90) points after teaching, the difference was statistically significant ( t=-23.49, P<0.001). After teaching, the grades of full-time students improved more than that of part-time graduate students, there was statistical significance in the master group ( t=4.41, P<0.001), while not in the doctor group ( t=0.94, P=0.351). Conclusions:The mastery of key points on clinical epidemiology have significantly improved after teaching among the postgraduates of different types. Different teaching methods and processes should be adopted to the variety of postgraduates according to their knowledge foundations and shortcomings. Besides, standardizing their learning habits are of certain significance to improve the learning effect.

BACKGROUND: Hypertension is associated with stroke-related mortality. However, the long-term association of blood pressure (BP) and the risk of stroke-related mortality and the influence path of BP on stroke-related death remain unknown. The current study aimed to estimate the long-term causal associations between BP and stroke-related mortality and the potential mediating and moderated mediating model of the associations. METHODS: This is a 45-year follow-up cohort study and a total of 1696 subjects were enrolled in 1976 and 1081 participants died by the latest follow-up in 2020. COX proportional hazard model was used to explore the associations of stroke-related death with baseline systolic blood pressure (SBP)/diastolic blood pressure (DBP) categories and BP changes from 1976 to 1994. The mediating and moderated mediating effects were performed to detect the possible influencing path from BP to stroke-related deaths. E value was calculated in the sensitivity analysis. RESULTS: Among 1696 participants, the average age was 44.38 ± 6.10 years, and 1124 were men (66.3%). After a 45-year follow-up, a total of 201 (11.9%) stroke-related deaths occurred. After the adjustment, the COX proportional hazard model showed that among the participants with SBP ≥ 160 mmHg or DBP ≥ 100 mmHg in 1976, the risk of stroke-related death increased by 217.5% (hazard ratio [HR] = 3.175, 95% confidence interval [CI]: 2.297-4.388), and the adjusted HRs were higher in male participants. Among the participants with hypertension in 1976 and 1994, the risk of stroke-related death increased by 110.4% (HR = 2.104, 95% CI: 1.632-2.713), and the adjusted HRs of the BP changes were higher in male participants. Body mass index (BMI) significantly mediated the association of SBP and stroke-related deaths and this mediating effect was moderated by gender. CONCLUSIONS In a 45-year follow-up, high BP and persistent hypertension are associated with stroke-related death, and these associations were even more pronounced in male participants. The paths of association are mediated by BMI and moderated by gender.
Adult ; Blood Pressure/physiology* ; China/epidemiology* ; Follow-Up Studies ; Humans ; Hypertension ; Male ; Middle Aged ; Risk Factors ; Stroke

Objective:By describing and analyzing the epidemic characteristics and trends of the attack rate, the crude mortality and relevant indexes in Hubei province during the pandemic of COVID-19 to provide comprehensive evaluations of the epidemic trends and the effects of intervention measures.Methods:Based on the case data reported in Hubei province during the COVID-19 epidemic, combined with the important time of major interventions and event, the cumulative attack rate, the sequential increase rate of new cases, baseline increase rate of new cases, the observation-confirmed case conversion rate, the cumulative crude mortality, the daily severe case rate, and the ratio of death to severe were used to describe and analyze the epidemic characteristics in different phases of the COVID-19 epidemic.Results:The epidemic experienced an outbreak phase from January 10 to February 3 with large amount of case reported, a peak phase from February 4 to February 19 with continuous increasing number of new cases and deaths, a platform phase from February 20 to March 3 with balanced diagnosis and treatment number, and a descending phase from March 4 to March 18 with decreased diagnosis and increased treatment number. Up to March 18, the cumulative attack rate of the COVID-19 epidemic in Hubei province increased from 0.03/10 000 on January 19 to 11.46/10 000, from 0.04/10 000 on January 10 to 45.13/10 000 in Wuhan city, and from 0.002/10 000 on January 20 to 3.70/10 000 in other areas of Hubei province other than Wuhan city. The increase rate of new cases fluctuated during the epidemic period and reached the highest at February 12 in Hubei province. The cumulative crude mortality in Hubei Province increased rapidly from 1.01% on January 19 to 5.13% on January 26, then decreased to 2.54% on February 13, and then slowly increased to 4.62% on March 18, and similar trend was also observed in Wuhan city. The daily severe rate in Hubei Province increased from 26.88% on January 27 to 34.27% on March 18. The ratio of death to severe decreased from 7.37% on January 23 to 0.35% on March 18.Conclusions:The epidemic cycle of COVID-19 in Hubei province proposed to be 60 days, which was about 1.76 times of the combination of the longest incubation period or isolation period (14 d) and the average hospitalization time of confirmed patients in Hubei province (20 d). It suggested that the major anti-epidemic decisions made in China were effective.

Objective To summarize the methods and experiences of one-stage repair of aortic coarctation.Methods During January 2009 and September 2016,31 patients underwent surgery for coarctation of aorta (COA) in our department.Of them,fifteen patients were accompanied by patent ductus arteriosus (PDA),five associated with ventricular septal defect (VSD),five with VSD and PDA,and six patients were single COA.All patients accepted one-stage repair and follow-up.The surgical strategies and follow-up results were retrospectively reviewed.Results Excision of coarctation and anastomoses was performed in 24 patients,a bypass with artificial graft was performed in 3 patients,longitudinally section transverse suture was performed in 2 patients,and aortoplasty with patch graft was used in 2 patients.Accompanied intracardiac malformations were repaired simutaneously.One patient died of low cardiac output syndrome 1 d after operation.Other patients recovered smoothly.Thirty patients were followed up from 6 months to 7 years.The anastomotic systolic pressure difference disappeared in 21 patients.Eight patients still suffered from systolic pressure difference (5-20 mmHg),but had no need of reoperation.One patient suffered from anastomotic recoarctation 2 years and 3 months after operation and the pressure difference was 48 mmHg.After exerting balloon dilatation,the pressure difference reduced to 17 mmHg.Conclusions Surgery is an effective method of COA treatment.The surgical strategies should be selected according to the characters of coarctation lesions,intracardiac malformations,and the age of patient.

Objective To observe the effects of cyclic tensile strain (CTS) on in vitro expression of glycosaminoglycans (GAG) in rabbit chondrocytes of different ages.Methods Nine male New Zealand rabbits were grouped into juvenile (2 months), adult (8 months), and senior (31 months) groups. The bilateral knee joints were harvested using sterile technique from each rabbits. In each age group, rabbit articular chondrocytes were cultivated in vitro after randomization into a control group and a CTS group, with 6 specimens in each. In the next 3 days, CTS was applied (sin10％, 0. 5 Hz, 6 h/d) in the CTS group for 6 hours per day while no CTS was applied in the control group. After the first CTS treatment, the supernatant of cell culture was collected every 12 hours from each specimen in both groups to assess the GAG levels by Alcian blue assay.Results Expressions of GAG showed significant increases in both control and CTS groups in each age group ( P ＜ 0. 05) . Different age groups showed significant differences in the GAG secretion over different time points. Compared with the younger cells, the older ones showed the most significant difference in growth between the control and CTS groups at 12 hours, though the older cells produced less GAG than the younger ones in both groups at the end of the experiment (72 hours).Conclusions CTS can stimulate rabbit chondrocytes of different ages to secrete more GAG, and younger cells tend to produce more GAG than the older ones.

Objective To characterize the biomechanical behavior and properties of the chondrons enzymatically isolated from rabbit knee articular cartilage in virto. Methods Eight months old New Zealand white rabbits were randomly divided into chondroctye and chondron groups (4 rabbits in each group). In chondrocyte groups, the full articular cartilages from both knees were enzymatically isolated to chondrocytes by 0.4% pronase and 0.025% collagenase type-Ⅱ in turn. In chondron groups, chondrons were obtained from articular cartilage using the mixture of 0.3% dispase (a neutral protease) and 0.2% collagenase type-Ⅱin at 37C for 3 h. The micropipette aspiration was used to quantify changes in biomechanical properties of chondrons and chondrocytes and the viscoelastic parameters, including K1, K2, E∞ (equilibrium modulus), E0(instantaneous modulus), and μ (apparent viscosity), were calculated coupled with standard linear half-space viscoelastic solid model. Results In response to a constant negative pressure of 0.2-0.4 kPa, the chondrocytes exhibited standard linear viscoelastic solid properties. Namely, the cells showed an initial elastic response followed by a viscoelastic creep response. then cells continued to enter into the micropipette with a monotonically decreasing rate of deformation, until reaching equilibrium within about (110±18) s. Comparing with chondrocytes, the chondrons exhibited significant viscoelasticity under a greater negative pressure of 1.0-1.2 kPa. But the instantaneous length deformed into the micropipette significantly reduced, and the equilibrium time reduced to (36.5±4.5) s. The equilibrium modulus (E∞), the instantaneous modulus (E0) and the apparent viscosity (μ) of chondrons were significantly higher than the those of chondrocytes. Conclusion Comparing with chondrocytes, the chondrons exhibited significant viscoelastic properties, and viscoelastic properties of chondrons have increased in vitro.

OBJECTIVETo investigate the differences of psychological and behavioral development between children aged 1 to 3 years fostered by grandparents and those by parents.

METHODSPsychological and behavioral development of 443 children aged 1 to 3 years fostered by their grandparents and of aged-matched 443 children fostered by their parents were assessed with DST, an intellectual developmental screening test developed by Pediatric Hospital of Fudan University in Shanghai.

RESULTSThe abilities of social adaptation and intelligence development in children fostered by their grandparents were obviously retarded as compared with those in children fostered by their parents.

CONCLUSIONSThere are shortcomings in psychological and behavioral development in children aged 1 to 3 years fostered by grandparents.

Child Behavior ; Child Development ; Child Rearing ; Child, Preschool ; Female ; Humans ; Infant ; Intelligence ; Intergenerational Relations ; Male ; Parents ; Social Adjustment