With the continuous development of cancer treatment technology, the cure rate for tumors in children is increasing. However, the irreversible damage to ovarian development and function by chemotherapy and radiation in surviving children often leads to iatrogenic premature ovarian failure and even infertility. Therefore, it is of great significance to develop fertility preservation techniques for children with tumors. International and domestic guidelines indicate that ovarian tissue cryopreservation and transplantation should be considered first for female children. However, the application of this technique in children is not yet mature. Current research suggests that there are significant structural and functional differences between children's ovaries and adults', and fertility preservation strategies for adults are not fully applicable to children. Therefore, this paper analyzes and reviews the structure and function of children's ovaries, the mechanism of damage to ovarian tissues by chemotherapy and radiation, and the current research and application status of fertility preservation techniques for female children. It also looks forward to the development direction of fertility preservation techniques for female children.

With the continuous development of cancer treatment technology, the cure rate for tumors in children is increasing. However, the irreversible damage to ovarian development and function by chemotherapy and radiation in surviving children often leads to iatrogenic premature ovarian failure and even infertility. Therefore, it is of great significance to develop fertility preservation techniques for children with tumors. International and domestic guidelines indicate that ovarian tissue cryopreservation and transplantation should be considered first for female children. However, the application of this technique in children is not yet mature. Current research suggests that there are significant structural and functional differences between children's ovaries and adults', and fertility preservation strategies for adults are not fully applicable to children. Therefore, this paper analyzes and reviews the structure and function of children's ovaries, the mechanism of damage to ovarian tissues by chemotherapy and radiation, and the current research and application status of fertility preservation techniques for female children. It also looks forward to the development direction of fertility preservation techniques for female children.

Objective:To introduce the early results of total aortic arch replacement (TAA) without cardiopulmonary bypass (CPB) and without interruption of cerebral blood supply, using the technique of arch branches preferential reconstruction and whole brain perfusion for brain protection.Methods:Between June 2020 and March 2021, a total of 9 Stanford type A aortic dissection patients we performed total arch replacement by using the technique of arch branches preferential reconstruction and whole brain perfusion without cardiopulmonary bypass and without interruption of blood supply to the brain. The method of this reconstruction technique is as follows: A 24F aortic cannula was inserted into the true lumen at the root of the transverse innominate artery (IA) to connect one end of the artery for cardiopulmonary bypass. The access was connected to 14F artery via Y-connector and inserted into IA cavity to maintain blood supply to brain. Without cardiopulmonary bypass, the 10 mm branch of the four branch artificial blood vessel was anastomosed with the innominate artery IA. The perfusion collateral was connected to the second end of the artery of CPB (single pump and double tubes) to continue to supply blood for IA. The left common carotid artery (LCA) and left subclavian artery (LSCA) were reconstructed by the same method. When IA and LCA were anastomosed, the distal blood supply was not interrupted. After the three branches of the aortic arch were anastomosed, we started to turn the machine, then cooled down and blocked the ascending aorta to further complete the operation of the aortic root and arch. During the period of lower body circulatory arrest, the whole brain was perfused with low flow.Results:No intraoperative death or perioperative complications occurred in all patients, and they were discharged smoothly. The cardiopulmonary bypass time was (192.4±58.1) min, the aortic clamping time was (128.3±52.4) min, the lower body circulatory arrest time was (29.1±1.3) min, and the postoperative awake time was (8.2±3.7) h.Conclusion:Off-pump arch branches preferential reconstruction can provide physiological whole brain perfusion, shorten the cardiopulmonary bypass time and aortic occlusion time, and the operation is safe and effective.

Objective:To fundamentally solve the problems of valve dysfunction caused by limited size of artificial valve, high requirements for implantation technology, destruction of subvalvular structure and proliferation of fibrous endothelial tissue. We have developed a prosthetic valve with zero left ventricular occupancy. The valve frame is appropriately higher than the existing products, slightly chimney shaped, fully accommodates the movement of the valve leaves in the valve frame, and completely supraannular surgical implantation. This study uses this valve for preclinical animal test.Methods:Seven sheep underwent the replacement of the artificial valve under the direct vision of cardiopulmonary bypass. Warfarin was used for anticoagulation for 6 months 24 hours after operation. The blood biochemistry, anticoagulation and cardiac color Doppler ultrasound were detected after operation. The sheep were killed 180 days later for autopsy to observe whether the artificial valve caused thromboembolism. The efficacy and safety of valve were observed.Results:Two of the seven sheep died within 24 hours after operation, and five survived for a long time. Later, they were killed at 180 days. The mechanical properties of the artificial valve were good, and there was no thromboembolism around the artificial valve and important organs. The tissue layer of suture ring has been completely organized and endothelial cells, and the thickness of tissue layer is about 0.6-1.0 mm. The mitral valve of experimental animals can be opened and closed freely, with smooth surface and no abnormal echo. The follow-up of color Doppler ultrasound showed that the left ventricular ejection fraction was normal (0.60-0.70) before and 6 months after operation. The results of cross valve pressure difference and blood flow velocity of artificial valve were good (vmean was far lower than 5 mmHg(1 mmHg=0.133 kPa) and pmean was lower than 1 m/s) , suggesting that the hemodynamic performance of artificial valve was good. Left ventricular retrograde angiography showed that the artificial valve was completely located in the left atrium with good position and normal opening and closing. There was no obvious perivalvular leakage and other abnormalities. Within 7 days of blood test, the indexes of surgical stress were more abnormal than those before operation. At 12 and 24 weeks, there were no obvious abnormalities in blood routine test, liver and kidney function and other blood test indexes of animals in each group.Conclusion:The new chimney shaped mechanical valve implanted completely above the mitral annulus has good wear resistance, histocompatibility, antithrombotic and hemodynamic performance.

Bone homeostasis is a relative balance between bone formation and resorption. Signal transducer and activator of transcription 3 (STAT3), which is closely related to bone homeostasis, takes part in multiple intracellular and extracellular signal pathways. STAT3 participates in the process of osteoblast differentiation regulated by several factors. It can also maintain bone homeostasis by regulating the recruitment, differentiation and activation of osteoclasts. In addition, STAT3 is involved in the interaction between osteoblasts and osteoclasts. Patients with STAT3 mutations can have several inherited bone metabolism diseases. Furthermore, STAT3 plays a critical role in load-driven bone remodeling. Mechanical stimulation promotes osteoblast differentiation and bone formation through activating or enhancing STAT3 expression during bone remodeling process. This review summarizes the participation of STAT3 in maintaining bone homeostasis together with its possible mechanisms and discusses the connection between STAT3 and mechanical stimulation in bone remodeling, so as to provide a potential pharmacological target for the treatment of bone diseases.

Objective To study the clinical significance of serum hs-CRP level in smokers with carotid atherosclerosis (CA) and analyze its difference in subtypes of CA.Methods Two hundred and ninety-eight smokers with CA served as a smoker group and 120 non-smokers with CA served as a non-smoker group,50 healthy smokers without CA served as control group 1 and 50 healthy non-smokers served as control group 2.Their serum hs-CRP level was measured by colloid-enhanced immunoturbidimetry.Smokers were divided into stable plaque group and unstable plaque group.Effect of smoking on serum hs-CRP level in CA patients was analyzed.Results The serum hs-CRP level was significantly higher in smoker group and control group 1 than in non-smoker group and control group 2 (7.26±4.24 mg/L vs 3.56±2.28 mg/L,4.34±2.74 mg/L vs 3.17± 1.68 mg/L,P＜0.05).The smoking index was positively related with the serum hs-CRP level (r=0.395,P＜0.01).The number of daily smoked cigarettes was significantly greater in unstable plaque group than in stable plaque group (P＜0.05).The recurrence rate of ischemic stroke was significantly higher in smokers with a high serum hs-CRP level than in those with a low serum hs-CRP level (11.36％ vs 2.00％,P＜0.01).Conclusion Smoking can increase the serum hs-CRP level in CA patients,which is closely related with the stability of plaques and the recurrence of ischemic stroke.

Depression is a common psychiatric disorder, and approximately 30% patients with depression do not respond effectively to standard antidepressant medication; this condition is termed treatment resistant depression (TRD) and its neurobiological mechanism remains unclear. Neuroimaging techniques can non-invasively explore changes in brain structure, function and metabolism. These techniques have been applied in neurobiological research of TRD and revealed critical abnormalities in brain structure, function and metabolism in fronto-limbic system. In this paper, we reviewed the latest progress in neuroimaging researches on TRD, providing new insight and imaging evidence for further neurobiological studies of TRD.

Objective To summarize the experience with resurgery for recurrent valvular heart diseases.Methods From June 2004 to June 2015, 28 patients (15 males and 13 females) with ages ranging from 44 to 67 years (55.6±6.5 years) with recurrent heart valve disease underwent resurgery. The reasons for resurgery included perivalvular leakage (7 cases), bioprosthetic valve decline (6 cases in mitral valve and 3 in tricuspid valve), mechanical prostheses dysfunction (2cases), infective endocarditis after valve replacement (2 cases), restenosis of repaired native valve (1 case), and severe tricuspid insufficiency after left-side valve surgery (7 cases). Resurgery included mitral valve replacement in 18 patients and tricuspid valve replacement in 10. All the patients underwent third or fourth or even fifth cardiac surgery for valve replacement.Results There were 2 hospital deaths with a mortality of 7.1% (2/28). The main causes of early-stage deaths were low cardiac output syndrome. The main postoperative complications were respiratory failure in 3, low cardiac output syndrome in 2, reexploration for bleeding in 2 and serious infectious shock in 1. All the patients were found with the great improvement in heart function and the re-implanted prostheses worked well during follow-up.Conclusions Although resurgery for recurrent heart valve disease poses a continuing challenge to cardiac surgeon, it could be performed with the satisfactory results. The keys to a successful cardiac resurgery include appropriate operational timing, refined surgical technique and reasonable perioperative managements.

OBJECTIVETo summarize the clinical features, pathology and surgical treatment experiences in the patients with aortic paravalvular abscess by infective endocarditis.

METHODSThe study consisted of a retrospective analysis of 29 cases with aortic paravalvular abscess by infective endocarditis underwent surgical treatment between January 2001 and June 2013. Among the 29 patients, 22 were male and 7 were female, and the mean age was (37 ± 16) years (range from 11 to 63 years). The primary cardiac disease was congenital aortic valve malformation in 16 patients. There were 15 patients with a history of severe heart failure. Of 29 cases, 8 abscess cavities, 13 pseudoaneurysms and 6 fistulas were found, and complete aortoventricular discontinuity was present in 5 patients with serious infections. Of them, the abscess was above the annulus in 14 patients and below the annulus in 10 patients, and simultaneously involved the annulus above and below in 5 patients. 19 patients were culture positive either positive preoperative blood cultures or positive cultures of surgical specimens, including 9 patients with Staphylococcus infection. The paravalvular defect was repaired by patch in 19 cases, and by local closure in 10 cases. The valvular annulus was reconstructed simultaneously in 16 patients. Aortic valve replacement was performed in 26 patients, and Bentall procedure in 2 patients, including 23 with prosthetic mechanical valve and 5 with biological valve.

RESULTSOf the total 29 patients, 28 patients were recovered, and 1 patient was died of sepsis. During 3 months to 13 years postoperative follow-up (average 4.5 years), one was died of non-cardiac cause, and no patient had recurrent endocarditis and paravalvular leakage.

CONCLUSIONSAortic paravalvular abscess by infective endocarditis is not uncommon, prone to heart failure. According to the different pathological manifestations, the appropriate surgical approach and strategy can achieve satisfactory outcomes.

Abscess ; surgery ; Adolescent ; Adult ; Aortic Valve ; surgery ; Child ; Endocarditis, Bacterial ; complications ; surgery ; Female ; Heart Defects, Congenital ; complications ; surgery ; Heart Valve Diseases ; complications ; surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult