Objective To establish a diagnostic model for scleroderma by combining machine learning and artificial neural network based on mitochondria-related genes.Methods The GSE95065 and GSE59785 datasets of scleroderma from GEO database were used for analyzing expressions of mitochondria-related genes,and the differential genes were identified by Random forest,LASSO regression and SVM algorithms.Based on these differential genes,an artificial neural network model was constructed,and its diagnostic accuracy was evaluated by 10-fold crossover verification and ROC curve analysis using the verification dataset GSE76807.The mRNA expressions of the key genes were verified by RT-qPCR in a mouse model of scleroderma.The CIBERSORT algorithm was used to estimate the bioinformatic association between scleroderma and the screened biomarkers.Results A total of 24 differential genes were obtained,including 11 up-regulated and 13 down-regulated genes.Seven most relevant mitochondria-related genes(POLB,GSR,KRAS,NT5DC2,NOX4,IGF1,and TGM2)were screened using 3 machine learning algorithms,and the artificial neural network diagnostic model was constructed.The model showed an area under the ROC curves of 0.984 for scleroderma diagnosis(0.740 for the verification dataset and 0.980 for cross-over validation).RT-qPCR detected significant up-regulation of POLB,GSR,KRAS,NOX4,IGF1 and TGM2 mRNAs and significant down-regulation of NT5DC2 in the mouse models of scleroderma.Immune cell infiltration analysis showed that the differential genes in scleroderma were associated with follicular helper T cells,immature B cells,resting dendritic cells,memory activated CD4+T cells,M0 macrophages,monocytes,resting memory CD4+T cells and mast cell activation.Conclusion The artificial neural network diagnostic model for scleroderma established in this study provides a new perspective for exploring the pathogenesis of scleroderma.

Objective To establish a diagnostic model for scleroderma by combining machine learning and artificial neural network based on mitochondria-related genes.Methods The GSE95065 and GSE59785 datasets of scleroderma from GEO database were used for analyzing expressions of mitochondria-related genes,and the differential genes were identified by Random forest,LASSO regression and SVM algorithms.Based on these differential genes,an artificial neural network model was constructed,and its diagnostic accuracy was evaluated by 10-fold crossover verification and ROC curve analysis using the verification dataset GSE76807.The mRNA expressions of the key genes were verified by RT-qPCR in a mouse model of scleroderma.The CIBERSORT algorithm was used to estimate the bioinformatic association between scleroderma and the screened biomarkers.Results A total of 24 differential genes were obtained,including 11 up-regulated and 13 down-regulated genes.Seven most relevant mitochondria-related genes(POLB,GSR,KRAS,NT5DC2,NOX4,IGF1,and TGM2)were screened using 3 machine learning algorithms,and the artificial neural network diagnostic model was constructed.The model showed an area under the ROC curves of 0.984 for scleroderma diagnosis(0.740 for the verification dataset and 0.980 for cross-over validation).RT-qPCR detected significant up-regulation of POLB,GSR,KRAS,NOX4,IGF1 and TGM2 mRNAs and significant down-regulation of NT5DC2 in the mouse models of scleroderma.Immune cell infiltration analysis showed that the differential genes in scleroderma were associated with follicular helper T cells,immature B cells,resting dendritic cells,memory activated CD4+T cells,M0 macrophages,monocytes,resting memory CD4+T cells and mast cell activation.Conclusion The artificial neural network diagnostic model for scleroderma established in this study provides a new perspective for exploring the pathogenesis of scleroderma.

Objective To investigate the characteristics of hemodynamics of proper hepatic artery and portal vein after splenectomy and devascularization. Methods The clinical data of 103 patients with portal hypertension who underwent splenectomy and devascularization in the Capital Medical University-Affiliated You'an Hospital from April 2014 to February 2019 were retrospectively analyzed. Their hemodynamics of the proper hepatic artery and portal vein were recorded before and 1 week-, and 1-, 3-, 6-, 12-, and 24-months after surgery and then statistically analyzed. Continuous data with normal distribution were compared using paired-samples t test. Results Compared with the before surgery data, the portal vein diameter, portal vein flow, maximum velocity, and average velocity of the portal vein were all significantly decreased 1-week-, 1-, 3-, 6-, 12-, and 24-months after splenectomy and devascularization (all P < 0.05). The blood flow and velocity of the proper hepatic artery was significantly increased 1 week and 1 month after surgery (all P < 0.05); however, there was no statistically significant difference at 3-, 6-, 12-, and 24-months after surgery. Conclusion The diameter, flow, and flow velocity of the portal vein after splenectomy and devascularization were significantly lower than those before surgery, whereas the proper hepatic artery flow and flow velocity were increased within 1 month after surgery and then returned back to the pre-surgery levels 3 months after surgery.

Objective:To investigate the efficacy and safety of prolonged dual antiplatelet therapy (DAPT) (aspirin + clopidogrel) after coronary artery bypass grafting (CABG) for more than 12 months.Methods:1 900 patients who received CABG treatment in Tianjin Chest Hospital from January 2019 to October 2020 were continuously included, and 1 528 patients were finally identified according to the inclusion and exclusion criteria. According to whether the patients continued to take DAPT treatment 12 months after discharge, they were divided into the extended DAPT group and the standard DAPT group. Cox multivariate regression and propensity score matching (PSM) analysis were performed on major cardiovascular and cerebrovascular adverse events (MACCE) and clinically related bleeding events in the two groups during 12-24 months after discharge to evaluate the efficacy and safety of extended DAPT treatment for more than 12 months. Results:Of the 1 528 patients, 624 (40.8%) continued to take DAPT 12 months after discharge. Compared with patients receiving standard DAPT, patients receiving extended DAPT had a lower incidence of MACCE within 12 to 24 months ( HR=0.597, 95% CI: 0.399-0.892, P=0.012); ( HR=0.519, 95% CI: 0.338-0.798, P=0.003), and there was no significant increase in clinically relevant bleeding risk ( HR=1.209, 95% CI: 0.522-2.798, P=0.658), ( HR=1.112, 95% CI: 0.452-2.737, P=0.817). At the same time, prolonged DAPT treatment also brought a good net benefit. Conclusion:Prolonged DAPT treatment after CABG for more than 12 months significantly reduced the risk of ischemia at 12-24 months after surgery, and did not significantly increase the risk of bleeding at 12-24 months after surgery. It may be beneficial for patients treated with CABG to continue DAPT (aspirin+ clopidogrel) on the basis of intensive DAPT therapy for 1 year.

Objective:To study the impact and the mechanism of splenectomy combined with pericardial devascularization on cirrhotic livers.Methods:Serum samples and clinical data were collected preoperatively and postoperatively from 54 patients with cirrhosis who underwent splenectomy combined with pericardial devascularization from May 2013 to Oct 2014 at Beijing You’an Hospital, Capital Medical University. Changes in hepatic arterial and portal venous blood flow, liver function and fibroscan results were analyzed. The levels of nitric oxide (NO), endothelin-1 (ET-1), interleukin-6 (IL-6), hepatocyte growth factor (HGF), transforming growth factor-β1 (TGF-β1) and matrix metalloproteinase 1 (MMP1) were measured.Results:There were 31 males and 23 females, aged(45.48±10.21)years. Free portal vein pressure decreased significantly from (37.0±7.1) cmH 2O (1 cmH 2O=0.098 kPa) to (26.1±5.7) cmH 2O after surgery ( P<0.05). Significant increases in postoperative lumen diameter (4.0±1.0) mm vs (3.1±0.7) mm were observed, accompanied by increase in peak flow velocity and blood flow of the hepatic artery. Significant deductions in lumen diameter (11.9±2.0) mm vs (13.1±1.9) mm, accompanied by reduction of peak flow velocity and blood flow of the portal vein were observed following surgery (all P<0.05). The NO level was significantly elevated immediately after splenectomy and was subsequently remained at high levels. The ET-1 level decreased 2 days after surgery and became fluctuated at low levels. The IL-6 and HGF levels increased significantly 2 days after surgery and decreased gradually after 7 days and 1 month, respectively. The TGF-β1 and the MMP1 levels increased after surgery. The endotoxin level decreased significantly after surgery (all P<0.05). Conclusion:Splenectomy combined with pericardial devascularization induced hepatic blood flow restoration, hepatocyte regeneration and reversal of fibrosis in cirrhotic livers. Splenectomy has a protective effect on cirrhotic liver when combined with pericardial devascularization.

Objective:To investigate the protective effect of liriodendrin on acute myocardial infarction in rats and to explore the related mechanisms.Methods:From January to December 2019, 30 SPF male Wistar rats with a body weight of(200±10)g were randomly divided into a sham operation group, a control group, and a liriodendringroupwith 10 rats in each group using the numerical sampling method.The liriodendron group was intragastrically administered with a liriodendrinsolution(10 ml/kg)once a day from 5 days before myocardial infarction model construction to 3 days after surgery.The control group and the sham surgery group were intragastrically administered with 10 ml/kg normal saline.After surgery, high-sensitivity troponin T levels were measured in the three groups.Cardiac function of the rats was assessed using echocardiography on the 3rd day post-surgery.Then, the rats were sacrificed, followed by hematoxylin-eosin(HE)staining and TdT-mediated dUTP nick-end labeling(TUNEL)staining of cardiac tissues and measurement of interleukin(IL)-1β and tumor necrosis factor(TNF-α)levels.Western blot and real-time polymerase chain reaction(PCR)were used to detect the expression of apoptosis-related proteins and transcriptional activity.Results:High-sensitivity troponin T levels in the liriodendrin group[(1.74±0.63)μg/L]were lower than in the myocardial infarction group[(3.54±1.60)μg/L]at 2 hours after surgery( t=2.69, P<0.05). Echocardiography showed that, compared with the myocardial infarction group, the ejection fraction was higher in the liriodendrin group, and the left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left ventricular end-diastolic volume and left ventricular end-systolic volume were lower in the liriodendrin group( P<0.05). Histological staining showed that the myocardial tissue of the control group was severely damaged, with infiltration of a large number of in flammatory cells.The number of TUNEL-positive cells in the liriodendrin group(56.66±2.414)was statistically significantly reduced, compared with in the myocardial infarction group(76.55±1.843)( t=6.55, P<0.05). The levels of IL-1β and TNF-α in the myocardial infarction group were higher than those in the liriodendrin group( P<0.05). The expression of apoptosis-related proteins in the liriodendrin group was lower( P<0.05)and the transcriptional activity of mRNA was also lower( P<0.05)than in the myocardial infarction group. Conclusions:Liriodendrin may protect cardiomyocytes after myocardial infarction in rats by inhibiting local inflammation and cell apoptosis.

Objective:To investigate the risk factors of acute kidney injury(AKI) combined with continuous renal replacement therapy(CRRT) after Stanford type A dissection under moderate hypothermia circulatory arrest(MHCA).Methods:From October 2017 to March 2020, all patients with Stanford type A dissection and total arch replacement surgery under MHCA were enrolled. According to whether receiving CRRT treatment, the patients were divided into CRRT group(49 cases) and control group(72 cases). Both tow groups chose the brain protection strategy of moderate hypothermia, the left common carotid artery and the innominate artery were perfused anteriorly. Relevant medical data was collected.Results:There was no statistical difference in age, sex, smoking history, and drinking history between the two groups of patients( P>0.10). There were statistical differences between the two groups in the diameter of the aortic sinus and whether Bentall surgery was performed at the same time( P≤0.05). On the 1st postoperative day, the serum creatinine(sCr) of the CRRT group was significantly higher than that of the control group[(214.04±79.51) μmol/L vs.(127.32±58.08) μmol/L]. The change trend of sCr was not obvious within 2 to 4 days after operation. The sCr of the control group was significantly lower than that of the CRRT group within 4 days after surgery[(264.20±111.76) μmol/L vs.(104.24±76.00) μmol/L]. The diameter of aortic sinus, combined with Bentall surgery, intraoperative red blood cell transfusion, intraoperative platelet transfusion, intraoperative autologous blood transfusion, intraoperative bleeding were positively correlated with whether CRRT was performed after surgery( P<0.10), while intraoperative plasma The amount of blood transfusion was negatively correlated with postoperative CRRT( P<0.05). Conclusion:The diameter of the aortic sinus before surgery, combined Bentall surgery, intraoperative blood transfusion products and intraoperative bleeding are risk factors for postoperative CRRT.

Objective:The investigation and research on the application status of Hepatic Venous Pressure Gradient (HVPG) is very important to understand the real situation and future development of this technology in China.Methods:This study comprehensively investigated the basic situation of HVPG technology in China, including hospital distribution, hospital level, annual number of cases, catheters used, average cost, indications and existing problems.Results:According to the survey, there were 70 hospitals in China carrying out HVPG technology in 2021, distributed in 28 provinces (autonomous regions and municipalities directly under the central Government). A total of 4 398 cases of HVPG were performed in all the surveyed hospitals in 2021, of which 2 291 cases (52.1%) were tested by HVPG alone. The average cost of HVPG detection was (5 617.2±2 079.4) yuan. 96.3% of the teams completed HVPG detection with balloon method, and most of the teams used thrombectomy balloon catheter (80.3%).Conclusion:Through this investigation, the status of domestic clinical application of HVPG has been clarified, and it has been confirmed that many domestic medical institutions have mastered this technology, but it still needs to continue to promote and popularize HVPG technology in the future.

Objective To evaluate the role of live webcast as a new medium in the propaganda and education of liver transplant recipients. Methods According to the contents of live webcast propaganda and education meeting for liver transplant recipients, relevant data of the live webcast meeting were counted and analyzed, including baseline data of participants, participation pattern, viewing frequency and duration, etc. The characteristics between live webcast and traditional propaganda and education meetings were compared. Results By the end of the live webcast meeting, 273 participants were registered, including 2 oversea participants and 271 from China. These domestic participants were from 26 provinces, autonomous regions and municipalities in China. The total number of views was 1 526. Participants attended the meeting by clicking direct link (n=243), WeChat group access (n=22), WeChat chat access (n=7) and Dingding App access (n=1). The viewing duration was (68± 5) min. Compared with the traditional method, the number and places of registers of the live webcast propaganda and education meeting were increased. The questioning methods and filling out follow-up information were more convenient. Participants could attend the meeting free from charge anywhere, and saved more time. The live webcast propaganda and education meeting was not affected by the COVID-19 pandemic, and data statistical method was optimized. Conclusions Live webcast as a new medium, has a wide range of advantages, which provides a novel form of propaganda and education for the recipients after liver transplantation. It is of significance to improve the long-term survival rate and to enhance the quality of life of recipients after liver transplantation.

Objective:To evaluate the effect of coronary artery anatomical score(SYNTAX score) on in-hospital mortality of CABG patients.Methods:The clinical data of patients who were performed with a CABG surgery alone in the Department of Cardiovascular Surgery, Tianjin Chest Hospital from July 2017 to December 2018 were collected. The clinical end point was all-cause in-hospital death or against-advice discharge after surgery. Univariate analysis and multivariate logistic regression analysis were performed on the clinical data of the patients to obtain the risk factors affecting the in-hospital death of CABG in our center, to evaluate the influence of SYNTAX score on the in-hospital death of CABG. Results:Univariate logistic analysis showed that age, critical condition, creatinine level, serum albumin level, NT-proBNP level, NYHA grade, internal mammary artery use, SYNTAX score were correlated with in-hospital mortality. Multivariate analysis showed that age(≥75 years old), history of diabetes mellitus, critical state, creatinine clearance rate < 85 ml/min, albumin <35 g/L, NYHA Ⅲ-Ⅳ, SYNTAX score(≥29) were independent risk factors for in-hospital mortality after CABG. Conclusion:Coronary artery anatomy score - SYNTAX score(≥29) was an independent risk factor for in-hospital mortality in CABG patients in our hospital.