Objective To observe the incidence of pericardial tamponade(PT)after left atrial appendage closure(LAAC)in patients with non-valvular atrial fibrillation(NVAF),and to explore its related factors and outcomes.Methods NVAF patients who were hospitalized and treated with LAAC in Department of Cardiology of our hospital from August 2014 to March 2023 were selected for the study.The general clinical data,preoperative transthoracic echocardiography and transesophageal echocardiography data,results of routine preoperative laboratory tests,intraoperative data and follow-up data of the patients were collected through the hospital medical record management system.The enrolled patients were classified into the non-PT group(n=8)and the PT group(n =1184)according to whether PT occurred after LAAC or not.The incidence of PT,related risk factors and outcomes were statistically analyzed.Results This study included 639 males(53.6%)and 553 females(46.4%),with an average age of 68.1±9.65 years.The CHA2 DS2-VASc score was 4.51±1.72,and the HAS-BLED score was 3.36±1.09.PT occurred in 8 cases(0.67%),among them,6 cases occurred 1 to 33 h after LAAC,and 2 cases occurred on day 19 and day 27 after LAAC.As for the results of transesophageal echocardiography(TEE)and LAA angiography,compared with the non-PT group,the PT group had the significantly larger maximum caliber of the LAA(P=0.025,P=0.015),smaller maximum depth of the LAA(P=0.028,P=0.031),and lower success rate of one-time placement of the occluder(P=0.031);The occluder compression rate of the PT group was significantly greater than that of the non-PT group(P=0.046).Multivariate analysis showed that larger maximum diameter of LAA,smaller average effective depth of LAA and larger compression rate of occluder were the main risk factors for PT.All the 8 PT patients were cured by stopping antithrombotic drugs,pericardiocentesis or surgical drainage.During a mean follow-up of 39±27 months,there were no device-related thrombosis(DRT),ischemic stroke,systemic embolism and other complications in the PT group.Conclusion The incidence of PT after LAAC is low,which is related to the large diameter of LAA,the relatively insufficient depth of the LAA and the large compression rate of the occlude.PT can be cured by stopping antithrombotic drugs and pericardiocentesis/surgical drainage.

Objective To optimize the spray drying process of Banlangen(Isatidis Radix)formula granules based on quality by design(QbD)concept.Methods Using powder yield and the contents of uridine,adenosine,guanosine,and(R,S)-goitron as the critical quality attributes(CQAs),Plackett-Burman design was used to screen out critical process parameters(CPPs)for inlet temperature,spray pressure,liquid temperature,pump speed,and liquid relative density.The central-composite design(CCD)test was used to optimize the CPPs,which were screened.Based on the quadratic polynomial regression model,the design space of spray drying process of Banlangen(Isatidis Radix)formula granules was established,and further validated by experiments.Results Plackett-burman test results show that liquid relative density and inlet velocity are the key parameters for the study.The variance analysis results of CCD test showed that the constructed model in a good prediction ability,since the P-values of model was less than 0.01 and P-values of items lack of fit was more than 0.05.The optimized design space of CPPs was the liquid relative density 1.05-1.08,and pump speed 30%-40%.Conclusion Based on the QbD concept,the design space for the spray drying process of Banlangen(Isatidis Radix)formula granules can improve the stability of its process and help ensure the consistency of product quality.

Objective:To evaluate the effect of esketamine on Toll-like receptor 4 (TLR4)/nuclear factor-kappaB (NF-κB) during endotoxin-induced acute lung injury (ALI) in rats.Methods:Thirty SPF healthy male Srague-Dawley rats, weighing 200-220 g, were divided into 3 groups ( n=10 each) using a random number table method: control group (group Con), endotoxin-induced ALI group (group ALI) and esketamine group (group AK). Septic ALI model was developed by intraperitoneal injection of lipopolysaccharide 10 mg/kg. The equal volume of 0.9% sodium chloride was intraperitoneally injected in group Con. Esketamine 10 mg/kg was intraperitoneally injected at 30 min and 12 h after lipopolysaccharide injection in group AK. The rats were anesthetized at 24 h after developing the model, and the carotid blood samples were collected for measurement of PaO 2, and PaO 2/FiO 2 was calculated. The rats were then sacrificed for microscopic examination of the pathological changes of lung tissues which were scored and cell ultrastructure of lung tissues (with an electron microscope) and for determination of the count of the polymorphonuclear leukocyte (PMN) in broncho-alveolar lavage fluid(BALF), activity of myeloperoxidase (MPO) (by colorimetric assay) and expression of TLR4 and NF-κB p65 (by Western blot). The wet/dry lung weight (W/D) ratio was calculated. Results:Compared with group Con, the PaO 2 and PaO 2/FiO 2 were significantly decreased, the lung injury score, PMN count in BALF, W/D ratio and MPO activity were increased, the expression of TLR4 and NF-κB p65 was up-regulated in group ALI ( P<0.05). Compared with group ALI, PaO 2 and PaO 2/FiO 2 were significantly increased, the lung injury score, PMN count in BALF, W/D ratio and MPO activity were decreased, the expression of TLR4 and NF-κB p65 was down-regulated ( P<0.05), and the ultrastructure of lung tissue cells was improved in group AK. Conclusions:The mechanism by which esketamine attenuates endotoxin-induced ALI is associated with the blockade of TLR4/NF-κB signaling pathway in rats.

Rats ; Animals ; Urinary Bladder Neck Obstruction/pathology* ; Survivin/genetics* ; Urinary Bladder/pathology* ; Fibrosis

【Objective】 To study the application effect of gel adsorbent tank in the production of human prothrombin complex concentrate(PCC). 【Methods】 Six batches of PCC were produced from 1000 L cryoprecipitated plasma, using the same gel twice for adsorption within the tank.The number of gel repeated application was examined by retrospective confirmation, and the adsorption rate, specific activity and residue of finished virus inactivation reagent were determined before and after adsorption. 【Results】 All 6 batches of PPC, produced by the same gel, satisfied quality criteria. Both PPC solution and the gel presented good color. The average activities of coagulation Factors Ⅱ, Ⅶ, Ⅸ and Ⅹ of six batches of PCC were 118.2%, 157.0%, 140.5% and 176.8%, respectively. The The adsorption capacity of coagulation factor Ⅱ, Ⅸ and Ⅹ were both 100% in the first and second adsorption, while coagulation factor Ⅶ were 75% and 81%, respectively. The average specific activity of coagulation factor Ⅸ was 0.7 IU/mg. The average residues of polysorbate 80 and tributyl phosphate products were 0 μg/mL and 33 μg/mL, respectively. The same batch of gel can be repeatedly used up to 6 times during the PCC process. 【Conclusion】 The gel adsorption tank presents good application value in the production of PCC, which can realize process amplification and automatic control.

Objective To explore the application and effectiveness of one-staged or two-staged hybrid minimally invasive surgical and transcatheter ablation for long-standing persistent atrial fibrillation(LSPAF).Methods From Jun 2015 to Dec 2017,a cohort of 56 patients[18 female,mean age of(59.1 ±6.9) years] with long-standing persistent atrial fibrillation underwent one-staged(30 cases) or two-staged(26 cases) hybrid minimally invasive surgical and transcatheter ablation.Mean AF duration was(5.9 ± 3.0) years.Mean left atrial diameter was(45.4 ± 4.2) mm.Mean CHA2DS2-VASc score was 2.3 ± 1.2.Fourteen cases had a history of prior catheter ablation.All patients underwent continuous 24-hour or 48-hour holter monitoring at 3 months,6 months,1 year and yearly thereafter.Results All patients successfully underwent one-staged or two-staged hybrid minimally invasive surgical and transcatheter ablation.During ablation,LSPAF was terminated in 80.0％ (24/30) with one-staged hybrid ablation and 84.6％ (22/26) with two-staged hybrid ablation.At a mean follow-up of(20.3 ± 8.2) months,89.3％ (50/56) patients maintained sinus rhythm.Among them,86.7％ (26/30) patients with one-staged hybrid ablation maintained sinus rhythm,and 92.3％ (50/56) patients with two-staged hybrid ablation maintained sinus rhythm.Six patients with recurrent AF continued to receive warfarin and amiodarone drug therapy.No death or cerebrovascular events occurred.No patient required permanent pacemaker implantation.Conclusion One-staged or two-staged hybrid minimally invasive surgical and transcatheter ablation could be safely and effectively applied to the treatment of LSPAF.The early and midterm outcomes were satisfactory.

Objective To evaluate the efficacy and safety of dexmedetomidine applied in the endovascular stent graft exclusion for aortic dissection . Methods From January 2015 to December 2016, 82 patients with type DeBakey Ⅲ aortic dissection in our hospital were divided into either experimental group or control group according to random number table .In the experimental group, patients were given 15 min infusion of dexmedetomidine at 1 μg/kg, followed by 0.3 μg· kg-1 · h-1 continuous infusion .In the control group , patients were given propofol infusion at 4-6μg· kg-1 · h-1 combined with target controlled infusion of remifentanil at 3-5 μg/L.The two groups were operated under local anesthesia .The Ramsay score, MAP, and SpO2 were observed at baseline time ( T0 ) , anesthesia induction ( T1 ) , skin cut ( T2 ) , and accomplishment of surgery ( T3 ) . Results The Ramsay scores of the experimental group were lower than those of the control group at T 0, T1, T2, and T3[T0:(1.8 ±0.4) points vs.(2.1 ±0.6) points, t=2.664, P=0.009;T1:(2.8 ±0.3) points vs.(5.1 ±0.4) points, t=29.454, P=0.000;T2:(3.0 ±0.5) points vs.(4.8 ± 0.3) points, t=19.766, P=0.000; T3: (2.9 ±0.4) points vs.(3.9 ±0.6) points, t=8.880, P=0.000].The MAP of the experimental group was higher than that of the control group at T 1[(76.2 ±10.1) mm Hg vs.(67.2 ±11.4) mm Hg, t=-3.784, P=0.002],and there was no significant difference at other timepoints between the two groups (P >0.05).The SpO2 of the experimental group at T0, T1, and T2 were higher than those of the control group [T0: (96.0 ±1.0)% vs.(95.0 ±1.5)%, t=-3.552, P=0.000;T1:(95.5 ±1.1)% vs.(90.0 ±1.5)%, t=-18.933, P=0.000; T2: (95.0 ±1.3)% vs.(90.8 ± 1.1)%, t=-15.792, P=0.000].There was no significant difference in SpO 2 at T3 between the two groups(t=0.220,P=0.827).Conclusion Dexmedetomidine can be used safely in aortic dissection stent graft exclusion .

Objective To summarize the MRI characteristics of fat-containing hepatocellular carcinoma (HCC).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 18 patients with fat-containing HCC who were admitted to the Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University between January 2015 and April 2016 were collected.All patients underwent MRI examination.Observation indicators:(1) imaging examination;(2) pathological features;(3) treatment and follow-up.Follow-up using outpatient imaging examination was performed to detect tumor recurrence once at 1 month postoperatively and once every 3 months postoperatively up to December 2016.Measurement data with normal distribution were represented as-x±s.Results (1) Imaging examination:plain scans of MRI:of 18 patients,lesions of 9,7 and 2 patients were respectively located in left,right and caudate lobes of liver,and lesions were round-like,with a diameter of 1.6-9.0 cm.Tumors were single,and tumor thrombosis in the hepatic vein was seen in 1 patient.T2WI on fat-suppression of 15 and 3 patients showed respectively high signals and iso-signal;MRI examination showed that out-phase signal on T1WI was variously decreased than in-phase signal,showing focal or diffuse signal decreasing;lipid phase on T1WI showed diffuse distribution in 10 patients,patchy fat-containing regions were scattered within the peritumoral zone in 7 patients,and lipid of 1 patient was located in the central area.Dynamic contrast enhancement MRI showed that fast-in and fast-out,fast-in and slow-out,and slow-in and slow-out types were detected in 16,1 and 1 patients,respectively.Sixteen patients had capsule-like enhancement in delayed phase.Diffusion weighted imaging (DWI) showed high signals in 10 patients,slightly high signals in 6 patients and iso-signal in 2 patients.Apparent diffusion coefficient (ADC) value was (1.19± 0.20)×10-3 mm2/s,including (1.37±0.20) × 10-3 mm2/s in lipid-rich type,(1.17±0.13) × 10-3 mm2/s in clear cell type and (1.11±0.17)× 10-3 mm2/s in thick beam type.Of 18 patients,2 were preoperatively misdiagnosed as hepatic angiomyolipoma and 1 as hepatic adenoma.(2) Pathological features:pathological types of 18 patients with fat-containing HCC:5 and 13 patients were respectively in lipid-rich and non-lipid-rich types (4 in clear cell type and 9 in thick beam type);steatosis tumor cells,rich and translucent cytoplasms and large vacuolated lipid droplets were seen under the microscope;steatosis tumor cells were diffused or scattered within the lesions,some of which showed plaque-like performance of different sizes.Degree of microvascular invasion:grade M0,M1 and M2 were found in 12,3 (2 in thick beam type and 1 in clear cell type) and 3 (2 in thick beam type and 1 in lipid-rich type) patients,respectively.(3) Treatment and follow-up:18 patients underwent surgery and were followed up for 6-13 months,with a median time of 8 months.During the follow-up,5 patients in lipid-rich type and 4 in clear cell type had no recurrence;among 9 patients in thick beam type,1 of 4 with microvascular invasion had no recurrence,2 and 1 of 4 with microvascular invasion had respectively recurrence at 3 months postoperatively and 4 months postoperatively,and 5 without microvascular invasion had no recurrence.The lesions of 3 patients with recurrence is single,3 patients received local minimally invasive therapy and continuous follow-up.Conclusion MRI characteristics of fat-containing HCC include that decreased out-phase signal on T1WI compared with in-phase signal,high signal on DWI,low ADC value,fast-in and fast-out enhancement and capsule-like enhancement in delayed phase.

Objective To investigate the alteration of C/EBP α,C/EBP β and endoplasmic reticulum stress (ERS) related molecules (IRE1α and sXBP1) expression in pancreatic tissues in rats with hypertriglyceridemia related acute pancreatitis.Methods Ninety six Sprague Dawley (SD) rats were divided into 4 groups:control group,hypertriglyceridemia (HTG) group (n =24,fed with high fat diet for 2 weeks),AP group (n =24),HTG + AP group (n =24),and AP was induced by peritoneal injection of cerulein.The rats were sacrificed at 3,6,9,24 h after AP induction,respectively.The pathological changes of the pancreatic tissues were observed and scored by HE staining.Plasma levels of IL-1β,IL-6 and TNF-α were measured by ELISA.The expression of IRE1α,sXBP1,C/EBPoα,C/EBPβ mRNA were analyzed by real time PCR.The expressions of IRE1α,sXBP1,NF-kB,C/EBPα and C/EBPβ protein were determined by Western Blot.The expressions of C/EBPα and C/EBPβ proteins were also determined by immunohitochemistry.Results After two weeks of high fat diet,serum levels of triglyceride(TG) and total cholesterol (TC) in HTG group,HTG + AP group were much higher than those of the control group,and the difference was statistically significant (P ＜ 0.05).The pancreatic tissue injury was more severe in HTG + AP group,particularly at 9 h (P ＜ 0.05).And plasma IL-1β,IL-6 and TNF-α levels were also much higher in HTG + AP group when compared with that of AP group,the differences were all significant at 9 h (P=0.011;P=0.034;P =0.027).After AP induction,IRE1,sXBP1,C/EBP and C/EBPβ mRNA began to be up-regulated at 3 h,and IRE1 mRNA reached the highest level at 24 h,sXBP1 mRNA at 9 h,while C/EBP and C/EBPβ mRNA reached the highest level at 6 h.Compared with AP group,IRE1,sXBP1,C/EBP and C/EBPβ mRNA levels were much higher in HTG + AP group.In addition,as to IRE1 and sXBP1 mRNA,the difference was significant at 3,6,9,24 h,and C/EBP mRNA at 6,9,24 h,C/EBPβ mRNA at 6 and 9 h (P ＜ 0.05).After AP induction,IRE1α,sXBP1 and NF-kB proteins in the pancreatic tissue began to be up-regulated at 3 h,and all reached the highest level at 9 h.IRE1α,sXBP1 and NF-kB proteins were up-regulated more obviously in HTG + AP group,and the up-regulation in HTG + AP group was higher than that in AP group,and the high expressions of C/EBPα and C/EBPβ proteins could only be detected at 6 and 9 h in the HTG + AP group,while there was no expression detected in AP group.Conclusions C/EBPα,C/EBPβ,IRE1α and sXBP1 may be involved in the pathogenesis of HTG related AP,and IRE1α/sXBP1 pathway and C/EBPoα,C/EBPβ may mediate the pathologic injury and inflammation process of HTG related AP.

A reliable UPLC-MS method was developed for the simultaneous determination of 4 chemicals (Sudan Ⅰ, tetrabromobisphenol A, tris ( 1, 3-dichloroisopropyl ) phosphate and tris ( chlorisopropyl ) Phosphate) in children products. The samples were ultrasonic extracted with acetonitrile, and then the four chemicals were separated on a C18 column in 3 min. Results showed that the limit of quantification of the method was between 5 and 500μg/kg. The calibration curves were linear within 2-3 orders of magnitude with typical correlation coefficient above 0 . 9995 . The recoveries ranged from 83 . 7% to 97 . 8% with three addition levels. The sensitivity, recovery and selectivity of the method could fully meet the requirements of practical work.