Objective To investigate the risk factors for postoperative gastrointestinal bleeding (GIB) in patients with type A aortic dissection, and further discuss its prevention and treatment. Methods The clinical data of patients with type A aortic dissection admitted to the Department of Cardiovascular Surgery of the First Affiliated Hospital of Naval Medical University from 2017 to 2021 were retrospectively analyzed. Patients were divided into a GIB group and a non-GIB group based on the presence of GIB after surgery. The variables with statistical differences between two groups in univariate analysis were included into a multivariate logistic regression model to analyze the risk factors for postoperative GIB in patients with type A aortic dissection. Results There were 18 patients in the GIB group including 12 males and 6 females, aged 60.11±10.63 years, while 511 patients in the non-GIB group including 384 males and 127 females, aged 49.81±12.88 years. In the univariate analysis, there were statistical differences in age, preoperative percutaneous arterial oxygen saturation (SpO2)<95%, intraoperative circulatory arrest time, postoperative low cardiac output syndrome, ventilator withdrawal time>72 hours, postoperative FiO2≥50%, continuous renal replacement therapy (CRRT) rate, extracorporeal membrane oxygenation (ECMO) rate, infection rate, length of hospital stay and ICU stay, and in-hospital mortality (all P<0.05). In the multivariate logistic regression analysis, preoperative SpO2<95% (OR=10.845, 95%CI 2.038-57.703), ventilator withdrawal time>72 hours (OR=0.004, 95%CI 0.001-0.016), CRRT (OR=6.822, 95%CI 1.778-26.171) were risk factors for postoperative GIB in patients (P≤0.005). In the intra-group analysis of GIB, non-occlusive mesenteric ischemia (NOMI) accounted for 38.9% (7/18) and was the main disease type for postoperative GIB in patients with type A aortic dissection. Conclusion In addition to patients with entrapment involving the superior mesenteric artery who are prone to postoperative GIB, preoperative SpO2<95%, ventilator withdrawal time>72 hours, and CRRT are independent risk factors for postoperative GIB in patients with type A aortic dissection. NOMI is a major disease category for GIB, and timely diagnosis and aggressive treatment are effective ways to reduce mortality. Awareness of its risk factors and treatment are also ways to reduce its incidence.

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 analyze the short-term complications and long-term outcomes of spleenpreserving distal pancreatectomy (SPDP) in pediatric pancreatic tumors.Methods A retrospective analysis was conducted on 43 patients with tumors of the body and tail of the pancreas in Beijing Children's Hospital from Jan 2007 to Jan 2018.Results There were 17 boys (39.53％) and26girls (60.47％),with a median age of 123 (80,141) months.The median maximum diameter of primary tumor was 7.60 cm.Diagnoses included solid pseudopapillary tumor (n =28),pancreatoblastoma (n =10),neuroendocrine tumor (n =4),and pancreatic cyst (n =1).Two cases (4.65％) received tumor enucleation,4 cases (9.30％) did distal pancreatectomy plus splenectomy,and 37 cases (86.05％) did SPDP.16 cases (37.21％) had short-term complications,including pancreatic fistula (n =13),delayed gastric emptying (n =3),abdominal infection (n =7) and postoperative bleeding (n =2).After a median follow-up of 46 (23,71) months,38 cases (88.37％) were disease-free;two cases (4.65％) with tumor recurrence;one case of pancreatoblastoma died of tumor recurrence.Two cases lost to follow-up.Three patients had long-term complications,including chronic fatty diarrhea (n =2) and hypoglycemia (n =1).Three patients underwent second operation for recurrent tumor (one pancreatoblastoma and two solid pseudopapillary tumor).Conclusions SPDP is safe and effective in the treatment of tumors of the body and tail of the pancreas in children.

Objective To explore the efficacy of acupuncture in the treatment of nonalcoholic fatty liver disease by using magnetic resonance iterative decomposition of water and fat with echo asymmetry and least-squares estimation-quantitative FAT/R2 * imaging (IDEAL-IQ) technique.Methods Totally 36 patients with nonalcoholic fatty liver were divided into acupuncture group (25 cases) and control group (11cases).The patients were performed liver magnetic resonance IDEAL-IQ and the liver fatty component value (F value) was measured before and after the treatment,at the same time clinical indicators of liver function and blood lipid were measured.The Spearman correlation analysis was used to compare the consistency of F value and blood lipid in all patients.The t test was used to compare the differences of liver F values,liver function,blood lipids and other clinical indicators of two groups before and after the treatment.Results There were significantly positive correlation between the fat component and triglyceride (TG),total cholesterol (TC) level (r =0.836,0.852,P ＜ 0.05),and significant negative correlation between the fat component and high density lipoprotein (HDL) level in the fatty liver group (r =-0.735,P ＜0.05),The liver F values,alanine aminotransferase (ALT) and aspartate aminotransferase (AST) contents and TG,HDL,low density lipoprotein (LDL) and TC contents of the acupuncture group after treatment were statistically significant (P ＜ 0.05).Comparison of each index in the acupuncture group after treatment with the control group,the differences were statistically significant (P ＜ 0.05).Conclusions Acupuncture is an effective approach to treat nonalcoholic fatty liver disease,as it can improve liver function and down-regulate lipid level.Magnetic resonance IDEAL-IQ technique can quantitatively detect its therapeutic efficacy.

Objective To investigate the effect of Santong electroacupuncture (EA) on mRNA and protein expression of p75 neurotroph-in receptor (p75NTR) in rats with spinal cord injury (SCI). Methods A total of 72 female Sprague-Dawley rats were randomly assigned to sham operation group (group A, n=8) and model group (n=64). In the model group, Allen's method was used to make SCI rats model, in which 48 survived model rats were further subdivided into model control group (group B, n=12), EA group (group C, n=12), inhibitor Nogo extra cellular peptide residues 1-40 (NEP1-40) group (group D, n=12) and EA+inhibitor NEP1-40 group (group E, n=12) according to de-sign proposal. The treatment groups were electroacupunctured on Dazhui (GV14) and Yaoyangguan (GV3), bilateral Ciliao (BL32) and Zu-sanli (ST36) with loose-tight wave, for 20 minutes every day. After 7 and 14 days of treatment, injured spinal cord tissue was extracted for detecting. The mRNA and protein expression of p75NTR was detected by real-time fluorescent quantitative PCR, in situ hybridization and Western blotting respectively. The hind limb motor function was assessed with Basso-Beattie-Bresnahan (BBB) score. Results The BBB score increased in the treatment groups compared with group B, and was higher in group E than in groups C and D (P<0.05), as well as on the 14th day than on the 7th day in all the treatment groups (t>2.623, P<0.05). The mRNA and protein expression of p75NTR in spinal cord tissues decreased in the treatment groups compared with group B (P<0.05), and no significant difference was found among the treatment groups (P>0.05). Conclusion Santong elerctroacupuncture treatment could improve the hind limb motor function, which may associate with inhibition of the mRNA and protein expression of p75NTR in rats after SCI.

Objective To explore the effect of single follicular unit transplantation on eyebrow defects caused by burn , trauma, resection, inappropriate eyebrow trimming , congenital sparse or ill eyebrows .Methods A total of 252 patients with 387 eyebrow defects were recruited .The eyebrow contour was designed based on the contra-side eyebrow .The template was needed for bilateral eyebrow defects .The scalp strips from the back occipital or retroauricular region were taken and the grafts were harvested by scalp strip cutting or FUE .Grafts were cut into single follicular unit hair with a stainless steel blade .The recipient area was punched with 21 G or 22 G syringe needle .Then the hair shaft was clamped with microscope slide forceps and the follicles were transplanted to the defect area .Results 17 patients underwent secondary hair transplantation due to sparse hair 6 months after the first operation .12 patients had an obvious difference between the reconstructed eyebrow and the healthy one which can be improved by make-up.3 burn cases developed local infection and then healed after dressing .Transplanted hairs survived well in all the other patients with satisfactory hair direction and appearance .Conclusions It is feasible to use the hair at back occipital region and retroauricular region as donor sites .Hair transplantation could be an optimal choice for the eyebrow defect due to scar , skin graft or skin flap .The syringe needle is convenient as a punch device .Clamping the hair shaft with microscope slide forceps may help to achieve a simulation effect on the eyebrow appearance .

Objective To explore the effect of single follicular unit transplantation on eyebrow defects caused by burn , trauma, resection, inappropriate eyebrow trimming , congenital sparse or ill eyebrows .Methods A total of 252 patients with 387 eyebrow defects were recruited .The eyebrow contour was designed based on the contra-side eyebrow .The template was needed for bilateral eyebrow defects .The scalp strips from the back occipital or retroauricular region were taken and the grafts were harvested by scalp strip cutting or FUE .Grafts were cut into single follicular unit hair with a stainless steel blade .The recipient area was punched with 21 G or 22 G syringe needle .Then the hair shaft was clamped with microscope slide forceps and the follicles were transplanted to the defect area .Results 17 patients underwent secondary hair transplantation due to sparse hair 6 months after the first operation .12 patients had an obvious difference between the reconstructed eyebrow and the healthy one which can be improved by make-up.3 burn cases developed local infection and then healed after dressing .Transplanted hairs survived well in all the other patients with satisfactory hair direction and appearance .Conclusions It is feasible to use the hair at back occipital region and retroauricular region as donor sites .Hair transplantation could be an optimal choice for the eyebrow defect due to scar , skin graft or skin flap .The syringe needle is convenient as a punch device .Clamping the hair shaft with microscope slide forceps may help to achieve a simulation effect on the eyebrow appearance .

Kallistatin, which protects organs and cells against inflammation, fibrosis and oxidative stress, is mainly synthesized and secreted in liver. However, its relationship to human liver disease remains unclear. The purpose of this study was to explore the relationship between serum kallistatin and clinical evidence of both cirrhosis and hepatocellular carcinoma (HCC), and to determine if serum kallistatin levels could be used as a diagnostic indicator of hepatic health status, especially human liver cirrhosis (LC). Our cohort consisted of 115 patients with clinically proven liver fibrosis (LF), LC, or HCC by liver biopsies, and 31 healthy controls (CON). Serum kallistatin levels were quantified by ELISA. Results of the present study demonstrated that irrespective of the underlying etiology, serum kallistatin levels were significantly lower in the LF/LC group when compared with the CON group. A decrease in serum kallistatin levels appeared to reflect the extent of cirrhosis, with the lowest levels associated with higher grades of cirrhosis. Patients with LC had a noticeable correlation between serum kallistatin levels and other serum biochemical indicators. The area under the curve (AUC) for LC, viral liver cirrhosis (VLC) and alcoholic liver cirrhosis (ALC) was 0.845, 0.757 and 0.931, respectively. In conclusion, our findings demonstrated that kallistatin, a plasma protein produced by the liver, can be a useful and reliable diagnostic indicator of hepatic health status, especially for LC.

Human tissue kallikrein-binding protein (Kallistatin, KAL), a secretory protein that participates in the regulation of multiple signaling pathways by binding to the extracellular receptor, however, at present has not been reported about the intracellular activity, and whether it has the similar biological activity with extracellular activity. Here we constructed no signal peptide KAL (NSK) into the adeno-associated virus vector to explore the intracellular activity of KAL. Both the endothelial cell and lung cancer cells could express KAL, but not secreted after rAAV2-NSK transfection. The proliferation and migration of human umbilical vein endothelial cells (HUVECs) were inhibited, but the apoptosis rate was not affected. The proliferation rates, mobility and tubule formation of all the three tested lung cancer cells, such as NCI-H446, NCI-H460 and A549, were inhibited to different extents. This cellular study not only confirmed the intracellular activity, but also suggested it may serve as a kind of "balance factor" in multi-targeted controlling, which may provide a new train of thoughts to explain the regulatory contradiction in PI3K-Akt signaling pathways by KAL.

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