Objective To evaluate the postoperative survival quality in the patients with heart valve re-placement (HVR) in Three Gorges Reservoir area,and to analyze its main influencing factors.Methods A to-tal of 343 valvular heart disease patients from Three Gorges Reservoir area who received HVR treatment for the first time in this hospital from January 2019 to December 2021 were selected by the convenience sampling method.The general data questionnaire and the MOS 36-item short form health survey (SF-36) were adopted to conduct the survey.The main influencing factors affecting the survival quality were analyzed.Results Af-ter HVR,the physical components summary (PCS) score of SF-36 was 238.0±73.6,and the mental compo-nents summary (MCS) score was 254.8±83.6,and the scores in each dimension were significantly lower than those of the Chinese norm (P<0.05).The multiple stepwise linear regression analysis results showed that the age,gender,place of residence,education level,postoperative time,complications and readmission were the influencing factors of PCS and MCS scores (P<0.05).Conclusion The survival quality of the patients af-ter HVR is different from that of healthy population.The targeted intervention could be carried out according to the influencing factors of the survival quality of the patients,so as to improve their survival quality.

Objective    To reveal and demonstrate the hotspots and further research directions in screening technology for early lung cancer, and provide references for the future studies. Methods    Researches related to lung cancer screening from 2011 to 2021 in the Web of Science database were included. Biblioshiny, a bibliometrics program based on R language, was used to perform content analysis and visualization of the included literature information. Results    Researches related to lung cancer screening were increasing year by year. Six major cooperation groups were formed between countries. The current research hotspots in the field of early lung cancer screening technology mainly focused on the multi-directional fusion of radiographic imaging, liquid biopsy and artificial intelligence. Conclusion    Low-dose spiral CT screening is still the most important and mainstream method for the screening of early lung cancer at present. The combination and integration of artificial intelligence with various screening methods and the innovation of novel testing and diagnostic equipment are the current research hotspots and the future research trend in this field.

Objective:To explore the value and technique details of the overlay reconstruction technique of angiography in surgical planning of scalp arteriovenous fistulas.Methods:The clinical data of patients admitted from February 2014 to April 2020 in the Neurosurgical Department of Second Affiliated Hospital of Soochow University with scalp arteriovenous fistulas were analyzed retrospectively. Preoperative angiography was carried out in all patients for diagnosis, and the angiographical data was obtained without injection of the contrast agent by the mode of XperCT Cereb. Fast HD followed by three-dimension rotation angiography (3DRA) with the contrast agent. The overlay reconstruction was achieved for surgical planning to demonstrate feeding arteries and drainage veins surrounding the fistula. Surgeries were conducted by resection or devascularization of the lesion. All patients were followed up in the out-patient clinic to assess the healing and to detect the symptomatic recurrence and scalp necrosis. The pathological changes of the lesion were observed by HE staining.Results:Five patients were enrolled in this study, including three males and two females aged from 10 to 60 years old (average 34.2-year-old). Pulsatile mass of local scalp was presented in all patients, one with a thin scalp. Five patients suffered from five scalp arteriovenous fistulas, including three on the right side and two on the left. Feeding arteries mainly originated from the superficial temporal artery were confirmed in four cases, and the posterior auricular artery in one case. Single venous drainage was noted in two cases, as well as multiple drainage veins in three cases. Three lesions were supplied by unilateral feeding arteries, while bilateral feeding arteries supplied the rest lesions. Two fistulas were treated by resection, two were treated by devascularization, and one was treated by resection with skin grafting. One lesion was fed by a single artery, three lesions were fed by two arteries, and one lesion was fed by three arteries. Three lesions were fed by unilateral arteries, and two lesions were fed by bilateral arteries. Single fistula was detected in one lesion and multiple fistulas in four lesions. Single drainage was confirmed in two lesions, doubled drainages in two lesions, and tripledrainages in one lesion. All patients experienced surgical treatment in one stage.Two patients underwent complete resection of the lesion, two with complete devascularization, and one with autologous thigh skin grafting after resection. Postoperative pathological examination demonstrated dilated and congested vascular lumen, which was consistent with arteriovenous fistula. All patients healed well after surgery. With13-87 months follow-up, no recurrence and necrosis were noted. Two were reexamined by cerebral angiography, which showed no recurrence.Conclusions:Digital subtraction angiography facilitates the diagnosis of scalp arteriovenous fistula accurately and effectively. The overlay reconstruction technique of angiography is crucial for precise localization of fistula shunt and the surrounding feeders and drainages, which is helpful for surgical planning.

Objective:To explore the value and technique details of the overlay reconstruction technique of angiography in surgical planning of scalp arteriovenous fistulas.Methods:The clinical data of patients admitted from February 2014 to April 2020 in the Neurosurgical Department of Second Affiliated Hospital of Soochow University with scalp arteriovenous fistulas were analyzed retrospectively. Preoperative angiography was carried out in all patients for diagnosis, and the angiographical data was obtained without injection of the contrast agent by the mode of XperCT Cereb. Fast HD followed by three-dimension rotation angiography (3DRA) with the contrast agent. The overlay reconstruction was achieved for surgical planning to demonstrate feeding arteries and drainage veins surrounding the fistula. Surgeries were conducted by resection or devascularization of the lesion. All patients were followed up in the out-patient clinic to assess the healing and to detect the symptomatic recurrence and scalp necrosis. The pathological changes of the lesion were observed by HE staining.Results:Five patients were enrolled in this study, including three males and two females aged from 10 to 60 years old (average 34.2-year-old). Pulsatile mass of local scalp was presented in all patients, one with a thin scalp. Five patients suffered from five scalp arteriovenous fistulas, including three on the right side and two on the left. Feeding arteries mainly originated from the superficial temporal artery were confirmed in four cases, and the posterior auricular artery in one case. Single venous drainage was noted in two cases, as well as multiple drainage veins in three cases. Three lesions were supplied by unilateral feeding arteries, while bilateral feeding arteries supplied the rest lesions. Two fistulas were treated by resection, two were treated by devascularization, and one was treated by resection with skin grafting. One lesion was fed by a single artery, three lesions were fed by two arteries, and one lesion was fed by three arteries. Three lesions were fed by unilateral arteries, and two lesions were fed by bilateral arteries. Single fistula was detected in one lesion and multiple fistulas in four lesions. Single drainage was confirmed in two lesions, doubled drainages in two lesions, and tripledrainages in one lesion. All patients experienced surgical treatment in one stage.Two patients underwent complete resection of the lesion, two with complete devascularization, and one with autologous thigh skin grafting after resection. Postoperative pathological examination demonstrated dilated and congested vascular lumen, which was consistent with arteriovenous fistula. All patients healed well after surgery. With13-87 months follow-up, no recurrence and necrosis were noted. Two were reexamined by cerebral angiography, which showed no recurrence.Conclusions:Digital subtraction angiography facilitates the diagnosis of scalp arteriovenous fistula accurately and effectively. The overlay reconstruction technique of angiography is crucial for precise localization of fistula shunt and the surrounding feeders and drainages, which is helpful for surgical planning.

Purpose: Accumulating evidence has suggested that toll-like receptor 4 (TLR4) is critically involved in the pathogenesis of asthma. The aim of this study was to investigate the role of TLR4 in toluene diisocyanate (TDI)-induced allergic airway inflammation. Methods: TLR4−/− and wild-type (WT) C57BL/10J mice were sensitized and challenged with TDI to generate a TDI-induced asthma model. B-cell lymphoma 2 (Bcl-2) inhibitors, ABT-199 (4 mg/kg) and ABT-737 (4 mg/kg), were intranasally given to TDI-exposed TLR4−/− mice after each challenge. Results: TDI exposure led to increased airway hyperresponsiveness (AHR), granulocyte flux, bronchial epithelial shedding and extensive submucosal collagen deposition, which were unexpectedly aggravated by TLR4 deficiency. Following TDI challenge, TLR4−/− mice exhibited down-regulated interleukin-17A and increased colony-stimulating factor 3 in bronchoalveolar lavage fluid (BALF), while WT mice did not. In addition, TLR4 deficiency robustly suppressed the expression of NOD-like receptor family pyrin domain containing 3 and NLR family CARD domain containing 4, decreased caspase-1 activity in TDI-exposed mice, but had no effect on the level of high mobility group box 1 in BALF. Flow cytometry revealed that TDI hampered both neutrophil and eosinophil apoptosis, of which neutrophil apoptosis was further inhibited in TDI-exposed TLR4−/− mice, with marked up-regulation of Bcl-2. Moreover, inhibition of Bcl-2 with either ABT-199 or ABT-737 significantly alleviated neutrophil recruitment by promoting apoptosis. Conclusions These data indicated that TLR4 deficiency promoted neutrophil infiltration by impairing its apoptosis via up-regulation of Bcl-2, thereby resulting in deteriorated AHR and airway inflammation, which suggests that TLR4 could be a negative regulator of TDI-induced neutrophilic inflammation.

During the epidemic of coronavirus disease 2019 (COVID-19), the infection of the elderly population will bring great challenges to clinical diagnosis and treatment, outcome and management.Combined with the characteristics of anesthesia and the pathophysiological characteristics of COVID-19 on lung function impairment in elderly patients, Chinese Society of Anesthesiology formulated the " Recommendations for anesthesia management and infection control in elderly patients with COVID-19″. This recommendation expounds preoperative visit and infection control, anesthesia management protocol, anesthesia monitoring, anesthesia induction/endotracheal intubation, anesthesia maintenance and infection control, intraoperative lung protection strategy, anti-stress and anti-inflammatory management, hemodynamic optimization, infection control during emergence from anesthesia, and postoperative analgesia in elderly patients with COVID-19, and provides the reference for the safe and effective implementation of anesthesia management in elderly patients during the prevention and control of COVID-19 epidemic.

Purpose: Accumulating evidence has suggested that toll-like receptor 4 (TLR4) is critically involved in the pathogenesis of asthma. The aim of this study was to investigate the role of TLR4 in toluene diisocyanate (TDI)-induced allergic airway inflammation. Methods: TLR4−/− and wild-type (WT) C57BL/10J mice were sensitized and challenged with TDI to generate a TDI-induced asthma model. B-cell lymphoma 2 (Bcl-2) inhibitors, ABT-199 (4 mg/kg) and ABT-737 (4 mg/kg), were intranasally given to TDI-exposed TLR4−/− mice after each challenge. Results: TDI exposure led to increased airway hyperresponsiveness (AHR), granulocyte flux, bronchial epithelial shedding and extensive submucosal collagen deposition, which were unexpectedly aggravated by TLR4 deficiency. Following TDI challenge, TLR4−/− mice exhibited down-regulated interleukin-17A and increased colony-stimulating factor 3 in bronchoalveolar lavage fluid (BALF), while WT mice did not. In addition, TLR4 deficiency robustly suppressed the expression of NOD-like receptor family pyrin domain containing 3 and NLR family CARD domain containing 4, decreased caspase-1 activity in TDI-exposed mice, but had no effect on the level of high mobility group box 1 in BALF. Flow cytometry revealed that TDI hampered both neutrophil and eosinophil apoptosis, of which neutrophil apoptosis was further inhibited in TDI-exposed TLR4−/− mice, with marked up-regulation of Bcl-2. Moreover, inhibition of Bcl-2 with either ABT-199 or ABT-737 significantly alleviated neutrophil recruitment by promoting apoptosis. Conclusions These data indicated that TLR4 deficiency promoted neutrophil infiltration by impairing its apoptosis via up-regulation of Bcl-2, thereby resulting in deteriorated AHR and airway inflammation, which suggests that TLR4 could be a negative regulator of TDI-induced neutrophilic inflammation.

Objective To investigate the influence of epidural analgesia on labor duration under the new partogram recommendations using quantile regression.Methods In this study,we recruited 300 nulliparous women at full term who were hospitalized in Department of Obstetrics and Gynecology,Tongji Medical College,Huazhong University of Science and Technology from May to September,2018.The participants who were willing to receive epidural analgesia during labor were assigned to the epidural group (n=150),and those who were not to the control group (n=150).Labor duration and delivery outcomes were analyzed by Student's t test,Mann-Whitney U test,Chi-square test and Fisher's exact test.Quantile regression models were also used to investigate the effect of epidural analgesia on labor duration.Results The median durations of first-and second-stage labor in the epidural group were 600(400-840) and 66(45-98) min,respectively,which were significantly longer than those of the control group [420(320-610) and 52(33-87) min] (Z=-4.273,P＜0.001;Z=-3.210,P=0.001).Quantile regression analysis showed that,for the first stage of labor,epidural analgesia was associated with labor prolongation,and had significant effects on all the percentiles (all P＜0.05).The regression coefficients increased (95.630-285.000) correspondingly as the percentiles of the labor duration (from 10th to 90th percentiles) increased.For the second stage of labor,epidural analgesia showed a significant impact on prolongation only between the 25th and 75th percentiles (coefficients:10.000～18.143;all P＜0.05).Although the epidural group had a significant higher episiotomy rate [46.8％(65/139) vs 33.3％(48/144),x2=5.318,P=0.021],more times of urine catheterization during labor [1(0-1) vs 0(0-1),Z=-0.974,P=0.001]and higher rate of oxytocin administration during labor [48.7％(73/150) vs 30.0％(45/150),x2=10.952,P=0.001],when compared with the control group,there was no significant difference in cesarean section rate,assisted vaginal delivery rate and neonatal outcomes between the two groups (all P＞0.05).Conclusions Epidural analgesia may associated with the prolongation of the first and second stage of labor,especially with the first stage of labor,but has no adverse effects on maternal and neonatal outcomes.

Objective To investigate the expression and significance of BCAR1 protein in endometrial carcinoma.Methods The level of BCAR1 was measured by immunohistochemistry in 50 endometrial carcinoma samples and 30 normal proliferative endometrium samples.Estrogen receptor (ER) and progesterone receptor (PR) expression was investigated in endometrial carcinoma samples.Results The level of BCAR1 was higher in endometrial carcinoma than that in normal proliferative endometrium (64.0％ (32/50) vs.40.0％ (12/30) ;x2 =4.364,P =0.037).In endometrial cancer,increased BCAR1 expression was significantly correlated with relatively higher age,poor differentiation,positive expression of ER (x2 =6.272,r =0.354 ; x2 =5.640,r =0.366 and x2 =4.217,r =0.290 ; P ＜ 0.05).Conclusion BCAR1 promote carcinogenesis and positively correlate with poor differentiation and ER status in endometrial carcinoma.

AIM:To construct recombinant adenovirus vector carrying human miR-133a and study its expression in human mesenchymal stem cells(hMSCs).METHODS:The PCR product containing miR-133a was amplified from human genomic DNA and inserted into the adenoviral shuttle vector pAdTrack-CMV.Then the recombinant shuttle plasmid linearized by pmeⅠwas cotransformed into competent E.coli.BJ5183 with the adenoviral backbone plasmid pAdEasy-1 to generate the recombinant adenovirus vector rAd-mir-133a.rAd-mir-133a was then packaged and amplified in human embryonic kidney 293(HEK293) cells.The purified rAd-miR-133a was used to infect the hMSCs and the expression of miR-133a was detected by non-quantitative RT-PCR and real-time PCR.RESULTS:The recombinant adenovirus shuttle vector pAdTrack-CMV-miR-133a was constructed and verified by restriction endonuclease analysis and DNA sequence analysis.rAd-miR-133a was successfully packaged and amplified in HEK293 cells.The transcriptions of primary miR-133a and mature miR-133a were over-expressed in the hMSCs infected with rAd-miR-133a.CONCLUSION:The recombinant adenovirus vector carrying human miR-133a is successfully constructed,which lay a foundation for miR-133a function study.