Objective To investigate the effect of percutaneous balloon mitral valvuloplasty under echocardiographic guidance for patients with moderate to severe mitral stenosis during pregnancy. Methods A retrospective observational study was conducted to include pregnant women who were diagnosed with moderate to severe mitral stenosis and underwent percutaneous balloon mitral valvuloplasty under echocardiographic guidance in Fuwai Hospital from August 2018 to June 2022, and their baseline characteristics, surgical outcomes, echocardiographic results, and follow-up results were analyzed. Results A total of 3 pregnant women aged 30-35 years, with gestational age of 19-26 weeks, and New York Heart Association (NYHA) function class Ⅲ were included. All the procedures were successfully performed. The mitral valve orifice area increased from 0.9 cm2 preoperatively to 2.1 cm2 postoperatively. The mean transvalvular pressure gradient decreased from 15.0 mm Hg preoperatively to 6.7 mm Hg postoperatively. No perioperative adverse events occurred. The follow-up time ranged from 3 to 48 months. All patients delivered uneventfully and returned to normal life, with maternal-fetal safety. Conclusion Percutaneous balloon mitral valvuloplasty under echocardiographic guidance is a feasible and effective procedure for the treatment of patients with moderate to severe mitral stenosis in pregnancy, with satisfactory maternal-fetal outcomes.

Objective:To analyze the incidence and risk factors of acute kidney injury in children with biliary atresia after liver transplantation.Methods:The retrospective case-control study was conducted.The clinical data of 115 children with biliary atresia who received liver transplantation for the first time in Beijing Friendship Hospital Affiliated to Capital Medical University from December 2018 to November 2020 were collected.The patients were divided into AKI group ( n=39) and non-AKI group ( n=76) according to the diagnostic criteria of the Kidney Disease Improving Global Outcomes(KDIGO). The differences of clinical indicators between the two groups were compared, and multivariate logistic regression analysis was performed for statistically significant variables ( P<0.05) to further determine the independent risk factors for AKI after liver transplantation. The measurement data of normal distribution were expressed as mean±standard deviation ( ± s), and t-test was used for comparison between groups.Measurement data with non-normal distribution were represented by M( Q1, Q3), and Mann-Whitney U test was used for comparison between groups.Count data were expressed as cases and percentage, and comparisons between groups were made using Chi-square test or Fisher′s exact test. Results:The incidence of AKI in biliary atresia patients after liver transplantation was 33.9%. Univariate analysis showed that there were statistically significant differences in age ( OR=0.721, 95% CI: 0.553-0.938, P=0.014), preoperative infection ( OR=3.307, 95% CI: 1.294-8.468, P=0.013), PELD score ( OR=1.065, 95% CI: 1.031-1.101, P<0.001), serum creatinine numerical value ( OR=0.745, 95% CI: 0.657-0.858, P<0.001), intraoperative red blood cell transfusion ( OR=1.034, 95% CI: 1.028-1.051, P<0.001) and intraoperative plasma transfusion ( OR=1.055, 95% CI: 1.025-1.086, P=0.002) between the AKI group and the non-AKI group ( P< 0.05). Multivariate logistic regression analysis was performed on the selected indicators by univariate analysis, and the results showed that preoperative infection ( OR=3.763, 95% CI: 1.185-11.945, P=0.025) and low serum creatinine ( OR=0.685, 95% CI: 0.570-0.823, P<0.001), intraoperative red blood cell transfusion ( OR=1.033, 95% CI: 1.015-1.056, P=0.028) was independently associated with postoperative AKI ( P<0.05). The inpatient treatment time in ICU and in hospital between the two groups were statistically significant ( P<0.05). Conclusions:Preoperative infection, low creatinine numerical value and intraoperative red blood cell transfusion are independent risk factors for postoperative AKI in children with biliary atresia. AKI may prolong the time in ICU and in hospital.

【Objective】 To explore the factors influencing the survival and prognosis of patients with bladder urothelial carcinoma (BUC) after surgical treatment, and to establish an artificial intelligence algorithm to predict the effects of different surgical regimens. 【Methods】 BUC patients treated with surgery during Jan.2007 and Jan.2019 in The Second Hospital of Dalian Medical University and Nanfang Hospital of Southern Medical University were enrolled. The complete clinical and follow-up data were collected. Deep neural network (DNN) was used to establish an artificial intelligence algorithm model. A prediction model of survival and prognosis was established, and the influencing factors of survival were explored and ranked by the artificial intelligence algorithm. 【Results】 A total of 832 patients were involved, including 438 (52.64%) treated in The Second Hospital of Dalian Medical University, and 394 (47.36%) treated in Nanfang Hospital of Southern Medical University. Of all cases, 579 (69.6%) were non-muscle invasive bladder cancer, and 253 (30.4%) were muscle invasive bladder cancer. Transurethral resection of bladder tumor was conducted in 539 (64.8%) cases, partial cystectomy in 66 (7.9%) cases, and total cystectomy in 227 (27.3%) cases. The data of patients treated in Second Hospital of Dalian Medical University were used for DNN modeling, and the data of patients treated in Nanfang Hospital of Southern Medical University were used for external verification after modeling. Finally, it was concluded that the factors affecting survival and prognosis were T stage, pathological grade, hypertension or cardiovascular and cerebrovascular disease, hemoglobin, blood calcium, smoking, albumin, lymphocytes, age, ratio of albumin/globulin, operation method, N stage, and creatinine clearance rate in descending order. The model could be used for preoperative prediction. 【Conclusion】 Through DNN modeling and external verification, the influencing factors of postoperative survival can be predicted for patients with bladder cancer, and the surgical effects can also be predicted before operation. The model can provide artificial intelligence algorithm support for the selection of surgical methods and postoperative follow-up plans.

Objective:To investigate the dose of intravenously infused cisatracurium for the maintenance of deep neuromuscular blockade during thoracic surgery.Methods:Patients of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 18-64 yr, scheduled for elective thoracic surgery under general anesthesia, were studied.The patients were connected to a muscle relaxation monitor after entering the operating room.After the completion of muscle relaxant calibration and anesthesia induction, cisatracurium was intravenously infused at a constant rate to maintain deep neuromuscular blockade (post-tetanic count [PTC]≤5 ). The infusion rate was calculated by modified Dixon up-and-down method.The first patient received cisatracurium at 0.12 mg·kg -1·h -1.If the PTC was 0 or was maintained≤5 continuously, the infusion rate was decreased 0.01 mg·kg -1·h -1 in the next patient, until PTC was >5 during operation.The mean dose for the patient was used as initial dose.Then the infusion rate was increased/decreased by 0.005 mg·kg -1·h -1.The 95% effective dose of cisatracurium (ED 95) was the median of 6 thresholds. Results:A total of 22 cases completed the study.The ED 95 of continuous intravenous infusion of cisatracurium for the maintenance of deep neuromuscular blockade was 0.108 mg·kg -1·h -1(95% confidence interval 0.105-0.125 mg·kg -1·h -1). Conclusion:The dose of intravenous infusion of cisatracurium for the maintenance of deep neuromuscular blockade during thoracic surgery is 0.108 mg·kg -1·h -1.

Neural precursor cells-expressed developmentally down-regulated protein-8 (NEDD8) is one of the important members of the ubiquitin family, which plays an important role in maintaining cell stability, cell cycle regulation, signal transduction, transcription, and translation, DNA repair, and tumorigenesis through covalently bound substrates (also known as neddylation modification). In recent years, studies have found that the dysfunction of NEDD8 and its related enzymes is common in liver diseases, and is widely involved in the biological processes of hepatitis, liver fibrosis, proliferation, invasion, apoptosis and autophagy of liver cancer cells. This article focuses on the research progress of NEDD8 in liver diseases.

Objective To evaluate the risk factors for interventional treatment of neurological complications in elderly patients with rupture intracranial aneurysms.Methods Form December 2004 to December 2014,520 consecutive old patients (≥ 60 years) with ruptured intracranial aneurysm treated at the Department of Neurosurgery,Changhai Hospital,the Second Military Medical University were enrolled retrospectively.The imaging and clinical follow-up results at day 30 after procedure were documented.According to whether the occurrence of interventional therapy-related neurological complications (including intraoperative aneurysm rupture,interventional therapy-related thromboembolic events,early postoperative aneurysm rebleeding,new postoperative subdural hemorrhage or intraparenchymal hemorrhage),they were divided into a complication group (n =68) and a non-complication group (n =452).Univariate statistical analysis and multivariate Logistic regression analysis were used to screen the independent risk factors for the occurrence of neurologic complications after interventional therapy.Results The incidence of neurological complications in 520 patients with aneurysm was 13.1％ (n =68).Multivariate Logistic regression analysis showed that the history of hypertension (OR,2.207,95 ％ CI 1.149-4.240,P ＜ 0.05),Hunt-Hess grade Ⅳ-Ⅴ (OR,4.287,95％ CI 2.048-8.971,P ＜ 0.01),Fisher grade Ⅲ-Ⅳ (OR,2.686,95％ CI 1.483-4.865,P ＜ 0.01),wide-neeked aneurysm (OR,2.884,95 ％ CI 1.511-5.505,P ＜ 0.01),aneurysm bleb (OR,4.560,95 ％ CI 2.500-8.321,P ＜ 0.01),and aneurysm ＜ 3 mm (OR,5.748,95 ％ CI 2.122-15.570,P ＜ 0.01) were the independent risk factors for treatment-related neurological complications in the interventional treatment of intracranial ruptured aneurysms in the elderly.Conclusion The history of hypertension,high Hunt-Hess grade,high Fisher grade,wide-neck aneurysm,aneurysm bleb,and micro-aneurysm are the independent risk factors for treatment-related neurological complications in interventional treatment of intracranial ruptured aneurysms in the elderly.

Targeted therapies of breast cancer offer a possibility of effective and individualized therapy based on the molecular profile of the tumor.Currently there are three main types of targeted therapeutic drugs for breast cancer,the first category is the monoclonal antibody against the human epidermal growth factor receptor 2 (HER2) including trastuzumab,pertuzumab,lapatinib,T-DM1.The second is targeting VEGF such as bevacizumab.The last one everolimus is a mammalian target of rapamycin (mTOR) inhibitors.A number of trials suggest that the addition of targeted therapy to chemotherapy or endocrine therapy significantly improved PFS and OS in patients with breast cancer.

Objective To screen the risk factors for postoperative residual neuromuscular blockade (RNMB) in the patients undergoing thoracic surgery.Methods A total of 733 patients undergoing elective thoracic surgery with general anesthesia,without neuromuscular disease,skin temperature ≥32 ℃,were transferred to the postanesthesia care unit (PACU) after surgery and given synchronized intermittent mandatory ventilation.Neuromuscular blockade was monitored immediately after admission to the PACU,and the occurrence of postoperative RNMB was defined as a train of four (TOF) ratio ＜90％ at the time of extubation.The patients were divided into RNMB group and nonRNMB group according to whether or not postoperative RNMB occurred.Each parameter of baseline patient characteristics,complications,sites and methods of surgery,anesthesia time,requirement for muscle relaxants during surgery,TOF ratio on arrival to the PACU,requirement for muscle relaxant antagonists in the PACU,and extubation time were recorded.The risk factors of which P values were less than 0.05 would enter the multivariable logistic regression analysis to stratify the risk factors for postoperative RNMB.Results A total of 385 patients developed postoperative RNMB,and the incidence was 52.5％.The results of multivariate logistic regression analysis showed that complications such as diabetes,intraoperative application of two kinds of muscle relaxants,average intraoperative consumption of cisatracurium ≥ 0.14 mg · kg-1 · h-1,TOF ratio on arrival to the PACU ≤ 0.5,and extubation time ≤ 30 min were independent risk factors for postoperative RNMB (P＜0.05).Conclusion Complications such as diabetes,intraoperative application of two kinds of muscle relaxants,average intraoperative consumption of cisatracurium 0.14 mg · kg-1 · h-1,TOF ratio on arrival to the PACU ≤ 0.5,and extubation time ≤ 30 min are independent risk factors for postoperative RNMB in the patients undergoing thoracic surgery.

DNA methylation is one of the most important epigenetic mechanism and molecular biological basis in tumor suppressor gene silencing.It is now well recognized that solid malignant tumors can release a significant amount of genomic DNA into systemic circulation,and with more than 90％ of this total circulating cell-free DNA derived from tumor tissue,which can reflect the overall cell heterogeneity of the tumor itself.In breast cancer,the presence of abnormally high DNA concentrations in plasma has been reported,and changes in the levels of these circulating DNA associated with tumor burden and progression have been confirmed repeatedly.Accumulating data strongly suggested that DNA methylation patterns found in circulating cell free DNA were similarly with the primary tumor,and could be a useful biomarker in early diagnosis,prognosis assessment,and recurrence monitoring for breast cancer patients.Here,we summarize the latest advances in this research field.

Wnt/β-catenin signaling pathway regulates cell proliferation,differentiation,and takes part in the process of gene expression and cell migration.The recent researches have shown that abnormal Wnt/β-catenin signal is closely related to the development of breast cancer and other tumors.Elucidation of the relationship between Wnt/β-catenin and breast cancer can help to reveal its mechanisms and provide a new insight into breast cancer prevention and treatment.Here,we summarize the latest advances about components and mechanism of Wnt/β-catenin pathway in breast cancer as below.