Objective To compare the early outcomes of domestic third-generation magnetically levitated left ventricular assist device (LVAD) with or without concomitant mitral valvuloplasty (MVP). Methods The clinical data of 17 end-stage heart failure patients who underwent LVAD implantation combined with preoperative moderate to severe mitral regurgitation in Fuwai Central China Cardiovascular Hospital from May 2018 to March 2023 were retrospectively analyzed. The patients were divided into a LVAD group and a LVAD+MVP group based on whether MVP was performed simultaneously, and early outcomes were compared between the two groups. Results There were 4 patients in the LVAD group, all males, aged (43.5±5.9) years, and 13 patients in the LVAD+MVP group, including 10 males and 3 females, aged (46.8±16.7) years. All the patients were successful in concomitant MVP without mitral reguragitation occurrence. Compared with the LVAD group, the LVAD+MVP group had a lower pulmonary artery systolic pressure and pulmonary artery mean pressure 72 h after operation, but the difference was not statistically different (P>0.05). Pulmonary artery systolic pressure was significantly lower 1 week after operation, as well as pulmonary artery systolic blood pressure and pulmonary artery mean pressure at 1 month after operation (P<0.01). There was no statistically significant difference in blood loss, operation time, cardiopulmonary bypass time, aortic cross-clamping time, mechanical ventilation time, or ICU stay time between the two groups (P>0.05). The differences in 1-month postoperative mortality, acute kidney injury, reoperation, gastrointestinal bleeding, and thrombosis and other complications between the two groups were not statistically significant (P>0.05). Conclusion Concomitant MVP with implantation of domestic third-generation magnetically levitated LVAD is safe and feasible, and concomitant MVP may improve postoperative hemodynamics without significantly increasing perioperative mortality and complication rates.

Objective:To investigate the effects of thoracic segment epidural anesthesia on inflammatory factors in patients undergoing lung cancer surgery.Methods:The clinical data of 136 patients who underwent lung cancer surgery in the Second People's Hospital of Liaocheng from June 2020 to May 2022 were retrospectively analyzed. According to anesthesia methods, these patients were divided into an observation group ( n = 89) and a control group ( n = 47). The observation group was given thoracic segment epidural anesthesia, while the control group was given remifentanil infusion anesthesia. The tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10) levels in the epithelial lining fluid collected from the non-dependent lung, the plasma levels of TNF-α, IL-6, and malondialdehyde, arterial partial pressure of oxygen/inhaled oxygen fraction, the incidence of complications, the incidence of re-operations, numeric rating scale score, and the length of hospital stay were compared between the two groups. The effects of different anesthesia methods on lung cancer surgery were evaluated. Results:In each group, TNF-α, IL-6, and IL-10 levels in the epithelial lining fluid were significantly increased 30 minutes after termination of one-lung ventilation (T2) compared with those measured before one-lung ventilation (T1) ( t = 7.71, 77.10, 7.59, 3.41, 57.51, 5.74, all P < 0.05). In the observation group, TNF- α [(1.59 ± 0.53) ng/L, (1.89 ± 0.64) ng/L] measured at T1 and T2, IL-6 [(2.96 ± 0.82) ng/L] and IL-10 [(1.99 ± 0.53) ng/L] measured at T1 were significantly higher compared with those measured at the corresponding time points in the control group ( t = 10.45, 2.59, 2.00, 7.19, all P < 0.05). In the observation group, IL-6 measured at T2 [(38.91 ± 5.84) ng/L] was significantly lower than that in the control group ( t = 33.25, P < 0.001), and IL-10 measured at T2 [(2.51 ± 0.67) ng/L] was slightly, but not significantly higher than that in the control group ( P > 0.05). There was no significant difference in the plasma level of TNF- α measured at T1 and T2 between the two groups (both P > 0.05). Plasma levels of IL-6 in the two groups [(42.98 ± 5.29) ng/L, (27.93 ± 4.17) ng/L] measured at T2 were significantly increased compared with those measured at T1 ( t = 54.14, 61.06, both P < 0.001). In the observation group, TNF-α measured at T2 [(1.60 ± 0.56) ng/L] and IL-6 measured at T1 and T2 [(0.92 ± 0.16) ng/L, (27.93 ± 4.17) ng/L] were significantly lower compared with the control group ( t = 3.39, 6.96, 18.20, all P < 0.05). There were no significant differences in plasma level of malondialdehyde, arterial partial pressure of oxygen/inhaled oxygen fraction, numeric rating scale score, the incidence of complications, the incidence of re-operation, and the length of hospital stay between the two groups (all P > 0.05). Conclusion:Thoracic segment epidural anesthesia can reduce the local inflammatory response of the lung during lung cancer surgery.

With the widespread application of extracorporeal membrane oxygenation (ECMO) technology, ECMO centers have been established in most regions of China, and the demand for ECMO transport is also increasing. Critically ill patients with ECMO carry many catheters. ECMO devices and accessories are cumbersome and numerous, requiring a large amount of manpower to assist in the transfer. At present, most of ECMO transport equipment are vertical carts provided by equipment suppliers, which cannot accommodate all ancillary equipment and are difficult to be loaded into ambulances for transportation. Therefore, critically ill patients face many risks if they need to be transported inter-hospital. A specific vehicle for ECMO patients was designed by the medical staff of the department of critical care medicine of Zhujiang Hospital of Southern Medical University, which integrates the ECMO host, oxygenator, centrifugal pump, portable ventilator, coagulation instrument, injection pump, monitor, oxygen cylinder, and etc., to greatly facilitate the transportionation. This invention obtained the National Utility Model Patent of China (ZL 2019 2 1201261.4). The new ECMO transport vehicle can facilitate the interhospital transport of critically ill patients, reduce the occurrence of accidents, shorten the transport time and reduce the number of transport personnel, and has a good clinical application value.

OBJECTIVE：To study the intervention eff ects and pot ential m echanism of celastrol on non-alcoholic steatohepatitis （NASH）induced by methionine-choline deficiency （MCD）diet. METHODS ：Male C 57BL/6J mice were randomly divided into normal control group ，model group ，celastrol low-dose and high-dose groups [ 0.5，1 mg/（kg·d）]，with 7 mice in each group. The normal control group was given a methionine-choline sufficient diet ，while the model group and administration groups were fed an MCD diet to induce NASH model. At the same time ，normal control group and model group were given polyoxyethylene castor oil intragastrically；administration groups were given relevant drugs intragastrically ；the volume of gavage was 0.1 mL/g，once a day ， for consecutive 4 weeks. The liver morphology was observed ，and the pathological changes of liver tissue were observed by HE staining and oil red O staining. The levels of serum liver enzymes （AST，ALT），and the levels of lipid indexes （TC，TG）in serum and liver tissue were detected by enzyme method. The protein expression of NF-κB p65，TNF-α and IL-6 in liver tissue were determined by Western blotting assay. RESULTS ：Compared with normal control group ，the volume of the liver was reduced and the color was yellow ，and the surface was rough in model group ；inflammatory cell infiltration ，fat vacuoles and lipid droplets aggregation were found in the liver tissue ；the serum levels of TC and TG were significantly decreased ，the levels of serum liver enzymes and protein expression of NF-κB p65，TNF-α and IL-6 in liver tissue were significantly increased （P＜0.01）. Compared with model group ，the liver surface of each administration group was ruddy and smooth without brown spots ，the inflammatory cells and fat vacuoles in liver tissue were reduced ，and the coverage area of lipid droplets was reduced ；the levels of serum TC and TG were significantly increased ，the levels of serum liver enzymes ，the levels of TG and protein expression of NF-κB，TNF-α and IL-6（except for celastrol low-dose group ）in liver tissue were significantly decreased （P＜0.05 or P＜0.01）. CONCLUSIONS ： Celastrol can improve the liver injury of NASH model mice induced by MCD diet ，which is related to the reduction of TG accumulation in liver tissue and inhibition of the expression of inflammatory related factors.

Objective : To evaluate the effects of root calculus residue and root cement preservation by ultrasonic subgingival scaling and root planing (SRP) with or without perioscopy. Methods : Twelve teeth extracted due to severe periodontitis were randomly divided into three groups with four teeth in each group: ① Endoscope-assisted SRP group. The root surfaces of the affected teeth were cleaned with an EMS ultrasonic treatment instrument. ② Traditional SRP group. The affected teeth were treated by ultrasonic subgingival scaling and hand root planing with a Gracey curette. ③ Untreat group. The above operations were performed by the same senior physician. Under local anesthesia, each tooth was scraped for 10 minutes and then extracted. The residual amount of calculus on the root surface after plaque staining was observed and recorded. The thickness of the retained cementum at 1/3 of the root neck was measured. Results: The residual rate of calculus on the root surface was the lowest in the endoscope-assisted SRP group, which was significantly different from the traditional SRP group and the untreated group (P < 0.001). Histological observation showed that the mean residual cementum thickness at 1/3 of the root neck increased gradually from the cemento-enamel junction (CEJ), 2.5 mm below the CEJ and 5 mm below the CEJ. Ultrasound SRP assisted by endoscopy caused less damage to the cementum and preserved the cementum better than traditional subgingival scaling (P < 0.001). Conclusion Compared with traditional SRP therapy, endoscope-assisted SRP treatment can remove subgingival plaque and calculus more effectively and can better preserve the cementum of the root surface.

Neoadjuvant chemotherapy (NACT) is a vital part of the systemic treatment to breast cancer. With the formation of consensuses on NACT, controversial perspectives on NACT have been widely discussed, especially in the fields of indication and therapeutic strategy. To define the indication of NACT, blind obedience to the results of clinical trials is not recommended. Instead, indications of NACT should be strictly controlled based on the targets of the clinical practice. Oriented by the early effectiveness of NACT, various chemotherapy or local therapeutics for different molecular subtypes of breast cancer should be conducted to the patients with unsatisfied effect. What′s more, the evolvement of precision medicine accelerates the research of drugs and helps to form an individualized NACT plan. After clarifying the controversial opinions towards NACT in breast cancer, controlling the indication and optimizing the therapeutic strategy will improve the survival of breast cancer patients.

Objective:To develop an age-appropriate and disease-specific social adaptation measurement tool for adolescents infected with HIV in the context of Chinese culture, and to test its reliability and validity.Methods:Through literature review and consultation with 8 experts, this study constructed the conceptual framework of social adaptation of adolescents infected with HIV and formulated the dimensions and items of the scale. The convenient sampling method was adopted, and questionnaires were distributed online and offline at Beijing Ditan Hospital, Xuzhou Center for Disease Control and Prevention and Yunnan Provincial Infectious Disease Hospital from October 2020 to February 2021 for questionnaire validity testing. A preliminary age-specific and disease-adaptable Social Adaptation Scale for HIV Infected Adolescents was prepared using methods such as project analysis and reliability and validity testing.Results:The scale consisted of 3 dimensions of cognition, emotion and will, 5 variables, and a total of 23 items. The Cronbach's α coefficient of the scale was 0.856, and the split reliability was 0.836. The item-level content validity index ( I- CVI) of the scale was 0.750-1.000, the scale-level content validity index ( S- CVI) was 0.940, and the scale score and subjective well-being scale score were positivelycorrelated ( P<0.05) . Factor analysis extracted 5 common factors, and the cumulative explanatory variable was 61.156%. Conclusions:The scale has good reliability, validity and feasibility, which can be used as an evaluation tool for social adjustment of HIV-infected adolescents in China.

Neoadjuvant chemotherapy (NACT) is a vital part of the systemic treatment to breast cancer. With the formation of consensuses on NACT, controversial perspectives on NACT have been widely discussed, especially in the fields of indication and therapeutic strategy. To define the indication of NACT, blind obedience to the results of clinical trials is not recommended. Instead, indications of NACT should be strictly controlled based on the targets of the clinical practice. Oriented by the early effectiveness of NACT, various chemotherapy or local therapeutics for different molecular subtypes of breast cancer should be conducted to the patients with unsatisfied effect. What′s more, the evolvement of precision medicine accelerates the research of drugs and helps to form an individualized NACT plan. After clarifying the controversial opinions towards NACT in breast cancer, controlling the indication and optimizing the therapeutic strategy will improve the survival of breast cancer patients.

With the increasing cost of drug development and clinical trials, it is of great value to make full use of all kinds of data to improve the efficiency of drug development and to provide valid information for medication guidelines. Model-based meta-analysis (MBMA) combines mathematical models with meta-analysis to integrate information from multiple sources (preclinical and clinical data, etc.) and multiple dimensions (targets/mechanisms, pharmacokinetics/pharmacodynamics, diseases/indications, populations, regimens, biomarkers/efficacy/safety, etc.), which not only provides decision-making for all key points of drug development, but also provides effective information for rational drug use and cost-effectiveness analysis. The classical meta-analysis requires high homogeneity of the data, while MBMA can combine and analyze the heterogeneous data of different doses, different time courses, and different populations through modeling, so as to quantify the dose-effect relationship, time-effect relationship, and the relevant impact factors, and thus the efficacy or safety features at the level of dose, time and covariable that have not been involved in previous studies. Although the modeling and simulation methods of MBMA are similar to population pharmacokinetics/pharmacodynamics (Pop PK/PD), compared with Pop PK/PD, the advantage of MBMA is that it can make full use of literature data, which not only improves the strength of evidence, but also can answer the questions that have not been proved or can not be answered by a single study. At present, MBMA has become one of the important methods in the strategy of model-informed drug development (MIDD). This paper will focus on the application value, data analysis plan, data acquisition and processing, data analysis and reporting of MBMA, in order to provide reference for the application of MBMA in drug development and clinical practice.

Erythroid proliferations in myeloid neoplasms (MN-EP) is a group of heterogeneous diseases characterized by nucleated red blood cell proliferation and ineffective hematopoiesis in the bone marrow. Initial French-American-British (FAB) classification was used to diagnose and classify MN-EP according to morphological criteria. However, with the development of flow cytometry, cytogenetics and molecular biology techniques, FAB classification is obviously insufficient, which can not meet the clinical needs. Therefore, the World Health Organization (WHO) classification has introduced more accurate diagnostic classification standards and revised them several times. This paper reviews the research progress of MN-EP diagnostic classification.