Objective To analyze the clinical efficacy of valve surgeries for infective endocarditis and the affecting factors, and compare the early- and long-term postoperative outcomes of different surgery approaches. Methods The patients with infective endocarditis who underwent valve replacement/valvuloplasty in our hospital from 2010 to 2022 were retrospectively collected. The clinical data of the patients were analyzed. Results A total of 343 patients were enrolled, including 197 patients with mechanical valve replacement, 62 patients with bioprosthetic valve replacement, and 84 patients with valvuloplasty. There were 238 males and 105 females with an average age of (44.2±14.8) years. Single-valve endocarditis was present in 200 (58.3%) patients, and multivalve involvement was present in 143 (41.7%) patients. Sixty (17.5%) patients had suffered thrombosis before surgery, including cerebral embolisms in 32 patients. The mean follow-up time was (60.6±43.8) months. Early mortality within one month after the surgery occurred in 17 (5.0%) patients, while later mortality occurred in 19 (5.5%) patients. Eight (2.3%) patients underwent postoperative dialysis, 13 (3.8%) patients suffered postoperative stroke, 6 patients underwent reoperation, and 3 patients suffered recurrence of infective endocarditis. Smoking (P=0.002), preoperative embolisms (P=0.001), duration of surgery (P=0.001), and postoperative dialysis (P=0.001) were risk factors for early mortality, and left ventricular ejection fraction ≥60% (P=0.022) was protective factor for early mortality. New York Heart Association classification Ⅲ-Ⅳ (P=0.010) and ≥3 valve procedures (P=0.028) were risk factors for late mortality. The rate of composite endpoint events was significantly lower in the valvuloplasty group than that in the valve replacement group. Conclusion For patients with infective endocarditis, smoking and preoperative embolisms are associated with high postoperative mortality, multiple-valve surgery is associated with a poorer prognosis, and valvuloplasty has advantages over valve replacement and should be attempted in the surgical management of patients with infective endocarditis.

Objective To compare the perioperative renal function changes in patients undergoing heart transplantation (HT) and left ventricular assist device (LVAD) implantation. Methods Patients with end-stage heart failure who underwent surgical treatment at Beijing Anzhen Hospital, Capital Medical University from January 2019 to April 2024 were included. According to the surgical method, patients were divided into a HT group and a LVAD group, and the estimated glomerular filtration rate (eGFR) of patients before surgery and postoperative 1, 7, 30, 60 days was compared between the two groups. The patients with preoperative renal dysfunction were subdivided into subgroups for comparison of eGFR changes before surgery and 30 days after surgery between the two groups. Results A total of 112 patients were enrolled. There were 78 patients in the HT group, including 61 males and 17 females, aged (44.42±18.51) years. There were 34 patients in the LVAD group, including 30 males and 4 females, aged (54.94±11.37) years. Compared with the HT group, the average age of patients in the LVAD group was greater (P<0.001), body mass index was higher (P=0.008), preoperative eGFR was lower (P=0.009), and the proportions of smokers (P=0.017), alcohol drinkers (P=0.041), and diabetes mellitus (P=0.028) patients were higher. Among patients with preoperative renal dysfunction [eGFR<90 mL/(min·1.73 m2)], compared with the HT group, the postoperative eGFR of the LVAD group was significantly higher than that of the HT group, and it was significantly increased compared with that before surgery; the postoperative eGFR of the HT group was comparable to that before surgery, and more than half of the patients had a lower eGFR than before surgery. Among patients with preoperative renal dysfunction, 11 patients in the HT group received continuous renal replacement therapy, and 8 died early; 2 patients in the LVAD group received continuous renal replacement therapy, and 1 died early. Conclusion For end-stage heart failure patients with combined renal dysfunction, compared with HT, LVAD implantation enables patients to obtain better renal function benefits.

In China, more than half of heart failure patients are ischemic heart failure patients. And a large proportion of left ventricular assist device implantation patients are also ischemic heart failure patients. However, left ventricular assist device implantation in ischemic heart failure patients is facing with problems such as patient screening, coronary artery disease, small left ventricle, mitral insufficiency, and ventricular aneurysm. There are only a few retrospective studies with small sample sizes abroad trying to provide solutions to these problems. While there is a lack of systematic understanding of this issue in China. Therefore, we provide an overview of the application and progress of left ventricular assist devices in ischemic heart failure patients, aiming to help clinicians have a comprehensive understanding of this issue and provide some guidance.

Osteosarcoma, a highly malignant tumor originating from bone tissue, is characterized by a high mortality along with a poor prognosis. The heterogeneity of the tumor microenvironment plays a pivotal role in its development and prognosis. Single-cell sequencing technology emerges as a crucial tool in elucidating this heterogeneity by delineating the functional characteristics and gene expression patterns of tumor cells, immune cells, and stromal cells within osteosarcoma tissues. This technology enables the depiction of the intricate interaction network between these cells. Utilizing the high-resolution advantage of single-cell sequencing, novel cell subtypes such as SPP1 (+) macrophages, C1QC (+) macrophages, and CLEC11A (+) B cells have been identified in osteosarcoma tissues, contributing to tumor growth and invasion within the tumor microenvironment. Identification of osteosarcoma stem cell subpopulations suggests that SERPINA1_CSCL1, FUS_CSCL2, and SPP1_CSCL3 populations may serve as the origin of osteosarcoma cells. Moreover, single-cell sequencing has revealed that mregDCs promote immune escape and tumor progression by selectively expressing CCR7, CCL17, CCL19, and CCL22 factors, thereby recruiting Treg cells. Additionally, this technology aids in the development of personalized chemotherapy regimens by pinpointing potential drug resistance targets in osteosarcoma, leading to the establishment of a drug resistance risk score model. In terms of disease prognosis, single-cell sequencing has identified immune infiltration-associated genes in osteosarcoma (e.g., EPHX2, FDPS, GBP1, MMD, ZYX), facilitating the construction of a prognostic analysis model for osteosarcoma patients, thus aiding in prognostic prediction.

ObjectiveTo investigate the regulatory effects of Xuanfu Daizhetang on a mouse model of allergic asthma induced by ovalbumin （OVA）. MethodSixty female BALB/c mice （6-8 weeks old， SPF） were randomly divided into groups. Ten mice were assigned to the normal group and given 0.2 mL of saline， while the remaining groups received intraperitoneal injections of Al（OH）₃ at 5 g·L^-1 and OVA at 1 g·L^-1. The mice were divided into normal group （10 mL·kg^-1 saline）， OVA model group （10 mL·kg^-1 saline）， dexamethasone group （OVA+DEX， 1 mg·kg^-1）， OVA+ low-dose Xuanfu Daizhetang group （OVA+XL， 7.065 g·kg^-1）， OVA+ medium-dose Xuanfu Daizhetang group （OVA+XM， 14.13 g·kg^-1）， and OVA+ high-dose Xuanfu Daizhetang group （OVA+XH， 28.26 g·kg^-1）. An OVA-induced asthma model was established in mice. Hematoxylin-eosin （HE） and periodic acid-Schiff （PAS） staining methods were used to observe bronchial tissue pathological changes. Enzyme-linked immunosorbent assay （ELISA） was performed to measure the levels of immunoglobulin E （IgE）， interleukin-4 （IL-4）， IL-5， IL-13， IL-17A， and γ interferon （IFN-γ） in bronchoalveolar lavage fluid. Western blot was used to detect the phosphorylation of extracellular signal-regulated kinase （ERK）， p38 mitogen-activated protein kinase （MAPK）， and c-Jun N-terminal kinase （JNK） proteins in lung tissue. ResultCompared with the normal group， the OVA model group showed increased inflammatory cell infiltration in mouse alveoli， elevated levels of IL-4， IL-5， IL-13， IL-17A， IFN-γ in bronchoalveolar lavage fluid， and IgE in serum （P<0.05， P<0.01）， and promoted phosphorylation of MAPK signaling pathway-related proteins. Compared with the model group， the OVA+XL， OVA+XM， and OVA+XH groups showed reduced inflammatory cell infiltration in mouse alveoli， decreased levels of IL-4， IL-5， IL-13， IL-17A， IFN-γ in bronchoalveolar lavage fluid， and IgE in serum （P<0.05， P<0.01）， and inhibited phosphorylation of MAPK signaling pathway-related proteins. ConclusionThe results of this study suggest that Xuanfu Daizhetang has potential anti-allergic asthma activity， providing a theoretical basis for its future clinical application.

Objective:To investigate the etiological characteristics and drug resistance patterns of multidrug-resistant organism (MDRO) infection in patients after cardiac surgery, so as to help clinicians rationally prescribe antimicrobials recommended by guidelines, increase the success rate of empirical antibacterial therapy and improve the prognosis of inpatients.Methods:Clinical data of 409 patients diagnosed with nosocomial infection (NI) after cardiac surgery from January 2018 to October 2021 were retrospectively collected. According to the results of culture, these cases were divided into two groups: MDR bacterial infection group (MDR, n=176) and non-MDR bacterial infection group (non-MDR, n=233). The etiological characteristics of MDRO infection and the patterns of drug resistance to commonly used clinical antibiotics were analyzed. Meanwhile, the etiological distribution, drug resistance and clinical outcome corresponding to different surgical types and clinical infection types were statistically analyzed. Results:A total of 306 strains of MDR bacteria were detected. Among the 176 patients, 97 (55.1%) were infected with more than one kind of MDRO and the mix infections were mainly caused by Klebsiella pneumoniae, Acinetobacter baumannii and/or Pseudomonas aeruginosa. Carbapenem-resistant (CR) bacteria accounted for 69.6% (213/306). Regardless of surgical type and clinical infection type, Acinetobacter baumannii (114/306, 37.3%) was the most common pathogenic bacteria, followed by Klebsiella pneumoniae (72/306, 23.5%) and Pseudomonas aeruginosa (55/306, 18.0%). Most of the clinical specimens were sputum specimens (528/601, 87.9%) and most of the isolated strains were carbapenem resistant, MDR and extensively drug-resistant (XDR). The positive rates of MDR bacteria were 53.7% and 53.1% in patients undergoing coronary artery bypass grafting (CABG) and aortic surgery, respectively, while the positive rates of pandrug-resistant bacteria were relatively low. In vitro drug sensitivity test results showed that MDR bacteria were highly resistant to levofloxacin (64.4%) and cefepime (61.4%), and then to ciprofloxacin (54.6%), ceftazidime (53.9%) and cotrimoxazole (52.4%). However, the resistance rates to polycolistin (5.5%) and amikacin (7.2%) were low. Compared with non-MDR bacteria, MDR bacteria were less susceptible to ceftazidime (χ 2=156.663, P<0.001), ceftriaxone (χ 2=27.844, P<0.001), cefepime (χ 2=210.181, P<0.001), imipenem (χ 2=173.242, P<0.001), levofloxacin (χ 2=201.521, P<0.001), ciprofloxacin (χ 2=180.187, P<0.001), amikacin (χ 2=16.661, P<0.001), gentamicin (χ 2=46.047, P<0.001), tobramycin (χ 2=106.546, P<0.001), piperacillin (χ 2=7.325, P=0.007), ampicillin/sulbactam (χ 2=5.415, P=0.020), piperacillin/tazobactam (χ 2=139.506, P<0.001), cefoperazone/sulbactam (χ 2=102.832, P<0.001), cotrimoxazole (χ 2=121.217, P<0.001), aztreonam (χ 2=6.977, P=0.008) and minocycline (χ 2=53.107, P<0.001). Although there was no significant difference in the detection rates of pathogenic bacteria between patients undergoing different types of surgery or having different types of infection, the mortality rate of NI after cardiac surgery, especially MDR bacterial infection, was as high as 30.0%. Moreover, the mortality rate was closely related to the types of clinical infection. The all-cause mortality of common pulmonary infection and bloodstream infection (BSI) was 10.0% to 20.0%, and once the patient′s condition was not under control and progressed to severe infection or even septic shock, the all-cause mortality would double. Conclusions:MDR bacterial infections would bring great challenges to patients after cardiac surgery, especially gram-negative bacteria (GNB) such as Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa. More than half of the patients would have mixed infections caused by carbapenem resistant, XDR or even pandrug-resistant bacteria, resulting in limited choice of anti-infective drugs and poor prognosis in hospitalized patients.

Objective:To evaluate the perioperative and follow-up data of carotid artery stenting (CAS)+ coronary artery bypass grafting (CABG) and CABG alone, and to assess the safety and efficacy of CAS in the treatment of severe stenosis of the carotid artery in combination with asymptomatic carotid artery stenosis.Methods:A retrospective analysis of 700 CABG patients combined asymptomatic carotid artery severe stenosis at Beijing Anzhen Hospital, Beijing Chaoyang Hospital, and Beijing Tiantan Hospital from January 2018 to December 2022 was performed. According to whether or not underwent CAS treatment, they were divided into the CAS-CABG group(116 cases)and the CABG-only group(584 cases). The mean age of the CAS-CABG group was (64.8±7.3) years, and all of them underwent unilateral CAS surgery only; the mean age of the CABG only group was (65.5±7.6) years. The main results of the patients in the two groups were compared at 30 days after the operation and follow-up period.Results:The early postoperative stroke rate was significantly lower in the CAS-CABG group(2.6% vs. 9.1%, P=0.02), while the combined procedure did not increase the rates of mortality and adverse events during follow-up. Subgroup analysis revealed that there was no significant difference in stroke rates between the two procedures for asymptomatic unilateral carotid artery stenosis, advanced age, history of atrial fibrillation, and history of stroke were independent risk factors for early stroke in CABG for asymptomatic unilateral carotid artery stenosis. Conclusion:CAS-CABG is safe and effective in the treatment of coronary artery disease combined with asymptomatic carotid artery stenosis, and can reduce the incidence of early postoperative stroke in patients. CABG patients with asymptomatic carotid stenosis should be rationally screened for prophylactic CAS to reduce the risk of postoperative stroke in these patients.

The nucleus accumbens shell (NAcSh) plays an important role in reward and aversion. Traditionally, NAc dopamine receptor 2-expressing (D2) neurons are assumed to function in aversion. However, this has been challenged by recent reports which attribute positive motivational roles to D2 neurons. Using optogenetics and multiple behavioral tasks, we found that activation of D2 neurons in the dorsomedial NAcSh drives preference and increases the motivation for rewards, whereas activation of ventral NAcSh D2 neurons induces aversion. Stimulation of D2 neurons in the ventromedial NAcSh increases movement speed and stimulation of D2 neurons in the ventrolateral NAcSh decreases movement speed. Combining retrograde tracing and in situ hybridization, we demonstrated that glutamatergic and GABAergic neurons in the ventral pallidum receive inputs differentially from the dorsomedial and ventral NAcSh. All together, these findings shed light on the controversy regarding the function of NAcSh D2 neurons, and provide new insights into understanding the heterogeneity of the NAcSh.

Objective To explore the effects of tutor psychological counseling on adaptation in freshmen of university. Methods From September 2015 to September 2016, we selected 212 five-year undergraduate freshmen majored in clinical medicine from two classes of 2015 in Hubei University of Medicine as subjects by convenience sampling. Students of class 1 of clinical medicine were set as the experimental group (n=105). Students of class 2 of clinical medicine were set as the control group (n=107). Students of control group were taught according to conventional methods. Otherwise, students of the experimental group accepted targeted psychological counseling by instructors assisted by tutor. All of the students were evaluated with the China College Student Adjustment Scale (CCSAS) when they enrolled and one year after they enrolled. Results After implementing psychological counseling, the scores of 7 dimensions of CCSAS including interpersonal relationship, learning adaptation, campus adaptation, occupational selection, emotion, self-adaptation, satisfaction of students of the experimental group were (35.87±4.528), (45.10±7.682), (29.21±4.243), (33.02±4.290), (29.84±5.000), (29.07±5.432), (18.75±3.419) higher than those [(33.66±5.234), (37.91±8.280), (25.84±4.685), (28.79±3.683), (27.13±4.535), (25.21±4.455), (17.15±3.618)]of the control group with significant differences (t=-3.275, -6.559, -5.422, -7.698, -4.131, -5.650, -3.314; P<0.01). Conclusions Tutor psychological counseling improves the adaptation of freshmen of university. It is worth to be used widely.

Objective To analyze the causes for the biological monitoring abnormal results of the pressure steam sterilizer to eliminate non-standard operation and hidden risks during biological monitoring.Methods Totally 34 secondary or above medical institutions in Chongqing were selected randomly,and questionnaire survey was carried out over biological monitoring abnormal results and main influencing factors of the pressure steam sterilizer.Results Of the 126 abnormal results,there were 63 positive results (accounting for 50％) and the main influencing factors included expiration,aged seal ring,low-efficiency vacuum pump,nonstandard loading,bioindicator reproduction before sterilization,false positive result,polluted moist incubator and etc;There were 35 cases of results related to fast reader (accounting for 27.78％) and the main factors consisted of failure of reading light,improper input of bioindicator,dusts in the reading hole and etc;There were 18 cases of bioindicator discoloration before culture (accounting for 14.28％) and the main factor was reproduction occurred before the gemma was inactivated;There were l0 cases of nondiscoloring in case of positive control (accounting for 7.94％) and the main factors included non-crushed indicating mediostratum cultured in the incubator,insufficient shaking after crushing mediostratum and etc.Conclusion The main factors for abnormal biological monitoring of the sterilizer involve in equipment,personnel and material,and the quality control has to be executed from the three aspects.