Objective:To evaluate the influence of cytomegalovirus (CMV) infection on T cell senescence and cardiovascular disease (CVD) in maintenance hemodialysis (MHD) patients.Methods:It was a single center cross sectional study. Patients aged over 18 years old and received hemodialysis for at least 6 months at the Blood Purification Centre of the Department of Nephrology of Zhongshan Hospital Affiliated to Fudan University from January 2021 to April 2021 were enrolled. Demographic, hematological, nutritional and inflammatory markers were obtained. Anti-CMV-IgM and IgG antibodies were detected using the Roche Elecsys assay. CD28 - T cell was evaluated by flow cytometry. Mann-Whitney U test or Kruskal-Wallis H test was used for anti-CMV-IgG comparison among groups. Spearman correlation and linear regression were used to assess the relationship between anti-CMV-IgG and CD28 - T cell compartment. Logistic regression was used to assess the relationship between anti-CMV-IgG and CVD. Results:A total of 438 MHD patients (270 men and 168 women) were enrolled in the study. The median age was 62 (51, 70) years. The median time on hemodialysis was 57 (21, 100) months. The primary diseases included chronic glomerulonephritis [213 cases (48.6%)], diabetic nephropathy [82 cases (18.7%)], polycystic kidney disease [34 cases (7.8%)], hypertensive renal disease [34 cases (7.8%)], etc. Of these patients, 430 (98.2%) were seropositive for anti-CMV-IgG, 206 (47.0%) had anti-CMV-IgG titers exceeding the upper limit of 500 U/ml. Patients aged over 70 years old were 100% seropositive for anti-CMV-IgG. Patients on HD for more than 5 years had a higher seropositive rate of 99.1% than those with shorter HD duration, although these results were not statistically significant. Spearman correlation analysis showed that the anti-CMV-IgG titers in MHD patients were positively correlated with the proportion of CD4 + CD28 - T cells and CD8 + CD28 - T cells ( r=0.316, P<0.001; r=0.272, P<0.001). Multiple linear regression analysis showed that after adjusting for age and gender, lg[CD4 + CD28 - T cells(%)] and lg[CD8 + CD28 - T cells(%)] were positively correlated with lg[anti-CMV-IgG titers (U/ml)], respectively ( β=0.455, t=8.315, P<0.001; β=0.412, t=7.282, P<0.001). In analyzing the relationship between anti-CMV-IgG titers and CVD, patients were divided into six groups according to age and anti-CMV-IgG level. Group 1 included young patients with a lower anti-CMV-IgG titers (age ≤55 years old, anti-CMV-IgG <400 U/ml); Group 2 included young patients with a higher anti-CMV-IgG titers (age≤55 years old, anti-CMV-IgG ≥400 U/ml); Group 3 included middle-aged patients with a lower anti-CMV-IgG titers (5565 years old, anti-CMV-IgG<400 U/ml); Group 6 included old aged patients with a higher anti-CMV-IgG titers (age>65 years old, anti-CMV-IgG≥400 U/ml). The incidence of CVD was significantly different among the six groups ( χ2=18.780, P=0.002) and patients aged over 55 years old with higher anti-CMV-IgG level had a higher CVD incidence compared with group 1 ( P<0.05). Multivariate logistic regression analysis showed that increased age ( OR=1.020, 95% CI 1.002-1.038, P=0.033), male ( OR=1.855, 95% CI 1.161-2.965, P=0.010), history of diabetes ( OR=1.867, 95% CI 1.145-3.046, P=0.012), increased lg[NT-proBNP(μg/L)] ( OR=2.848, 95% CI 1.816-4.467, P<0.001) and lg[anti-CMV-IgG (U/ml)] ( OR=3.183, 95% CI 1.582- 6.405, P=0.001) were independent factors associated with CVD in MHD patients. Conclusions:CMV infection is extremely common in MHD patients. Increased anti-CMV-IgG is related to T cell senescence and CVD complications in MHD patients.

Background::Transplant renal artery stenosis (TRAS) is a vascular complication after kidney transplantation associated with poor outcomes. This study aimed to analyze the efficacy and safety of low-dose aspirin for preventing TRAS.Methods::After kidney transplantation, patients were enrolled from January 2018 to December 2020 in Henan Provincial People’s Hospital. A total of 351 enrolled recipients were randomized to an aspirin group with low-dose intake of aspirin in addition to standard treatment ( n = 178), or a control group with only standard treatment ( n = 173). The patients was initially diagnosed as TRAS (id-TRAS) by Doppler ultrasound, and confirmed cases were diagnosed by DSA (c-TRAS). Results::In the aspirin and control groups, 15.7% (28/178) and 22.0% (38/173) of the recipients developed id-TRAS, respectively, with no statistical difference. However, for c-TRAS, the difference of incidence and cumulative incidence was statistically significant. The incidence of c-TRAS was lower in the aspirin group compared with the control group (2.8% [5/178] vs. 11.6% [20/173], P = 0.001). Kaplan–Meier estimates and Cox regression model identified the cumulative incidence and hazard ratio (HR) of TRAS over time in two groups, showing that recipients treated with aspirin had a significantly lower risk of c-TRAS than those who were not treated (log-rank P = 0.001, HR = 0.23, 95% confidence interval [CI]: 0.09–0.62). The levels of platelet aggregation rate ( P < 0.001), cholesterol ( P = 0.028), and low-density lipoprotein cholesterol ( P = 0.003) in the aspirin group were decreased compared with the control group in the third-month post-transplantation. For the incidence of adverse events, there was no statistical difference. Conclusion::Clinical application of low-dose aspirin after renal transplant could prevent the development of TRAS with no significant increase in adverse effects.Trial Registration::Clinicaltrials.gov, NCT04260828.

Objective:To identify the disease-causing mutation in a Chinese family with Stickler syndrome type 1.Methods:The pedigree investigation was conducted.A Chinese family with Stickler syndrome type 1 was enrolled in the Shantou International Eye Center in June 2012.Medical history collection and clinical examinations, such as vision, intraocular pressure, slit lamp microscopy and fundus, were carried out in all the included family members and the diagnosis was made by clinical experts.Total genomic DNAs were extracted from the peripheral blood samples (5 ml) obtained from 5 patients and 4 healthy members.The potential variant of the proband's father Ⅲ-5 were screened by whole exome sequencing (WES) and stepwise bioinformatic analysis.The segregation and mutation conformation of the variant was verified by Sanger sequencing.The pathogenicity of the variant was predicted by SIFT, Polyphen2, and MutationTaster.Conservation and three-dimensional structure of amino acid mutation were analyzed by multiple sequence alignment and UniProt.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Joint Shantou International Eye Center (No.EC20110310[2]-P02).Written informed consent was obtained from each subject or the guardian.Results:An autosomal dominant inherence in 39 members of 4 generations including 15 patients and 24 phenotypically normal members was found in the family.The proband (Ⅳ-4) showed high myopia, retinal detachment and strabismus in the right eye, and the left eye was blind.A patient (Ⅲ-5) showed high myopia and cataract in the right eye, atrophy in the left eye.A patient (Ⅳ-9) showed binocular high myopia.A heterozygous variation, c.1693C>T: p.Arg565Cys, within the exon 26 of COL2A1 gene was revealed in patient Ⅲ-5, which was only found in the patients and not in phenotypically normal members, indiacating co-separation in this family.The variant was predicted to be a severe damage by SIFT, Polyphen2 and MutationTaster.The amino acid mutation at position 565 was highly conservative among human, mouse, rat, bovine and Xenopus laevis, which caused the arginine to cysteine substitution at the X position in triple helix repeat region Gly-X-Y, affecting the function of fibrous protein and becoming pathogenic. Conclusions:Variant c.1693C>T: p.Arg565Cys in COL2A1 gene is disease-causing in this family and this is the first report about the variant in China.

Objective:To evaluate the effect of controlled low central venous pressure with milrinone on laparoscopic hepatectomy in the patients.Methods:Fifty American Society of Anesthesiologists physical statusⅠ-Ⅲ patients of both sexes, aged 18-64 yr, with body mass index of 18-30 kg/m 2, of Child-Pugh grade A or B, undergoing elective laparoscopic hepatectomy, were divided into 2 groups ( n=25 each) using a random number table method: milrinone group (group M) and nitroglycerin group (group NG). After the start of surgery, milrinone 0.5 μg·kg -1·min -1 was continuously infused in group M, and nitroglycerin was continuously infused with the initial dose of 0.5 μg·kg -1·min -1 to maintain central venous pressure (CVP)≤5 mmHg in group NG.Mean arterial pressure and heart rate were recorded on admission to the operation room (T 0), at skin incision (T 1), at the beginning of liver resection (T 2), at completion of liver resection (T 3), at the end of operation (T 4), and CVP, cardiac index and stroke volume variation were recorded at T 1-4.Internal jugular vein blood samples were collected to determine the concentrations of hemogloblin, blood lactate at T 1 and T 4, and serum alanine aminotransferase, aspartate aminotransferase and creatinine concentrations at 1, 3 and 7 days after surgery.The score of blood oozing in hepatic surgical field, amount of norepinephrine used, blood loss, postoperative recovery and occurrence of complications within 7 days after operation were recorded. Results:Compared with group NG, cardiac index was significantly increased at T 2, 3, the CVP was decreased at T 2, the blood oozing score, blood loss, consumption of norepinephrine, and concentrations of blood lactate were decreased, and the postoperative drainage indwelling time was shortened in group M ( P<0.05). There was no significant difference in the serum alanine aminotransferase, aspartate aminotransferase and creatinine concentrations and incidence of postoperative complications at 1, 3 and 7 days after operation between the two groups ( P>0.05). Conclusions:Milrinone is better than nitroglycerin in decreasing central venous pressure, reducing blood loss, maintaining stable circulatory function and tissue perfusion in laparoscopic hepatectomy.

Mongolia is a parliamentary republic country in the north of our country. Healthcare system is mainly composed of three parts: state-owned medical institutions, private clinics and mixed-ownership medical institutions, characteris by the wide coverage but uneven resources. Due to the folk customs and climate, diseases of the digestive system are more common, and the main diseases that cause deaths of Mongolian residents are ischemic heart disease, stroke, and liver cancer. Mongolia is located by and culturally related to China, so the development and dissemination of Traditional Chinese Medicine (TCM) is likely acceptable to the public. Mongolia’s traditional medicine and TCM have long-term exchanges and influences, promoting each other’s development, which also are protected by Mongolian laws. The concerns such as the inheritance, study and protection of Mongolian traditional medicine, the promotion of non-medicinal therapies restrict the development Mongolian and Chinese traditional medicine. It is recommended that Mongolian and TCM jointly promote the development and dissemination of traditional medicine in the world by cultivating high-level medical talents, increasing research and protection of herbal medicines, and expanding the application of non-drug therapies.

Objective: To investigate the incidence of occult cervical lymph node metastasis and the common neck level of metastases in cN0 laryngocarcinoma, and the relationship between the clinicopathologic features of laryngocarcinoma and cervical lymph node metastasis. Methods: A total of 506 cases with cN0 laryngocarcinoma treated at the First Affiliated Hospital of Chongqing Medical University between March 2011 and March 2018 were enrolled, and their medical records and follow-up data were retrospectively analyzed. Of them, 211 cases of were glottic carcinoma in stage T1 without neck dissection and they were observed by clinical follow-up; other 295 cases, including glottic carcinoma, supraglottic carcinoma and hypopharyngeal carcinoma in stage T2-T4 were treated with surgical resection of the primary lesions and selective neck dissection. SPSS 22.0 software was used to analyze the data. Results: The total incidence of cervical lymph node metastasis was 10.87%(55/506), with a lower incidence in T1 stage glottic carcinoma(6/211,2.84%) than that in other cases(49/295,16.61%). The incidence of cervical lymph node metastasis in glottic carcinoma (29/426, 6.81%) was lower than those in supraglottic carcinoma (22/71,30.99%) and subglottic carcinoma (4/9) (χ²=35.810,P<0.01).The pN+ rates of glottic carcinoma at T1, T2, T3 were 2.84%(6/211), 5.31%(6/113), 16.05%(13/81), and 19.05%(4/21), respectively (χ²=18.572, P<0.01). The pN+ rates of supraglottic carcinoma at T2, T3 and T4 were 3/13, 32.50%(13/40) and 6/13, respectively (χ²=3.649,P>0.05). The incidence of cervical lymph node metastasis in poorly differentiated carcinoma (17/42, 40.48%) was higher than those in moderately differentiated carcinoma (26/205, 12.68%) and high differentiated carcinoma(12/246, 4.88%)(χ²=36.356, P<0.01). Moreover, 85 pN+ lymph nodes were obtained by selective neck dissection, respectively 43(50.59%) in level Ⅱa, 30(35.29%) in level Ⅲ, 1(1.18%) in level Ⅳ and 11(12.94%) in level Ⅵ. Conclusions The occult cervical lymph node metastasis was frequently found in cN0 laryngocarcinoma. Selective neck dissection should be performed with surgery for the primary lesions in T3-T4 glottic laryngeal cancer, T2-T4 supraglottic laryngeal cancer and subglottic carcinoma, and the neck dissection for level Ⅱa and Ⅲ is appropriate. It is required to detect pre-laryngeal and pre-tracheal lymph nodes in patients with subglottic laryngeal carcinoma.

Vena cava filter is a filter device designed to prevent pulmonary embolism caused by thrombus detached from lower limbs and pelvis. A new retrievable vena cava filter was designed in this study. To evaluate hemodynamic performance and thrombus capture efficiency after transplanting vena cava filter, numerical simulation of computational fluid dynamics was used to simulate hemodynamics and compare it with the commercialized Denali and Aegisy filters, and in vitro experimental test was performed to compare the thrombus capture effect. In this paper, the two-phase flow model of computational fluid dynamics software was used to analyze the outlet blood flow velocity, inlet-outlet pressure difference, wall shear stress on the wall of the filter, the area ratio of the high and low wall shear stress area and thrombus capture efficiency when the thrombus diameter was 5 mm, 10 mm, 15 mm and thrombus content was 10%, 20%, 30%, respectively. Meanwhile, the thrombus capture effects of the above three filters were also compared and evaluated by in vitro experimental data. The results showed that the Denali filter has minimal interference to blood flow after implantation, but has the worst capture effect on 5 mm small diameter thrombus; the Aegisy filter has the best effect on the trapping of thrombus with different diameters and concentrations, but the low wall shear stress area ratio is the largest; the new filter designed in this study has a good filtering and capture efficiency on small-diameter thrombus, and the area ratio of low wall shear stress which is prone to thrombosis is small. The low wall shear stress area of the Denali and Aegisy filters is relatively large, and the risk of thrombosis is high. Based on the above results, it is expected that the new vena cava filter designed in this paper can provide a reference for the design and clinical selection of new filters.
Blood Flow Velocity ; Hemodynamics ; Humans ; Software ; Thrombosis ; therapy ; Vena Cava Filters ; Vena Cava, Inferior

Objective To investigate the disease-causing mutation in a family with Leber congenital amaurosis (LCA).Methods A Chinese Han pedigree with LCA from Chaoshan area was recruited in Shantou International Eye Center in August 2011.The clinical features of the families were evaluated,including medical history,best corrected visual acuity,intraocular pressure and fundus photography.The peripheral blood sample of 5 ml was collected from each of the family members for the extraction of genomic DNA.DNA of the proband was investigated by whole exome sequencing (WES) and was filtered for function of variants and inheritance pattern.Then,Sanger sequencing was performed to confirm the WES result on all the participating subjects in the pedigree.Results There were 11 families of 3 generations in this pedigree,and 2 female LCA patients were found (Ⅱ 2 and Ⅱ4) who were sisters.The parents (Ⅰ-1 and Ⅰ-2) and children (Ⅲ-1,Ⅲ-2,Ⅲ-3 and Ⅲ-4) of the patients showed normal phenotype,suggesting an autosomal recessive pattern.The patients appeared severe visual impairment during early childhood.Ophthalmic examination showed diffuse pigmentation on the retina and attenuation of retinal artery in both patients.WES of proband revealed two compound heterozygous mutations (c.2234C ＞T,p.T745M;c.3488G＞T,p.C1163F) of the CRB1 gene.Sanger sequencing confirmed the mutations in both patients (Ⅱ-2 and Ⅲ-4),and the parents of the patients were found to carry one mutations respectively and the other subjects with normal phenotype had neither none or only one mutation.Conclusions The compound heterozygous mutation of c.2234C＞ T,p.T745M and c.3488G＞T,p.C1163F in CRB1 is responsible for LCA pathogenesis this Chinese Han pedigree.

Objective To explore the impact of local lipiodol deposition in liver of miniature pigs on the shape and size of the necrotic area after microwave ablation (MWA).Methods Ten healthy miniature pigs were selected and equally divided into experimental group and control group (each n=5).In experimental group,transcatheter hepatic arterial embolization with lipiodol was done before microwave ablation,while only standard microwave ablation was performed in control group.Immediate post-ablation CT images were obtained.Long-axis diameter (LAD),short-axis diameter (SAD),sphericity index (SI=SAD/LAD) and volume of ablation zone were calculated.The size and shape of the ablated areas were compared between two groups.Results The mean LAD,SAD,SI and volume of ablation zone in experimental group ([4.21 ± 0.52]cm,[2.87±0.38]cm,0.69±0.10,[18.72±6.08]cm3) were larger than those in control group ([3.71±0.42]cm,[2.19±0.42]cm,0.60±0.09,[9.44±2.29] cm3;all P＜0.05).Conclusion Local deposition of lipiodol in liver parenchyma of miniature pigs can help to produce larger and rounder necrosis in the ablation zone.

OBJECTIVETo explore the relationship between the time after thrombosis and the efficacy of combined ultrasound and microbubble treatment for rescuing the ischemic tissues.

METHODSRat models of thrombosis in the right common iliac artery were established and received combined ultrasound and microbubble treatment at 3, 6 and 12 h after thrombosis. The recanalization rate of the right common iliac artery was assessed using both 2-dimensional and Doppler ultrasound. The plateau acoustic intensity (AI) was quantified for estimating the skeletal microvascular blood volume, and skeletal muscle injury markers including myoglobin (Mb) and creatinine kinase (CK) were measured using ELISA. Postmortem TUNEL staining was used to detect the apoptotic rate of skeletal muscle cells in the hind limb of the rats.

RESULTSCompared with those in 3 h group, the recanalization rate and AI were significantly lower, and the levels of Mb and CK and the apoptotic rate of the skeletal muscle cells were significantly higher in both 6 h group and 12 h group ( < 0.05). Compared with those in 6 h group, the rats receiving treatment at 12 h after thrombosis showed significantly lowered AI and increased Mb, CK and apoptotic rate of the skeletal muscle cells ( < 0.05).

CONCLUSIONSThe efficacy of combined ultrasound and microbubble treatment for rescuing ischemic tissues tends to be attenuated as the time after thrombosis prolongs in rats.