Objective To investigate the efficacy of low-dose inhaled nitric oxide (iNO) in the treatment of severe hypoxemia after Sun’s operation. Methods The clinical data of patients undergoing Sun’s operation for acute Type A aortic dissection in our hospital from January 2020 to June 2022 were retrospectively analyzed. Patients who received conventional treatment before November 2021 were enrolled as a control group. After November 2021, iNO was used in our hospital, and the patients who received iNO as an iNO group. The preoperative clinical baseline data, perioperative clinical data and oxygenation index were compared between the two groups. Results A total of 54 patients were included in the control group, including 45 males and 9 females, with an average age of 53.0±10.9 years. A total of 27 patients were included in the iNO group, including 21 males and 6 females, with an average age of 52.0±10.6 years. The preoperative body mass index of the two groups was greater than 25 kg/m2, white blood cell count, C-reactive protein were significantly higher than normal level, but there was no statistical difference between the groups (P＞0.05). There were no statistical differences in intraoperative data between the two groups (P＞0.05). The iNO group had significantly shorter duration of mechanical ventilation, postoperative ICU stay, and postoperative hospital stay than the control group (P<0.001). After 12 h of iNO treatment, hypoxic condition improved obviously, oxygenation indices in 12 h, 24 h, 36 h,48 h, 60 h and 72 h in the iNO group were significantly higher than those in the control group (P<0.05). Conclusion The treatment of severe hypoxemia after Sun’s surgery with low-dose of iNO is safe and effective, can significantly improve oxygenation function, and has significant advantages in shortening ventilator use time, postoperative ICU stay and postoperative hospital stay, but it is not significant in changing postoperative mortality.

Objective To construct recombinant human butyrylcholinesterase(rhBChE)knock-in goat fetal fibroblast cell lines(GFFs)by using clustered regularly interspaced short palindromic repeats(CRISPR)/CRISPR-associated protein 9(Cas9)-mediated homology-directed repair mechanism for subsequent production of goat expressing rhBChE.Methods The efficient sgRNA sites targeting goat[3-casein(CSN2)gene were designed and screened,and the targeting efficiency of the sgRNA in goat mammary epithelial cells(GMECs)was confirmed by electro-transfection,flow sorting,and sequencing of PCR products.The red fluorescent reporter gene homology repair vector(P2A-mCherry)targeting the sgRNA was constructed,and then the integration and expression efficiency was detected by flow cytometry.The rhBChE homology repair vector(P2A-rhBChE)targeting the sgRNA of CSN2 gene was constructed in GFFs,the rhBChE positive cell clones were obtained via electro-transfection and flow sorting,and the rhBChE knock-in cell lines was identified by sequencing of PCR products.Results The sgRNA4 was identified as an efficient target of goat CSN2 gene,which could be also used for targeted integration of other genes.Three rhBChE knock-in cell lines were successfully constructed.Conclusion The rhBChE knock-in GFFs targeting goat CSN2 gene lays the foundation for the production of mammary bioreactors expressing rhBChE.

Objective To study the mechanical response of tibial prostheses and the distal tibial cancellous bone after implantation of radial and axial functionally graded materials(FGM)into the ankle joint.Methods Three FGM were used:titanium alloy-bioactive glass composite FGM(FGM-Ⅰ),titanium(Ti)alloy-ideal bone elastic composite FGM(FGM-Ⅱ),and Ti alloy-hydroxylapatite composite FGM(FGM-Ⅲ).A three-dimensional finite element model of total ankle arthroplasty(TAA)was established,and the simulation software ABAQUS was used for secondary development based on Fortra.By changing the volume fraction,the mechanical properties of the FGM tibial prosthesis can be adjusted both axially and radially.The stress distributions of the tibial prosthesis and cancellous bone after FGM axial and radial tibial component implantation in the standing position were analyzed.Results Compared with Ti alloy tibial prosthesis,three kinds of FGM could effectively reduce the stress concentration on the tibial prosthesis,and the overall effect of FGM-Ⅲ tibial prosthesis was better than that of FGM-Ⅰ and FGM-Ⅱ tibial prosthesis;the radial distribution of FGM could effectively reduce the maximum von Mises stress of the prosthesis.For the tibial cancellous bone,the three types of FGM radial tibial prostheses and FGM-Ⅲ axial tibial prostheses could effectively increase the distal stress,thus,relieving the stress shielding on the cancellous bone;the FGM-Ⅲ radial tibial prosthesis was the most effective in improving the stress level of the cancellous bone.Conclusions FGM-Ⅲ radial ankle prosthesis can effectively reduce the stress concentration phenomenon and the stress shielding effect on the prosthesis to prolong its life,with potential application prospects.

Objective To analyze the risk factors of poor prognosis in patients with extended-spectrum β-lactamase producing enterobacterales(ESBL-E)bloodstream infection,and establish a nomogram prediction model to provide help for clinical diagnosis and treatment.Methods A total of 235 patients with ESBL-E bloodstream infection were collected from the First People's Hospital of Jiande City.According to their prognosis,the patients were divided into survival group(n=211)and death group(n=224).The clinical data of the patients were collected,and the independent risk factors of poor prognosis were screened by multivariate Logistic regression analysis.The nomogram was established and verified.Results The mortality of ESBL-E bloodstream infection patients with shock,respiratory failure,diabetes and leukemia,ICU admission,hypoproteinemia,increased or decreased white blood cells,and thrombocytopenia was higher(P＜0.05).Multivariate Logistic regression analysis showed that combined shock,respiratory failure and leukemia were independent risk factors for death from ESBL-E bloodstream infection.Conclusion The nomogram prediction model of adverse prognostic risk factors in patients with ESBL-E bloodstream infection can provide help for clinicians to judge the poor prognosis in the early stage,and it is of reference significance to take early intervention measures to reduce the mortality of patients.

Magnetic Resonance Imaging(MRI)technology can directly show the changes of brain network and explain the central mechanism of Tai Chi remodeling of brain structure and function.In this paper,we collected the domestic and foreign research on the influence of Tai Chi movement on the brain network by using MRI technology,and combed it from the perspective of brain structure and function changes.The results revealed that Tai Chi may promote memory function,cognitive flexibility,inhibitory control,and working memory capacity by remodeling the structure and function of the medial temporal lobe and prefrontal cortex in older adults,which may be a potential central mechanism for Tai Chi to improve memory and cognitive control in the elderly.However,there are some problems in the current research,such as small sample size,insufficient long-term follow-up,and difficult evaluation of exercise intensity.It is necessary to carry out large-sample and long-term detailed research to further verify the current research results.

Objective:To classified the fluid location of of grade B and C postoperative pancreatic fistula (POPF) and propose processing flow.Methods:Data from 232 patients who underwent pancreatic surgery from January 2018 to December 2022 at Department of General Surgery & Hepato-billo-pancreatic,Beijing Hospital were collected retrospectively. Forty-six patients who suffered from grade B and C POPF underwent ultrasound-guided drainage. There were 32 males and 14 females, with an age of (60.2±13.7)years (range:18 to 85 years). The imaging data of postoperative CT were collected and the the fluid location was classified. Then analyzed the drainage status when patents were diagnosed as POPF. Machine learning was performed and a random forest model was applied to construct the relationship between intervention time and mortality. The optimal intervention time was calculated. The patients were then divided into early and late intervention groups and clinical data and outcomes were compared using the t test,Mann-Whitney U test, χ2 test or Fisher′s exact test between the two groups. Results:Based on the results of the random forest model, the optimal puncture time was within 5.38 days after the diagnosis of POPF. Based on the optimal time, 21 patients were subsumed into early intervention group and 25 patients were subsumed into late intervention group. The location of fluid collection was classified into four types: peripancreatic (32.7%,15/46), extra-pancreatic and epigastric (41.3%,19/46), extra-pancreatic and hypogastic (13.0%,6/46) and diffused (13.0%,6/46). The status of the drainage included normal in 10 patients (21.8%), displaced drain in 18 patients (39.1%) and drain removed or blocked in 18 patients (39.1%). The perioperative mortality rate was 19.0% (4/21) in the early intervention group and 8.0%(2/25) in the late. The late intervention group had significantly higher rates of positive drainage fluid cultures (88.0%(22/25) vs. 42.9%(10/21), χ2=10.584, P=0.001), secondary surgery (24.0%(6/25) vs. 0(0/21), P=0.025), and readmission within 90 days(32.0%(8/25) vs. 4.8%(1/21), χ2=5.381, P=0.020) than the early group, and a significantly longer postoperative hospital stay( M(IQR))(24(20)days vs. 39(53)days, Z=3.023, P=0.003). Conclusions:The location of the POPF fluid collection is classified into four types. Early radiological evaluation can detect abdominal effusion promptly,and early puncture and drainage will be beneficial in improving outcomes in these patents.

The adipose-derived stem cell exosomes are subcellular structures of adipose stem cells. They are nano-sized membrane vesicles that can transport various cell components and act on target cells by paracrine, and they play an important role in the exchanges of substance and information between cells. Scar healing is the commonest way of healing after skin tissue injury. Pathological scar can not only cause movement dysfunction, but also lead to deformity, which affects the appearance of patients and brings life and mental pressure to the patients. In recent years, many researches have shown that the adipose-derived stem cell exosomes contain a variety of bioactive molecules, which play an important role in reducing scar formation and scar-free wound healing, by affecting the proliferation and migration of fibroblasts and the composition of extracellular matrix. This article reviewed the recent literature on the roles and mechanisms of adipose-derived stem cell exosomes in scar formation, and prospected the future application and development of adipose-derived stem cell exosomes in scar treatment.

Objective:To classified the fluid location of of grade B and C postoperative pancreatic fistula (POPF) and propose processing flow.Methods:Data from 232 patients who underwent pancreatic surgery from January 2018 to December 2022 at Department of General Surgery & Hepato-billo-pancreatic,Beijing Hospital were collected retrospectively. Forty-six patients who suffered from grade B and C POPF underwent ultrasound-guided drainage. There were 32 males and 14 females, with an age of (60.2±13.7)years (range:18 to 85 years). The imaging data of postoperative CT were collected and the the fluid location was classified. Then analyzed the drainage status when patents were diagnosed as POPF. Machine learning was performed and a random forest model was applied to construct the relationship between intervention time and mortality. The optimal intervention time was calculated. The patients were then divided into early and late intervention groups and clinical data and outcomes were compared using the t test,Mann-Whitney U test, χ2 test or Fisher′s exact test between the two groups. Results:Based on the results of the random forest model, the optimal puncture time was within 5.38 days after the diagnosis of POPF. Based on the optimal time, 21 patients were subsumed into early intervention group and 25 patients were subsumed into late intervention group. The location of fluid collection was classified into four types: peripancreatic (32.7%,15/46), extra-pancreatic and epigastric (41.3%,19/46), extra-pancreatic and hypogastic (13.0%,6/46) and diffused (13.0%,6/46). The status of the drainage included normal in 10 patients (21.8%), displaced drain in 18 patients (39.1%) and drain removed or blocked in 18 patients (39.1%). The perioperative mortality rate was 19.0% (4/21) in the early intervention group and 8.0%(2/25) in the late. The late intervention group had significantly higher rates of positive drainage fluid cultures (88.0%(22/25) vs. 42.9%(10/21), χ2=10.584, P=0.001), secondary surgery (24.0%(6/25) vs. 0(0/21), P=0.025), and readmission within 90 days(32.0%(8/25) vs. 4.8%(1/21), χ2=5.381, P=0.020) than the early group, and a significantly longer postoperative hospital stay( M(IQR))(24(20)days vs. 39(53)days, Z=3.023, P=0.003). Conclusions:The location of the POPF fluid collection is classified into four types. Early radiological evaluation can detect abdominal effusion promptly,and early puncture and drainage will be beneficial in improving outcomes in these patents.

Objective:To evaluate the effect of continuous pump ropivacaine in rectus sheath in the postoperative analgesia after abdominoplasty.Methods:Patients with abdominoplasty who were admitted to the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences from August 2020 to December 2021 were retrospectively analyzed. They were divided into 2 groups: the control group received patient-controlled intravenous analgesia (PCIA) after the operation, sufentanil 100 μg + normal saline diluted to 100 ml, the rate was 2 ml/h, lasted for 48 h, locking time 15 min, Bolus: 0.5 ml; the study group underwent postoperative rectus abdominis intrathecal intubation and continuously infused 0.262 5% ropivacaine saline mixture 100 ml, the rate was 2 ml/h, lasted for 48 h, the locking time is 15 min, Bolus: 0.5 ml. The method of catheter placement in the study group: a catheter was placed unilaterally in the anterior sheath of the rectus abdominis under direct vision, and an incision was made 2 cm below the umbilical plane. The other end is pierced from the umbilicus and connected to the analgesic pump. The visual analogue scale (VAS) for pain and the number of analgesic pump boluses at 24 h and 48 h after operation, the occurrence of postoperative adverse drug reactions and the patient satisfaction at 1 month after operation were collected. The normally distributed measurement data were expressed as Mean±SD, and the comparison between the two groups was analyzed by t-test; the count data was expressed by the frequency (percentage), and the Fisher’s test was used for analysis. Results:A total of 56 patients were included, including 9 males and 47 females, ranging in age from 27 to 53 years old, with ASA graded from 1 to 2, body mass index (BMI) ranged from 26 to 33 kg/m 2. Their rectus abdominis separation ranged from 3 to 7 cm. Compared with the control group, the pain VAS score of the study group at 48 hours after the operation was lower (3.9±1.5 vs. 5.2±1.4, P<0.05), and the number of analgesic boluses was reduced (2.9±0.3 vs. 3.9±0.4, P<0.05), the incidence of adverse reactions such as nausea, vomiting decreased( P<0.05). The satisfaction rate 1 month after operation in the study group was significantly higher than that in the control group [100.0% (30/30) vs. 42.3% (11/26), P<0.05]. Conclusions:Continuous infusion of ropivacaine through anterior rectus intrathecal cannula can effectively relieve abdominal pain after total abdominoplasty, reduce adverse reactions caused by postoperative analgesics, improve patient comfort during hospitalization, and improve overall surgical satisfaction.

Objective:To evaluate the effect of continuous pump ropivacaine in rectus sheath in the postoperative analgesia after abdominoplasty.Methods:Patients with abdominoplasty who were admitted to the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences from August 2020 to December 2021 were retrospectively analyzed. They were divided into 2 groups: the control group received patient-controlled intravenous analgesia (PCIA) after the operation, sufentanil 100 μg + normal saline diluted to 100 ml, the rate was 2 ml/h, lasted for 48 h, locking time 15 min, Bolus: 0.5 ml; the study group underwent postoperative rectus abdominis intrathecal intubation and continuously infused 0.262 5% ropivacaine saline mixture 100 ml, the rate was 2 ml/h, lasted for 48 h, the locking time is 15 min, Bolus: 0.5 ml. The method of catheter placement in the study group: a catheter was placed unilaterally in the anterior sheath of the rectus abdominis under direct vision, and an incision was made 2 cm below the umbilical plane. The other end is pierced from the umbilicus and connected to the analgesic pump. The visual analogue scale (VAS) for pain and the number of analgesic pump boluses at 24 h and 48 h after operation, the occurrence of postoperative adverse drug reactions and the patient satisfaction at 1 month after operation were collected. The normally distributed measurement data were expressed as Mean±SD, and the comparison between the two groups was analyzed by t-test; the count data was expressed by the frequency (percentage), and the Fisher’s test was used for analysis. Results:A total of 56 patients were included, including 9 males and 47 females, ranging in age from 27 to 53 years old, with ASA graded from 1 to 2, body mass index (BMI) ranged from 26 to 33 kg/m 2. Their rectus abdominis separation ranged from 3 to 7 cm. Compared with the control group, the pain VAS score of the study group at 48 hours after the operation was lower (3.9±1.5 vs. 5.2±1.4, P<0.05), and the number of analgesic boluses was reduced (2.9±0.3 vs. 3.9±0.4, P<0.05), the incidence of adverse reactions such as nausea, vomiting decreased( P<0.05). The satisfaction rate 1 month after operation in the study group was significantly higher than that in the control group [100.0% (30/30) vs. 42.3% (11/26), P<0.05]. Conclusions:Continuous infusion of ropivacaine through anterior rectus intrathecal cannula can effectively relieve abdominal pain after total abdominoplasty, reduce adverse reactions caused by postoperative analgesics, improve patient comfort during hospitalization, and improve overall surgical satisfaction.