Objective To investigate the role of cardiac rehabilitation program in the early recovery after minimally invasive incision coronary artery bypass grafting with general anesthesia. Methods A retrospective study was performed on the patients who underwent minimally invasive incision coronary artery bypass grafting from January 2015 to January 2020 with general anesthesia in our hospital. The patients were divided into a cardiac rehabilitation group and a control group. The clinical data of the patients were collected in 6 months and 12 months after the beginning of cardiac rehabilitation program and were analyzed by propensity score-matching analysis with a ratio of 1∶1. The main outcomes were the peak oxygen uptake (VO2 peak) of cardiopulmonary function test and the number of patients attending cardiovascular specialties in tertiary hospitals during the follow-up period (20 months). Results A total of 600 patients were enrolled, including 200 patients in the cardiac rehabilitation group [137 males and 63 females, aged 61.00 (56.00, 65.00) years] and 400 patients in the control group [285 males and 115 females, aged 60.00 (56.00, 65.00) years]. After matching, 176 patients were included in each group, and the basical clinical data of the pateints were comparable (P>0.05). The VO2 peak of the cardiac rehabilitation group after 6 months and 12 months of cardiac rehabilitation was significantly different from that of the control group [6 months: 1.96 (1.59, 2.38) L/min vs. 1.72 (1.38, 2.12) L/min, P<0.001; 12 months: 2.40 (2.21, 2.63) L/min vs. 2.12 (1.83, 2.45) L/min, P<0.001]. During the follow-up period, there was a statistical difference in the cardiovascular specialist visits in tertiary hospitals (P=0.004). Conclusion Cardiac rehabilitation program has a positive effect on the recovery of minimally invasive incision coronary artery bypass grafting with general anesthesia, and can improve the exercise ability of patients.

[Objective] To investigate the clinical manifestations and explore the experience of diagnosis and treatment of spontaneous perirenal urine extravasation after urinary tract obstruction so as to improve the understanding of the disease. [Methods] The clinical data of 23 patients with spontaneous perirenal urine extravasation after obstruction treated at our hospital during 2018 and 2020 were retrospectively analyzed, including the primary diseases, clinical manifestations, imaging examination, treatment and prognosis. The key points of diagnosis and treatment were summarized. [Results] Of the 23 patients, there were 15 males and 8 females, with an average age of 43.4 years. These cases were diagnosed by imaging tests such as ultrasound, computed tomography urography (CTU) and CT. Ureteroscopic lithotripsy was performed in 3 patients with ureteral calculi, retrograde ureteral catheterization in 4 patients and percutaneous nephrostomy in 13 patients. Afterwards, a second phase surgery was performed based on the patients' condition. Of the 3 patients with tumor metastasis who underwent retrograde ureteral catheterization, 2 operation were successful, and 1 operation failed and then converted to nephrostomy and drainage under B-ultrasound localization. [Conclusion] CTU should be performed as soon as possible to make a definite diagnosis. Treatment can be achieved with ureteral retrograde catheterization or percutaneous nephrostomy to achieve local decompression, followed by secondary surgery to treat the primary cause of obstruction.

Biomaterials have gained substantial attention in the field of regenerative medicine and shown respectable potential in clinical translation. However, the function of biomaterials is hindered by the fibrotic encapsulation of foreign body response (FBR) under some circumstances. FBR also lowers the expected service life of implanted devices and causes pain, distortion of tissue or even malignant diseases. Therefore, the mechanism of FBR and the modulating factors need to be further investigated to improve the tissue biocompatibility of biomaterials. This article reviewed the process of FBR, summarized the properties and modification of biomaterials related to FBR, and discussed strategies to mitigate this immune reaction.

Objective:To evaluate the effect of flipped classroom combined with problem-based learning (PBL) on the standardized training for perioperative beside echocardiography.Methods:A total of 64 second-year standardized training students from the Department of Anesthesiology at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, were selected between January 2021 and June 2022 and assigned to control group ( n=32) and test group ( n=32) using a random number table method. Control group employed the traditional teaching model, and test group utilized the flipped classroom combined with PBL. After a 3-month period of teaching standard views and hemodynamic evaluation of bedside echocardiography, the comprehensive theoretical and clinical practice scores (a score of≥80 was considered excellent or good) were compared between the two groups. Additionally, a questionnaire was distributed to assess students′ self-directed learning ability and initiative, interest in learning, efficiency in mastering professional knowledge, satisfaction with teaching, communication and collaboration skills, and clinical thinking ability. Results:Compared with control group, the students in test group showed significant improvements in both comprehensive theoretical ([87 ± 8] vs [80 ± 8]) and clinical practical ([86 ± 8] vs [78 ± 8]) echocardiography scores( P<0.05 or 0.01).The excellent or good rate for comprehensive theoretical scores (88% vs 47%) and clinical practice scores (84% vs 50%) was significantly higher in test group than in control group( P<0.05 or 0.01).A total of 64 questionnaires were distributed, and all of them were returned, yielding a response rate of 100%. The students in test group demonstrated enhanced self-directed learning ability and initiative (94% vs 69%), increased interest in learning (91% vs 66%), improved efficiency in mastering professional knowledge (97% vs 75%), greater satisfaction with teaching (94% vs 62%), enhanced communication and collaboration skills (84% vs 62%), and improved clinical thinking ability (88% vs 59%) compared to control group ( P<0.05). Conclusions:The combination of a flipped classroom and PBL produces better effect than traditional teaching methods when used for standardized training for perioperative bedside echocardiography.

Biomaterials have gained substantial attention in the field of regenerative medicine and shown respectable potential in clinical translation. However, the function of biomaterials is hindered by the fibrotic encapsulation of foreign body response (FBR) under some circumstances. FBR also lowers the expected service life of implanted devices and causes pain, distortion of tissue or even malignant diseases. Therefore, the mechanism of FBR and the modulating factors need to be further investigated to improve the tissue biocompatibility of biomaterials. This article reviewed the process of FBR, summarized the properties and modification of biomaterials related to FBR, and discussed strategies to mitigate this immune reaction.

Objective:To evaluate the effect of perioperative application of hydroxychloroquine on the prognosis of patients undergoing cardiac surgery.Methods:All SLE patients in the Department of Cardiovascular Surgery of the First Affiliated Hospital of Zhengzhou University who took hydroxychloroquine and glucocorticoid for more than 7 days before operation were enrolled in the observation group(28 cases), including 3 males and 25 females, aged(38.3±8.2)years old. Patients who did not use hydroxychloroquine but only used glucocorticoid before operation were included in the control group(24 cases), including 2 males and 22 females, aged(37.9 ±9.8)years old. There was no significant difference in preoperative clinical data between the two groups in terms of sex, age, BMI, course of systemic lupus erythematosus, hemoglobin, albumin, C-reactive protein, ALT, serum creatinine, ejection fraction, diabetes, hypertension, hyperlipidemia, smoking, alcoholism, preoperative atrial arrhythmia, ventricular arrhythmia, atrioventricular block and so on. The constituent ratio of preoperative operation plan was basically the same between the two groups. The postoperative complications and survival of the two groups were compared.Results:There was no significant difference in early clinical indexes between the two groups, such as cardiopulmonary bypass time( t=0.12, P=0.19), chest drainage volume( t=0.30, P=0.77), second thoracotomy hemostasis( χ2=1.17, P=0.46). There was no significant difference in drug-related complications such as new retinopathy, myocardial concentric hypertrophy, atrial arrhythmia( χ2=1.27, P=0.26), ventricular arrhythmia( χ2=0.98, P=0.32), atrioventricular block( χ2=0.06, P=0.82) and other drug-related complications between the observation group and the control group. There was no significant difference between the two groups in postoperative acute heart failure( χ2=1.17, P=0.28), acute liver insufficiency( χ2=1.17, P=0.28), sternal infection and IABP use( χ2=0.47, P=0.50). Compared with the control group, the incidence of acute renal insufficiency after operation was lower in the observation group( χ2=4.51, P=0.04). The incidence of new postoperative pneumonia was lower( χ2=8.26, P=0.01). The length of postoperative antibiotic use, the length of postoperative ICU hospital stay, the postoperative hospital stay and the total cost of hospitalization in the observation group were significantly less than those in the control group( z=2.71, 2.09, 2.02, 2.02, P=0.01, 0.04, 0.04, 0.04). Compared with the control group, the in-hospital mortality rate of patients in the observation group was lower than that in the control group(3.6% vs. 12.5%, χ2=0.47, P=0.50), and the 6-month and 1-year survival rates of the observation group were higher than those of the control group(92.9% vs.83.3%, 92.9% vs.79.2%; χ2=0.41, 2.17; P=0.53, 0.34), but the difference was not statistically significant. Conclusion:Perioperative administration of hydroxychloroquine can significantly reduce the incidence of postoperative acute renal insufficiency and pneumonia, reduce the duration of postoperative antibiotic use, postoperative ICU hospital stay, postoperative hospital stay, and the cost of hospitalization. Hydroxychloroquine may reduce the in-hospital mortality and improve the long-term survival rate after cardiac surgery, but long-term large sample clinical studies are still needed.

【Objective】 To understand the current situation of blood components distribution in domestic prefecture-level blood stations through analyzing the components distribution data of 24 prefecture-level blood stations in China. 【Methods】 The data of components distribution of 24 blood stations from 2017 to 2020 as well as the data of blood deployment of 24 blood stations from 2019 to 2020 were collected and analyzed. 【Results】 From 2017 to 2020, positive annual growth in red blood cells, plasma and cryoprecipitate was observed in 22, 19 and 15 out of the 24 blood stations, and the annual growth median rate of above three components was 5.24%, 3.80% and 3.25%, respectively. Among the 24 prefecture-level blood stations, 23 carried out the preparation of cryoprecipitate. 【Conclusion】 The distribution of red blood cells, cryoprecipitate and plasma in prefecture-level blood stations is increasing year by year. However, there is a overstock of plasma, and most blood stations need blood employment.

Urinary tract infection (UTI) is one of the most common infectious diseases. It has the characteristics of high recurrence rate and prolonged course. At present, the problem of antibiotic resistance is becoming more and more serious, the incidence of adverse reactions is high, and the disadvantages of long-term administration appear, which brings severe challenges to the treatment of recurrent urinary tract infection. The prevention and treatment of UTI recurrence has become the focus of research. Recurrent urinary tract infection is related to the immune regulation mechanism of the body. Administration of immune regulation can provide new ideas for prevention and treatment. The vaccine based on immune regulation to prevent rUTI has made some progress. It can not only reduce the frequency of recurrences, but also decrease related symptoms. At the same time, the vaccine has good tolerance, high safety and good application prospect. This paper aims to summarize the progress of immune regulation and immune vaccines in vivo and clinical research.

Aging-elevated DNMT3A R882H-driven clonal hematopoiesis (CH) is a risk factor for myeloid malignancies remission and overall survival. Although some studies were conducted to investigate this phenomenon, the exact mechanism is still under debate. In this study, we observed that DNMT3A R878H bone marrow cells (human allele: DNMT3A R882H) displayed enhanced reconstitution capacity in aged bone marrow milieu and upon inflammatory insult. DNMT3A R878H protects hematopoietic stem and progenitor cells from the damage induced by chronic inflammation, especially TNFα insults. Mechanistically, we identified that RIPK1-RIPK3-MLKL-mediated necroptosis signaling was compromised in R878H cells in response to proliferation stress and TNFα insults. Briefly, we elucidated the molecular mechanism driving DNMT3A R878H-based clonal hematopoiesis, which raises clinical value for treating DNMT3A R882H-driven clonal hematopoiesis and myeloid malignancies with aging.

The regulatory effect of the immune system during tissue regeneration is gaining more and more attention, yet the underlying mechanisms remain unclear. Tissue regeneration requires a balanced immune response, especially the balanced polarization of macrophages (MΦ), to induce a conducive local microenvironment for tissue regeneration. In this review, the crucial effects of MΦ in tissue regeneration are summarized, including the elimination of cell debris, regulation of stem cell proliferation and differentiation, promotion of angiogenesi. In addition, the practical applications of MΦ in stem cell therapy and tissue engineering are introduced, in the hope of providing references for further exploration of the effect of immune cells on the stem cell niche, as well as the clinical translation of stem cell-based tissue engineering and regenerative medicine.