Objectives:To investigate the feasibility of using bedside echocardiography on the evaluation of potential donors with different causes of brain death for adult heart transplantation. Methods:Bedside echocardiographic and clinical data of consecutive potential donors for adult heart transplantation evaluated by the team of our institution from February 2018 to December 2020 were retrospectively analyzed.Based on different causes of brain death,the potential donors were divided into stroke(ischemic or hemorrhagic,n=398)and non-stroke(head trauma,brain tumor,anoxia,n=272)groups.The clinical and echocardiographic features were compared between the two groups.A total of 350 donors were assigned to our hospital by the China Organ Transplant Response System and met the inclusion criteria for donor selection.There were 195 cases in the stroke group and 155 in the non-stroke group.Retrieval operations were performed and the retrieval rate of hearts for transplantation in stroke donors was compared to that in non-stroke donors. Results:(1)Among the 670 potential heart donors,compared with the non-stroke group,donors in the stroke group were significantly older,had higher body mass index,larger left ventricular end-diastolic diameter,thicker interventricular septum,higher rates of echocardiographic abnormalities,higher prevalence of hypertension(all P<0.001).Among the 670 potential heart donors,17.5%(117 cases)did not meet the echo selection criteria,the common causes were left ventricular hypertrophy(59 cases,50.4%),left ventricular ejection fraction<50%(27 cases,23.1%),wall motion abnormalities(21 cases,17.9%),and left ventricular dilation(14 cases,12.0%).(2)Among the 350 donors who had met the selection criteria and assigned to our hospital by the China Organ Transplant Response System and underwent retrieval operation,70.3%(246 cases)were successfully procured,110 cases(44.7%)in the stroke group and 136 cases(55.3%)in the non-stroke group.The retrieval rate of stroke donors(110/195,56.4%)was lower compared with that of non-stroke(136/155,87.7%,P<0.001),104 cases(29.7%)were not retrieved,and the leading cause of unsuccessful organ retrieval was the occlusion of at least one major coronary artery(91 cases,87.5%). Conclusions:Bedside echocardiography is of great value as a screening tool for cardiac donors.Cardiac structures of the potential donor with stroke as the cause of brain death were different from those with non-stroke causes.The retrieval rate of stroke donors was lower than that of non-stroke donors,even if the initial criteria for donor selection were fulfilled.

Objective:To study the risk factors of patients with hepatocellular carcinoma (HCC) to transcatheter arterial chemoembolization(TACE) refractoriness.Methods:The clinical data of 106 HCC patients who underwent TACE at the Affiliated Hospital of Xuzhou Medical University from January 2020 to December 2021 were retrospectively studied. There were 90 males and 16 females, with the age of (59.9±9.3) years. These patients were divided into the TACE-refractory group ( n=47) and the control group ( n=59) based on whether TACE refratoriness occurred after surgery. Serum alpha-fetoprotein (AFP), protein induced by vitamin K absence or antagonist-II (PIVIKA-II), maximum diameter of tumor, number of tumor and tumor vascularization patterns between the two groups were compared. Multivariate logistic regression analysis was performed to analyse the risk factors of TACE refractoriness in patients with HCC after TACE. Results:The proportion of patients with AFP >400 μg/L, PIVIKA-II >40 AU/L, number of tumor and tumor vascularization patterns Ⅲ+ Ⅳ (uneven enhancement) were significantly higher in the TACE-refractory group than the control group (all P<0.05). The maximum diameter of tumor for patients in the TACE-refractory group was significantly larger than that in the control group ( Z=-2.41, P=0.016). Multivariate logistic regression analysis showed that patients with serum AFP >400 μg/L( OR=2.707, 95% CI: 1.008-7.271), multiple tumors ( OR=6.069, 95% CI: 2.115-17.415) and tumor vascularization patterns Ⅲ+ Ⅳ (uneven enhancement)( OR=7.813, 95% CI: 2.246-27.176) before the first TACE were at increased risks of TACE refractoriness (all P<0.05). Conclusion:Preoperative AFP >400 μg/L, multiple tumors and tumor vascularization patterns Ⅲ+ Ⅳ were independent risk factors for TACE refractoriness in patients with HCC.

Objective:To study the efficacy, feasibility and safety of transjugular intrahepatic portosystemic shunt (TIPS) in treatment of recurrent portal hypertension after splenectomy and devascularization in patients presenting with upper gastrointestinal bleeding.Methods:Cirrhotic patients with recurrent portal hypertension after splenectomy and devascularization and presenting with upper gastrointestinal bleeding from August 2015 to December 2020 were studied. Thirty-nine patients were included in this study. There were 24 males and 15 females, with age of (51.56±9.08) years old. These patients were treated with TIPS by using the Viabahn stent. Intraoperative portal vein pressure, success operative rate, hemostasis rate after surgery, changes in hematological indicators and postoperative efficacy and complication rate were studied.Results:Thirty-eight of 39 patients successfully underwent TIPS shunt and 1 patient failed because of portal vein spongiosis. The success rate was 97.44%(38/39). Thirty-three patients underwent TIPS and variceal vein embolization, while 5 patients were treated with TIPS alone. Thirty-nine Viabahn stents with a diameter of 8 mm were implanted in 38 patients, of which 5 patients had the stent expanded to its nominal diameter of 8 mm. The remaining 33 patients (86.84%) had a shunt with a diameter of 6 mm. The hemostasis rate of postoperative gastrointestinal bleeding was 97.37% (37/38). The portal vein pressure and portal venous pressure gradient decreased from (31.28±6.24), (20.61±5.14) mmHg (1 mmHg=0.133 kPa) to (19.58±4.69), (9.24±3.07) mmHg respectively, the differences were significant (all P<0.001). All patients were followed-up for 3 to 36 months, with a median follow-up of 12 months. The postoperative rebleeding rate was 6.90% (2/29). The incidence of hepatic encephalopathy was 13.79% (4/29), and the incidence of shunt disorder was 13.79% (4/29). Conclusion:TIPS was safe, effective and feasible in treating patients with recurrent portal hypertension after splenectomy and devascularization presenting with upper gastrointestinal bleeding. Most patients obtained good clinical outcomes with a 6 mm diameter shunt.

Objective:To establish and validate a fluorescence focus assay (FFA) for rapid titration of Japanese encephalitis virus (JEV) and to evaluate its application in the production of Japanese encephalitis vaccine.Methods:Recombinant JEV non-structural protein 1 (NS1) was expressed in a prokaryotic expression system. After purification, JEV-NS1 was used to immunize rabbits to induce polyclonal antibody. FFA was established with the polyclonal antibody to titer JEV. The accuracy of FFA was validated by comparing with plaque assay, and the specificity, precision, linearity, range and robustness of FFA were also validated. Twenty-eight batches of live-attenuated Japanese encephalitis vaccine were titrated with FFA and plaque assay to analyze the relationship between the two assays.Results:FFA established with polyclonal antibody against JEV-NS1 could be used to titrate JEV, and there was no cross reaction with other viruses (tick-borne encephalitis virus, yellow fever virus, coxsackievirus A2, coxsackievirus A4). Results of the validation tests showed that FFA met the requirement of quality control for live-attenuated Japanese encephalitis vaccine. FFA was more consistency than plaque assay.Conclusions:The established FFA could be used for virus titration in the production of live-attenuated Japanese encephalitis vaccine.

Objective:To study the effect of laparoscopic transabdominal preperitoneal (TAPP) and mesh plug repair on the sexual function of patients with indirect inguinal hernia.Methods:One hundred and four patients with indirect inguinal hernia who were treated in the No.922 Hospital of PLA Joint Logistics Support Force from January 2018 to October 2019 were selected and divided into two groups according to the method of random number table: routine group and TAPP group, with 52 cases in each group. The routine group was treated with mesh plug repair, and the TAPP group was treated with TAPP. The international erectile function index-5 (IIEF-5) was used to evaluate the sexual function of the patients after operation for 6 months, the visual analog pain scale (VAS) was used to evaluate the pain after operation for 1 month, and the relevant indexes of the operation and the incidence of complications were compared.Results:The IIEF-5 scores at 6 months after operation in two groups was higher than that before operation, the testicular volume and the maximum blood flow velocity of testicular artery in two groups were lower than those before operation, and the differences were statistically significant ( P<0.05); the IIEF-5 scores at 6 months after operation in the TAPP group was higher than that in the routine group [(23.86 ± 1.5) scores vs. (21.45 ± 3.85) scores], and the testicular volume and the maximum blood flow velocity of testicular artery were higher than those in the routine group [(9.65 ± 0.08) cm 3 vs. (9.39 ± 0.09) cm 3, (3.83 ± 1.05) cm/s vs. (2.88 ± 0.36) cm/s], and the differences were statistically significant ( P<0.05). One month after operation, the pain scores of two group were lower than that before operation, and the pain scores of TAPP group was lower than that of routine group [(1.65 ± 0.35) scores vs. (2.78 ± 0.39) scores], and the differences were statistically significant ( P<0.05). The operation time of TAPP group was higher than that of routine group [(44.35 ± 6.26) min vs. (41.80 ± 5.95) min], the bleeding volume, the time of getting out of bed, the time of hospitalization of TAPP group were lower than those of routine group [(54.66 ± 8.98) ml vs. (73.25 ± 15.25) ml, [(12.75 ± 2.42) h vs. (23.55 ± 3.66) h], (3.25 ± 1.01) d vs. (7.85 ± 1.44) d], and the differences were statistically significant ( P<0.05). The incidence of operation complications of TAPP group was lower than that of routine group [3.85%(2/52) vs. 21.15%(11/52)], and the difference was statistically significant ( χ2=7.121, P<0.05). Conclusions:Compared with conventional hernia repair, laparoscopic hernia repair can improve the sexual function, relieve the pain, improve the therapeutic effect and reduce the complications.

OBJECTIVE： To study the effects of aspirin on the growth and autoghagy of human gastric cancer cells SGC-7901 and BGC-823. METHODS： SGC-7901 and BGC-823 cells were selected as research objects， with phosphate buffer （PBS） as negative control treated for 48 h， MTT assay was used to detect the effects of 1， 2， 4， 6， 8， 10 mmol/L aspirin， 5 mmol/L aspirin alone or combined with 2.5 μmol/L chloroquine， 2.5 μmol/L 3-methyladenine （3-MA） on survival rate of gastric cancer cells. Flow cytometry was used to detect the effects of 2 and 5 mmol/L aspirin， 5 mmol/L aspirin alone or combined with 2.5 μmol/L chloroquine and 2.5 μmol/L 3-MA on the apoptosis rate and cell cycle distribution of gastric cancer cells. Hoechst33258 staining was used to observe the effects of 5 mmol/L aspirin on morphology of gastric cancer cell nucleus； Transwell chamber test was adopted to detect the effects of 5 mmol/L aspirin on the migration of gastric cancer cell. Laser confocal scanning microscopy was used to observe the effects of 5 mmol/L aspirin on autophagy formation in gastric cancer cells. Western blot method was used to detect the effects of 2 and 5 mmol/L aspirin on the protein expression of autophagy markers LC3-Ⅱin gastric cancer cells. RESULTS： Compared with negative control group， aspirin could inhibit the survival rates of SGC-7901 and BGC-823 cells in dose-dependent manner， but had no significant effects on apoptosis rate of SGC-7901 and BGC-823 cells； SGC-7901 and BGC-823 cells were blocked in G1 phase. Compared with aspirin alone group， the survival rates of SGC-7901 and BGC-823 were increased significantly after treated with aspirin+chloroquine and aspirin+3-MA， while the distribution rate of SGC-7901 and BGC-823 cells at G1 phase were decreased significantly， with statistical significance （P＜0.05 or P＜0.01）. Compared with negative control group， there were no obvious DNA fragmentation fragments， apoptotic bodies and fragments of dense bright blue， while the number of migration cells were decreased significantly in SGC-7901 and BGC-823 cells after treated with aspirin （P＜0.001）； the number of autophagosome was increased significantly and the protein expression of LC3-Ⅱ was enhanced significantly （P＜0.05）. CONCLUSIONS： Aspirin can significantly inhibit the growth of SGC-7901 and BGC-823 cells， and arrest cell cycle in G1 phase， the mechanism of which may be associated with the activation of autophagy.

Objective To evaluate the cone beam CT (CBCT) image quality and its long-term stability for HUs under different scanning conditions.Methods With the OBI system, Catphan 504 phantom using the different modes was scanned through one year. Analysis of variance (ANOVA) was used to evaluate the CBCT images.Results The results of contrast resolution under different scanning conditions met the requirements of acceptance test procedure. Spatial contrast resolution(≥5 lp/cm) of half-fan scanning conditions were inferior to those (≥7 lp/cm) of ful-fan mode. The accuracies of spatial linear distance and angle were within±1%. HUs in air density plug were constant, but HUs of other plugs with different conditions had the signifi cant difference (F=660.84,P=0). Under different conditions in a year, the mean HUs showed a good agreement.Conclusions HUs of CBCT image under different scanning conditions exist a little difference, but there is a good consistency for the long term stability analysis. It is helpful for CBCT images directly used for dose re-calculation in adaptive radiation therapy (ART).

Objective Evaluation of intensity-modulated radiation therapy(IMRT) delivery quality assurance(DQA) using EDOSE software based on accelerator electronic portal imaging device (EPID).Methods Analysed the dose response uniformity correction of EPID imaging plate in different fields and the gamma pass rates about the fields; And compared the calculated parameters of the EDOSE and the Pinnacle planning station.Results The uniformities on the homogeneous region of thefi elds are good after who corrected by EDOSE. The gamma(γ, 3mm/3%) pass rates are in the ideal range. The volume of the organs at risk(OAR) have no statistical signifi cance except the right lung; A part of the parameters have statistical signifi cance.Conclusions The results of the calculation and analysis of EDOSE has a high agreement with the planning system.

Adult ; Arcanobacterium ; pathogenicity ; Endocarditis ; microbiology ; Humans ; Male ; Young Adult

Objective Both underuse and overuse of anticoagulant therapy may lead to severe adverse effects. Emerging portable monitering devices, which provides reliable and accurate measurements, were reported to be potential alternatives to tra-ditional monitering recta-analysis regimens. This study was intended to evaluate the effects of serf-monitoring or serf-management (self-testing and serf-dosing) of anticoagulant as compared with that of traditional monitoring. Methods Relevant trials reported before October 2008 were identified in a number of electronic database and analyzed with software RevMan 4.2. The primary out-comes included death from any cause, major bleeding event, thromboembolic event and the proportion of patients whose interna-tional normalized ratio (INR) were within the therapeutic range. Results Seventeen RCT of serf-monitoring were identified.Pooled estimates revealed significant reductions in the thromboembolic events (odds ratio 0.46, 95% CI0.33 -0.64), all-cause mortality (0.61,0.40 -0.93), and major haemorrhage (0.80, 0.58 - 1.10) with self-monitoring as comparing with traditional monitoring. No difference was noted in minor haemorrhage. 15 trials reported improvements in the mean proportion of patients whose INR were within target range. Conclusion Self-management regimen is superior to traditional monitoring in the outcomes of oral anticoagulation. Patients capable of self-monitoring and serf-adjusting have fewer thromboembolic events and lower mortali-ty than those undergoing self-monitoring alone. However, self-monitoring requires education and training for patients.