[Early to mid-term clinical outcomes of aortic valve repair in patients with bicuspid aortic insufficiency]

Objective: To examine the early to mid-term clinical outcomes of aortic valve repair in patients with bicuspid aortic insufficiency. Methods: This is a retrospective cohort study. The clinical data of 124 patients with BAV insufficiency who underwent aortic valve repair from January 2017 to June 2023 in the Department of Cardiovascular Surgery at Fuwai Hospital were analyzed retrospectively. There were 117 males and 7 females with an age of (38.1±12.7) years (range: 14 to 65 years). Depending on whether the aortic sinus was replaced or not, surgical approaches were divided into valve sparing root replacement (reimplantation, remodeling, modified remodeling) and isolated aortic valve repair (annuloplasty, isolated aortic valve leaflet repair). Perioperative and follow-up data were collected. Kaplan-Meier method was used to plot the curves of survival rate, free recurrence rate of massive aortic valve insufficiency and free re-operation rate, and Log-rank test was used for comparison between groups. Results: Among the surgeries, there were 47 cases of reimplantation, 8 cases of remodeling, 8 cases of modified remodeling, 48 cases of aortic annuloplasty (external annuloplasty in 22 cases, CV-0 annuloplasty in 26 cases), and 13 cases of isolated leaflet repair. Leaflet plication was the most used leaflet repair technique, used in 103 patients. The cardiopulmonary bypass time was (133.7±56.9) minutes (range: 48 to 461 minutes), and aortic cross-clamp time was (103.8±47.8) minutes (range: 25 to 306 minutes), with no surgical mortality. All patients underwent outpatient or telephone follow-up. The cumulative follow-up time was 340.3 person-years and the mean follow-up time was (M (IQR)) 34.0 (25.5) months (range: 3 to 76 months). The 5-year survival rate was 98.4%, the 5-year freedom from significant insufficiency rate was 93.4% and the 5-year freedom from aortic valve reoperation rate was 95.6%. The subgroup analysis revealed a significantly better freedom from the significant insufficiency rate in the aortic valve annular reduction group compared to the non-reduction group (P<0.01). Conclusions: Aortic valve repair in patients with bicuspid aortic insufficiency could obtain steady early to mid-term outcomes. Aortic annuloplasty can reduce the risk of recurrent aortic valve insufficiency in patients undergoing aortic repair.

Acute exacerbation of chronic obstructive pulmonary disease in a slaughterhouse

We describe the case of a 52-year-old male who presented with two episodes of acute exacerbations (AE) of chronic obstructive pulmonary disease (COPD) during work, while suspending live chickens for slaughter. The patient was exposed to high levels of bioaerosols, including endotoxins and microorganisms. Endotoxins can induce bronchoconstriction and airway inflammation, and COPD patients are more vulnerable to airway infections caused by microorganisms inhaled with bioaerosols. This study suggests that a high level of bioaerosols may induce airway infections, resulting in acute exacerbations of COPD.

Efficacy and safety of intravitreal HLX04-O, an anti-VEGF monoclonal antibody, for the treatment of wet age-related macular degeneration

AIM: To evaluate the efficacy and safety of HLX04-O, an investigational ophthalmic formulation of HLX04 (bevacizumab biosimilar) for intravitreal injection, as a treatment for wet age-related macular degeneration (wAMD) in a phase 1/2 clinical trial (NCT04993352). METHODS: Eligible patients with wAMD were enrolled to receive HLX04-O intravitreal injections at a dose of 1.25 mg/0.05 mL every four weeks. Efficacy and adverse events were evaluated every month during study visits. RESULTS: A 76-year-old male with wAMD in his left eye participated in the trial and completed six cycles of HLX04-O intravitreal injections. Changes were observed in macular center point thickness (baseline vs last study visit, 437 vs 255 μm) and best-corrected visual acuity letter score (baseline vs last study visit, 36 vs 77) of the affected eye, which indicated an improvement in wAMD over treatment. No adverse events were reported by the data cutoff date. CONCLUSION: HLX04-O at 1.25 mg/0.05 mL every four weeks is well tolerated in this patient, demonstrating promising safety and efficacy in wAMD treatment. Large-scale studies are required to confirm the outcomes.

[Study on the dynamic changes of oral microbiota in type 2 diabetes patients with periodontitis after initial periodontal therapy]

Objectives: To clarify the effect of initial periodontal therapy on the dynamic changes of oral (saliva, dorsal tongue and subgingival plaque) microbiota in periodontitis patients with or without type 2 diabetes mellitus (T2DM). Methods: A total of 14 patients with chronic periodontitis (CP group) and 14 CP patients with T2DM (CP-T2DM group) were included from Department of Periodontology, School and Hospital of Stomatology,Cheeloo College of Medicine, Shandong University. The microbial samples were collected from saliva, dorsal tongue and subgingival plaque of first molars at baseline, 1.5 and 3 months after initial periodontal therapy, and were detected by 16S rRNA (V3-V4 region) gene sequencing. The sequencing data were analyzed to obtain microbial distribution and community structure information. The same professional periodontist evaluated the periodontal status of patients according to periodontitis detection indices before and after initial periodontal therapy. Meanwhile, patients' blood samples were collected and related metabolic indices were evaluated. Results: After initial periodontal therapy, the glycosylated hemoglobin levels [(7.46±1.69)%] in CP-T2DM group were significantly improved than that at baseline [(7.65±1.34)%] (t=0.52,P=0.610). The probing depth of the sampling sites [CP group: (2.94±0.46) mm, CP-T2DM group: (2.95±0.35) mm] and bleeding index (CP group: 1.91±0.42, CP-T2DM group: 1.67±0.49) at 3 months after treatment were significantly decreased than the probing depth [CP group: (3.99±0.77) mm, CP-T2DM group: (3.80±0.76) mm] (F=25.61, P<0.001; F=17.63, P<0.001) and bleeding index (CP group: 3.03±0.52, CP-T2DM group: 2.54±0.65) (F=28.43, P<0.001; F=20.21, P<0.001) at baseline. The flora analysis showed that the α and β diversity indices of the same sites in the CP and CP-T2DM groups did not change significantly before and after the initial therapy, but the bacterial abundance at each site changed. There were commonalities and differences in the microbial composition of each site in the CP and CP-T2DM groups. Among them, the relative abundance of Proteobacteria in saliva and dorsal tongue samples of the two groups after treatment was basically consistent with the change trend in the subgingival plaque microbes. In the subgingival plaque of the CP group, the relative abundance of Proteobacteria showed a gradual increase with the prolongation of initial periodontal therapy; while in the CP-T2DM group, it showed a trend of first increase and then decrease. Syntrophy, Dethiosulfate, Methanobacteriaceae and TG5 in CP and CP-T2DM groups were all significantly dominant bacteria in subgingival plaque at baseline (P<0.05). Moreover, in the CP-T2DM group Spirochetes also showed a significant advantage. At 1.5 months after treatment, Rhizobacteria, Alcaligenes, Comamomons, Delftia, Blautella, etc. were dominant in subgingival plaque (P<0.05). Firmicutes, Clostridia/Clostridiales, Enterococci and Ruminococci showed significant differences at 3 months (P<0.05). Conclusions: Plaques in saliva and tongue dorsal could reflect the effects of initial periodontal therapy on the dynamic changes of microorganisms to a certain extent. CP and CP-T2DM patients had differences in microbial composition and responses to initial periodontal therapy.

[Clinical characteristics and outcome of malignant hydronephrosis associated with colorectal carcinoma]

Objective: To explore the clinical characteristics and outcome of hydronephrosis associated with advanced or metastatic colorectal carcinoma. Methods: Clinical data of 311 patients with locally advanced or metastatic colorectal carcinoma between June 2017 and March 2020 in National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital were retrospectively collected. Thirty-nine patients with hydronephrosis diagnosed by CT scan were analyzed. Kaplan-Meier method was used for survival analysis, Log rank method was used for comparison of survival between the two groups with or without hydronephrosis, and univariate and multivariate analyses was performed by Cox proportional risk regression model. Results: The incidence rate of malignant hydronephrosis associated with metastatic colorectal carcinoma was 12.5% (39/311), 26 were male, and 13 were female. The median age was 43 years (23-74 years). Among the 39 patients, 29 had unilateral hydronephrosis and 10 had bilateral hydronephrosis. Eleven patients with hydronephrosis at the initiate diagnosis, 28 patients with hydronephrosis at relapse or advanced course, and the median time to hydronephrosis was 17 months (4-62 months). The disease control rate (DCR, 77.8% and 84.6%, respectively) and progression free survival (PFS were 6 and 7 months) were not significantly different between patients with hydronephrosis and without hydronephrosis received the first-line chemotherapy (P>0.05). The median overall survival (OS) after presence of hydronephrosis was 26 months (95%CI: 8.3, 43.7). Multivariate analyses showed that the blood vessel invasion (LVSI) was an independent risk factor for OS (P<0.05). Conclusions: Malignant hydronephrosis had no effect on the efficacy of the first-line chemotherapy and PFS of patients with colorectal carcinoma received the first-line chemotherapy. LVSI was the independent prognostic factor for OS of patients with malignant hydronephrosis.

[Artificial intelligence evaluation of simulated phantom lung nodules with different pre-adaptive iteration techniques]

Objective: To investigate the detection rate of pulmonary nodules and the accuracy of automated measurement in chest simulation phantom by artificial intelligent computer-aided detection of pulmonary nodules with different pre-adaptive iterative techniques (ASIR-V) in wide-spectrum CT scanning. Methods: Sixteen pulmonary nodules with different diameters, densities and shapes were placed in the chest simulation phantom from December 2017 to March 2018. The weight of ASIR-V was set at 0%, 20%, 30%, 40% and 50% respectively by using Revolution CT broadband energy spectrum scanning protocol. Spearman correlation analysis was used to analyze the dose volume CT dose index (CTDIvol) and dose length product (DLP) of each group. Scanning data were imported into Tuma Shenwei artificial pulmonary nodule analysis software to evaluate the nature of the detected nodules, and ICC was used to detect the differences among groups. Results: With the increase of ASIR-V weight, the effective dose of patients decreased gradually. CTDIvol of five groups of radiation dose volume CT dose index was 7.93, 7.24, 5.85, 5.15, 3.76 mGy,dose-length product DLP was 379, 346, 280, 246, 179 mGy·cm.There was a linear negative correlation between ASIR-V weights and CTDIvol as well as DLP, r value was-0.969, P<0.01.There was no significant difference in the detection rate of pulmonary nodules between AI and physicians (P>0.05). There was high intraclass correlation coefficients for the diameter, volume, CT value and malignant percentage of pulmonary nodules (ICCs:0.981-1.000). Conclusions: Radiation dose of unenhanced chest CT scan using wide detector spectral imaging decreased with the increasing of preset ASIR-V. Lung nodule detection rate and evaluation performance can be maintained well by using ASIR-V reconstructions at lower radiation dosage.

[Sero-epidemiological survey on hepatitis B virus in Yunnan province, between 2006 and 2014]

Objective: Through two nationwide sero-epidemiological survey programs on hepatitis B virus (HBV), hepatitis B markers in Yunnan province were compared between the findings in 2014 and in 2006. Results were used to understand the HBV epidemic status in Yunnan province and to estimate the efficiency of measures on prevention and control of the disease. Methods: People at the age of 1-29 years were sampled from 6 counties of the National Disease Surveillance sites in Yunnan province, by multi-stage random sampling method. Demographic information was collected by questionnaire, and 2-4 ml serum sample was taken to detect HBsAg, anti-HBs, anti-HBc, HBeAg and anti-HBe, by ELISA method. Results: were logged-in the database and analyzed by SPSS 17.0. Results Between the two studies, no statistically significant differences were observed on the overall HBV infection rates and the positive rates of HBsAg, HBeAg, anti-HBe, anti-HBc. Positive rate of anti-HBs in 2014 was significantly higher than that in 2006. The main two combination profiles of hepatitis B markers were through the fifth model which was positive only for anti-HBs and the sixth model which was negative for all markers in 2006, and the same in 2014. Detection rate through the fifth profile in 2014 was significantly higher than the rate in 2006, while the detection rate of the sixth profile in 2014 was significantly lower than the one in 2006. When analyzing the differences in the same age group, between the two surveys, results showed that the positive rate of anti-HBs in 2014 was significantly higher than that in 2006, in both the10-14 and the 15-19 years-old groups. Positive rate of anti-HBc in the 20-29 year-olds in 2014 was significantly lower than the one of 2006. The positive rates of HBsAg in the age groups of 1-4, 5-14 and 15-29 were 1.12%,1.61% and 1.25% respectively, in 2014. Conclusion: Prevention and control measures on HBV seemed in great progres. However, more effective prevention and control measures should be taken continually among people under the age of 15, in Yunnan province.

Perihilar branching patterns of renal artery and extrarenal length of arterial branches and tumour-feeding arteries on multidetector CT angiography

OBJECTIVE

The purpose of our study was to assess the extrarenal length of renal arterial branches and tumour-feeding arteries on multidetector CT (MDCT) angiography, in addition to the perihilar branching patterns, with relevance to segmental artery clamping.

METHODS

MDCT angiograms of 64 patients with renal masses <4 cm were retrospectively reviewed by 2 radiologists. The perihilar branching patterns of the single main renal artery were assessed according to the number of pre-segmental and segmental arteries. The extrarenal lengths of segmental plus pre-segmental arteries and the tumour-feeding arteries, measured on volume-rendered images, were compared according to the vascular segmentation and the tumour location, respectively.

RESULTS

In the 116 kidneys, 1 pre-segmental plus 5 segmental arteries (n=48) was the most common branching pattern. The mean extrarenal length of the inferior segmental plus pre-segmental arteries (33.05 mm) and the posterior segmental plus pre-segmental arteries (32.30 mm) was longer than any of the other segmental plus pre-segmental arteries (apical, 23.87 mm; superior, 26.80 mm; middle, 29.23 mm) (p<0.05). The mean extrarenal length of the lower pole tumour-feeding arteries (35.94 mm) was longer than those of the upper and mid-pole tumour-feeding arteries (24.95 mm, 29.62 mm), with significant difference between the lower and the upper pole tumour-feeding arteries (p<0.05).

CONCLUSION

Tumours in the lower pole, supplied by the inferior or posterior segmental artery, may be more amenable to segmental artery clamping.

ADVANCES IN KNOWLEDGE

MDCT angiography with volume rendering can demonstrate the extrarenal length of tumour-feeding arteries and may help in determining the accessibility for segmental artery clamping.

[In vivo transfection and expression of human coagulant factor VIII cDNA in mice]

The aim is to observe the expression of human factor VIII gene in mice tranduced in vivo and ex vivo. The vector pLNC-FVIII BD was generated by cloning a B-domain-deleted (760aa-1639aa) FVIII cDNA (FVIIIBD cDNA) into retroviral vector pLNCX. 2 x 10(6) of mouse bone marrow stroma cells transduced by LNC-FVIII BD were infused into 4-week-old BALB/c mice by tail-vein injection. pLNC-FVIII BD was conjugated with PAMAM dendrimer to form complex PAMAM-pLNC-FVIII BD, with which C57BL/6J were injected by tail vein (200 micro l contained 15 micro g/mouse) and sacrificed at days 1, 2, 7, 14, 21 and 28, respectively after injection. Tissue such as liver, spleen, lung and kindney were harvested, with which the transcription were detected by means of RT-PCR. In addition, blood was collected to be measured human FVIII Ag, human FVIIIc and anti-FVIII of human inhibitors. The results showed that the highest level of human FVIII in the recipient BALB/c mice was 8.6 +/- 1.44 ng/ml detected on the first day post-injection; anti-FVIII antibodies were detected from the first week post-injection, and then the level of FVIII Ag decreased and cannot be measured on the fourth week. In the C57BL/6J mice physiological level of human FVIII was expressed in plasma at 48 hours after injection and the average human FVIIIc was 0.62 U/ml and the average human FVIII Ag was 115.5 ng/ml, and gradually reduced later. Anti-FVIII of human inhibitors was not revealed all the time. Syngene image scanning demonstrated that the transcription of the human FVIII BD cDNA occurred mainly in spleen and lung, and secondarily in liver and kidney. No side effects of PAMAM-pLNC-FVIII BD were observed in mice tissue by pathological examination at 4 weeks. In conclusion, retrovirus-transduced bone marrow stroma cells effectively produced human FVIII after ex vivo transduction, but the development of anti-FVIII antibodies in recipient mice influenced the expression level. The human FVIII gene can successfully be transduced in vivo through injecting PAMAM-pLNC-FVIII BD cDNA into mice intravenously. There was physiological level expression of human FVIII in plasma at 48 hours after injection and the average human FVIIIc is 0.62 U/ml and the peak in the six mice was 0.89 U/ml, and gradually reduced later.

[Sperm-mediated expression of human clotting factor VIII gene in transgenic offspring of mice]

The expression of human clotting factor VIII gene was observed in transgenic off spring of mice through artificial insemination with sperm as carriers. Female mice were impregnated through artificial insemination by introducing sperm carrying pRC/RSV-hF VIII BD, which contained human F VIII BD (B-domain deleted) cDNA (hF VIII BD c DNA), into the uteri. During the fourth week after the birth of new-born mice, PCR was used to screen hF VIII BD cDNA positive transgenic mice, then blood of which was collected for detecting the antigen and Anti-hF VIII inhibitors, simultaneously, the transcription and expression of hF VIII BD cDNA were investigated by Northern blot and Western blot. The results showed that 7 became pregnant of 20 inseminated mice, and 11 new-born mice came into the world, out of which 9 survived at last. Three hF VIII BD cDNA-positive-transgenic mice had been screened out by PC R, in which the antigen of human F VIII in plasma was 8.65 ng/ml, 7.84 ng/ml and 8.44 ng/ml, respectively, the Anti-hF VIII inhibitors were all negative. Northern blot and Western blot showed that the transcription and expression of hF VIII BD cDNA existed in tissues such as spleen, liver, lung and kidney of 3 transgenic mice. It was concluded that transgenic mice carrying human F VIII gene can be generated by sperm-carrier techniques and express human F VIII protein. This experiment provides important data for manufacturing transgenic animal carrying human F VIII gene, which can work as a biological reactor to produce human F VIII protein, through sperm-carrier techniques.