BACKGROUND: Hypertension is associated with an increased risk of calcific aortic valve stenosis (CAVS). However, the directionality of causation between blood pressure traits and aortic stenosis is unclear, as is the benefit of antihypertensive drugs for CAVS. METHODS: Using genome-wide association studies (GWAS) summary statistics, we performed bidirectional two-sample univariable mendelian randomization (UVMR) to assess the causal associations of systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP) with CAVS. Multivariable mendelian randomization (MVMR) was conducted to evaluate the direct effect of hypertension on CAVS, adjusting for confounders. Drug target mendelian randomization (MR) and summary-level MR (SMR) were used to estimate the effects of 12 classes of antihypertensive drugs and their target genes on CAVS risk. Inverse variance weighting was the primary MR method, with sensitivity analyses to validate results. RESULTS: UVMR showed SBP, DBP, and PP have causal effects on CAVS, with no significant reverse causality. MVMR confirmed the causality between hypertension and CAVS after adjusting for confounders. Drug-target MR analyses indicated that calcium channel blockers (CCBs), loop diuretics, and thiazide diuretics via SBP lowering exerted protective effects on CAVS risk. SMR analysis showed that the CCBs target gene CACNA2D2 and ARBs target gene AGTR1 were positively associated with CAVS risk, while diuretics target genes SLC12A5 and SLC12A1 were negatively associated with aortic stenosis risk. CONCLUSIONS Hypertension has a causal relationship with CAVS. Managing SBP in hypertensive patients with CCBs may prevent CAVS. ARBs might exert protective effects on CAVS independent of blood pressure reduction. The relationship between diuretics and CAVS is complex, with opposite effects through different mechanisms.

OBJECTIVE: To investigate the effectiveness of Xuanshen Yishen Decoction (XYD) in the treatment of hypertension. METHODS: Hospital electronic medical records from 2019-2023 were utilized to emulate a randomized pragmatic clinical trial. Hypertensive participants were eligible if they were aged ⩾40 years with baseline systolic blood pressure (BP) ⩾140 mm Hg. Patients treated with XYD plus antihypertensive regimen were assigned to the treatment group, whereas those who followed only antihypertensive regimen were assigned to the control group. The primary outcome assessed was the attainment rate of intensive BP control at discharge, with the secondary outcome focusing on the 6-month all-cause readmission rate. RESULTS: The study included 3,302 patients, comprising 2,943 individuals in the control group and 359 in the treatment group. Compared with the control group, a higher proportion in the treatment group achieved the target BP for intensive BP control [8.09% vs. 17.5%; odds ratio (OR)=2.29, 95% confidence interval (CI)=1.68 to 3.13; P<0.001], particularly in individuals with high homocysteine levels (OR=3.13; 95% CI=1.72 to 5.71; P<0.001; P for interaction=0.041). Furthermore, the 6-month all-cause readmission rate in the treatment group was lower than in the control group (hazard ratio=0.58; 95% CI=0.36 to 0.91; P=0.019), and the robustness of the results was confirmed by sensitivity analyse. CONCLUSIONS XYD could be a complementary therapy for intensive BP control. Our study offers real-world evidence and guides the choice of complementary and alternative therapies. (Registration No. ChiCTR2400086589).
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Antihypertensive Agents/pharmacology* ; Blood Pressure/drug effects* ; Drugs, Chinese Herbal/pharmacology* ; Hypertension/physiopathology* ; Patient Readmission ; Treatment Outcome

Objective:To evaluate the association between heatwaves and fall-related mortality.Methods:A total of 61 421 fall-related mortality from 2013 to 2022 in 7 provinces of China were included in a time-stratified case-crossover design, with daily meteorological data derived from the fifth generation European Reanalysis dataset produced by the European Centre for Medium-Range Weather Forecasts. Conditional logistic regression chimeric distributed lag nonlinear model was used to analyze the association between heatwaves and fall-related mortality and stratified analysis was conducted according to gender and age.Results:Heatwaves were associated with an increased risk of fall-related morality. The risk of fall-related mortality during heatwaves was higher than during non-heatwave periods ( OR=1.11, 95% CI: 1.05-1.18). The attributable fraction of fall-related motality due to heatwaves was 10.25% (95% CI: 4.49%-15.36%). For each 1 ℃ increase above the heatwave threshold, the risk of fall-related mortality increased by 34% ( OR=1.34, 95% CI: 1.02-1.76). The effect of heatwave duration on fall-related mortality was not statistically significant. Stratified analyses indicated that women experienced a higher risk of fall-related mortality during heatwaves ( OR=1.13, 95% CI: 1.04-1.22) compared to man ( OR=1.10, 95% CI: 1.04-1.17). Conclusions:Heatwave increases the risk of fall-related mortality, and the intensity of heatwaves modify this risk. Women are vulnerable populations.

In tracheal resection and reconstruction, a technically demanding, complex, and high-risk procedure, management of the anastomotic site significantly impacts postoperative outcomes and long-term quality of life. However, comprehensive studies detailing perioperative anastomotic management strategies in tracheal reconstruction remain scarce. This review summarizes perioperative management strategies for tracheal reconstruction, covering preoperative assessment, surgical techniques, and other key aspects. It also highlights future research directions and challenges, aiming to provide clinicians with a systematic guide to perioperative management in tracheal reconstruction.

Objective To investigate the feasibility and safety of transoral transgastric natural orifice transluminal endoscopic surgery(TG-NOTES)cholecystectomy in miniature pigs.Methods A total of 11 miniature pigs were selected as the experimental subjects and underwent TG-NOTES cholecystectomy.These pigs were divided into the Group A and Group B according to the surgical procedures.Among them,7 miniature pigs in the Group A underwent endoscopic cholecystectomy without dissecting the gallbladder triangle,while 4 miniature pigs in the Group B underwent endoscopic cholecystectomy after dissecting the gallbladder triangle.The success rate of surgery,the time of each stage of surgery,the incidence of complications,the success rate of cholecystectomy and the survival rate of miniature pigs in the two groups were counted.One miniature pig in the Group A and 4 miniature pigs in the Group B were selected for survival experiments.After surviving for 1 week,they were killed and dissected to observe the healing of incision and incidence of complications.Results The surgical survival rate of experimental animals was 100%,and the success rate of cholecystectomy was 100%.There was no significant difference in the surgical time,time of cut the stomach into the abdomen,time of gallbladder exploration or time of gallbladder removal of miniature pigs between the two groups(P>0.05).The time of ligating gallbladder artery of miniature pigs in the Group B was longer than that in the Group A,and the time of isdating gallbladder was shorter than that in the Group A,with statistically significant differences(P<0.05).There was no significant difference in the average number of complications of miniature pigs between the two groups(P>0.05).The dissection of animals after survival experiments revealed that the incisions healed well without serious complications.Conclusion This study successfully establishes the surgical model of TG-NOTES cholecystectomy,and confirms the safety and feasibility of TG-NOTES cholecystectomy.

Objective:To investigate the diagnostic value of fetal MRI in external ear abnormalities.Methods:28 fetuses with suspected ear abnormalities based on ultrasound and MRI in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from August 2019 to February 2024 were enrolled retrospectively. The morphology of fetal auricle and external auditory canal were observed to determine the types of external ear abnormalities. The results of postpartum physical examination were taken as the gold standard, paired χ 2 test and kappa test were used with SPSS 21.0 software to compare the difference and consistency of fetal MRI and ultrasound in diagnosis of external ear abnormalities. Results:22 cases (31 ears) of microtia were found, of which 30 ears were detected by MRI (sensitivity 96.8%, specificity 100%, accuracy 98.2%) and 28 ears were detected by ultrasound (sensitivity 87.1%, specificity 96.0%, accuracy 91.1%). The detection rates of the two methods were higher in MRI, but there was no statistically significant difference between MRI and ultrasound in diagnosis of microtia ( P=0.688), and the results of the two examinations were consistent ( kappa=0.786, P<0.001). 24 ears of external auditory canal atresia were all correctly diagnosed by MRI. However, ultrasound could not detect any external auditory canal atresia. Conclusion:The diagnostic ability of MRI for fetal external ear abnormalities was similar to that of ultrasound, and it showed obvious advantages in the diagnosis of external ear canal atresia.

Objective:To explore the impacts of carnosic acid(CA)on learning and cognitive function in epileptic rats and the mechanism of regulating PKA-CREB signaling pathway in this process.Methods:Epilepsy rat models were prepared by intraperi-toneal injection of 50 mg/kg PTZ.After successful modeling,the rats were randomly grouped into control group,model group,CA low-dose group,CA high-dose group,CA high+PKA inhibitor group(CA high+H-89 group),with 15 rats in each group.The epileptic be-havior of rats in each group was evaluated;Morris water maze experiment was applied to test the cognitive ability of rats;HE staining and Nissl staining were applied to detect the morphology of hippocampal tissue and neurons of rats in each group;ELISA was applied to detect the contents of IL-1β,TNF-α,MDA,and the SOD activity in the hippocampus of rats in each group;and Western blot was applied to detect the protein expressions of PKA,p-PKA,CREB,p-CREB and BDNF in the hippocampus of rats in each group.Results:Compared with control group,the hippocampal neurons of rats in model group were irregularly arranged,with pyknosis of the nuclei,and the number of neurons decreased,the epilepsy frequency,Racine grading,escape latency,time of first platform crossing,and levels of IL-1β,TNF-α and MDA all increased,the frequency of crossing the platform,SOD activity,p-PKA/PKA,p-CREB/CREB,and the expression of BDNF protein all reduced(P<0.05);compared with model group,the arrangement of neuronal cells in hippocampal tissue of rats in CA group gradually became orderly,nuclear pyknosis gradually decreased,and the number of neurons increased,the epilepsy frequency,Racine grading,escape latency,time of first platform crossing,and levels of IL-1β,TNF-α and MDA all reduced,the frequency of crossing the platform,SOD activity,p-PKA/PKA,p-CREB/CREB,and the expression of BDNF protein all increased(P<0.05);further injection of PKA inhibitors on the basis of high-dose CA treatment showed that the improvement effects of high-dose CA on cognitive dysfunction,neuronal damage,inflammation,and oxidative stress in epileptic rats were reversed(P<0.05).Conclusion:CA can improve the learning and cognitive function of epileptic rats by activating the PKA-CREB signaling pathway.

Objective To investigate the association between intestinal microbiota dysbiosis and colonic polyps,Helicobacter pylori(Hp)infection,and intestinal metaplasia.Methods A total of 200 patients diagnosed with colonic polyps,Hp infection,or both conditions.These patients were classified into three groups:the colonic polyp group(n=90),the Hp infection with intestinal metaplasia group(n=49),and the colonic polyp combined with Hp infection and intestinal metaplasia group(n=61).Additionally,62 individuals who underwent routine health examinations at our hospital during the same period were enrolled as a control group.The study compared gut microbiota imbalances across these groups to investigate the association between intestinal dysbiosis and colonic pol-yps,Hp infection,and the co-occurrence of colonic polyps with Hp-related intestinal metaplasia.Logistic regression analysis was performed to identify risk factors associated with the development of intestinal metaplasia due to Hp infection in patients with colonic polyps.Results Compared to the control group,intestinal flora imbalance was significantly more prevalent in the colorectal polyp group,the Hp infection with intestinal metaplasia group,and the colorectal polyp combined with Hp infection and intestinal metaplasia group(P<0.05).Moreover,intestinal flora imbalance in the colorectal polyp with Hp infection and intestinal metaplasia group was significantly higher than that in both the colorectal polyp group and the Hp infection with intestinal metaplasia group(P<0.05).Regarding exhaled gas levels,H2 and CH4 concentrations were significantly elevated in the groups with colorectal polyps accom-panied by Hp infection and intestinal metaplasia,those with colorectal polyps alone,and those with Hp infection and intestinal metaplasia,compared to the control group(P<0.05).Similarly,exhaled H2S levels were significantly higher in the group with colorectal polyps complicated by Hp infection and intestinal metaplasia than in the control group(P<0.05).Furthermore,exhaled H2 and CH4 levels showed positive correlations with the presence of colorectal polyps,Hp infection with intestinal metaplasia,and colorectal polyps combined with Hp infection and intestinal metaplasia(P<0.05).Exhaled H2S levels were positively correlated with colorectal polyps complicated by Hp infec-tion and intestinal metaplasia(P<0.05).Logistic regression analysis indicated that a history of smoking,atrophic gastritis,peptic ulcer,and intestinal flora imbalance are independent risk factors for Hp infection-associated intesti-nal metaplasia in patients with colorectal polyps(P<0.05).Conclusion Intestinal flora imbalance is associated with colorectal polyps and Hp-induced intestinal metaplasia,suggesting that microbial dysbiosis may represent a potential risk factor for the development of these conditions.

Creutzfeldt-Jakob disease(CJD)is a rapidly progressive and fatal neurodegenerative disorder caused by prions,with certain infectivity and iatrogenic transmission risks.With the rapid progress and application of new dia-gnostic biomarkers and detection methods,as well as the construction and improvement of surveillance and reporting systems,the detection of CJD in patients domestically and internationally has shown an increasing trend year by year.Due to its long incubation period and heterogeneity of early symptoms,early identification and diagnosis of the disease is difficult,increasing the risk of transmission within medical institutions.Currently,there is a lack of con-sensus on the infection prevention and control of CJD.In order to timely identify and diagnose CJD as well as effec-tively block its transmission in medical institutions,this consensus summarizes 15 clinical concerns and formulates 24 specific recommendations based on the latest domestic and international research findings and clinical evidence,as well as combines with clinical practice,aiming to standardize healthcare-associated infection prevention and control measures for CJD and reduce its transmission risk in medical institutions.

Objective:To analyze the multi antigen distribution characteristics of Rh blood group system in Shunde area of Guangdong Province,explore the feasibility of Rh phenotype compatible blood transfusion for blood recipients in this area,and formulate the precise blood transfusion strategies.Methods:From June 2022 to December 2024,113 226 hospitalized patients scheduled for blood transfusion in Shunde Hospital of Southern Medical University and 30 832 blood donors'blood samples provided by Shunde central blood station in the same period were detected for ABO blood group and Rh phenotype by microcolumn gel method,and the Rh phenotype data of the recipients and blood donors were compared and analyzed.Results:Among 113 226 blood samples,112 963 cases(99.77％)were RhD positive,with CCDee(54.96％)and CcDEe(28.21％)phenotypes being the main phenotypes;263 cases(0.23％)were RhD negative,with ccDee(50.19％)and CcDee(36.88％)as the main phenotype.Among 30 832 blood donor samples,CCDee(54.65％)and CcDEe(27.93％)were the main phenotypes of Rh phenotype with RhD positive.The positive rates of D,C,c,E and e antigens of blood recipients and blood donors were in the same order from high to low D＞e＞C＞c＞E.The frequency of e antigen in RhD positive recipients with different ABO blood groups was statistically different from that of blood donors(P＜0.05),while there was no statistical difference in the other four antigens(P＞0.05),the distribution of ccDEe phenotypes was statistically different(P＜0.05),but there was no statistical difference in the distribution of other eight phenotypes(P＞0.05).In RhD positive recipients,the probability of finding compatible blood for phenotype CcDEe was 100％,the probability of finding compatible blood for phenotype CCDee,CCDEe and DcDee was 54％-65％,and the probability of finding compatible blood for other phenotypes was less than 10％.Providing blood with CCDee and ccDEE phenotypes according to Rh blood matching scheme can meet the needs of more than 99％of patients with 9 Rh phenotype compatible blood transfusion in this region.Conclusion:Rh phenotype detection should be carried out for hospitalized patients to be transfused,and the precise transfusion strategy of Rh phenotype isotype or compatibility should be implemented to make the transfusion treatment of patients more safe and reliable.