Objective To investigate the value of carotid and lower limbs arteries atherosclerosis in prediction of intracranial atherosclerosis combined with type 2 diabetes (T2DM). Methods Seventy-four patients with T2DM received the carotid artery , lower limbs arterial color Doppler ultrasound and cranial MRA examination. The data was analysised by Pearson correlation and Binary Logistic methods. Results With the increasement of degree of peri-arterial atherosclerosis , the intracranial arteriosclerosis was in a trend of increase. The correlation coefficients, OR values and AUC of LLAS and CAS + LLAS for intracranial atherosclerosis were 0.28 (P < 0.05) and 0.33 (P < 0.05), 0.14 (P < 0.05) and 9.28 (P < 0.05), 70.30% (P < 0.05) and 70.60% (P < 0.05), respectively. The cut-off point of LLAS and CAS + LLAS was lever 2. Conclusion The LLAS and CAS + LLAS with T2DM are independent risk factors for intracranial atherosclerosis , owning certain forecast values.

Objective To explore the medication regularity of prescriptions in Universal Relief:Cough Medicine in that to provide worthy reference for clinical treatment of cough.Methods The prescriptions in Universal Relief:Cough Medicine was collected and then established the database using Excel 2016 softwore,and carried out medication frequency analysis.SPSS Modeler 18.0 and Lantern 5.0 were used to perform association rules analysis and latent structure model analysis to explore medication rules of prescriptions in Universal Relief:Cough Medicine.Results 607 prescriptions were collected,involving 335 traditional Chinese medicines.A total of medication frequency is 3941,The most frequently used TCMs were ganca(glycyrrhizae radixet rhizoma)and shengjiang(zinglberis rhizoma recens)and kuxingren(armeniaeae semen amarum).The main efficacy of the medicine is to dissipate phlegm,relieve cough,relieve asthma,and replenish deficiency,and warm in nature,spicy,bitter,and sweet in taste and lung and spleen in meridian.14 strongly correlated material rules were sorted out by association rule analysis such as banxia(pinelliae rhizoma)+gancao(glycyrrhizae radixet rhizoma)→shengjiang(zinglberis rhizoma recens)、banxia(pinelliae rhizoma)→shengjiang(zinglberis rhizoma recens)and mahuang(ephedrae herba)+gancao(glycyrrhizae radixet rhizoma)→kuxingren(armeniaeae semen amarum).12 variables were obtained by latent structure model analysis,and according to professional knowledge inference,3 integrated cluster models and 1 single cluster and 4 core prescriptions were obtained.It was inferred that the common syndromes of Universal Relief:Cough Medicine were cold drink stoping in the lung,qi deficiency external phlegm dampness inside,phlegm heat blocking lung,and lung deficiency prolonged cough.Conclusion The medication rules of prescriptions in Universal Relief:Cough Medicine is mainly benefiting qi and resolving phlegm,cure both the symptoms and the disease,and in different situations combine with different treatment methods,such as warming the lung and resolving phlegm,clearing heat and resolving phlegm,tonifying qi and resolving external symptoms,and astringent lung qi.

Objective To investigate the risk factors for early neurological deterioration in mild acute ischemic stroke，to construct a clinical predictive model，and to perform internal validation of this model. Methods A retrospective analysis was performed for 739 patients with mild acute ischemic stroke who were admitted to Department of Neurology，Kuntong Hospital of Zunhua，from October 2020 to December 2023，and they were randomly divided into a training set with 534 patients （72.3%） and a validation set with 205 patients （27.7%） at a ratio of 7∶3. Univariate and multivariate logistic regression analyses were performed for the training set to determine the risk factors for early neurological deterioration in mild acute ischemic stroke. A clinical predictive model was constructed，and internal validation was performed in terms of discriminatory ability，calibration，and clinical decision making. A nomogram was plotted. Results The multivariate logistic regression analysis showed that female sex （OR=1.87，95% CI 1.14~3.09，P=0.014），time window ≤6 hours （OR=3.10，95%CI 1.56~6.19，P=0.001），a baseline NIHSS score of 2 points （OR=3.72，95%CI 1.30~10.61，P=0.014），a baseline NIHSS score of 3 points （OR=4.24，95%CI 1.45~12.35，P=0.008），a TOAST classification of large artery atherosclerosis （OR=3.88，95%CI 2.20~6.83，P<0.001），and the responsible arteries of the basilar artery，the middle cerebral artery，and the internal carotid artery （OR=8.39，95%CI 2.28~30.85，P=0.001； OR=6.22，95%CI 1.78~21.71，P=0.004； OR=5.38，95%CI 1.15~25.13，P=0.032） were independent risk factors for early neurological deterioration in mild acute ischemic stroke. The clinical predictive model constructed showed a moderate discriminatory ability （AUC>0.7），good calibration （P>0.05） in the Hosmer-Lemeshow goodness-of-fit test），and good clinical benefits in both the training set and the validation set. Conclusion This clinical predictive model can effectively predict the onset of early neurological deterioration in mild acute ischemic stroke and guide clinicians to make decisions，and therefore，it holds promise for clinical application.
Nomograms

Objective: To assess the efficiency and safety of low-dose decitabine in patients with lower-risk myelodysplastic syndrome (MDS) to couple with the clinical significance of MDS-related gene mutations. Methods: This study was done in 4 institutions in Zhejiang Province. A total of 62 newly diagnosed patients with lower-risk MDS were assigned to two groups of decitabine (12 mg·m^-2·d^-1 for 5 consecutive days) and best supportive care (BSC) . Their bone marrow samples were subject to examinations of MDS-related 15 gene mutations. The primary endpoints were the proportion of patients who achieved overall response (ORR) after at least two cycles and progression-free survival (PFS) , and their relevances to the gene mutations. Results: Of 62 enrolled patients, and 51 cases were included in the final analysis. 16 of 24 patients (66.7%) in decitabine group achieved ORR versus 8 of 27 (29.6%) in BSC group (χ²=6.996, P=0.008) ; PFS prolongation of decitabine versus BSC was statistically significant (not reached vs 13.7 months, P=0.037) . Among 51 patients, at least one gene mutation was identified in 20 patients (39.2%) , including 4 single SF3B1 mutation. PFS in cases with gene mutations (not including single SF3B1 mutation) was significantly shorter than of no gene mutation (9.2 months vs 18.5 months, P=0.008) , but not for ORR (37.5% vs 58.1%, P=0.181) . Among 16 patients with mutated genes, ORR in decitabine and BSC groups were 75% (6/8) and 0 (0/8) , respectively. The most adverse events in decitabine group were grade 3 to 4 neutropenia (45.8%) and grade 3 to 4 infections (33.3%) . Conclusion This preliminary study showed that low-dose decitabine produced promising results with an acceptable safety in lower-risk MDS patients, especially for those with mutated genes. Further study targeting poor prognostic lower-risk MDS patients should be warranted.

Objective    To summarize the clinical experiences of minimally invasive cardiac surgery (MICS) for cardiac atrioventricular valve reoperation. Methods    Perioperative data of 32 patients who underwent MICS for cardiac atrioventricular valve reoperation from 2009 to 2019 in the First Affiliated Hospital of Anhui Medical University were retrospectively reviewed, including 13 males and 19 females with a mean age of 51.0±12.6 years. All patients were given combined intravenous and inhalation anesthesia, and a double-lumen tube for mechanical ventilation. Cardiopulmonary bypass was established in all patients by femoral artery and venous cannulation or combined with percutaneous superior vena cava cannulation, without aortic cross-clamping. The MICS approaches included right anterolateral small incision surgery, thoracoscopic assisted small incision surgery and total thoracoscopic surgery. The clinical data of the 32 patients were compared with the perioperative indicators of 24 patients undergoing reoperation with conventional median thoracotomy during the same period. Results    Among them, 21 patients underwent isolated tricuspid valve replacement, 4 isolated tricuspid valvuloplasty, 1 combined tricuspid valve replacement and atrial septal defect repair and 6 combined mitral valve replacement and tricuspid valvuloplasty. Twenty-seven patients completed the operation in a beating heart, and 5 under the condition of ventricular fibrillation. Operation time (3.23±1.56 h vs. 5.46±2.13 h, P<0.001), postoperative mechanical ventilation time (9.19±5.40 h vs. 43.23±21.74 h, P<0.001), ICU stay (35.03±18.26 h vs. 79.15±22.43 h, P<0.001) and hospital stay of patients with minimally invasive surgery (9.35±6.43 d vs. 15.85±7.56 d, P=0.001) were shorter than those with median thoracotomy. And the extracorporeal circulation time was not significantly prolonged. There were 4 perioperative complications in patients with minimally invasive surgery, and 1 died in hospital after operation. Conclusion    MICS for cardiac atrioventricular valve reoperation can avoid the risk of median sternotomy and separation of cardiac scar adhesion. Especially, total thoracoscopic surgery has more advantages when compared with other operations, including less trauma, less myocardial ischemia reperfusion injury, more rapid recovery and fewer postoperative complications. Total thoracoscopic surgery may be the development direction of MICS for cardiac atrioventricular valve reoperation. However we should take effective and feasible measures to solve the problems caused by cardiopulmonary bypass.

【Objective】 To compare the histological characteristics of porcine pancreatic elastase （PPE） induced abdominal aortic aneurysms （AAA） and angiotensin Ⅱ （AngⅡ） induced AAA in mice. 【Methods】 In the PPE group， the mouse abdominal aorta segment from the infrarenal abdominal aorta to the iliac artery was isolated and its branch arteries were ligated to avoid leakage during PPE perfusion. We perfused the isolated aorta segment with a PPE solution at a concentration of 1.5 U/mL for 5 min and then closed the abdominal cavity. The diameter of the abdominal aorta was measured before and 14 days after the surgery， and the perfusion segment of the arteries was collected at day 14 after the surgery. The histological characteristics of the aneurysm were analyzed and graded by histological and immunohistochemical methods. In the AngⅡ group， ten apolipoprotein E knockout mice were prepared， and AngⅡ [1 000 ng/(kg·min)] was infused with osmotic pumps for 28 days. The aorta was separated and the aneurysm aorta segment was analyzed. The wild type mice were used as normal health controls. 【Results】 In the PPE group， the diameter of the PPE perfused aorta segments increased and was significantly larger than the basal diameter ［（0.52±0.02） mm vs. （1.23±0.11） mm］ at day 14 after surgery. All the ten mice developed AAA after PPE application. The histological results showed typical pathological features of AAA in PPE perfused mice， such as elastic fiber breakage， smooth muscle exhaustion， and increased inflammation. Six of the ten mice developed aneurysms after AngⅡ infusion （6/10）. The aneurysms/dilatations were mostly in the suprarenal abdominal aorta， but also in the thoracic aorta and aortic arch. The histology analysis showed that the formation of arterial dissection was common after AngⅡ infusion， and the typical vascular “false lumen” was found. The breakage of elastic fibers， the exhaustion of smooth muscle damage， and the inflammatory response were not as typical as the PPE model in AngⅡ perfused animals. 【Conclusion】 The histological characteristics of PPE induced AAA are very typical and well present the inflammatory process in the development of aneurysm. The AngⅡ model is suitable for the study of aneurysms combined with aortic dissection. Both models have their own advantages and can complement each other.

Exploring the mechanisms of maintaining microbial community structure is important to understand biofilm development or microbiota dysbiosis. In this paper, we propose a functional gene-based composition prediction (FCP) model to predict the population structure composition within a microbial community. The model predicts the community composition well in both a low-complexity community as acid mine drainage (AMD) microbiota, and a complex community as human gut microbiota. Furthermore, we define community structure shaping (CSS) genes as functional genes crucial for shaping the microbial community. We have identified CSS genes in AMD and human gut microbiota samples with FCP model and find that CSS genes change with the conditions. Compared to essential genes for microbes, CSS genes are significantly enriched in the genes involved in mobile genetic elements, cell motility, and defense mechanisms, indicating that the functions of CSS genes are focused on communication and strategies in response to the environment factors. We further find that it is the minority, rather than the majority, which contributes to maintaining community structure. Compared to health control samples, we find that some functional genes associated with metabolism of amino acids, nucleotides, and lipopolysaccharide are more likely to be CSS genes in the disease group. CSS genes may help us to understand critical cellular processes and be useful in seeking addable gene circuitries to maintain artificial self-sustainable communities. Our study suggests that functional genes are important to the assembly of microbial communities.
Gastrointestinal Microbiome ; genetics ; Genes, Microbial ; Humans ; Microbiota ; genetics ; Mining ; Models, Genetic ; Water Pollution