Objective:Preliminary explore the safety and efficacy of using only vitamin K antagonists without antiplatelet therapy after left ventricular assist devices (LVAD) implantation.Methods:This is a cohort study. Patients who underwent HeartCon LVAD implantation in TEDA International Cardiovascular Hospital from September 2020 to September 2022 were included. Oral warfarin sodium was given on postoperative days 1 to 2, with the target international standardized ratio (INR) of 2.0 to 2.5. Follow-up until September 2022, survival, INR level and occurrence of bleeding and thrombosis were recorded. Survival analysis was performed by the Kaplan-Meier method (censored for heart transplantation).Results:A total of 22 patients, including 16 male patients (72.7%), aged (51.0±13.3) years, were included. The duration of HeartCon LVAD support was (458±166) days and the INR during support was 2.28±0.26. One patient underwent the heart transplant at 307 d after implantation. One patient (4.5%) occured cardiac tamponade, two patients (9.1%) occured hemorrhagic stroke, five patients (22.7%) occured gastrointestinal bleeding, four patients (18.2%) occured gingival hemorrhage, two patients (9.1%) occured epistaxis, one patient (4.5%) occurred ischemic stroke, one patient (4.5%) occured pump thrombosis, and one patient (4.5%) occured aortic valve thrombosis. The survival rates were 100%, 95%, 95%, and 95% at 3 months, 6 months, 1 year, 2 years after implantation respectively.Conclusion:The single antithrombotic strategy using warfarin (target INR 2.0-2.5) without antiplatelet for patients with implantations of HeartCon type LVAD may be safe and effective.

Objective To predict the core targets and action pathways of Hedysari Radix based on UPLC-MS/MS and network pharmacology methods,and to verify the results of network pharmacology by molecular docking and molecular dynamics techniques.This article aims to investigate immune regulation mechanism of effective components absorbed into blood from Hedysari Radix.Methods Qualitative quantification of effective components absorbed into blood from Hedysari Radix were operated by using UPLC-MS/MS technique.The corresponding targets of effective components absorbed into blood from Hedysari Radix were screened by TCMSP and HERB databases.Targets of immune-related disease were obtained through DisGeNET,OMIM,TTD,and MalaCards databases.The network of"components absorbed into blood from Hedysari Radix-immune-related diseases"was then constructed.GO and KEGG enrichment analysis and mapped the PPI network were performed.Molecular docking and molecular dynamics techniques were applied for validation.Results A total of 8 prototype components absorbed into blood,synergistically acting on 101 targets,were identified by UPLC-MS/MS.They mediated 538 biological processes including immune response,positive regulation of gene expression,receptor binding,and cytokine activity.Meanuhile,116 signaling pathways,such as HIF-1,Toll-like receptor,JAK-STAT,T cell receptor,PI3K-Akt,and FoxO etc.were involved.The core targets were MAPK14,PTGS2,MMP9,PPARG,CCND1,etc..The results of molecular docking showed that formononetin and calycosin had strong docking binding activity with MAPK14.And molecular dynamics simulations further demonstrated that the binding between MAPK14 and formononetin or calycosin had good structural stability and binding affinity.Conclusion The results of serum pharmacochemistry,network pharmacology and molecular dynamics were verified to reveal the material basis and mechanism of Hedysari Radix in regulating immunity.The aim of this study is to provide scientific basis for its immunomodulatory mechanism.

In order to seek a patient friendly and low-cost intestinal examination method, a structurally simple pneumatic soft intestinal robot inspired by inchworms is designed and manufactured. The intestinal robot was consisted of two radially expanding cylindrical rubber film airbags for anchoring and one low density polyethylene film airbag for axial elongation, which achieved movement in the intestine by mimicking the crawling of inchworms. Theoretical derivation was conducted on the relationship between the internal air pressure of the anchored airbag and the free deformation size after expansion, and it pointed out that the uneven deformation of the airbag was a phenomenon of expansion instability caused by large deformation of the rubber material. The motion performance of the intestinal robot was validated in different sizes of hard tubes and ex vivo pig small intestine. The running speed in the ex vivo pig small intestine was 4.87 mm/s, with an anchoring force of 2.33 N when stationary, and could smoothly pass through a 90 ° bend. This work expects to provide patients with a new method of low pain and low-cost intestinal examination.
Animals ; Swine ; Robotics/instrumentation* ; Equipment Design ; Intestine, Small/physiology* ; Intestines/physiology* ; Humans

Malignant tumors are one of the main causes of human death worldwide and pose a serious threat to human health. The current treatment methods are mainly the combination of chemotherapeutics， surgery， radiotherapy， or hormone therapy. The treatment process has limitations such as multidrug resistance， non-selective targeting of cancer cells， and drug toxicity. With the development and application of traditional Chinese medicine （TCM）， Chinese medicine has the characteristics of multi-angle and multi-mechanism coordination and slight toxic and side effects. It can effectively inhibit tumor proliferation， differentiation， and metastasis， and avoid drug resistance， serving as the focus of current tumor treatment research. Hedysari Radix， one of the genuine medicinal materials in Gansu province， is a tonic Chinese medicine with a wide range of pharmacological effects such as anti-inflammation， immune regulation， anti-oxidation， prevention and treatment of diabetic complications. In the majority of the ancient works on herbs of the past dynasties， Hedysari Radix was included under the item of Astragali Radix and used as Astragali Radix. Hedysari Radix is superior to Astragali Radix in enhancing immunity， scavenging free radicals， and resisting liver fibrosis. Studies have found that the effective components of Hedysari Radix have a prominent anti-tumor effect and a significant inhibitory effect on various malignant tumors such as liver cancer， bladder cancer， gastric cancer， breast cancer， and colorectal cancer. They can also combine with clinical anti-cancer drugs to reduce the toxic and side effects of chemotherapy drugs and improve the tolerance of patients during chemotherapy. On the basis of current research， this study summarized the mechanism of Hedysari Radix active components in inducing cell apoptosis， blocking cell cycle， inhibiting tumor cell proliferation， migration， and invasion， regulating micro mRNA （miRNA）， inducing cell autophagy， enhancing immune regulation， as well as reducing toxicity and enhancing efficiency and sensitization with clinical chemotherapeutics， and systematically explained the anti-tumor mechanism of Hedysari Radix active components， aiming to provide a basic reference for the further exploration of the anti-tumor mechanism of Hedysari Radix and the further development and utilization of its effective components.

Vagus nerve stimulation (VNS) is a neuromodulation technique that achieves therapeutic purpose through intermittent and chronic stimulation of vagus nerve afferent fibers, which has a remarkable effect on functional diseases of the central nervous system, and has been approved by FDA for intractable epilepsy, depression and migraine treatments. Transcutaneous auricular vagus nerve stimulation(taVNS) is a new type of non-invasive nerve regulation therapy based on traditional VNS and vagus nerve anatomy, and has a wide range of central regulation; taVNS can improve the cognitive state by regulating functions of cognition-related cerebral cortex and nerve nuclei, regulating inflammatory response, promoting neurotransmitter transmission, and so on, which has a broad application prospect in cognition-related diseases. This paper mainly summarizes the recent advance in central mechanism of taVNS in improving cognitive function.

Objective:To investigate and summarize the early management experience of 22 patients with end-stage heart failure(ESHF) who underwent left ventricular assist device(LVAD) implantation in an intensive care unit(ICU) in a single center.Methods:Data of 22 patients with ESHF treated with LVAD in the ICU of TEDA International Cardiovascular Hospital from September 2020 to August 2022 were retrospectively analyzed. There were 16 males and 6 females, aged from 20 to 67 years old, with a mean age of(51.0±13.3)years old. There were 21 cases with dilated cardiomyopathy, 1 case with ischemic cardiomyopathy, 6 cases with tricuspid regurgitation, 1 case with intra-aortic balloon pump for cardiogenic shock, and 5 cases with cardiac resynchronization therapy for arrhythmia. After the operation, all patients received restricted fluid therapy, a " stepwise" anticoagulation strategy, and strict blood pressure management. The postoperative complications and treatment process were reviewed, the treatment and management experience were summarized, and the prognosis of the patients was statistically analyzed.Results:All 22 patients survived within 90 days after surgery, and 21 patients(95.5%) recovered well, the pump works fine and there was no hemolysis and thrombosis of LVAD. Major complications included: 1 case of severe pneumonia(4.5%), 2 cases of pericardial tamponade(9.1%), 1 case of intracerebral hemorrhage(4.5%), 1 case of mediastinal infection(4.5%), 5 cases of positive occult blood in gastric juice(22.7%), no cases of right ventricular failure、aortic insufficiency and cerebral infarction. The duration of postoperative mechanical ventilation was 17(8.5, 51.5) h, and the ICU stay was 14(10, 27) days.Conclusion:LVAD is another effective treatment for patients with ESHF in addition to heart transplantation. Good postoperative blood pressure control, " stepwise" anticoagulation strategy and " restrictive" fluid management can reduce postoperative complications in the early phase of post-operation, which is crucial for the prognosis of patients with LVAD.

Objective:To investigate and evaluate the efficacy of HeartCon left ventricular assist device (LVAD) in the treatment of adult patients with end-stage heart failure (ESHF).Methods:A prospective and observational study was conducted. Patients with ESHF who underwent LVAD implantation in the department of cardiac surgery of Teda International Cardiovascular Hospital from September 2020 to August 2021 were selected. The left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) classification, N-terminal pro-B type natriuretic peptide (NT-proBNP), and six minute walk distance (6MWD) before operation and 90 days after operation were compared. The incidence of equipment failures and major adverse events within 90 days after operation were recorded.Results:A total of 20 patients with ESHF were included, with 15 males and 5 females. Patients' age ranged from 20 to 67 years old, with an average of (50.2±13.6) years old. The range of body weight was 49.8-106.1 kg, with an average of (67.9±15.5) kg, and the body surface area (BSA) was from 1.49 to 2.32 m 2, with an average of (17.6±0.22) m 2. The operation process of all the patients were successful. The length of hospital stay ranged from 33 to 90 days, and the average was 56.0 (42.8, 75.0) days. Complications within 90 days after operation as follows, 2 cases with pericardial tamponade (10%), 1 case with cerebral hemorrhage (5%), 1 case with mediastinum infection (5%), 3 cases with acute renal injury (AKI, 15%), 5 cases with gastrointestinal bleeding (25%). There were no mechanical failure of LVAD and hemolysis events, right ventricular failure (RVF), cerebral infarction and death occurred. Compared with preoperative, the LVEDD significantly decreased (mm: 67.50±13.98 vs. 77.40±9.73), LVEF significantly increased (%: 34.80±9.76 vs. 22.70±5.62), NT-proBNP significantly decreased (ng/L: 2 028.65±1 752.05 vs. 4 796.45±4 355.40), 6MWD significantly increased (m: 385.20±144.12 vs. 85.81±63.50) at 90 days after operation, and the differences were statistically significant (all P < 0.05). 18 cases (90%) of the 20 patients reached NYHA classification Ⅰ and 2 cases (10%) reached NYHA classification Ⅱ, which were significantly improved compared with those before surgery (all patients' NYHA classification were Ⅳ before surgery). Conclusion:HeartCon LVAD can effectively improve the life quality of patients with ESHF, which has been proved safe and effective in clinical trials, but its long-term effects and complications need further observation and study.

Objective:To investigate the diagnostic value of synthetic MRI methods in the differentiation of benign and malignant breast lesions.Methods:Clinical and imaging data of 93 breast patients confirmed by pathology in the Second Affifiliated Hospital of Xi′an Jiaotong University from May 2019 to April 2020 were analyzed retrospectively. All patients underwent synthetic MRI technique, and the quantitative parameters of T 1, T 2, and proton density (PD) values were measured. Independent samples t-test and Wilcoxon test were used to compare the differences in clinical and imaging characteristics between the benign and malignant breast lesions. ROC curve was used for the comparison of the diagnostic efficacy of the quantitative parameters in differentiating malignant from benign breast lesions. Results:Of the 93 patients with breast lesions, 62 cases were malignant and 31 cases were benign. The quantitative T 2 values for benign and malignant lesions were 103 (93, 126)ms and 83 (77, 90)ms respectively, and the quantitative PD values were 87.7 (72.7, 96.7)pu and 73.5(63.3, 79.4)pu respectively. There were statistically significant differences between benign and malignant lesion( P<0.05). Taking quantitative T 2 values of 90.5 ms and PD values of 84.8 pu as the cut-off value, the area under the ROC curve in differentiating benign from malignant breast lesions were 0.87 and 0.75, accuracy values were 80.6% and 78.5%, specificity values were 87.1% and 54.8%, sensitivity values were 77.4% and 90.3% respectively. Conclusion:Synthetic MRI methods can be applied in the examination of breast lesions and has the potential to be an effective diagnostic method for the differential diagnosis between benign and malignant lesions of breast.

Objective To investigate the application value of multiple?arterial?phase imaging technique with differential sub?sampling with cartesian ordering (DISCO) in the gadoxetate acid disodium enhanced liver MRI. Methods From September 2017 to March 2018, 56 patients with suspected malignant focal liver disease diagnosed with ultrasound or CT in West China Hospital of Sichuan University were enrolled prospectively, and underwent preoperative enhanced MRI with gadoxetate acid disodium. Patients were divided into 2 groups by random?number table method. Twenty nine patients in group A underwent liver multiple?arterial?phase imaging with DISCO. Twenty seven patients in group B underwent single?arterial?phase imaging with liver acquisition with volume acceleration?flex (LAVA?Flex). The display rate of late?arterial?phase and respiratory motion artifacts of dynamic enhancement images were evaluated. The categorical variables was compared by Chi?square test. The respiratory motion artifacts between the single?arterial?phase and multiple?arterial?phases were compared by Mann?Whitney U test. The artifact scores among the various phases of the multi?arterial phase were compared by Kruskal?Wallis H. Results Compared to LAVA?Flex [74.1%(20/27)], a higher display rate of late?arterial phase [96.6%(28/29)] was found in DISCO (Group A), and the difference was statistically significant (χ2=5.770, P=0.016). In the evaluation of respiratory motion artifacts, the motion artifacts of the late?arterial images obtained by LAVA?Flex [3(3,4)] were more severe than the DISCO [2(2,3)], and the difference was statistically significant (Z=-3.250, P<0.01). Among the scores of motion artifacts in the 6 phases of DISCO, the artifact scores of phase 1, 2, 3, 4, 5, 6 were [3(3,4)], [2(2,3)], [2(2,3)], [3(2,3)], [3(3,4)] and [3(3,4)], respectively. The motion artifacts of phase 2, 3, 4 were better than phase 1, 5, 6, the differences were statistically significant (P<0.05), but there was no statistical differences among phase 2, 3 and 4 (P>0.05). Conclusion Compared with single?arterial?phase imaging, multiple?arterial?phases with DISCO using gadoxetate acid disodium can improve the capture rate of late arterial phase and reduce motion artifacts.

Objective To investigate the value of multi?arterial phase differential sub?sampling with cartesian ordering (DISCO) technique in the evaluation of hepatic vascular anatomy with gadolinium?ethoxybenzyl?diethylenetriamine pentaacetic acid (Gd?EOB?DTPA). Methods Forty?eight patients with suspected hepatic malignancy were prospectively enrolled and underwent both of Gd?EOB?DTPA enhanced DISCO MRI and CTA within two weeks. The hepatic arterial anatomy of two examination methods were evaluated by four?point scoring method. The arterial scores between DISCO and CTA images were compared by Wilcoxon test. The difference among multiple arterial scores of DISCO and CTA were compared by Kruskal?Wallis H test respectively. Results There was no difference of arterial scores in celiac artery, common hepatic artery, proper hepatic artery, left hepatic artery, right hepatic artery, first branch of right hepatic artery, splenic artery, left gastric artery and gastroduodenal artery between DISCO and CTA (P>0.05), but the arterial score of first branch of left hepatic artery [2 (2,2)] was lower than that of CTA [2 (2,3)] (Z=-3.138,P=0.002). In the multiple comparison among different arteries, there were differences between PHA and LAH (P<0.05), B?LHA and B?RHA (P<0.05) in DISCO, but no difference was found in CTA (P>0.05). Conclusion The DISCO sequence with Gd?EOB?DTPA enhancement MRI can supply comparable image quality to CTA in hepatic artery and its main branches display, which has no ionizing radiation and can also provide more diagnostic information for clinic.