ObjectiveTo investigate the mechanism of salt processing of Psoraleae Fructus （PF） through modern analytical techniques and biotechnology， focusing on its effects related to hepatotoxicity and anti-osteoporosis activity. MethodsThe zebrafish model was utilized to evaluate the impact of PF and salt-processed Psoraleae Fructus （SPF） on the hepatotoxicity （using 134.17 ， 178.89， 268.34 mg·L^-1 as low， medium， and high dose groups of PF， 135.04， 180.06， 270.08 mg·L^-1 as low， medium， and high dose groups of SPF， respectively） and anti-osteoporotic activity （using 33.54 ， 67.08 and 134.17 mg·L^-1 as low， medium， and high dose groups of PF， 33.76， 67.52， 135.04 mg·L^-1 as low， medium， and high dose groups of SPF， respectively）， which was using alizarin red skull staining of zebrafish as an indicator of different batches of PF. The specific dosage of a batch of PF was taken as an example. Then ultra-performance liquid chromatography-quadrupole-time of flight-mass spectrometry（UPLC-Q-TOF-MS） analysis was employed to identify the chemical composition of PF before and after salt processing， and PCA， OPLS-DA， and independent sample t-test were used to elucidating the compositional changes associated with the effects of salt processing on hepatotoxicity and anti-osteoporosis activity. ResultsUnder specific conditions， PF induced notable hepatotoxicity in zebrafish while simultaneously demonstrating protective effect against prednisolone-induced osteoporosis. In comparison to PF， SPF showed alleviated hepatotoxicity while retaining significant anti-osteoporosis activity. UPLC-Q-TOF-MS analysis revealed that after salt processing， the overall chemical composition of PF showed a downward trend， with 69 components showing a decrease in content， represented by psoralen， and 13 components showing an increase， represented by 4′-O-methyl psoralen B. Further multivariate statistical analysis revealed 11 key differential components before and after salt processing of PF， including psoralen and bakuchiol. ConclusionSalt processing effectively diminishes hepatotoxicity without impairing therapeutic efficacy against osteoporosis of PF， which may be related to the compositional changes before and after salt processing of PF and provides key evidence to reveal the scientific significance of salt processing of PF.

Since the first successful transcatheter aortic valve replacement (TAVR) was performed globally in 2002, the TAVR technology has become increasingly mature. With more than a decade of development in China, its application experience, device research and development, procedural improvements, evidence-based medicine, and guideline updates have continuously progressed, leading to a significant increase in the number of procedures conducted. Compared to traditional surgical operations, TAVR has different postoperative monitoring points and principles for the prevention and management of complications, necessitating the formulation of corresponding monitoring and treatment protocols that align with the technical characteristics of the procedure. This guideline is based on clinical practice and incorporates both domestic and international literature as well as the experiences of Fuwai Hospital. It distills and organizes routine postoperative monitoring practices, process optimization, and complication management for TAVR, establishing a set of practical guidelines for postoperative monitoring in China. These guidelines have strong practical value for optimizing postoperative management strategies and preventing and managing complications, which is beneficial for early functional recovery of patients, shortening hospital stays, and reducing complication rates. They provide guidance and reference for domestic peers and support the standardized development and quality improvement of postoperative management for TAVR in China.

Objective To investigate the mechanism of hippocampal neuronal plasticity of newborn neurons in the hippocampus by which exercise improves the fear and anxiety symptoms of post-traumatic stress disorder(PTSD).Methods Totally 40 C57BL/6J male mice were randomly divided into by control group(Ctrl)and PTSD group,the PTSD group was divided into a no-exercise group(PTSD),a low-intensity exercise group(L)and a high-intensity exercise group(H).The PTSD model mice were constructed by combining conditioned plantar-foot shock(CF)and single-session sustained stress(SPS).After the exercise intervention,the fear and anxiety levels of the mice were assessed using the conditioned fear test and the elevated cross maze test;Subsequently,the densities of the newborn mature neurons in dentate gyrus(DG)of hippocampus were detected by immunofluorescent double-labelling staining,and the newborn neuron morphology was marked by injecting retrovirus pRetro-U6-EF1-EGFP-3xFLAG-WPRE in DG of hippocampus to observe its morphology.The morphology of the newborn neurons was labelled to observe their dendritic length and the number of branch points;Meanwhile,the concentration level of adiponctin(APN)in the hippocampal area was determined by ELISA.Results The result showed that both high and low-intensity exercise interventions significantly reduced the freezing time of PTSD mice in the conditioned fear test,and in the elevated cross maze experiment,the residence time and the number of entries in the open arm of the mice in the H group increased significantly compared with those in the PTSD group,while the residence time and the number of entries in the closed arm were significantly reduced.In addition,both high and low-intensity exercise interventions significantly increased the surface density and dendritic length of newborn mature neurons in the hippocampal DG region of PTSD mice,and high-intensity exercise significantly increased the number of dendritic branching points,and the density of newborn mature neurons in the H group was more significantly increased compared with that in the L group.At the same time,the hippocampal APN concentration increased significantly in both L and H groups compared with the PTSD group,and it was more significant in the H group.Conclusion Exercises have an ameliorative effect on anxiety and fear symptoms in PTSD mice,and at the same time,it can increase hippocampal neuroplasticity and adiponctin secretion in PTSD mice,suggesting that the improvement of fear and anxiety symptoms in PTSD by exercise may be related to the increase of hippocampal neuroplasticity and APN secretion,and the improvement effect is better with high-intensity exercise.

Objective To investigate the association between D-dimer levels within 2 hours of admission and in-hospital major adverse events (MAEs) in patients with acute type A aortic dissection (ATAAD) who underwent total arch replacement combined with frozen elephant trunk (FET) implantation. Methods This retrospective study included patients with ATAAD who underwent total arch replacement with FET implantation at Fuwai Yunnan Cardiovascular Hospital from September 2017 to December 2022. Patients were divided into two groups based on the occurrence of in-hospital MAEs: a MAEs group and a non-MAEs group (control). Perioperative data were compared between the two groups. Univariate and multivariate logistic regression analyses were performed to identify risk factors for in-hospital MAEs, which included in-hospital death, gastrointestinal bleeding, paraplegia, acute kidney injury, low cardiac output syndrome, stroke, respiratory failure, multiple organ dysfunction syndrome, and severe infection. The predictive value of D-dimer was evaluated using the area under the receiver operating characteristic curve (AUC). Results A total of 218 patients were included (157 males, 61 females), with a mean age of (51.54±9.79) years. There were 152 patients in the non-MAEs group and 66 in the MAEs group. The overall incidence of in-hospital MAEs was 30.3%, and the in-hospital mortality rate was 2.8% (6/218). Compared to the non-MAEs group, the MAEs group had significantly higher levels of D-dimer and lactate, as well as longer cardiopulmonary bypass time, aortic cross-clamp time, and ICU length of stay (all P<0.05). Multivariate logistic regression analysis identified D-dimer as an independent risk factor for in-hospital MAEs [OR=1.077, 95%CI (1.020, 1.137), P=0.013]. The AUC for the D-dimer level within 2 hours of admission to predict in-hospital MAEs was 0.83 [95%CI (0.736, 0.870), P<0.001]. The optimal cutoff value was 2.2 μg/mL, with a sensitivity of 84.8% and a specificity of 73.0%. Conclusion The serum D-dimer level is an independent risk factor for in-hospital MAEs in patients with ATAAD following total arch replacement with FET implantation. D-dimer levels on admission can help clinicians optimize risk stratification and perioperative management, potentially reducing the incidence of early adverse events.

Objective To explore the postoperative characteristics and management experience of patients with coronavirus disease 2019 (COVID-19) undergoing cardiac and vascular surgery. Methods From December 7, 2022 to January 5, 2023, the patients with COVID-19 who were admitted to Cardiovascular Hospital Affiliated to Kunming Medical University and underwent cardiac and vascular surgery were selected. The clinical history, surgical information, postoperative recovery process and treatment plan were analyzed retrospectively. Results There were 18 patients in this group, including 11 (61.1%) males and 7 (38.9%) females, with an average age of 58.1±10.9 years. There were 7 patients of hypertension, 5 patients of diabetes, 3 patients of respiratory diseases, and 2 patient of chronic renal insufficiency. There were 5 (27.8%) patients receiving emergency operations and 13 (72.2%) elective operations. All the 18 patients underwent cardiac and vascular surgery in the period of COVID-19, and the time between the last positive nucleic acid test and the surgery was 1.50 (1.00, 6.25) days. There were 8 patients of pulmonary imaging changes, including 3 patients with chest patch shadow, 3 patients with thickened and disordered lung markings, and 2 patients with exudative changes before operation. Antiviral therapy was not adopted in all patients before operation. Three patients were complicated with viral pneumonia after operation, including 2 patients with high risk factors before operation, who developed into severe pneumonia after operation, and underwent tracheotomy. One patient with thrombus recovered after anticoagulation treatment. Another patient of mild pneumonia recovered after antiviral treatment. The other 15 patients recovered well without major complications. There was no operation-related death in the whole group. One patient died after surgery, with a mortality rate of 5.6%. Conclusion Patients with COVID-19 are at high risk of cardiac and vascular surgery, and patients with high-risk factors may rapidly progress to severe pneumonia. Patients with preoperative lung imaging changes or other basic visceral diseases should consider delaying the operation. Early antiviral combined with immunomodulation treatment for emergency surgery patients may help improve the prognosis.

Objective To explore the postoperative characteristics and management experience of patients with coronavirus disease 2019 (COVID-19) undergoing cardiac and vascular surgery. Methods From December 7, 2022 to January 5, 2023, the patients with COVID-19 who were admitted to Cardiovascular Hospital Affiliated to Kunming Medical University and underwent cardiac and vascular surgery were selected. The clinical history, surgical information, postoperative recovery process and treatment plan were analyzed retrospectively. Results There were 18 patients in this group, including 11 (61.1%) males and 7 (38.9%) females, with an average age of 58.1±10.9 years. There were 7 patients of hypertension, 5 patients of diabetes, 3 patients of respiratory diseases, and 2 patient of chronic renal insufficiency. There were 5 (27.8%) patients receiving emergency operations and 13 (72.2%) elective operations. All the 18 patients underwent cardiac and vascular surgery in the period of COVID-19, and the time between the last positive nucleic acid test and the surgery was 1.50 (1.00, 6.25) days. There were 8 patients of pulmonary imaging changes, including 3 patients with chest patch shadow, 3 patients with thickened and disordered lung markings, and 2 patients with exudative changes before operation. Antiviral therapy was not adopted in all patients before operation. Three patients were complicated with viral pneumonia after operation, including 2 patients with high risk factors before operation, who developed into severe pneumonia after operation, and underwent tracheotomy. One patient with thrombus recovered after anticoagulation treatment. Another patient of mild pneumonia recovered after antiviral treatment. The other 15 patients recovered well without major complications. There was no operation-related death in the whole group. One patient died after surgery, with a mortality rate of 5.6%. Conclusion Patients with COVID-19 are at high risk of cardiac and vascular surgery, and patients with high-risk factors may rapidly progress to severe pneumonia. Patients with preoperative lung imaging changes or other basic visceral diseases should consider delaying the operation. Early antiviral combined with immunomodulation treatment for emergency surgery patients may help improve the prognosis.