Objectives:This study aims to explore the impact of new-onset heart conduction block post transcatheter aortic valve replacement(TAVR)on the cardiac conduction status during 1-year follow-up.Methods:A total of 130 patients who completed TAVR surgery at Fuwai Central-China Cardiovascular Hospital from July 2019 to October 2022 were screened.Among them,56 cases with postoperative heart conduction block were selected for analysis.According to the degree of heart block,patients were divided into mild block group(n=36),moderate block group(n=9),and severe block group(n=11).The clinical characteristics and cardiac conduction conditions at 1-year follow-up between different groups were compared.Results:During a mean(8.5±4.1)months follow-up period,10(17.9%)patients had long-term atrioventricular conduction block,and 46(82.1%)patients had partial or complete recovery of heart block,with 28(50.0%)patients with completely recovered cardiac conduction.In the mild block group,22(61.1%)cases were completely recovered,9(25.0%)patients partly recovered,and 5(13.9%)cases uncovered.In the moderate block group,2(22.2%)cases were completely recovered,5(55.6%)patients partly recovered,and 2(22.2%)cases uncovered.Difference in long-term atrioventricular conduction block among three groups was statistically significant(P<0.001).The Kaplan-Meier curve shows that patients with moderate to severe heart block have a higher rate of long-term atrioventricular conduction block(86.1%vs.77.8%vs.72.7%,log-rank P=0.03).Cox multivariate analysis exhibited that old age(≥75 years old,HR=1.204,95%CI:1.051-1.525,P=0.041)and severe heart conduction block(HR=1.106,95%CI:1.100-1.616,P=0.031)are the two independent risk factors for long-term atrioventricular conduction block post TAVR.Conclusions:The ratio of complete cardiac conduction recovery post TAVR is 50.0%.Older age(≥75 year)and new-onset severe heart conduction block are independent risk factors for long-term atrioventricular conduction block post TAVR procedure.

Objective:This study aims to investigate the feasibility and safety of implanting leadless pacemakers in the low septum and its impact on cardiac electrical synchronization.Methods:A total of 36 patients who received leadless pacemaker implantation at Fuwai Central China Cardiovascular Hospital from January 2021 to August 2023 were included in this study.According to implantation sites of leadless pacemakers,patients were divided into mid-septal group(n=16)and low-septal group(n=20).The clinical characteristics and cardiac electrical synchronization were compared between the two groups.Results:There were 21 male patients,mean age was(68±13)years old.There was no statistical difference in the type of brady-arrhythmia between the two groups(P=0.73).There were 61 implant attempts in these 36 patients,and there was no significant difference in the number of attempts,procedure time,and pacemaker parameters between the two groups,but the average procedure time tended to be shorter in the low-septal group([84±37]minutes vs.[105±35]minutes,P=0.09).In terms of electrical synchronization,there was no statistical difference in QRS duration between the low-septal group and the mid-septal group([162.0±21.1]ms vs.[174.0±14.8]ms,P=0.20).There were no vascular puncture complications,cardiac perforation,or pericardial tamponade during the procedure.There were no complications and readmissions related to the leadless pacemaker during follow-up period.Conclusions:Our results show that the implantation of a leadless pacemaker in the low ventricular septum is safe and effective,has a similar impact on cardiac electrical synchronization as mid-septal pacing.

Objective:This study aims to investigate the feasibility and safety of implanting leadless pacemakers in the low septum and its impact on cardiac electrical synchronization.Methods:A total of 36 patients who received leadless pacemaker implantation at Fuwai Central China Cardiovascular Hospital from January 2021 to August 2023 were included in this study.According to implantation sites of leadless pacemakers,patients were divided into mid-septal group(n=16)and low-septal group(n=20).The clinical characteristics and cardiac electrical synchronization were compared between the two groups.Results:There were 21 male patients,mean age was(68±13)years old.There was no statistical difference in the type of brady-arrhythmia between the two groups(P=0.73).There were 61 implant attempts in these 36 patients,and there was no significant difference in the number of attempts,procedure time,and pacemaker parameters between the two groups,but the average procedure time tended to be shorter in the low-septal group([84±37]minutes vs.[105±35]minutes,P=0.09).In terms of electrical synchronization,there was no statistical difference in QRS duration between the low-septal group and the mid-septal group([162.0±21.1]ms vs.[174.0±14.8]ms,P=0.20).There were no vascular puncture complications,cardiac perforation,or pericardial tamponade during the procedure.There were no complications and readmissions related to the leadless pacemaker during follow-up period.Conclusions:Our results show that the implantation of a leadless pacemaker in the low ventricular septum is safe and effective,has a similar impact on cardiac electrical synchronization as mid-septal pacing.

Objectives:This study aims to explore the impact of new-onset heart conduction block post transcatheter aortic valve replacement(TAVR)on the cardiac conduction status during 1-year follow-up.Methods:A total of 130 patients who completed TAVR surgery at Fuwai Central-China Cardiovascular Hospital from July 2019 to October 2022 were screened.Among them,56 cases with postoperative heart conduction block were selected for analysis.According to the degree of heart block,patients were divided into mild block group(n=36),moderate block group(n=9),and severe block group(n=11).The clinical characteristics and cardiac conduction conditions at 1-year follow-up between different groups were compared.Results:During a mean(8.5±4.1)months follow-up period,10(17.9%)patients had long-term atrioventricular conduction block,and 46(82.1%)patients had partial or complete recovery of heart block,with 28(50.0%)patients with completely recovered cardiac conduction.In the mild block group,22(61.1%)cases were completely recovered,9(25.0%)patients partly recovered,and 5(13.9%)cases uncovered.In the moderate block group,2(22.2%)cases were completely recovered,5(55.6%)patients partly recovered,and 2(22.2%)cases uncovered.Difference in long-term atrioventricular conduction block among three groups was statistically significant(P<0.001).The Kaplan-Meier curve shows that patients with moderate to severe heart block have a higher rate of long-term atrioventricular conduction block(86.1%vs.77.8%vs.72.7%,log-rank P=0.03).Cox multivariate analysis exhibited that old age(≥75 years old,HR=1.204,95%CI:1.051-1.525,P=0.041)and severe heart conduction block(HR=1.106,95%CI:1.100-1.616,P=0.031)are the two independent risk factors for long-term atrioventricular conduction block post TAVR.Conclusions:The ratio of complete cardiac conduction recovery post TAVR is 50.0%.Older age(≥75 year)and new-onset severe heart conduction block are independent risk factors for long-term atrioventricular conduction block post TAVR procedure.

Objective:To investigate the mortality-related factors affecting patients with gastrointestinal perforation who are transferred to the intensive care unit (ICU) and to establish a prediction model, and to evaluate the predictive performance of the model.Methods:A retrospective analysis was performed on the medical records of 306 patients who underwent gastrointestinal perforation surgery in Shanxi Bethune Hospital (Shanxi Academy of Medical Sciences) from January 2021 to January 2024 and were transferred to intensive care unit after surgery, including 176 males and 130 females, aged from 28 to 92 years with the average of (66.07±16.03) years. According to the prognosis, patients were divided into survival group ( n=264) and death group ( n=42). Clinical characteristics of the two groups were compared, univariate and multivariate Logistic regression was used to analyze the risk factors of perioperative death, and the related risk factors were selected to establish a nomogram prediction model, the subject work curve was drawn, and the area under the curve (AUC) was calculated. Evaluate its predictive effectiveness; The calibration chart and clinical decision curve were further used to evaluate the prediction accuracy and clinical application value of the model. Results:Clinical data analysis showed that age, white blood cell count, procalcitonin, lactic acid level, preoperative shock, preoperative underlying diseases (cerebral infarction, hormone history), intraoperative blood loss, postoperative lung infection in the death group were higher than those in the survival group ( P<0.05), and hemoglobin was lower than those in the survival group ( P<0.05). Multivariate Logistic regression analysis showed age ( OR=1.422, 95% CI: 1.205-1.680, P<0.001), hemoglobin ( OR=0.945, 95% CI: 0.904-0.987, P=0.012), white blood cell count ( OR=1.832, 95% CI: 1.341-2.501, P<0.001), procalcitonin ( OR=1.099, 95% CI: 1.012-1.192, P=0.024), lactic acid level ( OR=16.435, 95% CI: 3.729-72.425, P<0.001), reoperative shock ( OR=172.358, 95% CI: 13.059-2274.773, P<0.001), intraoperative blood loss ( OR=1.041, 95% CI: 1.017-1.065, P=0.001) and postoperative pulmonary infection ( OR=38.670, 95% CI: 3.449-433.553, P=0.003) was an independent risk factor for perioperative death in intensive care patients after DTP. Based on the screened independent risk factors ( P<0.05), a nomogram model was established and receiver operating characteristic (ROC) curve was drawn. The model area under the curve was 0.985. The accurate graph shows that the predicted results of the model are in good agreement with the actual clinical results, and the analysis of clinical decision curve indicates that the model has high clinical prediction value. Conclusion:Age>71.5 years, hemoglobin< 109 g/L, white blood cell count>17.9×10 9/L, procalcitonin>6.225 ng/mL, lactate level>2.25 mmol/L, preoperative shock, intraoperative blood loss>45 mL and postoperative pulmonary infection are independent risk factors for perioperative death in intensive care patients after DTP.

The National Medical Products Administration has approved 6 small molecule drugs against novel coronavirus for marketing since 2022, of which 2 are imported drugs: Paxlovid (Nirmatrelvir/Ritonavir) of Pfizer and Molnupiravir of Merck; 4 are domestic products: Azvudine of Real, Deuremidevir Hydrobromide (VV116) of Junshi Biologics, Simnotrelvir/Ritonavir of Simcere pharmaceutical and Leritrelvir of Zhongsheng pharmaceutical. The overall mechanism of action if these drugs is inhibiting protease and RNA-dependent RNA polymerase to eliminate novel coronavirus. If applied early, the clinical symptoms can be effectively controlled and complications can be reduced. In this article, the resent progress of 6 newly approved anti-novel coronavirus small molecular drugs in China is reviewed for reference of clinical application.

In recent years, great progress has been made in small molecule therapeutic drugs and monoclonal neutralizing antibody preparations against 2019-nCoV. At least 5 oral drugs (Monupavir, AT-527, Proclutamide, Paxlovid and S-217622) and 2 monoclonal antibodies (Ambavirumab/Romisevirumab combination and Sotrovimab) have completed phase Ⅲ clinical trials exhibiting excellent antiviral effects. This article reviews the research progress of these 7 drugs to provide reference for clinical application.

Objective: Comparing the benefit of Abidor, lopinavir/ritonavir and recombinant interferon α-2b triple combination antiviral therapy and lopinavir/ritonavir and interferon dual combination antiviral therapy to hospitalized novel coronavirus pneumonia 2019 in Zhejiang province. Methods: A multi-center prospective study was carried out to compare the effect of triple combination antiviral therapy with dual combination antiviral therapy in 15 medical institutions of Zhejiang Province. All patients were treated with recombinant interferon α-2b (5 million U, 2 times/d) aerosol inhalation. 196 patients were treated with abidol (200 mg, 3 times/d) + lopinavir / ritonavir (2 tablets, 1 time/12 h) as the triple combination antiviral treatment group. 41 patients were treated with lopinavir / ritonavir (2 tablets, 1 time/12 h) as the dual combination antiviral treatment group. The patients who received triple combination antiviral therapy were divided into three groups: within 48 hours, 3-5 days and > 5 days after the symptom onset. To explore the therapeutic effects of triple combination antiviral drugs and dual combination antiviral drugs, as well as triple combination antiviral drugs with different antiviral initiate time. SPSS17.0 software was used to analyze the data. Results: The time of virus nucleic acid turning negative was (12.2 ± 4.7) days in the triple combination antiviral drug group, which was shorter than that in the dual combination antiviral drug group [(15.0 ± 5.0) days] (t = 6.159, P < 0.01 ). The length of hospital stay [12 (9, 17) d] in the triple combination antiviral drug group was also shorter than that in the dual combination antiviral drug group [15 (10, 18) d] (H = 2.073, P < 0.05). Comparing the antiviral treatment which was started within 48 hours, 3-5 days and > 5 days after the symptom onset of triple combination antiviral drug group, the time from the symptom onset to the negative of viral shedding was 13 (10,16.8), 17 (13,22) and 21 (18-24) days respectively (Z = 32.983, P < 0.01), and the time from antiviral therapy to the negative of viral shedding was (11.8±3.9) , (13.5±5.1) and (11.2±4.3) d. The differences among the three groups were statistically significant (Z=32.983 and 6.722, P<0.01 or<0.05). Conclusions The triple combination antiviral therapy of Abidor, Lopinavir/Litonavir and recombinant interferon α-2b showed shorter viral shedding time and hospitalization time compared with the dual combination antiviral therapy. The earlier the time to initiate triple antiviral treatment, the shorter the time of virus shedding.

OBJECTIVE：To study the improvem ent effects of total flavonoids from Morus alba on glycolipid metabolism ， inflammation and oxidative stress in gestational diabetes mellitus （GDM）model rats ，and to investigate the potential mechanism. METHODS：After feeding high fat diet for 8 weeks，female SD rats with FBG ＜6.67 mmol/L were caged with male SD rats . Pregnant female rats were randomly divided into control group ，GDM group ，M. alba total flavonoids low-dose ，medium-dose and high-dose groups （50，100，200 mg/kg），with 10 rats in each group. Except for control group ，other groups were given intraperitoneal injection of streptozotocin 25 mg/kg once to induce GDM model. After injection ，rats in each administration group were given corresponding drugs intragastrically ，control group and GDM group were given normal saline 10 mL/kg intragastrically ， once a day ，for consecutive 18 days. The levels of FBG were determined on the 3rd，7th and 18th day of pregnancy （G3d，G7d and G18 d）；the levels of blood lipids （TG，TC，LDL-C，HDL-C）and inflammatory factors （TNF-α，IL -6，IL-8），oxidative stress indicators（MDA，SOD，GSH，CAT）in serum were determined on G 18d. The protein and mRNA expressions of PPARγ and NF-κB， the expression of AMPK mRNA and p-AMPK protein were measured by Real-time-PCR and Western blotting. RESULTS ： Compared with control group ，the levels of FBG （G3d，G7d，G18d），TG，TC，LDL-C，TNF-α，IL-6，IL-8 and MDA ，protein and mRNA expression of NF-κB in GDM group were significantly increased，while the levels of SOD ，GSH and CAT ，the expressions of PPARγ protein and mRNA，AMPK mRNA and p-AMPK fcksjf@126.com protein were significantly decreased （P＜0.01）. Compared with GDM group ，the levels of FBG （G3 d，G7 d，G18 d），TG， huawei99@163.com TC，LDL-C in M. alba total flavonoids medium-dose and high- dose groups and the levels of TNF-α，IL-6，IL-8 and MDA ，protein and mRNA expression of NF-κB in M. alba total flavonoids groups were significantly decreased ；the levels of SOD ，GSH and CAT ，the expressions of PPARγ protein and mRNA， AMPK mRNA and p-AMPK protein were significantly increased （P＜0.05 or P＜0.01）. CONCLUSIONS ：Total flavonoids from M. alba can improve the glycolipid metablism ，inflammation and oxidative stress in GDM model rats ，the mechanism of which may be related to the activation of PPARγ pathway.

Objective:To compare the efficacy of the combination of abidol, lopinavir/ritonavir plus recombinant interferon α-2b (rIFNα-2b) and the combination of lopinavir/ritonavir plus rIFNα-2b for patients with COVID-19 in Zhejiang province.Methods:A multicenter prospective study was carried out to compare the efficacy of triple combination antiviral therapy and dual combination antiviral therapy in 15 medical institutions of Zhejiang province during January 22 to February 16, 2020. All patients were treated with rIFNα-2b (5 million U, 2 times/d) aerosol inhalation, in addition 196 patients were treated with abidol (200 mg, 3 times/d) + lopinavir/ritonavir (2 tablets, 1 time/12 h) (triple combination group) and 41 patients were treated with lopinavir/ritonavir (2 tablets, 1 time/12 h) (dual combination group). The patients who received triple combination antiviral therapy were further divided into three subgroups: <48 h, 3-5 d and >5 d according the time from the symptom onset to medication starting. The therapeutic efficacy was compared between triple combination group and dual combination group, and compared among 3 subgroups of patients receiving triple combination antiviral therapy. SPSS 17.0 software was used to analyze the data.Results:The virus nucleic acid-negative conversion time in respiratory tract specimens was (12.2±4.7) d in the triple combination group, which was shorter than that in the dual combination group [(15.0±5.0) d] ( t=6.159, P<0.01). The length of hospital stay in the triple combination group [12.0 (9.0, 17.0) d] was also shorter than that in the dual combination group [15.0 (10.0, 18.0) d] ( H=2.073, P<0.05). Compared with the antiviral treatment which was started within after the symptom onset of in the triple combination group, the time from the symptom onset to the viral negative conversion was 13.0 (10.0, 17.0), 17.0 (13.0, 22.0) and 21.0 (18.0, 24.0) d in subgroups of 48 h, 3-5 d and >5 d, respectively ( Z=32.983, P<0.01), while the time from antiviral therapy to viral negative conversion was (11.8±3.9), (13.5±5.1) and (11.2±4.3) d, respectively( Z=6.722, P<0.05). Conclusions:The triple combination antiviral therapy of abidol, lopinavir/litonavir and rIFNα-2b shows shorter viral shedding time and shorter hospitalization time, compared with the dual combination antiviral therapy; and the earlier starting triple combination antiviral therapy will result in better antiviral efficacy.