OBJECTIVE To analyze the prototype components absorbed into blood and brain of Lithocarpus litseifolius leaves， so as to provide a reference for clarifying the pharmacological material basis of its prevention and treatment of central nervous system dis eases. METHODS The ethanol extract of L. litseifolius leaves， as well as the gastric lavage fluid and perfusion solution were prepared. Using rats as subjects， plasma samples of intestinal wall metabolism， intestinal flora metabolism and hepatic metabolism were prepared via in situ intestinal perfusion and closed intestinal loop method； while comprehensive metabolic plasma samples， brain tissue samples， and cerebrospinal fluid samples were collected after intragastric administration. UPLC-HRMS technology was utilized to analyze and identify chemical components and prototype components absorbed into blood and brain of L. litseifolius leaves. RESULTS A total of 66 chemical constituents were identified in L. litseifolius leaves， primarily consisting of flavonoids， organic acids， and others. A total of 16， 13， 11， and 5 prototype components were identified in intestinal wall metabolism， intestinal flora metabolism， hepatic metabolism， and comprehensive metabolic plasma samples， respectively. Additionally， 4 prototype components were detected in brain tissue and 9 in cerebrospinal fluid. Phloridzin， trilobatin， phloretin-2- O -malonyl hexoside， and phloretin were identified as common components across all sample types. CONCLUSIONS Prototype components absorbed into blood and brain of L. litseifolius leaves， such as phloridzin， trilobatin， phloretin， and other components may serve as the pharmacological material basis for their therapeutic effects on central nervous system diseases.

This paper introduces a real-world cohort research model for community-acquired pneumonia （CAP） based on the Jiangsu Traditional Chinese Medicine （TCM） Dominant Diseases Diagnosis and Treatment Data Platform. Firstly， data cleaning is performed by standardizing diagnosis， symptoms， treatment and imaging， intelligently extracting unstructured information， and cleaning and constructing a standardized database. Secondly， for cohort establishment， CAP patients across the province are screened in accordance with CAP diagnostic criteria to build a high-quality disease-specific cohort. Lastly， in terms of protocol design， the characteristics of TCM research and the CAP disease profile are considered to determine appropriate inclusion and exclusion criteria， estimate sample size， define interventions， outcomes and economic evaluations， providing a reference for real-world TCM research on CAP.

This paper introduces a real-world cohort research model for community-acquired pneumonia （CAP） based on the Jiangsu Traditional Chinese Medicine （TCM） Dominant Diseases Diagnosis and Treatment Data Platform. Firstly， data cleaning is performed by standardizing diagnosis， symptoms， treatment and imaging， intelligently extracting unstructured information， and cleaning and constructing a standardized database. Secondly， for cohort establishment， CAP patients across the province are screened in accordance with CAP diagnostic criteria to build a high-quality disease-specific cohort. Lastly， in terms of protocol design， the characteristics of TCM research and the CAP disease profile are considered to determine appropriate inclusion and exclusion criteria， estimate sample size， define interventions， outcomes and economic evaluations， providing a reference for real-world TCM research on CAP.

Low anterior resection syndrome （LARS） is a common complication of sphincter-preserving rectal cancer surgery， and its manifestations change dynamically at different stages. By analyzing and summarizing the clinical symptoms and pathomechanism evolution of LARS across different stages， this paper proposes a staged prevention and treatment strategy using acupuncture. During perioperative stage， the main principle is activating the transport function of the body， supplemented by regulating the mind， with the use of dredging the bowels as needed. During the stoma reversal stage， treatment focuses primarily on fortifying the spleen， with draining dampness as a supplementary method， to help consolidate the intestines. During the radiotherapy or chemotherapy stage， the main focus is reinfor-cing healthy qi， with reducing toxin as an adjunct， to achieve the effect of activating the transport of the pivot. During the survival management stage， treatment primarily focuses on tonifying the kidneys and secondarily on fortifying the spleen， with regulating the corporeal soul as the therapeutic emphasis. Acupoints are selected and combined in accordance with the treatment principles at each stage， and different stimulation methods such as electroacupuncture and moxibustion are applied. An analysis of the mechanisms underlying acupuncture for LARS is also provided， offering a theoretical basis and practical approach for the prevention and treatment of LARS with acupuncture.

MRI is a non-invasive imaging technique with high soft tissue contrast,multi sequences and multi parameters imaging capabilities,which has been widely used in researches of lung diseases in recent years.However,MRI application still faces certain challenges due to the unique physiological structure of lung and respiratory motion artifacts on images.The advances of MRI in pulmonary diseases were reviewed in this article.

MRI is a non-invasive imaging technique with high soft tissue contrast,multi sequences and multi parameters imaging capabilities,which has been widely used in researches of lung diseases in recent years.However,MRI application still faces certain challenges due to the unique physiological structure of lung and respiratory motion artifacts on images.The advances of MRI in pulmonary diseases were reviewed in this article.

Objective This study aims to construct a prediction model for large artery atherosclerotic(LA A)ischemic stroke based on NOD-like receptor thermal protein domain associated protein 3(NLRP3)gene polymorphism and support vector machine(SVM)mod-el.Methods 84 LAA patients and 84healthy controls were selected to detect polymorphisms at rs10159239,rs10754558,rs12143966 and rs3806265 of NLRP3 gene,construct the SVM model,and the model performance was evaluated by receiver operating characteristic(ROC)curve.Results The genotype and allele frequency of NLRP3gene polymorphism sites were compared between the case group and the control group,and the difference was statistically significant(P＜0.05).The area under curve(AUC)of the ROC in the training and test sets is 0.900(95％CI:0.850-0.950)and 0.903(95％CI:0.807-0.999),respectively,with high prediction efficacy and no over-fit.The results of SHAP value analysis showed that:NLRP3 rs10159239genotype AG,rs10754558genotype CG and GG,rs12143966genotype GG and rs3806265genotype CT are the risk factors for disease development.Conclusions NLRP3gene polymor-phism is closely related to the risk of LA ischemic stroke.SVM model based on NLRP3 gene polymorphism can be used to predict the risk factors of LAA ischemic stroke,providing a new idea for early clinical diagnosis and precise prevention.

Objective To evaluate the safety and efficacy of transcatheter mitral valve-in-valve replacement(ViV-TMVR)in the treatment of bioprosthetic mitral valve failure.Methods Seventeen patients with bioprosthetic mitral valve failure who required ViV-TMVR were selected.Preoperative data including age,gender,body mass index(BMI),usage time of bioprosthetic mitral valve,comorbidities(hypertension,coronary heart disease,old cerebral infarction,atrial fibrillation and diabetes)and New York Heart Association(NYHA)functional class were recorded,and left ventricular end-diastolic diameter(LVEDD),right atrial diameter(RA),pulmonary artery systolic pressure(PASP),left ventricular ejection fraction(LVEF),type of bioprosthetic mitral valve failure,degree of bioprosthetic mitral valve regurgitation and stenosis,peak velocity and mean transvalvular pressure gradient of the bioprosthetic mitral valve,and Society of Thoracic Surgeons(STS)score were also collected.Intraoperative data included puncture route,valve type,intraoperative complications,operation time and immediate postoperative transesophageal echocardiography(TEE)assessment(peak velocity and mean transvalvular pressure gradient of the valve-in-valve,valve-in-valve regurgitation or paravalvular regurgitation)were collected.Postoperative data included time in the intensive care unit(ICU)/cardiovascular intensive care unit(CCU),total postoperative hospital stay and 30-day postoperative echocardiographic results and NYHA functional class were recorded.Patients were divided into the domestic NewMed valve group(10 cases)and the imported Edwards valve group(7 cases)based on the type of valve used.The safety and efficacy of ViV-TMVR were analyzed,and the efficacy of domestic valves and imported valves was compared.Results All 17 patients successfully underwent ViV-TMVR via the transseptal approach without serious complications,and the 30-day readmission rate was 0%.There were no significant differences in operation time of domestic valves and imported valves,mild paravalvular regurgitation of the valve-in-valve,peak velocity and mean transvalvular pressure gradient of the valve-in-valve immediately after surgery and at 30-day postoperatively,time in ICU/CCU,total postoperative hospital stay and the proportion of patients with NYHA functional class Ⅲ-Ⅳ at 30-day postoperatively between the domestic valve group and the imported valve group.During the 30-day follow-up,one patient died of cerebral hemorrhage,and one patient had major adverse cardiovascular events(MACE,cerebral hemorrhage).Compared with before the operation,the peak velocity and mean transvalvular pressure gradient of the valve-in-valve,LVEF,and PASP decreased immediately after surgery and at 30 days after surgery.Compared with immediately after surgery,the peak velocity and mean transvalvular pressure gradient of the valve-in-valve increased at 30 days postoperatively(P＜0.01),while there were no significant differences in LVEF and PASP.Conclusion Transseptal ViV-TMVR is safe and effective in the short term for patients with bioprosthetic mitral valve failure who are at high risk of re-thoracotomy,and the efficacy of domestic valves is comparable to that of imported valves.

Objective This study aims to construct a prediction model for large artery atherosclerotic(LA A)ischemic stroke based on NOD-like receptor thermal protein domain associated protein 3(NLRP3)gene polymorphism and support vector machine(SVM)mod-el.Methods 84 LAA patients and 84healthy controls were selected to detect polymorphisms at rs10159239,rs10754558,rs12143966 and rs3806265 of NLRP3 gene,construct the SVM model,and the model performance was evaluated by receiver operating characteristic(ROC)curve.Results The genotype and allele frequency of NLRP3gene polymorphism sites were compared between the case group and the control group,and the difference was statistically significant(P＜0.05).The area under curve(AUC)of the ROC in the training and test sets is 0.900(95％CI:0.850-0.950)and 0.903(95％CI:0.807-0.999),respectively,with high prediction efficacy and no over-fit.The results of SHAP value analysis showed that:NLRP3 rs10159239genotype AG,rs10754558genotype CG and GG,rs12143966genotype GG and rs3806265genotype CT are the risk factors for disease development.Conclusions NLRP3gene polymor-phism is closely related to the risk of LA ischemic stroke.SVM model based on NLRP3 gene polymorphism can be used to predict the risk factors of LAA ischemic stroke,providing a new idea for early clinical diagnosis and precise prevention.

Objective To evaluate the safety and efficacy of transcatheter mitral valve-in-valve replacement(ViV-TMVR)in the treatment of bioprosthetic mitral valve failure.Methods Seventeen patients with bioprosthetic mitral valve failure who required ViV-TMVR were selected.Preoperative data including age,gender,body mass index(BMI),usage time of bioprosthetic mitral valve,comorbidities(hypertension,coronary heart disease,old cerebral infarction,atrial fibrillation and diabetes)and New York Heart Association(NYHA)functional class were recorded,and left ventricular end-diastolic diameter(LVEDD),right atrial diameter(RA),pulmonary artery systolic pressure(PASP),left ventricular ejection fraction(LVEF),type of bioprosthetic mitral valve failure,degree of bioprosthetic mitral valve regurgitation and stenosis,peak velocity and mean transvalvular pressure gradient of the bioprosthetic mitral valve,and Society of Thoracic Surgeons(STS)score were also collected.Intraoperative data included puncture route,valve type,intraoperative complications,operation time and immediate postoperative transesophageal echocardiography(TEE)assessment(peak velocity and mean transvalvular pressure gradient of the valve-in-valve,valve-in-valve regurgitation or paravalvular regurgitation)were collected.Postoperative data included time in the intensive care unit(ICU)/cardiovascular intensive care unit(CCU),total postoperative hospital stay and 30-day postoperative echocardiographic results and NYHA functional class were recorded.Patients were divided into the domestic NewMed valve group(10 cases)and the imported Edwards valve group(7 cases)based on the type of valve used.The safety and efficacy of ViV-TMVR were analyzed,and the efficacy of domestic valves and imported valves was compared.Results All 17 patients successfully underwent ViV-TMVR via the transseptal approach without serious complications,and the 30-day readmission rate was 0%.There were no significant differences in operation time of domestic valves and imported valves,mild paravalvular regurgitation of the valve-in-valve,peak velocity and mean transvalvular pressure gradient of the valve-in-valve immediately after surgery and at 30-day postoperatively,time in ICU/CCU,total postoperative hospital stay and the proportion of patients with NYHA functional class Ⅲ-Ⅳ at 30-day postoperatively between the domestic valve group and the imported valve group.During the 30-day follow-up,one patient died of cerebral hemorrhage,and one patient had major adverse cardiovascular events(MACE,cerebral hemorrhage).Compared with before the operation,the peak velocity and mean transvalvular pressure gradient of the valve-in-valve,LVEF,and PASP decreased immediately after surgery and at 30 days after surgery.Compared with immediately after surgery,the peak velocity and mean transvalvular pressure gradient of the valve-in-valve increased at 30 days postoperatively(P＜0.01),while there were no significant differences in LVEF and PASP.Conclusion Transseptal ViV-TMVR is safe and effective in the short term for patients with bioprosthetic mitral valve failure who are at high risk of re-thoracotomy,and the efficacy of domestic valves is comparable to that of imported valves.