AIM: To investigate the relationship between Apelin and δ-like ligand 4(DLL4)expression levels and clinical stage and efficacy in patients with neovascular glaucoma(NVG).METHODS: A total of 96 NVG patients(96 eyes)who were admitted to our hospital from January 2022 to March 2024(NVG group)and 96 cataract patients(96 eyes)who underwent cataract surgery in our hospital during the same period(control group)were selected. NVG patients were divided into stage Ⅰ group(22 eyes), stage Ⅱ group(47 eyes)and stage Ⅲ group(27 eyes)according to the clinical stage; furthermore, patients were divided into ineffective group(20 eyes)and effective group(76 eyes)according to efficacy. Aqueous humor Apelin and DLL4 levels were detected by enzyme-linked immunosorbent assay. The influencing factors of the efficacy in NVG patients were analyzed by multivariate unconditional Logistic regression analysis, the evaluation efficiency of aqueous humor Apelin and DLL4 levels on the efficacy in NVG patients was analyzed by receiver operating characteristic(ROC)curve.RESULTS: Compared with the control group, aqueous humor Apelin and DLL4 levels in the NVG group were increased(all P<0.001). Aqueous humor Apelin and DLL4 levels in the stage Ⅰ, stage Ⅱ and stage Ⅲ groups increased in turn(all P<0.001). The effective rate of 96 NVG patients was 79.2%(76/96). Compared with the effective group, aqueous humor Apelin and DLL4 levels in the ineffective group increased(all P<0.001). Clinical stage III, high intraocular pressure, high Apelin and DLL4 were independent risk factors for ineffective treatment in NVG patients(all P<0.05). The area under the curve of the combined evaluation of aqueous humor Apelin and DLL4 levels in evaluating the efficacy of NVG patients was 0.874, which was greater than 0.790 and 0.786 of aqueous Apelin and DLL4 levels alone(all P<0.05).CONCLUSION: Aqueous humor Apelin and DLL4 levels in NVG patients increase, which relate to the increase of clinical stage and poor efficacy, and the combination of aqueous humor Apelin and DLL4 levels is more effective in evaluating the efficacy of NVG patients.

Transcatheter aortic valve replacement (TAVR) has emerged as the standard treatment for severe aortic stenosis, demonstrating comparable efficacy to traditional surgery in low and intermediate-risk patients. However, the bioprosthetic valves utilized in TAVR have a limited lifespan, and bioprosthetic valve failure, including calcification, rupture or infection may develop, leading to poor clinical outcomes. Elevated blood pressure has been identified as a key factor in aortic valve calcification, and its role in bioprosthetic valve failure is gaining increasing attention. Hypertension may accelerate the calcification process and exacerbate valve failure due to increased mechanical stress on the valve, activation of the renin-angiotensin system, and enhanced thrombus formation. Furthermore, elevated blood pressure interacts with prosthesis mismatch and paravalvular leak, jointly affecting valve durability. This review explores the impact of elevated blood pressure on bioprosthetic valve calcification and failure after TAVR, and emphasizes the importance of blood pressure control, optimized preoperative assessment, and appropriate valve selection in reducing valve failures.
Humans ; Transcatheter Aortic Valve Replacement/adverse effects* ; Calcinosis/etiology* ; Bioprosthesis ; Heart Valve Prosthesis/adverse effects* ; Prosthesis Failure ; Aortic Valve Stenosis/surgery* ; Aortic Valve/surgery* ; Hypertension/physiopathology*

COMPERA 2.0 risk stratification has been demonstrated to be useful in patients with precapillary pulmonary hypertension (PH). However, its suitability for patients at risk for post-capillary PH or PH associated with left heart disease (PH-LHD) is unclear. To investigate the use of COMPERA 2.0 in patients with severe aortic stenosis (SAS) undergoing transcatheter aortic valve replacement (TAVR), who are at risk for post-capillary PH, a total of 327 eligible SAS patients undergoing TAVR at our institution between September 2015 and November 2020 were included in the study. Patients were classified into four strata before and after TAVR using the COMPERA 2.0 risk score. The primary endpoint was all-cause mortality. Survival analysis was performed using Kaplan-Meier curves, log-rank test, and Cox proportional hazards regression model. The study cohort had a median (interquartile range) age of 76 (70‒80) years and a pulmonary arterial systolic pressure of 33 (27‒43) mmHg (1 mmHg=0.133 kPa) before TAVR. The overall mortality was 11.9% during 26 (15‒47) months of follow-up. Before TAVR, cumulative mortality was higher with an increase in the risk stratum level (log-rank, both P<0.001); each increase in the risk stratum level resulted in an increased risk of death (hazard ratio (HR) 2.53, 95% confidential interval (CI) 1.54‒4.18, P<0.001), which was independent of age, sex, estimated glomerular filtration rate (eGFR), hemoglobin, albumin, and valve type (HR 1.76, 95% CI 1.01‒3.07, P=0.047). Similar results were observed at 30 d after TAVR. COMPERA 2.0 can serve as a useful tool for risk stratification in patients with SAS undergoing TAVR, indicating its potential application in the management of PH-LHD. Further validation is needed in patients with confirmed post-capillary PH by right heart catheterization.
Humans ; Aortic Valve Stenosis/complications* ; Aged ; Hypertension, Pulmonary/mortality* ; Male ; Female ; Transcatheter Aortic Valve Replacement ; Aged, 80 and over ; Risk Assessment/methods* ; Proportional Hazards Models ; Kaplan-Meier Estimate ; Retrospective Studies

Objective To explore the neuroprotective effects of osteocalcin(OCN)on an Alzheimer's disease(AD)cell model and its potential mechanisms,providing a scientific basis for new therapeutic targets for AD.Methods Human neuroblastoma cell line SH-SY5Y was treated with 40 nmol/L okadaic acid(OA)for 24 h to establish an AD cell model.The cells were divided into a normal group(untreated SH-SY5Y cells),a model group(40 nmol/L OA intervention),and an OCN intervention group(intervention with various concentrations of OCN in the AD cell model),and AKT knockout/overexpression groups(AKT-KO group and AKT-OE group),and AKT-KO OCN group and AKT-OE OCN group.CCK-8 assay was used to detect the changes in cell viability.Wright's staining was employed to observe the morphological changes of AD cells.Western blotting was utilized to detect the protein levels of Tau,p-Tau,Bax,Bcl-2,Caspase-3 and their lytic types,as well as the expression of Tau,p-Tau,mTOR,AKT and p-AKT in each group after AKT knockout/overexpression.TUNEL staining and flow cytometry were applied to detect the changes in early and late apoptotic cells and the apoptotic rate in the OCN-treated AD cell model.Results ①Compared to the normal group,the model group exhibited a significant decrease in cell viability,noticeable morphological and structural damage,upregulation of p-Tau and Caspase-3,increased early and late apoptosis,and a significantly higher apoptotic rate(P<0.05).②After treatment of different concentrations of OCN for 24 h,cell viability was increased to varying degrees compared to the AD model group,with the 100 pg/mL OCN group showing a significant increase in cell viability(P<0.01)and marked improvement in cell number and morphology(P<0.01).③ Compared to the AD cell model group,the p-Tau/Tau ratio was decreased in all OCN treatment groups,particularly in the 100 pg/mL OCN intervention group,where the p-Tau/Tau ratio was significantly lower than that of the model group(P<0.01).④ Compared to the model group,a significant concentration-dependent decrease in the Cleaved Caspase-3/Caspase-3 ratio was observed when OCN concentrations ranged from 1 to 100 pg/mL,with a significant reduction in the Bax/Bcl-2 ratio in the 100 pg/mL group(P<0.000 1).⑤ The results of TUNEL staining and flow cytometry showed that,compared to the model group,all concentrations of OCN effectively inhibited the apoptosis in the AD model cells,with a significant reduction in early and late apoptotic cells and apoptotic rate in the 100 pg/mL OCN group.⑥ Compared with the control group and the model group,the P-AKT was significantly increased in the AKT-OE group after AKT overexpression(P<0.05).The expression level of AKT protein was decreased in the AKT-KO group after AKT knockout(P<0.05).When the AKT pathway was inhibited,the expression level of p-Tau was higher in the AKT-KO group than the control group(P<0.05),and when the AKT was overexpressed,the expression level was significantly inhibited(P<0.05).Conclusion OCN may inhibit cell apoptosis and reduce p-tau protein level by regulating the ratio of Caspase-3/Caspase-3 and Bax/Bcl-2,and thereby improve the morphology of AD model cells and effectively protect nerve cells,which may be related to the regulation of the AKT/mTOR pathway.

Objective To investigate the relationship between the levels of C1q/tumor necrosis factor-relat-ed protein 9(CTRP9),Klotho(Klotho)and chitinase 1(CHIT1)in aqueous humor with the disease severity and macular edema(ME)in patients with retinal vein occlusion(RVO).Methods A total of 174 in patients with ME caused by RVO who visited the hospital from January 2022 to June 2024(observation group)and 174 patients with simple RVO(RVO group)were selected.Observation group was divided into mild,moder-ate and severe subgroup according to the disease severity of ME.The levels of CTRP9,Klotho and CHIT1 in aqueous humor between RVO group and observation group were compared.The evaluation value of CTRP9,Klotho and CHIT1 levels in aqueous humor for ME in patients with RVO was analyzed by receiver operating characteristic(ROC)curve.The influencing factors of ME in patients with RVO were analyzed by univariate and multivariate Logistic regression model.The correlation between the levels of CTRP9,Klotho,CHIT1 in a-queous humor with the disease severity of ME in patients with RVO was analyzed by spearman correlation a-nalysis.Results Compared with RVO group,the levels of CTRP9 and Klotho in aqueous humor of observa-tion group were lower,and the level of CHIT1 was higher(P＜0.05).ROC analysis curve showed that,the area under the curve(AUC)of CTRP9,Klotho and CHIT1 in aqueous humor for evaluating ME in patients with RVOwere 0.757,0.773 and 0.813,respectively.The AUC of combined detection of the three was 0.939,and the efficiency of combined evaluation was higher than that of the single evaluation(Z=7.520,7.513,6.278,all P＜0.05).Multivariate Logistic regression model showed that high level of CHIT1 in aque-ous humor,hypertension and severe retinal vein tortuosity were risk factors for ME in patients with RVO(P＜0.05),and high levels of CTRP9 and Klotho in aqueous humor were protective factors(P＜0.05).Spearman correlation analysis showed that the levels of CTRP9 and Klotho in aqueous humor were negatively correlated with the disease severity of ME in patients with RVO(r=-0.584,-0.401,all P＜0.05),while level of CHIT1 in aqueous humor was positively correlated with the disease severity of ME in patients with RVO(r=0.809,P＜0.05).Conclusion The levels of CTRP9,Klotho and CHIT1 in aqueous humor have high value in the evaluation of ME in patients with RVO,and they are the influencing factors of ME in pa-tients with RVO.The level changes of the three are closely related to the disease severity of ME in patients with RVO.

Objective:This study aimed to retrospectively analyze the incidence and influencing factors of tricuspid regurgitation (TR) in the short term after pacemaker lead implantation at the Second Affiliated Hospital of Zhejiang University School of Medicine, so as to provide evidence for understanding pacemaker lead-related TR.Methods:Consecutive patients who underwent single- or dual-chamber permanent pacemaker implantation between June 2019 and December 2023 in the Department of Cardiology were enrolled. General clinical data and relevant parameters were collected. Changes in TR severity before and shortly after the procedure were assessed using echocardiography. TR progression was defined as an increase by one grade or more, and TR improvement as a decrease by one grade or more. Logistic regression analysis was employed to identify factors associated with TR progression.Results:A total of 219 patients were included (128 males, 91 females), with a mean age of 69.7 ± 11.2 years. The median follow-up time was 99 (26, 199) days. TR remained unchanged in 114 patients (52.1%), improved in 46 (21.0%)—including 36 (16.4%) with one-grade reduction, 9 (4.1%) with two-grade reduction, and 1 (0.5%) with three-grade reduction—and progressed in 59 patients (26.9%). Among those with progression, 51 (23.3%) had mild-to-moderate TR worsening by one grade, and 8 (3.7%) had moderate or worse TR worsening by at least two grades. Notably, one case involved lead perforation of the leaflet and two cases had lead impingement. Compared with the non-progression group ( n = 114), pacemaker indication (AV block vs. sick sinus syndrome), baseline left atrial diameter, pulmonary artery systolic pressure (PASP), and the severity of mitral regurgitation (MR) and TR were significantly associated with TR progression or improvement (all P < 0.05). Ordinal logistic regression analysis identified preoperative TR severity [ OR=10.57 (3.77–29.68), P < 0.001] and pacemaker indication [ OR=0.452 (0.222–0.918), P = 0.028] as independent predictors of postoperative TR progression. Patients with AV block were more likely to receive left bundle branch pacing ( P < 0.001), which may contribute to their lower risk of TR. Conclusions:Short-term progression of TR after pacemaker implantation is relatively common, although severe TR remains rare. Preoperative TR severity and pacemaker indication are independent predictors of short-term TR progression. The use of physiological pacing modalities may help reduce the incidence of TR following pacemaker lead implantation.

Ischemic stroke（IS） is a common cerebrovascular disease in clinics，with a high disability rate. In recent years，the incidence of IS has gradually increased，especially in young people，which seriously affects the physical and mental health and quality of life of patients. Western medicine has made some progress in the treatment of IS but still faces some limitations. Therefore， choosing a measure that can assist in the treatment of IS is particularly important. A large number of studies have confirmed that traditional Chinese medicine can treat IS based on the effective ingredients and extracts of traditional Chinese medicine monomers and formulas，utilizing advantages such as multiple targets，multiple bioactive ingredients，multiple systems，and fewer adverse reactions to ensure the safety and effectiveness of the treatment pathway. At present，the mechanism of action of traditional Chinese medicine in treating IS can be achieved by intervening in various signaling pathways，mainly including secretory glycoprotein/β-catenin（Wnt/β-catenin） signaling pathway，phosphatidylinositol 3-kinase/protein kinase B（PI3K/Akt） signaling pathway，nuclear factor kappa-B（NF-κB） signaling pathway，Toll-like receptor 4/NOD-like receptor protein 3（TLR4/NLRP3） signaling pathway，mitogen-activated protein kinase（MAPK） signaling pathway，and neurogenic site-gap homologous protein（Notch） signaling pathway. This article summarized the relationship between IS and related signaling pathways in recent years，as well as the regulation of IS-related pathways and corresponding mechanisms by traditional Chinese medicine，so as to provide a reference for future clinical and experimental research on IS.

Objective To evaluate the impact of optimizing the stroke green channel on the efficiency of acute ischemic stroke management in a county hospital. Methods A retrospective analysis of the emergency stroke green channel treatment data from Sixian People’s Hospital from May 2020 to April 2021 (before optimization of the green channel) and from May 2021 to April 2022 (after optimization of the green channel) was conducted. The rates of intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) patients, as well as door-to-needle time (DNT), door-to-puncture time (DPT), and the modified Rankin scale (mRS) scores of patients three months post-treatment before and after the optimization of the stroke green channel were compared. Results Within one year before and after optimization of the green channel, the number of acute visits for ischemic stroke was 3 143 and 2 623, respectively. Before optimization, 84 and 51 underwent IVT and MT, respectively. After optimization of the green channel, the ratios of patients underwent IVT (n＝215) and MT (n＝103) significantly increased, and both DNT and DPT were significantly shortened (P＜0.000 1); the proportion of MT patients with an mRS score of 0-2 at 3 months post-discharge significantly increased (46/99 vs 13/46, P＝0.038). Conclusion After optimizing the green channel at Sixian People’s Hospital, the efficiency of stroke treatment has significantly improved, and the patients’ prognosis improved.

Objective: To detect the expression of serum exosomal miR⁃30d⁃5p in occupational dermatitis medicamentosa⁃like of trichloroethylene(OMDT) patients and its correlation with liver function , then perform bioinformatics analysis and verify the target gene. Methods : Serum exosomes were extracted from 6 OMDT patients and 6 healthy controls , and miRNA was extracted from exosomes which were identified by transmission electron microscopy, nanoparticle tracking analysis and western blotting. The expression of serum exosomal miR⁃30d⁃5p was detected by real⁃time fluorescence quantitative PCR , then the correlation with liver function was analyzed. The target genes of miR⁃30d⁃5p were predicted by the miRWalk and miRBD databases. Gene ontology analysis and KEGG pathways analysis were performed. Finally , RHOB was verified by Dual⁃luciferase reporter assay. Results: The expression of serum exosomal miR⁃30d⁃5p significantly decreased in 6 OMDT patients at the peak of the disease(P < 0. 05) , and it was negatively correlated with the level of AST , ALT and GGT (correlation coefficient : rs = - 0. 943 ,P = 0. 005 ;rs = - 0. 886 , P = 0. 019 ; rs = - 0. 886 , P = 0. 019 ) . Bioinformatics analysis and dual⁃luciferase reporter assay showed that RHOB was the target gene of miR⁃30d⁃5p. Conclusion The expression of serum exosomal miR⁃30d-5p decreases in OMDT patients , which is negatively correlated with the level of liver function , and the target gene RHOB may be involved in the process of liver injury induced by trichloroethylene.