Objective To observe the inter-observer consistency of diameter of inferior vena cava(IVC)and IVC collapsibility index(IVCCI)measured and assessed with echocardiography and the correlations with right heart parameters in patients with right heart dysfunction.Methods Forty-seven patients with right heart dysfunction were prospectively recruited in observation group,while 50 adults with normal right heart function were taken as controls(control group).Parameters of the right heart were obtained with echocardiography,including the right ventricular fractional area change(FAC),the tricuspid annular plane systolic excursion(TAPSE),the myocardial performance index(MPI),the tricuspid annular systolic velocity(S')as well as early and late diastolic velocity(e',a')and e'/a' ratio,also the tricuspid valve orifice early and late diastolic velocities(E,A)and E/A ratio and E/e',the vena contracta width of tricuspid regurgitation(TR-VCW),the maximum velocity of tricuspid regurgitation(TR-Vmax),the pulmonary artery systolic pressure(PASP)and right atrial area(RAA).Besides,the maximal and minimal diameter of IVC(IVCDmax,IVCDmin)during the respiratory cycle were measured with two dimensional(2D)ultrasound and anatomical M-mode ultrasound,respectively,and the IVCCI were calculated.Then 20 subjects were randomly selected from each group,and IVC parameters were obtained.The basic data,right heart parameters and IVC parameters were compared between groups,intra-class correlation coefficient(ICC)between 2 sonographers of IVC parameters were calculated,and correlations between IVC parameters and right heart parameters were assessed.Results No significant differences of gender,age nor body mass index(BMI)was detected between groups(all P＞0.05).Compared with those in control group,MPI,e',e'/a',E,A,E/e',TR-VCW,TR-Vmax,PASP and RAA increased,whereas FAC,TAPSE,S'and a'decreased in observation group(all P＜0.05).The inter-observer consistencies were good for IVCDmax and IVCCI in observation group(ICC=0.787-0.971)and IVCDmax in the control group(ICC=0.971,0.964)obtained with 2D ultrasound and anatomical M-mode ultrasound,but poor for IVCCI in control group(ICC=0.169,0.456).Compared with those in control group,IVC parameters 2D-IVCDmax,2D-IVCDmin,M-IVCDmax and M-IVCDmin increased but 2D-IVCCI and M-IVCCI decreased in observation group(all P＜0.05).In control group,2D-IVCDmax was weakly negatively correlated with TAPSE and a'(r=-0.392,-0.364),weakly positively correlated with e'/a',E,E/A,TR-VCW and RAA(r=0.396,0.483,0.461,0.565,0.582),2D-IVCCI was weakly negatively correlated with TR-VCW and RAA(r=-0.386,-0.380),while M-IVCDmax was weakly negatively correlated with TAPSE(r=-0.384),and weakly positively correlated with e'/a',E,E/A,TR-VCW and RAA(r=0.357,0.453,0.473,0.549,0.550),M-IVCCI was weakly negatively correlated with MPI,E,TR-VCW and RAA(r=-0.347,-0.337,-0.475,-0.421).Conclusion In patients with right heart dysfunction,IVCD diameter and IVCCI obtained with echocardiography had good inter-observer consistencies.Parameters obtained with 2D ultrasound and anatomic M-mode ultrasound had certain relations with the right heart parameters.

ObjectiveTo comprehensively evaluate the clinical value of Feilike mixture and provide a basis for the allocation of medical resources， rational drug use， and hospital procurement and supply of Chinese patent medicines. MethodWith the data from available studies and provided by drug manufacturers， the methods of evidence-based medicine， pharmacoeconomics， and health technology assessment were employed to construct a multi-criteria decision-making analysis framework from the "6+1" dimensions of safety， effectiveness， economy， innovation， suitability， accessibility， and characteristics of traditional Chinese medicine （TCM）. The clinical evidence and value evaluation software of Chinese patent medicine， CSCv2.0， was used to comprehensively evaluate the clinical value of Feilike mixture. ResultBased on the existing clinical evidence， the following results were obtained. ① Safety： Multi-sources of evidence showed that Feilike mixture had little known risk and sufficient evidence， with the safety rated as grade A， which indicated good safety. ② Effectiveness： The systematic review and Meta-analysis showed that Feilike mixture combined with conventional Western medicine in the treatment of bronchitis shortened the time to disappearance of cough compared with conventional Western medicine alone， with the evidence rated as grade B by the Grading of Recommendations Assessment， Development， and Evaluations （GRADE） system， which indicated high effectiveness. ③ Economy： From the perspective of health system， Feilike mixture combined with conventional Western medicine was more economical than conventional Western medicine alone， and the quality evaluation of pharmacoeconomics rated the economy as grade B. ④ Innovation： Feilike mixture combined with conventional Western medicine improved the clinical treatment effect and had innovation advantages compared with similar drugs. From the aspects of cultivation， identification of medicinal materials， and production， the sufficient supply and safety of medicinal materials can be ensured for Feilike mixture. This medicine was rated as grade B in terms of the medicinal material quality， preparation technology， and patents， which indicated good innovation. ⑤ Suitability： According to the results of the questionnaire survey， the usage of Feilike mixture was easy to be mastered and accepted by doctors and nurses， without special administration time， complex personalized treatment， and special technical and management requirements. It is convenient for patients to use， with convenient supply and storage， and weak influences of policy， publicity， and drug information. Therefore， the suitability of Feilike mixture was rated as grade B. ⑥ Accessibility： Among the similar Chinese patent medicines， Feilike mixture had a moderate price， high production capacity， wide sales coverage， wide coverage of hospitals， sustainable supply of medicinal materials， and low costs of treatment for acute bronchitis， with the accessibility rated as grade A. ⑦ TCM characteristics： Feilike mixture is composed of Scutellariae Radix， Peucedani Radix， Stemonae Radix， Gentianae Rhodanthae Herba， Scleromitrion diffusum， Firmiana platanifolia Radix， and Aster ageratoides， with reasonable compatibility. This formula is derived from the medical experience of Miao ethnic group， with rich experience in human use and the TCM characteristics rated as grade B. According to the evaluation results in the "6+1" dimensions， Feilike mixture was evaluated as class B， with a high clinical value. ConclusionAccording to the existing clinical evidence， compared with conventional Western medicine alone， Feilike mixture combined with conventional Western medicine demonstrates a high clinical value and prominent TCM characteristics in the treatment of acute bronchitis with phlegm-heat invading lung. It is suggested that it should be translated into the basic clinical drug management policy results according to the conditions.

Transcatheter aortic valve implantation (TAVI) is an important alternative in treating high-risk patients with aortic valve regurgitation. Transcatheter tricuspid valve implantation (TTVI) is also an important treatment option for high-risk patients with tricuspid regurgitation. We reported a 72-year male patient who underwent TAVI due to severe aortic valve regurgitation using a J-Valve. During a two-year follow-up, the patient developed secondary tricuspid regurgitation to atrial fibrillation, and subsequently received TTVI using a LuX-Valve. Following the interventions, the patient's symptoms were significantly improved, and echocardiography indicated good hemodynamic performance of both transcatheter heart valves. This case highlights the feasibility and effectiveness of performing multiple valve implantations via transcatheter approaches in high-risk elderly patients.

Tumor metastasis depends on the dynamic balance of the actomyosin cytoskeleton. As a key component of actomyosin filaments, non-muscle myosin-IIA disassembly contributes to tumor cell spreading and migration. However, its regulatory mechanism in tumor migration and invasion is poorly understood. Here, we found that oncoprotein hepatitis B X-interacting protein (HBXIP) blocked the myosin-IIA assemble state promoting breast cancer cell migration. Mechanistically, mass spectrometry analysis, co-immunoprecipitation assay and GST-pull down assay proved that HBXIP directly interacted with the assembly-competent domain (ACD) of non-muscle heavy chain myosin-IIA (NMHC-IIA). The interaction was enhanced by NMHC-IIA S1916 phosphorylation via HBXIP-recruited protein kinase PKCβII. Moreover, HBXIP induced the transcription of PRKCB, encoding PKCβII, by coactivating Sp1, and triggered PKCβII kinase activity. Interestingly, RNA sequencing and mouse metastasis model indicated that the anti-hyperlipidemic drug bezafibrate (BZF) suppressed breast cancer metastasis via inhibiting PKCβII-mediated NMHC-IIA phosphorylation in vitro and in vivo. We reveal a novel mechanism by which HBXIP promotes myosin-IIA disassembly via interacting and phosphorylating NMHC-IIA, and BZF can serve as an effective anti-metastatic drug in breast cancer.

Objective:To investigate the clinical effects of Ilizarov external fixation combined pedicle flap transfer in the treatment of infected tibial nonunion plus soft tissue defects.Methods:A retrospective study was performed to analyze the data of 35 patients with infected tibial nonunion plus soft tissue defects who had been admitted to Department of Orthopedic Trauma, Tianjin Hospital Affiliated to Tianjin University from July 2005 to July 2020. There were 25 males and 10 females with an age of (37.5±6.0) years. Their original traumas were 27 open and 8 closed fractures, with a disease course ranging from 8 to 42 months. Three patients had undergone 1 operation, 7 patients 2 operations, and 25 patients 3 or more operations. All patients presented with different degrees of skin and soft tissue defects or bone exposure, wound sinus formation and bone scaring. The size of pedicle flaps transferred ranged from 6 cm×5 cm to 15 cm×10 cm. Surgical transfer of skin flap and external fixation were performed at one stage in 25 patients while staged surgery was performed in 10 patients. The first stage consisted of local debridement, vacuum sealing drainage, and delayed flap operation while the second stage consisted of delayed flap transfer and Ilizarov external fixation. The survival of skin flap, limb shortening, bony union and complications were observed after operation. The limb function was evaluated according to the criteria of The Association for the Study and Application of Methods of Ilizarov (ASAMI) for bone and functional results.Results:All patients were followed up for (23.8±7.4) months. Fracture union was achieved in all. The flaps survived postoperatively, the wounds were repaired by the first intention, infection did not recur, and bony union was achieved in 32 patients. Partial necrosis of the flap edge occurred in 3 cases, but responded to dressing change. In the 10 patients undergoing delayed flap operation, 100% of the flaps survived. In all patients, the limbs were shortened by (0.8±0.1) cm, and the tibial fractures got united after (7.2±1.2) months. By the ASAMI criteria for bone results, 29 cases were excellent and 6 cases good; by the ASAMI criteria for functional results, 25 cases were excellent, 8 cases good, and 2 cases fair.Conclusion:As Ilizarov external fixation combined pedicle flap transfer can repair bone and soft-tissue defects at the same time, this surgical scheme facilitates infection control and leads to reliable outcomes.

Objective:To investigate the effects and the possible mechanisms of Neiguan(PC6)and Gongsun(SP4)on the hypothalamic-pituitary-adrenal(HPA)axis in rats with functional dyspepsia(FD),thus to provide a theoretical basis for the clinical application of the Eight Confluent Points.Methods:Forty specific-pathogen-free Sprague-Dawley rats were divided into a blank group,a model group,an electroacupuncture(EA)group,and a Western medicine group by the random number table method,with 10 rats in each group.Rats in the blank group did not receive modeling or intervention.Rats in the other three groups were subjected to the FD with mood disorder model using the compound etiology modeling method.After the successful modeling,rats in the model group did not receive any interventions,rats in the Western medicine group received deanxit and mosaprid intervention,and those in the EA group received EA intervention on the ipsilateral Neiguan(PC6)and Gongsun(SP4)for 21 d.The sugar-water consumption rate was measured before the experiment and before and after interventions to assess the emotional status.The gastric emptying rate was measured after interventions to assess the gastrointestinal dynamics.The expression levels of hypothalamic corticotropin-releasing hormone(CRH),pituitary adrenocorticotropic hormone(ACTH),and adrenal corticosterone(CORT)were measured by enzyme-linked immunosorbent assay.Results:Compared with the blank group,the sugar-water consumption rate and the gastric emptying rate were decreased(P<0.01),and the hypothalamic CRH,pituitary ACTH,and adrenal CORT expression levels were increased(P<0.01)in the model group.Compared with the model group,the sugar-water consumption rate and the gastric emptying rate were significantly increased(P<0.01),while the expression levels of hypothalamic CRH,pituitary ACTH,and adrenal CORT were significantly decreased(P<0.01)in the EA group and the Western medicine group.The differences between the EA group and the Western medicine group were not statistically significant(P>0.05).Conclusion:The Eight Confluent Points Neiguan(PC6)and Gongsun(SP4)can improve the mood and gastrointestinal dynamics in FD rats,which may be achieved by down-regulating the hypothalamic CRH,pituitary ACTH,and adrenal CORT,as well as by correcting the HPA axis hyperfunction.

Ischemic stroke (IS) is a severe cerebrovascular disease with a high incidence, mortality, and disability rate. The first-line treatment for IS is the use of recombinant tissue plasminogen activator (r-tPA). Regrettably, numerous patients encounter delays in treatment due to the narrow therapeutic window and the associated risk of hemorrhage. Traditional Chinese medicine (TCM) has exhibited distinct advantages in preventing and treating IS. TCM enhances cerebral microcirculation, alleviates neurological disorders, regulates energy metabolism, mitigates inflammation, reduces oxidative stress injuries, and inhibits apoptosis, thereby mitigating brain damage and preventing IS recurrence. This article summarizes the etiology, pathogenesis, therapeutic strategies, and relationship with modern biology of IS from the perspective of TCM, describes the advantages of TCM in the treatment of IS, and further reviews the pharmacodynamic characteristics and advantages of TCM in the acute and recovery phases of IS as well as in post-stroke complications. Additionally, it offers valuable insights and references for the clinical application of TCM in IS prevention and treatment, as well as for the development of novel drugs.

Objective:To investigate the impact of the deep learning reconstruction algorithm TrueFidelity TM for Gemstone Spectral Imaging (TF-GSI) and the adaptive statistical iterative reconstruction algorithm (ASiR-V, hereinafter referred to as ASiR-V) based on phantom and animal models on the image quality of dual-energy CT images. Methods:GE Revolution Apex CT was used to scan the ACR 464 phantom and a mouse model of gastric cancer with lymph node metastasis ( n=16). TF-GSI and ASiR-V were separately used to reconstruct middle and high-grade images (TF-GSI-M, TF-GSI-H, ASiR-V-50%, and ASiR-V-100%) on the phantom and mouse based on virtual monoenergetic images at 70 keV. The task transfer function (TTF) of bone and acrylic, image noise power spectrum (NPS), and detectability index (d′) of the phantom images were evaluated. One-way ANOVA analysis was used to compare the image noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) for brain and liver on images of mice. The consistency of the two reconstruction-algorithm images (TF-GSI-H and ASiR-V100%) in the detection of small lesions by two radiologists (A and B) was evaluated using kappa test. Results:In terms of the phantom, the TF-GSI-H group had the best performance in TTF, NPS, and d′. Compared to ASiR-V-100%, the TTF50% of bone and acrylic in the TF-GSI-H group increased by 2.4% and 8.9%, respectively; the NPS peak decreased by 54.1%, compared to ASiR-V-100%; the d′ of bone and acrylic in the TF-GSI-H group relative to ASiR-V-100% increased by 52.7% and 59.5%, respectively. The TF-GSI group had reduced image noise compared to the ASiR-V group, and both SNR and CNR of the two tissues increased, but the differences between the groups were not statistically significant (all P>0.05). The two reconstruction-algorithm images showed good consistency in image evaluation by the two radiologists (A, Kappa=0.875, P<0.001; B, Kappa=0.625, P=0.012). In terms of the detection of micro-metastases in mice, the TF-GSI group outperformed the ASiR-V group (average accuracy: 83.5% vs 71.9%; average sensitivity: 77.8% vs 61.2%; average specificity: 85.7% vs 85.7%). Conclusion:Compared with iterative reconstruction algorithm, the DLIR algorithm showed improved spatial resolution, reduced image noise, and enabled detectability of micro-lesion for images from dual-energy CT.

Based on the unique syndrome characteristics of metabolic associated fatty liver disease （MAFLD） in Lingnan （岭南） area， this paper discussed the clinical experience of Huangqi （Radix Astragali） in the treatment of MAFLD in Lingnan area. It is summarized that spleen deficiency and yang weakness， and internal accumulation of damp-turbidity are the source of the disease， and at the early stage， Huangqi， commonly 15~30 g， could be used to fortify the spleen and warm the earth， thereby making the deficiency fire latent， as well as raise the clear and warm the exterior so as to inhibit damp-turbidity； medication needs to be progressively supplemented， and can be used together with Taizishen （Radix Pseudostellariae）， Baizhu （Rhizoma Atractylodis Macrocephalae）， Fuling （Poria）， and Fangfeng （Radix Saposhnikoviae） to back up the earth and inhibit dampness. Qi stagnation and blood constraint， yin dampness and heat accumulation are the pathogenesis of disease progression. Huangqi should be taken to invigorate the spleen and flourish the liver， unblock yang， and move stagnation. The dosage is often maintained at 30~60 g， to circulate the qi and unblock yang qi in the middle jiao （焦）， usually combined with Chaihu （Radix Bupleuri）， Baishao （Radix Paeoniae Alba） and Yujin （Radix Curcumae） integrating warm and cool medicinals. Stubborn turbid and fat condensing in the liver is a severe stage of the disease and may be concurrent with various pathogens such as dampness， phlegm， and heat， for which 60~90 g Huangqi should be used to invigorate blood and disperse fat， reinforce healthy qi and expel pathogens， often with medicinals that can disperse fat and direct the turbid downward such as Shanzha （Fructus Crataegi）， Juemingzi （Semen Cassiae）， Lulutong （Fructus Liquidambaris） and Zexie （Rhizoma Alismatis）. When prescribing， it is suggested to combine with other medicinals according to the season， thereby adjusting the ascending and descending of the property of Huangqi， thereby conforming to the nature of the four seasons.

Transcatheter aortic valve replacement (TAVR) has become the preferred treatment for severe aortic stenosis. The localization and anchor of many transcatheter heart valves available in the clinic today are dependent on the calcific aortic valve leaflet of patients. We reported here a successful case of transapical aortic valve implantation with Ken-Valve heart valve in an 82-year-old male patient with pure severe aortic regurgitation without native valve calcium. Postoperative follow-up (3 months after the surgery) showed that the cardiac function significantly improved. The echocardiography indicated that the Ken-Valve prosthesis worked well without perivalvular regurgitation. The short-term clinical effect was satisfactory. The Ken-Valve with three position anchors is proved to be suitable for the treatment of pure aortic regurgitation.