Objectives:To evaluate the learning curve of transcatheter aortic valve replacement(TAVR)in a single center by single operator using Venus A valve. Methods:A total of 150 patients with severe aortic stenosis who underwent TAVR using Venus A valve in Fujian Provincial Hospital from July 2018 to May 2022 were selected.According to the time order of TAVR,the 1st-50th patients were included in group A,the 51st-100th patients were included in group B and the 101st-150th patients were included in group C.The basic clinical data,perioperative parameters and postoperative follow-up data of the three groups were analyzed. Results:All high-risk patients with severe aortic stenosis had an average STS score(7.9±1.5)and were treated with Venus A valve.The total operation time of group A,group B and group C was(226.2±86.3)min,(115.2±47.1)min,(108.2±38.1)min;the peripheral path operation time was(45±10)min,(20±7)min,(18±6)min;the valve release time was(13.0±2.3)min,(5.0±2.1)min,(3.0±1.7)min;the X-ray fluoroscopy time was(24±8)min,(11±5)min,(10±3)min;the radiation dose was(1 266±227)mGy,(532±132)mGy,(519±108)mGy;and the total incidence of perioperative adverse events was 46%,18%,16%,respectively.The differences were statistically significant(all P<0.05).The total incidence of adverse events during follow-up within 6 months for patients in group A,group B,and group C were 6%,2%,and 0%(P>0.05).With the increase of TAVR cases,the correlation curve of each time node of TAVR and radiation dose tended to be stable after the 50th-60th cases. Conclusions:With the increase of procedural experience,the total operation time,operative time nodes,radiation dose and perioperative adverse events of TAVR with Venus A valve decreases gradually,and the operator usually needs 50-60 cases to cross the TAVR learning curve.

To promote the development of the prescription-based processing of Chinese herbal pieces,the China Association of Chinese Medicine published the social organization standard of the Standard for Prescription-based Processing of Chinese Herbal Pieces(T/CACM 1367-2021)in June 2021.The standard was led by the First Affiliated Hospital of Henan University of Chinese Medicine and Jiangsu Province Hospital of Chinese Medicine.It was jointly drafted by 28 Traditional Chinese medical institutions across the country.This paper introduced the standards in detail to promote the implementation and propel the inheritance and innovation of the processing of Chinese herbal pieces.

Objectives:To investigate the effect of body mass index(BMI)on perioperative and long-term prognosis of patients with severe aortic stenosis(AS)after transcatheter aortic valve replacement(TAVR). Methods:This retrospective study imcluded 180 patients with severe AS who received TAVR in Fujian Provincial Hospital from January 2019 to January 2022.According to the BMI,patients were divided into four groups:low weight group(BMI<18.5 kg/m2,n=23),normal weight group(18.5 kg/m2≤BMI<24.0 kg/m2,n=65),overweight group(24.0 kg/m2≤BMI<28.0 kg/m2,n=57),obesity group(BMI≥28.0 kg/m2,n=35).The general clinical characteristics,imaging parameters,perioperative indexes,all-cause death and the incidence of other adverse cardiac events during(18.0±6.8)months follow-up were compared among different groups.Risk factors for the perioperative complications and long-term outcomes of TAVR were evaluated. Results:The prevalence of hypertension and diabetes,left ventricular end-diastolic diameter,ventricular septal thickness and left ventricular posterior wall thickness were significantly higher in the obese group than in normal weight group(all P<0.05).The level of prealbumin in low weight group was lower than in normal weight group(P<0.05).The total perioperative complications in low weight group were higher than in normal weight group(60.9%vs.12.3%,P=0.042).During(18.0±6.8)months follow-up,the incidence of all-cause death in the low weight group was significantly higher than that in normal weight group,overweight group and obese group(17.4%vs.4.6%vs.3.5%vs.5.7%,P=0.003).Kaplan-Meier survival analysis evidenced higher mortality rate in low weight group at 18 months after TAVR(log-rank P<0.01).Multivariate Cox regression analysis showed that the risk of long-term adverse cardiovascular events was significantly higher in low weight group than in normal weight group(HR=7.633,95%CI:1.012-57.564,P=0.049). Conclusions:Low weight patients with severe AS have a higher incidence of perioperative complications and a poor long-term prognosis.Such patients should appropriately strengthen their nutritional intake and adjust their body weight to normal levels before performing TAVR.

By extracting quantitative radiomic features from regions of interest in medical images and correlating them with the biological features and heterogeneity of tumors, radiomics can provide critical information and a basis for personalized precision diagnosis and treatment. Peritumoral regions contain a wealth of microbiological information. Therefore, chest CT peritumoral radiomics, which can provide quantitative non-invasive assessment for patients with non-small cell lung cancer (NSCLC) by mining the deep heterogeneity of peritumoral regions, has broad prospects for future clinical applications. Given the rapid progress in computer and medical big data techniques, as well as the in-depth efforts in multi-center, high-quality, and large-sample data in the future, it is reasonably believed that radiomics research will be gradually normalized and reproducible. This is conducive to the translation and application of radiomics research to clinical practice, thus laying a foundation for personalized and accurate diagnosis, treatment, and follow-up for lung cancer patients.

Objective     To analyze predictive factors, clinical implications and prognosis effects of new-onset conduction block after transcatheter aortic valve implantation (TAVI). Methods     The clinical data of 86 patients who underwent TAVI through transfemoral approach from 2019 to 2021 in Fujian Provincial Hospital were retrospectively analyzed, including 59 males and 27 females with an average age of 72.9±8.0 years. The patients were divided into a normal group and a new-onset conduction block group according to whether there was new-onset conduction block after operation, and then the new-onset conduction block group was subdivided into a left bundle branch block (LBBB) group (28 patients) and a complete atrioventricular block (CAVB) group (11 patients). We compared the hemodynamics and TAVI-related complications between the postoperative and early follow-up periods, and used the multivariate logistic regression models to identify risk factors for the new-onset conduction block. Results     The median EuroSCORE of all patients were 8 (2) points before the operation. In the postoperative and early follow-up periods, the hemodynamics and TAVI-related complications had no statistical difference between the new-onset conduction block group and the normal group (P>0.05). The incidence of permanent pacemaker implantation (81.8%, 9/11) and mortality due to cardiac causes (18.1%, 2/11) in the CAVB group were significantly higher than those in the normal group and theLBBB group (P<0.05). Female, severe calcification of the aortic valve, too large valve size and deep valve implants were the risk factors for new-onset conduction block after TAVI. Conclusion    The incidence of LBBB and CAVB is high after TAVI, however, both of them do not significantly effect the hemodynamics of the patients. Higher incidence of permanent pacemaker implantation is found in the CAVB group which affects the rate of rehospitalization and mortality. Female patients, severe calcification of the aortic valve, too large valve size and deep valve implants are the risk factors for the new-onset conduction block after TAVI.

KRAS‒PDEδ interaction is revealed as a promising target for suppressing the function of mutant KRAS. The bottleneck in clinical development of PDEδ inhibitors is the poor antitumor activity of known chemotypes. Here, we identified novel spiro-cyclic PDEδ inhibitors with potent antitumor activity both in vitro and in vivo. In particular, compound 36l (K _D = 127 ± 16 nmol/L) effectively bound to PDEδ and interfered with KRAS-PDEδ interaction. It influenced the distribution of KRAS in Mia PaCa-2 cells, downregulated the phosphorylation of t-ERK and t-AKT and promoted apoptosis of the cells. The novel inhibitor 36l exhibited significant in vivo antitumor potency in pancreatic cancer patient-derived xenograft (PDX) models. It represents a promising lead compound for investigating the druggability of KRAS‒PDEδ interaction.

Objective:To compare the clinical efficacy and safety of percutaneous transluminal septal branch anhydrous alcohol ablation (PTSAAA) and percutaneous transluminal septal branch microsphere embolization (PTSBME) in the treatment of patients with symptomatic hypertrophic obstructive cardiomyopathy.Methods:The clinical data of 55 patients with symptomatic hypertrophic obstructive cardiomyopathy treated by PTSAAA and PTSBME were retrospectively analyzed, among whom 27 were treated with PTSAAA and 28 with PTSBME. The changes of postoperative indicators of the two groups of patients were compared, including the improvement degree of symptoms [shortness of breath after activity (cardiac function NYHA classification), chest tightness, chest pain (angina CCS classification) and amaurosis, the decrease of left ventricular outflow tract pressure gradient (LVOTPG)], the ventricular septum thickness shown by color Doppler echocardiography, the incidences of complications at postoperative month 6 and 12, and the incidences of cardiovascular events at follow-up month 12. LSD- t, χ 2 or Fisher exact probability methods were used to compare the differences of indicators between the two groups. Results:Compared to the relative indicators before operation, there were significant differences in shortness of breath after activity, chest pain and amaurosis, LVOTPG, ventricular septum thickness, the incidences of complications at postoperative month 6 and 12 and the incidences of cardiovascular events at follow-up month 12 in both the PTSAAA group and PTSBME group ( P<0.05). The PTSBME group was not inferior to the PTSAAA group in the improvement degree of amaurosis, cardiac function NYHA classification and angina CCS classification and left ventricular ejection fraction (LVEF) at postoperative month 6 and 12 ( P>0.05) as well as in the LVOTPG decrease and the ventricular septum thickness at postoperative month 6 [(16.8±7.5) mmHg vs (15.8±7.3) mmHg, (19.8±4.9) mm vs (17.4±4.1) mm, P>0.05], but was superior to the PTSAAA group in the LVOTPG decrease and the ventricular septum thickness at postoperative month 12 [(15.2±6.7) mmHg vs (9.8±5.4) mmHg, (18.4±5.1) mm vs (12.2±3.2) mm, P<0.05]. There were statistical significances in the incidences of cardiovascular events and third degree atrio-ventricular block and nosocomial mortality between the two groups (6 vs 1; 5 vs 0, P<0.05), and the PTSBME group was superior to the PTSAAA group in safety. Conclusion:PTSBME may be a safe and effective method for the management of patients with symptomatic hypertrophic obstructive cardiomyopathy.

Objective　To explore the correlations between serum hypoxia inducible factor-1α （HIF-1α），aquaporin-9 （AQP9） and hemorrhagic transformation （HT） in patients with acute ischemic stroke （AIS） and its clinical significance. Methods　183 newly diagnosed patients with acute AIS from October 2017 to April 2019 were divided into HT group （n=84） and non HT group （n=99），the baseline data of gender，age，body mass index （BMI），proportions of hypertension，diabetes，hyperlipidemia，the baseline NIHSS score，baseline systolic blood pressure，baseline diastolic blood pressure，baseline blood glucose，thrombolytic time window and serum samples were collected. The expressions of HIF-1α and AQP9 proteins were detected by Western blot （WB）；Pearson’s method was used to analyze the correlation between HIF-1α and AQP9 levels in patients with AIS in HT group；the risk factors of HT in AIS patients were analyzed by logistic regression；Using NIHSS score，thrombolysis time window，serum HIF-1α，AQP9 levels as independent variables，the working characteristic curve （ROC） of subjects was drawn to analyze the predictive value of HT in AIS patients. Results　Compared with the non HT group，the baseline NIHSS score，baseline systolic blood pressure，baseline diastolic blood pressure，baseline blood glucose，thrombolytic time window，serum HIF-1α，AQP9 levels of AIS patients in HT group were significantly higher （P<0.05）. There was a positive correlation between the levels of HIF-1α and AQP9 proteins in patients with AIS in HT group （r=0.679，P<0.05）. NIHSS score，thrombolysis time window and serum HIF-1α，AQP9 protein levels were independent risk factors for HT in AIS patients after thrombolysis （P<0.05）. The AUCs of NIHSS score，thrombolysis time window，serum HIF-1α and AQP9 in the diagnosis of HT in AIS patients were 0.707，0.790，0.881 and 0.869 respectively，the cutoff values were 13.39 points，296.31 min，0.33 and 0.32 respectively，the sensitivities were 44%，66.70%，86.90% and 83.30% respectively，and the specificities were 91.90%，87.90%，87.90% and 88.90% respectively. The AUC of the combination of four methods in the diagnosis of HT in AIS patients was 0.980，the sensitivity and specificity were 94.00% and 94.90%，respectively，and the diagnostic efficiency of the four methods was significantly higher than that of single index. Conclusion　The elevated levels of HIF-1α and AQP9 were closely related to the occurrence of HT in AIS patients，and the combination of NIHSS score and thrombolysis time window could significantly improve the predictive value of HT in AIS，which may have some clinical reference significance.

Homer syndrome results from an interruption of the oculosympathetic pathway.Typical clinical manifestations include ptosis,dilated pupils and less sweat on the affected side.The clinical symptoms caused by damage at different sites are not identical.An in-depth understanding of Horner syndrome may help us identify the causes of Horner syndrome early and estimate the severity of the disease.This article reviews the neuroanatomy and common etiology,clinical manifestations,diagnosis and treatment of Horner syndrome to provide reference for clinical work.

Objective The aims of this study were to develop an ultraviolet-visible spectrophotometry (UV-Vis) for the determination of quaternary ammonium alkaloid content in Lycium ruthenicumMurr., and to analysis the constitution of its nitrogenous compounds by liquid chromatograph - mass spectrometry(LC-MS). Methods The quaternary ammonium alkaloid content was determined by a UV-Vis spectrophotometer at 524 nm. The ultra performance liquid chromatography(UPLC) analysis was performed on BOS Hypersil C18 column(2.1 mm × 150 mm, 2.4μm), with 0.1％ formic acid solution(A)–acetonitrile(B) as the mobile phase for gradient elution. The flow rate was 0.3 ml/min, and the column temperature was 35℃, Multiple reaction monitoring (MRM) equipped with electrospray ion source was performed in positive ion mode for structure analysis.Results As a standard, the betaine was linear in the range of 981μg-4906μg,Y=0.0001X-0.0055, r=0.9993, and the average recovery rate was 98.53％,RSD=1.19％(n=6). There were 12 nitrogenous compounds analyzed by LC-MS, with N(1)-dihydrocaffeoyl-N(12)-caffeoyl spermine and p-Hydroxyl-cinnamyl-dihydrocaffeoyl spermidine were first reported.Conclusions The method developed in this subject is simple, accurate with good repeatability, which can be applied for determination of quaternary ammonium alkaloid content in Lycium ruthenicumMurr. And the structure analysis of its nitrogenous compounds will deepen the understanding of the compounds inLycium ruthenicumMurr.