Objective To evaluate the clinical efficacy of valve-in-valve transcatheter mitral valve replacement for the management of degenerated bioprosthetic mitral valves. Methods This study retrospectively analyzed the clinical data of patients who underwent transcatheter mitral valve replacement due to degenerated bioprosthetic mitral valves at the First Affiliated Hospital of Zhengzhou University from 2020 to 2023. The analysis included baseline characteristics, surgical details, perioperative complications, and hemodynamic changes during the early postoperative period and subsequent follow-up. Results A total of 31 patients were included in the study, comprising 7 males and 24 females, with an average age of (66.57±9.32) years. The average duration since the initial surgical placement of the bioprosthetic valves was (9.92±3.71) years. The procedures included 7 patients utilizing the transfemoral venous-atrial septal approach and 24 patients employing the transapical approach. All patients exhibited significant improvement in cardiac function postoperatively, with a reduction in the number of patients classified as New York Heart Association (NYHA) grade Ⅲ or Ⅳ and those with moderate to severe tricuspid valve regurgitation. Echocardiographic assessments revealed a decrease in peak flow velocity across the mitral valve and a reduction in the average transvalvular pressure gradient, while left ventricular ejection fraction remained unchanged. One patient experienced a recurrent stroke and died on the fifth postoperative day; however, the remaining patients were discharged uneventfully, without complications such as cardiac death, left ventricular outflow tract obstruction, or pacemaker implantation. During a median follow-up period of 12 months, no adverse events were reported, and hemodynamic stability was maintained. Conclusion Valve-in-valve transcatheter mitral valve replacement is a safe and effective option for patients with degenerated bioprosthetic mitral valves, demonstrating favorable hemodynamic outcomes and satisfactory short-term clinical results.

Objective To explore the effective components and possible targets and mechanism of Shenling Baizhu Powder in improving adipose tissue inflammation in children with obesity with the help of network pharmacology and molecular docking method;To conduct preliminary verification through animal experiments.Methods The active components and targets of Shenling Baizhu Powder were screened through the TCMSP database.GeneCards,OMIM,DisGeNET databases were used to obtain the disease targets.An active component-target network was constructed by taking the intersection of drug and disease targets.Protein-protein interaction networks were constructed and core targets were obtained for GO and KEGG pathway enrichment analysis.Molecular docking validation was performed to key components and core targets.Animal experiments were conducted by establishing a model of young obese rats induced by high fat diet,and Shenling Baizhu Powder were given for gavage.The contents of TG and TC in serum and mRNA expressions of TNF-α,IL-1β,INF-γ and Fas in rat adipose tissue of epididymis were detected.Results The key components of Shenling Baizhu Powder to improve the microinflammation of obesity in children were piperlonguminine,acacetin,luteolin,denudatin B,mandenol,inermine,etc.There were 515 common drug-disease targets,and the core targets were TP53,SRC,PIK3R1,HSP90AA1 and PIK3CA.The results of GO enrichment analysis included inflammatory response,positive regulation of MAPK cascade,membrane raft,protein serine/threonine/tyrosine kinase activity,etc.KEGG pathway enrichment analysis results included metabolic,immune,endocrine,cancer and related liver disease signaling pathways.The results of molecular docking showed that the key components could play a regulatory role on the core target.Animal experiments showed that Shenling Baizhu Powder could improve microinflammation and metabolic indexes of model rats.Conclusion Shenling Baizhu Powder can act on multiple targets through various active components and multiple signaling pathways,adjusting inflammatory response and immune process,alleviating insulin resistance,regulating glucose and lipid metabolism,thereby improving adipose tissue inflammatory in children with obesity.

【Objective】 To analyze the influence of different Inc parameters in the Monaco planning system on the left breast cancer volumetric modulated arc therapy (VMAT) planning, in the hope of providing some reference for plan design. 【Methods】 Seventeen left-breast cancer patients who were receiving radical radiotherapy were selected. The plans were enrolled in the design of VMAT with the same optimization conditions but different Inc parameters in the Monaco planning system. All plans used different Inc parameters like 10°, 20°, 30°, and 40°. The results of the plan were compared. The dosimetric parameters of the PTV and the organs at risk inquired by the plan were analyzed. The SPSS software was used for calculating the differences between the VMAT plans and evaluating the quality of the plans. 【Results】 The different Inc parameters affected the dosimetric parameters D98%, D2%, D50%, V55 Gy of PTV and CI, HI (F=10.528, F=15.154, F=15.513, F=16.979, F=4.632, F=14.277, all P<0.05). The MU of the four groups significantly differed (F=4.632, P<0.05), and the difference of V10 on the ipsilateral lung was significant (F= 3.324, P<0.05), the remaining parameters in the four groups had no statistically significant difference. 【Conclusion】 For the left-breast cancer volumetric modulated arc therapy, the smaller of Inc parameter on the plan had better dose distribution and conformity index while the monitor units increased. 40° was not suitable for the breast cancer VMAT plan, and the high amount beyond the range would increase the toxic and side effects on the skin.

Objective:To describe a systematic approach on identification of poisonous mushroom by investigating two cases of Omphalotus guepiniformis poisoning in Jianyang district, Nanping, Fujian province. Methods:Two incidents of food poisoning on 10 migrant workers were investigated. The remaining suspected mushroom samples were collected and the same fresh mushroom specimens were also collected in the following field investigations from the same dead tree and fallen trunk. These mushroom specimens were identified based on morphological and phylogenetic analyses.Results:On November 24 and 26, 2018, 8 and 2 migrant workers from Jianyang District, Nanping ate wild mushrooms and developed acute nausea, vomiting, abdominal pain and other symptoms within 10 to 90 min after consumption. They were diagnosed as mushroom poisoning, with gastroenteritis as the main manifestation. Further analysis showed that the more poisonous mushroom were consumed, the shorter latency and longer duration of nausea and vomiting were resulted. After admission, gastric lavage, catharsis, acid preparation, gastric protection, fluid replenishment and other symptomatic support treatments were given in time, all patients were discharged in 1-3 d. Based on morphological and phylogenetic analyses, the samples were identified as O. guepiniformis. Conclusions:The two incidents were caused by accidental consumption of O. guepiniformis. Awareness education about poisonous mushroom should be provided to migrant workers to prevent more such poisoning incidents in the future.

Objective:To investigate the association of WWP2 single nucleotide polymorphism (rs3790088, rs4247109) with delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) , and explore the influences of DEACMP genetic predisposition. Methods:From November 2006 to December 2017, 235 DEACMP cases and 429 acute carbon monoxide poisoning (ACMP) cases were selected. All ACMP patients were followed up for more than 90 days without DEACMP. The DNA in all blood samples were extracted with the blood Genome DNA Extraction Kit. The method of Sequenom Mass Array SNP technique was used to detect the genotype and allele of WWP2. All DEACMP patients were assessed every 3 days after hospitalization by the Hasegawa Dementia Scale (HDS) and Activity of Daily Living Scale (ADL) . The distribution of genotypes in conformty with Hardy-Weinderg law was analyzed by goodness-of-fit χ 2 test, and χ 2 test was used for association analysis. Results:For rs3790088, there were 226 DEACMP cases and 414 ACMP cases. For rs4247109, there were 234 DEACMP cases and 428 ACMP cases. For rs3790088 and rs4247109 in WWP2 gene: there were not significant differences in the gene genotype distribution and allele frequency of both DEACMP group and ACMP group ( P>0.05) . According to gender, there were not significant differences in WWP2 gene genotype distribution and allele frequency between two female groups and two male groups ( P>0.05) . After analysis by genetic model, the genotype distributions in both DEACMP group and ACMP group were not significantly differences in three genetic models (codominant genetic model, recessive genetic model and dominant genetic model, P>0.05) . Conclusion:It has not confirmed the genetic correlation between the two gene single nucleotide polymorphisms (rs3790088, rs4247109) of WWP2 gene and the incidence of DEACMP.

Objective:To investigate the association of WWP2 single nucleotide polymorphism (rs3790088, rs4247109) with delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) , and explore the influences of DEACMP genetic predisposition. Methods:From November 2006 to December 2017, 235 DEACMP cases and 429 acute carbon monoxide poisoning (ACMP) cases were selected. All ACMP patients were followed up for more than 90 days without DEACMP. The DNA in all blood samples were extracted with the blood Genome DNA Extraction Kit. The method of Sequenom Mass Array SNP technique was used to detect the genotype and allele of WWP2. All DEACMP patients were assessed every 3 days after hospitalization by the Hasegawa Dementia Scale (HDS) and Activity of Daily Living Scale (ADL) . The distribution of genotypes in conformty with Hardy-Weinderg law was analyzed by goodness-of-fit χ 2 test, and χ 2 test was used for association analysis. Results:For rs3790088, there were 226 DEACMP cases and 414 ACMP cases. For rs4247109, there were 234 DEACMP cases and 428 ACMP cases. For rs3790088 and rs4247109 in WWP2 gene: there were not significant differences in the gene genotype distribution and allele frequency of both DEACMP group and ACMP group ( P>0.05) . According to gender, there were not significant differences in WWP2 gene genotype distribution and allele frequency between two female groups and two male groups ( P>0.05) . After analysis by genetic model, the genotype distributions in both DEACMP group and ACMP group were not significantly differences in three genetic models (codominant genetic model, recessive genetic model and dominant genetic model, P>0.05) . Conclusion:It has not confirmed the genetic correlation between the two gene single nucleotide polymorphisms (rs3790088, rs4247109) of WWP2 gene and the incidence of DEACMP.

An 8-month-old female infant received propranolol 2 mg orally twice daily and prednisone 7.5 mg orally once daily for kaposiform hemangioendothelioma.Due to poor efficacy,propranolol and prednisone were discontinued and sirolimus 0.2 mg was given orally twice daily.The child's liver function was normal before sirolimus treatment.On day 10 of sirolimus treatment,the laboratory tests showed alanine aminotransferase(ALT) 58 U/L,aspartate aminotransferase(AST) 116 U/L,γ-glutamyltransfarase(γ-GT) 84 U/L,alkaline phosphatase(ALP) 181 U/L,total bile acid(TBA) 109.2 μmol/L,total bilirubin(TBil) 57.4 μmol/L,and direct bilirubin(DBil) 38.0 μmol/L.At the same time,the child developed decrease of appetite,milk refusal,and cry and scream all the time.The physical examination showed slightly yellow on her skin and sclera.Cholestatic liver injury caused by sirolimus was considered.Sirolimus was discontinued and liver-protective therapy and drugs for anti-jaundice were given.On day 6 of drug withdrawal,the laboratory tests showed ALT 58 U/L,AST 116 U/L,γ-GT 84 U/L,ALP 181 U/L,TBA 109.2 μmol/L,TBil 41.5 μmol/L,and DBil 20.8 μmol/L;the child's appetite recovered,yellowish skin and sclera improved markedly.On day 20 of drug withdrawal,the child was discharged.No abnormalities were found in the child's liver function after 15 days of discharge.

A 65-year-old male patient received oral Anweiyang capsules 0. 4 g four times daily for chronic gastritis. About 1 month after the medication,the patient developed intermittent headache, dizziness,and increased blood pressure,whose highest value was 180 / 100 mmHg. Levamlodipine besylate tablets 2. 5 mg once daily was given orally but the patient′s blood pressure was not well controlled. About 4 months later,laboratory tests showed obviously increased free cortisol in urine (2330 nmol/ 24 h),which was considered to be caused by Anweiyang capsules. Anweiyang capsules were stopped and the patient continued to take levamlodipine besylate tablets. On day 4 after the drug withdrawal,the patient′s blood pressure and urinary free cortisol began to decrease,which finally returned to normal on day 9. At 1 month of follow-up,no abnormalities were found on the blood pressure and urinary free cortisol in the patient.

An 8-month-old female infant received propranolol 2 mg orally twice daily and prednisone 7.5 mg orally once daily for kaposiform hemangioendothelioma.Due to poor efficacy,propranolol and prednisone were discontinued and sirolimus 0.2 mg was given orally twice daily.The child's liver function was normal before sirolimus treatment.On day 10 of sirolimus treatment,the laboratory tests showed alanine aminotransferase(ALT) 58 U/L,aspartate aminotransferase(AST) 116 U/L,γ-glutamyltransfarase(γ-GT) 84 U/L,alkaline phosphatase(ALP) 181 U/L,total bile acid(TBA) 109.2 μmol/L,total bilirubin(TBil) 57.4 μmol/L,and direct bilirubin(DBil) 38.0 μmol/L.At the same time,the child developed decrease of appetite,milk refusal,and cry and scream all the time.The physical examination showed slightly yellow on her skin and sclera.Cholestatic liver injury caused by sirolimus was considered.Sirolimus was discontinued and liver-protective therapy and drugs for anti-jaundice were given.On day 6 of drug withdrawal,the laboratory tests showed ALT 58 U/L,AST 116 U/L,γ-GT 84 U/L,ALP 181 U/L,TBA 109.2 μmol/L,TBil 41.5 μmol/L,and DBil 20.8 μmol/L;the child's appetite recovered,yellowish skin and sclera improved markedly.On day 20 of drug withdrawal,the child was discharged.No abnormalities were found in the child's liver function after 15 days of discharge.

A 65-year-old male patient received oral Anweiyang capsules 0. 4 g four times daily for chronic gastritis. About 1 month after the medication,the patient developed intermittent headache, dizziness,and increased blood pressure,whose highest value was 180 / 100 mmHg. Levamlodipine besylate tablets 2. 5 mg once daily was given orally but the patient′s blood pressure was not well controlled. About 4 months later,laboratory tests showed obviously increased free cortisol in urine (2330 nmol/ 24 h),which was considered to be caused by Anweiyang capsules. Anweiyang capsules were stopped and the patient continued to take levamlodipine besylate tablets. On day 4 after the drug withdrawal,the patient′s blood pressure and urinary free cortisol began to decrease,which finally returned to normal on day 9. At 1 month of follow-up,no abnormalities were found on the blood pressure and urinary free cortisol in the patient.