Objective To explore the effects of home-based exercise rehabilitation on cardiac structure, valvular function, and exercise capacity in patients with severe aortic stenosis (AS) after transcatheter aortic valve replacement (TAVR). Methods 49 patients with severe AS who underwent TAVR at Zhongshan Hospital, Fudan University, from January 2024 to February 2025 were enrolled. They were divided into an exercise group (n＝25) or a non-exercise group (n＝24) based on participating or not in home-based rehabilitation after TAVR. The exercise group received 12 weeks of home-based exercise training (aerobic exercise plus resistance training every week); the non-exercise group received routine care. Transthoracic echocardiography (TTE) was used to assess cardiac structural parameters before discharge (T0) and after 12 weeks of exercise (T1). Functional outcomes including the 6-minute walk test (6MWT), Duke Activity Status Index (DASI), and Short Physical Performance Battery (SPPB) were compared between the two groups. A linear mixed-effects model was used to analyze the effect of home-based rehabilitation on echocardiographic parameters. Patients were stratified by baseline 6MWT (＜240 m as low-function subgroup, ≥240 m as high-function subgroup) to compare exercise-related outcomes between subgroups. Results At T1, the exercise group had a longer 6MWT distance than the non-exercise group (P＝0.012). The linear mixed-effects model showed that after 12 weeks of exercise, the left ventricular end-diastolic diameter (LVEDD) decreased in the exercise group but slightly increased in the non-exercise group, with a significant difference in changes over time between the two groups (P_interaction＝0.030). The exercise group also showed greater improvement in effective orifice area index (P_interaction＝0.028) and effective orifice area (P_interaction＝0.042) than the non-exercise group. Subgroup analysis revealed that in the low-function subgroup, the exercise group showed greater improvement in the 6MWT (P_interaction＝0.035) and the effective orifice area index (P_interaction＝0.046) compared to the non-exercise group; in the high-function subgroup, the exercise group showed greater improvement only in LVEDD compared to the non-exercise group (P_interaction＝0.046). Conclusions Home-based exercise rehabilitation improves exercise capacity, optimizes left ventricular remodeling, and enhances valvular function in patients with severe AS after TAVR, with greater benefits observed in patients with lower baseline 6MWT.

Objective:To explore the characteristics and typology of self-care behavior among patients with chronic heart failure (CHF), and analyze their influencing factors.Methods:A cross-sectional study was used. A total of 318 patients with CHF who were hospitalized in the Heart Center of Zhongshan Hospital, Fudan University from November 2022 to July 2023 were selected by continuous enrollment method. The General Information Questionnaire, Heart Failure Self-care Index Scale, Brief Illness Perception Questionnaire, Self-efficacy for Managing Chronic Disease 6-item Scale, Perceived Social Support Scale, Atlanta Heart Failure Knowledge Test-V2 and Self-Care Confidence Scale were used to investigate. Latent profile analysis was utilized to delineate the characteristics and subtypes of self-care behaviors in CHF patients and examine the influencing factors.Results:A total of 291 patients were included in this study, including 190 males and 101 females, aged 67 (61, 74) years old. The analysis identified three latent categories of self-care behaviors among CHF patients: 26 cases in high self-care group, 131 cases in moderate self-care with deficiencies in maintenance and symptom perception group, and 134 cases in low self-care group.Ordered multicategorical Logistic regression analysis revealed that age ( OR=1.023, 95% CI 1.001-1.046, P<0.05), self-care confidence ( OR=0.859, 95% CI 0.817-0.904, P<0.01), and social support ( OR=0.966, 95% CI 0.940-0.993, P<0.05) were the factors influencing the potential categories of self-care behavior in CHF patients. Conclusions:The study identifies distinct categorical characteristics of self-care behaviors in patients with CHF. Healthcare professionals can leverage these findings to identify the self-care behavior characteristics and influencing factors for each patient category at an early stage, thereby providing personalized and precise support strategies to help patients enhance self-care behaviors.

It is a significant challenge to improve the blood-brain barrier (BBB) permeability of central nervous system (CNS) drugs in their development. Compared with traditional pharmacokinetic property tests, machine learning techniques have been proven to effectively and cost-effectively predict the BBB permeability of CNS drugs. In this study, we introduce a high-performance BBB permeability prediction model named balanced-stacking-learning based BBB permeability predictor(BSL-B3PP). Firstly, we screen out the feature set that has a strong influence on BBB permeability from the perspective of medicinal chemistry background and machine learning respectively, and summarize the BBB positive(BBB+) quantification intervals. Then, a combination of resampling algorithms and stacking learning(SL) algorithm is used for predicting the BBB permeability of CNS drugs. The BSL-B3PP model is constructed based on a large-scale BBB database (B3DB). Experimental validation shows an area under curve (AUC) of 97.8% and a Matthews correlation coefficient (MCC) of 85.5%. This model demonstrates promising BBB permeability prediction capability, particularly for drugs that cannot penetrate the BBB, which helps reduce CNS drug development costs and accelerate the CNS drug development process.
Blood-Brain Barrier ; Algorithms ; Area Under Curve ; Databases, Factual ; Permeability

Objective:To introduce the early results of total aortic arch replacement (TAA) without cardiopulmonary bypass (CPB) and without interruption of cerebral blood supply, using the technique of arch branches preferential reconstruction and whole brain perfusion for brain protection.Methods:Between June 2020 and March 2021, a total of 9 Stanford type A aortic dissection patients we performed total arch replacement by using the technique of arch branches preferential reconstruction and whole brain perfusion without cardiopulmonary bypass and without interruption of blood supply to the brain. The method of this reconstruction technique is as follows: A 24F aortic cannula was inserted into the true lumen at the root of the transverse innominate artery (IA) to connect one end of the artery for cardiopulmonary bypass. The access was connected to 14F artery via Y-connector and inserted into IA cavity to maintain blood supply to brain. Without cardiopulmonary bypass, the 10 mm branch of the four branch artificial blood vessel was anastomosed with the innominate artery IA. The perfusion collateral was connected to the second end of the artery of CPB (single pump and double tubes) to continue to supply blood for IA. The left common carotid artery (LCA) and left subclavian artery (LSCA) were reconstructed by the same method. When IA and LCA were anastomosed, the distal blood supply was not interrupted. After the three branches of the aortic arch were anastomosed, we started to turn the machine, then cooled down and blocked the ascending aorta to further complete the operation of the aortic root and arch. During the period of lower body circulatory arrest, the whole brain was perfused with low flow.Results:No intraoperative death or perioperative complications occurred in all patients, and they were discharged smoothly. The cardiopulmonary bypass time was (192.4±58.1) min, the aortic clamping time was (128.3±52.4) min, the lower body circulatory arrest time was (29.1±1.3) min, and the postoperative awake time was (8.2±3.7) h.Conclusion:Off-pump arch branches preferential reconstruction can provide physiological whole brain perfusion, shorten the cardiopulmonary bypass time and aortic occlusion time, and the operation is safe and effective.

With the development of laser technology, the applications of laser in the pulp diseases become more and more popular, especially in the treatment of root canals、pulp capping or pulpotomy, removal of filling materials or broken files, pulp analgesia and dental pulp devitalization. Laser as a means of adjuvant therapy can effectively improve the treatment result, and get a more stable prognosis in a long term. This article made a review on the effect of laser in the treatment of pulp diseases.

Objective To establish a regression model for predicting the resistance rate of Acinetobacter baumannii (Ab) to anti-bacterial agents.Methods The monitoring data of resistance rate of 1 249 Ab strains to 10 frequently used anti-bacterial agents and drug consumption data [the main indicators for the frequency of medication (DDDs) and antimicrobial use intensity (AUD)] of these agents from January 2014 to December 2016 in the First Affiliated Hospital of Sun Yat-sen University were collected.Pearson correlation analysis was performed to analyze the correlation between Ab resistance and AUD.A linear regression model was established for the anti-bacterial agents with correlation between drug resistance and AUD.Then the regression model was used to predict the resistance rate of Ab in January 2017 and February 2017.Results During the 3 years from 2014 to 2016, the resistance rate of Ab to tigecycline was the lowest (<7% for the 3 years), the resistance rate of Ab to ciprofloxacin was the highest (the average resistance rate was 82.1% for 3 years), there were 3 kinds of drugs whose average resistance rates were <70% and 7 kinds of drugs whose average resistance rates were >70% during the 3 years.The AUD of cefoperazone sodium sulbactam sodium, levofloxacin, tigecycline, panipenem/betamipron, and cefepime were increased.Pearson correlation analysis showed that the resistance rates of Ab to cefoperazone sodium sulbactam sodium and levofloxacin were correlated with their AUD (r=0.681, P=0.015;r=0.694, P=0.012).The data related to Ab resistance rates and AUD of cefoperazone sodium sulbactam sodium and levofloxacin were brought into the one variable linear regression equation.The variance analysis showed that the 2 regression equations fitted well(F=8.634, P=0.015;F=9.285, P=0.012).The AUD of cefoperazone sodium sulbactam sodium and levofloxacin in January and February, 2017 were respectively brought into the regression equation and the resistance rates of Ab were predicted.The results showed that the actual resistance rates were evenly distributed around the predictive values and within 95% of the predicted range.Conclusion In our hospital, AUD of cefoperazone sodium sulbactam sodium and levofloxacin were related to resistance rates of Ab and the linear regression model could predict the resistance rate of Ab by AUD.

Objective To establish a regression model for predicting the resistance rate of Acinetobacter baumannii (Ab) to anti-bacterial agents.Methods The monitoring data of resistance rate of 1 249 Ab strains to 10 frequently used anti-bacterial agents and drug consumption data [the main indicators for the frequency of medication (DDDs) and antimicrobial use intensity (AUD)] of these agents from January 2014 to December 2016 in the First Affiliated Hospital of Sun Yat-sen University were collected.Pearson correlation analysis was performed to analyze the correlation between Ab resistance and AUD.A linear regression model was established for the anti-bacterial agents with correlation between drug resistance and AUD.Then the regression model was used to predict the resistance rate of Ab in January 2017 and February 2017.Results During the 3 years from 2014 to 2016, the resistance rate of Ab to tigecycline was the lowest (<7% for the 3 years), the resistance rate of Ab to ciprofloxacin was the highest (the average resistance rate was 82.1% for 3 years), there were 3 kinds of drugs whose average resistance rates were <70% and 7 kinds of drugs whose average resistance rates were >70% during the 3 years.The AUD of cefoperazone sodium sulbactam sodium, levofloxacin, tigecycline, panipenem/betamipron, and cefepime were increased.Pearson correlation analysis showed that the resistance rates of Ab to cefoperazone sodium sulbactam sodium and levofloxacin were correlated with their AUD (r=0.681, P=0.015;r=0.694, P=0.012).The data related to Ab resistance rates and AUD of cefoperazone sodium sulbactam sodium and levofloxacin were brought into the one variable linear regression equation.The variance analysis showed that the 2 regression equations fitted well(F=8.634, P=0.015;F=9.285, P=0.012).The AUD of cefoperazone sodium sulbactam sodium and levofloxacin in January and February, 2017 were respectively brought into the regression equation and the resistance rates of Ab were predicted.The results showed that the actual resistance rates were evenly distributed around the predictive values and within 95% of the predicted range.Conclusion In our hospital, AUD of cefoperazone sodium sulbactam sodium and levofloxacin were related to resistance rates of Ab and the linear regression model could predict the resistance rate of Ab by AUD.

OBJECTIVETo analysis the influence of surgical revascularization on different timing after ST-elevation myocardial infarction (STEMI) on patients with coronary artery disease and left ventricular dysfunction.

METHODSClinical data of 225 patients admitted from January 2003 to July 2012 with history of STEMI and left ventricular dysfunction (ejection faraction<50%) who underwent isolated coronary artery bypass grafting was retrospectively reviewed. There were 186 male and 39 female patients. According to the timing of surgical revascularization after STEMI, the patients were divided into early revascularization group (ER group, <21 days), mid-term revascularization group (MR group, 21 to 90 days) and late revascularization group (LR group, >90 days). There were 20 male and 9 female patients in ER group with mean age of (63 ± 10) years, 48 male and 16 female in MR group with mean age of (63 ± 8) years, 118 male and 14 female in LR group with mean age of (62 ± 10) years, respectively. Thirty-day post-operative mortality and major complications were determined as the endpoints to evaluate the early results of operation.

RESULTSThe 30-day post-operative mortality were 3.4%,0 and 2.3% among three groups respectively and there was no statistic difference between groups (χ(2) = 2.137, P = 0.330).Low cardiac output syndrome mortality were 13.8%, 3.1% and 2.3% among three groups respectively and there was statistic difference between groups (χ(2) = 8.344, P = 0.015). The ejection fractions was significantly improved in all the three groups from 42% ± 6%, 41% ± 6% and 42% ± 6% preoperatively to 46% ± 7%, 45% ± 10% and 45% ± 9% postoperatively (t = -3.378 to -2.339, all P < 0.05). The left ventricular end diastolic dimension were significantly reduced in MR group and LR group from (54 ± 6) mm and (55 ± 6) mm preoperatively to (47 ± 8) mm and (49 ± 9) mm postoperatively (t = 5.634, 5.885; P = 0.000). There was no significant change in ER group pre- and postoperatively ((51 ± 6) mm vs.(49 ± 7) mm, t = 1.524, P = 0.133).

CONCLUSIONSThe patients with coronary artery disease and left ventricular dysfunction can benefit from surgical revascularization on different timing after STEMI, presenting as the reverse of left ventricle remodeling and the improvement of left ventricle function. The short-term results are mainly determined by the patients' condition, surgical technique and the level of perioperative management.It is recommended for this patient cohort to accept surgical revascularization three weeks after STEMI.

Aged ; Cardiovascular Diseases ; Coronary Artery Bypass ; Coronary Artery Disease ; surgery ; Coronary Disease ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; surgery ; Myocardial Ischemia ; Retrospective Studies ; Time Factors ; Ventricular Dysfunction, Left ; Ventricular Function, Left

Objective To evaluate physiologic ability and surgical stress (E-PASS) for predicting postoperative complications in patients undergoing elective colonic surgery. Methods The clinical data of 158 patients with colonic cancer who were admitted to the West China Hospital from August to October, 2009 were retrospectively analyzed. E-PASS was applied to evaluate the surgical risk. Three indexes of the E-PASS system,including preoperative risk score (PRS), surgical stress score (SSS) and comprehensive risk score (CRS) were compared with actual postoperative outcomes. Correlation between PRS, SSS, CRS and postoperative risks was analyzed using multiple linear regression analysis. Results Of the 158 patients, 27( 17.1% ) had postoperative complications, and the predictive value was 19.4% ± 2.0% according to the E-PASS. Dukes stages, physical performance indexes, severe heart disease, severe pneumonia disease, length of operation time were correlated with the incidence of complications (r = 0. 193, 0. 410, 0. 183, 0. 174, 0. 198, P ＜ 0.05). PRS, CRS and SSS had good predictive effect on postoperative risks (r = 0. 299, 0. 349, 0. 183, P ＜ 0. 05 ). Conclusions E-PASS system is a relatively simple, fast and user friendly tool for predicting the risk of short-term postoperative complications.

Objective To observe the effect of early rehabilitation treatment at different time point on the motor function and activity of daily living (ADL) and emotion in acute stroke patients. Methods 120 patients with acute stroke were randomly assigned to three reha-bilitation groups and one control group according to the disease course (3 days, 5 days, 8 days when the disease is steady). Each group con-sisted of 30 eases. The patients in each group were treated with the regular medication therapy, rehabilitation groups were treated with com-prehensive rehabilitation treatment including Bobath technique therapy. Neurological deficit, motor function, balance function, ADL, emo-tion of all the patients were assessed before and 21 days after rehabilitation intervention. Results After treatment, the motor function, bal-ance function, ADL and emotion of each rehabilitation group were improved. The patients'rehabilitation scores in FMA, Fugl-Meyer balance function, MBI and HRSD got much better than that in control group. The difference was statistic significant. The effect of rehabilitation treat-ment did not show difference among rehabilitation groups. Conclusion Early rehabilitation treatment for acute stroke does benefit for stroke patients. Effect does not show vary with the start time of rehabilitation treatment within 8 days after acute stroke.