Objectives:This study aims to establish a calcified aortic valve disease(CAVD)-related gene regulatory network,and clarify the impact of interactions between CAVD-related genes on CAVD.Methods:Differential expression gene method was used to screen candidate genes,and STRING software was used to construct protein-protein interaction networks for screened genes.The networks and genes with the highest scores were obtained.Monte Carlo method was used to rank the importance of genes in CAVD,and the top 1%genes were identified.Genes identified by these two methods are intersected to obtain the key genes.The correlation between the key genes and CAVD were confirmed by biological verification method.Then,key genes were used as query genes to establish CAVD gene regulatory module with a co-expression patterns-based gene regulatory network identifying method.Specifically,we first detected the underlying co-expression patterns of the seemingly uncorrelated genes,and then pieced the isolated gene pairs up into gene regulatory network with the help of the bridging genes.Finally,we verified the function of the established gene regulatory network through enrichment analysis and literature analysis.Results:We identified the CAVD gene regulatory network containing 211 genes from 18 084 candidate genes.Functional enrichment analysis indicate that the established gene regulatory network included genes with both known interactions and potential novel pathway interactions related to CAVD,serving as candidates for further experimental CAVD studies.Conclusions:Methodologically,the proposed method avoids the problem of complex computation,and relies only on available biological priors.It is also able to detect underlying co-expression patterns.The results will advance the understanding of the interactions of the CAVD-related genes and this method provides a novel way to identify underlying gene co-expression patterns in the setting of CAVD.

Objective:This multicenter retrospective study aimed to analyze the clinicopathological features of duodenal adenocarcinoma (DA) and identify prognostic factors for postoperative survival.Methods:Demographic characteristics, clinicopathological features, treatment outcomes and survival of DA patients undergoing surgical treatment at 18 Chinese medical centers from January 2012 to December 2023 were retrospectively analyzed.Results:Among the 2 056 DA patients included, 46.8% (963) had extra-ampullary DA (EA-DA), and 53.2% (1 093) had peri-ampullary DA (PA-DA). The 1-, 3-, and 5-year overall survival (OS) rates for patients who underwent radical surgery were 93.2%, 71.0%, and 57.2%, respectively. The median overall survival was 76 months, and the median progression-free survival (PFS) was 65 months. No differences in survival were observed between the laparotomy group and minimally invasive surgery (MIS) group either before or after propensity score matching (OS: 76 vs. 75 months before PSM, P=0.986; OS: 75 vs. 75 months after PSM, P=0.602). Furthermore, there were no significant differences between-group in operation time and postoperative complications ( P＞0.05). The MIS group experienced less intraoperative blood loss and shorter hospital stays. The multivariate Cox regression analysis revealed that advanced age ( HR=1.43,95% CI:1.18-1.73), elevated carbohydrate antigen 19-9 levels ( HR=1.24,95% CI:1.02-1.51), perineural invasion ( HR=1.44,95% CI:1.14-1.81), vascular invasion ( HR=1.35,95% CI:1.07-1.71), advanced T stage (T3-4 vs. T1-2: HR=1.86,95% CI:1.49-2.31), regional lymph node metastasis ( HR=1.93,95% CI:1.58-2.36), preoperative biliary drainage ( HR=1.26,95% CI:1.04-1.53), intraoperative blood loss ( HR=1.34,95% CI:1.11-1.62), clinically significant postoperative pancreatic fistulas ( HR=1.53,95% CI:1.12-2.09), and postoperative hemorrhage ( HR=1.62,95% CI:1.14-2.29) were independent risk factors for poor prognosis after surgery (all P＜0.05). Conclusions:Radical surgery is associated with favorable overall survival among DA patients, and no difference in survival is observed between EA-DA and PA-DA patients. MIS is a reliable alternative for DA treatment.

Objective:This multicenter retrospective study aimed to analyze the clinicopathological features of duodenal adenocarcinoma (DA) and identify prognostic factors for postoperative survival.Methods:Demographic characteristics, clinicopathological features, treatment outcomes and survival of DA patients undergoing surgical treatment at 18 Chinese medical centers from January 2012 to December 2023 were retrospectively analyzed.Results:Among the 2 056 DA patients included, 46.8% (963) had extra-ampullary DA (EA-DA), and 53.2% (1 093) had peri-ampullary DA (PA-DA). The 1-, 3-, and 5-year overall survival (OS) rates for patients who underwent radical surgery were 93.2%, 71.0%, and 57.2%, respectively. The median overall survival was 76 months, and the median progression-free survival (PFS) was 65 months. No differences in survival were observed between the laparotomy group and minimally invasive surgery (MIS) group either before or after propensity score matching (OS: 76 vs. 75 months before PSM, P=0.986; OS: 75 vs. 75 months after PSM, P=0.602). Furthermore, there were no significant differences between-group in operation time and postoperative complications ( P＞0.05). The MIS group experienced less intraoperative blood loss and shorter hospital stays. The multivariate Cox regression analysis revealed that advanced age ( HR=1.43,95% CI:1.18-1.73), elevated carbohydrate antigen 19-9 levels ( HR=1.24,95% CI:1.02-1.51), perineural invasion ( HR=1.44,95% CI:1.14-1.81), vascular invasion ( HR=1.35,95% CI:1.07-1.71), advanced T stage (T3-4 vs. T1-2: HR=1.86,95% CI:1.49-2.31), regional lymph node metastasis ( HR=1.93,95% CI:1.58-2.36), preoperative biliary drainage ( HR=1.26,95% CI:1.04-1.53), intraoperative blood loss ( HR=1.34,95% CI:1.11-1.62), clinically significant postoperative pancreatic fistulas ( HR=1.53,95% CI:1.12-2.09), and postoperative hemorrhage ( HR=1.62,95% CI:1.14-2.29) were independent risk factors for poor prognosis after surgery (all P＜0.05). Conclusions:Radical surgery is associated with favorable overall survival among DA patients, and no difference in survival is observed between EA-DA and PA-DA patients. MIS is a reliable alternative for DA treatment.

Objective:To compare the efficacy of body posture combined with pharmacotherapy and pharmacotherapy alone in the treatment of chronic subdural hematoma(CSDH).Methods:Firstly, retrospective case series study was conducted. Thirty cases of CSDH that had received body posture combined with pharmacotherapy at Department of Neurosurgery, Huashan Hospital Affiliated to Fudan University from December 2016 to October 2020 were studied retrospectively. Twenty-seven patients were male, and 3 patients were female. The age of patients ( M(IQR)) was 66(16) years (range:28 to 84). Nineteen patients had unilateral hematoma, and 11 patients had bilateral hematoma. All patients received pharmacotherapy and body posture therapy that was to raise their lower limbs 20 to 30 cm with leg lift pad and get abdominal compressed with customized abdominal belt in supine position. Patients were required to maintain the body posture as much as possible, with the maximum to 16 to 18 hours per day. Patients with unilateral hematoma should tilt the head to the affected side and avoid tilting it to the opposite side. For patients with bilateral hematoma, there was no need for head lateralization. Patient were treated with oral dexamethasone and atorvastatin simultaneously. The preliminary efficacy of body posture combined with pharmacotherapy was determined by hematoma improvement rate which was analyzed by Clopper-Pearson method. Then, the multi-center, prospective, randomized controlled trial had carried out in 9 medical centers from August 2020 to November 2021. The stratified block randomization method was adopted. Patients were randomized in a ratio of 1∶1 to either receive pharmacotherapy alone(the control group) or body posture combined with pharmacotherapy(the experiment group) for 3 months and followed up for 6 months. Effective treatment was defined as complete absorption of hematoma, or the hematoma volume decreased by more than 10 ml and Markwalder grading scale score had improved by more than 1 point compared to the baseline. The efficacy rate and surgery conversion rate at 3 months and recurrence at 6 months were observed. Comparison between groups was performed with paired sample t test, Mann-Whitney U test, χ2 test, corrected χ2 test, or Fisher exact probability method. Logistic regression was used to compare the effective rate and operation rate between the two groups. Results:In the respective study, 30 patients completed follow-up 13 to 353 days after treatment. At the last follow-up, the incidence of almost complete absorption or significantly absorption of hematoma (hematoma volume was significantly reduced accompanied by symptom improvement) was 93.3%. The 95% CI for the incidence that analyzed by the Clopper-Pearson method was 77.9% to 99.2%. One hundred and six patients were enrolled in the multicenter study. Fifty-five patients underwent body posture combined with pharmacotherapy. The age was 74(17) years (range:26 to 92). Thirty-nine patients were males and 16 were females. Fifty-one patients underwent pharmacotherapy alone. The age was 69(12) years (range:48 to 84). Thirty-seven patients were males and 14 were females. The length of body posture recorded in diary card was (15.7±2.3) hours(range:7.6 to 19.3 hours). The efficacy rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 83.6% (46/55) and 56.9% (29/51), respectively at 3 months. The result of the logistic regression analysis showed that the efficacy of body posture combined with pharmacotherapy group was better than that of pharmacotherapy alone group ( OR=3.88,95% CI:1.57 to 9.58, P=0.003). Surgery rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 5.5% (3/55) and 21.6% (11/51) respectively. The result of Logistic regression showed that the pharmacotherapy alone group was more likely to be converted to surgery ( OR=0.21,95% CI:0.05 to 0.80, P=0.023). At the 6 months, no recurrence of cases was found in the body posture combined with pharmacotherapy group. However, the recurrence rate of pharmacotherapy alone group was 6.3% (3/48), there was no significant difference between the two groups ( P>0.05). Conclusion:The effect of body posture combined with pharmacotherapy for chronic subdural hematoma is better than that of pharmacotherapy alone.

Objectives:This study aims to establish a calcified aortic valve disease(CAVD)-related gene regulatory network,and clarify the impact of interactions between CAVD-related genes on CAVD.Methods:Differential expression gene method was used to screen candidate genes,and STRING software was used to construct protein-protein interaction networks for screened genes.The networks and genes with the highest scores were obtained.Monte Carlo method was used to rank the importance of genes in CAVD,and the top 1%genes were identified.Genes identified by these two methods are intersected to obtain the key genes.The correlation between the key genes and CAVD were confirmed by biological verification method.Then,key genes were used as query genes to establish CAVD gene regulatory module with a co-expression patterns-based gene regulatory network identifying method.Specifically,we first detected the underlying co-expression patterns of the seemingly uncorrelated genes,and then pieced the isolated gene pairs up into gene regulatory network with the help of the bridging genes.Finally,we verified the function of the established gene regulatory network through enrichment analysis and literature analysis.Results:We identified the CAVD gene regulatory network containing 211 genes from 18 084 candidate genes.Functional enrichment analysis indicate that the established gene regulatory network included genes with both known interactions and potential novel pathway interactions related to CAVD,serving as candidates for further experimental CAVD studies.Conclusions:Methodologically,the proposed method avoids the problem of complex computation,and relies only on available biological priors.It is also able to detect underlying co-expression patterns.The results will advance the understanding of the interactions of the CAVD-related genes and this method provides a novel way to identify underlying gene co-expression patterns in the setting of CAVD.

Objective:To compare the efficacy of body posture combined with pharmacotherapy and pharmacotherapy alone in the treatment of chronic subdural hematoma(CSDH).Methods:Firstly, retrospective case series study was conducted. Thirty cases of CSDH that had received body posture combined with pharmacotherapy at Department of Neurosurgery, Huashan Hospital Affiliated to Fudan University from December 2016 to October 2020 were studied retrospectively. Twenty-seven patients were male, and 3 patients were female. The age of patients ( M(IQR)) was 66(16) years (range:28 to 84). Nineteen patients had unilateral hematoma, and 11 patients had bilateral hematoma. All patients received pharmacotherapy and body posture therapy that was to raise their lower limbs 20 to 30 cm with leg lift pad and get abdominal compressed with customized abdominal belt in supine position. Patients were required to maintain the body posture as much as possible, with the maximum to 16 to 18 hours per day. Patients with unilateral hematoma should tilt the head to the affected side and avoid tilting it to the opposite side. For patients with bilateral hematoma, there was no need for head lateralization. Patient were treated with oral dexamethasone and atorvastatin simultaneously. The preliminary efficacy of body posture combined with pharmacotherapy was determined by hematoma improvement rate which was analyzed by Clopper-Pearson method. Then, the multi-center, prospective, randomized controlled trial had carried out in 9 medical centers from August 2020 to November 2021. The stratified block randomization method was adopted. Patients were randomized in a ratio of 1∶1 to either receive pharmacotherapy alone(the control group) or body posture combined with pharmacotherapy(the experiment group) for 3 months and followed up for 6 months. Effective treatment was defined as complete absorption of hematoma, or the hematoma volume decreased by more than 10 ml and Markwalder grading scale score had improved by more than 1 point compared to the baseline. The efficacy rate and surgery conversion rate at 3 months and recurrence at 6 months were observed. Comparison between groups was performed with paired sample t test, Mann-Whitney U test, χ2 test, corrected χ2 test, or Fisher exact probability method. Logistic regression was used to compare the effective rate and operation rate between the two groups. Results:In the respective study, 30 patients completed follow-up 13 to 353 days after treatment. At the last follow-up, the incidence of almost complete absorption or significantly absorption of hematoma (hematoma volume was significantly reduced accompanied by symptom improvement) was 93.3%. The 95% CI for the incidence that analyzed by the Clopper-Pearson method was 77.9% to 99.2%. One hundred and six patients were enrolled in the multicenter study. Fifty-five patients underwent body posture combined with pharmacotherapy. The age was 74(17) years (range:26 to 92). Thirty-nine patients were males and 16 were females. Fifty-one patients underwent pharmacotherapy alone. The age was 69(12) years (range:48 to 84). Thirty-seven patients were males and 14 were females. The length of body posture recorded in diary card was (15.7±2.3) hours(range:7.6 to 19.3 hours). The efficacy rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 83.6% (46/55) and 56.9% (29/51), respectively at 3 months. The result of the logistic regression analysis showed that the efficacy of body posture combined with pharmacotherapy group was better than that of pharmacotherapy alone group ( OR=3.88,95% CI:1.57 to 9.58, P=0.003). Surgery rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 5.5% (3/55) and 21.6% (11/51) respectively. The result of Logistic regression showed that the pharmacotherapy alone group was more likely to be converted to surgery ( OR=0.21,95% CI:0.05 to 0.80, P=0.023). At the 6 months, no recurrence of cases was found in the body posture combined with pharmacotherapy group. However, the recurrence rate of pharmacotherapy alone group was 6.3% (3/48), there was no significant difference between the two groups ( P>0.05). Conclusion:The effect of body posture combined with pharmacotherapy for chronic subdural hematoma is better than that of pharmacotherapy alone.

Objective:To analyze the research status and research hotspots of Taohe Chengqi Decoction.Methods:Research literature about Taohe Chengqi Decoction was retrieved from CNKI, VIP, Wanfang Data, Wanfang medonline, SinoMed from the establishment of the database to May 1, 2023, included peach pit gas soup research literature. NoteExpress 3.7.0.9258 software was used to organize the title list, and CiteSpace 6.2.R2 was used for visualization analysis on the author, research institution and key words.Results:A total of 957 articles were included. The journal with the most publications was New Traditional Chinese Medicine (35 articles). The main treatment diseases were diabetes, thoracolumbar fractures, constipation and other diseases. Authors with more publications were Xiong Manqi (19 articles), Li Saimei (18 articles), Wang Jun (15 articles), Zhu Zhangzhi (12 articles); The institutions with more publications were Guangzhou University of Chinese Medicine, the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Beijing University of Chinese Medicine, etc. The research mainly focused on the clinical application of TCM, animal experiments and other fields. Conclusions:The number of research literature about Taohe Chengqi Decoction is on the rise, and the treatment of diabetes attracts more attention. The research hotspot is the emerging technology in studying mechanism of Taohe Chengqi Decoction.

Objective: To explore the acute effect of air pollution on mortality for patients with cardio cerebral vascular disease and to provide the basis for disease prevention and control.
Methods: The Mortality for patients with cardio cerebral vascular disease from 2001-01 to 2009-12 was from Tianjin Centers for Disease Control and Prevention, the meteorological and air pollution data were from Tianjin meteorological bureau and Tianjin environmental monitoring station respectively. The Single and multiple generalized additive model (GAM) extended poisson regression analysis was performed to calculate the relationship between air pollution and cardio-cerebral vascular disease mortality by controlling the time trends, weather, the day of week and air population.
Results: Results: Single GAM analysis indicated that when the effect of SO2, NO2 and PM10 in the air reached the maximum in the day, the RR values for the mortality in patients with cardio-cerebral vascular disease increased 1.13%[95%CI (0.76-1.51)%], 0.78% [95%CI ( 0.41-1.15)%] and 0.61% [95%CI ( 0.51-0.71)%] respectively; when the average concentration of SO2, NO2 and PM10 increasing 10μg/m3 per day, after 0-5 days, the RR values for the mortality elevated 0.70% [95%CI (0.47-0.94)%], 0.51% [95%CI (0.27-0.74)%] and 0.16% [95%CI (0.06-0.27)%] respectively. Multiple GAM analysis presented that when SO2, NO2 and PM10 increasing 10 μg/m3 per day, the RR values for the mortality elevated 0.77% [95%CI (0.58-0.97)%], 0.41% [95%CI (0.05-0.78) %] and 0.38% [95%CI (0.12-0.64%)%] respectively.
Conclusion: The air pollution could increase the mortality risk in patients with cardio-cerebral vascular disease, it is necessary to establish the prevention system in order to decrease the mortality risk in those patients.