Objective To explore the sex difference in clinical manifestations, echocardiographic features and prognosis of patients with bicuspid aortic valve (BAV) combined with moderate to severe aortic stenosis (AS). Methods The clinical data and echocardiographic follow-up parameters of patients diagnosed with BAV combined with moderate to severe AS at Zhongshan Hospital, Fudan University, from July 30, 2010 to August 1, 2015 were retrospectively collected. The composite endpoint was defined as all-cause mortality or surgical intervention. Kaplan-Meier survival curve and log-rank test were used to compare the risk of composite endpoint events between male and female patients, and Cox regression models were used to analyze independent risk factors for composite endpoint events. Results A total of 144 patients were included, with 69 males and 75 females, and a median age of 60 years. Compared to males, female patients were younger (58[46, 65] years vs 61[54, 67] years, P＝0.046), had a lower proportion of aortic valve calcification (61.1% vs 81.1%, P＝0.009), and a higher peak transvalvular pressure gradient (72[59, 88] mmHg vs 63[55, 72] mmHg, P＝0.002). In terms of left ventricular remodeling types, the proportion of concentric remodeling was higher in females than in males (36.0% vs 15.9%, P＝0.006), while the proportion of eccentric hypertrophy was lower in females than in males (10.7% vs 29.0%, P＝0.006). The proportion of female patients classified as New York Heart Association (NYHA) functional class Ⅲ-Ⅳ was higher than that of males (45.3% vs 17.4%, P＜0.001), and left ventricular ejection fraction was higher in females (68%[65%, 72%] vs 65%[60%, 70%], P＝0.003). With a median follow-up of 49 months, Kaplan-Meier survival analysis showed that the risk of composite endpoint events was higher in females than in males (P＜0.001). Independent risk factors for composite endpoint events included female (HR＝1.74, 95%CI 1.02-2.96, P＝0.042), severe AS (HR＝1.99, 95%CI 1.18-3.36, P＝0.010), and NYHA functional class Ⅲ-Ⅳ (HR＝2.08, 95% CI 1.24-3.47, P＝0.005). Conclusions Sex significantly affects the clinical manifestations, echocardiographic characteristics, and prognosis of patients with BAV combined with moderate to severe AS, suggesting that sex-specific echocardiographic assessment and follow-up monitoring should be conducted for these patients.

Objectives:To analyze the clinical characteristics,strategies,success and complication rates of lead extraction and re-implantation during the upgrade of cardiovascular implantable electronic devices(CIED)in non-infectious patients.Methods:This retrospective study collected and analyzed the baseline clinical data and surgical data of 66 non-infected patients who had their existing CIEDs(including cardiac pacemaker,implantable cardioverter defibrillator[ICD],cardiac resynchronization therapy pacemaker[CRT-P])upgraded to ICD or CRT-P or cardiac resynchronization therapy defibrillator(CRT-D)or subcutaneous implantable cardioverter defibrillator(S-ICD)in Peking University People's Hospital from March 2018 to March 2024.We analyzed the strategies of lead extraction and reimplantation as well as the operation success rate and complication rate.Results:Among the 66 patients,preoperative imaging revealed that 12 patients(18.2%)had severe stenosis/occlusion of the venous access route,with lead wear/perforation in 26 patients(39.4%).32 patients(48.5%)underwent transvenous lead extraction(TLE),of which all leads were removed in 27 patients(84.4%),and only non-functional leads were removed in 5 patients(15.6%).The success rate of the TLE procedure was 100%and no complication occurred.Among the 66 patients,functional leads retained and new leads were implanted on the same side in 28 patients(42.4%),all leads were removed and new leads were reimplanted on the opposite side in 22 patients(33.3%),only non-functional leads were removed and new leads were reimplanted on the same side in 5 patients(7.6%),all leads were removed and new leads were reimplanted on the same side in 5 patients(7.6%),and 6 patients(9.1%)had the leads abandoned and then were re-implanled.The success rate of the upgrade surgery was 100%,no complications were reported.Conclusions:When the existing CIEDs(including cardiac pacemaker,ICD,CRT-P)of non-infected patients are upgraded to ICD,CRT-P,CRT-D or S-ICD,lead extraction and reimplantation are safe and feasible,and reimplantation can be performed on the ipsilateral or contralateral side.

Objectives:To analyze the clinical characteristics,strategies,success and complication rates of lead extraction and re-implantation during the upgrade of cardiovascular implantable electronic devices(CIED)in non-infectious patients.Methods:This retrospective study collected and analyzed the baseline clinical data and surgical data of 66 non-infected patients who had their existing CIEDs(including cardiac pacemaker,implantable cardioverter defibrillator[ICD],cardiac resynchronization therapy pacemaker[CRT-P])upgraded to ICD or CRT-P or cardiac resynchronization therapy defibrillator(CRT-D)or subcutaneous implantable cardioverter defibrillator(S-ICD)in Peking University People's Hospital from March 2018 to March 2024.We analyzed the strategies of lead extraction and reimplantation as well as the operation success rate and complication rate.Results:Among the 66 patients,preoperative imaging revealed that 12 patients(18.2%)had severe stenosis/occlusion of the venous access route,with lead wear/perforation in 26 patients(39.4%).32 patients(48.5%)underwent transvenous lead extraction(TLE),of which all leads were removed in 27 patients(84.4%),and only non-functional leads were removed in 5 patients(15.6%).The success rate of the TLE procedure was 100%and no complication occurred.Among the 66 patients,functional leads retained and new leads were implanted on the same side in 28 patients(42.4%),all leads were removed and new leads were reimplanted on the opposite side in 22 patients(33.3%),only non-functional leads were removed and new leads were reimplanted on the same side in 5 patients(7.6%),all leads were removed and new leads were reimplanted on the same side in 5 patients(7.6%),and 6 patients(9.1%)had the leads abandoned and then were re-implanled.The success rate of the upgrade surgery was 100%,no complications were reported.Conclusions:When the existing CIEDs(including cardiac pacemaker,ICD,CRT-P)of non-infected patients are upgraded to ICD,CRT-P,CRT-D or S-ICD,lead extraction and reimplantation are safe and feasible,and reimplantation can be performed on the ipsilateral or contralateral side.

Objective To design and produce a bleeding alert bandage and investigate its effectiveness in patients undergoing hemodialysis.Methods The bleeding alert bandage consists of elastic bandage,monitoring element and monitoring box.A convenience sampling method was used to select patients who received regular hemodialysis treatment in the blood purification center of a tertiary A comprehensive hospital in Anhui Province from January 2021 to June 2021.These patients were randomly assigned into an experimental group and a control group,with 40 cases in each group.Patients in the control group were inspected every 30 min by traditional method.Patients in the experimental group were monitored in real-time with a bleeding alert bandage in addition to the 30 min rounds.The detection rate,incidence,and volume of bleeding at the puncture site were compared in 2 groups of patients.Results The incidence of bleeding from the puncture sites was 17.00％in the experimental group and 25.25％in the control group,with statistical significance(x2=8.170,P=0.004).The incidence of bleeding for severe bleeding from puncture sites was 1.50％in the experimental group and 11.50％in the control group,with statistical significance(x2=32.910,P＜0.001).The bleeding detection rate from puncture sites was 94.12％in the experimental group and 89.11％in the control group,with no statistical difference(x2=1.261,P=0.262).The detection rate for moderate bleeding from puncture sites was 100％in the experimental group and 85.37％in the control group,with statistical significance(x2=6.170,P=0.013).Additionally,the bleeding volume from the puncture site was 1.29(0.88,1.74)g in the experimental group and 2.77(1.60,4.77)g in the control group,with statistical significance(Z=-5.825,P＜0.001).The moderate bleeding volume from the puncture site was 1.49(1.27,1.81)g in the experimental group and 1.92(1.52,2.44)g in the control group,with statistical significance(Z=-2.835,P=0.005).Conclusion The bleeding alert bandage is effective in real-time monitoring and alerting of bleeding at the puncture sites during hemodialysis,which can help reduce the incidence of blood seepage,improve the detection rate of blood seepage,reduce the amount of bleeding and improve the safety of dialysis treatment.

Objectives:To evaluate the safety and efficacy of implantation of subcutaneous implantable cardioverter defibrillator(S-ICD)after transvenous lead extraction(TLE)in ICD patients without pacing indications. Methods:All patients who underwent TLE at Peking University People's Hospital from June 2018 to October 2023 were consecutively included.TLE indication,S-ICD implantation indication,defibrillation threshold(DFT)test,complications and postoperative follow-up were collected and analyzed. Results:A total of 11 patients with TV-ICD underwent S-ICD implantation after TLE,eight patients were males and median age were 56(44,65)years.The indications for TLE were infection and lead dysfunction.Nine patients were implanted with S-ICD for secondary prevention,and the most common cause of implantation was ion channelopathies(5 cases).The operative time for S-ICD was 51(48,58)minutes and no perioperative complications were noted.Eight patients underwent DFT testing,and 100%were successful.During a median follow up of 30(9,39)months,a total of six appropriate treatments occurred in two patients,and no complications occurred,including inappropriate treatment,ineffective treatment,infection,lead malfunction and death. Conclusions:Our study provides evidence for S-ICD implantation as a replacement after TV-ICD removal.The S-ICD implantation after TLE is safe and effective.

Objective:To understand the status of frailty among elderly inpatients,analyze its influencing factors,and explore the relationship of frailty with sarcopenia,and subjective social isolation in elderly inpatients.Methods:A total of 518 elderly inpatients from a tertiary hospital in Wuhu were selected as the research subjects.General information questionnaire,Frail Scale,SARC-F Scale,and Subjective Social Isolation Scale were used for investigation.Logistic regression analysis was used to analyze the influencing factors of frailty among elderly inpatients.Results:The incidence of frailty in 518 elderly inpatients was 52.5%(272/518).Logistic regression analysis revealed that recent falls(OR=3.458,95%CI:1.454-8.229),sarcopenia(OR=5.622,95%CI:2.494-12.677),subjective social isolation(OR=181.165,95%CI:57.307-572.721),polypharmacy(OR=2.409,95%CI:1.336-4.346),and 80-89 years old(OR=8.982,95%CI:0.640-2.357)were risk factors for frailty in elderly inpatients(P＜0.05).Conclusions:The prevalence of frailty is high among elderly inpatients.Healthcare professionals should pay attention to the assessment of frailty in elderly inpatients,and promptly implement targeted interventions to slow down or prevent the progression of frailty.

Background Schizophrenic patients have metabolic disorders,impaired language and information processing function.Inflammatory factors may play an important role in the occurrence and development of schizophrenia.Objective To explore the relationship of the inflammatory factor levels with metabolic levels,language fluency and information processing function in patients with schizophrenia,so as to provide references for clinical understanding of the neuropathological mechanisms of schizophrenia.Methods A total of 96 patients with schizophrenia were included in the study group,who were hospitalized in the Fourth People's Hospital of Hefei from January 2021 to December 2022 as well as met the diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders,fifth edition(DSM-5)and Mini-International Neuropsychiatric Interview(MINI)6.0.Meanwhile,population who underwent physical examination at the same hospital were included in the control group(n=42).A high-sensitivity multi factor electrochemiluminescence analyzer was used to detect the levels of inflammatory factors IL-4,IL-5,IL-7,IL-8,IL-10 and IL-13.A fully automated biochemical analyzer was used to detect the levels of metabolic indicators such as fasting blood glucose,triglycerides,high-density lipoprotein,apolipoprotein A,creatinine and urea nitrogen.Verbal fluency and information processing function of all participants were assessed by using Verbal Fluency Test(VFT)and Stroop Color Word Test(SCWT).Results There were statistically significant differences in the levels of IL-4,IL-5,IL-7,IL-8,IL-10,IL-13 and IL-15 between the study group and the control group(P<0.05).There were statistically significant differences in BMI,waist circumference,fasting blood glucose,triglycerides,high-density lipoprotein,urea nitrogen,apolipoprotein A and creatinine levels between the two groups(P<0.05).The differences in the correct number of household appliances,animals,fruits,vegetables,names starting with"water"and"self"in VFT between the two groups were statistically significant(P<0.05).The differences in point reaction time,character reaction time and character color reaction time in SCWT between the two groups were statistically significant(P<0.05).Correlation analysis showed that except for creatinine levels,the levels of IL-4 and IL-5 in patients with schizophrenia were correlated with other indicators(P<0.05).IL-7 levels were correlated with creatinine levels,household appliances,animals,fruits,correct number of names starting with"water"in VFT,point reaction time and word reaction time in SCWT(P<0.05).IL-8 levels were correlated with triglyceride levels,household appliances,animals,fruits,vegetables,correct number of names starting with"water"and"self"in VFT and word reaction time in SCWT(P<0.05).Except for creatinine levels and the correct number of names starting with"self",IL-10 levels were correlated with all other indicators(P<0.05).Except for creatinine and urea nitrogen levels,IL-13 levels were correlated with other indicators(P<0.05).Conclusion The levels of inflammatory factors in patients with schizophrenia may be related to their metabolic levels,language fluency and information processing function.

Objectives:To investigate the impact of reassessment and individualized reimplantation strategies on clinical outcomes in patients with cardiovascular implantable electronic device (CIED) infections following transvenous lead extraction (TLE).Methods:Patients who underwent TLE due to CIED infections at Peking University People's Hospital from January 2015 to January 2021 were included.Reimplantation decisions,including whether to reimplant and the type and location of the new device,were made based on patient history,infection type,and cardiac examination results.The reimplantation rate,device type,implantation site,and complications were recorded and analyzed.Results:A total of 993 patients were included in this study,of which 840 cases (84.6％) were pocket infections.Among the removed devices,827 cases (83.3％) were pacemakers.The clinical success rate of TLE was 98.3％ (976 cases),the perioperative mortality rate was 0.9％ (9 cases) .Excluding the perioperative death cases,out of 984 survived patients after reassessment,186 patients (18.9％) had no indication for reimplantation,69 patients (7.0％) refused reimplantation,and 729 patients (74.1％) opted for reimplantation.An individualized reimplantation strategy was developed according to their clinical situation.Devices were implanted in 703 patients (71.4％) on the contralateral side to reduce the risk of reinfection;leadless pacemakers (LP) were implanted in 24 patients (2.4％),and subcutaneous implantable cardioverter-defibrillators (S-ICD) were implanted in 2 patients (0.2％),based on specific indications.The rate of simultaneous reimplantation during TLE was 19.4％ (191/984),primarily among pacemaker-dependent patients with pocket infections.70 patients (7.1％) underwent device upgrade or downgrade.During a mean of (3.9±2.6) years follow-up,the all-cause mortality rate were 8.9％ (88 cases),and the pocket infection rate after reimplantation was 1.5％ (15 cases ) .Conclusions:Individualized reassessment after TLE for CIED infection patients can help optimize reimplantation decision-making and avoid unnecessary reimplantations and associated complications.The choice of reimplantation strategy should be strictly based on the clinical situations.Devices should preferably be re-implanted on the contralateral side to reduce reinfection risk.LP and S-ICD are suitable for patients with specific indications.Simultaneous reimplantation during TLE is feasible for some patients with pocket infections but further studies are required to evaluate the safety of this approach.

Objectives:To investigate the impact of reassessment and individualized reimplantation strategies on clinical outcomes in patients with cardiovascular implantable electronic device (CIED) infections following transvenous lead extraction (TLE).Methods:Patients who underwent TLE due to CIED infections at Peking University People's Hospital from January 2015 to January 2021 were included.Reimplantation decisions,including whether to reimplant and the type and location of the new device,were made based on patient history,infection type,and cardiac examination results.The reimplantation rate,device type,implantation site,and complications were recorded and analyzed.Results:A total of 993 patients were included in this study,of which 840 cases (84.6％) were pocket infections.Among the removed devices,827 cases (83.3％) were pacemakers.The clinical success rate of TLE was 98.3％ (976 cases),the perioperative mortality rate was 0.9％ (9 cases) .Excluding the perioperative death cases,out of 984 survived patients after reassessment,186 patients (18.9％) had no indication for reimplantation,69 patients (7.0％) refused reimplantation,and 729 patients (74.1％) opted for reimplantation.An individualized reimplantation strategy was developed according to their clinical situation.Devices were implanted in 703 patients (71.4％) on the contralateral side to reduce the risk of reinfection;leadless pacemakers (LP) were implanted in 24 patients (2.4％),and subcutaneous implantable cardioverter-defibrillators (S-ICD) were implanted in 2 patients (0.2％),based on specific indications.The rate of simultaneous reimplantation during TLE was 19.4％ (191/984),primarily among pacemaker-dependent patients with pocket infections.70 patients (7.1％) underwent device upgrade or downgrade.During a mean of (3.9±2.6) years follow-up,the all-cause mortality rate were 8.9％ (88 cases),and the pocket infection rate after reimplantation was 1.5％ (15 cases ) .Conclusions:Individualized reassessment after TLE for CIED infection patients can help optimize reimplantation decision-making and avoid unnecessary reimplantations and associated complications.The choice of reimplantation strategy should be strictly based on the clinical situations.Devices should preferably be re-implanted on the contralateral side to reduce reinfection risk.LP and S-ICD are suitable for patients with specific indications.Simultaneous reimplantation during TLE is feasible for some patients with pocket infections but further studies are required to evaluate the safety of this approach.

Objective To design and produce a bleeding alert bandage and investigate its effectiveness in patients undergoing hemodialysis.Methods The bleeding alert bandage consists of elastic bandage,monitoring element and monitoring box.A convenience sampling method was used to select patients who received regular hemodialysis treatment in the blood purification center of a tertiary A comprehensive hospital in Anhui Province from January 2021 to June 2021.These patients were randomly assigned into an experimental group and a control group,with 40 cases in each group.Patients in the control group were inspected every 30 min by traditional method.Patients in the experimental group were monitored in real-time with a bleeding alert bandage in addition to the 30 min rounds.The detection rate,incidence,and volume of bleeding at the puncture site were compared in 2 groups of patients.Results The incidence of bleeding from the puncture sites was 17.00％in the experimental group and 25.25％in the control group,with statistical significance(x2=8.170,P=0.004).The incidence of bleeding for severe bleeding from puncture sites was 1.50％in the experimental group and 11.50％in the control group,with statistical significance(x2=32.910,P＜0.001).The bleeding detection rate from puncture sites was 94.12％in the experimental group and 89.11％in the control group,with no statistical difference(x2=1.261,P=0.262).The detection rate for moderate bleeding from puncture sites was 100％in the experimental group and 85.37％in the control group,with statistical significance(x2=6.170,P=0.013).Additionally,the bleeding volume from the puncture site was 1.29(0.88,1.74)g in the experimental group and 2.77(1.60,4.77)g in the control group,with statistical significance(Z=-5.825,P＜0.001).The moderate bleeding volume from the puncture site was 1.49(1.27,1.81)g in the experimental group and 1.92(1.52,2.44)g in the control group,with statistical significance(Z=-2.835,P=0.005).Conclusion The bleeding alert bandage is effective in real-time monitoring and alerting of bleeding at the puncture sites during hemodialysis,which can help reduce the incidence of blood seepage,improve the detection rate of blood seepage,reduce the amount of bleeding and improve the safety of dialysis treatment.