Atrial functional mitral regurgitation (AFMR) is mitral regurgitation in patients with atrial fibrillation (AF), whose left atrium (LA) is enlarged, the left ventricle is not enlarged or only slightly enlarged, the left ventricular ejection fraction is preserved, and the mitral valve itself has no apparent lesion. At present, the etiology, pathophysiology and mechanism of this disease have not been completely clear yet. Existing studies have found that the causes of AFMR mainly include AF, enlargement of LA and mitral annulus, destruction of mitral annular shape, inability of mitral valve remodeling to compensate for mitral annular expansion, and hamstringing of the posterior mitral leaflet by atriogenic tethering. AFMR is demonstrated to be associated with an increased risk of mortality and readmission due to heart failure. Therefore, it serves as a primary therapeutic target for patients with heart failure and AF. However, the optimal treatment of AFMR still remains controversial. Therefore, this article will mainly expound the current definition, etiology, pathophysiological mechanism, treatment, and prognosis of AFMR.

Objective To evaluate the effect of structured therapy and education based on personal strength on ischemic stroke. Methods From March,2021 to September,2023,a total of 114 patients with ischemic stroke from the First People's Hos-pital of Kunshan were randomly divided into control group(n=57)and experimental group(n=57).The control group received routine medicine,rehabilitation training and standard health education,while the experimental group received routine medicine,rehabilitation training and structured therapy and education based on personal strength,for six weeks.They were compared with the scores of modified Rankin Scale(mRS),motor-evoked po-tential(MEP)latency and amplitude,modified Barthel Index and Self-Recovery Efficacy Scale score and recur-rence within three months after the start of the study.The scores of Morisky Medication Adherence Scale(MMAS)and Five Facet Mindfulness Questionaire(FFMQ)were also compared. Results After treatment,the score of mRS(t=5.002),MEP latency period(t=9.739)and amplitude(t=4.394),modi-fied Barthel Index(t=11.261),the score of Self-Recovery Efficacy Scale(Z=-2.638),and the scores of MMAS(t=19.521)and FFMQ(t=15.381)were better in the experimental group than in the control group(P<0.05). Conclusion Structured therapy and education based on personal strength could faciliate to improve the recovery and self-management of ischemic stroke patients.

Background and purpose:Amplification of the urokinase plasminogen activator receptor(uPAR)gene is closely associated with poor prognosis in pancreatic cancer patients.uPAR regulates epithelial-mesenchymal transition(EMT)and chemoresistance in pancreatic cancer cells through the mitogen-activated protein kinases(MAPK)signaling pathway,though the specific mechanisms remain unclear.This study aimed to investigate the mechanism by which uPAR promotes proliferation,invasion,and chemoresistance of pancreatic cancer cells by inhibiting autophagy.Methods:Pancreatic cancer tissue samples were collected from patients who underwent surgical resection and biopsy at the Changsha Central Hospital,Affiliated to University of South China(Changsha Central Hospital),between December 2021 and Jun 2022.The study was approved by the Ethics Committee of Changsha Central Hospital(Approval No.:2021-S0182,2022-S0084).Patient-derived organoids(PDOs)from pancreatic cancer samples were cultured in vitro.Six pancreatic cancer cell lines(AsPC-1,PANC-1,CAPAN-1,CAPAN-2,MIA PaCa-2 and PaTu8988T)were used in this study.uPAR-deficient models were constructed using clustered regularly interspaced short palindromic repeats(CRISPR)Cas9 technology.Cell proliferation and invasion abilities were measured using confocal microscopy,Western blot,enzyme-linked immunosorbent assay(ELISA),and MTS assays.Changes in MAPK and autophagy signaling pathways and gemcitabine-induced cell death were analyzed.The synergistic effects of combined treatments were evaluated using gene silencing(siRNA)or autophagy inhibitors.Results:In AsPC-1 cells,uPAR knockout significantly reduced the proliferation and migration abilities of clone cells compared to wild-type cells,as shown by MTS assays and wound healing experiments,and decreased sensitivity to gemcitabine(P＜0.05).Re-expression of uPAR restored the proliferation and invasion abilities of clone cells and partially restored sensitivity to gemcitabine(P＜0.05).Confocal microscopy revealed reduced F-actin and a rounded morphology in clone cells.Western blot analysis showed increased expressions of E-cadherin and Slug,decreased expression of vimentin,and increased expressions of phospho-focal adhesion kinase(p-FAK),p-p38MAPK,and the microtubule-associated protein light chain 3B(LC3B)in clone cells compared to wild-type cells.siRNA results indicated that silencing FAK or p38MAPK or combining autophagy inhibition could resensitize clone cells to gemcitabine(P＜0.05),with p38MAPK silencing reducing LC3B expression.Organoid studies showed varying responses to gemcitabine among 8 organoids,all expressing uPAR.uPAR expression levels were negatively correlated with gemcitabine IC50(r2=0.66,P＜0.05).Three organoids responded well to the combination of gemcitabine and autophagy inhibitors(P＜0.05).Conclusion:uPAR promotes pancreatic cancer cell activity through the p38MAPK signaling pathway,preventing FAK-mediated resistance and cell dormancy.The study suggests that pancreatic cancer patients with high uPAR expression respond better to gemcitabine,while tumors with low uPAR and high p38MAPK expressions may benefit from combined treatment with autophagy inhibitors and cytotoxic chemotherapy.

Objective To investigate the clinical value of postoperative platelet-to-neutrophil ratio(PNR)in predicting the prognosis of patients with acute anterior circulation cardiogenic large-vessel occlusion stroke after receiving endovascular treatment.Methods A total of 95 patients with acute anterior circulation cardiogenic large-vessel occlusion stroke,who were admitted to the Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University of China from January 2019 to January 2022,were enrolled in this study.Venous blood sampling was performed at admission and within 24 hours after thrombectomy,and the PNR,platelet-white blood cell ratio(PWR),platelet-lymphocyte ratio(PLR),and neutrophil-lymphocyte ratio(NLR)were calculated.According to the modified Rankin Scale score at 90 days(mRS-90),the patients were divided into good prognosis group(mRS-90 ≤2 points,n=45)and poor prognosis group(mRS-90 3-6 points,n=50).The clinical data were compared between the two groups.Multivariate logistic regression analysis was used to analyze the predictors of 90-d good prognosis.The area under the receiver operating characteristic curve(AUC)was used to compare the efficacy of PWR,PNR,and NLR in predicting good prognosis.Results Compared with poor prognosis group,in good prognosis group the patients were younger,the NIHSS score at admission was smaller,the incidence of postoperative contrast extravasation was lower,the postoperative 24-hour PWR and PNR values were higher,and the postoperative 24-hour NLR value was lower,the differences in the above indexes between the two groups were statistically significant(all P＜0.05).Multivariate analysis showed that bridging therapy(OR=4.746,P=0.021,95％CI:1.262-17.856),postoperative contrast medium extravasation(OR=0.254,P=0.022,95％CI:0.079-0.824)and postoperative 24-h PNR(OR=1.087,P=0.006,95％CI:1.025-1.153)were the independent predictors for 90-d good prognosis in patients with acute anterior circulation cardiogenic large-vessel occlusion stroke after receiving endovascular treatment.AUCs of postoperative 24-h PWR,PNR and NLR for predicting a good prognosis after thrombectomy were 0.734,0.736 and 0.704 respectively.PNR had the highest predictive efficacy,with a cutoff value of 25.08,a specificity of 84.00％,and a sensitivity of 67.78％.Conclusion In patients with acute anterior circulation cardiogenic large-vessel occlusion stroke after receiving endovascular treatment,a better clinical prognosis can be expected when the patient has a higher postoperative 24-h PNR value.

Objective To explore the feasibility of integrated imaging of portal vein and hepatic vein with"three low-contrast agents"combined with energy spectrum CT technology.Methods A total of 100 patients with enhanced abdominal CT scans were selected.The patients were randomly divided into two groups.The patients of experimental group(n=50)were injected with the isotonic con-trast agent iodixanol(320 mg I/mL)at a flow rate of 3 mL/s and a total volume of 1.2 mL/kg,and underwent energy spectrum CT scan in the portal venous phase.The patients of control group(n=50)were injected with the sub-hypertonic contrast agent iohexol(350 mg I/mL)at a flow rate of 5 mL/s and a total volume of 1.5 mL/kg,and underwent conventional multi-phase spiral CT enhancement scan.The image quality and radiation dose of portal vein and hepatic vein were compared between the two groups.Results The CT value of main portal vein in the experimental group was higher than that in the control group,and the difference was statistically sig-nificant(P＜0.05).There was no statistical significance in main portal vein contrast-to-noise ratio(CNR),main portal vein signal-to-noise ratio(SNR),hepatic vein CT value,and hepatic vein CNR between the two groups(P＞0.05).The SNR and image standard deviation(SD)of the hepatic vein in the control group were better than those in the experimental group(P＜0.05).There was no statistical significance in the subjective scores of portal vein and hepatic vein between the two groups(P＞0.05).The volume CT dose index(CTDIvol),dose length product(DLP),and effective dose(ED)of the portal venous phase spectrum CT scan in the experimental group were lower than those of the conventional single-phase spiral CT scan in the control group(P＜0.05).Conclusion"Three low-contrast agents"combined with energy spectrum CT technology can realize integrated imaging of portal vein and hepatic vein in late portal vein,and can reduce radiation dose.

Objective To investigate the application value of point-of-care lung ultrasound (POC-LUS) scoring in selecting respiratory support treatment modalities for neonatal infectious pneumonia (NIP). Methods A total of 89 NIP patients were selected as the study subjects and divided into control group (no assisted ventilation) with 46 cases, noninvasive group (noninvasive assisted ventilation) with 28 cases, and invasive group (invasive mechanical ventilation) with 15 cases based on the degree of dyspnea and blood gas analysis results. The POC-LUS scores of the three groups were compared, and the correlations of POC-LUS scores with arterial oxygen partial pressure [p_a(O₂)] and arterial carbon dioxide partial pressure [p_a(CO₂)] were analyzed. Receiver operating characteristic (ROC) curves were plotted to assess the predictive efficacy of POC-LUS scores for the need for noninvasive assisted ventilation or invasive mechanical ventilation in NIP patients. Results The POC-LUS scores of the noninvasive group and the invasive group were (31.7±7.3) and (42.1±8.0), respectively, which were higher than (21.5±7.3) of the control group. Additionally, the score of the invasive group was higher than that of the noninvasive group (P < 0.05). Correlation analysis revealed a significant negative correlation between POC-LUS scores and p_a(O₂) (r=-0.802, P < 0.05), and a significant positive correlation with p_a(CO₂) (r=0.807, P < 0.05). ROC curve analysis showed that the area under the curve (AUC) of POC-LUS scores for predicting the need for noninvasive assisted ventilation and invasive mechanical ventilation were 0.918 (95%CI, 0.862 to 0.973) and 0.938 (95%CI, 0.889 to 0.987), respectively. The sensitivity was 0.767 and 0.933, and the specificity was 0.935 and 0.824, with optimal cutoff values of 29.5 and 31.5, respectively. Conclusion POC-LUS scoring can quantitatively assess the severity of lung lesions in NIP patients and serves as a guiding tool for clinicians in selecting assisted ventilation treatment modalities.

Objective To investigate the therapeutic effect of self-made Bitong Ointment combined with umbilical dressing of traditional Chinese medicine in the treatment of children with pediatric allergic rhinitis differentiated as type of latent heat in the lung meridian. Methods Eighty children with allergic rhinitis differentiated as type of latent heat in the lung meridian were randomly divided into observation group and control group, with 40 cases in each group. The control group was treated with loratadine, while the observation group was additionally treated with self-made Bitong Ointment and umbilical dressing of traditional Chinese medicine. After 4 weeks of treatment, the clinical effect, TCM syndrome score, airway stress response, inflammatory factors, and therapeutic safety were evaluated. Results The total effective rate in the observation group was 95.00% (38/40), which was higher than 77.50% (31/40) in the control group. After treatment, the scores of main TCM syndromes such as frequent sneezing, clear and thin nasal discharge, decreased sense of smell, shortness of breath, and reluctance to speak in the observation group were lower than those in the control group. After treatment, the levels of indicators of airway stress response such as exhaled nitric oxide (FeNO), lipid peroxide (LHP) and inducible nitric oxide synthase (iNOS) in the observation group were lower than those in the control group. After treatment, the levels of inflammatory factors such as monocyte chemoattractant protein-4 (MCP-4), cysteinyl leukotriene receptor 1 (CysLTR1), and interleukin-9 (IL-9) in the observation group were significantly lower than those in the control group (P < 0.05). The incidence rate of adverse reactions during treatment was 15.00% (6/40) in the observation groupand 10.00% (4/40) in the control group, with no significant difference between the two groups (P>0.05). Conclusion The combination of self-made Bitong Ointment combined with umbilical dressing of traditional Chinese medicine is effective in the treatment of children with pediatric allergic rhinitis differentiated as type of latent heat in the lung meridian, which can improve the TCM syndromes, inhibit the airway stress response, reduce the expression levels of inflammatory factors, and has good therapeutic safety.

Objective:To investigate the effect of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) on sizes and components of thrombi in patients with acute ischemic stroke (AIS) after mechanical thrombectomy (MT).Methods:Ninety-eight AIS patients accepted MT in Department of Neurology, Huaian First Hospital Affiliated to Nanjing Medical University from June 2018 to June 2022 were enrolled; they were divided into bridging therapy group and direct thrombectomy group according to the treatments. Baseline data, prognoses and thrombus features between the 2 groups were compared.Results:No significant differences were observed between the 2 groups in terms of age, gender, previous medical history, baseline scores, sites and types of vascular occlusion, TOAST causative classifications, time frame, MT frequencies and techniques, successful recanalization, or prognoses 90 d after MT ( P>0.05). Compared with the direct thrombectomy group, the bridging therapy group had significantly reduced thrombus area (37[22, 78] mm 2vs. 27[14, 62] mm 2) and areas of major pathological components [red blood cells: 16.1([9.0, 37.4] mm 2vs. 11.8[6.1, 22.1] mm 2, fibrin/platelets: 19.5[9.5, 26.4] mm 2vs. 10.7[5.0, 22.8] mm 2, white blood cells: 4.0[2.2, 8.0] mm 2vs. 2.4[1.4, 5.7] mm 2, P<0.05); however, no significant differences in proportions of areas of major pathological components were noted between the 2 groups of patients ( P>0.05). Conclusion:The rt-PA intravenous thrombolysis can significantly reduce the thrombi volume and decrease the contents of major thrombus components in AIS patients after MT, but not change the proportions of major pathological components in thrombi.

In China, the survival rate of liver cancer remains low while the mortality rate is high. Effectively reducing the burden of liver cancer is still a major challenge in the field of public health and chronic disease prevention in the Chinese population. Optimizing screening strategies for liver cancer remains a profound approach to secondary prevention worthy of continuous explora-tion. This guideline was commissioned by the Bureau of Disease Control and Prevention of the National Health Commission. The National Cancer Center of China initiated the guideline develop-ment and convened a multidisciplinary expert panel and working group. Following the World Health Organization Handbook for Guideline Development, this guideline integrated the most up-to-date evidence of liver cancer screening, China′s national conditions, and existing practical experience in liver cancer screening. Evidence-based recommendations on the target population, screening technologies, surveillance strategies, and other key points across the process of liver cancer screening and surveillance management were provided. This guideline would help to standardize the practice of liver cancer screening in China.

In China, the survival rate of liver cancer remains low while the mortality rate is high. Effectively reducing the burden of liver cancer is still a major challenge in the field of public health and chronic disease prevention in the Chinese population. Optimizing screening strategies for liver cancer remains a profound approach to secondary prevention worthy of continuous exploration. To address this pressing issue, the Bureau of Disease Control and Prevention of the National Health Commission commissioned this guideline. The National Cancer Center of China initiated the guideline development and convened a multidisciplinary expert panel and working groups. Following the World Health Organization Handbook for Guideline Development, this guideline integrated the most up-to-date evidence of liver cancer screening, China's national conditions, and existing practical experience in liver cancer screening. Evidence-based recommendations on the target population, screening technologies, surveillance strategies, and other key points across the process of liver cancer screening and surveillance management were provided. This guideline would help standardize the practice of liver cancer screening in China.