Objective:To investigate the risk factors of vascular complications (VC) after transcatheter aortic valve implantation (TAVI) in patients with aortic stenosis.Methods:A total of 80 patients with aortic stenosis admitted to the Affiliated Hospital of Jining Medical University from January 2018 to June 2023 were retrospectively included as the study objects. All patients underwent TAVI surgery and were divided into VC group (13 cases, 16.3%) and N-VC group (67 cases, 83.7%) according to whether VC occurred after TAVI surgery. The preoperative basic characteristics, surgery-related indexes and preoperative laboratory indexes were compared between the two groups. Multivariate logistic regression analysis was used to screen out independent predictors of postoperative VC in patients with aortic stenosis after TAVI. Based on independent predictors, a nomogram model was constructed, and the calibration curve of the nomogram model was drawn for internal verification. Receiver operating characteristic (ROC) curves were drawn to predict VC after TAVI in patients with aortic stenosis, and the predictive efficacy of the combined prediction model was further analyzed.Results:The proportion of female patients, the proportion of diabetic patients, the mean cross-valve pressure difference, the proportion of vascular wall calcification, the proportion of transapical surgical routes, brain natriuretic peptide (BNP) and creatinine in VC group were significantly higher than those in the N-VC group, and the left ventricular ejection fraction was significantly lower than that in the N-VC group, with statistical significance (all P<0.05). Multivariate logistic regression analysis showed that gender, combined diabetes, surgical path and BNP were independent risk factors of postoperative VC in patients with TAVI (all P<0.05). Based on four independent risk factors, a nomogram model was constructed to predict the occurrence of VC after TAVI in patients with aortic stenosis. The calibration curve showed that the predicted value of VC after TAVI in patients with aortic stenosis was in good agreement with the actual observed value ( P>0.05). ROC curve analysis results showed that the area under the curve (AUC) of gender, combined diabetes, surgical path and BNP in predicting the occurrence of VC after TAVI in aortic stenosis patients were 0.745, 0.769, 0.834 and 0.857, respectively, and the AUC of the combined prediction was 0.938. Conclusions:Gender, age, surgical path and BNP are independent predictors of VC after TAVI in patients with aortic stenosis. The nomogram model based on independent predictors has high predictive value.

BACKGROUND: Congenital heart disease (CHD) is a leading cause of birth defect-related mortality. However, more recent CHD mortality data for China are lacking. Additionally, limited studies have evaluated sex, rural-urban, and region-specific disparities of CHD mortality in China. METHODS: We designed a population-based study using data from the Dataset of National Mortality Surveillance in China between 2008 and 2021. We calculated age-adjusted CHD mortality using the sixth census data of China in 2010 as the standard population. We assessed the temporal trends in CHD mortality by age, sex, area, and region from 2008 to 2021 using the joinpoint regression model. RESULTS: From 2008 to 2021, 33,534 deaths were attributed to CHD. The period witnessed a two-fold decrease in the age-adjusted CHD mortality from 1.61 to 0.76 per 100,000 persons (average annual percent change [AAPC] = -5.90%). Females tended to have lower age-adjusted CHD mortality than males, but with a similar decline rate from 2008 to 2021 (females: AAPC = -6.15%; males: AAPC = -5.84%). Similar AAPC values were observed among people living in urban (AAPC = -6.64%) and rural (AAPC = -6.12%) areas. Eastern regions experienced a more pronounced decrease in the age-adjusted CHD mortality (AAPC = -7.86%) than central (AAPC = -5.83%) and western regions (AAPC = -3.71%) between 2008 and 2021. Approximately half of the deaths (46.19%) due to CHD occurred during infancy. The CHD mortality rates in 2021 were lower than those in 2008 for people aged 0-39 years, with the largest decrease observed among children aged 1-4 years (AAPC = -8.26%), followed by infants (AAPC = -7.01%). CONCLUSIONS CHD mortality in China has dramatically decreased from 2008 to 2021. The slower decrease in CHD mortality in the central and western regions than in the eastern regions suggested that public health policymakers should pay more attention to health resources and health education for central and western regions.
Humans ; Heart Defects, Congenital/mortality* ; Male ; Female ; China/epidemiology* ; Infant ; Child, Preschool ; Adult ; Child ; Adolescent ; Infant, Newborn ; Middle Aged ; Young Adult ; Aged ; Rural Population

Objective To investigate the clinical features of chronic hepatitis C(CHC)patients with hepatitis C virus genotype 3(HCV GT3)infection and the risk factors for disease progression.Methods A multicenter retrospective cohort study was conducted among 1 002 CHC patients from 11 clinical centers in Northwest China from December 2017 to November 2023,and according to their genotype,they were divided into GT1,GT2,GT3,and GT6 groups.Clinical features were compared between the patients with different genotypes.The one-way analysis of variance was used for comparison of normally distributed continuous data between groups,and the Scheffe test was used for further comparison between two groups.The Kruskal-Wallis H test was used for comparison of data with skewed distribution between groups;the chi-square test or Fisher test was used for comparison of categorical data between groups.The multivariate logistic regression analysis was used to explore the influencing factors for the progression of CHC to liver cirrhosis.Results In terms of the genotype,there were 427 patients with GT1 infection,242 with GT2 infection,299 with GT3 infection(210 patients with GT3a infection,87 with GT3b infection,and 2 with unclassified genotype),and 34 with GT6 infection.The patients with GT3 infection had a significantly younger age than those with GT1 infection(51.3±0.5 years vs 53.2±0.6 years,P<0.05)or GT2 infection(51.3±0.5 years vs 53.7±0.8 years,P<0.05),and for the patients with liver cirrhosis,the patients with GT3 infection had a significantly younger age than those with GT1 infection(52.1±0.5 years vs 59.4±0.9 years,P<0.001)or GT2 infection(52.1±0.5 years vs 58.1±1.1 years,P<0.001).Among the patients with GT3 infection,male patients accounted for 77.9%and the patients with liver cirrhosis accounted for 46.2%,which were significantly higher than those among the patients with GT1,GT2 or GT6 infection(all P<0.001).At baseline,the patients with GT3 infection had significantly higher levels of alanine aminotransferase(ALT)and aspartate aminotransferase(AST)than those with GT1 or GT2 infection,significantly higher aspartate aminotransferase-to-platelet ratio index(APRI)and fibrosis-4(FIB4)than those with GT1,GT2 or GT6 infection,a significantly lower platelet count(PLT)than those with GT2 or GT6 infection,a significantly higher level of alpha-fetoprotein than those with GT2 or GT6 infection,and a significantly lower level of albumin(Alb)than those with GT6 infection(all P<0.05).There were no significant differences between the patients with GT3a infection and those with GT3b infection in age,sex,the proportion of patients with liver cirrhosis,comorbidities,HCV RNA quantification,PLT,ALT,AST,alkaline phosphatase,Alb,APRI,and FIB-4(all P>0.05).The multivariate logistic regression analysis showed that PLT≤150×109/L(odds ratio[OR]=10.72,95%confidence interval[CI]:5.76-35.86,P<0.001)and Alb≤35 g/L(OR=3.74,95%CI:1.22-11.45,P=0.021)were risk factors for liver cirrhosis.Conclusion Most CHC patients with GT3 infection are male in Northwest China,and compared with the patients with other genotypes,such patients tend to have a younger age of onset and higher degrees of liver inflammation activity and fibrosis.Low PLT and a low level of Alb are risk factors for progression to liver cirrhosis in CHC patients with GT3 infection.

[Objective]To explore the effects of astragalin(AST)on autophagy and apoptosis of astrocytes in the L4-5 dorsal horn of the spinal cord in mice with inflammatory pain induced by complete Freund's adjuvant(CFA).[Methods]Twenty-four male C57BL/6 mice,aged six months,were randomly assigned to four groups:control group,saline group,CFA model group,and CFA+AST group,six mice in each group.The inflammatory pain model was established by injection of 10 μL CFA into the right lateral malleolus fossa.The saline group were injected with an equal amount of normal saline at the same site.The inflammatory pain mice in CFA+AST group were further treated with AST(60 mg/kg)intraperitoneally once a day for 21 consecutive days.Multiplex immunofluorescence staining was used to detect the coexpression of autophagy-related factors including ATG 12 and Beclin-1,apoptosis-related factors including Cleaved-Caspase3 and Caspase9,and the astrocyte marker such as GFAP in the L4-5 spinal dorsal horn of the mice in each group.Western blot was used to examine the protein expression levels of autophagy-related proteins(ATG12,Beclin-1)and apoptosis-related proteins(Caspase 3,Caspase 9)in the L4-5 spinal dorsal horn of mice.[Results]Immunofluorescent staining showed that in the L4-5 dorsal horn of the spinal cord,the fluorescence intensity of ATG12(P<0.000 1)and Beclin-1(P<0.000 1)was significantly increased,while that of Cleaved-Caspase 3(P<0.001)and Caspase 9(P<0.000 1)was decreased in the CFA+AST group when compared to the CFA model group.Furthermore,AST could inhibit the activation of astrocytes.Western blot further confirmed that AST significantly upregulated the expression of ATG12(P<0.000 1)and Beclin-1(P<0.000 1)in the L4-5 spinal cord of CFA mice,and downregulated the expression of Caspase 3(P<0.01)and Caspase 9(P<0.001).[Conclusions]AST promotes autophagy of astrocytes and inhibits their apoptosis in the L4-5 spinal dorsal horn of CFA mice.

Objective To investigate the clinical features of chronic hepatitis C(CHC)patients with hepatitis C virus genotype 3(HCV GT3)infection and the risk factors for disease progression.Methods A multicenter retrospective cohort study was conducted among 1 002 CHC patients from 11 clinical centers in Northwest China from December 2017 to November 2023,and according to their genotype,they were divided into GT1,GT2,GT3,and GT6 groups.Clinical features were compared between the patients with different genotypes.The one-way analysis of variance was used for comparison of normally distributed continuous data between groups,and the Scheffe test was used for further comparison between two groups.The Kruskal-Wallis H test was used for comparison of data with skewed distribution between groups;the chi-square test or Fisher test was used for comparison of categorical data between groups.The multivariate logistic regression analysis was used to explore the influencing factors for the progression of CHC to liver cirrhosis.Results In terms of the genotype,there were 427 patients with GT1 infection,242 with GT2 infection,299 with GT3 infection(210 patients with GT3a infection,87 with GT3b infection,and 2 with unclassified genotype),and 34 with GT6 infection.The patients with GT3 infection had a significantly younger age than those with GT1 infection(51.3±0.5 years vs 53.2±0.6 years,P<0.05)or GT2 infection(51.3±0.5 years vs 53.7±0.8 years,P<0.05),and for the patients with liver cirrhosis,the patients with GT3 infection had a significantly younger age than those with GT1 infection(52.1±0.5 years vs 59.4±0.9 years,P<0.001)or GT2 infection(52.1±0.5 years vs 58.1±1.1 years,P<0.001).Among the patients with GT3 infection,male patients accounted for 77.9%and the patients with liver cirrhosis accounted for 46.2%,which were significantly higher than those among the patients with GT1,GT2 or GT6 infection(all P<0.001).At baseline,the patients with GT3 infection had significantly higher levels of alanine aminotransferase(ALT)and aspartate aminotransferase(AST)than those with GT1 or GT2 infection,significantly higher aspartate aminotransferase-to-platelet ratio index(APRI)and fibrosis-4(FIB4)than those with GT1,GT2 or GT6 infection,a significantly lower platelet count(PLT)than those with GT2 or GT6 infection,a significantly higher level of alpha-fetoprotein than those with GT2 or GT6 infection,and a significantly lower level of albumin(Alb)than those with GT6 infection(all P<0.05).There were no significant differences between the patients with GT3a infection and those with GT3b infection in age,sex,the proportion of patients with liver cirrhosis,comorbidities,HCV RNA quantification,PLT,ALT,AST,alkaline phosphatase,Alb,APRI,and FIB-4(all P>0.05).The multivariate logistic regression analysis showed that PLT≤150×109/L(odds ratio[OR]=10.72,95%confidence interval[CI]:5.76-35.86,P<0.001)and Alb≤35 g/L(OR=3.74,95%CI:1.22-11.45,P=0.021)were risk factors for liver cirrhosis.Conclusion Most CHC patients with GT3 infection are male in Northwest China,and compared with the patients with other genotypes,such patients tend to have a younger age of onset and higher degrees of liver inflammation activity and fibrosis.Low PLT and a low level of Alb are risk factors for progression to liver cirrhosis in CHC patients with GT3 infection.

[Objective]To investigate the potential value of thyroid hormones in cerebrospinal fluid in predicting autism-like behaviors induced by hypothyroidism in pregnant rats.[Methods]Twelve pregnant Wistar rats were randomly divided into a control group and a hypothyroidism group(hypothyroidism model group).Offspring from both groups had serum and cerebrospinal fluid levels of thyroid-stimulating hormone(TSH),total triiodothyronine(TT3),total thyroxine(TT4),free triiodothyronine(FT3),and free thyroxine(FT4)levels in serum and cerebrospinal fluid.Ultrasonic vocalization tests were conducted on postnatal day 2(P2),day 7(P7),and day 14(P14),while behavioral tests using the three-box social interaction test were performed on day 21(P21).[Results]Compared with the control group,free T4(FT4)levels in the cerebrospinal fluid of the hypothyroidism group were significantly reduced during the developmental period(P0-P21;P2:P<0.05;P7:P<0.05;P14:P<0.01;P21:P<0.01),with no statistical difference between the two groups only at P0(P>0.05).In the ultrasonic vocalization(USV)tests,the number and duration of USVs in offsprings from the hypothyroidism group were significantly reduced compared with those of the control group on P2,P7 and P14:for USV counts(P2:P<0.05;P7:P<0.001;P14:P<0.01);for USV duration(P2:P<0.05;P7:P<0.001;P14:P<0.001).In the three-box social tests,offsprings of the hypothyroidism group showed significantly reduced sniffing time with unfamiliar rats at P21 compared to the control group(all P<0.001).The FT4 levels in cerebrospinal fluid had a significantly positive correlation with USV counts(P7:r=0.883,P<0.05;P14:r=0.902,P<0.05)and sniffing time with unfamiliar rats(r=0.814,P<0.01).[Conclusion]Measuring free T4 in cerebrospinal fluid can predict autism-like behaviors in offsprings of rats induced by hypothyroidism during pregnancy.

Objective:To investigate the risk factors of vascular complications (VC) after transcatheter aortic valve implantation (TAVI) in patients with aortic stenosis.Methods:A total of 80 patients with aortic stenosis admitted to the Affiliated Hospital of Jining Medical University from January 2018 to June 2023 were retrospectively included as the study objects. All patients underwent TAVI surgery and were divided into VC group (13 cases, 16.3%) and N-VC group (67 cases, 83.7%) according to whether VC occurred after TAVI surgery. The preoperative basic characteristics, surgery-related indexes and preoperative laboratory indexes were compared between the two groups. Multivariate logistic regression analysis was used to screen out independent predictors of postoperative VC in patients with aortic stenosis after TAVI. Based on independent predictors, a nomogram model was constructed, and the calibration curve of the nomogram model was drawn for internal verification. Receiver operating characteristic (ROC) curves were drawn to predict VC after TAVI in patients with aortic stenosis, and the predictive efficacy of the combined prediction model was further analyzed.Results:The proportion of female patients, the proportion of diabetic patients, the mean cross-valve pressure difference, the proportion of vascular wall calcification, the proportion of transapical surgical routes, brain natriuretic peptide (BNP) and creatinine in VC group were significantly higher than those in the N-VC group, and the left ventricular ejection fraction was significantly lower than that in the N-VC group, with statistical significance (all P<0.05). Multivariate logistic regression analysis showed that gender, combined diabetes, surgical path and BNP were independent risk factors of postoperative VC in patients with TAVI (all P<0.05). Based on four independent risk factors, a nomogram model was constructed to predict the occurrence of VC after TAVI in patients with aortic stenosis. The calibration curve showed that the predicted value of VC after TAVI in patients with aortic stenosis was in good agreement with the actual observed value ( P>0.05). ROC curve analysis results showed that the area under the curve (AUC) of gender, combined diabetes, surgical path and BNP in predicting the occurrence of VC after TAVI in aortic stenosis patients were 0.745, 0.769, 0.834 and 0.857, respectively, and the AUC of the combined prediction was 0.938. Conclusions:Gender, age, surgical path and BNP are independent predictors of VC after TAVI in patients with aortic stenosis. The nomogram model based on independent predictors has high predictive value.

Background::Heterotaxy (HTX) is a thoracoabdominal organ anomaly syndrome and commonly accompanied by congenital heart disease (CHD). The aim of this study was to analyze rare copy number variations (CNVs) in a HTX/CHD cohort and to examine the potential mechanisms contributing to HTX/CHD.Methods::Chromosome microarray analysis was used to identify rare CNVs in a cohort of 120 unrelated HTX/CHD patients, and available samples from parents were used to confirm the inheritance pattern. Potential candidate genes in CNVs region were prioritized via the DECIPHER database, and PNPLA4 was identified as the leading candidate gene. To validate, we generated PNPLA4-overexpressing human induced pluripotent stem cell lines as well as pnpla4-overexpressing zebrafish model, followed by a series of transcriptomic, biochemical and cellular analyses. Results::Seventeen rare CNVs were identified in 15 of the 120 HTX/CHD patients (12.5%). Xp22.31 duplication was one of the inherited CNVs identified in this HTX/CHD cohort, and PNPLA4 in the Xp22.31 was a candidate gene associated with HTX/CHD. PNPLA4 is expressed in the lateral plate mesoderm, which is known to be critical for left/right embryonic patterning as well as cardiomyocyte differentiation, and in the neural crest cell lineage. Through a series of in vivo and in vitro analyses at the molecular and cellular levels, we revealed that the biological function of PNPLA4 is importantly involved in the primary cilia formation and function via its regulation of energy metabolism and mitochondria-mediated ATP production. Conclusions::Our findings demonstrated a significant association between CNVs and HTX/CHD. Our data strongly suggested that an increased genetic dose of PNPLA4 due to Xp22.31 duplication is a disease-causing risk factor for HTX/CHD.

Objective To investigate the correlation between abdominal obesity and autoimmune thyroid disease in the view point of helper T cells and cytokines.Methods Clinical and laboratory data were collected from 108 pa-tients with Hashimoto's thyroiditis(HT)plus abdominal obesity and 122 patients of Hashimoto's thyroiditis without abdominal obesity who visited the People's Hospital of Xinjiang Uygur Autonomous Region and also from the control population.Abdominal circumference was measured,and patients in the HT patients were grouped according to whether they were abdominally obese or not.The thyroglobulin antibody(TgAb)and thyroid peroxidase antibody(TPOAb)were detected,and the ratio of helper T cells and related cytokines were detected by flow cytometry and enzyme-linked immunosorbent assay.Results The abdominal circumference of the TgAb-positive group was higher than that of the TgAb-negative group(P＜0.05).Correlation analysis suggested that abdominal circumference was significantly and positively correlated with TgAb and IL-4 but negatively correlated with Th1.After correcting for gender and age,and abdominal obesity and IL-4 were risk factors for TgAb antibody positivity OR=3.080(95％CI:1.022-9.284)and OR=1.296(95％CI:1.022-9.284),both with P＜0.05.Conclusions Abdominal obesity may be an influential factor in TgAb antibody positivity,with larger abdominal circumference having higher TgAb antibody titers,lower Th1 levels,and higher IL-4 levels.Visceral adiposity may exacerbate autoimmune dam-age of thyroid tissue by disruption of helper T cell pathway.

Baitouweng Decoction is a classic prescription commonly used in the treatment of heat-toxin dysentery,with confirmed efficacy in the treatment of ulcerative colitis(UC).Clinical studies have found that Baitouweng Decoction,modified Baitouweng Decoction,combined with other Chinese materia medica or other therapies for UC can improve the clinical symptoms of patients,reduce the lesion activity score under colonoscopy,promote the healing of intestinal mucosal tissue,and also improve the overall efficiency of treatment,and reduce adverse reactions and recurrence rate.Pharmacological studies showed that Baitouweng Decoction may treat UC by regulating the expressions of related inflammatory factors and signaling pathways,regulating immune function,repairing intestinal mucosal barrier,and improving intestinal flora imbalance.This article systematically reviewed the clinical and basic research progress of Baitouweng Decoction in the treatment of UC,in order to provide a basis for relevant research.