Objective To compare and analyze the early- to mid-term outcomes of transcatheter aortic valve replacement (TAVR) combined with percutaneous coronary intervention (PCI) versus surgical aortic valve replacement (SAVR) combined with coronary artery bypass grafting (CABG) for the treatment of significant aortic stenosis (AS) and coronary artery disease (CAD). Methods The data of patients with significant AS and CAD who underwent surgical treatment at Central China Fuwai Hospital of Zhengzhou University from January 2018 to July 2023 were collected. These patients were divided into a TAVR+PCI group and a SAVR+CABG group according to the operation method. Propensity score matching (PSM) was used to select patients with close clinical baseline characteristics, and the early- to mid-term outcomes of the two groups were compared. Results A total of 272 patients were enrolled, including 208 males and 64 females, with a mean age of (64.16±8.24) years. There were 47 patients in the TAVR+PCI group and 225 patients in the SAVR+CABG group. After 1 : 1 PSM, 32 pairs were selected. There was no statistical difference in baseline data between the two groups (P>0.05). Compared with the SAVR+CABG group, the TAVR+PCI group had significantly shorter operative time, mechanical ventilation time, ICU stay, postoperative hospital stay, and less intraoperative bleeding, and significantly lower postoperative transfusion and complete revascularization rates (P<0.05). The differences in the rates of postoperative in-hospital death, myocardial infarction, stroke, or other complications between the two groups were not statistically significant (P>0.05), and the differences in the rates of moderate-to-severe perivalvular leakage, death, or readmission in the mid-term follow-up were not statistically significant (P>0.05). Conclusion In patients with significant AS and CAD, the early- and mid-term rates of death and complications are similar between those treated with TAVR+PCI and SAVR+CABG, and TAVR+PCI is a safe alternative to SAVR+CABG.

Objectives:To investigate the safety and efficacy of concomitant mitral valvuloplasty(MVP)and implantation of domestic third-generation magnetically levitated Corheart 6 left ventricular assist device(LVAD). Methods:Clinical data of 13 end-stage heart failure patients who underwent Corheart 6 LVAD implantation and MVP at Central China Fuwai Hospital of Zhengzhou University from October 2021 to March 2023 were retrospectively analyzed.Mortality and complication events during hospitalization and at follow-up were collected,and changes in myocardial injury biomarkers,renal function,hemodynamics,and echocardiographic indices were observed. Results:There were no perioperative deaths and no MVP-related complications in these patients.During a mean follow-up of(14.2±5.6)months,2 patients died due to COVID-19 pneumonia and cardiac arrest respectively,11 cases(84.6%)survived.There were no recurrences of moderate-to-severe mitral regurgitation in the survived patients.Compared with preoperative value,higher cardiac output,lower central venous pressure,pulmonary artery systolic pressure(PASP),and mean pulmonary artery pressure(PAMP)were evidenced at 24 h and 72 h postoperatively,estimated glomerular filtration rate was also reduced at 1 week post operation(all P<0.010).High-sensitive troponin T level was significantly increased at 1 week post operation and then reduced at 1 month post operation,but still not returned to pre-operative level([125.5±281.9]pg/ml at baseline,[1 295.6±654.6]pg/ml at 1 week post operation and[278.0±300.5]pg/ml at 1 month post operation).Echocardiography showed that compared with preoperative period,the left ventricular ejection fraction tended to be higher at 1 and 6 months postoperatively(both P>0.017),whereas left ventricular end-diastolic dimension,PASP,and PAMP were significantly reduced(all P<0.010). Conclusions:Domestic third-generation magnetically levitated Corheart 6 LVAD implantation with concomitant MVP is safe and feasible,there is no recurrence of moderate-to-severe mitral regurgitation,a significant reduction in pulmonary artery pressure,and significant hemodynamic improvement in early to mid-term postoperatively are observed in survived patients.

Objective:To determine the effects of early enteral nutrition (EEN) on the short-term prognosis of patients receiving veno-arterial extracorporeal membrane oxygenation (VA-ECMO).Methods:61 patients admitted to the Coronary Care Unit (CCU) of Henan Provincial Peoples' Hospital from February 2022 to March 2023 to receive VA-ECMO treatment were selected as the study objects according a retrospective survey. The patients were divided into an achievement group ( n=34) and a non-achievement group ( n=27) based on whether the feeding amount reached 70% or over of the target calories (25kcal/kg.d) on the 7th day of ECMO treatment. The general characteristics, disease information, complications, and prognosis between the two groups after ICU admission were recorded and compared. A multivariable Cox proportional hazards model was used to evaluate the impact of various factors on clinical outcomes. Kaplan-Meier analysis was used to draw survival curves for the two groups, and the predictive value of the ratio of actual EN intake to target energy was calculated by plotting the ROC curve. Results:A total of 61 patients were included, with an overall in-hospital mortality rate of 50.82% (31/61), with 32.35% (11/34) in the achievement group, and 70.37% (19/27) in the non-achievement group. Cox regression analysis revealed that the occurrence of hypoxic-ischemic encephalopathy (HR=0.341, 95% CI:0.119-0.975), ECOM weaning failure ( HR=0.269, 95% CI:0.111-0.651), and achieving EN targets on the 7th day of VA-ECMO treatment ( HR=10.891, 95% CI:1.178-100.718) were independent factors for patient mortality during hospitalization. The ROC curve for the percentage of EN achievement on the 7th day of VA-ECMO treatment and in-hospital mortality showed an area under the curve of 0.755, with a cutoff value of 0.73. Conclusion:The presence of ischemic hypoxic encephalopathy, ECOM weaning failure, and whether achieving EN targets or not is closely related to the prognosis of VA-ECMO patients. Patients who achieving EN targets of over 73% had the lowest in-hospital mortality rate. Therefore, more attention should be paid to the energy intake of VA-ECMO patients to reduce their risk of mortality.

Objective:To explore the risk factors of death in patients receiving ECMO treatment and to construct a nomogram prediction model.Methods:The clinical data of 412 consecutive patients with acute heart and (or) pulmonary failure who received ECMO treatment between April 2018 and June 2022 were retrospectively included.According to the patients' in-hospital survival, univariate correlation analysis was used to select risk factor variables, and then Lasso regression was used to screen all variables, combined with common variables, combined with clinical practice, plotted a nomogram to predict the probability of early mortality, using the area under the ROC curve (AUC), Harrell C index and calibration curve were used to evaluate and internally validate the performance of the model.Decision curve analysis was applied to assess its clinical utility.Results:Cerebral infarction, diabetes, history of cardiopulmonary resuscitation, neurological complications, acute kidney injury, lactate, hemoglobin, albumin, and platelet count were risk factors for death in patients receiving ECMO ( P<0.05).At the same time, according to the actual situation and difference variables, we constructed a nomogram with high reliability to predict the probability of death. Conclusions:The study identified the risk factors of death in patients receiving ECMO, successfully constructed and validated a nomogram prediction model, and provided a simple and reliable tool for ECMO death prediction, which is of great significance for individualized treatment of patients.

Objective To compare the efficacy, safety, and survivability of TCbHP versus AC-THP in the neoadjuvant therapy of HER2-positive breast cancer in real-world. Methods Clinical data of patients with HER2 positive breast cancer, who have received TCbHP or AC-THP as neoadjuvant therapy and completed surgery in 11 third-class hospitals in various cities of Hebei Province, were retrospectively collected.The total pathological complete remission (tpCR) rate, the incidence of grade 3 or higher adverse reactions and the completion rate of the given approaches were compared. Results A total of 110 cases were collected, including 78 cases in the TCbHP group and 32 cases in the AC-THP group.The tpCR rate of the TCbHP group was higher than that of the AC-THP group, but the difference was not statistically significant (64.10% vs. 56.25%, P=0.441).No significant difference was found in the breast pathologic complete response (bpCR) and axillary pathologic complete response (apCR) rates between the TCbHP group and the AC-THP group (70.51% vs. 56.25%, P=0.150;78.21% vs. 84.38%, P=0.462).Exploratory analysis revealed that the tpCR rate of the TCbHP group was significantly higher than that of the AC-THP group in patients with HR-positive breast cancer (51.11% vs. 22.22%, P=0.036).As for the patients with HR-negative breast cancer, the tpCR rate of the AC-THP group tended to be higher than that of the TCbHP group (100% vs. 81.82%, P=0.088).The incidence of grade 3 or higher adverse reactions in the TCbHP group was slightly higher than that in the AC-THP group (12.82% vs. 9.38%, P=0.753).No deaths occurred in the whole group.Moreover, no significant difference was observed in the completion rate of the given approaches between the TCbHP group and the AC-THP group (92.31% vs. 90.63%, P=0.718). Conclusion In real-world clinical practice, the neoadjuvant therapy of TCbHP and AC-THP are effective, safe, and well tolerated among patients with HER2-positive breast cancer.The tpCR rate between the two approaches was not significantly different.The AC-THP regimen could also be considered as one of the optimal regimens for HER2-positive breast cancer in neoadjuvant therapy.

AIM: Diabetes mellitus affects the pharmacokinetics of cytochrome P450 3A4 / 5 (CYP3A4/5) substrates. We evaluated the relationship between haemoglobin A1c (HbA1c) levels and the pharmacokinetics of controlled-release tacrolimus. METHODS: This retrospective observational cohort study included kidney transplant recipients (>18 years) receiving controlled-release tacrolimus orally. CYP3A5 genotypes were categorized as expressers (*1/*1 or *1/*3) and non-expressers (*3/*3). Multiple linear regression analysis determined the predictors for trough concentration / dose-normalized by body weight (C/D) ratio of tacrolimus at 7 days, 6 months and 12 months after administration. Correlations between the C/D ratio and HbA1c levels at baseline, 6 and 12 months after tacrolimus initiation were evaluated with Bonferroni correction. RESULTS: Out of 42 patients (CYP3A5 expressers, n=56, and non-expressers, n= 83), the multiple linear regression analysis showed that the C/D ratio on Day 7 was marginally higher in CYP3A5 non-expressers than in CYP3A5 expressers. Factors affecting the elevation of tacrolimus C/ D ratio after 6 and 12 months of treatment were male sex and CYP3A5 non-expressers and increased HbA1c levels and CYP3A5 non-expressers, respectively. The C/D ratio and HbA1c levels after 12 months was positively correlated in CYP3A5 non-expressers (y=54.6x+194.6, R=0.63, P=0.004, Bonferroni correction). Furthermore, intra-individual changes in the C/D ratio and HbA1c levels from 6 to 12 months were nearly correlated (y=54.5x + 20.2, R=0.41, P=0.036, Bonferroni correction). CONCLUSION: HbA1c and CYP3A5 genotypes might be considered to understand the inter- and intra-individual variability in blood tacrolimus concentrations after 6 months post-kidney transplantation.

Objective To investigate the status of radiological protection in Baoji City. Methods Using the questionnaire survey method, the survey forms were sent to the radiology clinics and other relevant units in the counties and districts of the city to investigate the basic situation of radiology and treatment of medical and health institutions, basic information of radiology and treatment equipment, personal information of radiation workers, and health monitoring of radiation workers. Results There is 1.13 X-ray diagnostic equipment per 10, 000 people, 0.015 radiotherapy equipment per 10, 000 people in Baoji City, and One million people own 11.4 CTs. There are 1, 102 radiation workers in Baoji City, and 2.92 per 10, 000 people. The occupational health check rate of medical radiation personnel was 87.7% within 2 years, the personal dose monitoring rate was 90.4%, the radiation worker training rate was 73.6% within 2 years, about the holding rate of "Radiation Staff Certificate" in Baoji City was 73.0%, and the occupational health file rate was 89.2%. The evaluation indexes of various health monitoring were lower, especially in township hospitals (35.7%～50.8%). Conclusion On the whole, the number of radiological diagnosis and treatment equipment is small, and Class A large equipment is almost blank. The city is stronger than the county in health monitoring. The status of health monitoring is very different from urban to rural areas.

Objective To evaluate the predicting value of circulating miRNAs for sepsis secondary to pneumonia in elderly patients.Methods From April 2016 to January 2017,44 cases with sepsis secondary to pneumonia,52 elderly patients with pneumonia and 21 healthy older adults as control were involved in this study.The expression levels of MiRNA-150 5p,miRNA-25-3p,miRNA-122 5p and miRNA-223-3p in plasma were evaluated by fluorescence quantitative PCR.The demographic characteristics,sequential organ failure assessment (SOFA)scores,prognosis and days stayed in ICU were recorded.The area under the receiver operating charaeteristic(ROC)curve was used to calculated the specificity and sensitivity of miRNA in identifying sepsis-associated pneumonia.Results There were significantly differences among levels of circulating miRNA-223-3p in pneumonia,sepsis and healthy control groups(F =36.441,P =0.000),△CT values were 2.39 ± 1.36,1.44± 1.43,and 4.58 ± 0.91,respectively.The relative expression levels of miRNA-223-3p in the three groups were significantly different (P =0.000),which were 0.189 (0.107,0.367),0.361 (0.221,0.735),and 0.044 (0.022,0.061),respectively.The AUC of miRNA-223-3p for predicting sepsis from pneumonia was 0.964(95 ％CI =0.925 1.000).At a cutoff value of 2.759,miRNA-223-3p yielded a sensitivity of 82.9％ and a specificity of 100.0％.Conclusions MiRNA-223-3p expression is up-regulated in patients with sepsis secondary to pneumonia compared to that of patients with pneumonia,and it could be used to predict sepsis associated pneumonia.

Objective To evaluate the curative effect of transcatheter arterial chemoembolization (TACE) combined with intensity modulated radiation therapy (IMRT) in treating advanced hepatocellular carcinoma (HCC),and to discuss the occurrence of adverse events.Methods A total of 59 patients with advanced HCC were enrolled in this study.The patients were randomly divided into TACE plus IMRT group (study group,n=30) and TACE group (control group,n=29).The early tumor response rate,progression free survival (PFS),median survival time (mST),and adverse reactions were analyzed.Results The early tumor response rate in the study group was 60.0％,which was significantly higher than 34.4％ in the control group (P=0.043).PFS of the study group was 260 days,which was remarkably higher than 195 days of the control group (P=0.006).The mST was 468 days in the study group,which was 431 days in the control group (P=0.195).In the study group,2 patients developed severe liver function damage,which was improved after active liver protection therapy for more than 20 days.Conclusion For the treatment of advanced HCC,TACE combined with IMRT can improve early tumor response rate and prolong PFS time,moreover,its adverse reactions can be well tolerated by patients.