COMPERA 2.0 risk stratification has been demonstrated to be useful in patients with precapillary pulmonary hypertension (PH). However, its suitability for patients at risk for post-capillary PH or PH associated with left heart disease (PH-LHD) is unclear. To investigate the use of COMPERA 2.0 in patients with severe aortic stenosis (SAS) undergoing transcatheter aortic valve replacement (TAVR), who are at risk for post-capillary PH, a total of 327 eligible SAS patients undergoing TAVR at our institution between September 2015 and November 2020 were included in the study. Patients were classified into four strata before and after TAVR using the COMPERA 2.0 risk score. The primary endpoint was all-cause mortality. Survival analysis was performed using Kaplan-Meier curves, log-rank test, and Cox proportional hazards regression model. The study cohort had a median (interquartile range) age of 76 (70‒80) years and a pulmonary arterial systolic pressure of 33 (27‒43) mmHg (1 mmHg=0.133 kPa) before TAVR. The overall mortality was 11.9% during 26 (15‒47) months of follow-up. Before TAVR, cumulative mortality was higher with an increase in the risk stratum level (log-rank, both P<0.001); each increase in the risk stratum level resulted in an increased risk of death (hazard ratio (HR) 2.53, 95% confidential interval (CI) 1.54‒4.18, P<0.001), which was independent of age, sex, estimated glomerular filtration rate (eGFR), hemoglobin, albumin, and valve type (HR 1.76, 95% CI 1.01‒3.07, P=0.047). Similar results were observed at 30 d after TAVR. COMPERA 2.0 can serve as a useful tool for risk stratification in patients with SAS undergoing TAVR, indicating its potential application in the management of PH-LHD. Further validation is needed in patients with confirmed post-capillary PH by right heart catheterization.
Humans ; Aortic Valve Stenosis/complications* ; Aged ; Hypertension, Pulmonary/mortality* ; Male ; Female ; Transcatheter Aortic Valve Replacement ; Aged, 80 and over ; Risk Assessment/methods* ; Proportional Hazards Models ; Kaplan-Meier Estimate ; Retrospective Studies

This study elucidates the pathogenesis and treatment strategies for tinnitus based on the theory of turbid toxin obstructing the orifices and by combining the theory of six-meridian syndrome differentiation.It is pointed out that turbid toxin is a pathogenic factor and a kind of pathological product arising from emotional disturbances,dietary irregularities,and metabolic dysfunctions,which leads to the dysfunction of zang-fu organs and meridians.The core pathogenesis of tinnitus is identified as turbid toxin obstructing the orifices.Following the theory of six-meridian syndrome differentiation,tinnitus can be treated in stages:in the early stage,tinnitus is attributed to shaoyang's failure in conveying and dispersing;in the progressive stage,tinnitus is due to taiyin's inability of transportation and transformation;in the late stage,tinnitus results from insufficient shaoyin failing in nourishment.Correspondingly,therapies of harmonizing shaoyang to expel pathogens,strengthening the spleen to eliminate turbidity,and nourishing the kidneys to resolve turbidity are performed with the modified use of Xiao Chaihu Decoction,Xiaoyao San combined with Shenling Baizhu San,and Erlong Zuoci Pills,respectively.The integration of the theory of turbid toxin obstructing the orifices and the theory of six-meridian syndrome differentiation not only enriches the traditional Chinese medicine pathogenesis of tinnitus,but also provides new insights for its clinical treatment.

Objective To develop a Self-Report Scale of Symptoms for Post Intensive Care Syndrome-Family(PICS-F)and validate its reliability and validity,providing a scientific tool for healthcare professionals to comprehensively assess post intensive care syndrome-family.Methods Based on the symptom experience dimension of Symptom Management Theory,a preliminary version of the scale was developed through literature analysis,semi-structured interviews,expert consultations,and a pilot survey.A convenience sampling method was used to conduct the pre-trial version of the scale questionnaire survey on 442 family members of ICU patients at a tertiary A comprehensive hospital in Wuhan from June to September 2024.The test of the validity and reliability was conducted.Results The developed scale consists of 4 dimensions and 20 items.Exploratory factor analysis identified 4 factors,with a cumulative variance contribution rate of 70.921％.The content validity index at the scale level was 0.941,and the content validity indices for individual items ranged from 0.809 to 1.000.Confirmatory factor analysis indicated that the model fit indices were within acceptable ranges.The overall Cronbach's αcoefficient for the scale was 0.941,and the split-half reliability was 0.832.Conclusion The Self-Report Scale of Symptoms for PICS-F demonstrates good reliability and validity.It can comprehensively reflect the primary symptoms of PICS-F,and can serve as an effective measurement tool for clinicians to assess PICS-F in family members of ICU patients.

Objective To develop a Self-Report Scale of Symptoms for Post Intensive Care Syndrome-Family(PICS-F)and validate its reliability and validity,providing a scientific tool for healthcare professionals to comprehensively assess post intensive care syndrome-family.Methods Based on the symptom experience dimension of Symptom Management Theory,a preliminary version of the scale was developed through literature analysis,semi-structured interviews,expert consultations,and a pilot survey.A convenience sampling method was used to conduct the pre-trial version of the scale questionnaire survey on 442 family members of ICU patients at a tertiary A comprehensive hospital in Wuhan from June to September 2024.The test of the validity and reliability was conducted.Results The developed scale consists of 4 dimensions and 20 items.Exploratory factor analysis identified 4 factors,with a cumulative variance contribution rate of 70.921％.The content validity index at the scale level was 0.941,and the content validity indices for individual items ranged from 0.809 to 1.000.Confirmatory factor analysis indicated that the model fit indices were within acceptable ranges.The overall Cronbach's αcoefficient for the scale was 0.941,and the split-half reliability was 0.832.Conclusion The Self-Report Scale of Symptoms for PICS-F demonstrates good reliability and validity.It can comprehensively reflect the primary symptoms of PICS-F,and can serve as an effective measurement tool for clinicians to assess PICS-F in family members of ICU patients.

Objective To observe the value of radiomics models based on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)enhanced hepatobiliary phase(HBP)MRI for assessing clinical pathological stage of hepatic fibrosis(HF).Methods Data of 240 patients with pathologically/clinically diagnosed and clinical pathological staged HF who underwent Gd-EOB-DTPA enhanced MR examination were retrospectively analyzed.The liver-to-muscle signal intensity ratio(SIR1)and liver-to-spleen signal intensity ratio(SIR2)were measured based on HBP images.Radiomics features of HBP images were extracted and screened to construct radiomics models.The signal intensity ratio(SIR)-radiomics combined models were constructed based on SIR and radiomics signatures.Receiver operating characteristic(ROC)curves were drawn to evaluate the efficacy of each model for assessing clinical pathological stage of HF.Results The area under the curve(AUC)of SIR1 and SIR2 models for assessing clinical pathological stage of HF were 0.63-0.70 and 0.65-0.71,respectively.The most effective radiomics model for assessing HF,significant HF,advanced HF and early cirrhosis was support vector machine(SVM),SVM,light gradient boosting machine and K-nearest neighbor model,respectively,with the AUC in validation set of 0.87,0.82,0.81 and 0.80,respectively,while the AUC of SIR-radiomics combined models in validation set of 0.88,0.82,0.82 and 0.81,respectively.Conclusion The radiomics models based on Gd-EOB-DTPA enhanced HBP MRI were helpful for assessing clinical pathological stage of HF.Combining with HBP SIR could improve their efficacy.

Objective To investigate the anti-inflammatory effects of Bupi Yichang Pills on mice with experimental colitis and its potential mechanism of action.Methods Dextran sulfate sodium(DSS)was used to model the experimental colitis,and low-,medium-and high-doses of Bupi Yichang Pills(1.5,3.0,6.0 g·kg-1·d-1)and Mesalazine(300 mg·kg-1·d-1)were fed at the same time.Mice were observed for general behavior and weighed.Hematoxylin-eosin staining was used to observe the pathological injury of colonic tissues.qPCR and ELISA were used to detect the levels of inflammatory cytokines(TNF-α,IL-1β,IL-6,IL-10,IL-35 and TGF-β1),qPCR and Western Blot were used to detect the mRNA and protein levels of glucose transporters and glycolytic kinases.Results Low-,medium-and high-doses of Bupi Yichang Pills significantly down-regulated disease activity index in colitis mice(P＜0.05,P＜0.01).The body mass and colon length were significantly increased,while colon mass,colon mass index and unit colon mass index were significantly reduced(P＜0.05,P＜0.01),and ulcer formation and inflammatory cell infiltration in colonic tissue were significantly improved.In addition,medium-and high-doses of Bupi Yichang Pills significantly down-regulated the mRNA levels and concentrations of pro-inflammatory cytokines including TNF-α,IL-1β and IL-6(P＜0.01),while significantly up-regulated the mRNA levels and concentrations of anti-inflammatory cytokines such as IL-10,IL-35 and TGF-β1(P＜0.01).We further found that high-dose of Bupi Yichang Pills significantly down-regulated the mRNA and protein expressions of glucose transporters(Glut1,Glut2,Glut4)and glycolytic kinases(HK2,Aldolase A,PKM2)in colonic tissue(P＜0.01).Conclusions Bupi Yichang Pills effectively alleviates DSS-induced experimental colitis,and its specific mechanism of action is related to the improvement of glycolytic metabolic pathways and the regulation of inflammatory cytokine expression.

Cerebrovascular diseases pose a serious threat to human health.According to the latest epidemiological data,stroke is one of the leading causes of death and disability among adults worldwide.Acute ischemic stroke(AIS),which is caused by local circulatory disorders in the brain,accounts for over 80%of all strokes and is the most common type of stroke.Due to extensive damage to the cerebral cortex or direct involvement of the autonomic nerve centers and pathways caused by AIS,the balance between the sympathetic and parasympathetic nervous systems is disturbed(with a predominance of sympathetic activation).Therefore,the organs targeted by the downstream pathways of the sympathetic and parasympathetic nervous systems are affected by the neurotransmitters they secrete,resulting in a range of systemic complications(such as cardiac complications,stroke-related infections,gastrointestinal complications,acute kidney injury,metabolic changes,and sexual dysfunction).These systemic pathological changes,in turn,affect the progression of AIS,thereby exacerbating brain damage or directly leading to patient death.Treatments targeting imbalances in the autonomic nervous system may play a role in reducing complications and improving the prognosis of AIS.This article reviews the systemic effects of autonomic dysfunction following AIS and its mechanisms,providing insights for the treatment of AIS and intervention of systemic complications.

Objective:To analyze the clinical efficacy of cetuximab combined with mFOLFOX6 chemotherapy regimen in the treatment of advanced colorectal cancer, to explore its effects on the distribution of T lymphocyte subsets, patients' physical status and tumor marker levels, and to analyze its safety.Methods:A total of 90 patients with advanced colorectal cancer admitted to the Hainan Cancer Hospital from April 2020 to April 2022 were selected and randomly divided into observation group ( n=45) and control group ( n=45) according to random number table method. The control group was treated with the mFOLFOX6 chemotherapy regimen, while the observation group was treated with cetuximab combined with the mFOLFOX6 chemotherapy regimen. Objective response rate (ORR), disease control rate (DCR), T lymphocyte subsets levels (percentages of CD3 +, CD4 +, CD8 +), Karnofsky performance status (KPS) score, tumor marker vascular endothelial growth factor (VEGF), endothelial cell-specific molecule 1 (ESM1), carcino-embryonic antigen (CEA) levels and the incidence of adverse reactions were compared between the two groups after treatment. Results:After 4 cycles of treatment, the ORR was 66.67% (30/45) in the observation group and 42.22% (19/45) in the control group, and there was a statistically significant difference ( χ2=5.42, P=0.020). The DCR of the observation group was 86.67% (39/45) and that of the control group was 66.67% (30/45), and there was a statistically significant difference ( χ2=5.03, P=0.025). The percentages of T lymphocyte subsets CD3 +, CD4 + and CD8 + in the observation group were (63.35±6.71) %, (35.67±3.96) % and (17.03±2.11) %, respectively, while those in the control group were (52.23±5.92) %, (30.55±3.51) % and (20.64±2.83) %, respectively. The percentages of CD3 + and CD4 + in the observation group were significantly higher than those in the control group ( t=8.34, P<0.001; t=6.49, P<0.001), while the percentage of CD8 + ratio was significantly lower ( t=6.86, P<0.001). The KPS score of the observation group was (95.55±9.74) points, and that of the control group was (85.03±8.92) points, and there was a statistically significant difference ( t=5.34, P<0.001). VEGF, ESM1 and CEA levels in the observation group were (303.45±33.21) ng/L, (75.66±8.36) pg/ml and (7.73±0.98) ng/ml, respectively, while those in the control group were (364.53±39.07) ng/L, (92.53±9.91) pg/ml and (9.95±1.13) ng/ml, respectively. VEGF, ESM1 and CEA levels in observation group were significantly lower compared with control group ( t=7.99, P<0.001; t=8.73, P<0.001; t=9.96, P<0.001). The total incidence of adverse reactions was 75.56% (34/45) in the observation group and 66.67% (30/45) in the control group, and there was no statistically significant difference ( χ2=0.87, P=0.352) . Conclusion:Cetuximab combined with mFOLFOX6 chemotherapy regimen in the treatment of advanced colorectal cancer patients has significant clinical efficacy, can improve the immune function of patients, alleviate clinical symptoms, regulate the level of serum tumor markers in patients without increasing adverse reactions, and has good safety.

Objective To establish the rapid discriminate analysis and quantitative analysis methods for carbonized Typhae Pollen(CTP)using near infrared spectroscopy coupled with chemometrics.Methods A total of 186 batches of CTP samples were prepared and categorized into three group including light degree CTP,moderate CTP,and heavy degree CTP.The NIR spectra of these samples were characterized.Then partial least squares-discriminant analysis(PLS-DA),k-nearest neighbors(KNN),support vector machine(SVM)algorithms were separately applied to build the discriminant models.The performance of discriminant models was evaluated in terms of the accuracy(ACC)and the error rate(ER).The partial least squares algorithm was used to establish the quantitative model for the prediction of 3,4-dihydroxybenzoic acid,3-hydroxybenzoic acid,4-hydroxybenzoic acid,azelaic acid,quercetin,quercetin-3-(2G-rhamnosylrutinoside),kaempferol,kaempferol-3-(2G-rhamnosylrutinoside),isorhamnetin,typhaneoside,isorhamnetin-3-O-neohesperidin,and naringenin of CTP samples.The correlation coefficients(rcal,rpre),the root mean square error of calibration(RMSEC),the root mean square error of prediction(RMSEP),and the ratio of performance deviation(RPD)were calculated to assess the PLS model.Results Compared with PLS-DA and KNN models,the SVM model yielded the best classification.The ACC of SVM model was 90.08％for calibration set and 93.44％for prediction set,while the ER was 9.08％for calibration set and 5.31 for prediction set.The values of rcal and r for PLS models were greater than 0.9,and the RPD of that was greater than 2.3.Conclusion In this study,the NIR spectroscopy coupled with chemometrics was firstly applied to develop the rapid discriminant analysis and quantitative analysis methods for CTP.The NIR-based method is rapid,non-destructive,and accurate,and it provides the scientific basis and method support for the rapid judgment of the processing degree of CTP and analysis of the changes of chemical components to ensure the quality of CTP.

Objective To establish the rapid discriminate analysis and quantitative analysis methods for carbonized Typhae Pollen(CTP)using near infrared spectroscopy coupled with chemometrics.Methods A total of 186 batches of CTP samples were prepared and categorized into three group including light degree CTP,moderate CTP,and heavy degree CTP.The NIR spectra of these samples were characterized.Then partial least squares-discriminant analysis(PLS-DA),k-nearest neighbors(KNN),support vector machine(SVM)algorithms were separately applied to build the discriminant models.The performance of discriminant models was evaluated in terms of the accuracy(ACC)and the error rate(ER).The partial least squares algorithm was used to establish the quantitative model for the prediction of 3,4-dihydroxybenzoic acid,3-hydroxybenzoic acid,4-hydroxybenzoic acid,azelaic acid,quercetin,quercetin-3-(2G-rhamnosylrutinoside),kaempferol,kaempferol-3-(2G-rhamnosylrutinoside),isorhamnetin,typhaneoside,isorhamnetin-3-O-neohesperidin,and naringenin of CTP samples.The correlation coefficients(rcal,rpre),the root mean square error of calibration(RMSEC),the root mean square error of prediction(RMSEP),and the ratio of performance deviation(RPD)were calculated to assess the PLS model.Results Compared with PLS-DA and KNN models,the SVM model yielded the best classification.The ACC of SVM model was 90.08％for calibration set and 93.44％for prediction set,while the ER was 9.08％for calibration set and 5.31 for prediction set.The values of rcal and r for PLS models were greater than 0.9,and the RPD of that was greater than 2.3.Conclusion In this study,the NIR spectroscopy coupled with chemometrics was firstly applied to develop the rapid discriminant analysis and quantitative analysis methods for CTP.The NIR-based method is rapid,non-destructive,and accurate,and it provides the scientific basis and method support for the rapid judgment of the processing degree of CTP and analysis of the changes of chemical components to ensure the quality of CTP.