Objectives:To assess the impact of intravascular ultrasound(IVUS)guidance for drug-eluting stent(DES)implantation on the long-term outcomes in coronary artery disease(CAD)patients with chronic kidney disease(CKD).Methods:A retrospective study was conducted on 1 800 CAD and CKD patients who underwent coronary DES implantation at Nanjing First Hospital from January 2018 to December 2022.Patients were divided into IVUS-guided group(IVUS group,n=333)and angiography-guided group(angiography group,n=1 467).Propensity score matching(PSM)was performed at a 1:2 ratio to adjust for differences in baseline clinical and angiographic characteristics between the two groups.Major adverse cardiovascular events(MACE),including cardiac death,target vessel myocardial infarction,and clinically driven target vessel revascularization,were evaluated over a 2-year follow-up.Cox proportional hazards regression was performed to identify independent predictors of MACE.Results:After propensity score matching,333 patients in the IVUS group were matched with 666 patients in the angiography group.Following matching,there were no significant differences in clinical characteristics and angiographic data between the two groups(all P>0.05).Regarding procedural data,IVUS group had a higher number of stents implanted,longer total stent length,larger average stent diameter,more frequent use of post-dilation balloons,larger post-dilation balloon diameter,and greater contrast agent usage(all P<0.05).MACE rate was significantly higher in the angiography group than that in the IVUS group(23.9%vs.18.0%,P=0.037).The difference was mainly attributed to a higher rate of cardiac death in the angiography group(16.1%vs.10.8%,P=0.013).Additionally,patients in angiography group had a significantly higher all-cause mortality rate compared to IVUS group(19.7%vs.13.8%,P=0.022).Multivariate cox regression analysis showed that IVUS guidance(HR=0.73,95%CI:0.55-0.99,P=0.042)was an independent protective factor,while hypertension(HR=1.60,95%CI:1.13-2.26,P=0.008),type 2 diabetes(HR=1.56,95%CI:1.19-2.05,P=0.001),acute coronary syndrome(HR=1.92,95%CI:1.12-3.30,P=0.018),and moderate to severe calcification(HR=1.55,95%CI:1.18-2.04,P=0.002)were independent risk factors for MACE at 2 years after DES implantation in CKD patients.Conclusions:Patients with CAD and CKD,IVUS-guided DES implantation is associated with a reduced risk of MACE and all-cause mortality at 2 years post-procedure compared to coronary angiography-guided implantation.

There is significant inter-individual variation of pharmacokinetics and pharmacody-namics in patients receiving tacrolimus(TAC)for an-ti-rejection therapy,which cause the rejection or toxic action.Based on results of therapeutic drug monitoring and pathophysiological index of trans-plant patients,the individualized dosing regimen can be designed and adjusted by using model in-formed precision dosing(MIPD).The patients'clini-cal outcome can be improved.In the consensus,the different methods of MIPD used for patients re-ceived TAC for anti-rejection therapy were intro-duced,which can be used for the designing and ad-justing doing regimen,predicting adverse drug reac-tion,improving medication adherence and econom-ics during therapy.

Objective To explore the influencing factors of reversible ischemic edema on cranial CT after mechanical thrombectomy for anterior circulation acute large vessel occlusive stroke(ALVOS).Methods A total of 142 patients with anterior circulation ALVOS who underwent mechanical thrombectomy in the First Hospital of Jiaxing from June 2022 to July 2024 were selected as research subjects.According to the results of the postoperative cranial CT scan after mechanical thrombectomy,they were divided into irreversible ischemic edema group(120 cases)and reversible ischemic edema group(22 cases).The baseline clinical data of the patients were collected.Multivariate Logistic regression analysis was used to identify the influencing factors for reversible ischemic edema on cranial CT after mechanical thrombectomy in patients with anterior circulation ALVOS.Receiver operating characteristic(ROC)curve was constructed to evaluate its predictive value for reversible ischemic edema.Results The results of multivariate Logistic regression analysis showed that age(OR=1.057,95％CI:1.018-1.102,P=0.005)and collateral circulation grade(OR=0.395,95％CI:0.186-0.769,P=0.010)were influencing factors for reversible ischemic edema on cranial CT after mechanical thrombectomy for anterior circulation ALVOS.ROC curve analysis results showed that age,collateral circulation grade and their combination had a certain predictive value for reversible ischemic edema on cranial CT after mechanical thrombectomy for anterior circulation ALVOS.The area under the curve(AUC)of age and collateral circulation grade was 0.664 and 0.715,respectively,and AUC of the combination was 0.785,the best cut-off value was 0.861,the sensitivity was 68.3％,and the specificity was 81.8％.Conclusion The low-density area in the ischemic region on cranial CT after mechanical thrombectomy for a small percentage of anterior circulation ALVOS may be reversible.Younger age and good collateral circulation compensation in patients undergoing mechanical thrombectomy are associated with reversible ischemic edema in postoperative cranial CT.

Legionella pneumophila is an important pathogen responsible for legionellosis.Understanding the genetic diversity,evo-lutionary traits,and potential pathogenicity of L.pneumophila in Fujian Province is crucial for the implementation of effective public health interventions.This study was aimed at investigating these aspects through the analysis of environmental isolates collected from 2019 to 2024.A total of 69 environmental isolates of L.pneumophila were collected,and serotypes were determined with agglutination methods.The predominant serotypes were LP1 and LP5,identified in 23 isolates(33.33%)and 15 isolates(18.84%),respectively.Whole-genome sequencing was conducted to assess the genomic characteristics of these isolates.The genomic sizes ranged from 3.26 Mb to 3.81 Mb,and the GC content ranged from 38.0%to 38.3%.Sequence type(ST)1 880 emerged as the dominant strain among the isolates.All isolates carried several virulence-associated genes,including mip,iraA,htpB,LPG_RS03055,and lspM,thus indicat-ing strong potential for pathogenicity.The prevalence of the multidrug resistance genes lpeA and lpeB was 23.2%,thereby suggesting a concerning level of antibiotic resistance.Various mobile genetic elements,such as genomic islands,insertion sequences,phages,and CRISPR/Cas systems,were also detected.In conclusion,our findings emphasize the importance of continued research and surveil-lance of L.pneumophila,particularly the ST1880 clone,to gain a deeper understanding of its transmission mechanisms and to imple-ment control measures effectively.These insights should aid in enhancing public health responses to legionellosis in Fujian Province.

Objective To explore the relationship between CT quantitative left heart structure parameters and recurrence after hypertrophic cardiomyopathy(HCM)and atrial fibrillation(AF)radiofrequency ablation(RFCA).Methods A total of 120 patients with HCM and AF admitted to our hospital from April 2021 to June 2023 were selected.Patients were divided into the relapse group and the non-recurrence group according to whether RFCA recurred 6 months after operation.All patients underwent CT examination,and left ventricular ejection fraction(LVEF),left atrial ejection fraction(LAEF),left atrial volume index(LAVI)and left atrial auricular volume of the two groups were analyzed.The clinical data of patients were collected.Logistic regression model was used to analyze the influencing factors of postoperative recurrence of RFCA in HCM patients with AF.Receiver operating characteristic curve(ROC)curve was used to analyze the predictive efficacy of left heart structure parameters for postoperative recurrence of RFCA in HCM patients with AF.Results The volume levels of LAVI and left auricle were higher in the relapsed group than those in the non-relapsed group,and the level of LAEF was lower than those in the non-relapsed group(P＜0.05).Logistic regression analysis showed that persistent atrial fibrillation,LAVI and high left atrial appendage volume were independent risk factors for postoperative recurrence in HCM patients with AF(P＜0.05),and high LAEF was protective factor(P＜0.05).The results of ROC curve analysis showed that the AUC value of LAVI,LAEF and left atrial appendage volume in predicting recurrence after RFCA in patients with HCM and AF was 0.902,which was higher than that of 0.789,0.755 and 0.675 of each individual test.The combined prediction efficiency of the three tests was higher than that of each single test(Z=2.177,2.555 and 3.628,P＜0.05).Conclusion High level of LAVI and left atrial appendage volume and low level of LAEF are risk factors for postoperative recurrence of RFCA.The combined detection of the three methods has high predictive value for postoperative recurrence of RFCA in HCM patients with AF.

Objective To investigate the mechanisms by which astaxanthin(AST)alleviates oxaliplatin(OXA)-induced neuropathic pain through antioxidant pathways so as to provide theoretical basis for clinical intervention.Methods Animal experiments:SD rats were divided into five groups(n=6):control group,OXA(4 mg/kg)group,OXA+Oil group,OXA+AST(5 mg/kg)group,and OXA+AST(10 mg/kg)group.Mechanical and cold pain thresholds were measured at day 0,7,14,and 21.Malondialdehyde(MDA)content and superoxide dismutase(SOD)activity in the dorsal root ganglia(DRG)were detected using the thiobarbituric acid(TBA)method and WST-1 assay,respectively.Western blotting was performed to analyze the expressions of Nrf2 and HO-1.Cell experiments:neuro-2a cells were divided into control group,OXA(50 μmol/L)group,AST(10 μmol/L)group,and OXA(50 μmol/L)+AST(10 μmol/L)group.Cells were treated with nerve growth factor(NGF,50 ng/mL)to induce growth,and morphological changes were observed under an inverted microscope.Intracellular reactive oxygen species(ROS)level and mitochondrial superoxide were measured using DCFH-DA fluorescent probe and MitoSOXTM red,respectively.Mitochondrial function was assessed by JC-1 assay.Western blotting was used to detect Nrf2 and HO-1 expressions.Results Animal experiments:① Mechanical and cold pain thresholds were reduced in OXA and OXA+Oil groups(P＜0.05),while AST significantly increased these thresholds in OXA-treated rats(P＜0.05).② SOD activity decreased while MDA content increased in the DRG of OXA-treated rats(P＜0.05).AST restored SOD activity and reduced MDA level(P＜0.05,P＜0.01).③ Western blotting showed elevated Nrf2 and HO-1 expressions in OXA group(P＞0.05),which were further upregulated by AST(P＜0.05,P＜0.01).Cell experiments:① OXA reduced the number of neurite-bearing cells and shortened the average neurite length(P＜0.05).Inverted microscopic observation revealed that AST intervention increased both parameters(P＜0.01,P＜0.001).② OXA increased intracellular and mitochondrial ROS fluorescence intensity(P＜0.05),which was attenuated by AST(P＜0.01).③ JC-1 assay revealed decreased mitochondrial membrane potential in OXA group(P＜0.01),which was partially reversed by AST(P＜0.05).④ Western blotting results showed that OXA upregulated Nrf2 and HO-1 expressions(P＜0.05,P＜0.01),and AST further enhanced their levels(P＜0.01).Conclusion AST alleviates OXA-induced neuropathic pain by promoting Nrf2/HO-1 expression,enhancing SOD activity,reducing lipid peroxidation and ROS production,and improving mitochondrial function.

Objective To explore the relationship between CT quantitative left heart structure parameters and recurrence after hypertrophic cardiomyopathy(HCM)and atrial fibrillation(AF)radiofrequency ablation(RFCA).Methods A total of 120 patients with HCM and AF admitted to our hospital from April 2021 to June 2023 were selected.Patients were divided into the relapse group and the non-recurrence group according to whether RFCA recurred 6 months after operation.All patients underwent CT examination,and left ventricular ejection fraction(LVEF),left atrial ejection fraction(LAEF),left atrial volume index(LAVI)and left atrial auricular volume of the two groups were analyzed.The clinical data of patients were collected.Logistic regression model was used to analyze the influencing factors of postoperative recurrence of RFCA in HCM patients with AF.Receiver operating characteristic curve(ROC)curve was used to analyze the predictive efficacy of left heart structure parameters for postoperative recurrence of RFCA in HCM patients with AF.Results The volume levels of LAVI and left auricle were higher in the relapsed group than those in the non-relapsed group,and the level of LAEF was lower than those in the non-relapsed group(P＜0.05).Logistic regression analysis showed that persistent atrial fibrillation,LAVI and high left atrial appendage volume were independent risk factors for postoperative recurrence in HCM patients with AF(P＜0.05),and high LAEF was protective factor(P＜0.05).The results of ROC curve analysis showed that the AUC value of LAVI,LAEF and left atrial appendage volume in predicting recurrence after RFCA in patients with HCM and AF was 0.902,which was higher than that of 0.789,0.755 and 0.675 of each individual test.The combined prediction efficiency of the three tests was higher than that of each single test(Z=2.177,2.555 and 3.628,P＜0.05).Conclusion High level of LAVI and left atrial appendage volume and low level of LAEF are risk factors for postoperative recurrence of RFCA.The combined detection of the three methods has high predictive value for postoperative recurrence of RFCA in HCM patients with AF.

Legionella pneumophila is an important pathogen responsible for legionellosis.Understanding the genetic diversity,evo-lutionary traits,and potential pathogenicity of L.pneumophila in Fujian Province is crucial for the implementation of effective public health interventions.This study was aimed at investigating these aspects through the analysis of environmental isolates collected from 2019 to 2024.A total of 69 environmental isolates of L.pneumophila were collected,and serotypes were determined with agglutination methods.The predominant serotypes were LP1 and LP5,identified in 23 isolates(33.33%)and 15 isolates(18.84%),respectively.Whole-genome sequencing was conducted to assess the genomic characteristics of these isolates.The genomic sizes ranged from 3.26 Mb to 3.81 Mb,and the GC content ranged from 38.0%to 38.3%.Sequence type(ST)1 880 emerged as the dominant strain among the isolates.All isolates carried several virulence-associated genes,including mip,iraA,htpB,LPG_RS03055,and lspM,thus indicat-ing strong potential for pathogenicity.The prevalence of the multidrug resistance genes lpeA and lpeB was 23.2%,thereby suggesting a concerning level of antibiotic resistance.Various mobile genetic elements,such as genomic islands,insertion sequences,phages,and CRISPR/Cas systems,were also detected.In conclusion,our findings emphasize the importance of continued research and surveil-lance of L.pneumophila,particularly the ST1880 clone,to gain a deeper understanding of its transmission mechanisms and to imple-ment control measures effectively.These insights should aid in enhancing public health responses to legionellosis in Fujian Province.

Objective:To explore the application effects of continuous and intermittent suturing of blood vessels under microscope in the repair of limb vascular injuries.Methods:A total of 110 patients with limb vascular injuries admitted to Kaifeng 155 Hospital from Feb 2023 to May 2024 were selected as the research subjects.According to the different methods of vascular suturing,they were divided into two groups,55 patients who underwent intermittent suturing of blood vessels under microscope were selected as the control group,while 55 patients who underwent continuous suturing of blood vessels under microscope were selected as the observation group.The perioperative indicators(arterial and venous suture time,blood circulation recovery time,hospitalization time,total blood loss),blood electrolyte levels(serum potassium ion,sodium ion,and plasma carbon dioxide binding capacity),and coagulation function indicators[prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT)]before surgery,2 h and 1 d after surgery,and the incidence of complications were compared between the two groups.Results:The perioperative related indicators in the observation group were better than those in the control group(P＜0.05).The serum potassium ion,sodium ion,plasma carbon dioxide binding capacity,PT,APTT and TT in the two groups at 2 h and 1 d after operation were significantly higher than those before operation(P＜0.05).And these indicators in the observation group at 2 h after surgery were significantly higher than those in the control group(P＜0.05).However,there was no statistically significant difference in the levels of these indicators between the two groups before surgery and at 1 d after surgery(P＞0.05).The incidence of complications in the observation group was significantly lower than that in the control group(P＜0.05).Conclusion:In the repair of limb vascular injuries,continuous suturing of blood vessels under microscope can effectively shorten the time of vascular suture,reduce blood loss,improve coagulation function and blood electrolyte level,promote postoperative recovery,improve limb motor function,and reduce complications.

OBJECTIVES: To identify potential molecular targets of quercetin in the treatment of clear cell renal carcinoma (ccRCC). METHODS: The therapeutic targets of quercetin were screened from multiple databases by network pharmacology analysis, and the targets significantly correlated with ccRCC were screened from 4907 plasma proteins using a Mendelian randomization method. The drug-disease network model was constructed to screen the potential key targets. The functions of these targets were evaluated via bioinformatics analysis, and the screened targets were verified in cultured ccRCC cells. RESULTS: Network pharmacology analysis combined with Mendelian randomization identified TP53 (OR=3.325, 95% CI: 1.805-6.124, P=0.0001), ARF4 (OR=0.173, 95% CI: 0.065-0.456, P=0.0003), and DPP4 (OR=0.463, 95% CI: 0.302-0.711, P=0.0004) as the core targets in quercetin treatment of ccRCC. Bioinformatics analysis showed that TP53 was highly expressed in ccRCC, and patients with high TP53 expressions had worse survival outcomes. Molecular docking studies showed that the binding energy between quercetin and TP53 was -5.83 kcal/mol. In cultured 786-O cells, CCK-8 assay and wound healing assay showed that treatment with quercetin significantly inhibited cell proliferation and migration. Quercetin treatment also strongly suppressed the expression of TP53 at both the mRNA and protein levels in 786-O cells as shown by RT-qPCR and Western blotting. CONCLUSIONS TP53 may be the key target of quercetin in the treatment of ccRCC, which sheds light on potential molecular mechanism that mediate the therapeutic effect of quercetin.
Humans ; Quercetin/pharmacology* ; Carcinoma, Renal Cell/genetics* ; Cell Proliferation/drug effects* ; Kidney Neoplasms/genetics* ; Cell Movement/drug effects* ; Tumor Suppressor Protein p53/metabolism* ; Cell Line, Tumor ; Computational Biology