OBJECTIVE To investigate the effects of evolocumab combined with atorvastatin on post-percutaneous coronary intervention （PCI） efficacy and coronary microcirculation in patients with acute ST-segment elevation myocardial infarction （STEMI）. METHODS This retrospective cohort study included 194 hospitalized patients with acute STEMI who underwent PCI in the First Affiliated Hospital of Nanyang Medical College from Jan. 2022 to Dec. 2024. The patients were divided into control group （100 cases） and combination therapy group （94 cases） according to the different therapy plans. The control group was given Atorvastatin calcium tablets orally， at a dose of 20 mg， once a day. On the basis of the control group， the combination therapy group received an initial injection of Evolocumab injection 140 mg within 24 hours after PCI， followed by subsequent injections every 2 weeks. Both groups received continuous treatment for at least 30 days. Blood lipid indicators [total cholesterol （TC）， triglycerides （TG）， low-density lipoprotein cholesterol （LDL-C） and high-density lipoprotein cholesterol]， inflammation indicators [C-reactive protein （CRP） and interleukin-6 （IL-6）]， vascular Δ 基金项目河南省医学科技攻关计划项目（No.LHGJ20230971） endothelial function and microcirculation indicators [fibrinogen， ankle-brachial index （ABI） and nitric oxide （NO）]， cardiac function indicators [left ventricular ejection （LVEF）， left ventricular end-diastolic diameter and left ventricular end-systolic diameter] before treatment and after 30 days of treatment， as well as the occurrence of adverse reactions during the treatment， were compared between the two groups. RESULTS Before treatment， there were no statistically significant differences in the levels of the indicators of blood lipid， inflammation， vascular endothelial function and microcirculation， and cardiac function between the two groups （P＞0.05）. After 30 days of treatment， the levels of TC， TG， LDL-C， CRP， IL-6 and fibrinogen in both groups were significantly reduced compared to those before treatment within the same group. The levels of NO and LVEF in both groups， as well as ABI in the combination therapy group， were significantly elevated compared to those before treatment within the same group. Moreover， the improvements in the levels of TC， LDL-C， CRP， IL-6， fibrinogen and NO in the combination therapy group were more pronounced than those in the control group during the same period （P＜0.05）. There were no statistically significant differences in the incidence of liver function impairment， gastrointestinal adverse reactions， or the overall incidence of adverse reactions between the two groups （P＞0.05）. CONCLUSIONS Compared with atorvastatin alone， evolocumab combined with atorvastatin more effectively reduces the blood lipid levels， improves the inflammatory status， vascular endothelial function and coronary microcirculation in patients with acute STEMI after PCI， while the safety is comparable to that of atorvastatin alone.

Objective The anti-inflammatory activity of medicinal plants in the six species of Selaginella genus were compared,and their effective parts and components were analyzed.Methods The total flavonoid content of various extraction parts and the main components of ethyl acetate part of Selaginella were determined by ultraviolet and high-performance liquid chromatography(HPLC),respectively.In vitro inflammatory cell models were constructed using Concanavalin A(ConA)and lipopolysaccharide(LPS)induced rat splenic lymphocytes and mouse macrophages,and cell viability was measured by CCK-8 methods.The nitric oxide(NO)level was determined by the Griess method,and the levels of IL-1β and TNF-α were determined by ELISA.The mRNA expression of inducible nitric oxide synthase(iNOS)and TNF-α,among other inflammatory factors,were detected by RT-PCR.Results The flavonoid content of the ethyl acetate part of Selaginella was relatively high,and biflavonoids such as amentoflavone was the main components.All the extraction parts of the six species of Selaginella showed no significant cytotoxicity.The ethyl acetate part,roberstonin-4'-methylether,and amentoflavone could significantly reduce the release of NO in RAW264.7 cells or lymphocytes,and the ethyl acetate part of Selaginella labordei were the most effective in both models.Selaginella labordei had a rich variety of biflavonoid components,with roberstonin-type biflavonoids relatively higher than other species.The mechanism of action was related to the inhibition of inflammatory factors such as IL-1β and TNF-α levels,the downregulation of mRNA expression of TNF-α,IL-6,IL-1β,iNOS,and others.Conclusion All six species of Selaginella have certain in vitro anti-inflammatory effects and Selaginella labordei showed stronger activity,with biflavonoids as their main active components.

Purpose To explore the forensic pathological features of deaths caused by craniocerebral injury in traf-fic accidents,in order to provide forensic practitioners with a more rigorous approach to identification.Methods A retrospective analysis was performed on 225 autopsy reports of traffic accident fatalities resulting from craniocerebral in-jury.The causes of death were classified,tabulated,and analyzed.Results Among the 225 autopsy reports,the main causes of death included primary brain injury,secondary brainstem injury,and complications.The main types of injuries craniocerebral injuries observed were skull fractures,cerebral hemorrhage,cerebral contusion,cerebral edema and so on.Conclusion The occurrence of craniocerebral injury is related to factors such as age,vehicle,collision speed,and road conditions,and there is an inherent regularity to these factors.Forensic practitioners should combine comprehesive and systematic pathological examinations,clinical data,and the inherent regularities of related factors to make objective,comprehensive,and accurate determinations of the cause of death in traffic accident-related craniocere-bral injuries.

Objective:To explore the influences of FibroScan detection on the pregnancy outcomes of pregnant rats transfected with hepatitis B virus and the growth of their offspring rats.Methods:Sixty SPF-grade SD rats with a male-to-female ratio of 5∶1 were selected，randomly divided the female rats into the groups of mid-pregnancy with hepatitis B，late-pregnancy with hepatitis B，normal mid-pregnancy，normal late-pregnancy，and control group，and the rats in the mid-pregnancy and late-pregnancy groups were subjected to FibroScan testing on the 10th and 15th days of gestation respectively. The number of offspring rats in each group was randomly reduced to 10 on the 3rd day after delivery，and the offspring rats were divided into the groups of mid-pregnancy with hepatitis B，late-pregnancy with hepatitis B，normal mid-pregnancy，normal late-pregnancy，and control group. The pregnancy outcome levels of pregnant rats were observed by adopting a stratified analysis strategy，including differences in weight changes，number of deliveries，fetal rat outcomes，lactation conditions，litter size，and litter weight. The growth levels of offspring rats，including differences in weight，body length，tail length，and the time of fur growth，tooth eruption，eye opening，and ear standing on the 21st day were observed，and the survival rate of the offspring rats was compared.Results:With regard to the pregnancy outcome levels of the pregnant rats，there were no statistically significant differences in weight changes during pregnancy among the five groups of pregnant rats［ F（4，45）=2.627，Adjusted P=0.222］. There were also no statistically significant differences in the number of deliveries，fetal rat outcomes，and lactation conditions（Adjusted P=1.000）. The number of deliveries［ F（4，21.095）=2.280，Adjusted P=0.222］and litter weight［ F（4，20.128）=2.159，Adjusted P=0.222］showed no statistically significant differences. After correction using the BH method，none of the indicators showed significant differences（ P>0.05）. In terms of the growth levels of the offspring rats，among the five groups of offspring rats，there were no statistically significant differences in body weight on the 21st day［H（4）=11.623，Adjusted P=0.135］，body length on the 21st day［H（4）=10.962，Adjusted P=0.135］，and tail length on the 21st day［H（4）=9.126，Adjusted P=0.058］. Besides，the differences in the time of fur growth，tooth eruption，eye opening，and ear standing［H（4）=0.000，Adjust P=1.000］showed no statistical significance. The survival rate on the 7th day，14th day，and 21st day was 100%，with no significant differences（Adjusted P=1.000）. After correction using the BH method，none of the indicators showed significant differences（ P>0.05）. Conclusion:FibroScan detection had no significant influences on the pregnancy outcomes of pregnant rats with hepatitis B or on the growth of their offspring rats in multiple stages，dimensions，and indicators，indicating that FibroScan detection is safe for pregnant rats. This research provides an animal experimental basis for the safe use of FibroScan in pregnant women with chronic HBV infection.

Purpose To explore the forensic pathological features of deaths caused by craniocerebral injury in traf-fic accidents,in order to provide forensic practitioners with a more rigorous approach to identification.Methods A retrospective analysis was performed on 225 autopsy reports of traffic accident fatalities resulting from craniocerebral in-jury.The causes of death were classified,tabulated,and analyzed.Results Among the 225 autopsy reports,the main causes of death included primary brain injury,secondary brainstem injury,and complications.The main types of injuries craniocerebral injuries observed were skull fractures,cerebral hemorrhage,cerebral contusion,cerebral edema and so on.Conclusion The occurrence of craniocerebral injury is related to factors such as age,vehicle,collision speed,and road conditions,and there is an inherent regularity to these factors.Forensic practitioners should combine comprehesive and systematic pathological examinations,clinical data,and the inherent regularities of related factors to make objective,comprehensive,and accurate determinations of the cause of death in traffic accident-related craniocere-bral injuries.

Objective The anti-inflammatory activity of medicinal plants in the six species of Selaginella genus were compared,and their effective parts and components were analyzed.Methods The total flavonoid content of various extraction parts and the main components of ethyl acetate part of Selaginella were determined by ultraviolet and high-performance liquid chromatography(HPLC),respectively.In vitro inflammatory cell models were constructed using Concanavalin A(ConA)and lipopolysaccharide(LPS)induced rat splenic lymphocytes and mouse macrophages,and cell viability was measured by CCK-8 methods.The nitric oxide(NO)level was determined by the Griess method,and the levels of IL-1β and TNF-α were determined by ELISA.The mRNA expression of inducible nitric oxide synthase(iNOS)and TNF-α,among other inflammatory factors,were detected by RT-PCR.Results The flavonoid content of the ethyl acetate part of Selaginella was relatively high,and biflavonoids such as amentoflavone was the main components.All the extraction parts of the six species of Selaginella showed no significant cytotoxicity.The ethyl acetate part,roberstonin-4'-methylether,and amentoflavone could significantly reduce the release of NO in RAW264.7 cells or lymphocytes,and the ethyl acetate part of Selaginella labordei were the most effective in both models.Selaginella labordei had a rich variety of biflavonoid components,with roberstonin-type biflavonoids relatively higher than other species.The mechanism of action was related to the inhibition of inflammatory factors such as IL-1β and TNF-α levels,the downregulation of mRNA expression of TNF-α,IL-6,IL-1β,iNOS,and others.Conclusion All six species of Selaginella have certain in vitro anti-inflammatory effects and Selaginella labordei showed stronger activity,with biflavonoids as their main active components.

Objective:To explore the influences of FibroScan detection on the pregnancy outcomes of pregnant rats transfected with hepatitis B virus and the growth of their offspring rats.Methods:Sixty SPF-grade SD rats with a male-to-female ratio of 5∶1 were selected，randomly divided the female rats into the groups of mid-pregnancy with hepatitis B，late-pregnancy with hepatitis B，normal mid-pregnancy，normal late-pregnancy，and control group，and the rats in the mid-pregnancy and late-pregnancy groups were subjected to FibroScan testing on the 10th and 15th days of gestation respectively. The number of offspring rats in each group was randomly reduced to 10 on the 3rd day after delivery，and the offspring rats were divided into the groups of mid-pregnancy with hepatitis B，late-pregnancy with hepatitis B，normal mid-pregnancy，normal late-pregnancy，and control group. The pregnancy outcome levels of pregnant rats were observed by adopting a stratified analysis strategy，including differences in weight changes，number of deliveries，fetal rat outcomes，lactation conditions，litter size，and litter weight. The growth levels of offspring rats，including differences in weight，body length，tail length，and the time of fur growth，tooth eruption，eye opening，and ear standing on the 21st day were observed，and the survival rate of the offspring rats was compared.Results:With regard to the pregnancy outcome levels of the pregnant rats，there were no statistically significant differences in weight changes during pregnancy among the five groups of pregnant rats［ F（4，45）=2.627，Adjusted P=0.222］. There were also no statistically significant differences in the number of deliveries，fetal rat outcomes，and lactation conditions（Adjusted P=1.000）. The number of deliveries［ F（4，21.095）=2.280，Adjusted P=0.222］and litter weight［ F（4，20.128）=2.159，Adjusted P=0.222］showed no statistically significant differences. After correction using the BH method，none of the indicators showed significant differences（ P>0.05）. In terms of the growth levels of the offspring rats，among the five groups of offspring rats，there were no statistically significant differences in body weight on the 21st day［H（4）=11.623，Adjusted P=0.135］，body length on the 21st day［H（4）=10.962，Adjusted P=0.135］，and tail length on the 21st day［H（4）=9.126，Adjusted P=0.058］. Besides，the differences in the time of fur growth，tooth eruption，eye opening，and ear standing［H（4）=0.000，Adjust P=1.000］showed no statistical significance. The survival rate on the 7th day，14th day，and 21st day was 100%，with no significant differences（Adjusted P=1.000）. After correction using the BH method，none of the indicators showed significant differences（ P>0.05）. Conclusion:FibroScan detection had no significant influences on the pregnancy outcomes of pregnant rats with hepatitis B or on the growth of their offspring rats in multiple stages，dimensions，and indicators，indicating that FibroScan detection is safe for pregnant rats. This research provides an animal experimental basis for the safe use of FibroScan in pregnant women with chronic HBV infection.

Objective     To evaluate the clinical effectiveness of valve-sparing aortic root replacement (VSARR) in the treatment of patients with dilated aortic root after operation for tetralogy of Fallot (TOF). Methods     A retrospective analysis was conducted on clinical data of TOF patients with aortic root dilation who underwent VSARR in our hospital from 2016 to 2022. Results     Finally 14 patients were collected, including 8 males and 6 females, with a median age of 22 years ranging from 12-48 years. Among them, 5 patients had severe aortic valve regurgitation, 4 moderate regurgitation, and 5 mild or no regurgitation. Six patients had sinus of valsalva dilation, and 8 significant dilation of the ascending aorta. One patient had residual shunt due to ventricular septal defect, and 9 severe pulmonary valve regurgitation. The David procedure was performed in 10 patients, Yacoub procedure in 2 patients, and Florida sleeve in 2 patients. There was no perioperative mortality in the group. The median follow-up time was 2.9 years (ranging from 0.4 to 6.0 years). One patient had mild aortic valve regurgitation, and the rest had minimal or no regurgitation. One patient had mild stenosis of the left ventricular outflow tract, and the rest patients had no obvious stenosis. Conclusion     VSARR is a satisfactory treatment for aortic root dilation in patients with TOF, with no significant increase in the incidence of left ventricular outflow tract stenosis or aortic regurgitation during mid-term follow-up.

Objective To investigate the safety and efficacy of transesophageal echocardiography assisted thoracoscopic left atrial appendage clipping in atrial fibrillation patients with high risk of stroke and bleeding.Methods Clinical data of 14 atrial fibrillation patients with high risk of stroke and bleeding from November 2021 to May 2023 was retrospectively analyzed.All the patients had suffered from cerebral infarction.The CHA2DS2-VASc score was 3-7(mean,5.0±1.4)and the HAS-BLED score was 3-4(mean,3.3±0.5).The thoracoscopic surgery was performed with two ports.The left atrial appendage clipping was performed by using a domestically produced E-Clip left atrial appendage closure system,assisted by transesophageal echocardiography.Results All the operations were successfully performed.The mean operation time was(39.6±7.7)min,the mean drainage volume after operation was(80.4±37.1)ml,and the drainage tube was removed at(26.0±2.5)h after operation.All the 14 patients were followed up for 3-21 months,with a median of 8 months.Complete closure of the left atrial appendage without residual leakage and no thrombosis in the left atrium were confirmed by transthoracic echocardiography.No new cerebral infarction or bleeding lesions in the brain was detected by CT scanning.The electrocardiogram showed that 2 patients converted to sinus rhythm and 12 patients still maintained atrial fibrillation rhythm.Conclusions Transesophageal echocardiography assisted thoracoscopic left atrial appendage clipping can completely closure left atrial appendage and avoid new onset of stroke in atrial fibrillation patients with high risk of stroke and bleeding.It can also play a role in electrical isolation of left atrial appendage so as to cure atrial fibrillation in few patients.

Objective The monosaccharide composition of Abelmoschus Manihot Radix polysaccharide was identified and then we evaluated the therapeutic effect on slow transit constipation.Finally,the pharmacodynamic substances and molecular mechanisms in the polysaccharide from Abelmoschus Manihot Radix to improve slow transit constipation were explored by network pharmacology and molecular docking techniques.Methods The polysaccharide from Abelmoschus Manihot Radix has been prepared by aqueous-alcoholic precipitation and has been determined by HPAEC method;The mice model of slow transit constipation was made by sc loperamide(10 mg?kg-1)and the therapeutic effect for the treatment of constipation was evaluated by two indicators:fecal water content and small intestinal propulsion rate;Pathological changes in the colon tissue of STC mice were observed by HE.Immunohistochemical method was used to detect zonula occludens-1(ZO-1)and claudin-1 expression in colon tissue of STC mice;qRT-PCR method was used to detect mRNA expressions of AQP3,AQP4,TNF-α,IL-1β and IL-6 in each group;Network pharmacology and molecular docking technology were used to explore the potential targets and pathways of the polysaccharide from Abelmoschus Manihot Radix in treating slow transit constipation.Results The Polysaccharide from Abelmoschus Manihot Radix significantly increased fecal water content and intestinal propulsion rate in mice caused by slow transit constipation,decreased the expressions of AQP3,AQP4,TNF-α,IL-1β and IL-6 mRNA(P<0.01,P<0.001),protected the integrity of the colonic barrier in STC mice,and increased the protein expressions of ZO-1 and claudin-1 in colon tissues of STC mice.By network pharmacology,it was found that monosaccharides such as rhamnose,fucose and glucuronic acid could mainly act on key targets such as STAT3,JUN,CASP3,HSP90AA1,VEGFA and IL-1β and regulate the Inflammatory mediator regulation of TRP channels,EGFR tyrosine kinase inhibitor resistance and AGE-RAGE signaling pathway in diabetic complications to improve the symptoms of constipation in mice.Western blot results showed that intervention with polysaccharides from the roots of Solanum palmatum significantly reduced the expression of CASP3,VEGFA and IL-1β protein in the colon tissue of constipated mice.Conclusion The polysaccharide from Abelmoschus Manihot Radix can treat slow transit constipation through multi-component,multi-target and multi-pathway therapy.It provides a scientific basis for the further clinical application of Abelmoschus Manihot and drug development(National patent ZL202310894613.3.has been authorized)and it is expected to promote the efficient utilisation of resources from the non-medicinal parts of Abelmoschus Manihot.