Structural valve deterioration (SVD) refers to intrinsic and irreversible pathological changes in the components of prosthetic heart valves, manifesting as fibrosis, calcification, wear and tear, loosening, as well as strut fracture or deformation of the valve framework. These changes ultimately lead to valve stenosis and/or regurgitation.The mechanisms may be related to mechanical stress, immune response and abnormal calcium-phosphorus metabolism. Studies have shown that risk factors for SVD include patient factors (such as age, underlying cardiovascular disease and comorbidities), valve factors (such as material properties, processing techniques, and valve type), and surgical factors (such as valve injury, suboptimal stent expansion, and irregular stent release morphology). Clinical imaging assessment of SVD demonstrates complementary advantages among echocardiography, multi-detector spiral CT and cardiac magnetic resonance imaging, with distinct diagnostic objectives. The primary management strategies for SVD after trans-catheter aortic valve replacement (TAVR) include drug therapy, redo-TAVR, surgical aortic valve replacement (SAVR) and the novel SURPLUS technique. Among them, redo-TAVR has become a common method because of its minimally invasive nature, but it is still necessary to further clarify the patient indications and optimize the surgical strategy. SAVR is reserved for young, low-risk patients; SURPLUS combines the advantages of SAVR and TAVR, making it suitable for cases where redo-TAVR is unfeasible or contraindicated, while the risk of SAVR is excessively high. This article reviews the latest progress of SVD following TAVR treatment to provide reference for research into the durability of bioprosthetic valve and clinical intervention of SVD.
Humans ; Transcatheter Aortic Valve Replacement/adverse effects* ; Heart Valve Prosthesis/adverse effects* ; Prosthesis Failure ; Aortic Valve/pathology* ; Aortic Valve Stenosis/surgery*

Epidural labor analgesia aims to provide effective medical services to alleviate labor pain in parturients, while adhering to the principles of voluntary participation and clinical safety. In 2018, Peking Union Medical College Hospital(PUMCH)became one of the first pilot units for labor analgesia in China, and has achieved satisfactory results in high-quality development of labor analgesia. This article mainly introduces the achievements and experience of labor analgesia at PUMCH, including: (1) prioritizing maternal and infant safety, arranging personnel rationally, and developing standardized treatment processes through multidisciplinary collaboration to ensure safe and comfortable childbirth; (2) leveraging the hospital's comprehensive capabilities in emergency treatment, and improving collaborative rescue plans for critically ill parturients and newborns; (3) implementing advanced teaching methods to effectively train and conduct simulated drills for labor analgesia and rescue of critically ill parturients; (4) conducting patient education and informative lectures to help parturients acquire a scientific understanding of labor analgesia. We hope that this experience can provide reference and inspiration for other hospitals.

OBJECTIVE To explore the mechanism by which gastrodin improves renal hyperten-sion in rats.METHODS A rat model of renal hypertension was established by ligating the renal artery.seventy-five rats were randomly divided into 5 groups(n=15):control group(sham operation group),model group,model+ramipril 1 mg·kg-1,model+gastrodin 100 and 200 mg·kg-1.The systolic blood pressure of the tail artery after modeling>18.12 kPa was regarded as the success of modeling.After the model was established,rats in the model+ramipril group were ig given ramipril 1 mg·kg-1 while the model+gastrodin group was ig given gastrodin 100 and 200 mg·kg-1 respectively for 4 weeks.Colori-metric assay kit was used to detect the serum superoxide dismutase(SOD)activity and malondialde-hyde(MDA)content in rats.ELISA was used to detect serum angiotensin-2(Ang-2)and aldosterone(ALD)contents,as well as serum and thoracic aortic tissue interleukin-1β(IL-1β),IL-6 and tumor necrosis factor α(TNF-α)content.HE staining was performed to detect pathological changes in thoracic aorta tissue of rats.The expressions of autophagy protein miceotubule associated protein light chain 3(LC3)-Ⅱand LC3-Ⅰwere detected by Western blotting.RESULTS The systolic pressure of the tail artery of rats after modeling exceeded 18.12 kPa,indicating that the modeling was successful.Compared with the control group,the contens of Ang-2(P<0.01)and ALD(P<0.01)in the model group were significantly increased,the activity of SOD(P<0.01)in serum and thoracic aorta tissue was significantly decreased,the content of MDA(P<0.01)was significantly increased,the contents of IL-1β,IL-6 and TNF-α in serum and thoracic aorta tissue were significantly decreased(P<0.01)and the ratio of LC-32/LC-31 in thoracic aorta tissue was significantly increased(P<0.01).Compared with the model group,gastrodin significantly increased the systolic pressure of the tail artery(P<0.01),the contents of Ang-2(P<0.01)and ALD(P<0.01)and the activity of SOD(P<0.01)in serum,as well as decreased the contents of MDA,IL-1β,IL-6 and TNF-α(P<0.01)in serum and thoracic aorta tissue.Meanwhile,gastrodin signifi-cantly decreased the ratio of LC3-Ⅱ/LC3-Ⅰ in rat thoracic aorta(P<0.01).CONCLUSION Gastrodin can improve the blood pressure of renal hypertensive rats,and the mechanism is possibly related to the reduction of autophagy protein LC3-Ⅱ/LC3-Ⅰratio.

Lung cancer is the most common cancer in China and even in the world, and it is also the main cause of cancer death. Patients with anaplastic lymphoma kinase (ALK) gene alterations have the opportunity to receive molecularly targeted therapies. The inhibitors of anaplastic lymphoma kinase, such as ALK-tyrosine kinase inhibitors (ALK-TKIs) significantly prolong the survival of patients. ALK gene variant types include point mutation, amplification, fusion/rearrangement, and ALK fusion is more common than other types. However, the effect of different types of gene changes in molecular targeted therapy is different. Therefore, this paper introduced the relevant contents of different variants of ALK gene, focused on the research progress of targeted therapy, and proposed the future development direction.
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Humans ; Lung Neoplasms/pathology* ; Anaplastic Lymphoma Kinase ; Molecular Targeted Therapy ; Receptor Protein-Tyrosine Kinases/antagonists & inhibitors* ; Protein Kinase Inhibitors/therapeutic use*

Objective:To investigate the mechanism by which Melittin-K1 reverses multidrug resistance of BEL-7402/5-FU cells.Methods:CCK-8 assay was used to evaluate the effect of Melittin-K1 on the growth of BEL-7402/5-FU cells and to explore whether Melittin-K1 could reverse the drug resistance of BEL-7402/5-FU cells. The expression of MDR1 mRNA level was detected by real-time fluorescence quantitative PCR assay. The flow cytometry was used to measure the expression of P-glycoprotein (P-gp) on the cell membrane surface and the accumulation of rhodamine-123 in cells.Results:Melittin-K1 significantly inhibited the growth of BEL-7402/5-FU cells in vitro in a time and dose-dependent manner. Melittin-K1 suppressed the level of MDR1 mRNA and inhibited the surface expression and function of P-gp in BEL-7402/5-FU cells. Conclusions:Melittin-K1, a novel peptide, exhibited the activity of reversing multidrug resistance of liver cancer cells.

Objective:To investigate the relationship between uncertainty in illness, coping with adaptive ability and psychological stress response among patients in Emergency Observation Room, and to provide reference for reducing the psychological stress level of patients.Methods:Questionnaire survey was conducted on 260 patients in Emergency Observation Room in a third-grade hospital in Dalian using the general data questionnaire, the Chinese version of the Mishel’Uncertainty in Illness Scale, the Chinese version of the Coping Adaptation Processing Scale and the Stress Response Questionnaire.Results:Coping with adaptive ability played a part in mediating the relationship between uncertainty in illness and psychological stress among patients in Emergency Observation Room. The mediating effect accounted for 32.23% of the total effect. Coping with adaptive ability can reduce the positive reinforcement effect of uncertainty in illness on psychological stress response through emotional and behavioral response pathways.Conclusions:Uncertainty in illness can directly or indirectly affect the psychological stress response of by responding to coping with adaptive ability. It can reduce the influence of psychological stress response on patients' psychosomatic function by reducing the uncertainty in illness and improving the ability to cope with adaptation.

Objective: To comb the thread and trend of critical care fields in China for nearly 15 years, analyze research frontiers, demonstrate research evolution paths, provide reference for researchers and clinicians to carry out related work. Methods: Using CiteSpace software and CNKI database to retrieve research literature about critical care from 2004 to 2018 in China for visual analysis. Results: A total of 3 049 valid articles were retrieved. The research frontiers were mainly about emergency and critical nursing, nursing quality management, intensive care, clinical teaching quality and ICU nurses. Research trends from critical care, critically ill patients, disease condition change, to quality control, family members, nursing skills, basic nursing, now gradually turned to humanized care, nursing strategies, sustainable human care concepts, evolution map showed that emerging trend was more active. Conclusions In last 15 years, research fields of critical care in China have evolved actively, exploring research frontiers, focus on important topics such as evidence-based nursing,humanistic care nursing concept, intensive care information system, and cluster management strategy, extending and deepening professional development of critical care.

Objective: To explore the mediating role of empowerment level in self-management and quality of life in patients with coronary heart disease, and to provide evidence for interventions to improve quality of life in patients with coronary heart disease. Methods: 215 patients with coronary atherosclerotic heart disease in cardiovascular department of hospital in Dalian were selected as the subjects. The Chronic Empowerment Scale, Self-management Behavior Scale of Coronary Heart Disease, China Cardiovascular Patient Quality of Life Assessment Questionnaire and self-made general information questionnaire were used for investigation. Results: The total empowerment, self-management and quality of life of patients with coronary heart disease were (158.75±20.39), (74.50±11.55), and (73.31±23.01). The empowerment, self-management and quality of life of patients with coronary heart disease were positively correlated (r=0.512-0.642, P<0.01). Self-management has a direct positive predictive effect on quality of life. The level of empowerment has a partial mediating effect between self-management and quality of life, and the contribution rate of mediating effect was 31.5%. Conclusions Empowerment, self-management and quality of life of patients with coronary heart disease are closely related. Self-management can influence the quality of life through the empowerment. Nurses should develop active and effective empowerment programs to improve patients' self-management ability and their quality of life.