Objective To investigate the effects of CYP2C9 and VKORC1 gene polymorphism on warfarin stable dose and myocardial injury in patients after heart valve replacement in Qiandongnan region.Methods Clinical data of 110 patients in Qi-andongnan who underwent heart valve surgery at Guizhou Medical University's Second Affiliated Hospital's Cardiothoracic De-partment(form November 2019 to October 2024)were collected.According to CYP2C9*3 genotype,patients were divided into wild type(AA type)and mutant type(AC type and CC type),and VKORC1-1639G>A genotype was divided into wild type(GG type)and mutant type(GA type and AA type).Levene variance homogeneity test was performed first to compare warfarin dose between different genotypes and INRcompliance timebetween groups.The factors affecting the stable dose of warfarin werean-alyzed by hierarchical regression.BP neural network model is used for risk prediction.Generalized linear mixed effects model(GLMMs)was used to analyze the relationship between CYP2C9 and VKORC1 gene status and postoperative myocardial inju-ry.Results The distribution of all genes was consistent with Hardy-Weinberg genetic balance(both P>0.05).CYP2C9*3 and VKORC1-1639G>A gene status were significantly different from atrial fibrillation,myocardial injury,thrombosis and hemor-rhage,and combined drugs(amiodarone,rifampicin,phenobarbital,voriconazole)(all P<0.05).The compliance rate(TTR)and warfarin stable dose of warfarin anticoagulation therapy for CYP2C9*3 genotype AA were significantly higher than that of genotype AC(both P<0.01),and the INR compliance time was significantly lower than that of genotype AC(both P<0.01).The warfarin stable dose and INR reach time of VKORC1-1639G>A genotype GG+GA were significantly higher than geno-type AA(both P<0.01),and TTR was significantly lower than genotype AA(both P<0.01).Stratified regression analysis showed that CYP2C9,VKORC1,age,amiodarone,BSA,BMI and gender had significant effects on warfarin stable dose(all P<0.05).BP neural network model construction showed that CYP2C9 and VKORC1 had the highest contribution to model classifi-cation,followed by amiodarone,BSA,BMI,gender and age.The model verification results showed that the accuracy was 93.54％,the sensitivity and specificity were 85.62％and 95.89％,respectively.The positive predictive value was 94.23％,the negative predictivevaluewas 93.15％,and the ROC AUC fitting of thepredictionmodelwas 0.958.The levels of cTnI,CK-MB and hs-CRP in CYP2C9*3 and VKORC1-1639G>A mutant patients were significantly higher than those in wild-type patients(P<0.05).GLMMs model analysis showed that CYP2C9 and VKORC1 gene mutations were still statistically associated with the risk of postoperative myocardial injury regardless of adjustment factors(P<0.01).Conclusion The CYP2C9 * 3 and VKORC1-1639G>A gene polymorphisms in patients who underwent heart valve replacement surgery in Qiandongnan area sig-nificantly affect the stable dose of warfarin and the rate of achieving anticoagulation targets.Moreover,the mutant genes are closely related to the increase in postoperative myocardial injury indicators and the increased risk.

Objective To investigate the effects of CYP2C9 and VKORC1 gene polymorphism on warfarin stable dose and myocardial injury in patients after heart valve replacement in Qiandongnan region.Methods Clinical data of 110 patients in Qi-andongnan who underwent heart valve surgery at Guizhou Medical University's Second Affiliated Hospital's Cardiothoracic De-partment(form November 2019 to October 2024)were collected.According to CYP2C9*3 genotype,patients were divided into wild type(AA type)and mutant type(AC type and CC type),and VKORC1-1639G>A genotype was divided into wild type(GG type)and mutant type(GA type and AA type).Levene variance homogeneity test was performed first to compare warfarin dose between different genotypes and INRcompliance timebetween groups.The factors affecting the stable dose of warfarin werean-alyzed by hierarchical regression.BP neural network model is used for risk prediction.Generalized linear mixed effects model(GLMMs)was used to analyze the relationship between CYP2C9 and VKORC1 gene status and postoperative myocardial inju-ry.Results The distribution of all genes was consistent with Hardy-Weinberg genetic balance(both P>0.05).CYP2C9*3 and VKORC1-1639G>A gene status were significantly different from atrial fibrillation,myocardial injury,thrombosis and hemor-rhage,and combined drugs(amiodarone,rifampicin,phenobarbital,voriconazole)(all P<0.05).The compliance rate(TTR)and warfarin stable dose of warfarin anticoagulation therapy for CYP2C9*3 genotype AA were significantly higher than that of genotype AC(both P<0.01),and the INR compliance time was significantly lower than that of genotype AC(both P<0.01).The warfarin stable dose and INR reach time of VKORC1-1639G>A genotype GG+GA were significantly higher than geno-type AA(both P<0.01),and TTR was significantly lower than genotype AA(both P<0.01).Stratified regression analysis showed that CYP2C9,VKORC1,age,amiodarone,BSA,BMI and gender had significant effects on warfarin stable dose(all P<0.05).BP neural network model construction showed that CYP2C9 and VKORC1 had the highest contribution to model classifi-cation,followed by amiodarone,BSA,BMI,gender and age.The model verification results showed that the accuracy was 93.54％,the sensitivity and specificity were 85.62％and 95.89％,respectively.The positive predictive value was 94.23％,the negative predictivevaluewas 93.15％,and the ROC AUC fitting of thepredictionmodelwas 0.958.The levels of cTnI,CK-MB and hs-CRP in CYP2C9*3 and VKORC1-1639G>A mutant patients were significantly higher than those in wild-type patients(P<0.05).GLMMs model analysis showed that CYP2C9 and VKORC1 gene mutations were still statistically associated with the risk of postoperative myocardial injury regardless of adjustment factors(P<0.01).Conclusion The CYP2C9 * 3 and VKORC1-1639G>A gene polymorphisms in patients who underwent heart valve replacement surgery in Qiandongnan area sig-nificantly affect the stable dose of warfarin and the rate of achieving anticoagulation targets.Moreover,the mutant genes are closely related to the increase in postoperative myocardial injury indicators and the increased risk.

En bloc resection of bladder tumor(ERBT),as an innovative procedure for conventional transurethral resection of bladder tumor(cTURBT),has become an important treatment option for non-muscle invasive bladder cancer(NMIBC).Although ERBT has been recommended by international guidelines,its technical standardization,verification of long-term survival benefits and stratification of indications are still the focus of future research.This article first provides an overview of the surgical techniques of ERBT,and then elaborates on the advantages and disadvantages of the three energy sources of ERBT,namely,electrocautery,laser,and Hybridknife.In terms of pathological assessment,current research suggests that the detection of detrusor muscle in surgical specimens can reflect the quality of the surgery.The integrity of pathological specimens and diagnostic consistency have promoted the progress of sub-staging of T1 bladder cancer and have also driven more research on microscopic indicators related to prognosis.Finally,this article reviews whether repeated transurethral resection can be avoided to help optimize individualized treatment for bladder tumor.

En bloc resection of bladder tumor(ERBT),as an innovative procedure for conventional transurethral resection of bladder tumor(cTURBT),has become an important treatment option for non-muscle invasive bladder cancer(NMIBC).Although ERBT has been recommended by international guidelines,its technical standardization,verification of long-term survival benefits and stratification of indications are still the focus of future research.This article first provides an overview of the surgical techniques of ERBT,and then elaborates on the advantages and disadvantages of the three energy sources of ERBT,namely,electrocautery,laser,and Hybridknife.In terms of pathological assessment,current research suggests that the detection of detrusor muscle in surgical specimens can reflect the quality of the surgery.The integrity of pathological specimens and diagnostic consistency have promoted the progress of sub-staging of T1 bladder cancer and have also driven more research on microscopic indicators related to prognosis.Finally,this article reviews whether repeated transurethral resection can be avoided to help optimize individualized treatment for bladder tumor.

Objective:To design an auxiliary device based on embedded microcontroller system for venipuncture,which can adjust posture,so as to resolve the problem that occurs failure in puncture due to insufficient exposure of the puncture site in various scenarios.Methods:The device consisted of a support component,an air ring,a component with lifting and angle adjustment,and a pedestal.By advanced embedded microcontroller technique,it can precisely regulate the posture of the support structure of patient's limbs,and fully expose the targeted puncture site,and create more favorable conditions for nurses in performing punctures.A total of 2,482 patients who underwent blood collection at emergency department of the 305th Hospital of the People's Liberation Army from September to October 2024 were selected.The 1,204 patients were enrolled in September were divided into control group(without using the auxiliary device for venipuncture),and the 1,278 patients were enrolled in October were divided into observation group(using the auxiliary device for venipuncture).The puncture's one-time success rates of junior nurses(experience≤3 years)for both groups were compared.Each group respectively selected 150 patients by using the random number table method to conduct investigate,and satisfaction scores for success rate of puncture,and comfort degree of puncture for position,as well as the pain,process and efficiency,were investigated Results:The puncture's one-time success rates of junior nurses for the patients of control and observation groups were respectively 85.05%and 89.36%,with a statistically significant difference(x2=10.35,P<0.05).The satisfaction scores of patients in the observation group were significantly higher than those in the control group,with a statistically significant difference(t=-5.529,P<0.05).Conclusion:This device is simple and convenient in operation,and has favorable stability.It is beneficial to adjust position and exposure puncture site for patients who undergo peripheral venipuncture.It can improve puncture's success rate and patients'satisfaction.

Objective: To investigate the clinical efficacy of en bloc resection of ureteral orifice in the treatment of tumors around ureteral orifice. Methods: Clinical data of 43 patients treated at our hospital during Jul.2018 and Jun.2023 were retrospectively analyzed，including 34 male and 9 female patients.Prior to surgical intervention，all patients were diagnosed with bladder masses via imaging or cystoscopy，and no concurrent upper urinary tract tumors were detected.The initial surgical procedure was transurethral resection of bladder tumor，which removed the tumors around ureteral orifice.Subsequently，electrocoagulation was employed for hemostasis，followed by the placement of a double-J tube into the affected ureter.Tumor recurrence and hydronephrosis were observed after operation. Results: All operations were successful without conversion to open surgery.The operation time was (61±25) min.The postoperative pathological results showed 28 cases of Ta stage tumors，14 cases of T1 stage tumors，and 1 case of T2 stage tumor.During the follow-up of (17±11) months，8 patients (19%) had tumor recurrence，among whom 4 (9%) had recurrent tumor involving the ureteral orifice，and 1 (2%) had transient hydronephrosis after removal of double-J tube. Conclusion: The en bloc resection of the ureteral orifice with placement of a double-J tube is safe and effective for the treatment of tumors around the ureteral orifice，with low recurrence rate.It is an optional procedure for early stage patients.

Background: and Purpose This study aimed to investigate the association between residual inflammatory risk (RIR) and vulnerable plaques using high-resolution magnetic resonance imaging (HRMRI) in symptomatic intracranial atherosclerotic stenosis (ICAS). Methods: This retrospective study included 70%–99% symptomatic ICAS patients hospitalized from January 2016 to December 2022. Patients were classified into four groups based on high-sensitivity C-reactive protein (hs-CRP) and low-density lipoprotein cholesterol (LDL-C): residual cholesterol inflammatory risk (RCIR, hs-CRP ≥3 mg/L and LDL-C ≥2.6 mmol/L), RIR (hs-CRP ≥3 mg/L and LDL-C <2.6 mmol/L), residual cholesterol risk (RCR, hs-CRP <3 mg/L and LDL-C ≥2.6 mmol/L), and no residual risk (NRR, hs-CRP <3 mg/L and LDL-C <2.6 mmol/L). Vulnerable plaque features on HRMRI included positive remodeling, diffuse distribution, intraplaque hemorrhage, and strong enhancement. Results: Among 336 included patients, 21, 60, 58, and 197 were assigned to the RCIR, RIR, RCR, and NRR groups, respectively. Patients with RCIR (adjusted odds ratio [aOR], 3.606; 95% confidence interval [CI], 1.346–9.662; P=0.011) and RIR (aOR, 3.361; 95% CI, 1.774–6.368, P<0.001) had higher risks of strong enhancement than those with NRR. Additionally, patients with RCIR (aOR, 2.965; 95% CI, 1.060–8.297; P=0.038) were more likely to have intraplaque hemorrhage compared with those with NRR. In the sensitivity analysis, RCR (aOR, 2.595; 95% CI, 1.201–5.608; P=0.015) exhibited an additional correlation with an increased risk of intraplaque hemorrhage. Conclusion In patients with symptomatic ICAS, RIR is associated with a higher risk of intraplaque hemorrhage and strong enhancement, indicating an increased vulnerability to atherosclerotic plaques.

Background: and Purpose This study aimed to investigate the association between residual inflammatory risk (RIR) and vulnerable plaques using high-resolution magnetic resonance imaging (HRMRI) in symptomatic intracranial atherosclerotic stenosis (ICAS). Methods: This retrospective study included 70%–99% symptomatic ICAS patients hospitalized from January 2016 to December 2022. Patients were classified into four groups based on high-sensitivity C-reactive protein (hs-CRP) and low-density lipoprotein cholesterol (LDL-C): residual cholesterol inflammatory risk (RCIR, hs-CRP ≥3 mg/L and LDL-C ≥2.6 mmol/L), RIR (hs-CRP ≥3 mg/L and LDL-C <2.6 mmol/L), residual cholesterol risk (RCR, hs-CRP <3 mg/L and LDL-C ≥2.6 mmol/L), and no residual risk (NRR, hs-CRP <3 mg/L and LDL-C <2.6 mmol/L). Vulnerable plaque features on HRMRI included positive remodeling, diffuse distribution, intraplaque hemorrhage, and strong enhancement. Results: Among 336 included patients, 21, 60, 58, and 197 were assigned to the RCIR, RIR, RCR, and NRR groups, respectively. Patients with RCIR (adjusted odds ratio [aOR], 3.606; 95% confidence interval [CI], 1.346–9.662; P=0.011) and RIR (aOR, 3.361; 95% CI, 1.774–6.368, P<0.001) had higher risks of strong enhancement than those with NRR. Additionally, patients with RCIR (aOR, 2.965; 95% CI, 1.060–8.297; P=0.038) were more likely to have intraplaque hemorrhage compared with those with NRR. In the sensitivity analysis, RCR (aOR, 2.595; 95% CI, 1.201–5.608; P=0.015) exhibited an additional correlation with an increased risk of intraplaque hemorrhage. Conclusion In patients with symptomatic ICAS, RIR is associated with a higher risk of intraplaque hemorrhage and strong enhancement, indicating an increased vulnerability to atherosclerotic plaques.

Background: and Purpose This study aimed to investigate the association between residual inflammatory risk (RIR) and vulnerable plaques using high-resolution magnetic resonance imaging (HRMRI) in symptomatic intracranial atherosclerotic stenosis (ICAS). Methods: This retrospective study included 70%–99% symptomatic ICAS patients hospitalized from January 2016 to December 2022. Patients were classified into four groups based on high-sensitivity C-reactive protein (hs-CRP) and low-density lipoprotein cholesterol (LDL-C): residual cholesterol inflammatory risk (RCIR, hs-CRP ≥3 mg/L and LDL-C ≥2.6 mmol/L), RIR (hs-CRP ≥3 mg/L and LDL-C <2.6 mmol/L), residual cholesterol risk (RCR, hs-CRP <3 mg/L and LDL-C ≥2.6 mmol/L), and no residual risk (NRR, hs-CRP <3 mg/L and LDL-C <2.6 mmol/L). Vulnerable plaque features on HRMRI included positive remodeling, diffuse distribution, intraplaque hemorrhage, and strong enhancement. Results: Among 336 included patients, 21, 60, 58, and 197 were assigned to the RCIR, RIR, RCR, and NRR groups, respectively. Patients with RCIR (adjusted odds ratio [aOR], 3.606; 95% confidence interval [CI], 1.346–9.662; P=0.011) and RIR (aOR, 3.361; 95% CI, 1.774–6.368, P<0.001) had higher risks of strong enhancement than those with NRR. Additionally, patients with RCIR (aOR, 2.965; 95% CI, 1.060–8.297; P=0.038) were more likely to have intraplaque hemorrhage compared with those with NRR. In the sensitivity analysis, RCR (aOR, 2.595; 95% CI, 1.201–5.608; P=0.015) exhibited an additional correlation with an increased risk of intraplaque hemorrhage. Conclusion In patients with symptomatic ICAS, RIR is associated with a higher risk of intraplaque hemorrhage and strong enhancement, indicating an increased vulnerability to atherosclerotic plaques.

Objective: To investigate the association between habitual reading/writing postures and the co-occurrence of common health conditions (overweight/obesity, visual impairment, hypertension, and scoliosis) and comorbidities among children and adolescents, in order to provide data support for the joint prevention of common diseases and comorbidities among children and adolescents. Methods: From September 2021 to June 2022, a multi-stage cluster random sampling method was used to select a total of 4 577 children and adolescents from 16 primary and secondary schools in Ningxia: Jinfeng District of Yinchuan City, Shapotou District of Zhongwei City, Yanchi County of Wuzhong City, and Pingluo County of Shizuishan City. A weighted complex sampling design was used to investigate the association of habitual reading and writing postures with common comorbidities in children and adolescents. Results: The prevalence rates of common diseases among children and adolescents in Ningxia were as follows: overweight/obesity was 22.87%, visual impairment was 62.52%, scoliosis was 2.30%, and hypertension was 1.30%. The prevalence of multimorbidity (co-occurrence of ≥2 conditions) among Ningxia children and adolescents was 15.95%. Multivariate unconditional Logistic regression analysis showed that frequent/always collapsing waist and sitting forward with head lowered increased the risk of common comorbidities in children and adolescents ( OR =1.90, P <0.05). Compared with the corresponding reference group, male children and adolescents aged 9 to 12 years and boys had relatively lower risks of overweight/obesity ( OR =0.71, 0.70); the risk of poor vision among children and adolescents aged 9 to 12 years, male, and urban was relatively low ( OR =0.59, 0.60, 0.73)( P < 0.05 ). Children and adolescents who often/always sat leaning to the left or right were at higher risk of poor vision ( OR =1.78); urban children and adolescents had a higher risk of developing scoliosis ( OR =3.71); children and adolescents aged 9 to 12 had a relatively low risk of developing hypertension ( OR =0.09), and children and adolescents who often/always bent their backs and sat forward on their knees had a higher risk of hypertension ( OR =5.03)( P <0.05). Conclusions Ningxia has a high incidence of common diseases and multiple diseases among children and adolescents, frequent or always collapsing waist and sitting forward with head lowered is associated with common comorbidities in children and adolescents in Ningxia. Proper postural measures for reading and writing should be carried out as soon as possible to encourage children and adolescents to develop good reading and writing habits for effectively preventing and controlling the occurrence of common diseases.