1.Comprehensive clinical evaluation of phosphate-lowering drugs in the treatment of chronic kidney disease with hyperphosphatemia
Lu LIU ; Cangsang SONG ; Xingde LI ; Chunni HAN ; Run SUN ; Chunjie YU ; Yalin LI
China Pharmacy 2026;37(14):1918-1924
OBJECTIVE To conduct a comprehensive clinical evaluation of phosphate-lowering drugs in the treatment of chronic kidney disease (CKD) with hyperphosphatemia, and to provide evidence-based support for clinical drug decision-making. METHODS Relevant studies meeting the inclusion and exclusion criteria were retrieved, a comprehensive evaluation of efficacy, safety and economics was conducted based on existing study results. Innovation was analyzed from three aspects including filling the clinical gap, and suitability was assessed from two aspects including technical suitability. Accessibility was evaluated based on the survey data from 37 medical institutions in Kunming, combined with information from the National Reimbursement Drug List and national centralized drug procurement. RESULTS A total of 10 meta-analyses and 2 pharmacoeconomic studies were included. In terms of efficacy, all three categories of phosphate-lowering drugs (calcium-based phosphate binders, non-calcium-based phosphate binders, sodium-hydrogen exchanger 3 inhibitors) effectively reduced serum phosphorus levels. Calcium-based phosphate binders elevated serum calcium levels more significantly; sevelamer was superior to calcium-based phosphate binders in reducing intact parathyroid hormone levels; iron-based phosphate binders improved iron metabolism and anemia-related indicators. In terms of safety, iron-based phosphate binders had the highest incidence of gastrointestinal adverse reactions, followed by lanthanum carbonate. In terms of economics, sevelamer demonstrated economic advantages over calcium-based phosphate binders and lanthanum carbonate. In terms of innovation, non-ca lcium-based phosphate binders addressed the clinical limitation of hypercalcemia associated with calcium-based phosphate binders; iron-based phosphate binders met the treatment needs of patients with comorbid iron deficiency anemia; tenapanor exhibited an innovative phosphorus-lowering mechanism. In terms of suitability, all three categories showed good suitability in various aspects. In terms of accessibility, sevelamer had the highest availability rate, while tenapanor was not yet available in medical institutions. All three categories have been included in the National Reimbursement Drug List ; the prices of lanthanum carbonate and sevelamer decreased substantially following centralized procurement with improved affordability. CONCLUSIONS For CKD patients with hyperphosphatemia, non-calcium-based phosphate binders are preferred, among which sevelamer is recommended as the first-line choice. Lanthanum carbonate may be considered for patients with gastrointestinal intolerance; iron-based phosphate binders are preferred for patients with comorbid iron deficiency anemia; tenapanor may be considered for patients with poor response to or intolerance of conventional regimens; calcium-based phosphate binders are not recommended as long-term first-line therapy.
2.Predictive value of exodrift for long-term postoperative eye position regression in children with intermittent exotropia
International Eye Science 2026;26(9):1536-1543
AIM:To investigate the predictive role of exodrift amount on long-term postoperative eye position regression in children with intermittent exotropia.METHODS:Prospective cohort study.Children with intermittent exotropia who underwent surgical treatment at the hospital between September 2023 and July 2025 were included. Based on the eye position regression status at 6 mo postoperatively, patients were divided into a regression group and a non-regression group. Clinical data of two groups were compared. The relationship between exodrift and visual function was analyzed. Multivariate linear regression was used to examine the association between exodrift and visual function. Logistic multivariable analysis identified factors influencing long-term postoperative eye position regression. A regression discontinuity design(RDD)was employed to evaluate the validity and robustness of the results. Interval likelihood ratios were analyzed to assess the relationship between exodrift and long-term postoperative eye position regression. Receiver operating characteristic(ROC)curves were used to evaluate the predictive value of exodrift for long-term postoperative eye position regression. Restricted cubic splines(RCS)were applied to analyze the dose-response relationship between exodrift and the risk of long-term postoperative eye position regression.RESULTS:This study initially included 133 children with intermittent exotropia. Among them, 5 cases were lost to follow-up. Eventually, 128 cases completed the follow-up(43 cases in the regression group and 85 cases in the non-regression group). The age of the children with intermittent exotropia ranged from 2 to 15 y(mean 9.89±2.61 y), with 82 boys and 46 girls. The age of the regression group was 9.82±2.64 y(26 boys and 17 girls). The age of the non-regression group was 9.96±2.58 y(56 boys and 29 girls). The two groups showed significant differences in Titmus near stereopsis, strabismus type, postoperative day 1 eye position, and postoperative day 1 exodrift(all P<0.05). There was no significant correlation between the amount of exodrift 1 d after the surgery and visual function(all P>0.05). Multiple linear regression analysis showed that there was no statistical significance between visual function and the amount of exodrift 1 d after surgery(all P>0.05). Titmus near stereopsis, convergence insufficiency type of strabismus, inward deviation(esophoria)at 1 d postoperatively, and an increased exodrift at 1 d postoperatively were identified as risk factors for postoperative eye position regression(all P<0.05). When exodrift after surgery was 9 PD at 1 d postoperatively, the risk of long-term eye position regression after surgery significantly decreased(P<0.001). When exodrift of the eye after surgery ≥14 PD at 1 d postoperatively, the probability of long-term eye position regression was relatively highest. When the cut-off value was 9 PD, the AUC of the predicted postoperative 1-day exodrift for predicting the long-term postoperative eye position regression was 0.809(95%CI: 0.749-0.869), indicating a relatively high predictive value. As the amount of exodrift increases 1 d after the surgery, the risk of long-term eye position regression also increases.CONCLUSION:The amount of exodrift 1 d after surgery is arisk factor for the long-term eye position regression in children with intermittent exotropia. The two are in a dose-response relationship. When the amount of exodrift 1 d after surgery is ≥14 PD, the risk of regression is the highest. The optimal cut-off value of 9 PD has a high predictive value for long-term eye position regression. Clinically, the amount of exodrift 1 d after surgery can be monitored to assess the risk of regression 6 mo after surgery, providing a reference basis for the clinical formulation of individualized follow-up plans.
3.Cost-effectiveness of angiographic quantitative flow ratio-guided coronary intervention: A multicenter, randomized, sham-controlled trial.
Yanyan ZHAO ; Changdong GUAN ; Yang WANG ; Zening JIN ; Bo YU ; Guosheng FU ; Yundai CHEN ; Lijun GUO ; Xinkai QU ; Yaojun ZHANG ; Kefei DOU ; Yongjian WU ; Weixian YANG ; Shengxian TU ; Javier ESCANED ; William F FEARON ; Shubin QIAO ; David J COHEN ; Harlan M KRUMHOLZ ; Bo XU ; Lei SONG
Chinese Medical Journal 2025;138(10):1186-1193
BACKGROUND:
The FAVOR (Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients with Coronary Artery Disease) III China trial demonstrated that percutaneous coronary intervention (PCI) lesion selection using quantitative flow ratio (QFR) measurement, a novel angiography-based approach for estimating fractional flow reserve, improved two-year clinical outcomes compared with standard angiography guidance. This study aimed to assess the cost-effectiveness of QFR-guided PCI from the perspective of the current Chinese healthcare system.
METHODS:
This study is a pre-specified analysis of the FAVOR III China trial, which included 3825 patients randomized between December 25, 2018, and January 19, 2020, from 26 centers in China. Patients with stable or unstable angina pectoris or those ≥72 hours post-myocardial infarction who had at least one lesion with a diameter stenosis between 50% and 90% in a coronary artery with a ≥2.5 mm reference vessel diameter by visual assessment were randomized to a QFR-guided strategy or an angiography-guided strategy with 1:1 ratio. During the two-year follow-up, data were collected on clinical outcomes, quality-adjusted life-years (QALYs), estimated costs of index procedure hospitalization, outpatient cardiovascular medication use, and rehospitalization due to major adverse cardiac and cerebrovascular events (MACCE). The primary analysis calculated the incremental cost-effectiveness ratio (ICER) as the cost per MACCE avoided. An ICER of ¥10,000/MACCE event avoided was considered economically attractive in China.
RESULTS:
At two years, the QFR-guided group demonstrated a reduced rate of MACCE compared to the angiography-guided group (10.8% vs . 14.7%, P <0.01). Total two-year costs were similar between the groups (¥50,803 ± 21,121 vs . ¥50,685 ± 23,495, P = 0.87). The ICER for the QFR-guided strategy was ¥3055 per MACCE avoided, and the probability of QFR being economically attractive was 64% at a willingness-to-pay threshold of ¥10,000/MACCE avoided. Sensitivity analysis showed that QFR-guided PCI would become cost-saving if the cost of QFR were below ¥3682 (current cost: ¥3800). Cost-utility analysis yielded an ICER of ¥56,163 per QALY gained, with a 53% probability of being cost-effective at a willingness-to-pay threshold of ¥85,000 per QALY gained.
CONCLUSION:
In patients undergoing PCI, a QFR-guided strategy appears economically attractive compared to angiographic guidance from the perspective of the Chinese healthcare system.
TRIAL REGISTRATION
ClinicalTrials.gov , NCT03656848.
Humans
;
Cost-Benefit Analysis
;
Percutaneous Coronary Intervention/methods*
;
Male
;
Female
;
Coronary Angiography/methods*
;
Middle Aged
;
Aged
;
Coronary Artery Disease/surgery*
;
Quality-Adjusted Life Years
;
Fractional Flow Reserve, Myocardial/physiology*
4.Early results and indications of Stand-alone oblique lateral interbody fusion in lumbar lesions.
Zhong-You ZENG ; Xing ZHAO ; Wei YU ; Yong-Xing SONG ; Shun-Wu FAN ; Xiang-Qian FANG ; Fei PEI ; Shi-Yang FAN ; Guo-Hao SONG
China Journal of Orthopaedics and Traumatology 2025;38(5):454-464
OBJECTIVE:
To summarize the early clinical results and safety of Stand-alone OLIF application of lumbar lesions, and explored its surgical indications.
METHODS:
Total of 92 cases of lumbar spine lesions treated with Stand-alone OLIF at two medical centers from October 2014 to December 2018 were retrospectively analyzed, including 30 males and 62 females with an average age of (61.20±12.94) years old ranged from 32 to 83 years old. There were 20 cases of lumbar spinal stenosis, 15 cases of lumbar disc degeneration, 11 cases of lumbar degenerative spondylolisthesis, 6 cases of discogenic low back pain, 7 cases of giant lumbar disc herniation, 13 cases of primary lumbar discitis, 6 cases of adjacent vertebral disease after lumbar internal fixation surgery, and 14 cases of degenerative lumbar scoliosis. Pre-operative dual energy X-ray bone density examination 31 cases' T-values ranged from -1 to -2.4, 8 cases' T-values ranged from -2.5 to -3.5, and the rest had normal bone density. The number of fusion segments: 68 cases of single segment, 9 cases of two segment, 12 cases of three segment , and 3 cases of four segment. Fusion site:L1,2 1 case, L2,3 4 cases, L3,4 10 cases, L4,5 53 cases, L2,3-L3,4 3 cases, L3,4-L4,5 6 cases, L1,2L2,3L3,4 1 case, L1,2L3,4L4,5 1 case, L2,3L3,4L4,5 10 cases, L1,2L2,3L3,4L4,5 3 cases. The clinical results and imaging results of this group of cases were observed, as well as the complications.
RESULTS:
The surgical time ranged from 40 to 140 minutes with an average of (60.92±27.40) minutes. The intraoperative bleeding volume was 20 to 720 ml with an average of (68.22±141.60) ml. The patients had a follow-up period of 6 to 84 months with an average of (38.50±12.75) months. The height of the intervertebral space recovered from (9.23±1.94) mm in preoperative to (12.68±2.01) mm in postoperative, and (9.11±1.72) mm at the last follow-up, there was a statistically significant difference(F=6.641, P=0.008);there was also a statistically significant difference between the postoperative and preoperative height of the intervertebral space(t=9.27, P<0.000 1);and there was also a statistically significant difference (t=10.06, P<0.000 1) between the last follow-up and postoperative height of the intervertebral space. At the last follow-up, cage subsidence grading was as follows:level 0 in 69 cases (76 segments), levelⅠin 17 cases (43 segments), level Ⅱin 5 cases (14 segments), and level Ⅲ in 1 case (1 segment);according to the number of segments, normal subsidence accounts for 56.72%, abnormal subsidence accounts for 43.28%. Bone mineral desity of normal subsidence groups was -0.50±0.07 whinch was better than that the abnormal subsidence groups -2.10±0.43, and the difference was statistically significant(χ2=2.275, P=0.014). As well as there was a statistically significant difference in the patient's VAS of backache from (6.28±2.11) in preoperative to (1.48±0.59) in last follow-up(t=8.56, P<0.05). The ODI recovered from (36.30±7.52)% before surgery to (10.20±2.50)% at the last follow-up, with a statistically significant difference (t=7.79, P<0.000 1). Complications involved 4 cases of intraoperative vascular injury, 21 cases of endplate injury, and 4 cases of combined vertebral fractures. The incision skin has no necrosis or infection. There were 4 cases of left sympathetic chain injury, 4 cases of transient left hip flexion weakness, 2 cases of left thigh anterolateral numbness with quadriceps femoris weakness, and 1 case of incomplete intestinal obstruction;8 cases were treated with posterior pedicle screw fixation due to fusion cage settlement accompanied by stubborn lower back pain, and 6 cases were treated with fusion cage settlement and lateral displacement. According to the actual number of cases, there were 38 complications, with an incidence rate of 41.3%.
CONCLUSION
The application of Stand alone OLIF in lumbar spine disease fusion has achieved good early results, with obvious clinical advantages, but also there are high probability of complications. It is recommended to choose carefully. It is necessary to continuously summarize and gradually clarify and complete the surgical indications and specific case selection criteria.
Humans
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Male
;
Female
;
Middle Aged
;
Spinal Fusion/methods*
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Lumbar Vertebrae/injuries*
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Aged
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Adult
;
Retrospective Studies
;
Aged, 80 and over
5.Application of oblique lateral interbody fusion channel technique in lumbar infection.
Sheng-Yun LI ; Jun LI ; Xiao-Rui ZHANG ; Jie SONG ; Xiu-Lei XU ; Kai LYU ; Xing ZHAO
China Journal of Orthopaedics and Traumatology 2025;38(5):473-481
OBJECTIVE:
To investigate the efficacy and safety of oblique lateral interbody fusion(OLIF) channel technique combined with pedicle screw internal fixation in the treatment of single-segment lumbar intervertebral space/vertebral body infection.
METHODS:
A retrospective analysis was conducted on 23 patients who underwent surgical treatment for lumbar infection from January 2021 to December 2022. The patients were divided into the OLIF channel group and the traditional open surgery group according to the surgical methods. There were 16 cases in the OLIF channel group, including 9 males and 7 females, with an average age of (68.5±12.1) years old;there were 7 cases in the traditional open surgery group, including 4 males and 3 females, with an average age of (75.0±3.2) years old. The operation time, intraoperative blood loss, hospital stay, incision length, visual analogue scale(VAS), activities of daily living (ADL) score, Oswestry disability index (ODI), erythrocyte sedimentation rate(ESR), C-reactive protein(CRP) before and 1 week and 3 months after the operation, and the intervertebral fusion status on the last follow-up CT were compared between the two groups.
RESULTS:
Compared with the open surgery group, the OLIF channel group had shorter operation time (209.87±31.5) min vs. (246.0±42.7) min, less intraoperative blood loss (225.625±91.1) ml vs. (364.2±74.8) ml, and shorter incision length (6.1±1.2) vs. (14.0±1.4) cm, and the differences were statistically significant(P<0.05). Before and 1 week and 3 months after the operation, the lumbar VAS in the OLIF group were (6.3±0.6), (2.8±0.7), (1.1±0.5), and those in the traditional open surgery group were (6.4±0.6), (3.4±0.5), (1.2±0.3);the ADL scores in the OLIF group were (45.0±4.5), (60.3±4.3), (94.1±4.2), and those in the open group were (46.4±5.6), (60.7±4.5), (92.9±4.9); the ODI scores in the OLIF group were (86.3±2.9)%, (69.5±4.1)%, (23.0±3.2)%, and those in the open group were (87.3±3.8)%, (69.8±4.2)%, (23.8±3.6)%, all of which showed significant improvement(P<0.05). Three months after the operation, CRP, PCT, and ESR were significantly lower than those before the operation, and CRP and PCT returned to normal, while ESR was still slightly elevated in some patients. The last follow-up CT showed that continuous trabecular bone formation was observed between the upper and lower endplates of the surgical segments in all patients, and the fusion time was (8.7±4.5) months.
CONCLUSION
The OLIF channel technique combined with posterior internal fixation is a minimally invasive and effective treatment method, which can effectively control infection, relieve pain, and improve the quality of life of patients. Compared with traditional open surgery, it has the advantages of minimally invasive, shorter operation time, and less intraoperative blood loss.
Humans
;
Male
;
Female
;
Spinal Fusion/methods*
;
Lumbar Vertebrae/microbiology*
;
Aged
;
Middle Aged
;
Retrospective Studies
;
Aged, 80 and over
;
Pedicle Screws
;
Infections/surgery*
6.Correlation between postoperative intervertebral space infection and expressions of β-catenin and GSK-3β proteins in peripheral blood of lumbar disc herniation patients
Naihao LIU ; Hongrui LIANG ; Yongsheng SONG ; Yingnan WANG ; Run LI
Chinese Journal of Nosocomiology 2025;35(5):667-671
OBJECTIVE To analyze the relationship between the postoperative intervertebral space infection and the expressions of β-catenin and glycogen synthase kinase-3β(GSK-3β)in the patients with lumbar disc herniation(LDH).METHODS A total of 201 patients with LDH who received surgical procedures in Harbin Orthopedics and Traumatology Hospital from Jan.2022 to May 2024 were enrolled in the study and were divided into the infection group and the no infection group according to the status of postoperative intervertebral space infection.The distri-bution and drug resistance of pathogens isolated from the patients of the infection group were detected.The rela-tive expression levels of peripheral blood Wnt,β-catenin and GSK-3β proteins were compared between the two groups.RESULTS Among the 201 patients who received surgical procedures,21 had postoperative intervertebral space infections,with the infection rate 10.45%.Totally 26 strains of pathogens were isolated from the 21 patients in the infection group,11(42.31%)of which were gram-negative bacteria,and 15(57.69%)were gram-positive bacteria.The operation duration of the infection group was(3.46±0.89)hour,longer than(3.09±0.73)hour of the no infection group(t=2.146,P=0.033).There were significant differences in the expressions of peripheral blood β-catenin and GSK-3β proteins between the infection group and the no infection group(P<0.05).Receiver operating characteristic(ROC)curve analysis showed that the areas under the curves(AUCs)of the relative ex-pression levels of β-catenin and GSK-3β were 0.836 and 0.800,respectively;the sensitivities were 52.40%and 66.70%,respectively;the specificities were 90.56%and 93.89%,respectively;the cut-off point were 5.65 and 2.15,respectively.CONCLUSIONS The LDH patients are at high risk of postoperative intervertebral space infec-tion,the patients with the infection show the activation of Wnt/β-catenin signaling pathways and the rise of ex-pression levels of β-catenin and GSK-3β proteins.The levels of the indexes may facilitate the prediction of postop-erative intervertebral space infection in the LDH patients.
7.Advancements and challenges of acupuncture randomized controlled trials.
Wei Song SEETOH ; Rachel Qin Rui LIM ; Run-Bing XU ; Ming-Xun SUN ; Peng ZHANG ; Mi-Na WANG
Journal of Integrative Medicine 2025;23(4):333-343
Acupuncture is an ancient treatment method used in traditional Chinese medicine and has been popularized worldwide. Over the past decade, there has been an increase in the amount of acupuncture research, mostly comprised of randomized controlled trials (RCTs) that aimed to answer the question on the efficacy of acupuncture. However, poor methodology and low replicability in these acupuncture RCTs have resulted in uncertainty about the efficacy of acupuncture. In this review, current advancements and challenges in acupuncture RCTs, regarding the methodological aspects of randomization, blinding, sham acupuncture and quality of reporting, were discussed. While there have been advancements in various aspects, current acupuncture RCTs still face pressing issues such as inadequate randomization and blinding, unviable sham acupuncture controls, and poor reporting quality. Given these limitations, this review seeks to identify the methodological problems that are responsible for these problems and to suggest solutions that could help to overcome them so as to improve the quality of future studies evaluating the efficacy of acupuncture. Please cite this article as: Seetoh WS, Lim RQR, Xu RB, Sun MX, Zhang P, Wang MN. Advancements and challenges of acupuncture randomized controlled trials. J Integr Med. 2025; 23(4): 333-343.
Acupuncture Therapy
;
Humans
;
Randomized Controlled Trials as Topic/methods*
;
Research Design
8.Improvement effect of isoquercitrin on anxiety rats through modulation of BDKRB2/PI3K/Akt pathway in hippocampus
De-di GUO ; Yi-wei ZHANG ; Xiang-jun WANG ; Xi-tai CHEN ; Huai-wei ZHAO ; Run-wei SONG ; Chang-lin WANG ; Chun-hong SONG
Chinese Pharmacological Bulletin 2025;41(7):1359-1367
Aim To explore the action mechanism of isoquercitrin(IQ)in ameliorating anxiety based on network pharmacology,cellular transcriptomics,molecu-lar docking and animal experiments.Methods The common targets of anxiety disorders and IQ were ob-tained by using relevant databases.The protein-protein interaction network,the biological function and signa-ling pathway enrichment analysis were conducted by u-sing the common targets.Primary hippocampal neurons were cultured in vitro,and corticosterone was added to induce neurons to establish a corticosterone injury mod-el.IQ treatment was added to the culture system,and transcriptomics was used to screen for differentially ex-pressed genes and enrich for differentially expressed pathways.Subsequently,the results were validated by quantitative real-time polymerase chain reaction(qRT-PCR).Possible targets and signaling pathways for IQ treatment on anxiety were speculated and screened u-sing network pharmacology,transcriptomics and molec-ular docking.The anxiety rat model was constructed,and the anxiety state of rats was evaluated after IQ in-tervention,and the protein expression level of hippo-campus was detected to verify the relevant mechanism.Results Network pharmacology,cellular transcrip-tome,and molecular docking analyses revealed that the key mechanism of IQ for anxiety may be related to the BDKRB2/PI3K/Akt signaling pathway.Animal exper-iments showed that IQ was effective in improving anxie-ty behaviour and learning memory ability in rats.IQ increased the movement distance and residence time in the central area of the open field,the time and number percentage of entries into the open arm in the elevated plus maze,and the spontaneous alternations score in the Y maze in rats,and significantly elevated protein expression of BDKRB2,PI3K,Akt and decreased pro-tein expression of NF-κB in the hippocampus.Conclu-sions Isoquercitrin can effectively treat anxiety,and the mechanism of action may be related to the regula-tion of BDKRB2/PI3K/Akt signaling pathway in hip-pocampus.
9.Effect of CYFIP1 on proliferation and apoptosis of colorectal cancer cell HT29
Fu-long YU ; Liang LI ; Hao QIANG ; Hui YUAN ; Song WANG ; Xiao-hu CHENG ; Run-ben JIANG ; Ya-ru YANG ; Zhi-ning LIU
Chinese Pharmacological Bulletin 2025;41(1):116-121
Aim To investigate the expression levels of cytoplasmic FMR1-interacting protein-1(CYFIP1)in colorectal cancer and assess the impact of CYFIP1 interaction on the proliferation and apoptosis of colorec-tal cancer cell HT29,along with its potential mecha-nisms.Methods Immunohistochemistry was em-ployed to assess CYFIP1 expression in 32 colorectal cancer tissues and adjacent tissues.Coexpressed genes were identified using the GEPIA2 website to predict potential correlations and binding sites.Following the construction of a siRNA-CYFIP1,alterations in cell proliferation,apoptosis,and levels of apoptosis-related proteins were evaluated through CCK-8 assay,Hoechst 33342/PI double staining assay,and Western blot a-nalysis,respectively.Results The immunohisto-chemical findings revealed a significantly elevated level of CYFIP1 expression in colorectal cancer tissues com-pared to paracancer tissues(P<0.05).The expres-sion of CYFIP1 did not show any correlation with age and gender,but exhibited associations with TNM stage and lymph node metastasis(P<0.05).A conserved TP53 binding site was predicted in the 3kbps DNA re-gion upstream of the CYFIP1 gene using GEPIA2,JASPAR databases,and rVista 2.0 promoter prediction software.Following transfection of HT29 cells with siRNA-CYFIP1,the clonogenesis and proliferation of cells significantly decreased(P<0.05).Additional-ly,the levels of cleaved caspase-3 were elevated,while the expression levels of caspase-3 and Bcl-2 were reduced after transfection with siRNA-CYFIP1(P<0.05),which might be related to the interaction be-tween CYFIP1 and TP53.Conclusions The upregu-lation of CYFIP1 in colorectal cancer is associated with TNM stage and lymph node metastasis.Upon silen-cing,CYFIP1 demonstrates the ability to suppress pro-liferation in HT29 cells and modulate the expression of apoptotic proteins.
10.Early right heart function management strategy and prognosis after left ventricular assist device implantation in patients with right ventricular dysfunction
Li LI ; Cui ZHANG ; Xin CHEN ; Luo ZHUO ; Huan XU ; Shangyu CHEN ; Yinying XUE ; Run FU ; Xiaochun SONG
Chinese Journal of Thoracic and Cardiovascular Surgery 2025;41(5):264-270
Objective:To investigate the early right heart function management strategy and prognosis after left ventricular assist device(LVAD) implantation in patients with preoperative right ventricular dysfunction.Methods:A retrospective study was conducted. From March 2022 to April 2024, a total of 28 patients with end-stage heart failure underwent LVAD implantation at Nanjing First Hospital and were admitted to the intensive care unit(ICU) after surgery. Among them, patients with preoperative right ventricular dysfunction were enrolled. All patients were implanted with Corheart 6 implantable left ventricular assist device. The clinical data, occurrence of postoperative right heart failure and postoperative survival situations of enrolled patients were collected and analyzed.Results:A total of 12 patients were included in this study, including 11 males and 1 female, the mean age was(58.4±7.6) years old. Upon postoperative admission to ICU, the most commonly used positive inotropic agent was epinephrine(9 cases), followed by dobutamine(8 cases). By the second day after surgery, the most frequently utilized vasoactive medications were epinephrine and phosphodiesterase type Ⅲ inhibitors, both with 9 cases of usage. None of the enrolled patients utilized temporary mechanical circulatory assist devices. The LVAD pump speed of the patients enrolled in the study was set at approximately 2 700 revolutions per minute, and the pump flow was approximately 3 liters per minute. During the first two days after the operation, the fluid balance of the enrolled patients ranged from(-523.4±775.6)ml to(-1 248.0±1 023.9)ml. At 48 h following the operation, the mean pulmonary artery pressure(MPAP)[(26.2±4.8) mmHg vs.(32.1±6.5) mmHg(1 mmHg=0.133 kPa), P=0.042] and the pulmonary artery wedge pressure(PAWP)[(15.6±5.5)mmHg vs.(24.9±5.9) mmHg, P=0.003) ] of the enrolled patients were significantly decreased compared to preoperative levels, while the cardiac index(CI) was significantly improved[(2.7±0.2)L·min -1·m -2 vs.(2.1±0.5)L·min -1·m -2,P=0.024]. Echocardiography showed that the left atrial diameter(LAD)[(51.5±7.6)mm vs.(57.2±9.0)mm, P=0.005] and left ventricular end diastolic diameter(LVDd)[(73.5±11.5)mm vs.(78.3 ± 12.3)mm, P=0.012) ] were significantly reduced post LVAD implantation as compared to before LVAD implantation, while there was no significant difference in tricuspid annular plane systolic excusion(TAPSE). Postoperative total bilirubin(TBIL) decreased significantly compared to preoperative levels[(15.5±5.0)μmol/L vs.(27.5±17.0)μmol/L, P=0.038]. Three patients experienced right heart failure after the LVAD implantation, with an incidence rate of 25%. Nevertheless, the right heart failure was rectified during the ICU treatment period. The mean ICU treatment time for all enrolled patients was(8.6±2.9) days, the average postoperative hospital stay was(24.3±4.8) days. All enrolled patients survived at 3 months after LVAD implantation. Conclusion:Despite the presence of right ventricular dysfunction in patients before LVAD implantation, with strict fluid management, reasonable LVAD parameters, and appropriate vasoactive drugs, they are able to smoothly pass through the perioperative period, achieve the goals of left ventricular decompression, increase cardiac output, improve perfusion of the end organs, and obtain favorable short-term therapeutic effects.

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