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 analyze the awareness of HCV infection status and willingness for HCV-RNA testing among hepatitis C cases in four provinces in China and to provide a reference for adjusting HCV prevention and control strategies.Methods:From September 2021 to September 2022, a cross-sectional survey was conducted using stratified random cluster sampling in four provinces (Jiangsu, Henan, Hubei, and Yunnan) in China, with an estimated sample size of 6 468 participants. The questionnaire included sociodemographic information, HCV infection awareness, willingness for HCV-RNA testing, and history of high-risk behaviors from the survey participants. Logistic regression models were used to analyze the factors associated with HCV infection awareness and willingness for HCV-RNA testing among hepatitis C cases. Statistical analysis was performed using R 4.1.3 software.Results:A total of 10 563 hepatitis C cases were surveyed. The awareness rate of HCV infection was 86.74% (9 162/10 563), and the willingness rate for HCV-RNA testing was 85.21% (9 001/10 563). Multivariate logistic regression models analysis showed that the awareness rate of HCV infection was lower among individuals aged ≥60 years, urban residents (with New Rural Cooperative Medical Insurance ), those without a history of blood transfusion, those without a history of paid blood donation, those without a history of injection drug use, and those without a family member with hepatitis C case.The awareness rate was higher among individuals with high or technical secondary school education, college education or above, and those married with a spouse (all P<0.05). In terms of willingness for HCV-RNA testing, it was lower among females, individuals aged ≥60 years, and those without a history of blood transfusion, paid blood donation, or injection drug use. The willingness was higher among farmers or migrant workers, employees of enterprises or institutions, and those in other occupations (all P<0.05). Conclusions:There was room for improvement in the awareness proportion of HCV infection and willingness for HCV-RNA testing among hepatitis C cases in the four provinces of China. More convenient policies and measures should be provided to increase the awareness rate of HCV infection and the willingness to undergo HCV-RNA testing in this population.

Objective:To evaluate the performance of deep learning reconstruction (DLR) in visualizing lenticulostriate arteries (LSAs) on cerebral CT angiography (CTA).Methods:This cross-sectional study retrospectively analyzed cerebral CTA from 38 patients who underwent cerebral CTA at the Fourth Affiliated Hospital of Harbin Medical University between January and December 2023. Images were reconstructed using filtered back projection (FBP), three-dimensional adaptive iterative dose reduction (AIDR), and DLR-advanced inteuigent clear-IQ engine(AiCE) algorithms (FBP group, AIDR group, DLR-AiCE group). On axial images, the mean CT values, standard deviation (SD), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were measured at the origin of LSAs, cerebrospinal fluid in lateral ventricles, temporal muscle, and head of the caudate nucleus. Subjective evaluations were performed for overall vascular visualization and LSAs delineation. Comparisons of subjective and objective evaluation indexes among the 3 groups were performed using the complex measurement ANOVA, Friedman test, or χ2 test. Results:The CT, SD, SNR and CNR values at the origin of LSAs, cerebrospinal fluid in lateral ventricles, temporal muscle, and head of the caudate nucleus demonstrated statistically significance among DLR-AiCE group, AIDR group and FBP group ( P<0.001), in which, except for the difference between the FBP group and the AIDR group in the CT value of the head of the caudate nucleus and the CT value of the cerebrospinal fluid of the lateral ventricle which was not statistically significant ( P>0.05), the remaining pairwise comparisons between the groups for each site measurements were statistically significant ( P<0.001). The difference in the overall comparison of the subjective scores of the overall vessels and LSAs in the images of the DLR-AiCE group, the AIDR group, and the FBP group was statistically significant ( P<0.001), and the two-by-two comparisons showed a statistically significant difference ( P<0.001) except for the difference in the subjective scores of LSAs between the FBP group and the AIDR group. Conclusion:The DLR-AiCE algorithm significantly reduces image noise and improves image quality, enabling superior visualization of LSAs, thereby enhancing diagnostic confidence.

Objective:To analyze the awareness of HCV infection status and willingness for HCV-RNA testing among hepatitis C cases in four provinces in China and to provide a reference for adjusting HCV prevention and control strategies.Methods:From September 2021 to September 2022, a cross-sectional survey was conducted using stratified random cluster sampling in four provinces (Jiangsu, Henan, Hubei, and Yunnan) in China, with an estimated sample size of 6 468 participants. The questionnaire included sociodemographic information, HCV infection awareness, willingness for HCV-RNA testing, and history of high-risk behaviors from the survey participants. Logistic regression models were used to analyze the factors associated with HCV infection awareness and willingness for HCV-RNA testing among hepatitis C cases. Statistical analysis was performed using R 4.1.3 software.Results:A total of 10 563 hepatitis C cases were surveyed. The awareness rate of HCV infection was 86.74% (9 162/10 563), and the willingness rate for HCV-RNA testing was 85.21% (9 001/10 563). Multivariate logistic regression models analysis showed that the awareness rate of HCV infection was lower among individuals aged ≥60 years, urban residents (with New Rural Cooperative Medical Insurance ), those without a history of blood transfusion, those without a history of paid blood donation, those without a history of injection drug use, and those without a family member with hepatitis C case.The awareness rate was higher among individuals with high or technical secondary school education, college education or above, and those married with a spouse (all P<0.05). In terms of willingness for HCV-RNA testing, it was lower among females, individuals aged ≥60 years, and those without a history of blood transfusion, paid blood donation, or injection drug use. The willingness was higher among farmers or migrant workers, employees of enterprises or institutions, and those in other occupations (all P<0.05). Conclusions:There was room for improvement in the awareness proportion of HCV infection and willingness for HCV-RNA testing among hepatitis C cases in the four provinces of China. More convenient policies and measures should be provided to increase the awareness rate of HCV infection and the willingness to undergo HCV-RNA testing in this population.

Objective:To evaluate the performance of deep learning reconstruction (DLR) in visualizing lenticulostriate arteries (LSAs) on cerebral CT angiography (CTA).Methods:This cross-sectional study retrospectively analyzed cerebral CTA from 38 patients who underwent cerebral CTA at the Fourth Affiliated Hospital of Harbin Medical University between January and December 2023. Images were reconstructed using filtered back projection (FBP), three-dimensional adaptive iterative dose reduction (AIDR), and DLR-advanced inteuigent clear-IQ engine(AiCE) algorithms (FBP group, AIDR group, DLR-AiCE group). On axial images, the mean CT values, standard deviation (SD), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were measured at the origin of LSAs, cerebrospinal fluid in lateral ventricles, temporal muscle, and head of the caudate nucleus. Subjective evaluations were performed for overall vascular visualization and LSAs delineation. Comparisons of subjective and objective evaluation indexes among the 3 groups were performed using the complex measurement ANOVA, Friedman test, or χ2 test. Results:The CT, SD, SNR and CNR values at the origin of LSAs, cerebrospinal fluid in lateral ventricles, temporal muscle, and head of the caudate nucleus demonstrated statistically significance among DLR-AiCE group, AIDR group and FBP group ( P<0.001), in which, except for the difference between the FBP group and the AIDR group in the CT value of the head of the caudate nucleus and the CT value of the cerebrospinal fluid of the lateral ventricle which was not statistically significant ( P>0.05), the remaining pairwise comparisons between the groups for each site measurements were statistically significant ( P<0.001). The difference in the overall comparison of the subjective scores of the overall vessels and LSAs in the images of the DLR-AiCE group, the AIDR group, and the FBP group was statistically significant ( P<0.001), and the two-by-two comparisons showed a statistically significant difference ( P<0.001) except for the difference in the subjective scores of LSAs between the FBP group and the AIDR group. Conclusion:The DLR-AiCE algorithm significantly reduces image noise and improves image quality, enabling superior visualization of LSAs, thereby enhancing diagnostic confidence.

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.

Background::Carotid intima-media thickness (IMT) and diameter, stiffness, and wave reflections, are independent and important clinical biomarkers and risk predictors for cardiovascular diseases. The purpose of the present study was to establish nationwide reference values of carotid properties for healthy Chinese adults and to explore potential clinical determinants.Methods::A total of 3053 healthy Han Chinese adults (1922 women) aged 18-79 years were enrolled at 28 collaborating tertiary centers throughout China between April 2021 and July 2022. The real-time tracking of common carotid artery walls was achieved by the radio frequency (RF) ultrasound system. The IMT, diameter, compliance coefficient, β stiffness, local pulse wave velocity (PWV), local systolic blood pressure, augmented pressure (AP), and augmentation index (AIx) were then automatically measured and reported. Data were stratified by age groups and sex. The relationships between age and carotid property parameters were analyzed by Jonckheere-Terpstra test and simple linear regressions. The major clinical determinants of carotid properties were identified by Pearson’s correlation, multiple linear regression, and analyses of covariance.Results::All the parameters of carotid properties demonstrated significantly age-related trajectories. Women showed thinner IMT, smaller carotid diameter, larger AP, and AIx than men. The β stiffness and PWV were significantly higher in men than women before forties, but the differences reversed after that. The increase rate of carotid IMT (5.5 μm/year in women and 5.8 μm/year in men) and diameter (0.03 mm/year in both men and women) were similar between men and women. For the stiffness and wave reflections, women showed significantly larger age-related variations than men as demonstrated by steeper regression slopes (all P for age by sex interaction <0.05). The blood pressures, body mass index (BMI), and triglyceride levels were identified as major clinical determinants of carotid properties with adjustment of age and sex. Conclusions::The age- and sex-specific reference values of carotid properties measured by RF ultrasound for healthy Chinese adults were established. The blood pressures, BMI, and triglyceride levels should be considered for clinical application of corresponding reference values.

Based on the"You Gu Wu Yun"theory in traditional Chinese medicine(TCM),this paper believes that"Gu"in"You Gu Wu Yun"is extended to"state"from the perspective of"TCM state".In order to avoid the adverse reactions of TCM,the macro,meso,and micro three views should be used together,and macro,meso,and micro parameters should be integrated.We should also carefully identify the physiological characteristics,pathological characteristics,constitution,syndrome,and disease of human body by combining qualitative and quantitative method,highlighting the relationship between the prescription and the"state".The correspondence between prescription and the"state"will reduce the risk of adverse reactions of TCM.In this paper,we hope to focus on the guiding role of the"You Gu Wu Yun"theory in TCM research,to give full play to the characteristics and advantages of TCM,and to dialectically treat the role of TCM.

The correspondence between prescription and syndrome is the advantage and characteristic of traditional Chinese medicine(TCM)treatment.However,the pathogenesis of clinical diseases is complex and the condition is changeable,and the clinical application is difficult to achieve the maximum effect under the existing cognition of the correspondence between prescription and syndrome.In this paper,the five categories of physiological characteristics,pathological characteristics,constitution,syndrome,and disease of the longitudinal classification of"TCM state"are introduced into the correspondence of prescription and syndrome.Under the vertical perspective of"TCM state",the theoretical connotation of the correspondence between prescription and syndrome is interpreted as"correspondence between prescription and state",namely correspondence of"prescription-physiological characteristics",correspondence of"prescription-pathological characteristics",correspondence of"prescription-constitution",correspondence of"prescription-syndrome",and correspondence of"prescription-disease".It is hoped to accurately grasp the corresponding connotation of the correspondence between prescription and syndrome,in order to deepen the clinical thinking mode of TCM.

Objective:To observe the effect of 3D-printed guide plate-assisted percutaneous bone cement-augmented sacroiliac screw fixation in the treatment of pelvic fragility fractures in the elderly.Methods:A total of 11 elderly patients with pelvic fragility fractures who underwent 3D-printed guide plate-assisted percutaneous cement-enhanced sacroiliac screw fixation (cemented group) in the Department of Traumatic Orthopaedics of the General Hospital of Ningxia Medical University from December 2022 to April 2024 were retrospectively analyzed. There were 3 males and 8 females, aged 73.18±4.42 years (range, 67-80 years). There were 4 cases of typeⅡand 7 cases of typeⅢ. At the same time, 10 elderly patients with pelvic fragility fractures who underwent percutaneous sacroiliac screw fixation assisted by 3D-printed guide plate (cementless group) were selected as control group, including 5 males and 5 females, aged 73.90±6.51 years (range, 67-85 years). Pelvic fragility fractures were classified as typeⅡin 5 cases and typeⅢin 5 cases. The perioperative indicators, visual analogue scale (VAS), Barthel index and postoperative complications were compared between the two groups.Results:All patients successfully completed the operation and were followed up for 17.05±5.48 months (range, 9-27 months). The operation time and fluoroscopy frequency in the bone cement group were 72.09±3.95 min and 12.45±0.93 times, which were significantly higher than those in the non-bone cement group 57.00±4.24 min and 8.50±0.97 times, the difference was statistically significant ( P<0.05). All patients' fractures healed in one stage, the healing time was 97.09±7.15 d in the cemented group and 103.00±13.14 d in the uncemented group, the difference was not statistically significant ( t=1.297, P=0.210), and there was no case of delayed healing or non-healing. The postoperative weight-bearing time of the bone cement group was 44.73±3.72 d, which was shorter than that of the non-bone cement group 59.10±7.37 d, and the difference was statistically significant ( P<0.05). The VAS scores of the bone cement group at 1 day, 1 week and 3 weeks after operation were 5.73±0.65, 4.64±0.51 and 3.27±0.65, respectively, which were lower than those of the non-bone cement group 6.80±0.42, 5.30±0.48 and 4.00±0.67. The difference was statistically significant ( P<0.05). The Barthel index of bone cement group was higher than that of non-bone cement group at 1 day, 1 week, 3 weeks, 6 weeks and 2 months after operation, and the difference was statistically significant ( P<0.05). Bone cement leakage occurred in 2 patients in the bone cement group, and they did not complain of special discomfort and were not treated. In the non-cemented group, two cases showed screw withdrawal and the sacroiliac screws were removed in a second operation; one case showed sacral plexus nerve injury, and the screws were removed and treated with oral methylcobalamin symptomatic therapy one month after the operation, and the symptoms were relieved after three months. Conclusion:3D-printed guide plate-assisted percutaneous cement-augmented sacroiliac screw fixation for the treatment of elderly pelvic fragility fracture can alleviate postoperative pain, shorten the weight-bearing time, and help to promote early recovery and improve postoperative quality of life.