Objective To evaluate the clinical efficacy of valve-in-valve transcatheter mitral valve replacement for the management of degenerated bioprosthetic mitral valves. Methods This study retrospectively analyzed the clinical data of patients who underwent transcatheter mitral valve replacement due to degenerated bioprosthetic mitral valves at the First Affiliated Hospital of Zhengzhou University from 2020 to 2023. The analysis included baseline characteristics, surgical details, perioperative complications, and hemodynamic changes during the early postoperative period and subsequent follow-up. Results A total of 31 patients were included in the study, comprising 7 males and 24 females, with an average age of (66.57±9.32) years. The average duration since the initial surgical placement of the bioprosthetic valves was (9.92±3.71) years. The procedures included 7 patients utilizing the transfemoral venous-atrial septal approach and 24 patients employing the transapical approach. All patients exhibited significant improvement in cardiac function postoperatively, with a reduction in the number of patients classified as New York Heart Association (NYHA) grade Ⅲ or Ⅳ and those with moderate to severe tricuspid valve regurgitation. Echocardiographic assessments revealed a decrease in peak flow velocity across the mitral valve and a reduction in the average transvalvular pressure gradient, while left ventricular ejection fraction remained unchanged. One patient experienced a recurrent stroke and died on the fifth postoperative day; however, the remaining patients were discharged uneventfully, without complications such as cardiac death, left ventricular outflow tract obstruction, or pacemaker implantation. During a median follow-up period of 12 months, no adverse events were reported, and hemodynamic stability was maintained. Conclusion Valve-in-valve transcatheter mitral valve replacement is a safe and effective option for patients with degenerated bioprosthetic mitral valves, demonstrating favorable hemodynamic outcomes and satisfactory short-term clinical results.

Objective:To analyze the clinical presentations and diagnostic and treatment process of one patient with autoimmune encephalitis(AE)with double positive anti-N-methyl-D-aspartate receptor(NMDAR)and anti-γ-aminobutyric acid B receptor(GABABR)secondary to herpes simplex virus encephalitis(HSVE),and to improve the clinicians'awareness of this disease.Methods:The clinical data of one AE patient with double positive anti-NMDAR and anti-GABABR secondary to HSVE were collected,the diagnostic and therapeutic processes were summarized,and the relevant literatures were reviewed.Results:The patient,a 36-year-old male,developed a headache followed by limb convulsions,and progressed to disturbed consciousness.After admission,the routine biochemistry of the cerebrospinal fluid(CSF)was abnormal,and the herpes simplex virus-1(HSV-1)IgG antibody showed positive in the CSF;both CSF and serum tests for NMDAR antibodies were positive;the head magnetic resonance imaging(MRI)results showed abnormal signals in the right occipital white matter,leading to the diagnosis of HSVE secondary to anti-NMDAR encephalitis.Several months later,the patient experienced psychiatric behavior abnormalities,cognitive dysfunction,and sleep disorders,and both the serum NMDAR and GABABR antibodies showed positive results,prompting the diagnosis of HSVE secondary anti-NMDAR encephalitis and anti-GABABR encephalitis.After treatment with steroid pulse therapy and intravenous immunoglobulin(IVIG),the patient's condition was improved and the patient was discharged.At one-year follow-up,the patient's psychiatric symptoms had completely resolved,leaving mild cognitive impairment.Conclusion:If the clinical symptoms of the patients recovering from antiviral treatment for HSVE is worsened,secondary AE should be highly suspected;it is important to complete autoimmunity antibody testing as soon as possible for the early diagnosis and treatment to improve the prognosis of the patient.

The complement lectin pathway is an important means to exert immune effect.Ficolin and Mannan-binding lectin(MBL)are the initiators of complement pathway.Both structure and function are very similar.They can activate the complement path-way by recognizing certain substances on the surface of pathogens,emphasizing phagocytosis or directly kill and dissolve related patho-gens,thereby playing an important role in the immune system,especially in fighting infection.The respiratory system diseases are mostly infectious diseases.In recent years,there have been reports that ficolin/MBL is related to many other respiratory diseases.This article discusses the related research of ficolin/MBL and respiratory diseases,hopes to provide theoretical support for related research.

Objective:To investigate the current status and quality and safety of radiation therapy resources in medical institutions in Hunan province.Methods:The basic situation questionnaire, quality and safety self-assessment form were designed according to the content of the survey, distributed and recovered through the network, and the survey was conducted on all medical institutions (excluding military hospitals) conducting radiotherapy in Hunan province in 2022, and the quality and safety evaluation was checked by the Hunan Radiotherapy Quality Control Center using stratified sampling field inspection. The differences between the self-evaluation scores of radiotherapy quality and safety and the on-site inspection scores of each unit was compared using Wilcoxon test.Results:By the end of 2022, there were 76 medical institutions (excluding military hospitals) conducting radiotherapy in Hunan province, including 62 tertiary hospitals and 14 secondary hospitals, with a total of 44 253 radiotherapy patients admitted annually. The total number of personnel engaged in radiotherapy was 1 381, including 746 physicians, 205 physicists, 397 technicians and 33 maintenance engineers. There were a total of 88 accelerators (including 3 tomotherapy units), 10 gamma knives, and 28 rear-loading machines, with 1.33 gas pedals per million population. There were 36 units that were carrying out three-dimensional conformal technology, 60 static intensity modulation technology, 20 volumetric rotational intensity modulation, 27 stereotactic radiotherapy, 44 image-guided radiotherapy, 33 respiratory motion management, and 27 rear-loading radiotherapy. In the quality and safety evaluation situation, the basic requirements of radiotherapy specialty scored high, with 2 units achieving full marks and no failing units. Radiotherapy personnel and organization, radiotherapy process, documentation record score and other aspects of no full-score units, the score was concentrated in 60~＜80 points, and all have part of the unit failed.Conclusions:The radiotherapy industry in Hunan province has been developed steadily in recent years in general, and the structure of radiotherapy personnel tends to be reasonable, but there still exists uneven distribution of radiotherapy resources, poor utilization of equipment in some areas, and inadequate development of technology. The overall quality and safety evaluation are good, but there are still many deficiencies in the organizational requirements of radiotherapy personnel, process requirements and documentation, which need to be continuously optimized and improved in the future, and at the same time, field inspections will be intensified to ensure the quality and safety of radiotherapy.

OBJECTIVE To study the improvement effect and possible mechanism of N-butylphthalide on inflammatory injury of bone marrow mesenchymal stem cells （BMSCs） in rats. METHODS BMSCs of rats were divided into control group， model group， N-butylphthalide low-concentration， medium-concentration and high-concentration groups （10， 20， 50 μmol/L）. BMSCs were cultured in vitro and lipopolysaccharide （the final concentration of 10 mg/L） was used to establish the inflammatory injury model. After the intervention of N-butylphthalide， the survival rate， apoptotic rate， the contents of tumor necrosis factor α （TNF- α）， interleukin 1β （IL-1β） and IL-6 in cell culture medium， the mRNA expression of nuclear factor-κB（NF-κB） p65， and the protein expressions of caspase-3， B-cell lymphoma 2 （Bcl-2）， Bcl-2 related X protein （Bax） and NF-κB p65 in cells were detected. RESULTS Compared with control group， the survival rate and protein expression of Bcl-2 were decreased significantly in model group （P＜0.05）； the apoptotic rate， contents of TNF-α， IL-1β and IL-6， the mRNA expression of NF-κB p65， and the protein expressions of caspase-3， Bax and NF-κB p65 were increased significantly （P＜0.05）. Compared with model group， above indexes were significantly reversed in all concentration groups of N-butylphthalide （P＜0.05）， in concentration-dependent manner. CONCLUSIONS N-butylphthalide can ameliorate the inflammatory injury of BMSCs induced by lipopolysaccharide， and its mechanism may be related to the inhibition of NF-κB signaling pathway.

Cerebral microbleed (CMB) is a type of cerebral small vessel disease (CSVD). Recently studies have found that there is a certain relationship between CMB and cognitive impairment. This article mainly reviews the etiology of CMB, the relationship between CMB and cognitive impairment, CMB and cognitive disorders and the possible mechanism of CMB-related cognitive impairment, in order to improve the understanding of cognitive impairment caused by CMB.

Objective:To realize the automatic evaluation of the target conformity, dose overflow, dose drop and other indicators in stereotactic body radiation therapy (SBRT) plan for the early non-small cell lung cancer (NSCLC) in the Eclipse planning system.Methods:Eclipse Scripting API application development interface and C# programming language were used to develop it with script plug-ins combined with independent programs. According to the requirements of the NSCLC SBRT plan in Radiation Therapy Oncology Group (RTOG) 0915 report, the automatic evaluation of related indicators was realized. A rule of equal interval sampling and double thresholds was designed during the period, which could more accurately and conveniently evaluate the dose drop outside the target area.Results:13 clinical cases of NSCLC SBRT plans were randomly selected, the method in this study and the module equipped with the Eclipse system to were utilized to evaluate and compare the results. It was concluded that the results of the two methods were in line with the clinical requirements, and the former was more efficient ( P<0.05). Conclusions:The NSCLC SBRT plan evaluation software in this article has a friendly interface. It can not only realize the automatic evaluation of target conformity, dose overflow and dose drop, but also effectively improve work efficiency and better serve the clinical and scientific research work of radiotherapy.

Objective:To realize the interactive form evaluation of radiotherapy dose and the automatic calculation of conformity index (CI) and heterogeneity index (HI) in the Eclipse planning system.Methods:The Eclipse Scripting API application development interface and C# programming language were employed to develop it with script plug-ins combined with independent programs. The visual interface programming and call the relevant dose query function in the API were utilized to realize the interactive table dose evaluation and the automatic calculation of HI. The functions of calling dosage structure creation and structure Boolean operation in the API were adopted to realize the automatic calculation of CI.Results:15 clinical radiotherapy cases of nasopharyngeal carcinoma were selected. The dose evaluation results were statistically compared between this method and the module equipped in the Eclipse system. The results showed that the accuracy was consistent between these two methods ( P>0.05), whereas the evaluation efficiency of this method was significantly higher compared with that of the Eclipse system module ( P<0.05). Conclusions:The interactive evaluation form in this article has a friendly interface, which allows users to more conveniently perform dose assessment, multi-plan comparison, and calculation of CI and HI, which effectively improves work efficiency and can better serve the clinical and scientific research work of radiotherapy.

Objective:To observe the presence or absence of necroptosis in PC12 cells after radiation injury, and to detect the expression of receptor-interacting protein 3(RIP3) and evaluate its regulatory effect on necroptosis.Methods:PC12 cells were treated with different doses of irradiation and their necroptosis was detected by lactate dehydrogenase (LDH) release at different time points. After pretreatment with necroptosis inhibitor Necrostatin-1(Nec-1), the changes of cell necroptosis were detected by LDH. The expression level of RIP3 after irradiation intervention was detected by Western blot (WB). After pretreatment with the RIP3-specific inhibitor GSK′872, the changes of cell necroptosis were detected by LDH. The best transfection sequence of RIP3 knockout was screened by WB. The cells were divided into the control group, irradiation group, solvent control group, no-load control group and pretreatment group. WB, immunofluorescence staining, MTT, LDH and Annex V-fluorescein Isothiocyanate/Propidium Iodide (AnnexV-FITC/PI) flow cytometry were used for detection and analysis.Results:After 4 Gy irradiation, the degree of cell necrosis was the highest after 3 hours of culture, and the expression level of RIP3 protein was up-regulated. The cell necrosis was decreased after Nec-1, GSK′872 and RIP3 gene knockdown pretreatment.Conclusions:The radiation injury of 4 Gy can induce the necroptosis of PC12 cells, and the most significant effect can be observed when cultured for 3 hours after irradiation. RIP3 is involved in the process of necroptosis of PC12 cells induced by radiation injury, and plays a pivotal positive regulatory role.

Objective To investigate the benefits of replanning after induction chemotherapy(IC) by analyzing the dosimetric impact of IC on intensity-modulated radiotherapy(IMRT)for locally advanced nasopharyngeal carcinoma(NPC)and the dosimetric characteristics of replanning after IC, and to provide data for the rational design of clinical radiotherapy plans. Methods 16 NPC patients underwent contrast-enhanced CT scan once before and after IC.Target volumes were delineated and the chemotherapy plans were created,defined as Plan-1 and Plan-2,respectively. Then the target structure after IC was copied to Plan-1, generating the third plan, defined as Plan-1-2. The paired t-test was used to compare the dosimetric parameters between Plan-1 and Plan-1-2 and between Plan-2 and Plan-1-2. Results Plan-1 vs. Plan-1-2:Plan-1-2 showed significantly reduced D meanof target volume compared with Plan-1(P<0.05). Plan-1-2 significantly increased D meanand D maxof the spinal cord(P<0.05),although significantly reduced D mean of the brain stem and D maxof the temporal lobes compared with Plan-1. Plan-1-2 also had significantly reduced conformity index(CI)and significantly increased homogeneity index(HI)for the target volume compared with Plan-1(P<0.05). Plan-2 vs. Plan-1-2:Compared with Plan-1-2, Plan-2 significantly increased D meanand D minof gross tumor volume(GTV)and primary GTV(P<0.05)and significantly reduced D meanof the temporal lobes and D maxand D meanof the spinal cord(P<0.05), with D max decreased to 430.48 cGy;Plan-2 had significantly increased CI and significantly reduced HI for the target volume compared with Plan-1-2(all P<0.05). Conclusions IMRT plan-1 after IC has worse dosimetric distribution,while replanning after IC has more dosimetric benefits.