Objective To investigate the feasibility and early efficacy of transapical transcatheter aortic valve replacement (TAVR) combined with transcatheter mitral valve edge-to-edge repair (TEER) in patients with high-risk aortic valve lesions combined with severe mitral regurgitation. Methods The clinical data of patients who underwent "one-stop" transapical TAVR+TEER in our hospital from August 2022 to October 2023 were retrospectively analyzed. Results Five patients were collected, including 3 males and 2 females with a mean age of 66.6±1.8 years. Four patients had aortic valve insufficiency combined with mitral regurgitation and one had aortic valve stenosis and insufficiency combined with mitral regurgitation. All patients successfully completed transapical TAVR+TEER, and the immediate postoperative echocardiographic results revealed that none of them had more than mild perivalvular leakage and mitral regurgitation, and the prosthetic valves were in good position and function. At 1 week postoperatively, echocardiographic results showed 5 patients with no displacement of the prosthetic valve, detachment of the mitral clip, or damage to the leaflets. At 1 month postoperatively, cardiac function was improved to varying degrees in 4 patients, and 1 patient died of multiorgan failure. At 2 months postoperatively, 1 patient died of cerebrovascular accident, and at 3 months postoperatively the echocardiographic results of the remaining 3 patients revealed that there was no more than mild perivalvular leakage or mitral regurgitation, and the patients' postoperative cardiac function and daily life ability were significantly improved. Conclusion In high-risk aortic valve lesions combined with severe mitral regurgitation, "one-stop" transapical TAVR+TEER is feasible with favorable early efficacy and safety.

Objective To explore the effect of management mode based on fishbone diagram analysis in antitumor drug formulation management.Methods The preparation of antitumor drugs in the Intravenous Drug Dispensing Center of Affiliated Provincial Hospital of Fuzhou University from January 2022 to February 2024 were selected as study object.Among them,72250 sets of antitumor drugs prepared from January 2022 to January 2023 were included in control group,which was managed by conventional drug preparation management mode.77 815 sets of antitumor drugs prepared from February 2023 to February 2024 were included in observation group,which was managed by the drug formulation management mode based on fishbone diagram analysis.The prescription review,antitumor drug formulation and antitumor drug distribution under two management modes were compared.Results The review time,drug discharge time,drug preparation time and drug distribution time of antitumor drug in observation group were significantly shorter than those in control group,and the incidence of irrational prescription,drug formulation error rate,drug loss rate and drug delivery error rate were significantly lower than those in control group(P＜0.05).Conclusion The drug dispensing management mode based on fishbone diagram analysis can significantly improve work efficiency and drug dispensing quality,and reduce dispensing error.

Inducing the degradation of KRAS represents a novel strategy to combat cancers with KRAS mutation. In this study, we identify ubiquitin-specific protease 2 (USP2) as a novel deubiquitinating enzyme of KRAS in multiple myeloma (MM). Specifically, we demonstrate that gambogic acid (GA) forms a covalent bond with the cysteine 284 residue of USP2 through an allosteric pocket, inhibiting its deubiquitinating activity. Inactivation or knockdown of USP2 leads to the degradation of KRAS, resulting in the suppression of MM cell proliferation in vitro and in vivo. Conversely, overexpressing USP2 stabilizes KRAS and partially abrogates GA-induced apoptosis in MM cells. Furthermore, elevated USP2 levels may be associated with poorer prognoses in MM patients. These findings highlight the potential of the USP2/KRAS axis as a therapeutic target in MM, suggesting that strategically inducing KRAS degradation via USP2 inhibition could be a promising approach for treating cancers with KRAS mutations.

Objective:To evaluate the value of preoperative serum miRNA-146a-5p expression in predicting postoperative delirium (POD) in the pediatric patients undergoing living donor liver transplantation.Methods:Eighty pediatric patients with congenital biliary atresia, aged 5-12 months, with body mass index of 4-10 kg, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, undergoing elective living donor liver transplantation in our hospital, were selected. Venous blood samples were collected at 1 day before surgery, and serum miRNA-146a-5p expression was detected by quantitative real-time polymerase chain reaction. The children′s cognitive function was evaluated using the Mini-Mental State Examination and the Modified Montreal Cognitive Assessment at 1 day before operation and at 1, 3 and 7 days after operation. The pediatric patients were divided into POD group and non-POD group according to whether POD occurred within 7 days after surgery. Multiple logistic regression analysis was used to evaluate the relationship between serum miRNA-146a-5p expression and POD, Pearson′s correlation analysis was used to analyze the correlation between miRNA-146a-5p and POD, and the receiver operating characteristic curves were used to evaluate the accuracy of serum miRNA-146a-5p concentrations in predicting the occurrence of POD.Results:There were 30 cases in POD group and 50 cases in non-POD group, and the incidence of POD was 38%. The results of multiple logistic regression analysis showed that down-regulated serum miR-146a-5p expression was an independent risk factor for POD in pediatric patients undergoing living donor liver transplantation ( P<0.05). The incidence of POD was negatively correlated with serum miRNA-146a-5p expression ( r=-0.658, P<0.001). The area under the receiver operating characteristic curve of serum miRNA-146a-5p expression in predicting POD was 0.870 in pediatric patients undergoing living donor liver transplantation, with a sensitivity of 0.825 and a specificity of 0.875. Conclusions:Preoperative serum miRNA-146a-5p expression has a certain predictive value for POD in the pediatric patients undergoing living donor liver transplantation.

Objective To evaluate the present development and status of quality control for intensive care unit (ICU) in Sichuan Provincial traditional Chinese medicine (TCM) hospitals including integrated traditional Chinese and western medicine hospitals and ethnic hospitals, and to provide practical references for improving the service quality of ICU. Methods Supervisory Group of Sichuan Provincial Critical Care Medicine Quality Control Center of TCM was established in September 2018. From September 8th to 17th, 2018, according to the Scoring Criteria of Quality Control and Supervision Project of TCM for Critical Care Medicine, a 10-day quality control professional guidance was hand out to TCM hospitals with independent ICU in Sichuan Province. The service level of different aspects of hospital quality control was evaluated and ranked from equipment and resource support, medical team, service capacity and level, ward quality, completion of critical care core indicators, completion of quality control of TCM, development of new technologies, diagnosis and treatment schemes for dominant diseases. Results There were 52 TCM hospitals across the province that had an ICU. Thirty-three hospitals were third-class (63.5%), while the rest 19 hospitals were second-class (36.5%). Province-level, city-level and county-level hospitals were accounted for 9.6% (5/52), 38.5% (20/52), and 51.9% (27/52), respectively. Average bed ratio of ICU was 1.8%. Doctor-bed and guard-bed ratios were 0.71∶1 and 2.0∶1, respectively. The average annual admission rate of patients and the average daily admission rate of beds were higher, which were basically 1%. Ward quality was high; the incidence of nosocomial infection was controlled below 10%. Compliance rate of septic shock bundle treatment was high. The incidences of ventilator-associated pneumonia (VAP), catheter-related bloodstream infection (CRBSI) and catheter-associated urinary tract infection (CAUTI) were 0.45%, 0.22%, and 0.30%, respectively. Participation rate of TCM was about 83.4%. Average number of new technologies was about 4.4. Average number of disease schemes was about 2.62. Conclusions ICU of Sichuan Provincial TCM hospitals reaches the standard level in service capacity and level, ward quality, critical medicine quality control, and participation rate of TCM treatment. Improvements are required for other prospects, including department scale, medical personnel allocation, new technical development, diagnosis and treatment schemes of dominant diseases.