Objective To analyze the short-term clinical outcomes of emergency conversion to surgery during transcatheter aortic valve replacement (TAVR). Methods Clinical data of patients who underwent emergency surgical conversion from TAVR in the Department of Cardiovascular Surgery, the Second Hospital of Hebei Medical University, from 2018 to 2023 were collected. Postoperative follow-up results at 1 month were recorded. Results A total of 253 patients underwent TAVR, of whom 11 (4.3%) required emergency conversion to surgery. Among these 11 patients, 7 were male and 4 were female, with a mean age of (69.55±5.01) years. The primary cause for emergency surgical conversion was valve stent displacement (63.6%), followed by left ventricular perforation/rupture (18.2%) and significant perivalvular regurgitation persisting after a second valve implantation (18.2%). One (9.1%) patient died intraoperatively. Among the 10 surviving patients, postoperative complications included pulmonary infection in 8 patients, severe pneumonia in 7, pleural effusion in 3, liver dysfunction in 8, renal dysfunction in 3, upper gastrointestinal bleeding in 5, cerebrovascular complications in 1, atrial fibrillation in 1, ventricular premature contractions in 1, atrioventricular block in 1, and complete left bundle branch block in 3. At 1-month postoperative follow-up, one additional patient died, yielding a 30-day mortality rate of 18.2% after TAVR emergency surgical conversion. The quality of life improved significantly compared to preoperative status in 9 (81.8%) patients, and no patients were readmitted for cardiovascular diseases. Conclusion The incidence of emergency conversion to surgery during TAVR is low, but the rates of surgical complications and 30-day postoperative mortality are high. Nevertheless, when severe complications occur during TAVR, emergency conversion to surgery can still yield satisfactory short-term clinical outcomes for a majority of these patients.

Objective:Percutaneous coronary intervention(PCI)is one of the most important treatments for coronary artery disease(CAD).However,in-stent restenosis(ISR)after PCI is a serious complication without effective measures for prevention and treatment.This study aims to investigate the Ras-related protein 1A(Rap1A)level in ISR patients and in the tumor necrosis factor-α(TNF-α)-induced inflammatory injury model of human umbilical vein endothelial cells(HUVECs),to explore the role of Rap1A in regulating TNF-α-induced inflammation in HUVECs and to provide a new potential target for ISR prevention and treatment. Methods:A total of 60 CAD patients,who underwent PCI between December 2020 and July 2022 from the Department of Cardiovascular Medicine of Xiangya Hospital,Central South University,and re-examined coronary angiography(CAG)1 year after the operation,were included.After admission,27 patients were diagnosed with ISR and 33 patients were diagnosed with non-in-stent restenosis(non-ISR)according to the CAG.Clinical data were collected,and the plasma Rap1A level was determined by enzyme linked immunosorbent assay(ELISA).In cell experiments,an inflammatory injury model was established with TNF-α treatment(10 ng/mL,24 h)in HUVECs.The mRNA and protein expression levels of Rap1A,interlukin-6(IL-6),and vascular cell adhesion molecule-1(VCAM-1)were measured by real-time reverse transcription PCR and Western blotting.Small interfering RNA(siRNA)was used to explore the role of Rap1A in regulating TNF-α-induced inflammation in HUVECs. Results:Compared with the non-ISR patients,a higher proportion of ISR patients had a history of smoking(P=0.005)and diabetes(P=0.028),and higher levels of glycosylated hemoglobin(HbA1c)(P=0.012),low-density lipoprotein cholesterol(LDL-c)(P=0.014),and hypersensitive C-reactive protein(hs-CRP)(P=0.027).The remaining projects did not show significant differences(all P＞0.05).The plasma level of Rap1A in the ISR group was significantly higher than that in the non-ISR group[942.14(873.28 to 1 133.81)μg/mL vs 886.93(812.61 to 930.98)μg/mL;P=0.004].Diabetes,LDL-c,and Rap1A were risk factors for ISR by univariate logistic regression analysis(all P＜0.05).The mRNA and protein expression levels of inflammatory factors IL-6 and VCAM-1 were increased in HUVECs after 10 ng/mL TNF-α treatment for 24 h compared with the control group(all P＜0.05),while the mRNA and protein levels of Rap1A were increased(both P＜0.05).After inhibition of Rap1A in HUVECs,the mRNA and protein expression levels of IL-6 and VCAM-1 were significantly decreased(all P＜0.05). Conclusion:The plasma Rap1A level was significantly elevated in patients with ISR,suggesting that Rap1A may be a potential biomarker for predicting ISR.In the TNF-α-induced HUVECs inflammatory injury model,the expression level of Rap1A was increased.The level of TNF-α-induced endothelial cell inflammation was decreased after inhibition of Rap1A expression,suggesting that Rap1A may be a potential target for the treatment of endothelial cell inflammation in ISR.

Objective:To explore the value of radiomics model based on intratumoral and peritumoral early dynamic contrast-enhanced (DCE) MRI for identifying benign and malignant in breast imaging reporting and data system (BI-RADS) 4 tumors.Methods:A total of 191 patients diagnosed with BI-RADS 4 breast tumors by breast MRI examination with clear pathological diagnosis from January 2016 to December 2020 in the First Affiliated Hospital of Bengbu Medical College were analyzed retrospectively, including 77 benign and 114 malignant cases, aged 23-68 (46±10) years. The one-slice image with the largest area of the lesion of the second stage DCE-MRI images was selected to outline the region of interest, and automatically conformal extrapolated by 5 mm to extract the intra-tumoral and peritumoral radiomics features. The included cases were randomly divided into training and testing cohorts in the ratio of 8∶2. The statistical and machine learning methods were used for feature dimensionality reduction and selection of optimal radiomics features, and logistic regression was used as the classifier to establish the intratumoral, peritumoral, and intratumoral combined with peritumoral radiomics models. The independent risk factors that could predict the benignity and malignancy of breast tumors were retained as clinical-radiological characteristics by univariate and multivariate logistic regression to establish a clinical-radiological model. Finally, the intratumoral and peritumoral radiomics features were combined with clinical-radiological features to develop a combined model of the three. The receiver operating curve was used to analyze the predictive performance of each model and calculate the area under the curve (AUC),the AUC was compared by DeLong test. The stability of the three-component combined diagnostic model was tested by 10-fold cross-validation, and the model was visualized by plotting nomogram and calibration curves.Results:In the training cohort, the AUC of the three-component combined model for identifying benign and malignant BI-RADS 4 breast tumors was significantly higher than that of the intratumoral radiomics model ( Z=3.38, P<0.001), the peritumoral radiomics model ( Z=4.01, P<0.001), the intratumoral combined with peritumoral radiomics model ( Z=3.11, P=0.002), and the clinical-radiological model ( Z=3.24, P=0.001). And the AUC, sensitivity, specificity, accuracy, and F1-score of the three-component combined model were 0.932, 91.2%, 86.9%, 87.0% and 0.89, respectively. In the testing cohort, the three-component combined model also had the highest AUC value (0.875), and diagnostic sensitivity, specificity, accuracy and malignancy F1-score were 95.7%, 62.5%, 76.9%, and 0.89, respectively. The AUC calculated by 10-fold cross-validation was 0.90 (0.85-0.92), and the predicted curve of the three-component combined model in the calibration curve was in good agreement with the ideal curve. Conclusion:The three-component combined diagnostic model based on the intratumoral and peritumoral radiomics features and clinical-radiological features of early DCE-MRI has good performance and stability for identifying the benign and malignant in BI-RADS 4 breast tumors, and it can provide guidance for clinical decision non-invasively.

OBJECTIVES: Percutaneous coronary intervention (PCI) is one of the important methods for the treatment of coronary artery disease (CAD). In-sent restenosis (ISR) after PCI for patients suffered from CAD is considered to be an essential factor affecting long-term outcomes and prognosis of this disease. This study aims to investigate the correlation between plasma Quaking (QKI) and cyclooxygenase-2 (COX-2) levels and ISR in patients with CAD. METHODS: A total of 218 consecutive CAD patients who underwent coronary angiography and coronary arterial stenting from September 2019 to September 2020 in the Department of Cardiology of Xiangya Hospital of Central South University were enrolled in this study, and 35 matched individuals from the physical examination center were served as a control group. After admission, clinical data of these 2 groups were collected. Plasma QKI and COX-2 levels were measured by enzyme linked immunosorbent assay (ELISA). Follow-up angiography was performed 12 months after PCI. CAD patients were divided into a NISR group (n=160) and an ISR group (n=58) according to the occurrence of ISR based on the coronary angiography. The clinical data, coronary angiography, and stent features between the NISR group and the ISR group were compared, and multivariate logistic regression was used to explore the factors influencing ISR. The occurrence of major adverse cardiovascular events (MACE) 1 year after operation was recorded. Fifty-eight patients with ISR were divided into an MACE group (n=24) and a non-MACE group (n=34), classified according to the occurrence of MACE, and the plasma levels of QKI and COX-2 were compared between the 2 groups. Receiver operating characteristic (ROC) curves were utilized to analyze the diagnostic value of plamsa levels of QKI and COX-2 for ISR and MACE occurrences in patients after PCI. RESULTS: Compared with control group, plasma levels of QKI and COX-2 in the CAD group decreased significantly (all P<0.001). Compared with the NISR group, the plasma levels of QKI and COX-2 also decreased obviously in the ISR group (all P<0.001), while the levels of high sensitivity C-reactive protein (hs-CRP) and glycosylated hemoglobin (HbAlc) significantly increased (all P<0.001). The level of COX-2 was negatively correlated with hs-CRP (r=-0.385, P=0.003). Multivariate logistic regression analysis showed that high level of plasma QKI and COX-2 were protective factors for in-stent restenosis after PCI, while hs-CRP was a risk factor. ROC curve analysis showed that the sensitivity and specificity of plasma QKI for evaluating the predictive value of ISR were 77.5% and 66.5%, respectively, and the sensitivity and specificity of plasma COX-2 for evaluating the predictive value of ISR were 80.0% and 70.7%, respectively. The sensitivity and specificity of plasma QKI combined with COX-2 for evaluating the predictive value of ISR were 81.3% and 74.1%, respectively. The sensitivity and specificity of plasma QKI for evaluating the prognosis of ISR were 75.0% and 64.7%, respectively. The sensitivity and specificity of plasma COX-2 for evaluating the prognosis of ISR were 75.0% and 70.6%, respectively. The sensitivity and specificity of plasma QKI combined with COX-2 for prognostic evaluation of ISR were 81.7% and 79.4%, respectively. The sensitivity and specificity of plasma COX-2 combined with QKI for evaluating ISR and MACE occurrences in patients after PCI were better than those of COX-2 or QKI alone (P<0.001). CONCLUSIONS High level of plasma QKI and COX-2 might be a protective factor for ISR, which can also predict ISR patient's prognosis.
C-Reactive Protein/analysis* ; Constriction, Pathologic/etiology* ; Coronary Angiography/adverse effects* ; Coronary Artery Disease ; Coronary Restenosis/therapy* ; Cyclooxygenase 2 ; Humans ; Percutaneous Coronary Intervention/adverse effects* ; Risk Factors ; Stents/adverse effects*

Based on ASP.NET framework, The Intelligent Estimated System for Rational Deployment of Medical Equipment (MERDIS) is designed and developed with SQL Server 2012 database and C# language. The system is used to realize the rational deployment suggestions and evaluation of medical equipment in hospitals. The system input the data of hospital medical equipment and clinical pathway into the database, and then feedback the deployment information to users which are calculated by big data information, so as to achieve the purpose of giving rational deployment of hospital medical equipment.
Databases, Factual ; Equipment Design ; Hospitals

Scrub typhus is a zoonotic disease caused by Orientia tsutsugamushi. We report here a middle-aged man with 3 days history of mild fever, dysphagia, and anarthria. On examination, he had nystagmus, quadriparesis, and a fresh eschar in the left scrotal region. Cerebrospinal fluid (CSF) and serum samples were positive for tsutsugamushi antibody. The magnetic resonance images (MRIs) showed T2 lesions in the brainstem, basal ganglia, frontal, corona radiate and spinal cord. After treatment with chloramphenicol and prednisolone, the clinical symptoms and signs improved. Our case highlights that encephalomyelitis may be caused by rickettsial disease such as scrub typhus.

OBJECTIVE: To explore the cause of inconsistent genotypes for an α-thalassemia carrier by using two commercial genotyping kits. METHODS: GAP-PCR and PCR-reverse dot blotting (PCR-RDB) were employed to determine the genotype of the carrier, while Sanger sequencing was used to verify the results. RESULTS: Sequencing analysis demonstrated that the subject has carried a α1 globin gene with a 3.7 kb heterozygous deletion. In addition, two novel mutations, IVS-II-55(T>G) and IVS-II-119(G>TCGGCCC), were found in intron 2 of α2 globin gene. CONCLUSION The two mutations located in the binding regions of PCR primers have caused failure of PCR amplification and misreading of the genotype. Combination of clinical and hematological phenotypes is indispensible to infer the genotype of carriers for accurate diagnosis.
Genotype ; Heterozygote ; Humans ; Mutation ; alpha-Thalassemia ; genetics

Objective The purpose of this study was to examine the predictive value of elevated cardiac troponin I (cTnI) and Score for the Targeting of Atrial Fibrillation (STAF) in the diagnosis of cardiogenic cerebral infarction. Methods Two hundred twenty-three patients with acute ischemic stroke were recruited in the study including 38 patients in cardiogenic cerebral infarction (CCI) group and 185 in non-cardiac cerebral infarction (NCCI) group. Clinical data were collected. Chemiluminescence immunoassay was used to detect serum cTnI concentrations in patients and STAF scores were calculated. The clinical baseline data of the two groups were compared. A receiver operating characteristic (ROC) curve was used to determine the boundary value of cTnI and STAF scores in diagnosing CCI and in analyzing their predictive value. Results In the CCI group, the patients were older with higher frequency in atrial fibrillation and ischemic heart disease. Moreover, the NIHSS scores, the value of cTnI and STAF scores were significantly higher in CCI group than in the NCCI group (P＜0.05). The area under the ROC curve of STAF scores was 0.954, and its 95%CI was between 0.924 and 0.985. The area under the ROC curve of the cTnI value was 0.852, and its 95% CI was between 0.788 and 0.916. The cutoff of STAF scores was 4 points, with a sensitivity of 92.1% and a specificity of 89.2%. The cutoff of cTnI value was 0.0085ng/ml, with a sensitivity of 73.7% and a specificity of 84.9%. Conclusion Serum cTnI value and STAF score have a good predictive value for CCI, and STAF score have a higher value than serum cTnI in predicting the diagnosis of CCI. Clinically, serum cTnI and STAF score may be helpful for etiology classification of acute ischemic stroke.

To investigate changes in the angiotensin converting enzyme 2 (ACE2) and angiotensin (1-7) [Ang (1-7)] and to explore the role of ACE2-Ang (1-7)-Mas receptor axis in hypertension with heart failure with preserved ejection fraction (HFPEF).
 Methods: A total of 70 patients with primary hypertension and preserved left ventricular ejection fraction (LVEF>50%) were recruited and patients were divided into a hypertension group (HBP) and a heart failure with preserved ejection fraction group (HFpEF) according to the diagnostic criteria of HFpEF. Thirty-five healthy participants were selected randomly as a control group. Enzyme linked immunosorbent assays (ELISA) method was used to detect concentration of Ang (1-7), ACE2, angiotensin II (Ang II), brain natriuretic peptide (BNP) in plasma. Male Sprague- Dawley (SD) rats was randomly divided into 2 groups: An HFpEF group (n=16) and a sham group (n=8). Rats (n=8) in the AAC group were given Ang (1-7) [0.5 mg/(kg.d), intraperitoneally] for 6 weeks, and the rest were given equal dose normal saline. Then all the rats were killed, and the hearts were taken out for hematoxylineosin (HE) staining. The protein expressions of angiotensin converting enzyme (ACE), ACE2, and Mas receptor were detected by Western blot.
 Results: The BNP and Ang II were significantly increased in the HBP group and the HFpEF group compared with the control group (P<0.01). There were not significantly different in levels of ACE2 and Ang (1-7) between the HBP group and control group (P>0.05), whereas those levels were significantly increased in the HFpEF group compared with the HBP group and control group (P<0.01). HE staining showed obvious hypertrophy of myocardial cell in the AAC group compared with the sham group. Hypertrophy of myocardial cell in the AAC+Ang (1-7) group was significantly higher than that in the AAC group. Expressions of ACE, ACE2, and Mas receptor proteins were significantly higher in the AAC group than those in the sham group (P<0.05), while the expressions of ACE2 and Mas receptor proteins in the AAC+Ang (1-7) group were significantly higher than those in the AAC group (P<0.05). There was no significant difference in the ACE protein expression between groups (P>0.05).
 Conclusion: ACE2 and Ang (1-7) are important predictive factors for the severity of heart failure and myocardial remodeling of HFpEF with hypertension; ACE2-Ang (1-7)-Mas receptor axis may play a protective role in preventing myocardial remodeling in HFpEF with hypertension.
Angiotensin I ; physiology ; Angiotensin II ; Animals ; Atrial Remodeling ; physiology ; Case-Control Studies ; Enzyme-Linked Immunosorbent Assay ; Heart Failure ; metabolism ; physiopathology ; Humans ; Hypertension ; metabolism ; physiopathology ; Male ; Peptide Fragments ; physiology ; Peptidyl-Dipeptidase A ; physiology ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Receptors, G-Protein-Coupled ; physiology ; Stroke Volume ; Ventricular Function, Left ; physiology ; Ventricular Remodeling ; physiology

Valproic acid is a first-line broad-spectrum antiepileptic drug, however, the pharmacokinetics of valproic acid are affected by many factors, such as heredity, drug combination and so on. So, how to realize the individualized dosing regimen of valproic acid has received much attention. Population pharmacokinetics combines classical pharmacokinetic principles and population statistical models to quantitatively evaluate the influence factor of drug concentration in the patient population. Thus, it can optimize characterization of the differences among individuals. This article reviews the researches about valproic acid in recent years, and summarizes the effect of the factors on the metabolism of valproic acid, such as drug combination and gene polymorphism. Additionally, focus on the latest research progress of individual administration of valproic acid under the guidance of population pharmacokinetics.