Aortic stenosis is a valve disease characterized by dynamic and continuous changes in structure and function of left ventricle.Left ventricular remodeling,which embodies pathological changes in myocardial cellular and ventricular geometry,is an important prognostic factor of patients with aortic stenosis.Aortic valve replacement is the only effective treatment for severe aortic stenosis.Current guideline recommendations for interventions are based on symptoms and left ventricular ejection fraction.With the improvements of modern imaging technology,different patterns of remodeling,including hypertrophy and fibrosis,could be identified now.Studies also explored the close association between left ventricular remodeling and function in the setting of aortic stenosis.In this review,we aim to elucidate the characteristic imaging features and potential mechanisms of left ventricular remodeling,and further,we highlight the clinical value of specific imaging features and clinical application of modern imaging methods in the evaluation,risk stratification,and intervention decision-making for patients with aortic stenosis.

Objective To analyze the current status and frontier trends of research on the application of cognitive-motor dual task training(CMDT)in stroke. Methods Relevant literatures on the application of CMDT in stroke were retrieved from CNKI,Wanfang data,VIP,SinoMed and Web of Science Core Collection from inception to October 11,2023,and was analyzed with CiteSpace 6.2R4. Results A total of 285 articles were included with 124 in Chinese and 161 in English.The annual number of publications showed a general upward trend.United States,Canada,Netherlands,China and United Kingdom were the lead-ing countries in terms of output in English.The scholar with the most publications in Chinese was Zheng Jiejiao,and the Department of Rehabilitation Medicine in Huadong Hospital of Fudan University was the leading institu-tion for Chinese publications.Vrije University Amsterdam was the leading institution for English publications.The most frequent Chinese keywords were gait,falls,balance,cognition and postural control.The most frequent English keywords were dual-task,walking,gait,balance and cognitive-motor interference.Bursting keywords from the past two years included gait training,cognitive tasks,balance ability and cognitive-motor interference. Conclusion The researches on the application of CMDT in stroke are on the rise,with hotspots including gait training,cognitive tasks and cognitive-motor interference.The mechanisms of CMDT and the development of optimal CMDT rehabilitation protocols for stroke may be researched more in the future.

Objective To analyze the research status and predict the development trend of clinical comprehensive evaluation of drugs in China, and to provide reference for clinical comprehensive evaluation. Methods CNKI, Wanfang and VIP database were used to search the published articles of clinical comprehensive evaluation. Literature searching was set from the building time of the database to 2022, the basic information about the published articles was obtained for the evaluation of the literature quality. Bibliometrics and CiteSpace 6.1.R3 software were used to visualize the research authors, research institutions, and key words. Results After data screening, a total of 126 Chinese published articles were selected. The analysis showed that the numbers of published articles were rising continuously, and China Academy of Chinese Medical Sciences and Xie Yanming were the institute and the author with the maximum number of literatures, respectively. Conclusion The clinical comprehensive evaluation of drugs was conducted based on the clinical value of drugs, guided by the policy requirements. It is suggested that researchers should conduct the comprehensive evaluation according to the focus and requirements of government agencies, the pharmaceutical industry and the clinical applications.

Atrial fibrillation is one of the important risk factors for ischemic stroke, which can lead to the cardioembolic stroke. On the contrary, ischemic stroke can also result in atrial fibrillation, namely, atrial fibrillation detected after stroke (AFDAS). Studies have shown that the pathophysiological mechanism and prognosis of AFDAS may be different from those of atrial fibrillation known before stroke. The monitoring of AFDAS and its effect on prognosis has become a hot research topic. This article reviews the definition, pathophysiological mechanism, monitoring methods and prognosis of AFDAS.

Objective:To investigate the correlation between serum 25-hydroxyvitamin D [25(OH)D], Essen Stroke Risk Scale (ESRS) and the incidence of coronary atherosclerotic heart disease.Methods:From July 2016 to January 2019, 186 patients who underwent coronary angiography (CAG) in the Department of Geriatric Cardiology at the Second Affiliated Hospital of Anhui Medical University were included.Among them, 117 patients were diagnosed with coronary heart disease, 69 cases without coronary heart disease.The serum 25(OH)D values and ESRS scores of the two groups were collected to analyze the relationship between 25(OH)D, and ESRS scores, coronary heart disease.At the same time, multivariate logistic regression was used to analyze the correlation between serum 25(OH)D and ESRS scores.Results:The serum level of 25(OH)D in the coronary heart disease group was (38.19±16.35)nmol/L, which in the non-coronary heart disease group was (45.37±19.01)nmol/L, the difference was statistically significant difference ( t=2.722, P<0.05). The ESRS scores in the coronary heart disease group was (2.32±1.38)points, which of the non-coronary heart disease group was (1.42±1.32)points, the difference was statistically significant ( t=-4.394, P<0.05). Multivariate logistic regression analysis showed that 25(OH)D was independently associated with coronary heart disease ( OR=0.944, 95% CI: 0.902-0.989, P=0.015), ESRS score was independently associated with coronary heart disease ( OR=1.716, 95% CI: 1.314-2.240, P<0.001). Conclusion:25(OH)D is a protective factor for coronary heart disease, ESRS score is an independent risk factor for coronary heart disease.

Objective:To evaluate the diagnostic value of Essen stroke risk score(ESRS) combined with neutrophil lymphocyte ratio(NLR) in coronary heart disease(CHD).Methods:From July 1, 2015 to June 30, 2019, patients who were hospitalized in the Second Affiliated Hospital of Anhui Medical University for suspected CHD and underwent coronary angiography were selected as the study objects.According to the results of coronary angiography, these patients were divided into CHD group (stenosis rate ≥ 50%) and control group(stenosis rate<50%). The clinical, laboratory and angiographic data of the two groups were collected, including NLR, ESRS and coronary narrow degree integral(Gensini integral method). Logistic regression model and receiver operator characteristic(ROC) were used to evaluate the diagnostic value of ESRS combined with NLR in CHD.Results:During the study period, 325 patients were enrolled, including 219 CHD patients and 106 controls.The age, hypertension, diabetes mellitus, peripheral artery disease, ESRS, NLR and fasting blood glucose levels in the CHD group were significantly higher than those in the control group(all P<0.05). Spearman correlation analysis showed that ESRS( r=0.515, P<0.001) and NLR( r=0.250, P<0.001) were positively correlated with coronary Gensini score.Two logistic regression models were established, where model 1 was logit(P1)=-2.072+ 0.566×ESRS+ 0.299×NLR+ 0.173×fasting blood glucose(the diagnostic accuracy rate was 71.7%) and model 2 was logit(P2)=-1.169+ 0.594×ESRS+ 0.302×NLR(the diagnostic accuracy rate was 70.8%). There was no significant difference in the diagnostic accuracy between the two models( P=0.499). Finally, logistic regression model 2 was selected as the joint diagnostic model.The area under curve of ESRS, NLR and logistic regression model 2 was 0.713, 0.634 and 0.736, respectively, and the difference was statistically significant(all P<0.05). The diagnostic threshold of ESRS was 2, and the diagnostic threshold of NLR was 2.74.The 95% CI of the joint diagnostic model 2 was (0.684, 0.783), which showed a sensitivity of 60.27% and a specificity of 78.30%.This model was superior to the diagnostic efficacy of ESRS( P=0.047) and NLR( P<0.001). Conclusion:The joint diagnostic model of ESRS combined with NLR is superior to the single index in the diagnosis of CHD, which may thus be used to predict the occurrence of CHD.

Objective:To compare the prognosis of hemodialysis (HD) and peritoneal dialysis (PD) in end-stage renal disease (ESRD) patients without diabetes mellitus and identify related influencing factors.Methods:Patients who started hemodialysis with an arteriovenous graft or fistula or PD in the First Affiliated Hospital of Zhengzhou University from January 1, 2013 to February 1,2019 were included. They were followed up until May 1, 2019. The patients were divided into HD group and PD group according to the initial dialysis modality. Kaplan-Meier method was used to obtain survival curves, the Cox regression model was used to evaluate influence factors for survival rates, and the inverse probability of treatment weighting (IPTW) was used to eliminate influence of the confounders in the groups.Results:There were 371 patients with maintenance dialysis enrolled in this study, including 113 cases (30.5%) in HD group and 258 cases (69.5%) in PD group. At baseline, the scores of standard mean difference ( SMD) in age, body mass index (BMI), combined with cerebrovascular disease, Charlson comorbidity index (CCI), blood potassium, plasma albumin and hemoglobin between the two groups were greater than 0.1. The score of SMD decreased after IPTW, and the most data were less than 0.1, which meant that the balance had been reached between the two groups. The Kaplan-Meier survival curve showed that the cumulative survival rates had no significant difference for all-cause death before using IPTW between the two groups (Log-rank χ2=0.094, P=0.759). After adjusting for confounders with IPTW, the Kaplan-Meier survival curve showed that the cumulative survival rates still had no significant difference for all-cause death between the two groups (Log-rank χ2=2.090, P=0.150). Univariate Cox regression analysis showed that there was no significant difference between HD and PD on survival rates in ESRD patients without diabetes mellitus for all-cause death (PD/HD, HR=1.171, 95% CI 0.426-3.223, P=0.760). Multivariate Cox regression analysis showed that there was no significant difference between HD and PD on survival rates in ESRD patients without diabetes mellitus (PD/HD, HR=1.460, 95% CI 0.515-4.144, P=0.477), and high plasma albumin ( HR=0.893, 95% CI 0.813-0.981, P=0.019) was an independent protective factor for survival in ESRD patients without diabetes mellitus. There was still no significant difference between HD and PD on survival rates in ESRD patients without diabetes mellitus after using IPTW (PD/HD, HR=1.842, 95% CI 0.514-6.604, P=0.348). Conclusion:The difference of cumulative survival rates between HD and PD is not significant in ESRD patients without diabetes mellitus.

Objective:To study the relationship between IL-1β and TNFα expression and cell apoptosis in gingival tissue of the subjects with diabetes associated periodontitis(DAP).Methods:20 cases of DAP(group DAP) and 20 cases of health controls(group H)were included.The cell apoptosis and the ultrastructural changes in gingival tissue were observed by Tunnel staining and transmission electron microscope (TEM).IL-1β and TNFα expression in gingival tissue were detected by immunohistochemical staining.SBI,GI,PD and AL of the subjects were measured.The relationship between the level of IL-1β,TNFα and the cell appotosis was analyzed.Results:Apoptosis was obvious in prickle cells and basal cells of gingival tissue of DAP group.The percentage of apoptosis cells of DAP group was significantly higher than that of group H(P＜0.01).The expression of IL-1β and TNFα in group DAP was significant higher than that of group H (P＜0.01),and the mainly positive expression cells were macrophages,plasmocytes and lymphocytes.Conclusion:IL-1β and TNFα play a role in cell apoptosis in the gingival tissue of the patients with DAP.

Objective To explore the application of Oxybuprocaine Hydrochloride Gel in colonoscopy examination. Methods 1000 patients received colonoscopy examination were randomly divided into experimental group and control group, 500 cases in each. Oxybuprocaine Hydrochloride Gel was applied on anal region in the experimental group before endoscopy for perianal anesthesia and lubrication. Paraffin oil was used in the control group to lubricate perianal and enteroscopy. The success rate of primary insertion, visual analogue pain score (VAS) score, examination time and postoperative complications were compared between the two groups. Results In the experimental group, the success rate of primary insertion (95%) was higher than that of the control group (76%), and the pain score was lower than that of the control group.The examination time was shortened, and the difference was statistically significant (P < 0.05). Conclusions Oxybuprocaine Hydrochloride Gel applied to colonoscopy can effectively reduce the patient's pain and discomfort, improve the success rate of primary insertion, shorten the examination time. And the method is worthy of clinical popularization and application.

Objective To investigate changes of metabolic syndrome (MS ) in patients with adrenocortical adenoma (ACA ). Methods Sixty‐five patients with aldosterone producing adenoma (APA) ,43 patients with cortisol‐secreting adenoma (CSA) and 24 patients with nonfunctional adrenal adenoma (NAA) were evaluated. Body Mass Index (BMI) ,blood pressure ,plasma lipid ,fasting and 2 h postprandial plasma glucose ,plasma and urinary aldosterone ,plasma potassium ,basic and upright plasma renin activity (PRA ) ,plasma and urinary cortisol ,plasma ACTH and plasma potassium ACA were examined and compared with those from 53 patients of essential hypertension (EH ) and 58 controls. Adrenalectomy was performed for all the patients with adrenocortical adenoma. The data after operation were compared with those before operation. Results (1) The prevalence of MS was 38.5% ,41.9% , 20.8% ,24.5% and 17.5% in the groups respectively. The prevalence of obesity/overweight was higher in CSA group than in the other groups. There were 44.6% patients with hyperglycemia in APA group ,and 48.8% in CSA group. The prevalence of hypertension was the highest in APA and EH group ,followed by CSA group ,NAA and control groups. There were 55.4% patients with lipid disturbance in APA group , and 46.5% in CSA group. (2 ) We divided all APA and CSA patients into groups with or without MS. The APA patients with MS had higher plasma aldosterone than those without MS. The CSA patients with MS had higher 08 :00 and 24 :00 plasma cortisol than those without MS. (3) After operation ,the plasma and urinary aldosterone were decreased and the plasma potassium was increased in APA patients. The 08 :00 ,24 :00 plasma cortisol and urinary cortisol were decreased and the 08 :00 plasma ACTH was increased in CSA patients. There were no significant differences in hormonal measurements of NAA patients before and after operation. (4 ) The prevalence of MS was 27.7% ,27.9% and 29.2% in three groups after operation. The systolic and diastolic blood pressures were decreased in APA patients after operation ,and the systolic blood pressure decreased in CSA patients. There was no significant difference in MS measurements of NAA patients before and after operation. Conclusions Our study indicates that patients with functional adrenocortical adenoma have a significantly higher prevalence of metabolic syndrome which is related to over secretion of adrenal cortex hormone. After operation ,accompanying normalization of hormonal secretion ,the condition of MS in functional adrenocortical adenoma patients is improved.