Objective To explore the valve regurgitation status of left heart after the implantation of left ventricular assist device (LVAD) and its effect on prognosis of patients with LVAD implantation. Methods A total of 35 patients with cardiomyopathy who underwent magnetic levitation LVAD implantation at Zhongshan Hospital, Fudan University from February 2021 to July 2024 were retrospectively selected. Clinical data during hospitalization were collected, including preoperative basic data and postoperative valve regurgitation status. Telephone follow-ups were conducted to monitor patients’ survival status and transthoracic echocardiography was used to assess left valve function. Kaplan-Meier survival curves and log-rank test were employed to compare the survival rate of patients with different levels of valve regurgitation. Results The 35 patients had a mean age of (53.9±11.1) years, with 85.7% male, and 3 patients (8.6%) died during hospitalization. Preoperatively, 17 patients (48.6%) had moderate or greater mitral regurgitation, while all 35 patients had less than moderate aortic regurgitation. One month postoperatively, thirty patients were followed up, among which 24 patients (80%) had less than moderate mitral regurgitation, including 11 cases with alleviated regurgitation compared to pre-surgery; 6 patients (20%) had moderate or greater mitral regurgitation, including 4 cases with stable regurgitation and 2 cases with progression of regurgitation compared to pre-surgery; 2 patients (6.7%) had progression of aortic regurgitation to moderate or greater. The follow-up time was 1.2 (1.0, 2.1) years, with 1-year survival rate of 91.4% and 3-year survival rate of 71.1%. Survival analysis showed that the 3-year survival rate of patients with moderate or greater mitral regurgitation one month postoperatively was significantly lower than that of patients with less than moderate regurgitation (66.7% vs 83.3%, P＝0.046). Conclusions After the implantation of magnetic levitation LVAD, most patients showed improvement in mitral regurgitation, while aortic regurgitation remained unchanged. The degree of mitral regurgitation one month postoperatively is associated with prognosis.

ObjectiveTo explore the method of optimizing the performance of traditional Chinese medicine （TCM） syndrome diagnostic models using Stacking ensemble learning. MethodsTaking the construction of TCM syndrome diagnostic model for lung cancer as an example， 2598 cases of clinical symptoms and signs from lung cancer patients in 9 hospitals were used as independent variables （i.e.， feature variables）， TCM syndrome information as dependent variables， and the clinical data were divided into training set and testing set in 8：2 ratio according to random number table method using Python 3.7 software. The stable features of TCM syndrome of lung cancer were screened using chi-square test， Spearman's correlation test， and Least Absolute Shrinkage and Selection Operator （LASSO） logistic regression analysis； nine machine learning algorithms are trained， including support vector machines （SVMs）， k-nearest neighbors （KNN） algorithm， Random Forest （RF）， Extremely Randomized Trees， Extreme Gradient Boosting （XGBoost）， Lightweight Gradient Boosting （LightGBM）， Adaptive Boosting （AdaBoost）， Gradient Boosting （GB） and the multi-layer perceptron （MLP）， to obtain 9 basic models. Four models with better performance were screened out from the above basic models and fused to form a fusion model by using the Stacking ensemble learning， and the fusion model was trained twice by the above nine machine learning algorithms and evaluated by accuracy rate， micro-average ROC curves， area under the curve （AUC）， and confusion matrix metrics， to screen the optimal diagnostic model. ResultsAfter data processing， 79 stable features and 13 TCM syndromes were obtained. In the basic model training， the comprehensive performance of RF， ExtraTrees， MLP and SVM basic models were better， so the predicted distributions of the syndromes of these four models were used as the secondary training data， and nine fusion models were obtained based on the Stacking ensemble learning （SVM， KNN， RF， ExtraTree， XGBoost， LightGBM， GB， AdaBoost， MLP）. Among them， the XGBoost fusion model performed the best， with an accuracy of 0.850 and 0.838 in the training set and test set， respectively， an overfitting difference of 0.012， and an area under the micro-average ROC curve of 0.996. All fusion models showed an improvement in accuracy and area under the micro-average ROC curve compared with the base model in the test set. ConclusionTaking the TCM syndrome information of lung cancer as an example， the XGBoost fusion model has significant advantages in improving the diagnostic performance of TCM syndrome information of lung cancer through Stacking ensemble learning. It can be seen that the advantages of Stacking ensemble learning to integrate multiple models and effectively improve the diagnostic efficiency of TCM diagnostic models， which provided a methodological reference for similar studies.

To investigate the role of chebulagic acid(CA)in regulating lipopolysaccharide(LPS)-in-duced inflammatory response in endometrial tissue of dairy cows,and to provide new ideas for the treatment and new drug development of endometritis in dairy cows.The endometrial tissues of dairy cows were isolated and cultured in vitro,stimulated with 1 mg/L LPS for 1 h and then co-cultured with CA(12.5,25.0,50.0,100.0 mg/L).Then the endometrial tissues of different treat-ment groups were collected for experiments.The protein secretion and gene expression levels of TNF-α,IL-6 and IL-1β were detected by ELISA and real-time fluorescence quantitative PCR.HE staining was used to observe the degree of endometrial tissue damage.The expressions of high mobility protein 1(HMGB-1)and hyaluronidase binding protein 2(HABP-2)were detected by immunofluorescence.The phosphorylation levels of ERK,p65 and IκBα were detected by Western blot.The results showed that the protein secretion levels of TNF-α at 6,24 h and IL-6 at 6,12 and 24 h,and the gene expression levels of IL-1β and IL-6 at 6,9,and 12 h and TNF-α at 6 h were sig-nificantly down-regulated after CA treatment with the LPS-induced endometrial tissue inflammation response model of dairy cows.HE staining showed that compared with the LPS group,the LPS+CA group had some improvements,the degree of epithelial cell exfoliation was reduced,the struc-ture of glands and blood vessels was relatively complete,the degree of inflammatory cell infiltra-tion was reduced,and there was no obvious necrosis or hemorrhage.The expression of HMGB-1 and HABP-2 in LPS+CA group was also significantly down-regulated.The phosphorylation levels of ERK,IκBα and p65 in the LPS+CA group were significantly decreased.In conclusion,CA can reduce LPS-induced inflammation in the endometrial tissue of dairy cows by inhibiting the activa-tion of MAPK and NF-κB pathways and down-regulating the expression of inflammatory factors in the uterine tissue.It is concluded that CA may be a potential therapeutic agent for endometritis in dairy cows and deserves further research and development.

Objective:To explore the diagnostic value of 18F-prostate specific membrane antigen (PSMA) PET/CT PRIMAY score combined with multiparameter MRI (mpMRI) PI-RADS score for clinically significant prostate cancer (CsPCa). Methods:The data of 63 patients with prostate cancer who underwent radical prostatectomy at Beijing Hospital from January 2019 to December 2023 were retrospectively analyzed. The median age was 70 (64, 75) years old with prostate-specific antigen (PSA) level of 8.46 (5.40, 14.80) ng/ml. All patients underwent 18F-PSMA PET/CT and mpMRI examination before surgery, and pathological large sections of prostate specimens were made after surgery. The prostate lesions were diagnosed and located by two radiologists and one pathologist respectively. Lesions with Gleason scores (GS)≥3+ 4 from the surgical pathology were diagnosed with CsPCa, and lesions with negative or GS=6 were diagnosed with non-CsPCa. The PSMA PET/CT images were evaluated using the PRIMARY study criteria (5-level PRlMARY score): no pattern (score of 1), diffuse transition zone or central zone(not focal) (score of 2), focal transition zone(score of 3), focal peripheral zone(score of 4), or an SUV max of at least 12 (score of 5). The degree of uptake of imaging agent in prostate lesions was semi-quantitatively evaluated using lesion-to-background ratios (LBR) of SUV max. MpMRI was evaluated according to the Prostate Imaging Reporting and Data System (PI-RADS) version 2.1. The patients were divided into CsPCa group and non-CsPCa group based on patients and lesions. Mann-Whitney U test and chi-square test were used to compare the differences between groups. Multivariate logistic regression analysis was performed to determine the independent predictive factors of CsPCa. Receiver operator characteristic (ROC) curve was used to determine the optimal diagnostic threshold for each independent predictor. Predictive models were constructed for PRIMARY score, PI-RADS score, and their combined application, and the diagnostic performance of each model for CsPCa was compared. Results:Of all 63 patients, there were 54 cases in CsPCa group (85.7%) and 9 cases in non-CsPCa group (14.3%).There was significant difference between CsPCa group and non-CsPCa group in the serum PSA level [9.64 (6.1, 15.3) ng/ml vs. 5.6 (4.6, 7.6) ng/ml]( P<0.05). There was no statistically significant difference in age [71 (64, 75) years vs. 65 (63, 69) years], and number of lesions [2 (1, 2) vs. 2 (1, 3)] (all P>0.05). Of all 109 lesions, there were 81 lesions in CsPCa group(including 49 lesions with Gleason score = 3+ 4, 16 lesions with Gleason score=4+ 3, 14 lesions with Gleason score = 8, and 2 lesions with Gleason score>8) and 28 lesions in non-CsPCa group(including 14 lesions with Gleason score = 3+ 3 and 14 with benign prostate lesions). There was significant difference between CsPCa group and non-CsPCa group in PRIMARY score [4 (3, 5) vs. 2 (1, 4)], LBR [2.69 (2.08, 4.48) vs. 1.89 (1.45, 2.48)], PI-RADS score [4 (3, 5) vs. 2 (2, 3)] (all P<0.05). There was no statistically significant difference in the lesion distribution including the number of lesions located in the transition zone [15(18.5%) vs. 8(28.6%)] and in the peripheral zone[66(81.5%) vs. 20(71.4%)]( P>0.05). Multivariate logistic regression analysis indicated that PRIMARY score ( OR=2.134, 95% CI 1.429-3.187) and PI-RADS score ( OR=2.689, 95% CI 1.618-4.469) were independent predictors of CsPCa (both P<0.01). ROC curves analysis revealed that the cut-off value for diagnosing CsPCa was both 3 for PRIMARY score and PI-RADS score. The accuracy for PRIMARY score, PI-RADS score, and their combined complication in diagnosing CsPCa was 72%, 67%, and 83%, respectively. The sensitivity was 72%, 63%, and 91%, and the specificity was 75%, 79%, and 57%, respectively. The positive predictive value was 89%, 89%, and 86%, and the negative predictive value was 48%, 42%, and 70%, respectively. The area under the curve of the PRIMARY score, PI-RADS score, and their combined complication of the ROC curve for CsPCa were 0.733 (95% CI 0.624-0.842), 0.708 (95% CI 0.599-0.817), and 0.743 (95% CI 0.623-0.862), respectively. The diagnostic efficacy of their combined complication was higher than PRIMARY score or PI-RADS score alone (both P<0.01). Conclusions:Both the 18F-PSMA PET/CT PRIMAY score and the mpMRI PI-RADS score have good diagnostic value for CsPCa. The combined application of the two imaging parameters can improve the accuracy, sensitivity, and negative predictive value, which have a higher diagnostic efficiency of CsPCa.

Objective:To investigate the application effect of WeChat group combined with case-based learning (CBL) in probation teaching of vascular surgery.Methods:A total of 128 intern doctors of the seven-year medical program in vascular surgery were selected and divided into experimental group (WeChat group combined with CBL teaching) and control group (CBL teaching alone), and a unified assessment method was used to evaluate the mastery degree of professional theories and clinical knowledge and assess the teaching effect of these two teaching modes in vascular surgery. SPSS 22.0 was used to perform the t-test. Results:Compared with the control group, the experimental group had significantly higher scores of theoretical examination [(86.36±7.42) vs. (84.71±6.72)] and clinical examination [(88.44±7.62) vs. (86.22±6.41)], as well as significantly higher degrees of satisfaction with learning interest, classroom climate, self-learning ability, clinical thinking ability, and teamwork spirit.Conclusion:The teaching mode of WeChat group combined with CBL can improve the effect of the probation teaching of vascular surgery and the self-learning and clinical thinking abilities of intern doctors.

【Objective】 To understand the occupational exposure of blood center staff during blood collection and supply, analyze the influencing factors, explore preventive measures and improve the self-protection awareness of staff, so as to further improve the prevention of such occupational exposure in blood centers. 【Methods】 Seventy-two occupational exposure cases, which occurred and registered in Beijing Red Cross Blood Center from January 2010 to December 2021, were reviewed by retrospective survery methods, and such cases were classified and analyzed statistically. The incidence of blood-borne occupational exposure was compared by genders, departments, occurrence locations, education level, occupation type, work link, causes of exposure and body parts, so as to analyze the influencing factors, and then propose corresponding prevention strategies. 【Results】 From 2010 to 2021, a total of 72 blood-borne occupational exposure cases occurred. When classified by gender, the exposure rate of women was more than twice that of men; by age, the exposure rate of 18~25 years old was the highest, reaching 7.84%, but 26~40 years old group contributed the most cases, accounting for 70.83% (51/72); by working years, the exposure rate of staff with working years less than 3 years was relatively high, but the staff with 4~10 working years contributed the most cases, accounting for 54.17% (39/72); by the education level, the the exposure rate of stall with bachelor degree and below was the highest(90.28%, 65/72); by the professional title level, the exposure rate of staff with primary and intermediate professional titles was relatively high (94.44% , 68/72); by departments, the exposure rate of Blood Donation Service was the highest (81.94%, 59/72), which was twice or even three times than that of other departments; by occupational type, nurses had the highest exposure rate, accounting for 87.5% (63/72); by body parts, hands were the most vulnerable body parts to occupational exposure; by location, the exposure rate on mobile vehicles is four times than that in indoor places; by the number of exposure times, the incidence of one exposure cases accounted for 72.22%(52/72)while multiple exposure was rare by work link, the exposure rate of the sampling link was significantly higher than that of the other links. 【Conclusion】 Blood-borne occupational exposure of staff in blood centers is closely related to gender, age, working years, professional title level, department, occupational type, occurrence place, and body part, and has nothing to do with the education level. More attention should be paid to middle-aged female nurses on the front line of blood donation service, staff with primary or intermediate titles and undergraduate degrees. Otherwise, training and protection should be enhanced, operation methods be standardized, the blood collection environment be improved, and the management, automation and intelligent level of blood collection be promoted.

Objective: To study the effect of low-to-moderate dose glucocorticoid therapy on viral clearance time in patients with COVID-19. Methods: A total of 72 patients diagnosed with COVID-19 from January 19 to February 17, 2020 at the First Affiliated Hospital, School of Medicine, Zhejiang University were recruited. All patients received oral abidol and/or combined lopinavir/ritonavir, darunavir antiviral, and symptomatic supportive care. Among them, 51 patients received methylprednisolone (0.75-1.50 mg·kg^-1·d^-1) (glucocorticoid treatment group), and 21 patients who did not use glucocorticoid were the control group. The time of stable virologic conversion insputumand the time of radiologic recovery in lungsince onset were compared between the two groups and among the normal patients.The Kruskal-Wallis test or Fisher exact test was used to compare the difference between groups. Results: The median ages of the glucocorticoid group and the control group were 52 [interquartile range (IQR):45, 62] years and 46 (IQR: 32, 56)years, and the differences were significant (P<0.05). The clinical conditions at hospital admission were different between the two groups (P<0.01). There were 52.0% critical ill patients in the glucocorticoid treatment group, compared to that of 71.4% normal patients in the control group. The median times from the onset tostable virologic conversion to negative in the two groups were 15 (IQR:13,20) days and 14 (IQR:12,20) days (P>0.05), and the difference was no statistically significant. The median times from onset to radiologic recovery were 13 (IQR: 11,15) days and 13 (IQR:12,17) days in the two groups, and there was no difference (P>0.05). In ordinary patients, the median timesfrom the onset tostable virologic conversion insputum were no difference (P>0.05), with 13 (IQR:11,18) days in the glucocorticoid group and 13 (IQR:12,15) days in the control group; The median times from onset to radiologic recovery in lungwere also no difference (P>0.05), with 12 (IQR: 10,15)days in the glucocorticoid group and 13 (IQR: 12,17) days inthe control group. Conclusions Low-to-moderate glucocorticoid treatment has no effect on the time of virus clearance in patients with different clinical types of COVID-19. The glucocorticoid is not recommended since no effectiveness on accelerating the improvement of radiologic recovery in lung has been observed.

Objective:To study the effect of low-to-moderate dose glucocorticoid therapy on viral clearance in patients with COVID-19.Methods:A total of 72 patients diagnosed with COVID-19 from January 19 to February 17, 2020 at the First Affiliated Hospital, Zhejiang University School of Medicine were recruited. All patients received oral arbidol and combination of lopinavir/ritonavir or darunavir/cobistitat for antiviral therapy, and symptomatic supportive care. Among them, 51 patients received methylprednisolone (0.75-1.50 mg·kg -1·d -1) (glucocorticoid treatment group), and 21 patients did not use glucocorticoid (control group). The time of virologic negative conversion in sputum and the time of radiologic recovery in lung since onset were compared between the two groups. The Kruskal-Wallis test or Fisher exact test was used to compare the difference between groups. Results:The median ages of the glucocorticoid group and the control group were 52 (45, 62) and 46 (32, 56) years ( χ2=4.365, P<0.05). The clinical conditions at hospital admission were different between the two groups ( P<0.01). The severe cases accounted for 52.0%, while moderate cases in the control group accounted for 71.4%. The median times from the onset to virologic negative conversion in the two groups were 15 (13, 20) and 14 (12, 20) days ( P>0.05). The median times from onset to radiologic recovery were 13 (11, 15) and 13 (12, 17) days in the two groups ( P>0.05). In moderate cases, the median times from the onset to virologic conversion in sputum were 13 (11, 18) days in the glucocorticoid group and 13 (12, 15) days in the control group ( P>0.05). The median times from onset to radiologic recovery in lung were 12 (10, 15) and 13 (12, 17) days, respectively ( P>0.05). Conclusions:Low-to-moderate glucocorticoid treatment has no effect on the time of virus clearance in patients with different clinical types of COVID-19, and also no effect on accelerating radiologic recovery in lung, so it is not recommended.

This article reviews the common bowel preparation programs, influencing factors and intervention strategies before colonoscopy in elderly subjects, with a view to provide reference for improving the quality of bowel preparation in elderly colonoscopy subjects in the future.

There are various contents about diagnosis and treatment of low back pain in(), which are closely related to meridians and collaterals, forming a complete theoretical system of meridian differentiation for low back pain. Its theory and application are interpreted in this paper from five main aspects, including 18 meridians and collaterals densely distributing in the tendons and bones of the waist, the pathogenesis of low back pain lying in the disorders of the meridianand blood, the nature of low back pain being reflected by the color and shape of meridians and collaterals, the disordered meridians of low back pain being first identified based on syndrome differentiation, the acupuncture prescription being selected according to meridian differentiation. The purpose of this paper is to guide clinical practice, explore the advantages and characteristics of meridian differentiation, and provide theoretical reference and evidence for promoting the standardization of TCM.