The implantation of left ventricular assist device (LVAD) has significantly improved the quality of life for patients with end-stage heart failure. However, it is associated with the risk of complications, with unplanned readmissions gaining increasing attention. This article reviews the influencing factors, prediction methods and models, and intervention measures for unplanned readmissions in LVAD patients, aiming to provide scientific guidance for clinical practice, assist healthcare professionals in accurately assessing patients' conditions, and develop rational care plans.
Pre-rehabilitation is an emerging preoperative management strategy designed to mitigate surgical stress responses and expedite postoperative recovery through optimized interventions, which typically includes exercise training, nutritional support, and psychological counseling. For patients undergoing transcatheter aortic valve replacement (TAVR), the implementation of pre-rehabilitation measures is particularly crucial. This article reviews the necessity and principal components of pre-rehabilitation in TAVR patients, and offers suggestions including constructing the best pre-rehabilitation intervention program for TAVR, enhancing patient compliance and engagement in the recovery process, and paying attention to the management of frailty for TAVR patients. The aim is to provide a reference for healthcare professionals seeking to further refine the pre-rehabilitation management model for TAVR patients.
Objective To investigate the ameliorative effects of the traditional Chinese medicine formula Fuling Yin on heart failure and its potential mechanisms at the mitochondrial level. Methods Ninety SD rats were randomly divided into a blank control group (n=15) and a modeling group (n=75) using a random number table method. A chronic heart failure model was established in the modeling group by intraperitoneal injection of doxorubicin hydrochloride. One rat from the blank control group and five rats from the modeling group were randomly selected to verify the success of modeling. After confirming that the model was successfully established, the rest successfully modeled rats were randomly divided into the model group, positive drug (trimetazidine) group, and Fuling Yin low-, medium-, and high-dose groups (n=14 per group). Treatment groups were administered the respective drugs via gavage daily, while the blank control group and model group received an equal volume of pure water for 4 consecutive weeks. Cardiac function was assessed by echocardiography. Heart weight index (HWI) was calculated. Serum brain natriuretic peptide (BNP) levels and myocardial adenosine triphosphate (ATP) content were detected by enzyme-linked immunosorbent assay. Histopathological changes were observed via hematoxylin-eosin staining. Mitochondrial ultrastructure was examined using transmission electron microscopy. Mitochondrial membrane potential (MMP) and mitochondrial permeability transition pore (mPTP) opening were detected by JC-1 fluorescence probe and colorimetric assay, respectively. The expression of apoptosis-related proteins, peroxisome proliferator-activated receptor-gamma coactivator-1α (PGC-1α), and key proteins of the mitogen-activated protein kinase (MAPK) signaling pathway were determined by Western Blot. Results Compared with the blank control group, the HWI and serum BNP levels in the model group were increased (P<0.01). Compared with the model group, the HWI and serum BNP levels in Fuling Yin groups were decreased (P<0.01). Pathological and ultrastructural observations showed disordered myocardial fiber arrangement, mitochondrial swelling, and cristae rupture in the model group; whereas in the Fuling Yin groups, myocardial pathological injury was alleviated, mitochondrial swelling was reduced, and membrane structure tended to be intact. Regarding mechanism indicators, compared with the model group, the myocardial ATP content increased, the red fluorescence intensity of MMP enhanced, and the mPTP opening degree decreased in the Fuling Yin groups (P<0.01). Additionally, the Bax/Bcl-2 ratio decreased, and caspase-3 protein expression was downregulated (P<0.01). Furthermore, PGC-1α protein expression was upregulated, while the expression of MAPK proteins was downregulated (P<0.01). Conclusions Fuling Yin can alleviate myocardial injury and delay ventricular remodeling in doxorubicin-induced heart failure rats. Its mechanism may be related to regulating the PGC-1α/MAPK signaling pathway to maintain mitochondrial homeostasis, thereby inhibiting mitochondria-mediated cardiomyocyte apoptosis.
ObjectiveTo explore the risk factors of lymph node metastasis in patients with colorectal cancer, and construct a risk prediction model to provide reference for clinical diagnosis and treatment.MethodsThe clinicopathological data of 416 patients with colorectal cancer who underwent radical resection of colorectal cancer in the Department of Gastrointestinal Surgery of the Second Affiliated Hospital of Nanchang University from May 2018 to December 2019 were retrospectively analyzed. The correlation between lymph node metastasis and preoperative inflammatory markers, clinicopathological factors and tumor markers were analyzed. Logistic regression was used to analyze the risk factors of lymph node metastasis, and R language was used to construct nomogram model for evaluating the risk of colorectal cancer lymph node metastasis before surgery, and drew a calibration curve and compared with actual observations. The Bootstrap method was used for internal verification, and the consistency index (C-index) was calculated to evaluate the accuracy of the model.ResultsThe results of univariate analysis showed that factors such as sex, age, tumor location, smoking history, hypertension and diabetes history were not significantly related to lymph node metastasis (all P>0.05). The factors related to lymph node metastasis were tumor size, T staging, tumor differentiation level, fibrinogen, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), fibrinogen/albumin ratio (FAR), fibrinogen/prealbumin ratio (FpAR), CEA, and CA199 (all P<0.05). The results of logistic regression analysis showed the FpAR [OR=3.630, 95%CI (2.208, 5.968), P<0.001], CA199 [OR=2.058, 95%CI (1.221, 3.470), P=0.007], CEA [OR=2.335, 95%CI (1.372, 3.975), P=0.002], NLR [OR=2.532, 95%CI (1.491, 4.301), P=0.001], and T staging were independent risk factors for lymph node metastasis. The above independent risk factors were enrolled to construct regression equation and nomogram model, the area under the ROC curve of this equation was 0.803, and the sensitivity and specificity were 75.2% and 73.5%, respectively. The consistency index (C-index) of the nomogram prediction model in this study was 0.803, and the calibration curve showed that the result of predicting lymph node metastasis was highly consistent with actual observations.ConclusionsFpAR>0.018, NLR>3.631, CEA>4.620 U/mL, CA199>21.720 U/mL and T staging are independent risk factors for lymph node metastasis. The nomogram can accurately predict the risk of lymph node metastasis in patients with colorectal cancer before surgery, and provide certain assistance in the formulation of clinical diagnosis and treatment plans.
Objective To summarize the clinical characteristics of foot and ankle deformities combined with knee and lower limb deformities and evaluate the advantages, clinical outcomes, and considerations of QIN Sihe’s surgical strategy for treating such complex deformities. Methods Between January 2022 and December 2024, 32 patients with foot and ankle deformities combined with knee and lower limb deformities were enrolled. The cohort included 23 males and 9 females, aged 10-67 years (mean, 41.1 years). The main etiologies included post-polio sequelae (20 cases) and congenital limb deformities (3 cases). Deformities were categorized as follows: equinovarus foot (12 cases), equinus foot (2 cases), equinovalgus foot (3 cases), equinus foot with swan-neck deformity (2 cases), calcaneus foot (5 cases), foot valgus (2 cases), knee flexion deformity (14 cases), genu recurvatum (4 cases), genu varum (3 cases), genu valgum (3 cases), lower limb shortening (3 cases), and lower limb external rotation (6 cases). QIN Sihe’s surgical strategies included osteotomies, tendon releases, and tendon transfers for deformity correction, followed by external fixation for residual deformity adjustment and stabilization. Outcomes were assessed using QIN Sihe’s Postoperative Evaluation Criteria for Lower Limb (Foot and Ankle) Deformity Correction and Functional Reconstruction. Results All patients were followed up 8-32 months (mean, 16.5 months). Complications included pin tract infection (1 case, 1 site), ankle pain (2 cases), delayed healing at the proximal tibial osteotomy site (1 case), and anterior talar dislocation (1 case). At last follow-up, insufficient correction of foot deformity was observed in 1 case; both knee and lower limb deformities were corrected, with only mild recurrence of knee flexion deformity in 1 case. The foot/ankle and knee joint function improved. Based on QIN Sihe’s Postoperative Evaluation Criteria for Lower Limb (Foot and Ankle) Deformity Correction and Functional Reconstruction, outcomes were rated as excellent in 30 cases and good in 2 cases, with an excellent-good rate of 100%. Conclusion Foot and ankle deformities combined with knee and lower limb deformities are complex, QIN Sihe’s surgical strategy can achieve satisfactory clinical outcomes for simultaneous correction.
Objective We aimed to evaluate the current status of the construction and practice of the stroke center in West China Hospital of Sichuan University and develope a future strategy to promote the standardized developement of inpatients care and evidence practice. Methods The current status of the Stroke Center in West China Hospital of Sichuan University was assessed. The procedure of diagnosis and treatment was inspected in detail, including triage, thrombolytic therapy, antithrombotic medication and anticoagulant, primary and secondary prevention, filter of risk factors, rehabilitation and education for patients. After that, new plans were made on the basis of the assessment and experiences acquired from practices in the Stroke Center in West China Hospital. Results The primary Stroke Center had been constructed in West China Hospital. The practice in West China Hospital showed that the Stroke Center significantly reduced the mortality and shortened the length of hospital stay of the patients with stroke. Conclusion It is proved that construction and implementation of the Stroke Center in West China Hospital are feasible.
