Objective This study aims to evaluate the impact of early surgery on long-term outcome of patients with left-sided native valve infective endocarditis (IE).Methods Clinical data were retrospectively reviewed in 239 consecutive patients with left-sided native valve IE from 2002 to 2012 in Peking Union Medical College Hospital (PUMCH).Propensity score was used to match patients in the early operation and conventional treatment groups.Results Early surgery was performed in 70 (29.3％)patients and the conventional treatment strategy was applied in 169 (70.7％) patients.The median followup period was 2 years.IE-related mortality was lower in the early operation group than in the conventional treatment group (10.0％ vs 23.1％,P =0.02).For 58 propensity score-matched pairs,the cumulative survival free from IE related death was significantly higher in the early operation group than in the conventional treatment group (P =0.027).Regression analysis of the matched cohorts revealed that early surgery was independently associated with decreased IE-related mortality (HR 0.286 ; 95％ CI 0.092-0.893 ;P =0.031).While either cardiac function with NYHA Class Ⅲ-Ⅳ (HR 4.044; 95％ CI 1.318-12.407;P =0.015) or uncontrolled infection (HR 52.064; 95％ CI 10.996-247.194; P ＜ 0.001) was associated with poor prognosis of increased mortality.Conclusions Early surgery improved long-term outcome in patients with left-sided native valve IE compared with conventional therapy.Risk factors related to increased mortality included heart failure and uncontrollable infection.

Objective To investigate the manifestations of cardiac involvement in the patients with mucopolysacharidosis Ⅰ (MPS Ⅰ).Methods The clinical data of 10 MPS Ⅰ patients were collected.Electrocardiography (ECG) and echocardiography (Echo) were performed in all patients and then analyzed.Results Among the ten patients,seven were men.The onset age of MPS was (0.5 ～ 8.0) years old and the age of diagnosis was (1.8 ～ 20.0) years old.Two patients had grade 2 precordial systolic murmur.ECG was abnormal in three patients with right ventricular hypertrophy in two and right axis deviation in another one.Echo showed valvular thickening and insufficiency in nine patients,enlarged left atrium and ventricle in one patient,hapulmonary hypertension and right ventricular hypertrophy in two patients and abnormal left ventricular configuration in five patients.Conclusions Cardiac involvement is common in MPS Ⅰ patients and may present as valvular thickening with regurgitation,abnormal left ventricular configuration and pulmonary hypertension.The cardiac involvement progresses with age.ECG and Echo should be done regularly during follow-up of MPS Ⅰ patients.

Objective To explore the safety and clinical efficacy of Ginkgo biloba lactone injection combined with Alteplase intravenous thrombolysis in treatment of acute ischemic stroke.Methods Totally 87 patients were recruited and divided into control group and test group.The,patients in control group (39 cases) were given Alteplase 0.9 mg/kg for injection,intravenous bolus total dose 10％ was given within 1 min,then intravenous infusion of the remaining 90％ was given in 1 h,and given basic therapy after 24 h.The 48 cases in test group,which were immediately iv Ginkgo biloba lactone injection after intravenous thrombolysis,6 mL added into 250 mL saline,once daily for 14 d,and also were given basic therapy after 24 h.All NIHSS scores were recorded before treatment,14 d and 90 d after treatment,and the adverse events were recorded.The modified Rankin scale (mRS) score and BI index were performed at 14 and 90 d after admission.Patients in two groups were classified according to the TOAST classification,and the patients with large-arteryatherosclerosis and small-artery occlusion were analyzed.Results No intracranial hemorrhage occurred in the two groups.The NIHSS score and mRS score of test group were significantly lower than that of control group,and BI index was significantly increased 90 d after treatment.The NIHSS score and mRS score of test group were significantly lower than that of control group,and BI index was significantly increased90 d after treatment of patients with large-artery atherosclerosis.But there was no significant difference between test group and control group of patients with small-artery occlusion.Conclusion Ginkgo biloba lactone injection combined with rt-PA intravenous thrombolysis in the treatment of acute ischemic stroke has high safety,and can improve the prognosis of patients.

Objective To evaluate the immunogenicity of the recombinant human papillomavirus type 68b (HPV68b) virus-like particles(VLPs)in a mouse model.Methods The L1 protein of HPV type 68b was successful expressed in the Hansenula polymorpha strain (NVSI-68b-1).Processes including purifi-cation and reconstitution were performed to achieve pure HPV 68b VLPs.The purity, morphology and immu-nogenicity of the purified HPV 68 b VLPs were further analyzed .The BALB/c mice were immunized with HPV68b VLPs formulated on aluminum adjuvant .Pseudovirus-neutralizing antibody ( PsV NAb) assay was performed to detect the neutralizing antibodies in serum samples .Results The HPV 68 b L1 VLPs were ob-tained as indicated by the results of SDS-PAGE, Western blot assay , HPLC, electron microscopy and dy-namic light scattering with a high purity of 95%.Transmission electron microscopy and dynamic light scat-tering analysis revealed that the HPV68b L1 VLPs resembled the native virus with an average particle diame-ter of 50 nm.High levels of HPV68b-neutralizing antibodies were detected in serum samples from the mice immunized with HPV68b L1 VLPs.Moreover, a cross-protective efficacy of HPV68b L1 VLPs for HPV68a was observed .Conclusion This study suggested that the recombinant HPV 68 b VLPs expressed in a Han-senula polymorpha strain might be used as a potential candidate for the development of HPV vaccine .

Tepoxalin is a potent inhibitor of both the cyclooxygenase and lipoxygenase pathways of the arachidonic acid cascade, as well as a potent anti-inflammatory and control-pain (postoperation, arthritis et. al.) agent. The new method about the use of novel synthesis reagents and the first using ionic liquid as reactive solvent to synthesize tepoxalin were presented in this paper. The ionic liquid can be easily recycled and reused for several runs efficiently. The analgesic activity of tepoxalin was detected by acetic acid test on mice. The analysis of variance showed that oral administration of tepoxalin could significantly inhibit the number of writhing response within 1 hour and prolong the latent time in a dose dependent manner as compared with CMC control group (P < 0.05). At the same time, tepoxalin had the same analgesic activity as diclofenac sodium.

Clinical research design is the beginning and the cornerstone for clinical research,and it functions as the preliminary step of translational research.In order to improve clinical research ability,foster quality research talents team,and to promote the development of translational research,Peking Union Medical College Hospital (PUMCH) started to provide the online course Designing Clinical Research (DCR),which has greatly contributed to enhancing clinical research capacity.The management of DCR online course serves as a great exploration on training junior medical professionals and international research collaboration.This study aims at sharing the management experiences of clinical research design and junior talents training.

Pertussis toxin (PT) is one of the major virulence factors of Borrelia pertussis and also an essential component of pertussis vaccines. Before using it in vaccine production, detoxification is necessa-ry because of its biological activity. This paper summarized the structure and detoxification process of PT as well as the safety and immunogenicity of pertussis vaccines prepared with detoxified PT.

With the development and widespread use of diphtheria-tetanus-pertussis (DTP)-based combined vaccines, the number of vaccinations and the cost of vaccination implementation have gradually decreased, which has a positive and profound impact on implementing immunization programmes and meeting differentiated needs. The development of formulation process is critical to the research on combined vaccines, and a formulation process with good robustness and flexibility plays a vital role in vaccine immunogenicity, antigen compatibility and product stability. This article discussed some common issues in the chemical manufacture and control (CMC) of DTP-based combined vaccines referring to the regulatory consensus of various countries and related organizations.

This article combs and summarizes the entire process of rare disease selection and priority theme determination,including the application and preliminary review of rare diseases,standardization of disease theme information,the evaluation methods of evidence sorting and disease selection for priority se-lection of disease themes,and other aspects of the content were analyzed in depth.It is expected to provide reference for the subsequent selection of rare diseases,improve the fairness,rationality and scientificity of rare disease selection,and further promote research and decision-making in China's rare disease-related fields.