Objective To investigate the clinical treatment of infective endocarditis with vegetations in pregnant women and the outcomes of the gestation. Methods Nine cases of pregnant women diagnosed as infective endocarditis with vegetations in Beijing Anzhen Hospital, Capital Medical University from January 2001 to October 2015 were enrolled in retrospective analysis. Consultations were held by doctors from department of obstetrics, anesthesiology, cardiology, cardial surgery and extracorporeal circulation to decide the individualized treatment plan for the 9 cases of pregnant women after admissions. Clinical treatments including general treatment, anti-infection treatment, cardiac surgery, and termination of pregnancy surgery were completed through collaboration among related departments. The clinical characters, therapeutic regimens, maternal and neonatal outcomes of the 9 cases were analyzed. Results (1)Clinical characters: the ages of the 9 cases of pregnant women were from 25 to 36 years old. The onset gestational ages were from 19 to 36 weeks. Clinical symptoms: fever, cough, sputum and progressive anemia were the main symptoms. Patients had cyanosis of lips, could not lie on the back or even be orthopnea, when heart failure happened. Heart murmur was audible and splenomegaly was touched in physical examination. Blood cultures were positive. Basic heart disease types: 7 cases of congenital heart diseases included 2 cases of aortic insufficiency, 1 case of mitral insufficiency, 1 case of patent ductus arteriosus, 1 case of right ventricular outflow tract stenosis and 2 cases of ventricular septal defect.Two cases of rheumatic heart diseases included 1 case of mitral stenosis, 1 case of mitral stenosis after artificial disc changed and jammed. According to endocardial vegetations attached position there were 3 cases of mitral valve vegetations, 2 cases of pulmonary valve vegetations, 3 cases of aortic vegetations and 1 case of right ventricular outflow tract neoplasm. Preoperative heart function classification:1 case of levelⅡ, 3 cases of levelⅢ, 5 cases of levelⅣ.(2)Treatments:general treatment included oxygen uptake, rest in bed, cardiac strengthen and diuretic therapy, etc. Combined and adequate antibiotics were applied in anti-infection treatment according to drug sensitive test. Nine cases of pregnant women were all performed surgical treatment of heart diseases and removal of the endocardial vegetations. Caesarean sections were performed for 2 cases in second trimester and for 7 cases in last trimester. Cardiac surgery and caesarean section were operated in 6 cases at the same time among 22-34 weeks of pregnancy. Cardiac surgery were respectively operated in 2 cases 11 days and 32 days after the caesarean section at 33, 37 weeks of pregnancy. While Cardiac surgery was operated (at 26 weeks of pregnancy) before the caesarean section (at 37 weeks of pregnancy) in another 1 case. (3) Maternal and neonatal outcomes:7 cases of pregnant women were rescued successfully, while 2 cases of pregnant women were death. Postoperative heart function classification: 1 case of level Ⅰ, 2 cases of levelⅡ, 4 cases of levelⅢand 2 cases of levelⅥ. Neonatal survivals were 6 cases including 2case of full-term infants, 4 cases of preterm infants. Stillbirth or neonatal death were 3 cases, which included 2 cases performed caesarean section in second trimester and 1 case of very low weight infant who was given up treatment by family because of severe asphyxia. Followed up periods were from 1 to 7 years with an average time of (2.0 ± 1.6) years. Infants and young children grew and developed well during the period of follow up. Conclusions The risk is extremely high of pregnancy with infective endocarditis with vegetations. But there is still a way to save the maternal and neonatal life by using a multidisciplinary collaboration formulation and implementation of individualized treatment plan and selecting the appropriate time for heart surgery and the termination of pregnancy.

Objective To observe the safety and efficacy of the SLIPA mask airway in the cesarean section operation under general anesthesia.Methods Fifty single birth pregnant women who underwent cesarean operation under general anesthesia were randomized into 2 groups.SLIPA mask group(group S,25 cases)and endotracheal intubation(ETT)group(group T,25 cases).Mean arterial pressure(MAP),heart rate(HR),partial pressure of carbon dioxide in end expired gas(P_(ET)CO_2),peak airway pressure(Paw)were measured before induction of anesthesia,just before intubation,2min after intubation,just before extubation,2 min after extubation.Bucking,style,reflow,vomiting,aspiration were observed at inmbation or SLIPA mask airway insertion,before and after extubation and intraoperative.Umbilical arteries and veins blood were collected at delivery for the blood gas analysis.All delivery times,operation time and Apgar scores at 1,5 min were recorded.Results The successful rate ofthe first time intubation was 100% in group S,there was 2 cases by the second time intubation in group T.There Was 3 cases with gently air leak,but no influence on respiratory management.After intubation and extubation,MAP and HR increased significantly in group T (P<0.05),while group S had no significant change.There was no occurrence of bucking,style,reflow,vomiting,aspiration intmoperative,but 17 cages occurred at extubation in group T.The incidence and degree of sore throat in group T(10 cases after 2 hours and 6 cases after 24 hours) were significantly higher than those in group S(P<0.05).The Apgar scores at 1,5 min and delivery times were not significant between the two groups(P>0.05).Conclusion There is less adverse effects of SLIPA mask airway than ETT under general anesthesia in the cesarean section operation,SLIPA mask airway is safe and efficacious.

Objective To explore the epidemiologic and clinical features of hand, foot and mouth disease (HFMD) caused by Coxsackie virus A16 (CA16) in Suzhou from 2010 to 2014, and analyze the relationship between the SNPs of oligoadenylate synthetase 1 (OAS1) and HFMD caused by CA16 infection.MethodsThe clinical data of children diagnosed with HFMD caused by CA16 during 2010 and 2014 were collected. The epidemiological characteristics were analyzed. Among them, 167 cases were selected to make comparison of the clinical features with 166 cases of HFMD caused by EV71 infection in the same period. The genotyping ofOAS1 rs10774671 was detected by TaqMan probe technique in 167 cases of CA16 infection children, 166 cases of EV71 infection children with HFMD and 163 healthy children. The relationship between polymorphism of gene and infection of CA 16 was analyzed.ResultsA total of 9 016 children with HFMD were included. CA16 nucleic acid detected to be positive in 762 cases. The detection rate was 8.45%. CA16 infection was most commonly in summer. Children under 5 years old accounted for 94.62% infected. Compared with EV71 infected children, CA16 infected children had shorter fever time, severer oral herpes, ulcer, and rash in hand, foot and hip, lesser nervous system involvement, fewer cases of high lactate dehydrogenase, high C reactive protein, high IgM or IgG, and signiifcant changes in the percentage of CD3+, CD3+CD4+, CD3+CD8+ and CD3-CD19+ (P all?

Objective:To evaluate the efficacy and safety of sequential platinum regimen in young patients with diffuse large B-cell lym-phoma (DLBCL). Methods:Newly diagnosed young patients with DLBCL, who were hospitalized from January 2005 to June 2012 in the Affiliated Cancer Hospital of Zhengzhou University, were selected according to the requirements. The patients were divided into stan-dard and sequential platinum regimen groups. The remission rates were compared usingχ2 test, whereas the five-year survival rates between the two groups were compared using the Kaplan–Meier method. Multivariate survival analysis was performed using the Cox proportional regression. Subgroup analysis was conducted to select candidate patients for the sequential platinum regimen. Results:A total of 331 patients were enrolled in the study, in which 129 were provided with sequential platinum regimen and 202 were provided with the standard regimen. Sequential regimen yielded higher rates of complete remission (80%vs. 63%, P=0.001), five-year progres-sion-free survival (PFS;60%vs. 50%, P=0.014), and overall survival (OS;70%vs. 58%, P=0.016) than the standard regimen. Multivariate analysis revealed that sequential regimen was an independent prognostic factor for PFS (hazard ratio HR=0.635, P=0.012) and OS (HR=0.625, P=0.021). Subgroup analysis showed that patients with good prognosis and patients who did not receive rituximab benefited more from the sequential platinum regimen. Sequential platinum regimen did not increase the occurrence of adverse effects com-pared with the standard regimen. Conclusion:Sequential platinum regimen is a safe treatment that can improve the survival of young patients with DLBCL. Patients with good prognosis and patients who did not receive rituximab can benefit more from the treatment with sequential platinum regimen.

Objective To determine the function of conserved amino acids in the fusion-promoting domain of Newcastle disease virus (NDV) hemagglutinin-neuraminidase (HN) protein,clearly understanding mechanism of cell fusion.MethodsUsing a PCR-based site-directed mutagenesis method and the method of homology recombination occurred in vivo to change six conservative amino acids into alanine respectively.Wild type (WT) and all mutant HN proteins were exepressed in BHK-21 cells by the vacciniaT7 RNA polymerase expression system.The amount of each HN protein at the cell surface was determined by fluorescence-activated cell sorter (FACS).Cell fusion efficiency,hemadsorption activity (or receptor binding activity) and neuraminidase activity were determined.Results There was no statistic difference of cell surface expression among WT and each mutant HN protein ( P＜0.05 ).Cell fusion efficiency of each mutant protein decreased to some extent,especially 1103A decreased to 14.2％ in head.Hemadsorption activity of mutant proteins were reduced in different extent,the maximum reduction of which was also 1103A,28.2％ of wt NDV HN.There was different neuraminidase activity among each mutant HN protein.L74A increased slightly to 118.6％.L110A decreased most to 5.2％.I103A decreased second most to 5.7％.Conclusion Conserved amino acids in fusion-promoting domain of NDV HN played an important role in cell fusion.I103 was identified as a key amino acid in this domain.

OBJECTIVESTo identify a NFB responsive element within the dimethylarginine dimethylaminohydrolase 2 gene (DDAH) promoter and demonstrate its role in DDAH2 transactivation.

METHODSDDAH2 promoter was analyzed with software to identify potential binding sites of transcription factors. A series of truncated DDAH2 promoter luciferase reporter plasmids were constructed and transfected into human embryonic kidney derived HEK293 cells. Luciferase assays were carried out to analyze the activity of the promoter. Electrophoresis mobility shift assay (EMSA) and chromatin immunoprecipitation (ChIP) were used to identify the NFB responsive element in vitro and in vivo. DDAH2 promoter luciferase reporter plasmid with mutated NFB site was constructed and transfected into cells, and its activity was compared with that of the wild-type plasmid.

RESULTSPotential bindings sites of many transcription factors were found within the DDAH2 promoter. The transcription activity of the DDAH2 promoter was high, and -530 to -437 was a positive regulating region. -476 to -469 of the DDAH2 promoter was a NFB responsive element, to which NFB can specifically bind. Mutation of the NFB element could significantly decrease the DDAH2 promoter activity.

CONCLUSION-476 to -469 of the DDAH2 promoter was a NFB responsive element and is important for the transactivation of DDAH2.

Amidohydrolases ; genetics ; metabolism ; Base Sequence ; Gene Expression Regulation, Enzymologic ; Humans ; Molecular Sequence Data ; NF-kappa B ; metabolism ; Promoter Regions, Genetic ; Protein Binding ; Response Elements

Objective:To explore the diagnostic value of spiral CT arterial enhancement fraction (AEF) in clinicopathological staging of colorectal cancer.Methods:The clinical data of 151 newly diagnosed colorectal cancer patients (colorectal cancer group) and 86 patients who underwent physical examination with no history of colorectal disease (the control group) admitted to Shanxi Province Cancer Hospital from September 2019 to May 2021 were retrospectively analyzed. All research subjects received whole abdominal spiral CT plain scan and three-phase enhanced scan, and the obtained images were transferred to the Siemens Syngo.via post-processing workstation for post-processing to obtain the AEF color map and its quantitative parameter AEF value. The correlation of AEF value with colorectal cancer stage and Ki-67 was analyzed, and its diagnostic performance for clinicopathological staging of colorectal cancer was evaluated by using receiver operating characteristic curve.Results:The AEF values ??of patients at stage Ⅰ, Ⅱ, Ⅲ, and Ⅳ colorectal cancer were (72±9)%, (65±11)%, (60±12)%, and (52±10)%, respectively, and the difference was statistically significant ( F = 22.15, P < 0.001). The AEF values ??of the control group and the colorectal cancer group were (85±6)% and (62±12)%, respectively, and the difference in AEF value of both groups was statistically significant ( t = 18.66, P < 0.001). The clinicopathological stage of colorectal cancer was negatively correlated with AEF value ( r = -0.548, P < 0.05). Taking the control group as the standard, the area under the curve (AUC) of AEF value for the diagnosis of colorectal cancer stage Ⅰ, Ⅱ, Ⅲ and Ⅳ were 0.866 (the sensitivity was 62.50%, the specificity was 96.51%) and 0.928 (the sensitivity was 76.74%, the specificity was 98.84%), 0.981 (the sensitivity was 92.68%, the specificity was 91.86%) and 1.000 (the sensitivity was 100.00%, the specificity was 98.84%), and the difference in diagnostic efficiency was statistically significant ( P < 0.05). The AEF value of colorectal cancer was negatively correlated with Ki-67 ( r = -0.537, P < 0.05). The Ki-67 positive index of patients at stage Ⅰ, Ⅱ, Ⅲ, and Ⅳ colorectal cancer was (55±12)%, (67±10)%, (73±12)%, and (79±11)%, respectively, and the difference was statistically significant ( F = 11.94, P < 0.001); the Ki-67 positive index of patients at stage Ⅳ was higher than those at stage Ⅰ+Ⅱ ( t = 3.45, P = 0.001); the clinicopathological stage of colorectal cancer was positively correlated with Ki-67 ( r = 0.393, P < 0.001). Conclusions:AEF quantitative color map and AEF value can reflect the characteristics of arterial and venous blood supply in colorectal cancer lesions. AEF value analysis before surgery is helpful for the clinicopathological staging of colorectal cancer.

Objective:To explore the incidence and risk factors of postoperative cardiovascular events in older orthopedic patients.Methods:The clinical data of 316 older patients undergoing orthopedic surgery from May 2018 to December 2021 in Xuanwu Hospital, Capital Medical University were retrospectively analyzed. The independent risk factors of postoperative cardiovascular events in elderly orthopedic surgery patients were analyzed.Results:Among the 316 elderly orthopedic surgery patients, 10 patients experienced postoperative cardiovascular events (event group), and 306 patients did not experience postoperative cardiovascular events (non-event group). There were no statistical differences in gender composition, age, operation method, American Association of Anesthesiologists (ASA) classification, operation time, postoperative hospital stay, nutritional status, weakness degree, ability of daily life (ADL) and the proportions of percutaneous coronary intervention (PCI) + coronary artery bypass grafting (CABG) + old myocardial infarction (OMI), hypertension, diabetes, atrial fibrillation, old cerebral infarction, peripheral artery stenosis between two groups ( P>0.05). The proportion of coronary heart disease in event group was significantly higher than that in non-event group: 6/10 vs. 19.93% (61/306), and there was statistical difference ( P<0.01). Multivariate Logistic regression analysis result showed that coronary heart disease was the independent risk factor of postoperative cardiovascular complications in older orthopedic patients ( OR = 4.63, 95% CI 1.22 to 17.56, P<0.05). Conclusions:Accompanying coronary heart disease can increase the incidence of postoperative cardiovascular events in older orthopedic patients, but cardiovascular events do not prolong the length of hospital stay.

Objective:To evaluate the efficacy of cerebral-placental-uterine ratio(CPUR)in predicting late-on-set fetal growth restriction(FGR).Methods:From May 2020 to May 2021,1255 women with singleton pregnancy who underwent prenatal examinations at the University of Hong Kong Shenzhen Hospital were selected for fetal growth and Doppler measurements at 35-37 +6 weeks of gestation.Pregnant women with birth weight of newbo-rns＜the 10th percentile were the FGR group.The pulsatility index(PI)of uterine artery(UtA),umbilical artery(UA)and fetal middle cerebral artery(MCA)were analyzed separately and in combination.ROC curve was used to analyze the cerebral-placental-uterine ratio(CPUR),cerebral-placental ratio(CPR),cerebral-uterine ratio(C-UtA)for predicting late-onset FGR;and to evaluate the sensitivity,positive and negative predictive value and of CPUR in the prediction of late-onset FGR.Results:The area under the curve(AUC)of CPUR,CPR,C-UtA and mean UtA-PI for FGR grope were 0.88,0.86,0.84 and 0.72.Under certain cut-off values and 87% specificity,the specificity of CPUR,CPR,C-UtA and mean UtA-Pifor predicting FGR group was 43.2%,46.6%,39.8% and 23.9%,respectively.The positive predictive values of CPUR,CPR,C-UtA and mean UtA-PI,UA-PI for predicting FGR group were 90.5%,71.9%,83.3%,63.6%and 5.2%,respectively.Conclusions:CPUR is more effective in predicting late onset FGR than CPR,C-UtA and mean UtA-PI.It can effectively increase the detection rate of fetal growth restrictionand reduce the FGR risk.

Objective To investigate the risk factors for early-stage complications among liver transplant recipients, and to establish and validate a risk prediction model for early-stage complications after transplantation. Methods A retrospective analysis was performed for the clinical data of 234 patients who underwent orthotopic liver transplantation in Department of Liver Transplantation, Tianjin First Central Hospital, from January 2016 to December 2018. According to the presence or absence of Clavien-Dindo grade ≥Ⅲ complications after liver transplantation, the patients were divided into complication group with 97 patients and non-complication group with 137 patients. The two groups were compared in terms of the indices including age, sex, body mass index (BMI), blood type, psoas muscle thickness/height (PMTH), Controlling Nutritional Status (CONUT) score, Model for End-Stage Liver Disease (MELD) score, total serum bilirubin, serum creatinine, international normalized ratio of prothrombin time, blood urea nitrogen, hemoglobin, white blood cell count, platelet count, amount of intraoperative red blood cell transfusion, amount of frozen plasma transfusion, blood loss, anhepatic phase, time of operation, donor age, donor BMI, cold ischemia time of donor liver, and warm ischemia time of donor liver. The independent samples t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. Univariate analysis and the binary logistic regression analysis were used to investigate the risk factors for early-stage complications after liver transplantation, and a risk prediction model for complications after liver transplantation was established based on the method for establishing a scoring system using the logistic model provided by Framingham Research Center. Internal validation of the model was performed by C-index, receiver operating characteristic (ROC) curve, calibration curve, and the Hosmer-Lemeshow test, and the decision curve was used to evaluate the clinical applicability of the model. The Kaplan-Meier method was used to compare the incidence rate of early-stage complications after liver transplantation between the patients with different risk scores. Results Compared with the non-complication group, the complication group had significantly higher MELD score, proportion of patients with low PMTH, total serum bilirubin, serum creatinine, blood urea nitrogen, CONUT score, amount of intraoperative red blood cell transfusion, and amount of frozen plasma transfusion, as well as a significantly lower level of hemoglobin (all P < 0.1). The multivariate binary logistic regression analysis showed that MELD score (odds ratio [ OR ]=1.104, 95% confidence interval [ CI ]: 1.057-1.154, P < 0.05), PMTH ( OR =2.858, 95% CI : 1.451-5.626, P < 0.05), and CONUT score ( OR =1.481, 95% CI : 1.287-1.703, P < 0.05) were independent risk factors for grade ≥Ⅲ complications in the early stage after liver transplantation. MELD score, PMTH, and CONUT score were included in a predictive model, and this model had the highest score of 24 points, a C-index of 0.828, an area under the ROC curve of 0.812( P < 0.001), a sensitivity of 0.792, and a specificity of 0.751, suggesting that this predictive model had good discriminatory ability. The calibration curve of this model was close to the reference curve, and the Hosmer-Lemeshow test obtained a chi-square value of 8.528( P =0.382), suggesting that this predictive model had a high degree of fitting. The decision curve showed that most patients were able to benefit from the predictive model and achieved a high net benefit rate, suggesting that this predictive model had good clinical applicability. The score of 11 was selected as the cut-off value according to the optimal Youden index of 0.507, and the patients were divided into low-risk (< 8 points) group with 55 patients, moderate-risk (8-10 points) group with 63 patients, high-risk (11-14 points) group with 67 patients, and extremely high-risk (≥15 points) group with 49 patients. These four groups had a 90-day cumulative incidence rate of early-stage postoperative complications of 3.6%, 28.6%, 59.7%, and 75.5%, respectively, and the incidence rate of complications increased with the increase in risk score ( P < 0.001). Conclusion MELD score, PMTH, and CONUT score are independent risk factors for early-stage complications among liver transplant recipients, and the risk prediction model established based on these factors has a high predictive value in high-risk patients.