Objective To study the clinical characteristics of the surgical treatment of cardiac valve disease in elderly patients.Methods Between January 2004 and February 2009,43 patients aged ≥65 underwent cardiac valve operation were enrolled as elderly group,85 patients aged <65 underwent the same operation served as control group in the same period,analyzed the clinical characteristics and difference between the two groups.Results The mortality of elderly group was higher than that of control group [11.6%(5/43) vs 2.4% (2/85),P<0.05].In elderly group,the duration of staying in ICU [(73.8±15.9) h],mechanical ventilation [(40.4±10.1)h],postoperative hospitalization time [(23.7±6.3) d]and the morbidity of postoperative complications [23.3%(10/43)]were higher than those of control group [(43.1±8.6)h,(28.5±5.8) h,(15.6±3.8) d,5.9%(5/85)](P<0.05 or <0.01).Conclusions Although there are high risks in patients aged 65 years and elderly with cardiac valve disease,the treatment results would be satisfactory ff select the right operating time and do full preparation with reasonable surgery strategy,the mortality and morbidity of postoperative complications could be reduced.

Objective:To observe the therapeutic effect and safety of warfarin on patients with atrial fibrillation. Methods:A total of 126 patients with atrial fibrillation from our hospital during Jun 2012-Jun 2013 were selected. According to hiding number random method,they were divided into aspirin group (n=63)and warfarin group (n=63).Coagulation function,blood lipid levels and end-point events were compared between two groups.Results:Compared with aspirin group,after treatment,there were significant reductions in levels of total cholesterol [(5.8 ±0.5)mmol/L vs.(5.2±0.7)mmol/L],triglyceride [(2.6±0.4)mmol/L vs.(2.4±0.3)mmol/L]and low density lipoprotein cholesterol [(2.7±0.5)mmol/L vs.(2.4±0.3)mmol/L],significant rise in level of high den-sity lipoprotein cholesterol [(1.1±0.2)mmol/L vs.(1.3±0.2)mmol/L],prothrombin time [(28.3±11.7)s vs. (36.9±10.4)s]and it′s international normalized ratio [(1.9±0.4)vs.(2.4±0.5)]in warfarin group,P <0.05 all.Incidence rate of endpoint events such as cerebral infarction and peripheral artery embolism etc.in warfarin group was significantly lower than that of aspirin group (3.17% vs.23.81%,P <0.01).The incidence rates of complications were 23.81% and 26.98% in warfarin group and aspirin group respectively,and they had no signifi-cant difference,P >0.05. Conclusion:For atrial fibrillation,the therapeutic effect and safety of warfarin is better than that of aspirin,is worth extending.

To explore the efficacy of managing benign prostatic hyperplasia (BPH) by family doctor system service in a local community.Among 132 BPH patients recruited from January 2012 to December 2013,74 of them received family doctor system service while the remainder medications only.After 6 months,international prostate symptom score (10.3 ± 5.6) and quality-of-life (2.98 ± 0.95) significantly improved in management group versus control group.And there were significant statistical differences (P ＜ 0.05).The intervention management of family doctor system service is effective for improving the symptoms and quality-of-life of BPH patients.

Objective To study the protective effect mechanism of Rosa laevigata Michx (RLM) on cardiotoxicity induced by adriamycin in rats. Method 30 SD rats were randomly into control group, doxorubicin group and RLM groups. The control group was injected with normal saline injection, while the model group was injected with adriamycin intraperitoneally at the dosage of 15 mg/kg every other day. For the RLM groups,1~5 g/kg RLM were given after adriamycin injection. The survival rate, plasma BNP was observed. Apoptosis of cardiomyocyte was detected by instituted-labeled DNA (TUNEL). The activity of GSH-PX, CAT and total SOD in the myocardium tissue were also observed. The expression level of CuZn-SOD , bcl-2 and bax were detected by real-time PCR. Results The survival rate was significantly improved in SD rats treated with RLM compared with that in the adriamycin group (P<0.01). The BNP level was increased when treated by adriamycin (P<0.01), and decreased after RLM administration (P<0.01). RLM could also upregulate the expression of the CuZn-SOD mRNA level, and enhance the activity of GSH-PX, CAT and T-SOD compared with that in adriamycin group. Adriamycin could induce myocardial cells apoptosis, as demonstrated by TUNEL. RLM could inhibit adriamycin-induced apoptosis, bax mRNA expression, and increase bcl-2 expression and bcl-2/bax ratio. Conclusion RLM exhibit some antioxidant activity through many stages, and the anti-apoptosis activity may be related to affect the expression of bax and bcl-2 expression.

Objective:To clarify the evidences of hippocampal injury after radiotherapy avoiding hippocampus and explore its relationships with cognition.Methods:A prospective design was adopted in this study.A total of 183 patients with nasopharyngeal carcinoma treated by intensity modulated radiation therapy (IMRT group) and 30 matched healthy control (HC group)were collected in the Affiliated Hospital of Jiangsu University and Southeast University Affiliated Zhongda Hospital from January 2017 to December 2019. All subjects were assessed by Montreal Cognitive Assessment (MoCA-B) at baseline and 6 months after radiotherapy, then the patients with nasopharyngeal carcinoma were divided into cognitive impairment group and non-cognitive impairment group. Subjects were scanned with Siemens 3.0 T MR, and T 1WI was used as analysis sequence.The individual standardized hippocampus ROIs were extracted based on Montreal Neurological Institute(MNI) brain template.All texture features were calculated using the Radiomics developed by C++and Delphi, and the intra group correlation coefficients (ICC), average direction, machine learning (random forest) and autocorrelation matrix were used for reducing the features dimension. One-way ANOVA and generalized linear models were used to compare the differences among different groups. Pearson correlations analyses were used to evaluate the relationships between important texture features and clinical data. Logistic regressions were used to calculate the abilities of texture features to predict cognitive impairment. Results:After 9 patients who lost follow-up were excluded, a total of 164 patients with nasopharyngeal carcinoma were included as IMRT group.Texture features of ROIs were extracted and dimensionally reduced successfully. Five differences features (Variance, Entropy, GlevNonU, RLNonUni and Contrast)were found among HC group, cognitive impairment group and non-cognitive impairment group, and the last three further showed significant differences within IMRT group (GlevNonU, P=0.011;RLNonUni, P<0.001;Contrast, P<0.001). Hippocampal doses were positively correlated with Variance ( r=0.448, P<0.05), and negatively correlated with Entropy ( r=-0.461, P<0.05). There was a positive correlation between MoCA-B scores with GlevNonU, RLNonUniand Contrast ( r=0.503, P<0.05; r=0.587, P<0.05; r=0.531, P<0.05). GlevNonU and Contrast were independent predictors of cognitive impairment in hippocampal avoidance of radiotherapy (OR=0.731, 95%CI 0.610-0.857; OR=0.651, 95%CI 0.496-0.853). Conclusion:Results of texture analysis could be used as micro imaging evidences of hippocampal injury in radiotherapy avoiding hippocampus, and could also effectively predict the occurrences of cognitive impairment.

The clinical data of 7 patients who underwent the treatment of gradual and persistent balloon dilatation (GPBD) by percutaneous transhepatic cholangiography (PTC)for traumatic biliary stricture in Zhongshan Hospital Affiliated to Dalian University were analyzed retrospectively.Balloon catheters were successfully implanted in 5 cases by PTC,and with the help of ERCP in 2 PTC failed cases.There was no bleeding,acute pancreatitis and other complications.Two balloon catheters were damaged and displaced,respectively.All the biliary strictures were relieved.No biliary sludge was attached on the surface of the balloon and in the bile duct.Bile duct mucosa had congestion edema and cellulose attachment.There was no biliary stricture recurrence in the follow-up of 5 to 27 months.This study showed GPBD by PTC was a simple,safe and effective method for treating traumatic biliary strictures.

Objective To evaluate endoscopic pancreaticobiliary separation (EPBS) in patients with gallstone and occult pancreaticobiliary reflux (OPBR).Methods The clinical data of 47 cases with gallstone and OPBR from Oct 2013 to Oct 2016 was analyzed retrospectively.Results The mean gallbladder bile amylase (GBA) was (864 ± 575) U/L.40 cases have undergone the treatment of endoscopic retrograde cholangiopancreatography.26 cases were diagnosed as duodenal papillitis,16 cases as periampullary diverticula,14 cases as long nipple,5 cases as atrophic papilla,3 cases as ampulla stone and 2 cases as papillary tumor.9 were diagnosed as pancreaticobiliary maljunction in the 14 patients with long nipple.33 cases were performed with EPBS.GBA was tested in 16 cases,and the GBA of 15 cases returned to normal level.The difference of GBA was statistically significant [(1 161 ±764) U/L vs.(47 ± 17) U/L,(t =5.641,P ＜ 0.05)].Patients were followed up for 1 to 4 years,among 36 cases without cholecystectomy,there was no recurrence of cholecystolithiasis after EPBS in 27 cases,but 2 cases had recurrent gallstones in 9 cases without EPBS,and the difference of gallstone recurrence rate was statistically significant (x2 =21.340,P ＜ 0.05).Conclusions Pancreaticobiliary junction diseases is an important cause for gallstone formation and OPBR.EPBS can avoid pancreaticobiliary reflux and reduce the recurrence rate of gallstone after choledochoscopic lithotomy.

PURPOSETo explore the impact of subtropical maritime monsoon climate on the frequency of ambulance use for trauma patients in a coastal region in China.

METHODStatistical analysis of data on ambulance use from the 120 Emergency Command Center in Shantou City, Guangdong Province, from January to December 2012 as well as daily meteorological data from a Shantou observatory was performed to determine how climatic factors (seasons, time, and weather) affect the frequency of ambulance use for trauma patients.

RESULTSThe daily ambulance use for trauma patients differed between spring and summer or autumn (p<0.05), between sunny and rainy days (p<0.05), and between cloudy and lightly or moderately rainy days (p<0.05).We found a linear correlation between daily maximum temperature and daily ambulance use for trauma patients (R² =0.103, p<0.05). In addition, there was significant difference in ambulance use between good and bad weather (p<0.05).

CONCLUSIONFrequency of ambulance use for trauma patients is affected by the subtropical maritime monsoon climate in the coastal region. Better weather contributes to increased daily frequency of ambulance use, which is the highest in autumn and lowest in spring.

OBJECTIVE:To explore an effective method to formulate management-related strategies for off-lable use of drugs by the evidence-based medicine. METHODS:The process of guideline formulation included seven procedures,i.g. establishment ofguideliesformulation workgroup;investigation and selection of the status quo on off-label drug use;identification of the clinical problems;retrieval and evaluation and comprehensing of evidence;applification of GRADE in evidence quality grading;formation of the recommendations consensus;peer review and result publication. And eventually guidelines were formed based on the steps. This study took off-label use of rheumatoid immunoprotective subjects as a case to explore. RESULTS & CONCLUSIONS:Based on the evidence evaluation system and above 7 steps,the methods and process of guideline formulation on off-label use of rheuma-toid immunoprotective subjects that integrated administration,law,clinical medicine,pharmacy subjects were made .The process of guideline formulation fully reflects multidisciplinary characteristics of the workgroup,the advanced nature of the process,the comprehensiveness of evidence ,the rigor of evidence quality grading,and the normalization of consensus. It provides reference in methodology for establishing a comprehensive evidence-based evaluation and management system of off-label use of drugs for all clinical specialist disease. Therefore,this scientific research results may promote the standardization and legalization of the off-label use of drugs management in China.

Objective To investigate the clinical value,safety and efficacy of pancreatic stent in prevention of postoperative acute pancreatitis in patients with benign biliary stricture (BBS) treated by fullcovered self-expanding removable metal stents (FCSERMSs).Methods From Jan 2011 to Dec 2017,92 BBS patients who met the inclusion criteria were admitted and divided into pancreatic stent (PS) group and control group.The acute pancreatitis (AP) and hyperamylase (HP) after FCSERMS implantation and removal was observed.Results 55 cases in PS group and 37 cases in control group underwent successful FCSERMS implantation.The incidences of postoperative elevated amylase and HP had no significant differences between the two groups (23.6％ vs.32.4％,3.6％ vs.10.8％,all P ＞0.05).The incidences of postoperative AP and moderately elevated amylase had significant differences (0 vs.13.5％,20.0％ vs.8.1％,all P ＜ 0.05).The average placement time of FCSERMSs was 7.84 ± 1.22 months.The incidence of elevated amylase,AP,HP and moderately elevated amylase after the FCSERMS and PS removed had no statistical differences (3.6％ vs.14.3％,0vs.2.9％,0 vs.2.9％,3.6％vs.8.6％,all P＞0.05).Conclusion The placement of pancreatic stents in the treatment of BBS with FCSERMS is a simple,safe and effective method for the prevention of post-ERCP pancreatitis.