Objective To review the experience of treatment for prosthetic valve endocarditis(PVE)after mitral valve replacement(MVR)in 16 cases.Methods From September 1979 to December 2010,16 patients were diagnosed as PVE after MVR by modified Duke University diagnostic criteria.There were 10 males and 6 females.Their ages ranged from 19 to 55 years old(mean 28 years old).The incidence of PVE was 0.97％(16/1657)after MVR.Blood culture positive was in 5 cases.Medical treatment alone was performed in 10 patients who were treated by using Penicillin or Vancomycin with other broad-spectrum antibiotics,using Fluconazole and Amphotericin if necessary.Combined medical and surgical management were performed in 6 cases.One emergency case was operated because of obstinate heart failure.Five cases underwent operation after adequate antibiotics treatment and general condition improvement.The infective tissue and vegetation were aggressively debrided after the infective prosthetic valve removed.Before the new valve was replaced paravalvular tissue must be flushed with diluted iodine solution and large quantities of normal saline.Tricuspid valve repair (TVR)was performed during the same period in 3 cases.Results Hospital death occurred in 8 patients and only 2 patients were recovery in group with medical treatment only.The main reasons of death were infective shock and cardiac failure in 4 patients,cerebral complications(embolism or bleeding)and multiple organs failure in 4 cases.While 6 patients cured after combined medical and surgical management.Follow-up had been carried out in 8 cases for 1.7 to 15 years(mean 5.1 years).Eight years later one patient was re-operated because of severe tricuspid regurgitation and paravalvular leak.There was no PVE recurrence in others.Conclusion Combined medical and surgical management for PVE get a better result than medical treatment alone.Good prognosis lies in timely diagnosis,adequate antibiotics,aggressive debridement of infective tissue and better myocardium protection during operation.

Objective:To explore the relationship between drug evidence and core prescription for depression.Methods:We retrieved literature of TCM for depression from CNKI, VIP and Wangfang databases to November 2019, 30th as well as there cords from Ancient and Modern Medical Records Cloud Platform (V 1.5). The Excel 2010 was used to establish the standardized database of medical records. After the standardization of medicines, Ancient and Modern Medical Records Cloud Platform (V1.5) statistics methodswere used for association rules analysis, complex networks, and analysis of drugs’ frequency, medical characteristics, core prescription drugs.Results:A total of 632 effective prescriptions were included, involving a total of 527 drugs. The results of frequency of herbs showed that 23 kinds of high-frequency herbs were obtained. Bupleuri Radix was the most frequently used medicine. Most herbs are warm or flat, with pungent, sweet and bitter in taste, belonging to the lung, liver, heart and spleen meridians. A total of 25 drug-pair association and 13 TCM association were obtained by association rule analysis. Conclusions:TCM treatment for depression is mainly based on soothing the liver and regulating qi, clearing the heart and calming the nerves. Bupleuri Radix, Curcumae Radix, Paeoniae Radix Alba, Chuanxiong Rhizoma, Ziziphi Spinosae Semen are the basic prescriptions. Angelicae Sinensis Radix, Ophiopogonis Radix, Albiziae Cortex, Polygalae Radix, Poria are used as reference.

Objective To observe the effect of the yang-warming and fluid retention-resolving mothed on neuroendocrine and inflammatory factors in chronic heart failure (CHF) rats. Methods A total of 50 healthy adult male SD rats were randomly divided into blank group (10), CHF group (40). In CHF group, the rat model of chronic heart failure was replicated by intraperitoneal injection of adriamycin (ADR). After the completion of the model making, doppler echocardiography was used to determine the cardiac function of rats. There rats were randomly divided into the model group, the yang-warming and fluid retention-resolving group, the Xuefu-Zhuyu group and the captopril group. After continuous administration for 28 d and 2 h after the last dose, the HE staining was used to observe the pathological morphological changes of myocardium in each group. The levels of AngⅡ, TNF-α and IL-6 in serum were by ELISA. Results Compared with model group, the content of serum AngⅡ(294.33 ± 25.45 pg/ml, 265.86 ± 27.80 pg/ml, 301.87 ± 41.67 pg/ml vs. 615.44 ± 22.31 pg/ml), TNF-α(117.15 ± 11.33 pg/ml, 114.02 ± 11.57 pg/ml, 133.35 ± 34.80 pg/ml vs. 185.72 ± 36.53 pg/ml), IL-6 (23.97 ± 4.77 pg/ml, 27.61 ± 7.01 pg/ml, 28.38 ± 5.78 pg/ml vs. 58.45 ± 6.36 pg/ml) in the yang-warming and fluid retention-resolving group, Xuefu-Zhuyu group and captopril group significantly decreased (P<0.01 or P<0.05). Compared with Xuefu-Zhuyu group, the content of serumAngⅡ (301.87 ± 41.67 pg/ml vs. 265.86 ± 27.80 pg/ml) in the captopril group significantly increased (P<0.05). Conclusions The yang-warming and fluid retention-resolving mothed can reduce early CHF rats through reducing the serum TNF-α, Ang and ILⅡ -6 content, which could be one of the mechanism of action of the treatment of CHF.

This article was aimed to study the preparation process of glycyrrhetinic acid (GA)-tanshinone IIA (TSN)-salvianolic acid B (SalB) compound liposomes with 3-succinic-30-stearyl glycyrrhetinic acid (18-GA-Suc) which is one of amphiphilicglycyrrhetinic acid derivatives as targeting molecule. The structure of the targeting molecule was validated by 1H-NMR and 13C-NMR methods. The feed ratio of 18-GA-Suc was optimized through single factor test and the incorporation ratio of 18-GA-Suc was determined by low-speed centrifugation. Meanwhile, physicochemi-cal properties between Suc-GTS-Lip and GTS-Lip were compared. In vitro release studies of three components in Suc-GTS-Lip were conducted by equilibrium dialysis method. The results showed that the optimum conditions were when the feed ratio of 18-GA-Suc was 10%lipid liposomal membrane (mol·mol-1). It revealed that the incorpora-tion ratio of 18-GA-Suc was 96.58%, and the encapsulation efficiencies of GA, TSN, and SalB were about 86.15%, 81.70%, and 91.05%, respectively. In addition, the Suc-GTS-Lip was spherical and uniformly dispersed with parti-cle size of 128.7 nm and zeta potential of-15.5 mV. The release model of GA and TSN was fitted well with Higuchi equation, while SalB was fitted well with Hixon-crowell equation. It was concluded that Glycyrrhetinic acid deriva-tives (18-GA-Suc) can be successfully expressed in the liposome membrane, and the optimal preparation method of Suc-GTS-Lip was stable. All three components encapsulated into liposomes had sustained-release effects, which laid a good foundation for its further study about liver-targeting.

Objective To retrospectively analyse the clinical data of off-pump coronary artery bypass grafting surgery(OPCAB)in our department and summarize the clinical experience of peri-operative management.Methods From January 2007 to May 2008,253 patients underwent OPCAB.Seventy-six cases with left main disease(including 18 cases of single left main lesion and 58 cases of complex lesion);13 cases had single vessel disease;32 cases had double vessels disease and 190 cases had triple vessels disease.Eighteen cases received emergency OPCAB.All vessel anastomosis were performed with coronary artery stablizer and shunt through median sternotomy.Resuits Three cases died after operation(1.2%).Intra-aortic balloon pump was used in 11 cases.Mechanical ventilation time was 3-168 h[(24.1±22.3)h],and ICU stay time was 1-14 day[(2.8±2.0)d].Postoperative hospital stay time was 8-42 days[(15.6±6.3)d].Conclusion OPCAB is reliable for most bypass cases.With appropilate peri-operative management,a satisfied result will be acceptable.

Objective To summarize the clinical experiences of 1386 patients undergoing off-pump coronary artery bypass grafting(OPCAB)during Jan 2002 to Mar 2008.Methods OPCAB was done through midsternumtomy under ordinary-temperature anesthesia after radial artery,left breast artery and vena saphena magna were taken.Patients over 70 years old accounted for 32.35%,and the oldest was 99 years old.Emergency and subemergency OPCAB was done in 111 cases,re-do CABG with off-pump technique was done in 52 patients.Results 24 cases died during perioperation,with mortality of 1.73%and all other patients discharged from the hospital.Following operation,the symptoms of angina pectoris were relieved and the life quality was much beaer than that before operation.Conclusion OPCAB is feasible for older patients,who are complicated with other chronic diseases for elder patients.Skillful technique of surgeon,right indications for OPCAB and management of peri-and postoperation are key to success of operation.

Objective To summarize the clinical experiences and early-to median effect of coronary artery bypass grafting(CABG)in patients aged 70 years or above.Methods From Dec.2006 to Dec.2007,86 patients aged 70 or above underwent CABG,of whom 71 cases underwent off-pump coronary artery bypass grafting(OPCAB),15 cases had CABG with cardiopulmonary bypass(CPB).5 cases underwent mitral valve replacement,3 underwent aortic valve replacement besides CABG,and one case underwent removal of ventricular aneurysm.Their clinical data were retrospectively analyzed.Results There was one case who died of enterobrosis after operation.The average ICU stay time was(77.4±49.6)h,the average postoperative stay time was 15 d,and the average drainage was 530 ml.22 postoperative complications were found.76 cases were followed up for 10-22 months.Follow up effect was better showing cardiac classification I-II and no angina pectoris,myocardial infarction and late death.Conclusion Patients with coronary heart disease in good condition will have not remarkable improvement in mortality as compared with ordinary patients but attention should be paid to their preoperative pulmonary function and angina pectoffs.OPCABG would have encouraging result in reducing the rate of postoperative complications and hospital death,which should be recommended as the first choice for the elderly patients.

ObjectiveTo investigate the mechanism of action of Sini powder in the treatment of liver cancer based on network pharmacology and molecular docking. MethodsTraditional Chinese Medicine Systems Pharmacology Database and Analysis Platform was used to obtain the compound and target of Sini powder, and the corresponding gene Symbol was obtained through Uniprot. The disease genes of liver cancer were obtained from Human Genome Database, and the genes with intersection with the target genes of Sini powder were screened out. Cytoscape3.7.1 software was used to draw the map of “traditional Chinese medicine (TCM)-compound-target” network. STRING was used to construct a protein-protein interaction (PPI) network, R studio software was used to conduct gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses on therapeutic targets, and then the results were visualized. The active component with the highest number of targets was selected as the ligand, and the target with the highest degree in the PPI network was selected as the receptor, so as to predict the structure of receptor-ligand complex and the amino acid residues that bind to each other. ResultsIn this study, 91 core targets and 141 relevant active components of Sini powder were screened out, among which quercetin and kaempferol were the main active components in the treatment of liver cancer. TP53 and HSP90AA1 were the main therapeutic targets. The GO enrichment analysis obtained 1007 items which met the screening criteria, which were mainly involved in the biological processes of antioxidation reaction, activity regulation of protein serine and threonine kinase, and cellular stress response. The KEGG enrichment analysis obtained 102 pathways, which mainly regulated the hepatitis B pathway and the PI3K-Akt signaling pathway in the prevention and treatment of liver cancer. The results of molecular docking showed a synergistic antitumor effect between the crystal structure domains VAL147, CYS220, GLU221, and PRO222 of quercetin-TP53. ConclusionThis study reveals the mechanism of action of Sini powder in the treatment of liver cancer by acting on multiple targets and signaling pathways, which provides a theoretical basis for biological experiments.

Objective: To compare the irradiated dose to unprotected lymph node stations (LNS) between volume-modulated arc therapy (VMAT) and 5-field intensity-modulated radiotherapy (5F-IMRT) in the treatment of patients with upper thoracic esophageal cancer. Methods: A total of 20 patients were selected for re-planning. LNS were not included in the GTV and CTV, instead, LNS were contoured as normal tissues. However, LNS were not constrained in the VMAT and 5F-IMRT inverse optimization for protection. Dosimetric parameters of conformal index (CI), homogeneity index (HI) of targets, V₉₅, V₁₁₀ of planning target volume (PTV), D_mean, V₅, V₂₀, V₃₀ of lung, D_mean, V₂₅ of heart, D_max of spinal cord, MU, as well as the equivalent uniform dose (EUD) and V₄₀ of LNS were compared between the two plans. Results: 5F-IMRT was superior in PTV_V_95% (t=-9.4, P<0.05), but worse in terms of CI (t=-5.3, P<0.05) compared with VMAT. 5F-IMRT reduced the V₅ of lung by 10.9% (t=-7.8, P<0.05) and the D_max of spinal cord by 9% (t=-10.2, P<0.05), but increased the MU (t=-6.2, P<0.05) compared with VMAT. The average EUD and V₄₀ of LNS in upper thoracic were significantly increased by 4.7% and 2.4% in 5F-IMRT compared with VMAT, respectively. The irradiated doses to LNS were significantly associated with the volume of PTV (R=0.716-0.933, P<0.05) expect for 106tbL. Conclusions The irradiated doses to unprotected LNS were less for IMRT plans and were highly associated with PTV volume in patients with upper thoracic esophageal cancer.

Objective : To analyze the status and influencing factors of the intention of people aged 18 to 25 years to primary medical institutions and their satisfaction for health services in Zhejiang Province, so as to provide basis for the improvement of health services in primary medical institutions. Methods: During November and December in 2019,the 18-25 year-old people in Zhejiang Province were recruited to investigate the general information, intention to seek medical advice and satisfaction for health services in primary medical institutions through WeChat. Logistic regression was performed to analyze the influencing factors of the intention and the satisfaction. Importance matrix was used to analyze the key drivers of the satisfaction. Results: Among the 620 people surveyed, with a response rate of 93.37%, 142 (22.90%) chose primary medical institutions for advice. Actually 516 (83.23%) people went to primary medical institutions last year, and 384 ( 74.42% ) of them were satisfied with the health services. The results of multivariate logistic regression analysis showed that the people aged 18-25 years who were under the new rural cooperative medical care system ( OR=3.062, 95%CI: 1.745-5.373 ) and who had records in community health centers ( OR=0.547, 95%CI: 0.308-0.970 ) were more likely to go to primary medical institutions for medical advice; the ability of doctors ( OR=1.478, 95%CI:1.168-1.871 ) ,the drug notification by medical staff ( OR=1.308, 95%CI: 1.065-1.606 ) , routine examination items ( OR=1.523, 95%CI: 1.227-1.889 ) , the ways of payment ( OR=1.168, 95%CI: 1.017-1.340 ) , the comfort of environment ( OR=1.785, 95%CI: 1.437-2.219 ) and the bulletin boards of health knowledge ( OR=1.302, 95%CI: 1.086-1.561 ) were associated with the satisfaction. The results of importance matrix analysis showed that the ability of doctors and routine examination items were the priorities to improve, followed by the drug notification by medical staff; the comfort of environment had competitive advantages; the ways of payment and the bulletin boards of health knowledge needed to be further analyzed. Conclusions The 18-25-year-old people in Zhejiang Province were less intended to seek medical advice in primary medical institutions, which was associated with the type of medical insurance and records in community health centers. They were satisfied with the health services, the ability of doctors and routine examination items were the key drivers.