Objective To investigate the efficacy of heart value replacement on elderly patients and summarize the experience of surgical treatment.Methods The clinical data and follow-up status of 76 elderly patients were analyzed retrospectively in our hospital from January 2008 to December 2011.The operative method,general effect,postoperative death,postoperative complications,survival rate and life quality followed-up were analyzed.Results No intraoperative death appeared and there were 4 early operative deaths with a mortality rate of 5.3％.There were 31 cases occurred postoperative complication with a complication rate of 40.8％ which including respiratory insufficiency,lung infection,arrhythmia,incision infection,pleural effusion,low cardiac output syndrome and renal insufficiency.The follow-up time was 18-52 months and the mean follow-up time was (24.7± 3.6)months.There were 5 cases lost of follow up and the follow-up rate was 93.4％.There were 6 patients died after a month postoperative with a mortality rate of 7.9％.The heart function of the survivors achieved differed degree improvements and the result at the end of follow-up were grade Ⅰ-Ⅱ 47 cases,grade Ⅲ 13 cases and grade Ⅳ 6 cases.Conclusions To correctly determine the surgery indications,do all the preoperative preparation,intraoperative rigorous operating with a good myocardial protection and to strengthen the postoperative care will be help to reduce the mortality and complications of the elderly patients with heart value replacement.

Objective To investigate the relationship between the prothrombotic state and leukoaraiosis(LA)in elderly patients with metabolic syndrome.Methods A total of 350 metabolic syndrome patients in the affiliated hospital of Zhejiang University who received treatment from January 2013 to January 2015.According to the results of head MRI,patients were divided into LA group(n=203)and non-LA group(n=147).The severity of LA was graded by its MRI appearance and the Blennow scale.The plasma levels of fibrinogen (Fib),prothrombin time (PT),thrombin time (TT),activated partial blood coagulation time(APTT),D-dimer (D-D) and yon willebrand factor (vWF) were measured and compared between the two groups.Results The levels of Fib,vWF and D-D were higher in LA group than in non-LA group(all P＜0.05).Spearman correlation analysis showed that the severity of leukoaraiosis was positively correlated with Fib,vWF and D-D(r=0.014,0.089,0.215,respectively,all P ＜ 0.05).Multivariate linear regression analysis showed that Fib,course of hypertension,vWF and HbA1c were the main influencing factors with the standardized regression coefficient of 2.516,0.312,0.206 and 0.167 respectively for leukoaraiosis in elderly patients with metabolic syndrome.Conclusions The course of hypertension and HbAlc level are positively related with LA.The prothrombotic state markers including Fib and vWF can be considered as the predictors for LA severity in elderly patients with metabolic syndrome.

Objective To summarize the experience of modified Nuss procedure with thoracoscope for the correction of pectus excavatum in children. Methods Forty-nine pediatric pectus excavatum were treated by modified Nuss procedure with thoracoscope from August 2006 to July 2008, the age ranged from 3 to 18 years, 36 patients were symmetric pectus excavatum and 13 patients were asymmetric pectus excavatum. Results The operations in all patients were successful. Only 1 case used two bars,other 48 cases used one bar. There were no major complications such as cardiac perforation occurred during the operation. The earlier complication was pneumatothorax in 1 case, and the average blood loss was less than 10 ml. The postoperative hospital length of stay was 6-8 days. All patients had a satisfied deformity correction and no needs of transfusion. Therapeutic results evaluation showed excellent in 43 patients and good in 6 patients. All patients were followed up in 0.5-23.0 months without bars displacement, 1 ease had chronic intermittent pain for 2 months. The bar had been removed in 1 case after operation 23 months who still kept in excellent result. Conclusions Modified Nuss procedure is easy to performed with minimal invasion and satisfied deformity correction. Thoracoscopic visualization facilitates the safety of this technique.

Objective: To analyze epidemiological characteristics of brucellosis in Shaoxing City, Zhejiang Province from 2005 to 2023, so as to provide the basis for developing targeted control measures. Methods: Data of brucellosis cases and epidemiological investigation in Shaoxing City from 2005 to 2023 were collected from the Monitoring and Reporting Management System of the Chinese Disease Prevention and Control Information System. The epidemiological characteristics of brucellosis were descriptively analyzed, the trend in incidence of brucellosis was analyzed using average annual percent change (AAPC). Results: A total of 270 cases of brucellosis were reported in Shaoxing City from 2005 to 2023, with an average annual incidence of 0.29/105. The AAPC was 0.812%, with no significant changing trend (P>0.05). The incidence of brucellosis peaked from February to March, with 80 cases (29.63%). The reported cases were mainly distributed in Shangyu District (139 cases, 51.48%) and Shengzhou City (74 cases, 27.41%). There were 188 male cases and 82 female cases, with a male-to-female ratio of 2.29∶1. The cases were primarily concentrated in the age group of 40 to <70 years, with 205 cases accounting for 75.93%. Among these, 86 cases were reported in the 50 to <60 years of age group, accounting for 41.95%. The majority of the cases were farmers, with 187 cases accounting for 69.26%. The median interval from onset to diagnosis was 22.73 (interquartile range, 39.97) days, with a delayed diagnosis rate of 62.96%. Infections through breeding, selling and transporting cattle and sheep resulted in 164 cases (60.74%), and through buying and slaughtering resulted in 36 cases (13.33%). An outbreak of brucellosis was reported in Xinchang County in 2018, with three confirmed cases. Conclusions The incidence of brucellosis in Shaoxing City had no significant change from 2005 to 2023. The peak period was from February to March. The cases were mainly distributed in Shangyu District and Shengzhou City. People aged 50 to <60 years, males, and farmers were the key groups for prevention and control.

Objective To study the effects of.breathing booster training and aerosol inhalation with terbutaline and ambroxol on pulmonary function in postoperative lung cancer patients. Methods A total of 84 patients requiring resection operations for lung cancer were randomly divided into treatment and control groups.In the peri-operative period,breathing booster training and terbutaline and ambroxol aerosol inhalation were given to the treatment group,while only aerosol inhalation was given to the control group.Therapeutic effects were evaluated according to patients pulmonary function and postoperative complications 2 weeks and 1 day before the operation,and again 2 weeks after the operation.Postoperative quality of life (QOL) was evaluated with St.George's respiratory questionnaire (SGRQ) 1 month after the operation. Results There was no statistically significant difference in average pulmonary function between the two groups 2 weeks before the operation.Two weeks after the operation,pulmonary function had decreased in both groups,but it was significantly better in the treatment group than in the control group.The treatment group also had significantly fewer pulmonary complications.The QOL of patients in the treatment group had improved significantly 1 month after the operation. Conclusion Breathing booster training and inhalation of terbutaline and ambroxol aerosol during the peri-operative period can significantly improve pulmonary function,reduce respiratory complications and improve the QOL of patients requiring lung cancer resection operations.This is most important for promoting their early recovery.

Objective To assess the therapeutic effect and quality of life (QOL) of patients with anastomotic stenosis after bougienage of esophagus following resection of esophagus with esophageal and of cardiac carcinoma.Methods A total of 135 patients suffering from anastomotie stenosis after resection operations were divided into a treatment group and a control group at random. All patients were given an esophageal dilator under gastroseope. In treatment group, deglutition training was given additionally, twice daily, 10 to 20 trials in each session. Therapeutic effect was evaluated according to patients' food intake and gastroscopy results of diameter of stenosis before treatment and 2,4,8 weeks after treatment. QOL was evaluated with Chinese version of SF-36 instrument. Results The food intake of all the patients improved. There was no difference of diameter of stenosis in degree Ⅰ stenosis patients be-tween two groups (P > 0.05 ) ; but the differences were statistically significant in degree Ⅱ and Ⅲ stenosis patients (P < 0.05). In treatment group, the degree and duration of improvement were more obvious. QOL of patients with degree Ⅱ and Ⅲ stenosis in both groups improved significantly after treatment ( P < 0.05 ), but compared with con-trol group the improvement was significantly greater in treatment group (P < 0.05). Conclusion The therapeutic effect of bougienage of esophagus can be strengthened with deglutition training. This combinative therapy is safe and effective.

Objective To evaluate the effects of lipoxin A4 (LXA4) administered at different time points on the expression of connexin43 (Cx43) during myocardial ischemia-reperfusion (I/R) in rats.Methods Seventytwo healthy male Sprague-Dawley rats,weighing 200-250 g,wcre equally and randomly divided into 6 groups:groups sham operation Ⅰ (group S1) and Ⅱ (group S2),groups myocardial I/R Ⅰ (group Ⅰ/R1) and Ⅱ (group I/R2),and groups LXA4 administered before chest opening (group LX1) and at 30 min of reperfusion (group LX2).Myocardial I/R was produced by 30 min occlusion of left anterior descending branch (LAD) of coronary artery followed by 120 min reperfusion.LXA4 100μg/kg was injected via femoral veins before chest opening and at 30 min of reperfusion in groups LX1 and group LX2,respectively.While normal saline 2 ml/kg was injected via the femoral vein at the corresponding time points in the other four groups.In groups S1 and S2,LAD was only threaded,but not ligated.Blood samples were taken from the femoral vein before chest opening and at 120 min of reperfusion for measurement of serum IL-8,TNF-α and cardiac troponin Ⅰ (cTnI) concentrations.The rats were then sacrificed after blood samples were taken at 120 min of reperfusion and hearts were removed for determination of Cx43 protein (by immunohistochemical SP method) and Cx43 mRNA expression (by real-time quantitative PCR),SOD activity and MDA content in myocardial tissues.The development of arrhythmia was observed from occlusion of LAD to 120 min of reperfusion.Duration of ventricular tachycardia (VTd) and ventricular fibrillation (VFd) was recorded.Scores of ventricular arrhythmias were calculated.Results The expression of Cx43 protein and mRNA was significantly down-regulated,and scores of ventricular arrhythmias,VTd,serum IL-8,TNF-α and cTnI concentrations,SOD activity and MDA content were increased in groups I/R1 and LX1 as compared with group S1,and in groups I/R2 and LX2 as compared with group S2 (P ＜ 0.05).The expression of Cx43 protein and mRNA was significantly up-regulated,SOD activity was increased,and scores of ventricular arrhythmias,VTd,VFd,serum IL-8,TNF-α and cTnI concentrations,and MDA content were decreased in group LX1 as compared with group I/R1,and in group LX2 as compared with group I/R2(P ＜ 0.05).The expression of Cx43 protein and mRNA was significantly lower,scores of ventricular arrhythmias,VTd and SOD activity were higher,and the serum IL-8,TNF-α and cTnI concentrations and MDA content were lower in group LX2 than in group LX1 (P ＜ 0.05).Conclusion LXA4 administered before myocardial ischemia and at 30 min of reperfusion can up-regulate the expression of Cx43 and reverse remodeling of Cx43,thus reducing myocardial I/R-induced arrhythmia in rats,and LXA4 administered before ischemia can provide better efficacy.

Objective To summarize the clinical experience of surgical treatment for complete atrioventricular septal defect in infants.Methods From December 2013 to June 2004,56 patients aged from 53 days to 12 months with complete atrioventricular septal defect were undergone operations.All patients were diagnosed by 2D-echocardiography,and 18 patients underwent cardiovascular computed angiography (CTA).Rastelli type A had 44 cases,type B 3 cases,and type C 9 cases.The single pericardium patch repair was used for 37 cases,the two-patch repair for 3 cases,and the modified single-patch repair for 16 cases.The time of mechanical ventilation was 26 to 172 hours,and the time of staying at Intensive Care Unit (ICU) was 3 to 19 days.Results There were 5 early deaths caused by severe low cardiac output in 2 cases,renal failure in 2 cases,and severe pulmonary inflammation in 1 case.One late death was due to severe mitral regurgitation with pneumonia and heart failure.The operative mortality was 10.7％.A total of 47 patients was followed-up for 3 months to 5 years after surgery and their heart function was satisfactory.Conclusions The operation should be done between 6 months and 1 year when the diagnosis of complete atrioventricular septal defect (CAVSD) is clear.Its early surgical intervention is satisfactory.The result of surgical treatment for CAVSD depends on both probing intracardiac anatomy carefully and complete correction of associated cardiac abnormalities.

A series of [1,3]dioxolo[4,5-f]isoindolone derivatives were designed, synthesized and evaluated as inhibitors of acetylcholinesterases (AChE). Furthermore, their effects on memory impairment of mice induced by scopolamine were investigated with step-through test. The results suggested that most of the target compounds exhibited potential inhibition on AChE with IC50 values at micromolar range. Compounds I1 (IC50 value of 0.086 μmol · L(-1)) and I2 (IC50 value of 0.080 μmol · L(-1)) showed the strongest AChE inhibitory activity, which are equipotent to donepezil (IC50 value of 0.094 μmol · L(-1)). Moreover, compounds I1-I4 could improve the memory impairment induced by scopolamine in mice.

Objective To assess the clinical value of measuring the concentration of serum osteoprotegerin (OPG) in detecting the bone metastases in patients with prostate cancer. Methods The concentration of serum OPG in 40 patients was determined by ELISA. The data of ECT bone scan and Gleason score was collected simultaneously. The correlations between serum OPG and bone metastases, Gleason score were tested. Results The concentration of serum OPG in patients with bone metastases by ECT scan was( 16 237. 19 ±5144. 26) ng/L,which was significantly higher than the concentration in patients without bone metastases , which was (12 123.32 ±4136. 50)ng/L. There was no significant correlation between serum OPG and Gleason score. Conclusions The serum OPG has an important clinical value in prediction of prostate cancer with bone metastases. There is no significant correlation between serum OPG and the Gleason score.