Currently,although surgical aortic valve replacement (SAVR) is still the golden standard in treatment of severe aortic stenosis according to the guideline,transcatheter aortic valve implantation (TAVI) is gradually becoming a common treatment for patients who are prohibitive or in high risk for SAVR.Recently,the valve manufacturers,including medical companies in China,are making their utmost to develop valve device,leading remarkable results achieved by TAVI.With the complications being controlled,TAVI displays promising future.It is likely that TAVI is expected to become a substitute for SAVR to treat patients with aortic stenosis or even aortic regurgitation.

Objective To investigate the effect of exogenous vascular endothelial growth factor (VEGF) on bone activity of rabbit heterotopic allograft decalcified bone.Methods 140 adult healthy China white rabbits were selected,no limitation with sex,20 rabbits as the donor preparation of allogenic decalcified bone,according to the random number table,the rest was divided into the experimental group (allograft decalcified bone ± VEGF) and the control group (Allograft decalcified bone),each group contained 60 rabbits.For the experimental group,the prepared 1.5 cm long homologous decalcified tibia was placed in rabbit right thigh of rectus femoris and vastus medialis muscle gap near by saphenous artery,and fixed on the femur with two 0.8 mm Kirschner wire.In the vicinity of the skin,implanted an osmotic pump which contain the VEGF solution 200 μl with concentration was 0.5 μg/ml.In the control group,implanted the isometric allograft decalcified bone in rabbit right thigh corresponding parts with the same method.Each group respectively at 0,2,4,6,8,10 weeks to death 10 white rabbits,By specimen observation,HE dyeing observation and detection of type Ⅰ glue protein fluorescence intensity,Analysis the bone activation degree of two groups of bone allograft decalcified.Results Experimental allograft decalcified bone gradually wrapped by connective tissue membrane,its surface appear different size of the pits and gradually increased and become deep,while the control group pits relatively little and shallow.In the experimental group and control group,the fluorescence intensity of type Ⅰ collagen reached its peak respectively at 8 weeks (47.57 ±3.50) and 10 weeks (45.07±6.02),with no statistically significant (P ＞ 0.05).Conclusion Rabbit allograft decalcified bone implanted in the muscle clearance with abundant blood supply can be transformed into activated bone after 10 weeks,and after applying exogenous VEGF,allograft decalcified bone can be transformed into activated bone after 8 weeks,the bone activation process obviously speed up.The reaults confirmed the exogenous VEGF can obviously promote the ectopic rabbit bone allograft decalcified bone activation process.

Objective To investigate whether chlorophyllin could protect human umbilical vein endothelial cell (HUVEC) against oxidative damage by inducing the expression of heme oxygenase-1 (HO-1) and to explore the underlying mechanism.Methods The cellular protection of chlorophyllin against oxidative damage was detected by cell-survival assay with flow cytometry.The level of free radicals was detected directly by electron spin resonance spectra.The induced expression of HO-1 was shown by RT-PCR,Western blot,immunofluorescence confocal laser microscopy and enzymatic activity test.Whether the activation of PI3K/Akt pathway was involved was detected by Western blot.Results Chlorophyllin could protect HUVEC against oxidative damage caused by H2O2 via scavenging the excessive free radicals.Chlorophyllin treatment could induce expression of HO-1 in a dose- and time-dependent manner.The activation of PI3K/Akt pathway was required in the induction of HO-1.LY294002,the specific inhibitor of PI3K,could suppress the activation of PI3K/Akt and the induced expression of HO-1 in a dose-dependent manner.Conclusions Chlorophyllin shows cellular protection against oxidative damage by counteracting the excessive free radicals.Up-regulation of HO-1 expression plays a pivotal role in the protection of chlorophyllin,while the activation of PI3K/Akt signaling pathway is required in the induction of HO-1.

Antibiotic-associated diarrhea(AAD) is a frequent adverse effect of antibiotic in children.AAD is associated with longer hospitalization, higher healthcare cost and even lead to death.Pediatricians usually do not pay enough attention to AAD.Domestic experts from pulmonary medicine, infection and gastroenterology are organized to develop the consensus, to improve the diagnosis, treatment and prevention of AAD, and contribute the children health in future.

OBJECTIVE: To investigate the epidemiological characteristics, phenotype, genotype, and prognosis of medium-chain acyl-CoA dehydrogenase deficiency (MCADD) in the Chinese population. METHODS: A retrospective analysis was performed for the clinical data of the neonates who underwent screening with high-performance liquid chromatography-tandem mass spectrometry from January 2009 to June 2018 and were diagnosed with MCADD by gene detection. RESULTS: A total of 2 674 835 neonates underwent neonatal screening, among whom 12 were diagnosed with MCADD. Gene detection was performed for 10 neonates with MCADD and found 13 mutation types at 16 mutation sites of the ACADM gene, among which there were 7 reported mutations (p.T150Rfs*4, p.M1V, p.R206C, p.R294T, p.G310R, p.M328V, and p.G362E), 5 novel mutations (p.N194D, p.A324P, p.N366S, c.118+3A>G, and c.387+1del G), and 1 exon 11 deletion; p.T150Rfs*4 was the most common mutation (4/16). The detection rate of mutation sites in the ACADM gene was 80%. No phenotype-genotype correlation was observed. Dietary guidance and symptomatic treatment were given after confirmed diagnosis. No acute metabolic imbalance was observed within 4-82 months of follow-up. All neonates had good prognosis except one who had brain dysplasia. CONCLUSIONS MCADD is relatively rare in southern China, and p.T150Rfs*4 is a common mutation in the Chinese population. Cases with positive screening results should be evaluated by octanoylcarnitine C8 value and gene detection.
Acyl-CoA Dehydrogenase ; deficiency ; Carnitine ; China ; Follow-Up Studies ; Humans ; Infant, Newborn ; Lipid Metabolism, Inborn Errors ; Mutation ; Neonatal Screening ; Retrospective Studies

Objective To investigate the induction factors of hypotension during cesarean sec-tion for perilous placenta previa under combined spinal-epidural anesthesia(CSEA)and to construct a nomogram prediction model.Methods A total of 130 parturients who underwent cesarean section for perilous placenta previa under CSEA from January 2020 to December 2023 in Yulin Maternity and Child Healthcare Hospital were selected as study subjects.A self-designed general information ques-tionnaire was used to investigate the basic information and the occurrence of hypotension of the sub-jects.According to the occurrence of intraoperative hypotension,the patients were divided into hypo-tension group(47 cases)and non-hypotension group(83 cases).Univariate analysis was performed on the general information of the two groups,and multivariate Logistic regression analysis was used to explore the induction factors of intraoperative hypotension.Results Univariate analysis showed that there were statistically significant differences in body mass index,anesthesia level,presence of multiple pregnancy,preoperative systolic blood pressure,operative time,and the occurrence of Bezold-Ja-risch reflex between the two groups(P＜0.05).Multivariate Logistic regression analysis revealed that body mass index ≥ 24 kg/m2,anesthesia level was in the eighth thoracic vertebra(T8)or a-bove,multiple pregnancy,preoperative systolic blood pressure＜90 mmHg,operative time＞1.5 h,and the occurrence of Bezold-Jarisch reflex were independent risk factors for hypotension during ce-sarean section for perilous placenta previa under CSEA(P＜0.05).A regression equation for the induction factors of hypotension during cesarean section for perilous placenta previa under CSEA was constructed:Logit(P)=-23.211+1.079 ×(body mass index≥24 kg/m2)+1.101 × anesthesia level(≥T8)+3.193 x multiple pregnancy+2.214 x preoperative systolic blood pressure(＜90 mmHg)+4.606 × operative time(＞1.5 h)+2.011 × occurrence of Bezold-Jarisch reflex.The nomogram showed high discrimination and accuracy for patients with preoperative systolic blood pres-sure＜90 mmHg.After 1,000 times of Bootstrap resampling for the nomogram model,a calibration curve was obtained,and the consistency index was calculated as 0.850,indicating good calibration of the nomogram model.The receiver operating characteristic(ROC)curve was plotted,with an ar-ea under the curve of 0.896 and 95％confidence interval of 0.802 to 0.956,suggesting good pre-dictive performance.Conclusion Body mass index ≥24 kg/m2,anesthesia level ≥ T8,multiple pregnancy,preoperative systolic blood pressure＜90 mmHg,operative time＞1.5 h,and the oc-currence of Bezold-Jarisch reflex are induction factors for hypotension during cesarean section for perilous placenta previa under CSEA.

Objective To investigate the induction factors of hypotension during cesarean sec-tion for perilous placenta previa under combined spinal-epidural anesthesia(CSEA)and to construct a nomogram prediction model.Methods A total of 130 parturients who underwent cesarean section for perilous placenta previa under CSEA from January 2020 to December 2023 in Yulin Maternity and Child Healthcare Hospital were selected as study subjects.A self-designed general information ques-tionnaire was used to investigate the basic information and the occurrence of hypotension of the sub-jects.According to the occurrence of intraoperative hypotension,the patients were divided into hypo-tension group(47 cases)and non-hypotension group(83 cases).Univariate analysis was performed on the general information of the two groups,and multivariate Logistic regression analysis was used to explore the induction factors of intraoperative hypotension.Results Univariate analysis showed that there were statistically significant differences in body mass index,anesthesia level,presence of multiple pregnancy,preoperative systolic blood pressure,operative time,and the occurrence of Bezold-Ja-risch reflex between the two groups(P＜0.05).Multivariate Logistic regression analysis revealed that body mass index ≥ 24 kg/m2,anesthesia level was in the eighth thoracic vertebra(T8)or a-bove,multiple pregnancy,preoperative systolic blood pressure＜90 mmHg,operative time＞1.5 h,and the occurrence of Bezold-Jarisch reflex were independent risk factors for hypotension during ce-sarean section for perilous placenta previa under CSEA(P＜0.05).A regression equation for the induction factors of hypotension during cesarean section for perilous placenta previa under CSEA was constructed:Logit(P)=-23.211+1.079 ×(body mass index≥24 kg/m2)+1.101 × anesthesia level(≥T8)+3.193 x multiple pregnancy+2.214 x preoperative systolic blood pressure(＜90 mmHg)+4.606 × operative time(＞1.5 h)+2.011 × occurrence of Bezold-Jarisch reflex.The nomogram showed high discrimination and accuracy for patients with preoperative systolic blood pres-sure＜90 mmHg.After 1,000 times of Bootstrap resampling for the nomogram model,a calibration curve was obtained,and the consistency index was calculated as 0.850,indicating good calibration of the nomogram model.The receiver operating characteristic(ROC)curve was plotted,with an ar-ea under the curve of 0.896 and 95％confidence interval of 0.802 to 0.956,suggesting good pre-dictive performance.Conclusion Body mass index ≥24 kg/m2,anesthesia level ≥ T8,multiple pregnancy,preoperative systolic blood pressure＜90 mmHg,operative time＞1.5 h,and the oc-currence of Bezold-Jarisch reflex are induction factors for hypotension during cesarean section for perilous placenta previa under CSEA.

Objective:To analyze the process of Chinese expert consensus on the core information on prevention of sarcopenia in the elderly(2021)in China, so as to realize the early diagnosis and treatment of sarcopenia and to improve the quality of life in the elderly.Methods:The index system framework was established by literature review and expert questionnaire discussion, and Delphi expert consultation method was adopted to construct the index system.Results:A total of 109 experts(128 person-times)in Geriatrics from various fields participated in Delphi expert consultation.Positive coefficient for four rounds of expert consultation were 88.9%, 100.0%, 100.0% and 100.0% respectively, with expert authority factors being concentrated on 0.78~0.90.Through 4 rounds of Delphi expert surveys, the core information index system for sarcopenia prevention in the elderly has been definitive: Chinese Expert Consensus(2021)consists of nine indicators including "enhancing public scientific awareness of myosis, and so on."Conclusions:The core information index system for sarcopenia prevention in the elderly has high levels of overall convergence, comprehensive coverage, strong authority, stability, comprehensiveness and popularity.

OBJECTIVETo investigate changes in clinicopathological features and survival of patients with gastrectomy at a single institution in China.

METHODSFrom January 1990 to December 2009, clinicopathological data of 2518 cases of gastric cancer patients who underwent surgical resection in the Sun Yat-sen University Cancer Center were analyzed retrospectively. The overall survival rate was determined using Kaplan-Meier method and log-rank test was used to determine significance. The prognosis was analyzed using univariate analysis and multivariate analysis by Cox proportional hazards model. Clinical features, pathological findings and survival differences were compared in this cohort between two consecutive periods(1990-1999 and 2000-2009).

RESULTSThe 5-year survival rates for the whole cohort and those undergoing radical resection was 48.1% and 53.7%, respectively. In the first period, the 5-year survival rate for the whole cohort and for patients undergoing radical resection was 40.1% and 45.7%. In the second period, the 5-year survival rates for whole cohort and for patients undergoing radical resection was 51.5% and 57.1%, respectively. For those who underwent radical resection, the mean number of lymph node dissection was significantly higher in the recent period (20.1±8.3 vs. 9.5±6.0, P<0.01). On multivariate analysis by means of the Cox proportional hazard model, age, location, tumor size, histological type, radical resection, lymphatic/venous invasion, depth of invasion, nodal status, number of retrieved lymph nodes, and treatment period were independent factors (P<0.05). The constitution, number of retrieved lymph nodes, and survival rate were all improved between the two intervals (P<0.05).

CONCLUSIONThe overall survival rate has gradually increased in gastric cancer patients over the past 20 years.

Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; Lymphatic Metastasis ; Multivariate Analysis ; Neoplasm Staging ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Stomach Neoplasms ; pathology ; surgery ; Survival Rate

Objective:To analyze the relationship between frailty status and the risk of death in the elderly based on the frailty index (FI).Methods:Data from a prospective cohort study conducted between 2005 and 2015 in elderly people of an urban community in Beijing were analyzed. The variables related to health and frailty status based on the 2005 baseline survey and death as outcome variables collected in 2015 were used. A FI model was used to evaluate the correlation between FI and mortality in the elderly people in different age groups was analyzed. Cox regression was applied to evaluate the influence of FI on the risk of death, and Kaplan-Meier curves was used to show the survival rate of different frailty levels in the elderly adults.Results:Of the 1 301 elderly people included in the analysis, 403 died during 2005-2015, with the 10-year mortality rate of 31.0 %(403/1 301). The mortality rate of the elderly increased with the increase of FI, but, with the increase of FI value, the rate of mortality increased slowly. The limit value of FI causing death was around 0.70, indicating any new health problem might cause death at this value. Cox regression analysis showed that higher FI was associated with higher risk for death ( HR=1.143, 95 %CI: 1.034-1.248, P=0.000), and FI was more significantly associated with death than age ( HR=1.143 vs. HR=1.048, t=5.827, P=0.000). With the increase of age, the effect of frailty on the risk of death decreased ( HR=1.179 to HR=1.120). Kaplan-Meier curves showed that the survival rate of the elderly in all age groups decreased with the increase of frailty (Log-rank=317.812, 354.203, 247.258, all P=0.000). The survival time between different frailty levels in the elderly were significantly different, except for the elderly adults aged ≥80 years with severe frailty level (0.4≤FI<0.5, FI≥0.5, P=0.368). Conclusions:Compared with other evaluation tools of frailty, FI model can better reflect the frailty status of the elderly in communities in Beijing and has a high sensitivity in predicting adverse outcomes such as mortality. In the intervention of frailty in the elderly, focusing on relatively young elderly might be more effective in reducing the adverse outcomes caused by frailty.