OBJECTIVETo study the treatment of paravalvular leakage (PVL) after cardiac valve replacement retrospectively.

METHODSBetween 1993 and 2005, 34 patients with PVL were observed, including aortic PVL in 6 patients and mitral valve PVL in 28 patients. Twenty-five patients with severe anemia and/or heart failure were reoperated, 9 patients without severe clinical symptoms and signs had treated conservatively. Repair of PVL was carried out in 14 patients, and the other 10 patients were performed prosthetic valve replacement.

RESULTSOf 9 patients who had treated conservatively, 1 patients died of septic shock, and 1 patient died of heart failure. During 6 - 72 months follow-up, of the seven survivals, 2 patients died of heart failure. And the other 5 patients were in NYHA class II. Echocardiography demonstrated no obvious enlargement of the PVL and diameter of the heart. Among the 25 patients who were reoperated, the overall operative mortality was 12% (3 patients). Twenty-one survivals were in NYHA class II during the follow-up of 4 - 132 months. While a mitral valve PVL and a aortic valve PVL were diagnosed among them after the reoperation 4 years and 6 months respectively.

CONCLUSIONSPatients with PVL and no severe symptoms can be treated conservatively and followed up. A more aggressive surgical treatment is recommended for patients with PVL and severe anemia and/or heart failure.

Adolescent ; Adult ; Aged ; Female ; Follow-Up Studies ; Heart Valve Prosthesis Implantation ; adverse effects ; Humans ; Male ; Middle Aged ; Postoperative Complications ; etiology ; therapy ; Treatment Outcome

OBJECTIVETo summarize the surgical experience for Stanford A aortic dissection.

METHODSSixty-eight patients with Stanford A aortic dissection underwent surgery from March 1998 to October 2004, acute aortic dissection in 45 cases, chronic aortic dissection in 23 cases. The operation were performed by using moderate hypothermic cardiopulmonary bypass in 53 cases, deep hypothermic circulatory arrest (DHCA) and retrograde cerebral perfusion (RCP) in 11 cases; DHCA with antegrade selective cerebral perfusion (SCP) in 4 cases. Surgical procedures included ascending aortic grafting in 7 cases, ascending and hemiarch grafting in 6, ascending and total arch grafting in 3, ascending and total arch grafting with Frozen elephant trunk procedure in 4. Concomitant procedures included Bentall procedure in 34 cases, Wheat procedure in 12 cases, aortic valvuloplasty in 2 cases, mitral valvuloplasty in 1 cases. Urgent surgery was in 39 cases (emergency surgery in 19).

RESULTSOperative mortality was 7% (urgent surgery mortality was 8%, elective surgery mortality was 7%). Fifty-eight cases were followed up for (37 +/- 22) months. Actuarial survival of 58 cases at 1, 3 and 5 years was 100%, 95% and 86% respectively.

CONCLUSIONThe choice of surgical procedures depend on the location of intimal tear for Stanford A aortic dissection. Proper surgical indication, technique and brain protections are the key factors of Stanford A aortic dissection surgery.

Adult ; Aged ; Aneurysm, Dissecting ; mortality ; surgery ; Aortic Aneurysm, Thoracic ; mortality ; surgery ; Blood Vessel Prosthesis Implantation ; Female ; Follow-Up Studies ; Heart Arrest, Induced ; methods ; Humans ; Hypothermia, Induced ; Male ; Middle Aged ; Retrospective Studies ; Survival Rate ; Vascular Surgical Procedures ; methods

OBJECTIVETo evaluate the effectiveness of the combined endocardial and epicardial saline-irrigated radiofrequency modified maze procedure for the treatment of atrial fibrillation (AF).

METHODSDuring a period of 3 years, 295 patients with AF having concomitant cardiac surgery underwent the procedure. Patients underwent either the endocardial and epicardial group (n=185) or the endocardial group (n=110) radiofrequency ablation. There were 124 males, 171 females with a mean age of (52 +/- 11) year old. Mean duration of preoperative AF was 36 +/- 43 months. And about 90.8 percent valve pathology was rheumatic. Valve operation was performed in 289 patients, coronary artery bypass graft surgery in 19 patients and congenital heart disease operation in 6 patients respectively. Follow-up for the whole patients ranged from 3 to 47 months (mean 28 +/- 5 months).

RESULTSTen patients died postoperatively (3.4%). Four patients died of low cardiac output, five patients died of multisystem and organ failure, one patient died of cerebral hernia. There were 2 patients died of nerves system complication during follow-up. At the end of the procedure 228 patients (77.3%) were sinus rhythm, including 78 patients (70.9%) in endocardial group while 150 patients (81.1%) in endocardial and epicardial group (P<0.05). At late follow-up, 191 of 259 patients (73.7%) were in stable sinus rhythm. Sinus rhythm was present in 64 patients (66.0%) in endocardial group while 127 patients (78.4%) in endocardial and epicardial group (P<0.05). Histopathology of the endocardial group revealed foci coagulative necrosis was limited to the endocardial side. While endocardial and epicardial ablation had full-thickness alteration of atrial tissue besides ill defined borders and inflammatory cell infiltration.

CONCLUSIONSCombined endocardial and epicardial saline-irrigated radiofrequency modified maze procedure was performed safely and efficiently. And it restored sinus rhythm better than endocardial ablation only.

Adult ; Aged ; Atrial Fibrillation ; surgery ; Catheter Ablation ; methods ; Endocardium ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Pericardium ; surgery ; Retrospective Studies ; Treatment Outcome

· AIM:To compared the therapeutic effect of improved macular hole surgery to traditional macular hole surgery for idiopathic macular hole (IMH).· METHODS:From April 2014 to June 2017,28 eyes of 28 IMH patients who were treated in our hospital were selected consecutively and received surgical treatment independently performed by the same physician in our hospital.The patients were divided into A (traditional group) and B (improvement group) groups.All 13 cases in Group A were treated with traditional vitrectomy internal limiting membrane peeling and C3 F8 tamponade,while all 15 cases in Group B were treated with improved indocyanine green-assisted internal limiting membrane peeling combined with macular hole reconstruction and air tamponade.All patients were reviewed at 1wk,1,3,and 6mo after surgery.The best corrected visual acuity (BCVA) before and after the operation,operation time,closure rate of the macular hole during the last review and prone time were compared between the two groups of patients.· RESULTS:There was no significant difference in closure rate between the two groups (P＞ 0.05).Postoperative BCVA increased in both groups compared with preoperatively and the differences were statistically significant (P ＜ 0.05).But there was no significant difference on BCVA between the two groups both preoperatively and postoperatively (P ＞ 0.05).The operation time in Group B was significantly shorter than that in Group A (P＜0.05).Prone time in Group B was significantly shorter than that in Group A,the difference was statistically significant (P＜0.05).· CONCLUSION:This study shows that compared with the traditional group,the improved indocyanine green-assisted peeling of internal limiting membrane combined with macular hole reconstruction and air tamponade can achieve similarly high closure rates while the operation procedure was simplified and the operation time was shortened.Reduced number of instruments into and out of the incision can reduce the incidence of complications.The postoperative patient's prone time is significantly shortened,with high comfort and good compliance.

Aim To investigate the effect of siRNA transfection of silencing Clkl gene on autophagy levels in AD model cells. Methods The Clkl gene was silted using siRNA transfection techniques. MTT was used to observe the effects of Aβ

The published literature of insomnia in the elderly treated with acupuncture was retrieved in CNKI, Wanfang and VIP from the date of establishment to December 31, 2019. Association rule analysis and cluster analysis were used to summarize the acupoint selection rules of insomnia in the elderly treated with acupuncture. A total of 37 articles were included, involving 60 acupuncture prescriptions. The most commonly used acupoints were Sanyinjiao (SP 6), Shenmen (HT 7), Anmian (Extra), Baihui (GV 20), Sishencong (EX-HN 1), Neiguan (PC 6), Xinshu (BL 15) and Taixi (KI 3). The most commonly used acupoint combinations were Sanyinjiao (SP 6)-Anmian (Extra)-Baihui (GV 20)-Sishencong (EX-HN 1)-Shenting (GV 24)-Shenmen (HT 7)-Xinshu(BL 15), Xinshu(BL 15)-Pishu (BL 20)-Shenshu (BL 23)-Shenting (GV 24), Zhaohai (KI 6)-Shenmai (BL 62), Taichong (LR 3)-Ganshu (BL 18), Daling (PC 7)-Taixi (KI 3), Neiguan (PC 6)- Zusanli (ST 36) and Guanyuan (CV 4)-Qihai (CV 6)-Zhongwan (CV 12). On the basis of acupoint selection according to disease differentiation, the acupoint selection rules and characteristics of insomnia in the elderly treated with acupuncture are regulating and supplementing the spleen and kidney and treating according to spleen-kidney.
Acupuncture Points ; Acupuncture Therapy ; Aged ; Cell Differentiation ; Humans ; Publications ; Sleep Initiation and Maintenance Disorders/therapy*

The Ministry of Education and other four departments jointly issued the Notice on the Construction of high-level schools of public Health, proposing that "it will take ten years to build a number of high-level schools of public health, and form a high-quality education development system to adapt to the construction of modern public health system". At present, the construction of high-level public health schools in various universities in China is in full swing. The high-level School of Public Health and the CDC have played an important role in constructing the national public health system and the human health community. The high-level public health schools are of strategic significance and important value to the development of the CDC. The review presents reflections and insights on the role of high-level public health schools in the development of the CDC and the challenges they might face.
Humans ; United States ; Schools, Public Health ; Schools ; Universities ; Public Health ; Centers for Disease Control and Prevention, U.S.

【Objective】Through summarizing the clinical manifestations and gene mutations of 5 types of RASopathies in childhood including Neurofibromatosis type1（NF1），Noonan syndrome（NS），Noonan syndrome with multiple lentigines（NSML），Costello syndrome（CS）and cardio-facio-cutaneous syndrome（CFC）and analyzing their commonalities and characteristics，to deepen the clinician′s understanding of the RASopathies and improve the domestic doctors′ diagnosis and treatment level of RASopathies.【Methods】The clinical data and gene mutation types of 11 patients of RASopathies who were diagnosed in Sun Yat- Sen Memorial Hospital from January 2015 to May 2018 were retrospectively analyzed. 【Results】The age of onset ranged from 6 months to 12 years and the main clinical manifestations of 11 patients included： short stature，craniofacial features，congenital heart defect，café-au-lait macules，developmental delay，thrombocytopenia， seizures and dystonia，cryptorchidism，etc. Five gene mutations were detected including NF1 gene，PTPN11 gene， RAF1 gene ，BRAF gene and HRAS gene.【Conclusions】The RASopathies are a clinically defined group of medical genetic syndromes caused by germline mutations in genes that encode components or regulators of the Ras/MAPK pathway. The RAS/MAPK pathway plays an important role in regulating growth development，promoting cell proliferation，differentiation，metabolism，and signal transduction of various hormones. Therefore，they share many overlapping characteristics，including craniofacial features，growth retardation，cardiac malformations，cutaneous and musculoskeletal abnormalities，neurocognitive impairment and tumor susceptibility. However ，each RASopathy exhibits different degree phenotypes because of mutations at different points in the pathway. In addition ，tumor susceptibility is one of the typical clinical features of RASopathies. Therefore，tumor monitoring is one of the most important contents in the follow-up process.

OBJECTIVE: To observe the clinical effect of acupuncture by stages on secondary dysmenorrhea of adenomyosis through prospective case-series study. METHODS: A total of 36 cases of adenomyosis patients with moderate-to-severe dysmenorrhea were treated with acupuncture by stages. The acupoints of Diji (SP 8), Sanyinjiao (SP 6), Ciliao (BL 32) and Shiqizhui (EX-B 8) were selected and acupuncture was given once a day during menstrual period; the acupoints of Guanyuan (CV 4), Zigong (EX-CA1), Sanyinjiao (SP 6) and Zusanli (ST 36) ect. were selected and acupuncture was given twice per week during non-menstrual period. All the treatment was given for three menstrual cycles. The visual analogue scale (VAS), Cox menstrual symptom scale (CMSS), Endometriosis Health Profile-5 (EHP-5) scores and the menstrual blood volume of pictorial blood loss assessment chart (PBAC) were observed before treatment and at the 1st, 2nd and 3rd menstrual cycle into treatment. Before treatment and at the 3rd menstrual cycle into treatment, the volume of uterus was measured by transvaginal ultrasound and the correlation among the quality of life, the severity of pain and symptoms was analyzed. RESULTS: The VAS, CMSS and EHP-5 scores at the 1st, 2nd and 3rd menstrual cycle into treatment were lower than those before treatment (<0.01, <0.05), and the PBAC scores were reduced but without statistical different (>0.05). Compared before treatment, at the 1st, 2nd and 3rd menstrual cycle into treatment, the PBAC scores were reduced in patients with PBAC>100 points (<0.01). Compared between 2nd and 1st menstrual cycle into treatment, between 3rd and 2nd menstrual cycle into treatment, the VAS, CMSS scores were all decreased (<0.01, <0.05). There was a significant positive correlation between the severity score of CMSS and EHP-5 at the corresponding time points of the 1st, 2nd and 3rd menstrual cycle into treatment (<0.01). CONCLUSION The acupuncture by stages has significant analgesic effect in patients with secondary dysmenorrhea of adenomyosis, and has the advantages of relieving the menstruation-related symptoms, regulating menstrual blood volume and improving the quality of life.

In ischemic stroke sequela phase, Rehmanniae Radix Praeparata-Corni Fructus drug pair has the effect in protecting damaged neurons, but its mechanism has not been clear. In this study, network pharmacology was used to predict the mechanism of Rehmanniae Radix Praeparata-Corni Fructus in the treatment of ischemic stroke sequela. Through database search and literature retrie-val, 40 active ingredients of Rehmanniae Radix Praeparata and Corni Fructus were obtained, and their targets were obtained through STITCH and TCMSP databases. The targets of ischemic stroke sequela were obtained through OMIM,GAD,TTD and DrugBank databases. By screening the intersections of active ingredients targets and stroke treatment targets, 21 potential targets were obtained. The DAVID database was used for GO enrichment analysis and KEGG pathway analysis of potential targets. GO enrichment analysis showed that Rehmanniae Radix Praeparata-Corni Fructus were mainly involved in regulation of blood pressure, negative regulation of extrinsic apoptotic signaling and positive regulation of angiogenesis. KEGG pathway analysis showed that Rehmanniae Radix Praeparata-Corni Fructus could inhibit inflammatory response and apoptosis signaling pathway by regulating HIF-VEGFA signaling pathway in neural stem cell proliferation, TNF signaling pathway and NF-kappaB signaling pathway. Molecular docking technique was used to verify that Rehmanniae Radix Praeparata-Corni Fructus component has a good binding activity with potential targets. The results showed that in ischemic stroke sequela phase, Rehmanniae Radix Praeparata-Corni Fructus drug pair could play an important role in recovering neural function, promoting the proliferation of neural stem cells, angiogenesis, preventing neural cells apoptosis and regulating inflammatory factors.
Brain Ischemia ; Cornus ; Drugs, Chinese Herbal ; Humans ; Ischemic Stroke ; Molecular Docking Simulation ; Stroke ; Technology