Objective The aim of the study was to compare the mid-and long-term results between mitral valve repair and mitral valve replacement in mitral regurgitation due to infective endocarditis.Methods From January 2005 to December 2014, 225 patients with mitral regurgitation due to infective endocarditis underwent surgical treatment at our institution.159 patients(70.7%) were male, and the mean age was(42±15) years(13-76 years).Among them, mitral valve repair was performed in 89 patients(repair group) and mitral valve replacement in 136 patients(replacement group).Preoperative clinical profiles, perioperative details and follow-up data were reviewed retrospectively.Results There was no operative death in both groups.Compared to replacement group, patients undergoing mitral valve repair suffered significantly less embolism events(9.0% vs.22.8%, P<0.05) and central nerve complications(6.7% vs.17.6%, P<0.05).Patients with mitral valve vegetation were significantly less in repair group as well(59.6% vs.89.0%, P<0.05).The mean cardiopulmonary bypass time[(87±30) min vs.(86±33) min, P>0.05] and aorta clamp time[(52±21) min vs.(51±23) min, P>0.05]were similar between repair group and replacement group.Intensive care stay was significantly shorter in repair group[(1.4±0.7)days vs.(1.9±1.3)days, P<0.05] and hospital stay was shorter in repair group as well[(8.3±4.5)days vs.(9.5±5.3)days, P=0.09].Perioperative cerebral hemorrhage was observed in no patient in repair group and 2 patients(1.5%) in replacement.There was no in-hospital death in repair group.2 in-hospital(1.5%) deaths occurred in replacement group and the causes of death were cerebral hemorrhage and low cardiac output syndrome.The mean follow-up time was(40±35) months(3-134 months), and follow-up was complete in 85% patients.10 years over follow-up, freedom from heart related adverse events was 88% in repair group and 86% in replacement group(P>0.05).Conclusion Mitral valve repair was safe and feasible in mitral regurgitation due to infective endocarditis, with good mid-and long-term outcomes.Thorough excision of infective tissue and vegetation was necessary to perform mitral valve repair.Yet mitral valve replacement was a viable option in patients for whom repair was infeasible due to severe damage of valve.

Objective To investigate the promotion effect of human transcriptional positive cofactor 4 (PC4) overexpression on lymphatic metastasis in lung adenocarcinoma .Methods 96 samples of lung adenocarcinoma tissue were collected .The immuno‐histochemistry(IHC) and real‐time quantitative polymerase chain reaction (qRT‐PCR) were adopted for detecting the expression levels of PC4 protein and mRNA .The correlation of PC4 expression with lymphatic metastasis and TNM stage was analyzed .Re‐sults The expression of PC4 protein was positively correlated mRNA in lung adenocarcinoma (r=0 .63 ,P<0 .01);the expression of PC4 protein was positively correlated with lymph node metastasis (χ2 =8 .29 ,P<0 .01) and TNM stage (χ2 =4 .71 ,P<0 .05);the expression of PC4 mRNA was also positively correlated with lymph node metastasis (χ2 = 8 .40 ,P< 0 .01) and TNM stage (χ2 =5 .10 ,P<0 .05) .Conclusion PC4 overexpression is found to be closely associated with the lymph node metastasis and TNM stage .PC4 may facilitate the lymph node metastasis of lung adenocarcinoma .

Objective To prepare compound ketoconazole ointment and perform the stability study .Methods Ketocon-azole ,mupirocin and mometasone furoate were used as active pharmaceutical ingredients (API) .PEG mixture was used as ma-trix to prepare the ointment .Stability of the API in the ointment was evaluated by the stress tests .Results The optimal ratio of PEG400 to PEG3350 for the ointment matrix was 2:1 .Mometasone furoate and mupirocin in the ointment were stable to the high temperature(40 ℃)while ketoconazole had some degradation .The stability of the API was improved by addition of 0 .5％ of L-A .During the accelerate test ,the ointment had no color change and the API percentages were above 98％ .Conclu-sion The novel compound ketoconazole ointment was successfully prepared and the formulation stability was excellent .

Objective To explore the surgical techniques in laparoscopic distal pancreatectomy for benign and low malignant tumors in the body or tail of the pancreas.Methods The clinical data of 21 cases of benign and low-malignant tumors in the body or tail of the pancreas undergoing LDP from Jan 2015 to Mar 2017 in the First Hospital of Shanxi Medical University were analyzed retrospectively.Results One patient was converted to open surgery(4.76％),13 patients underwent laparoscopic spleen-preserving distal pancreatectomy (Kimura procedure).The other 7 patients underwent LDP with splenectomy.The average size of the tumor was (6.0 ±3.1)cm;the operation time was 190 to 421 mins with mean time of (288.4 ± 56.9)min;the intraoperative blood loss was 30 to 800 ml with the mean volume of(235.7 ± 202.6)ml;Postoperative hospital stay was 6 to 17 days with the mean time of (8.9 ± 3.1) days.Six patients suffered from type A pancreatic fistula,and were cured by conservative treatment.Conclusions Laparoscopic spleen-preserving pancreatectomy for benign or low-grade malignant body and tail pancreatic tumors is feasible and safe.

Taking the curriculum integration of skin diseases as an example, this paper summarizes the skin diseases with high incidence in the army such as acne, tinea pedis, warts, folliculitis, corns and calluses, sunburns, etc. The results have been applied to the integration of the skin disease curriculum in Air Force Medical University. During the course integration process, we integrated the courses of dermatology, plastic surgery and burn surgery together, and simplified the teaching content according to the "organ-system" orientation and features of military medical university. In the teaching process, the PBL teaching method was used to guide the students to discuss with the problems. At the end of the course, the students were assessed by tests, and the satisfaction evaluation were carried out. The results showed that the application of high incidence of skin diseases in the army in curriculum integration can help improve the teaching effect and the satisfaction of students, which will provide a certain reference for the curriculum integration reform of military medical universities.

Objective To calculate the standardized cesarean delivery rate by considering the individual characteristics of puerprae, and to evaluate the medical quality of obstetrics in the hospital. Methods Medical records of 69 406 puerprae from January to December in 2016 were collected from 33 tertiary general hospitals in Shanxi province. A logistic regression model was used to construct a maternal risk adjustment model of cesarean delivery, with the area under the ROC curve (AUC) used to evaluate the goodness of fit of the model. Results Of the 69 406 puerprae, 30 881 used caesarean delivery, accounting to 44. 37% . The cesarean section rate difference was statistically significant among those of different age, nationality, conditions upon admission, whether to participate in a clinical pathway, fetus number, birth weight and maternal gestational age, as well as the severity of complications (P< 0. 001). According to the logistic model, those of older age, history of cesarean delivery, twins or triplet births, neonatal overweight, malposition, placenta previa, and those with various pregnancy complications tend to use maternal cesarean section surgery, with a goodness-of-fit of 0. 82. With risk adjusted, the ranking of actual cesarean section rate and standardized cesarean section rate varies among the hospitals. Conclusions With the factor of puerprae factor adjusted, the standardized cesarean delivery rate can eliminate risk factors of the puerprae, it is feasible to scientifically evaluate the cesarean delivery rate of the hospital′s obstetric department.

Objective The aim of the study was to compare the early and mid-term outcomes of isolate mitral valve repair through minimal invasive and median sternotomy approach .Methods From July 2009 to December 2015, 329 patients under-went minimal invasive isolated mitral valve repair through right thoracic approach at our institution .The mean age was(48 ±14) years(15-78 years), 202 patients(61.4％) were male and 137 patients(41.6％) were in NYHA class Ⅲ-Ⅳ.570 patients underwent isolate mitral valve repair through median sternotomy in the same period .Propensity score matching identify 248 pa-tient pairs with similar preoperative characteristics .Early and mid-term outcomes were compared between propensity-matched groups.Results After propensity matching, the mean cardiopulmonary bypass time[(91 ±27)min vs.(76 ±27)min, P<0.05] and aorta cross clamp time[(52 ±18)min vs.(43 ±15)min, P<0.05] were significantly longer in minimal invasive group.24 hours drainage volume was significantly less[(353 ±329)ml vs.(446 ±356)ml, P <0.05] and patients need transfusion was significantly fewer(22.2％ vs 31.5％, P<0.05) in minimal invasive group.Incidence of stroke, poor wound healing, renal failure requiring hemodialysis and tracheotomy were similar between the two groups(P>0.05).There were two in-hospital death in minimal invasive group(respiratory failure) and median sternotomy group(low cardiac output syndrome), respectively.Follow-up was 91％ complete and the mean follow-up time was(28 ±21) months(3-89 months).At 7 year after surgery, overall survival were 99％and 100％(P>0.05) in minimal invasive group and median sternotomy group, respective-ly.Freedom from reoperation were 100％ and 95％(P>0.05) and freedom from recurrent mitral regurgitation were 95％ and 90％(P>0.05).Conclusion Minimal invasive mitral valve repair was safe, effective and provide equivalent mid-term out-comes compared to median sternotomy approach .Minimal invasive surgery provided cosmetic benefits , decreased postoperative trauma.As the accumulation of clinical experience, complex repair is feasible through minimal invasive surgery.Adoption of minimal invasive surgery will increase the acceptance of early intervention strategy among asymptomatic MR patients and thus improve late outcomes and life quality .

Objective The aim of the study is to evaluate the early and long-term outcomes of mitral valve repair for degenerative mitral regurgitation.Methods From January 2003 to December 2015,clinical profiles of 1 903 patients with degenerative mitral regurgitation who underwent mitral valve repair at our institution were analyzed retrospectively.There were 1 312 males (68.9 ％) and 591 females (31.1％) the mean age was (54.2 ± 13.1) years.Early and long-term outcomes were summarized and risk factors for adverse events were assessed.Results There were 35 in-hospital deaths(1.8％) and in-hospital mortality for isolated mitral valve repair was 0.9％ (10/1 163).Perioperative complications included central nerve system complications(0.7％),respiratory failure requiring tracheotomy(1.8％),acute renal injury requiring hemodialysis(1.2％) and reoperation for bleeding(0.7 ％).NYHA function class Ⅲ-Ⅳ (OR =3.65),atrial fibrillation (OR =2.85) and ejection fraction ＜0.6(OR =2.34) were identified as independent risk factors for in-hospital mortality.12 years over follow-up,overall survival,freedom from reoperation for mitral valve and freedom from recurrent moderate/severe regurgitation were 85％ 、91％ and 75％,respectively.Age ＞ 60 years(HR =7.43),preoperative stroke(HR =6.51),ejection fraction ＜ 0.6 (HR =3.87),left ventricular end-systolic dimension ＞ 40 mm (HR =3.98) and pulmonary systolic pressure ＞ 50 mmHg (1 mmHg =0.133 kPa) (HR =2.85) were independent predictive factors for late death.Ejection fraction ＜ 0.6 (HR =4.01),left ventricular end-diastolic dimension ＞ 60 mm(HR =1.88),leaflet lesion involving anterior leaflet (HR =2.40) and residue mild regurgitation(HR =4.17) were independent predictors for late recurrent regurgitation.Leaflet lesion involving anterior leaflet(HR =2.40) and residue mild regurgitation (HR =3.35) were independent predictor for late reoperation for mitral valve.Conclusion Mitral valve repair is safe and effective in degenerative mitral regurgitation.Early surgical intervention for asymptomatic patients with preserved left ventricular function before onset of atrial fibrillation and pulmonary artery hypertension is associated with decreased incidence of adverse events and improved long-term outcomes.Early surgical intervention should be restricted in experienced high-volume centers.

Objective:To explore the accuracy of mpMRI combined with Partin table, MSKCC nomogram and CAPRA score in predicting extracapsular extension and seminal vesicle invasion of prostate cancer.Methods:From January 2016 to June 2021, a total of 178 patients who underwent laparoscopic radical prostatectomy were selected. The average age of patients was (68.3±3.5) years, the average preoperative PSA level was (24.5±7.1)ng/ml, and the average percentage of positive cores in biopsy was 44.3%. The clinical T 1c stage was determined in 67 cases (37.6%), T 2a in 69 cases (38.8%) and T 2b-2c in 42 cases(23.6%). Biopsy Gleason score of 3+ 3=6 was found in 45 cases(25.3%), 3+ 4=7 in 41 cases(23.0%), 4+ 3=7 in 26 cases(14.6%), 8 with different combinations in 36 cases(20.2%), and 9 or 10 in 30 cases(16.9%). According to preoperative PSA level, biopsy Gleason score, clinical stage, age, total biopsy cores and positive cores, the posibility of extracapsular extension and seminal vesicle invasion were predicted using 2012-version Partin table and MSKCC nomogram. CAPRA score of each patient was calculated. The prediction schemes were built as follows: ①mpMRI alone, ②mpMRI combined with Partin scale, ③mpMRI combined with MSKCC nomogram, ④mpMRI combined with CAPRA score. The results of each prediction scheme were compared with postoperative pathological reports. Logistic regression analysis was used to evaluate the relationship between predictive results and postoperative pathological outcomes. The receiver operating characteristic curve of each prediction scheme was drawn. The area under curve was used to compare the predictive accuracy of each combination scheme for the pathological results of prostate cancer. The decision analysis curve of each prediction scheme was drawn. The clinical benefits of each scheme were analyzed by comparing the net return under different risk thresholds. Results:mpMRI predicted extracapsular extension in 21 cases(11.8%) and seminal vesicle invasion in 16 cases(9.0%). The postoperative pathological results reported extracapsular extension in 27 cases(15.2%) and seminal vesicle invasion in 39 cases(21.9%). Logistic regression analysis showed that mpMRI and clinical scales were predictors related to the pathological results of prostate cancer( P<0.05). The receiver operating characteristic curve of each scheme showed that the area under curve for predicting extracapsular extension by using mpMRI, mpMRI combined with Partin table, mpMRI combined with MSKCC nomogram and mpMRI combined with CAPRA score were 0.599, 0.652, 0.763 and 0.780, respectively, and the area under curve for predicting seminal vesicle invasion were 0.607, 0.817, 0.826 and 0.820, respectively. Compared with simple application of mpMRI, except that the scheme of mpMRI combined with Partin table had no obvious advantage in predicting extracapsular extension( P=0.117), any other combined scheme had higher prediction accuracy( P<0.01). mpMRI combined with MSKCC nomogram or CAPRA score was better than mpMRI combined with Partin table in predicting extracapsular invasion ( P<0.01). There was no significant difference in predicting seminal vesicle invasion among these three combination schemes ( P>0.05). The net income of the combined prediction scheme was higher than that of using mpMRI alone under any risk threshold. The scheme of using mpMRI combined with MSKCC nomogram had the highest net income. Conclusions:mpMRI combined with clinical scales has good accuracy in predicting pathological characteristics of prostate cancer in Chinese population. Compared with other schemes in this study, the combination scheme of mpMRI combined with MSKCC nomogram has the highest prediction accuracy.