In recent years, research on the quality and safety detection of bear bile powder has mainly involved three aspects. First, the identification of active components and substitutes. Quantitative analysis of bile acids and other components is performed using HPLC, HPLC-tandem mass spectrometry, and other techniques, combined with near-infrared spectroscopy, X-ray diffraction, and polymerase chain reaction to identify adulteration. Isotope fingerprint analysis and glycosylation modification detection are used to distinguish natural products from biosynthetic substitutes, revealing significant differences in δ13C values and the proportion of specific glycosylation modifications between natural bear bile powder and synthetic products. Second, the detection of veterinary drug residues, mainly based on ultra-high performance liquid chromatography-tandem mass spectrometry, which can screen over 100 types of residues, but targeted purification strategies are needed to address interference from the bile acid matrix. Thirdly, heavy metal detection, mainly using inductively coupled plasma mass spectrometry and atomic absorption spectrometry, has revealed that contamination is associated with the breeding environment, with significant regional differences. Related detection technologies are gradually evolving from single-target analysis to multi-modal and intelligent approaches. Existing research faces issues, such as matrix effect interference, lack of international standards, and ethical controversies. It is suggested that future efforts should focus on the interdisciplinary application of detection technologies, develop rapid detection methods such as non-invasive monitoring and microfluidic chips, promote the standardization and equivalence evaluation of synthetic alternatives, and establish a full-chain quality control system integrating spatially resolved mass spectrometry imaging, artificial intelligence, and big data.

Objective    To analyze the diagnosis and treatment of patients with ventricular septal defect complicated with infective endocarditis. Methods    We retrospectively analyzed the clinical data of 40 patients with ventricular septal defect complicated with infective endocarditis in our hospital from 2001 to 2016. There were 25 males and 15 females, aged 20-62 (39.92±11.16) years. They were divided into two groups according to the duration from admission to surgery: a group A (an early operation group whose surgery was performed within 7 days after admission) and a group B (a conventional treatment group with the duration from admission to surgery>7 days). Among them, there were 27 patients in the group A including 15 males and 12 females with an average age of 39.56±11.80 years, and 13 patients in the group B including 10 males and 3 females with an average age of 40.69±10.13 years. All patients were examined by echocardiogram and blood bacterial culture to investigate their etiology, echocardiogram results and treatment status. And the clinical data of the two groups were compared. Results    Two patients died before operation in the group B, one died of heart failure, and one cerebral infarction. No reoperation during hospitalization, cerebral infarction, thromboembolism or other complications occurred. The ventilation time in the group A was significantly shorter than that in the group B (18.00±14.85 h vs. 31.00±29.57 h, P=0.015). There was no statistical difference in the extracorporeal circulation time, myocardial block time, or postoperative hospital stay between the two groups (P>0.05). After discharge, the patients continued antibiotic therapy for 3-6 weeks. Patients were followed up for 12-127 (75.74±6.01) months, 1 died of malignant tumors in the group A, 1 developed atrial fibrillation and 1 developed cardiac insufficiency in the group B, and the rest of patients did not complain of obvious discomfort. There was no residual shunt, recurrence of infective endocarditis, reoperation, postoperative stroke or thromboembolism. Conclusion    Preoperative echocardio-graphy and blood bacteriological culture are helpful for the diagnosis and treatment of patients with ventricular septal defect complicated with infective endocarditis. Early surgery is safe and effective for these patients, and can improve the long-term survival rate.

Objective To study the protective effect of chemokine C-C motif ligand 6 (CCL6) on glucose-oxygen deprivation induced injury in cardiomyocytes and its possible molecular mechanism.Methods Gene expression was analyzed in the public database Gene Expression Omnibus (GEO) database and gene expression of analyzed for myocardial tissue was analyzed gene expression in the sham group and the ischemia-reperfusion group (IR group).Rat H9C2 cardiomyocytes were cultured in vitro,and myocardial cell injury model was established by oxygen glucose deprivation (OGD).Cell viability was detected by MTT assay;apoptosis was determined by Annex V/PI double staining;the expression of related genes was detected by real-time PCR and Western blot.Results Compared with the sham group,transcriptome analysis and real-time PCR showed that the expression of CCL6 in the myocardial tissue of the IR group was significantly decreased (P＜0.01).Oxygen glucose deprivation induced a decrease in CCL6 expression levels in H9C2 cardiomyocytes in a time-dependent manner.In addition,oxygen glucose deprivation leads to decreased cell viability and increased apoptosis;while addition of CCL6 promotes cell viability and reduces apoptosis.The IncRNA microarray and real-time PCR showed that CCL6 treatment of cardiomyocytes resulted in a significant decrease in the expression of hicRNA IGF2-AS and further increased the phosphorylation of Akt and GSK-3β.Conclusion CCL6 can inhibit cardiomyocyte injury induced by glucose deprivation,and its molecular mechanism may be related to inhibition of IGF2-AS and enhancement of Akt/GSK-3β signaling pathway.

Objective To study the protective effect of stress-associated endoplasmic reticulum protein 1 (SERP1)on glucose and oxygen deprivation-induced injury in cardiomyocytes.Methods Gene expression was analyzed in the public database Gene Expression Omnibus(GEO)and screened for any difference in gene expression in myocardial tissues between the control group and the ischemiareperfusion group(IR group).Rat H9C2 cardiomyocytes were cultured and a myocardial cell injury model was established by oxygen glucose deprivation(OGD).The effect of SERP1 expression on cell viability,apoptosis and the endoplasmic reticulum stress pathway in cardiomyocytes were examined.Results Western blot results showed that the expression of SERP1 in myocardial tissues decreased in the IR group,compared with the control group(t =6.83,P =0.006).Oxygen and glucose deprivation induced decreased levels of SERP1 mRNA and protein expression in H9C2 cardiomyocytes in a timedependent manner (F =8.50 and 15.70,P =0.007 and 0.001).In addition,oxygen and glucose deprivation led to decreased cell viability and increased apoptosis,while exogenous addition of SERP1 had protective effects in H9C2 cardiomyocytes by promoting cell viability and reduced cell apoptosis.The lncRNA microarray and real-time PCR results showed that SERP1 could inhibit the expression of lncRNA CDKN2B-AS1 and further increase the phosphorylation of JAK2 and STAT3,leading to decreased expression of endoplasmic reticulum stress markers GRP78 and CHOP(all P＜ 0.05).Conclusions SERP1 can inhibit cardiomyocyte injury induced by glucose deprivation,and the underlying molecular mechanism may be related to the inhibition of CDKN2B-AS1 expression,promotion of the JAK2/STAT3 signaling pathway,and suppression of endoplasmic reticulum stress.

Objective This study aims to evaluate the results of one-stage ascending-to abdominal aortic bypass and aortic valve replacement for concomitant aortic coarctation with aortic valve pathology.Methods From June 2009 to March 2017,28 consecutive adult patients(23males and 5 females) with aortic coarctation combined with aortic valve pathology underwent one-stage ascending-to-abdominal aorta bypass and aortic valve replacement or a Bentall procedure.Age 19-59,mean age (33.6 ± 11.6) years;1 case of coronary heart disease and 12 cases of aortic root tumor.Results All patients successfully underwent the one-stage procedure.The mean aortic cross-clamp and cardiopulmonary bypass times were (71 ± 23) and (113 ±37) mins respectively.The average post-operative hospital stay was(15.9 ± 4.9) days and the average operation time was (5.2 ± 4.0)h.Systolic blood pressure decreased from (158 ± 36)mmHg(1 mmHg =0.133 kPa) pre-operatively to(121 ± 18)mmHg post-operatively.After the operation,follow-up 3-96 months,No deaths or significant gradients between the upper and lower extremities occurred during follow-up.Conclusion Ascending-to-abdominal aortic bypass and concomitant aortic valve procedures are a suitable therapeutic option for severe aortic coarctation combined with aortic valve pathology in adult patients.

Objective To determine the incidence and clinical features of headache after carotid endarterectomy (CEA).Methods A retrospective analysis was made on the data of patients undergoing CEA in the Department of Vascular Surgery,Peking Union Medical College Hospital from Jan 2014 to Jan 2015.There were 119 males and 24 females,including 97 cases of symptomatic carotid stenosis and 110 cases of severe carotid stenosis.Results The incidence of newly emergent headache after surgery was 44％ (63/143).The earliest time of headache was 30 minutes after surgery and the latest was 6 days after surgery.95％ of headache occurred within 48 hours after surgery (60/63).79.4％ (50/63) of the headache lay ipsilaterally with CEA,and bilateral headache accounted for 20.6％ (13/63).Severe headache accounted for 4.8％ (3/63),all were ipsilaterally frontal and temporal headache,complicating central nervous system symptoms.Conclusions After CEA headache is a common clinical symptom.Most were mild to moderate and unilateral,which can be relieved spontaneously.Cerebral hemodynamics need to be further examined to differentiate the different pathological states of severe headache on the operative side after CEA because of the high risk of developing hyperperfusion syndrome or cerebral infarction.History of TIA or stroke is the risk factor of post-CEA headache.

Objective This study aims to evaluate the initial results of a hybrid procedure for treating descending thoracic aortic disease that involves distal aortic arch.It also intends to report our initial experience in performing this procedure.Methods A total of 45 patients(35 males and 10 females) with descending thoracic aortic disease underwent a hybrid procedure,namely,thoracic endovascular aortic repair(TEVAR) combined with supra-arch branch vessel bypass,in our center from April 2009 to August 2014.Right axillary artery to left axillary artery bypass(n =20) or right axillary artery to left common carotid artery and left axillary artery bypass(n =25) were performed.The conditions of all patients were followed up from the 14th month to the 77th month postoperative[mean(38.0 ± 17.1) months].Mortality within 30 days,complications such as endoleak after the hybrid procedure,and stenosis or blockage of the bypass graft during the follow-up period were assessed.Results One case of death and one case of cerebral infarction were reported within 30 days.Two patients underwent open surgery beacuse of endoleak.And a newly formed intimal tear was observed in one patient and the patient underwent a second TEVAR during the follow-up period.Condusion Initial results suggest that the one-stage hybrid procedure is a suitable therapeutic option for thoracic aortic pathologies that involve distal aortic arch.However,this procedure is not recommended for type-B aortic dissection,in which a tear is located in the greater curvature or near the left subclavian artery,because of the high possibility of endoleak occurrence.

Objective To investigate the distribution of anxiety and depression disorders in patients of carotid artery stenosis (CAS),and the relationship between symptoms of cerebral infarction and the severity of anxiety and depression.Methods We used Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale(SDS) created by William W.K.Zung to evaluate the anxiety and depression disorders associated with CAS in 93 patients hospitalized at the Department of Vascular Surgery,and 146 hospitalized varicose veins patients as acontrols.Results The scales of CAS are significantly higher than the control group(SAS:32 ± 8 vs 29 ± 7,P ＜ 0.001 ; SDS:42 ± 14 vs 35 ± 11,P ＜ 0.001),within-group analysis of CAS shows that there is no statistical difference between symptomatic group and non-symptomatic group (SAS:32 ±8 vs 32 ± 7,P =0.780; SDS:41 ± 14 vs 42 ± 14,P =0.830),or between infarction group and non-infaction group (SAS:31 ± 8 vs 33 ± 8,P =0.147; SDS:39 ± 14 vs 43 ± 13,P =0.241).Conclusions CAS can cause anxiety and depression disorders,and the disorders are not related to symptoms of cerebral ischemia and cerebral infarction.