BACKGROUND: Based on the China-VHD database, this study sought to develop and validate a Valvular Heart Disease- specific Age-adjusted Comorbidity Index (VHD-ACI) for predicting mortality risk in patients with VHD. METHODS & RESULTS: The China-VHD study was a nationwide, multi-centre multi-centre cohort study enrolling 13,917 patients with moderate or severe VHD across 46 medical centres in China between April-June 2018. After excluding cases with missing key variables, 11,459 patients were retained for final analysis. The primary endpoint was 2-year all-cause mortality, with 941 deaths (10.0%) observed during follow-up. The VHD-ACI was derived after identifying 13 independent mortality predictors: cardiomyopathy, myocardial infarction, chronic obstructive pulmonary disease, pulmonary artery hypertension, low body weight, anaemia, hypoalbuminaemia, renal insufficiency, moderate/severe hepatic dysfunction, heart failure, cancer, NYHA functional class and age. The index exhibited good discrimination (AUC, 0.79) and calibration (Brier score, 0.062) in the total cohort, outperforming both EuroSCORE II and ACCI (P < 0.001 for comparison). Internal validation through 100 bootstrap iterations yielded a C statistic of 0.694 (95% CI: 0.665-0.723) for 2-year mortality prediction. VHD-ACI scores, as a continuous variable (VHD-ACI score: adjusted HR (95% CI): 1.263 (1.245-1.282), P < 0.001) or categorized using thresholds determined by the Yoden index (VHD-ACI ≥ 9 vs. < 9, adjusted HR (95% CI): 6.216 (5.378-7.184), P < 0.001), were independently associated with mortality. The prognostic performance remained consistent across all VHD subtypes (aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation, tricuspid valve disease, mixed aortic/mitral valve disease and multiple VHD), and clinical subgroups stratified by therapeutic strategy, LVEF status (preserved vs. reduced), disease severity and etiology. CONCLUSION The VHD-ACI is a simple 13-comorbidity algorithm for the prediction of mortality in VHD patients and providing a simple and rapid tool for risk stratification.

Objective To observe the clinical efficacy of Shuangye San(the prescription mainly composed of Mori Folium and Nelumbinis Folium)in the treatment of type 2 diabetes mellitus(T2DM)complicated with non-alcoholic fatty liver disease(NAFLD)of spleen deficiency and phlegm stasis type.Methods A total of 80 patients with T2DM complicated with NAFLD of spleen deficiency and phlegm stasis type were randomly divided into a treatment group and a control group,with 40 cases in each group.The control group was treated with conventional western medicine for lowering blood glucose and lipid,protecting liver and lowering enzymes.The treatment group was treated with the granules of Shuangye San orally on the basis of treatment for the control group.The course of treatment lasted for three months.The changes of traditional Chinese medicine(TCM)syndrome scores,homeostasis model assessment of insulin resistance(HOMA-IR),fasting insulin(FINS),fasting blood glucose(FBG),2-hour postprandial blood glucose(2hPG),glycosylated hemoglobin(HbA1C),total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),liver function indicators and B-ultrasound grading of fatty liver in the two groups were observed before and after treatment.After treatment,the clinical efficacy and safety of the two groups were evaluated.Results(1)After three months of treatment,the total effective rate of the treatment group was 85.00％(34/40),and that of the control group was 70.00％(28/40).The intergroup comparison(tested by chi-square test)showed that the efficacy of the treatment group was significantly superior to that of the control group(P＜0.01).(2)After treatment,the scores of TCM symptoms of obese physique,heaviness and weakness in the limbs,shortness of breath and unwilling to talk,tightness and stabbing pain in the chest,abdominal distension and poor appetite in the two groups were decreased compared with those before treatment(P＜0.05),and the decrease of TCM syndrome scores in the treatment group was significantly superior to that in the control group(P＜0.05).(3)After treatment,the levels of glucose and lipid metabolism indicators of FINS,HOMA-IR,FBG,2hPG,HbA1C,TC,TG and LDL-C in the two groups were significantly decreased compared with those before treatment(P＜0.05),and the level of HDL-C was significantly increased compared with that before treatment(P＜0.05).The decrease of FINS,HOMA-IR,FBG,2hPG,HbA1C,TC,TG and LDL-C levels and the increase of HDL-C levels in the treatment group were significantly superior to those in the control group(P＜0.05).(4)After treatment,the levels of liver function indicators of alanine aminotransferase(ALT),aspartate aminotransferase(AST)and gamma-glutamyl transpeptidase(GGT)in the two groups were significantly decreased compared with those before treatment(P＜0.05),and the decrease of liver function indicators in the treatment group was significantly superior to that in the control group(P＜0.05).(5)After treatment,the B-ultrasound grading of fatty liver of the two groups was significantly improved compared with that before treatment(P＜0.05),and the improvement of fatty liver B-ultrasound grading in the treatment group was significantly superior to that in the control group,and the difference was statistically significant(P＜0.05).(6)During the treatment,there were no adverse reactions such as impairment of liver and kidney function and abnormalities in routine blood,urine and stool test in the two groups.Conclusion Shuangye San exerts certain effect in the treatment of T2DM complicated with NAFLD of spleen deficiency and phlegm stasis type.It can alleviate the clinical symptoms of patients,correct the disorder of glucose and lipid metabolism,and improve liver function and fatty liver B-ultrasound grading.

Interleukin 6,a cytokine secreted in innate immune resistant virus infection,has recently attracted widespread attention because of its effects in cytokine storms.High IL-6 levels have been shown to effectively suppress viral infections,but experiments increasingly indicate that excessive IL-6 secretion in complex immune responses in the body is not only counterpro-ductive but also causes severe damage to the body.This article reviews current research progress in the roles of IL-6 in hepatitis B virus,influenza A virus,respiratory syncytial virus,severe acute respiratory syndrome coronavirus 2,rotavirus,and en-cephalomyocarditis virus infections,to provide new ideas and approaches for blocking viral infection and developing new antivi-ral drugs.

Interleukin 6,a cytokine secreted in innate immune resistant virus infection,has recently attracted widespread attention because of its effects in cytokine storms.High IL-6 levels have been shown to effectively suppress viral infections,but experiments increasingly indicate that excessive IL-6 secretion in complex immune responses in the body is not only counterpro-ductive but also causes severe damage to the body.This article reviews current research progress in the roles of IL-6 in hepatitis B virus,influenza A virus,respiratory syncytial virus,severe acute respiratory syndrome coronavirus 2,rotavirus,and en-cephalomyocarditis virus infections,to provide new ideas and approaches for blocking viral infection and developing new antivi-ral drugs.

Objective:To evaluate the effects of platelet-rich plasma(PRP)supernatants with different activation methods and storage time on human monocyte-derived macrophages phenotype and explore the possible mechanism.Methods:Human monocyte-derived macrophages were cultured in vitro with PRP or activated PRP supernatants activated with different activators.The expression of marker molecules on the surface of macrophages was detected by flow cytometry,and the concentration of growth factors in PRP supernatants was detected by ELISA.Results:After 24 h of coculture,the expression level of CD86 in macrophages stimulated by PRP supernatant(thrombin and CaCl2 activated)was significantly higher than that by PRP group(P＜0.05),and the expression of CD163 in macrophages was increased by CaCl2 activated PRP supernatant.Compared with different activator groups,the expression of CD163 in macrophages of CaCl2 activated group was significantly higher than that of thrombin and ADP groups(P＜0.05).ELISA results showed that the concentrations of FGF(P＜0.001)and EGF(P＜0.05)in the supernatant of PRP stored at-80 ℃ for more than 20 months and 10-20 months were significantly higher than those in the group stored at less than 10 months after CaCl2 activation,and the expressions of CD86(P＜0.01),CD163(P＜0.001)and CD206(P＜0.001)in macrophages cocultured with the supernatant of the two groups were significantly increased.Conclusion:PRP activated by different activators has different effects on the phenotype of macrophages.Meanwhile,the storage time will also affect the growth factor concentration and effect of PRP.

OBJECTIVE: To develop and validate a user-friendly risk score for older mitral regurgitation (MR) patients, referred to as the Elder-MR score. METHODS: The China Senile Valvular Heart Disease (China-DVD) Cohort Study functioned as the development cohort, while the China Valvular Heart Disease (China-VHD) Study was employed for external validation. We included patients aged 60 years and above receiving medical treatment for moderate or severe MR (2274 patients in the development cohort and 1929 patients in the validation cohort). Candidate predictors were chosen using Cox's proportional hazards model and stepwise selection with Akaike's information criterion. RESULTS: Eight predictors were identified: age ≥ 75 years, body mass index < 20 kg/m², NYHA class III/IV, secondary MR, anemia, estimated glomerular filtration rate < 60 mL/min per 1.73 m², albumin < 35 g/L, and left ventricular ejection fraction < 60%. The model displayed satisfactory performance in predicting one-year mortality in both the development cohort (C-statistic = 0.73, 95% CI: 0.69-0.77, Brier score = 0.06) and the validation cohort (C-statistic = 0.73, 95% CI: 0.68-0.78, Brier score = 0.06). The Elder-MR score ranges from 0 to 15 points. At a one-year follow-up, each point increase in the Elder-MR score represents a 1.27-fold risk of death (HR = 1.27, 95% CI: 1.21-1.34, P < 0.001) in the development cohort and a 1.24-fold risk of death (HR = 1.24, 95% CI: 1.17-1.30, P < 0.001) in the validation cohort. Compared to EuroSCORE II, the Elder-MR score demonstrated superior predictive accuracy for one-year mortality in the validation cohort (C-statistic = 0.71 vs. 0.70, net reclassification improvement = 0.320, P < 0.01; integrated discrimination improvement = 0.029, P < 0.01). CONCLUSIONS The Elder-MR score may serve as an effective risk stratification tool to assist clinical decision-making in older MR patients.

Alveolar echinococcosis is a parasitic zoonosis that severely damages human health. Currently, radical surgical resection is the first choice for hepatic alveolar echinococcosis. For the advanced hepatic echinococcosis patients with refractory radical resection, the palliative surgery combined with chemotherapy, liver transplantation, drug therapy, and radiofrequency microwave ablation may provide comprehensive tools. This article reviews the current situation and progress of comprehensive treatments for hepatic alveolar echinococcosis.

Objective To measure and analyze the set-up errors of postoperative intensity modulated radiation therapy of rectal cancer (PIMRTRC)with electronic portal imaging device (EPID),and to provide theoretical foundation for clinical realizing of accurate PIMRTRC.Methods Totally 30 patients after rectal carcinoma resection underwent sagittal and coronal photographing with EPID before the first time of therapy and one time per week during the treatment course.The obtained images were compared with DRR images in treatment planning system to get the setup errors at X(left-right),Y(head-foot) and Z (front-back)directions,and the extending margins of CTV and PTV in postoperative intensity modulated radiation therapy were calculated.EPID was used for setup correction,and SPSS 19.0 was involved in to execute statistical analysis. Results The linear displacement had the mean values plus/minus standard deviation at X, Y and Z directions before and after error correction being(-1.392 4±3.670 9)mm vs(-0.816 5±2.670 5)mm,(0.969 7±4.076 1)mm vs(0.418 2±2.911 4)mm, and(0.704 4±1.805 6)mm vs(0.471 7±1.641 3)mm respectively;the extending margin had the values being 7 mm vs 5 mm, 6 mm vs 4 mm, and 4 mm vs 3 mm respectively.Conclusion EPID ensures the correctness and accuracy in postoperative intensity modulated radiotherapy of rectal cancer,which makes target area gifted with maximized dose,the surrounding tissue and organs at risk protected adequately,and provides theoretical support for extending CTV margin.[Chinese Medical Equip-ment Journal,2018,39(5):59-63]

Objective To analyze the safety of atrial septal defect closure using Da Vinci surgical system. Methods Totally 23 atrial septal defect patients hospitalized from July to December 2016 underwent atrioseptopexy by using Da Vinci surgical system. The effect of atrioseptopexy was observed under cardiopulmonary bypass conditions. Results All the patients had the operation completed successfully, with the operating time being (2.8 ±0.5)h, the intraoperative cardiopulmonary bypass time being (35.4±18.4)min, aortic clamping time being (25.9±8.4)min, postoperative mechanical ventilation time being (5.7±1.5)h, amount of thoracic drainage fluid from 50 to 300 ml and postoperative hospital stay being (7 ±5.1)d. The follow-up 1 and 3 months after discharge showed there were no complications and death occurred, and the examinations by chest X-ray film and heart color ultrasound found no abnormality. Conclusion Da Vinci surgical system gains advantages in safety, reliability, patient satisfaction, operative incision and surgical trauma, and thus is worthy promoting clinically.

Euphorbia kansui is a commonly used traditional Chinese medicine for the treatment of edema, pleural effusion, and asthma, etc. According to the previous researches, terpenoids in E. kansui possess various biological activities, e.g., anti-virus, anti-allergy, antitumor effects. In this work, twenty five terpenoids were isolated from E. kansui, including thirteen ingenane- and eight jatrophane-type diterpenoids (with two new compounds, kansuinin P and Q) and four triterpenoids. Eighteen of them were analyzed by MTS assay for in vitro anticancer activity in five human cancer cell lines. Structure-activity relationship for 12 ingenane-type diterpenoids in colorectal cancer Colo205 cells were preliminary studied. Significant anti-proliferation activities were observed in human melanoma cells breast cancer MDA-MB-435 cells and Colo205 cells. More than half of the isolated ingenane-type diterpenoids showed inhibitory activities in MDA-MB-435 cells. Eight ingenane- and one jatrophane-type diterpenoids possessed much lower IC values in MDA-MB-435 cells than positive control staurosporine. Preliminary structure-activity relationship analysis showed that substituent on position 20 was important for the activity of ingenane-type diterpenoids in Colo205 cells and substituent on position 3 contributed more significant biological activity of the compounds than that on position 5 in both MDA-MB-435 and Colo205 cells.
Cell Line, Tumor ; Cell Proliferation ; drug effects ; Drugs, Chinese Herbal ; chemistry ; pharmacology ; Euphorbia ; chemistry ; Humans ; Molecular Structure ; Neoplasms ; drug therapy ; physiopathology ; Structure-Activity Relationship ; Terpenes ; chemistry ; pharmacology