To review the clinical characteristics, short-term outcomes, and risk factors of patients with infective endocarditis(IE) who underwent surgical treatment at a single center, and to summarize treatment experience.

Objective:To investigate the cognitive function and its influencing factors among residents in Qingdao city.Methods:The 5 311 research subjects over 65 years old were selected from Qingdao by simple random sampling and stratified sampling. All subjects were investigated by AD8 dementia early screening questionnaire and community screening instrument dementia (CSI-D) to evaluate the prevalence of cognitive decline in this study.The score of AD8 dementia early screening questionnaire ≥2 points or the score of CSI-D ≤7 points was considered to be cognitive decline. Mann-Whitney U test, Chi-square test, Fisher exact probability method, univariate and multivariate Logistic regression analysis and Bootstrap verification were performed using SPSS 26.0 software. Results:Among 5 311 subjects, 1 899 subjects had normal cognitive function (35.76%) and 3 412 subjects had cognitive decline (64.24%). The age of the cognitive decline group was significantly higher than that of the normal group ( P<0.01). There were significant differences in gender, educational level, rural residents, marital status, chronic medical history, hypertension, rheumatoid arthritis, cerebrovascular disease, intervertebral disc disease, ischemic heart disease, monthly household income and alcohol consumption between the two groups (all P<0.05). Univariate Logistic regression analysis showed that female ( β=0.313, OR=1.367, 95% CI=1.221-1.530), age ( β=0.052, OR=1.053, 95% CI=1.043-1.063), rural residents ( β=0.850, OR=2.340, 95% CI=2.042-2.682), widowed ( β=0.557, OR=1.745, 95% CI=1.500-2.029), chronic medical history ( β=0.290, OR=1.336, 95% CI=1.191-1.498), hypertension ( β=0.134, OR=1.143, 95% CI=1.020-1.281), rheumatoid arthritis ( β=0.458, OR=1.581, 95% CI=1.222-2.046), cerebrovascular disease ( β=0.584, OR=1.794, 95% CI=1.352-2.380), intervertebral disc disease ( β=0.578, OR=1.782, 95% CI=1.370-2.319), ischemic heart disease ( β=0.501, OR=1.651, 95% CI=1.272-2.143) were the risk factors for cognitive decline. Higher education level, higher monthly household income and abstinence ( β=-0.244, OR=0.783, 95% CI=0.619-0.992) were protective factors for cognitive decline. Multivariate logistic regression analysis showed that age ( β=0.035, OR=1.036, 95% CI=1.025-1.047), rural residents ( β=0.215, OR=1.239, 95% CI=1.047-1.468), chronic medical history ( β=0.191, OR=1.210, 95% CI=1.067-1.372), cerebrovascular disease ( β=0.480, OR=1.616, 95% CI=1.195-2.187), intervertebral disc disease ( β=0.456, OR=1.578, 95% CI=1.190-2.094) were risk factors for Alzheimer's disease. Higher education level and higher monthly household income were protective factors for Alzheimer's disease. Conclusion:The elderly with chronic diseases, low income and low education level may be at the high risk of cognitive function decline, which should be paid attention to in early screening and intervention.

Objective To investigate the factors influencing the prognosis of complex intracranial aneurysms treated with pipeline flow-directed device(PED)and to develop a nomogram prediction model.Methods The clinical data of a total of 98 patients with complex intracranial aneurysm,who were admitted to the Anyue County People's Hospital or the Second Affiliated Hospital of Guilin Medical College of China from January 2021 to April 2023 to receive PED treatment,were retrospectively analyzed.The influencing factors that might affect the prognosis of patients with complex intracranial aneurysm were collected.According to the modified Rankin Scale(mRS)score,the patients were divided into good prognosis group(being defined as mRS ≤2 points)and poor prognosis group(being defined as mRS＞2 points).The clinical data were compared between the two groups,and a nomogram model was established and validated.Results In the 98 patients,poor prognosis was seen in 10(10.20％).The differences in age,history of hypertension,history of diabetes mellitus,clopidogrel resistance,Fisher classification,repeated aneurysm rupture,aneurysm location,aneurysm size,aneurysm neck,multiple lesions,and Hunt-Hess grade on admission between good prognosis group and poor prognosis group were statistically significant(all P＜0.05).Multivariate analysis revealed that history of hypertension,clopidogrel resistance,repeated aneurysm rupture,aneurysm location,multiple lesions,and Hunt-Hess grade were the independent factors influencing the prognosis of patients with complex intracranial aneurysm after receiving PED treatment.The AUC of the nomogram model in predicting the prognosis of PED for complex intracranial aneurysms was 0.849(95％CI=0.758-0.939).The predicted curves of the model group and validation group were basically fitted to the standard curves.The results of the decision curve analysis showed that the net benefit to patients was greater than 0 when the probability threshold of the nomogram model for predicting a poor prognosis of PED for complex intracranial aneurysms was 0.10-0.90.Conclusion The factors causing poor prognosis of PED for complex intracranial aneurysms mainly include history of hypertension,clopidogrel resistance,repeated aneurysm rupture,etc.The nomogram model established in this study can predict the risk of poor prognosis in patients with complicated intracranial aneurysm after receiving PED treatment.

Objective:Osteopontin(OPN)has demonstrated neuroprotective effects in various stroke models.Its role in neuroinflammation after brain injury remains to be elucidated.This study aims to clarify the effect of OPN on neuroin-flammation,particularly on the functional states of microglia after subarachnoid hemorrhage(SAH).Methods:Thirty rats were randomly divided into the following groups:Sham,SAH,and SAH+OPN.SAH rat model was prepared by secondary injection of autologous arterial blood,and OPN was given intranasally in the treatment group.Neurological function was evaluated by modified Garcia score.The degree of cerebral edema was evaluated by measuring brain water content.The expression of microglia activation markers CD86,inducable nitric oxide synthase(iNOS),CD206 and arginase 1(Arg-1)after SAH and OPN treatment was detected by RT-qPCR.The levels of IL-1β,IL-6,IL-10,and IL-13 in cerebrospinal fluid were detected by enzyme-linked immunosorbent assay(ELISA).Results:Intranasal ad-ministration of OPN could improve the neurological dysfunction and cerebral edema in SAH rats.What's more,OPN could inhibit the expression of CD86,iNOS,IL-1β,and IL-6 in cerebral while promote the expression of CD206,Arg-1,IL-10,and IL-13.Conclusion:OPN alleviates the inflammatory response after SAH by inhibiting the polarization of microglia M1.

Objective:To analyze the patterns of antibacterial agents in Chinese children surveyed by the China multi-center monitoring network for the application of antibacterial agents in children and neonates in 2019 by using World Health Organization (WHO) Access, Watch, Reserve and Not-recommended (AWaRe) and typical anatomical/therapeutic/chemical (ATC) in this study.Methods:The cross-sectional method was adopted.A multi-center cross-sectional survey was conducted on one day from September to December 2019.The information of all inpatients taking antibiotics was uploaded to the network-based data collection system (https: //garpec-31.mobilemd.cn/login.aspx? relogin=true). This study covered 13 hospitals from 10 provinces and cities in China.All hospitalized children in the Respiratory Department, Infectious Disease Department, General Surgery Department, Pediatric Intensive Care Units, Neonatal Intensive Care Units and Neonatology joined in this survey.The clinically used antibacterial agents were classified by AWaRe and ATC, and the AWaRe and ATC distributions of antibacterial agents prescribed for Chinese children and neonates were described.Results:Of the 2 644 antibiotic prescriptions included from 13 hospitals, 2 134 (80.71%) were for children and 510 (19.29%) were for neonates.Of all antibiotic prescriptions, there were 368 (13.92%) Access antibiotics prescriptions, 1 973 (74.62%) Watch prescriptions, 60 (2.27%) Reserve prescriptions and 243 (9.19%) Not-recommended prescriptions.The top-five antibiotics prescribed for children and neonates were third-generation cephalosporins (1 056, 39.94%), macrolides (492, 18.61%), carbapenems (275, 10.40%), beta lactam-beta lactamase inhibitors (246, 9.30%), and second-generation cephalosporins (136, 5.14%). The use ratios of Access, Watch, Reserve and Not-recommended antibiotics in each center ranged from 0 to 30.00%, 36.67% to 97.20%, 0 to 17.02% and 0 to 33.33%, respectively.In 1 360 antibiotic prescriptions for children and neonates with pneumonia, there were 152 (11.18%) Access antibiotics, 1 051 (77.28%) Watch antibiotics, 37 (2.72%) Reserve antibiotics, and 120 (8.82%) Not-recommended antibiotics.The top-five antibiotics prescribed for children with pneumonia were third-generation cephalosporins (522, 38.38%), macrolides (388, 28.53%), beta lactam-beta lactamase inhibitors (141, 10.37%), carbapenems (117, 8.6%) and penicillins (49, 3.60%).Conclusions:Watch antibiotics and broad spectrum antibiotics such as third-generation cephalosporins and macrolides prone to induce resistance are the main antibacterial agents used in Chinese children and neonates with pneumonia.Broad-spectrum antibiotics may be overused in Chinese children and neonates.

Cloud technology and the Internet of things ( IOT) technology can be used in building the patient-centered critical care medical information platform.The platform could inenable medical staff to efficiently obtain critical care medical information, and raise critical patients′ cure rates. The authors introduced the critical process of rapidly building and improving the urgent care medical information integration platform in a campus of the First Affiliated Hospital of Zhejiang University Medical School.The IOT platform could effectively interconnect a variety of critical care medical equipments, and features such functions as vital signs monitoring and life support, bedside treatment data retrieval, remote diagnosis and treatment, and cloud sharing. The platform featured the advantages of complete information integration, fast construction, and satisfactory system extensibility. It could improve the medical work efficiency, improve the effect of critical care, and reduce the frequency of contact with patients, hence providing references for rapidly establishing a vital care treatment platform for public health events.

Objective:To investigate the clinical effectiveness of super pulsed carbon dioxide fractional laser debridement surgery on the treatment of chronic wounds.Methods:From December 2018 to May 2019, 37 patients with chronic wounds who met the inclusion criteria were admitted to the Affiliated Hospital of Southwest Medical University for a prospective randomized controlled study. Using the random number table, the patients were divided into surgical debridement group (19 patients, 4 males and 15 females, aged (58±16) years, 25 wounds) and laser debridement group (18 patients, 9 males and 9 females, aged (58±10) years, 23 wounds). In patients of surgical debridement group, oedematous and aging granulation tissue was scraped from the wound by scalpel handle or curet, and the residual necrotic tissue was removed by sharp surgical instruments. In patients of laser debridement group, oedematous and aging granulation tissue and necrotic tissue was removed by super pulsed carbon dioxide fractional laser therapeutic machine, laser gasification debridement was performed repeatedly till fresh normal tissue layer observed. In patients of the two groups, according to the wound in the first 3 d after the first debridement, debridement dressing was performed twice at least as before, then wound debridement dressing was performed once every 1 to 4 days as before according to the wound conditions. The wound healing rates on 7, 14, 21, and 28 d after the first debridement were calculated. The positive rates of bacterial culture of wounds before and after the first debridement were calculated. The color and texture of the wound granulation tissue before the first debridement and on 7, 14, and 28 d after the first debridement were observed and scored. The pain scores before every debridement, during every debridement, and after every debridement dressing change were evaluated by visual analogue scale. The times of debridement dressing change were recorded. Data were statistically analyzed with two independent sample t test, analysis of variance for repeated measurement, Fisher′s exact probability test, Mann-Whitney U test, and Bonferroni correction. Results:(1) On 7, 14, 21, and 28 d after the first debridement, the wound healing rates of patients in laser debridement group (29.5% (24.1%, 36.0%), 47.1% (42.7%, 62.4%), 71.4% (62.2%, 76.8%), and 88.6% (79.2%, 96.3%) were significantly higher than those of surgical debridement group (1.6% (1.0%, 12.8%), 12.7% (2.0%, 16.6%), 24.5% (8.9%, 45.5%), 43.9% (23.2%, 70.8%), Z=3.477, 3.553, 2.721, 2.193, P<0.05 or P<0.01). (2) Before the first debridement, the positive rates of bacterial culture of wounds in patients of laser debridement group and surgical debridement group were 92% (23/25) and 91% (21/23), respectively, which were similar ( P>0.05). After the first debridement, the positive rate of bacterial culture of wounds of patients in surgical debridement group was 64% (16/25), which was significantly higher than 13% (3/23) of laser debridement group ( P<0.01). (3) On 7, 14, and 28 d after the first debridement, the scores of color and texture of wound granulation tissue of patients in laser debridement group were significantly higher than those of surgical debridement group ( Z=3.420, 5.682, 6.142, 4.461, 5.337, 4.458, P<0.01). (4) The pain scores during every debridement and after every debridement dressing change in patients of laser debridement group were significantly lower than those of surgical debridement group ( t=2.847, 5.046, P<0.05 or P<0.01). (5) The time of debridement dressing change in laser debridement group was 8.0 (7.0, 10.0) times, which was significantly less than 10.0 (9.5, 12.5) times in surgical debridement group ( Z=2.261, P<0.05). Conclusions:Compared with traditional surgical debridement method, super pulsed carbon dioxide fractional laser debridement surgery is more effective in treating patients with chronic wounds. Laser debridement makes the wound healing more efficiently with reduced pain and better infection control; significantly reduces the number of dressing changes, and is especially suitable for the wound treatment in outpatients.

Objective: To evaluate the results of catheter ablation of ventricular tachycardia (VT) via direct ventricle puncture access in patients without traditional approach. Methods: Two idiopathic left fasicular VT patients with mechanical aortic and mitrial valve repalcement and 1 patient with right ventricular originated VT post mechanical tricuspid valve repalcement from March 2010 to July 2012 in Fuwai hospital were enrolled in this study. For left fasicular VT patients, catheter ablation was performed using transapical left ventricular access via minithoracotomy. For the patient with right ventricular originated VT, catheter ablation was performed via percutaneous right ventricle puncture at xiphoid. Abaltion was guided under EnSite NavX mapping system. The feasibility of VT ablation via direct ventricle puncture access and long-term VT recurrence were investigated. Results: Catheter ablation was successful in all patients, and all clinical VTs were eliminated. The procedure time was 53, 62 and 74 minutes respectively with radiation time 11, 16 and 20 minutes. The ablation time was 130, 170 and 240 seconds individually. No procedure related complication occurred. After a follow-up time of 76, 55 and 82 months respectively, no VT recurrence was found in patients with left fasicular VT. New-onset VT with different morphology with previous VT was recorded in the patient with right ventricular originated VT, subcutaneous implantable defibrillator was implanted finally in this patient. Conclusions For patients with endocardial origined ventricular arrhythmias which could not be ablated via traditional approaches, direct ventricle puncture access with hybrid techniques provides a new approach foreliminating VTs in these patients.

Objective To study the cardiac electrophysiology changes of canine asynchrony ischemic heart failure under left ventricular endocardial pacing.Methods Left bundle branch radiofrequency catheter ablation and left anterior descending coronary artery ligation were used to establish the model of ischemic heart failure in 18 healthy dogs.Eighteen healthy dogs were randomly divided into two groups,9 cases in each group.The experimental group was treated with cardiac resynchronization therapy(CRT) in left ventricular endocardium,and the control group underwent the sham operation.ECG and echocardiography were done at 6 weeks after operation.Results The left ventricular ejection fraction in the experimental group was significantly higher than that in the control group(38.32 ± 6.08 vs.30.62 ±8.96).The asynchronization index in the experimental group was significantly lower than that in the control group(35.99 ±5.25 vs.78.21 ± 7.02),and the difference was statistically significant(P＜0.05).QRS(60.58 ± 7.43 vs.68.33 ± 8.01) and QTc(347.09 ± 17.33 vs.367.81 ± 22.02)in the experimental group were significantly shorter than those in the control group(P＜0.05);moreover Tp-e(37.03±9.07 vs.45.76±7.11) and ARI(162.33±22.06 vs.187.21±23.87) in the experimental group were significantly lower than those in the control group(P＜0.05).Conclusion Left ventricular endocardial pacing can produce preferably electrophysiological effects and achieve the goal of effective cardiac resynchronization therapy.

To explore the safety and efficacy of left atrial appendage (LAA) occlusion under the guidance of local anesthesia and modified transseptal puncture technology by coronary sinus assisted positioning in patients with nonvavular atrial fibrillation (NVAF). Methods: A total of 16 NVAF patients received local anesthesia and percutaneous LAmbre or Amplatzer cardiac plug occluder implantation. There were 12 males and the patients mean age was at (71.0±6.0) years with CHA2DS2-VASc score at (4.1±1.5); all patients had walfarin contradiction or with walfarin related side effect. Transseptal puncture was conducted by coronary sinus catheter as the anatomic location marker. Results: All 16 patients finished transseptal puncture and no relevant complication occurred. 15/16 (93.8%) patients had successful LAA occlusion, 1 patient was abandoned because of LAA anatomic structure variation. The mean operative time was (65.0±23.0) min and the mean X-ray exposure time was (12.0±3.0) min. The mean diameter of occluder was (32.5±6.0)mm. Conclusion: LAA occlusion was safe and effective with local anesthesia and modified transseptal puncture technology by coronary sinus assisted positioning in relevant patients.