BACKGROUND: Valvular heart disease (VHD) has become increasingly common with the aging in China. This study aimed to evaluate regional differences in the clinical features, management strategies, and outcomes of patients with VHD across different regions in China. METHODS: Data were collected from the China-VHD Study. From April 2018 to June 2018, 12,347 patients who presented with moderate or severe native VHD with a median of 2 years of follow-up from 46 centers at certified tertiary hospitals across 31 provinces, autonomous regions, and municipalities in Chinese mainland were included in this study. According to the locations of the research centers, patients were divided into five regional groups: eastern, southern, western, northern, and central China. The clinical features of VHD patients were compared among the five geographical regions. The primary outcome was all-cause mortality or rehospitalization for heart failure. Kaplan-Meier survival analysis was used to compare the cumulative incidence rate. RESULTS: Among the enrolled patients (mean age, 61.96 years; 6877 [55.70%] male), multiple VHD was the most frequent type (4042, 32.74%), which was mainly found in eastern China, followed by isolated mitral regurgitation (3044, 24.65%), which was mainly found in northern China. The etiology of VHD varied significantly across different regions of China. The overall rate of valve interventions was 32.67% (4008/12,268), with the highest rate in southern China at 48.46% (205/423). In terms of procedure, the proportion of transcatheter valve intervention was relatively low compared to that of surgical treatment. Patients with VHD in western China had the highest incidence of all-cause mortality or rehospitalization for heart failure. Valve intervention significantly improved the outcome of patients with VHD in all five regions (all P  <0.05). CONCLUSIONS: This study revealed that patients with VHD in China are characterized by significant geographic disparities in clinical features, treatment, and clinical outcomes. Targeted efforts are needed to improve the management and prognosis of patients with VHD in China according to differences in geographical characteristics. REGISTRATION ClinicalTrials.gov , NCT03484806.
Aged ; Female ; Humans ; Male ; Middle Aged ; China/epidemiology* ; Heart Valve Diseases/therapy* ; Kaplan-Meier Estimate ; Tertiary Care Centers ; Treatment Outcome

Premature ovarian insufficiency(POI),also known as"ovarian insufficiency",has an incidence of 1％～5％.The incidence has been on the rise in recent years,seriously affecting women's physical and mental health and quality of life.At present,the cause and mechanisms of POI are still unclear,and the method and applications of model construction are also confusing.Most models have some shortcomings in pertinence and stability.The limitations greatly limit research into the clinical diagnosis and treatment of POI.This paper summarizes and discusses the etiology and pathogenesis of POI and the construction of POI animal models to provide a comprehensive reference for those studying POI.

Objective To explore the effectiveness of high-definition diffusion weighted imaging(DWI)sequence combined with T1 WI-fat suppression(FS)dynamic contrast enhancement(DCE)sequence for preoperative T-stage of rectal cancer by using 3.0T MRI standardized scanning.Methods A retrospective analysis was conducted on MRI images of 57 patients with rectal cancer confirmed by pathology.Before surgery,the patients underwent 3.0T MRI standardized rectal cancer scan methods,including routine sequence,high-definition DWI sequence,and T1 WI-FS DCE sequence,etc.Then two experienced physicians evaluated the T-stage of preoperative rectal cancer through high-definition DWI(transverse and sagittal sections)and T1 WI-FS DCE sequences in the double-blind method.Using the postoperative pathological results of rectal cancer as the"gold standard",two sequences were combined to evaluate the accuracy,sensitivity,and specificity of rectal cancer T-stage.Results Among the 57 cases,there were 9 cases of upper rectal cancer,39 cases of middle rectal cancer,and 9 cases of lower rectal cancer.The accuracy rates of preoperative T-stage diagnosis for rectal cancer by two evaluator were both 85.7％(6/7)in T1 stage,88.2％(15/17)and 94.1％(16/17)in T2 stage,96.9％(31/32)and 93.8％(30/32)in T3 stage,and both 100.0％(1/1)in T4 stage.For evaluator 1,the sensitivity and specificity of the rectal cancer T-stage diagnosis were 96.1％and 83.3％,and for evaluator 2 were 94.1％and 83.3％,respectively.For rectal cancer MRI diagnosis,the accuracy rates and sensitivity were higher when combining the high-definition DWI sequence and T1 WI-FS DCE sequence,compared with a single high-definition DWI sequence or T1 WI-FS DCE sequence,and the difference was statistically significant.The average preoperative apparent diffusion coefficient(ADC)value of rectal cancer was compared between the corresponding postoperative pathological T1 to T4 stage groups,and the difference was statistically significant.Conclusion The combination of high-definition DWI sequence and T1 WI-FS DCE sequence improves the accuracy of rectal cancer T-stage,providing assistance for personalized clinical treatment.

{L-End}Objective To investigate the role and mechanism of Toll-like receptor 2 (TLR2)/nuclear factor-κB(NF-κB) signaling pathway in the inflammatory response induced by aluminum in the rat GMI-R1 microglia cells. {L-End}Methods GMI-R1 cells in logarithmic growth phase were randomly divided into the control group, positive control group, and low-, medium-, and high-dose groups. The cells in the three dose groups were stimulated with maltolol aluminum at concentrations of 100, 200, and 400 μmol/L, respectively. The cells in the positive control group were stimulated with lipopolysaccharide at a mass concentration of 20 mg/L, while the cells in the control group were not treated. The morphological changes of cells were observed, and the cell survival rate was evaluated by CCK-8 method after 24 hours of culture. The secretion levels of tumor necrosis factor-α (TNF-α), interleukin (IL) -12 and IL-4 were detected by enzyme-linked immunosorbent assay. The relative protein expression of TLR2, NF-κB P65, cluster of differentiation (CD) 68 and CD206 of cells was detected by Western blotting, and the expression of CD68 and CD206 of cells was detected by immunofluorescence method. {L-End}Results The results of cell morphology showed that the number of GMI-R1 cells decreased, the number of activated cells increased, the degree of cell cytoplasm filling decreased, and the cell protrusions elongated with the increase of exposure dose, showing a dose-response relationship. The cell viability of the positive control group and the medium- and high-dose groups were significantly lower than those of the control group (all P<0.05). The secretion levels of TNF-α, IL-12 and the relative expression of TLR2 and CD68 proteins increased (all P<0.05) while the secretion level of IL-4 decreased (all P<0.05) in the cells of positive control group compared with the control group. The secretion levels of TNF-α and IL-12 increased (all P<0.05) while the secretion levels of IL-4 decreased in the cells of the three doses groups (all P<0.05), compared with the control group, and all showed a dose-effect relationship. The relative expression of TLR2 protein in the cells of the three doses groups increased (all P<0.05) compared with the control group. The relative expression of NF-κB p65 and CD68 protein in the cells of the medium- and high-dose groups increased (all P<0.05), but the relative expression of CD206 protein decreased (all P<0.05) compared with the control group. The relative expression of TLR2 and NF-κB p65 protein increased (all P<0.05) while the relative expression of CD206 protein decreased (all P<0.05) in cells of the high-dose group, compared with the low- and medium-dose groups. The average fluorescence intensity of CD68 increased (all P<0.05) while the average fluorescence intensity of CD206 decreased in the cells of high-dose group and the positive control group (all P<0.05), compared with the control group. {L-End}Conclusion Aluminum participated in and promoted the inflammatory response of GMI-R1 cells through the TLR2/NF-κB signaling pathway.

Objective : To investigate the expression of Ca2 + -independent phospholipase A2 β (iPLA2 β) in human renal tubular epithelial cells (HK-2) induced by high glucose(HG) ，the relationship between iPLA2 β and ferroptosis and the protective mechanism of HG treated HK-2 cells． Methods: The HK-2 cells were treated with 30 mmol /L glucose，the overexpression model was constructed by transfection of iPLA2 β plasmid．Ferrostatin-1 ( Fer1) (an inhibitor of ferroptosis) and erastin (an activator of ferroptosis) were used as controls．After 36 hours of intervention，the kit detected the levels of superoxide (SOD) ，malonaldehyde(MDA) and iron in HK-2 cells．DCF immunofluorescence was used to detect intracellular reactive oxygen species ( ROS) ．The expression of ACSL4， GPX4，LPCAT3，TFR1 in HK-2 cells were measured by Western blot. Results : The expression of iPLA2 β downregulated in HG-induced injury of HK-2 cells．The levels of ROS and MDA in HK-2 cells increased，while the levels of GSH and SOD decreased．The expression of ACSL4，LPCAT3 and TFR1 decreased，and the expression of GPX4 increased in HK-2 cells．However，these indexes were improved after Fer-1 intervention．iPLA2 β overexpression could reduce the injury of HK-2 cells via attenuation of KIM-1． Further research revealed that iPLA2 β overexpression inhibited oxidative stress and ferroptosis in HK-2 cells injury induced by high glucose．Meanwhile， the improvement effect of iPLA2 β on HG-induced HK-2 cells damage could be eliminated by erastin． Conclusion iPLA2 β prevents HG-induced injury of HK-2 cells via regulating ferroptosis.

Objective:To investigate the clinical effect of rectangular scar flap combined with autologous thinning split-thickness skin graft for repairing type Ⅳ axillary scar contracture deformity after extensive burns.Methods:From January 2015 to January 2019, patients with type Ⅳ axillary scar contracture deformity after extensive burns were admitted to the Department of Skin Wound Repair Center of Wuhan Third Hospital. Rectangular scar flaps were used to reconstruct the axillary area, Y-shaped incision was made on the short side to release the scar, the resulting defects after flap formation were repaired with autologous split-thickness skin grafts. The hyperplasia and contracture of the grafted skin, the size of rectangular scar flap, the appearance of axilla, the growth of residual axillary hair, and the range of motion of shoulder joint were observed during the follow-up of 18 months to 3 years.Results:A total of 6 cases were selected, including 2 males and 4 females, aged from 18 to 58 years, with the duration of scar contracture deformity ranging from 1 to 23 years. The rectangular scar flaps of all 6 patients survived. At the follow-up of 18 months to 3 years, the axillary scar hyperplasia and the skin graft contracture were mild. At 18 months after operation, the function of shoulder joint was restored with 180° shoulder abduction and lifting. Axillary appearance and residual axillary hair growth were satisfactory, the self-care ability and the quality of life of patients improved.Conclusions:Rectangular scar flap combined with autologous thinning split-thickness skin graft is a good method for repairing type Ⅳ axillary scar contracture in patients with lack of autologous skin sources for extensive burns.

Objective:To investigate the clinical effect of rectangular scar flap combined with autologous thinning split-thickness skin graft for repairing type Ⅳ axillary scar contracture deformity after extensive burns.Methods:From January 2015 to January 2019, patients with type Ⅳ axillary scar contracture deformity after extensive burns were admitted to the Department of Skin Wound Repair Center of Wuhan Third Hospital. Rectangular scar flaps were used to reconstruct the axillary area, Y-shaped incision was made on the short side to release the scar, the resulting defects after flap formation were repaired with autologous split-thickness skin grafts. The hyperplasia and contracture of the grafted skin, the size of rectangular scar flap, the appearance of axilla, the growth of residual axillary hair, and the range of motion of shoulder joint were observed during the follow-up of 18 months to 3 years.Results:A total of 6 cases were selected, including 2 males and 4 females, aged from 18 to 58 years, with the duration of scar contracture deformity ranging from 1 to 23 years. The rectangular scar flaps of all 6 patients survived. At the follow-up of 18 months to 3 years, the axillary scar hyperplasia and the skin graft contracture were mild. At 18 months after operation, the function of shoulder joint was restored with 180° shoulder abduction and lifting. Axillary appearance and residual axillary hair growth were satisfactory, the self-care ability and the quality of life of patients improved.Conclusions:Rectangular scar flap combined with autologous thinning split-thickness skin graft is a good method for repairing type Ⅳ axillary scar contracture in patients with lack of autologous skin sources for extensive burns.

Objective:To establish a colloidal gold technique assay for the rapid detection of immunoglobulin(Ig)M and IgG antibodies against 2019 novel coronavirus (2019-nCoV) and to evaluate its clinical performance.Methods:A total of 278 patients who were respectively treated at Wuhan Hankou Hospital and the People′s Hospital of Honghu from February 12, 2020 to February 20, 2020 were collected. According to the diagnostic criteria, 89 patients were confirmed with positive 2019-nCoV nucleic acid, and 189 were 2019-nCoV nucleic acid-negative suspected patients. A total of 273 medical examiners from Nanfang Hospital, Southern Medical University from 2015 to 2018 were selected as controls. The serum samples of patients were collected. 2019-nCoV nucleic proteins were obtained from prokaryotic expression vectors. Indirect IgM and IgG colloidal gold techniques were established by using recombinant nuclear protein. 2019-nCoV nucleic acid detection by reverse transcription-polymerase chain reaction (RT-PCR) was used as control. Serum specimens were tested for 2019-nCoV IgM and IgG. The specificity and sensitivity of colloidal gold assay were analyzed.Results:The positive rates of IgM and IgG with the colloidal gold detection in confirmed patients with positive 2019-nCoV nucleic acid were 78.7%(70/89) and 73.0%(65/89), respectively. The positive rates of IgM and IgG in medical examiners were 1.8%(5/273) and 0.7%(2/273), respectively. The sensitivity and specificity of IgM detection reagents were 78.7% and 98.2%, respectively, those of IgG detection reagents were 73.0% and 99.3%, respectively, and those of IgM combined with IgG detection were 87.6% and 98.2%, respectively. For suspected patients with negative 2019-nCoV nucleic acid, the positive rates of IgM and IgG were 59.8%(113/189) and 52.9%(100/189), respectively, and the positive rate of IgM combined with IgG detection was 66.1%(125/189).Conclusion:This reagent of 2019-nCoV antibodies detection (colloidal gold technique) fulfills the requirement for clinical application with high specificity and sensitivity, which can be served as a supplementary detection method for 2019-nCoV nucleic acid detection by RT-PCR.

ABSTRACT OBJECTIVE：To study the metabolic transformation of total glycosides of Cistanche deserticola in artificial gastric and intestinal juice，and to speculate its metabolic transformation pathway in vivo. METHODS：UPLC/Q-TOF-MS was adopted. The determination was performed on ACQUITY UPLC BEH column with mobile phase consisted of 0.2％ formic acid water-acetonitrile（gradient elution）at the flow rate of 0.2 mL/min. The detection wavelength was set at 330 nm，and column temperature was 25 ℃. The ion source was electrospray ion source，and mass to charge ratio（m/z）was 50→1 000. In the positive and negative ion mode，the metabolic components of the total glycosides of C. deserticola in artificial gastric and intestinal juice were identified analysis，and combined with the literature，the metabolic pathway of total glycosides of C. deserticola in artificial gastric and intestinal juice was speculated. RESULTS：After the total glycosides of C. deserticola were metabolized by artificial gastric juice，and a total of 69 components were estimated，including 14 prototype components （such as Mustard aldehyde glucoside，daucosstorol） and 55 metabolic components （such as Methyl-O-Kankanoside J，Methyl-O-Kankanoside E），it is speculated that its metabolic pathways were methylation，demethylation，hydroxylation，methoxylation，acetylation，sulfation，and glucuronidation. After the total glycosides of C. deserticola were metabolized by artificial intestinal juice，a total of 90 components were estimated，including 4 prototype components（such as Kankanoside M，Kankanoside L）and 86 metabolic components（such as Methyl-O-Kankanoside， Methyl-O-Kankanoside E）. It was speculated that its metabolic pathways were methylation， demethylation，hydroxylation，dehydroxylation，methoxylation，acetylation，sulfation and glucuronidation. CONCLUSIONS：This study preliminarily speculates that the total glycosides of C. deserticola may be metabolized by methylation，demethylation， hydroxylation and other metabolic pathway in artificial gastrointestinal juice，which may provide reference for the in vivo metabolic transformation of total glycosides of C. deserticola.

Objective: To establish a colloidal gold technique assay for the rapid detection of immunoglobulin(Ig) M and IgG antibodies against 2019 novel coronavirus (2019-nCoV) and to evaluate its clinical performance. Methods: A total of 278 patients who were treated at Wuhan Hankou Hospital and the People's Hospital of Honghu from February 12, 2020 to February 20, 2020 were collected. According to the diagnostic criteria, 89 patients were confirmed with 2019-nCoV nucleic acid positive diagnosis, and 189 were 2019-nCoV nucleic acid-negative suspected patients. A total of 273 medical examiners from Nanfang Hospital, Southern Medical University from 2015 to 2018 were selected as controls. The serum samples of patients were collected. 2019-nCoV nucleic proteins were obtained from prokaryotic expression vectors. Indirect IgM and IgG colloidal gold techniques were established by using recombinant N protein. 2019-nCoV nucleic acid detection by reverse transcription-polymerase chain reaction (RT-PCR) was used as control. Serum specimens were tested for 2019-nCoV IgM and IgG. The specificity and sensitivity of colloidal gold assay were analyzed. Results: The sensitivity and specificity of IgM detection reagents were 78.7% and 98.2%, respectively, those of IgG detection reagents were 73.0% and 99.3%, respectively, and those of IgM combined with IgG detection were 87.6% and 98.2%, respectively. For suspected patients with negative 2019-nCoV nucleic acid, the positive rates of IgM and IgG were 59.8% (113/189) and 52.9% (100/189), respectively, and the positive rate of IgM combined with IgG detection was 66.1% (125/189). Conclusion This reagent of 2019-nCoV antibodies detection (colloidal gold technique) fulfills the requirement for clinical application with high specificity and sensitivity, which can be served as a supplementary detection method for 2019-nCoV nucleic acid detection by RT-PCR.