Objective To evaluate the safety and efficacy of transcatheter mitral valve-in-valve replacement(ViV-TMVR)in the treatment of bioprosthetic mitral valve failure.Methods Seventeen patients with bioprosthetic mitral valve failure who required ViV-TMVR were selected.Preoperative data including age,gender,body mass index(BMI),usage time of bioprosthetic mitral valve,comorbidities(hypertension,coronary heart disease,old cerebral infarction,atrial fibrillation and diabetes)and New York Heart Association(NYHA)functional class were recorded,and left ventricular end-diastolic diameter(LVEDD),right atrial diameter(RA),pulmonary artery systolic pressure(PASP),left ventricular ejection fraction(LVEF),type of bioprosthetic mitral valve failure,degree of bioprosthetic mitral valve regurgitation and stenosis,peak velocity and mean transvalvular pressure gradient of the bioprosthetic mitral valve,and Society of Thoracic Surgeons(STS)score were also collected.Intraoperative data included puncture route,valve type,intraoperative complications,operation time and immediate postoperative transesophageal echocardiography(TEE)assessment(peak velocity and mean transvalvular pressure gradient of the valve-in-valve,valve-in-valve regurgitation or paravalvular regurgitation)were collected.Postoperative data included time in the intensive care unit(ICU)/cardiovascular intensive care unit(CCU),total postoperative hospital stay and 30-day postoperative echocardiographic results and NYHA functional class were recorded.Patients were divided into the domestic NewMed valve group(10 cases)and the imported Edwards valve group(7 cases)based on the type of valve used.The safety and efficacy of ViV-TMVR were analyzed,and the efficacy of domestic valves and imported valves was compared.Results All 17 patients successfully underwent ViV-TMVR via the transseptal approach without serious complications,and the 30-day readmission rate was 0%.There were no significant differences in operation time of domestic valves and imported valves,mild paravalvular regurgitation of the valve-in-valve,peak velocity and mean transvalvular pressure gradient of the valve-in-valve immediately after surgery and at 30-day postoperatively,time in ICU/CCU,total postoperative hospital stay and the proportion of patients with NYHA functional class Ⅲ-Ⅳ at 30-day postoperatively between the domestic valve group and the imported valve group.During the 30-day follow-up,one patient died of cerebral hemorrhage,and one patient had major adverse cardiovascular events(MACE,cerebral hemorrhage).Compared with before the operation,the peak velocity and mean transvalvular pressure gradient of the valve-in-valve,LVEF,and PASP decreased immediately after surgery and at 30 days after surgery.Compared with immediately after surgery,the peak velocity and mean transvalvular pressure gradient of the valve-in-valve increased at 30 days postoperatively(P＜0.01),while there were no significant differences in LVEF and PASP.Conclusion Transseptal ViV-TMVR is safe and effective in the short term for patients with bioprosthetic mitral valve failure who are at high risk of re-thoracotomy,and the efficacy of domestic valves is comparable to that of imported valves.

Objective To evaluate the safety and efficacy of transcatheter mitral valve-in-valve replacement(ViV-TMVR)in the treatment of bioprosthetic mitral valve failure.Methods Seventeen patients with bioprosthetic mitral valve failure who required ViV-TMVR were selected.Preoperative data including age,gender,body mass index(BMI),usage time of bioprosthetic mitral valve,comorbidities(hypertension,coronary heart disease,old cerebral infarction,atrial fibrillation and diabetes)and New York Heart Association(NYHA)functional class were recorded,and left ventricular end-diastolic diameter(LVEDD),right atrial diameter(RA),pulmonary artery systolic pressure(PASP),left ventricular ejection fraction(LVEF),type of bioprosthetic mitral valve failure,degree of bioprosthetic mitral valve regurgitation and stenosis,peak velocity and mean transvalvular pressure gradient of the bioprosthetic mitral valve,and Society of Thoracic Surgeons(STS)score were also collected.Intraoperative data included puncture route,valve type,intraoperative complications,operation time and immediate postoperative transesophageal echocardiography(TEE)assessment(peak velocity and mean transvalvular pressure gradient of the valve-in-valve,valve-in-valve regurgitation or paravalvular regurgitation)were collected.Postoperative data included time in the intensive care unit(ICU)/cardiovascular intensive care unit(CCU),total postoperative hospital stay and 30-day postoperative echocardiographic results and NYHA functional class were recorded.Patients were divided into the domestic NewMed valve group(10 cases)and the imported Edwards valve group(7 cases)based on the type of valve used.The safety and efficacy of ViV-TMVR were analyzed,and the efficacy of domestic valves and imported valves was compared.Results All 17 patients successfully underwent ViV-TMVR via the transseptal approach without serious complications,and the 30-day readmission rate was 0%.There were no significant differences in operation time of domestic valves and imported valves,mild paravalvular regurgitation of the valve-in-valve,peak velocity and mean transvalvular pressure gradient of the valve-in-valve immediately after surgery and at 30-day postoperatively,time in ICU/CCU,total postoperative hospital stay and the proportion of patients with NYHA functional class Ⅲ-Ⅳ at 30-day postoperatively between the domestic valve group and the imported valve group.During the 30-day follow-up,one patient died of cerebral hemorrhage,and one patient had major adverse cardiovascular events(MACE,cerebral hemorrhage).Compared with before the operation,the peak velocity and mean transvalvular pressure gradient of the valve-in-valve,LVEF,and PASP decreased immediately after surgery and at 30 days after surgery.Compared with immediately after surgery,the peak velocity and mean transvalvular pressure gradient of the valve-in-valve increased at 30 days postoperatively(P＜0.01),while there were no significant differences in LVEF and PASP.Conclusion Transseptal ViV-TMVR is safe and effective in the short term for patients with bioprosthetic mitral valve failure who are at high risk of re-thoracotomy,and the efficacy of domestic valves is comparable to that of imported valves.

Objective To evaluate the effect of modulating gut microbiota for improving brain injury in rats with post-stroke depression.Methods Adult SD rats were randomized into normal control,middle cerebral artery occlusion(MCAO),post-stroke depression(PSD),PSD with fecal transplantation,PSD with antibiotics(rifaximin),PSD with probiotics(lactobacilli),and PSD with fluoxetine treatment groups(n=9).Neurological function scores of the rats were determined,and the changes in sugar water preference and immobility time in forced swimming test were observed;plasma levels of trimethylamine N-oxide(TMAO)and hydrogen sulfide(H2S)were detected with ELISA,Occludin,and the expressions of occludin,caudin-5 and IgG proteins I the brain tissues were determined using Western blotting.Results Compared with those in the control group,the rats in MCAO and PSD groups had significantly increased neurological function scores,TMAO level,the ratio of TMAO/H2S,and immobility time in forced swimming test with a lowered level of H2S(P<0.05).These changes were more obvious in PSD rats,which also exhibited a reduced sugar water preference with increased IgG protein and decreased occluding and caudin-5 expressions in the brain tissue(P<0.05).TMAO/H2S ratio in PSD rats was positively correlated with neurological function score(R2=0.3235,P=0.0269)and immobility time in swimming(R2=0.6290,P=0.0004)and negatively with sugar water preference(R2=-0.4534,P=0.0059).Treatment with fecal transplantation,antibiotics,probiotics and fluoxetine all significantly reduced neurological function scores,immobility time in forced swimming,TMAO/H2S ratio,and IgG protein expression and increased sugar water preference and brain occludin and caudin-5 expressions of the PSD rats(P<0.05).Conclusion In PSD rats,TMAO/H2S ratio is correlated with neurological function score,immobility time in forced swimming and sugar water preference,and modulating intestinal flora can improve neurological function and depressive symptoms and improve the integrity of the blood-brain barrier.

Objective To evaluate the effect of modulating gut microbiota for improving brain injury in rats with post-stroke depression.Methods Adult SD rats were randomized into normal control,middle cerebral artery occlusion(MCAO),post-stroke depression(PSD),PSD with fecal transplantation,PSD with antibiotics(rifaximin),PSD with probiotics(lactobacilli),and PSD with fluoxetine treatment groups(n=9).Neurological function scores of the rats were determined,and the changes in sugar water preference and immobility time in forced swimming test were observed;plasma levels of trimethylamine N-oxide(TMAO)and hydrogen sulfide(H2S)were detected with ELISA,Occludin,and the expressions of occludin,caudin-5 and IgG proteins I the brain tissues were determined using Western blotting.Results Compared with those in the control group,the rats in MCAO and PSD groups had significantly increased neurological function scores,TMAO level,the ratio of TMAO/H2S,and immobility time in forced swimming test with a lowered level of H2S(P<0.05).These changes were more obvious in PSD rats,which also exhibited a reduced sugar water preference with increased IgG protein and decreased occluding and caudin-5 expressions in the brain tissue(P<0.05).TMAO/H2S ratio in PSD rats was positively correlated with neurological function score(R2=0.3235,P=0.0269)and immobility time in swimming(R2=0.6290,P=0.0004)and negatively with sugar water preference(R2=-0.4534,P=0.0059).Treatment with fecal transplantation,antibiotics,probiotics and fluoxetine all significantly reduced neurological function scores,immobility time in forced swimming,TMAO/H2S ratio,and IgG protein expression and increased sugar water preference and brain occludin and caudin-5 expressions of the PSD rats(P<0.05).Conclusion In PSD rats,TMAO/H2S ratio is correlated with neurological function score,immobility time in forced swimming and sugar water preference,and modulating intestinal flora can improve neurological function and depressive symptoms and improve the integrity of the blood-brain barrier.

With the increasing number of cancer patients in China, the lack of hospice communication between medical staff and cancer patients can easily cause doctor-patient conflicts. Facing the special group of cancer patients, by introducing the concept of hospice communication and comparing the current situation of hospice communication of cancer patients at home and abroad, this paper found the shortcomings of hospice communication between medical staff and cancer patients in China. This paper aimed to analyze the influencing factors of cancer patients’ hospice communication from three aspects of medical staff, cancer patients and social and cultural background, summarized the assessment tools and matters needing attention related to hospice communication, so as to provide reference for domestic medical staff to develop relevant tools for hospice communication with cancer patients, and help medical staff to implement more effective hospice communication with cancer patients in the context of tranquil care. It is also conducive to help patients open the topic of death from the perspective of doctors and build an open hospice communication environment that is more in line with national conditions of China.

Objective:To investigate the expression of the B cell ectopic gene 2 (BTG2) in the pancreatic cancer tissue and analyze its relationship with the clinicopathological features and prognosis.Methods:46 pairs of pancreatic cancer tissues and corresponding adjacent tissues kept in paraffin in the pathology department, and 9 fresh pancreatic cancer tissues and corresponding adjacent tissues resected by surgery in Department of Pancreatic Surgery of Sinopharm Dongfeng General Hospital from June 2015 to December 2020 were collected. BTG2 gene expression in 46 pairs of pancreatic cancer tissues and corresponding adjacent tissues were detected by immunohistochemical staining, and high and low BTG2 expression groups were divided. BTG2 gene expression in 9 fresh pancreatic cancer tissues and corresponding adjacent tissues were detected by RT-PCR. The correlation between BTG2 protein expression level and clinicopathological features was analyzed. Furthermore, the survival curve and death risk curve were drawn using the Kaplan-Meier method, and the Cox regression hazards model was applied for the univariate and multivariate analysis of the factors affecting the prognosis of pancreatic cancer.Results:29 of 46 (63.04%) pancreatic cancer tissues had high BTG2 expression, and 38(82.61%) of corresponding adjacent tissues had high BTG2 expression; and BTG2 high expression rate of adjacent tissues was significantly higher than that of cancer tissues. Three out of 9 pancreatic cancer tissues were highly differentiated, and six cases had medium-and low differentiation. The BTG2 expression of highly differentiated pancreatic carcinoma was significantly higher than that of moderately and poorly differentiated carcinoma tissues [(0.66±0.07 vs 0.24±0.18); the expression level of adjacent tissues was significantly higher than that of cancer tissues (1.00±0.00 vs 0.38±0.30), and all differences were statistically significant (all P values <0.001). Low BTG2 expression in pancreatic cancer was associated with low tumor differentiation and vascular invasion (all P values <0.05), but was not correlated with tumor location, volume, lymph node metastasis, CA19-9 level and postoperative liver metastasis. The median survival of high BTG2 expression group was significantly longer than that of low BTG2 expression group (525 d vs 266 d, P<0.001). Among patients with survival time ≥300 d, the survival time was significantly higher in the high BTG2 expression group than in the BTG2 low expression group (616±135d vs 426±113 d), and the difference was statistically significant ( P<0.001). Among patients with survival time <300 d, there was no significant difference between BTG2 high and low expression group. The results of the univariate analysis showed that tumor differentiation degree, vascular invasion, BTG2 expression, CA19-9 levels, and postoperative liver metastasis were all associated with the prognosis of pancreatic cancer. The results of the multivariate analysis showed that BTG2 expression level ( HR=2.572, 95% CI1.140-5.802, P=0.023), vascular invasion ( HR=0.023, 95% CI0.072-0.572, P=0.003) and postoperative liver metastasis ( HR=0.240, 95% CI0.102-0.564, P<0.001) were independent risk factors affecting the prognosis of patients with pancreatic cancer. Conclusions:BTG2 expression in pancreatic cancer tissues was significantly lower than that in adjacent tissues, and its low expression was associated with strong aggressiveness, low differentiation degree and poor prognosis of pancreatic cancer. The effect of BTG2 on the prognosis in pancreatic cancer patients was mainly in the long term.

Objective:The result of virological and immunological testing in newly diagnosed HIV cases identified in Dehong prefecture of Yunnan province from 2015 to 2017 was analyzed retrospectively to examine the feasibility of using routine HIV testing result in recent infection testing algorism (RITA).Methods:HIV recently tested result and routine HIV testing result were collected from 1 152 newly diagnosed HIV cases between 2015 and 2017 in Dehong prefecture of Yunnan province, the limiting antigen avidity enzyme immunoassay (LAg-EIA) was used to determine the recent infection and long-term infection. And the distribution of CD4 + T cell count, viral load, the S/CO value of antibody enzyme-linked immunological reaction (ELISA) and p31 bands appeared in Western blotting assay (WB) were analyzed in the recently infected HIV cases and long-term infected cases. Further, different RITAs integrating routine HIV testing result were compared in their capacity to determine the recently infected cases. Results:Among 1 152 newly diagnosed HIV cases, 205 recently infected cases and 947 long-term infected cases were determined by LAg-EIA. The proportion of CD4 + T cell count<200/μl, the proportion of ELISA sample/cutoff ratio (S/CO) value > 20, and the proportion of appearing p31 band in WB in recently infected HIV cases were significantly lower than those in long-term infected HIV cases. The RITAs that integrating LAg-EIA with the reclassification criteria of CD4 + T cell count <200 cells/μl or viral load value <1 000 copies (CPs)/ml reclassified 30 cases and 31 cases as long-term infection, respectively. The RITA that integrating LAg-EIA with both the reclassification criteria of CD4 + T cell count <200 cells/μl and viral load value <1 000 CPs/ml reclassified 60 cases as long-term infection. Conclusions:Routine HIV testing result can be integrated in RITA, and RITA can improve the accuracy of identifying recent HIV infection.

OBJECTIVETo observe the anaphylaxis and hemocytolysis of 6 kinds of tween-80 injection from different source.

METHODThe Hartley albinism guinea pig was used to carry on the active systematic anaphylaxis (ASA) and the passive cutaneous anaphylaxis (PCA). The in vitro hemolytic experiment and the hemocytolysis was observed by means of spectrophotometry on the domestic rabbit.

RESULTThe result of ASA and PLA of 6 kinds of tween-80 injection from different source assumed the negative. In observation time, the temolysis rate of 3 kinds of tween-80 injection are more than 5%, while the others are also more than 5% only in the highly concentrated test tube.

CONCLUSIONSix kinds of tween-80 injection from different source have not caused the immune-mediated anaphylaxis, but it may have hematolysis tendency on intravenous injection. The hemocytolysis of tween-80 may not be entirely caused by the impurities. It is worthy of further study that the physical and chemical properties of the product itself and the undeserved concentration is doubtful whether there is also some internal relations with the generation of hemolytic.

Anaphylaxis ; chemically induced ; Animals ; Chemistry, Pharmaceutical ; Female ; Guinea Pigs ; Hemolysis ; drug effects ; Injections ; Male ; Passive Cutaneous Anaphylaxis ; drug effects ; Polysorbates ; administration & dosage ; adverse effects ; chemistry ; Rabbits

Objective To study the therapeutic effects of Shuanglong Prescription (SP) for experimental myocardial infarction in rats. Methods Rat models of myocardial infarction were induced by ligation of coronary artery. Fourteen days after treatment, myocardial infarction area, biochemical parameters and myocardial capillary density were detected to observe the effect of SP.Results After 14- day treatment, SP could reduce the area of myocardial infarction, increase the ratio of 6- keto- PGF1? and TXB2 and the capillary density.Conclusion SP has certain therapeutic effect for myocardial infarction in rats. 