Objective To investigate the clinical efficacy of minimally invasive mitral valvuloplasty (MVP) in the treatment of infective endocarditis (IE) with mitral regurgitation (MR). Methods A retrospective analysis was conducted on the clinical data of patients who underwent MVP for IE with MR at the Department of Cardiovascular Surgery in Zhongshan Hospital, Fudan University from 2016 to 2020. Patients were divided into two groups based on the surgical incision: those with a right mini-thoracotomy were classified as a minimally invasive surgery (MIS) group, and those with a median sternotomy (MS) were classified as an MS group. All patients had isolated mitral valve involvement. Perioperative data were analyzed, and mid- to long-term outcomes were compared between the two groups. Results A total of 86 patients were included, with 40 in the MIS group [22 males and 18 females, with a mean age of (39.78±15.36) years ranging from 14 to 75 years] and 46 in the MS group [27 males and 19 females, with a mean age of (49.94±16.13) years ranging from 14 to 71 years]. The patients in the MIS group were relatively younger (P=0.004) with better preoperative cardiac function (P=0.004). There was no statistical difference in preoperative fever, gender, or comorbidities between the two groups (P>0.05). The MIS group had shorter postoperative ventilation times, less postoperative 24-hour drainage, less blood transfusion, and shorter total hospital stays compared to the MS group (P＜0.05). There was no statistical difference in cardiopulmonary bypass times or ICU stays between the two groups (P>0.05). The perioperative complication rates and mortality rates were not significantly different between the two groups (P>0.05). Follow-up was conducted for 11-92 months, with a mean duration of (49±19) months and an overall follow-up rate of 91.9%. During the follow-up, 3 patients in each group required reoperation for mitral valve issues, with no statistical difference in incidence (7.5% vs. 6.5%, P=0.691). There were no warfarin-related complications, recurrences, or deaths in either group during follow-up. Multivariate regression analysis identified age, preoperative cardiac function, and surgeon experience as influencing factors for the choice of surgical approach. Conclusion Minimally invasive MVP for IE with MR is relatively safe in the perioperative period and shows significant efficacy, with clear mid- to long-term outcomes. It is recommended for younger patients with better preoperative cardiac function and when performed by surgeons with extensive experience in mitral valvuloplasty.

Objective To investigate the efficacy and safety of Irbesartan Hydrochlorothiazide combined with Metoprolol as initial therapy in the treatment of heart failure in the elderly.Methods A total of 128 elderly patients with heart failure admitted into our hospital from September 2017 to August 2018 were randomly divided into Group A(n=64)and Group B(n=64).Group A was treated with oral Irbesartan Hydrochlorothiazide tablets.Group B was treated with sustained-release oral Metoprolol tablets in addition to what was given in Group A.Therapeutic effects were compared between the groups.Results Compared with Group A,the effectiveness rate of group B was significantly improved(93.8％ vs.81.3％,x2 =4.571,P=0.033).There was no significant difference in brain natriuretic peptide (BNP),interleukin (IL)-12,left ventricular ejection fraction (LVEF),left ventricular end-systolic diameter(LVESD),or left ventricular end-diastolic diameter(LVEDD)between the two groups before treatment (P＞0.05).Compared with Group B,BNP,IL-12,LVEF,LVESD and LVEDD had significantly better profiles in Group A after treatment (P ＜ 0.05).The time-domain measurements of heart rate variability such as sequential five-minute R-R interval means(SDANN),standard deviation of the N-N interval(SDNN),percent of differences between adjacent RR intervals ＞50ms(PNN50)and root mean square of the successive differences(RMSSD)were higher in Group B than in Group A after treatment.No serious adverse reactions were observed in either group,and there was no significant difference in the incidence of adverse reactions between the two groups(4.7％ vs.7.8 ％,x2 =0.533,P =0.465).Conclusions Irbesartan Hydrochlorothiazide combined with Metoprolol as initial therapy has good clinical effects in treating elderly heart failure.It can not only improve the clinical symptoms of patients,but also ensure clinical medication safety.

BACKGROUND:As the bone and marrow tissue have very special structure, it is difficult to simultaneously display the bone with tough hard tissue and bone marrow tissues containing various immature hematopoietic cel s in the conventional process of pathological section preparation. OBJECTIVE:To choose the best decalcifying solution that cannot only completely remove the calcium in the bone tissue but also protect the structure of bone marrow tissues and cel s from damage. METHODS:Bone marrow tissues from the long bone of dogs were randomly divided into four groups. Under the same conditions, the bone marrow tissues were decalcified with 14%formaldehyde saline solution of nitric acid (group A), 14%nitric acid solution (group B), 20%A saline solution of hydrochloric acid formaldehyde (group C) and 20%A hydrochloric acid aqueous solution (group D). Decalcified time was recorded, fol owed by routine dehydration, section, hematoxylin-eosin staining and microscopic observation. Pathological section quality and hematoxylin-eosin staining were compared among the four groups. RESULTS AND CONCLUSION:Group A had the best sections and hematoxylin-eosin staining, strongest decalcified ability, shortest decalcified time and minimum damage to the bone marrow. Group B had the worst results of section and hematoxylin-eosin staining, in which, the bone tissues were loose and became yel ow and the bone marrow tissue were damaged greatly, and the decalcified effect was worse. Group C was worse than group A in decalcified ability, damage degree, section quality and hematoxylin-eosin staining results. Group D also had a better result of section and hematoxylin-eosin staining as wel as exhibited uniform decalcification effect and less damage to the bone marrow, which was ranked between group B and group C. Al the four kinds of decalcifying solutions have a good decalcification ability, but the section quality and hematoxylin-eosin staining results rank as fol ows:Group A>Group C>Group D>Group B. Taken together, 14%formaldehyde saline solution of nitric acid is ideal for the clinical preparation of pathological sections.

Objective To discuss the method and efficiency of less invasive stabilization system (LISS) in treatment of comminuted tibia[ fractures. Methods A total of 14 patients with comminuted tibial fractures were treated with LISS between January 2005 and July 2006. There were 10 males and four females, at age range of 19-61 years (mean 34 years). Of all, 11 patients were with proximal fractures of tibia and three with distal ones, including six with open fractures and eight with closed ones. The period from injury to operation was 2-13 days. An observation was done on postoperative soft tissue recovery and fracture healing. Results The average period of follow-up was 9.4 months (4-16 mouths). All frac-tures were healed up after average 7.8 months (4-12 months). All incisions were healed up at one stage, with no complications on nerves, blood vessels or soft tissues. The axes of tibia were good, with sound function of knee and ankle joints. Conclusion LISS is characterized by easy operation, minor trauma, high healing rate and low complications in treatment of comminuted tibial fractures.

OBJECTIVE To investigate the management and sanitation status of the air circumstance in laminar flow operating rooms of grade two and above hospitals in Beijing.METHODS Air surveillance methods,cleaning methods of intakes,cleaning status of pipelines and frequency of renewing filter systems were investigated through interviewing charge nurse of 18 hospitals by questionnaires.RESULTS 50.0% of pipelines had never been cleaned,14.3% of intakes had never been cleaned.Air surveillance method of all hospitals was using sedimentation,with a low sensitivity.The monitoring systems were poor in 50.0% of hospitals.CONCLUSIONS Now there is only requirements of construction standard of clean surgery region,lacking routine regulations and technologies of contamination controlling standard,nor available dynamic contamination controlling system.Potential hazard exists in routine regulations of laminar flow operating room and it demands for making contamination controlling standard urgently in hospitals.