Objective To observe the clinical effects of Yiweining Capsules combined with rebamipide tablet in the treatment of spleen-stomach qi deficiency syndrome in chronic atrophic gastritis(CAG).Methods Totally 80 patients with CAG were divided into the study group and the control group by using the random number table method,with 40 cases in each group.Both groups were given rebamipide tablet,0.1 g/time,3 times a day,orally;on this basis,the study group added Yiweining Capsules 2 g/time,3 times a day,orally.Both groups were treated continuously for 12 weeks.The TCM efficacy,the efficacy of gastroscopy and the efficacy of histopathology in the two groups were observed.The TCM symptom score before and after treatment in two groups were observed.The adverse reactions were recorded.Results No cases fell off in both groups.The total effective rate was 92.5%(37/40)in the study group and 70.0%(28/40)in the control group,and the clinical efficacy of the study group was better than that of the control group(P<0.01).Compared with before treatment,the total TCM symptom scores in the two groups after treatment decreased(P<0.01);Compared with after treatment,the total scores of TCM symptom in the study group were lower than those in the control group(P<0.05,P<0.01).The total effective rate of gastroscopy in the study group(82.5%)was better than that in the control group(67.5%),with statistical significance(P<0.05).The overall efficacy rate of histopathdogy in the study group(87.5%)was better than that of the control group(70.0%),with statistical significance(P<0.01).There were no adverse reactions in both groups.Conclusion Yiweining Capsules combined with rebamipide tablet can effectively improve the clinical symptoms,gastroscopic manifestations and the degree of mucosal lesions in patients with CAG,with remarkable efficacy.

Objective:To analyze the applicability of the Institute of Medicine (IOM) recommendations of gestational weight gain (GWG) in women with twin pregnancies in Chengdu city.Methods:A total of 1 862 women delivering live twins ≥28 weeks of gestation at all midwifery institutions in Chengdu city from January 2013 to December 2019 were selected, and the women were divided into low GWG group (880 women), adequate GWG group (839 women) and excessive GWG group (143 women) according to the IOM recommendations of GWG. Information of the subjects was extracted from Chengdu “One-Card” Maternal and Child Health Information System. Chi-square test and analysis of variance were used to compare the basic information, pregnancy complications and perinatal adverse outcomes among the three groups. Multivariate logistic regression was used to analyze the relationship between GWG and pregnancy complications or perinatal adverse outcomes.Results:Of the women, 72.8% (611/1 862) had normal weight before pregnancy. The weight gain of low, adequate and excessive GWG groups was (11.8±3.4) kg, (18.8±2.6) kg and (26.1±2.9) kg, respectively. The incidence of low birthweight was highest in the low GWG group (71.0%), it was lowest in the excessive GWG group (51.0%), and it was 61.3% in the adequate GWG group ( P<0.001). There was no significant difference in gestational hypertension, gestational diabetes mellitus, premature rupture of membranes, very low birthweight, preterm birth, very premature birth, 5-minute Apgar score<7 and neonatal death within 7 days postpartum among the three groups (all P>0.05). The multivariable logistic regression analysis showed that, compared with women inadequate GWG group, those from the low GWG group tended to deliver infants with low birthweight ( OR=1.62, 95% CI: 1.32-2.00), whereas women from the excessive GWG group were less likely to deliver low birthweight infants ( OR=0.63, 95% CI: 0.44-0.91) (both P<0.05). Conclusion:The IOM recommendations for gestational weight gain are valuable in improving the pregnancy complications and perinatal outcomes of twin pregnancies in Chengdu city to certain extent, especially in improving the low birthweight of newborns.

Objective    To investigate the technique and efficacy of left atrial appendage (LAA) occlusion during off-pump coronary artery bypass grafting (OPCABG) in elderly patients with coronary artery disease (CAD) and atrial fibrillation (AF). Methods    From 2013 to 2018, 84 elderly patients with CAD and AF with reduced left ventricular ejection fraction (LVEF< 50%) underwent OPCABG in our department. There were 54 males and 30 females at age of 70-82 years. They were divided into a left atrial appendage (LAA) occlusion group (n=56) and a non-LAA occlusion group (n=28). Postoperative antithrombotic therapy: the LAA occlusion group was given warfarin + aspirin + clopidogrel “triple antithrombotic therapy” for 3 months after operation, then was changed to aspirin + clopidogrel “dual antiplatelet” for long-term antithrombotic; the non-LAA occlusion group was given warfarin + aspirin + clopidogrel “triple antithrombotic” for long-term antithrombotic after operation. The clinical effectiveness of the two groups was compared. Results    All patients underwent the surgery successfully. There were 56 patients in the LAA occlusion group, including 44 patients of LAA exclusion and 12 patients of LAA clip. The time of LAA occlusion was 3 to 8 minutes. There was no injury of graft vessels and anastomotic stoma. Early postoperative death occurred in 2 patients (2.4%). There was no statistical difference between the two groups in postoperative hospital stay (P=0.115). Postoperative LVEF of the two groups significantly improved compared with that before operation (P<0.05). There was no stroke or bleeding in important organs during hospitalization. During follow-up of 1 year, no cerebral infarction occurred in both groups, but the incidence of bleeding related complications in the LAA occlusion group was significantly lower than that in the non-LAA occlusion group (3.6% vs. 18.5%, P=0.036). Conclusion    For elderly patients with CAD and AF with reduced LVEF, LAA occlusion during OPCABG can effectively reduce the risk of stroke and bleeding related complications, and without increasing the risk of surgery.

Objective    To summarize the application and clinical effect of left anterior minimally invasive thoracotomy to surgical repair of subarterial ventricular septal defect (VSD) in children. Methods    From October 2015 to April 2019, 21 children with subarterial VSD underwent surgical repair via left anterior minimally invasive thoracotomy. There were 13 males and 8 females, aged 5-13 (9.1±2.2) years, and weighing 22-55 (35.6±9.5) kg. The diameter of subarterial VSD was 4-15 (9.1±3.3) mm. Eight patients had right coronary valve prolapse, and 4 aortic valve regurgitation (3 mild and 1 mild-to-moderate). The minimally invasive surgery was performed via left parasternal thoracotomy through the second or third intercostal space. The peripheral perfusion was performed with femoral arterial and venous cannulation. After aortic cross-clamp (ACC), subarterial VSD was performed with direct suture of patch closure through an incision on the root of pulmonary artery. Results    All patients successfully underwent surgical repair (patch closure, n=15; direct suture, n=6) of subarterial VSD through left anterior minimally invasive thoracotomy. The cardiopulmonary bypass time was 45-68 (57.1±6.3) min. The ACC time was 23-40 (32.6±4.7) min. The postoperative ventilation time was 5-9 (6.3±1.3) h, postoperative in-hospital time was 5-8 (5.7±1.0) d and drainage volume was 33-105 (57.5±17.7) mL in postoperative 24 h. No death, residual VSD shunt, atrioventricular block, wound infection or thoracic deformity occurred during the perioperation or follow-up. Only one patient still had trivial aortic valve regurgitation. Conclusion    Left anterior minimally invasive thoracotomy could be safely and effectively applied to surgical repair of subarterial VSD in children, with satisfactory early- and mid-term outcomes.

Objective: To summarize the safety and effect of modified surgery for hypertrophic obstructive cardiomyopathy(HOCM) with concomitantly significant mitral regurgitation(MR) through a single transaortic approach. Methods: From January 2008 to June 2018, 93 patients with HOCM and significant MR underwent modified Morrow procedure and edge-to-edge mitral valvuloplasty through a single transaortic approach. Preoperative left ventricular outflow tract pressure gradient(LVOTPG) was 51-199 mmHg(1 mmHg=0.133 kPa). Preoperative interventricular septum thickness(IVST) was 17-30 mm. All patients had significant MR with SAM phenomenon. The modified Morrow procedure and edge-to-edge mitral valvuloplasty through a single transaortic approach was performed under cardiopulmonary bypass and aortic crossclamp. Results: All patients successfully underwent the surgery of modified Morrow procedure and edge-to-edge mitral valvuloplasty through a single transaortic approach. No early death and interventricular septal perforation were occurred. In the early postoperative period, two patient(2.15%) received permanent pacemaker implantation due to the complete atrial-ventricular block. At discharge, postoperative LVOTPG(7-31 mmHg) and IVST(11-19 mm) were significantly decreased compared with the preoperative values(P<0.05). All patients had none or trivial MR. The mitral valve pressure gradient(MVPG) was 0-6 mmHg. SAM phenomenon disappeared in all patients. At a mean follow-up of(40.53±27.11) months, no patient had significant residual left ventricular outflow tract obstruction. All patients had none or trivial MR. No SAM phenomenon occurred. Conclusion Modified surgery of Morrow procedure and edge-to-edge mitral valvuloplasty through a single transaortic approach could be safely and effectively applied for patients with HOCM and concomitantly significant MR.

Objective     To explore the technique of performing minimally invasive Cox Maze Ⅳ procedure by bipolar clamp through right lateral minithoracotomy for atrial septal defect (ASD) combined with atrial fibrillation (AF) in adults. Methods     Thirty-five patients (21 males, 14 females with age ranging from 45 to 73 years) with ASD and persistent or long-standing persistent AF received minimally invasive Cox Maze Ⅳ procedure and ASD closure from August 2012 to April 2016 at Department of Cardiothoracic Surgery, Xinhua Hospital. Diameter of left atrium ranged from 39 to 60 mm and left ventricle ejection fraction (LVEF) ranged from 48% to 62%. Diameter of ASD ranged from 20 to 35 mm. Cox-maze Ⅳ procedure was performed through right minithoracotomy entirely by bipolar radiofrequency clamp. Then, mitral or tricuspid valvuloplasty and surgical ASD closure was performed through right minithoracotomy.   Results     All patients successfully underwent this minimally invasive surgery. No patient needed conversion to sternotomy. The mean cardiopulmonary bypass time was 120.1±14.1 min. The mean aortic cross-clamp time was 79.5±12.2 min. There was no early death or pacemaker implantation perioperatively. The average length of hospital stay was 10.1±2.7 d. At a mean follow-up of 22.8±12.2 months, sinus rhythm was restored in 32 patients (32/35, 91.4%). Cumulative maintenance of normal sinus rhythm without AF recurrence at 2 years postoperatively was 89.1%±6.0%. Conclusion     The minimally invasive Cox Maze Ⅳprocedure performed by bipolar clamp through right minithoracotomy is safe, feasible, and effective for adult patients with ASD combined with AF.

Objective To investigate the feasibility of differential expression proteins identification in peripheral blood mononuclear cells (PBMCs) of sepsis patients using Data Independent Acquisition liquid chromatography-mass spectrometry (DIA LC-MS). Methods Prospective studies were employed and targeted at 10 sepsis patients admitted to the Intensive Care Unit (ICU) of Shanghai Fifth People's Hospital Affiliated to Fudan University from April 2016 to July 2016. And 10 patients admitted to the ICU with similar age and sex that were not complicated with sepsis were served as the control group.The proteins from peripheral blood mononuclear cells in 10 sepsis patients and 10 control persons were analyzed using the latest DIA LC-MS technology and the skyline data extraction software; the model of data obtained from the above analysis was further discriminatorily analyzed with principal component analysis (PCA), partial least squares discriminant analysis (PLS-DA) and orthogonal partial least squares discriminant analysis (OPLS-DA); then the differential proteins of peripheral blood mononuclear cells were analyzed by Pathway analysis and GO analysis. The possible markers were identified by preliminary screening according to variable importance in the projection (VIP). The top 3 proteins (VIP > 1, P< 0.05) were verified by ELISA and their ROC curves were analyzed. Results Totally 1062 fragment ions were identified and 119 proteins were obtained. Among them, 31 proteins were up-regulated and 88 proteins down-regulated. Pathway analysis showed that carbon metabolism, platelet activation, bacterial invasion of epithelium, and complement coagulation cascade activation were participated in the development of sepsis. ELISA showed that significant difference of HMGB-1, MMP-8, and LCN2 in the expression of peripheral blood mononuclear cells in the sepsis and control people (P<0.01). The area under the ROC curve is greater than 0.85, which has good sensitivity and specificity. Conclusions DIA-MS is a compelling way for detecting differential expression proteins. PCA, PLSDA and OPLSDA are suitable for pattern recognition. The high expression of HMGB-1, NGAL and MMP-8 in immune cells may be the potential biomarker of the disease, which lays the foundation for research of early diagnosis and treatment of sepsis.

Objective To investigate the effects of transient receptor potential cation channel 6 (TRPC6) on the expression of nephrin, desmin and caspase 9 and on the apoptosis of podocytes in a mouse model of podocyte injury induced by TGF-β1.Methods Conditionally immortalized mouse podocytes were cultured in vitro and divided into four groups: control, TGF-β1 treatment, TGF-β1+PGPU6/GFP/Neo-TRPC6-mus-581 (TRPC6 knockdown) and TGF-β1+PGPU6/GFP/Neo-NC (negative control).Real-time RT-PCR and Western blot analysis were performed to detect the expression of nephrin, desmin and caspase 9 at mRNA and protein levels, respectively.Flow cytometry was used to analyze the apoptotic rate of podocytes.DAPI fluorescent staining was used to observe the morphological changes of apoptotic podocytes.Results Green fluorescent protein (GFP)-expressing podocytes at 48 hours after transfection were significantly more than those at 24 hours after transfection.The level of TRPC6 in mouse podocytes transfected with PGPU6/GFP/Neo-TRPC6-mus-581 was significantly decreased as compared with that of the control group (P<0.05).No significant difference in the expression of TRPC6 was observed between the negative control group and the control group.Compared with the control group, the TGF-β1 treatment group showed increased expression of desmin and caspase 9 at both mRNA and protein levels (P<0.01), but decreased expression of nephrin at mRNA and protein levels at 48 hours after TGF-β1 intervention (P<0.05).The up-regulated desmin and caspase 9 and the down-regulated nephrin induced by TGF-β1 could be inhibited by the means of TRPC6 knockdown.The apoptosis rate of podocytes in TGF-β1 treatment group was (14.0±2.1)%, while that in TRPC6 knockdown was (10.90±0.56)% (P<0.05).The apoptosis rate of podocytes in negative control group was higher than that in TGF-β1 treatment group (P>0.05).More apoptotic cells with typical morphological features of apoptosis were observed after exposure to TGF-β1 for 48 hours.Conclusion TGF-β1 could induce the apoptosis of podocytes, inhibit the expression of nephrin and enhance the expression of caspase 9 and desmin, the possible mechanisms of which may be related to TRPC6 signal pathway.These changes in TGF-β1-treated podocytes could be alleviated by inhibiting the expression of TRPC6, which might have a protective effect on podocyte injury.

[abstract] Objective To study the health education on diabetes nurse diabetes management mode at the core of application in the patients with follow-up effect. Methods Our hospital endocrinology in October 2015,participate in blood sugar management company research project(namely,doctors,nurses and patients ofthree Eonline and offline (O2O) integration management system).The project is the specialist education nurses,doctors and patients of organic whole,to form a closed-loop management.Use of the project with mobile tablet (PAD),SMS platform on the first base into a group of patients with type 2 diabetes insulin for 5 minutes on education and baseline data collection,and in the next 15 weeks of diabetes health education nurses via text message and phone tracking in the form of blood sugar and insulin dose data,at the same time for more than three months of education,guidance and management,to help patients with initial foundation of insulin self management knowledge and skills,promote the blood glucose control is at target. Results In 12 weeks of the completion of this project and follow-up,425 patients of FPG success rate is 82.6%. Conclusion Nurse diabetes health education as the core of diabetes management model is feasible in patients with type 2 diabetes, the effect is good,that greatly arouse the subjective initiative of patients;Improve the patients′self-management ability,improving according to the medical behavior;Improved treatment adherence to standard prompt patients FPG.

Objective    To analyze the mid-term results of surgical treatment for prosthetic valve endocarditis (PVE). Methods    We retrospectively analyzed the clinical data of 22 PVE patients operated in our institution from January 2006 to June 2016. There were 14 males and 8 females, aged 31-62 (49.6±11.8) years. PVE occurred following single valve replacements in 20 patients, including aortic valve replacements in 12 and mitral valve replacements in 8. Two patients suffered PVE after multi-valve replacement, which was aortic and mitral valves. Mechanical valves were used in all patients. Early PVE (<1 year after valve implantation) was detected in 10 patients, and late PVE (>1 year after valve implantation) in 12 patients. Blood culture was negative in 6 patients. Fifteen patients underwent emergent or urgent surgery (within one week after definite diagnosis) and 7 elective surgery. Paravalvular abscess was detected in 12 patients and repaired bovine pericardium. Results    Three patients (13.6%) died postoperatively in hospital, among whom two died of multiple systemic organ failure, and the other died of cerebral hemorrhage. Main postoperative complications included low cardiac output syndrome in 5 patients (22.7%), renal dysfunction in 6 (27.3%), respiratory failure in 5 (22.7%) and pulmonary infection in 4 (18.2%). During the follow-up of 6-120 (53.6±20.8) months, 2 deaths were observed in the middle term, including one sudden death and the other of cerebral infarction. No recurrent infection or valve-related surgery was observed during the follow-up. The survival rate was 86.4% in 1 year and 70.4% in 5 years. Conclusion    PVE is a very severe disease with high mortality. Early surgical treatment and complete removal of infectious tissues have preferable early- and mid-term results.