Objective:To describe the characteristics, etiology and patterns of outpatients and inpatients patients with moderate or severe valvular heart disease (VHD).Methods:This is a cross-sectional study. Outpatients and inpatients with moderate or severe VHD who underwent transthoracic echocardiography for first examination from 1 st January 2001 to 1 st January 2020 in Southwest Hospital, Army Medical University were enrolled. Data were collected from medical records and big data platform of Southwest Hospital. Characteristics of age and gender, etiology and types of VHD were descriptively analysed. Results:A total of 68 354 patients with moderate or severe VHD were enrolled. The age was 63 (50, 72) years. And 35 706 (52.24%) patients were female. (1) Age characteristics: There was similar age trend between male and female patients with moderate or severe VHD. The number of patients increased firstly and then decreased and reached its peak in the age group of 65-69 years old. The peak age of mitral stenosis patients was 45-49 years, which was earlier than that of whole patients with moderate or severe VHD. The median age of patients with bicuspid aortic valve was 42 years. (2) Gender characteristics: The proportion of tricuspid regurgitation, pulmonary regurgitation, mitral regurgitation, mitral stenosis and valve surgery in female patients with moderate or severe VHD were higher than those in male patients. The proportion of aortic regurgitation, aortic stenosis and bicuspid aortic valve in male patients with moderate or severe VHD were significantly higher than those in female patients (all P<0.05). (3) Etiology: The proportion of rheumatic VHD was 13.07% (8 934/68 354), which was higher than that of degenerative VHD (0.67% (458/68 354)). (4) Types of VHD: Tricuspid regurgitation made contribution to the largest proportion with 60.72% (41 503/68 354), followed by mitral regurgitation, aortic regurgitation, mitral stenosis, pulmonary regurgitation and aortic stenosis. Conclusions:There are certain regional characteristics in the prevalence of moderate or severe VHD in southwest China, suggesting different attention should be paid on the whole process of refined management of moderate or severe VHD.

Objective:To compare the efficacy of ulnar Z-shaped shortening osteotomy combined with arthroscopic deep suture anchor repair of the triangular fibrocartilage complex (TFCC) and ulnar Z-shaped shortening osteotomy alone in the treatment of ulnar impaction syndrome with moderate or severe distal radioulnar joint instability.Methods:A retrospective cohort study was conducted to analyze the clinical data of 30 patients with ulnar impaction syndrome accompanied by moderate or severe distal radioulnar joint instability, who were admitted to Affiliated Hospital of Qingdao University from January 2016 to June 2023, including 16 males and 14 females, aged 27-58 years [(42.4±9.9)years]. All the patients presented with positive ulnar variance and TFCC type IB injury, with the deep layer of TFCC affected. Fifteen patients were treated with Z-shaped shortening osteotomy of the ulna alone (osteotomy alone group), while the other 15 patients received Z-shaped shortening osteotomy of the ulna combined with arthroscopic suture anchor repair of the deep layer of TFCC (osteotomy combined with repair group). The operation time, intraoperative blood loss, and length of ulnar shortening were compared between the two groups. The forearm rotation, ulnar-radial deviation angle, palmar-dorsal flexion angle, grip strength, visual analogue scale (VAS), patient-rated wrist evaluation (PRWE) score, modified Mayo wrist score, and disabilities of the arm, shoulder, and hand (DASH) questionnaire score were assessed preoperatively, at 6 and 12 months postoperatively, and at the last follow-up. The incidence of postoperative complications was recorded.Results:The patients were followed up for 6-24 months [(15.8±4.9)months]. The operation time in the osteotomy combined with repair group was 3.0 (2.3, 3.0)hours, longer than 1.5 (1.3, 2.0)hours in the osteotomy alone group ( P<0.01). There were no significant differences in intraoperative blood loss and the length of ulnar shortening between the two groups ( P>0.05). There were no significant differences in forearm rotation, ulnar-radial deviation angle, palmar-dorsal flexion angle, grip strength, VAS, PRWE score, modified Mayo wrist score, and DASH score between the two groups preoperatively ( P>0.05). At 6 and 12 months postoperatively, and at the last follow-up, the forearm rotation degrees in the osteotomy combined with repair group were (130.3±8.8)°, (135.2±7.9)°, and (141.9±6.9)°, greater than (120.5±9.4)°, (123.7±10.2)°, and (130.9±8.5)° in the osteotomy alone group; the ulnar-radial deviation angles in the osteotomy combined with repair group were 23.0 (23.0, 26.5)°, 33.0 (30.0, 36.0)°, and 36.0 (32.5, 41.5)°, greater than 22.0 (20.0, 23.0)°, 23.0 (23.0, 28.0)°, and 25.0 (23.0, 33.5)° in the osteotomy alone group ( P<0.05 or 0.01). In the osteotomy combined with repair group, the palmar-dorsal flexion angles at 12 months postoperatively and at the last follow-up were (125.8±10.8)° and (132.9±16.8)°, greater than those in the osteotomy alone group [(99.1±15.7)° and (121.2±17.4)°] ( P<0.01), while there was no significant difference in the palmar-dorsal flexion angle between the two groups at 6 months postoperatively ( P>0.05). In the osteotomy combined with repair group, the grip strength at 6 months postoperatively was (14.6±1.0)N, greater than (12.8±1.8)N in the osteotomy alone group ( P<0.05), while there was no significant difference in grip strength between the two groups at 12 months postoperatively and at the last follow-up ( P>0.05). At 6, 12 months postoperatively, and at the last follow-up, the VAS scores in the osteotomy combined with repair group were (4.3±1.9)points, (2.7±1.1)points, and (2.1±0.7)points, lower than (6.5±2.5)points, (4.7±1.4)points, and (4.3±0.9)points in the osteotomy alone group; the PREW scores were (57.6±4.1)points, (47.3±2.4)points, and (35.0±3.4)points, lower than (67.8±4.5)points, (53.1±4.4)points, and (43.5±4.1)points in the osteotomy alone group ( P<0.05 or 0.01). The modified Mayo wrist scores in the osteotomy combined with repair group at 6, 12 months postoperatively, and at the last follow-up were (78.3±2.9)points, (80.1±3.0)points, and (83.5±3.9)points, higher than those in the osteotomy alone group [(69.0±4.3)points, (75.5±2.9)points, (78.8±2.4)points] ( P<0.01). The DASH scores in the osteotomy combined with repair group at 12 months postoperatively and at the last follow-up were (35.8±4.6)points and (28.4±5.4)points, lower than (43.3±5.0)points and (34.2±4.4)points in the osteotomy alone group ( P<0.01), while there was no significant difference in DASH scores between the two groups at 6 months postoperatively ( P>0.05). In both groups, forearm rotation, ulnar-radial deviation angle, palmar-dorsal flexion angle, grip strength, and modified Mayo wrist scores at all time points postoperatively were all higher than the preoperative values ( P<0.05), while the postoperative VAS, PREW, and DASH scores were lower than the preoperative values ( P<0.05), with statistically significant differences among different time points postoperatively ( P<0.01). The incidence of postoperative complications in the osteotomy combined with repair group was 6.7% (1/15), lower than 46.7% (7/15) in the osteotomy alone group ( P<0.05). Conclusion:Compared with the ulnar Z-shaped shortening osteotomy alone, ulnar Z-shaped shortening osteotomy with arthroscopic suture anchor deep repair of TFCC has the advantages of increased wrist range of motion, reduced pain, improved function, and lower incidence of complications, etc in treating ulnar impaction syndrome with moderate or severe instability of the distal radioulnar joint.

OBJECTIVE: To investigate the effect of electroacupuncture on osteoarthritis in rats and explore the possible mechanism. METHODS: Thirty SD rats were randomly divided into osteoarthritis model group, electro-acupuncture group and control group (n=10), and in the former two groups, early osteoarthritis was induced using a modified DMM surgical modeling method. After successful modeling, the rats in the electro-acupuncture group were treated with electro-acupuncture at bilateral "Housanli" and "Anterior knee point". Behavioral tests of the rats were performed and scored using the LequesneMG scale. Subchondral bone degeneration was observed in each group, and serum levels of IL-1β, ADAMTS-7, MMP-3 and COMP were measured using ELISA. The mRNA and protein expressions of IL-1β, Wnt-7B, β-catenin, ADAMTS-7, and MMP-3 in the cartilage tissue of the knee joints were detected using RT-PCR and Western blotting. RESULTS: In behavioral tests, the rats in the model and electroacupuncture groups had significantly higher LequesneMG scores after modeling than those in the control group (P < 0.05). After 20 days of treatment, LequesneMG scores were significantly lowered in rats in the electroacupuncture as compared with the model rats (P < 0.05). Imaging examination revealed obvious subchondral bone damage in both the electroacupuncture group and the model group, but the damages were significantly milder with former group. Compared with the model rats, the rats receiving electroacupuncture had significantly lower serum levels of IL-1β, ADAMTS-7, MMP-3 and COMP (P < 0.05) with also lower expressions of IL-1β, Wnt-7B, β-catenin, ADAMTS-7 and MMP-3 in the cartilage tissues at both the mRNA and protein levels (P < 0.05). CONCLUSION Electroacupuncture can alleviate joint pain and improve subchondral bone damage in rats with osteoarthritis by reducing IL-1β levels in the joint cartilage tissue and serum to alleviate joint inflammation and by reducing such cytokines as ADAMTS-7 and MMP-3 via regulating the Wnt-7B/β-catenin signaling pathway.
Rats ; Animals ; Electroacupuncture ; Matrix Metalloproteinase 3/metabolism* ; Rats, Sprague-Dawley ; beta Catenin/metabolism* ; Osteoarthritis/metabolism* ; Wnt Signaling Pathway ; Cartilage, Articular ; Inflammation/metabolism*

Objective:To explore the relationship between blocking antibody and lymphocyte subsets in elderly patients (age≥35 years old) with recurrent spontaneous abortion(RSA).Methods:A retrospective case-control study was conducted on the patients with recurrent spontaneous abortion who met the inclusion criteria from October 2014 to September 2019 in the Reproductive Center of Women Health Center of Shanxi.They were divided into two groups according to their ages: 66 cases in RSA group and 334 cases in normal pregnant age group.The blocking antibody and lymphocyte subsets were detected by flow cytometry.Results:The negative rate of blocking antibody in elderly recurrent spontaneous abortion patients was 77.27% (51/66), which was not significantly different from that in normal gestational recurrent spontaneous abortion patients (83.53%(279/334)) ( P=0.221), but significantly higher than that in normal women (23.46%(42/179)) ( P=0.001). The blocking antibody′s blocking efficiency results showed that the CD3′s blocking efficiency of elderly recurrent spontaneous abortion patients (0.10 (-0.50, 0.60)) was significantly lower than that of normal women (0.60 (0.00, 1.30)), the difference was statistically( P=0.001). The CD8 blocking efficiency of elderly recurrent spontaneous abortion patients (0.00 (-0.60, 0.63)) was significantly lower than that of normal women (0.30 (0.00, 0.70)), the difference was statistically( P=0.016). Lymphocyte subsets showed that the CD8 + T cell ratio in elderly recurrent spontaneous abortion patients (26.93±7.25) was significantly lower than that in normal gestational recurrent spontaneous abortion patients (29.22±7.29), the difference was statistically significant ( P=0.020). The CD4 + /CD8 + ratio in elderly recurrent spontaneous abortion patients (1.64±0.99) was significantly higher than that in normal gestational age recurrent spontaneous abortion patients (1.37±0.50), the difference was statistically significant ( P=0.030). The ratio of natural killer cells in elderly recurrent spontaneous abortion patients (16.13±7.10) was significantly higher than that in normal women (14.04±2.35), the difference was statistically significant ( P=0.022), and higher than that in normal gestational age recurrent spontaneous abortion women (15.57±7.02). Conclusion:There were differences in lymphocyte subsets between elderly RSA patients and normal pregnant women, and the increase of natural killer cell ratio may be an important factor in the occurrence of RSA, especially in elderly RSA patients.

Objective To introduce and discuss the efficacy of a new technique to perform transperitoneal single-docking robot-assisted laparoscopic nephroureterectomy (RNU).Methods A total of 44 patients diagnosed with urothelial neoplasm of the renal pelvis or were investigated from January 2016 to November 2019.RNU was performed by a single surgeon.Among the 44 patients,31 were male,and 13 were female.The median age was 63 (IQR:58-71).The median body mass index (BMI) was 23.08 (IQR:21.55-24.60) kg/m2.All operations were performed with general anesthesia.The patients were positioned 80 degrees flank with the diseased side up,and the head was tilted 10 degrees downwards.The camera port was placed one finger lateral to the umbilicus.For the right-sided tumors,robotic arm 1 was inserted through the trocar on the right pararectus line,8 cm above the umbilicus,and robotic arm 2 was inserted through the trocar on the same line,8 cm below the umbilicus.Assistant trocar 1 was placed where the anterior midline joins the perpendicular bisector of the camera port and robotic 2,and assistant trocar 2 was placed below the xiphoid process.For the left-sided tumors,all trocars were centrosymmetric to that of the right-sided tumors,except that assistant port 2 was placed 3 finger width above the pubic symphysis.The peritoneum was incised along the Toldt line,and the inferior vena cava was isolated (for left sided tumor,the abdominal aorta was isolated instead).The renal artery and vein were clipped with Hem-o-lok and ligated,and the kidney were isolated.The ureter was identified and isolated downwards across the common iliac artery and then clipped distal to the tumor site.The bladder cuff was resected and sutured under the laparoscopy.Results The median operation time was 145 (IQR:130-175) min,with the median console time of 119 (IQR:108.5-136.0) min,the anastomosis of bladder cuff of 12 min,and the median estimated blood loss of 50 (20-100)ml.After the surgery,6 Clavien-Dindo grade 2 complications occurred,including 2 chylous leakage,1 hemostasis,1 blood transfusion,1 deep vein thrombus,and 1 acute coronary syndrome.The median length of stay (LOS) was 8 (IQR:6.5-10.0) d.The median length of follow-up was 12 months.In total,5 patients were dead,including 3 cancer-specific death.Four recurrence occurred and caused 3 death.The 2-year overall survival and progression-free survival were 68.2％ and 77.9％,respectively.Conclusions The technique of RNU with simultaneous bladder cuff excision (BCE).Our technique improved the surgical outcome.The perioperative complication rate was low,and the short-term survival outcomes were satisfactory.

Objective To explore the diagnostic value of flow cytometry in detecting HPV E6／E7 mRNA of human papilloma virus (HPV) in the diagnosis of cervical lesions. Methods From January 2017 to September 2018,119 women with suspected cervical lesions in the department of gynecology and obstetrics of Shanxi Maternal and Child Health Hospital were selected. Flow cytometry was used to detect HPV E6 ／ E7 mRNA in cervical exfoliated cells of women,and the DNA of HPV was detected by the method of hybrid capture 2 (HC2). Results 31. 09%(37／119) HPV E6／E7 mRNA and 57. 14%(68 ／ 119) HPV DNA were positive in 119 cases. The positive rate of HPV E6／E7 mRNA in cervical intraepithelial neoplasia ( CIN)2+ group was 77. 78%(28／36),which was statistically significant compared with 20. 00%(4／20) in CIN1 group (χ2＝15. 246,P＜0. 01),and was statistically significant compared with 7. 94%(5／63) in nilm group (χ2＝50. 286,P＜0. 01) . In nilm group,HPV E6 ／ E7 mRNA positive rate was 7. 94%(5／63) and HPV DNA positive rate was 30. 16%(19 ／ 63),which was statistically significant (χ2＝10. 088,P＝0. 001) . In cin1 group,HPV E6／ E7 mRNA positive rate was 20. 00%(4 ／ 20) and HPV DNA positive rate was

Objective To compare split-cuff nipple and direct ureteroileal anastomosis during ureteroileal anastomosis.Methods Between December,2014 and March,2017,a prospective randomized study was conducted on 70 patients who underwent radical cystectomy and urinary diversion.In every patient,both ureters were randomized to be implanted using an antireflux,split-cuff nipple technique (group A) or a reflux,direct technique (group B).After pelvic lymph node dissection and radical cystectomy,a Mshape orthotopic ileal neobladder was constructed and two ureters were implanted with single-J tubes placed for 10-12 days.For split-cuff nipple technique,a 0.5 cm longitudinal incision in the ureter was made,and the ureteral wall was turned back on itself,construction a nipple.The cuff was stabilized at the corners with sutures.The ureter was then placed into the bowel with 0.5 cm nipple.The ureter was sutured to the full thickness of the bowel wall with interrupted 4-0 PDS.For direct technique,a 0.5 cm incision in the ureter was made,the full thickness of the ureter was sewn to the mucosa of the bowel.Results 70 patients were enrolled in the study,63 males and 7 females,(62.5 ± 10.4) years old.Over a median follow-up of 13.2 months,one patients had bilateral anastomosis stricture 3 months after operation,1 patient in group A had stricture 6 months after operation,2 patients in group B had stricture 6 and 12 months after operation,respectively.Six patients (8.6％) in group A found reflux compared with 21 patients (30.0％) in group B (P =0.004).The reflux pressure was (23.5 ± 9.0) cmH2O and (15.5 ± 4.9) cmH2O in group A and group B (P =0.042),respectively.The GFR of group A was (38.1 ± 7.6) ml/min compared with (38.6 ± 12.9) ml/min in group B at 12 months after operation.One patient in group A and four patients in group B had acute nephropyelitis.Four patients in group A had renal stones formation compared with 1 patients in group B.The time of anastomosis was (8.8 ± 3.5) minutes and (6.7 ± 1.5) minutes (P =0.037) for group A and group B,respectively.The patients in both groups had no urine leakage.Conclusion Compared with direct technique,split-cuff nipple technique had lower reflux rate,higher antireflux pressure and longer anastomosis time than direct technique.

A glassy carbon electrode (GCE) modified with gold nanoparticles loading on the reduced graphene oxide (rGO)-multi-walled carbon nanotubes (MWCNTs) composite film was fabricated by a two-step procedure.Firstly, rGO-MWCNTs composite were prepared by in-situ chemical reduction method with hydrazine as a reducing agent.Then, AuNPs were deposited on the surface of rGO-MWCNTs using simple cyclic voltammetry.This modified electrode was characterized using scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDS) and electrochemical methods.Furthermore, the electrochemical behavior of bisphenol A (BPA) was also investigated using this modified electrode.The results showed that the modified electrode had high electrochemical activity for the oxidation of BPA.In 0.10 mol/L phosphate buffer solution (PBS, pH 7.0), the linear range for the determination of BPA with differential pulse voltammetry (DPV) was in the range of 5.0 × 10-9 -1.0 × 10-7 mol/L and 1.0 × 10-7-2.0 × 10-5 mol/L.The detection limit was 1.0 × 10-9 mol/L (S/N=3).The as-prepared modified electrode was successfully used to determine BPA in river water and the shopping receipt samples with recovery ranges of 97%-110% and 98%-104%, respectively.

Objective To investigate the prediction value of deceleration capacity of rate (DC) and GRACE risk score for cardiovascular events in AMI patients.Methods Consecutive AMI patients with sinus rhythm hospitalized in our department during August 2012 to August 2013 were included in this prospective study.24-hour ECG Holter monitoring was performed within 1 week,and the DC value was analyzed,GRACE risk score was acquired with the application of GRACE risk score calculator.Patients were followed up for more than 1 year and major adverse cardiac events (MACE) were obtained.Analysised the Kaplan Meier survival according to DC and GRACE score risk stratification respectively.Results A total of 157 patients were enrolled in the study (average age:(58.9 ± 12.7)years old).The average follow-up was (20.54 ± 2.85) months.Mortality during follow-up was significantly higher in patients with DC ＞ 2.5 compared to patients with DC ≤2.5 (P ＜ 0.01).In terms of early warning cardiac death,the area under ROC curve of DC risk stratification was 0.898 (95％ CI0.840-0.940,P ＜0.01),the sensitivity was 84.6％,and the specificity was 84.0％.The area under ROC curve of GRACE risk stratification was 0.786 (95％ CI0.714-0.847,P ＜0.01),the sensitivity was 84.6％,and the specificity was 74.3％.In terms of early warning cardiac adverse events,the ROC curve of DC was 0.747 (95％ CI 0.672-0.813,P ＜ 0.01),with the 90.0％ sensitivity and 67.7％ specificity.The GRACE risk stratification was 0.708 (95％ CI 0.652-0.769,P ＜0.01),with the 63.3％ sensitivity and 75.6％ specificity.Subgroup analysis showed that mortality during follow-up was significantly higher in high risk patients than those with intermediate and low risk patients according to DC risk stratification in intermediate and low risk patients by GRACE risk stratification (P ＜0.01).Conclusion DC could predict cardiac death and MACE in patients with AMI.DC risk stratification is superior to GRACE risk score on outcome assessment in this AMI patient cohort.

Objective To evaluate the effect of preoperative aescuven forte tablets in the prevention of procedure for prolapse and hemorrhoids(PPH) complications.Methods One hundred and seventy-nine patients underwent PPH in the Erlonglu Hospital of Beijing from June 2013 to June 2014 were divided into postoperative aescuven forte tablets group (n =90) and preoperative aescuven forte tablets group (n =89).The postoperative pain,bleeding,retention of urine,anal swelling,length of stay in hospital and recurrence were compared between the two groups.Results The incidence of postoperative pain,bleeding,retention of urine,anal swelling were lower than in the preoperative aescuven forte tablets group (pain after operations rate:7.9％ (7/89) vs.20.0％ (18/90),x2 =5.484,P＜ 0.05;Wound bleeding:0 vs.6.7 ％ (6/90),P =0.026;retention of urine:9.0％ (8/89) vs.20.0％(18/90),x2 =4.370,P＜0.05;anal swelling:1.1％(1/89) vs.8.9％(8/90),P=0.035),and length of stay in hospital was shorter(11.9±3.9) d vs.(13.3 ±5.0) d,t=3.134,P＜0.05).There was no recurrence both of two groups follow up for more than 2 months.Conclusion Preoperative oral aescuven forte tablets of 2 h can reduce PPH complications and worthy of popularization and application.