Objective To investigate the level of coagulation factor Ⅺ(FⅪ)in patients with venous thrombosis of lower limbs and its correlation with recurrence risk.Methods A total of 220 pa-tients with deep vein thrombosis(DVT)admitted in our hospital from February 2018 to February 2019 were enrolled as the study group,and another 50 healthy individuals taking physical exami-nation during same period served as the control group.After a 3 years followed,the study group ultimately included 197 cases,according to the results of restricted cubic spline(RCS),the study group was divided into low(FⅪ＜10.3 U/L,94 cases),medium-(10.3-12.1 U/L,52 cases)and high-level groups(＞12.1 U/L,51 cases).The plasma level of FⅪ was detected in the study group 1 month after the end of anticoagulant therapy,and the results were compared with those of the control group during physical examination.Cox model was used to analyze the influence of FⅪ on the recurrence of DVT,and RCS was employed to analyze the relationship between DVT recur-rence and FⅪ level.Kaplan-Meier curve was plotted to analyze the recurrence risk of DVT with different FⅪ levels.The patients from the study group were followed up for 3 years.Results The FⅪ level was significantly higher in the study group than the control group(P＜0.05).During fol-low-up period,33 patients(16.75％)had DVT recurrence.The Cox model analysis after adjust-ment of sex and age showed that FⅪ level was a risk factor for DVT recurrence(P＜0.05).When the FⅪ level was set into tertile and the risk ratio was calculated after adjustment,FⅪ＜10.3 U/L,and the average FⅪ level at this stage was 9.2 U/L,the risk ratio was 0.82(95％CI:0.673-0.984);Patients with FⅪ between 10.3 and 12.1 U/L,and the average FⅪ at this stage was 11.4 U/L,the risk ratio of 1.04(95％CI:0.813-1.432).The those with FⅪ＞12.1 U/L,and the average FⅪ at this stage was 13.8 U/L,hazard ratio of 1.38(95％CI:0.921-1.563).Kaplan-Meier curve analysis showed that the recurrence risk was 28.62％(95％CI:25.633-31.609),30.10％(95％CI:27.594-32.606)and 38.06％(95％CI:34.306-41.371),respectively for the low-,medium-,and high-level groups,with significant correlation among the three groups(x2=6.631,P=0.036).Conclusion Compared with healthy individuals,plasma FⅪ level is at a high level in the DVT patients.With the increment of FⅪ level,the risk of DVT recurrence increases.Two FⅪ levels,10.3 U/L and 12.1 U/L,can be used as reference points for the obvious increase of DVT recur-rence rate.

Objective:To investigate the clinical significance of intraoperative prepositioning of dual mediastinal drains in elderly patients developing anastomotic leakage(AL)after a total endoscopic Ivor-Lewis procedure.Methods:This retrospective case-control study analyzed the clinical data of 500 elderly patients who underwent total endoscopic Ivor-Lewis surgery for esophageal or cardia cancer from January 2020 to December 2022.In the control group, one mediastinal drainage tube was placed intraoperatively, while in the study group, two mediastinal drainage tubes were placed.Both groups had a chest tube placed conventionally.The study compared the incidence of anastomotic leak(AL)at 1 month postoperatively, inflammatory indexes in patients with AL, grading of AL, rate of nasal fistula placement, incision infection, anastomotic stenosis, and incidence of hoarseness.Additionally, it compared ICU occupancy, ventilator use, and ICU length of stay between the two groups.Results:The analysis included clinical data from 455 elderly patients.Among the patients who developed AL, the study group had significantly lower peak body temperature[(39.58±1.03)℃ vs.(38.05±0.56)℃, t=4.298, P<0.05], white blood cell count[(18.63±3.35)×10 9/L vs.(14.28±2.78)×10 9/L, t=3.450, P<0.05], and C-reactive protein(CRP)levels[(154.66±41.64)mg/L vs.(122.19±31.29)mg/L, t=2.131, P<0.05]. The study group also had a significantly lower grading of AL and rate of nasal fistula placement(82.4% vs.30.0%, P<0.05). In terms of ICU indicators, the study group had a significantly lower ICU admission rate(64.7% vs.10.0%, P<0.05), shorter period of ventilator use[(6.47±8.15)days vs.(0.90±2.23)days, t=2.62, P<0.05], and shorter ICU stay[(11.70±8.89)days vs.(4.70±6.27)days, t=2.184, P<0.05]. Conclusions:Double mediastinal drainage tubes, have been found to significantly alleviate inflammation, decrease the rate of nasal fistula placement and ICU admission, and shorten the length of ICU stay in elderly patients.Therefore, they are considered safe and deserving of clinical promotion.

Objective:To study the predictive value of Barcelona clinic liver cancer (BCLC) staging system combined with albumin-indocyanine green (ALICE) score (ALICE-BCLC) in hepatectomy for hepatocellular carcinoma, and compare it with BCLC staging system combined with Child-Pugh score (CP-BCLC).Methods:The clinical data of 311 patients with hepatocellular carcinoma who underwent hepatectomy at Jinhua Hospital Affiliated to Zhejiang University from April 2012 to June 2021 were analyzed retrospectively. There were 271 males and 40 females, with a median age of 59 years old (range 26 to 92 years old). These patients were divided into two groups based on the ALICE-BCLC: the ALICE-BCLC grade 0 group ( n=63) and the ALICE-BCLC grade A group ( n=248); and another two groups based on the CP-BCLC: the CP-BCLC grade 0 group ( n=58) and the CP-BCLC grade A group ( n=253). The clinical data, including indocyanine green retention rate at 15 min, and albumin were collected and the scores were calculated. Follow-up was conducted by combining outpatient visits with telephone calls. The survival rate was calculated by the life method, and survival curves were drawn by the Kaplan-Meier method. The multivariate Cox regression model was used to determine the main factors affecting prognosis. Weighted Kappa was used to compare consistency of the two staging systems. Results:Multivariate analysis showed that a maximum tumor diameter >5 cm, total bilirubin >18 μmol/L, major hepatectomy, CP-BCLC grade A and ALICE-BCLC grade A to be independent risk factors affecting overall survival of patients with hepatocellular carcinoma after liver resection with curative intent (all P<0.05). The median survival of patients in the CP-BCLC grade 0 group and the CP-BCLC grade A group were 43.0 and 28.0 months, respectively. There was a significant difference between the two groups ( P=0.017). The median survival of patients in the ALICE-BCLC grade 0 group and the ALICE-BCLC grade A group were 41.4 and 28.1 months, respectively. There was a significant difference between the two groups ( P=0.035). The weighted Kappa coefficient of ALICE-BCLC and CP-BCLC was 0.949, showing a strong consistency ( P<0.001). Conclusion:ALICE-BCLC showed a good predictive value for prognosis of hepatocellular carcinoma after liver resection, and it had a similar overall prognostic discrimination ability as CP-BCLC.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been reapproved for heart failure (HF) therapy in patients with and without diabetes. However, the initial glucose-lowering indication of SGLT2i has impeded their uses in cardiovascular clinical practice. A challenge of SGLT2i then becomes how to separate their anti-HF activity from glucose-lowering side-effect. To address this issue, we conducted structural repurposing of EMPA, a representative SGLT2 inhibitor, to strengthen anti-HF activity and reduce the SGLT2-inhibitory activity according to structural basis of inhibition of SGLT2. Compared to EMPA, the optimal derivative JX01, which was produced by methylation of C2-OH of the glucose ring, exhibited weaker SGLT2-inhibitory activity (IC₅₀ > 100 nmol/L), and lower glycosuria and glucose-lowering side-effect, better NHE1-inhibitory activity and cardioprotective effect in HF mice. Furthermore, JX01 showed good safety profiles in respect of single-dose/repeat-dose toxicity and hERG activity, and good pharmacokinetic properties in both mouse and rat species. Collectively, the present study provided a paradigm of drug repurposing to discover novel anti-HF drugs, and indirectly demonstrated that SGLT2-independent molecular mechanisms play an important role in cardioprotective effects of SGLT2 inhibitors.

Objective To explore the role of multi-department cooperation in the prevention and control of nosocomial infection of multi-drug-resistant bacteria(MDRO). Methods Theretrospective analysis was conducted on 1 478 inpatients before the implementation of multi-department cooperative management (January 2019 to December 2019). The implementation of multi-department cooperative management began in January 2020, including :(1) the establishment of multi-department cooperative management organization system; (2) Establish a three-level MANAGEMENT network of MDRO; (3) Multidisciplinary joint training; (4) Clinical departments shall be equipped with clinical pharmacists; (5) The hospital infection monitoring system was used to conduct real-time monitoring on the submission of microbial samples, the detection rate of MDRO, the changes of drug-resistant bacteria and the use of antibiotics; (6) Led by the department of hospital pathology and medical Service, regular joint ward rounds should be conducted in the departments and key departments with high DETECTION rate of MDRO; (7) PDCA cycle mode was adopted for quality control of all links of nosocomial infection prevention and control measures; After the implementation of multi-department cooperative management (January 2020 to December 2020), all the hospitalized patients in 1849 cases were detected and counted, and the incidence of nosocomial infection, the detection rate of MDRO, the compliance rate of hand hygiene, the implementation rate of contact isolation, and the specimen inspection rate of therapeutic use of antibiotics and the reasonable utilization rate of antibiotics were compared before and after the implementation. Results The incidence of nosocomial infection and the detection rate of MDRO were significantly lower after the implementation of multi-department cooperative management than before (χ²=46.611, χ²=16.814, P < 0.05). The hand hygiene compliance rate and contact isolation implementation rate were significantly higher after the implementation of multi-department cooperative management than before (χ² = 25.357, χ²=29.227, P<0.05). After the implementation of multi-department cooperative management, the sample test rate of therapeutic use of antibiotics was significantly higher than that before the implementation of multi-department cooperative management (χ²=25.576, χ²=33.624, P<0.05). Conclusion The practice of multi-department cooperative management brings into full play the advantages of interdisciplinary complementarity, improves the ability of medical staff to implement the prevention and control measures for MDRO, and can effectively reduce the incidence of nosocomial infection in MDRO.

Objective:To investiagte the ability of albumin-indocyanine green (ALICE) score, albumin-bilirubin (ALBI) score and Child-Pugh score in predicting postoperative liver failure (PHLF) in patients with hepatocellular carcinoma, and to determine the clinical value of ALICE score.Methods:The clinical data of 397 patients with hepatocellular carcinoma who underwent hepatectomy in the Department of Hepatobiliary and Pancreatic Surgery, Jinhua Hospital Affiliated to Zhejiang University from June 2015 to June 2021 were retrospectively analyzed, including 350 males and 47 females, aged (58.9±11.2) years. Univariate and multivariate logistic regression were used to analyze the risk factors of PHLF. The predictive ability of ALICE score for PHLF was evaluated by receiver operating characteristic (ROC) curve, and compared with ALBI score and Child-Pugh score.Results:There were 74 patients with PHLF and 323 patients without PHLF. Multivariate logistic regression analysis showed that Child-Pugh score ( OR=1.630, 95% CI: 1.251-2.486, P=0.034), ALBI score ( OR=1.863, 95% CI: 1.028-3.119, P=0.049) and ALICE score ( OR=1.759, 95% CI: 1.216-3.078, P=0.038) were independent risk factors for PHLF in patients with hepatocellular carcinoma, and the risk of PHLF increased with the increase of grade. The area under the ROC curve of ALICE score predicting PHLF in patients with hepatocellular carcinoma was 0.613 (95% CI: 0.564-0.662), the area under the ALBI score was 0.612 (95% CI: 0.563-0.661), and the area under the Child-Pugh score was 0.555 (95% CI: 0.505-0.605). The ALICE score was better than the Child-Pugh score, and the difference was statistically significant ( z=2.04, P=0.041). In small liver resection patients, ALICE score was better than Child-Pugh score ( z=2.61, P=0.009). There was no significant difference betwenn ALICE score and ALBI score ( z=0.06, P=0.954). Conclusion:ALICE score can predict the occurrence of PHLF in patients with hepatocellular carcinoma, especially in patients with small liver resection, its value is similar to ALBI score, but better than Child-Pugh score.

Objective:To observe any effect of task-oriented training in the activities of daily living (ADL) for stroke patients.Methods:Sixty-two hemiplegic stroke survivors were randomly divided into an experimental group and a control group, each of 31. In addition to routine occupational therapy, the control group exercised on their own, while the experimental group underwent 45-minute task-oriented training sessions based on ADL action analysis every day, 5 days a week for 6 weeks consecutively. Before and after the treatment the upper limb functioning of both groups was quantified using Fugl-Meyer upper limb motor function scoring (FMA-UE) and Brunnstrom staging (BSS). ADL skill was assessed using the modified Barthel index (MBI).Results:After the treatment, the average FMA-UE and MBI scores of both groups were significantly better than before the treatment and better than the control group′s averages. The average BSS scores had also improved significantly, with that of the experimental group significantly better than the control group′s average.Conclusions:Task-oriented training based on ADL motion analysis can significantly improve upper limb motor functioning and ADL ability after a stroke despite hemiplegia. Its efficacy is better than that of conventional occupational therapy alone.

Objective     To summarize the clinical experience of cardiac surgery during pregnancy in a single center for the past 11 years. Methods    The clinical data of 26 pregnant patients (mean age 28.6±4.9 years) complicated with heart diseases who underwent non-emergency cardiac surgery with cardiopulmonary bypass from 2010 to 2020 in Guangdong Provincial People's Hospital were retrospectively analyzed. Patients were divided into two groups according to the gestational age at the time of surgery: a change group (gestational age<21 weeks) and a stable group (gestational age≥ 21 weeks). The hospitalization data and follow-up data of the patients were collected. Results    Mean gestational age at surgery was 23.4±4.2 weeks. Eleven patients had congenital heart diseases and fifteen had valvular heart diseases. Mean postoperative ICU stay was 2.5±2.4 d, and mean total hospital stay was 22.5±9.5 d. There were 5 postoperative fetal losses. There was no maternal death during follow-up. No statistical difference in the maternal postoperative outcomes between two groups. Conclusion    The number of patients undergoing cardiac surgery during pregnancy is increasing. The maternal mortality rate is low and the prognosis is good, but the fetal loss remains concern. Cardiac surgery performed before or after the establishment of cardiopulmonary adjustment in pregnancy does not change the maternal postoperative outcomes.

Obesity-related hypertension is a common hypertension as well as a common chronic disease with wide distribution and great harm to human health. In recent years, this disease has become one of the hot issues of public health due to the significant increase in prevalence. The pathogenesis and pathway of obesity-related hypertension are not yet clear, and the research on its pathogenesis has received extensive attention. Studies have shown that they are regulated in most biological processes, including differentiation, proliferation, migration, and apoptosis. The miR-200 family is a group of miRNAs, which have been suggested to play a crucial role in obesity-related hypertension and glucolipid metabolism dysfunction in recent years. This paper reviews relevant research results, suggesting that the expression level of miR-200 family in obese patients with hypertension is higher than that in healthy people, which regulates the occurrence and development of hypertension through mediating oxidative stress response and GATA expression level. This review reveals the relationship between miR-200 family and obesity-related hypertension, which offers new clues to explore potential therapeutic targets for obesity-related hypertension.

Objective:To translate the Cardiac Symptom Survey and analyze its reliability and validity in the post-valvular heart replacement survey and to provide the basis for the clinical application of this scale.Methods:The symptoms of 233 patients after heart valve replacement were investigated in Suining Central Hospital by Chinese version of the Cardiac Symptom Survey. The reliability of the scale was evaluated by Cronbach'α coefficient and the split half coefficient, the validity of the scale was evaluated by exploratory factor analysis and content validity index.Results:The internal consistency coefficient of the Chinese version of the Cardiac Symptom Survey ranged from 0.875 to 0.968, both above 0.870.The split half coefficient was 0.699,which demonstrated better internal consistency.The content validity index of the Chinese version of the Cardiac Symptom Survey ranged from 0.84 to 1.00.Factor analysis got five factors, which explained 68.133% of the total variance.Conclusions:The Chinese version of the Cardiac Symptom Survey has good reliability and validity in the investigation of the symptoms of patients after heart valve replacement, and can be used for the investigation and management of the symptoms of patients after heart valve replacement.