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.

Proximity labeling catalyzed by promiscuous enzymes,such as APEX2,has emerged as a powerful approach to characterize multiprotein complexes and protein-protein interactions.How-ever,current methods depend on the expression of exogenous fusion proteins and cannot be applied to identify proteins surrounding post-translationally modified proteins.To address this limitation,we developed a new method to label proximal proteins of interest by antibody-mediated protein A-ascorbate peroxidase 2(pA-APEX2)labeling(AMAPEX).In this method,a modified protein is bound in situ by a specific antibody,which then tethers a pA-APEX2 fusion protein.Activation of APEX2 labels the nearby proteins with biotin;the biotinylated proteins are then purified using streptavidin beads and identified by mass spectrometry.We demonstrated the utility of this approach by profiling the proximal proteins of histone modifications including H3K27me3,H3K9me3,H3K4me3,H4K5ac,and H4K12ac,as well as verifying the co-localization of these iden-tified proteins with bait proteins by published ChIP-seq analysis and nucleosome immunoprecipi-tation.Overall,AMAPEX is an efficient method to identify proteins that are proximal to modified histones.

Triptolide has wide clinical applications due to its anti-inflammatory, anti-tumor and immunosuppressive activities. In this study, we investigated the effect of blocking isopentenyl pyrophosphate (IPP) translocation on the biosynthesis of triptolide by exogenously adding D,L-glyceraldehyde (DLG) to the suspension cells of Ttripterygium wilfordii at different stages (7 d, 14 d). Subsequently, the cell viability, biomass accumulation, triptolide contents, as well as the profiles of the key enzyme genes involved in the upstream pathway of triptolide biosynthesis, were analyzed. The results showed that IPP translocation is involved in the biosynthesis of triptolide. IPP is mainly translocated from the plastid (containing the MEP pathway) to the cytoplasm (containing the MVA pathway) in the early stage of the culture, but reversed in the late stage. Blocking the translocation of IPP affected the expression of key enzyme genes involved in the upstream pathway of triptolide, which in turn affected the accumulation of triptolide. Understanding the characteristics and mechanism of IPP translocation provides a theoretical basis for further promoting triptolide biosynthesis through synthetic biology.
Diterpenes ; Epoxy Compounds ; Hemiterpenes ; Organophosphorus Compounds ; Phenanthrenes

Objective:To explore the surgical techniques and outcomes of closed reduction for geriatric subtrochanteric femoral fractures with certain radiological characteristics.Methods:A retrospective analysis was conducted in the 38 aged patients with subtrochanteric femoral fracture who had been treated at Department of Geriatric Orthopedics, Guangdong Provincial Hospital of Chinese Medicine from January 2015 to December 2019. There were 24 females and 14 males, aged from 62 to 95 years (average, 80.9 years). According to the Seinsheimer classification, there were one case of type ⅡB, 7 cases of type ⅡC, 18 cases of type ⅢA, 9 cases of type Ⅳ, and 3 cases of type Ⅴ. The time from injury to operation averaged 2.3 days (from 0.5 to 8.0 days). The fractures of this cohort were characterized by: ①The starting point of the medial fracture line was at the proximal end and the lesser trochanter separated. ②The fracture end was shortened and overlapped on the medial side and angled outward, showing a varus deformity. ③The alignment returned to normal after traction, with only partial lateral displacement left. Before fixation with proximal femoral nail antirotation (PFNA), all these patients were treated by closed reduction in a supine traction bed. In those whose reduction was unsatisfactory, a main nail was inserted or after the main nail was inserted reduction by leverage was performed through the screw blade incision. Intraoperatively, the quality of fracture reduction was evaluated according to the modified Baumgaertner assessment. Recorded were the patients’ operation time, intraoperative blood loss, fracture healing time, hip function and complications.Results:All the fractures achieved 100% of good to excellent reduction (38/38). The operation time ranged from 25 to 120 min (average, 55.6 min) and the intraoperative blood loss from 10 to 150 mL (average, 42.9 mL). This cohort of 38 patients was followed for 10 to 20 months (average, 15.3 months). All the fractures united after 3 to 8 months (average, 4.8 months). The Harris hip scores at the last follow-up ranged from 70 to 94 (average, 81.5). The follow-ups revealed no such complications as internal fixation failure, fracture re-displacement, malunion or nonunion.Conclusion:Closed reduction and PFNA fixation in a supine traction bed can lead to satisfactory clinical effects for the subtrochanteric femoral fractures with certain radiological characteristics in the aged patients.

Objective:To evaluate the clinical efficacy and safety of combination of traditional Chinese and Western medicine in the treatment of coronavirus disease 2019 (COVID-19) by Meta analysis.Methods:The clinical randomized controlled trials (RCT) and cohort studies on the treatment of COVID-19 with combination of Chinese traditional and Western medicine published on CNKI, Wanfang database, VIP database and PubMed were searched by computer from January 2020 to June 2020. Patients in the simple Western medicine treatment group were treated with routine treatment of Western medicine, and the patients in integrated traditional Chinese and Western medicine treatment group were treated with traditional Chinese medicine on the basis of routine treatment of Western medicine. The main outcome was the total effective rate of treatment. The secondary outcome were the antipyretic rate, chest CT recovery rate, lymphocyte count (LYM), C-reactive protein (CRP) level and safety. The Cochrane manual and the Newcastle Ottawa Scale (NOS) were used to evaluate the quality of the literature; the RevMan5.3 software was used to analyze the articles that meets the quality standards, and a funnel chart was drawn to evaluate the total effective publication bias.Results:Thirteen articles were analyzed, including 1 039 COVID-19 patients, 559 in integrated traditional Chinese and Western medicine treatment group and 480 in simple Western medicine treatment group. The results of Meta-analysis showed that compared with the simple Western medicine treatment group, the combination of routine treatment of Western medicine and traditional Chinese medicine Qingfei Paidu decoction, Lianhua Qingwen granule, Shufeng jiedu capsule, Xuebijing injection or Reyanning mixture could significantly improve the total effective rate, antipyretic rate and chest CT recovery rate [total effective rate: odds ratio ( OR) = 2.95, 95% confidence interval (95% CI) was 2.10-4.14, P < 0.000 01; antipyretic rate: OR =3.01, 95% CI was 1.64-5.53, P = 0.000 4; chest CT recovery rate: OR = 2.53, 95% CI was 1.83-3.51, P = 0.000 1], increase LYM levels [mean difference ( MD) = 0.26, 95% CI was 0.02-0.50, P = 0.03], and reduce of CRP content ( MD = -17.68, 95% CI was -33.14 to -2.22, P = 0.02). Based on the funnel chart analysis of 12 articles with total efficiency, the result showed that the funnel chart distribution was not completely symmetrical, indicating that there might be publication bias. Conclusions:On the basis of routine treatment with Western medicine, combined with traditional Chinese medicine can significantly improve the total effective rate of COVID-19 and improve the laboratory results and clinical symptoms of patients. Compared with the routine treatment of Western medicine alone, the combination of traditional Chinese and Western medicine has better clinical efficacy and safety.

Objective:To analyze the research status, research hotspots and frontier trends of traditional Chinese medicine (TCM) in the treatment of influenza in the past 20 years through the knowledge graph, so as to provide reference basis for further research.Methods:The related literatures of TCM in the treatment of influenza were collected in China National Knowledge Infrastructure (CNKI) from 2000 to 2019. The relevant graphs of authors, research institutions and key words were drawn by CiteSpace 5.6, the distribution and cooperation of main research forces in this field were analyzed, and the research frontiers and hot spot information in this field were discussed.Results:A total of 3 048 related literatures were obtained, involving 949 authors and 242 research institutions. The analysis of the number of articles showed that the volume of articles related to the treatment of influenza with TCM fluctuated greatly in the past 20 years, which was obviously affected by the sudden hot spots around 2010, but showed an overall upward trend, with an average annual volume of about 152 articles. The analysis of the author's cooperation map showed that a total of 77 core authors had published more than 5 articles, accounting for only 8.1% of all authors, and 5 authors had published more than 30 articles. Five major teams had been formed with Gu Ligang, Liu Qingquan, Lu Fangguo, Cui Xiaolan and Zhang Fengxue as the core. The analysis of the cooperation map of research institutions showed that the cooperation among institutions was not good, and only the scientific research institutes in Beijing and Guangzhou had formed a closely related cooperation network. The keyword co-occurrence map showed that 8 keywords appeared more than 100 times, especially ultra-high-frequency keywords, influenza virus ranked first ( n = 518). There were 14 key nodes, such as influenza virus, TCM treatment, viral pneumonia and so on, which supported the current research field of TCM in the treatment of influenza. Fourteen clusters were formed to classify the current research hotspots, including the nomenclature of influenza, virus type, TCM treatment, western medicine knowledge, etc., and the map showed that the clustering was reasonable and the structure was significant. Timeline graph showed that parainfluenza virus, virus disease, pharmacodynamics, heat-clearing and detoxifying drugs, bacteriostasis and experimental research had all been studied for more than 8 years, revealing the research hotspots and trends of TCM in the treatment of influenza. Conclusions:The overall research related to the treatment of influenza with TCM is relatively perfect. In the future, the close cooperation among authors and institutions should be strengthened. The molecular mechanism research, clinical and animal trials of TCM should be further studied, so as to improve the research system of TCM treatment of influenza.

Objective To explore the effects of thunder-fire moxibustion in improving affected upper limb hypermyotonia of patients after stroke, so as to provide a clinical basis for improving affected upper limb hypermyotonia (spasm) after stroke. Methods From June 2016 to February 2017, we selected 100 stroke patients from Fastern Area of Dongzhimen Hospital, Beijing University of Chinese Medicine. All of the patients were divided into control group and experimental group according to the order of admission, 50 cases in each group. Patients of control group accepted routine rehabilitation training. On that basis, patients of experimental group were also treated with thunder-fire moxibustion. We compared the rehabilitation efficacy of two groups with the activity of daily living (Barthel) and the Modified Ashworth Scale (MAS). Results The scores of MAS of experimental group were (1.83±0.64) and (1.27±0.85) respectively 14 and 28 days after intervention, lower than those of control group [(2.60±0.79), (1.99±0.85)]with significant differences (t=-2.711, -2.808; P<0.01). There was a significant difference in the score of activity of daily living between experimental group (55.44±19.77) and control group (48.85±13.73), (t=2.112, P=0.037). Conclusions The thunder-fire moxibustion combined with rehabilitation could improve the activity of daily living of patients after stroke and reduce the degree of affected upper limb spasm of patients.

[Objective]To evaluate the effects of sutureless technique in comparison to conventional techniques for repair of total anomalous pulmonary venous connection(TAPVC)with the method of propensity score analysis.[Methods]From October 2007 to December 2013,179 consecutive patients were enrolled in this study. Patients were operated with sutureless technique(n = 81)or Conventional technique(n=98),and followed up at an interval of 1 month,3 months,6 months and then once a year post-operation. During analysis,three type of propensity-score matching methods,including nearest neighbor caliper matching,Mahalanobis metric matching with propensity score ,optimal full matching were used to create balanced groups of patients receiving each treatment. Surgeons’performance difference was assessed with random frailty proportional hazards models with gamma. Composite endpoints was defined by postoperative death or late death or postoperative pulmonary venous obstruction(PVO),which was evaluated with Kaplan-Meier curve and multivariable Cox proportional hazard model,adjusted by Preoperative-PVO,age,gender,weight and TAPVC type.[Results]Nearest neighbor caliper matching method was the best choice during propensity score analysis. After matching ,sutureless group included 73 patients and Conventional group73 patients. In sutureless group,cardiopulmonary bypass(CPB)time(Z=2.18, P=0.030),cross-clamp time(Z=3.63,P<0.001),rate of composite endpoints(HR 95%CI=0.20(0.06~0.61),P=0.005),late death(HR 95%CI=0.03(0.01~0.55),P=0.017)were significantly better than that in Conventional group. In subgroup analysis ,for patients with pre-PVO,decreased composite endpoints was seen in sutureless group.[Conclusion]Comparison using thepropensity score analysis demonstrated that sutureless strategy for primary repair of TAPVC may associate with decreased mortality rate of post-PVO and CPB time and cross-clamp time.

Objective To observe the subfoveal choroidal thickness (SFCT) and choriocapillary blood flow area (CBFA) in the patients with idiopathic macular hole (IMH).Methods This is a prospective clinical study.Thirty-two patients with unilateral IMH (4 in stage 2,17 in stage 3,11 in stage 4) and 32 age-and sexmatched normal controls were enrolled in this study.All eyes were divided into three groups,including group A (32 affected eyes),group B (32 fellow eyes) and group C (32 normal eyes of controls).There was no significant difference in age (t=0.865) and gender (x2=0.000) in IMH patients versus normal control subjects (P＞0.05).There was no significant difference in refraction (F=0.957) and ocular axial length (F=0.562) between group A,B and C.The SFCT was detected by enhanced depth imaging of spectral-domain optical coherence tomography (OCT).The CBFA was detected by OCT angiography.The differences of SFCT and CBFA in three groups were analyzed by Kruskal-Wallis and non-parametric test.Results The mean SFCT was (182.53 ±64.52) μtm in group A,(199.21 t73.07) μtm in group B and (254.21 ±56.85) μtm in group C respectively.The SFCT was thinner in group A and B than that in group C (Z=-4.362,-3.190;P＜0.05),but was the same in group A and B (Z=-1.171,P＞0.05).The mean CBFA was (5.09±0.31) mm2 in group A,(5.41 ±0.20) mm2 in group B and (5.39±0.15) mm2 in group C respectively.The CBFA was reduced in group A than that in group B and C (Z=-4.467,-4.048;P＜0.05),but was samc in group B and C (Z=0.420,P＞0.05).Conclusion SFCT and CBFA are both reduced in IMH eyes.

Objective To observe the clinical efficacy ofvitrectomy combined with modified inverted internal limiting membrane (ILM) flap covering technique for complicated macular hole (MH).Methods This is a retrospective case series.Twenty-one eyes of 20 patients who underwent vitrectomy combined with modified inverted ILM flap covering technique were enrolled in this study.Among these eyes,9 eyes were idiopathic MH (IMH),with the mean basal diameter of (1 188.3 ± 155.1) μm,minimum diameter of (626.9± 86.2) μm,logarithm of the minimum angle of resolution (logMAR) best corrected visual acuity (BCVA) of 1.1 ± 0.3;2 eyes were MH with high myopia,with the mean basal diameter of (696.5 ± 232.6) μm,minimum diameter of (259.0±69.3) μm,logMAR BCVA of 1.3;5 eyes were high myopia MH with retinal detachment (RD),with the mean BCVA of 1.5 ± 0.1;3 eyes were rhegmatogenous RD (RRD) with MH,with the mean logMAR BCVA of 1.6;2 eyes were MH after vitrectomy for RRD,with the mean basal diameter of(1 606.0±69.3) μm,minimum diameter of (909.0±387.5) μm,logMAR BCVA of 1.6.All patients received 23G or 25G vitrectomy after removal of posterior vitreous cortex intraoperatively.Indocyanine green staining assisted circle-wise ILM peeling was performed.ILM of diameter 1.5 disc-diameters around fovea was residual and loosened;perfluoronoctane assisted inverting superior or temporal residual ILM covering on macular hole.C3F8,gas or silicone oil tamponade was performed at the end.BCVA and hole closure were followed up for 1-4 months.C3F8,gas or silicone oil was tamponaded at the end.BCVA and hole closure were followed up for 1-4 months.Results MH of 21 eyes were closed after surgery.Nine IMH were closed at type Ⅰ,with U shape closure in 7 eyes,V shape closure in 2 eyes.Two eyes of MH with high myopia,3 eyes of RRD with MH,2 eyes of MH after vitrectomy for RRD were closed at type Ⅰ of U shape.Five eyes of high myopia MHRD including MH closure at type [of U shape 3 eyes,type Ⅱ of W shape 2 eyes.The mean logMAR BCVA of IMH,MH with high myopia,high myopia MHRD,RRD with MH,MH after vitrectomy for RRD eyes were 0.8±0.3,0.9±0.2,1.4±0.1,0.7±0.3,0.9 ± 0.2,respectively.The mean postoperative logMAR BCVA in IMH eyes was improved compared preoperative one (P=0.02).There was no obvious change of pre-and postoperative logMAR BCVA in MH with high myopia,high myopia MHRD,RRD with MH,MH after vitrectomy for RRD eyes (P=0.18,0.10,0.11,0.18).Conclusion Vitrectomy combined with inverted ILM flap covering technique for complicated MH is an effective method to improve the success rate of MH closure and the visual function.