Objective To study the clinical effect of Shengjin Yiwei Decoction on chronic heart failure(CHF)complicated with gastrointestinal dysfunction in patients with deficiency of stomach Yin.Methods Totally 68 patients with stomach Yin deficiency syndrome CHF complicated with gastrointestinal dysfunction in our hospital were selected.On the basis of active treatment of heart failure,the control group was treated with omeprazole enteric-soluble capsule,domperidone tablet and pancrease enteric-soluble capsule,and the experimental group was treated with Shengjin Yiwei Decoction.The clinical efficacy of the two groups was compared.traditional Chinese medicine symptom quantification score,gastrointestinal function quantification score,serum gastrin(GAS),plasma motilin(MTL),interleukin(IL)-6 and tumor necrosis factor(TNF)-α levels.Results The effective rate of experimental group was significantly higher than that of control group(χ2=13.73,P<0.05).After treatment,the quantitative score of gastrointestinal dysfunction,quantitative score of TCM symptoms,serum IL-6 and serum TNF-α levels in 2 groups were significantly lower than before treatment,and the above indexes in test group were significantly lower than control group(P<0.05).The levels of serum GAS and plasma MTL in 2 groups were significantly higher than before treatment,and the above indexes in test group were significantly higher than those in control group(P<0.05).Conclusion Shengjin Yiwei Decoction has obvious curative effect on stomach and Yin deficiency syndrome CHF complicated with gastrointestinal dysfunction,can improve clinical manifestations,adjust the level of gastrointestinal hormones and inflammatory factors,and is worthy of clinical application.

Objective:To subdivide clinical classification of refractory atlantoaxial dislocation, and evaluate the reliability of new subdivide clinical classification of refractory atlantoaxial dislocation.Methods:From January 2010 to December 2018, 48 patients with refractory atlantoaxial dislocation were treated, including 19 males and 29 females, aged 16 to 65 years, with an average of 39.2±13.3 years. According to the changes of relative anatomical position of C 1 and C 2 under general anesthesia with heavy traction of 1/6 body weight, subdivide clinical classification of refractory atlantoaxial dislocation were proposed, and refractory atlantoaxial dislocation was divided into traction loosening type (atlantoaxial angle≥5°) and traction stabilization type (atlantoaxial angle<5°). The traction loosening type was directly reduced by posterior atlantoaxial screw-rod fixation and fusion without anterior or posterior soft tissue release. For traction stabilization type, transoral soft tissue release was performed first, and then transoral anterior reduction plate fixation and fusion or posterior atlantoaxial screw-rod fixation and fusion were performed. Atlantodental interval (ADI) and atlantoaxial angle (AAA) were measured and collected before and after surgery to evaluate atlantoaxial reduction. The space available for the spinal cord (SAC) were measured to evaluate spinal cord compression. Visual analogue score (VAS) was used to evaluate the neck pain levels, and Japanese Orthopaedic Association (JOA) scores was used to evaluate the neurological function. American Spinal Cord Injury Association impairment scale (AIS) was used to evaluate the degree of spinal cord injury. One week, 3, 6, 12 months postoperatively and the annual review of the X-ray and CT scan were checked, in order to evaluate the reduction, internal fixation and bone graft fusion. Results:Among all 48 cases, 22 cases were traction loosening type, of which posterior atlantoaxial screw-rod fixation and fusion were performed in 16 cases and occipitocervical fixation and fusion in 6 cases. 26 cases were traction stabilization type, and they all underwent anterior transoral release, and then, anterior TARP fixation and fusion were performed in 24 cases and posterior screw-rod fixation and fusion in the other 2 cases. X-ray, CT and MRI images and of all patients 1 week after surgery showed good atlantoaxial reduction and decompression of spinal cord. In each of the two types, there was one case lost to follow-up. For 46 cases in follow-up, the follow-up time ranged from 6 to 72 months, with an average of 38.0±17.2 months. Among 46 cases, 21 cases of traction loosening type showed that, ADI reduced from preoperative 9.9±2.2 mm to 2.3±0.9 mm at 3 months after surgery and 2.3±1.0 mm at the last follow-up, AAA increased from preoperative 57.9°±12.3° to 91.0°±2.2° at 3 months after surgery and 90.9°±2.2° at the last follow-up, SAC increased from preoperative 9.8±1.3 mm to 15.1±0.7 mm at 3 months after surgery and 14.9±0.7 mm at the last follow-up, VAS score reduced from preoperative 1.5±2.1 to 0.7±1.0 at 3 months after surgery and 0.3±0.6 at the last follow-up, and JOA score increased from preoperative 10.2±1.7 to 13.3±1.3 at 3 months after surgery and 14.9±1.5 at the last follow-up. Twenty-five cases of traction stabilization type presented that, ADI reduced from preoperative 9.7±2.0 mm to 2.1±1.4 mm at 3 months after surgery and 2.1±1.3 mm at the last follow-up, AAA increased from preoperative 55.8°±9.2° to 90.9°±1.4° at 3 months after surgery and 90.9°±1.3° at the last follow-up, SAC increased from preoperative 10.5±1.0 mm to 15.4±0.5 mm at 3 months after surgery and 14.8±2.8 mm at the last follow-up, VAS score reduced from preoperative 1.7±2.1 to 0.7±0.9 at 3 months after surgery and 0.3±0.5 at the last follow-up, and JOA score increased from preoperative 10.1±1.3 to 12.9±1.5 at 3 months after surgery and 14.4±1.3 at the last follow-up. In the traction loosening type, all the 10 grade D patients were improved to grade E at the last follow-up. In the 2 grade C patients of traction stabilization type before surgery, 1 patient was improved to grade E, 1 patient was improved to grade D, and all 11 patients with grade D were improved to grade E at the last follow-up. Bony fusion was obtained in all patients from 3 to 6 months, with an average of 4.4±1.5 months. During follow-up period, no looseness of internal fixation or redislocation happened.Conclusion:Refractory atlantoaxial dislocation can be divided into traction loosening type and traction stabilization type. For traction loosening type, satisfactory reduction can be achieved by using posterior atlantoaxial screw-rod system without soft tissue release. For traction stabilization type, anterior release is preferable, and then anterior TARP or posterior screw-rod can be used to achieve satisfactory reduction.

Objective    To discuss the operation skill and clinical effects of using domestic balloon-expandable Prizvalve® transcatheter "valve-in-valve" to treat the degenerated bioprosthesis in the tricuspid position. Methods    All the admitted surgical tricuspid valve bioprosthetic valve replacement patients were evaluated by computerized tomography angiography (CTA), ultrasound, and 3D printing technology, and 2 patients with a degenerated bioprosthesis were selected for tricuspid valve "valve-in-valve" operation. Under general anesthesia, the retro-preset Prizvalve® system was implanted into degenerated tricuspid bioprosthesis via the femoral vein approach under the guidance of transesophageal echocardiographic and fluoroscopic guidance. Results    Transcatheter tricuspid valve implantation was successfully performed in both high-risk patients, and tricuspid regurgitation disappeared immediately. The operation time was 1.25 h and 2.43 h, respectively. There was no serious complication in both patients, and they were discharged from the hospital 7 days after the operation. Conclusion    The clinical effect of the degenerated tricuspid bioprosthetic valve implantation with domestic balloon-expandable valve via femoral vein approach "valve-in-valve" is good. Multimodality imaging and 3D printing technology can safely and effectively guide the implementation of this innovative technique.

Objective: Several COVID-19 patients have overlapping comorbidities. The independent role of each component contributing to the risk of COVID-19 is unknown, and how some non-cardiometabolic comorbidities affect the risk of COVID-19 remains unclear. Methods: A retrospective follow-up design was adopted. A total of 1,160 laboratory-confirmed patients were enrolled from nine provinces in China. Data on comorbidities were obtained from the patients' medical records. Multivariable logistic regression models were used to estimate the odds ratio ( Results: Overall, 158 (13.6%) patients were diagnosed with severe illness and 32 (2.7%) had unfavorable outcomes. Hypertension (2.87, 1.30-6.32), type 2 diabetes (T2DM) (3.57, 2.32-5.49), cardiovascular disease (CVD) (3.78, 1.81-7.89), fatty liver disease (7.53, 1.96-28.96), hyperlipidemia (2.15, 1.26-3.67), other lung diseases (6.00, 3.01-11.96), and electrolyte imbalance (10.40, 3.00-26.10) were independently linked to increased odds of being severely ill. T2DM (6.07, 2.89-12.75), CVD (8.47, 6.03-11.89), and electrolyte imbalance (19.44, 11.47-32.96) were also strong predictors of unfavorable outcomes. Women with comorbidities were more likely to have severe disease on admission (5.46, 3.25-9.19), while men with comorbidities were more likely to have unfavorable treatment outcomes (6.58, 1.46-29.64) within two weeks. Conclusion Besides hypertension, diabetes, and CVD, fatty liver disease, hyperlipidemia, other lung diseases, and electrolyte imbalance were independent risk factors for COVID-19 severity and poor treatment outcome. Women with comorbidities were more likely to have severe disease, while men with comorbidities were more likely to have unfavorable treatment outcomes.
Adult ; Aged ; COVID-19/virology* ; China/epidemiology* ; Comorbidity ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Severity of Illness Index ; Treatment Outcome

OBJECTIVE: To screen new serum metabolic biomarkers for different drug resistance profiles of pulmonary tuberculosis (TB) and explore their mechanisms and functions. METHODS: We collected serum samples from TB patients with drug sensitivity (DS), monoresistance to isoniazid (MR-INH), monoresistance to rifampin (MR-RFP), multidrug resistance (MDR), and polyresistance (PR). The metabolites in the serum samples were extracted by oscillatory and deproteinization for LC-MS/MS analysis, and the results were normalized by Pareto-scaling method and analyzed using Metaboanalyst 4.0 software to identify the differential metabolites. The differential metabolites were characterized by function enrichment and co-expression analysis to explore their function and possible pathological mechanisms. RESULTS: Compared with the DS group, 286 abnormally expressed metabolites were identified in MR-INH group, 362 in MR-RPF group, 277 in MDR group and 1208 in PR group by LC-MS/MS analysis. Acetylagmatine ( < 0.05), aminopentol ( < 0.05), and tetracosanyl oleate ( < 0.05) in MR-INH group; Ala His Pro Thr ( < 0.001) and glycinoprenol-9 ( < 0.05) in MR-RFP group; trimethylamine ( < 0.05), penaresidin A ( < 0.05), and verazine ( < 0.05) in MDR group; and PIP (18:1(11Z)/ 18:3(6Z, 9Z, 12Z)) ( < 0.001), Pro Arg Trp Tyr ( < 0.001), N-methyldioctylamine ( < 0.001), and phytolaccoside E ( < 0.05) in PR group all showed significant differential expressions. Significant differential expressions of phthalic acid mono-2-ethylhexyl ester ( < 0.05) and eicosanoyl-EA ( < 0.05) were found in all the drug resistant groups as compared with DS group. CONCLUSIONS Acetylagmatine, aminopentol, tetracosanyl oleate, Ala His Pro Thr, glycinoprenol-9, trimethylamine, penaresidin A, verazine, PIP(18:1(11Z)/18:3(6Z, 9Z, 12Z)), Pro Arg Trp Tyr, N-methyldioctylamine, phytolaccoside E, phthalic acid mono-2-ethylhexyl ester, and eicosanoyl-EA are potentially new biomarkers that indicate monoresistance, multi-drug resistance and polyresistance of Mycobacterium tuberculosis. The combined use of these biomarkers potentially allows for assessment of drug resistance in TB and enhances the diagnostic sensitivity and specificity.
Biomarkers ; Chromatography, Liquid ; Humans ; Tandem Mass Spectrometry ; Tuberculosis, Multidrug-Resistant ; Tuberculosis, Pulmonary

Objective To investigate the effectiveness and safety of esophageal covered stent for the treatment of esophagogastric cervical anastomotic fistula. Methods Retrospective analysis of clinical and imaging data of patients with esophageal and gastric anastomotic neck fistula treated by esophageal membrane stent implantation in the Affiliated Tumor Hospital of Zhengzhou University from July 2015 to June 2018. Twenty‐one cases, 15 males and 6 females were enrolled. All patients showed fistula after esophagogastrostomy for esophageal carcinoma. All the fistulas were located in the cervical segment of esophagus and were diagnosed as anastomotic fistula 2 to 13 days after surgery. The length of esophagus residue, the position and size of the fistula were measured by esophagography. We retrospectively analyzed the data of patients with cervical anastomotic fistula treated with esophageal covered stent. Patients were followed up for more than 6 months by review and telephone follow‐up. Results In the 21 patients, 19 (90.5%) were successfully implanted stents at one time, and 2 (9.5%) were placed at a lower position. The esophageal stent was implanted for 10 to 60 days (31±19) days, and the stent was successfully removed after the fistula healed, with a procedure time of 6 to 23 minutes. No recurrence of fistula was found during follow‐up. Four patients had anastomotic scar stenosis, and eating smoothly after balloon dilatation. Conclusion Esophageal covered stent implantation is a safe and effective technique for gastroesophageal cervical anastomotic fistula.

Objective Toexploretheclinicalvalueofiterativedecompositionofwaterandfatwithechoasymmetryandleast-squaresestimationquantitationsequence(IDEAL-IQ)foraccurateandquantitativeevaluationofvertebraebodyfatfraction(FF)of lumbar.Methods Accordingtotheresultsofbonemineraldensity(BMD),60healthycheckers/patientsmatchingthestudycriteria weredividedintothenormalBMDgroup(groupA,n=17),thelowBMDgroup(groupB,n=18)andtheosteoporosis(OP)group (OP,groupC,n=25).Theageofthreegroupswasanalyzed.T1WI,T2WI,andIDEAL-IQsequenceswerescannedwithsagittallumbar.Rectangular ROIwereoutlinedonFatFracmaps,FFsweremeasuredthreetimesonvertebraebodyoflumbar1(L1),L2,L3,L4,L5,andtheFF ofeachlumbarwasrespectivelyaveragedtoanalyzethedifferencewithinandbetweengroups.Results Theageamongthethree groups(F=13.414,P=0.000)werestatisticallysignificantdifference.Inbothcomparisons,theagewassignificantdifferencebetweengroupA andB,aswellasbetweengroupAandC,butnotbetweengroupBandC.TheFFofL1-L5withineachgroupwerenotstatistically significantdifference(F=0.680,0.863,0.539,P=0.608,0.490,0.707),whilealldifferencesbetweeneachgroupwithFFofL1-L5 werestatisticalsignificance(F=12.758,9.646,5.195,8.048,8.849,P=0.000,0.000,0.008,0.001,0.000).Comparisonbetweenthe groups,theFFofL3andL5inthegroupAandBwerenotstatisticallydifferent,aswellastheL2,L3,L4inthegroupBandC, whiletheothersbetweentwogroupswerestatisticallysignificantdifference.Conclusion Astheageincreases,BMDgraduallydecreases,whilethe FFofL1-L5graduallyincreases.ItisofaccuratelyevaluatelumbarvertebraeFFbyIDEAL-IQ,whichmayhelppredictOP.

Objective To investigate the effect of embolization with ethanol-soaked gelatin sponge for the treatment of arterioportal shunting (APS) in patients with hepatocellular carcinoma (HCC). Methods From January 2016 to June 2017, a total of 78 patients with unresectable HCC were enrolled in this study. These patients were randomly divided into two groups by digital random method. The experimental group (n=39) received transarterial embolization of the shunt with ethanol-soaked gelatin sponge, while the control group (n=39) received only gelatin sponge shunt. Both of the two groups underwent transarterial chemoembolization if available. Changes in APS, tumor response (according to modified response evaluation criteria in solid tumor), changes in Eastern Cooperative Oncology Group (ECOG), and haemodynamics changes of the portal vein were analyzed. χ2 test and t test were used to compare the differences of qualitative and quantitative parameters between two groups. The APS grades were compared between the two groups before treatment and 2 months after treatment using rank sum test. Results Six patients were lost during the 2-month follow-up, and 72 patients were followed up, which include 38 patients in the experimental group and 34 patients in the control group. Compared to (14/34), the experimental group (25/38) has higher The APS improvement rates of the experimental group and the control group were 65.8％(25/38) and 41.2％(14/34), and there was significant difference (χ2=4.379, P<0.05). Of the 72 patients, 66 cases were conform to modified response evaluation criteria in solid tumor, which include 35 patients in the experimental group and 31 patients in the control group. Tumor response at 2 months of the experimental group and the control group were 57.1％(20/35) and 32.3％(10/31), and there was significant difference (χ2=4.106, P<0.05). The ECOG score was significantly decreased from 2 points to ≤1 point in 19 cases in the experimental group, while 12 cases in the control group (χ2=6.894, P<0.05). Compared with the control group, the diameter of the portal vein dropped significantly (t=2.082, P<0.05), while the blood flow velocity of portal vein increased (t=2.219, P<0.05) obviously in the experimental group 1 month after treatment. Conclusion Tansarterial embolization with ethanol-soaked gelatin sponge can effectively improve APS improvement rate, and quality of life of patients with unresectable HCC accompanied with APS.

BACKGROUND: Atlantoaxial posterior approach is currently the main surgical treatment for atlantoaxial instability and/or dislocation, but the shape of rod in normal screw-rod device system is cylindrical. To obtain satisfactory reduction of atlantoaxis, the rod will be pre-bent obviously before fixation; however, the cylindrical rod will be rotated when tighten the nuts. Extra devices will be required to adjust and maintain the direction of the rod, thereafter, the surgical field will be blocked by the device, and spinal injury will occur once the devices are not held tightly. While the novel automatic anti-rotation rod has the function of anti-rotation during nut-tightening process, and also holds all the advantages of normal rod. Further research should be performed for the differences in biomechanical characteristics between two methods.OBJECTIVE: To investigate the biomechanical properties of the novel automatic anti-rotation rod for internal fixation system of atlantoaxial posterior approach based on three-dimensional finite-analysis model of upper cervical spine.METHODS: The three-dimensional finite element model of upper cervical spine with internal rod fixation system was developed. The biomechanical characteristics of the internal fixation system were analyzed. RESULTS AND CONCLUSION: The traditional and novel three-dimensional finite element model with realistic and geometric similarity contained 198330 elements, 964747 nodes and 246788 elements, 996069 nodes,correspondingly. There was no obvious stress concentration in both two systems, stress was concentrated mainly in the screw-bone and screw-rod interfaces. The stress values of the novel system were higher than those of the traditional system, but the maximum Von Misses Stress of two systems was lower than the yield (795-827 MPa ) and ultimate (860-896 MPa) strength of titanium alloys. These results show that the design of the novel automatic anti-rotation rod-screw fixation system has matched the biomechanical requirements for new internal fixation instruments, and is one safe, effective and practical device for atlantoaxial posterior procedure showing promising application prospect.

Background and purpose: Short tandem repeats (STR) multiplex PCR fluorescence detection technology is the most widely used DNA technology in individual identity and genetic identification. It's the most direct method to obtain accurate conclusions. However, some studies have indicated that the rate of STR mutations in tumor tissue is significantly higher than that in normal tissues or blood. This study aimed to investigate the tendency of genetic instability in 20 STR loci on autosomal and Amel loci in tumor tissue samples from lung cancer. Methods: This study, collected 75 cases of human lung cancer tissues and the adjacent normal tissues. DNA samples were extracted by tissue DNA extraction kit, amplified using MicroreaderTM 21 Direct ID System PCR amplification kit. Capillary electrophoresis was performed using API 3130 analyzer, and results were analyzed by genetic analysis software (Gene Mapper ID V3.2). Results: STR alterations were detected in 24 specimens from 75 lung cancer tissues (32%). Fifty-five alterations were detected in the frequently used 21 STR loci in total, including additional alleles 10 times, loss of heterozygosity 10 times, partial loss of heterozygosity 35 times. Partial loss of heterozygosity was the most common genetic alteration types accounting for 63.64% of the total alteration frequency. And multiple genetic alteration types could occur in the same lung cancer tissue. Among them, the highest alteration frequency occurred on D5S818 (7 times), secondly on D3S1358 and D12S391 (both 5 times), and no alterations on D2S441 and Penta E. Combining the experimental results and analysis on clinical data, this study found the statistical differences between the staging of lung cancer and the age of the patients with the STR loci alterations (P<0.05). However, the alterations did have much relationship with the classification of lung cancer and the patient's gender (P>0.05). Conclusion: STR loci of the lung cancer tissue were not stable, and the alteration occurred in the aged or high malignant degree lung cancer tissue more frequently. Meanwhile, no alteration was detected on D2S441 and Penta E. In the future research the two STR loci should be verified to determine whether they can be used as the stable STR loci in such cases by increasing the sample size.