Objective To summarize the short-term results of valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) in the treatment of bioprosthetic valve failure after aortic valve replacement. Methods We reviewed the clinical data of patients who underwent ViV-TAVI from 2021 to 2022 in the First Affiliated Hospital of Zhengzhou University. The valve function was evaluated by echocardiography before operation, immediately after operation and 3 months after operation. The all-cause death and main complications during hospitalization were analyzed. Results A total of 13 patients were enrolled, including 8 males and 5 females with a mean age of (65.9±8.5) years, and the interval time between aortic valve replacement and ViV-TAVI was (8.5±3.4) years. The Society of Thoracic Surgeons mortality risk score was 10.3%±3.2%. None of the 13 patients had abnormal valve function after operation. The mean transvalvular pressure gradient of aortic valve was decreased (P<0.001), the peak flow velocity of aortic valve was decreased (P<0.001), and the left ventricular ejection fraction was not changed significantly (P=0.480). There were slight perivalvular leakage in 2 patients and slight valve regurgitation in 3 patients. Three months after operation, the mean transvalvular pressure difference and peak flow velocity of aortic valve in 12 patients were significantly decreased compared with those before operation (P≤0.001). Conclusion This study demonstrates that ViV-TAVI for the treatment of bioprosthetic valve failure after aortic valve replacement is associated with favorable clinical and functional cardiovascular benefits, the short-term results are satisfactory.

Objective:To further improve the understanding of paroxysmal nocturnal hemoglobinuria (PNH), we retrospectively analyzed and summarized the clinical characteristics, treatment status, and survival status of patients with PNH in Zhejiang Province.Methods:This study included 289 patients with PNH who visited 20 hospitals in Zhejiang Province. Their clinical characteristics, comorbidity, laboratory test results, and medications were analyzed and summarized.Results:Among the 289 patients with PNH, 148 males and 141 females, with a median onset age of 45 (16-87) years and a peak onset age of 20-49 years (57.8% ). The median lactic dehydrogenase (LDH) level was 1 142 (604-1 925) U/L. Classified by type, 70.9% (166/234) were classical, 24.4% (57/234) were PNH/bone marrow failure (BMF), and 4.7% (11/234) were subclinical. The main clinical manifestations included fatigue or weakness (80.8%, 235/289), dizziness (73.4%, 212/289), darkened urine color (66.2%, 179/272), and jaundice (46.2%, 126/270). Common comorbidities were hemoglobinuria (58.7% ), renal dysfunction (17.6% ), and thrombosis (15.0% ). Moreover, 82.3% of the patients received glucocorticoid therapy, 70.9% required blood transfusion, 30.7% used immunosuppressive agents, 13.8% received anticoagulant therapy, and 6.3% received allogeneic hematopoietic stem cell transplantation. The 10-year overall survival (OS) rate was 84.4% (95% CI 78.0% -91.3% ) . Conclusion:Patients with PNH are more common in young and middle-aged people, with a similar incidence rate between men and women. Common clinical manifestations include fatigue, hemoglobinuria, jaundice, renal dysfunction, and recurrent thrombosis. The 10-year OS of this group is similar to reports from other centers in China.

Objective:To investigate the current status and influencing factors of kinesiophobia in adult burn patients.Methods:A single center cross-sectional research method was conducted. A total of 170 adult burn patients, meeting the inclusion criteria, were admitted to the Department of Plastic Surgery and Burns of the West China Hospital of Sichuan University from October 2018 to December 2019. On admission, the self-made general information questionnaire was used to investigate the gender, age, education level, marital status, payment method of medical expenses, injury factors, and total burn area of patients. One month after admission or before discharge, the presence and degree of kinesiophobia of patients were evaluated by the Tampa Scale for Kinesiophobia (TSK), their pain degrees (results averaged) at the time of burn, debridement and dressing change, after burn operation, and at rest were evaluated by the Visual Analogue Scale, their social support levels were evaluated by the Social Support Revalued Scale, and their degrees of anxiety and depression were evaluated by the Hospital Anxiety and Depression Scale. According to the TSK score, the patients with score >37 points were included into kinesiophobia group, and the patients with score ≤37 points were included into non-kinesiophobia group. The general information of patients in the two groups, as well as the pain score, social support level score, anxiety score, and depression score mentioned above, were recorded. Data of patients between the two groups were statistically analyzed with unifactor analysis including chi-square test, independent sample t test, and Mann-Whitney U test. The factors with statistically significant differences in unifactor analysis were used as variables for multivariate logistic regression analysis to screen out the independent influencing factors of kinesiophobia in adult burn patients. Results:Questionnaires and scales of 170 patients were collected, and the recovery rate was 100%. The data of two patients complicated with cranial fracture aggravation were removed, and 168 valid data were obtained, with the effective rate of 98.82%. Among the 168 patients, 88 were male (52.38%) and 80 were female (47.62%), aged from 18 to 71 (41±6) years. Most of the patients had secondary school education or below, were married, and with no out-of-pocket medical expenses. The main factors of injury were flame and hydrothermal fluid, and the total burn area was 2%-75% ((28±5)%) total body surface area. The TSK score was (41±5) points, the pain score was 4.0 (2.6, 7.0) points, the social support level score was (40±5) points, the anxiety score was 8.5 (7.0, 13.0) points, and the depression score was 9.5 (6.5, 12.0) points. A total of 98 patients had kinesiophobia, and the incidence of kinesiophobia was 58.33%. There were no statistically significant differences in gender, age, educational level, marital status, or injury factors of patients between kinesiophobia group and non-kinesiophobia group ( P>0.05). The percentage of out-of-pocket expenses, total burn area, pain score, anxiety score, and depression score of patients in kinesiophobia group were significantly higher than those in non-kinesiophobia group ( χ2=6.402, t=2.39, Z=-8.05, -6.68, -7.89, P<0.05 or P<0.01), and the social support level score of patients in kinesiophobia group was significantly lower than that in non-kinesiophobia group ( t=5.22, P<0.01). The multivariate logistic regression analysis showed that total burn area, pain score, social support level score, anxiety score, and depression score were the independent influencing factors for the development of kinesiophobia in adult burn patients (odds ratio=0.79, 1.45, 0.78, 1.15, 1.17, 95% confidence interval=0.80-0.92, 1.24-1.74, 0.65-0.91, 1.06-1.29, 1.03-1.24, P<0.01). Conclusions:The incidence of kinesiophobia in adult burn patients is high, and the degree of kinesiophobia is mainly affected by total burn area, pain, social support level, anxiety and depression degrees, and so on. Thus these factors should be taken into consideration when designing interventions to reduce the incidence and degree of kinesiophobia.

Objective: To understand the satisfaction of the residents in Hangzhou with primary health care services and its influencing factors, so as to provide basis for improving the quality of primary health care services. Methods: This study adopted multi-stage stratified random sampling method to recruit the residents aged 14 years or over in Hangzhou from July to September, 2019. A self-designed electronic questionnaire for primary health care services in Hangzhou was used to collect the demographic information, the utilization of primary health care institutions, the scores of the indicators of primary health care services and the satisfaction. The ordinal and multinomial logistic regression model was conducted to analyze the influencing factors for the satisfaction with primary health care services. Results: Totally 1 600 questionnaires were issued, 1 454 valid ones were collected, and the response rate was 90.88%. Five ( 0.34% ) residents were very dissatisfied, 16 ( 1.10% ) residents were dissatisfied, 153 ( 10.52% ) residents were generally satisfied, 780 ( 53.65% ) residents were satisfied, and 500 ( 34.39% ) residents were very satisfied with primary health care services. The ordinal and multinomial logistic regression analysis showed that basic medical insurance for urban employees ( OR=0.514, 95%CI: 0.370-0.714 ) , no health records in primary health institutions ( OR=0.528, 95%CI: 0.331-0.844 ) or unknown ( OR=0.524, 95%CI: 0.331-0.829 ) , the queuing time spent for getting medicines ( OR=0.698, 95%CI: 0.531-0.917 ) , ways of getting medicines (OR=0.639, 95%CI: 0.452-0.903 ) and completeness of testing equipment ( OR=1.315, 95%CI: 1.012-1.710) were influencing factors for the satisfaction with primary health care services. Conclusions The residents in Hangzhou are generally satisfied with the primary health care services, which are associated with the type of medical insurance, the condition of health records in primary institutions, the queuing time spent for getting medicines, the ways of getting medicines and the completeness of inspection equipment.

Objective : To analyze the status and influencing factors of the intention of people aged 18 to 25 years to primary medical institutions and their satisfaction for health services in Zhejiang Province, so as to provide basis for the improvement of health services in primary medical institutions. Methods: During November and December in 2019,the 18-25 year-old people in Zhejiang Province were recruited to investigate the general information, intention to seek medical advice and satisfaction for health services in primary medical institutions through WeChat. Logistic regression was performed to analyze the influencing factors of the intention and the satisfaction. Importance matrix was used to analyze the key drivers of the satisfaction. Results: Among the 620 people surveyed, with a response rate of 93.37%, 142 (22.90%) chose primary medical institutions for advice. Actually 516 (83.23%) people went to primary medical institutions last year, and 384 ( 74.42% ) of them were satisfied with the health services. The results of multivariate logistic regression analysis showed that the people aged 18-25 years who were under the new rural cooperative medical care system ( OR=3.062, 95%CI: 1.745-5.373 ) and who had records in community health centers ( OR=0.547, 95%CI: 0.308-0.970 ) were more likely to go to primary medical institutions for medical advice; the ability of doctors ( OR=1.478, 95%CI:1.168-1.871 ) ,the drug notification by medical staff ( OR=1.308, 95%CI: 1.065-1.606 ) , routine examination items ( OR=1.523, 95%CI: 1.227-1.889 ) , the ways of payment ( OR=1.168, 95%CI: 1.017-1.340 ) , the comfort of environment ( OR=1.785, 95%CI: 1.437-2.219 ) and the bulletin boards of health knowledge ( OR=1.302, 95%CI: 1.086-1.561 ) were associated with the satisfaction. The results of importance matrix analysis showed that the ability of doctors and routine examination items were the priorities to improve, followed by the drug notification by medical staff; the comfort of environment had competitive advantages; the ways of payment and the bulletin boards of health knowledge needed to be further analyzed. Conclusions The 18-25-year-old people in Zhejiang Province were less intended to seek medical advice in primary medical institutions, which was associated with the type of medical insurance and records in community health centers. They were satisfied with the health services, the ability of doctors and routine examination items were the key drivers.

Objective:To explore the psychological experience of front-line nurses combating the COVID-19 epidemic and provide suggestions and evidence for clinical interventions.Methods:From January 25th to 27th, 2020, a semi-structured interview was conducted using phenomenological research methods on 10 front-line nurses combating COVID-19 from a Class Ⅲ Grade A hospital, and Giorgi phenomenological analysis was used to analyze the data.Results:The psychological experience of clinical front-line nurses in this study could boil down to three themes: negative psychological experience (fear, worry, and fatigue) , insufficient ability to cope with public health emergencies (insufficient awareness of disease, and insufficient emergency rescue nursing skills) , and rational understanding of the fight against the epidemic (a sense of mission and confidence) .Conclusions:Clinical front-line nurses have different levels of negative psychological experience and lack the ability to respond to public health emergencies. Hospitals should strengthen psychological assistance and humane care for clinical front-line nurses, promote training for emergency disaster rescue nursing, improve hospital emergency management capabilities, and ensure efficient rescue work.

Objective To evaluate the effects of a traditional Chinese medicine Rubia cordifolia L.aqueous extract (RCAE) on body weight, fat mass and parameters of glucose and lipid metabolism in high fat diet (HFD)-induced obese rats and its mechanism.Methods pGL3-Enhancer-PPARγ2 (625 bp)-Luc plasmid, a luciferase reportergene expression plasmid containing PPARγ2 promoter was constructed and stably transfected 3T3-L1 preadipocytes were established.PPARγ2 promoter`s activities in these cells were detected after administration with different concentration (0.1 mg/L~1 000 mg/L) of RCAE or with 100 mg/L RCAE for different action time.PPARγ2 mRNA expression in human adipocytes were detected after administration with 100 mg/L RCAE.Meanwhile, HFD-induced obese rats were administrated with low or high dose RCAE to investigate the effects of RCAE on serum glucose, lipid and insulin levels, body weight, visceral fat mass and so on.Results 10 mg/L RCAE could increase luciferase expression in 3T3-L1 cells to 1.43 folds of that in control group (P<0.01) and it reached 3.24 folds of that in control group when the concentration of RCAE was 1000 mg/L (P<0.01).With the administration with 100 mg/L RCAE, the luciferase activity of 3T3-L1 cells peaked at 28 h where it was 2.72 folds of that in control group (P<0.01), and the expression of PPARγ2 mRNA in human adipocytes increased to 2.27 folds of that in control group (P<0.01).Compared with HFD group, low dose RCAE significantly reduced the fasting insulin level, HOMA-IR and visceral fat mass (P<0.05).Conclusions Low dose RCAE significantly reduces the visceral fat mass and ameliorates insulin resistance in HFD-induced obese rats.The potential mechanism may be explained by the stimulation of PPARγ2 promoter activities and the increased expression of PPARγ2 gene.

Objective To explore the effects of combining traditional Chinese and western medicine nursing for leukemia patients′ hope levels and treatment adherence. Methods To select 90 leukemia paitents from January 2012 to July 2014 in our hospital for treatment, the patients were randomly divided into experimental group and control group by random number table. The patients of experimental group received combining traditional Chinese and western medicine nursing, while the patients of control groups underwent routine nursing methods. We compared the hope level, treatment adherence between two groups and quality of life before and after treatment in two groups. Results After treatment in the experimental group, patients′hope levels presented better than the patients of control group in positive attitudes towards reality and future, positive behavior and keeping close relationship with others (Z =4. 563, 2. 951, 2. 366;P <0. 05). The patients′compliance of experimental group was better than that of the control group (Z =3. 035,P <0. 05). Before treatment, the difference of quality of life had no statistical significance between two groups (P>0. 05), but after treatment, each dimensions of quality of life in the experimental group was higher than that of the control group (P<0. 05). Conclusions Combining traditional Chinese and western medicine nursing not only can improve patients′hope level and treatment adherence, but also can contribute patients′quality of life.

Objective To investigate the effects and toxicity of pirarubicin and chemotherapy regimen in treatment of malignant lymphoma in the elderly. Methods 50 cases(over 60 years of age) with non Hodgkin's lymphoma collected in Lishui Central Hospital of Zhejiang province from January 2011 to January 2013 were randomly divided into control group(n=25)and experimental group(n=25). Experimental group were received CTOP chemotherapy, control group were received the standard CHOP chemotherapy, vomiting, stomach, blood pressure, blood glucose control and other appropriate symptomatic treatment were adopted according to the speciifc circumstances of each patient in both two groups. Regular inspection were given to all patients, and bone marrow suppression, treatment of lymphoma, complications and other indicators were observed. Results Complete remission in experimental group after treatment was 13 cases, accounted for 52%within group, partial remission were 9 cases, accounted for 36%. The total effective number was 22, and the rate was 88%. Complete remission in control group after treatment was 8 cases, accounted for 32%within group, partial remission were 5 cases, accounted for 20%. The total effective number was 13 cases, and the rate was 52%. Bone marrow suppression in experimental group was signiifcantly less than control group (P<0.05). Conclusion Elderly patients with malignant lymphoma in chemotherapy plus pirarubicin can improve the therapeutic effect, reduce bone marrow suppression and complications.

Objective To investigate the effect of total glucosides of paeony(TGP) on hepatic dysfunction caused by Methotrexate (MTX) and Leflunomide (LEF) in patients with moderate or severe rheumatoid arthritis (RA).Methods From July 2010 to February 2011,204 cases with definite-diagnosed rheumatoid arthritis were included in three hospitals in Anhui province.All these patients suffered from moderate or severe rheumatoid arthritis and they were divided randomly into two groups,the therapeutic groups were treated with TGP combined with MTX and LEF and the control group were treated without TGP.The incidence of hepatic dysfunction was observed.Statistical anylysis was carried out by using t test and x2 test.Results One hundred and ninty-four patients had completed observation for at least 12 weeks.In the therapeutic group,only 10 of 105 patients had hepatic dysfunction compared to 31 of 89 patients in the control group.The incidence of hepatic dysfunction of the therapeutic group was significantly lower than the control group.After 12 weeks treatment with TGP,the effective respohse rates of the therapeutic group was 81.9％,which was higher than 74.6％ in the control group.The good response rate in the therapeutic group was 21.6％,which was better than 11.7％ in the control group.Although the difference between the two groups was not statistically significant,we could observed the tendency of increasing in effectiveness and the good response rate in the therapeutic group when compared with the control group.Conclusion TGP can decrease the incidence of hepatic dysfunction during the treatment with MTX and LEF,and it may improve the therapeutic effecacy of patients with RA.