Infective endocarditis (IE) has attracted widespread public attention. However, studies on its economic burden remain scarce. This retrospective study aimed to collect data on the clinical characteristics of patients with IE from electronic medical records and estimate the economic burden with disability-adjusted life years (DALYs). Additionally, the changing trend of IE from 2007 to 2016 and differences between native valve endocarditis (NVE) and prosthetic valve endocarditis (PVE) on economic burden were analyzed. There were 407 patients with IE enrolled in this study. The total DALY loss was 1710.2. The average indirect economic burden ranged from 6253.27 to14766.34 from 2007 to 2016 showing a stable trend, which was 1.67 to 2.46 times the annual per gross domestic product (GDP). Interestingly, the average indirect economic burden for females ranged from 5941.37 to17261.07 with a significant upward trend during this period (P = 0.035).The average DALY loss and indirect economic burden were highest in patient aged ≤ 19 (4.82, 21486.12) and lowest in those aged 80–89(0.46,342.87), decreasing significantly with age(both P<0.001). Finally, there were no significant differences in the average DALY loss and indirect economic burden between the PVE group and NVE group during this period (2.69 vs. 2.63, P = 0.740; 9224.0vs.11789.4, P = 0.136). The DALY loss and indirect economic burden associated with IE were notably high, particularly among younger patients and females. These findings highlight the need for targeted preventive care and early interventions, especially for youth and gender-specific strategies, to reduce disparities in IE burden.

This study aims to investigate the curative effect of Kangfuyan capsule in the treatment of damp-heat and blood stasis type of pelvic inflammatory disease (PID), and its influence on serum inflammatory factors IL-6, CRP and TNF-α. A total of 83 patients with PID were randomly divided into two groups: Western medicine group (control group, n=41) received oral antibiotics (azithromycin + metronidazole) alone and the traditional Chinese medicine combined with Western medicine group (experimental group, n=42) received Kangfuyan capsule based on Western medicine therapy. Clinical efficacy between these two groups and the influence of drugs in serum inflammatory factors (IL-6, CRP and TNF-α) were compared. The total effective rate was 78.05% in the control group and 97.62% in the experimental group and difference between these two groups was statistically significant (P<0.01). The symptoms and signs in the two groups significantly improved after treatment (P<0.05) and improvement rate was significantly better in the experimental group than in the control group (P<0.05). After treatment, serum inflammatory factor levels in the two groups were significantly lower than levels before treatment (P<0.05) and improvement rate was significantly better in the experimental group than in the control group (P<0.05). Kangfuyan capsule combined with antibiotics can effectively relieve the symptoms and signs of patients, improve the efficiency of treatment, provide high safety, and does not increase adverse reactions. The possible mechanism may be that this therapy suppresses chronic PID by reducing serum inflammatory factor (IL-6, CRP and TNF-α) levels.

Background Infective endocarditis (IE) especially in the elderly is a serious disease, with a worse prognosis. Methods A retrospective cohort study was conducted. A total of 405 patients with definite IE were divided into three groups: 205 patients under 50 years old, 141 patients between 50 and 64 years old and 59 patients over 65 years old. Results For older patients, clinical symptoms such as fever, anemia, and heart murmur were as common as the younger patients. IE in old patients had more frequent nosocomial origin (P=0.007) and tended to be more frequent with bad oral hygiene (p=0.008). The most frequent isolated pathogens in the old groups was streptococci and coagulase-negative staphylococci. The old patients had a lower operation rate (40.7% vs 58.9% vs 62.4%, P=0.012) and higher in-hospital mortality (20.3% vs 10.6% vs 8.8%, P=0.044) compared with the younger patients. Surgical treatment was a significant predictor of one-year mortality even after adjusting for the confounders (HR=2.45, 95% CI 1.027-10.598, P=0.009).The one-year survival rate was higher for older patients with surgical intervention than those without (95.8% vs 68.6%, P=0.007). Conclusions Older patients with IE presented with more comorbidities, bad oral hygiene, more nosocomial origin and a more severe prognosis than younger patients. Streptococci was the most frequent micro-organisms in this group. Surgery were underused in old patients and those with surgical treatment had better prognosis. Keywords: Infective endocarditis; older patients; risk factors; surgical

目的 探讨嗜酸性粒细胞性胃肠炎的临床特点、内镜下表现及诊断、治疗经验,以提高临床上对该病的认识.方法 收集本院收治的1例嗜酸性粒细胞性胃肠炎伴腹水的患者的临床资料,结合文献复习,探讨嗜酸性粒细胞性胃肠炎患者的临床表现、实验室检查和内镜表现的特点.结果 患者女,23岁,以"呕吐、腹痛、腹泻、腹胀"为主要表现,入院检查外周血嗜酸性粒细胞、血清总IgE、骨髓中嗜酸性粒细胞及腹水中嗜酸性粒细胞明显升高,胃、肠镜检查提示胃肠道黏膜充血、糜烂、炎性改变,肠镜下病变黏膜活检病理示:升结肠慢性炎症、嗜酸性粒细胞浸润,患者最终诊断为嗜酸性粒细胞性胃肠炎,经口服甲泼尼龙、抗过敏、腹腔穿刺置管引流腹水等治疗2周后症状缓解,复查外周血嗜酸性粒细胞降至正常,复查腹部B超未见腹腔积液,故好转出院,出院后随访.结论 嗜酸性粒细胞性胃肠炎患者临床表现、实验室检查和内镜表现多样,缺乏特异性,外周血嗜酸性粒细胞、血清总IgE、骨髓中嗜酸性粒细胞及腹水中嗜酸性粒细胞升高对本病有提示意义,确诊需组织病理学结果,大部分患者经糖皮质激素治疗预后较好.

Hepatitis B constitutes a severe public health challenge in China. The Community-based Collaborative Innovation hepatitis B (CCI-HBV) project is a national epidemiological study of hepatitis B and has been conducting a comprehensive intervention in southern Zhejiang since 2009. The comprehensive intervention in CCI-HBV areas includes the dynamic hepatitis B screening in local residents, the normalised treatment for hepatitis B infections and the upcoming full-aged hepatitis B vaccination. After two rounds of screening (each round taking for 4 years), the initial epidemiological baseline of hepatitis B in Qinggang was obtained, a coastal community in east China. By combining key data and system dynamics modelling, the regional hepatitis B epidemic in 20 years was predicted. There were 1041 HBsAg positive cases out of 12 228 people in Round 1 indicating HBV prevalence of 8.5%. Of the 13 146 people tested in Round 2, 1171 people were HBsAg positive, with a prevalence of 8.9%. By comparing the two rounds of screening, the HBV incidence rate of 0.192 per 100 person-years was observed. By consulting electronic medical records, the HBV onset rate of 0.533 per 100 person-years was obtained. We generated a simulated model to replicate the real-world situation for the next two decades. To evaluate the effect of interventions on regional HBV prevalence, three comparative experiments were conducted. In this study, the regional hepatitis B epidemic in 20 years was predicted and compared with HBV prevalence under different interventions. Owing to the existing challenges in research methodology, this study combined HBV field research and simulation to provide a system dynamics model with close-to-real key data to improve prediction accuracy. The simulation also provided a prompt guidance for the field implementation.

Background: To explore the trends in epidemiology and risk factors related to the prognosis of infective endocarditis in a teaching hospital over the past ten years. Methods: A retrospective cohort study was performed. A total of 407 consecutive patients were included. The clinical characteristics and risk factors related to the prognosis of infective endocarditis during this period were analyzed. Results: A total of 407 patients with infective endocarditis were included, the average age was 48 ±16 years old with an increasing trend and in-hospital mortality rate was 10.6% and one-year mortality rate was 12.2%. Among patients with underlying heart disease, congenital heart disease was the most common(25.8%), followed by rheumatic heart disease which showed a decreased trend during this period (P<0.001). There were 222(54.5%) positive blood cultures and streptococci (44.1%) was the main pathogens with an increasing trend. There were 403 patients (99%) with surgical indications, but only 234 patients (57.5%) received surgical treatment. Hemodialysis (P = 0.041, OR = 4.697, 95% CI 1.068-20.665), pulmonary hypertension (P = 0.001, OR = 5.308, 95% CI 2.034-13.852), Pitt score ≥ 4 (P <0.001, OR = 28.5, 95% CI 5.5-148.1) and vegetation length＞30mm (P = 0.011, OR = 13.754, 95% CI 1.832-103.250) were independent risk factors for in-hospital mortality. Conclusions: There was no significant change in the overall incidence of IE, the clinical features of IE have changed slightly during the past ten years. Streptococci IE was still the predominant. IE patients with hemodialysis, pulmonary hypertension, Pitt score ≥ 4 and vegetation length＞30mm had an worse in-hospital outcome.

感染性心内膜炎是一种具有严重并发症和较高病死率的疾病.目前,抗生素和手术治疗是其主要的治疗手段,越来越多的感染性心内膜炎患者需要手术干预,恰当的手术干预可以降低病死率,改善长期预后.不同患者手术治疗指征、时机及结局存在差异.本文就感染性心内膜炎患者手术治疗的指征和手术时机作一综述.

目的:比较有基础心脏病和无基础心脏病感染性心内膜炎(IE)患者的临床特点及预后.方法:回顾性分析2007年1月至2016年12月在浙江大学医学院附属第一医院确诊为IE的402例成人(≥16岁)住院患者的临床资料,比较有基础心脏病和无基础心脏病IE患者的临床特点、影响预后的相关因素.结果:无基础心脏病IE患者占总IE患者的45.5％(183/402);其中,27.3％(50/183)合并慢性疾病,37.1％(68/183)存在易感因素.与有基础心脏病的IE患者相比,无基础心脏病IE患者右心及全心受累比例更低(P=0.001),多瓣膜受累更少见(P<0.001),心力衰竭、心律失常、瓣周脓肿等心脏并发症的发生率更低(P均<0.05),但住院病死率和1年病死率差异无统计学意义(P均>0.05).多因素分析显示,年龄≥65岁(OR=14.6,95％CI:1.7～124.0,P=0.014)、长期血液透析(OR=20.0,95％CI:1.4～128.9,P=0.027)和Pitt≥2分(OR=83.9,95％CI:13.9～746.8,P<0.001)是无基础心脏病IE患者住院死亡的独立危险因素.无基础心脏病并发栓塞IE患者的1年生存率明显低于非栓塞患者(81.0％vs 95.9％,P=0.002);手术治疗患者的1年生存率明显高于非手术治疗患者(95.3％vs 84.8％,P<0.001).结论:无基础心脏病IE并不少见且多有易感因素,出现心脏并发症的比例相对较低,病死率较低,预后较好.年龄≥65岁、长期血液透析和Pitt评分≥2是住院死亡的独立危险因素.合并栓塞事件的患者1年生存率较低;抗生素联合手术治疗可以提高1年生存率.

目的 系统评价抗菌药联合炎琥宁注射液治疗感染性心内膜炎(infectious endocarditis,IE)的有效性和疗效.方法 计算机检索Cochrane Library、PubMed、中国知识资源总库(CNKI)、万方数据库(WangFang Data)、维普数据库(VIP)、中国生物医学文献数据库(CBM),截止日期2018年6月1日.纳入关于抗菌药联合炎琥宁注射液治疗IE与单用抗菌药比较治疗IE的随机对照试验(RCT),对纳入的研究资料提取和质量评价后,使用RevMan5.3软件进行Meta分析.结果 共纳入20篇RCT文献,总共1716例患者,其中试验组860例,对照组856例.Meta分析结果显示:在试验终点时,总体有效率、实验室检查(CRP、PCT、ESR)试验组均较对照组改善更为显著,两组比较,差异均有统计学意义(P<0.05).结论 抗菌药联合炎琥宁注射液治疗IE较单用抗菌药治疗IE的总体有效率更高,并且可以减轻机体炎症反应,进一步提高临床疗效.由于纳入研究的质量限制,需要进行更多的大规模,多中心,前瞻性临床试验以进一步验证.