To evaluate the features of carotid web (CW) by ultrasonography.

A total of 66 patients with CW were retrospectively enrolled from January 2018 to June 2019 at Xuanwu Hospital, Capital Medical University. All patients were examined by both ultrasonography and CTA, and were divided into either a<50% stenosis group (54 cases) or a ≥50% stenosis group (12 cases). The ultrasonographic characteristics of CW, including the length, thickness, direction (forward or backward to the flow), acute angle between the web and carotid wall, and thrombus between the web and carotid wall were compared between the two groups. The stenosis degrees of carotid artery were compared between patients with and without ischemic stroke.

Forty-two (42/66, 63.6%) patients were diagnosed with CW by initial CDFI examination, of whom 21 (21/66, 31.8%) were diagnosed with ulcerative plaque and 3 (3/66, 4.5%) were diagnosed with carotid dissection at first but confirmed by second examination. There were no differences in the web length, thickness, direction, or thrombus detected between the two groups (P>0.05). The angle between the web and carotid wall in the<50% stenosis group was significantly smaller than that of the ≥50% stenosis group (median angel 39o vs 73o, P=0.002), and the percentage of patients with an angle≤ 60o in the<50% stenosis group was significantly higher than that of the ≥50% stenosis group (74.1% vs 41.7%, P=0.042). The diameter of the residual carotid artery at CW location in the<50% stenosis group was significantly larger and peak systolic velocity was significantly higher in the<50% stenosis group than in the≥50% stenosis group (P<0.001). The stenosis degrees of carotid artery were not statistically different between patients with and without ischemic stroke (P=0.321).

Ultrasonography can be used to evaluate the characteristics of carotid web in 2D and color mode. When the angle between the CW and carotid wall is large, the carotid artery stenosis ≥ 50% is more likely to happen, but carotid artery stenosis is not the main cause of ischemic stroke.

The aim of the present study was to evaluate the efficiency of sling exercise, therapeuticultrasound, therapeuticultrasound and sling exercise in patients to alleviate pain and improve lumbar function with lumbar disc herniation.

Individuals were selected from a list of patients being followed at the department of Rehabilitation in the third hospital of Hebei Medical University. 30 patients who were diagnosed with lumbar disc herniation were collected, the diagnoses were established upon medical history, physical examination, and results of imaging studies. The patients were randomly divided into three groups: therapeuticultrasound group received 14 sessions of ultrasonic therapy to the lumbar region, Sling exercise group received 14 sessions of sling exercise, and therapeuticultrasound and sling exercise group received therapeuticultrasound and sling exercise therapy 14 sessions of therapeuticultrasound to the lumbar region,7 sessions per week, 2 weeks. The VAS and ODI were compared with the assessment of the patients before and at the end of the therapy.

At the end of treatment, three groups VAS scores (F=3.069, P=0.043) and ODI scores (t=12.676, P<0.001) was lower than that at the beginning of treatment (P<0.05), at the end of treatment the VAS scores (F=59.400, P<0.001) and of the ODI scores (t=12.737, P<0.001) of ultrasonic and sling exercise therapy group was lower than the other group, the difference is significantly.

All three groups could reduce pain and improve lumbar function, and the ultrasonic and sling exercise therapy was most effective for lumbar disc herniation treatment in the three groups.

To analyze the treatment of different types of traumatic cerebral infarction in children, and explore its pathogenesis in combination with literature so as to improve the cure rate and reduce disability rate.

The clinical data of 42 cases of traumatic cerebral infarction in children were retrospectively analyzed in The Hospital of 81^st Group Army PLA from January 2015 to December 2019. The diagnosis of traumatic cerebral infarction in children was made by CT scan and MRI scan. According to different conditions, children with traumatic cerebral infarction were classified, and different treatment strategies were selected. Children with lacunar infarction were treated with calcium antagonists and neurotrophic drugs, supplemented by hyperbaric oxygen and exercise rehabilitation. The children of focal cerebral infarction and complex cerebral infarction treated by junior dehydrant and hormone also included the calcium antagonist and nutritional nerve drugs. The therapeutic regimen perhaps adjusted by the evolution of the disease. The children of extensive cerebral infarction underwent emergency cranial decompression, and was treated by reducing intracranial pressure and preventing complications after operation. The treatment results and recovery were observed.

In 42 cases of traumatic cerebral infarction in children, 35 cases (83.3%) were good recovery, 4 cases (9.5%) were moderate disability, 2 cases (4.8%) were severe disability, 1 case (2.4%) died, and no vegetative state. The good recovery rate of lacunar infarction was 100%, that of focal cerebral infarction was 62.5%, that of mixed cerebral infarction was 60%, and that of extensive cerebral infarction was 50%.

It is of great significance to improve the therapeutic effect and prognosis of children with traumatic cerebral infarction to adopt different treatment schemes for different types of cerebral infarction.

To characterize the patients with supratentorial hypertensive intracerebral hemorrhage (ICH) in the Tibetan Plateau over an altitude of 4000 meters.

A total of 68 cases with supratentorial hypertensive ICH were retrospectively included in Ali Regional People’s Hospital from January 2017 to September 2018. The clinical and laboratory data were collected. A simple linear correlation analysis was applied to analyze the correlation between the amount of bleeding and sex, age, nationality, time from onset , systolic blood pressure (SBP), diastolic blood pressure (DBP), hemoglobin (Hb), serum triglyceride (TG), and cholesterol. According to computed tomography (CT) findings, 68 cases were divided into the basal ganglia ICH group (33 cases) and the lobar ICH group (35 cases). The characteristics between two groups were analyzed using t-test or χ² test.

The data of sex, age, nationality, time from onset, SBP, DBP, Hb, TG, and cholesterol of 68 cases on admission did not show any definitive correlation with the hematoma volumes (P＞0.05). The SBP and DBP of patients in the basal ganglia ICH group were significantly higher than that in the lobar ICH group, respectively [(184.9±28.5) mmHg vs (164.6±24.4) mmHg; (113.0±18.1) mmHg vs (103.0±18.4) mmHg] (t=0.499, 0.486; P=0.002, 0.033).

The relevant factors of hematoma volumes in patients with ICH in plateau area were not yet clear. Diastolic and systolic blood pressure of patients in the basal ganglia ICH group was higher than that in those in lobar ICH group.

To compare the efficacy evaluation of electrospun composite biomaterials and a porcine small intestine submucosa mesh for hernia repair.

A randomized, single-blind, controlled multicenter trial was performed in 3 hospitals in Shanghai. Eligible adult patients with primary unilateral reducible groin hernias were randomly assigned (1∶1) to electrospun composite biomaterials (experimental group) or porcine small intestine submucosa (control group) mesh groups. Patients were treated with the tARB technique and assessed at 1,3 and 6 months after the surgery. The primary endpoint was hernia recurrence. The secondary endpoints were postoperative complications including groin pain and operative site infections.

172 patients were assigned to experimental (n=86) and control (n=86) groups. At 6 months follow-up, postoperative complications occurred in 5 patients (5/86, 5.95%) and 2 (2/86, 2.35%) patients in the control and experimental groups, respectively (P>0.05). There was no significant difference in VAS or SVS score between the two groups.

We demonstrate that electrospun composite biomaterial mesh can be used as a ideal choice for inguinal hernia repair. Electrospun composite biomaterial has the characteristics of low recurrence rate, absorbability and long-term comfort.It can be further applied in clinical practice in the future.

Pancreaticoduodenectomy(PD)remains one of the most complicated hepatobiliary operations. The development of minimally invasive surgery for PD has always been an hot spot. Laparoscopic pancreaticoduodenectomy(LPD) has not been widespread carried out due to its difficulty and long learning curve. LPD accounts for 9% of all PD, according to the National Cancer Data base. Compared with laparoscopic surgery, robotic surgery system has significant advantages in the field of minimally invasive PD, including stereotactic amplified vision, filtering hand tremor and simulating the wrist. The article would review the surgical techniques and notes, which could provide clinical reference for other surgeons.

To investigate the protective effect and mechanism of Chimonanthus nitens Oliv. essential oil (CEO) on lipopolysaccharide (LPS)-induced inflammatory injury in intestinal epithelioid cell line No.6 (IEC-6) cells.

IEC-6 cells were stimulated with LPS to establish an inflammatory injury model, and CEO treatment was applied as an intervention. The cell counting kit-8 (CCK-8) assay was used to evaluate cell viability and determine the appropriate concentration for model induction. IEC-6 cells were divided into four groups: the control, CEO, LPS, and CEO + LPS groups. The CEO group and CEO + LPS group were pre-incubated with 20 mg / L CEO for 24 h, while the LPS group and CEO + LPS group were treated with 10 mg / L LPS to induce inflammatory injury. Interleukin-1 beta (IL-1β) secretion levels in the IEC-6 cell supernatants were measured using enzyme linked immunosorbent assay (ELISA). Reactive oxygen species (ROS) generation was assessed using flow cytometry. The expression levels of P65, phosphorylated P65, Cleaved caspase-1, and vesicle-associated membrane protein-associated protein B (VAPB) in IEC-6 cells were determined by western-blotting. Mitochondrial membrane potential changes, mitochondrial calcium levels, mitochondria-associated endoplasmic reticulum membranes (MAMs) formation, and co-localization of NOD-like receptor protein 3 (NLRP3) with MAMs were examined using confocal microscopy.

Significant differences were observed among the four groups in IL-1β secretion, P65 phosphorylation, Cleaved caspase-1 expression, ROS levels, mitochondrial membrane potential, mitochondrial calcium levels, and VAPB protein expression (F = 15.860, 22.260, 11.340, 65.220, 32.210, 15.800, 7.210; all P < 0.05). Compared with the control group, the IL-1β secretion, ROS production, P65 phosphorylation, Cleaved caspase-1 expression, mitochondrial calcium accumulation, and VAPB protein expression were significantly increased, while the mitochondrial membrane potential was decreased in the LPS group (all P < 0.05). Compared with the LPS group, the CEO + LPS group exhibited a significant increase in mitochondrial membrane potential, along with a reduction in IL-1β secretion, ROS production, P65 phosphorylation, Cleaved caspase-1 expression, mitochondrial calcium accumulation, and VAPB protein expression (all P < 0.05). Confocal microscopy showed that the formation of MAMs was less in the control group and CEO group, and the co-localization of NLRP3 with MAMs was also less. In the LPS group, the formation of MAMs increased, and the co-localization of NLRP3 with MAMs also increased. However, in the CEO + LPS group, the formation of MAMs and their co-localization with NLRP3 were improved.

CEO exerts a protective effect against LPS-induced inflammatory injury in IEC-6 cells. The underlying mechanism may involve the inhibition of nuclear factor kappa-B pathway activation and the regulation of VAPB protein expression, thereby influencing MAMs formation and function to mitigate mitochondrial damage.

To develop a prediction model for the prolonged ICU stay in patients with drug poisoning based on machine learning algorithms.

Drug poisoning patients included in the Medical Information Mart for Intensive Care Ⅳ (MIMIC-Ⅳ) and Electronic Intensive Care Unit-Collaborative Research Database (eICU-CRD) were divided into a non-prolonged group (≤ 48 hours) and a prolonged group (> 48 hours) according to the length of ICU stay. A total of 1 342 patients in MIMIC-Ⅳ were divided into a training dataset (939 cases) and a test dataset (403 cases) at a ratio of 7 ∶ 3, with eICU-CRD serving as an external test dataset (2 144 cases). In the training dataset, variables were jointly screened through single-factor analysis and least absolute shrinkage and selection operator (LASSO) regression. Six machine learning algorithms (logistic regression, extreme gradient boosting, light gradient boosting machine, random forest, decision tree, and support vector machine) were used for modeling. Meanwhile, the receiver operating characteristic (ROC) curve, Hosmer-Lemeshow (H-L) test, Brier score, and decision curve analysis (DCA) were used to evaluate the model performance in both internal and external test datasets.

Seven critical predictors were screened out in the training dataset: cerebrovascular disease, liver disease, aspiration pneumonia, sepsis, respiratory rate, sequential organ failure assessment (SOFA) score, and mechanical ventilation. The logistic regression model performed best in the training dataset [area under the curve (AUC) = 0.767, 95% confidence interval (CI) (0.667, 0.868), P < 0.001]. Its AUC was 0.762 [95%CI (0.712, 0.811), P < 0.001] in the internal test dataset, and 0.732 [95%CI (0.708, 0.756), P < 0.001] in the external test dataset. Moreover, the logistic regression model showed good calibration and net returns in both internal and external test datasets.

The logistic regression model constructed in this study consists of seven predictive factors, including cerebrovascular disease, liver disease, aspiration pneumonia, sepsis, respiratory rate, SOFA score, and mechanical ventilation. It can effectively predict the risk of prolonged ICU stay in drug poisoning patients, which is helpful for early clinical identification and intervention.

To explore the effectiveness of healthcare failure mode and effect analysis (HFMEA) in the safety management of clinical trial drug infusion.

Under the guidance of HFMEA theory, a risk assessment was conducted on the clinical trial drug infusion management process. Potential failure modes were analyzed, and the causes and effects of failure were explored. Based on risk factors, improvement measures were developed and implemented, and then the improvement effectiveness was evaluated, including the risk priority number (RPN), standardization rates of drug infusion, infusion bottle stickers, medical consumables, data collection and document recording, and satisfaction of nurses and doctors.

Through decision tree analysis, 28 potential failure causes were identified as key improvement targets. After implementing the HFMEA model, the total RPN score decreased from 247 to 93, with a decrease of 62.3%. Meanwhile, there were no adverse nursing events related to clinical trials. The standardization rates of drug infusion [95.0% (95 / 100) vs. 86.0% (86 / 100), χ² = 4.711, P = 0.030], infusion bottle stickers [100.0% (100 / 100) vs. 75.0% (75 / 100), χ² = 28.571, P < 0.001], medical consumables [96.0% (288 / 300) vs. 77.7% (233 / 300), χ² = 44.097, P < 0.001], data collection [93.0% (93 / 100) vs. 82.0% (82 / 100), χ² = 5.531, P = 0.019], and document recording [90.0% (90 / 100) vs. 76.0% (76 / 100), χ² = 6.945, P = 0.008] after implementation all significantly improved compared with those before implementation. Besides, the satisfaction scores of nurses and doctors increased from (4.2 ± 2.0) and (6.5 ± 2.4) before implementation to (8.2 ± 1.5) and (8.9 ± 1.2) after implementation respectively (t = 4.309, P = 0.040; t = 55.910, P < 0.001).

The prospective application of HFMEA can effectively improve the safety management level of clinical trial drug infusion by shifting passive post treatment to proactive prevention.

To explore the characteristics of traditional Chinese medicine constitutions in hospitalized elderly patients and their influence on the risk of common geriatric syndromes.

A total of 524 elderly patients admitted to the Department of Geriatrics of the First Affiliated Hospital, Zhejiang University School of Medicine from November 2023 to October 2024 were selected as the study subjects. According to their traditional Chinese medicine constitutions, patients were divided into the yang-deficient constitution (69 cases), qi-deficient constitution (244 cases), yin-deficient constitution (154 cases), gentleness constitution (15 cases), and other constitution (42 cases). The gender, age, educational level, smoking and drinking habits, and occurrence of common geriatric syndromes (frailty, sarcopenia, disability, and sleep disorders) of these elderly patients with different traditional Chinese medicine constitutions were compared. The different tongue colors of patients with common geriatric syndromes were detected and compared. Univariate and multivariate logistic regression analyses were used to investigate the influence of different traditional Chinese medicine constitutions on the risk of common geriatric syndromes.

The proportion of qi-deficient constitution was the highest [46.56% (244 / 524)] among hospitalized elderly patients, followed by the yin-deficient constitution [29.39% (154 / 524)] and yang-deficient constitution [13.17% (69 / 524)]. The gender ( χ² = 13.795, P = 0.008), age (F = 4.806, P < 0.001), frailty ( χ² = 10.640, P = 0.031), sarcopenia ( χ² = 11.530, P = 0.021), disability ( χ² = 13.083, P = 0.011), and sleep disorders ( χ² = 9.870, P = 0.043) among elderly patients with different traditional Chinese medicine constitutions all showed significant differences. Moreover, compared with the yin-deficient constitution, the proportions of males, sarcopenia, and disability were higher in patients with yang-deficient constitution (all P < 0.005), with an older age (P < 0.05), and the proportion of disability was also higher in patients with qi-deficient constitution (P < 0.005). Compared with the gentleness constitution, the proportion of sleep disorders was higher in patients with yang-deficient constitution (P < 0.005). There were statistically significant differences in the proportions of different tongue colors among elderly patients with sarcopenia ( χ² = 11.318, P = 0.010) and disability ( χ² = 19.561, P < 0.001), and the proportion of red tongue in elderly patients with sarcopenia and disability was higher than that of pale red tongue (both P < 0.008). Univariate and multivariate logistic regression analyses revealed that compared with the yang-deficient constitution, the risk of sarcopenia in elderly patients with gentleness constitution was significantly reduced [odds ratio (OR) = 0.260, 95% confidence interval (CI) (0.071, 0.958), P = 0.043], and the risk of sleep disorders in elderly patients with qi-deficient constitution [OR = 0.418, 95%CI (0.187, 0.936), P = 0.034] and gentleness constitution [OR = 0.147, 95%CI (0.041, 0.521), P = 0.003] was also remarkedly decreased.

Hospitalized elderly patients predominantly exhibit qi-deficient, yang-deficient, and yin-deficient constitutions. The proportion of geriatric syndromes is high in patients with biased constitutions (especially the yang-deficient constitution), and the risk of sarcopenia and sleep disorders is relatively high in patients with yang-deficient constitution.

探讨吲哚布芬联合智能背景下抗阻训练对急性冠脉综合征（ACS）患者支架植入术后血小板聚集及心血管事件的影响。

选取2023年4月至2024年10月首都医科大学附属北京朝阳医院收治的208例ACS行支架植入术患者，采用随机数字表法分为联合组（吲哚布芬+智能抗阻训练，104例）和对照组（常规抗血小板药物+智能抗阻训练，104例）。比较两组患者术后血小板聚集率、心血管事件、3型及以上出血情况、肌肉力量以及心功能指标[包括左心室射血分数（LVEF）和左室舒张末期内径（LVEDD）]。

联合组术后1个月[（43 ± 9）% vs.（55 ± 10）%，t = 9.529，P < 0.001]、3个月[（38 ± 7）% vs.（52 ± 10）%，t = 10.832，P < 0.001]的血小板聚集率均显著低于对照组。联合组患者总体心血管事件发生率显著低于对照组[12.5%（13 / 104）vs. 28.8%（30 / 104），χ² = 5.391，P = 0.021]，肌肉力量则显著高于对照组[（85 ± 13）N·m vs.（72 ± 10）N·m，t = 7.652，P < 0.001]；而组间3型及以上出血发生率比较，差异无统计学意义[5.8%（6 / 104）vs. 8.7%（9 / 104），χ² = 0.683，P = 0.401]。干预后，联合组LVEF显著高于对照组[（66.4 ± 2.2）% vs.（60.8 ± 3.6）%，t = 6.015，P < 0.001]，LVEDD则显著低于对照组[（41.4 ± 5.2）mm vs.（46.9 ± 6.2）mm，t = 5.905，P < 0.001]。

吲哚布芬联合智能抗阻训练在有效抑制血小板聚集、减少心血管事件的同时，显著改善心功能和生活质量，且不增加出血风险。

探究血清降钙素原（PCT）、C反应蛋白（CRP）、白细胞计数（WBC）、中性粒细胞计数（NE）水平对于胃肠炎型蘑菇中毒患者的诊断价值。

选择2021年7月至2023年9月至昭通市中医医院急诊中心就诊的55例胃肠炎型蘑菇中毒患者作为观察组，55例其他食物中毒引起的非感染性胃肠炎患者作为常规组，同期选取55例健康检查人群作为对照组。比较3组受试者的PCT、CRP、WBC、NE水平，并绘制受试者工作特征（ROC）曲线来评价PCT、CPR、WBC、NE及其联合检测在胃肠炎型蘑菇中毒患者中的诊断价值。

3组受试者血清PCT（H = 79.970，P < 0.001）、CPR（H = 34.108，P < 0.001）、WBC（F = 6.689，P < 0.001）、NE（F = 17.220，P < 0.001）水平比较，差异均有统计学意义。且观察组患者的血清PCT水平显著高于常规组（P < 0.05）。ROC曲线分析显示，血清PCT水平对胃肠炎型蘑菇中毒患者诊断具有显著的价值，其曲线下面积（AUC）为0.847，WBC及NE的诊断价值不高（AUC分别为0.690、0.687），CRP则无诊断价值（P = 0.119），四者联合的诊断价值最高，其AUC为0.923，敏感度、特异度分别为83.6%、92.7%。

血清PCT对胃肠炎型蘑菇中毒患者有显著的诊断价值，PCT、CPR、WBC、NE联合检测的诊断价值最高。此外，纳入本研究的蘑菇中毒患者虽PCT明显升高，但均未使用抗生素且预后良好，可为临床抗生素的规范使用提供一定参考意义。

To evaluate the clinical application value of T-Scan Ⅲ system in the evaluation of occlusal reconstruction and restoration effect of fixed dentures.

A retrospective analysis was conducted on the T-Scan Ⅲ dynamic bite data of 22 patients who were clinically diagnosed and completed fixed denture bite reconstruction in the Department of Prosthodontics, the Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University from January 2022 to December 2023. The detection time points included: Before bite reconstruction (T0), immediately after restoration (T1), and 1 year after restoration (T2). The analysis parameters included: Asymmetry index of the occlusal force (AOF), Central occlusal force (COF) position, Occlusion Time (OT) and Disocclusion Time (DT), percentage of left and right occlusion force distribution, etc. SPSS 18.0 software was used for statistical analysis of the data, and t-test or McNemar-test was used to compare the differences before and after treatment.

The AOF of patients undergoing fixed denture occlusal reconstruction decreased significantly from T0 stage (32 ± 10) % to T2 stage (10 ± 6) % (t = -5.820, P<0.001), and the balance of bite force distribution was significantly improved. The proportion of COF located outside the functional center decreased from 77.3% (17/22) in T0 phase to 13.6% (3/22) in T1/T2 phase (χ²=12.071, P<0.001), and the distance from the midline shortened from (9.80 ± 3.89) mm to (3.60 ± 2.04) mm (t = -5.391, P<0.001). OT shortened from (0.97 ± 0.14) s to (0.33 ± 0.10) s (t = -6.343, P<0.001) ; The DT of protrusive movement decreased from (0.81 ± 0.11) s to (0.19 ± 0.05) s (t = -6.445, P<0.001). The excursive movement DT showed synchronous improvement (t_{left side}=-6.340, P_{left side}<0.001; t_{right side}=-6.395, P_{right side}<0.001) .

T-Scan Ⅲ can be used for quantitative analysis of bite reconstruction effects, providing reliable basis for clinical evaluation and adjustment of treatment plans.