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 antituberculosis activity and mechanism of myricetin from the perspective of inhibiting bacterial RNA polymerase (RNAP).

The Escherichia coli RNAP (EcoRNAP) and Mycobacterium tuberculosis RNAP (MtbRNAP) were selected as target proteins. Bacterial RNAP inhibitors were identified using in vitro transcription experiments. The activity verification of myricetin was conducted in groups A and B, with four concentration gradients for each group. In the group A, myricetin at concentrations of 0, 12.5, 25, and 50 μmol/L was added first, followed by 20 nmol/L promoter DNA; the group B first added 20 nmol/L promoter DNA, followed by myricetin at concentrations of 0, 12.5, 25, and 50 μmol/L. The inhibition mechanism was studied using electrophoretic mobility shift assay (EMSA) in two groups: the control group (samples without myricetin) and the experimental group (samples with myricetin). Finally, the antituberculosis activity was tested against both antibiotic sensitive and resistant Mycobacterium tuberculosis strains.

In vitro transcription experiments demonstrated that myricetin had inhibitory activity against both EcoRNAP (F = 13.290, P = 0.015) and MtbRNAP (F = 9.431, P = 0.028). EMSA indicated that myricetin disrupted RNAP-promoter DNA interactions during transcription initiation, especially EcoRNAP (t = 22.692, P < 0.001) and MtbRNAP (t = 21.581, P < 0.001). Drug sensitivity experiments confirmed that myricetin had antimicrobial activity against both antibiotic sensitive and resistant Mycobacterium tuberculosis strains.

Myricetin inhibits bacterial transcription by disrupting RNAP-promoter DNA interactions and has antimicrobial activity against rifampin and isoniazid resistant Mycobacterium tuberculosis. Myricetin may serve as a novel antituberculosis lead compound.

To investigate risk factors associated with increased intracranial pressure (ICP) in children with sepsis-associated encephalopathy (SAE), and to construct a risk-predicting nomogram.

This single-center prospective observational study included 154 pediatric patients with SAE admitted to the pediatric intensive care unit (PICU) of Chengdu Women's and Children's Central Hospital from May 2022 to June 2024. The cohort comprised 56 patients with elevated ICP and 98 patients without elevated ICP. Clinical characteristics and noninvasive multimodality brain monitoring indices—including the disturbance coefficient (DC), systolic velocity of middle cerebral artery (VsMCA), mean velocity of middle cerebral artery (VmMCA), diastolic velocity of middle cerebral artery (VdMCA), pulsatility index (PI), and regional cerebral oxygen saturation (rScO₂)—were compared among patients. Univariate and multivariate logistic regression analyses were used to identify independent predictors of increased ICP. Then a nomogram was developed using R software. Model performance was evaluated by the receiver operating characteristic curve and area under the curve (AUC). Internal validation was performed via bootstrap resampling.

Multivariate logistic regression analysis identified three independent risk factors for elevated ICP: lower Glasgow coma scale (GCS) score at PICU admission [odds ratio (OR) = 0.560, 95% confidence interval (CI) (0.382, 0.837), P = 0.009], elevated VsMCA on the first day [OR = 1.053, 95%CI (1.010, 1.098), P = 0.025], and elevated rScO₂ on the first day [OR = 1.199, 95%CI (1.063, 1.348), P = 0.004]. The nomogram achieved an AUC of 0.927 [95%CI (0.887, 0.967), P < 0.001], a sensitivity of 92.9%, and a specificity of 79.6%. Calibration curves showed excellent agreement between predictions and observations.

The GCS-VsMCA-rScO₂-based nomogram provides accurate and clinically feasible prediction of elevated ICP in pediatric SAE, thus facilitating early intervention.

To classify sepsis patients based on blood urea nitrogen (BUN) trajectories and to examine their association with 28-day mortality.

Based on BUN measurements taken on the 1st, 3rd, and 7th days after admission, we employed a latent growth mixture modeling (LGMM) to identify trajectory classes. Additionally, we plotted Kaplan-Meier survival curves and performed log-rank tests, followed by the application of multivariable Cox proportional hazards models to evaluate associations with 28-day mortality. Prespecified subgroup analyses were also conducted.

A total of 210 patients diagnosed with sepsis were included in this study. Based on the longitudinal trajectories of BUN, three distinct trajectory patterns were identified: a low-initial slow-decline trajectory, a high-initial persistently high-level trajectory, and a moderate-initial slow-decline trajectory. The corresponding 28-day all-cause mortality rates for these trajectories were 20.0% (25/125), 64.0% (16/25), and 46.7% (28/60), respectively. Kaplan-Meier survival analysis demonstrated clear separation of the 28-day survival curves among the three groups, with a statistically significant difference observed between groups (log-rank χ² = 20.030, P < 0.001). In comparison to the low-initial slow-decline trajectory, patients in both the high-initial persistently high-level trajectory and the moderate-initial slow-decline trajectory demonstrated significantly lower overall survival probabilities; notably, the high-initial persistently high-level group exhibited the lowest 28-day survival rate, indicating the poorest 28-day prognosis (all P < 0.001). Cox regression analysis showed that, using the low-initial slow-decline trajectory as the reference, patients classified in the high-initial persistently high-level trajectory [hazard ratio (HR) = 2.500, 95% confidence interval (CI) (1.200, 5.400), P = 0.020] and those in the moderate-initial slow-decline trajectory [HR = 2.600, 95%CI (1.400, 4.700), P = 0.002] exhibited a significantly increased risk of 28-day all-cause mortality.

Dynamic BUN trajectories delineate prognostically heterogeneous subtypes of sepsis, with the persistently high trajectory exhibiting the highest mortality rate. Continuous monitoring of BUN levels can facilitate early risk assessment and enable risk-stratified management strategies.

To investigate the relationship between the urinary complement component 3a (C3a) and the risk of acute kidney injury (AKI) and 90-day mortality in critically ill patients, and its potential predictive significance.

The prospective study included 221 patients with critical illness admitted to the ICU of Baoji People's Hospital from March 2020 to December 2022. Enzyme-linked immunosorbent assay was used to detect the urinary C3a level of patients at admission. The primary endpoint was the incidence of AKI within 48 hours after admission to the ICU. According to whether AKI occurred, all critically ill patients were divided into an AKI group and a non AKI group. The secondary endpoints included all-cause mortality at ICU and 90 days, dialysis dependence at discharge, ICU length of stay, and total length of stay.

The median urinary C3a level in the AKI group was significantly higher than that in the non AKI group [7.73 (6.02, 10.14) μg/L vs. 3.68 (2.72, 5.32) μg/L, Z = 7.199, P < 0.001]. The higher urinary C3a level was an independent influencing factor for the occurrence of AKI in critically ill patients [odds ratio = 1.083, 95% confidence interval (CI) (1.014, 0.155), P = 0.017]; the area under the receiver operating characteristic curve for predicting AKI was 0.791 [95%CI (0.729, 0.852), P < 0.001], the optimal cutoff value was 6.06 μg/L, and the sensitivity and specificity were 75.31% and 80.00% respectively. In terms of short-term prognosis analysis, the higher urinary C3a level was also an independent influencing factor for the 90-day mortality in critically ill adult patients [hazard ratio = 1.046, 95%CI (1.023, 1.069), P < 0.001]. Patients were divided into a low-level urine C3a group (≤ 5.28 μg/L, 110 cases) and a high-level urine C3a group (> 5.28 μg/L, 111 cases) based on the median value. Compared with patients with low urinary C3a levels, patients with high urinary C3a levels had a lower 90-day survival rate (log rank χ² = 50.668, P < 0.001). In addition, compared with patients with low urinary C3a levels, patients with high urinary C3a levels had a higher ICU mortality rate [10.91% (12/110) vs. 47.75% (53/111), χ² = 36.110, P < 0.001], a higher proportion of dialysis dependence [2.73% (3/110) vs. 9.91% (11/111), χ² = 4.804, P = 0.028], longer ICU duration [8.00 (5.00, 14.00) d vs. 18.00 (12.75, 38.00) d, Z = 2.587, P = 0.010], and longer total hospital duration [10.00 (6.00, 18.00) d vs. 24.50 (17.00, 44.00) d, Z = 2.647, P = 0.008].

The higher urinary C3a levels at admission are associated with an increased risk of AKI and 90-day mortality, and have the potential to serve as a predictive biomarker for AKI and 90-day mortality risk in critically ill patients.

了解社区居民基础生命支持（BLS）知信行水平，分析其潜在剖面亚组特征和影响因素。

于2024年1月1日至5月31日采用分层整群随机抽样选取深圳市5个街道5个社区的1 348名社区居民为研究对象，采用一般资料调查表、普通民众BLS知信行量表进行调查，使用Mplus 8.3软件对样本数据进行潜在剖面分析，采用多分类logistic回归分析探究社区居民BLS知信行的影响因素。

社区居民BLS知信行水平存在3个潜在类别：低水平组共253人（BLS得分：25 ~ 41分），占总人数18.8%；中水平组共291人（BLS得分：42 ~ 48分），占总人数21.6%；高水平组共804人（BLS得分：49 ~ 66分），占总人数59.6%。Logistic回归结果显示，低水平组中参加过急救培训、学历高中及以下是其独立影响因素（P均< 0.05）；在中水平组中，仅有性别是其独立影响因素（P < 0.05）；在高水平组中，参加过急救培训、学历高中及以下以及年龄（36 ~ 59岁）均是其独立影响因素（P均< 0.05）。

社区居民BLS知信行现状处于中等偏上水平，社区管理者应根据居民不同急救能力类别的主要特征调整培训策略。

To address the challenges posed by large number of the point of care testing (POCT) equipment for blood glucose in large-scale hospitals, homogeneous quality management and concealed risks, this paper verified the practical value of 'isk-oriented sampling combined with technical evaluation' strategy for detecting systematic risks and guiding management decisions.

Four-party collaboration mechanism was established, risk-oriented sampling was conducted and public health "risk early warning" theory was introduced. From over 850 POCT glucose meters throughout the hospital, 115 devices (around 13.5%) exhibiting characteristic of "saturation operation" or "minor performance degradation" were selected as risk-oriented devices. Using the fully automatic biochemical analyzer as the reference method, fresh venous blood samples at five different concentration gradients were tested for on-site comparison. Bias was assessed using Bland-Altman analysis, followed by risk tracing and intervention.

The results showed that correlation coefficients (r) of the three brands of glucose meters and the biochemical analyzer were all above 0.99. However, at a biochemical analyzer measurement value of 13.1 mmol/L, Bland-Altman analysis results showed systematic negative bias in Brand Q and H (bias of -0.403 mmol/L and -0.688 mmol/L respectively) and the relative bias ranges were -16.79% to -7.63% for Brand Q and -17.56% to -9.16% for Brand H, with a few points exceeding the conventional ±15% error limit. Although an overall pass rate of 100% was achieved for all the three brands based on conventional standard, this strategy successfully identified the concealed concentration-dependent bias. The data analysis revealed that under the same experimental conditions, detection systems of different brands showed significant response inconsistency at high concentration ranges.

The strategy validated that with limited healthcare resource, risk-oriented sampling was able to effectively identify the systematic negative bias at high concentration ranges for devices with specific brands, which is concealed by conventional pass rate evaluation. These findings provide an evidence-based foundation for management strategy on implementing dynamic calibration of blood glucose POCT devices (to correct systematic drift), establishing of scientific retirement criteria, and implementing of targeted clinical supervision (to mitigate potential error accumulation).