BACKGROUND:With the increase of the incidence of cervical spondylosis,it is particularly important to control the postoperative bleeding and related inflammatory reaction of cervical vertebra. OBJECTIVE:A prospective study was conducted to investigate the combined effect of intravenous and topical tranexamic acid of different concentrations on postoperative blood loss and inflammatory response during posterior cervical decompressive laminectomy combined with lateral mass screw internal fixation and bone graft fusion. METHODS:From January 2020 to December 2022,150 patients who were scheduled to undergo posterior cervical decompressive laminectomy combined with lateral mass screw internal fixation and bone graft fusion for cervical spondylotic myelopathy in Tianjin People's Hospital were enrolled in the study.Patients were divided into A,B,and C groups(n=50)by randomized double-blind lottery.The patients in the A,B,and C groups were treated with 1%,3%,and 5%intravenous and topical tranexamic acid solution,respectively.Postoperative blood loss and inflammation-related indicators were compared among three groups.The occurrence of venous thromboembolism and hematoma was observed after operation. RESULTS AND CONCLUSION:(1)There were significant differences in blood loss-related indexes,such as intraoperative blood loss,overall blood loss,and occult blood loss among the three groups(P<0.01).The above indexes were significantly lower in groups B and C than that in group A.There was no significant difference between groups B and C(P>0.05).(2)On days 1 and 3 after surgery,the levels of inflammatory indicators including serum C-reactive protein and interleukin-6 were increased to varying degrees in the three groups compared to before surgery(P<0.05).As the drug concentration increased,its expression decreased,and there was a significant difference among the three groups(P<0.001).(3)Two cases of intramuscular venous thrombosis appeared in each of the three groups after surgery.No hematoma or pulmonary embolism occurred in all three groups.(4)It is concluded that in posterior cervical decompressive laminectomy combined with lateral mass screw internal fixation and bone graft fusion,intravenous combined with topical application of different concentrations of tranexamic acid is effective in reducing perioperative blood loss and inflammatory response.3%tranexamic acid achieves the same effect without significantly increasing the risk of postoperative venous thromboembolism.

Flap surgery is a surgical technique commonly used by microsurgeons and it is the main technique for wound repair. To be an excellent flap surgeon in the new era is to meet the needs of wound repair and treatment from the public and make contributions to a healthy China.

Objective To investigate awareness and attitude of advance directives among ICU nurses and analyze its influencing factors,and to provide references for promotion and application of advance directives in China.Methods A questionnaire survey of 256 ICU nurses from secondary and higher hospitals in Tianjin was conducted from December 2016 to January 2017,and a self-designed questionnaire of awareness and attitude of advance directives was used to measure nurses' awareness,attitude and obstacles of promotion.Results The total score of advance directives knowledge was(23.45±6.34).There were 222 nurses(90.6％)who supported the use of advance directives.‘Our country has no relevant legal support,and it is difficult to implement advance directives’ was the primary obstacle.The number of cared patients daily,children situation and hospital level were influencing factors of attitude (P＜0.05).Conclusion ICU nurses have relatively low level of knowledge of advance directives.ICU nurses hold a positive attitude towards advance directives,but there are still concerns;nurses who have the number of cared patients daily ≥3,have children,and from tertiary hospitals have a higher rate of approval.

Objective:To explore the risk factors of unplanned readmission in patients with acute myocardial infarction, and to construct a risk prediction model.Methods:This study used cross-sectional survey method. A total of 270 acute myocardial infarction patients admitted from Tianjin Union Medical Cencer from March 2020 to March 2021 were evaluated in a cardiology department. We used the electronic medical record system to collect the patients′ data. Patients were divided into two groups according to the occurrence of readmission within 1 year or not. Logistic regression analysis was performed to identify risk factors and formulated prediction model.Results:Totally 81 patients (30%) were readmitted. Binary Logistic regression model showed that the independent influencing factors of unplanned readmission in acute myocardial infarction patients included smoking ( X1), hypertension ( X2), marital status ( X3), hospitalization days ( X4), percutaneous coronary intervention ( X5), and heart failure ( X6). Area under ROC curve was 0.840, the maximum value of the Youden index was 0.560, and the sensitivity was 85.2%, the specificity was 70.8%, and the cutoff value was 0.377. Prediction model expression of unplanned readmission risk in patients with acute myocardial infarction was Logit(p/1-p)=-4.012+1.172 X1+1.104 X2+0.992 X3+0.118 X4+1.191 X5+1.093 X6. Conclusions:The risk prediction model of unplanned readmission in patients with acute myocardial infarction established in this article was with a good predictive effect, and it could be used in early identification of those patients with high-risk in unplanned readmission. At the same time, combined with the risk factors of depression, targeted intervention measures can be formulated.

Objective:To investigate the inhibitory effect of specific inhibitor of necroptosis necrostatin-1 (Nec-1) on necroptosis of retinal ganglion cells (RGCs) in rats with acute ocular hypertension.Methods:Twenty-four adult male Sprague Dawley rats were randomly divided into normal control group, model control group, Nec-1 treatment group and negative control group by random number table method, with 6 rats in each group.High intraocular pressure (IOP)-induced ischemia and reperfusion model was established through anterior chamber irrigation of 0.9% sodium chloride solution in left eyes of the rats, raising the IOP to 110 mmHg (1 mmHg=0.133 kPa) for 60 minutes.Nec-1 (4 mmol/L, 2 μl) or dimethyl sulfoxide (2 μl) was intravitreally injected immediately in Nec-1 treatment group and negative control group following modeling, respectively, according to grouping.No intervention was administered to the normal control group.Paraffin sections of rat retinas of the left eyes in different groups were prepared seven days after modeling.The retinal structure was observed by hematoxylin-eosin staining, and the expression levels of thymocyte antigen-1 (Thy-1) and glial fibrillary acidic protein (GFAP) were detected via immunohistochemical staining.All animal experiments were approved by an Ethics Committee of Tianjin Union Medical Center (No.2017 Quick audit C01).Results:Seven days after modeling, compared with normal control group, the retinal nerve fiber layer was thinner in model control group and negative control group, and the RGCs were arranged loosely, and cells in the inner nuclear layer were reduced and arranged disorderly, and cells in the outer nuclear layer were normal or enlarged.Compared with model control group and negative control group, the nerve fiber layer was thickened and the number of RGCs was significantly increased in Nec-1 treatment group.The number of Thy-1-positive RGCs was decreased in model control group, negative control group and Nec-1 treatment group than normal control group, and there were more Thy-1-positive RGCs in Nec-1 treatment group than model control group and negative control group.The integrated absorbance ( A) value of GFAP protein in normal control group, model control group, negative control group and Nec-1 treatment group was 47.209±15.311, 116.220±18.194, 116.382±19.020, 92.818±10.236, respectively, showing statistically significant differences among them ( F=24.675, P<0.001). The integrated A value of GFAP protein was significantly increased in model control group, negative control group and Nec-1 treatment group than normal control group, and the integrated A value of GFAP protein in Nec-1 treatment group was lower than that in model control group and negative control group, with statistically significant differences (all at P<0.05). Conclusions:Nec-1 can promote RGCs survival by inhibiting the necroptosis of RGCs in rats with acute intraocular hypertension.

Objective:To investigate the incidence of lower extremity deep vein thrombosis (DVT) after hip replacement surgery in middle-aged and elderly patients and to explore the risk factors.Methods:A total of 121 middle-aged and elderly patients who underwent hip replacement in the Tianjin People's Hospital from January 1, 2018 to December 31, 2020 were collected for analysis. The basic characteristics of the patients included were statistically described by univariate and multivariate logistic regression analysis.Results:There were 98 male patients and 23 female patients, with an average age of 59.55±9.53 years. 51 patients developed postoperative DVT of the lower limbs, with an incidence of 42.1%. Older age ( OR=1.129, 95% CI=1.013-1.239), body mass index (BMI, kg/m 2) ≥24 ( OR=1.493, 95% CI=1.066-2.314), history of diabetes ( OR=1.293, 95% CI=1.114-2.094), and long postoperative hospital stay ( OR=1.203, 95% CI=1.056-1.377) were risk factors. Conclusions:The risk of lower extremity DVT after hip replacement surgery was higher in middle-aged and elderly patients. In clinical practice, we should pay attention to risk factors and focus on key groups to prevent the occurrence and development of lower extremity DVT.

Objective To analyze the implementation of day surgery in a public hospital in Tianjin,and to provide refer-ence for the quantity and quality of day surgery.Methods The implementation of day surgery in a public hospital in Tianjin from 2020 to 2022 was analyzed.Results From 2020-2022,the main types of daytime operations were secondary(43 kinds)and ter-tiary operations(28 kinds).In terms of the implementation of professional disciplines,anorectal surgery,urology surgery and orthopedics carried out the largest number of operations,among which anorectal surgery accounted for 70.76％(2 285/3 229).Conclusion It is necessary to further improve the development of professional disciplines,the management system of day surger-y,and the guarantee of medical services,strengthen the construction of weak links in the management path of day surgery and im-prove the coverage and accessibility of day service.

Extramammary Paget disease (EMPD) is a kind of rare clinical malignant tumor in the skin. Surgical treatment is the main treatment method, and the Mohs microsurgery is considered the first choice which can control the incision margin accurately and reduce the recurrence rate. Due to the insidious and multifocal nature of the disease, the postoperative recurrence rate is still high. The other treatment methods include radiation therapy, chemotherapy, targeted therapy, photodynamic therapy, local drug therapy and laser therapy. Further research on the progress of EMPD treatment is helpful for the management and treatment of patients in clinical practice.

Objective To explore the cost structure and influencing factors of high-multiplication cases.Methods Using medical insurance settlement data from a tertiary hospital in Tianjin from April 2023 to March 2024,this study analyzes the characteristics of high-multiplication DRG cases and compares hospitalization costs between high-multiplication and normal-multi-plication patients.The grey relational analysis method is employed to assess the grey correlation between hospitalization costs and various itemized expenses for both groups.Results Significant differences were found between the high-multiplication group and the normal-multiplication group in terms of gender,age,insurance type,length of stay,base points,and all hospitalization costs except for surgical expenses(P＜0.05).Within the cost structure,drug costs from multiple DRG groups showed the strongest correlation with total hospitalization costs.Treatment costs ranked highest in overall grey correlation.Conclusion Enhancing the management of high-multiplication cases is crucial.Future efforts should focus on improving separate payment policies for high-multiplication and special cases,refining clinical pathways,standardizing medical practices,optimizing performance distribution methods,and strengthening operational management to enhance the fine management of medical insurance.

[摘 要] 细胞焦亡是一种以促炎为特点的细胞程序性死亡方式，其生物学特征为依赖于半胱氨酸天冬蛋白酶（caspases）家族 蛋白切割gasdermin家族蛋白，使活化的gasdermin家族蛋白在质膜上形成离子穿孔，导致细胞肿胀裂解。目前已知的细胞焦亡 信号途径包括gasdermin-D（GSDMD）介导的经典途径和非经典途径，以及gasdermin-E（GSDME）介导的化疗药物等处理后的细 胞焦亡途径。越来越多的研究显示，细胞焦亡与肿瘤细胞死亡及相关正常组织细胞损伤密切相关，陆续有多种药物或者提取物 被证实其抗肿瘤分子机制与焦亡相关，这为抗肿瘤治疗的研究提供了新的思路和方法。本文就细胞焦亡的分子机制与焦亡相关 药物抗肿瘤治疗的研究进展进行综述。