Purpose To observe the changes of left atrial (LA) structure and function in patients with paroxysmal atrial fibrillation after radiofrequency catheter ablation by echocardiography in order to provide basis for clinical evaluation of surgery.Materials and Methods Forty-four patients with paroxysmal atrial fibrillation and treated with radiofrequency catheter ablation in PLA General Hospital from January 2015 to June 2016 were enrolled.According to whether or not to restore sinus rhythm after operation,the patients were divided into sinus rhythm group and atrial fibrillation recurrence group.The paramrters of LA including diameter,maximum and minimum volume,systolic volume,ejection fraction,active ejection fraction,conduit function index and dilatation index were measure by echocardiography before and at least 6 months after radiofrequency catheter ablation.The data were compared between and within groups.Results All patients were followed up for (6.0±0.5) months after ablation operation.29 of 44 patients (66％) maintained sinus rhythm;the anteroposterior,vertical,and left to right diameters of LA in patients with sinus rhythm after operation were significantly lower than those before operation,but the ejection fraction of LA increased (all P＜0.05).However,in patients with atrial fibrillation recurrence after operation,the volume of LA increased (P＜0.05);the diameters of LA did not show significant differences;the ejection and active ejection fraction of LA had significantly decreased (P＜0.05).Compared with patients with sinus rhythm after operation,patients with atrial fibrillation recurrence after operation were older and had higher proportion of hypertension (P＜0.05).Conclusion After ablation,the diameter of LA decreases and the ejection fraction increases in patients with sinus rhythm;the volume of LA increases and the function reduces in patients with atrial fibrillation recurrence.

Objective To investigate the clinical value of serum metabonomic profile of pancreatic cancer using nuclear magnetic resonance (NMR)-based metabonomics.Methods The retrospective case-control study was adopted.The clinical data of 23 patients with pancreatic cancer (PC group) and 16 healthy volunteers (control group) who were admitted to the Fujian Medical University Union Hospital between December 2013 and December 2014 were collected.The serum of the 2 groups was measured by 1H NMR spectroscopy.Multivariate statistical analyses were performed to identify the characteristic metabolites in the 2 groups,including principal component analysis (PCA),partial least squares discriminant analysis (PLS-DA) and orthogonal partial least squares discriminant analysis (OPLS-DA).Observation indicators included:(1) multivariate statistical analysis of serum metabonomic profile,results of PCA,PLS-DA and OPLS-DA,(2) screening of metabolites.Measurement data with normal distribution were presented as x ± s.The comparison between groups was evaluated with the t test.The count data were analyzed using the chi-square test.Results (1) The multivariate statistical analysis of serum metabonomic profile:results of PCA showed that expression rates of principal component 1 (PC1) and principal component 2 (PC2) to original data were 54.9％ and 23.5％,with both cumulative contribution rate of 78.4％.Results of PLS-DA showed that the separative trend between PC group and control group was appeared,and variance of X and Y matrixes and predictive value were 0.254,0.816 and 0.385.Results of OPLS-DA showed that the differences of samples between the 2 groups were further increased,and differential metabolites were screened according to the distinction of scores between the 2 groups,value of R2X,R2Y and Q2 was 0.254,0.816 and 0.433.(2) Screening of metabolites:35 serum metabolites were detected in the 2 groups.Compared with the control group,levels of 3-hydroxybuyarate,citrate,formate,glutamate,isoleucine,methionine and phenylalanine in the PC group were elevated (r =0.524,0.511,0.656,0.566,0.503,0.498,0.648,P ＜0.05),and levels of 3-methylhistidine,alanine,glutamine,LDL and VLDL in the PC group were decreased (r =-0.607,-0.508,-0.560,-0.568,-0.559,P ＜ 0.05).Conclusions Compared with healthy controls,several amino acids,citrate and lipoproteins demonstrate the metabolic differences in the serum of patients with pancreatic cancer.NMR based metabonomic profile technology can distinguish the difference of serum metabolites between patients with pancreatic cancer and healthy controls.NMR based metabonomic technology may be a promising method for the diagnosis of pancreatic cancer.

Objective To evaluate the clinical efficacy of interventional occlusion of ventricular septal rupture (VSR) complicating acute myocardial infarction (AMI). Methods Six patients with VSR complicated after AMI underwent transcatheter interventional occlusion in Chinese PLA General Hospital between May 2009 to May 2015 were retrospectively analyzed. Their clinical features, interventional treatment protocols, and occurance of postoperative complications were studied. Results Among the 6 patients, VSR were successfully occluded in 5 patients. One patient failed the operation due to instability of occluder after it was deployed and the occluder was retrieved. The paitents died of heart failure 6 months later. Among the 5 patients with successful closure, 4 patients presented mild residual shunt after occlusion and acute left heart failure occurred in 1 patient after operation. Two patients died during hospital stay after operation. Between them, one patient died 3 hours after operation because of cardiac tamponade and the other patient died of cardiogenic shock after withdrawal from IABP. Three patients were followed up until now and follow up echocardiography showed satisfactory cardiac function without heart failure. Conclusions Transcatheter occlusion was a reliable therapy for patients with ventricular septal rupture complicated in acute myocardial infarction which could improve cardiac function and reduce mortality.

Olfactory neuroblastoma is a rare malignant tumor. Although multiple therapeutic modalities including surgery, radio-therapy, or chemotherapy could be used in patients with olfactory neuroblastoma, no standardized treatment has been achieved. This re-view introduces a case of adult olfactory neuroblastoma treated by a multiple disciplinary team in Tianjin Medical University Cancer In-stitute and Hospital. This review also aims to explore a complete set of diagnostic and treatment practices for the benefit of future pa-tients.

With the continuously exploration,in recent years,further understanding of anatomical characteristics of the cervical pedicle brings great breakthrough in cervical pedicle screw implantation.In addition,pedicle screw implantation in cervical spine is considered as a technique with high safety and reliability,which can be widely used in cervical trauma fracture,cervical instability,degenerative,inflammatory,benign or malignant tumor,deformity and other neck diseases.Because of the tremendous differences between upper cervical spine (C1,C2) and lower cervical spine (C3-7) in anatomical morphology,cervical pedicle screw implantation in C1 and C2 differs from in lower cervical spine.Due to the similar structure of C3-7,pedicle screw implantation methods are based on the same principle and sharing a few points in common.The pedicle screw technique can be classified in two groups according to the practice methods:navigation technology and manual placement of cervical pedicle screw.Navigation nailing is considered as reliable,easy handing,and with clear operative vision,however,with disadvantages as complex procedures,highly cost operation equipment,and risk in navigation draft.Therefore,manual placement of pedicle screw is more reasonable and practical comparing with the former.In this study,it analyzed anatomical characteristics of lower cervical pedicle and the measurement of pedicle structure,discussed technique of manual placement of pedicle screw in lower cervical spine and biomechanical study of pedicle screw,and summed up the comparison of the advantages and disadvantages of current representative manual placement technology.

OBJECTIVEThis study used cone beam computed tomography (CBCT) to access the distribution and position of accessory mandibular foramina in the mandibular body of Jiangxi adults, and some safety rules of operation for clinics were provided.

METHODSTwo hundred CBCT image subjects of Jiangxi adults were selected, which were divided into 4 groups by age with the same sex ratio. The number and position of accessory mandibular foramina in mandibular anterior teeth, premolars and molars region were described and the relationship between accessory mandibular foramina incidence and factors of age, gender and lateral were analyzed.

RESULTSA total of 1 123 accessory mandibular foramina were found, with a mean of 5.62±2.10 per person. The accessory mandibular foramina incidence decreased from the mesial region to the distal, and the lingual was higher than the buccal. There was no significant difference in the number of accessory mandibular foramina in male and female (P=0.195). However, the number of accessory mandibular foramina was negatively correlated with age (r(s)=-0.301). Three highest frequency regions of accessory mandibular foramina were mandibular symphysis area (98.0%), lingual alveolar area of lower medial (88.0%) and lateral incisors and inferior area of lingual premolar (55.0%).

CONCLUSIONSAccessory mandibular foramina are widely presented in the body of everyone's mandible, addition attention should be paid to avoid the complications causing by the damage of canal contents in the clinics.

A good social network can ensure the safety of women during pregnancy and reduce the incidence of adverse pregnancy outcomes. However, there is currently relatively little research on the overall social network of pregnant women, and the influencing factors of the overall social network of pregnant women are not yet clear. This paper reviews the current situation, influencing factors, and measurement tools of the social network in pregnant women, aiming to improve their social network, help them access high-quality nursing resources, ensure the health of pregnant women and infants, and decrease the incidence of adverse pregnancy outcomes.

Objective:To investigate the current status of the use and management of medical devices in various primary medical and health institutions under hierarchical medical diagnosis and treatment.Methods:A stratified random cluster sampling method was used to select 450 medical personnel from 50 township and urban primary medical and health institutions of Shijiazhuang from May to August 2023 and a questionnaire network survey on the use and management of medical devices was conducted,which covered 16 items across three dimensions including the use of commonly used medical devices in primary medical institutions,maintenance and quality control management.Results:A total of 450 questionnaires were distributed and 450 valid questionnaires were collected,including 239 from township primary level medical institutions and 211 from urban primary level ones.According to the results of 211 urban primary level questionnaires,the proportions of the training and examination carried out by the medical staff of urban grass-roots medical and health institutions prior to the use of medical devices,understanding parameters of medical devices and timely detection of malfunction of medical devices were 62.6%(132/211),77.7%(164/211)and 70.1%(148/211),respectively,which were higher than those at the township primary level,the difference was statistically significant(x2=17.750,29.649,22.384,P<0.05).The proportions of urban primary medical and health institutions with maintenance system,inspection and maintenance standards,regular calibration provisions,and equipment calibration standards were 64.0%(135/211),53.6%(112/211),55.9%(118/211)and 55.0%(116/211),respectively,which were higher than those of the township primary level,the difference was statistically significant(x2=5.834,34.728,6.004,25.540,P<0.05).The difference was not statistically significant between urban primary level and township primary level in each item of quality control management(P>0.05).Conclusion:Primary medical and health institutions were required to strengthen training and assessment before medical and health personnel use medical devices;improve related system and standards for medical device maintenance;formulate quality control management system for commonly used medical devices;strengthen analysis and discussion processes after quality control,and promote continuous improvement of medical device quality management.

Objective:To summarize the best evidence for prevention and management of aspiration in neurosurgical ICU patients and provide evidence for clinical nursing work.Methods:Relevant evidence on prevention and management of aspiration in neurosurgical ICU patients, including guidelines, consensus, system reviews, and randomized controlled trials (RCTs) which were published from 1st January, 2010 to 30th June, 2019 in any language was retrieved from guideline websites, relevant websites and databases. Two researchers evaluated the quality of the included literature and performed evidence extraction on those literatures that met the quality standards.Results:Totally 9 clinical practice guidelines, 8 expert consensus, 13 Meta analysis / systematic reviews and 10 RCTs were included, which were collected and extracted to form the final version of best evidence for aspiration prevention and management including 10 primary indicators and 29 secondary indicators.Conclusions:Medical staff should take effective measures in early assessment of aspiration risks, artificial airway management, position management, enteral nutrition management, sedation and analgesia management, etc., and reduce the incidence of aspiration in neurosurgical ICU patients by applying the best evidence. In addition, hospitals should provide various forms of education and training to medical staff, form transdisciplinary cooperation teams, and strengthen the prevention and management of aspiration.

Objective:To summarize the best evidence for the prevention and management of aspiration pneumonia in elderly patients to provide a basis for clinical nursing work.Methods:We systematically searched the domestic and foreign guide nets, websites of relevant institutions and databases on the relevant evidence for the prevention and management of aspiration pneumonia, including guidelines, expert consensus, systematic reviews, randomized controlled trials (RCT) , and the search time limit was from January 1, 2010, to June 30, 2020, and the language was not limited. Two researchers evaluated the quality of the included literature, and extracted, analyzed, and integrated evidence that met the quality evaluation criteria.Results:A total of 8 guidelines, 5 expert consensus, 10 systematic reviews, and 19 RCTs were included. The evidence was collected and extracted to form a prevention and management strategy for elderly patients with aspiration pneumonia including 11 first-level indicators and 32 second-level indicators.Conclusions:Medical and nursing staff should take effective measures in risk assessment, posture management, oral management, airway management, medication management, functional exercise and so on to reduce the risk of aspiration. Medical and nursing staff should also strengthen training for their own, elderly patients and main caregivers, and reduce the incidence of aspiration in elderly patients by applying the best evidence, so as to reduce the incidence of aspiration pneumonia.