AIM: This paper, starting from the perspective of "human beings' living world", tries to reveal the historical epoch premise of mental health and redefines the criteria of mental health by "harmonization of human beings'relationships".METHODS: Sorting out the criteria of mental health by studying a large numbers of literatures.RESULTS: Four kinds of harmonious relationships in human beings' living world are disclosed, namely, the symbiosis of man and nature, the interaction between man and man, the integration of human beings and their egos, and the signification of mental health by inosculating man and "god".CONCLUSION: Grasping the real philosophical connotation of mental health to focus on human beings' realistic life quality through "the fashion of man".

Objective To observe the efficacy and safety of 150 mg clopidogrel and triple antiplatelet in acute anterior myocardial infarction ( AMI) patients undergoing percutaneous coronary intervention ( PCI).Methods Totally 50 patients who had been diagnosed as acute anterior myocardial infarction and prepared to PCI treatment were randomly divided into two groups:150 mg clopidogrel group ( asprin 100 mg/d qd+clopidogrel 150 mg/d qd) and triple antiplatelet group ( cilostazol 100 mg bid+asprin 100 mg/d qd+clopidogrel 75 mg/d qd).The coronary lession through CAG, incidence of major cardiovascular events and safety in 6 months were observed and assessed.ResuIts There was no significant difference in level of target lesion diameter between two groups after PCI instantly (2.75 ±0.29 mm vs.2.69 ±0.31 mm).There were no significant differences of late lumen loss (LLL) and target lesion revascularization (TLR) between triple antiplatelet group and 150 mg clopidogrel group (0.22 ±0.46 mm vs.0.38 ±0.65 mm; 8%vs.24%) , but the two indexes were improved in a certain extent.There were no significant differences in hemorrhage and major adverse cardiovascular events ( MACE) between two groups.ConcIusion The triple antiplatelet therapy could reduce the late lumen loss and target lesion revascularization, and not increase hemorrhage and adverse cardiovascular events.

The objective of this study is to combine troponin and indicators of cardiac acoustics for synthetically evaluating cardiac fatigue of rabbits, analyzing exercise-induced cardiac fatigue (EICF) and exercise-induced cardiac damage (EICD). New Zealand white rabbits were used to conduct a multi-step swimming experiments with load, reaching an exhaustive state for evaluating if the amplitude ratio of the first to second heart sound (S1/S2) and heart rate (HR) during the exhaustive exercise would decrease or not and if they would be recovered 24-48 h after exhaustive exercise. The experimental end point was to complete 3 times of exhaustions or death from exhaustion. Circulating troponin I (cTnI) were detected from all of the experimental rabbits at rest [(0. 02±0. 01) ng/mL], which, in general, indicated that there existed a physiological release of troponin. After the first exhaustive swim, cTnI of the rabbits increased. However, with 24-hour rest, S1/S2, HR, and cTnI of the tested rabbits all returned toward baseline levels, which meant that the experimental rabbits experienced a cardiac fatigue process. After repeated exhaustion, overloading phenomena were observed, which led to death in 3 out of 11 rabbits, indicating their cardiac damage; the troponin elevation under this condition could be interpreted by pathological release. Evaluation of myocardial damage can not be based on the troponin levels alone, but can only be based on a comprehensive analysis.
Animals ; Fatigue ; Heart ; physiopathology ; Heart Rate ; Myocardium ; pathology ; Rabbits ; Swimming ; Troponin I ; blood

Japanese gastric cancer treatment guidelines list options for treatment of each stage of early gastric cancer (EGC).The treatment of EGC is closely related to the lymph node metastasis, and the accurate prediction of lymph node metastasis is related to the choice of the treatment options and the prognosis of the patients.The lymph node metastasis of EGC is evaluated according to the clinicopathological factors, imaging,molecular markers and sentinel lymph node (SLN) tracer biopsy.A two-step method for the management of EGC treated with endoscopic mucosal resection/endoscopic submucosal dissection (EMR/ESD) is recommended.While for those EGC patients not suitable to receive EMR/ESD, imaging or molecular marker and SLN tracer biopsy technology are applied to determine lymph node status.

ObjectiveTo provide anatomy information for harvesting a pedicle or free posterior interosseous artery cutaneous branches-chain flaps. MethodsFourteen forearms from fresh human cadaver were used to study the anatomy characteristics of the posterior interosseous artery cutaneous branches-chain flaps with the following three methods:latex perfusion for microanatomy,denture materials and vinyl chloride mixed packing for cast,and PVA-bismuth oxide perfusion for molybdenum target X-ray arteriography.The cutaneous perforator with a diameter ≥ 0.2 mm were included for statistical analysis.Results① There were 6.2 cutaneous branches raised from posterior interosseous artery. Measuring from the radial edge of ulnar head to the lateral epicondyle of humerus as the standard distance, the distal cutaneous branch clusters located at 21.24％ relative to the standard distance,while the proximal clusters located at 47.86％.② There were two large cutaneous perforators from the posterior interosseous artery at(5.82 ± 1.22)cm proximal to the ulnar styloid and (10.34 ±0.98)cm distal to the epicondyle of humerus.The diameter and pedicle length of the distal perforators were(0.50± 0.04)mm and (16.79 ± 5.12)mm respectively,while the proximal perforator were (0.60 ± 0.08 )mm in diameter with a pedicle (21.20 ± 12.28)mm in length.③ The vascular chains parallel to the posterior interosseous artery were formed via anastomosis of the adjacent cutaneous perforators. ConclusionThere is clinical significance to use pedicle or free posterior interosseous artery cutaneous branches-chain flaps.

This paper presents a preliminary study of rabbit experiment modality incorporating a new indicator for evaluating cardiac function changes, providing a basis for subsequent study of cardiac fatigue. Using only biochemical indicators, such as troponins, is difficult to make a distinction between exercise-induced cardiac fatigue (EICF) and exercise-induced cardiac damage (EICD). Therefore, some new indicators are needed to evaluate cardiac fatigue synthetically. In our study, we used New Zealand white rabbits to conduct a multi-step swimming experiments with load. We made the rabbits reach an exhaustive state to evaluate whether the amplitude ratio of the first to second heart sound (S1/S2) and heart rate (HR) during the exhaustive exercise would be decreased and whether they would be able to recover after the exhaustive exercise for 24 hours. During the first phase of swimming, S1/S2 and HR were increased, and then decreased at exhaustive state. They were recovered after the exhaustive exercise for 24 hours. Overloading led to deaths of three rabbis, and new phenomena from overloading and related to this kind of death were observed. The experiments proved that Multi-steps swimming experiments with loads by using New Zealand white rabbit is useful for studying cardiac fatigue and premonition of sudden cardiac death.
Animals ; Cardiovascular Physiological Phenomena ; Death, Sudden, Cardiac ; Female ; Heart ; physiology ; Heart Rate ; physiology ; Male ; Muscle Fatigue ; physiology ; Myocardial Contraction ; physiology ; Myocardium ; chemistry ; Physical Endurance ; physiology ; Rabbits ; Stress, Physiological ; physiology ; Swimming

Objective:To evaluate the clinical application value of MR amide proton transfer weighted imaging (APTWI) in predicting the pathological grade of brainstem glioma (BSG).Methods:The data of 41 BSG patients in Beijing Tiantan Hospital, Capital Medical University from August 2019 to June 2020 who underwent both MRI and APTWI 2 weeks before surgery and had pathological grading results were retrospectively analyzed. According to the pathological results, 41 patients were classified into high-grade BSG (20 patients) and low-grade BSG (21 patients). Combined with conventional MR images, the signal intensity (%) of amide proton transfer (APT) in the parenchymal area of the tumor was obtained on APTWI images. χ 2 test or independent sample t-test was used to analyze the differences in gender distribution, age and APT signal intensity between patients with high and low grade BSG. Receiver operating characteristic (ROC) curve was drawn to predict the efficacy of APT signal intensity in the differential diagnosis of high and low grade BSG, and Youden index was calculated to obtain the optimal diagnostic threshold; the predictive ability of APT signal intensity was analyzed in combination with Hosmer-Lemeshow goodness of fit test. Results:There was no significant difference in age [(23±18) years, (20±17) years, t=0.97, P=0.340] and gender distribution (9/11, 9/12 for males/females, χ 2=0.02, P=0.890) between high-grade and low-grade BSG patients. The APT signal intensity of high-grade BSG [(3.9±0.9)%] was significantly higher than that of low-grade BSG [(2.8±0.9)%], and the difference had statistical significance ( t=4.16, P<0.001). The area under the ROC curve of APT signal intensity to distinguish high-grade and low grade BSG was 0.836, and with 2.85% as the optimal diagnostic threshold of APT signal intensity, its sensitivity for the diagnosis of high-grade BSG was 90.0% and specificity was 71.4%. The Hosmer-Lemeshow test showed that APTWI had a good predictive ability for BSG grade (χ 2=13.33, P=0.101). Conclusion:APTWI can be applied in distinguishing high grade BSG from low grade BSG, and has clinical value in predicting glioma grading.

Objective:To explore the risk factors of recurrence after resection of thigh soft tissue malignant tumors and the evaluation of the postoperative lower limb function.Methods:A total of 211 patients who underwent thigh soft tissue malignant tumor resection in the Department of Orthopaedics of the second affiliated Hospital of Medical College of Zhejiang University from May 2011 to May 2021 were retrospectively analyzed, including 117 males and 94 females, aged 53 (43, 65) years. There were 59 cases of atypical/well-differentiated liposarcoma, 30 cases of other types of liposarcoma, 33 cases of malignant fibrous histiocytoma, 19 cases of fibrosarcoma, 12 cases of rhabdomyosarcoma, 12 cases of leiomyosarcoma, 9 cases of synovial sarcoma, and 37 cases of others. The tumor involvement of muscle, bone, blood vessel, nerve tissue and intermuscular compartment, postoperative Musculoskeletal Tumor Society (MSTS) functional score and recurrence were recorded. The relationship between anatomical structure and postoperative recurrence was analyzed by Cox logistic regression to determine risk factors; the cumulative recurrence rate of different compartment groups (medial compartment, anterior compartment, and posterior compartment) were compared; The Box plot was used to compare the postoperative function of patients with resection of different anatomical structures (e.g., vastus lateralis, biceps femoris, femur, etc.).Results:A total of 34 out of 211 patients relapsed, with a recurrence rate of 16.1%. The recurrence time ranged from 2.6 months to 91.6 months after operation, with a median recurrence time of 37.0 (18.2, 52.8) months. Three independent risk factors were found to be associated with recurrence, namely: pathological grade [ HR=3.86, 95% CI(1.75, 8.51)], involvement of vastus intermedius [ HR=3.05, 95% CI(1.53, 6.06)], and involvement of vastus medialis [ HR=3.17, 95% CI(1.56, 6.41)]. The recurrence rate of patients with anterior chamber tumor resection was 35.3%, which was higher than that of patients without tumor resection (16.2%), and the difference was statistically significant ( P=0.020). There was no significant difference in recurrence rate between patients with medial chamber tumor resection and patients without tumor resection ( P>0.05). The recurrence rate of patients with posterior compartment tumor resection was 12.3%, which was lower than that of unresectable patients (37.6%), and the difference was statistically significant ( P=0.002).The postoperative MSTS score of 167 patients averaged 26±3.2 points (9-30 points). After intraoperative resection of part of the femur, vastus intermedius, vastus medialis, and rectus femoris, the patient's function was relatively poor [corresponding median MSTS score: 25 (23, 28), 26 (24 28), 26 (24,28), 26(24, 27)]. Conclusion:The risk factors for local recurrence after resection of thigh soft tissue malignant tumors include: pathological grade of the tumor, and whether the vastus intermedius or vastus medialis is involved. Anterior compartment tumors have a higher recurrence rate after surgery. If the tumor involves the above-mentioned anatomical structures, more attention should be paid to the risk of local recurrence after surgery.

Objective:To explore the clinical characteristics of dislocation after resection and reconstruction of tumors involving pelvic area II, and to try to propose intraoperative and postoperative techniques to prevent its occurrence.Methods:From March 2011 to March 2021, 122 patients with resection and reconstruction involving pelvic area II were retrospectively analyzed. Among them, 17 had postoperative dislocation, 32 had pelvic area II, and 31 had pelvic area I+II. There were 40 cases in the pelvic area II+III, and 19 cases in the pelvic area I+II+III. There were 49 female patients and 73 male patients; the mean age was 47 years (9-73 years). The Musculoskeletal Tumor Society (MSTS) score of lower extremity patients after reduction was evaluated, and the clinical characteristics of dislocation, such as dislocation direction, dislocation time and reduction method, were counted and analyzed, and feasible prevention measures were analyzed based on the imaging characteristics after resection and reconstruction. dislocation method.Results:Among the 122 patients, there were 17 cases of dislocation, and the dislocation rate was 13.7%. Among them, 12 cases were anterior dislocation, accounting for 70.6% of anterior dislocation; 5 cases were posterior dislocation, and the proportion of posterior dislocation was 29.4%, difference (χ 2=4.52, P=0.033). There were 12 cases of dislocation within 3 months after operation, accounting for 70.6%; 1 case of dislocation occurred in 5 months after operation, and the other 4 cases of dislocation occurred for more than one year. The MSTS score of the dislocation patients after reduction was 56.1±15.6% (20%-80%). Combined with postoperative imaging examinations, the feasible methods for preventing dislocation include: The anteversion angle of the acetabular cup can be appropriately reduced (0°-10°); The acetabular cup can be appropriately shifted to the rear of the rotation center; Appropriately reducing the anteversion angle of the femoral neck prosthesis, the combination of the three can reduce the occurrence of femoral-acetabular prosthesis impingement; at the same time, the affected limb is controlled in a neutral position with strict nail shoes after surgery to avoid the occurrence of external rotation. Conclusion:The dislocation after tumor resection and reconstruction in pelvic area II is mostly anterior dislocation. Postoperative CT scan of the pelvis shows that the space between the neck of the femoral stem prosthesis and the lower edge of the acetabulum is small, which is prone to impingement. If the anteversion angle of the acetabular cup is appropriately reduced, the acetabular prosthesis is appropriately displaced posteriorly, and the anteversion angle of the femoral neck is reduced by 5°, the possibility of femoral-acetabular impingement can be reduced, thereby reducing the risk of postoperative dislocation.

OBJECTIVE To evaluate the safety of epinephrine hydrochloride injection(EHI) given by nebulized inhalation in guinea pigs with the off-label drug use. METHODS The actual dose of inhalation administration was determined by establishing a nebulized administration drug concentration assay. The systemic allergic reactions and respiratory toxicity of EHI after nebulized inhalation were evaluated by guinea pigs using the allergy test protocol with the combination of frequency and dose of epinephrine hydrochloride administration and allergy test. Thirty-two guinea pigs were randomly divided into 4 groups according to body weight: negative control group(equal volume of saline), positive control group(sensitizing dose: 20 mg·kg-1 ovalbumin), low dose group(sensitizing dose: 15.5 μg·kg-1 EHI) and high dose group(sensitizing dose: 31 μg·kg-1 EHI). The excitation dose of each group was two times the sensitization dose, at the time of excitation, the symptoms of allergic reaction were observed. After excitation, blood and alveolar lavage fluid were collected, whole blood was collected for hematological testing and isolated serum and alveolar lavage fluid were used for IgE testing. Bronchial and lung tissues were taken for histological testing and immunohistochemistry after dissection. RESULTS Using a nebulizer device to administer EHI to guinea pigs at a clinically equivalent dose at 3.95 min of administration. The guinea pigs in all groups showed normal weight gain during sensitization administration. At the time of excitation, the guinea pigs in the positive control group showed strong positive allergic reactions, while the guinea pigs in the negative control group, low dose group and high dose group showed no significant allergic reactions. Compared with the negative control group, eosinophils in the blood of the positive control guinea pigs were significantly higher(P<0.05) and the IgE content in the serum and alveolar lavage fluid was significantly increased(P<0.05 or P<0.01). Histopathological results showed that inflammatory cells infiltrated in the lung tissue of the positive control guinea pigs after excitation, and a large number of erythrocytes and exudate appeared in the alveoli. The immunohistochemical indiacated that the inflammatory symptoms in the lung tissues of the positive guinea pigs were associated with an increase in B lymphocytes. The hematological indexes, serum IgE content, immunohistochemical and histological examination results of guinea pigs in the low and high dose groups were not significantly different from those of the negative control group. CONCLUSION No allergic reaction and no respiratory toxicity occurred in guinea pigs given EHI by nebulization, and the administration of EHI by nebulized inhalation off-label drug use is safe and feasible.