Objective To investigate the value of prothrombotic state (PTS) in prediction of perioperative cardiac events in elderly patients with coronary heart disease undergoing noncardiac surgery.Methods One-hundred and twenty-eight ASA physical status Ⅰ or Ⅱ elderly patients (NYHA class Ⅰ or Ⅱ) of both sexes,aged 6575 yr,undergoing elective abdominal surgery,were enrolled in the study.Total intravenous anesthesia was performed during surgery.Venous blood samples were collected for detection of the levels of D-dimer,thrombus precursor protein and P-selectin (molecular markers of PTS).Detection of PTS was based on the three indexes mentioned above.The patients were divided into 2 groups according to the cardiac events occurred during surgery and within 3 days after surgery:non-cardiac event group and cardiac event group.The general data of patients and each index during surgery were recorded.Logistic regression analysis was used to pick out the potential risk factors for cardiac events.Results Twenty-nine patients developed cardiac events.There was no significant difference in age,obesity,ratio of diabetes,duration of operation,and ratio of PTS between non-cardiac event and cardiac event groups (P ＜ 0.05 or 0.01).Logistic regression analysis showed that old age,diabetes,prolonged duration of operation,and PTS were independent risk factors for cardiac events (P ＜ 0.01).Conclusion PTS produces some value in prediction of perioperative cardiac events in elderly patients with coronary heart disease undergoing noncardiac surgery.

PurposeTo evaluate the motion correction algorithm (snapshot freeze, SSF) and multi-cycle reconstruction on the imaging quality and interpretation of coronary CT angiography (CCTA).Materials and Methods Sixty patients with suspected coronary heart disease were divided into two groups according to the heart rate. Twenty-ifve patients with heart rate ≤65 beats per minute underwent prospectively ECG-gated CCTA on gemstone CT. Image quality and interpretability of standard (STD) and SSF reconstructions at 75% R-R interval were compared. Thirty-five patients with heart rate>65 beats per minute underwent retrospective ECG-gated CCTA. Image quality and interpretability of STD and SSF reconstructions at 45% and 75% R-R interval were compared. The image qualities and interpretability were assessed based on coronary artery segment, coronary artery bifurcation and overall coronary artery.Results For 25 patients with prospectively ECG gated CCTA, SSF reconstructions showed higher interpretability than STD reconstructions on per-segment level [96.3% (341/354)vs 90.7% (321/354),P<0.01]. Image qualities with SSF were higher than that with STD reconstructions for left anterior descending (LAD), left circumflex (LCX) and right coronary artery (RCA). There was no statistic significance for left main coronary artery (P>0.05). For 35 patients with retrospective ECG-gate CCTA, SSF reconstructions at 45% R-R interval showed higher interpretability (P<0.01,P<0.001). But there were no signiifcant difference for 75% R-R interval images (P>0.05). Image qualities with SSF were higher than that with single and double sector STD reconstructions (P<0.001). The image qualities were signiifcant different among SSF, single and double sector STD reconstructions for 45% R-R interval images of LM (P<0.01), but it was similar for 75% R-R interval images (P>0.05). There were signiifcant different for LAD, LCX and RCA on both 45% and 75% R-R interval images (P<0.01,P<0.001). Conclusion SSF may improve the image quality and interpretability of CCTA images using prospectively and retrospective ECG-gated techniques, especially for improving the image quality.

Objective To explore and compare the prognostic ability of the serum level of M2BPGi and MRI imaging technology for hepatic fibrosis. Methods 118 patients who were diagnosed as hepatitis C were enrolled from March 2014 to March 2015 in our hospital.Their baseline data were recorded,and they were texted by imaging examination of MRI.Then all patients were followed-up 2 years.The patients were divided into hepatic fibrosis group and control group according to the follow-up results.Univariate analysis and Cox model were used to show that the prognostic factors influencing the prognosis of hepatic fibrosis in patients;meanwhile,the statistical significance factors were calculated by ROC curve.Results The serological markers of IV-C,HA and serum level of M2BPGi in hepatic fibrosis group were higher than those in control group,but its ADC values of liver was lower than those in control group,and the difference was statistically significant(P < 0.05). COX regression analysis showed that the difference of M2BPGi(RR = 4.282,P = 0.003)and ADC values(RR = 0.654,P = 0.004). The ROC analysis of the hepatic fibrosis group and the control group showed that the AUC of the combination was 0.865,the sensitivity and specificity were 95.2%,60.5%,respectively.Conclusion The clinical value the com-bined prognostic of them is of high prognostic efficacy,which is hopeful to be used as an auxiliary prognostic meth-od in clinic.

Objective To develop a self-assessment scale of home volume management for patients with chronic heart failure(CHF),and to test its reliability and validity.Methods With the self-care theory as the theoretical framework,the initial scale was developed through literature analysis,qualitative interview and expert consultation.A questionnaire survey was conducted on 598 patients with CHF who were treated or reviewed in a tertiary hospital in Hangzhou from September 2022 to January 2023 to test the reliability and validity of the scale.Results The exploratory factor analysis extracted 4 common factors with the cumulative variance contribution rate of 61.268％.The results of confirmatory factor analysis showed that the main evaluation indicators were all within the acceptable range of the judgment standard.The item-level content validity index ranged from 0.853 to 1.000;the scale-level content validity index/average was 0.951.The Cronbach's a coefficient,half reliability and retest reliability of the overall scale were 0.930,0.723 and 0.867,respectively.Conclusion The self-rating scale of home volume management for CHF patients has good reliability and validity,and it can effectively assess the level of home volume management for CHF patients.

Objective:To explore the association between postoperative radiotherapy for bladder cancer and the risk of second primary rectal cancer.Methods:Eligible 75 120 patients with bladder cancer from the Surveillance, Epidemiology, and End Result database (SEER) of the National Cancer Institute (NCI) (1975-2017) were enrolled in this study. The second primary cancers referred to rectal cancers patients suffered after more than five years post-treatment for bladder cancer, and the cumulative incidence was estimated using Fine-Gray competing risk regression. The relative risk (RR) of rectal cancer in patients treated with or without radiotherapy (the RT group or the NRT group) was evaluated using Poisson regression.Results:Among the 75 120 patients, 70 045 (92.4%) were Caucasian, with a median age of 65.8 years (54-74 years). A total of 2 236 (3%) received postoperative radiotherapy, while 72 884 (97%) received surgery alone. The 30-year follow-up revealed a cumulative incidence of rectal cancer of 0.93% in the RT group and 0.43% in the NRT group ( P = 0.004). The competing risk regression analysis identified a significant association between radiotherapy and rectal cancer ( HR: 1.86; 95% CI 1.26-2.74, P < 0.009). Furthermore, the RR of radiotherapy-associated rectal cancer significantly increased as the diagnosis occurred earlier (1975-1985 vs. 1985-1994: RR 2.59; 95% CI 1.20-4.86, P < 0.001), and a lower age at the time of radiotherapy was associated with a higher probability of second primary tumors (≤50-year old vs. > 50 year old : RR 7.89, 95% CI 2.97-21.30, P < 0.001). As calculated using the Poisson distribution, the RR of second rectal tumors was higher in the RT group ( RR: 2.20, 95% CI 1.45-3.18, P < 0.001), even after adjusting the date of diagnosis ( RR: 1.77, 95% CI 1.17-2.57, P = 0.009). Conclusions:An increased risk of rectal cancer following bladder cancer radiotherapy necessitates aggressive follow-ups for the purpose of early detecting second primary rectal cancer associated with bladder cancer radiotherapy.