Objective To evaluate the coronary lesions with two-dimensional strain echocardiography. Methods Sixty-seven patients with suspected coronary heart diseases who underwent coronary angiography were divided into two groups. Forty-two of them with coronary stenosis ≥70% were considered as patient group, and the other 25 with coronary stenosis ＜50% were regarded as control group. Two-dimensional strain was performed in all patients within 24 h before coronary angiography. Longitudinal systolic strain rate (SRs), early (SRe) and late (SRa) diastolic strain rate, systolic strain (Ss), and time to SRe (T-SRe) were measured and compared. Results Ss, SRs, SRe and SRe/SRa decreased significantly in regions controlled by coronary artery with ≥70% stenosis in patient group compared with those controlled by coronary artery with ＜50% stenosis in control group. SRs and SRe were the independent predictive factors of coronary stenosis ≥70%, and the sensitivity and specificity of SRe ＜0.91 to identify coronary stenosis ≥70% was 72.46% and 89.65%, respectively. Conclusion Two-dimensional strain echocardiography may accurately evaluate the coronary lesions by detecting regional myocardial diastolic function.

Objective To evaluate the regional cardiac function for patients with coronary heart disease (CHD) with multiple tissue Doppler imaging (TDI) parameters in rest state and to discuss the value of regional cardiac function in diagnosing CHD.Methods Forty-seven patients with chief complain of chest pain underwent TDI examination.Maximum systolic velocity (Sm),maximum early diastolic velocity (Em),maximum late diastolic velocity (Am),isovoluminal contraction time (IVCT) and isovoluminal relaxation time(IVRT) of 16 segments of left ventricle were measured.All the patients underwent coronary angiography (CAG) at the same time.CHD was diagnosed by at least one coronary artery with no less than fifty percent diametric stenosis.Segments dominated by coronary artery with fifty to ninety and more than ninety percent diametric stenosis were defined as moderate and severe lesion segments respectively.Others were non-lesion segments.Results There was no significant difference of sex,age,heart rate,CHD risk factors,left ventricular ejection fraction (LVEF) and E/A among non-CHD (13 cases),one-lesion(11 cases),two-lesion (11 cases) and three-lesion (12 cases)(P ＞0.05).Compared with those in non-lesion segments (390sections),Sm,Em and Em/Am decreased and IVRT prolonged in both moderate lesion segments (162 sections) and severe lesion segments (144 sections) (P ＜ 0.01).IVCT prolonged only in severe lesion segments (P ＜0.05),but not in moderate lesion segments.If setting a criterion that no less than three segments with Sm ＜ 2.50 cm/s and IVRT ＞ 87 ms was for CHD diagnosis,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy were 79.4％ (27/34),84.6％ (11/13),93.1％ (27/29),61.1％(11/18) and 80.9％(38/47).Conclusions In rest state,regional cardiac function of lesion segments in CHD patients shows changes of decreased systolic and diastolic velocity and prolonged isovoluminal time.Analyzing segmental cardiac velocity and time comprehensively may help to diagnose CHD.

Nafamostat mesylate is a serine protease inhibitor used in the treatment of acute pancreatitis. The im-purities in nafamostat mesylate, the active pharmaceutical ingredient (API), were profiled via high performance liquid chromatography tandem ion trap coupled with time-of-flight mass spectrometer (HPLC-IT-TOF/MS). The chromatography was performed on an ACE-3 C18 column (200 mm × 4.6 mm, 3μm) using methanol and 0.1％ formic acid in purified water as mobile phase at a flow rate of 1.0 mL/min. The ions were detected by IT-TOF/MS with a full-scan mass analysis from m/z 100 to 800. In total, eleven impurities were detected in nafamostat mesylate API. The impurity profile was estimated based on the HPLC-IT-TOF/MS data, including accurate masses, MSn fingerprints of fragmentation pathways and a series of double-charged ions. Finally, seven impurities were identified and reported for the first time. The results will provide technical support for the quality control and clinical safety of nafamostat mesylate.

The standardized training of medical specialists in China is far from perfect. The training contents, training system, training methods, supervision and assessment methods need to be improved. The First Clinical College of The First Hospital of China Medical University have guided the trainees to strengthen the study of guidelines and consensus by emphasizing the concept of evidence-based medicine (EBM) of training teachers by means of Sino-U.S. exchanges, case discussions and other ways. At the same time, with the help of the modern network education platform and the problem-based learning teaching mode, the concept of EBM education has been further developed, which greatly enhances the ability of specialists to analyze and solve problems, and improves the training effect.

Objective:To investigate the influencing factors of constipation in patients with cerebral hemorrhage, construct a risk prediction model, and verify the predictive effect of the model to scientifically guide subsequent treatment and nursing.Methods:A total of 254 patients with cerebral hemorrhage hospitalized in Affiliated Hospital of Binzhou Medical Collegefrom May 2022 to November 2022 were selected in a prospective cohort study, and they were divided into constipation group ( n = 150) and non-constipation group ( n = 104) according to whether constipation occurred. Univariate analysis and logistic regression were used to analyze the influencing factors of constipation in patients with cerebral hemorrhage, and a risk prediction model was established and a nomogram was drawn. A total of 110 patients with cerebral hemorrhage hospitalized in the same hospital from December 2022 to March 2023 were selected as the validation group, and the Hosmer-Lemeshow test and ROC curve were used to verify the model. Results:In this study, four risk factors of hospital stay, Koubmwater swallowing test score, nutrition and diuretics were finally included to construct a risk prediction model, and the area under the ROC curve of the modeling group was 0.918, the 95% CI was 0.848 to 0.963, the optimal cut-off value was 0.7225, the sensitivity was 0.885, and the specificity was 0.837. External verification results showed a sensitivity of 0.926 and specificity of 0.611. Conclusions:The risk prediction model constructed in this study has good effect and can provide reference for clinical assessment of whether patients with cerebral hemorrhage have the risk of constipation.

OBJECTIVE: To compare the effectiveness of O-arm navigation and ultrasound volume navigation (UVN) in guiding screw placement during minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery. METHODS: Sixty patients who underwent MIS-TLIF surgery for lumbar disc herniation between June 2022 and June 2023 and met the selection criteria were included in the study. They were randomly assigned to group A (screw placement guided by UVN during MIS-TLIF) or group B (screw placement guided by O-arm navigation during MIS-TLIF), with 30 cases in each group. There was no significant difference in baseline data, including gender, age, body mass index, and surgical segment, between the two groups ( P>0.05). Intraoperative data, including average single screw placement time, total radiation dose, and average single screw effective radiation dose, were recorded and calculated. Postoperatively, X-ray film and CT scans were performed at 10 days to evaluate screw placement accuracy and assess facet joint violation. Pearson correlation and Spearman correlation analyses were used to observe the relationship between the studied parameters (average single screw placement time and screw placement accuracy grading) and BMI. RESULTS: The average single screw placement time in group B was significantly shorter than that in group A, and the total radiation dose of single segment and multi-segment and the average single screw effective radiation dose in group B were significantly higher than those in group A ( P<0.05). There was no significant difference in the total radiation dose between single segment and multiple segments in group B ( P>0.05), while the total radiation dose of multiple segments was significantly higher than that of single segment in group A ( P<0.05). No significant difference was found in the accuracy of screw implantation between the two groups ( P>0.05). In both groups, the grade 1 and grade 2 screws broke through the outer wall of the pedicle, and no screw broke through the inner wall of the pedicle. There was no significant difference in the rate of facet joint violation between the two groups ( P>0.05). In group A, both the average single screw placement time and screw placement accuracy grading were positively correlated with BMI ( r=0.677, P<0.001; r=0.222, P=0.012), while in group B, neither of them was correlated with BMI ( r=0.224, P=0.233; r=0.034, P=0.697). CONCLUSION UVN-guided screw placement in MIS-TLIF surgery demonstrates comparable efficiency, visualization, and accuracy to O-arm navigation, while significantly reducing radiation exposure. However, it may be influenced by factors such as obesity, which poses certain limitations.
Humans ; Imaging, Three-Dimensional ; Lumbar Vertebrae/surgery* ; Minimally Invasive Surgical Procedures ; Pedicle Screws ; Retrospective Studies ; Spinal Fusion ; Surgery, Computer-Assisted ; Tomography, X-Ray Computed ; Treatment Outcome