Objective To summarize the changing rules of free portal pressure (FPP) after splenectomy combined with pericardial devascularization and investigate its influencing factors.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 55 patients with portal hypertension who were admitted to the People's Hospital of Ningxia Hui Autonomous Region from January 2016 to September 2018 were collected.There were 39 males and 16 females,aged from 17 to 67 years,with a median age of 46 years.FPP was measured using CT portal vein angiography before splenectomy and intraoperative manometry after cantheterization to the right gastroepiploic veins.Observation indicators:(1) comparison between intraoperative and postoperative FPP;(2) dynamic changes of FPP at the seventh postoperative day;(3) comparison of FPP before and after Valsalva manoeuvre;(4) relationship of FPP with mean arterial pressure and heart rate.Measurement data with normal distribution were represented as Mean ±SD.Repeated measurement data were analyzed using repeated ANOVA.Paired data were analyzed by the paired t test.The linear correlation analysis was done for relevance.Results (1) Comparison between intraoperative and postoperative FPP:55 patients underwent open splenectomy combined with pericardial devascularization.The FPP before splenectomy,after splenectomy combined with pericardial devascularization intraoperatively,at the first and the seventh day postoperatively was (34±6)cmH2O (1 cmH2O=0.098 kPa),(28±6)cmH2O,(34±5)cmH2O and (30±5)cmH2O,respectively,showing a statistically significant difference (F=43.23,P＜0.05).The FPP before splenectomy was statistically significant different from the FPP after splenectomy combined with pericardial devascularization intraoperatively,at the first and the seventh day postoperatively,respectively (P ＜ 0.05).The FPP after splenectomy combined with pericardial devascularization intraoperatively was statistically significant different from the FPP at the first and the seventh day postoperatively,respectively (P＜0.05).There was a statistically significant difference between FPP at the first and the seventh day postoperatively (P ＜ 0.05).(2) Dynamic changes of FPP at the seventh postoperative day:the FPP was (30 ± 5) cmH2 O,(29 ± 5) cmH2 O,(29 ± 5) cmH2 O,(29 ± 5) cmH2 O,(28 ± 5) cmH2 O,(28± 5) cmH2 O,(28 ± 5) cmH2 O,(29 ± 5) cmH2 O,(29 ± 5) cmH2 O,(30 ± 5) cmH2 O,(30± 5)cmH2O,(30±5)cmH2O,(31±5)cmH2O,(31±5)cmH2O,(31±5)cmH2O,(31±5)cmH2O,(31±5)cmH2O,(32±5)cmH2O,(31±5)cmH2O,(31±5)cmH2O,(31±5)cmH2O,(31±5)cmH2O,(30± 5) cmH2O,(30±5) cmH2O from 00:00 to 24:00 at the seventh day postoperatively.Level of FPP was higher from 12:00 to 21:00 and lower from 01:00 to 08:00,with a peak value at 17:00 and valley value from 04:00 to 06:00.(3) Comparison of FPP before and after Valsalva maneuvre:the FPP was (30± 5) cmH2O and (32± 5) cmH20 before and after Valsalva manoeuvre,respectively,showing a statistically significant difference (t =82.72,P＜ 0.05).(4) Relationship of FPP with mean arterial pressure and heart rate.Linear correlation analysis showed positive correlations of FPP with mean arterial pressure and heart rate respectively,but the correlation was not significant (r =0.10,0.16,P＜ 0.05).Conclusions FPP can be reduced significantly after splenectomy combined with pericardial devascularization intraoperatively and it rises briefly again after operation.FPP has regularly circadian fluctuations and is significantly increased by Valsalva Manoeuvre.There is a positive correlation of FPP with mean arterial pressure and heart rate respectively,but the correlation is not significant.

Medical imaging is an important auxiliary means of disease diagnosis. In the process of diagnosis, diseases are usually presented in a static way, which is one of the characteristics of imaging diagnosis. However, this static representation of diseases imposes certain limitations, which can, to some extent, lead to the loss of medical humanities. Therefore, it is very important for imaging diagnostic doctors to correctly use philosophical thinking to understand, analyze, and solve problems. The reinforcement of philosophical thinking in imaging diagnosis entails commitment to the "patient-centered" perspective in medicine as well as the integration of comprehensiveness, regularity, and proactivity. This not only effectively trains the diagnostic thinking of imaging diagnostic doctors but also improves their humanistic quality, thereby addressing the problems associated with these limitations. This allows the diagnosis to be both technically accurate and emotionally attuned.

Objective:To know the current situation of kinesiophobia in patients after cardiac surgery under cardiopulmonary bypass, and to clarify its influencing factors, so as to provide reference for developing intervention strategies to improve kinesiophobia level.Methods:This was a cross-sectional study. From February 2022 to September 2022, the patients after cardiac valve surgery under cardiopulmonary bypass in the Second Affiliated Hospital Zhejiang University School of Medicine were investigated by convenience sampling methods. The survey was conducted using the General Information Questionnaire, The Tampa Scale for Kinesiophobia Heart, Exercise Self-Efficacy Scale, Pain Catastrophizing Scale, and Adaptation, Partnership, Growth, Affection and Resolve(APGAR) as research tools, and the influencing factors were analyzed using univariate and binary Logistic regression analysis.Results:A total of 219 patients were included, of which 97 patients (44.3%) had kinesiophobia. The results of binary Logistic regression analysis showed that monthly family income level, first time out of bed after operation, fear of falling, the family APGAR, and pain catastrophizing were significant influencing factors of kinesiophobia in patients after heart valve surgery under cardiopulmonary bypass (all P<0.05). Conclusions:The prevalence of kinesiophobia is high among patients after heart valve surgery under cardiopulmonary bypass. Clinicians should pay attention to patients with low monthly family income level, late first time out of bed after surgery, and fear of falling, as well as strengthen communication with patients and families, focus on the management of acute postoperative pain. In order to reduce or avoid the occurrence of kinesiophobia and enable patients to benefit from early ambulation.