Objective To explore the morphological change of upper airway in obese patients with multislice spiral CT (MSCT) scan and post-processing techniques and to reveal the relationship between structural abnormalities and the severity of obstructive sleep apnea hypopnea syndrome (OSAHS).Methods Adults with obesity were enrolled and divided into OSAHS group (n =25) and non-OSAHS group (n =25) based on polysomnography (PSG).MSCT covering upper airway was performed and measurements of soft tissue,bone structure and spatial structure of the upper airway were obtained from a 3-dimensional segmentation using image analysis.And their relationship between body mass index(BMI),neck circumference,apnea hyponea index(AHI) were analyzed.Results Compared with non-OSAHS control group,the area of the soft palate was significantly increased (P ＜ 0.05).The volume of the soft palate was further significantly increased (P ＜0.01);The cross-sectional area,anteroposterior diameter and volumes of the oropharynx in OSAHS group were decreased (P ＜ 0.05).The volume of the soft palate had significant positive correlation with BMI and AHI (P ＜ 0.01).Conclusion MSCT can evaluate obese patients from 2 days and 3 days structure on airway obstruction and surrounding soft tissues,and these results suggest the soft palate volume may be associated with severity of OSAHS.

ObjectiveTo evaluate the diagnostic value of multi-slice CT (MSCT) and multi-dimensional reconstructions for congenital pulmonary stenosis (PS) in children.MethodsThe enhanced thin CT images of 33 patients with PS were retrospectively analyzed,the data was transmitted to the workstation for multi-planar reformation ( MPR),volume rendering technique (VRT) and maximum intensity projection (MIP).The CT imaging features of PS were analyzed combining with operation resul ts and Ultrasonic Cardiogram (UCG).ResultsIn 33 cases of PS,there were 17 cases with pulmonary valve stenosis (PVS),10 cases with right ventricular infundibulum stenosis (RVIS),and 6 cases with pulmonary trunk stenosis (PTS).The first two were correctly diagnosed by UCG,5 cases of PVS and Icases of RVIS were correctly diagnosed by MSCTA,the later was correctly diagnosed by UCG and MSCTA.In 14 cases with collateral circulations between aorta and pulmonary artery ( APC ),all were correctly diagnosed by MSCTA,only 3 case was diagnosed by UCG,1 case was misdiagnosed as PDA.UCG can clearly demonstrate the others intra-cardiac deformities,such as ASD,VSD,RVH,PFO,SV,DORV,TECD and TBD,the accuracy rate of MSCTA was 39.4％,and MSCTA can clearly demonstrate the origin,course and diameter of extracardiac vascular abnormalities,such as PDA,RAA,TGA,TAPVD,CoA,PLSV and VLSA,the accuracy rate of UCG was 697％.ConclusionsMSCT and multi-dimensional reconstruction were a kind of non-invasive method,it was a good approach for extra-cardiac vascular malformations and APC in PS.Combining with UCG,it can further be used to improve the diagnostic accuracy of intra-cardiac malformation and supply diagnostic evidence for clinical treatment.

Objective To explore a 3D printing model of fracture restoration which can be used in preoperative planning and design for distal tibiofibular fractures.Methods A retrospective analysis was performed of the 35 patients with distal tibiofibular fracture who had been treated from October 2015 to September 2016 at our department.Bilateral tibiofibular CT scan was performed in all the cases to obtain Dicom data.Using Mimics 15.0 software,cross sections were created at 5 cm,10 cm and 15 cm above the knee joint at the bilateral upper tibiae and marked as PT5,PT10 and PT15.The long and short axles on the left and right sides were measured and compared (LL vs.RL;LS vs.RS).After the STL files for 3D models were generated using Mimics 15.0 software,a real-sized 3D model of the distal tibiofibular fracture and a mirror model of the contralateral tibiofibula were printed.The fracture lines were drawn and preoperative manoeuvre was performed on the mirror 3D printed model.The real operation used the implants preoperatively designed;the actual screw lengths were measured and compared radiographically with those designed in the preoperative manoeuvre.Results All the data were collected of the long and short axles on the 3 cross-sections (PT5,PT10 and PT15) of the left and right sides of the proximal tibia.The samples were paired into 6 groups.The correlation coefficients of paired samples were greater than 0.95,showing an extremely strong correlation.The differences between the left and right sides showed no statistically significance in paired samples of LR-RL and LS-RS groups on PT5,PT10 and PT15 cross-sections (P ＞ 0.05).All the 35 cases received surgical operation.The postoperative X-ray review showed fine agreement between actual surgery and preoperative design in terms of screw length and accuracy.The deviations were in an allowable range,leading to satisfactory internal fixation.Conclusions A mirror 3D model of the healthy side is of clinical value to some extent because it can serve as one for an anatomically reduced fracture which can be used for preoperative manoeuvre and preparation of implants.The contrasts between the long and short axles on the 3 cross-sections may simplify and facilitate comparisons of bilateral similarity,avoid the blindness in direct application of the health side mirror model for preoperative planning.

OBJECTIVE:To establish a method for the simultaneous determination of ornidazole and dexamethasone sodium phosphate in Compound ornidazole film. METHODS:HPLC was performed on the column of Inertsil ODS-3 with mobile phase of methanol-20 mmol/L phosphate buffer(pH was adjusted to 7.40 with glacial acetic acid)(55∶45,V/V)at a flow rate of 1.0 ml/min, column temperature was 30 ℃,detection wavelength was 242 nm and volume injection was 10 μl. RESULTS:The linear range were 1-100μg/ml for both ornidazole(r=0.999 7)and dexamethasone sodium phosphate(r=0.999 9);RSDs of precision,stabili-ty and reproducibility tests were lower than 2.0%;recoveries were 96.50%-99.80%(RSD=1.02%,n=9) and 96.50%-99.60%(RSD=0.99%,n=9). CONCLUSIONS:The method is specific with good precision and stability and high accuracy,and can be used for the simultaneous determination of ornidazole and dexamethasone sodium phosphate in Compound ornidazole film.

Objective To investigate the clinical application value of 3D printing technology in the treatment of complex posterior lateral tibial plateau fractures using the suprafibular approach.Methods A retrospective analysis was conducted on the clinical data of 67 patients with complex posterior lateral tibial plateau fractures treated with the suprafibular approach.Patients were divided into 3D printing group(35 cases)and conventional group(32 cases)based on whether 3D printing simulation surgery was used preoperatively.The operation time,intraoperative blood loss,and intrao-perative fluoroscopy frequency were compared between the two groups.Postoperative complications such as incision infection,popliteal vessel injury,and common peroneal nerve injury were observed.Fracture healing time was recorded during follow-up,and Rasmussen scores were evaluated at 6 months postoperatively.The Hospital for Special Surgery(HSS)knee function score was assessed during the final follow-up.Results The follow-up duration for 67 patients was 14 to 22 months.One patient in each group developed postoperative incision infection,and no complications such as poplite-al vessel injury,common peroneal nerve injury,or deep venous thrombosis of the lower extremity oc-curred.The operation time,intraoperative blood loss,and intraoperative fluoroscopy frequency were significantly lower in the 3D printing group than in the conventional group(P＜0.05).There were no significant differences in fracture healing time,Rasmussen scores at 6 months postoperatively,and HSS scores during the final follow-up between the two groups(P＞0.05).Conclusion The application of 3D printing technology in the treatment of complex posterior lateral tibial plateau fractures using the suprafibular approach can optimize surgical plans,shorten operation time,and reduce intraoperative blood loss and fluoroscopy frequency.

Objective:To compare the efficacy of off-pump coronary artery bypass grafting (CABG) or CABG plus mitral valve plasty (MVP) in patients with coronary heart disease complicated with moderate ischemic mitral insufficiency.Methods:The clinical data of 1 050 patients with coronary heart disease complicated with moderate ischemic mitral insufficiency who underwent surgical procedures from January 2009 to December 2020 were analyzed retrospectively. There were 733 males and 317 females, aging (63.3±9.0) years (range: 31 to 83 years). Patients were divided into CABG+MVP group and CABG group according to surgical methods, and the two groups of patients were matched for 1∶4 by the propensity score matching method. There were 107 patients in the CABG+MVP group and 406 patients in the CABG group after matching. The t test, Mann-Whitney U test, χ 2 test, Fisher′s exact probability method and repeated measures anova were used to compare the surgical outcomes and overall survival in the two groups. Results:There were no significant differences in perioperative death and postoperative complications between the two groups (all P>0.05). Compared with CABG group, CABG+MVP group had longer operation time ((5.6±1.2) hours vs. (4.2±1.0) hours, t=11.528, P<0.01), ICU stay( M(IQR))(43.0(47.3) hours vs. 25.0(33.6) hours, Z=2.483, P=0.013), and postoperative hospital stay (8(4) days vs. 7(5) days, Z=2.143, P=0.032). The amount of erythrocyte and platelet used in CABG+MVP group was significantly increased (2.0(6.5) U vs. 0(2.0) U, Z=7.084, P<0.01; 0(0.5) U vs. 0(0) U, Z=5.210, P<0.01). A total of 463 cases (93.9%) were followed up. Median follow-up was 32(31) months (range: 3 to 105 months). There was no significant difference in overall survival and no major adverse cardic and cerebrovascular events survival between CABG group and CABG+MVP group ( P=0.196, P=0.305). Echocardiography showed that there was no significant difference in ejection fraction left ventricular end-diastolic diameter between the two groups ( F=0.322, P=0.571; F=0.681, P=0.410). However, CABG+MVP improved mitral regurgitation better than CABG ( F=160.222, P<0.01). Conclusions:For patients with coronary heart disease with moderate ischemic mitral insufficiency, the rates of all-cause mortality and major adverse cardiac and cerebrovascular events are similar between the two surgeries. Although CABG+MVP improves mitral regurgitation better than CABG, it increases the duration of surgery, ICU stay, postoperative hospital stay, and blood transfusion requirement.

Objective To investigate the clinical application value of 3D printing technology in the treatment of complex posterior lateral tibial plateau fractures using the suprafibular approach.Methods A retrospective analysis was conducted on the clinical data of 67 patients with complex posterior lateral tibial plateau fractures treated with the suprafibular approach.Patients were divided into 3D printing group(35 cases)and conventional group(32 cases)based on whether 3D printing simulation surgery was used preoperatively.The operation time,intraoperative blood loss,and intrao-perative fluoroscopy frequency were compared between the two groups.Postoperative complications such as incision infection,popliteal vessel injury,and common peroneal nerve injury were observed.Fracture healing time was recorded during follow-up,and Rasmussen scores were evaluated at 6 months postoperatively.The Hospital for Special Surgery(HSS)knee function score was assessed during the final follow-up.Results The follow-up duration for 67 patients was 14 to 22 months.One patient in each group developed postoperative incision infection,and no complications such as poplite-al vessel injury,common peroneal nerve injury,or deep venous thrombosis of the lower extremity oc-curred.The operation time,intraoperative blood loss,and intraoperative fluoroscopy frequency were significantly lower in the 3D printing group than in the conventional group(P＜0.05).There were no significant differences in fracture healing time,Rasmussen scores at 6 months postoperatively,and HSS scores during the final follow-up between the two groups(P＞0.05).Conclusion The application of 3D printing technology in the treatment of complex posterior lateral tibial plateau fractures using the suprafibular approach can optimize surgical plans,shorten operation time,and reduce intraoperative blood loss and fluoroscopy frequency.

Objective:To compare the efficacy of off-pump coronary artery bypass grafting (CABG) or CABG plus mitral valve plasty (MVP) in patients with coronary heart disease complicated with moderate ischemic mitral insufficiency.Methods:The clinical data of 1 050 patients with coronary heart disease complicated with moderate ischemic mitral insufficiency who underwent surgical procedures from January 2009 to December 2020 were analyzed retrospectively. There were 733 males and 317 females, aging (63.3±9.0) years (range: 31 to 83 years). Patients were divided into CABG+MVP group and CABG group according to surgical methods, and the two groups of patients were matched for 1∶4 by the propensity score matching method. There were 107 patients in the CABG+MVP group and 406 patients in the CABG group after matching. The t test, Mann-Whitney U test, χ 2 test, Fisher′s exact probability method and repeated measures anova were used to compare the surgical outcomes and overall survival in the two groups. Results:There were no significant differences in perioperative death and postoperative complications between the two groups (all P>0.05). Compared with CABG group, CABG+MVP group had longer operation time ((5.6±1.2) hours vs. (4.2±1.0) hours, t=11.528, P<0.01), ICU stay( M(IQR))(43.0(47.3) hours vs. 25.0(33.6) hours, Z=2.483, P=0.013), and postoperative hospital stay (8(4) days vs. 7(5) days, Z=2.143, P=0.032). The amount of erythrocyte and platelet used in CABG+MVP group was significantly increased (2.0(6.5) U vs. 0(2.0) U, Z=7.084, P<0.01; 0(0.5) U vs. 0(0) U, Z=5.210, P<0.01). A total of 463 cases (93.9%) were followed up. Median follow-up was 32(31) months (range: 3 to 105 months). There was no significant difference in overall survival and no major adverse cardic and cerebrovascular events survival between CABG group and CABG+MVP group ( P=0.196, P=0.305). Echocardiography showed that there was no significant difference in ejection fraction left ventricular end-diastolic diameter between the two groups ( F=0.322, P=0.571; F=0.681, P=0.410). However, CABG+MVP improved mitral regurgitation better than CABG ( F=160.222, P<0.01). Conclusions:For patients with coronary heart disease with moderate ischemic mitral insufficiency, the rates of all-cause mortality and major adverse cardiac and cerebrovascular events are similar between the two surgeries. Although CABG+MVP improves mitral regurgitation better than CABG, it increases the duration of surgery, ICU stay, postoperative hospital stay, and blood transfusion requirement.

Objective To evaluate the second catalog of the key monitoring and rational use drugs(KMRUD),and to provide a reference framework for medical institutions to develop their own KMRUD catalogs and management policies.Methods A comprehensive search on official websites of national and provincial health administrative departments was conducted using the keywords"key monitoring","rational drug use",and"the second catalog".Announced catalogs and related policy documents pertaining to KMRUD use were collected and systematically organized.Comparative analyses were performed between the national KMRUD catalogs of the first and second batches,as well as between the second batch of provincial KMRUD catalogs and the national standard.Additionally,the adoption and variation of national KMRUD drug management policies across provinces,as well as the uniformity and divergence of provincial KMRUD management policies,were examined.Results The second national KMRUD catalog maintained 7 drug varieties from the first batch,eliminated 13,and introduced 23 new varieties.Of the 24 surveyed provinces,9 modified their provincial catalogs relative to the national second batch KMRUD catalog,resulting in alterations to 66 drug varieties within 10 Anatomical Therapeutic Chemical(ATC)classes,primarily systemic anti-infectives.Several provinces,including Xinjiang,Inner Mongolia,Liaoning,Shanghai,and Qinghai,implemented additional management measures such as the establishment of clinical application guidelines and the clarification of application conditions and principles.Moreover,provinces like Inner Mongolia,Shandong,Jilin,and Heilongjiang expanded their KMRUD management toolbox by developing drug monitoring indicators.The revision of inclusion rules from the first to the second KMRUD catalog has led to the incorporation of numerous essential clinical drugs.The prior protocol of medical institutions excluding drugs unilaterally is no longer viable,as it may disrupt the standard medication supply,potentially raising treatment costs.Conclusion Medical institutions ought to assimilate the updated implications of KMRUD use,draw on established provincial monitoring and management methodologies,enhance clinical application guidelines,and articulate conditions and principles for clinical use.Furthermore,by employing prescription review mechanisms,in-hospital monitoring,evaluation,and advanced warning systems,medical institutions can strategically oversee KMRUD use.

Objective:To explore the effects of ultra-high dose rate pulsed electron beams on Caenorhabditis elegans ( C. elegans). Methods:The adult wild-type strain (N2) of C. elegans was synchronized and cultured to L4 stage, and then randomly divided into control group (SHAM group), conventional radiotherapy dose rate group (CONV group) and ultra-high dose rate radiation group (UHDR group). The CONV and UHDR groups were exposed to 3 Gy of the pulsed electron beam at dose rates of 0.3 and 200 Gy/s, respectively. After irradiation, the egg-laying capacity of each group was assessed, and the developmental progress, motility, and survival rates each were evaluated at day 3, 6, and 10. Results:On the 3 rd day post-irradiation, both the CONV and UHDR groups showed shorter body lengths compared to the SHAM group ( t=4.81, 4.83, P<0.05), with no significant differences in body width ( P>0.05). On the 6 th and 10 th days, the CONV group showed a significant reduction in both body length and width compared to the SHAM group ( t=3.18-3.63, P<0.05), whereas the UHDR group displayed a significant increase in body length ( t=-9.85, -2.87, P<0.05) with no significant change in body width. When comparing the UHDR group to the CONV group on day 6 and 10, a significant increase in body width was observed ( t=-4.43, -3.37, P<0.05). Motor activity, including head swinging and body bending, significantly decreased in the CONV and UHDR groups compared to the SHAM group on day 6 ( t=2.91, 3.52, 3.97, 2.71, P<0.05), with no significant differences among the three groups by day 10 ( P>0.05). Egg-laying capacity significantly reduced in both irradiated groups compared to the SHAM group ( t=1.72, 5.54, P<0.05), while the UHDR group exhibited higher fecundity than the CONV group ( t=-5.99, P<0.05). Lifespan was significantly shortened in the CONV group compared to the SHAM group ( χ2=8.49, P<0.05), whereas the survival time of the UHDR group was not significantly differ from that of the SHAM group ( P>0.05). Conclusions:Exposure to a conventional electron beam result in developmental delays, reduced mobility, decreased fecundity, and a shortened lifespan in C. elegans. However, only slight side effects were observed when C. elegans were exposed to an ultra-high dose rate pulsed electron beam at the same dosage.