Objective To study the effects of QRS-complex duration of patients with chronic left heart failure on their in-hospital prognosis. Methods Total 174 patients admitted for chronic left heart failure ( New York Heart Association class 3 and 4 ) from January 2014 to June 2015 were enrolled the study. They were divided into two groups according to the QRS duration at admission:normal QRS duration group (QRS ≤120 ms, n=145) and prolonged QRS group (QRS ﹥120 ms, n=29). The differences of clinical characteristics and incidences of exacerbated left heart failure, fatal arrhythmias and cardiac death during hospitalization were compared between the two groups. The influences of QRS duration on in-hospital adverse cardiovascular events was analyzed by logistic regression. Resu1ts The proportion of males (75. 9% vs. 24. 1%, P=0. 001), plasma B-type natriuretic peptide (BNP) (7. 1 ± 0. 8 vs. 6. 6 ± 1. 0, P=0. 02), left ventricular end diastolic diameter (LVEDd) [(60. 7 ± 9. 9)mm vs. (53. 5 ± 10. 8)mm, P=0.001], left ventricular end systolic diameter (LVESd) [(49.1 ±13.3)mm vs. (39.7 ±13.0)mm, P﹤0. 001], and the incidence of exacerbated left heart failure (20. 7% vs. 4. 8%, P = 0. 003), fatal arrhythmias (55. 2% vs. 21. 4%, P ﹤0. 001) and cardiac death (6. 9% vs. 0. 7%, P =0. 019) during hospitalization were significantly higher in the prolonged QRS group than in the normal QRS group. Left ventricular ejection fraction( LVEF) in the prolonged QRS group was significantly lower than in the normal QRS group (39. 6% ±17. 3% vs. 50. 5% ± 17. 3%, P =0. 002). Heart rates [(92. 4 ± 21. 4)bpm vs. (81. 6 ± 19. 9)bpm,P=0. 035], plasma BNP(7. 2 ± 0. 8 vs. 6. 7 ± 1. 0, P=0. 029), LVEDd(63. 5 ± 9. 1 vs. 57. 9 ± 9. 1, P=0. 015), LVESd (52. 9 ± 12. 2 vs. 44. 3 ± 11. 8, P=0. 005), incidences of left heart failure deterioration (18. 2% vs. 3. 2%, P=0. 018), fatal arrhythmias (63. 6% vs. 36. 5%, P=0. 027) and cardiac death ( 9. 1% vs. 0%, P=0. 015 ) during hospitalization among male patients in the prolonged QRS group were significantly higher than those in the normal QRS group, but LVEF ( 35. 0% ± 15. 3%vs. 47. 1% ± 16. 2%, P =0. 003 ) was on the opposite. The incidence of left heart failure deterioration among female patients in the prolonged QRS group was higher than that in the normal QRS group ( 28. 6%vs. 6. 1%, P=0. 034). QRS complex duration was positively related to LVEDd ( r=0. 4019, P﹤0. 001) and LVESd ( r =0. 3289, P ﹤0. 001 ) . LVEF in male patients was significantly lower than in female patients (40. 0% ± 16. 7% vs. 53. 2% ± 17. 6%, P﹤0. 001). On the contrary, LVEDd [(59. 4 ± 9. 4) mmvs. (50.3±10.6)mm,P﹤0.001],LVESd[(46.6±12.5)mmvs. (36.2±12.4)mm,P﹤0.001] were greater in male patients than in female patients. After adjusting for gender , age, cigarette smoking, history of high blood pressure, serum creatinine, low-density lipoprotein cholesterol, LVEF, LVEDd, LVESd, use of angiotensin converting enzyme inhibitors ( ACEI) or angiotensin receptor blockers ( ARB) and aldosterone receptor blockers, multiple logistic regression analysis showed that prolonged QRS complex duration is an independent risk factor of adverse prognosis for the patients with HF during hospitalization (OR=4. 21,95%CI:1. 59-11. 12,P=0. 004), and female gender is a protective factor for them ( OR=0. 304,95%CI:0. 116-0. 793,P=0. 015). Conc1usions The incidences of left heart failure deterioration, fatal arrhythmias and cardiac death in the chronic left heart failure patients with prolonged QRS duration were higher than in those with normal duration. Female gender is a protective factor for chronic left heart failure.

There is no defined legislation on paternity testing in present China,thus the testing status quo is in a mess to some extent.Together with other unfavorable factors including the unstable marital status in modern society,increasing extramarital sexual behaviors and illegitimate children,and the ever-heated testing competition among testing institutes driven by the economic interests and so forth,the paternity testing is on a sharp rise these years,which leads to a increasing chaos in paternity testing field.Social ethical crisis is partially responsible for the current problem,thus related ethical issues to paternity testing are discussed in this article.

Objective To compare the bronchial blocker and double-lumen tube for one-lung ventilation in patients undergoing esophageal cancer resection.Methods Forty ASA physical status Ⅰ-Ⅲ patients of both sexes,aged 42-63 yr,scheduled for elective esophageal cancer resection,were randomly divided into 2 groups (n =20 each):double-lumen endotracheal tube group (group DLT) and bronchial blocker group (group BB).After induction of anesthesia,the patients were intubated with a left-sided double-lumen endotracheal tube and correct positioning was verified by fiberoptic bronchoscopy in group DLT.After induction of anesthesia,the patients were intubated with a conventional single-lumen endotracheal tube,and then the bronchial blocker was inserted under the guidance of fiberoptic bronchoscope in group BB.The intubation time,one-lung ventilation time,time to achieve lung collapse,operation time,extubation time,tube malposition and hypoxemia were recorded.The lung collapse was scored at the end of operation.Hoarseness and throat sore within 2 days after extubation and pulmonary infections within 7 days after operation were recorded.Results Compared with group DLT,intubation time and time to achieve lung collapse were significantly prolonged,and the incidence of hoarseness and throat sore within 2 days after extubation was decreased in group BB (P ＜ 0.05).There was no significant difference in the one-lung ventilation time,operation time,extubation time,lung collapse score,incidence of tube malposition,hypoxemia and pulmonary infections within 7 days after operation between the two groups (P ＞ 0.05).Conclusion The efficacy of bronchial blocker is similar to that of double-lumen tube when used for one-lung ventilation in patients undergoing esophageal cancer resection.

Objective To explore the disruption of circadian rhythm induced by the alteration of il?lumination leads to cognition impairement and mood dysreguation in mice. Methods 36 male C57BL/6 mice were divided into constant light group( CL) ,normal light group( N) and constant darkness group( CD) . Open field test was applied for the comparison of locomotor activity,tail suspension test and forced swimming test were conducted for assessment of mood state,and elevated plus?maze and Morris water maze were con?ducted for assessment of cognitive function. Results ( 1) Different circadian rhythms did not change the lo?comotor activity among three groups (CL:(200 160.00±955.28)cm,N:(208 148.00±578.11)cm,CD:(179 128.00±1 185.80)cm, P>0.05). (2) Compared with the control group,CL and CD mice showed significantly decreased immobility time in both TST (CD:(40.16±3.82)s,N:(18.83±2.27)s,CL:(46.00±2.80)s, P<0.01) and FST(CD:(181.33±9.03)s,N:(118.83±7.68)s,CL:(151.83±3.06)s, P<0.05). (3) Compared with the control group,CL and CD mice spent less time (CD:(21.76±6.88)s,N:(80.67±11.19)s,CL:(12.50±5.23)s, P<0.05) and made fewer entries (CD:3.33±0.49,N:6.83±0.91,CL:2.00±0.77, P<0.05) into open arms in elevated plus?maze, and exhibited less crossings in target quarter in Morris water maze (CL:2.67±0.76,N:5.00±0.26,CD:2.83±0.40, P<0.05). Conclusion Chronic constant light or darkness leads to negative impacts on mood and cognition in mice.

Objective To investigate the biomechanical and pathological changes in vivo in the taut bands (TB) of biceps femoris in rats after repeated low-frequency electrical stimulation.Methods Twenty-eight Wistar rats were randomly divided into a control group,an electrical intensity-dependent fatigue group,which were subject to electric intensity-dependent fatigue test,and an electrical frequency-dependent fatigue group,which were subject to electrical frequency-dependent fatigue test.After fatigue tests,the taut band of the biceps femoris and the non-taut band of the contralateral biceps femoris were harvested for pathological observation.The maximum contraction force (MCF),electrical intensity-and frequency-dependent fatigue characteristics and any pathological changes in the TBs were assessed and compared to the non-taut band region of the other biceps femoris.Results The MCF at the 15th and 20th stimulation (1.42 ± 0.28 g and 0.93 ± 0.54 g respectively) were significantly lower than that at the 1 st and 5th stimulation of the TBs.High stimulation intensity (HSI) at the 15th and 20th stimulation (3.76 ± 0.71 V and 3.44 ± 0.97 V) were also significantly lower than at the 1st TB stimulation.At the 10th,15th and 20th stimulation of the TBs,MCF and HSI were both significantly lower than in the bands which were not tight.In the frequency-dependent fatigue stimulation tests,the frequency which generated the MCF of the TBs was significantly lower than in the bands which were not tight,while the MCF of the TBs was significantly higher than that of non-TBs.After either intensity or frequency fatigue testing,more severe edema,uneven cytoplasmic death and degeneration of muscle fibers were observed in sections from TBs than from the bands which were not tight.Conclusions Taut muscle bands are significantly less fatigue-resistant than normal muscle fibers.Taut bands may contribute to the fatigue of myofascial pain syndromes.

Objective To investigate the nutritional status of the pupils with cerebral palsy and the factors related with nutrition. Methods The height and weight of 139 cerebral palsy pupil (6~18 years old) were measured. The rate of stunting, wasting, overweight and obesity were calculated, and compared with the norm, and among the subjects with different cerebral palsy type, grade of Gross Motor Function Classification System (GMFCS), famiy background (urban or rural), age, etc. Results The rate of stunting and wasting was more than the norm, and the obesity was less. The rate of stunting negatively correlated with the grade of GMFCS. The rate of wasting negatively correlated with the age. Conclusion It is important to focus on the physical development delay and malnutrition of children with cerebral palsy.

Objective To investigate the effect of fluoxetine-exposure during pregnant period on depression-like behaviors and hippocampal BDNF in offspring mice.Methods Sixteen C57BL/6 pregnant mice were randomly divided into fluoxetine group (Flu group) and normal saline group (NS group),including 8 mice in each group.And the mice in the Flu group and NS group were treated with fluoxetine (10 mg/kg) and normal saline respectively by intragastric administration from the date of conception 9 to day 18.The adult offspring mice were divided into 8 groups including 4 subgroup with 8 in each group based on gender and circadian rhythm.That was Flu-MD group,Flu-MN group,Flu-FD group,Flu-FN group,NS-MD group,NS-MN group,NS-FD group and NS-FN group;"M" and "F" stands for gender;and "D"and "N" stands for circadian rhythm.The depression-like behavior of offspring adult mice was observed by tail suspension and forced swimming test,and the expression of brain derived neurotrophic factor (BDNF) in hippocampus was detected by Western blot.Results (1) There was no deformity in the adult offspring mice of NS group and Flu group;(2) In the tail suspension test and forced swimming test,there was no significant difference in cumulative immobility time between the Flu group and the NS group (P＞0.05).There was no significant difference in cumulative immobility time between male and female mice in NS group or Flu group (P＞0.05).There were significant differences in immobility time between Flu-MD group and Flu-MN group (tail suspension test:Flu-MD group (175.94± 30.93)s,Flu-MN group (127.65±44.91)s;forced swimming test:Flu-MD group (108.17±44.92)s,Flu-MN group (169.00±62.50) s,P＜0.05),and there were no significant difference in the rest groups.(3) There was no significant difference in the expression of BDNF protein between the Flu group and NS group (P＞0.05).Conclusion There is no phenotypic abnormalities on offspring when female mice were exposed to fluoxetine during their pregnancy period.It does not increase the occurrence of depression-like behavior of the adult offspring and does not affect the expression of BDNF in hippocampus.

Objective:To report our experience in successful limb salvage in 2 cases of femoral fracture of Gustilo type ⅢC after warm ischemia beyond 10 hours.Methods:From February 2016 to April 2017, 2 patients with femoral fracture of Gustilo type ⅢC were treated at The Great Wall Orthopaedic and Hand Surgery Hospital after warm ischemia beyond 10 hours.Both of them were male, 42 and 27 years of age.After debridement, bone shortening for 8.0 cm and 10.0 cm respectively was followed by replantation. The fractures were fixated end to end with a compression plate, the femoral artery was anastomosed directly and the muscles were sutured end to end.Secondary osteotomy was conducted 4 months after successful replanta-tion, followed by unilateral external fixation for reconstruction.Limb lengthening began one week after sec-ondary osteotomy.The efficacy was assessed by the Paley criteria.Results:Scattered irregular necrosis occurred in the leg muscles but was cured by dermatoplasty through a decompressive incision 40 days after debridement for 4 times.The affected limbs in the 2 cases were successfully saved and lengthened to the same length as the opposite one.The limbs were lengthened for 8.0 and 10.0 cm and for 3.0 and 3.5 months, respectively.The unilateral external fixator was worn for 29 and 24 months, respectively.The plantar sensation recovered to S4 one year after operation.Follow-up at 6 months after removal of external fixation showed excellent bony outcomes and good functional outcomes in both cases According to the Paley criteria.Conclusion:For femoral fracture of Gustilo type ⅢC after warm ischemia beyond 10 hours, thorough debridement, plate fixation, bone shortening and replantation at one stage, followed by secondary limb lengthening using unilateral external fixation, may be practical and effective procedures, as long as in-dications for limb salvage should be comprehensively followed.

Objective:To analyze the hot spots and frontiers of medical quality and safety management since the new medical reform, and to provide reference for the continuous improvement of medical quality and safety management.Methods:Chinese literatures related to medical quality and medical safety management in CNKI database from April 2009 to December 2022 were retrieved, and the included literatures were processed and analyzed by CiteSpace software and Excel software.Results:1 921 literatures related to medical quality management and 2 497 literatures related to medical safety management were included. The publication trend showed a " double peak", showing a downward trend. The research hotspots in literature related to medical quality and safety management in China since the new medical reform have focused on practice exploration and influencing factors. The trend of future research is to closely follow the background of the times in medical quality and safety management research and intelligent medical quality and safety management evaluation system research.Conclusions:In the future, research on medical quality and safety management should be more in line with the changes of medical reform policies, focus on high-quality development to deepen the research on micro issues, promote information construction to continuously improve the indicator evaluation system, so as to promote the sustainable and high-quality development of medical quality and safety management in China.

Objective To reduce the occurrence of recurrent choledocholithiasis caused by biliary sphincter dysfunction after extensive endoscopic sphincterotomy ( EST ) for large stone extraction, and to investigate the sphincter-preserving effects of duodenal papilla occlusion by SureClip from MicroTech. Methods Three patients with large biliary stones ( 1. 0-2. 5 cm in stone size, 1. 2-3. 0 cm in common bile duct diameter) and without ERCP history underwent EST ( larger than 1. 0 cm) in Peking University Third Hospital from March 2018 to May 2018. Biliary and pancreatic stents were placed after stone extraction, followed by duodenal papilla occlusion with SureClip from MicroTech. Pressures of biliary duct and Oddi sphincter were measured at pre-EST, immediately after EST, and when stents were removed 3 weeks after EST, respectively. Healing conditions of papilla and complications were documented. Five pigs underwent similar experiments without stone extraction. Results The pressure of Oddi sphincter was significantly reduced after EST, and recovered after papilla occlusion 3 weeks after operation both in pigs and human. All stones were completely removed in the 3 patients without any post-ERCP complications. The papilla was healed under endoscopic observation when stents were removed 3 weeks after papilla occlusion. In animal experiments, histology revealed completely muscularis propria disruption of post-EST papilla without occlusion. In contrast, the muscle layer of post-EST papilla with occlusion by SureClip from MicroTech appeared scar healing. Conclusion The duodenal papilla occlusion by SureClip from MicroTech after EST works as "papilla remolding", which accelerates healing of papilla, and retains the sphincter pressure and anti-reflux barrier function.