Purpose To evaluate the predictive value of left atrial appendage(LAA)morphological assessment by preoperative left atrial CT imaging in the risk of peri-device leak(PDL)after left atrial appendage occlusion(LAAO)in atrial fibrillation.Materials and Methods Seventy-one patients with atrial fibrillation who successfully underwent LAAO in Nanchong Central Hospital from January 2020 to February 2024 were retrospectively analyzed.According to the results of left atrial CT imaging after LAAO,all patients were divided into the PDL group(n=26)and the non-PDL group(n=45).The long diameter,short diameter,long diameter/short diameter ratio,area,perimeter of both the LAA orifice and landing area,and LAA length and LAA depth were compared between the two groups.Univariate and multivariate Logistic regression analysis were used to explore the risk factors leading to the differences between the two groups.Results The long diameter,long diameter/short diameter ratio,area,perimeter of both the LAA orifice and landing area in the PDL group were statistically higher than those in the non-PDL group(t/Z=4.952,-5.570,-2.912,3.191,6.757,-6.462,-3.318,3.733,all P<0.05).The LAA orifice short diameter,LAA length,LAA depth and the short diameter of landing area in the PDL group were higher than those in the non-PDL group,but there were no statistically significant differences between the two groups(t/Z=-1.773,1.765,1.509,-1.415,all P>0.05).Univariate Logistic regression analysis showed that the long diameter,long diameter/short diameter ratio,area and perimeter of LAA orifice and landing area before operation were correlated with postoperative PDL(P<0.05).Multivariate Logistic regression analysis showed that,the long diameter/short diameter ratio of LAA landing area was an independent risk factor for postoperative PDL.Conclusion Preoperative evaluation of the morphology of LAA orifice and landing zone by left atrial CT imaging can predict the occurrence of PDL after LAAO in atrial fibrillation in advance.When the long/short diameter of the landing area is large,it is necessary to be highly alert to the occurrence of PDL,which provides a basis for selecting and customizing the occluder before LAAO in patients with atrial fibrillation.

Purpose To explore the feasibility of coronary CT angiography to predict major adverse cardiovascular events(MACE)in patients with grey zone of CT-derived fractional flow reserve(CT-FFR).Materials and Methods The imaging and clinical features of patients with suspected coronary heart disease who underwent coronary CT angiography examination and had a CT-FFR within 0.76-0.80 in Beijing Anzhen Hospital Affiliated to Capital Medical University from March 2017 to October 2018 were retrospectively collected.The incidence of MACE after coronary CT angiography was assessed by telephone at follow-up.The Cox regression model was used for feature selection,and the area under the receiver operating characteristic curve(AUC)was plotted to evaluate the predictive performance.Results The study included a total of 105 subjects,with an observed incidence rate of MACE at 31.4%(33/105).Multivariate Cox regression,adjusted for relevant parameters,indicated that △CT-FFR(HR=1.217,P=0.008),pericoronary fat attenuation index(HR=1.052,P=0.029)and plaque length(HR=1.068,P=0.047)were independent risk factors of MACE,and AUC were 0.705,0.656 and 0.701,respectively.The AUC of the combined model was 0.793,its predictive ability was higher than △CT-FFR(Z=-2.001,P=0.048),pericoronary fat attenuation index(Z=-2.402,P=0.016)and plaque length(Z=-2.004,P=0.045),respectively.Conclusion △CT-FFR,pericoronary fat attenuation index and plaque length are independent risk factors for predicting MACE in patients with grey zone of CT-FFR,and the combined model has best predictive efficacy.

Purpose To evaluate the predictive value of left atrial appendage(LAA)morphological assessment by preoperative left atrial CT imaging in the risk of peri-device leak(PDL)after left atrial appendage occlusion(LAAO)in atrial fibrillation.Materials and Methods Seventy-one patients with atrial fibrillation who successfully underwent LAAO in Nanchong Central Hospital from January 2020 to February 2024 were retrospectively analyzed.According to the results of left atrial CT imaging after LAAO,all patients were divided into the PDL group(n=26)and the non-PDL group(n=45).The long diameter,short diameter,long diameter/short diameter ratio,area,perimeter of both the LAA orifice and landing area,and LAA length and LAA depth were compared between the two groups.Univariate and multivariate Logistic regression analysis were used to explore the risk factors leading to the differences between the two groups.Results The long diameter,long diameter/short diameter ratio,area,perimeter of both the LAA orifice and landing area in the PDL group were statistically higher than those in the non-PDL group(t/Z=4.952,-5.570,-2.912,3.191,6.757,-6.462,-3.318,3.733,all P<0.05).The LAA orifice short diameter,LAA length,LAA depth and the short diameter of landing area in the PDL group were higher than those in the non-PDL group,but there were no statistically significant differences between the two groups(t/Z=-1.773,1.765,1.509,-1.415,all P>0.05).Univariate Logistic regression analysis showed that the long diameter,long diameter/short diameter ratio,area and perimeter of LAA orifice and landing area before operation were correlated with postoperative PDL(P<0.05).Multivariate Logistic regression analysis showed that,the long diameter/short diameter ratio of LAA landing area was an independent risk factor for postoperative PDL.Conclusion Preoperative evaluation of the morphology of LAA orifice and landing zone by left atrial CT imaging can predict the occurrence of PDL after LAAO in atrial fibrillation in advance.When the long/short diameter of the landing area is large,it is necessary to be highly alert to the occurrence of PDL,which provides a basis for selecting and customizing the occluder before LAAO in patients with atrial fibrillation.

Purpose To explore the feasibility of coronary CT angiography to predict major adverse cardiovascular events(MACE)in patients with grey zone of CT-derived fractional flow reserve(CT-FFR).Materials and Methods The imaging and clinical features of patients with suspected coronary heart disease who underwent coronary CT angiography examination and had a CT-FFR within 0.76-0.80 in Beijing Anzhen Hospital Affiliated to Capital Medical University from March 2017 to October 2018 were retrospectively collected.The incidence of MACE after coronary CT angiography was assessed by telephone at follow-up.The Cox regression model was used for feature selection,and the area under the receiver operating characteristic curve(AUC)was plotted to evaluate the predictive performance.Results The study included a total of 105 subjects,with an observed incidence rate of MACE at 31.4%(33/105).Multivariate Cox regression,adjusted for relevant parameters,indicated that △CT-FFR(HR=1.217,P=0.008),pericoronary fat attenuation index(HR=1.052,P=0.029)and plaque length(HR=1.068,P=0.047)were independent risk factors of MACE,and AUC were 0.705,0.656 and 0.701,respectively.The AUC of the combined model was 0.793,its predictive ability was higher than △CT-FFR(Z=-2.001,P=0.048),pericoronary fat attenuation index(Z=-2.402,P=0.016)and plaque length(Z=-2.004,P=0.045),respectively.Conclusion △CT-FFR,pericoronary fat attenuation index and plaque length are independent risk factors for predicting MACE in patients with grey zone of CT-FFR,and the combined model has best predictive efficacy.

Tendon-bone healing is a complex biological process. Multiple signaling pathways are involved in tendon-bone healing， including transforming growth factor-β signaling pathway， bone morphogenetic protein signaling pathway， Wnt signaling pathway， fibroblast growth factor signaling pathway and nuclear transcription factor-κB signaling pathway. This paper summarizes the research status of traditional Chinese medicine regulating related signaling pathways to promote tendon-bone healing. It is found that a variety of traditional Chinese medicine monomers or herbal extracts （such as baicalein， icariin， total flavonoids of Drynaria fortunei， parthenolide， total saponins of Panax notoginseng， etc.） and traditional Chinese medicine compounds （such as Taohong siwu decoction， Liuwei dihuang pill， Xujin jiegu liquid， etc.） can promote bone formation， anti-inflammatory， anti-oxidation， by regulating the above signaling pathways， thereby effectively promoting tendon-bone healing.

To revise GBZ 188 Technical Specification for Occupational Health Surveillance based on national laws, regulations, standards, specifications and legal documents of occupational disease, and combination with the actual situation in China. The main modifications are as follows: the occupational health surveillance for workers exposed to toluene (xylene may implement by reference), bromopropane, methyl iodide, ethylene oxide, chloroacetic acid, indium and its compounds, coal tar, coal tarasphalt, asphalt, β-naphthylamine, dust of metal and its compounds(tin, iron, antimony, barium and its compounds), hard metal dust, erionite dust, low temperature, laser, tick-borne encephalitis virus, Borrelia burgdorferi, and human immunodeficiency virus, for scraper or grind operators, and underground workers using squatting or kneeling position, crawling position, side-lying position, or shoulder position for a long period of time are included. The emergency health screening for workers exposed to arsenic, fluorine and its inorganic compounds, and acrylamide are included. The occupational medical examination (OME) for workers exposed to amino and nitro compounds of benzene, phosgene, monomethylamine, organic fluorine and dimethyl sulfate has been adjusted and made mandatory, with corresponding assessments required upon leaving the job. The special occupational health surveillance for workers exposed to mycobacterium tuberculosis and hepatitis virus is removed. The OME conclusion of reexamination is removed, and standardize recheck/additional inspection requirements. The optional items in OME performed before, during and after leaving post are removed, but the optional items in emergency medical examination are retained. Additional OME items are added. The Guideline for OME Summary Reports is added as informative appendix, and so on. The revised GBZ 188 Technical Specification for Occupational Health Surveillance is more scientific and practical.

Osteoarthritis (OA) is a common chronic degenerative disease, and its condition tends to worsen with age. The pathogenesis of OA is complex, and many risk factors can lead to the occurrence of OA. Iron is one of the essential trace elements in the body, and its metabolic balance is extremely important to human health. Iron overload is closely related to the occurrence and development of OA. Excessive iron deposition in joint tissue can easily lead to lesions of articular cartilage and synovium, as well as affect subchondral bone reconstruction and lead to the occurrence of OA. The author reviewed the relevant research literature in recent years, and reviewed the mechanism of iron overload in the occurrence and development of OA, in order to provide new ideas and directions for the research and diagnosis and treatment of OA.

Objective To investigate the incidence of osteonecrosis of the femoral head (ONFH) in divers of Dalian.Methods From January 2010 to December 2010,all registered 855 divers in Dalian were enrolled in this study.All divers underwent a unified medical examination and a questionnaire including height,weight,blood pressure and hip inspection.Radiological examination (anteroposterior and frog position)was used for all divers.Suspicious persons with hip pain but normal X-ray performance were confirmed by MRI.Results Sixty-eight divers were confirmed as ONFH,and the incidence of ONFH in divers of Dalian was 7.95％.According to the Ficat classification,12 patients (12 hips) were in Phase 1,40 patients (47 hips)in phase Ⅱ,3 patients (3 hips) in phase Ⅲ,13 patients (15 hips) in phase Ⅳ.The mean age of divers was 32.6+5.5 years (range,18-55 years).The onset ages of most patients ranged from 30 years to 50 years,accounted for 83.82％ (57/68).Among all patients,primary school education accounted for 10.58％ (38/359),junior high school education 6.28％ (28/446),high school education 4.26％ (2/47),university education 0 (0/3); seniority less than 5 years accounted for 4.55％ (20/440),6-10 years 9.69％ (28/289),11-15 years 13.04％ (12/92),16-20 years 21.05％ (4/19),more than 20 years 26.67％ (4/15); self-employed accounted for 11.88％ (19/160),private enterprise 8.41％ (38/452),and national enterprise 4.53％ (11/243).Conclusion The incidence of ONFH is high in divers of Dalian,which is different in terms of age,seniority,level of education,enterprise nature.

ObjectiveTo investigate the clinical value of transgastrie endoscopic surgery for the treatment of pancreatic abscess or pancreatic cyst and infection.MethodsThe clinical data of 22 patients with pancreatic abscess or pancreatic cyst and infection who underwent transgastric puncture and drainage or transgastric debridement under the guidance of endoscopic ultrasonography (EUS) at the Xinqiao Hospital of Third Military Medical University from July 2008 to August 2011 were retrospectively analyzed.All patients were comfirmed with bacteria infection after liquid aspiration culture. Patients with pancreatic abscess underwent endoscopic transgastric debridement,and for patients with pancreatic cyst and infection,10 F double pigtail stent and 8.5 F nasal bile duct were placed for drainage.ResultsThe results of liquid aspiration culture confirmed that 2 patients were infected by staphylococcus aureus,3 by proteus mirabilis,4 by pseudomonas aeruginosa,4 by klebsiella and 9 by escherichia coli bacilli.The double pigtail stent and nasal bile duct were installed under EUS (16 patients) or duodenoscope (6 patients).The lesions of 9 patients with pancreatic abscess were healed after endoscopic transgastric debridement with an average period of (6.5 + 1.8 )weeks,and the lesions of 13 patients with pancreatic cyst and infection were healed after transgastric puncture and drainage under the guidance of EUS with an average period of ( 8.3 ± 2.1 ) weeks.All patients were followed up for 2 years,and no recurrence of pancreatic abscess or pancreatic cyst was observed.ConclusionThe effect of transgastric endoscopic surgery for the treatment of pancreatic abscess or pancreatic cyst and infection is satisfactory.

Objective To evaluate the feasibility of endoscopic resection and closure for non-intraluminal gastric stromal tumors originating from the muscularis propria layer.Methods Included in the study were 46 patients with gastric submucosal lesions originating from the muscularis propria layer, detected by gastroscopy and endoscopic ultrasonography.The lesions were removed by endoscopic resection and closure, which were further diagnosed as stromal tumor by means of pathologic and immunohistochemical examinations.The patients were followed up with endoscopy for evaluation of therapeutic effect and complications.Results All lesions were successfully removed, with serosa layer remained in 2 cases and full layer resection in other 44, which were all closed by endoscopic clips.Combination managements of acid suppression,gastrointestinal decompression and intravenous antibiotics were applied in all patients.Pathology reports confirmed complete resection of all lesions, with 0.5 to 3.7 cm in diameter.Normal diet was restored in 44 patients 48 ～ 72 h after the procedure.Pneumoperitoneum and focal peritonitis occurred in 2 cases, one of which underwent rupture and was clamped again.The 2 patients recovered after 10-12 days of conservative treatments.Follow-up endoscopy revealed white ulcerous scar in all cases.Conclusion Endoscopic resection and closure therapy is a safe, economic and less invasive treatment for non-intraluminal gastric stromal tumors originating from the muscularis propria layer.