Objective To explore the construction of heart preservation model of empty beating donor based on extracorporeal membrane oxygenation (ECMO). Methods From January 2022 to August 2023, 20 Guangxi Bama miniature pigs weighing 25-30 kg were selected, half male and half female. Under general anesthesia and heparinization, a midline thoracotomy was performed. The pericardium was cut after freeing the anterior and posterior vena cavae, and a perfusion needle was inserted near the brachiocephalic artery in the ascending aorta, connected to a blood collection bag to collect 500-600 mL of blood. The anterior and posterior vena cavae were ligated, the aorta was blocked and perfused with HTK solution to stop the heart beating. The superior and inferior vena cavae were cut off, the right pulmonary vein was decompressed, the aorta and left and right pulmonary arteries and veins were cut off, and the whole heart was removed. An ECMO device was used to continuously perfuse a cardioprotective solution mainly composed of oxygenated warm blood, maintaining the isolated pig heart beating for 8 hours, monitoring (once/hour) ECMO perfusion parameters, blood gas indicators, perfusate electrolytes, inflammatory factors, myocardial enzymes, myoglobin, and troponin levels. Myocardial tissue was taken for hematoxylin-eosin (HE) staining to observe myocardial cell damage and evaluate the quality of heart preservation. Results Among the 20 isolated beating pig hearts, 17 successfully resumed beating, 3 experienced ventricular fibrillation, resuscitated after intracardiac electrical defibrillation, and all 20 pig hearts successfully beat for 8 hours. There was no statistical difference in ECMO perfusion parameters, blood gas indicators, perfusate electrolytes, and inflammatory factors at each time point (P>0.05). There were statistical increases in myocardial enzymes, myoglobin, and troponin levels (P<0.05). HE staining results suggested that there was no severe myocardial damage. Conclusion ECMO technology can be used for pig heart preservation with good results, and this study provides experimental evidence for improving heart preservation research in clinical heart transplantation.

Changes in biliary system dynamics are closely associated with the development and progression of related diseases， and with the in-depth interdisciplinary research on medical sciences and engineering， the value of biliary biomechanics in clinical diagnosis and treatment has become increasingly important. This article systematically reviews the characteristics of changes in biliary system dynamics under pathological conditions and explores the application value of technologies such as biliary manometry， hydrodynamic evaluation， and experimental simulation in clinical diagnosis， treatment， and postoperative management， so as to deepen the understanding of existing diagnostic and therapeutic modes and provide new ideas for promoting precision medicine for biliary tract diseases.

Objective:To explore the clinical effect of treating complex talar neck fractures with double-column fixation using plates and cannulated screws.Methods:A retrospective analysis was performed on the data of 13 patients with complex talar neck fractures treated with double-column fixation using plates and cannulated screws at Tianjin Hospital, Tianjin University from June 2019 to November 2023. There were 9 males and 4 females, with an age of 42.1±17.7 years (range, 15-66 years). There were 5 cases on the left and 8 cases on the right. Four cases were caused by traffic accidents, 8 by falling from a height, and 1 by a heavy object injury. According to the Hawkins classification, there were 12 cases of type II and 1 case of type III talar neck fractures. All the fractures were comminuted, including 12 cases of talar neck combined with talar body, and 3 cases combined with subluxation of subtalar joint. The time from injury to surgery was 3.3±1.6 d (range, 1-6 d). All patients were treated with anteromedial combined anterolateral approach, plate and cannulated screw double-column fixation pattern. The healing time of fractures and the occurrence of complications were recorded. Postoperative anteroposterior and lateral X-ray images were taken to assess the quality of fracture reduction based on the presence or absence of step-offs and angulation after reduction of fractures at the neck or body of the talus. The functional outcome was evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale.Results:All 13 patients were followed up for 33.8±15.2 months (range, 12-53 months). All fractures healed, and the healing time was 17.2±2.8 weeks (range, 13-23 weeks). Postoperative X-ray evaluation showed that 10 cases had anatomical reduction and 3 cases had near-anatomical reduction. After operation, there was no loosening or breakage of implant, loss of fracture reduction, irritation of skin and soft tissue by internal fixation. The AOFAS score was 88.1±13.0 points (range, 48-100 points), with 9 excellent cases, 3 good cases, and 1 poor case. Superficial skin necrosis in one surgical incision healed after dressing exchange. At the 1-year follow-up after surgery, 1 case developed avascular necrosis of the talus without collapse. And at the last follow-up (postoperative 13 to 53 months), 5 cases developed post-traumatic arthritis.Conclusion:Plate and cannulated screw double-column fixation in the treatment of complex talar neck fractures can achieve satisfactory reduction and strong fixation effects, which is beneficial in reducing complications related to poor reduction.

Objective:To construct a maintenance model of ophthalmic equipment of hospital based on Delphi method,so as to provide a new idea in management for ophthalmic equipment.Methods:The maintenance evaluation system of ophthalmic equipment was constructed by Delphi method,and the analytic hierarchy process(AHP)was applied to determine weight of evaluation index of equipment so as to standardize the management for ophthalmic equipment.A total of thirty used equipment that related to diagnosis and treatment for eye disease in Eye Hospital of China Academy of Chinese Medical Sciences from January 2022 to January 2023 were selected.According to different management modes,the conventional management mode(15 equipment)and Delphi method management mode(15 devices)were adopted respectively to manage equipment.A self-made questionnaire was adopted to investigate the satisfaction degree of medical staffs of the department of ophthalmology,and staffs of purchasing equipment for clinical configuration and use of ophthalmic equipment.The standardization degree of operation management for ophthalmic equipment,operation quality of equipment and satisfaction of medical staffs for clinical configuration of the two management modes were compared.Results:The scores of standardization degree of operation,disinfection and sterilization,maintenance and fault repair were respectively(92.14±5.36),(90.56±6.23),(91.98±5.65)and(92.16±6.36)after the Delphi method were adopted,which were higher than these of conventional management mode,and the differences of them were statistically significant(t=14.809,14.627,16.126,14.872,P<0.05).The average"power on"rate,operation rate,pass rate of acceptance and growth amplitude of cost-benefit of ophthalmic equipment were respectively(90.23±2.05)%,(96.36±3.98)%and(7.66±1.69)%after management with Delphi method was adopted,all of which were higher than these of conventional management mode,and the differences of them were statistically significant(t=9.649,4.248,8.479,16.867,P<0.05).The satisfaction rates of medical staffs of ophthalmic department and staffs of purchasing equipment for the rationality of clinical allocation process,standardization of system and effectiveness of quality of ophthalmic department of adopting Delphi method management mode were respectively 93.33%,93.33%and 90%,all of which were higher than those of conventional management mode,and the differences were statistically significant(x2=7.952,6.667,7.200,P<0.05).Conclusion:The application of the maintenance model of ophthalmic equipment of hospital based on Delphi method can enhance the qualities of managing and operating equipment,and improve the service level of equipment in management for ophthalmic equipment.

Objective To investigate the value of serum endothelium-specific molecule-1(Endocan)and N-terminal pro-B-type natriuretic peptide(NT-proBNP)levels in early prediction and disease evaluation of preg-nancy complicated with pulmonary hypertension(PH).Methods From March 2021 to March 2024,107 preg-nant women with dyspnea,palpitation and other symptoms during pregnancy in this hospital were selected as subjects.According to the results of echocardiography,the patients were divided into PPH group(62 cases)and control group(45 cases),and the relevant clinical data were collected.According to the pulmonary artery pressure measured by echocardiography during pregnancy,PPH group was divided into mild PPH group(35 cases),moderate PPH group(16 cases)and severe PPH group(11 cases).The levels of serum Endocan and NT-proBNP and the incidence of adverse events in each group were compared.The predictive value of Endocan and NT-proBNP for pregnancy complicated with PH was analyzed by receiver operating characteristic(ROC)curve.Results Compared with the control group,the mild,moderate and severe PPH groups had significant increases in Endocan and NT-proBNP levels(P<0.05).The ROC curve showed that Endocan≥9.07 ng/mL had a sensitivity of 65.7%and a specificity of 91.1%in predicting pregnancy complicated with PH.When NT-proBNP≥51.90 pg/mL,the sensitivity and specificity of predicting pregnancy complicated with PH were 54.3%and 68.9%,respectively.The sensitivity and specificity of Endocan combined with NT-proBNP in pre-dicting pregnancy complicated with PH were 80.0%and 80.0%,respectively.The incidences of heart failure,intensive care unit admission,iatrogenic abortion and preterm birth were significantly higher in the severe PPH group than in the mild and moderate PPH groups(P<0.05).Conclusion The increase of serum En-docan and NT-proBNP levels is related to the occurrence of pregnancy complicated with PH.The detection of serum Endocan and NT-proBNP levels can assist the early prediction of pregnancy complicated with PH and the evaluation of disease severity.

Objective To understand the current situation and influencing factors of work-related musculoskeletal disorders (WMSDs) in medical staff in Beijing City. Methods A total of 2 687 medical staff were selected as the research subjects using the multi-stage sampling method. The current situation of WMSDs and occupational stress, anxiety symptoms, depressive symptoms, and insomnia symptoms were investigated using the Musculoskeletal Disorders Questionnaire, the Core Occupational Stress Scale, the Generalized Anxiety Disorder Scale, the Patient Health Questionnaire Depression Scale, and the Self-Sleep Management Questionnaire. The Max-Min Hill-Climbing algorithm was used to construct a Bayesian network model to analyze the influencing factors and internal relationships of WMSDs and to conduct reasoning and prediction of the model. Results The prevalence of WMSDs among the research subjects was 88.9%. Binary logistic regression analysis was used to identify age, educational level, personal monthly income, anxiety symptoms, depressive symptoms, insomnia symptoms, prolonged forward-head desk work, and prolonged static posture work to construct the Bayesian network model. The model consisted of nine nodes and eleven directed edges. Prolonged static posture work, prolonged forward-head desk work, and anxiety symptoms were directly related to WMSDs. Age and educational level were indirectly related to WMSDs through their influence on prolonged forward-head desk work. Depression symptoms were indirectly associated with WMSDs through their influence on anxiety symptoms. The model's prediction accuracy was 90.5%. Conclusion The prevalence of WMSDs among medical staff in Beijing City is relatively high. Prolonged static posture work, prolonged forward-head desk work, and anxiety symptoms may directly increase the risk of developing WMSDs.

Objective To investigate the mastery of the management knowledge of patients with atrial fibrillation after coronary artery bypass grafting by cardiac surgeons in Beijing tertiary hospitals, and the practice status and obstacles of following the guidelines for postoperative atrial fibrillation. Methods A convenient sampling method was used to select cardiac surgeons from four tertiary hospitals in Beijing, and a self-designed questionnaire on the management of postoperative atrial fibrillation patients was used. Results A total of 227 valid questionnaires were collected. Only 47.9% of doctors and 12.8% of nurses passed in knowledge, and 31.3% of doctors and 28.5% of nurses passed in behavior. Among them, risk factor assessment, preventive medication, stroke and bleeding risk assessment were the weakest. "Lack of departmental requirements" was identified as a common barrier to healthcare workers' adherence to guidelines. Job title and participation in training were common influencing factors that affected the knowledge and behavior of healthcare workers, and knowledge level was an important factor affecting healthcare worker behavior. Conclusion In order to improve the effect of CABG surgery and improve the quality of postoperative patient management, hospitals should further strengthen the knowledge and skills training of medical staff on the management guidelines of postoperative atrial fibrillation with CABG, formulate relevant systems to ensure the clinical implementation of guidelines.

Objective:To explore the clinical effect of treating complex talar neck fractures with double-column fixation using plates and cannulated screws.Methods:A retrospective analysis was performed on the data of 13 patients with complex talar neck fractures treated with double-column fixation using plates and cannulated screws at Tianjin Hospital, Tianjin University from June 2019 to November 2023. There were 9 males and 4 females, with an age of 42.1±17.7 years (range, 15-66 years). There were 5 cases on the left and 8 cases on the right. Four cases were caused by traffic accidents, 8 by falling from a height, and 1 by a heavy object injury. According to the Hawkins classification, there were 12 cases of type II and 1 case of type III talar neck fractures. All the fractures were comminuted, including 12 cases of talar neck combined with talar body, and 3 cases combined with subluxation of subtalar joint. The time from injury to surgery was 3.3±1.6 d (range, 1-6 d). All patients were treated with anteromedial combined anterolateral approach, plate and cannulated screw double-column fixation pattern. The healing time of fractures and the occurrence of complications were recorded. Postoperative anteroposterior and lateral X-ray images were taken to assess the quality of fracture reduction based on the presence or absence of step-offs and angulation after reduction of fractures at the neck or body of the talus. The functional outcome was evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale.Results:All 13 patients were followed up for 33.8±15.2 months (range, 12-53 months). All fractures healed, and the healing time was 17.2±2.8 weeks (range, 13-23 weeks). Postoperative X-ray evaluation showed that 10 cases had anatomical reduction and 3 cases had near-anatomical reduction. After operation, there was no loosening or breakage of implant, loss of fracture reduction, irritation of skin and soft tissue by internal fixation. The AOFAS score was 88.1±13.0 points (range, 48-100 points), with 9 excellent cases, 3 good cases, and 1 poor case. Superficial skin necrosis in one surgical incision healed after dressing exchange. At the 1-year follow-up after surgery, 1 case developed avascular necrosis of the talus without collapse. And at the last follow-up (postoperative 13 to 53 months), 5 cases developed post-traumatic arthritis.Conclusion:Plate and cannulated screw double-column fixation in the treatment of complex talar neck fractures can achieve satisfactory reduction and strong fixation effects, which is beneficial in reducing complications related to poor reduction.

Objective:To construct a maintenance model of ophthalmic equipment of hospital based on Delphi method,so as to provide a new idea in management for ophthalmic equipment.Methods:The maintenance evaluation system of ophthalmic equipment was constructed by Delphi method,and the analytic hierarchy process(AHP)was applied to determine weight of evaluation index of equipment so as to standardize the management for ophthalmic equipment.A total of thirty used equipment that related to diagnosis and treatment for eye disease in Eye Hospital of China Academy of Chinese Medical Sciences from January 2022 to January 2023 were selected.According to different management modes,the conventional management mode(15 equipment)and Delphi method management mode(15 devices)were adopted respectively to manage equipment.A self-made questionnaire was adopted to investigate the satisfaction degree of medical staffs of the department of ophthalmology,and staffs of purchasing equipment for clinical configuration and use of ophthalmic equipment.The standardization degree of operation management for ophthalmic equipment,operation quality of equipment and satisfaction of medical staffs for clinical configuration of the two management modes were compared.Results:The scores of standardization degree of operation,disinfection and sterilization,maintenance and fault repair were respectively(92.14±5.36),(90.56±6.23),(91.98±5.65)and(92.16±6.36)after the Delphi method were adopted,which were higher than these of conventional management mode,and the differences of them were statistically significant(t=14.809,14.627,16.126,14.872,P<0.05).The average"power on"rate,operation rate,pass rate of acceptance and growth amplitude of cost-benefit of ophthalmic equipment were respectively(90.23±2.05)%,(96.36±3.98)%and(7.66±1.69)%after management with Delphi method was adopted,all of which were higher than these of conventional management mode,and the differences of them were statistically significant(t=9.649,4.248,8.479,16.867,P<0.05).The satisfaction rates of medical staffs of ophthalmic department and staffs of purchasing equipment for the rationality of clinical allocation process,standardization of system and effectiveness of quality of ophthalmic department of adopting Delphi method management mode were respectively 93.33%,93.33%and 90%,all of which were higher than those of conventional management mode,and the differences were statistically significant(x2=7.952,6.667,7.200,P<0.05).Conclusion:The application of the maintenance model of ophthalmic equipment of hospital based on Delphi method can enhance the qualities of managing and operating equipment,and improve the service level of equipment in management for ophthalmic equipment.

Osteoporotic proximal humeral fracture (OPHF) is one of the common osteoporotic fractures in the aged, with an incidence only lower than vertebral compression fracture, hip fracture, and distal radius fracture. OPHF, secondary to osteoporosis and characterized by poor bone quality, comminuted fracture pattern, slow healing, and severely impaired shoulder joint function, poses a big challenge to the current clinical diagnosis and treatment. In the field of diagnosis, treatment, and rehabilitation of OPHF, traditional Chinese and Western medicine have accumulated rich experience and evidence from evidence-based medicine and achieved favorable outcomes. However, there is still a lack of guidance from a relevant consensus as to how to integrate the advantages of the two medical systems and achieve the integrated diagnosis and treatment. To promote the diagnosis and treatment of OPHF with integrated traditional Chinese and Western medicine, relevant experts from Orthopedic Expert Committee of Geriatric Branch of Chinese Association of Gerontology and Geriatrics, Youth Osteoporosis Group of Orthopedic Branch of Chinese Medical Association, Osteoporosis Group of Orthopedic Surgeon Branch of Chinese Medical Doctor Association, and Osteoporosis Committee of Shanghai Association of Integrated Traditional Chinese and Western Medicine have been organized to formulate Expert consensus on the diagnosis and treatment of osteoporotic proximal humeral fracture with integrated traditional Chinese and Western medicine ( version 2024) by searching related literatures and based on the evidences from evidence-based medicine. This consensus consists of 13 recommendations about the diagnosis, treatment and rehabilitation of OPHF with integrated traditional Chinese medicine and Western medicine, aimed at standardizing, systematizing, and personalizing the diagnosis and treatment of OPHF with integrated traditional Chinse and Western medicine to improve the patients ′ function.