Objective To discuss the causes and the therapeutic strategy of acute cardiac tamponade(ACT)occurring as a complication of transcatheter aortic valve replacement(TAVR)so as to improve the success rate of the surgery and to make a further understanding of this complication.Methods The general clinical data,surgical procedures,and postoperative follow-up results of five patients,who received TAVR at the Affiliated Northern Jiangsu People's Hospital of Yangzhou University of China and developed ACT from March 2018 to September 2024,were retrospectively analyzed.Results After developing ACT,all the 5 patients received pericardiocentesis together with other adjuvant therapies including blood volume expansion with infusion,vasopressors,heparin neutralization,and blood transfusion.However,due to no obvious reduction in drainage volume and unstable hemodynamics all the 5 patients had eventually to receive open-chest surgery to identify the source of bleeding and to make hemostasis.Surgical exploration revealed that the perforation or rupture of cardiac structures caused by the temporary pacemaker lead or a super-stiff guide wire during the procedure was the main cause of ACT.Finally,after active treatment four patients recovered and discharged,and one patient died.The discharged patients were followed up for 3-12 months,and no procedure-related complications such as acute coronary artery occlusion,severe arrhythmia,exacerbation of heart failure symptoms,valve displacement,or stroke occurred.Conclusion As a severe complication occurring during the TAVR procedure,ACT requires to get a rapid diagnosis and management.Improvement of surgical techniques and operative methods,comprehensive preoperative assessment,and close intraoperative monitoring are crucial points for the prevention of ACT.

In recent years， the incidence of pulmonary nodules has kept rising. To give full play to the advantages of traditional Chinese medicine （TCM） in the treatment of pulmonary nodules and identify the breakthrough points of integrating TCM with Western medicine， the China Association of Chinese Medicine organized medical experts in TCM and western medicine to carry out in-depth discussion regarding this disease. The discussion encompassed the modern medical advances， TCM theories of etiology and pathogenesis， the role and advantages of TCM in the whole course management of pulmonary nodules， contents and methods of research on pulmonary nodules， and science popularization work， aiming to provide a reference for clinical practice and scientific research. After discussion， the experts concluded that the occurrence of pulmonary nodules was rooted in the deficiency of the lung and spleen and triggered by phlegm dampness， blood stasis， and Qi stagnation. TCM can treat pulmonary nodules by controlling and reducing nodules， improving physical constitution， ameliorating multi-system nodular diseases， reducing anxiety and avoiding excessive diagnosis and treatment， and serving as an alternative for patients who are unwilling or unfit for surgical treatment. At present， the optimal diagnosis and treatment strategy for pulmonary nodules has not been formed， which needs to be further studied from multiple perspectives such as clinical epidemiology， biology， and evidence-based medicine. The primary task of current research is to find out the advantages， effective prescriptions， and target populations and determine the effective outcomes of TCM in the treatment of pulmonary nodules. At the same time， basic research should be carried out to explore the etiology and biological behaviors of pulmonary nodules. The expert consensus on the diagnosis and treatment of pulmonary nodules with integrated TCM and Western medicine needs to be continuously revised to guide clinicians to conduct standardized， scientific， and accurate effective diagnosis and treatment.

Objective To investigate the application efficiency and potential of CT radiomics in differentiating malignant and benign sub-centimeter solid pulmonary nodules. Methods A retrospective study was performed on the sub-centimeter ( ≤ 10 mm) solid pulmonary nodules detected by enhanced CT in our hospital from March 2020 to January 2023. Malignancy was confirmed by surgical pathology, and benignity was confirmed by surgical pathology or follow-up. Lesions were manually segmented and radiomic features were extracted. The feature dimension was reduced via feature correlation analysis and least absolute shrinkage and selection operator (LASSO). The 5-fold cross validation was used to validate the model. Support vector machine, logistic regression, linear classification support vector machine, gradient boosting, and random forest models were established for CT radiomics. Receiver operating characteristic curves were drawn. Delong test was used to compare the diagnostic performance of the five classifiers. The optimal model was selected and compared to radiologists with medium and high seniority. Results A total of 303 nodules, 136 of which were malignant, were examined. Radiomics models were established after feature extraction and selection. On test set, the areas under the receiver operating characteristic curves of support vector machine, logistic regression, linear classification support vector machine, random forest, and gradient boosting models were 0.922 (95%CI: 0.893, 0.950), 0.910 (95%CI: 0.878, 0.942), 0.905 (95%CI: 0.872, 0.938), 0.899 (95%CI: 0.865, 0.933), and 0.896 (95%CI: 0.862, 0.930), respectively. Delong test indicated no significant differences in the performance of the five radiomics models, and the support vector machine model showed the highest accuracy and F1 score. The support vector machine model showed significantly higher diagnostic accuracy as compared to radiologists (83.8% vs. 55.4%, P < 0.001). Conclusion The radiomics models achieved high diagnostic efficiency and may help to reduce the uncertainty in diagnosis of malignant and benign sub-centimeter solid nodules by radiologists.

Objective To investigate the risk factors of in-hospital mortality and establish a risk prediction model for patients receiving venoarterial extracorporeal membrane oxygenation(VA-ECMO).Methods We retrospectively collected the data of 302 patients receiving VA-ECMO in ICU of 3 hospitals in Guangdong Province between January,2015 and January,2022 using a convenience sampling method.The patients were divided into a derivation cohort(201 cases)and a validation cohort(101 cases).Univariate and multivariate logistic regression analyses were used to analyze the risk factors for in-hospital death of these patients,based on which a risk prediction model was established in the form of a nomogram.The receiver operator characteristic(ROC)curve,calibration curve and clinical decision curve were used to evaluate the discrimination ability,calibration and clinical validity of this model.Results The in-hospital mortality risk prediction model was established based the risk factors including hypertension(OR=3.694,95%CI:1.582-8.621),continuous renal replacement therapy(OR=9.661,95%CI:4.103-22.745),elevated Na2+ level(OR=1.048,95%CI:1.003-1.095)and increased hemoglobin level(OR=0.987,95%CI:0.977-0.998).In the derivation cohort,the area under the ROC curve(AUC)of this model was 0.829(95%CI:0.770-0.889),greater than those of the 4 single factors(all AUC<0.800),APACHE Ⅱ Score(AUC=0.777,95%CI:0.714-0.840)and the SOFA Score(AUC=0.721,95%CI:0.647-0.796).The results of internal validation showed that the AUC of the model was 0.774(95%CI:0.679-0.869),and the goodness of fit test showed a good fitting of this model(χ2=4.629,P>0.05).Conclusion The risk prediction model for in-hospital mortality of patients on VA-ECMO has good differentiation,calibration and clinical effectiveness and outperforms the commonly used disease severity scoring system,and thus can be used for assessing disease severity and prognostic risk level in critically ill patients.

Objective To investigate the risk factors of in-hospital mortality and establish a risk prediction model for patients receiving venoarterial extracorporeal membrane oxygenation(VA-ECMO).Methods We retrospectively collected the data of 302 patients receiving VA-ECMO in ICU of 3 hospitals in Guangdong Province between January,2015 and January,2022 using a convenience sampling method.The patients were divided into a derivation cohort(201 cases)and a validation cohort(101 cases).Univariate and multivariate logistic regression analyses were used to analyze the risk factors for in-hospital death of these patients,based on which a risk prediction model was established in the form of a nomogram.The receiver operator characteristic(ROC)curve,calibration curve and clinical decision curve were used to evaluate the discrimination ability,calibration and clinical validity of this model.Results The in-hospital mortality risk prediction model was established based the risk factors including hypertension(OR=3.694,95%CI:1.582-8.621),continuous renal replacement therapy(OR=9.661,95%CI:4.103-22.745),elevated Na2+ level(OR=1.048,95%CI:1.003-1.095)and increased hemoglobin level(OR=0.987,95%CI:0.977-0.998).In the derivation cohort,the area under the ROC curve(AUC)of this model was 0.829(95%CI:0.770-0.889),greater than those of the 4 single factors(all AUC<0.800),APACHE Ⅱ Score(AUC=0.777,95%CI:0.714-0.840)and the SOFA Score(AUC=0.721,95%CI:0.647-0.796).The results of internal validation showed that the AUC of the model was 0.774(95%CI:0.679-0.869),and the goodness of fit test showed a good fitting of this model(χ2=4.629,P>0.05).Conclusion The risk prediction model for in-hospital mortality of patients on VA-ECMO has good differentiation,calibration and clinical effectiveness and outperforms the commonly used disease severity scoring system,and thus can be used for assessing disease severity and prognostic risk level in critically ill patients.

Articular cartilage (AC) injuries often lead to cartilage degeneration and may ultimately result in osteoarthritis (OA) due to the limited self-repair ability. To date, numerous intra-articular delivery systems carrying various therapeutic agents have been developed to improve therapeutic localization and retention, optimize controlled drug release profiles and target different pathological processes. Due to the complex and multifactorial characteristics of cartilage injury pathology and heterogeneity of the cartilage structure deposited within a dense matrix, delivery systems loaded with a single therapeutic agent are hindered from reaching multiple targets in a spatiotemporal matched manner and thus fail to mimic the natural processes of biosynthesis, compromising the goal of full cartilage regeneration. Emerging evidence highlights the importance of sequential delivery strategies targeting multiple pathological processes. In this review, we first summarize the current status and progress achieved in single-drug delivery strategies for the treatment of AC diseases. Subsequently, we focus mainly on advances in multiple drug delivery applications, including sequential release formulations targeting various pathological processes, synergistic targeting of the same pathological process, the spatial distribution in multiple tissues, and heterogeneous regeneration. We hope that this review will inspire the rational design of intra-articular drug delivery systems (DDSs) in the future.

Objective:To investigate the construction and application value of a predictive model for prolonged surgical duration in Da Vinci robotic radical gastrectomy for gastric cancer.Methods:The retrospective cohort study was conducted. The clinicopathological data of 534 patients who underwent Da Vinci robotic radical gastrectomy for gastric cancer in the Fujian Medical University Union Hospital from August 2016 to August 2021 were collected. There were 389 males and 145 females, aged (60±11)years. All 534 patients were randomly divided into the training dataset of 374 cases and the validation dataset of 160 cases with a ratio of 7∶3 based on random number method in the SPSS 25.0 software. Observation indicators: (1) incidence of prolonged surgical duration; (2) intraoperative and postoperative conditions in patients with prolonged surgical duration and without prolonged surgical duration; (3) complications in patients with prolonged surgical duration and without prolonged surgical duration; (4) analysis of risk factors influencing prolonged surgical duration; (5) construction and evaluation of an artificial neural network predictive model for pro-longed surgical duration. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers or per-centages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was analyzed using the nonparametric test. Univariate and multivariate analyses were conducted using the Logistic regression model. Based on the results of univariate analysis, a multilayer perceptron was employed to train an artificial neural network pre-dictive model for prolonged surgical duration. The receiver operating characteristic (ROC) curve was drawn, and the area under curve (AUC), the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were used to assess the model′s performance. Results:(1) Incidence of prolonged surgical duration. Of 534 patients, 284 cases underwent total gastrectomy, and 250 cases underwent distal gastrectomy, with operation time of (206±42)minutes and (187±36)minutes, res-pectively. Cases with prolonged surgical duration and without prolonged surgical duration who under-went total gastrectomy were 41 and 243, and cases with prolonged surgical duration and without prolonged surgical duration who underwent distal gastrectomy were 40 and 210. The gender (male, female), age, body mass index (BMI), tumor diameter, tumor location (upper stomach, middle stomach, lower stomach, mixed type), cases with neoadjuvant therapy, cases with preoperative American Society of Anesthesiologists (ASA) score as 1, 2, 3, cases with clinical T staging as stage T1, stage T2, stage T3, stage T4a, cases with clinical N staging as stage N0, stage N1, stage N2, stage N3, cases with clinical TNM staging as stage Ⅰ, stage Ⅱ, stage Ⅲ, cases with surgical resection scope as total gastrec-tomy or distal gastrectomy, cases with digestive tract reconstruction method as Billroth-Ⅰ anasto-mosis, Billroth-Ⅱ anastomosis, Roux-en-Y anastomosis, cases with surgeon experiences as ≤20 cases or >20 cases were 61,20, (61±9)years, (24±3)kg/m2, 4.0(2.5, 5.0)cm, 34, 10, 33, 4, 1, 3, 73, 5, 3, 6, 26, 46, 14, 41, 19, 7, 5, 13, 63, 41, 40, 1, 33, 47, 5, 76 in the 81 patients with prolonged surgical duration, versus 328, 125, (60±11)years, (23±3)kg/m2, 3.5(2.0, 5.0)cm, 129, 71, 227, 26, 6, 45, 382, 26, 73, 100, 118, 162, 211, 180, 52, 10, 138, 108,207, 243, 210, 13,200, 240, 15, 438 in the 453 patients without prolonged surgical duration, showing significant differences in the BMI, clinical T staging, clinical N staging, clinical TNM staging ( t=-3.68, Z=-4.63, -5.53, -5.56, P<0.05), and no significant difference in the gender, age, tumor diameter, tumor location, preoperative ASA score, surgical resec-tion scope, digestive tract reconstruction method, and surgeon experiences ( χ2=0.29, t=-0.95, Z=-1.27, χ2=5.92, Z=-1.46, χ2=0.25, 1.35, 0.87, P>0.05). There was no significant difference in cases with neoadjuvant therapy between them ( P>0.05). (2) Intraoperative and postoperative conditions in patients with prolonged surgical duration and without prolonged surgical duration. The operation time, volume of intraoperative blood loss, the number of lymph nodes dissected, time to postopera-tive first ambulation, time to postoperative anal exhaust, time to postoperative first intake of liquid diet, time to postoperative first intake of semi-liquid diet, duration of postoperative hospital stay were (261±34)minutes, 50(30, 50)mL, 39±15, (2.3±0.6)days, (3.4±0.9)days, (4.1±1.2)days, (5.7±1.2)days, 8.0(7.0, 9.0)days in the 81 patients with prolonged surgical duration, versus (186±29)minutes, 30(20,50)mL, 42±14, (2.2±0.6)days, (3.4±0.8)days, (4.1±1.1)days, (5.7±1.4)days, 8.0(7.0, 9.0)days in the 453 patients without prolonged surgical duration, showing significant differences in operation time, volume of intraoperative blood loss ( t=-20.46, Z=-3.32, P<0.05), and no significant difference in the number of lymph nodes dissected, time to postoperative first ambulation, time to postopera-tive anal exhaust, time to postoperative first intake of liquid diet, time to first intake of semi-liquid diet, duration of postoperative hospital stay ( t=1.87, -0.87, -0.16, 0.28, 0.03, Z=-1.45, P>0.05). (3) Complications in patients with prolonged surgical duration and without prolonged surgical duration. The overall incidence of complications, incidence of surgical complications (abdominal infection, anastomotic fistula, abdominal bleeding, incision-related complications, intestinal obstruction, lymphatic fistula), incidence of medical complications (pulmonary infection, liver-related complications) were 22.22%(18/81), 0, 0, 2.47%(2/81), 0, 8.64%(7/81), 1.23%(1/81), 12.35%(10/81), 1.23%(1/81) in the 81 patients with prolonged surgical duration, versus 13.47%(61/453), 2.65%(12/453), 0.44%(2/453), 1.77%(8/453), 0.44%(2/453), 3.31%(15/453), 0, 7.28%(33/453), 1.55%(7/453) in the 453 patients without prolonged surgical duration, showing a significant difference in the overall incidence of complications ( χ2=4.18, P<0.05), and no significant difference in the incidence of abdo-minal infection, anastomotic fistula, abdominal bleeding, incision-related complications, intestinal obstruction, lymphatic fistula, liver-related complications ( P>0.05). There was no significant difference in the incidence of pulmonary infection between them ( χ2=2.38, P>0.05). (4) Analysis of risk factors influencing prolonged surgical duration. Results of univariate analysis showed that BMI ≥25 kg/m2, tumor located in the lower stomach, clinical T3-T4a stage, clinical N1-N3 stage were correlated factors influencing prolonged surgical duration in Da Vinci robotic radical gastrectomy for gastric cancer ( odds ratio=1.88, 0.40, 6.24, 6.51, 3.08, 3.39, 17.15, 95% confidence interval as 1.03-3.42, 0.21-0.76, 1.40-27.76, 1.50-28.30, 1.43-6.60, 1.29-8.92, 4.84-60.74, P<0.05). Results of multivariate analysis showed that BMI ≥25 kg/m2, clinical T3 stage, clinical N3 stage were independent risk factors influencing prolonged surgical duration in Da Vinci robotic radical gastrectomy for gastric cancer ( odds ratio=2.31, 4.97, 11.08, 95% confidence interval as 1.19-4.46, 1.05-23.55, 2.72-45.13, P<0.05). (5) Construction and evaluation of an artificial neural network predictive model for pro-longed surgical duration. The BMI, tumor location, clinical T staging, and clinical N staging were incorporated into a multilayer perceptron to construct an artificial neural network predictive model for prolonged surgical duration. Results of ROC curve showed that the AUC, accuracy, sensitivity, specificity, positive predictive value, negative predictive value of the predictive model in the training dataset were 0.73 (95% confidence interval as 0.68-0.78), 91.4%, 68.1%, 94.8%, 65.3%, 95.4%. The above indicators of the predictive model in the validation dataset 0.72 (95% confidence interval as 0.65-0.79), 88.1%, 67.6%, 93.7%, 74.2%, 91.5%. Conclusions:BMI ≥25 kg/m2, clinical T3 stage, clinical N3 stage are independent risk factors influencing prolonged surgical duration in Da Vinci robotic radical gastrectomy for gastric cancer. The artificial neural network predictive model con-structed based on BMI, tumor location, clinical T staging, and clinical N staging can effectively predict patients at high risk of prolonged surgical duration in Da Vinci robotic radical gastrectomy for gastric cancer.

Objective: To explore the improvement influence of three combined exercise programs on sleep quality among college students with sleep disorders, so as to provide reference for the construction of exercise intervention programs for sleep disorder. Methods: A total of 35 college students with sleep disorders were randomly divided into AR group ( n =10), AM group ( n =8), RM group ( n =9) and CG group ( n =8). The three exercise groups were provided with exercise intervention for 8 weeks, 3 times/week , 60 min/time, and the CG group maintained previous lifestyle.Before and after the intervention,evaluation of subjective sleep quality and reduction rate of sleep disorder by PSQI, and Actigraph GT3X+ was used to monitor the changes in the objective sleep quality. Results: After the intervention,the total score of PSQI ( t =3.49, 2.31, 2.73), sleep quality score ( t =2.71, 3.00 , 5.29),sleep duration of AR group ( t =2.74), daytime dysfunction of AM group ( t =2.64) and sleep duration of RM group ( t = 2.29) significantly decreased ( P ＜0.05); The scores of sleep duration in AM group were significantly lower than those in AR group, and the scores of PSQI,sleep quality and daytime dysfunction in AM group were significantly lower than those in CG group (P<0.05). After intervention,TST ( t =-4.41, -8.37, -6.79) and SE ( t =-4.40, -5.86, -4.91) of AR group, AM group and RM group significantly increased( P <0.05), SOL ( t =4.18, 9.93), WASO ( t =2.91, 3.46) and NA ( t =4.80, 3.37) of AM group and RM group significantly decreased ( P <0.05). The changes of TST,SE and WASO in RM group were significantly higher than those in CG group, and SOL was significantly lower than those in CG group ( P <0.05). Conclusion The three kinds of combined exercise programs can improve the subjective and objective sleep quality of college students with sleep disorders, and reduce the incidence of sleep disorders; different combined exercise programs have different influence on the improvement of sleep quality of college students with sleep disorders, aerobic combined meditative movement exercise program has a prominent influence on the improvement of subjective sleep quality, and resistance combined meditative movement exercise program has a prominent influence on the improvement of objective sleep quality.

Objective:To explore the safety and efficacy of laparoscopic non-blocking partial nephrectomy assisted by high power lateral green laser in the treatment of T 1a renal tumor. Methods:The clinical data of 10 patients with T1a stage renal tumor from February 2021 to April 2021 in department of urology, Gongli hospital affiliated to Naval Military Medical University were retrospectively analyzed. There were 7 males and 3 females, aged 47.0-74.0 years, with average of(58.8±9.7)years old. The diameter of the tumor ranged from 2.0 cm to 3.8 cm, with an average of (3.1±0.6)cm. There were 6 cases on the left side and 4 cases on the right side, locate on lumbar side in 9 cases and ventral sied in 1 case. The R. E.N.A.L score was 4.0-6.0, with an average of (5.0±0.8). The preoperative creatinine was 66.9-90.1μmol/L, with an average of (75.1±9.0)μmol/L, preoperative GFR of 44. 6- 67. 3 ml /min, with an average of(56.7±7.7)ml/min, preoperative hemoglobin level of 119.0-156.0g/L, with an average of (135.8±11.4)g/L. All patients underwent laparoscopic non-blocking partial nephrectomy assisted by 180w lateral green laser, free the surrounding area of the tumor fully and completely expose the renal tumor. The laser fiber was placed through the green laser hand piece, and the fiber was connected with normal saline to wash the strip. The initial green laser vaporization power was set at 80W, and the hemostasis power at 35W.About 3mm away from the edge of the tumor, and one optical fiber away from the renal parenchyma, the renal parenchyma was cut with 80W power. In order to reduce the interference by smoke, high-pressure flushing was used through the optical fiber while vaporizing, and an attractor was used to push and peel the tumor. In case of bleeding during operation, hemostatic power can be used to close the bleeding point and gradually advance until the tumor was completely removed. The wounds of renal inner medulla and renal outer cortex were continuously sutured in 1-3 layers with barbed suture. It involved 9 cases via retroperitoneal approach and 1 case via abdominal approach. The operation time, postoperative hemoglobin decrease, extraction time of negative pressure drainage, postoperative hospital stay, postoperative pathology and postoperative complications were recorded, and the serum creatinine level and GFR level of the affected side were followed up 1 month after operation.Results:All the operations were successfully completed, and there was no conversion to open surgery or radical nephrectomy. One case changed to scissors fast resection and sutured hemostasis due to severe intraoperative bleeding. The operation time was 90.0-120.0 min, with the average of (104.5±9.0)min. The postoperative hemoglobin level was 96.0-132.0g/L, with an average of (115.2±11.8)g/L, and the difference was statistically significant ( P<0.05). The postoperative hemoglobin decreased from 12.0g/L to 25.0g/L, with an average of (20.6±4.6)g/L. The time of vacuum drainage was 5.0-7.0 days, with an average of (5.7±0.7)d. Postoperative hospital stay was 6.0-8.0 days, with an average of (6.7±0.7)d. No bleeding, urinary leakage and other complications occurred in all patients. There were 7 cases of clear cell carcinoma, 2 cases of papillary renal cell carcinoma and 1 case of angiomyolipoma. All margins were negative. One month after operation, creatinine ranged from 66.0 to 90.4μmol/L, with an average of (76.8±8.3)μmol/L, which was not significantly different compared with that before operation ( P>0.05). One month after operation, GFR was 45.1-60.8 ml/min, and with an average of (55.5±4.7)ml/min, and there was no significant difference compared with preoperative data( P>0.05). Conclusions:For T 1aN 0M 0 stage and exophytic renal tumors, laparoscopic non-blocking partial nephrectomy assisted by lateral green laser is safe and effective.

To evaluate the efficacy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for patients with metastases to the pancreas.Data on patients with pancreatic lesions who underwent EUS-FNA and confirmed as having metastases to the pancreas at the Endoscopy Center of Zhongshan Hospital, Fudan University from January 2015 to November 2020 were retrospectively analyzed.Characteristics of patients, EUS performance, pathological results, and follow-up were reviewed and analyzed. A total of 11 patients were diagnosed of metastasis to pancreas by EUS-FNA.The primary tumor mainly came from kidney (4/11) and lung (4/11), and the rest from colon (1/11), breast (1/11) and bladder (1/11), respectively. EUS performance of metastases to the pancreas mostly presented homogeneous hypoecho (10/11)with unclear margin (6/11). Enlarged lymphnodes were noticed in nearly half of the patients (5/11). The time span from detection of primary tumor to metastases ranged from 6 days to 27 years. EUS-FNA is effective in the diagnosis of metastases to the pancreas.