Objective: To investigate the clinical characteristics, diagnostic approach, and multidisciplinary treatment strategy for a rare case of congenital defect presenting as a complex of hemifacial microsomia with cardiac and spinal deformities, in order to provide a reference for the clinical management of such cases Methods : The clinical data of a 9-year-old patient with hemifacial microsomia (HFM) complicated by post-operative Tetralogy of Fallot and scoliosis were retrospectively analyzed. A definitive diagnosis was established through specialized examinations, imaging studies, bone age assessment, and intellectual evaluation. The patient presented with right-sided HFM (with 3 accessory auricles, a transverse facial cleft, a microform median cleft of the upper lip, hypoplasia of the mandible and facial soft tissues, and agenesis of the right parotid gland and coronoid process), increased orbital distance, dental malalignment, congenital absence of one lateral incisor, and rampant caries in both primary and permanent dentition. The patient had undergone open-heart surgery for Tetralogy of Fallot with a patent foramen ovale four years prior and also presented with scoliosis and systemic developmental delay (bone age approximately 7 years). A retrospective analysis of the diagnosis and treatment of this type of case was conducted in conjunction with a literature review. Results: A multi-disciplinary treatment (MDT) model was adopted. The patient first received treatment for dental caries, followed by excision of the right accessory auricles, repair of the transverse facial cleft, and correction of the microform upper lip cleft under general anesthesia. A 6-month follow-up showed significant improvement in facial appearance and good recovery of oral function. The literature review indicated that hemifacial microsomia is a congenital disease characterized by the hypoplasia of multiple tissue structures on one side of the face. Its etiology may be related to impaired blood supply to the first and second branchial arches during early pregnancy. It often affects the craniofacial bones, ears, and soft tissues, leading to functional impairments in respiration, feeding, speech, and hearing, as well as psychological issues, severely impacting the quality of life in serious cases. The combination with cardiac and spinal deformities is relatively rare and requires individualized sequential treatment plans based on clinical evaluation and surgical indications. This typically includes cardiac surgical correction, spinal orthopedics, early soft and hard tissue reconstruction (e.g., distraction osteogenesis, facial cleft repair, and accessory auricle excision), orthodontic and dental management during the growth period, and final facial contouring in adulthood. Conclusion HFM can be associated with cardiac and spinal deformities, presenting with complex clinical manifestations. Early diagnosis, MDT collaboration, and sequential treatment plans are key to improving patients’ prognosis and quality of life.

Objective To observe the safety of low-intensity focused ultrasound(LIFU)for stimulating rat vagus nerve.Methods Twelve male SD rats were randomly divided into stimulation group A,B,C and sham stimulation(D)group(each n=3).A LIFU stimulation system equipped with a suitable collimator was used to stimulate rat left vagus nerve in A,B,C groups,with acoustic pressure of 1.05,3.87 and 4.25 MPa,respectively,with the same pulse repetition frequency,duty ratio and stimulation mode.For rats in group D,the ultrasonic transducer was positioned on the left side of the neck but no stimulation was performed.The changes of heart rate and local neck temperature were recorded before,during and after LIFU stimulation.After stimulation,neck MR T2WI were acquired for group C and D.Then pathological examination of vagus nerve was performed to observe whether there were abnormal changes after stimulation.Results No significant difference of heart rate 5 min before,during and 5 min after stimulation was found among 4 groups(all P>0.05).The local temperature beneath the transducer of rats in group A,B,C and D ranged from 28.1-30.1℃,28.3-30.3℃,27.9-30.4℃ and 27.8-30.2℃,respectively,and the temperature fluctuation all less than 2.5℃.T2WI showed no obvious abnormality of neck soft tissue in group C nor D,while no significant pathological changes of rat vagus nerve was detected.Conclusion LIFU with proper parameters was safe for stimulating rat vagus nerve.

Objective:To systematically evaluate the qualitative researches on cardiac telerehabilitation experience of patients with cardiovascular disease (CVD), so as to provide reference for clinical development and improvement of cardiac telerehabilitation services.Methods:Qualitative studies on cardiac telerehabilitation experience of CVD patients in PubMed, Web of Science, Embase, CINAHL, Cochrane Library, Scopus, China National Knowledge Infrastructure, China Biology Medicine disc, Wanfang Database and VIP were searched by computer. The search period was from establishment of the databases to August 2023. The quality of the literature was evaluated according to the quality evaluation criteria of the Evidence-Based Health Care Center of the Joanna Briggs Institute in Australia, and the results were integrated by aggregative integration method.Results:A total of 13 articles were included, 52 research results were extracted and classified into 11 categories. Four integrated results were formed, including the benefits, promoting factors, obstacle, expectations and suggestions for cardiac telerehabilitation experience in CVD patients.Conclusions:CVD patients benefit significantly from participating in cardiac telerehabilitation. In the future, it is supposed to pay more attention to the factors that affect patients' participation in cardiac telerehabilitation, actively develop domestic cardiac telerehabilitation tools and optimize the cardiac telerehabilitation model according to the needs and suggestions of patients.

Objective:To systematically search and evaluate risk prediction models for ventilator-associated pneumonia (VAP) of ICU in order to provide references for developing higher-quality VAP risk prediction models.Methods:Relevant literature was retrieved from databases including China Biology Medicine disc, WanFang data, China National Knowledge Infrastructure, Embase, PubMed, CINAHL, Web of Science, and Cochrane Library. The search timeframe was from the establishment of the databases to September 30, 2023, limited to English and Chinese languages. Two researchers independently screened the literature and extracted data, and the PROBAST tool was used to evaluate the risk of bias and applicability of the included studies.Results:A total of 15 studies on VAP risk prediction models were included. The area under the receiver operating characteristic curve for the 15 models ranged from 0.722 to 0.982. The most frequently involved predictors were age, duration of mechanical ventilation, ICU length of stay, and comorbid chronic obstructive pulmonary disease. The overall adaptability was good, but the risk of bias was high. The main sources of bias included insufficient sample size, inappropriate data sources, lack of model performance evaluation, and inadequate attention to missing data.Conclusions:The risk of bias in studies on VAP risk prediction models is high, indicating that the field is still developing. Future research should focus on the effectiveness of different risk assessment methods to construct models with low bias, excellent predictive performance, and suitability for clinical practice in China.

Objective:To explore the relation of self-injury behavior to thyroid hormones and lipids in adoles-cent patients with depression.Methods:A total of 182 adolescent inpatients who met the diagnostic criteria for de-pression according to the Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition(DSM-5)were en-rolled,including 38 cases with self-injurious behavior and 144 cases without self-injurious.The differences in vari-ous indicators between the two groups were compared,and logistic regression analysis was used to analyze factors related to self-injury in adolescents with depression.Results:The patients with self-injurious behavior had higher levels of total cholesterol and high-density lipoprotein cholesterol(HDL-C)compared to those without self-injuri-ous behavior(P＜0.05).They also had lower levels of free thyroxine compared to the group without self-injurious behavior(P＜0.05).Logistic regression analysis results showed that those with longer duration of disease(OR=1.03)and higher HDL-C levels(OR=12.75)were more likely to have self-injurious behaviors.Conclusion:Long duration of disease and high level of HDL-C may be risk factors for self-injurious behavior in adolescents with de-pression,while low level of free thyroxine may serve as a protective factor.

Objective:To evaluate the effect of preoperative cognitive training on postoperative neurocognitive function in elderly patients undergoing coronary artery bypass grafting (CABG) and/or valve surgery.Methods:Seventy-four elderly patients of either sex, of American Society of Anesthesiologists Physical Status classification Ⅲ or Ⅳ, aged 60-90 yr, with body mass index of 19-28 kg/m 2, scheduled for elective CABG or valve surgery under general anesthesia, were divided into 2 groups ( n=37 each) using a computer-generated random number table method: cognitive training group (group CT) and control group (group C). Group CT was instructed to complete a cognitive training once 1 h per day for 5 consecutive days prior to surgery. Group C did not receive any cognitive training before surgery, and routine nursing was performed. At the 7th day after surgery, the patients′ neurocognitive function was evaluated by the Montreal Cognitive Assessment Scale(MoCA), the Postoperative Quality Recovery Scale (PQRS) was used to assess the patients′ recovery status, and the postoperative complications and morality in both groups were recorded. The patients were assessed using the Geriatric Depression Scale, MoCA and PQRS at the 1st month and 3rd month after operation. Results:The MoCA scores were significantly higher at the 7th day, 1st month and 3rd month postoperatively than in group C ( P<0.05). There was no significant difference in the postoperative case fatality rate and incidence of complications between the two groups ( P>0.05). Significant difference was observed in PQRS scores between the two groups at the 7th day after surgery ( P<0.05), but there were no significant differences in the PQRS scores and Geriatric Depression Scale scores between the two groups at the 1st month and 3rd month after operation ( P>0.05). Conclusions:The cognitive training can improve postoperative neurocognitive function in elderly patients undergoing CABG and/or valve surgery.

Objective To observe the changes of liver function,blood cell,and lung function of healthy young and middle-aged men before and after fast-advancing short-term high altitude exposure(FSHAE);and to explore the effects and possible mechanisms of FSHAE on the function of liver,blood cells,and lung tissues.Methods This study included 48 healthy young and middle-aged male volunteers,who collected physiological indicators,tested liver function indicators,blood cell indicators,and lung function-related indicators 1 day before entering the plateau(100m above sea level),and 15 days after FSHAE(3000m above sea level).Differences in the relevant parameters of each system were compared before and after FSHAE.Results Compared with those before entering the plateau,the physiological parameters of young and middle-aged men after 15 days of FSHAE heart rate increased significantly,respiratory rate increased,systolic blood pressure increased,mean arterial blood pressure increased,oxygen saturation decreased(P＜0.01),and diastolic blood pressure increased(P＜0.05),all of which were statistically significant;and the indicators of liver function:glutamic oxaloacetic aminotransferase,glutamic alanine aminotransferase increased(P＜0.01),glutamylamine aminotransferase,glutamate aminotransferase,glutaminase,and pulmonary function were increased(P＜0.01),glutamyl transpeptidase,alkaline phosphatase,and total bile acids were elevated,and total protein decreased(P＜0.05),and the differences were statistically significant.Hemocyte-related indexes:erythrocyte count,erythrocyte pressure volume,mean erythrocyte volume,mean hemoglobin volume,mean hemoglobin concentration,and hemoglobin were elevated,and platelet count decreased(P＜0.01),and the differences were statistically significant.although there was an elevation of leukocyte count(P＞0.05);Lung function-related indexes:decreased exertion lung volume(P＜0.05).There were decreased exertion expiratory volume in the first second,increased one-second rate(P＞0.05).Conclusion FSHAE can lead to oxidative stress in the organism,and acute hypoxic multisystemic injury will occur,with the simultaneous emergence of hypoxic adaptive regulation of various systems,self-compensatory repair of various organs of the organism,and there may be the possibility of interactions between various systems.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To explore the latent profile of discharge readiness of patients with lower extremity arteriosclerosis obliterans and analyze its influencing factors, so as to provide theoretical basis for individualized management of discharge readiness in patients with lower limb arteriosclerosis obliterans.Methods:From February 2022 to December 2022, 194 patients with arteriosclerosis obliterans of lower limbs who received surgical treatment in the vascular surgery department of Shandong Provincial Hospital Affiliated to Shandong First Medical University were investigated by using general information questionnaire, Readiness for Hospital Discharge Scale, Quality of Discharge Teaching Scale and Family APGAR Index for a cross-sectional survey. Latent profile analysis was used to identify different categories, and Logistic regression analysis was used to explore its influencing factors.Results:Totally 182 valid questionnaires were collected, of which 127 males and 55 females, and patients over 60 years old were the majority, accounting for 81.9%. Three latent profile models were identified in this study, namely, low discharge readiness group (27.47%), medium discharge readiness-high expected support group (41.21%) and high discharge readiness group (31.31%). Logistic regression analysis showed that first hospitalization ( OR=19.218, 95% CI 2.949-125.237), the quality of discharge guidance ( OR=0.896, 95% CI 0.857-0.937) were the predictive factors of medium discharge readiness-high expected support group ( P<0.05); family function ( OR=0.185, 95% CI 0.097-0.353) and the quality of discharge guidance ( OR=0.823, 95% CI 0.764-0.888) were the predictive factors of the low discharge readiness group of patients with arteriosclerosis obliterans (all P<0.05). Conclusions:There are different types of discharge readiness of patients with arteriosclerosis obliterans, and patients with poor quality of discharge guidance and poor family function are more likely to have a trend of low discharge readiness. Patients with low quality discharge guidance and first hospitalization are more likely to have a trend of moderate discharge readiness-high expected support. For this kind of patients, medical staff should take corresponding measures to improve their readiness for discharge.

Objective To investigate the effect of BMAL1 on H2O2-induced cardiomyocyte injury through NRF2-regulated ROS/NLRP3 inflammasome pathway.Methods H9c2 cells and H9c2 cells with stable over-expressed BMAL1 were cultured and divided into the control group,the H2O2 group,the BMAL1-OE group,the BMAL1-OE+H2O2 group,the BMAL1-OE+ML385 group and the BMAL1-OE+ML385+H2O2 group.All groups were pre-intervened with corresponding inhibitors,and then treated with 0.2 mmol/L H2O2,except for the control group and the BMAL1-OE group.After the intervention,CCK-8 assay was used to measure cell viability,fluorescent probe DCFH-DA was used to measure ROS generation and Western blot assay was used to detect BMAL1,NRF2 and NLRP3 protein expressions.ELISA was used to determine IL-1β release.Results Compared with the control group,the cell viability was decreased,ROS generation was increased,BMAL1 and NRF2 protein expressions were decreased,NLRP3 expression and IL-1β release were increased in the H2O2 group(P＜0.05).Compared with the H2O2 group,the cell viability was increased,ROS generation was decreased,BMAL1-OE and NRF2 protein expressions were increased,NLRP3 expression and IL-1β release were decreased in the BMAL1-OE+H2O2 group(P＜0.05).Compared with the BMAL1-OE+H2O2 group,the cell viability was decreased,ROS generation was increased,NLRP3 expression and IL-1β release were increased in the BMAL1-OE+ML385+H2O2 group(P＜0.05).Conclusion BMAL1 attenuates H2O2-induced H9c2 cardiomyocyte injury,and its mechanism may be related to the regulation of ROS/NLRP3 inflammasome pathway through NRF2.