The excessive inflammatory response after acute myocardial infarction (AMI) is detrimental to the repair of the infarcted myocardium, and anti-inflammatory interventions at the peak of inflammation have shown efficacy. Therefore, longitudinal monitoring of myocardial inflammatory evolution after AMI in vivo is important for individualized risk prediction, anti-inflammatory treatment strategies guidance and further prognosis improvement. 68Ga-pentixafor, a promising novel probe targeting C-X-C chemokine receptor 4 (CXCR4) on the surface of inflammatory cells, with no special preparation before imaging, allows in vivo visualization of the inflammation intensity, extent and evolution in the infarcted myocardium as well as the response of other related extra-cardiac organs. This review referred to its radiopharmaceutical characteristics, research status, explorations and limitations in AMI.

OBJECTIVE To explore the construction of mind map by clinical pharmacists for the consultation of pulmonary nocardiosis and its application in clinical practice， and to provide reference for promoting the correct selection of nocardiosis treatment drugs in clinical practice and ensuring drug safety and efficacy. METHODS A total of 7 patients with Nocardia pulmonary infection from January 2017 to April 2022 in our hospital were collected. Based on evidence-based medicine， a consultation mind map （mainly including understanding the medical history， identifying infectious bacteria， identifying risk factors， developing treatment plans， and conducting evaluations） was constructed to address the difficulties of large differences in drug sensitivity among different strains of Nocardia and numerous adverse reactions of Compound sulfamethoxazole as a first-line drug. The treatment plan was developed for 7 patients with pulmonary nocardiosis， and whole-process pharmaceutical care was provided. RESULTS Combined with the mind map， different antibiotic combination regimens were given according to the drug sensitivity results of Nocardia， the different species of Nocardia， and the patient’s allergy history. Among them， 4 cases were treated with imipenem cilastatin， the patients receiving Compound sulfamethoxazole and linezolid for a long time were given full pharmaceutical care， and the adverse drug reactions were timely treated.CONCLUSIONS Clinical pharmacists apply the consultation mind map of pulmonary nocardiosis to the treatment of inpatients， take advantage of pharmacy， participate in clinical drug therapy， and really play a role in the clinical treatment team so as to promote rational drug use.

Objective:To detect the changes of left ventricular myocardial work parameters, and evaluate the left ventricular systolic function in patients with hyperglycemia during pregnancy by left ventricular pressure-strain loop (PSL).Methods:From June 2021 to March 2022, 97 pregnant women who were admitted to the Second Affiliated Hospital of Harbin Medical University and clinically diagnosed as gestational hyperglycemia were prospectively and randomly selected. According to the blood glucose level, the patients were divided into gestational dominant diabetes mellitus (ODM) group(39 cases) and gestational diabetes mellitus (GDM) group(58 cases). Meanwhile, another 62 healthy pregnant women were selected as control group. The basic clinical data of the pregnant women were collected, and the conventional two-dimensional parameters of the heart were collected. The global longitudinal strain (GLS) was analyzed by two-dimensional speckle tracking technique. Then the cuff blood pressure was used as the left ventricular pressure to construct a non-invasive left ventricular pressure-strain loop. The global myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE) of each group were calculated and compared. The correlation between myocardial performance parameters and GLS, glycated hemoglobin(HbA 1c) were analyzed, and the independent factors affecting left ventricular systolic function were obtained by Logistic regression analysis. Twenty cases were randomly selected from the study subjects, and the intraclass correlation coefficients(ICC) of within the observers and between observers were calculated for repeatability test. Results:①Conventional ultrasound parameters: There were no significant differences among the three groups (all P>0.05). ②GLS and left ventricular myocardial performance parameters: GWI, GWE, GCW and GLS in GDM and ODM groups were significantly lower than those in control group (all P<0.001), GWW was significantly higher than control group ( P<0.001); GWI, GWE, GCW and GLS in ODM group were lower than those in GDM group (all P<0.001), while GWW was higher than control group ( P<0.001). ③GWE, GWI and GCW were negatively correlated with GLS ( r=-0.525, -0.408, -0.435; all P<0.05), GWW was positively correlated with GLS ( r=0.348, P<0.05). GWE, GWI and GCW were negatively correlated with HbA 1c ( r=-0.325, -0.262, -0.250; all P<0.05), while GWW was positively correlated with HbA 1c ( r=0.175, P<0.05). ④GWE, 1 h oral glucose tolerance test and HbA 1c were the influencing factors of left ventricular systolic function in patients with hyperglycemia during pregnancy. ⑤The predictive values of GWI, GWE, GCW, GWW and GLS for cardiac function in patients with gestational hyperglycemia were high, and the predictive value of GWE was the highest (AUC: 0.87, the best truncation value: 94.5%, specificity: 0.76, sensitivity: 0.82) and better than GLS. ⑥The repeatability of myocardial work parameters was better in both groups. Conclusions:Myocardial work parameters obtained by PSL are early and sensitive parameters for evaluating left ventricular systolic function impairment in patients with hyperglycemia during pregnancy which can provide reliable and objective quantitative indicators for early clinical intervention and improvement of prognosis.

Objective:To establish a model C-GALAD for detecting hepatocellular carcinoma (HCC) from the chronic liver disease and healthy people based on the serum markers.Methods:A clinical cohort including 229 hepatocellular carcinoma patients, 2 317 patients with chronic liver disease and 982 healthy people, was retrospectively collected from eight hospitals or physical examination institutions from April 2018 to October 2020. The data were divided into a training set and a testing set by stratified sampling with a 6∶4 ratio. A predictive model was established on the training set using a logistic backward regression method and validated on the testing set. In addition, clinical data from March to July 2021 in Beijing You′ an Hospital affiliated to Capital Medical University, including 84 patients with liver cancer and 204 patients with chronic liver disease collected were used for external independent validation of the model. The receiver operating characteristic curve (ROC) area under curve (AUC), the sensitivity and the specificity were used to evaluate the effectiveness of the model.Results:Through the logistic backward regression method, the seven signatures including age, gender, alpha-fetoprotein (AFP), alpha-fetoprotein alloplasm-3 ratio (AFP-L3%), des-gamma-carboxyprothrombin(DCP), platelet (PLT) and total bilirubin (TBIL) were selected as risk factors in the detection model. The area under the ROC curve (AUC) of the model on the testing set was 0.954, with an 88.04% sensitivity and a 94.85% specificity, and the AUC of model on the external independent validation set was 0.943, with an 89.29% sensitivity and a 90.2% specificity, which were better than other published models.Conclusion:The C-GALAD Ⅱ model can accurately predict the risk of hepatocellular carcinoma occurrence, and thus provide a trustworthy diagnosis method of hepatocellular carcinoma.

Objective:To provide useful information for in-depth understanding of the epidemic and molecular evolution of Coxsackievirus A4 (CV-A4), the genetic characteristics of the complete genome and recombination events in some genome regions of CV-A4 strain isolated from a patient with severe hand, foot and mouth disease (HFMD) in Yunnan province were analyzed.Methods:The CV-A4 strain was isolated from feces using RD, KMB17 and A549 cells respectively, and the viral RNA was extracted from the supernatant with CPE. The whole VP1 and complete genome sequences of the virus were amplified by RT-PCR and sequenced through Sanger’s sequencing. Complete genome sequence and genome regions of the isolated virus were analyzed through MEGA7.0 and SimPlot 3.5.1 software.Results:The virus isolated from RD cells belonged to CV-A4 and was designated as R11-20/YN/CHN/2011 strain. This CV-A4 strain was C2 sub-genotype through phylogenetic analysis based on the VP1 sequence. CV-A4 R11-20/YN/CHN/2011 has the highest nucleotide sequence identity with 09214/SD/CHN/2009 in VP1 and CVA4/SZ/CHN/09 in the complete genome. Recombination occurred between CV-A4 R11-20/YN/CHN/2011 and EV-A71 in 3D region.Conclusions:The CV-A4 R11-20/YN/CHN/2011 strain belongs to C2 sub-genotype and recombines with EV-A71 in 3D region.

Objective:To investigate the clinical application effect of latissimus dorsi muscle flap in reconstruction of muscle strength around shoulder after electric burns.Methods:From March 2014 to September 2020, 13 patients with electric burns and severe injury around shoulder were admitted to the First Affiliated Hospital of Air Force Medical University, including 11 males and 2 females, aged 19-55 years. A retrospective observational study was conducted. The left upper limbs were injured in 8 cases, and the right upper limbs were injured in 5 cases, all with eschar wounds of Ⅲ-Ⅳ degree. Among which, there were biceps defects in 6 cases, deltoid defects in 3 cases, triceps defects in 2 cases, and composite defects of multiple muscles around shoulder in 2 cases. The surgery was carried out in two stages. In stage Ⅰ, debridement and exploration of electric burn wounds around shoulders were conducted to preserve local tissue and save the limb as much as possible on the premise of guaranteeing the stability of the body condition. After the last debridement, the wound area was from 10 cm×6 cm to 40 cm×15 cm, the muscle defect area was from 8 cm×4 cm to 19 cm×12 cm, and the humerus was exposed in 7 patients. In stage Ⅱ, according to the residual limb defect degree, muscle reconstruction around shoulder was conducted with the latissimus dorsi muscle flap, and area of the latissimus dorsi muscle flap was 15 cm×6 cm to 20 cm×18 cm. The residual wounds were repaired with autologous split-thickness skin grafts of head, and the donor sites of muscle flaps were sutured directly. The survivals of the muscle flaps and wounds closure post operation, and the appearances of the donor sites and recipient sites during follow-up were observed. At the last follow-up, the shoulder joint function was evaluated using the trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association, and the satisfaction degrees of patients for appearance and function recoveries of shoulder were investigated by self-made questionnaire with reference to the concise test scoring system of shoulder joint.Results:All of the 13 muscle flaps around shoulder survived after surgery. Two patients had residual wounds in the skin grafting area, the wound in one of the patients was healed after dressing change, and the wound in the other 1 patient was healed with the second autologous split-thickness skin grafting on head after dressing change. During follow-up of 6 to 18 months for all the patients, the muscle flaps of patients were full in appearance and not bloated, and atrophic scar in the repaired area was soft in texture and closed with normal skin around. Linear suture scars were left in the donor sites of muscle flaps, which did not affect the overall appearance. At the last follow-up, the active abduction range of the shoulder joint was 60-90°, upward lift on 120-180°, muscle strength recovered to level Ⅳ and above in 8 cases and to level Ⅲ in 5 cases, and the shoulder joint function was evaluated as excellent in 8 cases and good in 5 cases; 10 patients were very satisfied and 3 patients were satisfied with the appearance and function recovery of the shoulders.Conclusions:The application of latissimus dorsi muscle flap provides a better choice for the muscle strength reconstruction around shoulder after electric burns, with good appearance of the operative areas and ideal prognosis of upper limb function.

High mobility group protein B1 (HMGB1), a highly conversed non-histone nucleoproteins with strong pro-inflammatory property, is one of the inflammatory mediator of the acute respiratory distress syndrome (ARDS). Numerous studies have confirmed that HMGB1 regulates ARDS by binding to receptor for advanced glycation end product (RAGE), Toll-like receptor (TLR) and etc. And it can significantly increase the mortality of ARDS. But the mechanism of HMGB1 release is still unclear. This study focuses on the HMGB1 release progress, which connected with Janus kinases/signal transducer and activator of transcription (JAK/STAT), nuclear factor-κB (NF-κB), Notch, inflammasome, tumor necrosis factor (TNF), mitogen-activated protein kinase (MAPK), reactive oxygen species (ROS), peroxisome proliferator-activated receptor (PPAR) and other signaling or dependent pathways in ARDS.

Objective:To summarize the anesthesia management of living small bowel transplantation.Methods:Severn patients undergoing living and allogeneic small bowel transplantation for the first time were selected.The intraoperative hemodynamics, indexes of blood gas analysis, body temperature and blood transfusion and volume of liquid infused were analyzed.Postoperative outcomes were tracked.Results:Six cases survived and were successfully discharged from hospital successfully, and one patient died.In the operation room, 71% patients were successfully extubated after surgery.Compared with the values during anatomical separation period, Hb during vascular anastomosis and intestinal reconstruction periods and concentration of Ca 2+ during intestinal reconstruction period were significantly decreased, and the blood glucose concentration during vascular anastomosis period were increased ( P<0.05 or 0.01). Compared with the values during vascular anastomosis period, the blood glucose concentration was increased significantly during intestinal reconstruction period ( P<0.05). Crystalloid solution (57±30) ml/kg and colloid solution which mainly containing 20% albumin (15±13) ml/kg were infused mainly during anatomical separation and vascular anastomosis periods in all the patients. Conclusion:The condition of successful living small bowel transplantation is fully evaluation and preparation before surgery.Intravenous-inhalational anesthesia combined with transverses abdominis plane block and rational infusion of colloid solution with vasoactive drugs to maintain hemodynamics stability and monitor blood gas, body temperature, active adjustment of electrolytes and internal environment and stable body temperature can be helpful in maintaining perioperative stable vital signs during the perioperative period, removing the tracheal tube early at the end of surgery, and reducing the development of postoperative complications in patients undergoing living small bowel transplantation.

Objective:To propose and verify a surgical classification system for the axial primary malignant and aggressive benign tumor.Methods:The CZH surgical classification system was originally developed for the axial primary malignant and aggressive benign tumor. The CZH surgical classification system includes seven types, according to the anatomic features and the extension of tumor violation. A total of 136 patients (79 males and 57 females) with axial primary malignant and aggressive benign tumor from multiple tertiary centers who received surgery from July 2006 to July 2019 were included. The average age was 44.40±17.55 years (8-83 years) old. There were 99 malignant tumors and 37 aggressive benign tumors included. The number of patients with each classification was presented as followed, Type I 13, Type II 15, Type IIIa 3, Type IIIb 20, Type IVa 43, Type IVb 12, Type Va 21, Type Vb 3, Type VI 2, Type VIIa 3 and Type VIIb 1. Surgical procedures were selected according to different types in classification. The inter- and intra-observer consistencies were evaluated by the Kendall's W test. The VAS, Frankel score, overall survival and recurrence free survival were recorded during the follow-up. Results:The inter- and intra-observer consistent coefficient was 0.973 and 0.996, respectively ( P<0.05). The single posterior approach was adopted for the Type II tumors. Other patients underwent surgery by the combined antero-posterior approach. The majority in anterior approach (113 cases) was the modified submandibular approach. The reconstruction modes included anterior "T" shape titanium mesh (112 cases) or the 3D printed prothesis (7 cases) combined with the posterior occipto-cervical fusion (92 cases) or the pedicle screw system (44 cases). The average surgical duration and the volume of intraoperative bleeding was 348.40±136.14 min (60-760 min) and 1 225.69±859.40 ml (80-4 000 ml), respectively. The operation duration and volume of intraoperative bleeding among each type were with statistical difference. The patients with Type IV, V tumors had longer operation duration than those with Type II tumors. Those with Type V and VII tumors had longer operation duration than those with Type I tumors. The patients with Type V tumors had more intraoperative bleeding than those with Type I-IV tumors. The average preoperative VAS score was 4.15±2.25 and then was reduced significantly to 0.62±0.71 and 0.38±0.59 at one and three months after operation, respectively. The Frankel score was also significantly ameliorated at one and three months postoperatively. There were 22 postoperative complications (16.2%). The complications included cerebral spinal fluid leak (12.5%), dysphagia and/or dysphonia (7.4%), dyspnea (5.1%), wound infection (3.7%), wound hemorrhage (2.2%) and pharyngeal dehiscence (1.5%). The incidence of postoperative complication was 25.9% in Type IV-VII tumors, while 11.8% in Type I-III tumors. Conclusion:CZH surgical classification system was verified with high observer consistency. This classification system could assist surgeons to select proper surgical approaches, resection modes and reconstruction modes, and thus ensure the safety of surgery and reduce the recurrence. The tumors in Type IV, V and VII may be with more challenging for surgeons. The incidence of postoperative complication in Type IV-VII tumors may be higher than that in Type I-III tumors.

Objective To explore the effect of PDCA [plan (P), design (D), check (C), act (A)] cycle on primary cardiopulmonary resuscitation (CPR) training for medical assistants in hospitals. Methods PDCA cycle was used to enhance continuous quality improvement (CQI) of team members to carry out brain storming to find out the root causes of the training difficulty, and directing to the 3 main root causes: lack of emergency rescue consciousness, without systematic training system and improper education procedure, it was proposed to arrange 3 great strategies: emergency rescue knowledge training, design of systematic training system and proper arrangement of training process. The changes of medical assistants' subjective willingness to perform the first aid, the accurate rates of answering questions on CPR location, frequency, depth, ratio of compression to breathing and awareness degree of CPR before and after training were observed. Results After training, the medical assistants' subjective willingness to perform the first aid was higher than that before training [91.7% (121/132) vs. 2.3% (3/132), P＜0.05]. The accurate answer rates on questions concerning CPR basic knowledge, such as location, frequency, depth and compression-breathing ratio had been greatly improved after training compared with those before training [location: 65.2% (86/132) vs. 4.5% (6/132), frequency: 40.2% (53/132) vs. 0 (0/132), depth: 90.2% (119/132) vs. 0 (0/132), compression-breathing ratio: 84.8% (112/132) vs. 1.5% (2/132 ), all P＜0.05]. After training, the percentage of medical assistants having very familiar awareness degree of CPR was significantly higher than that before training [65.2% (86/132) vs. 3.0% (4/132), P＜0.05]. Conclusion Via CPR training PDCA cycle, not only the efficiency of CPR training management is greatly improved, but also the training effect of participants is significantly elevated.