BACKGROUND:Cervical rotation-traction manipulation is effective and safe in the treatment of cervical spondylotic radiculopathy,and has been widely used in clinical work.However,its effects on the biomechanics of cervical vertebra and intervertebral disc and the area of intervertebral foramen have not been systematically clarified. OBJECTIVE:Based on the finite element analysis technique,a relevant research and analysis were carried out to provide digital evidence for the mechanism of effect of cervical rotation-traction manipulation in the treatment of cervical spondylotic radiculopathy. METHODS:The CT image data of a volunteer with no neck diseases were selected as the finite element model material at its left-handed physiological limit position.The initial construction of the finite element model was completed by Mimics 19.0 software,Geomagic Studio 2013 software,Hypermash 14.0 software,and ANSYS Workbench 2020 R2 software,respectively.Based on the literature,the grid division of cervical structure and the assignment of elastic modulus and elastic coefficient were completed.Based on the previous work of the team,the mechanical effects of cervical rotation-traction manipulation were simulated on the model.Effects of cervical rotation-traction manipulation on the mechanical parameters of each vertebral body and intervertebral disc in C3-T1 segment and on the cervical lateral foramen area were analyzed. RESULTS AND CONCLUSION:(1)During cervical rotation-traction manipulation,the stress of bone structure was significantly higher than that of soft tissue such as intervertebral disc.(2)When operating the technique,the stress at the top of each cervical vertebra was higher,the stress at the bottom was lower,and the stress at the facet joint and transverse process was lower.The stress at the top of the intervertebral disc was lower,the stress at the bottom was higher,but the highest point of the intervertebral disc stress was outside the top.(3)In addition,after loading the lifting force,the projected area of the C6/C7 intervertebral foramen increased significantly compared with that before loading.(4)It is indicated that the cervical rotation-traction manipulation has the mechanical characteristics of changing the stress structure of the cervical spine itself,and can expand the C6/7 intervertebral cervical foramen area on the opposite side of the patient's cervical rotation,so as to achieve the purpose of treating cervical spondylotic radiculopathy.

AIM:To investigate the effect of vaccarin(VAC)on endothelial dysfunction in type 2 diabetes mellitus(T2DM),and to uncover the underlying mechanisms.METHODS:(1)C57BL/6 mice received intraperitoneal injection of streptozotocin and were fed with a high-fat diet(21.8 kJ/kg,60%of the energy source was fat)to construct a T2DM mouse model.Thirty mice were randomly divided into control,T2DM and T2DM+VAC groups,with 10 mice in each group.The mice in T2DM+VAC group were given 1 mg/kg VAC via oral gavage for 6 weeks,while those in control and T2DM groups were given the same volume of PBS.The mRNA and protein expression levels of BCL2-interacting pro-tein 3(BNIP3),PTEN-induced kinase 1(PINK1)and parkin in the thoracic aorta were detected by RT-qPCR and West-ern blot.(2)Human umbilical vein endothelial cells(HUVECs)were stimulated by high glucose(HG;35 mmol/L glu-cose).Mitochondrial membrane potential,autophagy and mitochondrial superoxide levels were detected using JC-1,acri-dine orange(AO)and MitoSOX staining,respectively.RESULTS:Compared with control group,the mRNA and protein levels of BNIP3,PINK1 and parkin were significantly increased in the thoracic aorta of T2DM mice(P<0.05).Compared with T2DM group,the mRNA and protein levels of BNIP3,PINK1 and parkin in the thoracic aorta were significantly re-duced in T2DM+VAC group(P<0.05).The results of JC-1,AO and MitoSOX staining showed that VAC attenuated the decrease in mitochondrial membrane potential and the increase in autophagy and mitochondrial superoxide levels in HG-in-duced HUVECs.Treatment with VAC also inhibited HG-mediated mitochondrial damage in HUVECs after BNIP3 overex-pression.The effect of miR-570-3p mimic on mitochondrial damage was similar to VAC.RT-qPCR and Western blot showed that both miR-570-3p mimic and VAC significantly reduced the mRNA and protein levels of BNIP3,PINK1 and parkin.In contrast,inhibition of miR-570-3p exhibited the opposite effects.CONCLUSION:Treatment with VAC alle-viated endothelial dysfunction in T2DM by inhibiting HG-induced mitochondrial dysfunction through miR-570-3p/BNIP3.

Objective To explore the risk factors and countermeasures of the perfusionist-related near-miss event (NME) in cardiopulmonary bypass (CPB). Methods The clinical data of the patients who underwent cardiac surgery in the Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University from March 2020 to July 2021 were retrospectively analyzed. According to whether NME occurred during the operation, the patients were divided into an NME group and a non-NME group. The clinical data of the two groups were compared, and the risk factors for NME were analyzed. Results A total of 702 patients were enrolled, including 424 males and 278 females with a median age of 56.0 years. There were 125 patients in the NME group and 577 patients in the non-NME group. The occurrence rate of NME was 17.81%. Univariate analysis showed that there were statistical differences between the two groups in the gender, body surface area, CPB time, European system for cardiac operative risk evaluation score, emergency surgery, type of surgery, night CPB initiation, modified ultrafiltration use, multi-device control, average operation time, et al. (all P<0.05). The above variables were dimensionality reduction processed by least absolute shrinkage and selection operator regression, and the λ of minimum mean square error of 10-fold cross validation was 0.014. The variables of the corresponding model were selected as follows: multi-device control, night CPB initiation, minimum hematocrit, modified ultrafiltration use, CPB time. The results of multivariate logistic regression showed that night CPB initiation [OR=9.658, 95%CI (4.735. 19.701), P<0.01] and CPB time [OR=1.003, 95%CI (1.001, 1.006), P=0.014] were independent risk factors for NME. Conclusion Night CPB initiation and CPB time are independent risk factors for NME during CPB, which should be recognized and early warned in clinical work.

Acute kidney injury(AKI)remains a global public health problem with high incidence,high mortality rates,expensive medical costs,and limited treatment options.AKI can further progress to chronic kidney disease(CKD)and eventually end-stage renal disease(ESRD).Previous studies have shown that trauma,adverse drug reactions,surgery,and other factors are closely associated with AKI.With further in-depth exploration,the role of gut microbiota in AKI is gradually revealed.After AKI occurs,there are changes in the composition of gut microbiota,leading to disruption of the intestinal barrier,intestinal immune response,and bacterial translocation.Meanwhile,metabolites of gut microbiota can exacerbate the progression of AKI.Therefore,elucidating the specific mechanisms by which gut microbiota is involved in the occurrence and development of AKI can provide new insights from the perspective of intestinal microbiota for the prevention and treatment of AKI.

With the widespread use of CT scan in lung cancer screening,in clinical practice the detection rate of pulmonary ground-glass nodule(GGN),especially multiple GGNs,has become higher and higher.So far,the guidelines for the treatment of multiple pulmonary nodules mainly focus on the high-risk nodules,while there is no uniform guideline for the management of multiple high-risk GGNs.The main treatment strategies for GGNs include follow-up check and surgical resection.However,for patients who are unable to undergo or refuse to receive surgery,non-surgical therapies such as stereotactic body radiation therapy(SBRT),interventional ablation(such as radiofrequency ablation,micro wave ablation,cryoablation,etc.)can be considered.This article reviews the clinical management strategies and therapeutic evaluation of multiple pulmonary nodules,aiming to provide reference for the clinical management of multiple pulmonary nodules.

Objective: To explore the association between parental education level and time spent outdoors among children, so as to provide the scientific evidence for formulating policies of myopia prevention and control among children. Methods: The study was based on secondary analysis of data from outdoor intervention studies in Shanghai. The follow up period was from March to December 2018. It included control group children ( n =1 117) with complete questionnaire surveys, ocular examinations, and time spent outdoors. Generalized linear regression models and trend tests were used to analyze the effect of parental education level on time spent outdoors among children. Results: The median time spent outdoors was 76.4(59.7, 94.6) minutes. After adjusting for covariates including children s sex and age, generalized linear regression model suggested that there was no statistical significance between father s education level and outdoor activity time ( P >0.05). Compared with children whose mothers had a junior high school education or below, children whose mothers had high school/vocational high school education, college or above had shorter time spent outdoors ( β=-6.64, -8.84 , P <0.05). Trend tests revealed that time spent outdoors among children decreased with the increase of parental education level ( P trend <0.01). Conclusions The higher the education level of fathers or mothers, the shorter time spent outdoors of children. In addition to highlight outdoor activities at school, myopia prevention and control efforts should be focused on the role of parents in increasing children s outdoor activities.

Objective:Based on single-center clinical results of endovascular recanalization for symptomatic non-acute internal carotid artery occlusion (ICAO), a new patient classification method is proposed to distinguish the most suitable ICAO patient subgroups for endovascular recanalization.Methods:A total of 140 patients with symptomatic non-acute ICAO accepted endovascular recanalization in Department of Cerebrovascular Intervention, He'nan Provincial People's Hospital from January 2019 to December 2021 were selected. These patients were divided into low risk group ( n=57), medium risk group ( n=54) and high risk group ( n=29) according to the occlusion segments, occlusion times, plaque features, calcification at the occlusion site and occlusion segment angulation. The immediate postoperative recanalization rate, perioperative complications, perioperative death, and prognoses 90 d after endovascular recanalization (modified Rankin scale scores of 0-2 as good prognosis) were evaluated in the 3 groups. Results:The immediate postoperative recanalization rate was 82.9% (114/140), perioperative complication rate was 11.4% (16/140), and perioperative mortality was 0.7% (1/140). The success recanalization rate decreased gradually from the low risk group to the high risk group (100%, 85.2%, and 37.9%), while the perioperative complication rate was the opposite (0%, 11.1%, and 34.5%), with significant differences ( P<0.05). Ninety d after endovascular recanalization, 109 patients had good prognosis and 27 had poor prognosis; the good prognosis rate in low risk group, medium risk group and high risk group was 98.2%, 79.6% and 34.5%, respectively, with significant differences ( P<0.05). The vascular restenosis rate in low risk group, medium risk group and high risk group was 0%, 8.7% and 18.2%, and re-occlusion rate was 0%, 6.5% and 27.2%, respectively, 90 d after endovascular recanalization, with significant differences ( P<0.05). Conclusion:Endovascular recanalization is technically feasible for patients with symptomatic non-acute ICAO, especially those met the criterions of low and medium risk groups in our study.

Objective:To evaluate the safety and efficacy of endovascular interventional treatment of the intracranial vertebrobasilar trunk large aneurysms (VBTLAs) compared with conservative treatment.Methods:This is a prospective multi-center cohort study. From October 2012 to October 2018, a total of 69 patients with intracranial vertebrobasilar trunk large aneurysm (diameter>10 mm) from Henan Province People's Hospital and People's Liberation Army Rocket Medical Center were included in this study. Patients themselves chose either endovascular interventional therapy (interventional group) or conservative treatment (conservative group) after discussion with their doctors. The χ 2 test was used to compare the incidence of deaths, stroke, and all other serious adverse events including other site bleeding, myocardial infarction and others between the two groups. Results:A total of 69 patients were enrolled, of whom 51 patients were enrolled in interventional group, 18 patients underwent endovascular reconstructive therapy, 11 patients underwent deconstructive therapy, and 4 patients underwent conjunction interventional treatments. Eighteen patients were enrolled in conservative group, of whom 11 cases received simple risk factor control, 7 cases received antiplatelet and risk factors control. The proportions of hypertensive patients 94.4% (17/18) and giant aneurysms 50.0% (9/18) in the conservative group were higher than those in the surgery group 64.7% (33/51, χ 2=4.500, P=0.034), 19.6% (10/51, χ 2=4.730, P= 0.030).The incidence of all serious adverse events associated with protocol was 15.7% (8/51) in the interventional group and 44.4% (8/18) in the conservative group [risk ratio (RR) =0.353, 95% confidence intervals (CI): 0.156-0.801], and the difference was significant (χ 2=4.668, P=0.031). The incidence of fatal events associated with protocol was 2.0% (1/51) in the interventional group and 38.9% (7/18) in the conservative group (RR=0.050, 95%CI: 0.007-0.382), and the difference was significant (χ 2=14.281, P<0.001). The incidence of hemorrhage events associated with protocol was 2.0% (1/51) in the interventional group and 22.2% (4/18) in the conservative group (RR=0.088, 95%CI: 0.011-0.738), and the difference was significant (χ 2 =5.391, P=0.020). Follow-up imaging showed that the occlusion rate of aneurysms in 44 patients in the interventional group was 56.8% (25/44) after a median follow-up of 6 months. Imaging follow-up was obtained in 9 patients, whose occlusion rate of aneurysms was 0 and the median follow-up time was 12 months, in the conservative group. The difference was significant(χ 2 =7.534, P=0.006). Conclusion:Compared with conservative treatment, endovascular intervention of the intracranial VBTLAs has lower incidences of serious adverse events and death events.

Objective? To analyze the root causes of fall in elderly patients, explore the corresponding countermeasures and combine the balance function and knee joint strengthening training to reduce the incidence of fall in elderly patients. Methods? First, the cause of fall of the patients in the department of rehabilitation from November 2014 to October 2016 were analyzed with the method of root cause analysis and retrospective analysis, and targeted corrective measures were formulated. The elderly patients fell between the time period from November of 2016 to October of 2017 and November of 2017 to October of 2018 were enrolled into the control group and observation group by convenience sampling. Corrective measures were formulated based on root cause analysis and action (RCA2) to prevent falls in the control group, on the basis of that balance function training combined with strengthening training of knee joint control were adopted to prevent fall in the observation group. The two groups were compared in terms of the differences in the incidence of fall, five times of sitting and standing test(FTSST), 10 meters maximum walking speed (10MWS), Berg Balance Scale(BBS)and Tinetti Gait Analysis (TGA). The incidence of fall in the department before the implementation of corrective measures based on RCA2(November 2014 to October 2016) and the time period of November 2016 to October 2018 which is after the implementation of RCA2 based corrective measures were compared. Results? After implementing the corrective measures, the fall rate of the elderly patients reduced from 2.0% to 0.9% with statistical difference (χ2=4.343, P=0.037). There was statistical difference (χ2=3.899, P=0.048) in terms of the incidence of fall between the observation group (4.24%) and the control group (0.64%). Before intervention, the two groups had no statistical difference in the FTSST, 10MWS, BBS and TGA(P＞0.05). In the control group, there was no statistical difference before and after intervention (P＞ 0.05); in the observation group, there was statistical difference before and after intervention (P＜0.05). After intervention, the observation group was better than the control group in the FTSST, 10MWS, BBS and TGA with statistical difference (P＜0.05). Conclusions? The comprehensive use of root cause analysis and intensive training of knee joint control and balance function training to manage elderly patients scientifically can effectively reduce the incidence of falls.

ObjectiveTo investigate the acceptance and influencing factors of manual hyperinflation (MIH) in patients with open sputum suction after tracheotomy, so as to provide reference for improving the acceptance of MIH for patients. MethodsBy convenience sampling, 140 patients with tracheotomy on open suction in Affiliated Hangzhou First People＇s Hospital, Zhejiang University School of Medicine from October 2016 to September 2018 were selected as participants in the study and the Self-Designed Questionnaire was used to study the acceptance towards MIH of the patients. Univariate analysis and Logistics regression analysis were conducted to analyze the influencing factors of the acceptance of patients on MIH. A total of 140 questionnaires were distributed, and 134 valid ones were collected. ResultsUnivariate analysis showed that there were statistical difference in age, gender, family support, duration of tracheotomy, whether the medical staff had explained the relevant knowledge of MIH, and whether the patients had experienced MIH on patients＇acceptance of MIH (P＜ 0.05). The above 6 statistically significant factors were analyzed by multivariate Logistic regression and the results showed that age, gender, duration of tracheotomy, whether the patients had experienced MIH before were the influencing factors of the patients＇ acceptance on MIH(P＜ 0.05). ConclusionsAge, gender, duration of tracheotomy, whether or not the patents have experienced MIH are independent impact factors for the patients＇ acceptance of MIH and the above factors can be the cut-in points of explanation and education in the process of MIH,so as to improve the patients＇ acceptance of MIH and promote recovery.