Objective:To investigate the efficacy and safety of combined catheter-directed thrombolysis and anticoagulation for acute pulmonary embolism combined with lower limb deep vein thrombosis.Methods:A retrospective analysis was conducted using a case-control study approach on the clinical data of 58 patients with acute pulmonary embolism who received treatment at the Inner Mongolia Autonomous Region People's Hospital from August 2021 to August 2023. These patients were categorized into two groups based on whether they had lower-limb deep vein thrombosis or not. The group with pulmonary embolism alone ( n = 14) underwent targeted catheter thrombolysis in combination with anticoagulation treatment using low molecular-weight heparin. The group with both pulmonary embolism and deep vein thrombosis in the lower limbs (combined group, n = 44) received inferior vena cava filter placement, along with targeted catheter thrombolysis and anticoagulation treatment with low-molecular weight heparin. The improvement in pulmonary circulation was observed before and after the surgical interventions in both groups. A comparison was made regarding the improvement in indicators including arterial oxygen pressure, fingertip oxygen saturation, the proportion of pulmonary artery trunk thrombosis area to pulmonary artery trunk area, and respiratory rate, both before and after pulmonary artery catheterization and thrombolysis in both groups. Results:The surgery was successful for all patients. The symptom of shortness of breath was obviously relieved after surgery. After surgery, in the pulmonary embolism alone group, the respiratory rate was (22.75 ± 4.38) beats/min, the mean pulmonary artery pressure was (32.53 ± 3.63) mmHg (1 mmHg = 0.133 kPa), the arterial oxygen partial pressure was (81.46 ± 7.24) mmHg, and the fingertip oxygen saturation was (90.53 ± 4.57)%, respectively. In the combined group, the respiratory rate, mean pulmonary artery pressure, arterial oxygen partial pressure, and fingertip oxygen saturation were (23.35 ± 5.8) beats/min, (31.34 ± 4.53) mmHg, (82.34 ± 4.62) mmHg, and (92.57 ± 3.45)%, respectively. After surgery, the respiratory rate, pulmonary artery pressure, arterial oxygen partial pressure, and fingertip oxygen saturation in each group were significantly higher compared with the corresponding levels before surgery ( t = 6.33, 12.12, 17.32, 8.13, 6.86, 13.02, 15.52, 7.20, all P < 0.001). The proportion of pulmonary artery trunk thrombosis area to pulmonary artery trunk area in the group with pulmonary embolism alone was (19.56 ± 7.53)%, while in the combined group, it was (20.63 ± 4.83)%. After surgery, the proportion of pulmonary artery trunk thrombosis area to pulmonary artery trunk area in each group decreased compared with the corresponding value before surgery ( t = 19.36, 18.23, both P < 0.001). Conclusion:The surgical method combining catheter-directed thrombolysis with inferior vena cava filter placement is effective and safe for the treatment of acute pulmonary embolism combined with deep vein thrombosis in the lower limbs.

120 extracted maxillary first premolars were endodontically treated and randomly divided into 5 groups(n=24).The teeth in group A had 4 walls of coronal tooth structure,in group B,C,D and E had only 3 walls,missing the palatal,buccal,mesial and distal wall,respectively.The teeth in group A0-E0(n=6)were restored without post,in group A1-E1(n=6)with buccal post,in group A2-E2(n=6)with palatal post,in group A3-E3(n=6)with buccal and palatal post,respectively.The fracture resistance of group A was higher than that of B,C,D and E groups(P＜0.05).The fracture resistance of fiber posts placed in the buccal root canal was higher than that in the palatal root canal(P＜0.05).The 360° complete ferrule can provide the best fracture resistance,When the ferrule is not complete,it is recommended to place buccal fiber post for repair.

Objective:This paper introduces the concepts of " patient-centered cell therapy research management model", to provide reference for domestic medical institutions which conduct cell therapy clinical trials.Methods:We reviewed and summarized the experiences of conducting cell therapy at Peking University Shenzhen Hospital, including challenges and response plans regarding to the technology assessment, ethical evaluation risks and regulatory compliance. According to which, this paper aims to explore the reflections and practical experience of establishing a patient-centered, multi-stakeholder shared decision-making research management system.Results:The " patient-centered cell therapy research management model" ensures the reliability of research results through multi-stakeholder engagement in decision-making and management, adequate technical evaluation, effective ethical review and harmonized scientific research management, which not only meets the urgent health needs of the patient, but also promotes the standardized development of emerging technologies.Conclusions:The " patient-centered cell therapy research management model" is tailored for the cell therapy research, it is important to promote its further assessment and applications.

Neuropathic pain is a clinical symptom with complex mechanisms and high incidence. The commonly used analgesics have limited efficacy and can cause serious side effects. The theory of chronic pain entering collaterals was proposed by YE Tianshi， a famous physician focusing on warm diseases in the Qing dynasty， on the basis of the ancient therapies for pain. This theory is particularly suitable for the diagnosis and treatment of neuropathic pain in view of the clinical course and manifestations. The chronic neuropathic pain can enter the Yin collateral in deeper sites. The pathogenesis of neuropathic pain is summarized as a deficiency in origin and excess in superficiality. The root cause is the dysfunction of Zang-Fu organs， mainly the liver, kidney and heart， while the superficial causes are phlegm and stasis caused by the obstructed Qi and blood movement due to the consumption of Qi and blood in collaterals. Accordingly， the therapies such as dispelling blood stasis， resolving phlegm， and dredging collaterals should be adopted. This paper expounds the traditional Chinese medicine （TCM） pathogenesis and treatment of neuropathic pain， enriching the knowledge and providing new ideas for the TCM prevention and treatment of this disease as a collateral disease.

Objective:To explore the value and risk of electronic bronchoscope applied in perioperative management of children with congential tracheoesophageal fistula.Methods:Sixty-five children with congential tracheoesophageal fistula performed electronic bronchoscope examination from September 2014 to November 2020 were enrolled in this study.The results of examination and complications were analyzed.Results:Sixty-three children with congenital tracheoesophageal fistula were diagnosed by electronic bronchoscopy.The diagnosis rate was 96.92%.Fifty-four children with congenital tracheoesophageal fistula were diagnosed by esophagography.The diagnosis rate was 91.53%.Sixty-one children with congenital tracheoesophageal fistula were diagnosed by multislice spiral computed tomography.The diagnosis rate was 93.85%.Airway anatomic abnormity was found in 27 children, including three cases of nasopharyngeal soft tissue collapse, 14 cases of laryngomalacia, five cases of tracheal stenosis, nine cases of tracheobronchomalacia, and nine cases of tracheobronchial and abnormal opening of the bronchus.The incidence was 41.54%.Three children with difficult ventilator weaning were related to tracheobronchial stenosis or tracheobronchomalacia.They were gradually weaning from ventilator after a long period of mechanical ventilation and treatment.Two children with transient decrease in oxygen saturation were noticed as complication.Conclusion:Electronic bronchoscopy is a safe and effective method for the diagnosis of congenital tracheoesophageal fistula and recurrence after operation.It is of great value to the airway management after operation by early detection of respiratory anatomic abnormity.

Objective:To investigate the clinical manifestations and characteristics of tracheobronchial foreign bodies in children, and improve the diagnosis and treatment of foreign bodies.Methods:A retrospective analysis was performed on the clinical data of children with tracheobronchial foreign bodies confirmed by fiberoptic bronchoscopy between January 2010 to December 2019.The children with tracheobronchial foreign body who were treated in the Maternal and Child Health Hospital of Gansu Province.Results:A total of 967 cases were operated by soft electronic bronchoscope, and foreign bodies were removed by means of foreign body forceps or nets.Among them, 19 cases(3 cases with subglottic foreign bodies, one with row of pins, and the rest 15 cases with foreign bodies completely wrapped by granulation)were not removed, two cases were spontaneously coughed, and 946 cases (97.8%)were removed.Bronchial foreign bodies in children were more common in boys, with the ratio of male to female being 2.14∶1.The main age of onset was 1-3 years old(88.8%). The incidence was slightly higher in rural areas than that in urban areas(46.5% in urban areas, 53.5% in rural areas). Foreign bodies were inhaled most in March and least in June.From the perspective of season, winter and spring were more than summer and autumn.The foreign body types inhaled were mainly exogenous plant foreign body, accounting for 93.0%, among which peanut(31.7%)and melon seeds(19.2%)were the most common.The duration of foreign body inhalation was up to 347 cases(35.9%)in 1-3 days.There were 501 cases(51.8%)with endoscopic endobronchial inflammation, and 196 cases of children with varying degrees of granulomatous hyperplasia, accounting for 39.1% and 20.3% of the total.The foreign body in the right bronchus accounted for 50.0% and the left bronchus for 43.7%.There were 793 cases confirmed by imaging, with a positive rate of 81.9%, and 90.9% confirmed by CT.Conclusion:About 88.8% of tracheobronchial foreign bodies occurred in 1 to 3 years of age.The occurrence of foreign bodies had obvious gender, urban-rural and seasonal distribution characteristics, and more cases were male, in rural and winter as well as spring.

Objective:To explore the risk factors influencing the prognosis for patients with hepatocellular carcinoma (HCC) recurrence after liver transplantation and summarize the relevant diagnostic and therapeutic experiences.Methods:The clinicopathological features with diagnosis and treatment plan of 102 recurrent HCC patients fulfilling the Fudan Criteria were compared for survival rate (univariate analysis) and independent prognostic indicators were obtained by Cox multivariate analysis.Results:The 1/3/5-year overall survival rates were 92.2%, 48.6% and 34.6% and the 1/3/5-year survival rates with tumor were 63.2%, 31.0% and 16.7% respectively. Cox regression analysis indicated that patient age, whether tumor can be surgically resected or not and personalized diagnostic & therapeutic plan based upon targeted therapy were independent prognostic factors affecting the overall survival rates and survival rates with tumor.Conclusions:Although HCC recurrence and metastasis after liver transplantation seriously influence patient prognosis, satisfactory outcomes may be obtained for some patients through active, effective and precise managements.

Objective:To analyze the results of polysomnography(PSG) in 523 children, and explore the sleep monitoring results and related influencing factors of obstructive sleep apnea hypopnea syndrome(OSAHS).Methods:The PSG monitoring results of children with OSAHS and non-OSAHS were analyzed for children aging from 0 to 16 years old, who were monitored at Sleep Medicine Center of Gansu Maternal and Child Health Hospital from January 2014 to December 2019.Results:A total of 523 children underwent PSG monitoring during the past 5 years.The male to female ratio was 1∶0.47, of which 66.9%(350/523)were children with OSAHS.The average proportion of rapid eye movement sleep was 1.95%(7.7/394). The height of non-OSAHS group was significantly higher than that of OSAHS group[(108.72±16.39)cm vs.(104.80±16.60)cm, P=0.016]. The incidence of OSAHS decreased with age( P=0.038). The apnea index, hypopnea index, apnea hypopnea index, obstructive apnea index, microarousal index, oxygen desaturation index, mean apnea time, and longest apnea time in the OSAHS group were higher than those in the non-OSAHS group( P<0.05). And the lowest oxygen saturation and the mean oxygen saturation during sleep were lower than those in the non-OSAHS group( P<0.05). Logistic regression analysis on the clinical data of OSAHS children showed that open mouth breathing and snoring at night had significant effects on children′s OSAHS, and the differences were statistically significant( P<0.05). Conclusion:PSG is of great significance for the diagnosis of OSAHS.The more severe the degree of OSAHS, the worse severe the night sleep hypoxemia.PSG should be recommended before taking any treatment for children with sleep disorders.

Objective:To investigate the normal range of exhaled nitric oxide (FeNO) in 6-18-year-old children in China, so as to provide a data base for the establishment of FeNO standards for Chinese children.Methods:A multi-center study was conducted on 5 949 children aged 6-18 (3 101 males and 2 848 females) in 16 pro-vinces of 7 administrative districts in China.According to the technical standard recommended by American Thoracic Society/European Respiratory Association, FeNO was measured, and the relationship of FeNO with the sex, age, height, weight, body mass index and region was discussed.Results:The geometric mean FeNO value of Chinese children aged 6-18 was 14.1 ppb, and its 95% confidence interval (skewness distribution) was 1.0-38.2 ppb.The geometric mean FeNO values of children aged 6-11 and 12-18 were 13.1 ppb and 15.7 ppb, respectively, and their 95% confidence intervals (skewness distribution) were 1.0-38.1 ppb and 2.0-38.2 ppb.For children at and under 11 years old, FeNO decreased with age, with a mean decline of 1 ppb per year.The multiple linear regression results suggested that there was a significant correlation between FeNO and age for children aged 6-11, and FeNO of children aged 12-18 was significantly correlated with the gender, height, and region(all P<0.01). Conclusions:FeNO values of Chinese children and adolescents in this study are higher than those obtained by the previous study conducted from 2010 to 2012.For children aged 12-18, 16 ppb is recommended as the clinical cut-off point.For children at or under 11 years old, the influence of age on FeNO should be considered, and the cut-off point of FeNO decreases by 1 ppb as the age is reduced by one year.

Objective:To study the effects of different doses of atorvastatin combined with valsartan on blood pressure variability (BPV) and circadian rhythm in patients with hypertension.Methods:Eighty patients with grade 2 and grade 3 hypertension from March 2018 to March 2019 in Hefei First People′s Hospital were divided into low-dose group (20 mg/d atorvastatin combined with valsartan) and high-dose group (40 mg/d atorvastatin combined with valsartan) according to the random number table method. The efficacy after 8 weeks of treatment was compared between the two groups. The BPV, circadian rhythm, vascular endothelial factors [nitric oxide (NO), endothelin (ET)], serum disease-related factors [human cartilage glycoprotein (YKL-40), soluble intercellular adhesion molecule-1(sICAM-1), folate] and blood lipids [total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C)] were recorded before treatment and 8 weeks after treatment, and the occurrence of adverse reactions during medicine was counted in the two group.Results:After 8 weeks of treatment, the total effective rate was 97.50%(39/40) in low-dose group and was 92.50%(37/40) in high-dose group, and there was no significant difference in the total effective rate between the two groups ( P>0.05). After 8 weeks of treatment, the 24 h SBPV, daytime SBPV, nighttime SBPV, 24 h DBPV, daytime DBPV and circadian rhythm in the two groups were significantly decreased compared with those before treatment, and the 24 h SBPV, daytime SBPV, daytime DBPV and circadian rhythm in high-dose group were significantly lower than those in low-dose group: (9.53 ± 1.73)% vs. (10.89 ± 1.98)%, (9.14 ± 1.90)% vs. (10.33 ± 2.07)%, (11.56 ± 2.78)% vs. (13.06 ± 3.16)%, (4.78 ± 1.56)% vs. (5.70 ± 1.81)%( P<0.05). After 8 weeks of treatment, the levels of NO, folate and HDL-C in the two groups were significantly increased compared with those before treatment, and the levels with in high-dose group were significantly higher than those in low-dose group: (67.16 ± 13.14) μmol/L vs.(60.53 ± 12.50) μmol/L, (14.94 ± 2.07) mmol/L vs.(13.83 ± 2.28) mmol/L, (1.42 ± 0.15) mmol/L vs. (1.31 ± 0.18)mmol/L ( P<0.05). The levels of ET, YKL-40, sICAM-1, TC, TG and LDL-C in the two groups were significantly decreased compared with those before treatment, and the levels in high-dose group were significantly lower than those in low-dose group: (33.63 ± 5.15) ng/L vs. (37.44 ± 5.13) ng/L, (32.68 ± 6.16) μg/L vs. (36.94 ± 6.03) μg/L, (203.78 ± 41.19) ng/L vs. (249.93 ± 50.81) ng/L, (6.78 ± 1.03) mmol/L vs. (7.38 ± 1.30) mmol/L, (2.88 ± 0.61) mmol/L vs. (3.39 ± 0.85) mmol/L, (3.14 ± 1.05) mmol/L vs. (3.85 ± 1.44) mmol/L ( P<0.05). Conclusions:Different doses of atorvastatin combined with valsartan are effective in the treatment of hypertension, but high dose of atorvastatin combined with valsartan has better effects on blood pressure variability and circadian rhythm, and can effectively improve vascular endothelial function.