Objective To investigate the impact of red blood cell suspension infusion across various perioperative periods on patients with valvular heart disease. Methods The patients with valvular heart disease admitted to Tianjin Chest Hospital from 2018 to 2020 were selected. Based on the timing of perioperative red cell suspension infusion, patients were categorized into three groups: a group 1 receiving intraoperative red cell suspension infusion, a group 2 receiving red cell suspension infusion within 24 hours after entering the ICU, and a group 3 receiving red cell suspension infusion at both time points. The laboratory results, perioperative blood component infusion volume, and other relevant parameters were retrospectively analyzed. After propensity score matching, the differences in different variables among the three groups were compared. Results After propensity score matching, 102 patients were enrolled, including 52 males and 50 females, with an average age of (61.74±10.58) years. There were 34 patients in each group. The preoperative hemoglobin (Hb) value of the group 2 was significantly higher than that of the group 1 and the group 3, and the amount of red cell suspension and autoblood transfusion was the lowest (P<0.05). Group 1 had the highest postoperative Hb, as well as the highest Hb and hematocrit (HCT) levels within 24 hours post-surgery (P<0.05). The group 1 had the lowest plasma, platelet and cryoprecipitate infusion volumes, and the shortest cardiopulmonary bypass time, aortic occlusion time, postoperative ICU stay and hospital stay, and the least blood loss and total drainage volume (P<0.05). The difference between postoperative and preoperative Hb (△Hb1) was highest in group 1 (P<0.05). Conclusion For patients with valvular heart disease, intraoperative-only infusion of red blood cell suspension is associated with a better prognosis at discharge and during follow-up.

Objective: To evaluate the efficacy of the left spermatic vein transposition to the great saphenous vein in treating left varicocele (VC) secondary to nutcracker syndrome (NCS). Methods: Clinical data of 8 patients treated during Feb.2020 and Feb.2023 in our hospital were retrospectively analyzed.A meticulous preoperative evaluation of the vascular status of the spermatic vein and the great saphenous vein was performed using color Doppler ultrasound.A spermatic vein-great saphenous vein shunt surgery was performed in patients who were strictly selected.The clinical symptoms and hemodynamics of renal vein were compared before and after operation. Results: The median age of patients was 23.5(18-33) years.There was a notable reduction in post-exercise scrotal and lower back pain in all patients，and the score of scrotal pain decreased to 0 in 7 patients. The median quantification of urinary protein was 352.8(54.4-687.3) mg prior to surgical intervention，which significantly diminished to 125.5(25.9-255.1) mg 6 months after operation.Notably，3 cases of preoperative positive urine occult blood tests were undetectable in the subsequent postoperative assessments.The median peak blood flow velocity at the site of stenosis in the left renal vein measured at 74.4(48.7-117.6) cm/s preoperatively，subsequently reduced to 45.1(25.5-61.2) cm/s postoperatively.During the 6-month follow-up，no recurrence of varicocele，vascular anastomotic stenosis or thrombosis were observed. Conclusion: Our research indicates that spermatic vein to great saphenous vein bypass is safe and feasible in the treatment of left varicocele secondary to nutcracker syndrome for strictly selected patients，which can effectively alleviate renal vein congestion without significant complications.

BACKGROUND:Compensatory changes in sagittal parameters of the cervicothoracic spine after orthopedic surgery in patients with lumbar degenerative scoliosis and their intrinsic relationship,as well as the impact of these changes on quality of life,are still lacking.OBJECTIVE:To evaluate the compensatory alignment of cervical and thoracic vertebrae after correction of lumbar degenerative scoliosis.METHODS:103 patients who underwent surgical correction of lumbar degenerative scoliosis were included in this study.Patients'demographic characteristics and spinal sagittal parameters were assessed,and prediction equations between changes in cervical sagittal parameters and lumbar deformity correction were attempted.Simultaneously,the SRS-22 scale was used to assess the quality of life of patients and to explore the relationship between the compensatory changes of the cervical and thoracic spine after correction and the patients'health-related quality of life.RESULTS AND CONCLUSION:(1)At 3 months and 2 years after surgery,all indicators of the cervical spine and thoracic spine were significantly improved compared with those before surgery(P＜0.05),but there was no significant change at 3 months after surgery compared with 2 years after surgery(P＞0.05).At 3 months and 2 years after surgery,the lumbar spine parameters including lumbar lordosis,C7-S1 sagittal vertical axis,and pelvic incident-lumbar lordosis had significant changes compared with those before surgery(P＜0.05),but the change was not significant at 3 months after surgery compared with 2 years after surgery(P＞0.05).(2)Correlation analysis showed that the lumbar lordosis was highly correlated with the C3-C7 cervical lordosis,C1-C7 cervical lordosis,C2-7 sagittal vertical axis,thoracic inlet angle,and C7-S1 sagittal vertical axis(|r|≥ 0.5,P＜0.000 1).The lumbar lordosis was correlated with the thoracic kyphosis(r=-0.280).(3)Two prediction formulas were established for compensatory changes in cervical spine:cervical lordosis=0.524x,lumbar lordosis=-6.612,C2-7 sagittal vertical axis=-0.263x,and lumbar lordosis=-5.436(P＜0.05,R2＞0.6).(4)When postoperative C2-7 sagittal vertical axis was between 14.4 and 26.8 mm;cervical lordosis was between 9° and 41°,lumbar lordosis was between 42.7° and 68.7°,and sagittal vertical axis was between-40 and 40 mm,patients had better quality of life recovery.(5)It is indicated that significant compensatory changes in the sagittal plane of the cervical spine can be observed after correction of lumbar degenerative scoliosis.We found that each 1° increase in lumbar lordosis was associated with a corresponding increase of about 0.5° in cervical lordosis and a corresponding decrease of about 0.3 mm in the vertical axis of the C2-7 sagittal plane.Patient satisfaction was higher if compensatory changes were closer to normal sagittal plane.

BACKGROUND:Compensatory changes in sagittal parameters of the cervicothoracic spine after orthopedic surgery in patients with lumbar degenerative scoliosis and their intrinsic relationship,as well as the impact of these changes on quality of life,are still lacking.OBJECTIVE:To evaluate the compensatory alignment of cervical and thoracic vertebrae after correction of lumbar degenerative scoliosis.METHODS:103 patients who underwent surgical correction of lumbar degenerative scoliosis were included in this study.Patients'demographic characteristics and spinal sagittal parameters were assessed,and prediction equations between changes in cervical sagittal parameters and lumbar deformity correction were attempted.Simultaneously,the SRS-22 scale was used to assess the quality of life of patients and to explore the relationship between the compensatory changes of the cervical and thoracic spine after correction and the patients'health-related quality of life.RESULTS AND CONCLUSION:(1)At 3 months and 2 years after surgery,all indicators of the cervical spine and thoracic spine were significantly improved compared with those before surgery(P＜0.05),but there was no significant change at 3 months after surgery compared with 2 years after surgery(P＞0.05).At 3 months and 2 years after surgery,the lumbar spine parameters including lumbar lordosis,C7-S1 sagittal vertical axis,and pelvic incident-lumbar lordosis had significant changes compared with those before surgery(P＜0.05),but the change was not significant at 3 months after surgery compared with 2 years after surgery(P＞0.05).(2)Correlation analysis showed that the lumbar lordosis was highly correlated with the C3-C7 cervical lordosis,C1-C7 cervical lordosis,C2-7 sagittal vertical axis,thoracic inlet angle,and C7-S1 sagittal vertical axis(|r|≥ 0.5,P＜0.000 1).The lumbar lordosis was correlated with the thoracic kyphosis(r=-0.280).(3)Two prediction formulas were established for compensatory changes in cervical spine:cervical lordosis=0.524x,lumbar lordosis=-6.612,C2-7 sagittal vertical axis=-0.263x,and lumbar lordosis=-5.436(P＜0.05,R2＞0.6).(4)When postoperative C2-7 sagittal vertical axis was between 14.4 and 26.8 mm;cervical lordosis was between 9° and 41°,lumbar lordosis was between 42.7° and 68.7°,and sagittal vertical axis was between-40 and 40 mm,patients had better quality of life recovery.(5)It is indicated that significant compensatory changes in the sagittal plane of the cervical spine can be observed after correction of lumbar degenerative scoliosis.We found that each 1° increase in lumbar lordosis was associated with a corresponding increase of about 0.5° in cervical lordosis and a corresponding decrease of about 0.3 mm in the vertical axis of the C2-7 sagittal plane.Patient satisfaction was higher if compensatory changes were closer to normal sagittal plane.

Objective:To investigate the hemodynamic changes in the ascending aorta (AAo) before and after interventricular septal myocardial resection in obstructive hypertrophic cardiomyopathy (HOCM) using cardiac magnetic resonance four-dimensional blood flow (CMR 4D Flow) technology.Methods:HOCM patients who underwent interventricular septal myocardial resection at Guangdong Provincial People′s Hospital from May 2021 to September 2022 were prospectively included. Age and gender matched healthy volunteers (control group) were included during the same period. Both the control group and HOCM patients underwent CMR examination (including cine sequence and 4D Flow sequence) before and 6 months after surgery. CMR 4D flow technology was used to evaluate changes in AAo preoperative and postoperative blood flow patterns (eddy currents, spiral flow), maximum energy loss (EL max), and average energy loss (EL avg). HOCM patients underwent laboratory tests, including N-terminal pro-brain natriuretic peptide (N-pro BNP) and high-sensitivity troponin T (hsTnT). At the same time, the correlation between postoperative energy loss in HOCM patients and the degree of improvement in laboratory biomarkers was explored. Results:A total of 15 HOCM patients and 15 healthy volunteers were included. (1) In terms of blood flow patterns, the preoperative spiral flow degree of HOCM patients was significantly higher than that of the control group ( P=0.001), but the postoperative difference was not statistically significant ( P=0.059). The degree of eddy currents in HOCM patients before and after surgery was higher than that in the control group (all P<0.05). (2) In terms of energy loss, the preoperative EL max [21.17(14.30-28.10)mW vs 10.17(7.66-13.07)mW, P<0.001] and EL avg [4.87(3.46-5.77)mW vs 2.27(2.19-2.27)mW, P=0.023] of HOCM patients were higher than those of the control group, but there was no statistically significant difference between the postoperative and control groups (all P>0.05). Compared with preoperative, the postoperative EL max [12.33(8.70-17.41)mW] and EL avg [3.10(2.25-4.40)mW] of AAo in HOCM patients were significantly reduced (mean P=0.001). (3) Correlation analysis showed that there was a positive correlation ( r=0.587, P=0.021) between the EL max of AAo and the degree of improvement in hsTNT after interventricular septum myocardial resection, but no significant correlation ( r=0.229, P=0.413) with the degree of improvement in NT-pro BNP. Conclusions:The degree of postoperative AAo blood flow disorder in HOCM patients is reduced, and EL max and EL avg are significantly reduced. The EL max of postoperative AAo is positively correlated with the degree of improvement in hsTNT, suggesting that EL max may be applicable for prognostic evaluation of patients.

Objective A comprehensive evaluation of oral anticoagulants(OACs)was conducted using the A Quick Guideline for Drug Evaluation and Selection in Chinese Medical Institutions(the Second Edition),to provide a reference for drug selection and clinical medication decisions in medical institutions.Methods Evaluation evidence was collected,and the drugs included in the evaluation were quantified on four dimensions of clinical properties(efficiency and safety),pharmaceutical properties,economy and others.Results All oral anticoagulants included in the evaluation had a score of 70 or higher in the comprehensive evaluation,while warfarin had the highest overall score.Clinical properties and pharmacologic properties were identified as the core attributes for drug selection evaluation.When considering only these factors,edoxaban received the highest score.Conclusion OACs are the preferred option for patients requiring long-term anticoagulation therapy.Various OACs offer distinct clinical advantages.Utilizing the Guidelines(Second Edition)for oral anticoagulant selection and evaluation can offer visual evidence for drug selection and promote the scientific,rational,and safe use of drugs in clinical management.

Objective To explore the effect of omeprazole combined with different probiotics on regulating intestinal flora in reducing functional dyspepsia(FD)in children.Methods Two hundreds children with FD admitted to the Pediatric Department of Foshan Maternal and Child Health Hospital from January 2022 to February 2023 were se-lected as the study subjects.They were randomly divided into omeprazde(omep)group,groups of omeprazole+yeast(yeast group),+clostridium butyricum(clos group),and+bifidobacterium(bifi group)respectively.Results After treatment,serum level of IL-6,TNF-α,IL-1β,hs-CRP,VIP,SS,Enterobacter and Enterococcus in all groups significantly decreased as compared with the finding before treatment(P<0.05).Those targets in the three combined treatment groups were significantly lower compared to the ome group;After treatment,the serum MOT level,bifidobacteria,and lactobacilli in each group were significantly increased(P<0.05),and the results from three combined treatment groups demonstrated notably higher levels compared to the omep group(P<0.05);The scores of symptoms in all groups showed a significant alleviation after the treatment(P<0.05).Additionally,the three combined treatment groups exhibited significantly lower symptom scores than the group treated with omeprazole alone(P<0.05).There was no difference in the incidence of adverse reactions during treatment among the groups.Conclusions Omeprazole combined with different probiotics have achieved good results in the treatment of FD in children.

Objective:To investigate the value of the virtual monoenergetic image (VMI) obtained by a new dual-layer detector spectral CT combined with metal artifact reduction algorithms(O-MAR) in reduction of different types of artifacts caused by 125I seeds implantation and in improvement of the post-operative CT image quality. Methods:This was a cross-sectional study. Thirty-five patients who underwent dual-layer detector spectral CT scanning of the chest and abdomen after 125I seeds implantation were retrospectively included at the First Affiliated Hospital of Zhengzhou University from March to September 2022. The spectral data were collected and reconstructed into conventional CT image (CI), VMI image (50-150 keV, 20 keV/level), CI+O-MAR image, and VMI+O-MAR image (50-150 keV, 20 keV/level). The artifacts′ removal effects and image quality improvement in each group were evaluated. Two slices with the strongest artifacts were selected for analysis for each patient, resulting in a total of 70 slices. Objective indicators including artifact index (AI), signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of soft tissue regions affected by artifacts were measured and calculated. Subjective indicators including the overcorrected artifacts and new artifacts, the different forms of artifacts, the diagnosis of artifacts, and the image quality were assessed. One-way analysis of variance was used for comparisons among multiple groups. Paired t test was used to compare the quantitative indicators between the combined O-MAR group and the non-O-MAR group. Kappa statistics was used to evaluate the consistency between observers. Results:In high/low-density artifacts (ROI H/L), the AI values in all groups showed decrease with increasing VMI keV. In artifact-affected tissue (ROI T), SNR of the CI/VMI (70-150 keV)+O-MAR group were significantly higher than those of the CI/VMI group ( P<0.05), CNR of the CI/VMI(50-150 keV)+O-MAR group were significantly higher than those of the CI/VMI group ( P<0.05). Both overcorrection and new artifacts mainly presented in VMI 50 keV and VMI 70 keV groups; Compared with VMI (50-70 keV) group, significantly less numbers of overcorrection and new artifacts were found in VMI (50-70 keV)+O-MAR group ( P<0.05); regarding the comparison of artifact types, with the VMI keV increasing, the number of a-type banded artifacts gradually decreased on images with high-density artifacts, reaching a minimum of 3 in the VMI 150 keV+O-MAR group; while the number of e-type artifacts with little or no artifacts increased, with the highest number of 23 in the VMI 150 keV+O-MAR group. The total number of high-density artifacts in each type decreased with increasing VMI keV. As VMI keV increased, the diagnostic and image quality scores of high-density artifacts in each group were significantly higher than those of low-density artifacts in the VMI+O-MAR group ( P<0.05). Conclusions:VMI combined with O-MAR can significantly improve the objective and subjective image quality of follow-up CT imaging after 125I seed implantation, enhancing lesion visibility and diagnostic confidence. Additionally, VMI+O-MAR showed more pronounced correction effect on high-density artifacts.

Objective To explore the preference of medical staff in public hospitals for various incentive factors,and to provide theoretical basis for the hospital to formulate a reasonable incentive system and stimulate the enthusiasm of medical staff.Methods Based on the discrete choice experiment,it was conducted from March 2023 to June 2023,through the method of multistage stratified random sampling,the medical staff of a general hospital,a Traditional Chinese Medical Hospital and a maternal and child health hospital in one city in the east,west,south,north and middle of Hainan Province were investigated by questionnaire,and analyzed their incentive preference and willingness to pay by using the mixed logit model.Results All the six attributes have significant influence on medical staff's incentive preference,among which,medical staff prefer to choose the incentive effect brought by the annual salary of 350 000 yuan,good working atmosphere and working intensity of 8 hours,while hospital development has little influence on incentive preference.Among the non-economic factors,when the working atmosphere changes from depression to good,they are willing to get an annual salary of 168 305.4 yuan less,while when the hospital development changes from nothing to good,they are only willing to get an annual salary of 12 433.14 yuan less.Conclusion According to the different incentive needs of medical staff,it is more helpful to formulate accurate incentive schemes and adopt economic and non-economic incentive means to stabilize the hospital talent team and improve work enthusiasm.

Objective To explore the preference of medical staff in public hospitals for various incentive factors,and to provide theoretical basis for the hospital to formulate a reasonable incentive system and stimulate the enthusiasm of medical staff.Methods Based on the discrete choice experiment,it was conducted from March 2023 to June 2023,through the method of multistage stratified random sampling,the medical staff of a general hospital,a Traditional Chinese Medical Hospital and a maternal and child health hospital in one city in the east,west,south,north and middle of Hainan Province were investigated by questionnaire,and analyzed their incentive preference and willingness to pay by using the mixed logit model.Results All the six attributes have significant influence on medical staff's incentive preference,among which,medical staff prefer to choose the incentive effect brought by the annual salary of 350 000 yuan,good working atmosphere and working intensity of 8 hours,while hospital development has little influence on incentive preference.Among the non-economic factors,when the working atmosphere changes from depression to good,they are willing to get an annual salary of 168 305.4 yuan less,while when the hospital development changes from nothing to good,they are only willing to get an annual salary of 12 433.14 yuan less.Conclusion According to the different incentive needs of medical staff,it is more helpful to formulate accurate incentive schemes and adopt economic and non-economic incentive means to stabilize the hospital talent team and improve work enthusiasm.