ObjectiveTo observe the clinical effectiveness and safety of Xiaozhong Zhitong Mixture （消肿止痛合剂） combined with antibiotic bone cement in the treatment of diabetic foot ulcer （DFU） with damp-heat obstructing syndrome. MethodsA total of 72 DFU patients with damp-heat obstructing syndrome were randomly assigned to treatment group （36 cases） and the control group （36 cases）. Both groups received standard treatment and topical antibiotic bone cement for ulcer wounds， while the treatment group received oral Xiaozhong Zhitong Mixture （50 ml per time， three times daily） in additionally. Both groups underwent daily wound dressing changes for 21 consecutive days. Ulcer healing rate， serum levels of tumor necrosis factor-alpha （TNF-α）， interleukin-1 beta （IL-1β）， malondialdehyde （MDA）， superoxide dismutase （SOD）， C-reactive protein （CRP）， and white blood cell （WBC） count were observed before and after treatment， and visual analog scale （VAS） scores for wound pain， traditional Chinese medicine （TCM） syndrome scores， and the DFU Healing Scale （DMIST scale） were also compared. Liver and kidney function were evaluated before and after treatment， and adverse events such as allergic reactions， worsening ulcer pain were recorded. ResultsTotally 35 patients in the treatment group and 33 in the control group were included in the final analysis. The ulcer healing rate in the treatment group was （87.93±9.34）%， significantly higher than （81.82±12.02）% in the control group （P = 0.035）. Compared to pre-treatment levels， both groups showed significant reductions in serum CRP， WBC， MDA， IL-1β， and TNF-α levels， with an increase in SOD level （P＜0.05）. TCM syndrome scores， VAS， and DMIST scores also significantly decreased in both groups （P＜0.05）， with greater improvements in the treatment group （P＜0.05）. No significant adverse reactions were observed in either group during treatment. ConclusionXiaozhong Zhitong Mixture combined with antibiotic bone cement has significant advantages in promoting DFU healing， reducing inflammatory response， and alleviating oxidative stress in DFU patients with damp-heat obstructing syndrome， with good safety for DFU patients with damp-heat obstructing syndrome.

Neck dissection(ND)is one of the main treatment methods for oral and maxillofacial malignancies.Although ND type is in con-stant improvement,but intraoperative peal-pull-push injury of the accessory nerve,muscle,muscle membrane,fascia and ligament induced shoulder syndrome(SS)is still a common postoperative complication,combined with the influence of radiochemotherapy,not only can cause pain,stiffness,numbness,limited dysfunction of shoulder neck and arm,but also may have serious impact on patient's life quality and phys-ical and mental health.At present,there is still a lack of a systematic evaluation and rehabilitation management program for postoperative SS of oral and maxillofacial malignant tumors.Based on the previous clinical practice and the current available evidence,refer to the relevant lit-erature at home and abroad,the experts in the field of maxillofacial tumor surgery and rehabilitation were invited to discuss,modify and reach a consenusus on the etiology,assessment diagnosis,differential diagnosis,rehabilitation strategy and prevention of SS,in order to provide clinical reference.

Objective:To observe the relationship between different serum sodium ion levels and hospital death in patients with chronic heart failure.Methods:The clinical data of patients hospitalized with heart failure from January 2013 to December 2018 in Shengjing Hospital of China Medical University were continuously collected, and a retrospective cohort study database was established. The study collected clinical data of 10 488 patients. Use SPSS 26.0 software to establish a database and perform statistical analysis. The patients were divided into 6 groups by different blood sodium levels, the heart failure indicators and hospital deaths among the groups were compared, the lowest death rate group (141 - 145 mmol/L) was as a reference, and univariate Logistic analysis of different blood sodium levels were performed to clarify the risk of in-hospital death from heart failure with different blood sodium levels. GraphPad Prism 5 software was used to draw Kaplan-Meier curve and analyzed the cumulative survival rate during hospitalization.Results:In 10 488 patients, there were 417 cases occurred in-hospital deaths. The range of serum sodium at admission was 108.0 - 168.0 mmol/L, and the normal reference range was 135 - 145 mmol/L. The patients were divided into 6 groups according to the blood sodium level at the time of admission: group A (<130 mmol/L), group B(130 - 135 mmol/L), group C (136 - 140 mmol/L), group D (141 - 145 mmol/L), group E (146 - 150 mmol/L), group F(≥151 mmol/L), the hospital mortality of different blood sodium groups were 14.5%, 8.6%, 3.6%, 2.4%, 5.1% and 33.3% respectively. Took the lowest in-hospital mortality group D group as a reference, 6 groups with different serum sodium were included in a single factor binary Logistic regression analysis, the results showed that increased or decreased serum sodium may increase the risk of death in the hospital for patients with heart failure. Kaplan-Meier survival analysis showed that the accumulate survival rate among the 6 groups was statistically significant ( P<0.05). Conclusions:Patients with abnormal blood sodium at admission have a higher risk of death in the hospital during the hospital stay. The in-hospital mortality rate of patients with serum sodium ions ranging from 141 to 145 mmol/L is the lowest. With the increase or decrease in serum sodium, the in-hospital mortality rate increases with the increase or decrease in serum sodium. The blood sodium level and the mortality of patients with heart failure show a "U" shape. Curve relationship. Abnormal blood sodium on admission is an independent predictor of in-hospital mortality in inpatients with heart failure.

Osteoporotic thoracolumbar fracture in the elderly will seriously reduce their quality of life and life expectancy. For osteoporotic thoracolumbar fracture in the elderly, spinal reconstruction is necessary, which should comprehensively consider factors such as the physical condition, fracture type, clinical characteristics and osteoporosis degree. While there lacks relevant clinical norms or guidelines on selection of spinal reconstruction strategies. In order to standardize the concept of spinal reconstruction for osteoporotic thoracolumbar fracture in the elderly, based on the principles of scientificity, practicality and progressiveness, the authors formulated the Clinical guideline for spinal reconstruction of osteoporotic thoracolumbar fracture in elderly patients ( version 2022), in which suggestions based on evidence of evidence-based medicine were put forward upon 10 important issues related to the fracture classification, non-operative treatment strategies and surgical treatment strategies in spinal reconstruction after osteoporosis thoracolumbar fracture in the elderly, hoping to provide a reference for clinical treatment.

Objective:To investigate the value of serum urea nitrogen on in-hospital death in patients with heart failure.Methods:The clinical data of 9 459 patients with heart failure from January 2013 to December 2018 in Shengjing Hospital of China Medical University were retrospectively analyzed. Among them, 296 cases died in hospital (death group) and 9 163 cases survived (survival group). The clinical data of patients were collected, including general condition, disease history, physical examination, laboratory indicators and relevant physical examination, etc. Correlation was finished with Pearson correlation analysis. Multivariate Logistic regression analysis was used to determine independent risk factors for in-hospital death in patients with heart failure. Receiver operating characteristic (ROC) curve was used to determine the optimal predictive threshold of urea nitrogen for in-hospital death.Results:The in-hospital mortality in patients with heart failure was 3.1% (296/9 459). There were statistical differences in age, hypertension rate, diabetes rate, a history of atrial fibrillation rate, smoking history rate, hemoglobin, albumin, glycosylated hemoglobin, urea nitrogen, creatinine, uric acid, serum potassium, serum sodium, troponin I, N terminal brain natriuretic peptide precursor (NT-proBNP), left ventricular ejection fraction (LVEF) between death group and survival group ( P<0.01 or <0.05), and there were no statistical difference in gender composition, coronary heart disease rate, platelet, total cholesterol, low-density lipoprotein cholesterol (LDL-C), triglyceride, left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) between 2 groups ( P>0.05). Pearson correlation analysis result showed that the urea nitrogen was positively correlated with age, coronary heart disease, hypertension, diabetes, glycosylated hemoglobin, creatinine, uric acid, serum potassium, troponin I, NT-proBNP, LVEDV and LVESV ( r = 0.130, 0.024, 0.053, 0.128, 0.033, 0.739, 0.468, 0.377, 0.065, 0.432, 0.084 and 0.101; P<0.01 or <0.05); and the urea nitrogen was negatively correlated with gender, history of atrial fibrillation, hemoglobin, platelet, albumin, total cholesterol, LDL-C, serum sodium and LVEF ( r = -0.033, -0.063, -0.272, -0.077, -0.188, -0.070, -0.071, -0.199 and -0.113, P<0.01); and there were no correlation between urea nitrogen and smoking history or triglyceride ( P>0.05). Multivariate Logistic regression analysis result showed that age, hypertension, albumin, urea nitrogen, troponin I and NT-proBNP were independent risk factors for in-hospital death in patients with heart failure ( OR = 1.018, 0.613, 0.924, 1.082, 1.340 and 1.005; 95% CI 1.002 to 1.033, 0.427 to 0.881, 0.889 to 0.961, 1.040 to 1.126, 1.111 to 1.617 and 1.003 to 1.007; P<0.05 or <0.01). ROC curve analysis result showed that the area under the curve (AUC) of urea nitrogen for prediction of in-hospital death in patients with heart failure was 0.737 (95% CI 0.728 to 0.748), and the optimal threshold value was 11.41 mmol/L, with a sensitivity of 60.16% and a specificity of 77.01%; the AUC of NT-proBNP for prediction of in-hospital death in patients with heart failure was 0.726 (95% CI 0.712 to 0.740), and there was no statistical difference in the AUC between urea nitrogen and NT-proBNP ( Z=1.055, P=0.291). Conclusions:Elevated urea nitrogen level is independently associated with an increase in in-hospital mortality in patients with heart failure, and the optimal threshold for predicting in-hospital death is 11.41 mmol/L.

Objective To analyze the diagnostic and prognostic value of serum pepsinogen combine with Ca724 in the patients with gastric cancer .Methods One hundred and twenty patients with suspected gastric cancer were severed as research object .All patients were accepted on serum pepsinogen Ⅰ( PGⅠ) ,serum pep-sinogen Ⅱ( PGⅡ) , Ca724 and gastroscopy .As confirmed by gastroscope biopsy under pathological findings standards ,we analyzed the diagnostic and prognostic value of PGⅠ/PGⅡ( PGR) ,Ca724 and PGR combined with Ca724 in the patients with gastric cancer .Results All the observers ,92 patients were diagnosed with stomach cancer.The diagnostic sensitivity and accuracy of PGR combined with Ca 724 were higher than PGR and Ca724, and specificity was lower than PGR and Ca724.At the same time,there was diagnostic value of PGR,Ca724 and PGR combined with Ca724 in gastric cancer diagnostic (P<0.05),and the diagnostic value of PGR combined with Ca724 was higher than PGR check and Ca 724.In addition,during the different pathological ,there were sta-tistically significant differences of PGR and Ca724,the PGR in Ⅳ group was lowest,the Ca724 in the Ⅳ group was highest(P<0.05).Conclusion Combined serum pepsinogen and Ca 724 in the diagnosis and differential diagnosis of gastric cancer have a definite application value in the assessment of prognosis .

OBJECTIVE:To investigate the toxicity effect of Jianpi shengxue granule on perinatal rats. METHODS:Based on body mass,pregnant rats were randomly divided into negative control group and Jianpi shengxue granule low-dose,medium-dose, high-dose groups(0.77,2.31,6.93 g/kg),21 in each group,and intragastrically given relevant medicines from the 15th d of preg-nancy until 21st d after delivery,once a day. Effects of Jianpi shengxue granule on general toxicity and fertility of maternal rats were observed,as well as the effects on athletic ability,learning and memory ability,fertility of F1 offspring and early viability of F2 offspring. RESULTS:In terms of toxicity effect on maternal rats,compared with control group,the days of pregnancy in Jianpi shengxue granule high-dose group was significantly prolonged(P<0.05),initial body mass of administration was significantly re-duced (P<0.01). In terms of toxicity effect on offspring,compared with negative control group,the initial body mass of F1 off-spring in Jianpi shengxue granule high-dose group was significantly reduced(P<0.05),the time of 4th and 5th time for founding underwater platform was significantly shortened(P<0.01),and there was no obvious effect on fertility of F1 offspring and early vi-ability of F2 offspring (P>0.05);there was no obvious effect on the indexes of offspring in Jianpi shengxue granule medium-dose,low-dose groups. CONCLUSIONS:The no toxic dose of Jianpi shengxue granule in maternal and offspring rats is 2.31 g/kg.

Objective Establish an overall performance evaluation index system for innovative medical devices transforming project,a major science and technology project in Zhejiang province.Methods The weight of indexes was calculated using Delphi method,analytic hierarchy process and weight of percentile method.Results A three-level performance evaluation index system was established.First level included 3 indexes,as condition index,process index and result index,with weight of 0.3401、0.4042 and 0.2557 respectively.Meanwhile,second level and third level included 13 and 38 indexes.Conclusions The index system provide a performance evaluation tool for the innovative medical devices transforming project.

A study of the quality assurance system building made at the training bases in Zhejiang since 2011 found the following.Five management systems on training quality have been established, covering basic clinical conditions, training management, faculty management and training, training assessment,and training incentives.PDCA is called into play for continuous improvement and perfection to develop a training quality management system of local features and continuous improvement.

BACKGROUND:Xenogeneic ligament is readily available, which has ligament scaffold structure and is conducive to tissue ingrowth and creeping substitution. After processing, the xenogeneic ligament, with the presence of good growth scaffold function, can be completely eliminated antigenicity that can cause immune rejection. OBJECTIVE:To study the feasibility of biological xenogeneic ligament graft instead of alogeneic ligament graft for reconstruction of goat anterior cruciate ligament. METHODS: Twenty-four healthy adult goats were randomly divided into A, B, C groups, and then, the left knee joints of goats were removed to establish animal models of anterior cruciate ligament injury in the three groups. After the establishment of the tibia and femoral bone tunnel, groups A, B, C were respectively transplanted with biological xenogeneic ligament graft combined with bone marrow mesenchymal stem cels, biological xenogeneic ligament graft alone, and alogenic ligament. RESULTS AND CONCLUSION: After implantation, no rejection but good biocompatibility was found in the group A, in which, the transplanted ligament as a functional scaffold for anterior cruciate ligament reconstruction, and new tissues in-grew and replaced the scaffold under intraarticular environment to form the new ligament with good bone tendon healing. However, there were no differences in histology, immune response, biomechanical findings between groups A and C. Additionaly, in the group A, the host tissues were found to grow into the scaffold and establish a micro-circulation. These findings indicate that xenogeneic ligament combined with bone marrow mesenchymal stem cels can accelerate the establishment of micro-circulation and promote the growth of ligaments, especialy improve the ligament revascularization significantly, but has no influence on the biological characteristics of the ligament.