Objective To compare the differences in intraoperative radiation exposure between leadless and transvenous pacemaker implantation. Methods Cumulative dose (CD), dose area product (DAP), and fluoroscopy time during procedure were recorded and analyzed in 21 patients with leadless pacemaker implantation (Micra group), 55 patients with transvenous single-chamber pacemaker implantation (VVI group), and 216 patients with transvenous dual-chamber pacemaker implantation (DDD group). Results The fluoroscopy times of the Micra group, VVI group, and DDD group were 5.0 ± 1.9, 4.8 ± 1.4, and 7.6 ± 1.9 min, respectively (P < 0.001). Their CD values were 203.5 ± 76.1, 147.0 ± 41.0, and 249.6 ± 58.2 mGy, respectively (P < 0.001). Their DAP values were 18.6 ± 7.1, 13.4 ± 3.9, and 22.6 ± 5.6 Gy·cm², respectively (P < 0.001). Compared with the VVI group, the Micra group had similar fluoroscopy time (P=0.813) but higher CD (P=0.010) and DAP values (P = 0.012). Compared with the DDD group, the Micra group had reduced fluoroscopy time (P < 0.001), CD value (P = 0.033), and DAP value (P = 0.047). Conclusion Leadless pacemaker implantation is associated with increased radiation exposure compared to transvenous single-chamber pacemaker implantation. However, it offers a significant advantage in reducing radiation exposure for both medical staff and patients compared to transvenous dual-chamber pacemaker implantation.

This paper elaborated the structural principles,structures and working principles of the A5 type passive training system for hand function through discussed the clinical application of passive training system for hand function in the rehabilitation of patients with stroke.It analyzed a series of occurring common faults during system operation,such as system errors caused by missing components,improper sensitivity settings for spasticity,abnormal connections for equipment,motor failures,jam and pause of robotic hand,and faults of lifting table,and conducted fault analysis for them.After that,this paper proposed corresponding handling strategies and solutions for faults,which included software configuration,calibration and detection of robotic hand sensors,repair of connection fault,and regular maintenance and replacement of system's components.It provided theoretical basis for the maintenance and optimization of the passive training system for hand function.Thus,it can rapid remove troubles,and reduce the equipment's failure rate of passive training system for hand function,and improve the equipment's normal utilization rate,and ensure favorable performance of equipment in long-term use.

Objective To analyze the international research hotspots and development trends of social work intervention in chronic disease management,providing reference for domestic research on social work intervention in chronic disease manage-ment.Methods The research literature was retrieve on the core collection of Web of Science,articles published from the estab-lishment of the database from 2000 to 2024.CiteSpace were used to present the keyword co-occurrence,keyword clustering,au-thor collaboration network,and institutional collaboration network of social work intervention in chronic disease management.Results The post-documentation situation showed a fluctuating upward trend as a whole.The keywords that appeared frequently were"social support""management""quality of life""chronic disease"and"Care".There was multi-agency and multi-author collaboration.Conclusion Internationally,social work intervention in chronic disease management focuses on social support and quality of life.The research cooperation system in related fields is diversified,and social workers play an active role in the inter-disciplinary teams for chronic disease management.

Objective To analyze the international research hotspots and development trends of social work intervention in chronic disease management,providing reference for domestic research on social work intervention in chronic disease manage-ment.Methods The research literature was retrieve on the core collection of Web of Science,articles published from the estab-lishment of the database from 2000 to 2024.CiteSpace were used to present the keyword co-occurrence,keyword clustering,au-thor collaboration network,and institutional collaboration network of social work intervention in chronic disease management.Results The post-documentation situation showed a fluctuating upward trend as a whole.The keywords that appeared frequently were"social support""management""quality of life""chronic disease"and"Care".There was multi-agency and multi-author collaboration.Conclusion Internationally,social work intervention in chronic disease management focuses on social support and quality of life.The research cooperation system in related fields is diversified,and social workers play an active role in the inter-disciplinary teams for chronic disease management.

Objective To evaluate the risk of right heart failure after heart transplantation by establishing nomogram based on preoperative pulmonary artery pressure.Methods A total of 184 patients undergoing heart transplantation were retrospectively collected and divided into the training group(126 cases)and the verification group(58 cases).Patients in the training set were divided into the right heart failure group(60 cases)and the non-right heart failure group(66 cases)according to whether right heart failure occurred after operation.The differences of clinical data between the two groups were compared,and the influencing factors of right heart failure occurred after operation in the training set were screened by Lasso-Logistic regression.According to the screened influencing factors,nomograms were drawn,and the predictive efficiency of the model was evaluated by using the receiver's operating characteristic(ROC)curve,calibration curve,receiver's operating characteristic(ROC)curve and clinical decision curve.Further vertification of the clinical application effect of centralized evaluation model was conducted.Results The Lasso-Logistic regression analysis identified the following independent risk factors for right heart failure after heart transplantation:elevated total bilirubin(OR=2.649,95％CI:1.339-5.239),increased mean pulmonary artery pressure(OR=3.082,95％CI:1.608-5.910),elevated pulmonary artery resistance(OR=3.171,95％CI:1.710-5.879),and widened right ventricular outflow tract diameter(OR=2.681,95％CI:1.361-5.281),all of which demonstrated statistical significance(P＜0.05).The nomogram model was constructed accordingly.The AUC of the nomogram model was 0.846(95％CI:0.813-0.947).The calibration curve demonstrated good fit via the goodness-of-fit test(Hosmer-Lemeshow x2=0.862,P=0.361).Clinical decision curve analysis revealed that the net benefit rate remained＞0 when the high-risk threshold probability ranged from 1％to 95％,indicating favorable clinical utility of this nomogram model.Based on the model predictions,among 58 heart transplant patients in the validation cohort,34 were classified as high-risk for right heart failure and 24 as low-risk.Actual diagnosis results showed 29 cases with right heart failure and 29 without.The Kappa coefficient reached 0.483(95％CI:0.261-0.705),demonstrating high consistency between model predictions and actual clinical outcomes.Conclusion Preoperative pulmonary systolic pressure increase is an independent risk factor for right heart failure after heart transplantation.A nomogram prediction model for right heart failure after heart transplantation is established by combining other clinical risk factors,and it has good prediction efficiency.

This paper elaborated the structural principles,structures and working principles of the A5 type passive training system for hand function through discussed the clinical application of passive training system for hand function in the rehabilitation of patients with stroke.It analyzed a series of occurring common faults during system operation,such as system errors caused by missing components,improper sensitivity settings for spasticity,abnormal connections for equipment,motor failures,jam and pause of robotic hand,and faults of lifting table,and conducted fault analysis for them.After that,this paper proposed corresponding handling strategies and solutions for faults,which included software configuration,calibration and detection of robotic hand sensors,repair of connection fault,and regular maintenance and replacement of system's components.It provided theoretical basis for the maintenance and optimization of the passive training system for hand function.Thus,it can rapid remove troubles,and reduce the equipment's failure rate of passive training system for hand function,and improve the equipment's normal utilization rate,and ensure favorable performance of equipment in long-term use.

Objective To evaluate the risk of right heart failure after heart transplantation by establishing nomogram based on preoperative pulmonary artery pressure.Methods A total of 184 patients undergoing heart transplantation were retrospectively collected and divided into the training group(126 cases)and the verification group(58 cases).Patients in the training set were divided into the right heart failure group(60 cases)and the non-right heart failure group(66 cases)according to whether right heart failure occurred after operation.The differences of clinical data between the two groups were compared,and the influencing factors of right heart failure occurred after operation in the training set were screened by Lasso-Logistic regression.According to the screened influencing factors,nomograms were drawn,and the predictive efficiency of the model was evaluated by using the receiver's operating characteristic(ROC)curve,calibration curve,receiver's operating characteristic(ROC)curve and clinical decision curve.Further vertification of the clinical application effect of centralized evaluation model was conducted.Results The Lasso-Logistic regression analysis identified the following independent risk factors for right heart failure after heart transplantation:elevated total bilirubin(OR=2.649,95％CI:1.339-5.239),increased mean pulmonary artery pressure(OR=3.082,95％CI:1.608-5.910),elevated pulmonary artery resistance(OR=3.171,95％CI:1.710-5.879),and widened right ventricular outflow tract diameter(OR=2.681,95％CI:1.361-5.281),all of which demonstrated statistical significance(P＜0.05).The nomogram model was constructed accordingly.The AUC of the nomogram model was 0.846(95％CI:0.813-0.947).The calibration curve demonstrated good fit via the goodness-of-fit test(Hosmer-Lemeshow x2=0.862,P=0.361).Clinical decision curve analysis revealed that the net benefit rate remained＞0 when the high-risk threshold probability ranged from 1％to 95％,indicating favorable clinical utility of this nomogram model.Based on the model predictions,among 58 heart transplant patients in the validation cohort,34 were classified as high-risk for right heart failure and 24 as low-risk.Actual diagnosis results showed 29 cases with right heart failure and 29 without.The Kappa coefficient reached 0.483(95％CI:0.261-0.705),demonstrating high consistency between model predictions and actual clinical outcomes.Conclusion Preoperative pulmonary systolic pressure increase is an independent risk factor for right heart failure after heart transplantation.A nomogram prediction model for right heart failure after heart transplantation is established by combining other clinical risk factors,and it has good prediction efficiency.

OBJECTIVE To establish a method for determining the contents of clopidogrel(CLP),clopidogrel carboxylate(CLP-C),clopidogrel acyl-β-D-glucuronide(CLP-G)and contents of clopidogrel active metabolite(CAM)in rat plasma,and to investigate their in vivo pharmacokinetic characteristics.METHODS The Shisedo CAPCELL ADME column was used with a mobile phase consisting of water and acetonitrile(both containing 0.1%formic acid)in a gradient elution.The flow rate was 0.4 mL/min,and the column temperature was maintained at 20℃.The injection volume was 2 μL.The analysis was performed in positive ion mode using electrospray ionization with multiple reaction monitoring.The ion pairs for quantitative analysis were m/z 322.1→211.9(for CLP),m/z 308.1→197.9(for CLP-C),m/z 322.1→154.8(for CLP-G),m/z 504.1→154.9[for racemic CAM derivative(CAMD)].Six rats were administered a single intragastric dose of CLP(10 mg/kg).Blood samples were collected before medication and at 0.08,0.33,0.66,1,2,4,6,10,23 and 35 hours after medication.The established method was used to detect the serum contents of various components in rats.Pharmacokinetic parameters were then calculated using WinNonlin 6.1 software.RESULTS The linear ranges for CLP,CLP-C and CAMD were 0.08-20.00,205.00-8 000.00,and 0.04-25.00 ng/mL,respectively(r≥0.990).The relative standard deviations for both intra-day and inter-day precision tests were all less than 15%,and the relative errors for accuracy ranged from-11.68%to 14.40%.The coefficients of variation for the matrix factors were all less than 15%,meeting the requirements for bioanalytical method validation.The results of the pharmacokinetic study revealed that,following a single intagastric administration of CLP in rats,the exposure to the parent CLP in plasma was extremely low.Both the area under the drug concentration-time curve(AUC0-35 h)and the peak concentration of the parent CLP were lower than those of its metabolites.The AUC0-35 h of the active metabolite CAM was approximately 43 times that of CLP,though it had a shorter half-life(2.53 h).The inactive metabolite CLP-C exhibited the highest exposure level,but it reached its peak concentration the latest and was eliminated slowly.The AUC0-35 h of CLP-G was about four times that of CAM,and its half-life was similar to that of CLP-C.CONCLUSIONS This study successfully established an liquid chromatography-tandem mass spectrometry method for the determination of CLP and its three metabolites,and revealed their pharmacokinetic characteristics in rats.Specifically,the parent drug CLP was rapidly eliminated,while the inactive metabolites CLP-C and CLP-G exhibited long half-lives,and active metabolite CAM displayed a transient exposure pattern.

Objective:This study proposed a novel technique for aortic root reconstruction and evaluated its safety and effectiveness.Methods:Acute type A aortic dissection (ATAAD) patients who underwent Sun' s procedure from January 2020 to June 2022 in the First Affiliated Hospital of Xi'an Jiaotong University were retrospectively enrolled. These patients were divided into three groups according to their surgical procedures of aortic root: aortic root reinforcement combined with vascular grafts built-in and intermittent anastomosis technique (XJ-procedure) group, continuous suture and pledgeted interrupted reinforcement group and Bentall group. The perioperative data and postoperative follow-up results of the three groups were compared to analyze the efficacy of XJ-procedure in the root treatment of ATAAD.Results:A total of 509 patients were enrolled in this study, including 288 patients in the XJ-procedure group, 132 patients in the continuous suture and pledgeted interrupted reinforcement group and 89 patients in the Bentall group. The 30-day mortality of all patients was 7.5% (38/509), and were 7.3%, 8.3% and 6.7% in the XJ-procedure group, continuous suture and pledgeted interrupted reinforcement group and Bentall group, respectively. The operation time of the XJ-procedure group [355 (320, 380) min] was significantly lower than the other two groups. The cardiopulmonary bypass time [154 (140, 169) min] and the aortic cross-clamping time [80 (72, 89) min] of XJ-procedure group were lower than the Bentall group [166 (147, 184) min and 86 (77, 96) min]. The aortic root bleeding that required secondary cardiopulmonary bypass did not occur in the XJ-procedure group. There was no significant difference in early postoperative complications among the three groups. The incidence of residual aortic root dissection before discharge, in 3 and 6 months after operation was lower in the XJ-procedure group compared to the continuous suture and pledgeted interrupted reinforcement group ( P<0.001). Conclusion:The XJ-procedure technique is a safe, simple and mastered method for the aortic root treatment of ATAAD, which shows an accurate early clinical effect.

Objective To investigate the current situation of achievement transformation in tertiary medical hospitals in Shanghai and propose countermeasures for the existing problems to enhance the effectiveness of achievement transformation.Methods A questionnaire survey was done on the transformation and management of scientific research achievements in 47 terti-ary hospitals in Shanghai.Meanwhile,interviews were carried out among the managers and researchers from these hospitals.Re-sults In the past three years,the rate of transformation achievements in the hospitals was only 2.8%.In the achievement trans-formation existed such problems as weak awareness of scientific researchers,low patent quality,lack of full-time managers,and inflexible management mode.It was also believed that there is a need to improve main responsibilities,achievement management,system establishment,personnel training,resource sharing,department coordination and other related aspects.Conclusion The rate of achievement transformation in tertiary medical institutions in Shanghai is at a lower level.There are numerous problems and difficulties in the transformation.Therefore,urgent efficient countermeasures are needed to promote the transformation of a-chievement.