Objective To explore the risk factors of clopidogrel resistance in elderly patients with acute myocardial infarction(AMI)in order to provide personalized medication plans.Methods A prospective trial was conducted on 472 elderly AMI patients undergoing coronary stent placement in No.901 Hospital of Joint Logistics Support Force of PLA and Hangzhou Special Service Conva-lescent Center of Air Force from January 2018 to December 2022.All patients received clopidogrel for antiplatelet postoperatively,and after 7 consecutive days of administration,peripheral venous blood samples were collected to observe whether the patient had resistance to clopidogrel and to measure the concentration of active metabolites of clopidogrel and the maximum platelet aggrega-tion ratio(MARAA)of arachidonic acid induced platelets.According to MARAA,they were divid-ed into a clopidogrel resistant group(MARAA≥55％,142 cases)and a clopidogrel sensitive group of(＜55％,330 cases).The clinical characteristics were compared between the two groups,and multivariate logistic regression analysis was used to identify the risk factors for clopidogrel resistance.The impact of clopidogrel resistance on major adverse cardiovascular events was ana-lyzed.Results The clopidogrel resistant group had significantly higher MARAA level,decrease in the concentration of clopidogrel active metabolites,higher BMI,and larger ratios of obesity,CYP2C19*2 mutation,diabetes,hyperlipidemia and administration of hypoglycemic drugs when compared with the clopidogrel sensitive group(P＜0.01).Obesity,diabetes,hyperlipidemia and CYP2C19*2 mutation were risk factors for clopidogrel resistance in elderly AMI patients(OR=2.036,95％CI:1.282-3.235;OR=2.795,95％CI:1.803-4.334;OR=2.125,95％CI:1.355-3.331;OR=4.881,95％CI:2.807-8.486).The incidence of major adverse cardiovascular events was notably higher in the clopidogrel resistant group than the sensitive group(11.27％vs 4.55％,P＜0.01).After a prediction model was constructed with R4.0.3 statistical software,330 cases randomly selected from the dataset were assigned into a training set,and the remaining 142 cases into a validation set.The AUC value of the training set and the validation set was 0.750 and 0.780,respectively.Hosmer-Lemeshow Goodness of Fit test indicated that the model had good re-liability and predictive value(Chi-square=18.907,P=0.215).Conclusion Obesity,diabetes,hy-perlipidemia and CYP2C19*2 mutation are risk factors of clopidogrel resistance in elderly AMI patients,and clopidogrel resistance may lead to poor prognosis.

Methods: Motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SEPs) were recorded in 48 patients with TOLF (hybrid 20 vs. en bloc 28) during surgery. Patients were categorized based on MEP/SEP improvement, deterioration, or no change, and MEP/SEP improvement rates were measured in the improvement group. Furthermore, all patients were assessed using the Ashworth and modified Japanese Orthopedic Association scores. Results: The incidences of both MEP/SEP improvement (21.4% vs. 25.0%, p=0.772) and deterioration (21.4% vs. 20.0%, p=0.904) were similar between the en bloc and hybrid laminectomy groups, and no difference in preoperative and postoperative clinical assessments was observed between the two groups (p>0.05). In four patients (4/28, 14.3%) undergoing en bloc laminectomy, MEP amplitudes initially increased after OLF removal but gradually decreased. This delayed MEP reduction did not occur in the hybrid laminectomy group. Furthermore, more patients undergoing en bloc laminectomy had CFL than those undergoing hybrid laminectomy (46.4% vs. 15.0%, p=0.023). In the improvement group, the hybrid laminectomy group exhibited higher MEP improvement rates in the bilateral abductor hallucis than the en bloc laminectomy group (left side: 213.4%±35.9% vs. 152.5%±41.0%, p=0.028; right side: 201.2%±32.0% vs. 145.2%±46.3%, p=0.043). Conclusions Compared with en bloc laminectomy, hybrid laminectomy may be a safe and effective method for treating multilevel TOLF, potentially reducing intraoperative spinal cord irritation and CFL and causing relatively better functional recovery.

Objective To explore the risk factors of clopidogrel resistance in elderly patients with acute myocardial infarction(AMI)in order to provide personalized medication plans.Methods A prospective trial was conducted on 472 elderly AMI patients undergoing coronary stent placement in No.901 Hospital of Joint Logistics Support Force of PLA and Hangzhou Special Service Conva-lescent Center of Air Force from January 2018 to December 2022.All patients received clopidogrel for antiplatelet postoperatively,and after 7 consecutive days of administration,peripheral venous blood samples were collected to observe whether the patient had resistance to clopidogrel and to measure the concentration of active metabolites of clopidogrel and the maximum platelet aggrega-tion ratio(MARAA)of arachidonic acid induced platelets.According to MARAA,they were divid-ed into a clopidogrel resistant group(MARAA≥55％,142 cases)and a clopidogrel sensitive group of(＜55％,330 cases).The clinical characteristics were compared between the two groups,and multivariate logistic regression analysis was used to identify the risk factors for clopidogrel resistance.The impact of clopidogrel resistance on major adverse cardiovascular events was ana-lyzed.Results The clopidogrel resistant group had significantly higher MARAA level,decrease in the concentration of clopidogrel active metabolites,higher BMI,and larger ratios of obesity,CYP2C19*2 mutation,diabetes,hyperlipidemia and administration of hypoglycemic drugs when compared with the clopidogrel sensitive group(P＜0.01).Obesity,diabetes,hyperlipidemia and CYP2C19*2 mutation were risk factors for clopidogrel resistance in elderly AMI patients(OR=2.036,95％CI:1.282-3.235;OR=2.795,95％CI:1.803-4.334;OR=2.125,95％CI:1.355-3.331;OR=4.881,95％CI:2.807-8.486).The incidence of major adverse cardiovascular events was notably higher in the clopidogrel resistant group than the sensitive group(11.27％vs 4.55％,P＜0.01).After a prediction model was constructed with R4.0.3 statistical software,330 cases randomly selected from the dataset were assigned into a training set,and the remaining 142 cases into a validation set.The AUC value of the training set and the validation set was 0.750 and 0.780,respectively.Hosmer-Lemeshow Goodness of Fit test indicated that the model had good re-liability and predictive value(Chi-square=18.907,P=0.215).Conclusion Obesity,diabetes,hy-perlipidemia and CYP2C19*2 mutation are risk factors of clopidogrel resistance in elderly AMI patients,and clopidogrel resistance may lead to poor prognosis.

BACKGROUND:There is still no consensus on the optimal internal fixation for the treatment of Pauwels Ⅲ femoral neck fracture,and most of the related finite element analyses have been performed using a single simplified loading condition,and the biomechanical properties of commonly used internal fixation devices need to be further investigated. OBJECTIVE:To analyze the biomechanical characteristics of Pauwels Ⅲ femoral neck fractures treated with cannulated compression screw,dynamic hip screw,and femoral neck system by finite element method under different loading conditions of single-leg standing loads and sideways fall loads. METHODS:The DICOM data of healthy adult femur were obtained by CT scanning,imported into Mimics 15.0 software to obtain the rough model of bone tissue.The data exported from Mimics were optimized by Geomagics software,and then three internal fixation models were built and assembled with the femur model according to the parameters of the clinical application of the cannulated compression screw,dynamic hip screw,and femoral neck system by using Pro/E software.Finally,the three internal fixation models were imported into Ansys software for loading and calculation to analyze the stress distribution and displacement of the femur and the internal fixation under different working conditions of single-leg standing loads and sideways fall loads,as well as the stress characteristics of the calcar femorale and Ward's triangle. RESULTS AND CONCLUSION:(1)Under the single-leg standing load and the sideways fall load,the proximal femoral stress of the three internal fixation models was mainly distributed above the fracture end of the femoral neck.The peak stress of the proximal femoral end,fracture end,Ward triangle,and calcar femorale of the three internal fixation models were the smallest in the femoral neck system model and the largest in the cannulated compression screw model.(2)Under the single-leg standing load and the sideways fall load,the peak displacement of the proximal femur of the three internal fixation models was all located at the top of the femoral head,and the peak displacement was the smallest in the femoral neck system model and the largest in the cannulated compression screw model.(3)The peak displacement of the three internal fixation models was all located at the top of the internal fixation device under the single-leg standing and sideways fall loading conditions,and the peak displacement values were the smallest in the femoral neck system internal fixation model and the largest in the cannulated compression screw internal fixation model.(4)The internal fixation stress of the three internal fixation models was mainly distributed in the area near the fracture end of the internal fixation device under the single-leg standing and sideways fall loads,and the peak value of internal fixation stress was the smallest in the femoral neck system model and the largest in the cannulated compression screw model.(5)These results suggest that the mechanical stability of the femoral neck system is the best,but there may be a risk of stress shielding of the fracture end and calcar femorale.The stress of the internal fixation device of the femoral neck system is more dispersed,and the risk of internal fixation break is lower.

Methods: Motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SEPs) were recorded in 48 patients with TOLF (hybrid 20 vs. en bloc 28) during surgery. Patients were categorized based on MEP/SEP improvement, deterioration, or no change, and MEP/SEP improvement rates were measured in the improvement group. Furthermore, all patients were assessed using the Ashworth and modified Japanese Orthopedic Association scores. Results: The incidences of both MEP/SEP improvement (21.4% vs. 25.0%, p=0.772) and deterioration (21.4% vs. 20.0%, p=0.904) were similar between the en bloc and hybrid laminectomy groups, and no difference in preoperative and postoperative clinical assessments was observed between the two groups (p>0.05). In four patients (4/28, 14.3%) undergoing en bloc laminectomy, MEP amplitudes initially increased after OLF removal but gradually decreased. This delayed MEP reduction did not occur in the hybrid laminectomy group. Furthermore, more patients undergoing en bloc laminectomy had CFL than those undergoing hybrid laminectomy (46.4% vs. 15.0%, p=0.023). In the improvement group, the hybrid laminectomy group exhibited higher MEP improvement rates in the bilateral abductor hallucis than the en bloc laminectomy group (left side: 213.4%±35.9% vs. 152.5%±41.0%, p=0.028; right side: 201.2%±32.0% vs. 145.2%±46.3%, p=0.043). Conclusions Compared with en bloc laminectomy, hybrid laminectomy may be a safe and effective method for treating multilevel TOLF, potentially reducing intraoperative spinal cord irritation and CFL and causing relatively better functional recovery.

Methods: Motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SEPs) were recorded in 48 patients with TOLF (hybrid 20 vs. en bloc 28) during surgery. Patients were categorized based on MEP/SEP improvement, deterioration, or no change, and MEP/SEP improvement rates were measured in the improvement group. Furthermore, all patients were assessed using the Ashworth and modified Japanese Orthopedic Association scores. Results: The incidences of both MEP/SEP improvement (21.4% vs. 25.0%, p=0.772) and deterioration (21.4% vs. 20.0%, p=0.904) were similar between the en bloc and hybrid laminectomy groups, and no difference in preoperative and postoperative clinical assessments was observed between the two groups (p>0.05). In four patients (4/28, 14.3%) undergoing en bloc laminectomy, MEP amplitudes initially increased after OLF removal but gradually decreased. This delayed MEP reduction did not occur in the hybrid laminectomy group. Furthermore, more patients undergoing en bloc laminectomy had CFL than those undergoing hybrid laminectomy (46.4% vs. 15.0%, p=0.023). In the improvement group, the hybrid laminectomy group exhibited higher MEP improvement rates in the bilateral abductor hallucis than the en bloc laminectomy group (left side: 213.4%±35.9% vs. 152.5%±41.0%, p=0.028; right side: 201.2%±32.0% vs. 145.2%±46.3%, p=0.043). Conclusions Compared with en bloc laminectomy, hybrid laminectomy may be a safe and effective method for treating multilevel TOLF, potentially reducing intraoperative spinal cord irritation and CFL and causing relatively better functional recovery.

Objective:To analyze and summarize the operational mechanisms of the " National Facility for Translational Medicine (Shanghai)" (referred to as the Shanghai Facility), providing reference for the high-quality construction, management, and utilization of such facilities.Methods:Using the construction and operation of the Shanghai facility as a case study, this paper analyzed and discussed the facility's construction content, functional positioning, operational management systems, operational outcomes, in the meanwhile summarizing experience in construction and running of the facility.Results:Since the Shanghai facility was completed and officially put into operation in December 2020, significant achievements had been made in platform construction and operation.Conclusions:The successful operation of the Shanghai facility provides valuable experience for the construction of national major scientific and technological infrastructure in the field of translational medicine. In the future, its construction and management can be further improved through measures such as multi-channel fundraising, building-up of a multidisciplinary translational medicine talent team, and establishment of reasonable facility assessment criteria and talent evaluation standards.

Objective To investigate the impact of lower inspiratory peak flow rates on airway peak pressure when using a ventilator to maintain respiratory function during the advanced life support phase of in-hospital cardiopulmonary resuscitation(CPR).Methods A prospective study was conducted,30 patients who underwent CPR for more than 20 minutes admitted to Lishui Municipal Central Hospital between September 2021 and December 2023 were enrolled as the study subjects.Volume controlled ventilation(VCV)with a descending flow waveform was used,while other preset parameters remained unchanged.Airway peak pressure was measured at different peak flow rates(55,50,45,and 40 L/min).The influence of varying flow rates on peak pressure was analyzed.Results During CPR,patients were in a continuous state of chest compressions.When the ventilator parameters were set conventionally,alarms for high airway pressure,low tidal volume(VT),and high respiratory rate often occurred,which affected the effectiveness of ventilatory support.There was a significant variation in airway peak pressure among different patients.As the peak flow rate increased from 40 L/min to 55 L/min,the airway peak pressure gradually increased.During the process of reducing the peak flow rate,the pulse oxygen saturation(SpO2)of all patients remained stable without significant changes.The 40 L/min group had significantly lower peak pressures than the 50 and 55 L/min groups,whereas the 55 L/min group had significantly higher pressures than all others[cmH2O(1 cmH2O≈0.098 kPa):41.20±9.06 vs.47.90±9.04 and 53.70±7.96,all P<0.05].When comparing patients with peak flow rates of 40 L/min and 50 L/min,as well as 45 L/min and 55 L/min,the average airway peak pressure increased significantly with each 10 L/min increment in inspiratory peak flow rate.However,the SpO2 remained essentially unchanged or slightly increased as the peak flow rate decreased.There were no statistically significant differences in SpO2 among patients at different peak flow rate levels.When the peak flow rate was set at 55,50,45,and 40 L/min,the proportions of patients with airway peak pressure>40 cmH2O were 100.0%,83.3%,63.3%,and 53.3%,respectively.Among them,the proportions of patients with airway peak pressure>50 cmH2O were 66.7%,40.0%,16.6%,and 16.6%,respectively.As the peak flow rate decreased,the proportion of patients with airway peak pressure>40 cmH2O gradually decreased.If the peak flow rate was set at 45 L/min or lower,the number of patients with airway peak pressure>50 cmH2O during CPR was less than 50.0%of the total number of cases.Conclusions During mechanical ventilation in CPR,using volume-controlled ventilation(VCV)mode with a decelerating waveform,improper peak flow rate settings can easily trigger high airway pressure alarms and result in low tidal volume(VT),leading to poor synchrony between the ventilator and the patient.Compared to peak flow rates of 55 L/min and above,selecting an inspiratory peak flow rate of 40 L/min and setting the high-pressure alarm at 50 cmH2O is suitable for the mechanical ventilation needs of most patients and does not affect oxygenation levels.This is a more appropriate choice.

Objective To investigate the impact of lower inspiratory peak flow rates on airway peak pressure when using a ventilator to maintain respiratory function during the advanced life support phase of in-hospital cardiopulmonary resuscitation(CPR).Methods A prospective study was conducted,30 patients who underwent CPR for more than 20 minutes admitted to Lishui Municipal Central Hospital between September 2021 and December 2023 were enrolled as the study subjects.Volume controlled ventilation(VCV)with a descending flow waveform was used,while other preset parameters remained unchanged.Airway peak pressure was measured at different peak flow rates(55,50,45,and 40 L/min).The influence of varying flow rates on peak pressure was analyzed.Results During CPR,patients were in a continuous state of chest compressions.When the ventilator parameters were set conventionally,alarms for high airway pressure,low tidal volume(VT),and high respiratory rate often occurred,which affected the effectiveness of ventilatory support.There was a significant variation in airway peak pressure among different patients.As the peak flow rate increased from 40 L/min to 55 L/min,the airway peak pressure gradually increased.During the process of reducing the peak flow rate,the pulse oxygen saturation(SpO2)of all patients remained stable without significant changes.The 40 L/min group had significantly lower peak pressures than the 50 and 55 L/min groups,whereas the 55 L/min group had significantly higher pressures than all others[cmH2O(1 cmH2O≈0.098 kPa):41.20±9.06 vs.47.90±9.04 and 53.70±7.96,all P<0.05].When comparing patients with peak flow rates of 40 L/min and 50 L/min,as well as 45 L/min and 55 L/min,the average airway peak pressure increased significantly with each 10 L/min increment in inspiratory peak flow rate.However,the SpO2 remained essentially unchanged or slightly increased as the peak flow rate decreased.There were no statistically significant differences in SpO2 among patients at different peak flow rate levels.When the peak flow rate was set at 55,50,45,and 40 L/min,the proportions of patients with airway peak pressure>40 cmH2O were 100.0%,83.3%,63.3%,and 53.3%,respectively.Among them,the proportions of patients with airway peak pressure>50 cmH2O were 66.7%,40.0%,16.6%,and 16.6%,respectively.As the peak flow rate decreased,the proportion of patients with airway peak pressure>40 cmH2O gradually decreased.If the peak flow rate was set at 45 L/min or lower,the number of patients with airway peak pressure>50 cmH2O during CPR was less than 50.0%of the total number of cases.Conclusions During mechanical ventilation in CPR,using volume-controlled ventilation(VCV)mode with a decelerating waveform,improper peak flow rate settings can easily trigger high airway pressure alarms and result in low tidal volume(VT),leading to poor synchrony between the ventilator and the patient.Compared to peak flow rates of 55 L/min and above,selecting an inspiratory peak flow rate of 40 L/min and setting the high-pressure alarm at 50 cmH2O is suitable for the mechanical ventilation needs of most patients and does not affect oxygenation levels.This is a more appropriate choice.

Objective:To analyze and summarize the operational mechanisms of the " National Facility for Translational Medicine (Shanghai)" (referred to as the Shanghai Facility), providing reference for the high-quality construction, management, and utilization of such facilities.Methods:Using the construction and operation of the Shanghai facility as a case study, this paper analyzed and discussed the facility's construction content, functional positioning, operational management systems, operational outcomes, in the meanwhile summarizing experience in construction and running of the facility.Results:Since the Shanghai facility was completed and officially put into operation in December 2020, significant achievements had been made in platform construction and operation.Conclusions:The successful operation of the Shanghai facility provides valuable experience for the construction of national major scientific and technological infrastructure in the field of translational medicine. In the future, its construction and management can be further improved through measures such as multi-channel fundraising, building-up of a multidisciplinary translational medicine talent team, and establishment of reasonable facility assessment criteria and talent evaluation standards.