Objective To compare and analyze the early- to mid-term outcomes of transcatheter aortic valve replacement (TAVR) combined with percutaneous coronary intervention (PCI) versus surgical aortic valve replacement (SAVR) combined with coronary artery bypass grafting (CABG) for the treatment of significant aortic stenosis (AS) and coronary artery disease (CAD). Methods The data of patients with significant AS and CAD who underwent surgical treatment at Central China Fuwai Hospital of Zhengzhou University from January 2018 to July 2023 were collected. These patients were divided into a TAVR+PCI group and a SAVR+CABG group according to the operation method. Propensity score matching (PSM) was used to select patients with close clinical baseline characteristics, and the early- to mid-term outcomes of the two groups were compared. Results A total of 272 patients were enrolled, including 208 males and 64 females, with a mean age of (64.16±8.24) years. There were 47 patients in the TAVR+PCI group and 225 patients in the SAVR+CABG group. After 1 : 1 PSM, 32 pairs were selected. There was no statistical difference in baseline data between the two groups (P>0.05). Compared with the SAVR+CABG group, the TAVR+PCI group had significantly shorter operative time, mechanical ventilation time, ICU stay, postoperative hospital stay, and less intraoperative bleeding, and significantly lower postoperative transfusion and complete revascularization rates (P<0.05). The differences in the rates of postoperative in-hospital death, myocardial infarction, stroke, or other complications between the two groups were not statistically significant (P>0.05), and the differences in the rates of moderate-to-severe perivalvular leakage, death, or readmission in the mid-term follow-up were not statistically significant (P>0.05). Conclusion In patients with significant AS and CAD, the early- and mid-term rates of death and complications are similar between those treated with TAVR+PCI and SAVR+CABG, and TAVR+PCI is a safe alternative to SAVR+CABG.

Objective This study aims to observe the clinical effect of bone plate reduction in combination with a re-sorbable plate on large mandibular cysts.Methods Between October 2017 and September 2022,patients with large mandibular cysts in the presence of labial and buccal cortical bone were involved in the study.Intraoral approach was performed for bone plate reduction.Cone beam computed tomography(CBCT)scan was reviewed at 3,6,and 9 months postoperatively to observe postoperative complications.Osteogenic results were assessed at these times to determine the clinical outcomes of this procedure.Results Eleven cases with large mandibular cysts in the presence of cortical bone were evaluated.The average thickness of the cortical bone on the labial and buccal sides was measured to be about(1.98±0.37)mm before surgery,with a mean value of(0.73±0.17)mm at the thinnest part of the plate and up to 0.51 mm at the thinnest part of the plate.The cystic cavities were well re-vealed during the surgeries,which were completed suc-cessfully.Postoperatively,the wounds healed in one stage without infection.The percentages of cyst shrinkage were 20.01%,41.76%,and 73.41%at 3,6,and 9 months after surgery,respectively.Quantitative measurement of bone mineral density in the jaws by CBCT with MIMICS software.The bone mineral densities of the adult bone were 313.78,555.85,and 657.45 HU at the 3,6,and 9 month time intervals,respectively.No significant change in the patient's maxillofacial appearance were observed from the preoperative period as assessed by the patient's and observer's visual analog scale.Conclusion Bone plate reduction is an effective treatment for large mandibular cysts of the oral and maxillofacial re-gion with the presence of cortical bone.

Objective To make a comprehensive analysis of the index of benefit and medical service ability of disease,and provide references for the operation management of public hospital based on disease.Methods TOPSIS was used to compre-hensively evaluate the income contribution,income structure,daily income,the proportion of operation/grade 4 operation,DRG-CMI and other indexes.According to the Boston matrix,two-dimensional quadrant analysis was carried out to determine the dominant diseases in the operation management.Results Twelve main diseases in a hospital specialty were analyzed,and the comprehensive scores of two dimensions of benefit and medical service ability were formed.According to the scores,a two-dimen-sional quadrant map was drawn,and the characteristics of diseases in each quadrant were summarized to identify the dominant diseases that contribute greatly to the economic operation and technical difficulty evaluation of the specialty.Conclusion The combined application of TOPSIS and Boston matrix in specialty operation analysis can help public hospital to realize the classifica-tion management of disease balancing benefit and difficulty,so as to optimize the disease structure and improve the utilization rate of medical resources.

Microneedle percutaneous immunization is achieved by puncturing the stratum corneum of the skin with microneedles so that the vaccine is efficiently recognized by antigen-presenting cells to induce a specific immune response. Due to the advantages of efficient induction of immune response, low pain and easy storage, transdermal immunization by microneedles has been widely used for immunization of various vaccines in recent years. This review summarizes the materials of microneedles, application for transcutaneous immunization, as well as the challenges that need to be addressed.
Administration, Cutaneous ; Drug Delivery Systems ; Needles ; Vaccination ; Vaccines

OBJECTIVETo evaluate effectiveness therapeutic regimens for obstructive sleep apnea hypopnea syndrome (OSAHS) children at an acceptable cost.

METHODThis study was performed at Yuying Children's Hospital of Wenzhou Medical University from Mar. 2008 to Dec. 2010. Prospective random number table method was used for the analysis; 60 children with mild OSAHS were divided into Mild OSAHS Montelukast Treatment (MM) group and Mild OSAHS Adenotonsillectomy Treatment (MAT) group. 32 children in MM group were treated with leukotriene receptor antagonists (LTRAs), while 28 children in MAT group were treated with adenotonsillectomy. Also, 58 children with moderate and severe OSAHS were divided into severe OSAHS Montelukast Treatment (SM) group and severe OSAHS Adenotonsillectomy Treatmen (SAT) group. Twenty-two children in SM group were treated with LTRAs, while 36 children in SAT group were treated with adenotonsillectomy. All selected children were evaluated by polysomnography (PSG) and Obstructive Sleep Apnea-18 (OSA-18) items before and after a six-month treatment. Both records were taken and analyzed, surgical complications and the reason for non-remission after operation were also analyzed. Two therapies were compared based on economic consideration and therapeutic effect. Result (1) PSG: A significant change of a significant change of Apnea Hypopnea Index (AHI) was observed in MM group after the treatment (before receiving the treatment 4.56 ± 1. 26, and after receiving the treatment 3. 48 ± 1. 52, t =3. 50, P <0. 05). But for oxygen desaturation Index (ODI) (MM group 2. 18 ± 2. 19, and MAT group 1. 80 ± 2. 34) and Lowest Oxygen satuation (LSaO2) (MM group 91. 66 ± 2. 34, and MAT group 92. 79 ± 2. 18), there was no significant difference in MM group and MAT group after the treatment (ODI, t =0. 65, and LSaO2 t = - 1. 93, P >0. 05). (2) OSA-18 scores: Significant differences were found in sleeping disorder (before 14. 81 ± 6. 28, and after 10. 56 ± 3. 57), the degree of familial stress (before 13. 56 ± 3. 54, and after 8. 97 ± 2. 96), and OSA-18 total scores (before 52. 66 ± 1. 11, and after 42. 56 6. 48) in MM group after the treatment (sleeping disorder Z - 3. 14, the degree of familial stress Z = -4. 50, and OSA-18 total scores Z= -4. 01, P <0. 05). (3) In addition to the cost of drugs, groups with surgical treatment had a larger economic burden than those with LTRAs treatment. (4) Treatment was totally effective for 28 children (88%) in MM group, and 28 children (100%) in MAT group. Meanwhile, treatment also achieved an obvious effect on 2 children (9%) in SM group, and in 35 children (97%) in SAT group. In MAT group, 3 children improved (11%). And in SAT group, 7 children improved (19%), but treatment was found to be ineffective in 1 case (3%). Among those effective and ineffective cases in groups with surgical treatment, there were 9 children with nasal diseases.

CONCLUSION(1) Surgical treatment is recommended as the first choice for children with moderate and severe OSAHS. And for those who also suffer from nasal diseases, treatment combining drugs with surgery is necessary. (2) LTRAs therapy has a good effect for mild OSAHS. Surgery is also recommended when drugs could not achieve any obvious improvement in clinical symptoms of children with mild OSAHS.

Adenoidectomy ; Blood Gas Analysis ; Child ; Cost of Illness ; Humans ; Oxygen ; Polysomnography ; Prospective Studies ; Sleep Apnea, Obstructive ; surgery ; Sleep Wake Disorders ; Tonsillectomy ; Treatment Outcome

Two-factor designs are quite commonly used in scientific research. If the two factors have interactions, research designs like the factorial design and the orthogonal design can be adopted; however, these designs usually require many experiments. If the two factors have no interaction or the interaction is not statistically significant on result in theory and in specialty, and the measuring error of the experimental data under a certain condition (usually it is one of the experimental conditions which is formed by the complete combination of the levels of two factors) is allowed in specialty, researchers can use random block design without repeated experiments, balanced non-complete random block design without repeated experiments, single factor design with a repeatedly measured factor, two-factor design without repeated experiments and two-factor nested design. This article introduced the first three design types with examples.

OBJECTIVETo study the absorption and metabolism of five flavonoids of Herba Epimedii (icariin, epimedin A, epi-medin B, epimedin C and baohuoside I) in rat intestine.

METHODUsing the rat intestinal perfusion model, the contents of the five flavonoids in perfusates were measured by HPLC and the permeability coefficients in different intestines were calculated.

RESULTThe permeabilities of five flavonoids in duodenum, jejunum, ileum, colon according to the sequence were as: icariin: 6.365, 5.349, 1.004, 0.601, epimedinA: 4.120, 3.397, 0.401, 0.257, epimedin B: 3.645, 3.135, 0.990 7, 0.434, epimedin C: 3.114, 2.882, 0.688, 0.470, baohuoside I: 2.324, 2.398, 1.529, 1.045, respectively. The analysis of the perfusates showed that icariin, epimedin A, epimedin B, epimedin C could be hydrolyzed in intestine. Icariin had two hydrolytic metabolites, whereas epimedin A, B, C only had one hydrolytic metabolite, respectively.

CONCLUSIONThe results indicated that the absorption of all the five flavonoids was significantly different in different intestinal segments, and the permeability in ileum and colon was significantly lower than that of the duodenum and jejunum. The metabolites of icariin, epimedin A, epimedin B, epimedin C were related with their structures and enzymes in intestine, and the metabolites were more in duodenum, jejunum, whereas were less in ileum and colon.

Absorption ; Animals ; Epimedium ; chemistry ; Flavonoids ; metabolism ; pharmacokinetics ; Intestines ; drug effects ; physiology ; Male ; Models, Animal ; Perfusion ; Plant Extracts ; metabolism ; pharmacokinetics ; Rats ; Rats, Sprague-Dawley