Objective:To investigate the values of two-dimensional and three-dimensional echocardiographic parameters in predicting pulmonary vascular resistance (PVR) in chronic pulmonary thromboembolic pulmonary hypertension (CTEPH).Methods:A total of 141 patients diagnosed with CTEPH in China-Japan Friendship Hospital from November 2015 to December 2022 were included. Two-dimensional echocardiographic indicators reflecting PVR were constructed according to the calculation formula of PVR: echocardiographic estimated systolic pulmonary artery pressure (sPAP Echo)/left ventricular end-diastolic diameter (LVIDd), echocardiographic estimated mean pulmonary artery pressure (mPAP Echo)/LVIDd. sPAP Echo/left ventricular end-diastolic volume (LVEDV), sPAP Echo/left ventricular cardiac output (LVCO) were measured by three-dimensional echocardiography. The correlations between two-dimensional and three-dimensional echocardiographic ratios and invasive PVR were then analyzed using the Spearman correlation method. Using receiver operating characteristic curve analysis, cut-off values for the ratios were generated to identify patients with PVR>1 000 dyn·s -1·cm -5. Pre- and postoperative hemodynamics and echocardiographic data were analyzed, as well as the correlation between the reduction rate of the echocardiographic index and PVR in 54 patients who underwent pulmonary endarterectomy (PEA). Results:sPAP Echo/LVIDd, sPAP Echo/LVEDV and sPAP Echo/LVCO were moderately correlated with PVR( rs=0.62, 0.52, 0.63, both P<0.001). The ratio of sPAP Echo to LVEDV, when greater than or equal to 1.41, had a sensitivity of 0.800 and a specificity of 0.930 for determining PVR >1 000 dyn·s -1·cm -5 (AUC=0.860, P<0.001). Similarly, the ratio of sPAP Echo to LVIDd, when greater than or equal to 2.14, had a sensitivity of 0.647 and a specificity of 0.861 for determining PVR >1000 dyn·s -1·cm -5 (AUC=0.830, P<0.001). The sPAP Echo/LVIDd and mPAP Echo/LVIDd significantly decreased after PEA (both P<0.001). The sPAP Echo/LVIDd and mPAP Echo/LVIDd reduction rate (ΔsPAP Echo/LVIDd and ΔmPAP Echo/LVIDd) were significantly correlated with PVR reduction rate (ΔPVR), respectively ( rs=0.61, 0.63, both P<0.05). Conclusions:Two-dimensional ratio sPAP Echo/LVIDd and three-dimensional ratio sPAP Echo/LVEDV can be used to noninvasively estimate PVR in CTEPH patients. The conventional ratio sPAP Echo/LVIDd is convenient and reproducibly suitable for monitoring the improvement of PVR before and after treatment, and its ratio of 2.14 can predict the significant increase of PVR in CTEPH patients (>1 000 dyn·s -1·cm -5).

Objective:To observe the feelings of listening to music and the importance of music in the daily life of post-lingual deaf adults with cochlear implants, and to explore the relevant influencing factors.Methods:This was a cross-sectional survey study. From January 2021 to August 2021,the Music-Related Quality of Life Scale was used to evaluate the music needs and music experiences of 63 post-lingual deaf adults who met the inclusion criteria, including 27 males and 36 females, aged (40.7±12.3) years, at the time of surgery (36.8±13.1) years, and with a preoperative hearing aid ineffective time of (3.9±5.8) years. Indicators analyzed included age, duration of ineffective preoperative hearing aid wear, preoperative music preference, duration of postoperative cochlear implant use, current hearing aid modality, and auditory rehabilitation outcomes. Whether the six factors mentioned above constituted an influence on the subjects′ music listening was investigated using SPSS 25.0 statistical software.Results:All of the observations in the scale were correlated with a single factor. The two sub-dimensions of music experience section were related to the effect of auditory rehabilitation. In the importance section, the effect of auditory rehabilitation was the influential factor of the dimension of "participation importance", and the preoperative enjoyment of music was the relevant influential factor of the dimension of "perceived importance". There was a significant difference between the groups when they were grouped by the above factors ( P value<0.05), while there was no statistically significance between the groups when they were grouped by other factors ( P value>0.05). Conclusions:Post-lingual deaf adults show the need and attempt to listen to music after cochlear implantation. The effectiveness of auditory rehabilitation and the degree of music preference preoperatively are two important factors that influence music listening in implant recipients. Once the level of auditory communication has been restored to a certain degree, it is important to pay more attention to the needs of music for implant recipients and train them in time, especially for those with music preferences preoperatively.

Objective To propose strategies for developing clinical predictive models,aiming to assist researchers in conducting standardized clinical prediction model studies.Methods Literature review was conducted to summarize the operational steps and content for developing clinical predictive models.Then,a methodological framework was summarized and refined through expert consultation.Results The 11-step methodological framework for developing clinical predictive models was obtained by synthesizing the experience of 456 clinical predictive modeling studies and expert consultation,and the details were analyzed and elaborated.Conclusions This study presents methodological strategies and recommendations for the development of clinical predictive models,intended to serve as a guide for researchers.

Objective To investigate whether κ-opioid receptor (KOR) agonist U50488H alleviates acute lung injury (ALI) induced by cardiopulmonary bypass (CPB) in rats by regulating macrophage polarization. Methods Twenty-four adult male clean grade SD rats (weight of 50 to 450 g) were randomly divided into Sham group (sham surgery), CPB group (CPB), and U50488H group (KOR agonist+CPB), with 8 rats in each group. The U50488H group was intravenously injected with 1.5 mg/kg of U50488H 30 minutes before CPB. Arterial blood gas analysis was performed at 0, 1 hour and 2 hours after CPB to calculate the alveolar-arterial oxygen gradient (A-aDO₂) and respiratory index (RI). Rats of all three groups were euthanized 2 hours after CPB cessation, and the entire right lower lobe of the lung was excised. The extravascular lung water (EVLW) was measured using the gravimetric method, and lung tissue morphology changes were observed through hematoxylin-eosin (HE) staining. Enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of plasma lipopolysaccharide (LPS), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and interleukin-4 (IL-4). Immunofluorescence was used to measure the levels of iNOS and CD206 in the lung tissue of rats. Results Compared to the Sham group, the CPB group of rats showed significant increases in extravascular lung water (EVLW) and levels of TNF-α, plasma IL-6 and lung tissue iNOS expression, as well as significant decreases in plasma IL-4 levels and lung tissue CD206 expression (P < 0.05). At 0, 1 hour and 2 hours after CPB, A-aDO₂, RI and LPS in the CPB group weresignificantly higher than those in the Sham group, and A-aDO₂, RI and LPS in the U50488H group were significantly lower than those in the CPB group (P < 0.05). The rats in the CPB group showed severe lung injury with alveolar congestion/bleeding and extensive infiltration of inflammatory cells, while lung injury was significantly reduced in the U50488H group. Conclusion The KOR agonist U50488H can promote M2 polarization of lung macrophages in rats after CPB, reduce inflammatory response, increase anti-inflammatory factor release, and thereby reducing the occurrence of ALI after CPB.

Objective:To investigate the value of 18F-FDG PET/CT imaging signs and metabolic parameters in predicting tumor spread through air spaces (STAS) of stage Ⅰ lung adenocarcinoma. Methods:From January 2019 to December 2021, clinical, imaging and metabolic parameters of 381 patients (126 males, 255 females, age (61.2±9.2) years) with stage Ⅰ lung adenocarcinoma were retrospectively analyzed in the Affiliated Hospital of Qingdao University. According to the postoperative pathological results, patients were divided into STAS positive group and STAS negative group. According to the operation time, patients were divided into training set ( n=254) and verification set ( n=127). χ2 test or Mann-Whitney U test was used to compare the differences of different parameters between patients with STAS positive and negative, and binary logistic regression analysis was used to select the predictors of STAS status. The prediction model was established, and ROC curve was used to evaluate the predictive efficacy. Results:There were 49(19.3%, 49/254) patients with STAS positive and 205(80.7%, 205/254) patients with STAS negative in the training set, while those were 35(27.6%, 35/127) and 92(72.4%, 92/127) in the verification set. In the training set, the differences of age ( z=-2.30, P=0.021), type of lesions ( χ2=6.81, P=0.009), spiculation ( χ2=12.64, P<0.001), bronchus truncation ( χ2=6.98, P=0.008), ground glass ribbon sign ( χ2=26.93, P<0.001) and SUV max ( z=-4.62, P<0.001) between the two groups were statistically significant. Multivariate logistic regression analysis showed that age (odds ratio ( OR)=1.048, 95% CI: 1.004-1.094, P=0.032), ground glass ribbon sign ( OR=3.857, 95% CI: 1.693-8.788, P=0.001) and SUV max ( OR=1.133, 95% CI: 1.001-1.282, P=0.049) were independent predictors of STAS status in stage Ⅰ lung adenocarcinoma patients. The logistic regression model was P=1/(1+ e - x), x=-5.292+ 0.480×age (year)+ 1.493×ground glass ribbon sign+ 0.170×SUV max. The AUCs of the model in the training set and verification set were 0.770 and 0.801, with the sensitivity of 81.6%(40/49) and 82.9%(29/35), and the specificity of 69.8%(143/205) and 65.2%(60/92), respectively. Conclusion:Age, ground glass ribbon sign and SUV max have good predictive effects on the occurrence of STAS in stage Ⅰ lung adenocarcinoma.

Objective:To understand the mental health of residents and specialists during the COVID-19 outbreak and provide references for improving their mental health.Methods:An online questionnaire survey was conducted, using the Generalized Anxiety Disorder Scale and the Patient Health Questionnaire Depression Rating Scale, to evaluate the mental health of 302 residents and specialists in a top general hospital. SPSS 23.0 was used to perform t-test on the relevant data. Results:Among them, 32.5% (98/302) and 49.7% (150/302) of those physicians showed varying degrees of anxiety disorder and depression, of which 6.3% (19/302) and 18.6% (56/302) were moderate or higher anxiety and depression. After they were grouped according to work fatigue scores (boundary as 60 points), risk degree of infection with the COVID-19, frequency of duty, and sleep time (boundary as 7 h), there were statistically differences in the physician self-evaluation rates of anxiety and depression between the two groups ( P<0.05). After controlling the above variables, Logistic regression results showed that the physicians with high risk of infection with the COVID-19 were more likely to show anxiety ( OR=2.142, 95%CI=1.170-3.922) and depression ( OR=2.038, 95%CI=1.185-3.505) than those with low-risk. Conclusion:In the context of the COVID-19 outbreak, residents and specialists, especially those with high risk of infection with the COVID-19, show severe mental health problems such as anxiety disorders and depression, which requires special attention and support.

Objective To investigate the effect of replacing a smaller-size catheter after tubularized incised plate (TIP) urethroplasty on postoperative urethral complications.Methods The data of 116 hypospadias patients underwent TIP urethroplasty performed by the same urologist in our hospital from January 2014 to December 2017 were retrospectively analyzed.The age of patients ranged from 0.5-15.4 years,with the median age of 1.5 years.Meatal location was distal in 47 (39.5％),midshaft in 62 (52.1％) and proximal in 10(8.4％) patients.Unhealthy urethral plate occurred in 49 (42.2％) patients.F8 catheter was used for urethroplasty in 92 (79.3 ％) patients,F10 in 17 (14.7％),and F12 in 7 (6.0％).According to the pattern of urinary diversion,patients were divided into two groups.Conventional catheter group in 56 patients (group A):the catheter was chosen in as large size as possible for urethroplasty without tension.Replace a smaller-size catheter group in 60 patients (group B):replace a smaller-size catheter after urethroplasty on the basis of group A.There were no statistically significant differences in age,meatal location and catheter size between the two groups (P ＞ 0.05).Results The mean follow up was 23 months (range 6-66 months).There were 73(62.9％) cases of orifice overflow during indwelling catheterization.There were 5 (4.3％) patients needed further reoperation result from postoperative urethral complications,including 4 cases of fistula and 1 case of meatal stenosis.The process of replacing a smaller-size catheter after urethroplasty in group B was simple and without adverse reactions.There were 15 (26.8％) cases of orifice overflow in group A and 58 (96.7％) in group B.There were statistically significant differences in orifice overflow between the two groups (P ＜ 0.05).There were 5 (8.9％) cases of postoperative urethral complications in group A and 0 case in group B.There were statistically significant differences in postoperative urethral complications (P ＜ 0.05).Conclusions The process of replacing a smaller-size catheter after TIP urethroplasty in was simple and subsequently contributed to less postoperative urethral complications.The results of replacing a smaller-size catheter after TIP urethroplasty were superior to that of no replacing conventionally.

Objective To investigate the effect of small dose of dexmedetornidine on venous continuous infusion combined with oxycodone or fentanyl during brachial plexus blockade.Methods Sixty thyroid patients (ASA Ⅰ or Ⅱ) undergone brachial plexus anesthesia for cutting or cutting thyroid tumor patients were randomly and double-blindly into three groups (n =20 in each group).Group A:single brachial plexus anesthesia;group B:dexmedetornidine combined with fentanyl;group C:dexmedetornidine combined with oxycodone.Blood pressure (Bp),heart rate (HR),the determination of plasma norepinephrine (NE),cortisol (Cor),the concentration of blood glucose (Glu),VAS,Ramsay calm score,local anesthetics dosage and side effect formation rate at the beginning operation (To),skin incision (T1),separation of the glands (T2),gland excision (T3),and the end of the surgery (T4) were recorded.Results Compared to group A,the mean arterial pressure (MAP),HR,NE,Cor,and Glu were much lower at each time point (P ＜ 0.05) in groups B and C;Ramsay calm score and VAS score were significantly better at each time point (P ＜ 0.05);the incidence of chills and lidocaine additional quantity were significantly lower (P ＜0.01).However,compared to groups A and C,choking cough response rates were much higher in group B (P ＜ 0.01).Conclusions Small dose of dexmedetornidine on venous continuous infusion combined with oxycodone during brachial plexus blockade for thyroid patients both can eliminate the preoperative patients nervous anxiety,and effectively restrain perioperative stress response,maintain hemodynamics stable,implementation of intraoperative awaken to reduce complications.It is the new choice of anesthetic adjuvant.

Objective To evaluate the value of bispectral index(BIS)monitoring as an indicator for extubation sedation level after children's oper?ation by total intravenous anesthesia. Methods One hundred and eighty children(2?13 years old)were randomly divided into six groups with 30 cases in each. Group A kept BIS 56?60,and Group B 61?65,Group C 66?70,Group D 71?75,Group E 76?80,Group F 81?85 till extubation. All children were given fentanyl,propofol and cisatracurium besilate when induced,and maintained with propofol and remifentanil. All cases kept BIS 40?55 during the operation. Then the changes of electrocardiogram,mean arterial pressure,heart rate,SpO2,postoperative complications and recovery time were observed. Results Groups A and B were extubated at deep anesthesia,cycle stability,but with high incidence of adverse reactions and awaked with a long time. Groups E and F were extubated when awaked,but with greater stimulation and easier agitation. Groups C and D were lighter hemodynamic responses,less respiratory effects and less postoperative complications of anesthesia. Conclusion The BIS level of 66?75 is a good se?dation level for extubation,especially in the level of 71?75.

Objective To study the effects of using 25 kDa linear and branched PEI to transfer plasmid DNA pEGFP -C1 (pDNA ,encoding the enhanced green fluorescent protein reporter gene ) to the basilar membrane of the C57BL/6 mice cochlea in vitro .Methods L -PEI/pDNA and B -PEI/pDNA polyplexes were generated in 0 .1M phosphate buffer solution (PBS) or 5% glucose solution .Polyplexes were characterized by transmission electron mi-croscopy .Agarose gel retardation assay was used to determine the plasmid binding ability of L -PEI and B -PEI . The toxicity was investigated by MTT assay .The transfection was firstly evaluated in 293T cell line ,and then the appropriate amount of PEI and plasmid were applied for cochlear explant transfection of P4 mice pups .Results Un-der the same condition ,B -PEI had better transfection efficiency than L -PEI ,but its toxicity was also higher . When generated in PBS ,the polyplexes had lower toxicity than in glucose solution .L -PEI-pDNA nanoparticles could transfect the spiral limbus fibrocytes ,some spiral ganglion neurons and supporting cells ,but the efficiency was low .Conclusion L -PEI could be used as the non -viral vector for the transfection of the cultured basilar mem-brane of P4 mice pups ,but it should be modified to reach higher efficiency .