Although low temperature plasma ablation technology has significant advantages in clinical applications,its poor stability,high power consumption and thermal injuries to the tissues are still key factors limiting its widespread use.To address these issues,a device that uses bipolar pulses to excite plasma is developed,and it can flexibly adjust its output voltage,frequency and duty cycle,effectively reducing breakdown voltage and power consumption.By conducting simulation and saltwater discharge experiments,the excitation process of plasma is elaborated in detail.Meanwhile,the effects of two different pulse excitation modes on plasma excitation are discussed and compared.The results show that the bipolar pulse excitation mode is advantageous in reducing discharge current and breakdown voltage,and shortening the formation time of the vapor layer,which effectively relieves thermal injuries to the tissues.Finally,the broad application potential of the plasma ablation device is demonstrated in plasma ablation experiments which are conducted at different voltages,with pork as the experimental material.The study provides a new theoretical basis and practical guidance for the application of plasma ablation technology in minimally invasive surgery.

Objective:To explore the influencing factors of evacuation associated pulmonary edema (WIPE) in patients with mechanical ventilation of cardiogenic respiratory failure, and to build a risk warning model based on independent influencing factors.Methods:A total of 220 patients with cardiogenic respiratory failure who were treated and received mechanical ventilation in Chengbei Campus of Hangzhou First People′s Hospital from April 2021 to December 2023 were retrospectively selected by cross-sectional investigation method, and were divided into WIPE group (34 cases) and non WIPE group (186 cases) according to whether the patients had WIPE or not. Clinical data of the patients were analyzed using the hospital electronic medical record system. The influencing factors of WIPE were determined by univariate analysis and multivariate Logistic regression analysis, and the risk early warning model was constructed based on regression analysis. The corresponding nomogram was drawn by R language software, and the predictive efficiency of the model was tested by receiver operating characteristic curve and calibration curve.Results:WIPE group included 18 males and 16 females, aged (65.12±9.28) years. Non WIPE group included 107 males and 79 females, aged (60.25±8.40) years. Multivariate Logistic regression analysis showed that age ( OR=1.072), smoking history ( OR=3.412), acute physiology and chronic health evaluationⅡ( OR=1.184), cardiac function classification ( OR=4.043), shallow rapid breathing index ( OR=1.100), mechanical ventilation time ( OR=1.540), hypertension ( OR=4.903), left ventricular diastolic dysfunction ( OR=5.151) and chronic obstructive pulmonary disease ( OR= 5.536) were independent influencing factors (all P < 0.05). The area under the curve of the risk early warning model constructed based on the above 9 independent influencing factors was 0.938, and the sensitivity and specificity corresponding to the optimal cutoff value of 0.620 were 0.971 and 0.801, respectively, indicating good differentiation ability. The calibration curve results show that the average absolute error was 0.020, the calibration curve fits the ideal curve, and the model calibration performance was good. Conclusions:WIPE in patients with cardiogenic respiratory failure induced by mechanical ventilation is affected by cardiac function status, mechanical ventilation parameters and other factors. The risk early warning model based on the above 9 independent influencing factors has good predictive efficacy, and can provide reference for clinical prevention of WIPE.

Objective:To investigate the correlation between oral cleanliness and secondary Pulmonary infection in patients with severe chronic obstructive pulmonary disease (COPD) in mechanical ventilation, and to investigate the predictive effect of oral cleanliness on the risk of secondary pulmonary infection.Methods:Using the cross-sectional survey method, the purposeful sampling method was adopted to select 216 patients with severe COPD who were hospitalized in Hangzhou First People′s Hospital from June 2020 to December 2023 and received mechanical ventilation. The oral cleanliness index and general clinical data of patients at admission were collected using the hospital electronic medical record system. The independent influencing factors of secondary lung infection were analyzed by univariate analysis and multivariate Logisitic regression. The predictive value of oral cleanliness index on secondary lung infection was analyzed by patient operating characteristic (ROC) curve.Results:216 patients with severe COPD who underwent mechanical ventilation were included.Patients aged 37-84 (66.81 ± 8.98) years were included, including 125 males and 91 females.Among them, 89 cases developed secondary pulmonary infection, with an infection rate of 41.20%.Univariate analysis and multivariate Logistic regression analysis showed that, Beck Oral Rating Scale (BOAS) score ( OR = 1.371), visual simulation score of oral odor ( OR = 1.405), gum index ( OR = 3.508), plaque index ( OR = 14.357), smoking history ( OR = 6.772), duration of disease ( OR = 1.391), COPD assessment test score ( OR = 1.269) and mechanical ventilation time ( OR = 1.302) were independent factors for secondary pulmonary infection (all P<0.05). ROC curve analysis showed that oral cleanliness index combined with infection prediction was effective (the area under the ROC curve was 0.833) . Conclusions:Oral cleanliness was closely related to secondary pulmonary infection in patients with severe COPD with mechanical ventilation. BOAS score, visual simulation score of oral odor, gingival index and plaque index could predict secondary pulmonary infection independently, and combined test could predict secondary pulmonary infection.

Although low temperature plasma ablation technology has significant advantages in clinical applications,its poor stability,high power consumption and thermal injuries to the tissues are still key factors limiting its widespread use.To address these issues,a device that uses bipolar pulses to excite plasma is developed,and it can flexibly adjust its output voltage,frequency and duty cycle,effectively reducing breakdown voltage and power consumption.By conducting simulation and saltwater discharge experiments,the excitation process of plasma is elaborated in detail.Meanwhile,the effects of two different pulse excitation modes on plasma excitation are discussed and compared.The results show that the bipolar pulse excitation mode is advantageous in reducing discharge current and breakdown voltage,and shortening the formation time of the vapor layer,which effectively relieves thermal injuries to the tissues.Finally,the broad application potential of the plasma ablation device is demonstrated in plasma ablation experiments which are conducted at different voltages,with pork as the experimental material.The study provides a new theoretical basis and practical guidance for the application of plasma ablation technology in minimally invasive surgery.

Objective:To explore the influencing factors of evacuation associated pulmonary edema (WIPE) in patients with mechanical ventilation of cardiogenic respiratory failure, and to build a risk warning model based on independent influencing factors.Methods:A total of 220 patients with cardiogenic respiratory failure who were treated and received mechanical ventilation in Chengbei Campus of Hangzhou First People′s Hospital from April 2021 to December 2023 were retrospectively selected by cross-sectional investigation method, and were divided into WIPE group (34 cases) and non WIPE group (186 cases) according to whether the patients had WIPE or not. Clinical data of the patients were analyzed using the hospital electronic medical record system. The influencing factors of WIPE were determined by univariate analysis and multivariate Logistic regression analysis, and the risk early warning model was constructed based on regression analysis. The corresponding nomogram was drawn by R language software, and the predictive efficiency of the model was tested by receiver operating characteristic curve and calibration curve.Results:WIPE group included 18 males and 16 females, aged (65.12±9.28) years. Non WIPE group included 107 males and 79 females, aged (60.25±8.40) years. Multivariate Logistic regression analysis showed that age ( OR=1.072), smoking history ( OR=3.412), acute physiology and chronic health evaluationⅡ( OR=1.184), cardiac function classification ( OR=4.043), shallow rapid breathing index ( OR=1.100), mechanical ventilation time ( OR=1.540), hypertension ( OR=4.903), left ventricular diastolic dysfunction ( OR=5.151) and chronic obstructive pulmonary disease ( OR= 5.536) were independent influencing factors (all P < 0.05). The area under the curve of the risk early warning model constructed based on the above 9 independent influencing factors was 0.938, and the sensitivity and specificity corresponding to the optimal cutoff value of 0.620 were 0.971 and 0.801, respectively, indicating good differentiation ability. The calibration curve results show that the average absolute error was 0.020, the calibration curve fits the ideal curve, and the model calibration performance was good. Conclusions:WIPE in patients with cardiogenic respiratory failure induced by mechanical ventilation is affected by cardiac function status, mechanical ventilation parameters and other factors. The risk early warning model based on the above 9 independent influencing factors has good predictive efficacy, and can provide reference for clinical prevention of WIPE.

Objective:To investigate the correlation between oral cleanliness and secondary Pulmonary infection in patients with severe chronic obstructive pulmonary disease (COPD) in mechanical ventilation, and to investigate the predictive effect of oral cleanliness on the risk of secondary pulmonary infection.Methods:Using the cross-sectional survey method, the purposeful sampling method was adopted to select 216 patients with severe COPD who were hospitalized in Hangzhou First People′s Hospital from June 2020 to December 2023 and received mechanical ventilation. The oral cleanliness index and general clinical data of patients at admission were collected using the hospital electronic medical record system. The independent influencing factors of secondary lung infection were analyzed by univariate analysis and multivariate Logisitic regression. The predictive value of oral cleanliness index on secondary lung infection was analyzed by patient operating characteristic (ROC) curve.Results:216 patients with severe COPD who underwent mechanical ventilation were included.Patients aged 37-84 (66.81 ± 8.98) years were included, including 125 males and 91 females.Among them, 89 cases developed secondary pulmonary infection, with an infection rate of 41.20%.Univariate analysis and multivariate Logistic regression analysis showed that, Beck Oral Rating Scale (BOAS) score ( OR = 1.371), visual simulation score of oral odor ( OR = 1.405), gum index ( OR = 3.508), plaque index ( OR = 14.357), smoking history ( OR = 6.772), duration of disease ( OR = 1.391), COPD assessment test score ( OR = 1.269) and mechanical ventilation time ( OR = 1.302) were independent factors for secondary pulmonary infection (all P<0.05). ROC curve analysis showed that oral cleanliness index combined with infection prediction was effective (the area under the ROC curve was 0.833) . Conclusions:Oral cleanliness was closely related to secondary pulmonary infection in patients with severe COPD with mechanical ventilation. BOAS score, visual simulation score of oral odor, gingival index and plaque index could predict secondary pulmonary infection independently, and combined test could predict secondary pulmonary infection.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective To investigate the efficacy and safety of Cyberknife in the treatment of elderly patients(aged≥75 years)with early stage non-small cell lung cancer(NSCLC),and to compare the results with those of patients aged<75 years.Methods We retrospectively analyzed 75 patients with early(T1-2N0M0)NSCLC admitted to the 960th Hospital of Jinan People's Liberation Army from January 2013 to October 2019.There were 32(42.7%)patients aged<75 years,and 43(57.3%)patients aged≥75 years.All patients were treated with 45-66Gy/3-8F,60%-85%isodose line as the prescription dose to cover planning target volume(PTV),and irradiation once a day and five times a week.The clinical efficacy,survival status and radiotherapy toxicity of the two groups were compared,and the factors affecting the efficacy of elderly patients were analyzed.Results The disease control rates of patients aged<75 and≥75 years were 96.9%and 93.0%,respectively(P>0.05).The 5-year local control rate(LC),progression-free survival(PFS)and cancer-specific survival(CSS)were 70.9%and 85.4%,58.5%and 54.4%,and 70.4%and 64.5%,respectively(P>0.05).However,the overall survival(OS)of patients aged≥75 years was significantly lower than that of patients aged<75 years,and the 5-year OS was 49.2%and 68.2%,respectively(P<0.05).There was no significant difference in the treatment complications between the two groups(P>0.05).Multivariate analysis showed that biologic effective dose(BED)was an independent factor affecting OS in patients aged≥75 years.Conclusion Stereotactic body radiotherapy with cyberknife is a safe and effective treatment for elderly patients with early stage NSCLC who are not suitable for surgery.

Objective: To study the effect of long non⁃coding RNA (LncRNA) HAGLR on the expression of NODlike receptor pyrin domain⁃associated protein 3 ( NLRP3 ) inflammasome and fracture healing in tibial fracture (TF) mice and to explore the mechanism . Methods : First , HAGLR in osteoblast MC3T3 ⁃E1 was silenced by in vitro . Cell viability was detected by CCK⁃8 assay , cell apoptosis was detected by TUNEL assay , and the expressions of bone alkaline phosphatase (BALP) and osteocalcin were detected by qPCR . Western blot assay was used to detect the expressions of RUNX2 , phosphorylated RUNX2 ( p ⁃RUNX2 ) , NLRP3 , cysteine aspartic protease 1 (Caspase1) , apoptosis⁃associated spot⁃like protein ( ASC) and interleukin⁃1β . TF mouse models were established by tibial fracture operation in mice . HAGLR was overexpressed in the model mice , and RUNX2 was silenced or an inflammatory body inhibitor MCC950 was added on the basis of overexpression of HAGLR . The expressions of HAGLR and RUNX2 were detected by qPCR , and the expressions of insulin⁃like growth factor (IGF⁃1) were detected by Western blot . microCT was used to measure the volume of mouse callus (MBV) and the total tibial wet weight . Results : The apoptosis rate of MC3T3 ⁃E1 cells increased and the expression levels of RUNX2 ,p⁃RUNX2 , BALP and osteocalcin decreased ( P < 0. 05 ) . The expressions of NLRP3 , Caspase1 , ASC and IL⁃1β increased ( P <0. 05) . Compared with healthy tissue , the expressions of HAGLR and RUNX2 in TF mice decreased . Overexpression of HAGLR promoted the expressions of HAGLR and RUNX2 in TF mice , and increased the expression of MBV and tibia wet weight and IGF⁃1 (P < 0. 05) . Silencing RUNX2 on the basis of overexpression of HAGLR resulted in decreased expression of MBV , tibial wet weight and IGF⁃1 in TF mice (P < 0. 05) . However , the addition of NLRP3 inflammasome inhibitor MCC950 on top of the overexpression of HAGLR resulted in increased expressions of MBV , full⁃length tibia wet weight and IGF⁃1 (P < 0. 05) . Conclusion LncRNA HAGLR promotes the healing of tibial fractures by activating RUNX2 and inhibiting NLRP3 inflammasome .

Objective:To conduct theoretical analysis and experimental research on peripherally inserted venous catheters, establish theoretical models of interaction between different materials catheters and simulated skin tissues, and test different catheters at the same time to provide theoretical basis and experimental basis for the optimization design.Methods:According to the mechanical properties of the catheter at 25 ℃ and 37 ℃, a finite element model of the catheter and simulate skin tissue was established. The relationship between catheter folds and material and structure during puncture was analyzed, and the stiffness, radiographic properties, etc. were tested experimentally.Results:The performance of the catheter at different temperatures is closely related to its material. The wrinkle situation of the catheter is related to the catheter material and the inclination of the wedge surface. The elastic modulus of the polyurethane (PU) catheter is about 500 MPa and 250 MPa, respectively at room temperature (25 ℃) and body temperature (37 ℃), which meets the clinical needs of high rigidity during puncture and soft material during indwelling. When the catheter structure is the same, the PU catheter is less prone to wrinkles than the fluorinated ethylene propylene copolymer (FEP) catheter. When the catheter material is the same, the smaller the inclination of the wedge surface, the less likely the catheter to wrinkle.Conclusions:Appropriately reducing the inclination of the wedge-shaped surface of the needle of peripherally inserted venous catheters can improve the success rate of puncture. The PU catheters have good mechanical properties, they are not prone to wrinkles during puncture, and their stiffness can be reduced at body temperature, which can not only increase the success rate of puncture, but also reduce the occurrence of complications. Therefore, PU catheters have a better clinical application prospect.