Objective To investigate the impact of variations in volute cross-sectional area on the flow characteristics and hemolytic performance of centrifugal blood pumps by designing six volute structures.Methods Computational fluid dynamics and the Lagrangian method were used to analyze flow characteristics and predict hemolysis in blood pumps with different volute designs.Results The annular volute pump showed the poorest hydraulic performance,while the hydraulic performance of the S-shaped volute was the best,which was improved by 35.29％compared to that of the annular volute.Some volutes experienced stagnation zones at the helical inlet(0°-90°)and significant backflow at the outlet(270°-360°).The downward concave-shaped volute had the highest hemolysis index(HI),i.e.,9.59×10-4.Meanwhile,the HI of the annular volute was the lowest,which was 71.85％less than the concave-shaped volute.Conclusions Reducing the gradient of the area variation at the helical inlet and outlet can prevent flow stagnation and backflow.A higher HI arises due to the prolonged exposure of red blood cells to high shear stress.This study provides a theoretical basis for designing and optimizing volute structures of centrifugal blood pumps.

Objective:To evaluate strategies for screening and diagnosing Lynch syndrome associated endom-etrial carcinoma(LS-EC)in clinical practice and analyze clinicopathological characteristics of LS-EC.Methods:A total of 258 patients with endometrial carcinoma who underwent surgery in The Fourth Hospital of Hebei Medical University from January 2019 to January 2022 were included.All enrolled patients underwent postoperative immu-nohistochemical testing for mismatch repair(MMR)proteins.Based on the expression status of the four MMR proteins,the patients were divided into deficient mismatch repair(d-MMR)group(57 cases)and proficient mis-match repair(p-MMR)group(201 cases).Among them,23 patients in the d-MMR group underwent germline gene testing for Lynch syndrome(LS).According to germline gene testing results,these patients were further classified into LS-EC(n=8)and non-LS-EC(n=15)groups.Clinicopathological features of LS-EC patients were analyzed.Results:Among the 258 endometrial carcinoma patients,57cases(22.1%)exhibited d-MMR,with MLH1 and PMS2 co-deletion being the most common(61.4%,35/57).Among the23 d-MMR patients who under-went genetic testing,8 cases(34.8%)were identified as having LS-EC,including 5 cases(62.5%)of MLH1 gene mutation,1 case(12.5%)of MSH2 gene mutation,1 case(12.5%)of PMS2 gene mutation and 1 case(12.5%)of MSH6 gene mutation.Compared with the non-LS-EC group,the LS-EC patients showed significant familial aggregation and higher pathological grade(P<0.05).Conclusions:Immunohistochemical analysis of MMR proteins combined with family history represents an effective screening strategy for LS-EC,however defini-tive diagnosis requires germline genetic testing.Among LS-EC cases,MLH1 is the most frequently mutated gene.LS-EC patients are characterized by familial clustering and high pathological grade.Discrepancies between immu-nohistochistochemistry and genetic testing results present challenges in the definitive diagnosis of LS-EC.

Objective To investigate the impact of variations in volute cross-sectional area on the flow characteristics and hemolytic performance of centrifugal blood pumps by designing six volute structures.Methods Computational fluid dynamics and the Lagrangian method were used to analyze flow characteristics and predict hemolysis in blood pumps with different volute designs.Results The annular volute pump showed the poorest hydraulic performance,while the hydraulic performance of the S-shaped volute was the best,which was improved by 35.29％compared to that of the annular volute.Some volutes experienced stagnation zones at the helical inlet(0°-90°)and significant backflow at the outlet(270°-360°).The downward concave-shaped volute had the highest hemolysis index(HI),i.e.,9.59×10-4.Meanwhile,the HI of the annular volute was the lowest,which was 71.85％less than the concave-shaped volute.Conclusions Reducing the gradient of the area variation at the helical inlet and outlet can prevent flow stagnation and backflow.A higher HI arises due to the prolonged exposure of red blood cells to high shear stress.This study provides a theoretical basis for designing and optimizing volute structures of centrifugal blood pumps.

Objective:To evaluate strategies for screening and diagnosing Lynch syndrome associated endom-etrial carcinoma(LS-EC)in clinical practice and analyze clinicopathological characteristics of LS-EC.Methods:A total of 258 patients with endometrial carcinoma who underwent surgery in The Fourth Hospital of Hebei Medical University from January 2019 to January 2022 were included.All enrolled patients underwent postoperative immu-nohistochemical testing for mismatch repair(MMR)proteins.Based on the expression status of the four MMR proteins,the patients were divided into deficient mismatch repair(d-MMR)group(57 cases)and proficient mis-match repair(p-MMR)group(201 cases).Among them,23 patients in the d-MMR group underwent germline gene testing for Lynch syndrome(LS).According to germline gene testing results,these patients were further classified into LS-EC(n=8)and non-LS-EC(n=15)groups.Clinicopathological features of LS-EC patients were analyzed.Results:Among the 258 endometrial carcinoma patients,57cases(22.1%)exhibited d-MMR,with MLH1 and PMS2 co-deletion being the most common(61.4%,35/57).Among the23 d-MMR patients who under-went genetic testing,8 cases(34.8%)were identified as having LS-EC,including 5 cases(62.5%)of MLH1 gene mutation,1 case(12.5%)of MSH2 gene mutation,1 case(12.5%)of PMS2 gene mutation and 1 case(12.5%)of MSH6 gene mutation.Compared with the non-LS-EC group,the LS-EC patients showed significant familial aggregation and higher pathological grade(P<0.05).Conclusions:Immunohistochemical analysis of MMR proteins combined with family history represents an effective screening strategy for LS-EC,however defini-tive diagnosis requires germline genetic testing.Among LS-EC cases,MLH1 is the most frequently mutated gene.LS-EC patients are characterized by familial clustering and high pathological grade.Discrepancies between immu-nohistochistochemistry and genetic testing results present challenges in the definitive diagnosis of LS-EC.

The impeller, as a key component of artificial heart pumps, experiences high shear stress due to its rapid rotation, which may lead to hemolysis. To enhance the hemolytic performance of artificial heart pumps and identify the optimal combination of blade parameters, an optimization design for existing pump blades is conducted. The number of blades, outlet angle, and blade thickness were selected as design variables, with the maximum shear stress within the pump serving as the optimization objective. A back propagation (BP) neural network prediction model was established using existing simulation data, and a grey wolf optimization algorithm was employed to optimize the blade parameters. The results indicated that the optimized blade parameters consisted of 7 impeller blades, an outlet angle of 25 °, and a blade thickness of 1.2 mm; this configuration achieved a maximum shear stress value of 377 Pa-representing a reduction of 16% compared to the original model. Simulation analysis revealed that in comparison to the original model, regions with high shear stress at locations such as the outer edge, root, and base significantly decreased following optimization efforts, thus leading to marked improvements in hemolytic performance. The coupling algorithm employed in this study has significantly reduced the workload associated with modeling and simulation, while also enhancing the performance of optimization objectives. Compared to traditional optimization algorithms, it demonstrates distinct advantages, thereby providing a novel approach for investigating parameter optimization issues related to centrifugal artificial heart pumps.
Neural Networks, Computer ; Algorithms ; Heart-Assist Devices ; Hemolysis ; Humans ; Equipment Design ; Stress, Mechanical ; Computer Simulation

Objectives:Present study analyzed the efficacy and safety of percutaneous coronary intervention(PCI)using the distal transradial access(dTRA)for patients with complex coronary lesions. Methods:A total of 10 033 patients with complex coronary artery lesions(type B2 and type C lesions)who underwent percutaneous coronary intervention(PCI)via dTRA or conventional transradial access(TRA)at Fuwai Hospital between June 2021 and May 2022 were included(9 625 patients in the TRA group and 408 patients in the dTRA group).After propensity score matching,391 patients were included in each group.Baseline data,PCI intraoperative data(including lesion characteristics,intervention success rate,etc.),and incidence of major bleeding related to the access were compared between the two groups before and after propensity score matching. Results:Before propensity score matching,the proportions of patients with hypertension,hyperlipidemia,family history of coronary heart disease,history of myocardial infarction,and history of coronary artery bypass grafting were significantly higher in the dTRA group than in the TRA group(all P<0.05).After propensity score matching,the baseline data of the two groups were similar(all P>0.05).Before propensity score matching,compared with the TRA group,patients in the dTRA group had a higher proportion of patients with type B2 lesions,while the proportions of patients with type C lesions and those using intravascular ultrasound(IVUS)were lower(all P<0.05).The proportion of patients with chronic complete occlusion was similar between the two groups(P>0.05).After propensity score matching,compared with the TRA group,patients in the dTRA group had a lower proportion using IVUS and had a higher percent of stent implantation(both P<0.05).There was no statistically significant difference between the two groups in terms of SYNTAX score,guide catheter size,target lesion distribution,proportion of patients using intra-aortic balloon counterpulsation,success rate of intervention procedures,and incidence of major bleeding events related to the access(all P>0.05). Conclusions:Compared with the conventional TRA,interventional treatment of complex lesions through dTRA is equally safe and effective for patients with complex coronary lesions.

Objective:To construct quality indicator system for pelvic floor rehabilitation in patients after cervical cancer surgery based on the three-dimensional quality structure model, and provide a basis for evaluating the quality of pelvic floor rehabilitation.Methods:Based on the "structure-process-result" three-dimensional quality structure model, a quality indicator system for pelvic floor rehabilitation management in patients after cervical cancer surgery was constructed by literature review, semi-structured interview and Delphi technique from January to May 2023, and the importance and weight of the indicators was identified.Results:A total of 15 experts were included, including 3 males and 12 females, aged 38-56 (46.79 ± 6.38) years. The effective questionnaire recovery rates of 2 rounds of expert correspondence were 15/15, the authority coefficients of the experts were 0.938 and 0.923, and the Kendall coordination coefficients were 0.139 - 0.337 and 0.107 - 0.152 (all P<0.01). The final quality indicator system for pelvic floor rehabilitation in patients after cervical cancer surgery included 3 primary indicators, 10 secondary indicators and 42 tertiary indicators. Conclusions:The quality indicator system for pelvic floor rehabilitation in patients after cervical cancer surgery constructed based on three-dimensional quality structure model was scientific and practical, which could be used as an indicator for evaluating the quality of pelvic floor rehabilitation in patients after cervical cancer surgery.

Objective To analyze the clinical characteristics and influencing factors of non-small cell lung cancer (NSCLC) patients with chronic obstructive pulmonary disease (COPD) in Hubei province, and to provide a theoretical basis for the diagnosis and treatment of NSCLC patients with COPD. Methods A total of 246 NSCLC patients admitted to our hospital from 2018 to 2020 were selected and divided into control group (without COPD, n=125) and observation group (with COPD, n=121) according to COPD. The clinical characteristics of chest pain, hemoptysis, emasculation, atelectasis and pleural effusion were compared between the two groups. The values of FEV1/FVC, RV/TLC and DLCO in the two groups were measured by pulmonary function detector. The age, gender, smoking, smoking history, proportion of lung squamous cell carcinoma, TNM stage and other clinical data of all subjects were analyzed by self-made survey scale of our hospital. Univariate analysis and logistic regression were used to analyze the risk factors of COPD in NSCLC patients. Results Among 246 NSCLC patients, 121 patients (49.19%) were complicated with COPD, including 76 males and 45 females, and there was a statistical difference between the two groups (χ²=4.891, P>0.05). The average age of the observation group (61.02±4.82) was significantly higher than that of the control group (59.76±4.73) (t=2.069, P<0.05). The proportion of chest pain, hemoptysis, emaciation, atelectasis, pleural effusion and fatigue in the observation group were significantly higher than those in the control group (P<0.05). The values of FEV1/FVC, RV/TLC and DLCO in the observation group were significantly lower than those in the control group (P<0.05). There were significant differences in smoking history, proportion of lung squamous cell carcinoma and TNM score between the two groups (P>0.05). Male (OR=2.982), smoking history (OR=2.623) and lung squamous cell carcinoma (OR=3.147) were risk factors for COPD in NSCLC patients (P<0.05). Conclusions NSCLC patients with COPD are more common in male smokers in Hubei Province, often accompanied by pleural effusion , severe hemoptysis and other symptoms , and their lung function is decreased. Early detection and standardized treatment of COPD in the treatment of NSCLC can improve the prognosis of patients.

Clinical trials of drugs for rare diseases face special challenges such as a limited number of patients,difficult recruitment,long trial period,and frequent video interviews during the trial.Therefore,in the clinical operation of rare diseases,a decentralized clinical trials(DCT)model based on the"patient-cen-tred"research and development concept is implemented.With the help of decentralized elements and digital health technology,the barriers of geographical restrictions can be overcome and subjects do not have to be limit-ed to traditional clinical trial sites(hospitals/research centers),which can significantly reduce the burden on subjects,increase their representation,and obtain a wider range of scientific research data.To guide the indus-try's scientific and standardized application of DCT in the research and development of drugs for rare diseases,the Center for Drug Evaluation of the National Medical Products Administration(NMPA)organized the stake holders to draft the Technical Guideline for the Application of Decentralized Clinical Trials in the Research and Development of Drugs for Rare Diseases.This guideline provides scientific recommendations for the development and implementation of DCT for rare disease drugs.It aims to solve the difficult and key problems during rare disease drug research and development,improve the efficiency and optimize patient experience.This article,combining the research and development concepts in the guideline,explains the current research and develop-ment thinking on the application of DCT in the research and development of rare disease drugs,with a view of providing reference for the industry.

Objective:To understand the current situation of care needs for disabled elderly people, analyze the impact of the family environment and community services on the care needs and care pathways of older people with disabilities and to formulate effective interventions.Methods:A cross-sectional survey was conducted from August 2022 to March 2023 in five tertiary-level hospitals in Tangshan city. The survey included 332 elderly people who were disabled before hospitalization and their primary caregivers, who were selected using a convenience sampling method. The survey investigated their general information, degree of disability, family members′ support, children′s filial piety and old age ethical level, family relationships, and the care needs of the elderly people who were disabled. SPSS 22.0 was used for one-way and correlation analyses as well as multiple linear regression analyses, and AMOS 22.0 was used for the development of structural equations for path analysis.Results:Among 332 disabled elderly individuals, there were 166 males and 166 females each. The care needs score for elderly people with disabilities was 101.54 ± 16.38. The care needs of this population can be influenced by several factors, including the level of disability, number of chronic conditions, presence of chronic pain, filial piety and old age ethical level of caregivers, family relationships, and the availability of care services in the community or village. These factors had direct effects of 0.468, 0.155, -0.083, -0.350, -0.094, and 0.104, respectively.Chronic diseases and chronic pain indirectly affected the demand for care through the degree of incapacity (with respective indirect effect values of 0.065 and 0.049). Additionally, the demand for care was indirectly influenced by the level of filial piety and ethics of the caregiver through the degree of incapacity and the family relationships (an indirect effect value of -0.162).Conclusions:The care needs of the disabled elderly are high, and the personal physiology, family environment and community support of the disabled elderly will directly or indirectly affect their care needs. Therefore, many factors should be considered comprehensively considered to improve the quality of care of the disabled elderly.