This study summarizes the preoperative and intraoperative nursing experience in 5 cases of bridge-to-transplant heart transplantation with left ventricular assist device(LVAD)explant.Key points of nursing include:preoperative care and assessment of LVAD patients,preoperative discussion of the multidisciplinary team,safe transfer of patients to surgical rooms and other preoperative preparation,cardiomyocardial protection and multidisciplinary team cooperation during bridging transplantation,and intra-operative patient safety management.All 5 patients in this group successfully completed the surgery and were discharged.Pressure sores,wound infections,and other postoperative complications have not occurred.Postoperative cardiac function of 5 patients in this group were classified as New York Heart Association class Ⅰ～Ⅱ.The follow-up period for the 5 patients in this group ranged from 6 months to 6 years.The results of the most recent echocardiography follow-up showed that the left ventricular ejection fraction of all patients was all above 65％,with well prognosis.

Objective:To investigate the effectiveness of gastric-soleal turndown flap and knotless anchor bridging fixation via a modified incision in the treatment of chronic Achilles tendon rupture of Myerson type Ⅲ.Methods:A retrospective case series study was conducted to analyze the clinical data of the 18 patients who had been treated at Department of Minimally Invasive Orthopedics, Zhengzhou Orthopaedic Hospital from February 2020 to July 2023 for chronic Achilles tendon rupture of Myerson type Ⅲ by means of gastric-soleal turndown flap and knotless anchor bridging fixation via a modified incision. There were 15 males and 3 females, with an age of (37.2±6.8) years. All patients suffered from unilateral injury, involving 13 left sides and 5 right sides. Their body mass index was (22.6±2.5) kg/m 2. The operation time, blood loss, incision length, wound healing and complications were documented. The ankle dorsiflexion and plantar flexion at the last follow-up were compared between the affected side and the healthy side. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Achilles tendon total rupture score (ATRS) before operation were compared with those at the last follow-up. Results:All the 18 patients were followed up for (18.0±5.5) months. Their operation time was (69.1±5.2) minutes, blood loss (71.6±9.2) mL, incision at the broken end of the Achilles tendon (12.4±2.6) cm and incision at the proximal end (2.5±0.4) cm. At the last follow-up, the ankle dorsiflexion was 12.7°±1.9° and the ankle plantar flexion 35.2°±2.0° at the affected side, showing no significant difference from those at the healthy side (13.0°±2.1° and 34.7°±1.8°) ( P>0.05). The AOFAS ankle-hindfoot score was (89.4±3.4) points and the ATRS (85.3±3.2) points for the affected side at the last follow-up, showing significant improvements compared with the preoperative values [(54.2±4.2) points and (51.1±4.6) points] ( P<0.05). All the incisions healed at one stage after operation, with no such complications as incision infection or re-rupture of the Achilles tendon. One patient experienced mild pain at the anchor insertion site, but the pain disappeared 6 months after operation without any treatment. One patient had the symptoms of sural nerve injury which responded to 3 months of oral neurotrophic medication. Conclusion:In the treatment of chronic Achilles tendon rupture of Myerson type Ⅲ, gastric-soleal turndown flap and knotless anchor bridging fixation via a modified incision can result in limited invasion, a low incidence of complications, and definite effectiveness.

Objective:To study and explore the hemostatic effect and safety of new type of absorbable bone wax and conventional non-absorbable bone wax in surgery.Methods:A total of 141 patients from orthopedic department and cardiac surgery department,who underwent surgery at Beijing Jishuitan Hospital,and Fuwai Hospital of the Chinese Academy of Medical Sciences from July 2022 to October 2023,were selected.Patients were allocated via block randomization into the absorbable bone wax group(70 cases)and the non-absorbable bone wax group(71 cases).The success rates of hemostasis(within 3min),postoperative wound healing conditions,evaluation of using apparatuses(satisfaction and adhesion),incidence of postoperative complication and the severe adverse events of two groups were compared.Results:The success rates of hemostasis(within 3 minutes)of the absorbable bone wax group and the non-absorbable bone wax group were respectively 98.57%(69/70)and 100.00%(71/71),and the difference was not statistically significant(P>0.05).The differences of wound healing conditions before discharge,at 1st month and 3rd month after surgery between two groups were not significant(P>0.05).In the evaluation of using apparatuses,the satisfaction evaluation of 66 cases(94.29%)of 70 patients in the absorbable bone wax group was superior grade,and the adhesion of 57 cases(81.43%)was superior grade.The satisfaction evaluation of 62 cases(87.32%)of 71 patients in the non-absorbable bone wax group was superior grade,and the adhesion of 48 cases(67.61%)was superior grade.The differences of them between two groups were not statistically significant(P>0.05).There was no significant in the postoperative complication between two groups(P>0.05).The incidence of severe adverse events was 2.86%in the absorbable bone wax group,and it was 4.23%in the non-absorbable bone wax group,there was no statistically significant difference in that between two groups(P>0.05).Conclusion:The absorbable bone wax has the same hemostatic effect and safety with conventional non-absorbable bone wax,and the absorbable bone wax group has better evaluation for using apparatuses.

Objective To explore the association between single nucleotide polymorphism(SNP)of Rab37 gene and the age at menarche(AAM).Methods A case-control study design was used to conduct an epidemiologic survey on 2 060 women in a community in Jurong City,Jiangsu Province,and their venous blood samples were collected.ASA chip was used to explore the Rab37 gene genotyping of blood sample DNA to obtain the genotyping results for Rab37 SNPs rs62084865,rs10512597,rs35489971,rs1037170,rs6501732,rs77822106,and rs3178300.Based on menarche time of＜16 years old or≥16 years old,the participants were divided into 2 groups.Linear and logistic regression analyses were used to explore the association between the SNP of Rab37 gene and the age at menarche based on dominant,recessive and allelic models.Results Among the 2 060 healthy women,944 women had normal menstrual periods,while 1 116 women experienced delayed menarche.Linear regression analysis showed that the gene polymorphism of rs3178300 was negatively correlated with the age at menarche in females[recessive model:CC/CT+TT,β=-0.915,95%CI(-1.692,-0.137),P=0.021;allelic model:T/C,β=-0.221,95%CI(-0.410,-0.032),P=0.022].Logistic regression analysis indicated that the gene polymorphism of rs3178300 was significantly associated with the risk of delayed menarche in females[recessive model:CC/CT+TT,OR=0.295,95%CI(0.116,0.751),P=0.010;allelic model:T/C,OR=0.796,95%CI(0.652,0.972),P=0.025].The remaining 6 SNPs showed no significant association with age at menarche.Conclusion The rs3178300 polymorphism of Rab37 gene is significantly associated with delayed menarche in Chinese women.

Purpose To summarize the clinical pathological and immunohistochemical characteristics of esophage-al carcinoma with ductal differentiation of esophageal gland,and analyze the somatic mutation characteristics,key driv-ing mutation genes,and significantly mutated genes based on whole exome sequencing.Methods The clinicopatho-logical features of 9 cases of esophageal carcinoma with esophageal duct differentiation were retrospectively analyzed,and the immunohistochemistry EnVision two-step method was used to stain them,and 3 of the samples were subjected to whole exome sequencing and data analysis.Results Among the 9 patients,6 were males and 3 were females.The average age was 68.3 years old(61-80 years old).All 9 cases were located in the middle-lower segment of the e-sophagus.The diameter of the lesion was from 1.5 cm to 3.5 cm.Most areas of the tumor had a double-layer epithelial structure,including the inner layer of luminal epithelium and the outer layer of basal epithelium.Focal areas could be seen with keratinization and mucinous cells.Immunohistochemistry showed that CK7 was positive in the inner epitheli-um,while p63 was positive in the outer basal epithelium.S-100,SOX10 and c-myb were all negative,and p53 was mutated(diffuse strongly positive).The results of whole exome sequencing analysis showed somatic mutation character-istics(796 SNV,37 InDel,482 CNV),key driving mutation genes(12),and significantly mutated genes(TP53).No intraepithelial neoplasia was observed on the surface squamous epithelium of all cases,and no Barrett's esophagus or ectopic gastric mucosa was observed.The average follow-up time was 21.9 months(8 days-51 months),with 8 ca-ses surviving and 1 case dying of severe pulmonary infection 8 days after surgery.Conclusion Esophageal carcinoma with ductal differentiation of esophageal gland is a rare epithelial derived malignant tumor of the esophagus,character-ized by unique morphological,immunohistochemical,and molecular changes.

Objective:To design a management system of internet of things(IoT)smart operation room based on business process reconstruction theory,and explore the application effect of that in improving management effectiveness for operation room.Methods:Aimed at the existing problems of key points in the management for operation room,the process was reconstructed on the basis of the original information system,relevant systems,workflows and standards of operation room of Fuwai Hospital of Medical Sciences and Peking Union Medical College.Then,a management system of IoT smart operation room based on business process reconstruction theory was designed.The surgical data of 13159 patients who underwent relevant operation of cardiovascular surgery from January to December 2022 were selected,and they were divided into"before-application"group(6 483 cases)and"after-application"group(6 676 cases)according to the point before and after the system was applied.Some indicators'data,which included scheduling management situation of picking up and dropping off patients by medical auxiliaries,duration of preparing anesthesia,duration of preoperative waiting,interval duration of continuous surgery and usage amount of surgical gowns under same amount of surgery,between two groups were compared.Results:The transportation efficiency of patients who underwent surgery after system was applied was(1.38±0.09)surgeries/h,which was higher than(0.99±0.09)surgeries/h before it was applied,and the difference was statistically significant(t=6.604,P<0.001).The satisfaction score of medical auxiliaries increased from 3.83(3.33,4.5)before application to 4.50(4.33,4.83)after application,and the difference was significant(Z=2.02,P<0.05).The duration of preparing anesthesia and duration of preoperative waiting after the system was applied were respectively(62.04±2.29)and(8.09±2.46)min,both of which were less than those before the system was applied,and the differences of them between two groups were statistically significant(t=2.309,2.280,P<0.05).The usage amount of surgical gowns under same amount of surgery after the system was applied was(4.11±0.57)gowns/surgery,which was less than(5.81±0.29)gowns/surgery before the system was applied,and the difference was statistically significant(t=6.489,P<0.05).Conclusion:The application of the management system of IoT smart operation room based on business process reconstruction theory can provide more safely,high-qualitatively and efficiently medical services for patients,and improve work efficiency and management effectiveness for operation room,and reduce resource consumption and operating cost.

Objective:To analyze the risk factors of bacterial infection in patients with liver cirrhosis complicated with gastroesophageal varices after gastroscopy, and to construct a prediction model.Methods:Patients with gastroesophageal varices due to cirrhosis who underwent gastroscopy in the Third Hospital of Hebei Medical University from January 2021 to May 2023 were enrolled. All patients were divided into infection group and non-infection group according to whether bacterial infection occurred after gastroscopy. The detection of pathogens in the infection group and the source of specimens were analyzed. Multivariate binary logistic regression was used to analyze the risk factors of postoperative bacterial infection in patients with cirrhosis and gastroesophageal varices. The nomogram was drawn by R language to construct a risk prediction model. Receiver operator characteristic curve (ROC curve), calibration curve, Hosmer-Lemeshow test and decision curve were used to evaluate the model.Results:Among the 480 patients, 57 had postoperative bacterial infection and 423 had no infection. The incidence of infection was 11.88%(57/480). Seventy bacterial culture positive samples were obtained, mainly from blood and respiratory tract (30 samples (42.86%) and 25 samples (35.71%), respectively). A total of 82 strains of pathogenic bacteria were isolated, including 16 strains of Escherichia coli and 14 strains of Staphylococcus aureus. Multivariate binary regression analysis showed that length of hospital stay (odds ratio ( OR)=1.13, 95% confidence interval ( CI) 1.06 to 1.20, P<0.001), age ( OR=1.06, 95% CI 1.02 to 1.10, P=0.006), model for end-stage liver disease combined with sodium (MELD-Na) score ( OR=1.10, 95% CI 1.02 to 1.18, P=0.014), diabetes ( OR=1.25, 95% CI 1.07 to 1.96, P=0.043) and emergency gastroscopy ( OR=2.95, 95% CI 1.20 to 7.25, P=0.019) were independent risk factors for bacterial infection after gastroscopy in patients with cirrhosis and gastroesophageal varices. Based on the above risk factors, a nomogram prediction model was constructed. The results of ROC curve analysis showed that the area under the curve of the nomogram model for predicting bacterial infection after gastroscopy of gastroesophageal varices in cirrhosis was 0.82 (95% CI 0.73 to 0.90). The slope of the calibration curve was 0.98(95% CI 0.92 to 1.04), indicating that the predicted probability of the model was in good agreement with the actual probability. The results of Hosmer-Lemeshow test showed that the nomogram model fitted well ( χ2=6.35, P=0.415). The decision curve analysis showed that the clinical net benefit rate of the nomogram model was >0 when the threshold probability was 0.039 to 0.410. Conclusions:Older age, length of hospital stay, MELD-Na score, history of diabetes, and emergency gastroscopy are independent risk factors for bacterial infection after gastroscopy in patients with cirrhosis and gastroesophageal varices. The prediction model constructed in this study has a good predictive value for bacterial infection in such patients.

Objective To analyze the effects of different traction sites and directions on the maxilla and upper dentition when using clear aligners combined with protraction for the treatment of maxillary deficiency.Methods A three-dimensional(3D)finite element model including the zygomaticomaxillary complex,maxillary dentition,and clear aligners was constructed.The models were divided into Group 1(traction hook at the distal of the lateral incisor)and Group 2(traction hook at the distal of the canine).Each group was analyzed under four loading conditions with protraction angles of 0°,10°,20°,and 30° relative to the occlusal plane.A unilateral protraction force of 500 g was applied.The differences in stress distribution and displacement of the maxillary bone and dentition under different loading conditions were analyzed.Results When the protraction angle was 30°,both groups showed forward and downward displacement of the maxilla,while other angles resulted in counterclockwise rotation.Under the same protraction direction,the total displacement of the maxilla and displacements in all directions in Group 2 were greater than those in Group 1.The upper central incisors in Group 1 showed lingual displacement,which increased with the protraction angle.The maxillary dentition in Group 2 showed forward displacement,with the minimum total and sagittal displacements at a protraction angle of 30°.Stress concentration was mainly observed in the zygomaticomaxillary suture and anterior alveolar bone regions in both groups,decreasing as the protraction angle increased.Conclusions Clear aligners combined with protraction can be applied to skeletal Class Ⅲ patients with mild maxillary deficiency.When the protraction site is located at the distal of the canine with a 30° downward and forward angle to the occlusal plane,the maxilla can achieve ideal forward and downward displacement with the minimum labial movement of the upper anterior teeth.

Objective:To analyze the risk factors of bacterial infection in patients with liver cirrhosis complicated with gastroesophageal varices after gastroscopy, and to construct a prediction model.Methods:Patients with gastroesophageal varices due to cirrhosis who underwent gastroscopy in the Third Hospital of Hebei Medical University from January 2021 to May 2023 were enrolled. All patients were divided into infection group and non-infection group according to whether bacterial infection occurred after gastroscopy. The detection of pathogens in the infection group and the source of specimens were analyzed. Multivariate binary logistic regression was used to analyze the risk factors of postoperative bacterial infection in patients with cirrhosis and gastroesophageal varices. The nomogram was drawn by R language to construct a risk prediction model. Receiver operator characteristic curve (ROC curve), calibration curve, Hosmer-Lemeshow test and decision curve were used to evaluate the model.Results:Among the 480 patients, 57 had postoperative bacterial infection and 423 had no infection. The incidence of infection was 11.88%(57/480). Seventy bacterial culture positive samples were obtained, mainly from blood and respiratory tract (30 samples (42.86%) and 25 samples (35.71%), respectively). A total of 82 strains of pathogenic bacteria were isolated, including 16 strains of Escherichia coli and 14 strains of Staphylococcus aureus. Multivariate binary regression analysis showed that length of hospital stay (odds ratio ( OR)=1.13, 95% confidence interval ( CI) 1.06 to 1.20, P<0.001), age ( OR=1.06, 95% CI 1.02 to 1.10, P=0.006), model for end-stage liver disease combined with sodium (MELD-Na) score ( OR=1.10, 95% CI 1.02 to 1.18, P=0.014), diabetes ( OR=1.25, 95% CI 1.07 to 1.96, P=0.043) and emergency gastroscopy ( OR=2.95, 95% CI 1.20 to 7.25, P=0.019) were independent risk factors for bacterial infection after gastroscopy in patients with cirrhosis and gastroesophageal varices. Based on the above risk factors, a nomogram prediction model was constructed. The results of ROC curve analysis showed that the area under the curve of the nomogram model for predicting bacterial infection after gastroscopy of gastroesophageal varices in cirrhosis was 0.82 (95% CI 0.73 to 0.90). The slope of the calibration curve was 0.98(95% CI 0.92 to 1.04), indicating that the predicted probability of the model was in good agreement with the actual probability. The results of Hosmer-Lemeshow test showed that the nomogram model fitted well ( χ2=6.35, P=0.415). The decision curve analysis showed that the clinical net benefit rate of the nomogram model was >0 when the threshold probability was 0.039 to 0.410. Conclusions:Older age, length of hospital stay, MELD-Na score, history of diabetes, and emergency gastroscopy are independent risk factors for bacterial infection after gastroscopy in patients with cirrhosis and gastroesophageal varices. The prediction model constructed in this study has a good predictive value for bacterial infection in such patients.

Objective:To investigate the effectiveness of gastric-soleal turndown flap and knotless anchor bridging fixation via a modified incision in the treatment of chronic Achilles tendon rupture of Myerson type Ⅲ.Methods:A retrospective case series study was conducted to analyze the clinical data of the 18 patients who had been treated at Department of Minimally Invasive Orthopedics, Zhengzhou Orthopaedic Hospital from February 2020 to July 2023 for chronic Achilles tendon rupture of Myerson type Ⅲ by means of gastric-soleal turndown flap and knotless anchor bridging fixation via a modified incision. There were 15 males and 3 females, with an age of (37.2±6.8) years. All patients suffered from unilateral injury, involving 13 left sides and 5 right sides. Their body mass index was (22.6±2.5) kg/m 2. The operation time, blood loss, incision length, wound healing and complications were documented. The ankle dorsiflexion and plantar flexion at the last follow-up were compared between the affected side and the healthy side. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Achilles tendon total rupture score (ATRS) before operation were compared with those at the last follow-up. Results:All the 18 patients were followed up for (18.0±5.5) months. Their operation time was (69.1±5.2) minutes, blood loss (71.6±9.2) mL, incision at the broken end of the Achilles tendon (12.4±2.6) cm and incision at the proximal end (2.5±0.4) cm. At the last follow-up, the ankle dorsiflexion was 12.7°±1.9° and the ankle plantar flexion 35.2°±2.0° at the affected side, showing no significant difference from those at the healthy side (13.0°±2.1° and 34.7°±1.8°) ( P>0.05). The AOFAS ankle-hindfoot score was (89.4±3.4) points and the ATRS (85.3±3.2) points for the affected side at the last follow-up, showing significant improvements compared with the preoperative values [(54.2±4.2) points and (51.1±4.6) points] ( P<0.05). All the incisions healed at one stage after operation, with no such complications as incision infection or re-rupture of the Achilles tendon. One patient experienced mild pain at the anchor insertion site, but the pain disappeared 6 months after operation without any treatment. One patient had the symptoms of sural nerve injury which responded to 3 months of oral neurotrophic medication. Conclusion:In the treatment of chronic Achilles tendon rupture of Myerson type Ⅲ, gastric-soleal turndown flap and knotless anchor bridging fixation via a modified incision can result in limited invasion, a low incidence of complications, and definite effectiveness.