Objective To observe the value of MRI texture features combined with apparent diffusion coefficient(ADC)for differentiating uterine sarcoma(US)and cellular uterine leiomyoma(CUL).Methods Pelvic MRI data of 27 US patients(US group)and 34 CUL patients(CUL group)were retrospectively analyzed.The texture features of lesions were extracted from T2WI and diffusion weighted imaging(DWI),the ADC value were measured,and the average ADC value(ADCmean),the minimum ADC value(ADCmin)and standard ADC value(ADCst)were recorded.Then logistic regression(LR)models were constructed based on ADC value,optimal texture features alone and their combination,respectively,including LRADC,LRtexture and LRADC+texture models.Receiver operating characteristic curves were drawn,and the area under the curves(AUC)were calculated to evaluate the efficacy of each model for differentiating US and CUL.Results The ADCmean,ADCmin and ADCst in US group were all lower than those in CUL group(all P＜0.05).A total of 3 750 texture features were extracted from pelvic T2WI and DWI,5 optimal features were finally obtained,and the constructed LRADC+texture model and LRtexture model had similar efficacy of differentiating US and CUL(AUC=0.921,0.887;P＞0.05),which were both higher than that of LRADC model(AUC=0.696;both P＜0.05).The calibration curve of LRADC+texture model was basically consistent with the ideal curve,which had better clinical benefits than LRADC and LRtexture models.Conclusion MRI texture features combined with ADC value could improve efficacy for differentiating US and CUL.

Arrhythmia is an important disease among cardiovascular diseases. Malignant arrhythmias often occur clinically and are induced by abnormal ion channels， electrical activity disorders， myocardial fibrosis， inflammation， dysfunctional mitochondrial biogenesis， mitochondrial calcium overload， out-of-balance energy metabolism， oxidative stress， sympathetic hyperactivity， and other pathological cardiac remodeling， and they are the main causes of sudden cardiac death. In traditional Chinese medicine， arrhythmias are considered to be palpitations， which are commonly caused by deficiency of Qi and Yin. It is often manifested as a deficiency of the spleen and stomach， resulting in malfunction of the Qi mechanism， followed by a particularly severe decline in cardiac function. Shengmaisan is a representative formula for nourishing Qi and Yin， consisting of Ginseng Radix et Rhizoma， Ophiopogonis Radix， and Schisandrae Chinensis Fructus. In recent years， clinical studies have shown that Shengmaisan and its additions and subtractions are commonly used in the treatment of arrhythmias. In this article， the mechanisms of the active ingredients of Shengmaisan in the electrophysiology， biochemistry， structure， autonomic nervous system， and subcellular fraction of the heart are reviewed， and the multi-target， multi-system， and integrality of Shengmaisan in the treatment of arrhythmias of Qi and Yin deficiency are described. In addition， energy metabolism disorder is tightly juxtaposed with Qi and Yin deficiency syndrome. Mitochondria， as the center of myocardial energy metabolism， play a paramount role in cardiac remodeling， indicating that Shengmaisan will be a salient part of future research to ameliorate cardiac pathologic remodeling through energy metabolism of mitochondria， so as to provide a theoretical basis for the clinical treatment of these arrhythmias.

Objective:To investigate the surgical outcomes of acetabular posterior wall fractures in patients aged 50 and above.Methods:A retrospective study was conducted to analyze the clinical data of 67 patients with acetabular posterior wall fracture who had been treated through the Kocher-Langenbeck approach and fully followed up from August 2003 to November 2021. There were 54 males and 13 females, aged 59.0 (54.0, 63.0) years. The time from injury to surgery was 8.0 (5.0, 13.0) days. Open reduction and internal fixation was performed for 63 cases and hip arthroplasty for 4 cases by one stage. The operation time, intraoperative bleeding, quality of postoperative fracture reduction, recovery of hip function at the last follow-up, and incidence of complications during the follow-up period were recorded.Results:The operation time for the 67 patients was 90.0 (67.5, 101.3) min, and the intraoperative bleeding 350.0 (300.0, 450.0) mL. According to the Matta criteria, 63 patients with internal fixation achieved anatomical reduction. All the 67 patients were followed up for (112.8±62.4) months. According to the modified Merle d'Aubigné & Postel scoring system, the function of the affected hip was assessed at the last follow-up in the 63 patients with internal fixation as excellent in 56 cases, as good in 3 cases, as fair in 2 cases, and as poor in 2 cases, giving an excellent and good rate of 93.6% (59/63). The prostheses survived in all the 4 patients who underwent one-stage hip replacement, with hip Harris scores of 94, 92, 91, and 93, respectively. Complications included 15 cases (23.8%, 15/63) of heterotopic ossification and 1 case (1.6%, 1/63) of transient sciatic nerve palsy. Femoral head ischemic necrosis and traumatic arthritis occurred in 2 patients (3.2%, 2/63) who had to receive total hip arthroplasty 3 years after surgery.Conclusion:Open reduction and internal fixation is still the main treatment method for acetabular posterior wall fractures in patients aged 50 and above, because it can achieve good clinical outcomes and help the patients recover joint function and quality of life at an early stage.

Objective: To explore the association between dietary inflammatory index (DII) and metabolic syndrome (MetS) and its components among children aged 6-14 years in Beijing, so as to provide a reference for preventing MetS. Methods: A cross sectional study was carried out in 2 086 records of 1 832 children from the 2017 and 2019 Nutrition and Health Surveillance in Primary and Secondary school students of Beijing (NHSPSB). Three day consecutive 24 hour dietary recalls combined with weighing household cooking oils and condiments were used to collect dietary intake and calculate DII. MetS was diagnosed according to "Definition and Suggestion on the Metabolic Syndrome of Chinese Children and Adolescent". The Generalized estimating equations (GEEs) models were used to analyze the association between DII and the presence of MetS and its components (abdominal obesity, high triglyceride, low high density lipoprotein cholesterol, hypertension, and hyperglycemia). Results: The mean DII score was (1.64±1.07) for the included children. No significant association was found between DII scores and the likelihood of MetS (per 1 point increment: OR =1.16, 95% CI =0.92-1.48, P >0.05). In terms of the components of MetS, DII scores were positively associated with the odds of high triglyceride (per 1 point increment: OR =1.17, 95% CI =1.01-1.36, P <0.05). There was no statistically significant difference in the association among different age groups ( P >0.05). No significant associations were observed between DII and other MetS components( P >0.05). Conclusion DII scores may not be correlated with the risk of MetS, but proinflammatory diet might increase the risk of high triglyceride. DII score in childhood should be emphasized to identify and prevent MetS as soon as possible.

OBJECTIVE To analyze the influencing factors for the metabolism of voriconazole in adult patients， and to provide reference for the rational use of voriconazole in clinic. METHODS The clinical data of adult patients admitted in our hospital receiving voriconazole and therapeutic drug monitoring from April 2021 to March 2022 were collected. The trough concentration of voriconazole （c0） and plasma concentration of voriconazole-N-oxide concentration （cN） were determined， and voriconazole-to-voriconazole N-oxide concentration ratio （c0/cN） was calculated. Pearson’s correlation analysis was used to analyze the influencing factors for c0 and c0/cN of voriconazole. Multiple linear regression models were used to analyze the independent influencing factors for c0 and c0/cN of voriconazole. RESULTS The underlying diseases of the patients were mainly pneumonia， kidney disease and leukemia. The detected fungi were mainly Aspergillus， Candida and yeast-like fungi. Voriconazole was mainly administered by intravenous drip， especially in patients who used proton pump inhibitor in combination. The levels of C-reactive protein （CRP）， total bilirubin （TBIL）， direct bilirubin （DBIL） and indirect bilirubin （IBIL） were positively correlated with c0 of voriconazole， while platelet count and albumin levels were negatively correlated with voriconazole c0. The levels of CRP， TBIL and DBIL were positively correlated with c0/cN， while albumin levels were negatively correlated with c0/cN. Multiple linear regression analysis showed that the independent influencing factors of voriconazole c0 included the levels of CRP and IBIL， route of administration and dose of voriconazole， and the independent influencing factors of voriconazole c0/cN were the levels of CRP and DBIL and age. CONCLUSIONS The levels of CRP and IBIL， route of administration and dose of voriconazole are independent influencing factors of voriconazole c0； the levels of CRP and DBIL and age are independent influencing factors of voriconazole c0/cN. The influence of above indexes on the metabolism of voriconazole should be considered when using voriconazole clinically； and the route of administration and dose of voriconazole should be adjusted reasonably.

The passing of ethical review is a necessary conditions and prerequisite for the development of life science and medical research involving humans. At present, some medical and health institutions have no or insufficient ethical review capabilities. The lack of ethical review ability has become a bottleneck restricting the development of life science and medical research involving humans. According to documents such as Opinions on Deepening the Reform of the Review and Approval System and Encouraging the Innovation of Pharmaceutical and Medical Devices, Opinions on Strengthening the Ethical Governance of Science and Technology, institutions can entrust competent institutional ethics review committees or regional ethics review committees in writing to conduct ethical review. Entrustment ethical review provides a viable solution for institutions that need to carry out life science and medical research involving humans but do not have an ethics (review) committee or the ethics (review) committee is not competent to review. To conduct the entrustment ethical review, the entrustment between the principal and the trustee is required. According to The Measures for Ethical Review of Life Sciences and Medical Research Involving Humans, if medical and health institutions and their ethical review committees do not accept the formal entrustment to provide the ethical review opinions for other institutions, the local health authorities at or above the county level will impose administrative penalties and sanctions on the relevant institutions and personnel in accordance with the law. Signing the entrustment ethical review contract, implementing legal compliance entrusted ethical review to protect the rights and interests of the trustee and the principal, and protect the research participants.

Objective:To observe the effect of pre injection of three different doses of butorphanol tartrate on postoperative pain in gynecological laparoscopic surgery.Methods:A prospective study was conducted on 172 patients who underwent gynecological laparoscopic surgery under general anesthesia at the First Affiliated Hospital of Dalian Medical University from April to December 2022. According to the random number table method, patients were divided into B1 group, B2 group, and B3 group. These three groups were given 10, 20, and 30 μ g/kg butorphanol tartrate 15 minutes before surgery, respectively. Ramsay sedation score at 10 minutes after patient administration, the pain Numerical Rating Scale (NRS) scores and Bruggrmann Comfort Scale (BCS) for resting and active states at 2, 6, 12, 24, and 48 hours after surgery, hemodynamic parameters at different time points during surgery, postoperative use of adjuvant analgesics and effective number of compressions for patient-controlled intravenous analgesia (PCIA) and the incidence of postoperative adverse reactions were recorded.Resultsl:There was no statistically significant difference in general characteristics among the three groups of patients (all P>0.05). At 10 minutes after administration, there was a statistically significant difference in Ramsay scores between groups B2 and B3 compared to group B1 (all P<0.05). At 12 and 24 hours after surgery, the resting NRS score of B3 group was lower than that of B2 group and B1 group, and B2 group was lower than B1 group (all P<0.05); At 6, 12, and 24 hours after surgery, the NRS scores of postoperative activity in the B2 and B3 groups were lower than those in the B1 group (all P<0.05); At 6 and 12 hours after surgery, the NRS score of the B3 group was lower than that of the B2 group (all P<0.05). At 6 and 24 hours after surgery, there was a statistically significant difference in BCS between groups B2 and B3 compared to group B1 (all P<0.05). There was no statistically significant difference in the hemodynamic parameters at each time point during surgery, the effective number of PCIA compressions within 48 hours after surgery, and the incidence of postoperative adverse reactions among the three groups of patients (all P>0.05). There was a statistically significant difference in the rate of postoperative addition of analgesics among the three groups ( P<0.05). Conclusions:Intravenous injection of 15 minutes before gynecological laparoscopic surgery 30 μg/kg butorphanol tartrate can achieve good analgesic effects with fewer adverse reactions, and can be used as a priority dose for preventive analgesia in gynecological laparoscopic surgery.

Objective:To study the environmental characteristics of launch section during the space medical rescue mission of Shenzhou-13 spacecraft, evaluate the influence of special environment on peripheral veins, and investigate the coping strategies.Methods:Combined with the practice of launch section during space medical rescue mission of Shenzhou-13 spacecraft, the main factors of aerospace special environment, cold and faint light, were selected and the related literature was reviewed to explore the feasibility, advantages and disadvantages of peripheral venipuncture, central venous catheter and bone marrow puncture. The experience of the space medical rescue mission was summarized and the coping strategies were provided for follow-up task training.Results:The environmental characteristics of launch section during the space medical rescue mission of Shenzhou-13 spacecraft included cold, faint light, sand-wind and complex terrain. The vascular filling, vascular elasticity and visibility of peripheral vein decreased in different degrees under special environmental, the vascular visibility was most affected. The literature analysis showed that bone marrow puncture was a suitable method to establish infusion access in cold and faint light environment.Conclusions:The special environment of space launch mission has greater impact on peripheral veins. In order to assurance the successful implementation of manned space project, the training of basic operational skills should be consolidated, the training of ability in special environment should be enhanced and the advanced clinical auxiliary equipment should be equipped in follow-up space medical mission training.

Objective:To investigate the techniques used in blood flow control of Kimura laparoscopic spleen-preserving pancreatectomy (LSPDP).Methods:Forty·five patients with benign or low-grade malignant pancreatic diseases undergoing LSPDP at Huzhou Central Hospital from May 2014 to Oct 2021 were analyzed retrospectively. Patients were divided into splenic vascular flow control group ( n=22) and routine management group ( n=23). Results:There was no significant difference in gender, age, BMI, accompanying symptoms, hypertension, diabetes, lesion size and pathological diagnosis between the two groups (all P>0.05). A higher overall spleen preservation rate (90.9% vs. 52.2%, χ2=8.213, P=0.004), lower incidence of morbidity with Clavien grade ≥ Ⅱ (22.7% vs. 73.9%, χ2=9.911, P=0.002) and shorter postoperative hospital stay [(9.6±4.5) d vs. (14.3±6.6) d, t=2.447, P=0.008] were achieved in the vascular flow control group compared with those in the routine group. Conclusion:Splenic vascular flow control techniques improve the success rate of spleen preservation in laparoscopic distal pancreatectomy, reduce the postoperative complications and shorten the postoperative hospital stay.

The endocrown, a modified overlay or crown, is considered to have the advantages of adhesive retention and mechanical retention. Marginal adaptation and mechanical strength are common criteria for evaluating endocrowns. This review studied these aspects of endocrowns to guide further clinical application. Results from previous academic studies indicate that endocrowns made of different materials, such as glass-based ceramics, zirconia-based ceramics and resin-based ceramics, exhibit clinically acceptable marginal adaptation. Zirconia is a common dental material, but when used in endocrowns, it tends to present a risk of irreparable tooth root fractures. Compared with products manufactured with zirconia, endocrowns manufactured with resin-based ceramics and glass-based ceramics, such as lithium disilicate ceramics, do not tend to cause irreparable results, such as tooth root fracture, but their mechanical strengths are not as good as those of zirconia. At the same time, the tooth prepration design such as the types of endocrowns, the pulp chamber extension depth and angles, the endocrown thickness can influence the mechanical strength of endocrowns as well. Compared with traditional zirconia, self-glazed zirconia, a new type of material used to restore defective teeth, has the similar elasticity modulus（210 GPa）and better aesthetic advantages, and is suitable for short crown patients with insufficient occlusal space. Further study is warranted to improve the performance of endocrowns made from ceramic materials to prevent root fracture.