Objective:To perform two-step clustering analysis based on urodynamics in patients with neurogenic bladder (NB) and exploring characteristics affecting success rate of sacral neuromodulation (SNM).Methods:The data of 174 NB patients who received SNM therapy in our hospital from September 2018 to August 2023, were retrospectively analysed. There were 94 males and 80 females, with average age of (50.4±17.9)years, median duration of 2 (1, 3)years, and body mass index of 21.5 (20, 25) kg/m 2. Among them, 50 patients had chronic diseases (hypertension or diabetes). Additionally, 77 patients (44.3%) presented with voiding symptoms, 47 patients (27.0%) with storage symptoms, and 50 patients (28.7%) with mixed symptoms. The etiologies included spinal cord lesions in 110 patients (63.2%), brain lesions in 21 patients (12.1%), peripheral nerve lesions in 36 patients (20.7%), and other causes in 7 patients (4.0%). All patients underwent urodynamics and SNM phase 1 test. If patient's subjective symptoms or objective indicators improved > 50%, it is defined as treatment success and feasible to received second stage of SNM. The success rate was analyzed. Clinical indicators and urodynamic parameter were collected for exploring the difference of the above indicators between two groups (with or without conversion). The 174 patients were grouped using two-step clustering analysis, dividing them into two groups. The differences in clinical data, urodynamic parameters, and the conversion rate of SNM phase II between the two groups were compared. Results:Among these patients, 126 (72%) underwent the second stage of SNM. Compared with the non-conversion group, patients in the conversion group exhibited the following characteristics: high proportion of female[51.6% (65/126) vs. 31.2% (15/48)], younger[(48.1± 18.3)year vs. (56.4±15.4) year], lower proportion of history of chronic disease[23.9% (30/126) vs. 41.7% (20/48)], storage predominant symptoms predominant[33.3% (42/126) vs. 10.4% (5/48)], sensitive bladder sensation[50.0% (63/126) vs. 11.1% (14/48)], normal detrusor contractility [26.2% (33/126) vs. 10.4% (5/48)] and detrusor-sphincter dyssynergia [21.4% (27/126) vs. 4.2% (2/48)]and lower post-void residual [105.5(49.3, 231.3) ml vs. 197.9(114.8, 284.8) ml], ( P<0.05). After excluding multicollinearity, patients were divided into two group mainly based on coordination, detrusor stability, and detrusor contractility through two-step clustering analysis: 98 patients in Group 1 and 76 patients in Group 2. The success rate was higher in Group 2 [82.9% (63/76) vs. 64.3% (63/98), P=0.006]. Compared with Group 1, Group 2 exhibited the following characteristics: higher proportion of storage symptoms [43.4% (33/76) vs. 14.3% (14/98)], sensitive bladder sensation [67.1% (51/76) vs. 26.5% (26/98)], detrusor overactivity [46.1% (35/76) vs. 3.1% (3/98)], normal detrusor contractility [43.4% (33/76) vs. 5.1% (5/98)], and detrusor-sphincter dyssynergia [38.2% (29/76) vs. 0] ( P all<0.05). Additionally, group 2 had lower post-void residual [69.0 (23.8, 136.6) ml and 197.9 (123.2, 287.4) ml] and smaller bladder capacity [(281.9±144.9) ml vs. (430.4±176.7) ml] ( P all<0.01). Conclusions:Patients with storage symptoms, low post-void residual, sensitive bladder sensation, detrusor overactivity, normal contractility, or detrusor-sphincter dyssynergia indicate a higher conversion rate to second stage, making them more suitable for SNM testing.

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.

Purpose: This study aims to comprehensively evaluate the clinical efficacy of chemotherapy or endocrine therapy maintenance in metastatic breast cancer (MBC) patients. Materials and Methods: The meta-analysis of randomized clinical trials (RCTs) and propensity score matching of multicenter cohort study evaluated MBC patients who underwent first-line chemotherapy or endocrine therapy maintenance. This study is registered with PROSPERO: CRD42017071858 and ClinicalTrials.gov: NCT04258163. Results: A total of 2,867 patients from 15 RCTs and 760 patients from multicenter cohort were included. The results from meta-analysis showed that chemotherapy maintenance improved progression-free survival (PFS) (hazard ratio [HR], 0.63; 95% confidence interval [CI], 0.54 to 0.73; p < 0.001; moderate-quality evidence) and overall survival (OS) (HR, 0.87; 95% CI 0.78 to 0.97; p=0.016; high-quality evidence) than observation. In the cohort study, for hormone receptor–positive MBC patients, chemotherapy maintenance improved PFS (HR, 0.67; 95% CI, 0.52 to 0.85; p < 0.001) and OS (HR, 0.55; 95% CI 0.42 to 0.73; p < 0.001) compared with observation, and endocrine therapy maintenance also improved PFS (HR, 0.65; 95% CI, 0.53 to 0.80; p < 0.001) and OS (HR, 0.55; 95% CI, 0.44 to 0.69; p < 0.001). There were no differences between chemotherapy and endocrine therapy maintenance in PFS and OS (all p > 0.05). Regardless of the continuum or switch maintenance therapy, showed prolonged survival in MBC patients who were response to first-line treatment. Conclusion This study provided evidences for survival benefits of chemotherapy and endocrine therapy maintenance in MBC patients, and there was no difference efficacy between chemotherapy and endocrine therapy maintenance for hormone receptor–positive patients.

Objective:To analyze the application value of the mechanical thrombectomy system in the treatment of acute limb ischemia.Methods:The clinical data of 50 patients with lower limb ischemia who were treated with the Rotarex mechanical thrombectomy system from Jun 2017 to Sep 2019 were retrospectively analyzed.Results:In 4 cases of popliteal artery rupture occurred during the operation. The success rate of the operation was 92%. Catheter-directed thrombolysis was used in 7 cases, percutaneous transluminal angioplasty was used in 4 cases and percutaneous transluminal angioplasty combined with stent implantation was used in 39 cases. The ankle-brachial index of these 50 patients before and after operation was 0.18±0.24 and 0.64±0.28 respectively ( t=12.87, P<0.001). Treatment was successful in 43 cases. Follow-up ranged from 1 to 24 months, 5 cases were amputated, 2 cases had no improvement of toe ulcer gangrene, 9 cases had thrombus recurrence, and no complications such as bleeding were observed. The primary patency rates at 3, 6 and 12 months were 92%, 84% and 74%, respectively. Conclusion:The mechanical thrombectomy system is safe and effective in the treatment of acute lower limb ischemia with ideal short-term patency.

Objective To study the values of clinicopathological features and expression of thyroid transcription factor 1 (TTF-1) in predicting the mutation status of epidermal growth factor receptor (EGFR) gene in patients with non-small cell lung cancer (NSCLC). Methods Mutation status of exons 18, 19, 20 and 21 in EGFR, and expression of TTF-1 protein in 283 cases of NSCLC diagnosed in Shanxi Provincial Cancer Hospital from January 2013 to December 2014 were analyzed by using amplification refractory mutation system (ARMS) and immunohistochemical method. The correlation of EGFR mutations with the clinicopathological features and TTF-1 expression were studied to explore the values of them in the prediction of EGFR mutations. Results Among 283 cases of NSCLC, the rate of EGFR gene mutation was 30.0 ％(85/283), including 3 cases with double mutations(exon 18 and exon 20 double mutations in one case, exon 19 and exon 21 double mutations in one case, exon 20 and exon 21 double mutations in one case). The EGFR gene mutations were associated with gender, histological type, history of smoking, and expression of TTF-1 (all P<0.001), but not related to age and tumor location (P= 0.785, P= 0.138). The combination of factors with high mutation rates (women, adenocarcinoma, no smoking, and TTF-1 positive) made the positive predictive value of EGFR mutations up to 57.6 ％. And the combination of factors with low mutation rates (male, nonadenocarcinoma, smoking history, TTF-1 negative) made the EGFR negative predictive value up to 90.3％. Conclusion The combination of clinicopathological features and TTF-1 expression status in patients with NSCLC has a great predictive value for EGFR mutations, which can provide a useful reference for clinical treatment decision-making.

Objective To investigate the effect of intrathecal injection of ropivacaine in the treatment of carpal tunnel syndrome with nervi medianus entrapment syndrome. Methods 164 patients with carpal tunnel syndrome were selected and divided into two groups, 82 cases in the control group were given intrathecal injection of lidocaine + methylprednisolone + vitamin B1, 82 cases in the experimental group received injection of ropivacaine + methylprednisolone + vitamin B1, the symptom score, nerve electrophysiological examination index, high frequency ultrasound quantitative parameters, the clinical effect and total recurrence rate were compared after treatment. Results The effective rate in the control group(74.39%)was lower than the experimental group(87.81%)(P<0.05); compared with the control group, the visual analogue scale (VAS), global symptom score (GSS), fatigue severity scale (FSS) and Levine carpal tunnel syndrome questionnaire score were lower in the experimental group after treatment, the nervi medianus distal motor latency (DML) level was lower, sensory nerve action potential (SNAP) and sensory conduction velocity (SCV) levels were higher after treatment, the diameter of the nervi medianus, the transverse diameter (a), anteroposterior diameter (b) of nervi medianus and cross sectional area (CSA) were lower after treatment, with significant difference (P<0.05); the total recurrence rate in the control group(53.66%)was higher than the experimental group(37.80%), with significant difference (P<0.05). Conclusion The clinical effect of intrathecal injection of ropivacaine in the treatment of carpal tunnel syndrome with nervi medianus entrapment syndrome was obvious, can effectively alleviate pain, improve the symptoms of nervi medianus entrapment, restore the nervi medianus conduction velocity and function, and reduce the recurrence rate.

BACKGROUND: Previous studies suggest that vascular endothelial growth factor 121 may be an optimal target gene for thetreatment of acute myocardial infarction.OBJECTIVE: To investigate effect of direct myocardial injection of adenovirus recombinant human vascular endothelial growthfactor 121 gene (Ad-hVEGF121) on myocardial infracted rat heart structure, function and angiogenesis.METHODS: Totally 78 male SD rats were randomly divided into the sham-surgery (n=18), acute myocardial infarction (n=24),Ad-VEGF121 (n=19) and normal saline (n=17) groups. Among them, left anterior descending coronary arteries of the latter threegroups were ligated to prepare acute myocardial infarction models and rats were randomly selected to receive Ad-hVEGF12 ornormal saline via three points in the cardiac muscle at the 10-15 minutes after ligation. The chest was exposed without ligation inthe sham-surgery group.RESULTS AND CONCLUSION: At 2 weeks after injection, cardiac ultrasound showed that, compared with the sham-surgerygroup, the number of new capillaries, body weight and left ventricular mass / body weight of the acute myocardial infarction,Ad-hVEGF121 and normal saline groups were obviously increased (P < 0.05 or P < 0.01), especially those received transfectedrAd-hVEGF12, had higher density of blood capillaries than those of the normal saline and acute myocardial infarction groups.However, there were no obviously differences between each group in infarct size, cardiac structure or functions. The directmyocardial injection of Ad-VEGF121 can significantly promote the formation of new blood vessels within the myocardium.

Objective:To investigate the effect of chronic alcohol consumption on both left ventricular myocardial collagen and diastolic function in rats,and their relationship thereof.Methods:Twenty-four male Wistar rats were randomly divided into 2 groups:control group(n=12)and ethanol group(n=12).The changes in cardiac diastolic function were evaluated by echocardiography and tissue Doppler imaging(TDI).The value of myocardial hydroxyproline content was determined by hydroxyproline reagent kit.The expressions of collagen Ⅰ and collagen Ⅲ mRNA were detected by RT-PCR analysis.Results:It was found that mitral E and mitral annulus Ea were decreased,mitral annulus Aa was increased,and isovolumic relaxation time(IVRT)was prolonged in the ethanol group compared with those in control group(P＜0.05).The value of Ea/Aa ratio was greater than 1 in control group and less than 1 in ethanol group(P＜0.01).It was found that myocardial hydroxyproline content,collagen Ⅰ,collagen Ⅲ mRNA expression and their ratio significantly increased in ethanol group compared with those in the control group(P＜0.01).There was positive correlation between hydroxyproline content,collagen Ⅰ,collagen Ⅲ mRNA expression,and collagen Ⅰ /collagen Ⅲ mRNA ratio with IVRT(P＜0.05),and negative correlation between hydroxyproline content,collagen Ⅰ,collagen Ⅲ mRNA expression,and collagen Ⅰ /collagen Ⅲ mRNA ratio with the Ea/Aa ratio(P＜0.01).Conclusion:Chronic ethanol consumption can induce increase in left ventricular myocardial collagen synthesis and impairment in diastolic function in rats.Left ventricular diastolic dysfunction correlates with increase in myocardial collagen synthesis positively.

Objective To learn surgical nurses about their critical thinking ability and learning ability in order for nursing administrators to provide theoretical basis for improvement of critical thinking and self-learning ability of surgical nurses. Methods We investigated 200 nurses of three hospitals in surgery by California Critical Thinking Disposition Inventory(CCTDI) and Scale of Self-directed Learning Competence. Results Surgical nurse' critical thinking score was (282.41±19.87), and has a positive critical thinking; self-learning ability score was (131.65±10.29), the overall scores was at higher levels. Conclusions Care managers should pay attention to the surgical nurse' critical thinking skills and independent learning abilities and improve their quality of nursing staff.

Objective To determine the cardiac structure and function by transthoracic highfrequency ultrasonography in Wistar rats, and to explore the patterns of age-related changes.Methods Male Wistar rats aged 1, 2, 5, 12, and 20 months (n= 12 each group) underwent transthoracic echocardiographic analysis to examine the parameters of cardiac structure and function.Finally, the rats were sacrificed and the left ventricles were weighed. Results The left atrial dimension (LAD), left ventricular end-diastolic diameter (LVEDD), interventricular septum thickness at diastole (IVSD), left ventricular posterior wall thickness (LVPWd) and left ventricular mass (LVM) increased with age (all P ＜ 0.05 ) . There was a positive relationship between echocardiographic value and the autopsy weight LVM (r=0. 78, P＜0.01). There were no statistical significances in ejection fraction and fractional shortening among groups (all P＞0.05). Isovolumic relaxation time (IVRT) prolonged with age (P＜0. 01). After 2 month-old, tissue Doppler imaging Ea gradually decreased with age, Aa tended to increase with age. Ea/Aa ratio was more than 1 value in 1-, 2- and 5-months-old group, and it was less than 1 value in 12-, and 20-month-old group.Multivariate analysis showed that age was the influence factor of LAD, LVEDd and Ea. Conclusions Transthoracic high-frequency ultrasonography can be used to evaluate cardiac structure and function in rats; In aged rats, the wall-thickness, LAD and LVEDd are significantly increased. There is no significant change in systolic function, but diastolic function is decreased.