Objective To observe the clinical efficacy of Ruanjian Sanjie Pills in the treatment of patients with hepatitis B-related cirrhosis in compensatory stage differentiated as blood stasis blocking collaterals syndrome.Methods A total of 80 cases of patients with hepatitis B-related cirrhosis in compensatory stage admitted to Bao'an Hospital of Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine from January 2023 to April 2024 were randomly divided into the trial group and the control group,40 cases in each group.The control group was treated with oral administration of Entecavir for hepatitis B virus(HBV),and the trial group was treated with Ruanjian Sanjie Pills on the basis of treatment for the control group,the course of treatment covering one year.Before and after treatment,the two groups were observed in the changes of routine blood test indicators of white blood cell count(WBC)and platelet count(PLT),liver function indicators[albumin(ALB),total bilirubin(TBIL),alanine transaminase(ALT)and aspartate transaminase(AST)],prothrombin time(PT),liver stiffness measurement(LSM),and traditional Chinese medicine(TCM)syndrome scores.After treatment,the clinical efficacy and safety were evaluated.Results(1)There were three cases in the control group and four cases in the trial group fell off,and eventually 37 cases in the control group and 36 cases in the trial group were enrolled in the efficacy statistics.(2)After one year of treatment,the total effective rate of the trial group was 91.67%(33/36)and that of the control group was 67.57%(25/37),and the intergroup comparison(tested by chi-square test)showed that the therapeutic efficacy of the trial group was significantly superior to that of the control group(P<0.05).(3)After treatment,the routine blood test indicators of WBC and PLT in the trial group were increased compared with those before treatment(P<0.05),while the WBC and PLT in the control group did not change significantly(P>0.05).The post-treatment WBC and PLT in the trial group were significantly higher than those of the control group(P<0.05).(4)After treatment,the ALB of patients in the two groups was increased compared with that before treatment(P<0.05),and the PT value of patients in the two groups and the ALT of the trial group were decreased compared with those before treatment(P<0.05),but TBIL and AST of the two groups and ALT of the control group did not differ from those before treatment(P>0.05).The comparison between the two groups showed that the decrease of PT value in the trial group was significantly superior to that of the control group(P>0.05),but no statistically significant differences of ALT,AST,TBIL and ALB were shown between the two groups(P>0.05).(5)After treatment,the LSM of patients in the two groups was decreased compared with that before treatment(P<0.05),and the decrease in the trial group was significantly superior to that in the control group(P<0.05).(6)After treatment,the TCM syndrome scores of the two groups of patients were decreased compared with those before treatment(P<0.05),and the decrease in the trial group was significantly superior to that in the control group(P<0.05).(7)There were no significant adverse reactions or adverse events occurring in the two groups during the treatment.Conclusion Ruanjian Sanjie Pills can improve the clinical symptoms of patients with hepatitis B-related cirrhosis in the compensatory stage,improve the coagulation function,reduce the hardness of the liver,and slow down the process of cirrhosis,with satisfactory efficacy and good safety.

Objective:To analyse the clinical significance of selective single embryo transfer by time-lapse mo-nitoring(TLM)or conventional morphology assessment(CMA)in vitro fertilization/intracytoplasmic sperm in-jection and embryo transfer(IVF/ICSI-ET),and to initially explore the predictive value of Raman spectral analy-sis of embryo culture medium for clinical pregnancy rate.Methods:The study is a prospective randomized con-trolled clinical trial.We assigned 139 patients treated with IVF/ICSI-ET in Reproductive and Genetics Center of Suzhou Municipal Hospital from April 2019 to July 2020,which were randomly assigned to either the CMA or the TLM group.We performed selective single-embryo transfer(fresh cycle and FET)after selecting the optimal em-bryos with TLM or CMA respectively.If the patient's first embryo transfer was unsuccessful,a second one would be performed to compare the differences in the cumulative live birth rate of embryo transfer and other pregnancy outcomes between the two groups.Meanwhile,we collected 15 μl of embryo culture medium at day 3 after IVF/ISCI fertilization for Raman spectroscopy analysis.Results:There were no differences in cumulative live birth,cu-mulative clinical pregnancy,cumulative premature birth,cumulative early spontaneous abortion,cumulative ectopic pregnancy and LGA or SGA between TLM and CMA groups(P＞0.05).The Neonatal sex ratio in the TLM group was lower than that in the CMA group,but the difference was not significant(P＞0.05).Raman spectros-copy analysis of embryo culture medium predicted the clinical pregnancy rate with 67.21％accuracy.Conclu-sions:In young women with a good ovarian reserve,the advantage of using TLM to evaluate embryos is not obvi-ous,so we should remain vigilant that embryo selection based on morphokinetic parameters may affect the sex ratio.Raman spectroscopic analysis of embryo culture medium is not yet able to effectively predict the planting ability of embryos.

Objective:To improve the understanding of craniocerebral diseases and aeromedical assessment from the perspective of imaging by analyzing the results of craniocerebral MRI examination of military flying personnel.Methods:The results of craniocerebral MRI examination were retrospectively analyzed among the military flying personnel who underwent annual physical examination in Air Force Healthcare Center for Special Services Hangzhou from September of 2020 to December of 2021. They were divided into 20-29 years group, 30-39 years group, 40-49 years group, 50-59 years group according to the age, and they were divided into fighter pilots, bomb-transporter pilots, helicopter pilots, air combat/technical personnel according to the aircraft type and post. The detection of craniocerebral MRI examination results of the flying personnel in different age groups and aircraft type and post groups were compared. The influence of abnormal results on the conclusion of aeromedical assessment was analyzed. The α level of statistical analysis was set at 0.05, and the difference was statistically significant with P< α/statistical count for pairwise comparison among groups. Results:Among the craniocerebral MRI examination results of 975 military flying personnel, 473 cases were with no obvious abnormality, 194 were anatomical variation of Willis circle, 27 were congenital brain malformation, 54 were cerebrovascular disease, 279 were white matter hyperintensities (WMHs), 22 were tumor and tumor-like lesions, 26 were arachnoid cyst, 29 were empty sella, 7 were intracranial calcinosis and 2 were craniocerebral trauma. The proportion of no obvious abnormality in 20-29 years group and 30-39 years group were higher than those in other age groups; the detection rates of WMHs in 40-49 years group and 50-59 years group was higher than those in the other age groups; the detection rates of cerebrovascular diseases and empty sella in 50-59 years group were higher than those in the other age groups, and the differences were significant (all P< α/6=0.008). The proportion of no obvious abnormality in fighter pilots and helicopter pilots were higher than those in others; the detection rate of WMHs in air combat/technical personnel was higher than that in others; the detection rate of arachnoid cyst in bomb-transporter pilots was higher than that in fighter pilots, and the differences were significant (all P< α/6=0.008). Most of the abnormal results detected by craniocerebral MRI examination had no significant impact on the conclusion of aeromedical assessment, and those with greater impact were cerebrovascular disease, tumor and tumor-like lesions (both P< α/351=0.001). Conclusions:The MRI examination not only preliminarily explains the basic characteristics of the distribution of craniocerebral diseases among military flying personnel of different ages, aircraft types and posts from the perspective of imaging, but also provides the basis for dynamic follow-up and accurate aeromedical assessment.

Objective:To explore the effects of cyclosporine A (CsA) on the clinical outcomes of patients with unexplained repeated implantation failure (URIF) undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles. Methods:A retrospective cohort study was conducted, and the data of URIF patients at the Center for Human Reproduction and Genetics of the Affiliated Suzhou Hospital of Nanjing Medical University from April 2016 to March 2020 was analyzed. Totally 94 cycles with CsA application were enrolled, and 188 cycles of control group were selected according to age, body mass index (BMI), basal follicle-stimulating hormone (FSH), the number of high-quality embryos transferred and embryo stage matched with CsA group. The general conditions, characteristics of previous failed transfer cycles and the de novo transfer cycles, clinical outcomes, obstetric and neonatal complications were compared between the two groups, and regression analysis of CsA and clinical outcomes. Results:1) There were no statistical differences between the two groups in baseline characteristics such as age, BMI, basal FSH, duration of infertility, indications for IVF/ICSI, number of previous failed cycles, number of high-quality embryos and blastocyst transferred rate (all P>0.05). There were also no significant differences in the number of embryos transferred, the number of high-quality embryos, the rate of transferred blastocyst and the endometrial thickness on transfer day of the de novo transfer cycles (all P>0.05). 2) The embryo implantation rate, the clinical pregnancy rate and the live birth rate in CsA group [53.39% (63/118), 58.51% (55/94), 45.74% (43/94)] were distinctly higher than those of control group [38.43% (93/242), 45.74% (86/188), 33.51% (63/188)]. The differences were statistically significant ( P=0.007, P=0.043, P=0.046). While there were no differences in miscarriage rate and ectopic pregnancy rate between the two groups (all P>0.05). 3) The differences of the rates of preterm birth, multiple pregnancy, obstetric and neonatal complications were all not statistically significant between the two groups (all P>0.05). No birth defects were observed in both groups. 4) The multivariate logistic regression analysis showed that CsA was an independent promoter of clinical pregnancy (after adjusted OR=1.694, 95% CI:1.019-2.816, P=0.042) and live birth (after adjusted OR=1.700, 95% CI:1.012-2.853, P=0.045) in URIF patients after adjusting for age, BMI, basal FSH, the number of embryos transferred and the endometrial thickness on transfer day. Conclusion:CsA showed remarkably enhancement on embryo implantation rate, clinical pregnancy rate and live birth rate of de novo embryo transfer in patients with URIF, without increasing the risk of obstetric and pediatric complications. CsA application may be used as an effective treatment for URIF patients.

Objective:To explore the effects of cyclosporine A (CsA) on the clinical outcomes of patients with unexplained repeated implantation failure (URIF) undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles. Methods:A retrospective cohort study was conducted, and the data of URIF patients at the Center for Human Reproduction and Genetics of the Affiliated Suzhou Hospital of Nanjing Medical University from April 2016 to March 2020 was analyzed. Totally 94 cycles with CsA application were enrolled, and 188 cycles of control group were selected according to age, body mass index (BMI), basal follicle-stimulating hormone (FSH), the number of high-quality embryos transferred and embryo stage matched with CsA group. The general conditions, characteristics of previous failed transfer cycles and the de novo transfer cycles, clinical outcomes, obstetric and neonatal complications were compared between the two groups, and regression analysis of CsA and clinical outcomes. Results:1) There were no statistical differences between the two groups in baseline characteristics such as age, BMI, basal FSH, duration of infertility, indications for IVF/ICSI, number of previous failed cycles, number of high-quality embryos and blastocyst transferred rate (all P>0.05). There were also no significant differences in the number of embryos transferred, the number of high-quality embryos, the rate of transferred blastocyst and the endometrial thickness on transfer day of the de novo transfer cycles (all P>0.05). 2) The embryo implantation rate, the clinical pregnancy rate and the live birth rate in CsA group [53.39% (63/118), 58.51% (55/94), 45.74% (43/94)] were distinctly higher than those of control group [38.43% (93/242), 45.74% (86/188), 33.51% (63/188)]. The differences were statistically significant ( P=0.007, P=0.043, P=0.046). While there were no differences in miscarriage rate and ectopic pregnancy rate between the two groups (all P>0.05). 3) The differences of the rates of preterm birth, multiple pregnancy, obstetric and neonatal complications were all not statistically significant between the two groups (all P>0.05). No birth defects were observed in both groups. 4) The multivariate logistic regression analysis showed that CsA was an independent promoter of clinical pregnancy (after adjusted OR=1.694, 95% CI:1.019-2.816, P=0.042) and live birth (after adjusted OR=1.700, 95% CI:1.012-2.853, P=0.045) in URIF patients after adjusting for age, BMI, basal FSH, the number of embryos transferred and the endometrial thickness on transfer day. Conclusion:CsA showed remarkably enhancement on embryo implantation rate, clinical pregnancy rate and live birth rate of de novo embryo transfer in patients with URIF, without increasing the risk of obstetric and pediatric complications. CsA application may be used as an effective treatment for URIF patients.

Objective:To improve the understanding of craniocerebral diseases and aeromedical assessment from the perspective of imaging by analyzing the results of craniocerebral MRI examination of military flying personnel.Methods:The results of craniocerebral MRI examination were retrospectively analyzed among the military flying personnel who underwent annual physical examination in Air Force Healthcare Center for Special Services Hangzhou from September of 2020 to December of 2021. They were divided into 20-29 years group, 30-39 years group, 40-49 years group, 50-59 years group according to the age, and they were divided into fighter pilots, bomb-transporter pilots, helicopter pilots, air combat/technical personnel according to the aircraft type and post. The detection of craniocerebral MRI examination results of the flying personnel in different age groups and aircraft type and post groups were compared. The influence of abnormal results on the conclusion of aeromedical assessment was analyzed. The α level of statistical analysis was set at 0.05, and the difference was statistically significant with P< α/statistical count for pairwise comparison among groups. Results:Among the craniocerebral MRI examination results of 975 military flying personnel, 473 cases were with no obvious abnormality, 194 were anatomical variation of Willis circle, 27 were congenital brain malformation, 54 were cerebrovascular disease, 279 were white matter hyperintensities (WMHs), 22 were tumor and tumor-like lesions, 26 were arachnoid cyst, 29 were empty sella, 7 were intracranial calcinosis and 2 were craniocerebral trauma. The proportion of no obvious abnormality in 20-29 years group and 30-39 years group were higher than those in other age groups; the detection rates of WMHs in 40-49 years group and 50-59 years group was higher than those in the other age groups; the detection rates of cerebrovascular diseases and empty sella in 50-59 years group were higher than those in the other age groups, and the differences were significant (all P< α/6=0.008). The proportion of no obvious abnormality in fighter pilots and helicopter pilots were higher than those in others; the detection rate of WMHs in air combat/technical personnel was higher than that in others; the detection rate of arachnoid cyst in bomb-transporter pilots was higher than that in fighter pilots, and the differences were significant (all P< α/6=0.008). Most of the abnormal results detected by craniocerebral MRI examination had no significant impact on the conclusion of aeromedical assessment, and those with greater impact were cerebrovascular disease, tumor and tumor-like lesions (both P< α/351=0.001). Conclusions:The MRI examination not only preliminarily explains the basic characteristics of the distribution of craniocerebral diseases among military flying personnel of different ages, aircraft types and posts from the perspective of imaging, but also provides the basis for dynamic follow-up and accurate aeromedical assessment.

Objective:To explore the influential factors of lumbar inter-vertebral disc degeneration and provide the references on flying personnel′s recruitment, physical checkup for transformation and medical identification.Methods:Lumbar MRI images and relevant data of 458 flying personnel who underwent medical identification in the Second Area of Air Force Healthcare Center for Special Services Hangzhou from March 2018 to May 2019 were retrospectively analyzed. Two thousand two hundred and ninety lumbar inter-vertebral discs of 458 flying personnel were semi quantitatively scored according to the Pfirrmann standard. The sum of five inter-vertebral disc scores of each flying personnel was taken as the lumbar inter-vertebral disc degenerative factor (LIVDDF). This factor was taken as the dependent variable ( y), and the age ( x1), height ( x2), weight ( x3), and flying hours ( x4) of flying personnel were taken as independent variables for linear regression analysis. The subgroup analysis was carried out based on the grouping of aircraft type and flight post. Results:The range of LIVDDF was 5-18, with an average of 10.87±2.83. Total analysis showed that age and weight were the influential factors of lumbar inter-vertebral disc degeneration in flying personnel. The regression equation was y=1.029+0.182 x1+0.038 x3 ( r=0.68, P<0.01). Subgroup analysis on the different aircraft types showed that the influential factor was age in the fighter subgroup. The regression equation was y=2.569+0.225 x1 ( r=0.59, P<0.01). Age and height were the influential factors in the trans-bomber aircraft subgroup. The regression equation was y=-8.848+0.186 x1+7.160 x2( r=0.69, P<0.01). Flying hours was the influential factor in the helicopter subgroup. The regression equation was y=7.823+0.001 x4 ( r=0.65, P<0.01). Subgroup analysis on different flight post showed that the influential factors were age in flying personnel. The regression equation was y=3.176+0.207 x1 ( r=0.65, P<0.01). Age and weight were the influential factors in crew members. The regression equation was y=-0.113+0.171 x1+0.056 x3( r=0.74, P<0.01). Conclusions:Age and weight are the main influential factors of lumbar inter-vertebral disc degeneration in flying personnel, but these factors show different influence on aircraft type and flight post. Due to the small sample size in this study, aviation related factors are not fully included. So other influential factors of lumbar inter-vertebral disc degeneration of flying personnel may exist.

Objective:To explore the demand and mode of palliative care for emergency dying patients by analyzing the case data of emergency death and cardiopulmonary resuscitation.Methods:The data of 776 cases of emergency clinical death and cardiopulmonary resuscitation in the Second Affiliated Hospital of Soochow University from 2017 to 2020 were retrospectively analyzed.Results:A total of 687 patients were included with (70.38 ± 16.57) years old, and 49.8% (342/687) of them were 75 years old and above; among them, 36.0% (247/687) patients or their families chose not to give cardiopulmonary resuscitation (DNR) in the last stage of their lives,and 63.2%(156/247) of DNR patients were 75 years old and above. The top four etiology of DNR were cerebral hemorrhage, respiratory failure, multiple organ dysfunction syndrome and out of hospital cardiac and respiratory arrest.After successful cardiopulmonary resuscitation, 37.5% (45/120) of the patients' family members chose to give up treatment again. The median stay time of DNR patients in the emergency room was 738.7 minutes.Conclusions:The patients who choosed DNR were mainly 75 years old and above, with cerebral hemorrhage, respiratory failure, multiple organ failure and cardiac and respiratory arrest. The detention of these patients in the emergency room increases the congestion of the emergency room, and at the same time, they can not get a peaceful palliative care environment. It is suggested that emergency medical staff should strengthen the awareness and improve the ability of palliative care. A relative independent area and corresponding soothing palliative treatment and nursing should be given to the DNR patients.

Objective:To explore the influential factors of lumbar inter-vertebral disc degeneration and provide the references on flying personnel′s recruitment, physical checkup for transformation and medical identification.Methods:Lumbar MRI images and relevant data of 458 flying personnel who underwent medical identification in the Second Area of Air Force Healthcare Center for Special Services Hangzhou from March 2018 to May 2019 were retrospectively analyzed. Two thousand two hundred and ninety lumbar inter-vertebral discs of 458 flying personnel were semi quantitatively scored according to the Pfirrmann standard. The sum of five inter-vertebral disc scores of each flying personnel was taken as the lumbar inter-vertebral disc degenerative factor (LIVDDF). This factor was taken as the dependent variable ( y), and the age ( x1), height ( x2), weight ( x3), and flying hours ( x4) of flying personnel were taken as independent variables for linear regression analysis. The subgroup analysis was carried out based on the grouping of aircraft type and flight post. Results:The range of LIVDDF was 5-18, with an average of 10.87±2.83. Total analysis showed that age and weight were the influential factors of lumbar inter-vertebral disc degeneration in flying personnel. The regression equation was y=1.029+0.182 x1+0.038 x3 ( r=0.68, P<0.01). Subgroup analysis on the different aircraft types showed that the influential factor was age in the fighter subgroup. The regression equation was y=2.569+0.225 x1 ( r=0.59, P<0.01). Age and height were the influential factors in the trans-bomber aircraft subgroup. The regression equation was y=-8.848+0.186 x1+7.160 x2( r=0.69, P<0.01). Flying hours was the influential factor in the helicopter subgroup. The regression equation was y=7.823+0.001 x4 ( r=0.65, P<0.01). Subgroup analysis on different flight post showed that the influential factors were age in flying personnel. The regression equation was y=3.176+0.207 x1 ( r=0.65, P<0.01). Age and weight were the influential factors in crew members. The regression equation was y=-0.113+0.171 x1+0.056 x3( r=0.74, P<0.01). Conclusions:Age and weight are the main influential factors of lumbar inter-vertebral disc degeneration in flying personnel, but these factors show different influence on aircraft type and flight post. Due to the small sample size in this study, aviation related factors are not fully included. So other influential factors of lumbar inter-vertebral disc degeneration of flying personnel may exist.

Objective To study the effects of dexmedetomidine on the swallowing reflex. Methods Sixty adult volunteers (ASAⅠ-Ⅱ) were randomly divided into two groups, dexmedetomidine sedation group and propofol sedation group respectively. The BIS value was maintained between 60-65 in both groups. Swallowing reflex was induced by water injection in the pharynx at different depths of sedation, and the swallowing movements were observed. Meanwhile, the RR, SpO2 and OAA/S scores were recorded. Results The swallowing reflex existed in dexmedetomidine sedation group when BIS values was maintained at 60, which had significant difference compared with that in propofol sedation group. The RR, SpO2, OAA/S score in dexmedetomidine sedation group also had statistical difference compared with that in propofol sedation group during swallowing reflex test. Conclusions Slow infusion of dexmedetomidine to maintain the BIS value above 60 will not affect swallowing reflex, and can obtain satisfactory hemodynamic stability. It′clinical safety is high.