Objective To propose a whole-life cycle management model for valvular heart disease (VHD), systematically elucidate its underlying logic and implementation pathways, and concurrently review and analyze its preliminary application outcomes. Methods Since 2020, West China Hospital of Sichuan University has established a management system encompassing "assessment-decision-intervention-follow-up", including: (1) a risk-stratified, tiered management pathway; (2) six core functions ("promotion, screening, prevention, diagnosis, treatment, and rehabilitation") coordinated by disease-specific managers; (3) an intelligent decision support information platform; and (4) a collaborative network of multidisciplinary teams and regional academic alliances. To evaluate the effectiveness of this management model, we retrospectively included three cohorts: (1) the population screened by echocardiography from 2020 to 2024, analyzing the detection rate of aortic valve disease and risk stratification; (2) patients enrolled in the whole-life cycle management from April 2021 to December 2024, assessing follow-up outcomes, hospital satisfaction, and changes in quality of life; (3) patients who underwent transcatheter aortic valve replacement (TAVR) from January 2022 to January 2024, evaluating the one-year all-cause mortality rate, perioperative complications, and improvements in New York Heart Association (NYHA) classification. Results Between 2020 and 2024, a total of 583 874 individuals underwent echocardiographic screening. A total of 48 089 patients with aortic valve disease were identified, including 3 401 (7.1%) high-risk patients, 18 657 (38.8%) moderate-risk patients, and 26 031 (54.1%) low-risk patients. Among them, 2 417 patients were enrolled in whole-life cycle management. Patient satisfaction scores showed a yearly increase, rising from 73.89 points before 2020 to 93.74 points in 2024. The 1-year mortality rate in the TAVR cohort decreased to 5.3%, significantly lower than the 8.2% observed under early standard management between 2014 and 2019 (P<0.01). Conclusion Through process optimization and resource integration, the VHD whole-life cycle management model has demonstrated significant effectiveness in standardizing diagnostic and follow-up procedures, enhancing patient satisfaction and quality of life, and reducing mortality. These outcomes highlight its practical value for broader implementation in China.

The standardized workflow of computer-aided static guided implant surgery includes preoperative exami-nation,data acquisition,guide design,guide fabrication and surgery.Errors may occur at each step,leading to irrevers-ible cumulative effects and thus impacting the accuracy of implant placement.However,clinicians tend to focus on fac-tors causing errors in surgical operations,ignoring the possibility of irreversible errors in nonstandard guided surgery.Based on the clinical practice of domestic experts and research progress at home and abroad,this paper summarizes the sources of errors in guided implant surgery from the perspectives of preoperative inspection,data collection,guide de-signing and manufacturing and describes strategies to resolve errors so as to gain expert consensus.Consensus recom-mendation:1.Preoperative considerations:the appropriate implant guide type should be selected according to the pa-tient's oral condition before surgery,and a retaining screw-assisted support guide should be selected if necessary.2.Da-ta acquisition should be standardized as much as possible,including beam CT and extraoral scanning.CBCT performed with the patient's head fixed and with a small field of view is recommended.For patients with metal prostheses inside the mouth,a registration marker guide should be used,and the ambient temperature and light of the external oral scan-ner should be reasonably controlled.3.Optimization of computer-aided design:it is recommended to select a handle-guided planting system and a closed metal sleeve and to register images by overlapping markers.Properly designing the retaining screws,extending the support structure of the guide plate and increasing the length of the guide section are methods to feasibly reduce the incidence of surgical errors.4.Improving computer-aided production:it is also crucial to set the best printing parameters according to different printing technologies and to choose the most appropriate postpro-cessing procedures.

Objective The purpose of this study is to compare the wear properties of UHMWPE acetabular liners after undergoing 3 million(3 Mc)and 5 million(5 Mc)cycles of in-vitro wear testing.The results will serve as a reference for the design of in-vitro testing for hip prostheses and as a control for clinical revision removals.Methods Wear tests were conducted on three different sizes of acetabular liners(28 mm,32 mm,and 36 mm internal diameters)using a hip simulator to determine the amount of wear after 3 and 5 million cycles.The analysis included the number,size,and shape of abrasive particles.Results After 3 and 5 million cycles of wear,the amount of wear on the acetabular liner increased as the inner diameter increased.The abrasive particles had an average equivalent circular area diameter(ECD)of 0.27 μm and 0.29 μm,and 94.4%and 90.1%of the aspect ratio(AR)less than 4.Conclusion The amount of wear on the acetabular liner after 3 Mc wear can indicate the wear performance of the product.The number of particles increased and the percentage of fibrous particles was higher after 5 Mc wear compared to 3 Mc wear.

Objective To analyze coating properties of porous artificial joints,including coating morphology and coating mechanical properties,and summarize the range of coating properties of current mainstream products,to provide references for the design and development of new products,as well as provide the basis for the long-term implant removal analysis.Methods Samples for the surface morphology,shear strength,and tensile strength of the coatings used in the experiment were prepared in accordance with ASTM F1854,ASTM F1044,and ASTM F1 147 standards,respectively.The coatings were processed using plasma spraying.The surface morphology(coating thickness,porosity,and pore intercept)of the coatings for all 17 products(Nos.1-17)was tested;for products Nos.1-7 and Nos.15-16,the shear strength test between the coating and substrate was conducted first in accordance with the test method of ASTM F1044.Then,according to the test method of ASTM F1 147,the tensile strength test between the coating and substrate was conducted.For product No.17,the shear and tensile strengths of the composite coating and simple titanium coating were tested,respectively,according to the test method of ASTM F1044 and ASTM F1 147.Results A total of 15 products(88.2％)had coating thicknesses between 300 μm and 500 μm.There were 16 metal-coated products(Nos.1-16),of which 11(68.75％of the total)had coating porosities between 30％and 50％,and 14(87.5％of the total)had coating pore intercepts between 50 μm and 150 μm.The mechanical properties of the coatings were independent of the substrate material used.The shear and tensile strengths of the composite coatings with hydroxyaptite(HA)were significantly lower than those of the pure metal coatings.Conclusions For the design and manufacture of artificial joints with porous coatings,the performance of the coating can be referred to the following indexes:the coating thickness is 300-500 μm,the coating porosity is 30％-50％,the coating pore intercept is 50-150 μm.The substrate materials can be selected based on the use of the product.The effects of a lower bonding force on product performance should be considered when designing prostheses with composite coatings containing HA.This range of performance metrics provides control for long-term clinical extraction analyses.

In vitro wear tests were conducted on knee tibial liner manufactured from a new highly cross-linked polyethylene material(XLPE-DG)with dodecyl gallate.The characteristics(quantity,size and shape)of wear mass loss(wear volume),wear rate and wear particles were studied,and the wear performance in different wear stages was analyzed,so as to provide data support for the research and development and clinical application of domestic medical polyethylene materials.In accordance with the International Organization for Standardization(ISO)14243-1 and 14243-2 standard methods,4 total knee arthroplasty prostheses were selected as test samples(3 in the test group and 1 in the control group).The lubricant in the test was calf serum,and the XLPE-DG liner was tested for cyclic wear using a knee joint simulator.The wear volume and the wear rate after 1 million cycles(1 Mc),3 million cycles(3 Mc),and 5 million cycles(5 Mc)were calculated respectively.The abrasive debris images obtained by the scanning electron microscope(SEM)was analyzed by using image analysis software to analyze the characteristics of the debris of the wear debris(number,size and shape).After passing the 5 Mc wear test,the wear amount of XLPE-DG liner was(23.86±0.75)mg,with a corresponding wear rate of(4.39±0.75)mg/Mc and the wear amount during the 3-5 Mc stage was similar to that of the 1-3 Mc stage(8.79 mg vs.8.74 mg).The number of wear debris decreased with the increase of the number of wear times.The average value of the equivalent circular area diameter(ECD)of the wear debris of XLPE-DG liner after 5 Mc was 0.13 μm(minimum value 0.04 μm,maximum value 0.8 μm),and the average ECD of 77.11%±6.89%particles was<0.2 μm,the average value of ECD decreased with the increase of the number of wear times.The average value of the aspect ratio(AR)of the liner after 5 Mc wear was 2.8(minimum 1.0,maximum 9.9),of which 77.9%had an AR value of<4 and the particles are mainly round.The XLPE-DG liner demonstrated excellent wear resistance and can reduce the risk of periprosthetic inflammation,osteolysis,and prosthetic loosening in clinical applications,and have good clinical application potential.

Objective:To investigate the risk factors of post-stroke depression (PSD) in patients with first acute stroke 6 months after onset.Methods:Three hundred and sixty-seven patients with acute stroke who were treated for the first time in the Affiliated Hospital of Xuzhou Medical University were selected retrospectively. After onset for 6 months, the patients were followed up and divided into PSD group and non-PSD group. The clinical data, blood index, imaging data, degree of nerve damage and the patient's stigma level were compared between the two groups.Results:Totally 182 and 185 cases were included in the PSD and non-PSD groups, respectively. The incidence of PSD at 6 months post-stroke was 49.6% (182/367). The results of univariate analysis showed that diseased region, drinking history, monthly income, standard of culture, serum cortisol, total cholesterol (TC), high sensitivity C-reactive protein (hs-CRP), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), Stigma Scale for Chronic Illness-8 Chronic Disease Stigma Scale-8(SSCI-8) scores, National Institute of Health Stroke Scale (NIHSS) scores and subtype of stroke were risk factors for PSD ( P<0.05). Binary Logistic regression analysis showed that diseased region at frontal lobe ( OR = 3.245, P = 0.011), basal ganglia region ( OR = 2.820, P = 0.007), cerebellar hemisphere ( OR = 4.594, P = 0.010) and serum cortisol ( OR = 1.174, P<0.001), hs-CRP ( OR = 1.057, P<0.001), SSCI-8 scores ( OR = 1.674, P<0.001), NIHSS scores ( OR = 1.283, P<0.001) were independent risk factors for PSD. Conclusions:PSD is a common complication in patients with stroke. Diseased region (at frontal lobe, basal ganglia region, cerebellar hemispheres), hs-CRP, serum cortisol, level of morbidity stigma and degree of neurological impairment are development risk factors for the PSD at 6 months of acute stroke.

Objective To analyze the short-and long-term efficacy and influencing factors of 125I seed implantation for relapsed primary lung cancer.Methods Forty patients who received 125I seed implantation for relapsed primary lung cancer were retrospectively included.CT examination was performed 3 months after surgery to evaluate the short-term efficacy.Patients were divided into the effective group(complete remission and partial remission)or the ineffective group(stable disease and progressive disease).Patient deaths and survival times were documented through telephone or electronic case inquiry.Factors influencing short-term efficacy and long-term survival were evaluated using logistic and Cox regression analysis,respectively.Results Among the 40 patients,16 cases were effective and 24 were ineffective.Multivariate logistic regression analysis indicated that postoperative dose delivered to 100%gross tumor volume(D100)(OR= 0.944,95%CI:0.898-0.992,P= 0.023)was an independent factor for short-term efficacy.The median duration of follow-up was 12 months.Twenty-five patients died,ten survived,and five were lost to follow-up.Multivariate Cox regression analysis suggested that the longest tumor diameter(HR= 1.310,95%CI:1.010-1.698,P= 0.042)was an independent factor for long-term survival.Conclusion 125I seed implantation has improved the short-and long-term efficacy of treatment for relapsed primary lung cancer.Postoperative D100 is an independent factor influencing short-term efficacy,and longest tumor diameter is an independent factor for long-term survival,in patients receiving 125I seed implantation for relapsed primary lung cancer.

Objective To evaluate the efficacy of transverse thoracic muscle plane-thoracic nerve block combined with general anesthesia when used for modified radical mastectomy. Methods Sixty female patients, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, aged 45-63 yr, weighing 48-72 kg, scheduled for elective modified radical mastectomy, were divided into 3 groups ( n=20 each) using a random number table method: thoracic nerve block-general anesthesia group ( group P+G ) , transverse thoracic muscle plane-thoracic nerve block-general anesthesia group ( group T+P+G) and general anesthesia group ( group G ) . Anesthesia was induced with midazolam, propofol, fentanyl and cisatracurium and maintained with sevoflurane, fentanyl and cisatracurium. Thoracic nerve block typeⅠ and Ⅱ was per-formed after implanting laryngeal mask airway in group P+G. Transverse thoracic muscle plane block was performed after performing thoracic nerve block typeⅠandⅡin group T+P+G. Flurbiprofen 50 mg was in-travenously injected after operation as a rescue analgesic to maintain the Visual Analogue Scale score≤3. The consumption of opioids, emergence time and time for removal of the laryngeal mask airway were recor-ded. Ramsay sedation score was recorded at 10 min after removal of the laryngeal mask airway. The require-ment for rescue analgesia, time of passing flatus and development of nausea and vomiting within 24 h after operation were recorded. Results Compared with group G, the emergence time, time for removal of the laryngeal mask airway and time of passing flatus were significantly shortened, and the Ramsay sedation score, consumption of fentanyl and requirement for rescue analgesia were decreased in P+G and T+P+G groups ( P<0. 05) , and the incidence of nausea and vomiting was significantly decreased in group T+P+G ( P<0. 05) . Compared with group P+G, the time for removal of the laryngeal mask airway and time of pass-ing flatus were significantly shortened, the consumption of fentanyl was decreased ( P<0. 05) , and no sig-nificant change was found in the requirement for rescue analgesia or incidence of nausea and vomiting in group T+P+G ( P>0. 05) . Conclusion Transverse thoracic muscle plane-thoracic nerve block combined with general anesthesia can provide satisfactory perioperative analgesia and is helpful in improving prognosis for the patients undergoing modified radical mastectomy.

Objective To evaluate the role of oxidation reaction in the decrease in the activity of acetylcholinesterase (AChE) in the diaphragm of rats with sepsis.Methods Thirty pathogen-free healthy adult male Sprague-Dawley rats,weighing 220-260 g,were divided into 3 groups using a random number table:sham operation group (group S,n=8),sepsis group (group Sep,n =12) and antioxidant group (group Ant,n=10).Sepsis was induced by cecal ligation and puncture.Group S underwent simple laparotomy.N-acetylcystein 20 mg/kg was injected subcutaneously at 3,6,12 and 18 h after operation,and deferoxamine 20 mg/kg was injected subcutaneously at 3 h after operation in group Ant,while the equal volume of normal saline was given instead in S and Sep groups.At 24 h after operation,the surviving rats were sacrificed,and the diaphragm was removed for determination of the malondialdehyde (MDA) content and activities of AChE,myeloperoxidase (MPO),superoxide dismutase (SOD) and catalase (CAT).SOD/CAT ratio was calculated.Results Compared with group S,the AChE activity was significantly decreased,and MPO and SOD activities were increased in Sep and Ant groups,the MDA content and SOD/CAT ratio were significantly increased,and the CAT activity was decreased in group Sep,and the CAT activity was significantly increased in group Ant (P＜0.05).Compared with group Sep,the AChE and CAT activities were significantly increased,and the MDA content,MPO and SOD activities and SOD/CAT ratio were decreased in group Ant (P＜0.05).Conclusion Oxidation reaction is partially involved in the decrease in the activity of AChE in the diaphragm of rats with sepsis.

Lack of protection in education was one of possible reason contributed to the traditional Chinese medicine(TCM) psychology pathogenesis while the research conducted. This paper discusseds the following aspects: the concept, the causes, the impact and the types of protection. It also provided series thought on the development of TCM psychology pathogenesis, TCM psychology family treatment and family education of TCM psychology prevention.