Background and aims:Noninvasive assessments play a crucial role in ruling out high-risk esophageal varices(HREV)in cirrhotic patients.However,the value of sound touch elastography(STE)in predicting HREV has not been comprehensively investigated.Therefore,this study aimed to establish prediction models based on liver and spleen stiffness measurements obtained by STE and provide assessment strategies and cutoff values tailored for different clinical situations.Methods:This prospective study included cirrhotic patients who underwent esophagogastroduodeno-scopy(EGD).Liver and spleen stiffness measurements by STE were performed within six months of EGD examination.Various prediction models and their corresponding cutoff values were established for different clinical situations,incorporating spleen diameter and laboratory parameters.Results:A total of 154 cirrhotic patients were included in the study and stratified into training(n=119)and validation(n=35)sets.Multivariable analysis revealed platelet,spleen diameter and spleen stiffness measurement as independent predictors of HREV.The model incorporating spleen stiffness measurement,platelet,and spleen diameter demonstrated superior performance in predicting HREV,yielding an area under the receiver operating characteristic curve(AUC)of 0.878 and 0.853 in the training set and validation set,respectively.Application of this model for screening cirrhotic patients could avoid EGDs in 39.7％(27/68)and 35.3％(6/17)of patients in the training and validation sets,respectively.Conclusions:Liver and spleen stiffness measurements obtained through STE are valuable for predicting HREV in cirrhotic patients.The developed prediction models and their corresponding cutoff values provide tailored solutions for various clinical situations,thereby effectively reducing the need for un-necessary endoscopies.

Objective To investigate the changes in the structural parameters and mechanical properties of the necrotic femoral head and compare the effects of core decompression and hone grafting with those of bone cement filling on the mechanical properties and pre-vention of articular surface collapse of the necrotic femoral head.Methods Thirty-two fresh human femoral heads were collected from patients who underwent total hip arthroplasty at our hospital between June 2020 and January 2022.The femoral heads were divided into four groups:8 femoral neck fractures(TFF group),8 osteonecrosis of the femoral head(ONFH group),8 osteonecrosis of the femoral head treated with cement percutaneous injection(CPI group),and 8 osteonecrosis of the femoral head treated with core decompression and bone graft(CDBG group).Cement filling or core decompression was performed under radiographic guidance.All samples were scanned and three-dimensionally reconstructed using micro-CT.The spatial heterogeneity of the femoral head was observed,and the bone morphometric parameters of each region of interest were calculated.Mechanical analysis was performed to evaluate the femoral head parameters of dis-placement and stress in vitro.Results Bone microarchitecture and morphometry in necrotic femoral heads were markedly altered.The biomechanical properties of the necrotic zone in the femoral head were markedly weakened.After the necrotic area was filled with bone cement,the biomechanical properties of the necrotic zone of the femoral head increased significantly.In addition,after core decompres-sion and bone grafting in the necrotic area,the biomechanical properties increased significantly in the necrotic zone of the femoral head.Conclusion Bone cement filling or bone grafting in the necrotic area can change the biomechanical mechanism of the femoral head,improve the load-supporting ability,and prevent femoral head collapse.Cement filling may be a practical approach for the treatment of osteonecrosis of the femoral head that can be useful for practicing orthopedists.

Objective In the context of expanding in size and improving the quality of medical consumables,the"one product,one policy"approach has brought challenges to the management of consumables in public hospitals.This study investi-gated the potential management problems in the process of centralized procurement with volume of medical consumables in a pub-lic tertiary hospital in Guangdong Province,and accordingly worked out the corresponding management countermeasures and then assessed their implementation effects.Methods The fishbone diagrams was applied to systematically analyze the potential prob-lems in the implementation process of centralized procurement with volume of medical consumables.Targeted measures were worked out from May to July 2023 in the hospital.The time series data of centralized procurement of coronary stents,pacemak-ers,tubular/end-to-end anastomoses,and spinal products from December 2022 to December 2023 were analyzed.Changes in the monthly implementation rate and contract completion volume pre-and post-intervention were measured to evaluate the effectiveness of the intervention.Results The fishbone diagrams analysis revealed that the primary factors impeding procurement implementa-tion were internal system flaws,personnel management inadequacy,supply issues,and an absence of an information system.Post-intervention,the monthly implementation rate(t=-4.19,P＜0.05)and contract completion(t=-2.38,P＜0.05)significantly improved.Conclusion The implementation of intervention management for centralized procurement with volume of medical consumables can effectively promote the related implementation effect in the department.In the context of centralized pro-curement,clinical and health management personnel need to bolster their professionalism to ensure the procurement management efficiency and quality.It is crucial to deepen policy understanding and implementation,enhance production and distribution process supervision and disciplinary mechanisms,ensure multi-departmental coordination for supply security,and improve hospi-tal information systems and procurement platforms.

Objective:To analyze the curative effect of Ligasure hemorrhoidectomy combined with knot-free barbed wire for patients with mixed hemorrhoidectomy in day ward.Methods:Retrospectively analyzed the case data of 126 patients, aged from 22 to 76 years (average age was 45.8 years), with grade Ⅲ and Ⅳ mixed hemorrhoids in the day ward of Beijing Friendship Hospital, Capital Medical University from January 2021 to December 2021, including 53 male cases and 73 female cases. According to the operation method, all patients were assigned to the observation group ( n=63) and the control group ( n=63). In the observation group, patients were operated with Ligasure hemorrhoidectomy combined with knot-free barbed wire. In the control group, patients underwent the Milligan-Morgan. Normal distribution of measurement data were expressed as mean±standard deviation ( ± s), and t test was used for comparison between groups. Count data were compared by Chi-square test or continuity correction Chi-square test.The operation time, intraoperative bleeding, postoperative pain, postoperative complications and hospitalization expenses were compared between the two groups. Results:The operation time and intraoperative blood loss in the observation group were significantly lower than those in the control group ( t=-7.74, P<0.001; t=-7.07, P<0.001). There was no significant difference in visual analogue scale between the two groups on the 1st, 3rd, 7th days after operation( t=-1.47, P=0.144; t=-0.32, P=0.749; t=-0.34, P=0.732). There were no significant differences in postoperative urinary retention, postoperative bleeding and perianal edema between the two groups ( χ2=0.34, P=0.559; χ2=1.81, P=0.179; χ2=1.92, P=0.165). However, the total incidence of complications in the observation group was significantly lower than that in the control group, the difference was statistically significant ( χ2=4.15, P=0.042). Hospitalization cost of observation group was higher than control group ( t=4.73, P<0.001). Conclusions:For patients with grade Ⅲ and Ⅳ mixed hemorrhoids in the day ward, Ligasure hemorrhoidectomy combined with knot-free barb wire can significantly shorten the operation time, reduce intraoperative blood loss, and lower the incidence of postoperative complications. It is safe and effective, which can meet the hemorrhoidectomy’s requirements of rapid, efficient and safe in the day ward.

Background Diacetyl (DC) is widely used in the food flavoring industry and excessive occupational exposure to DC can cause serious respiratory diseases. However, there is no corresponding national standard method for the determination of DC in the air of workplace. Objective To establish a method for the determination of DC in workplace air by high performance liquid chromatography using 4-nitro-o-phenylenediamine (NPDA) as precolumn derivatization. Methods DC in the air of workplace was collected by solution absorption method. This experiment used NPDA as the derivatization reagent. By adjusting acidity of solution and optimizing concentration ration of DC/NPDA, derivatization temperature, and time, a method for the determination of DC in workplace air was proposed, and its performance indexes such as linearity, detection limit, and lower limit of quantification were obtained. Sampling efficiency was evaluated by relative comparison method, and sample stability was evaluated by sample preservation test. Accuracy and precision of the method were evaluated by standard addition recovery test with blank samples, and an interference test was carried out by adding standard samples. The established method was applied to actual samples to evaluate its adaptability. Results A combination of 60 °C for 2 h was selected for derivatization because a higher derivatization reaction temperature and a longer reaction time associated with a higher derivatization efficiency. The solution was separated by SB-C18 column (250 mm×4.6 mm, 5 μm) at 30 ℃, using a mixture of methanol and water (v/v, 65%/35%) as mobile phase with an elution flow rate of 1.0 mL·min⁻¹, and was detected with a variable wavelength detector (λ_max=257 nm) by qualitative analysis based on retention time and quantitative analysis based on external standard method. In terms of the proposed method, the linear range of detection was from 5 μg·L⁻¹ to 2000 μg·L⁻¹, with a correlation coefficient of 0.9999, and a detection limit of 1.3 μg·L⁻¹, the quantitative detection of the lower limit was 4.3 μg·L⁻¹, with a sampling volume V₀ of 3.0 L, the minimum detection concentration was 4.3 μg·m⁻³, and the minimum quantitative concentration was 14.3 μg·m⁻³. The recovery rate was 99.1%-100.8%, the intra-batch precision was 0.5%-3.0%, and the inter-batch precision was 1.2%-2.0%. The average sampling efficiency of this method was 94.5%, and the sample could be stored at 4 °C for at least 14 d. The coexisting components in the air of the workplace did not interfere with the determination of DC. The DC content in the air of a flavor workplace was 5.86-8.85 mg·m⁻³. Conclusion A determination method for DC in workplace air by high performance liquid chromatography using NPDA as precolumn derivatization after being collected by 1.0% phosphoric acid absorbent is proposed and has the advantages of simple operation, high sensitivity, and good accuracy. With no DC loss and degradation, the method may satisfy the request for DC determination in the air of workplace.

Objective:To establish a method for determination of the butanone in urine by gas chromatography (GC) with pre-column derivation.Methods:For detecting of butanone in urine, potassium iodide and potassium dichromate were added into urine under acidic condition, sample derivatization was undertaken in 50 ℃ water bath for 60 min and the iodine butanone was extracted with n-hexane. After the sodium thiosulfate solution was used to remove excess iodine, urine samples were centrifuged at 10000 r/min for 5 min, then the supernatant was analyzed using temperature rising programming with the Agilent Hp-5 column (30 m×0.32 mm, 0.25 μm) and electron capture detector (ECD) as the detector. The detector temperature was 300 ℃, the inlet temperature was 200 ℃, and the carrier gas was nitrogen.Results:For detecting of butanone in urine, potassium iodide and potassium dichromate were added for derivatization under the acidic condition. After extraction and centrifugation, the supernatant directly put through column and detected by ECD. In present study, the sample pretreatment condition was optimized, the relative standard deviations of intra-day and inner-day, the spiked samples and its recovery were evaluated for analyzing the accuracy of the proposed method.Conclusion:This method has proved to be simple, efficient and highly sensitivity, it can be utilized for butanone detection in occupational population.

Objective:To establish a method for determination of the butanone in urine by gas chromatography (GC) with pre-column derivation.Methods:For detecting of butanone in urine, potassium iodide and potassium dichromate were added into urine under acidic condition, sample derivatization was undertaken in 50 ℃ water bath for 60 min and the iodine butanone was extracted with n-hexane. After the sodium thiosulfate solution was used to remove excess iodine, urine samples were centrifuged at 10000 r/min for 5 min, then the supernatant was analyzed using temperature rising programming with the Agilent Hp-5 column (30 m×0.32 mm, 0.25 μm) and electron capture detector (ECD) as the detector. The detector temperature was 300 ℃, the inlet temperature was 200 ℃, and the carrier gas was nitrogen.Results:For detecting of butanone in urine, potassium iodide and potassium dichromate were added for derivatization under the acidic condition. After extraction and centrifugation, the supernatant directly put through column and detected by ECD. In present study, the sample pretreatment condition was optimized, the relative standard deviations of intra-day and inner-day, the spiked samples and its recovery were evaluated for analyzing the accuracy of the proposed method.Conclusion:This method has proved to be simple, efficient and highly sensitivity, it can be utilized for butanone detection in occupational population.

Objective: To establish a method for determination the S-phenylmercapturic acid in urine by dispersive solid-phase extraction using Humic Acid/Fe₃O₄ magnetic nanocomposite as adsorbent. Methods: The 5 ml of urine samples were adjusted to pH 1.0 and extracted by Fe3O4@HA. Then the analytes were separated on EC-C₁₈ capillary column and detected by HPLC-VWD. The S-phenylmercapturic acid was characterized by the retention time and quantified by peak area and external standard method. Results: The standard curves of SPMA showed significant linearity between 0.04~1.00 mg/L (r=0.999 7) . The average recovery was 94.2%~102.4%. The intra-day and inter-day precisions (RSD) were 2.9~6.7% (n=6) and 3.1~7.5% (n=6) respectively. The detect limit of SPMA was 0.012 g/L (S/N=3) . Conclusion This method is simple, rapid, sensitive and accurate. It is applicable for determination of SPMA in the urine of works who were exposed to benzene.

Objective: To establish a method for determing the trichloroethylene(TCE)and trichloroethanol(TCOH)in blood samples by liquid-liquid extraction-gas chromatography with electron capture detector. Methods: With this method,ether was used as extraction solvent and trichloromethane was used as an internal standard. The whole blood sample was extracted with ether, and dehydrated by anhydrous sodium sulfate. Then the analytes were separated on HP-5 capillary column(30m×0.32mm×0.15μm)and detected byECD.The retention time was for qualitative analysis and the internal standard was for quantitation. Results: The standard curves of TCE and TCOH showed significant linearity between 95.5μg/L-7640.0μg/L(r=0.9997)and 19.0μg/L-1520.0μg/L(r=0.9992). The average recovery was 95.5%-103.6%.The intra-day and inter-day precisions(RSD)were 2.5%-6.8%(n=6)and 1.6%-4.3%(n=6) respectively. The detect limit of TCE and TCOH were 2.10 μg/L and 0.56μg/L(S/N=3)respectively.The blood can be kept 7 days at-20℃ refrigerator without significantly loss. Conclusion This method is proved to be simple,practical and highly sensitive. It can satisfy the request for the determination of blood samples of humans exposed to TCE.

Objective To explore the clinical result and complications of noncyclic-PPH surgery in treating internal hemorrhoids.Methods In this study,we evaluate the clinical outcome,such as clinical efficacy,operation time,length of hospital stay,postoperative pain degree and incidence of complications in 120 hemorrhoid patients,randomly divided into control group (60 cases) and observation group (60 cases)based on digital table method,receiving respectively noncyclic-PPH,or PPH (procedure for prolapse and hemorrhoids).Results Two groups were similar in average operation time and average length of hospital stay (P ＞ 0.05).The postoperative VAS score at each time point,was significantly lower in noncyclic-PPH group than the control group (P ＜ 0.05).Non-cyclic PPH group were also significantly lower in postoperative complications than the control group (P ＜ 0.05).Conclusion Compared with PPH surgery,patients with noncyclic-PPH have fewer pain complications or trauma.