Objective To compare the mid- and long-term clinical results of mitral valve plasty (MVP) and mitral valve replacement (MVR) in the treatment of functional mitral regurgitation (FMR). Methods Patients with FMR who underwent surgical treatment in the Department of Cardiovascular Surgery of the General Hospital of Northern Theater Command from 2012 to 2021 were collected. The patients who underwent MVP were divided into a MVP group, and those who underwent MVR into a MVR group. The clinical data and mid-term follow-up efficacy of two groups were compared. Results Finally 236 patients were included. There were 100 patients in the MVP group, including 53 males and 47 females, with an average age of (61.80±8.03) years. There were 136 patients in the MVR group, including 72 males and 64 females, with an average age of (61.29±8.97) years. There was no statistical difference in baseline data between the two groups (P＞0.05). There was no statistical difference between the two groups in the extracorporeal circulation time, aortic occlusion time, postoperative hospital and ICU stay, intraoperative blood loss, or hospitalization death (P＞0.05), but the time of mechanical ventilation in the MVP group was significantly shorter than that in the MVR group (P=0.022). The total follow-up rate was 100.0%, the longest follow-up was 10 years, and the average follow-up time was (3.60±2.55) years. There were statistical differences in the left atrial diameter, left ventricular end-diastolic diameter, left ventricular end-systolic diameter and cardiac function between the two groups compared with those before surgery (P<0.05). The postoperative left ventricular ejection fraction in the MVP group was statistically higher than that before surgery (P=0.002), but there was no statistical difference in the MVR group before and after surgery (P=0.658). The left atrial diameter in the MVP group was reduced compared with the MVR group (P=0.026). The recurrence rate of mitral regurgitation in the MVP group was higher than that in the MVR group, and the difference was statistically significant (10.0% vs. 1.5%, P=0.003). There were 14 deaths in the MVP group and 19 in the MVR group. The cumulative survival rate (P=0.605) and cardiovascular events-free survival rate (P=0.875) were not statistically significant between the two groups by Kaplan-Meier survival analysis. Conclusion The safety, and mid- and long-term clinical efficacy of MVP in the treatment of FMR patients are better than MVR, and the left atrial and left ventricular diameters are statistically reduced, and cardiac function is statistically improved. However, the surgeon needs to be well aware of the indications for the MVP procedure to reduce the rate of mitral regurgitation recurrence.

Objective: To summarize the laboratory findings of a case of hemolytic disease of the fetus and newborn (HDFN) caused by Rh system anti-c antibodies and to review the literature, so as to explore the characteristics of anti-c HDFN. Methods: The ABO blood type, Rh blood type, direct antiglobulin test (DAT) results, and the presence of unexpected antibodies and their titers were determined by serological methods. The cases of anti-c HDFN in our laboratory in China and abroad were statistically analyzed, and the incidence of severe HDFN caused by anti-c, anti-D and anti-E was compared. Results: The blood type of the child was B (Rh CcDee) with a positive DAT. Anti-c antibody was detected in both serum and eluate, with a serum antibody titer of 4. The mother’s blood type was AB (Rh CCDee) with a negative DAT, and anti-c antibody was detected in the serum with a titer of 128. Among 20 cases of anti-c HDFN, 17 were DAT positive, and 9 (45%, 9/20) underwent blood transfusion or exchange transfusion. The incidence of severe HDFN was 47.60% (10/21) for anti-c, 47.60% (10/21) for anti-D and 31.30% (5/16) for anti-E. Conclusion: Maternal pregnancy and/or blood transfusion are the main reasons for the production of Rh alloantibodies such as anti-c. The prevention and management of anti-c should be similar to that of anti-D. Rh antigen-matched (five antigens of Rh blood group) transfusion is necessary for women of childbearing age to avoid antibody production, and Rh typing and antibody screening during prenatal examination is recommended to ensure early detection, intervention and treatment.

Objective:To gain a deeper understanding of the comorbidity status of elderly patients with coronary heart disease and the effect of comorbidity on their hospitalization costs.Methods:Using the convenient sampling method, a total of 8 334 elderly hospitalized patients diagnosed with coronary heart disease in Beijing Hospital from January 2018 to December 2021 were selected as the research objects. General Inforamtion Questionnaire and Charson comorbidity index (CCI) were used to investigate the comorbidity of patients.Results:Among the 8 334 elderly patients with coronary heart disease included, 88.18% (7 349/8 334) had comorbidity, and there was a statistically significant difference in hospital costs among patients with different CCI scores ( P<0.01). Elderly patients with coronary heart disease with comorbidity had higher hospital costs. The results of the binomial logistic regression analysis showed that comorbidities increased the hospitalization costs of elderly coronary heart disease patients in both the unadjusted model and the gradually adjusted model for age, gender, occupation, education level, admission department, admission status, admission year, admission mode length of stay and disease classification ( P<0.05) . Conclusions:The comorbidity in elderly patients with coronary heart disease is serious, which is an important factor affecting hospitalization costs. In medical practice, it is necessary to strengthen the comprehensive management of elderly patients with coronary heart disease, pay attention to the influencing factors of hospitalization costs, optimize prevention and treatment strategies, control the occurrence and progression of comorbidities among patients, deepen the reform of medical insurance payment methods such as grouping payments based on disease diagnosis, so as to accurately reduce hospitalization costs and promote the sustainable and healthy development of the medical and health system.

Objective:To explore the effectiveness of applying the ADDIE (analysis, design, develop, implement, evaluate) Model in clinical teaching for nursing interns in spine surgery department.Methods:Using a convenience sampling method, 44 nursing interns in the Department of Orthopedics at Peking Union Medical College Hospital were selected as the control group from July 2021 to May 2022, and were taught using traditional methods. From July 2022 to May 2023, 45 nursing interns were selected as the observation group, and a teaching team was formed to design a training program based on the five stages of the ADDIE instructional design model. This program was tailored to improve the overall clinical competence of the spinal surgery nursing interns. After training, the teaching effects were evaluated based on knowledge test scores, skills test scores, overall clinical competence, and teaching satisfaction.Results:After the training, the skills test scores in specialized nursing for the observation group were (94.87±1.10) points, higher than the control group's (93.98±1.41) points, with a statistically significant difference ( P<0.01). The observation group also scored higher than the control group in clinical judgment, organizational effectiveness, overall performance, and total score in the Mini-Clinical Evaluation Exercise, with statistically significant differences ( P<0.01). Additionally, the observation group reported higher satisfaction with the teaching plan and methods compared to the control group ( P<0.05) . Conclusions:Clinical teaching for spinal surgery nursing interns based on the ADDIE instructional design model can improve their specialized practical skills and overall clinical competence. The interns also expressed a high level of acceptance for this teaching design model.

Objective:To investigate the relationship between the expression of serum microRNA-16(miR-16)and depression in patients with acute cerebral infarction(ACI).Methods:A total of 189 ACI patients treated in Neurol-ogy Department of Zigong First People's Hospital between December 2019 and September 2021 were selected as the disease group,and another 175 healthy volunteers who simultaneously underwent physical examination in our hospi-tal were selected as healthy group.The expression of serum miR-16 was detected by quantitative real time polymer-ase linked reaction(qRT-PCR).ACI patients was divided into depression group(n=56)and no depression group(n=133)according to presence of depression during 6-month follow-up after treatment.Serum miR-16 expres-sion and general data were compared between two groups.Multivariate Logistic regression was used to analyze influ-encing factors of depression in ACI patients.Results:The expression of serum miR-16[(13.24±2.41)vs.(5.76±1.02)]in the disease group was significantly higher than that of healthy group(P＜0.001).After 6-month fol-low-up,the incidence of depression was 29.63％among the 189 ACI patients.Compared with no depression group,patients in depression group had significant higher serum miR-16 expression[(12.75±2.23)vs.(14.42±2.68)],score of National Institute of Health Stroke Scale(NIHSS)at admission[(15.12±2.88)points vs.(18.23±3.42)points],proportions of introversion(38.35％vs.67.86％)and aphasia(43.61％vs.62.50％),and signif-icant lower Barthel index score[(56.24±9.89)points vs.(48.41±9.45)points](P＜0.05 or＜0.01).Multivari-ate Logistic regression analysis suggested that serum miR-16 expression(OR=3.071,95％CI 1.653～5.562,P＜0.001),introversion(OR=4.623,95％CI 2.321～6.589,P=0.009),aphasia(OR=3.854,95％CI 1.785～6.112,P＜0.001)and NIHSS score at admission(OR=4.354,95％CI 2.121～6.563,P＜0.001)were independent risk factors for depression in ACI patients,while Barthel index score was its independent protective factor(OR=0.626,95％CI 0.335～0.914,P=0.017).Conclusion:The expression of serum miR-16 in ACI patients is signifi-cantly higher than that of healthy people.Serum miR-16 expression,introversion,aphasia,NIHSS score at admis-sion and Barthel index score are all independent influencing factors for depression in ACI patients.

Noise-induced hearing loss(NIHL)is a public health problem that requires immediate attention.Nearly one-third of hearing loss can be attributed to noise exposure.However,the molecular mechanism of NIHL is complex,and there is currently no specific drug available for preventing and treating NIHL.Therefore,it is particu-larly important to establish standardized preclinical research models of NIHL and identify molecular targets for treat-ment so as to carry out the prevention and drug treatment of NIHL effectively.In this article,we summarized the research methods and pharmacological treatment studies on NIHL to provide references for the prevention and treat-ment of NIHL.

Traumatic supraorbital fissure syndrome (TSOFS) is a symptom complex caused by nerve entrapment in the supraorbital fissure after skull base trauma. If the compressed cranial nerve in the supraorbital fissure is not decompressed surgically, ptosis, diplopia and eye movement disorder may exist for a long time and seriously affect the patients′ quality of life. Since its overall incidence is not high, it is not familiarized with the majority of neurosurgeons and some TSOFS may be complicated with skull base vascular injury. If the supraorbital fissure surgery is performed without treatment of vascular injury, it may cause massive hemorrhage, and disability and even life-threatening in severe cases. At present, there is no consensus or guideline on the diagnosis and treatment of TSOFS that can be referred to both domestically and internationally. To improve the understanding of TSOFS among clinical physicians and establish standardized diagnosis and treatment plans, the Skull Base Trauma Group of the Neurorepair Professional Committee of the Chinese Medical Doctor Association, Neurotrauma Group of the Neurosurgery Branch of the Chinese Medical Association, Neurotrauma Group of the Traumatology Branch of the Chinese Medical Association, and Editorial Committee of Chinese Journal of Trauma organized relevant experts to formulate Chinese expert consensus on the diagnosis and treatment of traumatic supraorbital fissure syndrome ( version 2024) based on evidence of evidence-based medicine and clinical experience of diagnosis and treatment. This consensus puts forward 12 recommendations on the diagnosis, classification, treatment, efficacy evaluation and follow-up of TSOFS, aiming to provide references for neurosurgeons from hospitals of all levels to standardize the diagnosis and treatment of TSOFS.

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.

Objective To analyze the effects of deep learning image reconstruction(DLIR)and adaptive statistical iterative recon-struction V(ASIR-V)on the imaging quality of chest CT in patient with pulmonary nodules,and to evaluate the differences based on different image reconstruction techniques in the detection of efficiency of computer-aided diagnosis(CAD)for pulmonary nodules.Methods The image data of pulmonary nodules of eighty patients with chest CT screening were reconstructed with ASIR-V 80％,DLIR-low(DLIR-L),DLIR-medium(DLIR-M)and DLIR-high(DLIR-H)images,respectively.The objective image quality and sub-jective image quality of the four groups were compared and analyzed.Objective image quality includes CT value of region of interest(ROI),noise,signal-to-noise ratio(SNR),contrast-to-noise ratio(CNR)and image average gradient.The diagnostic efficacy of CAD in detecting pulmonary nodules of reconstructed images among four groups were further evaluated.Results There were no signifi-cant difference in CT value of ROI of reconstructed images among the four groups(P＞0.05).The noise,SNR and CNR of DLIR-H images were similar to those of ASIR-V 80％(P＞0.05),but significantly better than those of DLIR-L and DLIR-M(P＜0.05).The average gradient of DLIR-L,DLIR-M and DLIR-H images were significantly higher than those of ASIR-V 80％(P＜0.05).The subjective image quality scores of DLIR-L,DLIR-M and DLIR-H images were significantly higher than those of ASIR-V 80％(P＜0.05),and the subjective image quality score of DLIR-H image was the highest.CAD showed the highest true positive rate in DLIR-H images for detecting pulmonary nodules(P＜0.05),and CAD showed the highest false positives per capita in ASIR-V 80％images for detecting pulmonary nodules(P＜0.05).Conclusion The noise,SNR and CNR of DLIR-H images are similar to those of ASIR-V 80％,with the significantly higher image clarity and subjective image quality scores.DLIR-H has advantages in CAD detection of pulmonary nodules,which is an ideal image reconstruction technology for chest CT pulmonary nodule screening.

Objective To investigate the safety and efficacy of mitral valve replacement combined with cryoablation Maze surgery in patients with atrial functional mitral regurgitation (AFMR). Methods From January 2014 to June 2020, patients with AFMR who underwent mitral valve replacement in our department were enrolled. They were divided into two groups, a cryoablation Maze group who received cryoablation Maze surgery during mitral valve replacement, and a non-cryoablation Maze group who did not receive cryoablation Maze surgery. The baseline data, surgical data, efficacy, and prognosis between the two groups were compared. Results Finally 85 patients were enrolled. There were 16 males and 24 females with an average age of 58.65±6.86 years in the cryoablation Maze group, and 24 males and 21 females with an average age of 61.29±8.30 years in the non-cryoablation Maze group. There was no statistical difference in baseline data between the two groups (P＞0.05). The aortic occlusion time and extracorporeal circulation time of the cryoablation Maze group were longer than those of the non-cryoablation Maze group with statistical differences (P＜0.01). There was no statistical difference in postoperative ICU retention time, ventilator assistance time, length of hospital stay, intraoperative blood loss, drainage volume on the first day or occurrence rate of complications (temporary pacemaker application, electrical cardioversion, thoracic puncture drainage, hospitalization death) between the two groups (P＞0.05). At the time of discharge, postoperative 3-month, 6-month, 12-month, and 24-month, the maintenance rates of sinus rhythm in the non-cryoablation Maze group were statistically different from those of the cryoablation Maze group (P＜0.001). Compared with the non-cryoablation Maze group, the decrease values of left atrial diameter, left ventricular end-diastolic diameter, left ventricular end-systolic diameter and pulmonary artery systolic pressure were statistically different (P＜0.05). Postoperative cardiac function grading of both groups was grade Ⅰ or Ⅱ, which was significantly improved compared with preoperative level, but there was no statistical significance between the two groups (P＞0.05). There was no statistical difference in the incidence of adverse events during follow-up (P＞0.05). Conclusion Cryoablation Maze surgery combined with mitral valve replacement is safe and effective in the treatment of AFMR patients, which is conducive to the recovery and maintenance of sinus rhythm, and is beneficial to the remodeling of the left atrium and left ventricle, the reduction of pulmonary systolic blood pressure, and the improvement of life quality of the patients.