Objective To observe the value of noninvasive right ventricular pressure-strain loop(RVPSL)for quantitative evaluation on right ventricular myocardial function changes in liver cirrhosis patients after TIPS.Methods Totally 26 cases of liver cirrhosis who would undergo TIPS were prospectively recruited as liver cirrhosis group.Echocardiography was performed before and 1 week,1 month after TIPS,and parameters of right ventricular myocardial function,including routine right ventricular echocardiography,right ventricular strain and right ventricular myocardial work were acquired.Meanwhile,30 healthy adults were recruited as control group,and the above parameters were recorded.Then these parameters were compared between groups,also before and after TIPS within liver cirrhosis group,and the changes of right ventricular myocardial function after TIPS were evaluated.Results Right ventricular global work index(RVGWI),right ventricular global constructive work(RVGCW)and right ventricular global wasted work(RVGWW)in liver cirrhosis group were higher than those in control group at all time points(all P＜0.05).One weak and 1 month after TIPS,right ventricular global longitudinal strain(RVGLS)and right ventricular free wall longitudinal strain(RVFWLS)in liver cirrhosis group were all higher than those in control group(all P＜0.05).In liver cirrhosis group,RVGWI,RVGCW and RVGWW 1 week after TIPS were all higher than those before TIPS and 1 month after TIPS(all P＜0.05),while RVGLS 1 weak and RVGWI 1 month after TIPS were both higher than those before TIPS(both P＜0.05).Conclusion Noninvasive RVPSL could be used to sensitively and quantitatively evaluate right ventricular function changes in patients with liver cirrhosis after TIPS.

Objective To observe the value of noninvasive right ventricular pressure-strain loop(RVPSL)for quantitative evaluation on right ventricular myocardial function changes in liver cirrhosis patients after TIPS.Methods Totally 26 cases of liver cirrhosis who would undergo TIPS were prospectively recruited as liver cirrhosis group.Echocardiography was performed before and 1 week,1 month after TIPS,and parameters of right ventricular myocardial function,including routine right ventricular echocardiography,right ventricular strain and right ventricular myocardial work were acquired.Meanwhile,30 healthy adults were recruited as control group,and the above parameters were recorded.Then these parameters were compared between groups,also before and after TIPS within liver cirrhosis group,and the changes of right ventricular myocardial function after TIPS were evaluated.Results Right ventricular global work index(RVGWI),right ventricular global constructive work(RVGCW)and right ventricular global wasted work(RVGWW)in liver cirrhosis group were higher than those in control group at all time points(all P＜0.05).One weak and 1 month after TIPS,right ventricular global longitudinal strain(RVGLS)and right ventricular free wall longitudinal strain(RVFWLS)in liver cirrhosis group were all higher than those in control group(all P＜0.05).In liver cirrhosis group,RVGWI,RVGCW and RVGWW 1 week after TIPS were all higher than those before TIPS and 1 month after TIPS(all P＜0.05),while RVGLS 1 weak and RVGWI 1 month after TIPS were both higher than those before TIPS(both P＜0.05).Conclusion Noninvasive RVPSL could be used to sensitively and quantitatively evaluate right ventricular function changes in patients with liver cirrhosis after TIPS.

Objective:To compare the clinical efficacy of robot-assisted pedicle screw placement with visualization technology and conventional robot-assisted pedicle screw placement, and analyze the accuracy and safety of robot-assisted pedicle screw placement with visualization.Methods:This retrospective study analyzed data from 60 patients (39 males and 21 females) with an average age of 51.03±18.04 years (range 12-78 years) who underwent open spinal pedicle screw fixation surgery for thora columbar diseases at the Orthopedic Department of the First Affiliated Hospital of China Medical University between August 2020 and September 2022. The cases included 25 cases of spinal stenosis, 15 cases of lumbar fractures, 7 cases of thoracic fractures, 3 cases of lumbar spondylolisthesis, and 10 cases of spinal deformities. 30 patients underwent solid pedicle screw placement using robot-assisted visualization technology (visualization group), while the remaining 30 patients received hollow pedicle screw placement using conventional robot-assisted technology (conventional group). After screw placement, "O"-arm X-ray scans were performed for verification, and screw placement accuracy was evaluated based on the Gertzbein-Robbins standard. The study recorded and compared the time required for screw placement, number of fluoroscopy sessions, and perioperative complications between the two groups to provide a comprehensive assessment of surgical outcomes.Results:There were no significant differences in age and gender between the two groups ( P>0.05). In the visualization group, a total of 178 pedicle screws were placed, with 172 screws (96.6%) achieving satisfactory placement, while the conventional group placed 254 pedicle screws, with 240 screws (94.5%) achieving satisfactory placement. The difference in accuracy rates between the two groups was not statistically significant (χ 2=1.087, P=0.297). The visualization group required a mean of 2.60±1.03 fluoroscopy sessions during surgery, significantly less than the conventional group's mean of 5.57±2.12 sessions ( t=-6.860, P=0.001). Moreover, the visualization group had a shorter mean screw placement time of 13.23±3.68 minutes compared to the conventional group's mean of 24.68±15.75 minutes ( t=-3.870, P=0.040). All patients in both groups completed the surgery without postoperative complications such as infection, hematoma, or nerve root injury. Conclusion:The technique of robot-assisted pedicle screw placement with visualization effectively preserves the high precision achieved in conventional robotic surgery. With its advantage of real-time monitoring for screw position, it reduces the intraoperative fluoroscopy times and shortens the screw placement time, thereby further enhancing surgical efficiency.

OBJECTIVE To s tudy the impr ovement effects of tilianin on the atherosclerosis （AS）model mice and its potential mechanism. METHODS Eight C 57BL/6J mice were taken as the normal group. Forty ApoE－/－ mice were randomly divided into model group ，tilianin low-dose ，medium-dose and high-dose groups [ 2.1，3.5，7.0 mg/（kg·d）] and simvastatin group [positive control drug ，3.5 mg/（kg·d）]，with 8 mice in each group. Normal group was given normal diet ，and other groups were given high-lipid diet to induce AS model. At the same time ，normal group and model group were given normal saline intragastrically ， administration groups were given relevant drug intragastrically ，once a day ，for 12 consecutive weeks. The levels of TC ，TG， LDL-C，HDL-C，Ox-LDL，IL-1β，IL-6，MCP-1 and TNF-α in plasma were determined. The pathomorphological changes of the aorta in mice were observed. The positive rate of ICAM- 1，VCAM-1 and PCNA in the aorta were determined. mRNA expressions of MMP- 2，MMP-9，TGF-β1，Smad2 and Smad 3 as well as protein expressions of TGF-β1，Smad2/3 and p-Smad 2/3 were also determined in aorta of mice. RESULTS Compared with normal group ，the plasma levels of TC ，TG，LDL-C，Ox-LDL，IL-1β， IL-6，MCP-1 and TNF-α in model group were increased significantly（P＜0.01），while HDL-C level was significantly reduced （P＜0.01）. Lipid plaques were formed in the aorta ，and the plaque area was large and caused severe stenosis of the lumen. mRNA expressions of MMP- 2，MMP-9，TGF-β1，Smad2 and Smad 3 as well as positive rate of ICAM- 1，VCAM-1，PCNA and protein expression TGF-β1，Smad2/3，and p-Smad 2/3 in the aorta were significantly increased （P＜0.01）. Compared with model group ， most of above indexes of medication groups were improved significantly （P＜0.05 or P＜0.01）. CONCLUSIONS Tilianin can inhibit the activation of TGF-β1/Smads signaling pathway and then inhibit the proliferation of vascular smooth muscle cells ，reduce ， inflammation and regulate lipid metabolism to inhibit the No.81960766） formation of AS.

OBJECTIVE：To s tudy the effects of Dracocephalum moldavica total flavonoids （TFDM）on AMPK/SIRT 1/PGC-1α signaling pathway ，and to explore the mechanism of its protective effect on myocardial ischemia reperfusion injury （MIRI）rats. METHODS：Totally 50 healthy male SD rats were randomly divided into sham operation group ，model group ，TFDM group [ 60 mg/（kg·d），by extract] ，Compound C+TFDM group [ig administration of 60 mg/（kg·d）TFDM+intravenous injection of 250 μg/kg Compound C（AMPK inhibitor ）via tail vein 15 min before reperfusion] ，EX-527+TFDM group [ig administration of 60 mg/ （kg·d）TFDM+ip injection of 5 mg/kg EX- 527（SIRT1 inhibitor）20 min before reperfusion] ，with 10 rats in each group. They were given relevant medicine intragastrically ，once a day ，for consecutive 7 days. After last ig administration ，sham operation group underwent sham operation ，other 4 groups were established MIRI model by ligating left anterior descending coronary artery ， ischemia for 30 min and reperfusion for 2 h. After reperfusion ，the myocardial histopathological changes were observed by HE staining；RP-HPLC method was used to determine the contents of ATP ，ADP，AMP and NAD + in cardiac tissue. mRNA expressions of AMPK ，SIRT1 and PGC- 1α were detected by quantitative real-time PCR assay. Western blotting assay was the expressions of SIRT 1 and PGC- 1α protein in myocardium. RESULTS： Compared with sham operation group ， model group showed myocardial fib ers arranged disorder and horizontal stripes disappearance ，cell swelling burst and necrosis ，and nuclei deformation displacement ；the contents of ATP and NAD+，mRNA expression of AMPK ，SIRT1 and PGC- 1α，protein expression of SIRT 1 and PGC- 1α in cardiac tissue were decreased significantly （P＜0.05 or P＜0.01）；the contents of ADP and AMP ，the phosphorylation level of AMPK protein were increased significantly （P＜0.01）. Compared with model group ，myocardial pathological morphology were improved significantly in TFDM group ；the contents of ATP and NAD + in cardiac tissue ，mRNA expression of AMPK ，SIRT1 and PGC- 1α，the phosphorylation level of AMPK protein ，the protein expression of SIRT 1 and PGC- 1α were increased significantly（P＜0.05 or P＜ 0.01），while the contents of ADP and AMP were decreased significantly （P＜0.01）. Compared with TFDM group ，improvement effects of Compound C + TFDM group and EX- 527 + TFDM group on above indexes were reversed （P＜0.05 or P＜0.01）. CONCLUSIONS：TFDM may play a protective role on myocardium by activating AMPK/SIRT 1/PGC-1α signaling pathway and regulating energy metabolism.

Objective: To estimate the correlation between red cell distribution width (RDW) level and left atrial appendage thrombogenic milieu (LAATM) in elderly patients with non-valvular atrial fibrillation (NVAF). Methods: This was a retrospective case-control study. A total of 782 NVAF patients (age>60 years old) who finished transesophageal echocardiography (TEE) from January 2010 to December 2016 at Chaoyang Hospital was retrospectively screened, and diveded into LAATM group (n=65) and non LAATM group (n=717). RDW level was compared between the two groups. Potential association between RDW and LAATM was analyzed using multivariate logistic regression analysis. The accuracy of RDW for detecting LAATM was evaluated through receiver operating curve (ROC) analysis. Results: There were significant differences in age, history of heart failure, course of atrial fibrillation (AF), type of AF, NT-proBNP level, RDW level, left ventricular end systolic diameter, left ventricular end diastolic diameter, left ventricular ejection fraction (LVEF), left atrial diameter, CHADS₂ score and CHA₂DS₂-VASc score between the two groups (P<0.05). RDW level in LAATM group was significant higher than non LAATM group (13.4% (12.6%, 14.1%) vs. 12.1% (11.2%,13.0%), P<0.001). Multivariate logistic regression showed that RDW level associated with LAATM (OR=4.07, 95%CI 2.09-7.91, P<0.001). In ROC analysis, area under the curve was 0.81 (95%CI 0.74-0.88, P<0.001). When RDW level was 13.1%, LAATM could be diagnosed (sensitivity was 73.1% and specificity was 80.5%). Conclusions RDW value is associated with the presence of LAATM in elderly NVAF patients. The RDW level has a certain reference value for predicting LAATM.

Objective To explore the learning curve of the Tianji orthopedic robot in assisting percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCF).Methods A retrospective study was conducted of the consecutive 44 OVCF patients (71 fractured vertebrae) who had been treated with PKP assisted by the Tianji orthopedic robot from May 2018 to March 2019 at Department of Ortbopedics,The First Hospital of China Medical University.They were 2 men and 42 women,aged from 55 to 89 years (average,68.6 years).Their operations were performed by the same surgical team.The patients were divided into 4 even groups (n =11) according to the date of operation.The accuracy of robot-assisted puncture,total operation time,robot operation time,PKP operation time and complications were statistically analyzed and compared between the 4 groups.Natural logarithm regression analysis of total operation time,robot operation time and PKP operation time was conducted to determine the association between operation time and operation number [y =aln(x) + b,x indicating operation number and y operation time].Results The 4 groups were comparable due to insignificant differences in age,gender or operative segment between them (P ＞ 0.05).The total rate of accurate puncture was 95.8％ (68/71).The rates of accurate puncture were 92.9％ (13/14),94.4％ (17/18),94.7％ (18/19) and 100％ (20/20) for groups 1,2,3,and4,respectively,with no significant differences between groups (P ＞ 0.05).The total operation time for the 4 groups was respectively 56.6 ± 6.6 min,46.4 ± 8.5 min,40.2 ± 4.7 min and 40.4 ± 5.7 min and the robot operation time for the 4 groups was respectively 32.1 ±4.9 min,23.8 ±5.1 min,18.9 ±2.7 min and 19.6 ± 5.3 min,showing significant differences between the 4 groups (P ＞ 0.05) and a significant difference between groups 1 and 2 versus groups 3 and 4 (P ＞ 0.05) but no significant difference between group 3 and 4 (P ＞ 0.05).The natural logarithm regression analysis showed that the total operation time [y =-7.2861n(x) + 66.616,R2 =0.4889,P ＜ 0.001] and robot operation time [y =-5.6621n(x) +39.763,R2 =0.5196,P ＜ 0.001] decreased significantly with the increase of operation number but became stable in groups 3 and 4.There was no significant difference in PKP operation time among the 4 groups (P ＞ 0.05).The main intraoperative complication was leakage of bone cement in the anterior vertebral space and intervertebral space,with a total incidence of 8.5％ (6/71),showing no significant difference among the 4 groups (P ＞ 0.05).Conclusions The puncture accuracy of the Tianji orthopedic robot in assisting PKP for OVCF may not change with the increased operation number.The total operation time and robotic operation time decrease with the increased operation number.The learning curve of the Tianji orthopedic robot becomes stable very fast,indicating the surgical technique is easy to learn.

Objective To estimate the correlation between red cell distribution width (RDW) level and left atrial appendage thrombogenic milieu (LAATM) in elderly patients with non?valvular atrial fibrillation (NVAF). Methods This was a retrospective case?control study. A total of 782 NVAF patients (age>60 years old) who finished transesophageal echocardiography (TEE) from January 2010 to December 2016 at Chaoyang Hospital was retrospectively screened, and diveded into LAATM group (n=65) and non LAATM group (n=717). RDW level was compared between the two groups. Potential association between RDW and LAATM was analyzed using multivariate logistic regression analysis. The accuracy of RDW for detecting LAATM was evaluated through receiver operating curve (ROC) analysis. Results There were significant differences in age, history of heart failure, course of atrial fibrillation (AF), type of AF, NT-proBNP level, RDW level, left ventricular end systolic diameter, left ventricular end diastolic diameter, left ventricular ejection fraction (LVEF), left atrial diameter, CHADS2 score and CHA2DS2?VASc score between the two groups (P<0.05). RDW level in LAATM group was significant higher than non LAATM group (13.4% (12.6%, 14.1%) vs. 12.1% (11.2%,13.0%), P<0.001). Multivariate logistic regression showed that RDW level associated with LAATM (OR=4.07, 95%CI 2.09-7.91, P<0.001). In ROC analysis, area under the curve was 0.81 (95%CI 0.74-0.88, P<0.001). When RDW level was 13.1%, LAATM could be diagnosed (sensitivity was 73.1% and specificity was 80.5%). Conclusions RDW value is associated with the presence of LAATM in elderly NVAF patients. The RDW level has a certain reference value for predicting LAATM.

Objective To investigate the risk factors for bacterial infection of H7N9 inpatients,and provide reference for the prevention of bacterial infection.Methods The clinical and bacterial infection data in 24 H7N9 infections in Shenzhen from Dec 2013 to May 2014 was retrospectively analyzed.Results A total of 10 cases were infected with an infection rate of 41.7％.The lung was the main infected sites.Of all the bacteria isolated,there were 20 strains of gram-negative bacillus (64.5％),11 strains of grampositive cocci (35.5％).7 patients encountered extensively drug resistant acinetobacter baumannii.The risks factors for bacterial infection of H7N9 inpatients were delayed antiviral therapy,invasive mechanical ventilation,severe ARDS,lower lever of lymphocytes,CD4 + cells and oxygenation indexes,persistent lymphocytopenia.Conclusions The incidence of bacterial infection in H7N9 patients is relatively high;there are so many risk factors that we should take corresponding measures to effectively reduce the incidence.

Objective To explore the application value of real-time three-dimensional echocardiography (RT-3DE) in diagnosis of structural heart disease through a comparison with two dimensional echocardiography (2DE).Methods Ninety-two patients with heart disease were enrolled from October 2009 to February 2014 , all of whom were examined by RT-3DE.By cutting and spiraling structural 3D images of lesions in regions of interest , we made a diagnosis of lesions .In addition, the size of atrial(ASD) and ventricular septal defects (VSD),based on surgical results,was measured and analyzed.By comparing the coherence and difference of diagnosis on structural heart disease examined by 2DE and RT-3DE, the accuracy and superiority of RT-3DE were evaluated.Results (1)The 3D images of 92 patients with heart disease were successfully obtained by RT-3DE.The structure of lesions was displayed directly from various angles .In addition, the position, scope and degree of lesions and the spatial relationship of adjacent structures were accurately confirmed.RT-3DE provided more direct, accurate and abundant information than 2DE.(2)In the diagnosis of congenital heart disease, the diagnostic accordance rate of RT-3DE was the same as that of 2DE, but was slightly higher in the diagnosis of valvular disease and other lesions .( 3 ) Compared with 2DE, the ASD maximum diameters obtained from RT-3DE were more correlaed with surgical findings (r=0.94,0.86),so were the VSD maximum diameters (r=0.93, 0.84).Conclusion RT-3DE is easy to operate and quick to produce image ,which can provide more spatial information than 2DE in structural heart disease diagnosis , increase the accuracy rate of diagnosis , and serve as a supplement to 2DE.