OBJECTIVE To evaluate the impact of dual antiplatelet therapy （DAPT） at different durations on prognosis and safety after percutaneous coronary intervention （PCI）.METHODS PubMed，The Cochrane Library， Embase， Medline， CNKI， Wanfang data， and VIP database were searched to collect randomized controlled trials of DAPT in patients after PCI， from database inception to March 20， 2026. After literature screening， data extraction， and quality assessment， a meta-analysis was performed using RevMan 5.4 software.RESULTS A total of 19 studies were included， involving 44 072 patients. Meta-analysis results showed that there were no statistically significant differences between the two groups in incidence rate of major adverse cardiovascular events [relative risk（RR）＝0.99， 95% confidence interval（CI）（0.90， 1.08）， P ＝0.80]， all-cause mortality rate[RR＝0.93， 95%CI（0.81，1.05）， P ＝0.24]， cardiovascular-related mortality rate[RR＝0.87， 95%CI（0.73， 1.04）， P ＝0.12]， the incidence rate of myocardial infarction [RR＝1.11，95%CI（0.97，1.27）， P ＝0.14]， the incidence rate of stent thrombosis[RR＝1.50，95%CI（0.99，2.28）， P ＝0.06]， the incidence rate of revascularization[RR＝1.00， 95%CI（0.86， 1.15）， P ＝0.95]， the incidence rate of stroke[RR＝1.03， 95%CI（0.82， 1.28）， P ＝0.81]. The incidence rate of bleeding events in the short-term DAPT group was significantly lower than in the long-term DAPT group[RR＝0.61， 95%CI（0.53， 0.69）， P ＜0.000 01].CONCLUSIONS Short-term and long-term DAPT in patients after PCI were associated with comparable risks of all-cause mortality， cardiovascular-related mortality， myocardial infarction， stent thrombosis， revascularization， stroke， and major adverse cardiovascular events； however， short-term DAPT showed a more prominent advantage in reducing bleeding risk.

Objective To investigate the correlation between insulin resistance and interleukin-6 (IL-6), chemerin, total cholesterol (TC)/high density lipoprotein cholesterol (HDL-C) ratio, triglyceride (TG)/HDL-C ratio, low density lipoprotein cholesterol (LDL-C)/HDL-C ratio and insulin resistance in obese patients with type 2 diabetes mellitus (T2DM), and to provide scientific basis for T2DM prevention and control. Methods A total of 355 obese T2DM patients in Songjiang Hospital Affiliated to Shanghai Jiaotong University School of Medicine were selected from January 2021 to December 2023. IL-6, chemerin and lipids were detected, and the assessment of insulin resistance was conducted through the homeostasis model assessment of insulin resistance (HOMA-IR). Results Among the 355 obese T2DM patients, there were 280 cases of insulin resistance, with the incidence rate of 78.87%. The BMI, IL-6, chemerin, TC/HDL-C, LDL-C/HDL-C, and TG/HDL-C in the insulin resistance group were higher than those in the non-insulin resistance group (P<0.05). The above insulin resistant patients were divided into 4 subgroups by means of insulin resistance, and there were significant differences in BMI, IL-6, chemerin, and TG/HDL-C among the subgroups (P<0.05). IL-6, chemerin, and TG/HDL-C were positively correlated with HOMA-IR in obese T2DM patients (P<0.05), while TC/HDL-C and LDL-C/HDL-C had no significant correlation with HOMA-IR (P>0.05). BMI, IL-6, chemerin, and TG/HDL-C were all influencing factors of insulin resistance in obese T2DM patients (P<0.05). Conclusion IL-6, chemerin and TG/HDL-C are correlated with insulin resistance in obese patients with T2DM and are influencing factors for the occurrence of insulin resistance.

OBJECTIVE From the perspective of China’s health system， to evaluate the cost-effectiveness of maintenance therapy with clopidogrel or aspirin monotherapy in percutaneous coronary intervention （PCI） patients after dual antiplatelet therapy （DAPT）. METHODS A Markov model was adopted with a research period of 25 years and a cycle period of 1 year. Cohort simulations were conducted respectively for the clopidogrel group and aspirin group to predict and compare the long-term economic and health outcomes of PCI patients receiving either clopidogrel or aspirin monotherapy maintenance regimens after DAPT， and cost-effectiveness analysis was conducted. The willingness-to-pay （WTP） threshold was set at the level of 1 times China’s per capita gross domestic product （GDP） in 2024[95 749 yuan per quality-adjusted life year （QALY）]， and the incremental cost- effectiveness ratio （ICER） was calculated. The robustness of the basic analysis results was verified by using single-factor sensitivity analysis and probabilistic sensitivity analysis. RESULTS After PCI， patients received DAPT， clopidogrel monotherapy maintenance treatment reduced the occurrence of death events， and aspirin monotherapy maintenance treatment had a lower probability of stroke and myocardial infarction events. The ICER of the clopidogrel group regimen compared with the aspirin group regimen was 34 644.87 yuan/QALY， which was less than the WTP threshold set in this study. The results of univariate sensitivity analysis indicated that notable uncertainties affecting the basic analysis results were the probability of event-free progression to death in the aspirin group， the event-free cost in the clopidogrel group， and the event-free cost in the aspirin group. The results of probabilistic sensitivity analysis indicated that when the WTP threshold was 95 749 yuan /QALY， the economic probabilities of the clopidogrel group and the aspirin group were 83% and 17%， respectively. The economic probability of the clopidogrel group regimens showed an upward trend with the increase of the WTP threshold. CONCLUSIONS Compared to aspirin monotherapy for maintenance therapy， under the WTP threshold of 1 times China’s per capita GDP in 2024， receiving clopidogrel monotherapy for maintenance therapy after DAPT in PCI patients is more cost-effective.

【Objective】 To compare the outcomes of robot-assisted laparoscopic transperitoneal and retroperitoneal operation for huge (>6 cm) adrenal tumors. 【Methods】 The clinical data of 45 patients with huge adrenal tumors who underwent robotic surgery during Jan.2017 and Dec.2021 were retrospectively analyzed, including 28 cases via the transperitoneal approach and 17 cases via the retroperitoneal approach. 【Results】 No patients were converted to open operations. There were no significant differences in postoperative drainage time (2.24±0.44 vs. 2.36±0.49) d, operation time (130.88±5.96 vs. 136.61±8.39) min, blood loss (189.41±13.91 vs. 192.5±12.36) mL and postoperative hospital stay (7.06±0.56 vs. 7.46±0.69) d between the retroperitoneal and transperitoneal approaches. Retroperitoneal approach was better than transperitoneal approach in early postoperative feeding [(38.82±6.75 vs. 74.14±6.57) h, P<0.01] . 【Conclusion】 Robotic surgery is safe and effective in the treatment of large adrenal tumors. The choice of surgical approach should be based on patients’ condition, tumor volume and location.

Objective: To discuss the application of digital technology in the education of implant dentistry. Methods: According to the teaching method that combines case-, problem- and team-based learning, a course on implant theory was carried out in a class of 20 students. Then, all the students in this class were divided into two groups to receive two clinical operation training courses. The first was the training of a free-hand implant, and the second was an implant operation under a digital template. The courses introduced digital technology into preclinical education and simulated implant training. After the two courses, students were organized to analyze the accuracy of the implant, the operation time and the experiences of these two courses. Through the comparison of students′ operations of free-hand and template implants, students could analyze their own faults and propose a method of improvement. The students scored the two classes. Results : Through the two classes, all the students completed the implant operation under the guidance of a template and free-hand method and found their own problems and solutions. The combination of theory and practice deepened the students′ understanding of the teaching content. Finally, the classes were graded comprehensively by students, showing that the students′ satisfaction with the digital template class was higher than that with the free-hand class (P < 0.05). Conclusion The addition of a digital implant technology class significantly improved students′ comprehensive assessment, improved the teaching effect and was more acceptable to students in terms of gaining additional professional skills.

Objective To compare the clinical effect of tensile band wire fixation and plate fixation for treating children with olecroanon fracture.Methods Sixty-three children with olecroanon fracture at Children's Hospital of Chongqing Medical University from January 2006 to January 2014 were selected.In those cases of fracture by means of open reduction,41 cases were treated with tensile band wire,and 22 cases were treated with internal fixation with anatomical plate.Operation time,bleeding during operation,recovery time postoperatively,postoperative complications and joint function recovery were analyzed by using independent sample t-test and chi-square test.Results In the group of tensile band wire,there was no case of Kirschner wire loosening and displacement fracture.In group of steel plate,there were 2 cases of myositis ossificans.In the 2 groups,there was no case of bone nonunion.The average operation time:plate fixation group was (65.3 ± 8.4) min and tension band wire group was (58.4 ± 12.6) min,and there was a significant difference between the both groups (t =7.419,P ＜ 0.05);blood loss:plate fixation group was (5.3 ±0.8) mL and tension band wire group was (4.7-± 1.2) mL,and there was a significant difference between the both groups (t =2.595,P ＜ 0.05);fracture healing time:plate fixation group was (74.1 ± 8.4) d and tension band wire group was (61.7 ±9.3) d,and there was a significant difference between the both groups (t =10.636,P ＜0.05).With Broberg-Morrey to evaluate two groups'quality rate of function recovery,there was no significant difference in statistics with 85.3％ (35/41 cases) in tensile band wire group and 81.8％ (17/22 cases) in steel plate group(x2 =0.651,P ＞ 0.05).Conclusions Olecranon fracture in children using tension band wire fixation may be a better way,more suitable for promotion and implementation at basic hospital.

Objective: To observe the clinical effect of acupuncture plus occupation therapy for fine motor functions in children with spastic cerebral palsy. Methods:A total of 80 cerebral palsy kids with fine motor dysfunction were allocated into two groups by envelop, 40 cases in each group. Cases in the control group were treated with occupation therapy. Based on the therapy given to the control group, cases in the treatment group were supplemented with acupuncture at the points of the three yang meridians of hand. The treatment was done every other day and 10 times for a course. There was a 15-day interval between two courses, and 3 courses in total. The therapeutic efficacies were evaluated using Peabody developmental motor scale 2 (PDMS-2) and modified Ashworth scale (MAS) before and after treatment. Results:After treatment, the standard score for grasping (Grs), standard score for visual-motor integration (Vis), fine motor quotient (FMQ) and modified Ashworth scale (MAS) were significantly improved in both groups (P<0.05). The improvement in the treatment group was more obvious than that in the control group (P<0.01). Conclusion:Acupuncture plus occupation therapy can achieve better effect than occupation therapy alone in improving fine motor functions of upper limbs in cerebral palsy kids.

Objective:To observe the clinical effect of Nie-pinching spine coupled with point application and injection for cerebral palsy (CP) in children with spleen deficiency.
Methods:A total of 70 CP children with spleen deficiency were randomly allocated into a treatment group (n=35) and a control group (n=35). Children in the treatment group were treated with comprehensive rehabilitation training, Nie-pinching spine, point application and point injection, whereas children in the control group were treated with comprehensive rehabilitation training and oral administration of multi-enzyme tablets. One course of treatment made up of 20 d. There was a 20-day interval between two courses. The cases were treated for a total of 3 courses. Then the therapeutic efficacies were evaluated using scores of spleen-deficiency symptoms and gross motor function measure (GMFM).
Results:After 3 courses of treatment, the total effective rates for spleen-deficiency symptoms and rehabilitation were 85.7% and 77.1% respectively in the treatment group, versus 51.4% and 57.1% respectively in the control group, showing statistical differences (bothP<0.05).
Conclusion:In addition to comprehensive rehabilitation training, Nie-pinching spine combined with point application and injection obtained better effects than oral administration of multi-enzyme tablets.

Objective: In order to understand temporal and spatial distributions of alternating electromagnetic field (AEMF) of a coil thoroughly, the 3-D finite-element models of this kind of Biomagnetic Fields are established and analyzed for the research on bioeffect of magnetic field on microcirculation. Methods: Designing CAD models, setting boundary conditions, meshing models and obtaining numerical solutions were completed all within Comsol Multiphysics in terms of the theory of electromagnetic field. Results: Axial and radial plot of spatial attenuation rate of the AEMF, which were accordance with measured data, were simulated while the temporal and spatial distributions of AEMF were acquired. Conclusion: Models of 3-D finite-element of this kind of biomagnetic fields which appeared to exactly simulate the real magnetic field were first established systematically, and solved the placing problem of magnetic fields for the research on bioeffect of magnetic field on microcirculation and provided platforms for the simulation of hemodynamic of blood flow in the magnetic field.

Back ground Superoxide anion produced by oxidative stress combined with nitric oxide(NO)released by cellular NO synthase(NOS)generates peroxynitrite(ONOO-)which was one of reactive oxygen species.Objective To study the role of peroxynitrite in the pathogenesis of myocardial stunning(MS)and the effects of aminoguanidine(AMD).Methods Twenty-four dogs were randomly divided into four groups:(1)Short-time myocardical stunning(MS)group:the animals underwent 15 min occlusion of left anterior descending coronary artery(LAD),followed by 120 min of reperfusion.(2)Long-time MS group:60 min of LAD occlusion,followed by 120 min of reperfusion.(3)AMD group:Dogs were subjected to the same ischemia/reperfusion management as Long-MS group,but AMD was administrated(total 100 mg/kg).(4)Sham-operation group.Left ventricular function was evaluated by echocardiography and blood samples were taken from coronary venous sinus for the examination of NO at different time points.The stunned myocardium was examined immunohistochemically and electronic microscope.Results(1)Systolic thickening of stunned myocardium region and left ventricular ejection fraction were markedly declined during LAD occlusion in the 3 experimental groups,but progressively improved with the time of reperfusion.The improvement was faster in short-MS and AMD groups than in long-MS group.(2)Plasma NO concentrations in coronary venous sinus were greatly increased during reperfusion in short-and long-MS group,while no significant elevation was found in AMD group.(3)A marked increase in the immunoreactivity to nitrotyrosine,a specific "footprint" of peroxynitrite,was shown in the stunned myocardium both in short-and long-MS group,with larger and stronger positive foci in long-MS group.The positive staining was located in myocardial cytoplasm,especially at myofibrils and contractile bands.Treatment with AMD significantly reduced the nitrotyrosine staining in the stunned myocardium.(4)No ultrastructural changes of myocardial cells were noted in stunned myocardium in short-MS group except a slight loss of mitochondrial granules.On the contrary,myocyte edema,myofilament fractures,granule loss and swelling of mitochondrias were significant in long-MS group.AMD significantly ameliorated the ultrastructural abnormalities.Conclusion Myocardial stunning was associated peroxynitrite with production which mainly deteriorate the contractile proteins of myofibrils.AMD significantly inhibit the peroxynitrite formation leading to attenuation of the ultrastructural and functional injuries of stunned myocardium.