Objective To explore the role of CLEARstent Live(CSL),a real-time stent visualiza-tion tool,in guiding percutaneous coronary intervention(PCI)for patients with complex coronary artery disease(CAD)and its effect on the risk of restenosis of stented coronary arteries.Methods A total of 140 patients with complex CAD undergoing PCI in our hospital from September 2022 to October 2023 were enrolled,and randomly divided into routine group(conventional stent doc-king technique)and CSL group(PCI under CSL visualization),with 70 patients in each group.The quality of angiographic images,basic conditions of surgical treatment,cardiac function and inci-dence of in-stent restenosis were compared between the two groups.Results The effective radia-tion dose,developing time,and dose area product were significantly lower,and the image quality score was obviously higher in the CSL group than the conventional group(P＜0.01).There were no significant differences in success rate of stent implantation,operation time,stent length or stent number between the two groups(P＞0.05).The CSL group had notably shorter length of hospital stay(9.83±1.21 d vs 11.85±1.68 d,P=0.000)and higher treatment cost[(3.01±0.63)× 104 Yuan vs(2.79±0.52)×104 Yuan,P=0.026]when compared with the conventional group.In both group,surgical treatment resulted in significantly elevated cardiac index and decreased left ventricular end-diastolic diameter and left ventricular end-systolic diameter at 7 d after operation(P＜0.05).The incidence of in-stent restenosis was statistically lower in the CSL group than con-ventional group[4.29％(3 cases)vs 25.71％(18 cases),x2=12.605,P=0.000].Conclusion CSL visualization provides better image quality for patients with complex CAD undergoing PCI,thus reducing the risk of in-stent restenosis and improving the treatment efficacy.

Objective To explore the role of CLEARstent Live(CSL),a real-time stent visualiza-tion tool,in guiding percutaneous coronary intervention(PCI)for patients with complex coronary artery disease(CAD)and its effect on the risk of restenosis of stented coronary arteries.Methods A total of 140 patients with complex CAD undergoing PCI in our hospital from September 2022 to October 2023 were enrolled,and randomly divided into routine group(conventional stent doc-king technique)and CSL group(PCI under CSL visualization),with 70 patients in each group.The quality of angiographic images,basic conditions of surgical treatment,cardiac function and inci-dence of in-stent restenosis were compared between the two groups.Results The effective radia-tion dose,developing time,and dose area product were significantly lower,and the image quality score was obviously higher in the CSL group than the conventional group(P＜0.01).There were no significant differences in success rate of stent implantation,operation time,stent length or stent number between the two groups(P＞0.05).The CSL group had notably shorter length of hospital stay(9.83±1.21 d vs 11.85±1.68 d,P=0.000)and higher treatment cost[(3.01±0.63)× 104 Yuan vs(2.79±0.52)×104 Yuan,P=0.026]when compared with the conventional group.In both group,surgical treatment resulted in significantly elevated cardiac index and decreased left ventricular end-diastolic diameter and left ventricular end-systolic diameter at 7 d after operation(P＜0.05).The incidence of in-stent restenosis was statistically lower in the CSL group than con-ventional group[4.29％(3 cases)vs 25.71％(18 cases),x2=12.605,P=0.000].Conclusion CSL visualization provides better image quality for patients with complex CAD undergoing PCI,thus reducing the risk of in-stent restenosis and improving the treatment efficacy.

OBJECTIVE To analyze the factors influencing patient satisfaction in the outpatient pharmacy of tertiary maternity and child specialist hospitals in Chongqing,and provide a reference for improving the pharmaceutical management capability of tertiary maternity and child specialist hospitals and enhancing patients'medical experience.METHODS Utilizing KANO model,a questionnaire was developed and data were analyzed.Key influencing factors were identified through the categorization of requirement attributes,Better values,Worse values,and two-dimensional matrix analysis.The impact of these categorized demand factors on overall satisfaction was further validated through Structural Equation Modeling (SEM).RESULTS Cronbach's α coefficient for the survey questionnaire was 0.855,exceeding the acceptable threshold of 0.7;Bartlett test for sphericality yielded a value of 5538.56 with P<0.01,indicating good reliability and validity of the survey results.Through the KANO model's factor selection process,the top four key factors influencing patient satisfaction in outpatient pharmacies were determined to be:medication pick-up time (r=0.45),pharmacist service attitude (r=0.45),rational medication consultation (r=0.41),self-service calling system (r=0.40),all of which were subsequently validated through SEM.CONCLUSIONS The four factors of medication pick-up time,self-service calling system,pharmacist service attitude,and rational medication consultation significantly influence patient satisfaction in the outpatient pharmacies of tertiary maternity and child hospitals in Chongqing.

Objective:To analyze the current situation and influencing factors of work-related musculoskeletal disorders (WMSDs) among scientific researchers in a computer workstation of a high-tech aerospace enterprise, and to provide data support for the improvement of occupational health management policies in this type of enterprise.Methods:From March to April 2023, using convenient sampling method, 1398 scientific researchers using computer workstations in an aerospace high-tech enterprise in Beijing were selected as the research subjects. The incidence of WMSDs in various parts of the body was investigated by using the Musculoskeletal Disorders Questionnaire, and the influencing factors of WMSDs in neck, lower back, shoulder and upper back were analyzed by logistic regression.Results:The total incidence of WMSDs was 55.4% (774/1398) in the scientific researchers who used computer workstations. The top 4 body parts in WMSDs incidence were neck (24.3%, 340/1398), lower back (20.4%, 285/1398), shoulder (18.7%, 262/1398), upper back (12.7%, 177/1398). The results of multivariate logistic regression analysis showed that feeling slightly tired and tired after work, setting a rest/break time of 10 to 15 min before the next continuous job, and operating computer for 2 to 4 hours and >4 hours were the influencing factors for the occurrence of neck WMSDs ( OR=3.08, 1.90, 0.60, 2.00, 1.49, P<0.05). Female, 5-<10 years of working experience, feeling slightly tired, tired and very tired after work, operating computer for 6-<8 hours and 8-10 hours a day were all the influencing factors for the occurrence of WMSDs in the lower back ( OR=1.82, 0.64, 2.95, 1.80, 1.61, 1.82, 1.73, P<0.05). Female, feeling slightly tired and tired after work were the influencing factors of shoulder WMSDs occurrence ( OR=2.42, 2.09, 2.00, P<0.05). Female, 5-<10 years, 10-15 years of working age, 1-3 times of physical exercise/quarter, feeling slightly tired, tired and very tired after work were the influencing factors for the occurrence of upper back WMSDs ( OR=2.76, 2.19, 2.78, 0.48, 4.20, 2.66, 2.19, P<0.05) . Conclusion:The incidence of WMSDs among scientific researchers in computer workstations of aerospace high-tech enterprises is high, which is closely related to individual characteristics and workstation usage characteristics. Measures should be taken to prevent and improve the WMSDs status of scientific researchers.

[Objective] To review the clinical information, imaging features, pathological manifestations and prognosis of low-grade oncocytic tumor (LOT), so as to improve the clinical understanding of the disease. [Methods] The imaging, clinicopathological and postoperative follow-up data of 3 LOT cases treated in Peking University Third Hospital during Feb.2020 and Sep.2022 were retrospectively collected. [Results] All patients were male, aged 51—70 years.All tumors were single, with the maximum diameter of 14—21 mm. None of the patients had any specific clinical manifestations.The mass showed a circular isodense shadow on CT.All patients underwent nephron-sparing tumor resection.Postoperative pathology showed that the incision surface of the tumors was brownish-yellow or brown, and the tumors were solid or partially cystic.HE staining showed that the cells were uniformly eosinophilic; the nucleus was round or oval, with slight local perinuclear halo.Immunohistochemistry showed positive CK7 but negative CD117.Genetic testing in case 2 showed 1 potentially clinically significant somatic mutation TSC2.During the follow-up of 12-23 months, no recurrence occurred. [Conclusion] There were no obvious clinical symptoms and imaging features of LOT, which morphologically showed heterozygous or borderline characteristics with renal eosinophilia and renal chromophobe cell carcinoma, and the biological behavior was indolent.Nephron-sparing tumor resection promised good prognosis.

Objective:To investigate the feasibility and safety of distal radial artery approach in emergency percutaneous coronary intervention(PCI) of elderly ST-segment elevation myocardial infarction(STEMI) patients.Methods:This study is a cross-sectional study. Elderly patients with acute myocardial infarction who received emergency PCI at the Third Central Hospital of Tianjin from January 2020 to December 2022 were selected. They were divided into the distal radial artery group and the classic radial artery group based on the puncture location. The success rate, puncture time, surgical success rate, and surgical time of the two groups were observed; The incidence of complications in patients, including radial artery occlusion rate, radial artery spasm rate, local hematoma rate, aneurysm incidence rate were recorded.Results:There were 70 cases in the distal radial artery group, including 33 males (47.1%), aged (65.6±6.7) years old; There were 70 cases in the classic radial artery group, including 35 males (50.0%), aged (66.4±6.9) years old. There was no statistically significant difference in puncture success rate, puncture time, surgical success rate, and surgical time between the distal radial artery group and the classical radial artery group ( P>0.05). The incidence of radial artery occlusion in the distal radial artery group was significantly lower than that in the classical radial artery group (1.4% vs. 8.6%, P=0.024). The postoperative compression time in the distal radial artery group was significantly shorter than that in the classical radial artery group ((291.6±10.5) min vs. (343.5±9.8) min, P=0.047). There was no statistically significant difference in the incidence of radial artery spasm, local hematoma, and aneurysm between the two groups ( P>0.05). Conclusions:The distal radial artery approach has a lower radial artery occlusion rate, shorter compression time, and better safety. It can be used as a new approach for emergency PCI in elderly patients with STEMI for clinical application.

Objective:To analyze the current situation and influencing factors of work-related musculoskeletal disorders (WMSDs) among scientific researchers in a computer workstation of a high-tech aerospace enterprise, and to provide data support for the improvement of occupational health management policies in this type of enterprise.Methods:From March to April 2023, using convenient sampling method, 1398 scientific researchers using computer workstations in an aerospace high-tech enterprise in Beijing were selected as the research subjects. The incidence of WMSDs in various parts of the body was investigated by using the Musculoskeletal Disorders Questionnaire, and the influencing factors of WMSDs in neck, lower back, shoulder and upper back were analyzed by logistic regression.Results:The total incidence of WMSDs was 55.4% (774/1398) in the scientific researchers who used computer workstations. The top 4 body parts in WMSDs incidence were neck (24.3%, 340/1398), lower back (20.4%, 285/1398), shoulder (18.7%, 262/1398), upper back (12.7%, 177/1398). The results of multivariate logistic regression analysis showed that feeling slightly tired and tired after work, setting a rest/break time of 10 to 15 min before the next continuous job, and operating computer for 2 to 4 hours and >4 hours were the influencing factors for the occurrence of neck WMSDs ( OR=3.08, 1.90, 0.60, 2.00, 1.49, P<0.05). Female, 5-<10 years of working experience, feeling slightly tired, tired and very tired after work, operating computer for 6-<8 hours and 8-10 hours a day were all the influencing factors for the occurrence of WMSDs in the lower back ( OR=1.82, 0.64, 2.95, 1.80, 1.61, 1.82, 1.73, P<0.05). Female, feeling slightly tired and tired after work were the influencing factors of shoulder WMSDs occurrence ( OR=2.42, 2.09, 2.00, P<0.05). Female, 5-<10 years, 10-15 years of working age, 1-3 times of physical exercise/quarter, feeling slightly tired, tired and very tired after work were the influencing factors for the occurrence of upper back WMSDs ( OR=2.76, 2.19, 2.78, 0.48, 4.20, 2.66, 2.19, P<0.05) . Conclusion:The incidence of WMSDs among scientific researchers in computer workstations of aerospace high-tech enterprises is high, which is closely related to individual characteristics and workstation usage characteristics. Measures should be taken to prevent and improve the WMSDs status of scientific researchers.

Objective To determine the effect of thrombus aspiration combined with intracoronary injection of recombinant human TNK tissue type plasminogen activator(rhTNK-tPA)on micro-circulation and cardiac function during primary PCI in elderly patients with acute myocardial in-farction(AMI).Methods A retrospective study was conducted on 90 elderly patients with STEMI undergoing primary PCI in Tianjin Third Central Hospital from January 2021 to October 2023.According to their treatment strategies,they were divided into simple suction group(n=46)and combination group(n=44).The suction group received a suction catheter for thrombus aspiration within the coronary artery,while the combined group got a suction catheter for thrombus aspira-tion within the infarct related blood vessels,and then received a local injection of rhTNK-tPA into the lesion through the suction catheter.Their general data,proportion of ST segment resolution(STR)≥70％at 90 min after surgery,postoperative TIMI blood flow grade,postoperative TIMI myocardial perfusion grade(TMPG),corrected TIMI frame count(CTFC)and cardiac ultrasound indicators as well as the incidence of adverse cardiac events during hospitalization were compared between the two groups.Results Larger proportions of postoperative STR ≥70％,postoperative TIMI blood flow grade 3 and TMPG grade 3,and lower CTFC were observed in the combination group than the suction group(P＜0.05).In 1 week after surgery,the simple suction group had lower left ventricular ejection fraction[LVEF,(52.5±6.2)％vs(58.3±6.4)％,P＜0.05],but larger left ventricular diameter(LVD,44.1±3.9 mm vs 51.9±2.5 mm,P＜0.05)than the com-bined group.The incidence of MACE during hospitalization was obviously lower in the combined group than the suction group(20.5％vs 37.0％,P＜0.05).Conclusion Combined intracoronary injection of rhTNK-tPA based on thrombotic aspiration can effectively reduce the coronary thrombus burden,improve myocardial microcirculation perfusion,reduce the incidence of MACE during hospitalization,and not increase the risk of bleeding in elderly STEMI patients.

Objective:To investigate the prognostic value of the ratio of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) combined with activated partial thromboplastin time (APTT) in elderly patients with non-valvular atrial fibrillation (NVAF) treated with rivaroxaban.Methods:One hundred and twenty-two elderly patients with NVAF who were anticoagulated with rivaroxaban from June 2020 to June 2021 in the Third Central Hospital of Tianjin were enrolled and divided into four groups based on the median method. The patients in the Q1 group ( n = 32) have low AST/ALT/low APTT. The patients in the Q2 group ( n = 27) have low AST/ALT/high APTT. The patients in the Q3 group ( n = 29) have high AST/ALT/low APTT. The patients in the Q4 group ( n = 34) have high AST/ALT/high APTT. The efficacy endpoint events, and safety endpoint events were analyzed in the four groups, and univariate and multivariate Cox regression analyses were performed for the composite endpoint events. Results:The effectiveness endpoint events were mainly cardiovascular deaths, the number of which in the Q1 to Q4 groups was 0 (0), 1 (3.70%), 4 (13.79%), and 5 (14.71%), respectively. The safety endpoint events were mainly non-major bleeding events, the number of which in the Q1 to Q4 groups was 5 (15.62%), 2 (7.41%), 6 (20.69%), and 5 (14.71%), respectively. Compared to the Q1 group, the Q4 group had an increased risk of composite endpoint events after incorporating traditional risk factor correction ( HR: 3.851, 95% CI: 1.167 to 12.704). Conclusions:AST/ALT ratio combined with APTT can provide risk stratification for distant bleeding and cardiovascular adverse events in elderly NVAF patients treated with rivaroxaban anticoagulation and has some predictive value for their prognosis.

Objective:To investigate the effect of different P2Y12 inhibitors on the long-term prognosis of patients with diabetes mellitus (DM) and acute coronary syndrome (ACS), with or without the CYP2C19 loss-of-function (LOF) gene. Method:266 consecutive ACS patients undergoing percutaneous coronary intervention (PCI) were enrolled. According to the CYP2C19 LOF genotype, the patients were divided into rapid metabolizing-type (without the CYP2C19 LOF gene) and moderate-slow metabolizing type (with the CYP2C19 LOF gene). Each type was divided into the A group (with diabetes) and the B group (without diabetes). Each group was divided into the ticagrelor subgroup and the clopidogrel subgroup according to the type of P2Y12 platelet inhibitor. The MACE events were recorded for each subgroup over 3 years, and the prognostic impact of the CYP2C19 LOF genotype and the type of P2Y12 used were analyzed. Results:There were no significant differences in MACE, revascularization, stroke, heart failure rehospitalization, major bleeding, or all-cause mortality among subgroups of patients with rapid metabolizing type at 3 years after PCI (all P>0.05). In patients with moderate-slow metabolizing-type, the use of tegretol significantly reduced the probability of MACE events and cardiac revascularization (all P<0.01) and significantly reduced the reoccurrence of heart attack in patients with DM. Conclusions:In DM combined with ACS patients with rapid metabolizing type, the choice of different P2Y12 inhibitors after PCI had no significant effect on their prognosis. In DM combined with ACS patients with moderate-slow metabolizing type, tegretol not only significantly reduced the incidence of MACE, revascularization, and reinfarction, but also did not increase the risk of major bleeding. In terms of reducing the reoccurrence of heart attack, the benefit of using tegretol in the DM patients was greater than in the non-DM patients.