Objective To explore the evaluation of the relationship between myocardial damage and left ventricular diastolic function in patients with acute myocardial infarction(AMI)by using cardiovascular MR T2WI sequences.Methods A total of 155 AMI patients were selected.All patients were divided into two groups based on whether left ventricular diastolic dysfunction occurred,including diastolic dys-function group and diastolic normal group.Clinical data of all patients,myocardial injury and cardiac function indicators at admis-sion,black blood T2 short time inversion recovery(T2-STIR)sequence of cardiac MR,and T2 prepulse steady state free procession during free breathing(T2 p-SSFP)sequence images of bright blood were collected.Pearson’s method was used to analyze the rela-tionship between T2WI sequences and myocardial injury as well as cardiac function indicators.Multivariate logistic regression analysis was used to evaluate the influencing factors of left ventricular diastolic dysfunction.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of cardiovascular MR T2WI sequences in left ventricular diastolic dysfunction.Results Com-pared with the T2-STIR sequence,the T2 p-SSFP sequence showed a significant decrease in the signal-to-noise ratio(SNR)of the dis-tal myocardial,the SNR of the edematous myocardial,and the contrast-to-noise ratio(CNR)of the edematous myocardial and the dis-tal myocardial(P<0.05).The distal myocardial SNR,edematous myocardial SNR,and edematous myocardial and distal myocardial CNR of T2WI sequences were positively correlated with cardiac troponin I(c Tn I),creatine kinase isoenzyme MB(CK-MB),myoglobin(MB),and left ventricular ejection fraction(LVEF),respectively(P<0.05).Compared with diastolic normal group,patients in diastolic dysfunction group had significantly higher distal myocardial SNR,edematous myocardial SNR,and edematous myocardial and distal myocardial CNR in the T2-STIR and T2 p-SSFP sequences(P<0.05).Logistic regression analysis showed that distal myocardial SNR,edematous myocardial SNR,and edematous myocardial and distal myocardial CNR were risk factors for left ventricular diastolic dysfunction in AMI patients(P<0.05).The ROC curve analysis showed that the distal myocardial SNR,edematous myocardial SNR,and edematous myocardial and distal myocardial CNR of T2WI sequences had diagnostic value for left ventricular diastolic dysfunction in AMI patients.Conclusion Cardiovascular MR T2WI sequences exhibit significant prominence in individuals diagnosed with AMI and demonstrate a positive correlation with myocardial injury.These sequences serve as valuable tools for assessing the disease’s severity and hold substantial predictive potential concerning left ventricular diastolic dysfunction.

Elderly patients are a crucial population for medical treatment and referral.The establishment of standardized and efficient referral channels is essential for enhancing the referral process, improving treatment outcomes for the elderly, and optimizing the allocation of medical resources.Referral network analysis examines the integrity, structure, and dynamics of referrals to infer the characteristics of the network.This can offer insights for enhancing referral policies and elevating medical service standards.While existing research predominantly concentrates on referral networks within the general population, there is a noticeable gap in studies focusing on elderly patients.This review article assesses domestic and international research on networks formed between medical institutions or physicians through patient referrals, aiming to inform and enhance referral policies in our country.

Elderly patients are a crucial population for medical treatment and referral.The establishment of standardized and efficient referral channels is essential for enhancing the referral process, improving treatment outcomes for the elderly, and optimizing the allocation of medical resources.Referral network analysis examines the integrity, structure, and dynamics of referrals to infer the characteristics of the network.This can offer insights for enhancing referral policies and elevating medical service standards.While existing research predominantly concentrates on referral networks within the general population, there is a noticeable gap in studies focusing on elderly patients.This review article assesses domestic and international research on networks formed between medical institutions or physicians through patient referrals, aiming to inform and enhance referral policies in our country.

Objective To explore the evaluation of the relationship between myocardial damage and left ventricular diastolic function in patients with acute myocardial infarction(AMI)by using cardiovascular MR T2WI sequences.Methods A total of 155 AMI patients were selected.All patients were divided into two groups based on whether left ventricular diastolic dysfunction occurred,including diastolic dys-function group and diastolic normal group.Clinical data of all patients,myocardial injury and cardiac function indicators at admis-sion,black blood T2 short time inversion recovery(T2-STIR)sequence of cardiac MR,and T2 prepulse steady state free procession during free breathing(T2 p-SSFP)sequence images of bright blood were collected.Pearson’s method was used to analyze the rela-tionship between T2WI sequences and myocardial injury as well as cardiac function indicators.Multivariate logistic regression analysis was used to evaluate the influencing factors of left ventricular diastolic dysfunction.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of cardiovascular MR T2WI sequences in left ventricular diastolic dysfunction.Results Com-pared with the T2-STIR sequence,the T2 p-SSFP sequence showed a significant decrease in the signal-to-noise ratio(SNR)of the dis-tal myocardial,the SNR of the edematous myocardial,and the contrast-to-noise ratio(CNR)of the edematous myocardial and the dis-tal myocardial(P<0.05).The distal myocardial SNR,edematous myocardial SNR,and edematous myocardial and distal myocardial CNR of T2WI sequences were positively correlated with cardiac troponin I(c Tn I),creatine kinase isoenzyme MB(CK-MB),myoglobin(MB),and left ventricular ejection fraction(LVEF),respectively(P<0.05).Compared with diastolic normal group,patients in diastolic dysfunction group had significantly higher distal myocardial SNR,edematous myocardial SNR,and edematous myocardial and distal myocardial CNR in the T2-STIR and T2 p-SSFP sequences(P<0.05).Logistic regression analysis showed that distal myocardial SNR,edematous myocardial SNR,and edematous myocardial and distal myocardial CNR were risk factors for left ventricular diastolic dysfunction in AMI patients(P<0.05).The ROC curve analysis showed that the distal myocardial SNR,edematous myocardial SNR,and edematous myocardial and distal myocardial CNR of T2WI sequences had diagnostic value for left ventricular diastolic dysfunction in AMI patients.Conclusion Cardiovascular MR T2WI sequences exhibit significant prominence in individuals diagnosed with AMI and demonstrate a positive correlation with myocardial injury.These sequences serve as valuable tools for assessing the disease’s severity and hold substantial predictive potential concerning left ventricular diastolic dysfunction.

【Objective】 To reduce the incidence of postoperative intestinal obstruction, we tried to improve surgical techniques by closing the cavity formed during radical cystectomy + ileal passage (Bricker) via laparoscopy to prevent the formation of abdominal hernia. 【Methods】 During Oct.2018 and Feb.2022, 41 patients were involved (conventional group). After standard laparoscopic radical cystectomy + pelvic lymphadenectomy, the ileum channel was established. The right medial retroperitoneum was sutured to cover the mesothelium and end of the ileum channel under open operation or endoscope. The space between the ureter and mesothelium of the ileum channel was sealed, and the end of the ileum channel and both ureters were externalized. During Feb.2022 and Dec.2022, 15 patients were involved (modified group). The right inner and outer lateral peritoneums below the ileal conduit were sutured to "bottom out" the gap between the ileal conduit and the right abdominal wall in addition to standard procedures. The recovery of intestinal function and incidence of bowel obstruction were compared between the two groups. 【Results】 In the conventional group, the intestinal function recovered within 2 to 6 days after surgery, with a median ventilation time of 3 days. Intestinal obstruction occurred in 3 patients, 2 of whom improved after conservative treatment while 1 underwent surgical exploration after ineffective conservative therapy. There were no significant differences in the time of discharge and ventilation between the two groups, but no intestinal obstruction occurred in the modified group. 【Conclusion】 Peritoneal externalization at the end of ileal passage can reduce the incidence of intra-abdominal hernia and postoperative intestinal obstruction, which is worthy of clinical application.

As a key of military medical stodents education,clinical practice teaching continues to progress with the changing needs of society and the army advances.Transforming teaching philosophy,reforming curriculum,strengthening the hardware construction,improving the faculty building,exploring new models of teaching,practicing learner-centered teaching are important teaching experiences,according to the actual situation in our hospital for many years.In this paper,we illustrate the main contradiction,the current response measures taken and achievement achieved