Objective To research the procedure for creating an animal model of mitral regurgitation by implanting a device through the apical artificial chordae tendineae, and to assess the stability and dependability of the device. Methods Twelve large white swines were employed in the experiments. Through a tiny hole in the apex of the heart, the artificial chordae tendineae of the mitral valve was inserted under the guidance of transcardiac ultrasonography. Before, immediately after, and one and three months after surgery, cardiac ultrasonography signs were noted. Results All models were successfully established. During the operation and the follow-up, no swines died. Immediately after surgery, the mitral valve experienced moderate regurgitation. Compared with preoperation, there was a variable increase in the amount of regurgitation and the values of heart diameters at a 3-month follow-up (P<0.05). Conclusion In off-pump, the technique of pulling the mitral valve leaflets with chordae tendineae implanted transapically under ultrasound guidance can stably and consistently create an animal model of mitral regurgitation.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

Objective:To evaluate the feasibility of using cortical bone trajectory (CBT) screws in the osteoporotic thoracolumbar fixation by comparing the bone CT values at the bone-screw interface between traditional trajectory (TT) screws and CBT screws in patients with different bone densities.Methods:The high-resolution CT imaging data of thoracolumbar segments following thoracic or lumbar spine fractures from April 2020 to October 2022 were collected at The Second Hospital Affiliated to Wenzhou Medical University for retrospective analysis. They were divided into 3 groups: a normal bone mass group, an osteopenia group and an osteoporosis group. From each group 30 cases were chosen (90 cases in total, 36 males and 54 females). All the data were imported into Mimics 18.0 for three-dimensional bone reconstruction in which placement of TT and CBT screws was simulated on the vertebrae from T10 to L2 (non-fractured vertebrae). Regions of interest (ROI) where each simulated screw intersected the bone were segmented to measure their CT bone values. For each vertebra in each group, the relative difference percentage in average CT value of ROI between TT and CBT screws was calculated. The CT values of ROI were compared in the same group between TT and CBT screws from T10 to L2; the CT values of ROI were compared in the same screws among the 3 groups from T10 to L2; the CT values of ROI were compared between the CBT screws in the osteopenia and osteoporosis groups and the TT screws in the normal bone mass group; the relative difference percentages in average CT value of ROI between CBT and TT screws were compared between the 3 groups from T10 to L2.Results:The average CT value of ROI for CBT screws was significantly higher than that for TT screws from T10 to L2 in every group ( P< 0.001); as for the CT values of ROI for CBT and TT screws from T10 to L2, the osteoporosis group0.05). At T10, T12, and L1, the relative difference percentage in average CT value of ROI between CBT and TT screws was significantly higher in the osteopenia and osteoporosis groups than that in the normal bone mass group ( P<0.05), but there was no such a difference between the osteopenia and the osteoporosis groups ( P>0.05). At T11 and L2, there was no significant difference between the 3 groups in the relative difference percentage in average CT value of ROI between CBT and TT screws ( P>0.05). Conclusions:As bone mass decreases, both CBT and TT screws lead to a significant decrease in the bone density at the bone-screw interface. In patients with osteoporosis, CBT screws can still lead to a higher bone density at the bone-screw interface than TT screws, thus providing a higher strength at the bone-screw interface.

Objective:To investigate the efficacy and safety of ixazomib combined with lenalidomide and dexamethasone (IRd) regimen in treatment of multiple myeloma (MM) patients in the real world practice.Methods:The clinical data of 24 MM patients treated with IRd regimen from January 2019 to January 2021 in the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology were retrospectively analyzed, and their efficacy and adverse reactions were analyzed. Among the 24 patients, 5 patients were relapsed and refractory (relapsed/refractory group), and 19 newly treated patients (conversion group) who responded to bortezomib induction therapy but converted to IRd regimen due to adverse reactions or other reasons.Results:The 24 patients were treated for a median of 4 cycles (2-7 cycles), with 8 cases of complete remission (CR), 6 cases of very good partial remission (VGPR), 8 cases of partial remission (PR), 1 case of disease progression (PD), 1 case of minimal response (MR), and the overall response rate (ORR) was 91.7% (22/24); the median progression-free survival (PFS) time was 15 months (95% CI 6.6-23.4 months); 6 CR patients were negative for minimal residual disease (MRD). The common adverse reactions were hematological adverse reactions, peripheral neuropathy, fatigue, gastrointestinal reactions, and infections. The incidence rate of grade 3-4 adverse reactions was 25.0% (6/24). In the relapsed/refractory group, the best efficacy was VGPR in 1 case, PR in 3 cases, and MR in 1 case, all patients withdrew from the IRd regimen therapy due to PD after transient remission or poor effect; in the conversion group, the best efficacy was CR in 8 cases, VGPR in 5 cases, PR in 5 cases, and PD in 1 case, 57.9% (11/19) patients maintained their original best response, and 36.8% (7/19) patients improved their best response to CR; the difference in median PFS time between the two groups was statistically significant (7 months vs. not reached, P = 0.018). Conclusions:The IRd regimen is safe and effective for MM patients, especially for the conversion patients after effective bortezomib induction therapy. Although patients with relapsed/refractory MM who have previously used multi-line therapy respond to IRd regimen, the duration of remission is limited.

Objective To observe the effect of Shenqi Fuzheng injection combined with chemotherapy on reducing the side effects of malignant tumor chemotherapy. Methods Eighty cancer patients in Traditional Chinese Medicine Hospital of PLA General Hospital from January 2015 to March 2017 were randomly divided into treatment group and control group by using random number table method, each group contained 40 cases. The patients in the treatment group were given Shenqi Fuzheng injection combined with chemotherapy, while the control group used chemotherapy only. Results The incidence of WBC and Plt reduction in the treatment group [35.0 % (14/40), 32.5 % (13/40)] was lower than those in the control group [70.0 % (28/40), 57.5 % (23/40)], and the differences were statistically significant (χ 2= 9.825, P = 0.002;χ2=5.051, P=0.025). The incidence rates of digestive tract reaction and oral ulcers[52.5 %(21/40), 32.5 % (13/40)]were lower than those in the control group[75.0 %(30/40), 60.0 %(24/40)], and the differences were statistically significant (χ2= 4.381, P = 0.036; χ2= 6.084, P = 0.014). The quality of life in the treatment group was significantly improved compared with the control group [(51.4 ±5.1) points vs. (48.3±5.5) points], and the difference was statistically significant(t =2.595,P =0.011). Conclusions Shenqi Fuzheng injection combined with chemotherapy can reduce chemotherapy-induced side effects and improve the life quality of the patients.The injection can be used as the adjuvant therapy for chemotherapy in clinic application.

Objective To evaluate the cleanliness and tolerance of different administration speed on polyethylene glycol electrolyte solution (PEG-ES) for colonoscopy preparation. Methods 97 consecutive asymptomatic individuals underwent colonoscopy and therapy were enrolled and randomly assigned into 2 groups. Subjects in group A drank 2000 ml PEG-ES (1000 ml every 10 ~ 20 min rapidly) within 1 h before colonoscopy;Subjects in group B drank 2000 ml PEG-ES (250 ml every 10 min) within 2 h before colonoscopy. The total time of drinking PEG-ES, the first defecation time and total numbers of defecation after drinking PEG-ES, score and degree of Boston bowel preparation scale (BBPS) and PEG-ES related adverse effects of the two groups were assessed and compared. Results There were no significant differences in gender, age and cecal insertion rate between group A and group B (P > 0.05). The total time of drinking PEG-ES, the first defecation time in group A were significant faster than those in group B, while total numbers of defecation was significantly more than that in group B (P < 0.05). No patients in the two groups complained PEG-ES related bellyache and vomiting, a little subjects in group B complained PEG-ES related nausea and bloating (P < 0.05), but the incidence were both less than 10.00 %. Accepting rate of colonoscopy preparation in group A was lower than that in group B, but both more than 90.00%, while accepting rate of re-colonoscopy than that in group B. BBPS score of the right half colon, transverse colon, total colon were significantly higher in group A than that in group B respectively (P < 0.05), while that of the left colon no significant differences between the two groups (P > 0.05). Conclusions Both regimens met the requirement of conventional colonoscopy and therapy, while rapid drinking PEG-ES within 1 h provides more better colonic cleansing quality for colonoscopy preparation.

Objective To evaluate the therapeutic effectiveness and safety of endoscopic submucosal dissection (ESD) with improved snare for colorectal polyps and submucosal tumors.Methods The clinical data such as clinical pathological characteristics, en bloc resection rate, curative resection rate, complications and follow-up results of 20 patients with colorectal polyps or submucosal tumors, who were treated by ESD, were retrospectively analyzed.Results 20 patients (total 24 lesions) with colorectal polyps or submucosal tumors were performed ESD operation successfully, in which 16 cases (total 20 lesions) were treated by ESD with improved snare (the trial group), 4 cases were treated by ESD with HOOK knife (the control group).The surgical success rate was 100.0% (24/24), the en blot resection rate was 100.0% (24/24). The mean polyps diameter in the trial group was (2.4 ± 0.9) cm (1.2~4.0 cm), while that in the control group was (2.2 ± 0.6) cm (1.5~3.0 cm). The mean procedure time in the trial group was (83.3 ± 23.9) min (45.0~120.0 min), while the control group was (66.2 ± 15.4) min (45.0~80.0 min), compared with the control group, the trial group need more times to complete the operation. The postoperative pathology as follows: 15 cases were adenoma (including 3 cases of adenoma with partial gland high-grade intraepithelial neoplasia), 1 case was hyperplastic polyp, 1 case was high-grade intraepithelial neoplasia, 2 cases were neuroendocrine tumor (total 4 lesions) 1 case was stromal tumor. Except for 1 case of stromal tumor from the muscularis propria was taken full thickness resection, no patient appeared complications such as hemorrhage, perforation, infection. No patient need intraoperative and postoperative surgical treatment.Conclusion Improved snare can be used to endoscopic submucosal dissection for large colorectal polyps and submucosal tumors safely and effectively, expanded the use and indications of snare in endoscopic resection, but need more times to completed the operation.

Objective To investigate the protective effects of Trimetazidine(TMZ)on the ischemia reperfusion injury (IRI)of fatty liver in autotransplantation model. Methods Fatty liver model was established by feeding high fat diet. Male Wistar rats (n=30) were randomized into three groups;Sham group, TMZ group and Model group. Liver was autotransplanted in both TMZ group and Model group. Serum levels of ALT, SOD, MDA, Bcl-2 and activated Caspase-3 were assessed 6 hours after the operation. The pathological performances of liver were also determined. Results Compared with the Model group, serum levels of ALT,AST, MDA and SOD levels decreased significantly in the TMZ group(P<0.05). Serum level of Bcl-2 was higher while level of activated Caspase-3 was lower in TMZ group than those in Model group(P<0.05). Histo?logical assay and TUNEL staining showed reduced hepatocyte swelling and narrowed sinusoid as well as decreased hepatic apoptosis in TMZ group compared with Model group. Conclusion TMZ can reduce oxidative stress, promote the expression of Bcl-2 and inhibit the activation of Caspase-3, which all contribute to its protective effect on fatty liver with ischemia-re?perfusion injury.

To analyze the polyps in the aspects of distribution, helicobacter pylori ( HP) infection and the use of proton pump inhibitors ( PPI) in different histological types of gastric polyps;to observe the morphosis under endos-copy histopathology and the surveillance situation in colonic polyps. The infection rates of HP in gastric hyperplasic polyps, inflammatory polyps and adenomatous polyps were 31.11%, 45.31% and 58.33%;the using rate of PPI among inflammatory polyps patients was higher. The main histopathological type of colonic polyps was adenomatous polyps;20 cases of colorectal polypectomy surveillance of 2 years had recurrence. The occurrence of gastric adeno-matous polyps may be related to HP infection;PPI had no obvious correlation with the pathological type of the gas-tric polyps. Colorectal adenoma should strengthen the surveillance colonoscopy of postpolypectomy.

Objective To design the training method of first aid medicine in one minute and observe its application effect .Methods To count the number of taking first aid medicine in one minute according to the instruction and answer the accuracy dose .To answer one or two related knowledge of first aid medicine including the effect, usage, dosage, adverse reactions and observation points .To design the score of taking first aid medicine in one minute , and the clinical nurses were trained and assessed according to the standard of the score in every quarter , and which were as the basis for judgment whether the project was up to standard in nurses and award the excellent department or individual nurse .Results Before and after the training , the number of taking first aid medicine in one minute in 80 nurses were respectively (12 ±2.52), (22 ±4.19), and the difference was statistically significant (U=18.29,P<0.01); the accuracy rate of medicine dose were respectively 77%and 98%, and the difference was statistically significant (χ2 =20.16,P<0.01); the average score of the knowledge of first-aid medicine exam were respectively (67 ±2.66), (93 ±3.73), and the difference was statistically significant (U=50.76,P<0.01).Conclusions The training method of first aid medicine in one minute is fun and can quickly improve the familiarity with first aid medicine in nurses .Training again at a given time can solve the problem of forgetting because the nurses did not use the first aid skills for a long time , and which provide the force guarantee for the rapid and effective clinical first aid .