BACKGROUND:Traditional scoliosis orthosis has some disadvantages,such as complex manufacturing process,long processing cycle,poor fit and so on.Three-dimensional printed scoliosis orthosis has the advantages of high manufacturing precision and personalization. OBJECTIVE:To evaluate the efficacy of three-dimensional printed scoliosis orthosis for scoliosis based on multi-criteria decision model. METHODS:Clinical data of 72 patients with scoliosis admitted to Chen Xinghai Hospital of Integrated Traditional Chinese and Western Medicine from January 2019 to October 2022 were retrospectively collected and divided into two groups according to the treatment of orthosis.Study group(n=23)received three-dimensional printed scoliosis orthosis.Traditional group(n=49)received the traditional polypropylene spine brace treatment.The clinical efficacy and complications were compared between the two groups.A multi-criteria decision model for the treatment of scoliosis with three-dimensional printed scoliosis orthosis was established,and the stability of the benefit value,risk value and decision model of the two groups were evaluated. RESULTS AND CONCLUSION:(1)Compared with the traditional group,there were significant differences in the top vertebral offset distance,Cobb angle,top vertebral rotation,Functional Movement Screen score,visual analog scale score and total effective rate in the study group at 6 months after surgery(P<0.05).(2)Among the benefit indexes,Cobb angle had the greatest impact on the condition of patients,while the risk indexes had the greatest impact on dyspnea.(3)The benefit values of the study group and the traditional group for scoliosis were 79 and 64,and the risk values were 74 and 57,respectively.The combined benefit and risk values found that the benefit-risk value of the study group was 16 higher than that of the traditional group.(4)In the range of 0-100%relative risk weight,the benefit-risk value of the study group was always higher than that of the traditional group,which proved that the multi-criteria decision-making model had good stability.(5)It is indicated that three-dimensional printed scoliosis orthosis can better restore the physiological curvature of scoliosis and improve the efficiency of treatment.

【Objective】 To study the correlation between platelet transfusion efficacy and KIR receptor-HLA ligand. 【Methods】 Thirty-three leukemia patients with positive HLA antibody were tested for cross-matching with donor platelets. Platelets from suitable donors were selected for transfusion, and the 24-hour platelet corrected count increment (CCI) was used to determine the transfusion effect. KIR and ligand genotyping were performed on blood samples from patients and donors by PCR-SSP method, and the relationship between platelet transfusion effects and KIR receptor-HLA ligand was analyzed. 【Results】 In 74 occasions of platelet transfusion, 42 were ineffective and 32 were effective. When the donor had C2 gene and HLA-B Bw4-80T gene, the frequency of ineffective platelet transfusion in the recipient was 69.0% (29/42) and 52.4% (22/35), respectively, which was significantly higher than that in the effective group [25.0% (8/32) and 25.0% (8/32)]. When the donor had C1 gene, and the frequency of effective platelet transfusion in the recipient was 100.0%(32/32), which was higher than that in the ineffective group [83.3%(35/42)]. When the recipient-donor matching mode was KIR2DL1-C2 and KIR3DL1-(HLA-B Bw4-80T), the frequency of ineffective platelet transfusion was 69.0%(29/42) and 40.5%(22/42),higher than that of the effective group [25% (8/32) and 18.8% (6/32)]. When the recipient-donor matching model was KIR2DL3-C1, the rate of effective platelet transfusion in 32 patients (100.0%), which was higher than that (35 patients 83. 3%) in the ineffective group. When the mismatch mode of recipient iKIR+donor HLA ligand receptor was KIR2DL1-C2, the frequency of effective platelet transfusion in the recipient was 78.1% (25/32), which was much higher than that in the ineffective group [31.0% (13/42)]. When the mismatch mode was KIR3DL1-(HLA-B Bw4-80T), the rate of effective platelet transfusion in the recipient was 68.8% (22/32), which was higher than that in the ineffective group (42.9%, 18/42). The difference between the above groups was statistically significant(P<0.05). 【Conclusion】 HLA-C1 and HLA-C2 genes are the key factors affecting the efficacy of platelet transfusion.For platelet refractorines, HLA-C1 is the protective gene, while HLA-C2 and HLA-B Bw4-80T are the susceptible genes. The recipient iKIR+donor HLA ligand receptor model may play an important role in platelet refractoriness.

Objective To summarize the experience of applying transradial sheathless technique in treat-ment of bifurcation coronary lesions. Methods The clinical data on 39 patients with bifurcation coronary lesions who received transradial PCI using sheathless guide catheter produced by ASAHI or self-made sheathless guide catheter were retrospectively analyzed. Passing ability of sheathless guide catheter, success rate and complications of PCI were observed.Results There were 10 patients with left main bifurcation lesions, 29 left anterior descend-ing branch and diagonal branch bifurcation lesions. 33 patients were treated using sheathless of 7.5 Fr and 6 were treated by self-made sheathless guide catheter.PCI achieved expected goal.No catheter placement related complica-tions, cardiovascular or cerebrovascular events were observed in 39 patients in their hospital stay. Conclusions Transradial sheathless technique can be applied in of coronary lesions. Sheathless of 7.5 Fr is easy to use and has perfect passing ability.Sheathless guide catheter is effective,safe and highly practicable.Both procedures are worth of clinical application.

Objective To discuss the clinical effects and the major adverse cardiac events of intracoronary prostaglandin E1 injection prior to percutaneous coronary intervention (PCI) in early(within 24h of symptom onset) interventional treatment for patients with acute non -ST segment elevation myocardial infarction ( NSTEMI ) . Methods 122 patients with NSTEMI who underwent early interventional treatment were divided into three groups according to the digital table:41 cases in prostaglandin E 1 group,41 cases in nitroglycerin group ,40 cases in control group.The TIMI blood flow was compared among the three groups after PCI .All patients were followed up during 6 months about major adverse cardiac events ( MACE) and the cardiac structure and function by echocardiography . Results After primary PCI,the corrected TIMI frame count(CTFC) was significantly better in the prostaglandin E 1 group[(20.22 ±6.82)] than in the nitroglycerin group[(26.35 ±8.71)] and the control group[(27.02 ±9.65), t=6.451,6.763,all P<0.05].The TIMI myocardial perfusion grade (TMP) was significantly better in the prosta-glandin E1 group(7.3％) than in the nitroglycerin group(26.8％) and the control group(30.0％)(P<0.05). There was no statistically significant difference between the nitroglycerin group and the control group (P>0.05).All patients were followed up for 6 months,the LVDd in the prostaglandin E1 group[(46.8 ±3.7)mm] was significantly lower than that in the nitroglycerin group[(49.5 ±5.8) mm] and the control group [(50.2 ±4.9) mm,t=6.312, 5.893,all P<0.05].The LVEF in the prostaglandin E1 group [(55.8 ±8.2)％] was significantly higher than that in the nitroglycerin group [(49.3 ±7.9)％] and the control group [(50.5 ±6.8)％,t=7.011,5.981,all P<0.05].The incidence rate of MACE in the prostaglandin E 1 group(4.9％) was significantly lower than that in the nitroglycerin group(12.2％) and control group(12.5％)(χ2 =5.834,5.719,all P<0.05).There was no statistically significant difference between the nitroglycerin group and the control group (P>0.05).Conclusion Intracoronary administration of prostaglandin E 1 injection prior to balloon dilation can significantly improve the myocardial microcir-culation perfusion,and can decrease MACE in patients with NSTEMI who underwent early interventional treatment .

Objective To study the correlation between aldosterone/renin ratio (ARR) and heart rate variability (HRV),QT interval in patients with essential hypertension.Methods A total of 179 people were divided into two groups according to median number of ARR,and 24 h Holter,24 h ambulatory blood pressure,ECG,serum potassium,serum sodium were monitored,then HRV and QT interval index were compared between the two groups.Results There were significant differences between the two groups in SDNN,SDNN index,SDANN index,RMSSD,QTc,blood potassium,sodium (P ＜ 0.05),while gender,age,diabetes,smoking,BMI,average heart rate,heart rate standard deviation showed no significant difference.At the same time,correction factors showed that ARR was still negatively correlated with SDNN,SDNN Index,SDANN Index,RMSSD,serum potassium (r =-0.444,-0.677,-0.381,-0.623,-0.432,P ＜ 0.05),andwaspositivelycorrelated with QTc,serum sodium (r =0.391,0.379,P ＜ 0.05).Multivariate logistic regression analysis showed that SDNN,SDNN Index,SDANN Index were the independent factors related to ARR (P ＜0.05).Conclusion High aldosterone is closely related to heart rate variability reduction.

Objective To explore the clinical efficacy of prostaglandin E1 injected by coronary or peripheral venous in early stage (within 24 h of symptom onset) in treating patients with acute non-ST segment elevation myocardial infarction (NSTEMI) by percutaneous coronary intervention (PCI) and its influence on major adverse cardiac events (MACE).Methods A total of 136 patients with NSTEMI underwent PCI within 24 h were divided into intracoronary injection group,peripheral vein injection group and control group.All the patients were followed up for 9 months,no reflow or slow blood flow,the incidence of angina pectoris,heart failure,and target vessel revascularization,recurrent myocardial infarction and cardiac death and major cardiac adverse events during hospitalization were compared between three groups.The changes of left ventricular end diastolic diameter (LVDd),left ventricular ejection fraction (LVEF) and other indicators were compared.Results After PCI,the corrected TIMI frame count (CTFC) and TIMI myocardial perfusion grade (TMP) were significantly better in intracoronary injection group than peripheral vein injection group and control group (P ＜ 0.05).All patients were followed up for 9 months,LVDd in intracoronary injection group was significantly lower than those in peripheral vein injection group and control group (P ＜ 0.05).LVEF in intracoronary injection group was significantly higher than that in peripheral vein injection group and control group (P ＜ 0.05).The incidence rate of MACE in intracoronary injection group was significantly less than that in peripheral vein injection group and control group (P ＜ 0.05).There was no significantly difference between the peripheral vein injection group and control group (P ＞ 0.05).Conclusion For NSTEMI patients with early PCI,intracoronary injection and peripheral intravenous injection of prostaglandin E1 can get a better myocardial microcirculation reperfusion during operation,and intracoronary injection can significantly reduce the incidence of adverse cardiac events.

Objective To study the correlation between aldosterone/renin ratio (ARR) and heart rate variability (HRV),QT interval in patients with essential hypertension.Methods A total of 179 people were divided into two groups according to median number of ARR,and 24 h Holter,24 h ambulatory blood pressure,ECG,serum potassium,serum sodium were monitored,then HRV and QT interval index were compared between the two groups.Results There were significant differences between the two groups in SDNN,SDNN index,SDANN index,RMSSD,QTc,blood potassium,sodium (P ＜ 0.05),while gender,age,diabetes,smoking,BMI,average heart rate,heart rate standard deviation showed no significant difference.At the same time,correction factors showed that ARR was still negatively correlated with SDNN,SDNN Index,SDANN Index,RMSSD,serum potassium (r =-0.444,-0.677,-0.381,-0.623,-0.432,P ＜ 0.05),andwaspositivelycorrelated with QTc,serum sodium (r =0.391,0.379,P ＜ 0.05).Multivariate logistic regression analysis showed that SDNN,SDNN Index,SDANN Index were the independent factors related to ARR (P ＜0.05).Conclusion High aldosterone is closely related to heart rate variability reduction.

Objective To explore the clinical efficacy of prostaglandin E1 injected by coronary or peripheral venous in early stage (within 24 h of symptom onset) in treating patients with acute non-ST segment elevation myocardial infarction (NSTEMI) by percutaneous coronary intervention (PCI) and its influence on major adverse cardiac events (MACE).Methods A total of 136 patients with NSTEMI underwent PCI within 24 h were divided into intracoronary injection group,peripheral vein injection group and control group.All the patients were followed up for 9 months,no reflow or slow blood flow,the incidence of angina pectoris,heart failure,and target vessel revascularization,recurrent myocardial infarction and cardiac death and major cardiac adverse events during hospitalization were compared between three groups.The changes of left ventricular end diastolic diameter (LVDd),left ventricular ejection fraction (LVEF) and other indicators were compared.Results After PCI,the corrected TIMI frame count (CTFC) and TIMI myocardial perfusion grade (TMP) were significantly better in intracoronary injection group than peripheral vein injection group and control group (P ＜ 0.05).All patients were followed up for 9 months,LVDd in intracoronary injection group was significantly lower than those in peripheral vein injection group and control group (P ＜ 0.05).LVEF in intracoronary injection group was significantly higher than that in peripheral vein injection group and control group (P ＜ 0.05).The incidence rate of MACE in intracoronary injection group was significantly less than that in peripheral vein injection group and control group (P ＜ 0.05).There was no significantly difference between the peripheral vein injection group and control group (P ＞ 0.05).Conclusion For NSTEMI patients with early PCI,intracoronary injection and peripheral intravenous injection of prostaglandin E1 can get a better myocardial microcirculation reperfusion during operation,and intracoronary injection can significantly reduce the incidence of adverse cardiac events.

Objective To evaluate PICCO (pulse indicator continuous cardiac output) to predict fluid responsiveness in patients with acute lung injury secondary to septic shock.Methods We conducted a prospective study on 42 patients with acute lung injury secondary to septic shock.global end-diastolic volume index (GEDVI),pulse pressure variation (PPV),stroke volume variation (SVV),central vein pressure (CVP) and other haemodynamic data were recorded before and after fluid administration of 500 mL of 6％ hydroxyethyl starch.Responders were defined as patients with an increase in stroke volume index of at least 15％ after fluid loading.Performance of variables was analyzed using receiver operator characteristics analysis.Results GEDVI and PPV,but not SVV and CVP,were able to predict fluid responsiveness in patients with acute lung injury secondary to septic shock 1 hrs after admission to intensive care unit (ICU).The best area under the ROC curve (AUC) was found for GEDVI (AUC 0.802,P ＜0.01) and PPV (AUC 0.752,P ＜0.01) ; the optimal cut-off of GEDVI and PPV were 643.5 mL/m2 and 13.5％,respectively.At this cut point,the sensitivity was 90.9％,the specificity was 91.9％,however,only GEDVI was able to predict fluid responsiveness in patients with acute lung injury secondary to septic shock 6hrs afteradmission to ICU.The best area under the ROC curve (AUC) was found for GEDVI (AUC 0.788,P ＜ 0.01).the GEDVI ＜ 559 mL/m2 during loading were found to predict volume responsiveness with a sensitivity of 100％,specificity of 62.5％.Conclusions GEDVI and PPV predict fluid responsiveness in patients with acute lung injury secondary to septic shock in the early hours.

Objective To summarize the clinical features,treatment and follow-up of patients with severe coronary artery spasm.Methods Twenty-one patients with confirmed coronary artery spasm were selected.The study reviewed the patients' general conditions including age,gender,complication,smoking and drug situations.The clinical features,electrocardiogram and coronary angiography data were analyzed.Their diagnosis,treatment and prognosis were evaluated.Results Male (86％,18/21) had higher incidence in severe coronary artery spasm.Smoking (62％,13/21) was a major risk factor.Coronary artery spasm often happened on the base of a fixed narrow (57％,12/21),and the clinical process was treacherous.Coronary angiography was very important for early diagnosis.Calcium antagonist was the core of the treatments and should be sustained at full dose.Interventional therapy was not efficacious.Although patients in acute phase had higher risk,long-term prognosis was good.Conclusions Coronary artery spasm is a common problem,but it is often overlooked.Timely diagnosis is the key to prevent fatal events.Calcium antagonist is the core of the coronary artery spasm drugs.The long-term prognosis of coronary artery spasm is good.