Objective To investigate the effect of osimertinib combined with aspirin on the survival pe-riod of the advanced lung adenocarcinoma patients with epidermal growth factor receptor(EGFR)mutation.Methods Sixty lung adenocarcinoma patients with EGFR mutation in advanced non-small cell lung cancer(NSCLC)first diagnosed in Banan District Second People's Hospital of from August 2020 to October 2021 were selected as the study subjects and divided into the observation group and control group by the random number table method,30 cases in each group.The observation group adopted osimertinib combined with aspi-rin,and the control used osimertinib merely.The overall response rate(ORR),disease control rate(DCR),progression-free survival(PFS),overall survival(OS)and the adverse reactions occurrence were compared between the two groups.Results ORR and DCR after 3,6,12 months medication in the observation group were higher than those in the control group,but the differences were not statistically significant(P＞0.05).Compared with the control group,PFS and OS in the observation group were longer,and the differences were statistically significant[14.9(11.8,17.2)m vs.10.5(8.9,12.5)m;24.1(19.5,27.4)m vs.18.1(16.1,21.1)m,P＜0.05].In addition,PFS and OS in male and female patients with brain metastasis,EGER19 and 21 ex-on mutation in the observation group were longer than those in the control group,and the differences were statistically significant(P＜0.05).There was no statistically significant difference in overall and≥Ⅲ degree adverse reactions between the two groups(P＞0.05).Conclusion Osimertinib combined with aspirin could prolong PFS and OS of the advanced lung adenocarcinoma patients with EGFR mutation without increasing the risk of adverse reactions.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective To apply the personal digital assistant(PDA)scanning positioning two-dimensional code recognition technology in writing nursing records in patients with acute ischemic stroke treated with intravenous thrombolysis,and to evaluate the application effect.Methods The quasi-experimental design was conducted.The nursing records routinely written by emergency nurses using mobile nursing cart for 58 patients with acute ischemic stroke treated with intravenous thrombolysis admitted to department of emergency of Zhejiang Hospital from September 2021 to February 2022 was taken as the control group,and the nursing records written by emergency nurses using PDA for 51 patients with acute ischemic stroke treated with intravenous thrombolysis from March 2022 to August 2022 through scanning positioning two-dimensional code recognition technology was used as the observation group.The differences of time required for writing nursing records and the incidence of errors in nursing records were compared between the two groups,and the satisfaction of emergency nurses in the observation group using PDA scanning positioning two-dimensional code to write nursing records was evaluated.Results The time required for writing nursing records in the observation group was significantly shorter than that in the control group[seconds:137(109,192)vs.480(436,604),P<0.05],the incidence of inadequate records of the first course of specialist assessment[3.92％(2/51)vs.20.69％(12/58)],and the incidence of insufficiently detailed records of thrombolytic observations[7.84％(4/51)vs.43.10％(25/58)]were significantly lower than the control group(both P<0.05).The differences between the observation group and the control group were not statistically significant when comparing the incidence of irregularities in thrombolytic drug pump records[0％(0/51)vs.1.72％(1/58)],incidence of irregularities in muscle strength assessment records[1.96％(1/51)vs.5.17％(3/58)],and the occurrence of typos in the nursing records[0％(0/51)vs.3.44％(2/58),all P>0.05].In addition,the overall satisfaction of emergency nurses in the observation group using PDA scanning positioning two-dimensional code to write nursing records was 92.94％(2 844/3 060),and the average score of each item in the synchronous nursing record of the positioning two-dimensional code was>4.5 points,among which the satisfaction score of ease of operation was(4.78±0.50),the acceptance of emergency nurses using PDA scanning positioning two-dimensional code to write nursing records was good,and could meet the clinical needs.Conclusion Using PDA scanning positioning two-dimensional code assists the writing of nursing records in the stroke treatment process,shortens the time required for writing nursing records of emergency nurses,reduces the incidence of errors in nursing records,and improves the quality of nursing records;At the same time,for emergency nurses,it can effectively reduce the burden of writing nursing records and improve their satisfaction with nursing records,which is worthy of clinical promotion.

【Objective】 To explore the surgical characteristics and clinical efficacy of percutaneous endoscopic visualization trephine for thoracic spinal stenosis. 【Methods】 We made a retrospective analysis of 37 patients with single-segment thoracic spinal stenosis treated with percutaneous endoscopic visualization trephine from January 2019 to June 2020. Among them， there were 14 males and 23 females； their age ranged from 31 to 82 years old， with an average of （57.6±11.8） years old. Their posture， length of hospital stay， length of operation and blood loss were recorded. The visual analogue scale （VAS）， Oswestry disability index （ODI） and the modified Japanese Orthopaedic Association （JOA） score were used to evaluate the preoperative and final conditions of patients and calculate the improvement rate. 【Results】 The operation was successfully completed in all the patients， and no patients developed epidural hematoma， incision infection or postoperative paralysis. Among the 37 patients， 24 ones with ossification of ligamentum flavum （OLF） were in the prone position， and 13 patients had lateral surgery. Among them， thoracic disc herniation （TDH） occurred in 3 cases， OPLL in 5 cases and OLF+OPLL in 5 cases. The hospital stay was （7.2±1.6） days， the operation time was （96.5±20.0） min， and the blood loss was （41.9±10.8） mL. VAS score decreased from （7.0±0.9） to （1.9±0.8）； ODI improved from （41.7±2.1） to （16.1±1.7）； and JOA score increased from （5.8±1.4） to （8.6±1.4）. The preoperative and postoperative differences were statistically significant （P<0.05）. 【Conclusion】 Percutaneous endoscopic visualization of thoracic spinal stenosis is treated by choosing different positions according to the type of compression. The spinal canal is fully decompressed. The surgical method is safe and minimally invasive， and the postoperative effect is satisfactory.

OBJECTIVE:To observe the efficacy and safety of Sanjiao fuzheng mixture combined with concurrent chemoradiotherapy of paclitaxel and nedaplatin in the treatment of local advanced non-small cell lung cancer (NSCLC). METHODS:A total of 68 patients with local advanced NSCLC selected from our hospital during Jan. 2015 to Jan. 2017 were divided into control group and observation group according to random number table,with 34 cases in each group. Control group was given Paclitaxel injection 135 mg/m2 intravenously,d1+Nedaplatin for injection 75 mg/m2 intravenously,d3,21 d as a treatment course,for 2 courses;routine fractionated intensity modulated radiation therapy,2 Gy each time,5 times a week,60-70 Gy in total;given 2 cycles of primary chemotherapy continuously after radiotherapy. Observation group was additionally given Sanjiao fuzheng mixture 250 mL/d,divided into 3 times,till the end of treatment,on the basis of control group. Clinical efficacies were observed in 2 groups. The levels of nutritional indexes (BMI,PAB,ALB,Hb) and tumor markers (SCC-Ag,CEA,TK1, CYFRA21-10) before and after treatment were observed. The occurrence of ADR were recorded. RESULTS:There was no statistical significance in the total effective rate between 2 groups (observation group 82.35％ vs. control group 73.53％)(P>0.05). After treatment,the levels of BMI,PAB,ALB and Hb in 2 groups were significantly lower than before treatment,but the observation group was significantly higher than the control group. The levels of SCC-Ag,CEA,TK1 and CYFRA21-1 in 2 groups were significantly lower than before treatment,and the observation group was significantly lower than the control group,with statistical significance (P<0.05). The incidence of Ⅲ-Ⅳ degree aleucocytosis,Ⅰ-Ⅱ degree hemoglobin reduction and thrombocytopenia in observation group were significantly lower than control group, with statistical significance (P<0.05). CONCLUSIONS:The efficacy of Sanjiao fuzheng mixture combined with concurrent chemoradiotherapy of paclitaxel and nedaplatin is similar to that of concurrent chemoradiotherapy of paclitaxel and nedaplatin for localadvanced NSCLC,which can improve nutritional status significantly,and reduce the incidence of ADR.

Objective To investigate the correlation between the changes of fat and microcirculation in vertebral marrow and the intervertebral disc degeneration. Methods This was a cross-sectional cohort study. Based on the inclusion and exclusion criteria, all 82 patients were recruited, while 246 lumbar intervertebral disc (L2/3-L4/5) were studied. Each disc was assessed by using Pfirrmann grades. The chemical shift imaging (CSI) was performed to calculate the signal intensity ratio (SIR) of the corresponding upper and under vertebral marrow. And intravoxel incoherent motion (IVIM) imaging was performed to obtain the IVIM parameters of slow apparent diffusion coefficient (Dslow), fast apparent diffusion coefficient (Dfast) and perfusion fraction (f). At the same time, b values of 0, 600 s/mm2 were used to obtain the ADC value of each disc. The ADC values of disc, the SIR values and IVIM parameters of the upper and under vertebral marrow between the different segments and different Pfirrmann grading groups were compared using one-way ANOVA or non-parametric test. The correlation of the Pfirrmann grading and ADC value of disc with the parameters of the vertebral marrow were analyzed, respectively. Results Only the f value of the upper and under vertebral marrow showed significant difference between the different segments groups of L2/3 to L4/5 discs (F=5.351 and 8.482, both P<0.05). The ADC values of discs, the SIR value of the upper vertebral marrow and the Dslow value of the under vertebral marrow had significant difference between the different Pfirrmann grading groups (all P<0.05). The Pfirrmann grading was negatively correlated with the disc ADC values (r=-0.651, P<0.01), and was mildly and positively correlated with the SIR values of the upper and under vertebral marrow (r=0.238 and 0.266, both P<0.01). The disc ADC values had a slightly negative correlation with the SIR value of the upper and under vertebral marrow(r=-0.230 and-0.247, both P<0.01). Conclusions The changes of the SIR value and all IVIM parameters of the vertebral bone marrow were not very obvious with the increasing of the grading of the intervertebral disc degeneration, which may be not an effective supplement for the grading of intervertebral disc degeneration.

Objective To investigate the correlation between the changes of fat and microcirculation in vertebral marrow and the intervertebral disc degeneration. Methods This was a cross-sectional cohort study. Based on the inclusion and exclusion criteria, all 82 patients were recruited, while 246 lumbar intervertebral disc (L2/3-L4/5) were studied. Each disc was assessed by using Pfirrmann grades. The chemical shift imaging (CSI) was performed to calculate the signal intensity ratio (SIR) of the corresponding upper and under vertebral marrow. And intravoxel incoherent motion (IVIM) imaging was performed to obtain the IVIM parameters of slow apparent diffusion coefficient (Dslow), fast apparent diffusion coefficient (Dfast) and perfusion fraction (f). At the same time, b values of 0, 600 s/mm2 were used to obtain the ADC value of each disc. The ADC values of disc, the SIR values and IVIM parameters of the upper and under vertebral marrow between the different segments and different Pfirrmann grading groups were compared using one-way ANOVA or non-parametric test. The correlation of the Pfirrmann grading and ADC value of disc with the parameters of the vertebral marrow were analyzed, respectively. Results Only the f value of the upper and under vertebral marrow showed significant difference between the different segments groups of L2/3 to L4/5 discs (F=5.351 and 8.482, both P<0.05). The ADC values of discs, the SIR value of the upper vertebral marrow and the Dslow value of the under vertebral marrow had significant difference between the different Pfirrmann grading groups (all P<0.05). The Pfirrmann grading was negatively correlated with the disc ADC values (r=-0.651, P<0.01), and was mildly and positively correlated with the SIR values of the upper and under vertebral marrow (r=0.238 and 0.266, both P<0.01). The disc ADC values had a slightly negative correlation with the SIR value of the upper and under vertebral marrow(r=-0.230 and-0.247, both P<0.01). Conclusions The changes of the SIR value and all IVIM parameters of the vertebral bone marrow were not very obvious with the increasing of the grading of the intervertebral disc degeneration, which may be not an effective supplement for the grading of intervertebral disc degeneration.

OBJECTIVE:To investigate the effectiveness and safety of 2 kinds of proton pump inhibitors in the treatment of coronary heart disease (CHD).METHODS:In retrospective study,a total of 92 patients with CHD were selected from our hospital during Jun.2015-May 2016,and then divided into rabeprazole group (30 cases),esomeprazole group (32 cases) and control group (30 cases) according to therapy plan.Control group received basic therapy plan.Rabeprazole group and esomeprazole group were additionally given sodium rabeprazole enteric-coated tablets and Esomeprazole magnesium enteric-coated tablets 20 mg,po,bid,on the basis of control group.A treatment course lasted for 30 d,and both medication groups received 2 courses of treatment.Blood uric acid levels,urine pH values,blood ion levels (Na+,K+,Ca2+,Cl-) were detected before and after treatment.The occurrence of cardiovascular adverse events,coronary adverse events and other adverse events were observed in 2 groups during treatment.RESULTS:Before treatment,there was no statistical significance in above indexes among 3 groups (P＞0.05).After treatment,the levels of blood uric acid,K+ (except for control group),Ca2+ and Cl-were decreased significantly,while urine pH values and blood Na+ levels were increased significantly;the levels of blood uric acid and Ca2+ in rabeprazole group and esomeprazole group were significantly lower than control group,while urine pH value and blood Na+ level were significantly higher than control group,with statistical significance (P＜0.05).After treatment,the level of blood uric acid in rabeprazole group was significantly lower than esomeprazole group,with statistical significance (P＜0.05).But there was no statistical significance in urine pH values or ion levels between 2 groups (P＞0.05).Compared with control group,the incidence of acute thrombosis in rabeprazole group and esomeprazole group were decreased significantly,and the incidence of joint swelling and pain were increased significantly,with statistical significance (P＜0.05).There was no statistical significance in the incidence of coronary adverse events among 3 groups (P＞0.05).CONCLUSIONS:Rabeprazole and esomeprazole can significantly reduce the level of blood uric acid and the incidence of acute thrombosis,increase urine pH value and blood Na+ levels,decrease blood Ca2+ level and increase the risk of fracture or hypocalcemia in patients with CHD.Therefore,the dosage regimen should be adjusted according to the specific situation of patients in clinical practice

Background Recent studies have demonstrated that glaucoma progression had great relationship with corneal biomechanical properties.However,there are not enough studies about corneal biomechanical properties in different types of glaucoma.Objective This study was to evaluate the corneal biomechanical properties in chronic primary angle-closure glaucoma (CPACG) and primary open angle glaucoma (POAG).Methods Prospective observational study was adopted.Sixty-eight cases (68 eyes) with CPACG and 69 POAG patients (69 eyes) from Zhongshan Ophthalmic Center were investigated by a novel technique named Corvis-ST which can measure corneal deformation.The Cronbach's αt coefficient and intraclass correlation coefficient (ICC) were used to evaluate the repeatability of the parameters from Corvis-ST.The differences of corneal biomechanical properties between POAG and CPACG were evaluated by independent-samples t test.Multiple regression analysis was used to assess the association between parameters of deformation response and clinical factors.This study protocol was approved by Ethic Committee of Zhongshan Ophthalmic Center and complied with Helsinki Declaration.Written informed consent was obtained from each patient prior to any medical examination.Results There were no statistic differences about age,sex and intraocular pressure (IOP) between CPACG and POAG patients (all at P＞0.05).However,differences existed in the number of anti-glaucoma medications (t =-2.388,P =0.020).Measurements of central corneal thickness (CCT),deformation amplitude (DA),and peak distance (PD) demonstrated excellent repeatability (ICC≥ 0.8).There were no statistic differences about CCT,first applanation time/length/velocity (A1 T,A1 L,A1V),second applanation time/length/velocity (A2T,A2L,A2V),DA between CPACG and POAG patients (all at P＞ 0.05).The highest concavity time was shorter (t =2.920,P =0.005),PD was bigger (t =-2.453,P =0.017),and central curvature radius (CCR) was smaller (t =1.997,P =0.050) in POAG than those in the CPACG patients.DA,A1V,A2T and PD were negatively associated with IOP (r =-0.709,-0.531,-0.645,-0.554;all at P＜0.001).However,A1T and A2V were positively associated with IOP (r=0.744,0.546;both at P＜0.001).And CCR was positively associated with CCT (r =0.181,P =0.039).Conclusions It is useable to evaluate corneal biomechanical properties of glaucoma by Corvis ST.Under the same level of IOP,the corneal concavity of POAG is easier than that of CPACG,which indicates that cornea in POAG patients is more deformable.

PurposeTo investigate the physical characteristics of the lumbar bone marrow fat content by analyzing the correlation of the lumbar bone marrow fat content with age, gender, body mass index (BMI) and waist circumference. It may be helpful to deepen the understanding the occurrence regularity of osteoporosis. Materials and Methods A total of 144 subjects were recruited including both healthy volunteers and the patients with chronic low back pain. The height, weight and waist circumference were measured, and the body mass index was calculated. All the subjects took spectroscopy sequence at the third lumber vertebra with single-voxel point resolved spectroscopy (PRESS) method. Lipid (1.3 ppm) to water (4.67 ppm) ratio (LWR) and lipid fractions (FF%) were measured. LWR and FF% of L3 were compared among the patients with different gender, age, BMI and waist circumference. The correlation of LWR and FF% of L3 and age were analyzed.Results The LWR and FF% of L3 showed no signiifcant difference between the male and female (t=-0.267 and-0.993,P>0.05). There was statistical difference of LWR and FF% among the different age groups (F=3.723 and 5.478,P<0.05). LWR and FF% of female in 61-70 year-old group showed signiifcant higher than that in 20-30, 31-40, 41-50 and 51-60 year-old group (P<0.05). FF% of L3 in 20-30 year-old female group showed signiifcant lower than that in >70 year-old group (P<0.05). LWR of L3 for both male and female in 60-70 year-old group also showed signiifcant higher than that in 20-30, 31-40, 41-50 and 51-60 year-old group (P<0.05). FF% for both male and female in 20-30 year-old group showed signiifcant lower than that in 31-40, 41-50, 51-60, 61-70 and>70 year-old group (P<0.05). FF% of 61-70 year-old group was signiifcant different from that in 31-40, 41-50, 51-60 year-old group (P<0.05). The LWR and FF% of L3 showed no signiifcant difference between the different BMI groups and waist circumference groups (P>0.05). Age was positive correlated with FF% of L3 (r=0.321,P<0.05).Conclusion The lumbar bone marrow fat content is correlated with age, but is not correlated with gender, BMI and waist circumference.