Objective To investigate the factors influencing international normalized ratio (INR)>3.0 in patients undergoing warfarin anticoagulation therapy after mechanical heart valve replacement. Methods A retrospective analysis was performed on the clinical data of patients who underwent mechanical heart valve replacement surgery and received warfarin anticoagulation therapy at West China Hospital of Sichuan University from January 1, 2011 to June 30, 2022. Based on the discharge INR values, patients were divided into two groups: an INR≤3.0 group and an INR>3.0 group. The factors associated with INR>3.0 at the time of discharge were analyzed. Results A total of 8901 patients were enrolled, including 3409 males and 5492 females, with a median age of 49.3 (43.5, 55.6) years. The gender, body mass index (BMI), New York Heart Association (NYHA) cardiac function grading, INR, glutamic oxaloacetic transaminase, and preoperative prothrombin time (PT) were statistically different between the two groups (P<0.05). Multivariate logistic regression analysis revealed that lower BMI, preoperative PT>15 s, and mitral valve replacement were independent risk factors for INR>3.0 at discharge (P<0.05). Conclusion BMI, preoperative PT, and surgical site are factors influencing INR>3.0 at discharge in patients undergoing warfarin anticoagulation therapy after mechanical heart valve replacement. Special attention should be given to patients with lower BMI, longer preoperative PT, and mitral valve replacement to avoid excessive anticoagulation therapy.

Morita therapy has been bom for more than 100 years.Inpatient Morita therapy is highly oper-able and easy to master.It can improve many refractory neuroses through four-stage treatment.But more neuroses are treated in outpatient clinics,and Morita therapy cannot be used in hospitalized patients.Therefore,the formula-tion of expert opinions on outpatient operations is particularly important.This paper is based on domestic and for-eign references,and after many discussions by domestic Morita therapy experts,and then drew up the first version of the expert opinions on operation of outpatient Morita therapy.Meanwhile the operation rule of Morita therapy in three stages of outpatient treatment was formulated:in the etiological analysis stage,under the theoretical guidance of Morita therapy,analyze the pathogenic factors,to improve treatment compliance and reduce resistance;during the operating stage,guide patients to engage in constructive and meaningful actions,realizing the achievement of letting nature take its course principle;in the cultivating character and enriching life stage,pay attention to positive infor-mation,expanding the scope and content of actions,improving the ability to adapt to complex life,and preventing recurrence caused by insufficient abilities.It will lay a foundation for the promotion of Morita therapy in domestic outpatient clinics,so that more patients with neurosis and other psychological diseases could receive characteristic Morita therapy treatment in outpatient clinics.

Objective:To evaluate the mechanical performance of customized metal prosthesis with tibia stems of varying lengths for tibial bone defects reconstruction.Methods:Morphologically matched postoperative finite element models of bone defect revision were developed, with three gradients (15 mm, 30 mm, and 45 mm) according to the degree of bone defect and were reconstructed with 3D printed tantalum metal prosthesis using three tibial stem lengths (80 mm, 120 mm, and 150 mm), respectively. Conventional static and dynamic (walking gait) loading was performed to analyze the peak tibial stress distribution and accumulated sliding distance at the prosthetic interface, and to assess the effects of the three tibial stems of different lengths on the stability of the customized tibial defect restorations and the internal tibial stress state.Results:The peak accumulated sliding distance of the dynamically loaded morphologically matched restorations ranged from 17.94 to 21.31 mm with static loading, which were 68% to 84.3% higher than those of 10.26 to 11.69 mm with static loading. The peak tibial stresses in the dynamically loaded model were greater than those in the statically loaded model, with an increase of 28%-49.2%, including 132.94-143.88 MPa in the statically loaded model and 170.41-200.14 MPa in the dynamically loaded model. The overall accumulated sliding distance of the tibia prosthetic model gradually decreased from the tibial osteotomy surface, and the accumulated peak sliding distances ranged from 10.26 to 11.69 mm for static loading, and from 17.94 to 21.31 mm for dynamic loading. The bone tissue stresses in the anterolateral and medial-posterior tibia increased gradually from top to bottom, and the maximum stress value in each section was in the posterior medial tibia (the maximum value was 200.14 MPa). The highest bone tissue stress in the lateral tibia was affected by the tibial stem length, which resulted in a different location, and it was the area most affected by stress shielding (maximum value of 170.65 MPa).Conclusion:For stability assessment of morphologically matched tantalum customized prosthesis, physiological gait dynamic loading studies are more reliable than static loading; the choice of tibial stem length depends on a combination of accumulated peak sliding distances and tibial bone stress distribution factors.

ObjectiveThe mechanisms underlying therapeutic efficacies of Detumescence Analgesic Plaster was analyzed based on "effect-target" associations. MethodBased on CNKI and PubMed databases， the chemical components of Artemisia seed， bastard speedwell， and menthol in Detumescence Analgesic Plaster were collected. The capacity of transdermal absorption was predicted based on the Encyclopedia of Traditional Chinese Medicine （ETCM 2.0）. Golden Triangle of compounds with Accepted used for candidate target prediction based on the Integrative Pharmacology-based Research Platform of Traditional Chinese Medicine （TCMIP v2.0）according to the similarity of chemical structures. At the same time， the SoFDA data platform was employed to collect the symptoms related to the efficacy of Detumescence Analgesic Plaster and its related genes information. In addition， based on the interaction between the above-mentioned candidate targets and their efficacy-related genes， the "effect-target" interaction network of Detumescence Analgesic Plaster was constructed. The key targets by topological features calculation， and functional mining was carried out to explain the efficacy mechanism of Detumescence Analgesic Plaster. ResultA total of 165 candidate targets were obtained based on ETCM 2.0 and TCMIP v2.0 databases， and symptoms related to the efficacy of clearing heat， detumescence， and relieving pain， as well as 1 744 related genes were collected based on the SoFDA database. Network construction and analysis showed that the core effect targets of Detumescence Analgesic Plaster were mainly involved in regulating the "immune-inflammation" balance of the body and maintaining the homeostasis of material and energy metabolism， blood circulation， and nervous system functions， and they were closely related to the efficacy of this prescription in clearing heat， reducing detumescence， and relieving pain. Among them， the heat clearing group of Detumescence Analgesic Plaster had the functions of heat clearing， detoxifying， antibacteria， and anti-inflammation. The biological function of its key effect target group was related to correcting the imbalance of "immune-inflammation" induced by pathogens. The detumescence group of Detumescence Analgesic Plaster had the functions of reducing water and swelling and resolving hard lumps， and the biological function of its core effect target group was related to improving microcirculation disturbance. The pain relieving group of Detumescence Analgesic Plaster had the functions of removing stasis， promoting blood circulation， and relieving pain， and its core effect target group was related to correcting the nervous system and the disorder of material and energy metabolism. ConclusionThe heat clearing， swelling reducing， and pain relieving effects of Detumescence Analgesic Plaster may be closely related to its act on related candidate targets， so as to correct the imbalance of "nerve-immunity-vascular-axis"， regulate neuronal excitability and inflammatory response， and intervene in material and energy metabolism. The relevant research results lay a theoretical foundation for clarifying the advantages of Detumescence Analgesic Plaster and assisting its clinical precise positioning.

Background ¹³⁷Cs in atmospheric aerosol is the product of past nuclear weapon tests and nuclear accidents. When ¹³⁷Cs is released into the atmosphere, it will deposit in dry land and marine environment, causing pollution of soil surface, water, agricultural products, and animal byproducts, and affecting public health. Objective To identify the variation pattern of ¹³⁷Cs activity concentration in aerosol and its correlation with dust concentration in Beijing area from 2017 to 2020. Methods A total of 958 aerosol samples were collected from November 1, 2017 to June 30, 2020 in Beijing with a high volume air sampler at a sampling flow rate about 600 m³·h⁻¹ and a collection time for each sample about 24 h. The activity concentration of ¹³⁷Cs in the aerosol samples was determined with a low-background high-purity germanium γ spectrometer. The dust concentration was calculated using the difference in the mass of the aerosol filter before and after sampling. The detection rate of ¹³⁷Cs and dust concentration in different seasons were compared. Spearman rank correlation test was used to analyze the correlation between ¹³⁷Cs activity concentration and dust concentration. Results From 2017 to 2020, the ¹³⁷Cs activity concentrations of 33 from 958 aerosol samples in Beijing were above the minimum detectable activityconcentration, the overall detection rate of ¹³⁷Cs was 3.4%, and the activity concentration ranged from 1.86 to 45.53 μBq·m⁻³, with a median value of 4.85 μBq·m⁻³. The detection rate of ¹³⁷Cs was highest in spring, followed by autumn, and lowest in winter and summer (8.4%, 3.0%, 1.1%, and 0.5%, respectively). The dust concentration ranged from 0.03 to 1.55 mg·m⁻³, with an average value of 0.18 mg·m⁻³. There was a statistically significant difference in the dust concentrations in spring, summer, autumn, and winter (F=45.51, P<0.05), and the highest value was 0.24 mg·m⁻³ in spring (P<0.05). The ¹³⁷Cs activity concentration was positively correlated with the dust concentration (P<0.05). Conclusion The ¹³⁷Cs activity concentration in aerosol in Beijing from 2017 to 2020 fluctuates within the range of background level, and its activity concentration is highest in spring, followed autumn, and lowest in summer and winter.

Objective:To explore the clinical value of quantitative parameters on spectral CT in predicting the invasiveness of lung adenocarcinoma manifesting as ground-glass nodules (GGN).Methods:The clinical and imaging data of 129 patients with pathologically confirmed lung adenocarcinoma who were surgically resected in the First Affiliated Hospital of Zhengzhou University from March to October 2022 were retrospectively analyzed, including 45 males and 84 females, aged from 33 to 81. According to the pathological results, they were divided into the minimally invasive adenocarcinoma (MIA) group ( n=64) and the invasive adenocarcinoma (IAC) group ( n=65). All patients underwent enhanced spectral CT within two weeks before surgery. The iodine density map, Z-Effective (Z eff) map, and electron density (ED) map were reconstructed on the post-processing workstation, and the spectral parameters, including normalized iodine concentration (NIC), arterial enhancement fraction (AEF), Z eff, and ED were measured and calculated. Conventional CT features were analyzed, including maximum diameter, CT value, nodule types, margin, lobulation sign, spiculation sign, bubble sign, pleural retraction sign, abnormal vascular sign, and air bronchial sign. The clinical features, conventional CT characteristics and spectral CT parameters of two groups were compared using the independent sample t test, the Mann-Whitney U test, and the χ 2 test. Multivariate logistic regression analysis was used to evaluate the independent risk factors of lung adenocarcinoma invasiveness, and the model was constructed. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the performance of parameters and models in predicting the invasiveness of lung adenocarcinoma. Results:There were significant differences between the MIA group and IAC group in maximum diameter, CT value, nodule type, margin, spiculation sign, pleural retraction sign, air bronchial sign, venous phase NIC, AEF, venous phase Z eff, arterial phase ED, venous phase ED ( P<0.05). Multivariate logistic regression analysis showed that the maximum diameter (OR=1.183, 95%CI 1.062-1.318), CT value (OR=1.004, 95%CI 1.001-1.007), venous phase NIC (OR=1.185, 95%CI 1.083-1.298), AEF(OR=0.975, 95%CI 0.957-0.994), venous phase Z eff (OR=0.031, 95%CI 0.005-0.196) were independent influence factors for the invasiveness of lung adenocarcinoma. The conventional CT model was established with the maximum diameter and CT value, and the spectral CT model was established with venous phase NIC, AEF, and venous phase Z eff. The combined model was established with all the parameters above. Areas under the ROC curve of the conventional CT model, the spectral CT model, and the combined model for predicting the invasiveness of lung adenocarcinoma were 0.828, 0.854, and 0.902, respectively. Conclusion:The quantitative parameters of double-layer detector spectral CT can be used as an indicator to predict the invasiveness of lung adenocarcinoma manifesting as GGN, and AEF has the highest diagnostic efficacy. Spectral CT combined with conventional CT features can further improve the diagnostic efficiency.

Objective:To summarize the experience of the precise prevention and control strategy of novel coronavirus infection in the pediatric intensive care unit(PICU)during the epidemic of the Omicron variant.Methods:A retrospective analysis was performed on the strategies and management experience of precise prevention and control of novel coronavirus infection in PICU at Pediatric Hospital of Fudan University from March 1 to May 10, 2022.Results:According to the national and Shanghai novel coronavirus infection prevention and control standards, the PICU in our hospital, in accordance with the specialty characteristics of PICU, cooperated with the hospital′s department of infection and medical department to jointly construct a precise ward management strategy for the outbreak of the omicron mutants infection.Precise prevention and control management strategies were formulated from four aspects: the admission process of critically ill children, the division of PICU ward areas and nosocomial infection protection, the reception management system for children′s family members, and the " bubble management" system for PICU staff, and run them for 3 months.During the epidemic, there was no nosocomial infection of novel coronavirus infection in children or medical staff.During the period, a total of 140 critically ill children were admitted, including 87 cases transferred from the general ward in the hospital, 48 cases from the emergency department(non-febrile, 3 cases transferred by the transfer team), four cases from fever clinic, and one case from control ward.Four of the critically ill children had no emergency nucleic acid test report when they were admitted to the PICU.Among the 140 critically ill children, 54 patients received mechanical ventilation, 18 patients received blood purification, and two patients were monitored after liver transplantation.Seventy-eight (55.7%) children had underlying diseases.Conclusion:During the current round of novel coronavirus epidemic in Shanghai, PICU in our hospital formulated the admission and ward management procedures for critically ill children, which ensured the prevention and control of nosocomial infection of novel coronavirus, and at the same time ensured the treatment of critically ill children to the greatest extent.

Objective:To monitor and analyze the activity concentrations of 7Be and 210Pb in atmospheric aerosol in Beijing from 2017 to 2020. Methods:Totally 1 074 atmospheric aerosol samples were collected by high flow air sampler (SnowWhite) including 275 in spring, 266 in summer, 262 in autumn and 271 in winter and subjected to analysis by low background high-purity germanium gamma-ray spectrometery (ORTEC) to determine the activity concentrations of 7Be and 210Pb. Results:The activity concentrations of 7Be in atmospheric aerosol were from 0.56 to 14.84 mBq/m 3, with an avearage of 6.84 mBq/m 3, and from 0.01 to 9.37 mBq/m 3 for 210Pb, with an avearage 3.19 mBq/m 3. The differences in activity concentrations of 7Be and 210Pb in atmospheric aerosol among differernt seasons were statistically significant ( F=32.66, 93.93, P<0.05). Activity concentration of 7Be was highest in spring, followed by autumn, and lowest in summer and winter. Activity concentration of 210Pb ranged from winter, autumn, spring to summer in descending order. Conclusions:The activity concentrations of 7Be and 210Pb in atmospheric aerosol in Beijing from 2017 to 2020 fluctated within the range of normal level.

Objective:To investigate the expression and ratio of CD4 +CD25 +Foxp3 +regulatory T cells (Tregs) to helper T cells 17 (Th17) in the peripheral blood of children with B-cell acute lymphoblastic leukemia (B-ALL). Method:54 children with newly diagnosed B-ALL in Children′s Hospital Capital Institute of Pediatrics from February 2017 to October 2019 were selected as the research subjects, with a median age of 4.9 (3.1 to 7.4) years. These children were divided into a pre-treatment group and a post-treatment group. According to the disease outcome after treatment, they were further divided into a complete remission group (45 cases), and a relapse/refractory group (9 cases). 20 healthy children were selected as the control group. Flow cytometry (FCM) was used to detect the proportions of CD4 +CD25 +Foxp3 +Treg cells and Th17 cells. The ratio of Treg/Th17 cells was calculated. Result:Before treatment, the proportion of Treg cells in the relapse/refractory group and the complete remission group (respectively 6.11±0.48, 6.20±1.16) were higher than those in the control group (4.89±1.46) (P<0.05), and the ratio of Treg/Th17 cells in peripheral blood of children with B-ALL in relapse/refractory stage and complete remission stage (respectively 8.34±2.14, 5.91±1.92) were higher than those in the control group (3.55±1.68) (P<0.05); The ratio of Treg/Th17 cells in the relapsed/refractory group was higher than that in the complete remission group (P<0.05). After treatment, the proportion of Treg cells and ratio of Treg/Th17 cells in peripheral blood of children with B-ALL in relapse/refractory stage (respectively 6.09±0.80, 7.37±1.19) were higher than those in complete remission stage (respectively 5.25±0.87, 4.22±1.50) and control group (respectively 4.89±1.46, 3.55±1.68) (P<0.05). Compared with that before treatment, children in complete remission stage after treatment had lower proportions of Treg cells and the ratio of Treg/Th17 cells, as well as higher proportions of Th17 cells in the peripheral blood (P<0.05). There were no significant differences in the proportions of Treg cells and Treg/Th17 ratio between the pre-treatment group and the post-treatment group of children in relapse/refractory stage (P>0.05).Conclusion:In peripheral blood of children with B-ALL, there is a ratio change of Treg/Th17 cells caused by the increase of CD4 +CD25 +Foxp3 +Treg cells and the decrease of Th17 cells, which tends to be normal with the remission of the disease. Regular detection of Treg and Th17 cells helps to monitor the immune status and provide prognosis of children with B-ALL, and may provide a basis for the immunotherapy of B-ALL.

Objective:To collect and summarize evidence for improvement of readiness for hospital discharge of patients after PCI.Methods:BMJ Best Practice, UpToDate, Joanna Briggs Institute (JBI) evidence-based health care center database, National Institutes of Health and Clinical Optimization Guidelines Network, Scotland Inter Hospital Guidelines Network, Ontario Registered Nurses Association, International Guidelines Collaboration Network, American Heart Association website, European Heart Association website, Cochrane The literatures about improving the discharge readiness of patients after PCI in library, PubMed, CINAHL, CNKI and Wanfang databases included guidelines, system reviews, best practice information books, evidence summary, expert consensus, and randomized controlled studies. The retrieval time limit was from the establishment of the database to October 2019. Four researchers evaluated the quality of the literature, and extracted evidence from the literature that met the quality standards.Results:A total of 5 articles were included, including 2 guidelines, 2 expert consensus, 1 systematic reviews,3 randomized controlled trials. The best evidence included evaluation of discharge readiness, education of knowledge and skills to patients and caregivers, improvement of self-efficacy of patients and caregivers in disease management, and assurance of social support and health resources for patients and caregivers after discharge.Conclusion:It is suggested that in clinical practice, medical personnel should use the discharge readiness assessment tool to comprehensively evaluate patients after PCI, carry out programmed health education, improve patients' self-efficacy in disease management, and ensure social and medical support for patients and caregivers after discharge as much as possible.