Objective:To compare postural reduction combined with percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fractures (OVCFs).Methods:From January 2019 to January 2020,68 patients with OVCFs who met the inclusion and exclusion criteria in the Second Hospital of Tangshan Hebei Province were included in the observation study. A prospective randomized controlled study was used. The matched groups were divided into PVP combined group (adjust the overextension of the operating table by 20°-30°, if the posture reduction fails, pry the puncture needle on both sides in reverse according to the compression degree of the end plate before operation, and inject bone cement) and PKP group (do not adjust the operating table before operation, insert a balloon and expand on both sides after operation, and inject bone cement), with 34 cases in each group. The Cobb angle of the injured vertebrae was measured by taking the anterior and lateral X-ray film of the patient's lumbar spine before operation. The degree of pain and low back function were evaluated by visual analogue scale (VAS) and Oswetry disability index (ODI). The operation time and fluoroscopy times were recorded during the operation. On the second day after operation, the anterior and lateral X-ray of lumbar spine were taken to measure the Cobb angle of injured vertebrae. All patients were underwent computed tomography (CT) check the bone cement for leakage, record the VAS score, and record the ODI 3 months after operation to evaluate the patient's function. Follow up at the end of 12 months after operation to count the treatment cost and re-fracture of the patient. The data analysis and measurement data were compared by independent sample t-test between the two groups, paired sample t-test was used for intra-group comparison before and after operation. χ 2 test was used for counting data comparison between two groups. Results:All patients were followed up for 12 months. The operation time ((42.7±5.9) min), fluoroscopy times ((20.0±3.6) times) and treatment cost ((19 153±601) yuan) in the PVP combined group were better than those in the PKP Group ((67.4±7.3) min, (30.1±5.9) times, (27 496±669) yuan), and the difference was statistically significant ( t values were 15.39, 8.46, 54.12; all P<0.001). Cobb angle: Postoperative Cobb angle of injured vertebrae in the two groups (PVP combined group (10.7±4.5)°) and (PKP group (13.4±3.8)°) decreased compared with preoperative (PVP combined group (17.0±5.1)°) and (PKP group (16.7±5.1)°) ( t values were 10.61, 5.61; all P=0.001), and PVP combined group recovered better than PKP group, with statistically significant difference ( t=2.70, P=0.009). VAS score: Postoperative (PVP combined group (3.9±1.5) points) and (PKP group (4.1±1.6) points) was lower than preoperative the scores of (PVP combined group (6.9±1.1) points) and (PKP group (7.1±0.9) points), and the difference was statistically significant ( t values were 8.63, 8.88; all P=0.001). There was no significant difference in VAS scores between the two groups ( t=0.48, P=0.630). ODI scores: The scores of (PVP combined group (0.315±0.068)) and (PKP group (0.319±0.077)) after operation were lower than preoperative (PVP combined group (0.574±0.066), (PKP group (0.553±0.075)), and the difference was statistically significant ( t values were 18.54, 14.16, all P=0.001). There was no significant difference in ODI between the two groups ( t=0.25, P=0.803). There was no statistical significance in the two groups of postoperative bone cement leakage (χ 2=0.22, P=0.642). In PVP combined group, 1 case was re-fractured due to trauma, and there was no re-fracture in PKP group. Conclusion:Postural reduction combined with percutaneous needle prying reduction of PVP and PKP can alleviate the pain, improve the postoperative function and restore kyphosis in patients with OVCFs. Postural reduction combined with needle prying reduction of PVP has more advantages in operation time, radiation injury to doctors and patients, treatment cost, and the effect of correcting deformity is more significant.

Objective:To explore the feasibility and advantages of planned initiation of extracorporeal membrane oxygenation(ECMO)prior to liver transplantation.Methods:From November 2017 to July 2021, clinical data were retrospectively reviewed for 3 liver transplantation recipients assisted by ECMO.There were such preoperative symptoms of right ventricular dysfunction as fatigue, chest tightness and palpitations.In the first case, right heart catheterization was not performed due to patient refusal; another two patients were screened by transthoracic Doppler echocardiography(TDE)and diagnosed through right heart catheterization as portopulmonary hypertension(POPH)and pulmonary hypertension.Results:Three recipients with pulmonary hypertension received catheterization in right femoral artery and vein.After freeing of diseased liver and before blocking inferior vena cava, V-A ECMO support was performed.The dose of heparin was adjusted according to activated clotting time(ACT)and perioperative vital signs remained stable.They were ventilated for 54, 12 and 62 hours and supported by ECMO for 27, 61 and 14 hours.All were smoothly discharged.During a mean follow-up period of 26(9-22)months, liver functions were normal.Conclusions:Patients with end-stage liver disease with pulmonary hypertension should undergo routine TDE examinations during waiting period before liver transplantation.Those with pulmonary hypertension should undergo further right heart catheterization to confirm the diagnosis and severity of the disease.Planned application of ECMO through multidisciplinary consultations can expand surgical indications for liver transplantation, maintain intraoperative hemodynamic stability and facilitate smooth liver transplantation and postoperative patient recovery.

Objective:To investigate the influencing factors for anastomotic biliary stric-ture after liver transplantation.Methods:The retrospective case-control study was conducted. The clinical data of 428 recipients who underwent allogeneic orthotopic liver transplantation in the First Hospital of Jilin University from September 2014 to August 2021 were collected. There were 324 males and 104 females, aged (52±10)years. Observation indicators: (1) surgical conditions of recipients; (2) occurrence of anastomotic biliary stricture after liver transplantation and its treat-ment; (3) analysis of influencing factors for anastomotic biliary stricture after liver transplantation. Follow-up was conducted using outpatient examination to detect occurrence of anastomotic biliary stricture and treatment up to August 30, 2021. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measure-ment data with skewed distribution were represented as M( Q1, Q3) or M(range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were represented as absolute numbers, and the chi-square test was used for comparison between groups. Logistic regression model was used for multivariate analysis. Results:(1) Surgical conditions of recipients: the operation time of 428 recipients was 465(420,520)minutes, the cold ischemia time was 368(320,450)minutes, and the volume of intraoperative blood loss was 2 500(1 500,4 000)mL. Of the 428 recipients, 142 cases were performed continuous biliary posterior wall anastomosis + interrup-ted anterior wall anastomosis by polygluconate sutures, 286 cases were anastomosed with polypro-pylene sutures, including 169 cases undergoing continuous biliary posterior wall anastomosis combined with interrupted anterior wall anastomosis, 73 cases undergoing completely interrupted biliary anterior and posterior wall anastomosis, and 44 cases undergoing completely continuous biliary anterior and posterior wall anastomosis. None of the 428 recipients had indwelling T tubes. (2) Occurrence of anastomotic biliary stricture after liver transplantation and its treatment:all the 428 recipients were followed up for 3 to 72 months, with a median follow-up time of 28 months. During the follow-up, 50 patients developed anastomotic biliary stricture, of which 41 patients were treated with endoscopic retrograde cholangiopancreatography, 8 patients were treated with percutaneous transhepatic cholangial drainage, and 1 patient was treated with surgery, showing no recurrence. (3)Analysis of influencing factors for anastomotic biliary stricture after liver transplanta-tion: results of univariate analysis showed that anastomosis method and donor liver cold ischemia time were related factors for postoperative anastomotic biliary stricture of recipients undergoing allogeneic orthotopic liver transplantation ( χ2=15.74, Z=-2.04, P<0.05). Results of multivariate analysis showed that completely interrupted biliary anterior and posterior wall anastomosis and donor liver cold ischemia time were independent influencing factors for postoperative anastomotic biliary stricture of recipients undergoing allogeneic orthotopic liver transplantation ( odds ratio=0.25, 1.00, 95% confidence interval as 0.08-0.85, 1.00-1.01, P<0.05). Conclusions:Suture type is not an influencing factor for postoperative anastomotic biliary stricture of recipients undergoing allogeneic orthotopic liver transplantation. Completely interrupted biliary anterior and posterior wall anastomosis and donor liver cold ischemia time were independent influencing factors.

Objective:Rapid assessment of the outcome after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) is an important clinical issue. In this study, an electrocardiogram (ECG) analysis method based on dynamic learning was proposed.Methods:A total of 203 patients with ACS after successful PCI were enrolled for prospective analysis at the Emergency Department of Qilu Hospital of Shandong University from April 2019 to December 2020. All patients were divided into group without ≥70% postoperative stenosis ( n=72) and group with ≥ 70% postoperative stenosis ( n=131) according to the presence of 70% or more stenosis after PCI. The clinical data of ACS patients were collected and analyzed by χ2 test, t-test, or Mann-Whitney test. ECGs were recorded before and 2 h after PCI, and were dynamically analyzed to generate cardiodynamicsgram (CDG) using dynamic learning. In the group without ≥ 70% postoperative stenosis, the model and CDG index for evaluating myocardial ischemia were obtained by training support vector machine (SVM) using 10 times 10-fold cross-validation. Results:There was no significant difference in clinical data between the two groups. The prediction accuracy and sensitivity of the support vector machine model for myocardial ischemia in group without≥70% postoperative stenosis were 73.61%, and 84.72% respectively. CDG transformed from disorderly to regular after PCI, and CDG index decreased significantly ( P<0.001): 90.28% (65) patients in group without≥70% postoperative stenosis, and 79.39% (104) patients in group with≥70% postoperative stenosis had lower CDG indexes than before PCI. Conclusions:In this study, CDG obtained by dynamic learning can intuitively and effectively evaluate the changes of myocardial ischemia before and after PCI, which is helpful to assist clinicians to formulate the next treatment plan.

Objective:To explore the feasibility and application value of three dimensional (3D) printing technology in creating models of abnormal fetal aortic arch and its branches.Methods:Eleven cases of abnormal fetuses confirmed fetal aortic arch and its branches anomalies from March 2019 to July 2020 in Renmin Hospital of Wuhan University were prospectively enrolled. All the fetuses underwent two dimensional(2D) echocardiography and spatio-temporal image correlation (STIC) technology examination. The 3D volume images of fetal heart were post-processed by Mimics software to create images of the great vessels and their branches in standard tessellation language format (STL) file. The STL file was output to the 3D printer and the 3D printing models of fetal great vessels and their branches were obtained. Compared with conventional ultrasound, the characteristics and application value of 3D printed models of abnormal fetal aortic arch and its branches were analyzed.Results:Eleven fetuses were successfully modeled and printed out large blood vessels and their branch models. The 3D printing model had its own advantages in displaying large blood vessels and their branch abnormalities. It could provide high quality imaging anatomical details and visualize great vessels origin, branch and position and can better display vascular ring spatial relations.Conclusions:It is feasible to use 3D printing technology to make the fetal aortic arch and its branch abnormal model. The 3D printing model can directly display its characteristic changes and provide a certain reference basis for accurately determining the type of vascular ring in the prenatal stage.

Objective To investigate the role of multi-disciplinary team (MDT) in the treatment of complex cholestatic liver injury after liver transplantation. Methods MDT consultation was conducted to clarify the causes and therapeutic strategies for one case of complex cholestatic liver injury after liver transplantation admitted to Liver Transplantation Center of the First Hospital of Jilin University on June 23, 2020. And the role of MDT in the treatment of complex cholestatic liver injury after liver transplantation was summarized. Results The patient presented with abnormal liver function after liver transplantation. The diagnosis of biliary stricture, rejection and biliary tract infection was confirmed successively. Endoscopic retrograde cholangiopancreatography (ERCP) stent internal and external double drainage, glucocorticoid shock and anti-infection therapy yielded low clinical efficacy. After MDT consultation, complex cholestatic liver injury after liver transplantation was confirmed. It was suggested to optimize the immunosuppressive regimen based on the exclusion of rejections by pathological examination, deliver targeted anti-infection interventions and prevent the potential risk of concomitant drug-induced liver injury. The patient was discharged after proper recovery. Conclusions The causes of complex cholestatic liver injury after liver transplantation are diverse, and the condition changes dynamically. MDT consultation are performed to deepen the understanding of this disease, strengthen the classification of diagnosis and treatment ideas and enhance the precision and efficacy of corresponding treatment.

Objective:To investigate the feasibility of three dimensional(3D) printing fetal heart from spatio-temporal image correlation (STIC) volume-rendered data.Methods:Eight fetuses with normal heart and 3 fetuses with confirmed cardiac anomalies identified by two-dimensional echocardiography from February to May 2019 in Renmin Hospital of Wuhan University were prospectively enrolled in this study. All the fetuses underwent two-dimensional (2D) echocardiography and STIC technology examination. The 3D volume images of fetal heart were post-processed by Mimics software to create images of the fetal heart in standard tessellation language format(STL). The STL file was output to the 3D printer and the 3D printing models of fetal heart and great vessels were obtained. In the process, the numerical values of each index of fetal hearts were measured from 3D digital model, 3D printing models and routine echocardiography images, respectively. The accuracy of 3D modeling was assessed by comparing the measured values of the model with the measured values of the source data.Results:In all the fetuses, STIC volume data of the fetal heart were successfully reprocessed and printed out, the anatomical structure and vascular course could be visually displayed. It showed no significant difference in all the heart size parameters between 3D digital model, 3D printing models and routine echocardiography images (all P>0.05). Moreover, the size parameters were concordant well between the two methods, all of the data points fell within the limits of agreement. Conclusions:The 3D printing of fetal heart using STIC volume images as the data source is feasible.

Forty eight singleton normal fetuses underwent two-dimensional echocardiography with fetal heart quantitative technique (fetal HQ) in People′s Hospital of Wuhan University on September 2019. Fetal ventricular intima was successfully tracked by fetal HQ software in 45 cases; the length, transverse width, area, and global spherical index(GSI) of four-chamber view were measured with fetal HQ, meanwhile the dynamic tracking curve of ventricular intima was obtained. The left (right) ventricular global strain (GS), fetal area change (FAC), left ventricular ejection fraction (EF) and 24 segment end diastolic diameter (ED), short-axis shortening (FS), spherical index (SI) were calculated. Fetal heart shape and size and cardiac function parameters, as well as z-score of each parameter after adjustment for gestational age, were obtained successfully. The length, transverse width and area were linearly correlated with gestational age, while other parameters and their Z scores were not significantly correlated with gestational age. Z score of measured values of each parameter fell within the normal range of -2

From November.2015 to December 2016,targeted hand ultrasonographic examinations were carried out on 532 fetuses with family history,suspected limb deformities or other abnormalities.The number,size and shape of metacarpal and phalangeal bones were observed from coronal,axial and sagittal view.Three-dimensional ultrasound examination was performed on the suspected short fingers of fetal hands.Follow-up data were obtained in 382 cases.In 6 cases of prenatally detected brachydactyly,5 were bilateral and 1 case was unilateral.In these cases,more than one ossification centers of phalanxes were not present or significantly smaller.In 6 cases of brachydactyly,the termination of pregnancy was performed in 4 (including 2 cases with multiple malformations,and 2 cases with brachydactyly family history but without other abnormalities),while in other 2 cases without other abnormalities the pregnancy was retained until birth.X-rays and autopsies confirmed the prenatal diagnosis of brachydactyly in 4 cases of pregnancy termination,but duplicated distal phalanges of bilateral thumbs of 1 case was missed in prenatal scan.It is suggested that the targeted ultrasonographic scan of the fetal hands in high-risk population during pregnancy helps to detect severe brachydactyly.

Objective To explore the influencing factors of sub-health status among the migrant workers in Dongguan City.Methods A total of 740 migrant workers in Dongguan city were extracted by the stratified random sampling method.The SubHealth Measurement Scale Version 1.0(SHMS V 1.0) was adopted to test the health status.The data were analyzed by Logistic regression analysis.Results The univariate analysis showed that the marital status,average daily working time,monthly family per capita income,living conditions,drinking,breakfast,nutritional status,vigils,living conditions satisfaction,sedentary desk operation and experiencing negative events had statistical significance(P＜0.05).In the Logistic regression analysis:average daily working time,vigils and experiencing negative events were the risk factors of sub-health status occurrence,their odds ratio(OR) and 95 ％ confidence interval(CI)were 1.971(1.211,3.205),2.183(1.378,3.459) and 2.135(1.353,3.369),respectively.Breakfast and nutritional status were the protective factors of sub-health status occurrence,their OR and 95 ％ CI were 0.706 (0.526,0.947) and 0.386(0.239,0.625),respectively.Conclusion The unhealthy living habits and experiencing negative events affect the health of migrant workers in Dongguan City.