In cardiac ablation procedures,the accuracy of catheter positioning determines the authenticity of the cardiac model and the accuracy of the ablation target.This article reviews the literature on catheter positioning in electrophysiology and summarizes the key technologies for catheter positioning,such as magnetic-electric fusion and interference suppression.Addressing the limitations of electric and magnetic positioning individually,the paper elaborates on the rationale for catheter positioning technology based on magnetic-electric fusion.It also outlines the framework of a complex catheter positioning system.Specifically,the magnetoelectric conversion matrix is established first,followed by the optimization of the catheter shape.The interference factors such as magnetic field interference,body movement,respiration,and heartbeat in catheter positioning and their suppression methods are analyzed and discussed in detail.Finally,the development trend of three-dimensional electrophysiology catheter positioning technology is prospected,offering feasible insights for the research on catheter positioning technology based on magnetic-electric fusion.

Objective:To examine the efficacy and experience of staged and segmented two hybrid surgeries for total repair of Debakey type Ⅰ aortic dissection (TIAD).Methods:This study was a retrospective case series. The clinic data of 10 patients with acute TIAD who were admitted to the Department of Cardiac Surgery, Second Hospital of Lanzhou University or the First People′s Hospital of Lanzhou, between January 2016 and August 2022, were retrospectively studied. Ten patients underwent hybrid surgeries in two hospitalizations (stages), including 7 males and 3 females with an age of (60±7) years (range: 49 to 71 years). In stage 1, the first type Ⅱ hybrid arch repair was performed to treat the ascending, total arch, and descending thoracic aorta for acute TIAD without circulatory arrest. In stage 2, the second hybrid surgery including infrarenal abdominal aorta replacement, visceral arteries bypass and endovascular thoracoabdominal aortic repair was performed to treat residual thoracoabdominal aortic dissection after the first hybrid operation (segmented). Basic data, preoperative concomitant diseases, high-risk factors, surgical approaches and postoperative complications of all important organs, as well as CT imaging were analyzed.Results:There was no death in the 20 hybrid surgical procedures. In stage 1 type Ⅱ hybrid surgery, 4 cases underwent reconstruction of the aortic sinutubular junction, while Bentall and David surgery was performed for 3 cases, respectively. A patient received coronary artery bypass grafting. Then all patients were sequentially treated with arch debranching and thoracic aortic endovascular repair. Postoperative complications included renal insufficiency (4/10), hemofiltration (1/10), hypoxemia (4/10), neurologic event (1/10) and type Ⅱ endoleak (1/10). Complete false lumen thrombosis occurred in 9/10 of the patients. All complications recovered successfully at discharge and the average hospital stay was (21±4) days (range: 16 to 28 days) in the first hospitalization. At stage 2, the second hybrid surgery was successfully performed in all patients. No paraplegia, hepatic or renal insufficiency, or endoleak occurred. However, branch graft embolism of the left renal artery was found in one patient 3 days after laparotomy, as well as of superior mesenteric artery in another. Superior mesenteric artery occlusion was successfully treated by endovascular recanalization. Complete false lumen thrombosis occurred in all patients. Although all patients had different degrees of intestinal dysfunction, they were gradually relieved at discharge, and the average hospital stay was (19±2)days (range:16 to 21 days) in the second hospitalization. During follow-up, CT angiography showed aortic remodeling in all patients.Conclusion:Staged and segmented two hybrid surgeries are safe and feasible for total repair of Debakey type Ⅰ aortic dissection and are associated with acceptable early and midterm outcomes.

Objective:To examine the efficacy and experience of staged and segmented two hybrid surgeries for total repair of Debakey type Ⅰ aortic dissection (TIAD).Methods:This study was a retrospective case series. The clinic data of 10 patients with acute TIAD who were admitted to the Department of Cardiac Surgery, Second Hospital of Lanzhou University or the First People′s Hospital of Lanzhou, between January 2016 and August 2022, were retrospectively studied. Ten patients underwent hybrid surgeries in two hospitalizations (stages), including 7 males and 3 females with an age of (60±7) years (range: 49 to 71 years). In stage 1, the first type Ⅱ hybrid arch repair was performed to treat the ascending, total arch, and descending thoracic aorta for acute TIAD without circulatory arrest. In stage 2, the second hybrid surgery including infrarenal abdominal aorta replacement, visceral arteries bypass and endovascular thoracoabdominal aortic repair was performed to treat residual thoracoabdominal aortic dissection after the first hybrid operation (segmented). Basic data, preoperative concomitant diseases, high-risk factors, surgical approaches and postoperative complications of all important organs, as well as CT imaging were analyzed.Results:There was no death in the 20 hybrid surgical procedures. In stage 1 type Ⅱ hybrid surgery, 4 cases underwent reconstruction of the aortic sinutubular junction, while Bentall and David surgery was performed for 3 cases, respectively. A patient received coronary artery bypass grafting. Then all patients were sequentially treated with arch debranching and thoracic aortic endovascular repair. Postoperative complications included renal insufficiency (4/10), hemofiltration (1/10), hypoxemia (4/10), neurologic event (1/10) and type Ⅱ endoleak (1/10). Complete false lumen thrombosis occurred in 9/10 of the patients. All complications recovered successfully at discharge and the average hospital stay was (21±4) days (range: 16 to 28 days) in the first hospitalization. At stage 2, the second hybrid surgery was successfully performed in all patients. No paraplegia, hepatic or renal insufficiency, or endoleak occurred. However, branch graft embolism of the left renal artery was found in one patient 3 days after laparotomy, as well as of superior mesenteric artery in another. Superior mesenteric artery occlusion was successfully treated by endovascular recanalization. Complete false lumen thrombosis occurred in all patients. Although all patients had different degrees of intestinal dysfunction, they were gradually relieved at discharge, and the average hospital stay was (19±2)days (range:16 to 21 days) in the second hospitalization. During follow-up, CT angiography showed aortic remodeling in all patients.Conclusion:Staged and segmented two hybrid surgeries are safe and feasible for total repair of Debakey type Ⅰ aortic dissection and are associated with acceptable early and midterm outcomes.

Objective: To observe the effects of electroacupuncture (EA) with three frequencies (100 Hz, 2 Hz, and 2 Hz/100 Hz) on the apoptosis of neurons and c-Jun N-terminal kinase (JNK) signaling pathway in the hippocampus of rats with vascular dementia (VD), and explore the mechanism of EA intervention for VD. Methods: Fifty male Sprague-Dawley rats were randomly divided into a model group, a sham operation group, a 100 Hz EA group, a 2 Hz EA group, and a 2 Hz/100 Hz EA group, with ten rats in each group. The VD model rats were established by repeated ischemia-reperfusion of bilateral common carotid arteries. The rats in the EA groups received EA intervention at Baihui (GV20), Dazhui (GV14), Geshu (BL17) and Zusanli (ST36), once a day for 14 d. Afterward, Morris water maze was used to examine the learning and memory performances of the rats in each group, hematoxylin-eosin staining to observe the histomorphological changes in the hippocampal CA1 region, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling to test the apoptosis of neurons in the hippocampal CA1 region, and Western blot to detect the protein expression levels of JNK, phosphorylated JNK (p-JNK), Caspase-8, and Caspase-3 in the hippocampus tissue. Results: Compared with the sham operation group, the escape latency of the model group in water maze test was prolonged; the number of crossing the original platform was decreased (P<0.01); the hippocampal neurons were severely damaged and the number of surviving neurons was decreased (P<0.01), whereas the number of apoptotic neurons was increased (P<0.01); the protein expression levels of JNK, p-JNK, Caspase-8, and Caspase-3 in the hippocampus were significantly increased (P<0.01). Compared with the model group, the escape latency of each EA group was significantly shortened; the number of crossing the original platform was significantly increased (P<0.01); the damage of hippocampal neurons was alleviated, the number of surviving neurons was increased (P<0.01), and the number of apoptotic neurons was decreased (P<0.01); the protein expression levels of JNK, p-JNK, Caspase-8, and Caspase-3 in the hippocampus were decreased (P<0.01). The results in the 2 Hz EA group and the 2 Hz/100 Hz EA group were superior to those in the 100 Hz EA group. Conclusion: EA with the three frequencies (100 Hz, 2 Hz, and 2 Hz/100 Hz) can improve the learning and memory performances in VD rats subjected to ischemia-reperfusion, its mechanism may be related to the inhibition of neuronal apoptosis and the regulation of the related protein expression of JNK signaling pathway, and the intervention effects of EA with 2 Hz and 2 Hz/100 Hz are more significant.

Objective:To explore the relationship between the expression level of micro RNA-133a(miR-133a) and the indexes of heart failure in patients with ischemic heart failure and its clinical application value.Methods:From January 2018 to September 2019, the clinical data of 80 patients diagnosed as ischemic heart failure in Shenyang Fourth People′s Hospital were analyzed prospectively.According to the classification of New York Heart Association(NYHA), 20 cases were divided into NYHA class Ⅰ group, class Ⅱ group, class Ⅲ group and class Ⅳ group, and 20 healthy people in the same period were selected as the healthy control group.The concentration of brain natriuretic peptide (BNP) in peripheral blood was detected by automatic immune analyzer, the indexes of cardiac function were detected by echocardiography, the expression of miR-133a in serum was detected by qRT-PCR, the difference of expression concentration of miR-133a in different functional grades was compared, and the correlation between the concentration of miR-133a and BNP and the indexes of echocardiography was analyzed.Results:The expression of miR-133a in healthy control group(0.167±0.024), NYHA Ⅰ group(0.289±0.012), NYHA Ⅱ group (0.415±0.034), NYHA Ⅲ group(0.981±0.217) and NYHA Ⅳ group(1.238±0.249) was statistically significant( F=106.4, P<0.001). Pearson correlation analysis showed that miR-133a was positively correlated with BNP in NYHAⅡ, Ⅲ and Ⅳ grade( r=0.815, 95% CI: 0.582-0.924, P<0.001; r=0.465, 95% CI: 0.029-0.753, P<0.05; r=0.749, 95% CI: 0.459-0.895, P<0.001). MiR-133 was negatively correlated with EF( r=-0.811, 95% CI: -0.875--0.719, P<0.001), positively correlated with LVPW, LV and EDV( r=0.331, 95% CI: 0.120-0.513, P<0.01; r=0.845, 95% CI: 0.764-0.896, P<0.001; r=0.705, 95% CI: 0.572-0.803, P<0.001). Conclusion:The expression of miR-133a in patients with ischemic heart failure is increased, which is related to the index of cardiac dysfunction, and has certain diagnostic and prognostic value.

OBJECTIVETo investigate the efficacy of single-hand four-needle suture with sled-shaped needle three-tail fixed stitch in closure of pesudohernia sac of direct hernia under transabdominal preperitoneal (TAPP) inguinal hernia repair.

METHODSA randomized controlled trail was conducted on adult patients with unilateral direct inguinal hernia undergoing laparoscopic TAPP repair from January 2014 to January 2018 at the Sixth Affiliated Hospital of Sun Yat-sen University. A total of 156 patients were enrolled prospectively in the study and were randomly divided into single-hand four-needle suture group (trial group, 76 cases) and traditional tacking group (control group, 80 cases). In trial group, sled-shaped needle three-tail knot-free stitch was applied to the continuous four-needle suture. The sled-shaped needle three-tail fixed stitch was made as follows: straighten the tail of a 3-0, 1/2-circle looper VICRYL Rapide into a sled shape; use suture overlap method to make and tighten a single knot; thread the end of the needle into the single knot loop;knot two ends of the thread next to the first knot; tighten the second knot, leaving about 12 cm to the end of the needle;cut the end of the loop (leaving about 0.6 cm) and the other end of the thread(leaving about 1.5 cm). In the control group, a hernia repair tack was used to fix the pseudohernia sac on pectineal ligament. This study was approved by the Hospital Ethics Committee(approval number: L2014ZSLYEC-016). Operation time, pseudoherina sac closure time, hospitalization cost, morbidity of postoperative complication, VAS score and postoperative recurrence were compared between two groups.

RESULTSAll the patients completed operations successfully. There were no significant differences between trial group and control group in age [(60.2±0.4) years vs. (61.1±0.7) years)], gender (male ratio 93.4% vs. 92.5%), BMI [(25.1±0.2) kg/m vs. (24.9±0.2) kg/m ], defection area [(16.1±0.4) cm vs. (15.7±0.7) cm ] (all P > 0.05). As compared to control group, trial group had longer operative time[(34.2±1.9) minutes vs. (30.3±1.1) minutes, t=5.484, P=0.045], longer closure time of psudohernia sac [(4.2±0.5) minutes vs. (1.8±0.7) minutes, t=7.423, P=0.031], but lower VAS score (3.2±0.1 vs. 5.3±0.6, t=-3.186, P=0.015) and lower total cost [(9 897.3±104.4) yuan vs. (12 325.6±169.7) yuan, t=-3.972, P=0.023]. No severe complication and death were found in either groups intra-operatively and postoperatively. No mesh infection and relapse occurred during postoperative follow-up of 1-24 (12.0±1.2) months. During follow-up, seroma occurred in 2 cases (2.6%) of trial group and 3 cases (3.8%) of control group without significant difference (χ =1.284, P=0.799), and all were absorbed and disappeared within 30 days after local application of mirabilite.

CONCLUSIONCompared to tack fix method, single-hand four-needle suture with sled-shaped needle three-tail fixed stitch can effectively close pseudohernia sac, reduce hospitalization cost and ameliorate postoperative pain in TAPP repair, which is worth promotion.

Hernia, Inguinal ; surgery ; Herniorrhaphy ; methods ; Humans ; Laparoscopy ; Male ; Middle Aged ; Surgical Mesh ; Suture Techniques ; Sutures ; Treatment Outcome

Objective To evaluate the diagnostic value of urine-based prostate cancer antigen 3 ( PCA3 ) score in detecting prostate cancer during initial prostatic biopsy .Methods Urine was collected after digital rectal examination ( DRE) ( three strokes per lobe ) from 248 men before prostate biopsy .The specimens were collected between January 2010 and December 2012.The expression of PCA3 mRNA and prostate specifc antigen (PSA) mRNA was determined by quanti-tative real time polymerase chain reaction ( qRT-PCR ) .PCA3 scores were calculated by PCA 3 mRNA/PSA mRNA × 1000 .The ability of the PCA3 score to predict the biopsy outcome was assessed with AUC-ROC analysis and compared with the serum PSA levels.Results The rate of positive prostate biopsy was 32.3%(80 patients with positive prostatic biopsy versus 168 patients with negative prostate biopsy ) .PCA3 scores were significantly higher in patients with positive biopsy than in those with negative biopsy results (P<0.001).The ROC curve analysis demonstrated that the area under the ROC curve (AUC) of serum total PSA (tPSA), PCA3 score and the duplex model combining tPSA and PCA 3 score was 0.620, 0.693 and 0.724, respectively.Further analysis of the diagnostic performance of PCA3 score revealed that at a cut-off of 90.2456, the sensitivity was 67.5%and the specificity was 61.9%for discriminating positive biopsy from negative biopsy. The duplex model combining tPSA and PCA 3 score represented a better approach than tPSA alone in PCa diagnosis by pros-tatic biopsy (P=0.011), but there was no statistically significant difference between tPSA and PCA 3 score (P=0.160). In addition , a comprehensive diagnostic model based on multiple risk factors of prostate cancer combined with PCA 3 score could further improve the predictive accuracy of prostate cancer .Conclusion PCA3 could be a good predictor of prostate cancer in initial prostate biopsy in Chinese population .The comprehensive diagnostic model can improve the diagnostic potency .Further large-scale multicenter studies in China are needed to confirm our findings .

Objective To study the quick triage assessment system for emergency nurse, establish evaluation model and method, select indicators and contents, guide triage nurses to be accurate, fast, convenient and practical, and also to optimize the use of emergency medical resources. Methods Screening the target population to conduct the research, collecting main indicators and features covered with main symptom and characteristics of severe critical emergency patients, selecting manifestation form of triage assessment system. Results The selected indicators and contents were demonstrated by a table-based form, and the quick triage assessment form for emergency nurse was established to instruct triage work. Conclusions This established quick triage assessment form is simple, intuitive and can improve the quality of emergency triage work. It possesses feasibility, practicality and achieves the optimal medical services with the limited emergency medical resources, which shows both social and economic effect.

Objective To determine the influence of intense pulsed light (IPL) on the secretion of TGF-β1 in cultured human fibroblasts and the intervention of JNK inhibitor.Methods The callan foreskin fibroblasts were cultured and divided into 2 groups. In the IPL treatment group, cells were irradiated with IPL with fluences of0 (negative control), 10, 18, 27, 36, and 36 J/cm2 × 2 (irradiated with IPL with fluences of 36 J/cm2 twice). In the IPL + inhibitor group, cells were irradiated with IPL with fluences of 36 J/cm2 after incubation with the inhibitor SP600125 for 2 h. TGF-β1 in the culture supernatant was evaluated 48 h after the irradiation using enzyme-linked immunosorbent assay. Results Compared with the negative control, TGF-β1 in the culture supernatant decreased at the IPL irradiation of 10, 18, 27, and 36 J / cm2, whereas TGF-β1 increased at the IPL irradiation of 36 J/cm2× 2. In the IPL + inhibitor group, the concentration of TGF-β1 in the culture supernatant decreased compared with the controls (P<0.05). Conclusion IPL can suppress the secretion of TGF-β1 at the lower fluence and promote the secretion at a higher fluence. JNK inhibitor may play an inhibitive role when IPL regulates the TGF-β1 secretion in cultured human fibroblasts. IPL may stimulate TGF-β1 secretion of the fibroblast cells in human skin via JNK signal pathway.

Objective To investigate the effects of different means of liquid resuscitation on microcirculation in rats with hemorrhagic shock. Method A model of rats with hemorrhagic shock was established in 40 Wistar rats. The rats were randomly divided into 4 groups according on different means of liquid resuscitation, and killed 24 hours after the examination, group A: without liquid resuscitation; group B: low-molecular-weight-40; group C: 7.5% hypertonic saline,group D:low-molecular-weight-40 + hyperonic saline. As well as the microcirculation in kidney was observed using electron microscope. Results In group without resuscitation, the microcirculation in kidney damaged severely; While in group with hypertonic or low molecule dextran alone, there was harm with dif-ferent degrees, and the microcirculation in kidney was nearly perfect in group with both hypertonic and low molecule dextran alone. Conclusions Different means of liquid resuscitation may infect the microcirculation in kidney, which with both hypertonic and low molecule dextran can protect the microcirculation in kidney.