Objectives:To establish a comprehensive system of Cardiovascular Academic Performance Evaluation(CAPE)and rank global TOP100 medical institutions in the fields of cardiovascular diseases(CVD). Methods:CVD-related terms were extracted from Medical Subject Headings(MeSH),Embase thesaurus(EMtrees)and International Classification of Diseases(ICD)by CVD-related professionals,as well as by librarians and information professionals.Terminology databases(named as Fuwai Subject Headings)were established,and nine sub-disciplines were proposed,including ischemic heart diseases,hypertension,vascular diseases,arrhythmia,pulmonary vascular diseases,heart failure,congenital heart diseases,cardiomyopathy,and valvular heart diseases.The mapping patterns of sub-discipline,cardiovascular terminology and entry terms were pre-defined.The CVD-related research literature published from January 1,2016 to December 31,2022 were retrieved from Web of Science,PubMed and Scopus.Based on this,metadata were fused and duplicates were excluded.Fuwai Subject Headings were searched and matched into four respects for each literature,including subject words,titles,keywords,and abstracts,which was used to generate an information table of"Position—CVD terminology—Frequency",and to calculate CVD correlation scores and sub-discipline scores.We standardized the names of medical institutions and scholars,and make a ranking system for CAPE based on original articles with strong cardiovascular correlation(correlation score≥4).When evaluating the science and technological performance for Chinese hospitals in cardiovascular diseases,National Natural Science Foundation Projects,authorized invention patents,prize achievements,research platforms,and registered data of drug clinical trials in Center for Drug Evaluation(CDE)were considered besides research papers. Results:During 2016 and 2022,1 545 103 CVD research literatures were found worldwide.After excluding meeting abstracts,books,biographies,news,videos,audio texts,retracted publications,and corrections,1 178 019 CVD research literatures were further evaluated.518 058 literatures were indexed as"strongly correlated to CVD"using Fuwai Subject Headings.Besides papers,other data sources were also collected,including 11 143 CVD-related Natural Science Foundation Projects,19 382 CVD-related effective authorized invention patents,103 CVD-related national prize achievements,24 CVD-related national research platforms,and 2 084 CDE registered data of CVD-related drug clinical trials.Research teams from nine sub-disciplines reviewed and validated research literature in respective fields,and classification rules of corresponding sub-disciplines were created and improved based on their opinions.Finally,eleven individual indexes were chosen to construct CAPE system for ranking global TOP100 medical institutions in overall CVD field and TOP30 in nine sub-disciplines.From 2016 to 2022,the number of cardiovascular disease research papers published by Chinese institutes has increased by 123.5%,with a total of approximately 76.8 thousands papers published(about 30 papers per day on average),ranked the second under the United States(approximately 114.1 thousands papers).However,the proportion of papers published by the Chinese Journal Citation Reports(JCR)and the Chinese Academy of Sciences only ranked eighth in the world.In the comprehensive academic performance of original cardiovascular research papers in global hospitals from 2020 to 2022,only two Chinese medical institutions ranked in the TOP20 as evaluated by CAPE system. Conclusions:Based on multi-source data from 2016 to 2022,CAPE initiated to establish a cardiovascular academic performance evaluation system.

Objective To summarize the multi slice spiral computed tomography(MSCT)features of bronchiolar adenoma(BA).Methods The imaging data of 9 cases of BA confirmed by surgery and pathology were analyzed retrospectively,and relevant literature was also reviewed.Results Among the 9 cases of BA,there were 8 cases with peripheral BA(away from the pleura≤5 mm)inclu-ding 4 cases close to the pleura and 1 case in central area.BA were located in the superior lobe of the right lung in 3 cases,the middle lobe of the right lung in 2,the inferior lobe of the right lung in 2,and the inferior lobe of the left lung in 2.Five cases were solid nod-ules,2 were ground-glass nodules and other 2 were cystic cavity nodules.In 2 cases of the solid nodules,the boundary on the non-venous side was blurred.In the 1 case of the ground-glass nodule,linear and reticular shadows were observed in the lesion,accompanied by a blurred boundary.2 nodules had mild pleura indentation,and other 7 nodules were found blood vessels entering into or adhering to the lesion,3 of which were accompanied by vascular thickening.In 8 cases with 2-48 month followed up,1 cystic cavity nodule was accompa-nied by obstructive pneumonia and then inflammatory absorption,1 solid nodule enlarged accompanied by the appearance of vacuoles,and the rest 6 had no changes.One central type nodule was operated after the CT examination.Conclusion BA are mainly manifes-ted as peripheral nodules of the lung,mostly close to the pleura and away from the pleura≤5 mm.Most BA are solid nodules,and sometimes are ground-glass or cystic cavity nodules.Some nodules show blurred boundaries or inflammation on the non-venous side,and few nodules increase during follow-up,with or without small vacuoles.

In recent years,artificial intelligence(AI),such as image recognition and fixed-point and digital scan-ning,has been increasingly applied in dental orthodontics.ChatGPT is an emerging artificial intelligence technology that has attracted a considerable amount of attention from people of all walks of life since its introduction.This paper discusses the application potential of ChatGPT in the field of orthodontics from two perspectives—education and clini-cal practice—and analyzes its limitations.Current reports show that ChatGPT can improve the efficiency of teaching in orthodontic education as well as assist users in completing medical mock exams training,writing papers and conducting academic research,etc.In the clinic,ChatGPT can be used to engage patients in medical dialog,simplify clinical proce-dures and improve diagnostic and treatment efficiency.However,because ChatGPT is still in the early stages of research and application,there are problems such as insufficient data,inaccurate answers,and poor academic ethics and privacy.In the future,additional studies,training and optimization are needed to ensure the safety,ethics and benefit of AI,lay-ing the foundation for improving the use of AI in the field of orthodontics.

Objective:To investigate the surgical situations and perioperative outcome of pancreaticoduodenectomy in Jiangsu Province and the influencing factors for postoperative 90-day mortality.Methods:The retrospective case-control study was conducted. The clinicopathological data of 2 886 patients who underwent pancreaticoduodenectomy in 21 large tertiary hospitals of Jiangsu Quality Control Center for Pancreatic Diseases, including The First Affiliated Hospital of Nanjing Medical University, from March 2021 to December 2022 were collected. There were 1 732 males and 1 154 females, aged 65(57,71)years. Under the framework of the Jiangsu Provincial Pancreatic Disease Quality Control Project, the Jiangsu Quality Control Center for Pancreatic Diseases adopted a multi-center registration research method to establish a provincial electronic database for pancrea-ticoduodenectomy. Observation indicators: (1) clinical characteristics; (2) intraoperative and post-operative conditions; (3) influencing factors for 90-day mortality after pancreaticoduodenectomy. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(IQR), and comparison between groups was conducted using the Mann-Whitney U test. Count data were expressed as absolute numbers or constituent ratio, and comparison between groups was conducted using the chi-square test, continuity correction chi-square test and Fisher exact probability. Maximal Youden index method was used to determine the cutoff value of continuous variables. Univariate analysis was performed using the corresponding statistical methods based on data types. Multivariate analysis was performed using the Logistic multiple regression model. Results:(1) Clinical characteristics. Of the 2 886 patients who underwent pancreaticoduodenectomy, there were 1 175 and 1 711 cases in 2021 and 2022, respectively. Of the 21 hospitals, 8 hospitals had an average annual surgical volume of <36 cases for pancreaticoduodenectomy, 10 hospitals had an average annual surgical volume of 36-119 cases, and 3 hospitals had an average annual surgical volume of ≥120 cases. There were 2 584 cases performed pancreaticoduodenectomy in thirteen hospitals with an average annual surgical volume of ≥36 cases, accounting for 89.536%(2 584/2 886)of the total cases. There were 1 357 cases performed pancrea-ticoduodenectomy in three hospitals with an average annual surgical volume of ≥120 cases, accounting for 47.020%(1 357/2 886) of the total cases. (2) Intraoperative and postoperative conditions. Of the 2 886 patients, the surgical approach was open surgery in 2 397 cases, minimally invasive surgery in 488 cases, and it is unknown in 1 case. The pylorus was preserved in 871 cases, not preserved in 1 952 cases, and it is unknown in 63 cases. Combined organ resection was performed in 305 cases (including vascular resection in 209 cases), not combined organ resection in 2 579 cases, and it is unknown in 2 cases. The operation time of 2 885 patients was 290(115)minutes, the volume of intra-operative blood loss of 2 882 patients was 240(250)mL, and the intraoperative blood transfusion rate of 2 880 patients was 27.153%(782/2 880). Of the 2 886 patients, the invasive treatment rate was 11.342%(327/2 883), the unplanned Intensive Care Unit (ICU) treatment rate was 3.087%(89/2 883), the reoperation rate was 1.590%(45/2 830), the duration of postoperative hospital stay was 17(11)days, the hospitalization mortality rate was 0.798%(23/2 882), and the failure rate of rescue data in 2 083 cases with severe complications was 6.529%(19/291). There were 2 477 patients receiving postoperative 90-day follow-up, with the 90-day mortality of 2.705%(67/2477). The total incidence rate of complication in 2 886 patients was 58.997%(1 423/2 412). The incidence rate of severe complication was 13.970%(291/2 083). The comprehensive complication index was 8.7(22.6) in 2 078 patients. (3) Influencing factors for 90-day mortality after pancreaticoduodenectomy. Results of multivariate analysis showed that age ≥ 70 years, postoperative invasive treatment, and unplanned ICU treatment were independent risk factors for 90-day mortality after pancreaticoduodenectomy ( odds ratio=2.403, 2.609, 16.141, 95% confidence interval as 1.281-4.510, 1.298-5.244, 7.119-36.596, P<0.05). Average annual surgical volume ≥36 cases in the hospital was an independent protective factor for 90-day mortality after pancreaticoduodenectomy ( odds ratio=0.368, 95% confidence interval as 0.168-0.808, P<0.05). Conclusions:Pancreaticoduodenectomy in Jiangsu Province is highly con-centrated in some hospitals, with a high incidence of postoperative complications, and the risk of postoperative 90-day mortality is significant higher than that of hospitallization mortality. Age ≥ 70 years, postoperative invasive treatment, and unplanned ICU treatment are independent risk factors for 90-day motality after pancreaticoduodenectomy, and average annual surgical volume ≥36 cases in the hospital is an independent protective factor.

Objective:To explore the application effect of self-made pillow for infants with prone position ventilation after open heart surgery.Methods:This study was a case-control study. A total of 50 infants with congenital heart disease admitted to Cardiovascular Surgery ICU, General Hospital of Northern Theater Command, Chinese PLA from July to December 2020 were selected as the control group, and 50 infants with congenital heart disease admitted from January to June 2021 were selected as the experimental group. The control group used the traditional tool for prone position ventilation, and the experimental group used the self-designed pillow for infant in prone position ventilation. The incidence of adverse events (pressure ulcer, unplanned extubation, tube discount), operation and duration, and blood gas analysis (PaO 2, PaCO 2) indexes were compared between the two groups. Results:The incidence of pressure ulcer in the experimental group was 2%(1/50), which was lower than 14%(7/50) in the control group, and the difference was statistically significant ( χ2=2.78, P<0.05). There were no statistically significant differences in the incidence of unplanned extubation and the incidence of tube discount between the two groups (both P>0.05). The operation time was (4.25 ± 2.46) min in the experimental group and (6.73 ± 3.25) min in the control group, and the difference between the two groups was statistically significant ( t=-2.24, P<0.05). The duration of the experimental group was (62.67 ± 18.45) min, and that of the control group was (38.53 ± 20.74) min, the difference between the two groups was statistically significant ( t=6.98, P<0.05). Conclusions:The application of self-made pillow and traditional tools in pediatric prone position ventilation can effectively increase PaO 2, reduce PaCO 2 and improve lung oxygenation. However, the application of self-made prone position ventilation pillow can greatly reduce the operation time of nurses, increase the duration of prone position ventilation, and reduce the occurrence of adverse events.

CRISPR-Associated Protein 9 ; Gene Editing ; CRISPR-Cas Systems/genetics*

【Objective】 To compare the clinical effects and screw placement accuracy for treating lumbar disc herniation between robot-assisted minimal invasive transforaminal lumbar interbody fusion (RA-MIS-TLIF) and minimal invasive transforaminal lumbar interbody fusion (MIS-TLIF). 【Methods】 We retrospectively recruited 69 patients with single segment lumbar disc herniation treated between January 2018 and August 2019 at Honghui Hospital of Xi’an Jiaotong University. There were cases of 33 RA-MIS-TLIF (RA group) and 36 MIS-TLIF (MIS-TLIF group). Subsequently, the patients’ baseline characteristics were collected, including age, gender, body mass index, complication with diabetes, duration of symptoms, operated segment, and follow-up time. We also collected perioperative parameters such as operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, screw placement accuracy, wound drainage, hospitalization duration, postoperative complicatins, and fusion rate. Lower back pain, lower extremity pain visual analogue score (VAS), and lumbar Japanese Orthopaedic Association Scores (JOA) were obtained preoperatively, postoperative 3 days/6 months/12 months, and the last follow-up. 【Results】 All the procedures were successfully completed and the follow-up time was 14.82±1.83 (RA group) and 15.11±1.62 (MIS-TLIF group) months, without significant difference (P>0.05). Compared with MIS-TLIF group, RA group had less intraoperative blood loss [(116.67±18.48) min vs. (128.06±22.53) min], fluoroscopy frequency [(12.42±2.28) vs. (15.67±2.46)], screw placement accuracy (93.18% vs. 84.03%), postoperative drainage [(73.03±23.52) mL vs. (88.33±28.54) mL], and shorter hospitalization stay [(6.45±1.52)d vs. (7.69±1.85) d] (all P<0.05). However, operation time did not significantly differ (P>0.05). The VAS of lower back pain and lower extremity pain, and lumbar JOA were significantly improved after the operation (P<0.001). At the same time point, there was no significant difference between the two groups (P>0.05). Meanwhile, fusion rate and incidence of complications did not significantly differ between the two groups (P>0.05). 【Conclusion】 Both robot-assisted MIS-TLIF and MIS-TLIF can achieve excellent clinical effects in treating single-segment lumbar disc herniation. However, the former can improve the accuracy of screw placement and reduce intraoperative blood loss, fluoroscopy frequency, postoperative drainage and hospitalization time, which indicates a promising application.

Objective:To compare the complications in young adults with femoral neck fracture after internal fixation with compression buttress screws (CBS) versus 3 parallel partially threaded cannulated screws (PTS).Methods:A prospective study was conducted of the 120 young adults with femoral neck fracture who had been treated from July 2016 to December 2017 at Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital. Of them, 60 were subjected to PTS fixation (control group) and 60 to CBS fixation (observation group) according to their will. In the control group, there were 38 males and 22 females with an age of (46.1±7.6) years, and 17 cases of types Ⅰ-Ⅱ and 43 cases of type Ⅲ by the modified Pauwels classification; in the observation group, there were 42 males and 18 females with an age of (44.8±8.1) years, and 11 cases of types Ⅰ-Ⅱ and 49 cases of type Ⅲ. The 2 groups were compared in postoperative complications. A stratified analysis was performed according to the modified Pauwels classification.Results:Comparability was indicated between the 2 groups because there was no significant difference in their baseline demographic information ( P>0.05). The incidences of fixation failure (8.3%, 5/60), nonunion (5.0%, 3/60), femoral neck shortening<10 mm(10.0%, 6/60) and lateral withdrawal (11.7%, 7/60) in the observation group were significantly lower than those in the control group [38.3% (23/60), 28.3% (17/60), 41.7% (25/60) and 71.7% (43/60), respectively] ( P<0.05). There was no significant difference in the incidence of avascular necrosis of the femoral head or of medial migration between the 2 groups ( P>0.05). The stratified analysis showed that the incidences of fixation failure and nonunion in the observation group were significantly lower than in the control group for fractures of the modified Pauwels type Ⅲ ( P<0.05). The incidences of femoral neck shortening<10 mm and fixation loosening in the control group were significantly higher than in the observation group for fractures of all the modified Pauwels types ( P<0.05). Conclusion:Compared with conventional PTS fixation, CBS fixation can significantly reduce postoperative complications in young adults with femoral neck fracture, especially those with high energy fracture of the modified Pauwels type Ⅲ.

Objective:To compare the biomechanical properties of dynamic hip screw (DHS), traditional cannulated compression screw (CCS) configuration, traditional CCS configuration+medial locking plate and compression buttress screw (CBS) in the treatment of femoral neck fracture by finite element analyses.Methods:A simulation model of Pauwels type Ⅲ femoral neck fracture with discontinuous medial cortex was established by the finite element method. The maximum displacement, maximum principal stress, normal form equivalent stress, hip varus angle and fracture end stress were compared between DHS (group A), traditional CCS configuration (group B), traditional CCS configuration+medial locking plate (group C) and CBS (group D) in the simulation model.Results:In the internal fixation model in groups A, B, C and D, respectively, the maximum displacement of the femur was 0.41 mm, 2.04 mm, 0.94 mm and 0.30 mm; the maximum displacement of internal fixation 0.34 mm, 1.18 mm, 0.84 mm and 0.22 mm; the peak normal form stress of internal fixation 83.6 MPa, 231.4 MPa, 259.8 MPa and 194.8 MPa; the maximum principal stress of internal fixation 52.3 MPa, 216.3 MPa, 151.7 MPa and 74.6 MPa; the maximum normal form stress of the femur 101.1 MPa, 282.3 MPa, 100.5 MPa and 181.2 MPa; the maximum principal stress 99.7 MPa, 201.0 MPa, 60.9 MPa and 56.1 MPa; the axis angle of the femoral neck after loading 179.55°, 176.97°, 179.66° and 179.64°; the normal form equivalent stress at the fracture end ranged from 42.0 to 50.0 MPa, from 258.7 to 282.3 MPa, from 50.8 to 58.1 MPa, and from 45.3 to 60.4 MPa.Conclusion:Considering stability, stress distribution and prevention of hip varus and femoral neck shortening, CBS may be a choice treatment for femoral neck fracture because it is comparable to DHS in mechanical stability.

Objective:To understand the trend of Helicobacter pylori （Hp） resistance to clarithromycin and levofloxacin and to provide guidance for Hp eradication therapy. Methods:From January 2014 to December 2018， a total of 66 515 patients with gastrointestinal symptoms were enrolled in the First People's Hospital of Wenling. The patients were divided into the following groups： childhood （0 to 6 years old）； juvenile （7 to 17 years old）； youth （18 to 40 years old），middle age （41 to 65 years old），and old age （≥66 years old）. All patients received gastroscopy， gastric mucosal biopsy， Hp culture and drug sensitivity test of clarithromycin and levofloxacin. Results:The Hp positive rate showed a significant downward trend in 2016， 2017 and 2018 （χ²=14.317， 47.079， 88.054， all P<0.05）. The average resistance rate of Hp to clarithromycin from 2014 to 2018 was 22.72% （4 732/20 831） showing an increasing trend， but the increase was slower after 2017. The average resistance rate to levofloxacin was 30.55% （6 364/20 831）， and the overall trend showed a sharp rise from 2015 to 2017 （χ²=38.383， 49.569， both P<0.05）， and a significant decline was detected after 2017 （χ²=18.841， P<0.05）. The resistance rate of Hp to levofloxacin in patients increased with age. The clarithromycin resistance rate first decreased and then increased with age， and the resistance rate in old age （32.52%， 763/2 346） was higher than that in youth （22.09%， 1 086/4 916） and middle age patients （21.21%， 2 854/13 458）， and the differences were significant （χ²=991.071， 144.968， both P<0.05）. The resistance rate of Hp rose from 12.73% （14/110） in juvenile to 43.31% （1 016/2 346） in old age （χ²=228.867， P<0.05）. Conclusion:In recent years， the positive rate of Hp infection in Wenling area has a decreasing trend. Although the resistance rate of Hp to clarithromycin and levofloxacin has been rising slowly or decreasing， it is still at a high level. In the selection of Hp eradication program， the differences between patients in different age groups should be considered with particular attention on the minors.