Objective To evaluate the application value of the second generation snap shot freeze(SSF2)combined with artificial intelligence reconstruction in free heart rate coronary computed tomography angiography(CCTA).Methods The examination data of 37 patients undergoing CCTA were divided into two groups for reconstruction.Group A,reconstruction by artificial intelligence after SSF2 algorithm correction;group B,original images automatically split and multi-phase reconstruction by artificial intelligence.Image quality were compared on volume rendering(VR),curve planar reformation(CPR),maximum intensity projection(MIP)image,subjective evaluation,objective scoring,and signal-to-noise ratio(SNR).Independent samples t-test and Chi-square test were used,and P<0.05 was considered statistically significant.Results There were statistically significant differences in the image quality score and SNR of the two reconstruction methods(P=0.009).Group A scored better,with higher signal intensity,lower noise intensity,and better SNR.The difference in the number of right coronary artery(RCA)analyzable segments between the two groups was statistically significant(P<0.05).The excellent and good rate of subjective evaluation of coronary artery segments in group A RCA(98.6%)was higher than that in group B(69.6%).Conclusion Using SSF2 combined with artificial intelligence reconstruction technology can significantly improve the image quality of CCTA,improve the success rate of CCTA examination,and improve the overall work efficiency.

Objective:To explore the treatment of thoracoabdominal combined injury in a child with heart rupture caused by sheep horns under limited medical conditions.Methods:To summarize the diagnosis and treatment of a child with thoracoabdominal combined injury and cardiac rupture who were treated with epidural anesthesia and having spontaneous breath, and even more there was no oxygen supply and perioperative monitoring during operation.Results:After the complete of thoracoabdominal exploration, the repair of heart, stomach and diaphragm, postoperative anti-infection, nutritional support and symptomatic treatment, the little patient recovered successfully.Conclusions:Thoracoabdominal injuries combined cardiac rupture requires rapid judgment of the patient’s condition, control of bleeding, discharge cardiac tamponade and cardiac repair as soon as possible. In order to save life, unconventional measures can be used when it is necessary.

{L-End}Objective To investigate the current status of sleep quality and its influencing factors among coal miners in a company in Shanxi Province. {L-End}Methods A total of 1 047 coal miners from a coal mine company in Shanxi Province were selected as the study subjects by convenient sampling method. The occupational stress, occupational burnout and sleep quality of the study subjects were investigated using Occupational Stress Core Scale, Maslach Burnout Inventory-General Survey and Pittsburg Sleep Quality Index Scale. {L-End}Results The detection rates of occupational stress, occupational burnout, sleep disorder were 58.9%, 59.1% and 57.9%, respectively. The result of multivariate logistic regression analysis showed that education level, alcohol consumption, work shift, duration of dust-exposure, phase of respiratory symptoms, self-assessment of health, occupational stress and occupational burnout were independent influencing factors of sleep disorders in the coal miners (all P<0.05). Among them, the risk of sleep disorders in drinkers was higher than that in non-drinkers (P<0.05); the risk of sleep disorders was higher in miners working in a rotating work shift with two shifts than in those with three shifts (P<0.05); the higher the education level, the longer the duration of dust-exposure, the more serious the phase of respiratory symptoms, the worse the self-assessment of health, the higher the degree of occupational stress and the higher the degree of occupational burnout, the higher the risk of sleep disorders (all P<0.05). {L-End}Conclusion The incidence of sleep disorders in coal miners in this company is relatively high. Occupational stress, occupational burnout, education level, alcohol consumption, work shift, duration of dust-exposure, respiratory symptoms and health status are risk factors for sleep disorders in coal miners.

OBJECTIVE：To study the effects and active ingr edients of Tibetan medicine Lamiophlomis rotata against rheumatoid arthritis （RA）. METHODS ：Fifty-six SD rats were randomly divided into normal control group （0.5％ sodium carboxymethylcellulose），model group （0.5％ sodium carboxymethylcellulose ），methotrexate group （positive control group ，3 mg/kg），L. rotata water extract low-dose ，medium-dose and high-dose groups （0.5，1，2 g/kg，by crude drug ），L. rotata total flavonoid group （200 mg/kg，by flavonoid extat ），with 8 rats in each group. Except for normal control group ，other groups were given Freund ’s complete adjuvant （FCA）on the rat ’s right hind footpad to induce adjuvant-induced arthritis model. The next day after injection of FCA ，rats in all groups were given relevant medicine intragastrically ，once a day （once every 3 days for methotrexate group ）for 30 days. At 15th and 30th day of administration ，the degree of paw swelling of left hind foot was measured，and the arthritis index ，spleen index were calculated. At the end of 30th day of administration ，the levels of TNF-α，IL-1β， IL-6 and IL- 10 in rat serum were determined by ELISA assay ，the thymus index and spleen index were calculated ，the pathological changes of the ankle joints were observed by HE staining. RESULTS ：Compared with normal control group ，degree of paw swelling，arthritis index at 15th and 30th day of administration as well as the spleen index and the levels of TNF-α，IL-1β， msxmX0146） IL-6 in serum at 30th day of administration were significantly com increased in model group （P＜0.01）；while the thymus indexyunbinji- and IL- 10 level at 30th day of administration were ang@swu.edu.cn significantly decreased（P＜0.01）；synovial cell proliferation and infiltration of articular cavity were observed in ankle joint. Compared with model group ，degree of paw swelling ，arthritis index at 15th and 30th day of administration as well as the spleen index and the levels of TNF-α，IL-1β，IL-6 in serum at 30th day of administration were significantly decreased in each medicine group （P＜0.01）；while the thymus index and IL- 10 level at 30th day of administration were significantly increased （P＜0.01）；the pathological changes of arthritis were significantly improved. Compared with L. rotata water extract high-dose group ，there were no significant differences in degree of paw swelling at 15th day of administration as well as the arthritis index ，spleen index ，levels of inflammatory cytokines and pathological changes of ankle joint in L. rotata total flavonoid group （P＞0.05）. CONCLUSIONS ：Tibetan medicine L. rotata shows well anti-RA activity ，and total flavonoids may be the active ingredients of its efficacy.

Objective:To explore the curative effect of assisted surgery based on 3D printing technology on complex Pilon fractures.Methods:From June 2017 to June 2018, 52 patients with complex Pilon fracture treated in the General Hospital of Armed Police Navy were selected in the study.The patients were divided into study group ( n=26) and control group ( n=26) according to different operation mode.The control group was treated with traditional open reduction and internal fixation, and the study group was supplemented with 3D printing technology.The differences of treatment effect, operation time, intraoperative hemorrhage, fracture healing time, hospitalization time, incidence of complications, ankle function score and VAS pain score between the two groups were compared. Results:The total effective rate of the study group was 88.5%(23/26), which was higher than 65.4%(17/23) of the control group (χ 2=3.900, P=0.048). The mean operation time ( t=-3.770, P<0.001), mean fracture healing time ( t=-2.206, P=0.032) and mean hospitalization time ( t=-9.542, P<0.001) of the study group were shorter than those of the control group, and the amount of intraoperative bleeding ( t=-20.226, P<0.001) was less than that of the control group, the differences were statistically significant.The total incidence of complications in the study group was 15.4%(4/23), which was lower than 42.3%(11/23) in the control group (χ 2=4.591, P=0.032). With the development of time, the ankle function score of the two groups increased gradually, and the VAS pain score decreased gradually ( P<0.05). One month after operation, the ankle function score of the study group was higher than that of the control group ( t=2.340, P=0.023), but there was no statistically significant difference between the two groups in VAS pain score ( t=-0.278, P=0.782). At the last follow-up, the ankle function score of the study group was higher than that of the control group( t=2.760, P=0.008), and the VAS pain score of the study group was lower than that of the control group( t=-3.633, P<0.001), the differences were statistically significant. Conclusion:3D printing assisted surgery is better than traditional open reduction and internal fixation in the treatment of complex Pilon fracture, with shorter operation time, fracture healing time and hospitalization time, less intraoperative bleeding, lower incidence of complications and better postoperative recovery.

Objective: Abstract: Objective: To investigate the expression and significance of miR-138 and programmed cell death protein 1 (PD-1) in the patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). Methods: A total of 30 patients with HBV-related HCC, 20 with HBV-related cirrhosis (LC) and 30 with chronic hepatitis B (CHB) were recruited from Jiaozuo People′s Hospital. The blood samples from all patients and the peritoneal effusion samples from HCC and LC patients were collected. The levels of miR-138 and soluble PD-1 (sPD-1) in blood and peritoneal effusion samples were detected by real-time PCR and ELISA, respectively. The expressions of PD-1 in T lymphocytes were measured with flow cytometry and western blot. The targeting effect of miR-138 on the 3′-non-coding region (3′-UTR) of PD-1 gene was verified by the dual-luciferase reporter gene system. Results: The relative expression levels of miR-138 in the peritoneal effusion and plasma of HBV-related HCC patients were significantly lower than those in LC and CHB patients (P＜0.05). The serum sPD-1 levels and the expression levels of PD-1 in CD3 + T lymphocytes of HBV-related HCC patients were significantly higher than those in LC and CHB patients (P＜0.05). The relative expression levels of miR-138 were negatively correlated with serum sPD-1 levels and the expression levels of PD-1 in CD3 + T lymphocytes (P＜0.05). The dual-luciferase reporter gene system and western blot results demonstrated that there was a targeting relationship between miR-138 and the 3′-UTR of PD-1 gene. After miR-138 was transfected, the expression level of PD-1 was significantly down-regulated. Conclusion miR-138 participates in the development and progression of HBV-related HCC probably by targeting PD-1.

Objective To evaluate the therapeutic effects of flute-needle vacuum assistant hole closure technique for large idiopathic macular hole (IMH).Methods The clinical data of 25 eyes with IMH of 408-939 μm in 23 patients who received pars plana vitrectomy with internal limiting membrane (ILM) peeling and flute-needle vacuum assistant hole closure technique from Feburary in 2017 to June in 2018 in Peking University International Hospital were retrospectively analyzed.The changes of best corrected visual acuity (BCVA) before and after operation were evaluated.The shapes of the hole closure were categorized,and the manifestations of outer retina were observed by optical coherence tomography (OCT),including external limiting membrane (ELM) and ellipsoid zone(EZ).Results The hole closure rate after surgery were 100％ (25/25),with the U type closure in 16 eyes and V type closure in 9 eyes.The BCVA was 0.76 ± 0.27 after operation,which was significantly improved in comparison with 1.05 ±0.29 before operation (t =3.61,P =0.01).The ELM of OCT image was (1 050.00±380.39)μm before operation,and that after operation reduced to (623.32 ± 328.66) μm,showing a significant difference between them (t =6.63,P=0.00).A fully reduced EZ band was seen after operation in comparison with before operation ([1 147.28±354.41] μm versus ([818.28±247.33] μm) (t=4.12,P=0.00).Conclusions A combination procedure of vitrectomy with flute-needle vacuum assistant hole closure technique is effective for large IMH,which is beneficial to the anatomical repair and functional recovery of outer retina.

Objective? To explore the effect of biofeedback exercise on the recovery of rectal function in patients with middle and low rectal cancer. Methods? From June 2015 to December 2016, 126 patients with low and middle rectal cancer who were going to undergo preoperative radiotherapy and chemotherapy, anterior rectal resection and preventive stoma were selected by purposive sampling. They were randomly divided into control group 1 (blank control group), control group 2 (pelvic floor muscle exercise group) and invention group (biofeedback exercise group) by random coding generated by SPSS software and were tracked longitudinally for 6 times in 16 months by high resolution anorectal manometry, 11 manometric indices including initial rectal sensory capacity and rectal fecal sensory capacity were measured. Results? The study was completed in 109 cases, including 38 cases in control group 1, 35 cases in control group 2, and 35 cases in invention group. The main effects of the changes of five indices, including anal resting pressure, rectal resting pressure, anal maximum systolic pressure, anal maximum systolic time and anal high pressure zone, were time (P＜ 0.05). The four indices of rectal initial capacity, rectal fecal sensory capacity, rectal maximum tolerance capacity and rectal compliance in the invention group were higher than those in the control group 1 (P＜0.05); the maximum rectal tolerance capacity and rectal compliance in the invention group were higher than those in the control group 2 (P＜ 0.05). Conclusions? The biofeedback exercise could significantly improve the sensory indicators of patients with middle and low rectal cancer and promote recovery.

Objective To explore the reasons why colorectal cancer patients refuse to accept genetic screening associated with hereditary bowel cancer and to provide a basis for further measures to improve the rate of genetic and bowel cancer screening in patients and families.Methods Totally 14 patients first diagnosed of colorectal cancer from 3 Class Ⅲ Grade A hospitals in Guangzhou between August and December 2017 and refused to accept genetic screening associated with bowel cancer were selected by purposive sampling. The phenomenological method in qualitative studies were used for unstructured interview in these patients. The data were organized and analyzed with Colaizzi analysis.Results This study boiled down to 4 topics: lack of knowledge, avoidance of facts, strong psychological defense mechanism, lack of confidence in existing medical technologies, distrust on medical workers and worries about negative effects.Conclusions Medical and nursing workers shall explore further the reasons why the patients refuse to accept genetic screening, provide genetic counselling, improve the rate of genetic screening in high-risk patients, and improve the diagnosis rate of hereditary bowel cancer.

Objectives To evaluate the efficacy and safety of administering Ivabradine in the elder patients with chronic heart failure(HF).Methods Totally 52 outpatients with chronic stable HF in Fuwai Hospital and Anzhen Hospital from August 2015 to February 2016,with heart rates (HR)of ＞70 bpmafter optimized medical therapy were selected and administrated Ivabradine for 3 months(Ivabradine group).50 patients who received optimized medical therapy except Ivabradine for economic or other reasons were recruited as control group during the same period.Initial dose of Ivabradine was 2.5 mg two times a day,up to a maximum of 7.5 mg two times a day,adjusting the dose according to HR.Resting HR of the patients was maintained around 60 beats/min and not lower than 55 beats/min.HR,N-terminal pro-brain natriuretic peptide (NT-proBNP),6-minute walk distance,Minnesota heart failure quality of life(MLHFQ),left ventricular ejection fraction(LVEF) and adverse effects were recorded.Results At baseline,no significant differences were found in HR,NT-proBNP,the scores of MLHFQ,6-minute walk distance (all P＞ 0.05) between Ivabradine group and control group.After 3 months of treatment,compared with control group,Ivabradine group showed significantly decreased levels of HR,the scores of MLHFQ and NT-proBNP(allP＜0.01),and significantly increased 6-minute walk distance and LVEF(all P＜0.01).Compared with baseline data,Ivabradine treatment showed the decreased levels of HR [(69.5 ± 10.2)bpm vs.(80.2 ± 7.8)bpm,P＜0.05],the scores of MLHFQ [(14.9±4.3)scores vs.(23.5±6.2)scores(P＜0.05)]and NT-proBNP [1 682 ng/L (212-3 628) vs.2 450 (254-5 344) ng/L,P ＜ 0.05] significantly,and showed the significantly increased levels of 6-minute walk distance [(386.4 ± 101.8)m vs.(282.9 ± 86.3)m,P＜ 0.05]and LVEF [(40.0±6.0)％vs.(31.0±7.0)％ (P＜0.05)].Few adverse effects were recorded.Conclusions In elderly outpatients with stable HF,Ivabradine treatment is effective and safe.