[The accuracy and feasibility study of freehand pedicle screw insertion for subaxial cervical spine assisted with safe core-referred technique].

Objectives: To construct the "safe core" of the pedicle screw trajectory using CT imaging data of the subaxial cervical spine in adults, and to assess the accuracy and feasibility of the pedicle screw insertion assisted with the "safe core-referred technique" for subaxial cervical spine with a cadaver specimen study. Methods: This is an experimental study. From January 2015 to March 2020,60 adults' CT images data of the cervical spine were collected from the database of the First Affiliated Hospital of Gannan Medical University,and were imported into Mimics 20.0 software. Virtual cervical pedicle trajectory and safe core were constructed according to the self-designed "virtual construction method of pedicle in the subaxial cervical spine". The success rate of the construction and the spatial position data of the virtual safe core of was recorded,including the distance between the safe core and the tangent line of the upper and lower outer edge of Luschka's joint on coronal plane,and the distance between the safe core and the posterior edge of the vertebral body on sagittal plane.The 3.5 mm column was used to simulate the pedicle screw placement,using the safe core as the only hub in pedicle screw trajectory.The length of the anterior pedicle screw trajectory,the interval of the abductive angle of the pedicle screw in axial plane, and the projection area of the entry area on periapical radiograph was calculated.In addition,8 adult cervical cadaver specimens were collected for the pedicle screw insertion experiment.The left side group used the "safe core-referred technique" for pedicle screw insertion,while the right side group used the Abumi method for pedicle screw insertion.The accuracy of pedicle screw placement was verified by CT scan.The difference between the accuracy of subjective judgment based on X-ray monitoring of operator and the actual accuracy of pedicle screw insertion verified by CT scan was compared between the two groups.The chi-square test was used to compare the intergroup data. Results: The total success rate of the virtual construction method for the safe core of the subaxial cervical spine was 97.0% (291/300); The distance between the safe core and the tangent line of the upper and lower outer edge of Luschka's joint on coronal plane was (M(IQR)) 0.91 (0.98) mm (range: 0 to 1.85 mm);The distance between the safe core and the posterior wall on the sagittal plane of the vertebral body was (2.01±0.86) mm (range: 0.67 to 3.53 mm). The distance (anterior pedicle screw trajectory) from the posterior cortex to the central point of the safe core was (11.58±1.00)mm (range: 8.27 to 14.93 mm).The projection area of the entry point on the coronal plane was (36.18±11.67) mm2 (range: 13.38 to 83.11 mm2). Pedicle screw insertion experiment in cervical cadaver specimen showed the rate of intraoperative correction of the pedicle screw trajectory was 7.5% (3/40) in the experimental group and 12.5% (5/40) in the control group (χ2=0.139,P=0.709). The operator 's correct rate of subjective judgment on CT in the stage of pedicle screw trajectory preparation was 100% (40/40) in the experimental group and 82.5% (33/40) in the control group, the difference was statistically significant (χ2=5.638,P=0.018). The actual correct rate of CT verification in the stage of pedicle screw insertion was 100% (40/40) in the experimental group and 90.0% (36/40) in the control group, the difference was statistically significant (χ2=2.368,P=0.124); The operator 's correct rate of subjective judgment in the stage of pedicle screw insertion completion was 100% (83/83) in the experimental group and 92.9% (79/85) in the control group (χ2=4.199,P=0.040). Conclusions: The virtual safe-core of subaxial cervical spine can be use as a reliable anatomical fluoroscopy landmark for freehand pedicle screw insertion."Safe core-referred technique" can improve the accuracy rate of the operator's subjective judgment on the intraoperative fluoroscopy monitoring,and hence improve the accuracy of freehand pedicle screw insertion technology for subaxial cervical spine. And it still needs to be further verified in clinical practice.

[Ferroptosis and drug-induced liver injury].

Ferroptosis is a type of regulated cell death driven by iron-dependent lipid peroxidation that has received extensive attention in recent years. A growing body of evidence suggests that ferroptosis contributes to the progression of drug-induced liver injury. Therefore, the role and mechanism of ferroptosis in the process of drug-induced liver injury deserve further extensive and in-depth exploration, which will aid in the discovery of novel biomarkers as well as the identification of potential approches of targeting ferroptosis to intervene in drug-induced liver injury.

[Construction and evaluation of a nomogram for predicting the prognosis of patients with colorectal cancer with peritoneal carcinomatosis treated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy].

Objectives: To construct a nomogram incorporating important prognostic factors for predicting the overall survival of patients with colorectal cancer with peritoneal metastases treated with cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC), the aim being to accurately predict such patients' survival rates. Methods: This was a retrospective observational study. Relevant clinical and follow-up data of patients with colorectal cancer with peritoneal metastases treated by CRS + HIPEC in the Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University from 2007 January to 2020 December were collected and subjected to Cox proportional regression analysis. All included patients had been diagnosed with peritoneal metastases from colorectal cancer and had no detectable distant metastases to other sites. Patients who had undergone emergency surgery because of obstruction or bleeding, or had other malignant diseases, or could not tolerate treatment because of severe comorbidities of the heart, lungs, liver or kidneys, or had been lost to follow-up, were excluded. Factors studied included: (1) basic clinicopathological characteristics; (2) details of CRS+HIPEC procedures; (3) overall survival rates; and (4) independent factors that influenced overall survival; the aim being to identify independent prognostic factors and use them to construct and validate a nomogram. The evaluation criteria used in this study were as follows. (1) Karnofsky Performance Scale (KPS) scores were used to quantitatively assess the quality of life of the study patients. The lower the score, the worse the patient's condition. (2) A peritoneal cancer index (PCI) was calculated by dividing the abdominal cavity into 13 regions, the highest score for each region being three points. The lower the score, the greater is the value of treatment. (3) Completeness of cytoreduction score (CC), where CC-0 and CC-1 denote complete eradication of tumor cells and CC-2 and CC-3 incomplete reduction of tumor cells. (4) To validate and evaluate the nomogram model, the internal validation cohort was bootstrapped 1000 times from the original data. The accuracy of prediction of the nomogram was evaluated with the consistency coefficient (C-index), and a C-index of 0.70-0.90 suggest that prediction by the model was accurate. Calibration curves were constructed to assess the conformity of predictions: the closer the predicted risk to the standard curve, the better the conformity. Results: The study cohort comprised 240 patients with peritoneal metastases from colorectal cancer who had undergone CRS+HIPEC. There were 104 women and 136 men of median age 52 years (10-79 years) and with a median preoperative KPS score of 90 points. There were 116 patients (48.3%) with PCI≤20 and 124 (51.7%) with PCI>20. Preoperative tumor markers were abnormal in 175 patients (72.9%) and normal in 38 (15.8%). HIPEC lasted 30 minutes in seven patients (2.9%), 60 minutes in 190 (79.2%), 90 minutes in 37 (15.4%), and 120 minutes in six (2.5%). There were 142 patients (59.2%) with CC scores 0-1 and 98 (40.8%) with CC scores 2-3. The incidence of Grade III to V adverse events was 21.7% (52/240). The median follow-up time is 15.3 (0.4-128.7) months. The median overall survival was 18.7 months, and the 1-, 3- and 5-year overall survival rates were 65.8%, 37.2% and 25.7%, respectively. Multivariate analysis showed that KPS score, preoperative tumor markers, CC score, and duration of HIPEC were independent prognostic factors. In the nomogram constructed with the above four variables, the predicted and actual values in the calibration curves for 1, 2 and 3-year survival rates were in good agreement, the C-index being 0.70 (95% CI: 0.65-0.75). Conclusions: Our nomogram, which was constructed with KPS score, preoperative tumor markers, CC score, and duration of HIPEC, accurately predicts the survival probability of patients with peritoneal metastases from colorectal cancer treated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy.

[The pulmonary toxicity of e-cigarette vaping exposure and the benefits of air cleaner application].

To evaluate e-cigarette vaping-induced respiratory toxicity and the interventional effects of air cleaners. A randomized controlled trial study of toxic vaping by the respiratory tract were conducted at the Key Laboratory of Environmental Medical Engineering, Ministry of Education, the School of Public Health, Southeast University from January to December 2022. 8-week-old male C57BL/6JGpt mice selected with a random number table method were used to establish a vaping-exposure model at different periods (0 d, 3 d, 7 d or 14 d), or exposed to clean air as a control group. Mice were exposed to regular heated vaping (200 ℃) and high-temperature heated vaping (280 ℃). Total lung RNA was extracted from control and e-cigarette exposed mice for transcriptome sequencing analysis. Reactive Oxygen Species (ROS) generation and mitochondrial membrane potential (MMP) were detected by flow cytometry. Total superoxide dismutase (SOD) and superoxide (O2-) were evaluated using a microplate reader. Real-Time Quantitative PCR (RT-qPCR) was used to detect gene expression. Air filter and ionizer were used to intervene the toxicity of vaping. Data were expressed as (x¯±s), differences between multiple groups were compared using one-way or two-way ANOVA. The results showed that, RNA sequencing assays suggested that the differential genes between the control and vaping exposure groups were significantly enriched in the oxidative stress (Fold Enrichment=3.18) and mitochondrial oxidative phosphorylation (OXPHOS) (Fold Enrichment=5.74) pathways. Both types of heated vaping exposure caused significantly increased the score of alveolitis (F=10.8, P<0.001), increased endogenous ROS generation (F=16.8, P<0.001), decreased MMP (F=13.6, P<0.01), and gene expression of mitochondrial complex I dysfunction. The toxic effects of high-temperature heated vaping were stronger compared to regular heated vaping (F=2.9, P<0.05). The filter demonstrated better protective effects against vaping than the ionizer by reducing pulmonary alveolitis (F=7.4, P<0.01). Air cleaners could partially alleviate oxidative stress and mitochondrial dysfunction. In conclusion, this study demonstrate that vaping brings potential health risks. Air cleaners could partially reverse mitochondrial dysfunction, but cannot completely prevent the toxic effects, effective interventions remain to be investigated.

[Feasibility and safety of bridge therapy with active fixed electrodes connected to external permanent pacemakers for patients with infective endocarditis after lead removal and before permanent pacemaker implantation].

Objective: To analyze the feasibility and safety of bridge therapy with active fixed electrodes connected to external permanent pacemakers (AFLEP) for patients with infective endocarditis after lead removal and before permanent pacemaker implantation. Methods: A total of 44 pacemaker-dependent patients, who underwent lead removal due to infective endocarditis in our center from January 2015 to January 2020, were included. According to AFLEP or temporary pacemaker option during the transition period, patients were divided into AFLEP group or temporary pacemaker group. Information including age, sex, comorbidities, indications and types of cardial implantable electionic device (CIED) implantation, lead age, duration of temporary pacemaker or AFLEP use, and perioperative complications were collected through Haitai Medical Record System. The incidence of pacemaker perception, abnormal pacing function, lead perforation, lead dislocation, lead vegetation, cardiac tamponade, pulmonary embolism, death and newly infection of implanted pacemaker were compared between the two groups. Pneumothorax, hematoma and the incidence of deep vein thrombosis were also analyzed. Results: Among the 44 patients, 24 were in the AFLEP group and 20 in the temporary pacemaker group. Age was younger in the AFLEP group than in the temporary pacemaker group (57.5(45.5, 66.0) years vs. 67.0(57.3, 71.8) years, P=0.023). Male, prevalence of hypertension, diabetes mellitus, chronic renal dysfunction and old myocardial infarction were similar between the two groups (all P>0.05). Lead duration was 11.0(8.0,13.0) years in the AFLEP group and 8.5(7.0,13.0) years in the temporary pacemaker group(P=0.292). Lead vegetation diameter was (8.2±2.4)mm in the AFLEP group and (9.1±3.0)mm in the temporary pacemaker group. Lead removal was successful in all patients. The follow-up time in the AFLEP group was 23.0(20.5, 25.5) months, and the temporary pacemaker group was 17.0(14.5, 18.5) months. In the temporary pacemaker group, there were 2 cases (10.0%) of lead dislocation, 2 cases (10.0%) of sensory dysfunction, 2 cases (10.0%) of pacing dysfunction, and 2 cases (10.0%) of death. In the AFLEP group, there were 2 cases of abnormal pacing function, which improved after adjusting the output voltage of the pacemaker, there was no lead dislocation, abnormal perception and death. Femoral vein access was used in 8 patients (40.0%) in the temporary pacemaker group, and 4 patients developed lower extremity deep venous thrombosis. There was no deep venous thrombosis in the AFLEP group. The transition treatment time was significantly longer in the AFLEP group than in the temporary pacemaker group (19.5(16.0, 25.8) days vs. 14.0(12.0, 16.8) days, P=0.001). During the follow-up period, there were no reinfections with newly implanted pacemakers in the AFLEP group, and reinfection occurred in 2 patients (10.0%) in the temporary pacemaker group. Conclusions: Bridge therapy with AFLEP for patients with infective endocarditis after lead removal and before permanent pacemaker implantation is feasible and safe. Compared with temporary pacemaker, AFLEP is safer in the implantation process and more stable with lower lead dislocation rate, less sensory and pacing dysfunction.

[Safety and efficacy of high-power, short-duration superior vena cava isolation in combination with conventional radiofrequency ablation in patients with paroxysmal atrial fibrillation: a randomized controlled trial].

Objective: For patients with paroxysmal atrial fibrillation, superior vena cava isolation on the basis of pulmonary vein isolation may further improve the long-term success rate of radiofrequency ablation. We aimed to explore the efficacy and safety of superior vena cava isolation by high-power and short-duration (HPSD) ablation plus conventional radiofrequency ablation (RA) in patients with paroxysmal atrial fibrillation. Methods: It was a prospective randomized controlled study. From January 1, 2019 to June 1, 2020, 180 patients who underwent radiofrequency ablation for paroxysmal atrial fibrillation in our center were consecutively screened. Patients were eligible if there was a trigger potential and the muscle sleeve length was greater than 3 cm. A total of 60 eligible patients were finally included and randomly divided into HPSD group (HPSD plus RA) and common power and duration (CPD) group (CPD plus RA) by random number table method (n=30 in each group). Efficacy was evaluated by ablation points, isolation time and ablation time. Safety was evaluated by the incidence of POP, cardiac tamponade, phrenic nerve injury, sinoatrial node injury and all-cause. Results: Superior vena cava isolation was achieved by 14 (13, 15) points in the HPSD group, which was significantly less than that in the CPD group (20(18, 22), P<0.001). The superior vena cava isolation time was 8 (7, 9) minutes in the HPSD group, which was significantly shorter than in the CPD group (17(14, 20) minutes, P<0.001). The average ablation time significantly shorter in HPSD group than in CPD group (78.0(71.1, 80.0) s vs. 200(167.5, 212.5)s, P<0.001). The average impedance drop was more significant in the HPSD group than in the CPD group (20.00(18.75, 21.00)Ω (and the percentage of impedance drop was 15%) vs. 12.00(11.75, 13.25)Ω (the percentage of impedance decrease was 12%), P<0.001). There was 1 POP (3.3%) in the HPSD group, and 3 POPs (10.0%) in the CPD group (P>0.05). There was no cardiac tamponade, phrenic nerve injury, sinoatrial node injury and death in both groups. Conclusions: HPSD technique for the isolation of superior vena cava is safe and effective in patients with paroxysmal atrial fibrillation undergoing conventional radiofrequency ablation.

[Clinical efficacy of split liver transplantation in the treatment of children with biliary atresia].

Objective: To compare the clinical efficacy of split liver transplantation (SLT) and living donor liver transplantation(LDLT) in the treatment of children with biliary atresia. Methods: The clinical data of 64 children with biliary atresia who underwent SLT and 44 children who underwent LDLT from June 2017 to May 2022 at Liver Surgery & Liver Transplantation Center,the Third Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed. Among the children who received SLT, there were 40 males and 24 females. The median age at transplantation was 8 months (range:4 to 168 months). Among the patients who received LDLT, there were 24 males and 20 females. The age at transplantation ranged from 4 to 24 months,with a median age of 7 months. Sixty-four children with biliary atresia were divided into two groups according to the SLT operation time: 32 cases in the early SLT group(June 2017 to January 2019) and 32 cases in the technically mature SLT group (February 2019 to May 2022). Rank sum test or t test was used to compare the recovery of liver function between the LDLT group and the SLT group,and between the early SLT group and the technically mature SLT group. The incidence of postoperative complications was compared by χ2 test or Fisher exact probability method. Kaplan-Meier method and Log-rank test were used for survival analysis. Results: The cold ischemia time(M (IQR)) (218 (65) minutes), intraoperative blood loss(175 (100) ml) and graft-to-recipient body weight ratio (3.0±0.7) in the LDLT group were lower than those in the SLT group(500 (130) minutes, 200 (250) ml, 3.4±0.8) (Z=-8.064,Z=-2.969, t=-2.048, all P<0.05). The cold ischemia time(457(158)minutes) and total hospital stay ((37.4±22.4)days) in the technically mature SLT group were lower than those in the early SLT group(510(60)minutes, (53.0±39.0)days).The differences were statistically significant (Z=-2.132, t=1.934, both P<0.05).The liver function indexes of LDLT group and SLT group showed unimodal changes within 1 week after operation. The peak values of ALT, AST, prothrombin time, activeated partial thromboplasting time, international normalized ratio, fibrinogen and creatinine all appeared at 1 day after operation, and the peak value of prothrombin activity appeared at 3 days after operation. All indicators returned to normal at 7 days after operation. The 1-,2-,and 3-year overall survival rates were 95.5% in LDLT group and 93.5% in the technically mature SLT group, and the difference was not statistically significant. The 1-,2-,and 3-year overall survival rates were 90.2% in the early SLT group and 93.5% in the technically mature SLT group, and there was no significant difference between the two groups(P>0.05). The main complications of the early SLT group were surgery-related complications(28.1%,9/32), and the main complications of the technically mature SLT group were non-surgery-related complications(21.9%,7/32). There were 5 deaths in the SLT group,including 4 in the early SLT group and 1 in the technically mature SLT group. Conclusion: The survival rate of SLT in the treatment of biliary atresia is comparable to that of LDLT.

[Effect of Li's catheter in the cardiac resynchronization therapy implantation].

Objective: To evaluate the effect of Li's catheter in cardiac resynchronization therapy (CRT) implantation. Methods: This study was a retrospective cohort study. Patients with indications for CRT implantation who visited the Department of Cardiology, Peking University People's Hospital from January 1, 2016 to January 1, 2022 were enrolled. Patients were divided into Li's catheter group (CRT implantation with Li's catheter) and control group (CRT implantation with the traditional method). The general clinical data of the patients were obtained through the electronic medical record system. Li's catheter is a new type of coronary sinus angiography balloon catheter independently developed by Dr. Li Xuebin (patent number: 201320413174.1). The primary outcome was the success rate of CRT device implantation, and the secondary outcomes included efficacy and safety parameters. Efficacy indicators included operation time, coronary sinus angiography time, left ventricular lead implantation time, X-ray exposure time, left ventricular lead threshold, and diaphragm stimulation. Safety outcomes included incidence of coronary sinus dissection, cardiac tamponade, and pericardial effusion. Results: A total of 170 patients were enrolled in this study, including 90 in Li's catheter group and 80 in control group. Age, male proportion of patients, proportion of patients with ischemic cardiomyopathy, hypertension, diabetes mellitus, chronic renal insufficiency, New York Heart Association (NYHA) functional classification, left ventricular ejection fraction, left ventricular end-diastolic diameter, proportion of left bundle branch block, and preoperative QRS wave width were similar between the two groups (all P>0.05). In Li's catheter group, 34 cases (37.8%) implanted with CRT defibrillators, and 28 cases (35.0%) implanted with CRT defibrillators in control group, the difference was not statistically significant (P=0.710). The success rate of CRT device implantation in Li's catheter group was 100% (90/90), which was significantly higher than that in control group (93.8%, 75/80, P=0.023).The operation time was 57.0 (52.0, 62.3) minutes, the time to complete coronary sinus angiography was 8.0 (6.0, 9.0) minutes, and the time of left ventricular electrode implantation was 8.0 (7.0, 9.0) minutes in Li's catheter group, and was 91.3 (86.3, 97.0), 18.0 (16.0, 20.0), 25.0 (22.0, 27.7) minutes respectively in control group, all significantly shorter in Li's catheter group (all P<0.05). The exposure time of X-ray was 15.0 (14.0, 17.0) minutes in Li's catheter group, which was also significantly shorter than that in control group (32.5 (29.0, 36.0) minutes, P<0.001). There was no coronary sinus dissection and cardiac tamponade in Li's catheter group, and 1 patient (1.1%) had diaphragmatic stimulation in Li's catheter group. In control group, 6 patients (6.7%) had coronary sinus dissection, and 1 patient (1.1%) developed pericardial effusion, and 3 patients (3.3%) had diaphragmatic stimulation. The incidence of coronary sinus dissection in Li's catheter group was significantly lower than that in control group (P=0.011). The postoperative left ventricular thresholds in Li's catheter group and control group were similar (1.80 (1.60, 2.38) V/0.5 ms vs. 1.80 (1.60, 2.40) V/0.5 ms, P=0.120). Conclusions: Use of Li's catheter is associated with higher success rate of CRT implantation, short time of coronary sinus angiography and left ventricular electrode implantation, reduction of intraoperative X-ray exposure, and lower incidence of coronary vein dissection in this patient cohort.

[The effect of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy on peritoneal carcinomatosis from colorectal cancer].

Objective: To evaluate the safety and efficacy of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS+ HIPEC) in patients with peritoneal carcinomatosis from colorectal carcinoma (CRC PC). Methods: The clinical and follow-up data of 90 consecutive CRC PC patients underwent CRS+ HIPEC in Beijing Shijitan Hospital from January 2015 to June 2018 were collected. Kaplan-Meier method and parallel Log rank test were used for survival analysis. Cox regression model was used for univariate and multivariate analysis. Results: A total of 90 CRC PC patients underwent CRS+ HIPEC, the median age was 53 years (rage: 13 to 81 years), and 51 cases were male, while other 39 were female. The median overall survival (mOS) was 21.9 months (95%CI: 15.7, 28.1). The 1-, 2-, 3-, and 5-year survival rates were 77.8%, 48.6%, 21.1%, and 5.5%, respectively. The incidence rate of serious adverse event (SAE) was 8.9% (8/90). The mortality rate of perioperative period was 2.2% (2/90). Univariate analysis showed the age (P=0.040), primary tumor site (P=0.020), preoperative carbohydrate antigen 125 (CA125) level (P<0.001), peritoneal cancer index (PCI) (P<0.001), completeness of cytoreduction (CC) (P<0.001), ascites (P=0.012) and postoperative adjuvant chemotherapy (P<0.001) were significantly associated with the OS. Multivariate Cox-analysis identified preoperative CA125 level(P=0.033), CC of 0 to 1 (P=0.014), and adjuvant chemotherapy postoperative (P=0.002) were independent prognostic factor for OS. Conclusions: CRS+ HIPEC can improve survival for CRC PC patients with acceptable morbidity and mortality. Stringent patient selection and complete CRS are two key factors for better survival.

[Value of D-dimer and left atrial size combined with CHA2DS2-VASc score in excluding left atrial thrombosis in patients with non-valvular atrial fibrillation].

Objective: To investigate the related factors of thrombosis in patients with non-valvular atrial fibrillation (NVAF), and whether the combination of D-dimer, left atrial anteroposterior diameter and CHA2DS2-VASc score can be used to exclude left atrial thrombosis. Methods: A total of 75 NVAF patients with left atrial thrombosis confirmed by transesophageal echocardiography in Peking University People's Hospital from January 1, 2015 to December 31, 2019 were enrolled as the thrombus group. From January 1 to October 31, 2019, 80 patients with NVAF without left atrial thrombosis were enrolled as the control group. The clinical data, CHA2DS2-VASc score, hematological biomarkers, ultrasound data of two groups were compared. The independent factors associated with left atrial thrombosis were screened by univariate analysis and multivariate logistic regression analysis. The positive predictive value and negative predictive value for the diagnosis of left atrial thrombosis were gained by the score calculated based on the independent related factors. Results: There were no significant differences in age, gender, proportion of persistent atrial fibrillation and duration of atrial fibrillation between the two groups. The CHA2DS2-VASc score [M (Q1, Q3)] of the thrombus group was higher than that of the control group [2.5 (1.0, 3.0) vs 1.8 (1.0, 3.0), P=0.012]. The prothrombin time activity [M (Q1, Q3)] of the thrombus group was 81.1 (72.0, 93.0)%, which was lower than that of the control group 88.8 (83.0,96.0)% (P=0.008). The activated partial thromboplastin time (APTT) of the thrombus group was longer than that of the control group [(32.1±4.8) s vs (30.2±3.7) s, P=0.006]. D-dimer [M (Q1, Q3)] of the thrombus group was 231.0 (71.5, 272.2) ng/ml, which was higher than that of the control group 121.7 (49.0, 140.0) ng/ml (P<0.001). The left atrial anteroposterior diameter in thrombus group was larger [(44.6±6.6) mm vs (38.9±5.3) mm, P<0.001], the proportion of mitral regurgitation was higher (58.1% vs 26.8%, P<0.001). The left ventricular ejection fraction [M (Q1, Q3)] of the thrombus group was 56.7% (45.8%, 66.3%), which was lower than that of the control group 63.3% (60.5%, 70.2%) (P=0.003). Multivariate logistic regression analysis showed that the factor related to left atrial thrombosis was left atrial anteroposterior diameter (OR=4.480, 95%CI: 1.616-12.423). The negative predictive value of the new scoring system combined with D-dimer, left atrial anteroposterior diameter and CHA2DS2-VASc score for left atrial thrombosis was 100%. Conclusions: In NVAF patients, the factor independently associating with left atrial thrombosis is left atrial anteroposterior diameter. The combination of D-dimer, left atrial anteroposterior diameter, and CHA2DS2-VASc score can help exclude left atrial thrombosis before ablation of NVAF.

A FPGA-based adaptive differential current source for electrical impedance tomography.

A high output impedance current source with a wide bandwidth is needed in electrical impedance tomography systems. Limitations appear mainly at higher frequencies and non-simple loads. In order to adjust the output current, the amplitude and phase are made to achieve the expected value automatically. A current source based on the field programmable gate array is designed. In this paper, we proposed a double DAC differential current source structure. By measuring the voltage of the sampling resistor in series with the load and using the proposed dynamic reference point demodulation algorithm, the actual current amplitude and phase on the load can be quickly obtained. Through the adaptive compensation module, the output current is adjusted to the expected value. The experimental results show that the output resistance of the current source can reach 10 MΩ and the output capacitance can be less than 0.8 pF in the frequency range of 10 kHz-1.28 MHz. At the same time, the current amplitude attenuation is less than 0.016%, and the phase error is less than 0.0025° after compensation. Therefore, the proposed current source achieves widebands, biocompatibility, and high precision.

[Efficacy of 1 384 cases of peritoneal carcinomatosis underwent cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy].

Objective: Peritoneal carcinomatosis refers to a group of heterogeneous (primary or secondary) malignancies in the surface of the peritoneum. Cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) is a comprehensive treatment strategy aiming at peritoneal carcinomatosis. This study analyzed the efficacy and safety of CRS+HIPEC in patients with peritoneal carcinomatosis, and explored prognostic factors. Methods: In this descriptive case-series study, the clinicopathological data of 1384 consecutive patients with peritoneal carcinomatosis treated in Zhongnan Hospital of Wuhan University (330 patients) and Shijitan Hospital of Capital Medical University (1054 patients) from January 2004 to January 2020 were collected retrospectively. Treatment patterns of CRS+HIPEC characteristics (operative time, number of resected organs, number of stripped peritoneum, number of anastomosis, and HIPEC regimens), safety [blood loss volume, postoperative severe adverse event (SAE) and treatment outcome], survival time and prognostic factors influencing survival were analyzed. The SAE was defined as grade III-IV adverse event according to the Peritoneal Surface Oncology Group International Textbook. Perioperative period was defined from the day of CRS+HIPEC to postoperative 30th day. OS was calculated from the day of CRS+HIPEC to the date of death or the last follow-up. Kaplan-Meier method was used for survival analysis, and log-rank test was used for comparison between groups. Cox regression model was used to identify the prognostic factors. Results: Among 1384 peritoneal carcinomatosis patients, 529 (38.2%) were male; median age was 55 (10-87) years old; median body mass index (BMI) was 22.6 kg/m(2); peritoneal carcinomatosis of 164 (11.8%) patients were from gastric cancer, 287 (20.7%) from colorectal cancer, 356 (25.7%) from pseudomyxoma peritonei, 90 (6.5%) from malignant peritoneal mesothelioma, 300 (21.7%) from gynecological cancer or primary peritoneal carcinoma, and 187 (13.5%) from retroperitoneal sarcoma, lung cancer, breast cancer, and other rare tumors. The median duration of CRS+HIPEC was 595 (90-1170) minutes, median number of resected organs was 2 (0-10), median number of resected peritoneal area were 4 (0-9), median peritoneal cancer index (PCI) was 21(1-39). Completeness of cytoreduction (CC) score of 0-1 was observed in 857 cases (61.9%). Regarding HIPEC regimens, there were 917 cases (66.3%) with cisplatin plus docetaxel, 183 cases (13.2%) with cisplatin plus mitomycin, 43 cases (3.1%) with adriamycin plus ifosfamide, and the other 240 cases (17.3%) with modified regimens. Perioperative SAE developed in 331 peritoneal carcinomatosis patients (23.9%) with 500 cases, of whom 21 patients (1.5%) died during the perioperative period due to ineffective treatment, while the others recovered after active treatment. During median follow-up time of 8.6 (0.3-82.7) months, there were 414 deaths (29.9%). The median OS was 38.2 months (95% CI: 30.6-45.8), and the 1-, 3-, 5-year survival rate was 73.5%, 50.4% and 39.3%, respectively. The median OS of peritoneal carcinomatosis patients from gastric cancer, colorectal cancer, pseudomyxoma peritonei, malignant peritoneal mesothelioma and female genital cancer or primary peritoneal carcinomatosis was 11.3 months (95% CI: 8.9-13.8), 18.1 months (95% CI: 13.5-22.6), 59.7 months (95% CI: 48.0-71.4), 19.5 months (95% CI: 6.0-33.0) and 51.7 months (95% CI: 14.6-88.8), respectively, and the difference among groups was statistically significant (P<0.001). Univariate and multivariate analyses revealed that the primary gastric cancer (HR=4.639, 95% CI: 1.692-12.724), primary colorectal cancer (HR=4.292, 95% CI: 1.957-9.420), primary malignant peritoneal mesothelioma (HR=2.741, 95% CI: 1.162-6.466), Karnofsky performance status (KPS) score of 60 (HR=4.606, 95% CI: 2.144-9.895), KPS score of 70 (HR=3.434, 95% CI: 1.977-5.965), CC score of 1 (HR=2.683, 95% CI: 1.440~4.999), CC score of 2-3 (HR=3.661,95% CI: 1.956-6.852) and perioperative SAE (HR=2.588, 95% CI: 1.846-3.629) were independent prognostic factors influencing survival with statistically significant differences (all P<0.05). Conclusions: CRS+HIPEC is an effective integrated treatment strategy for patients with peritoneal carcinomatosis, which can prolong survival with acceptable safety. Preoperative evaluation of patients' general condition is necessary and CRS+HIPEC should be carefully considered to perform for patients with preoperative KPS score <80. During the operation, the optimal CRS should be achieved on condition that safety is granted. In addition, it is necessary to prevent perioperative SAE to reduce the risk of death in peritoneal carcinomatosis patients.

[Identification of serum biomarkers and evaluation of metabolism disorders in patients with oral squamous cell carcinoma].

Objective: To explore the changes in serum metabolic profile in patients with oral squamous cell carcinoma (OSCC) and to identify the diagnostic biomarkers in order to provide new ideas for the early diagnosis of OSCC. Methods: In total, 76 OSCC patients who were diagnosed at the Department of Oral and Maxillofacial Surgery and 70 healthy individuals who at the Department of Medical Center of The First Affiliated Hospital of Zhengzhou University from August 2019 to January 2020 were recruited in The study. According to the random number table method, all subjects were divided into a test group (n=96) and a verification group (n=50). Subjects in the test group consisted of 51 OSCC patients and 45 healthy subjects and subjects in the verification group included 25 OSCC patients and 25 healthy individuals. Serum samples and clinical data of each of the subjects were collected. The serum samples were analyzed by ultra-high-performance liquid chromatography quadrupole-Orbitrap high resolution accurate mass spectrometry. Principal component analysis, orthogonal partial least square discrimination analysis and t-test were used to profile the differential metabolites in the test group. Pathway analysis of differential metabolites was performed. In addition, binary logistic regression analysis and receiver operating characteristic analysis were used in order to establish the potential diagnostic panel. Results: Twenty-one endogenous differential metabolites were identified showing significant association with OSCC. Results of pathway analysis suggested that OSCC associated with lipid metabolism and amino acid metabolism (P<0.05). A novel diagnostic panel consisting of lysophosphatidylcholine (LysoPC) (16∶0/0∶0), LysoPC[18∶1(9z)/0∶0], taurine and D-glutamic acid was defined. The panel performed a high area under the receiver operating characteristic curve (0.998, 95%CI: 0.994-0.999, P<0.05). Conclusions: There were obvious lipid and amino acid metabolism disorders in OSCC patients. It was an effective method to establish a diagnostic model by metabolomics.

[Evaluation of the effect of the water-saving irrigation project on Oncomelania hupensis control in hilly regions of Yixing City, Jiangsu Province].

OBJECTIVE: To evaluate the effect of the water-saving irrigation project on Oncomelania hupensis snail control in hilly regions of Yixing City, Jiangsu Province. METHODS: A retrospective survey combined with cross-sectional investigation was employed. The implementation of the water-saving irrigation development project in Yixing City from 2005 to 2007 was retrospectively collected, and the snail status was collected in regions where the water-saving irrigation project was located and the project-affected regions from 2003 to 2018, to examine the effect of the project on snail control. In addition, a cross-sectional survey was performed to investigate the destruction of the water-saving irrigation project in 2018. RESULTS: A total of 22 water-saving irrigation projects were implemented in 5 townships in hilly regions of Yixing City from 2005 to 2007, where snail habitats were treated covering 266.97 hm2. Before the implementation of the project from 2003 to 2006, cumulative 47.87 hm2 snail habitats were detected in regions where the project was located, and no snails were found in regions where the project was located from the implementation of the project in 2006 to 2018. However, a few snails were found in the project-affected regions in 2017 and 2018. In addition, there were problems found in the later-stage maintenance and management of the project. CONCLUSIONS: The water-saving irrigation projects shows a high efficiency on snail control in hilly regions of Yixing City. The later-stage maintenance of the project and monitoring of snails remain to be intensified to enhance the snail control efficiency of the water-saving irrigation project.

Application of Chrysomya rufifacies （Diptera, Calliphoridae） to Postmortem Interval Estimation in Southwest China: A Case Report.

ABSTRACT: Insect samples found on human corpses can provide the information important to estimating the minimum postmortem interval （PMImin）. A female cadaver, found in a deserted factory in Chongqing of China, was confirmed as a homicide case after the forensic investigation and autopsy. Determining the time of death was difficult due to the inconsistent degree of decomposition in different parts of the decedent. The insect specimens found on the cadaver were identified to be Chrysomya rufifacies （C. rufifacies, Macquart） by morphology and mitochondrial DNA sequence analysis. The PMImin was estimated to be 452 h, based on the developmental rate of C. rufifacies. The PMImin was estimated successfully to be almost precise, which provided an important entomological evidence for case investigation and suspect prosecution. In so doing, this highlights the usefulness of entomological evidence of specific species in the geographic area for PMI accurate estimation, especially in the case of advanced decomposed corpses.

Development of Dermestes Maculatus at a Constant Temperature and Its Larval Instar Determination.

ABSTRACT: Objective To establish the basic data for estimating minimum postmortem interval （PMImin） of heavily decayed and skeletonized remains by studying the development of Dermestes maculatus DeGeer （Coleoptera: Dermestidae）. Methods The developmental stages of Dermestes maculatus were observed at four constant temperatures of 20 ℃, 24 ℃, 28 ℃ and 32 ℃, and the changes in body length were also examined as the biological indicator to estimate larval day-age and instar. Results The total developmental time from egg to adult at 20 ℃, 24 ℃, 28 ℃ and 32 ℃ were （126.7±10.6） d, （69.4±8.2） d, （50.4±8.4） d and （49.6±6.5） d, respectively. The body length increased gradually, but changed irregularly as a whole. Conclusion The study provides basic data on the development and growth of Dermestes maculatus, especially on its developmental duration as a significant value for estimating PMImin of heavily decayed and skeletonized remains. Nevertheless, the change of body length is not found to be the best biological indicator for instar determination.

[The application of scales and characteristics of disability in the common genotypes of Charcot-Marie-Tooth disease].

Objective: To analyze the correlations among different common scales for evaluating the severity of the first-visit Charcot-Marie-Tooth disease (CMT), and explore the cross-sectional characteristics of neurological dysfunction in patients with four common genotypes (CMT1A, CMT1X, CMT2A and MPZ-related CMT) at their first visits. Methods: A total of 117 genetically confirmed CMT patients (aged ≥10 years) from the Department of Neurology of the Third Xiangya Hospital from 2009 to 2019 were included in the study, which consisted of 45 CMT1A, 41 CMT1X, 19 CMT2A, and 12 MPZ-related CMT patients. Clinical data of these patients at first visits were collected and neurological deficits were evaluated by Charcot-Marie-Tooth Neuropathy Score (CMTNS), Charcot-Marie-Tooth Examination Score (CMTES), Overall Neuropathy Limitation Scale (ONLS) and Functional Disability Scale (FDS). Spearman's correlation was performed to analyze the relationship between CMTNS, CMTES, ONLS and FDS. The age of onset, duration of disease, scores of CMTNS, CMTES, ONLS and FDS were compared among four genotypes. Results: In the 117 CMT patients, the male to female ratio was 1.79/1, and the age of onset was (19±13) years. The duration of disease was 10(3, 15) years, and the scores of CMTNS, CMTES, ONLS and FDS were 11.4±6.2, 8.8±5.7, 2.7±1.4 and 2.6±1.3, respectively. There was a significant correlation between CMTES, ONLS, FDS and CMTNS in the overall CMT patients and four subtypes respectively (r≥0.40, P<0.05). CMTNS, CMTES and ONLS scores of four subtypes showed positive correlations with duration of disease (P<0.05), but FDS scores of CMT1A, CMT1X and MPZ-related CMT patients exhibited no correlation with duration of disease (P>0.05) at their first visits. The age of onset in CMT2A patients was younger than that of the patients with the other three genotypes (P<0.05), furthermore, the scores of four scales in early-onset CMT2A patients were higher than those of adult-onset type CMT2A patients (CMTNS: P=0.031, CMTES: P=0.048, ONLS: P=0.042, FDS: P=0.047). In CMT1X patients, the males had higher scores than those of females for all four scales (CMTNS: P=0.028, CMTES: P=0.014, ONLS: P=0.023, FDS: P=0.002). Conclusions: CMTNS, CMTES and ONLS could be used in natural history studies and clinical trials according to the different clinical situations. In the four genotypes, CMT2A patients have younger age of onset, and the earlier the age of onset, the severer the dysfunction. Moreover, male CMT1X patients relatively have severer neurological dysfunction than female patients.

[Analysis of BK virus infection in kidney transplant recipients].

Objective: To compare the infection of BK virus in the recipients of living donor(LD) kidney transplant and deceased donor(DD) kidney transplant. Methods: A total of 911 recipients who underwent kidney transplantation in the Organ Transplantation Research Institute of the 8th Medical Center of the People's Liberation Army General Hospital from January 2015 to August 2019 were enrolled in this study. The DNA copies of BK virus in urine and peripheral blood of kidney transplant recipients were detected by real-time quantitative PCR. The patients were divided into LD group (n=255) and DD group (n=656). BK virus infection in recipients with DD kidney transplant were compared with that in recipients of LD kidney transplant. Results: The BK virus positive rate in the urine of all subjects was 13.06%(119/911), and that in blood was 2.96% (27/911). The positive rate of BK virus in urine after kidney transplantation was significantly higher than that in blood(P<0.000 1). The positive rate in urine was 9.02% (23/255) in LD group, which was significantly lower than that of 14.63% (96/656) in DD group in the same period (χ(2)=5.097, P=0.012); The positive rate of BK virus infection in relatives group was 0.78% (2/255), which was significantly lower than that of 3.81% (25/656) in DD group (χ(2)=5.849, P=0.007). Conclusions: There was a significant difference in the infection rate of BK virus between the LD and DD group. The incidence of BK virus infection in kidney transplant recipients from DD was higher than that of from LD kidney transplant recipients.

[Study on the influence of sleeve height and implant length on accuracy of static computer-assisted implant surgery].

Objective: To evaluate the influence of the sleeve lengths and implant lengths on accuracy of static computer-assisted implant surgery (sCAIS). Methods: Twenty-eight models of bilateral mandibular single tooth loss were included. Fifty-five implants were placed under the guidance of sCAIS (Straumann Bone Level 4.1 mm×10 mm). According to the height of metal sleeve of static guide plate, 55 implants were divided into 11 groups (free hand group, 1 mm group, 2 mm group, 3 mm group, 4 mm group, 5 mm group, 6 mm group, 7 mm group, 8 mm group, 9 mm group, 10 mm group), with 5 implants in each group. Eight research models were included. Group with 5 mm sleeve guides were used to place implants of different length, (Straumann Bone Level width 4.1 mm, height was 8 mm, 10 mm and 14 mm), 5 implants in each group. Eighteen patients with mandibular single tooth loss were included in the Department of Oral Implantology, Tianjin Stomatological Hospital from October 2018 to June 2019. There were 10 males and 8 females, 18-46(33.7±7.9) years old. A total of 18 implants were implanted and divided into 3 groups (free hand group, 3 mm group and 5 mm group) with 6 implants in each group. Digital software was used to compare the implant positions before and after implantation. Non-parametric Kruskal-Wallis test or one-way ANOVA were used to analyze the results. Results: There was no significant difference in implant vertical deviation between different sleeve height groups (1-10 mm) and free hand group, but the neck deviation in free hand group[(1.04±0.13) mm] was significantly higher than that in different sleeve height groups (1-10 mm) (P<0.05). The tip deviations of free hand group, 1 mm group and 2 mm group [(1.32±0.43), (0.83±0.10) and (0.78±0.11) mm, respectively] was significantly higher than that of 10 mm group [(0.31±0.14) mm](P<0.05). The angle deviation of free hand group and 1 mm group (3.99°±0.85° and 2.59°±0.69°), respectively] was significantly higher than that of 10 mm group (0.61°±0.03°) (P<0.05). The tip deviations of implants in the 14 mm group [(0.83±0.22) mm] was significantly higher than that in the 8 mm and 10 mm groups [(0.44±0.07) and (0.49±0.06) mm, respectively]. Clinical studies showed that there was no significant difference in neck deviation, tip deviation and angle deviation between 3 mm group and 5 mm group (P>0.05), but deviations were significantly lower than those in free hand group (P<0.05). Conclusions: The length of the sleeves has significant influence on the accuracy of the surgical guide. There was no significant difference in accuracy of the implant guide with 3 mm or 5 mm metal sleeves. The vitro study has some limitations and needs further systematic research.

A nomogram to predict major adverse cardiovascular events of patients with acute chest pain, Non-ST-segment deviation, and normal troponin concentrations.

OBJECTIVE: To explore the potential indicators including patients' characteristics, electrocardiogram (ECG), echocardiography, and serological assay in predicting the major adverse cardiovascular events (MACE) within 1 year for patients with low-risk chest pain with a nomogram. PATIENTS AND METHODS: The detected indicators of patients with low-risk chest pain were obtained as the alternative predictors for MACE. After the 1-year follow-up, patients with MACE were enrolled in the MACE group while the remained patients were in the non-MACE group. A nomogram was constructed based on the multivariable Cox regression to link the independent predictors and the MACE within 1 year for patients with low-risk chest pain. RESULTS: The incidence of MACE within 1 year was 6.94% according to the follow-up result. Multivariate analysis revealed that risk factors of CAD, P-terminal force in lead V1 (PTFV1), C-reactive protein (CRP), and transmitral inflow early diastolic peak velocity (E wave) /peak early diastolic velocity (Em) (E/Em) were the independent predictors for the MACE. A nomogram incorporating these independent predictors with a good discrimination (0.79 in C-index) and calibration was constructed to predict the incidence of MACE within 1 year. It could be used to help select the patients with a high risk of MACE and develop preventive treatment strategies. CONCLUSIONS: Risk factors of CAD, PTFV1, CRP, and E/Em were the independent predictors for the MACE within 1 year in patients with low-risk chest pain. The present nomogram provides a user friendly tool in the prediction of MACE for these patients.