This review discussesed the application of healthcare simulation in the post-graduation education of pediatric emergency and critical care medicine in China,puting forward the necessity of its application,introducing the application scenarios from four aspects:basic skills simulation training,specialized skills simulation training,situational simulation training and screen simulation training,and analyzing the existing problems from three aspects:teaching staff,curriculum research and training equipment.Some suggestions are put forward to strengthen the system guarantee,concentrate the development of multidisciplinary forces,and integrate the strength of domestic industry,university and research.

Objective:To discuss the clinical characteristics of autosomal recessive spinocerebellar ataxia type 16 patients caused by STUB1 gene mutation, in order to improve the clinical doctors′ understanding of the disease. Methods:The clinical manifestations, auxiliary examinations and genetic testing of 1 autosomal recessive spinocerebellar ataxia type 16 patient caused by STUB1 gene variants diagnosed in Qilu Hospital of Shandong University in May 2022 were collected, and the relevant literature was reviewed to summarize the clinical and genetic characteristics of this type of disease. Results:The proband was a 35-year-old male presenting with unsteady walk and dysarthria. Magnetic resonance imaging showed cerebellar atrophy. Next generation sequencing revealed compound heterozygous c.322dupG (p.Glu108Glyfs *4) and c.433A>C (p.Lys145Gln) variants in the STUB1 gene (according to the transcript NM_005861.4), and the c.322dupG (p.Glu108Glyfs *4) variant was a novel variant. Pedigree verification revealed the 2 variants were respectively inherited from the proband′s healthy parents. A total of 12 foreign literatures reported 32 autosomal recessive spinocerebellar ataxia type 16 patients. The main clinical manifestations were ataxia, dysarthria and tendon hyperreflexia. Besides, nystagmus, spasticity, action tremors, and myoclonus can be present. Magnetic resonance imaging predominantly showed cerebellar atrophy. Conclusions:The patient with autosomal recessive spinocerebellar ataxia type 16 caused by STUB1 gene variant is rare in China. The main clinical manifestation is cerebellar ataxia, and brain imaging reveals remarkable cerebellar atrophy. Genetic testing is helpful for definite diagnosis.

Objective To observe the imaging findings of embryonal tumor with multilayered rosettes(ETMR).Methods MRI(n=8)and CT(n=6)data of 8 children with pathologically confirmed ETMR were retrospectively reviewed,and the imaging findings were analyzed.Results ETMR present as masses with the maximum diameter of 32-96 mm and clear edges in all 8 cases,located supratentorially in 5 and infratentorially in 3 cases.The supratentorial ETMR were giant cystic solid masses,while the infratentorial ETMR had relatively small volumes.No peritumoral edema was noticed.Cystic solid masses were observed in 6 cases,and the cystic portion presented as low T1WI and high T2WI signals at the edge of the masses.After administration of contrast agents,mild focal uneven enhancement in the solid portion was found in 5 cases,while 1 case was not found enhancement.Among the above 6 cases,the intratumoral bleeding and empty blood vessel shadows within the masses were observed each in 5 cases,while adjacent dura mater invasion was noticed in 3 cases.Two ETMR present as solid masses with focal nodular uneven enhancement,and the enhanced area corresponded to the low signal area on apparent diffusion coefficient(ADC)image,among them,increased choline(Cho)/creatine(Cr)and decreased N-acetyl aspartate(NAA)was found in 1 case.Limited diffusion on diffusion weighted imaging(DWI)were detected in all 8 cases.Among 6 cases who underwent CT scanning,patchy or punctate calcification,corresponding to the low signal area on MRI were detected in 4 cases.Conclusion ETMR mostly present as supratentorial large solid cystic masses with clear edges,and the cystic portion often located at the edge of masses,with characteristic vascular flow voids often accompanied by intratumoral bleeding and some with calcifications but without peritumoral edema,which showed significantly limited diffusion on DWI and weakly inhomogeneous enhancement of the solid part.

The intestinal dysbacteriosis is closely associated with the occurrence and progress of radiation-induced intestinal injury. However, the specific mechanism remains unclear. Symbiotic bacteria in the human body play a significant role in maintaining the homeostasis of the intestinal microenvironment while participating in various physiological and pathological processes such as metabolism, immunoregulation, inflammation, and tumorigenesis. Ionizing radiation can destroy the intestinal epithelial barrier, creating an oxidative stress microenvironment. Consequently, the composition and structure of microbiota change, leading to dysbacteriosis through downstream inflammatory factors. Dysbacteriosis can further exacerbate radiation-induced intestinal injury by weakening the resistance of the intestinal epithelial barrier, activating inflammatory signaling pathways, and upregulating radiation-induced apoptosis response. The probiotic supplementation and fecal bacteria transplantation can reduce radiation-induced intestinal injury by regulating the balance of intestinal microbiota. This study reviews the advances in research on the pathogenesis and clinical protection of radiation enteritis based on gut microbiota, in order to provide a theoretical basis and reference for the prevention and treatment of radiation enteritis.

Objective To analyze the correlations between platelet-related parameters and the incidence of anxiety and depression in the patients undergoing peritoneal dialysis(PD),and evaluate the efficacy of the pa-rameters in the diagnosis of anxiety and depression in PD patients.Methods A total of 245 patients undergoing PD in the First Affiliated Hospital of Hebei North University from September 2022 to February 2023 were enrolled.The gener-alized anxiety scale(GAD-7)and the patient health questionnaire(PHQ-9)were used to evaluate the anxiety and depression of the patients,respectively.The personal information and biochemical indicators of the patients were col-lected,and the platelet count(PLT),mean platelet volume(MPV),and platelet distribution width(PDW)were measured.Logistic regression was adopted to analyze the relationships of platelet-related parameters with anxiety and depression in PD patients.Results Among the 245 patients undergoing PD,the incidences of anxiety and depression were 15.9% and 38.0% ,respectively.There were differences in the dialysis period(Z=-2.358,P =0.018;Z =-3.079,P=0.002),MPV(Z=-4.953,P<0.001;Z=-7.878,P<0.001),and PDW(Z =-4.587,P<0.001;Z=-7.367,P<0.001)between the anxiety group and the non-anxiety group as well as between the de-pression group and the non-depression group.The correlation analysis showed that MPV(r =0.358,P<0.001;r =0.489,P<0.001)and PDW(r =0.340,P<0.001;r =0.447,P<0.001)were positively correlated with anxiety and depression in the patients undergoing PD.The Logistic regression model showed that MPV(P =0.022,P =0.011),PDW(P =0.041,P =0.018),and dialysis period(P =0.011,P =0.030)were independent risk factors for the anxiety and depressive state in PD patients.The areas under the receiver operating characteristic curve of MPV in the diagnosis of anxiety and depression in PD patients were 0.750 and 0.800,respectively,and those of PDW were 0.732 and 0.780,respectively.Conclusion MPV and PDW have high efficacy in the diagnosis of anxiety and depression associated with PD and can be used as objective indicators to evaluate the anxiety and depression in the patients undergoing PD.

Pituitary adenoma is the third most common primary central nervous system tumor in adults.Radiomics can explore and analyze massive quantitative features in medical images,and has been used in the precise diagnosis and treatment of pituitary adenomas.The research progresses of MRI radiomics in pituitary adenoma were reviewed in this article.

Objective To screen the main environmental factors affecting the growth of Prunella vulgaris L.based on MaxEnt model and ArcGIS;To predict its potential suitable habitats in China;To provide reference for the artificial cultivation of Prunella vulgaris L.Methods Totally 346 pieces of sample point data of Prunella vulgaris L.were collected.Combined with data of 38 ecological factors,the main environmental factors affecting the distribution of Prunella vulgaris L.were screened using MaxEnt model.ArcGIS software was used to evaluate the habitat suitability of Prunella vulgaris L.and analyze the distribution of suitable areas for Prunella vulgaris L.worldwide and in China.Results The main ecological factors affecting the distribution of Prunella vulgaris L.were upper(0-30 cm)soil gravel volume percentage,soil effective water content,upper(0-30 cm)soil exchangeable sodium salt,specific soil types related to agricultural use in soil units and upper(0-30 cm)soil sand content.The highly suitable areas of Prunella vulgaris L.were mainly in Yunnan,Heilongjiang,eastern Inner Mongolia and central Sichuan.Conclusion The predicted results can provide a reference for the introduction of cultivation and sustainable resource utilization of Prunella vulgaris L.

OBJECTIVE To ascertain the substance benchmarks of the classic prescription Huangqi Guizhi Wuwu Decoction(HGWD),examine the quantitative value transfer throughout the entire process of HGWD,from herb pieces to decoction,concentrated solution and finally freeze-dried powder,and provide a valuable reference for the preparation method and scientific evaluation of bench-mark samples of classic prescriptions containing volatile substances.METHODS According to the Key information table of Ancient Classic Prescriptions(25 prescriptions)released by China,15 batches of HGWD were prepared.The multi-index content determination and characteristic chromatogram analysis methods were established,and the characteristic peak attribution and similarity evaluation were carried out.The multi-index contents of HGWD and its freeze-dried powder were investigated and compared,and the quantitative value transfer in the preparation process of decoction-concentrated solution-freeze-dried powder was analyzed.The physical form of the benchmark samples were scientifically and reasonably determined,and the content and transfer rate range of each component in the HGWD benchmark samples were determined,and the HGWD substance benchmarks were established.RESULTS The contents of cinnamaldehyde and cinnamyl alcohol in HGWD decreased significantly during the concentration and drying process,and the other in-dex components could be transferred more completely between the decoction,concentrated solution and freeze-dried powder.The simi-larity of the characteristic chromatograms of 15 batches of HGWD benchmark samples were all over 0.9,and 8 characteristic peaks were identified,which were from Paeoniae γadix Alba,Cinnamomi γamulus and Ginger.The paste-forming rate ranged from 8.0%to 11.0%.The content of Astragaloside Ⅳ was 0.04%-0.07%and the transfer rate was 9.0%-18.0%.The content of paeoniflorin was 1.5%-3.0%and the transfer rate was 33.0%-62.0%.The content of cinnamyl alcohol was 0.02%-0.04%,and the transfer rate was 25.0%-47.0%.The content of cinnamic aldehyde was 0.02%-0.05%and the transfer rate was 0.7%-1.5%.The content of cinnamic acid was 0.03%-0.06%and the transfer rate was 17.5%-34.0%.The content of 6-gingerol was 0.04%-0.08%and the transfer rate was 7.0%-14.0%.CONCLUSION The physical form of the decoction as the HGWD benchmark sample is deter-mined,which provides reference for the scientific selection of the physical form of the benchmark sample of classic prescriptions contai-ning volatile substances.The quality indexes of HGWD substance benchmarks are established,and the quantitative value transfer is an-alyzed,which provides the basis for the development of the classic prescription compound preparation.

Objective:To explore the diagnostic value of thromboelastography (TEG) combined with conventional coagulation test (CCT) for trauma-induced coagulopathy (TIC) in patients with electric burns in the early stage.Methods:This study was a retrospective case series research. From February 2018 to February 2024, the clinical data of 128 electric burn patients and 118 thermal burn patients who met the inclusion criteria and admitted to the Department of Burn Surgery of the Third Affiliated Hospital of Inner Mongolia Medical University were collected, including 224 males and 22 females, aged (38±14) years. The patients were divided into electric burn group (128 cases) and thermal burn group (118 cases) according to their injuries. The incidence of TIC, the indicators of CCT, including prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen level, D-dimer level, platelet count, and the detection indicators of TEG, including coagulation reaction time, K value, coagulation angle, maximum thrombus amplitude, comprehensive coagulation index, and lysis rate at 30 minutes after maximum amplitude within 8 hours of admission were compared between the two groups of patients. The Kappa test was used to analyze the consistency between CCT and TEG in diagnosing TIC in patients with electric burns in the early stage after burns. The receiver operating characteristic curves of CCT, TEG, and TEG combined with CCT in diagnosing TIC in 128 patients with electric burns were drawn, and the area under the curve (AUC), the maximum Jordan index, and sensitivity and specificity at this time were calculated.Results:The proportion of patients diagnosed with TIC in electric burn group was 19.5% (25/128) within 8 hours of admission, which was significantly higher than 10.2% (12/118) in thermal burn group ( χ2=4.21, P<0.05). Compared with those in thermal burn group, prothrombin time was significantly shortened ( t=-2.32, P<0.05), D-dimer level, fibrinogen level, and platelet count were significantly increased (with Z values of -2.11 and -4.16, respectively, t=4.69, P<0.05), the coagulation reaction time was significantly shortened ( t=-2.51, P<0.05), and the maximum thrombus amplitude and lysis rate at 30 minutes after the maximum amplitude were significantly increased (with t values of 2.50 and 2.10, respectively, P<0.05) in patients in electric burn group within 8 hours of admission. There were no statistically significant differences in the other CCT indicators and TEG detection indicators between the two groups of patients ( P>0.05). The CCT and TEG showed high consistency in the diagnosis of TIC in patients with electric burns in the early stage after burns (Kappa=0.63, P<0.05). The AUCs of TEG combined with CCT, TEG, and CCT in diagnosis of TIC in 128 patients with electric burns were 0.92, 0.84, and 0.77 (with 95% confidence intervals of 0.86-0.97, 0.71-0.97, and 0.71-0.97, respectively), with the maximum Jordan indexes of 0.86, 0.57, and 0.65. At this time, the specificity was 93.7%, 83.2%, and 88.2%, respectively, and the sensitivity was 92.3%, 87.5%, and 76.5%, respectively. Conclusions:Patients with electric burns are in a state of hypercoagulability of coagulation system and hyperfunction of fibrinolysis system in the early stage after burns, and TEG combined with CCT can increase the diagnostic rate of TIC in patients with electric burns.

Objective To develop a deep learning network based on attention mechanism to identify the number of the vertical man-dibular third molar(MTM)roots(single or double)on panoramic radiographs in an automatic way.Methods The sample consisted of 1 045 patients with 1 642 MTMs on paired panoramic radiographs and Cone-beam computed tomography(CBCT)and were randomly grouped into the training(80%),the validation(10%),and the test(10%).The evaluation of CBCT was defined as the ground truth.A deep learning network based on attention mechanism,which was named as RN-MTMnet,was trained to judge if the MTM on pano-ramic radiographs had one or two roots.Diagnostic performance was evaluated by accuracy,sensitivity,specificity,and positive predict value(PPV),and the receiver operating characteristic(ROC)curve with the area under the ROC curve(AUC).Its diagnostic perform-ance was compared with dentists'diagnosis,Faster-RCNN,CenterNet,and SSD using evaluation metrics.Results On CBCT images,single-rooted MTM was observed on 336(20.46%)sides,while two-rooted MTM was 1 306(79.54%).The RN-MTMnet achieved an accuracy of 0.888,a sensitivity of 0.885,a specificity of 0.903,a PPV of 0.976,and the AUC value of 0.90.Conclusion RN-MTM-net is developed as a novel,robust and accurate method for detecting the numberof MTM roots on panoramic radiographs.