OBJECTIVE:To evaluate the efficacy and safety of different immunosorbent columns in the treatment of rheumatoid arthritis through a network meta-analysis,and provide evidence-based basis for clinical diagnosis and treatment.METHODS:By computer,the databases of VIP,WanFang,CNKI,PubMed,CBM,CochraneLibrary,and Web of Science were searched for published cohort studies of immunosorbent column for the treatment of rheumatoid arthritis,with a time limit until August 2024.The quality of the included randomized controlled trials was assessed using the Cochrane5.4 manual.The quality of retrospective cohort studies were evaluated via the Newcastle-Ottawa Scale(NOS).Bayesian network meta-analysis was performed using R4.1.1 software.RESULTS:A total of 13 studies were included,with a total sample size of 891 cases,and 4 immunosorbent columns were included.The results of the network meta-analysis showed that the top three orders that reduce C-reactive protein level:HA280 adsorption column+conventional Western medicine＞PH-350 adsorption column+conventional Western medicine＞A protein adsorption column;the top three orders that reduce erythrocyte sedimentation rates:leukocyte adsorption column＞HA280 adsorption column+conventional Western medicine＞PH-350 adsorption column+conventional western medicine;the top three orders that reduce swollen joint count:leukocyte adsorption column＞A protein adsorption column+conventional western medicine＞PH-350 type adsorption column+conventional Western medicine;the top three orders that reduce tenderness joint counts:leukocyte adsorption column＞A protein adsorption column+conventional western medicine＞PH-350 adsorption column+conventional Western medicine;the top three orders that reduce patients' disease activity evaluation:PH-350 adsorption column+conventional western medicine＞leukocyte adsorption column＞A protein adsorption column;the top three orders that reduce visual analogue scale scores:PH-350 adsorption column+conventional Western medicine＞A protein adsorption column＞leukocyte adsorption column;the top three orders that reduce physician's disease activity assessment:PH-350 adsorption column+conventional Western medicine＞leukocyte adsorption column＞conventional Western medicine.CONCLUSION:Based on the 13 articles,in terms of reducing C-reactive protein level,HA280 adsorption column and conventional Western medicine are the preferred choice.In terms of reducing erythrocyte sedimentation rate,swollen joint count,and tender joint count,leukocyte adsorption column is the preferred choice.In terms of reducing patient's disease activity evaluation,physician's disease activity evaluation and visual analogue scale scores,PH-350 adsorption column and conventional Western medicine are the first choice.Different immunosorbent columns can be reasonably and accurately selected according to the patient's specific conditions.

OBJECTIVE:To evaluate the efficacy and safety of different immunosorbent columns in the treatment of rheumatoid arthritis through a network meta-analysis,and provide evidence-based basis for clinical diagnosis and treatment.METHODS:By computer,the databases of VIP,WanFang,CNKI,PubMed,CBM,CochraneLibrary,and Web of Science were searched for published cohort studies of immunosorbent column for the treatment of rheumatoid arthritis,with a time limit until August 2024.The quality of the included randomized controlled trials was assessed using the Cochrane5.4 manual.The quality of retrospective cohort studies were evaluated via the Newcastle-Ottawa Scale(NOS).Bayesian network meta-analysis was performed using R4.1.1 software.RESULTS:A total of 13 studies were included,with a total sample size of 891 cases,and 4 immunosorbent columns were included.The results of the network meta-analysis showed that the top three orders that reduce C-reactive protein level:HA280 adsorption column+conventional Western medicine＞PH-350 adsorption column+conventional Western medicine＞A protein adsorption column;the top three orders that reduce erythrocyte sedimentation rates:leukocyte adsorption column＞HA280 adsorption column+conventional Western medicine＞PH-350 adsorption column+conventional western medicine;the top three orders that reduce swollen joint count:leukocyte adsorption column＞A protein adsorption column+conventional western medicine＞PH-350 type adsorption column+conventional Western medicine;the top three orders that reduce tenderness joint counts:leukocyte adsorption column＞A protein adsorption column+conventional western medicine＞PH-350 adsorption column+conventional Western medicine;the top three orders that reduce patients' disease activity evaluation:PH-350 adsorption column+conventional western medicine＞leukocyte adsorption column＞A protein adsorption column;the top three orders that reduce visual analogue scale scores:PH-350 adsorption column+conventional Western medicine＞A protein adsorption column＞leukocyte adsorption column;the top three orders that reduce physician's disease activity assessment:PH-350 adsorption column+conventional Western medicine＞leukocyte adsorption column＞conventional Western medicine.CONCLUSION:Based on the 13 articles,in terms of reducing C-reactive protein level,HA280 adsorption column and conventional Western medicine are the preferred choice.In terms of reducing erythrocyte sedimentation rate,swollen joint count,and tender joint count,leukocyte adsorption column is the preferred choice.In terms of reducing patient's disease activity evaluation,physician's disease activity evaluation and visual analogue scale scores,PH-350 adsorption column and conventional Western medicine are the first choice.Different immunosorbent columns can be reasonably and accurately selected according to the patient's specific conditions.

ObjectiveTo explore the possible mechanisms of Shujin Jiannao Formula （舒筋健脑方） for cerebral palsy. MethodsThirty 7-day-old SD rats were randomly divided into normal group， model group， and Shujin Jiannao Formula group， with 10 rats in each group. The model group and Shujin Jiannao Formula group established a cerebral palsy model by the classic Rice-Vannucci method. After successful modeling， rats in Shujin Jiannao Formula group were given Shujin Jiannao Formula 16 g/（kg·d） by gavage， while the normal group and model group were given normal saline 10 ml/（kg·d） by gavage once a day. After one week of intervention， the rats' body weight was measured， and Zea-Longa scores， the righting reflex test， and the hindlimb suspension test were conducted for assessment； hematoxylin-eosin （HE） staining and Nissl staining were used to observe pathological changes in brain tissue， and the number of Nissl-positive neurons was counted； enzyme-linked immunosorbent assay （ELISA） was employed to measure levels of inflammatory cytokines in the brain tissue， specifically interleukin-1β （IL-1β） and tumor necrosis factor-α （TNF-α）； immunofluorescence was used to detect the expression levels of neurofilament protein 200 （NF200） and myelin basic protein （MBP） in brain tissue； Western Blot analysis was conducted to determine the protein levels of phosphoinositide 3-kinase （PI3K）， protein kinase B （Akt/PKB/Rac）， and mammalian target of rapamycin （mTOR） in brain tissue. ResultsCompared with the normal group， rats in the model group showed significantly higher Zea-Longa scores and lower scores in the hindlimb suspension test （P＜0.01）； pathological findings revealed loose structure in the cerebral cortex， hippocampal atrophy， and neuronal damage in brain tissue. Levels of IL-1β and TNF-α elevated， and the number of Nissl-stained positive neurons in the cortex and hippocampal CA1 region reduced， and immunofluorescence intensity of NF200 and MBP， as well as protein expression levels of PI3K and mTOR， significantly decreased （P＜0.05 or P＜0.01）. Compared with the model group， rats in Shujin Jiannao Formula group showed decreased Zea-Longa scores and increased hindlimb suspension test scores （P＜0.05）； pathological damage in brain tissue alleviated， levels of IL-1β and TNF-α reduced， the number of Nissl-stained positive neurons in the cortex and hippocampal CA1 region increased， and the immunofluorescence intensity of NF200 and MBP， as well as the protein levels of PI3K and mTOR， significantly elevated （P＜0.05 or P＜0.01）. There were no statistically significant differences among the groups in body weight， body-turning time， or AKT protein levels in brain tissue （P＞0.05）. ConclusionShujin Jiannao Formula can improve the neurological function of rats with cerebral palsy， exert neurorestorative effects， and its mechanism of action may be related to the reduction of inflammatory response in brain tissue and the activation of the PI3K/AKT/mTOR signaling pathway.

Psychotropic medication plays a crucial role in the field of mental illness,and the issues of drug efficacy and safety due to individual differences cannot be ignored.Genetic factors,especially the genetic poly-morphisms related to drug-metabolizing enzymes,drug action targets,and risk,have a significant impact on drug responses.Pharmacogenomics,by detecting genetic polymorphisms,can reveal a patient's inherited tend-encies towards drug efficacy,pharmacokinetic characteristics,and potential toxicity,thereby predicting the therapeutic effects and adverse reactions of drug treatment,and providing guidance for personalized therapy.Therefore,individualized medication based on pharmacogenomics helps to improve cure rates,reduce relapse rates,and decrease medical costs,which is of great significance to clinical medication in mental illness.

Objective To investigate the effects of prolonged low-dose neutron-γ radiation on peripheral blood lymphocytes of logging workers. Methods The health information of workers in a logging company was collected by on-site blood sample collection and questionnaire survey. Individual doses of γ and neutron radiation were recorded using LiF elements and CR-39, respectively. Lymphocyte count in peripheral blood was measured by blood cytometer. Cell cycle and cyclins were detected by flow cytometry. Results The annual dose of some logging workers exceeded 5 mSv. Lymphocyte counts showed a difference of 15% between the group exposed to the lowest annual dose of 0–1 mSv (mean: 2.45 × 10⁹/L) and the group exposed to the highest annual dose of 5–25 mSv (mean: 2.08 × 10⁹/L). In comparison to pre-shift workers, logging workers exhibited a G1-phase arrest in the lymphocyte cycle, along with increased expression of cyclins p21 and CDK2. Conclusion Prolonged exposure to low-dose neutron-γ radiation leads to reduced lymphocyte counts as well as changes in lymphocyte cycle and cyclin expression.

Objective:To improve the ability of radiation health technical institutions for biological dose estimation.Methods:A total of 144 institutions nationwide, including the CDC, prevention and treatment center for occupational disease, colleges and universities, scientific research institutes, nuclear industry systems, and medical and physical examination institutions, were organized to carry out the intercomparison of national biological dose estimation capabilities in 2022. The institutions participating in the comparison were divided into two types of A and B, through the identification of chromosome aberrations, to estimate the irradiation dose (A) or chromosome aberration rate (B). The results were summarized and compared, and the main problems were analyzed and discussed.Results:There were 60 institutions in type A, 52 qualified institutions (including 12 excellent institutions) and 8 unqualified institutions, with a pass rate of 86.7% (20.0% excellent) and a failure rate of 13.3%. There were 84 institutions participating in the biological dose estimation comparison of type B, with 48 qualified institutions, and 36 unqualified institutions, the qualified rate was 57.1%, and the unqualified rate was 42.9%.Conclusions:Most of the institutions participating in type A comparison have the ability to estimate biological dose, and more than half of the institutions participating in type B comparison have the ability to analyze chromosome aberration. The overall ability of institutions participating in type A comparison is higher than in type B.

Objective:To explore the effectiveness of a multimodal TeamSTEPPS course based on clinical cases in training surgical teams led by anesthesiologists, improve team cooperation in crisis management, and enhance clinical safety.Methods:The Department of Anesthesiology at Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, combined the TeamSTEPPS course with problem-based learning. Based on eight clinical cases, simulation-based training was conducted for interdisciplinary personnel, including anesthesiologists, surgeons, and operating room nurses. Pre- and post-training evaluations were conducted for 80 participants on theoretical knowledge and teamwork. Statistical analysis was performed using SPSS 27.0 software. The differences in scale scores before and after training were tested for normality. If normally distributed, results were expressed as mean ± standard deviation and analyzed using paired t-tests. Participant demographic data were represented using percentages. Results:The theoretical assessment scores after training were significantly higher than those before training [(76.45±8.34) vs. (60.21±5.90), t=13.55, P<0.001]. TeamSTEPPS Teamwork Perception Questionnaire and TeamSTEPPS Teamwork Attitudes Questionnaire scores were significantly higher after training than before training [(156.08±15.20) vs. (149.32±15.58) and (134.59±10.71) vs. (128.47±10.89)], with statistically significant differences ( P<0.001). Conclusions:The TeamSTEPPS management course in combination with problem-based learning can enhance the clinical theoretical knowledge of anesthesiologists and improve their team awareness and collaboration, thus improving their clinical competence in managing crisis events.

Objective:To analyze the factors influencing the teaching competence of anesthesiology residents in online theoretical courses, and to improve the teaching competence of residents.Methods:This single-center cross-sectional study included residents who participated in teaching the "Miller lectures" from September 2022 to January 2024. The primary outcome was the theoretical teaching competence of residents. Questionnaires were distributed to the audience after each lecture, and questionnaire scores were used to evaluate the teaching competence. Potential influencing factors included age, sex, grade, education level, theoretical knowledge, preparation time, involvement of junior and senior supervisors in guidance, and their teaching competence. The independent factors influencing the teaching competence of residents were analyzed using a multivariable linear regression model. A statistical analysis was conducted using R language (version 4.2.1).Results:This study included 44 anesthesiology residents, with an average teaching competence score of (9.34±0.34) (on a 10-point scale). The multivariable regression model revealed that grade (third year: coefficient 0.22, 95%CI 0.03 to 0.40, P=0.024), education level (master: coefficient 0.19, 95%CI 0.03 to 0.36, P=0.024; Doctor: coefficient 0.30, 95%CI 0.12 to 0.47, P=0.002), and junior supervisors' teaching competence (coefficient 0.97, 95%CI 0.70 to 1.24, P<0.001) were independent factors affecting resident teaching competence. Conclusions:In teacher-guided online theoretical courses with residents as the main lecturers, higher grade, education level, and teaching competence of guiding teachers are associated with high teaching competence of anesthesiology residents.

In the field of standardized residency training for anesthesiologists in China, there is currently a lack of a formative evaluation system targeting the clinical competencies of residents. By searching the domestic and international literature on the application of the Milestones Evaluation System in standardized residency training of anesthesiologists, this article comprehensively reviews the background of competency-based medical education, the construction and development of the ACGME Milestones System in the United States, the design and establishment of Milestones Evaluation System in China, the application of Milestones Evaluation System in anesthesiology, and the issues that need to be noted in the implementation process. This review provides a useful reference for the application and promotion of Milestones Evaluation System in standardized residency training of anesthesiologists in China.

Objective:To explore the effectiveness of a multimodal TeamSTEPPS course based on clinical cases in training surgical teams led by anesthesiologists, improve team cooperation in crisis management, and enhance clinical safety.Methods:The Department of Anesthesiology at Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, combined the TeamSTEPPS course with problem-based learning. Based on eight clinical cases, simulation-based training was conducted for interdisciplinary personnel, including anesthesiologists, surgeons, and operating room nurses. Pre- and post-training evaluations were conducted for 80 participants on theoretical knowledge and teamwork. Statistical analysis was performed using SPSS 27.0 software. The differences in scale scores before and after training were tested for normality. If normally distributed, results were expressed as mean ± standard deviation and analyzed using paired t-tests. Participant demographic data were represented using percentages. Results:The theoretical assessment scores after training were significantly higher than those before training [(76.45±8.34) vs. (60.21±5.90), t=13.55, P<0.001]. TeamSTEPPS Teamwork Perception Questionnaire and TeamSTEPPS Teamwork Attitudes Questionnaire scores were significantly higher after training than before training [(156.08±15.20) vs. (149.32±15.58) and (134.59±10.71) vs. (128.47±10.89)], with statistically significant differences ( P<0.001). Conclusions:The TeamSTEPPS management course in combination with problem-based learning can enhance the clinical theoretical knowledge of anesthesiologists and improve their team awareness and collaboration, thus improving their clinical competence in managing crisis events.