BACKGROUND:Three-dimensional visual model of cervical deep vein can be used to virtual simulation of puncture. The studies on elevating deep vein puncture in the clinic are stil in the stage of exploration.
OBJECTIVE:To find the application of three-dimensional virtual puncturation simulation to cervical deep vein puncturation.
METHODS:CT cross-sectional images were obtained from healthy volunteers. Mimics software was used to semi-automatical y cut and reconstruct of various tissue of the neck. Three-dimensional model revealed cervical deep veins and its surrounding anatomic structure. Cervical deep vein puncturation was simulated, including internal jugular vein, supraclavicular vein and subclavian vein.
RESULTS AND CONCLUSION:Three kinds of cervical deep vein puncturation were successful y simulated, showing three-dimensional adjacent relation of the virtual pin with surrounding anatomic structure. Safe angle, depth and optimal path of the pin were measured. A three-dimensional virtual puncturation simulation can provide visualized morphologic data for cervical deep vein puncturation.

Objective To develop a new multi-purpose face mask for oxygen provision in first aid,which can be used in both war time and peace time.Methods The structure,operating principle and application of a multi-purpose face mask,whose transparent silicone mask body has even the entrance of nested endoscopy and oxygen concentration regulating twist,are introduced in this paper.Results This mask can be used in painless endoscopy and emergent oxygen supply in tracheal intubatton.Conclusion The mask can greatly enhance the safety of painless endoscopy and it can also be used as mask for the use of general anesthesia.

Objective To assess the effect of variable durations of warm ischemia on renal function early after laparoscopic partial nephrectomy ( LPN ) and make the definite safety duration of renal warm ischemia.Methods The clinical data of 76 patients treated with LPN from October 2012 to June 2014 were retrospectively analyzed.The patients were divided into 3 groups based on warm ischemic time,namely group A (28 cases) with warm ischemia time less than 20 min,group B (34 cases) with warm ischemia time more than 20 min and less than 30 min, group C ( 14 cases ) with warm ischemia time more than 30 min.LPN was performed with renal artery clamping alone in all the patients.Preoperative and postoperative renal scintigraphic scan was performed to access glomerular filtration rate ( GFR) in all patients.The GFR values were compared among before, 1 week, 1 month and 3 months after operation.The factors predicting the early renal injury were assessed by multivariate regression analysis.Results The renal GFR of the kidney underwent LPN decreased 19.43(17.70,22.06) ml/min at 1 week,17.04(13.94,20.70) ml/min at 1 month,13.82(10.72,18.73) ml/min at 3 months after the surgery in group C,respectively.In group A, the renal GFR of the operated-side decreased 12.07(10.91,13.42) ml/min,10.04(9.16,11.75) ml/min, 8.44(7.07,9.72) ml/min,respectively.In group B, the renal GFR of the operated-side decreased 13.64 (12.48,16.72) ml/min,10.29(9.17,14.27)ml/min,9.63(7.85,12.59) ml/min,respectively.The GFR decreased greater in group C than that in group A and B(P<0.05).The total renal GFR decreased (10.70 ± 4.93)ml/min at three months in group C,compared with (5.64 ±4.12)ml/min in group A and (6.37 ± 4.32)ml/min in group B,respectively.The decreased value in group C was greater than that in group A and B(P<0.05).However,the differences of the total renal GFR among the 3 groups were not significant at 1 week and 1 month(P>0.05).The multivariate regression analysis revealed that warm ischemia duration was the independent risk factor of the early renal injury.Conclusions Warm ischemia duration is the major factor regarding the early renal recovery after LPN.Warm ischemia time more than 30 min may not only greatly affect the renal function but also the renal function recovery rate.

Objective Inflammation is a defensive reaction of body , but excessive inflammatory response can lead to physi-cal injury.The aim of this study was to explore the effects of luteolin on the secretion of inflammatory cytokines from lipopolysaccharide (LPS) and interferon-g(IFN-γ) activated RAW264.7 cells. Methods RAW264.7 cells were divided into 5 groups: control group (without any medicine), M1 group (polarized M1 cells activated by final concentration of 10 ng/mL LPS+20 ng/mL IFN-γ), M1+5L group (simultaneous activation of LPS and IFN-γplus final concentration of 5μmol/L luteolin), M1+10L group(simultaneous activa-tion of LPS and IFN-γplus 10μmol/L luteolin), M1+20L group(simultaneous activation of LPS and IFN-γplus 20μmol/L luteolin). The cell morphological transformation was observed by laser confocal microscope ;the mRNA levels of iNOS , IL-1βand IL-6 were test-ed by real-time quantitative PCR respectively;the secretion levels of TNF-αand IL-6 in culture supernatant were detected by ELISA;the changes of p-STAT3 (ser727) protein pathways were examined by western blot. Results Cellular morphology of activated RAW 264.7 cells changed obviously .Compared with the control group , the mRNA levels of iNOS, IL-1βand IL-6 decreased significantly in the other 4 groups(P<0.05).The iNOS level in M1+20L group significantly de-creased compared with M1 group[(29.52±3.07) vs (98.91±10.65), P<0.01].As to IL-1βlevel, it decreased significantly in M1+10L group(78.38±8.65) and M1+20L group(41.59±6.80) compared with M1 group(110.69±4.12)(P<0.05).While the IL-6 levels decreased significantly in M1+5L group(177.51±19.28), M1+10L group (106.14±5.63), M1+20L group(27.15±1.26), compared with M1 group(394.10±33.47)(P<0.05).LPS+IFN-γcould induce in-creased p-STAT3 (ser727) expression in M1 phenotype of RAW264.7 cells which was proved by its significant increase in M 1 group, M1+5L group and M1+10L group compared with control group (P<0.05).In comparison to M1 group, p-STAT3-ser expression in M1 phenotype downregulated in M1+5L group, M1+10L group, M1+20L group(P<0.05), along with dose-dependent characteristic.Com-pared with control group, the levels of IL-6 and TNF-αincreased significantly in M1 group, M1+5L group and M1+10L group.Com-pared with M1 group, the levels of IL-6 and TNF-αdecreased significantly in M1+5L group, M1+10L group and M1+20L group(P<0.05) , in which IL-6 showed concentration independence and TNF-αshowed no concentration independence . Conclusion Luteolin inhibits the secretion of pro-inflammatory cytokines through the down-regulation of p-STAT3 so as to exert anti-inflammatory effects .

BACKGROUND:Surface modification of orthopedic implants can reduce or prevent bacterial adhersion. Bacteriostatic and bactericidal ingredients released from special coating of metal surfaces prevent orthopedic surgery infection. OBJECTIVE:To prepare hydroxyapatite/nano-silver composite coating on the surface of medical titanium based on different preparation parameters and to observe the release properties of silver ions on the composite material surface in the simulated body fluid. METHODS:Using pulse electrochemical methods, hydroxyapatite and nano-silver were deposited in the solution containing silver, calcium and phosphate ions. Scanning electron microscopy, X-ray diffraction and energy dispersive spectroscopy were used to characterize its morphology and composition. The composite titanium materials containing 0.5, 1 mmol/L silver were immersed in the simulated body fluid, and Ag+concentration was detected by atomic absorption spectrometry at the different time points. RESULTS AND CONCLUSION:Nanoparticles were uniformly distributed in the coating which was interwoven with the nano needle-like hydroxypatite and dot-like silver particles. After high temperature processing, the coating became denser, and hydroxypatite became more crystal and silver particles exhibited no agglomeration. In the simulated body fluid, Ag+release was maximal at 1-7 days and became stable at 7-30 days which maintained an effective antimicrobial concentration. The material containing 0.5 mmol/L Ag+showed a lower amount of Ag+released than cytotoxic concentration at 30 days, but the material containing 1 mmol/L Ag+could release the total of Ag+close to the critical value of celltoxicity at 30 days. Above al , the material containing 0.5 mmol/L Ag+is more secure in the clinical application.

This paper systematically reviews the relevant literature on early clinical exposure (ECE) in China in recent years. It analyzes the main contents of literature, summarizes the various forms of ECE that the colleges and universities provide, and analyzes its positive effect on the students' learning interest and ability, their humanistic care for patients, as well as the teacher's self-improvement. Finally, according to the actual practical situation of ECE in medical universities in China and relevant experience from foreign studies, it is proposed that China should increase the emphasis on ECE in colleges and universities, strengthen the construction of teaching staff, and establish a scientific and systematic evaluation system.

Objective To investigate the efficacy of endovascular treatment (EVT) in acute cardioembolic large vessel occlusion (LVO) of anterior circulation and its influencing factors.Methods The clinical data of 83 patients with acute cardioembolic LVO of anterior circulation treated with EVT during June 2014 to June 2016 were analyzed retrospectively.The neurological outcomes in these patients were evaluated by National Institutes of Health Stroke Scale (NIHSS) on admission;cerebral vascular re-canalization after procedure was classified according to thrombolysis in cerebral infarction (TICI) grading;the recovery of neurological outcomes was classified by modified Rankin scale (mRS) at discharge.According to the mRS scores at discharge,these patients were divided into two groups:good curative effect group and poor curative effect group.Single factor analysis was performed on all clinical parameters that might influence the surgical outcomes;in addition,the influencing factors of surgical outcomes were analyzed by multiple factor Logistic regression analysis.Results Eighty-one patients (97.59％) had good re-canalization (TICI grading 2b-3) after EVT;41 patients (49.40％) had better curative effect (mRS scores ≤3 at discharge),and 42 patients (50.60％) had poor curative effect (mRS scores ≥4 at discharge);postoperative hemorrhagic transformation appeared in 26 patients,and 16 patients (19.28％) accepted decompressive craniectomy resulting from massive cerebral infarction,severe encephaledema or hemorrhagic transformation,and had poor curative effect.The single factor analysis showed that the differences of NIHSS scores on admission,occlusion site,angiographic re-canalization,time from the symptom onset to the vessel re-canalization and whether hemorrhagic transformation after operation between the good curative effect group and poor curative effect group were statistically significant (P＜0.05);multiple factor Logistic regression analysis showed that NIHSS scores on admission,angiographic re-canalization,time from the symptom onset to the vessel re-canalization and whether hemorrhagic transformation after procedure were significantly correlated to the treatment efficacy (OR=1.171,95％CI:1.028-1.333,P=0.017;OR=3.623,95％CI:0.931-14.095,P=0.063;OR=l.012,95％ CI:1.003-1.021,P=0.008;OR=3.146,95％CI:0.875-11.309,P=0.079).Conclusions Endovascular thrombectomy is an effective approach for cardioembolic acute anterior circulation stroke.Furthermore,the influential factors of surgical treatment are NIHSS scores on admission,angiographic re-canalization,time from the symptom onset to the vessel re-canalization and whether hemorrhagic transformation after procedure.

Objective:To investigate the current situation of general practitioners' occupational pressure in Heilongjiang Province, and explore its relationship with professional identity and perceived organizational support. It aims to provide references for the construction of general practitioners and the development of general medical education.Methods:The general situation questionnaire, perceived organizational support scale, occupational pressure scale, and professional identity scale were applied through network and site surveys for collecting data. A total of 288 questionnaires were collected with 263 valid questionnaires (91.3%). Pearson correction analysis and bootstrap analysis were performed for data analysis.Results:The average score of occupational pressure among general practitioners was (115.95±22.40), and the results of Pearson correction analysis showed that perceived organizational support was negatively correlated with occupational pressure ( r=-0.413, P<0.01) and positive correlation with professional identity ( r=0.587, P<0.01). There were also significant negative correlations between professional identity and occupational pressure ( r=-0.442, P<0.01). Moreover, the mediating effect showed that professional identity had a certain mediating effect on the relationship between perceived organizational support and occupational pressure (LLCI=-0.2039, ULCI=-0.0760, P<0.05). Conclusion:General practitioners' occupational pressure was at a high level, which can be reduced through improving the perceived organizational support and professional identity.

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare acquired hematopoietic stem cell disease. Gastrointestinal involvement is rarely seen in PNH. This study aims to analyze the clinical features in PNH patients complicated with ischemic bowel disease. Clinical date of 6 patients were collected at Peking Union Medical College Hospital from January 2010 to December 2020. The clinical manifestations, laboratory tests,imaging, endoscopic,and histopathological features and treatment were analyzed.Five in 6 patients were men, with a median age of 31 years old at onset. Most of disease course were recurrent episodes of chronic disease, with abdominal pain (5/6) and gastrointestinal bleeding (5/6). Laboratory examinations showed pancytopenia, reticulocytosis, elevated serum lactate dehydrogenase, high D-dimer and C-reactive protein levels in all patients. Multiple segments of small intestine were the most commonly involved and colon was also affected. Abdominal CT scan showed thickening and roughness or exudation of the intestinal wall (6/6), increased mesenteric density or “comb sign”(4/6), and cholestasis or gallbladder stones (5/6). Endoscopic manifestations included irregular shallow ulcers in the annular cavity (5/6), swelling mucosa with well-defined margins (6/6). Pathological biopsy revealed chronic inflammation of mucosa. The efficacy of steroids combined with anticoagulant therapy was better than that of steroids alone. Ischemic bowel disease in PNH patients is different from typical ischemic enteritis. Young patients, involvement of intestine with multiple segments are common characteristics. The anticoagulant is an essential agent for these patients.

Background/Aims: Risk of venous thrombosis is increased in patients with inflammatory bowel disease (IBD); data on Asian IBD patients is limited and status quo of thrombosis screening and prophylaxis are unknown. Therefore, we aimed to investigate the incidence, screening, prophylaxis, and risk factors for venous thrombosis among Asian IBD patients. Methods: Medical files of patients with Crohn’s disease (CD) and ulcerative colitis (UC) from 17 hospitals across China between 2011 and 2016 were reviewed for venous thrombosis, use of screening and prophylaxis. A case-control study was performed among hospitalized patients with venous thrombosis and their age-, sex-matched IBD controls hospitalized around the same period; disease characteristics and known provoking factors of venous thrombosis were recorded. Risk factors were analyzed in both univariate and logistic regression analyses. Results: A total of 8,459 IBD patients were followed for 12,373 person-year. Forty-six patients (0.54%) had venous thrombosis, yielding an incidence of 37.18 per 10,000 person-year. Incidence increased with age, especially among CD. Less than 20% of patients received screening tests and 35 patients (0.41%) received prophylaxis. Severe disease flare was an independent risk factor for venous thrombosis (odds ratio [95% confidence interval]: CD, 9.342 [1.813– 48.137]; UC, 5.198 [1.268–21.305]); past use of steroids and extensive involvement were 2 additional risk factors in CD and UC, respectively. Conclusions Incidence of venous thrombosis in China was 37.18 per 10,000 person-year (0.54%). Use of screening and prophylaxis were rare. Severe disease flare was an independent risk factor for thrombosis among hospitalized patients.