Objective To observe the effect of proprioceptive neuromuscular facilitation (PNF) technology combined with core stability training on the rehabilitation of patients with functional ankle instability (FAI).Methods Twenty FAI patients were randomly divided into an experimental group and a control group,each of 10.The control group was given routine rehabilitation together with ankle strengthening training and proprioception training.The experimental group was provided with PNF combined with core stability training in addition to the routine rehabilitation.Before and after the 12 training sessions,both groups were evaluated using the Cumberland ankle instability tool (CAIT).The strength of their ankle flexors and extensors was measured in isokinetic concentric contraction,ankle proprioception was tested and the star excursion balance test (SEBT) was administered.Results Before the intervention there were no significant inter-group differences in any of the measurements.Afterward,significant improvements were observed in the first three tests,with the experimental group's average improvement significantly better than that of the control group.All of the SEBT measurements were significantly better than before the treatment,with significant differences between the two groups in the posterolateral,posterior,posteromedial,medial and anteromedial directions.Conclusion PNF technology combined with core stability training can improve ankle strength and proprioception and the dynamic balance of FAI patients.

From a time-based to a competency-based medical education, the evolution of residency training began nearly 30 years ago, the development of valid and reproducible assessment tools faces challenges.Medical educators across specialties remain motivated to develop a relevant, generalizable, and measurable system.The Accreditation Council for Graduate Medical Education (ACGME) in the United States commits to the responsibility by assuring that the process and outcome of graduate medical education (GME) in the national residency programs produce competent, safe, and compassionate doctors.The Milestones Project is the ACGME′s evolution to a competency-based system, which allows each specialty to develop its own subcompetencies and 5-level progression of Milestones, along a continuum of novice to expert.Milestones 1.0 provided important foundational information and insights for the education community, that has had nearly 5 years of experience for residency training in Anesthesiology, needs to be improved.Milestones 1.0 highlighted challenges with assessment and evaluation of residents, some mismatch between subcompetencies and current and future clinical practices in Anesthesiology, and the need for faculty development tools.The ACGME assembled representatives from stakeholder groups using an iterative process within the Anesthesiology community to develop the second generation of Milestones in 2021.This article describes Milestones 2.0 for residency training in Anesthesiology in the United States, emphasizing the rationality and practicability, to provide evidence for residency training in Anesthesiology in China.There is a lack of systematic, cooperative and continuous research on medical education in Anesthesiology in China, and a lack of competency-based and milestone-based residency training in Anesthesiology.It is urgent to narrow the gap between developed countries and China to improve medical education and training in Anesthesiology.

Objective:To analyze the changes of peripheral perfusion index (PPI) with late-onset sepsis (LOS) in very low birth weight infants during hospitalization.Methods:Very low birth weight infants admitted to the neonatal intensive care unit of Children′s Hospital of Fudan University from August 1, 2021 to August 31, 2022 were consecutively included.Infants with admission age ≥three days and unstable circulation, or positive blood culture within three days after birth were excluded.From the day of admission, the PPI values of the right hand and either foot of the infants were measured with Masimo SET Radical-7 everyday while whether LOS occurred during hospitalization was observed.The mean PPI curve of very and extremely low birth weight infants without LOS was plotted.For those with LOS confirmed by blood culture, the PPI change trajectory three days before and after the occurrence of LOS was drawn, and the change trend of PPI before the occurrence of LOS was analyzed by trend chi-square test.Non-parametric test was used to analyze the effect of LOS on pre- and post-ductal PPI values.Results:A total of 107 very low birth weight infants were included in the final analysis.Among them, there were 11 infants confirmed as LOS by blood culture, 37 infants diagnosed as clinical LOS, and 59 infants without LOS.Pre-and post-ductal PPI values of very low birth weight infants without LOS were 2.06±1.30 and 1.72±0.92, respectively; those with clinical LOS were 1.90±0.94 and 1.58±0.83, respectively; those with LOS confirmed by blood culture were 1.92±1.11 and 1.62±0.82, respectively.For infants with LOS confirmed by blood culture, the pre-and post-ductal PPI values showed a continuous downward trend during three days before the onset of disease, with the lowest PPI values on the first day before the diagnosis of blood culture.The downtrend of pre-ductal PPI was statistically significant ( χtrend2=5.57, P<0.05). Conclusion:The PPI value of very low birth weight infants show a downward trend when LOS occurs.It should be observed dynamically in clinical practice, which is helpful to suspect or identify LOS as early as possible.

BACKGROUND:Mangiferin is a biphenylpyridone compound extracted from mango leaves,bark and roots.Previous studies have shown that mangiferin can exert anti-systemic inflammatory effects through the activation of transcription factors such as NF-κB and JAK/STAT. OBJECTIVE:To investigate the effects and mechanisms of mangiferin on proliferation,migration and inflammatory factor release of rheumatoid arthritis fibroblast-like synovial cells(RA-FLS). METHODS:RA-FLS were divided into blank group,R848(TLR7/8 agonists)stimulated group,mangiferin low-,medium-,high-dose groups(2,4 and 8 μg/mL)and positive control group(Cu-CPT8,TLR8 pathway inhibitor).The cytotoxic effect of different mass concentrations of mangiferin was detected using cell counting kit-8 method and the final cellular dosing mass concentration was screened.The proliferation ability of RA-FLS was detected by cell clone formation assay,the migration ability of RA-FLS was detected by scratch assay and Transwell migration assay,and the expression of interleukin 1β,interleukin 6 and tumor necrosis factor α mRNA in RA-FLS was detected by qRT-PCR. RESULTS AND CONCLUSION:Compared with the blank group,the viability of RA-FLS was inhibited after treatment with mangiferin at 2-10 μg/mL,but there was no significant difference among groups(P>0.05),indicating that the toxic effect on RA-FLS was minimal.Compared with the R848-stimulated group,mangiferin decreased the number of cell clones,the scratch healing rate and the number of migrating cells in all dosing groups(P<0.01);and the expression of interleukin 1β,interleukin 6 and tumor necrosis factor α mRNA was also reduced in the mangostin medium-and high-dose groups(P<0.01).Compared with the R848-stimulated group,the number of cell clones,the scratch healing rate and the number of migrating cells as well as the expression levels of interleukin 6 and tumor necrosis factor α mRNA were significantly reduced in the positive control group(P<0.05,P<0.01).But there was no significant difference in the expression level of interleukin 1β.To conclude,mangiferin may exert its anti-rheumatoid arthritis effects through the TLR7/8 signaling pathway by inhibiting RA-FLS proliferation,migration,and inflammatory factor release.