Objective To explore whether a low dose of 60Co γ-rays could induce the adaptive response in the formation of nucleoplasmic bridges (NPB) in human peripheral blood lymphocytes,and if so,the range of the priming dose.Methods Human peripheral blood samples from healthy males were collected and irradiated with 0,20,50,75,100,150 and 200 mGy (dose-rate was 25 mGy/min) of 60Co γ-rays.After 6 h,the samples were irradiated with a challenge dose of 2 Gy (dose-rate was 1 Gy/min).The cytokinesis-block micronucleus (CBMN) assay was carried out to analyze the NPB and micronuclei (MN) formation in binucleated cells.Results Within the dose range of 0-200 mGy,the yields of NPB and MN increased with irradiation dose of γ-rays and the dose response of NPB followed with a linearquadratic equation of y =(1.5 × 10-4) x2-(5.67 × 10-3)x + 0.598 (R2 =0.893 8).Compared with the samples irradiated with 2 Gy alone,the yields of NPB and MN were significantly reduced when the samples were irradiated with a priming dose of 75-100 mGy before 2 Gy irradiation (U =2.66,2.97,3.96,5.89,P ＜0.05).The biggest decrease ratio of NPB yields approached to 43.2％ at the priming dose of 100 mGy.Conclusions Low doses in the range of 75-100 mGy of 60Co γ-rays could induce the adaptive response of NPB formation in human peripheral blood lymphocytes.

Objective:To study the safety and efficacy of ultrasound-guided radiofrequency ablation in treatment of gallbladder polyps.Methods:The clinical data of 13 patients who underwent ultrasound-guided radiofrequency ablation for gallbladder polyps at the First Affiliated Hospital of Zhengzhou University from April 2019 to March 2020 were retrospectively analyzed. These were 8 males and 5 females, with ages ranging from 20 to 49 years. The incidence of adverse reactions and complications after treatment, the complete ablation rate of polyps and the absorption of postoperative lesions were studied, and the gallbladder systolic function of patients before and after treatment were compared.Results:Of 13 patients, surgery was successfully carried out and there was no serious complications of gallbladder perforation, bleeding and collateral organ injury. The median radiofrequency ablation time was 30 s, and the complete ablation rate was 100.0%(13/13). After 6 months of follow-up, the rate of reduction of lesion volume was 100.0(98.0, 100.0)% at 6 months after surgery, which was significantly higher than the rates of 46.0(40.0, 54.0)%, 72(64.0, 100.0)% and 87.0(81.0±100.0)% at 1, 2 and 3 months after surgery ( P<0.05). The gallbladder contractility rate at 3 months after operation was (78.38±10.83)% compared with that before operation (77.46±11.28)%, and there was no significant difference ( P>0.05). Conclusion:Ultrasound-guided radiofrequency ablation for gallbladder polyps was safe. It had a significant short-term efficacy for treatment of gallbladder polyps.

Post-stroke cognitive impairment (PSCI) refers to a clinical syndrome that occurs after a stroke and meets the diagnostic criteria for cognitive impairment, lasting for more than 6 months, and seriously affecting the daily life of patients. The complement system has been confirmed to be associated with PSCI. This article reviews the correlation between complement system and PSCI, as well as the possibility of complement system as an intervention target for PSCI.

Objective:To investigate the safety and efficacy of ultrasound-guided percutaneous radiofrequency ablation for gestational trophoblast tumor.Methods:The clinical data of 5 patients with gestational trophoblast tumor treated by ultrasound-guided percutaneous radiofrequency ablation in the First Affiliated Hospital of Zhengzhou University from January 2018 to December 2019 were retrospectively analyzed, the postoperative complications, changes in blood human chorionic gonadotropin (hCG), and the volume reduction rate of ablation lesion at 1, 3, and 6 months after surgery were observed.Results:None of the 5 patients with gestational trophoblast tumor had postoperative complications.Blood hCG decreased to normal level on 7 d, 8 d, 8 d, 12 d and 26 d, respectively. The volume reduction rates of ablation lesions 1, 3 and 6 months after operation in cases 1-5 were respectively 34.7%, 62.5%, 87.5%; 45.3%, 60.4%, 84%; 85.6%, 89.9%, 92.2%; 38.3%, 72.6%, 85.5%; 40.8%, 57.3%, 87%.Conclusions:Percutaneous radiofrequency ablation is minimally invasive, low risk, safe and effective treatment for gestational trophoblast tumors.

Objective:To investigate the safety and efficacy of transgluteal ultrasound-guided puncture and drainage in prone position in the treatment of deep pelvic abscess with pelvic adhesion.Methods:A total of 24 cases of deep pelvic abscess with pelvic adhesion treated in the ultrasound intervention room of the First Affiliated Hospital of Zhengzhou University from October 2018 to May 2021 were selected.Ultrasound-guided puncture and drainage were performed through the buttocks. The operation time, blood loss and distal limb pain during the operation were recorded. The decreasing trend of body temperature, the white blood cell, C-reactive protein and abscess size were observed. The incidence of complications such as bleeding, pain, infection and intestinal injury were counted.Results:There were 28 abscesses in 24 patients were successfully intubated through the buttocks, the abscesses disappeared after drainage, and there were no serious complications after operation. During the follow-up of 3-22 months, there was no abscess recurrence and no long-term complications.Conclusions:Ultrasound-guided transgluteal puncture and drainage is safe and effective in the treatment of deep pelvic abscess with pelvic adhesion.

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 investigate the correlation between heart rate variability (HRV) and early neurological deterioration (END) and poor outcomes in patients with branch atheromatous disease (BAD).Methods:Patients with BAD admitted to the Department of Neurology, Weihai Municipal Hospital from September 2020 to September 2022 were enrolled prospectively. END was defined as an increase of ≥2 points in the total score of the National Institutes of Health Stroke scale (NIHSS) or an increase of ≥1 in motor item score within 72 h of admission compared with the baseline. Poor outcome was defined as the score of the modified Rankin Scale >2 at 6 months after the onset. Multivariate logistic regression analysis was used to determine whether HRV parameters were the independent influencing factors of END and poor outcomes in patients with BAD. Results:A total of 117 patients with BAD were enrolled, including 76 males (65.0%), aged 64.27±6.95 years. Thirty-eight patients (32.4%) had END, and 21 (17.9%) had poor outcomes. Percentage of the number of pairs of adjacent R-R intervals differentiating by more than 50 ms (pNN50), number of adjacent R-R intervals differentiating by more than 50 ms (NN50), power in low frequency range (LF) and power in high frequency range (HF) in the END group were significantly lower than those in the non-END group, and the LF/HF ratio was significantly higher than the non-END group (all P<0.05). The standard deviation of the R-R interval (SDNN), standard deviation of the average of R-R intervals in all 5-min segments (SDANN), and HF in the poor outcome group were significantly lower than those in the good outcome group. Multivariate logistic regression analysis showed that HF (odds ratio [ OR] 0.994, 95% confidence interval [ CI] 0.991-0.998; P<0.001) was an independent protective factor of END in patients with BAD, and LF/HF ratio ( OR 1.455, 95% CI 1.056-2.005; P=0.022) was an independent risk factor for END in patients with BAD; SDANN ( OR 0.997, 95% CI 0.993-0.999; P=0.023) was an independent protective factor of good outcomes in patients with BAD. Conclusion:HF and LF/HF ratios are the independent influencing factors of END in patients with BAD, and SDANN is an independent influencing factor of the poor outcomes in patients with BAD, suggesting that autonomic dysfunction is involved in the pathophysiological mechanism of END and poor outcomes in patients with BAD.

Objective To investigate the effects of Danshen Tongluo Jiedu Decoction medicated serum for regulating miR-126 on autophagy in hypoxia/reoxygenation myocardial microvascular endothelial cells(CMECs)of rats.Methods Hypoxia/reoxygenation injury cell model was constructed by culturing CMECs in vitro.The cells were divided into blank group,model group,TCM group,silencing group,empty vector group,and silencing+TCM group by lentivirus transfection with miR-126 inhibitor.Lactate dehydrogenase(LDH)content in the supernatant of CMECs was detected using a reagent kit,and cell apoptosis rate was detected using flow cytometry,the miR-126 mRNA expression was detected using RT-PCR,the expressions of autophagy-related proteins Atg5,Beclin1 and p62 proteins were detected by Western blot.Results Compared with the blank group,the LDH content in the supernatant of the model group cells significantly increased,the apoptosis rate significantly increased,the miR-126 mRNA expression significantly decreased,the Atg5 and Beclin1 protein expressions significantly increased,and the p62 protein expression significantly decreased,with statistical significance(P<0.01).Compared with the model group,the TCM group and the silencing+TCM group showed a significant decrease in LDH content in the cell supernatant,a significant decrease in cell apoptosis rate,a significant increase in miR-126 mRNA expression,a significant decrease in Atg5 and Beclin1 protein expressions,and a significant increase in p62 protein expression in the TCM group,with statistical significance(P<0.05,P<0.01);the LDH content in the supernatant,apoptosis rate,Atg5 and Beclin1 protein expressions of the silence group cells significantly increased,while miR-126 mRNA expression significantly decreased(P<0.01).Compared with the TCM group,the LDH content in the cell supernatant and apoptosis rate of the silence group and the silencing+TCM group significantly increased(P<0.05,P<0.01),while the miR-126 mRNA expression significantly decreased(P<0.01);the expressions of Atg5 and Beclin1 proteins in the silence group significantly increased(P<0.01),and the expression of p62 protein significantly decreased(P<0.01).Compared with the silence group,the LDH content in the cell supernatant,apoptosis rate,and Atg5 and Beclin1 protein expression of the empty vector group group and the silencing+TCM group were significantly decreased(P<0.01),the miR-126 mRNA and p62 protein expression significantly increased(P<0.05,P<0.01).Conclusion Danshen Tongluo Jiedu Decoction medicated serum can inhibit autophagy and apoptosis of CMECs caused by hypoxia/reoxygenation injury,thereby protecting CMECs.Its mechanism may be related to promoting miR-126 expression.

Objective:To evaluate the effect of esketamine on extremity ischemia-reperfusion-induced lung injury in elderly patients undergoing total knee replacement.Methods:Sixty elderly patients of both sexes, aged 65-80 yr, with body mass index <35 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, scheduled for elective unilateral total knee replacement under neuraxial anesthesia, were divided into 2 groups according to the random number table method: control group (C group) and esketamine group (S group), with 30 cases in each group. Esketamine 0.3 mg/kg was intravenously infused before tourniquet inflation in group S. Immediately after the end of operation, the two groups received adductor block with 0.5% ropivacaine 15 ml under ultrasound guidance. And then patient-controlled intravenous analgesia was performed, patient-controlled intravenous analgesia solution included sufentanil 1.5 μg/kg in 100 ml of normal saline in group C and sufentanil 1.5 μg/kg and esketamine 0.75 mg/kg in 100 ml of normal saline in group S. The background infusion rate was 1.5 ml/h, the patient-controlled analgesia dose was 1.5 ml, and the lockout interval was 15 min in the two groups. When the visual analogue scale score at rest≥ 4 points within 3 days after surgery, ketorolac tromethamine 30 mg was intravenously injected for rescue analgesia. Blood samples from the radial artery were collected for blood gas analysis at 30 min before tourniquet inflation(T 0), 30 min after tourniquet inflation(T 1), and 3 min, 30 min and 24 h (T 4) after tourniquet release (T 2-4), and PaO 2 and PaCO 2 were recorded. The alveola-arterial oxygen partial pressure difference, oxygenation index and respiratory index were calculated. Peripheral venous blood samples were collected at T 0, T 3 and T 4 for determination of serum endothelin-1 and malondialdehyde by enzyme-linked immunosorbent assay. The requirement for rescue analgesia and occurrence of dizziness, hallucinations and pulmonary complications within 3 days after surgery were recorded. Results:Compared with group C, alveola-arterial oxygen partial pressure difference was significantly decreased at T 1-3, respiratory index was decreased, oxygenation index was increased at T 2, 3, and serum endothelin-1 and malondialdehyde concentrations were decreased at T 3, 4, and the rate of postoperative rescue analgesia was decreased in group S( P<0.05). There was no significant difference in the incidence of postoperative dizziness, hallucinations, and pulmonary complications between the two groups ( P>0.05). Conclusions:Esketamine can reduce extremity ischemia-reperfusion-induced lung injury in elderly patients undergoing total knee replacement, and the mechanism may be related to regulating vascular endothelial function and reducing lipid peroxidation.

Background::Few evidence is available in the early prediction models of behavioral and psychological symptoms of dementia (BPSD) in Alzheimer’s disease (AD). This study aimed to develop and validate a novel genetic-clinical-radiological nomogram for evaluating BPSD in patients with AD and explore its underlying nutritional mechanism.Methods::This retrospective study included 165 patients with AD from the Chinese Imaging, Biomarkers, and Lifestyle (CIBL) cohort between June 1, 2021, and March 31, 2022. Data on demographics, neuropsychological assessments, single-nucleotide polymorphisms of AD risk genes, and regional brain volumes were collected. A multivariate logistic regression model identified BPSD-associated factors, for subsequently constructing a diagnostic nomogram. This nomogram was internally validated through 1000-bootstrap resampling and externally validated using a time-series split based on the CIBL cohort data between June 1, 2022, and February 1, 2023. Area under receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) were used to assess the discrimination, calibration, and clinical applicability of the nomogram.Results::Factors independently associated with BPSD were: CETP rs1800775 (odds ratio [OR] = 4.137, 95% confidence interval [CI]: 1.276-13.415, P = 0.018), decreased Mini Nutritional Assessment score (OR = 0.187, 95% CI: 0.086-0.405, P <0.001), increased caregiver burden inventory score (OR = 8.993, 95% CI: 3.830-21.119, P <0.001), and decreased brain stem volume (OR = 0.006, 95% CI: 0.001-0.191, P = 0.004). These variables were incorporated into the nomogram. The area under the ROC curve was 0.925 (95% CI: 0.884-0.967, P <0.001) in the internal validation and 0.791 (95% CI: 0.686-0.895, P <0.001) in the external validation. The calibration plots showed favorable consistency between the prediction of nomogram and actual observations, and the DCA showed that the model was clinically useful in both validations. Conclusion::A novel nomogram was established and validated based on lipid metabolism-related genes, nutritional status, and brain stem volumes, which may allow patients with AD to benefit from early triage and more intensive monitoring of BPSD.Registration::Chictr.org.cn, ChiCTR2100049131.