Objective To summarize the computed tomographic (CT) manifestations of pulmonary aspergillosis after organ transplantation and compare different signs between pulmonary aspergillosis and bacterial pneumonia.Methods CT images of pulmonary aspergillosis (n =62) and bacterial pneumonia (n =68) in post-transplantation patients were reviewed.The signs were categorized with consolidation,mass,large nodule (≥1crn),small nodule and bud-in-tree pattern.Some detailed useful differentiating signs such as halo sign,air bronchogram sign,reversed halo sign,hypodensity sign and cavitation were also analyzed.Results CT patterns of pulmonary aspergillosis included consolidation,mass,large nodule,small nodule and bud-in-tree pattern.The most common was large nodule (75.8％),followed by consolidation (48.4％)and mass (29.0％).And small nodule (16.1 ％) and bud-in-tree (12.9％) patterns were concurrent.For consolidation pattern,the proportion of bacterial pneumonia (69.1％) was the larger;For mass pattern,the proportion of pulmonary aspergillosis (29.0％) was the larger.For large nodule pattern,there was no difference.The detail sign of large nodule in two groups had no difference In detailed signs of consolidation pattern,air bronchogram sign was more often seen in bacterial pneumonia while cavitation was more frequently found in pulmonary aspergillosis.In detailed signs of mass pattern,pulmonary aspergillosis often has single lesion (66.7％),cavitation (83.3％)and air crescent sign (77.8％) is more common.The proportion of halo sign was 30.7％.Conclusions CT manifestations of pulmonary aspergillosis are diverse after organ transplantation.There is some difference and yet overlap with bacterial pneumonia.

BACKGROUND:Total knee arthroplasty is one of the effective methods to treat end-stage knee osteoarthritis.However,some patients still experience chronic post-surgical pain.It is significant to find out the influencing factors of chronic post-surgical pain.Demographic factors,social psychological factors and perioperative pain were the focus of previous studies,but muscle factors closely related to the occurrence and development of knee osteoarthritis were rarely reported. OBJECTIVE:To evaluate the value of preoperative quantitative ultrasound analysis of quadriceps femoris in predicting chronic post-surgical pain after total knee arthroplasty. METHODS:A total of 250 patients with knee osteoarthritis who underwent the first unilateral total knee arthroplasty under elective general anesthesia from January to August 2022 in the Affiliated Hospital of Xuzhou Medical University were selected.All patients were treated with the same anesthesia and operative methods.Before the surgery,clinical data were recorded,and the thickness and echo intensity of quadriceps femoris on the operated side were measured by ultrasound imaging,which could quantify the degree of quadriceps femoris atrophy.Multivariate logistic regression was used to analyze the independent factors affecting the occurrence of chronic post-surgical pain,and receiver operating characteristic curves were used to evaluate its predictive value. RESULTS AND CONCLUSION:(1)250 subjects were involved in the result analysis,and 91 of them had chronic post-surgical pain,with an incidence of 36.4%.(2)There were significant differences between the chronic pain and non-chronic pain groups in preoperative pain score during movement,preoperative Western Ontario and McMaster University Osteoarthritis Index,preoperative anxiety and depression scale score,preoperative muscle thickness and echo intensity of quadriceps femoris,and postoperative acute pain score(P<0.05).(3)Multivariate logistic regression analysis showed that preoperative thickness of quadriceps femoris was an independent protective factor for chronic post-surgical pain and preoperative pain score during movement was an independent risk factor for chronic post-surgical pain.(4)Receiver operating characteristic curves showed that the area under the curve of the preoperative thickness of quadriceps femoris was 0.625(95%CI:0.555-0.695),and the critical value was 2.78 cm,sensitivity was 0.802,specificity was 0.415.(5)It is concluded that the preoperative thickness of quadriceps femoris is an independent protective factor for chronic post-surgical pain,but its predictive efficacy is low,and its clinical application needs to be further verified or modified.

Objective:To examine the correlations of C-reactive protein (CRP)/albumin ratio (CAR) with the postoperative complications of patients with colorectal cancer.Methods:The clinic data of 312 patients undergoing elective surgery for colorectal cancer in Hainan Hospital of People′s Liberation Army General Hospital between January 2013 and July 2018 was analyzed retrospectively. There were 188 males and 124 females, aged (61.0±12.9) years (range: 21 to 86 years). Logistic analysis was used to identify relative factors for postoperative complications. Receiver operating characteristic curves were developed to examine the cutoff values and compare diagnostic accuracy of the CAR and CRP levels.Results:Postoperative complications occured in 28.5% (89/312) cases. Hemoglobin on postoperative day(POD) 3 ( OR=0.977, 95% CI: 0.957 to 0.998, P=0.034), preoperative CRP ( OR=1.209, 95% CI: 1.055 to 1.386, P=0.006) and CAR on POD 3 ( OR=0.033, 95% CI: 0.016 to 0.067, P<0.01) were found to be significant independent relative factors for postoperative complications. The cutoff point of CAR on POD 3 was 0.325, patients with CAR≥0.325 were found to have more postoperative complications than those with CAR<0.325. The area under the curve of CAR on POD 3 and preoperative CRP were 0.872, 0.626, respectively. The positive predictive value of CAR on POD 3 was higher than that of preoperative CRP (79.9% vs. 55.1%). Conclusions:CAR is closely related to the occurrence of postoperative complications in colorectal surgery. Patients with CAR≥0.325 on POD 3 has higher incidence of postoperative complications.

Objective:To examine the correlations of C-reactive protein (CRP)/albumin ratio (CAR) with the postoperative complications of patients with colorectal cancer.Methods:The clinic data of 312 patients undergoing elective surgery for colorectal cancer in Hainan Hospital of People′s Liberation Army General Hospital between January 2013 and July 2018 was analyzed retrospectively. There were 188 males and 124 females, aged (61.0±12.9) years (range: 21 to 86 years). Logistic analysis was used to identify relative factors for postoperative complications. Receiver operating characteristic curves were developed to examine the cutoff values and compare diagnostic accuracy of the CAR and CRP levels.Results:Postoperative complications occured in 28.5% (89/312) cases. Hemoglobin on postoperative day(POD) 3 ( OR=0.977, 95% CI: 0.957 to 0.998, P=0.034), preoperative CRP ( OR=1.209, 95% CI: 1.055 to 1.386, P=0.006) and CAR on POD 3 ( OR=0.033, 95% CI: 0.016 to 0.067, P<0.01) were found to be significant independent relative factors for postoperative complications. The cutoff point of CAR on POD 3 was 0.325, patients with CAR≥0.325 were found to have more postoperative complications than those with CAR<0.325. The area under the curve of CAR on POD 3 and preoperative CRP were 0.872, 0.626, respectively. The positive predictive value of CAR on POD 3 was higher than that of preoperative CRP (79.9% vs. 55.1%). Conclusions:CAR is closely related to the occurrence of postoperative complications in colorectal surgery. Patients with CAR≥0.325 on POD 3 has higher incidence of postoperative complications.

Objective:To analyze the role of learning engagement and learning burnout in the relationship between supervisors' guidance and the personal ability of postgraduates in the Professional Master's Program in Clinical Medicine.Methods:A total of 4 016 postgraduates in the Professional Master's Program in Clinical Medicine from 61 colleges were surveyed in 2020. Common method bias was assessed using the Harman's single factor test and total score was determined by the entropy weight method. Causality and mediation effect were analyzed by linear regression, and mediation effect was tested by Bootstrapping.Results:The average scores of supervisors' guidance, learning burnout, learning engagement and personal ability were (4.13±0.87), (2.49±1.11), (3.88±0.83), and (3.71±0.78), respectively. Supervisors' guidance significantly and positively impacted learning engagement ( β=0.689, P<0.001) and personal ability ( β=0.504, P<0.001). Learning engagement played a partial mediating role (89.30% of mediation effect) between supervisors' guidance and personal ability. Learning burnout (interaction term β=0.078, P<0.001) positively regulated the relationship between supervisors' guidance and learning engagement. Conclusions:Learning engagement can mediate the effect of supervisors' guidance on the personal ability of postgraduates in the Professional Master's Program in Clinical Medicine, and learning burnout positively regulates the effect of supervisors' guidance on learning engagement. Strengthened supervisors' guidance, increased attention to students' learning burnout, and enhanced learning engagement can further improve the personal abilities of postgraduates in the Professional Master's Program in Clinical Medicine.

Objective:To investigate the "burnout-engagement continuum" status of postgraduate supervisors of the Professional Master's Program in Clinical Medicine and to identify key populations.Methods:From October to November 2023, an anonymous online questionnaire survey was conducted to determine the "burnout-engagement continuum" status of postgraduate supervisors of the Professional Master's Program in Clinical Medicine. The scores of different dimensions of job burnout are expressed as mean±standard deviation, and the distribution of supervisors of different status is presented in frequency and percentage. All data analyses were performed in R 4.3.1. Distribution of the five profiles among supervisors of different status was compared using the chi-square test and compared pairwise using the Bonferroni method.Results:A total of 2 664 valid questionnaires were collected. The scores of emotional exhaustion, cynicism and personal accomplishment were（2.46±0.95),（1.74±0.89), and（4.23±0.90), respectively. The prevalence of job engagement, inefficacy, overexertion, disengagement, and burnout among the supervisors were 42.76%（1 139/2 664), 43.54%（1 160/2 664), 33.03%（880/2 664), 14.71%（392/2 664), and 13.66%（364/2 664), respectively. In terms of demographics, the distribution of the "burnout-engagement continuum" was significantly different by age, sex, marital status, and highest education level（ P<0.05). In terms of work-related characteristics, the distribution of the "burnout-engagement continuum" was significantly different by income, professional title, administrative position, and working hours on weekdays and holidays（ P<0.05). The distribution of engagement, inefficacy, and overexertion was significantly different between the eastern and western regions（ P<0.05). Conclusions:There is a high percentage of individuals with burnout among postgraduate supervisors of the Professional Master's Program in Clinical Medicine, and inefficacy is a common negative state. Supervisors who work in the western regions, are under 45 years of age, are male, are married, have a doctorate degree, hold associate senior professional title, have lower relative income, are not holding administrative duties, and work more than 10 hours on workdays and more than 4 hours on holidays are key populations that require increased attention. The psychological state of supervisors can be improved by providing them with more resources, work benefits, and incentives.

Objective:To investigate the current status of and relationship between practice efficacy, professional identity, and anxiety among public health master's graduates.Methods:From a national survey on the satisfaction with education of fresh medical master's graduates conducted from June to July, 2022, we selected 461 master's graduates of public health with internship experience from 49 institutions. With the use of SPSS 21.0, we compared the scores of practice efficacy, professional identity, and self-rated anxiety by personal characteristics through t-tests and analysis of variance; and explored the mediating role of anxiety in the relationship between practice efficacy and professional identity through stratified regression analysis. Results:The public health master's graduates scored (3.47±1.23) points for anxiety, (3.92±0.88) points for practice efficacy, and (4.33±0.77) points for professional identity. The score of anxiety differed significantly by sex, the degree of being affected by public health emergencies/major outbreaks, and internship initiative (all P<0.05). The score of practice efficacy was significantly different by sex, the type of institution, the degree of being affected by public health emergencies/major outbreaks, and internship initiative (all P<0.05). The score of professional identity differed significantly by sex, the type of institution, major transfer, the degree of being affected by public health emergencies/major outbreaks, internship initiative, and internship duration (all P<0.05). Professional identity was positively correlated with practice efficacy ( r=0.652, P<0.01) and negatively correlated with anxiety ( r=-0.213, P<0.05). The stratified regression results showed that practice efficacy positively influenced professional identity ( β=0.782, P<0.001), and anxiety partially mediated the relationship between the two ( β=-0.104, P<0.05). Conclusions:Anxiety plays a mediating role in the relationship between practice efficacy and professional identity, suggesting that reducing anxiety can help enhance practice efficacy to promote the professional identity of public health master's graduates.

Objective:To investigate the enrollment scale and distribution of Master's Degree in Pediatrics programs in China, and to provide a reference for promoting pediatric education and disciplinary development.Methods:Data on colleges and universities authorized to award Master's Degree in Pediatrics in 2023 were collected, sorted, and analyzed for the number, structure, distribution, and enrollment scale and direction of these institutions using descriptive statistics.Results:Among the 117 clinical medicine academic master's degree programs in China, 72 enroll pediatric academic master's degree candidates, with an enrollment of 260 students. Among the 120 master's degree programs in clinical medicine, 104 enroll professional master's degree candidates, enrolling 1 195 students. Enrollment is mainly concentrated in East China, "non-double first-class" colleges and universities, medical colleges and universities with subject level B, and enrollment is carried out in the direction of secondary disciplines.Conclusions:The number of colleges and universities authorized to award Master's Degree in Pediatrics was small, and the distribution of these colleges and universities was unbalanced. The enrollment scale was small and the orientation of Professional Master's Degree was not reasonable. Some colleges and universities were authorized to award Master's Degree in Pediatrics, but did not enroll any students. It is suggested to increase the number of colleges and universities authorized to award Master's Degree in Pediatrics and strengthen the staffing of pediatric departments. The aim is to expand the enrollment scale of candidates for Master's Degree in Pediatrics, improving the differential training of candidates for Academic Master's Degree and Professional Master's Degree, and attach importance to the construction of pediatrics.

Objective To investigate the dosimetric feasibility of volumetric modulated arc therapy (VMAT)with a simultaneous integrated boost(SIB-VMAT58.75 Gy)for preoperative chemoradiotherapy in patients with locally advanced rectal cancer(LARC),and to provide a basis for clinical practice.Methods Nine patients with stage Ⅱ-Ⅲ rectal cancer who underwent preoperative concurrent chemoradiotherapy were involved in the study,and two plans were performed for each patient:SIB-VMAT58.75 Gy and VMAT50.00 Gy. For the SIB-VMAT58.75 Gy plan,the prescribed dose was 58.75 Gy(2.35 Gy/fraction)for the local rectal tumor and positive lymph nodes(GTV 58.75 Gy),and 50 Gy(2 Gy/fraction)for the regions at high risk of harboring microscopic disease(pelvic lymphatic drainage area)(PTV 50Gy).For the VMAT50.00 Gy plan,the prescribed dose was 50 Gy(2 Gy/fraction)for the regions at high risk of harboring microscopic disease(pelvic lymphatic drainage area)without a boost. The conformity index(CI),homogeneity index (HI),and dose for target areas and organs at risk(OAR)were assessed according to the dose-volume histogram. The paired t-test or nonparametric rank test was used to compare the differences between the two plans. Results Both plans met the prescription goal for PTV dose coverage. There was no significant difference in CI for the PTV between the two plans(1.0±0.0 vs. 1.0±0.0,P>0.05).The SIB-VMAT58.75 Gy plan had a worse HI than the VMAT50.00 Gy plan(0.2± 0.2 vs. 0.1± 0.0,P<0.05).There was no significant difference in V10-V50of the small intestine,bladder,femoral heads,and pelvis between the two plans(P>0.05),but D 2 cm3of the small intestine was significantly higher in the SIB-VMAT58.75 Gy plan than in the VMAT50.00 Gy plan(P=0.038). Conclusions The SIB-VMAT58.75 Gy plan for LARC achieves required target volume dose coverage and OAR dose constraints,which is safe and feasible in terms of dosimetry,and its clinical efficacy and adverse effects need further evaluation.

Objective: To investigate the effect of berberine on programmed necrosis of hepatocytes induced by metabolic-associated fatty liver disease (MAFLD) in mice and its related molecular mechanism. Methods: Twenty male C57BL/6N mice were randomly divided into four groups (n=5 in each group): control group (S), fatty liver group (H), berberine group(B), nuclear factor erythroid 2-related factor 2 inhibitor group (Nrf2), and all-trans-retinoic acid (ATRA) group (A). Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), triglycerides (TG), total cholesterol (TC), tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) concentrations were detected at the end of week 12 to calculate fatty liver index (liver mass/body mass ratio). Liver tissue was stained with HE, Masson and Oil Red O, and SAF score was used to evaluate the degree of liver injury. The expression levels of hepatic programmed necrosis-related proteins, namely receptor-interacting protein kinase 3 (RIPK3), phosphorylated mixed series protease-like domain (p-MLKL) and Nrf2 were detected by Western blot method. One-way ANOVA was used for intragroup comparisons and LSD-t tests were used for intergroup comparisons. Results: Compared with S group, H group serum ALT, AST, LDH, TG, TC, TNF-α, IL-1β levels and fatty liver index were significantly increased. The liver tissue was filled with vacuolar-like changes and inflammatory cell infiltration. Numerous red lipid droplets were observed with oil red O staining. Collagen fiber hyperplasia was evident with Masson staining. SAF scores (6.60 ± 0.55 and 0.80 ± 0.45) were significantly increased. The expressions of RIPK3 and p-MLKL were up-regulated. Nrf2 level was relatively increased, and the differences were statistically significant (P < 0.05). Compared with H group, berberine intervention group liver biochemical indexes, lipid levels, pro-inflammatory mediator expression, fatty liver index, and SAF score were significantly reduced, and the expression of RIPK3 and p-MLKL were down-regulated, while Nrf2 levels were further increased, and the differences were statistically significant (P<0.05). Compared with B group, treatment with Nrf2 inhibitor had antagonized the protective effect of berberine on fatty liver. Serum ALT, AST, LDH, TG, TC and TNF-α, IL-1β levels, fatty liver index, and SAF scores were significantly increased and the expressions of RIPK3 and p-MLKL were relatively increased, and the differences were statistically significant (P < 0.05). Conclusion: Berberine can significantly improve the metabolic-associated fatty liver disease injury in mice, and its mechanism is related to activation of Nrf2 and inhibition of programmed necrosis of hepatocytes.
Animals ; Berberine/therapeutic use* ; Fatty Liver ; Male ; Mice ; Mice, Inbred C57BL ; NF-E2-Related Factor 2/metabolism* ; Necrosis