Objective To introduce a new spinal surgery navigation system based on structured light scanning(structured light navigation system,SLNS),and to compare accuracy of pedicle screw placement using SLNS,CT based navigation system and free hand technique.Methods Thirty-two calf vertebral pedicles,40 and 32 were placed with pedicle screws using SLNS,CT navigation system,and free hand technique,respectively.The pedicle breakage ratio,transverse section angle (TSA),sagittal section angle (SSA),screw offset deviation of each screw were detected according to CT images.Results The pedicle breakage ratio of pedicle screws in SLNS group,CT navigation group and free hand group were 6%(2./32),5%(2/40),25%(8/32),respectively.The difference between each of the two navigation groups and free hand group were statistically significant regarding frequency of screw misplacement.The difference between the two navigation systems was not obvious.The average SSA error and TSA error in SLNS group were 2.58°±2.74° and 4.26°±5.20°.For CT navigation group,they were 2.95°±2.61° and 3.13°±-2.75°.There was no statistical difference between the two navigation methods for the SSA or TSA error.There was no statistical difference in offset deviation among SLNS group,CT navigation group and free hand group.Conclusion The SLNS is a new and practical navigation system,which has similar accuracy with CT navigation system.

Objective To discuss the clinical significance of serum neutrophil gelatinase associated lipocalin(NGAL)detection in the diagnosis of contrast induced nephropathy .Methods A total of 299 inpatients with contrast medium in department of inten‐sive care unit(ICU) ,department of cardiovascular disease ,department of urology from Guangdong Province Hospital of Traditional Chinese Medicine were enrolled ,and the fasting blood glucose and lipids were detected .Sera were collected before examination of contrast medium and 1 ,2 and 6 d after examination of contrast medium respectively .Serum creatinine(SCr)and cystatin C(CysC) were detected ,the concentration of NGAL was determined .CIN was defined as of increased by 44 μmol/L or 25% from baseline in SCr within 24-48 h .The NGAL detection variation tendency was analyzed in different time point .Results In 299 cases ,CIN oc‐curred in 28 patients ,the incidence rate was 9 .36% .The diabetes patients in the incidence of CIN was 16 .21% (12/74) ,no inci‐dence of diabetic patients was 7 .11% (16/225) .When compared with that of before contrast ,CIN in serum of patients with Cr and CysC coronary angiography in 2 d significantly increased after contrast medium ,returned to the level before angiography on 6 d .But the serum NGAL in angiography 1 d after it was significantly increased (P<0 .05) ,statistically significant differences compared with pre contrast ,and was still at a high level on sixth day .Conclusion Prediction of CIN level of serum NGAL in contrast after 1 d could be a good predictor for CIN ,and the prediction time is earlier than the serum levels of Cr and CysC .The level of serum NGAL can be used for early diagnosis of CIN .

Cells within tissues are subject to various mechanical forces,including hydrostatic pressure,shear stress,compression,and tension.These mechanical stimuli can be converted into biochemical signals through mechanoreceptors or cytoskeleton-dependent response processes,shaping the microenvironment and maintaining cellular physiological balance.Several studies have demonstrated the roles of Yes-associated protein(YAP)and its homolog transcriptional coactivator with PDZ-binding motif(TAZ)as mechanotransducers,exerting dynamic influence on cellular phenotypes including differentiation and disease pathogenesis.This regulatory function entails the involvement of the cytoskeleton,nucleoskeleton,integrin,focal adhesions(FAs),and the integration of multiple signaling pathways,including extracellular signal-regulated kinase(ERK),wingless/integrated(WNT),and Hippo signaling.Furthermore,emerging evidence substantiates the implication of long non-coding RNAs(lncRNAs)as mechanosensitive molecules in cellular mechanotransduction.In this review,we discuss the mechanisms through which YAP/TAZ and lncRNAs serve as effectors in responding to mechanical stimuli.Additionally,we summarize and elaborate on the crucial signal molecules involved in mechanotransduction.

Transcranial Doppler (TCD) is a method for measuring cerebral artery blood flow velocity, which has the advantages of low cost, non-invasive, high temporal resolution. Dynamic cerebral autoregulation (dCA) is to study the instantaneous change of cerebral blood flow (CBF) at the moment of arterial blood pressure or intracranial pressure change, that is, the ability to recover CBF in the face of sudden change of perfusion pressure. After the onset of acute ischemic stroke (AIS), effective dCA can maintain the stability of cerebral hemodynamics and avoid excessive or insufficient perfusion at the injured site. Therefore, it is of great significance to evaluate dCA in patients with AIS. However, at present, there is no recognized optimal evaluation method for dCA. This article mainly summarizes the advantages of TCD in evaluating dCA compared with other methods and the application of TCD combined with transfer function analysis (TFA) in evaluating dCA in AIS.

Objective:To assess the age-related differences in the management strategies and outcomes of patients with acute coronary syndrome (ACS) under the chest pain center model.Methods:Clinical data of 2 833 patients with ACS were enrolled in the retrospective observational registry between January 2017 and June 2019 at 11 hospitals with chest pain centers in Chengdu. The patients were divided into four groups according to their ages: < 55 years old group ( n = 569), 55-64 years old group ( n = 556), 65-74 years old group ( n = 804), ≥ 75 years old group ( n = 904). The collected data included the patients' demographic characteristics, cardiovascular risk factors, medical history, symptoms and signs of onset, experimental examination, types of ACS and the time from the symptom to the hospital (S-to-D), etc., and the clinical characteristics, management strategies, all-cause mortality in the hospital, and the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) within 1 year after discharge were compared. The primary end point was the clinical outcome of ACS patients in different age groups, including all-cause deaths in the hospital and the incidence of MACCE within 1 year after discharge. The secondary end point was the proportion of ACS patients underwent percutaneous coronary intervention (PCI) in different age groups. Multivariate Logistic regression was used to analyze the risk factors of all-cause deaths in ACS patients. Kaplan-Meier curve was used to express the incidence of MACCE within 1 year after discharge in different age groups. Multivariate Cox regression was used to analyze the factors affecting the incidence of MACCE within 1 year after discharge of ACS patients. Results:As age increased, the proportion of male patients gradually decreased, and the percentages of male patients aged < 55 years old, 55-64 years old, 65-74 years old, and ≥ 75 years old were 87.2% (496/569), 77.0% (428/556), 66.4% (534/804), and 60.1% (543/904), respectively; and ACS patients combined with hypertension, diabetes, coronary heart disease, and stroke history were more common [the percentages of patients with hypertension aged < 55 years old, 55-64 years old, 65-74 years old, ≥ 75 years old were 41.3% (235/569), 52.2% (290/556), 59.7% (480/804), and 66.9% (605/904); the percentages of diabetes were 18.6% (106/569), 25.5% (142/556), 27.0% (217/804), and 28.2% (255/904); the percentages of coronary heart disease were 10.1% (57/564), 13.9% (77/555), 17.6% (141/803), and 23.7% (213/899); the percentages of stroke were 0.7% (4/564), 4.0% (22/552), 4.5% (36/801), and 8.6% (77/894)]. But the percentages of patients with a history of active smoking, typical chest pain/chest tightness and dyslipidemia were significantly reduced [the percentages of smoking history were 60.2% (340/565), 48.0% (266/554), 33.7% (270/801), and 21.7% (195/899), typical chest pain/chest tightness were 96.9% (536/553), 96.4% (516/535), 91.8% (716/780), 90.2% (776/860); the percentages of dyslipidemia were 11.2% (63/565), 9.2% (51/553), 5.7% (46/802), and 4.9% (44/896)], the time of S-to-D was significantly prolonged [minutes: 176.0 (73.5, 557.0), 194.5 (89.3, 682.3), 221.0 (98.8, 940.5), and 270.0 (115.0, 867.0)], hemoglobin (Hb) level was significantly reduced(g/L: 145.44±17.43, 135.95±19.25, 129.75±19.03, 122.19±20.55), and the incidence of non-ST-segment elevation myocardial infarction (NSTEMI) increased significantly [18.6% (106/569), 20.5% (114/556), 26.6% (214/804), 26.5% (240/904)], and the differences were statistically significant (all P < 0.05). The proportion of Killip grade Ⅲ -Ⅳ were the highest in patients aged ≥ 75 years old, 9.0% and 12.6%, respectively. Compared with the groups aged < 55 years old, 55-64 years old, and 65-74 years old, the proportion of patients aged ≥ 75 years old who underwent PCI was the lowest, and the all-cause mortality in the hospital and the incidence of 1-year MACCE of patients underwent PCI were significantly lower than those of patients underwent conservative treatment [6.0% (28/463) vs. 10.4% (45/434), 14.6% (43/294) vs. 24.3 % (55/226), both P < 0.05]. As age increased, the hospital all-cause mortality and the 1-year MACCE incidence increased (all-cause mortality rates in < 55 years old, 55-64 years old, 65-74 years old, ≥ 75 years old groups were 0.9%, 2.2%, 5.5%, 8.3%, and the 1-year MACCE incidences were 5.0%, 6.7%, 13.9%, 18.7%, both P < 0.01). The multivariate Logistic regression analysis showed that age, cardiogenic shock, ST-segment elevation myocardial infarction (STEMI), the number of vascular disease and underwent PCI were the independent risk factors of all-cause mortality [the odds ratio ( OR) and 95% confidence interval (95% CI) were 1.644 (1.356-1.993), 11.794 (7.469-18.621), 2.449 (1.419-4.227), 1.334 (1.096-1.624), 0.391 (0.247-0.619), all P < 0.001]. Cox regression analysis showed that age, STEMI, the number of vascular disease and underwent PCI were independent risk factors of the occurrence of MACCE within 1 year after discharge [hazard ratio ( HR) and 95% CI were 1.354 (1.205-1.521), 1.387 (1.003-1.916), 1.314 (1.155-1.495), 0.547 (0.402-0.745), all P < 0.05]. Conclusions:In the chest pain center model, compared with other age of ACS patients, the proportion of NSTEMI in elderly patients group aged ≥ 75 years old was higher, the proportion of PCI was lower, and the clinical outcome was worse. However, the prognosis of elderly patients receiving PCI treatment was better than the patients receiving conservative treatment.

Objective To analyze and compare the chemical components of the volatile oil in different parts of Cryptotae-nia japonica .Methods Essential oils were extracted from the root ,stem ,leaf ,fruit of Cryptotaenia japonica through steam distillation .GC-MS analysis combined with Kovats retention index methods were used to analyze its main components .Results 28 peaks were separated and 28 compounds were identified from volatile oils from the root of Cryptotaenia japonica ,ac-counting for 86.66% of the total ,27 peaks were separated and 27 compounds were identified from volatile oils from stem of Cryptotaenia japonica ,accounting for 88 .01% of the total ,27 peaks were separated and 27 compounds were identified from volatile oils from leaves of Cryptotaenia japonica ,accounting for 94 .03% of the total ,26 peaks were separated and 26 com-pounds were identified from volatile oils from fruit of Cryptotaenia japonica ,accounting for 88 .32% of the total .35 kinds of volatile compounds were identified from the whole strain ,and the main components of each part of the volatile oil were sesquit-erpene compounds ,containing a small amount of monoterpenes .Among all the 35 compounds ,different parts of Cryptotaenia japonica share 22 compounds .Compounds 19 ,23 only exists in the volatile oil from the roots .Aromadendrene ,compound 25 , red myrrh alcohol only exists in the volatile oil from the fruit .So there is a certain difference in the types and quantity of the compounds .Conclusion The volatile oil of Cryptotaenia japonica contains many physiologically active substance .Take the whole plant as a medicine has its rationality ,which provide a scientific basis for the further research and development of Cryp-totaenia j aponica .

Objective:To evaluate the safety and feasibility of cancer tissue specimen delivery through a preventive ostomy incision during laparoscopic radical resection of rectal cancer .Methods:A total of 155 patients undergoing laparoscopic radical rectal cancer combined with prophylactic ileostomy at Peking University Third Hospital from Oct 2016 to Sep 2021 were retrospectively divided into two groups according to where the specimens were delivered through prophylactic colostomy incision (46 cases) or through newly made suprapubic incision (109 cases).Results:The by prophylactic colostomy incision delivery group had shorter surgery time [(243±66) min vs. (281±73) min, t=3.003, P<0.01] and shorter postoperative hospital stay [(7.5±2.2) d vs. (8.8±4.3）d， t=2.516， P<0.05], while there were no significant differences in intraoperative blood loss, intraoperative blood transfusion, postoperative first time of flatus, surgery-related complications and ostomy-related complications between the two groups (all P>0.05). Though the ostomy size in the prevention colostomy group was larger ( P<0.01), but there were no significant differences in the ostomy related complications between the two groups ( P>0.05). Conclusions:Laparoscopic radical resection of rectal cancer with specimen delivery through a preventive ostomy incision is of more aesthetic advantages without causing higher postoperative complications.

Insomnia is the second most common psychiatric disorder in clinical practice, and more than one-third of adults may experience different forms of insomnia during their lifetime, but the root causes behind insomnia need further clarification. Early evidences from twins and family studies had shown that insomnia can be attributed to genetics. In recent years, with the rapid development of gene sequencing technology, Nature Genetics had published several consecutive articles focusing on insomnia and genes, confirming that genetic factors played an important role in the occurrence and development of insomnia. Therefore, the recent research progresses on insomnia and circadian rhythm, cytokines, neurotransmitters, and other related genes were summarized in this review, which could help to understand the pathogenesis of insomnia and develop precise treatment strategies.

Under the"New Medicine"context,how to integrate medical engineering technology into modern teaching methods has become a key approach to enhancing the quality and efficiency of medical education.This paper aims to advance medical education and teaching reforms,promote the comprehensive improvement in the quality of higher education,and focus on enhancing the quality of medical talent cultivation.For this purpose,the authors proposed an innovative intelligent classroom teaching model,based on artificial intelligence technology.This model utilized advanced camera technology to capture students'facial expressions in real-time,combining artificial intelligence algorithms to analyze students'understanding of medical concepts,and assisted teachers in adjusting classroom teaching strategies in real-time to improve learning effectiveness.This approach has significantly enhanced the overall quality and efficiency of medical education and is of great significance for cultivating versatile medical professionals with high levels of expertise and practical skills.

Objective:To develop the Peripherally Inserted Central Catheter (PICC) Nursing Knowledge, Attitude and Practice Scale for Primary Caregivers of Patients with PICC, and to test its reliability and validity.Methods:Taking the theory of knowledge, attitude and practice as the basic framework, the item pool was initially constructed through literature review, group discussion, and semi-structured interviews from March to April 2021. From May to July 2021, the initial scale was formed through Delphi expert consultation, and the items of the scale were pre-tested and adjusted through cognitive interviews. From June to October 2021, convenience sampling was used to select the primary caregivers of 450 patients with PICC in a cancer hospital in Hunan Province for a formal survey to test the reliability and validity of the scale.Results:The formal scale consisted of 53 items in 3 dimensions, including 19 items in the knowledge dimension, 8 items in the attitude dimension, and 26 items in the practice dimension. The Cronbach's α coefficients of each dimension and the total scale were 0.949, 0.962, 0.972, and 0.981, respectively, and the test-retest reliability coefficients of each dimension and the total scale were 0.951, 0.935, 0.972, and 0.967, respectively. The split-half reliability coefficients of each dimension and the total scale were 0.889, 0.954, 0.889, and 0.882, respectively. The content validity index of the item ranged from 0.82 to 1.00.Conclusions:The reliability and validity of the PICC Nursing Knowledge, Attitude and Practice Scale for Primary Caregivers of Patients with PICC is good, and it can be used as a tool to evaluate the PICC nursing knowledge, attitude, and practice of primary caregivers of patients with PICC.