Objective:To explore the factors influencing the supportive communication ability of medical undergraduates, and to propose strategies to improve supportive communication.Methods:By cluster sampling, we selected 388 medical undergraduates of grades 2017 and 2018 from Harbin Medical University for a questionnaire survey on supportive communication, general self-efficacy, and health education abilities. SPSS 22.0 was used for descriptive statistical analysis. AMOS 22.0 was used to construct a structural equation model to verify the relationship between the three variables. Mediating effects were also tested.Results:The students showed good supportive communication ability, with a total score of (74.28±10.84) points. The general self-efficacy score was (27.81±5.58) points, and the total score of health education ability was (25.50±4.76) points. General self-efficacy had direct positive effects on supportive communication and health education abilities ( β=0.75, 0.31, both P<0.001). Health education ability had a direct positive effect on supportive communication ability ( β=0.14, P<0.001). Health education ability played a significant mediating role in the influence of general self-efficacy on supportive communication ability (standardized mediating effect value=0.042, P<0.01), with the mediating effect accounting for 5.1%. Conclusions:The health education competency of medical undergraduates can mediate the effect of general self-efficacy on supportive communication ability. By strengthening medical humanities education to increase general self-efficacy and also emphasizing the cultivation of health education competency, the supportive communication ability of students can be improved.

【Objective】 To explore the relationship between the methylation level of CNR1 and autism spectrum disorder (ASD), in order to provide a theoretical basis for the etiology of ASD. 【Methods】 A case-control study was conducted, recruiting 30 children with ASD from the Child Development and Behavior Research Center of Harbin Medical University and a rehabilitation facility, and 30 matched typically developed children from June 2017 to December 2018. The methylation levels of CNR1 in peripheral blood were measured by the Agena MassArray^® Mass Spectrometry System. A univariate conditional Logistic regression model was used to analyze the potential association between the methylation level of CNR1 and the risk of ASD with adjustment for age, BMI, body fat percentage and body fat. The correlations between the methylation level of CNR1 and the score of Social Responsiveness Scale (SRS) were evaluated by Pearson/Spearman correlation analysis. 【Results】 The methylation levels of the average methylation (t=2.224), CpG_3.4 (Z=2.187), CpG_9.10.11 (t=2.308), and CpG_28.29 (t=2.943) of the CNR1 promoter region in ASD children were significantly higher than controls (P<0.05). The methylation levels of the average methylation (OR=1.117, 95%CI: 1.003 - 1.245), CpG_9.10.11 (OR= 1.072, 95%CI:1.006 - 1.142), and CpG_28.29 (OR=1.078, 95%CI: 1.018 - 1.141) of the CNR1 promoter region were positively correlated with the risk of ASD (P<0.05). The methylation level of CpG_28.29 in ASD children was positively correlated with the scores of social motivation in SRS (r=0.421, P<0.05). 【Conclusions】 The methylation levels of CNR1 in peripheral blood are abnormal in ASD children and might be correlated with the risk of ASD and social function. The underlying mechanism needs to be further explored.

Objective:To examine the efficacy and experience of staged and segmented two hybrid surgeries for total repair of Debakey type Ⅰ aortic dissection (TIAD).Methods:This study was a retrospective case series. The clinic data of 10 patients with acute TIAD who were admitted to the Department of Cardiac Surgery, Second Hospital of Lanzhou University or the First People′s Hospital of Lanzhou, between January 2016 and August 2022, were retrospectively studied. Ten patients underwent hybrid surgeries in two hospitalizations (stages), including 7 males and 3 females with an age of (60±7) years (range: 49 to 71 years). In stage 1, the first type Ⅱ hybrid arch repair was performed to treat the ascending, total arch, and descending thoracic aorta for acute TIAD without circulatory arrest. In stage 2, the second hybrid surgery including infrarenal abdominal aorta replacement, visceral arteries bypass and endovascular thoracoabdominal aortic repair was performed to treat residual thoracoabdominal aortic dissection after the first hybrid operation (segmented). Basic data, preoperative concomitant diseases, high-risk factors, surgical approaches and postoperative complications of all important organs, as well as CT imaging were analyzed.Results:There was no death in the 20 hybrid surgical procedures. In stage 1 type Ⅱ hybrid surgery, 4 cases underwent reconstruction of the aortic sinutubular junction, while Bentall and David surgery was performed for 3 cases, respectively. A patient received coronary artery bypass grafting. Then all patients were sequentially treated with arch debranching and thoracic aortic endovascular repair. Postoperative complications included renal insufficiency (4/10), hemofiltration (1/10), hypoxemia (4/10), neurologic event (1/10) and type Ⅱ endoleak (1/10). Complete false lumen thrombosis occurred in 9/10 of the patients. All complications recovered successfully at discharge and the average hospital stay was (21±4) days (range: 16 to 28 days) in the first hospitalization. At stage 2, the second hybrid surgery was successfully performed in all patients. No paraplegia, hepatic or renal insufficiency, or endoleak occurred. However, branch graft embolism of the left renal artery was found in one patient 3 days after laparotomy, as well as of superior mesenteric artery in another. Superior mesenteric artery occlusion was successfully treated by endovascular recanalization. Complete false lumen thrombosis occurred in all patients. Although all patients had different degrees of intestinal dysfunction, they were gradually relieved at discharge, and the average hospital stay was (19±2)days (range:16 to 21 days) in the second hospitalization. During follow-up, CT angiography showed aortic remodeling in all patients.Conclusion:Staged and segmented two hybrid surgeries are safe and feasible for total repair of Debakey type Ⅰ aortic dissection and are associated with acceptable early and midterm outcomes.

Objective:To examine the efficacy and experience of staged and segmented two hybrid surgeries for total repair of Debakey type Ⅰ aortic dissection (TIAD).Methods:This study was a retrospective case series. The clinic data of 10 patients with acute TIAD who were admitted to the Department of Cardiac Surgery, Second Hospital of Lanzhou University or the First People′s Hospital of Lanzhou, between January 2016 and August 2022, were retrospectively studied. Ten patients underwent hybrid surgeries in two hospitalizations (stages), including 7 males and 3 females with an age of (60±7) years (range: 49 to 71 years). In stage 1, the first type Ⅱ hybrid arch repair was performed to treat the ascending, total arch, and descending thoracic aorta for acute TIAD without circulatory arrest. In stage 2, the second hybrid surgery including infrarenal abdominal aorta replacement, visceral arteries bypass and endovascular thoracoabdominal aortic repair was performed to treat residual thoracoabdominal aortic dissection after the first hybrid operation (segmented). Basic data, preoperative concomitant diseases, high-risk factors, surgical approaches and postoperative complications of all important organs, as well as CT imaging were analyzed.Results:There was no death in the 20 hybrid surgical procedures. In stage 1 type Ⅱ hybrid surgery, 4 cases underwent reconstruction of the aortic sinutubular junction, while Bentall and David surgery was performed for 3 cases, respectively. A patient received coronary artery bypass grafting. Then all patients were sequentially treated with arch debranching and thoracic aortic endovascular repair. Postoperative complications included renal insufficiency (4/10), hemofiltration (1/10), hypoxemia (4/10), neurologic event (1/10) and type Ⅱ endoleak (1/10). Complete false lumen thrombosis occurred in 9/10 of the patients. All complications recovered successfully at discharge and the average hospital stay was (21±4) days (range: 16 to 28 days) in the first hospitalization. At stage 2, the second hybrid surgery was successfully performed in all patients. No paraplegia, hepatic or renal insufficiency, or endoleak occurred. However, branch graft embolism of the left renal artery was found in one patient 3 days after laparotomy, as well as of superior mesenteric artery in another. Superior mesenteric artery occlusion was successfully treated by endovascular recanalization. Complete false lumen thrombosis occurred in all patients. Although all patients had different degrees of intestinal dysfunction, they were gradually relieved at discharge, and the average hospital stay was (19±2)days (range:16 to 21 days) in the second hospitalization. During follow-up, CT angiography showed aortic remodeling in all patients.Conclusion:Staged and segmented two hybrid surgeries are safe and feasible for total repair of Debakey type Ⅰ aortic dissection and are associated with acceptable early and midterm outcomes.

Vibrio vulnificus infection has a high disability rate and fatality rate. This paper summarized the diagnosis and treatment of a case of Vibrio vulnificus sepsis to help clinicians in the early detection and optimization of treatment options for such infections, thereby providing a clinical reference for related research. In September 2022, a case of sepsis caused by Vibrio vulnificus infection was admitted to the Emergency Department of Hainan Hospital of Traditional Chinese Medicine. Clinical treatment was conducted, and the report was analyzed. Meanwhile, Vibrio vulnificus literature was reviewed to analyze and summarize the treatment methods of Vibrio vulnificus sepsis. The 61-year-old patient was treated in the Emergency Department from September 23 to October 8, 2022, during which bacteriological examination of pus and wound infection samples identified the infection as being caused by Vibrio vulnificus. Therefore, targeted treatment with meropenem injection plus levofloxacin injection was administered for the infection, and early CRRT (continuous renal replacement therapy) was implemented to control the inflammatory cytokine storm of sepsis, and surgical debridement treatment was performed. After the patient's condition stabilized, the patient was transferred to the vascular surgery department, where two debridement + left lower limb skin grafting procedures were performed on October 27 and November 19. Then a third debridement + left lower limb third skin grafting + toe amputation was performed on December 10, the patient was discharged with improved condition post-surgery. At present, the patient can live independently and can move the affected limb autonomously. In clinical diagnosis and treatment of sepsis caused by Vibrio vulnificus infection, attention should be paid to the inflammatory cascade reaction. CRRT can eliminate inflammatory factors in the early stage, sensitive antibiotics for anti-inflammatory, surgical debridement interventional treatment, and multi-disciplinary linkage can be initiated to treat patients with Vibrio vulnificus sepsis.

Open surgery is currently the gold standard for the treatment of thoracoabdominal aortic aneurysm(TAAA), while endovascular aortic repair(EVAR) has also been widely carried out. Because it involves important branches supplying internal organs, the technical system for treating TAAA is particularly complex. However, with the advent of newer, low-cost, flexible stent systems, total endovascular repair techniques have become more feasible and attractive. For young and low-risk patients, the choice of open or endovascular treatment remains controversial. Despite the advantages of a minimally invasive procedure, EVAR carries a greater risk of spinal cord injury and may require secondary endovascular intervention to repair endoleak when its unique complication occurs, and the long-term durability after EVAR is not clear. This article reviews the open and endovascular treatment of TAAA, introduces the development of open surgery and endovascular repair, the advantages and disadvantages of various types of stents, and discusses how to select a more suitable surgical method for patients, providing clinicians with a treatment reference.

O⁃glycosylation is a common post⁃translational modification of mucins, widely present in both normal and tumor cells. In colorectal cancer (CRC) cells, there is a varying degree of dysregulation in O ⁃ glycosylation ⁃ related glycosyltransferases, molecular chaperones, and surface Tn antigen, sTn antigen, and T antigen. These dysregulations play a distinctive role in the occurrence and development of CRC, including invasion and metastasis, abnormal apoptosis and proliferation, immune escape, etc. They are extensively studied as novel tumor biomarkers and potential therapeutic targets. This article provides a comprehensive review of progress of research on mucin⁃type O⁃glycosylation and its relevance to the occurrence and development of CRC and its clinical application.

With the continuous in-depth study of minimally invasive cardiac surgery(MICS), minimally invasive cardiac surgery in children has also been developed in this period, but there is still a certain gap compared with adults. Because of the large difference in body size and the low tolerance of surgery in children, minimally invasive cardiac surgery in children still has a short board on complex cardiac diseases. This article reviews several commonly used minimally invasive techniques: (1) small incision cardiac surgery; (2) thoracoscopic and robot-assisted cardiac surgery; (3) minimally invasive cardiopulmonary bypass(MiECC) and cardiac surgery to avoid cardiopulmonary bypass; (4) hybrid surgery and enhanced cardiac rehabilitation surgery(ERACS) in pediatric cardiac surgery and their application and research progress.

Objective:To analyze the transmissible characteristics of imported COVID-19 cases in Xiamen.Methods:The nasopharyngeal swabs and serum specimens were collected from inbound passengers on the same flight. The nucleic acid and antibodies to SARS-CoV-2 were detected respectively. The type of COVID-19 was determined according to the condition. The mode of transmission was analyzed according to the incidence and laboratory diagnosis of positive cases, and seats of cases on the plane.Results:Five cases of common type, 3 cases of mild type and 1 case of asymptomatic infection were found in the same Russian flight. Three cases, 5 cases, 1 case and 1 case were detected for nucleic acid on November 21, 22, 25 and 26, 2020. The whole genome sequence was obtained in 3 cases and 85% in 1 case. According to epidemiology, evolutionary characteristics of virus genome, Results of qPCR and antibody and case seating, the risk of transmission in aircraft cabin was analyzed.Conclusions:This is COVID-19 cases reports of inbound personnel in aircraft, and there is a risk of transmission in the cabin. The imported cases were isolated timely and effectively with the whole closed-loop. No other cases of infection occurred. This report provides a reference for the detection and prevention of transmission of cases imported by aircraft.

Objective:To analyze the expression and clinical significance of serum microRNA-221 (miR-221) and microRNA-127 (miR-127) levels in children with severe pneumonia.Methods:151 children with severe pneumonia treated in Handan Central Hospital from January 2017 to December 2019 were prospective selected as severe pneumonia group. According to the prognosis of children in hospital, they were divided into death group (16 cases) and survival group (135 cases). Another 80 healthy children who underwent physical examination in our hospital during the same period were selected as normal control group. Microarrays were used to analyze the expression of miRNAs in the severe pneumonia group and the normal control group, and the miRNAs with the most significant up-regulation or down-regulation (based on the difference expression change ≥2 times threshold and P<0.05) were selected. The serum miR-221, miR-127 and inflammatory factor [C-reactive protein (CRP), calcitonin (PCT) and interleukin 6 (IL-6), interleukin 8 (IL-8), tumor necrosis factor-α (TNF-α)] levels were detected in the enrolled subjects. The correlation between serum miR-221 and miR-127 and the above inflammatory indicators in severe pneumonia group were analyzed. The diagnostic value and prognostic value of miR-221 and miR-127 in severe pneumonia were analyzed by receiver operating characteristic (ROC) curve. Results:The serum levels of miR-221 and miR-127 in severe pneumonia group were lower than those in normal control group, while the serum levels of CRP, PCT, IL-6, IL-8 and TNF-α were higher than those in the normal control group (all P<0.05). Serum miR-221 was negatively correlated with CRP, PCT, TNF-α (all P<0.05); Serum miR-127 was negatively correlated with CRP, PCT, IL-6 and IL-8 (all P<0.05). The serum levels of miR-221 and miR-127 in the death group were lower than those in the survival group ( P<0.05). The area under the curve (AUC) of miR-221 and miR-127 for the combined diagnosis of severe pneumonia was 0.871, and the AUC for the prognosis of severe pneumonia was 0.851. Conclusions:The serum levels of miR-221 and miR-127 in children with severe pneumonia decreased, which was negatively correlated with the levels of some inflammatory factors. The combined detection of miR-221 and miR-127 has high clinical value in the diagnosis and prognosis prediction of severe pneumonia.