Objective:To explore the safety and efficacy of shunt reduction using the Interlock-35 fibered interlocking detachable coil (IDC) occlusion system in the treatment of refractory hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS).Methods:From August 2022 to December 2023, at the Department of Gastroenterology of the Air Force Medical Center, the clinical data of patients with refractory HE after TIPS who were treated with shunt reduction using the Interlock-35 fibered IDC occlusion system were retrospectively collected, which included portal vein pressure gradient (PVPG), HE grades, blood ammonia levels, prothrombin time (PT), liver function parameters, and other related indicators. The primary indicators related to the efficacy of the shunt reduction included symptom improvement, and changes in PVPG, blood ammonia levels, and Child-Pugh score. The safety of shunt reduction was analyzed based on the incidence of complications such as gastrointestinal bleeding and ascites during the follow-up period. Paired t-test was used for statistical analysis. Results:A total of 21 patients were enrolled. Prior to shunt reduction, there were 5 cases with HE of grade 3 and 16 cases with HE of grade 2. Before operation, the blood ammonia was (103.14±27.69) mol/L; and the liver function Child-Pugh grade of 1 case was classified as grade A, 16 cases as grade B, and 4 cases as grade C. Shunt reduction was performed between 7 and 1 879 d, with a median time of 99 (54, 806) d after TIPS. The procedure was technically successful in all patients, with a total of 25 coils implanted. Before shunt reduction, the PVPG was (14.02±5.28) cmH 2O (1 cmH 2O=0.098 kPa), after shunt reduction procedure, the PVPG increased to (25.05±6.04) cmH 2O, and the difference was statistically significant ( t=-11.26, P<0.001). After operation, 16 patients returned to the hospital for follow-up examinations, with a median follow-up time of 114 (46, 195) d, the blood ammonia levels, PT, and Child-Pugh scores during the follow-up were all lower than those before operation ((78.19±27.85) μmol/L vs. (105.00±30.53) μmol/L, (14.09±1.65) s vs. (15.41±2.35) s, and 6.88±1.59 vs. 8.13±1.75, respectively), and the differences were statistically significant ( t=2.23, 3.23, and 2.61; P=0.040, <0.001, =0.020). There was no statistically significant in PVPG between during follow-up and immediately post-procedure ((28.91±6.20) cmH 2O vs. (25.22±5.92) cmH 2O, P>0.05). During the follow-up period, HE symptoms disappeared in 12 patients among the 16 patients who returned to hospital for follow-up, however gastrointestinal bleeding occurred in 5 patients and ascites occurred in 3 patients; additionally, 4 patients experienced intermittent HE symptoms (grade 1 in 3 cases, grade 2 in 1 case). After operation, 5 patients were followed up via telephone, among them, 3 patients died, and 2 patients experienced intermittent HE (grade 1) which could be spontaneously restored with dietary adjustments and(or) medication. Conclusions:Interlock-35 fibered IDC occlusion system for shunt reduction is a feasible and effective treatment for refractory HE after TIPS. It can effectively improve symptoms and decrease liver function score. After shunt reduction, early follow-up and adjustment of flow reduction can help reduce the occurrence of severe complications.

Objective:To explore the impact of metabolic syndrome in conjunction with hyperuricemia on the risk of new-onset cardiovascular disease.Methods:This study was a prospective cohort study. From June 2006 to October 2007, employees of Kailuan Group in Tangshan City, Hebei Province were selected as the research subjects. Participants were divided into four groups based on the presence or absence of metabolic syndrome and hyperuricemia. The groups include the normal group, pure hyperuricemia group, pure metabolic syndrome group, and the metabolic syndrome combined with hyperuricemia group. Four groups of participants were followed up, the primary endpoint was the occurrence of a first-ever cardiovascular disease event, including stroke and myocardial infarction. The cumulative incidence rates of cardiovascular disease in different groups during the continuous follow-up period were calculated using the Kaplan-Meier method, and the differences in cumulative incidence rates among groups were compared using the log-rank test. Multivariate Cox regression analysis was used to analyze the effect of hyperuricemia combined with metabolic syndrome on the risk of cardiovascular disease. The likelihood ratio test was used to analyze whether there was a multiplicative interaction and additive interaction between hyperuricemia and metabolic syndrome.Results:A total of 82 780 individuals were included, aged (51.5±12.6) years, and 68 622 (82.90%) were males, with a median follow-up of 14.97 years. Kaplan-Meier survival curve analysis showed that the cumulative incidence of cardiovascular disease was the highest in the metabolic syndrome combined with hyperuricemia group (log-rank P<0.001). Multivariate Cox regression analysis indicated that after adjusting for various confounding factors, the HR value and 95% CI of cardiovascular disease in the metabolic syndrome combined with hyperuricemia group were 1.24 (1.12-1.38) compared with the normal group, which were higher than those in the pure hyperuricemia group and the pure metabolic syndrome group alone. The effect of metabolic syndrome combined with hyperuricemia on the risk of cardiovascular disease demonstrated an additive effect (relative excess risk of interaction: 0.18(0.11-0.25), attributable proportion due to interaction: 0.14(0.09-0.19)). Conclusions:The combination of hyperuricemia and metabolic syndrome is an independent risk factor for cardiovascular disease. Compared to pure metabolic syndrome or hyperuricemia alone, the impact of metabolic syndrome combined with hyperuricemia on cardiovascular disease is more significant.

Objective:To explore the impact of metabolic syndrome in conjunction with hyperuricemia on the risk of new-onset cardiovascular disease.Methods:This study was a prospective cohort study. From June 2006 to October 2007, employees of Kailuan Group in Tangshan City, Hebei Province were selected as the research subjects. Participants were divided into four groups based on the presence or absence of metabolic syndrome and hyperuricemia. The groups include the normal group, pure hyperuricemia group, pure metabolic syndrome group, and the metabolic syndrome combined with hyperuricemia group. Four groups of participants were followed up, the primary endpoint was the occurrence of a first-ever cardiovascular disease event, including stroke and myocardial infarction. The cumulative incidence rates of cardiovascular disease in different groups during the continuous follow-up period were calculated using the Kaplan-Meier method, and the differences in cumulative incidence rates among groups were compared using the log-rank test. Multivariate Cox regression analysis was used to analyze the effect of hyperuricemia combined with metabolic syndrome on the risk of cardiovascular disease. The likelihood ratio test was used to analyze whether there was a multiplicative interaction and additive interaction between hyperuricemia and metabolic syndrome.Results:A total of 82 780 individuals were included, aged (51.5±12.6) years, and 68 622 (82.90%) were males, with a median follow-up of 14.97 years. Kaplan-Meier survival curve analysis showed that the cumulative incidence of cardiovascular disease was the highest in the metabolic syndrome combined with hyperuricemia group (log-rank P<0.001). Multivariate Cox regression analysis indicated that after adjusting for various confounding factors, the HR value and 95% CI of cardiovascular disease in the metabolic syndrome combined with hyperuricemia group were 1.24 (1.12-1.38) compared with the normal group, which were higher than those in the pure hyperuricemia group and the pure metabolic syndrome group alone. The effect of metabolic syndrome combined with hyperuricemia on the risk of cardiovascular disease demonstrated an additive effect (relative excess risk of interaction: 0.18(0.11-0.25), attributable proportion due to interaction: 0.14(0.09-0.19)). Conclusions:The combination of hyperuricemia and metabolic syndrome is an independent risk factor for cardiovascular disease. Compared to pure metabolic syndrome or hyperuricemia alone, the impact of metabolic syndrome combined with hyperuricemia on cardiovascular disease is more significant.

Objective:To explore the safety and efficacy of shunt reduction using the Interlock-35 fibered interlocking detachable coil (IDC) occlusion system in the treatment of refractory hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS).Methods:From August 2022 to December 2023, at the Department of Gastroenterology of the Air Force Medical Center, the clinical data of patients with refractory HE after TIPS who were treated with shunt reduction using the Interlock-35 fibered IDC occlusion system were retrospectively collected, which included portal vein pressure gradient (PVPG), HE grades, blood ammonia levels, prothrombin time (PT), liver function parameters, and other related indicators. The primary indicators related to the efficacy of the shunt reduction included symptom improvement, and changes in PVPG, blood ammonia levels, and Child-Pugh score. The safety of shunt reduction was analyzed based on the incidence of complications such as gastrointestinal bleeding and ascites during the follow-up period. Paired t-test was used for statistical analysis. Results:A total of 21 patients were enrolled. Prior to shunt reduction, there were 5 cases with HE of grade 3 and 16 cases with HE of grade 2. Before operation, the blood ammonia was (103.14±27.69) mol/L; and the liver function Child-Pugh grade of 1 case was classified as grade A, 16 cases as grade B, and 4 cases as grade C. Shunt reduction was performed between 7 and 1 879 d, with a median time of 99 (54, 806) d after TIPS. The procedure was technically successful in all patients, with a total of 25 coils implanted. Before shunt reduction, the PVPG was (14.02±5.28) cmH 2O (1 cmH 2O=0.098 kPa), after shunt reduction procedure, the PVPG increased to (25.05±6.04) cmH 2O, and the difference was statistically significant ( t=-11.26, P<0.001). After operation, 16 patients returned to the hospital for follow-up examinations, with a median follow-up time of 114 (46, 195) d, the blood ammonia levels, PT, and Child-Pugh scores during the follow-up were all lower than those before operation ((78.19±27.85) μmol/L vs. (105.00±30.53) μmol/L, (14.09±1.65) s vs. (15.41±2.35) s, and 6.88±1.59 vs. 8.13±1.75, respectively), and the differences were statistically significant ( t=2.23, 3.23, and 2.61; P=0.040, <0.001, =0.020). There was no statistically significant in PVPG between during follow-up and immediately post-procedure ((28.91±6.20) cmH 2O vs. (25.22±5.92) cmH 2O, P>0.05). During the follow-up period, HE symptoms disappeared in 12 patients among the 16 patients who returned to hospital for follow-up, however gastrointestinal bleeding occurred in 5 patients and ascites occurred in 3 patients; additionally, 4 patients experienced intermittent HE symptoms (grade 1 in 3 cases, grade 2 in 1 case). After operation, 5 patients were followed up via telephone, among them, 3 patients died, and 2 patients experienced intermittent HE (grade 1) which could be spontaneously restored with dietary adjustments and(or) medication. Conclusions:Interlock-35 fibered IDC occlusion system for shunt reduction is a feasible and effective treatment for refractory HE after TIPS. It can effectively improve symptoms and decrease liver function score. After shunt reduction, early follow-up and adjustment of flow reduction can help reduce the occurrence of severe complications.

Based on the characteristics of medical specialty, this research group has developed the virtual simulation experiment teaching project of Chinese revolutionary morality (red medicine spirit). This project uses 3D simulation technology and OpenGL technology to build a virtual experimental learning environment based on WebGL, learn general Fu Lianzhang's glorious deeds and immersive experience of the inheritance and development of the spirit of red medicine by contemporary "heroes in harms way" in the fight against the COVID-19 epidemic in the form of 3D animation interaction. Through research, it is found that virtual simulation teaching is conducive to promoting students' understanding and mastery of medical humanities and improving students' satisfaction with teaching, with good popularization value.

Voluntary service spirit is highly coupled with medical humanistic spirit. Participating in voluntary service is an important channel for medical students to grow up. There are deficiencies in medical students' voluntary service at the social, school and personal levels. It is of great significance to strengthen the top-level design of all staff, whole process and all-round volunteer service, build a volunteer service platform with distinctive characteristics, normal development and multi benefits, create a "school local co construction" volunteer service brand, select advanced figures in voluntary service for medical students, and establish and improve long-term mechanisms for the operation, incentive and guarantee of voluntary services, thus improving the medical students' awareness of voluntary service, protecting their legitimate rights and interests in the service process, expanding the influence of voluntary service and enhancing the effectiveness of voluntary service.

There are many problems in the humanistic education of medical students, such as the decoupling of teaching content and clinical practice, the irrational structure of teachers and the shortage of teaching hours, which leads to a great gap between teaching effect and expectation. Through the combina-tion of humanistic education and clinical practice of medical students and through the optimization of cur-riculum, teaching materials and teaching methods, as well as teachers' structure, we have established and improved the relevant security system, and gradually improved the medical school docking system, the humanistic quality assessment system for medical students and three-dimensional evaluation mechanism of hospital teaching teachers,and constantly raise the level of humanistic quality of medical students.

Objective To investigate the value of MR diffusion tensor imaging (DTI) quantitative parameters in evaluating the injury of the tibial nerve and the common peroneal nerve in patients with Guillain-Barre syndrome(GBS). Methods Sixteen healthy volunteers and sixteen patients with GBS underwent DTI examination of the tibial nerve and the common peroneal nerve. The denervation of skeletal muscles controlled by the tibial nerve and the common peroneal nerve was observed. The apparent diffusion coefficient (ADC) value, fractional anisotropy (FA) value, axial diffusivity (AD) value and radial diffusivity (RD) value were measured respectively,and diffusion tensor tractography (DTT) of the tibial nerve and the common peroneal nerve was performed. Between-groups comparison was made with the independent sample t test and receiver-operating characteristic (ROC) analysis was used to evaluate the diagnostic efficacy of the parameters. Results (1)The MR features of denervated skeletal muscles comprehend hyperintensity on T2WI SPAIR sequence and the instinct boundary, muscle atrophy occationally. (2)Compared with the healthy volunteer group, the ADC value of the tibial nerve and the common peroneal nerve of GBS group was increased and the FA value, AD value, RD value were decreased, and there was significant difference between the ADC value, FA value, AD value and RD value of GBS and volunteer groups respectively(P<0.05). The area under the curve (AUC) of FA value was higher than that of the corresponding ADC value in the tibial nerve and the common peroneal nerve. (3)DTT showed that the number of fibers decreased in patients with GBS compared to the normal volunteers. Conclusion MR can clearly show the denervated skeletal muscles controlled by the tibial nerve and the common peroneal nerve. The ADC value, FA value, AD value and RD value, the quantitative parameters of DTI, can evaluate the injury of the tibial nerve and the common peroneal nerve in patients with GBS.

In the perspective of the theory of intersubjectivity, the educators and the educated in the mental health education of college students establish a subject-subject relationship by experience teach-ing as an intermediary. By focusing on the needs of students, mobilizing the students ' active participation, adopting the experience teaching in small class, the way of formative evaluation, the relationship of mutual integration and mutual promotion are established , which realizes the validity of the College Students ' Mental Health Educationcourse.

Objective To study the application of strain ratio in differentiation of benign and malignant thyroid nodules through analyzing the influencing factors of the elastic strain ratio (SR) of thyroid nodules.Methods There were 468 patients with 476 thyroid nodules in present study, who came from the Nanjing Drum Tower Hospital from January 2012 to February 2014. SR characteristics of thyroid nodules were retrospectively analyzed, and the critical values were found by receiver-operating characteristic (ROC) curve. Then the size, echo, calcification, blood flow and the correlation between SR and pathology were analyzed by Pearson bivariate correlation analysis.Results The ROC curve showed that SR=0.5 was the best threshold value of SR in differential diagnosis of benign and malignant thyroid nodules. The diagnostic sensitivity, specificity, and the area under the curve were 84.8％, 85.9％, and 0.894, respectively. SR was negatively correlated with echo and calcification, while positively correlated with nodule size and blood flow (r=0.158,P=0.001;r=-0.209,P=0.000;r=-0.218,P=0.000;r=0.189,P=0.000;r=-0.519,P=0.000). The pathology of thyroid nodules had no correlation with nodule size and blood flow (r=-0.025,P=0.582;r=-0.070,P=0.126). The pathology was positively correlated with echo and calcification, while negatively correlated with age (r=0.265,P=0.000;r=0.185,P=0.000;r=-0.207,P=0.000;r=-0.519,P=0.000). Conclusion To improve the accuracy of diagnosis, the differential diagnosis of benign and malignant thyroid nodules should be based on two-dimensional ultrasound combined with SR and fine needle aspiration.