Objective:To evaluate the intervention effectiveness of scenario simulation teaching based on the Eilks model on the social context integration ability, critical thinking, and humanistic care of resident physicians in the department of stomatology.Methods:A total of 94 resident physicians in the department of stomatology were included in the study, with 53 in the experimental group and 41 in the control group. The control group received traditional teaching, while the experimental group received scenario simulation teaching based on the Eilks model. Through the five-link design of "text analysis, scientific background, social context, viewpoint debate, and meta reflection", the integration of social science issues (such as ethical conflicts and economic costs) and clinical decision-making was strengthened. Trainees were evaluated for clinical decision-making ability, clinical reflection ability, and doctor-patient communication ability. The data were subjected to t-test and chi-square test using SPSS 24.0. Results:In terms of clinical decision-making ability, the experimental group outperformed the control group in ethical cost balance [(7.85±1.08) vs. (6.12±1.73), t=5.68, P<0.001], multidisciplinary collaboration [(8.25±0.73) vs. (5.83±0.82), t=6.01, P<0.001)], and complication planning [(7.98±1.02) vs. (5.34±1.42), t=6.79, P<0.001]. In terms of clinical reflection ability, the experimental group scored higher in depth of cost-benefit analysis, intensity of evidence-based reflection, and cognitive upgrading (all P<0.001). In terms of doctor-patient communication skills, the experimental group demonstrated superior performance compared to the control group in information collection [(10.25±1.28) vs. (7.53±1.33)] and emotional support [(10.97±1.18) vs. (6.53±1.23)]. Conclusions:Based on the Eilks model, scenario simulation teaching effectively enhances the ability of residents in the department of stomatology to integrate social factors, optimize ethical decision-making, and perform empathetic communication through social conflict simulation (such as three-way role debate) and dual path critical thinking training. In the future, further optimization is needed in terms of personalized expression and the timeliness of basic training.

Objective:To evaluate the intervention effectiveness of scenario simulation teaching based on the Eilks model on the social context integration ability, critical thinking, and humanistic care of resident physicians in the department of stomatology.Methods:A total of 94 resident physicians in the department of stomatology were included in the study, with 53 in the experimental group and 41 in the control group. The control group received traditional teaching, while the experimental group received scenario simulation teaching based on the Eilks model. Through the five-link design of "text analysis, scientific background, social context, viewpoint debate, and meta reflection", the integration of social science issues (such as ethical conflicts and economic costs) and clinical decision-making was strengthened. Trainees were evaluated for clinical decision-making ability, clinical reflection ability, and doctor-patient communication ability. The data were subjected to t-test and chi-square test using SPSS 24.0. Results:In terms of clinical decision-making ability, the experimental group outperformed the control group in ethical cost balance [(7.85±1.08) vs. (6.12±1.73), t=5.68, P<0.001], multidisciplinary collaboration [(8.25±0.73) vs. (5.83±0.82), t=6.01, P<0.001)], and complication planning [(7.98±1.02) vs. (5.34±1.42), t=6.79, P<0.001]. In terms of clinical reflection ability, the experimental group scored higher in depth of cost-benefit analysis, intensity of evidence-based reflection, and cognitive upgrading (all P<0.001). In terms of doctor-patient communication skills, the experimental group demonstrated superior performance compared to the control group in information collection [(10.25±1.28) vs. (7.53±1.33)] and emotional support [(10.97±1.18) vs. (6.53±1.23)]. Conclusions:Based on the Eilks model, scenario simulation teaching effectively enhances the ability of residents in the department of stomatology to integrate social factors, optimize ethical decision-making, and perform empathetic communication through social conflict simulation (such as three-way role debate) and dual path critical thinking training. In the future, further optimization is needed in terms of personalized expression and the timeliness of basic training.

CD20 is a classic marker expressed by B cells. However, recent studies have found that CD20 is also dimly expressed on a small subset of CD3 +T cells, and the CD20 +T cells play an important proinflammatory role in multiple sclerosis (MS). Anti-CD20 monoclonal antibodies selectively deplete CD20 +T cells and effectively suppress inflammatory disease activity. Although CD20 +T cells have received increasing attention, the understanding of these cells is currently still in its infancy. This article provides an overview of the current knowledge about advanced progress of CD20 +T cells as well as their roles in MS.

Objective:To analyze the current situation of dosimetry audits for linear accelerators in China comprehensively based on the literature, including the range of output dose deviation and the qualified rate of output dose deviation.Methods:Literature search including non-full-text was carried out in CNKI database for literature on output dose verification using dosimeter comparison and quality control test, respectively. Data extraction and analysis were carried out for each kind of eligible literature. The data on the number of tested linear accelerators, the number of qualified linear accelerators, the qualified rate of output dose deviation and the range of output dose deviation were extracted, and the total qualified rate of output dose deviation was calculated based on the total number of tested linear accelerators and the total number of qualified linear accelerators. The data on qualified rate of output dose deviation and output dose deviation in past years were sorted out and their trend was analyzed.Results:A total of 11 literatures using dosimeter comparison method for output dose verification were retrieved, and the total qualified rate of the output dose deviation reported in these literatures was 90.7%. The qualified rate of the output dose deviation in the early years was either as low as 75% or as high as 100%, and remained around 90% in recent years. A total of 19 literatures using quality control test method for output dose verification were retrieved, and the total qualified rate of X-ray and electron beam output dose deviation reported in these literatures was 86.5% and 78.4%, respectively. Of the 12 data on X-ray output dose qualified rate in 2014-2019, 8 were below 90.0% and 4 were above 90.0%. Of the 7 data on X-ray output dose qualified rate in 2020-2023, 2 were below 90.0% and 5 were greater than or equal to 90.0%. The qualified rate of electron beam output dose was 46.2%-80.0% before 2021 and 100% from 2021 to 2023.Conclusions:The qualified rate of the output dose deviation of linear accelerators in China reported in the literature in recent years is on the rise, but the total qualified rate of the output dose deviation of linear accelerators in China is still lower than in developed countries. In order to ensure the therapeutic effect of the patients undergoing radiotherapy, measures should be taken to reduce the output dose deviation of linear accelerators and improve the level of qualified rate of output dose verification.

Objective:To construct a multi-sequence MRI radiomics combined with KRAS mutation nomogram model to predict the efficacy of pathological complete response (pCR) in patients with rectal cancer after neoadjuvant chemoradiotherapy.Methods:This study was a case-control study. A total of 126 patients with rectal cancer who were treated with neoadjuvant chemoradiotherapy in the Second Affiliated Hospital of Harbin Medical University from June 2020 to December 2023 were retrospectively collected. The pathological response of the postoperative specimens was graded, with 64 cases of pCR and 62 cases of non-pCR. KRAS gene detection was performed on the pathological tissues before neoadjuvant chemoradiotherapy. Among the patients, 34 cases had KRAS mutants and 92 cases had KRAS wild-types. The 126 patients were randomly divided into a training set and a validation set at a ratio of 8∶2 by the random number method, with 101 and 25 cases, respectively. The difference in KRAS mutation status between the pCR group and the non-pCR group was compared by the χ2 test. The radiomic features were extracted from the baseline T 2WI, diffusion-weighted imaging, and apparent diffusion coefficient images of the patients. The optimal radiomic features were screened out to establish the radiomics model. The radiomics-KRAS joint model was constructed by logistic regression, and a nomogram was drawn. The application efficiency of the model was evaluated by the receiver operating characteristic curve and calibration curve. Results:There was a statistically significant difference in KRAS mutation between the pCR group and the non-pCR group in the training set ( χ2=4.69, P=0.032). Ten radiomics features were screened out in MRI images to establish the radiomics model. In the training set and validation set, the areas under the curve (AUC) of KRAS mutation, radiomics model and radiomics-KRAS nomogram model for evaluating pCR after neoadjuvant chemoradiotherapy were 0.665 (95% CI 0.592-0.757), 0.746 (95% CI 0.651-0.895) and 0.818 (95% CI 0.742-0.934), respectively, and the AUCs of the validation set were 0.613 (95% CI 0.582-0.755), 0.738 (95% CI 0.627-0.839) and 0.833 (95% CI 0.768-0.961), respectively. The results of DeLong test showed that the AUC of radiomics-KRAS nomogram model was higher than that of KRAS mutation and radiomics model, and the difference was statistically significant ( Z=0.58, 0.63, P=0.024, 0.022 in the training set; Z=0.54, 0.61, P=0.018, 0.035 in the validation set). The calibration curve showed that the predicted probability of the radiomics-KRAS nomogram model was consistent with the actual probability. Conclusions:The multi-sequence MRI radiomics combined with the KRAS mutation nomogram model has the best efficacy in predicting pCR in patients with rectal cancer after neoadjuvant chemoradiotherapy, and has good practical application value.

Dilated cardiomyopathy(DCM)has a concealed onset with left or even whole heart enlargement as the main imaging manifestation.It is a common primary disease of heart failure and arrhythmia.With the continuous deepening of research in recent years,the intrinsic molecular mechanism of regulatory cell death(RCD)has gradually become clear.Researchers have found that the RCD mode plays a very important role in the occurrence and development of DCM.At present,the RCD modes involved in DCM mainly include apoptosis,necrotic apoptosis,pyroptosis,iron death,autophagy,and cuproptosis,and a certain correlation exists among them,which interact and regulate each other.This article provides an overview of the current research status on the mechanisms of the six RCD modes involved in DCM to provide a reference for future basic research and clinical applications.

Objective:To analyze the current situation of dosimetry audits for linear accelerators in China comprehensively based on the literature, including the range of output dose deviation and the qualified rate of output dose deviation.Methods:Literature search including non-full-text was carried out in CNKI database for literature on output dose verification using dosimeter comparison and quality control test, respectively. Data extraction and analysis were carried out for each kind of eligible literature. The data on the number of tested linear accelerators, the number of qualified linear accelerators, the qualified rate of output dose deviation and the range of output dose deviation were extracted, and the total qualified rate of output dose deviation was calculated based on the total number of tested linear accelerators and the total number of qualified linear accelerators. The data on qualified rate of output dose deviation and output dose deviation in past years were sorted out and their trend was analyzed.Results:A total of 11 literatures using dosimeter comparison method for output dose verification were retrieved, and the total qualified rate of the output dose deviation reported in these literatures was 90.7%. The qualified rate of the output dose deviation in the early years was either as low as 75% or as high as 100%, and remained around 90% in recent years. A total of 19 literatures using quality control test method for output dose verification were retrieved, and the total qualified rate of X-ray and electron beam output dose deviation reported in these literatures was 86.5% and 78.4%, respectively. Of the 12 data on X-ray output dose qualified rate in 2014-2019, 8 were below 90.0% and 4 were above 90.0%. Of the 7 data on X-ray output dose qualified rate in 2020-2023, 2 were below 90.0% and 5 were greater than or equal to 90.0%. The qualified rate of electron beam output dose was 46.2%-80.0% before 2021 and 100% from 2021 to 2023.Conclusions:The qualified rate of the output dose deviation of linear accelerators in China reported in the literature in recent years is on the rise, but the total qualified rate of the output dose deviation of linear accelerators in China is still lower than in developed countries. In order to ensure the therapeutic effect of the patients undergoing radiotherapy, measures should be taken to reduce the output dose deviation of linear accelerators and improve the level of qualified rate of output dose verification.

In the development of chemo-immunotherapy, many efforts have been focusing on designing suitable carriers to realize the co-delivery of chemotherapeutic and immunotherapeutic with different physicochemical properties and mechanisms of action. Besides, rapid drug release at the tumor site with minimal drug degradation is also essential to facilitate the antitumor effect in a short time. Here, we reported a cancer cell membrane-coated pH-responsive nanogel (NG@M) to co-deliver chemotherapeutic paclitaxel (PTX) and immunotherapeutic agent interleukin-2 (IL-2) under mild conditions for combinational treatment of triple-negative breast cancer. In the designed nanogels, the synthetic copolymer PDEA-co-HP-β-cyclodextrin-co-Pluronic F127 and charge reversible polymer dimethylmaleic anhydride-modified polyethyleneimine endowed nanogels with excellent drug-loading capacity and rapid responsive drug-releasing behavior under acidic tumor microenvironment. Benefited from tumor homologous targeting capacity, NG@M exhibited 4.59-fold higher accumulation at the homologous tumor site than heterologous cancer cell membrane-coated NG. Rapidly released PTX and IL-2 enhanced the maturation of dendritic cells and quickly activated the antitumor immune response in situ, followed by prompted infiltration of immune effector cells. By the combined chemo-immunotherapy, enhanced antitumor effect and efficient pulmonary metastasis inhibition were achieved with a prolonged median survival rate (39 days).

AIM: To build a meropenem population pharmacokinetic model for Chinese elderly through model-based meta-analysis. METHODS: Informations including dosing regimen, sampling times, concentrations, sample size, age, gender, body weight (BW) and creatinine clearance were extracted after the literature were retrieved. The model was built by NONMEM. Stepwise covariate modeling strategy was used for covariates analysis. RESULTS: A two-compartment model was applied to describe meropenem pharmacokinetics. After stepwise covariate modeling, covariates that remained significant in the final model were creatinine clearance (CLcr) on CL and the BW on V

OBJECTIVES: Safe and effective anticoagulation is essential for hemodialysis patients who are at high risk of bleeding. The purpose of this trial is to evaluate the effectiveness and safety of two-stage regional citrate anticoagulation (RCA) combined with sequential anticoagulation and standard calcium-containing dialysate in intermittent hemodialysis (IHD) treatment. METHODS: Patients at high risk of bleeding who underwent IHD from September 2019 to May 2021 were prospectively enrolled in 13 blood purification centers of nephrology departments, and were randomly divided into RCA group and saline flushing group. In the RCA group, 0.04 g/mL sodium citrate was infused from the start of the dialysis line during blood draining and at the venous expansion chamber. The sodium citrate was stopped after 3 h of dialysis, which was changed to sequential dialysis without anticoagulant. The hazard ratios for coagulation were according to baseline. RESULTS: A total of 159 patients and 208 sessions were enrolled, including RCA group (80 patients, 110 sessions) and saline flushing group (79 patients, 98 sessions). The incidence of severe coagulation events of extracorporeal circulation in the RCA group was significantly lower than that in the saline flushing group (3.64% vs. 20.41%, P<0.001). The survival time of the filter pipeline in the RCA group was significantly longer than that in the saline flushing group ((238.34±9.33) min vs. (221.73±34.10) min, P<0.001). The urea clearance index (Kt/V) in the RCA group was similar to that in the saline flushing group with no statistically significant difference (1.12±0.34 vs. 1.08±0.34, P=0.41). CONCLUSIONS Compared with saline flushing, the two-stage RCA combined with a sequential anticoagulation strategy significantly reduced extracorporeal circulation clotting events and prolonged the dialysis time without serious adverse events.
Humans ; Citric Acid/adverse effects* ; Prospective Studies ; Sodium Citrate ; Hemorrhage/chemically induced* ; Citrates/adverse effects* ; Anticoagulants/adverse effects* ; Renal Dialysis/adverse effects*