Objective:To evaluate the effect of virtual reality arthroscopic simulation system combined with case-based learning (CBL) in orthopedic clinical teaching.Methods:From January 2021 to June 2022, a total of 36 residents who took the standardized residency training at Department of Articular Orthopedics in The Third Affiliated Hospital of Soochow University were enrolled in this study. They were randomized into an experimental group and a control group, with 18 trainees in each group. The experimental group adopted the virtual reality arthroscopic simulation system combined with CBL teaching mode, while the control group adopted simple endoscopic simulation training box with traditional teaching mode. Theoretical and practical tests and questionnaire survey were carried out to evaluate the teaching effects in two groups. SPSS 22.0 was performed to conduct t-test on the measurement data between the two groups. Results:The theoretical and practical test scores of the experimental group [(89.39±3.09) and (82.72±4.28)] were better than those of the control group [(86.22±4.43) and (76.61±5.65)], with statistically significant differences ( t= 2.49, P=0.018; t=3.66, P=0.001). The questionnaire survey showed that the experimental group was better than the control group in creating novel forms of courses [(4.94±0.24) vs. (4.11±0.58), t=5.62, P<0.001], simulating more real scenes [(4.83±0.38) vs. (3.78±0.43), t=7.80, P<0.001], inspiring learning interests [(4.78±0.43) vs. (4.00±0.59), t=4.51, P<0.001], improving practical skills [(4.83±0.38) vs. (3.83±0.51), t=6.61, P<0.001], and building career confidence [(4.50±0.62) vs. (3.06±0.54), t=7.47, P<0.001], with statistically significant differences (all P<0.001). Conclusions:The virtual reality arthroscopic simulation system combined with CBL teaching mode can better simulate the real clinical scenes, help inspire the interest of learning and quickly improve practical skills, thereby improving the effect of orthopedic clinical teaching.

Objective To explore clinical efficacy of F-type forceps for assisted reduction in femoral shaft fracture reduc-tion.Methods Forty-five patients with femoral shaft fracture treated with intramedullary nail and internal fixation from January 2019 to December 2021 were retrospectively analyzed and divided into two groups according to different reduction methods.In observation group,there were 21 patients,included 15 males and 6 females,aged from 27 to 92 years old with an average of(53.38±18.81)years old;9 patients on the left side,12 patients on the right side;7 patients were type A,8 patients were type B and 6 patients were type C according to AO fracture classification;the time from injury to operation ranged from 7 to 13 days with an average of(4.62±3.34)days;reduction was assisted by F-shaped forceps.In control group,there were 24 patients,in-cluding 17 males and 7 females,aged from 20 to 92 years old with an average of(51.96±20.43)years old;12 patients on the left side,12 patients on the right side;11 patients were type A,8 patients were type B and 5 patients were type C according to AO fracture classification;the time from injury to operation ranged from 2 to 13 days with an average of(6.29±3.04)days;tra-ditional reset mode was adopted.Operative time,intraoperative blood loss,intraoperative fluoroscopy times,intraoperative open reduction ratio,clinical healing time of fracture,postoperative complications,hospital stay,hospital cost and Lysholm score of knee joint at 6 and 12 months after surgery were compared between two groups to evaluate clinical effect.Results All patients were followed up for 12 to 24 months with an average of(16.60±3.45)months.In observation group,operative time,intraoper-ative blood loss,intraoperative fluoroscopy times,open reduction cases,and clinical healing time of fractures were(58.19±7.93)min,(88.10±44.45)ml,(25.29±5.54)times,0 case,(4.76±0.77)months,respectively;while in control group was(79.33±22.94)min,(222.92±144.45)ml,(47.46±26.25)times,5 cases,(7.13±1.80)months,and the difference between two groups were statistically significant(P＜0.05).There were no significant difference in postoperative complications,length of stay and hospitalization cost between two groups(P＞0.05).At 6 months after surgery,Lysholm score of knee joint in observa-tion group(88.62±4.48)was better than that in control group(79.21±8.91)(F=21.948,P=0.000).There were no significant difference in support use,pain and squat score between two groups(P＞0.05).At 12 months after surgery,Lysholm scores of stair climbing and pain in observation group were(9.62±1.20)and(19.76±1.92),which were better than those in control group(7.83±2.04)and(21.88±2.88)(P＜0.05).There were no significant difference in scores and total scores of other items between two groups(P＞0.05).Conclusion Compared with traditional reduction method,F-type forceps instrument could short-en operation time,reduce intraoperative blood loss,reduce intraoperative fluoroscopy times,accelerate clinical healing of frac-ture,and promote earlier functional recovery of knee joint.

The gut microbiota plays a crucial role in maintaining overall health.Dysbiosis of the gut microbiota can promote the occurrence and progression of tumors,especially hepatobiliary and pancreatic tumors,by affecting intestinal homeostasis,gut metabolism,and immune function.Therefore,a better understanding of the role of the gut microbiome in the development and progression of hepatobiliary and pancreatic tumors may provide opportunities for developing new prevention and treatment strategies for patients with these malignancies.This article reviews recent research on the role of gut microbiota in the development and progression of hepatobiliary and pancreatic malignancies,aiming to provide a reference for future studies.

Diabetes mellitus is a metabolic disease with high incidence and many complications,among which type 2 diabetes mellitus(T2DM)accounts for a large proportion.Current studies have shown that T2DM is accompanied by damage of liver,kidney,and other organs and its complications seriously en-danger human health.Ferroptosis generates many Reactive Oxygen Species(ROS)through the Fenton reaction,and the accumulation of ROS activates Hypoxia Inducible Factor-1(HIF-1α).As a result,the level of vascular endothelial growth factor(VEGF)is increased.Ferrostatin-1(Fer-1),a ferroptosis in-hibitor,has strong antioxidant capacity.Therefore,based on the hypoxia-inducible factor-1α/vascular endothelial growth factor(HIF-1α/VEGF)signaling pathway,we explored the therapeutic effect of Fer-1 on the liver and kidney tissues of diabetic mice.db/db mice(21～22 weeks old)were used as the model of diabetes mellitus.Ferroptosis inhibitor Fer-1 was used as the intervention drug.db/m mice served as the blank control group,and body weight and blood glucose were measured for 4 weeks.Food intake and water intake were recorded in each group.The levels of Alanine aminotransferase(ALT)and Aspartate aminotransferase(AST)in the serum were measured.ROS and Glutathione(GSH)activity in liver and kidney tissues and urinary protein content were measured.Liver and kidney tissue sections were stained with Hematoxylin-Eosin(HE),and the pathological morphology was observed under a light microscope.The protein levels of HIF-1α,VEGF,and glutathione peroxidase 4(GPX4)in liver and kidney tissues were detected by Western blot.In db/db mice,Fer-1(1 mg·kg-1,ig)could significantly reduce the a-mount of food and water intake,the levels of ALT and AST in serum,the ROS production in liver and kidney tissues,and the level of urine protein,but significantly increase the activity of GSH,thus improve the pathological conditions of liver and kidney.Fer-1 also significantly inhibited HIF-1α and VEGF pro-tein indexes and increased GPX4 protein levels in liver and kidney tissues.Although Fer-1 can not change the body weight and reduce blood glucose in diabetic mice,it can play a therapeutic role in the liver and kidney tissues of diabetic mice in the middle and late stages,and its mechanism may be related to HIF-1α/VEGF and GPX4.

Three novel sesquiterpenoid heterodimers,designated as auckcostusolides A-C(1-3),were isolated from Aucklandia costus leaves.The structures of compounds 1-3 were elucidated through comprehensive spectroscopic analysis,with their absolute configurations established using a combination of X-ray single-crystal diffraction and electronic circular dichroism(ECD)calculations.Notably,compounds 1 and 2,despite sharing identical planar structures derived from two identical sesquiterpenoids,exhibited oppos-ite configurations at C-11 and C-8'.This configurational difference can be attributed to distinct Diels-Alder cycloaddition processes between the sesquiterpenoid monomers.Additionally,the cytotoxic effects of compounds 1-3 were evaluated against colorectal can-cer HCT116 cells,fibrosarcoma HT1080 cells,and hepatocellular carcinoma HepG2 cells.Compounds 1-3 induced cell death was characterized by endoplasmic reticulum(ER)swelling and cytoplasmic vacuolization,typical morphological changes associated with paraptosis.Mechanistic studies revealed that compounds 1 and 3 triggered paraptosis-like cell death through the accumulation of react-ive oxygen species(ROS),activation of ER stress,and stimulation of the MAPK signaling pathway.

Objective:To analyze the dose-response relationship of 99Tc m-dimercaptosuccinic acid (DMSA) in pediatric renal static imaging. Methods:A retrospective analysis of children (model group: n=199, 81 males, 118 females; validation group: n=30, 13 males, 17 females; all age: 1 month-14 years) who underwent 99Tc m-DMSA renal static imaging from January 2022 to November 2023 in Wuhan Children′s Hospital, Tongji Medical College, Huazhong University of Science and Technology were conducted. Post-administration radiation counts and related clinical data were collected. Imaging quality was evaluated using visual analogue scoring (VAS). ROC curve analysis was used to assess the relationship between radiation count intensity (RCI) and imaging quality. A nonlinear mixed-effects modeling method was employed to establish the dose-response relationship for 99Tc m-DMSA in pediatric renal static imaging. Internal and external validations of the model were performed. Final model was utilized to evaluate patient dosing protocols. Results:Body weight was considered as a significant determinant of the dose-response relationship in 99Tc m-DMSA renal static imaging( χ2 values: 120.79, 116.36, both P<0.05). ROC curve analysis showed that the quality of diagnostic images was acceptable when the anterior renal RCI was ≥32.61 (cut-point) and the posterior renal RCI was ≥35.46 (cut-point). Both internal and external validation results demonstrated that the dose-response model established exhibited good prediction performance. Based on the final model graph, the image quality could meet the requirements for clinical diagnosis. Conclusions:The 99Tc m-DMSA dose-response model for pediatric renal static imaging is successfully established. Individualized dosage based on the model can provide a reference for clinical individualized dosing decision-making.

AIM To observe the effects of Danggui Buxue Decoction on myocardial ferroptosis in a rat model of heart failure with preserved ejection fraction(HFpEF).METHODS The rats were randomly divided into the control group,the model group and the Danggui Buxue Decoction group.After 8 weeks feeding of 8%high-salt diet in the model and trial groups to induce the rats into HFpEFd models,rats of the Danggui Buxue Decoction group were given 4 g/kg Danggui Buxue Decoction once daily for 4 weeks,in contrast to those of the control group given 12 weeks feeding of 0.3%low-salt diet.The rats had their left ventricular ejection fraction(LVEF),left ventricular fraction shortening(LVFS),left ventricular end-diastolic diameter(LVIDD),and end-diastolic left ventricular posterior wall thickness(LVPWd)detected by echocardiography;their pathological changes of myocardial tissue by HE and Masson staining;their myocardial mitochondrial morphology observed by transmission electron microscopy;their serum BNP,NT-proBNP levels,myocardial tissue Fe3+levels,and their levels of ROS,MDA,LPO and GSH,and SOD activity in serum and myocardium detected by ELISA method;and their myocardial expressions of ferroptosis marker proteins GPX4,FTH1 and xCT detected by immunofluorescence staining and Western blot method.RESULTS Compared with the model group,the Danggui Buxuetang group displayed increased LVEF,LVFS(P＜0.01);decreased LVIDD,LVPWd(P＜0.05,P＜0.01);decreased serum BNP,NT-proBNP levels(P＜0.01);decreased myocardial Fe3+level(P＜0.01);decreased MDA,ROS and LPO levels in serum and myocardium(P＜0.01);increased GSH level and SOD activity(P＜0.01);and increased expressions of myocardial ferroptosis related protein GPX4,FTH1 and xCT(P＜0.05,P＜0.01).CONCLUSION Danggui Buxue Decoction protects the cardiac function of the rat model of HFpEF through inhibiting the occurrence of myocardial ferroptosis and reducing the myocardial oxidative stress level as well.

Objective:To analyze the etiology of chronic spontaneous urticaria (CSU) in children and associated factors affecting the disease severity.Methods:A single-center cross-sectional study was conducted. Children aged ≤ 17 years with CSU were prospectively enrolled at the Department of Dermatology, Children′s Hospital of Chongqing Medical University from November 2021 to November 2022. Clinical data were collected, serum total IgE and allergen-specific IgE (sIgE) were detected, and basophil activation test (BAT) and autologous serum skin test (ASST) were performed. According to the ASST and BAT results, the children were divided into the chronic autoimmune urticaria (CAU) group (positive for both ASST and BAT), non-CAU group (negative for both ASST and BAT), and partial CAU group (positive for either ASST or BAT). Differences in the etiology and clinical characteristics were analyzed between the CAU group and the non-CAU group. Based on the weekly urticaria activity score (UAS7), the children with CSU were divided into the mild group (UAS7 < 16 points) and moderate to severe group (UAS7 ≥ 16 points). Factors associated with the severity of CSU in children were analyzed using logistic regression. Non-normally distributed quantitative data were expressed as M ( Q1, Q3), and the non-parametric rank sum test (Kruskal-Wallis test) was used to compare quantitative data among multiple groups. Results:This study enrolled a total of 93 children with CSU, including 50 males (53.8%) and 43 females (46.2%), with the age being 5.9 (2.9, 9.2) years, and the disease duration being 4 (2, 8) months; 32 patients (34.4%) were complicated by angioedema, 28 (30.1%) had a family history of chronic urticaria, 49 (52.7%) had a family history of atopic diseases, 14 (15.1%) had a family history of autoimmune diseases, and 26 (28.0%) had at least one atopic comorbidity. Etiologic analysis showed that 32 cases (32/69, 46.4%) were positive for ASST and 28 (28/70, 40.0%) were positive for BAT. Both ASST and BAT were performed in 57 cases, and they were divided into the CAU group (18 cases), non-CAU group (24 cases), and partial CAU group (15 cases) according to the test results. There were no significant differences in the age, disease duration, gender ratio, proportion of patients with atopic comorbidity, or proportion of patients having a family history of atopic diseases among the 3 groups (all P > 0.05), while the proportion of patients with moderate to severe CSU (UAS7 ≥ 16 points) was higher in the CAU group (16/18) than in the non-CAU group (11/24, P < 0.05). Triggering factors were identified in 19 cases (20.4%), including 18 (19.3%) cases of food allergy and 1 case (1.0%) of antibiotic allergy. The serum total IgE level was elevated in 22 cases (22/89, 24.7%), and 40 (40/81, 49.4%) showed elevated levels of at least 1 sIgE. The UAS7 of the children with CSU was 16 (15, 21) points, and there were 31 (33.3%) children with mild CSU and 62 (66.7%) with moderate to severe CSU. Univariate logistic regression analysis showed that BAT positivity was associated with disease severity ( OR = 7.566, 95% CI: 2.238 - 25.572, P < 0.05). After adjustment for age and gender, multivariate logistic regression analysis showed that BAT positivity was associated with moderate to severe CSU ( OR = 6.725, 95% CI: 1.361 - 33.227, P < 0.05) . Conclusions:Autoimmunity may be the main cause of CSU in children, followed by allergic factors. ASST could be used as a primary screening test for the diagnosis of CAU in children, and BAT may help identify CAU and predict disease severity.

Objective To construct a set of graduation internship curriculum system suitable for undergraduate students majoring in biomedical engineering to facilitate standardizing the curriculum system of biomedical engineering major.Methods An initial version of the curriculum system was established with the way of letter and the methods of questionnaire survey,Delphi,expert interview and expert brainstorming;then the initial version was adjusted and refined using 2 rounds of expert consultation to form a set of curriculum system for graduation internship for undergraduate students majoring in biomedical engineering,and the curriculum system was validated.Results The curriculum system included 5 first-level catalogs,11 second-level catalogs and 39 third-level catalogs;the 36 third-level catalogs had a curriculum compliance rate of 0.85 to 0.97.Conclusion The curriculum system constructed can be used for graduation internship of biomedical engineering undergraduates,and references are provided for developing standardized and generally applicable graduation internship curriculum system for biomedical engineering undergraduates.[Chinese Medical Equipment Journal,2024,45(9):89-94]

Objective To quantitatively analyze the impact of environmental hygiene on the occurrence of health-care-associated infections(HAI).Methods Monitoring data of HAI and environmental hygiene from a tertiary first-class hospital from January 2018 to December 2022 were collected,and the impact of environmental bacterial colony forming unit(CFU)on the occurrence of HAI was analyzed by a time-series generalized additive model.Results The single-contamination model showed a significant positive correlation between HAI and staff's hand bacterial CFU(β1=0.009,P=0.012).For an increase of 1 interquartile range(IQR)in the monthly mean CFU per dish(MCFU/Dish)of staffs'hand,the incidence of HAI increased by 13.28％(95％CI:2.82％-24.81％).Subgroup and lag effect analysis showed that when the monthly MCFU/Dish(after hand disinfection)of staffs'hand in-creased by one IQR,the excess risk(ER)of HAI for the month(lag0)was 16.26％(95％CI:15.45％-17.09％).In the multi-contamination model,the correlation between surface contamination and HAI was also statistically sig-nificant.Conclusion There is a significant correlation between hospital environmental hygiene and the occurrence of HAI.