Objective:To explore the effects of small-group collaborative stratified teaching in critical care medicine training for professional postgraduate students.Methods:We randomly assigned 71 professional postgraduate students who entered the Intensive Care Unit of The Affiliated Hospital of Qingdao University for standardized training between June 2020 and November 2020 into experimental group and control group. An entrance examination was taken after one week of unified training. Then the experimental group adopted small-group collaborative stratified teaching, while the control group adopted traditional teaching for training. After two months of training, the Mini-Clinical Evaluation Exercise (Mini-CEX) assessment, post competency assessment, exit examination, and teaching satisfaction evaluation were conducted. SPSS 25.0 was used for the t test and chi-square test. Results:In the Mini-CEX assessment, the experimental group had significantly higher scores in history-taking skills [(7.42±0.60) vs. (7.00±0.55)], physical examination [(7.47±0.56) vs. (6.94±0.24)], communication skills [(7.56±0.50）vs.(7.24±0.49)], clinical dialectical thinking [(7.53±0.56) vs. (7.03±0.39)], clinical judgement [(7.50±0.51) vs.(6.90±0.42)], organization/efficiency [(7.58±0.50) vs. (7.15±0.44)], and overall clinical competence [(7.64±0.49) vs. (7.17±0.39); all P<0.05] than the control group. In the post competency assessment, the experimental group had significantly better performance in clinical basic competence [(89.15±9.12) vs. (86.24±10.23)], medical knowledge application [(48.37±5.87) vs. (46.98±3.68)], teamwork [(48.10±3.55) vs. (45.96±4.83)], information and management [(68.52±7.61) vs. (66.38±5.54)], and academic research [(22.18±0.95) vs. (20.87±1.22); all P<0.05] than the control group. The experimental group was also significantly superior to the control group in terms of the exit examination score and teaching satisfaction (both P<0.05). Conclusions:Small-group collaborative stratified teaching can improve the quality of critical care medicine training for professional postgraduate students, and strengthen their clinical comprehensive abilities and post competencies.

Objective To explore the post-traumatic growth course for women with termination of pregnancy due to fetal abnormalities and analyze the promoting factors,in order to provide a basis for nursing and intervention tactics.Methods The purposive sampling and theoretical sampling methods were used to select 16 women who were diagnosed with fetal abnormalities and decided to terminate pregnancy in the obstetrics department of a tertiary care maternity hospital in Beijing from May 2021 to February 2022.Women were interviewed by semi-structured interviews,and the data was analyzed by Charmaz's constructing grounded theory paradigm.Results Women with termination of pregnancy due to fetal abnormalities underwent 4 stages of post-traumatic growth:traumatic stress period,rumination and seeking of help period,and acceptance internalization period,and post-traumatic growth period.The behavior of each period was influenced by the psychological experience of the corresponding period and influenced the experience of the next period.Extroverted personality,previous normal pregnancy and delivery experience,positive perception of events,positive self-identification,good social support,appropriate hospitalization environment and regulations,open mindedness towards death and religious belief,affected women's post-traumatic growth.Conclusion The post-traumatic growth course of women with termination of pregnancy due to fetal anomaly is a complex continuously sublimated process.Medical staff should pay attention to psychological and behavioral changes in women's post-traumatic growth,combine the factors that promote post-traumatic growth,and provide targeted guidance to help them successfully go through this difficult period and achieve personal growth.

Objective:To compare the changes in pelvic floor electrophysiology and imaging in female patients with myofascial pelvic pain (MFPP), and to explore the characteristics and significance of these changes.Methods:A total of 49 MFPP patients who were admitted to the of Dalian Women′s and Children′s Medical Center (Group) from January 2019 to October 2021 were randomly selected as the research group, and 41 healthy women during the same period were selected as the control group. Both groups filled in the center′s medical history and general condition survey form. French PHENIX series pelvic floor muscle potential detection instrument was used to detect the resting vaginal muscle potential and maximum muscle potential of the two groups. The static tension, dynamic tension and pelvic floor muscle contraction force of the two groups were measured by French PHENIX series electronic tensioning apparatus with 5° and 10° opening respectively. Two dimensional transperineal ultrasound and three dimensional transvaginal ultrasound produced by B-K Company in Denmark were used to measure the length between the lower margin of the bladder neck from the symphysis pubis and the bladder neck and the bladder bottom (BND, BSD), the diameter of the genital tract hiatus and the angle of the anus and rectum. The area, anterior-posterior diameter, transverse diameter and different damage degrees of levator ani levator were measured.Results:The resting muscle potential of the study group was higher than that of the control group: 2 μV vs. 1 μV ( P<0.05); the maximum vaginal myopotential was higher than that of the control group: 7 μV vs. 6 μV ( P<0.05). The static tension, dynamic tension and contractile force: 204 g/m 2 vs. 175 g/m 2, 450 g/m 2 vs. 410 g/m 2 and 237 g/m 2 vs. 51 g/m 2 of pelvic floor muscle in the study group were higher than those in the control group when the tensioner was opened for 5° ( P<0.05). In resting state, BND, BSD and reproductive tract hiatus diameter in the study group were smaller than those in the control group: 14.0 mm vs. 16.7 mm, 15.3 mm vs. 19.7 mm, 46.7 mm vs. 49.5 mm ( P<0.05). The anal angle was greater than that of the control group: 129° vs. 112° ( P<0.05). The anal right angle in the study group was greater than that in the control group: 113° vs. 109° ( P<0.05). In the resting state, the area of levator ANI hiatus: 10.1 cm 2 vs. 11.6 cm 2, anterior and posterior diameters: 44.2 mm vs. 47.4 mm, transverse diameters and the defect scores of levator ani in the study group were all smaller than those in the control group ( P<0.05). Conclusions:MFPP presents with persistent pelvic floor muscle spasm and loss of coordination. MFPP can be treated by spasmolysis of pelvic floor muscle and fascia, which provides reference value for clinical treatment.

Objective:To study the application effect of prospective management based on failure cause analysis in optimizing the maintenance efficiency of digestive endoscope.Methods:The failure phenomena and causes of digestive endoscope were analyzed,basic management measures and common failure management countermeasures were formulated to carry out prospective management of digestive endoscope.The data of 43,866 operations of from 8 digestive endoscopes in clinically use from 2021 and 2022 in Department of Gastroenterology of The PLA Rocket Force Characteristic Medical Center were collected,and according to different management modes of digestive endoscope,the conventional management mode(21,737 times)and prospective management mode based on failure cause analysis(22,129 times)were adopted respectively.The differences in the incidence of digestive endoscope failure,maintenance grade(grade A,grade B,grade C,grade D and grade E)and the standardized evaluation(13 aspects in 3 dimensions)of the two management modes were compared.Results:The incidence rate of digestive endoscope failure in the prospective management mode was 0.15%(33/22,129),which was lower than that in the conventional management mode,the difference was statistically significant(x2=13.390,P<0.05).In the 33 times of digestive endoscope maintenance in the prospective management mode,the incidence rates of grade A,grade B,grade C,grade D and grade E maintenance were 12.12%(4/33),36.36%(12/33),27.27%(9/33),18.18%(6/33)and 6.06%(2/33),respectively,the maintenance grade data was better than that in the conventional management mode,the difference was statistically significant(Z=2.263,P<0.05).In the standardized evaluation of digestive endoscopes managed by the prospective management mode,the operation error rate was lower than that of conventional management mode,the difference was statistically significant(x2=4.110-34.909,P<0.05).Conclusion:The application of maintenance efficiency of digestive endoscopes by prospective management optimization based on fault cause analysis can reduce failure rate of digestive endoscopy and improve the standard use rate of digestive endoscopy.

BACKGROUND:Previous studies have found that qi deficiency and blood stasis syndrome is the main syndrome among various TCM syndromes of cervical spondylotic myelopathy.However,there is no report on proteomic markers as early diagnosis indicators for the transformation of developmental cervical spinal stenosis with qi deficiency and blood stasis syndrome to cervical spondylotic myelopathy. OBJECTIVE:To explore serum proteomics difference between developmental cervical spinal stenosis and cervical spondylotic myelopathy and to find and identify the potential serum biomarkers between them. METHODS:Serum samples of nine patients with cervical spondylotic myelopathy of qi deficiency and blood stasis syndrome(experimental group)and nine patients with developmental cervical spinal stenosis of qi deficiency and blood stasis syndrome(control group)were collected.The proteomic analysis was carried out by Tandem Mass Tag combined with liquid chromatography tandem mass spectrometry,so as to find and identify differentially expressed proteins. RESULTS AND CONCLUSION:A total of 1027 significantly differential proteins were initially screened by TMT technology and 89 significantly differential proteins were finally identified(P<0.05).Compared with the control group,there were 45 up-regulated proteins in the experimental group,such as α-actinin-4,α-actinin-1,cell division control protein 42 homolog,integrin-linked protein kinase and B-actin.Conversely,there were 44 down-regulated proteins in the experimental group compared with the control group,such as fibronectin,fibrinogen γ chain,fibrinogen α chain,fibrinogen β chain.Gene ontology enrichment analysis indicated that these differential proteins were involved in signal receptor binding,kinase binding,protein kinase activity,integrin binding,actin filament binding and other molecular functions.Based on the Kyoto Encyclopedia of Genes and Genomes pathway analysis,20 common differential signal/metabolic pathways were identified,including Rap1 signaling pathway,adherens junction,tight junction,platelet activation,and regulation of actin cytoskeleton.Protein-protein interaction analysis showed that ILK,FGA,FGB,FGG,FN1,Cdc42,ACTN1,ACTN4 and ACTB were located at the nodes of protein-protein interaction network and were closely related to bone formation and destruction system,nervous system,coagulation system,cellular inflammation and other systems.To conclude,the serum differentially expressed proteins between developmental cervical spinal stenosis and cervical spondylotic myelopathy can be successfully screened by Tandem Mass Tag combined with liquid chromatography tandem mass spectrometry.ILK,FN1,CDC42 and ACTN 4 are identified as specific markers for the transformation of developmental cervical spinal stenosis with qi deficiency and blood stasis syndrome into cervical spondylotic myelopathy.These findings provide a basis for further clarifying the transformation mechanism.

Cardiovascular diseases(CVDs)are a leading factor driving mortality worldwide.Iron,an essential trace mineral,is important in numerous biological processes,and its role in CVDs has raised broad discussion for decades.Iron-mediated cell death,namely ferroptosis,has attracted much attention due to its critical role in cardiomyocyte damage and CVDs.Furthermore,ferritinophagy is the upstream mechanism that induces ferroptosis,and is closely related to CVDs.This review aims to delineate the processes and mechanisms of ferroptosis and ferritinophagy,and the regulatory pathways and molecular targets involved in ferritinophagy,and to determine their roles in CVDs.Furthermore,we discuss the possibility of targeting ferritinophagy-induced ferroptosis modulators for treating CVDs.Collectively,this review offers some new insights into the pathology of CVDs and identifies possible therapeutic targets.

Objective To investigate the mechanisms of microRNA-211-5p (miR-211-5p) in regulation of proliferation, apoptosis, migration, invasion, and collagen synthesis of human hypertrophic scar fibroblasts (HSFBs) via the transforming growth factor (TGF)-β1/Smad homolog 2 (Smad2) signaling pathway. Methods HSFBs were randomly divided into control, miR-NC, miR-211-5p mimic, anti-miR-211-5p, and miR-211-5p mimic + SB431542 (TGF-β1/Smad2 signaling pathway inhibitor) groups. After 72 hours of continuous culture, quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR) was used to detect miR-211-5p expression, western blot was employed to assess TGF-β1 and Smad2 protein levels, methyl-thiazoldiphenyl-tetrazolium (MTT) assay was performed to measure cell proliferation, flow cytometry was utilized to analyze apoptosis rates, Transwell chambers were applied to evaluate cell invasion and migration, and western blot was again utilized to quantify type I collagen (Col-Ⅰ) and type Ⅲ collagen (Col-Ⅲ) protein expressions. An animal model of hypertrophic scars was established in rats using a constant temperature and pressure electric scalding apparatus. Following successful modeling, rats in each group received tail vein injections of miR-NC or miR-211-5p mimic. Scar healing was assessed, and histopathological changes in scar tissue were observed via hematoxylin and eosin (HE) staining. Results Compared with the control and miR-NC groups, the miR-211-5p mimic group exhibited increased miR-211-5p, TGF-β1, and Smad2 protein expressions, enhanced cell proliferation, reduced invasion and migration capabilities, decreased apoptosis rates, and elevated Col-Ⅰ and Col-Ⅲ protein expressions (P < 0.05). Conversely, the anti-miR-211-5p group displayed opposite trends, and significant differences were observed between the anti-miR-211-5p and miR-211-5p mimic groups for the aforementioned indicators (P < 0.05). Compared to the miR-NC group, the miR-211-5p mimic group had higher scar healing rates and fibroblast counts (P < 0.05). Compared to the miR-211-5p mimic group, the miR-211-5p mimic + SB431542 group showed reduced TGF-β1, Smad2 protein expressions, and weakened cell invasion and migration capabilities (P < 0.05). Conclusion MiR-211-5p may regulate proliferation, apoptosis, migration, invasion, and collagen synthesis of HSFBs by activating the TGF-β1/Smad2 signaling pathway.

Objective To conduct hazard vulnerability analysis(HVA)in a blood bank,aimed to identify high-risk e-vents and optimize emergency management measures.Methods The risk event evaluation index system was established by referring to the Kaiser model and the situation of Guangzhou Blood Center,and risk events were ranked by risk matrix and Borda count.Results The top five events with the highest risk values identified by Kaiser model were information system e-mergencies(39.61％),extreme weather(38.03％),major public sentiment(37.86％),public health events(37.37％)and policy changes(37.24％).The results of risk matrix and Borda count revealed 1 extremely high-risk indicator as information system emergency,5 high-risk indicators with the highest risk being major public sentiment,11 medium-risk indicators with the highest risk being major medical disputes and 1 low-risk indicator as external fires.Conclusion Conducting HVA in combination with the actual situation of blood banks can effectively identify high-risk events and provide theoretical basis for improving emergency management measures.

Background::Atopic dermatitis (AD) affects approximately 10% of adults worldwide. CM310 is a humanized monoclonal antibody targeting interleukin-4 receptor alpha that blocks interleukin-4 and interleukin-13 signaling. This trial aimed to evaluate the efficacy and safety of CM310 in Chinese adults with moderate-to-severe AD.Methods::This multicenter, randomized, double-blind, placebo-controlled, phase 2b trial was conducted in 21 medical institutions in China from February to November 2021. Totally 120 eligible patients were enrolled and randomized (1:1:1) to receive subcutaneous injections of 300 mg CM310, 150 mg CM310, or placebo every 2 weeks for 16 weeks, followed by an 8-week follow-up period. The primary endpoint was the proportion of patients achieving ≥75% improvement in the Eczema Area and Severity Index (EASI-75) score from baseline at week 16. Safety and pharmacodynamics were also studied.Results::At week 16, the proportion of EASI-75 responders from baseline was significantly higher in the CM310 groups (70% [28/40] for high-dose and 65% [26/40] for low-dose) than that in the placebo group (20%[8/40]). The differences in EASI-75 response rate were 50% (high vs. placebo, 95% CI 31%–69%) and 45% (low vs. placebo, 95% CI 26%–64%), with both P values <0.0001. CM310 at both doses also significantly improved the EASI score, Investigator’s Global Assessment score, daily peak pruritus Numerical Rating Scale, AD-affected body surface area, and Dermatology Life Quality Index compared with placebo. CM310 treatment reduced levels of thymus and activation-regulated chemokine, total immunoglobulin E, lactate dehydrogenase, and blood eosinophils. The incidence of treatment-emergent adverse events (TEAEs) was similar among all three groups, with the most common TEAEs reported being upper respiratory tract infection, atopic dermatitis, hyperlipidemia, and hyperuricemia. No severe adverse events were deemed to be attributed to CM310. Conclusion::CM310 at 150 mg and 300 mg every 2 weeks demonstrated significant efficacy and was well-tolerated in adults with moderate-to-severe AD.Trial Registration::ClinicalTrials.gov, NCT04805411.

Objective To investigate the effects of comprehensive nutrition management on glycolipid metabolism and pregnancy outcomes in patients with gestational diabetes mellitus(GDM).Methods A total of 121 pregnant women with GDM at 24-28 weeks gestation who were registered in the obstetrics department of 6 sub-central hospi-tals in China from May 2021 to July 2021 were included in this study and were randomly divided into intervention group(n=74)and control group(n=47).The intervention group received intensive comprehensive nutrition man-agement,including at least 6 outpatient interventions,individualized nutrition management and a half-day standard-ized outpatient education on gestational diabetes mellitus,continuous dynamic blood glucose monitoring and micro-blood glucose monitoring,and routine check of glycated albumin and urine every 4 weeks.Body weight,body com-position and diet and exercise implementation procedures and fetal development as well as complications were recor-ded.The control group received conventional nutritional guidance.The two groups were compared for difference in blood glucose related indicators at 37 weeks of gestation,weight gain before delivery,some lipid metabolism indica-tors,pregnancy outcomes,and oral glucose tolerance test(OGTT)at 42 days postpartum.Results Compared with the control group,the level of prenatal fasting blood glucose(P=0.006),intravenous plasma glucose(P=0.009)and blood ketone(P = 0.044)in the intervention group was significantly reduced.There was no significant difference in weight gain and weight attainment rate between the two groups.The 2-hour postpartum OGTTs of preg-nant women in the intervention group(P=0.006)were significantly lower than those in the control group,and the incidence of preeclampsia and postpartum blood loss were lower than those in the control group but no statistical difference was found.For newborns,the incidence of macrosomia(P=0.042)and planation(P=0.048)in the in-tervention group was slightly lower than that in the control group,and the results were statistically different.Other adverse pregnancy outcomes were not statistically different between the two groups.Conclusions Intensive compre-hensive nutrition management has a positive impact on the control of the blood glucose in pregnant women and im-proves the maternal and neonatal outcomes of women with GDM.