Objective To explore the independent risk factors for early failure of internal mammary artery grafts after coronary artery bypass grafting (CABG), and to construct and preliminarily evaluate a risk prediction model for the decline of internal mammary artery bridges, optimizing postoperative risk stratification and management strategies for patients. Methods Patients who underwent CABG at Fuwai Hospital, Chinese Academy of Medical Sciences from January 2016 to January 2020 were retrospectively enrolled. The primary endpoint was the failure of the internal mammary artery bridge one year after surgery, and the secondary endpoint was major adverse cardiac and cerebrovascular events (MACCE) within five years after surgery, including all-cause death, myocardial infarction, stroke, and revascularization. Patients were divided into a failure group and a non-failure group based on whether there was early failure of the internal mammary artery bridge after surgery. Independent risk factors for the failure of the internal mammary artery bridge were explored through the least absolute shrinkage and selection operator regression and multivariate logistic regression, and a failure risk prediction model was constructed and cross-validated. Patients were stratified for MACCE risk according to the total score of independent risk factors, and the 5-year cumulative MACCE-free rate was drawn using the Kaplan-Meier method. Results A total of 657 patients were included, among whom there were 54 patients in the failure group, including 38 males and 16 females, with an average age of (61.85±8.03) years; there were 603 patients in the non-failure group, including 467 males and 136 females, with an average age of (60.45±8.23) years. Multivariate logistic regression analysis showed that non-left main lesion [OR=3.28, 95%CI (1.41, 7.62), P=0.006], pulsatility index (PI)>3.0 [OR=2.63, 95%CI (1.20, 5.75), P=0.016], quantitative flow ratio (QFR)>0.80 [OR=5.57, 95%CI (2.98, 10.41), P<0.001] and in-hospital complications [OR=4.02, 95%CI (1.59, 10.19), P=0.003] were independent risk factors for the failure of internal mammary artery grafts after CABG. Compared with the prediction model in previous literature [area under receiver operating characteristic curve was 0.632, 95%CI (0.588, 0.688)], the risk prediction model constructed with QFR>0.80, PI>3.0, non-left main lesion and in-hospital complications had a higher predictive ability for early failure of internal mammary artery grafts [area under curve: 0.758, 95%CI (0.707, 0.817); net reclassification index: 0.272, 95%CI (0.180, 0.370); comprehensive discriminative improvement index: 0.109, 95%CI (0.059, 0.158); P<0.05]. The risk score of independent risk factors for internal mammary artery graft failure demonstrated significant MACCE risk stratification efficiency in the 5-year patient follow-up, with the high-risk group showing a significantly higher incidence of MACCE compared to the medium and low-risk groups (P=0.001). Conclusion QFR>0.80, PI>3.0, non-left main lesions, and in-hospital complications are independent risk factors for early failure of internal mammary artery grafts after CABG. The constructed risk prediction model based on this has preliminary capabilities in predicting the risk of internal mammary artery graft failure and MACCE risk stratification, which is beneficial for the postoperative management of CABG patients and improving their mid-long term prognosis.

General practice standardized residency training is a crucial part of postgraduate education for cultivating general practitioner. The factors influencing the quality of general practice residency training cover various aspects such as the residents themselves, teaching staff, management and decision-making levels, as well as teaching resources. Guided by the goal of "fostering virtue through education", and integrated the spirit of Norman Bethune and modern innovation theories and the educational philosophy, the China-Japan Union Hospital of Jilin University has carried out comprehensive reforms in this field. It has constructed a PDCA cycle management system based on the concept of total quality management to improve the quality of education from multiple links such as quality planning and process monitoring. In terms of faculty development, based on the dissipative structure theory, a mechanism of "selection, evaluation, incentive, and elimination" has been established. Teacher communities have been formed and a training college has been established to strengthen the teaching team. In terms of platform construction, the linkage between "teaching base-community" and "on campus-off campus" has been strengthened and resources have been integrated. The reform has achieved remarkable results, and our practice may provide a reference for general practice medical education.

Objective To investigate the effect of triptolide(TPL)on renal interstitial fibrosis in mice with unilateral ureteral obstruction(UUO)and its mechanism.Methods Six male C57BL/6J mice were randomly selected as the sham group,and 12 mice with UUO modeling were randomly divided into the model group(UUO)and the triptolide group(TPL).Changes in serum creatinine(SCr),blood urea nitrogen(BUN),and body weight were compared among the groups.Renal tissue specimens were collected at 14 d after UUO for HE and Masson staining.Immunohistochemistry staining was performed to observe the expression of α-smooth muscle actin(α-SMA)and fibronectin(Fn)in kidney tissues.Western blotting analysis was used to detect the protein expression levels of nucleotide combined with structure of oligomerization domain receptor protein 3(NLRP3),GSDMD,cGSDMD,IL-1β and IL-18.Results At week 1,the body weight of mice in the UUO and TPL groups significantly decreased compared with that in the sham group(P＜0.05).Body weight reduced in the TPL group compared with that in the Sham group at week 2(P＜0.01).There was no significant difference in body weight between the TPL and UUO groups.BUN levels did not differ significantly between the three groups.Compared with the sham group,the SCr level in the UUO group significantly increased[(15.680±1.508)μmol/L](P＜0.01).A reduction in SCr level was observed following TPL administration[(12.550±3.004)μmol/L](P＜0.05).HE staining showed that the renal tubules of mice in the UUO group were significantly dilated and atrophic,with interstitial edema and increased inflammatory cell infiltration,while the pathological damage of renal tissues was significantly alleviated after TPL treatment.Masson staining revealed that interstitial collagen deposition significantly increased in the UUO group(36.350±5.183)％(P＜0.01)and reduced after TPL administration(20.820±3.290)％(P＜0.01).Immunohistochemistry results demonstrated that the IOD levels of α-SMA(1.233±0.045)and Fn(1.337±0.045)were higher in UUO group mice than in the sham group,while the IOD levels of α-SMA(1.047±0.025)and Fn(1.113±0.021)were lower in the TPL group than in the UUO group(P＜0.05).Western blotting analysis indicated that the expression levels of NLRP3,cGSDMD,IL-1β and IL-18 in the UUO group mice were higher than those in the sham group,while the protein expression levels of the above-mentioned indicators significantly decreased after TPL treatment(P＜0.05).Conclusion TPL ameliorates renal interstitial fibrosis in mice with UUO by inhibiting NLRP3-mediated pyroptosis.

Objective To investigate the effect of triptolide(TPL)on renal interstitial fibrosis in mice with unilateral ureteral obstruction(UUO)and its mechanism.Methods Six male C57BL/6J mice were randomly selected as the sham group,and 12 mice with UUO modeling were randomly divided into the model group(UUO)and the triptolide group(TPL).Changes in serum creatinine(SCr),blood urea nitrogen(BUN),and body weight were compared among the groups.Renal tissue specimens were collected at 14 d after UUO for HE and Masson staining.Immunohistochemistry staining was performed to observe the expression of α-smooth muscle actin(α-SMA)and fibronectin(Fn)in kidney tissues.Western blotting analysis was used to detect the protein expression levels of nucleotide combined with structure of oligomerization domain receptor protein 3(NLRP3),GSDMD,cGSDMD,IL-1β and IL-18.Results At week 1,the body weight of mice in the UUO and TPL groups significantly decreased compared with that in the sham group(P＜0.05).Body weight reduced in the TPL group compared with that in the Sham group at week 2(P＜0.01).There was no significant difference in body weight between the TPL and UUO groups.BUN levels did not differ significantly between the three groups.Compared with the sham group,the SCr level in the UUO group significantly increased[(15.680±1.508)μmol/L](P＜0.01).A reduction in SCr level was observed following TPL administration[(12.550±3.004)μmol/L](P＜0.05).HE staining showed that the renal tubules of mice in the UUO group were significantly dilated and atrophic,with interstitial edema and increased inflammatory cell infiltration,while the pathological damage of renal tissues was significantly alleviated after TPL treatment.Masson staining revealed that interstitial collagen deposition significantly increased in the UUO group(36.350±5.183)％(P＜0.01)and reduced after TPL administration(20.820±3.290)％(P＜0.01).Immunohistochemistry results demonstrated that the IOD levels of α-SMA(1.233±0.045)and Fn(1.337±0.045)were higher in UUO group mice than in the sham group,while the IOD levels of α-SMA(1.047±0.025)and Fn(1.113±0.021)were lower in the TPL group than in the UUO group(P＜0.05).Western blotting analysis indicated that the expression levels of NLRP3,cGSDMD,IL-1β and IL-18 in the UUO group mice were higher than those in the sham group,while the protein expression levels of the above-mentioned indicators significantly decreased after TPL treatment(P＜0.05).Conclusion TPL ameliorates renal interstitial fibrosis in mice with UUO by inhibiting NLRP3-mediated pyroptosis.

General practice standardized residency training is a crucial part of postgraduate education for cultivating general practitioner. The factors influencing the quality of general practice residency training cover various aspects such as the residents themselves, teaching staff, management and decision-making levels, as well as teaching resources. Guided by the goal of "fostering virtue through education", and integrated the spirit of Norman Bethune and modern innovation theories and the educational philosophy, the China-Japan Union Hospital of Jilin University has carried out comprehensive reforms in this field. It has constructed a PDCA cycle management system based on the concept of total quality management to improve the quality of education from multiple links such as quality planning and process monitoring. In terms of faculty development, based on the dissipative structure theory, a mechanism of "selection, evaluation, incentive, and elimination" has been established. Teacher communities have been formed and a training college has been established to strengthen the teaching team. In terms of platform construction, the linkage between "teaching base-community" and "on campus-off campus" has been strengthened and resources have been integrated. The reform has achieved remarkable results, and our practice may provide a reference for general practice medical education.

Objective:To assess the efficacy and safety of computed tomography (CT)-guided percutaneous cryoablation in treating malignant liver tumors located explicitly at high-risk sites.Methods:Data were collected retrospectively from patients with malignant liver tumors undergoing percutaneous cryoablation at Tianjin Medical University Cancer Hospital between January 2018 and December 2021. In all, 46 patients with malignant liver tumors at non-high-risk sites were matched 1∶1 according to the maximum tumor diameter. Technical success rate, complete ablation rate, and complications at 12 and 24 months post-surgery were evaluated. A statistical analysis of the ablation effect difference between the high-risk site and non-high-risk site groups was conducted. Univariate and multivariate logistic regression analyses were performed to identify risk factors.Results:Both groups demonstrated a 100% intraoperative technical success rate, and no major complications related to cryoablation were observed. The complete ablation rate was 82.6% (38/46) and 71.7% (33/46) in the high-risk group and 84.8% (39/46) and 73.9% (34/46) in the non-high-risk group at 12 and 24 months, respectively. There was no significant difference in complete ablation rates between the two groups ( P>0.05). Multivariate analysis identified the distance between the tumor edge and high-risk site ≤5 mm and preoperative trans-arterial chemoembolization (TACE) treatment as independent risk factors for cryoablation effect. Conclusion:CT-guided percutaneous cryoablation is a safe and effective approach for patients with malignant liver tumor at high-risk sites. Our results emphasize the importance of proper preoperative planning and intraoperative manipulation.

【Objective】 To explore the role and mechanism of TRPC in promoting extracellular matrix (ECM) deposition in rat glomerular mesangial cells (HBZY-1). Methods Immunofluorescence staining was performed to observe the distribution and expression of TRPC1 and TRPC6 in HBZY-1 cells. After AngⅡ stimulation, qRT-PCR and Western blotting were used to detect the mRNA and protein expressions of Gαq/PLCβ4/TRPC signaling pathway main proteins and ECM deposition indicators (α-SMA, collagenⅢ and fibronectin). By silencing the expressions of TRPC1 and TRPC6 by RNA interference, the expressions of ECM deposition indicators were detected. Changes in [Ca²⁺]i influx were determined through Fluo-4AM Ca²⁺ imaging. 【Results】 Both TRPC1 and TRPC6 were expressed in HBZY-1, and were mainly located in cell membrane and cytoplasm. After AngⅡ stimulation, Gαq/PLCβ4/TRPC signaling pathway was activated, and the mRNA and protein expressions of Gαq, PLCβ4, TRPC1 and TRPC6 were all increased (P<0.05). [Ca²⁺]i influx also increased (P<0.01), and the mRNA and protein expressions of ECM deposition indicators (α-SMA, ColⅢ and Fn) were upregulated (P<0.05). Silencing the expressions of TRPC1 and TRPC6 by RNA interference led to decreased [Ca²⁺]i influx (P<0.05), and downregulated mRNA and protein expressions of ECM deposition indicators in HBZY-1 cells (P<0.05). The results suggested that inhibition of TRPC expressions could inhibit AngⅡ induced ECM deposition in HBZY-1 cells, which might be associated with decreased [Ca²⁺]i influx. 【Conclusion】 TRPC may be a novel therapeutic target of renal fibrosis.

Objective::The effectiveness of statins in reducing atherosclerotic calcification remains controversial. The aim of this study was to confirm that simvastatin reduces atherosclerotic calcification and stabilizes plaque by restricting endoplasmic reticulum stress (ERS)-mediated apoptosis.Methods::Twenty-four 8-week-old male apolipoprotein E (ApoE) -/- mice (C57BL/6J genetic background) were selected and randomly divided into model ( n = 12) and simvastatin ( n = 12) groups. Twelve male C57BL/6J mice were selected as control group ( n = 12). The mice were adaptively fed for 2 weeks and were put on a high-fat diet thereafter. After 9 weeks, they were treated with simvastatin (20 mg/kg) or phosphate-buffered saline daily for 8 weeks. Aortic sinus samples were obtained from ApoE -/- and C57BL/6J mice for hematoxylin and eosin, von Kossa, alizarin Red S, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling, and immunohistochemical staining after in vivo treatment with simvastatin. In addition, mouse vascular smooth muscle cells were analyzed after exposure to simvastatin in vitro.Results::Administration of simvastatin in vivo drastically attenuated the atherosclerosis, calcification, and apoptosis, and decreased the serum levels of triglycerides, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol. The expression levels of glucose-regulated protein, 78 kDa (GRP78), C/EBP homologous protein (CHOP), and caspase 12 (CASP12) in the aortic sinus decreased in the simvastatin group compared with the model group. In vitro, simvastatin or simvastatin plus ERS inhibitor (taurine) attenuated calcification and apoptosis, and reduced the expression of ERS-related proteins GRP78, CHOP, and CASP12. Conclusion::Treatment with simvastatin suppressed atherosclerotic calcification. This effect may be mediated through the inhibition of ERS-related apoptosis.

Objective::The effectiveness of statins in reducing atherosclerotic calcification remains controversial. The aim of this study was to confirm that simvastatin reduces atherosclerotic calcification and stabilizes plaque by restricting endoplasmic reticulum stress (ERS)-mediated apoptosis.Methods::Twenty-four 8-week-old male apolipoprotein E (ApoE) -/- mice (C57BL/6J genetic background) were selected and randomly divided into model ( n = 12) and simvastatin ( n = 12) groups. Twelve male C57BL/6J mice were selected as control group ( n = 12). The mice were adaptively fed for 2 weeks and were put on a high-fat diet thereafter. After 9 weeks, they were treated with simvastatin (20 mg/kg) or phosphate-buffered saline daily for 8 weeks. Aortic sinus samples were obtained from ApoE -/- and C57BL/6J mice for hematoxylin and eosin, von Kossa, alizarin Red S, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling, and immunohistochemical staining after in vivo treatment with simvastatin. In addition, mouse vascular smooth muscle cells were analyzed after exposure to simvastatin in vitro.Results::Administration of simvastatin in vivo drastically attenuated the atherosclerosis, calcification, and apoptosis, and decreased the serum levels of triglycerides, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol. The expression levels of glucose-regulated protein, 78 kDa (GRP78), C/EBP homologous protein (CHOP), and caspase 12 (CASP12) in the aortic sinus decreased in the simvastatin group compared with the model group. In vitro, simvastatin or simvastatin plus ERS inhibitor (taurine) attenuated calcification and apoptosis, and reduced the expression of ERS-related proteins GRP78, CHOP, and CASP12. Conclusion::Treatment with simvastatin suppressed atherosclerotic calcification. This effect may be mediated through the inhibition of ERS-related apoptosis.

Objective To investigate the potential heart sparing effects of tangential volumetric modulated arc therapy (T-VMAT) by comparing its dosimetric properties with conventional wedged tangential fields (W-TF) technique and 6-field intensity-modulated radiotherapy (6F-IMRT) in the locoregional radiotherapy of left breast cancer after conserving surgery,including internal mammary nodal irradiation.Methods Fifteen patients with left breast cancer were enrolled in this study.Three plans were generated for each patient:W-TF,6F-IMRT and T-VMAT with two arc segments of 50°.The prescription dose to planning tumor volume (PTV) was 50 Gy in 25 fractions.Dose-volume parameters and indices of conformity were calculated and compared for the PTV and organs at risk (OAR).Results Compared with W-TF,T-VMAT not only significantly decreased D D and the high dose areas (above 10 Gy) of the heart and left anterior descending branch (LAD) (P ＜ 0.05),but also had the trend of sparing the V5Gy although there was statistically significant difference (P ＞ 0.05).T-VMAT also significantly decreased Dmean V5Gy,V10Gy and V20Gy of the heart,as well as the D V5Gy and V10 Gy of LAD (P ＜ 0.05),compared to 6F-IMRT.Furthermore,T-VMAT did not result in higher V20Gy of ipsilateral lung and higher V5Gy of contralateral breast compared with W-TF (P ＞ 0.05).T-VMAT achieved distinctly better target coverage and conformity,meanwhile obviously lowered hot volume of V110 compared to W-TF (P ＜ 0.05).Conclusions T-VMAT not only significantly decreased the high dose areas,but also had the trend of sparing the low dose area for the heat and LAD.Moreover,there was no significant difference for V20Gy of ipsilateral lung and V5Gy of contralateral breast between T-VMAT and W-TF.