Objective:To investigate the influence of changes in the cognitive load of anesthesia residents on the teaching effectiveness of high-fidelity scenario simulation.Methods:Eighty-seven anesthesia residents in a grade-A tertiary hospital from February to November 2022 were divided into groups A, B, and C according to the random number method. Three cases were selected from the anesthesia crisis resource teaching case library for high-fidelity simulation training for the three groups, respectively, using the crossover design to control the order of the cases. Each round of training consisted of pre-training instruction, simulation teaching, and post-training summarization and analysis. After three rounds of simulation teaching, cognitive load, anxiety status, test scores, and non-technical skills were evaluated for all the study participants. SPSS 20.0 was used to perform analysis of variance with repeated measures and Pearson's correlation analysis.Results:All the three groups showed significantly higher cognitive load and anxiety scores during the first-round simulation training than during the second-round and third-round simulation trianing. The test scores were significantly lower in the first round [(87.07±5.66), (88.38±5.41), (89.07±6.17)] than in the second round [(95.69±2.29), (96.10±2.08), (96.07±2.60)] and the third round [(96.34±1.45), (96.38±1.50), (96.17±1.73); all P<0.05]. The non-technical skill scores were also significantly lower in the first round [(37.24±7.58), (38.69±7.27), (39.24±8.74)] than in the second round [(46.17±5.55), (47.07±5.59), (47.59±6.74)] and the third round [(47.17±5.21), (48.48±5.38), (48.24±6.83); all P<0.05]. For simulations with the same cases, the trainees showed significantly higher cognitive load and anxiety scores and significantly lower test scores and non-technical skill scores in the first round than in the second and third rounds ( P<0.05). Conclusions:Anesthesia residents have higher levels of cognitive load and anxiety in the first scenario simulation training, which can reduce learning outcomes, and repeated simulation training can reduce trainees' cognitive load and anxiety.

Objective:To reveal effect of celastrol(Cel)on apoptosis of liver and kidney cells in preeclampsia(PE)rats and its protective effect.Methods:Fifty pregnant SD rats were randomly divided into 5 groups(n=10):Control group,PE group,PE+low-dose Cel group(PE+L-Cel),PE+medium-dose Cel group(PE+M-Cel),PE+high-dose Cel group(PE+H-Cel),PE rat model was induced by injection of lipopolysaccharide through tail vein.Rats in PE+L-Cel group,PE+M-Cel group and PE+H-Cel group were intraperitoneally injected with 5,10 and 20 mg/(kg·d)Cel daily from 14～20 day of pregnancy.Control group and PE group were in-jected with equal volume of normal saline.Systolic blood pressure(SBP)and urine albumin of rats in each group were measured after treatment.Cell apoptosis of liver and kidney tissues were detected by TUNEL staining.Bcl-2 and Caspase-9 expressions in liver and kidney tissues were detected by immunohistochemical staining.ELISA was used to detect serum IFN-γ,IL-4,IL-17 and IL-10 levels.Results:Compared with PE group,SBP and urine albumin levels of PE+L-Cel group,PE+M-Cel group and PE+H-Cel group were decreased(P<0.05),cells apoptosis rates of liver and kidney tissues were decreased(P<0.05),positive expression of Caspase-9 was significantly reduced,Bcl-2 level was significantly increased,serum IFN-γ and IL-17 levels were reduced(P<0.05),while IL-4 and IL-10 levels were increased(P<0.05).Conclusion:Cel can reduce symptoms of PE rats and inhibit liver and kidney cell apoptosis,which may play a therapeutic effect by correcting imbalance of Th1/Th2 and Th17/Treg cells in PE rats.

Objective:To analyze the correlation between cuproptosis genes and immune infiltration during the occurrence and development of multiple sclerosis(MS),and to predict the traditional Chinese medicine,to provide theoretical basis for the mecha-nism study of cuproptosis in MS immune infiltration and Chinese medicine to intervene in immune regulation.Methods:The gout chip of MS was downloaded from the GEO database and standardized;based on the processed data,immune cells and functions were ex-tracted and quantified,and the correlation and differences of immune cells and functions were analyzed;at the same time,cuproptosis genes related to MS were screened out,a risk model was constructed,and enrichment analysis was carried out;the prediction of cu-proptosis genes and immune-related biological processes were carried out.Results:① Among immune cells,T follicular helper cell and B cell showed the strongest positive correlation;among the immune functions,parainflammation and typeⅠIFN reponse showed the strongest positive correlation;②B cell,T helper cell and human leukocyte antigen were lowly expressed in MS patients,while major histocompatibility complex class Ⅰ,parainflammation and typeⅠIFN response were significantly expressed;③ The cupropto-sis genes associated with MS were SLC31A1,PDHA1,NLRP3,MTF1,GLS and DBT,of which DBT was the most likely risk factor for MS;④The occurrence and development of MS involves biological processes such as IL-4 production,T-helper cell differentiation,and acute inflammatory response,which were related to pathways such as arginine biosynthesis,citrate cycle,and propanoate metabo-lism;⑤Banxia,Danshen,Jianghuang and other traditional Chinese medicines may be used as potential molecular drug sources.Con-clusion:The expression of cuproptosis gene is closely related to MS-related immune cells and functions,which can provide support for the basic research of MS.

Objective:To explore the categories of presenteeism among ICU nurses based on latent profile analysis, analyze the influencing factors of different categories, and provide a basis for formulating targeted interventions.Methods:Totally 802 ICU nurses from 24 provinces, municipalities, and autonomous regions in China were selected by convenience sampling between September and November 2022. Data were collected using a general information questionnaire, the Health and Work Performance Questionnaire (HPQ), the Perceived Social Support Scale (PSSS), and the Work-Family Conflict Scale (WFCS). Latent profile analysis was employed to identify categories of presenteeism among ICU nurses, and unordered multinomial Logistic regression was used to explore the influencing factors of each category.Results:Presenteeism among the 802 ICU nurses could be classified into three profiles: low presenteeism-normal coping group (28.8%), moderate presenteeism group (48.8%), and high presenteeism-work limitation group (22.4%). Unordered multinomial logistic regression analysis revealed that physical health status, presence of chronic disease, exposure to workplace violence in the past year, perceived social support, and work-family conflict were influencing factors for the latent categories of presenteeism among ICU nurses ( P<0.05) . Conclusions:There is heterogeneity in presenteeism among ICU nurses. Nursing managers should develop targeted interventions based on the characteristics of different types of presenteeism to reduce the rate of presenteeism among ICU nurses.

Rhythmic auditory stimulation(RAS)with repetitive and rhythmic sound sensory signals can improve motor functional recovery by inducing rhythmic movement for patients with motor dysfunction due to neurological impairment.As an emerging intervention for the treatment of post-stroke hemiplegic patients,RAS can improve the walking ability of post-stroke hemiplegic patients,correct abnormal gait,improve balance function,and improve patients'upper and lower limb function.Its mechanism of action may be related to the rhythmic entrainment motor system and auditory-motor synchronisation.In addition,RAS can be combined with various other rehabilitation techniques to better promote the recovery of motor function in stroke patients.This article reviewed the research progress of RAS in motor function recovery of post-stroke patients to provide guidance for clinical application.

Critical care medicine-related treatment is an interdisciplinary and multi-professional process,often leading to secondary or concomitant mental disorders in clinical practice.Currently,there is no consensus on the pharmacological treatment of related mental illnesses in China.The Chinese Society of Psychosomatic Medicine collaborated with the Critical Care Medicine expert group to form a consensus writing expert group.After a systematic review of relevant literature,summarizing published domestic and foreign literature,and extensive discussions,the consensus was developed.The consensus elaborates on the principles and processes of the standardized use of psychotropic drugs in critical care medicine,as well as the clinical indications,precautions,and specific drug selection of various psychiatric medications,providing feasible suggestions and guidance for the clinical application of psychiatric medications in the intensive care unit.

Diarrhea is a common and frequent disease in clinical practice.Many factors cause diarrhea,and numerous research method with animal models of diarrhea have been explored.Despite this,drugs for the treatment of diarrhea in clinical practice are limited,and some existing drugs are only suitable for diarrhea caused by a single factor.Therefore,the construction and selection of appropriate animal models of diarrhea are not only important for in-depth studies of the pathogenesis,but are also effective means for the clinical screening and evaluation of drugs for comprehensively preventing and treating diarrhea.This article reviews the literature on the establishment and evaluation of animal models of functional,bacterial,viral,and symptomatic diarrhea,as well as progress of therapeutic drug research,to provide a reference for animal experimental research into the prevention and treatment of diarrhea.

Objective:To evaluate the efficacy and safety of 308-nm excimer lamp and 308-nm excimer laser in the treatment of pediatric vitiligo.Methods:Clinical data were collected from children with stable vitiligo who received targeted phototherapy at the Department of Dermatology of Xijing Hospital from 2010 to 2015, and retrospectively analyzed. The patients were treated with either 308-nm excimer laser or 308-nm excimer lamp, and all were given topical drugs. The treatment lasted for at least 3 months, and follow-up for at least 6 months. The severity of vitiligo was assessed using the Vitiligo Area and Severity Index (VASI) score. The efficacy was evaluated after 3 months of treatment, and at least a 50% reduction in the VASI score (VASI50) was defined as "effectiveness". A logistic regression model was constructed using treatment efficacy as the dependent variable to screen factors related to the treatment outcome. The Wilcoxon signed-rank test was used to compare skewed data before and after treatment. Adverse reactions during treatment were recorded to evaluate the safety of targeted phototherapy.Results:A total of 194 children with stable vitiligo were included, comprising 103 males (53.1%) and 91 females (46.9%), with the age being 6 to 14 (10.2 ± 2.3) years. Among them, 138 (71.1%) received 308-nm excimer laser therapy, while 56 (28.9%) received 308-nm excimer lamp therapy. The VASI score ( M [ Q1, Q3]) was 0.12 (0.05, 0.40) at the baseline, significantly decreased to 0.06 (0.02, 0.19) after 3 months of treatment ( Z = 12.02, P < 0.001). After 3 months of treatment, 52 patients achieved VASI50, and 30 achieved VASI75, resulting in an overall response rate of 42.3% (82/194). Specifically, in the 308-nm excimer laser group, 38 patients achieved VASI50 and 26 achieved VASI75, with a response rate of 46.4% (64/138) ; in the 308-nm excimer lamp group, 14 patients achieved VASI50 and 4 achieved VASI75, yielding a response rate of 32.1% (18/56). Univariate logistic regression analysis indicated that lesions located on the head and neck or the trunk were more prone to repigmentation compared with those on the limbs ( OR = 3.56, 95% CI: 1.15 - 11.02, P = 0.027; OR = 6.58, 95% CI: 1.81 - 23.96, P = 0.004, respectively) ; additionally, facial lesions around the eyes were more prone to repigmentation compared with lesions on other facial areas ( OR = 4.58, 95% CI: 1.10 - 19.11, P = 0.037), and hair involvement in vitiligo lesions on the head and neck made repigmentation less likely to occur compared with lesions without hair involvement ( OR = 0.31, 95% CI: 0.13 - 0.75, P = 0.010). Multivariate logistic regression analysis revealed that the periorbital region was the most favorable site for repigmentation among facial areas ( OR = 5.37, 95% CI: 1.18 - 24.34, P = 0.029), and hair involvement in vitiligo lesions on the head and neck was an independent risk factor for phototherapy-induced repigmentation ( OR = 0.28, 95% CI: 0.08 - 0.96, P = 0.042). Among the 194 patients treated with targeted phototherapy for 3 months, 33 experienced short-term treatment-related adverse reactions, including erythema, blisters, desquamation, itching, and pain; most adverse reactions were mild, and no severe adverse reactions were observed. Conclusion:Targeted phototherapy using 308-nm excimer laser or 308-nm excimer lamp was safe and effective for the treatment of pediatric vitiligo.

Objective:To seek any relationship between the single nucleotide polymorphisms (SNPs) of the apolipoprotein E (ApoE) gene and blood lipid sensitivity to high-intensity interval training (HIIT).Methods:Two hundred and thirty Han Chinese college students (104 males and 126 females) who were not majoring in sports were recruited to perform a 28-minute high-intensity interval workout three times per week for 12 weeks. Before and after the intervention, blood levels of triglycerides (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), and total cholesterol (TC) were measured. The subjects′ DNA was genotyped to obtain SNP loci, and a linear regression model was constructed to quantify any association between ApoE genotypes and phenotypes.Results:(1) A total of 21 SNP loci were identified associated with ApoE genes, one of which (rs7412) was found to be correlated with the training effect on blood lipids. (2) The initial TT and LDL-C values of carriers of the T allele of gene rs7412 (individuals with the CT + TT genotypes) were, on average, significantly lower than those of CC genotype individuals. However, no significant differences in the initial TG and HDL-C values among different genotypes were observed. (3) After the training the average LDL-C levels among the ApoE rs7412 polymorphic groups had changed significantly, with a significantly greater decrease observed among the carriers of the T allele compared with those of CC genotype.Conclusions:ApoE polymorphism may be significantly associated with TT and LDL-C values in Han Chinese youth, with carriers of the T allele tending to display lower levels than those of CC genotype. The polymorphism of ApoE gene rs7412 may be related to LDL-C reduction through HIIT, with carriers of the T allele more sensitive to such training.

Objective To investigate whether an association existed between elevated serum β2-microglobulin levels and post stroke cognitive impairment(PSCI).Methods A total of 140 patients with ischemic stroke in Wenzhou People's Hospital during December 2022 to December 2023 were prospectively were enrolled including 73 patients in the PSCI group and 67 patients in the non-post stroke cognitive impairment(PSNCI)group.Serum β2-microglobulin and other biochemical indicators were measured within 24 hours after admission.PSCI was assessed using the mini-mental state examination(MMSE)score with a threshold of≥27 points serving as the diagnostic criterion.Results The age,National Institutes of Health Stroke Scale(NIHSS)score at admission,proportion of low education level,proportion of multiple or large area infarction and serum β2-microglobulin level in the PSCI group were higher than those in the PSNCI group.Multivariate Logistic regression analysis showed that age,NIHSS score at admission,multiple or large area infarction and serum β2-microglobulin level were risk factors for PSCI,and education level was a protective factor for PSCI.Conclusion The increase of β2-microglobulin level is a risk factor for cognitive impairment after ischemic stroke.The detection of β2-microglobulin level in stroke patients may realize the early detection of PSCI.