Venous system diseases mainly include varicose veins and venous malformations of lower limbs and the genital system. Most of them are chronic diseases that cause serious clinical symptoms to patients and affect their health and quality of life. Sclerotherapy has become the first-line therapy for venous system diseases. However, there are problems such as incomplete fibrosis and vascular recanalization after sclerotherapy, and improper operation will cause serious adverse consequences. Therefore, exploring a safe and effective sclerotherapy strategy is essential for developing clinically successful sclerotherapy. To solve the above problems, we proposed a new sclerotherapy strategy with a dual mechanism of "vascular damage and plasmin (PLA) system inhibition." We intended to construct a novel cationic surfactant (AEO_x-TA) by reacting tranexamic acid (TA), a parent structure, with fatty alcohol polyoxyethylene ether (AEO_x) by ester bonds. AEO_x-TA could damage vascular endothelium and initiate a coagulation cascade effect to induce thrombus. Furthermore, AEO_x-TA could be degraded by esterase and release the parent drug, TA, which could inhibit the PLA system to inhibit the degradation of thrombus and extracellular matrix and promote the process of vascular fibrosis. In addition, such surfactant-based sclerosants have foam-forming properties, and they can be blended with polyvinyl alcohol (PVA) to prepare a highly stable foam formulation (AEO_x-TA/P), which can achieve a precise drug delivery and prolonged drug retention time, thereby improving drug efficacy and reducing the risk of ectopic embolism. Overall, the novel cationic surfactant AEO_x-TA provides a new avenue to resolve the bottleneck: surfactant sclerosants' efficiency is relatively low in the current sclerotherapy.

Medical simulation-based assessments have emerged as a vital method for evaluating the clinical competence of healthcare professionals. These assessments provide examinees with opportunities to practice clinical skills in a controlled environment that mirrors real-life medical scenarios. However, assessment organizers must implement specific measures to ensure that these assessments yield valid and reliable results. The reliability of simulation-based assessments is a crucial component of quality assurance. This article delineates twelve practical recommendations to enhance the reliability of medical simulation-based assessments across the three key dimensions of raters, simulation environment, and assessment tools. These recommendations include ① selecting raters with relevant professional backgrounds and extensive experience in simulation-based teaching and assessment; ②providing raters with standardized training for the assessment; ③conducting mock ratings and piloting to reach consensus among raters; ④preventing excessive work hours or cognitively overload while rating; ⑤providing standardized personnel with adequate training and re-training; ⑥implementing immediate and long-term quality assurance measures for standardized patient role performance; ⑦maintaining consistent operation of simulation equipment; ⑧guaranteeing the simulation provides adequate functional fidelity for the examinees; ⑨clearly defining each element and item in assessment tools while controlling their quantity; ⑩ensuring consistency when multiple assessment tools are used; 11using assessment tools with evidence of construct validity when possible; and 12establishing systems to ensure consistency in data (scoring) collection while safeguarding data security. These strategies aim to assist medical educators in developing structured and reliable simulation-based assessment schemes.

Objective To explore the impact of electrostimulation biofeedback therapy combined with pelvic floor muscle training on postpartum pelvic floor function in first vaginal birth women.Methods A retrospective analysis was conducted on the clinical data of in first vaginal birth women.The control group(n=49)received pelvic floor muscle training,while the observation group(n=49)received electrostimulation biofeedback therapy in addition to pelvic floor muscle training.Com-parisons were made between the two groups before treatment and 10 weeks after treatment in terms of uterine artery blood flow indicators[peak systolic velocity(PSV),resistance index(RI),and pulsa-tility index(PI)of uterine artery],serological indicators[C-reactive protein(CRP),interleukin-6(IL-6)],pelvic floor ultrasound indicators(bladder neck mobility,anteroposterior diameter of levator hi-atal area,levator hiatal volume),pelvic floor function[Pelvic Floor Distress Inventory-20(PFDI-20)],pelvic floor muscle strength,and quality of life[Short Form-36 Health Survey(SF-36)].The costs of the two treatments were compared at the end of treatment.Results Ten weeks after treatment,PSV,muscle potential values of type Ⅰ and type Ⅱ muscles,and SF-36 scores were significantly increased in both groups compared with those before treatment,with the observation group showing higher values than the control group(P＜0.05).RI,PI,CRP,IL-6,bladder neck mobility,anteroposterior di-ameter of levator hiatal area,levator hiatal volume,and PFDI-20 scores were decreased in both groups compared with those before treatment,with the observation group showing lower values than the control group(P＜0.05).After treatment,the treatment cost in the observation group was significantly higher than that in the control group(P＜0.05).Conclusion Electrostimulation biofeedback ther-apy combined with pelvic floor muscle training can effectively improve postpartum uterine artery blood flow indicators,serological indicators,pelvic floor ultrasound indicators,pelvic floor muscle strength,and promote pelvic floor function recovery in first vaginal delivery women.

Medical simulation-based assessments have emerged as a vital method for evaluating the clinical competence of healthcare professionals. These assessments provide examinees with opportunities to practice clinical skills in a controlled environment that mirrors real-life medical scenarios. However, assessment organizers must implement specific measures to ensure that these assessments yield valid and reliable results. The reliability of simulation-based assessments is a crucial component of quality assurance. This article delineates twelve practical recommendations to enhance the reliability of medical simulation-based assessments across the three key dimensions of raters, simulation environment, and assessment tools. These recommendations include ① selecting raters with relevant professional backgrounds and extensive experience in simulation-based teaching and assessment; ②providing raters with standardized training for the assessment; ③conducting mock ratings and piloting to reach consensus among raters; ④preventing excessive work hours or cognitively overload while rating; ⑤providing standardized personnel with adequate training and re-training; ⑥implementing immediate and long-term quality assurance measures for standardized patient role performance; ⑦maintaining consistent operation of simulation equipment; ⑧guaranteeing the simulation provides adequate functional fidelity for the examinees; ⑨clearly defining each element and item in assessment tools while controlling their quantity; ⑩ensuring consistency when multiple assessment tools are used; 11using assessment tools with evidence of construct validity when possible; and 12establishing systems to ensure consistency in data (scoring) collection while safeguarding data security. These strategies aim to assist medical educators in developing structured and reliable simulation-based assessment schemes.

Objective To investigate the clinical features and maternal and fetal outcomes of acute pancreatitis in pregnancy(APIP)and the risk factors for disease aggravation,and to establish a predictive model.Methods A retrospective analysis was performed for 52 APIP patients who were admitted to Affiliated Hospital of Zunyi Medical University from January 2017 to December 2022,and according to disease severity,they were divided into mild acute pancreatitis(MAP)group with 32 patients,moderate-severe acute pancreatitis(MSAP)group with 8 patients,and severe acute pancreatitis(SAP)group with 12 patients.The logistic regression analysis was performed for the clinical data of each group,and the receiver operating characteristic(ROC)curves were plotted to assess the value of risk factors in predicting the severity of APIP.A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups,and the least significant difference t-test was used for further comparision between two groups.The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups,and the Wilcoxon rank-sum test was used for further comparision between two groups;the chi-square test was used for comparison of categorical data between groups.Results Of all patients in terms of etiology,26(50%)had hyperlipidemic pancreatitis,20(38.4%)had biliary pancreatitis,and 6(11.5%)had idiopathic pancreatitis.In terms of gestational week,1 patient(1.9%)was in early pregnancy,25(48.1%)were in mid-pregnancy,and 26(50.0%)were in late pregnancy.A total of 10 patients(19.2%)had acute respiratory distress syndrome(ARDS),among whom 9(90%)required respiratory support.There were significant differences between the patients with different severities of APIP in aspartate aminotransferase,alanine aminotransferase,blood urea nitrogen,blood glucose,C-reactive protein(CRP),international normalized ratio(INR),pneumonia,ARDS,sepsis,hepatic insufficiency,and coagulation dysfunction(all P<0.05).The univariate analysis showed that the severity of APIP was associated with blood glucose,blood urea nitrogen,CRP,and pneumonia(all P<0.05),and pneumonia was a risk factor for the aggravation of APIP(odds ratio=18.938,95%confidence interval:1.020—351.747,P=0.048).CRP,blood glucose,blood urea nitrogen,and INR used in combination had a larger area under the ROC curve than each index used alone(0.954 vs 0.778/0.796/0.721/0.801).Conclusion Pneumonia is a risk factor for the aggravation of APIP,and the combination of CRP,blood glucose,blood urea nitrogen,and INR can be used to predict the severity of APIP.

Objective To investigate the predictive value of dynamic diffusion tensor imaging(DTI)in the postoperative efficacy of cervical spondylotic myelopathy(CSM)and to determine whether DTI parameters in different positions can be used as predictors of poor neurological prognosis.Methods A total of 105 CSM patients who underwent cervical spine decompression surgery were included.The modified Japanese Orthopedic Association(mJOA)score was used to assess patients'neurological function before surgery and one year after surgery.Patients were divided into two groups based on the recovery rate:the good prognosis group(recovery rate ≥50％)(44 cases)and the poor prognosis group(recovery rate＜50％)(61 cases).Univariate analysis was performed based on patients'clinical characteristics,imaging features and dynamic DTI parameters.Significant variables were subjected to binary logistic regres-sion analysis to identify risk factors for poor postoperative prognosis in CSM patients.Results Univariate analysis results showed significant differences between the two groups in terms of diabetes,number of compression segments,pre-mJOA score,cross-sectional area of the spinal canal at the narrowest location[Area-N(natu-ral),Area-E(extension),Area-F(flexion)],apparent diffusion coefficient(ADC)(ADC-N,ADC-E,ADC-F)and fractional ani-sotropy(FA)(FA-N,FA-E,FA-F)(P＜0.05).Binary logistic regression analysisrevealed that Area-N[odds ratio(OR)0.226;95％confidence interval(CI)0.069-0.732,P=0.013],FA-N(OR 3.028;95％CI 1.12-8.19,P=0.029),Area-E(OR 0.248;95％CI 0.076-0.814,P=0.021),FA-E(OR 4.793;95％CI 1.737-13.228,P=0.002),Area-F(OR 0.288;95％CI 0.095-0.87,P=0.027),FA-F(OR 2.964;95％CI 1.126-7.801,P=0.028)were independent risk factors for poor prognosis.FA-E had significant predictive value for poor prognosis in CSM patients.Conclusion Dynamic DTI can predict the postoperative outcomes in CSM,and FA-E value can serve as an excellent predictor of poor neurological prognosis.

Objective To discover the existing problems and provide appropriate suggestions and countermeasures through the quality control inspection.MethodsA comprehensive quality control inspection was conducted for the radiotherapy equipment in 45 hospitals in Zhejiang province.The physical,technical,clinical and radiotherapy process and the parameters related to quality control were evaluated.Results As of December 31,2017,a total of 62 linear accelerators from 45 hospitals have been assessed.In the radiotherapy process,multiple quality control problems were identified in terms of radiotherapy equipment configuration,clinical work quality,radiotherapy technology and personnel qualifications.Besides,unreasonable equipment configuration,shortage of radiotherapy staff,clinical work flow and the quality assurance of physical radiotherapy remained to be resolved.Conclusion Regular quality control of radiotherapy plays a pivotal role in ensuring the accuracy,effectiveness and medical safety of radiotherapy.

Objective To investigate the dynamics of white blood cell count (WBC),prealbumin(PA),high sensitive C-reactive protein (hs-CRP),and vascular endothelial growth factor (VEGF) in hand-foot-and-mouth disease (HFMD) complicated with or without encephalitis and in vitro inhibitory effects of artesunate on VEGF secretion of mononuclear cells from HFMD patients.Methods Peripheral blood mononuclear cells from healthy control group,HFMD group and HFMD combined with encephalitis group were isolated by Ficoll density gradient centrifugation and treated with different concentrations of artesunate (25,50,100 mg/L).The expression of VEGF in the supernatant was examined by ELISA double antibody sandwich method.The levels of WBC,PA and hs-CRP in the three groups were also detected.Multiple samples were compared by one-way analysis of variance.Multiple comparison was performed by Dunnett T3 test.Correlation of two variables was analyzed by Spearman correlation test.Results There were significant differences in the levels of WBC,hs-CRP,PA and VEGF between the HFMD combined with or without encephalitis group and health control group (F=172.69,366.02,166.32 and 5 941.89,respectively,all P＜0.01).There were significant differences in the levels of VEGF secreted by mononuclear cells treated with three different concentrations of artesunate between the HFMD combined with or without encephalitis groups and health control group (F =194.265 and 4 750.69,respectively,both P＜0.01).Correlation analysis showed that the VEGF level secretion by mononuclear cells from HFMD patients with or without encephalitis were both negatively correlated with different concentrations of artesunate (r=-0.903 and-0.969,both P＜0.01).Conclusions Compared with HFMD without encephalitis,the secretion of VEGF by mononuclear cells,WBC and hs-CRP levels in HFMD complicated with encephalitis group all increase and PA decrease significantly.Artesunate can inhibit the secretion of VEGF by mononuclear cells of patients with hand-foot-and-mouth disease in a dosedependent manner in vitro.

Objective To evaluate the safety and clinical efficacy of stereotactic body radiation therapy (SBRT) for lung cancer.Methods A retrospective analysis was performed on 200 patients with primary non-small cell lung cancer (NSCLC)(118 patients) or solitary pulmonary metastasis (82 patients) who underwent SBRT in Zhejiang Cancer Hospital from January 2012 to September 2015.The 80% isodose line covered 95% of the planning target volume,and the 100% isodose line covered 100% of the internal gross tumor volume.The fractional dose was 4.0-18.0 Gy daily or every other day,and the biologically equivalent dose ranged from 40.0 to 151.2 Gy (median 100 Gy).Results All patients completed treatment.The follow-up rate was 96.0%.The complete response and partial response rates were 14.8%(17/115) and 65.2%(75/115) for the primary tumor group,versus 25%(19/77) and 38%(29/77) for the metastasis group.The incidence rates of grade Ⅱ and Ⅲ acute radiation pneumonitis were 4.7% and 3.1%,respectively.The median follow-up was 14.9 months.The 1-and 2-year local control rates were 95.7% and 84.3% for the primary tumor group,versus 92% and 73% for the metastasis group.The 1-and 2-year overall survival rates were 94.5% and 92.0% for the primary tumor group,versus 85% and 62% for the metastasis group.Conclusions SBRT is a safe and effective treatment for early primary NSCLC and solitary pulmonary metastasis,resulting in high 1-and 2-year local control and overall survival rates and low rate of complications.

Objective:To describe the current situation in the nursing practice and their turnover intention in township health centers, and to analyze the changing potential influence in the nursing practice scope and workloads on their intention to leave those health centers. Methods:By means of a questionnaire, we conducted a survey on 167 nurses and interviewed 44 of them, all from 45 township hospitals within three provinces in China. Results:Since the healthcare system reform, the nursing workload in the township health centers significantly increased. 62% of the re-spondents considered their workload as heavy. Typically, the nursing work accounted for about 60% and the public health service work accounted for only 21% of the working hours. About 30% of the respondents were intended to leave their current job. The participating public health service was associated with intention to leave the job after con-trolling the province, workload, marital status, formal position, educational level and length of nursing service (P<0. 05). Conclusions:Since the healthcare system reform, the nursing practice scope in township health centers has been expanded and the workload increased considerably. But so far, expanding the scope of the nursing work may have potentials in reducing the intention of nurses to leave their current positions.