Objective:To design a phonocardiographic gating device that was used in cardiac magnetic resonance imaging(MRI),so as to explore feasibility of synchronized acquisition for cardiac MRI.Methods:A phonocardiographic gating device was designed,which structure included a head of stethoscope,transmission pipeline,microphone and amplification filtering circuit,computer,and pseudo-electrocardiogram(ECG)trigger output circuit.The computer's runs included phonocardiographic recognition neural network of one-dimensional dilated convolutional layer and gating recurrent unit(GRU)layer,which parameters were determined by pre-train.The feasibility of using the phonocardiographic gating device in acquisition of cardiac MRI was explored by comparing the preparation time of examination and image quality for phonocardiographic gating device and ECG gating technique.Results:The average preparation time for the phonocardiographic gating device was(10.46±1.75)seconds,which was significantly shorter than that for ECG gating technique[(32.07±5.26)seconds](t=-11.02,P＜0.05).There were no statistically significant difference in the clarity of short-axis images of heart at end-systole and end-diastole,and the indicators of cardiac function between the two methods(P＞0.05).Conclusion:The phonocardiographic gating device can replace ECG gating for MRI examinations,which can effectively conduct triggering for phonocardiographic gating while reducing preparation time.It holds clinical application value,especially in equipment with high field strength.

Infection has brought huge disasters and heavy economic burdens to human health. With the continuous expansion of the global antimicrobial resistance crisis, more people will face threats to their lives. Considering the numerous problems existing in traditional antibiotic anti-infection strategies and the many challenges faced by the new non-antibiotic anti-infection strategies under development, it is urgent to explore a new approach to deal with the current situation now. Based on the results of previous research, some scholars have made significant progress in the field of antibacterial by taking advantage of the chemotactic tendency characteristics of bacteria, and proposed that chemotactic sterilization will be a new strategy. As an active inducement strategy, it does not cause bacteria to develop drug resistance and can completely eliminate bacteria while avoiding tissue damage. It will be an effective means for future anti-infection research. This article reviews the existing strategies for infection prevention and control and the latest research progress of chemotaxis and sterilization, aiming to provide a reference for wound anti-infection and systemic anti-infection research throughout the body, and offer new directions and ideas for future infection prevention and control strategies.

Objective: To assess the dynamic changes of microcirculation at acupoints in patients with primary dysmenorrhea and cold congelation and blood stasis syndrome using laser speckle blood flow imaging. Methods: Patients with primary dysmenorrhea and cold coagulation and blood stasis syndrome (primary dysmenorrhea group, n=53) and healthy female college students(control group, n=57) who met the inclusion and exclusion criteria from October 2020 to July 2022 were enrolled at Hebei University of Chinese Medicine. On the premenstrual and first day of menstruation, a laser speckle blood flow imaging system was used to measure the microcirculation blood flow perfusion on the surface of acupoints related to the conception, thoroughfare, and governor vessels, and stomach, spleen, and bladder meridians in the abdomen and lumbosacral regions. The dynamic changes in microcirculation were calculated based on the difference in average blood flow perfusion at each acupoint before and after menstruation. Receiver operating curve (ROC) analysis was used to analyze the diagnostic efficacy of dynamic changes in microcirculation on the surface of each acupoint. The microcirculation sensitization rate of acupoints was calculated. Results: Compared with the control group, the dynamic changes in microcirculation at the following acupoints in the primary dysmenorrhea group were increased (P<0.05): conception vessel (Yinjiao[CV7], Qihai[CV6], Shimen[CV5], Guanyuan[CV4]); left thoroughfare vessel (left Huangshu[KI16], left Zhongzhu[KI15], left Siman[KI14], left Qixue[KI13], left Dahe[KI12], left Henggu[KI11]); left stomach meridian (left Tianshu[ST25], left Wailing[ST26], left Qichong[ST30]); left spleen meridian (left Daheng[SP15], left Fujie[SP14]); right thoroughfare vessel (right Huangshu[KI16], right Zhongzhu[KI15], right Siman[KI14], right Qixue[KI13], right Dahe[KI12], right Henggu[KI11]); right stomach meridian (right Wailing[ST26], right Daju[ST27], right Shuidao[ST28], right Guilai[ST29], right Qichong[ST30]); and right spleen meridian (right Fujie[SP14]). The area under the ROC curve of conception vessel (Yinjiao[CV7], Qihai[CV6], Shimen[CV5], Guanyuan[CV4]), thoroughfare vessel (right Siman[KI14], left Huangshu[KI16], right Qixue[KI13], right Zhongzhu[KI15], right Dahe[KI12], left Zhongzhu[KI15], left Siman[KI14], right Huangshu[KI16], left Qixue[KI13], right Henggu[KI11], left Henggu[KI11], left Dahe[KI12]); stomach meridian (left Tianshu[ST25], right Guilai[ST29], left Wailing[ST26], right Shuidao[ST28], right Daju[ST27], right Wailing[ST26], right Qichong[ST30], left Qichong[ST30]), and spleen meridian (left Daheng[SP15], left Fujie[SP14], right Fujie[SP14]) was 0.610-0.682 (P<0.05). Compared with the control group, the sensitization rate of some acupoints in the primary dysmenorrhea group increased (P<0.05). Conclusion With the onset of menstruation, the blood flow perfusion of some acupoints in the abdomen (thoroughfare, and conception vessels, and stomach and spleen meridians) of patients with primary dysmenorrhea and cold blood coagulation and blood stasis syndrome increased, and the status of acupoints changed from a resting state to an active state. These acupoints are sensitive in patients with primary dysmenorrhea and cold blood coagulation and blood stasis syndrome and have a certain diagnostic efficacy, providing a basis for further analyzing the efficacy and mechanism of acupuncture and moxibustion to treat primary dysmenorrhea with cold blood coagulation and blood stasis syndrome.

Objective To evaluate the application of problem-based learning(PBL)and case-based learning(CBL)combined with ideological-political elements in surgical clinical ethics.Methods Eighty graduate students of grade 2022 majoring in surgery from Peking Union Medical College were selected as the subjects for the clinical ethics course offered in the first semester of the 2022-2023 academic year.They underwent the innovative pedago-gies of PBL and CBL combined with ideological-political elements.The satisfaction investigation and questionnaire surveys were performed to evaluate the effects.Results A total of 78 valid questionnaires were received.The results showed that 96.2%of students believed that this course supported them to understand the fundamental prin-ciples and knowledge of surgical clinical ethics and 94.9%of students expressed their willingness to expand their knowledge,indicating high satisfaction with the course.There were 91%of students acknowledged this model in terms of improving active learning and 93.6%stated that the course helped in developing good professional ethics.Most students responded positively to this model because of its contribution to enhance core clinical competencies.Conclusions The PBL and CBL combined with ideological-political elements have a better effect on surgical clini-cal ethics with high satisfaction of the students.

OBJECTIVE: To compare the efficacy and safety of intravenous colistin sulfate combined with nebulized inhalation versus intravenous monotherapy for pulmonary infections caused by carbapenem-resistant organism (CRO). METHODS: A multicenter retrospective cohort study was conducted. Clinical data were collected from patients admitted to the intensive care unit (ICU) of 10 tertiary class-A hospitals in Henan Province between July 2021 and May 2023, who received colistin sulfate for CRO pulmonary infections. Data included baseline characteristics, inflammatory markers [white blood cell count (WBC), neutrophil count (NEU), procalcitonin (PCT), C-reactive protein (CRP)], renal function indicators [serum creatinine (SCr), blood urea nitrogen (BUN)], life support measures, anti-infection regimens, clinical efficacy, microbiological clearance rate, and prognostic outcomes. Patients were divided into two groups: intravenous group (colistin sulfate monotherapy via intravenous infusion) and combination group ((intravenous infusion combined with nebulized inhalation of colistin sulfate). Changes in parameters before and after treatment were analyzed. RESULTS: A total of 137 patients with CRO pulmonary infections were enrolled, including 89 in the intravenous group and 48 in the combination group. Baseline characteristics, life support measures, daily colistin dose, and combination regimens (most commonly colistin sulfate plus carbapenems in both groups) showed no significant differences between two groups. The combination group exhibited higher clinical efficacy [77.1% (37/48) vs. 59.6% (52/89)] and microbiological clearance rate [60.4% (29/48) vs. 39.3% (35/89)], both P < 0.05. Pre-treatment inflammatory and renal parameters showed no significant differences between two groups. Post-treatment, the combination group showed significantly lower WBC and CRP [WBC (×10⁹/L): 8.2±0.5 vs. 10.9±0.6, CRP (mg/L): 14.0 (5.7, 26.6) vs. 52.1 (24.4, 109.6), both P < 0.05], whereas NEU, PCT, SCr, and BUN levels showed no significant between two groups. ICU length of stay was shorter in the combination group [days: 16 (10, 25) vs. 21 (14, 29), P < 0.05], although mechanical ventilation duration and total hospitalization showed no significant differences between two groups. CONCLUSIONS Intravenous colistin sulfate combined with nebulized inhalation improved clinical efficacy and microbiological clearance in CRO pulmonary infections with an acceptable safety profile.
Humans ; Colistin/therapeutic use* ; Retrospective Studies ; Administration, Inhalation ; Anti-Bacterial Agents/therapeutic use* ; Carbapenems/pharmacology* ; Male ; Female ; Middle Aged ; Gram-Negative Bacteria/drug effects* ; Aged ; Treatment Outcome ; Respiratory Tract Infections/drug therapy*

Objective:To design a phonocardiographic gating device that was used in cardiac magnetic resonance imaging(MRI),so as to explore feasibility of synchronized acquisition for cardiac MRI.Methods:A phonocardiographic gating device was designed,which structure included a head of stethoscope,transmission pipeline,microphone and amplification filtering circuit,computer,and pseudo-electrocardiogram(ECG)trigger output circuit.The computer's runs included phonocardiographic recognition neural network of one-dimensional dilated convolutional layer and gating recurrent unit(GRU)layer,which parameters were determined by pre-train.The feasibility of using the phonocardiographic gating device in acquisition of cardiac MRI was explored by comparing the preparation time of examination and image quality for phonocardiographic gating device and ECG gating technique.Results:The average preparation time for the phonocardiographic gating device was(10.46±1.75)seconds,which was significantly shorter than that for ECG gating technique[(32.07±5.26)seconds](t=-11.02,P＜0.05).There were no statistically significant difference in the clarity of short-axis images of heart at end-systole and end-diastole,and the indicators of cardiac function between the two methods(P＞0.05).Conclusion:The phonocardiographic gating device can replace ECG gating for MRI examinations,which can effectively conduct triggering for phonocardiographic gating while reducing preparation time.It holds clinical application value,especially in equipment with high field strength.

Infection has brought huge disasters and heavy economic burdens to human health. With the continuous expansion of the global antimicrobial resistance crisis, more people will face threats to their lives. Considering the numerous problems existing in traditional antibiotic anti-infection strategies and the many challenges faced by the new non-antibiotic anti-infection strategies under development, it is urgent to explore a new approach to deal with the current situation now. Based on the results of previous research, some scholars have made significant progress in the field of antibacterial by taking advantage of the chemotactic tendency characteristics of bacteria, and proposed that chemotactic sterilization will be a new strategy. As an active inducement strategy, it does not cause bacteria to develop drug resistance and can completely eliminate bacteria while avoiding tissue damage. It will be an effective means for future anti-infection research. This article reviews the existing strategies for infection prevention and control and the latest research progress of chemotaxis and sterilization, aiming to provide a reference for wound anti-infection and systemic anti-infection research throughout the body, and offer new directions and ideas for future infection prevention and control strategies.

Objective:To investigate the efficacy of acellular allogeneic dermal matrix (ADM) combined with autologous razor-thin scalp grafts in scar rehabilitation.Methods:A retrospective study was conducted on patients who underwent skin grafts transplantation to repair scar in the Department of Burns and Plastic Surgery of the First People’s Hospital of Chenzhou from July 2015 to December 2021. All the patients were divided into the observation group and the control group according to surgical methods. The observation group was treated with ADM combined with autologous razor-thin scalp grafts to repair the wound after scar resection, and the control group was treated with split-thickness skin grafts (STSGs) to repair the wound. Efficacy evaluation: On the 1st, 7th and 14th day after surgery, the patients in the two groups scored the pain degree of the donor sites through the visual analogue scale (VAS), with a score of 0 indicating no pain and a score of 10 indicating severe pain. The grid method was used to measure the surviving area of the skin and calculate the surviving proportion of the skin grafts. The wound healing time in donor and recipient sites were recorded. The postoperative complication was recorded, and the incidence of complications was calculated. Scars in donor and recipient sites were observed at the 3rd, 6th, 9th and 12th month after surgery, and the scars in recipient sites were scored by the Vancouver scar scale (VSS), with a total score of 0-13 points, and the higher the score, the more serious the scars were. SPSS 22.0 software was used for statistical analysis of the data. The normally distributed continuous data were represented as Mean±SD, and analyzed by t-test, and the non-normally distributed continuous data were represented as M ( Q1, Q3), and the Wilcoxon rank-sum test was used for comparison between groups. Enumeration data were expressed as examples and (or) percentages, and chi-square test was used for comparison between groups. The differences were considered statistically significant for probability values P<0.05. Results:A total of 50 patients, including 28 males and 22 females, aged (38.5±13.9) years, were enrolled in the observation group, and the wound area caused by scar resection and release was (70.4±17.7) cm 2. The scars were on upper limb in 16 cases, lower limb in 15 cases, trunk in 11 cases, neck in 8 cases. The control group included 50 patients, 30 males and 20 females, aged (34.8±14.6) years, and the wound area caused by scar resection and release was (66.2±16.5) cm 2. The scars were on upper limb in 15 cases, lower limb in 11 cases, trunk in 13 cases, neck in 11 cases. There was no significant difference in gender composition, age, skin graft site and the wound area caused by scar resection and release between these two groups ( P > 0.05). On the 1st, 7th and 14th day after surgery, the VAS scores of the observation group were 6.35 (5.11, 7.67) points, 4.95 (3.63, 6.46) points and 0.73 (0.18, 1.39) points, while the control group were 8.25 (7.14, 9.19) points, 7.00 (5.45, 8.06) points and 0.80(0.20, 1.55)points, respectively. The VAS score of the observation group was lower than that of the control group on the 1st and 7th day after surgery ( Z=-4.53, -3.86, both P < 0.001), and there was no significant difference in VAS score between the two groups on the 14th day after surgery ( P > 0.05). There was no significant difference between the two groups in terms of the survival ratio of skin grafts [(95.6±2.1) % vs. (95.8±2.3) %] ( P>0.05) and the postoperative incidence of complications [18% (9/50) vs. 10% (5/50)] ( P>0.05). The wound healing time in the donor sites in both groups were (6.80±0.88) days, (13.30±1.83) days ( t=-22.70, P<0.001), while the wound healing time in the recipient sites in both groups were 14.33 (12.73, 15.76) days and 8.91 (7.76, 10.67) days ( Z=-7.31, P<0.001). The average follow-up time was 21.8 months, the observation group had no scar formation at the donor site, while the control group had different degrees of scar hyperplasia. There was no significant difference in VSS scores between the two groups at the 3rd and 6th month after surgery ( P>0.05), while the VSS scores of the observation group at 9th and 12th month after surgery were 5.96 (4.81, 7.15) points and 5.85 (4.81, 6.75) points, which were significantly lower than those of in the control group [7.04(5.93, 8.14)points, 6.92(5.81, 8.06)points] ( Z=-2.82, P=0.005; Z=-3.54, P<0.001). Conclusion:The use of ADM combined with autologous razor-thin scalp graft to repair the wound after scar resection can effectively improve the appearance and function of the repair area, and reduce the pain and avoid scar hyperplasia in the donor sites.

Objective:To evaluate the clinical efficacy of acupuncture in the treatment of anxiety state in patients with primary insomnia(PI). Methods:Randomized controlled trials of acupuncture treatment for PI patients with an anxiety state in Web of Science,Cochrane Library,PubMed,Excerpta Medica Database(EMBASE),China National Knowledge Infrastructure(CNKI),Wanfang Data Knowledge Service Platform(Wanfang),and Chongqing VIP Database(VIP)were retrieved by computer.The retrieval time was from each database's inception to December 30,2022.Data extraction and evaluation were performed for the included studies.The Cochrane risk of bias assessment tool was used to assess the risk of bias in each article.Meta-analysis of valid data was performed using the RevMan 5.4 software.If the outcome indicator was a categorical variable,relative risk(RR)was used as the effect size.If it was a continuous variable,mean difference(MD)was used to calculate the effect size.Each effect size was expressed as a 95%confidence interval(CI).P<0.05 was considered to indicate a statistically significant difference. Results:A total of 18 studies were included,comprising a total of 1198 patients.The findings of the meta-analysis showed that electroacupuncture had a significant advantage in improving the Hamilton anxiety scale(HAMA)score than benzodiazepines[MD=-1.61,95%CI(-2.17,-1.06),P<0.001].Acupuncture was superior to sham acupuncture[MD=-14.90,95%CI(-20.39,-9.41),P<0.001]and benzodiazepines[MD=-3.39,95%CI(-4.67,-2.12),P<0.001]in reducing the self-rating anxiety scale(SAS)score.Acupuncture was superior to sham acupuncture in reducing the insomnia severity index(ISI)score[MD=-5.61,95%CI(-6.63,-4.89),P<0.001].Acupuncture was superior to benzodiazepines[MD=0.84,95%CI(-1.42,-0.25),P=0.005]and sham acupuncture[MD=-8.39,95%CI(-8.39,-7.86),P<0.001]in improving the Pittsburgh sleep quality index(PSQI)score.Acupuncture had a better effective rate than benzodiazepines[RR=1.16,95%CI(1.08,1.25),P<0.001]and sham acupuncture[RR=8.94,95%CI(4.63,17.25),P<0.001]in treating PI. Conclusion:Acupuncture or electroacupuncture has certain therapeutic advantages over benzodiazepines and sham acupuncture in the treatment of anxiety in PI patients.However,more high-quality randomized controlled trials are needed for further verification.

Objective:Using bioinformatics methods to study the immune infiltration mechanism of lupus nephritis(LN)and to explore potential target Chinese medicines,which can provide new directions for clinical treatment of LN.Methods:Gene expres-sion profile microarray dataset of LN was downloaded from GEO database,differential expressed genes(DEGs)were screened using R software,and GO and KEGG enrichment analysis were performed on these DEGs.Protein interaction network analysis of DEGs was performed by applying STRING database,key genes were screened by using Cytoscape,core gene expression was validated by Nephro-seq database,and the infiltration and correlation of 22 kinds of immune cells in LN were calculated by CIBERSORT deconvolution algorithm.Finally,herbal prediction of significantly enriched immune-related biological processes and key target genes were performed by Coremine Medical database.Results:A total of 367 LN-related DEGs were obtained,of which 253 were up-regulated and 114 were down-regulated.GO was mainly enriched in response to viruses,defense response to viruses,regulation of viral life cycle,regulation of viral processes,etc;KEGG was mainly enriched in S.aureus infection,COVID-19,influenza A,complement and coagulation cascade,pertussis,etc.Ten key genes were screened:IFIT3,OAS2,MX1,OAS1,RSAD2,XAF1,ISG15,IFIT1,ITGAM and PTPRC.Immune infiltration by CIBERSORT deconvolution algorithm showed that monocytes and initial B cells were highly expressed in LN,while memory B cells,naive CD4+T cells,follicular helper T cells and resting natural killer cells were lowly expressed in LN.Immune cell correlation analysis showed a positive correlation between initial B cells and plasma cells,a positive correlation between resting natural killer cells and resting dendritic cells,a negative correlation between monocytes and regulatory T cells,and a negative correlation between resting CD4+memory T cells and monocytes.Coremine Medical predicted that Salvia miltiorrhiza,Panax notogin-seng,Scutellaria baicalensis,ginseng,honey,monkey mushroom and peony were found to be most closely related to immunity in LN.Conclusion:The development and progression of LN are results of the combined involvement of multiple genes and pathways.Mono-cytes,memory B cells,initial CD4+T cells and initial B cells are most closely associated with LN.The predicted Salvia miltiorrhiza,Panax notoginseng,Scutellaria baicalensis,ginseng,honey,monkey mushroom and peony may be used as target herbs for the poten-tial treatment of LN.