Objective:To investigate the current status of depression and its correlation with psychological resilience in patients with acute aortic dissection(AAD)after discharge.Methods:This study was conducted among 67 patients with AAD who were treated in Department of Cardiothoracic Surgery,Chongqing Emergency Medical Center,from June 2023 to June 2024 and received telephone follow-up and questionnaire survey,and basic data were collected from all patients,including sex,age,dissection type,educational level,length of hospital stay,discharge time,and hospital costs.Self-Rating Depression Scale(SDS)and Connor-Davidson Resilience Scale(CD-RISC)were distributed,and finally 49 valid questionnaires were included for statistical analysis.SDS and CD-RISC scores were compared between AAD patients with different basic data variables,and the Pearson correlation analysis was used to investigate the correlation of SDS score with psychological resilience and the scores of each dimension.The multiple linear regression analysis was further performed.Results:The incidence rate of depression was 36.73％among the patients with AAD.With the basic data as vari-ables,there was a significant difference in SDS score between the patients with different sexes and discharge times(P<0.05),and there was a significant difference in CD-RISC score between the patients with different sexes and educational levels(P<0.05).The Pearson correlation analysis showed that SDS score was negatively correlated CD-RISC score(r=-0.408,P=0.004),and SDS score was also nega-tively correlated with the scores of the dimensions of strength,resil-ience,and optimism in psychological resilience(r=-0.283,-0.319,-0.493,all P<0.05).There was a linear regression relationship be-tween the dimension of optimism and the SDS score of depression.Conclusion:There is a relatively high risk of depression in patients with AAD,and there is a significant negative correlation between psychological resilience and depressive state.Strengthening the construction of psychological resilience in AAD patients is important to prevent the risk of depression in AAD patients.

Objective To investigate the effects and mechanisms of supplemented Buyang Huanwu decoction(BYHWD)on zinc home-ostasis and reproductive function in oligoasthenozoospermia(OAS)rats.Methods As many as 60 male SD rats were randomly divided into control,OAS,L-carnitine(0.323 g/kg),BYHWD low-dose(BYHWD-L,19.5 g/kg),BYHWD medium-dose(BYHWD-M,39 g/kg),and BYHWD high-dose(BYHWD-H,78 g/kg)groups,with 10 rats in each group.Except for the control group,all other groups were admini-stered adenine by gavage to establish an OAS model.After successful construction of the model,each group was treated by gavage with the corresponding drug doses or physiological saline once daily for 4 weeks.The general condition of the rats was recorded,testicular and epididymal coefficients were calculated,and sperm water volume and vitality were measured.Enzyme linked immunosorbent assay(ELISA)was used to measure the levels of serum testosterone(T),estradiol(E2),follicle-stimulating hormone(FSH),luteinizing hormone(LH),prolactin(PRL),as well as the levels of interleukin-1β(IL-1β),interleukin-6(IL-6),tumor necrosis factor α(TNF-α)and zinc containing enzymes alcohol dehydrogenase(ADH),alkaline phosphatase(ALP),and lactate dehydrogenase(LDH)in testicular tissue.The zinc con-tent in testicular tissue were also measured.Pathological changes in testicular tissue were observed using hematoxylin eosin(HE)staining.Toll-like receptor 4(TLR4),myeloid differentiation factor 88(MyD88),and nuclear factor kappa-B(NF-κB)protein expression in testicu-lar tissue were identified using immunohistochemistry.Results Compared to the control group,the OAS group exhibited significantly lower testicular and epididymal coefficients,sperm motility,sperm count,serum T and E2 levels(P＜0.05)and significantly higher FSH,LH,and PRL levels(P＜0.05).Furthermore,the OAS group showed significantly lower testicular tissue zinc content and levels of zinc containing enzymes ADH,ALP,and LDH(P＜0.05)than the control group.Conversely,IL-1β,IL-6,and TNF-α levels,along with protein expressions of TLR4,MyD88,and NF-κB were significantly higher in the OAS group than in the control group(P＜0.05).Compared to the OAS group,each drug intervention group showed improvements in testicular and epididymal coefficients,sperm motility,sperm count,T and E2 levels,testicular zinc content and zinc containing enzymes(ADH,ALP,and LDH)levels.Furthermore,the intervention groups demonstrated reduced FSH,LH,PRL,IL-1β,IL-6,and TNF-α levels,and TLR4/MyD88/NF-κB signaling pathway protein expression(P＜0.05).Conclusion BYHWD improves the reproductive function of OAS rats,potentially by regulating zinc homeostasis and TLR4/MyD88/NF-κB signaling pathway,consequently reducing the inflammatory response.

Objective:To explore the learning patterns of resident physicians in anesthesiology when performing tracheal intubation guided by Shikani laryngoscope, and provide a reference for the skill training of clinical anesthesiologists.Methods:From August 2023 to December 2024, a total of 19 resident physicians specializing in anesthesiology participated in this study at Peking University Third Hospital. All resident physicians received standardized training on clinical skills. None of them had received specialized training in Shikani laryngoscope-guided tracheal intubation. The relevant theoretical teaching and practical guidance were provided by the same senior attending physician throughout the study. A flipped-classroom teaching model was adopted, and each student was instructed by the teaching physician to perform the procedure on 15 cases in chronological order, resulting in a total of 285 cases. The cumulative sum (CUSUM) value for each tracheal intubation was calculated, and the learning curve was plotted using R software. A fourth-order polynomial nonlinear regression model was used to fit the curve and estimate the 95% confidence interval of the learning curve. The first-order derivative function of the regression model was further analyzed to reveal the dynamic changes in proficiency with the number of training sessions. The CUSUM curve was segmented using the maximum statistics test to identify the optimal breakpoint.Results:The maximum selection test revealed that the breakpoint for the increase in CUSUM level was at the eighth attempt.Conclusions:Resident physicians in anesthesiology can master Shikani laryngoscope-guided tracheal intubation after eight standardized training sessions. Moreover, the participants showed high satisfaction with the flipped-classroom teaching model.

Objective:To explore the learning patterns of resident physicians in anesthesiology when performing tracheal intubation guided by Shikani laryngoscope, and provide a reference for the skill training of clinical anesthesiologists.Methods:From August 2023 to December 2024, a total of 19 resident physicians specializing in anesthesiology participated in this study at Peking University Third Hospital. All resident physicians received standardized training on clinical skills. None of them had received specialized training in Shikani laryngoscope-guided tracheal intubation. The relevant theoretical teaching and practical guidance were provided by the same senior attending physician throughout the study. A flipped-classroom teaching model was adopted, and each student was instructed by the teaching physician to perform the procedure on 15 cases in chronological order, resulting in a total of 285 cases. The cumulative sum (CUSUM) value for each tracheal intubation was calculated, and the learning curve was plotted using R software. A fourth-order polynomial nonlinear regression model was used to fit the curve and estimate the 95% confidence interval of the learning curve. The first-order derivative function of the regression model was further analyzed to reveal the dynamic changes in proficiency with the number of training sessions. The CUSUM curve was segmented using the maximum statistics test to identify the optimal breakpoint.Results:The maximum selection test revealed that the breakpoint for the increase in CUSUM level was at the eighth attempt.Conclusions:Resident physicians in anesthesiology can master Shikani laryngoscope-guided tracheal intubation after eight standardized training sessions. Moreover, the participants showed high satisfaction with the flipped-classroom teaching model.

Objective To investigate the effects and mechanisms of supplemented Buyang Huanwu decoction(BYHWD)on zinc home-ostasis and reproductive function in oligoasthenozoospermia(OAS)rats.Methods As many as 60 male SD rats were randomly divided into control,OAS,L-carnitine(0.323 g/kg),BYHWD low-dose(BYHWD-L,19.5 g/kg),BYHWD medium-dose(BYHWD-M,39 g/kg),and BYHWD high-dose(BYHWD-H,78 g/kg)groups,with 10 rats in each group.Except for the control group,all other groups were admini-stered adenine by gavage to establish an OAS model.After successful construction of the model,each group was treated by gavage with the corresponding drug doses or physiological saline once daily for 4 weeks.The general condition of the rats was recorded,testicular and epididymal coefficients were calculated,and sperm water volume and vitality were measured.Enzyme linked immunosorbent assay(ELISA)was used to measure the levels of serum testosterone(T),estradiol(E2),follicle-stimulating hormone(FSH),luteinizing hormone(LH),prolactin(PRL),as well as the levels of interleukin-1β(IL-1β),interleukin-6(IL-6),tumor necrosis factor α(TNF-α)and zinc containing enzymes alcohol dehydrogenase(ADH),alkaline phosphatase(ALP),and lactate dehydrogenase(LDH)in testicular tissue.The zinc con-tent in testicular tissue were also measured.Pathological changes in testicular tissue were observed using hematoxylin eosin(HE)staining.Toll-like receptor 4(TLR4),myeloid differentiation factor 88(MyD88),and nuclear factor kappa-B(NF-κB)protein expression in testicu-lar tissue were identified using immunohistochemistry.Results Compared to the control group,the OAS group exhibited significantly lower testicular and epididymal coefficients,sperm motility,sperm count,serum T and E2 levels(P＜0.05)and significantly higher FSH,LH,and PRL levels(P＜0.05).Furthermore,the OAS group showed significantly lower testicular tissue zinc content and levels of zinc containing enzymes ADH,ALP,and LDH(P＜0.05)than the control group.Conversely,IL-1β,IL-6,and TNF-α levels,along with protein expressions of TLR4,MyD88,and NF-κB were significantly higher in the OAS group than in the control group(P＜0.05).Compared to the OAS group,each drug intervention group showed improvements in testicular and epididymal coefficients,sperm motility,sperm count,T and E2 levels,testicular zinc content and zinc containing enzymes(ADH,ALP,and LDH)levels.Furthermore,the intervention groups demonstrated reduced FSH,LH,PRL,IL-1β,IL-6,and TNF-α levels,and TLR4/MyD88/NF-κB signaling pathway protein expression(P＜0.05).Conclusion BYHWD improves the reproductive function of OAS rats,potentially by regulating zinc homeostasis and TLR4/MyD88/NF-κB signaling pathway,consequently reducing the inflammatory response.

OBJECTIVE: To compare effectiveness of injecting platelet-rich plasma (PRP) with different concentrations of leukocytes under ultrasound in treatment of supraspinatus tendon injury. METHODS: A clinical data of 30 patients with supraspinatus tendon injury, who met the selection criteria and were admitted between December 2022 and December 2023, was retrospectively analyzed. Thirty patients were treated with 4 injections of leukocyte-poor PRP (LP-PRP, n=10), leukocyte-rich PRP (LR-PRP, n=11), and triamcinolone ( n=9), with an interval of 7-10 days between each injection. There was no significant difference between groups ( P>0.05) in the age, gender, disease duration, affected shoulder side, Ellman classification, preoperative visual analogue scale (VAS) score, Constant score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and American Shoulder and Elbow Surgeons (ASES) score. At 1, 3, and 6 months after injection, the shoulder pain and function were evaluated by using the VAS score, Constant score, DASH score, and ASES score. MRI was conducted to observe supraspinatus tendon healing. RESULTS: No severe adverse reactions was observed in all groups. All patients were followed up 6-7 months, with an average of 6.5 months. After injection, the ASES score and Constant score gradually increased in the LR-PRP group and LP-PRP group, while the VAS score and DASH score decreased, with significant differences compared to before injection ( P<0.05). Except for no significant difference between 3 and 6 months after injection in LR-PRP group ( P>0.05), the above scores showed significant differences between different time points ( P<0.05). At 1 month after injection, the Constant score in triamcinolone group significantly increased compared to before injection, while the VAS score significantly decreased ( P<0.05). There was no significant difference in all scores between other time points in the triamcinolone group ( P>0.05). Except for 1 month after injection, there was no significant difference in Constant score and VAS score between groups ( P>0.05). At all other time points, the LR-PRP group and LP-PRP group had better scores than the triamcinolone group ( P<0.05). There was no significant difference between the LR-PRP group and the LP-PRP group ( P>0.05). MRI showed that only 4 patients in the LP-PRP group had signs of repair at the supraspinatus tendon injury site at 6 months after injection, while no significant tendon repair sign was observed in the other patients. CONCLUSION Compared with triamcinolone treatment, multiple injections of LP-PRP and LR-PRP under ultrasound can promote the recovery of shoulder joint function and significantly relieve pain in patients with supraspinatus tendon injury, and imaging improvement can be seen after LP-PRP treatment.
Humans ; Platelet-Rich Plasma ; Rotator Cuff Injuries/therapy* ; Female ; Male ; Treatment Outcome ; Pain Measurement ; Leukocytes ; Tendon Injuries/therapy* ; Middle Aged ; Ultrasonography ; Ultrasonography, Interventional ; Range of Motion, Articular ; Adult

Objective:To investigate the incidence and potential risk factors associated with postopera-tive spinal epidural hematoma(SEH)following anterior cervical spine surgery(ACSS).Methods:A retrospective analysis was conducted on the clinical data of patients who underwent ACSS for cervical spondylosis at Peking University Third Hospital between March 2013 and February 2022.Patients who developed postoperative SEH were categorized as the SEH group,while those in the cohort without SEH were randomly selected as the non-SEH group by individually matching with the same operator,same gender,same surgery year,and similar age(±5 years)at a ratio of 4:1.The general condition,pre-operative comorbidities,anticoagulant or antiplatelet therapy,preoperative coagulation and platelet counts,American society of Anesthesiologists physical status classification,cervical spondylosis classifi-cation,preoperative modified Japanese Orthopaedic Society score and cervical disability index score,sur-gical modality,surgical segment levels,ossification of the posterior longitudinal ligament among the surgi-cal level,surgery duration,estimated blood loss,postoperative drainage volume,preoperative mean arte-rial pressure,mean arterial pressure during postoperative awakening periods,hospital stay and hospitali-zation cost were compared between the two groups.A bivariate Logistic regression model was applied to screen out the independent risk factors and calculate the odds ratios of indicators associated with SEH.Receiver operating characteristic curve and area under the curve(AUC)were used to describe the dis-crimination ability of the indicators.Results:A total of 85 patients were enrolled in the study,including 17 patients in the SEH group and 68 patients in the non-SEH group.Seventeen patients with SEH under-went hematoma evacuation,and all of them were successfully treated and discharged from the hospital.Corpectomy(OR=7.247;95％CI:1.962-26.766;P=0.003)and the highest mean arterial pressure during awakening(OR=1.056;95％CI:1.002-1.113;P=0.043)were independent risk factors for SEH.The AUC values were 0.713(95％CI:0.578-0.848)and 0.665(95％CI:0.51-0.82)re-spectively.The patients with SEH had longer hospital stays(P＜0.001)and greater hospitalization costs(P=0.035).Conclusion:Corpectomy and elevated maximum mean arterial pressure during awakening are independent risk factors for the development of postoperative SEH following ACSS.High-risk patients should be closely monitored during the perioperative period.

Abstract OBJECTIVE To develop LC-MS method for the simultaneous determination of impurities A, C, and D of caspofungin acetate. METHODS Waters CORTECS® C18+(4.6 mm×150 mm, 2.7 μm) was used as the chromatography column. Mobile phase A and B were 0.1% formic acid-H2O and 0.1% formic acid-CH3CN, respectively. Electrospray ion source-single quadrupole mass spectrometry was used to detect impurities A and C in positive ion mode and impurity D in negative ion mode. RESULTS The correlation coefficient r was ≥ 0.999 in linearity ranges of impurities A, C and D. The average recoveries were 100.5%, 104.1% and 105.2%, respectively, with RSD<4%(n=6). The LOQs (S/N=10) of impurities A, C and D were 31.8, 6.99 and 15.5 ng·mL-1 respectively. The contents of impurities A, C and D in the three samples were all below the limits. CONCLUSION The developed LC-MS method is simple, sensitive, and applicable, which can be used to simultaneously determine impurities A, C and D in caspofungin acetate and can also provide a reference for the detection of other impurities in caspofungin acetate.

OBJECTIVE To analyze caspofungin acetate and the samples under different strong degradation conditions by LC-QTOF-MS, and to study the characteristics in mass spectra of caspofungin and its related impurities(impurities A, B, C, D and E). METHODS Chromatographic separation was accomplished on Waters CORTECS® C18+(4.6 mm×150 mm, 2.7 μm) column using a gradient elution with monile phase of 0.1% formic acid-H2O(A) and 0.1% formic acid-CH3CN(B) at a flow velocity of 0.6 mL·min-1; The analytes was detected in positive ion scan mode by ESI-QTOF-MS. RESULTS In MS1 spectra, except that impurity D mainly showed single-charge quasi-molecular ion, caspofungin and the other four impurities showed muti-charge quasi-molecular ions with high abundance; In MS2 spectra, caspofungin and its impurities that containing ethylenediamine generated fragment ions at m/z 1 033 by losing the ethylenediamine and the groups attached to it; caspofungin and its impurities produced a series of fragment ions mainly through the cleavage of peptide bonds, as well as through the loss of hydroxyl, acyl, or amino groups from amino acid residues; Impurity A and C showed characteristic fragment ions m/z 137.070 8 and m/z 77.071 1 with high abundance, respectively, which could be used to distinguish them from caspofungin and the other impurities. CONCLUSION Caspofungin and its five impurities have distict characteristics in their mass spectra. The research results can provide reference for identifying the structures of unknown impurities that may occur in the production process of caspofungin, so as to quickly discover the potential problems in the production process and reduce the quality risk of the products.

【Objective】 To study the changes of blood coagulation function of donors before and after peripheral blood stem cell(PBSC)mobilization and collection, so as to evaluate the safety of the current scheme. 【Methods】 30 donors who received PBSC mobilization and collection in Zhujiang Hospital from October 2018 to October 2020 were enrolled. After mobilization by G-CSF, the correlation between coagulation function, blood routine indexes and TEG indexes of donors was analyzed, and the influence of PBSC mobilization and collection on coagulation function of donors was evaluated. 【Results】 The TEG indexes R(min), K(min), α(°), MA(mm) and CI before and after PBSC collection were 6.12±1.18 vs 7.25±2.16, 1.98±0.41 vs 2.45±0.64, 62.82±4.98 vs 57.3±6.67, 60.93±3.26 vs 55.37±4.41, and -0.31±1.40 vs -2.32±2.18, respectively(P<0.05), suggesting that there was no risk of hypercoagulability after PBSC mobilization and collection. The peak values of WBC (×10⁹/L), Plt (×10⁹/L) and Hb (g/L) were 62.02, 357 and 162, respectively, which indicated that the blood routine indexes after PBSC mobilization and collection were in the safe range. After PBSC collection, the CI value of 26.7% (8/30) donors was less than -3, showing hypocoagulability. 【Conclusion】 The current mobilization and collection scheme of PBSC has little effect on the coagulation function. Most of the donors had no risk of hypercoagulability, but a few showed a trend of hypocoagulability after PBSC collection.