Objective:To investigate the effects of the "TECK" (theoretical class, experimental course, case discussion, and knowledge reinforcement) teaching model oriented by post competency in clinical pathology internship teaching.Methods:The intern students from 2015 to 2019 in the pathology direction of clinical medicine in the School of Pathology, Qiqihar Medical College, who were enrolled in the internship from 2019 to 2023, were selected as the research objects.We enrolled 32 medical students from grades 2017, 2018, and 2019 (research group) and 24 medical students from grades 2015 and 2016 (control group) who would participate in pathology internships. The control group adopted the traditional internship mode, while the research group adopted the competency-oriented "TECK" teaching mode. After the internship, the two groups were compared for internship assessment score and surveyed for post competency. With the use of SPSS 18.0 statistical software. Continuous data were presented as (mean±standard deviation) and t-test was used for comparison between groups. Count data were expressed in the number of cases, and chi-square test was used for comparison between groups.The significance level α was 0.05. Results:The research group showed significantly higher scores of skill assessment (82.81±4.20 vs. 79.58±5.09) and pathological diagnosis assessment (80.28±4.23 vs. 76.21±4.58) than the control group (both P<0.05), with no significant difference in the score of theoretical knowledge ( P>0.05). In terms of post competency, the research group was superior to the control group in clinical skills and medical care ability (12.38±0.94 vs. 11.35±0.76), disease prevention and health promotion ability (6.28±0.92 vs. 4.48±0.93), interpersonal communication and information management ability (19.81±1.09 vs. 17.00±1.28), and teamwork and scientific research ability (11.44±1.27 vs. 9.25±0.87; all P<0.05). There were no significant differences between the two groups in core values and professional literacy and medical knowledge and lifelong learning (both P>0.05). Conclusions:In undergraduate internships, the competency-oriented "TECK"teaching mode can significantly improve students' clinical operation and pathological diagnosis ability, and effectively cultivate their abilities of clinical skills and medical care, disease prevention and health promotion, interpersonal communication and information management, teamwork and scientific research.

Objective To analyze the characteristics of time in range(TIR)and its relationship with oxidative stress(OS)and insulin resistance status(HOMA-IR)in patients with type 2 diabetes mellitus(T2DM)and sleep apnea-hypopnea syndrome(OSAHS).Methods According to apnea-hypopnea index(AHI),165 T2DM in patients were divided into simple T2DM group(AHI<5 times/h,n=43),T2DM combine OSAHS mild group(OSAHS-G,5≤AHI<15 times/h,n=51),T2DM combined OSAHS moderate group(OSAHS-M,15≤AHI≤30 times/h,n=40)and T2DM combine OSAHS severe group(OSAHS-S,AHI>30 times/h,n=31).TIR was calculated by dynamic blood glucose monitoring.Superoxide dismutase(SOD),glutathione peroxidase(GSH-Px)and other indexes were detected and analyzed.Results Compared with simple T2DM group,the levels of HOMA-IR,8-iso-PGF2a and Ox-LDL were higher in T2DM combined OSAHS-G,OSAHS-M or OSAHS-S group,while the levels of TIR,SOD and GSH-Px were lower(P<0.05).Pearson correlation analysis showed that TIR was positively correlated with the levels of SOD and GSH-Px(P<0.05 or P<0.01),and negatively correlated with the levels of 8-iso-PGF2a,Ox-LDL,HbA1c,HOMA-IR and the severity of OSAHS(P<0.01).Logistic regression analysis showed that TIR,SOD and GSH-Px were protective factors for severe OSAHS in T2DM patients,while 8-iso-PGE2a and Ox-LDL were the risk factors for severe OSAHS.Conclusions The glucose level fluctuates greatly in patients with T2DM and OSAHS.Insulin resistance and oxidative stress are factors that affect the normalization of TIR.

Seven novel linear polyketides,talaketides A-G(1-7),were isolated from the rice media cultures of the mangrove sed-iment-derived fungus Talaromyces sp.SCSIO 41027.Among these,talaketides A-E(1-5)represented unprecedented unsaturated lin-ear polyketides with an epoxy ring structure.The structures,including absolute configurations of these compounds,were elucidated through detailed analyses of nuclear magnetic resonance(NMR)and high-resolution mass spectrometry(HR-MS)data,as well as elec-tronic custom distributors(ECD)calculations.In the cytotoxicity screening against prostate cancer cell lines,talaketide E(5)demon-strated a dose-dependent inhibitory effect on prostate cancer PC-3 cell lines,with an IC50 value of 14.44 μmol·L-1.Moreover,com-pound 5 significantly inhibited the cloning formation of PC-3 cell lines and arrested the cell cycle in S-phase,ultimately inducing ap-optosis.These findings indicate that compound 5 may serve as a promising lead compound for the development of a potential treat-ment for prostate cancer.

Objective:To investigate the correlation between thyroid hormone resistance and hyperuricemia in euthyroid population.Methods:It was a cross-sectional study. A total of 548 euthyroid subjects who were hospitalized or underwent physical examination in the Heart Center and Health Management Center of the First Affiliated Hospital of Tsinghua University from January 2021 to December 2022 were selected. Thyroid function, uric acid, blood lipid and other indicators were collected in the subjects, and thyroid function parameters were calculated: thyroid-stimulating hormone index (TSHI), thyrotropin T4 resistance index (TT4RI), parametric thyroid feedback quantile-based index (PTFQI), free triiodothyronine/free thyroxine (FT3/FT4), the sum activity of peripheral deiodinases (SPINA-GD) and the secretory capacity of the thyroid gland (SPINA-GT). According to uric acid level, the subjects were divided into high uric acid group and normal group, the clinical characteristics and thyroid function parameters of the two groups were compared, the correlation between thyroid hormone resistance and hyperuricemia was further explored.Results:Compared with the normal group, male proportion (94.4% and 52.5%), smoking rate (5.2% and 21.3%), body mass index [(27.10±3.96) and (24.26±3.42) kg/m 2], waist-to-hip ratio [0.90(0.86, 0.94) and 0.86(0.80, 0.91)], serum creatinine [(85.50±12.27) and (73.77±28.79) μmol/L], total cholesterol [(5.08±0.99) and (4.72±0.86) mmol/L], triglyceride [2.10(4.40, 5.59) and 1.14(0.79, 1.67)mmol/L], low-density lipoprotein [(3.19±0.97) and (2.85±0.84) mmol/L] and homocystine [(15.07±9.13) and (12.50±10.85) μmol/L] were all higher in the high uric acid group, and the level of high-density lipoprotein [1.15(1.43, 2.88) and 1.39(1.16, 1.64) mmol/L] was lower (all P<0.05). In the aspect of thyroid hormone and thyroid function parameters, the FT4[16.90(5.40,17.95) and 16.00(14.30,17.80) pmol/L], FT3[5.56(5.25, 5.94) and 5.22(4.81, 5.63) pmol/L], FT3/FT4 [0.34(0.31, 0.37) and 0.32(0.29, 0.36)], TSHI (2.70±0.50 and 2.58±0.60), PTFQI (0.406±0.332 and 0.335±0.353) and SPINA-GD [3.72(3.41, 4.05) and 3.52(3.18, 4.00) ]were all higher in high uric acid group than those in normal group(all P<0.05). Spearman correlation analysis showed that blood uric acid level was positively correlated with FT4 ( r=0.185), FT3 ( r=0.422), FT3/FT4 ( r=0.16), TSHI ( r=0.134), TT4RI ( r=0.09), PTFQI ( r=0.121) and SPINA-GD ( r=0.157) (all P<0.05). Conclusion:In people with euthyroid function, central resistance to thyroid hormone is correlated with hyperuricemia.

Objective:To report the results of national surveillance on the distribution and antimicrobial resistance profile of clinical Gram-positive bacteria isolates from bloodstream infections in China in 2022.Methods:The clinical isolates of Gram-positive bacteria from blood cultures in member hospitals of National Bloodstream Infection Bacterial Resistant Investigation Collaborative System（BRICS）were collected during January 2022 to December 2022. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical and Laboratory Standards Institute（CLSI）. WHONET 5.6 and SPSS 25.0 software were used to analyze the data.Results:A total of 3 163 strains of Gram-positive pathogens were collected from 51 member units，and the top five bacteria were Staphylococcus aureus（ n=1 147，36.3%），coagulase-negative Staphylococci（ n=928，29.3%）， Enterococcus faecalis（ n=369，11.7%）， Enterococcus faecium（ n=296，9.4%）and alpha-hemolyticus Streptococci（ n=192，6.1%）. The detection rates of methicillin-resistant Staphylococcus aureus（MRSA）and methicillin-resistant coagulase-negative Staphylococci（MRCNS）were 26.4%（303/1 147）and 66.7%（619/928），respectively. No glycopeptide and daptomycin-resistant Staphylococci were detected. The sensitivity rates of Staphylococcus aureus to cefpirome，rifampin，compound sulfamethoxazole，linezolid，minocycline and tigecycline were all >95.0%. Enterococcus faecium was more prevalent than Enterococcus faecalis. The resistance rates of Enterococcus faecium to vancomycin and teicoplanin were both 0.5%（2/369），and no vancomycin-resistant Enterococcus faecium was detected. The detection rate of MRSA in southern China was significantly lower than that in other regions（ χ2=14.578， P=0.002），while the detection rate of MRCNS in northern China was significantly higher than that in other regions（ χ2=15.195， P=0.002）. The detection rates of MRSA and MRCNS in provincial hospitals were higher than those in municipal hospitals（ χ2=13.519 and 12.136， P<0.001）. The detection rates of MRSA and MRCNS in economically more advanced regions（per capita GDP≥92 059 Yuan in 2022）were higher than those in economically less advanced regions（per capita GDP<92 059 Yuan）（ χ2=9.969 and 7.606， P=0.002和0.006）. Conclusions:Among the Gram-positive pathogens causing bloodstream infections in China， Staphylococci is the most common while the MRSA incidence decreases continuously with time；the detection rate of Enterococcus faecium exceeds that of Enterococcus faecalis. The overall prevalence of vancomycin-resistant Enterococci is still at a low level. The composition ratio of Gram-positive pathogens and resistant profiles varies slightly across regions of China，with the prevalence of MRSA and MRCNS being more pronounced in provincial hospitals and areas with a per capita GDP≥92 059 yuan.

Sudden unexpected death in epilepsy (SUDEP) refers to the sudden, unexpected and unexplained death of epilepsy patients, which is an important reason for the significant increase of the death risk of epilepsy patients. The risk factors of SUDEP are related to poor control of seizures, nocturnal seizures, prone position, antiepileptic drugs, comorbidity, etc. Epilepsy death caused by SUDEP has become a major public health problem. The latest progress in neuropathology and cardiopulmonary pathology of SUDEP was reviewed in this article.

Restless sleep disorder was first reported in children, manifested with the large muscle groups movement during sleep named as large muscle movement. The movement of large muscle group refers to the non-periodic abnormal movement of large muscle group such as head, trunk and limbs during sleep period according to the criteria of American Sleep Association in 2022. The clinical and neuroelectrophysiological research progress of restless sleep disorder, interpretation and clinical significance of large muscles movement are summarized in this article.

Objective:To summarize the clinical and electrophysiological characteristics of epilepsy patients with fixation-off sensitivity (FOS).Methods:Using "fixation-off sensitivity" and "epilepsy" as search terms, data were retrieved from the Electroencephalogram Monitoring Center Database of Xijing Hospital, Air Force Military Medical University. Information was collected on epilepsy patients with FOS who were seen at the Xijing Hospital Electroencephalogram Monitoring Center from March 2019 to May 2023. A retrospective analysis of video electroencephalograms and clinical information was conducted, along with follow-up. Single factor analysis and multi-factor Logistic regression analysis were used to analyze the risk factors affecting the prognosis of the patients.Results:A total of 78 patients met the inclusion criteria, including 43 females and 35 males; the age at first epilepsy onset was 12.00 (8.00, 15.25) years. Among these 78 patients, 46 were diagnosed with genetic generalized epilepsy, 11 with self-limited focal epilepy, 9 with familial cortical myoclonic tremor with epilepsy, 7 with developmental and epileptic encephalopathy, 3 with symptomatic epilepsy, and 2 with progressive myoclonic epilepsy. The fixation-off induction trial most commonly triggered seizures in epilepsy with eyelid myoclonia (EEM) patients, with eyelid myoclonia being the most common type of seizure. Twenty-five epilepsy patients with FOS showed a positive photoparoxysmal response, of whom 6 experienced photo-convulsive response. Sixty-eight patients completed follow-up with comprehensive clinical data. At the last follow-up, 45 patients had been free from tonic-clonic seizures for at least one year. A history of febrile seizures ( OR=20.559, 95% CI 2.179-193.997, P=0.008) and cognitive decline ( OR=3.752, 95% CI 1.118-12.588, P=0.032) were identified as risk factors for poor prognosis in epilepsy patients with FOS. The age of first epilepsy onset, the number of anti-seizure medications, and the intermittent photo stimulation trial results had no correlation with prognosis. Conclusions:FOS is more common in female epilepsy patients and can be observed in both generalized and focal epilepsy syndromes. EEM patients are prone to seizures during fixation-off induction trial, and the most common type of seizures is eyelid myoclonus seizure. Patients with epilepsy with FOS who have a history of febrile seizures and cognitive impairment tend to have poor prognosis.

Objective To observe the characteristics of patients with extra long-term hospital stays at an infectious dis-eases hospital,formulate corresponding strategies,and effectively control the length of stays so as to improve the efficiency of medical resource utilization.Methods Data of all discharged patients in 2023,including age,gender,disease name,discharge department,and length of stay,were retrieved from the hospital's medical record management system.Statistical analysis was conducted using Excel and SPSS.Results The analysis indicated that the proportion of male patients with excessively long hos-pital stays was significantly higher than that of female patients.Additionally,prolonged hospital stays were correlated with age,and elderly patients exhibited a higher proportion of extended stays.Most patients were covered by employee medical insurance and resident medical insurance,while only a small portion relied on self-funded medical insurance.Over half of the excessively hospitalized patients were affected with specific infectious and parasitic diseases(A00-B99).Controlling the length of these hos-pitalizations could reduce costs and alleviate patient burdens.Conclusion Controlling excessive hospital stays is effective through strengthened medical quality management,enhanced patient management in key departments,and a focus on specific dis-eases.Additional strategies for controlling extended hospital stay include improving doctor-patient communication,increasing comprehensive patient information sharing,reducing medical disputes,attaching importance to information technology,and rea-sonably utilize medical resources.

Objective To observe the effects of ginkgolides drops on anginal attacks and peripheral blood levels of microRNA-29 a(miR-29a)and intercellular adhesion molecule-1(ICAM-1)in patients with stable angina pectoris.Methods 78 patients with stable angina pectoris patients,who had visited the cardiology department of our hospital during the period of January 2022 to December 2023,were selected.The patients were divided in a Chinese medicine group or a conventional group by using the random number table method,39 in each group.The conventional group received conventional Western medicine treatment,while the Chinese medicine received ginkgo ketone ester drip pills on the basis of conventional Western medicine therapies.Occurrence of angina attack,treadmill electrocardiogram test indexes,blood rheology,6-minute walking distance,TCM symptom scores and changes in peripheral blood miR-29a and ICAM-1 were observed in the two groups.The rate of nitroglycerin discontinuation or reduction and the incidence of adverse reactions were counted.Results Before treatment,there was no statistically significant difference in occurrence of angina attacks between the two groups(P＞0.05).After treatment,the number of attacks per week,weekly glyceryl trinitrate uses,and duration of each attack decreased in both groups,with a greater decline in the Chinese medicine group than in the conventional group(P＜0.05).Before treatment,there was no statistically significant difference in the indicators of treadmill electrocardiogram test between the two groups(P＞0.05).After treatment,induction positive time,exercise termination time,and maximum ST depression time increased in both groups,with longer induction positive time and maximum ST depression time in the Chinese medi-cine group than in the conventional group,while exercise termination time,as compared with the baseline,did not differ statistically(P＞0.05).Maximum ST depression amplitude and ST recovery time decreased in both groups,with a greater decrease in the Chinese medicine group than in the conventional group(P＜0.05).Before treatment,there were no statistically significant differences in miR-29a,ICAM-1,and rheology between the two groups(P＞0.05).After treatment,ICAM-1 and whole blood high/low shear viscosity,FIB,platelet aggregation rate,and plasma viscosity decreased in both groups,with a bigger drop in the Chinese medicine group than in the conventional group(P＜0.05).As compared with the baseline,miR-29a did not differ statistically between the two groups(P＞0.05).Before treatment,there were no statistically significant differences in 6min walking distance and Chinese medicine symptom scores between the two groups.After treatment,6 min walking distance increased in both groups,with a greater increase in the Chinese medicine group than in the conventional group(P＜0.05);Chinese medicine symptom scores decreased in both groups,with a greater decrease in the Chinese medicine group than in the conven-tional group(P＜0.05).The glyceryl trinitrate reduction rate was higher in the Chinese medicine group(79.49%,31/39 cases)than in the conventional group(56.41%,22/39 cases),and the incidence of adverse reactions did not differ statistically between the Chinese medicine group and the conventional group(7.69%vs.5.13%,3/39 vs.2/39 cases;P＞0.05).Conclusions Ginkgolides drops for stable angina improve the degree of myocardial ischaemia and blood rheology,reduce angina attacks,lower ICAM-1 levels,and increase the rate of nitroglycerin discontinua-tion or reduction.