Critical care medicine is a discipline dedicated to the diagnosis and treatment of severe illnesses,demanding extensive knowledge,advanced skills,and exceptional teamwork and communication abilities.However,the complexity and dynamic nature of critically ill patients often render traditional face-to-face teaching methods insufficient.Emerging educational approaches like virtual reality(VR)and augmented reality(AR)offer simulated environments,but lack the depth of interaction with the real world,constraining the educational outcomes.Mixed reality(MR),which integrates elements of both VR and AR,provides an immersive and highly interactive learning experience by seamlessly bridging the virtual and real worlds.Although MR has begun to establish itself in medical education,its application in critical care medicine remains in its early stages.This article aims to elucidate the characteristics and evolution of MR,alongside its potential value and applications in critical care medical education.

Objective:To summarize the essential elements of clinical doctors′ ward rounds etiquette norms from the perspective of whether doctors′ speech and behavior in actual ward rounds pay attention to patients′ feelings and reflect humanistic care, in order to provide references for improving patients′ treatment effects and medical experience management.Methods:From July to October 2023, a purposeful sampling method was employed to select 16 clinical doctors with ward rounds experience from the eastern, central, western, and northeastern regions across the country. Semi-structured interviews were conducted online via video, focusing on issues related to etiquette norms during ward rounds. The Colaizzi′s seven-step analysis method was used to conduct an inductive analysis of the interview materials.Results:four themes were distilled: friendly and caring body language; accurate, understandable, clear, and timely explanations; appropriate praise and affirmation to encourage patients to actively participate in their disease management; and admonitions to patients and their families regarding disease-related precautions. These four themes were summarized as the " four essentials of ward rounds, " which could be encapsulated as " altruistic inquiry; accurate explanation; affirmative engagement and adequate advice" .Conclusions:The " four essentials of ward rounds" can be made a mandatory part of the clinical doctors′ workflow in the medical quality management process and are recommended for nationwide promotion. This can further enhance the communication skills of clinical doctors, strengthen patients′ trust, improve treatment compliance, and improve doctor-patient relationships, thereby improving the treatment effects, satisfaction, and experience of inpatients.

Objective:To summarize the essential elements of clinical doctors′ ward rounds etiquette norms from the perspective of whether doctors′ speech and behavior in actual ward rounds pay attention to patients′ feelings and reflect humanistic care, in order to provide references for improving patients′ treatment effects and medical experience management.Methods:From July to October 2023, a purposeful sampling method was employed to select 16 clinical doctors with ward rounds experience from the eastern, central, western, and northeastern regions across the country. Semi-structured interviews were conducted online via video, focusing on issues related to etiquette norms during ward rounds. The Colaizzi′s seven-step analysis method was used to conduct an inductive analysis of the interview materials.Results:four themes were distilled: friendly and caring body language; accurate, understandable, clear, and timely explanations; appropriate praise and affirmation to encourage patients to actively participate in their disease management; and admonitions to patients and their families regarding disease-related precautions. These four themes were summarized as the " four essentials of ward rounds, " which could be encapsulated as " altruistic inquiry; accurate explanation; affirmative engagement and adequate advice" .Conclusions:The " four essentials of ward rounds" can be made a mandatory part of the clinical doctors′ workflow in the medical quality management process and are recommended for nationwide promotion. This can further enhance the communication skills of clinical doctors, strengthen patients′ trust, improve treatment compliance, and improve doctor-patient relationships, thereby improving the treatment effects, satisfaction, and experience of inpatients.

Humans ; China/epidemiology* ; SARS-CoV-2 ; COVID-19

Objective: To investigate the effects of scleral crosslinking using genipin on ocular biological parameters and scleral biomechanics of form-deprivation myopia rabbits. Methods: Sixty healthy New Zealand rabbits of 14 days old were collected.The right eyes were selected as experimental eye.The rabbits were randomly divided into three groups: control group with no treatment; myopia model group with eyelid suture procedure performed on the right eye; genipin injection group with eyelid suture procedure performed on the right eye combined with subconjunctival injection of genipin.The suture was removed 60 days after the eyelid suture procedure.The diopter, length of vitreous cavity, and axial length were measured.The sclera at 1: 00 and 7: 00 position of the experimental eye was used to make a scleral strip.The thickness, elastic modulus, creep rate, ultimate stress and ultimate strain of the sclera were measured.This study was approved by the animal experimental Ethics Committee of Bethune International Peace Hospital (2018-ky-09). Results: The diopters of genipin injection group, myopia model group and control group were (2.50±1.38), (0.33±0.52) and (2.08±0.52)D, respectively, the axial lengths of the three groups were (15.33±0.82), (15.83±0.41) and (15.00±0.43)mm, respectively; the changes in vitreous cavity lengths were (1.50±0.79), (2.59±0.83) and (1.48±0.66)mm, respectively; and the ratios of vitreous cavity length to axial length were 0.46±0.02, 0.51±0.02 and 0.47±0.02, respectively.The diopter in myopia model group was significantly lower than those in control group and genipin injection group, the axial length in myopia model group was significantly longer than that in control group, the change in vitreous cavity lengths and ratio of vitreous cavity length to axial length in myopia model group were significantly higher than those in control group and genipin injection group, the axial length in myopia model group was significantly longer than that in control group, the differences were statistically significant (all at P<0.05). The elasticity modulus was (9.10±3.12)MPa and ultimate stress was (1.42±0.57)MPa in genipin injection group, which were significantly higher than (6.98±3.30)MPa and (1.15±0.57)MPa in control group, and (6.25±3.17)MPa and (0.82±0.38)MPa in myopia model group (all at P<0.05). The ultimate strain was (20.99±5.60)% in genipin injection group, which was significantly lower than (25.08±6.35)% in control group and (27.78±8.20)% in myopia model group, with significant differences between them (both at P<0.05). Conclusions Posterior sub-Tenon capsule injection of genipin for collagen crosslinking in the sclera increases the biomechanical strength of sclera and effectively prevents the development of form-deprivation myopia in rabbits, which provides a new idea for the prevention and treatment of myopia in the future.

Objective To analyze the correlation between K-ras gene mutation and clinicopathological characteristics and prognosis of colorectal cancer patients with different primary sites.Methods The clinical and pathological records of 69 patients who were pathologically confirmed as colorectal cancer and tested K-ras gene status at Wuxi People's Hospital Affiliated to Nanjing Medical University between May 2007 and August 2017 were adopted.The correlation between clinicopathological characteristics and prognosis of colorectal cancer patients with different primary sites and K-ras gene mutation status were retrospectively analyzed.And the patients were visited to adopt the prognosis data and perform the Kaplan-Meier survival analysis.Results The K-ras mutation rate was 50.7％(35/69),including 40.0％(12/30)in left-side colon cancer,73.3％(11/15)in right-side colon cancer and 50.0％(12/24)in rectal cancer.The mutation rate of K-ras gene in patients ≥ 60 years old [61.5％(24/39)vs.36.7％(11/30),χ2= 4.197,P = 0.041] or serum CA19-9 raising up abnormally was conspicuously high [65.6％(19/29)vs.37.5％(15/40),χ 2= 5.486,P =0.019].Other clinicopathological characteristics,such as gender,lesion location,histological classification,TNM stage,serum CEA expression,clinical features had no correlation with K-ras gene mutation status(all P＞ 0.05).And no relationship was found between prognosis and overall survival of colorectal cancer patients with different primary sites and K-ras gene mutation status(χ 2= 0.001,P = 0.997; χ 2= 0.583,P =0.445).In general,the 5-year survival rate of left-side colon cancer patients was highest(76.9％),followed by rectal cancer(69.7％),and right-side colon cancer was lowest(31.3％).The primary site of colorectal cancer was related to the overall survival of patients(χ2=11.004,P =0.004).Conclusions K-ras gene mutation in colorectal cancer is closely related to age and serum CA19-9 levels of the patients.The prognosis of left-side colon cancer is best,rectal cancer second,and right-side colon cancer poorest.Whether K-ras gene mutation is the prognostic factor of colorectal cancer is not clear.Testing the K-ras gene status and serum tumor index expression,distinguish the primary site and age group will provide the theory basis and promote the clinical targeted therapy and improve the survival of colorectal cancer patients.

Objective To observe the changes of brain neurotransmitters in patients with vasovagal syncope (VVS) with encephalofluc-tuogram technology (ET). Methods From August, 2015 to December, 2016, 30 patients with VVS were selected as case group, 30 controls matched with sex and age were selected from the outpatients without syncope. They were detected the function of gamma aminobutyric acid (GABA), glutamate (Glu), 5-hydroxytryptamine (5-HT), acetylcholine (Ach), norepinephrine (NE) and dopamine (DA) with ET. Results There was no significant difference between the two groups in the values of GABA, Glu, 5-HT, Ach and DA (t<1.680, P>0.05), while the values of NE was higher in the case group than in the control group (t=-3.552, P<0.001). Conclusion VVS may be related to the high level of activity of NE in the brain.

Objective: To investigate the efficacy and safety of using pegylated recombinant human granulocyte-colonystimulating factor (PEG-rhG-CSF) in preventing neutropenia in multiple chemotherapy cycles. Methods: A multicenter, prospective, open-label, singlearmstudy was designed. Patients with malignant tumors, such as lung, ovarian, and colorectal cancers, who received multiple cycles of chemotherapy with the prophylactic use of PEG-rhG-CSF for 2-4 consecutive cycles participated in the study. Results: After the prophylactic use of PEG-rhG-CSF, the incidence of grade IV neutropenia decreased from 4.76% (13/273) in the first cycle to 1.83% (5/273), 1.15% (2/174), and 2.08% (2/96) in subsequent cycles. Meanwhile, the incidence of grade III neutropenia decreased from 11.36% (31/ 273) in the first cycle to 6.23% (17/273), 2.87% (5/174), and 3.13% (3/96) in subsequent cycles. The incidence of febrile neutropenia (FN) during the first cycle was 0.73% (2/273). The duration of FN was 2 days in one case and 5 days in another case. FN was not observed during the second, third, or fourth cycle. After the secondary prophylactic use of PEG-rhG-CSF, the incidence of grade IV neutropenia decreased from 25% (7/28) to 3.57% (1/28), 0% (0/28), and 6.67% (1/15) in subsequent cycles. Meanwhile, the incidence of grade III neutropenia decreased from 71.43% (20/28) to 10.71% (3/28), 14.29% (4/28), and 0% (0/15) in subsequent cycles. The proportion of patients who received antibiotic therapy during the entire chemotherapy period was 10.48% (44/420). Conclusion: The application of PEG-rhG-CSF once per chemotherapy cycle can effectively reduce the occurrence of neutropenia in patients under multiple cycles of chemotherapy treatment with good safety.

Objective:To detect the proportion of lymphocyte subsets in peripheral blood of the ad-vanced breast cancer patients before and after chemotherapy with docetaxel and thiotepa,as well as the association between the proportion of peripheral blood lymphocyte subsets with the response rate and prog-nosis.Methods:The proportions of lymphocyte subsets (CD3 +T cell,CD3 +/CD4 +T cell,CD3 +/CD8 +T cell,CD3 -/CD16 +56 +NK cell,CD3 +/CD16 +56 +T cell,CD19 +B cell,CD4 +/CD25 +T cell,CD8 +/CD28 -T cell,CD8 +/CD28 +T cell)in the peripheral blood of 86 patients were analyzed with flowcytometry before and after chemotherapy.The result was analyzed in combination with clinico-pathological data.Results:The proportion of regulatory T cells (Treg)after chemotherapy in the disease control patients decreased significantly compared with that of the progressive patients (P=0.034).The difference of the proportions of Treg before and after chemotherapy affected significantly the overall survi-val (OS).The OS of the patients with decreased proportion of Treg was significantly longer than that of the patients with increased proportion of Treg,which was 23.5 and 9.4 months respectively (P<0.05). Conclusion:The patients with decreased proportion of Treg after chemotherapy had higher response rate and better survival benefit.