Objective:To explore the feasibility and mid-term efficacy of minimally invasive cardiac surgery coronary artery bypass grafting(MICS CABG) in the treatment of multi-vessel coronary artery disease.Methods:A retrospective analysis was conducted on 440 patients with multi-vessel coronary artery disease at the Minimally Invasive Cardiac Surgery Center of Beijing Anzhen Hospital, Capital Medical University, from January 2018 to December 2022. Among these patients, 145 who underwent MICS CABG were designated as the experimental group(MICS group). And 295 patients who underwent conventional sternotomy off-pump coronary artery bypass grafting(OPCABG) were collected during the same period. Propensity score matching was employed at a 1∶1 ratio to match patients in the OPCABG group, serving as the control group.The clinical data during hospitalization and the results of midterm follow-up were analyzed and compared using rank- sum test, Fisher' s exact test, Kaplan- Meier survival curve, and other methods. Results:After propensity matching, the baseline features were well balanced between the two groups( P>0.05), with 111 patients in each group. Patients who received MICS CABG had significantly reduce blood loss[MICS: 600 ml(500 ml, 900 ml) vs. OPCABG: 800 ml(600 ml, 1 000 ml), P<0.001], transfusion rate(MICS: 1.8% vs. OPCABG: 17.1%, P<0.001), and IABP implantation rate(MICS: 3.1% vs. OPCABG: 17.1%, P=0.001). In addition, patients who received MICS CABG had significantly better postoperative LVEF(MICS: 0.59±0.06 vs. OPCABG: 0.56±0.09, P<0.001) than the control group. The average follow-up time was 2.42 years, and there was no significant difference in the incidence of MACCEs in the mid-term( P=0.748). Conclusion:MICS CABG demonstrates rapid recovery and fewer postoperative complications. For patients with multiple coronary artery lesions, MICS CABG has a similar efficacy in the mid-term as conventional coronary artery bypass surgery.

Objective:To explore the feasibility and mid-term efficacy of minimally invasive cardiac surgery coronary artery bypass grafting(MICS CABG) in the treatment of multi-vessel coronary artery disease.Methods:A retrospective analysis was conducted on 440 patients with multi-vessel coronary artery disease at the Minimally Invasive Cardiac Surgery Center of Beijing Anzhen Hospital, Capital Medical University, from January 2018 to December 2022. Among these patients, 145 who underwent MICS CABG were designated as the experimental group(MICS group). And 295 patients who underwent conventional sternotomy off-pump coronary artery bypass grafting(OPCABG) were collected during the same period. Propensity score matching was employed at a 1∶1 ratio to match patients in the OPCABG group, serving as the control group.The clinical data during hospitalization and the results of midterm follow-up were analyzed and compared using rank- sum test, Fisher' s exact test, Kaplan- Meier survival curve, and other methods. Results:After propensity matching, the baseline features were well balanced between the two groups( P>0.05), with 111 patients in each group. Patients who received MICS CABG had significantly reduce blood loss[MICS: 600 ml(500 ml, 900 ml) vs. OPCABG: 800 ml(600 ml, 1 000 ml), P<0.001], transfusion rate(MICS: 1.8% vs. OPCABG: 17.1%, P<0.001), and IABP implantation rate(MICS: 3.1% vs. OPCABG: 17.1%, P=0.001). In addition, patients who received MICS CABG had significantly better postoperative LVEF(MICS: 0.59±0.06 vs. OPCABG: 0.56±0.09, P<0.001) than the control group. The average follow-up time was 2.42 years, and there was no significant difference in the incidence of MACCEs in the mid-term( P=0.748). Conclusion:MICS CABG demonstrates rapid recovery and fewer postoperative complications. For patients with multiple coronary artery lesions, MICS CABG has a similar efficacy in the mid-term as conventional coronary artery bypass surgery.

Objective Our previous studies established that microRNA (miR)-451 from human umbilical cord mesenchymal stem cell-derived exosomes (hUC-MSC-Exos) alleviates acute lung injury (ALI). This study aims to elucidate the mechanisms by which miR-451 in hUC-MSC-Exos reduces ALI by modulating macrophage autophagy. Methods Exosomes were isolated from hUC-MSCs. Severe burn-induced ALI rat models were treated with hUC-MSC-Exos carrying the miR-451 inhibitor. Hematoxylin-eosin staining evaluated inflammatory injury. Enzyme-linked immunosorbnent assay measured lipopolysaccharide (LPS),tumor necrosis factor-α,and interleukin-1β levels. qRT-PCR detected miR-451 and tuberous sclerosis complex 1 (TSC1) expressions. The regulatory role of miR-451 on TSC1 was determined using a dual-luciferase reporter system. Western blotting determined TSC1 and proteins related to the mammalian target of rapamycin (mTOR) pathway and autophagy. Immunofluorescence analysis was conducted to examine exosomes phagocytosis in alveolar macrophages and autophagy level. Results hUC-MSC-Exos with miR-451 inhibitor reduced burn-induced ALI and promoted macrophage autophagy. MiR-451 could be transferred from hUC-MSCs to alveolar macrophages via exosomes and directly targeted TSC1. Inhibiting miR-451 in hUC-MSC-Exos elevated TSC1 expression and inactivated the mTOR pathway in alveolar macrophages. Silencing TSC1 activated mTOR signaling and inhibited autophagy,while TSC1 knockdown reversed the autophagy from the miR-451 inhibitor-induced. Conclusion miR-451 from hUC-MSC exosomes improves ALI by suppressing alveolar macrophage autophagy through modulation of the TSC1/mTOR pathway,providing a potential therapeutic strategy for ALI.

Objective:To explore the effect of early quantitative pulmonary rehabilitation assessment in adult Intensive Care Unit (ICU) patients with mechanical ventilation in high altitude area.Methods:From March 2019 to October 2021, convenience sampling was used to select 287 adult ICU patients with mechanical ventilation of Qinghai Red Cross Hospital as the research object. According to the time of admission, the patients were divided into the control group (142 cases) and the experimental group (145 cases) . The control group was given the routine pulmonary rehabilitation, and the experimental group received the early pulmonary rehabilitation based on quantitative assessment. The Acute Physiology and Chronic Health EvaluationⅡ (APACHEⅡ) score and the Intensive Care Units Mobility Scale (IMS) score were compared between the two groups before enrollment, on the eighth and sixteenth days of pulmonary rehabilitation. The oxygenation index of the two groups of patients before enrollment and on the first, fourth, sixth, eighth and sixteenth days of pulmonary rehabilitation, the time of ICU stay, the time of mechanical ventilation, the success rate of ventilator removal and the complications of the two groups of patients with mechanical ventilation were also compared.Results:On the eighth and sixteenth days of pulmonary rehabilitation, the APACHE Ⅱ score of the experimental group was lower than that of the control group, and the IMS score was higher than that of the control group, with statistical differences ( P<0.05) . On the sixth, eighth and sixteenth days of pulmonary rehabilitation, the oxygenation index of the experimental group was higher than that of the control group, and the difference was statistically significant ( P<0.05) . The ICU stay time and mechanical ventilation time in the experimental group were lower than those in the control group, and the success rate of ventilator removal in the experimental group was higher than that in the control group, with statistical differences ( P<0.05) . Conclusions:Implementing early pulmonary rehabilitation for adult ICU patients with mechanical ventilation in high altitude area is conducive to promoting pulmonary rehabilitation of patients, improving the success rate of ventilator removal, and reducing patients' ICU stay time, mechanical ventilation time and the occurrence of complications.

Objective:To explore the effect of early quantitative pulmonary rehabilitation assessment in adult Intensive Care Unit (ICU) patients with mechanical ventilation in high altitude area.Methods:From March 2019 to October 2021, convenience sampling was used to select 287 adult ICU patients with mechanical ventilation of Qinghai Red Cross Hospital as the research object. According to the time of admission, the patients were divided into the control group (142 cases) and the experimental group (145 cases) . The control group was given the routine pulmonary rehabilitation, and the experimental group received the early pulmonary rehabilitation based on quantitative assessment. The Acute Physiology and Chronic Health EvaluationⅡ (APACHEⅡ) score and the Intensive Care Units Mobility Scale (IMS) score were compared between the two groups before enrollment, on the eighth and sixteenth days of pulmonary rehabilitation. The oxygenation index of the two groups of patients before enrollment and on the first, fourth, sixth, eighth and sixteenth days of pulmonary rehabilitation, the time of ICU stay, the time of mechanical ventilation, the success rate of ventilator removal and the complications of the two groups of patients with mechanical ventilation were also compared.Results:On the eighth and sixteenth days of pulmonary rehabilitation, the APACHE Ⅱ score of the experimental group was lower than that of the control group, and the IMS score was higher than that of the control group, with statistical differences ( P<0.05) . On the sixth, eighth and sixteenth days of pulmonary rehabilitation, the oxygenation index of the experimental group was higher than that of the control group, and the difference was statistically significant ( P<0.05) . The ICU stay time and mechanical ventilation time in the experimental group were lower than those in the control group, and the success rate of ventilator removal in the experimental group was higher than that in the control group, with statistical differences ( P<0.05) . Conclusions:Implementing early pulmonary rehabilitation for adult ICU patients with mechanical ventilation in high altitude area is conducive to promoting pulmonary rehabilitation of patients, improving the success rate of ventilator removal, and reducing patients' ICU stay time, mechanical ventilation time and the occurrence of complications.

The authors systematically reviewed the progress of health human resources development, personnel management system and conceptual changes from 2011 to 2020 in China, and analyzed the status quo in this regard. The past 10 years have witnessed rapid progress of health human resources, namely better personnel management system and constant innovation in human development concepts. As required by the strategy of empowering the country with talents in the new era, as well as the overall promotion for the Healthy China initiative and the high-quality development of the health industry, higher requirements have been put forward for the quantity and quality, structural distribution and management innovation of health human resources. Therefore it is necessary to further expand the coverage of talents work and innovate talents policy, thus keeping the upgrade of the capability and competence of health talents.

Health manpower is key to the functioning of the health system. There exists a general need to strengthen health human resources in countries at large as they achieve universal health coverage. Through the systematic collection and sorting out of the declarations, initiatives, guidelines in the world and topics at the World Health Assemblies on health manpower-related issues since 2000, this paper summarized and analyzed the key issues and trends on health manpower planning, education and training, international migration, and compensation management, in order to provide reference for China′s health manpower management and practice.

Objective To investigate the molecular characteristics of H5 subtype avian influenza viruses (AIV) in Weining, Guizhou Province. Methods Nine representative strains were randomly select-ed from H5 subtype AIV that were identified by real-time PCR in Weining, Guizhou Province from 2015 to 2017. Nucleic acid was extracted from each sample and hemagglutinin (HA) genes were amplified and then sequenced. Homology, genetic evolution and the sites related to pathogenicity, receptor binding regions as well as potential glycosylation of H5 AIV were analyzed by bioinformation software. Results Homology analysis revealed that there was 96. 1%-99. 9% and 95. 7%-100% similarity among the nine strains in nu-cleotide and amino acid of HA gene, respectively. These strains belonged to two branches, H5-1 and H5-2. The cleavage site motifs were PLREKRRKR↓GLF for five strains in H5-1 branch and PQRERRRKR↓GLF for four strains in H5-2 branch, which made them high pathogenic. QSG and QRG at the key receptor bind-ing sites were found in H5-1 and H5-2 branch strains, respectively. They were responsible for receptor bind-ing specificity of AIV. Mutations of 138Q, 139G and 53K were all detected in the nine strains. 129K, 189T, 140K and 282V mutations were discovered in the five strains of H5-1 branch, while 189N, 140M and 282I mutations were found in the four strains of H5-2 branch. Results of the glycosylation motif analysis showed that six sites were conservative, but there was an addition of 124NHT site in two strains of H5-2 branch isolated in 2017. Conclusion Two high pathogenic H5 subtypes of AIV could be epidemic in Wein-ing, Guizhou Province during 2015 to 2017. Although H5 subtype AIV did not possess specific receptor binding regions like human influenza viruses, they were in continuous variation with an increase in glycosyla-tion motifs, which might enhance their virulence and pathogenicity to human beings. Hence, surveillance and study on the molecular properties of H5 subtype AIV should be strengthened.