To explore the method of constructing the first-class undergraduate course of Treatise on Febrile Diseases. The undergraduates majoring in traditional Chinese medicine were selected as the teaching subjects. Three combinations (combination of theory and clinics, combination of science and education, and combination of ideological/political education and professional education) were adopted as the starting point. A variety of teaching methods were used. The combination of in-class and after-class and the combination of theory and clinics were implemented. Course construction was carried out from the aspects of course objectives, course resource construction, course content, organization and implementation, and course evaluation methods. Emphasis was placed on the process evaluation and formative evaluation. Questionnaire survey and final examination were used to evaluate the teaching effect. The results showed that a total of 10 first and second prizes were awarded in the provincial and municipal innovation competitions related to the theory of cold disease in the past three years. During the same time, more than 70 medical records were collected and collated, 82 research papers and 155 learning experiences were documented, five communities were visited along with the affiliated hospital and the school hospital for providing healthcare services in rural areas, and more than 20 traditional Chinese diagnosis and treatment activities were performed in these communities. The average score of students in overall course evaluation was 87. More than 94.00% (141/150) students highly evaluated the course construction. They believed that the course construction was very helpful to the theoretical study and clinical application of Treatise on Febrile Diseases, and improved their levels and abilities in classic reading, medical case evaluation and analysis, and syndrome differentiation and treatment. Students' recognition of this course has been improved and phased results have been achieved.

Objective:To explore the potential correlation between cumulative pulse pressure (cumPP) level and metabolic syndrome (MetS), and to provide insights for MetS management.Methods:A total of 3 968 subjects who underwent health checkup were selected to form a research cohort, and the data were categorized into three groups based on the tertiles of cumPP levels. Cox proportional hazards regression model was employed to analyze the association between different cumPP levels and the incidence of new-onset MetS. Results:The risk of MetS increased with the increased tiers of the cumPP levels (2.5%, 4.3%, and 4.6%, Ptrend<0.001) during the median follow-up period of 2.16 years. Spearman rank correlation analysis showed that cumPP was positively correlated with waist circumference, systolic blood pressure, diastolic blood pressure and fasting plasma glucose (all P<0.05). The Cox proportional hazards regression adjusted model showed that the risk of MetS in Q2 and Q3 was higher than that in Q1 in the total population, and the same results were observed in males (all P<0.05), while there was no statistical significance in females. Model 3 of the total population adjusted for a variety of confounding factors displayed a higher risk of MetS in Q3 compared with that in Q1[1.654 (95% CI 1.272-2.151) ]. When stratified by sex, and the risk of MetS in Q3 was 1.665 times higher than that in Q1 (95% CI 1.245-2.227), while there was no statistically significant risk in female. According to the visual nomogram of independent risk factors screened by multivariate analysis based on Cox proportional hazards regression model, the incidence of MetS at 1 year, 2 years, and 3 years was 0.18%, 3.97% and 7.39%, respectively. In addition, the dose-response curve was plotted according to cumPP, suggesting that the risk of MetS gradually increased with the increase of cumPP in the total population. Subgroup analyses based on baseline systolic blood pressure levels showed that higher cumPP levels were associated with a higher risk of developing MetS, regardless of whether systolic blood pressure was abnormal. Conclusions:Elevated cumPP levels is significantly related to the incidence of new-onset MetS. Maintaining pulse pressure within an appropriate range over long term is crucial for the management of MetS.

Objective To explore the CT manifestations and clinical features of checkpoint inhibitor-related pneumonitis(CIP).Methods Chest CT images and clinical data of 34 patients with CIP in Ningbo No.2 Hospitael were collected to retrospectively analysis.According to the site of tumor occurrence,22 patients were divided into lung cancer group and 12 patients in other malignant tumor group,and the differences in CT manifestations between two groups were compared.Results Cough(70.59％)and dyspnea(52.94％)were the common clinical symptoms.CIP occurred earlier and over a greater time span in lung cancer group 114.5(41.50,281.50)d than in other maligment tumor group 144(55.75,226.25)d.Eosinophil count was significantly higher only in other maligment tumor group(P=0.009).After hormonal therapy 18 patients improved,8 were stable and 8 progressed or even died.CT signs were prevalent in ground glass shadow(70.59％)and solid shadow(76.47％),and the imaging pattern was dominated by organic pneumonia pattern(47.6％),which was not related to type of primary tumor,and some of them could show nodular granulomatous reaction.Compared to lung cancer group,the other maligment tumor group was more likely to exhibit symmetrical infiltration(58.33％)distribution.Conclusion The clinical features of CIP are nonspecific,compared with other patients with primary malignancies,lung cancer patients are more likely to develop CIP,which is difficult to relieve after treatment,and are easy to develop severe disease.

Objective To accurately encode pelvic organ prolapse and ensure data accuracy.Methods ICD-10 coding analysis was performed in combination with the professional knowledge of the International Classification of Diseases(ICD-10)and specific clinical cases of pelvic organ prolapse.Results Vaginal anterior wall prolapse,regardless of severity,was encoded as N81.1;vaginal posterior wall prolapse,regardless of severity,as N81.6;uterine prolapse grade Ⅰ and Ⅱ,regardless of the presence or absence of vaginal anterior and posterior wall prolapse,as N81.2;uterine prolapse grade Ⅲ,whether the prolapse of the anterior and posterior vaginal walls is combined,or what level of the severity of the prolapse,as N81.3;cervical prolapse staging,regardless of severity or presence of vaginal anterior and posterior wall prolapse,as N81.2.In addition,the N81.-code does not include genital prolapse complicating pregnancy(O34.5),prolapse and hernia of ovary and fallopian tube(N83.4),vaginal fornix prolapse after hysterectomy(N99.3).Conclusion To ensure accurate coding,the composite coding rules must be cross-checked with volume one.ICD-10 failed to reflect the severity of vaginal prolapse in clinical practice.To consider the severity,coding should be extended in the N81.-segment.It is essential for coders to actively acquire clinical knowledge,rein-force professional knowledge,and enhance their responsibility to improve their coding proficiency and ensure data accuracy.

Pancreatic surgery is a high-risk and highly complex procedure, and there are a series of challenges and limitations associated with minimally invasive pancreatic surgery. With the development of robotic technology, robot-assisted pancreatic surgery has gradually become an effec-tive means, and has become an important approach in pancreatic surgeries. The authors summarize the technical characteristics, clinical applications, operation outcomes, and advantages and limita-tions of robot-assisted pancreatic surgery, aiming to explore the application of robot-assisted pan-creatic surgery in modern medicine and to provide an outlook on its future development.

Objective To explore the role of different CVP levels in the occurence and development of sepsis-associated acute kid-ney injury(SA-AKI).Methods Sepsis model was induced using the cecal ligation and puncture(CLP)method for 24h in male SD rats,with a sham group as the control.The rats in two groups were intravenously infused with Ringer's solution to induce an increase in CVP to 10,15 and 20mmHg,respectively.The hemodynamic parameters including mean arterial pressure(MAP),heart rate(HR),and arterial blood lactate(Lac)were dynamically monitored in rats.And side stream darkfield imaging(SDF)technique was used to de-tect the renal cortex microcirculation perfusion parameters including perfused small vessel density(PVD)and microvascular flow index(MFI).Renal injury markers including serum creatinine(CRE),urine neutrophil gelatinase associated lipocalin(NGAL),renal inflam-matory factor interleukin-6(IL-6)levels and renal histopathological changes were also detected.Results Compared with the sham group,the MAP of CLP rats significantly decreased,while HR and Lac significantly increased(P＜0.05).The renal PVD and MFI were significantly decreased(P＜0.05),while serum CRE,urine NGAL,and renal IL-6 were significantly increased(P＜0.05).Com-pared with CVP 10mmHg,the PVD and MFI of CLP rats were significantly decreased at CVP 20mmHg(P＜0.05);The PVD and MFI of sham group at CVP 15mmHg and 20mmHg were significantly lower than those of the CVP at CVP 10mmHg(P＜0.05).The IL-6 of CLP rats at CVP 15mmHg was significantly higher than that at CVP 10mmHg(P＜0.05),and the IL-6 levels at CVP 20mmHg were significantly higher than at CVP 15mmHg(P＜0.05).In CLP rats,increasing CVP led to cortical and medullary edema,vacuolar degen-eration of renal tubular epithelial cells,loss of brush borders,tubular obstruction,and disappearance of Bowman's space;medullary ede-ma was more pronounced than in the cortex.In the sham group,glomerular and tubular swelling occurred at CVP 20mmHg,and Bowman's space became narrower.Conclusion Excessive CVP levels can decrease renal cortical microcirculation perfusion and promote the acti-vation of local inflammation and renal tissue edema in CLP rats,which exerting a detrimental effect during the process of S-AKI.

OBJECTIVE To establish a method for the determination of propofol concentration in human plasma and apply it in patients with lymphedema. METHODS The concentration of propofol was determined by UPLC-MS/MS after protein precipitation of plasma samples using thymol as internal standard. The sample was eluted on a Kinetex C18 column with a mobile phase consisting of acetonitrile （A）-water （B） for gradient elution at the flow rate of 200 μL/min. The sample size was 5 μL， and the column temperature was set at 40 ℃. The sample chamber temperature was 15 ℃. Using multi-reaction monitoring mode， the ion pairs for quantitative analysis were m/z 177.0→161.2 （propofol） and m/z 149.0→133.1 （internal standard）， respectively. The above method was used to determine the plasma concentration of propofol in 6 patients with lymphedema. RESULTS The linear range of propofol was 50-5 000 ng/mL （r＝0.995 0）. RSDs of within- and between-batch precision were not more than 8.08%； no endogenous interference， carryover effect， or dilution effect was observed in blank plasma. The extraction recovery ranged from 89.80% to 93.73%， and matrix effects were within the range of 97.93%-101.73%. RSDs of the stability test were all lower than 3.27%. During intraoperative TCI 2-30 min， the plasma concentration of propofol in 6 patients was maintained in the range of 1 865.3-6 056.2 ng/mL， and the propofol was almost excreted within 4-8 h after operation. CONCLUSIONS The established UPLC-MS/MS method in this study can achieve the determination of propofol and a simple and fast sample pretreatment process without derivatization； it is proved to be suitable for the concentration monitoring of propofol in plasma samples of patients with lymphedema.

Objective:To gain insights into the cognitive processes and utilization patterns of medical students regarding teaching information platforms and resources,and aims to provide valuable references for the implementation of modern medical information technology in educational reforms.Methods:A survey was conducted among all voluntary medical students of grade 2019 to grade 2022.Questionnaire surveys and semi-open interviews were used to investigate.Results:The findings indicated that medical students possess a comprehensive understanding of various teaching platforms,with a high frequency of accessing course materials through these platforms.However,the browsing rate for case analyses recommended by teachers on these platforms remains relatively low.Students demonstrated awareness and utilization of quality courses,particularly MOOCs and micro-courses,which were more frequently utilized compared to other courses.Conclusion:Medical students have a strong awareness of information technology and the ability to solve academic problems through multiple platforms and channels.The construction of teaching platform resources needs to further optimize and improve its simplicity and affinity,and teachers should selectively push high-quality teaching resources to realize the rational application of medical information technology in teaching.

Objective    To investigate the clinical effect of 3D computed tomography bronchial bronchography and angiography (3D-CTBA) and guidance of thoracoscopic anatomic pulmonary segmentectomy by Mimics software system. Methods    A retrospective analysis was performed on patients who underwent thoracoscopic segmentectomy in the Department of Thoracic Surgery of Affiliated People's Hospital of Jiangsu University from June 2020 to December 2022. The patients who underwent preoperative 3D-CTBA using Materiaise's interactive medical image control system (Mimics) were selected as an observation group, and the patients who did not receive 3D-CTBA were selected as a control group. The relevant clinical indicators were compared between the two groups. Results    A total of 59 patients were included, including 29 males and 30 females, aged 25-79 years. There were 37 patients in the observation group, and 22 patients in the control group. The operation time (163.0±48.7 min vs. 188.8±43.0 min, P=0.044), intraoperative blood loss [10.0 (10.0, 20.0) mL vs. 20.0 (20.0, 35.0) mL, P<0.001], and preoperative puncture localization rate (5.4% vs. 31.8%, P=0.019) in the observation group were better than those in the control group. There was no statistically significant difference in the thoracic tube placement time, thoracic fluid drainage volume, number of intraoperative closure nail bin, postoperative hospital stay, or postoperative air leakage incidence (P>0.05) between the two groups. Conclusion    For patients who need to undergo anatomical pulmonary segmentectomy, using Mimics software to produce 3D-CTBA before surgery can help accurately identify pulmonary arteriovenous anatomy, reduce surgical time and intraoperative blood loss, help to determine the location of nodules and reduce invasive localization before surgery, and alleviate patients' pain, which is worthy of clinical promotion.

Objective To introduce a locating device for the entry point of intramedullary nail based on the inertial navigation technology,which utilizes multi-dimensional angle information to assist in rapid and accurate positioning of the ideal direction of femoral anterograde intramedullary nails'entry point,and to verify its clinical value through clinical tests.Methods After matching the locating module with the developing board,which are the two components of the locating device,they were placed on the skin surface of the proximal femur of the affected side.Anteroposterior fluoroscopy was performed.The developing angle corresponding to the ideal direction of entry point was selected based on the X-ray image,and then the yaw angle of the locating module was reset to zero.After resetting,the locating module was combined with the surgical instrument to guide the insertion angle of the guide wire.The ideal direction of entry point was accurately located based on the angle guidance.By setting up an experimental group and a control group for clinical surgical operations,the number of guide wire insertion times,surgical time,fluoroscopy frequency,and intraoperative blood loss with or without the locating device was recorded.Results Compared to the control group,the experimental group showed significant improvement in the number of guide wire insertion times,surgical time,fluoroscopy frequency,and intraoperative blood loss,with a statistically significant difference(P<0.01).Conclusion The locating device can assist doctors in quickly locating the entry point of intramedullary nail,effectively reducing the fluoroscopy frequency and surgical time by improving the success rate of the guide wire insertion with one shot,improving surgical efficiency,and possessing certain clinical value.