Fungal keratitis represents a significant cause of blindness, with current therapeutic approaches yielding limited success. The disease's onset and progression are primarily driven by fungal virulence factors and the host's immune response. The innate immune system is the first to respond, with neutrophils playing a pivotal role in the antifungal defense. Although neutrophils are critical for pathogen clearance, their excessive or abnormal activation can lead to tissue damage, exacerbating the disease. Thus, elucidating the mechanisms underlying neutrophil activity in fungal keratitis is crucial for refining treatment strategies. This article aims to systematically review the principal antimicrobial mechanisms employed by neutrophils, including phagocytosis, degranulation, and the formation of neutrophil extracellular traps(NETs). Furthermore, it explores the crosstalk between neutrophils and macrophages, alongside their collective impact and underlying mechanisms in the context of fungal keratitis. Exploration of the mechanisms of fungal keratitis facilitates precise intervention and enhances the efficacy of treatment.

Objective:To construct a dynamic competency assessment system suitable for standardized training of resident physicians in the department of pediatric infectious diseases, verify its teaching practice effectiveness, and enhance the core competence of specialist physicians.Methods:Based on the Delphi method, an evaluation system was constructed. Through two rounds of expert consultation ( n=20, authority coefficient Cr=0.889-0.895), 5 primary indicators, 13 secondary indicators, and 38 tertiary indicators were established, covering dimensions such as clinical thinking, operational skills, and professional ethics. The hierarchical and progressive design and dynamic feedback mechanism were adopted. Sixty residents were randomly divide into an observation group (dynamic evaluation system) and a control group (traditional evaluation). Differences between the two groups were compared in terms of short-term teaching effectiveness (e.g., OSCE assessment and Mini CEX score) and long-term clinical competencies (e.g., exit assessment pass rate and incidence of adverse events). SPSS 24.0 was used for t-test, Mann Whitney U test, and internal consistency test (Cronbach's alpha=0.89). Results:The observation group outperformed the control group in core specialty competencies and clinical practice outcomes. In terms of core specialty competencies, the observation group had a higher response speed score for pathogen results [(4.10±0.84) vs. (3.60±0.95), P=0.042]. This indicates that the dynamic evaluation system effectively enhanced the ability of trained physicians to quickly adjust treatment plans based on pathogenic evidence. The implementation rate of infection prevention and control standards and diagnostic accuracy were also higher in the observation group compared to the control group, reflecting the advantages of this system in standardizing clinical operations and improving diagnostic levels. In terms of long-term clinical competencies, the observation group showed significantly increased exit assessment pass rate and significantly decreased incidence of medical adverse events, further verifying the continuous promotion effect of the dynamic evaluation system on the clinical competence of trained physicians. Conclusions:The dynamic evaluation system constructed in this study can effectively enhance the core specialty competencies (e.g., pathogen response and infection prevention and control) and long-term clinical competence of residents in the department of pediatric infectious diseases, providing scientific basis for optimizing the training models of specialist physicians.

Objective:To construct a dynamic competency assessment system suitable for standardized training of resident physicians in the department of pediatric infectious diseases, verify its teaching practice effectiveness, and enhance the core competence of specialist physicians.Methods:Based on the Delphi method, an evaluation system was constructed. Through two rounds of expert consultation ( n=20, authority coefficient Cr=0.889-0.895), 5 primary indicators, 13 secondary indicators, and 38 tertiary indicators were established, covering dimensions such as clinical thinking, operational skills, and professional ethics. The hierarchical and progressive design and dynamic feedback mechanism were adopted. Sixty residents were randomly divide into an observation group (dynamic evaluation system) and a control group (traditional evaluation). Differences between the two groups were compared in terms of short-term teaching effectiveness (e.g., OSCE assessment and Mini CEX score) and long-term clinical competencies (e.g., exit assessment pass rate and incidence of adverse events). SPSS 24.0 was used for t-test, Mann Whitney U test, and internal consistency test (Cronbach's alpha=0.89). Results:The observation group outperformed the control group in core specialty competencies and clinical practice outcomes. In terms of core specialty competencies, the observation group had a higher response speed score for pathogen results [(4.10±0.84) vs. (3.60±0.95), P=0.042]. This indicates that the dynamic evaluation system effectively enhanced the ability of trained physicians to quickly adjust treatment plans based on pathogenic evidence. The implementation rate of infection prevention and control standards and diagnostic accuracy were also higher in the observation group compared to the control group, reflecting the advantages of this system in standardizing clinical operations and improving diagnostic levels. In terms of long-term clinical competencies, the observation group showed significantly increased exit assessment pass rate and significantly decreased incidence of medical adverse events, further verifying the continuous promotion effect of the dynamic evaluation system on the clinical competence of trained physicians. Conclusions:The dynamic evaluation system constructed in this study can effectively enhance the core specialty competencies (e.g., pathogen response and infection prevention and control) and long-term clinical competence of residents in the department of pediatric infectious diseases, providing scientific basis for optimizing the training models of specialist physicians.

Fungal keratitis is a serious blinding eye disease. The development of fungal infections depends primarily on the interaction of fungal virulence with host immune defense factors. The cornea is considered an immune-privileged organ, and resident macrophages are the main immune cells that respond to the heterogeneity exhibited by the microenvironment with their polarization. In the early stage of infection, macrophages polarize towards M1, which promotes inflammation and facilitates fungal clearance but produces a cellular storm that exacerbates immune damage; in the late stage of infection, macrophages polarize towards M2, which suppresses the inflammatory response and facilitates tissue repair, but may be immunosuppressed or even immune escape to the detriment of pathogen clearance. The balance between pro-inflammatory and anti-inflammatory responses is key to maintaining the functional integrity of the cornea. Current antifungal drug therapy is limited, so it is particularly important to find a therapeutic target for the inflammatory response triggered by the immune response in addition to antifungal therapy. In this review, the functional and phenotypic characterization of macrophage subsets associated with fungal keratitis was reviewed, more in-depth research is needed to explore the specific mechanisms by which macrophage polarization and their impact on fungal keratitis. Targeted regulation of macrophage differentiation based on their phenotype and function could be an effective approach to treat and manage fungal keratitis in the future.

Objective:To evaluate the safety and efficacy of the neoadventitia technique for root repair in acute type A aortic dissection(ATAAD).Methods:From January 2019 to February 2022, a total of 94 patients with ATAAD who underwent surgical treatment in Beijing Anzhen Hospital were retrospectively analyzed. According to the different treatment methods for the aortic root, the patients were divided into the neoadventitia technique group(58 cases) and the Bentall group(36 cases). The perioperative data and postoperative follow-up results of the two groups were compared, and the efficacy of the new adventitia technique in acute type A aortic dissection was analyzed.Results:There were no intraoperative deaths. The 30-day mortality was 3.4% and 5.6% in the neoadventitia group and Bentall group, respectively ( P=0.636). The cardiopulmonary bypass time[(154.3±29.8)min, P<0.001] and aortic clamp time[(94.7±20.6)min, P<0.001)]were significantly shorter in the neoadventitia group, compared with the Bentall group. Aortic regurgitation was significantly improved after the operation (0.33±0.50 vs. 1.02±0.80, P<0.001). No aortic root-related secondary intervention occurred during follow-up. There was no significant difference in mortality between the two groups( P=0.248). Conclusion:Neoadventitia root repair is a safe and feasible method for the treatment of ATAAD, which has good short-term and mid-term efficacy.

Objective:To explore the application and practice of "flipped classroom" in the teaching of general surgery interns.Methods:A total of 20 internship groups (3 to 5 people in each group) were randomly selected from the general surgery practice group in the Department of General Surgery of the Second Clinical Medical College of North Sichuan Medical College. They were randomly divided into the flipped group (45 people) and the traditional group (40 people), with 10 subgroups in each group. The flipped group adopted the flipped classroom teaching mode (students' self-study by handing out materials before class, students and teachers' discussion in class, and students and teachers' evaluation after class), while the control group adopted the current conventional teaching mode (students' preview before class, teachers' explanation in class, and teachers' question answering after class). At the end of the teaching, a questionnaire was used to evaluate the participation and completion of each student. The teaching effect was evaluated by medical history collection and case analysis. The participation, completion, and teaching effect between the two groups were compared and analyzed. SPSS 23.0 software was used for t-test and Chi-square test. Results:The participation of the flipped group was better than that of the traditional group [(17.45±1.83) vs. (15.57±1.52)], and the difference was statistically significant ( P < 0.05). There was no statistically significant difference between the flipped group and the traditional group. There was no significant difference in medical history collection scores between the two groups. The case analysis of the flipped group was better than that of the traditional group [(87.30±6.06) vs. (81.50±5.88), P < 0.05]. The questionnaire shows that about 90% of the students think that flipped classroom can improve their interest in learning [96% (43/45)], improve their autonomous learning ability [89% (40/45)], and have better learning effect. At the same time, 78% (35/45) of students think that learning time is too long. Conclusion:The flipped classroom teaching model can improve the teaching participation of general surgery students, improve students' interest in learning, improve their self-learning ability, and improve students' thinking ability of medical record analysis.

Objective:To evaluate the efficacy of new arch-clamping technique in Sun’s procedure to repair acute type A aortic dissection.Methods:67 consecutive patients with acute type A aortic dissection who underwent total arch replacement and frozen elephant trunk implantation(TAR+ FET) from Dec 2019 to Dec 2022 with using new arch-clamping technique during operation. Relative intraoperative and postoperative variables and complications were compared.Results:Cardiopulmonary bypass time was(166.66±32.81)min, the aortic occlusion time was(100.49±19.96)min, the circulatory arrest time was(3.97±1.63)min, the lowest nasopharyngeal temperature was(25.716±1.304)℃, and the lowest bladder temperature was(26.209±1.552)℃. The whole group died in hospital in 2 cases(2.98%), cerebral infarction in 3 cases(4.48%), transient neurological dysfunction in 4 cases(5.97%), paraplegia patients in 1 case(1.49%), renal failure requiring continuous dialysis in 4 cases(5.97%).Conclusion:New arch-clamping technique decrease postoperative complication, and is a safe and feasible innovative approach to effectively improve surgical outcome of Sun’s procedure for repair of acute type A aortic dissection.

Objective : To investigate the expression of programmed death 1 (PD1) on CXCR5 - CD4 + T cells from the patients with systemic lupus erythematosus ( SLE) and to analyze the clinical relevance to disease severity. Methods : The expression of PD1 on CXCR5 - CD4 + T cells was examined from 47 SLE patients and 35 healthy controls (HC) by the technique of flow cytometry. The expression of PD1 including percentage of PD1 + CXCR5 -CD4 + T cells and mean fluorescence intensity (MFI) on CXCR5 - CD4 + T cells was compared between SLE patients and HC. And its correlation with clinical indicators , laboratory inspection and the percentage of plasmablasts was analyzed. Moreover, the predictive value of the expression of PD1 on CXCR5 - CD4 + T cell was explored. Results: ① The percentage of PD1 + CXCR5 - CD4 + T cells from SLE patients significantly elevated compared with HC (P= 0. 008 3 , U = 540. 5) , and the MFI of PD1 on CXCR5 - CD4 + T cells from SLE patients significantly elevated compared with HC (P < 0. 000 1 , U = 187. 0) . ② The percentage of PD1 + CXCR5 - CD4 + T cells was associated with C3 ( rs = - 0. 335 2 , P = 0. 022 8) , anti - SSA (P = 0. 016 6 , t = 2. 5) , anti - histone (P = 0. 030 3 , t =2. 3) , treatment (P = 0. 020 2 , t = 3. 4) , plasmablasts ( rs = 0. 387 1 , P = 0. 0072) in SLE patients. The MFI of PD1 on CXCR5 - CD4 + T cells was associated with SLEDAI ( rs = 0. 403 1 , P = 0. 005 0) , ESR ( rs = 0. 356 1 , P= 0. 017 7) , CRP ( rs = 0. 337 4 , P = 0. 028 9) , RBC ( rs = - 0. 297 0 , P = 0. 042 6) , HGB ( rs = - 0. 302 9 , P= 0. 038 5) , HCT ( rs = - 0. 381 6 , P = 0. 008 1) , L ( rs = - 0. 393 7 , P = 0. 006 2) , L% ( rs = - 0. 391 2 , P= 0. 006 5) , N% ( rs = 0. 315 0 , P = 0. 031 1) , NLR ( rs = 0. 373 0 , P = 0. 009 8) , LMR ( rs = - 0. 431 5 , P =0. 002 5) , dNLR ( rs = 0. 315 0 , P = 0. 031 1) , anti⁃Ro52 (P = 0. 029 5 , t = 63. 5) , treatment (P = 0. 035 5 , W= 21) , plasmablasts ( rs = 0. 315 8 , P = 0. 030 6) . ③ Logistic regression analysis showed that the MFI of PD1 on CXCR5 - CD4 + T cells was a risk factor for SLE. ④ ROC analysis showed the AUC of the MFI of PD1 on CXCR5 -CD4 + T cells was 0. 886. A further established model based on combination of the MFI of PD1 on CXCR5 - CD4 + T cells and HGB showed predictive value in distinguishing SLE from HC with AUC of 0. 979. And predictive value was positively associated with SLEDAI ( rs = 0. 313 6 , P = 0. 030 3) . Conclusion Increased percentage of PD1 + CXCR5 - CD4 + T cells and increased MFI of PD1 on CXCR5 - CD4 + T cells in SLE are associated with disease severity and activity , and a model based on combination of the MFI of PD1 on CXCR5 - CD4 + T cells and HGB shows prominent value for predicting SLE.

Aortic aneurysm (AA) is a vascular disease involving the progressive dilation of aorta diameter. It is usually asymptomatic but with high mortality once rupture. Currently, there is no effective pharmacologic treatment. MicroRNA specifically refers to non-coding small RNAs consisting of 19-25 nucleotides. The characteristic of microRNA targeting multiple genes seems to form a complicated regulation network, which receives considerable attention. Emerging studies show that microRNAs are closely related to the occurrence and development of AA. Many microRNAs are involved in multiple cell processes and functions and may participate in the pathogenesis of AA, including endothelial cell dysfunction, inflammatory cell infiltration, smooth muscle cell apoptosis, and extracellular matrix degradation. This article will describe the animal models for AA research and the latest progression of microRNA and AA.

Objective : To investigate the expression of programmed death 1 (PD1) on CXCR5 －CD4 + T cells from the patients with rheumatoid arthritis (RA) and to analyze the clinical relevance to disease severity． Methods : The expression of PD1 on CXCR5 －CD4 + T cells were examined from 82 RA patients and 46 healthy controls (HC) by the technique of flow cytometry．The expression of PD1 including mean fluorescence intensity (MFI) on CXCR5 - CD4 + T cells and percentage of PD1 + CXCR5 －CD4 + T cells were compared between RA patients and HC．Moreo- ver，its correlation with laboratory inspection was analyzed. Results : ① The percentage of PD1 + CXCR5 －CD4 + T cells and the MFI of PD1 on CXCR5 －CD4 + T cells from RA patients were significantly elevated compared with HC (P＜0. 000 1，U = 1 082 ; P ＜0. 000 1 ，U = 917. 5) . ② The percentage of PD1 + CXCR5 － CD4 + T cells in RA patients were positively associated with rheumatoid factors (RF) (rs = 0. 267 9，P = 0. 022 9) ，increased RF (rs = 0. 419，P = 0. 001 1) ，increased anti-cyclic citrullinated peptide (anti-CCP) (rs = 0. 260 7，P = 0. 040 7) ，the percentage of plasmablasts (rs = 0. 302 4，P = 0. 029 3) ，DAS28-ESR (rs = 0. 244 7，P = 0. 042 7) . ③ The MFI of PD1 on CXCR5 －CD4 + T cells in RA patients were negatively with lymphocytes number (rs = －0. 338 7，P = 0. 002 0 ) ，lymphocytes percentage ( rs = －0. 347 9 ，P = 0. 001 4 ) ，lymphocyte-to-monocyte ratio ( rs = - 0. 263 7，P = 0. 017 4) ．The MFI of PD1 on CXCR5 － CD4 + T cells in RA patients were positively associated with neutrophil percentage ( rs = 0. 304 7 ，P = 0. 005 4 ) ，neutrophilto-lymphocyte ratio ( rs = 0. 341 1 ，P = 0. 001 8) ，platelet-to-lymphocyte ratio (rs = 0. 232 1，P = 0. 037 1) ，systemic immune inflammation index (rs = 0. 288 0，P = 0. 009 1) ，derived Neutrophil to lymphocyte ratio ( rs = 0. 320 3，P = 0. 003 6) ，erythrocyte sedi- mentation rate (rs = 0. 259 5，P = 0. 019 3) ，patient visual analogue scale (rs = 0. 241 6，P = 0. 043 9) ．The MFI of PD1 on CXCR5 － CD4 + T cells from high active RA patients was significantly elevated compared with non-high active group (P = 0. 040 7，U = 406. 0) ． Conclusion The abnormal expression of PD1 on CXCR5 －CD4 + T cells are observed in patients with RA．Increased expression of PD1 on CXCR5 － CD4 + T cells are associated with the production of antibody，the percentage of plasmablasts，inflammation，and also disease activity.