Background::The ratio of high-density lipoprotein cholesterol (HDL-C) to low-density lipoprotein cholesterol (LDL-C) predicts cardiovascular disease (CVD) endpoints, yet its prognostic validity in high-risk populations and for type 2 diabetes mellitus (T2DM)-related adverse events remains unestablished.Methods::This study included 32,609 people aged 35-75 years in Fujian Province, China, who were at high risk for CVD. The primary endpoint was all-cause mortality during follow-up. Cox proportional hazard models and restricted cubic spline (RCS) analysis were used to evaluate the correlation between the HDL-C/LDL-C ratio and the endpoints.Result::On the basis of the restricted RCS curve, the participants were classified as having a low (< 0.3), middle (0.3-0.5), or high (> 0.5) HDL-C/LDL-C ratio. Multivariate Cox regression analyses revealed that the risk of all-cause mortality (HR = 1.48, 95% CI 1.14-1.93, p < 0.01 for low; HR = 1.30, 95% CI 1.06-1.58, p < 0.05 for high) was increased in the low and high groups. Participants without T2DM who were at high risk for CVD had similar prognoses (HR = 1.65, 95% CI 1.19-2.28, p < 0.01 for low; HR = 1.35, 95% CI 1.05-1.74, p < 0.01 for high). However, this association was not found in participants with T2DM who were at high risk for CVD. Conclusion::HDL-C/LDL-C can be used to predict the prognosis of individuals at high risk for CVD, and maintaining HDL-C/LDL-C ratios between 0.3 and 0.5 may be the most helpful range for this population. Furthermore, maintaining this ratio range holds clinical significance for cohorts without T2DM, although further exploration is needed in this T2DM cohort.

Background::The ratio of high-density lipoprotein cholesterol (HDL-C) to low-density lipoprotein cholesterol (LDL-C) predicts cardiovascular disease (CVD) endpoints, yet its prognostic validity in high-risk populations and for type 2 diabetes mellitus (T2DM)-related adverse events remains unestablished.Methods::This study included 32,609 people aged 35-75 years in Fujian Province, China, who were at high risk for CVD. The primary endpoint was all-cause mortality during follow-up. Cox proportional hazard models and restricted cubic spline (RCS) analysis were used to evaluate the correlation between the HDL-C/LDL-C ratio and the endpoints.Result::On the basis of the restricted RCS curve, the participants were classified as having a low (< 0.3), middle (0.3-0.5), or high (> 0.5) HDL-C/LDL-C ratio. Multivariate Cox regression analyses revealed that the risk of all-cause mortality (HR = 1.48, 95% CI 1.14-1.93, p < 0.01 for low; HR = 1.30, 95% CI 1.06-1.58, p < 0.05 for high) was increased in the low and high groups. Participants without T2DM who were at high risk for CVD had similar prognoses (HR = 1.65, 95% CI 1.19-2.28, p < 0.01 for low; HR = 1.35, 95% CI 1.05-1.74, p < 0.01 for high). However, this association was not found in participants with T2DM who were at high risk for CVD. Conclusion::HDL-C/LDL-C can be used to predict the prognosis of individuals at high risk for CVD, and maintaining HDL-C/LDL-C ratios between 0.3 and 0.5 may be the most helpful range for this population. Furthermore, maintaining this ratio range holds clinical significance for cohorts without T2DM, although further exploration is needed in this T2DM cohort.

Objective To analyze the fluid resistance characteristics of different drafting formations in marathon swimming using computational fluid dynamics(CFD)method,and provide theoretical guidance for selecting optimal drafting strategies in competitions and training.Methods Multi-swimmer models were established via three-dimensional body scanning technology,and various formation models(I-,A-,V-,L-,H-type)were created by adjusting lateral and longitudinal distances between swimmers.The ANSYS Discovery Live software was used to simulate the overall resistance of different models and the resistance of individual swimmers within formations.Results The I3-type formation exhibited an overall drag reduction effect,reducing total resistance by 55.21％,whereas other formations increased overall resistance.The V-type formation showed the most significant resistance increase(31.88％).During drafting,the lowest resistance position was the rear position in the I3-type formation,while the highest resistance position was the middle position in the L-type formation.When leading,the fluid resistance of the leading swimmer in the A-type formation was significantly greater than that of an individual swimmer(P＜0.05).Conclusions Longitudinal drafting formations demonstrated superior drag reduction effects,with the rear position in a three-person longitudinal arrangement showing the optimal drag reduction.Considering both tactical considerations and drag reduction effects,swimmers are advised to avoid the middle position in lateral formations.

Objective To analyze the fluid resistance characteristics of different drafting formations in marathon swimming using computational fluid dynamics(CFD)method,and provide theoretical guidance for selecting optimal drafting strategies in competitions and training.Methods Multi-swimmer models were established via three-dimensional body scanning technology,and various formation models(I-,A-,V-,L-,H-type)were created by adjusting lateral and longitudinal distances between swimmers.The ANSYS Discovery Live software was used to simulate the overall resistance of different models and the resistance of individual swimmers within formations.Results The I3-type formation exhibited an overall drag reduction effect,reducing total resistance by 55.21％,whereas other formations increased overall resistance.The V-type formation showed the most significant resistance increase(31.88％).During drafting,the lowest resistance position was the rear position in the I3-type formation,while the highest resistance position was the middle position in the L-type formation.When leading,the fluid resistance of the leading swimmer in the A-type formation was significantly greater than that of an individual swimmer(P＜0.05).Conclusions Longitudinal drafting formations demonstrated superior drag reduction effects,with the rear position in a three-person longitudinal arrangement showing the optimal drag reduction.Considering both tactical considerations and drag reduction effects,swimmers are advised to avoid the middle position in lateral formations.

Objective:To explore the clinical value of a trinity strategy for the treatment of multiple orthopedic trauma.Methods:A retrospective case series study was conducted to analyze the clinical data of 1 267 patients with multiple orthopedic trauma admitted to Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and the First Affiliated Hospital of Navy Medical University from June 2013 to May 2023, including 862 males and 405 females, aged 18-93 years [(55.2±19.8)years]. Associated injuries included hemorrhagic shock in 632 patients, traumatic wet lung in 274, cranial injuries in 135, abdominal and pelvic bleeding in 116, pneumothorax in 89, urinary injury in 13, and vesical rupture in 8. All the patients were treated with the trinity strategy and the treatment process was divided into the phases of first aid, remodeling, and rehabilitation. The first aid phase focused on stabilizing symptoms and saving lives; the remodeling phase centered on restoring the anatomical structure and alignment; the rehabilitation phase aimed for functional recovery through the integration of both Western and traditional Chinese medicine. The all-cause mortality within 30 days after surgery and fracture healing time were calculated; the excellent and good rates of Constant-Murley shoulder score, Mayo elbow score, Gartland-Werley wrist score, Harris hip score, Hospital for Special Surgery (HSS) knee score and the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot score at the last follow-up and the overall excellent and good rate of all joint function scores were measured. The short form health survey (SF-36) scores were collected preoperatively and at 6 months postoperatively, including 8 aspects such as physical functioning, physical role, bodily pain, general health, vitality, social functioning, emotional role, and mental health. The incidence of postoperative complications was recorded.Results:All the patients were followed up for 6-18 months [(10.2±4.2)months]. The mortality rate during the acute phase (within 30 days after surgery) was 2.37% with 12 deaths due to hemorrhagic shock, 10 due to traumatic brain injury, 6 due to multiple organ dysfunction syndrome (MODS), and 2 due to pulmonary infection. The average fracture healing time averaged 3.8-18 months [(11.5±4.2)months], with 89.49% of the patients having bone union within 12 months after surgery, 8.93% having bone union within 18 months after surgery, and 1.58% undergoing reoperation. For the patients with internal fixation failure and nonunion, the average healing time was extended to (10.2±2.2)months and (13.7±3.3)months respectively. At the last follow-up, the excellent and good rates of Constant-Murley shoulder score, Mayo elbow score, Gartland-Werley wrist score, Harris hip score, HSS knee score, and AOFAS ankle-hindfoot score were 83.93%, 90.24%, 94.12%, 85.57%, 88.46%, and 92.31% respectively, with an overall excellent and good rate of 89.11%. At 6 months after surgery, the SF-36 scores of all the patients in the eight dimensions,including the physical functioning, physical role, bodily pain, general health, vitality, social functioning, emotional role, and mental health were (74.4±8.6)points, (44.7±14.4)points, (77.4±10.9)points, (68.4±18.2)points, (72.5±16.0)points, (76.8±8.7)points, (49.9±17.6)points, and (72.8±17.9)points, significantly improved compared with those before operation [(63.4±12.7)points, (30.9±17.4)points, (56.4±18.0)points, (55.4±24.7)points, (53.5±21.0)points, (55.8±24.3)points, (36.9±24.0)points, (58.8±21.6)points] ( P<0.01). Complications of different degrees occurred in 214 patients (16.89%), including lung infections in 118 patients (9.31%), lower extremity deep vein thrombosis in 50(3.95%), pressure injuries in 26(2.05%), internal fixation failure in 12(0.95%), and nonunion in 8(0.63%). Conclusions:The trinity strategy provides whole-process management, personalized treatment, and overall rehabilitation for multiple orthopedic trauma. It can decrease mortality, shorten fracture healing time, improve joint function and quality of life, and reduce the incidence of complications.

Anatomy is a subject in the field of medical morphology. Traditional experimental teaching of anatomy is confronted with the disadvantages of poor experimental conditions, high specimen loss rate and insufficient two-way interaction between teachers and students. Under the background of "Internet", we explore the development of new anatomy experimental teaching, by providing electronic screen and physical display platform, VR camera and elevating anatomic table, the entity learning space is created. And through the deployment of intelligent teaching platform and digital human anatomy system, the virtual learning space is built. Upon this, we have built the smart lab for online and offline integration based on big data, and also explored a new type of anatomy experiment teaching, aiming to promote the anatomy experiment teaching to meet the needs of modern medical education, and to provide reference for experimental teaching reform and overall wisdom campus construction.

Objective:To study the features and regularity of the diseases occurred among the officers and sailors of a certain large surface ship during a long oceangoing mission, and to provide some targeted preventive measures for improving the medical support in long oceangoing mission in future.Methods:A retrospective survey was conducted on the medical records of outpatient, emergence, and onboard medical inspection by classifying all the cases into different medical disciplines, to analyze the features of disease distribution and regularity among the crew members during a long oceangoing mission.Results:There were 673 case/times were included into this analysis from the 81-day-long 549-people-participation oceangoing mission. The top 3 disorders involved in the respiratory system, the motor system (trauma), and the digestive system, accounting for 70.58% of the total cases. Among them, the upper respiratory tract infection, hand injury, and oral ulcer accounted for 21.86%, 5.65%, and 5.28% of the disease spectrum respectively. The incidence of diseases requiring surgery and further medical care was relatively higher (24.59%), especially trauma and infectious diseases as the prevalent disorders, concentrating on the motor system and digestive system.Conclusion:The disease spectrum during the long oceangoing was related with the onboard living environment, individual body constitution, individual history of long oceangoing deployment, and gender difference. With regard to disease control, the efforts should be devoted to health education and disinfection of onboard environment, especially preventing infectious diseases. Personal health records and pre-warning of disease outbreak system should also be established if necessary. Meanwhile, the manning of medical team and the preparation of medical supplies should conform to the features and distribution regularity of diseases spectrum during a long oceangoing mission.

Objective:To study the features and regularity of the diseases occurred among the officers and sailors of a certain large surface ship during a long oceangoing mission, and to provide some targeted preventive measures for improving the medical support in long oceangoing mission in future.Methods:A retrospective survey was conducted on the medical records of outpatient, emergence, and onboard medical inspection by classifying all the cases into different medical disciplines, to analyze the features of disease distribution and regularity among the crew members during a long oceangoing mission.Results:There were 673 case/times were included into this analysis from the 81-day-long 549-people-participation oceangoing mission. The top 3 disorders involved in the respiratory system, the motor system (trauma), and the digestive system, accounting for 70.58% of the total cases. Among them, the upper respiratory tract infection, hand injury, and oral ulcer accounted for 21.86%, 5.65%, and 5.28% of the disease spectrum respectively. The incidence of diseases requiring surgery and further medical care was relatively higher (24.59%), especially trauma and infectious diseases as the prevalent disorders, concentrating on the motor system and digestive system.Conclusion:The disease spectrum during the long oceangoing was related with the onboard living environment, individual body constitution, individual history of long oceangoing deployment, and gender difference. With regard to disease control, the efforts should be devoted to health education and disinfection of onboard environment, especially preventing infectious diseases. Personal health records and pre-warning of disease outbreak system should also be established if necessary. Meanwhile, the manning of medical team and the preparation of medical supplies should conform to the features and distribution regularity of diseases spectrum during a long oceangoing mission.

Objective: To observe the effect of pyridoxamine and telmisartan on the indexes of myocardial remodeling in spontaneous hypertensive rats (SHR). Methods: A total of 48 male SHR at 22 weeks of age were randomly divided into 4 groups:①Hypertension (H) control group, the rats received distilled water 2 ml/d,②telmisartan (T) group, the rats received telmisartan 6 mg/(kg.d),③pyridoxamine (P) group, the rats received pyridoxamine 200 mg/(kg.d),④Combination (TP) group, the rats received both telmisartan and pyridoxamine. All animals were treated for 16 weeks and the systolic blood pressure (SBP) was measured before and after treatment. After treatment, the serum levels of nitric oxide (NO) and super oxide dismutase (SOD) were examined by chemiluminescent method, advanced glycation end-products (AGEs) was detected by ELISA, left ventricular weight index and collagen volume fraction (CVF) in myocardial tissue were calculated, the mRNA expression of myocardial receptor of advanced glycation end products (RAGE) was evaluated by real time RT-PCR. Results: Compared with H group, SBP levels were decreased in T and TP groups,P<0.01, while SBP in P group stayed similar,P>0.05. Compared with H group, the serum levels of NO and SOD were increased in T, P and TP groups,P<0.01; while compared with T group and P group, the levels of NO and SOD were further increased in TP group,P<0.05. Compared with H group, left ventricular weight index and CVF were decreased in T, P and TP groups,P<0.01; while compared with T group and P group, left ventricular weight index and CVF were further decreased in TP group,P<0.05. Pyridoxamine and telmisartan had the coordinative effect on left ventricular weight index and CVF, P<0.05. The serum levels of AGEs were lower in T group (5.99 ± 0.51) mg/L, P group (5.57 ± 0.91) mg/L and TP group (5.24 ± 0.63) mg/L than that in H group, (6.71 ± 0.50) mg/L,P<0.01; while compared with T group and P group, AGEs was further decreased in TP group,P<0.05. The mRNA expressions of RAGE were reduced in T group (0.035 ± 0.010), P group (0.036 ± 0.005) and TP group (0.024 ± 0.007) than that in H group (0.053 ± 0.010),P <0.01; while compared with T group and P group, the mRNA of RAGE was further reduced in TP group, P<0.05. Conclusion: Pyridoxamine could improve the oxidative stress and the indexes of myocardial remodeling independently from decreasing blood pressure in SHR. Combined intervention of P and T may break the coordination systems between AGEs-RAGE and renin-angiotensin, therefore further improve the indexes of myocardial remodeling in SHR.

The initiation of the long-term system in medical education satisfies the needs of the development of medical science and medical education.In order to improve the quality of the long-term education system in medical education,we have to realize our educational objectives,perfect education models,deepen the education reform and establish a scientific course system and a quality evaluation system.