Objective To analyze changes in sleep,mood state,and brain function in healthy populations living in near-sea-level environments before and after exposure to high-altitude environment,and to explore the correlations between regional brain functional changes and variations in sleep and mood states.Methods A total of 45 healthy volunteers were enrolled.The participants came from regions of near-sea-level altitudes and were exposed to the high-altitude environment for a short period of time.The Pittsburgh Sleep Quality Index(PSQI),Zung Self-Rating Depression Scale(SDS),Patient Health Questionnaire-9(PHQ-9),Zung Self-Rating Anxiety Scale(SAS),and Generalized Anxiety Disorder-7(GAD-7)were administered to assess sleep quality as well as depressive and anxiety symptoms at 4 time points—prior to high-altitude exposure,immediately after exposure,one month after returning to low-altitude regions,and three months after returning to low-altitude regions.Resting-state functional magnetic resonance imaging(rs-fMRI)data were collected before and after high-altitude exposure,and regional brain functional parameters,including the amplitude of low-frequency fluctuations(ALFF)and functional connectivity strength,were analyzed.Statistical analyses were performed,including a linear mixed-effects model to evaluate longitudinal changes in scale scores,paired-sample t-tests to compare brain function differences before and after exposure,and Pearson correlation analyses to examine the relationship between brain functional changes and alterations in sleep and mood states.Results Compared with the pre-exposure findings,the participants exhibited significantly increased PSQI scores(8.89±4.41 vs.5.08±2.69,P<0.05)and PHQ-9 scores(3.60±4.19 vs.1.54±2.30,P<0.05)immediately after high-altitude exposure.One month after returning to the low-altitude environment,both sleep and depression scores decreased relative to the findings immediately after exposure(PSQI:3.88±2.13 vs.8.89±4.41,P<0.05;PHQ-9:1.50±2.25 vs.3.60±4.19,P<0.05)and showed no statistically significant difference compared with the pre-exposure findings(P>0.05).Three months after returning to near-sea-level environment,sleep,depression,and anxiety scores were all reduced compared with the findings immediately after exposure(PSQI:3.76±2.31 vs.8.89±4.41,P<0.05;PHQ-9:1.24±2.13 vs.3.60±4.19,P<0.05;SAS:23.84±5.93 vs.27.93±7.05,P<0.05),also showing no significant difference compared with the pre-exposure levels(P>0.05).Brain function analysis revealed that,relative to the pre-exposure levels,ALFF in the bilateral superior temporal gyrus,insula,and dorsolateral prefrontal cortex(DLPFC)increased after high-altitude exposure(P<0.05),and that functional connectivity strength in the DLPFC was also elevated(P<0.05).Furthermore,changes in DLPFC functional connectivity strength were positively correlated with changes in sleep and mood scores(P<0.05).Conclusion High-altitude exposure has a significant impact on the sleep,mood states,and brain function of populations from near-sea-level regions,and DLPFC,in particular,is closely associated with changes in sleep and mood states.The findings of this study provide a theoretical basis for health management and intervention strategies in high-altitude environments.

Micropapillary urothelial carcinoma (MPUC) represents a rare but aggressive variant of urothelial carcinoma characterized by early lymphovascular invasion, distant metastasis, and poor clinical outcomes. We present a diagnostically challenging case of ureteral MPUC initially misdiagnosed as intestinal neuroendocrine tumor. After the pathological diagnosis was confirmed, the patient received adjuvant chemotherapy with gemcitabine and carboplatin. Despite therapeutic intervention, the patient developed widespread metastases and succumbed to the disease within 11 months of follow-up.

Micropapillary urothelial carcinoma (MPUC) represents a rare but aggressive variant of urothelial carcinoma characterized by early lymphovascular invasion, distant metastasis, and poor clinical outcomes. We present a diagnostically challenging case of ureteral MPUC initially misdiagnosed as intestinal neuroendocrine tumor. After the pathological diagnosis was confirmed, the patient received adjuvant chemotherapy with gemcitabine and carboplatin. Despite therapeutic intervention, the patient developed widespread metastases and succumbed to the disease within 11 months of follow-up.

Objective:To evaluate the residual risk (RR) of transfusion transmitted HIV (TT-HIV) after the implementation of nucleic acid amplification test (NAT) in blood screening test among blood centers in China.Methods:The data of blood donors and HIV infection markers from 2017 to 2020 were collected from 28 blood centers via the Platform of Comparison of blood establishments Practice in Chinese Mainland. The new infection rate/window period mathematical model was used for two types of blood screening strategies, namely, two rounds ELISA plus individual NAT take turn with pooling NAT (2ELISA+ ID-NAT/MP-NAT) and two ELISA plus one round pooling NAT (2ELISA+ MP-NAT), and the RR of HIV infection was estimated also based on first donors (FDs) and repeated donors (RDs) in different blood donation years. T-test analyses were conducted for comparing TT HIV RR among FDs and RDs in different blood donation years with two blood screening strategies, and the variation trend of RR in HIV test was observed.Results:From 2017 to 2020, the RR of FDs in 2ELISA+ ID-NAT/MP-NAT blood screening strategy was 2.869/10 6 person-year, 3.795/10 6 persons-year, 3.879/10 6 person-year, and 2.890/10 6 person-year respectively. The RR of RDs was 1.797/10 6 person-year, 1.502/10 6 person-year, 1.857/10 6 person-year, and 1.483/10 6 person-year respectively. Significant difference exists between RR of FDs and RDs, with F=9.898 and p<0.05. In 2ELISA+ MP-NAT strategy, the RR of FDs was 3.508/10 6 person-year, 1.868/10 6 person-year, 2.204/10 6 person-year, and 1.765/10 6 person-year respectively. The RR of RDs was 0.948/10 6 person-year, 0.926/10 6 person-year, 0.748/10 6 person-year, and 0.682/10 6 person-year respectively. Statistical difference existed between RR of FDs and RDs, with F=17.126 and P<0.05. There was no significant difference between the RR of FDs in these two strategies with F=3.493 and P>0.05, while there was a difference between the RR of RDs in these two strategies with F=24.516 and P<0.05, and a difference between the RR of total donors (TDs) in these two strategies F=20.216 and P<0.05. Conclusions:The RR of TT HIV significantly decreased after the introduction of NAT into blood test among blood centers in China. There were some differences in the RR of HIV testing among different blood screening strategies. There could be significant differences in the RR of HIV testing among different groups of blood donors. Compared with FDs, RDs is the low risk group for HIV.

Objective To discuss the application and effect evaluation of the standard operation procedure ( SOP ) teaching method during applying surgical practice teaching in local medical college . Method 123 undergraduate students from Grade 2011 clinical medical major in Medical College of Shaoguan University were selected as objects of study. The students were divided into test (odd) group and control (even) group by draw. The two groups were taught by the same teachers, while the SOP method was applied to the test group (n=62) and the traditional surgical clinical teaching method was applied to the control group (n=61). Meanwhile, we used a combined method of the formative assessment and final assess-ment to compare and analyze the teaching feedback. After their graduate internship, we compared their autonomous study capability, clinical evaluation thought, normativity of the operation and capability in their intern positions as well as the degree of satisfaction of the test of two groups by doing a survey among them. All these were analyzed by SPSS 18.0 software, and t test was used to compare two groups' measurement in-formation and count data with chi-square. Results The comprehensive evaluation scores of the test group were significantly higher than the control group, in which the margin was of statistical value [(79.394 ± 8.049) vs. (71.703±10.462), t=39.632, P=0.000]. The percentage of excellence of the test group was signif-icantly higher than the control group, in which the margin was of statistical value (59.68% vs. 39.35%, χ2=5.082, P=0.024). The percentage of failure of the test group was lower than the group taught by the tradi-tional method, in which the margin was of statistical value (3.22%vs. 16.39%, χ2=4.652, P=0.031). Its for-mative assessment result on the evaluation of the experimental teaching process and summative assessment scores were higher than the control group, and the difference was statistically significant [formative scores points: (46.018 ±5.749) vs. (42.771 ±6.459), t=19.445, P=0.000; summative scores: (33.659 ±3.437) vs. (29.063±4.366), t=36.249, P=0.000]. As far as their clinical graduate internship adaptation capabilities were concerned, students from the test group had more satisfaction on the teaching feedback over 4 perspectives than the other group, in which the margin was of statistical value. Experimental groups' satisfaction showed that: 93.55% of students thought the standard operation procedure (SOP) teaching method was beneficial to improving their clinical practice skills, 91.94%thought that it improved their surgical clinical work ability to adapt, 85.48% thought it helped to cultivate their surgical clinical thinking and innovation ability. Conclusions The SOP teaching method in surgical practice teaching helps to enhance students' clinical operation and adaptation capability and promote the teaching quality.

Research-oriented study is a comprehensive learning method focusing on the experimental process deriving from a main issue.Given our clinical teaching experience in years,we incorporated the research-oriented studies into the undergraduate Clinical Medicine course for grade 2009,integrating the trait of the clinical skills education and our local professional training objectives.In the studies,students selected their own topic,designed and did their experiments,searched for the information,processed and analyzed the experiment result and finally completed the thesis.Practice showed that after the strict implementation of research learning plan,students' learning interest,innovative thinking,practical skills,research ability and cooperation spirit all significantly enhanced.

Objective To explore the relationship between interleukin 1 receptor accessory protein-like 2 (IL1RAPL2) gene and cognitive abilities of children in Qin-Ba mountainous region. Methods Four tagged SNPs (rs5962434,rs5916817, rs3764765 and rs5962298 ) in IL1RAPL2 were selected, and then genotyped by PCR-SSCP method in a 320 children sample aged from six to fourteen years old. Results The results showed the rs5962434, rs5916817 ,rs3764765 and rs5962298 had no deviations from Hardy-Weinberg equilibrium (P＞0.05),and there were no significant statistical differences in the average psychometric scores of general cognitive ability(P=0.81,0.53,0.79,0.90) ,verbal comprehension (P=0.58,0.47,0.69,0.87 ) ,memory and concentration (P=0.69,0.35,0.76,0.90) among the compared genotype groups at each of the markers. Furthermore,the results also indicated that the four SNPs were not associated with perceptual organization in males and females respectively (P = 0.70,0.85,0.76,0.90,0.65,0.22,0.98,0.90 ). Conclusion The present work suggests that the human general cognitive ability, the three cognitive factors of C-WISC scale are not influenced manifestly by the genetic variations in IL1RAPL2.