Objective To analyze the influence path of medical students'professional identity on positive defensive medical behaviors and examine the mediating effect of medical risk perception between the two,aiming to provide theoretical support and practical reference for medical education to actively adapt to the demands of the medical and health system reform and promote the scientific guidance of positive defensive medical behaviors.Methods ln 2020,a questionnaire survey was conducted among medical students from four medical colleges in Heilongjiang Province using cluster sampling method,and data analysis was performed using SPSS 27.0 software.Results Medical students'professional identity showed a significant positive correlation with their positive defensive medical behavior(β=0.225,P＜0.001),with medical risk perception acting as a partial mediator(indirect effect accounting for 19%of the total effect).Professional identity(β=0.183,P＜0.001)and medical risk perception(β=0.195,P＜0.001)exerted direct positive effects on positive defensive medical behavior.Conclusion Medical students'professional identity drives them to adopt positive defensive medical behaviors by strengthening their sense of responsibility ethics and risk cognition ability,and medical risk perception is a key mediating variable in this process.Educational management should integrate policy-oriented clinical decision-making training and balance medical safety and efficiency through the collaborative mechanism of"professional identity-risk perception-behavioral practice".

Objective To investigate the efficacy of continuous suture and parachute continuous suture in forearm autologous arteriovenous endovascular fistula surgery,and to analyse their effects on postoperative fistula patency rate and complications.Methods 209 patients with end-stage renal disease(ESRD)admitted to our hospital from January,2020 to January,2024 were selected as observation objects,and they were divided into group A(simple intermittent suture,n=50),group B[simple continuous(two-point)suture,n=63]and group C(parachute continuous suture,n=96)The postoperative vascular anastomosis time,operation time,blood flow,vascular patency rate,thrombosis rate,complication rate and quality of life score of each group were compared.Results In group C,the vascular anastomosis time and overall operation time were the shortest,and the blood flow was less(P<0.05),but there was no significant difference in vascular patency rate,thrombosis rate and complication rate(P>0.05).In group C,the level of serum inflammatory factors decreased the most and the qual-ity of life improved the most significantly(P<0.05).Conclusions Continuous suture and parachute suture can shorten the operation time,reduce the level of serum factors and improve the quality of life.The best scheme should be selected according to the individual differences of patients.

Objective:To investigate the feasibility of transcatheter edge-to-edge repair (TEER) using a short-clip strategy for patients with moderate-to-severe or greater degenerative mitral regurgitation caused by commissural prolapse.Methods:This retrospective study included patients with severe mitral regurgitation secondary to commissural prolapse who underwent TEER at the Second Affiliated Hospital of Zhejiang University School of Medicine between September 2022 and July 2024. Preoperative clinical and imaging data, intraoperative details, procedural outcomes, and 1-month postoperative follow-up results were collected.Results:A total of 19 patients were enrolled, aged (74.1±6.1) years, including 12 males. Among them, 10 patients had external commissural prolapse, and 9 patients had internal commissural prolapse. Preoperatively, all patients exhibited severe mitral regurgitation (4+), with an effective regurgitant orifice area of (0.55±0.17) cm2, left atrial volume of (104.77±36.57) ml, left ventricular end-diastolic volume of (102.29±32.47) ml, left ventricular end-diastolic dimension of (5.34±0.59) mm, and prolapse width of (1.18±0.34) cm. All procedures utilized short clips (NTR or NTW clips) to target the prolapsed commissural region and were completed successfully without intraoperative complications. At 1-month follow-up, no mortality, stroke, single-leaflet device attachment, myocardial infarction, or unplanned mitral reintervention occurred. Mitral regurgitation severity improved to ≤2+ in all patients, with left atrial volume of (74.49±33.83) ml, left ventricular end-diastolic volume of (85.90±18.05) ml, and left ventricular end-diastolic dimension of (4.93±0.37) mm (all P<0.05). Conclusion:The short-clip strategy, focusing on precise clip placement at the commissural interface, is feasible and effective for TEER in patients with severe mitral regurgitation due to commissural prolapse.

Objective To investigate the efficacy of continuous suture and parachute continuous suture in forearm autologous arteriovenous endovascular fistula surgery,and to analyse their effects on postoperative fistula patency rate and complications.Methods 209 patients with end-stage renal disease(ESRD)admitted to our hospital from January,2020 to January,2024 were selected as observation objects,and they were divided into group A(simple intermittent suture,n=50),group B[simple continuous(two-point)suture,n=63]and group C(parachute continuous suture,n=96)The postoperative vascular anastomosis time,operation time,blood flow,vascular patency rate,thrombosis rate,complication rate and quality of life score of each group were compared.Results In group C,the vascular anastomosis time and overall operation time were the shortest,and the blood flow was less(P<0.05),but there was no significant difference in vascular patency rate,thrombosis rate and complication rate(P>0.05).In group C,the level of serum inflammatory factors decreased the most and the qual-ity of life improved the most significantly(P<0.05).Conclusions Continuous suture and parachute suture can shorten the operation time,reduce the level of serum factors and improve the quality of life.The best scheme should be selected according to the individual differences of patients.

Objective Based on the WSR methodology,a three-dimensional integrated perspective of Wuli,Shi-li,and Renli dimensions was used to sort out the logical relationships and architectures among negative defensive medical governance strategies,forming the priority governance strategies for improving negative defensive medical care.Methods Based on the literature research method and the expert consultation method,the governance strate-gy and the conceptual connotation of WSR are classified into items,and the role relationship in the complex sys-tem of passive defensive medical governance is clarified through the WSR methodology.Results A collection of 40 negative defensive medicine governance strategies has been developed,comprising 8 strategies in the Wuli dimen-sion,23 strategies in the Shili dimension,and 9 strategies in the Renli dimension.Conclusion The WSR methodology provides a three-dimensional systemic perspective for governance strategies against negative defen-sive medicine.Addressing this issue requires comprehensive and systematic governance strategies.

Objective Based on the WSR methodology,a three-dimensional integrated perspective of Wuli,Shi-li,and Renli dimensions was used to sort out the logical relationships and architectures among negative defensive medical governance strategies,forming the priority governance strategies for improving negative defensive medical care.Methods Based on the literature research method and the expert consultation method,the governance strate-gy and the conceptual connotation of WSR are classified into items,and the role relationship in the complex sys-tem of passive defensive medical governance is clarified through the WSR methodology.Results A collection of 40 negative defensive medicine governance strategies has been developed,comprising 8 strategies in the Wuli dimen-sion,23 strategies in the Shili dimension,and 9 strategies in the Renli dimension.Conclusion The WSR methodology provides a three-dimensional systemic perspective for governance strategies against negative defen-sive medicine.Addressing this issue requires comprehensive and systematic governance strategies.

Objective To analyze the influence path of medical students'professional identity on positive defensive medical behaviors and examine the mediating effect of medical risk perception between the two,aiming to provide theoretical support and practical reference for medical education to actively adapt to the demands of the medical and health system reform and promote the scientific guidance of positive defensive medical behaviors.Methods ln 2020,a questionnaire survey was conducted among medical students from four medical colleges in Heilongjiang Province using cluster sampling method,and data analysis was performed using SPSS 27.0 software.Results Medical students'professional identity showed a significant positive correlation with their positive defensive medical behavior(β=0.225,P＜0.001),with medical risk perception acting as a partial mediator(indirect effect accounting for 19%of the total effect).Professional identity(β=0.183,P＜0.001)and medical risk perception(β=0.195,P＜0.001)exerted direct positive effects on positive defensive medical behavior.Conclusion Medical students'professional identity drives them to adopt positive defensive medical behaviors by strengthening their sense of responsibility ethics and risk cognition ability,and medical risk perception is a key mediating variable in this process.Educational management should integrate policy-oriented clinical decision-making training and balance medical safety and efficiency through the collaborative mechanism of"professional identity-risk perception-behavioral practice".

Objective:To investigate the feasibility of transcatheter edge-to-edge repair (TEER) using a short-clip strategy for patients with moderate-to-severe or greater degenerative mitral regurgitation caused by commissural prolapse.Methods:This retrospective study included patients with severe mitral regurgitation secondary to commissural prolapse who underwent TEER at the Second Affiliated Hospital of Zhejiang University School of Medicine between September 2022 and July 2024. Preoperative clinical and imaging data, intraoperative details, procedural outcomes, and 1-month postoperative follow-up results were collected.Results:A total of 19 patients were enrolled, aged (74.1±6.1) years, including 12 males. Among them, 10 patients had external commissural prolapse, and 9 patients had internal commissural prolapse. Preoperatively, all patients exhibited severe mitral regurgitation (4+), with an effective regurgitant orifice area of (0.55±0.17) cm2, left atrial volume of (104.77±36.57) ml, left ventricular end-diastolic volume of (102.29±32.47) ml, left ventricular end-diastolic dimension of (5.34±0.59) mm, and prolapse width of (1.18±0.34) cm. All procedures utilized short clips (NTR or NTW clips) to target the prolapsed commissural region and were completed successfully without intraoperative complications. At 1-month follow-up, no mortality, stroke, single-leaflet device attachment, myocardial infarction, or unplanned mitral reintervention occurred. Mitral regurgitation severity improved to ≤2+ in all patients, with left atrial volume of (74.49±33.83) ml, left ventricular end-diastolic volume of (85.90±18.05) ml, and left ventricular end-diastolic dimension of (4.93±0.37) mm (all P<0.05). Conclusion:The short-clip strategy, focusing on precise clip placement at the commissural interface, is feasible and effective for TEER in patients with severe mitral regurgitation due to commissural prolapse.

Objective To investigate the renoprotective effects of a Sichuan dark tea-based medicated dietary formula(alternatively referred to as Qing,or clarity in Chinese)on mice with diet-induced obesity(DIO)and to explore the specific mechanisms involved.Methods Male C57BL/6 mice were randomly assigned to three groups,a control group,a DIO group,and a Qing treatment group,or the Qing group,with 8 mice in each group.The mice in the control group were given normal maintenance feed and purified water,and the other two groups were fed a high-fat diet for 12 weeks to establish the DIO model.After that,high-fat diet continued in the DIO group,while the Qing group was given Qing at the same time for 12 weeks,during which period the weight of the mice was monitored and recorded every week.The mice were sacrificed after 12 weeks.Serum samples were collected and the levels of triglyceride(TG),total cholesterol(TC),alanine aminotransferase(ALT),aspartate aminotransferase(AST),and albumin were measured to evaluate liver function.In addition,renal lipids were extracted to determine the levels of TG and TC in the kidney and periodic acid-Schiff(PAS)and oil red O stainings were performed to evaluate kidney pathological injury.Western blot was performed to determine the phosphorylated AMPK(pAMPK)/AMPK ratio in the kidney tissue.RT-qPCR and Western blot were used to determine the expression of proteins related to fatty acid oxidation,including acetyl-CoA carboxylase 1(ACC1),carnitine acyltransferase 1(CTP1),peroxisome proliferators-activated receptor γ(PPARγ),peroxisome proliferators-activated receptor-1 α(PPAR1α),sterol-regulatory element binding proteins(SREBP-1),and key proteins related to lipid synthesis,including fatty acid synthase(FASN)and stearoyl-coenzyme A desaturase 1(stearoyl-CoA desaturase)in the kidney tissue.16SrRNA and metabolomics were applied to analyze the gut microbiota in the intestinal contents and its metabolites.Results Compared with those of the control group,the levels of liver mass(P=0.000 3),serum ALT(P＜0.000 1)and AST(P=0.0001),and kidney TC(P=0.0191)and TG(P=0.0101)of the DIO group were significantly increased and there was lipid deposition in the kidney.Compared with those of the DIO group,mice in the Qing group showed effective reduction in liver mass(P=0.0316)and improvements in the abnormal serum levels of AST(P=0.0012)and ALT(P=0.002 7)and kidney TC(P=0.0200)and TG(P=0.0499).In addition,mice in the Qing group showed significant improvement in lipid deposition in the kidney.Qing group showed increased pAMPK/AMPK ratio in comparison with that of the DIO group.In comparison with those of the control group,mice in the DIO group had upregulated expression of lipid synthesis-related genes and proteins(SREBP-1,FASN,and SCD1).As for the fatty acid oxidation-related genes and proteins,DIO mice showed upregulated expression of ACC1 and downregulated expression of CPT1A,PPARy,and PGC1α in comparison with those of the control group.In the Qing goup,improvements in regard to all these changes were observed.The Qing group demonstrated improvement in the disrupted homeostasis of the gut microbiota.Short-chain fatty acids in the cecal contents,especially isovaleric acid and propionic acid,were also restored.Conclusion Sichuan dark tea-based medicated dietary formula may improve renal lipid metabolism by regulating gut microbiota and the levels of intestinal short-chain fatty acids,thereby protecting obesity-related kidney injury.Isovaleric acid and propionic acid may be the metabolites key to its regulation of gut microbiota.