OBJECTIVE To analyze the non-genetic risk factors for severe cutaneous adverse reactions （SCARs） related to antiepileptic drugs （AEDs） in HLA-B*15：02 negative patients， and provide a basis for clinical precision medication. METHODS A retrospective case-control design was used to include patients who underwent HLA-B*15：02 testing at our hospital from January 2022 to December 2024. Patients were divided into SCARs group （15 cases who were HLA-B*15：02 negative and diagnosed with SCARs） and control group （38 cases who were HLA-B*15：02 negative and used AEDs）. Risk factors were evaluated using univariate analysis and a multivariable Firth penalty likelihood logistic regression model （Firth regression）， and Benjamin-Hochberg false discovery rate （FDR） and Firth regression were used for correction， and sensitivity analysis was used to quantify the impact of potential biases in carbamazepine exposure rates in the control group on the results. RESULTS Univariate analysis showed that age≥50 years， use of carbamazepine， and combination use of antibiotics/antiviral drugs were risk factors for developing AEDs- related SCARs （OR＝18.15， 7.54， 13.46， 95%CI of 4.13-79.84， 1.89-30.08， 1.36-133.18， all P＜0.05）， while taking lamotrigine was a protective factor [OR＝0.10， 95%CI of 0.02-0.39， P＜0.05]. After FDR correction， the above factors still maintained statistical significance （P＜0.05）. The results of multivariate analysis showed that age≥50 years [adjusted OR＝16.27， 95%CI of 3.98-66.55， P＜0.001] and taking carbamazepine [adjusted OR＝7.11， 95%CI of 1.82-27.85， P＝0.005] were independent risk factors for the occurrence of SCARs-related AEDs. The results of sensitivity analysis showed that the adjusted risk OR range for taking carbamazepine was between 14.2 and 28.4. CONCLUSIONS Age≥50 years and use of carbamazepine are independent non- genetic risk factors for the development of SCARs-related AEDs in HLA-B*15：02 negative patients. It is recommended that elderly patients should prioritize the use of AEDs other than carbamazepine.

Objective To investigate the effects of different foot strike patterns during running on Achilles tendon(AT)morphology and mechanical loading.Methods Fourteen habitual rearfoot strike runners and 14 habitual forefoot strike runners were recruited.Morphological characteristics(tendon length,cross-sectional area,and thickness)of the AT were collected using ultrasound imaging.The AT loading characteristics(plantar flexion moment,tendon force,load rate,impulse,and stress)of subjects wearing cushioned running shoes while running at a speed of 10 km/h were collected and calculated using a three-dimensional force measurement treadmill.Results Compared to habitual rearfoot strike runners,habitual forefoot strike runners showed a significant increase in peak plantar flexion moment of ankle joint,AT peak force,average loading rate,and peak loading rate(P<0.05).However,the differences in AT length,cross-sectional area,and thickness between the two groups were not statistically significant(P>0.05).Conclusions Long-term forefoot strike patterns can adaptively enhance the mechanical loading characteristics of the AT during repetitive stretch-shortening cycles.

The occurrence of perioperative adverse events (PAEs) significantly affects postoperative recovery of patients. In recent years, more and more studies have found that the start time of surgery is closely related to the occurrence of PAE, especially in terms of hospital stay and cost, intraoperative and postoperative complications, and postoperative mortality. This review aims to summarize the impact of different types of surgeries on PAE starting in the morning or afternoon, and to elucidate the possible mechanisms by which morning or afternoon surgeries affect PAE occurrence from the perspectives of circadian rhythms, human factors, and infrastructure, in order to provide reference for reducing patient PAE and accelerating patient recovery.

Objective To explore the correlation between foot morphology and toe/metatarsophalangeal joint muscle strength. Methods Twenty-six male recreational runners were recruited. Foot length, truncated foot length, foot width, navicular height, dorsum height at 50% of the foot length, metatarsophalangeal joint strength, tensile force of the first and remaining four toes were measured by using digital caliper, metatarsophalangeal joint strength tester and dynameter, respectively. Partial correlations were used to analyze the correlation between foot morphology and foot muscle strength. ResultsWith adjusted age and body mass index (BMI), the foot width in standing position and truncated foot length in sitting and standing position were positively correlated to tensile force of the first toe; the foot length, foot width and truncated foot length were positively correlated to tensile force of the remaining four toes in both positions, and the arch height index in sitting position was negatively associated with tensile force of the remaining four toes; the foot width was positively correlated to metatarsophalangeal joint strength in both positions. Conclusions The longer foot length, foot width, truncated foot length, and the lower arch height in normal range might be related to the larger foot muscle strength. The consideration of the differences in foot morphological characteristics in different positions during the measurement of foot morphology can provide references for predicting foot muscle strength and preventing foot injury.

Objective To investigate the mechanical properties of Achilles tendon (AT) during running under different shoe conditions (minimalist vs conventional shoes). MethodsSixteen healthy male runners with habitual rearfoot strike patterns were recruited to complete the running trials at the speed of 3.16~3.50 m/s under two shoe conditions. The cross-sectional area of the AT was obtained by ultrasound imaging. Sagittal plane ankle kinematics and ground reaction forces were recorded by motion capture system and three-dimensional force platform simultaneously. Mechanical properties of the ankle and AT were calculated. Paired t test was used to compare the effects of two shoe conditions on various parameters (ankle angle, strike angle, AT force, stress, strain, etc). ResultsCompared with conventional shoes, foot inclination angle was significantly reduced by 39.9% with minimalist shoes. Obvious increase in ankle moment, peak AT force, peak AT loading rate, average loading rate, and obvious decrease in time to peak AT force were observed with minimalist shoes. Peak AT stress, peak AT strain and corresponding stress rate, peak strain rate also increased significantly with minimalist shoes. ConclusionsGreater AT loading was observed when runners with habitual rearfoot strike pattern in conventional shoes begin to wear minimalist shoes. Therefore, a gradual transition to minimalist shoes was recommended for them so as to improve the ability to load adaptively.

Objective:To investigate the effects of forced-air warming blankets combined with conventional warming strategies on the quality of postoperative recovery and cognitive recovery in elderly patients undergoing laparoscopic radical resection of colorectal cancer.Methods:This was a prospective, randomized, controlled trial.A total of 70 patients aged 65-75 years, who were classified as American Society of Anesthesiologists(ASA)grade-Ⅱ or Ⅲ, undergoing the laparoscopic radical resection of colorectal cancer under general anesthesia, were enrolled.Patients were randomly divided into two groups: the forced-air warming group(group FAW, n=35)and the conventional warming group(group CW, n=35). The inadvertent perioperative hypothermia(IPH), postoperative shivering, postoperative agitation, anesthesia recovery time and other postoperative complications were compared between the two groups.The post-operative quality of recovery scale(PQRS)was used to evaluate the quality of postoperative recovery and the recovery of cognitive function before and 1, 3, and 7 days after operation.Results:As compared with the group CW, the group FAW showed that the incidences of IPH, postoperative shivering and agitation were decreased(5.7% vs.22.8%, 2.8% vs.28.6%, 5.7% vs.31.4%, χ2=4.200, 10.057 and 7.652, P=0.042, 0.003 and 0.006), and the satisfaction degree of patients was increased at 48 hours after operation( P<0.01). The postoperative wake-up time was prolonged in the group CW as compared with the group FAW( P<0.01). Compared with the group CW, the proportion of patients with excellent overall recovery quality was increased in the group FAW 1 day after surgery( P<0.05). There was no significant difference in general recovery quality and cognitive recovery between the two groups at 3 and 7 days after operation. Conclusions:For elderly patients undergoing laparoscopic radical resection of colorectal cancer, the forced-air warming blanket combined with conventional warming strategies is more helpful to decrease the incidence of IPH, reduce postoperative shivering and improve the overall recovery quality at 1 day after operation, but no significant effect on postoperative recovery of cognitive function is found.

Objective:To evaluate the efficacy and safety of Huangqi Guizhi Wuwu Decoction for preventing oxaliplatin-induced peripheral neurotoxicity(OIPN).Methods:PubMed, ScienceDirect, EMbase, VIP, CNKI and WanFang Data were searched to collect the randomized controlled trials(RCTs) of Huangqi Guizhi Wuwu Decoction for OIPN from the date of establishment until July 2019. Two reviewers independently evaluated the quality of literature and extracted data. RevMan5.3 software was used for Meta-analysis.Results:Fifteen RCTs (849 patients) were included. The results of Meta-analyses showed statistically significant differences in favor of Huangqi Guizhi Wuwu Decoction group compared with control group for all incidence of OIPN [ RR=0.57, 95% CI(0.40, 0.81), P=0.002] and incidence of serious OIPN [ RR=0.35, 95% CI(0.25, 0.48), P<0.000 01]. No differences were observed in disease control rates between two groups. There was statistically significant differences between Huangqi Guizhi Wuwu Decoction group and mecobalamine group for all incidence of OIPN [ RR=0.51, 95% CI(0.39, 0.66), P<0.000 01] and incidence of serious OIPN [ RR=0.37, 95% CI(0.19, 0.70), P=0.002]. Conclusions:Huangqi Guizhi Wuwu Decoction is more safety and effective than mecobalamine on the prevention of OIPN and did not affect the efficacy of chemotherapy. So Huangqi Guzhi Wuwu decoction can be widely extended to clinical applications.

Objective: To explore the application effect of mixed reality technology in the teaching of hepatobiliary surgery. Methods: A total of 120 professional postgraduates majored in surgery who had received the four-month standardized training of residents in hepatobiliary surgery department of the First Affiliated Hospital of Army Military Medical University and the First Affiliated Hospital of Chongqing Medical University during 2016-2018 were selected and were equally allocated into the control group and the research group via random number table method. Students in the control group were trained with traditional surgical teaching mode and in the research group were trained with three-dimensional visualization model which was constructed by mixed reality. Students in both groups received assessment and questionnaires at the end of training. Results: Scores of theoretical examination and surgical operation assessment of students in the research group were higher than those in the control group (P<0.05). The error rate for separating gallbladder artery and bile duct in the laparoscopic simulated system of students in the research group was significantly lower than that in the control group (P<0.05). Students-teacher satisfaction degree in the research group was higher than that in the control group (P<0.05). Conclusion Using mixed reality technology to construct a three-dimensional visualization model and to implement hepatobiliary surgery teaching enables the trainees to better master anatomical key points in the hepatobiliary system and the hepatobiliary surgical approach, with good feedback.

Objective To identify the risk factors for postoperative cognitive dysfunction (POCD) in elderly patients undergoing total knee arthroplasty (TKA).Methods Ninety-six American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients,aged 65-80 yr,with body mass index of 18-25 kg/m2,undergoing elective TKA under total Ⅳ anesthesia,were divided into POCD group and non-POCD group according to whether POCD occurred on 7th day after surgery.The patient baseline characteristics in the perioperative period,plasma concentrations of interleukin-1beta (IL-1β),tumor necrosis factor-alpha (TNFα),neuron-specific enolase (NSE) and S-100β protein,and visual analogue scale (VAS) scores at 1 and 2 days after operation were recorded.Logistic regression analysis was used to identify the risk factors for POCD.Results Thirty-eight patients developed POCD at 7 days after operation,and the incidence was 39％.The results of logistic regression analysis showed that the number of operations,VAS score during activity at 1 day after operation,and concentrations of TNF-α,IL-1β,NSE and S-100β protein in plasma were risk factors for POCD (P＜0.05).Conclusion The number of operations,VAS score during activity at 1 day after operation,and concentrations of TNF-α,IL-1β,NSE and S-100β protein in plasma are risk factors for POCD in elderly patients undergoing TKA.

Objective To explore the application effects of three-dimensional teaching mode for clinical anesthesiology. Methods 43 students were selected into control group, who were from class one, grade 2010 in the Department of Anesthesiology, Ningxia Medical University. 42 students were selected into observation group, who were from class two, grade 2010 in the Department of Anesthesiology, Ningxia Medical University. The traditional teaching mode were used for the students in control group during the teaching of clinical anesthesiology, while three-dimensional teaching mode were used for the students in observation group during the teaching. At the end of teaching, the teaching results were compared between the control group and the observation group, mainly including the usual scores evaluated from an anaesthesia plan plus an anaesthesia case discussion, and the final scores. The teaching satisfaction questionnaire were used to assess the effects of two teaching methods on the students' interest in learning, the capacity of clin-ical practice, the abilities of exploring, analyzing and solving problems, etc. SPSS 17.0 software was used in statistical analysis. The students' teaching results were tested by using two independent samples t-test. The satisfactions of these teaching effects were tested by using the Chi-square test. Results The usual and final scores in the observation group were significantly higher than those in the control group [(88.1±5.1) vs. (75.3±4.2), (82.1±3.3) vs. (75.7±3.9); P<0.05]. Compared with the control group, the satisfactions of teaching effects in the observation group were higher such as to stimulate interest in learning (60.5% vs. 90.5%), to improve the abilities of self-study (30.2% vs. 83.3%) and clinical practice (51.2% vs. 85.7%), to widen the scope of knowledge (46.5% vs. 88.1%) and to cultivate the spirits of innovation (55.8% vs. 83.3%), etc (P<0.05). Conclusion During the teaching of clinical anesthesiology, the three-dimensional teaching mode has more advantages than the traditional one, which is good for improving the students' innovation and practice abilities.