Objective This study investigated the regulatory effect of high mobility group protein B1 (HMGB1) in the peripheral blood of patients with primary immune thrombocytopenia (ITP) on myeloid dendritic cells (mDC) and Th17/regulatory T cells (Treg) balance. Methods The study enrolled 30 newly diagnosed ITP patients and 30 healthy controls.Flow cytometry was used to measure the proportion of mDC, Th17, and Treg cells in the peripheral blood of ITP patients and healthy controls. ELISA was conducted to quantify the serum levels of HMGB1, interleukin 6 (IL-6), IL-23, IL-17, and transforming growth factor β(TGF-β). The mRNA levels of retinoic acid-related orphan receptor γt(RORγt) and forehead box P3(FOXP3) were detected by real-time PCR. The correlation between the abovementioned cells, cytokines, and platelet count was assessed using Pearson linear correlation analysis. Results The proportion of Th17 cells and the expression levels of HMGB1, IL-6, IL-23, IL-17 and the level of RORγt mRNA in the peripheral blood of ITP patients were higher than those in healthy controls. However, the Treg cell proportion and TGF-β level were lower in ITP patients than those in healthy controls. In patients with ITP, the proportion of mDC and the level of FOXP3 mRNA did not show significant changes. The proportion of mDC cells was significantly correlated with the expression of IL-6 and IL-23. Moreover, the expression of HMGB1 showed a significant correlation with the expression of mDC, IL-6, IL-23, RORγt mRNA, and IL-17. Notably, both the proportion of mDC cells and the expression of HMGB1 were negatively correlated with platelet count. Conclusion The high expression of HMGB1 in peripheral blood of ITP patients may induce Th17/Treg imbalance by promoting the maturation of mDC and affecting the secretion of cytokines, thereby potentially playing a role in the immunological mechanism of ITP.
Humans ; Th17 Cells/cytology* ; HMGB1 Protein/genetics* ; T-Lymphocytes, Regulatory/cytology* ; Female ; Male ; Dendritic Cells/metabolism* ; Adult ; Middle Aged ; Purpura, Thrombocytopenic, Idiopathic/genetics* ; Nuclear Receptor Subfamily 1, Group F, Member 3/genetics* ; Young Adult ; Interleukin-23/blood* ; Interleukin-17/blood* ; Interleukin-6/blood* ; Forkhead Transcription Factors/genetics* ; Myeloid Cells/cytology* ; Aged

Objective To explore the therapeutic effect of mesorectal excision in gasless transaxillary endoscopic thyroidectomy.Methods Clinical data of 75 patients who underwent gasless unilateral transaxillary endoscopic thyroidectomy from May 2020 to November 2022 were retrospectively analyzed.A total of 40 cases were treated with mesorectal excision(observation group),and 35 cases were treated with thyroid resection followed with central lymph node resection(control group).The operation time,intraoperative blood loss,postoperative hospital stay,number of lymph nodes dissected,and postoperative complications were compared between the two groups.Results All the patients successfully completed the operation.As compared with the control group,the observation group had shorter operation time[(91.8±19.7)min vs.(110.4±19.3)min,t =-4.133,P =0.000]and more lymph nodes dissected[(6.5±2.5)vs.(4.6±2.0),t = 3.610,P = 0.001].There were no statistically significant differences between the two groups in the amount of intraoperative bleeding,recurrent laryngeal nerve injury,and the postoperative hospital stay.There was no hypoparathyroidism,postoperative bleeding,or wound infection in both groups.Conclusion Mesorectal excision is safe and feasible in endoscopic thyroidectomy via axillary approach,with more thorough lymph node dissection in the central region and better protection of recurrent laryngeal nerve.

Objective To explore the learning curve of endoscopic mesothyroid excision via gasless axillary approach.Methods Clinical data of 44 patients who underwent endoscopic mesothyroid excision via gasless axillary approach between May 2020 and December 2022 by the same surgical team were retrospectively analyzed.Taking operation time as index,the learning curve of the operation was studied with the cumulative sum method(CUSUM).The cut-off value of the learning curve was regarded as the dividing line of different stages.The general data,operation time,intraoperative blood loss,hospital stay,number of lymph node dissection,and postoperative complications were compared between the different phases of the learning curve.Results The operations were successfully completed in all the 44 patients without conversion to open surgery.The cumulative sum fitting curve reached the top at the 21st case,which was used as the boundary to divide the learning curve into learning improvement stage and mature stable period.There was no statistically significant difference between the two stages in general data(P>0.05).The operation time in the learning improvement stage was significantly longer than in the mature stable period[(124.5±9.9)min vs.(82.0±8.8)min,t =15.166,P =0.000].The incidence of postoperative sternocleidomastoid muscle swelling and stiffness in patients in the learning improvement stage was higher than that in the mature stable period,but the difference was not statistically significant[6 cases(28.6%)vs.1 case(4.3%),χ2 =3.174,P =0.075].There was no significant difference between the two groups in terms of intraoperative bleeding,hospital stay,number of lymph node dissection,and other postoperative complications(all P>0.05).Conclusion To proficiently master the endoscopic mesothyroid excision via the gasless axillary approach,21 cases need to be completed.

Objective:To compare the clinical outcomes of internal fixation of McCrory-Bladin type III fracture of the lateral process of the talus (FLPT) with Kirschner wire Double-pully technique under subtalar arthroscopy and open reduction with Kirschner wire fixation.Methods:A retrospective cohort study was conducted to analyze the clinical data of 42 patients (42 feet) with McCrory-Bladin type III FLPT admitted to Xuzhou Central Hospital from May 2017 to May 2022, including 15 males (15 feet) and 27 females (27 feet); aged 18-55 years [(33.3±9.8)years]. Among them, 24 patients were treated with Kirschner wire Double-pully technique under subtalar arthroscopy (arthroscopy+Kirschner group), and 18 with open reduction and Kirschner wire fixation (open reduction+Kirschner group). The surgical duration, wound healing status, and assessment outcomes at 12 weeks, 12 months and the last follow-up, including American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF) score, and Foot and Ankle Ability Measure (FAAM) [Activities of Daily Living (ADL) and Sports (S) subscores], were compared between the two groups, respectively. Complication rates were also compared at the last follow-up.Results:All the patients were followed up for 12-27 months [(17.6±4.9)months]. The surgical duration in the arthroscopy+Kirschner group [(53.7±11.8)minutes] was longer than that in the open reduction+Kirschner group [(43.9±7.2)minutes] ( P<0.05). Bone grafting was not required in either group and all incision healing was achieved by primary intention. At 12 weeks, 12 months and the last follow-up, the arthroscopy+Kirschner group had higher AOFAS ankle-hindfoot score [(91.3±4.4)points, (94.0±4.2)points, (94.7±4.5)points] compared with the open reduction+Kirschner group [(74.7±11.2)points, (77.9±12.0)points, (79.2±12.0)points] (all P<0.01); the arthroscopy+Kirschner group had higher PROMIS-PF score [(69.5±3.7)points, (71.6±3.3)points, (72.5±3.2)points] compared with the open reduction+Kirschner group [(61.7±6.7)points, (62.9±6.8)points, (63.3±7.0)points] (all P<0.01); the arthroscopy+Kirschner group had higher FAAM-ADL score [(89.8±3.8)points, (92.5±3.3)points, (93.2±3.4)points] compared with the open reduction+Kirschner group [(70.3±15.2)points, (72.1±15.2)points, (73.1±16.0)points] (all P<0.01); and the arthroscopy+ Kirschner group had higher FAAM-S score [(91.5±3.6)points, (94.4±3.6)points, (94.9±3.5)points] compared with the open reduction+Kirschner group [(76.9±15.0)points, (78.6±16.2)points, (79.0±16.0)points] (all P<0.01). Subtalar joint arthritis developed in 2 patients [8.3% (2/24)] in the arthroscopy+Kirschner group at the last follow-up, but in 6 [33.3% (6/18)] in the open reduction+Kirschner group ( P<0.05). No nerve injury was found in either group. Conclusion:For McCrory-Bladin type III FLPT, the Kirschner wire Double-pully technique under subtalar arthroscopy, despite longer surgical duration, results in better physical function, improved activities of daily living, enhanced ankle function, and a lower rate of subtalar joint arthritis compared with open reduction with Kirschner wire fixation.

Objective:To explore the application effect of the teaching ward-round workshop on the teaching ability training for clinical teachers.Methods:From July to October 2019, 83 clinical teachers from The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University included in the study were divided into 8 groups for the training of teaching ward-round workshop. After the training, the evaluation results of clinical teaching ward-round, the satisfaction of clinical teaching ward-round, and the satisfaction of the workshop teaching model were compared. Chi-square test and t test were performed by SPSS 22.0. Results:The trainees were highly satisfied with the training mode of the teaching ward-round workshop. After the training, the clinical teaching ward-round assessment scores [(96.83±1.77) points] were higher than the average scores of the same period from April to June in 2019 [(91.25±2.86) points], with statistical significance ( P<0.05). In terms of satisfaction with clinical teaching ward rounds, the scores of 7 dimensions including preparation before ward rounds, highlighting the key and difficulties, and standard physical examination after the training were all higher than those before the training, with significant differences ( P<0.05). Conclusion:The training model of the teaching ward-round workshop helps to enhance the training effect, promote the teaching ability of clinical teachers, and improve the clinical teaching ward-round assessment results and satisfaction, which provides new ideas and references for the training of clinical medical professionals.

Objective:To evaluate the effect of tutorial system for medical undergraduates in a non-affiliated hospital of a medical university in Jiangsu.Methods:32 senior medical undergraduates in non-affiliated hospitals were divided into two groups. The experimental group adopted tutor-guided teaching, and the control group adopted traditional teaching. Professional theoretical knowledge, clinical ability, operational ability, foreign language level, basic research ability and participation of scientific research activities of students in the two groups were evaluated. SPSS 19.0 was used for t test, chi-square test and U test. Results:The results of operational ability ( t=3.537, P=0.000), the number of papers that had been read ( t=6.961, P=0.000), quality of these ( U=68.000, P=0.017), the number of literature reviews that had been written and reading notes ( χ2=4.747, P=0.000), participation in scientific research activities ( t=6.788, P=0.009) of students in the experimental group were better and higher than those in the control group. In the same period, there was no significant difference between the two groups in the scores of theoretical exam, clinical competence and foreign language tests. Conclusion:The implementation of tutorial system for medical students in non-affiliated hospitals is an effective measure to improve the quality of training. We should make full use of the short intership, to improve the comprehensive quality of students by establishing perfect rules, regulations and teaching evaluation system, and educate students in accordance with their own ability.

Objective To explore the influential factors of esthetic evaluation of mandibular prominence by orthodontic patients from two dimensions (ideal value and tolerance range).Methods 226 orthodontic patients were investigated by an electronic questionnaire of esthetic evaluation of mandibular prominence.Binary logistic regression was adopted to analyze the influential factors.Results The tolerable boundary value for female mandibular retrognathism was affected by age (OR1.360) and orthodontic history (OR2.849).The tolerable boundary value for female mandibular prognathism and male mandibular retrognathism were found to be affected by orthodontic history (OR2.557 and 2.845,respectively).The tolerable boundary value for male mandibular prognathism was affected by age (OR1.347) and orthodontic history (OR2.310).The ideal value of male mandibular prominence was affected by age (OR1.420).Conclusions Orthodontic patients' esthetic evaluation of mandibular prominence is influenced by age and treatment condition,but not by sex,education level,marital status and personal profile.

Objective To explore the application of fuzzy mathematics theory in the evaluation of medical students' comprehensive mental quality. Methods A total of 80 medical undergraduates studying in the Affiliated Huai'an No.1 People’s Hospital of Nanjing Medical University from October to December 2017 were randomly selected to conduct a questionnaire survey on medical students' mental quality. The questionnaires were designed by the study group, containing 3 first-level items (learning pressure, life stress and interpersonal stress), and 19 secondary items, with the recovery rate as 95%. Fuzzy comprehensive evaluation method was used for data processing and analysis. Results By comparing the data obtained from the comprehensive evaluation of the secondary factors with those of the pre-set evaluation set, the study concluded that 25.00% of the medical students need to adjust the future pressure, 41.70% the family health status pressure and 26.79% the appearance pressure according to the principle of maximum mem-bership degree. The comprehensive evaluation of the first four factors (0.249 7, 0.268 9, 0.270 2, and 0.211 2) showed that the comprehensive mental quality of medical students was "good". The quantitative analysis results showed that 27.02% of the medical students had good comprehensive mental quality, 24.97% need the mental quality adjustments, 26.89% had the average mental quality, and 21.12% had outstanding mental quality. Fuzzy comprehensive evaluation indicated that it is necessary to adjust the learning pressure and life stress of medical students, while the interpersonal stress had little effect on the mental quality of medical students. Conclusion The fuzzy comprehensive evaluation adopts the quantitative method to deal with the qualitative indicators uniformly, being scientific and reasonable. The corresponding data of each indicator can be easily identified with the help of the indicator system built up in the evaluation, which provides evidence for distinguishing and improving the corresponding decision-making for improving the medical students' mental quality. This evaluation method has strong applicability and provides new methods and ideas for objectively evaluating the comprehensive mental quality of medical students.

Objective To investigate the diagnostic values of transcranial Doppler ultrasonography (TCD) for vertebral artery hypoplasia (VAH) and focal vertebral artery stenosis (fVAS) with CT angiography (CTA) finding as a standard.Methods Consecutive patient who underwent TCD and CTA were included.According to the findings of CTA,they were divided into 3 groups:a normal group,a VAH group,and a fVAS group.The TCD parameters included the mean flow velocity (MFV),peak systolic velocity (PSV),pulsatility index (PI),resistance index (RI) and asymmetry index (AI),and they were compared among the groups,respectively.The receiver operator characteristic (ROC) curves were used to evaluate the sensitivity and specificity of TCD parameters for diagnosis of VAH and fVAS.Results A total of 405 patients were enrolled,including 278 (68.6％) in the normal group,75 (18.5％) in the VAH group,and 52 (12.8％) in the fVAS group.There were significant differences in MFV,PSV,PI,and RI on the affected sides among different groups (the affected side in the normal group was defined as the right side).The blood flow velocity in the VAH group was the slowest,and that in the fVAS group was the fastest.Other parameters had the same trend.There were significant differences in MFV and PSV on the unaffected side among different groups.The blood flow velocity in the VAH group was significantly faster,the fVAS group was slightly faster,and the fVAS group was less than the VAH group.There were significant differences in AI among different groups,and it could be used as an indicator for diagnosis of VAH (the area under the curve 0.78,95％ confidence interval 0.72-0.84;P＜0.001).With the AI ＞33.7％ as a cut-off value,the sensitivity and specificity of VAH diagnosis were 74.7％ and 68.7％.Conclusions Attention should be paid to identifying VAH and fVAS when using TCD for evaluation of vertebral artery.AI ＞33.7％ can be used as a reference index for diagnosis of VAH.

Objective To examine the distribution of systemic inflammation and risk factors of cardiovascular disease (CVD) in patients with psoriatic arthritis (PsA) by comparing with healthy controls.Methods Forty PsA patients and 44 controls were recruited into this cross-sectional study.We evaluated the disease activity and severity [erythrocyte sedimentation rate (ESR),C reactive protein(CRP) and Disease Activity Score (DAS)28],functional ability in patients with predominant axial involvement [Bath AS disease activity index (BASDAI) and Bath AS functional index (BASH)],traditional CVD risk factors and inflammation between these two groups of patients.Then,we compared risk factors for CVD between 40 consecutive PsA patients and 44 controls,adjusted for body mass index (BMI).The frequencies were compared using chi-square tests for categorical variables.Student's t-tests or Mann-Whitney U-tests were used forcontinuous variables where appropriate.Association between the traditionaland metabolic risk factors and the hs-CRP level were assessed using Spearman correlations.Finally,we also assessed the role of inflammation on the CVD risk factor by using a BMI and hs-CRP-adjusted model.Results The BMI of PsA patients was significantly higher than that of the controls.After adjusting for the BMI,PsA patients had a higher prevalence of hypertension (OR=5.615,95％CI 1.844-17.099) and diabetes mellitus (OR=10.655,95％CI 1.150-98.683) than the controls.PsA patients had significantly increased systolic and diastolic blood pressures [(SBP) and (DBP)],total cholesterol (TC)/high density lipoprotein cholesterol (HDL),insulin resistance,inflammatory markers (hsCRP,white cell count and platelet) and decreased HDL compared to the controls.As excepted,the hsCRP level [4.0 (2.1-13.9) vs 1.7 (1.3-2.2)],platelet and white cell counts were significantly increased in the PsA group reflecting underlying inflammation.Further adjustment for hsCRP level rendered the differences in the prevalence of hypertension (OR=3.544,95％CI 1.151-10.914);but the DBP,HDL and sugar levels were non-significantly different between the two groups,while the differences in other parameters were significant.Conclusion The data support the hypothesis that PsA may be associated with hypertension,obesity and dyslipidemia because of the shared inflammation pathway.