Objective To investigate the effects of different contrast injection schemes on the image quality of triple-rule-out com-puted tomography angiography(TRO-CTA).Methods A total of 691 patients with acute chest pain who underwent TRO-CTA exami-nation from multiple centers were prospectively selected and randomly divided into mixed group and unmixed group according to dif-ferent contrast injection methods.The image quality of aorta,pulmonary artery and coronary artery in the two groups was evaluated subjectively and objectively and the radiation dose was calculated.Results There were no significant differences in subjective image quality scores,aorta and coronary CT values,signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)between the two groups(P>0.05),while there were significant differences in pulmo-nary CT values,SNR,CNR and radiation dose between the two groups(P<0.05).Conclusion The utilization of a mixed contrast injection scheme in TRO-CTA can satisfy diagnostic require-ments while ensuring a low proportional dosage and reduced radiation dose,which has clinical application value.

Objective This study aims to explore the influence of social support on depressive symptoms and its threshold effect in elderly patients undergoing maintenance hemodialysis(MHD),thereby providing a basis for improving patients' depressive conditions.Methods A convenience sample of 440 elderly MHD patients was recruited from the hemodialysis centers of 3 general hospitals in Kunshan between October 2024 and February 2025.Data collection involved the use of a general information questionnaire,the Social Support Rating Scale(SSRS),and the Short Form Geriatric Depression Scale(GDS-15).Logistic regression and threshold effect analyses were conducted to identify influencing factors and assess their impact.Results A total of 432 valid questionnaires were recovered,yielding a response rate of 98.18％.The prevalence of depressive symptoms among elderly MHD patients was 27.8％,with an average social support score of 32.53±5.58,indicating a moderate level of social support.Logistic regression analysis revealed that the use of assistive devices,dialysis modality,marital status,social support,and type of vascular access were significant factors influencing depressive symptoms(P＜0.05).Restricted cubic spline analysis indicated a non-linear relationship between social support and depressive symptoms(P＜0.001).Threshold effect analysis showed that when the social support score was≥ 23,depressive symptoms decreased as the social support score increased(P＜0.05).Conclusion The impact of social support on depressive symptoms in elderly MHD patients has a critical threshold.This finding suggests that clinical healthcare providers should prioritize interventions for patients with low social support to improve their physical and mental health and quality of life by enhancing social support levels.

Objective To investigate the effects of different contrast injection schemes on the image quality of triple-rule-out com-puted tomography angiography(TRO-CTA).Methods A total of 691 patients with acute chest pain who underwent TRO-CTA exami-nation from multiple centers were prospectively selected and randomly divided into mixed group and unmixed group according to dif-ferent contrast injection methods.The image quality of aorta,pulmonary artery and coronary artery in the two groups was evaluated subjectively and objectively and the radiation dose was calculated.Results There were no significant differences in subjective image quality scores,aorta and coronary CT values,signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)between the two groups(P>0.05),while there were significant differences in pulmo-nary CT values,SNR,CNR and radiation dose between the two groups(P<0.05).Conclusion The utilization of a mixed contrast injection scheme in TRO-CTA can satisfy diagnostic require-ments while ensuring a low proportional dosage and reduced radiation dose,which has clinical application value.

Objective This study aims to explore the influence of social support on depressive symptoms and its threshold effect in elderly patients undergoing maintenance hemodialysis(MHD),thereby providing a basis for improving patients' depressive conditions.Methods A convenience sample of 440 elderly MHD patients was recruited from the hemodialysis centers of 3 general hospitals in Kunshan between October 2024 and February 2025.Data collection involved the use of a general information questionnaire,the Social Support Rating Scale(SSRS),and the Short Form Geriatric Depression Scale(GDS-15).Logistic regression and threshold effect analyses were conducted to identify influencing factors and assess their impact.Results A total of 432 valid questionnaires were recovered,yielding a response rate of 98.18％.The prevalence of depressive symptoms among elderly MHD patients was 27.8％,with an average social support score of 32.53±5.58,indicating a moderate level of social support.Logistic regression analysis revealed that the use of assistive devices,dialysis modality,marital status,social support,and type of vascular access were significant factors influencing depressive symptoms(P＜0.05).Restricted cubic spline analysis indicated a non-linear relationship between social support and depressive symptoms(P＜0.001).Threshold effect analysis showed that when the social support score was≥ 23,depressive symptoms decreased as the social support score increased(P＜0.05).Conclusion The impact of social support on depressive symptoms in elderly MHD patients has a critical threshold.This finding suggests that clinical healthcare providers should prioritize interventions for patients with low social support to improve their physical and mental health and quality of life by enhancing social support levels.

While the development of multi-campus hospitals is conducive to promoting the expansion and equal distribution of high-quality medical resources and improving the overall medical quality of municipalities, the model puts forward high requirements for the capabilities of integrated operation and management of public hospitals. As key part of health services and the higher medical education system, facing the multi-campus hospital reform, hospital affiliated to colleges and universities should carry out rearrangements in both medical and educational aspects at the same time. Shanghai Sixth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine has made substantial progress in integrated and homogenized management since the integration of the Lingang campus as a whole into the parent hospital in 2021. The department of undergraduate clinical medical education has analyzed the difficulties in teaching management and talent cultivation in the multi-campus system during the rearrangement process, forming a coordinated management mechanism for undergraduate clinical medical education within campuses under the concept of "homogeneity-difference-collaboration". This article may provide a reference for enriching multi-campus hospital management practice and improving the quality of undergraduate clinical medical education in hospitals affiliated to colleges and universities.

A quantitative method for clopidogrel using online-SPE tandem LC-MS/MS was developed and fully validated according to the well-established FDA guidelines. The method achieves adequate sensitivity for pharmacokinetic studies, with lower limit of quantifications (LLOQs) as low as 10 pg/mL. Chromatographic separations were performed on reversed phase columns Kromasil Eternity-2.5-C18-UHPLC for both methods. Positive electrospray ionization in multiple reaction monitoring (MRM) mode was employed for signal detection and a deuterated analogue (clopidogrel-d 4) was used as internal standard (IS). Adjustments in sample preparation, including introduction of an online-SPE system proved to be the most effective method to solve the analyte back-conversion in clinical samples. Pooled clinical samples (two levels) were prepared and successfully used as real-sample quality control (QC) in the validation of back-conversion testing under different conditions. The result showed that the real samples were stable in room temperature for 24 h. Linearity, precision, extraction recovery, matrix effect on spiked QC samples and stability tests on both spiked QCs and real sample QCs stored in different conditions met the acceptance criteria. This online-SPE method was successfully applied to a bioequivalence study of 75 mg single dose clopidogrel tablets in 48 healthy male subjects.

Objective To evaluate the effect of captopril in treatment of acute pancreatitis and its influence on serum C reactive protein ( CRP) .Methods 100 cases of acute pancreatitis patients were randomly divided into the control group and observation group,50 cases in each group.The control group was treated with fasting,gastroin-testinal decompression,somatostatin, anti-inflammatory and other conventional treatment, while the observation group was given captopril on basis of routine treatment,the effective rate after 7 days of treatment,pain relief time,amylase returned to normal time,pancreatic edema improved time,serum CRP before and after treatment were compared be-tween the two groups of patients.Results The effective rate after 7 days of treatment of the observation group was 86%,which was significantly higher than 72%of the control group(χ2 =7.334,P<0.05);The pain relief time,am-ylase returned to normal time,pancreatic edema improved time of the observation group after treatment were (1.75 ± 0.44)d,(3.49 ±1.22)d,(7.50 ±2.39)d,respectively,which of the control group were (2.25 ±0.58)d,(4.25 ± 1.59)d,(9.25 ±2.87)d,respectively,there were statistically significant difference between the two groups(t1 =3.55,t2 =4.18,t3 =8.33,all P<0.05);the serum CRP level of the observation group after treatment was (10.39 ± 3.66)mg/L,improved obviously compared to (25.46 ±8.33)mg/L of the control group,the differences between the two groups was statistically significant(t=11.45,P<0.05).Conclusion Captopril has a good effect in treatment of acute pancreatitis,which can effectively improve the level of serum CRP.

Objectives: To detect the expressions of mTOR and HIF-1?and their relationship with angiogenesis in gastric carcinomas. Methods: The expressions of mTOR and HIF-1?in gastric carcinomas tissues(n=70)and normal tissues(n=45)were measured by immunohistochemistry staining.CD34 immunostaining was used to measure the microvascular density(MVD).Results: The rates of the mTOR and HIF-1? positive expression were 51.4% and 67.1% respectively. MVD value of gastric cancer tissues was much higher than that of normal tissues(t=4.358, P