As a third major discipline on par with internal medicine and surgery,interventional radiology is one of the key branches of modern medicine.The unique practicality and innovation of interventional radiology make it play an irreplaceable role in the diagnosis and treatment of diseases.In recent years,with the rapid development of technology and the updating of educational concepts,the teaching mode of interventional radiology is facing new challenges and opportunities.This article combines the clinical training methods adopted by interventional physicians in Europe and Germany,integrates imaging,anatomy and pathology teaching,strengthens the foundation,uses virtual reality(VR),augmented reality(AR)technology,and simulation training to enhance the practical ability of medical students.At the same time,with the help of online education platforms,the innovative methods and optimization strategies such as personalized learning program are implemented,which can greatly improve the teaching effectiveness of interventional radiology and provide useful references for teaching reform in this field.

Objective To analyze the drug resistance characteristics,molecular typing,and biological properties of carbapenem-resist-ant Klebsiella pneumoniae(CRKP).Methods A retrospective analysis was conducted on 31 non-repetitive CRKP strains collected clinically from April 2019 to May 2021 at the Third People's Hospital of Nantong.The Vitek 2 Compact microbial analysis system was used for bacterial identification and in vitro drug susceptibility analysis.The broth dilution method was used to determine the minimum inhibitory concentration(MIC)of polymyxin B.The disk diffusion testing was performed to supplement the susceptibility of five com-monly used antibiotics:ertapenem,cefotaxime,cefoxitin,cefoperazone-sulbactam,and tigecycline.The carbapenemase-resistance phenotype of CRKP strains was initially determined by a combined assay of modified carbapenem inactivation method(mCIM)and ED-TA-carbapenem inactivation method(eCIM).Certain carbapenemase resistance genes(blaKPC,blaNDM,blaIMP,blaVIM,and blaOXA-48),AmpC enzyme genes(blaDHA,bla ACC,blaCIT,blaEBC,blaMOX,and blaFOX),extended-spectrum β-lactamases(ESBLs)genes(blaSHv,blaTEM,and blaCTX-M),and nine virulence genes were amplified by PCR and subsequently verified by sequencing.The stringing test was used to screen for hypermucoviscous phenotype strains.The growth curves in vitro and biofilm formation assays,and multilocus se-quence typing(MLST)were performed on 31 isolates.Outer-membrane proteins were extracted and separated by sodium dodecyl sulfate polyacrylamide gel electrophoresis(SDS-PAGE)to evaluate the expressions of OmpK35 and OmpK36.Results All the 31 isolates were resistant to ampicillin/sulbactam,ampicillin,aztreonam,cefazolin,ceftriaxone,cefotaxime,cefuroxime,ciprofloxacin,pip-eracillin,piperacillin/tazobactam,meropenem,and ertapenem with resistance rate of 100％.The resistance to polymyxin B was ob-served in 32.26％,whereas tigecycline retained 100％susceptibility.In terms of MLST,three sequence types(STs)were identified,with ST15 being the most prevalent,accounting for 61.29％(19/31)of the isolates.All strains produced serine carbapenemase,and only blaKPC-2 was detected among carbapenem resistance genes.The virulence genes fimH and entB were present in all strains(100％,31/31),while the detection rate of mrkD was 80.64％(25/31).Some strains carried virulence genes such as rmpA,rmpA2,and other virulence genes,whereas magA gene was not detected in any isolate.The carriage rates of rmpA2,iutA,and mrkD were higher in ST11 strains than in ST15 strains.The string test was positive in 38.71％of the strains.The growth test showed that there was no significant difference observed in the growth curves among all strains in vitro,and all were able to form biofilms with varying degrees.All ST11 strains exhibited OmpK36 protein alterations,while OmpK35 protein was intact in the 31 strains.Conclusion CRKP strains in this hospital showed high drug-resistance rate,and ST15 was the predominant sequence type.All the isolates carried blaKPC-2 and virulence genes.Enhanced molecular surveillance and strengthened prevention and control measures of CRKP infection are urgently needed.

Objective To analyze the drug resistance characteristics,molecular typing,and biological properties of carbapenem-resist-ant Klebsiella pneumoniae(CRKP).Methods A retrospective analysis was conducted on 31 non-repetitive CRKP strains collected clinically from April 2019 to May 2021 at the Third People's Hospital of Nantong.The Vitek 2 Compact microbial analysis system was used for bacterial identification and in vitro drug susceptibility analysis.The broth dilution method was used to determine the minimum inhibitory concentration(MIC)of polymyxin B.The disk diffusion testing was performed to supplement the susceptibility of five com-monly used antibiotics:ertapenem,cefotaxime,cefoxitin,cefoperazone-sulbactam,and tigecycline.The carbapenemase-resistance phenotype of CRKP strains was initially determined by a combined assay of modified carbapenem inactivation method(mCIM)and ED-TA-carbapenem inactivation method(eCIM).Certain carbapenemase resistance genes(blaKPC,blaNDM,blaIMP,blaVIM,and blaOXA-48),AmpC enzyme genes(blaDHA,bla ACC,blaCIT,blaEBC,blaMOX,and blaFOX),extended-spectrum β-lactamases(ESBLs)genes(blaSHv,blaTEM,and blaCTX-M),and nine virulence genes were amplified by PCR and subsequently verified by sequencing.The stringing test was used to screen for hypermucoviscous phenotype strains.The growth curves in vitro and biofilm formation assays,and multilocus se-quence typing(MLST)were performed on 31 isolates.Outer-membrane proteins were extracted and separated by sodium dodecyl sulfate polyacrylamide gel electrophoresis(SDS-PAGE)to evaluate the expressions of OmpK35 and OmpK36.Results All the 31 isolates were resistant to ampicillin/sulbactam,ampicillin,aztreonam,cefazolin,ceftriaxone,cefotaxime,cefuroxime,ciprofloxacin,pip-eracillin,piperacillin/tazobactam,meropenem,and ertapenem with resistance rate of 100％.The resistance to polymyxin B was ob-served in 32.26％,whereas tigecycline retained 100％susceptibility.In terms of MLST,three sequence types(STs)were identified,with ST15 being the most prevalent,accounting for 61.29％(19/31)of the isolates.All strains produced serine carbapenemase,and only blaKPC-2 was detected among carbapenem resistance genes.The virulence genes fimH and entB were present in all strains(100％,31/31),while the detection rate of mrkD was 80.64％(25/31).Some strains carried virulence genes such as rmpA,rmpA2,and other virulence genes,whereas magA gene was not detected in any isolate.The carriage rates of rmpA2,iutA,and mrkD were higher in ST11 strains than in ST15 strains.The string test was positive in 38.71％of the strains.The growth test showed that there was no significant difference observed in the growth curves among all strains in vitro,and all were able to form biofilms with varying degrees.All ST11 strains exhibited OmpK36 protein alterations,while OmpK35 protein was intact in the 31 strains.Conclusion CRKP strains in this hospital showed high drug-resistance rate,and ST15 was the predominant sequence type.All the isolates carried blaKPC-2 and virulence genes.Enhanced molecular surveillance and strengthened prevention and control measures of CRKP infection are urgently needed.

Objective To investigate the feasibility and clinical experience of kidney transplantation from donors with Marfan syndrome (MFS). Methods Clinical data of 2 recipients undergoing kidney transplantation from the same MFS patient were retrospectively analyzed and literature review of 2 cases was conducted. Characteristics and clinical diagnosis and treatment of kidney transplantation from MFS patients were summarized. Results The Remuzzi scores of the left and right donor kidneys of the MFS patient during time-zero biopsy were 1 and 2. No significant difference was observed in the renal arteriole wall compared with other donors of brain death and cardiac death. Two recipients who received kidney transplantation from the MFS patient suffered from postoperative delayed graft function. After short-term hemodialysis, the graft function of the recipients received the left and right kidney began to gradually recover at postoperative 10 d and 20 d. After discharge, serum creatinine level of the recipient received the left kidney was ranged from 80 to 90 μmol/L, whereas that of the recipient received the right kidney kept declining, and the lowest serum creatinine level was 232 μmol/L before the submission date (at postoperative 43 d). Through literature review, two cases successfully undergoing kidney transplantation from the same MFS donor were reported. Both two recipients experienced delayed graft function, and then renal function was restored to normal. Until the publication date, 1 recipient has survived for 6 years, and the other recipient died of de novo cerebrovascular disease at postoperative 2 years. Conclusions MFS patients may serve as an acceptable source of kidney donors. However, the willingness and general conditions of the recipients should be carefully evaluated before kidney transplantation. Intraoperatively, potential risk of tear of renal arterial media should be properly treated. Extensive attention should be paid to the incidence of postoperative complications.

AIM: To compare the outcome of C3F8 versus silicone oil tamponade after pars plana vitrectomy(PPV)and inverted internal limiting membrane(ILM)for the treatment of highly myopic macular hole retinal detachment(MHRD).METHODS: Retrospective clinical study. Totally 45 patients(45 eyes)with highly myopic MHRD who visited our hospital between January 2019 and August 2022 were selected as the research subjects. The patients were divided into two groups according to different intraocular tamponade agents: C3F8(22 eyes)and silicone oil(23 eyes)groups. All patients underwent conventional three-incision PPV, ILM was tamped, a venous blood clot was placed on the tamped ILM, and 15% C3F8 and silicone oil were used as tamponade, respectively. The best corrected visual acuity(BCVA), multifocal electroretinogram(mfERG), the closure of the macular hole, retinal reattachment and the complications were observed.RESULTS: The macular hole closure rate was 77% in the C3F8 group and 83% in the silicone oil group, respectively(P>0.05), and retinal reattachment rates were 95% and 96%, respectively(P>0.05). The visual acuity of the two groups significantly improved, which was 0.99±0.34 and 1.22±0.37, respectively, and the C3F8 group was better than that of the silicone oil group(t=-2.156, P=0.037). After operation, the response density of the first ring of P1 wave in the first order kernel in mfERG was 114.27±26.37 nV/deg2 for the C3F8 group and 98.08±24.36 nV/deg2 for the silicone oil group, and the response density of the second ring of P1 wave was 80.45±14.94 nV/deg2 for the C3F8 group and 67.73±15.33 nV/deg2 for the silicone oil group, all of which were significantly higher compared to pre-operation [the response density of the first ring of P1 wave: 58.13±13.96 nV/deg2 for the C3F8 group and 55.30±10.48 nV/deg2 for the silicone oil group, the response density of the second ring of P1 wave: 51.18±8.19 nV/deg2 for the C3F8 group and 47.43±11.97 nV/deg2 for the silicone oil group](all P<0.05). It was found that the response density of the first ring of P1 wave was lower in the silicone oil group than in the C3F8 group(P<0.05). There was no statistically significant difference in the incidence of complications between the two groups(P>0.05).CONCLUSION: Silicone oil tamponade or C3F8 tamponade after PPV combined with ILM can both promote retinal reattachment and macular hole closure in patients with MHRD, and the C3F8 tamponade was superior to silicone oil in visual function recovery.

Objective:To investigate the predictive value of early thyroid function changes on the efficacy of patients with Graves′ disease (GD) after 131I therapy. Methods:Data of patients with GD (59 males, 214 females; age (37.4±11.4) years) who underwent single therapy of 131I in Tianjin Medical University General Hospital from November 2017 to January 2019 were retrospectively analyzed. Symptoms, signs and laboratory tests (serum free triiodothyronine (FT 3) and serum free thyroxine (FT 4)) of patients were observed to assess the efficacy of 131I treatment. Efficacy was divided into complete remission (CR), partial remission (PR), non-remission (NR) or relapse. The changes of thyroid function (ΔFT 3=FT 3 before treatment-FT 3 after treatment)/FT 3 before treatment×100%; ΔFT 4=FT 4 before treatment-FT 4 after treatment)/FT 4 before treatment×100%) 1 month after 131I therapy in each efficacy group and differences among them were compared by using independent-sample t test, χ2 test, one-way analysis of variance and the least significant difference t test. ROC curves were drawn to analyze the predictive values of early thyroid function changes on the efficacy of 131I treatment for GD. Logistic regression analyses were performed to identify the influencing factors for the efficacy of 131I therapy. Results:CR rate and total effective rate of 273 GD patients after single therapy of 131I were 67.03%(183/273) and 92.67%(253/273), respectively. After 1 month, CR rate of euthyroidism group ( n=95) was significantly higher than that of hyperthyroidism group ( n=178; 81.05%(77/95) vs 59.55%(106/178); χ2=4.60, P=0.032). ΔFT 3 and ΔFT 4 at the first month were statistically significant and decreased sequentially in the CR group ( n=183), PR group ( n=70), NR or relapse groups ( n=20; F values: 15.40, 12.54, both P<0.001). ROC curve analysis showed that patients with ΔFT 3≥73.64% and (or) ΔFT 4≥59.03% had a higher probability of achieving CR, with sensitivities of 84.3% and 86.7%, and specificities of 62.6% and 62.6%, respectively. Logistic regression analysis showed that 24 h radioactive iodine uptake (odds ratio ( OR)=1.095, 95% CI: 1.031-1.139), dose of 131I given per gram of thyroid tissue ( OR=1.562, 95% CI: 1.321-1.694), ΔFT 3 ( OR=1.354, 95% CI: 1.295-1.482), ΔFT 4 ( OR=1.498, 95% CI: 1.384-1.608) were factors affecting the outcome of patients with GD treated with 131I treatment (all P<0.05). Conclusion:Effects of 131I treatment can be predicted based on the change of the thyroid function at the first month after 131I treatment in patients with GD.

Osteosarcopenia is a geriatric syndrome referring to the co-existence of osteoporosis and sarcopenia.Its pathogenesis involves factors such as genetics, mechanics of the musculoskeletal system, endocrine regulatory mechanisms and molecular signaling pathways.In clinical practice, aside from comprehensive assessment of risk factors, screening of bone density, muscle strength, muscle mass and the overall body function must also be undertaken.Intervention measures primarily include therapeutic exercise, nutritional support and drugs.

Objective:To investigate the therapeutic impact of combining vitamin D supplementation with dietary adjustments on elderly male patients with diabetes and osteosarcopenia.Methods:From January 2021 to May 2023, a total of 108 male patients diagnosed with diabetes and osteosarcopenia were admitted to Beijing hospital for research purposes.The patients were randomly assigned to either a control group( n=54)or a trial group( n=54).The control group received conventional dietary adjustments, while the trial group received vitamin D supplementation in addition to dietary adjustments.Various parameters including 25-(OH)-VitD 3 levels, blood glucose levels, appendicular skeletal muscle mass index(ASMI), bone mineral density, and bone metabolism indexes were measured before and after the treatment in both groups. Results:Compared to the pre-treatment period, the levels of 25-(OH)-VitD 3, grip strength, 6 m step speed, and ASMI increased in both groups, while fasting blood glucose and 2 h postprandial blood glucose decreased significantly(all P<0.05).Additionally, the experimental group showed higher levels of 25-(OH)-VitD 3, grip strength, 6 m step speed, and ASMI compared to the control group post-treatment, with lower levels of fasting blood glucose and 2 h postprandial blood glucose(all P<0.05).Compared with the pre-treatment period (bone density values in the lumbar spine: 0.41±0.09, the hip: 0.42±0.12 in the control group; bone density values in the lumbar spine: 0.43±0.07, the hip: 0.44±0.09 in the experimental group), the bone density values of the lumbar spine and the hip were higher in both groups after treatment(bone density values in the lumbar spine: 0.76±0.12, the hip: 0.78±0.12 in the control group; bone density values in the lumbar spine: 0.95±0.22, the hip: 0.97±0.28 in the experimental group). The bone density values of the lumbar spine and the hip in the experimental group were higher than those of the control group after treatment(all P<0.05).Furthermore, serum concentrations of parathyroid hormone(PTH)and osteoclast differentiation factor(RANKL)were significantly lower, while serum osteocalcin(OCN)was significantly higher in both groups post-treatment(all P<0.05).In the experimental group, serum PTH and RANKL concentrations were significantly lower and serum OCN was significantly higher compared to the control group post-treatment(all P<0.05). Conclusions:The results show that incorporating vitamin D into dietary changes can effectively regulate blood glucose levels, decrease bone loss, enhance bone density, and improve muscle quality in this patient population.

Hypoglycemia can lead to physical and psychological disorders, which are associated with a decrease in quality of life and an increase in mortality risk. Compared to those hospitalized, homebound and community patients have a higher incidence of hypoglycemia and are more vulnerable to the disorders. Hypoglycemia is preventable and treatable, timely intervention can preserve physical well-being of patients and reduce the mortality risk. This article reviews the incidence of hypoglycemia in community diabetic patients, and the knowledge and awareness of patients about hypoglycemia, including the onset inducement, symptoms, hazards, coping and prevention, to provide a reference for the prevention and treatment of hypoglycemia in diabetic patients.

ObjectiveTo investigate the Alzheimer-associated neurofilament protein （AD7c-NTP） in urine of middle-aged and elderly people and its correlation between common metabolites. MethodsA total of 1 150 middle-aged and elderly people who did their physical exmanination in the health examination center of the Sichuan Science City Hospital and the Third Hopital of Mianyang were recruited from March 2017 to March 2020. The level of urine AD7c-NTP were measured by enzyme-linked immunosorbent assay （ELISA）， and common metabolites in blood were measured by biochemical analyzer. Based on urine AD7c-NTP level ≤1.5 ng/mL， the objects was divided into normal group （n=956） and elevated group （n=194）. Thier demographic data and blood biochemical indicators were collected. ResultsThe urine AD7c-NTP level in middle-aged and elderly people was 0.60（0.30~1.20） ng/mL. The urine AD7c-NTP level was higher in women than that in men ［1.04（0.40~1.30） ng/mL vs. 0.84（0.30~1.00） ng/mL， Z=4.202， P˂0.01］. And the urine AD7c-NTP level was lower in the normal group than that in the elevated group ［0.50（0.30~0.90） ng/mL vs. 2.10（1.70~2.10） ng/mL， Z=22.035， P˂0.01］. The results of the univariate comparison showed that， the differences between the two groups in age （Z=6.545）， fasting glucose （Z=3.506）， blood uric acid （Z=2.574）， urea nitrogen （Z=2.891）， creatinine （Z=2.243）， total bilirubin （Z=3.936）， glutathione （Z=0.969）， total cholesterol （t=3.956） and low density lipoprotein （Z=-5.678） were were statistically significant （P˂0.05 or 0.01）. Spearman correlation analysis showed that， the urine AD7c-NTP level was positively correlated with age and the levels of urea nitrogen， glucose， total cholesterol and low density lipoprotein （r=0.177， 0.178， 0.171， 0.109， 0.149， P˂0.01）， and negatively correlated with the level of total bilirubin （r=-0.172， P˂0.01）. Conclusionthe urine AD7c-NTP level in middle-aged and elderly females was signifitcantly higher than in middle-aged and elderly males.The urine AD7c-NTP level of middle-aged and elderly people was positively correlated with age， urea nitrogen， glucose， total cholesterol and low density lipoprotein， and negatively correlated with total bilirubin.