Objective:To investigate the value of sequential ultrasound in assessing skeletal muscle and diaphragm thickness in elderly septic patients.Methods:A retrospective study was conducted.Fifty-one elderly patients with sepsis who underwent ultrasound examinations at Beijing Chaoyang Hospital from August 2021 to August 2023 were selected, including 30 males and 21 females.Ultrasound technology was used to measure the thickness of limb skeletal muscles(biceps brachii, flexor carpi radialis, quadriceps femoris, and tibialis anterior)and diaphragm, and sequential monitoring was performed at different time points(admission, the 3rd day after admission, and the 7th day after admission)to analyze the variation rules of their thickness.The correlations between the changes in muscle thickness and the severity of the disease[such as the Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)scores and the Sepsis Organ Failure Assessment(SOFA)scores], mechanical ventilation time, and length of hospital stay were analyzed.Results:Compared with those at admission, the thickness of limb skeletal muscles and diaphragm in elderly septic patients with mechanical ventilation significantly decreased with the prolongation of hospital stay( P<0.05).The degree of thickness reduction in the flexor carpi radialis and rectus femoris was positively correlated with the APACHE II score.The degree of thickness reduction in the biceps brachii was positively correlated with the SOFA score.The degree of thickness reduction in the flexor carpi radialis, rectus femoris, and diaphragm was positively correlated with both mechanical ventilation time and hospital stay( P<0.05).Correlation heatmap analysis showed that the thickness of the flexor carpi radialis was significantly correlated with hospital stay days and APACHE II score(correlation coefficients were 100.20 and 67.47, respectively), indicating that the longer the hospital stay and the more severe the condition, the more serious the atrophy of the flexor carpi radialis. Conclusions:Measuring the thickness of skeletal muscles and the diaphragm in elderly sepsis patients using ultrasound serves as an efficient and non-invasive method for assessing the disease state, predicting prognosis, and guiding clinical treatment decisions.This approach provides vital imaging-based evidence for refining diagnostic and therapeutic strategies for elderly sepsis patients, thereby promising to enhance clinical outcomes and the quality of rehabilitation for these individuals.

Objective To explore the effectiveness of an integrated laparoscopic simulation training course (best essential surgical technique training, BEST) in enhancing laparoscopic peritoneal suturing techniques in surgical residents.Methods As an integrated two-stage program, the BEST course applied basic laparoscopic training system with simple molds in phase Ⅰ training, and then adopted advanced laparoscopic training system, 3D Laparoscope and ex-vivo animal models in phase Ⅱ training. The laparoscopic suturing techniques were practiced in phase Ⅱ training. From August 2021 to July 2024, surgical residents in the second year of the national standardized training program were divided into pilot and control groups based on whether they had undergone the BEST course. Two cases of laparoscopic peritoneal suture were performed by the surgical residents under supervision in the department of gastrointestinal surgery. The operative time, quality of suture, and independent completion rate were compared between the two groups.Results A total of 33 surgical residents (19 in pilot group and 14 in control group) were included in this study, and a total of 66 cases of laparoscopic peritoneal suture were performed (38 in pilot group and 28 in control group). The operative time was significantly shorter in pilot group than that in control group (15.7 min vs. 17.5 min, P=0.025). The quality of suture was significantly better in pilot group compared to control group (P=0.023). In pilot group, all peritoneal sutures were performed by residents independently, whereas in control group, 3 cases (10.7%) were assisted by the supervisor, and the independent completion rate was different significantly (P=0.039).Conclusions The BEST course can help improve surgical residents′ laparoscopic peritoneal suturing techniques and could be promoted in the national standardized training program for surgical residents.

Objective:To investigate the value of sequential ultrasound in assessing skeletal muscle and diaphragm thickness in elderly septic patients.Methods:A retrospective study was conducted.Fifty-one elderly patients with sepsis who underwent ultrasound examinations at Beijing Chaoyang Hospital from August 2021 to August 2023 were selected, including 30 males and 21 females.Ultrasound technology was used to measure the thickness of limb skeletal muscles(biceps brachii, flexor carpi radialis, quadriceps femoris, and tibialis anterior)and diaphragm, and sequential monitoring was performed at different time points(admission, the 3rd day after admission, and the 7th day after admission)to analyze the variation rules of their thickness.The correlations between the changes in muscle thickness and the severity of the disease[such as the Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)scores and the Sepsis Organ Failure Assessment(SOFA)scores], mechanical ventilation time, and length of hospital stay were analyzed.Results:Compared with those at admission, the thickness of limb skeletal muscles and diaphragm in elderly septic patients with mechanical ventilation significantly decreased with the prolongation of hospital stay( P<0.05).The degree of thickness reduction in the flexor carpi radialis and rectus femoris was positively correlated with the APACHE II score.The degree of thickness reduction in the biceps brachii was positively correlated with the SOFA score.The degree of thickness reduction in the flexor carpi radialis, rectus femoris, and diaphragm was positively correlated with both mechanical ventilation time and hospital stay( P<0.05).Correlation heatmap analysis showed that the thickness of the flexor carpi radialis was significantly correlated with hospital stay days and APACHE II score(correlation coefficients were 100.20 and 67.47, respectively), indicating that the longer the hospital stay and the more severe the condition, the more serious the atrophy of the flexor carpi radialis. Conclusions:Measuring the thickness of skeletal muscles and the diaphragm in elderly sepsis patients using ultrasound serves as an efficient and non-invasive method for assessing the disease state, predicting prognosis, and guiding clinical treatment decisions.This approach provides vital imaging-based evidence for refining diagnostic and therapeutic strategies for elderly sepsis patients, thereby promising to enhance clinical outcomes and the quality of rehabilitation for these individuals.

Objective:Continuous glucose monitoring (CGM) technology is used to compare the advantages of insulin degludec (IDeg) as a basal insulin regimen compared with insulin glargine (IGlar) in the treatment of adult type 1 diabetes mellitus.Methods:30 adult patients with T1DM admitted to Heji Hospital Affiliated to Changzhi Medical College from September 2019 to December 2020 were screened. According to the random number table method, the patients were randomly divided into two groups (insulin degludec group and insulin glargine group) at a ratio of 1∶1, respectively treated with IDeg, IGlar and aspartate insulin for 12 weeks. The main outcome measures were the coefficient of variation of blood glucose (CV), mean amplitude of glycemic excursions (MAGE), time in range (TIR), time above range (TAR) and time below range (TBR). The secondary outcome measures were mean blood glucose (MBG), standard deviation of blood glucose (SD), fasting blood glucose (FPG), 2 h postprandial blood glucose (2 h BG), hemoglobin A1c (HbA 1c), means of daily differences (MOOD), and the frequency of hypoglycemic events. Results:At 12 weeks of treatment, the HbA 1c, FPG, 2 h BG, MBG, SD, CV and MAGE of insulin degludec group were lower than those of insulin glargine group, with statistically significant difference (all P<0.05). The TIR in the insulin degludec group was significantly higher than that in the insulin glargine group [73(63, 75)% vs 43(28, 63)%, P<0.001], and the TAR was lower than that in the glycerine group [25(17, 23)% vs 35(33, 64)%, P=0.003]. From the curve spectrum of blood glucose level of the two groups, the stability of blood glucose in the insulin degludec group was better than that in the insulin glargine group. After 12 weeks of treatment, 8 cases (8/15) in insulin degludec group had HbA 1c<7.0%, and 4 cases (4/15) in insulin glargine group had HbA 1c<7.0%, without statistically significant difference ( P=0.264). There were 7 cases (7/15) in the insulin degludec group and 1 case (1/15) in the insulin glargine group who achieved high quality blood glucose control, with statistically significant difference ( P=0.035). At the 12th week of outpatient follow-up, the incidence of nocturnal hypoglycemic events in insulin degludec group was significantly lower than that in insulin glargine group (4/15 vs 11/15, P=0.027). Conclusions:Compared with insulin glargine, insulin degludec can achieve higher blood glucose compliance rate, lower blood glucose level and reduce blood glucose fluctuations in patients with type 1 diabetes.

OBJECTIVE： To investigate the effects of Dendrobium officinale polysaccharides on gene expression profile of HUVEC. METHODS： HUVEC was selected as objects. MTS method was used to detect the effects of different doses of D. officinale polysaccharides （50， 100， 200， 400， 800 μg/mL） on the proliferation activity of HUVEC. The growth inhibitory concentration of 30％ cells （IC30） was calculated to screen the dose of follow-up tests. cDNA microarray assay was used to detect the changes of gene expression profile for HUVEC after treated with D. officinale polysaccharides for 24 h， so as to screen differentially expressed genes. GO enrichment analysis and KEGG pathway enrichment analysis were performed for top 5 differentially expressed genes by using DAVID bioinformatics resource database. Real-time fluorescence quantitative polymerase chain reaction （qRT-PCR） was used to validate the results of microarray detection with immunity-related differentially expressed genes as objects. RESULTS： After treated with 100， 200， 400， 800 μg/mL D. officinale polysaccharides， survival rate of HUVEC  were decreased significantly （P＜0.05 or P＜0.01）. IC30 value was 408 μg/mL. After treated with 400 μg/mL （by IC30） D. officinale polysaccharides， there were 91 differentially expressed genes in HUVEC cells， of which 84 were up-regulated and 7 were down-regulated. Top 5 genes of up-regulated and down- regulated expression were SELE， CCL2， CXCL6， IL8， ICAM1 as well as VWCE， CPT1A， CLU， CCL14， CINS4， which may be mainly associated with immune conditions and inflammatory responses. The differentially expressed genes mainly distributed in extracellular domain， and were enriched in biological processes such as production and response of cytokines and stimulus response， and played molecular functions such as chemokine and its receptor activity. The up-regulated genes as SELE， ICAM1 and CXCL2 were mainly enriched in TNF signaling pathway， influenza A （H1N1）， herpes simplex virus infection and other pathways. The down-regulated gene CCL14 was mainly enriched in chemokine signaling pathway. Results of qRT-PCR validation tests showed that relative expression of ICAM1 was increased significantly， while that of CCL14 was decreased significantly （P＜0.05）， which was in agreement with microarray detection results. CONCLUSIONS： After treated with D. officinale polysaccharides， the expression of 91 genes in HUVEC cells are different significantly， mainly being up-regulated. The differentially expressed genes may participate in immune regulation through TNF signaling pathway， influenza A （H1N1） and herpes simplex virus infection.

Objective To investigate the clinical value of MR diffusion tensor imaging (DTI) in evaluating diffuse axonal injury (DAI).Methods The DTI imaging data of DAI patients and healthy volunteers were analyzed retrospectively.Fractional anisotropy (FA) values were measured in corpus callosum,etc.The serum myelin basic protein (MBP) was detected.Results Compared to the control group,the FA values were lower in genu of corpus callosum,splenium of corpus callosum,anterior limb of the internal capsule,posterior limb of the internal capsule and thalamus in DAI group (P ＜ 0.01,P ＜ 0.05).The mean FA values of two groups were negatively correlated with serum MBP levels (r =-0.755,P =0.001).Conclusions DTI can noninvasively reflect the damages of white matter fibers in DAI patients,and it has importantly clinical significance in evaluating prognosis and therapeutic effect of DAI patients.

Objective To explore the correlations between quantitative parameters of dynamic contrast-enhanced MRI ( DCE-MRI) and nasopharyngeal carcinoma ( NPC) clinical stage.Methods 69 patients with NPC were selected from Oct 2013 to Oct 2015 in Shaoxing People's Hospital,39 men and 30 women,aged 39-76 years old,average 50.6 ±10.5 years old.All patients underwent clinical staging,DCE-MRI and histopathological examina-tion before treatment.Clinical stages were determined based on Chinese 2008 staging system.Value of the volume transfer constant ( Ktrans) and the extravascular extracellular space volume per unit volume of tissue ( Ve) was detec-ted by bi-compartmental pharmacokinetic model.The correlations between quantitative parameters and clinical stage were analyzed by Pearson correlation analysis.Results Mean Ktrans and Ve for NPC were (0.532 ±0.156) mL/min/100cm3 and (0.982 ±0.356),respectively.Ktrans of NPC showed negative correlation with clinical stage (r=-0.506,P=0.001),T stage (r=-0.326,P=0.014),N stage (r=-0.296,P=0.017) and M stage (r=-0.312,P=0.015),while Ve showed positive correlation with clinical stage (r=0.415,P=0.002),T stage (r=0.478,P=0.001),N stage (r=0.318,P=0.015) and M stage (r=0.346,P=0.011).Conclusion DCE-MRI quantitative parameters are significantly related to clinical stage of NPC,which has important values for clinical treat-ment and prognostic assessment.

Objective Discussion leukoreduction of red blood cells suspended in two different storage bag placement and he-molysis rate impact on the supernatant free hemoglobin (FHb),to ensure the clinical transfusion is safe and effective.Meth-ods Selected 20 donors to sample 400 ml whole blood per person to make leukodepleted red blood cells,which were evenly divided into 10 bags.The 10 bags were randomly divided into two groups,one to the upright position,one group of horizon-tal.The two groups were stored under the same conditions.Respectively,in the 7,14,21,28,35 day,randomly removed one storage bag from each group,FHb and red blood cell hemolysis rate were measured and analyzed statistically.Results FHb and hemolysis rate results stored in the first 21 days of testing,uprightgroup were (217.310±48.477)mg/L and (0.250± 0.056)%,respectively horizontal group (173.972±39.027)mg/L and (0.189±0.045)%,the results set upright than hori-zontal group,the results were statistically(t=3.114,P =0.003<0.05 and t=3.798,P =0.001<0.05),the difference was statistically significant.Conclusion In the blood storage period,storage bags can be placed horizontally to reduce the de-struction of red blood cells,blood storage is more favorable.

Objective To explore the curative effects of acupuncture, ultrashort wave combined with kinesio taping in the treatment of chronic ankle sprain for clinical references. Methods All 80 patients with chronic ankle sprain were randomly assigned to the control group and the treatment group. The control group was given the treatment of acupunc-ture and ultrashort wave, and the treatment group was further given the treatment of kinesio taping on the basis of acupuncture and ultrashort wave. One course of treatment lasted for seven days,and the treatment lasted for two courses of 14 days in total. The differences of clinical efficacy were observed between the two groups of patients. VAS and A Modern Practical Handbook of Orthopedics were applied for evaluation before and after the treatment. Results VAS scores and curative effective rate in the two groups all improved,and the improvement in the treatment group was more significant than that in the control group (P<0.01). Conclusion The application of acupuncture, ultrashort wave com-bined with kinesio taping in the treatment of chronic ankle sprain is effective in alleviating pain and improving ankle function.

Objective To investigate the biosecurity and biocompatibility of small intestinal submucosa (SIS) as scaffold for tissue engineering and to explore the possibility to induce synovial mesenchymal stem cells (SMSCs) differentiate into cartilage with SIS as the scaffold and SMSCs as the seed cells. Methods The SMSCs were isolated and cultured from the synovial mem-brane of knee joints of rabbits by a conventional method. The SIS was harvested from pigs according to the physical method and Abraham's method. 4 rabbits are divided into the experimental group and control group. The biosecurity of SIS as scaf-folds were investigated in pyrogen test, skin sensitization test and systemic toxicity test. The SMSCs and SIS were co-cultured in vitro and induced to differentiate into cartilage to explore the biocompatibility of SMSCs and SIS, the proliferation and differ-entiation ability of SMSCs on the scaffold of SIS. The varietyies were identified by the microscope. Results The SIS isolated with the physical method and Abraham's method is a milky and translucent membrane with a smooth surface. Under the electron microscope, SIS presented a porous Stereoscopic three-dimensional network structure, which is formed by fibrous tissues' intertex-ture. Its' porosity was about 80%and its aperture was 100-200μm. Meanwhile, the biosecurity and biocompatibility of SIS were also fine. In the trial that the SMSCs and SIS were co-cultured in vitro, the SMSCs can grow, adhere to and differentiate on the sur-face of SIS and into the hollows very well. It can also secrete extracellular matrix. Through scanning microscope observation, cells contact with each other by their neuritis, or adhered to the wall of hole by cellular protrution. On the surface of SIS, the SMSCs maintain the property that it can easily differentiate into the chondrogenic lineage in the chondrogenic medium. Immunochemistry staining showed positive expression of type II collagen post 21 days of co-cultrue. Conclusion SIS can be used as the scaffold to construct tissue engineering meniscus as it has good biosecurity and biocompatibility with SMSCs without disturbing the cell form or inhibiting the growth and function of SMSCs.