Training general practice residents is a crucial part of cultivating high-level general practitioners at the grass roots level. However, the traditional training model has revealed several deficiencies, such as insufficient clinical practice opportunities. Virtual patients, as a computer simulation-based tool, can significantly enhance training outcomes due to their advantages, including the simulation of practical clinical scenarios, diverse case conditions, and prompt feedback. This article reviews the current status and potential of applying virtual patients in the training of general practice residents and analyzes their advantages in optimizing clinical decision-making and doctor-patient communication. In view of issues such as insufficient standardization and situational simulation in the application of virtual patients, this article proposes optimization strategies such as enhancing case complexity and integrating flipped classrooms and large language models. All these measures aim to explore a wider application range of virtual patients in modern medical education, improving the training quality of general practitioners and the level of primary medical services.

Training general practice residents is a crucial part of cultivating high-level general practitioners at the grass roots level. However, the traditional training model has revealed several deficiencies, such as insufficient clinical practice opportunities. Virtual patients, as a computer simulation-based tool, can significantly enhance training outcomes due to their advantages, including the simulation of practical clinical scenarios, diverse case conditions, and prompt feedback. This article reviews the current status and potential of applying virtual patients in the training of general practice residents and analyzes their advantages in optimizing clinical decision-making and doctor-patient communication. In view of issues such as insufficient standardization and situational simulation in the application of virtual patients, this article proposes optimization strategies such as enhancing case complexity and integrating flipped classrooms and large language models. All these measures aim to explore a wider application range of virtual patients in modern medical education, improving the training quality of general practitioners and the level of primary medical services.

The intestine is the largest immune and metabolic site in the body and is thus important for animal health.The integrity of the mucosal barrier and function are fundamental factors protecting the health of the intestine.Stress has been reported to have profound effects on the gastrointestinal tract,including altering gut permeability,the intestinal barrier,and homeostasis.Tryptophan is a functional essential amino acid that alters the gut microbiota and regulates intestine structural and functional change,thus contributing to host physiology and metabolism.Changes in tryptophan metabolism and its metabolites in brain and intestinal tissues during stress suggest that tryptophan may play an important role in the stress response.We therefore review the literature on the mechanisms underlying stress-related diseases and the role of tryptophan metabolism in the regulation of gut homeostasis,with particular focus on functional bowel disorders and their relationship to stress,to provide a theoretical foundation for targeting tryptophan in stress-related intestine diseases.

Objective To explore the relationship between the expression levels of serum cingulate protein(CGN)and polyligand glycan 1(SDC-1)and the disease condition and outcome of hypertensive basal ganglia hemorrhage(HBGH).Methods A total of 123 patients with HBGH admitted to the Second People's Hospi-tal of Lianyungang from February 2019 to February 2022 were selected as the study objects,and 120 healthy volunteers who underwent physical examination in the hospital during the same period were selected as the health group.Serum CGN and SDC-1 expression levels were detected in the two groups.According to the dis-ease outcome,the patients were divided into the improved group(92 cases)and the deteriorated group(31 ca-ses).Receiver operating characteristic(ROC)curve and the area under the curve(AUC)were used to analyze the predictive value of serum CGN and SDC-1 expression levels on the disease outcome of patients with HB-GH.Results Serum CGN and SDC-1 expression levels in the severe group were higher than those in the mod-erate group and the mild group,and serum CGN and SDC-1 levels in the moderate group were higher than those in the mild group,and the differences were statistically significant(P＜0.05).Serum CGN and SDC-1 expression levels in HBGH patients in three groups were higher than those in health group,and the differences were statistically significant(P＜0.05).Serum CGN and SDC-1 expression levels in the deteriorated group were higher than those in the improved group,and the differences were statistically significant(P＜0.05).The AUC of serum CGN and SDC-1 for predicting the disease outcome of HBGH patients was 0.742(95％CI:0.792-0.697)and 0.861(95％CI:0.906-0.910),respectively,and the AUC of the combination of the two was 0.917(95％CI:0.962-0.870).The amount of blood loss and ventricular rupture in the deteriorated group were higher than those in the improved group,and the Glasgow Coma Scale(GCS)score on admission was lower than that in the improved group,and the differences were statistically significant(P＜0.05).Multi-variate Logistic regression analysis showed that serum CGN≥51.63 pg/mL(OR=3.815),serum SDC-1≥450.67 μg/L(OR=4.230)and GCS score ≤8(OR=5.333)were the influencing factors for disease outcome of HBGH patients(P＜0.05).Conclusion The increased expression levels of serum CGN and SDC-1 are closely related to the disease aggravation and the deterioration of the disease outcome in patients with HBGH,and they have certain predictive value for the disease outcome in patients with HBGH.

Objective:To reconstruct the three-dimensional (3D) dose distribution in radiotherapy based on the convolutional neural networks (CNN) through multi-perspective scintillation light processing.Methods:First, fluorescence images were captured from three orthogonal perspectives using a complementary metal-oxide-semiconductor (CMOS) imaging sensor. Then, the images were converted into 3D images, which were input to the trained CNN for dose reconstruction. Finally, the reconstructed doses in different fields were evaluated in terms of gamma pass rate, mean-square error (MSE), percentage depth dose (PDD), and cross beam profile (CBP). Additionally, as the CNN model, 3D-Unet was pre-trained on a virtual dataset.Results:With the 50% maximum dose of as the threshold and 3%/3 mm as the standard, the central-plane and stereo-mean gamma pass rates of all field reconstruction distributions were over 90%, with MSEs remained below 1%. Besides, the PDD and CBP curves showed MSEs below 1‰ and below 1%, respectively.Conclusions:The deep learning-based method for 3D dose reconstruction using scintillation light contributes to enhanced verification of instantaneous 3D relative dose based on plastic scintillation detectors.

Objective: To investigate the therapeutic effects of allogeneic hematopoietic stem cell transplantation (allo-HSCT) with FLAG sequential busulfan/cyclophosphamide(Bu/Cy) conditioning regimen for refractory/relapsed acute myeloid leukemia. Methods: From February 2012 to June 2017, 21 patients with refractory/relapsed acute myeloid leukemia underwent allo-HSCT with FLAG sequential Bu/Cy conditioning regimen. Transplantation-related complications and clinical outcome were retrospectively analyzed. Results: After conditioning, no hepatic veno-occlusive disease (VOD) and grade Ⅲ hemorrhagic cystitis occurred. 76.2% (16/21) patients had fever with 4 septicemia. One patient died of septic shock before engraftment. Twenty patients achieved neutrophil engraftment with a median time of 13 days (range, 10 to 21 days). Seventeen patients achieved platelet engraftment with a median time of 18 days (range, 9 to 25 days). The cumulative incidence of acute graft-versus-host disease (aGVHD) was 39.5%, and 3 patients developed grade Ⅲ-Ⅳ aGVHD. Of 19 patients who survived more than 100 days after transplantation, 4 had local chronic graft-versus-host disease (cGVHD). Of 21 patients, the median survival time was 15 months (range, 0.5 to 67 months) post-transplantation. Transplantation-related mortality rate was 28.7%. Leukemia relapse occurred in 4 patients with a median time of 4 months (range, 3 to 8 months) after transplantation. The cumulative relapse rate at 1 year was 21.4%. The 1-year and 3-year overall survival (OS) rates were 60.7% and 54.9% respectively. Log-rank analysis revealed that bone marrow blasts ≥ 20% or extramedullary leukemia before transplantation, poor platelet engraftment and grade Ⅲ-Ⅳ aGVHD were significantly related to shortened OS (P<0.05). Conclusions Allo-HSCT with FLAG sequential Bu/Cy conditioning regimen in patients with refractory/relapsed myeloid leukemia has acceptable transplantation-related risk and relapse rate. The 1-year and 3-year OS rates are comparable with those in remission patients.

Objective Primary renal mucosa associated lymphoid tissue lymphoma (MALT lymphoma)is very rare,here dis-cuss the clinical pathological characteristics and diagnosis,differential diagnosis of primary renal MALT lymphoma.Methods A case of primary renal MALT lymphoma was assayed for clinical and histopathological morphology,an well as immuno-histochemical staining,then reviewed the relevant literature.Results The clinical and imaging characteristics of renal lym-phoma lack of specific performance,the tissue section of the kidney biopsy showed diffuse infiltration of small lymphocytes. The small lymphocytes were centrocytes-like,monocytes-like,and plasma cell differentiation was recognized.Lymphoepithe-lial lesions were scattered.Follicular implanted phenomenon could been seen.Immunohistochemically result:the tumor cells were positive for CD20,PAX-5,CD79αand MUM-1,but negative for CD3,CD5,CD45RO,bcl-2,CD10,bcl-6 and CyclinD1. CD2 1 showed damage FDC network,positive for Kappa,negative for lambda,and it showed monoclonal phenotype,the Ki-6 7 index was about 35%.Final pathology diagnosis was primary renal MALT lymphoma.Conclusion Primary renal MALT lymphoma is very rare,the clinical manifestations and imaging characteristic of renal lymphoma are non-specific and misdiag-nosis frequently occurs in clinical practice,definite diagnosis depends on pathological examination,immunohistochemical stai-ning is helpful to differential diagnosis.

Objective:To explore the influence of buccal corridor of Han people on smile esthetics.Methods:An attractive adult male and a adult female were selected as the models.Buccal corridor was altered digitally with slider technology of Adobe Flash CS4 to obtain a continuous range of buccal corridors(0% -25%).96 orthodontists aged 35.1 ±7.2 years and 96 laypersons aged 37.3 ± 5.1 years were chosen as the raters.The minimum tolerable value(A%),the ideal value(B%)and the maximum tolerable value (C%)of buccal corridor of the models were statistically analyzed.Results:In the orthodontist groupA,B and C of the male model were 5.00 ±0.1 7,9.75 ±2.77 and 1 5.00 ±2.84,in layperson group were 4.79 ±1 .00,9.20 ±3.08 and 1 5.05 ±2.91 ,respec-tively;in orthodontist group,A,B and C of the female model were 3.92 ±0.1 7,1 1 .87 ±2.77 and 1 5.82 ±2.84,in layperson group were 4.00 ±1 .00,1 2.05 ±3.08 and 1 5.1 1 ±2.91 ,respectively(all data between groups,P >0.05).The ideal buccal corri-dor value(%)of the male and female models were 9.48 ±2.73 and 1 1 .96 ±1 .99 respectively(P <0.05).Conclusion:There is no difference between orthodontists and laypersons for buccal corridor esthetic judgment.The ideal esthetic buccal corridor size of male and female is different.

Immunoglobulins ( Ig ) , also called antibodies, are important components in humoral -mediated immunity. Ig can bind with their receptors, called immunoglobulin receptors ( IgR ) , trigger biologic activities respectively. Different sub-types of Igs show different function. And IgRs have been treated as therapeutic targets in inflammation and immunity related dis-eases for many years. This article reviewed the recent progresses in the study of IgR function and its therapeutic role in inflamma-tion and immunity related diseases.

OBJECTIVETo investigate the safety and efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for myelodysplastic syndrome (MDS) and secondary acute myelogenous leukemia (MDS-AML) using conditioning regimen with busulfan (Bu) and increased-dose of fludarabine (ID-Flu).

METHODSA total of 49 patients with MDS or MDS-AML were treated by allo-HSCT, the clinical data was analyzed retrospectively.

RESULTSAll patients achieved hematopoietic reconstitution. Neutrophil engraftment was at 10 - 22 days (median 13 days), and platelet engraftment was at 8 - 66 days (median 16 days). The cumulative incidences of Ⅱ-Ⅳ degree acute graft-versus-host disease (GVHD), hemorrhagic cystitis (HC), and hepatic venous occlusive disease (VOD) were 28.6%, 14.3% and 2.0%, respectively. The transplant-related mortality (TRM) was only 4.1% at 100d and 8.2% at 1-92 months of followed-up (median 14 months) period. Overall survival (OS) and disease free survival (DFS) was 75.5%, 73.5%, respectively. Kaplan-Meier curve showed that 3-year OS and 3-year DFS was (71.1 ± 7.8)%, (66.7 ± 8.3)%, respectively, with a relapse incidence (RI) 16.3%. OS for MDS and MDS-AML was 81.5% and 68.2%, and RI in two settings was 3.7%, 31.8%, respectively. OS for MDS-AML at complete remission (CR) and non-CR subgroup was 83.3% and 50.0%, respectively, while cumulative RR was 16.7% and 50.0%, respectively. OS and RI except for non-CR subgroup were 82.1% and 7.7%. Univariate analysis showed that pre-HSCT disease status had correlation with OS (P=0.031), but age, decitabine in conditioning regimen, stem cell source, HLA matching, patient-donor gender, dose of mononuclear cells and GVHD had no correlation with OS.

CONCLUSIONBu/ID-Flu conditioning regimen for MDS and MDS-AML has high efficiency, fewer complications, lower toxicity and TRM. The OS and DFS were higher and RI was lower except for refractory MDS-AML patients. The regimen is valuable for clinical application.

Busulfan ; Disease-Free Survival ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation ; Humans ; Leukemia, Myeloid, Acute ; Myelodysplastic Syndromes ; Recurrence ; Remission Induction ; Retrospective Studies ; Tissue Donors ; Transplantation Conditioning ; Transplantation, Homologous ; Vidarabine ; analogs & derivatives