Cardiovascular disease remains a significant factor leading to patient mortality and influencing outcomes during the perioperative period.Dexmedetomidine is an α2-adrenergic receptor agonist with functions such as analgesia,sedation,and anti-anxiety.This review summarizes various types of findings regarding dexmedetomidine in myocardial ischemia/reperfusion injury and conducts in-depth discussions on the corresponding mechanisms of the results,aiming to further clarify the potential cardioprotective effects of dexmedetomidine in patients with heart diseases.

OBJECTIVE: To explore the effectiveness of the combined anteversion angle technique in total hip arthroplasty (THA) for treating ankylosing spondylitis (AS) affecting the hip joint. METHODS: A retrospective analysis was conducted on the clinical data of 73 patients with AS affecting the hip joint who underwent THA between August 2018 and August 2021. According to whether the combined anteversion angle technique was used in THA, the patients were divided into study group (37 cases, combined anteversion angle technique was used in THA) and control group (36 cases, traditional THA). There was no significant difference in baseline data such as gender, age, body mass index, disease duration, preoperative Harris score, range of motion (ROM), acetabular anteversion angle, acetabular abduction angle, femoral anteversion angle, and combined anteversion angle between the two groups ( P>0.05). The operation time, hospital stay, and complications of the two groups were recorded and compared. The Harris score and hip ROM were compared between the two groups before operation, at 1, 3, 6, 12 months after operation, and at last follow-up. The acetabular component anteversion angle, femoral component anteversion angle, acetabular component abduction angle, and component combined anteversion angle were measured postoperatively. RESULTS: The operation time in the study group was significantly shorter than that in the control group ( P<0.05), and there was no significant difference in hospital stay between the two groups ( P>0.05). There was no intraoperative complication such as acetabular and proximal femoral fractures, neurovascular injuries in both groups, and the incisions healed by first intention. All patients were followed up 2-3 years, with an average of 2.4 years; there was no significant difference in the follow-up time between the two groups ( P>0.05). During the follow-up period, there was no complication such as hip dislocation, wound infection, delayed wound healing, deep venous thrombosis, and hip dislocation in both groups. The hip Harris score and ROM of the two groups gradually increased with time after operation, and the differences were significant when compared with those before operation ( P<0.05); the above two indicators of the study group were significantly better than those of the control group at each time point after operation ( P<0.05). Extensive bone ingrowth on the surface of the components could be observed in the anteroposterior X-ray films of the hip joint of the two groups at 12 months after operation, and the acetabular components was stable without femoral stem subsidence, osteolysis around the components, and heterotopic ossification. At last follow-up, the acetabular component anteversion angle, femoral component anteversion angle, and component combined anteversion angle in the study group were significantly superior to those in the control group ( P<0.05), except that there was no significant difference in the acetabular component abduction angle between the two groups ( P>0.05). CONCLUSION For patients with AS affecting the hip joint, the use of the combined anteversion angle technique during THA effectively promotes the recovery of hip joint function and enhances the postoperative quality of life of patients when compared to traditional THA.
Humans ; Arthroplasty, Replacement, Hip/methods* ; Hip Dislocation/surgery* ; Spondylitis, Ankylosing/surgery* ; Retrospective Studies ; Quality of Life ; Treatment Outcome ; Hip Joint/surgery* ; Hip Prosthesis

Abstract: Objective To analysis the genetic evolution characteristics of hemagglutinin (HA) gene of influenza A(H1N1)pdm virus in Changsha City from 2016-2023, to understand the trend of the HA genetic evolution and the mutations of the amino acid. It provides a scientific basis for the prevention and control of influenza epidemics, as well as the screening of vaccines under the new situation. Methods The A(H1N1)pdm09 virus strains from Changsha City from 2016 to 2023 were isolated using SPF chicken embryos, and then the HA genes were sequenced by MiSeq of Illumina Inc. The homology of HA gene was analyzed by MegAlign of the DNASTAR, and the phylogenetic tree was constructed using the Neighbor Joining (NJ) method in the Molecular Evolutionary Genetics Analysis version 11 (MEGA11). Results The homology of the HA gene of A(H1N1)pdm virus in Changsha from 2016 to 2023 was between 94.8%-99.9%, with the HA gene homology decreasing annually. The homology between the isolated strains of A(H1N1)pdm09 in Changsha City from 2016 to 2023 and the WHO recommended vaccine strain ranged from 96.8% to 99.0%, indicating a relatively good match between the flu isolates and the recommended vaccine strain. The phylogenetic tree of the HA gene of the A(H1N1)pdm09 influenza virus in Changsha City showed that the HA gene evolved into several different branches within the 6B branch, and it had currently evolved to 6B.1A.5a.2a branch. Constant mutations had occurred at the amino acid sites of the four antigenic determinant clusters of HA protein. Currently, amino acid mutations had occurred at 15 antigenic sites within the four antigenic determinant clusters, and the newly emerged A186T antigen mutant site in the isolates from 2023 was worth recent notice. The receptor-binding sites are relatively conserved in loop 130, minor amino acid mutations occurred in loop 220, whether the amino acid mutation site in loop 190 is becoming more stable needs to be further monitored. Taking A/California/07/2009 (CY121680) as the reference strain, most of the A(H1N1) pdm09 isolates in Changsha was increased 162 NQTY glycosylation site and was decreased 276 NTTC glycosylation site, and the glycosylation mutations at these two sites have become more stable recently. Conclusions The HA genes of influenza A(H1N1)pdm virus in Changsha are constantly evolving and mutating, suggesting influenza surveillance should be strengthened continuously.

Objective:Based on the statistical data of the comprehensive evaluation of professional degree graduate students by the guiding physicians, to conduct an empirical study on the quality of the enrollment of master of stomatology professional degree graduate students.Methods:A total of 67 master of stomatology professional degree graduate students from Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University were comprehensively evaluated by their guiding physicians when they went out the department. SPSS 25.0 software was used for t test and variance analysis. Results:The average score of 67 students was (91.39±3.55) points. There was good reliability and validity for the comprehensive evaluation index. Among the methods of promotion and exemption, unified examination, 7-year transfer to "5 + 3" of our school and enrollment of students from Hong Kong, Macao and Taiwan regions, the comprehensive evaluation total score of 7-year transfer to "5 + 3" of our school was the highest. The comprehensive evaluation results of the students with high initial scores were slightly higher than those students with low scores. The students who studied in the "Double First-class" universities and were with the fourth round of subject assessment grade A and grade B had better performances.Conclusion:We should attach importance to enrollment quality, through various channels to attract quality students and actively explore ways to improve the quality of graduate students. Meanwhile, we should make efforts to strengthen training quality and to build scientific comprehensive evaluation system for specialized degree graduate students. The connotation of "medicine-education collaboration" will be further deepened. And the training and development of oral medicine applied high-level medical talents will be promoted.

Standardized residency training is a systematic, standardized and homogeneous project. With the continuously increasing requirements for fine management, the management of standardized residency training is facing enormous challenges, and the construction of management information system is imperative. This paper introduces the basic modules design and application experience of management information system for standardized residency training in training hospitals, aiming at improving work efficiency, standardizing process management and ensuring training quality.

Objectives:To verify the effects and mechanisms of natural MSC-exosome in treating acute GVHD in mice, explore and establish a method for targeted modification of MSC-exosome, and verify the functions of the modified MSC-exosome.Methods:In different doses of MSC-exosome groups and MSC group, weight loss in acute GVHD mice was observed; then the proliferation levels of activated T cells were measured through T cell activation experiment in vitro and OVA antigen-specific T cell activation experiment in vivo. AAV2YF3 mutants carrying PD-L1 and PD-L1-ITGB1 were obtained after the construction of recombinant expression vectors and were then applied to infect human MSC to modify their exosome. The immunoregulatory functions of the modified MSC-exosome were measured with the abovementioned methods.Results:①Mouse MSC-exosome (300 μg×3 times) and MSC (1×10 6×3 times) effectively alleviated the weight loss in acute GVHD mice. ②Compared with IL-2, 10, 25 and 50 μg human MSC-exosome inhibited the proliferation of activated T cells in vitro, respectively, 86.0% (IL-2) , 40.0%, 39.6%, and 42.8%; compared with PBS, 50, 100 and 200 μg mouse MSC-exosome inhibited the proliferation of antigen-specific activated OT-1 cells in vivo, respectively, 42.6%, 33.1%, 14.2%, and 10.6%. ③After the infection of AAV2YF3 mutant carrying PD-L1 or PD-L1-ITGB1, the positive proportion of MSC-exosome exceeds 40% and 60%, respectively. ④Compared with the natural state, MSC-exosome modified by PD-L1 or PD-L1-ITGB1 showed better proliferation inhibitory effect in vivo and increased the proportion of Treg cells in vitro. Conclusions:MSC-exosome exhibited similar immunomodulatory effects with MSC. MSC-exosome after PD-L1 and PD-L1-ITGB1-targeted modification effectively inhibited the proliferation of activated T cells and increased the proportion of Treg cells.

The core of standardized training for residents is the cultivation of clinical practice ability,which is also the main content of the professional degree graduate training.With the integration of professional degree graduate training and standardized training of residents,the evaluation system of professional degree graduate tutors should be included in the quality index of graduate clinical skills training.Through the methods of document retrieval and expert consultation,the index structure,the examination content and the weight were set up,and the detailed rules for the evaluation of the professional degree graduate tutors were established to guide them strengthen the training of clinical skills for graduates and improve the cultivation quality of professional degree graduates.

Objective To understand the effect of standardized training teachers for fellowship training and to summarize the experience, in order to provide practical basis for standardized training of fellowship training and teachers training. Methods According to the requirements of standardized training for fellowship in Shanghai, the content of teacher training is drawn up. The training lasts for 4 days and 32 academic hours. After the training, 317 questionnaires were distributed through the form of electronic ques-tionnaire, and 301 questionnaires were recovered, with a recovery rate of 94.95％. Data statistics are in EXCEL (2016), and the data are expressed as percentage. Results Teachers participating in the training believe that fellowship training should pay most attention to the training of clinical operation skills and clin-ical thinking ability. Teachers have a high demand for training related to fellowship training policies, teach-ing ability, training quality control, teachers' professional quality and other aspects. The most popular teach-ing methods are teaching observation and discussion in small classes. 288 teachers (95.69％) thought that the teacher training was very effective or good, and 290 teachers (96.55％) thought that the teacher training would be very helpful or helpful to the future fellowship training and teaching work. Conclusion This teachers training has achieved good results. In the future, stratified and specialized training can be carried out to further improve the pertinence of teachers training. At the same time, we should strengthen the man-agement of the special training process and consolidate the special training quality. We will improve the evaluation methods and test the results.

The ability of clinical teachers plays a key role in residents standardized training. The teachers should fully understand the relevant policies and improve the awareness of resident standardized training. The construction of clinical teaching ability is the essential ability for clinical teachers and is the focus of the teacher training, which can guarantee to guide the improvement of residents' clinical thinking ability and the training of their clinical skills. Establishing teacher training system, making a suitable train-ing plan, selecting applicable training content and participating in various types of teacher training should effectively improve the comprehensive teaching ability of clinical teachers for resident standardized training.

OBJECTIVE To investigate the usage of antibiotics in surgical department of Chest surgery in PLA General Hospital.METHODS The antibiotics usage status among 412 cases of patients during perioperative period was retrospectively analyzed.RESULTS The utilization of antibacterials took up to 100.00%.The average of treatment course was13.89 days,Aminoglycosides,cephalosporin and penicillins was the main kinds,single use accounted for 28.64%,the bigeminy for 35.93%,and trigeminy for 30.58%,the utilization with four or more kinds of drugs were 4.85%.The rational usage and irrational usage accounted for 64.57% and 35.43% respectively.CONCLUSIONS Clinicians should strengthen the management of antibiotics in perioperative period for rational use.