With the increasing learning demand for clinical research among refresher clinicians, the current refresher training system remains incomplete. In response to such demands, we have developed a whole-course mentorship training model, constructed a standardized theoretical training framework, and created diverse learning modules in 2020 in department of anesthesiology, West China Hospital, Sichuan University, thereby establishing a more complete clinical research refresher training program for anesthesiology. Practice has shown that this system effectively addressed the issues such as uneven knowledge levels of refresher clinicians and complex learning objectives and significantly improved their clinical research abilities. 42 refresher clinicians completed a clinical research program independently when they completed the training, and 14 of them published academic papers as the first author, with their supervisors. In the future, we will further optimize the training system and improve the quality of training by enhancing humanities education, enriching assessment dimensions, and establishing a training evaluation mechanism, and in addition, we will attract the clinicians of primary hospitals and support the development of primary hospitals by strengthening the efforts on publicity.

Background::Triple-negative breast cancer (TNBC) is a type of highly invasive breast cancer with a poor prognosis. According to new research, long noncoding RNAs (lncRNAs) play a significant role in the progression of cancer. Although the role of lncRNAs in breast cancer has been well reported, few studies have focused on TNBC. This study aimed to explore the biological function and clinical significance of forkhead box C1 promoter upstream transcript (FOXCUT) in triple-negative breast cancer.Methods::Based on a bioinformatic analysis of the cancer genome atlas (TCGA) database, we detected that the lncRNA FOXCUT was overexpressed in TNBC tissues, which was further validated in an external cohort of tissues from the General Surgery Department of the First Affiliated Hospital of Nanjing Medical University. The functions of FOXCUT in proliferation, migration, and invasion were detected in vitro or in vivo. Luciferase assays and RNA immunoprecipitation (RIP) were performed to reveal that FOXCUT acted as a competitive endogenous RNA (ceRNA) for the microRNA miR-24-3p and consequently inhibited the degradation of p38. Results::lncRNA FOXCUT was markedly highly expressed in breast cancer, which was associated with poor prognosis in some cases. Knockdown of FOXCUT significantly inhibited cancer growth and metastasis in vitro or in vivo. Mechanistically, FOXCUT competitively bounded to miR-24-3p to prevent the degradation of p38, which might act as an oncogene in breast cancer. Conclusion::Collectively, this research revealed a novel FOXCUT/miR-24-3p/p38 axis that affected breast cancer progression and suggested that the lncRNA FOXCUT could be a diagnostic marker and therapeutic target for breast cancer.

Objective:To investigate the status of work performance among rural doctors in Shanxi province and the factors related to their performance.Methods:From July to September 2019, 528 rural doctors in Shanxi province were selected by multi-stage stratified cluster sampling for the survey. Their job competency, job performance, psychological capital and burnout were evaluated. The structural equation model was used to construct the job performance analysis based on post competency.Results:The total score of post competency of rural doctors in Shanxi province was (188.6±20.3), and the total score of job performance was (71.3±11.5), both of which were in the middle level. The structural equation model was well fitted [goodness-of-fit index (GFI)=0.958, normal fix index (NFI)=0.920, adjusted goodness-of-fit index (AGFI)=0.910, root mean square error of approximation (RMSEA)=0.076]. Post competency, psychological capital and job burnout had direct effects on job performance ( P<0.05), with influence coefficients of 0.64, 0.35 and -0.25, respectively. Job competency indirectly affected job performance through psychological capital and job burnout ( P<0.05). Conclusion:The study suggest that higher post competency would facilitate to improve the work performance of rural doctors.

Objective To analyze the clinical efficacy of AngioJet mechanical thrombus aspiration system for patients with acute pulmonary embolism (PE).Methods Clinical data of 28 cases of acute pulmonary embolism (PE) patients was retrospectively analyzed,8 cases (AngioJet group) were treated with AngioJet + CDT,20 cases were treated by pigtail catheter thrombolysis(CDT group)alone,the total amount of urokinase,thrombolytic time,related detection index and the occurrence of complications were compared between the two groups.Results The dosage of urokinase in the two groups was (72.5 ± 44.4) × 104U and (169.0 ± 59.3) × 104 U respectively,P ＜ 0.05.The catheter indwelling time was (1.0 ± 0.89) days and (2.65 ± 0.86) days respectively (P ＜ 0.05).There were no statistically significant differences in SBP,PaO2,SpO2 and D-dimer between the two groups before and after operation (P ＞ 0.05).Conclusion Both AngioJet and CDT are effective methods for the treatment of acute PE.The combination of the two methods can accelerate the improvement of clinical symptoms,reducing the dosage of thrombolytic drugs and the occurrence of surgery-related complications.

Objective To investigate the effect of different forbidden drink schemes on anesthesia induction and postoperative nausea and vomiting during pediatric interventional heart surgery.Methods One hundred and twenty pediatric patients underwent cardiac interventional procedures under general anesthesia were randomized into group A,B and C,with 40 patients in each group.Patients in cach group were fasted for 8 h preoperatively.Water was prohibited for patients in group A for 6 h preoperatively.Patients in groups B and C orally took 10％ glucose solution and a multivitamin drink (Outfast) at 2 h preoperatively,respectively.Nausea and vomiting after anesthesia induction were recorded for 24 h postoperatively.Results The sedation and mask acceptance scores were significantly higher in group B and C than those in group A,and were significantly higher in group C than those in group B (P ＜ 0.05,resoectively).Following anesthesia induction,MAP was significantly higher in group B and C than that in group A (P ＜ 0.05,resoectively).Both the severity and incidence of postoperative nausea and vomiting were higher in group B and C than those in group A,and was lower in group C than that in group B (P ＜ 0.05,resoectively).Conclusions Taking clear water orally 2 hours before surgery can decrease the restlessness of pediatric interventional heart surgery during anesthesia induction period,with stable smooth hemodynamics,reducing the degree of PONV.

Objective To investigate the biomarkers in hepatocellular carcinoma and their prognostic value via GEO (Gene Expression Omnibus) and TCGA (The Cancer Genome Atlas) database.Methods Datasets of hepatocellular carcinoma were downloaded from GEO (GSE67140) and TCGA.MicroRNA in SNU423,SNU449,HepG2,Hep3B,SNU398 cell lines which had low or high invasion capabilities were investigated and verified,in 81 patients with and 91 without vascular invasion hepatocellular carcinoma.The prognostic value of these microRNAs were studied via TCGA database,obtained from 362 patients with hepatocellular carcinoma,through Kaplan-Meier and Multivariate Cox proportional hazard analysis.Target genes were analyzed by GO and KEGG.Results Expressions of hsa-mir-1180,hsa-mir-149,hsa-mir-744 and hsa-mir-940 were all up regulated in high invasion capable cell lines (SNU423,SNU449) and vascular invasion patients with hepatocellular carcinoma (logFC＞l,P＜0.05).Results from the Survival analysis showed that hsa-mir-1180 (HR=1.623,95％ CI:1.114-2.365,P=0.012),hsa-mir-149 (HR=2.400,95％ CI:1.639-3.514) and hsa-mir-940 (HR =1.704,95 ％ CI:1.188-2.443,P =0.004) were independent risk factors on the prognosis of patients with hepatocellular carcinoma (P＜0.05).The mechanism might be related to factors as immune response,focal adhesion and adherence junction signaling pathways.Conclusion With TCGA and GEO data mining,we found that hsa-mir-1180,hsa-mir-149,hsa-mir-744 and hsa-mir-940 were all highly related to the prognosis of hepatocellular carcinoma,that enabled it to be used to further study the biomarkers related to the prognosis of hepatocellular carcinoma.

Objective To evaluate clinical outcome of patients treated with endovascular dilation and stent placement for ilio-femoral venous postthrombotic syndrome (PTS).Methods 42 PTS cases were enrolled in our group from June 2003 to December 2011.Dilation and stent placement in stenosis/ occlusion of ilio-femoral veins were performed in all cases,temporary femoral arteriovenous fistula was established in 24 cases.Results These were not severe perioperative complications.All patients were followed up for 8-75 months.Preoperative limb ulcers in 5 cases were healed.Early thrombosis in stents found in 3 cases was cleared by catheter directed thrombolysis (CDT).Severe in-stent restenosis (＞ 50％)was found in 10 cases,treated with dialation or re-stenting.Primary patency,assisted primary patency and secondary patency rates were 75％,78％,80.1％;64.1％,67.1％,69.6％;63.8％,65.3％,66％;61.7％,65％,65.2％,respectively,at 6 months,12 months,24 months and 36 months.Postoperative Venous Clinical Severrity Score (VCSS) decreased (P =0.000).There was statistical significant improvement in every dimension evaluated by the MOS item short from health survey(SF-36) after operation (P =0.000).Conclusion Ilio-femoral venous stenting is a safe and effective treatment for PTS and with good clinical midterm results.

Objective To evaluate ascending venography in the diagnosis of iliac vein compression syndrome.Methods From April 2011 to April 2013,we have had 556 patients with varicose veins suspected of Cockett syndrome.The degree of varicose veins by the International Union of Venous Clinical Classification (CEAP classification) was as following[1]:shallow varicose veins of lower limb (C2) in 190;varicose veins with limb swelling (C3) in 149 cases ; with body skin changes,such as pigmentation,eczema or lipid hard skin disease (C4) in 130; with healed ulcers (C5) in 17; with active ulcer(C6) in 70.Deep vein anterograde contrast and femoral venous cannula angiography were performed on 760 times.Results Iliac vein compression syndrome (Cockett) was detected by ascending venography in 154 patients,the diagnosis was established by following femoral venous cannula angiography.In the other 48 patients in whom Cockett syndrome was suspected by ascending venography,final diagnosis was reached by femoral venous cannula angiography.Altogether there were 202 iliac vein compression syndrome cases,with a positive rate 38.19％ (202/529).The narrowness was larger than 50％ in 173 cases.In 145 cases there were visible collateral vessels.Conclusions Deep vein ascending angiography is a useful screening method in the diagnosis and treatment of Cockett syndrome.

Objective To explore the short- term efficacy of argon- helium knife cryotherapy followed by chemotherapy in treating advanced non- small cell lung cancer (NSCLC) and to investigate its effect on the long- term survival. Methods During the period from March 2005 to March 2008, a total of 61 patients withⅢb or Ⅳ stage NSCLC received argon- helium knife cryotherapy followed by chemotherapy (study group), and other 52 patients with Ⅲb or Ⅳ stage NSCLC were treated with chemotherapy only (control group). The clinical data were retrospectively analyzed. The pain was evaluated by numeric rating scale (NRS) and the quality of life (QOL) was assessed by functional assessment of cancer therapy- general (FACT- G) scale. The clinical effect was evaluated according to RECIST criteria for solid tumor, and the patient’s survival time was recorded. Results (1) Twenty- six patients had local pain before the treatment, and the pain was relieved in different degrees after cryotherapy. The QOL, including all respects of FACT - G, was significantly improved after cryotherapy in all 61 patients. (2) The remission rate of the study group and the control group was 34.4% and 15.4% respectively, the difference between the two groups was statistically significant (P <0.05). (3) The median survival time of the study group and the control group was 12.9 months and 9.5 months respectively, and the one- year survival rate of the study group and the control group was 53.6% and 35.4% respectively. The differences between the two groups were statistically significant (P < 0.01). Conclusion Argon- helium knife cryotherapy is a safe and effective local treatment for advanced NSCLC, which can quickly reduce the tumor load, relieve the pain and improve patient’s quality of life. Cryotherapy with subsequent chemotherapy is superior to simple chemotherapy in improving the patient’s survival rate.

Objective To explore the possible protective effect of hyperbaric oxygen (HBO) on cognitive deficits induced by amyloid β25-35 (Aβ25-35) and neuronal apoptosis in the hippocampi of rats with Alzheimer's disease (AD).Methods The animal AD model was established in 24 Sprague-Dawley rats by bilateral hippocampal injection of Aβ25-35.Twelve rats were injected with normal saline as controls,and another 12 served as normal controls.After the injection,the model rats were further divided into a model group and a treatment group.All the rats were housed with normal feeding for 2 weeks and then those in the treatment groups received a total of 2 courses of HBO treatment (10 days each with an interval of 3 days in between).The other groups were left with no treatment.After the treatment,the rats' learning and memory ability were tested using Morris' water maze test,and any neuronal changes were observed using TUNEL staining.The expression of mRNA and Bcl-2 and Bax proteins in the hippocampus were detected using a RT-PCR and Western blotting.Results HBO significantly improved the learning and memory impairment and alleviated neuronal apoptosis in the hippocampus compared against the control group.In addition,HBO treatment significantly increased the mRNA and protein expression of Bcl-2 and down-regulated the expression of Bax.Conclusion HBO treatment can prevent learning and memory impairment induced by Aβ25-35 peptides,which might be mediated by inhibiting neuronal apoptosis in the hippocampus.