Objective:To investigate the application effect of teaching rounds with problem-based learning (PBL) and clinical teaching unit (CTU) in standardized residency training for anesthesiology.Methods:A total of 40 resident trainees in Department of Anesthesiology, The First Affiliated Hospital of Soochow University, were randomly divided into research group and control group, with 20 trainees in each group. In the first stage (1-4 months), the trainees in the research group received PBL-CTU teaching rounds, and those in the control group received conventional teaching rounds; in the second stage (5-8 months), both groups received the PBL-CTU teaching rounds. The two groups were compared in terms of general information, assessment results of theoretical knowledge and skill operation in the first and second stages, and questionnaire survey of the degree of satisfaction with teaching. SPSS 24.0 was used for statistical analysis; the t-test was used for continuous data, and the chi-square test was used for categorical data. Results:There were no significant differences between the two groups in terms of age, sex, educational level, residency grade, and comprehensive ability assessment before the study. After the first stage of training, compared with the control group, the research group had significantly better theoretical assessment score [(85.30±3.39) vs. (81.15±4.66), P=0.003], skill assessment score [(83.95±4.37) vs. (79.70±6.20), P=0.017], and effective communication ability (95.00% vs. 65.00%, P=0.048) and team collaboration ability (100.00% vs. 65.00%, P=0.013) in questionnaire survey of the degree of satisfaction with teaching. After the second stage of training, both groups had significant increases in theoretical assessment score [the research group: (89.30±4.12) vs. (85.30±3.39), P=0.002; the control group: (88.90±3.49) vs. (81.15±4.66), P<0.001] and skill assessment score [the research group: (88.40±4.84) vs. (83.95±4.37), P=0.004; the control group: (86.20±4.98) vs. (79.70±6.20), P=0.001], and the questionnaire survey showed that a relatively high degree of satisfaction (95.00%-100.00%) was achieved for teaching effect, while there were no significant differences in each indicator between the two groups. Conclusions:Compared with conventional teaching rounds, PBL-CTU teaching rounds significantly improve the levels of theoretical knowledge and clinical operation ability and enhance the quality of teaching rounds. All residents have achieved satisfactory learning outcomes and progress after the two stages of teaching activities.

Objective To investigate the value of quantitative parameters of diffusion weighted imaging(DWI)based on mono-expo-nential model(MEM),diffusion kurtosis imaging(DKI)model,and stretched-exponential model(SEM)in predicting the efficacy of neoadjuvant therapy in locally advanced gastric cancer(LAGC).Methods Forty LAGC patients who underwent MRI examinations before neoadjuvant therapy and before radical surgery were prospectively enrolled.A radiologist delineated lesions on DWI images and acquired quantitative parameters before and after treatment,including lesion volume,apparent diffusion coefficient(ADC)of MEM,mean diffusivity(MD)and mean kurtosis(MK)of DKI model,distribution diffusion coefficient(DDC),and α of SEM.According to pathological tumor regression grade(TRG),the patients were stratified into good response group(TRG 0-1)and poor response group(TRG 2-3).The pre-treatment parameters and Δ of pre-and post-treatment parameters were compared between the two groups with Mann-Whitney U test;multivariate analysis was performed with binary logistic regression.Multiple DWI models and the combined model were established,and the prediction efficiency of each model was calculated.Results There was no significant differ-ence in each parameter before neoadjuvant therapy between the two groups(P>0.05).The delta of volume,ΔADC,ΔMD,and ΔDDC pre-and post-treatment were all statistically different between the two groups(P<0.05).The area under the curve(AUC)of ΔADC,ΔMD,and ΔDDC in predicting good response for LAGC were 0.900,0.806,and 0.762,respectively.The AUC of the combined model was 0.946.Conclusion Quantitative parameters of MEM,DKI model,and SEM can help predict the efficacy of neoadju-vant-treated LAGC patients.

Objective: To assess the dynamic changes of microcirculation at acupoints in patients with primary dysmenorrhea and cold congelation and blood stasis syndrome using laser speckle blood flow imaging. Methods: Patients with primary dysmenorrhea and cold coagulation and blood stasis syndrome (primary dysmenorrhea group, n=53) and healthy female college students(control group, n=57) who met the inclusion and exclusion criteria from October 2020 to July 2022 were enrolled at Hebei University of Chinese Medicine. On the premenstrual and first day of menstruation, a laser speckle blood flow imaging system was used to measure the microcirculation blood flow perfusion on the surface of acupoints related to the conception, thoroughfare, and governor vessels, and stomach, spleen, and bladder meridians in the abdomen and lumbosacral regions. The dynamic changes in microcirculation were calculated based on the difference in average blood flow perfusion at each acupoint before and after menstruation. Receiver operating curve (ROC) analysis was used to analyze the diagnostic efficacy of dynamic changes in microcirculation on the surface of each acupoint. The microcirculation sensitization rate of acupoints was calculated. Results: Compared with the control group, the dynamic changes in microcirculation at the following acupoints in the primary dysmenorrhea group were increased (P<0.05): conception vessel (Yinjiao[CV7], Qihai[CV6], Shimen[CV5], Guanyuan[CV4]); left thoroughfare vessel (left Huangshu[KI16], left Zhongzhu[KI15], left Siman[KI14], left Qixue[KI13], left Dahe[KI12], left Henggu[KI11]); left stomach meridian (left Tianshu[ST25], left Wailing[ST26], left Qichong[ST30]); left spleen meridian (left Daheng[SP15], left Fujie[SP14]); right thoroughfare vessel (right Huangshu[KI16], right Zhongzhu[KI15], right Siman[KI14], right Qixue[KI13], right Dahe[KI12], right Henggu[KI11]); right stomach meridian (right Wailing[ST26], right Daju[ST27], right Shuidao[ST28], right Guilai[ST29], right Qichong[ST30]); and right spleen meridian (right Fujie[SP14]). The area under the ROC curve of conception vessel (Yinjiao[CV7], Qihai[CV6], Shimen[CV5], Guanyuan[CV4]), thoroughfare vessel (right Siman[KI14], left Huangshu[KI16], right Qixue[KI13], right Zhongzhu[KI15], right Dahe[KI12], left Zhongzhu[KI15], left Siman[KI14], right Huangshu[KI16], left Qixue[KI13], right Henggu[KI11], left Henggu[KI11], left Dahe[KI12]); stomach meridian (left Tianshu[ST25], right Guilai[ST29], left Wailing[ST26], right Shuidao[ST28], right Daju[ST27], right Wailing[ST26], right Qichong[ST30], left Qichong[ST30]), and spleen meridian (left Daheng[SP15], left Fujie[SP14], right Fujie[SP14]) was 0.610-0.682 (P<0.05). Compared with the control group, the sensitization rate of some acupoints in the primary dysmenorrhea group increased (P<0.05). Conclusion With the onset of menstruation, the blood flow perfusion of some acupoints in the abdomen (thoroughfare, and conception vessels, and stomach and spleen meridians) of patients with primary dysmenorrhea and cold blood coagulation and blood stasis syndrome increased, and the status of acupoints changed from a resting state to an active state. These acupoints are sensitive in patients with primary dysmenorrhea and cold blood coagulation and blood stasis syndrome and have a certain diagnostic efficacy, providing a basis for further analyzing the efficacy and mechanism of acupuncture and moxibustion to treat primary dysmenorrhea with cold blood coagulation and blood stasis syndrome.

OBJECTIVE: To compare the efficacy and safety of intravenous colistin sulfate combined with nebulized inhalation versus intravenous monotherapy for pulmonary infections caused by carbapenem-resistant organism (CRO). METHODS: A multicenter retrospective cohort study was conducted. Clinical data were collected from patients admitted to the intensive care unit (ICU) of 10 tertiary class-A hospitals in Henan Province between July 2021 and May 2023, who received colistin sulfate for CRO pulmonary infections. Data included baseline characteristics, inflammatory markers [white blood cell count (WBC), neutrophil count (NEU), procalcitonin (PCT), C-reactive protein (CRP)], renal function indicators [serum creatinine (SCr), blood urea nitrogen (BUN)], life support measures, anti-infection regimens, clinical efficacy, microbiological clearance rate, and prognostic outcomes. Patients were divided into two groups: intravenous group (colistin sulfate monotherapy via intravenous infusion) and combination group ((intravenous infusion combined with nebulized inhalation of colistin sulfate). Changes in parameters before and after treatment were analyzed. RESULTS: A total of 137 patients with CRO pulmonary infections were enrolled, including 89 in the intravenous group and 48 in the combination group. Baseline characteristics, life support measures, daily colistin dose, and combination regimens (most commonly colistin sulfate plus carbapenems in both groups) showed no significant differences between two groups. The combination group exhibited higher clinical efficacy [77.1% (37/48) vs. 59.6% (52/89)] and microbiological clearance rate [60.4% (29/48) vs. 39.3% (35/89)], both P < 0.05. Pre-treatment inflammatory and renal parameters showed no significant differences between two groups. Post-treatment, the combination group showed significantly lower WBC and CRP [WBC (×10⁹/L): 8.2±0.5 vs. 10.9±0.6, CRP (mg/L): 14.0 (5.7, 26.6) vs. 52.1 (24.4, 109.6), both P < 0.05], whereas NEU, PCT, SCr, and BUN levels showed no significant between two groups. ICU length of stay was shorter in the combination group [days: 16 (10, 25) vs. 21 (14, 29), P < 0.05], although mechanical ventilation duration and total hospitalization showed no significant differences between two groups. CONCLUSIONS Intravenous colistin sulfate combined with nebulized inhalation improved clinical efficacy and microbiological clearance in CRO pulmonary infections with an acceptable safety profile.
Humans ; Colistin/therapeutic use* ; Retrospective Studies ; Administration, Inhalation ; Anti-Bacterial Agents/therapeutic use* ; Carbapenems/pharmacology* ; Male ; Female ; Middle Aged ; Gram-Negative Bacteria/drug effects* ; Aged ; Treatment Outcome ; Respiratory Tract Infections/drug therapy*

Objective To investigate the value of quantitative parameters of diffusion weighted imaging(DWI)based on mono-expo-nential model(MEM),diffusion kurtosis imaging(DKI)model,and stretched-exponential model(SEM)in predicting the efficacy of neoadjuvant therapy in locally advanced gastric cancer(LAGC).Methods Forty LAGC patients who underwent MRI examinations before neoadjuvant therapy and before radical surgery were prospectively enrolled.A radiologist delineated lesions on DWI images and acquired quantitative parameters before and after treatment,including lesion volume,apparent diffusion coefficient(ADC)of MEM,mean diffusivity(MD)and mean kurtosis(MK)of DKI model,distribution diffusion coefficient(DDC),and α of SEM.According to pathological tumor regression grade(TRG),the patients were stratified into good response group(TRG 0-1)and poor response group(TRG 2-3).The pre-treatment parameters and Δ of pre-and post-treatment parameters were compared between the two groups with Mann-Whitney U test;multivariate analysis was performed with binary logistic regression.Multiple DWI models and the combined model were established,and the prediction efficiency of each model was calculated.Results There was no significant differ-ence in each parameter before neoadjuvant therapy between the two groups(P>0.05).The delta of volume,ΔADC,ΔMD,and ΔDDC pre-and post-treatment were all statistically different between the two groups(P<0.05).The area under the curve(AUC)of ΔADC,ΔMD,and ΔDDC in predicting good response for LAGC were 0.900,0.806,and 0.762,respectively.The AUC of the combined model was 0.946.Conclusion Quantitative parameters of MEM,DKI model,and SEM can help predict the efficacy of neoadju-vant-treated LAGC patients.

Objective:To design a phonocardiographic gating device that was used in cardiac magnetic resonance imaging(MRI),so as to explore feasibility of synchronized acquisition for cardiac MRI.Methods:A phonocardiographic gating device was designed,which structure included a head of stethoscope,transmission pipeline,microphone and amplification filtering circuit,computer,and pseudo-electrocardiogram(ECG)trigger output circuit.The computer's runs included phonocardiographic recognition neural network of one-dimensional dilated convolutional layer and gating recurrent unit(GRU)layer,which parameters were determined by pre-train.The feasibility of using the phonocardiographic gating device in acquisition of cardiac MRI was explored by comparing the preparation time of examination and image quality for phonocardiographic gating device and ECG gating technique.Results:The average preparation time for the phonocardiographic gating device was(10.46±1.75)seconds,which was significantly shorter than that for ECG gating technique[(32.07±5.26)seconds](t=-11.02,P＜0.05).There were no statistically significant difference in the clarity of short-axis images of heart at end-systole and end-diastole,and the indicators of cardiac function between the two methods(P＞0.05).Conclusion:The phonocardiographic gating device can replace ECG gating for MRI examinations,which can effectively conduct triggering for phonocardiographic gating while reducing preparation time.It holds clinical application value,especially in equipment with high field strength.

Objective:To design a phonocardiographic gating device that was used in cardiac magnetic resonance imaging(MRI),so as to explore feasibility of synchronized acquisition for cardiac MRI.Methods:A phonocardiographic gating device was designed,which structure included a head of stethoscope,transmission pipeline,microphone and amplification filtering circuit,computer,and pseudo-electrocardiogram(ECG)trigger output circuit.The computer's runs included phonocardiographic recognition neural network of one-dimensional dilated convolutional layer and gating recurrent unit(GRU)layer,which parameters were determined by pre-train.The feasibility of using the phonocardiographic gating device in acquisition of cardiac MRI was explored by comparing the preparation time of examination and image quality for phonocardiographic gating device and ECG gating technique.Results:The average preparation time for the phonocardiographic gating device was(10.46±1.75)seconds,which was significantly shorter than that for ECG gating technique[(32.07±5.26)seconds](t=-11.02,P＜0.05).There were no statistically significant difference in the clarity of short-axis images of heart at end-systole and end-diastole,and the indicators of cardiac function between the two methods(P＞0.05).Conclusion:The phonocardiographic gating device can replace ECG gating for MRI examinations,which can effectively conduct triggering for phonocardiographic gating while reducing preparation time.It holds clinical application value,especially in equipment with high field strength.

Objective:To investigate the application effect of teaching rounds with problem-based learning (PBL) and clinical teaching unit (CTU) in standardized residency training for anesthesiology.Methods:A total of 40 resident trainees in Department of Anesthesiology, The First Affiliated Hospital of Soochow University, were randomly divided into research group and control group, with 20 trainees in each group. In the first stage (1-4 months), the trainees in the research group received PBL-CTU teaching rounds, and those in the control group received conventional teaching rounds; in the second stage (5-8 months), both groups received the PBL-CTU teaching rounds. The two groups were compared in terms of general information, assessment results of theoretical knowledge and skill operation in the first and second stages, and questionnaire survey of the degree of satisfaction with teaching. SPSS 24.0 was used for statistical analysis; the t-test was used for continuous data, and the chi-square test was used for categorical data. Results:There were no significant differences between the two groups in terms of age, sex, educational level, residency grade, and comprehensive ability assessment before the study. After the first stage of training, compared with the control group, the research group had significantly better theoretical assessment score [(85.30±3.39) vs. (81.15±4.66), P=0.003], skill assessment score [(83.95±4.37) vs. (79.70±6.20), P=0.017], and effective communication ability (95.00% vs. 65.00%, P=0.048) and team collaboration ability (100.00% vs. 65.00%, P=0.013) in questionnaire survey of the degree of satisfaction with teaching. After the second stage of training, both groups had significant increases in theoretical assessment score [the research group: (89.30±4.12) vs. (85.30±3.39), P=0.002; the control group: (88.90±3.49) vs. (81.15±4.66), P<0.001] and skill assessment score [the research group: (88.40±4.84) vs. (83.95±4.37), P=0.004; the control group: (86.20±4.98) vs. (79.70±6.20), P=0.001], and the questionnaire survey showed that a relatively high degree of satisfaction (95.00%-100.00%) was achieved for teaching effect, while there were no significant differences in each indicator between the two groups. Conclusions:Compared with conventional teaching rounds, PBL-CTU teaching rounds significantly improve the levels of theoretical knowledge and clinical operation ability and enhance the quality of teaching rounds. All residents have achieved satisfactory learning outcomes and progress after the two stages of teaching activities.

Objective:To investigate the effect of bupivacaine liposome for erector spinae plane block on the quality of postoperative recovery in patients undergoing thoracoscopic lung resection.Methods:From July 2023 to January 2024, 128 American Society of Anesthesiologists Physical Status classification ⅠorⅡ patients of either sex, aged 18-75 yr, with body mass index of 18-32 kg/m 2, scheduled for elective thoracoscopic lung resection at the First Affiliated Hospital of Soochow University, were assigned to either bupivacaine liposome group (BL group) or bupivacaine hydrochloride group (BH group) using a random number table method, with 64 patients in each group. Patients received an ultrasound-guided erector spinae plane block following anesthesia induction. BL group received an injection of bupivacaine liposome 20 ml (266 mg) plus normal saline 10 ml, while BH group received an injection of bupivacaine hydrochloride 20 ml (100 mg) plus normal saline 10 ml. The primary outcome was the Quality of Recovery-15 (QoR-15) score at 24 h postoperatively. Secondary outcomes included the QoR-15 score at 3 days postoperatively, time to first patient-controlled analgesia press, and total opioid consumption within the first 3 days postoperatively. Other outcomes assessed were the time to ambulation, duration of chest tube placement, length of hospital stay, patient satisfaction scores at discharge, and development of adverse reactions during hospitalization. Results:Compared to BH group, QoR-15 scores were significantly increased at 24 h and 3 days postoperatively, the time to first patient-controlled analgesia press was significantly prolonged, the consumption of opioid was reduced within the first 3 days postoperatively, the time to ambulation was shortened, and patient satisfaction scores at discharge were increased in BL group ( P<0.05). There were no statistically significant differences between the two groups in terms of the chest tube duration, length of hospital stay, and incidence of adverse reactions during hospitalization ( P>0.05). Conclusions:Bupivacaine liposome for erector spinae plane block can improve the quality of postoperative recovery in patients undergoing thoracoscopic lung resection.

Objective We aimed to observe the differences in the effects of different acupuncture technique on the endometrium of mice with simple endometrial hyperplasia model and to explore the potential mechanisms. Methods According to the random number tables,32 female C57BL/6J mice were divided into a blank control group,a model group,a quick needle group and a retaining needle group,with 8 mice in each group. A mouse model of simple endometrial hyperplasia was established using bilateral ovariectomy combined with estrogen loading. In the quick needle group,mice were punctured at the bilateral for "Yinbai"(SP1) points and withdrawn immediately,with the treatmeat performed once every other day for a total of 12 times. In the retaining needle group,mice were punctured at the bilateral "Yinbai"(SP1) points and the needles were retained for 15 min each time,with the treatment also performed once every other day for a total of 12 times. After the intervention,samples were collected. HE staining was used to observe morphological changes in the mouse uterine tissue;ELISA was used to detect serum estradiol level;flow cytometry was used to detect the ratio of M1 and M2 macrophages(M1/M2) and immunohistochemical method was used to measure the expression of CD86 and CD206 in uterine tissue;and Western blotting was used to detect the expression of interleukin-13 (IL-13) and interferon-γ(IFN-γ) in uterine tissue. Results The endometrium of mice in the model group showed simple hyperplasia. Compared with the blank control group,the endometrium of the model group was thickened (P<0.01);the level of estradiol in the serum was increased (P<0.01);M1/M2 in uterine tissues was decreased (P<0.01),the expression of CD86 was decreased (P<0.01),and the positive expression of CD206 was increased (P<0.01);and the level of IFN-γ protein expression in uterine tissues was decreased (P<0.01),and the expression of IL-13 protein was increased (P<0.01). Compared with the model group,the endometrial thicknesses of the quick needle group and the retaining needle group were reduced (P<0.05),the levels of estradiol in serum were reduced (P<0.05),M1/M2 in uterine tissues increased (P<0.01),and the reduction of CD206 positive expression,and IL-13 protein expression reduced (P<0.01);the level of CD86 positive expression,IFN-γ protein expression increased (P<0.01). Compared with the quick needle group,IL-13 protein expression increased in the retaining needle group (P<0.01).Conclusion Both quick needle and retaining needle may be through the regulation of the expression of IFN-γ and IL-13,thus prompting the polarization of macrophages from M2 to M1 type,inhibiting the pro-cell proliferative ability and tissue repair ability of M2 type macrophages,thus reducing the degree of endometrial hyperplasia,and the quick needle group was superior to the retaining needle group in regulating the expression of IL-13.