BACKGROUND:Currently,the pre-dilatation balloons used in clinical coronary intervention are mainly the traditional high-pressure balloon and papillary balloon.They may slip off in the diseased vessel and then bruise the vessel. OBJECTIVE:To evaluate the safety and effectiveness of the new coronary rotary scoring balloon in vasodilatation. METHODS:(1)Finite element analysis:The three-dimensional finite element model of blood vessel was established by collecting relevant human tissue data,and then the three-dimensional finite element model of papillary balloon implantation in blood vessel and the three-dimensional finite element model of rotary scored balloon implantation in blood vessel were established to analyze the vascular stress,vascular displacement,balloon stress and balloon displacement during balloon expansion under different aeration pressures.(2)Animal experiments:Eight New Zealand rabbits with large ears were randomly divided into two groups,and the papillary balloon and rotary scored balloon were implanted in the iliac artery for expansion,with four rabbits in each group.After the balloon was withdrawn,samples were taken.Hematoxylin-eosin staining and transmission electron microscopy were used to observe the vascular injury. RESULTS AND CONCLUSION:(1)Finite element analysis:There was no significant difference in the elastic properties of the two types of balloon.Under the same aeration pressure,the vascular stress,vascular displacement,balloon stress,and balloon displacement of the papillary balloon group were much greater than those of the rotary scored balloon group,and the uniformity of each index was better than that of the rotary scored balloon group.With the increase of inflatable pressure,the increase of blood vessel stress,blood vessel displacement,balloon stress and balloon displacement in the papillary balloon group was much greater than that in the rotary scored balloon group.(2)Animal experiments:Hematoxylin-eosin staining and transmission electron microscope observation showed that the vascular damage caused by rotary scored balloon expansion was limited to the intima,while the vascular damage caused by papillary balloon expansion was more serious,and the intima and media were seriously damaged.Hematoma formation could be seen in some segments;more inflammatory cells were found around the blood vessels,and local macrophage accumulation could be seen.(3)The results show that compared with papillary balloon dilatation,the risk of vascular occlusion and dissection caused by rotary scored balloon dilatation was less,but there was a certain probability of balloon bending.

OBJECTIVE To investigate the current situation of pharmaceutical management in compact medical consortium of Guangdong province， and to provide decision-making basis for promoting the high-quality construction and sustainable development of the provincial medical consortium. METHODS A self-designed questionnaire was used to select 50 compact medical consortiums in Guangdong province. The survey was answered by the heads of the pharmacy department of the general hospitals. The survey covered the basic scale of the consortium， the appointment of chief pharmacists， the implementation of pharmaceutical management and pharmaceutical care homogenization within the consortium， the difficulties in promoting the homogenization， and the expected provincial support. Descriptive statistical analysis was performed on the survey results. RESULTS A total of 50 questionnaires were collected， and the effective recovery rate was 100%. There were 16 chief pharmacists （32.00%） in charge of the pharmacy department of the general hospital in the medical consortium. Thirty-seven medical consortiums （74.00%） had established a drug supply support system within the consortium， 35 medical consortiums （70.00%） had carried out pharmaceutical management and coordination work within the medical consortium， 23 medical consortiums （46.00%） had established a clinical medication guidance system， 25 medical consortiums chenwenying2016@163.com （50.00%） had established a bidirectional communication mechanism， and only 8 medical consortiums （16.00%） had developed new models of pharmaceutical care. At present， the difficulties in promoting the homogenization of pharmaceutical management and pharmaceutical care within the medical consortium were mainly found in three aspects： the wide gap in management level of each member unit， the lack and uneven level of pharmaceutical personnel， and insufficient policy support and implementation. Most medical consortiums hoped that relevant departments could promote the homogenization of pharmaceutical work by holding special training courses or special supervision. CONCLUSIONS At present， the compact medical consortium in Guangdong province has achieved initial results in the implementation of the chief pharmacist system， the homogenization of pharmaceutical management and pharmaceutical care. However， it is still necessary to improve the coverage of chief pharmacist appointments in the medical consortium， implement the homogenization of pharmaceutical management， and accelerate the homogenization process of pharmaceutical care.

Objective To develop a highly sensitive and rapid nucleic acid detection method for the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2). Methods We designed,developed,and manufactured an integrated disposable device for SARS-CoV-2 nucleic acid extraction and detection.The precision of the liquid transfer and temperature control was tested.A comparison between our device and a commercial kit for SARS-Cov-2 nucleic acid extraction was performed using real-time fluorescence reverse transcription polymerase chain reaction(RT-PCR).The entire process,from SARS-CoV-2 nucleic acid extraction to amplification,was evaluated. Results The precision of the syringe transfer volume was 19.2±1.9 μL(set value was 20),32.2±1.6(set value was 30),and 57.2±3.5(set value was 60).Temperature control in the amplification tube was measured at 60.0±0.0 ℃(set value was 60)and 95.1±0.2 ℃(set value was 95)respectively.SARS-Cov-2 nucleic acid extraction yield through the device was 7.10×106 copies/mL,while a commercial kit yielded 2.98×106 copies/mL.The mean time to complete the entire assay,from SARS-CoV-2 nucleic acid extraction to amplification detection,was 36 min and 45 s.The detection limit for SARS-CoV-2 nucleic acid was 250 copies/mL. Conclusion The integrated disposable devices may be used for SARS-CoV-2 Point-of-Care test(POCT).

Objective:To investigate the effects of stellate ganglion block(SGB)on serum inflammatory cytokines and the expression of toll-like receptor 4(TLR4),cysteine aspartate protease 3(caspase-3),and NF-κB(p65)pro-teins in rats with acute peritonitis(AP),with the goal of elucidating the mechanisms through which SGB modulates inflammatory responses.Methods:40 SPF grade male rats were randomly assigned to 4 groups:control group(Con-trol),acute peritonitis group(AP),acute peritonitis+right stellate ganglion block group(AP+SGB),and acute peri-tonitis+right stellate ganglion block+TLR4 inhibitor resatorvid group(AP+SGB+TAK-242),with 10 rats in each group.Acute peritonitis was induced in the AP,AP+SGB,and AP+SGB+TAK-242 groups via intraperitoneal injec-tion of 1 ml/100 g of 2％acetic acid solution.After establishing the model,blood samples were collected from the tail vein at 1 h,6 h,12 h,and 24 h respectively.Serum levels of interleukin-10(IL-10),tumor necrosis factor-alpha(TNF-α),interleukin-1 β(IL-1 β),and high mobility group protein B1(HMGB1)were measured using ELISA.After 24 hours,the peritoneal tissues were collected for analysis.Protein levels of TLR4,caspase-3,and NF-κB(p65)were quantified via Western Blot,while simultaneously,their mRNA expression levels were assessed using RT-qPCR.His-topathological alterations were evaluated by hematoxylin and eosin(HE)staining and then observed under optical microscopy.Results:At all time points,the AP,AP+SGB,and AP+SGB+TAK-242 groups showed significantly higher levels of IL-10,TNF-α,IL-1 β,and HMGB1 compared to the S group(P＜0.05).The AP+SGB group exhibi-ted significantly lower TNF-α,IL-1 β,and HMGB1 levels and higher IL-10 levels than the AP group at corresponding time points(P＜0.05).The AP+SGB+TLR4 group demonstrated further reductions in TNF-α,IL-1 β,and HMGB1 levels and additional increases in IL-10 levels relative to the AP+SGB group(P＜0.05).Both the AP+SGB and AP+SGB+TAK-242 groups showed significant decreases in TLR4,caspase-3,and NF-κB(p65)protein expression(P＜0.05).Similarly,TLR4 and NF-κB(p65)mRNA expression levels were markedly downregulated in these groups(P＜0.05).Conclusion:SGB can mitigate the inflammatory response in acute peritonitis rats by inhibiting the TLR4/NF-κB signaling pathway through the downregulation of TLR4 and NF-κB(p65).

Objective:To investigate the effects of stellate ganglion block(SGB)on serum inflammatory cytokines and the expression of toll-like receptor 4(TLR4),cysteine aspartate protease 3(caspase-3),and NF-κB(p65)pro-teins in rats with acute peritonitis(AP),with the goal of elucidating the mechanisms through which SGB modulates inflammatory responses.Methods:40 SPF grade male rats were randomly assigned to 4 groups:control group(Con-trol),acute peritonitis group(AP),acute peritonitis+right stellate ganglion block group(AP+SGB),and acute peri-tonitis+right stellate ganglion block+TLR4 inhibitor resatorvid group(AP+SGB+TAK-242),with 10 rats in each group.Acute peritonitis was induced in the AP,AP+SGB,and AP+SGB+TAK-242 groups via intraperitoneal injec-tion of 1 ml/100 g of 2％acetic acid solution.After establishing the model,blood samples were collected from the tail vein at 1 h,6 h,12 h,and 24 h respectively.Serum levels of interleukin-10(IL-10),tumor necrosis factor-alpha(TNF-α),interleukin-1 β(IL-1 β),and high mobility group protein B1(HMGB1)were measured using ELISA.After 24 hours,the peritoneal tissues were collected for analysis.Protein levels of TLR4,caspase-3,and NF-κB(p65)were quantified via Western Blot,while simultaneously,their mRNA expression levels were assessed using RT-qPCR.His-topathological alterations were evaluated by hematoxylin and eosin(HE)staining and then observed under optical microscopy.Results:At all time points,the AP,AP+SGB,and AP+SGB+TAK-242 groups showed significantly higher levels of IL-10,TNF-α,IL-1 β,and HMGB1 compared to the S group(P＜0.05).The AP+SGB group exhibi-ted significantly lower TNF-α,IL-1 β,and HMGB1 levels and higher IL-10 levels than the AP group at corresponding time points(P＜0.05).The AP+SGB+TLR4 group demonstrated further reductions in TNF-α,IL-1 β,and HMGB1 levels and additional increases in IL-10 levels relative to the AP+SGB group(P＜0.05).Both the AP+SGB and AP+SGB+TAK-242 groups showed significant decreases in TLR4,caspase-3,and NF-κB(p65)protein expression(P＜0.05).Similarly,TLR4 and NF-κB(p65)mRNA expression levels were markedly downregulated in these groups(P＜0.05).Conclusion:SGB can mitigate the inflammatory response in acute peritonitis rats by inhibiting the TLR4/NF-κB signaling pathway through the downregulation of TLR4 and NF-κB(p65).

Objective:To analyze the clinical characteristics of hospitalized premenopausal patients with hyperuricemia.Methods:The medical records of premenopausal women with hyperuricemia (serum uric acid ≥360 μmol/L during hospitalization) admitted in Peking Union Medical College Hospital from 2013 to 2018 were reviewed and the clinical data were analyzed.Results:A total of 2 099 patients were enrolled. Only 14.01% (294 cases) of the patients were concerned about hyperuricemia by physicians. Autoimmune diseases (32.11%, 674 cases), nephrotic disease (19.29%, 405 cases) and endocrine system diseases (9.72%, 204 cases) are the main reasons for hospitalization, while 6.34%(133 cases) of patients were in gestation. In terms of the etiology, renal diseases (49.35%, 1 035 cases), specific drug use (49.26%, 1 034 cases) were the main causes of secondary hyperuricemia in premenopausal women, followed by metabolic diseases (10.62%, 233 cases). There was no significant difference in serum uric acid level among premenopausal women of different ages ( H=4.47, P=0.107), but the etiology of hyperuricemia among patients of different ages had significant differences. The proportion of hyperuricemia in patients with cancer and metabolic syndrome,secondary to use of diuretics and anti-tuberculosis drugs had differences among different age groups ( χ2=90.96,52.89,19.26 and 6.41, P<0.05). Conclusion:Hyperuricemia is not uncommon in premenopausal women. There are many secondary factors leading to hyperuricemia in premenopausal women, among which drugs and renal lesions are the main causes. In addition, the secondary factors in women with hyperuricemia has differences among different age groups.

Objective:To observe the effect of acupuncture in the treatment of accommodative myopia in children.Methods:A total of 76 children with accommodative myopia who met the inclusion criteria were divided into a control group or a test group according to the random number table method,with 38 cases in each group.The control group was given education on eye hygiene,and the test group was treated with acupuncture twice a week for 2 months in addition to the intervention used in the control group.The patient's uncorrected visual acuity(UCVA),refraction,and axial length(AL)were measured before treatment and 1 month and 2 months after treatment.Results:After 1 month of treatment,there was no significant difference in the UCVA between the two groups(P＞0.05);after 2 months of treatment,the UCVA of the test group was better than that of the control group(P＜0.05).After 1 and 2 months of treatment,the refraction of the two groups was significantly different from that before treatment(P＜0.01),but there was no significant difference between the two groups(P＞0.05).After 1 and 2 months of treatment,the AL in the control group was increased compared with that before treatment(P＜0.05),while there was no significant change in the test group(P＞0.05),and there was no significant difference between the two groups(P＞0.05).Conclusion:Acupuncture treatment can improve UCVA in children with accommodative myopia.

Objective: To observe the clinical efficacy of electroacupuncture (EA) in controlling myopia in children and its effect on retinal blood flow. Methods: Sixty-eight myopic children were randomly divided into an observation group and a control group, with 34 cases in each group. The control group was given auricular acupressure treatment alone, and the observation group was treated with EA once a week in addition to the treatment used in the control group. The spherical equivalent refraction (SER) and axial length (AL) were measured at baseline, and after 3 months and 6 months of treatment. Optical coherence tomography angiography was used to measure the vessel density (VD) and perfusion density (PD) in the surface layer of the retina. Results: After 3 months and 6 months of treatment, the changes in SER between the two groups were not statistically significant (P>0.05). After 3 months of treatment, the changes in AL between the two groups were not statistically significant (P>0.05); after 6 months of treatment, the change amount of AL in the observation group was smaller than that in the control group (P<0.05); after 3 months and 6 months of treatment, the changes in VD and PD in the surface layer of the retina in the observation group were significantly greater than those in the control group (P<0.01). Conclusion: EA treatment once a week for 6 months can delay the increase of AL and improve the retinal surface blood flow in myopic children.

Objective:To explore the impact of Coronavirus disease 2019 (COVID-19) epidemic on career choosing perspective among medical students and to analyze the related factors.Methods:Semi-structured telephone interviews were conducted during March 1-25 2020 among 19 medical students of 8-year program from Peking Union Medical College. The grounded theory and thematic analysis were applied to code the data and identify categories and factors.Results:Among the 19 respondents aged 19-26 years, 9 were males and 10 were female; 10 were at the clinical stage, and 9 were at the premedical stage; 3 respondents had family members involved in medical profession. Thematic analysis identified 6 main categories that affect the variability of medical students' career prospects under the COVID-19 pandemic. The 6 themes were individual characteristics of students; occupational characteristics; systemic factors; COVID-19 events; stressors of physicians and influence of job satisfaction.The outbreak affected everyone's mind of future career to varying degrees. The participants had been exposed to more negative aspects, while only one participant changed her career intention. There were conflicting views on whether to choose some specialties in future, such as respiratory medicine, infectious disease and critical care medicine. The participants feel more pressure as a doctor from the attitude of the public. Almost all participants mentioned feeling unsafe due to the high risk of occupational exposure and doctor-patient relationships. Most valued the support from their family, faculty, classmates, and volunteers. Many participants expressed their hope to improve the medical policies and systems.Conclusions:The influence of COVID-19 outbreak on medical students' career choosing can be positive as well as negative in different degrees. However, we found no evidence that it altered their perspectives substantially.

The count and recognition of white blood cells in blood smear images play an important role in the diagnosis of blood diseases including leukemia. Traditional manual test results are easily disturbed by many factors. It is necessary to develop an automatic leukocyte analysis system to provide doctors with auxiliary diagnosis, and blood leukocyte segmentation is the basis of automatic analysis. In this paper, we improved the U-Net model and proposed a segmentation algorithm of leukocyte image based on dual path and atrous spatial pyramid pooling. Firstly, the dual path network was introduced into the feature encoder to extract multi-scale leukocyte features, and the atrous spatial pyramid pooling was used to enhance the feature extraction ability of the network. Then the feature decoder composed of convolution and deconvolution was used to restore the segmented target to the original image size to realize the pixel level segmentation of blood leukocytes. Finally, qualitative and quantitative experiments were carried out on three leukocyte data sets to verify the effectiveness of the algorithm. The results showed that compared with other representative algorithms, the proposed blood leukocyte segmentation algorithm had better segmentation results, and the mIoU value could reach more than 0.97. It is hoped that the method could be conducive to the automatic auxiliary diagnosis of blood diseases in the future.
Algorithms ; Leukocytes