OBJECTIVES: To explore the relationship between the Observer's Assessment of Alertness/Sedation (OAAS) score and the bispectral index (BIS) during propofol titration for general anesthesia induction and analyze the impact of BIS monitoring delay on anesthetic depth assessment. METHODS: This study was conducted among 90 patients (ASA class I-II) undergoing elective surgery under general anesthesia. For anesthesia induction, the patients received propofol titration at the rate of 0.5 mg·kg^-1·min^-1 till OAAS scores of 4, 3, 2, and 1 were reached. After achieving an OAAS score of 1, remifentanil (2 μg·kg⁻¹) and rocuronium (0.6 mg·kg⁻¹) were administered, and tracheal intubation was performed 2 min later. BIS values, mean arterial pressure (MAP), heart rate (HR), and propofol dosage at each OAAS score were recorded, and the correlation between OAAS scores and BIS values was analyzed. The diagnostic performance of BIS values for determining when the OAAS score reaches 1 was analyzed using ROC curve. RESULTS: All the patients successfully completed tracheal intubation. BIS values of the patients at each of the OAAS scores differed significantly (P<0.01), and the mean BIS value decreased by 4.08, 8.32, 5.43 and 5.24 as the OAAS score decreased from 5 to 4, from 4 to 3, from 3 to 2, and from 2 to 1, respectively. There was a significant correlation between the OAAS score and BIS values (ρ=0.775, P<0.001). The median BIS value for an OAAS score of 1 was 76, at which point 83.33% of the patients had BIS values exceeding 60. ROC curve analysis showed that for determining an OAAS score of 1, BIS value, at the optimal cutoff value of 84, had a sensitivity of 88.9%, a specificity of 73.3%, and an area under the curve of 0.842 (0.803-0.881). CONCLUSIONS OAAS score during induction of general anesthesia is strongly correlated with BIS value and is a highly sensitive and timely indicator to compensate for the delay in BIS monitoring.
Humans ; Propofol/administration & dosage* ; Male ; Female ; Middle Aged ; Anesthesia, General/methods* ; Adult ; Consciousness Monitors ; Aged ; Young Adult ; Monitoring, Intraoperative/methods* ; Electroencephalography

Objective: To investigate the mechanism by which serum amyloid P component (SAP) alleviates periodontitis in mice, providing an experimental basis to establish SAP as a novel therapeutic agent for periodontitis. Methods: Ethical approval was obtained from the Institutional Animal Ethics Committee. Periodontitis models were established in wild-type (WT) mice and SAP-transgenic (SAP-Tg) mice, divided into four groups: WT control (WT group), WT periodontitis (WT+P group), SAP-Tg control (Tg group), and SAP-Tg periodontitis (Tg+P group). On day 7, the mice were euthanized, and periodontal tissues, teeth, and alveolar bone were collected. SAP protein expression was detected by enzyme-linked immunosorbent assay (ELISA). Micro-CT and HE staining were used to measure alveolar bone resorption (distance from the cementoenamel junction to the alveolar bone crest). Tartrate-resistant acid phosphatase (TRAP) staining was performed to assess osteoclast number, and immunohistochemistry (IHC) was employed to evaluate macrophage infiltration. The expression levels of inflammatory cytokines including interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) were measured by qRT-PCR. Oral microorganism composition was analyzed using 16S ribosomal RNA (16S rRNA) gene sequencing. Additionally, macrophages from WT and SAP-Tg mice were isolated to establish an in vitro inflammation model, divided into WT+LPS and Tg+LPS groups. The expression of macrophage polarization-related genes including inducible nitric oxide synthase (iNOS), CD86, CD163, and CD206) were assessed by qRT-PCR. After the induction of osteoclast differentiation, TRAP staining was performed. Results: ELISA results demonstrated that periodontal tissues from Tg+P group mice exhibited higher levels of SAP expression compared to the WT+P group. Micro-CT and HE staining analyses revealed that the Tg+P group showed reduced alveolar bone resorption, indicated by a shorter distance between the cementoenamel junction and alveolar bone crest, compared to the WT+P group. Furthermore, TRAP staining results indicated a decrease in osteoclast numbers in the Tg+P group compared to the WT+P group. IHC and qRT-PCR results indicated reduced macrophage infiltration and decreased expression of IL-1β, IL-6, and TNF-α in the Tg+P group. Oral microorganism sequencing showed no significant difference in periodontitis-associated pathogenic bacteria between WT+P and Tg+P groups. In vitro experiments demonstrated that compared to the WT+LPS group, the Tg+LPS group exhibited downregulated M1 macrophage markers (iNOS and CD86) and upregulated M2 macrophage markers (CD163 and CD206). TRAP staining confirmed fewer osteoclasts in the Tg+LPS group. Conclusion SAP overexpression effectively alleviates periodontitis severity in mice by inhibiting M1 macrophage polarization, reducing pro-inflammatory cytokine expression, and suppressing osteoclast differentiation, thereby attenuating alveolar bone resorption.

Clinical teaching managers are the designers, implementers, and supervisors of clinical medical education. Their competence level directly affects the quality of hospital teaching management and clinical medical education. The competence evaluation systems for medical education managers in countries such as the United States and the United Kingdom are well-established, which provides a reference for the competence evaluation of clinical teaching managers in China. This research systematically reviews the construction process and current situation of the competence evaluation systems for medical education managers in the world, and summarizes the basis, methods, and dimensions of competence evaluation. According to the actual situation of clinical teaching management, suggestions were put forward, including developing systematic scientific evaluation tools, carrying out competence-oriented training and assessment, focusing on student-centered education, and creating a career path of sustainable development.

Objective:To develop the Competency Assessment Questionnaire for Clinical Teachers of Traditional Chinese Medicine Specialist Nurses and to test its reliability and validity.Methods:The first draft of the questionnaire was formed through literature review and expert consultation based on the competency theory. Convenience sampling was used to survey 218 clinical teachers of traditional Chinese medicine specialist nurses in 5 ClassⅢ Grade A hospitals in Zhejiang and Jiangsu provinces from June to July 2024 to test the reliability and validity of the questionnaire.Results:The Competency Assessment Questionnaire for Clinical Teachers of Traditional Chinese Medicine Specialist Nurses contained 5 dimensions, including professionalism and personal attributes, professional knowledge and skills, clinical practice ability, clinical teaching ability, and research management ability, with a total of 35 items. The scale-level content validity index was 0.875. The Cronbach's α coefficient was 0.974, the folded half reliability was 0.845, and the retest reliability was 0.912.Conclusions:The Competency Assessment Questionnaire for Clinical Teachers of Traditional Chinese Medicine Specialist Nurses has good reliability and validity, and can be used as a valid tool for evaluating the core competencies of clinical teachers of traditional Chinese medicine specialist nurses.

Clinical teaching managers are the designers, implementers, and supervisors of clinical medical education. Their competence level directly affects the quality of hospital teaching management and clinical medical education. The competence evaluation systems for medical education managers in countries such as the United States and the United Kingdom are well-established, which provides a reference for the competence evaluation of clinical teaching managers in China. This research systematically reviews the construction process and current situation of the competence evaluation systems for medical education managers in the world, and summarizes the basis, methods, and dimensions of competence evaluation. According to the actual situation of clinical teaching management, suggestions were put forward, including developing systematic scientific evaluation tools, carrying out competence-oriented training and assessment, focusing on student-centered education, and creating a career path of sustainable development.

Objective:To develop the Competency Assessment Questionnaire for Clinical Teachers of Traditional Chinese Medicine Specialist Nurses and to test its reliability and validity.Methods:The first draft of the questionnaire was formed through literature review and expert consultation based on the competency theory. Convenience sampling was used to survey 218 clinical teachers of traditional Chinese medicine specialist nurses in 5 ClassⅢ Grade A hospitals in Zhejiang and Jiangsu provinces from June to July 2024 to test the reliability and validity of the questionnaire.Results:The Competency Assessment Questionnaire for Clinical Teachers of Traditional Chinese Medicine Specialist Nurses contained 5 dimensions, including professionalism and personal attributes, professional knowledge and skills, clinical practice ability, clinical teaching ability, and research management ability, with a total of 35 items. The scale-level content validity index was 0.875. The Cronbach's α coefficient was 0.974, the folded half reliability was 0.845, and the retest reliability was 0.912.Conclusions:The Competency Assessment Questionnaire for Clinical Teachers of Traditional Chinese Medicine Specialist Nurses has good reliability and validity, and can be used as a valid tool for evaluating the core competencies of clinical teachers of traditional Chinese medicine specialist nurses.

The occurrence of benign prostate hyperplasia(BPH)was related to disrupted sex steroid hormones,and metformin(Met)had a clinical response to sex steroid hormone-related gynaecological disease.How-ever,whether Met exerts an antiproliferative effect on BPH via sex steroid hormones remains unclear.Here,our clinical study showed that along with prostatic epithelial cell(PEC)proliferation,sex steroid hormones were dysregulated in the serum and prostate of BPH patients.As the major contributor to dysregulated sex steroid hormones,elevated dihydrotestosterone(DHT)had a significant positive rela-tionship with the clinical characteristics of BPH patients.Activation of adenosine 5'-monophosphate(AMP)-activated protein kinase(AMPK)by Met restored dysregulated sex steroid hormone homeostasis and exerted antiproliferative effects against DHT-induced proliferation by inhibiting the formation of androgen receptor(AR)-mediated Yes-associated protein(YAP1)-TEA domain transcription factor(TEAD4)heterodimers.Met's anti-proliferative effects were blocked by AMPK inhibitor or YAP1 over-expression in DHT-cultured BPH-1 cells.Our findings indicated that Met would be a promising clinical therapeutic approach for BPH by inhibiting dysregulated steroid hormone-induced PEC proliferation.

Objective:To study the clinical application and complications of umbilical arterial catheterization (UAC) in premature infants.Methods:From January 2021 to December 2022, premature infants with UAC successfully inserted in NICU of our hospital were enrolled. According to birth weight (BW), the infants were assigned into three groups: <1 000 g, 1 000~1 499 g and ≥1 500 g. The perinatal data, UAC usage, UAC-related complications and risk factors of UAC-related complications were retrospectively analyzed.Results:A total of 39 premature infants received UAC, with gestational age 29.3(27.3, 30.4) weeks and BW 1 100 (900, 1 310) g. The insertion length (IL) of UAC was calculated using the average value of two formulas: a, IL (cm) =4×BW (kg) +7; and b, IL(cm) =3×BW (kg)+9. The accuracy of tube end position was determined using chest/abdomen radiography. 30(76.9%) cases had accurate position, 6(15.4%) had higher position and 3(7.7%) had lower position. The proportion of appropriately positioned tube end in <1 000 g, 1 000~1 499 g and ≥1 500 g groups were 80.0%, 76.5% and 71.4%, respectively, without statistically significant differences ( P>0.05) .No significant differences existed among the three groups in UAC duration and UAC routinely removal rate ( P>0.05). 9 cases (23.1%) of UAC were removed for specific reasons, including 4 cases of arterial spasm, 2 cases of withdrawal of treatment, 1 case of tube end displacement, 1 case of abdominal distension and 1 case of death. 21 cases received 1 U/ml heparin (0.9%NaCl solution) 0.5~1 ml/h arterial infusion. 23.8% (5/21) had hypernatremia and the level of sodium became normal after reducing the concentration of NaCl solution. Arterial vasospasm occurred in 4 patients with skin color changes of one side of the lower extremities. After UAC removal, the skin color returned to normal. Conclusions:UAC is helpful and safe for preterm infants, however, its complications should be alerted to.

Objective To investigate whether an association existed between elevated serum β2-microglobulin levels and post stroke cognitive impairment(PSCI).Methods A total of 140 patients with ischemic stroke in Wenzhou People's Hospital during December 2022 to December 2023 were prospectively were enrolled including 73 patients in the PSCI group and 67 patients in the non-post stroke cognitive impairment(PSNCI)group.Serum β2-microglobulin and other biochemical indicators were measured within 24 hours after admission.PSCI was assessed using the mini-mental state examination(MMSE)score with a threshold of≥27 points serving as the diagnostic criterion.Results The age,National Institutes of Health Stroke Scale(NIHSS)score at admission,proportion of low education level,proportion of multiple or large area infarction and serum β2-microglobulin level in the PSCI group were higher than those in the PSNCI group.Multivariate Logistic regression analysis showed that age,NIHSS score at admission,multiple or large area infarction and serum β2-microglobulin level were risk factors for PSCI,and education level was a protective factor for PSCI.Conclusion The increase of β2-microglobulin level is a risk factor for cognitive impairment after ischemic stroke.The detection of β2-microglobulin level in stroke patients may realize the early detection of PSCI.

Beta-amyloid (Aβ) is considered to be a central event in Alzheimer's disease (AD). However, it has been found that some population have Aβ deposition in the brain and even AD related pathology without obvious cognitive impairment, which indicates that there are factors in the body to avoid or cope with Aβ damage, and this phenomenon is called Aβ tolerance. Starting from the concepts of resilience and reserve, this paper intends to sort out the epidemiology and quantitative methods, brain characteristics and influencing factors of Aβ tolerance, in order to further deepen clinicians' understanding of Aβ tolerance in AD diagnosis and treatment, so as to provide new ideas for prevention and treatment of the disease.