Narrative will represents an emerging concept in the context of population aging. Guided by life value orientation and premised on respecting individuals’ wishes and needs， it presents individuals’ unique life stories through narrative form. It conveys the holistic experience， meaning interpretation， and life understanding of the experienced events. Preserved and transmitted in a manner that aligns with individuals’ expectations， it also facilitates human beings’ pursuit， reflection， and growth in life meaning through interpersonal interactions that transcend space and time. This paper comprehensively introduced the essence of narrative wills by reviewing their conceptual evolution， connotation attributes， value manifestation， implementation paths， and specific case analysis， aiming to provide a reference for their implementation.

Objective:To evaluate whether the reconstructed image on the basis of deep learning(DL)can improve the success rate and display quality of automatic segmentation of computed tomography(CT)with ultralow dose for chest of children on airway.Methods:The clinical data of 41 consecutive cases who adopted ultralow dose CT to underwent reexamination on chest at Beijing Children's Hospital,Capital Medical University from February 2020 to September 2020 were selected,whose average age was(4.43±1.61 years).The scan protocol of ultralow dose CT was(0.05 mGy).The reconstructed images included 6 groups,which were respectively filtered reflection projection(FBP)image with 0.625 mm thickness,50%adaptive iterative recombination(ASIR-V)images,100%ASIR-V images,low energy DL(DL-L),medium energy DL(DL-M),and high energy DL(DL-H).The automatically segmentation software was used to conduct automatically segmentation for airway,and the success rate of automatic segmentation was recorded.For images that were successful segmented,a 5-point scale was adopted to subjectively evaluate the displayed quality for airway(5 point is the best).In addition,the CT values and noise values of the images of 6 groups for airway were objectively measured.Results:The success rate of automatic segmentation of DL-H image was the highest(60.98%),and that of the 100%ASIR-V was the lowest(39.02%).The subjective score of DL-H image of the automatic segmentation was the highest(4.06±0.55)point,and that of 100%ASIR-V was the lowest(2.44±0.76)point.DL-H can display more fine and small airways.The noise values of objective measurement showed that both of DL-H and 100%ASIR-V had the lowest noise value,and there was no statistical difference in that between them.Conclusion:The use of high energy deep learning iterative reconstruction(DLIR)algorithm can improve the success rate and display effect of automatic segmentation of ultralow dose CT for chest of children on airway,and DLIR is contribute to improve the accuracy of automatic segmentation algorithm of artificial intelligence.

Objective:To evaluate whether the reconstructed image on the basis of deep learning(DL)can improve the success rate and display quality of automatic segmentation of computed tomography(CT)with ultralow dose for chest of children on airway.Methods:The clinical data of 41 consecutive cases who adopted ultralow dose CT to underwent reexamination on chest at Beijing Children's Hospital,Capital Medical University from February 2020 to September 2020 were selected,whose average age was(4.43±1.61 years).The scan protocol of ultralow dose CT was(0.05 mGy).The reconstructed images included 6 groups,which were respectively filtered reflection projection(FBP)image with 0.625 mm thickness,50%adaptive iterative recombination(ASIR-V)images,100%ASIR-V images,low energy DL(DL-L),medium energy DL(DL-M),and high energy DL(DL-H).The automatically segmentation software was used to conduct automatically segmentation for airway,and the success rate of automatic segmentation was recorded.For images that were successful segmented,a 5-point scale was adopted to subjectively evaluate the displayed quality for airway(5 point is the best).In addition,the CT values and noise values of the images of 6 groups for airway were objectively measured.Results:The success rate of automatic segmentation of DL-H image was the highest(60.98%),and that of the 100%ASIR-V was the lowest(39.02%).The subjective score of DL-H image of the automatic segmentation was the highest(4.06±0.55)point,and that of 100%ASIR-V was the lowest(2.44±0.76)point.DL-H can display more fine and small airways.The noise values of objective measurement showed that both of DL-H and 100%ASIR-V had the lowest noise value,and there was no statistical difference in that between them.Conclusion:The use of high energy deep learning iterative reconstruction(DLIR)algorithm can improve the success rate and display effect of automatic segmentation of ultralow dose CT for chest of children on airway,and DLIR is contribute to improve the accuracy of automatic segmentation algorithm of artificial intelligence.

Objective:To explore the effect of ultrasound-guided superficial cervical plexus block on chronic pain after intracranial space-occupying resection by suboccipital retrosigmoid approach.Methods:A single-center, randomized, double-blind, parallel controlled trial was conducted on 106 consecutive patients who underwent selective resection of acoustic neuromas in the cerebellopontine angle through the suboccipital retrosigmoid approach in Beijing Tiantan Hospital, Capital Medical University from November 2019 to April 2021. The patients were divided into experimental group and control group by random number table method, with 53 cases in each group. The patients in experimental group underwent superficial cervical plexus block with 0.5% ropivacaine under ultrasound-guided, and the patients in control group received an equal volume of 0.9% sodium chloride. Three months after surgery, the patients were followed up for chronic postoperative pain and the chronic postoperative pain rating scale (NRS) score via telephone. The nature of chronic pain was evaluated using the short-form McGill pain questionnaire-2 (SF-MPQ-2).Results:The incidence of chronic postoperative pain and the NRS score of chronic postoperative pain in experimental group were slightly lower than those in control group: 39.6% (21/53) vs. 50.9% (27/53) and 0 (0, 2) scores vs. 1 (0, 3) scores, but there were no statistical difference between the two groups ( P>0.05). There were no statistical difference in SF-MPQ-2 various scores and total score after surgery between the two groups ( P>0.05). Conclusions:Ultrasound-guided superficial cervical plexus block has a certain analgesic effect on chronic pain after intracranial space-occupying resection by suboccipital retrosigmoid approach, but it still requires further verification through an adequate sample size.

Objective:To investigate the application effect of the teaching model of massive open online course (MOOC)+small private online course (SPOC) in the undergraduate clinical teaching of Fundamentals of Surgery.Methods:A total of 30 undergraduate medical trainees in the five-year program were randomly divided into experimental group and control group, with 15 trainees in each group. With the chapter of basic surgical procedures as an example, the trainees in the control group received traditional teaching, and those in the experimental group received MOOC+SPOC teaching. Theoretical assessment and surgery simulation were performed at one week after the course to evaluate the teaching effect. SPSS 17.0 was used for the t-test and the chi-square test. Results:The experimental group had a theoretical assessment score of (92.5±6.4) points and a basic skill operation score of (91.7±2.2) points, while the control group had a theoretical assessment score of (85.3±7.3) points and a basic skill operation score of (83.6±6.4) points. The experimental group had an excellent rate of 60% (9/15) in theoretical assessment and 66.7% (10/15) in basic skill operation test, while the control group had an excellent rate of 40% (6/15) in theoretical assessment and 33.3% (5/15) in basic skill operation test. The experimental group had significantly higher scores and grades than the control group ( P<0.05). Conclusion:MOOC+SPOC teaching can significantly enhance the understanding of theoretical knowledge and the mastery of operational skills among trainees and improve teaching effect, and therefore, it has a good application prospect.

Objective:To explore the effect of Toll-like receptor 9 (TLR9) signaling pathway activation on the transcriptome in the renal tubular cells.Methods:Mouse primary renal tubular epithelial cells were extracted and cultured. When the degree of cell fusion reached 80%, they were divided into two groups, which were added with 10 μL phosphate buffered saline (PBS, PBS control group) and TLR9 activator cytosine phosphate guanidine oligodeoxynucleotide (CpG-ODN) with a final concentration of 5 μmol/L (CpG-ODN treatment group). The RNA sequencing was performed on the Illumina platform after extraction. DEGseq software was used to analyze the differential expression of genes between the two groups. Goatools and KOBAS online software were used to analyze the differential genes involved signal pathways. Homer software was used to predict transcription factors.Results:Compared with the PBS control group, there were a total of 584 differentially expressed genes in the CpG-ODN treatment group, of which 102 were up-regulated and 482 were down-regulated. The most significantly enriched gene ontology (GO) terms of differentially expressed genes included response to interferon-β, defense response to virus and other inflammatory pathway. The most significantly enriched Kyoto Encyclopedia of Genes and Genomes (KEGG) signaling pathways included 2'-5'-oligoadenylate synthase activity, regulation of ribonuclease activity, negative regulation of virus life cycle, cellular response to interferon-βand defense response to protozoan. The results of transcription factor prediction showed that interferon regulatory factor 3 (IRF3) was the most significantly enriched transcription factor in the promoter sequence of differential genes; the most significant transcription factor downstream of TLR9 was IRF3, and other predicted transcription factors such as transcription factor 21 (TCF21), zinc finger protein 135 (ZNF135), and PR domain containing 4 (PRDM4) might be new candidates for TLR9 signaling pathway.Conclusion:CpG-ODN activates TLR9 signaling pathway, and primary renal tubular epithelial cells can directly respond to CpG-ODN stimulation and undergo transcriptome changes, which provides a basis for further research on the molecular mechanism of TLR9 pathway in sepsis induced acute kidney injury.

Objective: To study the age of onset of malignant tumors in cancer registration areas in Zhejiang province from 2000 to 2015. Methods: Based on the incidence data of cancer from 14 national cancer registration areas in Zhejiang province between 2000 and 2015, the incidence rate, average/standardized average age of onset, and age-specific incidence proportion were calculated, and standardized by Segi′s world population. The population was divided into 7 age groups (0-29, 30-39, 40-49, 50-59, 60-69, 70-79, ≥80 years old). The average age of onset and age-specific incidence proportion were analyzed by using a linear regression. The change trend of the proportion; the average annual percent change (AAPC) of the incidence rate was calculated by using the Joinpoint log-linear regression model. The birth cohort was constructed by using the standardized incidence rate and the year of onset of cancer, and the distribution characteristics of the age groups were described. Results: From calendar year 2000 to 2015, the average age of onset of malignant tumors in Zhejiang Province decreased from 59.7 to 57.6, with an average annual percent decrease of 0.09 year (P=0.033). After the merge of age groups, the standardized incidence proportion of 30-49 and ≥60 years old group standardization increased by an average annual change of 0.38% and decreased by an average annual change of 0.39%, respectively (both P values <0.001). The results of the log-linear regression model showed that the standardized incidence rate of the 30-39 and 40-49 years old age groups increased rapidly, with the AAPC (95%CI) about 5.2% (4.4%-6.0%) and 3.4% (2.5%-4.3%), respectively. The incidence rate of female increased rapidly, especially for 30-39 and 40-49 years old age groups with the AAPC about 6.2% (5.1%-7.2%) and 4.9% (4.0%-5.9%), respectively. The results of the birth cohort analysis showed that the population with different birth years in the same age groups saw an increasing trend with the increase of the birth year. Conclusion The age of onset of malignant tumors in the cancer registration areas in Zhejiang Province is getting younger. The incidence rate and number of people with malignant tumors in 30-49 years old age group is evident. These characteristics are more obvious in female than that in male.

Objective To explore the application of 3D printing technology in clinical apprenticeship teaching in spinal surgery. Methods 38 eight-year clinical medical students admitted to the Department of Spine Surgery were randomly divided into experimental group (19 patients) and control group (19 patients). Taking odontoid fracture as an example. The traditional method is used for teaching, and the experimental group is taught with traditional teaching method combined with 3D printing technology . After the apprenticeship, the students of the two groups were tested in theory and simulated operation to evaluate the teaching effect. SPSS 17.0 was used for statistical analysis. The measurement data was expressed as mean ± standard deviation, and the t-test was used to compare the measurement data between two groups. Results The results showed that the scores of immediate examination and one month after class in the control group were (82.23 ±7.52) and (72.36 ±6.39) points respectively. The scores of immediate examination and one month after the class in the experimental group were (85.58 ±6.32), (80.87 ±6.23). The scores of the two examinations in the experimental group were significantly higher than those in control group , and the differences were statistically significant (P<0.05). Conclusion The 3D printing technology can significantly improve the teaching effect in the clinical apprenticeship teaching of spine surgery, and it has a bright prospect for application.

Objective To investigate the effect of scan table on size-specific dose estimate ( size-specific dose estimate, SSDE) in children's CT scan. Methods CT imaging data and CTDIvol of 44 children ( 15 heads, 13 chests, 16 abdomen-pelvis) who underwent Siemens SOMATOM Definition AS+ 64 row 128-slice CT scan were retrospectively collected. CTDIvol of each patient was recored, WED ( water equivalent diameter) was calculated by two different methods ( with or without table) , donated as WED-T and WED-NT, then the corresponding SSDEWED ( SSDEWED-T and SSDEWED-NT ) was calculated. And the SSDEWED-NT was used as reference to evaluate the difference between WED and SSDEWED obtained by two different methods. Results Including part of table will lead to the overestimate for WED, with mean differences of 0. 10％, 2. 82％ and 2. 54％ for head, chest and abdomen-pelvis, respectively, while SSDEWED will be underestimated by 0. 06％ ( head ) , 2. 70％ ( chest ) and 1. 59％ ( abdomen-pelvis ) . Conclusions Including par of the patient table has a certain effect on SSDEWED for children, more attention should be paid for the application of SSDEWED.

Objective To compare the clinical curative effect of allogeneic bone ring and titanium mesh in repairing adolescent spinal tuberculosis kyphosis.Methods Forty-four cases of kyphosis after adolescent spinal tuberculosis operation in this hospital from January 2012 to January 2015 were selected as the study subjects and divided into the control group and observation group ac-cording to the treatment types,22 cases in each group.The control group was repaired with titanium mesh,while the observation group was given allogeneic bone ring fusion repair.Postoperative follow up lasted for 2 -5 years.The perioperative indexes,repair material and vertebral fusion and neurological score,preoperative and postoperative Cobb angle,ESR,CRP and postoperative com-plications occurrence were compared between the two groups.Results There was no statistically significant difference in periopera-tive indexes between the two groups(P>0.05).The fusion time,occurrence rate of local pain and motion limitation had statistical differences between the two groups(P<0.05).The occurrence rate of material loosening had no statistical difference(P>0.05). No grade A and B spinal injury appeared in both groups.The incidence rate of grade D and E in the observation group was signifi-cantly lower than that in the control group,the difference was statistically significant(P<0.05).The postoperative Cobb angle, ESR and CRP had no statistical difference between the two groups(P>0.05),moreover no significant adverse reactions and post-operative tuberculosis recurrence occurred.Conclusion Allogeneic bone ring and titanium mesh have satisfactory effect for repairing juvenile spinal tuberculosis kyphosis,allogeneic bone ring fusion time is longer,early stability is worse than the titanium mesh,the brace protection is needed in the early time,but the clinical effect of patients is more significant,which is worthy of being promoted and applied in clinical treatment.