Objective:To construct a multimodal induction educational system suitable for standardized pediatric residency training bases, and to evaluate its effectiveness, thereby obtaining suggestions for further improvement.Methods:Twelve residents newly enrolled in the 2023 standardized residency training program who commenced their first-year training were included as study subjects. The induction educational system comprised multiple modules: department introduction, training plan and assessment requirements, departmental workflow, routine diagnosis and treatment of major diseases, specialized skills/procedures, and lifestyle guidance. Training materials and methods were tailored to the characteristics of each training module. Checklists were used for supervision and review, and a competency checklist was designed to evaluate residents' mastery of the training at two weeks of induction, which would guarantee the effectiveness of the training. A questionnaire survey, powered by wjx.cn, was used to obtain the experience and suggestions from the residents and ward instructors on induction education, and content ranking analysis was performed on the survey results.Results:The survey revealed that, before starting a new rotation, residents' top three educational needs were departmental workflow, routine diagnosis and treatment of common diseases, and specialized skills/procedures. Residents preferred face-to-face lectures and demonstrations by attending physicians or senior residents; instructors suggested improving relevant materials (such as resident physician manuals and video materials) and face-to-face lectures. The residents considered the current induction educational system to be greatly beneficial in basic theories, treatment principles, basic skills, and auxiliary examination processes.Conclusions:Through the above research, a multimodal induction educational system suitable for the standardized pediatric residency training base in the Peking University First Hospital has been preliminarily established, and suggestions for further improvement have been obtained, which is conducive to further improving the system and residents' post competency.

Objective:This study aims to analyze the performance of five automatic cell type annotation methods in single cell RNA sequencing (scRNA-seq) data.Methods:Simulated data were generated using the Splatter package in R language, taking into account two data characteristics: the number of cells and the number of genes. The actual data came from the GSE10245 scRNA seq dataset of non-small cell lung cancer in Gene Expression Omnibus (GEO) database, the data had been pre-processed and batch effects had been eliminated. The automatic cell type recognition (ACTINN) of neural networks, the single-cell type annotation method based on deep learning (scDeepSort), the reference batch transcriptome annotation scRNA seq R-package (SingleR), the cross platform and cross species scRNA seq data classifier (SingleCellNet), and the cross scRNA seq dataset projection (scMap-cell) were implemented using the Tensorflow library in Python. The performance evaluation indicators for cell type annotation included accuracy (ACC), F1-score, and Matthews correlation coefficient (MCC). Each method was validated using ten fold cross validation, and the average value was taken after 50 repeated runs for performance comparison between methods. The Dunnett's t-test in the DescTools package of R language was used for multiple comparisons between ACTINN and other four methods. Results:Under 12 different scenarios (3 levels of cell numbers × 4 levels of gene numbers), simulated data analysis showed that compared with scDeepSort, SingleR, SingleCellNet, and scMap-cell, the percentage increase in ACC value of ACTINN ranged from 3.31% to 14.59%, 1.38% to 13.03%, 12.98% to 25.25%, and 20.72% to 29.62%, respectively; the range of F1 score improvement percentages were 2.75% - 22.74%, 2.46% - 23.68%, 5.07% - 27.47%, and 10.27% - 31.47%, respectively; the percentage increase ranges for MCC values were 3.42% - 9.75%, 2.26% - 7.61%, 5.41% - 11.11%, and 8.27% - 15.22%, respectively. Actual data analysis showed that the ACC value of ACTINN was 81.0%, which was increased by 2.1%, 5.2%, 7.9%, and 8.9% compared with the above four methods, respectively; the F1-score value was 80.5%, which was increased by 2.3%, 5.9%, 2.4%, and 6.0%, respectively; the MCC value was 83.3%, which was increased by 0.9%, 2.5%, 3.4%, and 11.2%, respectively. The results of Dunnett's t-test showed that the difference was not statistically significant in ACC values between scDeepSort and ACTINN ( P = 0.821), in F1-score values between scDeepSort and ACTINN ( P = 0.498), and in MCC values between scDeepSort, SingleCellNet and ACTINN ( P = 0.904, 0.134). However, the differences were statistically significant in other multiple comparisons ( P < 0.05). Conclusions:ACTINN and scDeepSort have good performance in cell type annotation, with ACTINN showing outstanding performance and SingleR showing robust performance, while SingleCellNet and scMap-cell have relatively limited performance. This suggests that self-attention mechanism algorithm based on Transformer framework is expected to promote further development of automatic cell annotation methods.

Objective To explore the changes in neural activity in patients with type 2 diabetes mellitus(T2DM)and their corre-lation with executive function,and to analyze the neural mechanisms underlying the decline in executive function in T2DM patients.Methods Thirty-one T2DM patients(T2DM group)and thirty-two healthy controls(HC)(HC group)matched for body mass index(BMI)underwent resting-state functional magnetic resonance imaging(rs-fMRI)scans and N-back task tests were included.Differ-ences in the amplitude of low-frequency fluctuation(ALFF),regional homogeneity(ReHo),and seed-based functional connectivity(FC)between the two groups were compared,and partial correlation analyses were performed between the difference results and N-back task performance.Results The T2DM group showed prolonged reaction time(RT)in the 1-back and 2-back tasks.T2DM patients exhibited increased ALFF in the bilateral caudate nucleus,left medial superior frontal gyrus,and right postcentral gyrus,as well as elevated ReHo in the right putamen.FC analysis revealed significant alterations in FC between the caudate nucleus,putamen,and multiple brain regions in T2DM patients,with some of these FC changes significantly correlated with RT and accuracy(ACC)in the N-back task.Conclusion The decline in executive function in T2DM patients may be associated with abnormal neural activity in brain regions such as the striatum,salience network,and frontoparietal control network.FC further decreases under increased cognitive load.These findings provide evidence for the study of the neural mechanisms of executive function impairment in T2DM patients.

Aim To compare the observation results of atomic force microscopy(AFM)and scanning electron microscopy(SEM),and to summarize the main problems and solutions of AFM in observing biological macromolecules,using the observa-tion subjects of protein samples purified by our research group.Methods The protein samples were diluted to 15 nmol·L-1 with PBS,fixed on glass slides,silicon wafers,and mica sheets,dried,and made into solid-phase observation samples.SEM sam-ples were plated with platinum before observation.The surface structures of proteins were observed using AFM and SEM,sample heights were calculated,and differences in results were com-pared.Results Protein samples with positive charges tended to shift to the right during observation due to the repulsion of the AFM probe;mica sheets could effectively eliminate the positive charge of proteins to avoid sample movement;PBS provided a stable environment for protein samples,but the crystallization of PBS salts interfered with probe operation and imaging clarity;SEM samples needed to be plated with platinum before observa-tion and could not achieve the precision of AFM.Conclusions Both AFM and SEM can directly observe protein structures in vitro,with AFM providing higher precision results;when protein sample stability permits,ultrapure water is preferred as the sol-vent carrier,and volatile liquids such as ethanol can also serve as solvent carriers.The application of AFM offers a new approach for pharmacological studies on interactions between biological macromolecules.

Objective:To survey the current status of reality shock among new nurses and to explore its influencing factors, and provide reference for promoting the workplace adaptability of new nurses.Methods:New nurses from 9 tertiary Grade A hospitals in Shaanxi Province were selected by convenience sampling method from February to May 2024. General data questionnaire, the Reality Shock Scale, the Feedback-Seeking Behaviour Scale, and the Role Clarity Scale were used to conduct a cross-sectional investigation, and multiple linear regression was used to analyze the influencing factors of new nurses′reality shock.Results:A total of 362 valid questionnaires were collected, including 68 males and 294 females. The scores of reality shock, feedback-seeking behaviour, and role clarity were (70.12 ± 20.18), (54.25 ± 10.65) and (31.94 ± 4.45) points respectively. Reality shock was negatively correlated with feedback-seeking behaviour and role clarity ( r=-0.583, -0.785, both P<0.01), feedback-seeking behaviour was positively correlated with role clarity ( r=0.652, P<0.01). Gender, only-child status, entry time, feedback-seeking behaviour and role clarity were the influencing factors of reality shock ( t values were -15.60-2.23, all P<0.05), accounted for 63.6% of the total variation. Conclusions:The reality shock of new nurses is above the medium level, and nursing managers should be aware of the problems and sense of gap that new nurses may encounter in the process of role transformation. In addition, pay more attention to the emotional needs and mental health status of new nurses who are male, only child, with short entry time, and have low feedback-seeking behavior and role clarity. Diversified training programs and targeted intervention strategies should be developed to help new nurses reduce reality shock.

Objective To study the changes of lipid peroxidation and antioxidant capacity in patients with hypercholesterolemia.Methods A total of 100 patients with elevated cholesterol treated in the People's Hospital of Qitaihe from January to May 2024 were included in hypercholesterolemia group,and another 80 people with normal blood lipid in the hospital during the same period were included in control group.Malondialdehyde(MDA),glutathione(GSH),glutathione reductase(GR)and total antioxidant capacity(TAC)were determined in all subjects.Results The levels of total cholesterol,low density lipoprotein-cholesterol and MDA in hypercholesterolemia group were significantly higher than those in control group,while the levels of GSH,GR and TAC were significantly lower than those in control group(P＜0.05).Conclusion Patients with hypercholesterolemia have severe lipid peroxidation,which may cause vascular endothelial cell damage.

Objective To study the changes of lipid peroxidation and antioxidant capacity in patients with hypercholesterolemia.Methods A total of 100 patients with elevated cholesterol treated in the People's Hospital of Qitaihe from January to May 2024 were included in hypercholesterolemia group,and another 80 people with normal blood lipid in the hospital during the same period were included in control group.Malondialdehyde(MDA),glutathione(GSH),glutathione reductase(GR)and total antioxidant capacity(TAC)were determined in all subjects.Results The levels of total cholesterol,low density lipoprotein-cholesterol and MDA in hypercholesterolemia group were significantly higher than those in control group,while the levels of GSH,GR and TAC were significantly lower than those in control group(P＜0.05).Conclusion Patients with hypercholesterolemia have severe lipid peroxidation,which may cause vascular endothelial cell damage.

Objective To form an expert consensus on nasogastric tube and intestinal tube placement in children(hereinafter referred to as the"consensus"),and provide a reference for pediatric medical workers regarding the operation of gastrointestinal tube placement in children.Methods A"consensus"formulation group was established.The"5.0"EBHC Pyramid Model was employed to systematically search,evaluate,summarize and extract relevant evidence to form the initial draft of the"consensus".The RAND-UCLA expert consensus method was utilized.Through a round of expert inquiries by correspondence and a round of face-to-face expert discussions,the data were collated,analyzed,refined,and modified to form the final version of the"consensus".Results The effective recovery rate of the expert inquiry questionnaire was 100％.The coefficient of expert authority(Cr)was 0.891.The Kendall's concordance coefficient of the inquiries was 0.692(P＜0.01),which was statistically significant.The median of the"RAND-UCLA"suitability score were 7-9 points,and the disagreement index(DI)value was＜1.00.The final"consensus"encompasses 9 aspects,including qualification requirements for the tube placement personnel,indications and contraindications,preoperative assessment,preoperative preparation,measurement of tube length,key points of tube placement,methods for confirming the position,tube flushing,fixation,and recording,with 47 recommendations.Conclusion This"consensus"is scientific,rigorous,and practical,covering all links of the gastrointestinal tube placement process in children,providing reference and guidance for the safe and standardized implementation of gastrointestinal tube placement in children.

AIM To investigate the effects of rice wine type and wine processing method on chemical constituents and anti-coagulation effect of Angelicae sinensis Radix.METHODS Wine-washed products and wine-stir-fried products were prepared by different types and ages of rice wine,respectively,after which HPLC was adopted in the content determination of tryptophan,chlorogenic acid,vanillic acid,phthalic acid,ferulic acid,senkyunolide I,senkyunolide H,coniferyl ferulate and ligustilide,and PT,APTT,TT were detected in rabbit plasma.RESULTS Phenolic acids and volatile constituents demonstrated lower contents in the wine-stir-fried products than those in the raw product(P＜0.05),while those in the wine-washed products displayed no obvious changes(except for senkyunolide I)(P＞0.05).The contents of volatile constituents in the wine-washed products were higher than those in the wine-stir-fried products(P＜0.05).After being processed with dry rice wine,various constituents exhibited increased contents as compared with those after being processed with sweet rice wine(P＜0.05).Compared with the raw product,prolonged PT,APTT and TT were observable in the processed products prepared by 3-year semi-dry rice wine(P＜0.05).CONCLUSION The optimal rice wine type is determined to be 3-year semi-dry.Wine-washed Angelicae sinensis Radix shows high contents of ferulic acid and volatile constituents,whose activating blood and resolving stasis effect may be stronger.

Objective:Chimeric antigen receptor T-cell(CAR-T)immunotherapy has made major breakthroughs in the treatment of blood tu-mors.However,current CAR-T therapies face several limitations:they require autologous cells,involve a lengthy and costly production pro-cess,and use lentiviral transduction that carry risk of insertional carcinogenesis due to random integration.Therefore,there is an urgent need to develop a universal cost-effective cancer immunotherapy method generating CAR-T cells for in vivo cancer immunotherapy.Meth-ods:This study successfully established an exosome-mediated,T-cell targeted delivery system,demonstrating both precise design and func-tional efficacy for biomedical applications.To optimize CAR-T cell generation the transfection dose was adjusted,and the kinetics of CAR-T cell percentage were recorded.The cytotoxicity of the resulting CAR-T cells was evaluated in vitro by calcein-AM release.To test the tumor-killing in vivo of engineered exosomes,human PBMCs were injected into NPG mice via the tail vein to establish humanized mice,followed by intravenous injection of tumor cells to induce cancer.Results:To overcome the limitations of conditional autologous CAR-T cells,we de-veloped a T cell-targeted exosome system capable of specifically targeting human CD3+,CD4+,and CD8+T cells.CAR-T production was dose-dependent,with transfection efficiency reaching upto 97.8%at 106 particles/cell.Both in vitro cytotoxicity assays and in vivo animal experi-ments demonstrated that exosome-incubated CAR-T cells effectively eliminated CD19-positive Raji cells,highlighting their specificity and therapeutic potential in antigen-directed applications.Conclusions:We successfully established a CD8-targeting exosome delivery system for CAR-T cell production capable of transforming CD8+T cells into functional CAR-T cells,which showed significant tumor-killing ability in vitro and in mice.Compared with the traditional lentiviral vector for the preparation of CAR-T cells in vitro,in vivo-reprogrammed CAR-T cells us-ing our CD8-targeted exosome delivery system,with higher transfection efficiency,shorter production period,lower cost,and eliminated the risk of insertion carcinogenesis.This strategy promises to bring a new era of universal CAR-T medicine,which can improve cancer immuno-therapy and may hold promise as a therapeutic platform to treat various diseases.