Objective:To evaluate the diagnostic value of coronary angiography-derived fractional flow reserve (FFR) and index of microcirculatory resistance (IMR) for identifying coronary functional abnormalities.Methods:This diagnostic study enrolled patients with clinically suspected or diagnosed coronary artery disease who underwent coronary angiography at Beijing Anzhen Hospital, TEDA International Cardiovascular Hospital, and Qilu Hospital of Shandong University between December 2021 and June 2022. All enrolled patients successfully underwent invasive wire-based FFR and IMR measurements during angiography. In a core laboratory, FFR and IMR for the target vessels were measured using artificial intelligence technology based on coronary angiographic images. Spearman correlation analysis was used to evaluate the correlation between angiography-derived FFR and wire-based FFR, and between angiography-derived IMR and wire-based IMR. Coronary hemodynamic abnormality was defined as FFR≤0.80; the diagnostic performance of angiography-derived FFR for identifying this abnormality was evaluated. Microcirculatory dysfunction was defined as IMR≥25; the diagnostic performance of angiography-derived IMR for identifying microcirculatory dysfunction was evaluated.Results:A total of 181 patients, aged (60.6±8.8) years, with 62 (34.3%) females, and 181 target vessels were included in the final analysis. Angiography-derived FFR showed a significant positive correlation with wire-based FFR ( r=0.78, P<0.001). For identifying coronary hemodynamic abnormality, angiography-derived FFR showed an accuracy of 89.0%, sensitivity of 88.8%, specificity of 89.1%, positive predictive value (PPV) of 88.8%, negative predictive value (NPV) of 89.1%, and an area under the receiver operating characteristic curve ( AUC) of 0.88. Angiography-derived IMR showed a significant positive correlation with wire-based IMR ( r=0.93, P<0.001). For identifying microcirculatory dysfunction, angiography-derived IMR demonstrated an accuracy of 89.5%, sensitivity of 86.8%, specificity of 90.2%, PPV of 70.2%, NPV of 96.3%, and an AUC of 0.95. Conclusion:Angiography-derived FFR and IMR exhibit strong correlations with their invasive wire-based counterparts and demonstrate high diagnostic value for assessing coronary hemodynamics and coronary microcirculatory function.

Objective:To investigate the current status of knowledge, attitude, and practice in career planning among medical students and its influencing factors, and to facilitate the education of medical career planning.Methods:The convenience sampling method was used to distribute a self-made questionnaire, and related data were gathered from 295 medical students in Wuhan, China. SPSS 26.0 was used to perform analyses of related categorical variables, including descriptive statistics, univariate tests, rank-sum tests, and the binary logistic regression analysis.Results:The results showed that the medical students with good performance of career planning knowledge, attitude, and practice accounted for 68.48%, 87.12%, and 54.92%, respectively. Major, grade, professional satisfaction, and professional learning objectives were influencing factors for career planning knowledge among the medical students ( P<0.05); the intention for laboratory participation, the basis for major selection, and professional learning objectives were influencing factors for career planning attitude ( P<0.05); grade, internship experience, and professional learning objectives were influencing factors for career planning practice ( P<0.05). Conclusions:Related measures should be adopted to strengthen career planning education for medical talents, such as perfecting the whole-process and multi-agent career planning guidance system, stimulating the enthusiasm of students, and clarifying professional learning objectives.

Objective:To investigate the current status of knowledge, attitude, and practice in career planning among medical students and its influencing factors, and to facilitate the education of medical career planning.Methods:The convenience sampling method was used to distribute a self-made questionnaire, and related data were gathered from 295 medical students in Wuhan, China. SPSS 26.0 was used to perform analyses of related categorical variables, including descriptive statistics, univariate tests, rank-sum tests, and the binary logistic regression analysis.Results:The results showed that the medical students with good performance of career planning knowledge, attitude, and practice accounted for 68.48%, 87.12%, and 54.92%, respectively. Major, grade, professional satisfaction, and professional learning objectives were influencing factors for career planning knowledge among the medical students ( P<0.05); the intention for laboratory participation, the basis for major selection, and professional learning objectives were influencing factors for career planning attitude ( P<0.05); grade, internship experience, and professional learning objectives were influencing factors for career planning practice ( P<0.05). Conclusions:Related measures should be adopted to strengthen career planning education for medical talents, such as perfecting the whole-process and multi-agent career planning guidance system, stimulating the enthusiasm of students, and clarifying professional learning objectives.

Objective:To evaluate the diagnostic value of coronary angiography-derived fractional flow reserve (FFR) and index of microcirculatory resistance (IMR) for identifying coronary functional abnormalities.Methods:This diagnostic study enrolled patients with clinically suspected or diagnosed coronary artery disease who underwent coronary angiography at Beijing Anzhen Hospital, TEDA International Cardiovascular Hospital, and Qilu Hospital of Shandong University between December 2021 and June 2022. All enrolled patients successfully underwent invasive wire-based FFR and IMR measurements during angiography. In a core laboratory, FFR and IMR for the target vessels were measured using artificial intelligence technology based on coronary angiographic images. Spearman correlation analysis was used to evaluate the correlation between angiography-derived FFR and wire-based FFR, and between angiography-derived IMR and wire-based IMR. Coronary hemodynamic abnormality was defined as FFR≤0.80; the diagnostic performance of angiography-derived FFR for identifying this abnormality was evaluated. Microcirculatory dysfunction was defined as IMR≥25; the diagnostic performance of angiography-derived IMR for identifying microcirculatory dysfunction was evaluated.Results:A total of 181 patients, aged (60.6±8.8) years, with 62 (34.3%) females, and 181 target vessels were included in the final analysis. Angiography-derived FFR showed a significant positive correlation with wire-based FFR ( r=0.78, P<0.001). For identifying coronary hemodynamic abnormality, angiography-derived FFR showed an accuracy of 89.0%, sensitivity of 88.8%, specificity of 89.1%, positive predictive value (PPV) of 88.8%, negative predictive value (NPV) of 89.1%, and an area under the receiver operating characteristic curve ( AUC) of 0.88. Angiography-derived IMR showed a significant positive correlation with wire-based IMR ( r=0.93, P<0.001). For identifying microcirculatory dysfunction, angiography-derived IMR demonstrated an accuracy of 89.5%, sensitivity of 86.8%, specificity of 90.2%, PPV of 70.2%, NPV of 96.3%, and an AUC of 0.95. Conclusion:Angiography-derived FFR and IMR exhibit strong correlations with their invasive wire-based counterparts and demonstrate high diagnostic value for assessing coronary hemodynamics and coronary microcirculatory function.

Objective By employing surgically induced varicocele(VC)in SD rats and an apomorphine(APO)test,we screened rats with erectile dysfunction(ED)after VC and explored method to establish VC and ED models.Methods Sixty rats were randomly divided into Control,Sham,and Model groups with 20 rats in each group.Using the Turner method,we partially ligated the left renal vein to induce left VC three times.APO tests were conducted to screen rats with ED after inducing VC.The numbers of erections,genital grooming,and yawning were observed and recorded.The diameter of bilateral spermatic veins were measured.Both testises and kidneys were weighed.HE staining was used to observe pathological changes of penis and left testis.The success rate of modeling was calculated in the Model group.Results A VC and ED model was successfully established in 15 out of 20 rats in the Model group with a success rate of 75％.After modeling,the diameter of the left spermatic vein in the model group was increased significantly(P＜0.01)and was significantly larger than that before modeling(P＜0.01).The diameter of the right spermatic vein in the Model group was increased(P＜0.05)and higher(P＜0.05)than that before modeling.The weight of the left testis in the Model group was significantly decreased(P＜0.01)compared with that of the right testis.No significant difference in the bilateral kidney weights were observed between or within groups(P＜0.05).In the Model group,the numbers of erections,yawning,and genital grooming decreased significantly(P＜0.01)with the time of modeling.Pathological changes of the left testis and penis were significant in the Model group.Conclusions The Turner method increases the diameter of the spermatic vein in rats,causing testis injury and weight loss,and APO tests can be used to screen rats with ED after VC induction.The combination of the two method is suitable to establish an animal model of VC with an ED status similar to humans.

Objective:To investigate the impact of the deep-learning-based CT fractional flow reserve (CT-FFR) on clinical decision-making and long-term prognosis in patients with obstructive coronary heart disease.Methods:In this single-center retrospective cohort study, consecutive patients with obstructive coronary heart disease (with at least one stenosis≥50%) on their first coronary computed tomography angiography (CCTA) in Beijing Anzhen Hospital from February 2017 to July 2018 were included. Baseline clinical and CT characteristics were collected. Deep-learning-based CT-FFR and Leiden CCTA risk score were calculated. All patients enrolled were followed up for at least 5 years. The study endpoint was major adverse cardiovascular events (MACE), defined as the composite of cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, and unplanned revascularization. Receiver operating characteristic (ROC) curves were drawn to define the optimal cut-off point of the Leiden score in predicting the 5-year MACE, and survival analysis and Cox regression were performed to explore the related factors of MACE.Results:A total of 622 patients, aged 61 (54, 66) years, with 407 (65.4%) males were included. Diagnostic coronary angiography was performed in 78 patients after their baseline CCTA, with 34 (43.6%) patients had CT-FFR>0.80. During a follow-up time of 2 181 (2 093, 2 355) days, 155 patients (24.9%) suffered from MACE. ROC derived optimal cut-off point of Leiden score for predicting MACE was 15.48. Survival analysis found that male patients, Leiden risk score>15 and CT-FFR≤0.80 had worse prognosis. Multivariate Cox regression analysis identified CT-FFR≤0.80 as an robust and independent predictor of MACE ( HR=4.98, 95% CI 3.15-7.86, P<0.001). Conclusion:Deep-learning-based CT-FFR aids in clinical decision-making and the evaluation of long-term prognosis in patients with obstructive coronary heart disease.

OBJECTIVE: N6-methyladenosine (m ⁶A) is a common epigenetic modification in eukaryotes. In this study, we explore the potential impact of m ⁶A-associated single nucleotide polymorphisms (m ⁶A-SNPs) on heart failure (HF). METHODS: Data from genome-wide association studies (GWAS) investigating HF in humans and from m ⁶A-SNPs datasets were used to identify HF-associated m ⁶A-SNPs. Their functions were explored using expression quantitative trait locus (eQTL), gene expression, and gene enrichment analyses. Mediation protein quantitative trait locus (pQTL)-Mendelian randomization (MR) was used to investigate the potential mechanism between critical protein levels and risk factors for HF. RESULTS: We screened 44 HF-associated m ⁶A-SNPs, including 10 m ⁶A-SNPs that showed eQTL signals and differential expressions in HF. The SNP rs1801270 in CDKN1A showed the strongest association with HF ( P = 7.75 × 10 ^-6). Additionally, MR verified the genetic association between the CDKN1A protein and HF, as well as the mediating effect of blood pressure (BP) in this pathway. Higher circulating level of CDKN1A was associated with a lower risk of HF (odds ratio [ OR] = 0.82, 95% confidence interval [ CI]: 0.69 to 0.99). The proportions of hypertension, systolic BP, and diastolic BP were 48.10%, 28.94%, and 18.02%, respectively. Associations of PDIA6 ( P = 1.30 × 10 ^-2) and SMAD3 ( P = 4.80 × 10 ^-2) with HF were also detected. CONCLUSION Multiple HF-related m ⁶A-SNPs were identified in this study. Genetic associations of CDKN1A and other proteins with HF and its risk factors were demonstrated, providing new ideas for further exploration of the molecular mechanisms of HF.
Humans ; Polymorphism, Single Nucleotide ; Heart Failure/genetics* ; Mendelian Randomization Analysis ; Genome-Wide Association Study ; Cyclin-Dependent Kinase Inhibitor p21/metabolism* ; Quantitative Trait Loci ; Adenosine/metabolism* ; Male ; Female ; Genetic Predisposition to Disease

Objective:To search, evaluate and summarize the evidence of the safety and application of closed tracheal suction systems and to provide reference for clinical nursing work.Methods:BMJ Best Practice, UpToDate, Joanna Briggs Institute Evidence-based Health Care Center, Guidelines International Network, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network, Registered Nurses' Association of Ontario, American Assocition for Respiratory Care, Society of Critical Care Medicine, Medlive, Cochrane Library, PubMed, Embase, CINAHL, CNKI, Wanfang Database, China Biology Medicine disc were searched for related guidelines, system reviews, expert consensus, best practices, etc. The retrieval time was from the database construction to February 28, 2021. Two researchers independently evaluated the quality of the included literature and extracted and summarized the evidence of the literature that met the quality standards.Results:A total of 20 literatures were included, including 3 clinical decisions, 2 guidelines, 11 systematic reviews and 4 expert consensuses. A total of 27 pieces of best evidence were compiled from five aspects, including indications for use, clinical effects, safety, methods of use and replacement.Conclusions:This study summarizes the best evidence on the clinical application of closed sputum suction devices in adults. When applying the evidence, clinical nurses need to select the best evidence in combination with the clinical environment to standardize the clinical application of closed tracheal suction systems.

Objective: To evaluate the effect of sexuality education for parents of preschoolers, to provide a basis for sexuality educational programs in rural settings. Methods: This community intervention trial chose four kindergartens in Jiangyang District of Luzhou City as the intervention group and other four kindergartens in Jiangyou City of Mianyang City of Sichuan Province as the control group. Sexuality education for parents was carried out in the intervention group, and the control group received routine arrangement. The baseline survey was conducted from March to May 2019, and the final survey was conducted in December 2019. The investigators conducted a face to face or self filled questionnaires among each parent who agreed to participate in the survey by using the self designed questionnaire "Research on Current Situation and Countermeasures of Early Childhood Sexuality Education in Rural Areas (Parent)". Results: Before the intervention, there was no significant difference in the basic information of parents and their children, and the situation of early childhood sexuality education between the intervention group and the control group( P > 0.05 ). After intervention, parents of the intervention group and the control group showed differences in correct rate of the knowledge regarding early childhood sexuality education (41.5%，32.1%), proportion of recognition of parental responsibility (90.7%， 81.3 %), sexuality education in the family (55.7%，45.9%), sexuality education in schools (70.2%，39.1%) and attitude behavior consistency (28.9%，16.3%) ( χ 2=4.05，8.05，4.17，42.48，9.59， P <0.05). Conclusion Sexuality education towards parents is effective through improving knowledge, responsibility, the implementation of sexuality education in the family, and attitude behavior consistency among parents.

Objective:To investigate the status quo of nursing capacity for chronic respiratory disease in community health service centers.Methods:A questionnaire survey on nursing capacity for chronic respiratory disease was conducted in November 2018 among nurses working in internal medicine, general practice and chronic disease management departments of 4 community health service centers in Beijing Miyun District. The questionnaire included the knowledge and work content of chronic respiratory diseases. At the same time semi-structured interviews was conducted on the role of nurses in the management of chronic respiratory diseases among nurses selected by purposive sampling method.Results:In the study 63 valid questionnaires were collected and 14 nurses were interviewed. The results showed that the total score of nurses′ knowledge about chronic respiratory diseases was (62.0±14.4), and the scores of knowledge of chronic obstructive pulmonary disease (COPD), bronchial asthma and obstructive sleep apnea were (55.5±19.3), (61.0±21.6), (69.5±25.1), respectively. The total knowledge score of nurses with middle-rank professional title or above was higher than that of those with primary title [(67.0±12.9) vs. (54.0±13.6), t=-3.07, P<0.01]. The work contents mainly involved were nursing procedures(22/63,34.9%), health education(18/63,28.6%) and nursing evaluation(8/63,12.7%).Three themes were extracted from the deep interviews: the main work contents for nurses should be nursing procedures, nurses should participate in the chronic respiratory disease management as a member of the integrated medical team; nurses expected practice-oriented trainings of chronic respiratory disease management. Conclusions:The knowledge of chronic respiratory diseases among nurses in community health center needs to be improved, and the nursing skills special for respiratory diseases are needed. It is suggested to develop training courses and nursing guidelines suitable for community health centers and for nurses to participate in chronic respiratory disease management as team members, so that nurses in primary care institutions can play a better role in the management of chronic respiratory diseases.