Objective To establish sex-and age-specific reference interval of thyroid stimulating hormone(TSH)for the population in Pidu District of Chengdu by an indirect method.Methods Data that did not meet the screening criteria were excluded.The TSH data of 37 514 patients from Traditional Chinese Medicine Hos-pital of Pidu District from March 2022 to August 2023 were collected.The data were deleted according to the screening criteria.The skewness-kurtosis method was used to test the normality,and the Turkey method was used to eliminate the outliers.The TSH levels of different genders and ages were compared by Mann-Whitney U test and Kruskal-Wallis H test,respectively.Non-parametric methods were used to calculate TSH reference interval.Its reliability was verified by two methods:when the relative deviation from the reference interval of the reagent specification was less than the reference change value(RCV)or more than 90％of the TSH result was within the reference interval,the result were proved to be reliable.Results A total of 25 761 valid TSH data were included,9 363 men and 16 398 women.They were divided into 8 subgroups according to age:10-＜18,18-30,＞30-40,＞40-50,＞50-60,＞60-70,＞70-80,＞80-90.Male TSH reference interval is 0.457-4.884,0.465-4.229,0.445-4.918,0.457-4.826,0.471-5.160,0.425-5.477,0.456-5.645,0.465-6.418 pIU/mL,respectively.The reference range of female TSH was 0.546-5.196,0.592-5.499,0.606-5.815,0.549-5.915,0.527-6.099,0.457-5.927,0.435-6.078,0.415-6.321 pIU/mL.The rela-tive deviations between the upper limit and lower limit of the reference interval and the reagent specification were smaller than the RCV(49.85％).When used to validate the population,each group had more than 90％TSH results in the reference interval.Conclusion A gender-and age-specific TSH reference interval is estab-lished by indirect method using big data,which can provide reference for accurate diagnosis and treatment of thyroid diseases.

Objective:To improve the dosimetric accuracy of cell irradiation experiments by developing a method of accurately measuring the absorbed dose of ultra-thin solution in culture dishes under 200 kV medium-energy X-rays using EBT3 films.Methods:EBT3 film dose calibration was performed under Cyberknife 6 MV beam, and the beam quality (half-value layer) and effective energy of the 200 kV beam used in this study generated from Small Animal Radiation Research Platform through measurements and calculations were obtained to determine the EBT3 energy response correction factor. The 200 kV beam was utilized to irradiate three commonly used culture dishes filled with ultra-thin liquid placed on EBT3 films and the corrected EBT3 doses were taken as the liquid absorbed doses. The dose linearity of immersed films was also measured and analyzed. In addition, after modeling the irradiation environment, the independent Monte Carlo calculations of the liquid absorbed dose were performed by MCNP5 program. The calculation results were compared with the film measurement results to verify the accuracy of the measured doses.Results:The 200 kV beam had a half-value layer of 8.77 mm aluminum and effective energy of 57.4 keV, corresponding to an energy response correction factor of 0.889. The average liquid absorbed doses of large, medium and small culture dishes measured by EBT3 films under the specified parameters of 200 kV beam were (1.434±0.004) Gy, (1.467±0.011) Gy and (1.469±0.027) Gy after correction, respectively. The percentage errors from the corresponding Monte Carlo calculation doses were 0.07%, -0.70%, and 0.47%, respectively, where the relatively consistent results could be found. In addition, the dose linearity of immersed EBT3 films was also good, with coefficient of determination R2=0.9972. Conclusion:The method of measuring the dose of ultra-thin cell solution using EBT3 films proposed in this study is feasible, and the dose results obtained yield high accuracy under 200 kV beam.

Objective To explore the application value of ultrasound-guided use of bupivacaine for subarachnoid block in hip replacement surgery for elderly femoral neck fractures.Methods A total of 108 elderly patients who underwent hip replacement surgery at Ganzhou Traditional Chinese Medicine Hospital from March 2020 to March 2022 were selected as the study subjects.They were divided into conventional anesthesia group and ultrasound guided anesthesia group by means of random number table,54 cases in each group.Patients in the conventional anesthesia group received routine general anesthesia;Patients in the ultrasound guided anesthesia group received unilateral lumbar anesthesia with bupivacaine under ultrasound-guided guidance.Compare the effectiveness of two anesthesia methods during surgery.Results Compared with the conventional anesthesia group,the anesthesia effect of the ultrasound guided anesthesia group was better(P<0.05);The surgery time,amount of bleeding during surgery,postoperative recovery time,and length of hospital stay in the ultrasound guided anesthesia group were all lower than those in the conventional anesthesia group(P<0.05).The ultrasound guided anesthesia group performed better in terms of hemodynamic stability,with a smaller range of changes,and significantly lower pain scores at different postoperative time points compared to the conventional anesthesia group(P<0.05).Conclusion In elderly patients undergoing hip replacement surgery,using ultrasound-guided bupivacaine for subarachnoid block can achieve ideal anesthesia and analgesic effects compared to traditional general anesthesia,shorten drug onset time,alleviate pain in elderly patients,maintain hemodynamic stability,and have significant clinical application effects.

Objective:To analyze changes in energy metabolism and oxylipin metabolism in macrophages after stimulation by Mycobacterium marinum ( M. marinum) using targeted metabolomics, and to provide insights into the mechanisms underlying the immune defense by macrophages against M. marinum infections. Methods:Mouse bone marrow-derived macrophages were obtained from the bilateral femurs of mice, and cultured cells were divided into two groups: the active M. marinum group and the inactivated M. marinum group. Bacterial suspensions were prepared using M. marinum clinical isolates; the active M. marinum group was treated with live M. marinum suspensions for 12 hours, while the inactivated M. marinum group with inactivated M. marinum suspensions for 12 hours. Cell morphology was observed through microscopy, and cell length was measured. Cell lysates collected from both groups were subjected to liquid chromatography-tandem mass spectrometry analysis to detect energy and oxylipin metabolites. A t-test was utilized to compare the lengths of macrophages between the two groups, while principal component analysis and orthogonal partial least squares-discriminant analysis were conducted to identify differential metabolites. Results:Under the microscope, macrophages in the active M. marinum group formed more granuloma-like cell aggregates compared with those in the inactivated M. marinum group; the macrophages were significantly thinner and longer in the inactivated M. marinum group (439.52 ± 91.67 μm) than in the active M. marinum group (289.96 ± 70.11 μm, P < 0.001). Principal component analysis and orthogonal partial least squares-discriminant analysis of energy metabolism and oxylipin metabolism in macrophages demonstrated good separation between the two groups. As for the energy metabolism, a total of 12 differential metabolites were identified, with the amino acid metabolism showing the most significant changes. Specifically, there was a significant increase in the content of L-citrulline, while the content of L-leucine and serine decreased. As for the oxylipin metabolism, 20 differential metabolites were identified, with the arachidonic acid metabolism showing the most significant changes. Conclusions:Macrophages stimulated by live M. marinum exhibited altered amino acid metabolism and arachidonic acid metabolism compared with those stimulated by inactivated M. marinum, characterized by an increase in L-citrulline content, a decrease in L-leucine and serine levels, and alterations in arachidonic acid content.

The aim of this experiment was to investigate the effects of Chinese angelica polysaccha-ride(CAP)on peritoneal macrophage function before and after selenization.In the experiment,CAP and selenized Chinese angelica polysaccharide(sCAP)were applied to mouse peritoneal mac-rophages,and the phagocytic activity of macrophages as well as the expression of the cellular phe-notypes F4/80,MHC-Ⅱ,CD80 and CD86 were detected by flow cytometry,and the changes of IL-6,IL-10,NO,MIP-1α,and TNF-α content in the supernatant of macrophage were detected by ELISA.The results showed that the phagocytic activity of peritoneal macrophages was significantly higher in the sCAP mass concentration of 1.96 mg/L than in the other groups(P＜0.05);and the expression of F4/80,MHC-Ⅱ,CD80 and CD86 were significantly higher in the sCAP mass concen-tration of 1.96 mg/L than in the CAP group and cell control group(P＜0.05);the contents of IL-6,IL-10,NO,and MIP-1α in the supernatant of macrophages were significantly higher than those in other groups when the mass concentration of sCAP ranged from 7.81 to 1.96 mg/L(P＜0.05).The results showed that sCAP had an enhancing effect on the immunomodulatory function of ab-dominal macrophages and was optimal at a mass concentration of 1.96 mg/L.

Objective:Correct chest compression posture (CCP) is an important basis for high-quality cardiopulmonary resuscitation, but the research on CCP was still very limited. In this study, a new automatic analysis model was developed to achieve the purpose of objectification, standardization and automation of CCP monitoring.Methods:A total of 15 participants, including 11 professionals and 4 nonprofessionals, were recruited to participate in the field experiment. The video data were recorded simultaneously with zed cameras in the front and 45-degree sides. All participants performed 120 consecutive external chest compression operations on the Smartman CPR simulator. Three experts annotated the videos independently. An intelligent algorithm was used to extract human bone points for subsequent analysis and model development. The chi-square test was used to compare the rates of the professional and nonprofessional groups.Results:The results showed that problems with wrists, fingers, center of body weight and elbow bending had the highest incidence. Through 28 800 sets of standard human skeleton point coordinate data, we obtained a reasonable range of arm angles of 169.24°- 180.00° for the left arm and 168.49°-180.00° for the right arm. By the same method, the reasonable range of the center of gravity angle is 0.00°-18.46°. Based on these results, a new chest compression posture detection model based on a dual ZED camera was developed, which can accurately identify CCP errors (accuracy 91.31%; sensitivity 80.16%; specificity 93.53%).Conclusions:This study innovatively proposed an objective evaluation method for CCP. Moreover, a new chest compression posture detection model based on a dual ZED camera was developed, which can accurately identify CCP errors to achieve automation and standardization of quality control in CPR training.

Background: There is no standard cut-off value of serum IgG4 concentration and serum IgG4/total IgG ratio for the diagnosis of IgG4-related disease (IgG4-RD) or as a marker of treatment responses. We aimed to explore this issue through a retrospective cohort analysis of adults in southwest China. Methods: The diagnostic performance of serum IgG4 concentration and IgG4/IgG ratio for IgG4-RD was evaluated in a retrospective analysis of 177 adults newly diagnosed as having IgG4-RD and 877 adults without IgG4-RD. Dynamic analysis was performed to evaluate the significance of serum IgG4 concentration on IgG4-RD treatment responses. Results: The serum IgG4 concentration differed according to sex. The optimal cut-off values of serum IgG4 concentration and IgG4/IgG ratio for IgG4-RD diagnosis were 1.92 g/L and 0.12 in males and 1.83 g/L and 0.11 in females, respectively. For patients with serum IgG4 concentration >2.01 g/L, the cut-off values in the total population were >3.00 g/L and 0.19, respectively. The median serum IgG4 concentration decreased over time, and the decrease rate increased over time. The serum IgG4 concentration significantly decreased at >1 week post-treatment (P=0.004), and the median decrease rate was close to 50% at >4 weeks post-treatment. Conclusions Serum IgG4 can be a good indicator for IgG4-RD diagnosis; however, different diagnostic cut-off values should be determined according to sex. The decreasing rate is more conducive than the serum IgG4 concentration to monitor treatment efficacy. The IgG4/IgG ratio did not improve the diagnostic efficacy for IgG4-RD.

Objective:To explore the therapeutic effect of multi-mode sequential combination of artificial liver in the treatment of hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF).Methods:The clinical data of HBV-ACLF patients treated with artificial liver in Wuxi Fifth People′s Hospital from January 2018 to June 2021 were retrospectively analyzed. Eighty-six patients were divided into artificial liver multi-mode sequential combination therapy group (sequential combination group) and conventional treatment group. The cytokine level changes and model for end-stage liver disease (MELD) score were analyzed at 14 days of disease duration. The survival outcome and complications of artificial liver were analyzed after 30 days of follow-up. Two independent samples t test and chi-square test were used for statistical analysis. Cox regression analysis was used to analyze the risk factors of death, and Kaplan-Meier method was used to analyze the survival rate of patients. Results:A total of 86 patients were enrolled, including 48 patients in sequential combination group with the average number of artificial liver of 4.68 times/person, and 38 patients in conventional treatment group with the average number of artificial liver of 3.17 times/person. At 14 days of disease duration, interleukin (IL)-6, IL-8, interferon γ-inducible protein (IP)-10 level and MELD score in sequential combination group decreased significantly than those in the conventional treatment group ( t=3.80, 3.62, 4.95 and 1.11, respectively, all P<0.050). After 30 days of follow-up, 63 patients survived and 23 patients died. Cox regression analysis showed that baseline international normalized ratio (hazard ratio ( HR)=0.558, 95% confidence interval ( CI) 0.193 to 0.856, P=0.027), baseline antithrombin Ⅲ activity ( HR=0.876, 95% CI 0.824 to 0.932, P<0.001), artificial liver mode ( HR=0.819, 95% CI 0.236 to 0.992, P=0.005), spontaneous peritonitis ( HR=0.170, 95% CI 0.045 to 0.647, P=0.009) and hepatic encephalopathy ( HR=0.004, 95% CI 0.001 to 0.030, P<0.001) were independent influencing factors for 30-day survival outcome. The cumulative survival rate of sequential combination group was higher than that of conventional treatment group, and the difference was statistically significant ( χ2=5.45, P=0.020). There were no significant differences in the proportions of bleeding, deep vein thrombosis, heart rate and blood pressure instability between the two groups ( χ2=0.63, 1.20 and 0.54, respectively, all P>0.050). The platelet decline of patients in sequential combination group was slighter than that in conventional treatment group, and the difference was statistically significant ( t=-4.17, P=0.002). Conclusions:Multi-mode sequential combination therapy of artificial liver could eliminate cytokines and reduce MELD score more effectively in patients with HBV-ACLF, and prolong the survival time of patients and have little effect on platelet count.

OBJECTIVE To establish the fingerprint of Guiqi tongmai mixture and evaluate its quality in combination with chemical pattern recognition . METHODS Using narirutin as reference peak ，HPLC fingerprint of Guiqi tongmai mixture was established with Similarity Evaluation System of Chromatographic Fingerprint of TCM （2012 edition）. Common peaks identification and similarity evaluation were conducted . Hierarchical cluster analysis （HCA），principle component analysis （PCA）and orthogonal partial least square -discriminate analysis （OPLS-DA）were performed ，and the value of variable importance in the projection （VIP） greater than 1 was taken as the standard to screen the differential markers affecting the quality of Guiqi tongmai mixture . RESULTS Nineteen common peaks in the HPLC fingerprints of thirteen batches of Guiqi tongmai mixture were calibrated ，and the similarities of them were 0.928-0.990；eight common peaks were identified ，including the peak 7（hydroxysafflor yellow A ），peak 8（albiflorin），peak 9（paeoniflorin），peak 10（calycosin-7-O-glucoside），peak 12（liquiritin），peak 14（ammonium glycyrrhizinate ）， peak 16（narirutin）and peak 19（hesperidin）. According to the results of HCA ，thirteen batches of samples could be clustered into three categories ：S5，S9 and S 11-S13 were clustered into one category ；S4 and S 8 were clustered into one category ；S1-S3，S6- S7 and S 10 were clustered into one category . The results of PCA indicated that the accumulative variance contribution rate of the principle components 1-7 was 92.115%. The results of OPLS -DA showed that VIP values of narirutin ，paeoniflorin，liquiritin， ammonium glycyrrhizinate ，the components corresponding to peak 11 and peak 1 were greater than 1. CONCLUSIONS HPLC fingerprint of Guiqi tongmai mixture is established ，and it could be used for quality evaluation of Guiqi tongmai mixture by combining with chemical pattern recognition techniques . Six components such as narirutin are differential markers affecti ng the quality of Guiqi tongmai mixture .

Pathophysiology is a comprehensive subject, which is very important to cultivate the clinical comprehensive thinking of medical students. Pathophysiology involves a wide range of subjects and contents, and is one of the major and difficult courses in basic medicine. Based on many years of research and practice, we have developed main-line-problem-based learning (ML-PBL). ML-PBL is a diversified teaching mode, including the main line teaching method, clinical case discussion method, and the main line synopsis explaining method. The analysis of application results shows that ML-PBL teaching improves the student performance. Furthermore, ML-PBL is more conducive to cultivating the comprehensive clinical thinking ability, improving the independent learning ability, and fully mobilizing the learning initiative.