Objective:To investigate the roles of simulated participants in the facilitation of medical scenarios simulation-based course and to provide a reference for the standardized construction of medical scenarios simulation-based course.Methods:Thirty scenario simulation-based teaching sessions on perioperative crisis events conducted during the 2022-2023 academic year were observed on-site. The performance of simulated participants in facilitating case execution and the skills used in facilitation were observed and recorded. At the end of the course, surveys regarding facilitation were administered to students, simulated participants, and instructors for analysis.Results:In the facilitation of 30 scenario simulation-based teaching sessions on perioperative crisis events, the roles of simulated participants included surgeon, anesthesia nurse, circuit nurse, and standardized patient. Two simulated participants accounted for 80.00% and three participants for 20.00% of the total sessions. The simulated participants performed excellently in helping the learners quickly integrate into the scenario and controlling the direction of the case, with an excellence rate of 90.00%-100.00%. However, they had some variations in driving the progress of the case and responding to unexpected situations, with an excellence rate of 50.00%-60.00%. The facilitation skills used by simulated participants included hinting, prompting, and instructing. The performance of facilitation was closely related to the use of skills by the simulated participants. Simulated participants with proficient skill usage significantly enhanced teaching effectiveness. Post-session surveys revealed that learners generally perceived simulated participants as having a positive impact on facilitation, and both simulated participants and instructors emphasized the need for strengthened communication prior to simulation-based teaching.Conclusions:The simulated participants played important roles in guiding learners, advancing case progression, and achieving teaching objectives. Instructors should not only consider the scripting of simulated participants during lesson planning but also prioritize their training and communication during course implementation.

Kleine-Levin Syndrome(KLS)is a rare neurological disease characterized by recurrent episodes of hypersomnia, hyperphagia, hypersexuality, and cognitive and behavioral abnormalities, with complete functional recovery between episodes. Its pathogenesis remains unclear. We report a 33-year-old female with a 17-year clinical course, characterized mainly by recurrent hypersomnia. During episodes, the patient exhibited prominent anorexia, irritability, derealization, and disorientation, followed by brief periods of excitement after episode resolution. Inter-episode periods were entirely normal. Long-term polysomnography monitoring was conducted for a total of 7 792 minutes. Unlike the typical hyperphagia commonly observed in KLS, this case was marked by prominent anorexia, underscoring the clinical heterogeneity of KLS.This report adds to the limited documentation of rare cases in China.

Objective:To evaluate the efficacy and safety of intrasaccular flow disruptor in wide-necked intracranial aneurysms.Methods:One hundred and seventeen patients with wide-necked intracranial aneurysms treated with intrasaccular flow disruptor were collected from Department of Neurointervention (First Affiliated Hospital of Zhengzhou University), Department of Neurosurgery (Beijing Tiantan Hospital, Capital Medical University), Department of Cerebrovascular Surgery, Neurosurgery Center (Zhujiang Hospital, Southern Medical University), and Department of Neurosurgery (First Affiliated Hospital of Harbin Medical University) from August 2022 to March 2024. Raymond-Roy Occlusion Classification (RROC) was employed to evaluate aneurysm embolization immediately after procedure; cranial CT or MRI within 48 hours of embolization were performed to identify any new intracranial hemorrhage, subarachnoid hemorrhage, or new symptomatic cerebral infarction related to the intracranial aneurysms. Modified Rankin Scale (mRS) was used to assess the neurological function at discharge. Imaging follow-up and outpatient follow-up were performed at 6 months after embolization to evaluate the aneurysm occlusion degree and complications.Results:A total of 117 intrasaccular flow disruptors were implanted in 117 patients, with a technical success rate of 100%; 115 patients (98.3%) enjoyed successful one-time release of their disruptors, and 2 patients (1.7%) required retrieval and redirection of the disruptors before second successful attempt. Flow disruptor plus stent was performed in 13 patients (11.1%). Immediately after procedure, RROC grading I was noted in 3 patients, grading II in 51 patients and grading III in 63 patients. Cranial CT or MRI within 48 hours of embolization indicated no new intracranial hemorrhage, subarachnoid hemorrhage, or symptomatic cerebral infarction related to the intracranial aneurysms. All patients had mRS score of 0 at discharge. Eighty-three patients completed a 6-month follow-up (RROC grading I in 41 patients, grading II in 33 patients and grading III in 9 patients), without ischemic or hemorrhagic adverse events.Conclusion:The results of this study preliminarily suggest that intrasaccular flow disruptor is effective and safe in wide-necked intracranial aneurysms.

Objective:To evaluate the efficacy and safety of Neuroform Atlas stent-assisted coil embolization in patients with middle cerebral artery bifurcation aneurysms.Methods:A retrospective analysis was performed; the clinical data of 46 patients with middle cerebral artery bifurcation aneurysms accepted Neuroform Atlas stent-assisted coil embolization in First Affiliated Hospital of Zhengzhou University, Beijing Tiantan Hospital Affiliated to Capital Medical University, First Affiliated Hospital of Harbin Medical University, Zhujiang Hospital of Southern Medical University and First Affiliated Hospital of Chongqing Medical University from January 2022 to March 2024 were collected. There were 28 ruptured aneurysms (60.87%) and 18 unruptured aneurysms (39.13%). Follow-up was performed for more than 3 months; Raymond-Roy grading was used to evaluate the aneurysm embolization immediately after embolization and during follow-up; perioperative hemorrhagic or ischemic complications were recorded; modified Rankin Scale (mRS) was used to evaluate the prognosis of the patients at discharge and during follow-up (mRS score≤2: good prognosis, and mRS score>2: poor prognosis).Results:Coil embolization was successful in all 46 patients. DSA immediately after embolization showed that 41 patients (89.13%) had completely occluded aneurysms (Raymond-Roy grading I), 2 patients (4.35%) had residual aneurysm neck (Raymond-Roy grading Ⅱ) and 3 patients (6.52%) had partially occluded aneurysms (Raymond-Roy grading Ⅲ). Perioperative complications occurred in 5 patients, including 2 with postoperative cerebral infarction, 1 with hydrocephalus, 1 with postoperative pneumonia leading to respiratory failure, and 1 with stent thrombosis during embolization. Both at discharge and 3 months after embolization, 43 patients (93.48%) had good prognosis and 3 patients (6.52%) had poor prognosis. No obvious ischemic complications (such as stent restenosis) or hemorrhagic complications (such as re-rupture of the aneurysms) were found in all patients. Thirty patients (65.22%) had imaging follow-up for 6-12 months: 26 (86.67%) had Raymond-Roy grading I, 3 (10.00%) had Raymond-Roy grading II, and 1 (3.33%) had Raymond-Roy grading III.Conclusion:Neuroform Atlas stent-assisted coil embolization has good short-term efficacy and high safety in middle cerebral artery bifurcation aneurysms, but long-term follow-up observation is still needed to verify its efficacy.

Objective:To explore the changes of brain excitation/inhibition balance and gray matter volume (GMV) and their correlations with clinical features in benign childhood epilepsy with centrotemporal spikes (BECTS).Methods:A cross-sectional study was performed; 83 BECTS children enrolled from Department of Diagnostic Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University from January 2015 to January 2024 were selected as BECTS group. During the same period, 101 age- and gender-matched healthy children were recruited as healthy control group through advertisements in local primary schools. Data of conventional MRI and resting-state functional MRI (rs-fMRI) of the two groups were collected. Whole brain GMV was analyzed by voxel-based morphometry (VBM), and Hurst index was calculated based on time series data of blood oxygen level dependent (BOLD) signal of rs-fMRI. Correlations of GMV and Hurst index with disease duration and onset age in children with BECTS were explored by Pearson correlation analysis.Results:Compared with the healthy control group, the BECTS group had significantly increased GMV and decreased Hurst index in the bilateral Rolandic region ( P<0.05). Pearson correlation analysis showed that in the BECTS group, GMV in bilateral Rolandic region was negatively correlated with onset age ( r=-0.267, P=0.015) and positively correlated with disease course ( r=0.267, P=0.015); Hurst index in bilateral Rolandic region was positively correlated with onset age ( r=0.323, P=0.003) and negatively correlated with disease course ( r=-0.240, P=0.029); Hurst index was negatively correlated with GMV in bilateral Rolandic region ( r=-0.328, P=0.003). Conclusion:BECTS children have excitation/inhibition imbalance in epilepsy-related regions and cortical structural delay, and both of them are related to onset age and disease course.

Objective:Persistent proatlantal intersegmental artery (PPIA) is a rare variant of persistent carotid-vertebrobasilar anastomoses and mostly discovered incidentally. To explore the clinical features of PPIA, and enhance the understanding of this rare cerebrovascular variation.Methods:A retrospective analysis was performed. The clinical data of 6 patients with PPIA admitted to Department of Neurointervention, First Affiliated Hospital of Zhengzhou University from June 2018 to June 2024 were analyzed. The imaging features, associated cerebrovascular diseases, treatments and follow-up results were summarized.Results:Among the 6 PPIA patients, 4 were with type I and 2 were with type II; 5 were with left PPIA and 1 patient was with right PPIA; 5 patients had bilateral vertebral artery hypoplasia or absence, and 1 patient had absence of the ipsilateral vertebral artery and normal development of the contralateral vertebral artery. Four PPIA patients were combined with intracranial aneurysms: 2 patients received dual stent-assisted embolization and flow diverter device combined with covered stent implantation, respectively (after 6 months of follow-up, modified Rankin scale score of 0 indicating good prognosis and healed intracranial aneurysms), and the other 2 patients with micro-aneurysms were not treated. One patient was combined with internal carotid artery stenosis and accepted stent placement (good prognosis at 6 months after follow-up). One patient was combined with acute basilar artery tip occlusion and accepted aspiration thrombectomy (died of brain herniation 7 days after thrombectomy).Conclusions:PPIA is often accompanied by vertebral artery developmental abnormalities and prone to have concurrent intracranial aneurysms or ischemic stroke. When performing surgical treatment for cerebrovascular diseases associated with PPIA, PPIA protection to ensure blood supply of the posterior circulation is essential.

Objective:To analyze the clinical characteristics and cytokines expression characteristics in infants with mild and severe respiratory syncytial virus (RSV) infection.Methods:From May 2023 to December 2023, plasma samples and clinical information were collected from 16 infants with RSV infection and 14 control infants. Cytek Aurora flow cytometry (Cytek, America) and Enzyme linked immunosorbent assay (ELISA) were used to detect the expression levels of 25 cytokines after mild and severe RSV infection.Results:Cough and nasal obstruction were the main clinical manifestations in infants with mild RSV infection, accompanied by polypnea, wheezing and other symptoms. The main symptoms of severe RSV infection were cough and rales, accompanied by fever and polypnea. In comparison with the control group, the expression levels of IL-2, IL-4, IL-5, IL-6, IL-9, IL-13, IL-22, TNF-α, IFN-α, IFN-β, MIP-1β, I-TAC, ENA-78, GROα, Eotaxin, and MCP-1 in the RSV infection group all exhibited an upregulation trend. Both IP-10 and MIP-3α demonstrated a downward trend in the RSV infection group; however, there was no statistically significant difference ( P>0.05). The levels of IL-10, IFN-γ, MIP-1α, and IL-8 in the RSV infection group were significantly higher than those in the control group, whereas the levels of MIG, TARC, and RANTES in the RSV infection group were significantly lower than those in the control group ( P<0.05). The levels of IL-2, IL-4, IL-5, IL-6, IL-9, IL-10, IL-13, IL-22, IFN-β, IFN-γ, TNF-α, IL-8, I-TAC, MIP-1β, Eotaxin, and MCP-1 in the mild RSV infection group were significantly higher than those in the severe RSV infection group ( P>0.05). Among these, the levels of MIG, RANTES, TARC, MIP-3α, and ENA-78 in the mild infection group were all lower than those in the severe infection group. The expressions of ENA-78 and MIP-1α in the severe infection group were significantly higher than those in the mild infection group and also higher than those in the control group. There was no significant difference in IP-10 and GROα between the mild and severe RSV infection groups ( P>0.05). Conclusions:The differences in clinical features and cytokines between infants with mild and severe RSV infection provide important data support for the prevention and treatment of RSV infection in infants.

OBJECTIVE: To explore the correlation between mechanical power normalized to dynamic lung compliance (Cdyn-MP) and weaning outcomes and prognosis in mechanically ventilated patients. METHODS: A prospective, observational cohort study was conducted. Patients who underwent invasive mechanical ventilation (IMV) for more than 24 hours and used a T-tube ventilation strategy for extubation in the intensive care unit (ICU) of Lianyungang First People's Hospital and Lianyungang Second People's Hospital between January 2022 and December 2023 were enrolled. The collected data encompassed patients' baseline characteristics, primary causes of ICU admission, vital signs and laboratory indicators during the initial spontaneous breathing trial (SBT), respiratory mechanics parameters within the 4-hour period prior to the SBT, weaning outcomes and prognostic indicators. Mechanical power (MP) and Cdyn-MP were calculated using a simplified MP equation. Univariate and multivariate Logistic regression analyses were utilized to determine the independent risk factors associated with weaning failure in patients undergoing mechanical ventilation. Restricted cubic spline (RCS) analysis and Spearman rank-sum test were employed to investigate the correlation between Cdyn-MP and weaning outcomes as well as prognosis. Receiver operator characteristic curve (ROC curve) was constructed, and the area under the ROC curve (AUC) was computed to evaluate the predictive accuracy of Cdyn-MP for weaning outcomes in mechanically ventilated patients. RESULTS: A total of 366 patients undergoing IMV were enrolled in this study, with 243 cases classified as successful weaning and 123 cases classified as failed weaning. Among them, 23 patients underwent re-intubation within 48 hours after the successful withdrawal of the first SBT, non-invasive ventilation, or died. Compared with the successful weaning group, the patients in the failed weaning group had significantly increased levels of sequential organ failure assessment (SOFA) score, body temperature and respiratory rate (RR) during SBT, and respiratory mechanical parameters within the 4-hour period prior to the SBT [ventilation frequency, positive end-expiratory pressure (PEEP), platform pressure (Pplat), peak inspiratory pressure (Ppeak), dynamic driving pressure (ΔPaw), fraction of inspired oxygen (FiO₂), MP, and Cdyn-MP], dynamic lung compliance (Cdyn) was significantly reduced, and duration of IMV, ICU length of stay, and total length of hospital stay were significantly prolonged. However, there were no statistically significant differences in age, gender, body mass index (BMI), smoking history, main causes of ICU admission, other vital signs [heart rate (HR), mean arterial pressure (MAP), saturation of peripheral oxygen (SpO₂)] and laboratory indicators [white blood cell count (WBC), albumin (Alb), serum creatinine (SCr)] during SBT of patients between the two groups. Univariate Logistic regression analysis was conducted, and variables with P < 0.05 and no multicollinearity with Cdyn-MP were selected for inclusion in the multivariate Logistic regression model. The results demonstrated that SOFA score [odds ratio (OR) = 1.081, 95% confidence interval (95%CI) was 1.008-1.160, P = 0.030], and PEEP (OR = 1.191, 95%CI was 1.075-1.329, P = 0.001), FiO₂ (OR = 1.035, 95%CI was 1.006-1.068, P = 0.021) and Cdyn-MP (OR = 1.190, 95%CI was 1.086-1.309, P < 0.001) within the 4-hour period prior to the SBT were independent risk factors for weaning failure in patients undergoing IMV. The RCS analysis after adjusting for confounding factors showed that as Cdyn-MP within the 4-hour period prior to the SBT increased, the risk of weaning failure in patients undergoing IMV significantly increased (P < 0.001). The Spearman rank correlation test showed that Cdyn-MP within the 4-hour period prior to the SBT was positively correlated with respiratory mechanical parameters including ΔPaw and MP (r values were 0.773 and 0.865, both P < 0.01), and negatively correlated with Cdyn (r = -0.587, P < 0.01). Cdyn-MP within the 4-hour period prior to the SBT was positively correlated with prognostic indicators such as duration of IMV, length of ICU stay, and total length of hospital stay (r values were 0.295, 0.196, and 0.120, all P < 0.05). ROC curve analysis demonstrated that, within the 4-hour period preceding the SBT, Cdyn-MP, MP, Cdyn, and ΔPaw possessed predictive value for weaning failure in patients undergoing IMV. Notably, Cdyn-MP exhibited superior predictive capability, evidenced by an AUC of 0.761, with a 95%CI ranging from 0.712 to 0.810 (P < 0.001). At the optimal cut-off value of 408.5 J/min×cmH₂O/mL×10^-3, the sensitivity was 68.29%, and the specificity was 71.19%. CONCLUSION Cdyn-MP is related to weaning outcomes and prognosis in mechanically ventilated patients, and has good predictive ability in assessing the risk of weaning failure.
Humans ; Prospective Studies ; Ventilator Weaning ; Prognosis ; Respiration, Artificial ; Intensive Care Units ; Lung Compliance ; Female ; Male ; Middle Aged ; Aged

Objective:To analyze the clinical characteristics and cytokines expression characteristics in infants with mild and severe respiratory syncytial virus (RSV) infection.Methods:From May 2023 to December 2023, plasma samples and clinical information were collected from 16 infants with RSV infection and 14 control infants. Cytek Aurora flow cytometry (Cytek, America) and Enzyme linked immunosorbent assay (ELISA) were used to detect the expression levels of 25 cytokines after mild and severe RSV infection.Results:Cough and nasal obstruction were the main clinical manifestations in infants with mild RSV infection, accompanied by polypnea, wheezing and other symptoms. The main symptoms of severe RSV infection were cough and rales, accompanied by fever and polypnea. In comparison with the control group, the expression levels of IL-2, IL-4, IL-5, IL-6, IL-9, IL-13, IL-22, TNF-α, IFN-α, IFN-β, MIP-1β, I-TAC, ENA-78, GROα, Eotaxin, and MCP-1 in the RSV infection group all exhibited an upregulation trend. Both IP-10 and MIP-3α demonstrated a downward trend in the RSV infection group; however, there was no statistically significant difference ( P>0.05). The levels of IL-10, IFN-γ, MIP-1α, and IL-8 in the RSV infection group were significantly higher than those in the control group, whereas the levels of MIG, TARC, and RANTES in the RSV infection group were significantly lower than those in the control group ( P<0.05). The levels of IL-2, IL-4, IL-5, IL-6, IL-9, IL-10, IL-13, IL-22, IFN-β, IFN-γ, TNF-α, IL-8, I-TAC, MIP-1β, Eotaxin, and MCP-1 in the mild RSV infection group were significantly higher than those in the severe RSV infection group ( P>0.05). Among these, the levels of MIG, RANTES, TARC, MIP-3α, and ENA-78 in the mild infection group were all lower than those in the severe infection group. The expressions of ENA-78 and MIP-1α in the severe infection group were significantly higher than those in the mild infection group and also higher than those in the control group. There was no significant difference in IP-10 and GROα between the mild and severe RSV infection groups ( P>0.05). Conclusions:The differences in clinical features and cytokines between infants with mild and severe RSV infection provide important data support for the prevention and treatment of RSV infection in infants.

Objective:To propose a thyroid nodule ultrasound image segmentation method based on a feature-adaptive extraction and gated fusion mechanisms net (FAGF-Net).Methods:The FAGF-Net was constructed by designing a feature coupling encoder (FC-Encoder), which integrated a convolutional neural network and a Transformer to extract both local and global features. The perception of multi-scale geometric characteristics of nodules was enhanced by developing a multi-scale feature space coupling module (MFSC-Module), and a context-gated feature attention module (CGFA-Module) was introduced to filter redundant information and suppress noise interference. A retrospective analysis was conducted on 3 493 physician-annotated two-dimensional thyroid nodule ultrasound images obtained from the publicly available TN3K medical imaging dataset. The dataset was divided into training and validation sets at a ratio of 8∶2, resulting in 2 794 training images and 699 validation images. FAGF-Net was compared with several mainstream semantic segmentation models, including UNet, Deeplabv3, HRNet, PSPNet, and SegFormer using UNet as the baseline model. Additionally, module ablation experiments were performed to evaluate the effectiveness of each core module within the FAGF-Net. Visual comparisons were also conducted between the original ultrasound images, the annotated nodule regions, and the segmentation results produced by the different models.Results:The accuracy, intersection over union and Dice coefficient of the FAGF-Net method were 95.59%, 83.53% and 90.60%, respectively. These values were 3.77%, 2.29% and 3.55% higher than those of the UNet method (91.82%, 81.24% and 87.05%). Additionally, the FAGF-Net method achieved a frame rate of 19.8, meeting the requirements for image segmentation in medical environment scenarios. The module ablation experiments showed that compared with the UNet, the accuracy (92.85%), intersection over union (81.76%) and Dice coefficient (88.45%) of the FC-Encoder model were increased by 1.03%, 0.52% and 1.40%, respectively. The accuracy (93.13%), intersection over union (81.91%) and Dice coefficient (88.76%) of the CGFA-Module model were introduced separately, which were 1.31%, 0.67% and 1.71% higher than those of UNet, respectively. Compared with the FC-Encoder model alone, the accuracy (94.61%), intersection over union (82.45%) and Dice coefficient (89.54%) of the MFSC-Module increased by 1.76%, 0.69% and 1.09%, respectively when FC-Encoder was used as the feature double branch extraction encoder. Compared with the FC-Encoder model alone, the accuracy (94.39%), intersection over union (82.33%) and Dice coefficient (89.46%) of the CGFA-Module were increased by 1.54%, 0.57% and 1.01%, respectively, when FC-Encoder was used as the feature double branch extraction encoder. Visualization results showed that the FAGF-Net method produced smoother and more complete in boundary fitting and was more accurate at identifying small and low-contrast lesions.Conclusions:A thyroid nodule ultrasound image segmentation method based on FAGF-Net was proposed, which effectively improves the segmentation accuracy of thyroid nodule ultrasound image segmentation.