Poloxamer， as a non-ionic surfactant， exhibits a unique triblock [polyethylene oxide-poly （propylene oxide）-polyethylene oxide] structure， which endows it with broad application potential in various fields， including solid dispersion technology， nanotechnology， gel technology， biologics， gene engineering and 3D printing. As a carrier， it enhances the solubility and bioavailability of poorly soluble drugs. In the field of nanotechnology， it serves as a stabilizer etc.， enriching preparation methods. In gel technology， its self-assembly behavior and thermosensitive properties facilitate controlled drug release. In biologics， it improves targeting efficiency and reduces side effects. In gene engineering， it enhances delivery efficiency and expression levels. In 3D printing， it provides novel strategies for precise drug release control and the production of high-quality biological products. As a versatile material， poloxamer holds promising prospects in the pharmaceutical field.

Objective:To explore the effects of workshops combined with problem-based learning (PBL) in clinical teaching of joint surgery.Methods:A total of 60 students who would participate in standardized residency training from September 2019 to June 2021 were randomly divided into traditional lecture-based learning (LBL) group, PBL group, and workshops combined with PBL group, with 20 students in each group. The effects were evaluated by theoretical knowledge and clinical skill assessment and anonymous teaching quality questionnaire surveys. SPSS 25.0 was used to perform the t test and chi-squared test. Results:The workshop+PBL group showed the highest theoretical knowledge score (86.40±9.76), clinical skill score (92.15±4.49), and total score (88.70±5.75), compared with the PBL group (78.45±10.40, 85.80±10.00, and 81.39±7.27, respectively) and the LBL group (80.10±6.77, 85.20±8.12, and 82.14±6.14, respectively). According to the teaching quality questionnaire surveys, the workshop+PBL group was significantly superior to the PBL and LBL groups in self-ability evaluation and the degree of satisfaction with teaching ( P<0.05). Conclusions:Workshops combined with PBL can effectively improve students' scores of theoretical knowledge and clinical skills, with better self-ability evaluation results and higher satisfaction with teaching, which is worthy of application and promotion in clinical teaching of joint surgery.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To observe multiple locus variable-number tandem repeat analysis (MLVA) typing of Brucella isolated from Himalayan marmot in Qinghai-Tibet Plateau of Qinghai Province, and to explore the relationship between the strains and strains previous isolated from Qinghai Province. Methods:Blood samples of Himalayan marmot were collected in Qinghai-Tibet Plateau of Qinghai Province from March 2019 to October 2020. Pathogens were isolated and cultured from Brucella antibody positive samples identified by using the rose bengal test (RBT). Conventional biological methods and molecular biological methods (BCSP31-PCR and AMOS-PCR) were used for strain identification. At the same time, MLVA method was used to genotype the isolated strains, and cluster analysis was used to analyze the genetic relationships between the strains based on the genotype of 70 Brucella isolated from different hosts in Qinghai Province. Results:A total of 1 466 blood samples of Himalayan marmot were collected from Qinghai-Tibet Plateau. Two strains of Brucella were isolated and cultured from 64 RBT-positive samples, named QH2013054 and QH2013062, respectively. They were identified as Brucella ovis biotype Ⅲ by conventional and molecular biological methods. The MLVA genotyping results showed that QH2013054 and QH2013062 were different at the Bru16 locus, indicating different MLVA genotypes. Cluster analysis showed that strain QH2013054 had the same MLVA genotype as 7 strains, among which 6 strains were from 3 farmers and 3 sheep from the same family in Gonghe County, and 1 strain was from a farmer in Menyuan Hui Autonomous County. The strain QH2013062 had the same MLVA genotype as 4 strains, including 3 strains from 3 farmers in Menyuan Hui Autonomous County and 1 strain from a farmer in Tu Autonomous County of Huzhu. Conclusions:The strains of Brucella isolated from Himalayan marmot in Qinghai-Tibet Plateau of Qinghai Province have the same MLVA genotype as some strains of Brucella isolated from humans and sheep in Qinghai Province. It is speculated that the host humans, sheep and Himalayan marmot in Qinghai-Tibet Plateau may have a common source of infection.

Objective To compare the ultrasonographic characteristics of different molecular sub-types of invasive breast cancer and analyze their relationships with prognosis.Methods The clinical and ultrasonic data of 250 patients with invasive breast cancer were retrospectively analyzed,and they were divided into Luminal A type(n=53),Luminal B type(n=104),human epidermal growth fac-tor receptor 2(HER2)overexpression type(n=45)and triple-negative type(n=48)according to pathological findings.The ultrasonic characteristics as well as 3-year disease-free survival(DFS)and overall survival(OS)among different molecular subtypes were compared,and the influencing factors the prognosis of invasive breast cancer were analyzed.Results There were significant differences in ultrasonic imaging characteristics such as tumor growth direction,posterior echo and microcalcification between different molecular subtypes of invasive breast cancer(P＜0.05).Single factor analysis showed that molecular subtypes,tumor size,tumor staging,axillary lymph node metastasis and hypere-choic halo were associated with DFS and OS of patients with invasive breast cancer(P＜0.05).Multi-factor Cox regression analysis showed that molecular subtypes,tumor staging and hyperechoic halo were the independent influencing factors of DFS and OS in patients with invasive breast cancer(P＜0.05).Conclusion There are some differences in the ultrasonic characteristics and prognosis of dif-ferent molecular types in patients with invasive breast cancer.Molecular subtypes,tumor staging and hyperechoic halo are the independent prognostic factors of invasive breast cancer.

Objective To compare the ultrasonographic characteristics of different molecular sub-types of invasive breast cancer and analyze their relationships with prognosis.Methods The clinical and ultrasonic data of 250 patients with invasive breast cancer were retrospectively analyzed,and they were divided into Luminal A type(n=53),Luminal B type(n=104),human epidermal growth fac-tor receptor 2(HER2)overexpression type(n=45)and triple-negative type(n=48)according to pathological findings.The ultrasonic characteristics as well as 3-year disease-free survival(DFS)and overall survival(OS)among different molecular subtypes were compared,and the influencing factors the prognosis of invasive breast cancer were analyzed.Results There were significant differences in ultrasonic imaging characteristics such as tumor growth direction,posterior echo and microcalcification between different molecular subtypes of invasive breast cancer(P＜0.05).Single factor analysis showed that molecular subtypes,tumor size,tumor staging,axillary lymph node metastasis and hypere-choic halo were associated with DFS and OS of patients with invasive breast cancer(P＜0.05).Multi-factor Cox regression analysis showed that molecular subtypes,tumor staging and hyperechoic halo were the independent influencing factors of DFS and OS in patients with invasive breast cancer(P＜0.05).Conclusion There are some differences in the ultrasonic characteristics and prognosis of dif-ferent molecular types in patients with invasive breast cancer.Molecular subtypes,tumor staging and hyperechoic halo are the independent prognostic factors of invasive breast cancer.

Objective:To retrieve, evaluate, and summarize the best evidence for the assessment of gastrointestinal function in critically ill patients by bedside ultrasound.Methods:Guidelines, evidence summaries, group standards, expert consensus, systematic reviews, and randomized controlled trials on the assessment of gastrointestinal function in critically ill patients by bedside ultrasound were retrieved by computer on domestic and foreign guideline websites, society websites and databases based on evidence-based nursing. The search period was from January 1, 2010 to April 30, 2021. The quality of the article was independently assessed by two researchers using the Appraisal of Guidelines for Research and Evaluation Ⅱ and the critical appraisal tool of the Joanna Briggs Institute (JBI) in Australia (2016) . Combined with the judgment of the research team, the data from the article that met the criteria were extracted and the evidence was graded and recommended according to the JBI quality level of evidence system (2014 Edition) .Results:A total of 22 articles were included, involving 5 guidelines, 1 evidence summary, 1 group standard, 6 expert consensuses, 4 systematic reviews, and 5 randomized controlled trials. A total of 33 pieces of evidence were summarized from 6 aspects, namely, the feasibility of nurses applying bedside ultrasound, fundamentals of ultrasound assessment of gastrointestinal tract, ultrasound assessment of gastric contents, ultrasound assessment of gastric motility, ultrasound assessment of bowel, ultrasound guided enteral nutrition program.Conclusions:Nurses who have been systematically trained can use ultrasound to assess gastrointestinal function in critically ill patients in real time. Ultrasound-guided enteral nutrition for critically ill patients needs to be standardized and improved, and many studies need to be carried out.

The S1 protein of the infectious bronchitis virus (IBV) is a major structural protein that induces the production of the virus-neutralization antibodies. The monoclonal antibody against the IBV M41 S1 protein was used as a target for biopanning. After three rounds of biopanning, randomly selected phages bound to the monoclonal antibody. Sequence analysis showed that the dominant sequence was SFYDFEMQGFFI. Indirect competitive enzymelinked immunosorbent assay showed that SFYDFEMQGFFI is a mimotope of the S1 protein that was predicted by PepSurf. The mimotope may provide information for further structural and functional analyses of the S1 protein.

The S1 protein of the infectious bronchitis virus (IBV) is a major structural protein that induces the production of the virus-neutralization antibodies. The monoclonal antibody against the IBV M41 S1 protein was used as a target for biopanning. After three rounds of biopanning, randomly selected phages bound to the monoclonal antibody. Sequence analysis showed that the dominant sequence was SFYDFEMQGFFI. Indirect competitive enzymelinked immunosorbent assay showed that SFYDFEMQGFFI is a mimotope of the S1 protein that was predicted by PepSurf. The mimotope may provide information for further structural and functional analyses of the S1 protein.

Objective:To provide evidence for guiding enteral nutrition programs for critically ill patients by evaluating the application effect of ultrasonic monitoring gastric residual volume.Methods:CNKI, China Biology Medicine disc, Wanfang, VIP, Chinese Clinical Trial Registry, PubMed, Embase, Cochrane Library, ClinicalTrials.gov and other databases were systematically searched to collect randomized controlled trails (RCTs) of application of ultrasonic monitoring of gastric residual volume in enteral nutrition of critically ill patients. The search time limit was from the establishment of the database to December 31, 2019. Two researchers independently searched literature, screened literature, extracted data and evaluated the quality of the literature. RevMan 5.3 software was used for Meta-analysis.Results:A total of 10 articles were included, involving 897 patients. Compared with the syringe withdrawal method, ultrasonic monitoring of gastric residual volume could reduce the incidence of reflux or vomiting [ RR=0.53, 95% CI (0.38-0.75) ] and the incidence of aspiration [ RR=0.48, 95% CI (0.30-0.77) ], increase albumin level [ MD=1.53, 95% CI (0.71-2.35) ] and reduce operating time of nurses [ MD=-5.62, 95% CI (-7.59--3.65) ], and the combined effects were statistically significant ( P<0.05) . However, the incidence of diarrhea [ RR=0.77, 95% CI (0.53-1.11) ] and in-hospital mortality [ RR=0.73, 95% CI (0.41-1.28) ] were not changed, and the combined effects were not statistically significant ( P>0.05) . Conclusions:Ultrasonic monitoring of gastric residual volume in enteral nutrition of critically ill patients may be helpful to reduce the incidence of complications and improve the nutritional status of patients.