Objective:To compare the testing effects of different testing methods in the functional inspection of precision surgical scissors and needle holders.Methods:By consulting relevant literature and professional books,three testing methods and materials for precision surgical scissors and needle holders were selected.The cutting performance of the precision surgical scissors were tested by gauze cloth,cotton wool,and silicone film method in the Interlock surgical instrument testing set.The clamping performance of precision needle holder was tested by using light,needle clips,and thread clamping method in the Interlock surgical instrument testing set.100 pieces of precision surgical scissors and needle holders which were qualified for cleaning and disinfection in the hospital were selected for effectiveness testing,and a self-made satisfaction questionnaire to investigate the satisfaction of surgeons with the use of instruments.Results:After 100 precision surgical scissors tested using three methods of gauze,cotton wool,and silicone film,the qualified number of cutting performance was 94,76,and 58,respectively,the difference was statistically significant(x2=36.526,P<0.05).The satisfaction rate of surgeons with the use of precision surgical scissors passed the silicone film test was the highest at 100%,followed by cotton wool cloth at 82.0%,and the gauze method at the worst at 67.0%,the difference was statistically significant(x2=48.439,P<0.05).After 100 precision needle holders were tested by using three methods of light irradiation,needle clamping,and wire clamping,the qualified number of clamping performance was 96,78,and 62,respectively,the difference was statistically significant(x2=38.160,P<0.05).The satisfaction rate of surgeons with the precision needle holders passed the clamp line test was the highest at 100.0%,followed by the clamp needle at 79.0%,and the worst under light at 62.0%,the difference was statistically significant(x2=57.705,P<0.05).Conclusion:The function and quality of precision surgical scissors and needle holders tested by the test objects in Interlock Surgical Instrument Test Suite can objectively and accurately reflect the functional status of surgical scissors and needle holders,provide reference for regular maintenance and upkeep of instruments,and ensure safe use of instruments.

Objective To establish a predictive model for survival outcomes of glioma patients based on both brain radiomics features from preoperative MRI multi-sequence images and clinical features.Methods We retrospectively analyzed the MRI images and clinical data of 388 glioma patients and extracted the radiomics features from the peritumoral edema zone,tumor core,and whole tumor on T1,T2,and T1-weighted contrast-enhanced(T1CE)and fluid attenuated inversion recovery(FLAIR)sequences.The cases were divided into a training set(271 cases)and a test set(117 cases).Random survival forest algorithms were used to select the radiomics features associated with overall survival(OS)in the training set to construct a radiomic score(Rad-score),based on which the patients were classified into high-and low-risk groups for Kaplan-Meier survival analysis.Cox proportional hazard regression models for the 3 different tumor zones were constructed,and their performance for predicting 1-and 3-year survival rates was evaluated using 5-fold cross-validation and AUC analysis followed by external validation using data from another 10 glioma patients.The best-performing model was used for constructing a nomogram for survival predictions.Results Five radiomics features from the tumor core,7 from the peritumoral edema zone,and 5 from the whole tumor were selected.In both the training and test sets,the high-and low-risk groups had significantly different OS(P<0.05),and age,IDH status and Rad-score were independent factors affecting OS.The combined model showed better performance than the Rad-score model with AUCs for 1-year and 3-year survival prediction of 0.750 and 0.778 in the training set,0.764 and 0.800 in the test set,and 0.938 and 0.917 in external validation,respectively.Conclusion The predictive model combining preoperative multi-modal MRI radiomics features and clinical features can effectively predict survival outcomes of glioma patients.

Objective To establish a predictive model for survival outcomes of glioma patients based on both brain radiomics features from preoperative MRI multi-sequence images and clinical features.Methods We retrospectively analyzed the MRI images and clinical data of 388 glioma patients and extracted the radiomics features from the peritumoral edema zone,tumor core,and whole tumor on T1,T2,and T1-weighted contrast-enhanced(T1CE)and fluid attenuated inversion recovery(FLAIR)sequences.The cases were divided into a training set(271 cases)and a test set(117 cases).Random survival forest algorithms were used to select the radiomics features associated with overall survival(OS)in the training set to construct a radiomic score(Rad-score),based on which the patients were classified into high-and low-risk groups for Kaplan-Meier survival analysis.Cox proportional hazard regression models for the 3 different tumor zones were constructed,and their performance for predicting 1-and 3-year survival rates was evaluated using 5-fold cross-validation and AUC analysis followed by external validation using data from another 10 glioma patients.The best-performing model was used for constructing a nomogram for survival predictions.Results Five radiomics features from the tumor core,7 from the peritumoral edema zone,and 5 from the whole tumor were selected.In both the training and test sets,the high-and low-risk groups had significantly different OS(P<0.05),and age,IDH status and Rad-score were independent factors affecting OS.The combined model showed better performance than the Rad-score model with AUCs for 1-year and 3-year survival prediction of 0.750 and 0.778 in the training set,0.764 and 0.800 in the test set,and 0.938 and 0.917 in external validation,respectively.Conclusion The predictive model combining preoperative multi-modal MRI radiomics features and clinical features can effectively predict survival outcomes of glioma patients.

Objective:To evaluate the clinical application value of MR amide proton transfer weighted imaging (APTWI) in predicting the pathological grade of brainstem glioma (BSG).Methods:The data of 41 BSG patients in Beijing Tiantan Hospital, Capital Medical University from August 2019 to June 2020 who underwent both MRI and APTWI 2 weeks before surgery and had pathological grading results were retrospectively analyzed. According to the pathological results, 41 patients were classified into high-grade BSG (20 patients) and low-grade BSG (21 patients). Combined with conventional MR images, the signal intensity (%) of amide proton transfer (APT) in the parenchymal area of the tumor was obtained on APTWI images. χ 2 test or independent sample t-test was used to analyze the differences in gender distribution, age and APT signal intensity between patients with high and low grade BSG. Receiver operating characteristic (ROC) curve was drawn to predict the efficacy of APT signal intensity in the differential diagnosis of high and low grade BSG, and Youden index was calculated to obtain the optimal diagnostic threshold; the predictive ability of APT signal intensity was analyzed in combination with Hosmer-Lemeshow goodness of fit test. Results:There was no significant difference in age [(23±18) years, (20±17) years, t=0.97, P=0.340] and gender distribution (9/11, 9/12 for males/females, χ 2=0.02, P=0.890) between high-grade and low-grade BSG patients. The APT signal intensity of high-grade BSG [(3.9±0.9)%] was significantly higher than that of low-grade BSG [(2.8±0.9)%], and the difference had statistical significance ( t=4.16, P<0.001). The area under the ROC curve of APT signal intensity to distinguish high-grade and low grade BSG was 0.836, and with 2.85% as the optimal diagnostic threshold of APT signal intensity, its sensitivity for the diagnosis of high-grade BSG was 90.0% and specificity was 71.4%. The Hosmer-Lemeshow test showed that APTWI had a good predictive ability for BSG grade (χ 2=13.33, P=0.101). Conclusion:APTWI can be applied in distinguishing high grade BSG from low grade BSG, and has clinical value in predicting glioma grading.

Objective:To improve the loading technology of precision micro instruments, so as to ensure not only the quality of cleaning and sterilization, but also the safe use of instruments.Methods:From January to March, 2021, 80 sets of precision micro instruments from Sterilization Supply Center, Shanghai Jiao Tong University School of Medicine Affiliated Ruijin Hospital were randomly divided into silica gel pad loading group (group A) and silica gel stent loading group (group B), 40 sets in each group. The cleaning effect, drying effect, loading effectiveness and sterilization wet bag of the instruments in the two groups were compared, and the staff of the disinfection supply center were satisfied with the operation of the loading technology of the instruments in the two groups.Results:The qualified cleaning numbers of the instruments in group A and B were 37 and 39 respectively, and there was no significant difference between the two groups ( χ2 = 1.05, P>0.05). The qualified drying numbers in the group A and B were 29 and 38 respectively, the difference between the two groups was significant ( χ2 = 7.44, P<0.05). The effective number of loading in the group A and B were 30 cases and 39 cases respectively, the difference was significant between the two groups ( χ2 = 8.54, P<0.05). The number of sterilized wet bags in the group A and B were 6 cases and 0 cases respectively, the difference was significant between the two groups ( χ2 = 6.49, P<0.05). The satisfaction of 44 personnel in the disinfection supply center with the operation of loading technology were 36 and 43 respectively, the difference was statistically significant between the two groups ( χ2 = 6.07, P<0.05). Conclusion:Loading precision micro instruments with silica gel stent can not only ensure the cleaning and sterilization quality of instruments, but also make the loading of instruments more safe and stable, greatly improve the working efficiency of instrument treatment and accelerate the turnover efficiency of instruments.

Objective: In order to evaluate the therapeutic effects and safety of denosumab and bisphosphonates in glucocorticoid induced osteoporosis patients. Methods: Standard studies were obtained by searching CNKI, CBM, VIP, Wanfang, Pubmed, Embase and Cochrane databases. Results: Three RCTs with 869 patients were included in this study. It showed that the mean changes of lumbar spine, total hip and femoral neck bone mineral density (BMD) for patients in denosumab group were increased by 2.47%, 1.43% and 1.07% respectively compared to those of bisphosphonates group.There was no statistically significant difference between patients receiving denosumab and those receiving bisphosphonate in terms of adverse events and serious adverse events. Conclusions Denosumab has an effective increase for lumbar spine, total hip and femoral neck bone mineral density, and the safety of both is similar.

Objective To investigate the clinical features and related risk factors of osteoporosis and osteoporotic fracture (OPF) in patients with rheumatic diseases (RD),and the fracture predictive values of fracture risk assessment tool fracture risk assessment (FRAX(R))for Han patients.Methods A total of 313 untreated RD patients were included.Each individual BMD was measured at lumbar spine and femoral neck with Dual-energy X-ray absorptionary.Ten-year probability of fracture (％) was calculated by fracture risk assessment tool FRAX(R) of Chinese model.Each individual previous fracture was confirmed by X-ray or CT examination.The associations between BMD,FRAX),previous fracture and age,bone mass index,nationality,erythrocyte sedimentation rate (ESR) and RD types were analyzed.T test or Wilcoxon test was used to compare the difference between groups for statistical analysis.Pearson/Spearman rank order and binary regression were used to analyze the correlations between variables of normal/non-normal and two classification distribution.Results ① The BMD of patients with untreated RD was significantly lower than that of control group (P=0.000).Individuals diagnosed with "osteopenia" in the RD group and control group were accounted for 39.3％ (123/313) and 15.8％ (47/296) respectively.Individuals diagnosed with "osteoporosis" in RD group and control group were accounted for 11.5％ (36/313) and 5.4％ (16/296) respectively.② The next 10-year probability of the hip (Z=-2.28,P=0.02) and major osteoporotic fracture (Z=-1.98,P=0.03) were higher than those of the control group,as well as the actual incidence of OPF (x2=25.11,P=0.00),the difference was statistically significant.③ 27.3％(18/66) and 55.0％(11/20) of the previous OPF patients in RD group and control group achieved the diagnostic criteria of "high risk" of hip fracture.And 12.1％ (8/66) and 35.0％ (7/20) achieved the "high risk" of major osteoporotic fracture.④ Patients with RA,SLE and pSS had significantly increased risk of fracture.Ten-year fracture risks were negatively related to advanced age,female gender and ESR.Conclusion Bone loss and increased fracture risk are prevalent in the early stage of untreated rheumatism patients.RA,SLE plays an important role in low bone mass.The FRAX China model may underestimate 10-year fracture probability of RD patients and controls.Further explore should be done to predict the FRAX China model on different areas and different RDs.

Objective To detect the change of exoression level of plasma microRNA‐21(miR‐21) and TGF‐β1 in cardiac remode‐lin affer acute myocardial infarction(AMI) of the pateins .Methods 200 pateints with AMI and 100 normal controls(age ,sex matched) were enrolled .Blood samples were obtained from the normal controls and patients with AMI on the 3 days ,7 days and 14 days .Real‐time PCR was developed to detect the expression of miR‐21 and TGF‐β1 in plasma .Results The expression of miR‐21 was significantly up‐regulation in the 3 days ,7 days and 14 days in MI group than that cntrol group ,0 .74 ± 0 .21 vs .2 .62 ± 0 .23 , vs .3 .67 ± 0 .25 ,vs .4 .13 ± 0 .27 up‐regulation in the 3 days ,7 days and 14 days in MI group than that cntrol group ,0 .98 ± 0 .18 vs .2 .35 ± 0 .24 ,vs .3 .67 ± 0 .25 ,vs .4 .13 ± 0 .27 ,P<0 .05 ,respectively .The expression of miR‐21 and TGF‐β1 were up‐regulation with the change of cardiac function .Positive relationship between miRNA‐21 expression and LVDd (r=0 .757 ,P<0 .05);Positive relationship between TGF‐β1 mRNA expression and LVDd(r=0 .701 ,P<0 .05) .Conclusion The expression of miR‐21 and TGF‐β1 were up‐regulation in cardiac remodelin affer AMI of the pateins ,which involved in regulation in cardiac remodelin affer AMI .

Medical education should combine clinical professional skills with humanities skills,integrate humanities knowledge into vocational education.Taking 2008 grade seven-year program clinical medicine students in the 2nd affiliated hospital of Harbin Medical University as fostering object,we made researches into students' understanding of doctor-patient relationship before practice and their mastering of skills.Through conducting questionnaire,we got to know the effect of humanities practice skill training for seven-year program clinical medicine students.Meanwhile,we compared students' self evaluation results before and after training,discussed on how to improve medical students' communication skills,cultural skills and the reform direction in an aim to guide students to transit from students to clinical doctor.

Objective To make a summary of the clinical application and cooperation of piezosurgery in jaw bone tumour operation. Methods 64 patients with jaw bone tumour were selected since 2007 and were divided into the piezosurgery group and the routine group, they used piezosurgery and routine osteotome respectively. Feelings during operation, operation time, hemorrhage, postoperative reaction and complication were observed and compared. Results Discomfort and hemorrhage during operation was lighter, but operation was longer in the piezosurgery group compared with the routine group. Complications such as postoperative infection, hemorrhage and nerve damage did not occurred. Conclusions Application of piezosurgery in jaw bone tumor operation can increase comfort degree and reduce hemorrhage, it requires proficiency in operation procedures and master key aspects of nursing, so that can cooperate well.