Objective:To evaluate the efficacy of esketamine combined with propofol for colonic transendoscopic enteral tubing (TET) in pediatric patients with autism.Methods:Sixty pediatric patients with autism of both sexes, aged 3-12 yr, weighing 15-45 kg, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, who underwent painless transendoscopic enteral tubing (TET) from October 2022 to August 2023, were selected and divided into 2 groups ( n=30 each) by a random number table method: normal saline + propofol group (group NP) and esketamine + propofol group (group EP). In group NP, normal saline 10 ml was intravenously injected, and 30 s later propofol 2.0 mg/kg was given. In group EP, esketamine 0.3 mg/kg (diluted to 10 ml in normal saline) was intravenously injected, and 30 s later propofol 2.0 mg/kg was given. TET was performed when the Modified Observer′s Assessment of Alertness/Sedation Scale score ≤2. Propofol 0.5-1.0 mg/kg was added if the sedation depth was not enough, and the Modified Observer′s Assessment of Alertness/Sedation Scale score was maintained ≤2 until the end of surgery. The degree of body movement during TET was observed and recorded. The injection pain during induction, total consumption of propofol, operation time, spontaneous emergence time, and completion of operation were recorded. Adverse reactions such as respiratory depression, nausea and vomiting, hypotension, bradycardia, and postoperative agitation were recorded during operation and in the emergence period. Results:Compared with group NP, the degree of intraoperative body movement was significantly lighter, the total consumption of propofol and incidence of injection pain and intraoperative hypotension were significantly lower, and no significant change was found in the spontaneous emergence time and incidence of adverse reactions during recovery in group EP ( P<0.05). Conclusions:Esketamine (0.3 mg/kg) combined with propofol (2.0 mg/kg) can be safely and effectively used for colonic TET in pediatric patients with autism, and esketamine does not increase the risk of adverse reactions during resuscitation in a resuscitation strategy without early awakening.

Objective:To investigate the teaching activity based on an online radiological teaching case library that integrates various teaching models including problem-based learning (PBL), case-based learning (CBL), flipped classroom, and microclass, as well as its application effect in standardized residency training in department of radiology.Methods:A total of 65 physicians who completed standardized residency training in Department of Radiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, from 2016 to 2022 were enrolled as subjects and were divided into control group with 32 physicians and experimental group with 33 physicians. The physicians in the control group received traditional teaching, and those in the experimental group received blended teaching with PBL, CBL, flipped classroom, and microclass based on a teaching case library. The two groups were compared in terms of the test scores of clinical thinking and decision making at the end of the course and their assessment and feedback for the teaching method. SPSS 22.0 was used to perform the t-test and the chi-square test. Results:For the assessment of clinical thinking and decision making, compared with the control group, the experimental group had significantly higher score of objective essay questions (49.83±1.27 vs. 48.74±1.64, P<0.05), score of subjective essay questions (39.57±1.75 vs. 36.02±1.81, P<0.05), and total score (89.40±1.54 vs. 84.76±1.93, P<0.05). The experimental group had significantly better assessment and feedback for the teaching method than the control group ( P<0.05). Conclusions:For physicians participating in standardized residency training, the blended teaching model based on teaching case library that integrates PBL, CBL, flipped classroom, and microclass can effectively improve the test scores of clinical thinking and decision making, stimulate their learning initiative and participation enthusiasm in medical imaging, and enhance their comprehensive ability for clinical diagnosis.

Targeted radiation therapy using radionuclides is a favored approach for treating tumors.This procedure involves the delivery of drugs to the lesion site via carriers or interventional methods,followed by the emission of radiation energy that selectively irradiates the lesion tissue.This approach minimizes damage to normal tissue and achieves the desired therapeutic effect.Factors such as the type of therapeutic radionuclide,radiation energy,physical half-life,method of preparation,and toxicity determine their clinical application.In this paper,the characteristics and clinical application of therapeutic radionuclides were reviewed to providing reference for the clinical application of targeted therapeutic radionuclides.

Objective:To establish selection criteria of community mentors for postgraduates in general medicine.Methods:A subject index system of selection criteria of community tutors for general practice postgraduates was drafted and refined based on literature retrieving and in-depth interviews during January to December 2020. Twenty experts in general practice related fields were invited for two rounds of Delphi consultation. Analytic hierarchy process was used to calculate index weight coefficient and consistency test; and the developed selection criteria were evaluated.Results:Through the in-depth interviews with 11 general practice faculty and 11 general practice postgraduates, the following five first-level thematic frameworks were refined: (1) the professional qualities; (2) the basic qualities; (3) the clinical ability; (4) the teaching ability; (5) the scientific research ability. After two rounds of Delphi expert consultation, the selection criteria of community tutors for postgraduates in general practice were finally constructed, including 5 first-level indicators (professional quality, basic quality, medical practice ability, teaching and guidance ability, academic research ability) and 28 second-level indicators. The positive coefficients of experts were 85% and 100%; the expert authority coefficients were 0.825 and 0.860; and the expert opinion coordination coefficients were 0.486 and 0.515, respectively (all P<0.05). the weight coefficients of the five first-level indicators were 0.345, 0.210, 0.138, 0.210 and 0.097, respectively. Conclusion:The criteria and index system on the selection of community mentors for general practice postgraduates has been successfully developed in the study.

Anxiety is a major mood disorder, and the high morbidity, co-morbidity and disability of anxiety disorders seriously affect people's quality of life, so the importance and urgency of research on anxiety cannot be overstated. Animal models are the main carriers for studying the mechanism of disease occurrence and development, drug efficacy evaluation and drug development.Unconditioned anxiety model is a common anxiety model.Elevated plus maze test, open field test and light-dark box test are widely accepted paradigms for the detection of unconditioned anxiety.This kind of behavioral paradigm based on environmental exposure takes advantage of the conflict between curiosity and fear of the unfamiliar environment to simulate and detect the anxiety of animals.However, the validity of these behavioral paradigms for evaluating anxiety in animals is questionable.In this paper, we discuss the concept of anxiety, the definition of anxiety behavior in the behavioral test of unconditioned anxiety, and the factors to be considered in the test of unconditioned anxiety behavior.On this basis, new solutions were proposed to the contradictions and blind spots in order to improve the test paradigm of anxiety behavior and provide a more reliable animal model for the evaluation of anxiety.This paper presents a new approach to address the contradictions and blind spots of this paradigm.

Objective:To investigate the necessity and feasibility of the virtual simulation teaching experiment software of the bronchoscopy intelligent navigation-based fiducial marker implantation technology in the clinical application of radiotherapy.Methods:This study developed a 3D virtual operation and interactive system using the Unity3D engine, tools including 3Dmax and Maya, and the SQL database. The scenes in the system were produced using the currently popular next-generation production process. Targeting the priorities and difficulties in the implantation of fiducial markers, the system developed in this study allowed for simulated demonstration and training based on 12 steps and 10 knowledge points. Internal tests and remote evaluation tests were adopted in this system to obtain the test result of each subject. Then, the application value of the system was analyzed based on the test result.Results:As of May 1, 2022, the system had received 2 409 views and 425 test participants, with an test completion rate of 100% and an experiment pass rate of 96.5%. Moreover, this system won unanimous praise from 167 users, primarily including the students majoring in multilevel medical imaging technology and medical imaging science from the Fujian Medical University, as well as the radiotherapy-related staff of this university.Conclusions:The virtual simulation teaching experiment software of the bronchoscopy intelligent navigation-based fiducial marker implantation technology can be applied to the teaching of students and the training of related professionals.

Objective:To compare the clinical efficacy of anatomical reconstruction of coracoclavicular ligament at the original insertion point and clavicular hook plate fixation in the treatment of acromioclavicular joint dislocation.Methods:Retrospective analysis was made on the data of 67 patients with acromioclavicular joint dislocation who received surgical treatment in the Department of Orthopaedics of the First Affiliated Hospital of Nanjing Medical University from June 2015 to January 2021. According to the surgical method, they were divided into reconstruction group (using the technique of anatomical reconstruction of coracoclavicular ligament at the original insertion point) and hook plate group (using the clavicular hook plate). There were 37 cases in the reconstruction group, including 26 males and 11 females, aged 47.2±9.6 years (range, 18-65 years), 13 cases on the left and 24 cases on the right. Among the 37 patients, 8 were sports injuries, 14 were falls, 11 were traffic accidents, and 4 were external force injuries. The average time from injury to surgery was 8.3±2.3 days. There were 30 cases in the hook plate group, including 24 males and 6 females, aged 47.4±9.7 years (range, 18-67 years), 12 cases on the left and 18 cases on the right. Among the 30 patients, 7 were sports injuries, 11 were falls, 9 were traffic accidents, and 3 were external force injuries. The average time from injury to surgery was 7.9±2.6 days. The surgical time, incision length, intraoperative bleeding, hospital stay, postoperative coracoclavicular separation ratio, and postoperative complications were compared between the two groups. Constant-Murley score and visual analog scale (VAS) were used to assess the shoulder joint function and pain degree of patients.Results:Both groups of patients were followed up, with a follow-up time of 12.3±0.4 months for the reconstruction group and 12.2±0.5 months for the hook plate group. The operation time (105.8±10.0 min), incision length [12.0 (11.0, 13.0) cm] and hospitalization time (6.8±2.1 d) in the reconstruction group were longer than those in the hook plate group [48.3±4.9 min, 10.0 (10.0, 11.0) cm, and 5.5±2.7 d], while the intraoperative blood loss (75.1±3.9 ml) was less than that in the hook plate group (90.3±6.3 ml), the differences were statistically significant ( P<0.05). The VAS [4.0 (3.0, 5.0), 3.0 (3.0, 3.0), 2.0 (1.0, 2.0) points] and Constant-Murley score (65.4±4.5, 84.9±2.5, 90.1±2.5 points) of the reconstruction group at 3 days, 3 months, and 12 months after surgery were better than those of the hook plate group [5.0 (4.0, 5.0), 4.0 (4.0, 4.0), 3.0 (3.0, 4.0) and 56.9±3.5, 79.6±4.0, 86.8±2.4 points], the difference was statistically significant ( P<0.05). At the last follow-up, there was a statistically significant difference in the separation ratio of coracoclavicular distance between the reconstruction group (0.12±0.08) and the hook plate group 0.22±0.15 ( t=3.25, P=0.002). There was no significant difference ( Z=-0.52, P=0.605) in the separation ratio of acromioclavicular distance [0.16 (0.05, 0.25) and 0.16 (0.04, 0.40)]. In the hook plate group, 6 cases had shoulder joint foreign body sensation and 2 cases had acromioclavicular joint redislocation (both Rockwood type III). Because the shoulder joint function did not affect their daily life, neither patient underwent secondary surgery. And no case of acromioclavicular joint redislocation occurred in the reconstruction group. Conclusion:Compared with the clavicular hook plate fixation, anatomic reconstruction of coracoclavicular ligament at the original insertion point in the treatment of acromioclavicular joint dislocation can reduce the pain of the shoulder joint earlier, which has the characteristics of small trauma, good effect, and reduces the steps of internal fixation removal, and has good clinical curative effect.

Abstract As a common public health problem in society, it can seriously affect sleep, and lead to sleep structure disorder, sleep pattern changes, and sleep disturbance. Poor sleep can adversely affect the normal development of physiological, psychological, cognitive, and behavioral functions, and reduce quality of life. On the basis of summarizing the definition, classification, and epidemic status of child abuse, this paper summarizes the sleep characteristics and influencing factors of childhood abuse victims. It aims to provide a scientific basis for developing prevention and intervention measures to address sleep problems among childhood abuse victims, so as to improve sleep quality, and promote their physical and mental health.

Objective:To analyze, with Wuhan as an example, the problems found in the infrastructure development of China′s healthcare institutions, and put forward optimization suggestions for future epidemic prevention and control.Methods:From May to June 2020, we surveyed with questionnaires 56 healthcare institutions in Wuhan, covering such aspects as basic information of the institutions, infectious disease infrastructure readiness, and the converted wards for COVID-19. Statistical descriptions were used to analyze data so acquired.Results:The number of beds in the infectious departments of healthcare institutions in Wuhan amounted to 1.64 per 10 000 people, yet the existing 1 873 beds and about 5 000 convertible beds failed to meet the medical needs against the outbreak of COVID-19. After the outbreak, a total of 19 084 convertible beds were set up, of which general hospitals accounted for 88%; the area occupied by each converted bed in traditional Chinese medicine hospitals, hospitals of traditional and Western medicine, and maternal and child hospitals (<30.0m 2) was lower than that in general hospitals and specialist hospitals (>40.0m 2). Conclusions:Healthcare institutions should scientifically allocate " peacetime-wartime adaptive" hospital beds, optimize both the number and efficiency of these beds, and prepare for the worst scenarios, so that the infrastructure can be built and maintained in strict accordance with standards, government departments can rationally arrange infectious disease prevention and control facilities and strengthen their planning in case of emergencies.

Objective:To compare the efficacy of the combination of abidol, lopinavir/ritonavir plus recombinant interferon α-2b (rIFNα-2b) and the combination of lopinavir/ritonavir plus rIFNα-2b for patients with COVID-19 in Zhejiang province.Methods:A multicenter prospective study was carried out to compare the efficacy of triple combination antiviral therapy and dual combination antiviral therapy in 15 medical institutions of Zhejiang province during January 22 to February 16, 2020. All patients were treated with rIFNα-2b (5 million U, 2 times/d) aerosol inhalation, in addition 196 patients were treated with abidol (200 mg, 3 times/d) + lopinavir/ritonavir (2 tablets, 1 time/12 h) (triple combination group) and 41 patients were treated with lopinavir/ritonavir (2 tablets, 1 time/12 h) (dual combination group). The patients who received triple combination antiviral therapy were further divided into three subgroups: <48 h, 3-5 d and >5 d according the time from the symptom onset to medication starting. The therapeutic efficacy was compared between triple combination group and dual combination group, and compared among 3 subgroups of patients receiving triple combination antiviral therapy. SPSS 17.0 software was used to analyze the data.Results:The virus nucleic acid-negative conversion time in respiratory tract specimens was (12.2±4.7) d in the triple combination group, which was shorter than that in the dual combination group [(15.0±5.0) d] ( t=6.159, P<0.01). The length of hospital stay in the triple combination group [12.0 (9.0, 17.0) d] was also shorter than that in the dual combination group [15.0 (10.0, 18.0) d] ( H=2.073, P<0.05). Compared with the antiviral treatment which was started within after the symptom onset of in the triple combination group, the time from the symptom onset to the viral negative conversion was 13.0 (10.0, 17.0), 17.0 (13.0, 22.0) and 21.0 (18.0, 24.0) d in subgroups of 48 h, 3-5 d and >5 d, respectively ( Z=32.983, P<0.01), while the time from antiviral therapy to viral negative conversion was (11.8±3.9), (13.5±5.1) and (11.2±4.3) d, respectively( Z=6.722, P<0.05). Conclusions:The triple combination antiviral therapy of abidol, lopinavir/litonavir and rIFNα-2b shows shorter viral shedding time and shorter hospitalization time, compared with the dual combination antiviral therapy; and the earlier starting triple combination antiviral therapy will result in better antiviral efficacy.