Objective:To analyze the role of learning engagement and learning burnout in the relationship between supervisors' guidance and the personal ability of postgraduates in the Professional Master's Program in Clinical Medicine.Methods:A total of 4 016 postgraduates in the Professional Master's Program in Clinical Medicine from 61 colleges were surveyed in 2020. Common method bias was assessed using the Harman's single factor test and total score was determined by the entropy weight method. Causality and mediation effect were analyzed by linear regression, and mediation effect was tested by Bootstrapping.Results:The average scores of supervisors' guidance, learning burnout, learning engagement and personal ability were (4.13±0.87), (2.49±1.11), (3.88±0.83), and (3.71±0.78), respectively. Supervisors' guidance significantly and positively impacted learning engagement ( β=0.689, P<0.001) and personal ability ( β=0.504, P<0.001). Learning engagement played a partial mediating role (89.30% of mediation effect) between supervisors' guidance and personal ability. Learning burnout (interaction term β=0.078, P<0.001) positively regulated the relationship between supervisors' guidance and learning engagement. Conclusions:Learning engagement can mediate the effect of supervisors' guidance on the personal ability of postgraduates in the Professional Master's Program in Clinical Medicine, and learning burnout positively regulates the effect of supervisors' guidance on learning engagement. Strengthened supervisors' guidance, increased attention to students' learning burnout, and enhanced learning engagement can further improve the personal abilities of postgraduates in the Professional Master's Program in Clinical Medicine.

Objective:To investigate the "burnout-engagement continuum" status of postgraduate supervisors of the Professional Master's Program in Clinical Medicine and to identify key populations.Methods:From October to November 2023, an anonymous online questionnaire survey was conducted to determine the "burnout-engagement continuum" status of postgraduate supervisors of the Professional Master's Program in Clinical Medicine. The scores of different dimensions of job burnout are expressed as mean±standard deviation, and the distribution of supervisors of different status is presented in frequency and percentage. All data analyses were performed in R 4.3.1. Distribution of the five profiles among supervisors of different status was compared using the chi-square test and compared pairwise using the Bonferroni method.Results:A total of 2 664 valid questionnaires were collected. The scores of emotional exhaustion, cynicism and personal accomplishment were（2.46±0.95),（1.74±0.89), and（4.23±0.90), respectively. The prevalence of job engagement, inefficacy, overexertion, disengagement, and burnout among the supervisors were 42.76%（1 139/2 664), 43.54%（1 160/2 664), 33.03%（880/2 664), 14.71%（392/2 664), and 13.66%（364/2 664), respectively. In terms of demographics, the distribution of the "burnout-engagement continuum" was significantly different by age, sex, marital status, and highest education level（ P<0.05). In terms of work-related characteristics, the distribution of the "burnout-engagement continuum" was significantly different by income, professional title, administrative position, and working hours on weekdays and holidays（ P<0.05). The distribution of engagement, inefficacy, and overexertion was significantly different between the eastern and western regions（ P<0.05). Conclusions:There is a high percentage of individuals with burnout among postgraduate supervisors of the Professional Master's Program in Clinical Medicine, and inefficacy is a common negative state. Supervisors who work in the western regions, are under 45 years of age, are male, are married, have a doctorate degree, hold associate senior professional title, have lower relative income, are not holding administrative duties, and work more than 10 hours on workdays and more than 4 hours on holidays are key populations that require increased attention. The psychological state of supervisors can be improved by providing them with more resources, work benefits, and incentives.

Objective:To understand the evaluation of graduate education quality by medical graduate supervisors in China, to identify the shortcomings of graduate education quality, and to put forward corresponding suggestions.Methods:From October to November 2023, a self-designed questionnaire was used to investigate the evaluation of school management, supervisor team construction, graduate training process, and graduate training results by 6 025 medical graduate supervisors from 37 universities in China. SPSS 26.0 was used to conduct t-test and analysis of variance to explore the differences in scores given by different supervisor groups for various aspects. Results:The scores given by medical graduate supervisors for school management, supervisor team construction, graduate training process, and graduate training results were (4.63±0.60), (4.59±0.62), (4.58±0.59), and (4.54±0.62), respectively. Supervisors who work in clinical medicine, aged 46-55 years, with 5 or fewer years of teaching experience, supervising master's students, instructing only professional degree students, instructing three or fewer students, holding a bachelor's degree as their highest degree, with the title of professor, holding an administrative position, and working an average of 8-9 hours per day on weekdays and 4 or fewer hours per day on holidays, gave higher scores on all aspects of graduate education quality ( P<0.05). Conclusions:The supervisors gave high scores on the quality of medical graduate education. It is suggested that the quality of graduate education should be continuously improved by optimizing school management systems, strengthening the construction of supervisory teams, and focusing on the process and results of graduate education.

Objective To explore the clinical efficacy of urokinase arterial thrombolysis combined with tirofiban sequential therapy in acute cerebral infarction with digital subtraction angiography(DS A)negative.Methods The clinical data of 82 acute cerebral infarction patients with DSA negative were collected.All patients were divided into the control group(n=41)and the observation group(n=41).The control group received routine treatment such as arterial thrombolysis and dual antiplatelet.The observation group was treated with arterial thrombolysis and intravenous tirofiban treatment for 36 h,and subsequent treatment was the same as the control group.The National Institutes of Health Stroke Scale(NIHSS)scores were analyzed at different time points including before,during,and after interven-tion.The modified Rankin scale(mRS)scores and changes in coagulation function were compared before and 90 d after intervention,and the incidence of complications of all patients were recorded.The differences of all indicators were analyzed.Results The NIHSS scores during and 30 d after intervention in the control group and at various time points during and after intervention in the observa-tion group were lower than those before intervention(P＜0.05).The NIHSS score of the observation group at various time point after intervention was significantly lower than those of the control group(P＜0.05).The clinical effective rate of the observation group 30 d after intervenion was significantly higher than those of the control group(92.68％vs 78.05％).The mRS scores of the two groups 90 d after intervention were significantly lower than those before intervention,and the observation group was significantly lower than the control group(P＜0.05).There were significant differences in prothrombin time(PT),thrombin time(TT),and fibrinogen(FIB)between the two groups 3 d after intervention compared to before intervention(P＜0.05).There was no difference in FIB and PT 7 d after intervention between the two groups(P＞0.05),while TT of the observation group was significantly higher than that of the control group(P=0.038).There was no significant difference in the incidence of complications between the two groups(P=0.073).Conclusion Urokinase arterial thrombolysis combined with tirofiban can effectively improve the neurological function and prognosis of acute cerebral infarction patients with DSA negative,shorten the recovery time,with good clinical safety.

This article introduces a recent paper published in JAMA titled " Tirzepatide for weight reduction in Chinese adults with obesity: The SURMOUNT-CN randomised clinical trial". The paper details the design, results, and implications of a randomized controlled clinical study of the efficacy and safety of tirzepatide in overweight/obese adults in China(SURMOUNT-CN). This study represents the first Chinese evidence supporting tirzepatide for the treatment of obesity, offering a potent therapeutic option for the prevention and treatment of obesity and weight-related comorbidity.

Objective:To develop a novel, flexible, dual-arm, master-slave digestive endoscopic minimally invasive surgical robot system named dual-arm robotic endoscopic assistant for minimally invasive surgery (DREAMS) and to evaluate its feasibility for endoscopic submucosal dissection (ESD) by using ex vivo porcine stomachs.Methods:A novel endoscopic robot (DREAMS) system was developed which was composed of a flexible two-channel endoscope, two flexible robotic manipulators, a master controller, a robotic arm, and a control system. A total of 10 artificial round-like lesions with diameters ranging from 15 to 25 mm were created (5 in gastric antrum and 5 in gastric body) by using fresh peeled stomach of healthy pigs as the model. Submucosal dissection was performed with the assistance of the DREAMS system by two operators. The main outcome was submucosal dissection speed, and the secondary outcomes included muscular injury rate, perforation rate, and grasping efficiency of the robot.Results:All 10 lesions were successfully dissected en bloc by using the DREAMS system. The diameter of the artificial lesions was 22.34±2.39 mm, dissection time was 15.00±8.90 min, submucosal dissection speed was 141.79±79.12 mm 2/min, and the number of tractions required by each ESD was 4.2 times. Muscular injury occurred in 4/10 cases of ESD. No perforation occurred. Conclusion:The initial animal experiment shows the DREAMS system is safe and effective.

Objective:To investigate the difference of lymphocyte subsets between elderly patients with rheumatoid arthritis and non-elderly patients and its clinical significance.Methods:A total of 124 patients with rheumatoid arthritis in Affiliated Hospital of Nantong University from January, 2017 to December, 2019 were enrolled.The patients were divided into elderly group(≥60 years old, 34 cases)and non-elderly group(<60 years old, 90 cases). Rheumatoid arthritis activity(DAS-28)scoring was performed for each patient.Peripheral blood mononuclear cells(PBMCs)were extracted by Ficoll density centrifugation.Lymphocytes were labeled and detected by 18-color flowcytometry with more than 30 fluorescent antibodies.Results:DAS-28 scoring showed that the disease activity score of the elderly group(4.56±1.89)was higher than that of the non-elderly group(3.37±1.49)( t=3.633, P<0.001). Flow cytometry showed that MAIL%T(mucus-associated lymphoid tissue T cell subset)( Z=-2.798, P=0.005), Tn%CD8 T cells(initial CD8 T cells)( Z=-2.179, P=0.029), VD2% T(Vδ2+ T, γδT cell subtype)( Z=-2.806, P=0.005), PD1-CD28-%Th( Z=-2.050, P=0.040)and IGM+ D-%B( Z=-2.376, P=0.017)were lower in the elderly group than in the non-elderly group.While, CD45+ CD27+ %CD8 T cells( Z=-3.069, P=0.002), abT%T cell(αβT cells)( Z=-2.103, P=0.035), CD27-CD28+ %T cells( Z=-2.341, P=0.019), ASC%PBMC( Z=-2.341, P=0.019)and ASC%CD19+ ( Z=-2.000, P=0.046)subgroup expression were higher in the elderly group than in the non-elderly group. Conclusions:The disease activity of elderly patients with rheumatoid arthritis is significantly higher than that of younger patients.The expressions of abT%T and CD4% abT in effector T cells of elderly patients with rheumatoid arthritis are higher than those of younger patients, while the expression of VD2% T is lower.The expression level of CD45RA+ CD27+ %CD8 T with cytotoxic effect is higher; However, the expression level of Tn%CD8 T in naive cells is lower.

Acute leukemia marks the main type of non-solid cancer in children.Studies have proved that long non-coding RNA plays important roles in the pathogenesis of hematological malignancies and can be applied as a biomarker for diagnosis, prognosis and efficacy monitoring of leukemia patients.This article briefly reviews the roles of long non-coding RNA in the tumorigenesis and progression of childhood acute leukemia.

OBJECTIVE: To investigate the effects of subacute dynamic silica dust inhalation on the histopathology of major organs and the cytokine changes in lung tissues. METHODS: Male Kunming specific pathogen free mice were randomly divided into control group and dust exposure groups of 3, 14 and 28 d, with 7 mice in each group.The mice of the 3 exposure groups were given for 3, 12 and 24 days with silica dust at a concentration of 1 000.00 mg/m~3 using the self-made automatic dust inhalation device, 6 hours per day and 6 days per week. Rats in the control group were not treated with dust. After the end of treatment, rats were sacrificed. The organ coefficients of the liver, kidney, spleen and lung were calculated. The pathological changes of the organs were observed by hematoxylin-eosin staining method. The pulmonary fibrosis of lung tissues was evaluated by Masson staining method. Sirius scarlet picric acid staining was used to observe the collagen fiber area ratio in lung tissues. Enzyme-linked immunosorbent assay was used to detect the levels of interleukin(IL)-1β, tumor necrosis factor(TNF)-α, transforming growth factor(TGF)-β1 and matrix metalloproteinase 2(MMP-2) in lung tissues. Colorimetric method was used to detect the level of hydroxyproline(HYP) in lung tissues. RESULTS: After the exposure to silica dust, the histology of liver, spleen and kidney tissues were not significantly changed in the mice of the 3 dust exposure groups. The lung organ coefficients increased in the mice of dust exposure groups of 3, 14 and 28 d compared with the control group(P<0.05). The spleen coefficient of mice in dust exposure groups of 3 and 14 d were higher than that in control group(P<0.05). Among the dust exposure groups, the score of pulmonary fibrosis and HYP level in lung tissues were increased with the prolonged dust exposure time(P<0.05). The collagen fiber area ratio of collagenⅠand Ⅲ, and the levels of IL-1β, TGF-β1 and MMP-2 in lung tissues increased in the 3 dust exposure groups compared with the control group(P<0.05). The collagen fiber area ratio of collagen Ⅲ, and the level of IL-1β in lung tissues of the 14 and 28 d of dust exposure group increased(P<0.05), and the TGF-β1 level decreased(P<0.05), when compared with the 3 d group. The collagen fiber area ratio of collagen Ⅰ in lung tissues of 14 d group and the level of MMP-2 in the 28 d group were higher than that of the 3 d group(P<0.05). The level of TNF-α in lung tissues of 14 d group was higher than that of the control group(P<0.05), and while in 28 d group it was lower than those of the other 3 group(P<0.05). CONCLUSION: Subacute dynamic inhalation of silica dust can cause acute lung injury in mice. There is no obvious pathological change in liver, kidney and spleen. The pathological changes of lung tissue are inflammation and fibrosis, and the degree of fibrosis increases with the extension of dust exposure time, and cytokines also changed.

In recent years, the prevalence of metabolic diseases, including obesity, diabetes, nonalcoholic fatty liver disease, and metabolic syndrome, increased significantly. Fatigue is common in metabolic diseases and may lead to functional disability. This complicated feeling imposes a huge influence on patients with metabolic diseases physically and psychologically, which seriously affects the quality of life and brings serious burden to the social economy. There were an increasing number of researches on fatigue and metabolic diseases. This article reviews the evidences of the linkages between fatigue and metabolic diseases.