Thalamocortical circuitry has a substantial impact on emotion and cognition.Previous studies have demonstrated alterations in thalamocortical functional connectivity(FC),characterized by region-dependent hypo-or hyper-connectivity,among individuals with major depressive disorder(MDD).However,the dynamical reconfiguration of the thalamocortical system over time and potential abnormalities in dynamic thalamocortical connectivity associated with MDD remain unclear.Hence,we analyzed dynamic FC(dFC)between ten thalamic subregions and seven cortical subnetworks from resting-state functional magnetic resonance images of 48 patients with MDD and 57 healthy controls(HCs)to investigate time-varying changes in thalamocortical FC in patients with MDD.Moreover,dynamic laterality analysis was conducted to examine the changes in functional lateralization of the thalamocortical system over time.Correlations between the dynamic measures of thalamocortical FC and clinical assessment were also calculated.We identified four dynamic states of thalamocortical circuitry wherein patients with MDD exhibited decreased fractional time and reduced transitions within a negative connectivity state that showed strong correlations with primary cortical networks,compared with the HCs.In addition,MDD patients also exhibited increased fluctuations in functional laterality in the thalamocortical system across the scan duration.The thalamo-subnetwork analysis unveiled abnormal dFC variability involving higher-order cortical networks in the MDD cohort.Significant correlations were found between increased dFC variability with dorsal attention and default mode networks and the severity of symptoms.Our study comprehensively investigated the pattern of alteration of the thalamocortical dFC in MDD patients.The heterogeneous alterations of dFC between the thalamus and both primary and higher-order cortical networks may help characterize the deficits of sensory and cognitive processing in MDD.

Objective To analyze the application of pelvic floor ultrasound combined with pelvic floor muscle strength detection in the evaluation of postpartum pelvic floor function and prediction of pelvic floor dysfunction three years after delivery.Methods A total of 192 women at 42 days postpartum were enrolled,including 85 in the vaginal delivery group and 107 in the cesarean section group.The abnormal rates and levels of the indicators related to pelvic floor muscle strength detection and pelvic floor ultrasound were compared.The patients were followed up for three years,and the incidence of pelvic organ prolapse and stress urinary incontinence were analyzed.Results The results of pelvic floor ultrasound were abnormal in 102 patients(53.13%).The abnormal rate of fatigue of typeⅠmuscle fibers was highest(85.94%)in pelvic floor muscle strength detection.The abnormal rates of bladder neck mobility,bladder posterior angle opening,cystocele,levator ani muscle injury,levator hiatus area,perineal body activity,and vaginal dynamic pressure were significantly higher in the vaginal delivery group than those of the cesarean section group(P<0.05).There were significant between-group differences in the mean values of bladder neck movement,levator hiatus area,distances from the bladder neck to the lower margin of the pubic symphysis and from the ampulla of the rectum to the lower margin of the pubic symphysis during the Valsalva movement,vaginal dynamic pressure,and muscle strength(P<0.05).After the 3-year follow-up,the incidences of pelvic organ prolapse and stress urinary inconti-nence were significantly higher in the vaginal delivery group than in the cesarean section group(P<0.05).In the patients with pelvic floor dysfunction,the results of pelvic floor ultrasound and pelvic floor muscle strength detection were both abnormal at 42 days postpartum.Conclusion The patients with abnormal results of pelvic floor ultrasound and pelvic floor muscle strength detection at 42 days post-partum are more likely to have pelvic floor dysfunction in the future.

Objective To explore the feasibility of electrical impedance tomography(EIT)for real-time and accurate monitoring of respiration during HP anti-G movements and the key parameters of pulmonary ventilation.Methods Twelve healthy male students in our university were enrolled in September 2023 and subjected in this study.HP anti-G movements were performed 3 times each for 30 s in the anti-G physiological training apparatus,during which EIT and ophthalmic horizontal arterial pressure were measured to analyze the relationship of the global and local parameters of pulmonary ventilation,including inspiratory volume(IV),expiratory uniform(EU),expiratory speed(ES),center of ventilation(COV)and right-to-left lung ventilation ratio(RtoL)with anti-G ability of anti-G straining maneuver(AGSM).Results The average eye horizontal systolic blood pressure(SBP)at the eye level was 148.82±22.75 mmHg during HP anti-G movements,which was significantly higher than that during quiet breathing(PJ)(95.17±8.51 mmHg,P＜0.001).From the global pulmonary ventilation,the participants had significantly increased IV during HP anti-G movements(P＜0.001).According the d value(mean increase of eye horizontal SBP=SBPHP-SBPPJ),the subjects were divided into 3 groups,with the d value of＞60,30～60 and＜30 mmHg,respectively.The inspiratory volume ratio(IVHP/IVPJ)was the highest in the＞60 mmHg group and the smallest in the＜30 mmHg group(P＜0.01).The subjects had significantly decreased EU and more evenly expiration(P＜0.05),but no change was seen in the expiratory uniformity ratio(EUHP/EUPJ)among the 3 groups.ES was obviously faster during HP anti-G movements(P＜0.001),and the expiratory speed ratio(ESHP/ESPJ)had no significant difference among the 3 groups.The inspiratory time and expiratory time were 0.77±0.32 and 1.59±0.21 s,respectively,and both of them were notably shorter during HP anti-G movements(P＜0.001,P＜0.01).From the local pulmonary ventilation,COV during HP anti-G movements was significantly smaller than that during PJ(P＜0.001),and the ventilation center deviated to the ventral side,and RtoL was decreased and the ventilation distribution deviated to the left lung(P＜0.05).Conclusion EIT can perform real-time imaging of pulmonary global and local ventilation during HP anti-G movements,and it has a great application prospect in AGSM training and monitoring.

Curettage is the main treatment method for oral maxillofacial cystic lesions,but simple curettage may easily damage surrounding structures such as adjacent teeth and nerves,leading to incomplete removal of the cyst and large jaw defects.The curettage assisted by endoscopy can provide a good surgical field for the surgeons,can clearly identify the important anatomical structure during the operation and can remove the cyst wall tissue as much as possible,thereby reducing the damage and reducing the recurrence rate of the lesion.This article combines the characteristics of maxillofacial surgery with clinical treatment experience,summarizes relevant literature from both domestic and international sources,and engages in discussions with experts in order to provide reference for the clinical treatment of jaw cystic lesions with endo-scope assisted curettage.

【Objective】 To explore the surgical treatments and therapeutic outcomes for benign testicular tumor. 【Methods】 Clinical data of 53 patients with benign testicular tumor treated with surgery during May 2004 and Jul.2021 were retrospectively analyzed. 【Results】 The postoperative pathological diagnosis of 53 patients included 33 patients with epidermal cysts, 12 with mature teratomas, 2 with bilateral testicular tumors (one of them was epidermal cysts in the left and mature teratoma in the right, and the other was bilateral leiomyomas), and 6 benign cases. Testis sparing surgery (TSS) group had 23 patients and radical orchiectomy (RO) group had 30 patients. There were no significant differences in patients’ age, tumor location, disease course, and ultrasound examination results between the two groups (P>0.05). The tumor size of the RO group was (2.60±0.94) cm, which was larger than that of the TSS group (1.55±0.52) cm (P<0.001). There were no statistically significant differences in surgical time and postoperative hospital stay between the two groups (P>0.05). A total of 15 patients (13 with TSS and 2 with RO) underwent intraoperative frozen rapid pathological examination (FSA), which was consistent with post-operative paraffin pathological results. Durign the follow up of 2-219 months,median 38 months, there was no recurrence in either groups. 【Conclusion】 Testis sparing surgery is a reliable treatment modality for benign testicular tumor, which may also decrease the level of androgen and incidence of asthenozoospermia. It can be considered for tumors less than 2 cm with benign tendency or uncertain nature.

Homozygous familial hypercholesterolemia (HoFH) is a rare and serious autosomal genetic metabolic disease. Patients without intervention often die younger than 30 years old from early atherosclerotic cardiovascular disease (ASCVD)incurred by extremely high levels of low-density lipoprotein cholesterol (LDL-C). We present a case of HoFH, a child with compound heterozygous mutation in this study. The effect of conventional lipid-lowering therapy through diet control and lipid-lowering drugs was unsatisfactory. The blood-lipid purification proves effective but has poor compliance and difficult to maintain for a longer time. The patient received orthotopic liver transplantation and had been followed for 2 years, with the patient shows normal LDL-C, well growth and development. We hope the case will provide the clinician with better understanding of the diagnosis and treatment of the rare disease of HoFH.

Objective : To investigate the mechanism of AMD3100 reversing the resistance of human hepatocellular carcinoma cells to Sorafenib by regulating carbonic anhydrase IX ( CA9) and chemokine receptor 4 ( CXCR 4 ) . Methods : The Sorafenib resistant cell lines Huh7 / Sor and HepG2 / Sor were established from human hepatocellular carcinoma cells Huh7 and HepG2．The effects of Sorafenib alone or in combination with AMD3100 on the proliferation of Huh7，HepG2，Huh7 / Sor，HepG2 / Sor cells were detected．The difference of invasive ability between Sorafenib resistant cells and non-resistant cells，and the effect of AMD3100 on the invasive ability of hepatocellular carcinoma cells were observed．And the regulation effect of Sorafenib alone or in combination with AMD3100 on the expression of CA9 and CXCR4 proteins in Huh7，HepG2，Huh7 / Sor and HepG2 / Sor cells was detected. Results: Compared with the Control group，AMD3100 (50 μmol / L) increased the inhibitory effect of Sorafenib on the proliferation of Huh7 / Sor and HepG2 / Sor cells (P＜0．05) ．Compared with Huh7 cells，the invasive ability of Sorafenib resistant Huh7 / Sor cells was significantly enhanced (P＜0. 05) ，and AMD 3100 (50 μmol / L) decreased the invasive ability of Huh7 and Huh7 / Sor cells (P＜0．05) ．Compared with Huh7 and HepG2 cells，the protein expression of CA9 and CXCR4 in Huh7 / Sor and HepG2 / Sor cells increased (P＜0. 05) ．AMD3100 (50 μmol / L) down-regulated the protein expression of CA9 and CXCR4 in Huh7，HepG2，Huh7 / Sor and HepG2 / Sor cells (P ＜0. 05 ) . Conclusion AMD3100 can reduce the resistance of human hepatocellular carcinoma cells to Sorafenib by downregulating the expression of CA9 and CXCR4，and enhance the inhibition of Sorafenib on the proliferation and invasion of human hepatocellular carcinoma cells.

Objective:To master the epidemic trend of human brucellosis in Qinghai Province, so as to provide basis for scientific prevention and control of the disease.Methods:In 2019 and 2020, at the national and provincial brucellosis monitoring sites in Qinghai Province, a total of 18 counties (cities and districts, hereinafter referred to as counties), no less than 400 serum samples were sampled every year for brucellosis Rose-Bengal plate agglutination test (RBPT) and serum tube agglutination test (SAT), which would be tested and judged according to the criteria of "Diagnosis for Brucellosis" (WS 269-2019).Results:In 2019, a total of 1 612 people were monitored in national brucellosis monitoring sites, 93 were RBPT positive, 54 were SAT positive, 54 were diagnosed, and the prevalence rate was 3.35% (54/1 612). In 2020, 1 677 people were monitored in national brucellosis monitoring sites, 151 were RBPT positive, 80 were SAT positive, 80 were diagnosed, and the prevalence rate was 4.77% (80/1 677). There were significant differences in RBPT positive rate, SAT positive rate and prevalence rate among national monitoring sites between the two years (χ 2 = 12.52, 4.24, 4.24, P < 0.05). In 2019, a total of 6 043 people were monitored in provincial brucellosis monitoring sites, 128 were RBPT positive, 91 were SAT positive, 87 were diagnosed, and the prevalence rate was 1.44% (87/6 043). In 2020, 5 664 people were monitored, 108 were RBPT positive, 59 were SAT positive, 52 were diagnosed, and the prevalence rate was 0.92% (52/5 664). There was no significant difference in RBPT positive rate among provincial monitoring sites between the two years (χ 2 = 0.66, P = 0.416), and the differences in SAT positive rate and prevalence rate were statistically significant among provincial monitoring sites between the two years (χ 2 = 4.98, 14.57, P < 0.05). Conclusion:In 2019 and 2020, there are human brucellosis in national and provincial brucellosis monitoring sites in Qinghai Province.

Objective:To investigate the clinical efficacy of posteromedial approach through anterior border of tibialis posterior tendon combined with posterolateral approach in open reduction and internal fixation of Klammer type II/III posterior pilon variant fracture.Methods:A retrospective case series study was conducted on 37 patients with posterior pilon variant fracture treated by posteromedial approach through anterior border of tibialis posterior tendon combined with posterolateral approach in Jiangsu Province People's Hospital and its Liyang branch between January 2015 and December 2019. There were 17 males and 20 females, aged 25-65 years［（49.5±9.3）years］. Klammer classification was type II in 20 patients and type III in 17 patients. The quality of fracture reduction, incision healing and postoperative complications were observed. The loss of fracture reduction or implant failure was detected during the follow-up. The fracture union time was recorded. At the final follow-up, the residual pain was assessed by the visual analogue scale（VAS）and the ankle function by the American Orthopedic Foot and Ankle Society（AOFAS）ankle-hindfoot score.Results:All patients were followed up for 12-20 months［（15.6±1.2）months］. An anatomic fracture reduction was observed in all patients, showing the incision healing by first intention. No skin necrosis, posteromedial neurovascular bundle injury, deep venous thrombosis, checkrein deformity or other complications occurred. During the follow-up, there was no reduction loss or implant failure. The fracture healing time ranged from 11 to 16 weeks［（13.2±1.4）weeks］. At the final follow-up, the VAS was decreased from 6-9 points［（8.0±0.8）points］preoperatively to 0-2 points［（1.2±0.6）points］（ P<0.01）. At the final follow-up, the AOFAS ankle-hindfoot score ranged from 80 to 100 points［（89.7±4.6）points］, which showed excellent results in 15 patients and good in 22 patients, with the excellence rate of 100%. Conclusion:The posteromedial approach through anterior border of tibialis posterior tendon combined with posterolateral approach in open reduction and internal fixation of Klammer type II/III posterior pilon variant fracture can achieve good fracture reduction, with low incidence of complications, pain relief and satisfactory ankle function recovery.

According to the three steps of teaching design, teaching practice and teaching reflection, the research group organized and implemented WeChat public platform to assist the teaching of the battlefield first aid course. Teaching design focused on three aspects: teaching content setting, learning process development and learning effect evaluation. Content setting highlighted the relevance of key content and knowledge points. The learning process emphasized two steps:teaching before class and internalizing in class . A variety of evaluation methods were used in teaching effect evaluation . Through investigation , interview and analysis of test results, it was shown that this new teaching method was generally accepted by experimental class students. Students in this class have generally improved their three core abilities and their test scores were also higher than those of the control class. This research provides fresh ideas and a useful example for the implementing WeChat public platform as an assist in the teaching of other courses in the military medical university. In addition, the research group believe that in-depth research and discussions are still needed on how to effectively deal with such problems as the lack of diversification of contents in WeChat public platform.