Critical care medicine is a discipline dedicated to the diagnosis and treatment of severe illnesses,demanding extensive knowledge,advanced skills,and exceptional teamwork and communication abilities.However,the complexity and dynamic nature of critically ill patients often render traditional face-to-face teaching methods insufficient.Emerging educational approaches like virtual reality(VR)and augmented reality(AR)offer simulated environments,but lack the depth of interaction with the real world,constraining the educational outcomes.Mixed reality(MR),which integrates elements of both VR and AR,provides an immersive and highly interactive learning experience by seamlessly bridging the virtual and real worlds.Although MR has begun to establish itself in medical education,its application in critical care medicine remains in its early stages.This article aims to elucidate the characteristics and evolution of MR,alongside its potential value and applications in critical care medical education.

Humans ; China/epidemiology* ; SARS-CoV-2 ; COVID-19

Objective: To investigate the effects of scleral crosslinking using genipin on ocular biological parameters and scleral biomechanics of form-deprivation myopia rabbits. Methods: Sixty healthy New Zealand rabbits of 14 days old were collected.The right eyes were selected as experimental eye.The rabbits were randomly divided into three groups: control group with no treatment; myopia model group with eyelid suture procedure performed on the right eye; genipin injection group with eyelid suture procedure performed on the right eye combined with subconjunctival injection of genipin.The suture was removed 60 days after the eyelid suture procedure.The diopter, length of vitreous cavity, and axial length were measured.The sclera at 1: 00 and 7: 00 position of the experimental eye was used to make a scleral strip.The thickness, elastic modulus, creep rate, ultimate stress and ultimate strain of the sclera were measured.This study was approved by the animal experimental Ethics Committee of Bethune International Peace Hospital (2018-ky-09). Results: The diopters of genipin injection group, myopia model group and control group were (2.50±1.38), (0.33±0.52) and (2.08±0.52)D, respectively, the axial lengths of the three groups were (15.33±0.82), (15.83±0.41) and (15.00±0.43)mm, respectively; the changes in vitreous cavity lengths were (1.50±0.79), (2.59±0.83) and (1.48±0.66)mm, respectively; and the ratios of vitreous cavity length to axial length were 0.46±0.02, 0.51±0.02 and 0.47±0.02, respectively.The diopter in myopia model group was significantly lower than those in control group and genipin injection group, the axial length in myopia model group was significantly longer than that in control group, the change in vitreous cavity lengths and ratio of vitreous cavity length to axial length in myopia model group were significantly higher than those in control group and genipin injection group, the axial length in myopia model group was significantly longer than that in control group, the differences were statistically significant (all at P<0.05). The elasticity modulus was (9.10±3.12)MPa and ultimate stress was (1.42±0.57)MPa in genipin injection group, which were significantly higher than (6.98±3.30)MPa and (1.15±0.57)MPa in control group, and (6.25±3.17)MPa and (0.82±0.38)MPa in myopia model group (all at P<0.05). The ultimate strain was (20.99±5.60)% in genipin injection group, which was significantly lower than (25.08±6.35)% in control group and (27.78±8.20)% in myopia model group, with significant differences between them (both at P<0.05). Conclusions Posterior sub-Tenon capsule injection of genipin for collagen crosslinking in the sclera increases the biomechanical strength of sclera and effectively prevents the development of form-deprivation myopia in rabbits, which provides a new idea for the prevention and treatment of myopia in the future.

Objective To analyze the correlation between K-ras gene mutation and clinicopathological characteristics and prognosis of colorectal cancer patients with different primary sites.Methods The clinical and pathological records of 69 patients who were pathologically confirmed as colorectal cancer and tested K-ras gene status at Wuxi People's Hospital Affiliated to Nanjing Medical University between May 2007 and August 2017 were adopted.The correlation between clinicopathological characteristics and prognosis of colorectal cancer patients with different primary sites and K-ras gene mutation status were retrospectively analyzed.And the patients were visited to adopt the prognosis data and perform the Kaplan-Meier survival analysis.Results The K-ras mutation rate was 50.7％(35/69),including 40.0％(12/30)in left-side colon cancer,73.3％(11/15)in right-side colon cancer and 50.0％(12/24)in rectal cancer.The mutation rate of K-ras gene in patients ≥ 60 years old [61.5％(24/39)vs.36.7％(11/30),χ2= 4.197,P = 0.041] or serum CA19-9 raising up abnormally was conspicuously high [65.6％(19/29)vs.37.5％(15/40),χ 2= 5.486,P =0.019].Other clinicopathological characteristics,such as gender,lesion location,histological classification,TNM stage,serum CEA expression,clinical features had no correlation with K-ras gene mutation status(all P＞ 0.05).And no relationship was found between prognosis and overall survival of colorectal cancer patients with different primary sites and K-ras gene mutation status(χ 2= 0.001,P = 0.997; χ 2= 0.583,P =0.445).In general,the 5-year survival rate of left-side colon cancer patients was highest(76.9％),followed by rectal cancer(69.7％),and right-side colon cancer was lowest(31.3％).The primary site of colorectal cancer was related to the overall survival of patients(χ2=11.004,P =0.004).Conclusions K-ras gene mutation in colorectal cancer is closely related to age and serum CA19-9 levels of the patients.The prognosis of left-side colon cancer is best,rectal cancer second,and right-side colon cancer poorest.Whether K-ras gene mutation is the prognostic factor of colorectal cancer is not clear.Testing the K-ras gene status and serum tumor index expression,distinguish the primary site and age group will provide the theory basis and promote the clinical targeted therapy and improve the survival of colorectal cancer patients.

Objective: To investigate the efficacy and safety of using pegylated recombinant human granulocyte-colonystimulating factor (PEG-rhG-CSF) in preventing neutropenia in multiple chemotherapy cycles. Methods: A multicenter, prospective, open-label, singlearmstudy was designed. Patients with malignant tumors, such as lung, ovarian, and colorectal cancers, who received multiple cycles of chemotherapy with the prophylactic use of PEG-rhG-CSF for 2-4 consecutive cycles participated in the study. Results: After the prophylactic use of PEG-rhG-CSF, the incidence of grade IV neutropenia decreased from 4.76% (13/273) in the first cycle to 1.83% (5/273), 1.15% (2/174), and 2.08% (2/96) in subsequent cycles. Meanwhile, the incidence of grade III neutropenia decreased from 11.36% (31/ 273) in the first cycle to 6.23% (17/273), 2.87% (5/174), and 3.13% (3/96) in subsequent cycles. The incidence of febrile neutropenia (FN) during the first cycle was 0.73% (2/273). The duration of FN was 2 days in one case and 5 days in another case. FN was not observed during the second, third, or fourth cycle. After the secondary prophylactic use of PEG-rhG-CSF, the incidence of grade IV neutropenia decreased from 25% (7/28) to 3.57% (1/28), 0% (0/28), and 6.67% (1/15) in subsequent cycles. Meanwhile, the incidence of grade III neutropenia decreased from 71.43% (20/28) to 10.71% (3/28), 14.29% (4/28), and 0% (0/15) in subsequent cycles. The proportion of patients who received antibiotic therapy during the entire chemotherapy period was 10.48% (44/420). Conclusion: The application of PEG-rhG-CSF once per chemotherapy cycle can effectively reduce the occurrence of neutropenia in patients under multiple cycles of chemotherapy treatment with good safety.

Objective To observe the changes of brain neurotransmitters in patients with vasovagal syncope (VVS) with encephalofluc-tuogram technology (ET). Methods From August, 2015 to December, 2016, 30 patients with VVS were selected as case group, 30 controls matched with sex and age were selected from the outpatients without syncope. They were detected the function of gamma aminobutyric acid (GABA), glutamate (Glu), 5-hydroxytryptamine (5-HT), acetylcholine (Ach), norepinephrine (NE) and dopamine (DA) with ET. Results There was no significant difference between the two groups in the values of GABA, Glu, 5-HT, Ach and DA (t<1.680, P>0.05), while the values of NE was higher in the case group than in the control group (t=-3.552, P<0.001). Conclusion VVS may be related to the high level of activity of NE in the brain.

Objective To introduce improved program for traction wire production in endoscopic submucosal dis-section assisted by oral traction. Methods A retrospective analysis was performed on 40 patients who received en-doscopy intervention. Through the use of improved traction and normal traction, they were divided into experimental group and control group. Then analyze and compare their clinical data like gender, age, traction line installed perfect time, fixed lesions after hemostatic clip off times, one-time complete resection, enbloc resection rate, bleeding and perforation and other complications and other clinical conditions. Results The improvement time was (53.30 ±12.85) s in experimental group, it was significantly shorter than that in control group (105.00 ± 11.68) s ( = 3.42, <0.05). The experimental group fixed lesions after hemostatic clamp off times were significantly less than that in con-trol group (χ2=2.37, <0.05). Conclusions Using innovative methods, adequate preoperative preparation, the op-erator's tacit understanding of nursing cooperation, close attention to the disease after surgery is the key to achieve the desired results of endoscopic surgery.

Objective:To detect the proportion of lymphocyte subsets in peripheral blood of the ad-vanced breast cancer patients before and after chemotherapy with docetaxel and thiotepa,as well as the association between the proportion of peripheral blood lymphocyte subsets with the response rate and prog-nosis.Methods:The proportions of lymphocyte subsets (CD3 +T cell,CD3 +/CD4 +T cell,CD3 +/CD8 +T cell,CD3 -/CD16 +56 +NK cell,CD3 +/CD16 +56 +T cell,CD19 +B cell,CD4 +/CD25 +T cell,CD8 +/CD28 -T cell,CD8 +/CD28 +T cell)in the peripheral blood of 86 patients were analyzed with flowcytometry before and after chemotherapy.The result was analyzed in combination with clinico-pathological data.Results:The proportion of regulatory T cells (Treg)after chemotherapy in the disease control patients decreased significantly compared with that of the progressive patients (P=0.034).The difference of the proportions of Treg before and after chemotherapy affected significantly the overall survi-val (OS).The OS of the patients with decreased proportion of Treg was significantly longer than that of the patients with increased proportion of Treg,which was 23.5 and 9.4 months respectively (P<0.05). Conclusion:The patients with decreased proportion of Treg after chemotherapy had higher response rate and better survival benefit.

Objective To investigate the promoting effect of individualized intervention on social function rehabilitation in patients with schizophrenia. Methods Total of 200 hospitalized patients with schizophrenia in a tertiary psychiatrichospital were selected as the research object and were randomly assigned to the study group ( n=100) and the control group ( n=100) . Patients in control group were treated with routine treatment and nursing, whilepatients in study group were given individualized intervention combined with routine treatment and nursing. Brief psychiatric rating scale ( BPRS) was used to assess the severity of the psychotic symptoms.Insight and treatment attitude questionnaire ( ITAQ) was used to assess the treatment compliance of patients. Activity of daily living scale (ADL) and personal and social performance scale(PSP) were used to assess their social function. Then, we compared the results of two groups that before and after the intervention. Results Before the intervention, there was no significant difference in BPRS, ITAQ and ADL scores between two groups ( P>0.05) . The PSP scores of the study group were lower than those of the control group ( P<0.05) . After the intervention, the ITAQ and PSP scores of two groups were significantly higher than those before the intervention, and the BPRS and ADL scores were significantly lower than those before the intervention ( P<0.05) . After the intervention, there was no significant difference in BPRS and ITAQ scores between two groups ( P>0. 05) . The ADL scores of the study group were significantly lower than those of the control group, and the PSP scores were significantly higher than those of the control group (P<0.05).Conclusions Personalized intervention enhances the patient′s self-care ability, daily activities ability and social competence, and promotes the recovery of social function.

The aim of this paper is to explore the prevention of rabbit postoperative abdominal cavity adhesion with poly (lactic-co-glycotic acid) (PLGA) membrane and the mechanism of this prevention function. Sixty-six Japanese white rabbits were randomly divided into normal control group, model control group and PLGA membrane group. The rabbits were treated with multifactor methods to establish the postoperative abdominal cavity adhesion models except for those in the normal control group. PLGA membrane was used to cover the wounds of rabbits in the PLGA membrane group and nothing covered the wounds of rabbits in the model control group. The hematologic parameters, liver and kidney functions and fibrinogen contents were detected at different time. The rabbit were sacrificed 1, 2, 4, 6, 12 weeks after the operations, respectively. The adhesions were graded blindly, and Masson staining and immunohistochemistry methods were used to observe the proliferation of collagen fiber and the expression of transforming growth factor β1 (TGF-β1) on the cecal tissues, respectively. The grade of abdominal cavity adhesion showed that the PLGA membrane-treated group was significant lower than that in the model control group, and it has no influence on liver and kidney function and hematologic parameters. But the fibrinogen content and the number of white blood cell in the PLGA membrane group were significant lower than those of model control group 1 week and 2 weeks after operation, respectively. The density of collagen fiber and optical density of TGF-β1 in the PLGA membrane group were significant lower than those of model control group. The results demonstrated that PLGA membrane could be effective in preventing the abdominal adhesions in rabbits, and it was mostly involved in the reducing of fibrinogen exudation, and inhibited the proliferation of collagen fiber and over-expression of TGF-β1.
Abdominal Cavity ; surgery ; Animals ; Collagen ; metabolism ; Lactic Acid ; Polyglycolic Acid ; Rabbits ; Tissue Adhesions ; prevention & control ; Transforming Growth Factor beta1 ; metabolism