OBJECTIVE To evaluate the comprehensive value of novel oral anticoagulant drugs （NOACs） after major orthopedic surgery. METHODS The evaluation evidence was collected through literature research； evidence and value：impact on decision-making （EVIDEM） framework was introduced to integrate the evaluation process； the multi-criteria decision analysis （MCDA） method was used to construct a multi-dimensional evaluation system； the weights assigned to each evaluation criterion were determined by the combination of Delphi method and analytic hierarchy process， and the rivaroxaban， dabigatran and apixaban were comprehensively evaluated. RESULTS The clinical comprehensive evaluation system of NOACs after major orthopedic surgery was successfully established， and the final clinical comprehensive evaluation weights of NOACs （rivaroxaban， dabigatran， apixaban） after major orthopedic surgery were calculated， with scores of 0.399 7 for rivaroxaban， 0.244 4 for apixaban， and 0.355 9 for dabigatran， indicating that rivaroxaban demonstrated the highest overall clinical value. Among them， rivaroxaban had the highest weight score in the evaluation of pharmaceutical characteristics， cost-effectiveness and other attributes in a single dimension. In terms of efficacy and safety evaluation， apixaban had the highest weighting score. CONCLUSIONS Among NOACs， rivaroxaban is more suitable for routine anticoagulation management after major orthopedic surgery， especially in terms of pharmacological properties， cost-effectiveness and other attributes.

Objective To investigate the clinical diagnostic value of plasma serine protease inhibitor Ka-zal-type 4(SPINK4)expression in colorectal adenocarcinoma(CRC)and progressive adenoma(AA).Methods A total of 62 patients with CRC(CRC group)and 15 patients with AA(AA group)diagnosed by colonoscopy and pathological examination in this hospital from June 2020 to December 2021 were selected,and 22 healthy people undergoing physical examination during the same period were selected as the HC group.The expression of SPINK4 in plasma was detected by ELISA,and the expression of CEA in plasma was detected by electrochemiluminescence,and the correlation was analyzed.The diagnostic efficiency was analyzed by re-ceiver operating characteristic(ROC)curve,and the expression of p53 in CRC tissues was detected by immu-nohistochemistry.Results The expression of plasma SPINK4 in the CRC group and AA group was lower than that in the HC group(Z=3.72,-0.41,P＜0.05),and the expression of CEA in the CRC group was higher than that in the HC group(Z=-3.63,P＜0.05).The area under the curve(AUC),accuracy,sensi-tivity and specificity of SPINK4 combined with CEA in the diagnosis of CRC and AA were higher than those of SPINK4 and CEA alone.The positive rate of mutant type p53 in SPINK4 low expression group and CEA high ex-pression group was significantly increased in CRC patients(72.55％,75.00％,P＜0.05).Conclusion The expression of plasma SPINK4 is decreased in CRC and AA,and the combined detection of SPINK4 and CEA has a good di-agnostic efficiency in CRC and AA.

The biological clock(also known as the circadian rhythm)is the fundamental reliance for all organisms on Earth to adapt and survive in the Earth's rotation environment.Circadian rhythm is the most basic regulatory mechanism of life activities,and plays a key role in maintaining normal physiological and biochemical homeostasis,disease occurrence and treatment.Recent studies have shown that the biologi-cal clock plays an important role in the development of oral tissues and in the occurrence and treatment of oral diseases.Since there is cur-rently no guiding literature on the research methods of biological clock in stomatology,researchers mainly conduct research based on pub-lished references,which has led to controversy about the research methods of biological clock in stomatology,and there are many confusions about how to rationally apply the research methods of circadia rhythms.In view of this,this expert consensus summarizes the characteristics of the biological clock and analyzes the shortcomings of the current biological clock research in stomatology,and organizes relevant experts to summarize and recommend 10 principles as a reference for the rational implementation of the biological clock in stomatology research.

Purpose::To assess the value of the driving pressure variation rate (ΔP%) in predicting the outcome of weaning from invasive mechanical ventilation in patients with acute respiratory distress syndrome.Methods::In this case-control study, a total of 35 patients with moderate-severe acute respiratory distress syndrome were admitted to the intensive care unit between January 2022 and December 2022 and received invasive mechanical ventilation for at least 48 h were enrolled. Patients were divided into successful weaning group and failed weaning group depending on whether they could be removed from ventilator support within 14 days. Outcome measures including driving pressure, PaO 2:FiO 2, and positive end-expiratory pressure, etc. were assessed every 24 h from day 0 to day 14 until successful weaning was achieved. The measurement data of non-normal distribution were presented as median (Q 1, Q 3), and the differences between groups were compared by Wilcoxon rank sum test. And categorical data use the Chi-square test or Fisher's exact test to compare. The predictive value of ΔP% in predicting the outcome of weaning from the ventilator was analyzed using receiver operating characteristic curves. Results::Of the total 35 patients included in the study, 17 were successful vs. 18 failed in weaning from a ventilator after 14 days of mechanical ventilation. The cut-off values of the median ΔP% measured by Operator 1 vs. Operator 2 in the first 4 days were ≥ 4.17% and 4.55%, respectively ( p < 0.001), with the area under curve of 0.804 (sensitivity of 88.2%, specificity of 64.7%) and 0.770 (sensitivity of 88.2%, specificity of 64.7%), respectively. There was a significant difference in mechanical ventilation duration between the successful weaning group and the failure weaning group (8 (6, 13) vs. 12 (7.5, 17.3), p = 0.043). The incidence of ventilator-associated pneumonia in the successful weaning group was significantly lower than in the failed weaning group (0.2‰ vs. 2.3‰, p = 0.001). There was a significant difference noted between these 2 groups in the 28-day mortality (11.8% vs. 66.7%, p = 0.003). Conclusion::The median ΔP% in the first 4 days of mechanical ventilation showed good predictive performance in predicting the outcome of weaning from mechanical ventilation within 14 days. Further study is needed to confirm this finding.

To effectively introduce and utilize global advanced educational resources, the implementation of Chinese-foreign joint education program in medical universities and the establishment of an internal quality assurance system with Chinese characteristics and substantially equivalent to international standards of medical education is crucial for improving the quality of Chinese medical talent cultivation and achieving high-quality development of education opening up to the outside world in the new era. Using the Chinese-Foreign Joint Education Program jointly run by Chongqing Medical University and University of Leicester as an example, this paper proposes a plan for the development of an internal quality assurance system with three core indicators of management mechanism, team building, and student services. This plan provides experience and a reference for domestic universities to carry out cross-border medical education and improve the quality and efficiency of Chinese-foreign joint education programs.

Objective To compare image quality of 5.0T and 3.0T time of flight MR angiography(TOF-MRA)and displaying choroidal anterior arteries(AChA).Methods Data of 80 patients who underwent head 5.0T(5.0T group,n=40)and/or 3.0T TOF-MRA(3.0T group,n=42)were retrospectively analyzed,among them 2 patients underwent both 5.0T and 3.0T TOF-MRA.The subjective scoring and objective evaluation of image quality were performed,and the results were compared between groups.AChA was divided into proximal,intermediate and distal segments(A1,A2,A3 segment),the quantity of left and right AChA shown on 5.0T and 3.0T TOF-MRA were recorded,and the length and diameter of left and right AChA dispalyed on MRA were comparatively observed.Results The subjective scores of image quality of 5.0T group were higher than that of 3.0T group(5.0[4.0,5.0]vs.5.0[3.0,5.0],Z=6.417,P=0.029).The signal-to-noise ratio(91.01±5.04)and contrast-to-noise ratio(72.47±5.14)of 5.0T group were both larger than those of 3.0T group([62.11±4.16],[48.92±4.62],t=28.339,19.681,both P＜0.001).There were 80 segments of AChA-A1,80 of AChA-A2 and 60 segments of AChA-A3 displayed on 5.0T TOF-MRA,while 60 segments of AChA-A1,36 of AChA-A2 and 12 segments of AChA-A3 displayed on 3.0T TOF-MRA,respectively.In 5.0T group,the length of the left and right AChA was(24.01±7.41)mm and(22.72±9.36)mm,with diameter of(1.16±0.12)mm and(1.19±0.14)mm,respectively,whereas in 3.0T group,the relative values were(18.35±8.67)mm,(16.80±6.94)mm,(0.99±0.25)mm and(0.95±0.29)mm,respectively,all in 5.0T group were greater than in 3.0T group(t=3.242,3.183,4.595,3.846,all P＜0.001).Conclusion Compared with 3.0T TOF-MRA,5.0T TOF-MRA of AChA might provide better image quality and clearer vessel depiction,being helpful to clinical diagnosis and treatment of ACHA-related cerebral vascular diseases.

Objective To compare image quality of 3.0T and 5.0T MR cholangiopancreatography(MRCP).Methods Eighteen patients with bile duct dilation(bile duct dilation group)and 7 healthy volunteers(healthy group)were prospectively enrolled.MRCP was performed with 3.0T and 5.0T scanners,respectively,and the ability for displaying details of bile duct tree,signal-to-noise ratio(SNR)and image artifacts were compared between 3.0T and 5.0T MRCP.Results In bile duct dilation group,the number of branches,total branch length and the maximum branch length of bile duct tree on 5.0T MRCP were all greater than those on 3.0T MRCP(all P＜0.05).In healthy group,the number of branches and total branch length of bile duct tree on 5.0T MRCP were both greater than those on 3.0T MRCP(both P＜0.05).In both groups,the SNR of 5.0T MRCP was greater than that of 3.0T MRCP,but the difference was not significant(both P＞0.05).No significant difference of image artifacts was found between 3.0T and 5.0T MRCP(P=0.054).Conclusion 5.0T MRCP might display better anatomical details of bile duct tree than 3.0T MRCP,with SNR and image artifacts comparable to 3.0T MRCP.

Objective To explore the functional connectivity characteristics and intensity of brain network in depression at rest.Methods Patients with major depressive disorder(MDD)and healthy controls(HCs)underwent resting state functional magnetic resonance imaging.The total brain degree centrality(DC)of the two groups was calculated to assess the functional connection strength.Support vector machine(SVM)method was used to investigate whether abnormal DC value can recognize MDD.Results A total of 26 patients and 37 controls were included in the analysis.Compared to HCs,MDD group showed decreased DC value in the left middle frontal gyrus(t=-4.98,P＜0.05,GRF corrected)and increased DC value in the right middle temporal gyrus(t=5.02,P＜0.05,GRF corrected),right parahippocampal gyrus(t=4.80,P＜0.05,GRF corrected),and right posterior cerebellar gyrus(t=4.98,P＜0.05,GRF corrected).Additionally,no significant correlations were found between abnormal DC values and clinical variables(i.e.,17-item Hamilton depression scale and Beck depression scale scores)in MDD group(P＞0.05).SVM analysis showed that decreased DC value in the left middle frontal gyrus might be used to distinguish MDD group from HCs with an accuracy of 84.13%,a specificity of 81.08%,and a sensitivity of 88.46%,the area under the operational characteristic curve is 0.87.Conclusions Altered DC values in the left middle frontal gyrus and right middle temporal gyrus,right parahippocampal gyrus,right posterior cerebellum may contribute to the pathophysiology of MDD.The change of functional connection strength of the left medial frontal gyrus may be helpful for the recognition of MDD.

Objective To observe the effect of cervical degenerative change on the expression of vascular endothelial growth factor(VEGF)and vascular endothelial growth factor receptor-2(VEGFR-2).Methods The C3 to C7 segments of bilateral healthy cervical vertebrae of adult cadavers were taken as the control group,and the C3 to C7 segments of bilateral degenerative cervical vertebrae of adult cadavers were taken as the experimental group.The expression changes of VEGF and VEGFR-2 of the two groups were observed and analyzed by immunohistochemistry,immunofluorescence staining and real-time quantitative PCR.Results The protein and mRNA expressions of VEGF and VEGFR-2 in the experimental group were higher than those in the control group,with statistically significant differences(P<0.05).Conclusion Cervical Luschka joint degenerative change significantly up-regulates the expression of VEGF and VEGFR-2,which is closely related to the microenvironmental changes around the Luschka joint caused by degeneration of joint-like structure.

GJ-4 is crocin enrichments extracted from Gardenia jasminoides J. Ellis, and our previous studies have shown that GJ-4 significantly improved learning and memory impairment induced by Aβ in mice. Herein, a memory deficit model was developed by injecting okadaic acid (OA) into the lateral ventricle of mice, and the neuroprotection and underlying mechanism of GJ-4 on neuronal injury caused by Tau hyperphosphorylation were investigated. The Animal Care & Welfare Committee, Institute of Materia Medica, CAMS & PUMC has approved all procedures (No.00000318). GJ-4 at different doses was intragastric administration to mice for 16 days. Step-down test and Morris water maze test showed that GJ-4 could significantly improve OA-induced memory impairment in mice, and reduced the loss of Nissl bodies in the hippocampus of mice. GJ-4 could also decrease the phosphorylation level of Tau protein at Ser396, Thr231 and Ser404 via increasing protein phosphatase 2A (PP2A) activity and inhibiting glycogen synthase kinase-3β (GSK-3β) activity. Besides, further researches indicated that GJ-4 could inhibit the level of oxidative stress in the brain of OA mice, reduce neuronal apoptosis and inhibit the neuroinflammation mediated by activation of astrocytes in the hippocampus of mice, and eventually achieve its effects in improving learning and memory impairment in mice. According to these findings, we anticipated that GJ-4 might be a potential therapeutic drug for Alzheimer's disease.