According to the "Regulations on clinical application management of medical technologies", physicians intending to carry out restricted technologies must undergo standardized training and pass assessments in accordance with the clinical application management standards for the respective technology. As ventricular assist technology is classified as a nationally restricted technology, standardized training is one of the essential conditions for its application. This paper primarily explores the standardized training for the clinical application of ventricular assist technology in Shanghai, in light of its background, clinical application, and current training status. It proposes the training requirements for ventricular assist technology, animal training assessment standards, and clinical practice assessment standards in Shanghai, aiming to promote the standardized development and high-quality advancement of ventricular assist technology in Shanghai.

Objective Utilizing a specially engineered miR-144-GFP-H1 human embryonic stem cell(hESC)reporter line,this study leverages GFP fluorescence as an indicator of miR-144 expression to gauge the progression of erythropoiesis.The investigation is aimed at elucidating the potential roles of lncRNAs within the erythropoietic framework and conducting an initial assessment of their functional impact.Methods The miR-144/451-GFP-H1 cell line(hereafter referred to as 144-H1)was utilized for in vitro erythrocyte induction culture.The subpopulations of cells entering the erythropoiesis stage were characterized by the surface molecules CD71 and GPA.The GFP reporter gene of miR-144 served as a critical determi-nant to distinguish between GFP-positive cells(with a high propensity for erythropoiesis)and GFP-negative cells(with a low propensity for erythropoiesis).Transcriptome sequencing was performed on both groups to identify differentially ex-pressed long non-coding RNAs(lncRNAs).LncRNA entries with potential for validation were selected for preliminary func-tional verification.The CRISPR/Cas9 gene editing technique was employed to design functional interference strategies for the targeted lncRNAs,obtaining 144-H1 cell lines with knocked-out function of the specific lncRNAs.These knockout cell lines,along with non-knockout 144-H1 cell lines,were used for parallel erythrocyte induction culture to identify differential nodes.This approach preliminarily verified their impact on erythropoiesis in an in vitro development model.Results 1)The constructed 144-H1 cell line was capable of expressing GFP fluorescence upon entering the stage of in vitro erythrocyte in-duction,indicating the activation of miR-144/451.2)Within the CD71,GPA double-positive group,significant differences in lncRNA expression were observed between the GFP-positive and GFP-negative subpopulations.3)Gene editing strategies involving the deletion of sequence segments capable of effectively interfering with the function of multiple lncRNA entries were designed and verified for successful editing.In the knockout cell lines,parts of the lncRNA sequences were directly de-leted.4)In parallel validation experiments of erythrocyte induction culture,cell lines with LINC01569 knocked out exhibited significant differences in flow cytometric subpopulations and cell proliferation capabilities compared to the non-knockout cell lines:①The knockout cell lines showed sustained high expression of GFP fluorescence.②The proportion of the CD71-GPA double-positive group in the knockout cell lines continuously decreased during erythrocyte maturation.③No significant ex-pression of hemoglobin was observed in the knockout cell lines,lacking the characteristic red color.④The cell proliferation capability of the knockout cell lines was significantly lower than that of the non-knockout cell lines(P＜0.05).Conclusion The successful employment of the 144-H1 cell line facilitated an exploration into the potential functions of lncRNAs in e-rythropoiesis.This enables the design of more refined in vitro developmental experiments to enhance the precision in captu-ring lncRNA functions.Among the differentially expressed lncRNA entries,LINC01569 was preliminarily validated to play a regulatory role in erythropoiesis.The functional absence of LINC01569 severely impacts the normal differentiation and prolif-eration of erythrocytes.The specific regulatory mechanism of LINC01569 in erythropoiesis warrants further investigation and research.

A domestically produced self-expanding transcatheter aortic valve controllable bending delivery system(VitaFlow? Ⅲcontrollable bending retrievable delivery system)was first used to perform transcatheter aortic valve replacement(TAVR)in a symptomatic severe aortic valve stenosis patient with severe heart failure and high risk of surgery in China on September 22,2023.The patient successfully completed TAVR under general anesthesia,with good valve position and function after the operation.Before discharge and at one month of follow-up,the patient's symptoms and degree of heart failure were significantly improved.The follow-up results of this case showed that the VitaFlow? Ⅲ controllable bending retrievable delivery system for TAVR is safe and feasible,and future prospective,multicenter clinical trials are expected to evaluate its efficacy.

Objective:To compare the efficacy of articaine infiltration anesthesia and lidocaine nerve block anesthesia in pulpotomy of deciduous mandibular second molars.Methods:Single blind crossover test was used for the pediatric patients who required bilateral de-ciduous mandibular second molar pulpotomy were given articaine infiltration anesthesia and lidocaine nerve block anesthesia respectively before the 2 times of operation.After the injection of anesthetic drugs and dental pulp treatment,the patients'responses to pain were e-valuated through sound,eye and body movements,and Wong-Baker facial pain rating scales.Quantitative comparisons were made.Student's t-test and chi-square test were performed for the collected data.Results:50 pediatric patients who met the inclusion criteria and successfully completed 2 treatments without any missed visits or adverse events.During the process of articaine infiltration anesthe-sia,the scores of the 3 indicators of pain severity,namely sound,eye and body movements,were lower than those of lidocaine nerve block anesthesia(P＜0.05).The analysis of facial pain rating scales also suggested that patients'pain and discomfort during the infiltra-tion anesthesia process with articaine were milder(P＜0.05).During the treatment of pulpotomy,both pain assessment methods showed no statistically significant difference in pain perception between the 2 anesthesia injections(P＞0.05).Conclusion:Articaine infiltra-tion anesthesia may effectively replace lidocaine nerve block anesthesia in pulp treatment of mandibular primary molars.

Acute kidney injury (AKI) is a common serious complication after acute ischemic stroke (AIS), which is associated with an increased mortality and disability. However, the clinical prevalence is often underestimated or overlooked. This article reviews the pathogenesis, risk factors, predictive factors, and predictive models of AKI in patients with AIS, in order to provide a basis for early clinical identification and diagnosis of AKI in patients with AIS.

Objective:To develop a risk prediction model for acute kidney injury (AKI) in young, middle-aged and elderly patients with acute ischemic stroke (AIS), and verify the predictive ability of the model.Methods:Patients admitted to the Department of Neurology, Lianyungang Hospital Affiliated to Xuzhou Medical University from January 2018 to August 2022 were retrospectively included as a modeling cohort, and patients with AIS from September 2022 to September 2023 were prospectively included as a validation cohort. Independent risk factors for AKI were determined by multivariate logistic regression analysis, and risk prediction models for AKI in young AIS patients group and middle-aged and elderly AIS patients group were developed. The predictive power of the model was tested using the receiver operating characteristic (ROC) curve. Results:The young group included 760 patients with AIS, of which 584 (76.84%) were in the modeling cohort, and 146 (25.00%) had AKI. Multivariate logistic regression analysis showed that anemia, systolic blood pressure, homocysteine, alcohol consumption, blood urea nitrogen, and National Institutes of Health Stroke Scale (NIHSS) score were independent risk factors for AKI (all P<0.05). ROC analysis showed that the area under the curve of the predictive model was 0.938 (95% confidence interval 0.912-0.963), the Youden index was 0.747, and the optimal cut-off value was 0.249. The sensitivity and specificity of predicting AKI were 84.8% and 89.9%, respectively. A total of 1 417 patients with AIS were included in the middle-aged and elderly group, of which 833 patients (58.79%) were in the modeling cohort and 230 (27.61%) had AKI. Multivariate logistic regression analysis showed that hypertension, atrial fibrillation, previous stroke history, smoking, infection, triglycerides, NIHSS score, use of antihypertensive drugs, use of loop diuretics, serum creatinine, and blood urea nitrogen were the independent risk factors for AKI ( P<0.05). ROC analysis showed that the area under the curve of the predictive model was 0.838 (95% confidence interval 0.808-0.868), the Youden index was 0.539, the optimal cut-off value was 0.242, and the predictive sensitivity and specificity were 78.3% and 75.6%, respectively. The Hosmer-Lemeshow goodness of fit test showed the predictive accuracy of the model was in good agreement with the actual occurrence of risk (the young group: χ2=8.968, P=0.345; the middle-aged and elderly group: χ2=11.250, P=0.188). The validation cohort analysis shows that the model had high prediction accuracy and credibility in two groups. Conclusion:The model can specifically predict the risk of AKI in young, middle-aged and elderly patients with AIS, with high sensitivity and specificity.

Ankylosing spondylitis (AS) is a chronic inflammatory disease with early onset of reduced bone mineral density,which can lead to spinal deformity and even fracture,affecting patients′ quality of life seriously. To improve the compliance and long-term quality of life for AS patients, it is neccessary to enhance the awareness and knowledge of this disease among community primary health care providers.

Objective:To investigate the regulatory effect of dehydroepiandrosterone (DHEA) on the microglial activation after subarachnoid hemorrhage (SAH) in vivo and in vitro.Methods:C57BL/6 mice were used for in vivo experiments. A SAH model was induced by intravascular puncture. They were randomly divided into solvent group, model group, and DHEA pretreatment group. TUNEL staining was used to detect neuronal apoptosis level at 24 h after modeling. Iba-1/CD86 fluorescence double staining was used to detect the activation of microglia. Quantitative fluorescent polymerase chain reaction and Western blot analysis were used to detect the expression of inflammatory factors, including interleukin (IL) -1β, IL-6, tumor necrosis factor (TNF) -α, and inducible nitric oxide synthase (iNOS). The primary cultured microglia was used for in vitro experiments and it was simulated SAH by hemoglobin stimulation. They were randomly divided into control group, model group, and DHEA pretreatment group. Iba-1/CD86 fluorescence double staining was used to detect the microglial activation, and fluorescence quantitative polymerase chain reaction and Western blot analysis were used to detect the expression of inflammatory factors.Results:In vivo model experiments showed that DHEA significantly reduced neuronal apoptosis ( P<0.01) and microglial activation ( P<0.01) after SAH modeling, and IL-6 expression level significantly decreased ( P<0.01), while IL-1β, TNF-α and iNOS showed a downward trend, but there were no statistical differences. In vitro model experiments showed that DHEA could significantly inhibit microglial activation ( P<0.001) and the expression levels of various inflammatory factors ( P<0.001). Conclusions:DHEA pretreatment can reduce neuronal apoptosis and microglia activation after SAH, and it has neuroprotective effect.

OBJECTIVE： To study the effects of cimetidine on low dose rate irradiation-induced liver cell apoptosis in Beagle dogs. METHODS： Healthy male Beagle dogs were randomly divided into normal control group， model control group， positive drug group （lentinan， 21.33 mg/kg） and cimetidine low-dose， medium-dose and high-dose groups （5.33， 10.67， 21.33 mg/kg）， with 4 Beagle dogs each. Except for normal control group， other groups were given 60Co-γ accumulative irradiation （dosage rate： 0.040 8 mGy/min） for 23 d； the medication groups were given relevant medicine orally before irradiation， once a day. Twenty-four hours after stopping irradiation， TUNEL method was used to detect the apoptosis of liver cells in Beagle dogs. The percentage of apoptotic cells was calculated. The expression level of apoptosis-related proteins （Bax， Bcl-2， Caspase-3， p53） in liver tissue was detected by immunohistochemistry. RESULTS： Compared with normal control group， apoptotic cells and Bax， Caspase-3， p53 positive cells were increased significantly in liver tissue of Beagle dogs in model control group； the percentage of apoptotic cells， protein expression levels of Bax， Caspase-3 and p53 were increased significantly； Bcl-2 positive cells were decreased significantly， and its protein expression level was decreased significantly （P＜0.05 or P＜0.01）. Compared with model control group， above positive cells of liver tissue in Beagle dogs were changed to different extents in medication groups； the percentage of apoptotic cells and protein expression levels of p53 in medication groups， protein expression levels of Bax in positive drug group， cimetidine low-dose and high-dose groups as well as protein expression levels of Caspase-3 in cimetidine groups were decreased significantly； protein expression levels of Bcl-2 were increased significantly in cimetidine groups. The percentage of apoptotic cells in cimetidine medium-dose and high-dose groups as well as protein expression levels of Caspase-3 in cimetidine groups were all lower than positive control group. Protein expression level of p53 in cimetidine low-dose group was significantly higher than positive drug group （P＜0.05 or P＜0.01）. CONCLUSIONS： Cimetidine can inhibit the low dose rate irradiation-induced apoptosis of liver cells in Beagle dogs， and certainly protect liver cells against irradiation. The mechanism of it may be associated with up-regulating the protein expression of Bcl-2 and down-regulating the protein expression of Bax， Caspase-3 and p53 in liver cells.

Objective To investigate the clinical effect of lenalidomide combined with modified MP regimen in the treatment of multiple myeloma( MM) . Methods Eighty=four elderly multiple myeloma patients treated in Tangshan City Workers'Hospital from January 2013 December 2016 were enrolled in this study. The patients were randomly divided into treatment group ( 42 cases) and control group ( 42 cases) . The patients in the treatment group were given LMP regimen +α2b? interferon. The patients in the control group received the standard MPT regimen. The changes of the level of β2 microglobulin in the two groups before and after treatment were compared,and the total effective rate in the two groups was compared. Results No statistically significant difference was showed between the two groups in β2 microglobulin before treatment ( P>0. 05) . After treatment,β2 microglobulin concentration in the treatment group was (3. 11±0. 28) and was (4. 75±0. 36) in the control group,there was significant difference between two groups ( t=9. 094,P<0. 05); the total effective rate of the treatment group was 83. 33％,59. 52％ in the control group,there was significant difference between two groups ( t=5. 833,P=0. 016) . The incidence of adverse reactions in the treatment group was 9. 52％,the control group was 26. 19％,and the two groups were statistically significant ( t=3. 977,P=0. 046) . Conclusion The clinical effect of Lenalidomide combined with modified MP regimen in the treatment of MM is better than that of conventional treatment,the total effective rate is highwe,with less adverse reactions.