Objective:To evaluate the effect of virtual reality arthroscopic simulation system combined with case-based learning (CBL) in orthopedic clinical teaching.Methods:From January 2021 to June 2022, a total of 36 residents who took the standardized residency training at Department of Articular Orthopedics in The Third Affiliated Hospital of Soochow University were enrolled in this study. They were randomized into an experimental group and a control group, with 18 trainees in each group. The experimental group adopted the virtual reality arthroscopic simulation system combined with CBL teaching mode, while the control group adopted simple endoscopic simulation training box with traditional teaching mode. Theoretical and practical tests and questionnaire survey were carried out to evaluate the teaching effects in two groups. SPSS 22.0 was performed to conduct t-test on the measurement data between the two groups. Results:The theoretical and practical test scores of the experimental group [(89.39±3.09) and (82.72±4.28)] were better than those of the control group [(86.22±4.43) and (76.61±5.65)], with statistically significant differences ( t= 2.49, P=0.018; t=3.66, P=0.001). The questionnaire survey showed that the experimental group was better than the control group in creating novel forms of courses [(4.94±0.24) vs. (4.11±0.58), t=5.62, P<0.001], simulating more real scenes [(4.83±0.38) vs. (3.78±0.43), t=7.80, P<0.001], inspiring learning interests [(4.78±0.43) vs. (4.00±0.59), t=4.51, P<0.001], improving practical skills [(4.83±0.38) vs. (3.83±0.51), t=6.61, P<0.001], and building career confidence [(4.50±0.62) vs. (3.06±0.54), t=7.47, P<0.001], with statistically significant differences (all P<0.001). Conclusions:The virtual reality arthroscopic simulation system combined with CBL teaching mode can better simulate the real clinical scenes, help inspire the interest of learning and quickly improve practical skills, thereby improving the effect of orthopedic clinical teaching.

Objective:To analyze the costs and effectiveness of five common screening modes and genetic screening for thalassemia in China in order to find the optimal way and provide evidence for the implementation of thalassemia prevention and control projects in Hunan Province.Methods:From June 2020 to April 2021, 12 971 couples from 14 cities and autonomous prefectures in Hunan Province were selected as the study population. The diagnosis of thalassemia was based on the results of genetic testing. Results of routine blood test and hemoglobin electrophoresis were collected and analyzed. The efficacy of five screening modes, at the cut-off value of <80 fl or 82 fl for the mean corpuscular volume (MCV), was analyzed by positive predictive value, negative predictive value, Jorden index and cost-effectiveness ratio. Sensitivity analysis was used to assess the feasibility of genetic screening at different costs after fixing the costs of routine blood and hemoglobin electrophoresis. The five thalassemia screening models are as follows: Mode 1: The woman had a blood routine test first. If the result was positive, the spouse required a blood routine test. If both results were positive, a thalassemia gene test should be offered to the couple. Mode 2: Both husband and wife were screened by blood routine and hemoglobin electrophoresis. If one or both of them were positive, both would be tested for thalassemia gene. Mode 3: The couple received blood routine tests initially. If either was positive, both should receive hemoglobin electrophoresis testing. If either was positive, both parties will conduct thalassemia gene testing. Mode 4: The woman was screened by blood routine and hemoglobin electrophoresis. If any one of them was positive, the woman would be tested for thalassemia gene. If the gene test result was positive, the spouse should receive thalassemia gene. Mode 5: Both spouses conducted a blood routine test. If either was positive, both would conduct hemoglobin electrophoresis test. If both were positive, both spouses should receive thalassemia gene testing. Gene testing mode: The woman would be tested for thalassemia, and her spouse would have thalassemia test too if her result was positive.Results:When using MCV<80 fl as the cut-off for diagnosing thalassemia, the Youden indices of the five prenatal screening modes in Hunan Province were 0.551, 0.639, 0.898, 0.555 and 0.356, while when using MCV<82 fl as the cut-off, the Youden indices were 0.549, 0.629, 0.851, 0.548 and 0.356. When the MCV cut-off value was <80 fl, the missed diagnosis rates of the five screening modes were 44.44%, 0.00, 0.00, 18.52% and 62.96%, and the cost-effectiveness ratios were 21 709, 250 939, 76 870, 138 463 and 92 860 yuan (RMB)/couple, respectively. When the price of genetic testing was lower than 55 yuan (RMB), the cost-effectiveness ratio of genetic screening was lower than that of Mode 3.Conclusions:MCV<80 fl can be considered as the positive criteria in blood routine screening for thalassemia in Hunan Province, and the cost-effectiveness ratio of Mode 3 (the couple received blood routine tests initially. If either was positive, both should receive hemoglobin electrophoresis testing. If either was positive, both parties will conduct thalassemia gene testing) is the best. Genetic screening has certain advantages with the decreasing price.

Objective:To analyze the relationship between plasma uranium concentration and renal injury.Methods:A case-control study was conducted in Hunan province, involving 102 renal injury cases and 102 matched controls. The association between plasma uranium concentration and renal injury was analyzed using conditional logistic regression models, and the dose-response relationship was analyzed through restricted cubic spline regression. The linear regression model and Spearman correlation were used to analyze the association between plasma uranium concentration and renal injury indicators.Results:The median of plasma uranium concentration was 8.94 ng/L in all subjects and 10.19 ng/L in the case group. The plasma uranium may be a risk factor for renal injury, with a dose-response relationship between the both representing nonlinear association ( χ2=5.15, P<0.05). The risk of renal injury was 4.21 times higher in the group exposed to highest uranium concentration than that in the group exposed to lowest uranium concentration. Plasma uranium concentration was closely related to glomerular filtration rate, serum creatinine and β 2-microglobulin ( r=0.211, -0.142, 0.195, P<0.05). Conclusions:The plasma uranium concentration is significantly associated with the renal injury, which may provide epidemiology evidence for the prevention of renal injury.

Background Exposure to uranium can result in multi-organ toxicity in humans. Some experimental studies have shown that uranium presents a damaging effect on liver, but no relevant population studies have been reported. Objective To investigate a potential association of plasma uranium exposure with liver injury. Methods The inhabitants of two representative areas of heavy metal pollution in northern and southern Hunan were selected as the research subjects. A total of 740 participants were recruited through 1∶1 paired case-control design based on a pre-determined diagnostic criterion for liver injury (defined as two or more anomalies among alanine aminotransferase, aspartate aminotransferase, and total bilirubin in the health examination) and the principle of case-control comparability. Information such as general demographic characteristics and medical history were collected through questionnaires and physical examination. Plasma uranium and liver function were determined by laboratory tests. Spearman correlation was applied to assess the association between plasma uranium concentration and liver injury indexes, and restricted cubic spline model was used to evaluate the dose-response relationship between plasma uranium concentration and liver injury. The participants were divided into four groups from Q1 to Q4 according to the quartile values of plasma uranium concentration of the control group after natural logarithmic transformation (with the Q1 group as the reference group), and the association between plasma uranium concentration and liver injury was evaluated by conditional logistic regression. Results The plasma uranium level in M (P₂₅, P₇₅) of the case group was 10.89 (6.78-18.53) ng·L⁻¹, higher than that in the control group, 9.26 (5.01-14.38) ng·L⁻¹ (P<0.001). The results of Spearman correlation analysis showed that alanine aminotransferase and aspartate aminotransferase were positively correlated with plasma uranium level (r_s=0.138, r_s=0.167; P<0.001). The restricted cubic spline model showed that the risk of liver injury increased with the increase of plasma uranium concentration (overall effect P<0.001). After adjusting for confounding factors such as gender, age, smoking, alcohol consumption, and prevalence of hypertension and hyperlipidemia, the results of conditional logistic regression analysis showed that the risks of liver injury in the Q2 group, the Q3 group, and the Q4 group were 2.043 (95%CI: 1.135-3.680), 2.246 (95%CI: 1.238-4.075), and 3.536 (95%CI: 1.955-6.397) times higher than that of the Q1 group respectively. Conclusion Plasma uranium exposure is associated with liver injury. This study is the first to provide population-level evidence of such an association.

Objective:To discuss the effect of bipolar radio frequency (RF) in combination with small incision on lower facial (cheek, chin and neck) shaping and rejuvenation.Methods:From August 2019 to June 2020, 26 patients (aged 35-60 years, with mean 45 years) required for facial rejuvenation and received the fine liposuction in the lower cheek, mandibular margin and submental neck area in Beijing Huangsi Plastic Surgery Hospital. With the help of bipolar RF device - EMBRACE RF (diamond carving), the facetite face and hand radiofrequency were adopted for the subcutaneous tissue to tighten the skin. A concealed small incision was made from the front of the ear to the posterior ear. The superficial layer of the superficial muscular aponeuritic system (SMAS) was stripped, folded, tightened and suspended. The excessive skin was removed while reducing multilayer tension. The incision was cosmetically sutured.Results:All 26 patients had their wounds primary healing, with no complications such as skin necrosis and sensory disorder. All the 24 patients were followed up for 6-12 months. Their scars were concealed and tiny, the skin was tight, the lifting effect was obvious, and the pouch of mouth corners disappeared or alleviated. The contour of the mandibular margin was defined and the mental cervical angle was clear. The shape of the neck was slender and the fat chin was significantly improved. The effect of facial rejuvenation was distinct. Two patients felt it worked but did not achieve the expected results. They were satisfactory after giving the second surgery 6 months later. The satisfactory rate of the first surgery was 92.3% in 24 patients.Conclusions:Bipolar RF in combination with small incision lifting surgery is effective in lower facial (cheek, chin and neck) shaping and rejuvenation. The trauma is little and the wound is recovered fast. The scar is concealed and tiny. It is worthy of clinical application.

Objective: To explore the genetic basis for a patient with autism. Methods: High-throughput sequencing was carried out to detect copy number variations in the patient. Results: DNA sequencing found that the patient has carried a 0.11 Mb deletion in distal 2p16.3 spanning from genomic position 50 820 001 to 50 922 000, which resulted removal of exon 6 and part of intron 7 of the NRXN1 gene. The same deletion was not found his parents and brother. Conclusion Partial deletion of the NRXN1 gene may underlie the disease in this patient.

OBJECTIVE: To explore the genetic basis for a patient with autism. METHODS: High-throughput sequencing was carried out to detect copy number variations in the patient. RESULTS: DNA sequencing found that the patient has carried a 0.11 Mb deletion in distal 2p16.3 spanning from genomic position 50 820 001 to 50 922 000, which resulted removal of exon 6 and part of intron 7 of the NRXN1 gene. The same deletion was not found his parents and brother. CONCLUSION Partial deletion of the NRXN1 gene may underlie the disease in this patient.
Autistic Disorder ; genetics ; Cell Adhesion Molecules, Neuronal ; genetics ; DNA Copy Number Variations ; Gene Deletion ; Humans ; Male ; Nerve Tissue Proteins ; genetics

Objective To investigate the current prevention status of hospital acquired venous thromboembolism(VTE) in Shandong province, to further improve the prevention and control of VTE system, and provide reference for prevention of hospital care to improve the quality of VTE. Methods An electronic questionnaire survey was conducted among nurses in 81 hospitals of Shandong province. The questionnaire mainly included three parts:basic information,the current prevention status of hospital acquired VTE and the training needs of nurses. A total of 3 766 valid questionnaires were recovered. Results 59.26%(48/81)hospitals established multi-discipinary team to prevent VTE,76.00%(38/50)of the tertiary hospitals established multi-discipinary team, which was higher than 32.26% (10/31) of the secondary hospitals, the difference was statistically significant (χ2=15.166, P=0.000). The VTE risk assessment scale had been routinely used to assess the risk of VTE in hospitalized patients,80.37%(352/438) tertiary hospital departments implemented grading nursing care while 71.43%(175/245) secondary hospitals departments implemented grading nursing care, the difference was statistically significant(χ2=7.120, P=0.008). Each level hospital mechanical preventive equipment configuration rate was less than 70%.Training needs of nurses:92.11%(3 469/3 766)nurses believed that it was necessary to organize the VTE related knowledge training for nurses,but there were significant differences in the training of nurses with different professional titles (Z=-12.607, P=0.000). 48.04%(1 149/2 392) nurses with junior grade professional titles were not trained. Conclusions The hospital attaches great importance to the prevention of hospital acquired VTE,but the construction level of VTE prevention system is unevenness, and primary hospitals should be further reinforced. The risk assessment scale selection lacks of uniform standards, mechanical preventive equipment allocation rate should to be further improved. And the training of primary nurses should be further strengthened.

Objective To investigate the value of leucine-rich repeat-containing G protein coupled receptor 5 (LGR5) and aldehyde dehydrogenase 1A1 (ALDH1A1) in progression and prognosis of non small-cell lung cancer (NSCLC),in order to find new targets for NSCLC-targeted imaging and radiation therapy.Methods Fresh tissues (n =24) and paraffin embedding tissues (n =109) of patients with NSCLC were collected from the First Affiliated Hospital of Soochow University between November 2009 and March 2012.Quantitative real time-PCR was used for the investigation of expression of LGR5 and ALDH1A1 mRNA in 24 NSCLC patients.Immunohistochemistry (IHC) was used for detecting LGR5 and ALDH1A1 expressions in NSCLC tissues and adjacent normal tissues.Data were analyzed by Mann-Whitney u test,x2 test,Pearson correlation analysis,Kaplan-Meier method,Cox proportional hazards regression model.Results Compared with adjacent normal tissues,LGR5 and ALDH1A1 mRNA were frequently increased in NSCLC tissues (u values:150,74,both P＜0.01),and the expression of LGR5 and ALDH1A1 mRNA was significantly correlated (r=0.416,P＜0.05).Positive LGR5 and ALDH1A1 expression was defined in 28.44％ (31/109) and 41.28％ (45/109) of the NSCLC tumors,respectively.Further analysis indicated that 24 of the LGR5 positive samples (77.42％,24/31) expressed ALDH1A1 (r=0.388,P＜0.01).LGR5 and ALDH1A1 ex pressions in NSCLC with higher TNM stage were significantly higher than those in NSCLC with lower TNM stage (x2 values:4.64,5.24,both P＜0.05).Coexpression of LGR5 and ALDH1A1 in NSCLC with lymph node metastasis was higher than that in NSCLC without lymph node metastasis (x2=4.12,P＜0.05).High expression of LGR5 or ALDH1A1 was related to poor prognosis (x2 values:6.24,4.18,both P＜0.05),and NSCLC patients with coexpression of LGR5 and ALDH1A1 had a poorer prognosis than the others (x2 =10.63,P＜0.01).Both of them were independent risk factors of a poorer prognosis (corrected hazard ratio (95％ CI):2.361(1.106-5.037),2.306(1.101-4.830);both P＜0.05).Conclusions The expressions of LGR5 and ALDH1A1 are closely associated with the tumorigenesis,metastasis and poor prognosis of NSCLC.LGR5 and ALDH1A1 might be new targets for NSCLC-targeted tumor imaging and radiation therapy.

Objective To observe the expression of triggering receptor expressed on myeloid cells (TREM),Caspase-3 and interleukin (IL)-6 in optic nerve tissue of ischemic optic neuropathy (ION).Methods Twenty Sprague-Dawley rats were randomly divided into control group and model group,10 rats in each group.The permanent ligation of bilateral internal carotid arteries (BICA) was performed for 14 days to establish subacute ION model as model group.The control group were separated BICA without ligation.The expressions of TREM-1,TREM-2,Caspase-3 and IL-6 in rat retina were detected by reverse transcription PCR and Western blot,respectively.Results Compared with the control group,the expressions of TREM-1,Caspase-3,IL-6mRNA (t=6.058,7.86,6.055) and protein (t=9.671,9.524,14.501) in the optic nerve tissue of the model group were increased,while the expression ofTREM-2 mRNA and protein (t=9.283) was decreased,and the difference was statistically significant (P＜0.05).Conclusion In ischemic optic nerve tissue,TREM-1 mRNA and protein were significantly expressed,the expressions of TREM-2 mRNA and protein decreased significantly.