Objective To enhance the quality of medical services in the intensive care unit(ICU)of provincial traditional Chinese medicine(TCM)hospitals.Methods In November 2023,Sichuan Provincial Critical Care Medicine Quality Control Center of TCM launched the"quality control supervision project scoring standard for critical care medicine of TCM"to conduct quality control evaluation and business guidance for all TCM hospitals with independent ICU.The survey covered structural indicators,control indicators,participation of TCM,development of new technologies,and diagnosis and treatment programs for dominant diseases.Results In terms of structural indicators:a total of 110 TCM hospitals in the province have independent ICU,an increase of 1.12 times compared with 2019.The control indicators showed that the ICU patients admission rate was higher than that of the national ICU admission rate in 2017,and the admission rate of patients with acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)score≥15 points increased.However,the mortality of ICU exceeded the national average.The implementation of core indicators had been significantly improved,but the incidence of outcome indicators such as ICU ventilator-associated pneumonia(VAP),ICU intravascular catheter-related bloodstream infection(CRBSI),and ICU catheter-related urinary tract infection(CAUTI)had increased since 2019,mainly in secondary hospitals.The average number of new technologies was about(5.5±3.4),the participation rate of TCM decreased,and the dominant diseases increased compared with 2019,mainly sepsis,respiratory failure and hemorrhagic stroke.Conclusions The number of ICU units in TCM hospitals at all levels in Sichuan province has grown rapidly,and key performance indicators have also improved compared to previous periods.However,greater efforts are still needed in preventing the occurrence rates of VAP,CRBSI,and CAUTI.There is a shortage of medical resources allocation,and the imbalance in regional medical resources and professional training remains an urgent issue to be addressed.Additionally,the participation rate of TCM and the dominant diseases need further enhancement.

Objective To study the effect of microRNA-183(miR-183)on the growth and development of ze-brafish inner ear,and its mechanism in the regeneration and growth of inner ear hair cells,otocyst and otolith in-jured by cisplatin.Methods Synthesized miRNAs(agomir)and antisense morpholino oligonucleotides(MOs)were injected into zebrafish embryos by microinjection to construct the model of these miRNAs'levels.The 72-hours post fertilization zebrafish were immersed in 50 μmol/L cisplatin for 24 hours.MiRNA microarray analysis,RT-qPCR and other techniques were used to detect the changes of miR-183 and FOXO1 gene expression.FM1-43FX fluores-cence staining was used to understand the injury and regeneration of inner ear nerve thalamic hair cells.The micro-scope was used to observe the growth and development of otocyst and otoliths.Results ① After the treatment of cisplatin,the inner ear hair cells of zebrafish were damaged and the growth and development of otocyst and otoliths were hindered.After the removal of cisplatin,the inner ear hair cells could be regenerated,and the growth and de-velopment of otocyst and otoliths also recovered gradually.② miR-183 was activated after the removal of cisplatin,which was one of the most differentially expressed members in zebrafish larva miRNA(P＜0.001),and the expres-sion level increased continuously to the peak and then gradually returned to the normal level.③ Compared with the control group,after the removal of cisplatin,the overexpression of miR-183 could promote the recovery of the num-ber of hair cells and the area of otocyst and otoliths,while the recovery was inhibited in the group with low expres-sion of miR-183.④ After the removal of cisplatin,FOXO1 was activated and the expression was up-regulated(P＜0.01).When miR-183 was overexpressed,FOXO1 was inhibited and expression was down-regulated(P＜0.01).Conversely,when miR-183 was low,the expression of FOXO1 increased(P＜0.01).Conclusion The increase of miR-183 expression occurs simultaneously with the regeneration of inner ear hair cells and the recovery of growth and development of the otolith area after cisplatin removal.The overexpression or low expression of miR-183 can promote or inhibit the regeneration of inner ear hair cells and the recovery of growth and development of the otolith area,indicating that there is a positive regulatory relationship between them.The mechanism may be related to the negative regulation of miR-183 on FOXO1.

This article reports a case data of primary malignant melanoma of the penis admitted to the Affiliated Hospital of Qinghai University. A 56-year-old patient was admitted to the hospital 1 month after the discovery of a penile mass. Physical examination: An irregular cauliflower-like mass about 1.5 cm×2.0 cm in size was seen below the external urethral orifice, covered with yellow necrotic tissue, and tenderness was positive. Several nodes were palpable in the left and right groin areas, tenderness positive. Laboratory examination showed no abnormality. The CT examination of head, chest, abdomen and pelvis showed no obvious abnormality. The biopsy of the penile mass showed malignant melanoma of the penis. The pathological results of biopsy of the right inguinal lymph node considered local inflammation. Combined with the patient's medical history, physical examination, imaging examination and lymph node biopsy results, a diagnosis of primary penile malignant melanoma was made. Partial penile resection was performed, and the postoperative pathological diagnosis was malignant melanin invasion of the epidermis with ulceration. There was no local recurrence and metastasis during the 9-month follow-up.

Objective To analyze the epidemiological characteristics and risk factors of bronchiectasis in patients with chronic obstructive pulmonary disease (COPD) in Suining area, and to provide theoretical basis for COPD prevention and treatment of bronchiectasis. Methods A total of 582 patients with ACUTE exacerbation of COPD (AECOPD) admitted to grade A Hospitals in Suining area from 2019 to 2020 were selected as the investigation objects. According to whether the patients had bronchiectasis, they were divided into control group (without bronchiectasis, n=485) and observation group (with bronchiectasis, n=97). The risk factors of bronchiectasis in COPD patients were analyzed by univariate analysis and logistic regression. The clinical data of the two groups were compared, including age, sex, whether there were other diseases, respiratory tract infection, proportion of purpuric sputum, colonization rate of Pseudomonas aeruginosa. Results Of 16.84% (49/291) AECOPD patients occurred Bronchiectasis. The colonization rate of Pseudomonas aeruginosa in observation group was significantly higher than that in control group (P<0.05). The values of FVC and FEV1/FVC in observation group were significantly lower than those in control group (P<0.05). The levels of serum CRP and PCT in the observation group were significantly higher than those in the control group (P<0.05). Male (OR=2.515), high proportion of GOLD grade III/IV (OR=3.654), smoking (OR=3.472), diabetes (OR=3.829) and bacterial infection (OR=4.159) were independent risk factors for bronchiectasis in COPD patients (P<0.05). Conclusion COPD patients in Suining area have a high risk of bronchiectasis.The lung function was declined significantly.It has a high colonization rate of Pseudomonas aeruginosa. Patients who are male, have a high proportion of GOLD class III/IV, smoke, have diabetes, and have bacterial infections should be given interventions that can reduce the risk of bronchiectasis in COPD patients.

Macrophages, as important immune cells, are involved in the key processes that maintain the homeostasis of intrahepatic microenvironment. Recent studies have shown that different liver diseases can induce macrophage polarization (MPP) and form M1 and M2 phenotypes with mutual antagonism. The former promotes the clearance of pathogens and inhibits tumor progression, while the latter exerts an anti-inflammatory effect and promotes tissue repair. However, there are significant differences in the mechanism of action and phenotypic switching of MPP in different liver diseases or at different pathological stages of the disease. This article focuses on the origin and polarization characteristics of intrahepatic macrophages and summarizes the research advances in the role of MPP in the pathogenesis and therapeutic drugs of non-neoplastic liver diseases such as viral hepatitis, alcoholic liver disease, non-alcoholic fatty liver disease, and liver fibrosis, in order to explore the potential of MPP in regulating the immune response and inflammatory response of liver diseases.

Objective:To investigate the diagnostic performance of MRI Liver Imaging Reporting and Data System version 2018 in high-risk hepatocellular carcinoma (HCC) patients with intrahepatic parenchymal substantial lesions ≤3.0 cm.Methods:A retrospective analysis was conducted in hospitals between September 2014 to April 2020. 131 pathologically confirmed non-HCC cases with lesions ≤3.0 cm in diameter were randomly matched with 131 cases with lesions ≤3.0 cm in diameter and divided into benign (56 cases), other hepatic malignant tumor (OM, 75 cases), and HCC group (131 cases) in a 1:1 ratio. MRI features of the lesions were analyzed and classified according to LI-RADS v2018 criteria (tie-break rule was applied to lesions with both HCC and LR-M features). Taking the pathological results as the gold standard, the sensitivity and specificity of the LI-RADS v2018 classification criteria and the more stringent LR-5 criteria (with three main signs of HCC at the same time) were calculated for HCC, OM or benign lesions diagnosis. Mann -Whitney U test was used to compare the classification results. Results:The number of cases classified as LR-M, LR-1, LR-2, LR-3, LR-4, and LR-5 in HCC group after applying the tie-break rule were 14, 0, 0, 12, 28, and 77, respectively. There were 40, 0, 0, 4, 17, 14 and 8, 5, 1, 26, 13, 3 cases in benign and OM group, respectively. There were 41 (41/77), 4 (4/14) and 1 (1/3) lesion case in the HCC, OM and benign group, respectively, that met the more stringent LR-5 criteria. The sensitivity of LR-4 combined with LR-5 (LR-4/5) criteria, LR-5 criteria and more stringent LR-5 criteria for HCC diagnosis were 80.2% (105/131), 58.8% (77/131) and 31.3% (41/131), respectively, and the specificity were 64.1% (84/131), 87.0% (114/131) and 96.2% (126/131), respectively. The sensitivity and specificity of LR-M were 53.3% (40/75) and 88.2% (165/187), respectively. The sensitivity and specificity using LR-1 combined with LR-2 (LR-1/2) criteria for the diagnosis of benign liver lesions were 10.7% (6/56) and 100% (206/206), respectively.Conclusions:LR-1/2, LR-5, and LR-M criteria have high diagnostic specificity for intrahepatic lesions with a diameter of ≤3.0 cm. Lesions classified as LR-3 are more likely to be benign. The specificity of LR-4/5 criteria is low, while the more stringent LR-5 criteria has a high specificity for HCC diagnosis.

Objective    To analyze the effectiveness of in vitro fenestration versus bypass surgery techniques in the treatment of type B aortic dissection involving the left subclavian artery by thoracic endovascular aortic repair (TEVAR). Methods    Among the 53 patients with type B aortic dissection involving the left subclavian artery admitted to our center from January 2017 to October 2020, 23 underwent in vitro fenestration + TEVAR (a fenestration group with 18 males and 5 females aged 53.6±5.3 years), and 30 patients underwent left common carotid artery-left subclavian artery bypass + TEVAR (a bypass group with 24 males and 6 females aged 51.8±3.8 years). The effectiveness and safety between the two groups were compared. Results    The surgical success rate was 100.0% in both groups. And there was no death within postoperative 30 days and during the follow-up. There was no endoleak immediately postoperatively and during 1-year follow-up in the two groups. The operation time and hospitalization expenses in the fenestration group was less or shorter than those in the bypass group (P<0.05). The reduction in blood pressure of the left upper limb in the fenestration group was greater than that in the bypass group (P<0.05). There was no symptom of left upper limb ischemia, dizziness or hoarseness in both groups. Conclusion    The two methods of reconstruction of the left subclavian artery are safe and effective. In vitro fenestration can reduce surgical trauma and costs, and bypass surgery can provide better forward blood flow for the left subclavian artery.

Objective:Since December 2019, novel coronavirus infection has occurred in Hubei province and spread throughout the country quickly. This new crown viral pneumonia was named as coronavirus disease of 2019 (COVID-19) by WHO. However, at present, there is a high incidence of acute aortic dissection in winter and spring. How to prevent the spread of the epidemic and choose the appropriate treatment is an important topic for the patients with acute aortic dissection.Methods:From January 16, 2020 to February 26, 2020, a total of 37 of acute aortic dissection operations were carried out in several cardiovascular surgery centers in Hubei Province. There were 18 cases of Stanford type A aortic dissection and 19 cases of Stanford type B aortic dissection. There were 10 cases (55.55%) with ascending aorta replacement and 7 cases (38.89%) with Bentall procedure for aortic root surgery, and total arch replacement with stented elephant trunk implantation were performed in 14 cases (77.8%). In 19 patients with Stanford type B aortic dissection, thoracic endovascular aortic repair was performed, with the left subclavian artery chimney technique in 2 cases.Results:No deaths occurred within 30 days of hospitalization. Preoperative nucleic acid testing excluded 7 cases of novel coronavirus infection, and 3 suspected cases underwent emergency surgery. the three-level protective standard was adopted in the majority of the surgeries(62.2%, 23/37), and 11 patients were negative in the reexamination of viral nucleic acid after the operation.Conclusion:During the epidemic period, patients with acute aortic dissection should be carefully identified with actife COVID-19 before surgery. The treatment principles-" prevention and control of pneumonia epidemic should be emphasized, conservative medical management should be taken in the comfirmed cases, the selective operation should be delayed as far as possible, and the operation should be reasonable performed in critical cases" should be followed, which can save patients' lives to the greatest extent and prevent the spread of the virus.

Objective:To investigate the effect of periacetabular osteotomy (PAO) assisted by preoperative 3D printing planning on the treatment of early developmental dislocation of the hip (DDH).Methods:A retrospective study was conducted of the 39 patients (44 hips) with CROWE type Ⅰ DDH who had been treated at Department of Orthopaedics, Guizhou Provincial People＇s Hospital from May 2015 to April 2019. In the observation group of 19 patients (22 hips) who were treated by PAO assisted by preoperative 3D printing planning, there were 4 males (4 hips) and 15 females (18 hips) with a mean age of 23(19, 39) years; in the control group of 20 patients (22 hips) who were treated by mere PAO, there were 2 males (2 hips) and 18 females (20 hips) with a mean age of 23(20, 29) years. The 2 groups were compared in terms of operation time, intraoperative bleeding, hospital stay, fluoroscopic frequency, Wiberg lateral center-edge angle (LCE), acetabular index (AC), acetabulum coverage rate, Harris hip scores (HHS) and complications at the final follow-up.Results:There were no significant differences between the 2 groups in their preoperative general data, showing compatibility of the 2 groups ( P>0.05). Both groups were successfully followed up for 6 to 12 months (mean, 9.6 months). The operation time [100 (90, 120) min], intraoperative bleeding [160 (150, 180) mL], hospital stay [6 (5, 7) d], and fluoroscopic frequency [24 (22, 25) times] in the observation group were all significantly better than those in the control group [140 (100, 157) min, 200 (180, 250) mL,9(7, 11) d and 28 (24, 32) times] in the control group ( P<0.05). However, there were no significant differences between the 2 groups in LCE, AC or acetabulum coverage rate immediately after operation, or in HHS or complications at the final follow-up( P>0.05). Conclusions:Although PAO has a definite therapeutic effect on early DDH, PAO assisted by preoperative 3D printing planning can effectively reduce operation time, intraoperative bleeding, hospital stay and intraoperative fluoroscopy. Thus, combination of the two can result in a better therapeutic effect than PAO alone.

A 25-year-old man with extensive burn due to industrial dust explosion was admitted to the First Affiliated Hospital of Naval Medical University on 16th October, 2018. Four days after the first skin grafting and vacuum sealing drainage surgery, the patient developed signs of uncontrolled severe inflammation and shock. However, several atypical manifestations interfered the diagnosis of septic shock. After giving emergency treatment including fluid resuscitation, broad-spectrum antibiotics, and administration of vasopressor agents, the patient′s condition was alleviated, but quickly relapsed and deteriorated, with acute pulmonary edema appeared in the evening of the same day. Finally, the condition was reversed by completely removing the negative pressure devices on upper limbs and thorough dressing change. This case suggests that the diagnosis and treatment of infection in patients with extensive burn need comprehensive analysis. Timely intervention of the wound is the key to control the exacerbation of sepsis. In addition, the possibility of pulmonary edema in patients with sepsis should be on high alert.