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.

AIM:To investigate the mechanism through which esculetin induces ferroptosis of mouse breast cancer 4T1 cells.METHODS:Molecular docking of esculetin with p53,solute carrier family 7 member 11(SLC7A11)and glutathione peroxidase 4(GPX4)proteins was performed,and Kaplan-Meier curves and time-dependent receiver oper-ating characteristic curves were drawn.The 4T1 cells were divided into 6 groups,namely the control(CON),1/2 IC50,IC50,2 IC50,erastin,and capecitabine groups.The appropriate drug concentration for treating 4T1 cells was screened by CCK-8 assay.The invasion and migration abilities of 4T1 cells following esculetin treatment at the selected drug concentra-tion were analyzed by scratch test and Transwell assay.Mitochondrial morphological change were examined by electron mi-croscopy.The levels of ferroptotic cell death were then quantified by Fe2+,reactive oxygen species(ROS),malondialde-hyde(MDA),glutathione(GSH),and GPX4 assays.Western blot was performed to evaluate the protein levels of p53,SLC7A11,GPX4 and acyl-CoA synthetase long-chain family member 4(ACSL4).RESULTS:Compared with CON group,the esculetin 1/2 IC50,IC50 and 2 IC50 groups showed smaller size,increased membrane density,and decreased ridge of mitochodria,as well as decreased levels of GSH and GPX4,reduced cell invasion and migration abilities,and de-creased levels of SLC7A11 and GPX4 proteins(P＜0.05).Furthermore,these groups exhibited increased levels of Fe2+,ROS,and MDA,as well as elevated p53 and ACSL4 protein abundance(P＜0.05).CONCLUSION:Esculetin pro-motes ferroptosis of 4T1 cells through a mechanism involving the p53/SLC7A11/GPX4 regulatory axis.

Objective:To study the risk factors of venous thromboembolism(VTE)and the predictive value of the improved VTE score model to identify the risk of VTE in gynecological surgery patients.Methods:From Janu-ary 1,2020 to December 31,2022,41 patients with VTE after gynecological surgery were selected as the VTE group,and a total of 164 patients with adjacent gynecological surgeries during the same period were selected as the non-VTE group with a ratio of 1 :4.Univariate and multivariate Logistic regression analysis were used to ana-lyze the risk factors of VTE after gynecological surgery,and a modified VTE risk factor rapid assessment model(referred to as the improved VTE score model)was constructed.The receiver operating characteristic(ROC)curve was used to study the predictive value for VTE for in gynecological surgery,and compared with the Caprini score model(Caprini table for short).Results:①Multivatiate Logistic regression analysis showed that there were independent risk factors for postoperative VTE in gynecology surgery(OR＞1,P＜0.05),including age≥60 years,BMI≥28 kg/m2,malignant tumors,surgery time＞3 hours,history of thrombosis,and the increased D-di-mer difference before and after surgery.②The Area under Curve(AUC)of ROC was 0.963 in the improved VTE score model with a Youden index 81.10％,sensitivity 87.80％and specificity 93.29％.The AUC of the Caprini score model was 0.888 with Youden index 63.41％,sensitivity 73.17％and specificity 90.24％.The improved VTE score model the Caprini score model identified 92.68％and 85.37％of VTE patients as high-risk or ex-tremely high-risk,respectively,but the difference was not statistically significant(P＜0.05).Conclusions:More attention should be paid to the six independent risk factors for postoperative VTE in gynecology surgery.The two score models showed a similar identified level.However,the improved VTE score model is more simple and easier to operate,has better practicality,and has certain clinical promotion value.

OBJECTIVE To study the efficacy and mechanism of Shugan Jianpi Jiedu decoction in the treatment of the precancerous lesions of breast cancer through animal experiment. METHODS SD rats were taken and divided into 6 groups(10 rats in each group), namely blank group, breast precancerous lesion model group, tamoxifen group, Shugan Jianpi Jiedu decoction groups with low dose, middle dose, and high dose. DMBA modeling method was used to carry out modeling for breast precancerous lesion. HE staining was used to observe the pathological changes of breast tissue. CD4+, CD8+ were detected by flow cytometry. ELISA was used to detect IL-2, IL-4, IL-6, IL-10, IL-12, E2, P. The protein expression of ER, PI3K, p-Akt and mTOR was detected by Western blotting. RESULTS HE staining showed changes in rat mammary tissue, indicating successful modeling. Compared with the blank group, the content of CD4+ decreased and the content of CD8+ increased in the model group(P<0.01); compared with model group, the content of CD4+ increased and the content of CD8+ decreased in low, middle, high dose groups of Shugan Jianpi Jiedu decoction and tamoxifen group(P<0.01). The levels of IL-2, IL-4 and IL-10 in the model group were significantly lower than those in the blank group(P<0.01), while IL-12 and IL-6 were significantly increased(P<0.01). Compared with the model group, the concentrations of IL-2, IL-4 and IL-10 in the low, middle and high dose groups of Shugan Jianpi Jiedu decoction and the tamoxifen group were significantly increased(P<0.01), while IL-12 and IL-6 decreased significantly(P<0.05 or P<0.01). Compared with the blank group, the contents of E2 and P in the model group increased significantly(P<0.05 or P<0.01), the contents of E2 and P in the low, middle and high dose groups of Shugan Jianpi Jiedu decoction and the tamoxifen group were significantly lower than those in the model group(P<0.01). The Western blotting results showed that compared with the blank group, the expression of ER, PI3K, p-Akt and mTOR in the model group was significantly increased(P<0.01). Compared with the model group, the expression of ER, PI3K, p-Akt and mTOR in the low, medium and high dose groups of Shugan Jianpi Jiedu decoction and the tamoxifen group were significantly decreased(P<0.01). CONCLUSION Shugan Jianpi Jiedu decoction may inhibit the expression of ER, thus inhibiting the expression of PI3K/Akt/mTOR signaling pathway. Meanwhile, it can affect the immune response and reverse the precancerous lesions of breast cancer.

Objectives:To understand the differences in clinical characteristics, treatment status, and prognosis between outpatient and inpatient heart failure patients in the real world.Methods:A prospective, multicenter registration study was conducted to select 972 outpatient or inpatient heart failure patients from 24 different regions and levels of hospitals in China from December 2012 to November 2014. Demographic and clinical data, as well as treatment status, were collected and followed up at 1 year. The difference in medication treatment status between baseline and 1-year follow-up was compared using McNemar paired χ 2 test. Pearson χ 2 test was used to compare the differences in clinical data, treatment status, and outcomes between outpatient and inpatient patients. Results:There were 610 outpatient patients (62.8%), and the proportion of outpatient patients under 65 years old was higher than that of hospitalized patients [44.9%(274/610) vs 35.1%(127/362), P<0.05]. The proportion of NYHA grade Ⅲ/Ⅳ patients was as high as 50.8%(310/610), and 92.5%(564/610) of outpatient patients had difficulty breathing while walking uphill. 27.9%(170/610) of outpatient patients had jugular vein pressure greater than 6 cmH 2O, and 24.3%(148/610) of outpatient patients had pulmonary moist rales. There was no significant difference in the main causes of heart failure between outpatient and inpatient patients ( P=0.063), with ischemic cardiomyopathy being the main cause. At baseline, the use of beta blockers in outpatient patients was higher than that in hospitalized patients [63.0%(384/610) vs 54.4%(197/362), P<0.05], while the use of diuretics and aldosterone receptor antagonists was lower than that in hospitalized patients [53.1%(324/610) vs 72.1%(261/362), 49.5%(302/610) vs 61.3%(222/362), P<0.05]. There was no statistically significant difference in the use of ACEI/ARB between the two groups [67.4%(411/610) vs 62.4%(226/362), P>0.05]. At one-year follow-up, the use of ACEI/ARB in outpatient patients decreased [63.5%(360/567) vs 67.4%(411/610), P<0.05], the usage rate of aldosterone receptor antagonists in hospitalized patients decreased by [50.3%(165/328) vs 61.3%(222/362), P<0.05]. The one-year all-cause mortality rate of the two groups of patients was close to [6.7%(41/610) vs 9.4%(34/362), P=0.124], The hospitalization rate for heart failure in the outpatient group was lower than that of hospitalized patients [25.4%(155/610) vs 36.5%(132/362), P<0.05], but still>25.0%. Conclusions:Outpatient heart failure patients still have obvious symptoms and signs, and the prognosis is poor. The standardized management of outpatient heart failure patients cannot be ignored.

Liver cancer is one of the most dangerous malignant tumors in China. It has the characteristics of high mortality and occult onset. At present, the treatment of liver cancer is mainly targeted drugs, surgery and chemoradiotherapy, which is prone to high recurrence rate and strong drug resistance. In this paper, glutamine metabolism as the breakthrough point, the glutamine metabolism enzymes and related genes related to liver cancer are reviewed, in order to provide an open new idea for the pathogenesis and drug treatment of liver cancer.

Objective: To explore the occurrence of cognitive impairment in Chinese heart failure (HF) patients and it's impact on prognosis. Methods: In this prospective observational study, a total of 990 HF patients were enrolled from 24 hospitals in China during December 2012 to November 2014. All patients were administrated with the interview-format Montreal Cognitive Assessment (MoCA), according to which they were divided into MoCA<26 (with cognitive impairment) group and MoCA≥26 (without cognitive impairment) group. Baseline data were collected and a 1-year follow up was carried out. Univariate and multivariate logistic or Cox regression were performed for 1-year outcomes. Results: Cognitive impairment was evidenced in 628 patients (63.4%) and they were more likely to be older, female, and with higher proportion of New York Heart Association(NYHA) class Ⅲ-Ⅳ, chronic obstructive pulmonary disease (COPD), ischemic heart disease, while body mass index (BMI), education level, and medical insurance rate were lower (all P<0.05) as compared to patients in MoCA≥26 group. The rate of percutaneous intervention, device implantation, cardiac surgery and evidence-based medications were significantly lower in MoCA<26 group than in MoCA≥26 group (all P<0.05). During the 1-year follow up, patients in the MoCA<26 group had higher all-cause mortality (10.2%(64/628) vs. 2.2%(8/362), P<0.01), cardiovascular mortality (5.9%(37/628) vs. 0.8%(3/362), P<0.01) and major adverse cardiac and cerebrovascular events (MACCE) (9.6%(60/628) vs. 2.5%(8/362), P<0.01) than patients in the MoCA≥26 group. In univariate regression, MoCA<26 was associated with increased all-cause mortality (HR(95%CI):4.739(2.272-9.885), P<0.01), cardiovascular mortality (HR(95%CI):7.258(2.237-23.548), P=0.001) and MACCE (OR(95%CI):4.143(2.031-8.453), P<0.01). After adjustment by multivariate regression, MoCA<26 was indicated as an independent risk factor for all-cause mortality (HR(95%CI): 6.387(2.533-16.104), P<0.01), cardiovascular mortality (HR(95%CI): 10.848(2.586-45.506), P=0.001) and MACCE (OR(95%CI): 4.081(1.299-12.816), P=0.016), while not for re-hospitalization for HF (OR(95%CI):1.010(0.700-1.457), P=0.957). Conclusions Cognitive impairment is common in HF patients,and it is an independent prognostic factor for 1-year outcomes. Routine cognitive function assessment and active intervention are thus recommended for HF patients.

Objective To understand the cleanliness of hands and uniforms of health care workers(HCWs)while they were working in a hospital.Methods Specimens of hands and uniforms of HCWs while they were working were collected and detected.Results A total of 342 specimens were collected, 173 were specimens from hands and 169 were from uniforms, the total qualified rate was 78.65%,qualified rates of hands and uniforms were 76.30% and 81.07% respectively.Qualified rates of hands and uniforms of different HCWs were compared respectively, differences were both statistically significant (both P<0.05);qualified rates of hands and uniforms of nurses were both highest (87.93% and 92.86% respectively), followed by doctors (75.86% and 87.72% respectively), while medical auxiliary persons were the lowest(64.91% and 62.50% respectively).Correlation analysis between qualified rates of hands and uniforms of HCWs in general wards showed that the correlation coefficient was 0.930 (P<0.01).Conclusion Cleanliness of hands and uniforms of HCWs needs to be further improved, especially medical auxiliary persons;cleaning frequency and cleanliness standard of HCWs' uniforms needed to be studied further.

Objective To compare the positive rates and complications of ultrasound?guided transperi?neal and transrectal prostate biopsies with 12+X method. Methods From January 2011 to January 2015,252 cases patients underwent ultrasound?guided prostate biopsies with 12+X method for suspected prostate carcinoma were selected as research subjects,including 114 cases were perineal puncture( transperineal group) and 138 ca?ses were transrectal puncture( transrectal group) . The positive rates and complications of biopsy were compared between the two groups. Results The positive rates in the transperineal and transrectal groups were 43. 5%( 50/114) and 41. 3%( 57/138) ,and there was no significant difference( P>0. 05) . No statistically significant differ?ences were observed between the two groups according to different PSA levels(≤4. 0,>4. 0-≤10. 0,>10. 0-≤20. 0,>20. 0 μg/L) ( P>0. 05) . There were no significant differences between two groups in complications such as:hematuria,lower urinary tract symptoms and acute urinary retention( P>0. 05) . The incidence rates of post?biopsy infection and rectal bleeding were remarkably lower(2. 6%(3/114) vs. 13. 0%(18/138),1. 8%( 2/114) vs. 11. 6%( 6/138) ,P=0. 005,0. 002) in transperineal group than in transrectal group. However,the perineal swelling rate was remarkably higher in the transperineal group than that in the transrectal group( 8. 8%( 10/114) vs. 0. 7%( 11/138) ,P=0. 003) . Conclusion Ultrasound?guided transperineal and transrectal pros?tate biopsies with 12+X method are both effective for the diagnosis of prostate carcinoma. The positive rates of the two approaches are similar,but the complications are different. The choice between the two approaches depended on the clinical features of the patients.

Objective To explore the influence of different feeding methods on feeding tolerance and nutritional status of preterm infants.Methods Forty-eight cases of preterm infants were randomly divided into experiment group and control group,24 cases in each group.The experiment group adopt 24 hours continuous feeding by infusion pump,and the control group with syringe injection,with injection time of 3~5mins every 2 hours.The two groups were compared in terms of feeding tolerance,body weight and nutritional status.Results The feeding intolerance of experiment group was lower than that in the control group,weight and prealbumin were higher than those in the control group(P<0.05 or P<0.01).Conclusion The continuous feeding is the ideal feeding method,which can improve growth,feeding tolerance and nutritional status of preterm infants.