The community teaching bases play an important role in training of general practice talents. To raise the training quality, the development of their own capacity is crucial, but community medical institutions also need close cooperation with the departments of general practice in medical schools and the higher-level general hospitals. This article discusses the integration model of management, teaching and research in general practice talent training based on the cooperation of community teaching bases with relevant governmental departments, professional societies/associations, general hospitals and medical schools.

Objective To observe whether the IL-23/Th17 inflammatory pathway is involved in the development of calcific aortic valve disease,and whether secukinumab can delay the progression of calcific aortic valve disease by inhibiting this pathway.Methods Forty-seven mice were divided into a blank control group,model group,and secukinumab group according to the random number table method.The blank control group was fed normal chow,while the model group and secukinumab group were fed pro-calcification chow for 16 weeks to establish a calcific aortic valve disease model.After intervention with secukinumab for 4 weeks,peak flow velocity changes in the aortic valves were detected under Doppler ultrasonography in all mice.Relevant indexes were determined by hematoxylin and eosin staining,Von Kossa staining,immunohistochemical staining,ELISA,and qPCR.Results Compared with the model group,the secukinumab group showed significantly reduced peak flow velocity(P＜0.05)and serum IL-6,IL-17,and IL-23 levels(P＜0.05)in the aortic valve.Compared with the secukinumab group,the model group's leaflet thickness was significantly increased,and there were more calcium deposits.Immunohistochemical result showed that macrophage infiltration(P＜0.05),IL-17A(P＜0.05)and IL-23(P＞0.05)levels in the valve leaflets were reduced in the secukinumab group compared with the model group.PCR result suggested that the expression of STAT3,BMP-2,and α-SMA mRNA was significantly lower in the secukinumab group than the model group(P＜0.05).Conclusions The IL-23/Th17 inflammatory pathway is involved in the pathogenesis of calcific aortic valve disease.The inflammation,fibrosis,osteogenic differentiation,and calcification of mouse valves were alleviated after intervention with secukinumab,which may delay disease progression by inhibiting the IL-23/Th17 inflammatory pathway.

Objective To systematically evaluate the risk prediction model for central venous catheter-related bloodstream infections and provide references for clinical practice.Methods Databases such as CNKI,Wanfang,CBM,VIP,PubMed,Web of Science,Cochrane Library,etc.were retrieved.The search period is from database establishment to June 2,2023.There are 2 researchers who independently screened and extracted the literature,and evaluated the quality of the literature using bias assessment tools of predictive model risk.Results A total of 9 articles were included,including 9 risk prediction models for catheter-related bloodstream infections.The total sample size was 80～11 901 cases;the number of outcome events was 19～403 cases;the C index of the included model was 0.81～0.93.The area under the curve of the subjects ranged from 0.73～0.90.The predictors that appear more frequently in the model mainly included the history of diabetes,albumin value,the number of days of catheterization,the location of catheterization.The evaluation results of the bias assessment tool of predictive model risk for research show that the overall applicability of the included risk prediction models is good,but the bias risk is high.The reasons are related to the improper source of research sample data,inappropriate processing of continuous variable methods,failure to process missing data,insufficient model performance evaluation,and non-standard evaluation indicators.Conclusion There are still some shortcomings in the risk prediction model for central venous catheter-related bloodstream infections.In the future,the quality of related model research should be further improved,especially in terms of predictive factor analysis,model evaluation indicators,etc.,which should be further standardized.

Objective:To investigate the effect of online acceptance and commitment therapy(ACT) group intervention on psychological flexibility of undergraduate students with facial negative physical self.Methods:From March to June 2022, thirty-two undergraduates with facial negative physical self-image were recruited, assessed and selected from a university in Zhejiang Province.The subjects were randomly divided into the training group( n=16) and the control group( n=16). The training group received 20 days of online ACT group intervention, while the control group kept waiting.The cognitive fusion questionnaire(CFQ), acceptance and action questionnaire version Ⅱ(AAQ-Ⅱ) and negative physical self scale-face(NPSS-F) were used to measure the two groups before and after intervention and 1 month after intervention.Repeated measurement analysis of variance(ANOVA) conducted was used to compare scale results with SPSS 26.0. Results:(1)The interaction effect between group and time of CFQ scores was statistically significant( F(1.625, 48.755)=4.316, P=0.025, ηp2=0.126). After intervention, the CFQ score of the training group was significantly lower than those of the control group(34.38±8.66, 40.94±8.82, P<0.05). The CFQ scores of the training group after intervention and 1 month after intervention(36.00±9.49) were both significantly lower than those before intervention(41.87±8.72, all P<0.05). (2)The interaction effect between group and time of AAQ-Ⅱ scores was marginally statistically significant( F(2, 29)=3.009, P=0.065, ηp2=0.172). After intervention, the AAQ-Ⅱ score of the training group was significantly lower than those of the control group(24.12±4.97, 28.69±6.78, P<0.05). The AAQ-Ⅱ score of the training group after intervention was significantly lower than those before intervention(28.75±6.11, P<0.05). (3)The interaction effect between group and time of NPSS-F scores was not statistically significant( F(2, 29)=1.509, P=0.238, ηp2=0.094), while the main effect of time was marginally statistically significant between the two groups( F(2, 29)=3.315, P=0.051, ηp2=0.186). The NPSS-F score of the training group after intervention was significantly lower than those before intervention(16.06±6.67, 18.81±7.85, P<0.05). Conclusion:Online ACT group intervention can effectively reduce the cognitive fusion and experiential avoidance of undergraduate students with facial negative physical self, then can improve their psychological flexibility.

BackgroundCompared with male adolescents， depression among female adolescents is of higher prevalence and greater severity. The level of generalized trust correlates with the severity of depression， and attachment correlates with the level of generalized trust. Therefore， based on the mediating role of generalized trust between attachment and depression， this study explores the pathogenesis of depression in female adolescents. ObjectiveTo explore the mediating role of generalized trust between paternal， maternal and peer attachment and depression in female adolescents， so as to provide references for improving the depression of female adolescents. MethodsThis study included 73 female adolescents who met the diagnostic criteria for depressive disorder in the International Classification of Diseases， tenth edition（ICD-10） as well as received outpatient and inpatient treatment in Hangzhou Seventh People's Hospital between March 2022 and October 2022. Investigation was conducted by use of Revised Inventory of Parent and Peer Attachment （IPPA-R）， the Inclusive General Trust Scale （IGTS） and Children's Depression Inventory （CDI）. Pearson correlation analysis was used to explore the correlation between each scale score. The Bootstrap method was used to test the mediating role of generalized trust between attachment and depression. Results① CDI score in female adolescents with depression was negatively correlated with scores of paternal， maternal and peer attachment in IPPA-R （r=-0.463， -0.459， -0.447， P<0.01）. Scores of paternal， maternal and peer attachment in IPPA-R were positively correlated with IGTS score （r=0.372， 0.318， 0.395， P<0.01）. IGTS score was negatively correlated with CDI score （r=-0.531， P<0.01 ）. ②The test of mediating role showed that the direct effect of paternal， maternal and peer attachment on depression level was significant in female adolescents with depression （effect size=-0.138， -0.136， -0.107， 95% CI： -0.236~-0.039， -0.242~-0.029， -0.203~-0.012）. ③The mediating role of generalized trust between paternal， maternal peer attachment and depression level was significant （effect size=-0.069， -0.066， -0.071， 95% CI： -0.127~-0.021， -0.137~-0.010， -0.145~-0.018）. ConclusionPaternal， maternal and peer attachment can influence the depression level of female adolescents both directly and indirectly through the generalized trust.

Objective:To examine the effectiveness of thin struct bare stents for the treatment of spontaneous isolated dissection of the superior mesenteric artery (SIDSMA).Methods:The data of 32 patients admitted to First Hospital of Jiaxing (20 cases) and Jinling Hospital (12 cases) with SIDSMA from January 2016 to January 2021 were retrospectively analyzed. There were 27 males and 5 females, aging (54.8±9.4) years (range: 36 to 75 years). All patients were treated with thin struct bare stents. Controllable spring coils were used to fulfill the false lumen in 2 cases. Symptoms, vascular remodeling pattern at the SIDSMA lesion, and patency of the stents were observed during follow-up.Results:The surgical success rate was 100%. According to the length of the lesions and stents, the number of stents implanted was 1 in 17 cases, 2 in 11 cases and 3 in 4 cases. The angiography showed that blood flow in the stent was smooth. The numerical rating scale for abdominal pain decreased from 6.1±1.5 (range: 4 to 10) preoperatively to 1.0 (1.0) (range: 0 to 3) 1 hour postoperatively ( W=528, P<0.01). The compression rate of the true lumen of the superior mesenteric artery decreased from (92.3±6.7)% (range: 25% to 94%) preoperatively to 0.8 (1.2)% (range: 0 to 3.2%) 1 month postoperatively ( W=528, P<0.01). The primary patency rate of CT angiography at 1 month postoperatively was 100%. The vascular remodeling rate was (92.3±6.7)% (range: 80% to 100%). All patients were followed for (46.3±17.0) months (range: 24 to 76 months). The cumulative patency rates in 1, 2 and 5 years were all 100%. Conclusion:The use of thin struct bare stents for SIDSMA could obtained the expected safety and efficacy.

Objective:To examine the effectiveness of thin struct bare stents for the treatment of spontaneous isolated dissection of the superior mesenteric artery (SIDSMA).Methods:The data of 32 patients admitted to First Hospital of Jiaxing (20 cases) and Jinling Hospital (12 cases) with SIDSMA from January 2016 to January 2021 were retrospectively analyzed. There were 27 males and 5 females, aging (54.8±9.4) years (range: 36 to 75 years). All patients were treated with thin struct bare stents. Controllable spring coils were used to fulfill the false lumen in 2 cases. Symptoms, vascular remodeling pattern at the SIDSMA lesion, and patency of the stents were observed during follow-up.Results:The surgical success rate was 100%. According to the length of the lesions and stents, the number of stents implanted was 1 in 17 cases, 2 in 11 cases and 3 in 4 cases. The angiography showed that blood flow in the stent was smooth. The numerical rating scale for abdominal pain decreased from 6.1±1.5 (range: 4 to 10) preoperatively to 1.0 (1.0) (range: 0 to 3) 1 hour postoperatively ( W=528, P<0.01). The compression rate of the true lumen of the superior mesenteric artery decreased from (92.3±6.7)% (range: 25% to 94%) preoperatively to 0.8 (1.2)% (range: 0 to 3.2%) 1 month postoperatively ( W=528, P<0.01). The primary patency rate of CT angiography at 1 month postoperatively was 100%. The vascular remodeling rate was (92.3±6.7)% (range: 80% to 100%). All patients were followed for (46.3±17.0) months (range: 24 to 76 months). The cumulative patency rates in 1, 2 and 5 years were all 100%. Conclusion:The use of thin struct bare stents for SIDSMA could obtained the expected safety and efficacy.

Objective:To investigate the relationship between dietary vitamin A intake and its sources in the first trimester and gestational diabetes mellitus (GDM).Methods:A prospective study was conducted to select women at 6-14 weeks of gestation in an obstetric clinic of a maternal and child health care medical institution in Chengdu in 2017. The types and quantities of food during the first trimester were collected by 3-day 24-hour dietary recalls. Dietary vitamin A intake was calculated based on the Chinese Food Composition Table (2018), and it was divided into animal and plant vitamin A intakes according to its food sources. An oral glucose tolerance test was performed at 24-28 weeks of gestation to diagnose GDM according to the Chinese guidelines for diagnosis and treatment of gestational diabetes mellitus (2014). According to the estimated average requirement (EAR) and recommended nutrient intake (RNI), dietary vitamin A intake was divided into low-level group (RNI). Animal and plant vitamin A intakes were divided into four groups (Q1-Q4) according to the quartile method, respectively. The association between dietary vitamin A intake, its different sources of vitamin A intake and GDM in the first trimester was analyzed by log-binomial regression models.Results:A total of 1 298 valid samples were finally included. The average dietary vitamin A intake, animal and plant vitamin A intakes in the first trimester were 341.1 (227.8-501.0) μgRAE/d, 139.3 (69.6-195.3) μgRAE/d and 184.2 (99.4-301.1) μgRAE/d, respectively. After adjusting for confounding factors, log-binomial regression analysis showed that the risk of GDM in high-level group of dietary vitamin A intake was lower than that in low-level group [ RR (95% CI):0.53 (0.36-0.80)]. Pregnant women in the highest quartile of animal vitamin A intake had a lower risk of GDM than those in the lowest quartile [ RR (95% CI):0.66 (0.47-0.95)]. No relationship between plant vitamin A intake and GDM was found. Conclusion:Dietary vitamin A intake in the first trimester is associated with the occurrence of GDM, and higher intake than RNI may reduce the risk of GDM. Higher vitamin A intake from animal-derived food is associated with decreased risk of GDM.

Objective:To investigate the relationship between dietary vitamin A intake and its sources in the first trimester and gestational diabetes mellitus (GDM).Methods:A prospective study was conducted to select women at 6-14 weeks of gestation in an obstetric clinic of a maternal and child health care medical institution in Chengdu in 2017. The types and quantities of food during the first trimester were collected by 3-day 24-hour dietary recalls. Dietary vitamin A intake was calculated based on the Chinese Food Composition Table (2018), and it was divided into animal and plant vitamin A intakes according to its food sources. An oral glucose tolerance test was performed at 24-28 weeks of gestation to diagnose GDM according to the Chinese guidelines for diagnosis and treatment of gestational diabetes mellitus (2014). According to the estimated average requirement (EAR) and recommended nutrient intake (RNI), dietary vitamin A intake was divided into low-level group (RNI). Animal and plant vitamin A intakes were divided into four groups (Q1-Q4) according to the quartile method, respectively. The association between dietary vitamin A intake, its different sources of vitamin A intake and GDM in the first trimester was analyzed by log-binomial regression models.Results:A total of 1 298 valid samples were finally included. The average dietary vitamin A intake, animal and plant vitamin A intakes in the first trimester were 341.1 (227.8-501.0) μgRAE/d, 139.3 (69.6-195.3) μgRAE/d and 184.2 (99.4-301.1) μgRAE/d, respectively. After adjusting for confounding factors, log-binomial regression analysis showed that the risk of GDM in high-level group of dietary vitamin A intake was lower than that in low-level group [ RR (95% CI):0.53 (0.36-0.80)]. Pregnant women in the highest quartile of animal vitamin A intake had a lower risk of GDM than those in the lowest quartile [ RR (95% CI):0.66 (0.47-0.95)]. No relationship between plant vitamin A intake and GDM was found. Conclusion:Dietary vitamin A intake in the first trimester is associated with the occurrence of GDM, and higher intake than RNI may reduce the risk of GDM. Higher vitamin A intake from animal-derived food is associated with decreased risk of GDM.

Objective:To explore the risk factors of postpartum sepsis and provide references for clinical prevention of postpartum sepsis.Methods:The clinical data of postpartum patients who were treated and delivered in the maternity ward of Shengjing Hospital Affiliated of China Medical University from January 2016 to December 2018 were analyzed retrospectively. Among them, 99 patients with postpartum sepsis were assigned to the case group and 212 patients without postpartum sepsis in the same period were selected with a simple random method and as the control group. The clinical data of the two groups were collected by consulting the hospital electronic medical record system. Single factor and multivariate Logistic regression were applied to analyze the risk factors of postpartum sepsis.Results:The infection sites of 99 postpartum sepsis patients were mainly genital tract and respiratory system, accounting for 28.28% (28/99) and 26.26% (26/99), respectively. In blood culture of 99 cases of postpartum sepsis patients, 58.59% (58/99) pathogens of Gram-positive bacteria were detected with the highest proportion, among which Streptococcus was mainly, accounting for 23.23%(23/99). The proportion of Gram-negative bacteria was 38.38%(38/99), and Escherichia coli was mainly, accounting for 31.31% (31/99). Multivariate Logistic analysis showed that gestational diabetes ( OR = 2.643, 95% CI 1.123 - 6.276), genital tract infection ( OR = 7.542, 95% CI 3.571-15.959), vaginal trial (switch to cesarean section) ( OR = 1.218, 95% CI 1.008-1.493), premature rupture of membranes ( OR = 1.152, 95% CI 1.019 - 1.449), postpartum hemorrhage ( OR = 1.562, 95% CI 1.263 -1.881) and cesarean delivery ( OR = 2.074, 95% CI 1.442 - 2.993) were the risk factors of postpartum sepsis. Conclusions:The main risk factors affecting postpartum sepsis includes gestational diabetes, genital tract infection, vaginal trial (switch to cesarean section), premature rupture of membranes, postpartum hemorrhage and cesarean delivery. It is necessary to take corresponding intervention measures to strengthen prevention of these risk factors, which is of great significance for prevention and treatment of postpartum sepsis.