Humans ; Aged ; Lung Diseases ; Pneumonia/drug therapy* ; Adrenal Cortex Hormones/therapeutic use* ; Pulmonary Disease, Chronic Obstructive/drug therapy* ; Administration, Inhalation ; Community-Acquired Infections/drug therapy*

Objective:To investigate the effects of navigation bronchoscopy and artificial intelligence in the standardized training of residents on basic bronchoscopy skills, with the goal of enhancing their practical abilities.Methods:We selected 26 trainees (14 on standardized training of residents and 12 on standardized training of specialists) who participated in the basic navigational bronchoscopy skills and technique training (NBSTAT) at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from September 2023 to January 2024. The training was structured around a modular curriculum with navigation as the core design concept, consisting of five modules: lesion identification, precise localization, route planning, navigation operation, and real-time error correction. Theoretical teaching and skill practice were combined. The skill proficiency of the trainees was assessed using the Ruijin Hospital bronchoscopy simulation training system and the electromagnetic navigation bronchoscopy system. SPSS 26.0 was used to perform the t-test and Wilcoxon rank-sum test for comparisons. Results:After the training, the trainees as a whole showed significant improvements in practicing the skills, with the simulated operation time was reduced from (125.08±48.16) seconds to (77.69±24.75) seconds, the number of errors decreased from 1 to 0, the total score increased from (60.77±15.01) to (75.19±17.63), and the navigation operation time was reduced from 3 (3, 4) minutes to 2 (2, 3) minutes (all P<0.05). There were no significant differences in these assessment items between resident trainees and specialist trainees. The satisfaction rate of the trainees with the training reached 100.00%. Conclusions:The curriculum is effective in basic bronchoscopy skill training, remarkably enhancing the bronchoscopy skills of resident and specialist physicians, which is a useful approach for physicians to cope with the continuous development of diagnostic and therapeutic techniques for pulmonary diseases.

Purpose/Significance To sort out and analyze the application status of artificial intelligence(AI)large models in medi-cine,so as to provide new perspectives for research in this domain.Method/Process Based on a review of relevant literatures,the paper outlines the application scenarios and examples of AI large models in the fields of smart medical care,medical metaverse,medical re-search and development,etc.It also summarizes the risks and challenges in the application of AI large models in medicine.Result/Con-clusion AI large models have great development potential in medicine,and it is necessary to promote the core technologies of AI large models and improve relevant regulations and laws.

Objective To explore the correlation between serum microRNA-29a-3p(miR-29a-3p),throm-bospondin 2(THBS2)and cardiopulmonary function in children with chronic pulmonary heart disease.Meth-ods A total of 136 children with chronic pulmonary heart disease treated in Shijiazhuang Hospital of Tradi-tional Chinese Medicine from July 2019 to September 2023 were selected as the study subjects.Based on their clinical signs,cardiopulmonary function,and symptoms,they were divided into a compensated group(74 ca-ses)and a decompensated group(62 cases).Real-time fluorescence quantitative PCR(RT-qPCR)method was applied to detect serum miR-29a-3p level,and enzyme-linked immunosorbent assay(ELISA)was applied to detect serum THBS2 level.Moreover,ultrasound diagnostic equipment was applied to detect cardiac function indicators such as left ventricular ejection fraction(LVEF)and cardiac output(CO).Creatine kinase isoenzyme(CK-MB)and troponin(cTnl)were detected by electroluminescence analysis.Pulmonary function indicators were detected by pulmonary artery systolic pressure(PASP),mean pulmonary artery pressure(MPAP)and pulmonary artery diastolic pressure(PADP).Pearson correlation was used to analyze the corre-lation between serum miR-29a-3p and THBS2 levels and cardiopulmonary function indexes in children with chronic pulmonary heart disease,and multivariate Logistic regression analysis was used to screen the influen-cing factors of the disease in children with chronic pulmonary heart disease.Receiver operating characteristic(ROC)curve was drawn to analyze the evaluation value of serum miR-29a-3p and THBS2 levels in children with chronic pulmonary heart disease.Results The THBS2,CK-MB,cTnI,PASP,MPAP,and PADP in the decompensated group were higher than those in the compensated group(P＜0.05),while miR-29a-3p,LVEF,and CO were lower than those in the compensated group(P＜0.05).Serum miR-29a-3p in children with chro-nic pulmonary heart disease was positively correlated with LVEF and CO(P＜0.05),but negatively correla-ted with CK-MB,cTnI,PASP,MPAP,and PADP(P＜0.05).THBS2 was negatively correlated with LVEF and CO(P＜0.05),but positively correlated with CK-MB,cTnI,PASP,MPAP,and PADP(P＜0.05).MiR-29a-3p was a protective factor for exacerbation of chronic pulmonary heart disease in children(P＜0.05),while THBS2 was an independent risk factor for exacerbation of chronic pulmonary heart disease in children(P＜0.05).ROC curve analysis results showed that the area under the curve(AUC)of serum miR-29a-3p and THBS2 levels alone and in combination for evaluating the severity of chronic pulmonary heart disease in children were 0.827,0.817 and 0.915,respectively.Conclusion Serum miR-29a-3p and THBS2 levels are both factors affecting the disease of children with chronic pulmonary heart disease,and are closely related to the disease and cardiopulmonary function of children with chronic pulmonary heart disease.

Chronic pelvic pain caused by pelvic venous disorder(PeVD)is a common condition in women.However,clinical physicians'cognition of this disease is not yet comprehensive,so PeVD is easy to be misdiagnosed,thus affecting its treatment.With the development of interventional radiology,the venography and sclerotic agent embolization therapy have gradually become the standard mode for the diagnosis and treatment of this disorder.This consensus focuses on the following aspects:selection of indications,selection of technical methods,intraoperative manipulation,treatment of corresponding complications,gathering the views of domestic multidisciplinary experts engaged in interventional radiology,vascular surgery and medical imaging,clinical management methods,systematical elaboration of the classification and diagnosis of PeVD,and experience in sclerotic agent embolization therapy,aiming to improve the clinical physicians'cognition of PeVD and to promote the standardization of its clinical treatment.

Objective To investigate the accuracy of cone-beam CT(CBCT)by measuring tongue thickness(TT)in predicting difficult glottis exposure in patients undergoing maxillofacial surgery.Methods Ninety-seven patients undergoing elective maxillofacial surgery under general anesthesia were selected,45 males and 52 females,aged 18-67 years,ASA physical status Ⅰ or Ⅱ.The TT was measured by CBCT before operation.The inter-incisor distance(IID),BMI,thyromental distance(TMD),and modified Mal-lampati test(MMT)were also recorded.According to the Cormack-Lehane(CL)grade at the time of gener-al anesthesia induction,the patients were divided into two groups:the easy laryngoscope exposure group(group E,CL gradeⅠorⅡ,n = 86)and the difficult laryngoscope exposure group(group D,CL gradeⅢ or Ⅳ,n = 11).The relationship between IID,BMI,TMD,MMT,TT,and laryngoscopy exposure was analyzed,and the receiver operating characteristic(ROC)curve was used to analyze the relationship be-tween each index and difficult laryngoscopy exposure.Results Compared with group E,the BMI,MMT,and TT of group D were significantly increased(P＜0.05),while the TMD was significantly decreased(P＜0.05).The area under the ROC curve(AUC)of BMI,TMD,MMT,and TT to predict difficult glot-tis exposure was 0.690,0.714,0.726,and 0.797,the sensitivity was 36.4%,63.6%,63.6%,and 81.8%,and the specificity was 95.3%,69.8%,76.7%,and 68.6%,respectively.Using BMI,MMT,TMD,and TT as a model to predict difficult glottis exposure,the AUC was 0.913,the sensitivity was 90.9%and the specificity was 83.7%.Conclusion TT measured by CBCT is an independent impact factor for predicting difficult laryngoscope exposure.The comprehensive model incorporating BMI,TMD,MMT,and TT has a better predictive effect.

Objective:To retrospectively analyze the treatment status of tyrosine kinase inhibitors (TKI) in newly diagnosed patients with chronic myeloid leukemia (CML) in China.Methods:Data of chronic phase (CP) and accelerated phase (AP) CML patients diagnosed from January 2006 to December 2022 from 77 centers, ≥18 years old, and receiving initial imatinib, nilotinib, dasatinib or flumatinib-therapy within 6 months after diagnosis in China with complete data were retrospectively interrogated. The choice of initial TKI, current TKI medications, treatment switch and reasons, treatment responses and outcomes as well as the variables associated with them were analyzed.Results:6 893 patients in CP ( n=6 453, 93.6%) or AP ( n=440, 6.4%) receiving initial imatinib ( n=4 906, 71.2%), nilotinib ( n=1 157, 16.8%), dasatinib ( n=298, 4.3%) or flumatinib ( n=532, 7.2%) -therapy. With the median follow-up of 43 ( IQR 22-75) months, 1 581 (22.9%) patients switched TKI due to resistance ( n=1 055, 15.3%), intolerance ( n=248, 3.6%), pursuit of better efficacy ( n=168, 2.4%), economic or other reasons ( n=110, 1.6%). The frequency of switching TKI in AP patients was significantly-higher than that in CP patients (44.1% vs 21.5%, P<0.001), and more AP patients switched TKI due to resistance than CP patients (75.3% vs 66.1%, P=0.011). Multi-variable analyses showed that male, lower HGB concentration and ELTS intermediate/high-risk cohort were associated with lower cytogenetic and molecular responses rate and poor outcomes in CP patients; higher WBC count and initial the second-generation TKI treatment, the higher response rates; Ph + ACA at diagnosis, poor PFS. However, Sokal intermediate/high-risk cohort was only significantly-associated with lower CCyR and MMR rates and the poor PFS. Lower HGB concentration and larger spleen size were significantly-associated with the lower cytogenetic and molecular response rates in AP patients; initial the second-generation TKI treatment, the higher treatment response rates; lower PLT count, higher blasts and Ph + ACA, poorer TFS; Ph + ACA, poorer OS. Conclusion:At present, the vast majority of newly-diagnosed CML-CP or AP patients could benefit from TKI treatment in the long term with the good treatment responses and survival outcomes.

Objective:To investigate the effect of exogenous recombinant human Annexin A6(rhANX A6)intervention on early plasma membrane damage and its metabolic characteristics in skeletal muscle in mice with eccentric exercise injury models. Method:Fifty-six C57 male mice,aged 8 weeks,were randomly divided into the quiet control group(group C),exercise group injected with phosphate-buffer saline(group EP)and exercise group injected with rhANX A6(group ER).The exercise groups were further subdivided based on different post-exercise sampling times:EP2,EP6,EP12,and ER2,ER6,ER 12,with 8 mice in each subgroup.Two hours before exercise,the group EP and group ER received intraperitoneal injections with l*PBS buffer(1 x concentration)and rhANX A6(0.8 mg/kg),respectively.ELISA was used to detect the content of ANX A6 in serum creatine kinase(CK),Annexin A6(ANX A6)and skeletal muscle in each group of mice,and Evans Blue dye(EBD)was used to observe the damage of the skeletal muscle plasma membrane of each group of mice. Result:The serum CK activity in all EP subgroups and ER12h were significantly higher than those in the C group(P＜0.01).At the same time point,CK levels in all EP subgroups were significantly higher than in the ER group(P＜0.05).The average fluorescence intensity of EBD-positive regions in all EP and ER subgroup was significantly higher than that in group C(P＜0.01).All EP subgroups had significantly higher intensities than the ER group(P＜0.01).The serum ANX A6 levels in all ER subgroups and EP6h,EP12h were signifi-cantly higher than that in group C(P＜0.01).At 12h time point,ANX 46 levels in the ER group were signifi-cantly higher than in the EP group(P＜0.05).ANX A6 levels in skeletal muscle of all EP and ER subgroups were significantly higher than that in group C(P＜0.05);All ER subgroups had significantly higher than those in the EP group(P＜0.05). Conclusion:Exogenous rhANX A6 injection 2 hours before eccentric exercise in mice can significantly improve the early plasma membrane injury in skeletal muscle after exercise.It is speculated that rhANX A6 directly in-volved in the repair of early plasma membrane damage in skeletal muscle induced by eccentric exercise.

Objective:To evaluate the effectiveness of oral-nasal oxygen supply mouth guard in painless gastroscopy for snoring patients.Methods:The snoring patients who underwent painless gastroscopy at two Endoscopy Centers of Shanghai East Hospital, Tongji University in July 2022 were randomly divided into the observation group (using oral-nasal oxygen supply mouth guard) and the control group (using ordinary nasal oxygen tube and mouth guard). Parameters such as the wearing time and the removal time of the mouth guard, lowest pulse oxygen saturation (SpO 2), incidence of hypoxemia, and the satisfaction of medical staff were compared between the two groups. Results:The wearing time of mouth guard was 11.63±0.84 seconds and the removal time was 5.33±0.76 seconds in the observation group ( n=40), which were lower than those in the control group ( n=47) (14.91±1.21 seconds, t=-14.463, P<0.001; 10.38±0.80 seconds, t=-30.095, P<0.001). The wearing satisfaction score was 9.80±0.61, the lowest SpO 2 was (96.70±3.42)%, the removal satisfaction score was 9.75±0.67, and the anesthesiologists' satisfaction score was 9.20±1.42 in the observation group, which were higher than those in the control group [7.70±0.93, t=12.209, P<0.001; (94.06±3.72)%, t=3.417, P=0.001; 7.96±0.98, t=9.803, P<0.001; 8.13±1.35, t=3.615, P=0.001] with significant difference. There was no significant difference in the incidence of hypoxemia [10.00% (4/40) VS 14.89% (7/47), χ2=0.130, P=0.718] and endoscopic physician satisfaction score (9.30±0.97 VS 9.02±1.31, t=1.112, P=0.269) between the two groups. Conclusion:The oral-nasal oxygen supply mouth guard is easy to wear and remove, effectively reducing SpO 2 fluctuations during painless gastroscopy for snoring patients. It can enhance medical staff satisfaction with high clinical value.

H 1-antihistamines are widely used in the treatment of various allergic diseases, but there are still many challenges in the safe and rational use of H 1-antihistamines in pediatrics, and there is a lack of guidance on the prescription review of H 1-antihistamines for children.In this paper, suggestions are put forward from the indications, dosage, route of administration, pathophysiological characteristics of children with individual difference and drug interactions, so as to provide reference for clinicians and pharmacists.