BACKGROUND:In recent years,High-definition transcranial direct current stimulation(HD-tDCS)has garnered significant attention due to its potential non-invasive modulation of brain function.However,there is still a lack of visual analysis in the literature regarding this technique. OBJECTIVE:To perform a visual analysis of HD-tDCS-related research so as to explore the current status and trends in this field. METHODS:English literature related to HD-tDCS was retrieved from the Web of Science Core Collection database covering the period from January 1,2010 to May 6,2023.The VOSviewer software was used to visualize and analyze the source journals,countries/regions,authors,institutions,cited references,and keywords of the included literature,creating a knowledge map to uncover the research landscape and hotspots. RESULTS AND CONCLUSION:A total of 336 articles were included,showing a consistent increase in the annual publication count of HD-tDCS research.Among these,the United States contributed the highest number of publications(141 articles)with 4 221 citations,followed by China with 70 articles and 401 citations.Brain Stimulation was the most prolific journal(28 articles),Marom Bikson was the most productive author(37 articles),and The City College of New York was the most active institution(35 articles).The most frequently mentioned keywords in the field included motor cortex,regulation,working memory,excitability,and dorsolateral prefrontal cortex.Notable recent keywords in the last 5 years include attention-deficit/hyperactivity disorder,brain networks,and stimulation intensity.Currently,the volume of HD-tDCS research is relatively limited,but is on an upward trajectory,indicating substantial research potential.It is expected that future studies in this domain will continue to focus on the application of HD-tDCS in cognitive and neuropsychiatric disorders,while also exploring its therapeutic mechanisms targeting the motor cortex and dorsolateral prefrontal cortex based on brain network analysis.

[Objective]To investigate the efficacy of a blended instruction model which incorporated preceptorship into the clinical anatomy course at Sun Yat-sen University and improve satisfaction and performance of medical students.[Methods]The study recruited participants including 375 Chinese students aged 20-24 years old,2 anatomy professors,49 surgeons and 7 lab technicians. The students were divided into 10 teams and each team was tutored by 1 anatomy professor,2 surgeons and 1 lab technician. After the course ended,the Course Experience Questionnaire (CEQ) and Student Experience in Education Questionnaire (SEEQ) were used in the survey to measure the quality of teaching and students' overall educational experience. Students' performance scores were collected and analyzed.[Results]The response rates for CEQ and SEEQ were 60.3％ (226/375) and 54.6％ (200/375),respectively. CEQ indicated a moderate level of overall satisfaction with 7.12 out of 10. Subscales like Clear Goals,Good Teaching and Generic Skills showed moderately positive reception of the course,while subscales like Appropriate Workload and Appropriate Assessment revealed students' concerns about heavy workload and difficult exam. There was no statistically significant difference in perceptions between male and female students. The students who are more satisfied with the quality of the course are also more satisfied with the way it is taught (P<0.01). SEEQ further confirmed the universal appeal of the course,with high scores in dimensions like Learning,Enthusiasm and Individual Rapport among the students. Qualitative responses highlighted areas of improvement,such as consistent teaching methods,practical hands-on experience for the students and alignment between what was taught and tested.The students after the preceptorship introduction achieved better academic performance than before.[Conclusions]The blended instruction model incorporating preceptorship enhances the student satisfaction and performance in clinical anatomy course,and also stimulates students' learning enthusiasm and group interaction. We need further improvement in the teaching quality control,syllabus contents and course assessment for teaching of clinical anatomy.

Objective:To compare the patient-reported outcomes and short-term clinical outcomes between robotic-assisted and laparoscopic-assisted radical gastrectomy for locally advanced gastric cancer.Methods:This single-center prospective randomized controlled trial was conducted in the Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University from October 2020 to August 2022. Patients with locally advanced gastric cancer who were to undergo radical gastrectomy were selected and randomly divided into two groups according to 1∶1, and received robotic surgery and laparoscopic surgery, respectively. Patient-reported outcomes and short-term clinical outcomes (including postoperative complications, surgical quality and postoperative short-term recovery) were compared between the two groups by independent sample t test, Mann-Whitney U test, repeated ANOVA, generalized estimating equation, χ2 test and Fisher′s exact test. Results:A total of 237 patients were enrolled for modified intention-to-treat analysis (120 patients in the robotic group, 117 patients in the laparoscopic group). There were 180 males and 59 females, aged (63.0±10.2) years (range: 30 to 85 years). The incidence of postoperative complications was similar between the robotic group and laparoscopic group (16.7% (20/120) vs. 15.4% (18/117), χ2=0.072, P=0.788). The robotic group had higher patient-reported outcomes scores in general health status, emotional, and social domains compared to the laparoscopic group, differences in time effect, intervention effect, and interaction effect were statistically significant (general health status: χ2 value were 275.68, 3.91, 6.38, P value were <0.01, 0.048, 0.041; emotional: χ2 value were 77.79, 6.04, 6.15, P value were <0.01, 0.014, 0.046; social: χ2 value were 148.00, 7.57, 5.98, P value were <0.01, 0.006, 0.048). However, the financial burden of the robotic group was higher, the differences in time effect, intervention effect and interaction effect were statistically significant ( χ2 value were 156.24, 4.08, 36.56, P value were <0.01, 0.043,<0.01). Conclusion:Compared to the laparoscopic group, the robotic group could more effectively relieve postoperative negative emotions and improve recovery of social function in patients.

Dry eye,also known as keratoconjunctivitis sicca,is clinically manifested as dry eyes,itching,burning,blurred vision and other symptoms,which seriously affects the life quality of patients.In recent years,the incidence of dry eye has increased year by year,and it has become one of the common clinical diseases in ophthalmology.At present,the treatment methods of dry eye mainly include drug treatment,surgical treatment and clinical nursing,among which drug is the most commonly used method for the treatment of dry eye.Therefore,this paper summarizes the application and research progress of clinical medication of dry eye based on permeation pathways and inflammatory pathways in recent years,so as to provide some ideas for the follow-up treatment of dry eye and drug development.

Objective:To compare the patient-reported outcomes and short-term clinical outcomes between robotic-assisted and laparoscopic-assisted radical gastrectomy for locally advanced gastric cancer.Methods:This single-center prospective randomized controlled trial was conducted in the Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University from October 2020 to August 2022. Patients with locally advanced gastric cancer who were to undergo radical gastrectomy were selected and randomly divided into two groups according to 1∶1, and received robotic surgery and laparoscopic surgery, respectively. Patient-reported outcomes and short-term clinical outcomes (including postoperative complications, surgical quality and postoperative short-term recovery) were compared between the two groups by independent sample t test, Mann-Whitney U test, repeated ANOVA, generalized estimating equation, χ2 test and Fisher′s exact test. Results:A total of 237 patients were enrolled for modified intention-to-treat analysis (120 patients in the robotic group, 117 patients in the laparoscopic group). There were 180 males and 59 females, aged (63.0±10.2) years (range: 30 to 85 years). The incidence of postoperative complications was similar between the robotic group and laparoscopic group (16.7% (20/120) vs. 15.4% (18/117), χ2=0.072, P=0.788). The robotic group had higher patient-reported outcomes scores in general health status, emotional, and social domains compared to the laparoscopic group, differences in time effect, intervention effect, and interaction effect were statistically significant (general health status: χ2 value were 275.68, 3.91, 6.38, P value were <0.01, 0.048, 0.041; emotional: χ2 value were 77.79, 6.04, 6.15, P value were <0.01, 0.014, 0.046; social: χ2 value were 148.00, 7.57, 5.98, P value were <0.01, 0.006, 0.048). However, the financial burden of the robotic group was higher, the differences in time effect, intervention effect and interaction effect were statistically significant ( χ2 value were 156.24, 4.08, 36.56, P value were <0.01, 0.043,<0.01). Conclusion:Compared to the laparoscopic group, the robotic group could more effectively relieve postoperative negative emotions and improve recovery of social function in patients.

Objective To investigate the risk factors for postoperative pulmonary embolism in patients with spontaneous cerebral hemorrhage,and construct and verify the nomogram model.Methods A retrospective cohort study was conducted on 558 patients admitted in the First Affiliated Hospital of Chongqing Medical University and the Three Gorges Hospital Affiliated to Chongqing University.And 393 of them who hospitalized from January 2015 to January 2021 were assigned into a modeling group,and the other 165 patients from February 2021 to January 2023 into a validation group.Univariate and multivariate stepwise logistic regression analyses were used to screen out the risk factors associated with pulmonary embolism after spontaneous cerebral hemorrhage surgery.Then a nomogram model was build based on these factors and verified.Results Based on age,blood loss,Glasgow coma scale(GCS)score,surgical treatments,levels of fibrin degradation products,D-dimer and hemoglobin,plasma osmolality,and deep vein thrombosis,a risk model of pulmonary embolism was built.Receiver operating characteristic(ROC)curve analysis showed the model had good discriminability for the presence of pulmonary embolism,and the area under the curve(AUC)value was 0.908.Hosmer-Lemeshow goodness-fit test indicated that the model had a good fit to the verification set(Chi-square=14.805,df=8,P=0.063),the correction curve was close to the ideal curve,and the prediction probability of the model was close to the actual occurrence probability,suggesting the model having good accuracy.Decision curve analysis revealed that the established nomogram model can get benefits under a large range of threshold probabilities.Conclusion We develop a prediction model for postoperative pulmonary embolism in patients with spontaneous cerebral hemorrhage after surgical treatment,which shows good prediction performance in both the training and validation groups,and can be used for accurate,prompt and quick identification for the occurrence of pulmonary embolism in clinical practice.

Objective To investigate the radiographic anatomical relationship between tibial plateau and distal femur and evaluate the impact of reset tibial plateau of various widths after reduction of the Schatzker Ⅳ-C tibial plateau fractures on postoperative outcomes.Methods We collected and reviewed the X-ray images of the normal knees of 207 standard neutrally-positioned adults(non-fracture group)and pre-and post-operative immediate anterior-posterior X-ray images of the knees of 60 patients with Schatzker Ⅳ-C fractures(fracture group)in our hospital from August 2012 to August 2022.We measured the proximal tibial joint width(TAW),distal femoral width(DFW),and distal femoral joint width(FAW)in both groups and calculated the TAW/DFW and TAW/FAW ratios.In the fracture group,the cases with TAW between FAW and DFW were assigned to the well-reduced group,while those with TAW outside this range between FAW and DFW to the poorly-reduced group.Both groups were assessed using the Hospital for Special Surgery knee score(HSS)one year after operation.Results In the non-fracture group,there were no significant differences in gender or affected side in terms of TAW/DFW and TAW/FAW ratios(P＞0.05),while in the fracture group,there were statistically significant differences in the TAW/DFW and TAW/FAW ratios compared to the non-fracture group(P＜0.05).There was a statistically signifi-cant difference in the one-year postoperative HSS scores between the well-reduced and poorly-reduced groups in the fracture group(P＜0.05).Conclusion The radiographic anatomical relationship between the tibial plateau and distal femur in normal adults is relatively constant,providing a radiological reference for resetting the tibial plateau to a satisfactory width during reduction of Schatzker Ⅳ-C fractures.TAW/DFW＞1 or TAW/FAW＜1 indicates a poor reduction of the fracture and predicts poor postoperative recovery of knee joint function.

Objective:To observe the stimulation of cigarette smoke extract(CSE)at different times influencing the alveolar macrophage efferocytosis and phagocytosis function,and to explore the effect of CSE on inflammatory response in lung diseases and molecular mechanism.Methods:Rat alveolar macrophages NR8383 were intervened with 10%CSE for 6 h,12 h,24 h,48 h,divided into 6 h blank control group,6 h-10%CSE group,12 h blank control group,12 h-10%CSE group,24 h blank control group,24 h-10%CSE group,48 h blank control group,48 h-10%CSE group.10%CSE intervention 12 h in combination with PPAR inhibitor/ago-nist,divided into PPAR inhibitor group and PPAR agonist group.Alamar Blue colorimetry was used to detect the proliferation and toxi-city of PPAR agonist on NR8383 cells.Flow cytometry was used to detect the efferocytosis and phagocytosis of NR8383 cells,and M1 and M2 polarizations.The contents of TNF-α,TGF-β1 and MFG-E8 were detected by enzyme-linked immunosorbent assay.Western blot was used to detect the expressions of PPARγ and CD36 protein.mRNA expressions of PPARγ and CD36 were detected by qPCR.Results:After 6 hours of 10%CSE stimulation,the phagocytosis and efferocytosis of NR8383 cells were increased,the expression of PPARγ was down-regulated,the expression of CD36 mRNA was increased,and the expressions of TNF-α,TGF-β1 and MFG-E8 were increased,but there was no obvious polarization direction.After 12 hours CSE stimulation,the efferocytosis and phagocytosis functione of NR8383 cells were significantly decreased,the expressions of PPARγ and CD36 were significantly down-regulated,the expression of TNF-α was increased,the expressions of TGF-β1 and MFG-E8 were decreased,and the cells were polarized to M1-type macrophages.After 24 hours of intervention,the efferocytosis rate of NR8383 cells were decreased,but the phagocytosis function of E.coli was increased,the expression of PPARγ was down-regulated,the expressions of CD36 protein was decreased,the expression of TNF-α was decreased,while there was no statistical difference,the expressions of TGF-β1 and MFG-E8 were still decreased,and there was obvious tendency of M1 polarization.After 48 h,the efferocytosis rate of NR8383 cells were still decreased,but the phagocy-tosis ability was significantly increased,the expression of PPARγ was significantly decreased,the expression of CD36 was significantly increased,the expression of TNF-α was decreased,the expressions of TGF-β1 and MFG-E8 were increased,and the polarization of macrophages towards M1 and M2 were increased.After 12 h stimulation with 10%CSE combined with PPAR agonist and inhibitor,it was found that PPAR agonist enhanced the efferocytosis and phagocytosis of NR8383 cells,up-regulated the expression of PPARγ and CD36,inhibited the expression of inflammatory factor TNF-α,and promoted the expressions of anti-inflammatory factor TGF-β1 and cytokinesis cofactor MFG-E8.Conclusion:With the stimulation time of CSE,alveolar macrophages gradually change from the activated state of early inflammatory response to chronic inflammatory response,which leads to alveolar macrophage efferocytosis and phagocyto-sis dysfunction,and the mechanism is related to the inhibition of PPARγ pathway.

In order to facilitate the accurate comprehension and correct implemention of the national occupational health standard Health standard for operators of nuclear power plants (GBZ/T 164-2022), this article presents an in-depth elucidation encompassing the significance of the standard promulgation, the background of its revision, the current status of the relevant domestic and international standards, the basis for revision of the principal technical inclusion and the application scope of the standard. The aim is to provide a guidance the selection, appropriate evaluation, and occupational health monitoring of nuclear power plant operators, ultimately ensuring the safe operation of nuclear facilities.

Objective:To investigate the relationship between plasma atherogenic index (AIP) trajectory and the risk of hypertension in health examination population.Methods:In this retrospective cohort study, a total of 15 389 subjects who had undergone health examinations at the Health Management Center of the Second Affiliated Hospital of Dalian Medical University three or more times from January 2012 to December 2022 were consecutively selected. The general data, anthropometric parameters and laboratory parameters were collected. The study population without hypertension at baseline inclusion was screened, and AIP trajectory groups of different genders were determined by group-based trajectory modeling. The baseline characteristics and the incidence of hypertension at the end of follow-up were observed in each AIP trajectory group of men and women. Cox proportional hazards regression models were used to analyze the association of AIP trajectories with the risk of hypertension.Results:Four AIP trajectory groups (low level group, low gain group, medium gain group and high gain group) were identified in both male and female subjects, with the highest incidence of hypertension in the low gain group (38.18% in females and 40.92% in males). After adjusting for all confounders, the risk of hypertension was positively associated with increased AIP trajectories in the low ( HR=1.29, 95% CI: 1.02-1.63), medium ( HR=1.66, 95% CI: 1.23-2.23), and high ( HR=1.89, 95% CI: 1.26-2.85) gain groups in women; the risk of hypertension was positively associated with increased AIP trajectories in only the high gain group in men ( HR=1.33, 95% CI: 1.01-1.74). Conclusion:Elevated AIP trajectory is positively correlated with the risk of hypertension in health examination population.