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ObjectiveTo improve the response capabilities to disasters and prevent major epidemics， it is of practical use to study the capability evaluation system of the national emergency medical rescue team that combines theoretical training and practical exercises， to enhance the overall quality of the teams. MethodsFirst， a capability assessment system for the national emergency medical rescue team was constructed based on the INSARAG External Classification （IEC） standards of the national emergency medical rescue team. Then， based on the outcome based education （OBE） concept， we conducted innovative research on the curriculum design and exercise programs for team building and member training. Finally， an empirical analysis was conducted on the effectiveness of the evaluation system and training exercises based on the statistical analysis of the comprehensive quality evaluation of the Shanghai national emergency medical rescue team from 2020 to 2023， as well as the empirical analysis of the rescue exercise on the Cruise of spectrum. ResultsBased on the linear regression analysis of each core competency indicators， the five core competencies in the evaluation system， including rescue skills， medical and health knowledge， disaster coping ability， team cooperation ability， and mental resilience training， were positively correlated with the cumulative number of trainings （r=0.71， r=0.76， r=0.81， r=0.84， r=0.96，all P<0.05）， indicating that the training was effective and the course design was reasonable. Empirical cases showed that the three-dimensional rescue drill model had remarkable results in the actual combat application and ability improvement of team members. ConclusionThe training courses and drills designed based on the three-level assessment system are effective in improving the comprehensive capabilities of the national emergency medical rescue team.
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Traditional Chinese Medicine has a long history and plays a decisive role in the fields of modern medicine and pharmacy.It is an important part of our country's traditional medicine.With the progress of the times,people are paying more and more attention to the innovation and development of traditional Chinese medicine.However,the current traditional Chinese medicine talents trained by major universities cannot meet the needs and requirements of society.This is closely related to the current talent training model of universities.Local high-level universities have unique advantages and potential in cultivating inno-vative talents in traditional Chinese medicine.They can incorporate traditional Chinese medicine culture with local characteristics into the teaching content and practical links of training traditional Chinese medicine talents,and build innovative traditional Chi-nese medicine talents integrating science and education.The training model is more conducive to cultivating top innovative talents that meet the needs of society and and the development of traditional Chinese medicine.This article analyzes and discusses how local high-level universities can develop innovative talent training models that suit the needs of traditional Chinese medicine by combining local characteristics and disciplinary advantages,so as to provide useful reference and inspiration for local high-level u-niversities in cultivating talents in traditional Chinese medicine.
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Objective:To evaluate the role of nuclear factor E2-related factor 2 (Nrf2)/heme oxidase-1 (HO-1) in reduction of renal ischemia-reperfusion (I/R) injury by the human umbilical cord mesenchymal stem cells (hucMSCs)-derived exosomes (hucMSCs-exo) in mice.Methods:The hucMSCs were cultured, and exosomes were extracted and identified by transmission electron microscopy, nanoparticle tracking analysis and Western blot. Thirty-six male SPF-grade C57BL/6 mice, weighing 20-25 g, were used. Thirty mice were selected and divided into 5 groups ( n=6 each) by a random number table method: sham operation group (Sham group), sham operation + Nrf2 inhibitor ML385 group (Sham + ML385 group), renal I/R group (I/R group), renal I/R + exosome group (I/R+ EXO group), and renal I/R + exosome + Nrf2 inhibitor ML385 group (I/R+ EXO+ ML385 group). A model of renal I/R injury was prepared by clamping the bilateral renal pedicles for 45 min followed by perfusion in anesthetized animals. ML385 30 mg/kg was intraperitoneally injected at 45 min before preparing the model in Sham+ ML385 group and I/R+ EXO+ ML385 group, and hucMSCs-exo 100 μg was injected via the tail vein at 15 min before reperfusion in I/R+ EXO group and I/R+ EXO+ ML385 group. Serum blood urea nitrogen (BUN) and creatinine (Cr) concentrations were detected at 24 h of reperfusion. The renal tissues were obtained for examination of the pathological changes and for determination of contents of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α) and malondialdehyde (MDA), superoxide dismutase (SOD) activity and reactive oxygen species (ROS) levels and expression of Nrf2 and HO-1 protein and mRNA (by Western blot and quantitative real-time polymerase chain reaction). The left 6 mice were allocated to sham operation group (Sham-IM group, n=3) and renal I/R group (I/R-IM group, n=3) by a random number table method for VISQUE in living imaging observation. Results:The exosomes showed a typical cup-shaped morphology with a transmission electron microscope, the nanoparticles tracked and analyzed the average diameter of the exosome, with an average diameter of 96.7 nm, and the positive expression of surface markers CD9, CD63 and TSG101 was detected using Western blot. The renal fluorescence intensity value was significantly increased in I/R-IM group as compared with Sham-IM group ( P<0.05). Compared with Sham group, the serum BUN and Cr concentrations were significantly increased, the contents of IL-6, TNF-α and MDA and ROS levels were increased, the activity of SOD was decreased, the expression of Nrf2 and HO-1 protein and mRNA was down-regulated ( P<0.05), and the pathological changes of renal tissues were aggravated in I/R group, and no significant change was found in serum BUN and Cr concentrations in Sham+ ML385 group ( P>0.05). Compared with I/R group, the serum BUN and Cr concentrations were significantly decreased, the contents of IL-6, TNF-α and MDA and ROS levels were decreased, the activity of SOD was increased, the expression of Nrf2 and HO-1 protein and mRNA was up-regulated ( P<0.05), and the pathological changes of renal tissues were significantly attenuated in I/R+ EXO group. Compared with I/R+ EXO group, the serum BUN and Cr concentrations were significantly increased, the contents of IL-6, TNF-α and MDA and ROS levels were increased, the activity of SOD was decreased, the expression of Nrf2 and HO-1 protein and mRNA was down-regulated ( P<0.05), and the pathological changes of renal tissues were aggravated in I/R+ EXO+ ML385 group. Conclusions:The mechanism by which hucMSCs-exo reduces renal I/R injury may be related to activation of the Nrf2/HO-1 signaling pathway in mice.
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In recent years, researchers have found that patients with nonalcoholic fatty liver disease (NAFLD) often have urolithiasis, and the incidence of urolithiasis increases gradually with the severity of NAFLD. Meanwhile, the detection rate of NAFLD was higher in patients with urolithiasis than in normal controls. In this paper, we reviewed the domestic and international studies on the correlation between urolithiasis and NAFLD and described the related pathogenesis, such as insulin resistance, oxidative stress, abnormal lipid metabolism and impaired glyoxalate detoxification. Meanwhile, this paper proposed preventive measures to reduce the risk of development and recurrence of NAFLD-associated urolithiasis by addressing the common risk factors of both diseases, including metabolism-related diseases, lifestyle and diet.
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Endometrial carcinoma is one of common malignant tumors in female reproductive system, but it is extremely rare in leptomeningeal metastasis. The clinical manifestations and signs of meningeal carcinomatosis are complex and not specific. It is difficult to get a precise diagnosis early, and it has high rate of misdiagnosis and missed diagnosis. Accurate diagnosis and treatment of a case of leptomeningeal metastasis from endometrial carcinoma by next-generation sequencing and cerebrospinal fluid cytology are reported. The patient is an elderly female with a history of endometrial cancer. The main manifestations were fever, headache and dizziness; cerebrospinal fluid cytology showed tumor cells; AKT1 gene and TP53 gene were detected in endometrial carcinoma tissue, plasma and cerebrospinal fluid by next-generation sequencing. After treatment with intrathecal chemotherapy, immunotherapy combined with anti angiogenesis, the patient′s condition still progressed gradually and died finally. The purpose of this case report is to raise clinical awareness of recognition and treatment in early meningeal metastasis of endometrial carcinoma.
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ObjectiveTo conduct a systematic review of systematic reviews of the effect of preoperative prerehabilitation training on postoperative function of patients after total knee arthroplasty. MethodsThe systematic reviews and meta-analysis about the application of preoperative prerehabilitation training after total knee arthroplasty were retrieved from Cochrane Library, Embase, PubMed, Web of Science, Wanfang Data, CNKI and VIP database, from establishment to March 10th, 2023. The methodological quality was evaluated using AMSTAR. The meta-analysis of the reseaches without repetitive content was performed using RevMan 5.3. ResultsA total of ten systematic reviews/meta analyses were included. Compared with the routine rehabilitation, preoperative prerehabilitation training might decrease the scores of Western Ontario and McMaster Universities Osteoarthritis Index (MD = -1.34, 95%CI -1.94 to -0.74, P < 0.001), and Hospital for Special Surgery Knee Score (MD = -1.04, 95%CI -1.69 to -0.40, P = 0.001), shorten the length of hospital stay (MD = -1.01, 95%CI -1.66 to -0.36, P = 0.002), and enhance muscle strength three months after operation (SMD = 0.63, 95%CI 0.30 to 0.97, P < 0.001). ConclusionPreoperative prerehabilitation training can improve postoperative knee function, enhance muscle strength three months after operation, and shorten length of hospital stay for the patients after total knee arthroplasty.
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Objective To investigate the protective effect of human umbilical cord mesenchymal stem cell-derived exosome (hucMSC-Exo) on renal ischemia-reperfusion injury (IRI), and to clarify the critical role and regulating mechanism of transient receptor potential canonical (TRPC) 6/poly adenosine-diphosphate-ribose polymerase (PARP) 1 signaling pathway during this process. Methods The hucMSC-Exo was extracted by ultracentrifugation, and identified by transmission electron microscope (TEM), nanoparticle tracing analysis and Western blot. SD rats were randomly divided into the sham operation group (group S), sham operation+TRPC6 inhibitor SKF96365 group (group SS), renal IRI group (group IRI), exosome treatment group (group EXO) and exosome +TRPC6 inhibitor SKF96365 group (group ES), with 6 rats in each group. Serum creatinine and blood urea nitrogen levels were detected. Pathological changes of renal tissues were observed by hematoxylin-eosin (HE) staining and Paller score was calculated. The expression levels of key molecules of necroptosis in rat renal tissues, including receptor-interacting protein kinase (RIPK)1, RIPK3 and mixed-lineage kinase domain-like protein (MLKL), TRPC6 and PARP1, were detected by Western blot. Results Typical saucer-like structure was observed under TEM. Nanoparticle tracing analysis showed that the average diameter of the extracted substance was 125.9 nm. Western blot revealed that the surface markers of CD9, CD63 and CD81 were positively expressed, confirmed that the extracted substance was exosome. Compared with group S, the serum creatinine and blood urea nitrogen levels were up-regulated, the pathological damage of renal tissues was worsened, Paller score was elevated, the relative expression levels of TRPC6 and PARP1 proteins were down-regulated, and the relative expression levels of RIPK1, RIPK3 and MLKL proteins were up-regulated in group IRI (all P < 0.05). Compared with group IRI, the serum creatinine and blood urea nitrogen levels were down-regulated, the pathological damage of renal tissues was mitigated, Paller score was decreased, the relative expression levels of TRPC6 and PARP1 proteins were up-regulated, and the relative expression levels of RIPK1, RIPK3 and MLKL proteins were down-regulated in group EXO (all P < 0.05). Compared with group EXO, the serum creatinine and blood urea nitrogen levels were up-regulated, the pathological damage of renal tissues was aggravated, Paller score was increased, the relative expression levels of TRPC6 and PARP1 proteins were down-regulated, and the relative expression levels of RIPK1, RIPK3 and MLKL proteins were up-regulated in group ES (all P < 0.05). Conclusions hucMSC-Exo may alleviate the necroptosis induced by renal IRI in rat models, which is related to the activation of TRPC6/PARP1 signaling pathway.
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Ischemia-reperfusion injury (IRI) refers to the reperfusion injury caused by the recovery of blood supply of ischemic tissues or organs, which commonly occurs in organ transplantation and other surgical procedures. IRI may cause a series of severe clinical issues, such as delayed graft function, acute kidney injury, myocardial infarction, ischemic stroke and circulatory arrest, etc. These events yield high incidence and fatality. At present, no effective solution has been available. Transient receptor potential canonical 6 (TRPC6), a member of Ca2+ channel family, is highly expressed in multiple types of cells. It may adjust many physiological functions by regulating intracellular Ca2+ concentration, which has become an important target for developing therapeutic drugs for multiple diseases. In this article, research progresses on the introduction and function of TRPC6, the association between TRPC6 and IRI and the therapeutic prospect of TRPC6 targeted drugs in IRI were reviewed, aiming to provide novel insights into the prevention and treatment of IRI during organ transplantation
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@#ObjectiveTo understand the risk factors exposure and population distribution characteristics of the elderly population at high risk of stroke in Sanlin Community，Pudong New Area，Shanghai，and to provide basis for the development of prevention and treatment strategies for the elderly population at high risk of stroke. Methodsfrom 2015 to 2017 by using cluster sampling method of pudong new area three forest community more than 65 years old and permanent population of field investigation and related physical examination，blood lipid，fasting blood glucose，glycosylated hemoglobin，homocysteine，ECG detection，with screening of ischemic cerebral apoplexy risk groups and its risk factors. ResultsFrom 2015 to 2017，there were 9，195 residents in total，1，504 people with high risk of stroke were screened，and the proportion of high risk population was 16.78%；535 people（5.82%）had a history of tia or stroke，and 969 people（10.54%）had more than 3 risk factors. Among the 1，504 high-risk groups，the risk factor exposure rates ranged from high to low for hypertension，overweight，hyperlipidemia，diabetes，history of stroke，smoking，family history，physical inactivity，and atrial fibrillation. Among the 969 patients with risk factors ≥3，the incidence of diabetes and hyperlipidemia exposure was higher in women than in men，and the incidence of smoking and overweight in men was higher than in women. The detection rate of Hcy hyperemia was 53.72% in the community population participating in screening. The detection rate was 63.8% for males and 45.7% for females，and the difference was statistically significant. ConclusionThe detection rate of high-risk groups over 65 years old in Sanlin area was similar to that in other areas of Shanghai. Hypertension，overweight，and hyperlipidemia were the three risk factors with the highest exposure rates. Men and women have different exposures to certain risk factors. High homocysteine in the elderly，male population detection rate is high. In order to prevent stroke，regular follow-up management should be carried out in combination with the occurrence of risk factors in different populations.
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Objective:To explore the current status of village doctors′ vulnerability in Shandong province in the context of ongoing healthcare reform.Methods:A cross-section study was conducted from October 2015 to November 2015 based on a self-designed questionnaire for village doctors. The questionnaire included 6 parts: fundamental state, disturbance from surroundings, disturbance from job, emotional support, instrumental support and self-ability of village doctors. Mean and standard deviation were adopted to describe the level of disturbance and support. Quadrant analysis was adopted to analyze village doctors′ vulnerability. The set pair analysis was adopted to calculate the vulnerability index and sample cluster analysis was adopted to classify village doctors based on the vulnerability index.Results:The total disturbance score was 3.39±0.46, and contribution from professional risk was the biggest(19.95%). The self-ability score was 3.33±0.40, and contribution from financial support was the smallest(4.09%). According to the set pair analysis, village doctors′ vulnerability total score was 0.49±0.06, ranging in a medium category. According to the sample cluster analysis, 27.2%(277/1 018)of the village doctors stayed at the upper category, as 30.3%(309/1 018) was defined as a medium category. According to the quadrant analysis, 35.5%(361/1 018)of the village doctors were found as in crisis vulnerability.Conclusions:In general, village doctors′ vulnerability stays in the medium category. They have to fight against high disturbance from surroundings, with more emotional support and less financial support expected.