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Tianlong Ling,* Yuguang Shen,* Yuanruohan Zhang,* Jian Tang, Enhao Zhao Department of Gastrointestinal Surgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Enhao Zhao; Jian Tang, Department of Gastrointestinal Surgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, No. 1630 East Road, Shanghai, 200120, People’s Republic of China, Tel + 13818147043, Email microenhao@163.com; tkf28@163.comAbstract: Facing resource shortages and increasing gaps between regions and populations during the 20th century, around the 70s, the Chinese government authorized local governments to independently operate their own medical system, including medical education, to provide basic medical services and meet healthcare needs. These multiple independent but unparallel medical education systems throughout the nation inevitably created education quality disparities. Around the beginning of the 21st century, the Chinese government started a medical education standardization reform. This study aims to review and critically analyze these reform efforts toward standardization in medical schools and postgraduate and continuing education. All the background information, data, findings, government measures, etc. presented in this article were obtained through literature searches on PubMed, Baidu Scholar, and respective official online documents. Some of the key search criteria are, but not limited to, medical education reform in China and medical education history in China. These data were accessed in 2022. Standardization has been the core of reform in all three phases of medical education in China since the beginning of the 21st century. The three/five/eight principle, which refers to years of medical school, has been the backbone of medical school education in pursuing the “ 2030 healthy China” goal. The government streamlined postgraduate education further by establishing official licensing examination and launching a five+three+X model, which represents years required for medical school education, standardized residence, and specialty training, respectively. The standardization of continuing education is ongoing. Official and unified appraisal tests are in the pilot stage, whereas other areas have yet to change. Hopefully, this study will provide insight for future reform or research, or inform other countries.Keywords: medical education, reform, China, postgraduate, continuing education

E Zhao,1 Zhengting Duan,2 Jingmei Li1 1Department of Rehabilitation, Guangyuan Central Hospital, Guangyuan, People’s Republic of China; 2Department of Rehabilitation, The First People’s Hospital of Guangyuan, Guangyuan, People’s Republic of ChinaCorrespondence: Jingmei Li, Department of Rehabilitation, Guangyuan Central Hospital, Guangyuan, People’s Republic of China, Email 13981261881@163.com

Honghong Zheng,1,* Zhehong Li,2,* Shuai Zheng,1 Jianjun Li,1 Ji Yang,1 Enhong Zhao1 1Department of Gastrointestinal Surgery, The Affiliated Hospital of Chengde Medical University, Chengde, 067000, People’s Republic of China; 2Department of Orthopedic, The Affiliated Hospital of Chengde Medical University, Chengde, 067000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Enhong Zhao, The Affiliated Hospital of Chengde Medical University, No. 36 Nanyingzi St., Chengde, 067000, People’s Republic of China, Email zhenghh1215@163.comPurpose: Patients with middle-aged and elderly rectal cancer (MERC) usually have poor prognosis after surgery. This study aimed to develop a nomogram to achieve individualized prediction of overall survival (OS) in patients with MERC and to guide follow-up and subsequent diagnosis and treatment plans.Patients and Methods: A total of 349 patients were randomly assigned to the training and validation cohorts in a 7:3 ratio. Multivariate Cox regression analysis was performed using the results of univariate Cox regression analysis to confirm independent prognostic factors of OS. Thereafter, the nomogram was built using the “rms” package. Subsequently, discriminative ability and calibration of the nomogram were evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Integrated discrimination improvement (IDI), net reclassification improvement (NRI), and the area under the ROC curves (AUC) were compared between the nomogram and the tumor-node-metastasis (TNM) staging system (8th edition). Finally, we established a predictive model to assess the survival benefit of patients with MERC by calculating nomogram scores for each patient.Results: Six variables were identified as independent prognostic factors and included in the nomogram: smoking history, family history, hematochezia, tumor size, N stage, and M stage. Based on these factors, we successfully constructed a nomogram and evaluated its discriminative and predictive abilities using ROC curves, calibration curves, and DCA. ROC curves, IDI, and NRI showed that the nomogram had outstanding clinical utility compared with the TNM staging system (8th edition) for OS prediction. The predictive model successfully distinguished between high-, medium-, and low-risk MERC patients.Conclusion: Our nomogram provided a more satisfactory survival prediction ability than the TNM staging system (8th edition) for MERC patients. In addition, the nomogram was able to accurately categorize patients into different risk groups after surgery.Keywords: nomogram, rectal cancer, web-based nomogram, overall survival, prognosis

Yuanyuan Mao, Jin Guo, Jingjing Yuan, Erxian Zhao, Jianjun Yang Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of ChinaCorrespondence: Jianjun Yang, Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, No.1 East Jianshe Road, Zhengzhou, Henan, 450052, People’s Republic of China, Tel/Fax +8613783537619, Email Jianjunyang1971@163.comBackground: Remimazolam is a new medication with sedative and hypnotic effects. It has been demonstrated non-inferior to propofol in general anesthesia with regard to efficacy and safety. However, whether general anesthesia with remimazolam is better than propofol in terms of patients’ recovery quality remains unknown.Patients and Methods: Patients enrolled in this study were randomized to remimazolam or propofol group. In remimazolam group, general anesthesia was induced with remimazolam and sufentanil and maintained with remimazolam and remifentanil. In propofol group, general anesthesia was induced with propofol and sufentanil and maintained with propofol and remifentanil. Neuromuscular blocking agent cisatracurium was also injected during anesthesia. Sedation level was monitored by bispectral index (BIS). Our primary outcome was the quality of patients’ postoperative recovery, using the Quality of Recovery-15 (QoR-15) scale. Secondary outcomes included SpO2, HR, MBP and frequency of application of vasoactive drugs during anesthesia, as well as incidences of adverse events in the post anesthesia care unit (PACU).Results: The global scores of QoR-15 scale were lower in remimazolam group at postoperative day 1 and day 3 compared to propofol group, but differences between the two groups only had clinical significance at postoperative day 1. Among the five dimensions of QoR-15 scale, scores for physical comfort and emotional state were lower in remimazolam group than propofol group. MBP and HR were higher in remimazolam group than propofol group after anesthesia induction. SpO2 was similar in the two groups. The frequency of application of vasoactive drugs during anesthesia was higher in propofol group than remimazolam group. There was no statistical difference in the incidences of adverse events between the two groups.Conclusion: General anesthesia with remimazolam can provide more stable hemodynamics but also cause temporary reduction in the quality of recovery in patients undergoing urologic surgery, compared to propofol.Keywords: remimazolam, propofol, quality of recovery, urologic surgery

Yangyang Wang,1,2,* Shuchang Wang,1,* Chunchao Zhu,1 Hui Cao,1 Zizhen Zhang,1 Enhao Zhao1 1Department of Gastrointestinal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, People’s Republic of China; 2State Key Laboratory for Oncogenes and Related Genes, Shanghai Cancer Institute, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200240, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zizhen Zhang; Enhao ZhaoDepartment of Gastrointestinal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai 200127, People’s Republic of ChinaTel +8618800299532Fax +86-21-58394262Email zzzhang16@hotmail.com; microzhaoenhao@163.comPurpose: Adenocarcinoma of the esophagogastric junction (AEG) patient immune characteristics were analyzed in this study, and these features were compared with patient clinical pathology and prognosis.Patients and Methods: The clinicopathological data and prognostic information of 96 AEG patients who were admitted to Ren Ji Hospital between December 2008 and December 2015 were collected. PD-1/PD-L1, Tim-3/Gal-9, and CD3/CD8/Foxp3 expression in these patients, as well as the correlation of the expression of these molecules with clinicopathological data and survival time, were analyzed. Comparisons of count data were performed using the chi-square test or Fisher’s exact test. The survival rate and survival curves were calculated and drawn, respectively, with the Kaplan–Meier method, and the Log rank test was used for survival analysis.Results: The positive rate for PD-L1 and Gal-9 in these AEG patients was 30.21% and 31.25%, respectively. Tim-3 positivity had a close relationship with patient Siewert type. CD8+ T cell infiltration and patient TNM stage, as well as CD3+CD8+ T cell infiltration and patient Lauren type, had a close relationship based on analysis of the correlation between immune factor expression and clinicopathological data. The group with high CD8+ T cell infiltration had an improved survival rate, while the combined analysis of Tim-3 and Gal-9 expression showed that the double-positive group had a significantly poorer prognosis than groups with other Tim-3 and Gal-9 expression patterns. The PD-L1 expression level had a close relationship with T cell infiltration in AEG patients, especially CD3+ and CD8+ T cell infiltration.Conclusion: Tim-3 expression was higher in patients with Siewert type I tumors than in patients with tumors of other Siewert types. Patients with high CD8+ T cell infiltration had a better prognosis than patients with low CD8+ T cell infiltration, and CD8+ T cell infiltration was closely related to AEG patient TNM stage. The Tim-3 and Gal-9 double-positive group showed poor prognosis, and immune therapy could be recommended for these AEG patients.Keywords: AEG, adenocarcinoma of the esophagogastric junction, Siewert type, immune characteristic, survival prognosis

Guodong Wang,1,2 Ai Guo,1 Fei Yu,1 Bo Yang,1 Haomiao Yu,1 Naicheng Diao,1 Lifeng Ma,1 Hua Qiang,2 Erhong Zhao2 1Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, People’s Republic of China; 2Department of Orthopaedics, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, People’s Republic of ChinaCorrespondence: Ai GuoDepartment of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, No 95, YongAn Road, Xicheng District, Beijing 100050, People’s Republic of ChinaTel +86 106 313 8293Email guoaij@139.comPurpose: We developed a simple method to minimize leg length discrepancy (LLD) during hip arthroplasty. The purpose of this study is to evaluate the accuracy of the method.Patients and methods: A total of 47 patients who suffered from unilateral femoral neck fracture and underwent hip hemiarthroplasty between 2015 and 2018 were enrolled in this study. We measured the diameter of the contralateral femoral head (D) and the distance (L) between the center of the femoral head and the top of lesser trochanter in the antero-posterior pelvic X-ray view before the operation, the ratio (R) of D to L was calculated. During the operation, the diameter of the femoral head (d) was measured using a Vernier caliper. Then, the distance should be obtained from the center of the femoral head prosthesis to the lesser trochanter was calculated according to the contralateral ratio R.Results: The mean LLD was 4.4±3.2 mm (−4.0 to 11.1 mm), 80.9% of the patients had LLD

Abstract Background Cotton is a major fiber and oil crop worldwide. Cotton production, however, is often threatened by abiotic environmental stresses. GRAS family proteins are among the most abundant transcription factors in plants and play important roles in regulating root and shoot development, which can improve plant resistance to abiotic stresses. However, few studies on the GRAS family have been conducted in cotton. Recently, the G. hirsutum genome sequences have been released, which provide us an opportunity to analyze the GRAS family in G. hirsutum. Results In total, 150 GRAS proteins from G. hirsutum were identified. Phylogenetic analysis showed that these GRAS protins could be classified into 14 subfamilies including SCR, DLT, OS19, LAS, SCL4/7, OS4, OS43, DELLA, PAT1, SHR, HAM, SCL3, LISCL and G_GRAS. The gene structure and motif distribution analysis of the GRAS members in G. hirsutum revealed that many genes of the SHR subfamily have more than one intron, which maybe a kind of form in the evolution of plant by obtaining or losing introns. Chromosomal location and duplication analysis revealed that segment and tandem duplication maybe the reasons of the expension of the GRAS family in cotton. Gene expression analysis confirmed the expression level of GRAS members were up-regulated under different abiotic stresses, suggesting that their possible roles in response to stresses. What’s more, higher expression level in root, stem, leaf and pistil also indicated these genes may have effect on the development and breeding of cotton. Conclusions This study firstly shows the comprehensive analysis of GRAS members in G. hirsutum. Our results provide important information about GRAS family and a framework for stress-resistant breeding in G. hirsutum.

Stable lattice oxygen redox (l-OR) is the key enabler for achieving attainable high energy density in Li-rich layered oxide cathode materials for Li-ion batteries. However, the unique local structure response to oxygen redox in these materials, resulting in energy inefficiency and hysteresis, still remains elusive, preventing their potential applications. By combining the state-of-the-art neutron pair distribution function with crystal orbital overlap analysis, we directly observe the distinct local structure adaption originated from the potential O–O chemical bonds. The structure adaptability is optimized based on the nature of multi transition metals in our model compound Li1.2Ni0.13Mn0.54Co0.13O2, which accommodates the oxygen redox and at the same time preserves the global layered structure. These findings not only advance the understanding of l-OR, but also provide new perspectives in the rational design of high-energy-density cathode materials with reversible and stable l-OR.

Objective To understand the characteristics and trends of diabetes death among the permanent population in Urumqi, and to provide a theoretical basis for the scientific prevention and control of diseases. Methods The diabetes death data in Urumqi from January 1, 2017, to December 31, 2022, was derived from the population death information registration management system in the Chinese Disease Control and Prevention Information System, and a total of 2 661 deaths were collected. Statistical analysis of diabetes mortality, potential years of life lost ( PYLL), potential years of life lost rate (PYLLR), average years of life lost ( AYLL), early death probability and its average annual growth rate, complication composition ratio (in order) were carried out. The gray GM ( 1, 1) model was used to predict the diabetes mortality rate in 2023 .,2024 and 2025. Results The diabetes mortality rate in Urumqi from 2017 to 2021 fluctuated between 9. 21 - 16. 37 per 100,000, with an average annual growth rate of 12. 19%. The average annual growth rate of male mortality was 1. 23 times that of women. The mortality rate increases with age, reaching a peak of 401. 48 per 100,000 at the age of over 85. Deaths over the age of 65 accounted for 76. 66% of the total number of deaths. The average annual growth rate of PYLL, PYLLR, AYLL, and early death probability in men was higher than that in women. The average annual growth rate of type 2 diabetes PYLL, PYLLR, and early death was higher than that of type 1 diabetes. Diabetic nephropathy ( 17. 01 % ) accounted for the first place in diabetic mortality, followed by other and unspecified diseases and multiple complications. The forecast model results showed that the diabetes mortality rate in Urumqi will increase in the next three years, reaching 18.31 per 100,000 in 2025. Conclusion The burden of diabetes deaths on Urumqi residents is increasing, and the loss of life expectancy is gradually increasing, so health education and health promotion should be strengthened, and diabetes prevention and control should be strengthened to reduce the risk of death caused by diabetes and its complications. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study was to compare the early clinical outcomes of laparoscopic-assisted proximal gastrectomy with continuous interposition of jejunal cis-peristaltic dual-channel anastomosis and esophagogastric anastomosis. PATIENTS AND METHODS: A retrospective analysis of 130 patients who underwent laparoscopic-assisted radical resection of proximal gastric cancer in the Department of Gastrointestinal Surgery at the Affiliated Hospital of Chengde Medical College between June 2018 and October 2022 was conducted. Continuous interposition jejunal double-channel anastomosis (double-tract anastomosis) was used in 71 patients and esophagogastric anastomosis (esophagogastrostomy) in 59 patients. The basic clinical data, preoperative and postoperative clinical test indexes, postoperative complications and improvement of symptoms compared to preoperative ones, basic nutritional status and Visick classification of esophageal reflux symptoms at 6 months after surgery were compared between the two groups. Postoperative contrast images of patients in the continuous interposition jejunal double-tract group were collected and analyzed for the ratio of contrast agent remaining in the stomach to that remaining in the small intestinal channel. RESULTS: A total of 130 cases meeting the criteria were included in this study, including 71 cases involving the double-tract (DT) anastomosis method and 59 cases involving the esophagogastrostomy (EG) anastomosis method. There was no significant difference in preoperative information and perioperative safety between the two groups. Visick score of the DT group was significantly better than that of the EG group. CONCLUSIONS: Double-tract jejunal anastomosis can effectively improve esophageal reflux symptoms after proximal gastrectomy. At the same time, its anastomotic method also improves the nutritional status in the short term compared to the esophagogastric anastomosis and is a more ideal procedure for reconstructing the digestive tract after proximal gastrectomy. [ABSTRACT FROM AUTHOR]