Application of the “Three Threes” Method in Clinical Teaching of Internal Jugular Vein Puncture

Objective: To clarify the role of the “Three Threes” method in clinical teaching of internal jugular vein puncture and explore improvements in teaching methods. Methods: A doctor was assigned to the induction room of the Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital) for two months. The time required for catheterization, the first puncture success rate, and occurrence of puncture-related complications were compared before and after learning the “Three Threes” method. Results: Using the “Three Threes” method reduced the catheterization time by 43%, increased the first puncture success rate by 17%, and led to fewer puncture-related complications. Conclusion: The application of the “Three Threes” method not only improves the success rate of internal jugular vein puncture but also reduces complications, making it easier for students to master the technique.

Evaluation of the Effectiveness of the “1 + 1 + 1” Method in Theoretical Teaching of Emergency Pericardiocentesis

Background: Pericardial effusion may progress to cardiac tamponade when pressure around the heart increases to a level comparable to that of the right and left atria. Patients with cardiac tamponade need timely completion of emergency pericardiocentesis to relieve the threat to the patient’s life, and to save valuable time for patients who need emergency thoracotomy and pericardial window drainage. Pericardiocentesis is a necessary clinical skill for residents in standardized training. In addition, nurses who are familiar with this technology can better assist clinicians to perform this operation. In order to make the medical staff quickly master the theoretical knowledge of emergency pericardiocentesis, we designed a “1 + 1 + 1” teaching method for the theoretical teaching of emergency pericardiocentesis. Objective: This study aims to explore the effectiveness of the “1 + 1 + 1” teaching method in the theoretical teaching of emergency pericardiocentesis. Methods: We used an English teaching video of emergency pericardiocentesis and applied the “1 + 1 + 1” teaching method for theoretical teaching. A questionnaire survey was conducted before and after the lecture among 19 medical staff of different years of service to understand their mastery of the theoretical content of emergency pericardiocentesis before and after the lecture. According to the years of service, the medical staff were divided into three groups: 1 - 3 years (Group A), 4 - 10 years (Group B), and over 10 years (Group C), and the changes in the mastery of various contents by the overall medical staff and each group were statistically analyzed. Results: Before the lecture, the number of people who mastered the indications, contraindications, most commonly used methods, and common complications of emergency pericardiocentesis were 15, 12, 16, and 17, respectively, whereas after the lecture, these numbers increased to 17, 19, 19, and 19, respectively. The overall mastery before and after the lecture was statistically significant (p Conclusion: The “1 + 1 + 1” teaching method can effectively improve the overall mastery level of medical staff’s theoretical knowledge of emergency pericardiocentesis, especially in improving the mastery of contraindications of this operation.

Entry-Level Forward Surgical Team Training Is Associated with Increased Confidence of Primary Combat Surgeons

Background: In recent years, we have established an entry-level Forward Surgical Team (FST) training program in a Chinese military medical university for the 5th grade undergraduates, who would be deployed to different military medical services as primary combat surgeons. This study aimed to assess the role of this pre-service training in improving their confidence with combat medical skills, after several years since they received the training. Methods: We conducted a nationwide survey of 239 primary combat surgeons who have ever participated in an entry-level FST training program before deployment between June 2016 and June 2020, which was for evaluating on a 5-point Likert scale the benefits of entry-level FST training and conventional surgery training in improving their confidence with combat medical skills. The difference in scores was compared using the student t-test. Significance was considered as P Results: The total score was significantly higher for entry-level FST training than that for conventional surgery training (30.76 ± 4.33 vs. 28.95 ± 4.80, P There was no significant difference between the training for surgical skills confidence scores (18.03 ± 8.04 vs. 17.51 ± 8.30, P = 0.098), but for non-technical skills, the score of entry-level FST training was significantly higher than that of conventional surgery training (12.73 ± 5.39 vs. 11.44 ± 5.62, P The distributions of confidence scores were different under various subgroups by demographics. There were no significant differences in scores between the two training in all specific surgical skill sets except “life-saving surgery” (P = 0.011). Scores of all 4 non-technical skill sets were significantly higher for entry-level FST than those for conventional surgery training (P Conclusions: The training should be considered as an essential strategy to improve confidence in combat medical skills, especially life-saving surgery and non-technical skills, for primary combat surgeons.

The Role of Structured Framework in Simulated Cardiac Emergency for Cardiothoracic Training

Background: Both technical and nontechnical skills are important factors in cardiac emergency incident. The effects of structured framework on these skills have not been thoroughly studied. We hypothesized that structured framework can improve the clinical performance and reduce errors to improve patients’ safety. Methodology: A total of 24 teams composed of cardiac residents, attending surgeons and ICU nurses performed simulated emergency incident tasks in cardiopulmonary resuscitation (CPR) and tracheal intubation (TI) scenarios. Framework education was introduced to the assigned groups in two separate semesters. All the scenarios were recorded by video for further evaluation by cardiologist and emergency medicine specialist. Clinical performance, time consumption in simulated scenarios, correlation between framework training and nontechnical skills performance were assessed. Results: The average percentages of CPR completed in the Group 1 (G1) with framework education and the Group 2 (G2) were 85% (SEM: 6.20%) and 53% (SEM: 5.77%) respectively (P < 0.001). And the average percentages of TI completed in G2 with framework education was 87% (SEM: 3.96%), higher than G1 (50%, SEM: 5.64%) (P < 0.001). As for time consumption, the mean time to complete CPR in groups with framework education was shorter than in groups without framework education (P o complete TI in groups with framework education was shorter than in groups without framework education (P < 0.005). Further, there was a significant correlation between framework training and communication in simulated scenarios. Conclusion: The framework provides the whole procedure of the task to every participant. Structured framework education can improve nontechnical skills as well as technical skills of doctors and nurses. Further, researches should be conducted to evaluate the clinical performance and correlation between technical skills and nontechnical skills in cardiothoracic training.

The Usage of Triage Systems in Mass Casualty Incident of Developed Countries

Victims are usually overwhelmed by local medical system in an unexpected mass casualty incident (MCI). Triage systems originate from wartime necessity to achieve the greatest efficiency to the maximum number of victims. In peacetime, the triage systems are applied to allocate constrained medical resources for the victims in MCI. There are several kinds of triage systems in different countries, such as Simple Triage and Rapid Treatment (START), Sort, Assess, Life-saving interventions, Treatment and/or Transport (SALT), Sacco Triage Method (STM), Careflight triage and Triage Sieve (TS). The START system is widely used in developed countries, especially in USA. The SALT is formulated by a work group of the Centers for Disease Control and Prevention (CDC) based on scientific data. STM is a triage algorithm designed for resource-constrained condition. Besides, the other triage systems show their power in managing the victims in MCI. However, the data of theses popular triage tools are mainly based on simulated tests, lacking of validity and reliability of triage systems. Therefore, the application, reliability, sensitivity and specificity of existing triage tools require to be validated in the real condition of MCI. Furthermore, due to the difference among triage tools used in different countries, international cooperation is demanded for a more highly organized mass-casualty medical response.

A lightweight DDoS detection scheme under SDN context

Software-defined networking(SDN),a novel network paradigm,separates the control plane and data plane into dif-ferent network equipment to realize the flexible control of network traffic.Its excellent programmability and global view present many new opportunities.DDoS detection under the SDN context is an important and challenging research field.Some previous works attempted to collect and analyze statistics related to flows,usually recorded in switches,to address DDoS threats.In contrast,other works applied machine learning-based solutions to identify DDos and achieved promising results.Generally,most previous works need to periodically request flow rules or packets to obtain flow statistics or features to detect stealthy exceptions.Nevertheless,the request for flow rules is very time-consuming and CPU-consuming;moreover may congest the communication channel between the controller and the switches.Therefore,we present FORT,a lightweight DDoS detection scheme,which spreads the rule-based detection algorithm at edge switches and determines whether to start it by periodically retrieving the ports state.A time-series algorithm,ARIMA,is utilized to determine the port statistics adaptively,and an SVM algorithm is applied to detect whether a DDoS attack does occur.Representative experiments demonstrate that FORT can significantly reduce the controller load and provide a reliable detection accuracy.Referring to the false alarm rate of 1.24%in the comparison scheme,the false alarm rate of this scheme is only 0.039%,which significantly reduces the probability of false alarm.Besides,by introducing the alarm mechanism,this scheme can reduce the load of the southbound chan-nel by more than 60%in the normal state.

Molecular cloning,sequencing,and expression profiles of heat shock protein 90 (HSP90) in Hyriopsis cumingii exposed to different stressors:Temperature,cadmium and Aeromonas hydrophila

Heat shock protein 90(HSP90)represents a suite of highly conserved and multi-functional molecular chaperone proteins that play an important role in cellular stress responses.In order to better understand the expression of HSP90 in mollusks,a full-length complementary DNA(cDNA)of HSP90(HcHSP90)was identified in Hyriopsis cumingii.HcHSP90 cDNA was 2659 bp in length,consisting of 30 and 50-untranslated regions and an open reading frame of 2187 bp,that encoded a 728 amino acid protein.Homology analyses showed that the HcHSP90 protein was highly conserved and had 5 well-conserved family signatures of HSP90 proteins.HcHSP90 mRNA expressed in various tissues of H.cumingii.The expression level of HcHSP90 was the highest in the digestive gland.In all tissues,with the exception of the digestive gland where it was down-regulated,HcHSP90 mRNA expression was significantly induced by temperature treatments(0,5,25,and 35℃)relative to the control(15℃).Exposure of H.cumingii to different concentrations of cadmium(50,100,and 200 mg/L),up-regulated HcHSP90 mRNA in the haemolymph and gill but without an obvious dose-dependent response.When H.cumingii were infected with Aeromonas hydrophila,HcHSP90 mRNA expression in the haemolymph was up-regulated and peaked 36 h post-infection,while in the gills it was significantly up-regulated 3 h post-infection in the gills,then remained constant until returning to pre-challenge expression levels at 36 h post-infection.The results show that HcHSP90 expression can be significantly regulated by changes in temperature,cadmium exposure and bacterial infection.We deduced that HSP90 may play an important role in helping H.cumingii to cope with environmental stress.

Research on Adaptive Optics Image Restoration Algorithm Based on Improved Joint Maximum a Posteriori Method

In this paper, we propose a point spread function （PSF） reconstruction method and joint maximum a posteriori （JMAP） estimation method for the adaptive optics image restoration. Using the JMAP method as the basic principle, we establish the joint log likelihood function of multi-frame adaptive optics （AO） images based on the image Gaussian noise models. To begin with, combining the observed conditions and AO system characteristics, a predicted PSF model for the wavefront phase effect is developed; then, we build up iterative solution formulas of the AO image based on our proposed algorithm, addressing the implementation process of multi-frame AO images joint deconvolution method. We conduct a series of experiments on simulated and real degraded AO images to evaluate our proposed algorithm. Compared with the Wiener iterative blind deconvolution （Wiener-IBD） algorithm and Richardson-Lucy IBD algorithm, our algorithm has better restoration effects including higher peak signal-to-noise ratio （PSNR） and Laplacian sum （LS） value than the others. The research results have a certain application values for actual AO image restoration.

克隆整合影响严重光胁迫下第一分株世代的生长和沉积物特征但不影响后续分株世代的生长和沉积物特征

克隆整合通过缓冲环境压力和提高资源获取效率使克隆植物受益。然而,在一个克隆系统中,受益于克隆整合的连接分株世代的数量很少受到关注。我们进行了一个盆栽实验来评估沉水植物苦草(Vallisneria natans)克隆系统内的生理整合程度,该克隆系统由一个母株和3个依次连接的后代分株组成。母株生长在正常光照下,而后代分株被严重遮荫。母株与后代分株间的匍匐茎被切断或保持连接,但3个后代分株之间的连接仍然存在。与遮荫的后代分株连接时,苦草未遮荫的母株的光合能力显著增强,但其生物量积累大大减少。克隆整合显著增加了第一分株世代(相邻分株)的生物量积累和土壤的碳氮可用性、胞外酶活性和微生物生物量,但没有增加后续分株世代的这些特征。我们的结果表明,在严重光胁迫下,来自苦草母株的支持可能仅限于克隆系统中相邻的后代分株,这暗示着一个分株世代的效应。我们的结果有助于更好地理解克隆植物的层次结构和分段化。这些发现表明克隆整合程度在分株种群的生态相互作用中起着至关重要的作用。

Utilizing quantum coherence in Cs Rydberg atoms for high-sensitivity room-temperature terahertz detection: a theoretical exploration

In recent years,terahertz (THz) technology has made significant progress in numerous applications;however,the highly sensitive,room-temperature THz detectors are still rare,which is one of the bottlenecks in THz research.In this paper,we proposed a room-temperature electrometry method for THz detection by laser spectroscopy of cesium(^(133)Cs) Rydberg atoms,and conducted a comprehensive investigation of the five-level system involving electromagnetically induced transparency (EIT),electromagnetically induced absorption (EIA),and Autler–Townes (AT) splitting in^(133)Cs cascades.By solving the Lindblad master equation,we found that the influence of the THz electric field,probe laser,dressing laser,and Rydberg laser on the ground state atomic population as well as the coherence between the ground state and the Rydberg state,plays a crucial role in the transformation and amplitude of the EIT and EIA signals.Temperature and the atomic vapor cell’s dimensions affect the number of^(133)Cs atoms involved in the detection,and ultimately determine the sensitivity.We predicted the proposed quantum coherence THz detection method has a remarkable sensitivity of as low as 10^(-9)V m^(-1)Hz^(-1/2).This research offers a valuable theoretical basis for implementing and optimizing quantum coherence effects based on Rydberg atoms for THz wave detection with high sensitivity and room-temperature operation.