The application of clinical path teaching method and case-based learning in the standardized residency training in the department of endocrinology / 中华医学教育探索杂志

Objective:To explore the application effect of clinical path teaching method (CPTM) and case-based learning (CBL) in the standardized residency training in the department of endocrinology.Methods:A total of 120 residents who participated in the standardized residency training in the Department of Endocrinology in The First Affiliated Hospital of University of Science and Technology of China from June 2020 to June 2021 were selected as subjects. They were randomly divided into the control group (30 cases) who received traditional teaching mode, CPTM group (30 cases), CBL group (30 cases) and the experimental group (30 cases) who received CPTM + CBL combination teaching mode. The graduation examination results, usual performances and the teaching satisfaction among the four groups were compared.Results:The students in experimental group had higher score in learning methods, task completion, clinical thinking ability and operational assessment than the rest three groups. In addition, the students in experimental group were more enthusiastic to learn than the control group and CPTM group, and the difference was statistically significant ( P<0.05). The students in experimental group had better performance in graduation examination (55.97±5.58) than the control group (51.97±4.54), CPTM group (53.48±3.37) and CBL group (51.36±3.72).The teaching satisfaction of the students in experimental group was higher than that of the rest three groups. Furthermore, the teaching experience of teachers in experimental group was better. Conclusion:CPTM combined with CBL teaching method can improve the thinking skills and learning initiative, which is beneficial to cultivate the clinical ability of residents in the standardized residency training of endocrinology.

Secondary herpes zoster wound cured by allogeneic platelet-rich plasma: a case report / 中国输血杂志

【Objective】 To investigate the feasibility of allogeneic platelet-rich plasma (PRP) for the treatment of herpes zoster wounds secondary to systemic lupus erythematosus (SLE), especially large ulcer wounds. 【Methods】 The treatment process of a patient with massive herpes zoster wounds in perineum and hip accompanied by extensive soft tissue necrosis secondary to SLE was retrospectively analyzed. The clinical efficacy of allogeneic PRP was explored combined with treatment key points and literature review. 【Results】 The patient′s wound bed was prepared until the wound was fresh, then treated externally with allogeneic PRP 3 times a week. The wound was healed completely after 42 days. 【Conclusion】 In the case of autologous PRP unavailable or unsuitable, allogeneic PRP is a safe alternative, which can effectively promote tissue regeneration, and this patient achieved curative effect in a short period of time.

Associations between indoor volatile organic compounds and nocturnal heart rate variability of young female adults: A panel study / 北京大学学报(医学版)

OBJECTIVE@#To investigate the association between short-term exposure to indoor total volatile organic compounds (TVOC) and nocturnal heart rate variability (HRV) among young female adults.@*METHODS@#This panel study recruited 50 young females from one university in Beijing, China from December 2021 to April 2022. All the participants underwent two sequential visits. During each visit, real time indoor TVOC concentration was monitored using an indoor air quality detector. The real time levels of indoor temperature, relative humidity, noise, carbon dioxide and fine particulate matter were monitored using a temperature and humidity meter, a noise meter, a carbon dioxide meter and a particulate counter, respectively. HRV parameters were measured using a 12-lead Holter. Mixed-effects models were used to evaluate the association between the TVOC and HRV parameters and establish the exposure-response relationships, and two-pollutant models were applied to examine the robustness of the results.@*RESULTS@#The mean age of the 50 female subjects was (22.5±2.3) years, and the mean body mass index was (20.4±1.9) kg/m2. During this study, the median (interquartile range) of indoor TVOC concentrations was 0.069 (0.046) mg/m3, the median (interquartile range) of indoor temperature, relative humidity, carbon dioxide concentration, noise level and fine particulate matter concentration were 24.3 (2.7) ℃, 38.5% (15.0%), 0.1% (0.1%), 52.7 (5.8) dB(A) and 10.3 (21.5) μg/m3, respectively. Short-term exposure to indoor TVOC was associated with significant changes in time-domain and frequency-domain HRV parameters, and the exposure metric for most HRV parameters with the most significant changes was 1 h-moving average. Along with a 0.01 mg/m3 increment in 1 h-moving average concentration of indoor TVOC, this study observed decreases of 1.89% (95%CI: -2.28%, -1.50%) in standard deviation of all normal to normal intervals (SDNN), 1.92% (95%CI: -2.32%, -1.51%) in standard deviation of average normal to normal intervals (SDANN), 0.64% (95%CI: -1.13%, -0.14%) in percentage of adjacent NN intervals differing by more than 50 ms (pNN50), 3.52% (95%CI: -4.30%, -2.74%) in total power (TP), 5.01% (95%CI: -6.21%, -3.79%) in very low frequency (VLF) power, and 4.36% (95%CI: -5.16%, -3.55%) in low frequency (LF) power. The exposure-response curves showed that indoor TVOC was negatively correlated with SDNN, SDANN, TP, and VLF when the concentration exceeded 0.1 mg/m3. The two-pollutant models indicated that the results were generally robust after controlling indoor noise and fine particulate matter.@*CONCLUSION@#Short-term exposure to indoor TVOC was associated with significant negative changes in nocturnal HRV of young women. This study provides an important scientific basis for relevant prevention and control measures.

Association of ambient fine particulate air pollution with hospitalization costs and stays for depression in China: a multicity analysis / 中华预防医学杂志

Objective: To explore the effect of fine particulate matter (PM2.5) pollution on depression hospitalization cost and length of stay in 57 cities of China. Methods: A total of 84 207 patients with depression in 57 cities of China from January 2013 to December 2017 were selected as the subjects. The demographic characteristics and hospitalization status of the patients were obtained from the database of basic medical insurance for urban workers and urban residents in China. The environmental exposure data of the same period were obtained from the national air quality real-time release platform of China Environmental Monitoring Station. A generalized additive model based on quasi-Poisson distribution was used to analyze PM2.5 exposure effect in each city, and the nonlinear mixing of moving average temperature, relative humidity and date was controlled by natural smooth spline function. Results: Among the included cities, southern cities accounted for 50.88% (29), and the number of female inpatients, hospitalization costs and hospitalization days accounted for 62.65%, 63.50% and 60.85% (42 735 cases, 567.78 million yuan and 1.14 million days, respectively). The proportion of hospitalized cases, hospitalization cost and length of stay in the age group of 40 to 64 years old were 59.15% (40 346 cases), 53.92% (482.15 million yuan) and 52.07% (0.98 million days), respectively. PM2.5 level was positively correlated with the number of hospitalized cases with depression, hospitalization cost and length of stay. When the 3-day moving average of PM2.5 exposure level increased by 10 μg/m3, the number of hospitalization cases increased by 0.64%. The attributed percentage (95%CI) of hospitalized cases, hospitalization costs and length of stay were 3.35% (0.57%-6.04%), 3.04% (0.52%-5.48%) and 3.07% (0.49%-5.56%), respectively. Subgroup analysis showed that the attributed percentage of hospitalization cases, hospitalization cost and length of stay to PM2.5 exposure ranged from 3.97% to 4.68%, 4.04% to 4.33% and 4.13% to 4.30% in northern China, male and cold season, respectively. Conclusion: PM2.5 exposure is associated with the increase of hospitalization cost and length of stay among Chinese urban population with depression.

Application of Hierarchical Weighted TOPSIS to Evaluate Rational Drug Use of Saxagliptin in a Hospital / 中国药房

OBJECTIVE：To provide method reference for scientifically eva luating the rationality of the use of saxagliptin . METHODS：Based on the drug instructions ，clinical guidelines ，clinical pathways ，related references ，clinical endocrinology department and pharmaceutical experts of a hospital jointly discussed and formulated the evaluation criteria for the rationality of the use of saxagliptin. AHP method was used to assign weights to various indexes of evaluation criteria ；TOPSIS method was used to analyze the use of saxagliptin of 106 cases in the hospital during Nov. 2018-Apr. 2019 retrospectively and evaluate rational drug use. RESULTS ：A total of 6 primary indicators and 12 secondary indicators were established. The first three indicators with a relatively high index weight were indications （with a weight of 0.25），dose and adjustment of administration （with a weight of 0.21）and frequency of administration （with a weight of 0.15）. Among 106 cases，39.6％ of drug use were reasonable ，51.0％ were basically reasonable and 9.4％ were unreasonable. Evaluation results made by weighted TOPSIS were consistent with the actual situation. CONCLUSIONS ：TOPSIS method weighted by AHP is reasonable and feasible for evaluating the rationality of saxagliptin use.

Value of ultrasound combined with serum CA125, CA199 and CEA in the differential diagnosis of ovarian benign and malignant tumors / 中国医师杂志

Objective To investigate the diagnostic values of ultrasonography combined with serum cancer antigen 125 (CA125),serum carbohydrate antigen 199 (CA199),serum carcinoembryonic antigen (CEA) in ovarian malignant tumors.Methods From November 2015 to December 2017,140 patients with ovarian cancer admitted to the hospital were selected as subjects,and ultrasound examination was carried out with IU22 ultrasound diagnostic instrument.The patients were divided into 92 cases of benign ovarian tumors and 4-8 cases of malignant ovarian tumors through pathological diagnosis.The serum CA125,CA199 and CEA of all patients were detected by automatic biochemical analyzer,and receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of four combined detection in ovarian malignancies.Results The coincidence rate of ultrasound diagnosis in ovarian benign tumor patients was significantly higher than that in ovarian cancer patients (P ＜ 0.05).The levels of serum CA125,CA199 and CEA in benign ovarian tumors were significantly lower than those in malignant ovarian tumors (P ＜0.05),and the levels of serum CA125,CA199 and CEA in patients with stage Ⅰ to Ⅱ were significantly lower than those in stage Ⅲ to Ⅳ (P ＜ 0.05).The area of serum CA125,CA199 and CEA under the ROC curve was 0.788,0.750 and 0.708,respectively.The boundary points of diagnosis were 50.61 U/ml,36.47 U/ml and 4.32 ng/ml,respectively.The area under the combined diagnosis curve of the serum CA125,CA199 and CEA was 0.832.The sensitivity,specificity and accuracy of the combined detection were higher than that of single index detection and serum combined detection.Conclusions Ultrasound combined with serum CA125,CA199 and CEA levels detection can improve the sensitivity,specificity and accuracy of diagnosis of ovarian benign and malignant tumors,which has certain clinical value.

Relationship between retinol binding protein 4,25-hydroxy vitamin D and lower extremity arteriald disease in type 2 diabetes mellitus patients / 中国糖尿病杂志

Objective To investigate the relationship among retinol binding protein 4(RBP-4), 25-hydroxy vitamin D [25(OH)D]concerntrations and lower extremity arterial disease (LEAD)in type 2 diabetes mellitus (T2DM) patients. Methods A total of 197 T2DM patients and 80 healthy subjects were recruited in this study.The diabetic patients were assigned to group without complications (non-LEAD)and group complicated with LEAD (LEAD).Biochemical indications,serum RBP4 and 25(OH)D concentrations were measured. Results Serum RBP4 levels in LEAD group[(39.14 ± 2.14) μg/ml] increased as compared with that in group non-LEAD [(30.01 ± 2.09)μg/ml]and NC group [(14.09 ± 1.88)μg/ml](P<0.01).Serum 25(OH)D concentrations in LEAD group [(11.63 ± 6.83)ng/ml]were lower than that in Non-LEAD group [(18.02 ± 6.42)ng/ml]and NC group[(23.39 ± 4.68)ng/ml](P<0.05).Serum RBP-4 was positively associated with triglycerides (TG),low density lipoprotein cholesterol (LDL-C),homeostasis model assessment for insulin resistance (HOMA-IR),body mass index (BMI), waist-hip ratio (WHR)and negatively associated with 25(OH)D and high density lipoprotein cholesterol (HDL-C).Serum 25(OH)D had a negative correlation with RBP-4,HbA1c,fasting plasma glucose(FPG),HOMA-IR and duration.Logistic regression analysis showed that HDL-C and 25(OH)D were protective factors of LEAD. Conclusion Increased serum RBP-4 levels and reduced 25(OH)D concentrations are significantly associated with the occurrence of LEAD in patients with T 2DM.

Construction of Harmonious Doctor-patient Relationship under the Background of the New Criminal Law Amendment / 中国医学伦理学

Under the background of current strained doctor-patient relationship,the new Criminal law Amendment stipulates that people who makes medical troubles shall be persecuted for their criminal liability in order to reconstruct harmonious doctor-patient relationship.Through questionnaire survey,this paper investigated the cognitive status,cognitive channel,and improvement measures of doctor-patient relationship after the new Criminal law Amendment in college students in Nanjing,analyzed the causes,and discussed the possible path to construct harmonious doctor-patient relationship.Doctor-patient communication should be enhanced;patients should seek medicine service rationally;hospitals should effectively deal with complaints and disputes and vigorously strengthen the enforcement strength of the new Criminal law Amendment.

The application value of contrast-enhanced ultrasound in the BI-RADS-US 4 breast lesions / 中华超声影像学杂志

Objective To assess the value of contrast-enhanced ultrasound (CEUS) in differential diagnosis of BI-RADS-US 4 breast lesions.Methods A total of 123 lesions underwent CEUS.The CEUS features of lesions were categorized into 5 malignant or benign indexes respectively,lesions displaying any two of the five features were diagnosed as malignant or benign.The diagnostic effect of CEUS for BI-RADS-US 4 lesion was analyzed according to the pathological results as the gold standard.Results CEUS of the 123 BI-RADS-US 4 breast lesions indicated that 75 lesions were malignant while 48 were benign.Pathological results confirmed that there were 72 malignant lesions and 51 benign.The proportions of malignant lesions in 4A category,4B category and 4C category were 16.2 ％,58.5 ％ and 93.3 ％ respectively.The accuracy,sensitivity,specificity,positive predictive value,and negative and positive predictive value of CEUS for the diagnosis of BI-RADS-US 4 lesions were calculated as 92.7％,95.8％,88.2％,92.0％ and 93.7 ％ respectively.Lesions showing false positive in CEUS mainly needed surgical treatment,such as fibroma with active growth mesen-chyme,intraductal papilloma and granulomatous mastitts.Conclusions Surgical treatment rather than aspiration biopsy are suggested for those diagnosed being malignant in CEUS of the BI-RADS-US-4 lesions,as they can be treated as BI-RADS5 lesions.Short-term visit or aspiration biopsy are suggested for BI-RADS-US-4 lesions diagnosed being benign in CEUS.

Characterizing and estimating rice brown spot disease severity using stepwise regression, principal component regression and partial least-square regression / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Detecting plant health conditions plays a key role in farm pest management and crop protection. In this study, measurement of hyperspectral leaf reflectance in rice crop (Oryzasativa L.) was conducted on groups of healthy and infected leaves by the fungus Bipolaris oryzae (Helminthosporium oryzae Breda. de Hann) through the wavelength range from 350 to 2,500 nm. The percentage of leaf surface lesions was estimated and defined as the disease severity. Statistical methods like multiple stepwise regression, principal component analysis and partial least-square regression were utilized to calculate and estimate the disease severity of rice brown spot at the leaf level. Our results revealed that multiple stepwise linear regressions could efficiently estimate disease severity with three wavebands in seven steps. The root mean square errors (RMSEs) for training (n=210) and testing (n=53) dataset were 6.5% and 5.8%, respectively. Principal component analysis showed that the first principal component could explain approximately 80% of the variance of the original hyperspectral reflectance. The regression model with the first two principal components predicted a disease severity with RMSEs of 16.3% and 13.9% for the training and testing dataset, respectively. Partial least-square regression with seven extracted factors could most effectively predict disease severity compared with other statistical methods with RMSEs of 4.1% and 2.0% for the training and testing dataset, respectively. Our research demonstrates that it is feasible to estimate the disease severity of rice brown spot using hyperspectral reflectance data at the leaf level.

Study of Xiaoyao Tablet on hepatoprotective action / 中成药

Objective: To study the protective effect of Xiaoyao Tablet(XYT)(Radix Bupleuri, Radix Angelicae Sinensis, Rhizoma Atractylodis Macrocephalae, Radix Paeoniae Alba, Poria, Radix Glycyrrhizae, Herba Menthae, Roasted ginger) on liver. Methods: Using the acute hepatic injury model induced by Tetrachloride and D-galactosamine (CD-GaIN) in rats or mice, we observed the influence of XYT on ALT and AST level in the serum, MDA level and glutathione-s-transferase(GST) activity in the liver homogenates. The pain-killing effect was tested by body twisting model induced by glacial acetic acid and by hot plate model in mice. Results: The XYT reduced the serum ALT level significantly in the acute hepatic injury model in rats and mice. In the CCl 4 reduced acute hepatic injury mice model, XYT decreased the MDA level and increased the GST activity in liver significantly, also it reduced the MDA level in the serum. The XYT reduced twisting number in mice induced by glacial acetic acid. In the hot plate test, the pain threshold was increased. Conclusion: The drug has the similar hepatoprotective function to Xiaoyao Pills.