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Guided by the emphasis on learning process, the educational reform has designed a "trinity" comprehensive evaluation system (quantitative clinical practice, in-class medical record analysis, and staged comprehensive written test) as the formative evaluation of the course. Through this assessment system, students' self-learning potential is stimulated, clinical skills practice is strengthened, and "taking exams to promote learning and taking exams to promote teaching" is realized. In the practice of teaching reform, it has been found that compared with the conventional teaching class, the students in the teaching reform class have higher participation and are more satisfied with the process assessment of the "trinity" comprehensive evaluation system.
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The COVID-19 disease caused by infection with SARS-CoV-2 and its variants is devastating to the global public health and economy. To date, over a hundred COVID-19 vaccines are known to be under development and the few that have been approved to fight the disease are using the spike protein as the primary target antigen. Although virus neutralizing epitopes are mainly located within the RBD of the spike protein, the presence of T cell epitopes, particularly the CTL epitopes that are likely to be needed for killing infected cells, has received comparatively little attention. In this study, we predicted several potential T cell epitopes with web-based analytic tools, and narrowed them down from several potential MHC-I and MHC-II epitopes by ELIspot and cytolytic assays to a conserved MHC-I epitope. The epitope is highly conserved in current viral variants including the most recent Omicron and compatible with presentation by most HLA alleles worldwide. In conclusion, we identified a CTL epitope suitable for evaluating the CD8+ T cell-mediated cellular response and potentially for addition into future COVID-19 vaccine candidates to maximize CTL responses against SARS-CoV-2.
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Objective@#To investigate the effect of enteral nutrition feeding procedure in ICU in severe patients in order to reduce complications and promote rehabilitation of patients.@*Methods@#A total of 184 severe patients admitted to ICU from January to October 2018 were selected as the subjects of the study. 90 patients admitted to the family from January to May were the control group, and 94 patients admitted to the family from June to October were the observation group. The control group adopted routine nutritional support and nursing, and the observation group carried out intensive enteral nutrition feeding process. The nutritional status, immunity, gastrointestinal dysfunction, complications of nosocomial infection and outcome of patients in two groups were compared between the two groups.@*Results@#The nutritional indicators of hemoglobin, serum total protein and serum albumin after a week of treatment were (119.73 ± 9.96), (58.88 ± 2.65), (29.09 ± 1.42) g/L, immunization indicators IgA, IgG, IgM were (2.56±0.10), (2.98±0.36), (1.65±0.15) g/L in the observation group. The control groups were (108.02±9.21), (51.90±2.74), (27.80±1.59), (2.09±0.18), (2.01±0.24), (1.41±0.13)g/L, the difference between the two groups was statistically significant (t=5.81-22.48, P<0.01). The incidence of gastrointestinal dysfunction (gastric retention, diarrhea) in the observation group were 11.70%(11/94), 8.51%(8/94), the incidence of nosocomial infections (ventilator associated pneumonia, catheter related blood stream infection, catheter-associated urinary tract infections) were 6.12‰(5/817), 1.53‰(1/650), 0, the outcome indicators of patients (nutritional standard time, ICU hospitalization time, and mortality rate) were (6.12±1.03) d, (10.98±2.03) d, 13.82%(13/94), all were lower than the control group′s 23.33%(21/90), 20.00%(18/90), 13.06‰(11/842), 11.28‰(8/709), 2.88 ‰(2/694), (7.98 ± 1.54) d, (12.21 ± 1.87) d, 26.67%(24/90), the difference between the two groups was statistically significant (χ2=4.33-8.22, t=6.19, 2.26, P<0.05).@*Conclusions@#The procedure of enteral nutrition feeding in patients with severe illness can effectively reduce enteral nutrition complications and enable patients to obtain effective nutrition early.
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Objective To design a record sheet of the core control measures for multi-drug resistant bacteria in ICU and apply it to clinical practice. Methods Through consulting the guidelines and literature, we designed the ICU core control measures to execute the record sheet and applied the record sheet to patients with multiple resistant bacteria infection. The implementation rate of the core control measures of medical personnel before and after the use of the record sheet(the awareness rate of medical personnel, the awareness rate of nursing staff, the compliance rate of hand hygiene, the implementation rate of isolation medical orders, the implementation rate of isolation marks, the implementation rate of single room isolation or bedside isolation, and the exclusive implementation rate of items), qualified rate of surface disinfection of articles, qualified rate of use of antimicrobial agents and incidence of multi-drug resistant bacteria infection were compared. Results After implementing the record sheet using the ICU multi-drug resistant bacteria core control measures, the implementation rate of medical personnel's core control measures, the conformity rate of surface disinfection of articles and the acceptance rate of antimicrobial drug use were all improved, the difference was statistically significant (χ2=2.85-432.18, P<0.05 or 0.01); incidence of multi-drug resistant bacteria infection from 15.7%(112/713) to 6.8% (51/748), the difference is statistically significant (χ2=28.22, P<0.05). Conclusions The implementation of ICU multi-drug resistant core control measures can improve the rate of implementation of multi-drug resistant core control measures, reduce the incidence of multi-drug resistant infections, and standardize the operation of medical personnel against multiple drug resistant bacteria. The application of ICU multi-drug-resistant core control measures to the management of nosocomial infections in patients with multiple drug-resistant bacteria will help improve the quality of care and ensure the safety of patients.
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Objective@#To design a record sheet of the core control measures for multi-drug resistant bacteria in ICU and apply it to clinical practice.@*Methods@#Through consulting the guidelines and literature, we designed the ICU core control measures to execute the record sheet and applied the record sheet to patients with multiple resistant bacteria infection. The implementation rate of the core control measures of medical personnel before and after the use of the record sheet(the awareness rate of medical personnel, the awareness rate of nursing staff, the compliance rate of hand hygiene, the implementation rate of isolation medical orders, the implementation rate of isolation marks, the implementation rate of single room isolation or bedside isolation, and the exclusive implementation rate of items), qualified rate of surface disinfection of articles, qualified rate of use of antimicrobial agents and incidence of multi-drug resistant bacteria infection were compared.@*Results@#After implementing the record sheet using the ICU multi-drug resistant bacteria core control measures, the implementation rate of medical personnel's core control measures, the conformity rate of surface disinfection of articles and the acceptance rate of antimicrobial drug use were all improved, the difference was statistically significant (χ2=2.85-432.18, P<0.05 or 0.01); incidence of multi-drug resistant bacteria infection from 15.7%(112/713) to 6.8%(51/748), the difference is statistically significant (χ2=28.22, P<0.05) .@*Conclusions@#The implementation of ICU multi-drug resistant core control measures can improve the rate of implementation of multi-drug resistant core control measures, reduce the incidence of multi-drug resistant infections, and standardize the operation of medical personnel against multiple drug resistant bacteria. The application of ICU multi-drug-resistant core control measures to the management of nosocomial infections in patients with multiple drug-resistant bacteria will help improve the quality of care and ensure the safety of patients.
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<p><b>OBJECTIVE</b>To explore the correlation between efficacy of electroacupuncture (EA) on mammary gland hyperplasia (MGH) and the regulatory pathway of intercostal nerve.</p><p><b>METHODS</b>Fifty female SD rats were randomly divided into a blank group (group A, 12 rats), a model group (group B, 12 rats), an EA group (group C, 13 rats) and an intercostal nerve transection group (group D, 13 rats). The rats in the group B, group C and group D were prepared into MGH model; after model was successfully prepared, the 7th intercostal nerve was cut off in the group D. EA was applied at back acupoints including bilateral "Tianzong" (SI 11), "Ganshu" (BL 18) and "Shenshu" (BL 23) as well as chest acupoints including bilateral "Wuyi" (ST 15), "Hegu" (LI 4) and "Danzhong" (CV 17) in the group C and D. The two groups of acupoints were selected alternately. EA was given for 20 min, once a day; 5-day treatment was taken as one course; there was an interval of 2 days between course; totally 20 treatments were given. After treatment, the height and diameter of papilla were observed; the contents of serum estradiol (E) and progestin (P), the expression of estrogen receptor α (ERα) and progestrone receptor (PR) in mammary gland were measured.</p><p><b>RESULTS</b>(1) The height and diameter of papilla: after treatment, the height and diameter of papilla in the group C were significantly smaller than those in the group B (both<0.05); the height and diameter of left-side papilla in the group D were significantly bigger than those in the group C (both<0.05). (2) Serum Eand P: after treatment, compared with the group B, the contents of Eand E/P were reduced and the content of P was increased in the group C and group D (all<0.05). Compared with the group C, the contents of Eand E/P were increased and the content of P was reduced in the group D (all<0.05). (3) ERα and PR in mammary gland: compared with the group B, the content of ERαwas decreased and the content of PR was increased in the group C (both<0.05). Compared with the group C, the content of ERαwas increased and the content of PR was decreased in the group D ((both<0.05).</p><p><b>CONCLUSION</b>The efficacy mechanism of EA for MGH is likely to be related with the pathway of intercostal nerve; the mechanism may be acupuncture regulating the contents of serum Eand P as well as contents of ERα and PR in mammary gland.</p>
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Objective The experiment was designed to study the therapeutic mechanism of "Tong Tiao" acupuncture in the treatment of mammary gland hyperplasia (MGH) on the rat model.Methods A total of 75 healthy unpregnant female SD rats were randomly divided into six groups: blank, model, control group, vagus cutting therapy, sham operation, and vagus cutting with non-treatment group. All the groups except the blank group were prepared by MGH rat model. The vagus cutting therapy and vagus cutting with non-treatment group were treated by cutting the right cervical vagus nerve, while the sham operation group was treated by exposing the vagus nerve without any operation. All the treatment groups were treated with "Tong Tiao". The rat papillary height was measured. The breast tissue morphology and breast ultrastructure were observated. And the flow cytometry in rat peripheral blood T lymphocyte subsets CD3+, CD4+, CD8+, CD4+/CD8+ were calculated. Results Compared with the model group, the papillary height (1.22 mm ± 0.21 mm,1.24 mm ± 0.20 mmvs. 1.53 mm ± 0.16 mm) in the normal treatment and the sham treatment group decreased significantly the vagus cutting therapy and vagus cutting non-treatment group showed no difference (P>0.05). Compared with the model group, the Mammary gland morphology and ultrastructure in the normal treatment group, the sham operation group and the vagus cutting therapy groups were improved, but the vagus cutting non-treatment group showed on improvement. Compared with model group, the serum CD3+(61.5％ ± 10.5％, 61.1％ ± 12.4％, 59.8％ ± 11.8％vs. 57.7％ ± 9.4％), CD4+(37.2％ ± 8.9％, 37.9％ ± 10.9％, 36.1％ ± 12.2％ vs. 34.6％ ± 6.9％), CD4+/CD8+(1.59 ± 0.8, 1.58 ± 0.8, 1.38 ± 0.6vs. 1.23 ± 0.7) in the normal treatment group, the sham treatment group and vagus cutting therapy group, elevated significantly (P<0.01,P<0.05), while the vagus cutting non-treatment group showed no difference (P>0.05). Compared with model group, the serum CD8+ (24.2％ ± 11.3％, 24.5％ ± 10.6％,25.5％ ± 8.8％vs. 27.7％ ± 9.9％) in the normal treatment group, sham treatment group and vagus cutting therapy group decreased significantly lower (P<0.01,P<0.05), but vagus cutting non treatment group showed no difference (P>0.05). Conclusions the mechanism of acupuncture treatment for MGH may be related to the vagus nerve by regulating the CD3+, CD4+, CD8+ and CD4+/CD8+ levels of T lymphocytes.
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Objective To establish a pre-hospital and in-hospital first aid rapid linkage treatment platform in order to provide quick rescue time for emergency patients. Methods The interconnection first aid APP was made.The emergency center and traffic command center were combined to participate in first aid. The traffic command center controls the traffic lights in real time to provide the optimal transportation path for the emergency patients.The first aid center carries out preliminary treatment,and shares the patient information to the hospital in real time to make the most suitable doctors waiting for the consultation. The therapeutic effects of patients with acute critical disease before and after the platform applied was compared. Results It has realized the tripartite information linkage between the hospital, the emergency center and the traffic command center. In the experimental group, the pre-hospital emergency response time,the hospital rescue time and the emergency success rate were(16.28±3.08)min, (17.89±5.84)min,87.85%(217/247),the control groups'pre-hospital emergency response time,the rescue time in hospital and the success rate of acute critical patients were(18.29±1.87)min,(24.84±1.69)min, 63.01% (138/219), the data of two groups were statistically significant (t=3.783, 5.745, χ2=5.404, P<0.05). Conclusions The establishment of pre-hospital and in-hospital first aid rapid linkage treatment platform of emergency patients can optimize the patient first aid survival chain, provide greater rescue opportunities for emergency patients.
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<p><b>OBJECTIVE</b>To study the regulating effect of thyroid pathway on electroacupuncture (EA) for mammary gland hyperplasia (MGH) so as to provide new research ideas for the mechanism of EA for MGH and to provide the evidence for clinical application.</p><p><b>METHODS</b>Sixty adult female SD rats were randomly divided into a blank group, a model group, an EA group, an EA with thyroidectomy group, an EA with sham operation group, 12 rats in each one. Except the blank group, the MGH model was established. Thyroid ablation was performed in the EA with thyroidectomy group, and sham operation was used in the EA with sham operation group, exposing thyroid without excision, 1 day after model establishment. EA was applied in the EA, the EA with thyroidectomy, and the EA with sham operation groups on the 4th day after model establishment, and not used in the other groups, but catching, routine disinfection and fixation were all the same as the above groups. The acupoints in the group A were bilateral "Tianzong" (SI 11), "Ganshu" (BL 18) and "Zusanli" (ST 36); and those in the group B were bilateral "Wuyi" (ST 15), "Hegu" (LI 4) and "Danzhong" (CV 17). The two groups of points were alternately used. EA, continuous wave, 2 Hz and 1 mA, was connected at "Tianzong" (SI 11) and "Ganshu" (BL 18), "Wuyi" (ST 15) and "Hegu" (LI 4) at the same side, 2 pairs EA a time, 20 min a time, once a day. All the intervention was given for 4 courses, 5 times as 1 course with 2 days between courses. After intervention, the height and diameter of the rat papilla were measured. Estrogen (E) and progestational hormone (P) in the serum were detected by enzyme linked immunosorbent assay (ELISA), and the contents and protein expression of estrogen receptor α (ERα) and progesterone receptor (PR) in the mammary glands were detected by immunofluorescence and Western-blot.</p><p><b>RESULTS</b>(1) The height and diameter of papilla in the model group increased compared with those in the blank group (both <0.01). The height and diameter of papilla in the EA, EA with sham operation groups reduced compared with those in the model group (all <0.01). Those in the EA with thyroidectomy group were lower than those in the model group, without statistical significance (both >0.05). (2) Compared with the blank group, E increased and P decreased in the model group (both <0.01). Compared with the model group, E decreased and P increased in the EA and EA with sham operation groups (all <0.01). The contents of E and P had no statistical significance between the model and the EA with thyroidectomy groups (both >0.05). (3) Compared with the blank group, the ERα content and protein expression increased and the PR content and protein expression decreased in the model group (all <0.01). Compared with the model group, the ERα content and protein expression decreased and the PR content and protein expression increased in the EA and EA with sham operation groups (all <0.01). The ERα and PR content and protein expression had no statistical significance between the model and the EA with thyroidectomy groups (all >0.05).</p><p><b>CONCLUSION</b>The effect of EA for MGH may be closely related to the regulation of thyroid.</p>
