Objective To observe the application effect of point massage combined with physiotherapy in the treatment of insomnia for community elderly.Methods 30 elderly patients with insomnia who accepted point massage combined with physiotherapy were selected as observation group,and 30 elderly patients treated in tertiary hospital with insomnia who took alprazolamum for treatment were selected as control group.The SRSS score of the two groups before and after treatment,as well as treatment efficacy were compared.Results The insomnia treatment efficacy of the observation group was higher than that of the control group(Z =2.45,P <0.05).The SRSS rating of the observation group before treatment was (30.76 ±7.1 9)points and after treatment was (1 5.43 ±3.95)points.The SRSS rating of the control group before treatment was (32.33 ±6.98)points,which after treatment was (21 .93 ±6.73)points.The SRSS scores of both two groups after treatment were decreased (t =1 0.23,5.87,all P <0.05),with obvious differ-ences.The SRSS scores of the observation group decreased more obviously and was lower than that of the control group (t =4.56,P <0.05).Conclusion The point massage combined with physiotherapy can effectively improve insomnia of the elderly,which is also with advantages of easy operation and no obvious side effects and high cooperation degree etc,and it is suitable to be promoted in community.

Objective To investigate the effect of the clinical teaching model based on the miniclinical evaluation exercise (Mini-CEX) scale in Department of General Surgery,and to provide a reference for improving the quality of clinical teaching in Department of General Surgery.Methods A total of 82 nursing interns in Department of General Surgery from June 2016 to June 2018 were enrolled,among whom 41 undergraduates in 2016 were enrolled as control group and 41 undergraduates in 2017 were enrolled as intervention group.The undergraduates in the control group were taught with the traditional clinical teaching method,and those in the intervention group were taught with the clinical teaching model based on the Mini-CEX scale.The two groups were compared in terms of department examination results,score of the Mini-CEX scale,and quality assessment score of clinical nursing teaching,in order to evaluate the teaching quality in Department of General Surgery.Results Compared with the control group,the intervention group had significantly higher department examination score [(96.56 ± 4.23) vs.(90.42 ± 5.12)] and total score of Mini-CEX scale [(5.22 ± 0.45) vs.(4.01 ± 1.03)].The intervention group had a significantly higher excellent rate than the control group (P＜0.05).The intervention group also had a significantly higher quality assessment score of clinical nursing teaching than the control group [(98.34 ± 6.12) vs.(92.45 ± 5.16)].Conclusion The clinical teaching model based on the Mini-CEX scale can improve the quality of teaching and clinical teaching skills in department of general surgery and thus improve the clinical skills and comprehensive quality of nursing interns.

Objective To predict the presence of MVI,the general clinicopathological of HCC patients' data of the preoperative neutrophil-lymphocyte ratio (NLR),platelet-lymphocyte ratio (PLR),altplatelet ratio (APRI) were evaluated.Methods 143 cases of HCC patients who underwent radical resection and ≤ 5 cm of tumor diameter in Chifeng Clinical Medical School of Inner Mongolia Medical University from January 2011 to December 2014 were analysed retrospectively and followed up.The relationship between NLR,PLR,APRI and other clinical parameters was evaluated.Results According to ROC Curve,the NLR truncation value was 2.00,PLR to 115.00,APRI 1.6.The single factor analysis of x2 test showed that NLR (x2=6.419;P＜0.05),APRI (x2=3.975;P＜0.05),AFP (x2=33.37;P＜0.05),Degree of differentiation (x2 =9.839;P＜0.05) were significant differences between MVI positive (MVI+) and negative (MVI-) groups,and the difference was statistically significant;Logistic regression multifactor analysis showed that NLR (OR 2.678;95％ CI 1.033～6.944;P＜0.05) and AFP (OR 1.724;95％CI 1.023～2.905;P＜0.05) are independent predictors of MVI.Conclusion Preoperative NLR and AFP are convenient,economical and reliable hematological indices for predicting the presence of MVI in HCC patients.

Objective:To analyze the intensity-modulated radiotherapy (IMRT) process based on the TG100 report, aiming to improve the quality control method and guarantee the safety and quality of IMRT.Methods:Based on the TG100 report, a risk analysis team was established. The flow chart of overall and each sub-step of IMRT was constructed. The failure mode and effect analysis method were adopted to determine all potential error modes in the process. The probability of of the error mode, the probability of being checked out and the severity of the effect of the error mode on the clinical bed were evaluated based on the pre-set scoring standard. The priority value of each error mode was calculated and ranked from high to low priority value. The top 20% is defined as the high-risk error mode, which was analyzed by error tree to improve the quality control method.Results:IMRT consisted of 11 main steps and 41 sub-steps, and 180 failure modes were detected. The priority values were ranged from 30 to 178. A total of 36 high-risk failure modes were found. The top 5 high-risk failure modes (RPN) consisted of setup error (178), electronic portal imaging device (EPID) registration (172), contouring error (166), treatment delivery error (160) and prescription dose error (156).Conclusion:TG100 report is practical and convenient to utilize, which can effectively and systematically improve IMRT process and provide safety and quality assurance of IMRT process.

Objective:To create AAPM TG 119 test plans for intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) in order to evaluate the accuracy of the United Imaging Healthcare′s URT treatment planning system (URT-TPS). The plans were delivered to the phantom using the United Imaging Healthcare′s URT-Linac 506C.Methods:The overall accuracy of IMRT and VMAT planning, measurement, and analysis were evaluated for four test geometries provided by American Association of Physicists in Medicine (AAPM) Task Group Report 119(TG-119) on multi-target, prostate, head and neck and C-shape (easy). The dose distributions were measured in the coronal plane. The point measurements were measured by a Farmer type ion chamber and fluence measurements were completed with film and Delta4 phantom, respectively. Measured planar dose distributions were analyzed using gamma index with criteria 3%/3 mm.Results:For IMRT and VMAT plans, the planning results matched the TG-119 planning results. Measured point doses of IMRT and VMAT were within 2.62% and 3.90% of the planned doses, respectively. Measured film dosimetry gamma values of IMRT and VMAT were> 97.50% and> 93.27%, respectively.Conclusion:Based on these analyses which were performed in line with the TG119 recommendations, it is evident that the URT treatment planning system and URT-Linac 506C have commissioned IMRT and VMAT techniques with adequate accuracy.

In order to study the molecular mechanism and physiological significance of the interaction between PGRN and Rev-erbβ, the PGRN gene in HEK293 (Rev-erbβ-/-) marked as C3-6 cell lines was knocked out by CRISPR/Cas9 system to generate the Rev-erbβ and PGRN double genes knockout HEK293 cell lines. First, four sgRNAs were designed for PGRN gene, and PGRN sgRNA2 and sgRNA3 with the higher activity were used to construct the Lentiviral vector, pLenti/CMV-Loxp-Cas9-sgRNA2-U6-sgRNA3-U6-Loxp-EF1α-Puro. Then, the lentivirus vector carrying Cas9 and double PGRN sgRNA were used to infect HEK293 C3-6 cells. Through drug screening, cloning and sequencing, we obtained the monoclonal HEK293 (Rev-erbβ-/-; PGRN-/-) marked as C3-6/23 cell lines. Using qRT-PCR and Western blotting, we detected PGRN mRNA and protein expression in C3-6/23 cell lines. Finally, genetic complementation was used to study the effect of PGRN-mediated Rev-erbβ on the regulation of the target gene promoter transcriptional activity in the C3-6/23 cell lines. In HEK293 C3-6/23 cell lines, the two DNA chains of PGRN gene were both deletion mutagenesis, and the expression mRNA and protein of PGRN did not reach the detection level. At the same time, the interaction between PGRN and Rev-erbβ enhanced the regulation of Rev-erbβ on the transcription of target gene promoter in the cell lines. Using CRISPR/Cas9 system, we successfully constructed the double knockout HEK293 (Rev-erbβ-/-; PGRN-/-) monoclonal cell lines. The study found that PGRN could affect Rev-erbβ on the regulation of target gene promoter transcription in the C3-6/23 cell lines; however, the mechanism of PGRN involvement in mediating Rev-erbβ in transcriptional regulation remains to be further studied.

Objective: To explore the application effect of Mini-Clinical Evaluation Exercise(Mini-CEX) in clinical teaching rounds of nursing students, and to provide reference for improving the quality of clinical teaching. Methods: A total of 120 nursing students from June 2017 to June 2018 were divided into control group and intervention group by the time of practice with 60 cases each. The control group adopted traditional nursing teaching rounds, while the intervention group adopted Mini-CEX-based nursing teaching rounds. The comprehensive results of nursing students′practice, Mini-CEX and autonomous learning ability of the two groups were compared and analyzed. Results: The overall evaluation of Mini-CEX of nursing students was (7.23 ± 0.51) in the intervention group and (5.27 ± 1.12) in the control group, and the difference was statistically significant (t=12.337, P <0.01). The excellent rate of nursing students was 58.3%(35/60) in the intervention group and 30.0%(18/60) in the control group, and the difference was statistically significant (χ²=10.914, P <0.01). The total score of autonomous learning ability was (114.85 ± 6.27) in the intervention group and (90.78 ± 8.22) in the control group, and the difference was statistically significant (t=18.034, P < 0.01). The comprehensive results of nursing students′ practice was (87.04 ± 6.46) in the intervention group and (74.35 ± 6.04) in the control group, and the difference was statistically significant (t=11.115, P< 0.01). Conclusions Clinical teaching rounds based on mini-clinical exercise assessment scale can improve the clinical comprehensive service ability, self-learning ability and humanistic care ability of intern nurses.

Since December 2019, a novel coronavirus (2019-nCoV, SARS-CoV-2) pneumonia (COVID-19) outbreak has occurred in Wuhan, Hubei Province, and the epidemic situation has continued to spread. Such cases have also been found in other parts of the country. The spread of the novel coronavirus pneumonia epidemic has brought great challenges to the clinical practice of thoracic surgery. Outpatient clinics need to strengthen the differential diagnosis of ground glass opacity and pulmonary plaque shadows. During the epidemic, surgical indications are strictly controlled, and selective surgery is postponed. Patients planning to undergo a limited period of surgery should be quarantined for 2 weeks and have a nucleic acid test when necessary before surgery. For patients who are planning to undergo emergency surgery, nucleic acid testing should be carried out before surgery, and three-level protection should be performed during surgery. Patients who are planning to undergo emergency surgery in the epidemic area should be confirmed with or without novel coronavirus pneumonia before operation, and perform nucleic acid test if necessary. Surgical disinfection and isolation measures should be strictly carried out. Among postoperative patients, cases with new coronavirus infection were actively investigated. For the rescue of patients with novel coronavirus infection, attention needs to be paid to prevention and treatment and related complications, including mechanical ventilation-related pneumothorax or mediastinal emphysema, and injury after tracheal intubation.