Objective:To evaluate the efficacy and safety of a novel domestic pulmonary thromoboectomy system Tendvia TM in the treatment for high-risk patients complicated with acute pulmonary embolization (APE). Methods:The study was designed as a prospective single-center clinical trial. Twenty-four high-risk patients with APE were recruited and underwent percutaneous mechanical thromoectomy (PMT) with the Tendvia TM pulmonary thromoboectomy system. The primary efficacy endpoint was the reduction of RV/LV ratio at the post-operative 48 h. The secondary efficacy endpoints included technical success rate, mean pulmonary arterial pressure (mPAP), arterial PaO 2 and the instant post-operative thrombus clearance rate. The evaluation of the safety included the intraoperative complications and related complications during the follow-up period associated with the PMT operation and the major adverse event (MAE) rate within the post-operative 48 h. The pre-and post-operative data were compared with paired sample t-test or Wilcoxon rank sum test to evaluate the efficacy and safety of Tendvia TM pulmonary thromoboectomy system. Results:The technical success rate of PMT with Tendvia TM pulmonary thromoboectomy system was 100% (24/24). The 48 h pre-operative RV/LV ratio was 1.19±0.25 and the post-operative RV/LV ratio was 0.82±0.16. The mean RV/LV ratio of the patients was decreased by 0.37±0.25 at post-operative 48 h with significant statistical difference ( t=7.03, P<0.001). The 48 h pre-operative mPAP was (31.09±6.09) mmHg and the post-operative mPAP was (25.91±4.36) mmHg. The mPAP of the patients was reduced by 5.18 mmHg at post-operative 48 h with significant statistical difference ( t=6.73, P<0.001). The pre-operative PaO 2 was (74.66±11.28) mmHg and the post-operative PaO 2 was (88.01±10.57) mmHg. The pressure of oxygen in artery was increased by 13.36 mmHg. The differences were statistically significant( t=-4.08, P<0.001). The rate of thrombus removal was 68.17%±22.66%. 87.5% (21 cases) of patients achieved a thrombus removal greater than grade Ⅱ. One patient underwent catheter directed thrombolysis (CDT) after PMT based on the evaluation of operator. The patient′s thrombus removal achieved grade Ⅲ after 48 h and the CDT was ceased. Hemoptysis occurred intra-operatively in one case underwent PMT and the symptom of the patient was alleviated with conservative medication. The MAE incidence within the post-operative 48 h was 4.17% (1/24). No device-related mortality or all-cause mortality occurred in the trial. Conclusions:The Tendvia TM pulmonary thromoboectomy system is a safe and effective device to remove the pulmonary arterial thrombus for the treatment of patients with APE. The Tendvia TM pulmonary thromoboectomy system can be a new choice in the treatment for the patients with APE.

Objective:To explore superior mediastinal lymph node zoning of thyroid cancer for accurate anatomical definition as a reference for surgical access. Methods:A method for zoning superior mediastinal lymph nodes for thyroid cancer was proposed. From Sep 2018 to Nov 2019, 36 cases of thyroid cancer with superior mediastinal lymph nodes metastases were reviewed. The diagnosis, surgical approaches, pathology, characteristics of lymph node metastasis, complications and follow-up results were analyzed.Results:The superior mediastinal lymph nodes were grouped into 10 areas: 1, 2Ra, 2Rb, 2La, 2Lb, 3A, 3P, 4R, 4La and 4Lb. According to the location of the superior mediastinum metastatic lymph nodes, direct vision approach through the neck incision, laparoscope-assisted approach, thracoscepy, laparoscope-assisted combined with thrascopy approach or conventional median sternotomy was performed for regional lymph node dissection. The average follow-up time was (10±4) months. No residual or recurrence of tumor in superior mediastinal area was found.Conclusions:The zoning of the superior mediastinal lymph nodes in thyroid cancer can be used as a guide for surgical approach to lymph node dissection .

Exoelectrogens are promising for a wide variety of potential applications in the areas of environment and energy, which convert chemical energy from organic matter into electrical energy by extracellular electrons transfer (EET). Microorganisms with different mechanisms and EET efficiencies have been elucidated. However, the practical applications of exoelectrogens are limited by their fundamental features. At present, it is difficult to realize the extensive application of exoelectrogens in complex and diverse environments by means of traditional engineering strategies such as rational design and directed evolution. The exoelectrogens with excellent performance in environments can be screened with efficient strain identification technologies, which promote the widespread applications of exoelectrogens. The aims of this review are to summarize the methods of screening based on different types of exoelectrogens, and to outline future research directions of strain screening.
Bioelectric Energy Sources ; Electricity ; Electron Transport

Objective To observe whether Mini-Clinical Evaluation Exercise ( Mini-CEX ) is effective and feasible for improving the clinical competency of residents receiving standardized training. Methods 40 residents receiving standardized training in the Second Affiliated Hospital of Amy Medical university were randomly divided into control group and experimental group, with 20 trainees in each group. From October 2015 to April 2018, the experimental group was trained by the traditional teaching methods combined with Mini-CEX, and the other was trained by traditional teaching method. At least 2 Mini-CEX were conducted for each trainee of the experimental group in each department. The Mini-CEX, defense of case report and OSCE evaluation were carried out to assess the clinical competence of residents after the standardized training. Satisfaction surveys were conducted for teachers and students who had used Mini-CEX . SPSS 18 . 0 was used to analyze the data . Independent samples t test was used for inter-group comparison and paired sample t test was used for intra-group comparison. P<0.05 was statistically significant. Results Mini-CEX showed that the scores of the two groups in the clinical competence assessment were improved; the scores of the experimental group were higher than those of the control group , and the improvement in scores of experimental group was higher than that of the control group (the differences were statistically significant, P<0.05). The average score of defense of case report of the experimental group was (81.16 ±3.75),while that of the control group was (70.13 ±3.88) (t=-9.140, P=0.000). The average total score of OSCE evaluation of the experimental group was (96.300±4.681), while that of the control group was (91.775 ±3.227) (t=-3.559, P=0.001). Satisfaction rate of teachers and students were 95.0％ and 92.5％respectively. Conlusion Mini-CEX can improve the clinical competence of residents receiving standardized training.

Objective To understand the prevalence,treatment and influence factors of hypertension in maintenance hemodialysis (MHD) patients in Anhui Province.Methods A total of 2724 adult patients on MHD from January 1st 2014 to March 31st 2014 in 26 hospitals of southern,northern and central Anhui Province were investigated.Their demographic characteristics,primary disease,complications,medications,dialysis and laboratory examination were explored.The prevalence treatment rate and control rate of hypertension were analyzed.Associated factors for controlling hypertension [systolic blood pressure (SBP) ＜ 140 mmHg and diastolic blood pressure (DBP) ＜ 90 mmHg] were assessed by logistic regression analysis.Results (1) The prevalence of hypertension in the hemodialysis patients was 87.0％.Their treatment rate and control rate were 93.2％ and 23.9％ respectively.The average of SBP was (145.90±21.18) mmHg,and the DBP on average was (83.60± 12.21) mmHg.The most commonly used anti-hypertensive drug is calcium channel blocker (88.2％).Over one third (45.7％) of patients were treated with two kinds of anti-hypertensive drug,26.2％ with 1 kind,21.7％ with 3 kinds,and 6.4％ with 4 kinds or more.(2) Compared with non-hypertension patients,patients with hypertension have older age,higher body mass index (BMI),phosphorus,SBP and DBP,as well as lower hemoglobin and Kt/V (all P ＜ 0.05).(3) The multivariate logistic regression analysis showed that Ca ＞ 2.50 mmol/L (OR=2.084,95％CI 1.008-4.307,P=0.047) positively correlated with controlling hypertension,while smoke (OR=0.594,95％CI 0.356-0.911,P=0.046) and BMI 18.5 ～ 23.9 kg/m2 (OR=0.516,95％CI 0.293-0.907,P=0.022) negatively correlated with it.Conclusions High prevalence yet low control rate of hypertension in MHD patients in Anhui Province were observed.Hypocalcemia may be a protective factor for hypertension control,while smoke and BMI may be risk factors for it.

Objective To explore the impact of biological big data on clinical study management.Methods To understand the changeof clinical study resulted from big data from the perspectiveof scientific study management.Results Bigdata Clinical Trial (BCT) based on massive clinical study data will turn out to be one of the most important parts of clinical study gradually.General rules target population will be obtained from clinical study model of the whole population.Reality fact will be more closely approached by the results of study on macro factors.Precise trend of dynamic changes can be demonstrated via data of full time linear tracking studies.Data collection will include those unordered data which are potentially inaccurate andregarded as useless in small data time.Conclusions Revolutionary changes will be presented in clinical study model in which data acquisition and info analysis are used as the primary approaches in big data era,and prediction of clinical study developmenttrend based on big data as well as innovation of management model for clinical study will make power ful support for better utilization of big data tools and accomplishment for big data realization and precision technology.

Objective To evaluate the therapeutic effect of Xiao'er Zhixie Paste (XZP) by using the young rat model of chronic diarrhea,and to explore its mechanism.Methods Chronic diarrhea model in young rats was induced by ig senna.Rats were ig with Montmorillonite powder of 1.62 g/kg,XZP of low,medium,and high dose (2.03,4.05,and 8.10 g/kg) for treatment.Loose stools rate,loose stool grade and diarrhea index were determined 1 and 3 d after treatment respectively.The water content of small intestine was measured and blood was collected for testing serum succinate dehydrogenase (SDH),amylase,D-xylose by colorimetric determination,testing serum D-lactic acid,IL-1 β,and TNF-α by Elisa after administration.Results The rate of loose stools in XZP 4.05 and 8.10 g/kg dose group,and diarrhea index in 8.10 g/kg dose group significantly reduced after the first treatment.The loose stools rate of XZP 2.03,4.05,and 8.10 g/kg dose group,diarrhea index,serum D-lactic acid level in 4.05,8.10 g/kg group significantly reduced,and serum D-xylose level in 8.10 g/kg dose group significantly increased 3 d after treatment.However,XZP had no significant effect on SDH,amylase activity and IL-1β,TNF-α levels.Conclusion XZP has obvious therapeutic effect on chronic diarrhea in young rats,the mechanism is to increase improve the absorptive function and permeability of intestinal tract.

Objective To understand the clinical characteristics of elderly patients aged 60 years and over in Anhui Province who receive maintenance hemodialysis (MHD).Methods Clinical data of MHD patients in hemodialysis centers of 26 hospitals in Anhui Province from March 31, 2014 to January 1, 2014 were collected.With non-elderly MHD patients (aged over 18 old and under 60) serving as controls, similarities and differences in the primary disease, vascular access, nutritional status, mineral and bone disorders (MBD), and other related aspects in MHD patients were compared.Results The top three original diseases for elderly patients were chronic glomerulonephritis (CGN) (32.8 ％), hypertensive nephrosclerosis (HNS) (27.7 ％) and diabetic nephropathy (DN) (26.2％).The proportion of patients with DN and HNS in the elderly was higher than in the control group (P ＜ 0.001).Vascular access types in elderly MHD patients were arteriovenous fistula (AVF) (89.4 ％), tunneled cuffed catheter (TCC) (8.9 ％), and temporary venous catheter (1.3％).The proportion of patients with AVF was lower (P＜0.001) and the proportion of patients with TCC was higher (P＜0.001) in the elderly group than in the control group.The incidence of anemia was higher in the elderly patients than in the control group (P＜0.05);the proportion of elderly patients with hemoglobin (Hb) levels was 30.3％, in which had no significant difference as compared with the control group (P ＞ 0.05).The incidence of hypoalbuminemia was 21.2％ in elderly patients, which was higher than in the control group.The proportions of elderly MHD patients with normal levels of adjusted serum calcium, serum phosphorus, and intact parathyroid hormone (iPTH) were 52.0％, 27.9％ (higher than in the control group, P＜0.001), and 47.9％, respectively, while there was no difference in adjusted serum calcium and iPTH between the two groups (P＞0.05).The treatment rates for low serum calcium,hyperphosphatemia and secondary hyperparathyroidism (SHPT) in elderly patients were 50.6％,51.6％ and 71.5％, respectively, which had no significant difference as compared with those in the control group (P＞0.05).Conclusions Elderly patients with MHD show distinct characteristics in primary diseases, vascular access types, and nutrition and MBD status, including higher proportions of HNS and DN as their primary diseases.The type of vascular access is still dominated by AVF, and the proportion of TCC is higher.The nutritional status is poor, with a lower incidence of high phosphorus and a higher incidence of low iPTH.Efforts should be made to promote compliance in elderly patients to better control MBD, improve nutritional status and increase safety and effectiveness of treatment.

Objective To explore the prevalence,awareness and risk factors of chronic kidney disease (CKD) in general adult population of Anhui province,China. Methods A total of 3800 residents (older than 18 years) from Anhui province were randomly selected using a stratified,multi-stage sampling.All the residents were interviewed and tested for urinary albumin to creatinine ratio (abnormal:≥30 mg/g) and reduced estimated GFR [abnormal:＜60 ml·min1·(1.73 m2)-1]. The associations of CKD with demographic characteristics, healthy charactefistcs (hypertension,diabetes and hyperuricemia) were examined. Results Eligible data of 3374 subjects were enrolled in the study.After the adjustment of age and gender component,the prevalence of albuminuria was 9.8％ (95％CI 8.8％-10.9％),and reduced eGFR was 2.1％ (95％ CI 1.7％-2.7％).Approximately 10.4％(95％CI 9.4％-11.5％)subjects had at least one indicator of kidney damage.The awareness rate of CKD was 6.5％.Female,age,hypertension,diabetes mellitus,and hyperuricemia were independently associated with CKD.While obesity,hyperlipdemia.smoking and alcohol drinking were not associated with the prevalence of CKD. Conclusions The prevalace of chronic kidney disease is 10.4％ and the awareness rate is 6.5％ in general adult population of Anhui province.Independent risk factors associated with CKD are female,age,hypersion,diabetes mellitus and hyeruricemia.

In recent years,medical colleges have generally accepted the higher education assessment(evaluation).How to put the good practices and experience we obtained during the educational assessment into the daily teaching management and achieve normalization of teaching evaluation is of great significance to continuously improving the teaching quality.It is the primary condition to establish the evaluation index system for evaluating clinical teaching quality by regular teaching assessment. In this paper,the author constructed a clinical teaching quality evaluation index system through systematic research and exploration.