Objective To explore the influence of the scores and weights of the regular grade on the evaluation of students' learning effect.Method To compare the impact of the regular grade before and after adjustment on the total mark,analyze the problems exposed during scoring and search for the solutions according to Medical Microbiology results of four grades including Grade 2010 to 2013.SPSS 13.0 software was used for statistical analysis and Pearson method was used for correlation analysis and theory achievement scores.Results The regular grade of four grades scored highly,with the average (95.00 ± 3.80),(96.00 ± 4.55),(95.00 ± 2.84) and (95.00 ±-2.82) respectively.What was more,it had randomness.The correlation coefficient between regular grade and total mark were 0.069,0.149,0.984 and 0.285 respectively.The regular grade of Grade 2010 was the same as Grade 2013 and the theoretical score of Grade 2013 was 4 points lower than Grade 2010(71 vs.75),however the total mark of Grade 2013 was 1 point higher than Grade 2010 (80 vs.79),which showed the more the regular grade weights,the greater it impacted on the total mark.Conclusion The appropriate score and weight of the regular grade is important to evaluate the students' learning effect objectively.

Objective To evaluate the reproducibility of ADC measurements at 1.5 vs 3.0 T and at 1.5 T of different scanners in liver,spleen and pancreas of healthy volunteers.Methods Abdominal DWI were performed on 33 healthy volunteers by using GE 1.5 T,Siemens 1.5 T and Philips 3.0 T MR scanners.The mean ADC values of liver,spleen,pancreatic head,body,and tail were calculated.The ADC data were analyzed by using paired-sample t tests.Results The mean ADC of liver at GE 1.5 T,Siemens 1.5T and Philips 3.0 T were (1.56 ±0.10) ×10-3,(1.67 ±0.15) ×10-3 and(1.35 ±0.12) ×10-3 mm2/s,spleen were (0.96±0.10) × 10 3,(0.98 ±0.11) ×10-3and(0.81 ±0.14) × 10-3 mm2/s,pancreatic head were (2.09 ± 0.27) × 10-3,(2.20 ± 0.21) × 10-3 and (2.05 ± 0.27) × 10-3 mm2/s,pancreatic body were (2.03 ± 0.27) × 10-3,(2.09 ± 0.30) × 10-3 and (1.76 ± 0.25) × 10-3 mm2/s,pancreatic tail were (1.88 ± 0.28) × 10-3,(1.88 ± 0.27) × 10-3 and (1.56 ± 0.27) × 10-3 mm2/s,respectively.From the aspect of different field strength MR scanners,there were significant differences in mean ADC of liver (t =11.073,P ＜0.01 in GE 1.5 T vs Philips 3.0 T; t =12.795,P ＜0.01 in Siemens 1.5 T vs Philips 3.0 T),spleen (t =4.143,P ＜ 0.01 in GE 1.5 T vs Philips 3.0 T; t =5.376,P ＜ 0.01 in Siemens 1.5 T vs Philips 3.0 T),pancreatic body (t =4.677,P ＜ 0.01 in GE 1.5 T vs Philips 3.0 T; t =5.174,P ＜0.01 in Siemens 1.5 T vs Philips 3.0 T) and tail (t =5.356,P ＜0.01 in GE 1.5 T vs Philips 3.0 T; t =4.648,P ＜0.01 in Siemens 1.5 T vs Philips 3.0 T),but there were no significant differences in mean ADC of pancreatic head (t =0.340,P ＞ 0.05 in GE 1.5 T vs Philips 3.0 T; t =1.349,P ＞ 0.05 in Siemens 1.5 T vs Philips3.0 T).From the aspect of different 1.5 T MR scanners,there were significant differences in mean ADC of liver (t =-4.563,P ＜ 0.01),but there were no significant differences in mean ADC of spleen (t =-0.732,P ＞ 0.05),pancreatic head (t =-0.879,P ＞ 0.05),body (t =-1.020,P ＞0.05) and tail (t =0.054,P ＞ 0.05).Conclusion Between 1.5 T and 3.0 T MR scanners,there were significant differences in mean ADC of liver,spleen,pancreatic body and tail,but there were no significant differences in mean ADC of pancreatic head.At different 1.5 T MR scanners,there were significant differences in mean ADC of liver,but there were no significant differences in mean ADC of spleen,pancreatic head,body and tail.

OBJECTIVETo find a way to view ECG from different manufacturers in electrocardiogram information system.

METHODSDifferent format ECG data were transmitted to ECG center by different ways. Corresponding analysis software was used to make the diagnosis reports in the center. Then we use PDF convert to change all ECG reports into PDF format. The electrocardiogram information system manage these PDF format ECG data for clinic user.

RESULTSThe ECG reports form several major ECG manufacturers were transformed to PDF format successfully. In the electrocardiogram information system it is freely to view the ECG figure.

CONCLUSIONSPDF format ECG report is a practicable way to solve the compatibility problem in electrocardiogram information system.

Objective:To investigate the correlation and dose-response relationship of pulse pressure and pulse pressure index with metabolic syndrome in the elderly population.Methods:This was a cross-sectional study.A total of 114 212 subjects aged 65 years and over in Wujin District receiving health examination in 2019 were enrolled, including 40 388(35.4%)patients with metabolic syndrome.The survey contents included a questionnaire, physical examination and laboratory tests.Logistic regression and restricted cubic splines were used to analyze the correlation and dose-response relationship of pulse pressure and pulse pressure index with metabolic syndrome.Results:With increases in pulse pressure levels and pulse pressure index, the prevalence of metabolic syndrome and its components increased accordingly( P<0.01). After adjusting for confounding factors, the ORvalue of metabolic syndrome gradually increased along with increases in pulse pressure and pulse pressure index.Compared with the first quartile, pulse pressure and pulse pressure index in the second, third and fourth quartiles were correlated with metabolic syndrome(pulse pressure: OR=1.52, 95% CI: 1.47~1.58, OR=1.89, 95% CI: 1.82~1.96 and OR=2.15, 95% CI: 2.07~2.23, respectively; pulse pressure index: OR=1.22, 95% CI: 1.18~1.26, OR=1.36, 95% CI: 1.31~1.41 and OR=1.47, 95% CI: 1.42~1.53, respectively). Restricted cubic spline analysis showed that pulse pressure and pulse pressure index had non-linear dose-response relationships with metabolic syndrome( χ2=309.23 and 57.14, P<0.01). Conclusions:Pulse pressure and pulse pressure index are correlated and show non-linear dose-response relationships with metabolic syndrome and its components in the elderly.

Objective To investigate the role of DWI in differentiating autoimmune pancreatitis ( AIP) from pancreatic cancer ( PC) , and in the therapeutic effect evaluation of AIP.Methods DWI data of 26 cases with AIP , 29 cases with PC and 30 cases with normal pancreas ( NP ) were analyzed retrospectively.The distribution type and signal feature of lesions in cases with AIP or PC were evaluated by Chi-squared test.ADC values were measured and compared among 3 groups by Kruskal-Wallis test.ADC values of AIP and PC were analyzed by using ROC curve to determine the optimal threshold and diagnostic efficiency.ADC values were compared in AIP ( n=15 ) before and after steroid therapy by paired t test.Results Diffuse lesions were detected in 21 cases with AIP and 3 cases with PC, while focal lesions in 5 cases with AIP and 26 cases with PC (χ2 =27.64, P<0.01).On DWI, most of AIP (n=19) and PC (n=24) showed hyper-intense signal, while a few of AIP (n=7) and PC (n =5) showed iso-intense signal (χ2 =0.75, P>0.05).The median ADC values of AIP, PC and NP were 1.15 ×10 -3,1.35 × 10 -3 ,1.59 ×10-3 mm2/s, respectively; and the difference was statistically significant ( H=45.60, P <0.01).ROC analysis yielded an optimal ADC cutoff value of 1.255 ×10 -3 mm2/s (80.8% sensitivity, 79.3%specificity and 0.871 area under curve for the diagnosis of AIP ).ADC values of AIP ( n=15) were markedly increased from the baseline (1.10 ±0.19) ×10 -3 to (1.57 ±0.12) ×10 -3 mm2/s after steroid therapy (t=-10.14, P<0.01).Conclusions DWI may be useful for diagnosing and evaluating the effect of steroid therapy in AIP.ADC values of AIP were significantly lower than those of pancreatic cancer and normal pancreas.After steroid therapy , ADC values were markedly increased in AIP.

Objective To investigate the application value of pancreaticojejunostomy with double-layer continuous suture in total laparoscopic pancreaticoduodenectomy (TLPD).Methods The retrospective crosssectional study was conducted.The clinicopathological data of 21 patients who underwent TLPD with pancreaticojejunostomy using double-layer continuous suture in the Second Hospital of Jilin University between January and December 2017 were collected.The anastomosis used Child method,and pancreaticojejunostomy,choledochojejunostomy and gastroenteric anastomosis in turn were done.Observation indicators:(1) surgical and postoperative recovery;(2) postoperative pathological examination;(3) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival and tumor recurrence or metastasis up to February 2018.Measurement data with normal distribution were represented as x±s.Measurement data with skewed distribution were described as M (P25,P75).Results (1) Surgical and postoperative recovery:21 patients underwent successful TLPD with pancreaticojejunostomy with double-layer continuous suture.The operation time,time of pancreaticojejunostomy and volume of intraoperative blood loss were respectively (352±25)minutes,(46±8)minutes and (168±34) mL.There was no intraoperative blood transfusion.The time of postoperative abdominal drainage-tube removal was (10.1±4.4)days.Of 21 patients,12 were complicated with biochemical fistula,and 3 with grading B of pancreatic fistula (pancreatic duct in type Ⅱ),and they were improved by inhibiting pancreatic secretion and drainage patency.There was no occurrence of biliary fistula,chylous fistula,postoperative bleeding,abdominal infection and delayed gastric emptying.The duration of postoperative hospital stay of 21 patients was (11.3± 2.0) days.(2) Postoperative pathological examination:surgical margins of 21 patients were negative.The pathological type:8,6,4,2 and 1 patients were diagnosed as distal bile duct cancer,ampulla cancer,duodenal papilla and duodenal cancer,pancreatic head cancer and neuroendocrine cancer of ampulla,respectively.(3) Follow-up and survival situations:21 patients were followed up for 3-12 months,with a median time of 7 months.During the follow-up,all the patients survived,and there was no tumor recurrence and metastasis.Conclusion Pancreaticojejunostomy with double-layer continuous suture is safe and feasible for TLPD,with advantages of exact anastomosis effect and good application value.

Objective:To evaluate whether underdilated stent could reduce the occurrence of hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) creation.Methods:A total of 197 patients with decompensated liver cirrhosis, who had underwent TIPS creation at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, were analyzed retrospectively, including 110 males and 87 females with age 25-79 (54±11) years old. Uncovered and covered stents with 8 mm diameter were implanted in all subjects, and then dilated by balloon catheters with 6 mm or 8 mm diameter. The patients were divided into two groups, including underdilated group (6 mm, n=105) and control group (8 mm, n=92).Kaplan-Meier curves were used to illustrate cumulative rate of HE, and the differences were assessed with the log-rank test. Multivariate analyses with a Cox regression model were conducted to explore the risk factors for HE. Results:During a median follow-up period of 29 (12-54) months, 16 (15.2%) patients developed HE in the underdilated group and 27 (29.3%) patients in the control group. There was a significant difference in the cumulative rate of HE ( P=0.014), but no statistical differences were found in terms of variceal rebleeding, shunt dysfunction and survival between the two groups ( P=0.608, P=0.659, P=0.968). In multivariated analysis, group assignment (underdilated vs. control, HR=0.291, 95% CI 0.125-0.674, P=0.004) was identified as an independent risk factor for HE after TIPS creation. Conclusion:Underdilated TIPS could reduced the risk of HE compared with completely dilated TIPS, with comparable risk of variceal rebleeding, shunt dysfunction and mortality. And it is worthy of applying this technique to a large sample of patients in clinical practice.

Objective To investigate the clinical effects of high restrictive anti-dislocation prosthesis total hip arthroplasty(THA)in treating elderly femoral neck fracture patients with hemiplegia.Methods From June 2015 to January 2017,Fortythree elderly femoral neck fracture patients with hemiplegia were treated with CombiCup THA system.There were 15 males and 28 females with an average age of 71.5±5.6 years (60-84 years).The left side was involved in 20 cases,while the right side in 23 cases.There were 15 cases with Garden Ⅲ type and 28 cases with type Ⅳ.Lower limb muscle strength grade were 20 cases in grade 3,19 cases in grade 4,and 5 cases in grade 5.Sixteen cases walked independently before injury,while 27 of them walked with the aid of crutches.The duration between injuries to operation ranged from 2 days to 5 days.The size of the prosthesis and offset distance were recorded by template technique pre-operation.The appropriate type of prosthesis was selected to restore the offset and to reconstruct the abductor muscle arm,according to the actual measurement in the operation and the preoperative plan.Based on the bone mineral density and medullary cavity morphology,biological or cemented femoral stem prosthesis was selected.The quality of the implant and the length of both lower limbs were evaluated by pelvic X-ray immediately after operation.The patients were followed-up at 2 weeks,1 months,2 months,3 months,6 months,1 and 2 years.Functional exercise guidance and complications were recorded at the follow-up duration.At the last follow-up,the hip function and limb function were evaluated according to the Harris score and Fugl-Meyer motor function assessment respectively.Results Based on pelvic X-ray evaluation after operation,all prosthesis position were favorable with the average angle of acetabular abduction 45.1±2.3 degrees and the length difference of both limbs less than 5 mm (average 2.2±0.8 mm).The follow-up duration ranged from 6 to 24 months with an average of 11.2±3.5 months.There was no complication such as prosthesis dislocation and infection.Deep venous thrombosis in calf occurred in 3 patients at 2 days after operation,who underwent recanalization after thrombolysis.At the last follow-up,the average score of Harris hip function and Fugl-Meyer were 90.2±3.8 (77 to 96) and 97.1±2.5 (83 to 100),respectively.No dislocation,infection,loosening,subsidence and osteolysis phenomenon was found during the follow-up.Conclusion The elderly patients with Garden type Ⅲ or Ⅳ femoral neck fractures accompanied with hemiplegia can be treated with anti-dislocation prosthesis THA.It does have the advantages of low dislocation rate and imoroved hemiolegic limb function.

Gastric cancer is a common malignant tumor of the gastrointestinal tract， with the pathogenesis remains to be fully elucidated. Although surgery， radiotherapy， chemotherapy， targeted therapy， and immunotherapy have demonstrated obvious clinical efficacy in the treatment of gastric cancer， the patients suffer from complications and adverse effects. Basic experiments and clinical studies have proved that Chinese medicine can treat gastric cancer in a multi-component and multi-target manner， the mechanisms of which remain to be deciphered. Therefore， the mechanism of Chinese medicine against gastric cancer needs to be unveiled by network pharmacology and tools of molecular biology. According to Chinese medicine， the occurrence of gastric cancer is mainly attributed to liver Qi stagnation， phlegm stasis and Qi stagnation， body fluid deficiency and heat accumulation， deficiency of healthy Qi， and cancer toxin accumulation. According to the available literature， herbal compound formulas such as Sancao Tiaowei decoction， Xiaojianzhong decoction， and Yiqi Huayu Jiedu decoction focus on tonifying， clearing heat， and detoxifying， while herbal active components are mainly insecticidal， heat-clearing， blood-activating， stasis-removing， and Qi-regulating drugs. The therapeutic effects of these Chinese medicines are consistent with the etiology and pathogenesis of gastric cancer. It has been demonstrated that Chinese medicines play a role in promoting apoptosis and autophagy， blocking cell cycle， and reversing cellular drug resistance to treat gastric cancer by regulating phosphatidylinositol-3 kinase/protein kinase B （PI3K/Akt）， mitogen-activated protein kinase （MAPK）， nuclear factor-kappa B （NF-κB）， transforming growth factor-β （TGF-β）/Smad， Wnt/β-catenin， and Hedgehog signaling pathways， while there is a lack of systematic understanding. By systematically summarizing the signaling pathways related to the regulation of gastric cancer by Chinese medicine， this study aims to clarify the molecular mechanisms of Chinese medicine against the development， invasion， and metastasis of gastric cancer， with a view to providing new targets， perspectives， and ideas for the treatment of gastric cancer and promoting the modernization of traditional Chinese medicine.

Natural products, as a gift of nature to humanity, have long been used as drugs or pharmacological actives to help people cure various diseases. Yet we still know comparatively little about their ability to be materials. In recent years, some small molecule natural products isolated from traditional Chinese medicines have been found to have new features, namely, self-assembly to form gels (., natural product gels, NPG). However, the application development of these natural products is seriously lacking, which greatly weakens their practical value and delays the maturity of the field. Here, a series of self-assembled triterpenoid natural products are used as materials (gel scaffolds) to construct drug delivery systems. Surprisingly, these NPG not only exhibit the excellent self-healing, controlled gelation, good safety and sustained release, but also achieve synergistic treatment of tumors through bioactive natural products. Compared with non-bioactive gel scaffolds, NPG scaffolds show great advantages in tumor therapy, including optimal tumor inhibition, preferable health, better body recovery, stronger immune function, less toxic side effects and longer survival. The successful construction of NPG scaffolds not only takes full advantage of the self-assembled natural products, but also takes an important step in the development of new applications for natural products.