To cultivate students' thinking ability,help them form the custom of finding,analysing and solving the problems independently in course of clinical work,we carried out the designed experiment teaching in surgery experiment teaching for 27 students,got good result,and abtained the students' praise.

To cultivate clinical comprehensive ability of medical students in the new time,the clinical knowledge foundation must been requested,along with reforming of teaching way,valuing of practice teaching,strengthening the ability of innovation.Besides We should establish the scientific cultivating system of innovation ability,build a strong academic atmosphere for students,create the teaching atmosphere of training the student comprehensive and innovation ability,form the well-innovated circulation of teaching and studying,and cultivate the high-level medical students with innovation ability for adapting to modern society.

From the status quo of medical and health services in rural areas,there exist the following problems:the insufficient number of clinicians,low quality of clinicians,the imbalance of the professional ranks and titles,and aging.Based on investigation and analysis of the rural community health technicians of Huzhou City,Zhejiang Province,the author put forward the new countermeasures of orientation training clinicians in rural communities according to the rural communities residents new demand for medical and health services.

Objective To investigate the impact of nurses in operation room of implementing the comprehensive nursing intervention on psychological status and complications for laparoscopic common bile duct exploration patients. Methods All patients were selected in our hospital from January 2013 to March 2014 undergoing laparoscopic common bile duct exploration, according to different nursing methods they were randomly divided into intervention group and control group, 40 cases in each group. Two groups of patients were given perioperative nursing by nurses in operation room, the control group received the routine nursing and random symptomatic care, intervention group focused on the implemen-tation of comprehensive nursing intervention in nursing care such as psychological intervention, complications of T line pipe and complication care. The SAS score of two groups of patients before and after psychological intervention, opera-tion time, amount of bleeding complications, postoperative exhaust time, hospitalization time and rate of complication of two groups in surgery were compared. Results The postoperative SAS score of intervention group and the control group decreased significantly than preoperative (P<0.05). And the SAS score of the patients in the intervention group was significantly lower than that of the control group (P<0.05). The intraoperative bleeding volume, postoperative exhaust time of the intervention group were improved significantly compared with the control group (P<0.05), the operation time, hospitalization time of intervention group was shorter than that of the control group, but there were no significant dif-ference (P>0.05). The biliary stricture did not occur in two groups. In the intervention group, one case of gallstone residue, one case of postoperative. The complication rate in the intervention group was 5.0%,was significantly lower than the control group’s 12.5%(P<0.05). Conclusion Nursing in operation room to laparoscopic choledocholithotomy in patients through the implementation of comprehensive nursing intervention is beneficial to reduce the patients psycho-logical anxiety, reduce the incidence of complications and improve the operative effects.

Objective:To construct the clinical nursing pathway (CNP) design for children with anti-NMDA receptor autoimmune encephalitis taking project time as frame.Methods:The CNP draft for anti-NMDA receptor autoimmune encephalitis draft was designed by consulting literatures at home and abroad, screening evidence-based evidences, retrospective case analysis. Delphi method was used to two rounds of expert consultation of CNP draft to determine the CNP.Results:A total of 12 experts were interviewed with 0.91 for the expert authority coefficient. There were 50 items in the first round of consultation, and the consent rates ranged from 66.67% to 100%. There were 49 items in the second round of consultation, the consent rates of two items were 85.71% and others were all 100%. The CNP for children with anti-NMDA receptor autoimmune encephalitis had 49 items.Conclusions:Delphi method-based CNP text is highly efficient and practical, but it needs to be continually updated according to the variation.

Epilepsy is a chronic disease caused by sudden abnormal discharge of brain neurons, leading to short-term brain dysfunction. The incidence of children is relatively high. Continuous nursing is an extension of post-discharge nursing and its scope of application is becoming more and more extensive. This article reviews the current situation of continuous nursing in children with epilepsy and the needs of continuous nursing service, aiming to provide references for the formulation and research of subsequent continuous nursing service scheme.

Objective:To study the regulation and mechanism of Asperosaponin Ⅵ on polarization of M1/M2 macrophages.Methods:MTT assay was used to detect the effects of Asperosaponin Ⅵ on RAW264.7 cell viability.The levels of TNF-α and IL-6 in supernatant of RAW264.7 cells induced by lipopolysaccharide(LPS)were determined by ELISA.The content of nitric oxide(NO)in supernatant of RAW264.7 cells induced by LPS was determined by Griess method.The gene expression levels of TNF-α,IL-6,argi-nase-1(Arg-1),heme oxygenase-1(HO-1)and suppressor of cytokine signaling protein-2(SOCS2)were detected by fluorescence quantitative PCR.Western blot was used to detect the expression levels of iNOS and p-p65 protein.Results:In LPS induced RAW264.7 cells,Asperosaponin Ⅵ inhibited protein or gene expression levels of TNF-α,IL-6,iNOS and p-p65,and increased HO-1 gene expression.Asperosaponin Ⅵ inhibited NO secretion in RAW264.7 cells induced by LPS.Asperosaponin Ⅵ increased the gene expression levels of M2 macrophage markers Arg1 and SOCS2 induced by IL-4.Conclusion:Asperosaponin Ⅵ inhibited RAW264.7 macrophage polarization to M1 type and promote it polarization to M2 type,which can play its anti-inflammatory and immunomodulato-ry role by regulating M1/M2 macrophage polarization.

The occurrence of benign prostate hyperplasia(BPH)was related to disrupted sex steroid hormones,and metformin(Met)had a clinical response to sex steroid hormone-related gynaecological disease.How-ever,whether Met exerts an antiproliferative effect on BPH via sex steroid hormones remains unclear.Here,our clinical study showed that along with prostatic epithelial cell(PEC)proliferation,sex steroid hormones were dysregulated in the serum and prostate of BPH patients.As the major contributor to dysregulated sex steroid hormones,elevated dihydrotestosterone(DHT)had a significant positive rela-tionship with the clinical characteristics of BPH patients.Activation of adenosine 5'-monophosphate(AMP)-activated protein kinase(AMPK)by Met restored dysregulated sex steroid hormone homeostasis and exerted antiproliferative effects against DHT-induced proliferation by inhibiting the formation of androgen receptor(AR)-mediated Yes-associated protein(YAP1)-TEA domain transcription factor(TEAD4)heterodimers.Met's anti-proliferative effects were blocked by AMPK inhibitor or YAP1 over-expression in DHT-cultured BPH-1 cells.Our findings indicated that Met would be a promising clinical therapeutic approach for BPH by inhibiting dysregulated steroid hormone-induced PEC proliferation.

Benign prostatic hyperplasia(BPH)is one of the major chronic complications of type 2 diabetes mellitus(T2DM),and sex steroid hormones are common risk factors for the occurrence of T2DM and BPH.The profiles of sex steroid hormones are simultaneously quantified by LC-MS/MS in the clinical serum of patients,including simple BPH patients,newly diagnosed T2DM patients,T2DM complicated with BPH patients and matched healthy individuals.The G protein-coupled estrogen receptor(GPER)inhibitor G15,GPER knockdown lentivirus,the YAP1 inhibitor verteporfin,YAP1 knockdown/overexpression lentivirus,targeted metabolomics analysis,and Co-IP assays are used to investigate the molecular mechanisms of the disrupted sex steroid hormones homeostasis in the pathological process of T2DM complicated with BPH.The homeostasis of sex steroid hormone is disrupted in the serum of patients,accompanying with the proliferated prostatic epithelial cells(PECs).The sex steroid hormone metabolic profiles of T2DM patients complicated with BPH have the greatest degrees of separation from those of healthy individuals.Elevated 17β-estradiol(E2)is the key contributor to the disrupted sex steroid hormone homeostasis,and is significantly positively related to the clinical characteristics of T2DM patients complicated with BPH.Activating GPER by E2 via Hippo-YAP1 signaling exacerbates high glucose(HG)-induced PECs prolifer-ation through the formation of the YAP1-TEAD4 heterodimer.Knockdown or inhibition of GPER-mediated Hippo-YAP1 signaling suppresses PECs proliferation in HG and E2 co-treated BPH-1 cells.The anti-proliferative effects of verteporfin,an inhibitor of YAP1,are blocked by YAP1 overexpression in HG and E2 co-treated BPH-1 cells.Inactivating E2/GPER/Hippo/YAP1 signaling may be effective at delaying the progression of T2DM complicated with BPH by inhibiting PECs proliferation.

Traumatic cerebrospinal fluid leakage commonly presents in traumatic brain injury patients, and it may lead to complications such as meningitis, ventriculitis, brain abscess, subdural hematoma or tension pneumocephalus. When misdiagnosed or inappropriately treated, traumatic cerebrospinal fluid leakage may result in severe complications and may be life-threatening. Some traumatic cerebrospinal fluid leakage has concealed manifestations and is prone to misdiagnosis. Due to different sites and mechanisms of trauma and degree of cerebrospinal fluid leak, treatments for traumatic cerebrospinal fluid leakage varies greatly. Hence, the Craniocerebral Trauma Professional Group of Neurosurgery Branch of Chinese Medical Association and the Neurological Injury Professional Group of Trauma Branch of Chinese Medical Association organized relevant experts to formulate the " Chinese expert consensus on the diagnosis and treatment of traumatic cerebrospinal fluid leakage in adults ( version 2023)" based on existing clinical evidence and experience. The consensus consisted of 16 recommendations, covering the leakage diagnosis, localization, treatments, and intracranial infection prevention, so as to standardize the diagnosis and treatment of traumatic cerebrospinal fluid leakage and improve the overall prognosis of the patients.