This article analyzes and summaries the problems and difficulties existing in the first-aid medicine's clinical teaching.Combined with his own teaching experience,the author has made some exploration on the teaching time,the way of teaching and inspection form,which has got a good teaching effect.It provids the reference and development for the clinical teaching of first-aid medicine.

Objective To explore the effects of application of virtual simulation technology in basic nursing practice teaching.Methods Convenience sampling method was used to select 204 nursing students of grade 2013 in Fenyang College of Shanxi Medical University as the research subjects.Virtual reality software and simulator were used to build realistic experiment environment.Tasks of virtual simulation training were primary,intermediate and advanced.Questionnaire survey was conducted after training to investigate teaching effects,and theoretical and operating test scores of grade 2013 were compared with those of grade 2012.Results In the primary,intermediate and advanced tasks,there were 87.3％,77％ and 60.8％ of the students having scores of 91～100;theoretical and operating test scores of grade 2013 were better than those of grade 2012(P＜0.01);98％ of the students considered virtual simulation enhanced proficiency of operation,93.1％ of the students considered virtual simulation facilitated learning,91.1％ of the students liked virtual simulation learning,and 90.1％ of the students considered virtual simulation stimulated interests in learning.Conclusion The application of virtual simulation experiment teaching in basic nursing practice teaching can promote the innovation of teaching mode and improve the teaching quality and teaching effect.

Objective To understand the characteristics of High-density lipoprotein cholesterol (HDL-C) distribution through analyzing serum HDL-C levels in healthy checkup subjects among local urbanese.Methods The checkup results of 36 454 cases were collected from 2009 to 2013 in Tangshan Gongren hospital (male:n =20 343,female:n =16 111).The cases with liver injury,abnormal blood glucoses,kidney injury and defined cerebrovascular diseases and metabolic disease were excluded.25 197 cases were analyzed as normal subjects including 11 114 males and 14 083 females.Kolmogorov-Smimov test,kruskal-wallis test,and Dunn multiple comparison test was performed using Bioconductor software 3.0.2 for testing normality distribution and comparing the difference of two or multiple groups,respectively.Results were analyzed statistically with R 3.0.2.Results The results showed that the average level (1.22-± 0.31) mmol/L of HDL-C among the overall population is lower than that of national average level(1.30 mmol/L).The median serum HDL-C level in female is higher than in male (1.27 and 1.08,x2 =2 606.34,P ＜0.01).HDL-C levels in male continuously increase from 1.06 mmol/L to 1.11 mmol/L with aging,especially in groups of over 50 years old than in groups of below 50 years old (x2 =75.19,P ＜ 0.01).Conclusions Based on 2007 guidance on prevention and treatment by national health bureau,this study showed that there are 29.69％ of the apparent healthy subjects,especially about 42.94％ of the male,representing low HDL-C level under the low limit of 1.04 mmol/L.These results showed that serum HDL-C level in Tangshan urbanese is lower than that of national average level,and HDL-C level in male is tended to increase with aging.

Objective To investigate the expressions and clinicopathological significance of 3q27-3q29-related p63 protein in diffuse large B-cell lymphoma (DLBCL). Methods An immunohistochemical Envision~(TM) method was used to detect the expressions of p53 and 3q27-3q29-related p63 protein in 102 cases of DLBCL and 15 cases of reactive hyperplasia of lymph node (RHL). Results The tumor cell expressions of p53(62 %) and p63(56 %) in DLBCL were significantly higher than that in RHL (0 and 13 % P < 0.05). The expressions of p53 and p63 were significantly different (1) between stage Ⅰ + Ⅱ (the positive rate 48.3 % and 41.4 %, respectively) and stage Ⅲ+Ⅳ(the positive rate 79.5 % and 75 %, respectively; P <0.05), (2) between GCB type (the positive rate 28 % and 28 %, respectively) and non-GCB type(the positive rate 72.7 % and 64.9 %, respectively; P <0.05). The expressions of p53 and p63 had no relationship to gender, age, B symptoms and locations. The expression of p53 was positively correlated with that of p63 in DLBCL (P <0.05, Cp=0.629). p53 and p63 protein expression in negative group the 5-year overall survival rate is higher than that in positive group (38 % and 6 %, 51% and 4 %, respectively), the difference was statistically significant (P <0.05). Conclusion It was likely that p63, as the oncogene, participated in the occurrence and development of DLBCL together with p53. Also, p63 and p53 might play a synergistic role in the occurrence DLBCL. Combined detection of 3q27-3q29-related 1963 protein and p53 protein in DLBCL, might be one of the indicators to the prognosis of DLBCL.

OBJECTIVETo summarize the clinical characteristics of an infant with chronic myelogenous leukemia (CML) and the effects of imatinib on the case.

METHODThe clinical features of an infant with CML, who was treated with imatinib in the Norman Bethune International Peace Hospital at June 2009, were retrospectively analyzed and the reports in literature were reviewed. The 1-year-old boy suffered from recurrent low-degree fever and pallor. He had a moderate anemia, distended abdomen and marked splenomegaly. Bone marrow aspiration revealed CML in chronic phase)CP). The t (9; 22))q34; q11) could be detected and BCR-ABL (p210) was positive. The boy was diagnosed as CML-CP and treated with imatinib 100 mg per day. There were 10 related papers and more than 100 child CML patients were reported as retrieved from CNKI)from its establishment to August 2014) and Wanfang Database)from its establishment to August 2014) when "Child", " Chronic" and "Leukemia" were used as keywords. And there were 30 related papers including 400 cases from PubMed Database (from its establishment to August 2014) and one detailed report of an infant with CML was retrieved when "childhood" and "chronic myeloid leukemia" "imatinib" were used as keywords. The clinical effects of imatinib in infant CML cases were analyzed and summarized based on the literature.

RESULTThe boy obtained a complete hematologic response (CHR) at the 6th week of diagnosis, a complete cytogenetic response (CCyR) at the 3rd month and a complete molecular response)CMR) at the 12th month without side effect. This boy grows very well and after a 62-month follow-up, his disease was stable. According to the domestic literature, 5 children CML cases aged 6 -12 years were treated with imatinib without side effects and got complete hematologic response (CHR) after 2-month-therapy. The dose, metabolic characteristics and clinical observation of imatinib can be found in foreign literature and imatinib showed good response with good tolerance in children with CML. Imatinib is regarded as the first line drug for children CML. But it may affect the development of the children.

CONCLUSIONThe children with CML-CP had a good response to imatinib, but more experience in the treatment of children with CML with iniatinib is needed.

Anemia ; Antineoplastic Agents ; therapeutic use ; Fusion Proteins, bcr-abl ; Humans ; Imatinib Mesylate ; therapeutic use ; Infant ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; drug therapy ; Male ; Remission Induction ; Retrospective Studies

Objective To investigate the expression and clinical significance of p63, CD_(44v6) and human papilloma virus (HPV) 16/18 in carcinoma of cervix and precancerous lesion and to study their role in the pathogenesis of the infiltrative carcinoma of the cervix(ICC). Methods 145 patients were selected, among whom were 60 cases of ICC, 55 cases of cervical intraepithelial neoplasia (CIN) and 30 cases of normal cervical epidermis (NCE). Immunohistochemistry streptavidin peroxidase (SP) was used to detect the expressions of p63 and CD_(44v6) protein and hybridization in situ was used to measure HPV 16/18 gene on tissue microarray. Results HPV 16/18, p63 and CD_(44v6) in ICC were significantly higher than those in CIN and NCE groups (P < 0.05). The expressions of HPV 16/18 gene in CIN I 、CIN II and CIN III were 27.3 % , 43.8 %, 70.6 % respectively. p63 protein was mainly expressed in squamous cell carcinoma, but not in adenocarcinoma. p63-positive rate was related to the grade of squamous cell carcinoma and clinical stage. CD_(44v6) positive rate was related to the pathological grade and clinical stage. Moreover, the positive rate of lymph node metastasis was significantly higher than the cases without metastasis (P <0.05). The expression of HPV16/18 was positively correlated with that of p63 in ISCC (P <0.05, Cp =0.49). Conclusion HPV16/18 possibly participate in the pathogenesis and progress of cervical squamous carcinoma. p63, as the cancer gene, may participate in the occurrence and development of cervical cancer caused by HPV 16/18. p63 could be a differentiation indicator of cervical squamous carcinoma, and it could be one of the markers which would be differentiated into squamous cell in malignant tumour. CD_(44v6) could be used as one of the indicators of distant metastasis of cervical cancer.

Objective To investigate the relationship between muscle mass reduction and quality of life in elderly lung cancer patients at the initial visit.Methods Totally 221 patients with non-small cell lung cancer undergoing chest and abdominal CT examination were included in this study at Fenyang Hospital in Shanxi Province.The Pearson's correlations of skeletal muscle index(SMI) and skeletal muscle radiodensity(SMD)with the disease stage,physical function,role of physical function,global quality of life,fatigue and dyspnea were analyzed.Results The average age of 221 patients was(70.2t9.0)years.The mean SMI for men and women was(46.7± 7.8)cm2/m2 and(39.4 ±6.4) cm2/m2 respectively.Multivariate linear regression analysis showed that SMI affected the body function,role of physical function,global quality of life,and fatigue dimension(all P ＜ 0.05),and SMD affected the physical function of life quality and dyspnea dimension(P ＜0.05).SMI was related to the physical function and role of physical function(men:r =0.287 and 0.245,P =0.001 and 0.006;women:r=0.296 and 0.395,P =0.004 and 0.000).In male patients,SMO was also associated with low global quality of life and fatigue(r=0.191 and-0.198,P =0.032 and 0.026).The above relationships did not change even after adjusting for the effect of age and disease stages.Low SMD was associated with low physical function and dyspnea in both men and women(men:r =0.287 and 0.245,P=0.037 and 0.049;women.:r=0.281 and-0.262,P=0.006 and 0.010),and SMD was associated with dyspnea only in women even after adjusting for age and disease stages.A correlation between SMI and the disease stage was found in both men and women(male:r =-0.266,P=0.003;female:r=-0.223,P=0.005).Conclusions Changes in muscle mass may affect the physical function,role of physical function and global quality of life in elderly patients with non-small cell lung cancer.

OBJECTIVETo determine whether increased expressions of gelatinases occur with aging in vivo in kidney tissue of autoimmune MRL/lpr mice by in situ zymography.

METHODSMRL/lpr mice at the age of 8 weeks, 16 weeks and 24 weeks were investigated. Kidney protein extracts were compared for activities of MMP-2/9 by gelatin zymography. Immunohistochemistry and SDS-PAGE gelatin zymography were used to determine the expressions and activities of gelatinase A (MMP-2) and gelatinase B (MMP-9). To determine the net gelatinase activities in murine lupus kidney, in situ zymography was used with autoradiographic emulsion as substrate.

RESULTSBoth gelatinase A and B were seldom detected in the kidney tissue in 8 week old mice, Increased expressions of both latent and activated form enzymes of MMP-2/9 were identified in kidney extraction by SDS-PAGE gelatin zymography and immunohistochemical staining showed both MMP-2 and MMP-9 were obviously up-regulated within glomerulus as well as tubular-interstitium in mice at the age of 16 and 24 weeks. In situ zymography showed markedly increased gelatinase activities in kidney tissue consistent with the results of immunohistochemical staining, it is mainly derived from MMPs and inhibited by EDTA but not by PMSF or aprotinin.

CONCLUSIONSThese in vivo results suggested that MMP-2/-9 expressions were significantly up-regulated with aging in murine lupus nephritis, which may play an important role in promoting the remodeling formation of ECM and thus contribute to the progression of renal damage in this model.

Aging ; physiology ; Animals ; Autoimmune Diseases ; enzymology ; immunology ; pathology ; Disease Models, Animal ; Electrophoresis, Polyacrylamide Gel ; Female ; Lupus Nephritis ; enzymology ; immunology ; pathology ; Male ; Matrix Metalloproteinase 2 ; metabolism ; Matrix Metalloproteinase 9 ; metabolism ; Mice ; Mice, Inbred MRL lpr ; Up-Regulation

Objective:To explore the diagnostic value of quantitative analysis of contrast-enhanced ultrasound for deep venous thrombosis of lower extremity after total hip arthroplasty.Methods:A total of 150 patients suspected of deep venous thrombosis of lower extremity undergoing total hip arthroplasty treatment in Jiaozhou Central Hospital of Qingdao from June 2021 to June 2022 were selected. Color Doppler ultrasound diagnostic instrument was used to examine the deep vein vessels of the lower limbs of patients, and quantitative analysis of contrast-enhanced ultrasound was performed to record the color Doppler detection results of patients. Quantitative parameters of contrast-enhanced ultrasound including time to peak (TIP), derived peak intensity (DPI), slope of ascending branch of curve (C) were compared between patients with deep vein thrombosis of lower extremities and normal patients. According to the onset time of symptoms of lower extremity thrombus group, patients were divided into acute stage, subacute stage and chronic stage, and the thrombus elasticity score and thrombus strain ratio among the three subgroups were compared.Results:Angiography results showed that 82 patients were diagnosed with deep vein thrombosis of lower extremities. The Kappa = 0.904, sensitivity was 95.00%, specificity was 91.43%, accuracy was 93.33%, positive prediction rate was 92.68%, and negative prediction rate was 94.12% by using contrast-enhanced ultrasonography and angiography in the diagnosis of deep vein thrombosis of lower extremity. The Kappa = 0.616, the sensitivity was 77.55%, specificity was 88.46%, accuracy was 81.33%, positive prediction rate was 92.68%, negative prediction rate was 67.65% by using ultrasonography and angiography in the diagnosis of deep venous thrombosis of lower extremities. The TIP level in patients with deep venous thrombosis of lower limbs was higher than that in normal patients, the DPI and C levels were lower than that in normal patients: (40.21 ± 12.34) s vs. (13.50 ± 4.59) s, (- 32.27 ± 7.56) dB vs. (- 11.33 ± 3.07) dB, (1.88 ± 0.40) dB/s vs. (4.75 ± 1.34) dB/s, there were statistical differences ( P<0.05). There were 28 cases of acute stage thrombosis, 22 cases of subacute stage thrombosis, and 32 cases of chronic stage thrombosis. There were statistically significant differences in thrombus elasticity score and thrombus strain ratio among patients with lower extremity thrombosis at different periods. Thrombus elasticity score and thrombus strain ratio of patients with acute stage thrombus were the lowest. Conclusions:Quantitative analysis of contrast-enhanced ultrasound has good consistency in the diagnosis of lower extremity deep vein thrombosis after total hip arthroplasty, and has certain clinical significance for staging diagnosis of lower extremity deep vein thrombosis.

Objective To investigate the susceptibility and resistance of clinical isolates from hospitals in several regions of China .Methods Fifteen general hospitals and two children′s hospitals were involved in this program . Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby‐Bauer method or automated systems .Results were analyzed according to CLSI 2014 breakpoints .Results A total of 78 955 clinical isolates were collected from January to December 2014 ,of which gram negative organisms and gram positive cocci accounted for 72 .6% and 27 .4% ,respectively . Methicillin‐resistant strains in S .aureus(MRSA)and coagulase negative Staphylococcus(MRCNS)accounted for an average of 44 .6% and 83 .0 % ,respectively .The resistance rates of methicillin‐resistant strains to β‐lactams and other antimicrobial agents were much higher than those of methicillin‐susceptible strains .However ,92 .0% of MRSA strains were still susceptible to trimethoprim‐sulfamethoxazole ,while 85 .6% of MRCNS strains were susceptible to rifampin .No staphylococcal strains were found resistant to vancomycin ,teicoplanin or linezolid .In Enterococcus spp .,the resistance rates of E .f aecalis strains to most tested drugs (except chloramphenicol) were much lower than those of E . f aecium .Some strains of both species were resistant to vancomycin .Vancomycin resistant strains of E . f aecalis and E . f aecium were mainly V anA ,V anB or V anM type based on their phenotype or genotype .Regarding non‐meningitis S .pneumoniae strains ,the prevalence of penicillin‐susceptible S .pneumoniae strains isolated from both adults and children were higher than those isolated in 2013 ,but the prevalence of penicillin‐intermediate S . pneumoniae or penicillin‐resistant S . pneumoniae strains decreased . The prevalence of ESBLs producingstrainswas55.8% in E.coliand29.9% in Klebsiellaspp.(K.pneumoniaeand K.oxytoca)and24.0% in Proteus mirabilis isolates on average . ESBLs‐producing Enterobacteriaceae strains were more resistant than non‐ESBLs‐producing strains in terms of antibiotic resistance rates . The strains of Enterobacteriaceae were still highly susceptible to carbapenems .Overall less than 10 % of these strains were resistant to carbapenems . About 62 .4% and 66 .7% of Acinetobacter spp .(A .baumannii accounts for 93 .0 % ) strains were resistant to imipenem and meropenem ,respectively . Compared with the data of year 2013 ,extensively‐drug resistant strains in K . pneumoniae and A .baumannii increased . Conclusions The antibiotic resistance of clinical bacterial isolates is growing .The disseminated multi‐drug or pan‐drug resistant strains in a special region poses a serious threat to clinical practice and implies the importance of strengthening infection control .