Objective To investigate the effects of different treatment modes on the prognosis of patients with severe trauma.Methods The general data of 396 patients with severe trauma [injurey severity scores (ISS) ≥25] in our hospital emergency for treatment from January 1,2008 to January 1,2012 was collected.The trauma patients were divided into study group and control group.In the study group,the trauma patients were cared by emergency physician of our hospital for pre-hospital treatment during transportation by ambulance since January 1,2010.In the control group,the trauma patients were served with traditional pre-hospital emergency care by the 120 and 999 before January 1,2010.The injury severity score,medical care and outcomes were recorded in trauma database and the efficiency and quality of medical care were compared between two groups.Results The emergency treatment time,length of hospital stays,ICU admission rate,prehospital mortality rate,long-term (6 months) disability rate,and complication rate in the study group were lower than those in the control group,presenting (78.23 ± 21.57) min vs.(96.45 ± 35.14) min,(23.55±12.46) dvs.(28.67±20.72) d,8.1％ (18/222)vs.65.5％ (114/174),13.3％ (34/256) vs.21.6％ (48/222),4.1％ (9/222)vs.9.2％ (16/174),8.1％ (18/222)vs.18.4％ (32/174),in which the differences were statistically significant (P ＜ 0.05).Hospital mortality in the study group was also lower than that in the control group,showing 8.1％ (18/222) vs.12.6％ (22/174),but there was no statistically significant difference (P ＜ 0.05).There was no significant difference in time from occurrence of injury to receiving treatment between the two groups.Conclusion Emergency physicians-cared mode had advantages to improve treatment success rates and reduce mortality in patients with multiple trauma compared with the current conventional emergency mode.It is a good alternative emergency mode.

Objective To synthesize a lipophilic prodrug of triptolide (TP) and improve its druggability .Methods Trip-tolidestearate (TP-SA)was synthesized via the DMAP-catalyzed DCC method and identified by MS ,1H-NMR and 13C-NMR. The shake-flask method was used to study the oil/water partition coefficient .The preparations of TP and TP-SA liposomes and emulsions were compared .Their encapsulation efficiency and stability were investigated .Results TP-SA was synthesized suc-cessfully .Its log P in octanol/water system was 2 .33 .It was difficult to prepare TP liposome or emulsion .By contrast ,TP-SA liposome and emulsion can be prepared successfully with the same formulation process .The particle size of TP-SA lipo-somes were about 90 nm and TP-SA emulsions were about 110 nm .The encapsulation efficiency was above 95% .Their stabili-ty were studied at 4℃ and 25℃ .The preparation parameters ,such as particle size and encapsulation efficiency ,had no signif-icant change in a week .Conclusion Triptolide stearate enhanced drug lipophilicity .Its druggability was improved significant-ly .These data can be used for the TP related drug design and development .

Objective:To explore the evaluation and demand of clinical medical postgraduates for the supervisors' ethics and morality, and to explore ways to construct their ethics and morality in medical education.Methods:In the study, 2 268 clinical medical postgraduates in a medical university in Jiangsu Province were investigated with their satisfaction, compliance and suggestions. Rank sum test was carried out for the satisfaction by using SPSS 26.0, and qualitative analysis was carried out for suggestions.Results:The overall satisfaction of graduate students to the ethics and morality of supervisors was high. All the items described in the supervisors' ethics were "very consistent" more than 80%. Through qualitative analysis, the feedback were divided into six themes namely "supervision and feedback", "supervisor training", "reward and punishment system", "communication", "caring for students" and "academic guidance".Conclusion:The evaluation of clinical medical supervisors' ethics and morality is generally at a high level. The cultivation and guidance of supervisors' ethics and morality, supervision mechanism, and reward and punishment system still need to be improved.

Objective To explore the effect of smoking on endothelium-dependent vascular relaxing function and endogenous apelin-13 level.Methods Forty healthy volunteers,including 20 smokers and 20 non-smokers were randomly selected and participated in the study from December 2014 to April 2015.During the study period the smokers were asked to quit smoking for one month and the non-smoking group was given short-term smoking intervention.The changes of vascular endothelial function and plasma apelin13 levels were compared between the smoking group and non-smoking group,and before and after intervention.Results Flow-mediated dilatation (FMD) in smoking group was significantly lower than that in non-smoking group [(5.34 ± 1.83) ％ vs.(8.12 ± 2.62) ％,t =-3.75,P ＜ 0.01].FMD in smoking group was significantly increased after 1 month of quitting smoking [(5.34 ± 1.83) ％ vs.(9.05 ± 2.18) ％,t =-6.66,P ＜ 0.01],FMD in non smoking group was slightly decreased [(8.12 ± 2.62) ％ vs.(7.78 ± 1.96) ％,t =0.90,P =0.38] after short-term smoking.The level of plasma apelin-13 in smoking group was significantly lower than that of non smoking group [(44.22 ± 16.58) pg/ml vs.(70.12 ± 24.35) pg/ml,t =-3.79,P ＜ 0.01].The level of plasma apelin-13 in smoking group was significantly increased after 1 month of smoking cessation intervention [(44.22 ± 16.58) pg/ml vs.(65.32 ± 17.13) pg/ml,t =-4.26,P ＜0.01].In non smoking group,the level of plasma apelin-13 was significantly decreased after short-term smoking [(70.12 ± 24.35) pg/ml vs.(45.83 ± 15.66) pg/ml,t =4.93,P ＜ 0.01].Conclusion Cigarette smoking leads to endothelial dysfunction.Short term occlusion of tobacco may significantly improve endothelial function and increase plasma apelin-13 level,suggesting that apelin-13 may be involved in the occurrence and development of endothelial dysfunction induced by cigarette smoking.

Twenty general practice residents who received training in Tongren Hospital from 2018 to 2020 were enrolled. The residents undertook rotation in chronic disease care clinic of the general medicine department, and a multi-disciplinary integrated teaching mode was applied. The theoretical knowledge test, skill assessment and self-evaluation were performed before and after rotation. The 360-degree evaluation was carried out when leaving the department (study group), the results were compared with that of internal medicine (control group) in the same period. The teaching effect was comprehensively evaluated. The scores of theoretical knowledge and skill assessment after rotation were significantly higher than those before rotation ( P<0.01). The self-evaluated ability was significantly higher than that at admission, especially in general practice thinking (7.85±0.88), doctor-patient communication (7.95±0.69), health education (7.80±0.70) and disease management (8.20±0.62) ( P<0.01). The 360-degree evaluation showed that the study group was better than the control group in interpersonal communication skills [(4.75±0.44) vs. (4.41±0.50)], system-based work ability[(4.75±0.44) vs. (4.31±0.47)], practice-based learning and improvement [(4.80±0.41) vs. (4.33±0.48)], patient care [(4.75±0.44) vs. (4.28±0.46)] and training mode satisfaction [(4.85±0.37) vs. (4.38±0.49)] (all P<0.05). The study indicates that the multi-disciplinary integrated teaching mode applied for rotation in the chronic disease care clinic of the general medicine department can improve the teaching effect and raise the teaching quality for general practice residency training.

To present the clinical characteristics and the misdiagnosis rate of acute coronary syndrome manifested primarily as throat discomfort, we conducted a multicentric and retrospective study in the cardiology and otorhinolaryngology departments. Records of patients with primary complaint of throat discomfort, absence of chest pain at onset, and an ultimate diagnosis of acute coronary syndrome, as well as patients with pharyngitis (as controls) were collected from May 2015 to April 2016. The patients' main manifestations were compared. Logistic regression results showed that chest tightness, dyspnea, perspiring, and exertional throat symptoms were significantly associated with acute coronary syndrome, with odds ratios of 8.3 (95% CI 2.2-31.5), 10.9 (95% CI 1.8-66.9), 25.4 (95% CI 3.6-179.9), and 81.2 (95% CI 13.0-506.7). A total of 25 (56.82%) out of 44 acute coronary syndrome patients, who were first admitted to the otorhinolaryngology department, were misdiagnosed, with a 12% (3/25) mortality rate. Throat discomfort can be the principal manifestation of acute coronary syndrome. Such patients exhibit high misdiagnosis and mortality rates. Exertional throat symptoms, chest tightness, perspiring, and dyspnea were important indicators of acute coronary syndrome in patients whose main complaint was throat discomfort. The awareness of this condition will result in prompt diagnosis and reduce morbidity and mortality.
Acute Coronary Syndrome/etiology* ; Dyspnea/etiology* ; Humans ; Pharyngitis/diagnosis* ; Pharynx ; Retrospective Studies