Objective To study the dynamic changes of soluble interleukin 2 recepter (sIL 2R) level and lymphocyte subsets over clinical course, the relationship between them and biochemical parameters of renal function, and to explore the role of the disturbance of celluar immune function in the pathogenesis of hemorrhagic fever with renal syndrome (HFRS). Methods The level of sIL 2R in sera was detected by double antibody sandwich ELISA method. The percentages of lymphocyte subsets were measured by flow cytometry. Results The level of sIL 2R in patients with HFRS increased significantly in febrile phase, reached its peak in hypotensive and oliguric phase and then decreased gradually in diuretic phase but still higher than that of normal in convalescent phase with values being (463.06?157.02) pmol/ml, (636.85?270.36) pmol/ml, (287.75?118.74) pmol/ml and (191.75?55.60) pmol/ml in different stages, respectively ( P 0.05). The percentage of CD3 +,CD4 + cells decreased significantly while the percentage of CD3 +, CD8 + cells increased significantly, which resulted in the decrease or reverse of CD4 +/CD8 + ratio in febrile phase. These changes were most obvious in hypotensive and oliguric phase, returned gradually in diuretic phase, but still abnormal in convalescent phase ( P

Through the reform and practice of the "four-in-one" cultivation model of clinical medical talents, the training mode of applied high-quality medical and health talents with different orientations is established, and the curriculum teaching system suitable for the development of modern medical education is constructed to promote the reform of education and teaching. It solves the problems of single medical talents training mode, fragmentation of curriculum system, single teaching and training in teaching, and insufficient support for talent training. This reform established a set of curriculum system, teaching methods and evaluation methods to strengthen the cultivation of medical students' post competency, and achieved the goal of improving the quality of clinical medical personnel training in local medical colleges.

Objective:To explore the effect of project improvement on improving early out-of-bed activity of patients after total knee arthroplasty (TKA) .Methods:From June 2018 to March 2019, a project improvement team was established in Department of Joint Surgery of a ClassⅢ Grade A hospital in Shandong province. The 56 patients undergoing TKA before the implementation of the project improvement were set as the pre-improvement group, and 58 patients undergoing TKA after the implementation of the project improvement were set as the post-improvement group. Based on the analysis of project improvement methods, the improvement was made from the following aspects, including formulating and implementing the standardized plan of early postoperative out-of-bed activity plan for TKA patients, perfecting management strategy of cluster pain and perfecting the implementation standard of drainage tube management in the department. The incidence of postoperative complications, knee joint function recovery and postoperative hospital stay were compared between the two groups.Results:After the implementation of project improvement, out-of-bed activity time for the first time was shortened to (21.49±4.94) h, the time for postoperative straight leg elevation was shortened to (32.10±11.48) h, time for 90°knee flexion was shortened to (23.08±5.93) h, and the postoperative hospital stay was shortened to (4.12±1.03) d. The differences were statistically significant ( t=-26.06, -5.37, -6.88, -10.37; P<0.01) . There was no statistically significant difference in the incidence of incision bleeding before and after the implementation of the project improvement ( P>0.05) . The incidence of postoperative constipation decreased from 17.9% (10/56) before improvement to 3.4% (2/58) , and the postoperative erection intolerance increased from 5.4% (3/56) before improvement to 20.7% (12/58) . The differences were statistically significant (χ 2=6.28, 4.36; P<0.05) . Conclusions:The implementation of the project improvement can shorten early out-of-bed activity of patients after TKA, reduce the incidence of postoperative constipation, accelerate the rehabilitation process of knee function, and shorten the postoperative hospital stay.