Objective:To investigate the problems and improve the quality of clinical education.Method:A questionnaire was made among 200 medical students at Ji'ning medical college.Results:About eighty-eight percent of the students were satisfied with their clinical education,but there were still some problems:absence of clear objectives in clinical practice;shortage of enthusiasm of the students;lack of responsibility of some teachers and too many factors affecting clinical practice.Conclusion:The key points to improve clinical education quality are to set up clear education objectives,develop appropriate clinical practice methods,improve teaching staff quality and reform the teaching content.

0.05). Conclusion Fluoride contents of local wheat in some areas of Chongqing exceeded standard.

Objective To investigate the effects of Deanxit on elderly patients with anxiety and depression symptoms after percutaneous coronary intervention (PCI).Methods The Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale(HAMD) were used to evaluate the anxiety and depression symptoms in elderly patients (more than 70 years old) with coronary heart disease after PCI.Thus,80 patients with anxiety and depression after PCI were singled out,they were randomly divided into Deanxit group (n =40,2 Deanxit tablets daily) and control group (n =40,conventional therapy).HAMA and HAMD scores were performed after treatment for 12 weeks.Results HAMA and HAMD scores of the Deanxit group were (10.2 ± 5.7) points,(11.8 ± 6.2) points,which were significantly lower than (17.8 ±5.5)points,(18.3 ±4.3)points in the control group (P =0.012,P =0.020).Conclusion Deanxit can significantly improve the anxiety and depression symptoms in elderly patients after PCI.

Objective: To compare the efifcacy and safety of sirolimus-eluting stent (SES) and everolimus-eluting stent (EES) for treating the patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS). Methods: A total of 400 NSTE-ACS patients treated in Jining Medical College Hospital from 2013-09 to 2014-09 were studied. According to different stents, the patients were divided into 2 groups: SES group,n=220 and EES group,n=180. A prospective follow-up study was conducted for 1.5 years to compare the incidence rate of major adverse cardiovascular events (MACE). The patients were further stratiifed by GRACE scores as Low risk group (score<109), Medium risk group (score 109-140) and High risk group (score>140). MACE free survival was studied by Kaplan-Meier curve and analyzed by Long-rank test, predictive value of GRACE for 1.5 year MACE incidence rate was examined. Results: There were 355/400 (89%) patients completed (16.7 ± 5.7) months of follow-up study including 205 in SES group and 150 in EES group. MACE occurrence rates were similar between SES group and EES group (16.10% vs 18.0%), P>0.05. By GRACE score stratiifcation, MACE rates in High risk SES group were higher than High risk EES group (48.00%vs 16.00%),P<0.05; while they were similar between Medium risk groups (14.49% vs 28.00%) and Low risk groups (9.11% vs 12.86%), allP>0.05. ROC curve indicated that the predictive value of GRACE score for 1.5 year MACE incidence was for AUC=0.762, 95% CI (1.026-1.050),P<0.001. Conclusion: Implanting of EES would be more beneifcial for NSTE-ACS patients with high GRACE risk; GRACE score has the better predictive value for their long-term prognosis.

Objective To investigate deanxit clinical efficacy of depression in elderly patients with acute coronary syndrome(ACS).Methods 88 elderly patients with ACS and depression were randomly divided into Deanxit (2 tablets daily ; Deanxit,n =43) or placebo (control,n =45) treatment in addition to standard therapy.SDA score,SDS score,MACE and cardiac autonomic nerve function were performed at 12 weeks follow-up.Results In deanxit group,SDA score and SDS score were significantly reduced (34.28 ± 6.35 vs 52.68 ± 5.74,41.19 ±4.63 vs 54.68 ± 4.32,P ＜ 0.05),MACE were also decreased (4.6％ vs 28.9 ％,P ＜ 0.05).SDNN were significantly higher than control (109.03 ± 23.08 vs 98.29 ± 27.44,P ＜ 0.05),but LF was reduced (152.89 ± 92.75vs 249.21 ± 64.17,P＜ 0.05).Conclusion Deanxit can improve the depression and clinical symptoms in elderly patients with ACS and depression.By improving the cardiac autonomic nerve function,deanxit possible reduce the onset of severe arrhythmia and improve the short-term prognosis.

Objective: To clarify the predictive value for long-term prognosis of GRACE score and SYNTAX score in patients with non-ST elevation acute coronary syndrome (NSTE-ACS).
Methods: A total of 784 NSTE-ACS patients treated in our hospital from 2009-01 to 2014-01 were retrospectively studied. According to the treatment, the patients were divided into 3 groups: Medication group,n=410, Stent group,n=325 and CABG group,n=49. Based on 2 scoring systems, the patients were divided into another 3 groups: Low risk group, Medium risk group and High-risk group. The relationship between GRACE score and SYNTAX score was studied by Pearson correlation analysis, survival analysis was conducted by Kaplan-Meier method, univariate and multivariate analysis were performed by Cox proportional hazard model, and the area under curve (AUC) of ROC analysis was used to compare two methods.
Results: All 784 patients completed the follow-up study at the median of 47.7 months. Pearson correlation analysis showed that there was a weak positive correlation between GRACE score and SYNTAX score (r=0.40,P<0.01). Survival analysis presented that by GRACE score system, the MACE occurrence rates in Low risk group, Medium risk group and High-risk group were elevated accordingly as 13.81%, 23.64% and 36.55% respectively. And by SYNTAX system, MACE occurrence rates in Medium risk group and High-risk group were 39.29% and 37.93%, which were both higher than that in Low risk group (23.99%), while the scores between Medium and High risk groups were similar,P>0.05. Cox proportional hazard model and ROC analysis indicated that GRACE and SYNTAX scores had the important predictive value for lone term prognosis of NSTE-ACS. ROC analysis of GRACE score, SYNTAX score, the combination of GRACE and SYNTAX scores showed that 3 of them all had good predictive value for MACE occurrence, three of 95% CI had signiifcant overlapping without statistic differences.
Conclusion: GRACE score and SYNTAX score are related, both of them have important while similar predictive value for long term prognosis in NSTE-ACS patients, the combination of 2 scores cannot increase the predictive value. GRACE score is appropriate for the risk stratiifcation in NSTE-ACS patients.

Objective To analyze the willingness and influencing factors for usage of pre-exposure prophylaxis(PrEP) among male students who have sex with men (MSM) in universities of Guangxi. Meth-ods 295 MSM students in universities were recruited by Snow-balling methods. Questionnaires were self-administered to collect social demographic information,AIDS related risky sexual behaviors and willingness for usage of PrEP. Logistic regression was employed for univariate and multivariate analysis. Results Of the 295 MSM,58(19.7%)had ever heard PrEP,265(89.8%) said that they would like to use PrEP. Multivari-ate logistic regression analysis showed that those who had found partners through friends ( OR=11.419,95%CI:1.363~95.641), those who would advise his friend to use PrEP ( OR=87.946,95%CI:13.660-566. 222),those who concerned the convenience to gain the medicine ( OR=119.652,95%CI:3.765-3802.184) and those who said that they could take medicine every day ( OR=88.245,95%CI:10.237-760.696) were more likely to accept PrEP. The subjects whose partners would be angry if they stick to use condoms( OR=0.106,95%CI:0.019-0.606),and those who suspected the effectiveness of drugs( OR=0.010,95%CI:0. 001-0.112) were less likely to accept PrEP. Conclusion The acceptability of PrEP is high in university students'MSM. The safety of drugs and the convenience to gain the medicine are the main influencing factors for usage of PrEP.Using of PrEP should be strengthened to the MSM.

OBJECTIVETo assess the methodological quality and reporting quality on Meta-analysis being published in the Chinese Journal of Gastrointestinal Surgery.

METHODSComputerized literature searching was carried out in Wanfang Medical Online to collect articles that Meta-analysis was used in the Chinese Journal of Gastrointestinal Surgery since it was founded till July, 2014. Manual retrieval was also conducted. Two researchers independently screened for literature and extracted data. Qualities on methodologies or on the processes of reporting and reviewing were evaluated by both AMSTAR and PRISMA scales.

RESULTSForty-two papers on meta-analyses were included in this study. Results on the quality of methodology evaluation showed that the lowest and highest scores were 6 and 9 respectively, the median score was 7. Two articles (4.8%) were rated as high, 40 articles (95.2%) as moderate and 0 articles (0%) as low. Although the quality of methodology was above the average, however, there were still some problems seen in some papers as the conflict of interest was not stated, the list of studies (included and excluded) was not provided, a comprehensive literature search was not performed, the likelihood of publication bias was not assessed, etc. Results on the quality of reporting evaluation showed that the lowest and highest scores were 14 and 22 respectively, the average score was 18.43 ± 2.03, 3 articles (7.1%) scored less than 15 points, 35 articles (83.3%) scored 15.5-21 points, and 4 articles (9.6%) scored 21.5-27 points. The included reviews had high quality on the titles of the report, inclusion criteria, rationale of introduction, synthesis of results, results of individual. However, the abstract, objectives of introduction, scheme and registered, inclusion criteria, research screening, additional analysis, conclusion limitations, funding support etc. were lack of comprehensive reports.

CONCLUSIONSArticles on Meta-analysis published in the Chinese Journal of Gastrointestinal Surgery are of high quality. The Chinese Journal of Gastrointestinal Surgery can provide better evidence for clinical decision to gastrointestinal surgeons. However, both of qualities on methodology and reports sill call for continuous improvement.

BACKGROUND: The incidence of lung cancer is increasing annually. Clinicians pay special attention to lung tests during physical examinations. Due to the popularity of low-dose computed tomography, not only can lung cancer be diagnosed early, but physical examinations often reveal the presence of pulmonary nodules, an important health issue that cannot be ignored. Patients with pulmonary nodules are prone to adverse emotions such as anxiety and depression. Many studies have shown that patients with emotional disorders have immune system dysfunction and changes in inflammation levels. This study aimed to investigate the changes in anxiety, depression, the ratios of T helper cells 17 (Th17) and regulatory T cells (Tregs), and inflammation levels in patients with pulmonary nodules. METHODS: A total of 143 subjects from The First Affiliated Hospital of Anhui Medical University were included from April 2019 to July 2019. All of the subjects were assessed with the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory-II (BDI-II). Overall, 40 cases were healthy controls (HC) and 103 cases were patients with pulmonary nodules. The patients were divided into two groups according to the scale scores: 62 cases in a non-anxiety and non-depression (NAD) group and 41 cases in an anxiety and/or depression (AD) group. The percentage of Th17 and Tregs in the peripheral blood and inflammatory factors in the serum were detected. The absolute Th17 cell counts were calculated and the differences between the groups and correlations between these indicators were analyzed. RESULTS: There were statistically significant differences in the percentage of Th17 cells, the absolute counts of Th17 and Th17/Treg cells, and the levels of interleukin-2 (IL-2), IL-6, and tumor necrosis factor-α (TNF-α) among three groups (all P<0.001). The AD group was higher than the HC and NAD groups (all P<0.05). There was no statistically significant difference between the HC and NAD groups (all P>0.05). The previously described indicators had no significant correlation with the severity of anxiety and depression (P>0.05). There were no significant differences in the percentage of Tregs or levels of IL-4 and IL-10 between the groups (all P>0.05). The proportion of anxiety and/or depression in female patients with pulmonary nodules was higher than that in males (P<0.05). CONCLUSIONS Patients with pulmonary nodules are prone to varying degrees of anxiety and depression, which leads to immune dysfunction and low-grade inflammation.