Clinical medicine is a practical discipline.Students combine theoretical knowledge with practical operation and develop clinical thinking at stage of clinical practice.From the perspective of education administration,a series of measures were carried out throughout the whole teaching in clinical internship in our university.Students were trained to gain the abilities of combing knowledge with practice,analyzing and solving issues individually and thinking logically and scientifically.Through years of research and practice,remarkable achievements were gained and both clinical skill and comprehensive quality of our students were greatly enhanced.

Objective:To evaluate the functional status and assistive facilities requirements for the elderly with disabilities in rural areas of Liaoning Province, and to provide reference for the configuration of assistive facilities and the construction of further rehabilitation management mode for the elderly with disabilities.Methods:A total of 929 disabled rural elderly people in 15 deep poverty-stricken areas in Liaoning Province from 2019 to 2020 were selected to evaluate the functional status and needs of assistive devices by using general information questionnaire, disability status questionnaire and assistive device evaluation form for disabled elderly people.Results:There were 149 cases (16.0%) with grade 1 disability, 465 cases (50.1%) with grade 2 disability, 178 cases (19.2%) with grade 3 disability and 137 cases (14.7%) with grade 4 disability. The elderly with disabilities mainly had difficulties in long-distance walking, bathing, toilet use, defecation control, short distance walking, squatting, and transfer. The proportion of disabled elderly was 89.8% (834/929), 84.9% (789/929), 82.6% (767/929), 79.9% (742/929), 76.6% (712/929), 76.1% (707/929) and 60.5% (562/929), respectively. With the increase of disability severity, bathing, short walking, metastasis, shopping and preparing meals accounted for the greater proportion of the elderly with disabilities, and the differences were statistically significant ( P< 0.01). The elderly with disabilities had the greatest demand for wheelchairs, followed by mattresses for preventing stress injuries and four-legged walking sticks, with a demand rate of 56.3% (523/929),9.4% (87/929) and 7.0% (65/929), respectively. The elderly with different levels of disability had different needs on ordinary wheelchair, pressured-injury mattress, four-legged walking stick, stool chair, wheelchair with toilet seat and common walking stick, and the needs had statistically significant differences ( P<0.01). Conclusions:The elderly with disabilities in rural areas of Liaoning Province are mainly moderate to severe, mainly physical disabilities, and have great obstacles in self-care and daily living activities, with the highest demand for ordinary wheelchairs, anti-stress injury mattresses and four-legged canes. In the future, further intervention measures and rehabilitation management models should be developed according to the assessment results of the functions and assistive devices of the elderly with disabilities in rural areas, so as to meet the nursing and rehabilitation needs of the elderly with disabilities and improve their life quality.

Objective:To explore the inhibitory mechanism of herb cake-partitioned moxibustion on tumor growth in colitis-associated colorectal cancer(CAC)based on histone lysine demethylase 4D(KDM4D). Methods:Inbred male Sprague-Dawley rats were randomly divided into a normal group,a CAC group,a herb cake-partitioned moxibustion group,and an inhibitor group.Except the normal group,rats in the other three groups were treated with azoxymethane(AOM)combined with dextran sulfate sodium(DSS)to make CAC rat models.Rats in the normal group and the CAC group did not receive interventions;rats in the herb cake-partitioned moxibustion group received moxibustion at Qihai(CV6)and bilateral Tianshu(ST25),2 cones for one point each time,once a day for 30 d with 1-day rest every week;rats in the inhibitor group received intraperitoneal injection of KDM4D inhibitor,5-chloro-8-hydroxyquinoline(5-c-8HQ),once a day for 30 d.After intervention,the general condition,colon length,tumor number and volume,and histopathological colon changes were observed.The expression of adenomatous polyposis coli(APC),axis inhibitor(Axin),cyclin D1,matrix metalloproteinase(MMP)-7 and MMP-9 mRNAs were detected by real-time quantitative polymerase chain reaction.The proliferating cell nuclear antigen(PCNA),cleaved caspase3,KDM4D,APC,and Axin proteins were detected by immunohistochemistry. Results:Compared with the normal group,the general condition was poor,the colon length was significantly shortened(P<0.01),the number and volume of colonic tumors were increased(P<0.01),the structure of glandular duct was obviously disordered with"back-to-back"and cowall phenomenon,and also high-grade adenocarcinoma formed;the protein expression levels of PCNA and KDM4D were significantly increased(P<0.01),while cleaved caspase3,APC,and Axin were significantly reduced(P<0.01);the mRNA expression levels of cyclin D1,MMP-7,and MMP-9 were significantly increased(P<0.01),while APC and Axin were significantly reduced(P<0.01)in the CAC group.Compared with the CAC group,the general condition was improved,the length of colon was significantly increased(P<0.01),the number and volume of the colonic tumors were reduced(P<0.05),and the colon tissues showed epithelial cell proliferation with enlarged and deep staining nuclei,dysplasia and inflammatory cell infiltration;the protein expression levels of PCNA and KDM4D were significantly reduced(P<0.01),while the cleaved caspase3,APC,and Axin were significantly increased(P<0.01);the mRNA expression levels of cyclin D1,MMP-7,and MMP-9 were reduced(P<0.05),while the APC and Axin were increased(P<0.05)in the colon tissues of rats in the herb cake-partitioned moxibustion group and the inhibitor group. Conclusion:Herb cake-partitioned moxibustion regulated abnormally expressed KDM4D in CAC rats,activated APC and Axin,the upstream molecules of Wnt/β-catenin pathway,inhibited abnormally activated downstream molecules of Wnt/β-catenin pathway.This may be a key mechanism of herb cake-partitioned moxibustion in inhibiting CAC tumor growth.

Ankylosing spondylitis is a refractory autoimmune disease,and heterotopic ossification is one of the most important pathological features.The mechanism of heterotopic ossification in ankylosing spondylitis involves many aspects,including ossification-related genes,ossification-related factors,ossification-related cells,ossification signaling pathways,and mechanical stress.This article elaborates the pathogenesis of heterotopic ossification in ankylosing spondylitis from different aspects of multiple channels,pathways,targets,and factors,hoping to provide reference for expanding clinical and basic research and in-depth understanding of ankylosing spondylitis.

Leptin, an adipocyte-derived peptide hormone, has been shown to facilitate breathing. However, the central sites and circuit mechanisms underlying the respiratory effects of leptin remain incompletely understood. The present study aimed to address whether neurons expressing leptin receptor b (LepRb) in the nucleus tractus solitarii (NTS) contribute to respiratory control. Both chemogenetic and optogenetic stimulation of LepRb-expressing NTS (NTS^LepRb) neurons notably activated breathing. Moreover, stimulation of NTS^LepRb neurons projecting to the lateral parabrachial nucleus (LPBN) not only remarkably increased basal ventilation to a level similar to that of the stimulation of all NTS^LepRb neurons, but also activated LPBN neurons projecting to the preBötzinger complex (preBötC). By contrast, ablation of NTS^LepRb neurons projecting to the LPBN notably eliminated the enhanced respiratory effect induced by NTS^LepRb neuron stimulation. In brainstem slices, bath application of leptin rapidly depolarized the membrane potential, increased the spontaneous firing rate, and accelerated the Ca²⁺ transients in most NTS^LepRb neurons. Therefore, leptin potentiates breathing in the NTS most likely via an NTS-LPBN-preBötC circuit.
Leptin/pharmacology* ; Membrane Potentials ; Neurons/metabolism* ; Solitary Nucleus/metabolism*

The nucleus tractus solitarii (NTS) is one of the morphologically and functionally defined centers that engage in the autonomic regulation of cardiovascular activity. Phenotypically-characterized NTS neurons have been implicated in the differential regulation of blood pressure (BP). Here, we investigated whether phenylethanolamine N-methyltransferase (PNMT)-expressing NTS (NTS^PNMT) neurons contribute to the control of BP. We demonstrate that photostimulation of NTS^PNMT neurons has variable effects on BP. A depressor response was produced during optogenetic stimulation of NTS^PNMT neurons projecting to the paraventricular nucleus of the hypothalamus, lateral parabrachial nucleus, and caudal ventrolateral medulla. Conversely, photostimulation of NTS^PNMT neurons projecting to the rostral ventrolateral medulla produced a robust pressor response and bradycardia. In addition, genetic ablation of both NTS^PNMT neurons and those projecting to the rostral ventrolateral medulla impaired the arterial baroreflex. Overall, we revealed the neuronal phenotype- and circuit-specific mechanisms underlying the contribution of NTS^PNMT neurons to the regulation of BP.
Solitary Nucleus/metabolism* ; Blood Pressure/physiology* ; Phenylethanolamine N-Methyltransferase/metabolism* ; Neurons/metabolism* ; Paraventricular Hypothalamic Nucleus/metabolism*