Facing the diverse social environment and development, several aspects of higher clinic medical education,such as educational philosophy,personnel cultivating goal and mode,are undertaking all kinds of shift,which can be embodied in the medical curriculum reform.

Objective To investigate the security characteristics of rural young boarding pupils and its influencing factors.Methods 210 boarding and 265 non-boarding rural young pupils of Huojia in Henan were tested by questionnaires,including of a self-developed questionnaire,security questionnaire and adolescent mental resilience scale.Results ①The scores of the interpersonal security (25.99 ± 5.53),the determine control sense factor (24.63 ±6.17) and the total security(50.62 ± 10.37) in the boarding pupils were statistically lower than non-boarding pupils (27.36 ± 6.38,26.00 ± 6.55,53.36 ± 11.77,P ＜0.05).②There were statistically significant difference in the scores of the interpersonal security,the determine control sense factor and the total security among the different grades(P＜0.05),but there were no statistically sex difference in the scores(P ＞ 0.05).③Group regression analysis showed that,no family factors in the young boarding pupils had influence on the score of the security sense factors and the total (P＞0.05),and marital relationship of parents,only child,father' s and mother(')s education background of non-boarding pupils had certain influence on the score of the interpersonal security,the determine control sense factor and the total security (β =-0.43-0.27,P＜ 0.05).④The group regression analysis showed that,the problem solving and self-efficacy,parents'high expectations in mental toughness respectively had some effect on the interpersonal security of boarding and non-boarding pupils(β =-0.15,β =0.25,P＜0.05),and social ability and family care,schools resilience respectively had influence on the determine control sense in boarding and non-boarding pupils (β =-2.91-2.87,P＜0.05),and social ability,parents'high expectations respectively had influence on the total security in boarding and non-boarding pupils (β =-0.17,β=0.22,P＜0.05).Conclusion The security-sense in boarding young pupils are lower than the non-boarding young pupils,and family factors and mental toughness have different effects on security-sense of two kinds pupils.

Objective To investigate the clinical features and long - term prognosis of neonatal lupus erythe-matosus(NLE)and to improve the understanding of NLE. Methods The clinical manifestations and related serologi-cal tests of NLE children diagnosed from June 2010 to January 2014 were analyzed. Regular follow - up was carried out to detect the general condition,rash,blood routine,urine routine,liver and kidney function,complement,red blood cell sedimentation rate(ESR),auto antibodies,electrocardiogram,and ultrasound cardiogram. Results Among the 11 NLE cases,there were 6 male and 5 female patients. All had lesions on skin,3 cases had hematologic changes,7 cases were had liver damage,and 4 cases had heart impairment. The antinuclear antibody and anti - sjogren sydrome A/ Ro antigen (SSA/ Ro)were positive in all the patients. The anti - sjogren sydrome B antigen was positive in 5 patients. The anti -double stands deoxyribonucleic acid antibody was positive in 4 patients. Antibody against U1 - ribonudeoprotein was positive in 3 patients,and the level of ESR was higher in 5 patients. The antinuclear antibody and anti - SSA/ Ro anti-body were positive in all mothers. Only 1 mother had no symptom before pregnancy,7 patients had SLE,3 patients had sjogren syndrome. Seven patients received protect liver enzyme treatment,3 cases of glucocorticoid therapy,and 1 case had combined intravenous treatment with gamma globulin. Among the 11 cases,10 cases were followed up for 10 months to 4 years,while 1 case died from complete bundle branch block after 5 weeks of birth. At 1 year old,10 cases of cuta-neous lupus damage had liver damage were resorted to normal,and the rheumatic autoimmune related autoantibodies of 9 cases turned to be negative,but 1 case was diagnosed as Kawasaki disease when she was 1 year old. Conclusions One of the most common clinical manifestations of NLE was damage of skin,had the liver and blood system abnormity were common but usually not serious. Heart disease especially complete atrioventricular block was less. The long - term follow - up for children with NLE is necessary,and the majority of the prognosis is good,as only a few have the possibi-lity of developing other autoimmune diseases.

Objective To investigate the efficacy and safety of tocilizumab inpatients with refractory systemic'onset juvenile idiopathic arthritis (SoJIA),and to provide a new option for the treatment of this severe disease.Methods We retrospectively studied 25 cases of hospitalized patients with refractory SoJIA treated withtocilizumab,of whom 22 had data that fit for analysis,from May 2005 to February 2016.Data of 22 cases were collected retrospectively from physicians in charge of the patients.Children with SoJIA were treated with nonsteroidal antiinflammatory drugs (NSAIDs),Glucocorticoid (GC),methotrexate,cyclosporin A,etanerceptetc before,but still in high disease activity due to inadequate response were involved.Weretrospective analyzedthe laboratory test results like C'reactive protein (CRP),Erythrocyte sedimentation rate (ESR),Ferritin and other inflammatory index.Improvement of pain,fever,rash,hepatosplenomegaly and lymphadenectasis of active SoJIA (disease course ≥6 months,and inadequate response to NSAIDs and GC) after tocilizumab treatment (Body weight ≥30 kg,8 mg/kg;Body weight＜30 kg,12 mg/kg,per 4 weeks) were analyzed.Safety data of 22 cases were collected throughout the treatment period including neutropenia,infections,anaphylaxis and elevated liver enzymes etc.We also retrospectively analyzedthe dose change of GC and the long'term effect.Dichtomous paramenters were compared teween groups using thex2 test.Continuous parameters were compared using the analysis of uariance.Results In comparison to the indices before the treatment,the level of CRP [(8.7±2.2) mg/L vs (111.6±74.4) mg/L,F=5.192,P=0.002],ESR [(6.4±6.3) mm/1 h) vs (65.6±24.3) mm/1 h,F=50.393,P=0.000],white blood cell (WBC) [(8.4±2.5)×109/L vs (17.6±8.6)×109/L,F=9.321,P=0.000],Neutrophil count [(4.9±2.4)×109/L vs.(14.4±8.7)×109/L,F=10.541,P=0.000],blood platelet (PLT) [(269.5±79.2)×109/L vs (405.4± 145.3)×109/L,F=5.704,P=0.000] and globulin [(19.2±4.1) g/L vs (30.1±3.8) g/L,F=22.896,P=0.000] decreased rapidly and hemoglobin [(118.3±9.0) g/L vs (108.5±9.8) g/L,F=4.693,P=0.002] increased significantly at 24 weeks after Tocilizumab (TCZ) treatment.Clinical manifestationssuch as fever,rash,hepatosplenomegaly,joint swelling and pain were significantly improved.GC dose [(1.25±3.8) mg·kg-1·d-1 vs (16.2±12.8) mg·kg-1·d-1,F=8.21,P=0.000] were significantly reduced after TCZ treatment (P＜0.05);American College of Rheumatology (ACR) Pedi 30/50/70/90 was improved after TCZ treatment.Adverse events occurred in 3 cases of 25 children,who were not included in the statistical analysis group.Conclusion This retrospective case series has demonstrated the efficacy of tocilizumab in SoJIA,low incidence of adverse reactions.Further studies are needed to be developed because this case series haslimited sample size.

Objective To investigate the clinical effects of calcium dobesilate combined with insulin in the treatment of elderly patients with diabetic nephropathy in early stage.Methods 100 elderly patients with diabetic nephropathy in early stage were chosen,and they were randomly divided into two groups according to the digital table,each group in 50cases.The control group were given benazepril alone,and the observation group were given benazepril combined with calcium dobesilate on the basis of intensive insulin intervention.The levels of FPG,2hPG,Scr,BUN,mAlb,β2-MG,Cys-C and hs-CRP and QOL-C30 scores before and after treatment of the two groups were compared.Results There were no statistically significant differences in the levels of FPG,2hPG after treatment between the two groups(all P ＞0.05).Before treatment,the levels of Scr,BUN,mAlb and β2-MG of the control group were (81.16 ± 18.92) mmol/L,(5.63 ± 1.15) mmol/L,(105.71 ± 21.77) mg/24h,(543.46 ± 74.70) μg/L,respectively,which of the observation group were (81.59 ± 19.04) mmol/L,(5.58 ± 1.13) mmol/L,(106.33 ± 2 L 82) mg/24h,(548.20 ± 75.37) μg/L,respectively.After treatment,the levels of Scr,BUN,mAlb and β2-MG of the control group were (78.35 ± 14.35) mmol/L,(5.17 ± 0.97) mmol/L,(69.84 ± 14.24) mg/24h,(395.56 ±42.38) μg/L,respectively,which of the observation group were (73.10 ± 10.74) mmol/L,(4.63 ± 0.71) mmol/L,(52.92 ± 10.52) mg/24h,(337.89 ± 25.04) μg/L,respectively.The levels of Scr,BUN,mAlb and 32-MG after treatment of the observation group were significantly lower than those of the control group and before treatment (t =2.45,2.66,2.18.2.40;2.82,3.10,2.58.3.34;2.61,3.20;2.66.3.05;all P ＜ 0.05).Before treatment,the levels of Cys-C and hs-CRP of the control group were (1.82 ± 0.67) mg/L,(22.73 ± 6.54) mg/L,respectively,which of the observation group were (1.87 ± 0.70) mg/L,(1.17 ± 0.27) mg/L,respectively.After treatment,the levels of Cys -C and hs-CRP of the control group were (1.59 ± O.50) mg/L,(19.35 ± 5.60) mg,/L,respectively,which of the observation group were (22.58 ± 6.50) mg/L,(15.88 ± 4.03) mg/L,respectively.The levels of Cys-C and hs-CRP after treatment of the observation group were significantly lower than those of the control group and before treatment (t =2.32,2.67;2.85,3.19,2.66,3.02;all P ＜ 0.05).The QOL-C30 scores of the control group before and after treatment were (52.65 ± 7.70) points,(68.29 ± 9.84) points,respectively.The QOL-C30 scores of the observation group before and after treatment were (53.22 ± 7.78)points,(80.53 ± 12.10)points,respectively.The QOL-C30 scores of the observation group after treatment were significantly higher than those of the control group and before treatment (t =2.38,2.78,3.15,all P ＜ 0.05).Conclusion Bigeminy drug regimen assisted with intensive insulin intervention in the treatment of elderly patients with diabetic nephropathy in early stage can efficiently protect renal function,reduce the levels of inflammatory cytokines and is helpful to improve the quality of life.

Objective Toexploretheriskfactorsofchronicinjuryofmedialcollateralligament(MCL)inpatientswithosteoarthritis(OA). Methods Thestudywasconductedretrospectivelyandatotalof191patientsinourhospitalfromFebruary2017toApril2018were collected,amongthem,86casesofOApatientswithchronicinjuryofMCLastheobservationgroup,42casesofpatientswithacute MCLinjurycausedbytraumaasthecontrolgroup1,63casesofOApatientswithoutMCLinjuryascontrolgroup2.TheMRImanifestationsof kneejointsintheobservationgroupandthecontrolgroup1werecompared,thedifferencesofthedamagemechanismsbetweenthe twogroupswereanalyzed.TheMRImanifestationsandrelatedclinicaldataoftheobservationgroupandthecontrolgroup2wereanalyzed,and thefactorsthatmightcausethechronicinjuryofMCL wereidentifiedbyunivariateregressionanalysis,thenwereincludedinthe non-conditional L o g istic regression m odel for m ultivariate analysis and the risk factors and protective factors of chronic injury of MCLwerefinallyscreenedout.Results Thedifferencesinthe MRImanifestationsbetweentheobservationgroupandthecontrol group1,includingthegradingoftheMCLinjury,thegradingandthedislocationofmedialmeniscus,thedistributionofbonemarrow edema,theanteriorandposteriorcruciateligamentinjuriesandthestenosistypesofthejointspacewerestatisticallysignificant(P<0.05).The resultsrevealedthatthechronicinjuryofMCLwasrelatedtoage,sex,medialmeniscusdislocation,thegradingofmedialmeniscus, osteophyte,anteriorcruciateligamentinjury,posteriorcruciateligamentinjury,andthestenosistypeofthejointspaceusingtheunivariateanalysis (P<0.05).Theresultsrevealedthatosteophyte(OR=38.231,95%CI:6.573-222.370),medialmeniscusdislocation (OR=6.504, 95%CI:1.508-28.046),anteriorcruciateligamentinjury(OR=7.236,95%CI:1.188-44.090)wereriskfactorsforchronicinjury ofMCLinOApatientsandlateraljointspacestenosis(OR=0.014, 95%CI:0.002-0.092)andpatella-femoraljointspacestenosis (OR=0.006,95%CI:0.000-0.071)wereprotectivefactorsusing multiple L o g istic regression model.Conclusion Thepathogenicfactorsaredifferentbetweenchronicinjuryof MCLin OA patients andacuteinjuryofMCL.Osteophyte,medialmeniscusdislocation,anteriorcruciateligamentinjuryareriskfactorsforchronicinjury ofMCLinOApatients,andlateraljointspacestenosisandpatella-femoralspacestenosisareprotectivefactors.

Objective To study the expression of kinesin family member C1 ( KIFC1 ) in hepatocellular carcinoma (HCC) and analyze its correlation with the clinicopathological features and prognosis of patients. Methods The expression levels of KIFC1 protein in the HCC tissues from 82 patients were determined by immunohistochemical staining. The correlation between KIFC1 protein and clinicopathological characteristics (including age, gender, tumor nodules, tumor grade, tumor volume, lymph node metastasis, and alpha-fetoprotein expression) was analyzed. The Kaplan-Meier analysis was used to analyze the effect of KIFC1 expression level on overall survival and progression-free survival in patients with HCC. The expression level of KIFC1 mRNA in liver cancer tissue was analyzed by GPEIA database. The correlation between KIFC1 expression and prognosis was analyzed by KM-plotter. Results KIFC1 protein is significantly overexpressed in liver cancer tissues, and its expression level is significantly correlated with tumor nodule number (P=0.023) and tumor size (P=0.011). Patients with high expression of KIFC1 had poor overall disease and disease-free survival (all P<0.05). KIFC1 mRNA is significantly overexpressed in liver cancer tissues and correlated with disease-free survival and overall survival. Conclusions The expression of KIFC1 protein is highly expressed in liver cancer tissues, and its expression level is related to the clinicopathological characteristics of liver cancer. Bioinformatics analysis results show that KIFC1 is related to the poor prognosis of patients, suggesting that KIFC1 is expected to be a potential predictor and therapeutic target for liver cancer prognosis.

Objective To explore whether serum potassium can influence insulin secretion ability in pa tients with impaired glucose regulation (IGR).Methods 320 subjects with IGR were enrolled in our study.All subjects underwent a standard OGTT.Their clinical and biochemical parameters were measured.Insulin secretion indices were measured by DI0,DI30,and DI120.Results In IGR,DI0 was negatively correlated with BMI (r=-0.122,P=0.015),total cholesterol (TC) (r=-0.182,P=0.032),low density lipoprotein-cholesterol (LDL-C) (r=-0.1 78,P=0.026) and triglyceride (TG) (r=-0.179,P=0.01 1).DI30 was negatively correlated with TC (r=-0.146,P=0.001),TG(r=-0.192,P=0.027)and LDL-C(r=-0.134,P=0.014).DI120 was negatively correlated with TC(r=-0.222,P＜ 0.001),TG(r=-0.209,P＜0.001)and LDL-C (r=-0.183,P＜0.001) while postively correlated with serum potassium (r=0.208,P＜0.001).The multiple regression model analysis showed that serum potassium (β=0.380,P＜0.001) was independently correlated to DI120.Conclusion In patients with IGR,serum potassium is associated with insulin secretion ability,which may provide a new treatment strategy for preventing IGR into T2DM.

Objective:To investigate the clinical efficacy of different administration methods for labor analgesia.Methods:This randomized controlled study was conducted on 152 parturient women who underwent vaginal delivery at the Xinxiang Central Hospital from February to June 2023. These women were divided into a control group and an observation group, with 76 women per group. Women in the control group received 3 mL of 0.1% ropivacaine hydrochloride after routine epidural catheterization, followed by 3 mL of analgesic drugs after 3 minutes. For those without any special reactions, an analgesic pump containing 9 mL of medication was used after 3 minutes until the end of labor. In the observation group, 3 mL of 0.1% ropivacaine hydrochloride was administered as a trial dose before the epidural catheter was inserted into the epidural space. After 3 minutes, the postpartum woman lay flat and was given another 3 mL of analgesic pump medication. After 3 additional minutes, an additional 9 mL of the medication was administered. The analgesic pump was connected and turned on until the catheter was removed after delivery. The epidural catheter failure rate was assessed in each group. Before epidural puncture (T 1), within 30 minutes after the onset of anesthesia (T 2), and at the time of full dilation of the cervix (T 3), Visual Analogue Scale scores, the number of patient attempts to additionally use an analgesia pump, maternal satisfaction, the number of cases requiring cesarean section conversion, the incidence of adverse reactions (such as nausea, vomiting, and fever), and Apgar scores for newborns were recorded in each group. Results:The epidural catheter failure rate in the observation group was 1.3% (1/76), which was significantly lower than 10.5% (8/76) in the control group ( χ2 = 5.79, P < 0.05). At T 2 and T 3, the Visual Analogue Scale score in the observation group was (0.89 ± 0.08) points and (2.1 ± 0.07) points, respectively, which were significantly lower than (2.55 ± 0.07) points and (3.35 ± 0.07) points in the control group ( t = 238.54, 133.17, both P < 0.001). The number of patient attempts to additionally use an analgesia pump in the observation group was (1.00 ± 0.84) counts, which was significantly less than (4.00 ± 0.65) counts in the control group ( t = 29.47, P < 0.001). Maternal satisfaction in the observation group was 100% (76/76), which was significantly higher than 92.1% (70/76) in the control group ( χ2 = 6.25, P < 0.05). The number of cases requiring cesarean section conversion in the observation group was 0 (0/76), which was significantly lower than 52.6% (4/76) in the control group ( χ2 = 4.10, P < 0.05). Conclusion:Administering a trial dose (3 mL) of 0.1% ropivacaine hydrochloride before placing the epidural catheter during labor analgesia can greatly increase the placement success rate of the catheter and enhance pain relief effectiveness. This has a certain clinical application value.

The mucosal immune system is the first line of defense against pathogens such as bacteria and viruses invading the bodies. The female reproductive tract mucosal immune system not only resists the invasion of pathogens through innate and adaptive immunity, but also contribute to successfully fertilization and pregnancy, thus maintaining the health of women′s reproductive system. The innate immunity of female genital tract involves the mechanical barrier of the mucosal epithelium, microbial barrier of commensal bacteria, immunological barrier of immune cells and their receptors, and adaptive immunity including B cell-mediated humoral immunity and T cell-mediated cellular immunity. Female genital mucosal immunity is not only involved in local inflammation, but may also have anti-tumor effects. Moreover, the female genital tract mucosal immune is also regulated by sex hormone to maintain a homeostasis of local microenvironment. Herein, this paper summarized recent progress in female genital mucosal immunity.