Based on the analyses of the status of humanistic medicine education both at home and abroad, the article emphasized the need for the implement of medical humanities education with the whole process and multidisciplinary integration. In combination with practice, from the three modules of the ex-plicit curriculum, implicit curriculum and integrated curriculum, the author discussed the specific conno-tation of the whole course of medical humanities education. The article also summarized the main points of the course system in teaching practice from the aspects of training objectives, teaching staff construction, teaching methods improvement and innovation, and humanistic quality evaluation of medical students.

Objective To evaluate the correlation of Omentin-1, the high sensitivity C-reactive protein (hsCRP) and coronary heart disease (CHD). Methods Sixty-eight patients with CHD were divided into the unstable angina pectoris (UAP) group (n=36), stable angina pectoris (SAP) group (n=32). And 30 normal subjects without CHD diagnosed by coronary arteriography (CAG) were served as the control group. The serum level of Omentin-1 was measured by enzyme linked immu-nosorbent assay (ELISA) and the serum level of hsCRP was measured by turbidmetric immunoassay. Results The serum level of Omentin-1 was significantly lower, but the serum level of hsCRP was significantly higher in CHD group than that of control group (P<0.05). The serum level of hsCRP was significantly lower in SAP group than that of UAP group (P<0.05). There was no significant difference in serum level of Omentin-1 between groups (P>0.05). The serum level of Omentin-1 was significantly lower in patients with single, double and three-vessel lesion group than that of control group, but the serum level of hsCRP was significantly higher in CHD group than that of control group (P<0.05). There were no significant differ-ence in serum levels of Omentin-1 and hs-CRP between single, double and three-vessel lesion groups (P>0.05). The se-rum level of Omentin-1 was negatively correlated with serum level of hsCRP (P<0.01). Conclusion The serum level of Omentin-1 and hsCRP may correlate with CHD, but which may not reflect the severity of artery stenosis.

Objective To investigate the incidence and major risk factors of preterm birth in urban hospitals in China so as to provide evidence for effective interventions to reduce preterm birth.Methods Postpartum women delivered between 22 and 37 weeks of gestation were selected from 15 urban hospitals in Beijing,and Guangdong,Hu'nan,Hubei,Sichuan and Shaan'xi Province.Between April 2012 and March 2013,data of 10 days were collected every 3 months.Questionnaire was obtained under informed consent from 9 143 cases,including 958 cases of preterm birth and 8 185 cases of term birth.Demographics,history of pregnancy,prenatal care,and incidences of complication and/or comorbidities,lifestyle and dietary habit during pregnancy were included in the questionnaire.Chi-square test for univariate analysis and logistic regression multivariate analysis were used for statistics.Results The incidence ofpreterm birth was 9.9％(10 986/111 095) in the 15 hospitals.Among the 958 preterm birth cases,2.3％(22/958) were in gestational weeks ＜28,22.7％(217/958) in ≥ 28-＜34 gestational weeks,and 75.1％(719/958) in ≥ 34-＜37 gestational weeks.Univariate analysis showed that the influencing factors related to preterm birth included(preterm birth groups vs term birth group):maternal age ＞40 years or ＜18 years[1.6％(15/958) vs 1.2％(100/8 185),0.6％(6/958) vs 0.1％(7/8 185),22=18.515,P=0.000],ethnic Han [97.7％(919/941) vs 96.3％(7 811/8 115),22=4.819,P=0.028],less educated (lower than junior middle school) [27.1％(257/950) vs 14.9％(1 215/8 132),22=91.879,P=0.000],unmarried status[2.8％(27/955) vs 1.3％(110/8 154),22=12.609,P=0.000],family income ＜5 000 yuan(RMB)/ month [40.5％(380/939) vs 30.8％(2 479/8 060),22=40.457,P=0.000],being preterm born [14.2％(134/942) vs 2.6％(211/8 099),22=349.801,P=0.000],adverse obstetric history [12.9％(72/958) vs 8.5％(346/8 185),22=12.009,P=0.001],previous preterm delivery [50.0％(36/72) vs 17.1％(59/346),x2=36.840,P=0.000],fetal malformation history[4.2％(3/72) vs 18.8％(65/346),22=9.351,P=0.002],reproductive technology assisted conception [7.7％(72/930) vs 2.1％(172/8 037),x22=98.816,P=0.000],antenatal visits ＜5 times [21.0％(195/930) vs 12.0％(966/8 037),22=68.634,P=0.000],second hand smoking [24.5％(235/958) vs 19.6％(1 603/8 185),x2=13.573,P=0.000],unpleasant events during pregnancy [27.6％(264/958) vs 22.0％(1 802/8 185),x2=15.213,P=0.000],folic acid supplementation before and during pregnancy [before pregnancy:39.1％(375/958) vs 49.0％(4 007/8 185);during pregnancy:61.2％(586/958) vs 67.0％(5 485/8 185),x2=31.842,11.667,P=0.000,0.001],multivitamin supplementation during pregnancy [43.4％(416/958) vs 48.1％(3 937/8 185),x2=7.393,P=0.007],and pregnant complications,including anemia,premature rupture of membranes,intrauterine infection,pregnancy complication heart diseases,oligohydramnios,placental abruption,placental previa,fetal distress,multiple gestation,etc [59.9％(574/958) vs 38.9％(3 184/8 185),x2=156.47l,P=0.000].Logistic regression multivariate analysis showed that the following factors were significantly associated with preterm birth:antenatal visits ＜5 times (OR=1.916,95％CI:1.060-3.462),intrauterine infection (OR=5.441,95％CI:1.723-17.176),severe preeclampsia during pregnancy (OR=11.220,95％CI:1.041-2.149),premature rupture of membranes (OR=3.188,95％CI:1.916-5.305) and placenta previa (OR=6.607,95％CI:2.919-14.801).Conclusions There are multiple factors for preterm birth in urban hospitals in east-northern part of China,and quality of antenatal care should be improved and pregnant complications should be closely monitored and managed timely.

OBJECTIVE: To compare the cost-effect of 2 therapeutic regimens and to find out a better therapeutic regimen with reasonable price and better effect, hoping to improve the quality of burn patients and reduce the waste of medical resources. METHODS: We collected 1017 burn patients from Hunan and Sichuan, and divided them into a research group (the moist exposed burn therapy group) and a control group (the escharectomy and grafting group). We analyzed the cost and effect of the 2 groups from general condition, direct medical cost during treatment and curative effect. RESULTS: The average total cost of the research group [93633.71 (82260.79, 107576.34) yuan] was significantly lower than the control group [175077.93 (131433.23, 228918.83) yuan] (P<0.05). The total effective rate of the research group was higher (97.28%) than that in the control group (92.89%) (P<0.05). The cost-effect of the research group (962.52) was better than that of the control group (1884.79). CONCLUSION Cost-effect analysis is objective and direct in the evaluation of different treatments. The moist exposed burn therapy is a better and cheaper therapeutic regimen.
Adolescent ; Adult ; Burns ; economics ; surgery ; therapy ; China ; Cost-Benefit Analysis ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

Objective To understand the characteristic of subtype distribution among foreigners who were living with HIV-1,in Guangzhou.Methods HIV-1 RNAs were extracted from 114 serum specimens in foreigners diagnosed with HIV-1 infections between 2008 and 2010,and in 2015.Partial pol gene of HIV-1 genome from these RNA samples were amplified by nested reverse transcription polymerase chain reaction (nested-PCR) with nucleotide sequenced.Subsequently,phylogenetic tree was reconstructed using the pol sequences of samples and references.Results Among all the 114 samples,57.9％ were from males and 42.1％ from females,with an average age as 35.21 years old and the standard deviation as 9.63 years.A total of 6.8％ of the samples were from Africans.The top three subtypes were identified as CRF02_AG,subtype G and subtype C,accounted for 30.7％,14.9％ and 12.3％ respectively.Compared with samples gathered from 2008 to 2010,the proportions of subtype A1 and CRF01_AE significantly increased,while the other subtypes significantly decreased in 2015 (x 2=37.570;P=0.013,99％ CI:0.010-0.016).Proportions of CRF01_AE and subtype G among males outnumbered the females but the proportions of subtype A1,CRF02_AG and URF among females appeared the other way round (x2=15.528;P=0.029,99％CI:0.024-0.033).Proportions of CRF02_AG and subtype G among HIV-1 positive Africans were larger than those from other Southeast Asian countries or areas,However,the proportion of CRF01_AE among HIV-1 positive patients from Southeast Asian countries was higher than those patients from other areas (x2=39.399;P=0.009,99％ CI:0.006-0.011).The rates of resistance to any drug of protease inhibitors (PIs),reverse transcriptase inhibitors (RTIs),as well as to PIs,NRTIs,and NNRTIs alone,were 21.9％,12.3％,6.1％ and 7.0％,respectively.One of nine CRF01_AEs from the HIV-1 positive patients were found closely clustered in those phylogenetic tree (bootstrap=0.855) samples,collected from local patients in Guangzhou.Conclusions Our findings showed that these foreign subtypes had been spread to the natives,more from the Africans than from the other areas,in Guangzhou.These types of viruses were different from the strains identified locally,suggesting that they might have been brought in by foreigners living with HIV-1,in Guangzhou.Programs related to care,support and behavioral intervention for HIV positive foreigners living in Guangzhou,should be strengthened.

Objective To summarize the experience of patient positing,port placements setting and robot cart docking in pediatric robot-assisted laparoscopic upper urinary tract operations.Methods From March 2017 to December 2017,140 robot-assisted laparoscopic upper urinary tract procedures were performed in our institution,including 110 cases of pyeloplasty,15 upper pole heminephroureterectomy,12 simple nephrectomy and 3 adrenalectomy.There were 103 males and 37 females with a range age from 1 month to 18 years.The assistant surgeon was adjacent to the instrument nurse,and patients were placed in a supine position with 60°-80° inclination and keep the legs low to the body.Room setup and patient positioning were similar to the traditional laparoscopic surgery.Semi-hidden incision technique was used in 140 patients:the camera port was placed umbilicus,two additional arm ports (one 5 mm and one 8 mm) were placed under direct vision,the 8 mm arm port was placed on the line of a Pfannenstiel incision and the 5 mm arm port was placed below the Xiphoid along the midline.Finally,a 3 or 5 mm assistant port was placed approximately 3 cm lateral to the inferior arm port,the line of a Pfannenstiel incision.Results The average time was (11.5 ± 3.2) min (10.5-16.5 min) from skin incision to robot cart docking completed.All surgeries were successfully completed without open conversion.One patient required an additional assist port for severe adhesion after the previously open surgery,there was no injury to other viscera.Average operative time was (146.9 ± 48.7)min (78-259 min) and average post-operative hospitalization time was (5.7 ± 1.4) d(4-10 d),respectively.There was no visual scar on abdominal 6 weeks postoperatively,and all parents made comments about their satisfaction with the cosmetic appearance.All operations got complete success at a mean follow up of 6 (1-9) months.Conclusions A good room setup,patient positioning and the semi-hidden incision technique port placements are maintaining the safety of the patient,avoiding compression injuries,allowing maximum mobility of the robotic arms,and facilitating a smooth and efficient surgery,and improving post-operative recovery.

Objective To introduce the development strategy of“Internet Plus”AIDS prevention services and its implementation results from 2010 to 2015 in Guangzhou, China. Methods A gay men's health column was created for an active website aimed at men who have sex with men (MSM), in collaboration with local community organizations and the Guangzhou CDC. We designed intervention tools (including scenario-based applications and HIV risk self-assessment systems) and an online HIV testing service platform, integrated with applied psychology and behavioral theory as well as the“Internet Plus”concept, to intervene in HIV infection risk factors among MSM. Data of clients who accessed the“Internet Plus”AIDS services from 2010 to 2015 were used to evaluate service operation. Six-year consecutive surveys, conducted between April and July of each service year, were collected using a national AIDS sentinel surveillance questionnaire. For each year of surveillance, information on HIV prevalence, HIV interventions received during the past year, unprotected anal intercourse in the past 6 months, and HIV testing in the past year were compared using the chi-squared (χ2) test, to roughly reflect the effect of“Internet Plus”AIDS prevention services. Results As of 31 December 2015, a total of 34 395 MSM had received“Internet Plus”services and HIV testing. The number of MSM tested increased from 2 338 in 2010 to 8 054 in 2015. From 2010 to 2015, newly identified HIV cases in each year were 59, 166, 312, 283, 291, and 270, which accounted for 25.0%, 32.8%, 38.8%, 35.1%, 30.5%, and 23.2% of MSM HIV cases of Guangzhou, respectively. Sentinel surveillance data showed that during the study period, 3 047 MSM were investigated, with 405, 400, 401, 633, 608, and 600 each year, respectively. The proportion of participants who had received any HIV intervention during the past year was 74.3% (301), 70.8% (283), 83.3% (334), 85.0%(538), 69.1%(420), and 83.8%(503) each year, respectively (trend χ2=6.53, P=0.011). HIV testing done during the past year accounted for 44.0%(178), 44.3%(177), 49.4%(198), 53.4%(338), 56.1%(341), and 60.2%(361) each year, respectively (trendχ2=40.83, P<0.001). Unprotected anal intercourse in the past 6 months accounted for 59.3% (240), 62.0% (248), 56.6% (227), 57.0% (361), 48.4% (294), and 43.7%(262) each year, respectively (trend χ2=42.21, P<0.001). Conclusion The“Internet Plus”AIDS prevention services in this study represent a manner to enhance traditional HIV prevention strategies. We found these services to be effective in implementation of the national AIDS control and prevention strategy, especially for the expansion of intervention, testing, and case identification among high-risk populations.

Objective To introduce the development strategy of“Internet Plus”AIDS prevention services and its implementation results from 2010 to 2015 in Guangzhou, China. Methods A gay men's health column was created for an active website aimed at men who have sex with men (MSM), in collaboration with local community organizations and the Guangzhou CDC. We designed intervention tools (including scenario-based applications and HIV risk self-assessment systems) and an online HIV testing service platform, integrated with applied psychology and behavioral theory as well as the“Internet Plus”concept, to intervene in HIV infection risk factors among MSM. Data of clients who accessed the“Internet Plus”AIDS services from 2010 to 2015 were used to evaluate service operation. Six-year consecutive surveys, conducted between April and July of each service year, were collected using a national AIDS sentinel surveillance questionnaire. For each year of surveillance, information on HIV prevalence, HIV interventions received during the past year, unprotected anal intercourse in the past 6 months, and HIV testing in the past year were compared using the chi-squared (χ2) test, to roughly reflect the effect of“Internet Plus”AIDS prevention services. Results As of 31 December 2015, a total of 34 395 MSM had received“Internet Plus”services and HIV testing. The number of MSM tested increased from 2 338 in 2010 to 8 054 in 2015. From 2010 to 2015, newly identified HIV cases in each year were 59, 166, 312, 283, 291, and 270, which accounted for 25.0%, 32.8%, 38.8%, 35.1%, 30.5%, and 23.2% of MSM HIV cases of Guangzhou, respectively. Sentinel surveillance data showed that during the study period, 3 047 MSM were investigated, with 405, 400, 401, 633, 608, and 600 each year, respectively. The proportion of participants who had received any HIV intervention during the past year was 74.3% (301), 70.8% (283), 83.3% (334), 85.0%(538), 69.1%(420), and 83.8%(503) each year, respectively (trend χ2=6.53, P=0.011). HIV testing done during the past year accounted for 44.0%(178), 44.3%(177), 49.4%(198), 53.4%(338), 56.1%(341), and 60.2%(361) each year, respectively (trendχ2=40.83, P<0.001). Unprotected anal intercourse in the past 6 months accounted for 59.3% (240), 62.0% (248), 56.6% (227), 57.0% (361), 48.4% (294), and 43.7%(262) each year, respectively (trend χ2=42.21, P<0.001). Conclusion The“Internet Plus”AIDS prevention services in this study represent a manner to enhance traditional HIV prevention strategies. We found these services to be effective in implementation of the national AIDS control and prevention strategy, especially for the expansion of intervention, testing, and case identification among high-risk populations.

Objective: To evaluate the safety and efficacy of enhanced recovery after surgery (ERAS) in robot-assisted laparoscopic pyeloplasty in pediatric patients. Methods: Sixty pediatric patients of both sexes with hydronephrosis, aged 3-12 yr, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing robot-assisted laparoscopic pyeloplasty from March 2018 to April 2019, were divided into 2 groups using a random number table method: control group (group C, n=28) and ERAS group (n=32). In ERAS group, preoperative ERAS education was carried out, the time of preoperative food and water deprivation was shortened, pediatric patients drank glucose water at 2 h before surgery, anesthetic regimen was optimized, lung protective ventilation and target-directed fluid therapy were performed, and intraoperative warming and multi-mode antiemetic measures were carried out during operation, and multi-mode analgesic measures were taken after operation, and pediatric patients received water and food intake early through the mouth and got out of bed as soon as possible after operation.In group C, the traditional concept was adopted for perioperative management.Immediately after tracheal intubation, at 30 min and 1 and 2 h after establishing pneumoperitoneum, at 5 min after the end of pneumoperitoneum and at 5 min after extubation, the airway peak pressure and tidal volume were recorded, and blood gas analysis was performed.The occurrence of cardiovascular events was recorded during surgery.The postoperative time of extubation, time of first intake, the first postoperative off-bed time, the first flatus time, time of pulling out the ureter and drainage tube, and length of hospital stay were recorded.The Pediatric Anesthesia Emergence Delirium scale was used to assess the agitation during the recovery period.The Faces Pain Scale-Revised scale was used to assess the degree of pain within 72 h after surgery.When Faces Pain Scale-Revised scale score ≥4, fentanyl 0.25 μg/kg was intravenously injected as rescue analgesic.The requirement for rescue analgesia was recorded.The overall complications were evaluated by using Clavin-Dindo grading, and postoperative complications included nausea and vomiting, abdominal distension, abdominal pain, incision infection, abdominal infection, anastomotic leakage, fever, etc. Results: Compared with group C, the preoperative food and water deprivation time was significantly shortened, the time of postoperative extubation was prolonged, the postoperative length of hospital stay, time of first intake, the first postoperative off-bed time, the first flatus time, and time of pulling out the ureter were shortened, airway peak pressure was decreased at 1 and 2 h of pneumoperitoneum, arterial blood lactate concentrations were decreased at each time point of pneumoperitoneum (P<0.05 or 0.01), and no significant change was found in the incidence of postoperative agitation, nausea and vomiting, incision infection, abdominal infection or fever in group ERAS (P>0.05). No intraoperative adverse cardiovascular events were found, and no pediatric patients required rescue analgesia after operation in two groups. Conclusion ERAS can be safely and effectively used for the pediatric patients undergoing robot-assisted laparoscopic pyeloplast.

BACKGROUND:Ischemic postconditioning is one of the effective ways to reduce ischemia-reperfusion injury and has been more and more widely used in clinical practice in recent years,but its specific molecular mechanism has yet to be studied. OBJECTIVE:To investigate the role and mechanism of piRNA-005854 in the aging cardiomyocytes caused by hypoxic postconditioning. METHODS:In vitro,cardiomyocytes were administered 8 mg/mL D-galactose for 9 days to induce their aging.β-Galactosidase staining was used to observe the aging of cardiomyocytes.Senescent cells were treated with hypoxia/reoxygenation and hypoxic postconditioning.ELISA was utilized to detect changes in myocardial injury markers creatine kinase isoenzyme MB and lactate dehydrogenase levels.Western blot assay was applied to detect the expression changes of autophagy-related proteins LC3II,p62,ULK1 and phosphorylated ULK1 in aging cardiomyocytes.qRT-PCR was employed to determine the expression level of piRNA-005854.piRNA-005854 inhibitor and piRNA-005854 mimics were transferred into aging cardiomyocytes and followed with hypoxic postconditioning.Western blot assay was used to examine the expression of LC3II,p62,ULK1 and phosphorylated ULK1. RESULTS AND CONCLUSION:(1)D-galactose induced obvious senescence of cardiomyocytes 9 days later.(2)Compared with the normoxia group,creatine kinase isoenzyme MB and lactate dehydrogenase levels increased in the hypoxia/reoxygenation group(P<0.01);LC3 II/I expression was increased;p62 expression was decreased;ULK1 phosphorylation level was increased,and piRNA-005854 expression was increased(P<0.01).(3)Compared with the hypoxia/reoxygenation group,creatine kinase isoenzyme MB and lactate dehydrogenase levels significantly reduced in the hypoxic postconditioning group(P<0.01);LC3 II/I expression significantly decreased(P<0.05);p62 expression increased(P<0.01);ULK1 phosphorylation level decreased(P<0.05),and piRNA-005854 expression decreased(P<0.01).(4)After transfection of piRNA-005854 inhibitor,LC3II/I expression was decreased(P<0.01);the expression of p62 was increased significantly(P<0.05);the phosphorylation level of ULK1 was decreased significantly(P<0.01).After transfection of piRNA-005854 mimics,LC3II/I expression was increased significantly;the expression of p62 was decreased,and the phosphorylation level of ULK1 was increased significantly(P<0.01).(5)The results show that piRNA-005854-mediated reduction of ULK1-dependent autophagy level is a possible mechanism that hypoxic postconditioning exerts its protective effect on aging cardiomyocytes.