Background/Aims: The occurrence and development of hepatitis B virus-associated acute-onchronic liver failure (HBV-ACLF) is closely related to the immune pathway. We explored the heterogeneity of peripheral blood T cell subsets and the characteristics of exhausted T lymphocytes, in an attempt to identify potential therapeutic target molecules for immune dysfunction in ACLF patients. Methods: A total of 83,577 T cells from HBV-ACLF patients and healthy controls were screened for heterogeneity by single-cell RNA sequencing. In addition, exhausted T-lymphocyte subsets were screened to analyze their gene expression profiles, and their developmental trajectories were investigated. Subsequently, the expression of exhausted T cells and their capacity in secreting cytokines (interleukin 2, interferon γ, and tumor necrosis factor α) were validated by flow cytometry. Results: A total of eight stable clusters were identified, among which CD4 + TIGIT + subset and CD8 + LAG-3 + subset, with high expression of exhaust genes, were significantly higher in the HBV-ACLF patients than in normal controls. As shown by pseudotime analysis, T cells experienced a transition from naïve T cells to effector T cells and then exhausted T cells. Flow cytometry confirmed that the CD4 + TIGIT + subset and CD8 + LAG-3 + subset in the peripheral blood of the ACLF patients were significantly higher than those in the healthy controls. Moreover, in vitro cultured CD8 + LAG-3 + T cells were significantly fewer capable of secreting cytokines than CD8 + LAG-3- subset. Conclusions Peripheral blood T cells are heterogeneous in HBV-ACLF. The exhausted T cells markedly increase during the pathogenesis of ACLF, suggesting that T-cell exhaustion is involved in the immune dysfunction of HBV-ACLF patients.

Objective:To investigate the effect of curriculum on the awareness and attitude on the rural-oriented medical education among medical students.Methods:The grade 2019 and 2020 medical students of rural-oriented program in Hebei Medical University were enrolled. Two different curricula were adopted in the first year, for students of grade 2020 more courses in general medicine, humanities and social sciences were added, and not for those of grade 2019. A questionnaire survey was conducted at the end of their first academic year. The questionnaire contained the basic information of students, opinions and satisfaction with curriculum design, understanding of policies about rural-oriented medical education, and the sense of career identity; each item in the questionnaire was scored by 5-point Likert scale.Results:A total of 173 questionnaires were distributed and 161 valid questionnaires were recovered, with a recovery rate of 93.1%; there were 55 responders (15 males and 40 females) from grade 2019, and 106 from grade 2020 (52 males and 54 females). The main reasons for choosing rural-oriented program were job security (60.0% (33/55) in 2019 and 58.5% (62/106) in 2020), the main way to know the relevant policies of the program was through the internet (54.5% (30/55) in 2019 and 66.0% (70/106) in 2020); 34.5% (19/55) of grade 2019 students were willing to continue working in rural areas after contracted period of service, while the percentage was 47.2% (50/106) for grade 2020. Students in grade 2020 had a higher satisfaction scores on the content and quality of teaching courses, as well as teaching satisfaction compared to those in grade 2019( t=2.34 and 3.00, P<0.05). The awareness of relevant policies before enrollment and policies related to contract violations among grade 2020 students was higher than that of grade 2019( t=2.70 and 5.08, P<0.05); the scores of all questions about general practice answered by students in grade 2020 were higher than those in grade 2019( t=3.96, 3.37, 3.55, 2.85, 3.84, 5.26 and 5.10,all P<0.05). There were no statistically significant differences in the scores of cognitive, emotional, behavioral, and adaptive aspects of career identity between students of two grades( t=0.70, 0.78, 0.74 and 1.37,all P>0.05). Conclusions:The reformed curriculum has positive effect on the satisfaction and awareness of rural-oriented medical education program and relevant policies among medical students in the program; however, it has less effect on the sense of career identity and willingness to continue to work in rural areas after the contracted period of serve.

Objective:To evaluate the safety and efficacy of dual stent-assisted coil embolization in intracranial ruptured vertebral artery dissecting aneurysms (VADAs).Methods:Seventeen patients with intracranial ruptured VADAs (17 aneurysms), treated with dual stent-assisted coil embolization in our hospital from September 2015 to March 2020, were recruited. DSA was performed immediately after surgery to evaluate the embolization degrees of VADAs. At the end of follow-up, modified Rankin scale (mRS) was used to evaluate the prognoses of these patients, and DSA was used to determine the healing status of aneurysms.Results:The postoperative immediate DSA showed that total occlusion was achieved in 6 patients (35.3%), subtotal occlusion in 8 (47.1%) and partial occlusion in 3 (17.6%). Two patients died during the perioperative period and 2 patients presented symptoms of cranial nerve palsy after surgery. Fifteen patients were followed up for 5-24 months, 14 were with good prognosis, and one was with poor prognosis. Eleven patients underwent DSA follow-up, which showed that 8 aneurysms healed completely, 2 aneurysms were stable, and 1 aneurysm recurred.Conclusion:Dual stent-assisted coil embolization may be an effective and safe treatment method for intracranial ruptured VADAs.

Objective:To investigate the status quo and training needs of general practitioner (GP) job-transfer training program in Hebei Province.Methods:An online survey with self-designed questionnaire was conducted on May 2019 through WeChat among 165 trainees in the General Practice Training Center of Hebei Province. A total of 165 questionnaires were distributed and 149 were valid with an effective rate of 90.3%. The contents of the questionnaire included the basic information of the trainees, the evaluation of the current training, and the needs of the GPs′ job-transfer training.Results:Among 149 participants, there were 131 (87.9%)from the secondary hospitals or above, 146(98.0%)with bachelor′s degree or above, and 128 (85.9%)with intermediate or above professional titles. The survey showed that 72.0%(67/93)thought the main reasons affecting participation in the training were busy work load and insufficient personnel, the main problems of training were too short training duration(45.2%, 42/93), the not focused training contents(38.7%, 36/93) and lack of practice(37.6%, 35/93). In the 149 trainees, 136(91.3%) thought that the most important contents should be standardized diagnosis and treatment of common diseases; 104(69.8%), 118(79.2%), 115(77.2%) and 98(65.8%) considered that the knowledge of prevention and health-protection, first aid, latest progress and chronic disease management were needed for training; 110(73.8%)and 80(53.7%)thought the mastery of clinical practice and basic theory were needed. And 57.7% (86/149)of the trainees believed that research training was needed, and there was significant difference in the demand for research training among participants from different work units and with different professional titles (χ 2=15.371,10.625,all P<0.05). The accepted training methods were case study(53.7%, 81/149) and practical work(37.6%, 56/149). For training duration, 43.6% (65/149) thought it should not exceed 6 months and 56.4% (84/149) preferred more than 1 year; there was a significant difference in demanded training duration among trainees from different work units, with different education background and professional titles (χ 2=16.225,6.243,25.966, all P<0.05). Conclusion:We need a multi-channel and multi-level training model to establish a better job-transfer training system for general practitioners, in order to meet different training needs and to improve the effectiveness of the training.

The organ system-based teaching model integrates the morphology and function of various organ and system of human body, breaks the boundaries of disciplines, and avoids the duplication and disjunction between disciplines. With this model general practitioners can effectively and efficiently learn basic knowledge and clinical skills in the training. This article introduces the organ system-based teaching model and its application in general practice job-transfer training in China.

Objective To survey the current status and training requirement of rural doctors in Hebei province.Methods A questionnaire survey was conducted among1 200 rural doctors selected from 11 cities of Hebei province by stratified sampling from October to December 2017.The self-designed questionnaire included general condition,job satisfaction,impact of medical reform policies,training needs of rural doctors.Results A total of 1 200 questionnaires were distributed and 1 170 valid ones were retrieved with a recovery rate of 97.5％.Among the 1 170 responders,there were 726 males(62.1％) and 444 females (37.9％);748 (63.9％) were aged more than 40 years;612 (52.3％) hold secondary school degree;826 (70.6％) had been working in the village for more than 10 years,and the overall job satisfaction rate was 30.8％ (360/1 170).Among all responders,73.8％ (864/1 170) worked in the standardized village clinics,and 72.0％ (842/1 170) were contracted with local residents as family doctors;52.8％ (618/1 170) responders believed that the reform policy improved the health care for villagers.In all responders,98％ (1 147/1 170)thought they needed training,93.6％ (1 095/1 170) had received training.The training contents they most needed werethe management of common diseases (904,77.3％),followed by medical humanities(650,55.6％)and first aid knowledge (492,42.1％).The influencing factors for training were lack of time,no energy (656,54.3％),lack of appropriate training forms (510,43.6％),economic reasons (476,40.3％) and so on.Conclusion The working status of rural doctors need to befurther improvedand the training need to be strengthened to increase their job satisfaction.

Objective To investigate the influence of WeChat + family centered health intervention on the self-efficacy of elderly hypertensive patients in General clinic. Methods A total of 102 elderly hypertensive patients aged≥60 years in General clinic from February 2017 to July 2017 were enrolled.They were divided into experimental group and control group with the table of random number, with 51 cases in each group. The experimental group used the WeChat+ family centered health intervention model,while the control group adopted the traditional health education model.The changes of blood pressure and self-efficacy were evaluated before intervention, 3 months and 6 months after intervention respectively. Results There were no statistic significant difference in blood pressure and self-efficacy total score between the two groups before intervention(P>0.05). At 3 months after intervention,the blood pressure(systolic pressure/diastolic pressure)of the patients were(144.20±4.60), (80.00±5.00)mmHg(1 mmHg=0.133 kPa)in the experimental group,those of which were(154.20±7.16), (87.00±3.81)mmHg in the control group,the differences were statistically significant (t=-2.628,-2.490,P<0.05).At 6 months after intervention,the blood pressure(systolic pressure/diastolic pressure)of the patients were(141.60±6.43),(76.00±4.85)mmHg in the experimental group,those of which were(151.60± 5.94),(85.40±4.56)mmHg in the control group,the differences were statistically significant (t=-2.555,-3.158,P<0.05).There were differences in systolic and diastolic pressure in patients with different groups at different time,and the differences were statistically significant(F=18.668,18.174,P<0.01).The total score of self-efficacy at 3 months and 6 months after intervention was(30.14±0.43),(32.56±0.23)points in the experimental group and (28.14 ± 0.15), (29.40 ± 0.19) points in the control group, the difference was statistically significant(t=9.736, 23.819, P<0.05). The differences in the total score of patients′self-efficacy in different groups at different time had statistically significance (F=2 631.551, P<0.01). Conclusions The WeChat+family centered health intervention model can significantly improve the self-efficacy of the elderly patients with high blood pressure in the General clinic.

The brain computer interface (BCI) can be used to control external devices directly through electroencephalogram (EEG) information. A multi-linear principal component analysis (MPCA) framework was used for the limitations of tensor form of multichannel EEG signals processing based on traditional principal component analysis (PCA) and two-dimensional principal component analysis (2DPCA). Based on MPCA, we used the projection of tensor-matrix to achieve the goal of dimensionality reduction and features exaction. Then we used the Fisher linear classifier to classify the features. Furthermore, we used this novel method on the BCI competition II dataset 4 and BCI competition N dataset 3 in the experiment. The second-order tensor representation of time-space EEG data and the third-order tensor representation of time-space-frequency BEG data were used. The best results that were superior to those from other dimensionality reduction methods were obtained by much debugging on parameter P and testQ. For two-order tensor, the highest accuracy rates could be achieved as 81.0% and 40.1%, and for three-order tensor, the highest accuracy rates were 76.0% and 43.5%, respectively.
Algorithms ; Brain-Computer Interfaces ; Electroencephalography ; Humans ; Principal Component Analysis

This paper presents a feature extraction method based on multivariate empirical mode decomposition (MEMD) combining with the power spectrum feature, and the method aims at the non-stationary electroencephalogram (EEG) or magnetoencephalogram (MEG) signal in brain-computer interface (BCI) system. Firstly, we utilized MEMD algorithm to decompose multichannel brain signals into a series of multiple intrinsic mode function (IMF), which was proximate stationary and with multi-scale. Then we extracted and reduced the power characteristic from each IMF to a lower dimensions using principal component analysis (PCA). Finally, we classified the motor imagery tasks by linear discriminant analysis classifier. The experimental verification showed that the correct recognition rates of the two-class and four-class tasks of the BCI competition III and competition IV reached 92.0% and 46.2%, respectively, which were superior to the winner of the BCI competition. The experimental proved that the proposed method was reasonably effective and stable and it would provide a new way for feature extraction.
Algorithms ; Brain ; physiology ; Brain-Computer Interfaces ; Discriminant Analysis ; Electroencephalography ; Humans ; Magnetoencephalography ; Principal Component Analysis

Brain-computer interface (BCI) systems identify brain signals through extracting features from them. In view of the limitations of the autoregressive model feature extraction method and the traditional principal component analysis to deal with the multichannel signals, this paper presents a multichannel feature extraction method that multivariate autoregressive (MVAR) model combined with the multiple-linear principal component analysis (MPCA), and used for magnetoencephalography (MEG) signals and electroencephalograph (EEG) signals recognition. Firstly, we calculated the MVAR model coefficient matrix of the MEG/EEG signals using this method, and then reduced the dimensions to a lower one, using MPCA. Finally, we recognized brain signals by Bayes Classifier. The key innovation we introduced in our investigation showed that we extended the traditional single-channel feature extraction method to the case of multi-channel one. We then carried out the experiments using the data groups of IV-III and IV - I. The experimental results proved that the method proposed in this paper was feasible.
Bayes Theorem ; Brain ; physiology ; Brain-Computer Interfaces ; Electroencephalography ; Humans ; Magnetoencephalography ; Multivariate Analysis ; Principal Component Analysis