Based on the theory of "Johari Window", this study introduced how to stimulate information content obtained in doctor-patient communication and how to apply the comprehensive geriatric assessment creatively from the four modules of open area, blind area, hidden area and unknown area in the model. It helped students to gain the trust and cooperation of patients, rapidly narrow down the blind area, hidden area and unknown area, guide patients to actively extend the open area, improve the teaching quality of doctor-patient communication in a scientific way.

Objective:To investigate the expression of programmed death ligand 1 (PD-L1) in rectal cancer tissues and the correlation of PD-L1 expression with clinicopathological characteristics and overall survival of patients.Methods:The clinical data of 200 newly treated rectal cancer patients in Shanxi Provincial Cancer Hospital from January 2014 to December 2015 were retrospectively analyzed. The expression of PD-L1 in rectal cancer tissues was detected by immunohistochemistry. The correlations of PD-L1 expression with gender, age, tumor T stage, lymph node metastasis, tumor differentiation, histological type, tumor TNM stage, neutrophil-to-lymphocyte ratio (NLR) and overall survival of patients were analyzed.Results:The positive expression rate of PD-L1 was 24% (48/200). The positive expression rate of PD-L1 was high in patients with lymph node metastasis and high NLR (≥ 3.5) (both P < 0.05). The 5-year overall survival rate in PD-L1-positive group was 42%, and the PD-L1-negative group was 59%, and the difference between the two groups was statistically significant ( P < 0.05). The results of multivariate analysis showed that lymph node metastasis ( HR = 3.456, 95% CI 2.148-5.556, P < 0.01), NLR ≥ 3.5 ( HR = 1.871, 95% CI 1.169-2.996, P = 0.009), and PD-L1-positive expression ( HR = 2.187, 95% CI 1.373-3.484, P = 0.001) were independent adverse influencing factors for the overall survival of rectal cancer patients. Conclusion:PD-L1 is highly expressed in rectal cancer tissues, and the positive expression of PD-L1 is associated with poor overall survival of patients.

Objective:To analyze the clinical characteristics and prognostic factors of severe fever with thrombocytopenia syndrome patients with high novel Bunya viral load.Methods:The clinical data of 141 patients with severe fever with thrombocytopenia syndrome whose viral load higher than 1×10 4 copies/mL were retrospectively collected from May 20, 2013 to October 30, 2019 in Weihai Central Hospital. All patients were diagnosed by laboratory tests. According to the prognosis, the cases were divided into survival group and death group. The clinical manifestations, laboratory test results and the influence of viral load on the conditions and the risk factors of prognosis were compared and analyzed. Chi-square test, rank sum test and logistic regression analysis were used for statistical analysis. Results:There were 76 patients in survival group, with a median age of 64 years. There were 65 patients in death group, with a median age of 71 years. There were significant differences in neurological injury, coma, hemorrhage, atrial fibrillation with rapid ventricular rate, and renal injury between the survival group and the death group ( χ2=16.45, 64.06, 11.25, 6.98 and 33.80, respectively, all P<0.01). There were significant differences in activated partial thromboplastin time (APTT), aspartate aminotransferase (AST), creatine kinase (CK), creatine kinase isoenzymes (CK-MB), lactic acid dehydrogenase (LDH), hydroxybutyrate dehydrogenase (HBDH), creatinine, and platelet count between the survival group and the death group ( Z=6.33, 4.51, 2.93, 4.65, 5.00, 4.93, 5.36 and -4.34, respectively, all P<0.01). The RNA quantification of viral load in 138 cases ranged from 1.06×10 4 to 6.53×10 7 copies/mL, and the remaining three cases were higher than 1.00×10 8 copies/mL. The viral load of the two groups were 4.63(4.32, 5.22) and 5.29(4.92, 6.17) lg copies/mL, respectively ( Z=4.91, P<0.01). The mortalities of patients with viral loads of 1.00×10 4-<1.00×10 5 copies/mL, 1.00×10 5-<1.00×10 6 copies/mL and 1.00×10 6-<1.00×10 7 copies/mL were 29.33%(22/75), 51.28%(20/39), 80.95% (17/21), respectively. Six cases with viral loads higher than 1.00×10 7 copies/mL were dead. Logistic regression analysis showed that when age ≥60 years old, viral load >1.00×10 6 copies/mL, platelet count <30.00×10 9/L, LDH ≥5 000.00 U/L, APTT ≥84.00 s, the risk of death increased significantly. Conclusions:The occurrences of coma, hemorrhage, atrial fibrillation with rapid ventricular rate, renal injury suggest that the patients′ conditions are more serious and the risk of death is higher. Age, viral load, platelet count, LDH and APTT can be used as indicators to assess the risk of death.

Objective: To explore the clinical application value of enhanced recovery after surgery (ERAS) in the laparoscopic surgery for cholecystolithiasis comorbid with choledocholithiasis. Methods: The prospective study was conducted. The clinicopathological data of 52 patients with cholecystolithiasis comorbid with choledocholithiasis who were admitted to the Third Affiliated Hospital of Zunyi Medical University from September 2016 to September 2018 were collected. Patients were divided into 2 groups by random number table: patients in observation group received laparoscopic cholecystectomy + choledocholithotomy + choledochoscopic exploration + T-tube drainage (or primary suture of common bile duct) and perioperative management guided by the concept of enhanced recovery after surgery (ERAS), and patients in control group received traditional perioperative management. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) postoperative complications; (4) postoperative pain scores; (5) changes in hepatic function and blood routine during perioperative period. Follow-up using outpatient examination and telephone interview was performed to detect complications during the postoperative 6 months up to March 2019. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the paired t test or repeated ANOVA. Count data were described as absolute numbers and percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Results: Fifty-two patients were screened for eligibility, including 20 males and 32 females, aged 25-68 years, with an average age of 53 years. There were 30 patients in the observation group and 22 in the control group. (1) Surgical situations: the operation time and volume of intraoperative blood loss were (133±19)minutes and (47±21)mL in the observation group, and (136±22)minutes and (49±23)mL in the control group, respectively, showing no significant difference between the two groups (t=-0.386, -0.211, P>0.05). (2) Postoperative situations: time to out-of-bed activity, time to initial food intake, time to first anal flatus, duration of postoperative hospital stay, and hospital expenses were (18±4)hours, (19±5)hours, (28±2)hours, (4.0±1.0)days, and (1.82±0.22)×10⁴ yuan in the observation group, and (29±7)hours, (46±9)hours, (37±4)hours, (6.6±1.6)days, and (2.25±0.29)×10⁴ yuan in the control group, respectively, showing significant differences between the two groups (t=-7.054, -14.169, -9.426, -6.582, -5.809, P<0.05). (3) Postoperative complications: 1 of 30 patients in the observation group had postoperative biliary leakage, with a postoperative complication rate of 3.3%, and was cured after symptomatic support treatment. Six of 22 patients in the control group had postoperative complication, with a postoperative complication rate of 27.3%, including 2 of biliary leakage, 1 of hemorrhage, 1 of abdominal infection, 1 of pulmonary infection, 1 of urinary infection, and they were cured after symptomatic support treatment. There was a significant difference between the two groups (χ²=4.358, P<0.05). (4) Postoperative pain scores: from postoperative 6 hours to 48 hours, the postoperative pain score changed from 2.4±0.7 to 1.9±0.9 in the observation group, and from 4.1±0.7 to 2.9±0.9 in the control group, respectively, showing a significant difference in the changing trend between the two groups (F=78.053, P<0.05). (5) Changes in hepatic function and blood routine during perioperative period: from preoperation to postoperative 3 days, levels of alamine aminotransferase (ALT), aspartate transaminase (AST), gamma-glutamyltransferase (GGT), total bilirubin (TBil), and count of white blood cells in the observation group changed from (77±20)U/L to (53±12)U/L, from (85±22)U/L to (61±17)U/L, from (166±39)U/L to (55±24)U/L, from (40±13)μmol/L to (29±12)μmol/L, from (7.0±2.0)×10⁹/L to (6.8±1.9)×10⁹/L, and changed from (79±23)U/L to (62±14)U/L, from (88±24)U/L to (64±17)U/L, from (179±34)U/L to (74±29)U/L, from (45±13)μmol/L to (35±12)μmol/L, from (7.9±2.4)×10⁹/L to (7.5±1.9)×10⁹/L in the control group, respectively. The levels of ALT, AST, GGT, TBiL, and count of WBC showed increasing at postoperative 1 day, and decreasing at postoperative 3 days. There was no significant difference in the changing trend between the two groups (F=0.058, 0.471, 3.021, 1.593, 2.172, P>0.05). Conclusion ERAS is safe and effective in the laparoscopic surgery for choledocholithiasis comorbid with cholecystolithiasis.

Objective: To evaluate and describe the changes of core muscle groups based on DAVID spine biomechanics training system in ankylosing spondylitis (AS) patients. Methods: The clinical data of 100 patients of AS and 31 healthy controls were collected. Clinical symptoms, Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis function index (BASFI), Bath ankylosing spondylitis measurement index (BASMI), ankylosing spondylitis disease activity (ASDAS), and simultaneous detection of DAVID spine biomechanics training system, simple core muscle fitness test: Eight-grade abdominal bridge, PLANK exercise (flat support), Abdominal static muscle endurance test, Back static muscle endurance test were compared using t-test analysis and spearman correlation analysis. Results: ① Between AS and healthy male control o group, there were significant differences of spinal mobility in forward flexion, right rotation, left rotation (42±13 vs 48±1, 52±14 vs 69±12, 52±13 vs 58±11; all P values <0.05); and significant differences of spinal muscle strength in forward bending force, right rotation force, left rotation force, right bending force (103±42 vs 146±17, 87±34 vs 104±13, 80±35 vs 101±13, 161±55 vs 186±19; all P values <0.05), and significant differences in the left/right rotational force (1.17±0.21 vs 1.02±0.111, P<0.05) of spine balance strength comparison.② Between AS and healthy controls of female group, there were differences in forward bending force (49±23 vs 77±10, P<0.05) of spinal muscle strength; and significant differences in forward bending/backward extension strength, left and right rotation strength (0.32±0.11 vs 0.58±0.21, 1.29±0.21 vs1.03±0.11, all P values <0.05) of spine balance strength; ③ In AS group, the spinal mobility was correlated with age (Rear extension r=-0.28, right flexion r=-0.268, left flexion r=-0.404, right rotation r=-0.367, left rotation r=-0.235; all P values <0.05), course of disease (Rear extension r=-0.354, forward flexion r=-0.283, right flexion r=-0.204, left flexion r=-0.284, right rotation r=-0.339, left rotation r=-0.23; all P values <0.05), body mass index (BMI) (Rear extension r=-0.23, forward flexion r=-0.288, right flexion r=-0.22, left flexion r=-0.201, right rotation r=-0.26, left rotation r=-0.29; all P values <0.05), sacroiliac joint stage(Rear extension r=-0.375, forward flexion r=-0.446, right flexion r=-0.331, left flexion r=-0.367, right rotation r=-0.368, left rotation r=-0.314; all P values <0.05) and BASDAI (Rear extension r=-0.381, forward flexion r=-0.374; all P values <0.05). Spinal muscle strength was correlated with gender (Posterior extensor force r=0.344, flexor force r=0.507, right rotation force r=0.376, left rotation force r=0.399, right flexion force r=0.433, left flexion force r=0.445; all P values <0.05); the left/right spine rotation strength was correlated with gender (r=0.271, P<0.05). ④ In the simple core muscle fitness test, eight-grade abdominal bridge was correlated with spinal muscle strength (Rear extension force r=0.234, right rotation r=0.290, left rotation r=0.219, right flexion r=0.35, left flexion r=0.327; all P values <0.05); PLANK exercise was correlated with spinal muscle strength (Rear extension force r=0.234, right rotation r=0.290, left rotation r=0.219, right flexion r=0.35, left flexion r=0.327; all P values <0.05); abdominal static muscle endurance test was correlated with forward flexion strength (r=0.341, P<0.05); back static muscle endurance test was correlated with spinal mobility (Rear extension r=0.262, forward flexion r=0.23, right rotation r=0.455, left rotation r=0.426, right flexion r=0.387, left flexion r=0.46; all P values <0.05); correlated with spine strength (right flexion r=0.256, left flexion r=0.272; all P values <0.05). Conclusion Compared with healthy people, AS patients have decreased activity, strength and balance of spinal core muscle. There are significant decline in spinal mobility and muscle strength of male AS patients and muscle imbalance of female AS patients. Simple core muscle fitness test could be used in clinic to measure the changes of AS patients'core muscle group.

OBJECTIVE To investigate the immunogenicities of Poria cocos polysaccharides, PCP-Ⅰand PCP-Ⅱ, as a vaccine adjuvant. METHODS ①Keyhole limpet hemocyanin (KLH) was linked to PCP-Ⅰor PCP-Ⅱrespectively to prepare immuno-antigen KLH-PCP-Ⅰor KLH-PCP-Ⅱ. Bovine serum albumin (BSA) was also linked to PCP-Ⅰor PCP-Ⅱrespectively to prepare screening-antigen. Rabbits were immunized with KLH-PCP-Ⅰor KLH-PCP-Ⅱplus Freund adjuvant by intradermal injection twice, and serum specific antibody titers were determined by ELISA. ②BALB/c mice were immunized with PCP-Ⅰ or PCP-Ⅱ alone intramuscularly twice, and serum polysaccharide antibody titers were determined by ELISA.③BALB/c mice were co-immunized intramuscularly or subcutaneously with PCP-Ⅰor PCP-Ⅱplus hepatitis B surface antigen (HBsAg) or porcine reproductive and respiratory syndrome virus inactivated vaccine (PRRSV) twice, and serum polysaccharide-antibody titers were determined by ELISA. RESULTS ①Serum anti-KLH and anti-polysaccharides (PCP-Ⅰor PCP-Ⅱ) antibodies were pro?duced after rabbits were immunized with KLH-PCP-Ⅰor KLH-PCP-Ⅱplus Freund adjuvant twice.②Serum anti-PCP-Ⅰor anti-PCP-Ⅱantibodies were not found after mice were immunized with PCP-Ⅰand PCP-Ⅱalone twice.③After mice were immunized with HBsAg or PRRSV plus PCP-Ⅰor PCP-Ⅱtwice, serum anti-PCP-Ⅰor anti-PCP-Ⅱantibodies were not found. CONCLUSION PCP-Ⅰand PCP-Ⅱshow weak immunogenicity, which may be quite safe as a vaccine adjuvant.

Objective: To determine the contribution of follow-up formula (FUF) to the nutrient intake of 7-24-month-old infants and young children. Methods: The cluster random sampling method and the convenience sampling method were used in combination, and geographic and economic factors were taken into consideration. Four areas of China (Beijing, Hebei, Guangxi, Guangdong) were selected, with 120 infants chosen from each of these areas (half of which were 7-12 months old, and half were 13-24 months old). A dietary survey was completed by a continuous 24-hour weighing method over two days. Questionnaires were completed by their caregivers which included weighing the FUF and supplementary food given to the infant, and recording the frequency of breast feeding and any supplementary nutrients. A total of 518 questionnaires were distributed, and 472 questionnaires qualified for inclusion. Nutrient intake was calculated using the China food composition, infant formula food nutrient content and infant nutrition supplement brand-label information databases, and then the nutrient intake proportion (the percentage of estimated energy requirement (EER%), recommended nutrient intake (RNI%) or adequate intake (AI%)), and the contribution rate of FUF were analyzed. Results: A total of 472 infants were investigated (227 infants aged 7-12 months old, 245 infants aged 13-24 months old). The findings revealed that the median energy intake of 7- 12-month-old and 13- 24-month-old infants were 2 530.08 kJ and 3 445.48 kJ, respectively, which accounted for 85.18% and 94.14% of EER, respectively; and the median intake of protein reached 91.50% and 105.88% of their RNI/AI, respectively. For micronutrients, the median intake of vitamin B₁, vitamin B₂, niacin, vitamin E, potassium, zinc and manganese in 7- 12-month-old infants and vitamin B₂, vitamin E, potassium, magnesium, iron and manganese in 13-24-month-old children accounted for 82.00% and 114.29% of RNI/AI (RNI%/AI%), respectively. The intake of vitamin B₆, iron and selenium in 7-12-month-old infants and vitamin B₁, vitamin B₆, vitamin C, calcium and selenium in 13-24-month-old children was less than 80% RNI/AI. Furthermore, some nutrients showed higher intake levels, such as vitamin A, calcium, phosphorus and magnesium in 7-12-month-old infants and vitamin A and phosphorus in 13-24-month-old children, which were higher than 130% RNI/AI. In total, 40.53% (92) of infants aged 7-12 months and 52.65% (129) of children aged 13- 24 months were fed FUF as part of their diet, and its contribution rate to macronutrients was 29.69% for carbohydrates and 51.77% for fats, and to micronutrients was 2.04% for manganese and 74.24% for vitamin C. Conclusion FUF contributes to the nutrient intake of infants and young children aged from 7-24 months old at different rates depending on the macronutrient or micronutrient analyzed.

Objective To examine the clinical effect of simultaneous intervention for heart and lung on chronic obstructive pulmonary disease (COPD) of stationary phase combined with stable angina pectoris with Qi deficiencyblood stasis-phlegm blockade syndrome.Methods Ninety-six COPD stationary phase combined with stable angina pectoris patients with Qi deficiency-blood stasis-phlegm blockade syndrome were randomized into control group,Juhong [Exocarpium Citri Rubrum] tablet group,the Tongxinluo (通心络) group and the Ju&Tong group,24 cases in each group.The control group was given western medicine routine therapy.In addition to the treatment of the control group,Juhong tablet 3.6 g was given to the Juhong tablet group orally,twice each day;Tongxinluo capsule 1.04 g was given to the Tongxinluo group orally,three times each day;Juhong tablet and Tongxinluo capsule were given to the Ju&Tong group.Each group was treated for 8 weeks.The following intems were compared before and after treatment including the scores of cough,cough up phlegm,dyspnea and St.George's Respiratory Questionnaire (SGRQ),anginal attacks,durante dolors,nitroglycerin consumption,pulmonary function [including forced expiratory volume in one second (FEV1) and forced vital capacity (FVC)],as well as the levels of serum C reactive protein (CRP),interleukin 1β (IL-1β) and interleukin 10 (IL-10).Results After treatment,the scores of cough,cough up phlegm,dyspnea and SGRQ decreased in the Juhong tablet group,the Tongxinluo group and the Ju&Tong group.FEV1 and FVC increased.Anginal attacks,durante dolors,nitroglycerin consumption,as well as the levels of serum CRP,IL-1 βand IL-10 decreased.Moreover,the effect of certain indexes in the Ju&Tong group was superior to those in the Juhong tablet group and the Tongxinluo group (P ＜ 0.05 or P ＜ 0.01).Conclusion Simultaneous intervention for heart and lung might improve clinical symptoms and pulmonary function of COPD stationary phase combined with stable angina pectoris with Qi deficiency-blood stasis-phlegm blockade syndrome patients.Inhibiting chronic persistent inflammation might be one of the important mechanisms.

Objective To investigate the efficacy and safety of low dose tirofiban combined with reteplase in the thrombolytic treatment of young and middle-aged patients with acute myocardial infarction (AMI).Methods A total of 120 AMI patients were selected and randomly divided into group A and group B,60 cases in each group.The patients in the group A were given reteplase combined with low dose of tirofiban [0.05 μg/(kg·min)],and the patients in the group B were given reteplase combined with routine dose of tirofiban [0.1 μg/(kg·min)].The vascular recanalization rate,the platelet aggregation rate,the levels of coagulation and fibrinolysis related indicators,the main clinical events and bleeding complications were compared between two groups.Results The vascular recanalization rate of group A was 76.67%,which was similar to 81.67% of group B (P>0.05).After treatment,the platelet aggregation rate were significantly lower than that before treatment in both groups (P<0.05).After treatment,the levels of Fg and D-D were significantly lower than those before treatment in both groups,and the levels of PLT and t-PA were significantly higher than those before treatment (P<0.05).After one month of treatment,there was no significant difference in incidence rate of clinical events between two groups (P>0.05).The incidence rate of bleeding complications in group A was significantly lower than the group B (P<0.05).Conclusion The thrombolytic effect of low dose tirofiban on treatment of AMI is similar to that of the conventional dose,but it can reduce the risk of bleeding and improve medication safety.

Objective To investigate the efficacy and safety of low dose tirofiban combined with reteplase in the thrombolytic treatment of young and middle-aged patients with acute myocardial infarction (AMI).Methods A total of 120 AMI patients were selected and randomly divided into group A and group B,60 cases in each group.The patients in the group A were given reteplase combined with low dose of tirofiban [0.05 μg/(kg·min)],and the patients in the group B were given reteplase combined with routine dose of tirofiban [0.1 μg/(kg·min)].The vascular recanalization rate,the platelet aggregation rate,the levels of coagulation and fibrinolysis related indicators,the main clinical events and bleeding complications were compared between two groups.Results The vascular recanalization rate of group A was 76.67%,which was similar to 81.67% of group B (P>0.05).After treatment,the platelet aggregation rate were significantly lower than that before treatment in both groups (P<0.05).After treatment,the levels of Fg and D-D were significantly lower than those before treatment in both groups,and the levels of PLT and t-PA were significantly higher than those before treatment (P<0.05).After one month of treatment,there was no significant difference in incidence rate of clinical events between two groups (P>0.05).The incidence rate of bleeding complications in group A was significantly lower than the group B (P<0.05).Conclusion The thrombolytic effect of low dose tirofiban on treatment of AMI is similar to that of the conventional dose,but it can reduce the risk of bleeding and improve medication safety.