The geriatrics department of Zhongnan Hospital covers all subspecialties of internal medicine with six separated wards, so it is difficult to manage and teach the students who participate in standardized training for resident physicians. In the residents' standardized training of geriatrics department, the interactive support platform named micro-teaching assistant was applied to carry out teaching activities such as classroom check-in, classroom testing and classroom discussion of teaching rounds and small lectures. It not only effectively manages the teaching order, but also improves students' enthusiasm and autonomy by encouraging them to participate in classroom interaction actively. The case analysis quiz and interactive discussion have a good effect on consolidating and deepening the students' professional knowledge, and improving the ability of clinical analysis and problem solving. The attendance rates, class discussion and test scores were recorded in a real and objective way, so that teachers can observe the whole process of students' learning and then make a formative assessment. At the same time, teachers are urged to adjust the teaching contents and progress in time, so as to achieve the goal of promoting "teaching" and "learning" mutually.

Objective:To explore the levels of vitamin A(VA) and vitamin D(VD) in blood of children with tic disorder (Tic disorder, TD) and their associations with tic symptoms severity and clinical types, so as to provide evidence for better prevention and treatment of TD.Methods:A total of 245 children with TD from September 2018 to April 2019 in the department of child Health care, affiliated hospital of qingdao university were enrolled as the case group and 63 healthy children who underwent routine physical examination at the same time as the control group. The levels of VA and VD were measured and their relationship with the severity of tic symptoms and clinical types were analyzed.Results:(1)The VD level of the case group was significantly lower than that of the control group ((23.72±8.87) μg/L , (26.61±7.59) μg/L, t=-2.24, P=0.03), and the proportion of insufficiency or even lack (37.31%, 75/201) was higher than the control group (15.79%, 9/57) (χ 2=9.37, P=0.002). (2)According to the Yale global tic severity scale(YGTSS), the children in the case group were divided into mild TD group, and moderate-to-severe TD group. ①There were significant differences in serum VA and VD levels in mild TD group, moderate-to-severe TD group and the control group ( F=29.79, P<0.01; F=10.90, P<0.01). Among them, the content of VA and VD in moderate-to-severe TD group were lower than those in mild TD group and control group (VA: (0.29±0.06)mg/L, (0.35±0.06)mg/L, (0.34±0.06)mg/L; VD: (21.01±8.30)μg/L, (25.84±8.76)μg/L, (26.61±7.59)μg/L). ②VA and VD levels of children with TD were negatively correlated with the severity of symptoms ( r=-0.325; P<0.01; r=-0.228; P=0.001). (3)According to DSM-V classification criteria, TD children were divided into PTD group, CTD group and TS group. ①There was no significant difference in serum VA level among different clinical types of TD children ( F=0.87, P=0.46). ②The levels of serum VD were different among the four groups ( F=4.13, P=0.007). Among them, the VD level in TS group was the lowest, and its content was significantly lower than that in control group ((21.83±7.60)μg/L, (26.61±7.59)μg/L, P<0.05)). The prevalence of insufficient or even lack of serum VD in children with different subtypes of TD was higher than that in the control group (χ 2=10.88, P=0.01). Conclusion:Vitamin D deficiency exists in children with TD. The level of vitamin A and vitamin D in serum of children with TD is related with the severity of tic symptoms.The VD level is related with clinical type of TD.

Objective:To investigate the personality traits of patients with anxious depression and the relationship between personality traits and clinical symptoms.Methods:From December 2011 to October 2014, 177 first-episode untreated patients with depression from the psychiatric department of the First Affiliated Hospital of Kunming Medical University and 185 healthy controls(HC group) recruited by the community were included.All patients were divided into anxious depression group ( n=92) and non-anxious depression group ( n=85) according to whether the anxiety/somatization factor score ≥7.The simplified version of Neuroticism Extraversion Openness Five-Factor Inventory (NEO-FFI) and the Hamilton depression scale-17 (HAMD-17) were used to assess all the subjects.Statistical analyses were conducted in SPSS 21.0.Analysis of covariance was used to compare the differences of the scores on personality dimensions among the three groups.The relationship between personality dimensions and anxious depression was confirmed by Logistic regression, linear regression analysis and generalized linear models. Results:The differences of the scores on the four dimensions of neuroticism ( F=108.863, P<0.01), extraversion ( F=86.357, P<0.01), agreeableness ( F=50.615, P<0.01), and conscientiousness ( F=24.730, P<0.01) among the three groups were statistically significant.Further pairwise comparision showed, the score of neuroticisms was higher in the anxious depression group(43.05±8.92) and non-anxious depression group(39.85±7.21) than that in the HC group (30.16±6.25)( P<0.01, Bonferroni corrected). The scores of extroversion (31.22±6.33, 32.61±6.83), agreeableness (38.66±5.80, 39.46±6.19) and conscientiousness (39.75±6.89, 38.85±7.26) were lower in the anxious depression group and non-anxious depression group than those in the HC group (40.29±5.37, 44.79±4.68, 44.09±5.66, all P<0.01, Bonferroni corrected). The score of neuroticisms in anxious depression group was higher than that in non-anxious depression group, and the difference was statistically significant ( P<0.01, Bonferroni corrected). Logistic regression analysis with age, gender and years of education controlled showed that the score of neuroticism ( B=0.082, OR=1.085, 95% CI=1.020-1.154, P=0.009) and conscientiousness ( B=0.060, OR=1.062, 95% CI=1.006-1.120, P=0.028) were risk factors for anxiety symptoms in patients with depression.Linear regression analysis showed that the scores on neuroticism had positive predictive effects on the anxiety/somatization factor score ( B=0.055, 95% CI=0.021-0.089, P=0.002) and cognitive impairment factor score ( B=0.074, 95% CI=0.023-0.125, P=0.005) in the anxious depression group. Conclusion:Compared to non-anxious depression, patients with anxious depression show higher level of neuroticism, and the level of neuroticism can positively predict the symptoms of anxiety and cognitive impairment.The high level of neuroticism and conscientiousness may be risk factors for the occurrence of anxiety symptoms in patients with depressed.

OBJECTIVE To evaluate the quality of guidelines/consensus on therapeutic drug monitoring （TDM） of anti-tumor necrosis factor-α （TNF-α） in patients with inflammatory bowel disease （IBD） in China and globally. METHODS PubMed， Embase， CNKI， Wanfang data， VIP， and release websites of guidelines/consensus in China and globally were searched to collect guidelines/expert consensus on TDM with anti-TNF-α for IBD patients. The search period was from database establishment to June 2023. After two investigators independently screened the literature and extracted the data， the methodological quality of the included guidelines/consensuses was evaluated using the Appraisal of Guidelines for Research and Evaluation Ⅱ. The main recommendations of the included guidelines/consensuses were summarized. RESULTS A total of 9 articles were included， 3 were guidelines and 6 were expert consensus. The standardized percentages of the 9 guidelines/consensus in the 6 dimensions （scope and aims， participants， rigor of formulation， clarity of expression， application， and editorial independence） were 90.43%， 41.98%， 52.55%， 85.49%， 19.00%， and 76.85%， respectively. Eight guidelines/consensus had a recommendation of grade B and one consensus of grade C. The main recommendations involve TDM application scenarios， threshold ranges， strategy adjustments， detection methods， and interpretation of results. Most guidelines/consensus recommend passive TDM for non-responders. It is recommended to set the TDM concentration range according to the expected treatment results and make strategy adjustments in combination with the disease condition and TDM results. Additionally， the same test method is recommended for the same patient. Some guidelines/consensus hold that no differences were noted in the interpretation of results between biosimilar and original drug. CONCLUSIONS The overall quality of the included guidelines/consensus was fair， with relatively consistent recommendation. Clinicians need to understand the characteristics and limitations of TDM with this class of drugs， and interpret and apply results of TDM in combination with specific clinical treatment goals.

Thymic neuroendocrine tumors (TNETs) are a series of rare diseases with aggressive biology and poor prognosis. Clinical manifestations of TNETs are atypical, and ectopic secretion of adrenocorticotropic hormone can be found in some cases, resulting in associated endocrine symptoms. Due to the low morbidity and strong heterogeneity, it’s difficult to diagnose, treat and obtain new treatment regimen. Early complete surgical resection is an effective treatment. For advanced cancer, clinical trials of new drugs are expected to improve the survival of patients.