Clinical practice is a special learning phase. Interns, as both students and doctors are confronted with multiple pressures from studies, employment and examination. Their ideology tends to fluctuate due to the influence of the society. Therefore, it's very important to strengthen the ideo-logical and political education. It is relatively difficult in managing interns due to their dispersed loca-tion and unfixed daily schedule. Internet not only expands the space and time of the ideological edu-cation, but also it has the features of vivid, interesting, timely, open and resource conservation. On the basis of analyzing the characteristics and difficulties of the clinical ideological education and the pros and cons of the network, we proposed the methods to utilize the advantages of network informa-tion technology to enhance the ideological and political education of clinical interns.

Objective To evaluate the effects and security of PFNA and DHS in the treatment of unstable intertrochanteric fractures through meta analysis .Methods The randomized controlled trials(RCT) for comparing PFNA and DHS in the treatment of unstable intertrochanteric fracture were retrieved from MEDLINE ,EMbase ,Pubmed ,Cochrane library ,CBM ,CNKI ,VIP data‐bases by computer .The related orthopedic relevant documents and conference papers were collected by manual retrieval .The Rev‐Man5 .1 statistical software was used for conducting the meta analysis .Results Nineteen RCT were included ,involving 1 690 pa‐tients ,in which 871 cases were treated by using PFNA and 819 cases were treated by using DHS .Compared with DHS ,PFNA had the advantages of little trauma ,less blood loss ,short operation time ,short fracture healing time and postoperative bed time ,good hip function and low incidence of postoperative coxa vara and screw cutting ,but there were no statistical differences in the aspects of length of hospital stay ,fatality rate ,and incidences of fracture nonunion ,breakage of internal fixation ,femoral head necrosis ,short‐ening of the femoral neck ,femoral shaft fractures ,deep vein thrombosis ,urinary tract infection and other complications between the two groups(P>0 .05) .Conclusion The retrieved literatures show that PFNA internal fixation is superior to DHS internal fixation in treatment of unstable intertrochanteric fractures .

Objective To evaluate the alexithymia in the continuous ambulatory peritoneal dialysis (CAPD) patients in our peritoneal dialysis center,and determine the factors affecting alexithymia in CPAD patients.Methods The patients with end-stage renal disease treated by CAPD were divided into alexithymia group (total score≥61)and non-alexithymia group(total score≤51),according to the Toronto Alexithymia Scale(TAS-20).Risk factors for alexithymia were analyzed by Logistic regression statistical model.Results (1)The TAS-20 score was(55.8±9.2) in 86 cases of patients with CAPD.Among them,TAS-20 scores of 38 cases were ≥61 points with an average score (64.5 ±4.4),and the scores of 30 cases were ≤ 51 points with an average score (48.9±5.3),which had a significant difference(t=10.1,P＜0.01).(2) There were significant differences in the pay-way and the residual urine volume between the two groups(P＜0.01).There were significant correlations of alexithymia with the pay-way and the residual urine volume(P＜0.01).(3) The level of serum albumin was significantly lower in alexithymia groups than that in non-alexithymia(P＜0.01).The level of serum calcium,phosphorus and parathormone were significantly higher in alexithymia group than that in non-alexithymia group(P＜0.05).There were significant negative correlations of alexithymia with the level of serum albumin(P＜0.01) and positive correlations of alexithymia with the level of serum calcium,phosphorus and parathormone(P＜0.05).(4) There were significant differences score in SF-36 total score,Physical Function,Bodily Pain,General Health,Vitality,Social Function,Role-Emotional and Mental Health (P＜ 0.01);There were significant negative correlations of alexithymia with SF-36,Physical Function,Bodily Pain,General Health,Vitality,Social Function,Role-Emotional and Mental Health (P＜ 0.05).(5) The Kt/v was 1.65±0.47 in alexithymia group and 2.13±0.69 in non-alexithymia group.There were significant differences in the two groups(t=2.5,P=0.017).There were significant negative correlations of alexithymia with Kt/v(r=-0.417,P=0.007)by Pearson correlation analysis.Logistic regression analysis showed that the level of serun albumin,SF-36 scores,residual urine volume,the pay-way and Kt/v were the risk factors for alexithymia.Conclusion The incidence rate of alexithymia is higher.The level of serum albumin,SF-36 scores,residual urine volume,the pay-way and Kt/v are the risk factors for alexithymia.

Objective To develop an artificial neural networks tool and use it to identify proteomic patterns in serum so as to distinguish gastric cancer from controls. Methods Serum samples from 84 gastric cancer patients and 75 controls were randomized into training set (106 samples) and test set (53 samples). At first, samples of the training set were detected using SELDI mass spectrometry and CMIO protein chips. Using a multi-layer ANN with a back propagation algorithm, a proteomic pattern that could distinguish cancer from control samples was identified in the training set. The discovered pattern was then used to determine the accuracy of the classification system in the test set. Results Totally 5 differentially expressed proteins between patients and controls were identified. The five proteins (P < 0.05, m/z at 7567,6742,5262,4869, 4256) were chosen to develop ANN based diagnostic model. The model was blindly tested in the test set for diagnosing gastric cancer. The sensitivity and specificity was 90.0% and 91.3% respectively. Conclusions Combination of SELDI with the artificial neural networks can get a high sensitivity and specificity approach to identify the gastric cancer from the controls. The method shows great potential for early diagnosis of gastric cancer and screening of new tumor biomarkers.

The following problems in medical journals of China were analyzed, including limited free full-text access, low international influence power, severe duplicated construction, academic misconducts, weakened peer review, and overemphasis on journal assessment indexes, with suggestions put forwards for their solution, such as exploring novel channels for digital publication and distribution , actively preparing journals publishedin English , and improving the academic level of journals.

Objective To investigate the clinical characteristics of myeloperoxidase (MPO)-antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (MPO-AAV) with pulmonary injury and the relationship between pulmonary injury and ANCA against light chain of MPO (LCMPO-ANCA).Methods A total of 195 patients with newly diagnosed primary active MPO-AAV were recruited in this prospective study.Indirect immunofiuorescence assay was used to detect peri-nuclear ANCA (p-ANCA).Immunoblotting and ELISA were used to detect myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA).Clinical features of patients with both positive p-ANCA and MPO-ANCA were collected.Disease activity was evaluated by Birmingham Vasculitis Activity Score-version 3 (BVAS-V3) Recombinant light chain of MPO was used to coat substrate of LCMPO-ANCA by ELISA.The clinical characteristics of pulmonary injury and its correlation with serum levels of p-ANCA,MPO-ANCA and LCMPO-ANCA were explored.Results All 195 patients (64 male and 131 female),consisted of 191 patients (98.0％) with microscopic polyangiitis,3 patients (1.5％) with granulomatosis with polyangiitis,and 1 (0.5％) with eosinophilic granulomatosis with polyangiitis including 64 men and 131 women.Their mean age was (63.2 ±13.5) years old.The level of MPO-ANCA had a positive correlation with general BVAS-V3 (r =0.193,P =0.007) in all patients,and the level of LCMPO-ANCA was positively related with the pulmonary BVAS-V3 (r =0.228,P =0.001).As for multiple systemic damages,the incidence of lung involvement was 60.51％(118/195),which ranked second to renal involvement (71.80％,140/195).The most common pulmonary injuries represented as pulmonary infiltration of 80.51％ (95/118),pleural effusion / pleurisy of 41.53％(49/118),pulmonary nodule or cavity of 22.03％ (26/118).Compared with those without lung involvement,the patients with pulmonary injuries were older [(66.39 ± 10.70) years old vs (58.30 ±15.72) years old;t =4.277,P =0.001],had a shorter course of disease [2.00(1.00,10.50) months vs 3.00(1.00,3.50) months;t =-2.283,P=0.024],and higher scores of general BVAS-V3 (18.21 ±6.08 vs 15.18 ± 5.64;t =3.501,P =0.001).Also,in the patients with pulmonary lesions,the positive rate of LCMPO-ANCA was significantly higher (35.59％ vs 6.49％;x2 =21.569,P ＜ 0.001),and the level of LCMPO-ANCA was significantly higher (0.377 ±0.229 vs 0.285 ±0.079;t =3.399,P =0.001)than those without lung involvement.The pulmonary BVAS-V3 in the patients with LCMPO-ANCA was significantly higher than that in the patients without LCMPO-ANCA (4.34 ± 2.10 vs 2.59 ± 2.52;t =4.301,P ＜ 0.001),whereas the pulmonary BVAS-V3 was not correlated with LCMPO-ANCA (r =0.035,P =0.708) in patients with lung injuries.Conclusion Pulmonary injury was relatively common and insidious in patients with MPO-AAV.To monitor ANCA level is necessary in patients with pulmonary injury.LCMPO-ANCA might play an important role in the pathogenesis of pulmonary lesions in AAV.

Objective To explore effect of irregular chemotatic factor fractalkine(FKN),phosphatidyl inositol 3 kinase and nuclear factor?κB(NF?κB)on interleukin?6(IL?6)expression in peripheral blood monocytes and the effect of valsartan intervention,so as to research the signal conduc?tive mechanism of FKN impacting on IL?6. Methods Peripheral blood monocytes were isolated from fresh blood of healthy volunteers by the densi?ty gradient centrifugation. The extractive peripheral blood monocytes were divided into seven groups:the control group,the FKN group,the LY294002 group(PI3K inhibitors),the PDTC group(NF?κB inhibitors),the FKN+valsartan group,the FKN+LY294002 group,and the FKN+PDTC group,the latter two were pretreated by LY294002 and PDTC respectively before FKN inducing PBMC cells. The IL?6 expression in cell me?dium was measured in each group by ELISA at 12 hours and 24 hours after PBMC treatment. Results After 12 hours of culture,compared with the control group,the expression of IL?6 in the FKN group was decreased(P<0.05),while LY294002 and PDTC groups had no significant difference (P>0.05). Compared with the FKN group,the expression of IL?6 was decreased in the FKN+valsartan group(P<0.05),increased in the FKN+LY294002 group(P<0.05),and was decreased in the FKN+PDTC group(P<0.05). After 24 hours of culture,the IL?6 expression in each group had no significant difference(P>0.05). Conclusion FKN can adjust the expression of peripheral blood PBMC IL?6 in a two?way pattern, inhibiting the expression of IL?6 by PI3K pathway and promoting the expression of IL?6 by NF?κB pathway,overall,FKN can inhibit the expression of IL?6. Valsartan can increase FKN to inhibit the expression of IL?6.

Objective To investigate the expression of CD55 and myeloperoxidase (MPO) on neutrophils in patients with MPO-specific anti-neutrophil cytoplasmic antibody associated vasculitis(MPO-AAV), and analyze the relationship between the expression and clinical manifestation.Methods Forty untreated patients with active MPO-AAV (patient group) and 30 healthy volunteers (control group) were enrolled in this study.The CD55 on neutrophils and both membrane and cytoplasmic MPO were detected by flow cytometry.Serum fragment-from the activated complement factor B(Ba) and MPO were measured by ELISA.The clinical activity of vasculitis was valued by Birmingham vasculitis activity score-version 3(BVAS-V3).The significance of laboratory data was evaluated by Spearman correlation test and multivariate linear regression analysis.Results (1)The mean fluorescence intensity(MFI) of CD55 expressed on neutrophils was significantly higher than that in control group[4 068.6±2 306.0 vs 2 999.5±1 504.9,P=0.033].Similar results of serum MPO and Ba in patient group were found compared to controls [500.0(381.0, 612.7) IU/L vs 286.9(225.5, 329.1) IU/L,P<0.001;35.2(25.2, 79.5) ng/L vs 18.0(15.0, 28.0) ng/L,P<0.001], respectively.However, MIF of cytoplasmic MPO in patients was significantly lower than that of control group(1 577.1±1 175.9 vs 3 105.3±2 323.0,P=0.003).(2) In patient group, cytoplasmic intensity of MPO was negatively associated with the serum levels of MPO(r=-0.710,P<0.001) and Ba (r=-0.589,P=0.001).Moreover, serum MPO was positively associated with serum Ba(r=0.691,P<0.001).Membrane intensity of CD55 on neutrophils was positively correlated with patient age (r=0.514, P=0.001), C reactive protein (r=0.376, P=0.018), peripheral neutrophils count (r=0.485, P=0.001) and BVAS-V3 (r=0.484, P=0.002), whereas negative correlation between membrane CD55 and disease duration was seen (r=-0.403,P=0.01).(3) The result of multiple linear regression analysis showed there was statistically significant positive correlation between MFI of CD55 expressed on neutrophils and BVAS-V3 (β=0.001,P=0.027).Conclusions In MPO-AAV,CD55 expression on neutrophils is markedly enhanced, which is one of the independent risk factors related to disease activity.It might protect neutrophils from attacking AAV, CD55 expression on neutrophils is markedly enhanced, which is one of the independent risk factors related to disease activity.It might protect neutrophils from attacking by complement alternative pathway.Activated neutrophils release more MPO and lysosome to intensify the inflammation reaction and aggravate the disease.Thus CD55 might become a new potential target for the treatment of this disease in the future.

Objective:To discuss the influence of mindfulness-based stress reduction plus micro-class education on the complications and knowledge mastery rate in surgical patients with diabetes mellitus.Methods:A total of 105 patients, diagnosed as diabetes mellitus complicated with appendicitis in the Affiliated Hospital of Chengde Medical College were selected from January 2019 to January 2020. They were hospitalized for laparoscopic appendectomy and were randomly divided into the control group ( n = 52) and the study group ( n = 53) in accordance with the random number table. The patients in the control group were given routine nursing care, and the patients in the study group were given mindfulness decompression therapy combined with micro-classroom education. The blood glucose control and psychological emotion of the two groups before and after operation, and the postoperative complications and the mastery rate of disease knowledge of the two groups were compared. Results:There was no significant difference in blood glucose indexes between the two groups at baseline ( P>0.05); FBG, HbA1c and other indicators in the two groups were improved during operation and 24h after operation, but FBG (7.38±0.54) mmol/L, HbA1c (6.39±0.21)% and FBG (6.90±0.52) mmol/L and HbA1c (6.10±0.39)% in the study group were lower than those in the control group [(8.16±1.21) mmol/L, (7.53±1.05)%, (7.60±0.57) mmol/L, (6.50±0.41)%], the difference was statistically significant ( t value was 6.789-13.264, P < 0.05); there was no significant difference in SAS and SDS scores between the two groups at baseline ( P > 0.05), until discharge, the SAS and SDS scores of the treatment group were 35.81±5.49 and 42.08±4.91 respectively, which were significantly lower than those of the control group (42.21±5.53, 6.51±4.72) respectively, compared with the corresponding scale scores of the control group, the difference between the two groups after treatment was statistically significant ( t value was 5.386, 4.265, P < 0.05). Compared with 17.31% (9/52) of the control group, the incidence of complications in the study group decreased to 5.66% (3/53), there was significant difference ( χ2 value was 6.789, P < 0.05). The qualified rate of disease knowledge mastery in the study group (98.11%,52/53) was significantly higher than that in the control group (86.53%, 45/52), and the difference was significant ( χ2 value was 5.062, P < 0.05). Conclusion:The mindfulness-based stress reduction plus micro-class education can effectively control the laparoscopic appendectomy patients blood glucose, stabilize the mental emotions, increase the illness knowledge mastery degree, keep in good mood, reduce the postoperative complications and promote the fast recovery.