Confronted with similar problems and difficulties in mainland,Taiwan reformed its medical education. The reform included setting up flexible program,formulating objective and detailed rotary guide,making the best of the resources,implementing medical humanities education based on the reality and forming unique cultivation system and mode. These measures can be taken as references for medical education reform in mainland.

Objective Doppler ultrasonography was used to screen the incidence of central venous catheter (CVC) thrombosis in severe patients to observe the incidences of catheter-related thrombosis (CRT) at subclavian (SC) and internal jugular (IJ) venous insertion sites, and to analyze the factors affecting the thrombosis. Methods One hundred and twenty three adult patients with IJ or SC CVC admitted to the Department of Intensive Care Unit (ICU) of Zhongnan Hospital of Wuhan University from May to December 2015 were enrolled to be the research objects, they were divided into an IJCVC group (35 cases) and a SCCVC group (88 cases) according to different catheterization sites; they were divided into an operation group (85 cases) and a non-operation group (38 cases) according to whether operation was performed or not; and they were also divided into an anticoagulation group (25 cases) and a non-anticoagulation group (98 cases) according to whether anticoagulation therapy was used or not. Doppler ultrasonography was performed every day to observe the incidences of CRT during ICU stay. Results One hundred and twenty-three patients were included in this study. CRT was detected in 11 (8.9%) patients, with an incidence of 22.1 per 1 000 catheter-days. All the 11 cases with CRT were presented within 3 days after the insertion, with 9 cases (81.8%) on the first day and 2 cases (18.2%) on the third day. The incidence of CRT in SCCVC group was significantly lower than that in IJCVC group [5.7% (5/88) vs. 17.1% (6/35), P < 0.05], with the rates of 12.6 and 59.4 per 1 000 catheter-days, respectively. There were no statistical significant differences in the incidences of CRT between operation group and non-operation group [11.8% (10/85) vs. 2.6% (1/38)], and between anticoagulation group and non-anticoagulation group [8.0% (1/25) vs. 9.2% (2/98), both P > 0.05]. Conclusions The incidence of CRT at IJCVC site is estimated to be 3-times higher than that at SCCVC site, anticoagulants or surgical operation may have impacts on the incidence of CRT, although there were no statistically significant differences. The CRT usually occurs within 3 days after the catheter insertion. Frequent bedside ultrasonography in the first 3 days after catheterization can confirm the diagnosis and guide clinical treatment.

Composed by high fat, low carbohydrate, adequate protein and other nutrients, ketogenic diet (KD) is a kind of diet.KD simulates starvation has fatty acid metabolism to produce ketone body, thus providing energy in liver, and it has various functions such as anti-inflammation.KD has been used in nervous system diseases, but its mechanism is still not very clear.As a result, the review expounds KD mechanism of anti-inflammatory action from the inhibition of pathogenic microorganisms, adjusting intestinal flora, relieving pain and reducing oxidative stress in several aspects.

Objective: To examine nurses′ experiences regarding the benefits and obstacles of using WeChat in health education for patients with PICC-line. Methods: A semi-structured interview was conducted with 12 nurses who using WeChat to assist health education for patients with PICC-line. Data were analyzed based on Colaizzi′s phenomenological research method. Results: Ten themes of three aspects were extracted: the benefits of using WeChat in health education include reduction in medical care consumption and costs, reduction in workload, facilitating improvement in the quality of care, promotion of the nurse–patient relationship, improvement in self-worth and professional knowledge; the obstacles of using WeChat in health education include perceived risk, disturbance to personal life, Sense of uncertainty; the advice of using WeChat in health education. Conclusions Exploring the experiences and obstacles of nurses regarding using WeChat in health education for patients with PICC-line can help improve the quality of health education and meanwhile provide the reference and basis for clinical health education.

Objective: o explore the problems encountered in the application of GBZ/T 237-2011 edition of "Diagnosis of Chronic Obstructive Pulmonary Disease Caused by Occupational Stimulating Chemicals" , and to provide reference for the revision of the new standard. Methods: Delphi expert survey method was used to consult experts on the reasonableness of six primary indicators (scope of application, diagnostic principles, diagnostic indicators, treatment principles, diagnostic grading, appendix A) and their corresponding secondary indicators in the Diagnosis of Chronic Obstructive Pulmonary Disease (COPD) caused by Occupational Stimulant Chemicals. Results: The results of the first round of Delphi method showed that the reasonable mean of the diagnostic criteria about long-term occupational history, smoking history and clinical diagnostic criteria was less than 7, and the coefficient of variation was greater than 0.25, indicating that the experts disagreed with the scope of application of the original criteria; the average of smoking history and 3-year working age were 1.78 and 3.43 (less than 7) respectively, which indicated that the experts agreed that the two diagnostic indexes were not conducive to the practical work of occupational disease clinicians; among the diagnostic indicators, smoking history and smoking volume were taken into account in a comprehensive way, and the average values were 7.61 and 7.61 (greater than 7) , respectively. the coefficient of variation was less than 0.25, indicating that the experts had concentrated their opinions and agreed that such indicators could be considered into the diagnostic index system. Conclusion "Diagnosis of Chronic Obstructive Pulmonary Disease Caused by Occupational Stimulating Chemicals" should be improved by expanding the scope of occupational irritant gases. Smoking problems can be considered in combination with clinical practice, and occupational exposure history can be considered to reduce appropriately.

Objective To develop a diagnostic model based on deep neural network for intelligent discrimination of thyroid function. Methods A total of 1616 patients ( 283 males, 1333 females, average age:52 years) who underwent thyroid imaging between May 2016 and June 2018 were selected. According to the clinical diagnosis, the 1616 cases included 299 normal thyroid cases, 876 hyperthyroidism cases and 441 hypothyroidism cases. Feature extraction and learning training were performed on 1000 training set sam-ples by two deep neural network models ( AlexNet;deep convolution generative adversarial networks ( DCGAN) ) using deep learning algorithm. Performance verifications were implemented on 616 test set samples. The con-sistency between the verification results of the two models and the clinical diagnosis was analyzed by Kappa test. Meanwhile, the time advantage of the intelligent diagnosis models was analyzed. Results The average diagnostic time of AlexNet model was 1 s/case, and the classification accuracy for normal thyroid, hyperthy-roidism, hypothyroidism were 82.29％(79/96), 94.62％(369/390), 100％(130/130), respectively. The Kappa value between results of AlexNet model and clinical diagnosis was 0.886 ( P<0.05) . The average di-agnostic time of DCGAN model was 1 s/case, and the classification accuracy for normal thyroid, hyperthy-roidism, hypothyroidism were 85.42％(82/96), 95.64％(373/390), 99.23％(129/130), respectively. The Kappa value between results of DCGAN model and clinical diagnosis was 0.904 ( P<0.05) . Conclusion The deep neural network intelligent diagnosis model can quickly determine the functional status of thyroid gland in thyroid imaging, and it has a high recognition accuracy, thus providing a new method for thyroid image review.

Objective: To investigate the functional classification of differentially expressed genes in manganese-poisoned rats and related metabolic pathways, and to provide a reference for the study of the mechanism of manganese poisoning and gene regulation in the prevention and treatment of manganese poisoning. Methods: Six healthy specific pathogen-free male Sprague-Dawley rats were randomly divided into control group and experimental group according to body weight, with 3 rats in each group. Rats in the experimental group were injected intraperitoneally with MnCl₂·4H₂O (25 mg/kg) at 0.2 ml/100 g once every 48 h, and the control group was injected with phosphate-buffered saline at the same dose. After one month of exposure, the rats were anesthetized and then sacrificed by cardiac puncture blood collection. The striatum was isolated on ice, and RNA was extracted to establish a DNA data library. Whole genome sequencing was used to identify the differentially expressed genes in the rats with manganese poisoning. Gene Ontology functional enrichment analysis and pathway enrichment analysis were performed to investigate the possible metabolic pathways in which the differentially expressed genes may participate. Results: A total of 18439 genes were detected in the striatum of rats, and 17 differentially expressed genes were screened out. Among them, 10 genes were up-regulated, and 7 genes were down-regulated. According to gene function analysis, 164 functional branches and 26 metabolic pathways with high gene enrichment were screened out. The genes were enriched in synaptic signaling, signal transduction, etc., especially behavioral function. The metabolic pathways with high gene enrichment were endocytosis pathway, PI3K-Akt pathway, and neuroactive ligand-receptor interaction pathway, in which the PI3K-Akt pathway had enrichment of the same differentially expressed gene (29 517) as the FoxO signaling pathway and mTOR signaling pathway, and the neuroactive ligand-receptor interaction pathway had enrichment of the same differentially expressed gene (24 415) as the glutamatergic synaptic pathway. Conclusion The differentially expressed genes in manganese-poisoned rats may influence the susceptibility to manganese poisoning through the PI3K-Akt pathway, mTOR metabolic pathway, or FoxO metabolic pathway, and may be involved in behavioral changes.

Objective To explore the changes in serum energy metabolites in patients with peripheral T-cell lymphoma,and investigate serum biomarkers for monitoring peripheral T-cell lymphoma from the perspective of energy metabolism.Methods Multiple/selected reaction monitoring(MRM/SRM)was used to detect the energy-related metabolites in the sera of 16 patients with newly diagnosed peripheral T-cell lymphoma admitted in the Hematology Medical Center of the Second Affiliated Hospital of Army Medical University from November 2020 to December 2021,as well as 10 recruited healthy volunteers.The corresponding clinical data including medical history,laboratory results and image data were collected and retrospectively analyzed.Results Significant differences were seen in the contents and expression profiles of serum energy metabolism-related products between the patients and the healthy volunteers.The patients had significantly reduced serum contents of cyclic AMP,succinate,citrate and cis-aconitate(P＜0.05),and elevated D-glucose 6-phosphate content(P＜0.05).The serum contents of citrate and succinate were negatively correlated with the risk stratification(low-,moderate-and high-risk)and clinical stage of the disease(P＜0.05).Meanwhile,there was a negative correlation between the contents of L-malic acid and citrate and the mid-term efficacy evaluation results,such as complete/partial response(CR/PR)or stable disease(SD)(P＜0.05).For patients with extranodal NK/T cell lymphoma(n=10),there were also significant reductions in the contents of cyclic AMP,succinate,citrate,isocitrate and cis-aconitate in the sera of patients compared with healthy volunteers(P＜0.05),and the contents of citrate and succinate were negatively correlated with the clinical stage(P＜0.05)and were rather correlated with mid-term efficacy evaluation results(CR/PR or SD)(P＜0.05).For patients with angioimmunoblastic T-cell lymphoma(n=6),the serum contents of cyclic AMP,citrate and succinate were significantly lower,while the content of D-glucose 6-phosphate was higher when compared with the healthy volunteers(P＜0.05),and the content of succinate was negatively correlated with both clinical stage and risk grade of the patients(P＜0.05).Conclusion There are 5 serum differential metabolites identified between patients with peripheral T-cell lymphoma and healthy controls,and succinate and citrate are expected to be serum biomarkers of peripheral T-cell lymphoma.

OBJECTIVETo explore the clinical efficacy of herbal-partitioned moxibustion on moderate and severe persistent allergic rhinitis (AR) with spleen-deficiency syndrome.

METHODSWith prospective case series study method, forty-seven patients of moderate and severe persistent AR with spleen-deficiency syndrome were treated with herbal-partitioned moxibustion at Yintang (GV 29), Shenque (CV 8), Hegu (LI 4) and Zusanli (ST 36), once every two days, three treatments a week, continuously for 8 weeks. The visual analogue scale (VAS), rhinoconjunctivitis quality of life questionnaire (RQLQ) and scores of spleen-deficiency syndrome were recorded before treatment, 2 weeks, 4 weeks and 8 weeks into treatment as well as 4 weeks after treatment; in addition, the improvement rate of each index was compared before and after treatment.

RESULTSCompared before treatment, the VAS, RQLQ and scores of spleen-deficiency syndrome were significantly reduced 2 weeks, 4 weeks and 8 weeks into treatment as well as 4 weeks after treatment (<0.05,<0.01). The efficacy was gradually increased 2 weeks, 4 weeks and 8 weeks into treatment (all<0.01). On the 8 weeks into treatment, the improved and markedly effective rate was 59.6% (28/47) for VAS, 19.1% (9/47) for RQLQ and 14.9% (7/47) for scores of spleen-deficiency syndrome; the total effective rate was all 85.1% (40/47). Compared with 4 weeks after treatment, there was no significant difference (all>0.05).

CONCLUSIONSThe herbal-partitioned moxibustion has superior efficacy for moderate and severe persistent allergic rhinitis with spleen-deficiency syndrome.