Objective To evaluate the diagosis value of different spiral computed tomography(CT) chest scanning methods in the differentiation of various pulmonary diseases,in order to avoid x-ray irradiation damage and reduce patients economic burden,but the diagnosis criterion should be guaranteed still.Methods 1000 cases of chest scan by spiral CT were randomly analyzed.In 927 conventional scan cases,including 155 cases of simple plainscan,474 cases of direct contrast scan,25 cases of plain plus contrast scans,73 cases of CT angiography.In addition,high resolution CT(HRCT) for 105 cases,thin layer scan for 86 cases,dynamic scan for 6 cases,and 40 cases bronchgraphy diagnosis were also carried out in the conventional scanning cases.Results The different CT scanning methods were adapted for diffenent pulmonary diseases.An adaptive scanning method and technique can decrease X-ray irradiation dosage and rise accuracy of diagnosis.Conclusions Aptimal scanning method and technique should be alternative according the clinical need and the patients status.

Objective Analysis of the teaching effect of the micro-classroom in the experimental teaching of diagnostics.Methods In the 50 classes of undergraduate clinical specialty of 2014 level of guangdong medical mniversity,2 classes were selected as the control group (n=67) by random number table method,2 classes were selected as the experience group (n=65).Theoretical knowledge and clinical skills were calculated.Recognition of two groups of students on two kinds of teaching methods.The data of two groups were compared using t-test and chi-square test.Results The results of the theoretical knowledge and clinical skills of the experimental group were significantly higher than the control group (P< 0.05).There was a significant difference between the two groups (P< 0.05),which was found to be able to deepen the understanding of theoretical knowledge,to improve the ability of clinical skills operation,to cultivate clinical thinking and to mobilize the enthusiasm of independent learning.Conclusions Micro classroom teaching can significantly improve the quality of experimental training of diagnoses.

Objective To investigate the effects of gambogic acid on proliferation,invasion and protein expression of MMP-2 in LoVo human colon cancer cell line.Methods The CCK-8 assay was used to determine the anti-proliferation ability.Transwell chamber assay was used to study the invasion of LoVo colon cancer cells.Western Blot was applied to examine the protein expression of MMP-2.Results CCK-8 assay showed that after cells treated with 1,2,4 μmol/L GA for 24 h,48 h the inhibition rates were(0.16±0.11)％,(0.24±0.08)％,(0.58±0.01)％,(0.67±0.03)％,(0.79±0.01)％ and (0.27±0.05)％,(0.69±0.09)％,(0.85±0.01)％,(0.87±0.01)％,(0.89±0.01)％,and there had statistically significant differences between control group (0 μmo/L) with experimental group (P＜0.05).Gambogic acid can effectively inhibit LoVo cells invasion at a low-dose concentration,which the numbers of cells that digested the matrigel in control group (0 μmo/L)was 120.50± 8.69 and 69.83 ±4.75 in experimental group (1 μnol/L),P＜ 0.05).Western Blot revealed that Gambogic acid can down-regulate the expression of MMP-2,which the levels of down-regulating the expression of MMP-2 after treated with 1,2,4 umol/L GA were 48.67％,74.72％and 82.70％ (P＜0.05) Conclusion Gambogic acid can effectively inhibit the growth and invasion of the LoVo cells,which may be related with down-regulating the expression of MMP-2.

Objective To investigate the mechanism and clinical characteristics of rapid spontaneous resolution of acute subdural hematoma in children. Methods The clinical data of 9 children with rapid spontaneous resolution of acute subdural hematoma were retrospective analyzed. Results Subdural hematoma of three cases were completely dissolved within 8 h, while those of the other 6 cases were significantly reduced which were completely dissolved in 48-72 h. Conclusions Rapid spontaneous resolution of acute subdural hematoma in children is rare in clinical practice. The redistribution and dilution of hematoma and the anatomical characteristics of the children patient determine the possibility of hematoma dissipation. The conservative treatment can get a good prognosis.

Objective To evaluate the application value of dual-source CT coronary angiography in low tube voltage setting and the influence of heart rate on image quality and radiation doses.Methods 323 patients suspected of coronary artery disease received retrospective ECG-gating coronary angiography with dual-source CT scanner,who were divided into low tube voltage group (100 kVp,n =201) and conventional voltage group (120 kVp,E group,n =122).No beta-blockers were taken before CT scan.All patients in low tube voltage group were divided into four groups according to the heart rate (HR):group A,HR≤59 beats per minute (bpm),n =50; group B,60≤HR ＜69 bpm,n =64; group C,70≤HR ＜91bpm,n =62;group D,HR ≥ 91 bpm,n =25.All images were transferred to a workstation for further processing.The best R-R interval reconstruction images of all groups were evaluated.The value of pitch,CT volume dosage index(CTDIvol),dose length product(DLP) and effective dose(E)were recorded.The pitch,the score of imaging quality of coronary artery segments and the radiation dose were compared with One-Way ANOVA.The influence of heart rate on image quality and radiation doses of coronary artery was analyzed.Results The value of pitch in groups A-D was 0.24 ± 0.03,0.29 ± 0.04,0.33 ± 0.05,0.38 ± 0.06,respectively,with statistical difference (F =62.57,P ＜ 0.05).The value of CTDIvol in groups A-E was (21.59±7.97),(20.24±6.03),(18.23±7.55),(18.14 ±5.75),(38.62±16.21)mGy,respectively,with statistical difference (F =85.16,P ＜ 0.05).The value of E in group A-E was (5.31 ±2.18),(4.85 ±1.70),(4.49 ± 1.86),(4.37 ±1.50),(8.75 ± 4.07) mSv,respectively,with statistical difference(F =44.83,P ＜ 0.05).The image score was (4.65 ±0.46),(4.55 ± 0.53),(4.55 ±0.53),(4.47 ±0.72),(4.66 ± 0.44) (F =1.89,P ＞ 0.05).Conclusions No beta-blockers was taken before CT scan,and a high quality image could be acquired by using dual-source CT coronary angiography in low tube voltage setting(100 kVp).When the auto ECG-gating is selected,medium and low HR have little influences on radiation dose,while the radiation dose could be decreased significantly at higher HR,but the possibility to obtain the high quality image decreased.

Objective To analyze the impact of the comprehensive reform of public hospitals in Tianjin on the cost structure of inpatients at a tertiary general hospital.Methods Homepage data of the medical records from January 2015 to June 2018 were selected from a tertiary general hospital in Tianjin.The Beijing version of diagnosis related groupings(BJ-DRGs) was used to compare the expense structure of these inpatients before and after such a reform.Wilcoxon signed rank sum test,Z test and Pearson correlation analysis were performed for each index.Results Since the reform,the number of hospital discharges and that of DRGs had remained basically stable,while the case mixed index(CMI) weight increased slightly(from 1.0065 to 1.0386);the total hospitalization expenses,medical expenses,nursing expenses,management expenses and consumables expenses had increased.On the other hand,the expenses of medication and medical technology decreased,and the differences of these expenses were statistically significant (P ＜0.05).The time consumption index (0.87) and drug consumption index (0.80) were always lower than average,but the cost consumption index (1.38) remains above average with a slight rise.Conclusions The reform of public hospitals in Tianjin has encouraged such hospitals to improve their service procedures by adjusting such measures as pricing of medical services,and promoted their proactive management of hospitals.Hence the initial goal of "controlling costs,adjusting structure,and reducing costs" has been met.However,cost rise control still deserves major attention.

Portal vein thrombosis (PVT) is one of the most common complications of liver cirrhosis. Due to coagulation disorder and the risk of bleeding in liver cirrhosis, there are many controversies over the treatment of liver cirrhosis with PVT in clinical practice. Common therapies for PVT include anticoagulant therapy, intervention, and thrombolysis. This article elaborates on the current status of the treatment of liver cirrhosis with PVT, in order to provide help for the development of standard and reasonable clinical treatment strategies.

Objective:To evaluate the short-term rehabilitation effect of wearable visual training devices based on extended reality (XR) glasses in patients after macular hole surgery.Methods:A self-controlled study was conducted.Eleven patients with monocular low vision after macular hole surgery were recruited at Renmin Hospital of Wuhan University from October 2022 to March 2024.All patients underwent biofeedback training for 3 months using the independently developed visual rehabilitation training glasses LOOKBON T10.The LogMAR best corrected visual acuity (BCVA), retinal sensitivity, effective fixation rate, fixation stability, reading speed, vertical metamorphopsia (MV), horizontal metamorphopsia (MH), and Chinese version of the visual-related quality of life assessment form (CVRQoL-25) were compared before and after training.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Renmin Hospital of Wuhan University (No.WDRY2024-K263).Written informed consent was obtained from each subject.Results:After training, the patients' BCVA, retinal sensitivity, effective fixation rate, fixation stability, and reading speed were 0.69±0.19, (21.61±2.75)db, (92.43±4.06)%, (93.09±4.31)%, and (104.82±21.85) characters/minute, respectively, which were significantly improved compared to 0.85±0.28, (17.71±3.17)db, (31.83±19.05)%, (32.35±19.12)%, and (69.64±20.17) characters/minute before training ( t=5.253, -5.987, -11.561, -12.003, -11.682; all at P<0.001).After training, MV and MH were (0.29±0.20)° and (0.21±0.24)°, respectively, which were significantly reduced compared to pre-training (0.44±0.24)° and (0.43±0.41)° ( t=9.238, 4.068; both at P<0.01).After training, the CVRQoL-25 score was 1 193.18±229.43, which was significantly higher than pre-training 947.73±203.86 ( t=-11.687, P<0.001). Conclusions:The application of wearable visual training equipment based on XR glasses can effectively improve the visual function of patients with poor visual function recovery after macular hole surgery, and enhance their quality of life.

Objective: To isolate a bacteriophage against pan-drug resistant Klebsiella pneumoniae in a burn patient, and to study its biological characteristics, genomic information, and effects on bacterial biofilm. Methods: (1) In 2018, pan-drug resistant Klebsiella pneumoniae UA168 (hereinafter referred to as the host bacteria) solution isolated from the blood of a burn patient in Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (hereinafter referred to as Ruijin Hospital) was used to isolate and purify the bacteriophage against pan-drug resistant Klebsiella pneumoniae from the sewage of Ruijin Hospital with sewage co-culture method, drip plate method, and double-agar plate method. The bacteriophage was named as phage KP168 and the plaque morphology was observed. (2) The phage KP168 solution was taken for cesium chloride density gradient centrifugation and dialysis, and then the morphology of phage KP168 was observed through transmission electron microscope after phosphotungstic acid negative staining. (3) The phage KP168 solution was taken to determine the lytic ability of the phage KP168 against 20 strains of pan-drug resistant Klebsiella pneumoniae isolated from the burned patients′ blood in Ruijin Hospital by the drip plate method, and then the lysis rate was calculated. (4) The phage KP168 solution at a initial titer of 9.3×10¹¹ plaque-forming unit (PFU)/mL (400 μL per tube) and the host bacteria solution at a concentration of 1×10⁹ colony-forming unit (CFU)/mL (4 mL per tube) were conventionally shaking cultured together for 4 hours at multiplicity of infection (MOI) of 10.000, 1.000, 0.100, 0.010, or 0.001, respectively (1 tube per MOI). The titer of phage KP168 was measured by the double-agar plate method (the measurement method was the same below) to select the optimal MOI. The experiment was repeated three times. (5) The host bacteria solution at a concentration of 1×10⁹ CFU/mL (4 mL per tube) and the phage KP168 solution at an adjusted titer of 5×10⁷ PFU/mL (400 μL per tube) were mixed at the MOI of 0.005. The plaques were counted 0 (immediately), 1, 2, 3, 4, 5, 15, and 30 minutes (1 tube at each time point) after mixing by the double-agar plate method (the counting method was the same below), and the percentage of adsorbed phages was calculated to screen for the optimal adsorption time. The experiment was repeated three times. (6) The host bacteria solution at a concentration of 1×10⁹ CFU/mL (300 μL per tube) and the phage KP168 solution at a titer of 5×10⁸ PFU/mL (60 μL per tube) were mixed at MOI of 0.005 and conventionally shaking cultured after standing for the optimal adsorption time. The phage KP168 titer was measured 0 (immediately), 10, 20, 30, 40, 50, 60, 70, 80, 90, and 100 minutes after culture, and a one-step growth curve was drawn. The experiment was repeated three times. (7) The phage KP168 solution at a titer of 2.5×10¹⁰ PFU/mL was left to stand for 1 hour at 37, 40, 50, 60, or 70 ℃ (3 tubes at each time point, 1 mL per tube) for counting the plaques, and then the thermal stability curve was drawn. SM buffer at a pH values of 5.0, 6.0, 7.0, 7.4, 8.0, 9.0, or 10.0 were added to the phage KP168 solution at a titer of 3.0×10¹⁰ PFU/mL, respectively. The mixed solution was left to stand for 1 hour at 37 ℃ (3 tubes of each pH, each tube containing 100 μL phage KP168 solution and 900 μL SM buffer), and then the plaques were counted, and an acid-base stability curve was drawn. (8) The phage KP168 solution was taken for DNA extraction and sequencing after dialysis as in experiment (2). The whole genome was annotated with Prokka to obtain the coding sequence of phage KP168. Nucleotide′s BLAST function was used to proceed nucleic acid sequence alignment for finding a known phage with the highest similarity to the phage KP168 nucleic acid sequence, and Blastx function was used to translate the coding sequence into protein for its function prediction. The comparison with Antibiotic Resistance Genes Database and Virulence Factors Database was proceeded. (9) In a 96-well plate, at a MOI of 1.000, 0.100, 0.010 or 0.001 (3 wells per MOI), 20 μL phage KP168 solution at a initial titer of 5.8×10¹⁰ PFU/mL was added to 200 μL host bacteria solution at a concentration of 1.5×10⁸ CFU/mL (the same concentration below) for co-cultivation for 48 hours. After 200 μL host bacteria solution was left to stand for 48 hours, 20 μL phage KP168 solution at a titer of 1×10^6, 1×10^7, 1×10^8, 1×10^9, or 1×10¹⁰ PFU/mL (3 wells per titer) was added respectively for action for 4 hours. In both experiments, 200 μL host bacteria solution added with 20 μL SM buffer (3 wells) acted as a negative control, and 220 μL LB culture medium (3 wells) acted as a blank control. Absorbance values were measured by a microplate reader, and inhibition/destruction rates of biofilm were calculated. The experiments were both repeated three times. Results: (1) The plaques of phage KP168 successfully isolated and purified were transparent and round, and its diameter was approximately 1.5 mm. (2) The phage KP168 has a regular polyhedron structure with a diameter of about 50 nm and without a tail. (3) The phage KP168 could lyse 13 of 20 strains of Klebsiella pneumoniae from burned patients, with a lysis rate of 65.0%. (4) When MOI was 1.000, the titer was the highest after co-culturing the phage KP168 with the host bacteria for 4 hours, which was the optimal MOI. (5) After the mixing of the phage KP168 with the host bacteria for 4 minutes, the percentage of the adsorbed phage reached the highest, which was the optimal adsorption time. (6) The one-step growth curve showed that during the lysis of the host bacteria by phage KP168, the incubation period was about 10 minutes, and the lysis period was about 40 minutes. (7) With the condition of 40 ℃ or pH 7.4, the number of plaques and the activity of phage KP168 reached the highest. (8) The genome of phage KP168 was a linear double-stranded DNA with a length of 40 114 bp. There were 48 possible coding sequences. It had the highest similarity to Klebsiella phage_vB_Kp1. The most similar known proteins corresponding to the translated proteins of coding sequences contained 23 hypothetical proteins and 25 proteins with known functions. No resistance genes or virulence factor genes were found. The GeneBank accession number was KT367885. (9) After 48 hours of co-cultivation of the phage KP168 and the host bacteria at each MOI, the inhibition rates of biofilm were similar, with an average of about 45%. After the phage KP168 with a titer of 1×10⁹ PFU/mL acted on the biofilm formed by the host bacteria for 4 h, the destruction rate of biofilm was the highest, reaching an average of 42%. Conclusions In this study, a bacteriophage against pan-drug resistant Klebsiella pneumoniae from a burn patient, phage KP168, is isolated from sewage, which belongs to the tailless phage. It has a wide host spectrum, short adsorption time, and short incubation period, with certain thermal and acid-base stability. Its genomic information is clear, and it does not contain resistance genes or virulence factor genes. It also has an inhibitory effect on the formation of bacterial biofilm and a destructive effect on the formed bacterial biofilm.

The correct thoughts and principles of diagnosis and treatment of chronic refractory wounds need to be formulated. Through the relevant domestic and international consensus and based on clinical experience, the Thoughts and principles of diagnosis and treatment of chronic refractory wounds in China is proposed. It is considered that in the diagnosis and treatment of chronic refractory wounds, in the case of fully understanding the patient′s medical history, the following thoughts and principles should be complied in order. (1) Pay attention to the cleanliness of the wound after being cleaned. (2) Reasonably perform debridement to avoid being " excessive" or " not thorough". (3) Reasonably perform examination, diagnosis, and differential diagnosis of pathogenic factors. (4) Treat according to etiology. (5) Find comorbidities and prevent adverse outcomes. (6) Select the correct wound treatment method reasonably and timely. When the conservative wound care treatment is considered, pay attention to embodying the concept of etiological treatment, treat the wound according to the principles of safety, phase, selectivity, and effectiveness, and make a reasonable choice of continuing conservative treatment or surgical treatment in time after completing the preparation of the wound bed. When surgical treatment is considered, pay attention to the selection of reasonable surgical method and donor site, pay attention to the healing rate of surgical wound site and the outcome of donor site, and give reasonable protection to the wound site after surgery. (7) Carry out rehabilitation treatment after wound healing and related health education.