Objective To explore the application and effectiveness of simulated patient role play in the inquiry and the medical record writing teaching.Methods Carrying out the teaching model of simulated patient role play in the Second Clinical Medical College of Southern Medical University to the undergraduate students of grade 2009 snd 2010 in diagnose inquiry and medical record writing training class.A self-designed student questionnaire mainly about atmosphere of class,study enthusiasm,Self-evaluation of learning efficiency,the effect of the medical record writing in-class training and so on was used to do the survey.On the other hand,questionnaire for teachers included students' performance,students' writing ability,etc.100 students and 50 teachers were investigated with the survey.The percentage of the options of each question on the questionnaire was calculated in order to analyze the new teaching mode.Results The random questionnaire survey showed that 85％ (85/100) of the students believe that the new teaching mode can activate classroom atmosphere and improve learning motivation.About 62％(62/100) of the students said medical record writing errors can be obtained and corrected timely in-class training.Most students in grade 2009 have better capacity in medical record writing than those students who did not contact with new teaching mode.Conclusion The teaching model of simulated patient role play in the analogue inquiry and medical record writing is efficient and feasible in medical education,which can improve students' practical ability and is expected to be applied in undergraduate medical education.

Objective To investigate and analyze the clinical learning environment and professional identity among undergraduate nursing students, and discuss the relationship between two variable, so as to provide basis for ensuring the stability of the nursing staff. Methods 288 undergraduate nursing students who were practicing in Tianjin 3A grade hospital were evaluated using questionnaires about clinical learning environment and professional identity. The correlation analysis was performed between two variable. Besides, multiple regression analysis was used to identify factors that affect the nursing students′ professional identity. Results The total score of 288 nursing students′clinical learning environment and their professional identity was (3.44±0.66) points and (3.65±0.55) points respectively, which were at the middle level. The score of clinical learning environmental was positively correlated with professional identity score (P<0.01). The result of multiple regression analysis showed that professional selectivity had influence on nursing students′ professional identity. With controlling the demographic variables, undergraduate nursing students′ clinical learning environment could explain 58.2% of professional identity. Conclusions Undergraduate nursing students′ clinical learning environment and professional identity are at the middle level. Hospitals should pay more attention to the relationship that clinical learning environment have influence on undergraduate nursing students′professional identity.Measures should be taken to ensure the stability of the high-quality nursing personnel.

Objective To investigate the effect of IL-1 7A on lipopolysaccharide (LPS)-induced neuroinflammation and fear conditioning test.Methods Among 70 male SD rats aged 18 months, firstly,thirty rats were randomly divided into five groups:control group(group A),LPS 6 h group (group B),12 h group(group C),24 h group(group D),48 h group(group E).Group A were injected intraperitoneally with normal saline and groups B,C,D and E were injected with LPS 500 μg/kg.Ani-mals of groups A,B,C,D and E were killed respectively after LPS injection and their hippoeampus tis-sue was detected for the concentration of IL-1 7A.Secondly,forty rats were randomly divided into 4 groups:control group(group O),IL-1 7A antibody group(group P),LPS group (group Q),IL-1 7A antibody+LPS group(group R).Group P and group R were injected intracerebroventricularly with IL-1 7A antibodies 3 μl (200 μg/μl),groups O and Q were injected equal volume of normal saline.30 min later,groups Q and R were injected intraperitoneally with LPS 500 μg/kg,groups O and P were in-jected equal volume of normal saline.24 h later,contextual fear conditioning test was performed. Then,all animals were killed and their hippocampus tissue would be detected for the concentration of TNF-αand IL-6,as well as the expression of Iba1-positive cells.Results The concentration of IL-1 7A of groups B,C,D and E increased significantly compared with group A (P <0.01 ),there was no difference between groups E and A.The freezing time of groups Q and R was significantly shortened than that in group O(P <0.01 or P <0.05 ),the freezing time of group R was significantly longer than that in group Q(P <0.01).The concentration of TNF-αand IL-6 of groups Q and R was obvi-ously higher than group O(P <0.01 ),the concentration of TNF-α and IL-6 of group R lower than group Q(P <0.01).The expression of Iba1-positive cells in hippocampal area CA1 of groups Q and R was obviously increased compared with group O(P <0.01).Compared with group Q,the expression of Iba1-positive cells in hippocampal area CA1 of group R were obviously decreased (P < 0.05 ). Conclusion IL-1 7A is implicated in the early stage of LPS-induced neuroinflammation and the chan-ging of freezing time in contextual fear conditioning in aged rats.

Objective To investigate the level and influencing factors of nurses' professional growth,in order to provide evidence for promoting the satisfaction degree of nurses with their career and reducing nursing turnover rate.Methods A random sample of 526 clinical nurses from 6 third-level and firstclass hospitals in Tianjin were investigated with Career Growth Scale.Resalts The score of chnical nurses' professional growth averages was (2.44±0.53) points.Single factor analysis found that working purpose,the work-ing years and sex affected the total score of career growth and the score of each dimension statistically.Multiple linear regression analysis showed that working purpose was the greatest impact on the degree of the career growth score among influencing factors,followed by the working years and sex.Conclusions Nurses' professional growth is on the average level.All relevant departments should strengthen the construction of professional nurse,improve the promotion and salary system to strengthen the nurses' career growth,in order to enhance the nurse's career satisfaction,reduce the nurse turnover rate.

The effects of quercetin-3-O-β-D-glucuronide (Q3GA)on the triglyceride metabolism and oxidative stress in steatotic HepG2 cells and the underlying mechanism were investigated in this study.Significant fat accu-mulation was documented by Oil Red O staining;intracellular triglyceride levels were detected by triglyceride(TG)enzymatic assay.DCFH-DA staining assay was performed to observe reactive oxygen species (ROS)pro-duction of HepG2 cells.The level of malondialdehyde(MDA)and superoxide dismutase(SOD)were assayed by thibabituric acid method and xanthine oxidase method.Changes in the mRNA expression of peroxisome prolifera-tor-activated receptorα(PPARα);carnitine palmitoyltransferase 1 A(CPT1 A);medium chain acyl-CoA dehydro-genase (MCAD);cytochrome P450 4A11(CYP4A11)and acyl-CoA oxidase(ACO);which are related with fatty acid oxidation were assessed by RT-PCR.Our results showed that Q3GA obviously reduced fat deposition and TG content.At the same time;Q3 GA decreased MDA content and significantly increased the SOD activity with reduced ROS production.Moreover;the PPARα;CPT1A;MCAD expression-related fatty acid βoxidation was upregulated with the treament of Q3GA;while without any change of the expression of CYP4A11;ACO.In conclu-sion;Q3GA prevents FFA-induced HepG2 cell steatosis;and enhances mitochondrial fatty acidβoxidation;which may partly be related to its anti-oxidation ability.

OBJECTIVE To evaluate the status of the anxiety and depression in the inpatients of the otolaryngology with hospital anxiety and depression scale(HADs). METHODS A cross-sectional study was conducted from October 2014 to September 2016 at the Department of Otolaryngology, Affiliated Hospital of Yan'an University. We recruited 624 Chinese otolaryngology's inpatients to determine the prevalence of anxiety and depression using the HADs. HADs consists of 14 items, depression(seven items) and anxiety(seven times), each with four choices numbered alphabetically. Each of the subscales' scores ranges from 0 to 21, corresponding to total scores of 0 to 42, with higher scores indicating greater distress. Psychological distress was assessed for adult inpatients among the department of otolaryngology by a standardized HADs. In addition, the nasal bone fracture patients were treated as control and compared it to other diseases. Demographic data and clinical information collected from the patients and their hospital records were reviewed. RESULTS 1. Patients with sensorineural hearing loss, secretory otitis media, sudden sensorineural hearing loss, benign paroxysmal positional vertigo, peripheral facial paralysis, chronic sinusitis, polyp of vocal cord, laryngeal paralysis, fungal sinusitis and OSAHS revealed depressive and anxiety symptoms in comparison with the control. 2. Psychological distress of patients with sensorineural hearing loss and laryngeal paralysis were significantly related to education, which the anxiety or depression scores tended to increase with the education(P<0.05). CONCLUSION Depression and anxiety disorders were common in the local population of otolaryngology's inpatients. Recognizing the predictors for psychiatric morbidity could assist clinicians to identify those patients with a predisposition to developing psychiatric complications, and refer them for appropriate treatment. We recommend screening for psychological distress in patients with some otolaryngological diseases using a simple HAD tool to identify those patients who might benefit from a more psychologically based approach to therapy.

Teaching rounds is an important part of clinical teaching but it is difficult to implement in place for a variety of reasons. To endocrine and metabolic section as an example, Lack of enthusiasm, inadequate preparation and other issues result that teaching rounds is difficult to achieve the desired effect in the teaching rounds, especially in the English teaching rounds. In view of the above situation, based on the concept of PBL to carry out teaching rounds in English is not only an important method to cultivate the clinical thinking of medical students, but also an important measure to improve teachers' and students' English proficiency, as well as to cultivate medical students' clinical thinking. The last but not the least, carrying out teaching rounds in English is an important measure for medical education reform and improve-ment. Facts have proved that carrying out teaching rounds in English has a high practicality and feasibility in clinical practice.

Background Nanoemulsions (NEs) is one of the most popular ophthalmic colloidal drug delivery system due to its long-term stability, low toxicity and irritancy, considerable capacity for solubilization of lipophilic drug molecules and great potential in bioavailability improvement.The cornea pathway is the main route of intraocular absorption after topical use of NEs.Though NEs possess numerous physiological and physicochemical advantages,the use of NEs cannot always obtain satisfactory results.Objective This study was to investigate the impacts of epithelium and stroma on the corneal permeation of topical ophthalmic terbinafine hydrochloride nanoemulsions (TH-NEs).Methods TH-NEs was prepared by the self-emulsification method.The size and Zeta potential of the oil droplets in the formulation were analyzed using a dynamic light-scattering particle size analyzer.The high performance liquid chromatography (HPLC) was used for the in vitro release study.Sixty New Zealand albino rabbits were randomly divided into intact cornea group and cornea epithelium debrided group.The cornea epithelium of the left eyes was debrided in the cornea epithelium debrided group.The TH-NEs were instilled into the lower conjunctival sac of left eyes.Six rabbits were executed from each group 15,30,60,120 and 240 minutes after dosing,respectively.The corneas were collected and analyzed by HPLC.The fluorescein diacetate (FDA) was used to label the TH-NEs.Two C57BL/6 mice with left cornea epithelium debrided and 2 normal mice were used for the fluorescence tracing study.The fluorescence distribution of FDA labeled TH-NEs was observed by a two-photon laser confocal scanning microscope 30 minutes and 60 minutes after single instillation.Results The average size and Zeta potential of the oil droplets were 51.37 nm and-0.232 7 mV respectively,and 0.482％ of encapsulated drugs was released from the TH-NEs after 12 hours.The peak concentrations of TH in the intact cornea and epithelium debrided cornea were (17.85 ± 2.79) μg/g and (4.40± 1.75) μg/g respectively, which occurred 15 minutes postdose.The drug concentrations in the intact cornea were significantly higher than that in the debrided cornea 15,30,60 and 120 minutes after dosing, with significant differences between them (t =9.998,8.658,6.903,7.576;all at P=0.000).The fluorescence was observed in the cornea epithelium when the cornea was intact.The fluorescence intensity in the superior layer of corneal epithelium was obviously higher than that in the deep layers of corneal epithelium 30 minutes and 60 minutes after dosing.No fluorescence was observed in the cornea stroma of both eyes.Conclusions The cornea epithelium is the main of absorption and distribution position of TH-NEs.The cornea stroma is the dominating permeation barrier for the intraocular transportation of the TH-NEs.The cornea stroma may stop the permeation of TH-NEs by molecular exclusion mechanism.

Objective To summarize and analyze the dynamic change of HBsAg levels in patients with chronic Hepatitis B (CHB) after receiving nucleos(t)ide analogues (NAs) as antiviral treatment.Methods Patients who were performed quantitative Hepatitis B surface antigen(qHBsAg) from July 30, 2012 to December 30,2016 in Peking Union Medical College Hospital were retrospectively enrolled.qHBsAg, HBV DNA, HBeAg were collected and analyzed at baseline and at 192-week follow-up every 24 weeks.qHBsAg and HBeAg were assessed with chemiluminesent microparticle immuno assay(CMIA).HBV DNA was assessed with PCR and COBAS Amplicor.Results 60 patients were included.Patients in HBeAg-positive group had higher HBV DNA than that in HBeAg-negative group (P<0.05)at baseline and the two groups both were under detection limit after 48 weeks.BaselineqHBsAg in HBeAg positive-group and negative-group were (3.43±0.73) log10 IU/mL, (3.08±0.47) log10 IU/mL respectively.qHBsAg in HBeAg-positive group was higher than that in HBeAg negative-group on all follow-ups(P<0.05) except 48weeks.However on 168 weeks and 192 weeks, difference between the two groups was statistically significant(P<0.05).In HBeAg-positive group,quantitative HBeAg dropped significantly during antiviral treatment.Conclusions HBV replication can be suppressed in the process of long-term NAs treatment in CHB patients.However qHBsAg decline is not so obvious, which indicates that HBsAg cleavence is difficult,and long-term NAs therapy is still necessary.

This study aims to investigate the effects of fibroblast growth factor 21 (FGF-21) on learning and memory abilities and antioxidant capacity of D-galactose-induced aging mice. Kunming mice (37.1 +/- 0.62) g were randomly divided into normal control group, model group and FGF-21 high, medium and low dose groups (n = 8). Each group was injected in cervical part subcutaneously with D-galactose 180 mg x kg(-1) x d(-1) once a day for 8 weeks. At the same time, FGF-21-treated mice were administered with FGF-21 by giving subcutaneous injection in cervical part at the daily doses of 5, 2 and 1 mg x kg(-1) x d(-1). The normal control group was given with normal saline by subcutaneous injection in cervical part. At seventh week of the experiment, the learning and memory abilities of mice were determined by water maze and jumping stand tests. At the end of the experiment, the mice were sacrificed and the cells damage of hippocampus was observed by HE staining in each group. Reactive oxygen species (ROS), malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPx), catalase (CAT) and total antioxidant capacity (T-AOC) in the brain of mice were determined. The results showed that different doses of FGF-21 could reduce the time reaching the end (P < 0.01 or P < 0.05) and the number of touching blind side (P < 0.01 or P < 0.05) in the water maze comparing with the model group. It could also prolong the latency time (P < 0.05) and decrease the number of errors (P < 0.01 or P < 0.05) in the step down test. The result of HE staining showed that FGF-21 could significantly reduce brain cell damage in the hippocampus. The ROS and MDA levels of three different doses FGF-21 treatment group reduced significantly than that of the model group [(5.58 +/- 1.07), (7.78 +/- 1.92), (9.03 +/- 1.77) vs (12.75 +/- 2.02) pmol (DCF) x min(-1) x mg(-1), P < 0.01 or P < 0.05], [(2.92 +/- 0.71), (4.21 +/- 0.81), (4.41 +/- 0.97) vs (5.62 +/- 0.63) nmol x mg(-1) (protein), P < 0.01]. Comparing with the model group, the activities of SOD, GPx, CAT and T-AOC of the three different doses FGF-21 treatment groups were also improved in a dose-dependent manner. This study demonstrates that FGF-21 can ameliorate learning and memory abilities of D-galactose induced aging mice, improve the antioxidant abilities in brain tissue and delay brain aging. This finding provides a theoretical support for clinical application of FGF-21 as a novel therapeutics for preventing aging.