Objective To investigate the clinical efficacy and safety of ultra pulse CO2 laser combined with collagen dressing in treatment of cutaneous amyloidosis.Methods A total of 68 cases of primary cutaneous amyloidosis patients according to the different treatment methods was divided into two groups:the control group (n =33 cases) that was given acitretin capsules oral and topical compound flumetasone ointment packet treatment,and observation group (n =35 cases) with ultra pulse CO2 laser combined with collagen dressing external treatment.Two groups were observed in patients with curative effect and adverse reaction.Results Disease of integral observation group after treatment was significantly lower than the control group(t =3.12,P ＜0.05).The observation group had the efficiency of [88.6％ (31/35)] that was significantly higher than that of control group[17/33(51.5％),x2 =11.23,P ＜.0.01].The observation group had significantly shorter healing time [(5.38 ± 1.81) d] compared to the control group [(10.75 ±2.06)d,t =11.39,P ＜ 0.01].The observation group did not have recurrence,which was significantly different from the control group (x2 =4.90,P ＜ 0.05).Conclusions Ultra pulse CO2 laser combined with collagen dressing in treatment of primary cutaneous amyloidosis is a kind of effective treatment methods with remarkable curative effect and less adverse reactions.It is worthy of clinical application.

Objective To analyze the policy support of rural doctors for the essential medicine system,and explore the main influence factors and mechanism affecting the support degree.Methods 621 rural doctors from five cities in Shandong province were subject to a stratified random sampling for a quantitative questionnaire,to build a hypothesis model of policy support of rural doctors,which is verified using factor analysis and path analysis.Results 59.1% of rural doctors support the essential drugs policy.It was found that the essential medicine factor,the factor to influence the practitioner,and the supporting policy factor had a direct impact on policy support of rural doctors,with the effect of 0.305, 0.1 59 and 0.135 respectively;Essential medicine factor and the supporting policy factor indirectly influence the policy support of rural doctors through the factor to influence practitioners,with the effect of 0.065 and 0.032 respectively.Conclusion The essential medicine system needs to emphasize such rationality as the quality,list and pricing of essential medicines;it is imperative for the government to better oversee the purchase and supply of essential drugs,to cater to the interests of rural doctors,to encourage the enforcement of the system,and promote the development of village clinics.

Objective To explore the effect of the improved abdominal rotation card method in insulin injection. Methods A total of 100 hospitalized diabetes patients were randomly divided into control group (n=50) and observational group (n=50) according to the random number method. In the control group, insulin was injected to the subcutaneous tissue of abdomen with traditional method annular rotating method. Insulin was injected using improved abdominal rotation card method in the observational group. Compare accuracy and mastery rate of injection site rotation between the two groups. Compare fasting blood glucose (FBG), postprandial 2H blood glucose (PBG), HbA1c, the incidence of hypoglycemia and endermic induration between the two groups after three months. Results The nurses in the observation group had higher accuracy rate of the injection site rotation compared to the control group [98.6%(690/700) vs. 38.6%(270/700),χ2=584.66, P<0.01]. Mastery rate of the injection site rotation for the patients in the observation group were significantly higher than the control group [70.0% (35/50) vs. 20.0% (10/50), χ2=25.74, P < 0.01]. The incidence of endermic induration were significantly lower in observation group compared to the control group [2.0% (1/50) vs.16.0% (8/50), χ2=5.98, P < 0.01]. The incidence of hypoglycemia were significantly lower in observation group compared to the control group [4.0%(2/50) vs. 16.0%(8/50),χ2=4.00, P<0.01]. Conclusions The new abdominal rotation method in insulin injection can be a safe and effective therapy in patients with type 2 diabetes.

Objective To explore the electrophysiological properties and the disparity of visual cortical neurons in developing rats. Methods Whole cell patch clamp recording and intracellular labeling of brain slices were performed on rats at postnatal 14 and 28 days. The electrophysiological data were analyzed according to the cellular input resistance and resting membrane potential. Results When the input impedance of visual cortical neurons(IR) was lower, increased peak value of postsynaptic currents(PSCs), prolonged rise and decay time were found. At postnatal 14th day(before eyes opened), the intermediate cells and mature cells were 59.2% and 14.9% respectively, but at postnatal 28th day(14 days after eyes opened), the mature cells and immature cells were 62.5% and 12.5% respectively. Conclusion During the period of postnatal development, the visual cortical neurons become mature gradually, but maturation is not completely correlated with age.

Objective: To investigate the awareness of relevant knowledge and influencing factors among high-risk populations for chronic obstructive pulmonary disease (COPD), so as to provide the reference for improving COPD awareness and disease prevention. Methods: The COPD high-risk populations were selected from community health service centers of Nanfeng, Jingang, Daxin and Fenghuang townships in Zhangjiagang City, Jiangsu Province from 2020 to 2022. Basic information, lifestyle, health status and awareness of relevant knowledge were collected through questionnaire surveys. Anxiety symptoms was assessed using the Generalized Anxiety Disorder Scale. Factors affecting the awareness of relevant knowledge among COPD high-risk populations were identified using a structural equation model. Results: A total of 2 078 COPD high-risk populations were surveyed, including 1 111 females (53.53%) and 967 males (46.47%), and had a mean age of (60.85±6.59) years. The total awareness score of relevant knowledge among high-risk populations for COPD was (6.33±2.59) points, with an awareness rate of 72.18%. Structural equation model analysis showed that age, annual household income, educational level, smoking, respiratory diseases, occupational exposure and anxiety symptoms had direct effects on the awareness of relevant knowledge, with direct effect values of -0.057 (95%CI: -0.099 to -0.014), 0.048 (95%CI: 0.005 to 0.090), 0.162 (95%CI: 0.117 to 0.204), 0.060 (95%CI: 0.018 to 0.096), 0.055 (95%CI: 0.021 to 0.088), 0.139 (95%CI: 0.107 to 0.170) and -0.172 (95%CI: -0.209 to -0.135), respectively; while age, gender, and occupational exposure also had indirect effects on the awareness of relevant knowledge, with indirect effect values of -0.069 (95%CI: -0.090 to -0.051), -0.084 (95%CI: -0.113 to -0.053), and 0.007 (95%CI: 0.003 to 0.014), respectively. Conclusion The awareness of relevant knowledge among COPD high-risk populations is associated with age, gender, annual household income, educational level, smoking, respiratory diseases, occupational exposure and anxiety symptoms.

The M and NP genes of H5N1 avian influenza virus (A/chicken/Hubei/489/2004) were amplified by RT-PCR from viral RNA,and cloned into pMD 18-T vector respectively.The expression plasmid containing the M gene (pHM6-m) or the NP gene (pHM6-np) was then constructed by inserting the M or NP gene into the pHM6 eukaryote expression vector; the constructed plasmid was then sequenced.32 BALB/c mice (6-week-old) were divided into four groups at random.Three groups of BALB/c mice were inoculated one time the intramuscular route with either 30 μg of plasmid pHM6-m,30 μg of plasmid pHM6-np or the mixture of plasmid pHM6-m (15 μg ) and pHM6-np(15 μg) respectively.A additional group of mice were injected with 100 μ1 PBS as controls.Two weeks later,all mice were challenged with homologous H5N1 avian influenza virus,and observed in the following 12 days.The survival rates of mice in the pHM6-m group,the pHM6-np group and mixed plasmids group were 62.5% ,25.0% and 50.0%,respectively.Results showed that effective protection could be provided by either pHM6-m or pHM6-np,but pHM6-m provided a better protective effect than pHM6-np.

Objective To explore the manifestation of pancreatic metastases (PM)using contrast‐enhanced ultrasound (CEUS). Methods Eleven patients with PM confirmed by pathology or CT/MRI combined with clinical data were analyzed retrospectively. The manifestation on conventional ultrasound and the enhancement appearance on CEUS were analyzed. Results The primary malignant tumors included lung cancer(n=6), breast cancer(n=1), renal clear cell carcinoma(n=1), gastric cancer(n=1), rectal cancer(n=1)and leiomyosarcoma of uterus(n=1). Eight patients had one lesion and three were multiple. The maximum lesion diameter was 2. 0-5. 0cm. Eight of the 11 patients showed hypoechoic on conventional US. Three patients were diagnosed as probably PM, one probably malignant and 7 undetermined by US. In the early stage of CEUS, two patients showed hyper‐enhancement, six showed iso‐enhancement and 3 showed hypo‐enhancement I.n the late stage of CEUS, nine patients (9/11) showed hypo‐enhancement. Seven patients showed homogeneous enhancement S.ix patients were diagnosed as PM, three malignant, one neuroendocrine tumor and one undetermined by CEUS. Conclusions PM showed certain characteristics on CEUS. The hyper‐or iso‐enhancement at the early stage of CEUS and history of primary cancer is helpful for diagnosis of PM.

OBJECTIVETo study the association of single nucleotide polymorphisms (SNPs, rs223895 and rs223899) in TARC/CCL17 gene with Kawasaki disease (KD) and its clinical characteristics in Han children from Central China.

METHODSA case-control study was performed on 218 children with KD and 248 normal control children. The genotypes of SNPs (rs223895 and rs223899) in TARC/CCL17 gene were determined by polymerase chain reaction-restriction fragment length polymorphism. The association between the SNPs in TARC/CCL17 gene and the clinical characteristics of KD was assessed.

RESULTSThere were significant differences in the genotype (CC, CT, TT) and allele frequencies of SNP rs223895 between children with KD and controls (P<0.05), and C allele was a risk factor (OR=1.397). However, no significant differences were found between the two groups in the genotype and allele frequencies of SNP rs223899. Compared with those with other genotypes (CT+TT) of SNP rs223895, patients with CC genotype had significantly lower hemoglobin (Hb) and albumin (Alb) levels (P<0.05) and a significantly higher erythrocyte sedimentation rate (ESR) (P<0.05).

CONCLUSIONSThe SNP rs223895 in TARC/CCL17 gene is associated with the susceptibility to KD, and C allele is a risk factor. Moreover, SNP rs223895 may influence the levels of Hb, Alb, and ESR.

Chemokine CCL17 ; genetics ; Child ; Child, Preschool ; Female ; Genetic Predisposition to Disease ; Genotype ; Humans ; Infant ; Male ; Mucocutaneous Lymph Node Syndrome ; genetics ; Polymorphism, Single Nucleotide

Objective To investigate the effect of Case Based Learning (CBL) method in clinical practice of internal medicine. Methods 88 clinical medicine students were divided into CBL teaching group and traditional teaching group. Traditional teaching method was introduced to traditional teaching group while CBL teaching method was carried out in the other. The test papers and questionnaires were analyzed in both groups. Result The students in CBL teaching group mastered internal medicine knowledge better than the other group. Conclusion CBL teaching mode helps improve the overall teaching quality of internal medical in clinical practice,and the interns' interest in learning and their clinical practice ability can be greatly enhanced.

ObjectiveTo investigate the effects of the imbalance between regulatory T cells (Treg) and T helper 17 cells (Th17) in patients with chronic hepatitis B virus (HBV) infection.MethodsThe serum concentration of Treg/Th17 differentiation-related cytokines in 34 patients with chronic hepatitis B (CHB),20 patients with HBV related acute on chronic liver failure (ACHBLF),and 20 healthy controls (NC) were measured by enzyme-linked immunosorbent assay (ELISA) and proportion of peripheral Th17 and Treg cells were analyzed by flow cytometry.Numeration data was analyzed by Fisher's exact propability method and measurement data was tested by one-factor analysis of variance or Turkey multiple comparison.Results The levels of Th17 differentiation-related cytokines,II-1β (3.97±2.85) pg/mL,IL-6 (12.75±-8.87) pg/mL,and IL-21 (360.0±335.7) pg/ mL in patients with ACHBLF were significantly increased than those in NC,which were (1.87 ±0.94) pg/mL(q=4.559,P＜0.01),(5.28±0.72) pg/mL(q=7.309,P＜0.01) and (46.68±20.17) pg/mL(q=6.946,P＜0.01 ),respectively.The proportion of Th17 increased markedly in patients with ACHBLF than that in NC(q=3.972,P＜0.05).However,compared to NC and patients with ACHBLF,the Treg differentiation-related cytokine,TGF-β,in patients with CHB,increased significantly (q=4.536 and 5.323,respectively; both P＜0.01).And the population of Treg also increased markedly in CHB patients.The level of IL-17A which was the characteristic effector cytokine of Th17 was the highest in patients with ACHBLF.The peripheral Th17 cell proportion was positively correlated with the level of serum total bilirubin in patients with ACHBLF (γ=0.74,P＜0.01).Conclusions Th17 and Treg imbalance including cytokine profiles and cell numbers exists in patients with chronic HBV infection.The Th17 are active in patients with ACHBLF and Treg are active in patients with CHB.