This study explores the teaching effect on theoretical-experimental integrationteaching reform in sanitary chemistry experiment. We carry out various kinds of teaching method in sanitary chemistry experiment by aspects such as theoretical and experimental course package arrange-ment, the module integration of theory and experiment. The practice shows thattheoretical-experimen-tal integration teaching reform practice can improve the quality of sanitary chemistry experiment teaching and cultivate students' comprehensive quality.

25 is also an important impact factor among various components.

Objective To evaluate the values of bilateral inferior petrosal sinus sampling ( BIPSS),high dosage dexamethasone suppression test (HDDST) and pituitary image in the differential diagnosis of ACTH-dependent Cushing's syndrome. Methods Totally 87 patients with confirmed pathological diagnosis were recruited in the study.All received the procedure of BLPSS,HDDST,and pituitary MRI with dynamic enhancement.The diagnostic performances of three differential diagnosis methods in ACTH-dependent Cushing's syndrome were evaluated.Results Seventy-eight patients were diagnosed as cases of pituitary ACTH adenoma,and the remaining 9 were confirmed cases of ectopic ACTH syndrome due to the thymic carcinoid.The sensitivity and specificity of HDDST,pituitary MRI,and BIPSS for the diagnosis of ACTH-dependent Cushing's syndrome were 82.1％ and 100％,79.5％ and 44.4％,92.3％ and 100％,respectively.In Cushing's disease,the diagnostic accuracy was 83.9％ with HDDST,77.0％with pituitary MRI,and93.1％ with BIPSS.In those patients with Cushing's disease,the coincidence of lateralization was 83.9％ with BIPSS and 64.5％ with MRII.Conclusion BIPSS was better than the other two methods in differential diagnosis of ACTH-dependent Cushing's syndrome.Compared with the pituitary MRI,the concordant rate of BIPSS in lateralization of the tumor is higher,and it is more reliable.

Objective To investigate the effect of flipped classroom based on WeChat and mi-crolecture in medical chemistry experiment course in the context of "internet". Methods The classes were randomly divided into 2 groups, experimental group (flipped classroom teaching, n=97) and the control group (traditional teaching, n=98). Comparison of the chemistry experiment test results were performed with the use of t test between the two teaching groups at the end of the semester to evaluate the experimental teaching method. All statistical processing and analyses were performed with SPSS software (version 12.0). Results The chemistry experiment test score of the experimental group was higher than that of the control group [(77.84±8.22) vs. (73.43±10.14), t=3.341, P=0.008), and the difference was statistically significant. The results of the questionnaire showed that the students in the experimental group generally consider that flipped classroom teaching is better than the traditional teaching in terms of the cultivation of comprehen-sive quality and the teaching effect. Conclusion In the context of "internet", flipped classroom teaching with WeChat microlecture can better mobilize the enthusiasm of students to learn and participate in medical chemistry experiment course, which has been welcomed by students and further suggest good application prospects.

Objective: Researching the influence on patients with different eating ways after the operation of mandibular angle osteotomy of inside oral cavity. Method: By using the method of convenience sampling, 50 patients were chosen who had operation of mandibular angle osteotomy of inside oral cavity in orthopedic surgery department of our hospital from January 2017 to December 2017 and the number was arranged according to the order of hospitalization. Patients with singular member were divided into the month feeding group (liquid diet were fed with the injection syringe which linked leather hose of 4-5cm after 6 hours awakening after general anesthesia in operation); patients with even number were divided into the nasal feeding group (stomach tube was put in the operation and nasal feeding was provided after 6 hours awakening after general anesthesia in operation and 5 hours after the operation). In every group, there were 25 patients. Observation scale which was made by themselves was used to evaluate the patients in the two groups and comparison for difference was made in the two groups, including weight change, wound drainage amount, oral wound secretion, the aspects of choke and cough, and the comfortable sensation of eating. Results: For weight, in nasal feeding group, (2.19±0.48) kg were reduced and in month feeding group, (5.78±0.58) kg were reduced; the difference had the statistical significance (t=23.870, P<0.05). For wound drainage amount, in nasal feeding group, the number was(38.00±11.00)ml and in month feeding group, the number was (65.00±13.00) ml, the difference was statistically significant (t=7.927, P<0.01). In the aspects of choke and cough, and wound secreta in oral cavity, in nasal feeding group, the number were 16% (4/25) and 44% (11/25) respectively which was superior to the month feeding group with the number of 44% (11/25) and 76% (19/25), the difference had the statistical significance (χ²=4.667, 5.333, P<0.05). For the comfortable sensation of eating, in the two groups, there was no significant statistical difference (χ²=0.764, P>0.05). Conclusion The nasal feeding way can improve recovery level for patients after the operation of mandibular angle osteotomy of inside oral cavity and it is worthy of promotion in clinic application.

Objective: To understand the status of awarences and the influencing factors of food safety among medical students in Shangdong Province,and to provide a reference for improving a healthy eating habit among students on their knowledge about food safety,attitude and behavior. Methods: A total of 2 322 students from 2 medical colleges and universities in Shandong province selected through stratified cluster sampling were investigated with questionnaires. Results: Univariate analysis of variance showed that food safety knowledge differed by gender, grade, major, origin of student, whether learned nutrition knowledge, monthly cost on food (χ2/H=20.48, 128.02, 98.61, 36.50, 77.60, 171.03,P<0.01). In multiple Logistic regression analysis, results showed that gender, major,origin of student, monthly cost on food and the attention of food affect college students’ food safety awareness (P<0.05). Conclusion Food safety awareness among medical students in Shandong Province is relatively high but varies by multiple factors. It is necessary to improve food safety awareness of medical students through various channels.

Objective: To compare the clinical efficacy and safety of bortezomib, cyclophosphamide, dexamethasone (VCD) regimen and bortezomib dexamethasone (VD) regimen in the treatment of the patients with newly diagnosed multiple myeloma (NDMM). Methods: The clinical data of 73 patients with NDMM in Shanxi Dayi Hospital from January 2013 to January 2016 were retrospectively analyzed. According to the chemotherapy regimen, the patients were divided into VCD group (41 cases) and VD group (32 cases). The efficacy and adverse reactions of the two groups were evaluated. Results: The overall response rate of VCD group and VD group was 80.5% (33/41) and 78.1% (25/32) respectively, and the difference was not statistically significant (χ ²= 0.061, P= 0.804); and complete remission (CR) rate was 36.6% (15/41) and 15.6% (5/32) respectively, and the difference was statistically significant (χ ²= 3.970, P= 0.046); the median progression-free survival (PFS) was 27 months and 24 months respectively, and the median overall survival (OS) was 35 months and 33 months respectively, and the differences were not statistically significant (all P > 0.05). Most adverse reactions occurred in grade 1-2, in which peripheral polyneuropathy and thrombocytopenia were the most common. Peripheral neuritis was the most common finding among the adverse reactions of grade 3. The incidence of adverse reactions in both groups was not statistically significant (P > 0.05). Conclusions VCD and VD regimen could be recommended as a better induction therapy for NDMM patients. Compared with VD scheme, VCD scheme has a higher CR rate.

Objective:To compare clinical outcomes of arthroscopic double-row anchor suture bridge fixation versus open reduction and internal plating in the treatment of simple humeral fracture of the greater tuberosity.Methods:From March 2013 to March 2017 at Department of Orthopaedics, Jianhu Hospital Affiliated to Nantong University, 40 patients were treated for simple humeral fracture of the greater tuberosity. They were 23 men and 17 women, aged from 25 to 70 years (mean, 53.2 years). All the fracture displacements were larger than 5 mm and the fracture blocks smaller than 3 cm × 3 cm. They were complicated with no other injuries like rotator cuff tear, superior labrum anterior posterior (SLAP) injury or Bankart injury. Of them, 18 were treated by arthroscopic double-row anchor suture bridge fixation and 22 by open reduction and internal plating. The 2 groups were compared postoperatively in terms of joint activity, visual analogue scale (VAS) pain score, American Shoulder and Elbow Surgeon (ASES) score at the last follow-up.Results:There were no significant differences in the preoperative general data between the 2 groups ( P>0.05), indicating they were comparable. The arthroscopy and open reduction groups were followed up for an average of 19 and 20 months, respectively. All the patients obtained bony union within 3 months after surgery. At the last follow-up for the arthroscopy and open reduction groups, respectively, the shoulder flexion was 152.7°±13.3° and 137.7°±19.2°, the abduction 146.0°±16.4° and 132.4°±20.5°, the VAS score 0.8±0.4 and 1.3±0.6 and the ASES score 91.8±4.1 and 87.4±5.8, showing significant differences in the above items between the 2 groups ( P<0.05). In the open reduction group, 2 patients developed subacromial impingement syndrome which was relieved after removal of the plate following fracture union. Shoulder stiffness was observed in one case but improved after manipulative release under anesthesia. Conclusion:In the treatment of simple humeral fracture of the greater tuberosity, arthroscopic double-row anchor suture fixation has advantages over open reduction and internal plating because it can lead to less invasion, quicker recovery and better functional recovery of the shoulder after operation.

Objective:To identify the association of sex hormone and sex hormone-binding globulin (SHBG) levels in patients with Graves′ disease.Methods:Between December 2017 and July 2019, 152 patients with Graves′ disease were enrolled in the Department of Endocrinology and Metabolism of Zhongshan Hospital, Fudan University. Parameters such as height, weight, thyroid function, sex hormone, fasting blood glucose, insulin, C-peptide, glycosylated albumin, HbA 1C, and liver function were collected. The associations between SHBG and bioclinical characteristics were analyzed. Results:The glycosylated albumin level was negatively associated with SHBG in all subjects ( β=-0.308, P<0.01), while this association was not significant after the adjustment for thyroid hormones. Male patients had significantly lower SHBG level than female patients ( P<0.01). In male patients, SHBG was associated with luteinizing hormone ( r=0.465, P<0.01), estradiol ( r=0.629, P<0.01), testosterone ( r=0.786, P<0.01). While in female patients, SHBG was also associated with testosterone ( r=0.191, P<0.05). In multivariate linear regression analysis, estradiol was independently associated with SHBG ( β=0.329, P<0.01) in male subjects. Conclusion:The hypogonadism and infertility in Graves′ disease patients could partially be attributed to the association between SHBG and Graves′ disease.

Objective: To explore the effects of transcutaneous electrical acupoint stimulation (TEAS) on pain of patients in expansion process of skin soft tissue dilator on forehead by water injection. Methods: From June 2016 to June 2017, 100 patients in expansion process of skin soft tissue dilator on forehead by water injection meeting the inclusion criteria were admitted to Outpatient Department of Orthopedic Surgery of Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine. There were 43 men and 57 women among the patients, aged 27 to 55 years, and the prospective randomized controlled study was performed on them. The patients were divided into TEAS nursing group and routine nursing group according to the random number table, with 50 patients in each group. Patients in routine nursing group were performed with routine nursing in every water injection in outpatient department and 2 days later. On the basis of routine nursing, patients in TEAS nursing group were performed with TEAS treatment by responsible nurses in each water injection in outpatient department. The Shangxing, Diwei, and Hegu points were positioned accurately, and electrical stimulation was performed on the 3 points simultaneously by pulse acupuncture treatment instrument, with 30 minutes each time. Two days after every water injection of outpatient department, TEAS nursing was performed at home by patients and their family members under remote guidance of the responsible nurses, with 2 times each day and 30 minutes each time. Besides, follow-up was done by phone by the responsible nurses everyday. The nursing of patients in the 2 groups lasted the whole expansion process. After the expansion process, the overall pain degree and the most severe pain degree of patients during expansion process were scored by numerical rating scale, and the overall comfort degree and its dimensions of patients during expansion process were scored by the responsible nurses every day by simplified Comfort Status Scale. Data were processed with independent sample t test and chi-square test. Results: During expansion process, the overall pain score degree and the most severe pain degree score of patients in TEAS nursing group were (5.4±1.2) and (6.5±1.0) points, which were significantly lower than (6.1±1.3) and (7.5±1.4) points of patients in routine nursing group (t=-2.62, -4.00, P<0.05 or P<0.01). During expansion process, the physiological dimension, sociocultural dimension, psychological spirit dimension, environmental dimension, and total score of the overall comfort degree of patients in TEAS nursing group were (9.6±2.9), (20.1±2.8), (29.1±1.9), (22±3), and (80±6) points, significantly higher than (5.7±2.1), (16.8±2.8), (26.0±2.8), (21±4), and (69±8) points of patients in routine nursing group (t=8.03, 6.35, 7.60, 2.11, 10.64, P<0.05 or P<0.01). Conclusions TEAS with appropriate intensity, frequency, and duration can alleviate the pain of patients during expansion process of skin soft tissue dilator on forehead by water injection and improve their comfort degree.