This article analyzed current negative influence on medical students caused by network and the authors put forward 6 pieces of measures to enhance network moral education of medical students,such as establishing and consummating network moral and ethic norm system,strengthening character teaching to medical students by network,promoting construction of resources of network moral education,heightening managing quality of moral educators in high education,cultivating healthy campus network culture atmosphere,and building good online surroundings for medical students by joint of blocking up and dredging.

The present paper makes a tentative study on the significance and the approaches of the undergraduates' ideological education in the present new situation,stressing that currently universities and colleges must strengthen the construction of the CPC organizations at universities and boost the construction of the education of talented people in an all-round way with the thought of "3 represents" as guidelines,the strengthening of the construction of the CYLC as foundation and the conducting of the ideological education of the construction of the CPC as means.

Objective To study the efficacy of L-3,5-diiodotyrosine (DIT) and inorganic iodine (KIO3) in iodine-deficiency Wistar rats.Methods Sixty Wistar rats,weighting about 160-180 g,were divided into two groups according to body weight by the random number table method:iodine-deficiency model (40 rats) was fed with low-iodine food (the iodine content was 35.9 μg/kg);optimal-iodine model (20 rats) was fed with low-iodine food and given with KIO3 water (the iodine content was 18 mg/L) 0.5 ml by intragastric once a day.Model was established for 3 months.Iodine-deficiency model was subdivided into low iodine (LI) group,KIO3 group and DIT group,eight,nine,ten rats in each group;from optimal-iodine model,nine rats were randomly selected as optimal iodine (NI) group.LI group was fed with low-iodine food;KIO3 group was fed with low-iodine food and given with KIO3 water (the iodine content was 18 mg/L) 0.5 ml by intragastric once a day;DIT group was fed with low-iodine food and given with DIT water (the iodine content was 18 mg/L) 0.5 ml by intragastric once a day;NI group was fed with low-iodine food and given with KIO3 water (the iodine content was 18 mg/L) 0.5 ml by intragastric once a day.After 3 months,24-hour urine of the rats was collected.According to the method for determination of iodine in urine by As3 +-Ce4+ catalytic spectrophotometry (WS/T 107-2006),iodine content in urine was detected.Rats were anesthetized intraperitoneally with 25％ urethane,blood from abdominal aortic was collected to determinate the serum thyroid hormone [total triiodothyronine (TT3),total thyroxine (TT4),free triiodothyronine (FT3),free thyroxine (FT4)] level in rats by automatic electrochemical luminescence immunoassay.All the rats were sacrificed to analyze the thyroid weight.Results ① The urine iodine showed significant differences in the four groups (x2 =25.24,P ＜ 0.05).The median of urine iodine concentration in the LI,NI,KIO3 and DIT groups were 3.00,286.14,223.37,214.33 μg/L,respectively.The urine iodine concentration in LI group was significantly lower than those of other three groups (all P ＜ 0.05).② The serum TT3,TT4,FT3,FT4 levels showed significant differences in the four groups (F =63.48,140.73,130.20,365.27,all P ＜ 0.05).And the hormone levels in KIO3 group were lower than those of the DIT group [TT3:(1.57 ± 0.20) vs.(1.97 ± 0.18) mmol/L,TT4:(51.23 ± 4.90) vs.(71.94 ± 5.27) mmol/L,FT3:(5.34 ± 0.45) vs.(6.98 ± 0.33) pmol/L,FT4:(26.18 ± 2.30) vs.(35.47 ± 2.28) pmol/L,all P ＜ 0.05].③The color of thyroid in KIO3 and DIT groups became pale pink.The absolute and relative thyroid weight showed significant differences in the four groups (F =225.05,345.40,all P ＜ 0.05).The absolute thyroid weight [(31.76 ± 1.75) mg] and relative thyroid weight [(11.69 ± 3.47) mg/100 g] in DIT group was lower than that of the KIO3 group [(36.31 ± 5.23) mg,(12.83 ± 4.38) mg/100 g,all P ＜ 0.05].Conclusion Animal experimental results show that DIT has a better iodine-supplementing efficacy than that of KIO3.

Objective To establish a arsenic cerium catalytic rate method for determination of urinary iodine,and increase the linear range of urinary iodine determination.Methods Standard series and urine samples after digestion treatment,were tested using dynamics function of spectrophotometer to record the curve of absorbance value (A) change with time (t) during arsenic cerium catalytic reaction for each measurement system,choice (A1,t1) and (A 2,t2) on this curve and calculating the reaction rate (v),v =(lgA1-lgA2)/(t2-t1).Through the determination of the standard series it could calculate regression equation of iodine concentration (C) with X:C =a ± bX,X =1 000 (v-v0),and the v0 is the reaction rate of reagent blank.Results (① C and X were positively correlated.The standard series linear range was 0-1 200 pμg/L and correlation coefficient r was higher than 0.999 1.The minimum detection limit was 3.9 μg/L (0.25 ml urine).②)Precision:5 urine samples (A,B,C,D,E) were selected within the range of 0-1 200 μg/L and the measured value were (72.3 ± 2.7),(148.2 ± 5.2),(210.5 ± 4.4),(562.7 ± 6.8),and (899.3 ± 8.0) μg/L.The relative standard deviation (RSD) was between 0.9％-3.8％.(③)Accuracy:4 samples (A,B,C,D) were measured for standard addition recovery test,recovery was between 94.2％-107.2％;urinary iodine standard material [the given values were (67.9 ± 9.0),(142.0 ± 10.0),(195.0 ± 10.0),(558.0 ± 17.0),(885.0 ± 28.0) μg/L] were determined and the results were in the range of uncertainty of the standard material.④Method contrast:with the national health standard method (method for determination of iodine in urine by arsenic cerium catalytic spectrophotometry) to determinate 120 urine samples,the results showed that there were 60 urine samples within 0-300 μg/L,60 urine samples were more than 300 μg/L.Then rate method was used to test the 120 urine samples.For the 60 samples within the scope of 0-300 μg/L,the determination results of the two methods were positively correlated (r =0.994,P ＜ 0.01);the results of the rate method were lower than those of the standard method and the difference was statistically significant (t =2.047,P ＜ 0.05).But the average deviation was only 2.1 μg/L,for the determination of urine iodine there was no practical significance;for the 60 samples higher than 300 μg/L,the determination results of the two methods were positively correlated (r =0.993,P ＜ 0.01) and the difference was not statistically significant (t =-1.092,P ＞ 0.05).Conclusions Arsenic cerium catalytic rate method has increased the linear range of urinary iodine determination.Using this method,the vast majority samples can be tested directly without dilution,thereby reducing the workload for determination of urine iodine.

Objective:To investigate the effect of NEMO binding domain peptide (NBDP) on lung inflammation and apoptosis in mice with acute respiratory distress syndrome (ARDS) and its mechanism.Methods:Thirty-six male BALB/c mice were divided into normal saline (NS) control group, ARDS model group, NBDP negative control group and 6, 12 and 18 μg NBDP pretreatment group by random number table method, with 6 mice in each group. ARDS mouse model was reproduced by aerosol inhalation lipopolysaccharide (LPS) 50 μL. An equivalent among of NS was inhaled in NS control group. The mice in NBDP negative control group were inhaled the materials similar to the non-functional NBDP 30 minutes before the aerosol inhalation LPS; 6, 12 and 18 μg of NBDP 50 μL were respectively inhaled in NBDP pretreatment groups. After inhalation of LPS for 6 hours, mice were sacrificed to get lung tissue and observe the degree of pathological injury and edema. Western blotting was used to detect the phosphorylation of nuclear factor-κB (NF-κB) pathway related proteins [NF-κB inhibitor (IκB) kinaseα/β(IKKα/β), IκBα and NF-κB p65; p-IKKα/β, p-IκBα, p-p65] and the expression of caspase-3 in lung tissue. The bronchoalveolar lavage fluid (BALF) was collected and the levels of inflammatory markers such as myeloperoxidase (MPO), interleukins (IL-1β, IL-8), and tumor necrosis factor-α (TNF-α) were detected by enzyme linked immunosorbent assay (ELISA).Results:ARDS model group had severe edema and hemorrhage, alveolar structure destruction, pulmonary hemorrhage and hyaline membrane formation etc. under light microscope, consistent with the pathological characteristics of ARDS lung tissue, suggesting that the ARDS model was successfully reproduced. ELISA showed that MPO, IL-1β, IL-8 and TNF-α levels of BALF in ARDS model group were obviously higher than those in NS control group. There were no significant differences in the above inflammatory indicators between NBDP negative control group and ARDS model group. The levels of MPO, IL-1β, IL-8 and TNF-α in NBDP pretreatment groups were significantly lower than those in ARDS model group in a dose-dependent manner, especially in 18 μg NBDP, the differences were statistically significant as compared with ARDS model group [MPO (ng/L): 393.32±19.35 vs. 985.87±101.50, IL-1β (ng/L): 43.05±5.11 vs. 97.68±10.88, IL-8 (ng/L): 84.64±2.32 vs. 204.00±17.37, TNF-α (ng/L): 229.13±17.03 vs. 546.73±62.72, all P < 0.05]. Western blotting showed that p-IKKα/β, p-IκBα, p-p65 and caspase-3 protein expressions in ARDS model group were significantly higher than those in NS control group. There was no significant difference in above NF-κB pathway and apoptosis-related protein expression between the NBDP negative control group and ARDS model group. The p-IKKα/β, p-IκBα, p-p65 and caspase-3 protein expression in NBDP pretreatment groups were significantly lower than those in ARDS model group in a dose-dependent manner, especially in 18 μg NBDP, the differences were statistically significant as compared with ARDS model group [p-IKKα/β protein (p-IKKα/β/β-actin): 0.15±0.02 vs. 0.42±0.04, p-IκBα protein (p-IκBα/β-actin): 0.10±0.01 vs. 0.93±0.30, p-p65 protein (p-p65/β-actin): 0.22±0.05 vs. 1.37±0.21, all P < 0.05]. Conclusion:NBDP can inhibit inflammatory response and apoptosis in ARDS lung tissue in a dose-dependent manner, and its mechanism is associated with interference NF-κB signaling pathway transduction.

Objective To compare the influence of sevoflurane inhalation sedation and propofol intravenous sedation on duration of endotracheal intubation as well as the length of intensive care unit (ICU) stay and total length of hospital stay in postoperative critical patients.Methods Six databases including CNKI,Wanfang data,PubMed,Embase,Cochrane Library and Web of Science were searched for randomized controlled trials (RCTs) about the influence of sevoflurane inhalation sedation or propofol intravenous sedation on the sedation time,the duration of endotracheal intubation,the length of ICU stay,the total length of hospital stay and the adverse effects rate in postoperative critical patients from the time of database establishment to July 2018.At the same time,the reference materials of included literature were retrieved manually.All literatures were screened by three independent reviewers,and the data extraction and quality evaluation of the included studies were conducted.Meta-analysis was used for RCT that met the quality standards.Results A total of 7 RCT studies were enrolled involving 537 patients who were all transferred into ICU after surgery with trachea cannula.Among the patients,272 received sevoflurane sedation while the other 265 received propofol sedation.All the included studies were well designed and of high quality.The results of Meta-analysis showed that compared with propofol sedation,sevoflurane sedation could significantly shorten the duration of endotracheal intubation [standardized mean difference (SMD) =-0.60,95％ confidence interval (95％CI) =-0.88 to-0.31,P ＜ 0.000 1]and the total length of hospital stay (SMD =-0.36,95％CI =-0.61 to-0.12,P =0.003),and lower the cardiac troponin T (cTnT) within 12-24 hours after ICU admission (SMD =-0.61,95％CI =-0.85 to-0.36,P ＜ 0.000 01).There was no significant difference in the sedation time (SMD =-0.07,95％CI =-0.29 to 0.15,P =0.52),the length of ICU stay (SMD =-0.19,95％CI =-0.39 to 0.01,P =0.06),the incidence of nausea and vomiting [odds ratio (OR) =1.19,95％CI =0.61 to 2.32,P =0.61] or incidence of delirium (OR =0.80,95％CI =0.34 to 1.90,P =0.62) between sevoflurane group and propofol group.Conclusions Sevoflurane inhalation sedation may lead to shorter duration of endotracheal intubation and total length of hospital stay,and had better protection for myocardium as compared with propofol intravenous sedation.The above conclusions needed further study to confirm,due to the lack of literature enrolled in this Meta-analysis.

Objective? To?systematically?analyze?the?effect?of?haemoperfusion?(HP)?combined?with?continuous?veno-veno?haemofiltration?(CVVH)?in?the?treatment?of?the?patients?with?paraquat?poisoning?(PQP).? Methods? Words?of?paraquat,?poisoning,?continuous?venous?hemofiltration,?hemoperfusion,?hemodiafiltration?in?Chinese?and?paraquat,?poisoning,?intoxication,?haemofiltration,?continuous?venovenous?haemofiltration,?haemoperfusion?in?English?were?chosen?as?keywords,?the?Chinese?and?English?literatures?about?acute?PQP?treated?with?HP?combined?with?CVVH?published?in?Wanfang?database,?CNKI,?CBM,?VIP?database,?PubMed,?Embase,?Cochrane?Library?were?searched?by?computer,?and?the?retrieval?time?was?from?the?establishment?of?the?database?to?July?2018.?The?experimental?group?was?treated?with?HP?combined?with?CVVH,?while?the?control?group?was?treated?with?HP?alone.?Besides,?the?outcome?indicators?included?mortality,?survival?time?of?dead?patients?(the?patient's?time?from?exposure?to?poison?to?death),?serum?creatinine?(SCr),?alanine?aminotransferase?(ALT),?arterial?partial?pressure?of?oxygen?(PaO2),?and?incidence?of?circulatory?and?respiratory?failure.?The?literature?data?were?extracted?by?two?researchers?independently,?the?quality?of?the?literature?was?evaluated? according?to?the?modified?Jadad?score?table?or?Newcastle-Ottawa?scale?(NOS),?and?the?Meta-analysis?was?carried?out?by?RevMan?5.3?software;?and?the?stability?of?the?results?of?Meta-analysis?was?tested?by?sensitivity?analysis.?Further,?the?publication?bias?was?analyzed?through?drawing?a?funnel?diagram.? Results? Finally,?20?articles?were?included,?with?18?in??Chinese?and?2?in?English.?Among?them,?6?were?randomized?controlled?trial?(RCT)?and?14?were?case-control?studies.?Furthermore,?a?total?of?2?870?patients?were?involved,?with?1?558?in?the?control?group?and?1?312?in?the?experimental?group.?Meta-analysis?showed?that?the?mortality?rate?of?patients?in?the?experimental?group?was?significantly?lower?than?that?in?the?control?group?[odds?ratio?(OR)?=?0.55,?95%?confidence?interval?(95%CI)?=?0.42?to?0.73,?P

Objective To explore the experience of patients with rheumatoid arthritis participating in the shared medical appointments(SMA),so as to provide references for medical staff to formulate targeted intervention strategies.Methods By the descriptive phenomenology research method in qualitative research,14 patients with rheumatoid arthritis who participated in the SMA in a tertiary A integrated traditional Chinese and western medicine hospital in Shanghai from August to October 2023 were selected for the in-depth interviews,and the data were analyzed and themes were extracted by Colaizzi 7-step analysis method.Results The experience of patients with rheumatoid arthritis participating in SMA can be summarized into 3 themes:①Driving factors of participation in SMA(seeking clarity and resolution,seeking support and hope);②Perceived benefits of participation in SMA(feelings of efficiency and convenience,reduced isolation,increased security,reduced stigma,increased self-efficacy,insights and experiences,lifestyle changes);(3)Barriers to participation in shared outpatient procedures(obscure medical terminology,inapplicability to some special groups,single content and form of sharing,worries and concerns about personal privacy disclosure,transportation inconvenience and time conflicts).Conclusion Medical staff should pay attention to the experience of patients with rheumatoid arthritis participating in the SMA,improve the training skills of medical staff,solve the obstacles in the process of participation in the SMA,and promote the continuous improvement and development of the SMA.

Objective To compare the lung protection roles of intraperitoneal pre-injection with penehyclidine for two kinds of rat models with pulmonary and extrapulmonary acute respiratory distress syndrome (ARDSp and ARDSexp). Methods Forty healthy adult Sprague-Dawley (SD) rats were randomly divided into five groups (each n = 8): the rats in sham group received only tracheotomy; the ARDS rat models were reproduced by intratracheal inhalation of 0.1 mol/L hydrochloric acid (HCl) 2 mL/kg to simulate ARDSexp (HCl group) and 0.15 mL/kg oleic acid (OA) intravenous injection to simulate ARDSp (OA group) after tracheotomy; and the rats in two intervention groups were intraperitoneal injected with penehyclidine 0.5 mg/kg. All rats were received mechanical ventilation immediately after model reproduction. Carotid arterial blood was collected 4 hours after model reproduction for determining the arterial partial pressure of oxygen (PaO2), and oxygenation index (PaO2/FiO2) was calculated. Carotid venous blood and lung tissues were harvested, and the levels of myeloperoxidase (MPO), interleukin-8 (IL-8) and nuclear factor-κB (NF-κB) in serum and lung tissue were determined by enzyme linked immunosorbent assay (ELISA). Pulmonary pathology was observed under optical microscope, and pathological score of Smith was calculated. Results Under optical microscope, a large number of inflammatory cells infiltration in lung tissue, obvious alveolar collapse, fibrous exudation in alveolar and alveolar hyaline were found in HCl group. In OA group, however, microvascular congestion and interstitial pulmonary edema were the main pathological changes, with alveolar structure being kept relatively intact. Compared with sham group, pathological score of Smith in HCl and OA groups were increased, oxygenation was lowered, and inflammatory factors levels in serum and lung tissue were increased with levels in lung tissue being higher than those in serum, without significant difference between the two models. When pretreated with penehyclidine, however, pathological injury induced by HCl or OA was alleviated, and pathological score of Smith was also decreased as compared with that of corresponding model groups (5.48±1.76 vs. 9.69±2.02, 3.97±2.14 vs. 8.71±2.18, both P < 0.05), PaO2/FiO2was raised significantly [mmHg (1 mmHg = 0.133 kPa): 323±55 vs. 211±27, 307±56 vs. 207±31, both P < 0.05], the inflammatory factors levels in serum and lung tissue were obviously decreased [MPO (μg/L): 11.91±1.55 vs. 14.82±1.25, 12.75±1.16 vs. 16.97±2.06 in serum, 25.80±3.36 vs. 35.18±4.01, 24.23±1.24 vs. 33.94±1.43 in lung tissue; IL-8 (ng/L): 358±30 vs. 459±25, 377±38 vs. 427±34 in serum, 736±53 vs. 866±51, 701±53 vs. 809±39 in lung tissue; NF-κB (ng/L):483±68 vs. 632±73, 514±83 vs. 685±78 in serum, 984±75 vs. 1 217±123, 944±90 vs. 1 163±105 in lung tissue;all P < 0.05]. But all parameters above were similar between the two pretreatment groups (all P > 0.05). Conclusions Inflammatory cell infiltration and alveolar collapse mainly happened in HCl induced ARDSp, while pulmonary interstitial edema and hemorrhage was mostly seen in ARDSexp rats induced by OA intravenous injection. There was no significant difference in oxygenation and inflammatory response between the two models of rats. Pre-intraperitoneal injection of penehyclidine equally improved oxygenation state, inhibited lung inflammation response, and reduced lung injury in the two kinds of ARDS, but there was no difference in protective role between two models pretreated with penehyclidine.

Objective To evaluate the relationship between hypophosphatemia and prognosis in critically ill patients. Methods Some hypophosphatemia-associated prospective or retrospective clinical cohort studies were searched through CNKI, Wanfang Data, PubMed, Embase, Cochrane library, and Google Scholar English database respectively, with the guidance of these key words such as hypophosphatemia, intensive care, prognosis and fatality rate. The articles were concerned about the correlation between hypophosphatemia and the prognosis of patients in intensive care unit (ICU). The literatures collected were restricted from the creation of data base to April 2017. The mean value of < 0.8 mmol/L in serum phosphorus concentrations of the patients within the first 2 days of ICU admission would be treated as the diagnostic criteria of hypophosphatemia. Literature qualities were assessed by Newcastle-Ottawa scale (NOS). Meta-analysis was carried out by RevMan 5.3, and the sensitivity analysis was performed to test the stability of the meta-analysis. The existence of bias was analyzed by using the funnel graph analysis. Results Ten articles were ultimately included in the analysis, including 9 in Chinese and 1 in English, all of which were high qualities. 1 555 patients were involved in these clinical studies, of whom 606 patients had hypophosphatemia and other 949 were normal phosphatemia. Meta analysis results showed that patients with hypophosphatemia had higher acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score as compared with that of normal phosphatemia group [standardized mean difference (SMD) = 0.64, 95% confidence interval (95%CI) = 0.24-1.04, P = 0.002]. Subgroup analysis showed that APACHE Ⅱ score increased in mild, moderate and severe hyperphosphatemia subgroups, and there were significant differences between any two subgroups (all P < 0.01). Longer duration of mechanical ventilation (SMD = 0.50, 95%CI =0.23-0.78, P = 0.000 3) and the length of ICU stay (SMD = 0.36, 95%CI = 0.06-0.67, P = 0.02), and even higher ICU mortality [odds ratio (OR) = 2.99, 95%CI = 2.09-4.27, P < 0.000 01] were seen in patients with hypophosphatemia as compared with normal phosphatemia patients. However, serum creatinine (SCr) levels (SMD = -0.19, 95%CI =-2.76-2.39, P = 0.89) and serum albumin (Alb) level (SMD = -0.63, 95%CI = -1.54-0.27, P = 0.17) were all similar between hypophosphatemic group and normal phosphatemia group. Sensitivity analysis excluded the effect of heterogeneity on statistical results. The funnel graphics were basically symmetrical, which indicated that the included literatures were distributed well, and the publication bias was small. Conclusions Occurrence of hypophosphatemia in ICU patients is associated with severity of illness, prolonged duration of MV and length of ICU stay, and higher mortalities. Levels of serum phosphorus may have certain clinical values for assessing prognosis of ICU patients.