Objective To analyze the clinical features of patients with negative double balloon enteroscopy(DBE)findings.Methods A total of 115 patients with suspected small intestinal diseases underwent DBE examination from gastroenterology department of Wuhan University People's hospital on December 2005 to July 2009.The negative and positive cases were 32 and 83 respectively,then compared clinical data of negative group with that of positive group.Results 83 cases with small intestinal diseases were detected from 115 patients by DBE examination,and the daignosis rate was 72.2%(83/115).2 patients occurred acute pancreatitis and 1 occurred hyperamylasemia.The level of initial hemoglobin of negative group was higher than that of positive group(107.938?26.015 vs 93.518?32.367,P=0.016).meanwhile,there were significant difference in clinical symptoms(unexplained alimentary tract hemorrhage,obscure partial bowel obstruction,abdominal pain and diarrhea)between two groups(P=0.035).Moreover,the positive detection rate of unexplained alimentary tract hemorrhage(81.8%)was obviously higher than that of abdominal pain(57.7%)or diarrhea(40%).Conclusion DBE examination is an effective method in the diagnosis of small bowel diseases at present,however,patients with higher level of initial hemoglobin or the main symptoms as abdominal pain or diarrhea should be prudent to choose.

Objective To analyze the reasons of invalid detections occurred in using three kinds of nucleic acid detection systems in our laboratory since 2016.Methods Analyze the numbers and types of invalid detections,for Roche Cobas S201 system from January to December 2016,Procleix Tigris system from January to September 2016,and Procleix Panther system from September 2016 to March 2017,respectively.Results The invalidation rates of Cobas s201,Tigris,and Panther systems were 0.90％ (402/44 838),4.01％ (2 960/73 835),and 1.34％ (1 093/81 741),respectively,and there were statistically significant differences between the three detection systems (P＜0.05).Except for the differences between Roche Cobas s201 and Panther 1404,there were statistically significant differences between instruments (P＜0.05).Failure of instruments,invalid detection of reagent calibrators,fault operation and sample quality are the causes of invalid detection.Conelusion The main reason of invalidation is instrument failure and reagent calibrator failmre.Invalid detections of nucleic acid screening is related on different detection systems.

In order to compensate for the deficiencies of current medical education, improve the comprehensive quality of medical students, the First Clinical College, Tongji Medical College of Huazhong University of Science and Technology took the lead in carrying out the health management practice of rela-tives and friends, and made a beneficial exploration of humanistic education for medical students. Relatives and friends were regarded as the specific practice objects, and by telephone and network at school, face-to-face communication during the vacation, medical students established, managed and track the health records of relatives and friends. The students could practice while learning, which made medical students, in im-proving the knowledge structure, enhance their emotional communication with friends and relatives, improve their doctor-patient communication ability, establish the concept of humanistic care, and cultivate their occupation moral respect for life and their dedication to medicine and the sense of responsibility and mission to the society. It provides a new strategy for medical humanities education.

Objective To study the change of levels of IL-6,IL-17,IL-23,IL-8,TNF-α and IFN-γ and their clinical significance on children with different types of Henoch-Schonlein purpura (HSP) Methods The blood specimens of 180 children with HSP as disease group and 30 health children as normal group were collected respectively.Disease group included 30 children at acute stage and 30 at convalescence stage of primary abdominal type,30 at acute stage and 30 at convalescence stage of primary non-abdominal type,30 at acute stage of secondary abdominal type,and 30 at acute stage of secondary non-abdominal type.The plasma levels of IL-6,IL-8,IL-17,IL-23,TNF-α and IFN-γ in the two groups were measured by ELISA method for comparison and analysis.Results The plasma levels of IL-6,IL-8,IL-17,IL-23 and TNF-α in disease group were higher than those in the normal group (P＜0.05).Those levels in the children at acute stage and of primary group were also found to be higher than those at convalescence stage (P＜0.05) and of secondary group (P＜0.05) respectively.Comparison of IL-6,IL-8,IL-17,IL-23 and TNF-α between abdominal type and the non-abdominal type had no significant difference (P＞0.05).The plasma level of IFN-γ in disease group was lower than those in normal group (P＜0.05).The levels of IFN-γ in the children at acute stage and of primary group were lower than those at convalescence stage (P ＜0.05) and of the secondary group (P ＜0.05) Comparison of IFN-γ between abdominal type and non-abdominal type had no significant difference (P＞0.05) Conclusions The plasma levels of IL-6,IL-8,IL-17,IL-23,TNF-o,IFN-γ show obvious changes in children with HSP,which suggests that the changes of cytokines are associated with the pathogenesis and prognosis of Henoch-Schonlein purpura.

Objective:To establish the model of rats with UC by 2,4,6 trinitrobenzene sulfonic acid ( TNBS)/ethanol to understand the changes of IL-17,IL-23,TGF-β1,IFN-γin pathogenesis of ulcerative colitis (UC) and the impacts of mesalazine,mont-morillonite powder and clostridium on that.Methods:85 rats were divided randomly into 6 groups including the model ,mesalazine, montmorillonite,clostridium,mesalazine combined with montmorillonite powder group (15 rats per group ) and an additional control group of 10 normal rats.TNBS/ethanol was used to establish the model of rats with UC.The dosage of model, mesalazine, montmorillonite powder ,clostridium and mesalazine combined with montmorillonite powder were converted by surface area of rat and given to the rats by gastric-tube daily.All rats were executed at the 12th day of the molding and treatment ,and the blood and colon samples were collected.The content of IL-17,IL-23,TGF-β1,IFN-γwas measured in the blood by the ELISA method.The different changes of the four cytokines were compared separately.Results: ( 1 ) TNBS/ethanol was used to establish the model of rats with UC.The obvious inflammation can be observed on distal colon of rats by pathologic sections of HE stained .(2) The levels of plasma IL-17,IL-23 and IFN-γin the model,mesalazine,montmorillonite,clostridium and mesalazine combined with montmorillonite powder group were higher than ones in the control gruop (P<0.05),meanwhile,the levels of plasma TGF-β1 are lower (P<0.05).3.Comparing with the model group,the levels of plasma IL-17,IL-23 and IFN-γin the mesalazine,montmorillonite,clostridium and mesalazine combined with montmorillonite powder group were lower , and the levels of TGF-β1 were higer.The differences have statistic significative ( P<0.05).(4)Comparing the efficacy of treatment among mesalazine ,montmorillonite powder,clostridium and mesalazine combined with montmorillonite powder ,mesalazine and mesalazine combined with montmorillonite powder gets the best results ( P<0.05 ).The efficacy between montmorillonite powder and clostridium is similar.Conclusion:(1) TNBS/ethanol can be used to establish the model of rats with UC and can be successfully approved by the measurement of symptoms and pathologic investigation .(2)The IL-17,IL-23 and IFN-γare very active higher in the blood of rats with experimental ulcerative colitis induced by TNBS /ethanol, and have a positive correlation with inflammation.The TGF-β1 is in decrease in the blood of rats with colitis , and has a Negative Correlation with inflammation.(3)Mesalazine,montmorillonite powder,clostridium and mesalazine combined with montmorillonite powder may renovate the damage of inflammatory tissues of rats with experimental ulcerative colitis , and relieve the symptom of inflammation by reducing exudation of proinflammatory cytokines IL-17, IL-23 and immune regulatory cytokines IFN-γby producing the exudation of proinflammatory cytokines TGF-β1 to be good for recovery of UC.

Long-term care is a long-term guarantee mechanism to meet the care needs of the old adults and ensure the quality of life. Among them, the professionalism and stability of the care team is a key factor to ensure the development of long-term care work. This paper analyzes the possible reasons for slow development of time bank with volunteers as the main body in the process of localization, and constructs a new model of diversified caring bank from the construction of care team, so as to promote the high-quality and sustainable development of long-term care in China.

Objective:To explore the elements of the diversified caring bank based on long-term care insurance system to provide a basis for the construction of diversified caring bank framework system.Methods:The phenomenological research method was adopted to conduct semi-structured interviews with 15 nursing management personnel in pension institutions in Suzhou and Suzhou long-term care insurance policy implementation management personnel in March to May 2021. NVivo 11 was used to manage interview data, and applied Colaizzi 7-step analysis to conduct inductive analysis and extract the themes.Results:The elements of the diversified caring bank based on long-term care insurance system were divided into three main modules: diversified caring personnel, diversified caring content and diversified incentive measures. The diversified caring personnel module included full-time and part-time caring personnel. Diversified caring content included six elements: daily life assistance, professional life caring, professional medical caring, communication and emotional support, emergency caring and special disease caring. Diversified incentive measures module included two elements: labor currency and "benefit" care currency.Conclusions:The diversified caring personnel provides continuous power for disabled caring; diversified caring content provides ways to meet the various needs of the disabled elderly; diverse incentives are effective ways to attract and stabilize the caring workforce.

OBJECTIVETo construct an eukaryotic expression plasmid for AY358935 gene and explore its function.

METHODScDNA of the AY358935 gene was amplified by reverse transcription-PCR and cloned into pGEM-Teasy. The pGEM-T-AY was validated by sequencing and served as a template for the construction of eukaryotic expression plasmid. The pcDNA3.1-AY recombinant was validated by double enzyme digestion and used for transient transfection of M14 cells. Expression of the AY358935 protein and proliferation of the M14 cells were determined respectively by Western blotting and 3-(4,5)-dimethylthiahiazo(-z-y1)-3,5-di-phenytetrazoliumromide (MTT) colorimetry.

RESULTSThe amplicons of RT-PCR were confirmed to have similar size with the cDNA fragment of the AY358935 gene as well as cloned region of pcDNA3.1-AY. The cloned region of pGEM-T-AY was sequenced to be identical with cDNA sequence of the AY358935 gene. M14 cells were transfected by the AY358935 gene, pcDNA3.1 and liposomes, respectively. After 48 h, expression of the AY358935 protein in M14 cells transfected with the AY358935 gene was significantly higher than other two groups. They also had a significantly higher absorbance value (A=0.74) than other two groups (A=0.39 and 0.46, respectively; P<0.05).

CONCLUSIONAn eukaryotic expression plasmid of the AY358935 gene was successfully constructed. Product of the AY358935 gene may promote the proliferation of M14 cells.

Objective:To investigate the application effect of virtual simulation combined with flipped classroom in experimental teaching of the nursing care of falls in the elderly.Methods:The 497 nursing undergraduates in the class of 2019 in Chongqing Medical University were selected as subjects and were then divided into control group (two classes with 251 students) and intervention group (two classes with 246 students). The students in the control group received traditional experimental teaching, and those in the intervention group received blended experimental teaching with virtual simulation combined with flipped classroom. At the end of the course, the use of virtual simulation platform was analyzed for the students in the intervention group, and a questionnaire survey and theoretical examination were used to compare the effect of experimental teaching between the two groups. SPSS 27.0 was used for the t-test and the chi-square test. Results:The frequency of use of the virtual simulation platform was (2.65±1.38) times per person in the intervention group, with an online learning time of 54.12-147.32 minutes. The questionnaire survey showed that compared with the control group, the intervention group had significantly higher scores of the achievement of teaching objectives and teaching satisfaction ( P<0.05). Compared with the control group after teaching, the intervention group had significantly higher scores of teaching promotion in terms of stimulating learning interest, cultivating self-learning ability, developing clinical thinking ability, improving innovation, and enhancing health education ability ( P<0.05). The intervention group had a significantly higher theoretical examination score than the control group [(79.38±5.09) vs. (77.88±4.97), P<0.05]. Conclusions:In the blended experimental teaching of the nursing care of falls in the elderly, virtual simulation combined with flipped classroom can help students master related knowledge and skills and cultivate their self-learning ability, clinical thinking ability, innovation ability, and health education ability.

Objective To evaluate the value of barium esophagography and CT in the diagnosis of congenital pyriform sinus fistula (CPSF).Methods The preoperative radiographic data of 5 9 CPSF patients were analyzed retrospectively,which were confirmed by operation.5 5 patients underwent barium esophagography,and 5 7 patients underwent pre-and post-contrast CT scans.The images of barium esophagography and CT were analyzed and the positive diagnostic rates (PDR)between the two imaging modalities and among the different CT features were compared.Results Among the 5 9 patients,left fistula was found in 5 5 cases,right fistula was found in 2 cases and bilateral fistula in 2 cases.For the patients examined with barium esophagography,53 sinus tracts or fistulas from the pyriform in 52 patients(including 2 patients with bilateral fistula)were depicted.The other 3 patients had negative results.The overall PDR of barium esophagography was 93.0%(53/57).CT findings of CPSF included the narrowness of pyriform fossa,sinus tract or fistula in the neck,bubble sign medial to the superior pole of thyroid,low density in thyroid,thyroid morphologic change,and so on.For the 5 7 patients (including 2 patients with bilateral fistula)examined with CT.The PDR of narrowness of pyriform fossa was 44.1%(26/59),the PDR of sinus tract or fistula was 1 3.6%(8/5 9),the PDR of bubble sign medial to the superior pole of thyroid was 55.9%(33/5 9),the PDR of low density in thyroid was 1 6.9%(1 0/5 9),the PDR of thyroid morphologic change(defect sign of superior pole of thyroid)was 9 1.5%(54/5 9 ).And the total PDR of thyroid density or morphologic change was 94.9%(56/59).Conclusion Barium esophagography can be the main modality to diagnose CPSF because of its high PDR.Although the PDR of CT for direct sign(sinus tract or fistula)is not high,its PDR for indirect sign (thyroid density or morphologic change)is very high.So CT has great value for patients suspected of CPSF.