Community psychiatry is an important branch of psychiatry. This article introduced the concept of community psychiatry, the importance and necessity of setting up community psychiatry course in psychiatry , and the modern teaching methods in teaching community psychiatry course . Combined with the research results about knowledge and attitude of college students on mental illness and the teaching activity, the author further explalned the necessity of setting up community psychiatry in the teaching of undergraduate medical students, and put forward the problem-based learning and case teaching method to make it more easy for students to grasp and understand the knowledge points.

Aged ; Antigens, CD ; metabolism ; Antigens, Differentiation, Myelomonocytic ; metabolism ; Carcinoma, Signet Ring Cell ; metabolism ; pathology ; surgery ; Diagnosis, Differential ; Gastrectomy ; methods ; Histiocytic Sarcoma ; metabolism ; pathology ; surgery ; Humans ; Lymphatic Metastasis ; Male ; Phosphoglucomutase ; metabolism ; Stomach Neoplasms ; metabolism ; pathology ; surgery

Objective The study aimed to evaluate the application effect of clinical pathways in laparoscopic cholecystectomy patients by using the meta-analysis.Methods Published randomized controlled trials (RCT) about laparoscopic cholecystectomy patients were searched and screened in China National Knowledge Infrastructure (CNKI),China Scientific Journal Database by VIP,Wanfang Database under present standards.The quality of the included studies was evaluated by certain standards.The Review Manager 5.2 software was used for analysis.Results Totally 29 studies including 5 570 cases were eligible to the criteria (2 753 in the experimental group and 2 853 in the control group) altogether.The meta-analysis showed that the hospitalization time and hospitalization costs in the clinical nursing pathway group were significantly less than those of the control group (SMD=-1.69 and-3.75),the satisfaction degree and the mastering of health knowledge in the clinical nursing pathway group were significantly higher than those of the control group (RR=1.16 and 1.26),the differece had statistical significance.Conclusions Application effect of clinical nursing pathways is superior to the traditional nursing method in laparoscopic cholecystectomy patients.

Objective To investigate the role of SHBG in PCOS. Methods Three hundred and ten PCOS patients were divided into the low-SHBG group , the normal-SHBG group , and 95 healthy women were enrolled in the healthy control group. Results (1) In the low SHBG group, the incidences of IR and MS were higher than those in the the normal SHBG group and the healthy control group (P < 0.05); (2) In the low SHBG group, DHEAS was significantly higher than that in the normal SHBG group (P < 0.05); (3) In the low SHBG group, FINS, HOMA-IR, TG, TC/HDL, TG/HDL, LDL/HDL were significantly higher than those in the normal SHBG group and the healthy control group , but HDL was significantly lower than that in the normal SHBG group (P < 0.05); (4) SHBG was positively correlated with HDL, but was negatively correlated with FPG, FINS, HOMA-IR, TG, TC/HDL, TG/HDL, LDL/HDL. Conclusions Uner the low SHBG level, PCOS patients have high levels of DHEAS, and SHBG may be a risk factor for MS, IR and dislipidemia.

Objective To detect the pre- and post-treatment levels of serum interleukin (IL-20) in asthmatic patients during the acute exacerbation period and to investigate the role of IL-20 in the pathogenesis of bronchial asthma and relative clinical significance. Methods Forty-five cases of mild to moderate asthma outpatients in the First Affiliated Hospital of Guangxi Medical University from May 2013 to October 2013 were chosen as the asthma group and 32 healthy people who underwent routine physical examination as the control group. All the patients were treated with inhalation salmeterol and fluticasone 50/250 μg/μg (sucking twice a day) together with ventolin if necessary , and even with theophylline sustained-release tablets as the additional treatment in moderate asthma group for 1 week. The serum levels of IL-20 as well as immunoglobulin E (IgE) were detected by ELISA in the asthma group before and after treatment as well as in the control group. Other data including ECP , the number of eosinophil ceils (EOS) and the pulmonary function (FEV1%) were detected as well. The differences of IL-20 levels between the asthma group before and after treatment and the control group were analyzed and the correlation between IL-20 and Ig E, EOS, ECP and FEV1% were analyzed. Results Compared with the healthy control group [(13.58 ± 6.17)pg/L], the levels of IL-20 in the mild and moderate asthma pretreatment group were significantly increased [(23.43 ± 13.60)pg/L and (33.78 ± 22.69)pg/L]. Compared with the mild asthma group, the levels of IL-20 in the moderate asthma pretreatment group were significantly higher. After treatment , the levels of IL-20 [(15.73 ± 8.27)pg/L and (19.64 ± 11.69)pg/L] were decreased respectively in the asthmatic patients. The Pearson correlative analysis showed that there were positive correlations between the levels of 1L-20 and IgE , EOS and ECP respectively and there were negative correlations between IL-20 levels and FEV1%. Conclusion IL-20 may be involved in the pathogenesis of asthma.

Toll-like receptors (TLRs) family may play important roles in inflammatory bowel disease. This study examined the expression of TLR2, TLR4 and TLR9 in the colonic tissues of patients with ulcerative colitis (UC) and explored their roles in the pathogenesis of UC. Colonic biopsies were taken from the colon of 30 patients with mild or moderate UC (at active phase) and 10 healthy controls during colonoscopy. TLR2, TLR4 and TLR9 protein expression levels were immunohistochemically detected. The mRNA expression levels of TLR2, TLR4 and TLR9 were assessed by reverse transcription polymerase chain reaction (RT-PCR). The disease activity index (DAI), colonoscopic and histologic grades and fecal microbial flora were determined. Histological examination showed that the intestinal mucous membrane of UC patients underwent acute inflammation changes. Immunohistochemistry exhibited that the expression levels of TLR2, TLR4 and TLR9 in colon epithelia and inflammatory cells were higher in UC patients than in control group (P<0.01). The mRNA expression levels of TLR2, TLR4 and TLR9 were increased in UC patients but were not detected in the normal controls. Expression levels of TLR2, TLR4 and TLR9 were positively correlated, and bore close correlation with DAI, colonoscopic and histologic grades and fecal microbial flora. An important mechanism of UC might be that abnormal activation of mucosal immunity by intestinal dysbacteriosis caused dysregulation of TLRS that mediates innate immunity.

Objective:To investigate the clinical characteristics and prognosis of Philadelphia (Ph) chromosome-positive chronic myeloid leukemia (CML) patients with additional chromosomal abnormalities.Methods:The data of 351 CML patients with Ph-positive in the Affiliated Hospital of Qingdao University from January 2009 to January 2019 were retrospectively analyzed. The bone marrow chromosomal karyotype analysis of all patients was performed by using R-banding technique. The clinical characteristics and karyotype of Ph-positive CML patients with additional chromosomal abnormalities at initial diagnosis were summarized, and Kaplan-Meier was used to analyze the differences in overall survival (OS) of patients with different karyotypes.Results:Among 351 patients with Ph-positive CML, 32 (9.1%) cases had variant translocation. At initial diagnosis, 47 cases had additional chromosomal abnormalities including 29 cases in chronic phase accounting for 9.15% (29/317) of all patients in chronic phase, 3 cases in accelerated phase accounting for 25.00% (3/12) of all patients in accelerated phase, 15 cases in blast crisis accounting for 68.18% (15/22) of all patients in blast crisis; there was a statistically significant difference in the chromosomal abnormalities rate of all different phases ( χ2=50.799, P<0.05). Among 47 Ph-positive CML patients with additional chromosomal abnormalities, 13 patients had complex karyotypes with more than 3 additional chromosomal abnormalities, the proportion of complex karyotypes in chronic phase, accelerated phase and blast crisis was 13.79% (4/29), 33.33% (1/3) and 53.33% (8/15), respectively, and the difference was statistically significant ( χ2=9.26, P<0.05). The study showed that the most common additional chromosomal abnormalities in chronic phase were double Ph (48.28%, 14/29) and -Y (10.34%, 3/29), while the most common chromosomal abnormalities in the blast crisis were +8 (26.67%, 4/15) and double Ph (26.67%, 4/15). Kaplan-Meier survival analysis showed that at initial diagnosis the OS time of patients with additional chromosomal abnormalities was worse than that of those with the non-additional chromosomal abnormalities group ( χ2 = 61.138, P<0.05). The OS of patients with complex karyotypes for Ph - positive CML patients with additional chromosomal abnormalities at initial diagnosis was worse than that of patients with non-complex karyotypes, and the difference was significant ( χ2 = 4.945, P < 0.05). Conclusions:The additional chromosomal abnormalities is closely related to the progression of CML, and the prognosis of CML patients with additional chromosomal abnormalities is poorer than that of patients with only Ph translocation. Moreover, the more complex the additional chromosomes are, the more likely blastic changes are, and the poorer prognosis. And additional chromosomeal abnormalities during the treatment of CML patients may also lead to the progression of blastic changes.

Objective:To observe the adverse reactions of killer cytokine-induced (CIK) in the treatment of malignant tumor and to analyze the possible mechanism ,and to develop the targeted prevention and treatment measures .Methods: The clinical data, including various adverse reactions , laboratory tests and the corresponding preventive measures against adverse reactions .In 1 240 patients with malignant tumor after treated with CIK cells from May 2013 to September 2015 were retrospectively analyzed .Results:The main adverse reactions after the first infusion of CIK cells were weak (10%),fever(7.25%),shiver (4%),arthralgia (3%),systemic in flammatory response syndrome reaction ( 3%) , digestive tract discomfort ( 0.96%) , acute allergic reaction ( 0.08%) , rash (0.08%),angina pectoris (0.08%),tumor lysis syndrome(0%),infection(0%).With the increase of the treatment ,the incidence of adverse reactions increased and the fever was the main performance ,after the fourth course into the platform .The combination of blood pressure increased or decreased and severe allergic reaction and systemic inflammatory response syndrome was needed to be treated .The CIK cells were pretreated before treatment could reduce the incidence of these reactions .Conclusion:CIK cells therapy is a safe and effective adoptive immunotherapy for malignant tumor and its adverse reactions can be treated expectantly , but rare adverse reactions may have potential risks .

Objective:To study the correlation between HBV Pre-S1 antigen,HBeAg levels and HBV DNA copies,so as to assess the clinical value of Pre-S1 in detection of HBV replication.Methods:A total of 363 HBsAg-positive samples were col- lected.The levels of Pre-S1 antigen,HBeAg and HBV DNA copies were determined by ELISA,time-resolved immuno-fluores- cent method and real-time fluorescent quantitative PCR(FQ-PCR),respectively.The correlation between the determination re- sults was analyzed.Results:Pre-S1 antigen level was correlated with the level of HBeAg(X~2=94.4,P

Objective:To evaluate the rate of basicervical fractures and document their diagnosis and treatment.Methods: From January 2005 to May 2016,28 basicervical fractures of the 832 trochanteric fractures were collected and evaluated.The patients were treated with multiple screws,dynamic hip screw (DHS),intramedullary nail.Via the operation time,postoperative hospitalization,loss of blood duration the operation,hidden blood loss,total blood loss,mean union time and the final follow-up Harris hip score,the characteristics of different internal fixations were compared and analyzed.Results: The incidence of basicervical fractures was 3.37％ (28/832) in our study.In the intramedullary nail group (16 patients),the operation time was 55 (20,120) min,the postoperative hospitalization was 3(2,7) d,the intraoperative blood loss was 50(5,100) mL,the hidden blood loss was 533.37 (376.19,987.15) mL,and the total blood loss 627.35 (406.19,1037.16) mL.The union time and final follow-up Harris score were 6 (3,9) months and 90.25 (74,100) min.In the DHS group (8 patients),the operation time was 87.5 (65,115) min,the postoperative hospitalization was 5.5 (2,17) d,the intraoperative blood loss was 100 (50,300) mL,the hidden blood loss was 278.11 (202.43,849.97) mL,and the total blood loss 580.19 (368.55,899.97) mL.The union time and final follow-up Harris score were 5.5 (4,12) months and 85.5 (84,87) min.In the multiple screws group (4 patients),the operation time was 47.5 (35,75) min,the postoperative hospitalization was 5 (2,12) d,the intraope-rative blood loss was 20 (2,70) mL,the hidden blood loss was 150 (100.00,412.01) mL,and the total blood loss 195.00 (120.00,414.01) mL.The union time and final follow-up Harris score were 4 (4,6) months and 80 (61,97) min.The patients treated with multiple screws and intramedullary nail had a shorter operation time than the DNS group,but no obvious difference was found between the other two groups (P=0.367).Postoperative hospitalization had no significant difference among the three groups.The intraoperative bleeding was more in the DHS group,the other two groups had no significant difference (P=0.100).However,the hidden blood loss was more in the intramedullary nail group,the other two groups had no significant difference (P=0.134).The total blood loss in the intramedullary nail group was more than multiple screw group,similar to the DHS group (P=0.483).One patient treated with multiple screws underwent internal fixation failure three months after operation.The mean union time and final follow-up Harris scores had no significant difference among the three groups (P>0.05).Conclusion: Through this study,we found that the incidence of basicervical fractures is low.Fractures with no shift can be confirmed by preoperative X-ray.For displaced fractures,preoperative CT + 3D reconstruction is recommended.Surgical treatment by closed reduction and internal fixation with DHS or intramedullary nail is shown to be very effective.