Objective To study the splenic injuries caused by high-altitude falling and underwater explosion and the 2-dimensional ultrasound and contrast-enhanced ultrasound(CEUS)characteristics.Methods Twenty-three healthy Beagle dogs were divided into high-altitude falling group(n=13)and underwater explosion group(n=10).Free-fall high-platform device and gram-grade trinitrotoluene were used to simulate high-altitude falling injury and underwater explosion injury in Beagle dogs,respectively.Ultrasound examination of the spleen was performed immediately after injury,with follow-up examinations every hour.CEUS examination was performed in surviving dogs.Spleen specimens were taken from deceased dogs after injury to observe gross injuries.Pathological changes in tissue morphology and cell apoptosis were observed by hematoxylin-eosin(H-E)staining.Results In the high-altitude falling model,6,2,1,and 1 dogs died in the 6 m,7 m,8 m,and 9 m groups,respectively;in the underwater explosion model,1 and 4 dogs died in the buoyancy and frogman groups,respectively.Two-dimensional ultrasound examination of the high-altitude falling model showed spleen rupture(disruption of splenic parenchymal structure),perisplenic fluid accumulation,subcapsular hematoma,intrasplenic hematoma,increased splenic vein echo,and uneven splenic parenchymal echo.Two-dimensional ultrasound examination of the underwater explosion model showed increased splenic vein echo and uneven splenic parenchymal echo,which were less serious compared with the high-altitude falling model.CEUS results indicated 4 major contrast patterns in both models.The Beagle dogs with type Ⅰ(large focal contrast defect),type Ⅱ(diffuse contrast defect),or type Ⅲ(no contrast agent entry into the splenic vein)contrast patterns all had splenic rupture after injury.H-E staining results showed true splenic rupture,diffuse intrasplenic hemorrhage,splenic hematoma/ecchymosis,subcapsular hematoma/ecchymosis,and venous congestion after spleen injury,which were consistent with the 2-dimensional ultrasound findings.Conclusion High-altitude falling causes more serious spleen injuries in Beagle dogs compared with underwater explosions.Routine ultrasound performs well in diagnosing typical splenic injuries,while CEUS has advantages in evaluating atypical splenic injuries and has good predictive ability for delayed splenic rupture.

As excellent demonstration courses with distinctive teaching characteristics and the first-class teaching level, quality courses can improve the quality and effects of standardized training. Based on years of experience in teaching and training and focusing on the problems in standardized training, we have established a series of quality courses, including targeted short video lessons for systematic and comprehensive learning and module-based training, flipped classroom teaching based on case analysis, and real-time remote teaching and online teaching under the background of "Internet Plus". These courses aim at strengthening students' theoretical basis and practical ability and building their clinical thinking, so as to improve teaching effects and training quality.

OBJECTIVE：To investigate the effects of integrated su pervision mode by doctors ，pharmacists and nurses on the whole-process implementation of therapeutic drug monitoring （TDM）. METHODS ：The patients monitored with TDM in our hospital admitted from Jan. to Dec. 2018 were selected as control group ，treated with the traditional drug supervision mode （i.e. the work of doctors ，nurses and pharmacists was relatively independent ）. Treatment group was composed of inpatients monitored with TDM from Jan. to Dec. 2019，treated with the integrated supervision mode of doctors ，nurses and pharmacists （i.e. doctors ，nurses and pharmacists cooperated with each other ，taking the patients and sample as the center ，pharmacists as the key link formulated the implementation standards of each link ，and clarified their respective responsibilities ）. The concentration compliance rate ，the incidence of incorrect samples ，critical value notification rate ，clinical satisfaction ，drug recommendation feedback and adoption ， compliance rates of 6 kinds of monitored drugs （sodium valproate ，digoxin，tacrolimus，cyclosporin，methotrexate，vancomycin） were compared between two groups. RESULTS ：The overall compliance rate ，critical value notification rate and clinical satisfaction rate of the observation group were respectively 64.57％，99.39％ and 97.22％，which were significantly higher than 57.86％， 96.80％ and 92.22％ of control group （P＜0.05）. The incidence of incorrect samples in observation group was 0.72％，which was significantly lower than 3.09％ of control group （P＜0.001）. The feedback rate of individual pharmacists （89.19％），the feedback rate of doctors （80.50％）and the adoption rate of medication suggestions （69.98％）in the observation group were significantly higher than control group （50.34％ ，71.46％ and 55.36％ ，P＜0.001）. The compliance rate of tacrolimus concentration in observation group was slightly lower than control group （73.40％ vs 75.77％，P＞0.05）. The concentration compliance rate of other 5 varieties was higher than control group ，and the differences of valproate sodium ，digoxin and vancomycin concentrations between two groups were statistically significant （P＜0.05）. CONCLUSIONS ：The implementation of integrated doctors ，nurses and pharmacists supervision mode in TDM can effectively improve the drug concentration compliance rate ，realize the . dynamic supervision and feedback of individualized drug use ， which is conducive to ensure the safety of clinical medication.

Objective:To investigate the "V" -shaped anatomical approach in the prevention of bile duct injury during laparoscopic complex cholecystectomy and its clinical application value.Methods:The patients with complex gallbladder from June 2020 to June 2021 in the First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology were selected as the research objects, and they were randomly divided into observation group and control group, with 60 cases in each group. All patients underwent laparoscopic cholecystectomy. The observation group underwent laparoscopic cholecystectomy through the triangle "V" shape of the gallbladder, and the control group did not use the "V" shape anatomy. The operation status, complications and postoperative recovery of the two groups of patients were compared.The measurement data of normal distribution were expressed by ( Mean± SD), and t test was used for comparison between groups, and chi-square test was used for comparison between groups of count data. Results:The conversion rate to laparotomy, intraoperative bleeding and operation time of observation group were 3.33%, (97.31±13.27) mL, (65.27±13.82) min, which were significantly lower than those in the control group[8.33%, (111.27±25.18) mL, (81.35±12.12) min], the differences between the two groups were statistically significant( P<0.05). The incidence of biliary injury, total incidence of complications of the observation group were 0, 8.33%, which were significantly lower than those in the control group(6.67%, 28.33%), the differences between the two groups were statistically significant( P<0.05). The postoperative exhaust time, drainage tube retention time, hospitalization cost and hospitalization time of the observation group were (9.89±3.58) h, (32.58±5.17) h, (3 142.92±137.93) yuan, (4.73±1.42) d, and significantly lower than those in the control group [(11.65±2.45) h, (46.18±6.49) h, (3 424.29±156.34) yuan, (5.38±1.25) d], the differences between the two groups were statistically significant ( P<0.05). Conclusions:For laparoscopic complex cholecystectomy, the use of the triangular "V" -shaped gallbladder anatomical approach is more conducive to the operation, can reduce the patient's operation time and intraoperative blood loss, reduce the rate of intraoperative conversion to laparotomy, and reduce biliary tract injury and bile leakage. Such as the incidence of complications, prompting patients to recover as soon as possible, it is worthy of clinical application and promotion.

Objective To investigate the feasibility of low-c oncentration iso_osmolar contrast agent together with low tube voltage and iterative reconstruction algorithm in rabbit liver computed tonography (CT) perfusion imaging.Methods A total of 15 bealthy New Zealand rabbits were scanned twice of liver CT perfusion scans each with 24 hours interval.The first scan (routine group) was acquired at 100 kV and 100 mAs with ultravist (370 mg/ml),while the second (double low group) was acquired at 80 kV and 100 mAs with iodixanol (270 mg/ml) at 24 hours after the first scan.The obtained images were reconstructed with filtered back projection (FBP) and adaptive iterative dose reduction (AIDR-3D)algorithms in the controlled and experimental groups,respectively.The perfusion parameters including hepatic artery perfusion(HAP),portal vein perfasion(PVP),hepatic perfusion index(HPI),and total liver perfusion(TLP) and image quality as image quality score,average CT value of abdomen aorta,signalto-noise ratio(SNR),carrier-to-noise ratio(CNR),and figure of merit(FOM) were compared used pair ttest or Mann-Whitney U-test between the two groups wherever appropriate.The effective radiation dose and iodine intake were also recorded and compared.Results The image quality and perfusion parameters had no significantly different between the two groups except for FOM.The effective radiation dose and iodine intake were 38.79％ and 27.03％ lower in the double low group.Conclusions Low concentration iso _osmolar contrast agent (iodixanol,270 mg/ml) together with low tube voltage (80 kV) helps to reduce radiation dose and iodine intake without compromising perfusion parameters and image quality in liver CT perfusion imaging.

Objective To investigate the pathogenic mutations of BRCA1 and BRCA2 in patients with early-onset breast cancer(≤35 years) and explore the relationships between BRCA1/2 mutations and clinical features.Methods Seventy-four patients with early-onset breast cancer were enrolled,who were treated in Hospital 307 between September 2014 and June 2016.High-throughput sequencing was used to test the 49 exon sequences and adjacent sequences of BRCA1 and BRCA2.χ2 test was used to analyze the distribution of BRCA1/2 pathogenic mutations in each group that was set up according to clinical features.Results Fifteen mutations(20.27%) were identified,including 5(6.76%) in BRCA1 and 10(13.51%) in BRCA2.Eleven new pathogenic mutations were discovered,and BRCA1:c.5470_5477delTGCCCAAT was found in one patient.The frequency of BRCA1/2 mutations in the group with a family history of breast cancer or ovarian cancer was higher than in the group without a family history (40.91% vs 11.54%) (χ2=6.534,P=0.011).Conclusion BRCA1/2 pathogenic mutation is significant for early-onset breast cancer,especially for those with a family history of breast or ovarian cancer.The new mutations may be specific to Chinese people.BRCA1:c.5470_5477delTGCCCAAT may be the ancestor mutation among the Chinese.

Objective To investigate the diagnostic value and safety of medical thoracoscopy in unexplained exudative pleural effusion.Methods A retrospective analysis was conducted using the clinical data of 70 routine medical thoracoscopy examinations of unexplained exudative pleural effusion in patients.The lesions were examined pathologically under direct vision.Results White military nodules were observed under endoscopy,with multiple pro-truding nodules,focal irregular thickening of the pleura,pleural congestion,edema and adhesion.The diagnostic accu-racy of thoracoscopy was 95.7%.Among the diagnosed cases,there were 35 cases of tuberculous pleurisy,20 cases of malignant pleural effusion,8 cases of parapneumonic effusion,4 cases of pleural effusion from congestive heart failure and 3 cases of idiopathic pleural effusion,with no serious complications.Conclusion Medical thoracoscopy is a safe and accurate method in the diagnosis of unexplained exudative pleural effusion.Medical thoracoscopy is beneficial in the establishment of treatment method quickly and allows observation of the pleural lesions in pleural effusion patients using the naked eye.

OBJECTIVETo investigate the diagnostic value of thoracoscopy on idiopathic coalworker's pneumoconiosis with pleural effusion in general medicine.

METHODRoutine (general medicine) thoracoscopyof patients suffering from iIdiopathiccoalworker's pneumoconiosis with pleural effusion, pathological examination of lesions obtained (direct vision).

RESULTPathological examination revealed grayish-white miliary nodules with multiple protruding nodules, irregular focal pleura thickening, pulmonary congestion, edema, fibrous adhesion. Thorascopy produced a diagnostic rate of 93.3%. Confirmed cases includes 13 cases of tuberculous pleurisy, 11 cases of malignant pleural effusion, 4 cases of cardiac insufficiency with pleural effusion and 2 cases of idiopathic pleural effusion, with no serious complications.

CONCLUSIONThoracoscopy of idiopathic coalworker's pneumoconiosis with pleural effusion is a safe, accurate diagnostic methodin general medicine, and could benefit the establishment of a treatment method quickly, visual observation of the lesions of patients suffering from coalworker's pneumoconiosis with pleural effusion using thoracoscopy, and at the same time offer preliminary investigationof the correlation between the intensity and compactibilityof coal macule distribution and clinical stages of coalworker's Pneumoconiosis.

Anthracosis ; diagnosis ; Heart Failure ; diagnosis ; Humans ; Lung ; pathology ; Pleural Effusion ; diagnosis ; Pleural Effusion, Malignant ; diagnosis ; Pulmonary Edema ; diagnosis ; Thoracoscopy ; Tuberculosis, Pleural ; diagnosis

Objective:To observe the effect and the underlying mechanism of wild chrysanthemum eye drops in the treatment of rabbit evaporative dry eye. Methods:The dry eye model was established by cauterizing the meibomian gland orifices in sixteen New Zealand white rabbits. In the sixth week after the operation, they were divided into four groups treated by wild chrysanthemum eye drops, dextran and hypromellose eye drops, solvent control solution and physiological saline, respectively. Corneal fluorescence stai-ning, rose bengal staining and conjunctival goblet cell density were performed and detected before and after the operation. Results:Be-fore the treatment, no significant difference was found in the tested indices among the four groups (P>0. 05). After the treatment, the fluorescence staining and rose bengal staining in wild chrysanthemum eye drops group were lighter than those in the untreated groups, and the conjunctival goblet cell density was higher than that in the untreated groups(P<0. 05). The difference was not statistically sig-nificant among dextran and hypromellose eye drops, solvent control group and blank control group (P>0.05). Conclusion: Wild chrysanthemum eye drops can alleviate ocular surface inflammation of dry eye in rabbits, which suggests good application prospect in the treatment of dry eye.

Objective:To study the optimum extraction conditions for Yaotong granules. Methods:An orthogonal test was adopted to optimize the percolation extraction process of total alkaloids by orthogonal experiment with the yield of dry extract and total extraction rate of tetrandrine and fangchinoline as the indices. Results:The optimal extraction conditions were as follows:the medicinal materials were soaked with crude powder in 60% ethanol for 48h,then percolated at the rate of 2 ml·min-1 ·kg-1 . Conclusion:The extraction technology for Yaotong granules is simple and rapid with stable results,which can provide theoretical basis for the production of Yaotong granules.