Objective To explore the characteristics of surface electromyogram (sEMG) of the forearm muscles of Parkinson's disease patients with or without load. Methods 26 Parkinson's disease patients and 28 healthy individuals participated in this study. All the subjects performed isometric contraction for elbow flexion without load or with a load of 1.5 kg. The sEMG signals were collected by surface elec-trodes and processed by linear time and frequency domain method. Results The values of median frequency (MF) and mean power frequen-cy (MPF) were higher in the patients than in the healthy controls without load (P<0.05). The value of average EMG (AEMG) was lower in the patients than in the healthy controls with a load of 1.5 kg (P<0.001). For the patients, the values of MF and MPF were higher without load than with a load of 1.5 kg (P<0.001), and the value of AEMG was lower without load than with a load of 1.5 kg (P<0.001). For the healthy controls, only the value of AEMG was lower without load than with a load of 1.5 kg (P<0.001). Conclusion The values of MF and MPF are higher in Parkinson's disease patients than in the healthy controls without load while the value of AEMG is lower in Parkinson's dis-ease patients than in the healthy controls with load.

Using novel virtual reality (VR) technology to carry out the construction of clinical medical examination question bank, while deepening the reform of clinical medical course examination, it continues to innovate the medical professional evaluation system and improve the flexibility, diversity and scientificity of clinical medicine in teaching and assessment. It is of great and far-reaching significance to improve the teaching level and the quality of medical education in medical colleges and universities. This paper analyzes and discusses the necessity and feasibility of building a clinical medical examination question bank, and the advantages and prospects of integrating VR technology to carry out the construction of clinical medical examination question bank. At the same time, the exploration and practice of the examination question bank construction based on VR technology disscussed in detail would provide innovative thinking and reference for the clinical medical teaching and evaluation, medical personnel training and other aspects in China.

Objective:By detecting the level changes of CXC chemokine ligand 8(CXCL8)in acute myelogenous leukemia(AML)patients at different disease stages,to analyze its correlation with the clinical condition and prognosis of AML patients,and to explore the effect of CXCL8 in the bone marrow microenvironment on the occurrence and development of AML and the regulatory mech-anism of malignant biological behavior of AML cell lines,to provide novel reference for the basic research and clinical diagnosis and treatment of AML.Methods:Bone marrow specimens from AML patients at different disease stages were collected,and ELISA was used to detect the content of CXCL8;quantitative real-time PCR(qRT-PCR)was used to detect the expression of CXCL8-specific receptor CXCR1/2 in different AML cell lines.U937 cells were selected as the AML disease model,and different concentrations of exogenous rCXCL8 were intervened in U937 cells,and the morphological changes of the cells were observed under the microscope.BM-MSCs from newly diagnosed AML patients were co-cultured with U937 cells,and ELISA was used to detect the difference in the content of CXCL8 in the co-culture system;Annexin V/PI double staining flow cytometry was used to detect the effects of rCXCL8 and anti-CXCL8 on the apoptosis of U937 cells respectively,and Western blot was used to reveal the accompanying molecular protein mechanism.Results:The level of CXCL8 in newly diagnosed and relapsed AML patients was significantly higher than that in healthy people(P<0.05),the level of CXCL8 in relapsed stage of AML was significantly higher than that in other disease stages of AML(P<0.01),and the level of CXCL8 in AML patients with CR stage and no infection was significantly higher than that in healthy people(P>0.05).The content of CXCL8 in the co-culture system of BM-MSC and U937 cells and the level of CXCL8 mRNA in U937 cells in the co-culture system were significantly higher than those in the monoculture group without BM-MSC(P<0.05).Intervention of rCXCL8 in U937 cells could promote cell proliferation by up-regulating Bcl-2 expression and down-regulating Bax expression,and up-regulate the expression of CXCL8-specific receptors CXCR1/2.After antagonizing CXCL8(anti-CXCL8),it will induce U937 cell apoptosis by up-regulating of Bax expression and down-regulating of Bcl-2 expression while inhibiting the activation level of ERK1/2 signaling pathway.Conclusion:CXCL8 is closely related to the disease and prognosis of AML,and is an effective monitoring indicator for disease pro-gression and prognosis evaluation of AML patients.CXCL8 in the bone marrow microenvironment is an important chemokine for malig-nant proliferation and immune escape of leukemia cells.By antagonizing CXCL8,U937 cells can be induced to undergo apoptosis,whose mechanism may be related to the expression changes of Bcl-2 family proteins and the inhibition of ERK1/2 signaling pathway activation.

Objective:To explore the clinical effect of R-MAD (rituximab, methotrexate, cytarabine, dexamethasone) regimen in the treatment of primary ocular adnexal double-expression diffuse large B-cell lymphoma (DLBCL).Methods:The clinical data of an elderly patient with primary ocular adnexal double-expression DLBCL who was treated with R-MAD regimen in June 2019 in Fujian Medical University Union Hospital was retrospectively analyzed. The clinical manifestations, diagnosis and treatment, prognosis were also analyzed, and the related literature was reviewed.Results:The patients was a 71-year-old male. After initial treatment of R-CHOP chemotherapy, the patient's eye mass did not shrink, the swelling and pain became worse, the curative effect was not good, and the disease progression continued. After the patient was given R-MAD chemotherapy for 3 courses, the eye swelling subsided and pain symptoms were significantly improved, satisfactory results were obtained, and no obvious adverse reactions occurred.Conclusions:R-MAD regimen has an ideal effect on the patient with primary ocular adnexal double-expression DLBCL, which can significantly improve symptoms, delay disease progression, and improve the quality of life of patients, but the prognosis still needs to be followed up in the long-term.

At present, chemotherapy combined with radiotherapy or targeted therapy is the key method for the treatment of lymphoma. However, clinical treatment measures are not only effective for patients to obtain disease remission and long-term survival, but also have a negative impact on reproductive function of patients. For young patients with good curative effects, long-term survival and remission, normal childbearing becomes an important aspect of long-term prognosis evaluation of lymphoma, and it is also a concern of lymphoma patients. This article will systematically present the epidemiology of lymphoma, the impact of lymphoma on reproductive function, the status and challenges of reproductive function protection in lymphoma patients, the ethical issues of human reproduction, and the principles and selection of reproductive protection for patients with lymphoma. The analysis and discussion are expected to provide reference for the reproductive protection and eugenics of lymphoma patients in China.

Objective:To investigate the expression level of small nucleolar RNA SNORD15A in bone marrow of patients with acute leukemia (AL) and its relationship with clinical characteristics and prognosis of patients.Methods:Bone marrow blood samples of 53 newly treated AL patients and 29 healthy subjects without clinical diagnosis of hematologic diseases or other malignant diseases (control group) at the Affiliated Hospital of Guangdong Medical University from March 2018 to December 2021 were collected. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to detect the relative expression of SNORD15A in bone marrow blood mononuclear cells of the two groups. The median relative expression of SNORD15A (0.148) was used as the boundary, and AL patients were divided into low expression group (<0.148) and high expression group (≥0.148). The relationship between the expression level of SNORD15A and the clinical characteristics, clinical indicators and overall survival (OS) of AL patients was analyzed. Kaplan-Meier method was used for survival analysis and log-rank test was performed; Cox proportional hazards model was used for univariate and multivariate analyses of OS of patients.Results:The relative expression of SNORD15A was 0.148 (0.012-1.376) in newly treated AL patients and 0.921 (0.513-2.288) in the control group, and the difference was statistically significant ( Z = -6.85, P < 0.01). The differences in SNORD15A relative expression between patients with different prognostic stratification, efficacy and with or without fever and bleeding were statistically significant (all P < 0.05). The differences in platelet count, plateletcrit and albumin levels between SNORD15A low expression group and high expression group were statistically significant (all P < 0.05), and the differences in molecular biology and cytogenetic characteristics were not statistically significant (all P > 0.05). The patients in SNORD15A high expression group had better OS than the low expression group ( P < 0.05). The results of univariate Cox regression analysis showed that SNORD15A was an influencing factor for patients' OS ( HR = 0.063, 95% CI 0.005-0.766, P < 0.05); the results of multivariate Cox regression analysis showed that fatigue ( HR = 4.754, 95% CI 1.014-22.290), fever ( HR = 0.147, 95% CI 0.029-0.746) and hemoglobin ( HR = 0.970, 95% CI 0.944 -0.998) were independent influencing factors for OS (all P < 0.05). Conclusions:SNORD15A is lowly expressed in AL and may be an indicator for disease monitoring and prognostic assessment in AL patients.

Objective:To investigate the expression level of flap endonuclease 1 (FEN1) in bone marrow mononuclear cells of patients with acute myeloid leukemia (AML) and its relationship with clinicopathologic features and therapeutic effect, so as to provide a new direction for disease monitoring and targeted therapy in AML patients.Methods:The data of 57 newly treated AML patients and 26 healthy individuals (the healthy control) from the First Clinical College of Guangdong Medical University and Fujian Medical University Union Hospital from November 2018 to December 2020 were retrospectively analyzed. Bone marrow samples of all subjects were collected. Quantitative real-time fluorescence polymerase chain reaction (qRT-PCR) was used to detect FEN1 mRNA expression in bone marrow mononuclear cells of all subjects. Bone marrow samples from 9 newly-diagnosed AML patients and 4 healthy controls were collected, and FEN1 protein expression level was detected by using Western blotting. Differences in FEN1 mRNA expression in AML patients achieving different therapeutic effects were compared among AML patients whose data with evaluable efficacy. AML patients were divided into high FEN1 expression group (≥ critical value) and low FEN1 expression group (< critical value), taking the median relative expression level of FEN1 mRNA as the critical value. The correlation of FEN1 expression level with clinicopathologic features, laboratory indicators, cellular and molecular genetic changes in AML patients at initial diagnosis was analyzed.Results:The median relative expression of FEN1 mRNA in newly treated AML patients was higher than that in healthy controls [0.696 (0.025-3.661) vs. 0.246 (0.013-1.237), Z = 1.75, P = 0.041]. Western blotting showed that the expression level of FEN1 protein in AML patients was higher than that in healthy controls. The relative expression of FEN1 mRNA in 15 recurrent AML patients was higher than that in 19 patients patients achieving complete remission (CR) [1.153 (0.047-4.172) vs. 0.259 (0.023-1.148), Z = 2.71, P = 0.009]. The proportion of patients with French-American-British(FAB) type M 5, fever at initial diagnosis and lymph node enlargement in FEN1 high expression group (32 cases) was higher than that in FEN1 low expression group (25 cases) (all P < 0.05). There were no significant differences in the proportion of gender, age, fatigue, pale skin mucosa and large liver and spleen of patients between the two groups (all P > 0.05). At initial diagnosis, the white blood cell count, lactate dehydrogenase, C-reactive protein and bone marrow primitive cell proportion in FEN1 high expression group were higher than those in FEN1 low expression group (all P < 0.05), and the hemoglobin and platelet count in FEN1 high expression group were lower than those in FEN1 low expression group (all P < 0.05). There were no significant differences in procalcitonin level, the proportion of chromosome karyotype, cytogenetic prognosis grade and patients with or without gene mutation between the two groups (all P > 0.05). Conclusions:FEN1 expression is up-regulated in AML patients and further increased in relapsed patients. FEN1 expression in AML patients is associated with adverse clinicopathological features and poor detection results of laboratory indicators, which may become indicators for disease monitoring in AML patients.

Objective:To investigate and analyze the status quo of death cognition and hospice care attitude of clinical medical graduate students, to compare the differences between the two groups, and to explore the correlation between death cognition and hospice care attitude, so as to provide the reference for the reform and construction of death cognition and hospice care education in medical colleges and universities in China.Methods:A survey was carried out on 496 doctoral and postgraduate students majoring in clinical medicine by using the "Questionnaire of General Sociology Survey", the Chinese version of the "Death Attitude Profile Revised Scale", and the Chinese version of the "Frommelt Attitudes Toward Care of the Dying Scale Form B (FATCOD-B)" to investigate the death cognition and hospice care attitude of 496 doctoral and postgraduate students majoring in clinical medicine, and classified and compared the survey results of the two groups. The results of this study were statistically analyzed by t-test, Pearson correlation analysis and other statistical methods. Results:A total of 469 valid questionnaires were recovered after excluding 27 unqualified questionnaires. Statistical analysis showed that the scores of each dimension in the death attitude description scale of doctoral students were ranked as follows: approach acceptance (4.28±0.53), neutral acceptance (3.99±0.41), death avoidance (2.74±0.63), fear of death (2.65±0.57) and escape acceptance (2.47±0.69) the scores of postgraduates were ranked as neutral acceptance (3.96±0.52), approach acceptance (2.84±0.61), fear of death (2.78±0.65), death escape (2.62±0.73), escape acceptance (2.39±0.77). At the same time, the scores of hospice care attitude in the doctoral group were higher than those in the master group [(110.63±8.96) vs. (106.78±6.52)], and the difference was statistically significant ( P<0.001). In addition, the scores of "fear of death" and the scores of hospice care attitudes were negatively correlated with the scores of doctoral and master students ( r=-0.25, r=-0.21), while the scores of hospice care attitudes were positively correlated with the scores of "neutral acceptance" in death cognition ( r=0.50, r=0.32). However, the hospice care attitude scores of doctoral students were negatively correlated with the "death avoidance" scores in death cognition ( r=-0.27). Conclusion:Doctoral and postgraduate students have a certain awareness of hospice care, while their death cognition and hospice care attitude still need to be improved and strengthened from sociology, psychology, ethics and other perspectives. The above will promote the harmony between doctors and patients while meeting the needs of an aging society in China.

Virtual reality technology is a technology that creates a visual environment for people to experience through computer simulation, with features of immersion, interaction and imagination. This technology was used in engineering mechanics and urban planning in early times In medicine, diagnostics serves as a bridge for medical students to transit from basic medicine to clinical medicine. Using virtual reality technology to produce standardized patients (SPs) allows medical students to simulate the role of clinicians in the classroom, complete the diagnosis and treatment for virtual patients using various electronic media and the mastered theoretical knowledge of diagnostics, set up simulation training and online-and-offline teaching according to the diagnostic course standards which compensates the disadvantages in traditional medical teaching. Virtual reality technology has practical significances for cultivating medical students' clinical skills and thinking through procedural process evaluation, real-time feedback, etc.. This paper will discuss the prospect of virtual reality technology, its application as well as its advantages in diagnostic teaching.

Objective To explore the relationship between hemoglobin (Hb) level during the first trimester of pregnancy and gestational diabetes mellitus (GDM). Methods A total of 1 276 participants, who underwent scheduled prenatal examination and normal singleton delivery at the Fifth People′s Hospital of Shanghai and Hospital of Intergrated Chinese and Western Medicine in Minhang District, from January 2016 to May 2018 were included. There were 99 cases of GDM (GDM group) and 1 177 cases of normal (control group) pregnant women.Based on the serum Hb level during the first trimester of pregnancy, participants were divided into three groups, 236 cases of low Hb level group (Hb<110 g/L), 868 cases of normal Hb level group (110 g/L≤Hb<130 g/L), and 172 cases of high Hb level group (Hb≥130 g/L). Maternal clinical data were collected, including Hb level during the first trimester of pregnancy, three-point blood glucose (BG) of oral glucose tolerance test (OGTT) and fasting insulin during the second trimester of pregnancy. Homeostasis model assessment of insulin resistance index (HOMA-IR) and homeostasis model assessment of pancreatic β cell function index (HOMA-β) were used to evaluate insulin resistance and pancreatic β cell function. Results (1) Hb level during the first trimester of pregnancy in GDM group was significantly higher than that in control group [(123±10),(119±11) g/L, P<0.05]. There were no significant difference in gravidity, parity, index of liver and renal function (all P>0.05). (2) Pre-pregnancy body mass index (BMI), 1-hour BG and 2-hour BG of OGTT were significantly increased in the high Hb level group during the first trimester of pregnancy, which were (23±4) kg/m2, (7.3±2.0) mmol/L, and (6.5±1.4) mmol/L (P<0.05), respectively. The pre-pregnancy BMI, 1-hour BG and 2-hour BG of the normal or low Hb level group were (22±3) kg/m2, (6.7±1.6) mmol/L, (6.1± 1.2) mmol/L; (22±3) kg/m2, (6.5±1.5) mmol/L, (5.9±1.1) mmol/L, respectively. There were no statistically significant difference in levels of fasting blood glucose, fasting insulin, HOMA-IR and HOMA-β within 3 groups (all P>0.05). (3) In the high Hb level group, prevalence of pregnancy overweight or obesity and GDM were the highest, which were 37.2%(64/172) and 15.1%(26/172), respectively; the differences were statistically significant (all P<0.05). (4) The serum Hb level in the first trimester was positively related with pre-pregnancy BMI (r=0.130, P<0.05), 1-hour BG (r=0.129, P<0.05), 2-hour BG (r=0.134, P<0.05), fasting insulin (r=0.096, P<0.05), and HOMA-IR (r=0.101, P<0.05).Logistic regression indicated that Hb≥130 g/L during the first trimester of pregnancy was an independent risk factor for GDM ( OR=2.799, 95% CI :1.186-6.604; P<0.05). Conclusion The high level of Hb (Hb≥130 g/L) during the first trimester of pregnancy is associated with GDM.