Since initiation of training on laboratory of molecular biology in my school, we accumulated experience in teaching process especially among international students and application of pedagogy as well as technology. Strengths, weakness and opportunities are analyzed to improve teaching quality.

Objective To explore the efficacy of endoscopic sphincterotomy with small incision combined with balloon dilatation (sEST+EPBD)in the treatment of patients with choledocholithiasis and juxtapapillary duodenal diverticula (JPDD).Methods From January 2011 to January 2015 ,149 patients with choledocholithiasis and JPDD who underwent endoscopic retrograde cholangio-pancreatography (ERCP)were enrolled.Among them,60 patients were in sEST+EPBD group and 89 were in endoscopic sphincterotomy (EST)group.Success rate of ERCP and first-time stone removal,changes of total bilirubin (TBil)and direct bilirubin (DBil)levels,as well as the incidence of postoperative complications between the two groups were compared.Chi-square test or t-test was performed for statistical analysis. Results The ERCP success rate sEST+EPBD group was 100.0% (60/60),and the first-time success rate of stone removal was 91 .7%(55/60);correspondingly,ERCP success rate of EST group was 98.9%(88/89),and the success rate of first-time stone removal was 77.5 %(69/89).There was no statistically significant difference in success rate of ERCP between the two groups (χ2 =0.19,P =0.410).The first-time success rate of stone removal of sEST +EPBD group was higher than that of EST group,and the difference was statistically significant (χ2 =5 .53,P =0.020).After operation,the TBil level of sEST+
EPBD group was (152.62 ±109.04 )μmol/L,which was lower than that before operation ((266.02 ± 143.31)μmol/L),and the difference was statistically significant (t =4.88,P <0.01 ).After operation, the DBil level of sEST +EPBD group was (87.13 ±65 .90)μmol/L,which was lower than that before operation ((175 .70 ± 100.53 )μmol/L),and the difference was statistically significant (t = 5 .71 ,P <0.01).After operation,the TBil level of EST group was (251 .90 ±247.90)μmol/L,which was lower than that before operation ((340.20 ±176.20 )μmol/L),and the difference was statistically significant (t=2.74,P <0.05).After operation,the DBil level of EST group was (168.10±140.60)μmol/L,which was lower than that before operation ((228.40 ±139.60 )μmol/L),and the difference was statistically significant (t = 2.87,P = 0.005).The complication rate of sEST + EPBD group after operation was 8.3%(5/60),which was lower than that of EST group (20.2%,18/89 ),and the difference was statistically significant (χ2 =3.88,P =0.049 ).Conclusion sEST+EPBD could increase the first-time success rate of stone removal in patients with choledocholithiasis and JPDD,and it is a safe and effective treatment.

Objective: To investigate the effect of cough assist on sputum excretion and the outcome of withdrawal of mechanical ventilation after mechanically ventilated chronic obstructive pulmonary disease (COPD) patients with cough weakness. Methods: From January 2017 to December 2018, 74 patients with cough and weakness COPD after extubation of mechanical ventilation in the Department of Respiratory Critical Care Medicine of Hunan Provincial People's Hospital were divided into control group(n=37) and observation group (n=37) according to the random number table method. The patients in the control group were treated routinely after weaning and extubation, and the observation group was treated with cough assist after withdrawal of mechanical ventilation and extubation on the basis of the control group. The differences in drainage effect, blood gas index, reintubation rate and early prognosis index between the two groups were compared. Results: After the intervention treatment, the first active sputum excretion and the total sputum volume on the first day were (5.6±3.4) ml and (33.1±5.2) ml in the observationgroup, and (4.2 ±2.0) ml and (29.1±7.4) ml in the control group, the difference was statistically significant (t=-2.10, 2.875, P<0.05). The number of significant cases of respiratory sound improvement in the observation group and the control group was 21 and 14 cases, respectively, and the difference between the two groups was statistically significant (Z=-1.974, P < 0.05). The oxygen partial pressure (PaO₂) and oxygenation index (PaO₂/FiO₂) carbon dioxide partial pressure (PaCO₂) values of the observation group were (80.0±8.4), (345.9±19.2), (46.7±6.6)mmHg, and (74.8±9.1), (310.7±21.9), (50.9±7.1)mmHg in the control group. The difference was statistically significant (t=-2.504,-2.710, 2.579, all P<0.05). The reintubation rate, noninvasive ventilation time, and hospitalization days after the initial extubation in the observation group were as follows: 5.6%(2/36), (64.1±18.9)h, (6.0±1.7)d, and 22.2%(8/36), (76.7±15.3)h, (7.2±2.8)d in the control group. The difference was statistically significant (χ²=4.181, t=2.528, 2.438, all P<0.05). The non-invasive ventilation rate within 72h in the observation group and the control group were 63.9% (23/36) and 75.0% (27/36), the difference was not statistically significant (χ²=0.222, P>0.05). Conclusions The application of cough assist in RICU patients with cough weakness after extubation by mechanical ventilation can improve the expectoration efficiency of cough, improve oxygenation, reduce carbon dioxide retention, reduce the rate of re-intubation, shorten the time of noninvasive ventilation and hospitalization after extubation, and improve the curative effect.

To prepare a lipid nanoparticle (LNP)-based subunit vaccine of Mycobacterium tuberculosis (Mtb) antigen EsxV and study its immunological characteristics, the LNP containing EsxV and c-di-AMP (EsxV: C: L) was prepared by thin film dispersion method, and its encapsulation rate, LNP morphology, particle size, surface charge and polyphase dispersion index were measured. BALB/c mice were immunized with EsxV: C: L by nasal drops. The levels of serum and mucosal antibodies, transcription and secretion of cytokines in lung and spleen, and the proportion of T cell subsets were detected after immunization. EsxV: C: L LNPs were obtained with uniform size and they were spherical and negatively charged. Compared with EsxV: C immunization, EsxV: C: L mucosal inoculation induced increased sIgA level in respiratory tract mucosa. Levels of IL-2 secreted from spleen and ratios of memory T cells and tissue-resident T cells in mice were also elevated. In conclusion, EsxV: C: L could induce stronger mucosal immunity and memory T cell immune responses, which may provide better protection against Mtb infection.
Animals ; Mice ; Mycobacterium tuberculosis ; Antigens, Bacterial ; Immunization ; Nanoparticles ; Vaccines, Subunit ; Mice, Inbred BALB C