Constructing internal quality control system is an important measure to improve teaching quality in the universities.Teaching supervision plays an important role in the teaching quality guaranteeing system.This article introduced and summarized the practice of teaching supervision in Tianjin Medical University including the establishment of three-leveled teaching supervision,emphasis of process management,innovation,significance and achievements of teaching supervision.

BACKGROUND:The changes of single cytokine before and after transplantation has no clinical significance in the diagnosis of acute rejection, but the joint monitoring of cytokines is better to determine the immune status of transplanted patients. OBJECTIVE:To observe the dynamics changes of Th1/Th2 cytokines before and after transplantation in order to investigate the clinical significance in the diagnosis of acute rejection. METHODS:It was a prospective cohort study. The Th1 and Th2 cytokine levels in the rejection group and non-rejection group were dynamical y monitored with double-antibody sandwich enzyme-linked immunosorbent assay before, and 3, 7 and 14 days after transplantation. RESULTS AND CONCLUSION:Before renal transplantation, the Th1 (γ-interferon and interleukin-12) cytokine levels in the rejection group were significantly higher than those in the non-rejection group (P<0.05);the Th2 (interleukin-4 and interleukin-10) cytokine levels in the rejection group were significantly lower than those in the non-rejection group (P<0.05). After renal transplantation, there were no significant changes in Th1 and Th2 cytokines levels of the non-rejection group at different time points;the Th1 cytokine levels in the rejection group were increased rapidly at different time points, and reached a peak before acute rejection, and the Th1 cytokine levels at different time points in the rejection group were significantly higher than those in the non-rejection group;the Th2 cytokines were increased gradual y in the rejection group, and reached a peak before acute rejection, and the Th2 cytokine levels at different time points in the rejection group were stil lower than those in the non-rejection group. The results showed that the Th1/Th2 cytokines in the non-rejection group were kept stably before and after renal transplantation, but not in the rejection group, in which, the Th1 cytokines were increased rapidly before acute rejection and the Th2 cytokines were increased gradual y.

Objective To observe the clinical efficacy of auricular point sticking with magnetic bead in treating insomnia in hepatocirrhosis patients. Method Ninety patients with hepatocirrhosis complicated with insomnia were randomized into a treatment group and a control group, 45 in each group. The treatment group was intervened by auricular point sticking with magnetic bead, while the control group was by auricular point sticking with medical adhesive tape. After successive 2-week treatments, the Insomnia Severity Index (ISI) and the Evaluation Criteria of Therapeutic Efficacy for Mental Disorders were observed for evaluating the treatment result. Result The ISI was significantly improved in the treatment group after intervention (P<0.05), and the improvement was significantly different from that in the control group (P<0.05). The total effective rate was 86.7% in the treatment group versus 60.0% in the control group, and the difference was statistically significant (P<0.01). Conclusion Auricular point sticking with magnetic bead is easy-to-operate and can produce a satisfactory efficacy in treating insomnia of hepatocirrhosis patients.

To increase the rescue competency of residents, also the critical thinking, team dynamics, and the capability to handle with emergencies, Shanghai East Hospital developed a rescue course integrated with 24 standardized simulation cases learning and medical simulation education for residents training pro-gram. The instructor candidates should complete the simulation training and pass the instructor certification. Every course was monitored by the course director to ensure the teaching quality. After two and a half years of practice, it is found that the teaching of case teaching and simulation teaching is better than traditional teaching, and it plays an important role in the security of medical security.

Objective:To explore the clinical effectiveness of high-frequency color Doppler ultrasound (HFCDU) assisted harvest of radial artery perforator-pedicled lateral forearm neurocutaneous vascular flap to repair soft tissue defect below the elbow.Methods:A retrospective study was conducted on the clinical data of patients who underwent repair of soft tissue defects below the elbow using the radial artery perforator-pedicled lateral forearm neurocutaneous vascular flap at the Second Hospital of Tangshan from January 2016 to June 2021. Prior to the surgery, HFCDU was utilized to identify and measure the course of the lateral forearm cutaneous nerve and the perforating branch of the radial artery surrounding the wound. Subsequently, the flap rotation point, axis, and area were meticulously designed. During the surgical procedure, the skin flap was harvested either through a subcutaneous tunnel or by direct transfer, while the nerve stump at the defect site was anastomosed end-to-end with the lateral cutaneous nerve of the forearm contained in the skin flap. After reducing the wound at the donor site, it was either directly sutured or repaired using a medium-thick skin graft harvested from the thigh. After surgery, the survival of the skin flap, wound healing at the donor site, and the survival of the skin graft were observed. At the last follow-up, the static two-point discrimination of the flap was measured, and patient satisfaction with the appearance of the flap was assessed using the Michigan hand outcomes questionnaire(MHQ). This questionnaire categorized satisfaction into five levels: very dissatisfied (1 point), dissatisfied (2 points), fair (3 points), satisfied (4 points), and very satisfied (5 points). The scar condition of the donor site was evaluated according to the Vancouver scar scale (VSS), which scored from 0 to 15 points, with higher scores indicating more severe scarring. Descriptive analysis of the data was performed using SPSS 27.0 software.Results:A total of 33 patients were included in the study, comprising 20 males and 13 females, with an average age of (41.0±11.7) years (range, 23-65 years). The defect locations included 6 forearms, 9 wrists, and 18 hands, with all patients having exposed bones and (or) tendons. The defect area ranged from 3.0 cm × 2.5 cm to 12.0 cm × 5.0 cm. The detection result of cutaneous nerves and perforating blood vessels using HFCDU were consistent with the actual findings during surgery, showing no discrepancies. The area of the skin flaps ranged from 3.5 cm × 3.0 cm to 13.0 cm × 6.0 cm. All 33 skin flaps survived postoperatively, with good blood supply and no infections reported; the wounds at the donor site healed primarily, and all grafted skin survived. The duration of postoperative follow-up was (15.6±2.9) months (range, 10-24 months), and the patients’ static two-point discrimination of the flap was measured at (12.5±3.3) mm (range, 8-20 mm). The result of the MHQ indicated that 23 patients were very satisfied with the appearance of the flap (5 points), while 10 patients were satisfied (4 points). The VSS score for the donor site was (4.3±0.9) points (range, 3-6 points), indicating that the scar at the donor site was mild.Conclusion:HFCDU can accurately identify the lateral forearm cutaneous nerve and the perforating branch of the radial artery.The radial artery perforator-pedicled lateral forearm neurocutaneous vascular flap can provide a reliable blood supply, good appearance, sense and patient satisfaction, which is suitable for repairing soft tissue defects below the elbow.

Objective:To explore the clinical effectiveness of high-frequency color Doppler ultrasound (HFCDU) assisted harvest of radial artery perforator-pedicled lateral forearm neurocutaneous vascular flap to repair soft tissue defect below the elbow.Methods:A retrospective study was conducted on the clinical data of patients who underwent repair of soft tissue defects below the elbow using the radial artery perforator-pedicled lateral forearm neurocutaneous vascular flap at the Second Hospital of Tangshan from January 2016 to June 2021. Prior to the surgery, HFCDU was utilized to identify and measure the course of the lateral forearm cutaneous nerve and the perforating branch of the radial artery surrounding the wound. Subsequently, the flap rotation point, axis, and area were meticulously designed. During the surgical procedure, the skin flap was harvested either through a subcutaneous tunnel or by direct transfer, while the nerve stump at the defect site was anastomosed end-to-end with the lateral cutaneous nerve of the forearm contained in the skin flap. After reducing the wound at the donor site, it was either directly sutured or repaired using a medium-thick skin graft harvested from the thigh. After surgery, the survival of the skin flap, wound healing at the donor site, and the survival of the skin graft were observed. At the last follow-up, the static two-point discrimination of the flap was measured, and patient satisfaction with the appearance of the flap was assessed using the Michigan hand outcomes questionnaire(MHQ). This questionnaire categorized satisfaction into five levels: very dissatisfied (1 point), dissatisfied (2 points), fair (3 points), satisfied (4 points), and very satisfied (5 points). The scar condition of the donor site was evaluated according to the Vancouver scar scale (VSS), which scored from 0 to 15 points, with higher scores indicating more severe scarring. Descriptive analysis of the data was performed using SPSS 27.0 software.Results:A total of 33 patients were included in the study, comprising 20 males and 13 females, with an average age of (41.0±11.7) years (range, 23-65 years). The defect locations included 6 forearms, 9 wrists, and 18 hands, with all patients having exposed bones and (or) tendons. The defect area ranged from 3.0 cm × 2.5 cm to 12.0 cm × 5.0 cm. The detection result of cutaneous nerves and perforating blood vessels using HFCDU were consistent with the actual findings during surgery, showing no discrepancies. The area of the skin flaps ranged from 3.5 cm × 3.0 cm to 13.0 cm × 6.0 cm. All 33 skin flaps survived postoperatively, with good blood supply and no infections reported; the wounds at the donor site healed primarily, and all grafted skin survived. The duration of postoperative follow-up was (15.6±2.9) months (range, 10-24 months), and the patients’ static two-point discrimination of the flap was measured at (12.5±3.3) mm (range, 8-20 mm). The result of the MHQ indicated that 23 patients were very satisfied with the appearance of the flap (5 points), while 10 patients were satisfied (4 points). The VSS score for the donor site was (4.3±0.9) points (range, 3-6 points), indicating that the scar at the donor site was mild.Conclusion:HFCDU can accurately identify the lateral forearm cutaneous nerve and the perforating branch of the radial artery.The radial artery perforator-pedicled lateral forearm neurocutaneous vascular flap can provide a reliable blood supply, good appearance, sense and patient satisfaction, which is suitable for repairing soft tissue defects below the elbow.

Objective: To analyze the clinical features of dyslipidemia in patients with primary biliary cholangitis (PBC). Methods: The clinical and laboratory data of 136 PBC patients in Peking Union Medical College Hospital from 2010 to 2016 were retrospectively analyzed.The liver function was compared between patients with normal and abnormal blood lipids. Results: Among 136 PBC patients, 100(74%)had abnormal serum lipids. The incidence of increased cholesterol, low-density lipoprotein and triglyceride was 61%(59/96), 58%(48/83) and 47%(46/97), respectively; while that of reduced HDL-C was 26%(21/82). The incidences of pruritus [26%(26/100) vs. 8%(3/36), χ²=4.93, P=0.032], serum total bilirubin (TBIL) [17.3(12.2, 28.2) μmol/L vs. 14.5 (9.4, 21.1) μmol/L, Z=2.25, P=0.024], direct bilirubin (DBIL)[5. 5 (3.4, 12.4) μmol/L vs. 4.4(2.9, 7.1) μmol/L, Z=2.00, P=0.045], and glutamyl aminotransferase (GGT)[193.0(64.3, 454.8)U/L vs. 105.5(53.5, 179.5)U/L, Z=2.02, P=0.043], alkaline phosphatase(ALP)[183(86, 351)U/L vs. 135(85, 188) U/L, Z=1.98, P=0.048] in PBC patients with dyslipidemia were significantly higher than thosein patients with normal serum lipids.Pearson regression analysis showed that in PBC patients with dyslipidemia, the ALT was positively corrected with TG and TC(r=0.248 and 0.272, P=0.015 and 0.008); ALB was positively correlated with LDL-C(r=0.335, P=0.002); DBIL was positively corrected with HDL-C(r=0.252, P=0.022); TC was positively correlated with ALP and GGT(r=0.313 and 0.346, P=0.002 and 0.001); GGT was positively correlated with LDL-C(r=0.251, P=0.022). Conslusion Increased TC and LDL-C were more common in PBC patients. PBC patients with dyslipidemia have more severe liver damage than the patients with normal serum lipids.

Objective:To investigate the affinity and toxicity of epithelial cell adhesion molecule (EpCAM) targeted nucleic acid aptamer drug conjugate SYL3C-MMAE on human gastric epithelial cells GES-1 (hereinafter referred to as GES-1 cells) and human gastric cancer cells AGS and MKN45 (hereinafter referred to as AGS cells and MKN45 cells).Methods:The experimental study was conducted. The expression level of EpCAM in gastric cancer tissues was detected using immunohistochemistry. The mRNA expression level of EpCAM in gastric cancer tissues was detected using real-time fluorescence quantitative PCR (RT-PCR). The expression level of EpCAM protein in GES-1, AGS and MKN45 cells was detected using Western blot. The affinity of SYL3C on GES-1, AGS and MKN45 cells was detected using flow cytometry. SYL3C-MMAE was synthesized through a thiol-maleimide reaction. The toxicity of drugs on GES-1, AGS and MKN45 cells was detected using CCK-8 assay. The cell cycle condition of GES-1, AGS and MKN45 cells after drug treatment was detected using propidium iodide (PI) staining. Observation indicators: (1) expression of EpCAM in gastric cancer; (2) affinity of antibodies targeting EpCAM and SYL3C on GES-1, AGS and MKN45 cells; (3) situation of drug synthesis; (4) drug toxicity and inhibition of cell cycle. Measurement data with normal distribution were represented as Mean± SD. One-way ANOVA was used for comparison among multiple groups, and pairwise comparison was conducted using the least significant difference test. Comparison of unequal variances was conducted using the Welch' t test. Measurement data with skewed distribution were represented as M(IQR), and comparison between groups was conducted using the paired rank sum test. Count data were described as absolute numbers, comparison between groups was conducted using the paired chi-square test. Results:(1) Expression of EpCAM in gastric cancer. Results of immunohistochemistry on tissue microarrays showed that the positive rate of EpCAM was 82.9%(29/35) and 22.9%(8/35) in the 35 pairs of gastric cancer and its adjacent tissues (normal tissues), respectively, showing a significant difference between them ( P<0.05). Results of RT-PCR showed that the mRNA relative expression levels of EpCAM was 1.23 (4.13) and 4.04 (1.72) in 12 pairs of gastric cancer and its adjacent tissues respectively, showing a significant difference between them ( Z=-2.67, P<0.05). Results of Western blot showed that the relative expression levels of EpCAM protein in GES-1, AGS, and MKN45 was 0, 1.00, and 0.27, respectively, with the expression level of EpCAM protein in AGS cells as the standard. (2) Affinity of antibodies targeting EpCAM and SYL3C on GES-1, AGS and MKN45 cells. Results of flow cytometry showed that antibodies targeting EpCAM and SYL3C had good affinity on AGS and MKN45 cells but no affinity on GES-1 cells. (3) Situation of drug synthesis. Results of mass spectrometry showed that the drug solution of compound formed by connecting SYL3C with monomethylorestatin E (VcMMAE) exhibited a strong peak at the molecular weight position of 16 355, consistent with the expected molecular weight of the SYL3C-MMAE complex, indicating that SYL3C-MMAE was successfully synthesized. (4) Drug toxicity and inhibition of cell cycle. Results of CCK-8 assay showed that the half maximal inhibitory concentration (IC 50) of VcMMAE on GES-1, AGS and MKN45 cells was 123.00, 30.48 and 51.83 nmol/L, respectively. The IC 50 of SYL3C-MMAE on GES-1, AGS and MKN45 cells was 241.80, 20.66 and 27.64 nmol/L, respectively. Results of PI staining and flow cytometry showed that both VcMMAE and SYL3C-MMAE could induce G2/M phase blockage in the cell cycle of GES-1, AGS and MKN45 cells. Conclusion:The SYL3C-MMAE has a good affinity on gastric cancer cells. Compared with VcMMAE, SYL3C-MMAE exhibits efficient inhibition on gastric cancer cells, but less influence on normal cells.

Objective:To identify the development trajectories of self-neglect behavior in older adults and explore the associated influencing factors.Methods:A fixed cohort was constructed based on the data from three surveys of Chinese longitudinal healthy longevity survey (CLHLS) from 2011 to 2018. A total of eight variables from 4 dimensions including living environment, lifestyle, social interaction, and health care were selected to evaluate self-neglect. Group-based trajectory model was used to identify the development trajectory of self-neglect behavior in the older adults, and polynomial Logistic regression model was used to explore its influencing factors by Stata 16.1.Results:Finally, 2 754 older adults aged 60 and above were included.The development trajectory of self-neglect behavior in older adults, based on the group-based trajectory model, can be classified into stable-low group ( n=268, 9.7%), descending-moderate group ( n=2 224, 80.8%), and decreasing-high group ( n=262, 9.5%). Polynomial Logistic regression showed that, compared with stable-low group, living in rural areas ( B=1.116, OR=3.053, 95% CI= 2.278-4.091) and higher activities of daily living scores( B=0.137, OR=1.147, 95% CI=1.046-1.258) were the risk factors of descending-moderate group. Education levels with 1-6 years( B=-0.398, OR=0.672, 95% CI=0.469-0.963), >6 years( B=-1.072, OR=0.342, 95% CI=0.229-0.513), being married( B=-0.476, OR=0.621, 95% CI=0.444-0.870), self-reported good health( B=-0.808, OR=0.446, 95% CI= 0.213-0.932), improved health status( B=-0.704, OR=0.495, 95% CI=0.320-0.766), self-reported average economic status( B=-1.065, OR=0.345, 95% CI=0.148-0.802), self-reported good economic status( B=-1.634, OR=0.195, 95% CI=0.082-0.467), and a higher cognition score( B=-0.142, OR=0.867, 95% CI=0.798-0.942) served as protective factors of descending-moderate group. In addition to the above factors, being in the age group of 75-89 years( B=0.481, OR=1.617, 95% CI=1.057-2.473) was a risk factor for decreasing-high group compared to stable-low group. Conclusions:Three types of self-neglect behavior trajectories among older adults were identified in this study, suggesting that physical health and economy are the influencing factors of the development trajectory of self-neglect of the elderly.

Review the literature on the economic evaluation of PCV-10, PCV-13 and PPSV-23 for providing references for decision-making and research in China. A total of 17 literatures were included, and the basic information to descriptive characteristics, methodology, modeling and the results were extracted. The 14 studies adopted Markov model, 2 studies adopted decision tree model and 1 study adopted probabilistic model. The cost including vaccine price and administration costs, direct medical expenses and indirect lost. All the 17 studies use QALY as the outcome, some studies also use LYG as the outcome. 9 of 13 studies (69.2%) involving people over the age of 50 concluded that pneumococcal vaccination was cost-effective. To provide effective references for decision-makers, China should collect the relevant epidemiological parameters, vaccine effect of pneumococcal disease in the Chinese population and carry out the economic evaluation of pneumococcal vaccination.