New teaching approaches and modes should be developed in the education of socialist value of honor and disgrace,in order to unify socialist value of honor and disgrace with the personal development of medical professionals,realize the social function of medical professionals during the cultural transmission,stress the construction of hospital culture which is oriented by socialist value of honor and disgrace,strengthen the timely characteristics of teaching content and mode in moral education,thus morality and the socialist value of honor and disgrace could be developed in the whole society.

Objective To investigate the effects of plateletpheresis on blood conservation following cardiopulmonary bypass.Methods 20 patients undergoing open heart surgery were divided randomly into experiment and control groups.All patients underwent routine CPB.Plateletpheresis was performed in experiment group by using COBE SPECTRA.Other blood conservation approaches were similar in two groups.Results The number of platelets collected in experiment group exceeded 20% of total platelets of every patients.In the experiment group,less transfusion was need.The changes of Hb and Hct at every time point were similar in the two groups.Platelet counts,aggregation,and prothrombin time in the experiment group restored to preoperative levels significantly earlier than in the control group.The chest tube drainage at 2,4,8,and 16 h and the total drainage after operation were significantly lower in the experiment group than those in the control group.Conclusion By protecting platelets from destruction by extracorporeal circulation,plateletpheresis is beneficial to the recovery of haemostatic system.It is a useful blood conservation method.

Objective To evaluate two different MRI techniques , enhanced 3D STIR SPACE and unidirectionally-encoded DWIBS MR Neurography in visualizing the brachial plexus.Methods Twenty healthy volunteers underwent MR scanning by the procedures of unidirectionally -encoded DWIBS and enhanced 3D STIR SPACE sequence of the brachial plexus.Original images were reconstructed with coronal maximum intensity projection ( MIP ).The image quality was assessed by comparing the visualization of various parts of the brachial plexus and the suppression ratio of image background.The degree of visualization was compared via χ2-test of paired data , and comparison of background suppression scores was performed using a nonparametric Wilcoxon signed rank sum test.Results The successful rate of visualizing the brachial plexus supraclavicular section ( C5-T1 ) was 84% ( 167/200 ) and 99% ( 198/200 ) , respectively, for the DWIBS and enhanced 3D STIR SPACE, and the rate for the infraclavicular section was 33%( 13/40 ) and 95% ( 38/40 ).The differences between these two techniques were statistically significant (χ2 value was 28.18 and 31.15 respectively, P <0.01).In all images, the scores of grade (Ⅰ-Ⅳ) of background suppression were 0, 0, 4 and 16 for unidirectionally-encoded DWIBS, respectively;while they were 15, 4, 1 and 0 for enhanced 3D STIR SPACE.There was significant difference between the two techniques ( Z =3.96,P <0.01).Conclusions High-quality MR neurography of the brachial plexus can be obtained using the enhanced 3D STIR SPACE sequence.It offers a complete anatomical coverage of the brachial plexus , and thus demonstrates a better capacity in depicting the anatomy of brachial plexus as compared with the unidirectionally-encoded DWIBS.

Objective To evaluate the clinical diagnostic value of pelvic floor sEMG in pelvic floor dyssynergia (PFD) by using receiver operating characteristic curve (ROC curve). Methods The pelvic floor sEMG of 90 patients with PFD and 101normal controls were determined by the Glazer protocol.Parameters including amplitude (AVG),coefficient of variance (CV),onset time and median frequency (MF),and the ROC curve werealso investigated. Results Compared to the control group,the PFD group had a higher AVG of pre-baseline (P < 0.05), a lower AVG during Flick and Tonic steps(P < 0.05), and ahigher CV duringTonic and Endurance steps(P < 0.05).The area under curve(AUC) of CV duringthe tonic step was 0.883 withthe best cut-off of 0.355, and with sensitivity of 88.4%and the specificity of 71.1%, respectively; The AUC of CV duringEndurance step was 0.825 withthe best cut-off of 0.305, and with the sensitivity of 84.9%and the specificity of 67.8% , respectively. Conclusion The CVs of the tonic and the endrnace phases can be used as valuable clinical values in diagnosis of PFD.

Objective The expression of TNF-α was detected in sera of rabbits treated by ulinastatin with acute lung injury in duced by underwater explosion.Methods Rabbits were randomly divided into two groups such as the injured group and ulinastatin therapy group.Established underwater explosion device was used to cause acute lung injury in rabbits.TNF-α in sera of the rabbits were measured by ELISA at 4,12 and 24 hours after the explosion.The SPSS17.0 software was used to analyze the data and P＜0.05 was considered to be significant.Results There was no significant difference between the concentrations of TNF-α in the sera of rabbits in the injure group (538.20±201.43 ng/L) and that of in the ulinastatin group (386.90± 109.22 ng/L,t=2.088,P=0.051) at 4 hours after burst.However,there was evidently decreased in the level of TNF-α in the ulinastatin group (400.60 ± 78.98 ng/L) compared with the injury group (573.80 ± 178.24 ng/L,t =2.809,P =0.012) at 12 hours after burst.Moreover and TNF-α in the ulinastatin group (356.10 ± 130.99 ng/L) was also decreased compared to the injure group (552.30± 169.64 ng/L,t=2.895,P=0.010) at 24 hours after burst.Conclusion The TNF-α expression in sera of the rabbits in ulinastatin group were dramatically decreased than thai of in injury group at 12 hours after burst,which may be benefit to rabbits with acute lung injury induced by underwater explosion.

AIM:R-spondin 2 (Rspo2), one member of R-spondin family which contains four secreted proteins , plays an important role in skeletal muscle development .However, the impact of Rspo2 on vascular smooth muscle cell ( SMC) differentiation is little known . This study aims at revealing the role and mechanism of Rspo 2 on SMC differentiation from embryonic stem cells (ESCs).METHODS:A well-established model for studying SMC differentiation from ESCs were used , in which mouse embryonic stem cells ( ES-D3) were seeded on collagen IV-coated flasks and cultured in differentiation medium (DM) for 2, 4, 6 and 8 days.Smooth muscle specific markers, includingα-smooth muscle actin (α-SMA), SM22 and smooth muscle myosin heavy chain (SM-MHC), were detected to in-sure the successful model by qRT-PCR and Western blot .After 3-day pre-differentiation, ESCs were treated with recombinant Rspo 2 protein, overexpression plasmid or shRNA plasmid for 96 h, and the mRNA and protein expression of smooth muscle markers was detected.To explore the role of Rspo2 on SMC differentiation in vivo, 3-day predifferentiated ESCs (106 in 50μLα-MEM) incubated with Rspo2-overexpression plasmid were mixed with 50 μL of Matrigel ( Becton Dickinson Labware ) and then subcutaneously injected into C57BL/6J mice.After 12 days, mice were sacrificed and the implants were harvested for immunofluorescence staining , qRT-PCR and Western blot.Furthermore, electrophoretic mobility shift assay (EMSA), chromatin immunoprecipitation assay (ChIP) and lucif-erase reporter assay were performed to investigate the transcriptional activity of SMC differentiation related transcription factors , inclu-ding serum response factor (SRF), myocardin (MYO), myocyte-specific enhancer factor 2C (MEF-2C).Involvement of Rspo2 re-ceptor, leucine-rich repeat-containing, G-protein-coupled receptors (Lgr)4,5,6, and β-catenin pathway during Rspo2-induced MSC differentiation were also uncovered by overexpression or inhibition of the respective protein .RESULTS:Our results showed that Rspo 2 mRNA and protein expression was significantly and consistently increased during ESC differentiation towards SMCs .Recombinant Rs-po2 protein and enforced Rspo 2 expression in ESCs resulted in up-regulation of smooth muscle markers and transcription factors , while knockdown decreased the expression of these genes .Expectedly , Rspo2 overexpression also promotes SMC differentiation in vivo.
Mechanistically , our data showed that Rspo 2 could promote SRF binding to SM22 promoter region .Evidence also revealed that one of three Rspo2 receptors, LGR5, was up-regulated while the other two , LGR4 and LGR6, was down-regulated.Silencing of LGR5 inhibi-ted Rspo2-induced SMC differentiation, whereas knockdown of LGR4 had no impact.Finally, activation or inhibition of β-catenin could promote or inhibit SMC differentiation , respectively .CONCLUSION: Our findings demonstrate for the first time that Rspo 2 plays a positive role during smooth muscle cell differentiation from embryonic stem cells .We confirmed that Rspo 2 can up-regulate smooth muscle markers at transcription level .We also revealed Rspo promote smooth muscle cell differentiation through activation of LGR 5 re-ceptor and Wnt/β-catenin pathway .

Objective:To investigate the changes of intestinal flora and its clinical significance in children with Helicobacter pylori (Hp)-positive duodenal ulcer before and after Hp eradication treatment. Methods:A total of 98 children with duodenal ulcer admitted to Ji′nan Second Maternal and Child Health Hospital from January 2018 to December 2020 were selected and divided into Hp infection group and Hp uninfected group according to whether they had Hp infection.Stools of Hp infection group were collected before treatment, treatment for 7 days, treatment for 14 days, and 30 days after treatment withdrawal for 16S rDNA sequencing.The independent samples t test was used to compare the detection of intestinal flora in the Hp infection group and the Hp uninfected group.Paired t test was used to compare the detection of intestinal flora in the Hp infection group before and after treatment.Nonparametric test was used to compare the bacterial diversity [diversity (Shannon, Simpson) index and richness (Chao 1) index] of Hp infection group and Hp uninfected group and the flora diversity of Hp infection group before and after treatment. Results:There was no significant difference in the detected numbers of Bifidobacterium [(5.92±1.85) lg copies/g feces vs.(6.58±2.01) lg copies/g feces], Lactobacillus [(4.89±1.35) lg copies/g feces vs.(4.47±1.59) lg copies/g feces], Bacteroides [(8.42±2.12) lg copies/g feces vs.(8.01±2.20) lg copies/g feces], Clostridium perfringens[(5.90±1.90) lg copies/g feces vs.(5.88±2.01) lg copies/g feces], Enterococcus[(5.41±1.27) lg copies/g feces vs.(5.02±1.48) lg copies/g feces], Enterobacter[(5.01±1.80) lg copies/g feces vs.(5.37±1.47) lg copies/g feces], and yeast [(5.90±1.85) lg copies/g feces vs.(5.88±2.01) lg copies /g feces] in the Hp infection group and the Hp uninfected group (all P>0.05). There was no statistically significant difference between the Shannon index (3.84±0.52 vs.3.90±0.45), Simpson index (0.16±0.04 vs.0.15±0.05), and Chao 1 index (178.52±40.22 vs.185.32±42.47) of the intestinal flora diversity between the Hp infection group and the Hp uninfected group (all P>0.05). Compared with before treatment, the number of Bifidobacterium, Lactobacillus and Bacteroides detected in the Hp infection group decreased at different times after treatment (all P<0.05). Compared with treatment for 7 days and treatment for 14 days, the number of Bifidobacterium [(4.54±1.78) lg copies/g feces vs.(4.20±1.22) lg copies/g feces vs.(5.21±1.55) lg copies/g feces], Lactobacillus [(4.01±1.20) lg copies/g feces vs.(3.89±1.32) lg copies/g feces vs.(4.43±1.10) lg copies/g feces], and Bacteroides [(6.78±1.88) lg copies/g feces vs.(6.55±1.90) lg copies/g feces vs.(7.68±2.00) lg copies/g feces] detected increased after 30 days of treatment (all P<0.05). There was no statistically significant difference in the number of Clostridium perfringens, Enterococcus, Enterobacter and yeast detected in Hp infection group at different times before and after treatment (all P>0.05). Compared with before treatment, the Shannon index and Chao 1 index at different time after treatment decreased, and the Simpson index increased (all P<0.05). Compared with treatment for 7 days and treatment for 14 days, the Shannon index (2.85±0.45 vs.2.57±0.48 vs.3.20±0.50) and Chao 1 index (148.45±32.33 vs.140.32±30.47 vs.160.42±38.42) increased, and Simpson index (0.25±0.06 vs.0.27±0.08 vs.0.19±0.05) decreased 30 days after treatment (all P<0.05). Conclusions:Hp infection has no significant effect on the intestinal flora of children with duodenal ulcer.Anti-Hp treatment can lead to imbalance of intestinal flora and decrease of intestinal flora diversity.The effect of a large number of antibiotics on intestinal flora should be considered in anti Hp treatment.

ObjectiveTo analyze drug resistance status and risk factors in elderly tuberculosis patients in Ninghai County of Zhejiang Province， and to provide basis for prevention and control of drug-resistant tuberculosis. MethodsClinical data were collected from 142 elderly tuberculosis patients （with positive sputum culture） who were diagnosed and treated in medical institutions in Ninghai from 2016 to 2020. The risk factors of drug resistance were analyzed by Chi-square test and logistic regression model. ResultsThe overall drug resistance rate was 33.80%， and the drug resistance rate in patients with recurrent pulmonary tuberculosis was significantly higher than that in patients with initial pulmonary tuberculosis， and the difference was statistically significant. Multivariate unconditional logisitic regression analysis showed that irregular medication and disease recurrence were independent risk factors for multidrug resistance in the elderly patients. ConclusionThe drug resistance rate in elderly tuberculosis patients in Ninghai is high. It is necessary to strengthen the management and supervision of tuberculosis in the community， and to carry out effective health education and visit for elderly patients， especially for newly treated patients， and to avoid treatment failure caused by irregular medication and interruption of treatment.

PURPOSE: Details of patients hospitalized for asthma exacerbation in mainland China are lacking. To improve disease control and reduce economic burden, a large sample survey among this patient population is indispensable. This study aimed to investigate the clinical characteristics and outcomes of such patients.METHODS: A retrospective study was conducted on patients hospitalized for asthma exacerbation in 29 hospitals of 29 regions in mainland China during the period 2013 to 2014. Demographic features, pre-admission conditions, exacerbation details, and outcomes were summarized. Risk factors for exacerbation severity were analyzed.RESULTS: There were 3,240 asthmatic patients included in this study (57.7% females, 42.3% males). Only 28.0% used daily controller medications; 1,287 (39.7%) patients were not currently on inhaled corticosteroids. Acute upper airway infection was the most common trigger of exacerbation (42.3%). Patients with severe to life-threatening exacerbation tended to have a longer disease course, a smoking history, and had comorbidities such as hypertension, chronic obstructive pulmonary disease (COPD), and food allergy. The multivariate analysis showed that smoking history, comorbidities of hypertension, COPD, and food allergy were independent risk factors for more severe exacerbation. The number of patients hospitalized for asthma exacerbation varied with seasons, peaking in March and September. Eight patients died during the study period (mortality 0.25%).CONCLUSIONS: Despite enhanced education on asthma self-management in China during recent years, few patients were using daily controller medications before the onset of their exacerbation, indicating that more educational efforts and considerations are needed. The findings of this study may improve our understanding of hospital admission for asthma exacerbation in mainland China and provide evidence for decision-making.
Adrenal Cortex Hormones ; Asthma ; China ; Comorbidity ; Disease Progression ; Education ; Female ; Food Hypersensitivity ; Hospitalization ; Humans ; Hypertension ; Inpatients ; Medication Adherence ; Mortality ; Multivariate Analysis ; Pulmonary Disease, Chronic Obstructive ; Retrospective Studies ; Risk Factors ; Seasons ; Self Care ; Smoke ; Smoking

OBJECTIVETo observe the short- and long-term efficacy of acupuncture combined with biofeedback in the treatment of functional anorectal pain (FARP).

METHODSClinical data of 142 patients who met the functional gastrointestinal disorders and functional anorectal pain based on criteria of Rome III( undergoing acupuncture with biofeedback therapy from August 2010 to November 2015 in Pelvic Floor Center of The Third Affiliated Hospital of Nanjing University of Chinese Medicine were retrospectively analyzed. Telephone and outpatient clinic recheck were used as standard follow-up. The clinical effect of short-term and long-term data collected from the disease-based database was evaluated with visual analogue pain scale (VAS) (0-10 points), short form health survey questionnaire (SF-36) (0-148 points). The overall satisfaction and effectiveness (VAS was >30%) were evaluated at the end of treatment (short-term) and during follow-up (long-term).

RESULTSThe effective follow-up data were obtained from 71.1%(101/142) of patients and the median follow-up time was 28(3-67) months. The VAS of 101 cases was 6.09±1.78, 1.99±1.89 and 3.55±2.60 before treatment, at the end of treatment and during follow-up respectively. Though the VAS during follow-up was higher than that at the end of treatment, but still significantly lower than that before treatment(P<0.05). The SF-36 score of 31 patients was 82.0±16.9, 94.0±15.1 and 88.1±15.3 before treatment, at the end of treatment and during follow-up respectively. Though the SF-36 score during follow-up was lower compared to at the end of treatment, but still significantly higher compared to before treatment (P<0.05). The effective rates were 85.9%(122/142) at the end of treatment and 75.2%(76/101) during follow-up, and the satisfactory rates were 92.3%(131/142) and 84.2%(85/101), respectively.

CONCLUSIONAcupuncture with biofeedback has significant short-term and long-term efficacy in treating functional anorectal pain, and its degree of satisfaction is high.