Professional postgraduates in geriatric medicine are one of the most important re-courses of geriatric specialists. However, training model for geriatric postgraduates is still unclear in China. In general, geriatric medicine has no independent training plan, and is included in internal medicine training. Such model cannot represent the feature of geriatric medicine. The present paper aimed to discuss the ability construction for geriatric postgraduates based on the geriatric medicine specialist training experience both at home and abroad, including diagnosis and treatment of multi-system diseases, ability of geriatric assessment, management of geriatric syndromes, consultation for geriatric rehabilitation and ability for continuity health service in order to cultivate the compound tal-ents suitable for the aging society requirement for geriatric medicine in China.

In medical clinical study, the researchers and the ethics committee members' personal economic in-terests and responsibilities conflicts may produce damage to experimental research and the subjects, may make the study being questioned the authenticity and the objectivity of clinical trial results, also damage to the subjects' rights and interests and damage the credibility of hospital. In order to prevent the happening of the conflict, put forward the strategies:strengthen legislation construction, improve the treatment method, set up a conflict of interest com-mittee, adhere to the principle of open, review and restriction to the personnel, regularly organize researchers and ethics committee members attend the training.

Objective To investigate the expression of PD-1 on CD4 +and CD8 + T cells in patients with HBeAg-positive chronic hepatitis B(CHB)treated with telbivudine.Methods Fifty-six HBeAg-positive CHB patients admitted in the First Affiliated Hospital of Zhengzhou University during January 201 3 and June 201 4 were enrolled in this study.The expression of PD-1 on CD4 +and CD8 + T cells was detected with flow cytometry at baseline,24,48 and 72 wks after telbivudine treatment.The relationship of PD-1 expression with alanine aminotransferase (ALT)level,HBeAg seroconversion and HBV DNA loads was analyzed.t test and completely random variance analysis were used to analyze the data.Results The PD-1 expression on CD4 + and CD8 + T cells at baseline was higher in patients with low ALT levels compared to those with high ALT levels(t =1 2.20 and 9.69,both P <0.01 ),while higher levels of PD-1 expression was also observed in patients with high HBV DNA load (≥5 lgIU /mL)compared to those with low HBV DNA load (t =4.39 and 4.85,both P <0.01 ).PD-1 levels on CD4 + and CD8 + T cells presented a declining trend after telbivudine treatment(F =6.98 and 8.97,both P <0.01 ),PD-1 expression in patients with HBeAg seroconversion showed lower levels compared with baseline values (t =1 8.45 and 1 8.01 ,both P <0.01 ). Conclusion In HBeAg-positive CHB patients,the expression of PD-1 on CD4 + and CD8 + T lymphocytes shows a decreasing trend during the treatment with telbivudine,indicating that antiviral therapy may alleviate the immunosuppression in these patients.

Objective:To evaluate the effects of mind-body exercise on breast cancer patients using a Meta-analysis.Methods:Randomized controlled trials (RCTs) on the effects of mind-body exercises on breast cancer patients were systematically searched in PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure, WanFang data, VIP, and China Biology Medicine disc, with a search period from database inception to November 30, 2023. The references of the included studies were also reviewed. After two reviewers independently screened the literature, extracted information, and evaluated the quality of the included studies, a Meta-analysis was performed using RevMan 5.3 software.Results:A total of 23 RCTs involving 1 730 breast cancer patients were included. The Meta-analysis showed that, compared to conventional care, mind-body exercise significantly reduced anxiety in breast cancer patients [ SMD=-0.46, 95% CI (-0.71, -0.21), P<0.01], as well as in those undergoing chemotherapy [ SMD=-0.30, 95% CI (-0.54, -0.07), P=0.01]. Mind-body exercise also alleviated depression in breast cancer patients. Subgroup analysis found that the Baduanjin group [ SMD=-1.13, 95% CI (-1.63, -0.64), P<0.01] was more effective in alleviating depression than the yoga group [ SMD=-0.24, 95% CI (-0.41, -0.07), P<0.01]. However, there was no statistically significant effect of mind-body exercise on improving the quality of sleep in breast cancer patients [ SMD=-0.41, 95% CI (-0.89, 0.06), P=0.09]. In terms of the effect of mind-body exercise on fatigue levels in breast cancer patients, subgroup analysis showed that Baduanjin [ SMD=-0.91, 95% CI (-1.26, -0.55), P<0.01] and Tai Chi [ SMD=-0.57, 95% CI (-0.92, -0.21), P<0.01] significantly reduced fatigue levels, while yoga [ SMD=-0.43, 95% CI (-0.98, 0.12), P=0.13] did not show a statistically significant effect on reducing fatigue levels in breast cancer patients. Conclusions:Mind-body exercises can reduce anxiety and depression and alleviate the level of fatigue in breast cancer patients. However, the effects of different exercise modalities on improving sleep quality in breast cancer patients vary.

Objective VATER/VACTERL-like association is associated with adverse pregnancy outcomes.Genetic evidence of this disorder is sporadic.In this study,we aimed to provide genetic insights to improve the diagnosis of VACTERL. Methods We have described a Chinese family in which four members were affected by renal defects or agenesis,anal atresia,and anovaginal fistula,which is consistent with the diagnosis of a VACTERL-like association.Pedigree and genetic analyses were conducted using genome and exome sequencing. Results Segregation analysis revealed the presence of a recessive X-linked microdeletion in two living affected individuals,harboring a 196-380 kb microdeletion on Xq27.1,which was identified by familial exome sequencing.Genome sequencing was performed on the affected male,confirming a-196 kb microdeletion in Xq27.1,which included a 28%loss of the CDR-1 gene.Four family members were included in the co-segregation analysis,and only VACTERL-like cases with microdeletions were reported in X27.1. Conclusion These results suggest that the 196-380 kb microdeletion in Xq27.1 could be a possible cause of the VATER/VACTERL-like association.However,further genetic and functional analyses are required to confirm or rule out genetic background as the definitive cause of the VACTERL association.

Acute traumatic spinal cord injury (SCI) represents one of the most devastating injuries that afflict the human body. Ascorbic acid ( AA) plays an important role in mammalian central nervous system, especially in SCI. In this study, the change of AA concentration after SCI was investigated by using an on-line electrochemical method integrated with in vivo microdialysis. A microdialysis probe (2 mm in length) was implanted into the spinal cord of an anesthetized rat (Thoracic-10). Microdialysis perfusate (2 μL/ min) was collected in the sample loop of an on-line injector for direct injection onto a glassy carbon electrode which was modified with the heat-treated single-walled carbon nanotubes (SWNTs). Normal ascorbic acid concentration in the extracellular fluids of spinal cords was (26. 17 ± 1. 25) μmol/ L (n =8). The experimental spinal cord injury, induced by a lesion at T-10, significantly increased the extracellular ascorbic acid levels to (53. 24± 1. 95) μmol/ L (n =8). This study provides the experimental evidence on the essential roles of ascorbic acid in spinal cord injuries.

Objective To design an air-cushioned belt for skin traction of lower extremities to reduce the incidence of deep vein thrombosis and pressure ulcers in patients with lower limb fractures. Methods The belt was composed of upper and lower leggings.The legging had an air cushion at its interior surface,and the air cushion consisted of several chambers.There was a connecting tube between every two chambers, and each tube was equipped with a pressure non-return valve. The chamber on the top of the cushion had a charging mechanism for inflation.Totally 100 patients from June to December 2016 were selected and divided equally into an experiment group and a control group.The experiment group used the developed air-cushioned belt,and the control group applied the traditional one.The incidence rates of deep venous thrombosis of lower limbs were compared in the two groups,and χ2test was carried out on the results.Results There were no cases of pressure ulcers and deep venous thromboses of lower limbs occurred in the experiment group,while 5 cases of deep venous thromboses of lower limbs and 4 cases of pressure ulcer happened in the control group,and there were significant differences between the incidence rates in the groups(P<0.05).Conclusion The air-cushioned belt has easy operation,relieves the patients'pains and the nurses'workload when used to prevent deep venous thrombosis of lower limbs and pressure ulcer,and thus is worthy promoting clinically.

Vitreous hemorrhage in children is caused by trauma or non-traumatic factors.Long-term vitreous hemorrhage not only affects children's vision,but also can lead secondary glaucoma,traumatic retinal detachment and other serious complications.Ocular trauma,some ocular and systemic diseases are the common etiology leading to vitreous hemorrhage in children.A small amount of vitreous hemorrhage can be treated by observation and conservative treatment.However,if the vitreous hemorrhage has no obvious absorption or serious complications appeared,it needs to be treated by surgery.The choice of treatment time and methods need to be further studied.

Objective To develop a nurse medication unsafe behavior scale, so as to provide an effective tool for evaluating nurses' unsafe behaviors and provide scientific basis for the safe medication management of clinical nurses. Methods From July to August 2016, a semi-structured interview was conducted among 5 nursing managers and 5 clinical nurses from an affiliated hospital of a medical university in Harbin city selected by purposive sampling method. The initial scale was formed by analyzing semi-structured interview data, combining with relevant literature. From November to December 2016, a pre-test was conducted among 380 nurses from an affiliated hospital of a medical university in Harbin city, who met the inclusion criteria, selected by convenience sampling method, by pre-test version of the scale. A large sample test scale was formed by expert review and pre-test. From January to February 2017, a total of 1 243 clinical nurses from 2 medical university affiliated hospitals, 2 provincial class Ⅲ grade A hospitals and 1 municipal class Ⅲ grade A hospital were selected by convenience sampling method for a large sample test, and the reliability and validity of the scale were tested to form the final scale. Results The nurse medication unsafe behavior scale consisted of 4 factors (treatment of medical orders, medication preservation and dispensing, medication administration and medication monitoring) and 25 items. The cumulative variance contribution rate was 60.897%. Confirmatory factor analysis showed that the fit indexes χ2/df, GFI, CFI, IFI and RMSEA were 2.872, 0.922, 0.951, 0.951 and 0.050 respectively. The content validity index was 0.96. The Cronbach's α coefficient and split half were 0.935 and 0.841 respectively. Conclusions The nurse medication unsafe behavior scale has good reliability and validity. It can be used as a valid tool to measure nurse medication unsafe behavior.

Objective To evaluate the efficacy and safety of epalrestat, an aldose reductase inhibitor, and epalrestat plus methylcobalamine on diabetic peripheral neuropathy, as compared with methylcobalamine. Methods A total of 444 subjects with diabetic neuropathy were enrolled in the study, and divided into methylcobalamine group ( n= 145 ) , epalrestat group ( n = 143 ) , and methylcobalamine combined with epalrestat group ( n = 156 ) . Therapeutic efficacay was assessed in terms of clinical symptoms and physical examinations by using Michigan Neuropathy Screening Instrument ( MNSI ) , and electrophysiological assessments. Results After 4 to 12-weeks′treatment, symptoms and signs of neuropathy ( using MNSI ) are significantly improved in the three groups ( P<0. 01). The mean changes of MNSI ( questionnaire) score from baseline were higher in epalrestat group and methylcobalamine combined with epalrestat group as compared with that of methylcobalamine group(P<0. 05), but no difference was detected in the change of MNSI ( physical examination ) score from baseline among three groups. After treatment for 12 weeks, motor nerve conduction velocity ( MNCV ) was significantly improved in epalrestat group and methylcobalamine combined with epalrestat group(P<0. 05), but no difference was detected in MNCV at 12 week among three groups(P>0. 05). Conclusion Epalrestat is effective and safe in the treatment of diabetic neuropathy. Furthermore, epalrestat is more efficacious in ameliorating symptoms and MNCV of neuropathy than methylcobalamine. However, while no improved efficacy is shown with the combined treatment.