ObjectiveTo analyzing the psychological status of hospitalized patients of internal medicine and its impact factors.Methods Hospitalized patients of internal medicine underwent a survey by using Chinese Health Questionnaire (CHQ-12),Social Support Scale and Disease-Cognition Scale.Those with a score of ＞4 received further investigation of Symptom Check-List 90 (SCL-90).Correlation analysis was performed between all factors of SCL-90 and social support or disease-cognition scale score.Results There was no significant difference of psychological status between males and females ( P ＞0.05 ).All SCL90 factors were negatively correlated with social support,of which obsessive,paranoid,and phobic presented stronger negative correlations with social support and objective support (P ＜ 0.05 ).Furthermore,all factors were negatively correlated with disease-cognition scale score.A significantly negative correlation between phobic factor and disease-cognition scale score was identified ( P ＜ 0.05 ).Improvement was found in 26.2％ patients after intervention.Conclusion Patients tend to show unhealthy emotion when they are under the stress of hospitalization.Hospitalization support system may need to be improved and patients' cognition of disease should be increased.

Objective To investigate the characteristics of quality of life (QoL) and self-awareness in girls with idiopathic central precocious puberty (ICPP) and the correlation between QoL and the self-awareness.Methods The inventory of subjective life quality (ISLQ) and Children's self-concept scale (PHCSS) were employed to evaluate the level of QoL and self-awareness in 24 ICPP girls with ICPP (ICPP group) and 24 normal control girls (control group),and the correlation analysis between QoL and the self-awareness in the ICPP group was made.Results The score of overall (70.85±14.11 vs 80.21±6.07) and emotion component satisfaction (62.61± 12.91 vs 73.74±5.02),dimensions satisfaction on school life (5.80± 1.44 vs 6.69±0.65),depression experience (6.55± 1.14 vs 7.29±0.45),anxiety experience (5.93± 1.35 vs 6.96±0.82) and physical emotion (6.33±1.17 vs 7.12±0.83) in ICPP group was respectively lower than control group (P＜0.05).There was no difference in cognitive component between control group and ICPP group,as well as for other dimension satisfaction.Moreover,the score in total self-awareness,physical appearance and anxiety in ICPP group was respectively lower than those in control group (P＜0.05).In addition,a positive correlation was found between the subjective QoL and the children self-concept in ICPP group (P＜0.01).Conclusion The girls with ICPP show a lower subjective QoL and self assessment than normal girls.It is important to take care of the psychological feature of the girls with ICPP to improve the self-assessment and overall QoL during the medication.

We integrate web-based learning with team based learning,which is called WTBL method (Web-based and team-based Learning). WTBL method is constructed and applied to the teaching practice of core curriculum group courses of clinical medicine. We build some small private online courses. The students can preview online and do the case discussions by teamwork in class. The application of WTBL teaching method has realized the flipping of classroom, and helps to enhance students' self-learning ability and teamwork ability.

Objective:To observe the expression of molecular chaperone-mediated autophagy in hippocampal neurons and its relationship with brain injury after recurrent-status seizures.Methods:Seven-day-old SD rats were divided into two groups according to simple randomization: the control group (NS group, 6 rats) and the recurrent-seizure group (RS group, 39 rats). Rats in the RS group were subjected to recurrent seizures after repeated inhalation of flurothyl, with 30 minutes once each day for consecutive 7 days.A total of 30 convulsive models were successfully established (9 rats that failed to establish models were discarded), and they were further divided into 0 h, 1.5 h, 3 h, 12 h and 24 h after the last seizure according to simple randomization, with 6 rats in each group.Western blot and reverse transcription-polymerase chain reaction (RT-PCR) were adopted for the observation of the expression of molecular chaperone-mediated autophagy markers [heat shock cognate protein 70 (Hsc70), lysosome-associated membrane protein type 2a (LAMP-2a), heat shock protein 40(HSP40) and heat shock protein 90(HSP90)] in hip-pocampal neurons, and apoptosis was detected by TdT-mediated dUTP nick-end labeling (TUNEL).Results:(1) RT-PCR and Western blot showed that, compared with the NS group, the expression of Hsc70, as a molecular chape-rone, started to increase at 1.5 h and continued until 24 h after the last seizure in the RS group ( P<0.05). HSP90 increased immediately after the last seizure and lasted until 24 h after the seizure ( P<0.01); the expression of HSP40 and LAMP-2a also showed high expression after the last seizure episode ( P<0.05). (2) The TUNEL method showed that the number of apoptotic cells in the hippocampal CA1 region increased significantly at 3 h (36.33±5.16)/40 field, 12 h (44.83±4.83)/40 field and 24 h (54.83±7.16)/40 field after the last seizure compared with NS group(15.16±2.48)/40 field ( P<0.01). (3) Pearson correlation analysis showed that the level of apoptosis in hippocampal CA1 region of rats after recurrent seizures was positively correlated with the expression of molecular chaperone marker molecules (Hsc70: r=0.734, P=0.001; LAMP2a: r=0.790, P<0.001). Conclusions:After recurrent seizures in developmental rats, the presence of increased expression of multiple molecular chaperone-mediated autophagy, which may positively correlate with apoptosis, may be involved in the process of brain injury.

Objective:To analyze the terminal survey data of hospice care services in a district of Beijing in 2020, and discuss its current situation and existing problems of hospice care services in this district for countermeasures, hence providing reference for the development of hospice care services.Methods:Data were collected from the " Terminal Survey Forms of the Second Batch of Hospice Care Pilot Areas in China in 2020" , which were reported by 4 tertiary hospitals and 5 community health service centers in a district of Beijing. The reporting timeframe ranged from January to December 2020. Text analysis method was used to analyze the hospice care mode, relevant security policies, hospice care team, case diagnosis categories, average hospitalization days and patient cost burden. All the data were subject to descriptive analysis.Results:In 2020, only 4 tertiary hospitals carried out outpatient, consultation and inpatient services of hospice care among the 9 medical institutions in a certain district of Beijing, and none of them carried out home hospice care services. The number of doctors and nurses engaged in hospice care in the four hospitals was 35 and 40 respectively; There were 267 inpatient cases of hospice care, including 121 cases of malignant tumors, accounting for 45.32%; The average hospitalization days of hospice patients (40.0 days) was more than that of the hospital (7.8 days); The average daily hospitalization cost of hospice patients (3 428.7 yuan) was lower than that of the hospital (3 605.6 yuan); Hospice care services had not been included in the scope of medical insurance payment, and the relevant security policies were not perfect.Conclusions:The work of hospice care service in a district of Beijing remains at an initial stage, and the professional team building and supporting policies for hospice care fail to catch up with the demand in this district. The authors suggest to speed up the development of hospice care in primary medical institutions, build a network of " hospital -community-family" levels, enhance training of professionals and technical personnel of hospice care, as well as establish and improve the medical security system, so as to promote the rapid development of hospice care services in this district.

Objective:To explore the practical effect of goal-oriented hierarchical responsibility system in the teaching of emergency standardized training.Methods:A total of 43 residents who rotated in the Emergency Department of Huashan Hospital Affiliated to Fudan University from March 2019 to August 2019 were selected as the control group, and traditional teaching was implemented. Another 41 residents who rotated from September 2019 to March 2020 were selected as the research group, and the goal-oriented hierarchical responsibility system of teaching was implemented. They were all taught for 3 months, and the scores of theoretical and clinical skills, clinical comprehensive ability and teaching recognition before and after teaching were compared between the two groups. SPSS 24.0 was used for t-test and Chi-square test. Results:After teaching, the scores of theoretical knowledge questions, question and answer questions and case analysis in the two groups were higher than those before teaching ( P<0.05), and the scores of the research group were higher than those in the control group ( P<0.05). After teaching, the scores of 8 items in the study group on understanding of skill indications, anatomy and operation, preparation before operation, aseptic operation, operation ability, post-operation treatment, communication ability, humanistic care and overall performance were higher than those in the control group ( P<0.05). The recognition rates of teaching management, teaching methods, teaching content and teaching effect in the research group were higher than those in the control group ( P<0.05). Conclusion:The application of goal-oriented hierarchical responsibility system in the teaching of standardized training of emergency residents is helpful to improve their theoretical and clinical skill examination results and clinical ability, with high degree of teaching recognition.

Objective To study the critical thinking situation among different nationalities undergraduate nursing students and explore its training in basic nursing teaching , so as to provide the evidence for the teaching reform .Methods Routine teaching methods and case teaching methods were respectively used in ‘basic nursing ’ teaching among different nationalities undergraduate nursing students , and the Critical Thinking Disposition Inventory ( CTDI-CV ) was used to investigate their critical thinking abilities . Results Among 69 undergraduate nursing students in the study , gender:55 female students (79.7%),and 14 male students(20.3%), nationality:37 minorities(53.6%) ,and 32 Han nationality(46.4%),and more than 91.3%of students approved the importance of critical thinking training .Before and after the study , critical thinking total scores of different nationalities respectively were (251.21 ±22.94) and (256.65 ±31.46), both less 280 ,and the dimensions the score of which were more than 40 were self-confidence and thirst for knowledge . The critical thinking total scores of male students before and after the study were respectively higher than those of female students [(254.28 ±34.20) vs (250.87 ±21.68), (289.71 ±54.62) vs (252.91 ±25.89)].The dimensions the score of which were more than 40 in male students respectively were analysis , self-confidence , thirst for knowledge , and systemic capacity , and that in female students only was self-confidence dimension before and after the study .Conclusions Undergraduate nursing students have high approval for the training of critical thinking , however their critical thinking level is in medium .Critical thinking total score of male students is higher than that of female students , and male students have positive tendency of critical thinking after the study,which show that reformed teaching methods can significantly improve the male students ’ critical thinking while no significant effectiveness is found in improving the entirety critical thinking of undergraduate nursing students.More explore and lots work need to do for the critical thinking training in the future .

Objective To explore the mechanism of immediate effect regulated by acupuncture on acupoints in patients with migraine without aura(MwoA)during the interictal period.Methods A total of 28 MwoA patients were enrolled and resting-state functional magnetic resonance imaging(rs-fMRI)were performed at baseline and after acupuncture for 30 minutes.Paired t test was used to compare the differences of regional homogeneity(ReHo)and voxel-mirrored homotopic connectivity(VMHC)between two groups.Additionally,the correlation between the changes of rs-fMRI indexes and clinical scores was analyzed.Results In MwoA patients after acupuncture for 30 minutes,the mean regional homogeneity(mReHo)was decreased in the right lingual gyrus and right cere-bellum and was increased in the right middle frontal gyrus,while the z transformation voxel-mirrored homotopic connectivity(zVMHC)was significantly decreased in the bilateral cuneus compared with baseline.There was no significant correlation between imaging data and clinical scales.Conclusion Patients with MwoA after acupuncture for 30 minutes show abnormal ReHo and VMHC in multiple brain regions,which suggest that the mechanism of immediate effect may act through regulating pain-related brain regions.

Objective:To explore the role of tripartite motif-containing protein 21(TRIM21)in chronic apical periodontitis(CAP)and its potential mechanism.Methods:Human CAP tissue and normal periodontal tissue were collected.The expression of inflamma-tory factors(IL-1 β,IL-6,TNF-a,TGF-β1),osteoclast related genes(TRAP,RANKL,CTSK),macrophage polarization related genes(CD86,iNOS,CD206,Arg1)and TRIM21 were detected by RT-qPCR.TRIM21 protein was detected by immunohistochemical staining,and the osteoclasts was detected by tartrate resistant acid phosphatase(TRAP)staining.The inflammation cell model was es-tablished by stimulating Raw264.7 cells with lipoteichoic acid(LTA)or lipopolysaccharide(LPS),and the expression of the above factors was detected.The bone marrow-derived macrophages(BMDMs)extracted from wild-type and TRIM21-/-mice stimulated by LPS were used to verify the expression of the above factors by RT-qPCR,the osteoclasts were detected by TRAP staining,and the po-larization of macrophages was detected by immunofluorescence staining.Results:In CAP tissue the expression of inflammatory factors,osteoclast related genes,CD86,iNOS and TRIM21 increased,while CD206 and Arg1 decreased,and osteoclasts were more than that in normal tissue.The stimulation of LTA/LPS promoted the proliferation of Raw264.7 cells,and the expression of these factors in cells was consistent with that in tissues.After LPS stimulation,BMDMs of TRIM21-/-mice had lighter inflammation,lower expression of os-teoclast specific genes,fewer osteoclasts and lower M1 polarization than those of wild type mice.Conclusion:TRIM21 might promote the progress of CAP by promoting M1 polarization of macrophages.