Clinical teaching plan of pneumothorax and hemorrhagic shock was prepared with mind maps. The process of making this teaching plan was demonstrated as follows:relationship among all levels of subjects in this course was manifested by text and graph as belong and relevance. It is sim-ple, smooth, focused, lucid and easy to understand and remember. Application of mind mapis ex-tremely simple;it is suitable for medical education and is conducive to enhancing teaching efficiency.

We innovated video assessment integrated teaching method on the basis of clinical case discussion,teaching rounds,problem-based learning,case method and micro teaching.According to this video feedback teaching,students became teaching subject and teacher acted as guide.In order to realize the purposes of early contact with clinical practice,more clinical practice and repeated clinical practice teaching,we implemented student-centered small class teaching,which was heuristic,inquisitive,interactive and was discussion-based.At the same time with the help of medical simulation equipment and video feedback teaching,this method developed students' life-long learning ability and work competence and combined theory with practice,demonstration with imitation as well as standards with innovation.This method was not only suitable for theoretical study but also for skills training,especially for standardization training.

Objective To evaluate the incidence of autoimmune thyroid disease (AITD) in systemic lupus erythematosus (SLE) and examine the correlation between AITD and SLE activity.Methods The study group included 220 SLE patients with the screening of thyroid function (FT3,FT4,TSH) and antithyroid autoantibodies (TgAb,TPOAb) were hospitalized into Affiliated Hospital,Jining Medical College between July 2009 and October 2013.The control group included 160 healthy subjects.We compared the prevalence of AITD between SLE patients and normal controls and also the positive rate of anti-thyroid autoantibodies was observed.We also compared the positive rate of anti-thyroid autoantibodies between AITD in SLE and simple SLE group and also analyzed the correlation between two groups of patients and SLE activity (evaluated by the titer of anti-dsDNA,C3,C4,CH50,SLEDAI score).Results Among them,45 patients suffered from AITD (20.5％).There were hyperthyroidism (n =6,13.3％) and hypothyroidism (including subclinical hypothyroidism) (n =26,57.8％),Hashimoto' s thyroiditis (n =13,28.9％).And 74 SLE cases were positive for anti-thyroid autoantibodies.The prevalence of AITD and the positive rate of anti-thyroid autoantibodies in SLE patients (20.5％,33.6％) were higher than that in normal controls (3.13％,7.50％)(P ＜ 0.05).The positive rate of anti-thyroid autoantibodies of SLE with AITD patients (62.2％) was higher than that in simple SLE (21.5％).No significant differences existed in anti-dsDNA titre,C3,C4,CH50 and SLEDAI score between two groups (P ＞ 0.05).Conclusions The SLE patients have a great prevalence of AITD and a positive rate of anti-thyroid autoantibodies.Those with anti-thyroid autoantibodies have a higher incidence of AITD and it has nothing to do with SLE activity.It is essential to monitor thyroid function and thyroid autoantibodies during the follow-ups.

The paper described the periodic progress of public hospitals reform in Anhui province,and analyzed the difficulties encountered,proposing measures and recommendations.These include reasonable adjustment of medicine prices for betterment of public hospital compensation mechanism; toplevel design in supportive measures of county-level public hospital reform; breakthrough of existing personnel system to ease shortage of medical staff in primary institutions; encouragement of diversified investment in medical sector to invite private resources into public hospital reform.

Objective To investigate the substantia nigra (SN) and brainstem raphe (BR) echogenic features of Parkinson's disease (PD) patients with musculoskeletal pain.Methods A total of 115 PD patients recruited in the Second Affiliated Hospital of Soochow University from October 2014 to May 2016 were assessed with the following rating scales:Unified Parkinson's Disease Rating Scale (UPDRS),Hoehn and Yahr Staging Scale (H/Y),Hamilton Rating Scale for Depression (HRSD),Beck Depression Inventory Ⅱ (BDI-Ⅱ) and Visual Analogue Scale (VAS).All the subjects underwent transcranial sonography during the clinical evaluation.And the patients were divided into PD with musculoskeletal pain (n =54) and PD without musculoskeletal pain (n =61) groups,or PD with depression(n =74) and PD without depression(n =41) groups.Results Compared with PD patients without pain,PD patients with musculoskeletal pain had higher scores of UPDRS-Ⅱ,-Ⅲ,HRSD,BDI,NMSQ and H/Y (UPDRS-Ⅱ score:12.56 ±6.01 vs 8.79 ±4.38,t =-3.801,P ＜0.01;UPDRS-Ⅲ score:24.43 ± 12.43 vs 20.07 ± 11.12,t=-1.986,P=0.049;HRSD score:11.65-±6.94 vs 8.38-±5.36,t=-2.844,P=0.005;BDI score:14.09 ±6.20 vs 9.74 ±6.00,t =-3.826,P ＜0.01;NMSQ score:8.57 ± 4.06 vs 5.60 ± 3.38,t=4.193,P＜0.01;H/Y:2.0(1.5,2.6) vs 1.5(1.0,2.0),Z=-3.011,P=0.003).Positive BR was more frequent in depressed than in non-depressed PD patients without pain (63.6％ vs 14.3％;x2 =15.25,P ＜0.01).Positive BR was positively associated with sex(r =0.228,P =0.014),age(r =0.184,P =0.049),disease duration (r =0.196,P =0.035),and depression (r =0.396,P ＜ 0.01).However,positive BR did not correlate with musculoskeletal pain.No correlation was found between positive SN and clinical characteristics of PD patients.Conclusions PD patients with musculoskeletal pain have worse activity of daily living,more severe motor symptoms,more non-motor symptoms,and are more depressed.SN and BR echogenecity do not correlate with musculoskeletal pain,however,hypoechogenic or interrupted BR is associated with depression in PD patients.

Objective:To explore and analyze the correlation between miR-31 in peripheral blood and oxidative stress indicators of diabetic nephropathy.Methods:A total of 94 patients with diabetic nephropathy who were admitted to Affiliated Hospital of Jining Medical College from September 2019 to September 2020 were selected. Patients were divided into mild diabetic nephropathy [estimated glomerular filtration rate (eGFR) 60-90 ml/min, 36 cases] group, moderate diabetic nephropathy (eGFR 30-60 ml/min, 27 cases) group and severe diabetic nephropathy (eGFR 0-30 ml/min, 31 cases) group according to the severity of the disease, and 30 healthy people in the same period were selected as the control group. Real time quantitative polymerase chain reaction (qRT-PCR) was used to detect the expression of miR-31 in peripheral blood. Serum superoxide dismutase (SOD), malondialdehyde (MDA), advanced oxidation protein products (AOPP) and other oxidative stress indicators, as well as serum urea nitrogen, creatinine and glomerular filtration rate. Pearson was used to analyze the correlation between peripheral blood miR-31 and oxidative stress indexes and renal function.Results:The expression of miR-31 in peripheral blood of patients with diabetic nephropathy was significantly lower than that in the control group, and the expression of miR-31 in peripheral blood of patients in severe and moderate diabetic nephropathy group was significantly lower than that in the mild diabetic nephropathy group (all P<0.05), with statistically significant difference (all P<0.05). Pearson correlation analysis showed that serum miR-31 expression was negatively correlated with the severity of diabetic nephropathy ( r=-0.526, P<0.05). The levels of serum MDA, SOD and AOPP in the diabetic nephropathy group were significantly higher than those in the control group, and the levels of serum MDA, SOD and AOPP in the severe and moderate diabetic nephropathy groups were higher than those in the mild diabetic nephropathy group, with statistically significant difference (all P<0.05). The levels of serum creatinine and blood urea nitrogen in the diabetic nephropathy group were higher than those in the control group, and the glomerular filtration rate was lower than that in the control group (all P<0.05). The levels of serum creatinine and blood urea nitrogen in the severe and moderate diabetic nephropathy group were higher than those in the mild diabetic nephropathy group, while the level of glomerular filtration rate was lower than that in the mild diabetic nephropathy group, with statistically significant difference (all P<0.05). Pearson correlation analysis showed that the expression of miR-31 in peripheral blood was negatively correlated with the levels of MDA, SOD, AOPP, serum creatinine and urea nitrogen (all P<0.05), but positively correlated with glomerular filtration rate ( P<0.05). Conclusions:The expression of miR-31 in peripheral blood gradually decreases with the severity of renal damage. Its level is negatively correlated with oxidative stress indicators of diabetic nephropathy, and positively correlated with glomerular filtration rate, which can be used for for clinical treatment and disease evaluation.

Objective:To explore the adjunctive diagnostic value of transcranial sonography (TCS) combined with olfactory test in early Parkinson′s disease (PD) and the clinical value of both in the cognitive function of PD patients.Methods:TCS and olfactory test were performed in 157 early PD patients(PD group) and 157 healthy controls(control group) in the Second Affiliated Hospital of Soochow University from January 2018 to January 2022. The differences in clinical characteristics, TCS, and olfactory test results between the two groups were analyzed. The values of TCS, olfactory test, and their combination in diagnosing early PD were evaluated using clinical diagnosis as the gold standard. The correlations of the midbrain area, the midbrain substantia nigra hyperechoic area, and the third ventricle width in TCS examination with the cognitive score were analyzed in the PD group. According to the olfactory test scores, 157 patients with early PD were divided into two groups: 110 cases of PD with olfactory dysfunction (PD-OD) and 47 cases of PD without olfactory dysfunction (PD-NOD). The differences in clinical scores and TCS results between the two groups were compared.Results:The midbrain substantia nigra hyperechoic area, substantia nigra hyperechoic positivity rate, third ventricle width, and olfactory dysfunction rate were higher in the PD group compared to the control group, while the midbrain area and olfactory test scores were lower than those in the control group (all P<0.001). The sensitivity and the coincidence rate of TCS combined with the olfactory test for early PD diagnosis (90.0%, 77.1%) were higher than those of TCS alone (60.0%, 71.3%) and olfactory test alone (70.1%, 72.3%), but the specificity (63.7%) was lower than that of both alone (82.8% for TCS and 75.2% for olfactory test), (all P<0.001). MoCA score, visual space and executive ability, memory, attention, and language were positively correlated with the area of the midbrain ( rs=0.38, 0.32, 0.27, 0.25, 0.23; all P<0.05) and negatively correlated with the width of the third ventricle ( rs=-0.39, -0.22, -0.39, -0.22, -0.32; all P<0.05), and orientation was negatively correlated only with the width of the third ventricle ( rs=-0.24, P<0.05). The MoCA score of PD-OD group[22(18, 25)] was lower than that of PD-NOD group[24(20, 26)]( P=0.040). Conclusions:The combination of TCS and olfactory test can enhance the sensitivity and diagnostic agreement rate for early PD diagnosis, providing some auxiliary value. The cognitive function of PD patients is positively correlated with the midbrain area and negatively correlated with the width of the third ventricle. The cognitive function of PD patients with olfactory dysfunction is lower than that of PD patients without olfactory dysfunction. TCS and olfactory test may help assess cognitive function in PD patients.

Objective:To investigate the value of macrophage migration inhibitor factor (MIF) in early severe acute pancreatitis (SAP).Methods:①Animal experiment: according to the random number table method, 24 male Sprague-Dawley (SD) rats were divided into Sham group and SAP 3, 6 and 12 hours groups, with 6 rats in each group. SAP rat model was prepared by injecting 5% sodium taurocholate via the retrograde cholangiopancreatic duct. Liver, kidney, lung, pancreas and serum samples were harvested after 3, 6 and 12 hours. In the Sham group, tissue and serum were harvested immediately after pancreas was turned over. The histopathological changes of the pancreas were observed microscopically by hematoxylin-eosin (HE) staining. The MIF levels of serum, liver, kidney, lung and pancreas were measured by enzyme linked immunosorbent assay (ELISA). ② Clinical study: an observational study was conducted. Seventy-two adult patients within 24 hours of the onset of abdominal pain (blood amylase was 3 times the normal level), and the clinical diagnosis met the criteria of acute pancreatitis (AP) admitted to the emergency department of the First Affiliated Hospital of Zhengzhou University from December 2018 to October 2019 were enrolled. Venous blood was extracted and serum MIF level was determined by ELISA. Acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) was recorded for 24 hours. Patients were divided into SAP group (17 cases), moderate severe acute pancreatitis (MSAP) group (25 cases), and mild acute pancreatitis (MAP) group (30 cases) according to the revised Atlanta criteria for comparison between groups.Results:① The results of animal experiments showed that the serum, liver, and pancreatic MIF levels of rats in the SAP group all reached the peak at 6 hours after modeling, and the differences were statistically significant compared with the Sham group [serum MIF (ng/L): 2 862.79±238.33 vs. 1 728.32±197.59, liver MIF (ng/L): 2 141.39±328.07 vs. 1 372.70±163.41, pancreas MIF (ng/L): 4 468.00±1 324.31 vs. 1 572.06±108.40, all P < 0.01]; although the levels of MIF in serum, liver and pancreas decreased at 12 hours after modeling, they were still significantly higher than Sham group. However, there was no statistically significant difference in MIF levels of lung and kidney in SAP rats compared with Sham group at 3, 6 and 12 hours after molding. ② Clinical observation showed that early serum MIF levels of SAP, MSAP and MAP patients decreased in order, (14.83±2.99), (10.17±2.64), and (7.21±2.47) μg/L, respectively; APACHEⅡ scores also decreased in order, 10.41±3.74, 7.60±3.18 and 4.00±2.41 respectively. Correlation analysis showed that serum MIF levels in patients with SAP, MSAP, and MAP had a good correlation with APACHEⅡ scores of the respective groups, showing that MIF levels was positively correlated with disease severity (SAP: r = 0.51, P = 0.03; MSAP: r = 0.45, P = 0.02; MAP: r = 0.45, P = 0.01). Conclusion:MIF can predict the occurrence of early SAP, and it is related to the severity of early AP.

OBJECTIVETo investigate infection-related mortality (IRM) after allogeneic hematopoietic stem cell transplantation in patients with refractory/relapse acute leukemia.

METHODSWe conducted a retrospective analysis of 127 patients with refractory/relapse acute leukemia and investigated the incidence, causes and risk factors of IRM.

RESULTSSixty-seven of the patients died after the transplantation. The 5-year overall survival and disease-free survival was (35.2∓5.3)% and (30.8∓5.6)% among these patients, respectively. IRM occurred in 28.3% (36/127) of the patients. Multivariate analysis showed that grade II-IV acute graft-versus-host diseases (aGVDH, P=0.049, OR=3.017) and post-transplant invasive fungal infection (P=0.032, OR=3.223) were independent risk factors of IRM.

CONCLUSIONAs a common cause of transplant-related mortality, IRM is more frequent in cases of refractory/relapse acute leukemia than in cases with a standard risk profile, and effective prophylaxis and treatment of severe GVHD remain currently the primary measures for reducing post-transplant IRM.

Adolescent ; Adult ; Female ; Graft vs Host Disease ; mortality ; Hematopoietic Stem Cell Transplantation ; adverse effects ; mortality ; Humans ; Leukemia ; mortality ; pathology ; surgery ; Male ; Middle Aged ; Multivariate Analysis ; Mycoses ; mortality ; Recurrence ; Retrospective Studies ; Young Adult

Objective:To explore the efficacy and safety of sivelestat, a neutrophil elastase (NE) inhibitor, in the treatment of acute lung injury (ALI) in the intensive care unit (ICU).Methods:A retrospective analysis was performed on 171 patients with ALI in the ICU of the First Affiliated Hospital of Zhengzhou University from June 2020 to June 2021, including 77 patients in the sivelestat group and 94 patients in the conventional treatment group. Acute physiology and chronic health evaluation (APACHE) Ⅱ score, Murray lung injury score, oxygenation index (PaO 2/FiO 2 ratio), inflammatory cytokines (IL-6, IL-10, TNF-α), ventilator-free days (VFD), the length of ICU stay, and the 28-day mortality were collected to assess the efficacy of sivelestat. At the same time, adverse reactions and laboratory test results within 30 days after the use of sivelestat were recorded to assess the safety. Results:Compared with conventional treatment, oxygenation index, Murray lung injury scores, IL-6, IL-10, and TNF-α were significantly improved after 7 days of sivelestat treatment. Compared with the conventional treatment group, the VFD was significantly longer ( P = 0.0119) and the length of ICU stay was significantly shorter ( P = 0.0269) in the sivelestat group. The mortality was 14.29% in the sivelestat group and 22.34% in the conventional treatment group and, with no statistically significant. In the meantime, sivelestat did not increase adverse reactions within 30 days after treatment. Conclusions:Sivelestat treatment is safe and more effective than conventional treatment for ALI patients in the ICU.