Diagnostics is one of the most important bridge courses for medical students from basic to clinical. Doctor-patient communication runs through the whole process of patient diagnosis and treatment. How to improve medical students' ability of doctor-patient communication? Our teaching team has carried out continuous reform and explored the scientific effective teaching mode. Recently, through the construction of "doctor-patient communication skills" quality online course, efforts have made to build an online and offline blended learning mode, which has gradually realize the integration with diagnostics teaching, and has achieved remarkable results. It also provides a scientific practical basis for the integration of doctor-patient communication and other clinical courses, which is worthy of promotion.

Objective To establish a simple scoring system for the diagnosis of liver fibrosis in chronic hepatitis B (CHB), and to observe its sensitivity and specificity. Methods Two hundred and thirty-three patients diagnosed as CHB by liver biopsy were divided into model group (N = 154) and validation group (N = 79). The general information, biochemical parameters and imaging data of all patients were observed. With hepatic fibrosis being obvious or not as the end point of primary study in the model group, we established a simple scoring system for the diagnosis. The cut-off, sensitivity and specificity of the system were tested in the model group by ROC curve, and its diagnostic efficacy was tested in the validation group. Results(1) A simple scoring system for the diagnosis of liver fibrosis called MDFS was established in the model group, and the dimensions of the system included sex, HBV-DNA, Fibroscan (FS) value and splenomegaly. In MDFS, male, HBV-DNA≥ 107 U/mL,FS value≥7.3 kPa, and splenomegaly were assigned 1 point, -2 points, 3 points, and 2 points respectively. (2) The best cut-off value in MDFS was 2 points.(3) ROC curve of the model group indicated that the specificity and sensitivity were 92.86% and 54.76% respectively, the area under curve(AUC) was 0.790, and the Youden index was 0.4762. In the validation group, the diagnostic cut-off value was over 2 points, and the sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 52.17%, 82.35%, 2.96, and 0.58 respectively. (4) The scoring results of MDFS for different traditional Chinese medical syndromes of CHB showed that the scores of blood stasis blocking collaterals > damp-heat accumulation > deficiency of spleen and kidney yang> liver depression and spleen deficiency = stagnation of liver Qi. Conclusion The MDFS diagnostic scoring system has medium efficiency. The specificity of MDFS is relatively high and MDFs has a relatively low misdiagnosis rate for the diagnosis of obvious hepatic fibrosis in CHB. The MDFS is expected to be a noninvasive and simple diagnosing way for hepatic fibrosis in CHB.

OBJECTIVE: To explore the effect of systematic self-management education on quality of life, anxiety and depression of patients with Type 2 diabetes in communities. METHODS: A total of 248 patients with Type 2 diabetes from 10 communities of Changsha from February 2009 to July 2010 were randomized into an intervention group and a control group. The intervention group received systematic self-management education, while the controls received routine community education. The quality of life, anxiety and depression were measured by adjusted diabetes-specific quality of life scale (A-DQOL), self-rating anxiety scale (SAS) and self-rating depression scale (SDS) respectively. RESULTS: The quality of life, morbidity of anxiety or depression of the intervention and the control group were comparable at the baseline (P>0.05). One and half year later, there was significant difference between the two groups (P<0.01). Compared with the control group, the intervention group got better quality of life (P<0.01), less morbidity of anxiety (8.94% vs. 44.4%, P<0.01) and depression (23.58% vs. 56.00%, P<0.01). CONCLUSION Systematic self-management education can effectively improve the quality of life, reduce the level of anxiety and depression of patients with Type 2 diabetes in communities, which deserves further generalization.
Aged ; Aged, 80 and over ; Anxiety ; etiology ; psychology ; Depression ; etiology ; psychology ; Diabetes Mellitus, Type 2 ; complications ; psychology ; Female ; Health Education ; methods ; Humans ; Male ; Middle Aged ; Quality of Life ; Self Care ; methods

OBJECTIVE: To explore the effectiveness of systematic self-management education on blood sugar level of patients in the community with type 2 diabetes. METHODS: A total of 248 patients with type 2 diabetes from 10 communities of Changsha were randomized into intervention or control groups in February 2009. The intervention group received systematic self-management education, while the other received routine community education. Before and after intervention, fasting plasma glucose, 2 h postprandial plasma glucose and glycosylated hemoglobin were measured, and evaluated between the 2 groups. RESULTS: Fasting plasma glucose, 2 h postprandial plasma glucose and glycosylated hemoglobin levels of patients with diabetes from the two groups were generally comparable at baseline (P>0.05). After the intervention, these three indicators were all statistically significant between the 2 groups (P<0.01, P<0.05, P<0.01, respectively). After intervention, blood sugar levels in the intervention group were obviously improved (P<0.01), while in the control group, fasting plasma glucose was not statistically improved (P>0.05), 2 h plasma glucose and glycosylated hemoglobin levels were improved (P<0.01, P<0.05, respectively). CONCLUSION Systematic self-management education effectively encourages patients with type 2 diabetes to control their blood sugar levels, and deserves further promotion.
Aged ; Aged, 80 and over ; Blood Glucose ; analysis ; China ; Diabetes Mellitus, Type 2 ; blood ; therapy ; Female ; Health Education ; methods ; Humans ; Male ; Middle Aged ; Patient Education as Topic ; methods ; Self Care ; methods ; Self Report

Maffucci syndrome is characterized by multiple enchondromas and multiple hemangiomas. Here we report on a 24-year-old woman who was diagnosed with Maffucci syndrome. Our report reviews the literature and outlines of the treatment and management plans for patients with this rare and potentially dangerous disease.

Objective:To analyze the public demands for information about congenital birth defects in “Baidu zhidao” based on word frequency retrieval.Methods:Based on discussion between obstetrics and gynecology experts and epidemiological experts, the key words related to congenital birth defects were determined and the search strategy was formulated. Python 2.7 was used for web crawler search. Questions related to congenital birth defects were obtained on the “Baidu zhidao” platform, and then the R 4.0.2 software was used to process the data, complete the semantic analysis of keywords and statistical analysis of word frequency, and draw word cloud graph and polar chart to describe the key results.Results:A total of 16668 non-repetitive questions were retrieved from “Baidu zhidao” platform, and the frequency of semantic words was 15 371. Among them, 35.02% were the names and symptoms of congenital birth defects. In addition, the frequency of congenital heart disease was the highest (26.09%). The results of subject analysis of key words of birth defects showed that the average word frequency of diagnosis and treatment semantic words (49.55) was significantly higher than that of etiology and prevention semantic words (12.47). In addition, the key words of examination, cause, treatment, development and heredity were more frequently used in the semantic words related to the seven types of systemic malformations.Conclusion:The public in China has a high demand for information on congenital birth defect related diseases, and their causes, prevention and treatment, especially congenital heart disease.

Objective:To investigate the influence of effects of transarterial chemoembo-lization (TACE) before liver transplantation on the prognosis of hepatocellular carcinoma.Methods:The retrospective cohort study was conducted. The clinicopathological data of 311 hepatocellular carcinoma patients undergoing TACE before liver transplantation who were admitted to the Third Medical Center of Chinese PLA General Hospital from January 2005 to December 2012 were collec-ted. There were 276 males and 35 females, aged from 47 to 59 years, with a median age of 52 years. All the 311 patients underwent TACE before liver transplantation. Observation indicators: (1) effects of hepatocellular carcinoma patients undergoing TACE and its relationship with clinicopathological factors; (2) follow-up; (3) influencing factors for prognosis of hepatocellular carcinoma patients after liver transplantation. Follow-up was conducted using outpatient examination or telephone interview to detect recurrence and metastasis of tumor and survival and graft loss of patients up to December 2017. The patients were followed up every 2 to 4 weeks within 3 months after liver transplantation, and once every 1 to 3 months thereafter. Measurement data with normal distri-bution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M(range) or M( Q1, Q3), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Comparison of ordinal data was analyzed using the nonparametric rank sum test. The COX regression model was used for univariate and multivariate analyses. The Kaplan-Meier method was used to draw survival curves and calculate survival rates, and the Log-rank test was used for survival analysis. Results:(1) Effects of hepatocellular carcinoma patients undergoing TACE and its relationship with clinicopathological factors. Of the 311 patients undergoing TACE, 57 cases had pathologic complete response (pCR) and 254 cases had pathologic partial response (pPR), respectively. Cases with alpha fetoprotein (AFP) <20 μg/L,20?400 μg/L, >400 μg/L, cases with microvascular invasion, cases with tumor number as single nodule, cases with tumor distribution at right lobe of liver, cases with tumor caliber of feeding artery (CFA) >1 mm were 26, 26, 5, 51, 6, 43, 46 in patients with pCR, versus 87, 64, 103, 158, 59, 125, 159 in patients with pPR, showing significant differences in the above indicators ( Z=3.35, χ2=4.54, 15.71, 12.89, 6.79, P<0.05). (2) Follow-up. All the 311 patients were followed up for 47.0 to 59.0 months, with a median follow-up time of 44.6 months. There were 11 cases undergoing tumor recurrence and 11 cases undergoing tumor metastasis in the 57 patients with pCR, and there were 96 cases undergoing tumor recurrence and 66 cases under-going tumor metastasis in the 254 patients with pPR. The 1-, 3-, 5-year tumor recurrence free rates were 98.2%, 91.1%, 80.3% in the 311 patients, respectively. The 1-, 3-, 5-year tumor recurrence free rates were 100.0%, 91.1%, 80.3% in the 57 patients with pCR, versus 82.0%, 68.4%, 59.4% in the 254 patients with pPR, showing significant differences in the above indicators ( χ2=13.47, P<0.05). Cases with graft loss were 11 and 96 in the 57 patients with pCR and the 254 patients with pPR, respectively, showing a significant difference ( χ2=7.06, P<0.05). (3) Influen-cing factors for prognosis of hepatocellular carci-noma patients after liver transplantation. Results of univariate analysis showed that gender, basic diseases as viral hepatitis C, AFP (20?400 μg/L, >400 μg/L), Milan criteria, microvascular invasion, tumor number, tumor distribution, tumor CFA, times of TACE, effects of TACE were related factors influencing prognosis of hepatocellular carcinoma patients after liver transplantation ( hazard ratio=0.49, 3.97, 1.78, 1.84, 2.41, 1.96, 3.00, 1.76, 0.19, 2.01, 3.07, 95% confidence interval as 0.30?0.81, 2.23?7.05, 1.03?3.06, 1.18?2.85, 1.63?3.56, 1.28?3.01, 2.04?4.40, 1.20?2.59, 0.13?0.28, 1.28?3.14, 1.63?5.76, P<0.05). Results of multi-variate analysis showed that AFP >400 μg/L, exceeding Milan criteria, tumor number as multiple nodule,effects of TACE as pPR were independent risk factors influencing prognosis of hepatocellular carcinoma patients after liver transplantation ( hazard ratio=1.59, 2.06, 1.99, 2.05, 95% confidence interval as 1.22?2.07, 1.35?3.13, 1.29?3.07, 1.02?4.10, P<0.05) and tumor CFA >1 mm was an independent protective factor influencing prognosis of hepatocellular carcinoma patients after liver transplantation ( hazard ratio=0.10, 95% confidence interval as 0.05?0.19, P<0.05). Conclusions:The effects of TACE are related to AFP, microvascular invasion, tumor number, tumor distribution and tumor CFA. AFP >400 μg/L, exceeding Milan criteria, tumor number as multiple nodule,effects of TACE as pPR are independent risk factors influencing prognosis of hepatocellular carcinoma patients after liver transplantation and tumor CFA >1 mm is an independent protective factor influencing prognosis of hepatocellular carcinoma patients after liver transplantation.

Objective:High-throughput screening to obtain small molecular compounds against Gram-negative bacilli by targeting BamA outer membrane protein.Methods:The sybyl-X2.1 software was used to perform high-throughput virtual screening of small molecular compounds in Chemdiv compound library based on the molecular docking. The top 150 hits by high-throughput screening were re-screened through in vitro biological experiments. The top 4 small molecules with obvious antibacterial activity were selected for in-depth molecular docking analysis, and the small molecule 8308-0401 with the highest docking score was selected for further experiments. The antibacterial effect of 8308-0401 combined with rifampicin was tested by checkerboard assay. Finally, the affinity between 8308-0401 and BamA was tested by plasma surface resonance assay. Results:The docking score of the top 150 hits calculated by high-throughput virtual screening had a mean value of 5.63. In vitro biological experiments showed that small molecules 8308-0401, 8365-1335, C066-2507 and L582-0346 exhibited strong antibacterial activity. Among those molecules, 8308-0401 showed the highest molecular docking score, and synergistic antibacterial activity against both types of strains and clinical isolates when combined with rifampicin. 8308-0401 has a strong affinity to BamA with binding a constant of 182 μmol/L. Conclusion:The small molecule 8308-0401 exerts antibacterial activity against Gram negative bacilli by targeting the outer membrane protein BamA.

Neutrophils originate from the bone marrow,differentiating from hematopoietic stem cells,and are the most prevalent polymorphonuclear leukocytes in the blood,accounting for approximately 70%of the total white blood cells in adult peripheral blood.Neutrophils are recognized as one of the relatively short-lived cells in the body,with a normal half-life of just a few hours in the peripheral blood,which rely on continuous replenishment from the bone marrow to maintain the number.As short-lived effectors of the innate immune system,neutrophils participate in various inflammatory and immune processes,and constitute the first line of defense against infection,playing a crucial role in the activation and regulation of both innate and adaptive immunity.Neutrophils were once considered as key effectors of inflammation and infection.Because of their short lifespan and non-proliferative nature,the role of neutrophils in cancer was overlooked.Their role in cancer has been increasingly recognized in recent years.However,more and more studies demonstrate that neutrophils play a much more significant role in cancer than previously thought.Breast cancer is one of the common malignant tumors in women,and its morbidity and mortality are in the forefront of female malignant tumors.The incidence of breast cancer is rising globally,posing a severe threat to the physical and mental health of women worldwide.Recent studies confirm that tumor-associated neutrophils(TANs)have become a critical component of the tumor microenvironment(TME)and play a significant role in the development,progression and metastasis of breast cancer.TANs are formed via the interaction of various tumor-derived cytokines which stimulate and recruit neutrophils to accumulate in the TME.The strong plasticity and diversity of neutrophils endow TANs with dual potential to both promote and inhibit tumors.TANs advance breast cancer progression by promoting tumor growth and metastasis,supporting tumor angiogenesis,immune suppression,and generating neutrophil extracellular traps(NETs).Conversely,TANs mediate antitumor responses through direct tumor cell killing and contributing to the formation of antitumor immune network.Research on TANs-related breast cancer therapies,particularly in triple-negative breast cancer(TNBC),has become a research hotspot.This review summarized recent advances in the origin,formation,classification and function of TANs in breast cancer,as well as a detailed discussion of their clinical relevance.We further combined recent clinical studies to systematically summarize the treatment strategies targeting TANs in breast cancer,with the aim of providing new insights into the functional mechanisms of TANs and the treatment of breast cancer.

OBJECTIVETo study transforming growth factor-beta1 (TGF-beta1) autoproduction in keloid fibroblasts and the regulation effect of blocking TGF-beta intracellular signaling on rhTGF-beta1 autoproduction.

METHODSKeloid fibroblasts cultured in vitro were treated with either rhTGF-beta1 (5 ng/ml) or recombinant adenovirus containing a truncated type II TGF-beta receptor gene (50 pfu/cell). Their effects of regulating gene expression of TGF-beta1 and its receptor I and II were observed with Northern blot.

RESULTSrhTGF-beta1 up-regulated the gene expression of TGF-beta1 and receptor I, but not receptor II. Over-expression of the truncated receptor II down-regulated the gene expression of TGF-beta1 and its receptor I, but not receptor II.

CONCLUSIONSTGF-beta1 autoproduction was observed in keloid fibroblasts. Over-expression of the truncated TGFbeta receptor II decreased TGF-beta1 autoproduction via blocking TGF-beta receptor signaling.

Activin Receptors, Type I ; biosynthesis ; pharmacology ; Cells, Cultured ; Down-Regulation ; Fibroblasts ; drug effects ; metabolism ; Gene Expression ; Humans ; Keloid ; metabolism ; Protein-Serine-Threonine Kinases ; RNA, Messenger ; genetics ; metabolism ; Receptors, Transforming Growth Factor beta ; biosynthesis ; metabolism ; Sensitivity and Specificity ; Signal Transduction ; Trans-Activators ; metabolism ; Up-Regulation