ObjectiveTo analyze the effect of standardized training on post competency of rehabilitation therapists, based on World Health Organization rehabilitation competency framework (RCF), and combined with the characteristics of rehabilitation and the requirements of standardized training in China. MethodsFrom 2018 to 2022, a total of 30 rehabilitation therapists who participated in the standardized training were selected. Before and after the standardized training, the closed-book theoretical assessment and Mini-clinical Evaluation Exercise (Mini-CEX) assessment were carried out, and a 360-Degree Evaluation scale was distributed to their teachers, peers and patients. Through multi-dimensional post competency analysis, the data obtained from the scales were combined with the five dimensions of basic theoretical knowledge, clinical practice ability, medical humanities literacy, scientific research and teaching ability, and organizational management ability to analyze the effect of standardized training on post competency of rehabilitation therapists. ResultsAfter training, the therapists improved in theory and case analysis (Z > 2.716, P < 0.05). They also improved in medical interview skills, physical examination, humane care/professionalism, clinical judgment ability and overall clinical level (Z > 2.162, P < 0.05) according to Mini-CEX. The medical ethics, daily work, management ability, social ability, interpersonal communication ability, basic professional ability and operation ability improved (Z > 1.978, P < 0.05) according to the 360-Degree Evaluation scale. The effect of standardized training was significant in basic theoretical knowledge, clinical practice ability and medical humanities literacy by the post competency analysis model. ConclusionThe effect of standardized training of rehabilitation therapists is significant, and the therapists can be competent for daily work in diagnosis and treatment after training.

OBJECTIVE: To analyze the risk factors of in-hospital death in patients with sepsis in the intensive care unit (ICU) based on machine learning, and to construct a predictive model, and to explore the predictive value of the predictive model. METHODS: The clinical data of patients with sepsis who were hospitalized in the ICU of the Affiliated Hospital of Jining Medical University from April 2015 to April 2021 were retrospectively analyzed,including demographic information, vital signs, complications, laboratory examination indicators, diagnosis, treatment, etc. Patients were divided into death group and survival group according to whether in-hospital death occurred. The cases in the dataset (70%) were randomly selected as the training set for building the model, and the remaining 30% of the cases were used as the validation set. Based on seven machine learning models including logistic regression (LR), K-nearest neighbor (KNN), support vector machine (SVM), decision tree (DT), random forest (RF), extreme gradient boosting (XGBoost) and artificial neural network (ANN), a prediction model for in-hospital mortality of sepsis patients was constructed. The receiver operator characteristic curve (ROC curve), calibration curve and decision curve analysis (DCA) were used to evaluate the predictive performance of the seven models from the aspects of identification, calibration and clinical application, respectively. In addition, the predictive model based on machine learning was compared with the sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation II (APACHE II) models. RESULTS: A total of 741 patients with sepsis were included, of which 390 were discharged after improvement, 351 died in hospital, and the in-hospital mortality was 47.4%. There were significant differences in gender, age, APACHE II score, SOFA score, Glasgow coma score (GCS), heart rate, oxygen index (PaO₂/FiO₂), mechanical ventilation ratio, mechanical ventilation time, proportion of norepinephrine (NE) used, maximum NE, lactic acid (Lac), activated partial thromboplastin time (APTT), albumin (ALB), serum creatinine (SCr), blood urea nitrogen (BUN), blood uric acid (BUA), pH value, base excess (BE), and K⁺ between the death group and the survival group. ROC curve analysis showed that the area under the curve (AUC) of RF, XGBoost, LR, ANN, DT, SVM, KNN models, SOFA score, and APACHE II score for predicting in-hospital mortality of sepsis patients were 0.871, 0.846, 0.751, 0.747, 0.677, 0.657, 0.555, 0.749 and 0.760, respectively. Among all the models, the RF model had the highest precision (0.750), accuracy (0.785), recall (0.773), and F1 score (0.761), and best discrimination. The calibration curve showed that the RF model performed best among the seven machine learning models. DCA curve showed that the RF model exhibited greater net benefit as well as threshold probability compared to other models, indicating that the RF model was the best model with good clinical utility. CONCLUSIONS The machine learning model can be used as a reliable tool for predicting in-hospital mortality in sepsis patients. RF models has the best predictive performance, which is helpful for clinicians to identify high-risk patients and implement early intervention to reduce mortality.
Humans ; Hospital Mortality ; Retrospective Studies ; ROC Curve ; Prognosis ; Sepsis/diagnosis* ; Intensive Care Units

Objective: To understand the prevalence and associated factors of school bullying among primary and secondary school students in Haidian District, and to provide scientific basis for intervention plan. Methods: From September to October 2021, 1 906 primary and secondary school students in Haidian District were selected by stratified cluster random sampling for electronic questionnaire survey,an electronic questionnaire survey was conducted on students by using the questionnaire of the Student Health Status and Influencing Factors Questionnaire. Results: The prevalence of campus bullying among primary and secondary school students in Haidian District was 4.3%, of which primary school (7.6%) > junior middle school (4.1%) > vocational high school (2.5%) > senior high school (1.9%) ( χ 2=23.49, P ＜0.01), boys (5.5%) were more than girls (3.0%) ( χ 2=7.44, P ＜ 0.01 ), students from abnormal families (6.9%) were higher than students from normal families (3.9%) ( χ 2=4.24, P =0.04). Multivariate Logistic regression analysis showed that students in primary school had a higher risk of being bullied in school ( OR =2.13). Abnormal family ( OR = 1.07 ), smoking experience ( OR =2.28), experience of being beaten and scolded by parents( OR =2.49) and fighting behavior ( OR =1.84) were positively correlated with school bullying ( P <0.05). Conclusion Campus bullying is prevalent in primary and secondary schools in Haidian District, which warrents further attention of schools and education departments. Family school partnership and targeted prevention and intervention measures for key populations are expected.

Objective: To investigate the feasibility and effectiveness of endoscopicretrograde cholangio-pancreatography(ERCP)in the management of long-term complications after pancreaticoduodenectomy. Methods: From January 2009 to July 2018, the clinical data of 62 patients with biliary or pancreatic long-term complications after pancreatoduodenectomy were reviewed at Department of General Surgery, and the corresponding ERCP were carried out in the multi-disciplinary cooperation.There were 39 males and 24 females.The age was 56.5 years(aging from 13 to 76 years). The time of treatment was 3 months to 20 years after pancreatoduodenectomy.The long-term biliopancreatic complications after pancreatoduodenectomy included 51 cases of biliary calculi, 42 cases of bilioenteric anastomotic stenosis with proximal bile duct dilatation, and 11 cases of pancreaticointestinal anastomosis stenosis with distal pancreatic duct dilatation.All patients received conventional duodenoscopy or single-balloon enteroscopy assisted ERCP under general anesthesia. Results: A total of 95 ERCP were performed in 62 patients, averaging 1.5 times per case.The long-term complications of cholangiopancreatic after pancreatoduodenectomy(ERCP indications) included 56 times of bile duct stones(58.9%), 45 times of bilioenteric anastomatic stricture(47.4%), 11 times of recurrent pancreatitis(11.6%), 6 cases(6.3%) of bilioenteric anastomatic foreign body, 3 times of intrahepatic bile duct stenosis(3.2%). Among the 95 times, 82 times(86.3%) achieved endoscopic endoscopy, 76 times(80.0%) were diagnosed successfully, and 72 times(75.8%) were successfully treated with ERCP.Small intestinal perforation occurred in 1 patient undergoing duodenoscopy, and then healed by surgical repair. Conclusion Multi-disciplinary collaboration of ERCP is safe and effective in the treatment of long-term complications after pancreaticoduodenectomy, but the long-term effect still needs further clinical follow-up.

Objective To investigate the relationship of ELK-3 and epithelial-mesenchymal transition ( EMT) for ex-ploring its possible mechanism .Methods The human hepatocellular carcinoma cells ( HCC) were divided into small interference RNA transfection group and Ras-ELK-3 pathway inhibitor group .The protein level of ELK-3 target gene EGR-1 E-cadherin ,vimentin and p38 in HCC were determined by Western blot analysis .Results The protein level of ELK-3 and its target gene EGR-1 in treated human hepatocellular carcinoma cells significantly decreased as compared with the negative control group (P<0.01).The protein level of E-cadherin was significantly increased (P<0.01), while vimentin and p38 were decreased in HCC cells with ELK-3 interference (P<0.01).Conclusions ELK-3 in-terference can inhibit the epithelial-mesenchymal transition of HCC cells by down-regulating p38.

Objective To investigate the epidemiological and clinical characteristics of measles in patients of different age groups in Northeast China in 2014.Methods The clinical data of patients with measles in ten hospitals of infectious diseases in Northeast China from January 2014 to June 2014 were collected.Patients were divided into <16 age group and ≥16 age group, and the epidemiology , clinical characteristics, treatment and prognosis of all patients were retrospectively reviewed .SPSS 17.0 was used for data analysis.Results There were 1 401 patients with measles, in which 402 were <16-year old, and 999 were ≥16-year old.Clinical manifestations were mainly maculopapule (100.0%), fever (84.58%), cough (85.80%), Koplik’ s spot (73.23%), pharyngeal hyperemia (71.23%), diarrhea (43.97%), expectoration (40.97%), tears (39.40%) and runny nose (30.55%).The incidences of Koplik’s spot, sputum, pharyngeal hyperemia and diarrhea in <16 age group were lower than those in ≥16 age group (χ2 =8.364, 29.768, 10.953 and 6.701, P<0.05 or <0.01); while the incidence of runny nose was higher than that in ≥16 age group (χ2 =6.703, P<0.05).Abnormalities were found in blood routine examination, C-reactive protein (CRP), liver and kidney function, serum electrolyte levels, myocardial enzymes, and so on.Increasing in WBC, PLT and creatine kinase isoenzyme (CKMB), and decreasing in WBC were observed in 38(9.45%), 122(30.35%), 279(69.40%) and 105(26.12%), patients in <16 age group, which were higher than those in ≥16 age group [45(4.5%), 14(1.40%), 347(34.73%) and 202(20.22%)], and the differences were of statistical significance (χ2 =12.593, 274.033, 139.385 and 5.830, P<0.05 or P<0.01).Increasing in alanine aminotransferase (ALT), CRP, total bilirubin level (TBil), creatine kinase (CK), and decreasing in albumin (Alb), K+, Na+, Cl-were observed in 70(17.41%), 7(1.74%), 38(9.45%), 7(1.74%), and 214(53.23%), 59(14.68%), 45(11.19%), 94(23.38%) patients in <16 age group, which were lower than those in ≥16 age group [668(66.87%), 89(8.91%), 277(27.73%), 714(71.47), and 268(26.83%), 339(33.93%), 642(64.26%), 450 (45.05%)], and the differences were of statistical significance (χ2 =281.230, 23.073, 50.687, 159.740, and 14.674,114.286, 44.268, 271.546, P<0.01).Laryngitis and pneumonia were the most common complications.The incidence of laryngitis in <16 age group was 12.69% (51/402), which was higher than that in ≥16 years group (93/999, 9.31%,χ2 =3.545, P<0.05);while the incidence of spot shadows demonstrated by X-ray in <16 years group ( 72.89%, 121/166 ) was higher than that in ≥16 years group (265/445, 59.55%,χ2 =9.249, P<0.01).Conclusions There are differences in clinical features of measles in patients between <16 age group and ≥16 age group.Basic immunization in children and revaccination in adults should be enhanced to control the epidemics of measles .

Objective To investigate the influence of ionic strength on the stability of the methotrexate-loaded dendrimer nanoparticles. Methods The influences of different ions (Na+,Cl-) and different concentrations of sodium chloride on the stability of the nanoparticles were studied. The particle size was measured by dynamic light scattering(DLS) and drug-loading content was determined by high-performance liquid chromatography (HPLC) in order to evaluate the stability. Results The Cl- was finally verified to play an important role in stabilizing the nanoparticles and the effective concentration of the sodium chloride was recommended to be below 1. 80% . Conclusion The recommended concentration (less than 1. 80% ) of the sodium chloride significantly improves the stability of the nanoparticles and benefits for long term storage.

OBJECTIVETo establish a model of gastric precancerous lesion by using Aristolochic manshuriensis which contains aristolochic acids.

METHODThe SD rats were randomly divided into four groups: control and three different doses of ethanol extractive of A. manshuriensis (EEA) (corresponding to aristolochic acid I 2.5, 5.0, 10.0 mg x kg(-1)), respectively. EEA was intragastrically given to rats every other day. At the end of the 10th, 15th, 20th week, part of the rats in each group was sacrificed and the stomachs were weighed. The gastric tumor was assessed by the weight and the relative stomach weight to the body weight. The stomachs were fixed in 4% neutral formalin, and the paraffin imbedding tissues were sliced and HE stained. Histomorphology was observed under the light microscope to determine gastric hyperplasia, mucosa precancerosis (atypical hyperplasia) and gastric cancer formation.

RESULTThe rats treated with different doses of EEA for 10 weeks induced mucosa papillary, epithelioma hyperplasia. Histological observation showed mucosa precancerosis lesions characterized as atypical hyperplasia at the dose levels corresponding to aristolochic acid I 5.0 and 10.0 mg x kg(-1) treated for 10 weeks. The incidence rate of gastric precancerosis in those two groups was 100% at the 15th week. Malignant tumors were observed in most of the animals in 10.0 mg x kg(-1) group. The animals in 5.0 mg x kg(-1) group were well tolerant compared to 10.0 mg x kg(-1) group during the course of experiment, so the dose of aristolochic acid I 5.0 mg x kg(-1) and 10-15 weeks treatment were considered to be optimum to establish the model of gastric precancerosis.

CONCLUSIONA rat model of gastric precancerosis can be induced within a short duration by giving an oral administration of the ethanol extract of A. manshuriensis which contains aristolochic acids.

Animals ; Aristolochia ; chemistry ; Aristolochic Acids ; administration & dosage ; Disease Models, Animal ; Drugs, Chinese Herbal ; administration & dosage ; Humans ; Male ; Rats ; Stomach Neoplasms ; drug therapy ; pathology

OBJECTIVETo investigate the substance basis and the mechanism of pseudoanaphylactoid reactions (PR) induced by Shuanghuanglian injection (SHLI).

METHOD(1)The study of PR and the substance basis of PR of SHLI: ICR mice were divided into different test groups, the mice were intravenously injected with solutions of different concentration of SHLI, baicalin, forsythin, caffeotannic acid, positive control Compound 48/80 and normal sodium. All test substances were mixed with 0.4% Evans blue. The reaction and vascular permeability of the ears were observed and measured 30 min after SHLI injection. (2) The study of mechanisms: Mice were pretreated with an oral administration of Astemizol, intraperitoneal injection of cyclophosphamide 75 mg x kg(-1) or Compound 48/80 4 mg x kg(-1), then mice were intravenously injected with SHLI. At last, vascular permeability of the ears in pretreated groups was compared with SHLI treatment alone group.

RESULTSHLI of 300 mg x kg(-1) and 600 mg x kg(-1) caused obvious vascular hyperpermeability, but baicalin, forsythin and caffeotannic didn't cause vascular hyperpermeability in the ears. The Astemizol can decrease the degree of SHLI-induced vascular hyperpermeability of the ears in the mice. After intraperitoneal injected with cyclophosphamide, there was a slight decrease in the degree of SHLI-induced vascular hyperpermeability, but there was no marked changes in the degree of the SHLI-induced vascular hyperpermeability after the mice were pretreated with Compound 48/80.

CONCLUSIONSHLI in clinic equivalent dose can cause vascular hyperpermeability. Baicalin, forsythin and caffeotannic may not result in the PR of SHLI. The mechanism of the PR maybe relate to that SHLI stimulates histamine release, the activation of leucocyte maybe take part in the SHLI-induced PR, too. Antihistamine drug can prevent the genesis of PR which induced by SHLI.

Anaphylaxis ; chemically induced ; pathology ; physiopathology ; Animals ; Chemistry, Pharmaceutical ; Drugs, Chinese Herbal ; administration & dosage ; adverse effects ; chemistry ; Injections ; Mice

OBJECTIVETo modify the empirical method of precision-cut liver slice technique, and study the hepatotoxicity of monocrotaline by this technique.

METHODLiver slices were prepared by the domestic shaking slicer. The technique of precision-cut liver slice was established by detecting MTT reduction used as the slice viability under different culture medium, thickness of slices, pH and culture temperature. After monocrotaline and liver slices co-culture for 6, 24 h, the slice viability, enzyme activity of GPT, GOT, LDH, GGT and protein concentration were detected by MTT reduction, enzyme kinetics method and BCA protein assay method, respectively.

RESULTWhen the thickness of slices was 200 microm and pH of medium was 6.8, culture temperature was 37 degrees C, BPM culture medium, the viability of slices could maintain on a steady level. LDH leakage was significantly increased and protein content was obviously decreased after monocrotaline co-culture for 24 h with final concentration 0.02, 0.1 and 0.5 g x L(-1). No statistically significant difference between control group and monocrotaline 3 dose groups was observed in the slice viability and the content of GPT, GOT, LDH, GGT and protein after monocrotaline co-culture for 6 h.

CONCLUSIONThe slice viability could retain 24 h in modified BPM medium surroundings; monocrotaline displayed liver toxicity in some degree after co-culture for 24 hours in 0.02, 0.1 and 0.5 g x L(-1) concentration.

Animals ; Hydrogen-Ion Concentration ; L-Lactate Dehydrogenase ; metabolism ; Liver ; drug effects ; metabolism ; Male ; Monocrotaline ; toxicity ; Rats ; Rats, Sprague-Dawley ; Temperature ; Toxicity Tests