Objective:To investigate the application value of scenario simulation combined with standardized patient teaching in the training of doctor-patient communication skills among interns.Methods:A total of 110 clinical medicine interns were selected from Qilu Hospital of Shandong University and were divided into experimental group and control group using a random number table, with 55 interns in each group. The interns in the control group received traditional lecturing, and those in the experimental group received scenario simulation combined with standardized patient case-based teaching. The SEGUE Communication Skill Evaluation Scale and Patient Satisfaction Questionnaire were used to assess the improvement in communication skills in both groups, and Physician Self-Evaluation Scale and Course Satisfaction Questionnaire were used to assess the effectiveness of the course and the degree of satisfaction with the course. SPSS 26.0 was used for the t-test, the Mann-Whitney U test, and the rank sum test. Results:After training, both groups showed significant improvements in communication skills and patient satisfaction [experimental group in terms of communication skills: (55.38±13.11) vs. (74.82±6.75), P<0.001; experimental group in terms of patient satisfaction: 39.00 (39.00, 42.00) vs. 81.00 (79.00, 83.00), P<0.01; control group in terms of communication skills: (56.53±12.34) vs. (65.45±10.18), P<0.001; control group in terms of patient satisfaction: 39.00 (39.00, 42.00) vs. 73.00 (68.00, 77.00), P<0.001], and the experimental group had significantly higher scores than the control group [communication skills: (74.82±6.75) vs. (65.45±10.18), P<0.001; patient satisfaction: 81.00 (79.00, 83.00) vs. 73.00 (68.00, 77.00), P<0.001]. The Physician Self-Evaluation Scale showed that the experimental group had a significant improvement compared with the control group ( P<0.05). The results of the Course Satisfaction Questionnaire showed that the degree of overall satisfaction of the course was only 87.28% in the control group, while all the interns in the experimental group were satisfied with the course ( P<0.001); the new teaching method showed great advantages ( P<0.001). Conclusions:In the training of doctor-patient communication skills among interns, the application of scenario simulation combined with standardized patient case-based teaching can significantly improve their abilities of the application of knowledge application, humanistic concern, and communication skills, and therefore, it is an effective and promising method for the training of doctor-patient communication skills.

Objective:To investigate the application value of scenario simulation combined with standardized patient teaching in the training of doctor-patient communication skills among interns.Methods:A total of 110 clinical medicine interns were selected from Qilu Hospital of Shandong University and were divided into experimental group and control group using a random number table, with 55 interns in each group. The interns in the control group received traditional lecturing, and those in the experimental group received scenario simulation combined with standardized patient case-based teaching. The SEGUE Communication Skill Evaluation Scale and Patient Satisfaction Questionnaire were used to assess the improvement in communication skills in both groups, and Physician Self-Evaluation Scale and Course Satisfaction Questionnaire were used to assess the effectiveness of the course and the degree of satisfaction with the course. SPSS 26.0 was used for the t-test, the Mann-Whitney U test, and the rank sum test. Results:After training, both groups showed significant improvements in communication skills and patient satisfaction [experimental group in terms of communication skills: (55.38±13.11) vs. (74.82±6.75), P<0.001; experimental group in terms of patient satisfaction: 39.00 (39.00, 42.00) vs. 81.00 (79.00, 83.00), P<0.01; control group in terms of communication skills: (56.53±12.34) vs. (65.45±10.18), P<0.001; control group in terms of patient satisfaction: 39.00 (39.00, 42.00) vs. 73.00 (68.00, 77.00), P<0.001], and the experimental group had significantly higher scores than the control group [communication skills: (74.82±6.75) vs. (65.45±10.18), P<0.001; patient satisfaction: 81.00 (79.00, 83.00) vs. 73.00 (68.00, 77.00), P<0.001]. The Physician Self-Evaluation Scale showed that the experimental group had a significant improvement compared with the control group ( P<0.05). The results of the Course Satisfaction Questionnaire showed that the degree of overall satisfaction of the course was only 87.28% in the control group, while all the interns in the experimental group were satisfied with the course ( P<0.001); the new teaching method showed great advantages ( P<0.001). Conclusions:In the training of doctor-patient communication skills among interns, the application of scenario simulation combined with standardized patient case-based teaching can significantly improve their abilities of the application of knowledge application, humanistic concern, and communication skills, and therefore, it is an effective and promising method for the training of doctor-patient communication skills.

Objective:To explore the risk factors for stone recurrence after laparoscopic common bile duct exploration (LCBDE) combined with laparoscopic cholecystectomy (LC) and to develop a risk prediction model.Methods:Clinical data of 344 patients with bile duct stones who underwent LCBDE combined with LC at Hebei General Hospital from January 2016 to March 2022 were retrospectively analyzed, including 165 males and 179 females, aged (62.72±13.56) years old. Patients were divided into two groups based on whether stones recurred during the follow-up period: recurrence group ( n=37) and non-recurrence group ( n=307). Clinical data such as common bile duct diameter, stone size, number of stones and duration of T-tube drainage were collected from the patients. Logistic regression was used to analyze the risk factors for postoperative stone recurrence, and then developed a logistic regression model. The predictive efficacy of the model was assessed by the area under the receiver operating characteristic (ROC) curve, and the Hosmer-Lemeshow test. Results:The results of multifactorial logistic regression analysis showed that patients with ≥2 choledochal stones had a high risk of stone recurrence after LCBDE combined with LC ( OR=3.094, 95% CI: 1.069-8.954, P=0.037). In contrast, regular postoperative oral choleretic medication was a protective factor for stone recurrence after LCBDE combined with LC ( OR=0.160, 95% CI: 0.072-0.354, P=0.001). A logistic regression model, based on the number of common bile duct stones and regular postoperative oral choleretic medication, was developed to predict the recurrence of bile duct stones in patients who underwent LCBDE combined with LC. The area under the ROC curve for this model was found to be 0.821 (95% CI: 0.758-0.885). The Hosmer-Lemeshow test, χ 2=7.26, P=0.509, suggested that there is good agreement between the model's predicted probabilities and ideal probabilities. Conclusions:The number of stones (≥2) is an independent risk factor for stone recurrence after LCBDE combined with LC in patients with bile duct stones. Regular postoperative oral choleretic medication is a protective factor for stone recurrence after LCBDE combined with LC. Predictive models based on the number of choledochal stones and regular postoperative oral choleretic medication have better efficacy in predicting postoperative stone recurrence.

Animals ; Macaca mulatta ; Optic Disk ; Glaucoma ; Craniocerebral Trauma ; Intraocular Pressure ; Low Tension Glaucoma

ObjectiveTo genotype Oncomelania hupensis， based on microsatellites， in different snail-bearing environments in Jiaxing City， Zhejiang Province， for population genetics analysis in order to explore the reasons and influencing factors for the existence or proliferation of snails and to provide scientific basis for effective monitoring and control of snails. MethodsA total of 90 snail samples from three populations were collected in Yaobang Village （YB） and Sanxing Village （SX） in Pinghu City， and Yunhe Farm （YH） in Xiuzhou District， all were selected for snail checking in key snail habitats of Jiaxing City in 2022. DNA of the snails was genotyped and analyzed for population genetics using nine microsatellite loci. ResultsA total of 84 alleles were observed， and the mean number of alleles （Na） was 7.889， 5.667， and 3.778 for YB， SX， and YH respectively； the number of effective alleles （NeA） was 4.807， 3.329， and 2.294， respectively； and the coefficients of inbreeding （F_IS） were 0.400， 0.377， and 0.493， respectively. Under the Infinite Allele Model （IAM）， the SX and YH might have a recent bottleneck. The NEstimator and LDNe software calculated effective population sizes （Ne） were above 31.9. AMOVA analysis showed that the variation of snails in the three populations mainly existed among individuals， accounting for 41.4% of the total variation. The value of the index of genetic differentiation between populations （F_ST） was 0.286， indicating a high degree of genetic differentiation. The results of the principal component analysis and phylogenetic tree were consistent， and the three populations were divided into two lineages， YB and SX were one lineage， and YH belonged to another independent lineage. Population history and dynamics analysis showed that the gene flow of the three populations was insufficient， population divergence history indicated that YH might have diverged from SX first， and YB was produced by the contact fusion of SX and YH. ConclusionThe genetic diversity of snail populations in Jiaxing City is generally low， and the snail populations are unstable， with a great degree of genetic differentiation and insufficient gene flow among populations. This study can provide a basis for evaluating the effectiveness of the control of the snail as well as monitoring the trend of the spread of the snail.

Objective: Dendrobium polysaccharide(DOP-1-1) was prepared and its effects on the proliferation, differentiation and mineralization of pre-osteoblast MC3 T3-E1 cells were investigated. Methods : A homogeneous polysaccharide(DOP-1-1) was obtained from Dendrobium officinale polysaccharide(DOP) through systematic separation and purification, and the structure of DOP-1-1 was studied by high-performance gel permeation chromatography, monosaccharide analysis, infrared spectroscopy, methylation analysis, GC-MS and NMR spectroscopy.In vitroexperiments were performed to detect the effects of DOP-1-1 on the proliferation, differentiation and mineralization of MC3 T3-E1 cells by MTT method, ALP activity determination and Alizarin Red S staining. At the same time, Western blot was used to determine the effect of DOP-1-1 on the expression of bone-related proteins(Pin1, BMP2, RUNX2) in MC3 T3-E1 cells. Results : DOP-1-1 was a homogeneous polysaccharide with relative molecular weights of 3 611, which was composed of mannose, glucose and galactose. DOP-1-1 had excellent activity of promoting osteoblast proliferation in a low concentration, and the effects of 2.0 and 4.0 μmol/L of DOP-1-1 were equivalent to Positive Control 17β-estradiol(E2). Compared with the control group, E2 and DOP-1-1(4.0, 8.0 μmol/L) increased the ALP activity and mineralization rate in MC3 T3-E1 cells(P<0.01). In particular, the ALP activity and mineralization rate of DOP-1-1(8.0 μmol/L) were higher than those of the positive control E2(P<0.001). In addition, the expression of Pin1, BMP2, and RUNX2 protein in MC3 T3-E1 cells in the DOP-1-1 group was higher than that in the control group(P<0.05). Conclusion DOP-1-1 can promote the proliferation, differentiation and mineralization of MC3 T3-E1 cells in vitro, and its mechanism is related to the activation of Pin1/BMP2 signaling pathway.

Background: Vitamin D receptor (VDR) is associated with the occurrence and development of ulcerative colitis (UC). The expression and function of VDR may be affected by its gene polymorphisms, and thus affecting the occurrence of UC. However, results of studies are still in controversary. Aims: To explore the relationship between VDR gene polymorphisms and UC. Methods: Studies on correlation of VDR gene (Apa, Bsm, Fok, Taq) polymorphisms with UC were retrieved from SinoMed, CNKI, Wanfang, VIP, Embase, PubMed, The Cochrane Library databases. Literatures were enrolled according to the inclusion and exclusion criteria, and the data were extracted. RevMan 5.3 was used to conducted meta-analysis. Results: A total of 11 studies involving 1 811 UC patients were included. Meta-analysis showed that VDR gene Fok polymorphism (FF + Ff vs. ff: OR=0.67, 95% CI: 0.49-0.92, P=0.01), allele (F vs. f: OR=0.81, 95% CI: 0.68-0.96, P=0.02) were significantly correlated with the susceptibility of UC. Among which, Fok polymorphism (FF+Ff vs. ff: OR=0.59, 95% CI: 0.37-0.94, P=0.03), allele (F vs. f: OR=0.76, 95% CI: 0.60-0.97, P=0.03) were significantly correlated with the susceptibility of UC in Asian, but not in Caucasian population (P>0.05). No significant association was observed between Apa, Bsm, or Taq polymorphisms and UC (P>0.05). Conclusions: Existing evidence shows that VDR gene Fok polymorphism might contribute to UC susceptibility, however, Apa, Bsm, and Taq polymorphisms might not be significantly correlated with UC.

Objective To investigate the exposure to stroke risk factors, the proportion of high?risk individuals, and the relationship between risk factor exposure and impaired cerebrovascular hemodynamics in patients at Pu'er People's Hospital. Methods Between April 2014 and June 2017, this study enrolled inpatients and outpatients of the neurology department of Pu'er People's Hospital who underwent cerebrovascular hemodynamic examinations to evaluate stroke risk. A total of 30 103 (12 793 males and 17 310 females) participants aged 22 to 99 (53.3±14.5) years were included. The distribution of exposure rates for stroke risk factors and proportion of high?risk individuals were determined according to age and sex. The relationships between integral scores of cerebrovascular hemodynamics and exposure to risk factors were also analyzed. Results Exposure rates for risk factors of hypertension, dyslipidemia, diabetes, heart disease, stroke family history, cigarette smoking, alcohol drinking, and overweight or obesity in males were 36.6%, 11.4%, 8.8%, 5.9%, 7.0%, 41.6%, 37.8%, and 51.4%, respectively. The exposure rates in females were 31.2%, 11.3%, 7.6%, 5.5%, 6.8%, 0.7%, 1.6%, and 48.8%, respectively. Differences between age groups for all risk factors were significant (P<0.01). Exposure rates for hypertension, diabetes, cigarette smoking, alcohol drinking, and overweight or obesity in males were significantly higher than in females (P<0.01). High?risk males and females accounted for 41.8% and 35.6% (χ2=119.82, P<0.01) and the rates in both groups increased significantly with age (χ2=1 838.2, 2 881.5, P<0.01). Risk factors including age, hypertension, dyslipidemia, diabetes, heart disease, stroke family history, alcohol drinking, and body mass index were independent predictors of increased individual risk of stroke. Conclusions Exposure levels for stroke risk factors and the proportion of individuals at high risk of stroke were relatively high in the hospital population. Cerebrovascular dysfunction is closely related to exposure to common risk factors for stroke.

Objective To investigate the difference between Han nationality residents and the Hani nationality residents in southern Yunnan about the effects of stroke risk factors on cerebral vascular hemodynamic indicators.Methods In the cohort crowds,Hani nationality outpatient patients were selected as the Hani nationality group,the Han nationality outpatient patients with the same gender and similar age were randomly selected as the Han nationality group with the ratio of nearly 1 ∶ 3.The risk factors of stroke and the differences of the hemodynamic indicators were compared between the two groups.Results The dyslipidemia proportion of the Hani nationality group was lower than that of the Han nationality group [48 cases (11.5 ％) vs.257 cases (17.5 ％),x2 =8.867,P =0.003],and the drinking proportion of the Hani nationality group was higher than that of the Han nationality group [79 cases (18.9％) vs.214 cases(14.6％),x2 =4.498,P =0.034],the other risk factors exposure rates had no statistically significant differences between the two groups (all P ＞ 0.05).The ratio of numbers of cerebral vascular hemodynamic indicators below 75 points(optimum truncation points) in the Hani nationality group and the Han nationality group were 30.3％ and 31.9％,respectively,the proportion of the two groups of integral value distribution had statistically significant difference (x2 =12.614,P ＜ 0.01);Vmean (left:t =0.632,P =0.527;right:t =0.642,P =0.532),Vmin (left:t =-0.349,P =0.727;right:t =-0.540,P =0.589),Wv(left:t =0.297,P =0.767;right:t =1.119,P =0.263),Zcv(left:t =0.297,P =0.767;right:t =1.247,P =0.213),Rv(left:t =0.837,P =0.403;right:t =1.222,P =0.222),DR(left:t =0.720,P =0.482;right:t =0.396,P =0.692),Cp(left:t =0.614,P =0.539;right:t =1.486,P =0.138) and other indicators of the two groups had no statistically significant differences.Conclusion The Hani nationality residents'stroke risk factors and CVHI integral distribution in different age groups are different from Han people in southern Yunnan.

Objective To investigate the clinical features and treatment of solid pseudopapillary neoplasm (SPN) of the pancreas.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 69 patients with SPN of the pancreas who were admitted to the Qilu Hospital of Shandong University from January 2012 to July 2017 were collected.Serum tumor markers detection,enhanced computed tomography (CT) and magnetic resonance imaging (MRI) of abdomen were carried out preoperatively for all the patients,and a part of the patients received endoscopic ultrasonography (EUS).Surgery plans were formulated after completion of examinations.Observation indicators:(1) clinical features;(2) treatment situation;(3) results of pathological examination;(4)follow-up.All the patients were followed up via outpatient examination and telephone interview to detect the survival and tumor recurrence and metastasis till July 2017.Measurement data with normal distribution were presented by (x)±s and were compared by Student's t test.Count data were compared by chi-square test.Results (1) Clinical features:① epidemiologic features:the ratio of male to female was 1∶5.9;patients were aged between 9 and 65 years,including 40 under 30 years and 29 above or equal to 30 years.The onset age was (34± 15)years for male patients and (28 ± 11)years for female patients,respectively,with no statistically significant difference (t=1.364,P＞0.05).Of 69 patients,SPN was located at pancreatic uncinate process in 25 patients,at neck of pancreas in 12 patients,body and tail of pancreas in 32 patients.② Medical history:history of acute or chronic pancreatitis and abdominal trauma were denied by all the 69 patients.③ Clinical manifestation:26 patients had no obvious symptoms and were detected by physical examination;31 patients had discomfort in upper abdomen,nausea and vomiting;other patients were admitted to the hospital because of upper abdominal mass (10 patients),jaundice (1 patient) or nausea,constipation (1 patient).④ Laboratory examination:the levels of preoperative carcinoembryonic antigen (CEA) and CA19-9 were normal.⑤ Imaging examination:plane scan of the CT examination showed round or round-like low-density shadows in the 69 patients,including 51 of cystic solid lesion,13 of solid lesion and 5 of cystic lesion.Complete capsules were observed in 64 patients,blurred boundary between pancreas and adjacent viscera in 5 patients,calcified foci in the pancreatic parenchyma and capsules in 14 patients.Ten patients received MRI examination,and the T1-weighted images showed equal or slightly lower signal,T2-weighted images showed slightly higher signal in the plane scan,and T1-weighted and T2-weighted images of the tumor capsule showed continuous or non-continuous ring-like signal.The results of enhanced scan showed slightly heterogeneous enhancement of the capsule and the parenchyma of the pancreas in the arterial phase,and progressive enhancement in the venous and delayed phase,while the enhancement degree was lower than that of the normal pancreas parenchyma.The parenchyma was cloud-,papillaor mural nodule-like enhanced.Obvious enhancement was observed in capsule while not in the cystic components.The boundaries of the tumors in 5 patients were clear under EUS.Hypo-,iso-and hyperechoic regions were found in the masses,and the masses were confirmed as cyst-solidary type.Obvious calcified foci were found in 1 patient.(2) Treatment outcome:twenty-seven patients received laparoscopic surgery,including tumor expiration in 13 patients,distal pancreatectomy with preservation of spleen in 8 patients,distal pancreatectomy combined with splenectomy in 2 patients,middle pancreatectomy in 2 patients,pancreaticoduodenectomy with preservation of pylorus in 1 patient,pancreatic head resection with preservation of duodenum under the assistance of laparoscopy in 1 patient.Forty-two patients received open surgery,including tumor expiration in 12 patients,distal pancreateetomy with preservation of spleen in 10 patients,distal pancreatectomy combined with spleneetomy in 6 patients,middle pancreatectomy in 5 patients,pancreaticoduodenectomy in 7 patients (with preservation of pylorus in 2 patients) and pancreatic head resection combined with preservation of duodenum in 1 patient.One patient with SPN + hepatic metastasis received distal pancreatectomy+ metastatic foci resection in the lesser omental bursa,and then followed by radiofrequency ablation in the hepatic metastatic foci.Postoperative complications:21 of 69patients had postoperative complications,including 17 intestinal fistulas,2 abdominal bleedings,1 incomplete obstruction,1 pleural effusion + atelectasis,and all of them were cured by symptomatic treatment.(3)Pathological examination:the resection margins of 69 patients were negative.The mean diameter of the tumor was (7±4) cm (21 patients with tumor diameter ＜ 5 cm,and 48 with tumor diameter ≥5 cm).The tumor diameters of 4 in 10 male patients were above or equal to 5 cm,and the number was 44 in 59 female patients,with statistically significant difference (x2 =4.828,P＜0.05).The tumor diameters of 32 in 40 patients who aged under 30 years were above or equal to 5 cm,and the number was 16 in 29 patients who were aged above or equal to 30 years,with statistically significant difference (x2=4.895,P＜0.05).Solid,pseudo-papillary and cystic regions in the SPN tissues were seen under the light microscope.Tumor cells were surrounded the blood vessels and were arranged in the nest or sheet shape in the solid region;blood vessels were surrounded by one or multiple layers of tumor cells in the axis or pseudopapillary shape in the pseudopapillary region;large amount of mucus and clusters of blood cells were seen in the cystic regions.The result of immunohistochemistry showed that the positive rates of α1-antitrypsin,vimentin,β-catenin,progesterone receptor,CD10,synaptophysin and chromogranin A were 100.0％ (39/39),96.6％ (28/29),95.7％ (45/47),94.4％ (51/54),92.5％ (49/53),72.9％ (35/48) and 5.6％ (3/54),respectively.(4) Follow-up:63 of 69 patients were followed up for 1-68 months,with median time of 29 months.No SPN recurrence or metastasis was detected.One patient died of lung cancer at postoperative month 35 and other patients survived well.Conclusions SPN of pancreas is mostly detected in young female patients,and it could be solid or cystic.Abdominal enhanced CT or MRI examination could clarify the diagnosis.EUS-fine needle aspiration examination could provide pathological evidence for definitive diagnosis.Typical cellular morphology and pseudopapillary regions may provide hints for the diagnosis of SPN,and the diagnosis could be clarified when combined with the detection of vimentin,α 1-antitrypsin or other indexes.Complete resection of SPN and ensure negative resection margin are fundamental principles of treatment.