Objective:To analyze the advantages and disadvantages of online and offline laboratory medicine continuing education and training, and to discuss the future continuing education and training mode under new technology development and new situation.Methods:A questionnaire was administered to the trainees who participated in the 2019 and/or 2020 national continuing medical education project—Clinical Application and Evaluation of New Technologies and Methods of Laboratory Medicine—sponsored by the Department of Laboratory Medicine, West China Hospital, Sichuan University. One hundred and twenty-four questionnaires were completed for the 2019 offline training, and 503 questionnaires were completed for the 2020 online training. The rank sum test, Fisher's exact test, and chi-square test were performed for statistical analysis with the use of SPSS 26.0.Results:The participants in 2020 were significantly younger and the proportion of female participants in 2020 was significantly higher compared with those in 2019. Intermediate titles or above accounted for 66.93% (83/124) in 2019, and intermediate titles or below accounted for 88.67% (446/503) in 2020. The proportion of people from Sichuan Province was significantly higher in 2019. The proportion of trainees from primary institutions was significantly lower in 2019. In 2019, public institutions were mainly tertiary hospitals (74.31%, 81/109), and the majority of participants from private institutions were from third party testing institutions (60.00%, 9/15). In 2020, the percentage of tertiary hospitals in public institutions decreased to 60.99% (258/423), while the percentage of community medical institutions increased to 10.64% (45/423), and 75.00% (60/80) of trainees from private institutions were from tertiary and secondary medical institutions. Trainees with lower educational levels were more likely to appreciate the value of the training course, especially with higher degrees of satisfaction with improvements in theoretical levels and practical skills, and participants from primary institutions believed that the training course could effectively improve their theoretical and practical levels. The number of participants who provided suggestions on laboratory medicine continuing education and training needs in 2019 (83.75%, 67/80) was higher than that in 2020 (48.51%, 244/503). The overall pass rate of post-training assessment in 2020 was 88.52% (424/479).Conclusions:Online and offline training modes have different audience groups and training effects. Online continuing education can provide training opportunities to more primary care personnel and junior and intermediate professionals, which is conducive to improving the basic professional literacy and testing skills of laboratory personnel on the whole. At the same time, the integration of online and offline modes will promote the development of laboratory medicine continuing education.

Objective To analyze the acupoint selection rule for cancer-related fatigue with acupoint stimulation using data mining techniques.Methods Clinical randomized controlled trial research literature about treatment for cancer-related fatigue with acupoint stimulation was retrieved from CNKI,Wanfang Data,VIP,SinoMed,PubMed,Web of Science and Embase from establishment of the databases to October 13,2023.The frequency anlysis,association rule analysis and clustering analysis on acupoints were performed using Excel 2021 and R 4.3.1.Results Totally 187 articles were included,with 214 combinations of acupoints involving 102 acupoints,with a total frequency of 1 044.The most frequently used acupoints were Zusanli(ST36),Qihai(CV6),and Guanyuan(CV4).The top three meridians used were the Conception Vessel,stomach meridian,and spleen meridian.The acupoints were mainly distributed in the lower limbs and thoracoabdominal,and the most commonly used specific acupoint was the crossing point.Moxibustion was the most commonly used intervention measure.Association rule analysis indicated that the core combination of acupoints in this study was Zusanli(ST36),Qihai(CV6),Guanyuan(CV4),and Sanyinjiao(SP6).Analysis of acupoint selection for cancer-related fatigue with different types of cancer demonstrated that acupoints with tonifying properties were most frequently chosen.Clustering analysis identified five effective combinations of acupoints.Conclusion The acupoint selection for treating cancer-related fatigue should focus on tonifying qi and nourishing blood,as well as supporting healthy qi to eliminate pathogenic factors.Special attention is given to the use of specific acupoints,and various acupoint combination methods are employed based on the differentiation of zang-fu organs and meridians to enhance clinical efficacy.

Based on the Delphi method, combined with the results of the previous literature study and expert interviews, 3 rounds of expert consultation were conducted to evaluate the degree of concentration of expert opinions and their importance from 3 aspects: arithmetic mean, full score ratio ( Ki), and rank sum ( Si), to construct a diagnostic scale for rheumatoid arthritis (RA) cold-dampness syndrome. In this study, 30 expert questionnaires were distributed in the 1st round, 30 questionnaires were recovered, and the expert coordination coefficient was 0.309; 30 expert questionnaires were distributed in the 2nd round, 30 questionnaires were recovered, and the expert coordination coefficient was 0.320; and 30 expert questionnaires were distributed in the 3rd round, 29 questionnaires were recovered, and the expert coordination coefficient was 0.387. The maximum value of the coefficient of variation of the experts of the 3 rounds was 0.27, and the minimum value was 0.09, suggesting that the consistency and credibility of the experts' evaluation of the importance of the entries of cold-dampness syndrome were high. In this study, the mean values and weights of 17 entries were finally obtained, of which the top 5 entries were cold pain in joints (4.793, 0.066 6); aggravated by cold (4.586, 0.063 7); white tongue coating (4.552, 0.063 2); aggravated in cloudy and rainy days (4.448, 0.061 8); and painful joints that are not warm to the touch (4.379, 0.060 8). This study completed the screening of relevant entries and conducted preliminary discussions, laying the foundation for constructing a diagnostic scale for RA cold-dampness syndrome and forming the final diagnostic criteria. The research method is scientific and reliable, which can provide reference for the diagnostic standard of RA cold-dampness syndrome, but further clinical practice research is still needed.

Objective:The drug-resistant genes carried by carbapenem-resistant Klebsiella pneumoniae(CRKP)limit clinical treatment options,and its virulence genes severely affect patient prognosis.This study aims to investigate the distribution of virulence genes,capsular serotypes,and molecular epidemiological characteristics of CRKP in ICU,to understand the characteristics of CRKP infections in ICU,and to provide a scientific basis for effective monitoring and control of CRKP infections in ICU. Methods:A total of 40 non-duplicate strains of CRKP isolated from the ICU of Guangdong Provincial People's Hospital between January 2021 and December 2022 were collected and analyzed.Whole-genome sequencing was used to analyze the distribution of resistance genes,virulence genes,and capsular serotypes of the strains.The sequences of 7 housekeeping genes of CRKP genome were uploaded to the Klebsiella pneumoniae(KPN)multilocus sequence typing(MLST)database to determine the sequence types(STs)of the strains. Results:The age of the 40 ICU CRKP-infected patients was(69.03±17.82)years old,with various underlying diseases,and there were 20 patients with improved clinical outcome and 20 patients with death.The isolated strains primarily originated from mid-stream urine and bronchoalveolar lavage fluid.Whole-genome sequencing results revealed that the strains predominantly carried blaKPC-1(29 strains,72.5%)and blaNDM-1(6 strains,15.0%),with 5 strains carrying both blaKPC-1 and blaNDM-1.Various virulence genes were detected,among which the carriage rates of genes such as entA,entB,entE,entS,fepA,fepC,fepG,yag/ecp,and ompA reached 100%,while the carriage rates of genes such as entD,fimB,iroB,iroD,fes,and pla were low.The CRKP strains isolated from ICU were predominantly ST11(27 cases,67.5%),with KL64 being the main capsular serotype(29 cases,72.5%).A total of 23 ST11-KL64 CRKP strains were detected,accounting for 57.5%. Conclusion:The main type of ICU CRKP is ST11-KL64,carrying various virulence genes,primarily those related to iron absorption.Furthermore,blaKPC has shifted from blaKPC-2 to blaKPC-1.Therefore,close monitoring of the molecular epidemiological changes of CRKP is necessary,and strict control measures should be implemented to effectively curb the occurrence of CRKP infections.

Objective:To explore the predictive value of pulmonary effective arterial elastance (Ea) in patients with heart failure (HF).Methods:This is a retrospective cohort study, which retrospectively included 284 patients with HF who underwent right heart catheterization at Heart Failure Center in Fuwai Hospital between September 2013 and February 2022. Data regarding baseline clinical characteristics, hemodynamic profiles, and prognosis were collected. Ea was calculated as mean pulmonary arterial pressure/stroke volume. Patients were divided into Ea<0.555 group and Ea≥0.555 group according to the median value of Ea (0.555 mmHg/ml, 1 mmHg=0.133 kPa). The primary outcome was the primary clinical event, set as the first occurrence of a series of composite events, including all-cause death, heart transplantation, left ventricular assist device implantation, and HF rehospitalization. Event-free survival was defined as the absence of primary clinical events. Spearman correlation analysis was used to calculate the correlation coefficient between Ea and parameters reflective of right heart function. The Kaplan-Meier analysis was used to compare the different groups for the estimation of outcomes with the log-rank test. We used Cox proportional-hazards regression models to estimate hazard ratios ( HR) for primary clinical event. Subgroup analysis was performed based on the age, gender, New York Heart Association (NYHA) functional class, left ventricular ejection fraction, presence of pulmonary hypertension, and serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) values. We used receiver operating characteristic (ROC) curve to calculate the area under the curve ( AUC) of Ea for predicting event-free survival in patients with HF. Results:The median age was 51 years, and 206 (72.5%) patients were male. Ea and pulmonary vascular resistance (PVR) were significantly correlated ( r=0.698, P<0.001). The correlation between Ea and pulmonary arterial elastance (PAC) were even more significant ( r=-0.888, P<0.001). Compared with Ea<0.555 group, Ea≥0.555 group presented with higher serum NT-proBNP values (4 443 (1 792, 8 554) ng/L vs. 1 721 (480, 4 528)ng/L, P<0.001), higher PVR (3.4 (2.5, 4.7) Wood vs. 1.4 (0.9, 2.2) Wood, P<0.001), lower cardiac output (3.0 (2.3, 3.9) L/min vs. 4.3 (3.8, 4.9) L/min, P<0.001), and lower PAC (1.6 (1.3, 2.0) ml/mmHg vs. 4.0 (3.0, 6.0) ml/mmHg, P<0.001). The median follow-up time was 392 (166, 811) days. The Kaplan-Meier survival curve demonstrated a lower event-free survival rate in the Ea≥0.555 group compared to the Ea<0.555 group ( Plog-rank<0.001). After multivariate adjustment, Ea ( HR=1.734, P<0.001) remained significantly associated with the primary outcome. Subgroup analysis indicated that Ea was associated with the primary outcome across all subgroups. The AUC was 0.724 ( P<0.001) for Ea to predict event-free survival calculated from ROC analysis. Conclusions:Ea is closely related to parameters reflective of right ventricular afterload. Increased Ea is an independent predictor of adverse outcomes in patients with HF.

Objective To investigate the effect of combination of rope-assisted proprioceptive neuromuscular facilitation(PNF)training and rope-assisted brain-computer interface(BCI)training on upper limb function in stroke patients with hemiplegia. Methods From March,2022 to February,2023,96 inpatients with stroke hemiplegia from the Second Affiliated Hospital of Guangxi Medical University were randomly divided into conventional group(n=32),PNF group(n=32)and combined group(n=32).All the groups received routine rehabilitation treatment.The conventional group re-ceived upper limb PNF training,the PNF group received upper limb rope-assisted PNF training,and the com-bined group received both upper limb rope-assisted PNF training and upper limb rope-assisted BCI training,for four weeks.They were assessed with Functiongal Test for the Hemiplegic Upper Extremity-Hong Kong version(FTHUE-HK),Fugl-Meyer Assessment-Upper Extremities(FMA-UE)and modified Barthel Index(MBI)before and after treatment. Results The intra-group effect(F>341.219,P<0.001),inter-group effect(F>21.705,P<0.001)and interaction effect(F>3.171,P<0.05)were significant in the scores of FTHUE-HK and MBI.The intra-group effect(F=520.472,P<0.001)and inter-group effect(F=41.939,P<0.001)were significant in the scores of FMA-UE,and the interaction effect was not(P>0.05).After treatment,the FTHUE-HK,FMA-UE and MBI scores were the best in the combined group(P<0.05). Conclusion The combination of rope-assisted PNF training with rope-assisted BCI device training could further improve the motor function of the upper limbs in stroke patients with hemiplegia,and enhance their activities of daily liv-ing.

Objective To explore the acupoint selection law for acupoint stimulation to improve gastrointestinal function after colorectal cancer surgery based on data mining technology.Methods Literature about acupoint stimulation to improve gastrointestinal function was retrieved from CNKI,VIP,Wanfang Data,SinoMed,PubMed,Web of Science and Cochrane Library from the establishment of databases to July 1,2023.Data extraction and analysis were performed using Excel 2021.Association rule analysis and clustering analysis were conducted using R language.Results Totally 197 articles were collected,with 242 combinations of acupoints involving 69 acupoints and the total use frequency of acupoints was 878 times.The top 3 acupoints used in frequency were Zusanli(ST36),Shangjuxu(ST37),and Neiguan(PC6).The top 3 involved meridians were the stomach meridian,Conception Vessel,and spleen meridian.The acupoints were mainly distributed in the lower limbs,and the most commonly used intervention method was needle punching.The association analysis discovered a combination of acupoints centered around Zusanli(ST36),which included Shangjuxu(ST37),Neiguan(PC6),and Sanyinjiao(SP6).Clustering analysis identified 4 effective cluster combinations.Conclusion Acupoint stimulation improves gastrointestinal function after colorectal cancer surgery.Multiple acupoint selection ideas are used,and the summarized acupoint selection and compatibility law in this study can provide reference for clinical research and application.

OBJECTIVE: To explore the clinical and genetic characteristics of two children with Williams-Beuren syndrome (WBS). METHODS: Two children who had presented at the Department of Pediatrics, General Hospital of Ningxia Medical University respectively on January 26 and March 18, 2021 were selected as the study subjects. Clinical data and results of genetic testing of the two patients were analyzed. RESULTS: Both children had featured developmental delay, characteristic facies and cardiovascular malformation. Child 1 also had subclinical hypothyroidism, whilst child 2 had occurrence of epilepsy. Genetic testing revealed that child 1 has harbored a 1.54 Mb deletion in the 7q11.23 region, whilst child 2 has a 1.53 Mb deletion in the same region, in addition with a c.158G>A variant of the ATP1A1 gene and a c.12181A>G variant of the KMT2C gene. Based on the guidelines from the American College of Medical Genetics and Genomics, the c.158G>A and c.12181A>G variants were rated as variants of unknown significance (PM1+PM2_Supporting+PP2+PP3；PM2_Supporting). CONCLUSION Both children had characteristic features of WBS, for which deletions of the 7q11.23 region may be accountable. For children manifesting developmental delay, facial dysmorphism and cardiovascular malformations, the diagnosis of WBS should be suspected, and genetic testing should be recommended to confirm the diagnosis.
Child ; Humans ; Williams Syndrome/diagnosis* ; Genetic Testing ; Facies ; Epilepsy/genetics* ; Chromosomes, Human, Pair 7/genetics* ; Chromosome Deletion

ObjectiveTo investigate the prevalence of overweight， obesity and fatty liver disease （FLD） in adult residents in a suburban area of Shanghai， and to explore the relationship between these conditions and eating out of home （EOH）. MethodsAdult residents from Zhongshan Street， Songjiang， Shanghai， were invited to report their frequency of EOH and undergo a physical examination using B-ultrasonography from May to September 2017. Binary logistic regression analyses were conducted to examine the relationship between EOH and conditions of overweight， obesity， and FLD. ResultsAmong the final sample size of 6 608 participants， the prevalence rates of overweight， obesity， and FLD were 41.65%， 14.71% and 38.29%， respectively. After adjusting for potential confounders， logistic analyses revealed that participants with an EOH frequency > once/week had a 1.44-fold higher prevalence of obesity （P=0.006）， a 1.35-fold higher prevalence of overweight/obesity （P=0.005）， and a 1.36-fold higher prevalence of FLD （P=0.008）. ConclusionThe prevalence of overweight， obesity， and FLD is relatively high in Songjiang， Shanghai. EOH may be a risk factor for these diseases， and residents are recommended to reduce the frequency of EOH.

By searching the papers about medical ethics education in Chinese database CNKI and foreign database Web of Science Core Collection, and using the bibliometrics software CiteSpace to draw the knowledge map of medical ethics education at home and abroad, this paper conducted a quantitative and qualitative analysis of the evolution of hot spots and the development trend of medical ethics education research, and found that the development level of medical ethics education in the world varies greatly. China has experienced the development and evolution from medical ethics education to medical humanities, and its research hotspots mainly focus on the topics of "medical ethics" "medical education" "practice teaching" "medical humanities" "teaching reform" and so on. While foreign countries focus on "medical education" "clinical ethics" "hospice care" "health care" "global public health" "science and technology ethics" "organ transplantation" "curriculum construction" "health policy" and other topics. Through the comparative analysis of the development trend and the evolution of hot spots of education, this paper put forward theoretical reference direction for improving the medical ethics education system in China and further perfecting the discipline construction of medical ethics in China.