Strengthening the cultivation of innovation ability is the new requirement put forward by the state for higher educa-tion.High-quality curriculum design is the primary means of achieving high-quality talent cultivation.By constructing the"disease case library"and"problem graph"of immune system and related diseases,and adopting the teaching method of"combining large and small cases and integrating online and offline",this study not only consolidates students'basic knowledge,but also builds a bridge for students from theory to practice,from knowledge accumulation to creation and application.It further exercises students'ability to dis-cover,analyze and solve problems,and enhances students'innovation awareness and ability.

Strengthening the cultivation of innovation ability is the new requirement put forward by the state for higher educa-tion.High-quality curriculum design is the primary means of achieving high-quality talent cultivation.By constructing the"disease case library"and"problem graph"of immune system and related diseases,and adopting the teaching method of"combining large and small cases and integrating online and offline",this study not only consolidates students'basic knowledge,but also builds a bridge for students from theory to practice,from knowledge accumulation to creation and application.It further exercises students'ability to dis-cover,analyze and solve problems,and enhances students'innovation awareness and ability.

Objective To observe the value of shear wave elastography(SWE)for evaluating hepatic iron overload in children with β-thalassemia major(β-TM),as well as the correlations of relative parameters with MR T2*value and serum ferritin.Methods Totally 96 children with β-TM and 100 healthy children(control group)were retrospectively enrolled.Children with β-TM were divided into hematopoietic stem cell transplantation(HSCT)group(n=41)or non-HSCT group(n=55)according to underwent HSCT or not.SWE parameters were compared among groups.Spearman correlation was performed to observe the correlations of liver shear wave velocity with MR T2*value and serum ferritin,as well as Young's modulus with MR T2*value and serum ferritin in children with β-TM.Results Liver shear wave velocity(LSWV)and Young's modulus in HSCT group and non-HSCT group were all higher than those in control group(all P＜0.001).No significant difference of LSWV nor Young's modulus was found between HSCT group and non-HSCT group(both P＞0.05).SWE parameters of children with β-TM were moderately and negatively correlated with MR T2*value(r=-0.501,P＜0.05;r=-0.514,P＜0.05),while weakly and positively correlated with serum ferritin(r=0.488,P＜0.05;r=0.470,P＜0.05).Conclusion SWE was helpful for evaluating hepatic iron overload in children with β-TM,with parameters being negatively correlated with MR T2*value and positively correlated with serum ferritin.

OBJECTIVE To investigate the current situation of pharmaceutical management in compact medical consortium of Guangdong province， and to provide decision-making basis for promoting the high-quality construction and sustainable development of the provincial medical consortium. METHODS A self-designed questionnaire was used to select 50 compact medical consortiums in Guangdong province. The survey was answered by the heads of the pharmacy department of the general hospitals. The survey covered the basic scale of the consortium， the appointment of chief pharmacists， the implementation of pharmaceutical management and pharmaceutical care homogenization within the consortium， the difficulties in promoting the homogenization， and the expected provincial support. Descriptive statistical analysis was performed on the survey results. RESULTS A total of 50 questionnaires were collected， and the effective recovery rate was 100%. There were 16 chief pharmacists （32.00%） in charge of the pharmacy department of the general hospital in the medical consortium. Thirty-seven medical consortiums （74.00%） had established a drug supply support system within the consortium， 35 medical consortiums （70.00%） had carried out pharmaceutical management and coordination work within the medical consortium， 23 medical consortiums （46.00%） had established a clinical medication guidance system， 25 medical consortiums chenwenying2016@163.com （50.00%） had established a bidirectional communication mechanism， and only 8 medical consortiums （16.00%） had developed new models of pharmaceutical care. At present， the difficulties in promoting the homogenization of pharmaceutical management and pharmaceutical care within the medical consortium were mainly found in three aspects： the wide gap in management level of each member unit， the lack and uneven level of pharmaceutical personnel， and insufficient policy support and implementation. Most medical consortiums hoped that relevant departments could promote the homogenization of pharmaceutical work by holding special training courses or special supervision. CONCLUSIONS At present， the compact medical consortium in Guangdong province has achieved initial results in the implementation of the chief pharmacist system， the homogenization of pharmaceutical management and pharmaceutical care. However， it is still necessary to improve the coverage of chief pharmacist appointments in the medical consortium， implement the homogenization of pharmaceutical management， and accelerate the homogenization process of pharmaceutical care.

Objective To compare the diagnostic performance of PI-RADS v2.1 and PI-RADS v2 in the detection of clinically significant prostate cancer(csPCa) by Meta-analysis. Methods The major biomedical databases were searched (CNKI, CBM, Medline, and Embase) with the keywords "PIRADS v2.1" or "PI-RADS v2.1". The Quality Assessment of Diagnostic Accuracy Studies Tool v2 (QUADAS-2) was used to evaluate literature quality. Meta-analysis was performed using STATA17.0 and ReMan5.4 software. Forest plots were used to represent the sensitivity and specificity of PI-RADS v2.1 and PI-RADS v2 for each study. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were combined, and diagnostic performance was evaluated using asummary receiver operating characteristic curve (SROC). Subgroup analysis was performed on three covariables: tumor location, threshold, and the nationality of authors. Results A total of 12 studies were included, involving 3 158 patients and 3 243 lesions. Forall zones and the whole gland, PI-RADS v2.1 had a larger area under the SROC curve (AUC) for csPCa performance, compared with PI-RADS v2. Subgroup analysis: PI-RADS v2.1 also had a larger area under the SROC (AUC) to detect transitional zone csPCa. Different diagnostic thresholds: when a score of 4 was used for the threshold, PI-RADS v2.1 had the maximum area under SROC (AUC) for csPCa performance detection. Author nationality: Researches of PI-RADS v2.1 in Chinese authors had the largest area under the SROC (AUC) in detecting csPCa performance. Conclusion Compared with PI-RADS v2, the diagnostic performance of PI-RADS v2.1 in detecting csPCa is not obviously improved and overall specificity is still low.

Objective This study analyzed the incidence and mortality trends of four types of digestive tract tumors in China from 1990 to 2019,including gastric cancer,esophageal cancer,colorectal cancer,and liver cancer,in order to provide scientific basis for the formulation of prevention and control strategies for digestive tract tumors in China.Methods The Global Burden of Disease Study 2019(GBD 2019)database was used to analyze the trends of standardized incidence and standardized mortality of digestive tract tumors in China by the Joinpoint regression model.The age-period-cohort model was used to explore the age-period and cohort effects on the incidence and mortality of digestive tract tumors.Results The incidence order of digestive tract tumors in 2019 was stomach cancer(43.09/100,000),Colon and rectum(42.74/100,000),esophageal cancer(19.55/100,000)and liver cancer(14.80/100,000).The death order was gastric cancer(29.64/100,000),Colon and rectum(18.40/100,000),esophageal cancer(18.09/100,000)and liver cancer(13.20/100,000).After eliminating the influence of population age structure,the standardized in-cidence and standardized mortality of liver cancer,gastric cancer and esophageal cancer from 1990 to 2019 showed a decreasing trend year by year(AAPC liver cancer incidence=-3.1％,AAPC gastric cancer incidence=-0.07％,AAPC esophageal cancer inci-dence=-1.5％;AAPC liver cancer death=-3.4％,AAPC gastric cancer death=-1.9％,AAPC esophageal cancer death=-1.8％)(P＜0.001),and the standardized incidence and standardized mortality of Colon and rectum showed an increasing trend year by year(AAPC Colon and rectum incidence=3.1％,AAPC Colon and rectum death=1.1％)(P＜0.001).The results of age-period-cohort model showed that the incidence and mortality of gastric cancer,esophageal cancer and Colon and rectum were increas-ing with age,reached the peak in 85+group,80-84 group and 85+group,respectively.The incidence and mortality of liver cancer peaked in the 55-59 group and then decreased.The risk of Colon and rectum showed an increasing trend year by year,and the risk of death showed a first increasing trend and then decreasing trend.The incidence and mortality of liver cancer showed a decreasing trend followed by an increasing trend,while the overall incidence and mortality of gastric cancer and esophageal cancer showed a decreasing trend year by year.The earlier birth cohort of esophageal cancer and liver cancer,the higher risk of morbidity and mortality,while the later birth cohort of Colon and rectum,the higher risk of morbidity and mortality.The risk of gastric cancer showed the fluctuation.Conclusion The disease burden of digestive tract tumors in China is still heavy in China,especially the standardized incidence and standardized mortality of Colon and rectum are still increasing year by year.It is necessary to implement targeted prevention and treat-ment measures to effectively reduce the disease burden of digestive tract tumors.

Objective:To construct a clinical prediction model for early postoperative parastomal hernia in patients with enterostomy and to conduct internal and external validation and evaluation of clinical benefit.Methods:A total of 1 071 patients with enterostomy treated in Zhongshan Hospital Affiliated to Fudan University from October 2013 to December 2020 were selected as the research objects by the convenient sampling method. Patients from October 2013 to December 2019 were selected as the modeling group ( n=943) . The data of patients were obtained by questionnaire and other methods. The clinical prediction model of early postoperative parastomal hernia in patients with enterostomy was constructed based on Cox regression analysis and the model was internally verified by Bootstrap method. Patients from January to December 2020 were selected as the validation group ( n=128) for external validation of the model. C-statistic, area under receiver operating characteristic curve and calibration map were used to evaluate the discrimination and calibration of the model. Decision curve analysis was used to draw decision curve analysis chart to evaluate the clinical benefit of the prediction model. Results:Age, history of alcohol consumption, postoperative body mass index, diabetes mellitus, respiratory diseases, history of abdominal surgery, stoma route, stoma nature and C-reactive protein were independent influencing factors for early postoperative parastomal hernia in patients with enterostomy ( P<0.05) . The C- index value of early postoperative nomogram was 0.710 (95% CI: 0.660-0.750) . Conclusions:The clinical prediction model of early parastomal hernia in patients with enterostomy has good predictive performance, which can help clinical medical staff to screen out high-risk groups in time and guide medical staff to focus on prevention.

Objective:To construct a clinical prediction model for early postoperative parastomal hernia in patients with enterostomy and to conduct internal and external validation and evaluation of clinical benefit.Methods:A total of 1 071 patients with enterostomy treated in Zhongshan Hospital Affiliated to Fudan University from October 2013 to December 2020 were selected as the research objects by the convenient sampling method. Patients from October 2013 to December 2019 were selected as the modeling group ( n=943) . The data of patients were obtained by questionnaire and other methods. The clinical prediction model of early postoperative parastomal hernia in patients with enterostomy was constructed based on Cox regression analysis and the model was internally verified by Bootstrap method. Patients from January to December 2020 were selected as the validation group ( n=128) for external validation of the model. C-statistic, area under receiver operating characteristic curve and calibration map were used to evaluate the discrimination and calibration of the model. Decision curve analysis was used to draw decision curve analysis chart to evaluate the clinical benefit of the prediction model. Results:Age, history of alcohol consumption, postoperative body mass index, diabetes mellitus, respiratory diseases, history of abdominal surgery, stoma route, stoma nature and C-reactive protein were independent influencing factors for early postoperative parastomal hernia in patients with enterostomy ( P<0.05) . The C- index value of early postoperative nomogram was 0.710 (95% CI: 0.660-0.750) . Conclusions:The clinical prediction model of early parastomal hernia in patients with enterostomy has good predictive performance, which can help clinical medical staff to screen out high-risk groups in time and guide medical staff to focus on prevention.

Objective:To analyse the pathogenic bacteria distribution and clinical characteristics of late-onset sepsis (LOS) among premature infants with gestational age less than 34 weeks in Henan Province.Methods:The clinical data of 6 590 premature infants admitted to 17 medical institutions in Henan Province from January 2019 to December 2020 were retrospectively analyzed. The gestational age of infants was less than 34 weeks and was admitted to the neonatal ward within 7 days after birth. SPSS 19.0 statistical software was used for data analysis.Results:Among 6 590 premature infants LOS developed in 751 cases (11.40%), of whom the diagnosis was confirmed in 276 cases (36.75%) and 475 cases (63.25%) were diagnosed clinically. The fatality rate related to LOS was 13.58%. There were significant differences in the incidence of LOS and infection-related mortality among infants with different gestational ages and body weights ( χ2=388.894 and 13.572, χ2=472.282 and 9.257, P<0.05 or <0.01). Among 276 children with confirmed LOS, 286 strains of pathogenic bacteria were isolated. Gram-negative bacteria were most prevalent (178 strains), accounting for 62.24% of all infections, followed by fungi (58 strains, 20.28%). Klebsiella pneumoniae was most frequently detected Gram-negative bacteria (117 strains, 40.91%), among which 32.48% (38/117) was carbapenem-resistant Klebsiella pneumoniae. The proportion of diagnosed sepsis, the proportion of catheterization, and the infection-related mortality of infants with LOS in tertiary hospitals were all higher than those in secondary hospitals ( χ2=6.212, 5.313 and 4.435, all P<0.05). The proportion of exclusive breastfeeding in secondary hospitals was lower than that in tertiary hospitals ( χ2=19.216, P<0.05). The time of antibacterial drug use before infection in specialized hospitals was longer than that in general hospitals ( χ2=3.276, P<0.05). Conclusion:The incidence of LOS among preterm infants in Henan Province is high, which was mainly caused by Gram-negative bacteria. The clinical characteristics of LOS caused by different pathogens and in different health institutions are different, the prevention and control strategy should be developed accordingly to reduce the incidence LOS of preterm premature infants.

Objective:To investigate the immediate and lasting effects of enhanced external counterpulsation(EECP)on blood pressure in elderly patients with hypertension.Methods:In this real-world prospective non-randomized controlled study, the elderly hypertensive patients who were newly diagnosed as hypertension or had poor blood pressure control in the Geriatrics Department of Shandong University Qilu Hospital from May 2019 to December 2019, were enrolled as EECP group, and those with systolic blood pressure(SBP)≥180mmHg(1mmHg=0.133 kPa)or had contraindications for EECP treatment were excluded from EECP group(28 cases). Based on the 1∶1 ratio being consistent with the tendency score-matching method, patients' blood pressure was matched at 3 d before the start of the EECP treatment course, with other matched data of baseline data, coexisting disease, cardiovascular medication were choosed as control group(n=28). The EECP group received an additional 36 hours of EECP treatment(6 times/week, 1 hour/time)including lifestyle improvement and anti-hypertensive drugs.The patient's supine blood pressure was collected 3 minutes before each EECP treatment(baseline), 30 minutes during treatment, and 3 minutes after treatment.In the EECP group, family self-measured blood pressure was collected 3 days before the start of the 6-week treatment course(0w), the 6th week(6w)of the treatment course, and the 2nd week(+ 2w), 4th week(+ 4w)and 12th week(+ 12w)after the end of the treatment course, respectively.And the data of control group were collected at the same time point mentioned above.Results:Compared with baseline, the average immediate SBP of elderly hypertensive patients at the 30th minute of EECP treatment was decreased by(5.5±13.6)mmHg( P<0.001), and the average immediate diabolic blood pressure(DBP)was decreased by(1.1±7.5)mmHg( P<0.001). When the baseline SBP was between 160 and 169 mmHg, the probability of a further increase in SBP during treatment was 2.2%(2/89 cases), and when the baseline SBP was between 170 and 179 mmHg, the probability of a further increase in SBP during treatment was 0%(0/57). At 6 weeks, the decrease in SBP was significantly greater in the EECP group than in the control group[(-17.0±8.7)mmHg vs.(-10.5±7.3)mmHg, P<0.01], and the difference continued to + 2w[(-15.5±6.6)mmHg vs.(-10.6±2.5)mmHg, P<0.01]and + 4w[(-13.3±5.4)mmHg vs.(-10.7±2.1)mmHg, P<0.05]. At + 12w, the blood pressure drop was still greater in EECP group than in the control group, but it did not achieve statistically significant differences.Smoking history, history of diabetes, family history of hypertension, and improvement of comorbidities were the key factors that affect the continuous anti-hypertensive effect of EECP. Conclusions:EECP treatment has an immediate effect on lowering blood pressure in elderly hypertensive patients.A 6-week course of EECP treatment has a sustained effect on lowering blood pressure, and the effect can last from 4 to 12 weeks after the end of the course of treatment.