OBJECTIVE To explore the course construction and teaching reform of solid preparation with the aim of cultivating high-quality technical and skilled talents. METHODS Teaching objectives were set according to the post requires of solid preparation. Examples from pharmaceutical companies were used and the teaching content was reorganized by integrating professional courses and certificates. School and enterprise cooperation was deepened, information-based and multi-scenario learning resources were built, and high-quality curriculum politics teaching resources were created. Professional education and ideological education, knowledge imparting and value guidance were fully integrated. Based on the project-driving method, the integration of "Theoretical-Virtual-Real" and online and offline blended teaching was carried out. The evaluation method was "three comprehensive evaluation". RESULTS AND CONCLUSION Through the practice of course construction and teaching reform, students’ grades significantly increased and their skills become proficient. Their recognition of their profession significantly improved, and their awareness of quality and responsibility was significantly enhanced. Good reform effects had been achieved.

Objective:To explore the effects of Zhiyan mixture on the activation of classically activated macrophages(M1)and T helper cells 2(Th2)immune responses in mice with mycoplasma pneumoniae(MP)infection.Methods:C57BL/6J mice were divided into control group,MP group,Zhiyan mixture group and azithromycin group.Except control group,models of MP infection were prepared by nasal drip of MP bacterial solution(1×107 CFUs/ml)in the other groups.Zhiyan mixture group was given intragastric administration of Zhiyan mixture,azithromycin group was given intragastric administration of azithromycin,control group and MP group were given the same volume of normal saline.The pathological damage of lung tissues were observed by HE staining,and patho-logical scoring was conducted.The changes of MP load in lung tissues were detected by solid culture method.M1 level was detected by flow cytometry.The mRNA levels of inducible nitric oxide synthase(iNOS),TNF-α and CXC chemokine 1(CXCL1)in lung tissues were detected by PCR.The levels of IL-4,IL-5,IL-10 and IL-13 in lung tissues were detected by ELISA.The expressions of NF-κB pathway-related proteins in lung tissues were detected by Western blot.Results:The pathological scores of lung tissues,MP load,F4/80+cell level,ratios of CD86+/F4/80+and MHC Ⅱ+/F4/80+,and mRNA levels of iNOS,TNF-α and CXCL1 in MP group,Zhiyan mix-ture group and azithromycin group were higher than those in control group(P<0.05),levels of IL-4,IL-5,IL-10 and IL-13,and ex-pressions of p-p65/p65 and p-IKK/IKK in lung tissues were all higher than those in control group(P<0.05).The pathological scores of lung tissues,MP load,F4/80+level,ratios of CD86+/F4/80+and MHC Ⅱ+/F4/80+,and mRNA levels of iNOS,TNF-α and CXCL1 in Zhiyan mixture group and azithromycin group were lower than those in MP group(P<0.05),levels of IL-4,IL-5,IL-10 and IL-13 were higher than those in MP group(P<0.05),and protein expressions of p-p65/p65 and p-IKK/IKK in lung tissues were lower than those in MP group(P<0.05).Conclusion:Zhiyan mixture can improve lung injury in mice with MP infection,which may be related to reducing M1 activity,increasing Th2 immune response and inhibiting NF-κB pathway.

Objective:To investigate the role of blood ammonia in the evaluation of the prognosis of septic patients in the emergency department and to compare its value with mortality in emergency department sepsis (MEDS) score.Methods:A retrospective clinical study was conducted to septic patients who were diagnosed in the Emergency Department of West China Hospital of Sichuan University from June 2017 to May 2018, and met the diagnostic criteria established by the diagnostic criteria of the American College of Chest Physicians/Society of Critical Care Medicine in 2001. The subjects who had other diseases that affected blood ammonia level and were lost to follow-up were excluded. MEDS scores were collected, and the survival status of patients was followed up by telephone. The independent samples t test was used to compare the differences between the two groups, receiver operating characteristic (ROC) curve was used to assess the accuracy of the prediction of sepsis mortality, and the logistic regression model was used to explore the value of the combined use of blood ammonia and MEDS score.Results:Eighty subjects were finally included in the study and divided into the 1-week survival group ( n=52), 1-week death group ( n=28); 4-week survival group ( n=37), 4-week death group ( n=43); 12-week survival group ( n=33), 12-week death group ( n=47); 1-year survival group ( n=32), and 1-year death group ( n=48). There was no statistical difference in the demographic characteristics of subjects between the groups. The average blood ammonia level of all the subjects who died was higher than that of the patients who survived in the same period [(116.57 ± 85.33) μmol/L vs (77.63 ± 35.82) μmol/L, (108.53 ± 73.00) μmol/L vs (71.19 ± 32.53) μmol/L, (106.74 ± 71.59) μmol/L vs (69.21 ± 28.84) μmol/L, (105.77 ± 71.14) μmol/L vs (69.50 ± 29.25) μmol/L, P<0.05]. Based on death after one week, four weeks, twelve weeks and one year, the area under ROC curve (AUC) of blood ammonia was 0.668 (95% CI: 0.542-0.793, P=0.014), 0.706 (95% CI: 0.593-0.819, P=0.002), 0.705 (95% CI: 0.592-0.818, P=0.002), and 0.697 (95% CI: 0.582-0.811, P=0.003), respectively. Compared with the use of blood ammonia, lactic acid or MEDS score alone, the combined use of blood ammonia and MEDS score increased the accuracy of prognosis evaluation in sepstic patients ( P<0.05). Conclusions:Blood ammonia has a high value in predicting the short-term and 1-year prognosis of septic patients in the emergency department. The combined use of blood ammonia and MEDS score can further improve its predictive value.

Objective:To explore emergency nurses' experiences and feelings about nursing interruption events and measures to avoid or reduce work interruption events, so as to provide references for emergency nursing managers to strengthen the management of nursing interruption events.Methods:Using methods of descriptive qualitative research and purposive sampling, a total of 12 nurses from 3 nursing units in Emergency Department of a ClassⅢ Grade A hospital in Chengdu were selected for semi-structured interviews from August to September 2019. The obtained interview data were analyzed by thematic analysis.Results:Through thematic analysis, the extracted themes included the source of the interruption events, the nurses' current affairs at the time of occurrence, effects and coping strategies.Conclusions:The occurrence of emergency nursing interruption events has more adverse effects on emergency nurses. Nursing managers should take various measures from multiple perspectives to reduce the occurrence of nursing interruption events and avoid adverse nursing events to ensure patient safety.

The aim of this study was to evaluate the safety and immunogenicity of the first domestic ACYW135 meningococcal conjugate vaccine and a control vaccine named AC group meningococcal conjugate vaccine for 3 months (90-119 days) infants. From February 2017 to June 2018, a randomized, blinded, and similar vaccine-controlled clinical trial design was adopted at the Henan Vaccine Clinical Research Base. The subjects were 3 months old healthy infants, a total of 720, based on a 1∶1 ratio. The random allocation table for entry was randomly assigned to the experimental group and the control group. According to the 3, 4, and 5 month-old vaccination procedures, the subjects were vaccinated with test vaccine (ACYW135 group meningococcal conjugate vaccine) and control vaccine (group A group C meningococcal polysaccharide conjugate vaccine), of which 720 were given the first dose, 696 were given the second dose (test group: 346; control group: 350), and 692 were given the third dose (test group: 344; Control group: 348). The overall adverse reaction rate of the test vaccine was 21.90% (230 cases), which was lower than the 32.04% (339 cases) of the control vaccine (<0.001). The incidence of systemic adverse reactions was 19.52% (205 cases), which was lower than that of the control vaccine (27.69%) (293 cases) (<0.001). The local adverse reaction rate was 3.04% (32 cases), which was lower than the control group (7.84%) (83 cases) (<0.001). The graded adverse reaction test vaccine was 0.57% (6 cases), which was lower than the control group of 2.36% (25 cases) (<0.001). The positive conversion rate of anti-bacterial serum antibodies showed that there was no significant difference between the test vaccine group A (91.42%), C (88.76%) and the control vaccine (92.92%) (87.02%) (>0.05). Group Y and W135 was 88.17% (298 cases), 99.41% (336 cases), respectively. The GMT results showed that the test vaccine group A was 56.24, the control vaccine was 57.43 (>0.05); the group C test vaccine (43.53) was higher than the control group (27.28) (<0.001). The group Y and W135 are 89.22 and 140.66, respectively. Among them, the proportion of the group C GMT antibody ≥ 1∶128 for test vaccine (31.07%, 105 cases) was higher than the control vaccine (16.22%, 55 cases) (<0.001). ACYW135 group meningococcal conjugate vaccine has more safety and immunogenicity after application to 3 month old infants.
Antibodies, Bacterial ; Humans ; Infant ; Meningococcal Vaccines ; adverse effects ; immunology ; Vaccines, Conjugate

Objective To compare the value of ultrasound guided and CT-guided percutaneous biopsy in diagnosis of chest lesions not blocked by bone nor lung.Methods A total of 244 patients with chest lesions not blocked by bone nor lung were collected and divided into ultrasound-guided group (n=114) or CT-guided group (n=130).The puncture success rate,biopsy success rate and the complication rate were compared between the two groups.Results The puncture success rate (98.25％ [112/ 114]) and biopsy success rate (96.49％ [110/114]) in ultrasound-guided group were higher than those in CT-guided group (86.92％ [113/130],79.23％ [103/130]),and the complication rate (3.51％ [4/114]) in ultrasound-guided group was lower than that in CT-guided group (16.92％ [22/130],all P＜0.01).Conclusion For chest lesions not blocked by bone nor lung,ultrasound is more secure and effective than CT for guiding percutaneous biopsy.

Pupose To explore the role of histogram analysis of apparent diffusion coefficient (ADC) maps obtained from multiple b value diffusion weighted imaging (DWI) in the assessment of progression of high-grade glioma (HGG) treated with chemoradiotherapy so as to determine the optimal b value.Materials and Methods Forty-one consecutive patients with HGG proved histopathologically who had undergone concurrent chemoradiotherapy at Second Hospital of Hebei Medical University from September 2014 to October 2015 were enrolled in the study.All the subjects underwent diffusion weighted MR imaging before and after therapy with b values of 0,1000,2000 and 3000 s/mm2.Based on the clinical and radiographic follow-ups,the patients were divided into progression and nonprogression groups.ADC maps were calculated according to hyperintense FLAIR lesions after completion of chemoradiotherapy.The fifth percentile (C5) in terms of cumulative histograms in different b-value ADC maps in multiple b value DWI was calculated,and the C5 of each ADC map between progression and non-progression groups was compared.Moreover,receiver operating characteristic analysis was used to determine the best cutoff values and diagnostic accuracy for predictors in the differentiation of true progression from non-progression.Results The C5 of all different b value ADC maps were significantly lower in the progression group than those in the non-progression group (P＜0.01).In terms of the accuracy of assessing the progression after therapy,the C5 in the high b value ADC maps was significantly higher than that in the low b value ADC maps.The area under the receiver operating characteristic curve (AUC) of the C5 was 0.717,0.832,0.909,0.933 and 0.937 respectively in the 5 ADC maps [ADC(1000/0),ADC(2000/0),ADC(30000/0,ADC(3000/1000) and ADC(3000/2000)].When the cutoff value of C5 was 405.6 mm/s2 in ADC(3000/2000) map,the sensitivity,specificity,positive predictive value and negative predictive value were 90.9％,89.7％,89.9％ and 91.0％,respectively.Conclusion The C5 in ADC map can effectively differentiate tumor progression of HGG,and that of high b values have higher accuracy.

Objective To evaluate the application value of ADC of different b-value ADC maps in multiple b-value DWI for assessment of early treatment response and detection of tumor progression.Methods Totally 47 postoperative patients with glioma were enrolled.All of them accepted chemoradiotherapy after operation.Conventional MRI and multiple b-value DWI (b=0,1 000,2 000,3 000 s/mm2) scans were performed.The mean and minimal ADC values (ADC and ADCrmin) were measured in 5 differrent corresponding ADC maps,such as ADC(1 000/0),ADC(/2 000/0),ADC(3 000/0),ADC(3 000/1000） and ADC(3 000/2 000).And the relative values (rADC and rADCmin) were calculated.The differences of ADC values among different reaction types (complete response,partial response,stable disease and progressive disease)and between progressive and non-progressive groups were compared.ROC analysis was used to determine the best cutoff values and diagnostic efficiency of ADC value for diagnosis of tumor progression.Results The rADC in ADC(3 000/0),ADC(3 000/1000） and ADC(3 000/2 000) maps were significantly different among different response types and between progressive group and non progressive group (all P＜0.05).The ADC in ADC(3 000/1000） and ADC(3000/2 000) maps were significantly different among different response types and between progressive group and non-progressive group (all P＜0.05).The ADC and rADC in ADC(3 000/2 000) map had the maximum area under curve (0.86,0.84).When ADC and rADC in ADC3 000/2 000 map were 408.65 × 10-6 mm2/s and 1.12,the sensitivities and specificities were 89.3 ％0,71.0 ％00 and 92.9 ％,77.4 ％,respectively.Conclusion The ADC and rADC in high b-value ADC maps are helpful to discriminate the early treatment response from tumor progression,which can provide valuable information for identification of tumor progression of glioma after treatment.

Objective To look for more serum biomarkers supporting the diagnosis of multiple system atrophy ( MSA) and providing more evidence for early treatment.Methods All patients and healthy controls were enrolled from January 2011 to March 2015 in the First Affiliated Hospital of Zhengzhou University.Demographic features and biochemical examination results were collected.The t test was used to compare the lipid levels between MSA patients and controls.LSD-t test was used to compare the lipid levels among subtypes of MSA patients.Multivariate Logistic regression analysis was conducted to analyze the influencing factors.The relevance between lipid levels and onset age, disease duration and Hoehn & Yahr stage was calculated by Spearman correlation coefficients.Results Participants included 195 MSA patients and 195 age-and gender-matched controls with no neurological diseases.The levels of total cholesterol ((4.33 ±0.90) mmol/L), triglyceride ((1.27 ±0.71) mmol/L), low-density lipoprotein (LDL;(2.70 ±0.76) mmol/L) were significantly lower in patients than in controls ((4.52 ±0.85), (1.47 ± 0.86), (2.85 ±0.71) mmol/L ,t=2.056,2.528 and 2.149 respectively, all P<0.05).The levels of total cholesterol ((4.28 ±0.96) mmol/L) and triglyceride ((1.20 ±0.64) mmol/L) were significantly lower in MSA-P patients than in control group ((4.52 ±0.85), (1.47 ±0.86) mmol/L;LSD-t=1.983, 2.566, both P<0.05).After adjusting for age, gender and histories, the odds ratio ( OR) was 0.31 (95%CI 0.15-0.65, P =0.002 ) for MSA patients in the highest quartile of triglyceride and 0.38 (95%CI 0.17 -0.83,P=0.016) for those in the highest quartile of high-density lipoprotein (HDL), compared with the lowest quartiles.And HDL level was in a significantly positive correlation with onset age (r=0.15, P=0.039).Conclusion Our data suggest that triglyceride and HDL may be associated with the prevalence of MSA, and the lower levels of HDL, the earlier onset of MSA.

Objective To compare the effect of multifunction air disinfection machines with ultraviolet light disinfection and natural ventilation in the improvement of air quality in respiratory wards, so as to provide reference evidence for the effective control of hospital infection rates. Methods Four respiratory wards were divided into four groups, and the total number of air bacteria in these wards after three kinds of effective disinfection were compared.Results There was no significant difference about the total bacterial count among four groups before disinfection. 30 min after disinfection, there was still no significant difference, but the total bacterial count with different disinfection methods were statistically different after 60 min and 120 min.Conclusions Three kinds of disinfection all can effectively improve the air quality in wards. But the sterilization effect of air disinfection machines and ultraviolet light are better than natural ventilation, and the using environment of air disinfection is better than ultraviolet light disinfection.