To explore the effectiveness of "near peer learning" (NPL) in the electromyography(EMG)teaching module for neurology residents.

Objective:To evaluate the application value of double-layer spectral detector CT (DLSDCT) in differentiating central lung cancer from atelectasis.Methods:Fifty-one patients with central lung cancer accompanied by atelectasis confirmed by pathology in Shandong Cancer Hospital from January to December 2020 were enrolled. The differentiating rates of tumor from atelectasis of the conventional CT, 40 keV virtual monoenergetic imaging (MonoE), iodine density map (ID), and 40 keV MonoE-ID fusion images of unenhanced scan, arterial and venous phase were retrospectively analyzed. Cochran′s Q test was used to compare the differentiating rate (Bonferroni correction afterwards), and Friedman test was used to compare the maximum diameter of the tumor of each imaging method.Results:Of the 51 patients, none of the conventional CT images, 40 keV MonoE, ID and 40 keV MonoE-ID fusion images in the unenhanced scan could distinguish lung tumors from atelectasis; the number of cases in which the conventional CT images, 40 keV MonoE, ID and 40 keV MonoE-ID fusion images in the arterial phase could distinguish lung tumors from atelectasis regions was 4, 5, 5 and 6, respectively; the number of cases in which the conventional CT, 40 keV MonoE, ID and 40 keV MonoE-ID fusion images in the venous phase could distinguish lung tumors from atelectasis regions was 17, 35, 39 and 38, respectively, and the difference was statistically significant (χ 2=52.40, P<0.001). The differentiating rates of the 40 keV MonoE, ID, and 40 keV MonoE-ID fusion image were significantly higher than that of conventional CT image (χ2=-0.35, -0.43, -0.41, P<0.001, Bonferroni correction afterwards); There was no significant difference in the differentiating rate among 40 keV MonoE, ID and MonoE-ID fusion image ( P=1.00). Seventeen tumors could be differentiated in conventional CT images, 40 keV MonoE, ID and 40 keV MonoE-ID fusion images of venous phase, and the maximum diameters of lung tumors were (50±21) mm, (50±23) mm, (50±23) mm, and (50±23) mm, respectively, and the difference was not statistically significant (χ2=3.61, P=0.31). Conclusions:The venous phase spectral images of DLSDCT can differentiate most central lung cancer from atelectasis. Therefore, it has great clinical application value in tumor staging, efficacy evaluation, and radiotherapy.

After years of exploration, Central South University has comprehensively reformed and upgraded the curriculum in both horizontal and vertical integration, including optimizing and constructing a basic clinical core curriculum system with organ system integration as the main line, utilizing the advantages of comprehensive universities to further advance the cross-teaching reform of science, engineering, arts and medicine, strengthening pre-medical education with the goal of early exposure to medicine, promoting the reform of early contact clinical integrated teaching according to the concept of "early, multiple and repeated clinical practice", and accelerating the integration of clinical skills training courses with the support of clinical skills simulation teaching. After the integration, the faculty team has gradually matured and the teaching quality has been significantly improved, which has strengthened the students' medical thinking and overall literacy.

Objective:To investigate the clinical and biological characteristics of relapsed childhood low-risk acute B lymphoblastic leukemia (B-ALL).Methods:The clinical and laboratory data of 34 children who admitted in Beijing Boren Hospital from July 2017 to July 2018 were retrospectively analyzed, and 127-339 mutations of hematological malignancy related genes were analyzed.Results:The median time from the diagnosis to the recurrence was 871 d (87-1 446 d). The recurrence at early stage and late stage had 26 cases (76%) and 8 cases (24%), respectively. The recurrence before maintenance treatment, during maintenance therapy and after withdrawal of chemotherapy had 3 cases (9%), 12 cases (35%) and 19 cases (56%) (13 cases relapsed within 1 year after withdrawal, 6 cases relapsed after withdrawal 1-2 years and no one relapsed after withdrawal 2 years). The sites of recurrence included bone marrow alone accounting for 26 cases (76%), both intramedullary and extramedullary disease (EMD) accounting for 6 cases (18%), EMD alone accounting for 2 cases (6%). Flow cytometry showed that 9 patients presented minimal residual disease (MRD)-positive (6 cases with one positive, 2 cases with twice positive and 1 case with 3 times positive), including 8 cases occurred at early stage and 1 case occurred at late stage; and the level of MRD was 0.02%-3.82%. Complex chromosomal karyotype appeared in 6 relapsed children with normal or hyperdiploid karyotype at first diagnosis. Hematological malignancy related gene mutation detection was made in 28 cases, and the results showed that each patient had at least one gene mutation, and 2 or more gene mutations were detected in 25 cases (89%). The high frequency of gene mutations were as follows: CREBBP (7 cases, 25%), NRAS (7 cases, 25%), KRAS(7 cases, 25%), TP53 (4 cases, 14%), and NT5C2 (4 cases, 14%).Conclusions:The recurrence of childhood low-risk B-ALL occurs mostly in the maintenance treatment or in two years of withdrawal of chemotherapy. Positive MRD after complete remission is likely to show the risk of early recurrence. The gene mutations after the poor prognosis in cancer cells may be related to the recurrence of childhood low-risk B-ALL, and the common gene mutations include CREBBP, RAS signaling pathways genes and TP53, NT5C2.

Objective: To investigate students' satisfaction degree on "organ-centered" integrated teaching model for Circulatory Disease, and reveal potential problems and propose improvement methods. Methods: All grade 2016 students from the second department of clinical medicine and pediatrics major were selected as study objects and students' satisfaction degree on "organ-centered" integrated curriculum for circulatory system were investigated. Self-designed questionnaires were adopted; eighteen questions related to the satisfaction degree were designed; questionnaires were distributed and collected by WJX software. Multivariate Logistic regression analysis and word frequency analysis of the results were performed using R software. Result: The results of the questionnaire showed that students were not satisfied with the integrated teaching model. Word frequency analysis showed that students' problems mainly were limited class hours but too many learning content, fast teaching speed and insufficient curriculum integration. Multivariate Logistic regression analysis further showed that students' satisfaction degree was related to their mastery of knowledge and post-class review (P<0.05). Conclusion Our teaching and research section should fully summarize the teaching experience and shortcomings in the "organ-centered" integrated curriculum for Circulatory System Disease, and try our best to make the in-class teaching clearer, integrate the basic and clinical knowledge, encourage students to review lessons in time and cultivate their ability of independent learning, so as to ultimately improve students' satisfaction for teaching and teachers' teaching quality.

Medical simulation teaching is an emerging and developing teaching method in our coun-try. At present, the simulation teaching centers are developing rapidly in higher education institutions, but how to improve the effectiveness in the operation of the centers is still a subject that needs to be discussed. Based on our own experience, this paper analyzes the related factors in developing medical simulation teach-ing centers, making summary and demonstrations from aspects of team building, teacher training, docking needs, staffing and so on, so as to provide references and suggestions for the construction of medical simu-lation center higher education institutions.

Objective To optimize the extraction and β-cyclodextrin clathration process of volatile oil in Tianma-Shouwu tablet.Methods The extraction of volatile oil was optimized through the orthogonal design L9(34) with the volatile oil extraction amount as assessment index. The saturated aqueous solution preparation of clathrate form was used. The volume of β-cyclodextrin and volatile oil, clathration temperature, clathration time was investigated by central composite design-response surface methodology, with the score of volatile oil inclusion ratio and utilization ratio as the index. The results were fitted by second-order polynomial equation, and then the best clathration process was determined. Results The optimization extraction process of volatile oil in Tianma-Shouwu tablet was as follows:to add 8 times water,immerse 30 minutes,steam distill 6 hours;and the best clathration process was as follows: the ratio of β-cyclodextrin and volatile oil was 9.50:1, clathration temperature 43 ℃, and clathration time 4.2 hours. Conclusions The optimized extraction and clathration process were reasonable, stabled and repeatable.

Objective: To compare the value of two 3D imaging reconstruction methods for left atria and pulmonary vein on guiding the catheter ablation for atrial fibrillation (AF). Methods: From January 2014 to January 2017, a total of 100 drug refractory paroxysmal AF patients were divided into left atria direct angiography group (n=50), and indirect angiography group (n=50). 3D CARTO system was applied for mapping and guiding the ablation procedure. Patients assigned to direct angiography group were treated as follows: intraoperative puncture of atrial septum, inject contrast agent directly into the left atrium, conduct left atrial and pulmonary venous rotation angiography, reconstruct three-dimensional image, integrate the image into real-time X-ray system to facilitate circumferential pulmonary vein isolation. Patients assigned into the indirect angiography group were treated as follows: inject contrast agent through the right ventricle, conduct delayed rotation angiography of the left atria and pulmonary vein to guide circumferential pulmonary vein fixation and ablation. The left atrial and pulmonary venous image acquisition, the operation and X-ray exposure time, the success rate and the incidence of complication of the two groups were compared. The patients were followed up for 3-6 months. Results: General clinical characteristics of the two groups were similar(all P>0.05). Ablation was successful in all 100 patients. The operation time[(112.0±21.4)min vs. (134.0±24.3)min]and X-ray exposure time((10.7±4.7)min vs. (15.8±5.2)min)were significantly lower in direct angiography group than in indirect angiography group (both P<0.01). There was no significant difference between the two groups in the immediate (86%(43/50) vs. 82%(41/50), P=0.59) and short-term (76%(38/50) vs. 72%(36/50), P=0.65) success rate and complication rate (1 aneurysm in the direct angiography group, 1 pericardial tamponade in the indirect angiography group). In-hospital mortality was zero percent. Conclusion It is safe and effective method to guide the radiofrequency catheter ablation of paroxysmal atrial fibrillation by reconstruction 3D image of left atrium and pulmonary vein. Compared with indirect angiography group, direct angiography group can improve the imaging quality of left atrium and pulmonary vein, decrease the X-ray exposure time of the ablation procedure.

[ ABSTRACT] AIM: To evaluate the guiding effect of high-frequency stimulation ( HFS) on renal denervation ( RDN) , and to compare the similarities and differences of blood pressure changes at the time of electrical stimulation and radiofrequency ablation .METHODS:A total of 6 Kunming dogs were included in this study .Renal artery abnormalities were excluded by angiography .High-frequency stimulation and radiofrequency ablation were performed at the same sites from distal to proximal segments of the renal artery .Invasive blood pressure ( BP) was recorded during the whole proce-dure.The change of the blood pressure was analyzed .HE and Masson staining was adopted to detect the structural changes in the wall of the renal artery and surrounding tissues .The immumohistochemical staining for tyrosine hydroxylase ( TH) was used to observe the renal nerve damage after ablation .RESULTS: Electrical stimulation and radiofrequency ablation were delivered in a total of 50 sites.The BP increasing response was induced at 34%sites (n=17), while the rest sites (66%, n=33) had no response.Compared with the baseline , HFS caused the increases in systolic BP of (0.34 ±3.38), (0.41 ±3.04), (10.47 ±5.73), (13.27 ±3.63), (10.17 ±1.87) and (0.78 ±1.87) mmHg in 6 serial 20 s time segments during 120 s of HFS at positive BP response sites .Similarly, the increases in systolic BP by (-0.88 ±3.44) , (-1.64 ±3.47), (13.17 ±3.12), (12.82 ±3.21), (9.50 ±2.68) and ( -6.09 ±2.21) mmHg were observed dur-ing 120 s of ablation procedure at the same sites in 6 serial 20 s time segments .At non-responding sites , HFS and ablation failed to cause a significant increase in systolic BP .The mean area of nerves in the response sites was ( 0.51 ±0.28 ) mm2, whereas that in non-response sites was (0.09 ±0.06) mm2(P<0.01).The average absorbance values of TH in re-nal nerves at ablation and non-ablation sites were 0.031 ±0.015 and 0.085 ±0.018 ( P <0.01 ) , respectively . CONCLUSION:Renal sympathetic nerves can be effectively mapped by HFS .Radiofrequency ablation guided by HFS is valid to injure sympathetic nerves around renal artery .

Objective To establish an HPLC fingerprint ofJinjing solid beverage,and provide experimental evidence of evaluating its quality.Methods Ten batches ofJinjing solid beverage were analyzed by HPLC under the gradient elution condition. A Kromasil C18 column(4.6 mm×250 mm, 5μm) was used, and the flow phase was acetonitrile-H2O(acidified to 0.1% with phosphoric acid) with gradient elution, and the detection wavelength was 327 nm, and the flow rate was 1.0 ml/min, and the column temperature was 35℃. The data were evaluated by the similarity evaluation software for TCM fingerprint.Results The HPLC fingerprint ofJinjing solid beverage were established. Twelve common peaks including chlorogenic acid were identified with similarity of more than 0.9.Conclusion HPLC method is a reliable, available and quick method, that provides a means for controlling and evaluating the quality ofJinjing solid beverage.