With the advancement of competency-based medical education, scenario-based simulation has been increasingly valued in China for its effectiveness in cultivating and assessing the competencies of healthcare practitioners in specific clinical scenarios. This expert interview focuses on five questions: the necessity of scenario-based simulation, the sources and applicability of teaching cases, curriculum development, the role of teaching teams, and suggestions for simulation practitioners and educational managers. The discussion aims to help a growing number of practitioners in simulation-assisted medical education better understand the connotation and significance of scenario-based simulation, clarify its practical path, and further promote the effective implementation of scenario-based simulation in China.

With the advancement of competency-based medical education, scenario-based simulation has been increasingly valued in China for its effectiveness in cultivating and assessing the competencies of healthcare practitioners in specific clinical scenarios. This expert interview focuses on five questions: the necessity of scenario-based simulation, the sources and applicability of teaching cases, curriculum development, the role of teaching teams, and suggestions for simulation practitioners and educational managers. The discussion aims to help a growing number of practitioners in simulation-assisted medical education better understand the connotation and significance of scenario-based simulation, clarify its practical path, and further promote the effective implementation of scenario-based simulation in China.

Objective: To investigate the effects and mechanisms of Xuebijing injection (XBJ) on Chimeric antigen receptor-T (CAR-T) cell function and its therapeutic potential against CAR-T therapy-associated cytokine storms (CRS). Methods: Anti-CD19 CAR-T cells were established based on FMC63 antibodies. Different doses of XBJ (1 and 10 mg/mL) were added to the culture system. Untreated anti-CD19 CAR-T cells served as negative controls. After 48-h co-culture, the effects of XBJ on CAR-T cell function were assessed. Carboxyfluorescein diacetate succinimidyl ester staining was used to assess the effect of XBJ on CAR-T cell proliferation. Flow cytometry, luciferase reporter gene assays, and real time cellular analysis were employed to evaluate the effects of XBJ on CAR-T cell cytotoxicity in vitro. RNA-sequencing was performed to analyze the effects of XBJ on CAR-T cell gene expression. Network pharmacology predicted potential XBJ therapeutic targets for CRS, which were verified in a THP-1 macrophage inflammation model. Results: XBJ enhanced both the proliferation and tumor killing capacities of CAR-T cells. Transcriptome analysis showed that XBJ treatment affects multiple genes and pathways in CAR-T cells, with differential gene enrichment in multiple cell proliferation and growth factor pathways. Potential targets for CRS control by XBJ were predicted using network pharmacology, and the inhibitory effect of XBJ on the expression of relevant genes was verified using a macrophage model. Conclusion The results of this study indicate that XBJ can enhance the killing effect of CAR-T cells on tumor cells and that the mechanism is related to the regulation of T cell proliferation and activation. Moreover, XBJ inhibited excessive inflammation associated with CAR-T therapy. However, the current findings remain to be further validated through in vivo experiments.

Objective: To investigate the interaction between traditional Chinese medicine (TCM) syndromes of histiocytic necrotizing lymphadenitis (HNL) and pathological types of HNL, so as to discover the distribution rule of TCM syndromes for indiction of intervention of HNL. Methods: A total of 166 patients with HNL were included. The baseline data of the patients, clinical feature, the four diagnosis information of TCM and histopathological of cervical lymph node were collected. The syndromes of TCM were judged. The pathological types were confirmed by cervical lymph node biopsy. The Multi-way ANOVA was used to analyze the correlation between traditional Chinese medicine syndromes of HNL and its pathological types. Results: Among the 166 patients, the ratio of different types are as follow: wind-heat and phlegm-toxin syndrome (57.83%, 96/166), heat-toxin exuberance syndrome (34.34%, 57/166), and phlegm and blood stasis syndrome (7.83%, 13/166). The pathological types include proliferative type (57.83%, 96/166), necrotizing type (35.54%, 59/166), and xanthomatous type (6.63%, 11/166). There were significant differences in targeted lymph node diameter, pain scores, body temperature (F value were 3.737, 34.484, 34.805, all Ps<0.05), while the difference of WBC (F=1.194, P>0.05) among three TCM Syndrome types were notsignificant. There were significant differences in pain scores, body temperature (F value were 12.153, 25.931, all Ps<0.05), but not for the targeted lymph node diameter, WBC (F value were 2.249, 0.671, all Ps>0.05) among three pathological types. The corresponding analysis result showed that, on point sets, wind-heat and phlegm-toxin syndrome were correlated with proliferative type, heat-toxin exuberance syndrome correlated with necrotizing type, and phlegm and blood stasis syndrome correlated with xanthomatous type (χ²=235.100, P<0.001). Conclusions There is a close correlation between syndrome types of TCM and pathological types of HNL. The pathological change of wind-heat and phlegm-toxin syndrometends toproliferative type, heat-toxin exuberance syndrome tends to necrotizing type, and phlegm and blood stasis syndrome tends to xanthomatous type.

Objective To explore the prevalence and clinical significance of metabolic disorder of lipids, glucose and uric acid at different fibrosis stages of patients with chronic hepatitis B (CHB).Methods From January 2006 to December 2014, 1 812 CHB patients in Department of Infectious Diseases, Shunde Hospital of Southern Medical University were retrospectively enrolled and analyzed.All biochemistry indexes were obtained by automatic biochemical instrument.Polymerase chain reaction was used for detecting serum hepatitis B virus (HBV) DNA, and particles immune detection kit was used for detecting hepatitis B e antigen (HBeAg).In statistical analyses, chi-square test, nonparametric test and Logistic analysis were used.Results The metabolic disorder prevalence in 1 812 CHB patients was as follows, 455 cases (25.1%) with decreased high density lipoprotein, 435 cases (24.0%) with increased uric acid, 342 cases (18.9%) with increased total cholesterol, 254 cases (14.0%) with increased triglyceride, 171 cases (9.4%) with decreased apolipoprotein A, 165 cases (9.1%) with increased apolipoprotein B, 162 cases (8.9%) with increased low density lipoprotein and 117 cases (6.5%) increased fasting blood glucose.Patients who had mild liver fibrosis tended to have metabolic disorders of uric acid (26.4%), total cholesterol (22.8%) and high density lipoprotein cholesterol (20.5%).Patients who had moderate liver fibrosis tended to have metabolic disorders of high density lipoprotein (27.2%) and uric acid (20.9%).Patients who had severe liver fibrosis tended to have metabolic disorders of high density lipoprotein (33.6%) and uric acid (22.2%).Multivariate Logistic regression analysis showed that inflammation activty (OR=17.31, 95% CI: 13.410-22.336, P=0.001), age (OR=1.019, 95%CI:1.005-1.035, P=0.010), sex (OR=1.497, 95% CI: 1.061-2.111, P=0.022), apolipoprotein A (OR=0.50, 95% CI: 0.281-0.892, P=0.019) and HBV DNA (OR=0.904, 95% CI: 0.858-0.952, P=0.001) may be independent predictors of moderate and severe liver fibrosis.Conclusions CHB patients with mild liver fibrosis tend to have metabolic disorders of uric acid, total cholesterol and high density lipoprotein cholesterol;patients with moderate liver fibrosis tend to have metabolic disorders of high density lipoprotein and uric acid;and patients with severe liver fibrosis tend to have metabolic disorders of high density lipoprotein and uric acid.

Objective To investigate the distribution features of TCM patterns and differentiation method of thyroid cancer through cluster analysis on data of TCM four examinations after surgery.Methods The data of TCM four examinations were collected from 304 patients by applying cross-section epidemiological survey,and then given quantitative classification and a database was established.The quantitative scores of each patient were given cluster analysis by using sample clustering analysis method (Q clustering) for getting the proportion of each category of four examination information.The preliminary criterion for patterns of thyroid cancer was made according to the proportion of four examinations information and expert survey of Delphi method at earlier stage,which was combined with clinical practice to determine the patterns.Results All 304 patients were clustered into 9 categories indicated by from A1 to A9.The frequency of A1 was 77 cases;A2,7;A3,1;A4,7;A5,105;A6,7;A7,87;A8,11 and A9,2.Based on clinical practice and experts' experiences,A1 and A7,A5 and A6,and A3 and A4 were merged and evaluated respectively as pattern of dual deficiency of qi and yin (164 cases,53.9％),pattern of liver depression and qi stagnation (112 cases,36.8％) and spleen-kidney yang deficiency pattern (8 cases,2.6％).A2 was evaluated as pattern of yin damaged by stasis heat (7 cases,2.3％).The proportions of four examination information of A8 and A9 were disperse and evaluated as other patterns (13 cases,4.4％).Conclusion The distribution of TCM patterns in the patients with thyroid cancer after surgery has its regularity.It is feasible to evaluate TCM patterns with cluster analysis combining with experts' experiences.

ObjectiveTo investigate the influencing factors for hepatocyte steatosis in patients with chronic hepatitis B (CHB) and the high-risk population by classification tree model analysis, and to establish a simple method to assess the risk of hepatocyte steatosis in CHB patients. MethodsThe clinical data and pathological results of the CHB patients who underwent liver biopsy in Department of Infectious Diseases, The First People's Hospital of Shunde, from January 2006 and December 2014 were collected. The classification tree model was applied to analyze the influencing factors for hepatocyte steatosis, and index value curve, misclassification matrix, and error of estimation were applied for overall evaluation of classification results of the classification tree model. ResultsThe influencing factors for hepatocyte steatosis in CHB patients were body mass index (BMI), total cholesterol, and low-density lipoprotein, and the most important factor was BMI. This classification tree model had a sensitivity of 84.3%, a specificity of 81.5%, an accuracy of 82.9%, and an error of estimation of 0.171, suggesting that this model was well fitted. ConclusionClassification tree model analysis shows that the pathogenesis of hepatocyte steatosis in CHB patients is closely related to the influencing factors BMI, total cholesterol, and low-density lipoprotein. A simple classification method is established based on these factors to evaluate the risk of hepatocyte steatosis in CHB patients. It is necessary to conduct further clinical studies to investigate the clinical value of this method.

Objective To study the clinical and pathological features of hepatic steatosis in patients with chronic hepatitis B (CHB)based on a matched case-control study.Methods Cross-sectional study was carried out on CHB patients who received liver biopsy in the Department of Infectious Diseases, Shunde First People′s Hospital from January 2006 to December 2014.Clinical data of the patients were collected.A total of 216 matched pairs were created according to gender and age.The clinical and pathological feathers of both groups were compared and analyzed. Quantitative data with normal distribution were compared by t test and those with abnormal distribution were compared by nonparametric rank sum test of two- or multi-independent samples. Categorical data were compared by χ2 test. Results In matched pairs,rates of overweight/obesity were 84.2% in fatty liver group and 18.5 % in non-fatty liver group (χ2 =189.30,P =0.001 ),patients with high cholesterol in the two groups were 30.6% and 13.4%,respectively (χ2 =18.47,P =0.001 ),high triglycerides were 27.3% and 9.7%, respectively (χ2 =22.15 ,P =0.001),high low-density lipoprotein were 16.7% and 5 .6%,respectively (χ2 =13.50,P =0.001),high uric acid were 31 .0% and 15 .3%,respectively (χ2 =15 .04,P =0.001 ) and rates of alcohol history were 38.9% and 25 .9%,respectively (χ2 =8.08,P =0.001).The differences of hepatitis B virus (HBV)DNA and status of hepatitis B e antigen between the two groups were not statistically significant (both P >0.05 ).Compared to fatty liver group,rates of hepatic inflammation activity degree ≥ 3 (54.6% vs 37.5 %,χ2 = 12.75 ,P <0.01 )and fibrosis staging ≥ 3 (53.2% vs 41 .7%,χ2 =5 .80,P =0.016)in non-fatty liver group were both significantly higher.Conclusions CHB patients with overweight/obesity,high cholesterol,high triglycerides,high low-density lipoprotein,high uric acid and drinking history are more likely to develop hepatic steatosis.The inflammatory grade and fibrosis stage in non-fatty liver group are more serious than those in fatty liver group.

ObjectiveTo analyze the prevalence and clinical features of hepatic steatosis in patients with chronic hepatitis B. MethodsThe clinical data of patients with chronic hepatitis B who were hospitalized at the Department of Infectious Diseases, the First People′s Hospital of Shunde, Guangdong, China, from January 2006 to December 2014, were retrospectively collected for analysis and comparison of clinical and pathological indicators. The patients were divided into fatty liver group and non-fatty liver group depending on the presence or absence of fatty liver. Continuous data of the two groups were compared using the t test and categorical data were compared using the χ2 test. If data were not normally distributed, comparisons were made using the Mann-Whitney U test. ResultsThe incidence of fatty liver increased with age (P＜0.05) and peaked at an age of ≥45 years in both groups. Fatty liver was more likely to occur in men than in women below 30 years and between 30 and 44 years (P＜0.05). Diabetes, abnormal levels of cholesterol, triglycerides, low-density lipoprotein, and uric acid, and a history of alcohol consumption were significantly more frequent in the fatty liver group than in the non-fatty liver group (P＜0.05). Levels of body mass index, gamma-glutamyl transpeptidase, albumin, blood urea nitrogen, creatinine, uric acid, glucose, total cholesterol, triglycerides, low-density lipoprotein, apolipoprotein A, apolipoprotein B, aspartate aminotransferase were significantly different between the two groups (P＜0.05). Inflammation and fibrosis were significantly milder in the fatty liver group compared with the non-fatty liver group (P＜0.05). Patients in the non-fatty liver group were more likely to be complicated by grade 3 liver inflammation and stage 3 fibrosis (P=0.001 and P=0.015). ConclusionFatty liver patients are more likely to present with glucose and lipid metabolism disorder. Hepatic steatosis is not significantly correlated with HBeAg, but may be somewhat associated with HBV DNA, inflammation grade and fibrosis stage. Further studies are needed to establish their connections. .

Objective To investigate the influence of fixed nurse specialists triage to improve the quality of patient triage.Methods Nurses were divided into the fixed nurse specialist triage group (group A) and the out-patient department rotation nursing group (group B),respectively,each group was responsible for triage of patients in clinic of medical department for five days.Then the number of two subdiagnosis error and the average daily working overtime for doctors were compared.Results A total of 3806 patients were in clinic triage in group A,165 patients had triage error.A total of 3812 patients were in clinic triage in group B,308 patients had triage error.The average daily working overtime of doctors in group A was(5.24 ± 0.37)hours,and(8.16 ± 0.58) hours in group B.The errors in triage and working overtime of doctors had significant differences between two groups.Conclusions Fixed specialist nurse triage can significantly improve the quality of patient triage in clinic.