Starting from the connotation of "New Medicine" in the context of Healthy China, Guangxi Medical University has launched a reform of medical humanities education based on the concept of holistic medicine and the competency-based approach. With the construction of first-class courses and majors as the starting point, the university aims to position itself, clarify goals, and innovate concepts based on "value orientation", and it reconstructs the education system and reshapes the education model with the integration of medical humanities and the combination of learning and practice, thereby establishing a holistic education system with the integration of medical humanities centered on longitudinally sequenced medical humanities curricula. The university also constructs a participatory teaching method based on online-offline platforms, pre-class/post-class engagement, and on-campus/off-campus collaboration, as well as a teaching assessment system with multiple subjects, multiple dimensions, dynamic evolution, and virtue orientation. The university has also built a diversified collaborative educational practice platform among universities, hospitals, and communities, thereby forming a comprehensive medical humanities teaching model with the teaching of humanistic knowledge, the cultivation of humanistic spirit, and the training of good behaviors.

Starting from the connotation of "New Medicine" in the context of Healthy China, Guangxi Medical University has launched a reform of medical humanities education based on the concept of holistic medicine and the competency-based approach. With the construction of first-class courses and majors as the starting point, the university aims to position itself, clarify goals, and innovate concepts based on "value orientation", and it reconstructs the education system and reshapes the education model with the integration of medical humanities and the combination of learning and practice, thereby establishing a holistic education system with the integration of medical humanities centered on longitudinally sequenced medical humanities curricula. The university also constructs a participatory teaching method based on online-offline platforms, pre-class/post-class engagement, and on-campus/off-campus collaboration, as well as a teaching assessment system with multiple subjects, multiple dimensions, dynamic evolution, and virtue orientation. The university has also built a diversified collaborative educational practice platform among universities, hospitals, and communities, thereby forming a comprehensive medical humanities teaching model with the teaching of humanistic knowledge, the cultivation of humanistic spirit, and the training of good behaviors.

Objective: To investigate the refractive progression and associated factors of children of different ages and refractive status, and to provide guidance on myopia prevention and control program formulation and work practice. Methods: A total of 20 kindergartens, primary schools, and secondary schools in 2 districts of Shanghai were selected based on the existing cohort, and baseline data in 2015 and one year follow up data in 2016 were collected from 1 510 children aged 4 to 14, including cycloplegic spherical equivalent refraction (SER), axial length (AL), and corneal curvature. The distribution and progression of SER and AL in children of different ages and refractive status were analyzed, and the influencing factors of SER progression (ΔSER) were explored using multiple linear regression. Results: ΔSER remained relatively stable at age 4 and 5 (average -0.08 to -0.07 D/year), and SER drifted significantly towards myopia (average -0.50 to -0.31 D/year) in all groups older than 6 years, dropping back to -0.44 to -0.33 D/year after age 11; Elongation of AL (ΔAL) was 0.27 to 0.35 mm/year in 4 to 10 years group, and decreased to 0.15 to 0.22 mm/year in 11 to 14 years group. The ΔSER and ΔAL were greatest in the new onset myopes [(-0.90± 0.05 )D, (0.51±0.02)mm], followed by the low myopia group [(-0.68±0.04)D, (0.36±0.02)mm], then followed by the moderate to high myopia group[(-0.49±0.06)D，(0.23±0.03)mm] and the lowest in the hyperopia group[(-0.21±0.02)D, ( 0.26 ±0.01)mm], with a statistically significant difference among these groups ( P <0.05). Age ( β =-0.07), baseline SER ( β = 0.05 ) and ΔAL ( β =-0.78) were independent influencing factors for refractive progression in the 4 to 10 years old group, while ΔAL( β =-1.55) was the only independent influencing factor in the 11 to 14 years old group ( P <0.05). Conclusion The elongation of AL in preschoolers is mostly physiologically and should be prevented from growing beyond the physiological range by increasing outdoor activities. The primary students, as well as students with pre myopia or low myopia are the priority groups for dynamic monitoring and intervention in myopia prevention and control.

Objective:To provide a reference for diving medical doctors on the diagnosis and differentiation of the patients with discomfort symptoms after recreational diving, by analyzing those patients′ clinical data and summarizing the features of clinical symptoms, the first diagnosis and consultation at the clinical visit.Methods:The clinical data of 102 outpatients and inpatients with discomfort after recreational diving admitted in and visited the Department of Hyperbaric Oxygen of the Sixth Medical Center of PLA General Hospital from October 2011 to October 2018 were retrospectively analyzed. The age, gender and other demographical data of the patients, as well as the diving history, the first diagnosis, the first consulted department, the department that made confirmed diagnosis, and the number of departments that the patients were transferred, were analyzed.Results:Among the 102 patients included in the study, the age of 30-44 years old accounted for the highest proportion (49.0%), dizziness and headache were the most common symptoms (34.3%) among all discomfort symptoms, and the clinical symptoms mainly involved head, heart, lung, and digestive system. The symptoms of digestive system and the vegetative nervous system were more commonly seen in women than those in men. The diving depths which was less than 10 meters accounted for 84.3%. The majority of patients experienced multiple dives within 24 hours (42.2%). The patients who had the discomfort symptoms after arriving at surface accounted for 69.6%. The proportion of decompression sickness in the diagnosis only accounted for 16.7%. The emergency department was the most-visited department (51.9%) within all the first consulted departments. The average number of departments in which the patients were transferred between the first consulted department and the department that made confirmed diagnosis was 2.2±1.7. Multiple dives, diving depth, suspected history of improper decompression, and the time of symptoms appearing were all significantly correlated with the diagnosis of decompression sickness ( P<0.05). Age, sex, the frequency of previous exercise, stress or panic during the diving were significantly correlated with the diagnosis of non-decompression sickness ( P<0.05). Conclusion:Regarding the diagnosis of the patients with discomfort symptoms after recreational diving, diagnosis other than decompression sickness should be considered.

Objective:To provide a reference for diving medical doctors on the diagnosis and differentiation of the patients with discomfort symptoms after recreational diving, by analyzing those patients′ clinical data and summarizing the features of clinical symptoms, the first diagnosis and consultation at the clinical visit.Methods:The clinical data of 102 outpatients and inpatients with discomfort after recreational diving admitted in and visited the Department of Hyperbaric Oxygen of the Sixth Medical Center of PLA General Hospital from October 2011 to October 2018 were retrospectively analyzed. The age, gender and other demographical data of the patients, as well as the diving history, the first diagnosis, the first consulted department, the department that made confirmed diagnosis, and the number of departments that the patients were transferred, were analyzed.Results:Among the 102 patients included in the study, the age of 30-44 years old accounted for the highest proportion (49.0%), dizziness and headache were the most common symptoms (34.3%) among all discomfort symptoms, and the clinical symptoms mainly involved head, heart, lung, and digestive system. The symptoms of digestive system and the vegetative nervous system were more commonly seen in women than those in men. The diving depths which was less than 10 meters accounted for 84.3%. The majority of patients experienced multiple dives within 24 hours (42.2%). The patients who had the discomfort symptoms after arriving at surface accounted for 69.6%. The proportion of decompression sickness in the diagnosis only accounted for 16.7%. The emergency department was the most-visited department (51.9%) within all the first consulted departments. The average number of departments in which the patients were transferred between the first consulted department and the department that made confirmed diagnosis was 2.2±1.7. Multiple dives, diving depth, suspected history of improper decompression, and the time of symptoms appearing were all significantly correlated with the diagnosis of decompression sickness ( P<0.05). Age, sex, the frequency of previous exercise, stress or panic during the diving were significantly correlated with the diagnosis of non-decompression sickness ( P<0.05). Conclusion:Regarding the diagnosis of the patients with discomfort symptoms after recreational diving, diagnosis other than decompression sickness should be considered.

Objective To develop a diagnostic model based on deep neural network for intelligent discrimination of thyroid function. Methods A total of 1616 patients ( 283 males, 1333 females, average age:52 years) who underwent thyroid imaging between May 2016 and June 2018 were selected. According to the clinical diagnosis, the 1616 cases included 299 normal thyroid cases, 876 hyperthyroidism cases and 441 hypothyroidism cases. Feature extraction and learning training were performed on 1000 training set sam-ples by two deep neural network models ( AlexNet;deep convolution generative adversarial networks ( DCGAN) ) using deep learning algorithm. Performance verifications were implemented on 616 test set samples. The con-sistency between the verification results of the two models and the clinical diagnosis was analyzed by Kappa test. Meanwhile, the time advantage of the intelligent diagnosis models was analyzed. Results The average diagnostic time of AlexNet model was 1 s/case, and the classification accuracy for normal thyroid, hyperthy-roidism, hypothyroidism were 82.29％(79/96), 94.62％(369/390), 100％(130/130), respectively. The Kappa value between results of AlexNet model and clinical diagnosis was 0.886 ( P<0.05) . The average di-agnostic time of DCGAN model was 1 s/case, and the classification accuracy for normal thyroid, hyperthy-roidism, hypothyroidism were 85.42％(82/96), 95.64％(373/390), 99.23％(129/130), respectively. The Kappa value between results of DCGAN model and clinical diagnosis was 0.904 ( P<0.05) . Conclusion The deep neural network intelligent diagnosis model can quickly determine the functional status of thyroid gland in thyroid imaging, and it has a high recognition accuracy, thus providing a new method for thyroid image review.

Objective To investigate the clinical efficacy of hyperbaric oxygen (HBO) therapy on steroid-induced necrosis of the femoral head (SNFH) at the stages of ARCO Ⅱ a and Ⅲ a.Methods A prospective,randomized,controlled trial was performed in 53 patients (20 were excluded),who were conformed to have SNFH at the stages of ARCOⅡa and Ⅲa through clinical medical care and or hospitalization.Before enrollment,the Harris and MRI scores (the indexes of femoral head necrosis,the areas of necrosis and bone marrow edema) were evaluated in all the subjects.After enrollment,the patients were randomly assigned to the experimental group or the cross group.Before enrollment and after 60 sessions of HBO therapy,the patients in the experimental group were evaluated the second time,which included Harris/MRI scores and relief rate of coxalgia.After 3-month intervention and 6-month HBO therapy,the patients in the cross group had evaluations the second and third times,which also included Harris/MRI scores and relief rate of coxalgia.Results Following HBO therapy,the Harris scores of either the experimental group or the cross group all increased,and the bone marrow edema scores decreased [Before HBO therapy in the experimental group:(68.4 ± 8.2) scores,after HBO thercopy:(76.2 ± 3.6) scores;Before HBO therapy in the cross group:(67.5 ± 4.1) scores;after HBO therapy:(76.1 ± 3.9)scores] (P ＜ 0.05),while the Harris scores,the area of femoral head necrosis and the bone marrow edema scores all failed to improve in the patients of the cross group (P ＜ 0.05).Following HBO therapy,statistical significance could be noted in the relief rate of coxalgia in both groups (P ＜ 0.05).Conclusions HBO therapy could improve Harris and MRI scores of the patients at middle stage of steroid-induced necrosis of the femoral head,and could also alleviate coxalgia symptoms of the patients with SNFH.

Objective To investigate the clinical efficacy of hyperbaric oxygen (HBO) therapy on steroid-induced necrosis of the femoral head (SNFH) at the stages of ARCO Ⅱ a and Ⅲ a.Methods A prospective,randomized,controlled trial was performed in 53 patients (20 were excluded),who were conformed to have SNFH at the stages of ARCOⅡa and Ⅲa through clinical medical care and or hospitalization.Before enrollment,the Harris and MRI scores (the indexes of femoral head necrosis,the areas of necrosis and bone marrow edema) were evaluated in all the subjects.After enrollment,the patients were randomly assigned to the experimental group or the cross group.Before enrollment and after 60 sessions of HBO therapy,the patients in the experimental group were evaluated the second time,which included Harris/MRI scores and relief rate of coxalgia.After 3-month intervention and 6-month HBO therapy,the patients in the cross group had evaluations the second and third times,which also included Harris/MRI scores and relief rate of coxalgia.Results Following HBO therapy,the Harris scores of either the experimental group or the cross group all increased,and the bone marrow edema scores decreased [Before HBO therapy in the experimental group:(68.4 ± 8.2) scores,after HBO thercopy:(76.2 ± 3.6) scores;Before HBO therapy in the cross group:(67.5 ± 4.1) scores;after HBO therapy:(76.1 ± 3.9)scores] (P ＜ 0.05),while the Harris scores,the area of femoral head necrosis and the bone marrow edema scores all failed to improve in the patients of the cross group (P ＜ 0.05).Following HBO therapy,statistical significance could be noted in the relief rate of coxalgia in both groups (P ＜ 0.05).Conclusions HBO therapy could improve Harris and MRI scores of the patients at middle stage of steroid-induced necrosis of the femoral head,and could also alleviate coxalgia symptoms of the patients with SNFH.

Objective To explore the CT and MRI manifestations and clinical features of juxtaglomerular cell tumor (JGCT). Methods A retrospective analysis the data of eight JGCT patients who resected by surgery and comfirmed by histopathology. Seven cases were examined by CT before operation, five of whom underwent CT scan and dynamic enhanced scan, two of whom underwent CT scan, and all of the eight underwent MRI scan and dynamic enhanced scan. The clinical manifestations of patients were also observed, whether they have hypertension and reduced blood potassium, recorded the results of lying and standing test, and collected the segmental renal vein blood to detect the renin levels. Meanwhile, the CT and MRI manifestations were also recorded. Results (1) We found that all of the eight patients appeared hypertension, and hypokalemia were found among five cases. Seven patients proceeded the lying and standing test, six of whom the plasma renin activity (PRA) were elevate in erect position, and the levels of angiotensin Ⅱand aldosterone (ALD) were rised among all of the seven cases in erect position. Four patients were collected the segmental renal vein blood, and one of whom has positive result of the renin activity. (2) The tumors of all the eight cases were single, the border was clear, and the average size was 2.7 cm (range 1.9 to 3.8 cm). The CT scan results showed there's no calcification or pseudocapsule were detected, four cases showed homogeneous iso-density, one case with slightly high density, another one showed low density with dotty high density and one case with low density. The dynamic enhanced CT scan showed that four cases performed continuous enhancement from cortical to medullary phase, and no obvious enhancement was found in one case. The T2WI results of MRI scan showed six cases had pseudocapsule, 6 cases had heterogeneous signal (4 cases with patchy low signal and 2 cases with patchy high signal), and 2 cases had homogeneous signal (one case with iso-high signal and another with high signal). The T1WI results showed two cases performed low signal, anther two cases showed iso-signal, and four cases with heterogeneous signal. The DWI results showed all of the 8 lesions with homo-or peripheral high signal. The dynamic enhanced MRI scan results showed seven cases performed gradual enhancement, and the border of another case became clear on delay phase. Conclusions JGCT has specific clinical and imaging features, and the combination will help make a correct diagnosis.

OBJECTIVETo investigate the changes of cytokines in induced sputum at different stages of silicosis patients.

METHODSA total of 200 workers from one of the Shandong Province gold mine were chosen as object of observation. Among which 40 patients at silicosis stage I and 40 patients at silicosis stage II were divided into silicosis observed object group, silicosis stage I group, silicosis stage II group, and another 80 workers exposed to silica dust without suffering from silicotic Clinical symptoms, however, were chosen as group of dust exposed, and 40 logistical workers without being exposed and history of silicosis's illness were chosen as control group. And ask their basic information by questionnaire. Then, spray-inhalation the induced sputum and apply the ELISA to assess the level of tumor necrosis factor (TNF), interleukin (IL), macrophage inflammatory protein-1 (MIP-1α), monocyte chemotactic factor-1 (MCP-1), metalloproteinases (MMP), transforming growth factor-β (TGF-β), platelet derived growth factor (PDGF) in induced sputum from subjects.

RESULTSThe level of TGF-β [(901.60 ± 30.09) ng/L] in the induced sputumof patients in silicosis stage I group is lower than that in the observed object group [(913.02 ± 20.51) ng/L], and the level of MMP-9 [(212.49 ± 5.97) ng/L], MCP-1 [(129.91 ± 4.30) ng/L] has various degrees of increase than that in control group, observed object group and dust exposed group. All the differences have statistical significances (P < 0.05). The level of TNF-α [(85.76 ± 3.78) ng/L] in the induced sputum of patients in silicosis stage I group reaches the maximum, there are significant differences comparing with that level in the silica dust exposure group and the control group, whose differences are statistically significant (P < 0.05). Compared with the control group, the level of MMP-2 (427.95 ± 23.64) in the induced sputum of patients in silicosis stage I group has increased, whose differences also have statically significant (P < 0.05). Compared with the control group, silica dust exposed group, the observation group of objects, the pneumosilicosis patients of IL-16 in induced sputum IL-16 (21.40 ± 9.24) decreased, the content of PDGF [(5.96 ± 0.51) ng/L], MMP-2 [(447.86 ± 27.10) ng/L], MMP-9 [(223.91 ± 12.28) ng/L], MCP-1 [(122.87 ± 6.08) ng/L] increased, the differences are statistically significant (P < 0.05).

CONCLUSIONAs silicosis biomarkers, TNF-alpha, TGF-beta, IL-16, PDGF, MMP-2, MMP-9 and MCP-1 have certain significance, further suggesting that early detection rate of patients with silicosis can be improved by employing the multiple indexes discriminate equation.

Biomarkers ; metabolism ; Case-Control Studies ; Chemokine CCL2 ; metabolism ; Chemokine CCL3 ; metabolism ; Cytokines ; metabolism ; Discriminant Analysis ; Dust ; Humans ; Interleukin-16 ; metabolism ; Matrix Metalloproteinase 2 ; metabolism ; Matrix Metalloproteinase 9 ; metabolism ; Platelet-Derived Growth Factor ; metabolism ; Silicosis ; diagnosis ; Sputum ; chemistry ; Transforming Growth Factor beta ; metabolism ; Tumor Necrosis Factor-alpha ; metabolism