Objective:To comprehensively evaluate the skin thickness, blood flow grades, skin stiffness, and post-treatment changes in ultrasound indices in patients with different clinical types of port-wine stains (PWS) by multimodal ultrasound, and to explore the application value of multimodal ultrasound in the quantitative evaluation of and efficacy assessment for PWS.Methods:An observational study was conducted, including 298 patients with PWS. High-frequency ultrasound was used to measure the thickness of and blood flow signals in skin lesions, and shear wave elastography to measure the maximum Young's modulus (Emax) and maximum shear wave propagation velocity (Cmax) of the skin layers. Differences in various ultrasound indices were analyzed between skin lesions and surrounding normal skin. After photodynamic therapy, ultrasound re-evaluation was performed on 124 patients to analyze changes in ultrasound indices before and after treatment. Statistical analysis was conducted using t test, analysis of variance, and rank sum test. Results:In 106 patients with pink PWS, the skin thickness was 1.41 ± 0.28 mm, the blood flow was mainly rated as grade 0 (81%), the Emax was 16.24 ± 1.82 kPa, and the Cmax was 2.28 ± 0.09 m/s. There were no significant differences in the above indices between normal skin and treated skin (all P > 0.05). In the 121 patients with purplish red PWS, the skin thickness was 1.86 ± 0.23 mm; the blood flow was mainly rated as grade 1 (45%), which was higher than that of normal skin; after treatment, both the skin thickness and blood flow grades were decreased ( P < 0.05) ; there were no significant differences in the Emax and Cmax between purplish red PWS lesions (16.41 ± 1.82 kPa, 2.32 ± 0.13 m/s, respectively) and normal skin or treated skin (all P > 0.05). In the 71 patients with thickened PWS, the skin thickness was 2.51 ± 0.32 mm, the blood flow was mainly trated as grade 3 (55%), the Emax was 22.22 ± 2.46 kPa, and the Cmax was 2.75 ± 0.11 m/s, which were all significantly higher than those of normal skin (all P < 0.05) ; all the indices were decreased after treatment. Conclusions:Multimodal ultrasound can be used for the quantitative assessment of different clinical types of PWS and their treatment outcomes. Purplish red PWS and thickened PWS showed thicker skin layers and higher blood flow grades, and thickened PWS showed higher skin stiffness values. All ultrasound indices were decreased after treatment.

Objective To explore the effect of repetitive transcranial direct current stimulation(tDCS)on anti-fatigue capacity,power output,and muscle activation during continuous vertical jumps of aver-age undergraduates.Methods Thirty healthy male college students were randomly assigned to an anodal tDCS(a-tDCS)group and a sham tDCS(sham-tDCS)group,receiving a total of 10 repeated anodal tDCS and sham tDCS for 5 consecutive days on the primary motor cortex respectively.Before and right after the intervention,as well as one month after the intervention,all students underwent the continuous vertical jump test.The two-factor repeated measure ANOVA(stimulation condition×time)was employed to evaluate alterations in fatigue index,total jump height,lower limb stiffness and mus-cle activation characteristics.Results The fatigue index of the a-tDCS group was significantly lower than the sham-tDCS group(P<0.05).After a-tDCS,the total jump height was significantly higher than before(P<0.05).In the sham-tDCS group,the touchdown time during continuous vertical jumps in-creased more significantly right and a month after the intervention(P<0.05 for both).Moreover,lower limb stiffness of the a-tDCS group at the last moment of the continuous vertical jumps was significant-ly higher than the sham-tDCS group(P<0.05).After a-tDCS,the activation of the rectus femoris mus-cle increased significantly in the eccentric phase of the end of the test(P<0.05).However,no signifi-cant differences were found in the mean power and post-test rating of perceived exertion after the stim-ulation.Conclusion Ten sessions of tDCS conducted over five consecutive days demonstrates an en-hancement in neuromuscular activation during high-intensity jumping exercise.This observed augmenta-tion contributes to attenuating the decline in exercise capacity associated with fatigue.

Anti-seizure medications (ASMs) are the main therapy for epilepsy.There are many kinds of ASMs with complex mechanism of action, so it is difficult for pharmacists to examine prescriptions.This paper put forward some suggestions on the indications, dosage forms/routes of administration, appropriateness of usage and dosage, combined medication and drug interaction, long-term prescription review, individual differences in pathophysiology of children, and drug selection when complicated with common epilepsy, for the reference of doctors and pharmacists.

Corona virus disease 2019 (COVID-19) patients with trauma are at high risk of venous thromboembolism (VTE), which must be taken seriously in the therapeutic processes. Hypercoagulable state is induced by 2019 novel coronavirus (2019-nCoV) in many ways, such as increasing the level of inflammatory factors and fibrinogen, and inducing endothelial cell injury. The venous wall injuries from trauma and operation directly or indirectly trigger off the exogenous coagulation pathway and the microcirculation can be damaged at the same time, which may initiate the exogenous pathway of VTE. Immobilization of limbs and forced bed rest during the treatment of traumatic patients will slow venous blood flow. Chronic non-communicable diseases such as diabetes in the elderly were independent risk factors for VTE. Furthermore, the persistent fever, severe lung disease, respiratory failure, sepsis and invasive technology application add the risk of VTE and the difficulty of treatment. In order to help effective prevention VTE of for COVID-19 patients with trauma, the authors put forward relevant technical suggestions for prevention and nursing of VTE to provide basis for nursing work during pandemic of COVID-19.

Objective:To compare the efficacy of the combination of abidol, lopinavir/ritonavir plus recombinant interferon α-2b (rIFNα-2b) and the combination of lopinavir/ritonavir plus rIFNα-2b for patients with COVID-19 in Zhejiang province.Methods:A multicenter prospective study was carried out to compare the efficacy of triple combination antiviral therapy and dual combination antiviral therapy in 15 medical institutions of Zhejiang province during January 22 to February 16, 2020. All patients were treated with rIFNα-2b (5 million U, 2 times/d) aerosol inhalation, in addition 196 patients were treated with abidol (200 mg, 3 times/d) + lopinavir/ritonavir (2 tablets, 1 time/12 h) (triple combination group) and 41 patients were treated with lopinavir/ritonavir (2 tablets, 1 time/12 h) (dual combination group). The patients who received triple combination antiviral therapy were further divided into three subgroups: <48 h, 3-5 d and >5 d according the time from the symptom onset to medication starting. The therapeutic efficacy was compared between triple combination group and dual combination group, and compared among 3 subgroups of patients receiving triple combination antiviral therapy. SPSS 17.0 software was used to analyze the data.Results:The virus nucleic acid-negative conversion time in respiratory tract specimens was (12.2±4.7) d in the triple combination group, which was shorter than that in the dual combination group [(15.0±5.0) d] ( t=6.159, P<0.01). The length of hospital stay in the triple combination group [12.0 (9.0, 17.0) d] was also shorter than that in the dual combination group [15.0 (10.0, 18.0) d] ( H=2.073, P<0.05). Compared with the antiviral treatment which was started within after the symptom onset of in the triple combination group, the time from the symptom onset to the viral negative conversion was 13.0 (10.0, 17.0), 17.0 (13.0, 22.0) and 21.0 (18.0, 24.0) d in subgroups of 48 h, 3-5 d and >5 d, respectively ( Z=32.983, P<0.01), while the time from antiviral therapy to viral negative conversion was (11.8±3.9), (13.5±5.1) and (11.2±4.3) d, respectively( Z=6.722, P<0.05). Conclusions:The triple combination antiviral therapy of abidol, lopinavir/litonavir and rIFNα-2b shows shorter viral shedding time and shorter hospitalization time, compared with the dual combination antiviral therapy; and the earlier starting triple combination antiviral therapy will result in better antiviral efficacy.

Objective: Comparing the benefit of Abidor, lopinavir/ritonavir and recombinant interferon α-2b triple combination antiviral therapy and lopinavir/ritonavir and interferon dual combination antiviral therapy to hospitalized novel coronavirus pneumonia 2019 in Zhejiang province. Methods: A multi-center prospective study was carried out to compare the effect of triple combination antiviral therapy with dual combination antiviral therapy in 15 medical institutions of Zhejiang Province. All patients were treated with recombinant interferon α-2b (5 million U, 2 times/d) aerosol inhalation. 196 patients were treated with abidol (200 mg, 3 times/d) + lopinavir / ritonavir (2 tablets, 1 time/12 h) as the triple combination antiviral treatment group. 41 patients were treated with lopinavir / ritonavir (2 tablets, 1 time/12 h) as the dual combination antiviral treatment group. The patients who received triple combination antiviral therapy were divided into three groups: within 48 hours, 3-5 days and > 5 days after the symptom onset. To explore the therapeutic effects of triple combination antiviral drugs and dual combination antiviral drugs, as well as triple combination antiviral drugs with different antiviral initiate time. SPSS17.0 software was used to analyze the data. Results: The time of virus nucleic acid turning negative was (12.2 ± 4.7) days in the triple combination antiviral drug group, which was shorter than that in the dual combination antiviral drug group [(15.0 ± 5.0) days] (t = 6.159, P < 0.01 ). The length of hospital stay [12 (9, 17) d] in the triple combination antiviral drug group was also shorter than that in the dual combination antiviral drug group [15 (10, 18) d] (H = 2.073, P < 0.05). Comparing the antiviral treatment which was started within 48 hours, 3-5 days and > 5 days after the symptom onset of triple combination antiviral drug group, the time from the symptom onset to the negative of viral shedding was 13 (10,16.8), 17 (13,22) and 21 (18-24) days respectively (Z = 32.983, P < 0.01), and the time from antiviral therapy to the negative of viral shedding was (11.8±3.9) , (13.5±5.1) and (11.2±4.3) d. The differences among the three groups were statistically significant (Z=32.983 and 6.722, P<0.01 or<0.05). Conclusions The triple combination antiviral therapy of Abidor, Lopinavir/Litonavir and recombinant interferon α-2b showed shorter viral shedding time and hospitalization time compared with the dual combination antiviral therapy. The earlier the time to initiate triple antiviral treatment, the shorter the time of virus shedding.

Objective? To explore the knowledge level of disaster emergency response of emergency nurses in Wenzhou, and to provide reference basis for developing targeted disaster nursing education and training policies. Methods? A total of 175 emergency nurses from 7 hospitals in Wenzhou were recruited from June to October 2017 by convenience sampling method. All the research subjects were investigated with the Nurses' Disaster Emergency Knowledge Scale and Disaster Nursing Training Needs Questionnaire. Results? A total of 164 valid questionnaires were collected. The average score of the Nurses' Disaster Emergency Knowledge Scale of 164 emergency nurses was (49.17±17.23). The differences in the scores of Nurses' Disaster Emergency Knowledge Scale of nurses with different professional title, working age, continuing education credit for disaster nursing and experience in the rescue of major emergencies were statistically significant (P＜0.05). There were 138 (84.15%) emergency nurses willing to join the disaster relief work, 160 (97.56%) of the emergency nurses believe it necessary to strengthen continuing education on disaster nursing, and 123 (75.00%) emergency nurses hope for systematic education on disaster nursing. Conclusions? Emergency nurses in Wenzhou have a slightly inadequate knowledge reserve for disaster emergency response. It is necessary to strengthen emergency nursing training for emergency nursing staff.

Objective To investigate the level of knowledge, attitude and practice (KAP) of cardiopulmonary resuscitation (CPR) and analyze its related influencing factors in order to provide the basis for the construction of CPR training and management model and enhance the knowledge level and operational skills of CPR among community residents in Shacheng district of Wenzhou City. Methods From June 2015 to June 2016, a total of 560 community residents in Shacheng district of Wenzhou City were randomly selected as the subjects based on community house number using the random number table method, and they were investigated by general information questionnaire, CPR training questionnaire, and CPR KAP questionnaire. Univariate and multivariate linear regression analyses were used to analyze the influencing factors on KAP of CPR among community residents; the bivariate correlation analysis was used to analyze the correlations between KAP of CPR and the dimensions of KAP in the community residents. Results Of the 560 community residents, 33.39% knew CPR, only 15.89% had received CPR training and 12.14% knew how to handle cardiac arrest (CA), the average score of CPR KAP in community residents was (42.50±11.34) scores, which was positively correlated with knowledge, attitude and behavior dimensions (r = 0.56, 0.45, 0.49, all P ＜ 0.05). The average scores of CPR KAP of residents with various occupations were as follows: farmers, workers, students, teachers, company staff, medical workers, and other residents (respectively 37.24±9.34, 38.28±8.12, 43.12±8.45, 45.45±10.23, 44.89±9.89, 49.67±7.45, 40.00±10.45), the average scores of CPR KAP of residents with various educational levels were as follows: elementary school and below, junior high school, senior high school or secondary technical school, college education, bachelor degree or above (respectively 35.65±8.76, 37.67±10.65, 40.87±9.87, 44.56±10.78, 49.87±9.23), the average scores of CPR KAP were differed by whether they knew CPR or not (47.34±8.76 vs. 40.07±11.23), whether they had received CPR training or not (49.56±9.56 vs. 41.17±11.78), and whether they knew how to deal with CA or not (51.89±9.34 vs. 41.20±11.18), which were statistically significant (all P ＜ 0.05). Multiple linear regression analysis showed that the education level [95% confidence interval (95%CI) =1.12 - 2.24, P = 0.00), whether they knew the CPR or not (95%CI = 0.87 - 1.89, P = 0.00), and whether they had received CPR training or not (95%CI = 1.32 - 2.58, P = 0.00) and whether they knew how to deal with CA or not (95%CI =1.87 - 3.23, P = 0.00) were the factors affecting the residents' KAP of CPR. Conclusions The CPR KAP level of community residents in Shacheng district of Wenzhou city is low, and the level is influenced by many factors such as education level, etc. Local public health departments should actively carry out effective training of CPR knowledge and skills, and from the CPR knowledge, attitude and practice aspects, comprehensively enhance the residents' level of CPR KAP.

Background To study the pathogenesis and management of diabetic retinopathy (DR) has an important clinical significance.With the development of biomedical photonics in recent years,photobiomodulation therapy has been paid more and more attention.However,the sudy on biological regulation of light to DR is rarely reported.Objective This study was to explore the photobiomodulating effects on the apoptosis of retinal neuronal cells induced by high glucose environment and tried to offer a basis for the management of DR.Methods The retinal neurons were isolated from Wistar rats using immunomagnetic beads and primarily cultured in Neurobasal,and the cells were identified by Nissl staining.The cells were divided into normal control group,high-glucose group and high-glucose+LED group.The glucose at the concentration of 25 mmol/L was added into medium for 48 hours in the high-glucose group,and the cells induced by high-glucose were irradiated in incubator by LED for consecutive 300 seconds per time in a 12-hour interval with the wavelength of 620 nm,maximal power of 1 W,central light radiation exposure of 6.67 mW/cm2 and spot diameter of 2.0 cm.The apoptosis rate of the cells was assayed by flow cytometry;the intracellular Ca2+ content was determined by laser scanning confocal microscope;the relative expression level of phosphorylated serine-threonine kinase (p-AKT) protein in the cells was detected by Western blot.Results The cells grew well 2-3 days after cultured with the polygon and oval shape,and nucleolus were visible.More neuronal processes were obtained in 5-7 days after culture.Nissl staining showed the blue violet color in cytoplasma of neurons.The proportion of neurons and glial cells was 91％.The apoptosis rates of the cells were (7.634±3.176)％,(33.642 ±9.315)％ and (23.914±6.375)％ in the normal control group,high-glucose group and high-glucose+LED group,respectively,and the apoptosis rates of high-glucose group and high-glucose + LED group were significantly higher than that in the normal control group,while the apoptosis rate in the high-glucose+LED group was lower than that in the high-glucose group (all at P＜0.01).The fluorescence of Ca2+ in the cytoplasma was strong in the highglucose group and weak in the normal control group.The fluorescence pixel values in the high-glucose group and highglucose+LED group were significantly higher than that in the normal control group,and that in the high-glucose+LED group was reduced in comparison with high-glucose group (all at P＜0.05).The expressing band of p-AKT protein was strong in the normal control group and weak in the high-glucose group.The relative expressing levels were 10.34± 3.18,2.16±0.46 and 7.15 ±1.72 in the normal control group,high-glucose group and high-glucose+LED group,and relative expression level of high-glucose+LED group was significatly lower than that in the high-glucose group (P＜ 0.05).Conclusions High-glucose environment inhibits PI3K/AKT pathway and calcium homeostasis of retinal neurons,which results in cell apoptosis.Low intensity of LED light irradiation activates the anti-apoptotic PI3K/AKT pathway and therefore reduces apoptosis induced by high glucose.

Objective To investigate students' experiences of learning achieved through the flipped classroom based on Massive Open Online Course(MOOC). Methods Qualitative study in which data were gathered from semi-structured and in-depth interviews conducted with 8 key students from the flipped classroom. The interviews were analyzed using Nancy′s phenomenology 7-step analysis method. Results Four themes emerged from the interviews: personalized learning, active learning, cooperative learning, and the critical role of teacher. Conclusions Overall, our research highlights the efficacy of MOOC-based flipped classroom. The implementation of the flipped classroom in this study improved personalized, active, and cooperative learning, and promoted the positive teacher-student relationship. Further research is needed to continue the investigation into maintaining students′ learning initiatives, controlling teach-learning progression,and strengthening formative evaluation.