Nuclear emergency medical rescue is one of the important courses of military medical professional education, and improving the training level of nuclear emergency medical rescue plays a very important role in improving post competency of trainees. Based on the problem of disconnection between "teaching" and "need" in the occupational education of nuclear emergency medical rescue in the past, this study proposes the curriculum goal of "the combination of three abilities" and performs the optimization and practice of the occupational education curriculum system of nuclear emergency medical rescue from the aspects of curriculum setting, curriculum content, teaching methods, and assessment and evaluation. The results show that the new curriculum system can significantly improve the comprehensive ability of nuclear emergency medical rescue among trainees and better meet the requirements for their posts, thereby playing an important role in cultivating high-quality military medical talents in nuclear emergency medical rescue.

The central nervous system is one of the most sensitive targets of microwave radiation. Microwave radiation can affect spatial learning and memory and neural information transmission. The effects of microwave radiation on neurotransmitters in the hippocampus and the underlying mechanisms are still unclear. This paper reviews the effects of microwave radiation on learning/memory and neurotransmitters as well as the mechanisms of action on neurotransmitters. This paper aims to provide a scientific basis for future research in this area.

Objective To investigate the effect of high altitude on peak expiratory flow (PEF) in elderly patients with heart failure and respiratory tract infection and its relationship with inflammatory response. Methods A total of 380 elderly patients over 60 years old with heart failure and respiratory tract infection admitted to our hospital from January 2020 to September 2022 were selected by cluster sampling method as research objects, including 190 long-term residents in high-altitude areas and 190 long-term residents in non-high-altitude areas.Information on current diseases, peak expiratory flow (PEF) levels, and inflammatory status (serum TNF) were collected- α， CRP, PCT and IL-6 levels) and other potential influencing factors; The relevant test indexes were collected at the time of enrollment (baseline) and at the time of discharge after treatment (the shortest hospital stay of 6 days and the longest hospital stay of 21 days); To compare the effects of long-term living at high altitude on PEF level and inflammatory state. The study used spss19 0 statistical software package for analysis. Results In this study, 380 elderly patients over 60 years old with heart failure and respiratory tract infection were enrolled, including 190 long-term residents in high-altitude areas (high-altitude group) and 190 long-term residents in non-high-altitude areas (control group). The mean age of patients in the high altitude group was (66.20±6.56) years old, the proportion of male patients was 53.16%, and the proportion of patients with heart failure duration less than 5 years was 70.00%. The average age of the control group was (66.93±6.77) years old, the proportion of male patients was 53.85%, and the proportion of patients with heart failure duration less than 5 years was 71.79%. The levels of PEF, FEV1 and FVC in 2 groups were higher than the baseline level at discharge (t=2.095, 7.139, 11.047, 14.594, 14.104, 12.250, all P<0.05). And the high altitude group was significantly lower than the control group (t=5.260, 6.912, 6.262, P<0.05). The baseline levels of TNF-α, CRP, PCT and IL-6 in the high altitude group were higher than those in the control group. After treatment, the levels of several inflammation-related factors decreased in both groups, but the high altitude group was still higher than the control group. The expression levels of inflammation-related factors (TNF-α, CRP, IL-6, PCT) in subjects at high altitude were negatively correlated with the levels of lung function related indicators (PEF, FEV1, FVC) (r=-0.453, -0.496, -0.379, -0.563, -0.467, -0.522, -0.497, -0.518, -0.419, -0.416, -0.438, -0.480), and the correlation coefficients were statistically significant (P<0.05). Conclusion High altitude living factors are associated with the decrease of PEF. At the same time, it indirectly aggravates the inflammatory state of patients, and it is more difficult for therapeutic intervention to control the inflammation to the ideal level within the same time, which is worthy of clinical attention.

Objective To investigate the association of energy metabolic markers with the risk of spontaneous bacterial peritonitis (SBP) in patients with decompensated hepatitis B virus-related liver cirrhosis (HBV-LC). Methods A retrospective analysis was performed for the clinical data of the patients with decompensated HBV-LC who were admitted to Mengchao Hepatobiliary Hospital of Fujian Medical University from November 2017 to November 2019, and baseline clinical parameters and energy metabolic markers were compared between the patients with SBP and those without SBP within 2 weeks after admission. A multivariate logistic regression analysis was performed to investigate the risk factors for SBP. The t -test was used for comparison of normally distributed continuous data between two groups, and the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between two groups; the Fisher's exact test was used for comparison of categorical data between two groups. The receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic efficiency of the newly established logistic regression model, and with the corresponding point of Youden index as the cut-off value, the DeLong test was used to compare the area under the ROC curve (AUC). Results A total of 50 patients with decompensated HBV-LC were included, among whom 23 (46%) developed SBP within 2 weeks after admission and 27 (54%) had no SBP during hospitalization. Compared with the non-SBP patients, the SBP patients had significantly lower triglyceride, prealbumin, and prothrombin time activity (PTA) and significantly higher international normalization ratio, C-reactive protein (CRP), and Model for End-Stage Liver Disease score (all P < 0.05). Comparison of baseline energy metabolic markers showed that compared with the non-SBP patients, the SBP patients had significantly lower respiratory quotient (RQ) [0.79(0.76-0.86) vs 0.85(0.79-0.91), P =0.041] and carbohydrate oxidation (CHO) rate [20.50%(15.25%-41.05%) vs 41.6%(22.25%-68.05%), P =0.041]. The multivariate logistic regression analysis showed that PTA was an independent risk factor for SBP in the patients with decompensated HBV-LC during hospitalization (odd ratio=0.004, P =0.008), and the regression model established based on the variables including PTA, CRP, RQ, and CHO had an AUC of 85.0% and a cut-off value of 0.60 at the maximum Youden index, with a specificity of 85.19% and a sensitivity of 73.91%, suggesting that this model had a better discriminatory ability than CRP (AUC=74.5%, P =0.049) and procalcitonin (AUC=56.4%, P < 0.01). Conclusion There are significant reductions in the energy metabolic markers RQ and CHO in the patients with decompensated HBV-LC who develop SBP within a short term, and their combination with PTA, CRP, and CHO/RQ ratio can help clinicians identify the patients at a high risk of SBP in the early stage and enhance nutrition support for such patients.

Objective To investigate the risk factors for short-term prognosis in patients with HBV-related acute-on-chronic liver failure (ACLF). Methods A retrospective analysis was performed for the clinical data of 119 patients with HBV-related ACLF who were admitted to Mengchao Hepatobiliary Hospital of Fujian Medical University from October 2019 to October 2020, and according to their survival status on day 90, they were divided into death group and survival group. The patients were given antiviral therapy with entecavir or tenofovir. Related clinical data were collected, including alanine aminotransferase (ALT), aspartate aminotransferase, cholinesterase (ChE), albumin (Alb), cholesterol, alpha-fetoprotein, and HBV DNA at baseline, as well as the incidence rate of important complications. Model for End-Stage Liver Disease (MELD) score was also calculated. The t -test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-squared test was used for comparison of categorical data between two groups; a logistic regression analysis was used to investigate the influencing factors for the 90-day prognosis of patients with HBV-related ACLF and establish a new predictive model; the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficiency of the new model in predicting the prognosis of HBV-related ACLF. Results Of all patients, 33 died within 90 days, resulting in a mortality rate of 27.7%. There were significant differences between the survival group and the death group in age, ALT, Alb, ChE, MELD score, and incidence rates of hepatic encephalopathy, primary peritonitis, and hepatorenal syndrome (all P < 0.05). The logistic regression analysis showed that baseline hepatic encephalopathy (odds ratio [ OR ]=10.404, 95% confidence interval [ CI ]: 2.522-42.926, P =0.001), serum Alb at baseline ( OR =0.853, 95% CI : 0.764-0.952, P =0.005), and MELD score at baseline ( OR =1.143, 95% CI : 1.036-1.261, P =0.008) were independent predictive factors for the short-term prognosis of patients with HBV-related ACLF. A new predictive model was established based on the combination of these three indices, and the ROC curve analysis showed that this new model had an area under the curve of 0.833, while MELD score had an area under the ROC curve of 0.672. Conclusion As for the evaluation of the 90-day prognosis of patients with HBV-related ACLF, the new prognostic model established based on hepatic encephalopathy, Alb, and MELD score has a better predictive value than MELD score alone.

OBJECTIVE：To explore the mode of pharmaceutical care for oral medication of tumor patients with dysphagia by clinical pharmacists ，so as to promote clinical rational and safe drug use. METHODS ：Based on typical cases ，the problems existing in the oral medication of tumor patients with dysphagia were analyzed ，and the medication guidance and pharmaceutical care given by clinical pharmacists were expounded. RESULTS ：Clinical pharmacists found that tumor patients with dysphagia had some problems during oral medication ，such as improper administration position ，tube feeding of slow-controlled release preparations after opening the capsule ，limited administration route ，biting cytotoxic drugs ，unknown solubility of targeted drugs ，interaction of multiple drugs. In view of the above problems ，clinical pharmacists assisted physicians and nursing staff to provide pharmaceutical care to patients in combination with the patient ’s disease characteristics ，pharmacy，pharmacokinetics，pharmacodynamics，drug solubility，drug interaction and other factors ，such as skillfully using appropriate drug delivery location and mode ，using local drug delivery mode ，selecting appropriate dosage form based on pharmaceutical knowledge （the characteristics of new dosage form ）， guiding patients to use drugs correctly by being familiar with the characteristics of cytotoxic drugs and targeted drugs ，paying attention to potential drug interactions and guiding nurses to use drugs correctly. The situation of improper medication was improved. CONCLUSIONS ：Clinical pharmacists should participate in clinical therapy actively ，and make appropriate interventions with professional knowledge of pharmacy so as to promote the correct use of oral medication for tumor patients with dysphagia.

Objective:To investigate and analyze the energy metabolism characteristics and the correlation between energy metabolism and the risk of secondary bacterial infection in patients with hepatitis B virus-related chronic liver disease (HBV-CLD).Methods:Data of 183 cases admitted to the Mengchao Hepatobiliary Hospital of Fujian Medical University from November 2017 to November 2020 were retrospectively analyzed. 79 cases of chronic hepatitis B, 51 cases of hepatitis B-related liver cirrhosis, and 53 cases of hepatitis B-related liver failure were collected. Among them patients with liver failure and decompensated liver cirrhosis were defined as severe liver disease group. The Quark RMR indirect calorimetry (COSMED Corporation, Italy) was used to exam the patients' energy metabolism condition, and the incidences of secondary bacterial infection of the patients during hospitalization were recorded. Shapiro-Wilk test and normal QQ plot were used to analyze the normal distribution of continuous variable data, which was consistent with the normal distribution and was described by mean ± standard deviation. In addition, if it did not conform to the normal distribution, the median and interquartile distance were used to describe it. Levene’s test was used to test the homogeneity of variance of the data, which was consistent with the normal distribution. The t-test was used to compare the means of the two groups of samples. One-way analysis of variance was used to compare the mean values of the three groups of samples, and then the Tukey's test was used to compare the two groups. If the variance was uneven or did not conform to the normal distribution, the Wilcoxon rank sum test was used to compare the differences between the two groups. Kruskal-Wallis test (H test) was used to compare the differences between the three groups of samples, and then the Dunnett’s test (Z test) was used for comparison between the two groups. Categorical variable data were analyzed using chi-square test. Logistic regression analysis was used to screen independent risk factors, and the criteria for variable inclusion ( P < 0.05). Results:The respiratory entropy (RQ) and non-protein respiratory entropy (npRQ) of the three groups had statistically significant difference ( P < 0.05). Among them, the RQ and npRQ of the chronic hepatitis B group were higher than hepatitis B-related liver cirrhosis group and hepatitis B-related liver failure group. There were statistically significant differences in fat oxidation rate (FAT%) and carbohydrate oxidation rate (CHO%) between the three groups ( P < 0.05). Compared with hepatitis B-related liver cirrhosis group and hepatitis B-related liver failure group, chronic hepatitis B group ( P < 0.05) had lower FAT% and higher CHO%. There were no statistically significant differences in the measured and predicted resting energy expenditure and protein oxidation rate (PRO%) between the three groups. The incidence of secondary bacterial infection in patients with severe liver disease was 48.39% (45/93). Compared with the non-infected group, the RQ and npRQ values ??of the infected group were significantly decreased ( P < 0.05), while FAT% was significantly increased ( P < 0.05). Logistic regression analysis showed that glutamyltransferase, cholesterol, and npRQ were independent risk factors for secondary bacterial infections in patients with severe liver disease. Glutamyltransferase elevation, and cholesterol and npRQ depletion had suggested an increased risk of secondary bacterial infection. Subgroup analysis of patients with hepatitis B-related liver failure also showed that compared with non-infected group, RQ value and npRQ value of secondary bacterial infection group were significantly decreased ( P < 0.05), while FAT% was significantly increased ( P < 0.05). Conclusion:Patients with hepatitis B virus-related chronic liver disease generally have abnormal energy metabolism. Low RQ, npRQ, CHO% and high FAT% are related to the severity of the disease; while npRQ reduction is related to the risk of secondary bacterial infection in patients with severe liver disease, and thus can be used as a clinical prognostic indicator.

Objective:To explore the effects of immersion hypothermia and body temperature afterdrop during rewarming on animal bodies by establishing animal body temperature afterdrop model.Methods:The mini-swine were submerged in the simulated low temperature seawater (1.0℃) from the chest down. When their body temperatures dropped to 28.0℃, they were immediately removed from the seawater and placed in the warm water of 35.0℃ for rewarming. The body temperature, electrocardiogram, and heart rate were real-time monitored. Blood samples were collected before the mini-swine entering the seawater, when being removed from the seawater, and when the ventricular fibrillation occurred as a result of body temperature afterdrop. The levels of blood glucose, platelets, blood urea nitrogen, creatinine, serum potassium, total bilirubin, lactate dehydrogenase (LDH), aspartate aminotransferase (AST), cold shock protein (CSP), and adrenaline were measured.Results:As the seawater immersion went on, the body temperatures of the mini-swine gradually decreased and their heart rates gradually increased. But the heart rates began to decrease when the body temperature dropped to an average of 35.5℃. During rewarming, the body temperature continued to drop, then began to rise from the lowest average of 25.3℃. The average body temperature afterdrop was 2.7℃. The heart rates began to rise from the lowest average of 50 beats per minute. When the body temperature rose to an average of 37.1℃, the heart rates returned to an average of 112 beats per minute. Compared with the values before seawater immersion, the blood glucose, blood urea nitrogen, creatinine, total bilirubin, serum potassium, AST, and CSP of the mini-swine were significantly increased when they were removed from the seawater, with statistically significant differences ( P<0.05). Compared with the values at the removal from seawater, when the ventricular fibrillation caused by the afterdrop occurred, the blood glucose level was significantly reduced, while the values of blood urea nitrogen, creatinine, total bilirubin, and AST were significantly increased, with statistically significant differences ( P<0.05), but the values of platelet, LDH, and adrenaline had no significant changes. Conclusion:Low temperature seawater immersion and body temperature afterdrop significantly affect heart rate, blood glucose, and liver and kidney functions, which can provide a theoretical basis for preventing and treating temperature afterdrop during rewarming in patients with hypothermia.

Objective:To explore the effects of immersion hypothermia and body temperature afterdrop during rewarming on animal bodies by establishing animal body temperature afterdrop model.Methods:The mini-swine were submerged in the simulated low temperature seawater (1.0℃) from the chest down. When their body temperatures dropped to 28.0℃, they were immediately removed from the seawater and placed in the warm water of 35.0℃ for rewarming. The body temperature, electrocardiogram, and heart rate were real-time monitored. Blood samples were collected before the mini-swine entering the seawater, when being removed from the seawater, and when the ventricular fibrillation occurred as a result of body temperature afterdrop. The levels of blood glucose, platelets, blood urea nitrogen, creatinine, serum potassium, total bilirubin, lactate dehydrogenase (LDH), aspartate aminotransferase (AST), cold shock protein (CSP), and adrenaline were measured.Results:As the seawater immersion went on, the body temperatures of the mini-swine gradually decreased and their heart rates gradually increased. But the heart rates began to decrease when the body temperature dropped to an average of 35.5℃. During rewarming, the body temperature continued to drop, then began to rise from the lowest average of 25.3℃. The average body temperature afterdrop was 2.7℃. The heart rates began to rise from the lowest average of 50 beats per minute. When the body temperature rose to an average of 37.1℃, the heart rates returned to an average of 112 beats per minute. Compared with the values before seawater immersion, the blood glucose, blood urea nitrogen, creatinine, total bilirubin, serum potassium, AST, and CSP of the mini-swine were significantly increased when they were removed from the seawater, with statistically significant differences ( P<0.05). Compared with the values at the removal from seawater, when the ventricular fibrillation caused by the afterdrop occurred, the blood glucose level was significantly reduced, while the values of blood urea nitrogen, creatinine, total bilirubin, and AST were significantly increased, with statistically significant differences ( P<0.05), but the values of platelet, LDH, and adrenaline had no significant changes. Conclusion:Low temperature seawater immersion and body temperature afterdrop significantly affect heart rate, blood glucose, and liver and kidney functions, which can provide a theoretical basis for preventing and treating temperature afterdrop during rewarming in patients with hypothermia.

Objects:To explore the association of colonic vitamin D receptor (VDR) expressionwith imbalance of Th17/regulatory T cells (Tregs) in patients with ulcerative colitis (UC) .Methods:The specimens of peripheral blood and colonic tissue were retrospectively collected from 30 UC patients and 15 controls (colonic polypadenoma) , respectively. The clinical data of all the participants were simultaneously recorded, including age, gender, smoking, body mass index, UC activity (assessed by Mayo scoring system) . The electrochemiluminescence method was conducted to measure the serum level of 25-hydroxyvitamin D [25 (OH) D]. Moreover, the immunohistochemical staining method was applied for examining the protein expression levels of VDR, Th17 and Treg cells related factors (RORγt, IL-17, Foxp3, IL-10, respectively) in the colonic tissues.Results:Compared with the controls, the expressions of RORγt, IL-17, Foxp3 and IL-10, together with the ratio of RORγt/Foxp3, were significantly higher in UC patients [0.32 (0.20, 0.46) ×10 -2 vs. 0.17 (0.11, 0.19) ×10 -2, 0.56 (0.30, 0.76) ×10 -2 vs. 0.19 (0.16, 0.26) ×10 -2, 0.26 (0.16, 0.33) ×10 -2 vs. 0.18 (0.12, 0.21) ×10 -2, 0.29 (0.19, 0.37) ×10 -2 vs. 0.06 (0.04, 0.09) ×10 -2, 1.14 (0.81, 1.86) vs. 0.86 (0.78, 0.92) , all P<0.05], meanwhile the expressions of RORγt, IL-17, Foxp3, IL-10, and the ratio of RORγt/Foxp3 were higher in patients with active UC than inactive UC [0.45 (0.31, 0.53) ×10 -2 vs. 0.16 (0.13, 0.20) ×10 -2, 0.73 (0.56, 0.78) ×10 -2 vs. 0.26 (0.21, 0.33) ×10 -2, 0.26 (0.24, 0.35) ×10 -2 vs. 0.17 (0.14, 0.26) ×10 -2, 0.35 (0.28, 0.38) ×10 -2 vs. 0.16 (0.11, 0.20) ×10 -2, 1.77 (0.90, 2.07) vs. 82.84 (64.12, 112.67) , all P<0.05]. The colonic VDR expression in UC patients was significantly lower than that in controls [0.66 (0.28, 19.15) ×10 -2 vs. 2.94 (2.61, 3.21) ×10 -2, P<0.001], meanwhile VDR expression was also shown to be lower in patients with active UC than that in those with inactive UC [0.37 (0.26, 0.69) ×10 -2 vs. 2.63 (1.78, 3.24) ×10 -2, P<0.001]. The subsequent linear regression analysis suggested that the ratio of RORγt/Foxp3 in colonic tissue of UC patients was independently and negatively associated to the colonic VDR expression ( β = -0.530, P = 0.003) . Conclusion:The lower colonic VDR expression is associated to the imbalance of Th17/Treg cells in UC patients.