Objective:To explore and evaluate the optimization and application of case-based learning (CBL) in the reform practice for integrated curriculum of the digestive system.Methods:The 174 undergraduate students majoring in eight-year clinical medicine enrolled in 2019 at the Peking University Health Science Center were selected as research objects. CBL was used in the integration and optimization of the digestive system curriculum. These included increasing class hours, selecting disease modules, lesson preparation involving multi-disciplinary teachers, and joint teaching. Upon completion of teaching, a comprehensive evaluation of teaching effectiveness was conducted through questionnaires administrated to teachers and students, feedback from supervision experts, and scores of students. SPSS 21.0 was used for the t-test and a reliability analysis was conducted on the questionnaire results. Results:Teachers, students, and supervision experts were highly satisfied with CBL. More than 95% of teachers believed that joint teaching facilitated the sharing of diverse professional knowledge among teachers, enhanced the in-depth instruction of imaging knowledge, promoted the transformation of teaching ideas, and improved teaching ability. More than 70% of students agreed that joint teaching deepened their understanding of diseases, stimulated learning interest, and established a theoretical foundation for clinical practice. The average score of class performance was (47.60±2.41) points (a total score of 50 points). The answers of students to case-based questions in final exams were satisfactory. The average score of final evaluation was (82.24±8.82) points.Conclusions:The optimization and application of CBL in the integrated curriculum of the digestive system is highly accepted by teachers and students. This method improves the interest of learning and facilitates the establishment of overall medical thinking and clinical thinking in students.

Objective:To explore and evaluate the optimization and application of case-based learning (CBL) in the reform practice for integrated curriculum of the digestive system.Methods:The 174 undergraduate students majoring in eight-year clinical medicine enrolled in 2019 at the Peking University Health Science Center were selected as research objects. CBL was used in the integration and optimization of the digestive system curriculum. These included increasing class hours, selecting disease modules, lesson preparation involving multi-disciplinary teachers, and joint teaching. Upon completion of teaching, a comprehensive evaluation of teaching effectiveness was conducted through questionnaires administrated to teachers and students, feedback from supervision experts, and scores of students. SPSS 21.0 was used for the t-test and a reliability analysis was conducted on the questionnaire results. Results:Teachers, students, and supervision experts were highly satisfied with CBL. More than 95% of teachers believed that joint teaching facilitated the sharing of diverse professional knowledge among teachers, enhanced the in-depth instruction of imaging knowledge, promoted the transformation of teaching ideas, and improved teaching ability. More than 70% of students agreed that joint teaching deepened their understanding of diseases, stimulated learning interest, and established a theoretical foundation for clinical practice. The average score of class performance was (47.60±2.41) points (a total score of 50 points). The answers of students to case-based questions in final exams were satisfactory. The average score of final evaluation was (82.24±8.82) points.Conclusions:The optimization and application of CBL in the integrated curriculum of the digestive system is highly accepted by teachers and students. This method improves the interest of learning and facilitates the establishment of overall medical thinking and clinical thinking in students.

Objective:To evaluate the clinical efficacy of Xiaoqinglong Decoction Granules in the treatment of chronic persistent cold syndrome of bronchial asthma; To explore its treatment mechanism.Methods:A randomized double-blind controlled study was performed. Totally 60 patients from the Respiratory Department of Guang'anmen Hospital, Chinese Academy of Traditional Chinese Medicine from January 2021 to January 2022 were selected as the observation subjects. They were divided into two groups using a random number table method, with 30 cases in each group. The control group was given conventional treatment plus placebo, and the experimental group was given conventional treatment plus Xiaoqinglong Decoction Granules. The treatment for both group lasted for 14d. TCM syndromes and clinical symptoms before and after treatment were scored. Asthma Control Test Questionnaire (ACT) was used to evaluate asthma control status, and the Asthma Quality of Life Questionnaire (Mini AQLQ) was used to evaluate the physiological and psychological effects of asthma on patients; FEV1 was detected using a German Jaeger lung function instrument FEV1/FVC. A exhaled nitric oxide (FeNO) detection instrument was used to observe the changes in FeNO at a flow rate of 50 ml/s, and non-targeted metabolomics analysis was performed using liquid chromatography-mass spectrometry (LC-MS); adverse reactions were observed during treatment and drug safety was evaluated.Results:Eventually 47 cases were included, 24 cases of test group and of 23 cases of control group. Xiaoqinglong Decoction Granules could reduce the TCM syndrome score of patients with chronic duration cold syndrome of asthma ( P<0.05). 2 weeks after treatment, follow up for 4 weeks experimental group clinical symptom score [3.00(1.00,4.00),3.00(0.00,4.00) vs. 3.5(3.00,5.00), Z=8.62], breathing symptom scores [1.00(0.00,1.00),1.00(0.00,1.00) vs. 1.00(0.75,2.00), Z=6.80], cough symptom score [0.50(0.00,1.00),1.00(0.00,1.00) vs. 1.00(0.00,1.25), Z=6.12] were lower than those in the experimental group before treatment in the same group ( P<0.01 or P<0.05). The ACT score of the experimental group at 4 weeks of follow-up was [22.50 (21.00, 24.00) vs. 9.00 (15.00, 21.50), Z=-4.87], Mini AQLQ score (78.5 ± 12.46 vs. 71.27 ± 9.70, t=-2.46) and the control group had an ACT score of [24.00 (19.00, 25.00) vs. 21.5 (8.00, 23.00) Z=-3.18] at 4 weeks of follow-up was higher than before treatment in the same group ( P<0.01 or P<0.05). The experimental group was followed up for 4 weeks with a FEV1 of [2.96 (2.27, 3.49) L vs. 2.60 (2.32, 3.49) L, Z=-3.72], FEV1/FVC [(80.83 ± 6.84)% vs. (77.46 ± 8.15)%, t=-2.32] and FeNO [24.00 (12.50, 31.00) ppb vs. 30.00 (17.00, 91.00) ppb, Z=-3.72] was higher than before treatment in the same group ( P<0.01 or P<0.05). Through LC-MS technique analysis, there were 75 kinds of different metabolites between the experimental group before and after treatment, and 295 kinds of different metabolites between the control group and the experimental group after treatment. Further intersection of differential metabolites showed that they were mainly concentrated in histidine metabolic pathway, phosphonate metabolic pathway and phosphate metabolic pathway. Related metabolites 2-aminoethyl phosphonate and thiomalonic acid were involved. Conclusions:Xiaoqinglong Decoction Granules can effectively improve the TCM syndrome and clinical symptoms of patients with chronic persistent cold syndrome of asthma, especially for wheezing, cough and chest tightness, which can improve the levels of FEV1 and FEV1/FVC in patients and effectively reduce FeNO. Through metabolomics studies, it is speculated that Xiaoqinglong Decoction Granules may play a role in the treatment of asthma by regulating histidine metabolism pathway through thiomalonic acid.

Objective:To evaluate the long-term clinical efficacy of endoscopic submucosal dissection (ESD) in the treatment of early colorectal cancer and precancerous lesions, and to explore the risk factors of local recurrence after operation.Methods:From January 1, 2011 to December 31, 2022, the clinical and endoscopic follow-up data of 1 095 patients (1 186 lesions) who underwent ESD at Peking University Third Hospital and were pathologically diagnosed as early colorectal cancer or precancerous lesions after ESD were retrospectively analyzed. The long-term efficacy of ESD was evaluated, which included 5-year overall survival rate, disease-specific survival rate, local recurrence rate, and recurrence-free survival rate. The Kaplan-Meier method was used for survival analysis. Multivariate Cox proportional hazards regression models were performed to analyze local recurrence related clinical pathological factors.Results:After ESD, 1 067 patients were followed up, and the median follow-up period was 44.4 (20.3, 62.1) months. There were 734 patients having endoscopic follow-up (798 lesions, the follow-up rate was 67.0%). During the follow-up period, 26 patients died, and the 5-year overall survival rate and disease-specific survival rate were 96.0% and 100.0%, respectively. During the follow-up period, local recurrence was observed in 17 lesions, with a recurrence rate of 2.1%(17/798) and a median time of recurrence after ESD was 11.8 (4.9, 21.4) months. The 5-year cumulative recurrence rate was 3.4%, and the 5-year recurrence-free survival rate was 94.0%. The results of multivariate Cox regression analysis showed that lesions located in the rectum ( HR=2.64, 95% confidence interval (95% CI) 1.00 to 6.94, P=0.049), histologically incomplete resection ( HR = 4.40, 95% CI 1.62 to 11.94, P=0.004), and positive vertical margin ( HR=10.27, 95% CI 2.95 to 35.77, P<0.001) were independent risk factors for local recurrence after ESD in the treatment of colorectal mucosal lesions. Conclusions:Long-term efficacy of ESD in the treatment of colorectal mucosal lesions are favorable. Lesions located in the rectum, histologically incomplete resection, and positive vertical margin are independent risk factors for local recurrence after ESD in the treatment of colorectal mucosal lesions.

Rheumatoid arthritis （RA） is a systemic chronic auto-inflammatory disease， characterized by infiltration of inflammatory cells， pannus formation， articular cartilage destruction， and bone matrix destruction. Therefore， improving articular cartilage destruction has an important impact on the treatment of RA. Chinese medicine has a good application effect in improving cartilage destruction of RA due to its characteristics of multiple components， multiple targets， high activity and low side effects. Based on this， the author reviewed relevant literature to summarize the relevant research and mechanism of Chinese medicine and its active components in improving RA cartilage destruction. The results showed that Chinese medicine and its active components can improve RA cartilage destruction by regulating inflammatory factors， phosphatidylinositol 3-kinase/protein kinase B， Wnt/β- catenin， nuclear factor-κB， mitogen-activated protein kinase， Janus kinase 2/signal transduction and activator of transcription 3/ vascular endothelial growth factor， microRNAs， fibroblastic synovial cells.

Objective To explore factors influencing non-en bloc resection of endoscopic submucosal dissection(ESD)for colorectal neoplasms.Methods A retrospective analysis was conducted on clinical and pathological data of 1251 patients(1312 lesions)who underwent colorectal ESD from January 2011 to December 2022 and were pathologically confirmed as adenoma,serrated lesion,or early colorectal cancer.Clinical and pathological characteristics were compared between the en bloc resection group and the non-en bloc resection group.Univariate and multivariate logistic regression analyses were performed to identify factors influencing en bloc resection in ESD.Results The average size of the1312 lesions was(25.8±16.3)mm.Among the included lesions,there were728 adenomas(55.5%),193 serrated lesions(14.7%),and 391 early colorectal cancers(29.8%).ESD was completed in 1306 lesions and stopped due to perforation or technical difficulties in6 cases.The en bloc resection rate was89.5%(1174/1312),the complete resection rate was 73.8%(968/1312),and the curative resection rate was 70.6%(926/1312).Multivariate logistic regression analysis revealed that diameter of the lesions≥40 mm(OR =6.329,95%CI:4.278-9.384,P<0.001),negative lifting sign(OR =2.384,95%CI:1.424-3.903,P =0.005),scar location lesions(OR =2.997,95%CI:1.310-6.484,P = 0.023),protruded lesions(OR =8.458,95%CI:2.678-40.453,P =0.008),lateral spreading lesions(OR =5.898,95%CI:1.917-27.796,P =0.025),and hybrid ESD(OR =10.162,95%CI:5.705-19.692,P<0.001)were independent factors influencing en bloc resection of ESD for early colorectal cancer and precancerous lesions.Conclusions Diameter of the lesions≥40 mm,negative lifting sign,scar location lesions,protruded lesions,lateral spreading lesions,and hybrid ESD were significantly associated with non-en bloc resection of ESD for colorectal neoplasms.Strict evaluation should be conducted preoperatively to improve the efficacy of ESD.

Objective:To explore the risk factors of seroma after laparoscopic totally extraperitoneal hernia repair.Methods:The clinical data of 236 patients underwent laparoscopic totally extraperitoneal hernia repair from July 2018 to June 2021 in Jiaozhou Central Hospital of Qingdao City were retrospectively analyzed. The related risk factors of seroma after laparoscopic totally extraperitoneal hernia repair were analyzed.Results:Among 236 patients, the seroma occurred in 36 cases (seroma group), the incidence of seroma was 15.25%; no seroma occurred in 200 cases (non-seroma group). There were statistical differences in the duration of disease ≥5 years, scrotal hernia, internal inguinal ring defect ≥3 cm, rupture of hernia sac, experience of operators <5 years between 2 groups ( P<0.01 or <0.05); there were no statistical difference in age, body mass, type of patch, preoperative complications (including diabetes, chronic obstructive pulmonary disease and cardiac cerebrovascular disease) and operative time between 2 groups ( P>0.05). Multivariate Logistic regression analysis result showed that the duration of disease ≥5 years, scrotal hernia, rupture of hernia sac and experience of operators<5 years were independent influencing factors of seroma after laparoscopic totally extraperitoneal hernia repair ( OR = 5.147, 5.006, 0.044 and 3.315; 95% CI 1.513 to 17.516, 1.845 to 13.583, 0.008 to 0.240 and 1.029 to 10.679; P<0.01 or<0.05). Conclusions:The duration of disease ≥5 years, scrotal hernia, rupture of hernia sac and experience of operators<5 years are independent influencing factors of seroma after laparoscopic totally extraperitoneal hernia repair, and preoperative assessment of risk factors is helpful to reduce the incidence of seroma.

Objective:To investigate the therapeutic effects of finger pressing on Hegu acupoint on nausea and to find an optimal method to reduce nausea in first-time complete denture wearers. Methods:Forty-one first-time complete denture wearers who received treatment between June 2016 and December 2019 in Huxi Hospital Affiliated to Jining Medical University were included in this study. They were randomly divided into observation group ( n = 21) and control group ( n = 20). The observation group received finger pressing on Hegu acupoint for 3 minutes before complete denture wearing and before three meals. The control group received self-adaptive therapy. After 3, 7 and 14 days of wearing complete denture, the number of wearers without nausea, the number of wearers with normal swallowing function, and the number of wearers with masticatory efficiency were recorded in each group. Efficacy was compared between two groups. Results:After 3 and 7 days of wearing complete denture, the percentage of complete denture wearers without nausea was 85.71% (18/21) and 95.24% (20/21), respectively, which were significantly higher than those in the control group [45.00% (9/20), 65.00% (13/20), χ2 = 5.58, 4.19, both P < 0.05 ]. After 14 days of wearing complete denture, there was no significant difference in number of wearers without nausea between observation and control groups ( P > 0.05). After 3 days of wearing complete denture, there was significant difference in percentage of wearers with normal swallowing function among total number of complete denture wearers between observation and control groups [57.14% (12/21) vs. 15.00% (3/20), χ2 = 8.16, P < 0.01). After 7 and 14 days of wearing complete denture, there was no significant difference in percentage of wearers with normal swallowing function among total number of complete denture wearers between observation and control groups (both P > 0.05). After 3 and 7 days of wearing complete denture, masticatory efficiency in the observation group was (42.03 ± 5.02)% and (50.34 ± 5.05)%, which were significantly higher than those in the control group [(37.00 ± 4.00)%, (47.13 ± 4.03)%, t = 3.51, 1.65, both P < 0.05]. After 14 days of wearing complete denture, there was no significant difference in masticatory efficiency between the two groups ( P > 0.05). Conclusion:Finger pressing on Hegu acupoint has good clinical effects on alleviating nausea in complete denture wearers and can shorten the adjustment time to first time wearing complete denture.

In this paper, the domestic and international demand and development trend of clinical diagnostic radionuclides are analyzed, and the medium and high-energy cyclotrons, adequate and systematic facilities, and preparation techniques required for the production of medical radionuclides based on solid targets are introduced. This paper focuses on the research and development carried out by some important medical institutions and scientific research institutes in China over the years in the aspects of medium and high-energy cyclotrons, beam transmission lines, high-power irradiation target stations and new medical isotope production processes etc. It also looks forward to some new directions for the development of medical radionuclides in China during the 14th Five-Year Plan period.

OBJECTIVE：To stu dy the improvement effects o f Trillium tschonos kii total sapo nins（TTM）on adjuvant-induced arthritis model rats and its mechanism. METHODS ：SD rats were randomly divided into model group （n＝44）and blank group （n＝6）. Model group was given Complete Freund ’s adjuvant to induce the adjuvant-induced arthritis model ；blank group was given constant volume of normal saline with same method. Model group were divided into model group ，Tripterygium wilfordii polyglycoside tablets group （40 mg/kg），TTM low-dose ，medium-dose and high-dose groups （50，100，200 mg/kg），with 6 rats in each group. Administration groups were given relevant medicine intragastrically ；blank group and model group were given normal saline intragastrically ，once a day ，for consecutive 9 days. After last intragastric administration ，the body weight and foot swelling degree （bilateral）were detected ，and arthritis score was performed. The contents of tumor necrosis fator α（TNF-α）， interleukin 1β（IL-1β）and IL- 6 were detected ；the pathomorphological changes of rat ankle were observed ；protein expression of NOD-like receptor protein 3 （NLRP3），apoptosis associated spot-like protein （ASC），caspase-1 were detected ；the protein expression of NLRP 3 in synovial tissue of ankle joint were also determined. RESULTS ：Compared with blank group ，foot swelling degree，serum contents of TNF-α，IL-1β and IL-6，the protein expression of NLRP 3，ASC and caspase- 1 in knee tissue as well as the protein expression of NLRP 3 in synovial tissue of ankle joint were increased significantly in model group （P＜0.05 or P＜ 0.01），while the body weight was decreased significantly （P＜0.05）. The obvious proliferation of synovial cells ，the congestion and inflammatory cell infiltration of synovial tissue were all observed. Compared with model group ，most of the above indexes were all reversed significantly in TTM groups （P＜0.05 or P＜0.01）；the pathological changes such as synovial cell proliferation ， congestion of synovial tissue and chondrocyte destruction were all relieved ，and inflammatory cell infiltration was alleviated.CONCLUSIONS：TTM can improve rheumatoid arthritis of rats， the mechanism of which may be associated with 用。E-mail：yulingling@ctgu.edu.cn inhibiting the activity of NLRP 3/caspase-1 signaling pathway and decreasing the expression of inflammatory factors TNF-α，IL-1β，IL-6.