ObjectiveTo explore the possible mechanism of action of Lifei Xiaoji Pill （理肺消积丸， LXP） in the treatment of non small cell lung cancer based on the Warburg effect and the USP47/BACH1 pathway. MethodsFifty C57BL/6 mice were randomly divided into five groups， model group， LXP group， inhibitor group， LXP + inhibitor group， and cisplatin group， with 10 mice in each group. A lung cancer mouse model was established by subcutaneously injecting Lewis cells. On the next day， the model group mice were given 0.2 ml of saline by gavage daily， the LXP group given 240 mg/（kg·d） of LXP solution once a day by gavage， the inhibitor group intraperitoneally injected with P22077 at a dose of 10 mg/（kg·d） every day， the LXP + inhibitor group given both LXP by gavage and P22077 by intraperitoneal injection once a day， and the cisplatin group received 0.5 mg/（kg·d） cisplatin intraperitoneally every other day. All treatments lasted for 14 days. On the day after the last dose， tumor weight and volume were measured， tumor histopathology was examined by HE staining， apoptosis in tumor tissues was detected by TUNEL staining， and proliferation cell nuclear antigen （PCNA） protein levels were detected by immunohistochemistry. Warburg effect indicators， including glucose concentration， lactate content， and adenosine triphosphate （ATP） production in tumor tissues， were measured. Western Blot and qRT-PCR were used to detect the protein and mRNA expression levels of USP47， BACH1， hexokinase 2 （HK2）， and glyceraldehyde 3-phosphate dehydrogenase （GAPDH）. ResultsCompared with the model group， all drug intervention groups showed reduced tumor weight and volume， improved tumor pathology， decreased PCNA positive rate， increased apoptosis rate， and reduced expression levels of USP47， BACH1， and HK2 proteins and mRNA （P＜0.05 or P＜0.01）. Except for lactate content in the cisplatin group， the glucose concentration in tumor tissues of other drug intervention groups increased， while lactate content and ATP production decreased （P＜0.05 or P＜0.01）. Compared with the LXP group， the LXP + inhibitor group showed more significant improvements in these indicators （P＜0.05 or P＜0.01）. Compared with the cisplatin group， the LXP + inhibitor group had lower mRNA expression of HK2 and GAPDH， and lower protein levels of USP47 and HK2 （P＜0.05 or P＜0.01）. Compared with the inhibitor group， the cisplatin group had higher HK2 protein levels， while the LXP + inhibitor group showed lower mRNA expression of BACH1， HK2， and GAPDH （P＜0.05 or P＜0.01）. ConclusionLXP significantly inhibits tumor growth in lung cancer mice， and its mechanism of action may be related to inhibiting the Warburg effect via the USP47/BACH1 pathway.

Hyperparathyroidism is common in patients with chronic kidney disease with reduced renal function and has been observed after kidney transplantation. The optimal treatment for cases in which hyperparathyroidism persists after kidney transplantation has not been determined. Methods: This retrospective study included 83 patients with tertiary hyperparathyroidism who underwent kidney transplantation between 2000 and 2018 at a single tertiary center in Korea. Sixty-four patients underwent parathyroidectomy and 19 patients were treated with cinacalcet following renal transplantation. Biochemical parameters and clinical outcomes were compared between the two groups. Results: Serum calcium and parathyroid hormone (PTH) levels improved in both the parathyroidectomy and cinacalcet groups. One year after treatment, parathyroidectomy resulted in a lower mean serum calcium level than cinacalcet (9.7 ± 0.7 mg/dL vs. 10.5 ± 0.7 mg/dL, p = 0.001). Regarding serum PTH, the parathyroidectomy group showed a significantly lower PTH level than the cinacalcet group at 6 months (129.1 ± 80.3 pg/mL vs. 219.2 ± 92.5 pg/mL, p = 0.002) and 1 year (118.8 ± 75.5 pg/mL vs. 250.6 ± 94.5 pg/ mL, p < 0.001). There was no statistically significant difference in the incidence of kidney transplant rejection, graft failure, cardiovascular events, fracture risk, or bone mineral density changes between the two groups. Conclusion: Parathyroidectomy appears to reduce PTH and calcium levels effectively in tertiary hyperparathyroidism. However, creatinine level and allograft rejection should be monitored closely.

Objective:To analyze the current hotspots of international research on patient safety in recent 10 years, and to provide reference for the scientific research and practical management of patient safety in China.Methods:Based on Web of Science database, CiteSpace visual analysis software was used to analyze the related literature on patient safety collected from January 2009 to December 2018. Word frequency analysis and Co-word clustering were performed on research institutions, authors, countries, journals, cited literature and high frequency keywords.Results:At present, the international research on patient safety is mainly concentrated in European and American higher educational institution with Harvard University as the core; the core journals are The Journal of the American Medical Association, New England Journal of Medicine, Lancet and other journals with the highest international academic influence; the patient safety phase is excavated through keyword co-occurrence cluster analysis. There are 9 international research hotspots, such as safety practice management, safety index research, safety education and safety culture construction. Conclusion:The relevant research background and current situation in the international field of patient safety are in a mature and stable stage. The research team is mainly concentrated in developed areas such as Europe and the United States, and a more closely cooperative and shared research model has been formed. The research hotspot and focus are closely around the multi-disciplinary and multi-field research theme of "patient-centered" advocated by the World Health Organization, which is worthy of domestic researchers' reference and learning. Also, the research and exploration work cored on patient safety domestically needed to be further structured and promoted.

Objective:To explore the application method and effect of online teaching of pediatrics in undergraduate clinical medicine.Methods:From March to August, 2020, two classes of pediatrics were selected as research objects: 67 students from Batch 2016 "5+3" clinical medicine class were taught by providing recorded teaching resources and online communication and answering questions (hereinafter referred to as "recorded courses"); 39 students from Batch 2015 "5+3" clinical medicine class were taught by live courses and online communication and answering questions (hereinafter referred to as "live courses"). Through the questionnaire survey on the two groups of students, the effect of the two online teaching methods were compared and the medical students' views and suggestions on them were collected. SPSS 26.0 was used for statistical analysis.Results:Most of the students in the two groups (98.1%) agreed with the effect of the online teaching of pediatrics and thought it could meet their learning needs. There was no significant difference in the online teaching effect between recorded courses group and live courses group ( P > 0.05). However, they had a poor recognition with the implementation of complete online teaching in the future, while they preferred the combination of online teaching with practical exercises in offline hospitals. Conclusion:Online teaching of pediatrics has been recognized by medical students. The two online teaching methods have their own advantages: recorded courses are more planned and the content is more rigorous; live courses are more interactive and flexible. However, considering that medicine is a highly practical subject, it still needs to be supplemented by offline practice while giving full play to the advantages of online teaching.

Objective:To put forward the teaching improvement direction and promote homogeneous training by analyzing the assessment results of the trainees having the training of cardiopulmonary resuscitation (CPR) in three hospitals like Beijing Children's Hospital, and identifying related influencing factors.Methods:From August 27 to September 27, 2020, students and teachers who participated in the standardized teaching of CPR in three hospitals were included in the study. The teaching process followed the international unified standard curriculum plan for basic life support implementer. The teaching effect was evaluated by written examination, single-person CPR, automatic external defibrillator (AED) skill test and student satisfaction surveys on the team CPR training effect. SPSS 20.0 was used to analyze the differences between groups, and logistic regression analysis was used to find out the factors affecting the assessment results.Results:Twenty-five teachers from three children's hospitals gave lessons for 27 times, and 154 students completed the training and assessments. Among them, 144 passed the written examination, accounting for 93.5%, while 130 passed the single-person CPR+AED skill test at one time, accounting for 84.4%. There were significant differences in the results of written examination and skill test among students from these three hospitals ( P<0.05). Multivariate analysis showed that the professional title of the students and the experience of the teachers affected the scores of the skill test. There were regional differences in students' identities, positions and professional titles, but their learning needs for team CPR were the same, accounting for 44.8%, which was higher than that of single skills. A percentage of 94.8% students believed that the ability of "closed-loop communication" was an important factor in team CPR, and 74.7% students were satisfied with the teaching effect of this skill in class. Conclusion:At present, measures such as dual lecturer system and separation of teaching and examination should be taken to ensure the implementation of standardized teaching. Through standardized quantitative assessment, the quality of training can be ensured and the training effect of CPR homogenization can be realized. Each training center should also improve the teaching level of efficient team CPR to promote the improvement of post competency for medical staff.

Objective:To construct the nursing quality evaluation index system for Intensive Care Unit (ICU) aspiration prevention so as to provide a scientific basis for the monitoring and evaluation of nursing quality of ICU inpatients aspiration prevention.Methods:We initially constructed an item pool of quality evaluation index and a questionnaire by taking "structure-process-outcome" three-dimensional quality model as the framework and combining literature retrieval, semi-structured interviews and group discussions. We also used Delphi method combined with analytic hierarchy process to determine the index system and its weight.Results:In two rounds of questionnaires, the response rates were 100% and 96%, and the authority coefficients were 0.894 and 0.912, and the judgment coefficients were 0.960 and 0.964, and the familiarity coefficients were 0.828 and 0.860, and the Kendall's W were 0.072 and 0.189 respectively. The nursing quality evaluation index system for ICU aspiration prevention included 3 first-level indicators (structural indicators, process indicators, and outcome indicators) , 12 second-level indicators and 48 third-level indicators. Conclusions:The nursing quality evaluation index system for ICU aspiration prevention is scientific, reliable and instructive, which provides a scientific decision-making basis for the clinical practice of ICU nurses and improves the ICU nursing quality and guarantees patient safety.

Objective? To explore the clinical application of information technology in the multidisciplinary chain management of surgical patient handover, in order to reduce the safety hazard in the process of surgical patient handover. Methods? In the contemporary controlled study, 300 patients were selected as the control group from February to July 2017 by cluster sampling, and 303 patients were selected as experimental group from February to July 2018. Traditional sectional handover method was adopted in the control group, to managed the patients＇ handover from each section. In the experimental group, based on the information communication platform between the surgery room and relevant clinical departments, by clinical electronic documents chain transfer method, quality inspection and supervision information feedback technology, to achieve shared decision and improvement of patients handover problems, we built the multidisciplinary management pattern. The two groups were compared for statistical difference from six aspects:the rate of acceptance specification, the accuracy of identity verification method, the rate of operation labeling verification, the accuracy of inventory of items, the evaluation of pipeline patency, and the evaluation of skin condition at the compression site. Results? The rate of standard delivery of surgical patient handover increased from 49.33% to 92.08% in the two groups. The experimental group was better than the control group in the rate of correct delivery of handover from the following five aspects: identity recognition, indication of surgical site, inventory of articles carried, unobstructed pipeline and skin state of the pressure site with statistical significance (P＜ 0.01). Conclusions? The multidisciplinary chain management model of surgical patient handover supported by information technology is effective in clinical application, which can significantly reduce the risk of hazard in patient handover and is worthy of clinical promotion.

Objective To investigate changes in serum levels of antinuclear antibody(ANA), anti?double?stranded DNA(dsDNA)antibody and anti?extractable nuclear antigen(ENA)antibody before and after anti?tumor necrosis factor?α(TNF?α)therapy in psoriatic patients. Methods Clinical data obtained from 32 patients with psoriasis were analyzed retrospectively. Of the 32 patients, 13 received intravenous injection of 5 mg/Kg infliximab at week 0, 2, 6 for 3 sessions, then once every 8 weeks(infliximab group), while other 19 received subcutaneous injection of 25 mg etanercept twice every week(etanercept group). The treatments in the 2 groups both lasted more than 3 months. Serum levels of ANA, anti?dsDNA antibody and anti?ENA antibody and changes of clinical symptoms were detected and observed respectively before each treatment in the infliximab group, as well as every 3- 6 months in the etanercept group. The 75%reduction in psoriasis area and severity index(PASI75)and disease activity score of 28 joints(DAS28) were used to evaluate clinical efficacy. Serum levels of ANA, anti?dsDNA antibody and anti?ENA antibody were measured by indirect immunofluorescence(IIF)assay, Western blot analysis combined with enzyme?linked immunosorbent assay(ELISA), and Western blot analysis, respectively. Results After 3?month treatment, the 32 patients achieved clinical remission to different extents. Of 32 patients receiving anti?TNF?αtherapy, 7(21.9%)developed new autoantibodies. Concretely speaking, 4 patients in the infliximab group developed autoantibodies in 8.3 ± 5.1 months, including 3 cases positive for ANA and 3 for anti?ENA antibody. Three patients in the etanercept group developed autoantibodies in 9.0 ± 3.0 months, including 3 cases positive for ANA and 1 for anti?ENA antibody. Conclusion Partial patients with psoriasis may develop autoantibodies after anti?TNF?αtherapy.

Objective To explore the application value of real time three-dimensional echocardiography (RT-3DE) on right ventricular systolic function in patients with moderate and severe pulmonary hypertension (PH).Methods Twenty-five patients with moderate PH (group Ⅱ) and 25 patients with severe PH(group Ⅲ) were selected,30 normal cases were selected to be control group(group Ⅰ).Tricuspid annular systolic peak velocity (S'),right ventricular Tei index(RIMP),tricuspid annular planet systolic excursion(TAPSE) and right ventricular fractional area change(RVFAC) were measured by conventional ultrasound echocardiography.Right ventricular end diastolic volume (RVEDV),right ventricular end systolic volume (RVESV),right ventricular stroke volume (RVSV) and right ventricular ejection fraction (RVEF) were measured by RT-3DE.The correlation between all the parameters and pulmonary artery systolic blood pressure (PASP),and the correlation between RVEF and S',RIMP,TAPSE,RVFAC were analyzed respectively.Results The differences of RVEDV,RVESV,TAPSE,RVFAC in each group were all statistically significant (all P ＜0.01);RIMP,RVEF between group Ⅰ and group Ⅱ,as well as between group Ⅰ and group Ⅲ were statistically significant (all P ＜0.01);S',RVSV only between group Ⅰ and group Ⅲ was statistically significant (P ＜0.01).The correlation coefficients of RVEF and RIMP,S',TAPSE,RVFAC were-0.707,0.402,0.574,0.763,respectively (all P ＜ 0.01).The best parameters associated with RVEF in each group were RVFAC,RIMP,RVFAC,which correlation coefficients were 0.787,-0.679,0.744,respectively (all P ＜0.01).Conclusions RT-3DE is a objective and accurate method to evaluate the right ventricular volume and RVEF in patients with moderate and severe PH,and it can select out the sensitive indicators to evaluate those patients' right ventricular systolic function from conventional echocardiographic parameters,provide important reference value for clinical.

Objective To assess the left ventricular systolic function in young strength male athletes by three-dimensional speckle tracking echocardiography (3D-STE).Methods A total of 45 young strength male athletes (athlete group) and 30 healthy young men (control group)were enrolled.Traditional echocardiography combined with 3D-STE were applied for all the subjects to obtain heart rate (HR),left ventricular end-diastolic diameter (LVEDD),the thickness of interventricular septum (IVS) and posterior wall thickness (PWT),relative wall thickness (RWT),left ventricular end-diastolic volume (EDV),endsystolic volume (ESV),left ventricular ejection fraction(LVEF),stroke volume (SV),left ventricular mass (LVM),left ventricular global longitudinal strain (GLS),global circumferential strain (GCS),global area strain (GAS),global radial strain (GRS).Results There were a significant increase inLVEDD,IVS,PWT,RWT,EDV,ESV,SV,LVM and significant decrease in HR,GLS,GCS,GAS and GRS in athlete group compared with the control group (P ＜ 0.05).However,there was no significant difference in LVEF between two groups (P ＞0.05).Conclusions There are subclinical changes of left ventricular systolic functionin of young strength male athletes.3D-STE can accurately assess the changes,and provide reliable information for clinical assessment of athletes' heart function.