Objective:To investigate the effectiveness of the S-PAL model (combining a student standardized patient with peer assisted learning) in experimental teaching of physical diagnostics.Methods:Eighty-four undergraduate students of grade 2022 in clinical medicine of Chongqing Medical University were divided into experimental group ( n=44, experimental class teaching combined with S-PAL model-based autonomous practice) and control group ( n=40, experimental class teaching combined with traditional autonomous practice). Performance evaluation and teaching feedback and satisfaction survey were conducted. SPSS 27.0 was used to perform the t-test, chi-square test, and Fisher's exact test. Results:There were no significant differences between the two groups in terms of age, sex, the grade point average, and pre-training theoretical scores. The academic assessment score of the experimental group (66.34±15.45) was significantly higher than that of the control group (55.12±15.02). The experimental group was superior to the control group in clinical skills assessed with the mini-clinical evaluation exercise. The experimental group had a higher degree of satisfaction with teaching than the control group. The experimental group highly accepted autonomous practice based on the S-PAL model.Conclusions:The S-PAL model can improve medical undergraduates' academic performance and satisfaction with teaching in physical diagnostics, and also promote their doctor-patient communication skills, which is a good self-learning model as a complement to physical diagnostics teaching.

To evaluate the advantages of using PBL case library in teaching circulatory system diseases to clinical medicine undergraduate students, a PBL case library was established and applied in teaching practice in the reform of circulatory system teaching. The PBL case library achieved the characteristics of combining theories with cases, morphology with functions, and basic knowledge with clinical knowledge. The PBL case library also realized the informatization, query, and update of cases. Preliminary application showed that the median practical score of students in the case library group was 94.00 points, which was significantly higher than the 92.00 points in the control group ( P=0.005). The average lesson preparation time for teachers in the case library group was (5.00±1.00) hours, which was significantly shorter than the (6.89±0.42) hours in the control group ( P<0.001). The difficulty score for lesson preparation among teachers in the case library group was significantly lower than that of the control group [(1.89±1.05) vs. (3.22±0.44), P<0.001]. However, there were no significant difference in theoretical scores and student satisfaction with teachers and courses. These results suggest that the construction of case library can improve practical teaching effectiveness and enhance the efficiency of lesson preparation for teachers.

Anxiety disorders are one of the most epidemic and chronic psychiatric disorders. An incomplete understanding of anxiety pathophysiology has limited the development of highly effective drugs against these disorders. GPR17 has been shown to be involved in multiple sclerosis and some acute brain injury disorders. However, no study has investigated the role of GPR17 in psychiatric disorders. In a well-established chronic restraint stress (CRS) mouse model, using a combination of pharmacological and molecular biology techniques, viral tracing, in vitro electrophysiology recordings, in vivo fiber photometry, chemogenetic manipulations and behavioral tests, we demonstrated that CRS induced anxiety-like behaviors and increased the expression of GPR17 in basolateral amygdala (BLA) glutamatergic neurons. Inhibition of GPR17 by cangrelor or knockdown of GPR17 by adeno-associated virus in BLA glutamatergic neurons effectively improved anxiety-like behaviors. Overexpression of GPR17 in BLA glutamatergic neurons increased the susceptibility to anxiety-like behaviors. What's more, BLA glutamatergic neuronal activity was required for anxiolytic-like effects of GPR17 antagonist and GPR17 modulated anxiety-like behaviors via BLA to ventral hippocampal CA1 glutamatergic projection. Our study finds for the first and highlights the new role of GPR17 in regulating anxiety-like behaviors and it might be a novel potential target for therapy of anxiety disorders.

In 2022, the American Heart Association/American Stroke Association (AHA/ASA) issued Guidelines for Diagnosis and Treatment of Spontaneous Cerebral Hemorrhage (2022). This evidence-based guidelines provide treatment recommendations of cerebral hemorrhage. In particular, the guidelines emphasize the concepts of cerebral small-vessel disease, treatment of anticoagulant-related cerebral hemorrhage, and early rehabilitation at home. The authors interprets this guideline based on relevant research progress.

Objective To establish an improved type Ⅱ cardio-renal syndrome rat model and evaluate it.Methods Twenty male SD rats were randomly divided into sham and model groups with 7 rats in the sham group and 13 rats in the model group.The model group received the method of squeezing the heart under a small animal anesthesia machine to permanently ligate the left anterior descending branch of the coronary artery to cause myocardial infarction.One week later,unilateral nephrectomy(right nephrectomy)was performed.The rats underwent cardiac echocardiography,pathological staining,and blood and urine tests at 6 weeks to verify model establishment.Results Compared with the sham group,the cardiac function assessed by echocardiography and the endogenous creatinine clearance rate in the model group rats were significantly decreased(P<0.01),and the levels of brain natriuretic peptide,blood creatinine,urea nitrogen,and 24 h urine protein in the model group were significantly increased(P<0.01).HE staining revealed a disordered myocardial arrangement,glomerular atrophy,and inflammatory cell infiltration in model group rats.Picric acid-Sirius red staining showed a significant increase in myocardial collagen fibers,an irregular arrangement of renal tubules,and a large amount of collagen deposition in model group rats.The positive staining area ratio was also significantly increased(P<0.01).Conclusions This improved modeling method provided a typeⅡcardio-renal syndrome rat model with s simple operation,minimal surgical trauma,and low mortality rate.This model simulates the early onset of cardiac and renal function damage and pathological changes in type Ⅱ CRS,laying the foundation for systematic and in-depth research on the pathogenesis and pathological mechanism of type Ⅱ cardio-renal syndrome.

BACKGROUND: The expression of programmed cell death ligand 1 (PD-L1) as a biomarker for immunotherapy in non-small cell lung cancer (NSCLC) is routinely detected in clinical pathology department. However, the spatial heterogeneity of PD-L1 expression in intrapulmonary tumors and extrapulmonary metastases is still a challenge for the clinical testing. This study aims to explore the differences of PD-L1 expression in test samples obtaining from different sites of NSCLC. This study may contribute to the detection strategy of PD-L1 in patients with advanced lung cancer. METHODS: One hundred and thirty-one cases of consecutively detected PD-L1 (22c3 assay, Dako) staining in metastatic NSCLC and 972 cases of non-paired intrapulmonary NSCLC were collected. The discrepancies of tumor proportion score (TPS) of PD-L1 expression in intrapulmonary samples and extrapulmonary metastatic samples of different sites were compared. RESULTS: The positive expression rate of PD-L1 in extrapulmonary metastatic NSCLC (TPS ≥ 1%) was 61.83%, and the TPS was significantly higher than that in intrapulmonary tumors (P=0.03). The PD-L1 scores of the specimens obtained from different sites were significantly different (P=0.007). The positive rates of PD-L1 in liver and adrenal metastases were 85.71% and 77.78% respectively, and their TPS were significantly higher than that of the intrapulmonary samples (P<0.05). The positive rates of PD-L1 in lymph node, bone, brain, soft tissue, and pleural metastases was 40.00%-66.67%, with no significant differences compared to intrapulmonary tumors. The analysis of histological subtype and sample type showed that the PD-L1 score of extrapulmonary samples of adenocarcinoma subtype or surgical specimen was significantly higher than that of intrapulmonary tumors. The analysis of clinicopathological parameters showed that the PD-L1 positive expression or high expression were significantly correlated with male patients, smoking history, and epidermal growth factor receptor (EGFR) wild type. CONCLUSIONS The expression of PD-L1 in metastatic NSCLC is generally higher than that in intrapulmonary tumor, and the positive rate of PD-L1 expression was discrepant in different sites of specimen. The differences of PD-L1 score between extrapulmonary metastatic samples and intrapulmonary samples may be associated with different metastatic sites, histological subtype, and specimen type.
B7-H1 Antigen/metabolism* ; Biomarkers, Tumor/metabolism* ; Carcinoma, Non-Small-Cell Lung/drug therapy* ; Humans ; Immunohistochemistry ; Lung Neoplasms/drug therapy* ; Male

Triterpenoids are a class of natural products of great commercial value that are widely used in pharmaceutical, health care and cosmetic industries. The biosynthesis of triterpenoids relies on the efficient synthesis of squalene epoxide, which is synthesized from the NADPH dependent oxidation of squalene catalyzed by squalene epoxidase. We screened squalene epoxidases derived from different species, and found the truncated squalene epoxidase from Rattus norvegicus (RnSETC) showed the highest activity in engineered Escherichia coli. Further examination of the effect of endogenous cytochrome P450 reductase like (CPRL) proteins showed that overexpression of NADH: quinone oxidoreductase (WrbA) under Lac promoter in a medium-copy number plasmid increased the production of squalene epoxide by nearly 2.5 folds. These results demonstrated that the constructed pathway led to the production of squalene epoxide, an important precursor for the biosynthesis of triterpenoids.
Animals ; Escherichia coli/genetics* ; NADPH-Ferrihemoprotein Reductase ; Protein Engineering ; Rats ; Repressor Proteins ; Squalene ; Squalene Monooxygenase/genetics*

Objective To understand the current distribution and characteristics of advanced schistosomiasis patients who accepted medical assistance in Hunan Province in 2015,so as to provide the evidence for perfecting the policy and measures of the medical assistance to advanced schistosomiasis patients. Methods The patients who had been diagnosed as advanced schis-tosomiasis were verified and confirmed according to the standard of the medical assistance to advanced schistosomiasis patients in Hunan Province in 2015. The epidemiological survey was conducted to investigate the demographic characteristics,history of diagnosis and treatment,and medical assistance to these persons. Results There were 3850 advanced schistosomiasis patients who accepted the medical assistance in Hunan Province in 2015,and among them,2664 patients were male(69.19%),and 1186 were female(30.81%). Most of them(92.82%)came from the main schistosomiasis endemic areas,such as Yueyang, Changde and Yiyang. There were 2369 cases of ascites(61.53%),1466 cases of splenomegaly(38.08%),15 cases of colon proliferation and dwarf(0.39%). The mean age of advanced schistosomiasis patients who accepted the medical assistance was (62.94 ± 11.67)years old,with 64.31% of them being more than 60 years old. The age of initial diagnosis of advanced schistoso-miasis was(53.85 ± 21.32)years old,and it was concentrated in 40-60 years old(68.57%). The mean duration of advanced schistosomiasis was(9.58 ± 10.06)years,and it was mainly distributed in 10 years(75.95%). The mean duration from initial diagnosis of schistosomiasis to advanced schistosomiasis was(22.33 ± 14.20)years. The priority of the medical assistance to ad-vanced schistosomiasis patients was given to the county hospitals(76.57%);and the effective rate of assistance was 94.46%. To-tally 86.57% of the patients with advanced schistosomiasis got the medical insurance(rural cooperative medical care,urban medical care,etc.). Conclusions The burden of the medical assistance to advanced schistosomiasis patients is still heavy be-cause of many patients and low cure rate in Hunan Province. The ascites patients and high age patients should be the important objects of the medical assistance.

Objective To explore the effect of target monitoring and intervention combination strategies on prevention of catheter-related bloodstream infections (CRBSI) in intensive care unit (ICU) patients.Methods Target monitoring and intervention combination strategies were implemented in patients with central venous catheters in ICU since January 2015.372 patients with central venous catheters in 2014 were selected as the control group,and 426 patients who received target monitoring and intervention combination strategy were taken as the intervention group.The incidence rates of CRBSI in two groups were compared.Results There were 5 cases of infection in the intervention group,and the incidence rate of infection was 1.17％;there were 13 cases of infection in the control group,and the incidence rate of infection was 3.49％ (x2=13.38,P＜0.05).The incidence rate of CRBSI in the intervention group was 1.41‰,while it was 4.17‰ in the control group (x2 =8.94,P＜ 0.05).Conclusions Target monitoring and intervention combination strategies can significantly reduce the incidence of CRBSI in patients with central venous catheters in ICU.

Objective To observe the clinical curative effect of Ⅲb~Ⅳstage non-small cell lung cancer treated by radiofrequency ablation combined with chemotherapy. Methods Forty-eight Ⅲb~Ⅳstage non-small cell lung cancer patients were divided into the study group (RFA + chemotherapy) and 74 were in control group (chemotherapy alone) by the method of non randomized controlled. Curative effect was evaluated every two cycles during the treatment. A 6 to 36 months follow-up was conducted after the treatment. Results The objective response rate of experiment group and control group was 58.3%and 41.9%respectively (P>0.05) with no significant difference and disease control rates of experiment group and control group were 91.7% and 75.7% respectively (P<0.05). MST were 14.4 months and 8.2 months respectively (P<0.01), with statistically significant differences in experiment group and control group and clinical benefit efficient were 87 . 5% and 66 . 2% respectively ( P < 0.05). Conclusion The treatment of radiofrequency ablation combined with chemotherapy for advanced non-small cell lung cancer can significantly improve the patient′s survival and the clinical curative effect.