Objective:To explore the implementation effect of the"four-step teaching of encouraging and sharing"combined anchor-based teaching mode in the course of laboratory diagnostics under the background of automatic laboratory.Methods:The"four-step teaching of encouraging and sharing"combined anchor-based teaching mode conducted teaching in course of laboratory diagnostics through carefully designed"anchors",self-directed learning,a second"anchor"placement,and outcome sharing.A total of 224 medical students of the 2021 and 2022 grades,who majored Chinese medicine in Beijing University of Chinese Medicine and conducted their internships in the Laboratory of Dongfang Hospital,Beijing University of Chinese Medicine from April 2023 to April 2025,were selected.According to different teaching modes,the 108 medical students of 2022 grade were divided into the combined teaching group that adopted the"four-step teaching of encouraging and sharing"combined anchor-based teaching mode to conduct teaching,and 116 medical students of 2021 grade were divided into the conventional teaching group that adopted conventional teaching mode to conduct teaching.After completed the courses,the comprehensive competency of these students of two groups during the internship were measured,and the application effect of the"four-step teaching of encouraging and sharing"combined anchor-based teaching mode was assessed by self-made survey questionnaire.Results:The scores of theoretical knowledge test and clinical case analysis assessment of the students of combined teaching group were respectively(44.19±2.36)and(48.20±1.52),all of which were higher than(38.36±2.14)and(37.56±2.47)of conventional teaching group,and the differences of them between two groups were statistically significant(t=28.72,55.71,P<0.05),respectively.In the combined teaching group,91.67%of the students expressed a preference for the"four-step teaching of encouraging and sharing"combined anchor-based teaching mode.Conclusion:Under the background of automatic laboratory,the"four-step teaching of encouraging and sharing"combined anchor-based teaching mode of laboratory diagnostics can effectively enhance students'transfer ability for knowledge,and strengthen their self-directed learning awareness,and lay a solid foundation for training clinical practice abilities of medical students.

Objective:To explore the implementation effect of the"four-step teaching of encouraging and sharing"combined anchor-based teaching mode in the course of laboratory diagnostics under the background of automatic laboratory.Methods:The"four-step teaching of encouraging and sharing"combined anchor-based teaching mode conducted teaching in course of laboratory diagnostics through carefully designed"anchors",self-directed learning,a second"anchor"placement,and outcome sharing.A total of 224 medical students of the 2021 and 2022 grades,who majored Chinese medicine in Beijing University of Chinese Medicine and conducted their internships in the Laboratory of Dongfang Hospital,Beijing University of Chinese Medicine from April 2023 to April 2025,were selected.According to different teaching modes,the 108 medical students of 2022 grade were divided into the combined teaching group that adopted the"four-step teaching of encouraging and sharing"combined anchor-based teaching mode to conduct teaching,and 116 medical students of 2021 grade were divided into the conventional teaching group that adopted conventional teaching mode to conduct teaching.After completed the courses,the comprehensive competency of these students of two groups during the internship were measured,and the application effect of the"four-step teaching of encouraging and sharing"combined anchor-based teaching mode was assessed by self-made survey questionnaire.Results:The scores of theoretical knowledge test and clinical case analysis assessment of the students of combined teaching group were respectively(44.19±2.36)and(48.20±1.52),all of which were higher than(38.36±2.14)and(37.56±2.47)of conventional teaching group,and the differences of them between two groups were statistically significant(t=28.72,55.71,P<0.05),respectively.In the combined teaching group,91.67%of the students expressed a preference for the"four-step teaching of encouraging and sharing"combined anchor-based teaching mode.Conclusion:Under the background of automatic laboratory,the"four-step teaching of encouraging and sharing"combined anchor-based teaching mode of laboratory diagnostics can effectively enhance students'transfer ability for knowledge,and strengthen their self-directed learning awareness,and lay a solid foundation for training clinical practice abilities of medical students.

Objective:To investigate the clinical efficacy of robot-assisted screw fixation for unstable pelvic ring multifocal fractures.Methods:A retrospective analysis was performed on 76 patients with unstable pelvic fractures treated with orthopaedic robot-assisted screw fixation in the Trauma Center of the Affiliated Central Hospital of Shandong First Medical University from January 2015 to June 2022, including 43 males and 33 females, aged 52.53±13.68 years (range, 16-87 years). There were 43 cases of falling injuries from high places, 22 cases of traffic accidents, 11 cases of crushing injuries and heavy objects. Fifty-five patients were employed before the injury, while 21 were not. Fractures were classified according to the Tile classification, with 72 cases classified as type B and 4 cases as type C. Robot-assisted fixation techniques included internal fixator (INFIX), anterior ring screws, sacroiliac screws, and LC-II screws. Intraoperative blood loss, fluoroscopy frequency, surgical time, and the success rate of initial guidewire placement were recorded. Fracture reduction quality was evaluated using the Matta criteria, and postoperative pelvic function recovery was assessed using the Majeed criteria.Results:A total of 150 surgical procedures were performed on 76 patients, including 34 cases of INFIX fixation, 48 cases of anterior ring screws, 61 cases of sacroiliac joint screws, and 7 cases of LC-II screws. The mean intraoperative fluoroscopy frequency was 46.63±17.50 times (range, 15-93 times). Intraoperative fluoroscopy frequency varied among different fixation techniques, with INFIX group at 16.44±4.32 times, LC-II group at 21.59±5.80 times, anterior ring screws group at 29.44±11.65 times, and sacroiliac screws group at 23.10±11.87 times. The intraoperative blood loss was 20 (10, 47.5) ml (range, 5-300 ml), and the surgical time was 105 (86, 150) min (range, 30-290 min). The mean surgical time varied among different fixation techniques. All patients were followed up for an average of 6.46±2.26 months (range, 3-16 months). Clinical healing was achieved in all patients within 6 months, with an average time of 3.14±0.50 months. At the last follow-up, fracture reduction quality assessed by the Matta score was excellent in 21 cases and good in 43 cases, with an excellent/good rate of 84% (64/76). The Majeed score was 81.82±9.14 points (range, 50-92 points). For patients who were employed before the injury, the Majeed score was 86.55±4.85 points (range, 60-92 points), with 49 cases rated as excellent, 5 cases as good, and 1 case as fair. For patients who were not employed before the injury, the Majeed score was 69.43±5.34 points (range, 50-73 points), with 18 cases rated as excellent, 2 cases as good, and 1 case as fair. The overall excellent and good rate was 97% (74/76). Among patients who underwent INFIX internal fixation, 8 cases experienced lateral femoral cutaneous nerve injury postoperatively, all of which recovered sensation after 3 months; 1 case using LC-II screws experienced screw loosening postoperatively and was advised to reduce activity, then the screw was removed after fracture healing at 6 months postoperatively; 1 case using anterior ring channel screws experienced surgical site infection postoperatively, which was controlled after debridement.Conclusion:In the treatment of unstable pelvic ring multiple fractures, robot-assisted screw fixation has less blood loss, less fluoroscopy times, high success rate of planning guide needle, satisfactory reduction quality and postoperative function.

Objective To explore the immunopathological mechanism for the imbalance between the positive signal mediated by inducible costimulator (ICOS) and the negative signal mediated by programmed death-1 (PD-1) in patients with myasthenia gravis (MG).Methods Eighty-two patients with MG,56 healthy controls (HC) and 20 non-MG (NMG) patients,collected in the First Affiliated Hospital of Suzhou University from February 2014 to December 2016,were chosen to participate in the study.The expression of ICOS and PD-1 on peripheral blood mononuclear cells was detected by immuno-fluorescence staining and flow cytometry.The levels of soluble programmed death-1 (sPD-1),soluble programmed death ligand 1 (sPD-L1),IL-4 and other cytokines were detected by enzyme-linked immunosorbent assay.Results (1) Flow cytometry analysis:The co-expression of PD-1,ICOS on CD4 + T cells from MG group (9.64％ (8.82％)) was higher than in HC (1.81％ (2.10％),Z =-7.389,P ＜0.05) and NMG group (2.86％ (1.49％),Z =-4.636,P ＜ 0.05).The expression of ICOS on CD4 + T cells,ICOS ligand (ICOSL) on CD14+ monocytes and CD19+ B cells were increased in MG group comparing with that of the control groups.The proportion of PD-1 + CD4 + T cells (MG group 16.82％ (10.66％),HC 9.34％ (9.18％),Z =-4.345,P＜0.05;NMG group 7.07％ (3.40％),Z=-4.594,P＜0.05) and PD-1 Ligand (PD-L1) + CD14+ monocytes was higher in MG patients.All of these were detected by flow cytometry.(2) ELISA analysis:Serum sPD-1 expression significantly increased in MG group compared with that in the control groups (MG group (1.87 ± 0.64) ng/ml,NMG group (1.49 ± 0.70) ng/ml,t =2.04,P ＜ 0.05;HC (1.05 ± 0.50)ng/ml,t =2.08,P ＜ 0.05),while for serum sPD-L1,there was no significant difference between MG and control groups.(3) Serum cytokines detection:The expression of IL-4 was increased in MG patients (MG group (61.88 ±5.15) pg/ml,HC (32.03 ±1.84) pg/ml,t=2.50,P＜0.05;NMG group (42.62± 3.31) pg/ml,t =2.34,P ＜0.05),and there was a negative correlation between the expression of sPD-1 and the concentration of IL-4.Conclusions The increased expression of PD-1 + ICOS + CD4 + T cells suggested the subset involved in the pathological progress of MG.sPD-1 might disturb the ligation of PD-1 on T cells and PD-L1 on antigen presenting cells,while the ligation of ICOS and ICOSL passed positive signal,leading to over activity of the subsets and the progression of disease.