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 investigate the therapeutic effect of anterolateral thigh Flow-through flap transfer surgery combined with Masquelet technique in reconstruction of Gustilo IIIC open fractures of distal tibia.Methods:Between July 2017 and May 2021, 7 patients who had Gustilo IIIC injuries in the lower limb were treated in the Department of Orthopaedics Surgery, Wuxi 9th People's Hospital by emergency surgery with transfer of anterolateral thigh Flow-through flap combined with Masquelet technique. The patients were 5 males and 2 females, aged 36 to 63 (50.0±10.4) years old. Size of soft tissue defects was 11 cm × 4 cm to 23 cm × 7 cm, the length of bone defects was 3.5-7.5 (5.34±1.52) cm and the bridging length for vascular defects was 7-12 (9.21 ± 2.34) cm. The size of the flaps was 12 cm × 5 cm - 24 cm × 8 cm. All patients received postoperative follow-up at the outpatient clinic and complications of wound, fracture healing and the recovery of limb function were observed.Results:All flaps survived uneventfully and successful limb salvage were achieved in all 7 patients, together with all bone grafts healed without infection. The follow-up lasted for 12-38 (26.69±10.73) months. At the last follow-up, the appearance and functional recovery of the lower limbs were satisfactorily. The function of ankle was evaluated according to American Orthopedic Foot and Ankle Society (AOFAS) : 3 patients in excellent, 3 in good and 1 in fair.Conclusion:Emergency anterolateral thigh Flow-through flap transfer surgery with Masquelet technique is a safe, effective and feasible surgical procedure for Gustilo IIIC open fractures of distal tibia. It allows to close the wound and rebuild the blood supply in distal limb in the primary or emergency surgery, and allows to perform bone grafting and internal fixation in stage-II surgery. The patients benefit from high rate of success in limb salvage and good function recovery of the affected limb.

Objectives:To explore the safety and early effectiveness of decompression under full-endoscope and percutaneous pedicle screw fixation in the treatment of single-level thoracolumbar burst fractures.Methods:The clinical data of 9 patients with single-segment thoracolumbar burst fracture treated with spinal canal decompression under full-endoscope and percutaneous pedicle screw fixation from April 2021 to June 2022 in our hospital were analyzed retrospectively,including 7 males and 2 females.The age ranged from 23 to 61(39.3±9.1)years old.According to AO classification,there were 6 cases of type A,2 cases of type B and 1 case of type C.Fracture segments were T12 in 2 cases,L1 in 3 cases,L2 in 3 cases,and L3 in 1 case.According to the classification of American Spinal Injury Association(ASIA)grading,there were 2 cases of type C,2 cases of type D,and 5 cases of type E.The decompression and percutaneous pedicle screw fixation were operated through the same incision in the injured vertebrae for screw placing.The operation-related indexes and complications were recorded.The patients'low back pain was evaluated by visual analogue scale(VAS)score before operation,on 3rd day after operation and at the last follow-up.The sagittal Cobb angle,height ratio of vertebral anterior edge,and the rate of spinal canal occupation were measured on spinal X-ray and CT images,and the recovery of neurological function was evaluated at the last follow-up.Results:All 9 patients successfully completed the operation,and the operative time was 105-145min(1 12.4± 21.2min),bleeding volume was 50-110mL(83.9±19.6mL),and hospitalization time was 7-13d(9.1±1.3d).No serious complications such as wound infection,cerebrospinal fluid leakage,aggravated nerve injury occurred.The follow-up time was 6-13months(8.4±3.9 months),all the fractures healed successfully,and the healing time was 3-6 months(4.7±1.6 months).The VAS score of low back pain on the 3rd day after operation and at final follow-up significantly improved compared with that before operation(P＜0.05),and it was also significantly improved at the last follow-up compared with that on the 3rd day after operation(P＜0.05).The Cobb angle,anterior height ratio of injured vertebrae,and invasion rate of spinal canal were significantly improved compared with those before operation(P＜0.05),respectively,but there was no statistical difference between the last follow-up and postoperative 3d(P＞0.05).One patient recovered from grade C to grade D of ASIA classification,while another three patients with neurological injury recovered completely.Conclusions:Decompression under full-endoscope and percutaneous pedicle screw fixation through the same incision in the injured vertebrae for screw placement in the treatment of single-level thoracolumbar burst fractures can obtain effective nerve root and spinal canal decompression,with good correction and small operative trauma,which is a safe and effective option.

Objective:To study the application of hyperbaric oxygen (HBO) combined with out-of-hospital continuing nursing based on three-dimensional quality evaluation model in patients with ulcerative colitis, and investigate the factors influencing patients’ quality of life.Methods:All research objects were treated with HBO in Yan’an University Affiliated Hospital. The patients ( n=60) with ulcerative colitis treated from January 2018 to December 2018 were selected as the control group; while the patients ( n=60) treated from January 2019 to December 2019 were selected as the observation group. The control group received the conventional out-of-hospital continuing nursing, while the observation group received out-of-hospital continuing nursing based on three-dimensional quality evaluation model. The nursing time for both groups were three months. The negative emotions, quality of life, and self-care ability of the two groups were compared, and the risk factors affecting the quality of life were analyzed. Results:After nursing, the Zung self-rating anxiety scale (SAS) and Zung self-rating depression scale (SDS) scores of the two groups decreased significantly, and the observation group decreased more significantly than the control group in terms of the SAS scores (33.14±3.86 vs. 43.55±3.77) and the SDS scores (35.47±2.95 vs. 45.46±3.46), and the differences were statistically significant ( P<0.05). The physical functioning ( t=2.563, P=0.012), role physical ( t=3.539, P=0.001), bodily pain ( t=2.448, P=0.016), general health ( t=5.301, P<0.001), vitality ( t=2.489, P=0.014), social functioning ( t=3.860, P<0.001), role emotional ( t=5.883, P<0.001), mental health ( t=3.729, P<0.001), and other indicators of the observation group were significantly higher than those of the control group. After nursing, the assessment scores of drug dependence, psychological adjustment ability, sleep quality, diet adjustment, and pain recognition in the observation group were significantly higher than those in the control group; the differences in quality of life assessment involving gender, education level, monthly income, marital status, mental status, exercise, lifestyle, drinking, smoking, and comorbid chronic diseases between the two groups were significant ( P<0.05); through multivariate analysis, gender, education level, monthly income, marital status, mental status, exercise, lifestyle, drinking, smoking, and comorbid chronic diseases were independent risk factors affecting the quality of life of patients. Conclusion:HBO combined with out-of-hospital continuing nursing based on three-dimensional quality evaluation model is of positive influence on the negative emotions and quality of life of patients with ulcerative colitis. And it is suggested high attention be paid to unmarried patients, and the patients with low monthly income, severe negative emotions, low education level, and chronic diseases.

Objective:To study the application of hyperbaric oxygen (HBO) combined with out-of-hospital continuing nursing based on three-dimensional quality evaluation model in patients with ulcerative colitis, and investigate the factors influencing patients’ quality of life.Methods:All research objects were treated with HBO in Yan’an University Affiliated Hospital. The patients ( n=60) with ulcerative colitis treated from January 2018 to December 2018 were selected as the control group; while the patients ( n=60) treated from January 2019 to December 2019 were selected as the observation group. The control group received the conventional out-of-hospital continuing nursing, while the observation group received out-of-hospital continuing nursing based on three-dimensional quality evaluation model. The nursing time for both groups were three months. The negative emotions, quality of life, and self-care ability of the two groups were compared, and the risk factors affecting the quality of life were analyzed. Results:After nursing, the Zung self-rating anxiety scale (SAS) and Zung self-rating depression scale (SDS) scores of the two groups decreased significantly, and the observation group decreased more significantly than the control group in terms of the SAS scores (33.14±3.86 vs. 43.55±3.77) and the SDS scores (35.47±2.95 vs. 45.46±3.46), and the differences were statistically significant ( P<0.05). The physical functioning ( t=2.563, P=0.012), role physical ( t=3.539, P=0.001), bodily pain ( t=2.448, P=0.016), general health ( t=5.301, P<0.001), vitality ( t=2.489, P=0.014), social functioning ( t=3.860, P<0.001), role emotional ( t=5.883, P<0.001), mental health ( t=3.729, P<0.001), and other indicators of the observation group were significantly higher than those of the control group. After nursing, the assessment scores of drug dependence, psychological adjustment ability, sleep quality, diet adjustment, and pain recognition in the observation group were significantly higher than those in the control group; the differences in quality of life assessment involving gender, education level, monthly income, marital status, mental status, exercise, lifestyle, drinking, smoking, and comorbid chronic diseases between the two groups were significant ( P<0.05); through multivariate analysis, gender, education level, monthly income, marital status, mental status, exercise, lifestyle, drinking, smoking, and comorbid chronic diseases were independent risk factors affecting the quality of life of patients. Conclusion:HBO combined with out-of-hospital continuing nursing based on three-dimensional quality evaluation model is of positive influence on the negative emotions and quality of life of patients with ulcerative colitis. And it is suggested high attention be paid to unmarried patients, and the patients with low monthly income, severe negative emotions, low education level, and chronic diseases.

Objective:To investigate the therapeutic efficacy of Ilizarov bone shortening-lengthening technique for tibial defects of bone and soft tissue without vascular injury.Methods:A retrospective analysis was made of the 28 patients who had been treated by Ilizarov bone shortening-lengthening technique at Department of Orthopaedics, Wuxi No.9 People's Hospital from January 2007 to October 2017 for tibial de-fects of bone and soft tissue without vascular injury.They were 20 males and 8 females, aged from 18 to 69 years (average, 36.4 years).By the Gustillo classification, 5 cases belonged to type Ⅱ, 6 to type ⅢA and 17 to type ⅢB.Infection was complicated in 17 cases.After debridement or epluchage, the area of skin defects ranged from 4 cm × 3 cm to 16 cm × 5 cm and the length of bone defects from 4.5 to 11.0 cm (average, 6.9 cm).The wound healing, bone healing, functionary recovery of lower extremity and complications were observed postoperatively.Bone healing and functional recovery of lower extremity were evaluated according to the grading of Association for the Study and Application of the Method of Ilizarov (ASAMI).The complications associated with Ilizarov technique were assessed according to the Paley criteria.Results:The follow-up for all the patients lasted from 12 to 45 months (average, 20.5 months).The healing time for wounds ranged from 13 to 35 days (average, 21.9 days), the healing time for lengthened bone from 6 to 12 months (average, 8.9 months), and the healing time for bone defects at the dock sites from 6 to 11 months (8.3 months).According to the ASAMI grading, the bone healing was excellent in 21 cases and good in 7, giving an excellent to good rate of 100%(28/28) while the functionary recovery of lower extremity was excellent in 10 cases, good in 15, fair in 2 and poor in one, giving an excellent to good rate of 89.3%(25/28).The incidence was 14.3%(4/28) for major complications after Ilizarov surgery, 57.1%(16/28) for minor complications, 60.7%(17/28) for overall complications, and 1.7 times for each case.Conclusion:In the treatment of tibial defects of bone and soft tissue without vascular injury, Ilizarov bone shortening-lengthening technique can deal with the difficulties in repair of soft tissue defects, characterized by simplified wound closure, fast and improved bone healing at the dock sites, reduced complications and satisfactory functionary recovery of lower extremity.

Objective :To evaluate therapeutic effect of allisartan isoproxil tablet on carotid atherosclerosis (CAS) le‐sion in patients with mild to moderate essential hypertension (EH).Methods :A total of 120 patients with mild to moderate EH complicated CAS treated in our hospital were enrolled .They were randomly divided into valsartan group (n＝60 ,received valsartan 80mg／d) and allisartan isoproxil group (n＝60 ,received allisartan isoproxil tablet 240mg／d) ,both groups received measure by carotid vascular ultrasound before treatment ,24 weeks and 48 weeks af‐ter treatment and its result were compared between two groups .Results :Compared with before treatment ,there were significant reductions in IMT ,size ,thickness and number of carotid atherosclerotic plaques on 24 weeks and 48 weeks after treatment in two groups ,and above indexes of 48 weeks were significantly lower than those of 24 weeks , P＜0.05 or ＜0.01. The decreased value of IMT in allisartan isoproxil group was significantly higher than that of valsartan group ,and there were no significant difference between two groups in time point of size ,thickness and number of carotid atherosclerotic plaques , P＞0.05 all.Conclusion :Therapeutic effect of two drugs on size ,thick‐ness and number of carotid atherosclerotic plaques are similar ;but therapeutic effect of allisartan isoproxil tablet on IMT is significantly better than that of valsartan .

Objective To investigate the expression of T cell immunoglobulin and mucindomain-containing molecule-3 (TIM3) on PBMCs,and the plasma concentrations of soluble forms of Galetcin9 and their clinical relationship with rheumatoid arthritis (RA).Methods Peripheral blood samples were collected from 39 patients,25 osteoarthritis (OA) patients and 20 healthy subjects (HC).The expressions of TIM3 on peripheral blood mononuelear cells (PBMCs) were detected by flow cytometry.The concentrations of soluble Galetcin9 were assessed by enzyme linked immunosorbent assay (ELISA).And the relationship between their expression levels and clinical manifestations were analyzed.Levene F test was used for statistical analysis,normal distribution data were compared by t test and Pearson correlation analysis,while Mann-Whitney U test and Spearman correlation analysis were used for non-normal distribution data.Results The expression of TIM3 on CD4+ T cells was significantly higher than that of the HC [(14.7±3.2)％ vs (5.1±0.8)％,t=2.339,P=0.022 7],while there was no statistical difference between the RA group and the OA group [(14.7±3.2)％ vs (5.8±0.4)％,t=1.928,P=0.058 9].The expression of TIM3 was significantly correlated with the concentration of RF in the serum and the corresponding DAS28 score (r=0.325 8,P=0.043 0;r=0.407 5,P=0.010 0).The expression of TIM3 on CD8 + T cells in RA patients was significantly higher than that in the HC and OA [(21.1±3.4)％ vs (8.3±1.5)％,t=2.531,P=0.0142;(21.1±3.4)％ vs (10.7±1.0)％,t=2.314,P=0.024 0] which was significantly correlated with the concentration of RF in serum and the corresponding DAS28 score (r=0.451 5,P=0.003 9;r=0.524 1,P=0.000 6) as well.However,the expression of TIM3 on CD56+ NK cells was not significantly different from that of either OA or HC[(56.4±3.4)％ vs (50.6±3.8)％,t=1.047,P=0.299 8;(56.4± 3.4)％ vs (56.1±3.4)％,t=0.048,P=0.961 9],the concentration of serum RF and the corresponding DAS28 score were not significantly related.We also found that plasma Galectin 9 concentrations in RA patients were significantly higher than those of OA patients [(4.24±0.22) ng/ml vs (3.15±0.18) ng/ml,t=3.187,P=0.024] and healthy subjects [(4.24±0.22) ng/ml vs (2.55±0.14) ng/ml,t=5.567,P＜0.01],which was correlated with RF and DAS28 (r=0.479 2,P=0.002 0;r=0.353 0,P=0.027 5) while there was no correlation with CRP (r=0.176 3,P=0.283 1).Conclusion The upregulated expressions of TIM3 on peripheral lymphocytes and the high levels of plasma concentration of soluble Galectin 9 are closely correlated with the severity of the disease,suggesting that TIM3/Galectin 9 pathway may play a critical role in the pathogenesis of RA.