Aiming at the current situation of insufficient integration of medical humanities teaching and clinical practice,as well as the need for further research and improvement in the teaching system,guided by the concept of medicine and humanistic literacy integration advocated by the new medical science,this paper deeply discussed the construction of clinical medical humanities teaching system from four aspects,including the selection of clinical medical humanities teachers and team building;the teaching path that combines theoretical education,narrative medicine,and clinical skill training infused with medical humanities content;curriculum ideological and political construction with the goal of establishing the core concept and value orientation of"patient-centered";the teaching assessment and evaluation method characterized by formative evaluation.The clinical medical humanities teaching system emphasizes the practicality,experiential,and emotional aspects of medical humanities teaching,deeply integrating medical humanities with clinical practice teaching content throughout the clinical internship period of medical education,with a view to enhancing the humanistic practice ability and literacy of medical students.

Objective To use metabolomics method to study the metabolic profiles of amino acids and lysophosphatidylcholine(LPC)in the serum of rats with nonalcoholic fatty liver disease(NAFLD),to identify biomarkers for NAFLD,and to speculate on the possible mechanism responsible for its occurrence.Methods NAFLD rats were prepared by feeding a high-fat diet and intraperitoneal injection of carbon tetrachloride.Levels of 15 LPCs and 18 amino acids in the serum were determined in control and NAFLD rats by liquid chromatography-mass spectrometry.Changes in serum LPC and amino acid metabolic profiles in NAFLD rats were analyzed by principal component analysis and orthogonal partial least squares discriminant analysis.Correlations between biomarkers and NAFLD were analyzed by Pearson's correlation analysis.Results The metabolic profiles of serum LPC and amino acids differed significantly between the NAFLD group and the control group and were completely distinct.LPC(20∶1),arginine,and glutamic acid had significant contributions to NAFLD and were identified as biomarkers.Furthermore,LPC(20∶1)and arginine were significantly correlated with serum biochemical indicators such as aspartate transaminase,alanine transaminase,low-density lipoprotein,and total bilirubin.Conclusions The metabolic profiles of serum LPC and amino acids may be closely related to NALFD.

This article aims to comprehensively review the concept, etiology, classification, classical cortical mapping, assessment, a proposed flowchart for the diagnosis and differential diagnosis, treatment, rehabilitation, mechanisms of development and recovery, prognosis, and influencing factors for post-stroke aphasia(PSA)types in the Chinese language.We emphasize the necessity and significance of neuroimaging assessment of the brain and blood vessels and neuropsychological assessment in the diagnosis and differential diagnosis of PSA in Chinese.We also recommend and encourage the use of the dichotomies of internal vs.external and anterior vs.posterior as a starting point, based on the association of anatomical locations of the brain and blood vessels with brain language areas and language disorders.A classification system of PSA in Chinese developed from this approach in the form of a flowchart is well-suited for guiding the clinical treatment of cerebral stroke.Incorporating the "four elements" , the flowchart enables convenient diagnosis, classification and differential diagnosis of PSA in Chinese and facilitates targeted and personalized rehabilitation planning to benefit the patient.This article introduces the use of memantine, piracetam, donepezil and other drugs for PSA treatment, evaluates clinical trials on memantine conducted in China and abroad and its mechanisms of action for the treatment of PSA, and discusses how rehabilitation therapy achieves therapeutic effects.For the treatment of PSA, clinical research and practice using drugs such as memantine, piracetam and donepezil in combination with non-pharmacotherapy and rehabilitation training should be promoted.

Objective:To explore the initial motivation of nursing students to engage in voluntary service for the aged, and to provide scientific basis for the formulation of strategies and measures of voluntary service for the aged.Methods:Totally 25 nursing students volunteers who regularly participated in the volunteer service for the aged in Changsha First Welfare Home were selected by objective sampling method for semi-structured in-depth interviews, and the data were analyzed by Colaizzi phenomenological 7-step analysis method.Results:Four themes of nursing students' initial motivation to participate in voluntary service for the aged were extracted: self-interest motivation, altruistic motivation, affinity motivation and achievement motivation. Among them, self-interest motivation included two sub-themes: enriching college life and life experience, improving one's own ability and gaining professional experience; altruistic motivation included two sub-themes: accompanying and helping the elderly and eliminating loneliness of the elderly; affinity motivation included two sub-themes: establishing emotional sustenance and making up for the lack of emotion; achievement motivation included two sub-themes: facing challenges bravely, acquiring a sense of achievement, serving society and others, and realizing one's own value.Conclusion:Nursing students have a clear initial motivation to participate in the voluntary service for the aged of the aged care facilities, and schools can strengthen the relevant education for students to participate in voluntary service in the training of nursing talents. The voluntary service for the aged can formulate corresponding development strategies and incentives according to the initial motivation of nursing students, so that promote the expansion and stability of the voluntary service for the aged team, and promote the development and improvement of voluntary service for the aged.

Objective To study the effects of painful procedures during neonatal period on rats' hippocampal gene expression in later life.Method A total of 28 newborn male rats were randomly assigned into two equal groups.From day1 (P1) to day7(P7) after birth,rats in the pain group received four times of needle acupuncture at the foot everyday,simulating the infants' experience in the NICU.Rats in control group were touched at the same side of the foot with a cotton swab.Transcriptome sequencing of the hippocampus of the two groups were examined on day 8 (P8) and day 21 (P21).The gene expression profiles were established and the differentially expressed genes were screened for functional analysis.Quantitative Real-time polymerase chain reaction (qRT-PCR) was used to confirm these differentially expressed genes (GABRB1,GRIN2A,IL1 RAPL1) related to pain-stimulated response or brain cognition,and one of the key genes was further verified using Western blotting.Result The sequencing results showed that there were only 6 differentially expressed genes in hippocampal tissues of rats on P8 in the two groups.Howerer,the number increased to 53 on P21 and 85.0％ of these genes were down-regulated (45/53).Gene Ontology (GO) function enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis showed that the differentially expressed genes were mainly expressed on the cell membrane,voltage-gated ion channels,synapses,neurotransmitter receptors,immune responses,etc.The qRT-PCR and Western-blot results of key genes were consistent with the transcriptome sequencing.Conclusion Pain stimuli at an early stage after birth may trigger differentially expression of voltage-gated ion channel proteins,neurotransmitter receptors,and some key genes such as GABRB1 on hippocampal synaptic cell membranes in rats.These phenomenon may provide initial explanation for the molecular mechanism of early pain stimuli on neonatal brain development.

Objective To reveal the virulence genes and the polymorphisms of chromosomal 16S rRNA gene of Yersinia enterocolitic strains isolated from different districts in Jiangsu Province,2015. Methods Five virulence genes(ail,virF,yadA,ystA and ystB)of Yersinia enterocolitic strains isolated from different districts in Jiangsu Province were detected by using polymerase chain reaction(PCR),and phylogenetic analysis of chromosomal 16S rRNA gene was performed by amplification and sequencing. Results In this study,73 Yersinia enterocolitic strains were collected in Jiangsu Province in 2015.Among them,56(76.7%)strains carried virulence genes,and ail-virF-yadA -ystA -ystB+were the dominate types in diarrhea patients and other hosts.All strains can be clustering into 4 groups according to the phylogenetic analysis of chromosomal 16S rRNA gene.Conclusions The non-pathogenic Yersinia enterocolitic(ystB+)is the dominant strain in Jiangsu province,and the pathogenic strains are also found in this region.The result of phylogenetic analysis of chromosomal 16S rRNA gene and the profiles of virulence genes are highly consistent.

Liquid biopsy is a diagnostic approach by analyzing body fluid samples. Peripheral blood is the most common sample. Urine, saliva, pleural effusion and ascites are also used. Now liquid biopsy is mainly used in the area of neoplasm diagnosis and treatment. Compared with traditional tissue biopsy, liquid biopsy is minimally invasive, convenient to sample and easy to repeat. Liquid biopsy mainly includes circulating tumor cells and circulating tumor DNA (ctDNA) detection. Detection of ctDNA requires sensitive and accurate methods. The progression of next-generation sequencing (NGS) and digital PCR promote the process of studies in ctDNA. In 2016, Nature published the result of whole-genome sequencing study of breast cancer. The study found 1 628 mutations of 93 protein-coding genes which may be driver mutations of breast cancer. The result of this study provided a new platform for breast cancer ctDNA studies. In recent years, there were many studies using ctDNA detection to monitor therapeutic effect and guide treatment. NGS is a promising technique in accessing genetic information and guiding targeted therapy. It must be emphasized that ctDNA detection using NGS is still at research stage. It is important to standardize ctDNA detection technique and perform prospective clinical researches. The time is not ripe for using ctDNA detection to guide large-scale breast cancer clinical practice at present.

OBJECTIVETo observe the differences in the clinical therapeutic effects on insomnia of spleen and stomach disharmony pattern in comparison of the combination of acupoint catgut-embedding therapy and auricular point pressure with the simple application of auricular point pressure.

METHODSOne hundred and eighty patients of insomnia of spleen and stomach disharmony pattern were randomized into an observation group (93 cases) and a control group (87 cases). In the observation group, the combination of acupoint catgut-embedding therapy and auricular point pressure was adopted. The acupoint catgut-embedding therapy was applied at Zhongwan (CV 12), Anmian (Extra), Xinshu (BL 15), Pishu (BL 20), Weishu (BL 21), Zusanli (ST 36), Yinlingquan (SP 9) and Sanyinjiao (SP 6), once every two weeks. The auricular point pressure was applied to Shenmen (TF), Pizhixia (AT), Xin (CO), Pi (CO), Wei (CO) on both sides alternatively, twice a week. The duration of treatment was 2 months for the two groups. In the control group, the auricular point pressure was simply used with the same points, manipulation and treatment duration as the observation group. After treatment, the clinical therapeutic effects were observed in the patients of the two groups. The Pittsburgh sleep quality index (PSQI) score was compared before and after treatment in the two groups. The recurrence was followed up in 3 months after the end of treatment.

RESULTSIt was observed that 2 cases were dropped out in the observation group, 4 cases in the control group. The dropped out cases were considered to be ineffective. After treatment, the total effective rate was 92.5% (86/93) in the observation group and was 80.5% (70/87) in the control group. The result in the observation group was better than that in the control group (<0.05). After treatment, PSQI scores were all reduced apparently in the two groups as compared with those before treatment (both<0.05). The score after treatment and the different value before and after treatment in the observation group were lower than those in the control group (both<0.05). In 3-month follow-up after treatment, the recurrence rate was 3.2% (3/93) in the observation group, which was lower than 13.8% (12/87) in the control group (<0.05).

CONCLUSIONIn the treatment of insomnia of spleen and stomach disharmony pattern, the acupoint catgut-embedding therapy combined with auricular point pressure are superior to the simple application of auricular point pressure in the clinical therapeutic effects, improving sleep quality and reducing the recurrence rate.

Objective To observe and compare the clinical efficacy of fire needling versus electroacupuncture in treating knee osteoarthritis of kidney and marrow deficiency type.Methods One hundred and ten patients with knee osteoarthritis of kidney and marrow deficiency type were randomly allocated to two groups, a fire needling group of 56 cases and an electroacupuncture group of 54 cases. The fire needling group received filiform needle acupuncture and fire needle pricking and the electroacupuncture group, electroacupuncture. Treatment was given once every other day, for a total of four weeks as one course. The Visual Analogue Scale (VAS) score and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score were recorded in the two groups before and after treatment. The clinical therapeutic effects were compared between the two groups.Results The VAS score and the WOMAC subscores significantly decreased in both groups after treatment compared with those before treatment (P<0.01). There were no statistically significant post-treatment differences in the VAS score and the WOMAC subscores between the two groups (P>0.05). The VAS score and the WOMAC subscores decreased further in both groups at four weeks after treatment compared with those at the end of treatment (P<0.01). In the electroacupuncture group, there were statistically significant differences in the VAS score and the WOMAC pain and stiffness subscores between eight weeks and four weeks after treatment (P<0.01) and in the WOMAC pain, stiffness and joint function subscores between at eight weeks after treatment and at the end of treatment (P<0.01). In the fire needling group, there were statistically significant differences in the VAS score and the WOMAC pain, stiffness and joint function subscores between at eight weeks after treatment and at the end of treatment (P<0.01). At four weeks after treatment, the VAS score and the WOMAC pain, stiffness and joint function subscores were significantly lower in the fire needling group than in the electroacupuncture group (P<0.05,P<0.01). At eight weeks after treatment, the VAS score and the WOMAC pain and stiffness subscores were still significantly lower in the fire needling group than in the electroacupuncture group (P<0.01). The total efficacy rate was 94.6% in the fire needling group and 90.7% in the electroacupuncture group; there was no statistically significant difference between the two groups (P>0.05).Conclusions Both filiform needle acupuncture plus fire needle pricking and electroacupuncture can markedly relieve the pain and stiffness and improve joint function in knee osteoarthritis of kidney and marrow deficiency type. Both have an equivalent short-term therapeutic effect. Filiform needle acupuncture plus fire needle pricking has a better long-term therapeutic effect than electroacupuncture.

Objective To investigate the practice and effect of specialist nursing inspection of intravenous infusion in the quality control of specialist nursing. Methods Intravenous infusion treatment nursing group used feed-forward control theory and methods, taking cross-sectional research methods yearly from 2014 to 2016 and referencing intravenous infusion special quality checklist to fully understand the hospital infusion tool selection situation and quality. Intravenous infusion related treatment system operational procedures was established and improved, the monthly quality control plan was made to do quality nursing of intravenous infusion specialist inspections and timely feedback of each month to various sections of the hospital. Results The rational choice of the hospital infusion tool was more reasonable. The proportion of steel needle in 2016 compared with in 2015 and 2014 was decreased by 8.9%(321/920-212/846), 18.8%(321/920-156/968). Intravenous infusion quality was significantly improved in the catheters′normative fix, nursing staffs′mastery of the skills and related expertise control rate, intravenous infusion treatment-related complications e.g. Phlebitis above grade two in 2016 were reduced 22 cases and 30 cases compared with in 2015 and in 2014, meanwhile the number was 18 and 31 in drug extravasation case. Conclusions Special nursing of intravenous infusion has a good effect on the improvement of nursing quality, and feed-forward control is an effective method for quality control of intravenous infusion therapy.