ObjectiveTo detect the proportion of splenic follicular helper T （Tfh） cells and their functionally related cytokine expression levels in the incomplete embryo implantation disorder （EID） model mice， and to explore the immunological mechanism of Tfh in infertility caused by embryo implantation disorder. MethodsSixteen female Kunming mice were randomly divided into two groups， with eight mice in each group. On day 4 of pregnancy， an incomplete EID mouse model was established by oral gavage of mifepristone suspension， while an equal volume of saline was administered to the control group. On day 8 of pregnancy， the mice were euthanized. Flow cytometry was used to detect the levels of Tfh cells in the spleen lymphocytes of both incomplete EID mice and normal control mice. qRT-PCR was performed to measure the mRNA levels of B-cell lymphoma 6 （Bcl-6） and C-X-C chemokine receptor type 5 protein （CXCR5） in the spleen lymphocytes of both groups. Western blot was employed to assess the protein expression levels of Bcl-6 and CXCR5 in the spleen lymphocytes of both groups. Serum levels of interleukin-4 （IL-4）， IL-6， and IL-21 were measured by ELISA. Immunohistochemistry （IHC） was used to observe the expression levels of progesterone receptor （PR）， Bcl-6， and CXCR5 proteins in the uterine endometrial tissue of mice in both groups. ResultsIncomplete-type EID mice had a reduced number of embryo implantation points and reduced endometrial PR expression. Flow assay results showed that the proportion of CD4⁺CXCR5⁺Tfh cells in splenic lymphocytes of incomplete-type EID mice was significantly higher than that of normal controls （P<0.05）. Compared with the normal control group， Bcl-6 and CXCR5 mRNA levels and protein levels were elevated in splenic lymphocytes of incomplete EID mice， with statistically significant differences （P<0.05）； serum IL-4， IL-6， and IL-21 levels were elevated in incomplete EID mice， and Bcl-6 and CXCR5 proteins in the endometrium were significantly elevated （P<0.05）. ConclusionThe increase of Tfh cells and their associated cytokines Bcl-6 and CXCR5 is associated with the development of incomplete EID， and may be involved in the development of female immune infertility.

With the elevating prevalence and comorbidity rate of chronic diseases,the burden of disease treatment for patients is increasing and quality of life is declining. Recently, the minimal disruptive medicine(MDM)has attracted more attention and its positive impact has been recognized. In this article we review the research progress in the clinical effects of MDM on chronic disease patients,which would promote the exploration and implementation of scientific and effective treatment strategies for general practice in China.

Objective : To investigate the expression of macrophage migration inhibitory factor (MIF) and its effect on autophagy and insulin resistance of ovarian granulosa cells in polycystic ovary syndrome ( PCOS) . Methods: Follicular fluid and ovarian granulosa cells were collected from 40 PCOS patients ( n = 40) and non PCOS patients (control group, n = 20) . PCOS included patients with IR (PCOS with IR, n = 20) and patients without IR (PCOS without IR, n = 20) . The expression of MIF in follicular fluid was detected by ELISA . The ratio of autophagy vacuoles to microtubule⁃associated protein light chain Ⅱ( LC3 Ⅱ) /microtubule⁃associated protein light chain Ⅰ( LC3 Ⅰ)in granulosa cells was observed by transmission electron microscopy and Western blot . Human ovarian granule cell line KNG was cultured in vitro and CCK⁃8 was used to detect the effects of different concentrations of MIF on granule cell activity . KNG cells were divided into four groups: normal culture group ( NC group), MIF group, chloroquine group (CQ group) and MIF + CQ group . The effects of MIF on the expression of autophagy related proteins LC3, autophagy related genes 7(Atg7), ubiquitin binding protein(p62), and insulin signaling pathway related proteins insulin receptor substrate⁃1(ISR⁃1), glucose transporter 4(GLUT4), protein kinase B(Akt) phosphorylation were observed by Western blot, and the effect of MIF on glucose uptake ability of granulosa cells was detected by glucose uptake test . Results : Compared with the control group or PCOS without IR group, MIF expression in follicular fluid and autophagy level of granulosa cells in PCOS with IR group increased (P < 0. 05 or P < 0. 01); In vitro experiments showed that MIF could significantly inhibit the cellular activity of KNG in granulocytes in a concentration⁃dependent manner, in which 100 ng/ml MIF was selected for subsequent relevant experiments; Compared with NC group, LC3Ⅱ/LC3I ratio and Atg7 protein in MIF group and MIF + CQ group increased (P < 0. 05), while p62 protein, IRS⁃1 protein, Akt phosphorylation level, GLUT4 protein expression level and glucose uptake ability decreased ( P < 0. 05 ), while the above autophagy markers in MIF + CQ group were significantly higher than those in MIF group (P < 0. 05), and the protein related to insulin signal transduction and glucose uptake increased (P < 0. 05) . Conclusion MIF may promote IR development in PCOS patients by up⁃regulating the autophagy level of granulosa cells, while inhibiting the autophagy of granulosa cells can improve MIF⁃induced IR.

Objective To evaluate medical students′ achievements of studying through the practical base website for humanistic quality education. Methods Totally 61 students from school of nursing and 135 students from the first clinical medical college of Southern Medical University in Guangzhou were organized as volunteers. They were divided into the intervention group and the control group (98 people per group) in completely random method by the Random Number Generators of SPSS 20.0. With a two-month experiment, the humanistic knowledge scores and humanistic caring ability scores of these two groups were investigated by the Humanistic Knowledge Test Paper and the Caring Ability Inventory. And the learning effects of the website by the intervention group was evaluated with the self-designed questionnaire. Results There was no significant difference (P>0.05) between students in the intervention group and the control group when it came to general information. Before the experiment, the score of humanistic knowledge test paper, the total score of caring ability inventory, the score in the dimension of cognition, patience, and courage of the intervention group were 6.29 ± 0.58, 172.40 ± 10.00, 58.98 ± 4.22, 51.56 ± 5.22, 61.86 ± 6.40, the scores of the control group were 6.36 ± 0.63, 172.65 ± 13.49, 59.31 ± 4.05, 50.83 ± 6.56, 62.52 ± 7.28, there were no significant differences between the two groups (all P>0.05). After the experiment, the score of humanistic knowledge test paper, the total score of caring ability inventory, the score in the dimension of cognition and courage of the intervention group were 7.82± 0.62, 182.34 ± 12.78, 65.04 ± 9.12, 65.17 ± 6.58, the scores of the control group were 6.37 ± 0.60, 170.73 ± 8.92, 58.29±5.61, 62.36±6.90, there were significant differences between the two groups (t=2.92-16.67, all P<0.01). The scores in the dimension of patience of the intervention group and the control group were 52.12±3.60 and 51.02±4.34, and there was no significant difference (t=1.94,P>0.05). As shown by the evaluation made by students in the intervention group about the learning effect of the website, the average score was the highest in the field of skills (3.95 ± 0.58), followed by the cognitive field (3.92 ± 0.46) and emotional field (3.75 ± 0.66). Most of the respondents believed that web-based learning could deepen students′ understanding of humanistic quality education (4.13 ± 0.57), independent web-based learning could strengthen the application of online resources (4.06±0.59) and students could master communicative skills required in different situations through web-based learning (4.05 ± 0.58). Conclusions Students are satisfied with the practical base website for humanistic quality education, the website has rich learning contents and can improve students′ interests and motivation. Through web-based learning, humanistic knowledge and humanistic caring ability of students can be improved to some extent. But the website is still in development, it needs an evaluation indicators system in order to do further research for all application effects of the website.

Objective Toestablishthe concept and structure elements of the nurse humanistic practiceability. Methods Using documentandtheoretical analysis to definethe concept of the nurse humanistic practiceability. And usestructuralanalysis to explain the structural elementsto formDelphiexpert consultationquestionnaire, which was investigated for 18 experts in 5provinces includingnursing education, nursing management, nursing clinicalcare,medical humanitiesandhumanistic medicine,and eventually established thetheory and structure model of the nurse humanistic practiceability. Results The effective recovery rates of the questionnaire were 81.8%(18/22)and 100%(18/18). The authority coefficients were 0.924, and the total consistency coefficients were 0.307 and 0.367 with statistical significance. TheDelphi expert consultation has established the concept, six-level structural elementsand15sub-elements. And for the first-class,the average value was 3.94-5.00,the coefficients variation of was 0.00-0.20;for the secondclass,the average value was 3.89-5.00,the coefficient variation were 0.00-0.19. Conclusions The study onconceptand structure elements of nurse humanistic practice ability has completed, which provide theoretical basis for improvement of nurse humanistic practice ability.

Objective In order to provide evidence for researches related to evaluating the
humanistic caring ability of head-nurses, we developed the questionnaire and launched reliability and validity test for it. Methods Through analyzing in documents, theories and scales, launching a 2-round experts consultation for 19 experts, the questionnaire consists of 3 first-class indicators, 8 second-class indicators and 36 third-class indicators. A total of 217 nurses, from third-grade class-A hospital who had a more than 5-year clinical experience, were selected by convenient sampling. Finally, the reliability and validity of the questionnaire had been summarized. Results The Cronbach α was 0.937 for the total questionnaire and 0.743-0.898 for each sub-scales. The split half reliability coefficient for the total questionnaire was 0.801 and 0.748-8.872 for each sub-scales. Test result of questionnaire content validity demonstrate the CVI was 0.91 for the total factors and 0.83-1.00 for each factor.Through exploratory factor analysis, 8 common factors were abstracted and cumulative variance contribution rate was 65.852%. Conclusions The questionnaire, developed for evaluating the humanistic caring ability of head-nurses, shows acceptable reliability and validity, and it′s worth to be popularizing and using in future.