Objective:To improve the teaching quality of Medical Microbiology by optimizing the teaching method,adjusting the teaching content and reforming the assessment model.Methods:The students of grade 2020 and 2021 of the same major were divided into the control group and the reform group.The control group received the traditional teaching method.The reform group received the"online + offline"blended teaching method,which integrates online learning resources and ideological and political education into the theoretical content of the curriculum.And the whole process assessment system was applied to the teaching method.The teaching quality was evaluated by the whole process examination results and questionnaire survey.Results:Compared with the control group,the score in the reform group was significantly improved(P＜0.01).Results of the questionnaire survey showed that students'satisfaction with the mixed teaching method reached 97.5% .The integration of hot issues of microbiology and curriculum ideological and political education significantly improved students'learning interest,and more students wanted to engage in the work of microbiology related fields in the future.Conclusion:The practice results show that optimizing the teaching method,adjusting the teaching content and reforming the assessment mode can stimulate the students'learning interest,improve the students'independent learning ability and improve the teaching quality.

Objective:To evaluate the reliability and clinical application of a self-established classification system for the lower 1/3 humeral fractures in adults.Methods:A retrospective study was performed to analyze the 88 patients with lower 1/3 humeral fracture who had been admitted to Department of Orthopedics, The Second Hospital of Fuzhou between January 2013 and December 2020. There were 61 males and 27 females with an age of (34.6±12.7) years. The lower 1/3 humeral fractures were classified according to the location of the fracture line, displacement, and bone mass into 3 types: type Ⅰ: transverse and short oblique ones; type Ⅱ: oblique and spiral ones; type Ⅲ: oblique and spiral ones with butterfly-shaped bone mass. After a junior orthopedic surgeon, an intermediate orthopedic surgeon, a senior orthopedic surgeon, and a radiologist had learned this novel classification system, they were asked to classify the lower 1/3 humeral fractures in this cohort independently to assess the reliability of the classification system. Our treatments were based on this novel classification. Open reduction and internal fixation with a unilateral plate through a lateral approach was performed for type Ⅰ fractures, internal fixation with a unilateral plate plus compression screws through a lateral approach for type Ⅱ fractures, and double plate internal fixation through the ulnar and anterolateral approaches for type Ⅲ fractures. The functions of the radial, ulnar, and musculocutaneous nerves and fracture healing time were observed postoperatively. The shoulder and elbow functions were evaluated using Neer shoulder function score and Mayo elbow function score.Results:Of the 88 patients in this cohort, 20 were type Ⅰ, 25 type Ⅱ, and 43 type Ⅲ. The mean Kappa value for inter-observer reliability was 0.878 at the first stage and 0.914 at the second stage, and the mean Kappa value for intra-observer reliability was 0.950. All patients were followed up for (14.1±3.7) months. Iatrogenic injury to the radial nerve was observed in 2 patients, but no injury to the ulnar nerve, the musculocutaneous nerve or important blood vessels or failure of internal fixation was reported. All patients achieved bony union after (12.7±2.0) weeks. The maximum elbow flexion was 137.8°±4.8°, and the maximum elbow extension 2.4°±1.6°. The Mayo elbow function score was (92.0±3.1) points and the Neer shoulder function score (92.2±3.2) points.Conclusions:Our classification system for the lower 1/3 humeral fractures in adults is reliable. As the treatments corresponding to the novel classification system can achieve satisfactory clinical outcomes, the classification system has a clinical value.

Objective To investigate the value of interleukin-6(IL-6),procalcitonin(PCT)and immuno-globulin G(IgG)in evaluating the susceptibility and recurrence of bacterial pneumonia in children with hor-mone-sensitive primary nephrotic syndrome(PNS).Methods A total of 150 children with hormone-sensitive PNS admitted to the hospital from January 2019 to March 2023 were selected as the study objects.The pa-tients were divided into concurrent group and non-concurrent group according to whether bacterial pneumonia was complicated or not within 3 months.The baseline IL-6,PCT and IgG levels of the two groups were com-pared,and the factors affecting susceptibility to bacterial pneumonia were analyzed by Logistic regression.Re-ceiver operating characteristic curve(ROC)was drawn to analyze the value of IL-6,PCT and IgG in assessing susceptibility to PNS bacterial pneumonia and the risk of PNS recurrence.Results IL-6[(7.84±2.49)pg/mL]and PCT[(0.39±0.11)ng/mL]in concurrent group were higher than those in non-concurrent group[(4.75±1.56)pg/mL,(0.29±0.09)ng/mL].IgG[(3.82±1.25)g/L]was lower than that of non-concurrent group[(5.92±1.97)g/L],and the differences were statistically significant(P＜0.05).Logistic regression e-quation showed that with the increase of IL-6 and PCT and the decrease of IgG,the susceptibility to bacterial pneumonia gradually increased,and the difference was statistically significant(P＜0.05).The AUC of IL-6,PCT and IgG for PNS bacterial pneumonia susceptibility was 0.792,0.744 and 0.677,respectively.The AUC of IL-6 and PCT combined IgG for PNS bacterial pneumonia susceptibility was 0.929,which was higher than that of IL-6,PCT and IgG alone(P＜0.05).The risk of PNS recurrence in patients with high IL-6 level was 7.054 times that of low IL-6 level,the risk of PNS recurrence in patients with high PCT level was 6.750 times that of low PCT level,and the risk of PNS recurrence in patients with high IgG level was 0.079 times that of low level,the differences were statistically significant(P＜0.05).Conclusion IL-6,PCT and IgG are the influencing factors of hormone-sensitive PNS bacterial pneumonia in children,and they are related to the recurrence of PNS.Clinically,IL-6,PCT and IgG levels can be used to evaluate the susceptibility and recur-rence risk of bacterial pneumonia in children,so as to provide guidance for preventive clinical intervention.

Objective:To evaluate the role of extracellular signal-regulated kinase (ERK)1/2 in glutamate-induced ferroptosis in PC12 cells.Methods:PC12 cells were divided into 6 groups ( n=21 each) using a random number table method: control group (C group), glutamategroup (Glu group), glutamate+ ERK1/2 over-expression group (Glu+ ERK1/2-OE group), glutamate+ ERK1/2 plasmid empty vector group (Glu+ Vec group), glutamate+ ERK1/2 knockdown group (Glu+ si-ERK1/2 group)and glutamate+ ERK1/2 SiRNA negative control group (Glu+ si-NC group). Cells were treated with glutamate at a final concentration of 6 mmol/L for 72 h in Glu group and with the equal volume of PBS buffer for 72 h in C group. Glu+ ERK1/2-OE group was transfected with ERK1/2 overexpression plasmid, Glu+ Vec group was transfected with plasmid empty vector, and Glu+ si-ERK1/2 group was transfected with ERK1/2 siRNA, Glu+ si-NC group was transfected with siRNA negative control for 48 h, and then glutamate at a final concentration of 6 mmol/L was added and cells were treated for 72 h. The cell viability, lactic dehydrogenase (LDH)activity and contents of glutathione (GSH), ferrous ions and malondialdehyde (MDA) were measured by enzyme-linked immunosorbent assay. Mitochondrial membrane potential (MMP) and lipid reactive oxygen species (Lip-ROS) were measured by flow cytometry. Results:Compared with C group, the cell viability, GSH content and MMP were significantly decreased, and the LDH activity, ferrous ions content, MDA content and Lip-ROS levels were increased in Glu group ( P<0.05). Compared with Glu+ Vec group, the cell viability, GSH content and MMP were significantly increased, and the activity of LDH, contents of ferrous ions and MDA, and Lip-ROS levels were decreased in Glu+ ERK1/2-OE group( P<0.05). Compared with Glu+ si-NC group, the cell viability, GSH content and MMP were significantly decreased, and the LDH activity, contents of ferrous ions and MDA, and Lip-ROS level were increased in Glu+ si-ERK1/2 group ( P<0.05). Conclusions:ERK1/2 is involved in glutamate-induced ferroptosis in PC12 cells.

Objective:To explore the prognostic value of lymphocyte subsets in adult hemophagocytic syndrome (HPS).Methods:A total of 172 adult HPS patients diagnosed in 8 medical centers from January 2013 to August 2020 were selected for the study, of whom 87 were male (50.6%, 87/172), and 85 were female (49.4%, 85/172), with 68 survivors and 104 deaths. The clinical data were summarized, and variables such as lymphocyte subsets, immunoglobulin characteristics and fibrinogen were retrospectively analyzed, and the correlation between the mentioned variables and patient prognosis was analyzed. The optimal cut-off values of continuous variables were calculated by MaxStat, and the prognostic factors of HPS patients were screened based on the Cox proportional hazard regression model.Results:The median age of HPS patients was 56 (42, 66) years old, and the 5-year cumulative survival rate was 37.4% (37.4/100). The median age, platelet and albumin were 48 (27, 63) years, 84×10 9/L and 32.3 g/L in the survival group, and 59 years, 45.5×10 9/L, and 27.3 g/L in the death group, respectively. The differences between the two groups was statistically significant ( Z=?3.368, P=0.001; Z=?3.156, P=0.002; Z=?3.431, P=0.001). Patients with differentiated cluster 8+(CD8+)<11.1%, CD3+<64.9%, CD4+>51%, and CD4/CD8 ratio>2.18 had poor prognosis (χ 2=7.498, P=0.023; χ 2=4.169, P=0.041; χ 2=4.316, P=0.038; χ 2=9.372, P=0.002). Multivariable analysis showed that CD4/CD8 ratio, age, fibrinogen and hemoglobin were independent prognostic factors in HPS patients ( HR=2.435, P=0.027; HR=5.790, P<0.001; HR=0.432, P=0.018; HR=0.427, P=0.018). Conclusion:Peripheral blood lymphocyte subsets can be used to evaluate the prognosis of patients with HPS; CD4/CD8 ratio, age, fibrinogen, and hemoglobin are independent prognostic factors in HPS patients.

Objective:To explore the prognostic influencing factors of adult lymphoma-associated hemophagocytic syndrome (LAHS) based on multicenter data.Methods:The clinical data of 86 LAHS patients diagnosed in 9 medical centers of Huaihai Lymphoma Working Group from January 2015 to August 2020 were retrospectively analyzed. The optimal cut-off value of continuous variables was obtained based on MaxStat algorithm. Cox proportional hazard regression model was used for univariate and multivariate analyses. Kaplan-Meier method was used for survival analysis, and log-rank test was performed.Results:Among the 86 adult LAHS patients, 50 (58.1%) were males and 36 (41.9%) were females, the median age of the patients was 57 years old (19-76 years old), and the median overall survival (OS) time was 1.67 months (95% CI 0.09- 3.24 months). The most common pathologic type was diffuse large B-cell lymphoma (58 cases, 67.44%). Based on MaxStat algorithm, the optimal cut-off values of age, albumin, serum creatinine, lactate dehydrogenase, fibrinogen and platelet count were 64 years old, 30.1 g/L, 67 μmol/L, 1 045 U/L, 4.58 g/L and 72×10 9/L, respectively. Multivariate analysis showed that patient's age, lactate dehydrogenase, albumin and fibrinogen levels were independent influencing factors for OS (all P < 0.05). Conclusions:LAHS is dangerous and progresses quickly. Patients with age ≥ 64 years old, lactate dehydrogenase ≥ 1 045 U/L, fibrinogen ≥ 4.58 g/L and albumin < 30.1 g/L have poor survival.

Objective:To explore a fast method to identify and confirm suspected clonorchis sinensis infection.Methods:For suspected clonorchis sinensis infection, the clonorchiasis serum antibody was detected first with ELISA. If the antibody was positive, the fecal examination for eggs was performed. If the fecal examination was negative, duodenal drainage under gastroscopy was recommended to detect eggs from the drainage fluid.Results:A total of 126 patients met the requirements and aged 54.14±13.33 (24- 87). There were 83 cases (65.87%, 83/126) with eggs positive in the drainage fluid, of which 53 cases were male, aged 55.91±11.47 (30-86), and 30 cases female, aged 55.87± 13.85(30-87). There was no significant difference in age between males and females( P>0.05). The time of catheterization (T1) of 126 cases was 3.79 ±1.45 min. The time of drainage (T2) of 126 cases was 31.39 ±14.29 min. There was no significant difference in T1 or T2 between the positive group and the negative group( P>0.05). The detection rates of eggs were 91.57% (76 cases) in intrahepatic bile duct drainage, 81.93% (68 cases) in the bile-cyst juice and 75.90% (63 cases) in the common bile duct fluid. No serious adverse reactions occurred during or after the operation. Conclusion:The detection rate of clonorchiosis sinensis can be effectively improved by the combination of clonorchiasis serum antibody test and gastroscopy-guided duodenal drainage.

Objective:Factors influencing the prognosis of hemophagocytic lymphohistiocytosis (HLH) in adults were analyzed based on multicentric data.Methods:Clinical data of 124 adult patients with HLH diagnosed in eight medical centers in the Huaihai Lymphoma Working Group from March 2014 to July 2020 were collected. The optimal truncation value of continuous variables was obtained based on the Maxstat algorithm, X-Tile software, and restricted cubic spline. Cox proportional risk regression model was used to construct the adult HLH risk prediction model, and the visualization of the model was realized through the histogram. The bootstrap resampling method was used to verify the model, C-index and calibration curve was used to verify the histogram, and the prediction accuracy was checked. Kaplan-Meier analysis was used to calculate the survival rate and draw the survival curve. Furthermore, the differences between groups were tested by log-rank.Results:The median age of the 124 patients was 55 (18-84) years, including 61 (49.19%) males. The most common etiology was infection. Serum ferritin increased in 110 cases (88.71%) , hepatosplenomegaly in 57 cases (45.97%) . Of the 124 patients, 77 (62.10%) died, and the median survival time of the patients was 7.07 months. Univariate results showed that the prognosis of adult HLH was influenced by sex, age, fibrinogen, serum creatinine, alanine aminotransferase, and albumin ( P<0.05) . The results of multivariate analysis showed that gender, platelet, albumin, alanine aminotransferase, and treatment regimens were independent influencing factors for prognosis. Based on the above five risk factors, the prediction model of the histogram was established, and the C-index of the model was 0.739. Finally, the calibration chart showed good consistency between the observed and predicted values of HLH. Conclusion:The prognosis of the adult hemophagocytic syndrome is influenced by many factors. Gender, platelet, albumin, alanine aminotransferase, and treatment regimens are independent risk factors. Therefore, the established histogram provides a visual tool for clinicians to evaluate the prognosis of adult HLH.

Sepsis remains a global disease with high morbidity and mortality. The changes of immune cell metabolism are of great significance in the pathophysiology of sepsis. Hypoxia-inducible factor (HIF) is not only a major regulator of hypoxic adaptive response, but also plays an important role in metabolic pathways such as glycolysis and pentose phosphate pathway of immune cells in sepsis. Current studies have found that pattern recognition receptors, transcription factors, certain metabolic byproducts and kinases all have varying degrees of influence on HIF activity or the cell metabolism involved. This review introduces the role and regulatory mechanism of HIF pathway in the metabolic changes of sepsis immune cells, so as to develop new approaches for the diagnosis and treatment of sepsis in the future.

Objective:To analyze the effects of adenovirus-mediated interleukin-37 (IL-37) on the growth and radiosensitivity of human non-small cell lung cancer (NSCLC) cell line A549, and to explore the possibility of IL-37 as a new radiosensitizer.Methods:Human NSCLC cell line A549 was used as the research object. A549 cells were divided into three groups: normal A549 cells (control group), empty virus transfected A549 group [NC group, the multiple of infection (MOI) was 100], Ad-IL-37 group (A549 cells were transfected by adenovirus with IL-37, MOI was 100). The expression of IL-37 protein in three groups was detected by Western blot. The three groups were irradiated with 4 Gy irradiation dose at the same time. The methyl thiazolyl tetrazolium (MTT) method was used to detect the absorbance (A) values and observe the proliferation of A549 cells; flow cytometry was used to observe the phase changes of A549 cells in each group after irradiation; Western blot was used to detect the expressions of apoptosis-related proteins (bax, bcl-2, Caspase-3, and Survivin) in each group after irradiation.Results:The expression level of IL-37 in the control group was 0.17±0.04, NC group was 0.29±0.14, and Ad-IL-37 group was 1.17±0.23 (F = 24.263, P = 0.001); there was no statistical difference in A values among the three groups at 24 h after irradiation (F = 2.587, P = 0.160), while the differences of A values among the three groups at 48, 72, 96, 108 h after irradiation were statistically significant (F values were 21.662, 33.635, 33.663, and 31.909, P values were 0.005, 0.001, 0.001, and 0.001, respectively). There was no significant difference in the cell proliferation inhibition rate between NC group and Ad-IL-37 group at 24 h after irradiation (t = 1.620, P = 0.247), while the differences were statistically significant at 48, 72, 96, 108 h after irradiation (t values were 5.414, 7.233, 15.306, and 19.035, P values were 0.032, 0.019, 0.004, and 0.003, respectively). The combination of IL-37 and radiation could affect the cell cycle, the proportion of S-phase cells was (36.4±1.0)% in the control group, (31.3±0.6)% in the NC group, and (27.2±2.9)% in the Ad-IL-37 group (F = 12.96, P = 0.007), and the proportion of in G 2/M-phase cells was (20.5±0.8)% in the control group, (24.7±2.9)% in the NC group, and (41.4±4.1)% in the Ad-IL-37 group, (F = 27.92, P = 0.001). IL-37 could up-regulate the expressions of pro-apoptotic factors bax and Caspase-3 proteins in A549 cells after irradiation (F values were 10.31 and 14.51, P values were both 0.01), and down-regulate the expressions of apoptotic factors bcl-2 and Survivin proteins (F values were 8.95 and 5.52, P values were 0.02 and 0.04). Conclusion:IL-37 could inhibit the growth of human NSCLC cell line A549 and has potential radiosensitization effects, which may be caused by affecting the apoptosis of tumor cells.