Objective:To investigate the attitudes and demands of medical students on medical education rituals in the context of the new era, to find out the existing problems, and to provide reference to the innovation and improvement of the rituals.Methods:An online questionnaire was conducted among medical students. SPSS 25.0 was used for descriptive statistical analysis and rank sum test of the data. Qualitative research methods such as in-depth interviews and panel discussions were used to comprehensively analyze the qualitative data.Results:"Post-00s" medical students, who are known as the aborigines of the Internet, are also looking forward to the return of traditional medical education rituals. Compared with junior students, senior students had lower awareness of the importance of rituals and lower willingness to participate in rituals, and the degree of professional identity arousal by the rituals was also lower ( P<0.05). Certain medical students indicated that they had never participated in medical education rituals, and some indicated that their specialties were not valued in the rituals. Conclusion:Medical education in the new era should revive traditional rituals and be adjusted to the changes in the background of the times and the characteristics of the student groups. The current ritual education fails to meet the needs of medical students at different stages, and its systematicness and continuity should be strengthened. The coverage of medical education rituals for medical students is incomprehensive and uneven, and it is necessary to further expand the coverage and appropriateness of rituals in medical-related specialties and fully consider the characteristics of each specialty in medical students.

Objective To evaluate the diagnostic efficacy of Kwak and ACR( 2017 ) thyroid imaging reporting and data systems ( T I‐RADS ) for thyroid nodules . Methods Cases of thyroid nodule who underwent surgery from January 2015 to M arch 2018 in 15 hospitals in Sichuan province were collected and the ultrasonographic features of thyroid nodules were retrospectively analyzed by trained senior ultrasound physicians using Kwak and ACR T I‐RADS classification methods . Totally ,12 712 thyroid nodules were observed ,7 023 thyroid nodules in 7 023 cases with complete ultrasound and surgical and pathological data were eventually enrolled in the study . T hyroid nodules with solid ,hypoechoic or very hypoechoic ,tall/wide ratio ≥ 1 , margin ill‐defined and microcalcification were classified as malignant signs of ultrasound . M alignant percentage was calculated and diagnostic tests were performed . Results ① T here was a statistical difference between the benign and malignant nodules in the two types of T I‐RADS classification ( P＜0 .01) . ② T he area under ROC curve of Kwak and ACR in the diagnosis of malignant nodules were 0 .89 and 0 .84 ,respectively . T he Youden index of Kwak and ACR were 0 .66 and 0 .57 ,respectively . ③Taking Kwak T I4B and ACR T R4 as critical points for malignancy ,the sensitivity ,specificity ,positive predictive value and negative predictive value of Kwak T I 4B were 75 .0% ,90 .9% ,83 .2% ,and 85 .9% , respectively . T he accuracy of Kwak T I4B was 84 .9% ; T he sensitivity ,specificity ,positive predictive value and negative predictive value of ACR T R4 were 88 .2% ,68 .9% ,62 .9% ,and 90 .8% ,respectively . T he accuracy of ACR T R4 was 76 .2% . T he Kappa value of Kwak TI4B and ACR T R4 was 0 .52 . T he χ2 value of Kwak T I4B and ACR T R4 was 2 174 .6 ( P ＜ 0 .01 ) . Conclusions T he diagnostic values of two T I‐RADS classification methods for thyroid malignant nodules are high . T he overall efficiency of Kwak T I‐RADS classification method is better than that of ACR TI‐RADS classification method .

To establish an HPLC method to determine osimertinib mesylate,Agilent ZORBAX Eclipse Plus C18 column (4.6 mm × 250 mm,5 μm) was used with a mobile phase consisting of methanol-buffer solution (20 mmoL/L NaH2PO4,pH 3.0 adjusted with 85％ H3PO4) (50 ∶ 50) at the flow rate of 1.0 mL/min.The detection wavelength was 210 nm,and the column temperature was kept at 35 ℃.The calibration curve was liner over the range from 50％ to 150％ of determination concentration (0.201 1-0.603 2 mg/mL,r =0.999 9).The limit of quantitation (LOQ) and limit of detection (LOD) were 0.32 μg/mL and 0.08 μg/mL,respectively.The contents of osimertinib mesylate in samples were 100.1％,99.5％ and 99.7％.Good chromatographic separation of osimertinib mesylate and its related substances,including synthetic impurities and degradation products,were obtained.The established HPLC method is specific,accurate,simple and durable,and could be used for the determination of osimertinib mesylate.

Objective To assess the mid-term and long-term efficacy of the permanent inferior vena cava filter in the treatment of deep vein thrombosis of lower limb and discuss the clinical significance of inferior vena cava filter.Methods Retrospectively analyze on the 86 cases with deep vein thrombosis of lower limb (41 males and 45 females,aged 50 to 94 years,mean age was 71.8 years) treated with implantation of permanent inferior vena cava filter in inferior vena cava from Janunary 2010 to October 2015.In these patients,there were 51 cases with embolism in the left leg,25 cases in the right leg,10 cases in both legs and 6 cases were accompanied with pulmonary embolism.The cases without contraindication underwent catheter directed thrombolysis and even percutaneous transluminal angioplasty or stents subsequently if necessary after inferior vena cava filter implantation.All the cases with no contraindication were treated with anticoagulant therapy.Results All the 86 patients were implanted inferior vena cava filter (B.Braun Vena Tech LP 76 and Cordis TrapEase 10)successfully.Sisty-five cases were underwent inferior wena cava filter implantation only,while 21 cases were treated with inferior vena cava filter implantation and catheter directed thrombolysis or even percutaneous transluminal angioplasty and stents.During the follow-up period(12 to 81 months,mean time was 51 months),27 patients died dueing to malignant tumor(17 cases) and other diseases (10 cases) rather than complications caused by inferior vena cava filter.Three patients had recurrence of deep vein thrombosis and 2 patients suffered from the thrombosis induced by stenosis of stents.Inferior vena cava filter appered tilted with angle less than 15 degrees in 6 cases.Three cases suffered from new thrombosis below the filter and 2 cases complained of the filter migration.No case was found with fracture of filter,perforation of the inferior vena cava,bleeding or pulmonary embolism(new onset or recurrent).Conclusions Application of permanent inferior vena cava filter may cause complications,though it is an effective approach to prevent pulmonary embolism in patients with deep vein thrombosis of lower limb.However,permanent inferior vena cava filter may be fit for patients with old age,incurable cancer or limited expected life.

Objective To investigate the alteration of energy metabolism and oxidative injury in the myocardia suffering from lethal ventricular tachyarrhythmia (LVTA). Methods Two LVTA-SCD SD rat models, induced by aconitine injection or coronary artery ligation (CAL), respectively, were developed. Rats that died from over-anaesthesia or CAL-induced heart failure were served as their controls, respectively. Mitochondrial membrane potential (MMP), reactive oxygen species (ROS), malonaldehyde (MDA), phosphocreatine (PCr) in the ventricular myocardia, and serum troponin I (cTnI) were detected, and compared between LVTA rats and their controls. Results Fourteen ACO-LVTA and six CAL-LVTA rats were successfully developed. As compared to their controls, ACO-LVTA and CAL-LVTA rats had higher ROS and MDA content, and lower concentration of PCr in the ventricular myocardia. MDA content in ACO-LVTA group is signiifcantly higher than that of its control (P<0.05). MMP in myocardia of ACO-LVTA is lower than that of its control, but is higher than those of two CAL groups. Serum cTnI in rats of both LVTA models is higher than those of their controls and pre-treated control. Specially, serum cTnI in CAL-LVTA was signiifcantly higher than that of ACO-LVTA and its control (P<0.01). The myocardial ROS content is correlated with the duration of VT and VF (P<0.05), with correlation coefifcients being 0.44 and 0.46, respectively. Conclusions After LVTA, the ventricular myocardia had lower MMP and PCr content, higher concentration of ROS, MDA, as well as higher serum cTnI than their controls, indicative of oxidative injury and alteration of energy metabolism under LVTA-SCD.

Objective To detect the levels of IL-1, IL-6,TNF-αand IFN-γin serum and colon tissue of rat mod-els of ulcerative colitis with spleen and kidney Yang deficiency, and to explore their roles in the pathogenesis of ulcerative colitis ( UC) .Methods The rat model of ulcerative colitis with Yang deficiency of spleen and kidney was induced by perfusion of rhubarb decoction plus intramuscular injection of hydrocortisone and combined with TNBS (2,4,6-trinitro-benzenesulfonic acid) and ethanol enema.Sixty SPF wistar rats ( body weight 180 ±10 g, male:female=1:1) were ran-domly divided into blank control group, UC model with spleen kidney Yang deficiency for 7 days, 14 days and 21 days groups, respectively.The levels of IL-1, IL-6, TNF-αand IFN-γin serum and colon tissue were detected by ELISA.Re-sults Compared with the blank group, the levels of IL-1, IL-6, TNF-αand IFN-γin serum and colon tissue of rat UC model group with spleen kidney Yang deficiency were greatly increased (P<0.05), especially evidently increased in the model group at 21 days.Conclusions The pro-inflammatory cytokines IL-1, IL-6, TNF-αand IFN-γplay an important role in the pathogenesis of ulcerative colitis with syndrome of spleen and kidney Yang deficiency.

An improved manufacturing process for rivastigmine(1)was developed by performing the condensation reaction of m-hydroxyacetophenone(4)with N-ethyl-N-methyl carbamoyl chloride, then Corey-Bakshi-Shibata(CBS)chiral reduction to(R)-3-(1-hydroxyethyl)phenyl ethyl(methyl)carbamate(2)and then mesylation with methanesulfonyl chloride and nucleophilic substitution with dimethylamine, respectively. To be successful, a crucial reductive process in the conversion of ketone(3)to chiralalcohol(2)had to be correctly understood and optimized via orthogonal experiment. The whole improved process was convenient for operation and purification, with completion of the synthesis of rivastigmine and an overall yield of 88%.

Objective To detect mechanism of action mode of Jiuxieling Granules in spleen and kidney yang deficiency ulcerative colitis. Methods The perfusion of Rhei Radix et Rhizoma Decoction plus intramuscular injection of hydrocortisone and combined with TNBS and ethanol enema were employed to establish UC animal model. Ninety rats were randomly divided into blank group, model group, SASP group and Jiuxieling Granules 7 days, 14 days and 21 days groups. All treatment groups received relevant medicine intervention. The levels of IL-1, IL-6, TNF-α, and IFN-γin serum and colon tissue were detected by ELISA. Results Compared with the blank group, the levels of IL-1, IL-6, TNF-α, and IFN-γ in serum and colon tissues of rats in model group increased (P<0.05);compared with the model group, the levels of IL-1, IL-6, TNF-α, and IFN-γin serum and colon tissues of rats in treatment groups were reduced greatly (P<0.05), among which Jiuxieling Granules 21 days group showed the most obvious effects (P<0.05). Conclusion Jiuxieling Granules can regulate the normal secretion of the levels of IL-1, IL-6, TNF-α, and IFN-γin serum and colon tissue of model rats, and inhibit inflammation and protect colonic mucosa.

Objective To summarize our clinical experience of surgical treatment for pediatric patients with ventricular septal defect(VSD) and mitral regurgitation(MR).Methods A retrospective study was performed including consecutive 84 patients with VSD and MR receiving mitral valvuloplasty(MVP) and VSD closure from January 2006 to January 2012 in Shanghai Xinhua Hospital.All patients were associated with pulmonary hypertension(PH,32-85 mm Hg).The diameters of ventricular septal defects were between 0.7 and 1.6 cm.Echocardiography showed that trivial MR (+) in 9 cases,mild MR (++)in 18 cases,moderate MR(+++) in 33 cases,and severe MR(++++) in 24 cases.VSD closure and MVP were performed with cardiopulmonary bypass under moderate systemic hypothermia.The results of repair were evaluated by transesophageal echocardiography (TEE) during operation.Results Intra-operative TEE results: no residual shunt of VSD,none MR in 80 cases,residual trivial MR in 4 cases.Mean Cardiopulmonary bypass (CPB) time was (84.6 ± 18.5) mins.Mean Aortic clump time was(50.8 ± 11.5) mins.Mean postoperative ventilation time was (38.7 ± 30.2) hours,and mean postoperative inhosptial time was(10.5 ±4.6) days.The in-hospital mortality was 1.2％ (1 case died).78 cases were fully followed up.There was no late death.Echocardiography showed that none MR in 62 cases,trivial MR in 10 cases,mild MR in 4 cases,moderate MR in 2 patients.The overall freedom from reoperation at 5 years was (97.4 ± 1.8) ％.Conclusion Ventricular septal defect with pulmonary hypertension need early surgical repair.MR was treated at the same time of VSD closure could effectively improve the surgical outcome of pediatric patients with ventricular septal defect and mitral regurgitation.

Objective To review the surgical methods and mid-term results of mitral valve repair in pediatric patients with moderate to severe mitral regurgitation (MR).Methods 132 children with moderate to severe MR,aged (18.9 ± 7.2)months,weighted(11.3 ±4.8) kg.The etiology for mitral regurgitation is congenital heart disease in 126 cases,infective endocarditis in 5 cases and Marfan syndrome in 1 case.Mitral valvuloplasty(MVP) was performed with cardiopulmonary bypass under moderate systemic hypothermia.The methods of MVP included annuloplasty,annuloplasty ring,cleft closure,reconstruction of posterior leaflet.The coucomitant cardiac anomalies were treated at the same time.The results of repair were evaluated by saline injection test and transesophageal echocardiography (TEE) during operation.Results Intra-operative TEE results: 131 cases had none to mild MR,and only one case had moderate MR.The patient underwent second repair immediately,subsequent TEE was mild.Mean cardiopulmonary bypass (CPB) time was (80.0 ± 31.1) minutes.Mean aortic clump time was (48.0 ± 17.9) minutes.The in-hospital mortality was 2.3％ (3 cases died).One died of heart failure on postoperative day 7,the other died of low cardiac output syndrome resulting on postoperative day 2.Another one was large ventricular septal defect(VSD) with pulmonary hypertension (PH),died of pulmonary infection.Mean postoperative ventilation time was (34.4 ± 31.9) hours,and mean postoperative inhosptial time was (9.0 ± 5.4) days.The average follow-up period was (40.5 ± 8.3) months (2 to 74 months).122 cases were fully followed up.Echocardiography showed that moderate MR was in 7 patients,and 3 patients had severe MR.4 patients underwent re-do mitral valve repair or mitral valve replacement.There was no late death.The overall survival rate at 5 years was 97.7％ and the overall freedom from reoperation at 5 years was 92.0％.Conclusion Pediatric patients with moderate to severe MR need early surgical treatment,the early and mid-term results were satisfactory.Individualized treatment protocol based on specific pathology was the keypoint of surgical therapy.