Background and Aims:The occurrence of duodenal fistula following infected pancreatic necrosis(IPN)in the later stage of treatment for acute necrotizing pancreatitis presents a significant clinical challenge.It often leads to severe complications such as difficulty in administering enteral nutrition,electrolyte imbalances,abdominal bleeding,and worsening infections.This study was performed to explore the efficacy of enteral nutrition combined with step-up drainage in treating IPN complicated by duodenal fistula and to share single-center experience. Methods:The clinical data of 66 patients with IPN complicated by duodenal fistula who underwent enteral nutrition combined with step-up drainage in the Severe Pancreatitis Treatment Center of the Nanjing Eastern Theater General Hospital between January 2018 and December 2020 were retrospectively analyzed. Results:Among the 66 patients,the median time from disease onset to the development of duodenal fistula was 53(32-75)d.In 46 cases(69.7％),suspicious digestive fluid-like discharge was observed from drainage tube or double-lumen tube.The diagnosis and location of the duodenal fistula were confirmed in 49 patients(74.2％)through fistulography,while the remaining cases were confirmed via surgical exploration or endoscopy.The duodenal fistulas were mainly located in the horizontal part(33.3％)or descending part(50.0％)of the duodenum.Nutritional access was safely established through nasojejunal tube in 61 patients(92.4％),while 5 patients(7.6％)required surgery to establish the access.Twenty patients(30.3％)experienced secondary abdominal bleeding,and 14 patients(21.2％)died.Among the 52 patients who recovered,49(94.2％)healed through step-up drainage,while 3(5.8％)required surgery due to delayed healing.Of the 49 patients who underwent non-surgical treatment,10(20.4％)achieved fistula closure through drainage tube,and 39(79.6％)achieved closure through continuous lavage drainage via double-lumen tube.The median healing time for duodenal fistula in non-surgically treated patients was 41(29-80)d. Conclusion:Patients with IPN complicated by duodenal fistula are in a critical condition.Enteral nutrition combined with step-up drainage is an effective treatment for these patients.

Objective:To explore an innovative model of ability-oriented training for general practitioners and to evaluate its implementation effectiveness.Methods:A total of 49 general practitioners who participated in the training in 2015 were selected as the research objects, and they were trained in a new mode with innovative teaching and training system and comprehensive assessment mode as the main content. The results of theoretical examination and self-assessment scores of post competency were compared before and after the training. SPSS 19.0 was used for t test. Results:The theoretical examination results of the first year of training were higher than those before training [(77.23±0.55) scores vs. (69.14±4.63) scores], with significant differences ( t=12.15, P=0.001); and the results of the second year of training were also higher than those of the first year of training [(83.72±0.45) scores vs. (77.23±0.55) scores], with significant differences ( t=8.12, P=0.001). The self-assessment questionnaire showed that there were significant differences in such five abilities of the students' competency as medical knowledge and clinical skills, autonomous learning, interpersonal communication, teamwork, core values and doctor professionalisms through the comparison of systematic training ( t=2.76, 4.53, 12.09, 2.33, 2.40, all P<0.05). Conclusion:The innovative training model for general practitioners is effective, and the practice of the new model could provide reference for continuously improving the training and education of general practitioners in China.

Objective: To study the active ingredients in the root bark of Aralia echinocaulis. Methods: Three triterpenoid saponins were separated from the 70% ethanol extracts and purified by column chromatography and their structures were determined by spectroscopic analysis. Compound 1 and 3 were evaluated for antioxidant activity by the in vitro DPPH free radical scavenging ability and the protective effect of OH

Objective:To explore an innovative model of ability-oriented training for general practitioners and to evaluate its implementation effectiveness.Methods:A total of 49 general practitioners who participated in the training in 2015 were selected as the research objects, and they were trained in a new mode with innovative teaching and training system and comprehensive assessment mode as the main content. The results of theoretical examination and self-assessment scores of post competency were compared before and after the training. SPSS 19.0 was used for descriptive analysis and t test of data. Results:The theoretical examination results before training were significantly different from those after the first year of training, and the results of the first year of training were also significantly different from those of the second year of training ( t values were 12.15 and 8.12, respectively), ( P<0.05). The self-assessment questionnaire showed that through systematic training, five aspects of the students' competency such as medical knowledge and clinical skills, autonomous learning, interpersonal communication, teamwork, core values and doctor professionalisms were significantly improved to different degrees ( P<0.05). Conclusion:The innovative training model for general practitioners is effective, and the practice of the new model could provide reference for continuously improving the training and education of general practitioners in China.

Objective To observe the clinical efficacy of moving cupping in the anterior cervical region plus bloodletting in treating acute pharyngitis.Method Thirty-six patients with acute pharyngitis were randomized into two groups, 18 cases each. The treatment group was intervened by moving cupping in the anterior cervical region plus bloodletting at Tiantu (CV22), and the control group was intervened by oral administration of Pu Di Lanoral liquid. The therapeutic efficacy was evaluated by using the acute pharyngitis symptoms grading scale, and the adverse reactions in the treatment group were also observed.Result The two treatment methods were both effective, and the between-group difference in comparing the total effective rate was statistically insignificant (P>0.05). Compared with the control group, the treatment group showed a swifter action; pharyngeal pain, dry and burning sensations in pharynx, and mucus congestion were effectively improved, the disease duration was shortened, and there were no adverse reactions in the treatment group.Conclusion Moving cupping in the anterior cervical region plus bloodletting can effectively mitigate the sufferings of the patients with acute pharyngitis without producing any adverse reactions.

Objective: To conduct an epidemiological investigation of two leptospirosis death cases reported in Guizhou Province in 2014. Methods: The information of the patients were investigated and analyzed. The serological detection, samples of the two patients was detected using ELISA and microscopic agglutination test (MAT). Leptospira carrier status of murine host animal in the living environment of the two patients was investigated in October and November of 2014. Leptospires in the kidney were cultured and isolated, the isolates were identified using Leptospira specific PCR and further identified with serogroup specific PCR and the conventional MAT. The relativity between the carrier status of murine and the death cases of human leptospirosis was analyzed. Results: The two death cases of human leptospirosis came from Liping County and the clinical symptoms were consistent with the diagnosis criteria for Leptospirosis. The results of ELISA detection showed that the anti-Leptospira antibody was positive for one of the death cases, MAT identified the serum reacted with sera-group icterohaemorrhagiae Leptospira, while the serum sample of the other case was failed to perform antibody detection due to hemolysis. 1 600 traps were placed in the living environment of the two death cases and 183 murine rodents were trapped. The murine density was 11.44% (183/1 600); 40 leptospirea suspected strains were isolated and all of them were isolated from Apodemus agrarius. The positive rate was 21.86% (40/183); 95 Apodemus agrarius were trapped and the murine density was 5.93% (95/1 600). Species specific PCR identified all the 40 strains as Leptospire. Serogroup specific PCR further identification showed that they were iterohaemorrahgiae serogroup Leptospria. interrogans. Conclusion Anti-iterohaemorrahgiae Leptospira antibody was detected from one of the two patients. 40 strains of iterohaemorrahgiae serogroup Leptospira interrogans were isolated and all of them were isolated from Apodemus agrarius in the living environment and the serogroup of the Leptospira matched with the serological detection results from patients, which indicated that the two death cases were caused by the infection of iterohaemorrahgiae serogroup Leptospira interrogans, and Apodemus agrarius were the potential source of infection.

Objective To construct the professional competency evaluation index system for clini-cal medical professional degree postgraduates. Methods With the literature review and expert consulting, we constructed preliminarily the evaluation index system framework; using the Delphi method, we selected indicators and determined the weights system. Data are recorded and processed using Excel 2003 and SPSS 19. Result The response rate of the Delphi survey were 97％and 96％. The mean of authorities was 0.827 and 0.812, and the harmonious coefficients had statistical significance (P<0.05). The professional compe-tency evaluation index system was established, which was composed of 2 first level indicators, 5 second level indicators and 31 third level indicators; The weight coefficients of the indicators at first level was 0.586 and 0.414. Conclusion The index system construction method is scientific, the process is reasonable, and has certain practical value.

MOOC (massive open online courses) is a hot spot of research and practice in the field of education in recent years. Based on the concept, origin and characteristics of MOOC, and the situation of the construction of MOOC in China, this study applies MOOC to teaching reform in accordance with the current situation of residency standardized training. It introduces the teaching process of curriculum design, online learning, offline teaching and supplementation, and full assessment and evaluation. Besides, it also analyzes the advantages and limitations of the application of the curriculum for the course and puts forward some suggestions for improvement in order to provide a reference for further deepening the reform of the teaching of resident physicians.

Standardized training of residents is a necessary way for clinical medical personnel train-ing. Residents graduating from medical colleges and universities should accept the standardized, scientific, strict pre-service training, in order to realize role conversion from medical students to hospital physicians. This paper summarizes and analyzes the pre-service training, focusing on the training object, course design, organization implementation, evaluation, questionnaire survey, and puts forward some thoughts and sugges-tions on strengthening and improving pre-service training form, expanding the content of training, and quan-tifying the evaluation of training effect.

OBJECTIVETo identify and characterize the Brucella strains from Guizhou province in 2010-2013.

METHODSA total of 12 strains of Brucella suspicious bacteria were isolated in Guizhou province from 2010 to 2013. Four strains (GZLL3, GZLL4, GZLL11 and SH2) were isolated from goat blood samples and eight strains (SH4, GZZY, GZSQ, GZZA, BR13001, BR13004, BR13005 and BR13006) were isolated from blood samples of patient 12 Brucella suspicious strains were identified and characterized using conventional methods. Brucella genus specific gene BCSP31-based PCR (BCSP31-PCR) was used to identify the genus of Brucella and IS711 insert sequence-based PCR (AMOS-PCR) was applied to identify the species of Brucella strains. Goats and patients originated Brucella strains were comparatively analysed using Pulse-field Gel Electrophoresis (PFGE).

RESULTSBoth of conventional methods and PCR identified the 12 Brucella suspicious strains as B. melitensis biotype 3. BCSP31-PCR identification results showed that a specific DNA bands (223 bp) were detected in all the 12 strains and positive control samples with no DNA band in negative samples. AMOS-PCR amplified a 731 bp-DNA bands in all the 12 strains, with 731 bp, 498 bp and 275 bp in M5, S2 and A19 strains, respectively, and no DNA band was detected in the negative control samples. PFGE analysis showed that 12 Brucella isolates from patients and goats showed consistent PFGE patterns with the digestion of restriction enzyme Xba I.

CONCLUSIONThe epidemic species/type of Brucella in both human and animal in Guizhou province was B. melitensis biotype 3 and goat was the main animal source of infection of brucellosis in Guizhou province.

Animals ; Bacterial Typing Techniques ; Brucella ; classification ; Brucellosis ; epidemiology ; China ; epidemiology ; DNA, Bacterial ; Goats ; Humans ; Molecular Typing ; Polymerase Chain Reaction