Objective:To explore the diagnostic value of quantitative analysis of contrast-enhanced ultrasound for deep venous thrombosis of lower extremity after total hip arthroplasty.Methods:A total of 150 patients suspected of deep venous thrombosis of lower extremity undergoing total hip arthroplasty treatment in Jiaozhou Central Hospital of Qingdao from June 2021 to June 2022 were selected. Color Doppler ultrasound diagnostic instrument was used to examine the deep vein vessels of the lower limbs of patients, and quantitative analysis of contrast-enhanced ultrasound was performed to record the color Doppler detection results of patients. Quantitative parameters of contrast-enhanced ultrasound including time to peak (TIP), derived peak intensity (DPI), slope of ascending branch of curve (C) were compared between patients with deep vein thrombosis of lower extremities and normal patients. According to the onset time of symptoms of lower extremity thrombus group, patients were divided into acute stage, subacute stage and chronic stage, and the thrombus elasticity score and thrombus strain ratio among the three subgroups were compared.Results:Angiography results showed that 82 patients were diagnosed with deep vein thrombosis of lower extremities. The Kappa = 0.904, sensitivity was 95.00%, specificity was 91.43%, accuracy was 93.33%, positive prediction rate was 92.68%, and negative prediction rate was 94.12% by using contrast-enhanced ultrasonography and angiography in the diagnosis of deep vein thrombosis of lower extremity. The Kappa = 0.616, the sensitivity was 77.55%, specificity was 88.46%, accuracy was 81.33%, positive prediction rate was 92.68%, negative prediction rate was 67.65% by using ultrasonography and angiography in the diagnosis of deep venous thrombosis of lower extremities. The TIP level in patients with deep venous thrombosis of lower limbs was higher than that in normal patients, the DPI and C levels were lower than that in normal patients: (40.21 ± 12.34) s vs. (13.50 ± 4.59) s, (- 32.27 ± 7.56) dB vs. (- 11.33 ± 3.07) dB, (1.88 ± 0.40) dB/s vs. (4.75 ± 1.34) dB/s, there were statistical differences ( P<0.05). There were 28 cases of acute stage thrombosis, 22 cases of subacute stage thrombosis, and 32 cases of chronic stage thrombosis. There were statistically significant differences in thrombus elasticity score and thrombus strain ratio among patients with lower extremity thrombosis at different periods. Thrombus elasticity score and thrombus strain ratio of patients with acute stage thrombus were the lowest. Conclusions:Quantitative analysis of contrast-enhanced ultrasound has good consistency in the diagnosis of lower extremity deep vein thrombosis after total hip arthroplasty, and has certain clinical significance for staging diagnosis of lower extremity deep vein thrombosis.

Objective:To assess the impact of integrated curriculum (vertically integrated curriculum system) and traditional curriculum system on the perceptions of post competency of undergraduate medical students.Methods:Bibliographic retrieval method and expert consultation were used to compile the questionnaire of perceptions on the post competency of undergraduate medical students. The questionnaire was conducted online to survey the undergraduate medical students from Shanghai Jiao Tong University School of Medicine during March to April, 2019. SPSS 20.0 software was applied for data analysis, chi-square test was used to analyze the classroom teaching forms of medical undergraduates who received different curriculum systems, and their cognition of the doctor post competency and cognitive pathways, and finally the top 10 important competencies were compared.Results:A total of 200 questionnaires were distributed and 167 were recovered, with a recovery rate of 83.5%. Workshop learning was more common in the vertically integrated undergraduate curriculum. Compared with Chinese traditional curriculum, the medical students taught by the vertically integrated undergraduate curriculum were much better informed about competency ( P<0.05). The access to knowledge of competency was also statistically different between two groups of students ( P<0.05). Conclusion:The vertically integrated curriculum is more efficient in helping undergraduate medical students to acquire knowledge about competency.

Objective:To evaluate the therapeutic effects of Tolvaptan on refractory heart failure in patients aged 75 years and older.Methods:This was a randomized controlled trial.A total of 68 patients with refractory heart failure aged 75 years and older were divided into the control group(n=38)and the experimental group(n=30)by randomly generated numbers.Patients in the control group were given levosimendan and recombinant human brain natriuretic peptide intravenously plus routine treatments such as diuresis and electrolyte correction.In the experimental group, 30 patients were given a single dose of 15 mg Tolvaptan per day in addition to what was received by the control group.The effects on heart failure were compared between the two groups 1 week after treatment.Changes in rehospitalization rate, emergency intervention frequency and mortality rate were recorded after a 3-month follow-up.Results:Clinical symptoms of heart failure were alleviated in both the experimental and control groups after treatment.Improvements in 24-h urine volume, body weight and 6-minute walking distance were more significant in the experimental group than in the control group after treatment[(1 470.5±200.6)ml vs.(972.5±201.7)ml, (-6.4±2.1)kg vs.(-2.8±1.9)kg, (189.3±13.7)m vs.(151.3±12.5)m, P<0.05]. Changes in serum sodium levels and improvement of LVEF were greater and reduction of N-terminal B-type brain natriuretic peptide(NT-proBNP)levels was more significant in the experimental group than in the control group after treatment[(5.2±2.1)μmol/L vs.(-1.1±2.4)μmol/L, (10.1±4.1)% vs.(7.0±4.0)%, (-6 670±1 815.7)ng/L vs.(-5 025.3±1 876.7)ng/L, P<0.05]. There was no significant difference in the incidence of adverse reactions between the two groups( P>0.05). The experimental group had shorter hospital stays, while the rehospitalization rate, emergency intervention times and mortality had no significant difference between the two groups during the follow-up period( P>0.05). Conclusions:Addition of Tolvaptan to treatment can increase urine volume, improve cardiac function, correct hyponatremia and shorten the length of hospitalization in refractory heart failure patients aged 75 years and older with good safety and has no significant impact on renal function.

Objective:To analyze the epidemiological and clinical characteristics of patients with imported corona virus disease 2019 (COVID-19) in Beijing City.Methods:A case-control study was performed to retrospectively analyze 69 cases of imported COVID-19 from abroad and 147 cases of domestic confirmed COVID-19 from China as a control group from January 20 to March 20, 2020 admitted to Beijing Ditan Hospital, Capital Medical University.The epidemiological and clinical characteristics were compared.Statistical analysis were performed by t test, Mann-Whitney U test, chi-square test and Fisher exact test. Results:The main sources of the cases in the import group were from the United Kingdom, Italy, Spain and other European countries, with 44.9%(31/69) of the overseas students entering the country by air. The age of the imported group (27(21, 40) years) was lower than the domestic group (43 (32, 59)years), the difference between the two groups was statistically significant ( U=2 828.500, P<0.01). Compared with the domestic group, the proportion of cases with contact history of confirmed cases in the imported group was lower (30.4%(21/69) vs 68.0%(100/147)), the interval between onset and admission ≤seven days was higher (81.2%(56/69) vs 66.0%(97/147)), the proportion of cases with underlying diseases was lower (21.7%(15/69) vs 44.2%(65/147)). The differences between the two groups were all statistically significant ( χ2=26.935, 5.233 and 10.175, respectively, all P<0.05). The proportion of mild cases in the imported group was higher than that in the domestic group (42.0%(29/69) vs 10.9%(16/147)). Seventeen cases with olfactory abnormality and 12 cases with taste abnormality were found in the imported group, while no olfactory and taste abnormality was found in the domestic group. The proportions of fever, weakness, muscle soreness and dyspnea were all lower than those of the domestic group, the differences between the two groups were all statistically significant ( χ2=13.851, 8.118, 9.730 and 16.255, respectively, all P<0.01). The proportions of cases with decreased lymphocyte absolute numbers (37.7%(26/69) vs 67.3%(99/147)) and increased C reactive protein level (15.9%(11/69) vs 51.8%(72/139)) were both lower than the domestic group, and the differences between the two groups were both statistically significant ( χ2=18.015 and 24.722, respectively, both P<0.01). The proportions of cases with ground glass shadow and consolidation of chest computed tomography were lower than those of the domestic group and the differences between the two groups were all statistically significant ( χ2=11.961 and 5.099, respectively, all P<0.05). In terms of complications, the proportions of cases with acute respiratory distress syndrome and acute myocardial injury were lower (2.9%(2/69) vs 10.9%(16/147) and 4.3%(3/69) vs 14.0%(16/114), respectively), and there were statistically significant differences between the two groups ( χ2=4.017 and 4.335, respectively, both P<0.05). There were no cases received mechanical ventilation and extracorporeal membrane oxygenation in the imported group, and the proportions of patients received oxygen therapy and antibiotic treatment were significantly lower than those in the domestic group (13.0%(9/69) vs 26.5%(39/147) and 13.0%(9/69) vs 39.5%(58/147), respectively) and the differences between the two groups were statistically significant ( χ2=4.942 and 15.797, respectively, both P<0.05). Conclusions:The majority of imported COVID-19 cases are mainly from European countries, mostly young and middle-aged, and mostly mild and ordinary types.The symptoms of olfactory and taste abnormality are found for the first time.

Animals ; Cells, Cultured ; Gastrointestinal Tract ; metabolism ; Neuroglia ; metabolism ; Neurons ; metabolism ; Peptide Fragments ; metabolism ; Peptides ; metabolism ; Proteins ; metabolism ; Rats

Currently,the undergraduate teaching of pediatrics in China is still the science-based curriculum,having a big gap with international medical teaching idea and mode.Medical colleges of the University of Ottawa and Shanghai Jiao Tong University co-established the 0ttawa-Shanghai Joint School of Medicine (OSJSM) in October 2014.By enriching the curriculum content (including theory,skill and professionalism),adding "active" teaching,introducing clinical pediatricians to the students-management group,and applying formative evaluation method,the OSJSM started transforming to the competency-based cultivation,improving the teaching quality.

Objective:To quantify the plasma concentrations of inorganic arsenic (As(III) and As(V)) and methylated metabo-lites ( MMA and DMA) , and to detect the total amount of arsenic in blood cells and plasma by high performance liquid chromatogra -phy-hydridegeneration-atomic fluorescence spectrometry ( HPLC-HG-AFS) and HG-AFS methods to clarify the arsenic species in acute promyelocytic leukemia (APL) patients.Methods:The blood cells and plasma were digested by the mixture of HNO 3-H2O2 and ana-lyzed by HG-AFS.For the arsenic species , the plasma samples were prepared with perchloric acid to precipitate protein .The superna-tant was separated on an anion-exchange column in 6 min with isocratic elution using 13 mmol · L-1 CH3 COONa, 3 mmol · L-1 NaH2 PO4 , 4 mmol· L-1 KNO3 and 0.2 mmol· L-1 EDTA-2Na.Results:The methods provided linear range of 0.2-20 ng· ml-1 for total arsenic and 2.0-50 ng· ml-1 for four arsenic species (r>0.9950).The spiked recoveries ranged from 81.2％to 108.6％, and the coefficients of variation for intra-and inter-batch precision were less than 9.3％and 12.5％, respectively.The developed methods were applied successfully in the assay of total arsenic and arsenic species in 5 APL patients.Conclusion:The method is simple, fast and accurate , which can be applied in the assay of arsenic compounds in plasma and blood cells in APL patients .

Objective:To investigate the improvement effects of duodenal-jejunal bypass (DJB)on the blood glucose homeostasis,insulin resistance and inflammation of the obese type 2 diabetic (T2DM)ZDF rats,and to discuss its possible mechanism.Methods:A total of 20 ZDF rats were randomly divided into DJB operation group and sham operation group (n = 10).There were 8 rats survived in each group after operation.The level of blood glucose (FBG)was detected by Roche glucose meter at 1 week before operation,2 weeks,4 weeks and 6 weeks after operation;the fasting serum insulin level of the rats was measured by ELISA kit;the insulin sensitivity index (HOMA-ISI)and insulin resistance index (HOMA-IR)were calculated.The rats were executed 6 weeks after operation.HE staining was used to observe the morphology of the inflammatory cells in BP limb of the rats;the expression levels of AMPK and pAMPK in BP lamb of the rats were observed by immunohistochemical staining;the expression levels of interleukin 1β(IL-1β),interleukin 6 (IL-6),tumor necrosis factorα(TNF-α),nuclear factorκB (NF-κB),and interleukin 10 (IL-10)mRNA of the rats were detected by QRT-PCR method.Results:From the 2nd week after operation,compared with before operation,the FBG levels of the rats in DJB operation group were decreased (t=3.798,P <0.05);compared with sham operation group,the FBG level of the rats in DJB operation group was decreased (t=3.205,P <0.05).Six weeks after operation,compared with sham operation group,the HOMA-IR of the rats in DJB operation group was significantly decreased (t=4.441,P <0.05)and the HOMA-ISI was significantly increased (t=-8.65,P < 0.05).The HE staining results showed that compared with sham operation group,the morphology of the inflammatory cells in BP limb of the rats in DJB operation group was significantly improved.The QRT-PCR results showed that the expression levels of IL-1β,IL-6,TNF-αand NF-κB of the rats in DJB operation group was significantly decreased compared with sham operation group (P < 0.05), while the expression level of IL-10 was significantly increased (P < 0.05).The immunohistochemical test results showed that the expression levels of AMPK and pAMPK in BP lamb of the rats in DJB operation group were increased compared with sham operation group.Conclusion:DJB can significantly improve the blood glucose homeostasis and insulin resistance in the T2DM rats,and its mechanism may be related to the decreased expressions of inflammatory factors and the activation of AMPK molecules in BP lamb of the T2DM rats.

Objective To observe the effects of ketamine on the patients with depression re-ceiving modified electric conulsive therapy (MECT).Methods Sixty patients with depression were randomly divided into ketamine group and propofol group (n =30 each group).Atropine 0.5-1.0 mg, propofol 1.0 mg/kg or ketamine 0.8 mg/kg i.v.were given before MECT,Scoline 0.7-1.0 mg/kg i. v.was given after the eyelash reflex disappeared.Hamilton Depression Rating Scale (HAMD)was completed after the 2 nd ,4 th and 6 th MECT,the time of convulsion,twitch index,energy percentage, respiratory recovery time and adverse reactions were recorded.Results The total score of HAMD was significantly decreased with the increasing times of MECT in both groups,compared with propo-fol group,ketamine group's HAMD total score decreased faster,especially after the 4th MECT,the score decreased significantly in ketamine group (P <0.05).The time of convulsion,twitch index,en-ergy percentage, respiratory recovery time, adverse reactions all had no statistical significance between the two groups.Conclusion Compered with propofol,ketamine,as an anesthetic of MECT, can effectively lower the score of HAMD.

Objective:To study the change of related molecular about apoptosis we reduce the expression of CD59 on acute T lymphocyte Jurkat cell lines .Methods: RNA interference (RNAi) was used to reduce the expression of CD59 gene by lentivirus,confocal was applyed to observe the transfection efficiency and the location of CD59 molecular then Real-time-PCR and Western blot were used to select the most effective group to do the rest experiment;Western blot was used to detect the change of expression about Bcl-2,Bax,Caspase-3 and Survivin;ELISA was used to investigate the expression of IL-3 and TNF-β.Results: Confocal observed each group′s transfection efficiency over 90%,CD59 molecules were mainly located in cell membrane;Real-time-PCR and Western blot showed group A had the best down-regulation efficiency;we defined RNAi-CD59-A as experimental group for subsequent experiments named RNAi-CD59;the experimental group can enhance the expression of Bax,caspase-3 (P<0.05),inhibit the expression of Bcl-2 and Survivin(P<0.05);ELISA showed that the expression of IL-3 in the down-regulation group increase(P<0.05),the expression of TNF-β decrease (P<0.05).Conclusion: Down-regulation CD59 can promote the expression of apoptosis molecular in acute leukemia Jurkat cell lines restrain the expression of proliferation molecular.