Objective:To analyze the online learning behaviors and learning results of students under different teaching modes with different learning motivations, and to provide a reference for optimizing the development of online teaching.Methods:Samples of students taking the physiology small private online course (SPOC) in 2019 and 2020, and students taking the massive open online courses (MOOC) in the same year were selected in the study to discuss the differences in learning behaviors of students under different teaching modes and learning effects on students with different learning motivations. The online learning behaviors of students were analyzed based on their learning engagement, interactive behavior and learning motivation. SPSS 25.0 was used to analyze the data with statistical methods such as function calculation, frequency statistics, regression analysis, rank sum test, correlation test and chi-square test.Results:The learning participation level ( z=14.36, P<0.001), and the human-machine and interpersonal learning interaction level ( z=-11.70, -16.18, both P<0.001) of SPOC learners in 2020 were higher than those in 2019. The overall interactive level was moderately correlated with performances of students ( r=0.42, 0.52, both P<0.001), and the correlation between interpersonal behavior and grades was much more stronger ( r=0.60, 0.55, both P<0.001). The performance composition of SPOC and MOOC learners in 2019 was completely different ( χ2=857.45, P<0.001). The learning effect of externally motivated students was significantly better than that of internally motivated students ( z=-28.42, P<0.001). Conclusion:The teaching mode adopted by the school can affect the learning effect by influencing the students' online learning engagement and interactive behavior. Besides, students' own learning motivation also plays a key role in their academic performance.

【Objective】 To discuss the interference of anti-CD47 in pre-transfusion test and the mitigation measures. 【Methods】 Blood sample of one patient received anti-CD47 treatment was collected to conduct routine serological tests including ABO/Rh phenotype, direct anti-human globulin test, irregular antibody screening, antibody identification and cross-match. Packed platelet from multiple type O blood donors was used to absorb with patient′s plasma. The patient′s plasma was absorbed with CCDee, ccDEE and ccdee red cells, respectively. Anti-IgG monoclonal Gamma-clone which lacks reactivity with human subclass IgG4 was used to perform antibody screening and cross-match. Capture-R was used to perform antibody screening. 【Results】 The direct anti-human globulin test was positive(1+ ), the reactivity in all phases was strong positive(3+ -4+ ). The anti-CD47 was eliminated after platelet and red cells absorption. Antibody screening became negative using Gamma-clone and Capture-R, and cross-match successfully using Gamma-clone. 【Conclusion】 Anti-CD47 monoclonal antibody can interfere with pre-transfusion test and cross matching. To remove the interference of anti-CD47 requires the use of Gamma-clone anti-IgG in the indirect antiglobulin testing or Capture-R.

Objective: To predict the efficacy of endoscopic tissue adhesives in the treatment of gastric varices in patients with liver cirrhosis by Nomogram model. Methods: From August 2014 to September 2017, 158 patients with liver cirrhosis caused esophagogastric variceal bleeding and received endoscopic tissue adhesives treatment at Zhongshan Hospital, Fudan University were collected. All patients were followed for 12 months. The primary outcome was rebleeding. The factors of rebleeding after endoscopic treatment of esophagogastric varices were analyzed. Nomogram prognostic model was developed and compared with Child-Pugh grading, computed tomography angiography (CTA) and hepatic venous pressure gradient (HVPG) in prognostic accuracy in rebleeding after endoscopic treatment in liver cirrhosis caused esophagogastric varices. Univariate and multivaricate Cox regression analysis, Kaplan-Meier curve and log-rank test were performed for statistical analysis. Results: During the follow-up, rebleading occurred in 18 cases (11.4%), 37 cases (23.4%) and 49 cases (31.0%) at 2, 6, and 12 months after endoscopic treatment. The results of univariate Cox regression analysis showed the risk factors of rebleeding after endoscopic treatment of gastric varices included gender, alcoholic liver cirrhosis, diabetes mellitus, Child-Pugh grade (Grade A vs. B or C), extraluminal vessels on CTA (presence vs. absence) HVPG (<16 mmHg vs. ≥16 mmHg, 1 mmHg = 0.133 kPa), extensive portal embolism, esophageal varices, type 2 gastric varices, injection points of tissue adhesive (≤3 points vs. > 3 points), injection volume of tissue adhesive (≤ 3 mL vs. > 3 mL) (hazard ratio (HR)=0.575, 2.018, 1.562, 3.433, 2.945, 1.859, 2.743, 0.324, 1.840, 1.477, and 1.716; 95% confidence interval (CI) 0.305 to 1.084, 0.902 to 4.514, 1.753 to 6.724, 1.663 to 5.217, 1.012 to 3.415, 0.852 to 8.830, 0.079 to 1.335, 1.012 to 3.317, 0.839 to 2.602, and 0.935 to 3.152; all P<0.2). The results of multivariate Cox regression analysis indicated that Child-Pugh grade, extraluminal vessels by CTA, and HVPG (HR = 2.095, 95% CI 1.099 to 3.995, P = 0.025) were all independent risk factors of rebleeding after endoscopic treatment of gastric varices (HR=2.665, 2.886, and 2.095; 95% CI 1.339 to 5.300, 1.580 to 5.271, and 1.099 to 3.995; all P<0.05). Kaplan-Meier curves showed that Child-Pugh grade (Grade A vs. B or C), extraluminal vessels on CTA (presence or absent) and HVPG (<16 mmHg vs. ≥16 mmHg) could effectively predict cumulative non-rebleeding rate in one year after endoscopic treatment of gastric varices, and the differences were statistically significant (all P<0.05). Receiver operataring characteristic curve analysis demonstrated that the predictive value of the model combined with Child-Pugh grade, extraluminal vessels on CTA and HVPG was higher than that of Child-Pugh grade and HVPG (AUC=0.746, 0.673 and 0.585; 95% CI 0.662 to 0.829, 0.583 to 0.762, and 0.486 to 0.683; P<0.01, P=0.001 and P=0.089, respectively). Patients were divided into low, medium, and high-risk groups according to the 25th and 75th percentiles of the Nomogram score. The results showed that Nomogram model could effectively distinguish high-risk groups of rebleeding after endoscopic treatment of gastric varices, and the difference was statistically significant (P <0.01). Conclusions Extraluminal vessels on CTA, HVPG and Child-Pugh grade are independent prognostic evaluation indexes of rebleeding after endoscopic treatment of gastric varices. The predictive accuracy of Nomogram model based on these three prognostic factors may be better than Child-Pugh grade and HVPG.

Objective Observation and discussion about the treatment effect with home-made vacuum drainage and Algoplaque on severe pressure ulcers. Methods The patients with severe pressure ulcers selected from Yuebei Peole′s Hospital of Shaoguan city from January to December 2016 were randomly divided into three groups:experimental group, control group A and group B (30 cases in each). The patients were treated with home-made vacuum drainage and Algoplaque in the experimental group, meanwhile a simple use of Algoplaque treatment in control group A and VSD technology in control group B only. Observed and compared the effect in the three groups on the time of dressing change, wound healing time and the total cost. Results The wound healing time of experimental group.contral group A and group B were (24.10 ± 2.12), (33.26 ± 1.71), (27.87 ± 1.95) days, the times of dressing change were 5.52 ± 0.96, 35.84 ± 1.81, 7.23 ± 1.09, dressing costs were (629.95 ± 28.10) yuan, (1354.29 ± 301.63) yuan, (10825.38±1678.21) yuan, and the differences were statistically significant (F=175.961, 5017.527, 1029.377, all P<0.01), and the wound healing time, dressing times, dressing costs were lower than the control group A and B in the observation group. Conclusion The treatment of home-made vacuum drainage and Algoplaque on patients with severe pressure ulcers can obviously reduce the time of dressing change and wound recovery, and the cost also. It is worthy to promote in clinic.

Objective To evaluate the safety and efficacy of endoscopic ultrasound (EUS) guided ethanol ablation of benign insulinoma and compare its' advantages and disadvantages with surgical treatment. Methods From April 2011 to February 2016, clinical data of 38 patients with benign insulinoma treated by EUS-guided ethanol ablation or surgical treatment were retrospectively analyzed. Results 97.4% (37/38) patients had a typical clinical manifestation of Whipple's triad, and the I/G ratio of 82.9% patients (29/35) was more than 0.3 with their onset of hypoglycemia. The positive preoperative etiologic diagnosis rates of transabdominal ultrasonography, CT, MRI, PET/CT and EUS were 50.0%, 67.6%, 66.7%, 75.0%, 89.7% respectively. In the current study, 18 patients underwent EUS-guided ethanol ablation (EUS-FNI group) and 20 patients received surgicaltreatment (surgical group). Compared with the surgical group, the operation time, intraoperative hemorrhage volume, postoperative complications, length of stay and hospitalization costs were significantly reduced in the EUS-FNI group (P < 0.05). No treatment-related complications was observed in EUS-FNI group, while 40.0% (8/20) patients in surgical group had complications. During the follow-up period, all these patients maintained stable blood glucose without taking medication, and there's no recurrence of insulinoma in EUS-FNI group after the last treatment with alcohol injection; In surgical group, only 90.0% (18/20) patients had no recurrence, episode of hypoglycemia was less after the operation in 10.0% (2/20) patients. Conclusion EUS-guided ethanol ablation of benign insulinoma is safe and effective, compared with traditional surgical treatment, EUS-guided ethanol ablation is minimally invasive, costs less, recovers fast after treatment and has fewer complications.

Objective To compare cost-effectiveness between endoscopical esophageal variceal ligation (EVL) combined non-selective beta-receptor blocker strategies and covered-stents transjugular intrahepatic portosystemic shunt (cTIPS) in preventing esophageal variceal rebleeding in liver cirrhosis with portal hypertension.And to explore the threshold of cost-effectiveness in stents in China.Methods According to clinical practice and associated guidelines,a six state Markov-based decision analytic model was established with TreeAge Pro Suite 2014 to compare the cost-effectiveness between two interfering strategies after followed up for seven years.The parameters such as costs,life years (LY),quality-adjusted life-years (QALY) and incremental costeffectiveness ratio (ICER) were directed.Results The results of baseline research in the seven-year follow-up period indicated that the cost of endoscopical EVL combined non-selective beta-receptor blocker B was 7 444.25 United States dollar (USD)/each,and yielded 1.98 QALY.The expected cost of cTIPS was 13 151.69 USD/ each and could have 2.34 QALY.In the 7th year,ICER was 16 001.74 USD.Based on willingness-to-pay (WTP) threshold of China (19 887.00 USD),cTIPS had better cost-effectiveness than endoscopical EVL combined non-selective beta-receptor blocker B.The price of covered stents less than 5 401.52 USD had cost-effectiveness.The results of single factor sensitivity analysis indicated that rebleeding probability of endoscopical EVL combined non-selective beta-receptor blocker B group was the most influential factor in the result of model.The second important factor was the cost of cTIPS.The probabilistic sensitivity analysis reported cTIPS to be the optimal strategy at WTP of 19 887.00 USD in 83％ of the iterations.Conclusions Seven-year follow-up indicates that cTIPS may be a more cost-effective strategy than endoscopical EVL combined non-selective beta-receptor blocker B in preventing esophageal variceal rebleeding.The price of covered stents less than 5 401.52 USD which have cost-effectiveness in China.

Objective The reactivity of the PICC comprehensive maintenance model and the ward maintenance model was evaluated.The differences between these two models were compared so that the better maintenance model could be chosen for improving the service of the PICC comprehensive maintenance model. Methods Four hundred and fifty patients with the PICC catheter were chosen randomly.Three hundred and forty patients received the PICC comprehensive maintenance model (mainly in the out-patient department and combined with the network maintenance ).One hundred and ten patients received the ward maintenance model (mainly in the in-patient ward).The WHO reactivity questionnaires of health system were provided.The results of the valid questionnaires were calculated and analyzed.Results Four hundred and twenty-nine questionnaires (326 for the comprehensive maintenance model and 1 03 for the ward maintenance model)were collected.The reactivity evaluation of confidentiality,communication,autonomy,timeliness,basic facilities and selective dimension in the comprehensive maintenance model were significantly higher than those in the ward maintenance model (P <0.05).There were no significant differences in the reactivity evaluation of dignity and social support dimension between the two groups (P >0.05).Conclusions The reactivity evaluation of healthy system in the comprehensive maintenance model is higher.It can provide timely and convenient PICC service and meet the expects and demands of patients.

Objective To evaluate the effects of personalized psychological video intervention on patients of mental nursing in ICU. Methods A total of 124 conscious patients in ICU were divided into control and experiment group equally from December 2013 to October 2014. Common mental nursing was used in the control group while personalized psychological video intervention was used in the experiment group. The effects were evaluated and compared by SCL-90, PSQI and satisfaction questionnaire after 2 days admission and after 7 days nursing interventions. Results After intervention in the experimental group, the somatization, obsessive system, interpersonal relationship, depression, anxiety, hostile, terror, crankiness and psychosis of SCL-90 were (1. 34 ± 0. 21), (1. 62 ± 0. 36), (1. 63 ± 0. 34), (1. 56 ± 0. 22), (1. 60 ± 0. 38), (1. 43 ± 0. 51), (1.26±0.30),(1.50±0.48),(1.36±0.33) respectively(t=2.108,2.934,2.884,2.335,2.775, 2. 696, 2. 365, 2. 005, 1. 999;P < 0. 05). After intervention, the scores of each PSQI dimensions was decreased in two groups, and the scores of experimental group were lower than those in the control group ( t=3. 129, 2. 635, 2. 116, 2. 568, 3. 221, 3. 227, 2. 548, 2. 494;P <0. 05). Conclusions Personalized psychological video intervention can effectively reduce conscious patients negative emotions in ICU, and improve the sleep quality and the satisfaction.

Objective To investigate the influence of psychological intervention on the physical and psychomotor development of children born of assisted reproductive technology. Methods 329 cases of ART born children in our hospital were set as the experimental group,the parturients were given pertinent psychological intervention.254 cases of children of spontaneous pregnancy were selected as the control group.The two groups were given follow-up for 24 months.Their physical condition at birth and psychomotor development during follow - up period were compared. Results Compared with the control group,length of infants at birth,body mass of the experimental group were significantly lower,and the incidence rate of premature birth,low birth weight,NICU stay during neonatal stage were higher.But there were no differences in psychomotor development between two groups. Conclusions ART born children of 24-month old show normal psychomotor development,but there are still more unfavorable physical factors,therefore,pertinent nursing intervention should be given based upon psychological intervention in clinic.

This paper introduces the perioperative nursing of 83 sialolithiasis patients undergoing sialolithectomy by sialoendoscope. The key points of successful nursing care were careful preoperative psychological nursing and equipment preparation, correct and skilled intraoperative cooperation, and early postoperative health instruction. As a result, all the patients underwent the surgery succesfully and recovered well except 3 cases who needed gland removal later.