Taking the micro-course The Connection Between Vertebrae as an example, this paper discusses the teaching design, production process and practical application of the anatomy micro-course, analyzes the existing problems and puts forward corresponding suggestions. The micro-course design integrates knowledge points with ideological and political elements, and applies a variety of teaching methods to make the teaching content interesting, enlightening and applicable. In the production process, using anatomical specimens, models and 3D software demonstration structure can make abstract knowledge intuitive and perceptual. Moreover, the artistry of micro-course is increased appropriately, and the misunderstanding of emphasizing appearance and neglecting design is avoided. The application of micro-course integrates the micro-course and online education platform to realize the intelligent education of information teaching. In addition, college teachers should improve the awareness of micro-course production and carry out systematic construction and application of micro-course resources.

Objective:To investigate the predictive value of platelet dynamics on the prognosis of 28-day in patients with extracorporeal membrane oxygenation (ECMO).Methods:From January 2017 to December 2020, 60 patients from the Emergency Medicine Center of the First Affiliated Hospital of Nanjing Medical University received ECMO for life support. The baseline data of the patients were collected, the minimum value of platelets on day 1-7 of the machine was calculated, and the platelet change value and change rate were calculated. The patients were divided into the survival group and death group according to the 28-day survival status after ECMO was installed, and the receiver operating curve (ROC) was drawn based on the platelet change value and change rate to evaluate its predictive value for prognosis.Results:Among patients receiving VV-ECMO, the platelet change value and change rate on day 7 had the best prediction effect on the patient's 28-day outcome ( AUCΔPLT7=0.772, P=0.016; AUCΔPLT7%=0.764, P=0.020), when the platelet change value was 4×10 9/L as the critical value, the sensitivity was 0.857, the specificity was 0.615, and when the platelet change rate was -28.99% as the critical value, the sensitivity was 0.857, the specificity was 0.615, and when the platelet change rate was -28.99%. The sensitivity was 0.643 with a specificity of 0.846. In patients receiving VA-ECMO, the platelet change rate on day 6 predicted the best effect on the patient's 28-day outcome ( AUCΔPLT6%= 0.707, P = 0.045). When the platelet change rate was -26.19% as the critical value, the sensitivity was 0.842 and the specificity was 0.643. Conclusions:Platelet dynamic changes of platelets are correlated with the 28-day prognosis of patients receiving ECMO, and the combination of platelet change value and the critical value of change rate can better predict the poor prognosis of patients in both ECMO modes.

Chlorfenapyr is a moderately dangerous insecticide widely used in agriculture. The mortality of acute poisoning patients is high, and there is no effective treatment. This paper retrospectively analyzes the clinical data of two cases of compound chlorfenapyr poisoning. The main symptoms of the patients were high fever, sweating, gradual coma, increased creatine kinase and myoglobin, with delayed poisoning symptoms. Despite comprehensive treatment, both patients died eventually. It indicated that chlorfenapyr was highly toxic and had a high mortality. In addition to routine symptomatic treatment for patients with acute poisoning, blood purification treatment should be actively carried out in the early stage.

Chlorfenapyr is a moderately dangerous insecticide widely used in agriculture. The mortality of acute poisoning patients is high, and there is no effective treatment. This paper retrospectively analyzes the clinical data of two cases of compound chlorfenapyr poisoning. The main symptoms of the patients were high fever, sweating, gradual coma, increased creatine kinase and myoglobin, with delayed poisoning symptoms. Despite comprehensive treatment, both patients died eventually. It indicated that chlorfenapyr was highly toxic and had a high mortality. In addition to routine symptomatic treatment for patients with acute poisoning, blood purification treatment should be actively carried out in the early stage.

Objective:To construct a nomogram model to predict the tolerance of postoperative chemotherapy in endometrial cancer patients by analyzing nutrition-related indexes.Methods:Patients with endometrial cancer who underwent surgery and postoperative chemotherapy in Suzhou Municipal Hospital from July 2013 to July 2019 were included in this study. Some nutrition-related indexes were collected, including age, diabetes, body mass index(BMI), blood albumin, prealbumin, lymphocyte count, hemoglobin, blood platelets, C-reactive protein and blood cholesterol, aspertate aminotransferase, alanine aminotransferase and chemotherapy tolerance. The model for prediction of postoperative chemotherapy tolerance of patients with endometrial cancer were constructed by analyzing these nutrition-related indexes.Results:A total of 83 patients were enrolled, aged from 32 to 81 years, with an average age of (55.15 ± 9.38) years, and BMI were 14.53 - 30.11 kg/m 2, with an average BMI of (22.03 ± 2.93) kg/m 2. All the 83 patients were confirmed as endometrial cancer by postoperative pathology, and received TP or TC chemotherapy after surgery. Before starting chemotherapy, 83 patients were scored on the NRS-2002 scale, 43 were considered to be at risk of malnutrition or nutrition. After receiving chemotherapy, 34 patients developed intolerance to chemotherapy, and the remaining 49 were tolerable. The results of univariate and multivariate regression analysis showed that the presence or absence of diabetes ( HR = 5.634, P = 0.038), lymphocyte count ( HR = 0.146, P = 0.004), and albumin ( HR = 0.857, P = 0.011) were independent influencing factors of chemotherapy tolerance. Conclusions:Diabetes mellitus, lymphocyte count and albumin level can be used to predict the tolerance of chemotherapy in patients with endometrial cancer. The nomogram model of these three nutrition-related indexeshad a good prediction ability to predict the tolerance of chemotherapy in patients with endometrial cancer.

Objective To study the prevalence situation of chronic diseases among teachers from some middle and primary schools in Chongqing City.Methods The physical examination data of 6969 teachers in 52 middle and primary schools in a district of Chongqing major city were collected.The survey data of overweight,obesity,hyperlipidemia,osteoporosis,fatty liver and hyperuricemia were statistically analyzed.Results The total morbidity rates of overweight,obesity,hyperlipidemia,osteoporosis,fatty liver and hyperuricemia were 31.3 ％,7.5 ％,35.1％,34.7 ％,22.4 ％ and 22.2 ％ respectively.The incidence rates of above diseases had difference among the age periods of ≤44 year old,＞44 ＜60 years old and ≥60 year old (P＜0.05).The incidence rate was significantly increased with age increase (P＜0.05).The incidence rate of osteoporosis in females was higher than that in males(P＜ 0.01);while the incidence rate of fatty liver and hyperuricemia in males were higher that in females (P＜0.01).Conclusion The incidence of chronic diseases among teachers in middle and primary schools is worth attention.Therefore it is necessary to carry out the health education aiming at the teacher population characteristics,strengthen their heath management and behavior intervention for increasing their health level.

Objective To explore the treatment experience of acute paraquat poisoning,thus to explore the prognostic factors and treatment measures.Methods The clinical data of 87 patients with paraquat poisoning who were treated with combined therapy in our hospital emergency department 2014-2015 were retrospectively analyzed.Results 49 cases survived and 38 cases were died in 87 paraquat poisoning patients,the survival rate was 56.32％.The average paraquat of the death group was 65.3mL,which was significantly higher than 41.2mL of the survival group(t =16.65,P ＜ 0.01).Conclusion Amount of poisoning is the key to the prognosis,white blood cells were significantly increased,early or large areas of lung disease is an important factor in poor prognosis;early gastric lavage,cathartic and timely blood purification,application of adrenal cortex hormones,antioxidant and other comprehensive treatment can reduce mortality.

OBJECTIVETo evaluate the feasibility of genetic and prenatal diagnosis for a family affected with pyruvate kinase deficiency (PKD).

METHODSTargeted sequence capture and high-throughput sequencing technology was used to detect the exons and exon-intron boundaries of the PKLR gene in a clinically suspected PKD patient. Meanwhile, the genotype of the pedigree was validated by Sanger sequencing. Prenatal genetic diagnosis was performed by amniotic fluid sampling after genotype of the mother of the proband was determined.

RESULTSThe proband was found to harbor double heterozygous mutations, c.661G>A (Asp221Asn) and c.1528C>T (Arg510Ter), which resulted in amino acid substitution Asp221Asn and Arg510Ter. Such mutations were confirmed by Sanger sequencing. The mother and father of the proband were detected to have respectively carried c.1528C>T (Arg510Ter) and c.661G>A (Asp221Asn) mutation. The fetus was found to have carried the same mutations as the proband. Following selected abortion, analysis of fetal tissue was consistent with the result of prenatal diagnosis.

CONCLUSIONThe compound mutations of c.661G>A and c.1528C>T of PKLR gene probably underlie the PKD in the family. Prenatal diagnosis of the mutations analysis can facilitate detection of affected fetus in time.

Adult ; Anemia, Hemolytic, Congenital Nonspherocytic ; embryology ; enzymology ; genetics ; Base Sequence ; Child, Preschool ; DNA Mutational Analysis ; Exons ; Female ; Genotype ; Humans ; Male ; Molecular Sequence Data ; Mutation ; Pedigree ; Pregnancy ; Prenatal Diagnosis ; Pyruvate Kinase ; deficiency ; genetics ; metabolism ; Pyruvate Metabolism, Inborn Errors ; embryology ; enzymology ; genetics

OBJECTIVETo observe the effect of sodium bicarbonate combined with ulinastatin on cholinesterase activity for patients with acute phoxim pesticide poisoning.

METHODSA total of 67 eligible patients with acute phoxim pesticide poisoning, Who were admitted to the emeryency department of hospital from March 2011 to February 2014, Acording to different treatments au patients were randomly divided into the conventional treatment group (n=34) and the sodium bicarbonate+ulinastatin group (n=35) . The conventional treatment group were given thorough gastric lavage with water, the sodium bicarbonate + ulinastatin group were given gastric lavage with 2% sodium bicarbonate solution. Both groups were given such treatments as catharsis, administration of oxygen, fluid infusion, diuresis, and antidotes such as atropine and pralidoxime methylchloride. On the basis of comprehensive treatment, people in the sodium bicarbonate+ulinastatin group were given 5% sodium bicarbonate injection and ulinastatin. The clinical effect of the two groups were compared.

RESULTSThe serum cholinesterase activity of the sodium bicarbonate+ulinastatin group was significantly higher than the conventional treatment group from the 5th day, and the difference was statistically significant (P<0.05) . The total atropine dosage, total pralidoxime methylchloride dosage and hospitalization days were better than the conventional treatment group, and the differences were statistically significant (P<0.05) . The difference in the time of atropinization between the two groups was not statistically significant (P>0.05) . The results of arterial blood pH, HCO3- of the sodium bicarbonate + ulinastatin group were higher than the conventional treatment group, and the difference of HCO3- at the 10th day was statistically significant (P<0.05) .

CONCLUSIONSSodium bicarbonate combined with ulinastatin can improve the therapeutic effect and reduce complications in the treatment of acute phoxim pesticide poisoning, and have beneficial effects on the recovery of cholinesterase activity.

Atropine ; therapeutic use ; Cholinesterases ; metabolism ; Glycoproteins ; therapeutic use ; Humans ; Organophosphate Poisoning ; drug therapy ; Organothiophosphorus Compounds ; poisoning ; Pesticides ; poisoning ; Pralidoxime Compounds ; therapeutic use ; Sodium Bicarbonate ; therapeutic use

Humans ; Hydrocarbons, Chlorinated ; poisoning ; Propane ; poisoning