ObjectiveTo investigate the clinical efficacy of Gandouling tablet （GDL） on abnormal lipid metabolism in Wilson's disease （WD） and the correlation between the prediction model of hepatic steatosis and the related indexes of lipid metabolism in WD. MethodA total of 86 patients with abnormal lipid metabolism in WD were selected. The 24-hour urine copper， alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， serum triglyceride （TG）， total cholesterol （TC）， apolipoprotein B （ApoB）， low density lipoprotein cholesterol （LDL-C）， bile acid （BA）， γ-glutamyl transferase （GGT）， prediction model of hepatic steatosis ［hepatic steatosis index （HSI） and Zhejiang University index （ZJU index）］， ultrasonic attenuation coefficient imaging （ATT）， and traditional Chinese medicine （TCM） syndrome score were statistically analyzed before treatment. Pearson correlation test was used to analyze the correlation between TG， TC， LDL-C， ApoB， ALT， AST， ALT/AST， BA， GGT， TCM syndrome score， ATT， and HIS and ZJU. The patients were divided into an observation group and a control group by random number table method， with 43 cases in each group. The observation group was treated with GDL combined with sodium dimercaptopropane sulfonate （DMPS）， while the control group was only treated with DMPS as a control. After six courses of treatment， 24-hour urine copper， TC， TG， LDL-C， ApoB， HSI， ZJU， ATT， TCM syndrome score， and clinical efficiency before and after treatment were observed and compared between the two groups. The correlation between HSI and ZJU and serum TC， TG， LDL-C， ApoB， ALT， AST， ALT/AST， BA， GGT， TCM syndrome scores， and ATT was analyzed. ResultPearson correlation analysis showed that serum TC （r = 0.811）， TG （r = 0.826）， LDL-C （r = 0.802）， ApoB （r = 0.820）， ALT （r = 0.497）， ALT/AST （r = 0.826）， TCM syndrome score （r = 0.716）， and ATT （r = 0.736） were positively correlated with HSI （P<0.01）， while AST， BA， and GGT had no significant correlation with HSI. TC （r = 0.718）， TG （r = 0.765）， LDL-C （r = 0.667）， ApoB （r = 0.699）， ALT/AST （r = 0.403）， TCM syndrome score （r = 0.666）， and ATT （r = 0.684） were positively correlated with ZJU （P<0.01）. ALT， AST， BA， and GGT had no significant correlation with ZJU. The total effective rate of the observation group was 86.05 （37/43）， and that of the control group was 72.09% （31/43）. The total effective rate of the observation group was higher than that of the control group （Z = -2.301， P<0.05）. After treatment， the 24-hour urine copper of the two groups increased significantly. The levels of TC， TG， LDL-C， and ApoB were significantly decreased， and the HSI， ZJU， and ATT were significantly decreased （P<0.01）. Compared with those in the control group after treatment， the above indexes improved better in the observation group （P<0.05， P<0.01）. ConclusionGDL can effectively improve the level of copper and lipid metabolism in patients with WD， with high clinical safety and good clinical application value. The prediction model of hepatic steatosis can effectively reflect the degree of abnormal lipid metabolism in WD.

Objective To analyze the correlations between platelet-related parameters and the incidence of anxiety and depression in the patients undergoing peritoneal dialysis(PD),and evaluate the efficacy of the pa-rameters in the diagnosis of anxiety and depression in PD patients.Methods A total of 245 patients undergoing PD in the First Affiliated Hospital of Hebei North University from September 2022 to February 2023 were enrolled.The gener-alized anxiety scale(GAD-7)and the patient health questionnaire(PHQ-9)were used to evaluate the anxiety and depression of the patients,respectively.The personal information and biochemical indicators of the patients were col-lected,and the platelet count(PLT),mean platelet volume(MPV),and platelet distribution width(PDW)were measured.Logistic regression was adopted to analyze the relationships of platelet-related parameters with anxiety and depression in PD patients.Results Among the 245 patients undergoing PD,the incidences of anxiety and depression were 15.9% and 38.0% ,respectively.There were differences in the dialysis period(Z=-2.358,P =0.018;Z =-3.079,P=0.002),MPV(Z=-4.953,P<0.001;Z=-7.878,P<0.001),and PDW(Z =-4.587,P<0.001;Z=-7.367,P<0.001)between the anxiety group and the non-anxiety group as well as between the de-pression group and the non-depression group.The correlation analysis showed that MPV(r =0.358,P<0.001;r =0.489,P<0.001)and PDW(r =0.340,P<0.001;r =0.447,P<0.001)were positively correlated with anxiety and depression in the patients undergoing PD.The Logistic regression model showed that MPV(P =0.022,P =0.011),PDW(P =0.041,P =0.018),and dialysis period(P =0.011,P =0.030)were independent risk factors for the anxiety and depressive state in PD patients.The areas under the receiver operating characteristic curve of MPV in the diagnosis of anxiety and depression in PD patients were 0.750 and 0.800,respectively,and those of PDW were 0.732 and 0.780,respectively.Conclusion MPV and PDW have high efficacy in the diagnosis of anxiety and depression associated with PD and can be used as objective indicators to evaluate the anxiety and depression in the patients undergoing PD.

Objective To explore and implement a differentiated management strategy for multi-campus hospitals to improve patient experience and satisfaction,and achieve the goal of homogenized management.Methods In December 2021,the Picker Patient Experience Questionnaire was used to survey the patient experience at 3 campuses of a tertiary A hospital in Hangzhou,and the reasons for the differences were analyzed.Based on policy document reviews,special group discussions,and expert meetings,differentiated management strategy for multi-campus hospitals was formulated.The patient experience and satisfaction before(December 2021)and after(December 2023)the implementation were compared.Results After the application of the one-hospital multi-campus difference management strategy,the overall medical experience score of the patients in the 3 campus was(58.54±2.36)points,which was higher than(58.13±3.24)points before the application(t=-3.223,P=0.001),and there was no statistically significant differences among the patients in the 3 campuses(F=0.781,P=0.458).After the application of the management strategy,the overall satisfaction score of the patients in the 3 campus was(98.44±6.22)points,which was higher than(97.98±6.87)points before the application of the management strategy(t=-2.490,P=0.013),and there was no statistical significance among the patients in the 3 campus(F=1.128,P=0.324).The number of banners and letters of commendation received by the 3 campuses increased from 1 661 before the application to 2 190 after the application,with a growth rate of 31.85％.Conclusion Differentiated management in a multi-campus hospital,aiming at homogenized quality through differentiated strategies,is practicable and can significantly improve the patient experience and satisfaction across different campuses.

Objective:To survey the status quo of clinical teaching by specialists in general practice residents training.Methods:Thirty-four general practice residents (14 males and 20 females, aged (27.9±1.8) years) who started standardized training in 2016, 2017 and 2019 in the First Affiliated Hospital of Zhejiang University School of Medicine were selected for interview. The semi-structured and open-ended telephone interviews were conducted 6 months after their completion of residency training. The 1st round of interviews with 12 residents of 2016 and 2017 batches was conducted in March 2020 and 2021 to understand their feelings and suggestions about specialty learning. Based on the interview results, literature review, expert consultation and internal discussion, a new model for specialty teaching was developed and applied for subsequent residency training. The second round of interviews was conducted with 22 residents of 2019 batch on March 2023 to investigate the implementation of the new model.Results:In the first round of interviews, 6 participants felt that the learning of specialty knowledge was not comprehensive enough; although all respondents said that they had received simulator training for the final exam in the specialty rotation, 2 people felt that it was not comprehensive and 2 mentioned that some of the items were not practised on a real person; all 12 respondents felt that there was a certain gap between the types of diseases they encountered in the specialty learning and the real world of work; 10 respondents mentioned that there was insufficient training in the management of chronic non-chronic diseases; 7 out of 9 respondents from primary care institutions mentioned that it was difficult to apply the learned specialty knowledge to real work due to local conditions; 7 respondents mentioned that the content and methods of teaching were inconsistent among different lecturers; and respondents hoped that the surgical training, physical exam training, medication instruction, and the length of outpatient follow-up consultations would be strengthened. In the second round of interviews, the feedback of respondents was more positive than in the first round, there were still problems with the separation of teaching and examination content, and insufficient practical training of skills; 2 respondents from general hospitals mentioned that the teaching of specialties should be further deepened, and 3 respondents from the primary care institutions mentioned that the teaching of treatment and follow-up management should be further strengthened. Twenty-one respondents generally accepted the new specialty teaching model, but said that there were big differences between teachers of different specialties and there were still problems such as insufficient guidance on drug treatment and follow-up.Conclusion:In general practice, residency training specialist teaching does not fully meet the requirements of the actual work of general practitioners, and although it has improved after optimization, there is still much room for improvement.

OBJECTIVE To explore the effects and mechanism of atorvastatin on the proliferation， autophagy and glucose metabolism of AGS cells in human gastric cancer. METHODS The effects of low， medium and high concentrations of atorvastatin （12.5， 25， 50 μmol/L） on the viability of AGS cells were investigated through preliminary experiments， and the concentration of action was screened. The formal experiment was divided into control group （no intervention）， atorvastatin group （25 μmol/L）， positive control group （50 mg/L 5-fluorouracil）， inhibitor group [25 μmol/L atorvastatin +10 μmol/L phosphatidylinositol-3-kinase （PI3K）/protein kinase B （Akt） signaling pathway inhibitor LY294002] and activator group （25 μmol/L atorvastatin +10 μmol/L PI3K/Akt signaling pathway activator SC79）， all of which were treated for 24 h. Glucose metabolism （glucose and lactic acid contents） and cell proliferation rate were detected， as well as the expression of autophagy-associated protein light chain 3 （LC3） Ⅰ， LC3Ⅱ and PI3K/Akt signaling pathway-associated proteins in cells. RESULTS Both medium and high concentrations of atorvastatin could significantly inhibit the viability of AGS cells （P＜0.05）， and 25 μmol/L atorvastatin was selected for the official experiment for follow-up experiments. Compared with the control group， the contents of glucose and lactic acid， cell proliferation rate， p-PI3K/PI3K and p-Akt/Akt ratios in the positive control group and atorvastatin group were significantly decreased （P＜ 0.05）， and the protein expression levels of LC3 Ⅰ and LC3 Ⅱ were significantly increased （P＜0.05）. Compared with the atorvastatin group， the inhibitor further promoted the changes in the above indexes （P＜0.05）， and the activator significantly reversed the changes in the above indexes （P＜0.05）. CONCLUSIONS Atorvastatin could inhibit glucose metabolism and proliferation of AGS cells in human gastric cancer and promote autophagy. The mechanism may be related to the inhibition of the PI3K/Akt signaling pathway.

Objective:To construct the core competence evaluation index system of general practice residents by the Delphi method.Methods:After the literature review of home and abroad and group discussion, the core competence evaluation index system of general practice residents in the outpatient environment was preliminarily developed. On this basis, the index system was determined through two rounds of expert consultation. Excel 2015 and SPSS 26.0 were used for data entry and statistical analysis.Results:The active coefficients of the two rounds of expert consultation were 95.0% (19/20) and 100.0% (19/19) respectively, and the degree of authority of the two rounds of expert consultation was 0.86. An index system consisting of 6 first-level indicators and 28 second-level indicators was determined. The 6 first-level indicators were medical services/patient care, medical knowledge, professionalism, systems-based practice, practice-based learning and improvement, interpersonal communication, and communication skills.Conclusion:This study has constructed a complete and highly reliable core competence evaluation index system of general practice residents based on the outpatient environment, which can provide reference for the cultivation of the outpatient reception ability of general practice residents in the future.

Objective:To understand the macronutrient content and influencing factors of donated breast milk in breast milk bank.Methods:A total of 458 first-time breast milk donors and their donated breast milk from June 2016 to June 2018 in Shanghai were selected as research objects by the convenient sampling method to determine the macronutrient content in donated breast milk. Multiple linear regression was used to analyze the influencing factors of the macronutrient content of donated breast milk.Results:In macronutrient content of 458 donated breast milk, the protein content was (0.95±0.24) g/dl, fat content was (4.03±1.25) g/dl, sugar content was (7.44±0.38) g/dl, dry matter was (12.75±3.16) g/dl and energy content was (71.12±11.33) kcal/dl.The results of multiple linear regression analysis showed that the time of milk donation and infant gender were the influencing factors of protein content in donated breast milk ( P<0.05). The time of milk donation, mode of delivery and season of birth were the influencing factors of the sugar content in donated breast milk ( P<0.05). The time of milk donation was the influence factor of energy content in donated breast milk ( P<0.05) . Conclusions:The content of macronutrients in donated breast milk in this study is lower than the demand for macronutrients in premature infants. The macronutrient composition of donated breast milk varies greatly among individuals, which is related to the time of milk donation, the mode of delivery, the infant gender and birth season of the baby. Therefore, further research is needed on how to add breast milk additives to donated breast milk in the later stage for targeted reinforcement to meet the growth and development needs of premature infants.

Objective:To investigate the relationship between serum transferrin(TRF)and the characteristics and prognosis of elderly patients with sepsis.Methods:A retrospective analysis was conducted on 49 elderly patients with sepsis treated at the Department of Critical Medicine and the Department of Respiratory and Critical Medicine of the First Affiliated Hospital of Suzhou University between October 2020 and March 2022 who had met the inclusion criteria.These patients were divided into a shock group(n=18)and a non-shock group(n=31); Based on outcomes, they were also divided into a death group(n=16)and a survival group(n=33).Through the random number table method, 30 healthy elderly people from the physical examination center of our hospital were selected as the control group.TRF and ferritin(SF)were measured on the 1st, 3rd and 7th day after admission, and the correlation between TRF and the sequential organ failure assessment score(SOFA)was analyzed.The predictive value of TRF on prognosis was evaluated via the receiver operating characteristic curve.Finally, the influence of multiple factors on prognosis was analyzed using the binary logistic regression model.Results:Compared with the control group at admission, SF levels of elderly patients with sepsis increased[709.20(402.40, 2000.00)μg/L vs.102.05(79.55, 199.75)μg/L, Z=-5.482, P<0.01], but TRF levels decreased[1.43(1.12, 1.72)g/L vs.2.23(1.80, 3.12)g/L, Z=5.395, all P<0.01], with statistical significance.On the 3rd and 7th day, TRF levels in the shock group were lower than in the non-shock group[(1.25±0.35)g/L vs.(1.55 ±0.51)g/L, 1.15(9.68, 1.34)g/L vs.1.56(1.19, 2.03)g/L]( t=-2.186, Z=3.258, P<0.05).There was a linear correlation between TRF and SOFA score on the 1st, 3rd and 7th day( R2=0.177, 0.176, 0.275, all P<0.01).TRF levels in the death group were lower than in the survival group on the 3rd and 7th day( Z=2.208, 3.423, P<0.05 for both).TRF levels on the 3rd and 7th day in elderly patients with sepsis had predictive value in evaluating the prognosis[area under receiver operating characteristic curve( AUC)values=0.696, 0.804, P<0.05, P<0.01].The survival curves based upon the best cutoff values(TRF=1.085 g/L on the 3rd day, TRF=1.330 g/L on the 7th day)between the two groups were statistically significantly( χ2=10.903, 13.318, P<0.01 for both).With TRF<1.085 g/L on the 3rd day, the risk of death in elderly patients with sepsis on the 28th day was 9.388 times the usual risk( OR=9.388, P<0.01), and with TRF<1.330 g/L on the 7th day, the risk of death was 14.625 times the usual risk on the 28th day( OR=14.625, P<0.01). Conclusions:Increased SF in elderly patients with sepsis is not related to disease severity, but the level of TRF is related to disease severity, and the level of TRF on the 3rd and 7th day is related to the prognosis and is an independent risk factor for all-cause death on the 28th day.

Objective To understand the epidemiological characteristics of acute respiratory virus infection in hospitalized patients, and to provide reference for clinical diagnosis and treatment, and to develop relevant intervention measures. Methods A total of 414 hospitalized patients with respiratory virus infection admitted to our hospital from March 2019 to March 2021 were selected. Immunofluorescence method was used to qualitative detect parainfluenza virus type 1-3, influenza A virus, respiratory syncytial virus (RSV), influenza B virus and adenovirus. Results Among the 414 ARTI patients, 84 cases were positive for respiratory virus, with a positive detection rate of 20.29% (84/414 ) . 76 cases were positive for single virus infection, with a positive detection rate of 18.36% (76/414) . The positive detection rate was 1.93% (8/414). The most common pathogens of virus infection were influenza A virus (25.00%), influenza B virus (20.23%) and RSV(17.86%). There was statistical significance in the positive rate of ARTI among different age groups (χ², P<0.05). The positive rate of respiratory virus in 1-8 years group was the highest (38.93%). There was statistical significance in the positive rate of 7 viruses (P<0.05). The patients with viral mixed infection were mainly children under 8 years old; There was statistical significance in the positive rate of ARTI in different seasons (χ², P<0.05). There was no significant difference in the seasonal distribution of PIV1, PIV2, ADV and mixed infection rates ( P>0.05). The positive rate of PIV3 was the highest in spring (4.04%), and the positive rate of RSV in spring and winter was 24.24% and 25.20%, respectively. The positive rates of influenza A virus and influenza B virus were the highest in winter (9.45%) and (7.09%). There was statistical significance in the positive rate of ARTI among different clinical diagnoses (χ², P<0.05). The positive rates of PIV2, PIV3, influenza A virus and influenza B virus were significantly different (P<0.05). The positive rate of bronchopneumonia virus was the highest (27.48%). Conclusion: RSV infection is the most common in patients with acute respiratory virus infection in Chengdu area, which mostly occurs in autumn and winter, and the main clinical manifestation is bronchopneumonia. The main infected population is children under 8 years old, and the surveillance of respiratory syncytial virus should be strengthened in the future.

Objective:To test curriculum management effect of graduate students'clinical practice of counseling psychology.Methods:Totally 26 students [average age (24.5 ± 1.0) years] who completed 30-day interns summer were investigated with the self-made questionnaire evaluating the quality of clinical practice.Results:All students obtained promotion in practice activities,the attendance ranged from 50.0％ to 96.2％.The overall satisfaction was (3.8 ± 0.8) and the average degree of supervisors'satisfaction was (4.0 ± 0.8).There were 92.3 ％ of the students had participated more than 224 hours' practice and completed all tasks.After the interns,the students had significantly improved in all 8 aspects of professional abilities.Conclusion:In graduate education of counseling psychology,curriculum management of clinical practice may be an effective approach to improve students' clinical skills.