Given the systematic, rigorous, and practical characteristics of medical disciplines, ensuring the teaching quality of online courses has become a significant focus. In traditional teaching models, teaching supervision is an important method to guarantee instructional quality, and introducing teaching supervision into online teaching activities is of great significance. This article systematically reviews and summarizes the domestic and international experience of conducting online medical courses. We explore the instructional supervision of online medical courses from the following perspectives: the meaning of supervision, the necessity of online supervision, online supervision methods and technical approaches, the feedback and application of supervision information, and the establishment of a standardized online supervision process.

Background Organic phosphate flame retardants are emerging environmental pollutants. While there have been multiple toxicities reported following organic phosphate flame retardants exposure, few studies focus on their potential developmental toxicities. It is necessary to elucidate these developmental toxicological effects and underlying mechanisms to improve risk assessments and better protect sensitive populations. Objective To evaluate potential developmental toxicities in early chicken embryos following exposure to triphenyl phosphate (TPhP) or cresyl diphenyl phosphate (CDP), to reveal TPhP and CDP’s capabilities to activate peroxisome proliferator-activated receptor γ (PPARγ) in vivo in an established chicken embryo gene reporter system, and to investigate the roles of PPARγ in TPhP/CDP-induced developmental toxicities with lentivirus-mediated in vivo gene silencing. Methods Firstly, diverse doses of TPhP and CDP were injected into the air sacs of fertilized eggs to assess the development of chicken embryos after 6 d of incubation, and an optimal dose was chosen for subsequent experiments. Subsequently, the report gene system was employed to evaluate the intraembryonic activation of PPARγ by TPhP and CDP. Eventually, PPARγ was silenced using lentivirus, and the embryos were co-treated with TPhP and CDP to further disclose the roles of PPARγ in the observed developmental toxicity. Results Following developmental exposure to TPhP or CDP, significantly lower chicken embryo weights (normalized with egg weights) were observed in the 6 d embryos (10, 30 mg·kg⁻¹ TPhP and 3, 10, 30 mg·kg⁻¹ CDP), indicating that both chemicals have general developmental toxicities and CDP is more potent. Additionally, exposure to CDP also resulted in remarkably increased sagittal brain area (normalized to embryo weights) and decreased sagittal eye area (normalized to embryo weights) (P<0.05), suggesting that CDP has specific developmental neurotoxicity and ocular toxicity. The PPARγ reporter gene experiment results revealed that rosiglitazone (positive control), TPhP, and CDP all significantly activated PPARγ relative to control (P<0.05). The potency order was rosiglitazone > CDP > TPhP. The lentivirus microinjection successfully achieved in vivo silencing of PPARγ in developing chicken embryos, and the estimated silencing efficacy was approximately 55% according to the real-time quantitative polymerase chain reaction (qRT-PCR) results. The in vivo silencing of PPARγ effectively alleviated TPhP or CDP-induced decrease of embryo weights (P<0.05), as well as CDP-induced increase of brain areas and decrease of eye areas (P<0.05). Conclusions Both TPhP and CDP can induce general developmental toxicities in early chicken embryos, and CDP is more potent than TPhP. Meanwhile, CDP can induce specific enlarged brain area and decreased eye area. The observed toxicities are associated with in vivo activation of PPARγ.

Coronavirus Disease 2019 (COVID-19) is caused by 2019 novel coronavirus (2019-nCoV). Type I and type III interferons, as important available clinically used broad-spectrum antiviral drugs, have been considered as promising candidate drugs for the treatment and prevention of COVID-19. In early 2020, more than 40 clinical trials, including the World Health Organization (WHO) SOLIDARITY study, have been launched in the world to explore the clinical efficacy and application method of interferons in the treatment of COVID-19. Meanwhile, animal models and human clinical specimens were used in many laboratories to explore the immunologic role and mechanistic function of interferons in COVID-19. However, the conclusion of the studies in the past three years were not consistent and even contradictory albeit numerous data were accumulated by the scientific community, which reflects the complexity of the role and function of interferons in COVID-19. Recently, the results of four large high-quality randomized controlled phase III clinical trials were reported. In this review, we systematically summarize and analyze the complicated and contradictory data from the level of immunopathological mechanism and clinical trials. We clarify that the heterogeneous clinical outcome of 2019-nCoV infection is closely related to the level and production time of interferons and that interferons are protective in the early stage of COVID-19 but may cause immunological damages in the late stage which may exacerbate inflammation. Further high-quality prospective clinical trials that strictly control confounding factors are still warranted to finally elucidate the precise role and clinical application of interferons in COVID-19.

Background::Clinical opportunistic screening is a cost-effective cancer screening modality. This study aimed to establish an easy-to-use diagnostic model serving as a risk stratification tool for identification of individuals with malignant gastric lesions for opportunistic screening.Methods::We developed a questionnaire-based diagnostic model using a joint dataset including two clinical cohorts from northern and southern China. The cohorts consisted of 17,360 outpatients who had undergone upper gastrointestinal endoscopic examination in endoscopic clinics. The final model was derived based on unconditional logistic regression, and predictors were selected according to the Akaike information criterion. External validation was carried out with 32,614 participants from a community-based randomized controlled trial.Results::This questionnaire-based diagnostic model for malignant gastric lesions had eight predictors, including advanced age, male gender, family history of gastric cancer, low body mass index, unexplained weight loss, consumption of leftover food, consumption of preserved food, and epigastric pain. This model showed high discriminative power in the development set with an area under the receiver operating characteristic curve (AUC) of 0.791 (95% confidence interval [CI]: 0.750–0.831). External validation of the model in the general population generated an AUC of 0.696 (95% CI: 0.570–0.822). This model showed an ideal ability for enriching prevalent malignant gastric lesions when applied to various scenarios.Conclusion::This easy-to-use questionnaire-based model for diagnosis of prevalent malignant gastric lesions may serve as an effective prescreening tool in clinical opportunistic screening for gastric cancer.

Objective    To investigate the diagnostic value and the best criteria of multiplanar reconstruction (MPR) of spiral CT in recurrent laryngeal nerve lymph node metastasis. Methods    We performed multiplanar reconstruction of the spiral CT data of 138 esophageal carcinoma patients admitted to our hospital between December 2016 and June 2019, including 113 males and 25 females with an average age of 47-85 (63.03±15.58) years. The short and long diameters of recurrent laryngeal nerve lymph nodes were measured respectively, and then ratio of short to long diameter was calculated. The three parameters were contrasted with the pathological results and the receiver operating characteristic (ROC) curves for the parameters were drawn. Results    Of the 138 patients, 291 left recurrent laryngeal nerve lymph nodes were dissected with an average number of 0-14 (2.11±0.41) per patient and the metastasis rate was 16.70%; while 436 right ones were dissected with the average number of 0-17 (3.16±0.45) per patient and the metastasis rate was 21.00%. The total metastasis rate was 29.70%. In the diagnosis of lymph node metastasis, the areas under ROC curve for short and long diameters as well as the ratio of short to long diameter of left recurrent laryngeal nerve lymph nodes were 0.808, 0.779, 0.621, respectively, while those for the right ones were 0.865, 0.807, 0.637, respectively. Conclusion    The metastasis rate of recurrent laryngeal nerve lymph nodes is high and the short diameter has a higher diagnostic value for recurrent laryngeal nerve lymph node metastasis.

Objective:To observe the epidemiology, clinical manifestations, laboratory tests, imaging findings, treatment and prognosis of patients with corona virus disease 2019.Methods:Clinical data of 109 patients with suspected and definite corona virus disease 2019 admitted to the Sixth Hospital of Wuhan from December 24, 2019 to January 28, 2020 were retrospectively analyzed. Statistical analysis was performed by using t test or chi-square test. Results:Among the 109 patients, 54(49.5%) patients had definite contact history. Among the 109 patients, 104(95.4%) presented with fever, 37(33.9%) with headache, 78(71.6%) with general pain, 88(80.7%) with fatigue and poor appetite, 23(21.1%) with diarrhea, 94(86.2%) with coughing, 23(21.1%) with shortness of breath, 57(52.3%) with palpitation, 45(41.3%) with chest distress, 4(3.7%) with chest pain, 40(36.7%) with lung rales. Forty-two cases (38.5%) had leukocyte count <4×10 9/L, 58 cases (53.2%) had lymphocyte count <1.5×10 9/L, 27 cases (24.8%) had hemoglobin <120 g/L, 37 cases (33.9%) had lactic dehydrogenase (LDH) >230 mmol/L, 29 cases (26.6%) had pro-brain natriuretic peptide>300 ng/mL, 87 cases (79.8%) had hypersensitive C reactive protein>10 mg/L, 26 cases (23.9%) had D-dimer>0.5 mg/L, 35 cases (32.1%) had coagulation disorder. On admission, chest computed tomography showed that 27 cases (24.8%) of pneumonia were unilateral, 82 cases (75.2%) were bilateral, and most of them were ground glass. The leukocyte counts, LDH, pro-brain natriuretic peptide and D-dimer of severe/critical cases ((11.33±4.87)×10 9/L, (527.51±260.87) mmol/L, (722.88±189.56) μg/L, (4.24±1.89) mg/L, respectively) were all higher than those of common cases ((4.02±1.49)×10 9/L, (159.75±30.31) mmol/L, (428.22±124.76) μg/L and (0.41±0.22) mg/L, respectively), while the lymphocyte count of severe/critical cases ((0.60±0.17)×10 9/L) was lower than common cases ((1.13±0.43)×10 9/L) ( t=11.36, 11.33, 9.81, 2.81 and 7.77, respectively, all P<0.05). The comprehensive treatment included antiviral drugs, prevention of bacterial infection and supportive treatment, and glucocorticoid and respiratory support treatment were administrated when necessary. Conclusions:The corona virus disease 2019 is characterized by highly infectious, rapid progression, and diverse clinical and imaging features. Early diagnosis and active comprehensive treatment could improve the prognosis and reduce the mortality.

Objective The aim of this study was to investigate the role and mechanism of ABL2 in lung cancer and its mech-anism. Methods The expression of ABL2 in lung cancer and adjacent tissues was detected by Real-Time PCR. A lung adenocarci-noma A549 cell line stably expressing of ABL2 was established,and the changes of cell proliferation and migration ability were detec-ted by MTT,cell migration and colony formation assays. Western blot was used to detect the expression of EMT,apoptosis and PI3K/AKT signaling pathway-related proteins. Results The expression of ABL2 in lung cancer tissues was significantly higher than that in adjacent tissues(P<0. 001). After silencing ABL2 in the A549 cells,compared with the control group,the migration ability of cells was weakened after 48 hours(P<0. 001),the growth rate of cells began to slow down from the third day(P<0. 05),and the average number of clones formed after 15 days also decreased(P<0. 01). The expression of E-cadherin( P<0. 001) was increased in the epithelial cell marker after silencing ABL2,and the expression of stromal cell markers N -cadherin ( P <0. 001),Vimentin ( P <0. 01)and Snail(P<0. 001)was decreased. The expression of apoptosis-related protein Bcl-XL(P<0. 01)was decreased and BAX ( P<0. 001)expression was up-regulated. The expression of PI3K/AKT signaling pathway-associated proteins such as PI3K P110 (P<0. 05),AKT(P<0. 01) and p-AKT( P<0. 05) was significantly decreased. Conclusion Silencing ABL2 gene can promote apoptosis,and inhibit proliferation and migration of lung cancer cells through a PI3K/AKT signaling pathway.

Objective T o explore the effectiveness of direct am plification for the ST R analysis of carti-lage, and to accelerate the effectiveness of disaster victim identification. Methods E ighty-eight cartilage sam ples w ere directly am plified by Pow erPlex誖21 kit, and the results of genotyping w ere com pared w ith that obtained by the m agnetic beads m ethod. Results In 88 cartilage sam ples, the ST R genotypes w ere successfully detected from 84 sam ples by direct am plification and m agnetic beads m ethod, and both the results of genotyping by tw o m ethod w ere consistent. Conclusion D irect am plification w ith Pow er-Plex誖21 kit can be used for ST R genotyping of cartilages. T his m ethod is operated easily and prom ptly, w hich has a potential application in the individual identification of m ass disasters.

ObjectiveTo explore the application value of individualized surgical treatment based on the CT portal venograpy (CTPV) classiifcation in cirrhotic portal hypertension.MethodsOne hundred and iffty-six patients with cirrhotic portal hypertension who received surgical treatment in Anhui Province Hospital between June 2010 and December 2014 were enrolled in this prospective study. According to different surgical procedures, the patients were divided into two groups: the individualized surgery based on CTPV classiifcation group (classification group) and traditional surgery group (traditional group). Among the 84 patients in the classiifcation group, 56 were males and 28 were females with the age ranging from 19 to 67 years old and the median of 45 years old. Among the 72 patients in the traditional group, 47 were males and 25 were females with the age ranging from 23 to 62 years old and the median of 43 years old. The informed consents of all patients were obtained and the local ethical committee approval was received. The patients in the classiifcation group underwent individualized surgery according to the pre-operative CTPV classiifcation, while the patients in the traditional group underwent splenectomy + pericardial devascularization. The effects of two surgical procedures on the portal hypertension, intraoperative and postoperative conditions and postoperative survival rate of the patients were observed. The observation indexes of two groups were compared usingt test and survival analysis was conducted using Kaplan-Meier method and Log-rank test.ResultsThe postoperative free portal pressure (FPP) in the classiifcation group was (27±3) cmH2O (1 cmH2O=0.098 kPa), signiifcantly lower than (33±8) cmH2O in the traditional group (t=-3.355,P<0.05). The FPP decrease range before and after surgery in the classiifcation group was (13±6) cmH2O, signiifcantly higher than (9±5) cmH2O in the traditional group (t=3.016,P<0.05). The length of surgery and intraoperative blood loss in the classiifcation group were respectively (188±84) min and (378±49) ml, significantly less than (240±76) min and (463±57) ml in the traditional group (t=-2.687,-3.015;P<0.05). The postoperative length of stay and hospitalization expense in the classiifcation group were respectively (12±4) d and (31 000 ± 15 000) yuan, signiifcantly lower than (15±5) d and (36 000±15 000) yuan in the traditional group (t=-2.061,-2.104;P<0.05). The 1, 3-year accumulative survival rate were respectively 94.05% and 85.71% in the classiifcation group, and were respectively 87.50% and 68.05% in the traditional group. The overall survival rate in the classiifcation group was signiifcantly higher than that in the traditional group (χ2=7.000,P<0.05).ConclusionsPre-operative CTPV classification and individualized surgical treatment for patients with cirrhotic portal hypertension can effectively reduce the portal vein pressure and has the advantages of smaller injury and better prognosis.

Objective To explore the impact of patients with esophageal cancer knowing diagnosis on the mental health of their children and investigate the factors.Methods 107 family carriers whose parent diagnosed esophageal cancer in General Hospital of Jinan Command were interviewed.Respondents were categorized into two groups:one group was those whose parents knew their diagnosis(Group A,n=45)and the other group was those whose parents did not know(Group B,n=62).The Chinese version of Self-reporting Inventory(SCL-90) was used.Results The scores of 107 children of esophageal cancer patients in depression(1.62±0.30),anxiety(1.78±0.34) and hostility (1.93±0.47) were higher than national norms (P＜0.01).Compared with group A,group B showed a significant higher degree of anxiety((1.89±0.33) vs (1.62±0.33),P＜0.01).In multiple regression analysis,age and the knowledge of esophageal cancer diagnosis had statistically significant difference (P＜ 0.05).Conclusion Patients' knowledge of the esophageal cancer diagnosis contribute to relieving family carers' symptoms of anxiety.