ObjectiveTo observe the clinical effect of modified Huanglian Wendantang on cardiovascular risk factors in patients with metabolic syndrome under the guidance of treating disease before its onset. MethodsA total of 82 patients with metabolic syndrome treated in the First Affiliated Hospital of Heilongjiang University of Chinese Medicine from July 2023 to July 2024 were selected and allocated into an observation group （41 cases） and a control group （41 cases） by the random number table method. The control group received routine treatment， and the observation group was treated with modified Huanglian Wendantang on the basis of routine treatment. Both groups were treated for 8 weeks. The therapeutic effects on TCM symptoms after treatment in the two groups were evaluated. The levels of obesity degree indicators， blood pressure indicators， glucose and lipid metabolism indicators， inflammatory factors， and vascular endothelial function indicators before and after treatment in the two groups were measured， and the treatment safety was evaluated. ResultsAfter treatment， the total response rate of TCM symptoms in the observation group was 97.56% （40/41）， which was higher than that （87.80%， 36/41） in the control group （χ²=5.205， P<0.05）. After treatment， both groups showed declines （P<0.05） in systolic blood pressure （SBD）， diastolic blood pressure （DBP）， triglyceride （TG）， total cholesterol （TC）， low density lipoprotein cholesterol （LDL-C）， fasting blood glucose， 2-hour postprandial blood glucose （2 h PG）， glycosylated hemoglobin （HbA1c）， fasting insulin （FINS）， Homeostatic Model Assessment for Insulin Resistance （HOMA-IR）， body mass index （BMI）， waist circumference （WC）， waist-to-hip ratio （WHR）， leptin （LEP）， interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）， endothelin-1 （ET-1）， and inducible nitric oxide synthase （iNOS）. Moreover， the declines in the observation group were more obvious than those in the control group （P<0.05， P<0.01）. After treatment， both groups showed elevated levels of high density lipoprotein cholesterol （HDL-C）， adiponectin （ADP）， nitric oxide （NO）， and endothelial nitric oxide synthase （eNOS） （P<0.05）， and the above indexes in the observation group were higher than those in the control group （P<0.01）. ConclusionUnder the guidance of the thought of treating disease before its onset， modified Huanglian Wendantang was used to treat patients with metabolic syndrome. The decoction improved the clinical efficacy by ameliorating IR to improve insulin sensitivity， reducing inflammation， and protecting the vascular endothelial function. It inhibits cardiovascular risk factors without inducing adverse reactions， being worthy of clinical application and promotion.

Objective:To evaluate the safety and effectiveness for the treatment of totally robotic fundoplication.Methods:A retrospective analysis was conducted on the clinical data of 21 patients with gastroesophageal reflux disease (GERD) who underwent unassisted totally robotic fundoplication at the Second Department of General Surgery, Yan'an Hospital Affiliated to Kunming Medical University from Aug 2023 to Jan 2024. The postoperative outcomes were evaluated using SF-36, GERD-Q, and NRS scoring indicators.Results:All 21 patients successfully underwent the surgery. The robotic surgery time was (99±41) minutes, with precise intraoperative anatomy and insignificant blood loss of (1.7±1.4) ml. There were no intraoperative or postoperative complications, and no conversions to open surgery . Postoperative recovery of bowel function was rapid (11.71±3.33) hours, with minimal postoperative pain (NRS score of 1.67±0.48).The postoperative hospital stay was short (3.86±2.90) days, and patient satisfaction was high, SF-36 score of (80.90±1.14);The symptoms of reflux after surgery was significantly reduced.Postoperative GERD-Q score of (4.38±1.69) significantly lower than the preoperative score of (13.90±2.07).Conclusion:Totally robotic fundoplication provides clear view of intraoperative anatomical structures, rapid postoperative recovery, minimal pain, and effective anti-reflux outcomes.

Objective To investigate the correlation between the proportion of peripheral blood follicular T helper cells(Tfh cells)and intracellular interleukin-21(IL-21)content with blue light retinal injury.Methods Brown Norway(BN)rats were randomly divided into 4 groups and were exposed to blue light for 3 hours a day to establish retinal light damage model.According to the duration of illumination,the rats was divided into 0 days(control group),3 days(3 d group),7 days(7 d group)and 14 days(14 d group).The proportion of Tfh cells and content of IL-21 in Tfh cells in peripheral blood of each group was detected by flow cytometry and ELISA sepa-rately after illumination.Electroretinogram(ERG)was used to evaluate retinal function.The changes of fundus in rats were observed by fundus photography.The thickness of outer nuclear layer of retina was analyzed by HE staining.Results After retinal blue light injury,with the extension of illumination time,the proportion of Tfh cells in peripheral blood and intracellular IL-21 content both increased(P<0.05).ERG showed that retinal function decreased after light damage and aggravated with the extension of illumination time,the latency and ampli-tudes of A-wave and B-wave increased and decreased respectively(P<0.05).The retinal fundus of rats showed depigmentation in 3 d,and the retinal vessels became thinner and exudate with the extension of illumination time.HE staining showed that the outer nuclear layer of retina(ONL)became thinner(P<0.05).Correlation analy-sis indicated that the proportion of Tfh cells in peripheral blood and the intracellular IL-21 content could jointly reflect the degree of injury(P<0.000 1),and the proportion of Tfh cells in peripheral blood was negatively corre-lated with ONL thickness and the amplitude of a and b waves,positively correlated with the peak time of a and b waves,(P<0.0001).Conclusion The proportion of Tfh cells in peripheral blood and the intracellular IL-21 content were increased after blue light damage to retina,and were significantly increased with the extension of light time with a certain correlation.

Objective:To investigate the clinical characteristics and structural and functional cardiac changes in heart failure with preserved ejection fraction(HFpEF)complicated with atrial fibrillation(AF)in elderly patients.Methods:As a cross-sectional study, 835 patients with HFpEF aged ≥60 years admitted to the Department of Geriatric Cardiovascular Medicine of the First Hospital of Lanzhou University between April 2009 and December 2020 were divided into an HFpEF+ AF group(267 cases)and an HFpEF group(568 cases)according to whether they had AF in addition to HFpEF, and their cardiac structure and function were evaluated.The optimal cutoff point of the ratio of the peak early diastolic velocity(E)to the maximum early diastolic velocity(e')of the mitral annulus(E/e')was analysed using the receiver operating characteristic(ROC)curve.The HFpEF+ AF group was divided into two subgroups, E/e'>11 and E/e'≤11, and differences in their clinical presentation, cardiac structural and function, and the relationship between the left and right heart were compared.Results:Compared with the HFpEF group, the left atrial volume index(LAVi)was larger[(60.0±23.3)ml/m 2vs.(43.9±19.0)ml/m 2, t=10.130, P<0.01]and the left ventricular ejection fraction(EF), mitral annular septal systolic velocity(s' S)and E/e' were smaller than in the HFpEF+ AF group(all P<0.01), whereas the right ventricular diameter(RVD), right atrial diameter(RAD)and area(RAA), tricuspid regurgitation velocity(TRv), and pulmonary arterial systolic pressure(PASP)in the HFpEF+ AF group were all greater than those in the HFpEF group(all P<0.05).In the E/e'>11 subgroup of HFpEF+ AF, the prevalence of hypertension, coronary heart disease and diabetes were higher, AF courses were shorter, and the decline of s' was more severe(all P<0.05).Furthermore, E/e' was independently correlated with LAVi, as was LAVi with PASP( t=2.114, 1.963, P=0.034, 0.042).The above-mentioned features were similar to those in the HFpEF group.The E/e'≤11 subgroup had a higher proportion of women, longer duration of AF than the E/e'>11 subgroup(median: 5 years vs.1 year, P=0.003), more noticeable enlargement of the right ventricle and right atrium, higher TRv and PASP( P<0.05). Conclusions:In elderly patients with HFpEF complicated with AF, the left atrial volume is increased further, and left ventricular systolic function and right heart morphology show serious deterioration, suggesting there might be two phenotypes of HFpEF+ AF with different pathophysiological mechanisms.

Objective:To investigate the proteins interacting with Mycobacterium tuberculosis Rv1705c in human body. Methods:Rv1705c was prokaryotically expressed and inclusion bodies were collected for further lysis and the purification of Rv1705c. ELISA assay was used to detect the secretion of IFN-γ after stimulating macrophages with Rv1705c protein. Purified and biotin-labeled Rv1705c sample was incubated on the HuProt? human proteome microarray to screen the interacting proteins. GenePix Pro 6.0 software was used to extract all features of the data obtained from the scanned images and further analysis was performed based on bioinformatics databases such as GO and KEGG. GST pull-down was performed to verify the interaction of Rv1705c with PSMA3 and RSAD2.Results:The purification results showed that Rv1705c was expressed in endosomes. The secretion of IFN-γ increased significantly after stimulating macrophages with Rv1705c. A total of 29 potential Rv1705c-interacting proteins were screened, and nine of them showed signal-to-noise ratio (SNR)>1.6, namely PSMA3, NLN, THOP1, UPF3A, RSAD2, OMG, PNKD, STEAP3 and MED8. Further bioinformatics analysis revealed that PSMA3, RSAD2 and C1QBP were involved in innate immune signaling pathway, and there were interactions of PSMA3 and RSAD2 with IFN. GST pull-down assay validated that PSMA3 and RSAD2 interacted with Rv1705c.Conclusions:This study showed that PSMA3 and RSAD2 interacted with Rv1705c, providing reference for further investigation on the mechanism of Mycobacterium tuberculosis infection.

Objective:To explore the effect of teaching based on task-driven joint feedback mechanism on improving the quality and satisfaction of teaching practical nursing students in department of gynaecology and obstetrics.Methods:A total of 203 practical nursing students who had internship in the Department of Gynaecology and Obstetrics, The First Affiliated Hospital of Hainan Medical University from June 2019 to June 2020 were selected as the research objects. They were divided into a control group ( n=96) and a study group ( n=107) according to the order of admission. The control group used traditional teaching, and the study group used task-driven joint feedback mechanism-based teaching. After the teaching, the teaching effect of the two groups of practical nursing students was evaluated through theoretical assessment, skill operation assessment and teaching satisfaction. SPSS 22.0 was used for t test and non-parametric rank sum test. Results:The theoretical assessment scores [(93.51±4.22) vs. (89.62±4.08)] and the total scores of the skill operation assessment [(93.20±4.14) vs. (82.06±3.82)] of the practical nursing students in the study group were better than those of the control group, and the difference was statistically significant ( P<0.05). The results of teaching satisfaction evaluation (teacher's ability and execution ability, teaching content and task design, teaching task completion, feedback mechanism execution and improvement after feedback) of the study group were better those of the control group, and the difference was statistically significant ( P<0.05). Conclusion:The teaching based on the task-driven joint feedback mechanism can effectively improve the teaching quality and teaching satisfaction of the practical nursing students in the department of obstetrics and gynecology.

Scientific and reasonable assessment of clinical practice is one of the core indicators of teaching quality evaluation. This paper reviews the application prospect of multi-source feedback evaluation in clinical practice, discusses the basic elements and processes, existing problems and solutions of the evaluation system. Moreover, the application exploration of multi-source feedback evaluation in clinical practice of interns was analyzed as a typical case. We wish it is helpful to promote the establishment of multi-source feedback evaluation mechanism in clinical practice teaching and provide a guarantee for the cultivation of excellent medical talents.

This paper reviewed international documents of disability statistics. The results showed that all disability measurements had been adopted International Classification of Functioning, Disability and Health (ICF) terminology and approach. Disability statistics in US tailored to ICF framework and classification. Disability statistics in China had partially adopted ICF approach.

Indolent B-cell lymphoma is still an incurable disease. However, with the further understanding of the pathogenesis of B-cell lymphoma in recent years, the number of treatment drugs and protocols for indolent B-cell lymphoma is increasing, including targeted drugs CD20 monoclonal antibody, BTK inhibitors, immunosuppressive agents, proteasome inhibitors, immune checkpoint inhibitors, which may have effects on the future treatment strategies. This paper summarizes the key clinical trials of targeted therapies for indolent B-cell lymphoma according to the 59th American Society of Hematology Annual Meeting.

Objective To analyze the clinical value of ovarian surgery in the treatment of primary ovarian mucinous carcinoma patients with fertility requirements.Methods 51 cases with fertility requirements with primary ovarian mucinous carcinoma who received surgical treatment were analyzed.The postoperative serum follicle stimulating hormone (FSH) and luteinizing hormone (LH),estradiol (E-2),anti Mullerian hormone (AMH) were deteced.The patients were followed up for 3 years,the survival rate and fertility were observed.Results Of 51 patients underwent surgery,postoperative 7d,14d,the FSH,LH levels in serum were higher than before operation (F=24.198,21.554,all P<0.05),E-2,AMH,PSV values were lower than before operation (F=24.407,35.028,11.064,all P<0.05).During the follow-up period to June 2015,there were 4 patients died of tumor recurrence,2 patients were lost to follow-up,45 patients survived,the survival rate was 88.23%.Of 45 patients survived,41 patients were normal menstrual cycle,menstruation,menstrual cycle 26-31 d,average (28.2±2.2)d;4 patients with irregular menstruation.Married women in the follow-up of 44 cases,including 28 patients with successful pregnancy,the pregnancy rate was 63.64%,there were 4 cases of spontaneous abortion,pregnancy in 3 patients because of abortion,pregnancy examination found 17 cases of abnormal pregnancy,4 cases of premature delivery.Conclusion In patients with primary ovarian mucinous carcinoma,it is feasible to use fertility preserving function,and the pregnancy rate is high,but the follow-up and monitoring should be strengthened to avoid the bad prognosis.