Using novel virtual reality (VR) technology to carry out the construction of clinical medical examination question bank, while deepening the reform of clinical medical course examination, it continues to innovate the medical professional evaluation system and improve the flexibility, diversity and scientificity of clinical medicine in teaching and assessment. It is of great and far-reaching significance to improve the teaching level and the quality of medical education in medical colleges and universities. This paper analyzes and discusses the necessity and feasibility of building a clinical medical examination question bank, and the advantages and prospects of integrating VR technology to carry out the construction of clinical medical examination question bank. At the same time, the exploration and practice of the examination question bank construction based on VR technology disscussed in detail would provide innovative thinking and reference for the clinical medical teaching and evaluation, medical personnel training and other aspects in China.

Detailed knowledge on tissue-specific metabolic reprogramming in diabetic nephropathy (DN) is vital for more accurate understanding the molecular pathological signature and developing novel therapeutic strategies. In the present study, a spatial-resolved metabolomics approach based on air flow-assisted desorption electrospray ionization (AFADESI) and matrix-assisted laser desorption ionization (MALDI) integrated mass spectrometry imaging (MSI) was proposed to investigate tissue-specific metabolic alterations in the kidneys of high-fat diet-fed and streptozotocin (STZ)-treated DN rats and the therapeutic effect of astragaloside IV, a potential anti-diabetic drug, against DN. As a result, a wide range of functional metabolites including sugars, amino acids, nucleotides and their derivatives, fatty acids, phospholipids, sphingolipids, glycerides, carnitine and its derivatives, vitamins, peptides, and metal ions associated with DN were identified and their unique distribution patterns in the rat kidney were visualized with high chemical specificity and high spatial resolution. These region-specific metabolic disturbances were ameliorated by repeated oral administration of astragaloside IV (100 mg/kg) for 12 weeks. This study provided more comprehensive and detailed information about the tissue-specific metabolic reprogramming and molecular pathological signature in the kidney of diabetic rats. These findings highlighted the promising potential of AFADESI and MALDI integrated MSI based metabolomics approach for application in metabolic kidney diseases.

Myosin light chain 9 (MYL9) is a regulatory light chain of myosin, which plays an important role in various biological processes including cell contraction, proliferation and invasion. MYL9 expresses abnormally in several malignancies including lung cancer, breast cancer, prostate cancer, malignant melanoma and others, which is closely related to the poor prognosis, but the clinical significance for its expression varies with different types of cancer tissues. Further elucidating the molecular mechanism of MYL9 in various types of malignant tumor metastasis is of great significance for cancer prevention and treatment. At the same time, as a molecular marker and potential target, MYL9 may have great clinical value in the early diagnosis, prognosis prediction, and targeted treatment of malignant tumors.
Biomarkers ; Humans ; Lung Neoplasms ; Male ; Myosin Light Chains/metabolism* ; Prognosis ; Prostatic Neoplasms

Objective: To search for specific metabolites in the lungs of pneumonia rats fed with a high-calorie diet, as well as explore the changes in the lung metabolites of young rats treated with Yinlai Decoction (YD) and its effects on inflammation-related metabolic pathways.Methods: Lipopolysaccharides (LPS) and a special high-calorie diet were used to induce Sprague Dawley (SD) rats to simulate the intestinal state of infant pneumonia. Liquid chromatography-mass spectrometry technology (LC-MS/MS) was used to detect metabolites in each group. Supervised orthogonal partial least squares discriminant analysis (OPLS-DA) model values were used for the detection results to find the differential metabolites. The metabolic pathways that are involved with the differential metabolites were clarified through enrichment analysis and topological analysis. Finally, the T cell receptor signaling pathway (TCR) signal conversion was analyzed by the network pharmacology method. Results: In the high-calorie diet combined with pneumonia group (M3), a total of 55 metabolites were determined to be different from the normal group (N). A total of 36 metabolites were determined to be different from those in the lung metabolites of the YD treatment group (T1). YD had a regulatory effect on glutathione metabolism, arginine and proline metabolism, ascorbic acid and aldehyde metabolism and phenylalanine metabolism. And the small molecule metabolites could act on the FYN and lymphocyte-specific protein tyrosine kinase (LCK) target proteins in the TCR signaling pathway, thereby affecting the immune function of the lungs. Conclusion: A high-calorie diet can cause abnormal sphingolipid metabolism in the lungs of young rats, thereby creating chronic lung inflammation in young rats. YD has a beneficial effect when used to treat young rats with LPS-induced pneumonia fed on high-calorie diets. Its mechanisms of action may affect the body's immune pathways by regulating the oxidative stress pathway affected by glutathione metabolism.

Objective:To explore the clinical effect of R-MAD (rituximab, methotrexate, cytarabine, dexamethasone) regimen in the treatment of primary ocular adnexal double-expression diffuse large B-cell lymphoma (DLBCL).Methods:The clinical data of an elderly patient with primary ocular adnexal double-expression DLBCL who was treated with R-MAD regimen in June 2019 in Fujian Medical University Union Hospital was retrospectively analyzed. The clinical manifestations, diagnosis and treatment, prognosis were also analyzed, and the related literature was reviewed.Results:The patients was a 71-year-old male. After initial treatment of R-CHOP chemotherapy, the patient's eye mass did not shrink, the swelling and pain became worse, the curative effect was not good, and the disease progression continued. After the patient was given R-MAD chemotherapy for 3 courses, the eye swelling subsided and pain symptoms were significantly improved, satisfactory results were obtained, and no obvious adverse reactions occurred.Conclusions:R-MAD regimen has an ideal effect on the patient with primary ocular adnexal double-expression DLBCL, which can significantly improve symptoms, delay disease progression, and improve the quality of life of patients, but the prognosis still needs to be followed up in the long-term.

Virtual reality technology is a technology that creates a visual environment for people to experience through computer simulation, with features of immersion, interaction and imagination. This technology was used in engineering mechanics and urban planning in early times In medicine, diagnostics serves as a bridge for medical students to transit from basic medicine to clinical medicine. Using virtual reality technology to produce standardized patients (SPs) allows medical students to simulate the role of clinicians in the classroom, complete the diagnosis and treatment for virtual patients using various electronic media and the mastered theoretical knowledge of diagnostics, set up simulation training and online-and-offline teaching according to the diagnostic course standards which compensates the disadvantages in traditional medical teaching. Virtual reality technology has practical significances for cultivating medical students' clinical skills and thinking through procedural process evaluation, real-time feedback, etc.. This paper will discuss the prospect of virtual reality technology, its application as well as its advantages in diagnostic teaching.

T-cell acute lymphonlastic leukemia(T-ALL) is one of the common hematological malignancies in children and adolescents, and it has a rapid progress and high mortality.Since the first activated mutation in NOTCH1 was found in T-ALL with t(7; 9) translocation in 1991.The pathogenesis and clinical treatment of NOTCH1 gene mutation and T-ALL had made some progress at subsequent years.However, there are still some differences in the prognosis of children and adults after using chemotherapy drugs.Therefore, the differences of prognosis of acute lymphoblastic leukemia with NOTCH1 gene mutation in adults and children and the latest treatment progress are reviewed and hope to provide guidance for clinical treatment.

OBJECTIVE: To study the effect of nanohydroxyapatite (nHA) for promoting surface mineralization of demineralized dentin discs and adsorption of lead ions in simulated sewage water. METHODS: Sixty dentin disks were prepared from freshly extracted teeth with intact crown (including 30 premolars and 30 molars) and treated with 10% citric acid for 2 min to simulate dentinal tubules with dentin hypersensitivity. The etched dentin discs were brushed with distilled water, 0.2 g HA or 0.2 g nHA for 2 min twice a day for 7 consecutive days, after which scanning electron microscopy (SEM) was performed and calcium and phosphorus contents in the dentin discs were detected using EDS. Lead ion adsorption capacities of HA and nHA were tested by mixing 1 mL serial concentrations of HA and nHA suspensions with 50 mL lead ion solutions (1.0 mg/L). After 24 h, the residual lead ion concentration in the supernatant was measured using ICP to calculate lead ion adsorption rate and adsorption capacity of the materials. RESULTS: SEM showed a smooth surface and empty dentin tubules in the acid- etched dentin dics. The dentin dics treated with HA were covered with masses of particles that loosely attached to the surface, and the diameter of the dentin tubules was reduced. In nHA group, the dentin discs showed a fine and homogeneous surface clogging with a tight attachment, and the dentin tubule diameter was obviously reduced. Daily brushing with HA and nHA, especially the latter, significantly increased calcium and phosphorus contents on the surface of the dentin dics ( < 0.000). In lead ion adsorption experiment, the lead ion adsorption rate of HA decreased as its concentration increased with the highest adsorption rate of 83.01%; the adsorption rate of nHA increased with its concentration until the adsorption equilibrium was reached, and its highest adsorption rate was 98.79%. A good liner relationship was found between the adsorption ability and concentration of HA. CONCLUSIONS Compared with HA, nHA has a better capacity for surface mineralization of acid-etched dentin discs and also a better ability of lead ion adsorption.

Objective To analyze the clinical efficacy of combined or single use of clofibrate and cytarabine in the treatment of adult patients with myelodysplastic syndromes (MDS) or acute leukemia (AL).Methods Clofarabine combined with cytarabine was used in the combined group and clofarabine or cyarabine alone was used in the control group.All the studies about cytarabine and clofarabine were searched in PubMed,Cochrance Library,Embase,CNKI,Wanfang and VIP database by computer,and then the data was extracted.Results The complete remission rate of the combined group was higher than that of the control group [33.1％ (93/281) vs.18.2％ (35/192),and the difference was statistically significant (RR =1.85,95％ CI 1.31-2.60,P ＜ 0.01).The overall response rate of the combined group was higher than that of the control group [44.0％ (124/282) vs.23.2％ (46/198)],and the difference was statistically significant (RR =1.92,95％ CI 1.44-2.56,P ＜ 0.01).However,the incidence of skin adverse reactions in the combined group was also higher than that in the control group [38.8％ (104/268) vs.3.1％ (6/192)],and the difference was statistically significant (RR =7.76,95％ CI 3.68-16.38,P ＜ 0.01).Conclusion The combination of clofarabine and cytarabine in the treatment of adult patients with MDS or AL has better clinical efficacy than single application,but it also has more serious skin adverse reactions.

Objective To OxplorO thO clinical Officacy of oral fluconazolO combinOd with clotrimazolO vaginal administration in thO trOatmOnt of candida vaginitis by mOta analysis. Methods FluconazolO combinOd with clotrima-zolO was sOlOctOd as OxpOrimOnt group and clotrimazolO alonO was sOlOctOd as control group. ThO randomizOd controllOd trials( RCTs) wOrO rOtriOvOd from PubMOd, CochranO library, EmbasO, China Notional KnowlOdgO infrastructurO (CNKI), WangFang and VIP databasO and rOfOrOncOs listOd in all studiOs. RCTs mOOting inclusivO studiOs wOrO includOd, thO data wOrO OxtractOd, thO quality was OvaluatOd and cross - chOckOd by two rOviOws indOpOndOntly according to CochranO Handbook for SystOmatic ROviOws of IntOrvOntions and thOn MOta -analysis was conductOd using Stata14.0 softwarO. Results A total of 15 studiOs and 1 792 patiOnts wOrO includOd.ThO OxpOrimOnt group had a highOr ovOrall OfficiOncy(OxpOrimOnt group in 96.13% and control group in 83.8% ),thO diffOrOncO was statistically significant (RR=1.13,95% CI 1.08~1.18,P<0.001). ThO rOcurrOncO ratO aftOr trOatmOnt( OxpOrimOnt group in 6.46% and control group in 20.74% ) had statistically significant diffOrOncO bOtwOOn thO two groups ( RR=0.31, 95% CI 0.21~0.46,P<0.001).Conclusion MOta analysis showOd that oral fluconazolO combinOd with clotrima-zolO vaginal administration has a bOttOr clinical Officacy.