ObjectiveTo evaluate the impact of narrative medicine education on the narrative ability of resident physicians undergoing standardized residency training， and to explore its application value in clinical practice. MethodsA total of 23 obstetricians and gynecologists who participated in residency training at the Fourth Hospital of Hebei Medical University from October 2021 to June 2024 were randomly selected to receive a 3-month residency training program integrated with narrative medicine education， including narrative theory learning， text reading， reflective writing， and scenario-based case analysis. A questionnaire survey was conducted to analyze the personal situation of resident physicians， their narrative ability before and after receiving narrative medicine education， and their satisfaction with teaching. ResultsThe results of the questionnaire survey showed that resident physicians who had received narrative medicine education scored higher on the narrative ability assessment scale than before training， including improved narrative abilities in the dimensions of life and health narrative awareness， professional narrative thinking， professional development narrative behavior， peer communication narrative behavior， and doctor-patient interaction narrative behavior （P<0.05）. However， there were no statistically significant differences in the dimensions of life and health narrative behavior and family connection narrative behavior （P>0.05）. Meanwhile， resident physicians’ interest in active learning， clinical thinking ability， doctor-patient communication ability， and satisfaction with teaching methods have also been improved （P<0.05）. ConclusionNarrative medicine education can effectively enhance the narrative ability of resident physicians and make up for the current deficiencies in humanistic literacy and ethical education in current medical education. It is of great significance for improving doctor-patient relationships and the quality of medical services. Therefore， it is recommended to integrate narrative medicine education into the regular training curriculum for resident physicians.

Objective: To evaluate the effectiveness of a comprehensive intervention for childhood obesity on self-efficacy, weight perception, and stage of behavior change, and to provide a scientific evidence for childhood obesity interventions. Methods: The study was a cluster randomized controlled trial. Twelve primary schools and 1 889 children (aged 7-11 years) from Dongcheng District in Beijing were recruited in September, 2013, and were administered a comprehensive intervention for childhood obesity. Six schools (930) were randomly allocated to the intervention group, and six schools (959) were randomly allocated to the control group. A face-to-face questionnaire survey was carried out, R 4.0.3 software was used to analyze the data, and multiple linear regression model was used to analyze the intervention effect. Results: After the intervention, mean (standard deviation) scores of self-efficacy among children in the intervention and control groups were (4.4±0.9) and (4.2±1.1), respectively. After the intervention, the proportion of children in the intervention group who underestimated or overestimated their body weight was 28.4% and 11.3 %, respectively, while the figures in the control were 37.1% and 6.9%; compared with the control, the risk of underestimating body weight decreased among children in the intervention group( OR=0.64, 95%CI=0.52-0.80, P <0.01), while the risk of weight overestimation increased( OR=1.79, 95%CI=1.26-2.54, P <0.01). After the intervention, the proportion of children in the contemplation or action stage of behaviour change was 65.3% and 83.6%, while the figures in the control group were 59.8% and 69.8 %, respectively; in comparison with the control group, more children in the intervention group were in comtemplation ( OR= 1.28 , 95%CI=1.03-1.59, P =0.02) or action stage of behaviour change( OR=2.59, 95%CI=2.04-3.27, P <0.01). Conclusion The comprehensive intervention for childhood obesity improved self-efficacy, weight perception, and facilitated behavior change, but may increase the risk of weight overestimation.

OBJECTIVE: By introducing the Medical Device Reporting (MDR) system and related inspection practice of the US, this paper puts forward some suggestions on implementing reporting responsibility of manufactures in China. METHODS: The MDR system and the related inspection system in the US were systematically analyzed. RESULTS: The US had established a sound system for discovering and reporting MDR, and a mechanism for inspecting the implementing of manufactures, forming an effective post-market surveillance system. CONCLUSIONS By learning from the experience of the US, we can carry out the post-market surveillance of medical devices adverse events in China from the aspects of implementing the existing system, strengthening the reporting ability and perfecting the inspection mechanism.
China ; Equipment and Supplies/standards* ; Product Surveillance, Postmarketing

OBJECTIVETo assess the association of transcobalamine II (TCN2) gene polymorphisms and serum levels of homocysteine (Hcy), vitamin Band folate with ulcerative colitis (UC) among Chinese patients.

METHODSFor 397 UC patients and 574 controls, two single nucleotide polymorphisms of the TCN2 gene (rs1801198, rs9606756) were tested with an improved multiple ligase detection reaction method. Serum Hcy, vitamin Band folate were measured with an enzymatic cycling assay and an chemiluminescence immunoassay, respectively.

RESULTSThe allelic and genotypic frequencies of rs1801198 and rs9606756 did not differ significantly between the two groups (all P> 0.05). Compared with those of the control group, the frequencies of G allele and CG+GG genotype of rs1801198 were greater in patients with moderate and severe UC (both P< 0.05). The same conclusion may also be drawn for the G allele and AG genotype of rs9606756 (both P< 0.05). Compared with the controls, average Hcy level was enhanced in UC patients (P< 0.01), whereas average vitamin Band folate levels were decreased in UC patients (both P< 0.01). In both groups, the average level of Hcy was lower in individuals carrying CC of (rs1801198) than in those with CG+GG (both P< 0.05). A similar conclusion was also drawn for individuals with AA of rs9606756 when compared with those carrying AG(both P< 0.05). Compared with patients with mild UC, average Hcy level was increased in those with moderate and severe UC (P< 0.01), while average vitamin Band folate levels were decreased in those with moderate and severe UC (both P< 0.01). The prevalence of hyperhomocysteinemia(HHcy), vitamin Bdeficiency and folate deficiency was greater in UC patients than in controls (all P< 0.01). In UC patients, the level of Hcy was negatively correlated with those of vitamin B(P< 0.01), albumin(P< 0.01), red blood cells(P< 0.01) and platelet (P< 0.05), but positively correlated with white blood cells(P< 0.01) and Mayo score (P< 0.01). Both HHcy and folate deficiency were independent risk factors for UC (OR=4.173, OR=5.206, both P< 0.01).

CONCLUSIONTCN2 (rs1801198, rs9606756) variations, as well as serum levels of Hcy, vitamin Band folate, are correlated with UC. Both HHcy and folate deficiency are independent risk factors for UC.

Adult ; Colitis, Ulcerative ; blood ; etiology ; genetics ; Female ; Folic Acid ; blood ; Genotype ; Homocysteine ; blood ; Humans ; Male ; Middle Aged ; Polymorphism, Single Nucleotide ; Transcobalamins ; genetics ; Vitamin B 12 ; blood

Objective To investigate postoperative infection rates of patients with different types of incisions and different risk indexes of operation in a tertiary hospital in Chengdu City through carrying out targeted monitoring of surgical incision,in order to determine important interventions for infection control.Methods The data about operating rooms in the hospital monitored in this study was collected via the Donghua software electronic information system,and the situation of postoperative infection of incision wounds was analysed as well.Results Among the 1 331 cases of patients,the total infection rate of postoperative incisions was 0.60％.The type Ⅰ,type Ⅱ and type Ⅲl/Ⅳ incision infection rate was 0.31％,0.69％ and 1.78％,respectively.The infection rate of patients whose surgical risk score was 0,1 point and ≥2 points was 0.13％,0.84％ and 1.74 ％,respectively.By Fisher exact test,there were statistically significant differences in postoperative infection rates among patients with different types of surgical incision and those with different surgical risk index scores(P＜0.05).Conclusion The postoperative infection rates of patients with type Ⅲ/Ⅳ incision and those with surgical risk index score≥2 points are the highest.It is necessary to emphasize and strengthen the intervention on controlling postoperative infections,effectively reduce the postoperative infection rate through active monitoring,in order to improve the quality of medical hospital treatment and ensure patients'safety.

C.citratus has been usedin many countries with a long history.Traditionally,it is applied as a food seasoning in cooking.It is also used in tea beverage and folk medicine as well.Modern application of C.citratus is focused on the development of citronella oil,which can be used for food additives,disinfectants,cosmetics,drugs and etc.C.citratus is also a potential plant in landscaping.Its special lemony flavor contains chemical constituents,mainly including citral,myrcene,linalool,geraniol,nerol,citronellol,and etc.The modern research showed that C.citratus had the main effects of anti-microbial,anti-inflammation,analgesia,anti-oxidation,anti-tumor,anti-anxiety,anti-hypertension,antihyperglycemia,and etc.With further studies,some new pharmacological properties of C.citrates are going to be discovered gradually.It is worthy of further research and development to meet the needs of the health industry.

OBJECTIVETo assess the associations of death receptor DR4 and DR5 gene polymorphisms with Crohn's disease (CD).

METHODSA total of 295 CD patients and 490 healthy controls were recruited. Three single nucleotide polymorphisms (SNPs) of the DR4 (rs13278062, rs20575) and DR5 (rs1047266) genes were determined with a SNaPshot method. Unconditional logistic regression analysis was carried out for determining the allelic and genotypic differences of the three SNPs between CD patients and the controls, as well as the influence of the DR4 and DR5 gene polymorphisms on the clinical features of CD patients. Linkage disequilibrium and haplotype analysis were calculated by haplotype 4.2 and R language software. A gene-gene interaction model was established to analyze whether the three SNPs can exert a synergistic effect on the susceptibility to CD.

RESULTSThe mutant allele (T) and genotype (GT+TT) of DR4 (rs13278062) were increased among CD patients compared to the controls (37.12% vs. 32.04%, P = 0.040, 95%CI: 1.010-1.550; 62.71% vs. 54.90%, P = 0.032, 95%CI: 1.028-1.855, respectively). However, the allelic and genotypic frequencies of DR4 (rs20575) and DR5 (rs1047266) did not differ between the two groups (all P > 0.05). Based on the Montreal Classification Standards, the CD patients were stratified by locations and behaviors of the disease. After multiple comparison correction (P < 0.0125), compared to ileocolonic CD patients respectively, the mutant allele (T) and genotype (GT+TT) of the rs13278062 polymorphism were significantly increased in colonic CD patients (41.04% vs. 25.64%, P = 0.002, 95%CI: 0.315-0.778; 66.04% vs. 41.03%, P = 0.001, 95%CI: 0.196-0.655, respectively) and terminal ileum CD patients (41.44% vs. 25.64%, P = 0.002, 95%CI: 0.311-0.762; 74.77% vs. 41.03%, P < 0.001, 95%CI: 0.126-0.437, respectively). In comparison to penetrating CD patients, the mutant allele (T) and genotype (GT+TT) of DR4 (rs13278062) were significantly decreased in stricturing CD patients (32.29% vs. 48.91%, P = 0.007, 95%CI: 0.300-0.828; 57.29% vs. 86.96%, P = 0.001, 95%CI: 0.078-0.520, respectively). A similar conclusion was drawn for the mutant genotype (GT+TT) of DR4 (rs13278062) in non-stricturing, non-penetrating CD patients (58.82% vs. 86.96%, P = 0.001, 95%CI: 0.086-0.536). Haplotype analysis indicated that the CT haplotype formed by rs20575 and rs13278062 was increased in CD patients compared to the controls (37.1% vs. 31.8%, P = 0.029, OR=1.279, 95%CI: 1.022-1.600). The outcome of a gene-gene interaction model indicated that the mutant genotype (GT+TT) of DR4 (rs13278062) and mutant genotype (CT+TT) of DR5 (rs1047266) may play a negatively synergistic role in CD patients (B = - 0.483, OR = 0.617, P = 0.030).

CONCLUSIONThe rs13278062 polymorphism of the DR4 gene not only can confer an increased risk for CD, but may also influence the location of the lesions and the disease behaviors. The CT haplotype formed by rs20575 and rs13278062 may be an independent risk factor for CD. Furthermore, the mutant genotype (GT+TT) of DR4 (rs13278062) and mutant genotype (CT+TT) of DR5 (rs1047266) may exert a negative synergistic effect on CD.

Adult ; Crohn Disease ; genetics ; Epistasis, Genetic ; Female ; Genetic Predisposition to Disease ; Genotype ; Haplotypes ; Humans ; Male ; Middle Aged ; Polymorphism, Single Nucleotide ; Receptors, TNF-Related Apoptosis-Inducing Ligand ; genetics

Objective To investigate associations of UC with the polymorphisms of TRAIL receptors.Methods From January 2008 to December 2012, 380 consecutive UC patients [215 males and 165 females, the average age was (42.63 ±14.61) years] as well as 539 sex-and age-matched healthy individuals [290 males and 249 females, the average age was (41.29 ±15.86) years] were recruited from four large scale comprehensive hospitals in Wenzhou city.Five single nucleotide polymorphisms of DR4 (rs20575, rs13278062), DR5(rs1047266), DcR2(rs1133782) and OPG (rs3102735) were detected by a SNaPshot technique.Distributions of mutant alleles and genotypes for targeted polymorphisms in TRAIL receptors were analyzed by Chi-square test or Fisher′s exact test. By means of unconditional Logistic regression analysis, it evaluated associations between the polymorphisms and the risk of UC attack as well as the clinical features of UC patients.Furthermore, an unconditional Logistic multiple regression analysis was employed to investigate the independent risk factors of UC and their multiplicative interaction effects on UC.Results The frequencies of mutant allele (G) and genotype (CG+GG) of DR4(rs20575) were higher in UC patients than those in the controls (3.55%vs 1.95%,χ2 =4.512, P=0.034;6.58%vs 3.71%,χ2=3.938, P=0.047, respectively).However, the frequeucies of mutant allele ( A) and genotype ( GA+AA) of DcR2(rs1133782) were decreased in UC patients compared to the controls(6.18%vs 9.09%,χ2=5.183, P=0.023; 11.32% vs 17.44%, χ2 =6.589, P=0.010, respectively).The frequencies of mutant allele (T) and homozygote (TT) of OPG(rs3102735) were significantly higher in UC patients than in the controls (86.32% vs 81.54%, χ2 =7.385, P=0.007;75.26% vs 66.98%, χ2 =7.346, P=0.007, respectively) .Furthermore, the genotype (GG) of DcR2 (rs1133782) was found to be the independent risk factor for UC attack (OR=4.937, 95%CI:2.320-10.504, P<0.001).Moreover, the (GG) of DcR2(rs1133782) and (CC) of DR4(rs20575) had an interactive effect on UC (OR=0.322, 95%CI:0.164-0.633, P=0.001).The same conclusion was drawn for the ( GG) of DR4( rs20575) and (TT) of OPG(rs3102735) (OR=1.580, 95%CI:1.165-2.144, P=0.003).Conclusions The genetic polymorphisms of DR4 ( rs20575 ) , DcR2 ( rs1133782 ) and OPG ( rs3102735 ) were associated with UC. The mutation of DcR2(rs1133782) might play a protective role in UC.Moreover, the DcR2(rs1133782) and DR4(rs20575) gene had a collaborative effect on UC.So did the DR4(rs20575) and OPG(rs3102735) genes.

Objective To analyze the tend of hospital infection ,to understand the hospital infection control situation and pro‐vide a scientific basis for hospital infection prevention and control .Methods Investigation by the bed in combination with case in‐vestigation form 2012 to 2014 ,and the data of three consecutive years were analyzed by statistical analysis .Results In 2012 ,2013 and 2014 ,the hospital infection rates were 4 .15% ,3 .38% and 2 .76% respectively ,there was no statistically significant difference (χ2 =3 .908 ,P=0 .142) .Hospital infection site mainly respiratory tract(61 .33% ) ,followed by the digestive tract(16 .67% ) and u‐rinary tract(6 .67% ) ,different parts of the infection rate after statistical tests ,the difference had no statistically significant (χ2 =12 .167 ,P=0 .239);Different departments category incidence of hospital infection ,infection rate of internal system presented the declining trend ,in 2012-2014 by the statistical tests ,the difference had statistically significant(χ2 =8 .347 ,P=0 .015) .Conclusion Continuous observation of hospital infection rates helps to understanding the trend of hospital infection ,finding focus of infection , improving the method of hospital infection management .

OBJECTIVETo establish nonalcoholic fatty liver disease (NAFLD) model induced by free fatty acid (FFA) and iron, and to explore the synergistic effect of FFA and Fe(2+) on the pathogenesis of NAFLD and mechanisms.

METHODSHuman liver carcinoma cell HepG2 was respectively treated with 0.250, 0.500, 1.000 mmol/L oleic acid, 0.500 mmol/L oleic acid+0.125 mmol/L Fe(2+), 0.500 mmol/L oleic acid+0.250 mmol/L Fe(2+), and 0.500 mmol/L oleic acid+0.500 mmol/L Fe(2+). Human liver carcinoma cell HepG2 was normally cultured in the control group. Lipid accumulation of cells were observed by oil red O staining and the determination of the triglyceride (TG) contents by GPO-PAP, then the expression of key genes involved in fatty acid β-oxidation (fatty acyl CoA synthetase-1 (ACSL-1), carnitine acyl transferase 1 (CPT-1a), fatty acid synthetase (FAS)) was determined using RT-PCR. The differences of TG content and ACSL-1, CPT-1a, FAS, mRNA relative value were analyzed among different groups.

RESULTSThe results of oil red O staining indicated that the contents of lipid droplets were obviously elevated with the increase of Fe(2+) concentration in human liver carcinoma cell HepG2 treated with 0.500 mmol/L oleic acid and different concentrations of Fe(2+). The TG contents of HepG2 cell in control group, 0.250, 0.500, 1.000 mmol/L oleic acid groups, 0.500 mmol/L oleic acid+0.125 mmol/L Fe(2+) group, 0.500 mmol/L oleic acid+0.250 mmol/L Fe(2+) group, 0.500 mmol/L oleic acid+0.500 mmol/L Fe(2+) group respectively were (90.0 ± 1.6), (131.7 ± 5.4), (153.7 ± 3.0), (254.1 ± 4.0), (164.5 ± 6.0), (180.1 ± 7.7), (235.6 ± 4.5) nmol/mg (F = 396.00, P < 0.05). The expression levels of ACSL-1 mRNA in 0.500 mmol/L oleic acid group, 0.500 mmol/L oleic acid+0.125 mmol/L Fe(2+) group, 0.500 mmol/L oleic acid +0.250 mmol/L Fe(2+) group, 0.500 mmol/L oleic acid +0.500 mmol/L Fe(2+) group respectively were (0.94 ± 0.02), (0.89 ± 0.04), (0.85 ± 0.02), (0.74 ± 0.04) (F = 50.00, P < 0.05); the mRNA levels of CPT-1a were (0.89 ± 0.03), (0.79 ± 0.05), (0.67 ± 0.04), (0.51 ± 0.05) (F = 79.00, P < 0.05); the mRNA levels of FAS were (1.31 ± 0.05) , (1.44 ± 0.03), (1.51 ± 0.05), (1.56 ± 0.06 ) (F = 79.70, P < 0.05).

CONCLUSIONThe NAFLD liver cell model could be established by oleic acid and Fe(2+) in HepG2 cells. FFA and iron might be involved in the pathogenesis of NAFLD through the intervention of fatty acid β-oxidation.

Carnitine O-Palmitoyltransferase ; Coenzyme A Ligases ; Fatty Acid Synthase, Type I ; Fatty Acids ; Fatty Acids, Nonesterified ; adverse effects ; Hep G2 Cells ; Humans ; Iron ; adverse effects ; Non-alcoholic Fatty Liver Disease ; chemically induced ; Oleic Acid ; RNA, Messenger ; Triglycerides