Taking the course of Chinese traditional medicine as an example, this paper discusses the construction and implementation effect of online teaching mode from the following four aspects: online teaching curriculum design, teaching implementation, teaching effect evaluation, and teaching reflection, with a view to providing beneficial reference for the follow-up hybrid teaching and promoting the construction of hybrid first-class courses by summarizing the experience of online teaching.

Objective:To investigate the epidemiological characteristics, diagnosis, treat-ment and prognosis of gallbladder cancer in China from 2010 to 2017.Methods:The single disease retrospective registration cohort study was conducted. Based on the concept of the real world study, the clinicopathological data, from multicenter retrospective clinical data database of gallbladder cancer of Chinese Research Group of Gallbladder Cancer (CRGGC), of 6 159 patients with gallbladder cancer who were admitted to 42 hospitals from January 2010 to December 2017 were collected. Observation indicators: (1) case resources; (2) age and sex distribution; (3) diagnosis; (4) surgical treatment and prognosis; (5) multimodality therapy and prognosis. The follow-up data of the 42 hospitals were collected and analyzed by the CRGGC. The main outcome indicator was the overall survival time from date of operation for surgical patients or date of diagnosis for non-surgical patients to the end of outcome event or the last follow-up. Measurement data with normal distribu-tion were represented as Mean±SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and com-parison between groups was conducted using the U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Univariate analysis was performed using the Logistic forced regression model, and variables with P<0.1 in the univariate analysis were included for multivariate analysis. Multivariate analysis was performed using the Logistic stepwise regression model. The life table method was used to calculate survival rates and the Kaplan-Meier method was used to draw survival curves. Log-rank test was used for survival analysis. Results:(1) Case resources: of the 42 hospitals, there were 35 class A of tertiary hospitals and 7 class B of tertiary hospitals, 16 hospitals with high admission of gallbladder cancer and 26 hospitals with low admission of gallbladder cancer, respectively. Geographical distribution of the 42 hospitals: there were 9 hospitals in central China, 5 hospitals in northeast China, 22 hospitals in eastern China and 6 hospitals in western China. Geographical distribution of the 6 159 patients: there were 2 154 cases(34.973%) from central China, 705 cases(11.447%) from northeast China, 1 969 cases(31.969%) from eastern China and 1 331 cases(21.611%) from western China. The total average number of cases undergoing diagnosis and treatment in hospitals of the 6 159 patients was 18.3±4.5 per year, in which the average number of cases undergoing diagnosis and treatment in hospitals of 4 974 patients(80.760%) from hospitals with high admission of gallbladder cancer was 38.8±8.9 per year and the average number of cases undergoing diagnosis and treatment in hospitals of 1 185 patients(19.240%) from hospitals with low admission of gallbladder cancer was 5.7±1.9 per year. (2) Age and sex distribution: the age of 6 159 patients diagnosed as gallbladder cancer was 64(56,71) years, in which the age of 2 247 male patients(36.483%) diagnosed as gallbladder cancer was 64(58,71)years and the age of 3 912 female patients(63.517%) diagnosed as gallbladder cancer was 63(55,71)years. The sex ratio of female to male was 1.74:1. Of 6 159 patients, 3 886 cases(63.095%) were diagnosed as gallbladder cancer at 56 to 75 years old. There was a significant difference on age at diagnosis between male and female patients ( Z=-3.99, P<0.001). (3) Diagnosis: of 6 159 patients, 2 503 cases(40.640%) were initially diagnosed as gallbladder cancer and 3 656 cases(59.360%) were initially diagnosed as non-gallbladder cancer. There were 2 110 patients(34.259%) not undergoing surgical treatment, of which 200 cases(9.479%) were initially diagnosed as gallbladder cancer and 1 910 cases(90.521%) were initially diagnosed as non-gallbladder cancer. There were 4 049 patients(65.741%) undergoing surgical treatment, of which 2 303 cases(56.878%) were initially diagnosed as gallbladder cancer and 1 746 cases(43.122%) were initial diagnosed as non-gallbladder cancer. Of the 1 746 patients who were initially diagnosed as non-gallbladder cancer, there were 774 cases(19.116%) diagnosed as gallbladder cancer during operation and 972 cases(24.006%) diagnosed as gallbladder cancer after operation. Of 6 159 patients, there were 2 521 cases(40.932%), 2 335 cases(37.912%) and 1 114 cases(18.087%) undergoing ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) examination before initial diagnosis, respec-tively, and there were 3 259 cases(52.914%), 3 172 cases(51.502%) and 4 016 cases(65.205%) undergoing serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis, respectively. One patient may underwent multiple examinations. Results of univariate analysis showed that geographical distribution of hospitals (eastern China or western China), age ≥72 years, gallbladder cancer annual admission of hospitals, whether undergoing ultrasound, CT, MRI, serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis were related factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.45, 1.98, 0.69, 0.68, 2.43, 0.41, 1.63, 0.41, 0.39, 0.42, 95% confidence interval as 1.21-1.74, 1.64-2.40, 0.59-0.80, 0.60-0.78, 2.19-2.70, 0.37-0.45, 1.43-1.86, 0.37-0.45, 0.35-0.43, 0.38-0.47, P<0.05). Results of multivariate analysis showed that geographical distribution of hospitals (eastern China or western China), sex, age ≥72 years, gallbladder cancer annual admission of hospitals and cases undergoing ultrasound, CT, serum CA19-9 examination before initially diagnosis were indepen-dent influencing factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.36, 1.42, 0.89, 0.67, 1.85, 1.56, 1.57, 0.39, 95% confidence interval as 1.13-1.64, 1.16-1.73, 0.79-0.99, 0.57-0.78, 1.60-2.14, 1.38-1.77, 1.38-1.79, 0.35-0.43, P<0.05). (4) Surgical treatment and prognosis. Of the 4 049 patients undergoing surgical treatment, there were 2 447 cases(60.435%) with complete pathological staging data and follow-up data. Cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb were 85(3.474%), 201(8.214%), 71(2.902%), 890(36.371%), 382(15.611%), 33(1.348%) and 785(32.080%), respectively. The median follow-up time and median postoperative overall survival time of the 2 447 cases were 55.75 months (95% confidence interval as 52.78-58.35) and 23.46 months (95% confidence interval as 21.23-25.71), respectively. There was a significant difference in the overall survival between cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb ( χ2=512.47, P<0.001). Of the 4 049 patients undergoing surgical treatment, there were 2 988 cases(73.796%) with resectable tumor, 177 cases(4.371%) with unresectable tumor and 884 cases(21.833%) with tumor unassessable for resectabi-lity. Of the 2 988 cases with resectable tumor, there were 2 036 cases(68.139%) undergoing radical resection, 504 cases(16.867%) undergoing non-radical resection and 448 cases(14.994%) with operation unassessable for curative effect. Of the 2 447 cases with complete pathological staging data and follow-up data who underwent surgical treatment, there were 53 cases(2.166%) with unresectable tumor, 300 cases(12.260%) with resectable tumor and receiving non-radical resection, 1 441 cases(58.888%) with resectable tumor and receiving radical resection, 653 cases(26.686%) with resectable tumor and receiving operation unassessable for curative effect. There were 733 cases not undergoing surgical treatment with complete pathological staging data and follow-up data. There was a significant difference in the overall survival between cases not undergoing surgical treatment, cases undergoing surgical treatment for unresectable tumor, cases undergoing non-radical resection for resectable tumor and cases undergoing radical resection for resectable tumor ( χ2=121.04, P<0.001). (5) Multimodality therapy and prognosis: of 6 159 patients, there were 541 cases(8.784%) under-going postoperative adjuvant chemotherapy and advanced chemotherapy, 76 cases(1.234%) under-going radiotherapy. There were 1 170 advanced gallbladder cancer (pathological staging ≥stage Ⅲa) patients undergoing radical resection, including 126 cases(10.769%) with post-operative adjuvant chemotherapy and 1 044 cases(89.231%) without postoperative adjuvant chemo-therapy. There was no significant difference in the overall survival between cases with post-operative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.23, P=0.629). There were 658 patients with pathological staging as stage Ⅲa who underwent radical resection, including 66 cases(10.030%) with postoperative adjuvant chemotherapy and 592 cases(89.970%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.05, P=0.817). There were 512 patients with pathological staging ≥stage Ⅲb who underwent radical resection, including 60 cases(11.719%) with postoperative adjuvant chemotherapy and 452 cases(88.281%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemo-therapy and cases without post-operative adjuvant chemo-therapy ( χ2=1.50, P=0.220). Conclusions:There are more women than men with gallbladder cancer in China and more than half of patients are diagnosed at the age of 56 to 75 years. Cases undergoing ultrasound, CT, serum CA19-9 examination before initial diagnosis are independent influencing factors influencing initial diagnosis of gallbladder cancer patients. Preoperative resectability evaluation can improve the therapy strategy and patient prognosis. Adjuvant chemotherapy for gallbladder cancer is not standardized and in low proportion in China.

Objective: To understand nutrient intake and dietary structure among migrant children in primary schools in Hongshan District of Wuhan, so as to carry out dietary nutrition intervention and evaluate the effectiveness of the intervention. Methods: Stratified random sampling was used to select children in grade 3-6 who were randomly assigned to the intervention group (n=218) and the control group (n=222) from primary schools with a large number of migrant children in Hongshan District of Wuhan. After the baseline survey, the intervention group was given a two month diet intervention with "nutrition class" and knowledge lecture, and the caregivers of the intervention group were also given an intervention. Results: At baseline, both groups had inadequate nutrient intake, with adequate intake rate of calcium, selenium, vitamin B 1 and vitamin B 2 less than 5%; children were lack of dietary diversity with adequate intake of vegitable, milk and milk product less than 5%. After intervention, the intake of energy, three main macronutrients, calcium, vitamin A, and vitamin C in the intervention group were higher than that of before intervention, as well as than the control group, differences were statistically significant (Z=2.22-8.65，2.62-8.46，P<0.05). In terms of dietary structure, adequate intake rate of cereals and miscellaneous beans increased from 55.5% to 68.8%, livestock and poultry meat increased from 45.9% to 56.4%, which were higher than that of the control group (56.3% and 44.6%) (χ 2=5.29-13.25，4.39-14.13，P<0.05). Conclusion Inadequate nutrient intake and unreasonable dietary structure of migrant children can be improved through short term dietary intervention including nutrition education to both parents and children.

Objective: To investigate the epidemiology and related clinical features of hemorrhagic fever with renal syndrome (HFRS) in Qingdao, and provide relevant evidence for clinical diagnosis and treatment. Methods: The retrospective analysis method was used to collect the epidemiological and clinical data of 104 patients with HFRS diagnosed in the Affiliated Hospital of Qingdao University from January 2014 to December 2018, and the general condition, clinical symptoms, laboratory examination and exposure history of the patients were analyzed. Results: One hundred and four patients with HFRS were aged from 10 to 87 years old, including 78 males and 26 females; mainly living in rural areas, accounting for 90.38% (94/104); and 54 cases from the Department of Nephrology, accounting for 51.92%. October to January of the following year was the main onset time, accounting for 68.27% (71/104). The clinical manifestations were 98 cases of fever, accounting for 94.23%; 66 cases of nausea and vomiting, accounting for 63.46%; and 57 cases of dizziness and headache, accounting for 54.81%. Laboratory examination showed more thrombocytopenia, urinary protein and occult blood positive, D-dimer elevation, C-reactive protein and procalcitonin elevation. Only 8 cases had a history of direct, indirect or suspicious contact. Conclusions The clinical features of HFRS are atypical. The main symptoms are fever, nausea and vomiting, dizziness and headache. Men are higher than women. The place of residence is mainly in rural areas. The exposure history is mostly unclear. Diagnosis should be combined with laboratory findings and early treatment to improve clinical outcomes.

Objective To explore the effect of combined Naikan therapy and modified Morita therapy on psychological distress and post traumatic growth in elderly patients with cancer pain.Methods Ninety elderly patients with cancer pain were randomly assigned into two groups;those in the study group(n =45)were given Naikan therapy and modified Morita therapy for 4 weeks and those in the control group (n =45) were given standardized aerodyne treatment and standardized nursing care.All subjects were assessed with the Distress Thermometer and Problem Listand the Post traumatic Growth Inventory before and after Naikan therapy and modified Morita therapy.Results Compared with the control group,the study group was associated with significantly decreased scores of psychological distress(1.8± 0.1 vs.3.9 ± 0.2,t =1.78,P＜0.05),emotional problems (1.2 ± 0.4,vs.2.4±0.4,t=1.41,P＜0.05)and family problems(1.1±0.1,vs.2.9±0.1,t=1.63,P＜0.05).The study group also showed markedly higher scores in posttraumatic growth(66.0± 19.9 vs.45.3± 27.6,t=2.58,P＜0.05),relationships to others(34.8±12.1 vs.23.8±12.2,t=1.91,P＜0.05),new possibilities(25.2 ± 10.1 vs.13.7± 4.4,t=1.94,P＜0.05),personal strength(20.7 ± 10.4 vs.7.6 ± 3.1,t =2.03,P ＜ 0.05),spiritual change (11.6 ± 5.6 vs.5.4 ± 2.7,t =1.26,P ＜ 0.05),and appreciation of life(18.9±6.2 vs.6.1±-2.1,t=1.88,P＜0.05) than the control group.Conclusions Naikan therapy and modified Morita therapy can decrease psychological distress and improve post traumatic growth in elderly patients with cancer pain.

Objective: To evaluate the efficacy and safety of Shexiang Tongxin dropping pill (ShXT) in the treatment ofslow blood flow after PCI (Percutaneous Transluminal Coronary Intervention), and to provide evidence for clinicaltreatment of patients with slow blood flow after PCI or to provide evidence for further research and design. Methods: "Shexiang Tongxin", "PCI", "percutaneous coronary intervention", "shexiangtongxin", "shexiang tongxin", "percutaneouscoronary intervention" were used as key words. Randomized controlled clinical trial (RCT), system evaluation, retrospective case analysis and case-control trials of randomized controlled clinical trials were searched in the databasesof Pubmed, Cochrane, web of science, CNKI, WIP, CBM, and other databases. Cochrane risk assessment tool and NOSrating scale were used to evaluate the quality of literature, and the classification of literature evidence was evaluatedaccording to Oxford criteria of evidence classification and recommended opinion strength in 2001. Results: A total of 3 articles of RCT related to the subject were selected, including 1 case control trial, including 335 patients. The resultsshowed that: (1) The frequency of thrombolysis, heart ejection fraction and TIMI blood flow in patients with slow coronaryartery flow after treatment with Shexiang Tongxin dropping pills were significantly higher than those before treatment. (P ＜ 0.05) . (2) After treatment with Shexiang Tongxin dropping pills, the effective rate of clinical symptoms was 97.8％, which was higher than that of the treatment group 11.1％. (3) There were no adverse reactions in the ShXT group duringthe treatment period. Conclusion: The efficacy and safety of Shexiang Tongxin dropping pills for patients with slow bloodflow after PCI were good. However, the dosage, method, period and outcome of the clinical study of slow blood flow afterPCI were not uniform because of the dosage, method, period of taking Shexiang Tongxin dropping pills in patients afterPCI. It is suggested that the clinical study should be aimed at the choice of different dosages before and after theadministration of drugs. The multicenter prospective randomized controlled trial can provide more evidence for itsclinical application.

Magnetic resonance imaging (MRI) simulator (MRI-Sim) can provide superior images for radiotherapy.Due to the complexity of MRI technology and the safety problem caused by strong magnetic field, the acquisition and implementation of MRI simulation is more complicated than CT simulation.In order to ensure the introduction of MRI-Sim, this paper reviews the selection, installation, and acceptance test of MRI-Sim, including the selection of host and auxiliary equipment, installation site preparation, and safety precautions,as well as MRI-Sim acceptance test and commissioning.

Objective To investigate the effectiveness of training at morning shift meeting in improving healthcare-associated infection(HAI) prevention and control among health care workers(HCWs) in newly established hospital departments.Methods On July 11-22, 2016, HAI management full-time personnel performed training for HCWs about HAI prevention and control at morning shift meeting of 8 newly established clinical departments and 1 laboratory, the questionnaire survey was conducted before, immediately after, and 3 months after training, training effectiveness was evaluated.Results A total of 239 HCWs were required to receive training, including 85 doctors (35.6％), 150 nurses (62.8％), and 4 technicians (1.7％).The knowledge of HAI prevention and control that most HCWs wanted to know was occupational exposure and occupational precaution(85.6％);most HCWs wanted to obtain knowledge of HAI through training in their respective department by HAI management full-time personnel(87.1％).Total awareness rates of HAI knowledge before, immediately after, and 3 months after training were 45.1％, 96.7％, and 83.9％ respectively, difference was significant(P<0.001);comparison among groups showed that HCWs'' awareness in influencing factors of HAI, hand hygiene opportunity, isolation measures, and medical waste classification 3 months after training was significantly lower than immediately after training(all P<0.001);the average scores of HAI prevention and control knowledge among HCWs immediately after and 3 months after training were both higher than before training(P<0.001);average score of HAI prevention and control knowledge among HCWs 3 months after training was lower than that of immediately after training(P<0.001).Conclusion The training at morning shift meeting of clinical departments can improve the awareness of HAI prevention and control knowledge among HCWs.

Objective    To investigate the effect of low-flow inhaling NO for short time on postoperative cardiac and pulmonary functions in infants with congenital ventricular septal defect complicated with severe pulmonary hypertension. Methods    Forty-five patients with congenital ventricular septal defect complicated with severe pulmonary hypertension from May 2014 to May 2016 in our hospital were enrolled. There were 19 males and 26 females, whose age ranged from 1 to 22 months (average age: 7.2±14.4 months) and weight ranged from 2.7 to 10.5 kg (average weight: 6.8±3.6 kg). The patients were randomly divided into three groups (n=15 in each): the blank group, the prior inhalation group and the posterior inhalation group. The blank group did not inhale NO, and the prior inhalation group inhalated NO for 10 min after tracheal and intubation. After the opening of the aorta, the posterior inhalation group inhaled NO for 10 min. The concentration of NO was 20 × 10–6. The pressure ratio of pulmonary circulation/systematic circulation, heart index and oxygenation index were calculated and the troponin value of the three groups was monitored 10 min after returning to intensive care unit (ICU) and postoperatively 1 h, 3 h and 24 h. Differences among above indicators between three groups were compared. Results    The troponin value of the posterior inhalation group within 3 h increased most, followed by the blank group and the prior inhalation group. Postoperatively 1 h and 3 h, the troponin value of the prior inhalation group was significantly less than that of the blank group and posterior inhalation group (P<0.01) and the value on postoperative 24 h in each group was lower than that on postoperative 3 h. The cardiac index of prior inhalation group was higher than that of the blank group and the posterior inhalation group at each time point. Postoperatively 3 h and 24 h as well as 10 min after returning to ICU, the cardiac index in prior inhalation group was significantly higher than that of the posterior inhalation group (P<0.05). The pressure ratio of pulmonary circulation/systematic circulation of posterior inhalation group increased more than that of blank group; the differences in two groups were significant between postoperative 3 h and 10 min after returning to ICU (P<0.01). There was no statistical significance in the pressure ratio on postoperative 24 h and 10 min after returning to ICU (P>0.05) in three groups. The index of oxygenation of the prior inhalation group was higher than that of the blank group and the posterior inhalation group and statistically different from that of posterior inhalation group (P<0.05). Conclusion    Inhaling NO 10 min preoperatively can reduce the injury to the heart and lung function effectively, but the result is the opposite when inhalating NO 10 min after aorta opening.

Medical device going home is an inevitable trend, however, using these devices has potential safety risks. Through introducing the home use electronic medical device products and related medical device standards, this paper provides recommendations on construction of standard system for home use electronic medical devices, to improve the advancement of existing medical device standard system and guide future medical standardization work, to fully utilize standars's guiding and security role in the scientific and technological innovation, industrial development.