Objective To investigate the needs and feedback from clinical medical students on the diversified teaching mode adopted by the Department of Endocrinology in Peking Union Medical College Hospital.Methods Questionnaires were distributed to the medicine students who were in clinical rotation in Peking Union Medical Col-lege,and the teaching status and teaching effect was investigated.Results A total of 95 valid questionnaires were received.The attending physicians and the teaching resident physicians performed well in the daily teaching activi-ties.The medical students believed that outpatient training was necessary in addition to ward rotations.After the ro-tation in the endocrinology department,the self-evaluated score of mastery of endocrinology knowledge had been significantly improved,especially in those who rotated in outpatient clinic,suggesting that outpatient teaching was of great significance.In addition,the establishment of a self-learning platform including clinical cases and videos in endocrinology could be used as an important supplementary means for clinical teaching.Conclusions Outpatient training improves learning outcomes of medical students,so must be kept and further strengthened in the future.Building a database of typical clinical cases and teaching videos can improve the training quality.

ObjectiveTo adapt the Stanford Expectations of Treatment Scale（SETS） into Chinese（C-SETS） and test the feasibility， validity and reliability of its application in patients with diarrhea-predominant irritable bowel syndrome（IBS-D） with liver-constraint and spleen-deficiency syndrome treated with traditional Chinese medicine（TCM）. MethodsWe obtained authorisation from the developer of the SETS， and followed the principle of "two-way translation" to translate the SETS by literal translation and back translation to form the C-SETS. Ninety-six IBS-D patients with liver-constraint and spleen-deficiency syndrome were enrolled as respondents and filled out C-SETS before receiving treatment； the feasibility was assessed by the recall rate， completion rate and the duration of filling out the scale； the reliability was assessed by Cronbach's α； the structural validity was assessed by exploratory and confirmatory factor analysis， and the content validity was assessed by correlation analysis. ResultsThe C-SETS consists of 10 items， with the 1st， 3rd， and 5th rating items constituting the Positive Expectations subscale， and the 2nd， 4th， and 6th rating items constituting the Negative Expectations subscale， each of which is rated on a 7-point Likert Scale. The recall of C-SETS was 100%（96/96）， the completion rate was 89.58%（86/96）； Cronbach's α for the Positive and Negative Treatment Expectations subscales were 0.845 and 0.854， respectively； exploratory factor analysis showed that the coefficient of commonality for all six entries was larger than 0.4， and that the six entries could be used by both factors to explain 77.092% of the total variance； validation factor analysis showed that the goodness-of-fit index， comparative fit index， root mean square of approximation error， canonical fit coefficient， and chi-square degrees of freedom ratio took the values of 0.943， 1.003， 0， 0.943， and 0.626， respectively； and the results of Spearman's analysis suggested that the C-SETS had good content validity. ConclusionThe C-SETS has well feasibility， reliability， and validity， which initially proves that it can be used as a tool to assess the treatment expectation of patients with IBS-D with liver-constraint and spleen-deficiency syndrome before receiving TCM treatment.

Objective:To explore the influencing factors of postoperative coping style of patients with esophageal cancer.Methods:This study was a cross-sectional study. From July 2018 to July 2020, convenience sampling was used to select 65 patients with esophageal cancer who underwent radical surgery for esophageal cancer in a ClassⅢ Grade A hospital in Henan Province as the research object. The General Information Questionnaire and the Chinese version of the Medical Coping Modes Questionnaire (MCMQ) were used to investigate the patients one day before the patients were discharged. Single factor analysis was used to analyze influencing factors. A total of 65 questionnaires were distributed and 65 valid questionnaires were returned with the valid response rate of 100%.Results:The results of single factor analysis showed that there were statistically significant differences in the confrontation dimension scores of patients with different ages, education levels, and family monthly income per capita ( P<0.05) . There were statistically significant differences in the avoidance dimension scores of patients with different genders and ages ( P<0.05) . There were statistically significant differences in the resignation dimension scores of patients with different ages, occupational status, and family monthly income per capita ( P<0.05) . Conclusions:Age, gender, occupational status, education level, and family monthly income per capita are the influencing factors of postoperative coping style of patients with esophageal cancer. Medical and nursing staff can take targeted intervention measures based on their influencing factors and guide patients to adopt a positive coping style to face the disease.

Objective To establish the quality control system of the Capital's Funds for Health(CFH),strengthen the process management,and improve the clinical research capacity.Methods The framework,contents and implementation method of the quality control system were developed with comprehensively adopting methodologies of literature analysis,expert discussion,summaries of policy and practice experiences.Results This quality control system of the Capital's Funds for Health is comprised of three tiers.The first tier is self-assessment,the principle investigator takes the responsibility;the second tier is the sponsor verification,the sponsor organization takes the responsibility;the third tier is the independent audit,the CFH office takes the responsibility.The contents of quality control focus on the compliance with ethical approval and informed consent,data authenticity,protocol deviation,progress of project,and quality assurance methods taken during the project implementation.Conclusions This three-tier quality control system of the Capital's Funds for Health provides a new idea and scheme for the quality control of clinical research projects supported by funding agencies in China,and its impacts will be evaluated in next implementation practices.

Objective: To analyze the prevalence of obesity and its influencing factors among residents aged 40 years and over in Taizhou,so as to provide reference for obesity prevention and control. Methods: From June 2014 to May 2015,people who were aged 40 years or above and received routine physical examination in six centers for disease control and prevention in Taizhou were recruited. Demographic characteristics and health relates behaviors were collected by a questionnaire survey;height,weight,waist circumference and hip circumference were collected by physical examination. Logistic regression analysis was conducted to explore the influencing factors for overall obesity and central obesity. Results : Totally 1 216 people were investigated,and 1 192 (98.03%) questionnaires were valid. The age of them ranged from 40 to 86 years old,with （51.92±8.91） years old on average. There were 547 males （45.89%） and 645 females （54.11%）. The prevalence rates of overall obesity and central obesity were 6.54% and 60.32%,respectively. The Results of multivariate logistic regression analysis showed that regular physical exercise （OR=0.597, 95%CI： 0.359-0.992） was a protective factor for overall obesity;female （OR=2.352,95%CI： 1.685-3.283）was a risk factor of central obesity;public servants or staff from enterprise and institution（OR=0.508, 95%CI： 0.289-0.892）,drinking （OR=0.637,95%CI：0.471-0.860）,salt intake of less than five grams per day （OR=0.590,95%CI：0.434-0.802）and regular physical exercise （OR=0.760,95%CI：0.583-0.991） were protective factors for central obesity. Conclusion The prevalence rates of overall obesity and central obesity among residents aged 40 years or above in Taizhou were 6.54% and 60.32%, respectively. Gender,occupation,drinking,salt intake and physical exercise were the influencing factors for obesity.

Objective To investigate the epidemiology of chronic kidney disease (CKD) in patients with hypertension and diabetes mellitus in Kunming urban area.Methods A multistage cluster randomized sampling method was used to collect 400 randomly selected patients (community managed hypertension and diabetes mellitus) in community service centers in the 4 main urban districts of Kunming,Yunnan province.The subjects were screened for CKD by questionnaires,physical examinations,and microalbuminuria tests.Results A total of 343 people were surveyed.The prevalence of albuminuria,proteinuria by routine urinalysis,decreased glomerular filtration rate,and CKD prevalence were respectively 37.3％,12.2％,5.0％ and 39.1％.A total of 134 patients with CKD (134/343) were screened.Logistic regression analysis showed male (OR=2.312,95％CI 1.325-4.037,P=0.003),hyperuricemia (OR=1.751,95％ CI 1.109-2.765,P=0.016) and obesity (OR=2.150,95％ CI 1.115-4.146,P=0.022) were related to CKD.Conclusions The prevalences of CKD and albuminuria are 39.1％ and 37.3％ in patients with chronic diseases (hypertension and diabetes) in the main urban community of Kunming,Yunnan.Hyperuricemia,male and obesity are independent risk factors for CKD.

Objective To explore the effect of CD40 small interfering RNA(siRNA)on the expressions of pe-ripheral blood interleukin(IL)-21 and IL -35 in rats with experimental autoimmune myocarditis (EAM)and its sig-nificance.Methods Twenty 6 -8 week male Lewis rats were divided into normal group,EAMgroup,CD40 siRNA group and siRNA group by using random number table,with 5 rats in each group.The normal rats were induced with phos-phate buffer saline in double foot pads on day 0 and day 7,while the rest 3 groups were induced with cardiac myosin protein to establish EAMmodels.The rats in CD40 siRNA group and siRNA group were respectively injected with CD40 siRNA and siRNA slow virus expression vector through the tail vein of rats on day 7.The rats were executed on 21 day after echocardiogram examination was made.The histopathologic changes were observed by using light microscope and the myocardial histopathology scores were calculated.Enzyme -linked immunosorbent assay was used to determine the levels of IL -21 and IL -35 in peripheral blood.Results (1)Except the normal group,the total incidence rate of rats of each group was 100%,and there was no rat death.(2)Compared with EAM group,the heart mass/body ratio and myocardial histopathology scores were lower in CD40 siRNA group,and the differences were significant (3.13 ±0.21 vs 3.80 ±0.29,2.22 ±0.43 vs 3.32 ±0.51,F =0.332,0.456,all P <0.05).(3)The echocardiogram showed that there was only 1 rat in EAM group with massive pericardial effusion,and there was no pericardial effusion in CD40 siRNA group.EAMgroup,CD40 siRNA group and siRNA group displayed hypertrophy of the ventricular septum and left ventricular wall,narrow heart cavity and weakening of ventricular wall motion.The left ventricular shortening rate in CD40 siRNA group was significantly higher than that in the EAMgroup[(63.34 ±11.06)% vs (38.56 ±6.98)%,F =16.080,P <0.05].(4)The peripheral blood level of IL -21 in CD40 siRNA group was lower than that in EAM group [(141.19 ±17.46)ng/L vs (157.81 ±17.58)ng/L,F =57.008,P <0.05],while its level of IL -35 was signifi-cantly higher than that in the EAMgroup [(195.96 ±18.26)ng/L vs (174.78 ±13.91 )ng/L,F =31.727,P <0.05].(5)The level of IL -21 in peripheral blood was positively correlated with myocardial histopathology scores in EAM group (r = 0.69,P < 0.05 ),but IL -35 was negatively correlated with myocardial histopathology scores (r =-0.64,P <0.05).Conclusions CD40 siRNA might relieve the myocardial inflammation and reduce the myocar-dial injury of EAMrats.The levels of IL -21 and IL -35 can partly reflect the degree of myocardial injury.The mecha-nism may be related to down -regulating the expression IL -21 and up -regulating the expression of IL -35.

Objective To investigate the current status of moral distress in clinical nurses,and analyze its influential factors.Methods A total of 240 clinical nurses were recruited by stratified sampling method.They were investigated with general situation questionnaire and moral distress scale.Results The average score of moral distress was (2.66±0.41).Multiple linear regression analysis showed that department of work and qualification were influencing factors on moral distress of clinical nurses.Conclusions This study found that nurses' moral distress was above the middle level.Some targeted measures should be taken by nursing managers,in order to help decrease nurses' moral distress.

Objective To investigate the effects and the possible mechanism of Ganglioside-1 (GM1) and rehabilitation on neurologic behaviors of rats with hypoxic-ischemic brain damage (HIBD). Methods 48 immature rats developed as model of HIBD were divided into 5 groups: control group, GM1 group, rehabilitation training group (R group), GM1+R group, and sham group. They were evaluated with Climb, Slope and Water Maze Tests. The expressions of activated caspase-3 in neurons were detected with immunohistochemistry. Results The achievement of Climb and Slope Test were significantly different among groups (P<0.001), which ranked as the sham group> GM1+R group> R group> GM1 group> control group (P<0.05). The latency of Water Maze Test was significantly different among groups (P<0.01),which was longer in the control and GM1 groups than in the sham group (P<0.05). The activated caspase-3 expressed in hippocampus and frontal cortex was less in the GM1 and R groups than in the sham group (P<0.05), more in the GM1 group, R group and GM1+R group than in the control group in hippocampus (P<0.05), more in the R group and GM1+R group than in the control group in frontal cortex (P<0.05).The expression of activated caspase-3 in both hippocampus and frontal cortex correlated with the achievement of Climb and Slope Test (P<0.05), but not with the latency of Water Maze Test (P>0.05). Conclusion Rehabilitation training and GM1 are effective on recovery of neural function in rats with HIBD with synergia, which may associated with the activated caspase-3 in terminal synapse.