ObjectiveTo clarify the application value of nutritional scoring in patients with sepsis and explore the impact of the modified Nutritional Risk in Critically Ill （mNUTRIC） score on the in-hospital fatality of sepsis patients in the emergency intensive care unit （EICU）. MethodsA retrospective analysis was conducted on the clinical data and laboratory examination results of 436 sepsis patients treated in the EICU of Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2021 to May 2024. The patients were divided into survival group （298 cases） and death group （138 cases） according to whether they died or not during hospital treatment， and then compared the two groups’ data. Logistic multi-factor regression analysis was used to analyze the risk factors for in-hospital death and the ROC curve to evaluate the predictive value of each risk factor for the prognosis of sepsis patients. ResultsThe death group exhibited higher Acute Physiology and Chronic Health EvaluationⅡ（APACHE Ⅱ） score， Nutritional Risk Screening 2002 （NRS 2002） score， mNUTRIC score， Sequential Organ Failure Assessment （SOFA） score， Padua Prediction Score for Venous Thromboembolism， the proportions of chronic kidney failure and pneumonia patients， C-reactive protein （CRP） level， lactate concentration and neutrophil count， but lower prognostic nutritional index， cholinesterase level， cholinesterase-albumin ratio and lymphocyte count than the survival group， with statistical significance （all P<0.05）. Logistic regression analysis revealed that the mNUTRIC score ［OR=1.254， 95%CI （1.109，1.417）］， CRP ［OR=1.004， 95%CI （1，1.007）］， and pneumonia ［OR=1.82， 95%CI （1.017， 3.257）］ were independent risk factors for in-hospital death in sepsis patients. ROC curve analysis showed that the area under the curve （AUC） of the mNUTRIC score for predicting in-hospital death in sepsis patients was 0.683 ［95%CI （0.623，0.742）］， with a sensitivity of 83% and a specificity of 49.3%. The AUC for CRP and pneumonia were 0.602 ［95%CI （0.533， 0.671）］， and 0.582 ［95%CI （0.516，0.647）］. ConclusionThe mNUTRIC score is an independent predictive indicator for in-hospital death in sepsis patients in the EICU.

Objective To explore the effectiveness of FOCUS-PDCA(find,organise,clarify,understand,select,plan,do,check and act)mode in prevention and treatment of incontinence-associated dermatitis(IAD)in emergency intensive care unit(EICU),and to reduce the incidence of IAD.Methods A pre-post control study design was employed in this study.Inpatients admitted to the EICU of the hospital between 1st January and 31st December 2022 were enrolled as study subjects.A total of 169 patients in EICU between January and June 2022 were assigned as a control group,while 197 patients in EICU between July and December 2022 as an trial group.Patients in the control group received conventional quality management,while those in the trial group were treated with the FOCUS-PDCA mode.The two groups were compared in terms of incidence of IAD,the knowledge,trust and behaviour scores of the nurses,and satisfaction from the communications with nurses before and after implementation of the FOCUS-PDCA mode.Results All patients in the two groups had completed the study.Following the implementation of FOCUS-PDCA mode,patients in the trial group exhibited a significantly decrease in incidence of IAD from 10.06%(trial group)to 1.52%(control group),significant increase of scores on the IAD knowledge,behaviour and satisfaction from communications with the nurses,from(36.07±3.98),(16.56±2.15)and(25.15±5.21),to(38.59±3.72),(18.07±1.66),and(30.67±5.84),respectively(all P<0.05).Conclusion FOCUS-PDCA mode can effectively decrease the incidence of IAD,enhance the IAD knowledge and behaviour of nurses and gain satisfactions from communication with nursing staff and clinical quality,thereby improving therapeutic outcomes.

Objective:To explore the role of "BOPPPS + mind map" in the medical immunology teaching.Methods:The students from Class 12 of 2019 Clinical Medicine Major of Changzhi Medical College were selected as the control group (traditional teaching method) ( n=35), and those from Class 13 as the test group ("BOPPPS model + mind map" teaching method) ( n=37). The teaching effect was compared by the final immunology exam scores between the two groups. A statistical analysis was conducted using the two independent samples t-test for continuous data. For the "BOPPPS model + mind map", a questionnaire survey was randomly conducted among students of various majors. Results:The immunology exam score in the test group was significantly higher than that in the control group [(67.30±1.81) vs. (59.54±1.98), P=0.005). The blended teaching was accepted by students, and drawing the mind map was conducive to promote learning. Drawing the mind map by hand ( n=177, 52.10%) or computer ( n=163, 47.90%) increased the knowledge sorting. Conclusions:The application of "BOPPPS model + mind map" in the "Medical Immunology" teaching for undergraduates helps to improve the quality of teaching, enhance students' understanding and memory of knowledge points, and consolidate immunology knowledge and skills.

To investigate the effects of sanguinarine (Sang) combined with cisplatin (Cis) in accelerating the apoptosis of bladder cancer EJ cells, CCK-8 method was used to detect the proliferation of bladder cancer EJ cells treated with different concentrations of Sang with the IC50 values calculated. Annexin V FITC/PI method was used to detect cell apoptosis in the control group, Sang group, Cis group and the combination group. Flow cytometer was used to detect cell cycle arrested. Western blot was used to detect the influence of Bcl-2 expression in the control group, Sang group, Cis group and the combination group. Nude mouse subcutaneous tumor model was constructed to verify that the combination group could accelerate the apoptosis of bladder cancer EJ cells and reduce the side-effects on mice. The safety of the Sang was evaluated by HE staining of vital organs in mice. In vitro, Sang could significantly inhibit the proliferation of EJ cells. Compared with the control group, the number of apoptosis EJ cells in the combination group was significantly increased (P < 0.05), and more cells were arrested in G2/M phase. The expression of Bcl-2 was significantly down-regulated in the combination group (P <0.001). In vivo, compared with the control group, the tumor growth was significantly slower, and a large number of apoptotic cells were inspected (P < 0.05) of the combination group. The side effects of cisplatin were reduced in the combination group. Sang has high biosafety and little side effect. Combined Sang and Cis can increase cell cycle G2/M block, down-regulate Bcl-2 expression, promote cell apoptosis and inhibit tumor growth.

OBJECTIVE： To study the phylogenetic relationships of 3 basic plants of Tibetan medicine “Dida”， such as Swertia puricea， Wertia mileensis， Halenia elliptica. METHODS： ISSR technology was used for PCR amplification of 9 samples of S. puricea （ZT-1 to ZT-5 from Gantongsi in Dali Cangshan， ZC-1 to ZC-4 from Binchuan county of Dali）， 2 samples of W. mileensis （QYD-1 to QYD-2） and 2 samples of H. elliptica （HM-1 to HM-2）. Using DNA genome of S. puricea as template， 8 primers were screened and used for PCR reaction. The PCR amplification products were read by hand， the original data matrix was established， and the polymorphic band ratio was calculated. At the same time， genetic similarity coefficient was calculated by using NTSYS 2.1 software， and UPGMA method was used to draw cluster diagram. RESULTS： A total of 113 clear and identifiable amplification product bands were obtained by 8 ISSR primers. The rate of polymorphic site was 100％. The genetic similarity coefficients for totally 13 samples of S. puricea， W. mileensis and H. elliptica ranged 0.301-0.500. Intraspecific genetic similarity coefficients for 9 samples of S. puricea ranged from 0.752 to 0.929. The cluster analysis showed， when the range line was 0.410， 13 samples could be divided into three groups， i.e. S. puricea， W. mileensis， H. elliptica； when the range line was 0.780， 9 samples of S. purpurea could be divided into 2 subgroups， one of which was only sample ZT-1 collected from Gantongsi in Cangshan， and the other contained the remaining 8 samples. CONCLUSIONS： ISSR technology can be used to identify S. punicea， S. glabra and H. elliptica at the molecular level. S. punicea has some genetic relationship with S. glabra and H. elliptica， but the genetic relationship is relatively distant and the genetic difference is large. S. punicea from two different locations in Dali area has little genetic difference and close relationship， but it shows abundant genetic diversity.

Objective? To explore the effects of the midwife-centered antenatal care model attended by pregnant women on reducing cesarean delivery rates and properly controlling neonatal weight. Methods? Totally 120 pregnant women who established medical records and attended antenatal care regularly in Hangzhou First People's Hospital from February 2017 to January 2018 were selected by on-site recruiting and divided into the treatment group (n=60) and the control group (n=60) according to the random number table. Pregnant women in the control group received conventional antenatal care, while pregnant women in the treatment group received the midwife-centered antenatal care in family groups. The cesarean delivery rate, postpartum hemorrhage rate, neonatal weight, incidence rate of fetal macrosomia and incidence rate of low birth weight infant were compared between the two groups. Results? The cesarean delivery rate of the treatment rate was 8.3%, while that of the control group was 35.0% (χ2=12.570, P＜0.01); the neonatal weight of the treatment group was (3.22±0.39) kg, while that of the control group was (3.51±0.47) kg (t=-3.70,P＜0.01). Conclusions? The midwife-centered antenatal care in family groups can reduce cesarean delivery rates and properly control neonatal weight, which is of significance in nursing research and clinical nursing work.

Objective To explore the application and effect of SPOC platform in medical immunol-ogy teaching. Methods The teaching reform class of Grade 2015 (41students) of Changzhi Medical College was taken as the experimental group, while the parallel class of imaging (37 students), preventive specialty (40 students), Class Nine of clinical medicine (37 students) and oral specialty (39 students) were randomly selected as the control group. "SPOC learning platform + traditional teaching" method was used for teach-ing and learning in the course of the test group. The traditional teaching method was utilized in the control one. For this type of teaching activity, a questionnaire survey was carried out among the students in the reform class, and the final exam score was used as the measure standard. The data were analyzed by SPSS 17.0 software. Results The results demonstrated that the students preferred to learn on the SPOC platform for mobile phones, and the number was significantly higher than that of learning through the computers. Students in the reform class basically liked this type of learning, and their final exam scores were more significant difference than the other classes in the same grade (t'=15.21, P=0.000). The classes in the experimental group and the control group were taken as the research objects, and the rank-sum test was performed, which was statistically significant ( χ2=81.65, P=0.000). Then, the two groups were compared in different classes: the statistical difference between the teaching reform class and image 1502 (t'=11.52, P=0.000), prevention 1502 (t'=7.38, P=0.000), clinical medicine 1509 (t'=8.93, P=0.000), oral 1501 class (t'=8.93, P=0.000) were found. The questionnaire survey demonstrated that 90.24% (37 students) of the reform class liked this form of learning and at the same time, it was suggested that the learning content on the platform should be further linked to the clinical practice and combined with scientific research to expand the students' thinking. Conclusion The SPOC learning platform has turned over the teaching of medical immunology and improved students' motivation and interests in learning.

Objective:To study the clinical efficacy of levosimendan combined with naoxintong capsule in the treatment of acute heart failure and effects on the serum amino terminal B type natriuretic peptide precursor (NT-proBNP),Galectin-3,endothelin 1 (ET-1),Cystatin C levels.Methods:90 patients with acute heart failure from March 2015 to June 2016 in our hospital were selected and divided into observation group (n=45) and control group (n=45) by lottery method.Patients in the control group were treated by levosimendan alone.Patients in the observation group were treated by Naoxintong capsule combined with levosimendan.The clinical effect,changes of serum NT-proBNP,galectin-3,ET-1,cystatin C levels before and after treatment and the incidence of adverse reactions were compared between two groups.Results:After treatment,the total effective rate was 93.33％ in the observation group,which was higher than that in the control group (77.78％) (P＜0.05);the left ventricular fractional shortening,left ventricular ejection fraction,stroke volume of both groups were higher than those before treatment,the blood pressure,heart rate and serum NT-proBNP,galectin-3,ET-1,cystatin C levels were lower than before treatment,and LVFS,LVEF,SV levels of the patients in the observation group were significantly higer than those of the control group (P＜0.05),the blood pressure,heart rate and serum NT-proBNP,galectin-3,ET-1,cystatin C levels were lower than those of the control group (P＜0.05).Conclusion:Levosimendan combined with Naoxintong Capsule could improve the therapeutic effect of acute heart failure with higher safety and reduce the levels of serum NT-proBNP,Galectin-3,ET-1 and Cystatin C.

Medical immunology is an important frontier and bridge subject to connect basic medicine and clinical medicine, and its knowledge is abstract and difficult to understand. Micro-course is the new teaching resource with the education information. Its design, development and research have become a hot topic in network learning and mobile learning. In this article, it is elaborated that teaching design is the soul of the quality for micro-course and because micro class software is simple and easy to learn, it is a positive guarantee for the civilization and popularization of micro class, and besides, PPT is the important material in the micro-course. The article also explores the knowledge system of the fragmented micro lessons in series, and analyzes the potential value of micro teaching in the course teaching and personnel training.

Objective To study the effect and safety of intra-arterial thrombolysis combined with mechanical ad-juvant in the treatment of acute large artery occlusive infarction of anterior circulation and posterior circulation. Methods Fourty-tow patients were divided into anterior circulation group (24 cases) and posterior circulation group(18 cases). The recanalization rate, NIHSS score (National Institute of Health stroke scale), GCS score ( Glasgow coma score,GCS), BI ( Barthel Index) excellent rate, symptomatic intracranial hemorrhage rate and mortality was analyzed after intra-arterial thrombolysis combined with mechanical aids therapy. Results The anterior circulation group was mainly caused by car-diogenic embolism (15/24, 62.5%) and posterior circulation group was mainly caused by atherosclerosis thrombosis (5/18, 72.2%). The NIHSS score was significantly lower after treatment (8.3±4.9 vs. 8.1±5.7) than before treatment(15.1±5.3 vs. 16.8±7.8)(P=0.001 vs. P=0.001), the GCS score was significantly higher after treatment(13.9±4.4 vs. 12.8±4.2)than be-fore treatment(9.5 ± 3.8 vs. 9.6 ± 3.7)(P=0.001 vs. P=0.021). The symptomatic intracranial hemorrhage rate was signifi-cant higher in anterior circulation group (5/24, 20.8%) than in posterior circulation group (0,0%) (P<0.05). Compared with the anterior circulation group, the recanalization rate trended to increase in posterior circulation group (P=0.830).The symptomatic intracranial hemorrhage rate in anterior circulation group (5/24,20.8%) was significant higher than in pos-terior circulation group (0,0%) (P<0.05), the mortality was similar between these two groups. Conclusions Intra-arterial thrombolysis combined with mechanical adjuvant therapy can improve neurological deficit in acute large artery occlusive infarction and increase the recanalization rate,which is more suitable for the treatment of posterior circulation infarction.