Objective:To improve the clinical ability of interns by establishing the evaluation index system focusing on the training of clinical competence, and to construct the performance incentive mechanism based on the index system.Methods:The subjective evaluation method and expert consultation method were used to construct 5 first-class indexes and 15 second-class indexes. And the indexes and score setting were consulted by experts through questionnaires and in-depth interviews.Results:According to the feedback results of expert consultation, the scores of teaching ward-rounds and small lectures in the index system were need to adjust. At the same time, the minimum graduation standards were set to determine whether to participate in the final examination.Conclusion:The scores of teaching ward-rounds and small lectures have been raised, the scores of case discussion lowered, and the final examination scores are not included in the minimum standards. After the establishment of the initial index system, a series of supporting measures, including two-way selection of tutors, postgraduate reexamination, and other policies, have been carried out for performance incentives. At the same time, new teaching methods, student-oriented teaching activities, and formative evaluation have been adopted to actively improve the clinical competence of interns.

Objective To explore the classification and changes of macrophage subsets in liver transplant rejection.Methods Rat liver transplantation model were established and divided into immune tolerance group(B-B),where the liver of BN rat donors was transplanted to BN rat recipients,and immune rejection group(L-B),in which the liver of Lewis rat donors was transplanted to BN rat recipients.Single-cell RNA sequencing and high-throughput RNA sequencing were used to distinguish the macrophage subsets of rat liver transplantation,and to find differential gene in rejection reactions.Immunohistochemistry was used to determine the changes and distribu-tion of protein expression and cell subsets.Results CD68 positive macrophages were higher in the rejection group than that in the tolerance group(P<0.05),and macrophages could be divided into 9 subsets.During the rejection reaction,the CXC chemokine ligand 9(CXCL9)in the 8th subsets of macrophages was significantly increased,while the gene for white blood cell differentiation antigen 74(CD74)in the 5th subsets was significantly increased(P<0.05).CD74 ranked first in the differential gene synthesis of macrophages during rejection,followed by CXCL9.Compared with the tolerance group,a large number of CD74 positive macrophages were observed in the hepatic portal area of the rejection group,and the infiltration of CD74 positive macrophages in the hepatic sinuses was also significantly increased(P<0.05),while a large number of CXCL9 positive macrophages were observed in the hepatic portal area and hepatic sinuses of the rejection group,especially in the portal area(P<0.05),and CD14 positive cells were significantly increased(P<0.05).Conclusions The CD74 positive macrophage subsets and CXCL9 positive macrophage subsets may be key subgroups in promoting liver transplant rejection,improving the mechanism of macrophage action in liver transplant rejection.

Objective:To explore the diagnostic value of virtual monoenergetic image (VMI) and electron density map (EDM) generated by non-contrast dual-layer spectral detector CT in acute pulmonary embolism(APE).Methods:The clinical and imaging data of 27 patients (41 lesions) who underwent CT pulmonary angiography (CTPA) using dual-layer spectral detector CT and were diagnosed with APE in the Third Affiliated Hospital of Sun Yat-sen University from October 2022 to May 2023 were retrospectively analyzed. All patients received a dual-layer spectral detector CT non-contrast scan. Based on the non-contrast scan data, conventional 120 kVp polyenergetic images (PI), virtual monoenergetic images (40, 70, 100 keV VMI), electron density maps (EDM), and effective atomic number maps (Z eff) were respectively reconstructed. Taking CTPA as the gold standard, the detection rate of APE in different reconstruction images of non-contrast scan were evaluated. The vascular lesion was used as the pulmonary embolism group and the corresponding position of the normal vessel at the same level of the diseased vessel as the control group, and the Wilcoxon rank-sum test was used to compare the differences of CT values on PI and 40, 70, and 100 keV VMI (CT PI, CT 40 keV, CT 70 keV, CT 100 keV) as well as the ED values on the EDM, and the Z eff value on the Z eff images between the 2 groups. Parameters with statistically significant differences were included in a multifactor logistic regression, resulting in the construction of a logistic regression model. Receiver operator characteristic curve and area under curve (AUC) were applied to evaluate the diagnostic efficiency of different spectral quantitative parameters and logistic regression model in identifying pulmonary embolism group from normal control group. Results:The detection rates of APE on PI, EDM, Z eff map, and EDM and Z eff map fusion images were 14.6% (6/41), 82.9% (34/41), 51.2% (21/41), and 97.6% (40/41), respectively. CT PI, ED, CT 40 keV, CT 70 keV and CT 100 keV in pulmonary embolism group were statistically higher than those in control group ( Z values were 1 009.00, 1 024.50, 1 038.00, 1 079.00 and 1 076.00, respectively, P<0.05). Finally, CT PI, CT 40 keV, and CT 100 keV were selected to construct the logistic regression model. The AUC, sensitivity, specificity, and accuracy of the logistic regression model for distinguishing the embolism group from the control group were 0.771, 0.769, 0.744, and 0.756, respectively. Conclusion:Non-contrast images of dual-layer spectral detector CT VMI and EDM have some clinical value in detecting and diagnosing APE.

As a kind of skills clinical medical students must master, the basic teaching of operative surgery is relatively backward in teaching mode and means, thus negatively affecting the teaching effect. The virtual reality is applied to the basic teaching of operative surgery, and the pre-designed course contents are presented in a situational way, so that students can experience the immersive learning style. It changes the classroom roles, gives full play to the advantages of virtual reality, and makes up the disadvantage of traditional education mode, finally improving the training effect.

This study aims to establish a information training and evaluation system from the perspective of training clinical skills of medical students, and investigate the effectiveness of the new training system and information platform through case analysis and comparative study. Results of data analysis showed that hybrid training mode integrating online and offline teaching can significantly improve the clinical skill training effect when compared with the traditional teaching mode. At the same time, it puts forward higher requirements for information environment and design of each teaching part.

Objective To explore the incidence of dysphagia and its potential risk factors.Methods From January 2014 to December 2015,a total of 187 patients who underwent single-level anterior cervical spine surgery were recruited in this retrospective analysis study.Specific perioperative data including age,gender,smoking,alcohol use,BMI,estimated blood loss,surgical segment,length of incision,and length of hospital stay were recorded respectively.The Bazaz grading system and the swallowing quality of life (SWAL-QOL) score were used to assess the presence and severity of dysphagia.According to the Bazaz grading system,the patients were divided into dysphagia group and non-dysphagia group 1 week after operation.One-factor x2 test and one-sample t test were used to univariate analyze the two groups of related factors,and select the potential variables for multivariate logistic regression analysis to identify the risk factors leading to dysphagia.Results The number of dysphagia patient was 99 (52.94％) at 1 week after surgery,and 16 (8.56％) at 1 year.The preoperative mean SWAL-QOL score was 65.62±4.41 points,which decreased to 58.72±7.54 points after surgery and rose up to 64.66±5.26 points at the 12-month follow-up.The SWAL-QOL score at 1 week after surgery was correlated with the operative time (r=-0.474;P ＜ 0.001).Multivariate analysis indicated that preoperative tracheal exercise (OR=0.302,95％CI:0.131,0.748),operation time ＜ 60 min (OR=0.407,95％CI:0.190,0.878),and arthroplasty (OR=0.211,95％CI:0.102,0.425) were the independent factors to reduce the incidence of postoperative dysphagia.Conclusion The incidence and severity of dysphagia symptoms after single-level anterior cervical spine surgery gradually decreased with the extension of follow-up time.Preoperative tracheal exercise,shortened operative time and manual artificial disc replacement may be helpful to reduce the postoperative occurrence of dysphagia.

OBJECTIVESTo compare the paravertebral muscle (such as multifidus, erector spinae, psoas muscle) changes between the patients with degenerative lumbar instability and normal person by MRI and to observe the degeneration of paravertebral muscles. To analyze the relationship between paravertebral muscle degeneration and lumbar curvature of degenerative lumbar instability.

METHODSSixty patients with degenerative lumbar instability were retrospectively enrolled from December 2011 to July 2013 as degeneration group, meanwhile 60 health persons with no degenerative lumbar instability were selected as control group. No significant differences were found in the gender, age and body mass index between the two groups. The cross-sectional area(CSA) and percentage of fat infiltration area (FIA) of the paravertebral muscles at the L4-S1 levels were measured using T2-weighted axial MRI and Image J soft ware. And the lumbar curvature(expressed as lumbar lordosis angle) of all the patients in lumbar X-ray were measured in the two groups. The measured data were analyzed with independent samples t-test.

RESULTSThe difference of multifidus cross-sectional area and the percentage of fat infiltration in the patients of degenerative lumbar instability at the L4-L5, L5-S1 level, compared with the control group, was statistically significant (t = 2.768, t = 6.216, P < 0.05). Between the two groups, the percentage of fatty infiltration in erector spinae showed significant differences (t = 5.862, P < 0.05). The cross-sectional area of erector spinae and the degeneration of the psoas muscle between the two groups was not statistically significant. The lumbar lordsis angle in the patients with degenerative lumbar instability was (43.9 ± 15.6)°, which was higher than the (39.3 ± 14.2)° in control group (t = 2.915, P < 0.05).

CONCLUSIONSCompared with the control group, patients with degenerative lumbar instability exists erector spinae and multifidus muscle degeneration, and erector spinae is more obvious. The degeneration among psoas muscle, erector spinae and multifidus muscle are inconsistent, which may be related to the increasing of the lumbar lordosis angle in the patients with degenerative lumbar instability.

Aged ; Case-Control Studies ; Female ; Humans ; Joint Instability ; diagnosis ; etiology ; pathology ; Lumbosacral Region ; physiopathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Muscle, Skeletal ; pathology ; Muscular Atrophy ; complications ; diagnosis ; pathology

Objective To evaluate the effects and cosmetic results of total removal of the glands for male gynecomastia . Methods A total of 13 male patients with gynaecomastia were operated by using the method of keyhole-style total removal of the glands from March 2012 to March 2013.The fat lysate was injected into the subcutaneous area of the breast enlargement .Then an incision about 1.0 cm in length was made by the side of areola , through which a vacuum aspiration was carried out to suck the fat tissues.Also, the hypertrophical breast tissues were excised gradually .Finally, the incision was closed with medical biological adhesive or absorbable suture . Results The time of unilateral operation was 40-100 min ( average , 70 min) .The amount of blood loss was 20-50 ml (average, 30 ml).Subcutaneous effusion occurred in 2 cases (accompanying local hematoma in 1 case), which was cured by repeated aspiration for 3 days.The postoperative hospitalization was 2-5 days (mean, 2.8 days).All the patients were cured with incision healed by first intention and no obvious scars left .There was no necrosis on the nipple or areola .The breast curve was flat and natural .A total of 8 cases were followed up for 3 months, with satisfactory appearance .Three patients felt numbness of nipples and areola of breast after surgery and the symptom disappeared 3 months later . Conclusion Keyhole-style total removal of the glands for the male ynaecomastia has advantages of easy operation ,safety,and good cosmetic results .

Objective To understand the comments for the essential drug system by doctors at township health centers in Nantong's six counties and to discuss the effect of implementing the essential drug system to different ownership systems.Methods The survey was made with stratified clusters random sampling method to select township health centers.Questionnaires were filled out by doctors,and leaders of the health bureau and township health centers were interviewed.Results After the implementation of the essential drug system,94.6％of the doctors found that the number of laboratory examinations increased in Rugao,Rudong and Haian.23.2％of the doctors in Tongzhou,Qidong and Haimen found that enthusiasm for work increased.Conclusion The compensation mechanism should be perfected and the financial subsidies should be paid in time.Supervision and management should be strengthened and the grassroots need for medicine be ensured.The skills training should be enhanced and the medical service ability be improved.

C-reactive protein (CRP), an acute-phase protein with an ability to bind to nuclear antigen, has been reported to regulate cytokine secretion and modulate immune responses. We previously reported that activated syngeneic lymphocyte-derived apoptotic DNA (apopDNA) could induce macrophage activation and contribute to the initiation and progression of lupus nephritis. It is reasonable to hypothesize that CRP might regulate apopDNA-induced macrophage activation. Herein, CRP was shown to promote macrophage-mediated apopDNA uptake by binding to apopDNA (CRP/apopDNA complex). Notably, CRP/apopDNA treatment inhibited the production of inflammatory cytokines and chemokines by macrophages which could be induced by apopDNA alone. Further coculture and transwell studies revealed that CRP/apopDNA-induced macrophages prohibited apopDNA-induced macrophage activation in an IL-10 dependent manner. These results provide insight into the potential mechanism of CRP regulatory activity in macrophage activation induced by apopDNA in the context of lupus nephritis and other autoimmune diseases.
Animals ; C-Reactive Protein ; metabolism ; pharmacology ; Cell Line, Tumor ; DNA ; metabolism ; pharmacology ; Enzyme-Linked Immunosorbent Assay ; Female ; Lupus Erythematosus, Systemic ; metabolism ; Lupus Nephritis ; metabolism ; Macrophage Activation ; drug effects ; physiology ; Mice ; Mice, Inbred BALB C ; Protein Binding ; Real-Time Polymerase Chain Reaction