Objective:To investigate the impact of achievement goals on the academic achievement of medical students.Methods:In May to June of 2019, an online questionnaire survey was performed for data collection, and the stratified sampling method was used for sampling. Demographic factors, Achievement Goal Scale, and Academic Achievement Scale were used in this study, and descriptive statistics, the Pearson correlation analysis, and the multivariate linear hierarchical regression analysis were performed to analyze the impact of achievement goals on the academic achievement of medical students.Results:For these medical students, the mean value of achievement-near to the goal orientation was (3.45±0.77), the mean value of achievement-dodge the goal orientation was (3.43±0.80), and the mean value of mastery goal orientation was (3.85±0.66). Achievement-near to the goal orientation had a significant positive impact on academic achievement ( β=0.336, P<0.01), and mastery goal orientation also had a significant positive impact on academic achievement ( β=0.540, P<0.01). Conclusion:The achievement goals dominated by mastery goal orientation is the most beneficial dimension for the development of medical students.

Objective : To investigate the effect and mechanism of celecoxib on retinal vascular endothelial growth factor(VEGF) in rats with diabetic retinopathy. Methods : Forty - five SD rats were divided into normal control group (NC) , diabetic retinopathy group (DR) , celecoxib intervention diabetic retinopathy group ( DR + C) . The diabetic model was established by intraperitoneal injection of 1% STZ. After one month , celecoxib (50 mg/kg) was given intragastric administration (1/day) in the DR + C group. Two months later, serum total cholesterol (TC) and insulin were detected. The histopathological changes of the retina were observed. The expression of junctional adhesion molecule⁃like protein (JAML) , VEGF and their signal pathway proteins and the distributions of interleukin⁃10 (IL⁃10) , vascular cell adhesion molecules⁃1(VCAM⁃1) were detected by Western blot. HUVEC cells were divided into normal glucose group (NG) , high glucose group (HG) and high glucose plus celecoxib group (HG + C) to detect the expression of the above proteins. Results : Compared with DR , retina in DR + C group was thinner. The retina in the DR + C group was thicker than that in the NC group. The levels of retinal JAML ,phosphatidylinositol kinase3(PI3K), phosphorylphosphatidylinositol kinase3(P⁃PI3K) , hypoxia⁃inducible factor1 ⁃α (HIF1 ⁃α ) , and VEGF in DR + C group were lower than those in DR group ,while higher than those in NC group. The expression of retinal IL⁃10 and VCAM⁃1 decreased . The content of TC in DR + C and DR group was higher than those in NC group (P < 0. 01) , while the content of insulin in DR + C and DR group was lower than thlse in NC group (P < 0. 001) . Compared with HG group , the expressions of JAML , PI3K , P ⁃PI3K , HIF1 ⁃α , VEGF in HG + C group decreased , but was higher than those in NG group. There was no significant difference in PI3K among the three groups. Conclusion Celecoxib can decrease the expression of VEGF , IL⁃10 , VCAM⁃1 in retina of DR rats , which may be related to the PI3K/HIF1 ⁃α signaling pathway mediated by JAML.

Objective:To investigate the current situation of general practitioners' occupational pressure in Heilongjiang Province, and explore its relationship with professional identity and perceived organizational support. It aims to provide references for the construction of general practitioners and the development of general medical education.Methods:The general situation questionnaire, perceived organizational support scale, occupational pressure scale, and professional identity scale were applied through network and site surveys for collecting data. A total of 288 questionnaires were collected with 263 valid questionnaires (91.3%). Pearson correction analysis and bootstrap analysis were performed for data analysis.Results:The average score of occupational pressure among general practitioners was (115.95±22.40), and the results of Pearson correction analysis showed that perceived organizational support was negatively correlated with occupational pressure ( r=-0.413, P<0.01) and positive correlation with professional identity ( r=0.587, P<0.01). There were also significant negative correlations between professional identity and occupational pressure ( r=-0.442, P<0.01). Moreover, the mediating effect showed that professional identity had a certain mediating effect on the relationship between perceived organizational support and occupational pressure (LLCI=-0.2039, ULCI=-0.0760, P<0.05). Conclusion:General practitioners' occupational pressure was at a high level, which can be reduced through improving the perceived organizational support and professional identity.

Objective:To compare the effect of the 2% chlorhexidinegluconate disinfectant and 0.5% iodophor disinfectant on the maintenance of central venous catheter (CVC) in patients with immunodeficiency.Methods:The patients were randomly divided into two groups. 2% chlorhexidinegluconate disinfectant was used in the experimental group, and 0.5% iodophor disinfectant was used in the control group. The CVC was sterilized once a week and continuously maintained for 3 weeks. According to the condition of catheter, the dressing was changed in time in case of any problem,and the reason and time for the catheter nursing care were recorded. The duration of changing the catheter dressing in different disinfectant, incidence rate of dressings looseness and incidence of catheter-related infections in two groups were analyzed.Results:The duration of skin drying and duration of caring in the experimental group were (0.62±0.10)min, (11.67±0.33) min, significantly shorter than the control group [(1.97±0.18) min, (14.48±0.33) min]( t values were 63.044, 57.296, P<0.01).In term of the adverse effects on CVC,there were no statistical differences between two groups ( P> 0.05). Conclusions:Both 2% chlorhexidinegluconate and 0.5% iodophor disinfectant have similar disinfection effect on CVC caring, but 2% chlorhexidinegluconate disinfection is more efficient and worthy of application in clinical settings.

This paper systematically reviews the relevant literature on early clinical exposure (ECE) in China in recent years. It analyzes the main contents of literature, summarizes the various forms of ECE that the colleges and universities provide, and analyzes its positive effect on the students' learning interest and ability, their humanistic care for patients, as well as the teacher's self-improvement. Finally, according to the actual practical situation of ECE in medical universities in China and relevant experience from foreign studies, it is proposed that China should increase the emphasis on ECE in colleges and universities, strengthen the construction of teaching staff, and establish a scientific and systematic evaluation system.

The nursing experience of one hemaphagocytic syndrome patient with skin damage complication who underwent haploidentical hematopoietic stem cell transplantation were summarized. The patients gradually appeared ulceration of elbow joint skin, perianal mucosa, and bilateral axillary skin during the phase of agranulocytopenia and immune inhibition after transplantation. The overall skin ulceration area was accounted for 13% of total body surface area. We chose different dressings, combination anti-infection with promoting wound healing for nursing and achieved great effect. The skin lesions gradually healed and the patient went to the general ward successfully.

Objective To investigate the effects of transcutaneous electrical acupoint stimulation (TEAS) on electroencephalography (EEG) in piglets anesthetized with sevoflurane.Methods Twelve piglets,aged three to seven days,weighing 1.5 to 3.5 kg,were randomly divided into 2 groups:TEAS (group T,n =6) and control (group C,n =6).Group T received continuous TEAS at points baihui and tianmen for 30 minutes.Anesthesia was induced with 8.0％ sevoflurane over 3 minutes and maintained with 3.5％ sevoflurane in both groups.The changes were observed on EEG.Results The heart rates (HR) at intubation and extubation were lower in group T than group C (P ＜ 0.05).Compared with group C,the EEG spike frequency was lower in group T during anesthesia induction and maintenance (P ＜ 0.05).Conclusion Sevoflurane can induce EEG spikes in piglets,which can be reduced by TEAS.

Objective To evaluate the diagnostic yield and safety of transbronchial lung biopsy (TBLB) under virtual bronchoscopic navigation (Direct Path), endobronchial ultrasonography with a guide sheath (GS) and rapid on-site evaluation using an ultrathin bronchoscopy (UNRE) for bacterial infection located in the peripheral third of the lung field. Methods Ninety-seven patients with bacterial infection, which located in the peripheral third of the lung field on CT images, were ran-domly assigned to UNRE (n=49) or non-UNRE (NUNRE, n=48) groups, who were treated in General Hospital of Tianjin Medical University between April 1, 2014 and March 31, 2015. The TBLB guided by UNRE was performed in two groups. The diagnostic yield, safety and complication rate were compared between two groups. Moreover, the differences of autofluo-rescence intensity of alveolar macrophage in alveolar lavage fluid were compared between two groups of patients. Results The diagnostic yield was significantly higher in UNRE group than that of NUNRE group (81.6% vs 56.2%, χ2=7.313, P <0.01). The diagnostic yield was higher in UNRE group with bronchus sign compared to that of NUNRE. All patients had a mild bleeding at the time of biopsy. There were no hemoptysis, pneumothorax or other serious complications. The autofluores-cence intensity of alveolar macrophage was different in different levels of infection in patients. Conclusion The procedure of UNRE has higher diagnostic rate and fewer complications. The careful selection of suitable cases can further improve the diagnostic accuracy. The autofluorescence intensity of alveolar macrophage in alveolar lavage fluid indicates the severity of infection in patients.

Objective To explore the repair possibilities of endothelial progenitor cells (EPCs)in peripheral blood in patients with different extents of obstructive sleep apnea (OSA) through measuring the levels of pro-angiogenic factors and different subgroups EPCs in peripheral blood in patients with OSA. Methods Ninety adult patients with OSA, 30 healthy controls with matched age and gender were enrolled for this study. The subjects performed Polysomnography, were divided in-to four group based on Apnea Hypopnea Index (AHI). The serum levels of HIF-1α, SDF-1αand VEGF were assessed by ELISA. Mononuclear cells were isolated from peripheral blood with density gradient centrifugation, and flow cytometry was used to detect levels of CD133+KDR+EPC, CD133+CD34+EPC, CD34+KDR+EPC and ALDHloCD34+KDR+EPC based on AL-DH activity, and CD133, CD34, PE-KDR related cell surface markers. Results The levels of CD133+KDR+EPC, CD133+CD34+EPC, CD34+KDR+EPC were higher in OSA groups than those of control group, both of which were higher in severe OSA group than those of in mild and moderate OSA groups. The levels of ALDHloCD34+KDR+EPC were higher in mild and moderate OSA groups than that of the control groups, and the levels of ALDHloCD34+KDR+EPC were significantly lower in se-vere OSA group than those of control, mild and moderate OSA groups. Serum levels of HIF-1α. VEGF were significantly high-er in OSA groups compared to those in control groups, both of which were higher in severe OSA group than those of mild and moderate OSA groups. Serum levels of SDF-1αwere significantly lower in severe OSA groups than those of mild, moderate OSA and control groups (P<0.05). Conclusion The mobilization and recruitment of different subtypes of EPCs are obvious-ly increased in patients with OSA, but ALDHloCD34+KDR+EPC with vascular repair capacity keeps to invariability, even de-creases in patients with severe OSA, which results in endothelial damage, and increases the risk of cardiovascular disease.

OBJECTIVETo explore the molecular biology mechanism of acupuncture on improving immune function damage induced by chemotherapy in cancer-bearing mice.

METHODSSeventy-two mice (36 mice in 3-day treatment and 5-day treatment, respectively) which were successfully made into cancer-bearing model were divided into a blank group, a model group, an acupuncture group and a moxibustion group by stratified randomization method, 9 mice in each one. Except for the mice in the blank group, the remaining mice were treated with intra-peritoneal injection of cyclophosphamide (CTX, 150 mg/kg), to establish the cancer-bearing mice of CTX. The mice in the blank group were treated with intraperitoneal injection of 0.9% NaCl (identical dose as other groups). After 4 h, the mice in the acupuncture group and moxibustion group were treated with acupuncture and moxibustion at "Dazhui" (GV 14), "Geshu" (BL 17), "Shenshu" (BL 23), "Zusanli" (ST 36), once a day. The mice in the blank group and model group were treated with immobilization and fixation during the same time. On the next day of the end of 3-day and 5-day treatment, the sample was collected. The ELISA method was applied to measure the contents of IL-12 and TNF-α in spleen of all the mice.

RESULTSAfter 3-day and 5-day treatment, compared with the blank group, the contents of IL-12 and TNF-α in spleen in the model group were reduced (all P < 0.05); compared with the model group, the contents of IL-12 and TNF-α in spleen in the acupuncture group and moxibustion group were increased (all P < 0.05), but the content of IL-12 and TNF-α in the acupuncture group was not different from that in the moxibustion group (both P > 0.05).

CONCLUSIONAcupuncture and moxibustion could effectively increase the contents of IL-12 and TNF-α in spleen of CTX cancer-bearing mice, which could relieve chemotherapy-induced immune function damage to improve immune function.

Acupuncture Therapy ; Animals ; Cyclophosphamide ; adverse effects ; Humans ; Interleukin-12 ; genetics ; metabolism ; Male ; Mice ; Moxibustion ; Neoplasms ; chemically induced ; genetics ; metabolism ; therapy ; Spleen ; metabolism ; Tumor Necrosis Factor-alpha ; genetics ; metabolism