Given the systematic, rigorous, and practical characteristics of medical disciplines, ensuring the teaching quality of online courses has become a significant focus. In traditional teaching models, teaching supervision is an important method to guarantee instructional quality, and introducing teaching supervision into online teaching activities is of great significance. This article systematically reviews and summarizes the domestic and international experience of conducting online medical courses. We explore the instructional supervision of online medical courses from the following perspectives: the meaning of supervision, the necessity of online supervision, online supervision methods and technical approaches, the feedback and application of supervision information, and the establishment of a standardized online supervision process.

Objective:To analyze the fail mode of neoadjuvant therapy combined with surgery for locally advanced esophageal squamous cell carcinoma (ESCC) after long-term follow-up.Methods:Clinical data of consecutive 238 patients with locally advanced resectable ESCC who underwent neoadjuvant therapy combined with surgery in Zhejiang Cancer Hospital from September 2012 to October 2019 were retrospectively analyzed. The failure mode in the whole cohort was analyzed after long-term follow-up. The overall survival (OS) and disease free survival (DFS) rates were analyzed by Kaplan-Meier method. Survival differences were determined by log-rank test.Results:The pathological complete response (pCR) rate was 42.0% in 238 patients. After a median follow-up of 46.1 months, tumor progression occurred in 96 patients (40.3%), including 25 patients (10.5%) with local recurrence, 61 patients (25.6%) with distant metastases, and 10 patients (4.2%) with simultaneous local recurrence and distant metastases. The median OS and DFS were 64.7 months and 49.9 months. And the 3-, 5-, and 7-year OS and DFS rates were 70.0%, 52.8%, 36.4% and 63.5%, 42.5%, and 30.0%, respectively. The 3-, 5-, and 7-year locoregional recurrence-free survival rates and distant metastasis-free survival rates were 86.0%, 71.4%, 61.2% and 70.6%, 55.9%, 43.0%. Compared with non-pCR patients, the overall progression rate and distant metastasis rate of pCR patients were lower (26.0% vs. 50.7%, 16.0% vs. 32.6%, both P<0.05). And the 3-, 5-, and 7-year OS (83.0% vs. 60.2%, 69.7% vs. 41.7%, 50.4% vs. 27.7%, all P<0.001) and DFS rates (80.4% vs. 51.4%, 63.9% vs. 31.2%, 45.9% vs. 20.3%, all P<0.001) were significantly better in pCR patients. Conclusions:Distant metastasis is the main failure mode of patients with locally advanced ESCC after neoadjuvant therapy. Patients with postoperative pCR can achieve better long-term survival.

Objective:To analyze the failure patterns and survival after stereotactic body radiotherapy (SBRT) in patients with T 1-2N 0M 0 non-small cell lung carcinoma (NSCLC). Methods:Clinical data of early-stage NSCLC patients who received SBRT at Zhejiang Cancer Hospital from January 2012 to September 2018 were retrospectively analyzed. The primary observed endpoint was the pattern of disease progression, which was divided into intra-field recurrence, regional lymph node recurrence and distant metastasis. Overall survival (OS) and progression-free survival (PFS) were calculated by Kaplan-Meier method. Univariate analysis was conducted by log-rank test, and multivariate analysis was performed by Cox's model.Results:A total of 147 patients with 156 lesions were included. The median follow-up time was 44.0 months (16.5-95.5 months). A total of 57 patients (38.8%) progressed: 14 patients (24.5%) had recurrence with the 1-, 3-, and 5-year local recurrence rates of 2.0%, 10.9%, and 14.3%, respectively; 36 patients (63.2%) had Distant metastasis with the 1-, 3- and 5-year distant metastasis rates of 12.2%, 22.4% and 28.6%, respectively; and 7 patients (12.3%) had recurrence complicated with distant metastasis. The 3-, 5- and 7-year OS rates were 80.5%, 64.2% and 49.9% for all patients, respectively. The median OS was 78.4 months. The 3-, 5- and 7-year PFS rates were 64.8%,49.5% and 41.5%, with a median PFS of 57.9 months (95% CI: 42.3-73.5 months). Univariate and multivariate analyses showed that biologically equivalent dose and age were the factors affecting the efficacy of SBRT (both P<0.05). Conclusion:Distant metastasis is the main failure pattern in patients with T 1-2N 0M 0 NSCLC after SBRT. High-risk population should be selected for further systematic treatment to improve the efficacy.

Objective To investigate the current status of perceived social support and challenge-hindrance working pressure source and explore the association between the perceived social support and challenge-hindrance working pressure source in clinical nurses. Methods The perceived social support scale and challenge-hindrance working pressure source scale were investgated in the study among 295 clinical nurses. Pearson correlation analysis was used to explore the association between the clinical nurses' perceived social support and challenge-hindrance working pressure source. Results The total score of clinical nurses' perceived social support was (62.12 ±10.48), the score of clinical nurses' challenging working pressure source was (22.63 ±3.67), and the score of hindrance working pressure source was (15.17±3.41). The clinical nurses' perceived social support and its dimensions were significantly positively related with the challenging working pressure source (P ＜0.01). Other support dimension of perceived social support was significantly negatively related with the hindrance working pressure source (P ＜0.01). Conclusions The perceived social support and challenge-hindrance working pressure source of clinical nurses are at a medium to high level. The higher level of clinical nurses' perceived social support is, the higher level of challenge working pressure sources. The family members, friends, leaders and colleagues should give more support for the clinical nurses, so as to enhance their subjective support, increase positive effect of working pressure source, promote their progress and improve their quality of nursing.

Objective To survey the current situation and explore the association between empathic ability and job adjustment disorder of pediatric nurses. Methods The Jefferson scale of empathy health professionals and job adjustment disorder scale were used for the survey among 189 pediatric nurses. Pearson correlation analysis was used to explore the association between empathic ability and job adjustment disorder of pediatric nurses. Results The total score of empathic ability of pediatric nurses was (76.32 ±5.03), the score of their job adjustment disorder was (23.69 ±6.03). Their empathic ability and its dimensions were significantly negatively related with job adjustment disorder (P ＜0.01). Conclusions The empathic ability of pediatric nurses was at a medium to low level, job adjustment disorder was at a medium to high level. The higher level of pediatric nurses' empathic ability, the lower level of job adjustment disorder is. Hospital staff should take measures to improve pediatric nurses' empathic ability, and the pediatric nurses themselves should also actively cultivate their own perception, and improve the empathic ability so as to better acclimatize themselves to pediatric nursing job and reduce the degree of job adjustment disorder.

Objective To investigate the role of diffusion kurtosis imaging (DKI) in indeterminate solitary pulmonary nodules (SPN) diagnosis and to compare with conventional diffusion weighted imaging (DWI). Methods From March 2016 to Dec 2017, forty-three consecutive patients (30 male, 13 female, age: 56 ± 11 years) with indeterminate SPNs were included. All patients underwent axial multi-b factor DWI (with b values=0, 50, 200, 400, 800, 1400, 2000 s/mm2) examination and were divided into benign group (19 cases) and malignant group (24 cases) according to pathological results of SPN. ADC Kurtosis (K) and Diffusivity (Dk) values were compared between malignant and benign group and among different subtypes of lung cancer using independent t test (normal distribution and homogeneity of variance) and Mann-Whitney U test (skewed distribution or variance). Receiver operating characteristic (ROC) curves were employed to evaluate the diagnostic performance. Results K values were significantly higher for malignant SPNs than for benign SPNs (0.839 ± 0.197 vs. 0.718 ± 0.120;t=2.359, P=0.023). ADC values were found to be significantly higher in benignity than malignant SPNs [(1.605 ± 0.422) × 10-3mm2/s vs. (1.278 ± 0.210) × 10-3mm2/s; t=-3.089, P=0.005). No difference was observed in Dk between the two groups (P=0.922). All parameters cannot differentiate subtypes of lung cancer. The ADC value had higher AUC (area under ROC curve) than that of K value. The sensitivity (70.8％) and accuracy (72.1％) of ADC value was higher than K value, the specificity of both methods was equal. Conclusion DKI is a feasible non-invasive tool which has comparable capability of conventional DWI in SPNs differentiation, although with lower sensitivity and accuracy. DKI can provide additional information for SPNs characterization and has a potential to be a robust way in SPNs interpretation.

Objective: To study dose-response relationships of fractionated irradiation induced pulmonary fibrosis in mice according to radiological imaging changes of lung. Methods: A total of 8-10 week old-female C57BL6 mice were randomized into different groups for whole thoracic irradiation. The prescribed doses were 0, 2.0, 4.0, 6.0, 7.0, 8.5 Gy per fraction in a total of 5 fractions. CT imaging was performed at 24 weeks post irradiation. The averaged lung density and volume changes were obtained by the three-dimensional segmentation algorithm, and further analyzed in Boltzmann regression modeling. Results: At the endpoint of 24 weeks, the dose-dependent pulmonary radiological alternations were revealed by coronal view of CT images. Translational analysis of fibrosis-related gene-signatures as well as histological collagen stainings further corroborated the radiological findings. According to Boltzmann modeling, the E₅₀ of radiation-induced lung density changes was found to be (30.80±0.80)Gy (adjusted R²=0.97); whereas the E₅₀ for radiation-induced lung volume reduction was determined as (31.31±7.07)Gy (adjusted R²=0.92). Both outcomes indicated a remarkable enhancement of tolerance to normal lung tissues after exposure with 5-fraction versus single fraction scheme. Conclusions The radiation-induced lung density and volume changes depend not only on total dose, but also the number and dose of fractions.

Aim To study the effect of Tongxinluo on the polarization of macrophages to type M2 and M1, and on Notch signaling pathway.Methods THP-1 was respectively induced by PMA and IL-4 or LPS to M2 and M1 type polarized macrophages, and treated by Tongxinluo.The expressions of marker molecules IL-10, TNF-α, IL-6 and protein of Notch signaling pathway were detected.Results The level of IL-10 increased in M2 group and there was no statistical difference on the level of IL-6 and TNF-α;the level of IL-10 decreased and IL-6, TNF-α increased in M1 group;the level of IL-10 increased and IL-6,TNF-α decreased in TXL group.There was no statistical difference in the expression of active Notch-1, DLL4 and Hes-1 between control group and M2 group;the expression of active Notch-1, DLL4 and HES-1 increased significantly in M1 group;the expression of active Notch-1, DLL4 and HES-1 decreased significantly in TXL group;there was no significant difference in the expression of Notch-1 protein in each group.Conclusion The polarization of macrophages to M1 type can be inhibited by Tongxinluo, and its mechanism may be related to the inhibition of activation of Notch-1 signaling pathway.

Objective To investigate the distribution characteristics of interleukin-27 gene rs17855750 G/T,rs40837 A/G polymorphism in Zhuang populations of Guangxi,and to compare the distribution differences of genotype and allele frequencies of interleukin-27 gene rs17855750 G/T,rs40837 A/G polymorphisms among different races.Methods The interleukin-27 gene rs17855750 G/T,rs40837 A/G polymorphisms were detected by SNaPshot SNP genotyping technique on 168 persons in Zhuang populations of Guangxi,frequencies of genotype and allele of interleukin-27 gene rs17855750 G/T,rs40837 A/G polymorphisms were analyzed in Zhuang populations,and was compared with the other four populations (HapMap-HCB,HapMap-JPT,HapMap-YRI,HapMap-TSI) from HapMap database.Results The most common genotype and allele of interleukin-27 gene rs17855750 G/T polymorphysms were TT(70.2％) and G(50.3％) in Zhuang populations of Guangxi,and the most common genotype and allele of interleukin-27 gene rs40837 G/T polymorphysms were AC(35.7 ％) and C(52.1 ％).There were no significant differences in the genotype and allele frequencies of interleukin-27 gene rs17855750 G/T,rs40837 A/G polymorphysms between male and female gender in Zhuang populations of Guangxi(P＞0.05).The frequencies of allele and genotype distribution of IL-27 gene rs17855750 G/T polymorphisms were not significantly different when compared with HapMap-HCB(P＞0.05),but were significantly different when compared with HapMap-JPT,HapMap-TSI and HapMap-YRI(P＜0.01);The frequencies of allele and genotype distribution of intetleukin-27 gene rs40837 A/G polymorphisms were significantly different when compared with HapMap-HCB(P＜ 0.05),and were significantly different when compared with HapMap-JPT,HapMap-YRI and HapMap-TSI(P＜0.01).Conclusion There are significant differences in the frequencies of allele and genotype distribution of interleukin-27 gene rs17855750 G/T,rs40837 A/G between Zhuang populations and other ethnic populations,and this variation may lead to a variety of clinical manifestation and morbidity of some diseases.

Iodinated radiocontrast media (IRCM) is widely used in current clinical practice. Although IRCM is generally safe, serious adverse drug reactions (ADRs) may still occur. IRCM-induced ADRs may be subdivided into chemotoxic and hypersensitivity reactions. Several factors have been shown to be associated with an increased risk of ADRs, including previous contrast media reactions, history of asthma and allergic disease, etc. Contrast media with lower osmolality is generally recommended for at-risk patients to prevent ADRs. Current premedication prophylaxis in at-risk patients may reduce the risk of ADRs. However, there is still a lack of consensus on the prophylactic role of premedication. Contrast-induced nephropathy (CIN) is another component of IRCM-related ADRs. Hydration remains the mainstay of CIN prophylaxis in at-risk patients. Despite several preventive measures, ADRs may still occur. Treatment strategies for potential contrast reactions are also summarised in this article. This article summarises the pathophysiology, epidemiology and risk factors of ADRs with emphasis on prevention and treatment strategies. This will allow readers to understand the rationale behind appropriate patient preparation for diagnostic imaging involving IRCM.
Acute Kidney Injury ; chemically induced ; prevention & control ; therapy ; Contrast Media ; adverse effects ; Drug Hypersensitivity ; etiology ; prevention & control ; therapy ; Drug-Related Side Effects and Adverse Reactions ; etiology ; prevention & control ; therapy ; Fluid Therapy ; Humans ; Iodine Radioisotopes ; adverse effects