Purpose/Significance Combined with flipped classroom and project-driven teaching mode,the curriculum reform is ex-plored to improve teaching effect,stimulate students to learn independently and participate deeply in class.Method/Process Taking the teaching of hospital information system course as an example,guided by the flipped classroom concept and combined with the project-driven method,the paper puts forward the reform plan of teaching design and applies it to the actual teaching process.Result/Conclusion The satisfaction degree of the students is higher,the initiative of students to study independently is improved,and the teaching quality is enhanced.

Objective:To evaluate the effect of the improved team-based learning (TBL) teaching method in the undergraduate probation course of ophthalmology based on the goal of cultivating excellent doctors.Methods:The undergraduates of clinical medicine were randomly divided into experimental group and control group. The control group ( n=50) was given conventional ophthalmology probation teaching, while the experimental group ( n=50) was given ophthalmology probation teaching of improved TBL teaching method. The theoretical examination performance and skill assessment results of students in the two groups were compared, and the subjective evaluation of the students on the teaching was also compared. SPSS 23.0 was used to conduct t-test and Wilcoxon's rank sum test. Results:The theoretical examination performance of experimental group (29.68±4.52) was better than that of control group (27.84±4.33), with significant differences ( P<0.05); the skill assessment results of experimental group (32.88±5.05) were also better than those of the control group (30.88±6.99), with significant differences ( P<0.05); the subjective evaluation of teaching effect in each item of experimental group was better than that of control group ( P<0.05). Conclusion:The improved TBL teaching method can not only improve students' theoretical knowledge and experimental skills, but also improve students' self-study and teamwork ability, which will provide a feasible educational reform plan for achieving the goal of cultivating excellent doctors.

Objective:To evaluate the feasibility of indocyanine green fluorescence imaging technology applied in thyroid surgery to identify parathyroid gland.Methods:From Oct 2021 to May 2022, data of 42 patients undergoing thyroidectomy via gasless unilateral axillary approach in Zhejiang Provincial Hospital of Traditional Chinese Medicine were retrospectively analyzed. Cases using intraoperative fluorescence imaging technology(42 cases) were compared with conventional laparocopic approach.Results:The number of parathyroid glands dissected in the study group 1.57±0.61 was higher than that in the control group 0.56± 0.59 ( t=-5.472, P<0.05). The PTH value of the study group was (2.88±1.23)pmol/L on the first day after operation, which was higher than that of the control group (2.16±0.10)pmol/L ( t=-1.844, P<0.05). The blood parathyroid hormone value on the third day(3.22±1.31)pmol/L was higher than that of the control group (2.55±0.81) pmol/L ( t=-2.041, P<0.05). There were 2 cases of hypoparathyroidism in the study group, less than 5 cases in the control group, but there was no significant difference between the two groups( χ2=0.942, P>0.05). There was 1 case of hypocalcemia in the study group and 3 cases in the control group ( χ2=0.731, P>0.05). Conclusion:Using indocyanine green fluorescence imaging technology to identify parathyroid gland is feasible, simple, fast, safe and effective.

OBJECTIVE To explore the difference in th e mechanis m of baicalein and wogonin inhibiting the energy metabolism of hepatoma cells. METHODS Human hepatoma HepG 2 cells were divided into blank control group （without medicine），different dose groups of baicalein and wogonin （1.25，2.5，5，10 and 20 μmol/L）. The effects of baicalein and wogonin on the viability of HepG 2 cells were detected by MTT assay. HepG 2 cells were divided into blank control group （without medicine），baicalein group and wogonin group. After administration ，the concentration of ATP in cell was detected by enhanced ATP kit. The levels of cell glycolysis and mitochondrial energy metabolism were evaluated by glycolysis and mitochondrial pressure test kit ；the affinity of baicalein and wogonin with key enzymes of energy metabolism was predicted by molecular docking ，and the key enzymes of energy metabolism with high affinity were screened ；the expression of key enzymes of energy metabolism was detected by Western blot. RESULTS Within the dose range of 2.5-20 μmol/L，the half inhibitory concentrations of baicalein and wogonin were 12.84 and 24.09 μmol/L；baicalein 1.25 μmol/L and wogonin 2.5 μmol/L had no effect on cell viability ，so it was selected as the dosage for subsequent experiments. Compared with blank control group ，the concentration of ATP in HepG 2 cells decreased significantly in baicalein group and wogonin group （P＜0.05）；the inhibitory effects on basic acidification rate of HepG 2 cells in wogonin group were significantly stronger than those of baicalein group （P＜0.05），but there was no significant difference between them on the basic oxygen consumption rate （P＞0.05）；baicalein had strong binding to pyruvate kinase M 2 and mitochondrial enzyme complexes Ⅰ（CⅠ），C Ⅱ and C Ⅳ，while wogonin only had strong binding to pyruvate kinase M 2； wogonin could significantly down-regulate the protein expressions of hexokinase ，phosphofructokinase，pyruvate kinase M 2，CⅠ， C Ⅱ and C Ⅳ（P＜0.05），but there was no statistical significance in the effect of baicalein on the regulation of these enzymes （P＞ 0.05）. CONCLUSIONS Both baicalein and wogonin can inhibit the energy metabolism of hepatoma HepG 2 cells，but the mechanism is different ：the effect of baicalein is related to the activity of key enzymes ，while the effect of wogonin is related to the inhibition of the expression of key enzymes of energy metabolism.

Objective:To evaluate the predictive value of pre-ablation stimulated thyroglobulin (Pre-sTg) and thyroglobulin reduction index (TRI) before 131I treatment for prognosis improvement in medium-low risk differentiated thyroid carcinoma (DTC) patients. Methods:One hundred and ninty-four patients with low-medium risk DTC who received 131I treatment at the Department of Nuclear Medicine of our hospital from July 2019 to June 2021 were included in to this prospective study. Multifactor Logistic regression analysis was performed to evaluate the influence on the prognosis of DTC patients. Results:Pre-sTg and TRI were the prognostic factors for radioiodine remnant ablation (RRA) ( P<0.05). When the cut off value for Pre-sTg was ≤8.64 ng/ml, the sensitivity, specificity, positive predictive value, negative predictive value and crude agreement for Pre-sTg were 71.43%, 62.96%, 83.33%, 62.96% and 69.07%. While the cut off value for TRI was >84.80%, the sensitivity, specificity, positive predictive value, negative predictive value and crude agreement for TRI were 54.29%, 70.37%, 81.72%, 28.24% and 58.25%. Conclusions:Pre-sTg and TRI are independent predictors of the efficacy of radioiodine remnant ablation (RRA), and can be used for early prediction of the efficacy of RRA treatment.

Objective:To evaluate the efficacy and safety of ribonucleic acid for injection Ⅱ combined with chemotherapy in the treatment of advanced non-small cell lung cancer (NSCLC).Methods:Based on the LinkDoc database, 2 111 patients who were diagnosed with stage Ⅲ B and Ⅳ NSCLC in 8 research centers such as Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology from January 2014 to December 2017 were included. Patients were divided into observation group (1 039 cases) and control group (1 072 cases) according to whether or not they had used ribonucleic acid for injection Ⅱ during chemotherapy. Inverse probability of treatment weighting was used to correct the confounding factors of patients, and there were 1 078 cases in the control group and 1 033 cases in the observation group; the overall survival (OS), progression-free survival (PFS) and the occurrence of adverse events and chemotherapy-related adverse reactions were compared between the two groups. Results:The median OS time of the observation group and the control group was 18.51 months and 15.65 months, and the median PFS time was 7.00 months and 5.49 months, and the differences were statistically significant ( P values ??were 0.001 and 0.003). The incidence of adverse events in the observation group was slightly higher than that in the control group [75.6% (781/1 033) vs. 74.1% (799/1 078)], and the incidence of chemotherapy-related adverse reactions in the observation group was slightly higher than that in the control group [43.9% (453/1 033) vs. 40.7% (439/1 078)], but the differences were not statistically significant (both P > 0.05). Conclusions:Ribonucleic acid for injection Ⅱ can prolong the OS and PFS time of patients with stage Ⅲ B and Ⅳ NSCLC receiving chemotherapy. It is safe and can increase the clinical benefit of patients to a certain extent.

OBJECTIVE：To establish the method for the content de termination of 17 quality markers in Dahuang zhechong pills（DHZCP）. METHODS ：HPLC method was adopted to determine the contents of 17 quality markers in 10 batches of DHZCP ， such as allantoin ，hypoxanthine，salidroside，hydroxypaeoniflorin，glycyrrhizin，isoglycyrrhizin，baicalin，p-methoxyphenylacetic acid，wogonin，cinnamic acid ，apigenin，naringin，norwogonin，aloe emodin ，rhein，chrysin，emodin. The determination was performed on Kromasil 100-5-C18（250 mm × 4.6 mm，5 μm）column with mobile phase consisted of 0.1％ phosphoric acid solution-acetonitrile （gradient elution ） at the flow rate of 1.0 mL/min. The column temperature was 30 ℃ ，the detection wavelength was 210 nm and the sample size was 20 μ L. RESULTS：The linear range of above 17 quality markers were 5.74-183.53，6.51-208.24，4.30-137.65，4.60-147.06，4.12-131.76，4.25-135.88，6.31-201.76，4.60-147.06，1.94-62.06，4.47- 142.94，0.69-22.06，2.29-73.24，2.33-74.41，1.42-45.29，6.65-212.94，1.11-35.44 and 1.47-47.06 μg/mL，respectively（all R2≥ 0.999 0）. RSDs of precision ，repeatability，stability and durability tests were all less than 2％（n＝6）；average recovery of 17 quality markers ranged from 96.31％ to 101.73％，and the RSDs were less than 3％（n＝6）. CONCLUSIONS ：The method is simple， rapid，speific，specise，reproducible，stable，accurate and durable ，and can be used for improving the quality standard of DHZCP.

Objective    By summarizing the clinical characteristics of perioperative patients with cross infection of novel coronavirus in thoracic surgery ward, to guide the prevention and treatment of nosocomial infection during the anti-epidemic period. Methods    The clinical data of 451 patients with chest diseases in the Department of Thoracic Surgery of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 1st to 24th, 2020 were analyzed and followed up. There were 245 surgical patients and 206 non-surgical patients. Results    In the department, 7 patients (7/451, 1.55%) were infected with the novel coronavirus and all of them were surgical patients, whose preoperative imaging data did not reveal the imaging changes of novel coronavirus. There were 5 males and 2 females, aged 56 to 68 years. The patients with old age, smoking, surgery, coronary heart disease, chronic liver disease and tumor history were more susceptible to infection. From the spatial distribution of patient beds, it was found that the distance among infected patients was greater than 1 m, and no cross infection was found in the other patients of the same ward. During follow-up, two family members of noninfected patients were found to be infected one week after discharge. However, there was no overlap of spatiotemporal distribution between the family members and the infected patients during the hospitalization period. Conclusion    The novel coronavirus pneumonia rate in the department of  thoracic surgery is low, which may be opportunistic infection. At the same time, a good control and prevention of epidemic disease can reduce the occurrence of cross infection in the department of thoracic surgery.

Objective    To investigate CT image features of ground glass opacity (GGO)-like 2019 novel coronavirus (2019-nCoV, SARS-CoV-2) pneumonia (COVID-19) and early-stage lung carcinoma for control and therapy of this acute severe respiratory disease. Methods    We retrospectively analyzed the clinical data of 71 GGO-like COVID-19 patients who received therapy in Tongji Hospital of Huazhong University of Science and Technology between January 17th and February 13th, 2020. These 71 GGO-like COVID-19 patients were as a COVID-19 group. And 80 GGO-like early-stage lung carcinoma patients who underwent resection were as a lung carcinoma group. Clinical features such as sex, age, symptoms including fever, cough, fatigue, myalgia and dyspnea, detailed exposure history, confirmatory test (SARS-CoV-2 quantitative RT-PCR) and pathologic diagnosis were analyzed. Results    Significantly different symptoms and exposure history between the two groups were detected (P<0.001). More lesions (61 patients at percentage of 85.92%, P<0.001), relative peripheral locations (69 patients at percentage of 97.18%, P<0.001) and larger opacities (65 patients at percentage of 91.55%, P<0.001) were found in chest radiographs of GGO-like COVID-19 compared with GGO-like early-stage lung carcinoma. Similar features appeared in early-stage of COVID-19 and lung carcinoma, while pneumonia developed into more extensive and basal predominant lung consolidation. Coexistence of GGO-like COVID-19 and early-stage lung carcinoma might occur. Conclusion    Considering these similar and unique features of GGO-like COVID-19 and early-stage lung carcinoma, it is necessary to understand short time re-examination of chest radiographs and other diagnostic methods of these two diseases. We believe that the findings reported here are important for diagnosis and control of COVID-19 in China.

Objective    To summarize our experience of surgical resection of multiple ground-glass opacity (GGO) in recent years. Methods    Clinical data of patients who underwent one-stage resections of multiple GGO from November 2015 to May 2019 in our hospital were collected, including 13 males and 52 females at an average age of 56.0±9.4 years. The clinical effects and pathological types of GGO were evaluated. Results    Time interval from first discovery to surgery was 8-1 447 (236.5±362.4) days. There were 48 patients with unilateral surgery and 17 patients with bilateral surgery during the same period. Except for 2 patients who underwent open thoracotomy due to total thoracic adhesions, other patients underwent video-assisted thoracoscopic surgery (VATS). The mean postoperative hospital stay was 12.2±4.3 days. No severe perioperative complication or death occurred. A total of 156 GGO lesions were resected, 80 lesions were pure GGO, including 58 (72.5%) malignant lesions and 22 (27.5%) benign lesions, with an average diameter of 7.7±3.3 mm and 5.5±2.6 mm, respectively. Another 76 lesions were mixed GGO, including 69 (90.8%) malignant lesions and 7 (9.2%) benign lesions, with an average diameter of 13.6±6.6 mm and 7.7±3.5 mm, respectively. Conclusion    Patients with multiple GGO should be treated with anti-inflammatory therapy firstly. When conservative treatment is ineffective and no benign outcomes are observed, surgical treatment should be considered. And when lung function is sufficient for patients to underwent surgeries, the simultaneous unilateral or bilateral thoracoscopic resection is suggested, and the sublobar resection or lobectomy methods can be adopted flexibly according to the clinical features of the lesion and the rapid pathological results, which will not increase the risk of postoperative complications. Otherwise, surgical resection should be given priority for pure GGO lesions with a diameter > 7.7 mm and mixed GGO lesions.