Objective:To explore the effect of Rain Classroom combined with situational teaching in clinical clerkship of internal medicine.Methods:A total of 72 undergraduate students with clinical majors of Batch 2015 were selected and randomly divided into a control group and an experimental group using computer scrolling pause method, with 36 students in each group. The control group adopted traditional teaching methods, and the research group adopted Rain Classroom combined with situational teaching. The teaching effect evaluation was carried out through a 10-point questionnaire based on the internal medicine theory examination, clinical skill assessment and learning interest, knowledge mastery and application, and clinical thinking and practical ability. SPSS 20.0 was used to conduct t-test. Results:The average scores of the students in the experimental group including the theoretical test (87.94±5.68) and the skill test scores (88.08±5.73) were significantly higher than those in the control group (83.00±5.89) and (83.86±4.80)( P<0.01). The results of the questionnaire showed that students' interest in learning improvement, self-learning ability, new knowledge acquisition, application of knowledge, clinical thinking, clinical practice, problem solving, self-expression, teamwork, doctor-patient communication ability in the study group were better than those in the control group ( P < 0.01). Conclusion:The Rain Classroom combined with situational teaching method is helpful to improve students' knowledge mastery and application, improve clinical thinking and practical ability, improve learning interest and clinical clerkship teaching effect.

目的：探讨研究型PBL（以问题为基础）/CBL（以案例为基础）的整合式教学模式在内分泌学住院医师规范化培 训中的应用价值和效果。方法：选取2020年9月-2021年3月在内分泌科规范化培训的临床专业型硕士研究生共50名 作为主要研究对象；根据随机化原则分为对照组和研究组。研究组采用研究型PBL/CBL整合式教学法，对照组采 用传统教学方法。两组学员均由内分泌学中心的带教老师进行教学查房和临床操作的培训，以理论考核及操作技能 考核成绩进行比较分析，并结合问卷调查表的形式反馈教学效果。结果：研究组与对照组的入科成绩比较差异无 统计学意义（P＞0.05），而研究组与对照组出科考核成绩比较差异有统计学意义（P＜0.05），且研究组的出科成 绩（85.4±7.46分）高于对照组（78.84±6.81分）；问卷调查结果显示，与对照组比较，研究组满意度得分较高（P ＜0.05）。两组学生在分析及解决问题能力、医患沟通能力、团队合作能力以及文献检索能力方面的得分差异有统计 学意义（P＜0.05），并且研究组的能力得分均高于对照组。结论：研究型PBL/CBL整合式教学有助于提升专硕研究 生分析与解决问题的能力、医患沟通能力等。通过整合式教学，学员考核成绩更好，满意度更高。

BACKGROUND:On the base of traditional modeling with high-frequency atrial pacing, insertable cardiac monitor is innovatively used to track the incidence of atrial fibrillation (AF), to observe the efficiency and safety of establishment in AF model. MATERIAL AND METHODS:Twelve adult beagle dogs were randomly divided into a blank control group and an AF model group. The thinnest available bipolar solid electrode lead-3830 was implanted in AF group, connected to AF pacemaker to establish a high-frequency atrial pacing model by AOO pacing mode, and the occurrence of AF was tracked in real time by an insertable cardiac monitor Reveal LINQ. The areas of the left and the right atrium were measured by echocardiography. In addition, the morphology of left atrial tissues was observed using light and electron microscopes. RESULTS:The insertable cardiac monitor Reveal LINQ sensitively, conveniently, accurately, efficiently, and dynamically recorded the AF load in AF group. After the successfully establishment of the AF mode, the area of the left atrium and right atrium were significantly enlarged compared with that before modeling by echocardiography. Furthermore, the area of the left atrium and right atrium in the AF group were larger than that in the control group. The morphological observation of the left atrium tissues in both groups prompted the reconstruction of the atrial structure in dogs in the AF group. CONCLUSIONS:The application of insertable cardiac monitor Reveal LINQ improves the efficiency of monitoring the AF load, with high sensitivity, convenience, and accuracy.

Background: Gout is a chronic systemic inflammatory disease that results from the deposition of monosodium urate crystals in joints and the associated activation of the innate immune system associated with hyperuricemia 1 . As the pathogenesis of gout is still a matter of speculation and debate, accumulating evidence converges on inflammasome activation and immunological dysregulation 2 . However, the detailed statuses of lymphocyte subsets in patients with gout are unknown and influence of immunomodulatory combination therapies on the lymphocyte subsets remain to be clearly evaluate 3 . Objectives: To evaluate the quantitative statuses of peripheral CD4 + T subpopulations in patients with gout and further investigate the effects of immunomodulatory combination therapies on those cells. Methods: Total 247 patients who met the clinical criteria of gout from the American College of Rheumatology and 206 healthy controls (HCs) were enrolled in this retrospective cross-sectional study. Among those patients, 70 follow-up patients donated their peripheral blood after receiving immunomodulatory drugs (e.g., low-dose interleukin-2, rapamycin, metformin, retinoic acid, etc). The absolute numbers of Th1, Th2, Th17 and Tregs in peripheral CD4 + T subsets were detected by flow cytometry combined with standard absolute counting beads. Results: Compared with HCs, the absolute numbers of Th1 and Th17 were evidently increased in gout patients ( P <0.001), while the level of Tregs was significantly decreased ( P <0.05) (Figure 1). After immunomodulatory combination treatments, there were dramatical increases in a wide variety of CD4 + T subsets such as Th1, Th17 and Tregs ( P <0.05). Interestingly, the increased amount of Tregs was much more than that of other Teffs, leading to the decrease ratios of Teffs/Tregs such as Th2/Tregs, restoring immune homeostasis (Figure 2). Conclusion: This cross-sectional study clarified the abnormal statuses of CD4 + T subsets in gout patients, suggesting that CD4+T subsets, especially Tregs, might be relevant and play a crucial role in the pathogenesis of gout, thus providing a potential therapeutic target for gout patients. Immunomodulatory combination therapies effectively increase the number of Tregs and may help for gout patients’ symptom remission. References: [1]Ramsubeik K, Ramrattan LA, Kaeley GS, et al. Effectiveness of healthcare educational and behavioral interventions to improve gout outcomes: a systematic review and meta-analysis. Therapeutic advances in musculoskeletal disease 2018;10(12):235-52. doi: 10.1177/1759720x18807117 [published Online First: 2018/12/06] [2]Stiburkova B, Pavelcova K, Pavlikova M, et al. The impact of dysfunctional variants of ABCG2 on hyperuricemia and gout in pediatric-onset patients. Arthritis Res Ther 2019;21(1):77. doi: 10.1186/s13075-019-1860-8 [published Online First: 2019/03/22] [3]Raucci F, Iqbal AJ, Saviano A, et al. In-depth immunophenotyping data relating to IL-17Ab modulation of circulating Treg/Th17 cells and of in situ infiltrated inflammatory monocytes in the onset of gouty inflammation. Data Brief 2019;25:104381. doi: 10.1016/j.dib.2019.104381 [published Online First: 2019/09/07] Acknowledgments: None. Disclosure of Interests: None declared

Objective The aim of this study was to analyze the status and influencing factors of public health service utilization in rural patients with severe mental illness in Yunnan province. Methods The main caregivers of patients with severe mental illness in Yunnan province were selected by stratified cluster sampling method. Multivariate logistic regression was used to analyze the influencing factors of public health service utilization. Results A total of 284 cases of rural patients with severe mental illness were investigated, including 144 males (50.7％) and 140 females (49.3％) . The rate of medical file filing, follow-up rate of village doctor, participation rate of free physical examination and health education acceptance rate among patients with severe mental illness were 89.8％, 84.9％, 73.2％and 56.7％respectively (<0.05) . Female patients had higher participation rate of free physical examination than male patients, and patients having work and patients with controlled disease condition and their caregivers had higher rates of health education acceptance rate than their counterparts ( <0.05) . Conclusion Measures should be taken to strengthen the work of medical examination for male patients, and to expand health education activities for patients having no work and patients with uncontrolled disease condition, so as to improve the public health service utilization in rural areas of Yunnan province.

This study sought to identify the feasibility of evaluating the factors that worsen Lead-induced tricuspid regurgitation (LITR) and quantify tricuspid regurgitation severity by Real-time Three-Dimensional Echocardiography (RT-3DE). The subjects were a cohort of 128 consecutive patients who had

AIMSFragmented QRS (f-QRS) complexes are associated with adverse cardiovascular events in patients with coronary heart disease; however, the effects on patients with dilated cardiomyopathy (DCM) remain elusive. This study is to investigate the changes of left ventricular (LV) synchrony and systolic function in DCM patients with f-QRS complexes.METHODS AND RESULTSTwenty DCM patients with f-QRS complexes and 29 DCM patients without f-QRS (n-QRS) complexes were enrolled. The LV segmental longitudinal, radial and circumferential time to peak strain and general longitudinal systolic strain, radial strain, circumferential strain were measured, respectively, by speckle tracking imaging. The LV segmental standard deviations and maximal differences were also calculated. The LV dyssynchrony was defined as the time in peak anteroseptal wall to posterior wall strain >130 ms or longitudinal strain delay index >25%. The mean QRS durations in f-QRS and n-QRS groups were not different (P = ns). The incidence of LV dyssynchrony was 15/20 (75%) vs. 5/29 (17%) in two groups (P < 0.01). Two patients died of sudden death in f-QRS group during 2 years follow-up; however, no death in n-QRS group (P < 0.05). Patients in f-QRS group showed worsening LV dyssynchrony in f-QRS group after 2 years follow-up (P < 0.05). Overall, LV function was comparable at baseline (P = ns), but had significantly worsened only in the f-QRS group (P < 0.05).CONCLUSIONThe f-QRS complex is significantly associated with LV dyssynchrony in DCM patients and can be used as a reliable index to evaluate ventricular synchrony and predict the prognosis in DCM patients with narrow QRS complexes.

This article clarifies the advantages and the problems of multimedia teaching methods in the circulation system of internal medicine. To advocate the combination of multimedia teaching methods and traditional teaching methods in the medical education.

　　本文对外语教学效率公式--教学效率等于考试成绩除课时量提出了置疑。并从直接影响教学效率的主要组成部分--教师的教，学生的学分析了影响这两个主要层面的诸多因素，从而说明了这个教学效率公式的不完整性，同时说明了教学的复杂性，教学评价的多面性和需考虑的因素。

目的:研究翼状胬肉侵入角膜面积和深度与角膜散光及角膜地形图改变的关系。方法:观察我院2012年6月至2013年1月60例60眼单眼鼻侧翼状胬肉患者,分别测量出其侵入角膜长度、角膜缘宽度和侵入角膜的面积,术中观察其侵入角膜深度。测量术前、术后第二天,术后1周及术后1月的视力、屈光度和角膜曲率,检测术后一月的角膜地形图平均角膜表面不规则指数(CIM)。结果:翼状胬肉侵入角膜面积与角膜散光呈正相关,翼状胬肉浸润角膜的深度与术后1月角膜表面不规则指数呈正相关。结论:翼状胬肉的手术时机选择并非仅观察侵入角膜面积的大小,也应关注其浸润深度。

Through the analysis of the various memorizing features when learners recite the language material in language learning,the paper clarifies that in recitation the memorizing of the language materials,learners form the image of the situation described by the language material and the text image in words in mind,and the students’ postures,limbs’ movement,facial expressions as well as the relationship between them.At the same time it also illustrates the recitation of the memory features.

模糊语言学提出了模糊性是语言的本质属性,也是语言的特性之一,同时形成了模糊语言的四种类型语言学概念.这种语言学概念的提出,主要是基于语言的社会属性特征—语用学的领域探索而获得的.其主要研究是人们的交际语言.模糊语言在交际中常常会引起歧义,因为它具有表层和深层含义.而表层和深层的含义可能出现许多种释义思路.文章用实例分析了模糊语言的释义思路及语用效果.因此模糊语言的研究,我认为更多应该从语义学和语用学的角度去研究.这也许会有更大的突破.

BACKGROUND:The complications of hypertension cause severe health problems in rural areas in China. We (i) screened the major factors inducing hypertensive complications and provided intervention measures; and (ii) verified the efficacy of the New Rural Cooperative Medical Scheme (NRCMS; a medical insurance scheme for rural residents) for hypertension management.METHODS:A survey was conducted in the villages of Yunnan (an underdeveloped province in southwest China). The NRCMS was initiated there in 2005. Data were collected through questionnaires, physical examination, electrocardiography, as well as blood and urine tests. To detect factors inducing hypertension complications, a generalized estimating equations model was developed. Multivariable logistic regression was used to analyze influencing factors for hypertension control.RESULTS:Poor management of hypertension was observed in women. Being female, old, poorly educated, a smoker, ignorant of the dangerousness of hypertension, and having uncontrolled hypertension made patients more prone to hypertension complications. Combination therapy with ≥ 2 drugs helped control hypertension, but most rural patients disliked multidrug therapy because they considered it to be expensive and inconvenient. The NRCMS contributed little to reduce the prevalence of complications and improve control of hypertension.CONCLUSIONS:The present study suggested that the NRCMS needs to be reformed to concentrate on early intervention in hypertension and to concentrate on women. To increase hypertension control in rural areas in China, compound products containing effective and inexpensive drugs (and not multidrug therapy) are needed.

Objective This study aimed to investigate what factors affect reconstruction timing of pacing system, and to explore how to optimise reconstruction timing of pacing system. The study will provide a new scientific basis for administration of patients with pacemaker therapy. Methods The data of total 473 cases of 332 patients with pacemaker reimplantation from the First Affiliated Hospital of Kunming Medical College from January 1992 to October 2010 were continuously collected. All patients accepted a long time follow-up, including basic information, the causes and time of the first pacemaker implantation and pacemaker reimplantation, pacemaker parameters, surgical treatment measures and related program data. All these data were recorded in detail and analysed using statistical methods to do a systematic review. Result (1) There were 287 cases in the planned reconstruction of pacing system group (60.7% of total reimplantation), there were 130 cases, (27.5%) in the group earlier than planned reconstruction of pacing system, and the total cases 56 cases, (11.8%) in the later reconstruction of pacing system group. The normal battery depletion was the first reason for the patients in the planned reconstruction of pacing system group; the complications and some factors of patients themselves were the most important reasons for the patient in the group earlier than planned reconstruction of pacing system; while poor economic conditions was the first reason for the patients of the later reconstruction of pacing system group. (2) Among three different reconstruction timing groups, 299 cases (63.2%) had reasonable timing for pacing system reconstruction; 174 cases (36.8%) had unreasonable timing for pacing system reconstruction. In the Unreasonable reconstruction timing group, there were 60 cases with complications, 37 cases of absence of attention, 29 cases with poor economic conditions; 26 cases of being traffic inconvenience, 13 cases of poor physical conditions, as well as nine cases due to medical sources factors. Conclusion (1) The reasons of unreasonable reconstruction timing are: the complications, the patients of lack of emphasis on disease, poor economic conditions, traffic inconvenience, poor physical condition, and medical source factors (doctor based only on pacemaker manufacturer warranty period or the patients will to replace the pacemakers). (2) In order to avoid the unreasonable reconstruction timing, doctor must take effective measures to decide reasonable reconstruction timing, which can reduce unnecessary costs and complications caused by the unreasonable reconstruction pacing system, effectively improve the pacing system safety and extend longevity of pacing system, so that pacing system can better adapt to the patients with diseases. (3) Optimisation of pacing system reconstruction timing should be taken effectively. For example, optimise preoperative period process when the pacemaker was implanted for the first time. During pacing system reimplantation, doctor must maximally reduce risk optimising pacing system follow-up process and increasing knowledge of both doctors and patients about follow-up. It is also very important that advanced hardware and software of pacing system, as well as new technologies of follow-up should be also used by the doctors.

The semantic changes of Chinese and English vocabularies in certain contexts or under particular language background are quite flexible, vivid, with broad and profound meanings and their meanings keep a great gap from their original ones. Certainly, due to the different unique respective features of Chinese and English, the phenomena of their semantic changes keep quite obvious variations ： in Chinese, the parts of speech remain rather fixed while in English they appear prettily flexible, bearing broader meanings. Thus, lan- guage learners must learn and master these changes, especially those in certain contexts under particular language background, besides grasping language sounds, forms as well as common semantics. Only in this way can they master and apply the language.

Background and objectives Cardiac resynchronisation therapy (CRT) is now an established non-pharmacologic therapy for advanced congestive heart failure (CHF) with electromechanical delay. However, lack of a favourable response in about 1/3 patients remains a challenge to cardiologists. This study evaluated the impact of biventricular (biv-) with atrioventricular node (AVN) preference pacing on patients with CHF after CRT. Methods From January 2008 to December 2009, 44 patients (34 male, mean aged 62.11±9.03) were included in the study. All patients met IA CRT indications, with sinus rhythm and normal AV conduction. Patients were randomly treated by either traditional biv-pacing or biv with AVNP (AVNP) pacing mode for at least 1 month, and then transferred to another mode. AVNP pacing was performed by titrating AV delay and VV delay under ECG monitoring until the ventricles were activated by both pacemaker and AVN, and the narrowest QRS complex appeared. Patients in traditional biv-pacing mode were optimised using echocardiography. QRS duration, echocardiography, NYHA classification, 6 min walk test, Minnesota Living with Heart Failure Questionnaire (MLHFQ) and cardiac events during follow-up were compared between 2 modes. Patients were programmed in the mode with most benefit at the end of study. Results 44 patients received CRT-P/D successfully. Compared with baseline, all patients experienced improvements in symptoms, exercise tolerance and quality of life as well as performance in ECG and echocardiography at the end of the study. There were no deaths, rehospitalisation and cardiac events. The AVNP pacing succeeded in all patients. Patients under AVNP mode had shorter QRS duration (118.35±21.59 vs 146.35±5.31 ms, p<0.0001), longer AVd (164 vs 128 ms, p<0.001) compared to traditional mode. At the end of follow-up, the LVFS (17.41±5.9 vs 15.66±4.90, p=0.019), LVEF (35.50±9.72 vs 32.68±9.74, p=0.048) and peak aortic valve velocity (115.00±20.93 vs 106.80±20.87 m/s, p=0.002) were larger in AVNP mode than traditional mode. The NYHA classification (1.82 vs 1.98, p=0.008), 6 min walk test (372.51±80.88 vs 328.66±108.89 m, p=0.0001) and MLHFQ scores (12.48±6.56 vs 18.16±12.25, p=0.0001) were higher in AVNP mode compared to traditional mode. Conclusions Ignoring AVN in the traditional biv-pacing mode would lead to wider QRS waveform, this might be one reason of non-response. The AVNP pacing combined resynchronisation and physiological pacing by multisite activation. In our study, patients experienced more benefits in symptom, cardiac function and quality of life under biv with AVNP pacing mode compared to traditional mode. For patients with sinus rhythm and normal AV conduction who did not response well to CRT, the new biventricular with AVNP pacing may improve benefits and increase the response rate.

为了探讨循证医学教学模式的应用价值,于2008年在儿科见习中应用了循证医学的理念。把05级临床医学二系儿科见习的两个大班随机地分为实验组和对照组,实验组应用循证医学理念,对照组采用传统式教学方法。用问卷调查表,理论考试及病历书写评价其效果。结果:循证医学教学模式对提高学习兴趣,培养良好的临床思维和学习方法具有积极作用。