Clinical Characteristics of Coronavirus Disease 2019 in China.

BACKGROUND: Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. METHODS: We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. RESULTS: The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. CONCLUSIONS: During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.).

Child Safety Seat‒Use Behavior Among Parents of Newborns: A Trans-Theoretical Model‒Guided Intervention in Shantou, China, 2021.

We evaluated the effect of a trans-theoretical model-based intervention on child safety seat (CSS)‒use behaviors among parents of newborns in Shantou, China. Parents' knowledge, attitude, and self-efficacy scores on CSS use were significantly higher at one, three, and six months after the intervention compared with scores at baseline. Parents' stage of CSS use also advanced as the intervention progressed. The trans-theoretical model‒based intervention and evidence generated from this study may provide guidance for future individualized interventions to improve CSS use. (Am J Public Health. 2023;113(12):1271-1275. https://doi.org/10.2105/AJPH.2023.307415).

Diffractive deep neural network based adaptive optics scheme for vortex beam in oceanic turbulence.

Vortex beam carrying orbital angular momentum (OAM) is disturbed by oceanic turbulence (OT) when propagating in underwater wireless optical communication (UWOC) system. Adaptive optics (AO) is a powerful technique used to compensate for distortion and improve the performance of the UWOC system. In this work, we propose a diffractive deep neural network (DDNN) based AO scheme to compensate for the distortion caused by OT, where the DDNN is trained to obtain the mapping between the distortion intensity distribution of the vortex beam and its corresponding phase screen representing OT. In the experiment, the distorted vortex beam is input into the DDNN model where the diffractive layers are solidified and fabricated, and the intensity distribution of the modulated light field of the vortex beam can be recorded. The experiment results show that the proposed scheme can extract quickly the characteristics of the intensity pattern of the distorted vortex beam, and the predicted compensation phase screen can correct the distortion caused by OT in time. The mode purity of the compensated vortex beam is significantly improved, even with a strong OT. Our scheme may provide a new avenue for AO techniques, and is expected to promote the communication quality of UWOC system immediately.

Longitudinal hematologic and immunologic variations associated with the progression of COVID-19 patients in China.

BACKGROUND: Crucial roles of hematologic and immunologic responses in progression of coronavirus disease 2019 (COVID-19) remain largely unclear. OBJECTIVE: We sought to address the dynamic changes in hematologic and immunologic biomarkers and their associations with severity and outcomes of COVID-19. METHODS: A retrospective study including 548 patients with COVID-19 with clarified outcome (discharged or deceased) from a national cohort in China was performed. Cross-sectional and longitudinal variations were compared and the associations with different severity and outcomes were analyzed. RESULTS: On admission, the counts of lymphocytes, T-cell subsets, eosinophils, and platelets decreased markedly, especially in severe/critical and fatal patients. Increased neutrophil count and neutrophils-to-lymphocytes ratio were predominant in severe/critical cases or nonsurvivors. During hospitalization, eosinophils, lymphocytes, and platelets showed an increasing trend in survivors, but maintained lower levels or dropped significantly afterwards in nonsurvivors. Nonsurvivors kept a high level or showed an upward trend for neutrophils, IL-6, procalcitonin, D-dimer, amyloid A protein, and C-reactive protein, which were kept stable or showed a downward trend in survivors. Positive correlation between CD8+ T-cell and lymphocytes count was found in survivors but not in nonsurvivors. A multivariate Cox regression model suggested that restored levels of lymphocytes, eosinophils, and platelets could serve as predictors for recovery, whereas progressive increases in neutrophils, basophils, and IL-6 were associated with fatal outcome. CONCLUSIONS: Hematologic and immunologic impairment showed a significantly different profile between survivors and nonsurvivors in patients with COVID-19 with different severity. The longitudinal variations in these biomarkers could serve to predict recovery or fatal outcome.

A longitudinal study on psychological burden of medical students during COVID-19 outbreak and remission period in China.

BACKGROUND AND OBJECTIVES: Due to their professional characteristics and future career orientation, medical students have a deeper understanding of COVID-19 and enact disease prevention and control measures, which may cause psychological burden. We aimed to assess the psychological impact during the COVID-19 outbreak period(OP) and remission period(RP) among medical students. METHODS: We surveyed the medical students in Shantou University Medical College twice-during the OP and the RP, surveying psychological burden of COVID-19 lockdowns and its associated factors. 1069 respondents were recruited in OP and 1511 participants were recruited in RP. We constructed nomograms to predict the risk of psychological burden using risk factors that were screened through univariate analysis of the surveyed data set. RESULTS: There was a statistically significant longitudinal increment in psychological burden from OP to RP, and stress as well as cognition in psychological distress were the most dominant ones. Common impact factors of the depression, anxiety and stress included frequency of outdoor activities, mask-wearing adherence, self-perceived unhealthy status and exposure to COVID-19. In addition, the high frequency of handwashing was a protective factor for depression and anxiety. The C-index was 0.67, 0.74 and 0.72 for depression, anxiety and stress, respectively. CONCLUSION: The psychological impact of COVID-19 was worse during the RP than during the OP. Thus, it's necessary to continue to emphasize the importance of mental health in medical students during the pandemic and our proposed nomograms can be useful tools for screening high-risk groups for psychological burden risk in medical students.

Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis.

BACKGROUND: The coronavirus disease 2019 (COVID-19) outbreak is evolving rapidly worldwide. OBJECTIVE: To evaluate the risk of serious adverse outcomes in patients with COVID-19 by stratifying the comorbidity status. METHODS: We analysed data from 1590 laboratory confirmed hospitalised patients from 575 hospitals in 31 provinces/autonomous regions/provincial municipalities across mainland China between 11 December 2019 and 31 January 2020. We analysed the composite end-points, which consisted of admission to an intensive care unit, invasive ventilation or death. The risk of reaching the composite end-points was compared according to the presence and number of comorbidities. RESULTS: The mean age was 48.9 years and 686 (42.7%) patients were female. Severe cases accounted for 16.0% of the study population. 131 (8.2%) patients reached the composite end-points. 399 (25.1%) reported having at least one comorbidity. The most prevalent comorbidity was hypertension (16.9%), followed by diabetes (8.2%). 130 (8.2%) patients reported having two or more comorbidities. After adjusting for age and smoking status, COPD (HR (95% CI) 2.681 (1.424-5.048)), diabetes (1.59 (1.03-2.45)), hypertension (1.58 (1.07-2.32)) and malignancy (3.50 (1.60-7.64)) were risk factors of reaching the composite end-points. The hazard ratio (95% CI) was 1.79 (1.16-2.77) among patients with at least one comorbidity and 2.59 (1.61-4.17) among patients with two or more comorbidities. CONCLUSION: Among laboratory confirmed cases of COVID-19, patients with any comorbidity yielded poorer clinical outcomes than those without. A greater number of comorbidities also correlated with poorer clinical outcomes.

Clinical characteristics and outcomes of hospitalised patients with COVID-19 treated in Hubei (epicentre) and outside Hubei (non-epicentre): a nationwide analysis of China.

BACKGROUND: During the outbreak of coronavirus disease 2019 (COVID-19), consistent and considerable differences in disease severity and mortality rate of patients treated in Hubei province compared to those in other parts of China have been observed. We sought to compare the clinical characteristics and outcomes of patients being treated inside and outside Hubei province, and explore the factors underlying these differences. METHODS: Collaborating with the National Health Commission, we established a retrospective cohort to study hospitalised COVID-19 cases in China. Clinical characteristics, the rate of severe events and deaths, and the time to critical illness (invasive ventilation or intensive care unit admission or death) were compared between patients within and outside Hubei. The impact of Wuhan-related exposure (a presumed key factor that drove the severe situation in Hubei, as Wuhan is the epicentre as well the administrative centre of Hubei province) and the duration between symptom onset and admission on prognosis were also determined. RESULTS: At the data cut-off (31 January 2020), 1590 cases from 575 hospitals in 31 provincial administrative regions were collected (core cohort). The overall rate of severe cases and mortality was 16.0% and 3.2%, respectively. Patients in Hubei (predominantly with Wuhan-related exposure, 597 (92.3%) out of 647) were older (mean age 49.7 versus 44.9 years), had more cases with comorbidity (32.9% versus 19.7%), higher symptomatic burden, abnormal radiologic manifestations and, especially, a longer waiting time between symptom onset and admission (5.7 versus 4.5 days) compared with patients outside Hubei. Patients in Hubei (severe event rate 23.0% versus 11.1%, death rate 7.3% versus 0.3%, HR (95% CI) for critical illness 1.59 (1.05-2.41)) have a poorer prognosis compared with patients outside Hubei after adjusting for age and comorbidity. However, among patients outside Hubei, the duration from symptom onset to hospitalisation (mean 4.4 versus 4.7 days) and prognosis (HR (95%) 0.84 (0.40-1.80)) were similar between patients with or without Wuhan-related exposure. In the overall population, the waiting time, but neither treated in Hubei nor Wuhan-related exposure, remained an independent prognostic factor (HR (95%) 1.05 (1.01-1.08)). CONCLUSION: There were more severe cases and poorer outcomes for COVID-19 patients treated in Hubei, which might be attributed to the prolonged duration of symptom onset to hospitalisation in the epicentre. Future studies to determine the reason for delaying hospitalisation are warranted.

Evaluation of selenite reduction under salinity and sulfate stress in anaerobic membrane bioreactor.

Current microbial reduction technologies have been proven to be suitable for decontaminating industrial wastewaters containing high concentrations of selenium (Se) oxyanions, however, their application is strictly limited by the elemental Se (Se0) accumulation in the system effluents. In this work, a continuous-flow anaerobic membrane bioreactor (AnMBR) was employed for the first time to treat synthetic wastewater containing 0.2 mM soluble selenite (SeO3 2-). The SeO3 2- removal efficiency by the AnMBR was approachable to 100% in most of the time, regardless of the fluctuation in influent salinity and sulfate (SO4 2-) stress. Se0 particles were always undetectable in the system effluents, owing to their interception by the surface micropores and adhering cake layer of membranes. High salt stress led to the aggravated membrane fouling and diminished content ratio of protein to polysaccharide in the cake layer-contained microbial products. The results of physicochemical characterization suggested that the sludge-attached Se0 particles presented either sphere- or rod-like morphology, hexagonal crystalline structure and were entrapped by the organic capping layer. According to the microbial community analysis, increasing influent salinity led to the diminished population of non-halotolerant Se-reducer (Acinetobacter) and increased abundance of halotolerant sulfate reducing bacteria (Desulfomicrobium). In the absence of Acinetobacter, the efficient SeO3 2- abatement performance of the system could still be maintained, as a result of the abiotic reaction between SeO3 2- and S2- generated by Desulfomicrobium, which then gave rise to the production of Se0 and S0.

Evaluation of parental education using biomechanical visualization to increase child restraint use in China.

INTRODUCTION: Despite demonstrated effectiveness of child restraint system (CRS), its use in China is extremely low due to the lack of national legislation requiring the use of CRS, as well as lack of child passenger safety knowledge among caregivers. Implementing an effective intervention is urgently needed to promote the use of CRS. In this study, we primarily evaluated the effectiveness of biomechanical visualization delivered in the context of CRS education to promote CRS use. METHODS: We conducted a cluster randomised controlled trial to test the effects of educational intervention programs on increased use of CRS. Participants included caregivers from 8 pre-schools located in two cities (i.e., Chaozhou and Shantou) in China. Following a baseline survey, 8 pre-schools were randomly assigned into 1 of 4 groups with 2 schools in each group: 1) CRS education-only, 2) CRS education with behavioral skill training, 3) CRS education with biomechanical visualization, and 4) control. The primary outcome was CRS use, and the secondary outcomes included scores of child passenger safety-related knowledge and CRS use-related attitudes. The effect of the intervention was assessed among caregivers at two time points: baseline preintervention and 6 months postintervention. RESULTS: More than 70% caregivers had never used CRS at baseline. No statistically significant between-group differences CRS use were observed at baseline preintervention (34.2%, 25.4%, 29.6% and 21.9%, respectively, P = 0.18). However, compared to the control group, odds of CRS non-use was significantly lower in caregivers assigned to the CRS education with biomechanical visualization (adjusted odd ratio (AOR) = 0.11, 95% confidence interval (CI) = 0.07-0.17), CRS education with behavioral skill training (AOR = 0.15, 95%CI = 0.10-0.24) and CRS education-only (AOR = 0.26, 95%CI = 0.17-0.41) groups, respectively. Statistically significant differences were also observed in the secondary outcomes postintervention across groups. Specifically, the CRS education with biomechanical visualization and CRS education with behavioral skill training groups had higher mean knowledge change scores than the CRS education-only group (3.3 ± 1.5 vs. 2.9 ± 2.2, p = 0.035 and 3.2 ± 1.9 vs. 2.9 ± 2.2, p = 0.039, respectively). We also observed a significantly higher increase in the attitudes scores in the CRS education with biomechanical visualization group compared with the CRS education-only group (4.7 ± 2.1 vs. 3.5 ± 2.8,p = 0.026). CONCLUSIONS: This study shows that both biomechanical visualization and behavioral skill training supplements to education improved understanding of CRS knowledge compared to education only, and all three strategies led to increased CRS use. Importantly, CRS education with biomechanical visualization was shown to be more effective than CRS education alone in improving caregiver's knowledge and attitudes. The use of biomechanical visualization may be an effective supplement to traditional education programs.

Recent advances in supported acid/base ionic liquids as catalysts for biodiesel production.

Biodiesel is considered a potential substitute for fossil diesel because of its unique environmentally friendly and renewable advantages. The efficient and durable heterogeneous catalysts are vital to greenly and efficiently drive the biodiesel production process. The ionic liquid-functionalized materials, possessing the characteristics of both homogeneous and heterogeneous catalysts, are one of the promising substitutions for conventional homogeneous acid/base catalysts for producing biodiesel. This mini-review focuses on recent advances in supported acid/base ionic liquids to synthesize ionic liquid-functionalized materials for producing biodiesel. The methods of immobilizing ionic liquids on supports were summarized. The merits and demerits of various supports were discussed. The catalytic activities of the ionic liquid-functionalized materials for biodiesel production were reviewed. Finally, we proposed the challenges and future development direction in this area.

Psychological Burden and Experiences Following Exposure to COVID-19: A Qualitative and Quantitative Study of Chinese Medical Student Volunteers.

Background: During the COVID-19 pandemic, some medical students devoted themselves to volunteer activities, but it was the first time that they had been exposed to such an infectious disease and they might have experienced fear in the face of the epidemic. We aimed to conduct a timely assessment of the psychological burden and experience on medical student volunteers during the COVID-19 pandemic. Methods: We used the 21-item Depression Anxiety Stress Scales to survey the psychology burden of students in April 2020. Semi-structured interviews were conducted with nine medical students who signed up for volunteer activities in Chinese from February to April 2020. Quantitative and qualitative methods were used to analyze the data. Results: The detection of depression, anxiety and stress of medical student volunteers were 26.8%, 20.2% and 11.1%, respectively. The volunteer's negative emotions were more pronounced before work and diminished gradually. Most participants expressed no concern about being infected themselves, but worry about family infection. Participant's motivations for volunteering were primarily their duties as medical students and encouragement from their families/teachers. The vast majority of medical students said they would be willing to work as medical assistants again and this experience would not affect their career choice. Conclusions: Chinese medical student volunteers tended to show negative emotions at the beginning of their work, and then gradually declined, while positive emotions emerged. Most medical students were willing to volunteer as medical assistants when their country needed them due to their sense of responsibility as medical students. This study on the psychological and experiential aspects were derived from Chinese medical student volunteers and might have a significant impact on future public health emergencies in similar settings.

Predictors of fatal outcomes among hospitalized COVID-19 patients with pre-existing hypertension in China.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is an emerging, rapidly evolving pandemic, hypertension is one of the most common co-existing chronic conditions and a risk factor for mortality. Nearly one-third of the adult population is hypertensive worldwide, it is urgent to identify the factors that determine the clinical course and outcomes of COVID-19 patients with hypertension. METHODS AND RESULTS: 148 COVID-19 patients with pre-existing hypertension with clarified outcomes (discharge or deceased) from a national cohort in China were included in this study, of whom 103 were discharged and 45 died in hospital. Multivariate regression showed higher odds of in-hospital death associated with high-sensitivity cardiac troponin (hs-cTn) > 28 pg/ml (hazard ratio [HR]: 3.27, 95% confidence interval [CI]: 1.55-6.91) and interleukin-6 (IL-6) > 7 pg/ml (HR: 3.63, 95% CI:1.54-8.55) at admission. Patients with uncontrolled blood pressure (BP) (n = 52) which were defined as systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg for more than once (≥2 times) during hospitalization, were more likely to have ICU admission (p = 0.037), invasive mechanical ventilation (p = 0.028), and renal injury (p = 0.005). A stricter BP control with the threshold of 130/80 mm Hg was associated with lower mortality. Treatment with renin-angiotensin-aldosterone system (RAAS) suppressors, including angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARB), and spironolactone, was associated with a lower rate of ICU admission compared to other types of anti-hypertensive medications (8 (22.9%) vs. 25 (43.1%), p = 0.048). CONCLUSION: Among COVID-19 patients with pre-existing hypertension, elevated hs-cTn and IL-6 could help clinicians to identify patients with fatal outcomes at an early stage, blood pressure control is associated with better clinical outcomes, and RAAS suppressors do not increase mortality and may decrease the need for ICU admission.

Risk Factors of Fatal Outcome in Hospitalized Subjects With Coronavirus Disease 2019 From a Nationwide Analysis in China.

BACKGROUND: The novel coronavirus disease 2019 (COVID-19) has become a global health emergency. The cumulative number of new confirmed cases and deaths are still increasing out of China. Independent predicted factors associated with fatal outcomes remain uncertain. RESEARCH QUESTION: The goal of the current study was to investigate the potential risk factors associated with fatal outcomes from COVID-19 through a multivariate Cox regression analysis and a nomogram model. STUDY DESIGN AND METHODS: A retrospective cohort of 1,590 hospitalized patients with COVID-19 throughout China was established. The prognostic effects of variables, including clinical features and laboratory findings, were analyzed by using Kaplan-Meier methods and a Cox proportional hazards model. A prognostic nomogram was formulated to predict the survival of patients with COVID-19. RESULTS: In this nationwide cohort, nonsurvivors included a higher incidence of elderly people and subjects with coexisting chronic illness, dyspnea, and laboratory abnormalities on admission compared with survivors. Multivariate Cox regression analysis showed that age ≥ 75 years (hazard ratio [HR], 7.86; 95% CI, 2.44-25.35), age between 65 and 74 years (HR, 3.43; 95% CI, 1.24-9.5), coronary heart disease (HR, 4.28; 95% CI, 1.14-16.13), cerebrovascular disease (HR, 3.1; 95% CI, 1.07-8.94), dyspnea (HR, 3.96; 95% CI, 1.42-11), procalcitonin level > 0.5 ng/mL (HR, 8.72; 95% CI, 3.42-22.28), and aspartate aminotransferase level > 40 U/L (HR, 2.2; 95% CI, 1.1-6.73) were independent risk factors associated with fatal outcome. A nomogram was established based on the results of multivariate analysis. The internal bootstrap resampling approach suggested the nomogram has sufficient discriminatory power with a C-index of 0.91 (95% CI, 0.85-0.97). The calibration plots also showed good consistency between the prediction and the observation. INTERPRETATION: The proposed nomogram accurately predicted clinical outcomes of patients with COVID-19 based on individual characteristics. Earlier identification, more intensive surveillance, and appropriate therapy should be considered in patients at high risk.

Clinical characteristics of COVID-19 infection in chronic obstructive pulmonary disease: a multicenter, retrospective, observational study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has been a global pandemic disease, with more than 4 million cases and nearly 300,000 deaths. Little is known about COVID-19 in patients with chronic obstructive pulmonary disease (COPD). We aimed to evaluate the influence of preexisting COPD on the progress and outcomes of COVID-19. METHODS: This was a multicenter, retrospective, observational study. We enrolled 1,048 patients aged 40 years and above, including 50 patients with COPD and 998 patients without COPD, and with COVID-19 confirmed via high-throughput sequencing or real-time reverse transcription-polymerase chain reaction, between December 11, 2019 and February 20, 2020. We collected data of demographics, pathologic test results, radiologic imaging, and treatments. The primary outcomes were composite endpoints determined by admission to an intensive care unit, the use of mechanical ventilation, or death. RESULTS: Compared with patients who had COVID-19 but not COPD, those with COPD had higher rates of fatigue (56.0% vs. 40.2%), dyspnea (66.0% vs. 26.3%), diarrhea (16.0% vs. 3.6%), and unconsciousness (8.0% vs. 1.7%) and a significantly higher proportion of increased activated partial thromboplastin time (23.5% vs. 5.2%) and D-dimer (65.9% vs. 29.3%), as well as ground-glass opacities (77.6% vs. 60.3%), local patchy shadowing (61.2% vs. 41.4%), and interstitial abnormalities (51.0% vs. 19.8%) on chest computed tomography. Patients with COPD were more likely to develop bacterial or fungal coinfection (20.0% vs. 5.9%), acute respiratory distress syndrome (ARDS) (20.0% vs. 7.3%), septic shock (14.0% vs. 2.3%), or acute renal failure (12.0% vs. 1.3%). Patients with COPD and COVID-19 had a higher risk of reaching the composite endpoints [hazard ratio (HR): 2.17, 95% confidence interval (CI): 1.40-3.38; P=0.001] or death (HR: 2.28, 95% CI: 1.15-4.51; P=0.019), after adjustment. CONCLUSIONS: In this study, patients with COPD who developed COVID-19 showed a higher risk of admission to the intensive care unit, mechanical ventilation, or death.

Synthesis of a new long-wavelength latent fluorimetric indicator for analytes determination in the DT-Diaphorase coupling dehydrogenase assay system.

We synthesized a new long-wavelength latent fluorogenic probe BQC (1) to monitor DTD activity. The fluorogenic chemical transformation of BQC triggered by DTD in the presence of NADH is through a series of tandem reactions, DTD-catalyzed benzoquinone reduction, trimethyl-locks cyclization and intramolecular urea formation, which are spontaneous and irreversible at physiological temperature in aqueous media. The fluorescence signal revealed by this process is specific and exhibited in the near red spectrum region with emission maxima at 595 nm, and it could be competitively inhibited by menadione. The fluorescent response of BQC is insensitive to various biological thiol reductants. Furthermore, pro-fluorophore BQC is a sensitive fluorimetric indicator for analytes determination in the oxygen-insensitive DTD-coupled dehydrogenases assay by including NAD(+) which will convert to NADH by reaction in the presence of analytes. This novel oxygen-insensitive assay demonstrates a good relationship in detecting 3-hydroxybutyrate and glucose-1-phosphate in 1-10 microM range, which presents to the applicability for the construction of fiber-optic biosensors in the future clinical diagnostic.

Development and biological evaluation of C(60) fulleropyrrolidine-thalidomide dyad as a new anti-inflammation agent.

Research studies in the field of C(60) fullerene derivatives have significantly increased due to the broad range of biological activities that were found for these compounds. We designed and prepared a new C(60) fullerene hybrid bearing thalidomide as a potential double-action anti-inflammatory agent, capable of simultaneous inhibition of LPS-induced NO and TNF-alpha production. The C(60) fulleropyrrolidine-thalidomide dyad, CLT, was an effective agent to suppress the release of NO and TNF-alpha by the LPS-stimulated macrophages RAW 264.7. Ten micromolars of CLT effectively inhibited LPS-induced NO and TNF-alpha production by 47.3+/-4.2% and 70.2+/-4% with respected to the control, respectively. Furthermore, preliminary biochemical investigation revealed that CLT was a potent agent to suppress both LPS-induced intracellular ROS production and iNOS expression, and CLT also inhibited the phosphorylation of ERK which is an important protein kinase involved in the activation of TNF-alpha synthesis in LPS-activated macrophages. We believed that the studies herein would hold promise for future development of a new generation of potent anti-inflammatory agents.

[Four-stage gradual expanding approach of problem based learning in otorhinolaryngology].

OBJECTIVE: The aim of the study is to cover the shortages of PBL, such as time-consuming, abstract, lacking of the course of clinic practice, and to introduce PBL to the teaching of otorhinolaryngology. METHOD: By the improvement of the international classic teaching model of PBL, we put forward "four-stage gradual expanding approach of PBL" and establish "four-stage gradual expanding approach of PBL in otorhinolaryngology". RESULT: Through the four stages of watching PBL, simulation PBL, internship PBL, practice PBL, we have accomplished the organic integration of theory teaching and clinical practice. CONCLUSION: This teaching method is more adaptive to the teaching of otorhinolaryngology, and it can help the medicine students to establish the whole concept of medicine and can stimulate them to form the good habits of self-regulated learning and life-long learning efficiently.

[The establishment of paired-standardized patients and its application in the PBL teaching of otorhinolaryngology].

OBJECTIVE: The aim of the study is to explore the establishment of paired-standardized patients (PSPs), which can cover the deficiency of standardized patients. METHOD: The outpatients and standardized patients consist of PSPs. The standard case of PSPs is established by the combination of PSPs and the laboratory and imaging information of the true patients. Then we apply the PBL model and PSPs to the clinic teaching in otorhinolaryngology. RESULT: The study of the ten standard cases of PSPs, which we have established, has enhanced the confidence and interest of medical students in clinical practice. CONCLUSION: PSPs can cover the deficiency of standardized patients, which includes lacking of change and lively. At the other hand, PSPs can practice the medical students' clinical skills and the way of evidence-based medicine and can stimulate them to form the good habit of self-regulated learning.

[Innovation of the curriculum system of otorhinolaryngology and its impact on education of capable medical students].

OBJECTIVE: The impact of the curriculum system innovation of otorhinolaryngology in the education of capable medical student was investigated. METHOD: The curriculum system of otorhinolaryngology in our college was innovated. The innovated curriculum of otorhinolaryngology was put in practice in 3 grades of undergraduate students and 2 grades of seven-year education system students. RESULT: The clinical practice ability and the mast of the knowledge of otorhinolaryngology were improved significantly. CONCLUSION: The principle of the curriculum system innovation of otorhinolaryngology in our college is effective and, therefore, valuable in education of potential and capable medical students for other subjects of clinical medicine.

[Innovation and practice of college educational system in otorhinolaryngology].

OBJECTIVE: A series of educational innovation was performed in order to resolve the difficulties and conflict in the education of otorhinolaryngology of medical college. METHOD: The college educational system of otorhinolaryngology was established and put in practice in four grades of medical undergraduate students of 1997-2000 grade. RESULT: The scores and ability of medical students in otorhinolaryngology are improved significantly. Educational supervisors and the managers give high appreciation to the educational innovation of otorhinolaryngology. It was demonstrated that the innovated educational system is satisfactory for the college education of otorhinolaryngology. CONCLUSION: The innovated college educational system of otorhinolaryngology afford a good way to solve the difficulties and conflict in the college education of otorhinolaryngology. It is also valuable to other subjects in the clinical medical education of college education system.