Curriculum System Reform for Management Majors Based on the Paradigm of “Sydney Accord”

The curriculum system is the guiding ideology of educational activities as well as the concretization and support of training objectives. It stipulates the planning scheme for the implementation of training objectives. The curriculum system is mainly composed of specific curriculum view, curriculum goal, curriculum content, curriculum structure, and curriculum activity mode, in which professional talent training goal, talent training specification, and systematic curriculum play important roles. This article relies on the first batch of research projects on teaching under the “13th Five-Year Plan” for higher education by Zhejiang Provincial Department of Education in 2018. It sorts out and summarizes the practical experience of teaching reform involved in the project, so as to further explore scientific and effective ways of professional teaching reform.

Conversion Therapy of Unresectable Pancreatic Cancer: A Retrospective Study of the Real World

Objective: A retrospective study of the real world was conducted to analyze whether patients with unresectable pancreatic cancer (URPC) can benefit from conversion therapy, and to screen out pancreatic cancer patients who are suitable for conversion therapy.Patients and Methods: Inquired about patients with URPC who visited Zhejiang Provincial People's Hospital from January 2015 to April 2021. We selected 25 patients with URPC who underwent conversion therapy, and 19 patients with locally advanced pancreatic cancer (LAPC) who directly underwent surgery to conducted a retrospective analysis. Results: The median overall survival (OS) of 25 patients with URPC who received conversion therapy was 28 months (95%CI: 15.46-40.54 months), and the median progression-free survival (PFS) was 12 months (95%CI: 9.26-14.74 months). The curative resection (R0) rate was 84% (22/25).Conclusions: Conversion therapy improves the R0 rate of patients with URPC, and prolongs OS and PFS.

Exhibition Reviews

Museum of Russian Icons, Clinton, Massachusetts by Sheila K. HoffmanLocal Cultures Assisting Revitalization: 10 Years Since the Great East Japan Earthquake, National Museum of Ethology (Minpaku), Osaka by Aya TanakaTianjin Museum of Finance, Tianjin by Bai XueVegetation and Universe: The Collection of Flower and Bird Paintings, Zhejiang Provincial Museum, Hangzhou by Ni Na Camellia NgThree Kingdoms: Unveiling the Story, Tokyo National Museum and Kyushu National Museum, Japan, and China Millennium Monument, Nanshan Museum, Wuzhong Museum, and Chengdu Wuhou Shrine, People’s Republic of China by Mingyuan JiangTempest, Tasmanian Museum and Art Gallery, Hobart by Ashleigh McLarinWonders from the South Australian Museum, South Australian Museum, Adelaide by Sandra KearneyBrett Graham, Tai Moana, Tai Tangata, Govett Brewster Art Gallery, New Plymouth by Riria Hotere-BarnesThe “Inbetweenness” of the Korean Gallery at the Musée Guimet, Paris by Sumi Kim

Microbiology and Risk Factors of Surgical Site Infection in Limb Fractures

Background: Limb fractures are becoming more common, and implant implants increase the risk of surgical site infection.The purpose of this study was to identify risk factors and microbiological characteristics for surgical site infection of limb fractures.Methods: We reviewed the data of 4,478 patients with limb fractures treated at Zhejiang Provincial People's Hospital from January 2010 to January 2020, including demographic, fracture, and microbiological characteristics. Chi-square tests and multivariate logistic regression were used to identify risk factors.Results: Staphylococcus aureus is a major threat to surgical site infection of limb fractures (26.46%). Open fractures are a risk factor for gram-negative infections. The following factors are considered as risk factors for surgical site infection: lower limb fractures, diabetes mellitus (OR 2.911 ; 95% CI 1.767-4.793), hypoproteinemia (OR 5.153 ; 95% CI 2.478-10.714), vascular injury(OR 8.531 ; 95% CI 4.028-18.070), nerve injury(OR 1.966 ; 95% CI 1.132-3.414) and open fractures (OR 9.561 ; 95% CI 6.565-13.925).Conclusions: Patients with these factors are at risk of surgical site infection after open reduction and internal fixation, and orthopedic surgeons should pay attention to these patients.

Epidemiological and clinical characteristics of COVID-19 pneumonia in Zhejiang province, China: a description of early stage

BackgroundThe outbreak of the 2019 novel coronavirus since December, 2019, has now causing nearly 75 thousand confirmed cases in China (until paper preparing). This epidemic has posed significant threats to international health and the economy. Zhejiang province, which once had the 2nd most accumulative cases among all provinces, has now dropped to top No.5 (until paper preparing). It had a high discharge rates (43.86%) from hospital and the lowest death rate among all top 5 epidemic provinces, this drew our attention to the epidemiological, clinical characteristics and local government engagement of this region.MethodsIn this study, we included all confirmed cases of COVID-19 pneumonia in Zhejiang province from Jan 21 to Feb 11, 2020. All data come from cases issued by Zhejiang provincial health commission.ResultsUntil Feb 11, 2020, 1143 cases were confirmed in Zhejiang province. We analysed the cases growth information in Zhejiang province and age, gender, severe cases percent, the source of the patients, the time of disease onset to confirm and the clinical symptoms of the patients. We also compared the clinical symptoms of elders and the young.ConclusionsThe patients in Zhejiang province had no age and gender preference, and the average time of disease onset to confirm was 5.9 days. The clinical symptoms were mainly fever, cough and weakness, similarly with before reported. The difference between elders and younger are not significant. Until paper preparing, Zhejiang province has very high discharge rate and low death rate, low cases increase rate in China.

Thyroid function abnormalities in COVID-19 patients

BackgroundThe novel coronavirus COVID-19, has caused a worldwide pandemic, impairing several human organs and systems. Whether COVID-19 affects human thyroid function remains unknown.Methods84 hospitalized COVID-19 patients in the First Affiliated Hospital, Zhejiang University School of Medicine (Hangzhou, China) were respectively enrolled in this study. In addition, 91 other patients with pneumonia and 807 healthy subjects were included as controls.FindingsWe found that the levels of TT3 and TSH were lower in COVID-19 patients than control groups (p<0·001). Within the group of COVID-19 patients, 61.9% patients (52/84) presented with thyroid function abnormalities. We found a larger proportion of patients in severe condition exhibited thyroid dysfunction than mild/moderate cases (74·6% vs. 23·8%, p < 0·001). Patients with thyroid dysfunction tended to have increased interval time for negative conversion of viral nucleic acid (14·1 ± 9·4 vs. 10·6 ± 8·3 days, p = 0·088). To note, thyroid dysfunction was also associated with decreased lymphocytes (p < 0·001) and increased CRP (p = 0·002). In 7 patients with dynamic changes of thyroid function, we observed the levels of TT3 and TSH gradually increased and reached normal range without thyroid hormone replacement at Day 30 post-admission. The correlation between TT3 and TSH level seemed to be positive rather than negative in the early stage, and gradually turned to be negatively related over time.InterpretationsThyroid function abnormalities are common in COVID-19 patients, especially in severe cases. This might be caused by virus attack and damage to the thyroid-pituitary axis. Therefore, more attention should be paid to thyroid function during treatment of COVID-19, and close follow-up is also needed after discharge.FundingThis study was supported by Zhejiang Provincial Science and technology department key R & D plan emergency project (No. 2020c03123-8).

Role of Drugs Affecting the Renin-Angiotensin-Aldosterone System on Susceptibility and Severity of COVID-19: A Large Case-Control Study from Zheijang Province, China

BackgroundMedical editorials have suggested that angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) should not be given to people with arterial hypertension during the coronavirus disease 2019 (COVID-19) pandemic because of a potential increased risk of worse clinical outcomes and that calcium channel blockers (CCBs) should be used as an alternative.MethodsUsing a cohort of 610 COVID-19 cases and 48,667 population-based controls from Zheijang, China we have tested the role of usage of ACEIs, ARBs, CCBs and other medications on risk and severity of COVID 19. Analyses were adjusted for age, sex and BMI and for presence of relevant comorbidities.FindingsHigher BMI, diabetes and cardio/ cerebrovascular disease are independent risk factors for the development of COVID-19. Individuals with hypertension taking CCBs had significantly increased risk [odds ratio (OR)= 1.67 (95% CI 1.2-2.9)) of manifesting symptoms of COVID-19 whereas those taking ARBs and diuretics had significantly lower disease risk (OR=0.24; 95%CI 0.17-0.34 and OR=0.32; 95%CI 0.19-0.57 respectively). Other antihypertensive drugs were not associated with increased risk of severe or critical form of the infection. Use of glucocorticoids was significantly associated with a severe/critical form of COVID-19 (OR= 7.56; 95%CI 1.17-48.93).InterpretationWe found no evidence to alter ARBs or ACEIs therapy in the context of the pandemic. Patients on corticosteroids with COVID-19 are at higher risk of developing a severe form of COVID-19and therefore should be monitored closely.FundingBy the Social Development Major Projects of Ningbo City (2016C51005), Medical Health Science and Technology Project of Zhejiang Provincial Health Commission (2018ZD039), Zhejiang Provincial natural science foundation (LGF20H030006) and by the NIHR Nottingham Biomedical Research Centre (Reference no: BRC-1215-20003).

Sonography of the Lungs: Diagnosis and Surveillance of Patients With COVID-19

The outbreak of a novel coronavirus (COVID-19) with symptoms that mimic bronchitis and other chest infections has created a need for quick diagnosis to prevent disease spread. Traditionally, computed tomography (CT) has been used as the primary method to identify infection and staging of the virus. While effective, repeated use of ionizing radiation, particularly in susceptible patient populations, can add risk as the disease is monitored through full recovery. Sonography of the chest may be a viable alternative for diagnosis and monitoring of COVID-19. In addition, new technology such as the remote robotic ultrasound equipment being used at Zhejiang Provincial People’s Hospital in Hangzhou, China, has the potential to facilitate sonographic evaluation with minimal disease exposure to the sonologist and to other patients by eliminating the need for patient transport to imaging facilities. Additional studies will need to be conducted to evaluate the effectiveness of sonography versus other imaging modalities in the diagnosis and treatment of COVID-19 and other novel diseases.

Assessing the Changes of Mumps Characteristics with Different Vaccination Strategies Using Surveillance Data: Importance to Introduce the 2-Dose Schedule in Quzhou of China

Background. From 2005 to 2016, the prevention and control of mumps in China have undergone three stages of transition. These include the use of MuCV as a self-supported vaccine, the introduction of one-dose MMR to the Expanded Program on Immunization (EPI), and the administration of two-dose MuCV following supplementary immunization activities (SIAs) using MM. Here, using surveillance data, we assessed the epidemiology of mumps during the three stages. Methods. Children in Quzhou of China born from 2005 to 2016 and registered in the Zhejiang Provincial Immunization Information System (ZJIIS) were included. We analyzed the epidemic data and calculated incidence and MuCV coverage via birth cohorts. Results. The average incidence of mumps in 2005-2006, 2007-2010, and 2011-2016 was 51.57, 41.02, and 12.53 per 100,000 individuals, respectively. The highest incidence was in children aged 6-14 years from 2005-2016, of which the majority were school students (67.84%). Approximately 90% of the reported outbreaks occurred in school children (primary school/middle school). The seasonal characteristics of mumps were less obvious from 2011 to 2016. The coverage of one-dose MMR in the 2005 birth cohort was 71.38%. For the 2006-2010 birth cohort, the coverage of one-dose MuCV was 96.82% and the coverage of two-dose MuCV was 17.68%. The children born from 2011 to 2016 were only free vaccinated with MMR; the coverage of one-dose MuCV was 99.10%. The mumps incidence in the three birth cohorts significantly declined (X2=805.90, P<0.001 for trend). Except the children less than two years old, the mumps incidence for the children born from 2006 to 2010 was higher than that for the children born from 2011 to 2016. Conclusion. The mumps incidence significantly declined following the introduction of one-dose MMR. The SIA using MM led to a rapid reduction of mumps cases. Therefore, we recommend a two-dose MuCV routine immunization schedule and improved vaccination coverage.