Demand and Analysis of Clinical Research Curriculum in Medical Universities

Objective:To investigate the needs of medical students regarding clinical research curricula to provide scientifically sound offerings and cultivate their clinical research thinking.Methods:From June to October 2022,medical students at medical universities in Shaanxi Province were surveyed using online questionnaires.The survey covered their demographic information,awareness of their major,understanding of clinical research,and preferences for curriculum content.Results:A total of 341 valid questionnaires were analyzed.Medical students demonstrated a strong awareness of their majors but a relatively low awareness of clinical research.There was significant demand for clinical research courses,with preferences for professionally oriented(81.8%),market-oriented(100%),theoretically and practically integrated teaching(78.6%),and application-focused(73.0%)courses.Conclusion:Medical colleges and universities should align clinical research curricula with the actual needs of medical students and clinical practice.Reforms in curriculum design and teaching methods are essential to better prepare students for careers in public health.

Exploration of Teaching Development Strategies for Double-Qualified Teachers in University- Affiliated Hospitals Based on Role Conflict Theory

This study draws on the classic theories and research achievements of university teacher development,and from the perspective of role conflict in social psychology,proposes policy recommendations for the development of clinical teachers in medical colleges,including following different stages of teacher development and designing teaching development strategies at different levels;designing the content and form of teaching development activities to meet the temporal and spatial needs of clinical teachers;and building an academic community for clinical teachers to promote the creation of teaching development behaviors.

Theoretical Analysis and Practical Reflection on the Role Conflict of Double-Qualified Teachers in University-Affiliated Hospitals

Taking role conflict as the starting point,this article examines and reflects on the development of clinical teachers.In the process of the occurrence,development,and resolution of role conflicts among clinical teachers,there are many hidden issues related to the development of clinical teachers.The development of clinical teacher teaching and role conflict management contain similar educational philosophies and practical issues.This study draws on classic theories and research achievements in the development of university teachers and conducts theoretical analysis and practical reflection on the development of clinical teachers in medical colleges from the perspective of role conflict in social psychology.Policy recommendations are proposed,including strengthening the construction of teaching systems at the hospital organizational environment level,enhancing the role identity and teacher beliefs of clinical teachers,promoting their teaching development and academic learning,and ensuring their normal teaching investment;promoting leadership support at the level of interpersonal interaction and leveraging the role of colleague support in alleviating role conflicts;enhancing individual teacher beliefs,teacher role learning,and role skills.

Exploring the Application of Refined Management in University Financial Management

The refined management of university finances primarily involves optimizing management methods and continuously improving financial management levels.This process helps enhance fund utilization efficiency,optimize resource allocation,ensure the rational use of educational funds,and provide solid financial support for the development of teaching,research,and other university undertakings.This paper explores the application of refined management in university financial management.

Current Situation and Improvement Strategies of Teaching Engagement by Teachers in Higher Medical Colleges Under the Background of“New Medical Education”

The“New Medical Education”is a new requirement for the development of medical education in the new era.As a key and core element of the construction of the“New Medical Education,”the engagement in teaching work of university teachers is a key issue that determines the level of teaching development of university teachers and affects the quality of talent cultivation in universities.Using the literature review method,this study analyzed 39 relevant literatures retrieved from China National Knowledge Infrastructure(CNKI)from 1997 to 2023.The concept,connotation,current situation,influencing factors,and improvement strategies of teaching engagement by university teachers were reviewed and summarized.The results showed that the issue of teaching engagement by university teachers has not received high attention in the field of higher education,especially in higher medical education,which has not yet been reported.Although the overall number of literature is not large,some of the conclusions have important implications for the next research on the influencing factors and mechanisms of double-qualified teacher engagement in higher medical colleges.

Construction and Practice of Teaching Staff and Teaching Quality Monitoring System in University Affiliated Hospitals Under the Background of Education Informatization

Objective:To build a set of teaching staff construction and teaching quality monitoring system suitable for clinical practice teaching in affiliated hospitals of medical colleges,achieve continuous improvement of clinical education and teaching level,and ensure the quality of medical education talent cultivation.Methods:A modern clinical practice teaching quality monitoring system is constructed based on organizational structure construction,teaching staff system construction,quality control system construction,and information platform construction,combined with external audit and evaluation.Results:The hospital has established a Faculty Development and Teaching Evaluation Office specifically responsible for the cultivation of clinical teachers and the evaluation and supervision of teaching quality.A relatively complete teacher construction and teaching quality monitoring system has also been established for clinical practice teaching,thus achieving integration with the school’s quality control system in terms of management mechanism.At the same time,a set of teaching quality control mode based on the“Internet+”platform has been created by means of informatization.At present,this mode has won three national computer software copyrights and two second prizes for school-level teaching achievements.Conclusion:Through five years of practice,an“Internet+”teaching quality evaluation and monitoring system with the characteristics of teaching hospitals affiliated to local medical colleges has been established.In order to further standardize the training system of clinical teachers in affiliated hospitals,achieve self-monitoring and self-improvement in terms of teaching quality,and ensure the continuous improvement of clinical teaching quality,we will continue to promote the development of clinical teachers with quality and excellence,enrich the main team of quality monitoring,guide the transformation of the education mode from being“centered on teachers”to being“centered on students,”and realize the integration of internal and external quality monitoring systems.

Etomidate protects retinal ganglion cells from hydrogen peroxide-induced injury via Nrf2/HO-1 pathway

AIM:To determine whether etomidate(ET)has a protective effect on retinal ganglion cells(RGCs)injured with hydrogen peroxide(H_(2)O_(2))and to explore the potential mechanism underlying the antioxidative stress effect of ET.METHODS:Cultured RGCs were identified by double immunofluorescent labeling of microtubule-associated protein 2 and Thy1.1.An injury model of H_(2)O_(2)-induced RGCs oxidative stress was established in vitro.Cells were pretreated with different concentrations of ET(1,5,and 10μmol/L)for 4h,followed by further exposure to H_(2)O_(2)at 1000μmol/L.Cell counting kit 8 and Annexin V/propidium iodide assays were applied to detect the viabilities and apoptosis rates of the RGCs at 12,24,and 48h after H_(2)O_(2)stimulation.The levels of nitric oxide,malondialdehyde,and glutathione in culture media were measured at these time points.Quantitative reverse transcription polymerase chain reaction(qRT-PCR)and Western blot were performed to observe the effects of ET on the messenger RNA and protein expression of inducible nitric oxide synthase(iNOS),nuclear factor erythroid 2-related factor 2(Nrf2),heme oxygenase 1(HO-1),glutathione peroxidase 1 and the level of conjugated acrolein in RGCs at 12,24,and 48h after H_(2)O_(2)stimulation and in the retina at 12h after optic nerve transection(ONT).RESULTS:The applications of 5 and 10μmol/L of ET significantly increased the viability of RGCs.Results from qRT-PCR indicated a decrease in the expression of iNOS and an increase in the expressions of Nrf2 and HO-1 in ETpretreated RGCs at 12,24 and 48h after H_(2)O_(2)stimulation,as well as in ET-treated retinas at 12h after ONT.Western blot analysis revealed a decrease in the expression of iNOS and levels of conjugated acrolein,along with an increase in the expressions of Nrf2 and HO-1 in ET-pretreated RGCs in vitro and ET-treated retinas in vivo.CONCLUSION:ET is a neuroprotective agent in primary cultured RGCs injured by H_(2)O_(2).The effect of ET is dosedependent with the greatest effect being at 10μmol/L.ET plays an antioxidant role by inhibiting iNOS,up-regulating Nrf2/HO-1,decreasing the production of acrolein,and increasing the scavenge of acrolein.

Study of Quality Standards of Xiao’er Qingre Enema Preparation in Hospitals

Objective:To establish the quality standards for the preparation of Xiao’er Qingre enema in hospitals.Method:Thin-layer chromatography(TLC)was used to identify Radix Isatidis and Glycyrrhizae in the prescription.The content of(R,S)-Goitrin was determined by high-performance liquid chromatography(HPLC).Results:In TLC identification,there was no interference between the negative controls of Radix Isatidis and glycyrrhizae,and the spots were well-separated.The HPLC results of(R,S)-Goitrin showed a good linear relationship between the peak area and concentration within the range of 0.476-95.2μg·mL-1(r=0.9999).Conclusion:The TLC and HPLC methods established in this experiment are simple,reproducible,and specific,making them suitable for the quality control Xiao’er Qingre enema preparation in hospitals.

Homogenization Construction of Three-Level Teaching Bases for General Practice Medicine Under the Internet+Model

With the continuous expansion of medical student enrollment,the number of clinical teaching bases is gradually increasing.However,there are significant differences in clinical teaching management models and teaching levels among different bases.Most clinical teaching bases have incomplete teaching management systems,inadequate teaching management institutions,insufficient teaching personnel,and inadequate implementation of teaching rules and regulations.This article combines the construction practice of three-level clinical teaching base of the General Medicine College and the First Affiliated Hospital of Xi’an Medical University.We establish a standardized management system for the three-level clinical teaching base;implement a teaching supervision system and strengthen the monitoring of teaching quality;adopt multiple evaluations to test the effectiveness of clinical teaching implementation;explore the path of homogenization construction of teaching bases in terms of unified teacher training,promoting the development of teacher teaching abilities with equal quality and excellence,and providing a reference for improving the quality of medical talent training.

Analysis of the Feedback on Teacher Training in an Affiliated Hospital in Shaanxi Province

Objective:This article aims to deeply analyze the feedback on teacher training in an affiliated hospital,so as to clarify the current needs and situation of teacher training and provide a scientific basis for further optimizing the teacher training system.Methods:The current situation and needs of teacher training in the affiliated hospital were collected by designing and distributing Tomato Form questionnaires on the DingTalk platform.The questionnaire adopted a percent-point system,all of which were indeterminate multiple-choice questions.Results:The average age of the clinical teachers participating in the survey was 40.44±7.85 years old,with an average teaching length of 4–10 years.The results showed that 60.20%of teachers think that the amount of teacher training in an affiliated hospital is sufficient;91.10%of teachers think that the factors affecting training conflict with working hours;97.96%of teachers believe that the training time has an impact on the training effect;81.63%of teachers prefer online training;51.53%of teachers tend to arrange training time on working days;33.16%of teachers tend to train once a month;17.78%of teachers prefer to receive training on clinical theoretical courses and practical teaching norms and skills content.Conclusion:Based on the above survey results,we propose to build a comprehensive management mechanism for teacher training,including improving the access,training,and assessment mechanism for clinical teachers,and adjusting and optimizing the training program according to actual needs.At the same time,an effective communication platform should be built to promote the deep integration of teaching and practice and enhance social recognition,so as to comprehensively improve the teaching quality and medical service of the hospital.

Situation and Development Path of Humanistic Education in Medical Colleges and Universities in China

Humanistic education,as the“internal structure”of medical education,attempts to cultivate medical students’humanistic knowledge,ability,and comprehensive quality as well as makes adjustments with the evolvement of medical education.The global medical education reform has undergone three stages:expert medicine,clinical practice medicine,and public service medicine.Public service medicine,which took place in the 21st century,is a system-based and competency-oriented education,highlighting the construction of a health service system with medical and educational cooperation as well as the cultivation of medical students’comprehensive quality.China’s medical education started late and has a weak foundation with many twists and turns.Through the rapid development of reform and opening-up,China has narrowed the gap with international medical education and established a perfect medical curriculum system.China has successively promulgated a number of documents,such as the“Outline of Reform and Development of Medical Education in China”and the“Opinions on Strengthening the Collaboration between Health Departments and Education Departments to Implement the Doctor of Excellence Education Training Program 2.0,”with the goal of cultivating high-quality excellent medical talents.Medical students in colleges and universities are senior talents in medical training,health care services,and medical research.Their humanistic quality is not only related to the growth of medical talents,but also the quality of medical services.This paper analyzes and discusses the problems encountered in improving humanistic education and looks forward to providing reasonable as well as effective solutions to the difficulties faced by humanistic education in the new era through comparative research.

A Study on the Cultivation of Professional Values among Rural-Orientated Targeted Medical Students in Shaanxi Province

Objective:Through investigation,we can grasp the current situation of the professional identity of rural-orientated targeted medical students in Shaanxi Province,so as to cultivate these medical students to establish correct professional values,thus improving the performance rate.Methods:Questionnaires were distributed,and interviews were carried out in three colleges and universities in Shaanxi Province.Results:Targeted medical students lack professional understanding,and their professional identity needs to be improved through medical education.Conclusion:It is suggested that colleges and universities should take measures such as setting up courses and lectures,strengthening communication between teachers and students,carrying out ritual education and social practice,as well as selecting teaching teachers to strengthen the professional values of targeted medical students。

Current Situation of the Teaching of Ophthalmology in General Practice Medical Education and the Application of TBL

Ophthalmology is an integral part of general practice education,and it is of great significance to have some knowledge on ophthalmology even if the general practitioner is not an ophthalmologist.The subject characteristics,the traditional mode of teaching,and the cognitive deviation of students have greatly influenced its teaching quality.The application of team-based learning(TBL)in ophthalmology education responds to the demand of modern medical education.Building a team,designing questions that combine theory and clinical practice,as well as employing a fair scoring system can stimulate students’learning interest and improve their learning autonomy and ability to ask questions and solve problems.

Revision of “Introduction to General Medicine” Based on the Six-Step Curriculum Development Process

Objective:Based on the six-step curriculum development process proposed by Professor Schneiderhan et al.,the course needs,the cognition,and course summative assessment results,combined with the career preferences and work value orientation of clinical medical students undertaking the course“Introduction to General Medicine”were surveyed.Methods:A self-designed questionnaire was used to collect information on the course cognition,course summative evaluation,and professional inclination of 233 junior medical students majoring in clinical medicine undertaking the course“Introduction to General Practice.”An analysis was conducted to provide a basis for curriculum revision in accordance with the structured composition of the curriculum development process.Results:(i)In terms of course cognition,before the course,67.0%of students were unaware of general medicine and general practitioners,73.0%of students had never participated in practical activities(including volunteer work),and 53.6%of students expressed interest in the course;there were significant differences in the growth environment,the frequency of participation in club activities,the cognition of general medicine/general practitioners before the course,participation in practical activities(including volunteer work),attentiveness to the current situation of medical treatment,and the interest toward the course(P<0.05);multi-factor logistics analysis showed that the factors influencing the interest toward the course include growth environment,frequency of participation in club activities,course cognition,participation in practical activities,and attentiveness to the current status of development of medical treatment.(ii)The course summative assessment results showed that 91.8%of students felt that it is necessary to learn this course,33.9%of students felt that the most important thing in the course is to learn the theoretical knowledge of general medicine and related diagnosis and treatment skills,53.2%of students felt that the most unfavorable factor affecting the learning of this course is the lack of interest in general medicine,and 64.4%of students hoped for more clinical practice to understand and participate in the work of general practitioners;paired t-test revealed differences in career preferences before and after the course(P<0.05);after the course,more students thought that general practitioner is an ideal career option.(iii)The results showed that 58.8%of students had considered their future specialty but did not have specific goals or plans,while 21.9%had considered their future specialty and had clear goals;there was a significant difference in professional inclination between genders as well as those who were attentive to the current state and development of medical treatment in our country and those who were not(P<0.05);with regard to the scores of importance in terms of the influencing factors of professional inclination,interest and possibility of professional development scored 3.92,ranking first,followed by income,which scored 3.91,and career prestige,which scored the lowest(3.62).Conclusion:Based on the needs assessment of clinical medical students,it is important to focus on improving students’interest in general medicine,especially their cognition and professional understanding of the course before the course itself,in addition to the development of relevant practical activities,and their attentiveness to the current state and development of medical treatment.The summative assessment results suggest that the implementation of this course has a positive influence on the career preferences of clinical medical students to a certain extent.Therefore,it is necessary to combine the course content with the development of general medicine,so as to stimulate students’interest in self-driven learning and in general medicine.This will attract more students whose work value orientation is influenced by interest and possibility of professional development to choose general practitioner as their future professional inclination.

Clinical Observation of Non-Staining Circular Capsulorhexis for Hypermature Cataract

Objective:To explore the circular capsulorhexis method and its clinical effect in phacoemulsification of hypermature cataract without staining.Methods:In this prospective randomized case-control study,22 patients(22 eyes)with hypermature cataract were randomly divided into a staining agent group(10 cases,10 eyes)and a non-staining agent group(12 cases,12 eyes).Both groups underwent phacoemulsification with foldable intraocular lens implantation under topical anesthesia.In the staining agent group,0.5%indocyanine green was used to stain the anterior lens capsule to assist in circular capsulorhexis;in the non-staining agent group,after puncturing the anterior lens capsule and aspirating the liquefied cortical material,the capsular bag was filled with viscoelastic agent to increase the contrast prior to circular capsulorhexis.The operability of the anterior capsule without staining in capsulorhexis was observed,and the effect of capsulorhexis,diameter of capsulorhexis opening,and operative time were compared and analyzed between the two groups.Results:Both groups successfully underwent circular capsulorhexis,with a success rate of 100%.The diameters of capsulorhexis opening in the staining agent group and non-staining agent group were 5.68±0.15 mm and 5.54±0.16 mm,respectively,without any statistical difference between the groups(P>0.05);the operative time of the staining agent group(40.40±5.42 s)was shorter than that of the non-staining agent group(50.92±3.97 s),and the difference was statistically significant(P<0.001).In both groups,phacoemulsification was successful,and intraocular lens were implanted into the capsular bags;their visual acuity showed significant improvement during the 1-month follow-up period after surgery,without any surgical complications.Conclusion:In hypermature cataract,injecting viscoelastic agent into the capsular bag for volume replacement,given a lack of capsule staining agent,can increase the contrast for capsulorhexis and reduce the risk of large capsular bag collapse on the zonular ligament.Thus,it is considered safe and effective.Circular capsulorhexis is conducive to a smooth phacoemulsification procedure.

DNA hypermethylation of COL4A1 in ultraviolet-Binduced age-related cataract models in vitro and in vivo

AIM:To explore the DNA methylation of COL4A1 in ultraviolet-B(UVB)-induced age-related cataract(ARC)models in vitro and in vivo.METHODS:Human lens epithelium B3(HLEB3)cells and Sprague Dawley rats were exposure to UVB respectively.The MTT assay was utilized to evaluate cell proliferation.Flow cytometry was employed for analysis of cell apoptosis and cell cycle.COL4A1 expression in HLEB3 cells and anterior lens capsules were assessed using Western blot and reverse transcription-polymerase chain reaction(RTPCR).The localization of COL4A1 in HLEB3 cells was determined by immunofluorescence.The methylation status of CpG islands located in COL4A1 promoter was verified using bisulfite-sequencing PCR(BSP).DNMTs and TETs mRNA levels was examined by RT-PCR.RESULTS:UVB exposure decreased HLEB3 cells proliferation,while increased the apoptosis rate and cells were arrested in G0/G1 phase.COL4A1 expression was markedly inhibited in UVB treated cells compared to the controls.Hypermethylation status was detected in the CpG islands within COL4A1 promoter in HLEB3 cells subjected to UVB exposure.Expressions of DNMTs including DNMT1/2/3 were elevated in UVB treated HLEB3 cells compared to that in the controls,while expressions of TETs including TET1/2/3 showed the opposite trend.Results from the UVB treated rat model further confirmed the decreased expression of COL4A1,hypermethylation status of the CpG islands at promoter of COL4A1 and abnormal expression of DNMT1/2/3 and TET1/2/in UVB exposure group.CONCLUSION:DNA hypermethylation of COL4A1 promoter CpG islands is correlated with decreased COL4A1 expression in UVB induced HLEB3 cells and anterior lens capsules of rats.

Facilitators and barriers to parent-child communication in pediatric palliative care:An integrative review

Objectives:This study aimed to identify facilitators and barriers to parent-child communication in pediatric palliative care,providing insights for medical professionals developing targeted interventions to enhance parent-child communication and improve its effectiveness.Methods:Whittemore and Knafl’s integrative review method was employed to guide a systematic search for literature in six databases(Medline,Embase,CINAHL Complete,PsycINFO,Web of Science,and Cochrane Library).Peer-reviewer articles published in the English language from inception to December 2023.All of the identified studies were screened,extracted,and analyzed independently by two researchers.Results:Twenty-four articles were included.Thefindings of the relevant studies were analyzed using thematic analysis.Four themes were identified as facilitators:legacy-making,resilience training programs,guidance from the healthcare team,and positive communication.Seven themes were identified as barriers:denial,being unprepared and evasive,mutual protection,being overwhelmed by painful emotions and overloaded with information,incorrect views of medical professionals and parents,negative communication,and cultural context.Conclusions:Parents and professionals should avoid myths about protecting the child and encourage open communication that respects the child’s wishes.The specialized pediatric palliative care team should carefully monitor parent-child communication,determine if any obstacles exist,and design more interventions to enhance it.

Ghrelin inhibits autophagy mediated by AKT/mTOR pathway to ameliorate retinal angiogenesis induced by high glucose stress

AIM:To observe the effect of ghrelin,a growth hormonereleasing peptide,on retinal angiogenesis in vitro under high glucose(HG)stress and to explore the possible mechanism of autophagy.METHODS:Human retinal microvascular endothelial cells(HRMECs)were treated with high concentration of glucose alone or in combination with ghrelin.The cell migration,tube formation and the expression of the autophagy-related proteins LC3-II/I,Beclin-1,p62,phosphorylated AKT(p-AKT)/AKT and phosphorylated mammalian target of rapamycin(p-mTOR)/mTOR were detected.Then,to clarify the correlation between ghrelin effect and autophagy,AKT inhibitor VIII was adopted to treat HRMECs,and cell migration,tube formation as well as the protein expressions of LC3-II/I,Beclin-1 and p62 were observed.RESULTS:Under HG stress,ghrelin inhibited migration and tube formation of HRMECs.Ghrelin inhibited the increases in the protein levels of LC3-II/I,Beclin-1 and the decreases in the protein levels of p62,p-AKT/AKT and p-mTOR/mTOR induced by HG stress.Moreover,under the action of AKT/mTOR pathway inhibitors,the effects of ghrelin on migration and tube formation were both reduced.In addition,the expression of LC3-II/I and Beclin-1 were significantly up-regulated and the expression of p62 was down-regulated.CONCLUSION:Retinal angiogenesis under in vitro HG stress can be inhibited by ghrelin through activating AKT/mTOR pathway to inhibit autophagy.

Investigating the charge transfer mechanism of ZnSe QD/COF S-scheme photocatalyst for H_(2)O_(2) production by using femtosecond transient absorption spectroscopy

Hydrogen peroxide(H_(2)O_(2))has gained widespread attention as a versatile oxidant and a mild disin-fectant.Here,an electrostatic self-assembly method is applied to couple ZnSe quantum dots(QDs)with a flower-like covalent organic framework(COF)to form a step-scheme(S-scheme)photocata-lyst for H_(2)O_(2)production.The as-prepared S-scheme photocatalyst exhibits a broad light absorption range with an edge at 810 nm owing to the synergistic effect between the ZnSe QDs and COF.The S-scheme charge-carrier transfer mechanism is validated by performing Fermi level calculations and in-situ X-ray photoelectron and femtosecond transient absorption spectroscopies.Photolumi-nescence,time-resolved photoluminescence,photocurrent response,electrochemical impedance spectroscopy,and electron paramagnetic resonance results show that the S-scheme heterojunction not only promotes charge carrier separation but also boosts the redox ability,resulting in enhanced photocatalytic performance.Remarkably,a 10%-ZnSe QD/COF has excellent photocatalytic H_(2)O_(2)-production activity,and the optimal S-scheme composite with ethanol as the hole scavenger yields a H_(2)O_(2)-production rate of 1895 mol g^(-1)h^(-1).This study presents an example of a high-performance organic/inorganic S-scheme photocatalyst for H_(2)O_(2)production.

Gigantic occipital epidermal cyst in a 56-year-old female:A case report

BACKGROUND Gigantic epidermal cysts(GECs)are rare benign skin appendicular tumours also known as keratinocysts.GECs have a high incidence and their wall is made up of epidermis.Epidermal cysts can occur in any part of the skin;clinical manifestations include skin colour hemispherical swelling;cystic;mobile;0.5 cm to several centimetres in diameter;and slow growth.CASE SUMMARY Herein,we report a case involving a 56-year-old female with a GEC in the occipitalia.On July 25,2023,a patient with a GEC was admitted to the neurosurgery Department of the Second Affiliated Hospital of Xi'an Medical University.The phyma was shown to be a solid mass during the operation and was confirmed to be a GEC based on pathological examination.CONCLUSION Epidermal cysts are common cystic nodules on the surface of the body,the aetiology is unclear,the clinical manifestations can vary,and the misdiagnosis rate is high.However,giant epidermal cysts are rare.In most cases,however,the prognosis is satisfactory.This paper analyses and summarizes the population,location,clinical and pathological characteristics and pathogenesis of the disease to strengthen the understanding of this disease and improve the accuracy of clinical diagnosis.