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Molecular Biology is the core course of biology major, whose fundamentals are classical and which develops rapidly as well. The introduction of the discipline frontiers is an ideal way to enhance the vitality of the classroom. Based on MOOC resources, the course group combined online independent study and offline face to face class to implement blended learning. Driven by the discipline frontiers, diversified teaching methods were introduced and classroom ecology was reconstructed. Multiple teaching sessions, including students’ independent study, questioning and presentation, class leading role of the teachers, questions and answers and knowledge expansion have been rolled out and unified so as to cultivate the science and humanity spirit of the students and enhance the vitality of the classroom. This blended teaching model effectively exercises students’ innovative thinking, improves students’ participation, and plays a positive role in enriching learning experience, stimulating professional dream and promoting students’ enlightenment.
ABSTRACT
Objective To evaluate the predictive value of neutrophil to lymphocyte ratio (NLR) on 28-day mortality of patients with severe pneumonia. Methods The clinical data of 214 severe pneumonia patients admitted to the department of emergency medicine of the First Affiliated Hospital of Xi'an Jiao Tong University from January 2015 to December 2018 were retrospectively analyzed. The clinical parameters, such as gender, age, underlying diseases, and blood routine, procalcitonin (PCT), liver and kidney function, blood lactic acid (Lac), arterial partial pressure of oxygen (PaO2) at admission or within 24 hours after admission were reviewed. NLR, oxygenation index (PaO2/FiO2) and acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) were calculated, and the change tendency of each index within 3 days after admission were observed. The patients were divided into survival group and death group according to 28-day outcomes. Multivariate Logistic regression analysis was used to screen the high risk factors of 28-day mortality in patients with severe pneumonia. Receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of NLR for 28-day mortality risk in patients with severe pneumonia. Results 214 patients were enrolled in the analysis, 132 survived in 28 days and 82 died. Compared with survival group, the white blood cell (WBC), neutrophil (NEU), NLR, PCT, Lac and APACHEⅡ scores were significantly increased, and lymphocyte (LYM) was significantly decreased in the death group. There was no significant difference in gender, age, basic diseases, platelet count (PLT), liver and kidney function parameters, or PaO2/FiO2 between the two groups. The NLR, PCT, Lac and APACHEⅡ score in the death group were increased gradually within 3 days after admission, PaO2/FiO2 was decreased gradually, which showed significant differences as compared with survival group at 3 days after admission [NLR: 27.15±7.61 vs. 14.66±4.83, PCT (μg/L): 13.52±3.22 vs. 6.41±4.22, Lac (mmol/L): 6.78±1.70 vs. 2.74±1.15, APACHEⅡ score: 37.76±5.30 vs. 22.11±4.94, PaO2/FiO2 (mmHg, 1 mmHg = 0.133 kPa): 114.12±20.16 vs. 186.49±13.95, all P < 0.05]. Multiple Logistic regression analysis showed that NLR [odds ratio (OR) = 1.163, 95% confidence interval (95%CI) =1.007-1.343, P = 0.040], PCT (OR = 1.210, 95%CI = 1.098-1.333, P = 0.001), Lac (OR = 1.263, 95%CI = 1.011-1.579, P = 0.040) and APACHEⅡ score (OR = 1.103, 95%CI = 1.032-1.179, P = 0.004) were the independent risk factors of 28-day mortality in the patients with severe pneumonia. ROC curve analysis showed that compared with the traditional indicators including PCT, Lac, and APACHEⅡ score, NLR showed a good predictive value for 28-day mortality in the patients with severe pneumonia [area under ROC curve (AUC): 0.791 vs. 0.707, 0.690, 0.720]. When the optimal cut-off value of NLR was 14.92, the sensitivity was 71.95% and the specificity was 73.48%, meanwhile, the positive likelihood ratio was 2.713 and the negative likelihood ratio was 0.382. Conclusion The increased NLR at admission is a high risk factor of 28-day mortality in patients with severe pneumonia, which is useful for predicting prognosis of patients with severe pneumonia.
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Dynamic changes in mRNA expressions of liver tissue apoptosis-promoting genes Fas and Bax and apoptosis-inhibiting gene Bcl-2 of vibrio vulnificus sepsis rats were detected and the effects of antibacterial agents were examined.The rat model with Vibrio vulnificus sepsis (VV group) was established and some of the Vibrio vulnificus sepsis rats were treated with antibacterial agents (AA group).The mRNA expressions of Fas,Bax and Bcl-2 were measured by reverse transcription polymerase chain reaction (RT-PCR).As compared with normal control group (NC group),the expressions of Fas and Bax mRNA in liver tissue at all different time points in VV group were increased significantly (P<0.05),and the highest levels of Fas and Bax mRNA expressions were 6 and 12 h after the infection,respectively.At the same time,the expression of Bcl-2 mRNA in liver tissue at all different time points in VV group were decreased significantly (P<0.05),and the lowest level of Bcl-2 mRNA expression appeared 2 h after the infection.The mRNA expressions of Bcl-2 in liver tissue 9 and 12 h after the infection in AA group were increased significantly (P<0.05) compared with NC group,while the expressions of Fas and Bax mRNA were not significantly different from those of NC group.Compared with VV group,the expression of Fas mRNA in AA group was decreased (P<0.05) and Bax mRNA was decreased significantly 12 and 16 h after the infection (P<0.05),while the expressions of Bcl-2 mRNA were increased significantly 9,12 and 16 h after the infection (P<0.05).It is concluded that the mRNA expressions of liver tissue apoptosis-promoting genes Fas and Bax were increased remarkably in vibrio vulnificus sepsis rats,whereas the expression of apoptosis-inhibiting gene Bcl-2 mRNA was decreased obviously in sepsis rats in early stage.The treatment with cefoperazone sodium and levofloxacin lactate could inhibit the expression of Fas mR.NA and Bax mRNA and enhance the expression of Bcl-2 mRNA at the same time.