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Objective:To investigate the effect of homogeneous management combined with staged teaching on physicians receiving standardized training of hepatobiliary surgery.Methods:A total of 46 physicians who received standardized training in Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, from January to March 2020 were selected as control group and were given conventional teaching, and 50 physicians who received standardized training from April to June 2020 were selected as observation group and were given homogeneous management combined with staged teaching. The two groups were compared in terms of professional level, clinical ability, and the degree of satisfaction with teaching before and after teaching. SPSS 24.0 was used to perform the independent samples t-test, the paired t-test, the chi-square test, and the rank sum test. Results:After teaching, both groups had significant increases in the scores of theoretical examination and operation skill examination, and compared with the control group, the observation group had significantly higher scores of theoretical examination (94.57±3.28 vs. 90.32±2.12) and operation skill examination (94.37±4.18 vs. 91.25±3.46). After teaching, both groups had significant increases in the scores of clinical consultation, physical examination, humanistic concern, clinical diagnosis, communication ability, organizational ability, and overall evaluation, and the observation group had significantly higher scores of the above seven aspects than the control group (6.98±0.94/6.45±0.14/6.95±0.88/6.65±0.93/6.53±0.26/6.84±0.92/6.58±0.35 vs. 6.13±0.31/6.21±0.76/6.21±0.42/6.18±0.35/6.32±0.61/6.33±0.24/6.25±0.71). The observation group had a significantly higher overall satisfaction rate than the control group [94.00% (47/50) vs. 78.26% (36/46)].Conclusion:In the standardized training and teaching of hepatobiliary surgery, homogeneous management combined with staged teaching can improve the professional level and clinical ability of physicians and enhance the degree of satisfaction with teaching.
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Background Zinc is a trace element essential for normal fetal heart development, and excess zinc can be toxic. The relationship between maternal and fetal zinc levels and the development of congenital heart disease (CHD) in the offspring is unclear. Objective To study the effects of maternal and neonatal zinc exposure levels on the risk of developing CHD in the offspring. Methods The data and biological samples of the study subjects were derived from the birth cohort established by Gansu Provincial Maternity and Child Care Hospital in Lanzhou from 2010 to 2012. Questionnaire surveys were conducted at baseline in the first trimester and at follow-up visits in the second trimester, the third trimester, and 42 d after delivery. Maternal venous blood during the third trimester and neonatal umbilical venous blood at delivery were collected, and information on their birth outcomes was extracted from medical records. Ninety-seven children with CHD diagnosed by echocardiography at birth and confirmed at the follow-up after 42 d were selected as the case group, and 194 healthy full-term infants were selected as the control group, 1∶2 matched for maternal age and geographical location from the database. The zinc concentrations in whole blood of pregnant mothers and umbilical cord blood of fetuses in both groups were measured by inductively coupled plasma mass spectrometry. According to the quartiles P25 and P75 of zinc levels in the whole blood of pregnant mothers and neonatal cord blood in the control group, zinc exposure was divided into three groups: low, medium, and high. After adjusting for maternal vaginal bleeding in early pregnancy, pre-pregnancy folic acid and vitamin supplementation, birth weight, and umbilical cerclage confounders, a multiple conditional logistic regression model was applied to analyze the associations between maternal whole blood and fetal umbilical cord blood zinc levels and the risk of CHD in the offspring, and a further subgroup analysis was performed by disease classification. Results The medians (P25, P75) of maternal whole blood zinc levels in the case group and the control group were 5.034 (3.456, 6.644) and 4.693 (3.411, 5.646) mg·L−1, respectively, with significant differences between the two groups (P=0.029). The medians (P25, P75) of neonatal cord blood zinc level was 2.153 (1.479, 2.405) mg·L−1 in the case group and 1.636 (1.304, 1.979) mg·L−1 in the control group, with significant differences between the two groups (P<0.001). The zinc levels of maternal whole blood and neonatal cord blood in the simple CHD group were significantly higher than those in the control group (P<0.05). The multiple conditional logistic regression model showed that compared with the maternal medium zinc exposure level group (3.41-5.65 mg·L−1), the risk of offspring CHD was 2.225 times of the high exposure level group (>5.65 mg·L−1) (OR=2.225, 95%CI: 1.017-4.868). Compared with the neonatal medium zinc exposure level group (1.30-1.98 mg·L−1), the neonatal high exposure level group (>1.98 mg·L−1) also had an increased risk of CHD (OR=4.132, 95%CI: 1.801-9.480). The subgroup analysis results showed that compared with corresponding medium exposure level groups, the risk of simple CHD in the offspring of the maternal high zinc exposure level group was increased (OR=4.081, 95%CI: 1.427-11.669), and the risks of simple CHD (OR=7.122, 95%CI: 2.126-23.854) and complex CHD (OR=5.165, 95%CI: 1.859-14.346) of neonates of the neonatal high zinc exposure level group were increased. Conclusion Under the exposure levels of the study population, high concentrations of zinc exposure in pregnant mothers and neonates may be associated with the incidence of CHD.
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Objective To systematically evaluate the correlation between vitamin D deficiency in early pregnancy and the outcome of preterm birth.Method PubMed,Embase,the Cochrane Library,Web of Science,Ebsco,CBM,CNKI and Wanfang Data databases were searched to collect cohort studies and case-control studies on the correlation between vitamin D deficiency in early pregnancy and preterm birth outcomes,and the retrieval time was from the establishment of the database to June 2019.Two researchers independently reviewed the literature,extracted the data and evaluated the risk of bias in the included studies.RevMan 5.3 software was used for Meta analysis.Result A total of 6 cohort studies and 3 nested case-control studies were included.A total of 30 891 newborns were included,including 1 912 premature infants.3 Chinese articles and 6 English articles were reviewed including three studies from China,three from North America,two from Europe and one from Australia.The diagnostic criteria for vitamin D deficiency and preterm birth were similar in these studies.After adjusting for age,race and other confounding factors,Meta-analysis results showed that vitamin D deficiency in early pregnancy did not increase the risk of preterm birth (OR =1.04,95％ CI 0.90 ～ 1.20,P =0.63).Subgroup analysis were conducted according to the study type,measurement method and regional population,and the results were consistent with the overall results.No significant publication bias was found in the meta-analysis results.Conclusion Current evidence suggests that vitamin D deficiency in early pregnancy has no significant influence on preterm birth.
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Objective To compare the efficacy of arthroscopic assisted percutaneous plate osteosynthesis and conventional open reduction and plate internal fixation in treatment of tibial plateau fractures of SchatzkerⅠ ~ Ⅳ . Methods Clinical data of 60 patients with tibial plateau fractures from July 2014 to July 2016 was retrospectively analyzed. All the patients were divided into observation group (30 cases) and control group (30 cases). Patients in observation group underwent arthroscopic assisted percutaneous internal fixation surgery, while patients in control group underwent conventional open reduction and plate internal fixation. Then record the operation index, the incidence of postoperative complications, maximum active angle of knee joint and the excellent rate of treatment. Results The operation index, postoperative complication rate, maximum active angle of knee joint and the treatment excellence rate in observation group was superior to control group. Conclusion With better clinical value, arthroscopic assisted percutaneous plate fixation was more satisfactory than conventional open reduction and plate internal fixation in treatment of tibial plateau fractures of Schatzker Ⅰ ~ Ⅳ .
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Objective To study the changes of cytokines in aqueous humor of patients with proliferative diabetic retinopathy (PDR)after intravitreal bevacizumab (IVB) and the correlation of these cytokines.Methods Fifty-six patients(63 eyes) with severe PDR underwent pars piana vitrectomy (PPV) with IVB pretreatment in our hospital from April,2014 to February,2015 were collected.All the patients received IVB therapy from 3 days to 7 days before PPV.Aqueous humor samples were collected at the time of IVB and PPV treatment.The concentrations of vascular endothelial growth factor (VEGF),interleukin-6 (IL-6),interleukin-8 (IL-8) and monocyte chemotactic protein-1 (MCP-1) were measured by cytoinetric bead array (CBA).The changes of these cyto-kines after IVB were analyzed by using Wilcoxon rank sum test for paired data.The correlation between these cytokines was analyzed by using Spearman rank test.Results From 3 days to 7 days after IVB,the concentration of VEGF in aqueous humor was (6.57 ± 12.29)pg · mL-1,lower than the pre-operation of (278.71 ±340.20)pg · mL-1,the difference was statistically significant (P ＜ 0.05).The concentration of IL-8 was (385.60 ± 1099.47) pg · mL-1,higher than pre-operation of(298.87 ± 1005.79) pg ·mL-1,the difference was statistically significant (P ＜ 0.05).IL-6 and MCP-1 were increased after IVB,but the difference was not statistically significant (all P ＞ 0.05).VEGF,IL-6,IL-8 and MCP-1 had an obviously relationship between each two factors(all P ＜ 0.05).Conclusion Angiogenesis in patients with PDR are regulated by a variety of cytokines,and targeted reduction of VEGF may compensatory increase the concentration of other inflammatory cytokines.
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OBJECTIVE:To study the effects of Tanshinone capsules on glucose and lipid metabolism and serum sex hormone level in rats with polycystic ovary syndrome (PCOS). METHODS:90 female SD rats were randomly divided into normal group (distilled water),model group (distilled water),positive control group (metformin 200 mg/kg) and Tanshinone capsules low-dose,medium-dose and high-dose groups(30,60,90 mg/kg),with 15 rats in each group. Those groups were induced PCOS mod-el except for normal group;after modeling,those groups were given relevant medicine intragastrically for consecutive 28 d,once a day. The ovulation rate was compared before intervention and 28 d after intervention. Body weight,fat wet weight,fasting insulin (FINS),fasting blood-glucose (FPG),AUC of glucose,HOMA-IR,ISI,serum levels of FSH,LH and T were detected. RE-SULTS:Compared with normal group,anovulation,body weight,fat wet weight,FINS,FPG,AUC of glucose,HOMA-IR, FSH,LH and T were all increased significantly in model group,while ISI decreased significantly(P<0.05). Compared with mod-el group,ovulation rate and ISI of positive control group and Tanshinone capsules groups were increased significantly after interven-tion, while body weight (except for Tanshinone capsules low-dose group), fat wet weight (except for Tanshinone capsules low-dose group),FINS,FPG,AUC of glucose,HOMA-IR,FSH,LH and T were all decreased significantly(P<0.05),especial-ly in Tanshinone capsules high-dose group and positive control group. CONCLUSIONS:Tanshinone capsules can regulate glucose and lipid metabolism and serum sex hormone secretion disorder in PCOS rats.
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BACKGROUND:The stem cel s transplanted into the damaged heart tissues can differentiate into cardiomyocytes, which bring new hope for the research of ischemic heart disease. OBJECTIVE:To explore the feasibility and safety of stem cel transplantation for the treatment of ischemic heart disease. METHODS:Various experimental methods to the feasibility and safety of stem cel transplantation for the treatment of ischemic heart disease were analyzed. REPAIR-AMI experiment was a randomized and double-blind and placebo-control ed multi-center study that used to analyze the therapeutic effect of intracoronary transplantation of bone marrow progenitor cel s immediately after acute myocardial infarction. MAGIC Cel-3-DES experiment was used to evaluate the safety of granulocyte colony-stimulating factor mobilized stem cel therapy and the effect of intracoronary injection of mobilized peripheral blood stem cel s on the treatment of acute myocardial infarction and old myocardial infarction. BOOST experiment was the randomized control ed study on autologous bone marrow cel transplantation through coronary vein after myocardial infarction. PROTECT-CAD experiment was the randomized control ed clinical trial about the direct injection of stem cel s into the myocardial for the treatment of ischemic heart disease. RESUTLS AND CONCLUSION:Stem cel transplantation may improve the left ventricular systolic function and left ventricular diastolic function as wel as the coronary flow reserve, and the related studies have been confirmed. Stem cel transplantation for the treatment of ischemic heart disease can increase the left ventricular ejection fraction. As the less clinical accident, stem cel therapy cannot increase the risk of restenosis based on the treatment of drug-eluting stents. It is safe and feasible of stem cel transplantation for the treatment of ischemic heart disease. Large sample, long scale and multi-center randomized control ed studies are needed to further evaluate the effect and risk of stem cel transplantation.
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Coronary stent can cause mechanical injury to tunica intima and stimulation to vessel wall, resulting to platelet and inflammatory cell aggregation and infiltration, release of inflammation mediators, chemotatic factor, adhesion molecule and growth factor, and promoting migration and proliferation of vascular smooth muscle cells. The inflammatory reaction post stenting is highly correlated with intravascular restenosis. The drug-eluting stent against proliferation of vascular smooth muscle cells and inflammatory reaction can reduce the intensity and duration of body inflammatory reaction, improve stent technique, relieve damage of stenting to vessel wall, and reduce incidence of intravascular restenosis.
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Resulting from the shape stability, metal vascular stent has limited the vascular retraction, and subsequently prevent the unfavorable vascular remodeling. However, the metal stent requires further anticoagulant therapy after implantation, induces the hyperplasy of vascular smooth muscle cells, and cannot completely prevent the occurrence of in-stent restenosis. Surface modification of metal stent may reduce thrombogenesis. Based on the metal stent, drug eluting stent can transfer the active drugs to the damaged vessels, release them into the vascular wall and inhibit the in-stent restenosis. The eluting drugs restrain both the proliferation of smooth muscle cells and the regeneration of normal endothelial cells, leading to delay the vascular endothelialization and increase the risk of delayed thrombogenesis. The effect of stent implantation on the modus and size of vascular injury varies according to different operational techniques, processing technologies and designs, thus influencing the occurrence of in-stent restenosis. It is a potential study topic of interventional therapy to develop new eluting materials and eluting drugs, modify formulation, as well as facilitate the stent structure.