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Objective:To study the teaching effect of the teaching method of case-based learning (CBL) combined with team-based learning (TBL) based on the standard patient (SP) in the clinical teaching of department of intensive care medicine.Methods:A total of 60 medical students clinically studying in the department of intensive care medicine were randomly divided into 2 groups, with 30 students in each group. The two groups received the clinical teaching through the lecture-based learning (LBL) teaching method and the CBL combined with TBL based on SP teaching method respectively. By evaluating the clinical synthesis ability of the students of two groups and the satisfaction survey of the two teaching methods, the teaching effect was evaluated. SPSS 19.0 statistical software was used to perform Chi-square test and t-test. Results:Compared with LBL teaching method, the students who accepted the CBL combined with TBL based on SP teaching method had significantly better clinical comprehensive ability ( P < 0.05), mainly in their clinical thinking ability [(4.18±0.55) vs. (3.66±0.47)], clinical skills [(4.03±0.61) vs. (3.59±0.52)] and communication ability with patients [(4.11±0.58) vs. (3.74±0.50)]. In addition, student satisfaction with teaching methods was also higher ( P <0.05), especially in the satisfaction of learning interest [(4.38 ± 0.72) vs. (3.65±0.56)], self-learning ability [(4.24±0.71) vs. (3.91±0.52)], clinical thinking ability [(4.09±0.66) vs. (3.22±0.54)], communication ability [(4.42±0.60) vs. (3.67±0.48)], and team cooperation spirit [(4.15±0.58) vs. (3.78±0.51)]. Conclusion:The teaching method of CBL combined with TBL based on SP is feasible and has good teaching effect in the clinical teaching of department of intensive care medicine.
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Antiviral drugs on influenza are important in the control program of influenza.Options for influenza treatment are currently limited to using the neuraminidase inhibitors (NAIs).Given limited effectiveness of NAIs and related resistance,there remains an urgent need for the development of influenza antiviral drugs that can improve the efficacy and provide low propensity of viral resistance.Several influenza-related antiviral drugs that are currently under the late-stage clinical trials all appear differently in the mechanism of action.It is hoped that when new antiviral drugs are licensed,care and outcomes of severe influenza cases will be improved.
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Antiviral drugs on influenza are important in the control program of influenza.Options for influenza treatment are currently limited to using the neuraminidase inhibitors (NAIs).Given limited effectiveness of NAIs and related resistance,there remains an urgent need for the development of influenza antiviral drugs that can improve the efficacy and provide low propensity of viral resistance.Several influenza-related antiviral drugs that are currently under the late-stage clinical trials all appear differently in the mechanism of action.It is hoped that when new antiviral drugs are licensed,care and outcomes of severe influenza cases will be improved.
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OBJECTIVE:To observe clinical efficacy and safety of salvianolate in the treatment of acute exacerbation of chron-ic obstructive pulmonary disease(AECOPD). METHODS:80 AECOPD patients were selected and randomly divided into observa-tion group and control group,with 40 cases in each group. Both groups received mechanical ventilation. Control group was given routine treatment of theophyllinum,bronchodilators and glucocorticoid;treatment group was additionally given Salvianolate injec-tion 200 mg,qd,ivgtt,on the basis of control group. Clinical efficacy was observed in 2 groups,blood hemorheology indexes were also observed before and after treatment. The mechanical ventilation time,ICU residence time and ADR were recorded in 2 groups. RESULTS:Clinical total effective rate of observation group was 95.00%,which was significantly higher than 70.00% of control group,with statistical significance(P0.05),and whole blood reduction viscosity of control group was improved significantly(P<0.05). Mechanical ventilation time and ICU residence time of treatment group was significantly shorter than that of control group (P<0.05). No ADR was found in 2 groups. CONCLUSIONS:Salvianolate can significantly improve the blood coagulation status of AECOPD patients receiving invasive mechanical ventilation,and has the advantages of good clinical efficacy and low cost of medical treatment.
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Objective To investigate the clinical therapeutic effect of Xuebijing injection for treatment of patients with ventilator-associated pneumonia (VAP).Methods A prospective study was conducted. Forty-eight patients with confirmed diagnosis of VAP requiring mechanical ventilation admitted into intensive care unit (ICU) of Hubei Provincial Hospital of Integrated Traditional Chinese and Western Medicine between May 2013 and September 2014 were enrolled. The patients were randomly divided into observation group (26 cases) and control group (22 cases) by random number table. All patients in both groups received western conventional treatment, and the patients in observation group were treated additionally with 50 mL Xuebijing injection intravenous drip twice a day, and control group received only routine western medicine, the therapeutic course in both groups being 7 days. The changes of white blood cell count (WBC), serum procalcitonin (PCT) levels and the clinical pulmonary infection score (CPIS) were observed, and the clinical therapeutic effect and 28-day prognosis were analyzed in both groups.Results After treatment for 7 days, the WBC, PCT levels and CPIS score were decreased compared with those before treatment in the two groups, and the degree of descent in observation group was more significant than that in the control group [WBC (×109/L): 9.16±1.62 vs. 12.03±2.34, PCT (μg/L): 0.17±0.04 vs. 0.28±0.69, CPIS score: 3.31±0.97 vs. 4.23±1.15, allP < 0.05]. The effective rate of observation group was higher than that of the control group [84.6% (22/26) vs. 54.5% (12/22), P < 0.05], while the 28-day fatality rate in the observation group was lower than that of control group [11.5% (3/26) vs. 36.4% (8/22),P < 0.05].Conclusion The clinical therapeutic effect is good when patients with VAP is treated with addition of Xuebijing injection on the basis of conventional western medicine therapy, as the injection can improve the therapeutic efficacy and reduce the fatality rate.
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Objective To investigate the relationship between the levels of serum procalcitonin (PCT) and cardiac troponin I (cTnI) in patients with sepsis.Methods According to the severity of the disease, 126 patients with sepsis in the Department of Critical Care Medicine of Hubei Provincial Hospital of Integrated Chinese and Western Medicine from June 2013 to February 2015 were divided into three groups: sepsis, severe sepsis and septic shock groups, 42 cases in each group. The changes of lactate (Lac) and central venous oxygen saturation (ScvO2) were monitored in the three groups within 72 hours after admission, the mortality and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score within 24 hours after admission, the levels of serum PCT and cTnI were compared among the three groups, and the correlations between serum PCT, cTnI levels and APACHE Ⅱ score were analyzed.Results Along with the increase of patients' severity in the three groups, the levels of Lac (mmol/L) were gradually increased (prior treatment: 5.82±2.42, 7.97±3.76, 10.30±2.82; 6 hours after treatment: 3.63±1.54, 5.08±1.98, 7.50±1.35; 12 hours after treatment: 2.70±1.55, 4.13±1.96, 6.23±1.16; 24 hours after treatment: 2.58±1.35, 3.95±2.44, 5.25±1.13; 48 hours after treatment: 2.15±1.82, 3.86±2.36, 4.12±1.72; 72 hours after treatment: 1.83±1.04, 3.78±1.84, 3.74±0.87), while the levels of ScvO2 were gradually reduced (prior treatment: 0.556±0.102, 0.502±0.095, 0.402±0.092; 6 hours after treatment: 0.627±0.062, 0.557±0.083, 0.504±0.075; 12 hours after treatment: 0.658±0.076, 0.601±0.083, 0.595±0.072; 24 hours after treatment: 0.676±0.059, 0.625±0.084, 0.603±0.050; 48 hours after treatment: 0.704±0.049, 0.656±0.066, 0.615±0.035; 72 hours after treatment: 0.755±0.053, 0.707±0.066, 0.629±0.048). The higher the Lac, the lower the ScvO2, and the differences among the three groups were of statistical significance (allP < 0.01). The mortalities of patients in the septic, severe septic and septic shock groups were as follows: 11.9% (5/42), 21.4% (9/42), 38.1% (16/42); serum PCT (μg/L): prior treatment: 5.21±2.92, 17.20±4.81, 40.71±5.22; 4 days after treatment: 2.51±1.52, 10.72±3.83, 46.45±4.25; the levels of cTnI (μg/L): prior treatment: 5.31±0.82, 9.50±0.31, 15.12±3.15; 4 days after treatment: 1.16±0.62, 5.35±0.53, 9.24±1.25; APACHE Ⅱ score: prior treatment: 10.41±3.72, 20.15±5.14, 35.17±4.58; 4 days after treatment: 7.25±2.22, 14.15±4.16, 28.12±3.13. Their levels were also increased along with the increase of the septic severity. The correlation analyses showed that the serum levels of PCT was significantly positively correlated with cTnI and APACHE Ⅱ score (r value was respectively 0.922, 0.921, bothP < 0.01).Conclusion Myocardial damage often easily occurs in patients with sepsis, and the more serious the illness, the more prominent the injury.
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<p><b>OBJECTIVE</b>To study the cell morphology change in dormancy and proliferation stage of colorectal cancer stem cells in order to provide reference to the treatment of colorectal cancer.</p><p><b>METHODS</b>The subpopulation of EpCAM(high)/CD44(+)/CD133(+) was isolated from fresh colorectal cancer tissues. These cells were tested by xenograft assay in NOD/SCID nude mice. Colorectal cancer stem cells underwent three-dimensional culture, and the growth curve of stem cells was drawn by WST-1. The expression of P27 and Ki-67 was examined by flow cytometry to understand the phase of dormancy and proliferation of colorectal cancer stem cells. Then the morphological differences of colorectal cancer stem cells between dormant and proliferation stages were recognized by immunofluorescence staining of actin.</p><p><b>RESULTS</b>The percentage of EpCAM(high)/CD44(+)/CD133(+) was 1.6%, and the subpopulation was confirmed to be colorectal cancer stem cells by means of the experiment of tumorigenicity in vivo. The growth curve of colorectal cancer stem cells was "S" type. Colorectal cancer stem cells grew slowly in the first three days. The expression of P27 was gradually up-regulated, and the level of Ki-67 was very low. These cells remained quiescence, which was the so-called dormancy. The expression of Ki-67 of colorectal cancer stem cells was at high level since the fourth day, and the P27 level was very low. According to the growth curve, this period belonged to the proliferative stage of colorectal cancer stem cells. On immunofluorescence staining, colorectal cancer stem cells with high level of P27 were round, large, and few pseudopodium, but no obvious death was found. These cells showed characteristics of dormancy. In contrast, the stem cells with high level of Ki-67 had much pseudopodium, showing proliferation and invasion.</p><p><b>CONCLUSIONS</b>Cancer recurrence and metastasis may be associated with the change of growth state of cancer stem cells. Colorectal cancer stem cells in the proliferation stage show greater proliferative and invasive ability as compared to the dormancy stage, which provides a new perspective for the treatment of colorectal cancer, and recurrence and metastasis of other tumors.</p>
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Animals , Mice , Antigens, CD , Antigens, Neoplasm , Cell Adhesion Molecules , Cell Cycle Checkpoints , Cell Proliferation , Cell Shape , Colorectal Neoplasms , Epithelial Cell Adhesion Molecule , Glycoproteins , Mice, Inbred NOD , Mice, Nude , Mice, SCID , Neoplasm Recurrence, Local , Neoplastic Stem Cells , Cell BiologyABSTRACT
Objective To investigate the protective effects of ulinastatin (UTI) on ischemiareperfusion injury of donor lungs,and the possible mechanism.Method Forty male SD rats were randomly divided into two groups:group C as control group and group U as UTI group.In group C donor lungs were antegradely flushed with 20 ml of cold (4 C) low potassium dextron (LPD) solution and 5 ml retrogradely.Meanwhile,in group U,UTI (500 000 U/L) was added in LPD solution and the same doses were used.According to the time after initiation of reperfusion,each group was divided into two subgroups:30 min (subgroup A) and 1 h (subgroup B).Arterial blood samples were collected for blood gas analysis.Lung samples were obtained at the end of reperfusion (30 min or 1 h).Microscopic examination of the donor lungs was conducted.Besides,the pulmonary water index (W/D),tissue malondialdehyde (MDA) and superoxide dismutase (SOD) content,and mRNA expression of tumor necrosis factor (TNF-a),intercellular adhesion molecule 1 (ICAM-1) and interleukin 10 (IL-10) were also measured.Results (1) One h after reperfusion,oxygenation index in group U was higher than that in group C (P =0.025) ; (2) The levels of W/D in subgroup A and subgroup B of group U were decreased as compared with group C (P =0.005 and P =0.006) ; (3)The microscopic changes of donor lung tissues in group U were lessen than in group C; (4) In subgroup A of group U,MDA content was decreased (P=0.039),and SOD content was increased (P=0.035),and similar results could be observed in subgroup B of group U (P =0.006 and P =0.030 respectively); (5) As compared with group C,the mRNA expression of TNF-α in group U was decreased at the time of 30 min after reperfusion (P =0.000),but no significant change was found at the time of 1 h (P =0.139).The mRNA expression of ICAM-1 was not decreased evidently at the time of 30 min (P=0.062),but significantly decreased at the time of 1 h (P=0.001).The mRNA expression of IL-10 was increased in subgroups A and B (P =0.004 and P =0.000 respectively).Conclusion This study demonstrated that UTI had protective effects of reducing ischemia-reperfusion injury on the donor lungs after lung transplantation in rat non-heart beating donor models.
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Objective To investigate the efficacy of Saururaceae lotion in treatment of gynecological inflammation ( chronic cervicitis,vaginitis).Methods 90 patients with gynecological inflammation(chronic cervicitis,vaginitis) were randomly divided into two groups,and each group 45 cases.The observation group was administered with Saururaceae lotion treatment, and the control group was treated with Jieeryin.Clinical efficacy and relapse situation were observed.Results The total effective rate of the observation group was 95.6% , higher than that of the control group(77.8% )(x2 = 5.362.P <0.05) ;The gynecological inflammation recurrence rate the observation group was 4.4% ,lower than that of the control group(33.3% )(x2 = 16.312,P <0.05).Conclusion Saururaceae lotion in treatment of gynecological inflammation was effective,and had low recurrence rate,and it was worthy of clinical application.
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Objectve The purpose of the study was to evaluate the surgical treatment method and outcomes of capitellar fractures. Methods From December 2004 to December 2006, sixteen patients with a capitellar fracture were included in the study. There were eight males and eight females. According to Bryan and Morrey classification, there were eight type Ⅰ fractures, one type Ⅲ fracture and seven type Ⅳ fractures. In three of type Ⅳ, a separate trochlear fracture fragment with impaction was seen. Distal lateral column posteroinferior metaphyseal comminutiou and/or impaction was observed in association with three fractures including two type Ⅳ fractures and one type Ⅲ fracture. One Mason type Ⅰ radial head fracture occurred in association with an ipsilateral type Ⅳ capiteilum fracture. The patients ranged from sixteen to sixty-five years old, with an average age of 44.9 years. An extensile lateral exposure and articular fixation with cannu-lated compression screws were performed within five days of injury. Clinical, radiographic, and functional el-bow index rating scale of Broberg-Money were evaluated retrospectively. Results The follow-up time ranged from 24 to 36 months,with the mean of 29 months. All fractures healed at an average of 7.9 (range, 6 to 11) weeks without radiographic evidence of osteonecrosis of the fracture fragment. Average arc of motion was 125.8°±16.8° in flexion-extension and 163.1°±10.62° in pronation-supination. The mean Broberg-Mor-rey was 92.0 points, with eight excellent results, seven good results, and one poor result. There were one pa-tient with a minimum of grade 1 radio-capitellar arthrosis.Fifteen of the sixteen adults were able to continue their former professional activities. The patient had persistent postoperative stiffness with a flexion contrac-ture at the last postoperative visit. Conclusion Prompt treatment with anatomic reduction and internal fixa-tion with lag screws followed by early rehabilitation can lead to functional arc and satisfactory outcome.
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BACKGROUND:Repeated injections or nasal spray of large doses of calcitonin can effectively prevent postmenopausal osteoporosis. Calcitonin should be taken for a long time.But the use of calcitonin is limited by the need for repeated protein administration, costly production methods and antigenicity. Gene therapy can provide effective economic therapeutic regimen for osteoporosis,and reduce side effect of drugs.OBJECTIVE:To describe the expression of human calcitonin produced in myoblasts and determine the effects of the recombinant protein on murine osteoblast cells.DESIGN:A gene-based controlled observational experiment.SETTING:Institute of Radiation Medicine,Fudan University.MATERIALS: The experiment was carried out at the Institute of Radiation Medicine, Fudan University from December 2005 to June 2006. Ten healthy SD fetal rats were selected from Institute of Radiation Medicine, Fudan University,Human Calcitoninsas monoclonal antibody was purchased from American Santa Cruz Biotechnology Company. L6 myoblast line was provided by Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences,Chinese Academy of Sciences. METHODS:The pcDNA3.0.-hCT liposome transfection mixture (transfection group) and empty vector pcDNA3.0 liposome mixture (control group) were added in the L6 myoblast medium, respectively.The expression and secretion of human calcitonin by myoblast cells were confirmed by enzyme-linked immunosorbent assay (ELISA),Western blot analysis and immunohistochemical analysis.1×10-14,1×10-13,1×10-12 mol/L recombinant human calcitonin and MEM were respectively added in myoblast medium. MAIN OUTCOME MEASURES:The proliferation and differentiation of rat myoblasts were observed by MTT and alkaline phosphatase (ALP).RESULTS: Human calcitonin was found by ELISA in the supematant of cell culture. Western blot and immunohistochemical analysis verified that human calcitonin could be expressed stably in myoblasts after transfection. Osteoblast proliferation and ALP activity were higher when recombinant human calcitonin was 1×10-14 and 1×10-13 mol/L than the control group (P＞0.05).It was significantly higher when the concentration was 1×10-12 mol/L than the control group (P＜0.05).CONCLUSION:The stable synthesis and secretion of biologically active human calcitonin can be achieved in myoblasts by gene transfection.Recombinant human calcitonin can enhance proliferation and differentiation of osteoblasts.
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0.05) .It was significantly higher when the concentration was 1?10-12 mol/L than the control group(P
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Objective To report the clinical results of the treatment of proximal humeral fractures with a locking proximal humeral plate (LPHP) through a small skin incision on the anterolateral shoulder. Methods In the period from May 2004 to June 2005, 17 cases of proximal humeral fractures were treated in our department. There were 3 Neer two-part fractures, 10 Neer 3-part ones and 4 Neer 4-part ones. Starting from 1.5cm anterior to the acromion, the skin was incised for 6 cm in length and the deltoid muscle was separated along the muscle fibers to expose the fracture fragments. Under direct vision the indirect reduction of the fracture was performed and the fragments were temporarily fixed with K-wires. The LPHP was inserted distally beneath the deltoid muscle and the position between the distal plate and the humeral shaft was adjusted through another small skin incision on the lateral upper arm. 4 locking screws were inserted to the proximal plate to fix the fracture fragments while screws were percutaneously inserted to the distal plate to fix it to the humeral shaft. Results This series experienced a primary wound healing, a mean operation time of (128?35) min, a mean intraoperative blood loss of 65?19 mL, and an average hospitalization of 4 days. A follow-up of mean 6.1 months, ranging from 3 months to 14 months, was performed in 12 cases of the 17 and revealed fracture union in all, with a mean healing time of 15.7 (ranging from 12 to 24) weeks. The final follow-up demonstrated a normal sensation on the lateral arms and a motion range in shoulder abduction of 80?to 150?and flexion of 80?to 160?. Conclusion The treatment of proximal humeral fractures by open reduction and internal fixation with LPHP through a small skin incision on the anterolateral shoulder has the advantages of simplifying operative maneuver, reducing tissue damage, decreasing blood loss, shortening bone healing time and improving functional recovery.
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Objective To investigate the early effects of minimally invasive insert in of interlocking intramedullary nails in treatment of femoral shaft fractures. Methods From September 2002 to December 2004, 23 cases of femoral shaft fractures were treated with close reduction and internal fixation using interlocking intramedullary nails. The nail was inserted into the medullary cavity with minimally invasive technique through a small skin incision proximally at the greater trochanter. The mean operative time, volume of transfusion, mean length of hospital stay and early complications after operation were recorded. Results The mean operative time was 90 minutes (ranging from 60 to 150 min) and the mean volume of transfusion was 60 mL (from 0 to 400 mL). There were no early significant complications after operation. The mean hospital duration after operation was 4 days (from 3 to 7 d). Conclusion Minimally invasive insertion of anterograde interlocking nails to treat femoral shaft fractures has advantages of causing little operative trauma, little transfusion, quick rehabilitation and no significant complications after operation
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Objective To investigate the functional changes of osteoblasts in female SD rats in vivo at different phases following ovariectomy and to analyze their mechanism. Methods 40 female SD rats aged 6 months were randomly divided into 2 groups: the sham operated group and the ovariectomized (OVX) group. During the 4-month experiment, 10 rats from each group were sacrificed to have the serum and the 4th lumbar vertebrae specimens at the end of the 2nd week and the 16th week respectively. Serum bone gla protein (BGP), serum bone specific alkaline phosphatase (BALP) were measured. The excretive function and morphologic changes of the osteoblasts were observed under TEM (Transmission Electronic Microscope). Results In the OVX group, the levels of BGP and BALP all increased at the end of the 2nd week, but showed no significant difference from those in the control group at the end of the 16th week. TEM indicated osteoblasts were activated at the end of the 2nd week, but tended to be inactivated in the ovariectomized group at the end of the 16th week. Conclusions When estrogen decreases in ovariectomized rats, osteoblasts experience a short activated period, but their capacity of bone formation decreases in the end. Abnormal function of osteoblasts may play an important role in pathogenesis of osteoporosis.