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Taking medical statistics major in Binzhou Medical University as an example, based on the outcome-based education theory, in order to enhance the innovation ability of university students, we put forward the systematic second classroom training system, including improving the personnel training system, implementing education, experiment teaching reform, and practice teaching reform. It has achieved outstanding results in the discipline competition, improved social service ability and high degree of employer satisfaction. The systematic second-class talent training system based on the outcome-based education theory can provide reference for other medical colleges and related applied majors.
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Objective:To investigate the correlation of monocyte/lymphocyte ratio (MLR) with the prognosis and adverse event in critically ill patients.Methods:Basic information of patients were extracted from Medical Information Mart for Intensive Care-Ⅲ (MIMIC-Ⅲ), including demographics, blood routine, biochemical indexes, systemic inflammatory response syndrome score (SIRS), sequential organ failure assessment (SOFA) score, and outcome, etc. MLR on the first day of intensive care unit (ICU) admission was calculated. The receiver operating characteristic curve (ROC curve) was applied to evaluate the prognostic value of MLR on the 30-day mortality and its cut-off value. According to the cut-off value, the patients were divided into two groups, and the differences between the groups were compared. Logistic regression model was used to analyze the relationship of MLR with 30-day mortality, continuous renal replacement therapy (CRRT), mechanical ventilation, the length of ICU stay, and total hospitalization time.Results:① A total of 43 174 critically ill patients were included. ROC curve showed that area under ROC curve (AUC) of MLR in predicting 30-day mortality was 0.655 [95% confidence interval (95% CI) was 0.632-0.687]. The cut-off value of MLR calculated according to the maximum Yoden index was 0.5. There were 16 948 patients with MLR ≥ 0.5 (high MLR group) and 26 226 patients with MLR < 0.5 (low MLR group). ② Compared with the low MLR group, the high MLR group had higher age, proportion of male, body mass index (BMI) [age (years old): 66.0 (51.7, 78.4) vs. 57.6 (27.1, 74.6), proportion of male: 57.2% vs. 52.5%, BMI (kg/m 2): 26.5 (22.5, 31.1) vs. 24.7 (14.3, 29.7)]. The high MLR group also had higher incidence of complications (hypertension: 49.2% vs. 44.6%, chronic heart failure: 32.6% vs. 21.7%, diabetes mellitus: 27.0% vs. 23.4%, chronic obstructive pulmonary disease: 21.5% vs. 16.1%, renal insufficiency: 19.3% vs. 13.1%), and higher white blood cell count (WBC), blood glucose, lactate (Lac), serum creatinine (SCr), SIRS score and SOFA score [WBC (×10 9/L): 13.8 (9.6, 19.2) vs. 11.5 (8.4, 15.6), blood glucose (mmol/L): 8.66 (6.88, 11.49) vs. 8.27 (6.55, 10.88), Lac (mmol/L): 2.2 (1.5, 3.7) vs. 2.1 (1.4, 3.3), SCr (μmol/L): 106.1 (70.7, 176.8) vs. 88.4 (70.7, 132.6), SIRS score: 3 (2, 4) vs. 2 (2, 3), SOFA score: 4 (2, 7) vs. 3 (1, 5)]. The 30-day mortality, and the proportion of patients with length of ICU stay > 5 days, total hospitalization time > 14 days, CRRT and mechanical ventilation > 5 days were significantly higher in high MLR group (30-day mortality: 20.0% vs. 8.3%, length of ICU stay > 5 days: 33.2% vs. 20.4%, total hospitalization time > 14 days: 33.7% vs. 16.2%, CRRT: 3.6% vs. 0.7%, mechanical ventilation > 5 days: 18.4% vs. 5.7%), with statistically significant differences (all P < 0.05). ③ After adjusted with the related factors, multivariate Logistic regression analysis showed that elevated MLR was an independent risk factor for increased 30-day mortality [odd ratio ( OR) = 1.54, 95% CI was 1.37-1.72, P < 0.001]. Moreover, the increased MLR was independently associated with the increased risk of usage of CRRT ( OR = 2.77, 95% CI was 2.18-3.51), mechanical ventilation > 5 days ( OR = 2.45, 95% CI was 2.21-2.72), the length of ICU stay > 5 days ( OR = 2.29, 95% CI was 2.10-2.49), and total hospitalization time > 14 days ( OR = 2.28, 95% CI was 2.08-2.49), all P < 0.001. Conclusions:Retrospective analysis of large sample shows that MLR elevation is an independent risk factor for 30-day mortality, usage of CRRT, prolonged mechanical ventilation time, prolonged hospitalization, prolonged length of ICU stay. MLR can be used for risk stratification of severe patients.
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Objective@#To investigate the characteristics of neuropsychological factors in patients with persistent postural-perceptual dizziness(PPPD) and provide the basis for the psychosomatic comprehensive treatment.@*Methods@#Cartel Personality Test (16PF), Symptom Checklist 90 (SCL-90), HAMA, HDMD, SAS and SDS were used to evaluate personality and mental state in patients with PPPD(PPPD group, n=65) and control group(n=63). Dizziness handicap inventory(DHI) was used to evaluate the degree of vertigo.The correlation analysis was carried out between the DHI scores and 16-PF, SCL-90 factor scores.@*Results@#(1)16PF factor scores: the factor scores of assertiveness(8.50±1.84), excitability (6.59±1.73), boldness (7.46±1.78), sensitivity (7.25±1.79), doubtfulness (6.55±1.74), fantasy(6.20±1.60), anxiety(7.67±1.61) and tension(6.81±1.67)in PPPD group were higher than those in the control group, and the differences were statistically significant (all P<0.05). The gregariousness (4.38±1.65), intelligence (4.51±1.67), stability (3.51±1.75), independence (4.39±1.56) and self-discipline (4.70±1.82) factor scores in PPPD group were lower than those in the control group, and the differences were statistically significant (all P<0.05). (2)SCL-90 factor scores: the factor scores of somatization(1.62±0.40), anxiety (1.64±0.56), interpersonal sensitivity (1.79±0.42), terrifying(1.71±0.53), total points(150.77±21.60), total average score (1.62±0.51) in PPPD group were higher than those in control group (all P<0.05). There were no differences in obsessive-compulsive (1.50±0.55), depression (1.45±0.44), hostility (1.69±0.60), paranoia (1.76±0.53), somatization (1.42±0.49) and psychotic (1.29±0.35) between PPPD group and the control group (all P>0.05). (3)The factor scores of HAMA(9.08±1.77) and SAS(37.88±2.96)in patients with PPPD were higher than that in the control group, and the differences were statistically significant (all P<0.05). There was no significant difference in HAMD (6.19±2.82) and SDS (36.36±4.71) scores between PPPD group and control group (all P>0.05). (4)The DHI scores were positively correlated with assertiveness, sensitivity, tension and doubtfulness factors of 16PF.The DHI scores were positively correlated with somatization, interpersonal sensitivity, anxiety and terrifying factors of SCL-90.@*Conclusion@#Patients with persistent postural-perceptual dizziness suffer from personality changes, mental disorders and anxiety disorder.
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Objective To investigate the characteristics of neuropsychological factors in patients with persistent postural-perceptual dizziness(PPPD) and provide the basis for the psychosomatic comprehen-sive treatment. Methods Cartel Personality Test (16PF),Symptom Checklist 90 ( SCL-90),HAMA,HD-MD,SAS and SDS were used to evaluate personality and mental state in patients with PPPD(PPPD group,n=65) and control group(n=63). Dizziness handicap inventory(DHI) was used to evaluate the degree of ver-tigo. The correlation analysis was carried out between the DHI scores and 16-PF,SCL-90 factor scores. Re-sults (1)16PF factor scores:the factor scores of assertiveness(8. 50±1. 84),excitability (6. 59±1. 73), boldness (7. 46±1. 78),sensitivity (7. 25±1. 79),doubtfulness (6. 55±1. 74),fantasy(6. 20±1. 60),anxie-ty(7. 67±1. 61) and tension(6. 81±1. 67) in PPPD group were higher than those in the control group,and the differences were statistically significant ( all P<0. 05). The gregariousness (4. 38± 1. 65), intelligence (4. 51±1. 67),stability (3. 51±1. 75),independence (4. 39±1. 56) and self-discipline (4. 70±1. 82) fac-tor scores in PPPD group were lower than those in the control group,and the differences were statistically sig-nificant (all P<0. 05). ( 2) SCL-90 factor scores:the factor scores of somatization ( 1. 62 ± 0. 40),anxiety (1. 64±0. 56),interpersonal sensitivity ( 1. 79 ± 0. 42),terrifying ( 1. 71 ± 0. 53),total points ( 150. 77 ± 21. 60),total average score (1. 62±0. 51) in PPPD group were higher than those in control group (all P< 0. 05). There were no differences in obsessive-compulsive (1. 50±0. 55),depression (1. 45±0. 44),hostility (1. 69±0. 60),paranoia (1. 76±0. 53),somatization (1. 42±0. 49) and psychotic ( 1. 29±0. 35) between PPPD group and the control group (all P>0. 05). ( 3) The factor scores of HAMA( 9. 08±1. 77) and SAS (37. 88±2. 96)in patients with PPPD were higher than that in the control group,and the differences were statistically significant (all P<0. 05). There was no significant difference in HAMD (6. 19±2. 82) and SDS (36. 36±4. 71) scores between PPPD group and control group (all P>0. 05). (4)The DHI scores were posi-tively correlated with assertiveness,sensitivity,tension and doubtfulness factors of 16PF. The DHI scores were positively correlated with somatization,interpersonal sensitivity,anxiety and terrifying factors of SCL-90. Con-clusion Patients with persistent postural-perceptual dizziness suffer from personality changes,mental disor-ders and anxiety disorder.
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BACKGROUND:Previous study has observed that the calf acellular dermal membrane exhibits slow repair efficiency, fast degradability speed and other shortcomings in the repair of cartilage defects. OBJECTIVE:To investigate the repair effect of the col agen type Ⅱ-modified acel ular dermal membrane on cartilage defects in rabbits. METHODS:The fetal rabbit chondrocytes were seeded onto the col agen type Ⅱ-modified acel ular dermal membrane, and the composite was then observed under scanning electron microscope at 3, 7 and 14 days. Cartilage defect models were established on the bilateral femoral condyles of 24 New Zealand white rabbits, and these model rabbits were randomly allocated to three groups. The cartilage-acellular dermal membrane and cartilage-collagen type Ⅱ-modified acellular dermal membrane were implanted into the defect regions of control and experimental groups, respectively. Those received no intervention were as blank control group. Collagen type Ⅱ immunohistochemical staining and Wakitani scoring system were performed at 6 and 12 weeks postoperatively. RESULTS AND CONCLUSION:Chondrocytes grew and adhered well in the scaffold. The Wakitani scores in the experimental group were significantly lower than those in the control and blank control groups at postoperative 6 and 12 weeks (P<0.05). At 6 and 12 weeks postoperatively, collagen type Ⅱ immunohistochemical staining was the strongest in the experimental group, with yellow and brown particles in the cytoplasm;the control group was positive for collagen type Ⅱ immunohistochemical staining, while the blank control group was negative for the staining. Our findings suggest that the collagen type Ⅱ-modified acellular dermal membrane is beneficial for the repair of cartilage defects.
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Objective To study the feasibility of the measurement of the thickness of rabbit knee joint cartilage by comparing the optical coherence tomography (OCT)and the undecalcified frozen section method on respectively measure the thickness of New Zeal-and white rabbit’s knee cartilage.Methods 50 standardized cultivation,adult and male New Zealand white rabbits (100 knees) were selected in this study.The measurement point was at the knee weight-bearing area of the medial femoral condyle with a 2 milli-meter diameter trephine,and the cartilage thickness data at the same center point and ±0.5 mm from the center were obtained.OCT and freeze-sectioning method were adopted at each site,respectively.The difference between OCT and histological method was com-pared and Bland-Altman plot was constructed.Results The thickness results of the center,+0.5 mm,-0.5 mm points were (296.5± 1.6)μm,(302.6± 3.5)μm,(287.9±5.6)μm by OCT,(278.4±1.9)μm,(290.3±5.9)μm,(280.3±4.6)μm by freeze-sectio-ning method,respectively.In Bland-Altman diagram,mean difference and 95% confidence interval were 18.1 1 (1 6.65,1 9.56)μm, 12.4 (5.5,1 9.2)μm,7.4 (2.8,12.0)μm.Intra-class correlation coefficients(ICC)for resemblance between the 2 techniques were 0.93(95%CI:0.89-0.95,P <0.000 1),0.84(95%CI:0.77-0.89,P <0.000 1),0.91(95%CI:0.87 -0.94,P <0.000 1),respec-tively.Conclusion As compared with the measurement of undecalcified frozen section,OCT for the rabbits’knee joint cartilage thickness measurement is feasible with the advantages of noninvasiveness,good repeatability.OCT can provide data reference in ani-mal experiments of cartilage tissue engineering for articular cartilage defect repair.
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Objective To study the relationship among neuropsychological factors, De Qi, and efficacy of acupuncture on chronic alco-holic peripheral neuropathy (CAPN) patients. Methods 55 male patients with CAPN were randomized into acupuncture manipulation group (n=25) and non-manipulation group (n=25). The degree of symptoms and clinical efficacy in patients were evaluated with Neuropathy Im-pairment Score in the Lower Limbs (NIS-LL) and Neurological Severity Score (NSS). The levels of De Qi for patients and acupuncturists were assessed by Subjective Acupuncture Sensation Scale (SASS), the psychological factors in patients were tested with Sixteen Personality Factor Questionnaire (16PF), Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA). Results 7, 14, 21, 28 days after treatment, the scores of De Qi and the average score were significantly higher in the manipulation group than in the non-manipulation group (P<0.05). The higher the scores of warmth, independence, intelligence, irritability and sensitivity, the more susceptible to SASS. 14, 28 days after treatment, the scores of SASS were lower in the depression group and anxiety group than in the healthy group (P<0.05). 28 days after treatment, the scores of NIS-LL and NSS were higher in the depression group and anxiety group than in the healthy group (P<0.05), and were lower in the acupuncture manipulation group than in the non-manipulation group (P<0.05). Conclusion Acupuncture is effective on CAPN. The neuropsychological factors play important role in De Qi and the efficacy.
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BACKGROUND:Chondrocytes co-cultured with bone marrow stromal stem cells on the scaffold of platelet-rich plasma are found to proliferate, and besides proliferative growth, bone marrow stromal cells exhibit a tendency of differentiating into chondrocytes. OBJECTIVE:To study the effect of platelet-rich plasma and human umbilical cord mesenchymal stem cells (hUCMSCs) on cartilage repair. METHODS:Forty healthy New Zealand white rabbits were selected to establish models of cartilage defects, and then randomly divided into normal saline group, platelet-rich plasma group, hUCMSCs group and combination group. Platelet-rich plasma was prepared by using double centrifugations to prepare passage 3 hUCMSCs. After modeling, intra-articular injection of normal saline (0.5 mL), 12.5%platelet-rich plasma (0.5 mL), 1×107 hUCMSCs (0.5 mL), 12.5%platelet-rich plasma+1×107 hUCMSCs (total y 0.5 mL) was done in corresponding groups, respectively. After 12 weeks of modeling, the injured cartilage was grossly observed, and hematoxylin-eosin staining was used to observe cartilage repair under light microscope;according to the O'Driscol histologic standard, histological examination was performed. RESULTS AND CONCLUSION:The repair effect in the normal saline group was significantly better that in the platelet-rich plasma group, hUCMSCs group, combination group (P<0.05), while the platelet-rich plasma group and combination group also exhibit better outcomes than the hUCMSCs group (P<0.05). These findings indicate that both platelet-rich plasma and hUCMSCs can promote cartilage repair;moreover, platelet-rich plasma with or without hUCMSCs is superior to hUCMSCs alone in the cartilage repair.
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Objective To investigate the effects of prostaglandin E1 (PGE1) on renal cell apoptosis in rats with diabetic nephropathy(DN). Methods Totally 55 male Wistar rats were intraperitoneally injected with streptozotocin (STZ) to develop DN model.46 successfully established DN rat models were randomly divided into 4 groups:PGE1 group received PGE1 intravenously at dose of 10 μg · kg-1 · d-1 for 10 d (n=12),angiotensin converting enzyme inhibitors(ACEI) group given ACEI orally at dose of 10 mg kg-1·d-1 for 8 W(n=12),PGE1+ACEI group given both PGE1 and ACEI (n=11),DN control group(n=11) and normal control group(n=10) given saline only.All rats were killed after 8 weeks and blood samples or kidney tissue were collected.Blood urea nitrogen (BUN),serum creatine(Scr),albuminuria of 24 h were detected.Renal pathological morphology and apoptosis of renal cells were observed by HE staining and terminal deoxynucleotidyl transferase-mediated dUTP nick-end-labeling (TUNEL) test. Results At 8 week after treatment,the 24-hour urinary albumin levels were decreased significantly in the following order:DN control group＞ PGE1 group ＞ ACEI group ＞PGE1+ ACEI group＞ control group[(374.6±54.1)μg,(570.0±72.5)μg,(253.1±28.9)μg vs.(1123.4±106.2)μg,P＜0.01 or P＜0.05].BUN[(9.3±2.6)mmol/L,(11.0±3.5)mmol/L,(8.4±2.2)mmol/Lvs.(15.1±4.0)mmol/L]and Scr [(74.5±19.2) umol/L,(83.5± 15.8)μmol/L,(64.6±17.3) μmol/L vs.(117.7±33.0)μmol/L]levels after treatment were also reduced in PGE1,ACEI and PGE1 + ACEI groups as compared with DN control group (P＜0.01or P＜ 0.05). Pathological manifestations of all treatment groups showed better results than DN group,and PGE1 + ACEI group was the best.There was no obvious apoptosis in glomerular area with on significant differences between groups.While apoptosis of renal tubules was observed in DN rats. Conclusions Renal tubule but not glomerular cell apoptosis may play some role in Prostaglandin E1 reduciug albuminuria.
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BACKGROUND: Alginic acid has a relatively mild gel condition and good biocompatibility, and it has been widely used in bio-tissue engineering.OBJECTIVE: To construct bone tissue engineering scaffolds using alginate gel composite bone xenograft approach, and to observe the cell biological properties and in vivo osteogenic potential in scaffolds.METHODS: The bone marrow was harvested from two 2-week-old New Zealand rabbits, 1 ×10~(-8)mol/L recombinant human bone morphogenetic protein-2 was used to induce bone marrow mesenchymal stem cells. The induced bone marrow mesenchymal stem cells at the second generation were incubated into 1% sodium alginate gel, after cultured for 4 days, the cell morphology in gel was observed by hematoxylin-eosin staining. Bone marrow mesenchymal stem cells at the second generation were divided into simple DMEM gel group and DMEM containing 1% sodium alginate gel group, followed by a culture of 7 days. Then bone morphogenic protein-2 immunohistochemical staining was performed. A total of 24 nude mice were randomly divided into two groups, both sides of the thigh muscle pockets were implanted with bone marrow-derived mesenchymal stem cells/alginate gel/bovine cancellous bone complex as an experimental group, with bone marrow-derived mesenchymal stem cells/bovine cancellous bone as a control group. At 2 and 4 weeks post-operation, the osteogenesis in the composite was observed by histological examination, the percentage area of new bone or cartilage was determined using image analysis system.RESULTS AND CONCLUSION: The bone marrow-derived mesenchymal stern cells in the sodium alginate gel exhibited a well-stacked morphology, they suspended in a gel, showing cell division and mitosis phase. In the simple DMEM gel group and DMEM gel containing 1% sodium alginate group, the immunohistochemical results showed that, cell division and proliferation were normal, with prominence at a variety of forms, large nucleus, and clear nucleolus. The bone morphogenetic protein-2 expression had no significant difference between the simple DMEM gel group and DMEM gel containing 1% sodium alginate group (P>0.05).Scanning electron microscopy revealed that, the alginate gel evenly composited in bovine cancellous bone micropores, cell grew at different planes. Animal experiments showed that there were significant differences regarding the percentage of new bone or cartilage area between the experimental group and control group at 2 and 4 weeks postoperation (P< 0.05). It is indicated that constructing bone tissue engineering scaffolds by using alginate gel/bovine cancellous bone, complies with the ultra-structural principle of tissue engineering scaffolds, can maximize the cell loads, achieve good bio-performance, without adverse affects on the proliferation, osteogenic phenotype and related biological properties of bone marrow-derived mesenchymal stem calls, the in vivo osteogenic efficiency was high.
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[Objective] Scoliosis with wedging of vertebra and open-up disc space over convex side can be reversed when PRSS(plate-rod system for scoliosis)was applied.In order to study the mechanical properties of the remedy for the scoliosis by PRSS,the photoelastic test was performed.[Method] The model that consists of five vertebra bodies and four intervertebral discs was built with aluminum and polycarbonate,thus the situation of low-grade scoliosis was simulated.The axial stress was loaded 0 kg,5kg,10 kg,15 kg,20 kg respectively,and the lateral side load was 0 kg,3 kg,6 kg,9 kg,and 12 kg respectively over the spinal column.According to the factual situation,the in-situ stress was measured by using photoelastic and strain gage method.ANSYS9.0 method was also applied to simulate the experiment process and evaluate the reliability of measurement.[Result]When PRSS was placed in,compressive stress was found to exert on the convex side whereas tensile stress was found on the concave side of the curvature,thus modulating bony growth of spinal vertebra,resulted in spinal column realignment.[Conclusion]The PRSS is an effective device to treat the scoliosis of the patients,especially in young children,because it not only can correct the deformity but also allows extension along with the children's growth.