On the application of teaching ward-round workshop in the teaching ability training for clinical teachers / 中华医学教育探索杂志

Objective:To explore the application effect of the teaching ward-round workshop on the teaching ability training for clinical teachers.Methods:From July to October 2019, 83 clinical teachers from The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University included in the study were divided into 8 groups for the training of teaching ward-round workshop. After the training, the evaluation results of clinical teaching ward-round, the satisfaction of clinical teaching ward-round, and the satisfaction of the workshop teaching model were compared. Chi-square test and t test were performed by SPSS 22.0. Results:The trainees were highly satisfied with the training mode of the teaching ward-round workshop. After the training, the clinical teaching ward-round assessment scores [(96.83±1.77) points] were higher than the average scores of the same period from April to June in 2019 [(91.25±2.86) points], with statistical significance ( P<0.05). In terms of satisfaction with clinical teaching ward rounds, the scores of 7 dimensions including preparation before ward rounds, highlighting the key and difficulties, and standard physical examination after the training were all higher than those before the training, with significant differences ( P<0.05). Conclusion:The training model of the teaching ward-round workshop helps to enhance the training effect, promote the teaching ability of clinical teachers, and improve the clinical teaching ward-round assessment results and satisfaction, which provides new ideas and references for the training of clinical medical professionals.

Autophagy enhanced by curcumin ameliorates inflammation in atherogenesis via the TFEB-P300-BRD4 axis

Disturbance of macrophage-associated lipid metabolism plays a key role in atherosclerosis. Crosstalk between autophagy deficiency and inflammation response in foam cells (FCs) through epigenetic regulation is still poorly understood. Here, we demonstrate that in macrophages, oxidized low-density lipoprotein (ox-LDL) leads to abnormal crosstalk between autophagy and inflammation, thereby causing aberrant lipid metabolism mediated through a dysfunctional transcription factor EB (TFEB)-P300-bromodomain-containing protein 4 (BRD4) axis. ox-LDL led to macrophage autophagy deficiency along with TFEB cytoplasmic accumulation and increased reactive oxygen species generation. This activated P300 promoted BRD4 binding on the promoter regions of inflammatory genes, consequently contributing to inflammation with atherogenesis. Particularly, ox-LDL activated BRD4-dependent super-enhancer associated with liquid-liquid phase separation (LLPS) on the regulatory regions of inflammatory genes. Curcumin (Cur) prominently restored FCs autophagy by promoting TFEB nuclear translocation, optimizing lipid catabolism, and reducing inflammation. The consequences of P300 and BRD4 on super-enhancer formation and inflammatory response in FCs could be prevented by Cur. Furthermore, the anti-atherogenesis effect of Cur was inhibited by macrophage-specific Brd4 overexpression or Tfeb knock-out in Apoe knock-out mice via bone marrow transplantation. The findings identify a novel TFEB-P300-BRD4 axis and establish a new epigenetic paradigm by which Cur regulates autophagy, inhibits inflammation, and decreases lipid content.

The application of multi-level comprehensive model in the evaluation of medical practical teaching effect / 中华医学教育探索杂志

Objective:To evaluate the effectiveness of medical practical training with a multi-level comprehensive model.Methods:We randomly selected 100 medical undergraduates who received practical training in The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University from 2017 to 2019, 20 medical education experts, and 30 teachers for a questionnaire survey using self-designed questionnaire with 3 first-level items, 8 second-level items, and 31 third-level items. Data processing and analysis was made by multi-level comprehensive model.Results:The comprehensive evaluation data (0.176 4, 0.512 3, 0.252 5, 0.058 8) obtained by the multi-level comprehensive model showed that the proportions of medical undergraduates achieving excellent, good, moderate, and poor effects of medical practical training were 17.64%, 51.23%, 25.25%, and 5.88% respectively. According to the principle of maximum membership, the final comprehensive evaluation result of the effectiveness of medical practical training was "good".Conclusion:This research has demonstrated the scientificity and feasibility of using the proposed multi-level comprehensive model to evaluate the effectiveness of medical practical teaching. In the comprehensive evaluation, the quantitative processing of qualitative indices can generate the matching score of each index in the multi-level index system. The evaluation results are intuitive and easy to analyze, thus providing the basis for the targeted improvement of medical practical teaching effect.

Evaluation of tutorial system for medical undergraduates in non-affiliated hospitals / 中华医学教育探索杂志

Objective:To evaluate the effect of tutorial system for medical undergraduates in a non-affiliated hospital of a medical university in Jiangsu.Methods:32 senior medical undergraduates in non-affiliated hospitals were divided into two groups. The experimental group adopted tutor-guided teaching, and the control group adopted traditional teaching. Professional theoretical knowledge, clinical ability, operational ability, foreign language level, basic research ability and participation of scientific research activities of students in the two groups were evaluated. SPSS 19.0 was used for t test, chi-square test and U test. Results:The results of operational ability ( t=3.537, P=0.000), the number of papers that had been read ( t=6.961, P=0.000), quality of these ( U=68.000, P=0.017), the number of literature reviews that had been written and reading notes ( χ2=4.747, P=0.000), participation in scientific research activities ( t=6.788, P=0.009) of students in the experimental group were better and higher than those in the control group. In the same period, there was no significant difference between the two groups in the scores of theoretical exam, clinical competence and foreign language tests. Conclusion:The implementation of tutorial system for medical students in non-affiliated hospitals is an effective measure to improve the quality of training. We should make full use of the short intership, to improve the comprehensive quality of students by establishing perfect rules, regulations and teaching evaluation system, and educate students in accordance with their own ability.

Application of fuzzy comprehensive model for evaluating the mental quality of medical students / 中华医学教育探索杂志

Objective To explore the application of fuzzy mathematics theory in the evaluation of medical students' comprehensive mental quality. Methods A total of 80 medical undergraduates studying in the Affiliated Huai'an No.1 People’s Hospital of Nanjing Medical University from October to December 2017 were randomly selected to conduct a questionnaire survey on medical students' mental quality. The questionnaires were designed by the study group, containing 3 first-level items (learning pressure, life stress and interpersonal stress), and 19 secondary items, with the recovery rate as 95%. Fuzzy comprehensive evaluation method was used for data processing and analysis. Results By comparing the data obtained from the comprehensive evaluation of the secondary factors with those of the pre-set evaluation set, the study concluded that 25.00% of the medical students need to adjust the future pressure, 41.70% the family health status pressure and 26.79% the appearance pressure according to the principle of maximum mem-bership degree. The comprehensive evaluation of the first four factors (0.249 7, 0.268 9, 0.270 2, and 0.211 2) showed that the comprehensive mental quality of medical students was "good". The quantitative analysis results showed that 27.02% of the medical students had good comprehensive mental quality, 24.97% need the mental quality adjustments, 26.89% had the average mental quality, and 21.12% had outstanding mental quality. Fuzzy comprehensive evaluation indicated that it is necessary to adjust the learning pressure and life stress of medical students, while the interpersonal stress had little effect on the mental quality of medical students. Conclusion The fuzzy comprehensive evaluation adopts the quantitative method to deal with the qualitative indicators uniformly, being scientific and reasonable. The corresponding data of each indicator can be easily identified with the help of the indicator system built up in the evaluation, which provides evidence for distinguishing and improving the corresponding decision-making for improving the medical students' mental quality. This evaluation method has strong applicability and provides new methods and ideas for objectively evaluating the comprehensive mental quality of medical students.

Overexpression of integrin-linked kinase improves cardiac function in a rat model of doxorubicin-induced chronic heart failure / 中华心血管病杂志

<p><b>OBJECTIVE</b>The aim of this study is to investigate the effects of cardiac integrin-linked kinase (ILK) overexpression in a rat model of doxorubicin-induced heart failure and the underlying mechanisms.</p><p><b>METHODS</b>Rat heart failure model was induced by intraperitoneal administration of doxorubicin (6 injections within 2 weeks: total dose = 15 mg/kg). Five weeks after the first injection, rats with heart failure were confirmed by echocardiography and then randomly divided into Ad-ILK group (intra-myocardial injected with adenoviral vector expressing ILK) and Ad-null group (intra-myocardial injected with empty ad-null, n = 20 each). After 4 weeks, ILK expression and activity were detected by Western blot, cardiac function was determined by echocardiographic and hemodynamic examinations. Apoptosis was measured by TUNEL analysis and cardiomyocyte proliferation was estimated by phospho-histone-H3 staining.</p><p><b>RESULTS</b>Western blot analysis revealed higher expression of ILK as well as the phosphorylation levels of Akt in Ad-ILK hearts as compared with ad-null controls. Four weeks after transfection, LVEF and LVFS were significantly higher in Ad-ILK group as compared with control group [LVEF: (60.56 ± 2.61)% vs. (51.94 ± 2.28)%, P < 0.05; LVFS: (28.10 ± 1.83)% vs. (22.82 ± 1.68)%, P < 0.05]. The LVEDD and LVESD, as well as LVEDP were significantly lower in Ad-ILK group compared with control group [LVEDD: (6.22 ± 0.24) mm vs. (7.15 ± 0.21) mm, P < 0.05; LVESD: (4.42 ± 0.23) mm vs. (5.65 ± 0.25) mm, P < 0.05; LVEDP: (12.96 ± 2.10) mmHg vs. (21.45 ± 2.48) mmHg (1 mmHg = 0.133 kPa) , P < 0.05]. Reduced levels of serum BNP was also seen in the Ad-ILK group. TUNEL analysis showed that ILK treatment significantly inhibited the apoptosis of cardiomyocytes [(0.23 ± 0.02)% vs. (0.45 ± 0.04)%, P < 0.05]. Moreover, increased cardiomyocyte proliferation was found in Ad-ILK group through the phospho-histone H3 staining [(0.60 ± 0.07)% vs. (0.24 ± 0.03)%, P < 0.01].</p><p><b>CONCLUSION</b>ILK gene therapy improves cardiac function in this rat model of heart failure, and is associated with reduced apoptosis and increased cardiomyocyte proliferation.</p>

Correlation between Depression and Prognosis in Patients with Coronary Heart Disease / 中国康复理论与实践

@#Objective To investigate primarily the correlation between depression and prognosis in patients with coronary heart disease(CHD).Methods 246 CHD patients were divided into the depression group and non-depression group.The relation between depression and incidence of short term cardiovascular events was compared.Results The incidence of angina pectoris,ST-segment elevated myocardial infarction,non ST-segment elevated myocardial infarction,congestive heart failure,ventricular tarchycardia,ventricular fibrillation and sudden death in the near future were 75.6%,11.1%,17.8%,26.7%,12.2%,8.9% and 7.8% respectively.Depression was an independent predictive factor of all cardiovascular events.Conclusion CHD patients complicated by depression have a high incidence of cardiovascular events,and the depression is an independent predictive factor of all cardiovascular events.