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Objective:To explore and optimize the teaching content of clinical case discussion course based on clinical pathophysiology and therapy (CPPT), and to improve the teaching quality of this course.Methods:Self-compiled evaluation form was sent to all the students who participated in this course in 2016-2017 school year, and the teaching satisfaction and teaching characteristics were evaluated. The differences of evaluation results from students with different educational programs or teachers with different seniority were compared, and the correlation between evaluation results and teachers' seniority was analyzed.Results:The students had a high evaluation on the course, but students from different programs had significant different comments on thinking inspiring, speech encouraging, questions guiding, process holding and effective feedback, as well as the self-evaluation of mastery degree. For teachers with different seniority, there were significant differences in scores in all aspects except speech encouraging, but no differences in mastery degree. Spearman analysis showed that there was a certain correlation between scores and teachers' seniority.Conclusion:The overall situation of the CPPT case discussion course in our school is worthy of recognition, but it needs to be improved in many aspects.
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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can cause acute respiratory distress syndrome, hypercoagulability, hypertension, and multiorgan dysfunction. Effective antivirals with safe clinical profile are urgently needed to improve the overall prognosis. In an analysis of a randomly collected cohort of 124 patients with COVID-19, we found that hypercoagulability as indicated by elevated concentrations of D-dimers was associated with disease severity. By virtual screening of a U.S. FDA approved drug library, we identified an anticoagulation agent dipyridamole (DIP) , which suppressed SARS-CoV-2 replication . In a proof-of-concept trial involving 31 patients with COVID-19, DIP supplementation was associated with significantly decreased concentrations of D-dimers ( < 0.05), increased lymphocyte and platelet recovery in the circulation, and markedly improved clinical outcomes in comparison to the control patients. In particular, all 8 of the DIP-treated severely ill patients showed remarkable improvement: 7 patients (87.5%) achieved clinical cure and were discharged from the hospitals while the remaining 1 patient (12.5%) was in clinical remission.
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Objective:To investigate the clinical characteristics of patients with lymphoplasmacytic lymphoma/Waldenstr?m macroglobulinemia (LPL/WM), and the diagnosis and optimal treatment of LPL/WM.Methods:The clinical data of 13 LPL/WM patients treated in Zhongnan Hospital of Wuhan University from January 2013 to June 2018 were retrospectively analyzed, and the literature was reviewed.Results:The median age of 13 patients was 60 years old (35-79 years old). There were 12 males and 1 female. Initial symptom was fatigue or edema of both lower limbs for majority of patients. All patients had immunoglobulin M (IgM) monoclonal, 3 of them had elevated immunoglobulin G (IgG) level, including 1 patient with monoclonal IgG. LDH was increased in 2 patients. Coombs test was positive in 5 patients. MyD88 gene mutation status was detected in 8 patients, of which gene mutation in 5 patients was positive. Among 13 patients, 1 patient lost follow-up, 3 patients died, 9 patients were alive with the median survival of 36 months (19-81 months).Conclusions:Incidence of LPL/WM is relatively low with a generally indolent evolution, but heterogeneity is not negligible. Few patients have poor treatment response with a quick disease progress. The high-risk patients undergoing hematopoietic stem cell transplantation after remission-induction chemotherapy may improve the prognosis.
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Objective To understand the effect of teacher training to provide reference for teachers' teaching methods in the standardization of clinical resident training.Method The teachers carried out five days of teacher training.Teacher training adopted the method of theory teaching and group discussion.The main content of the training had a "daily rounds with teaching","the proper use of ORIME evaluation","feedback of sandwich type","a minute tutor teaching method","SOAP method to report cases".Before the training,100 residents were randomly selected to evaluate the teaching in teaching teachers through self-designed questionnaire.After the training,the questionnaire survey was conducted among 100 residents again.All data were statistically analyzed by SPSS 22.0.The measurement data were represented by (mean or + standard deviation),and the date were compared by t test.Results Residents believed that after the teacher training,teachers' teaching level improved (P＜0.05).The three aspects of "general and phased learning goals","training students' clinical thinking ability through questions","requiring students to report cases and give guidance and feedback" were the most obvious.The pre training score was (3.28 ± 0.92) (3.31 ± 1.12) (3.55 ± 0.85),and the corresponding score was after training (3.98 ±0.85) (4.19 ± 0.85) (4.11 ± 0.74).Conclusion From the comparison of the survey results before and after the residents,the teachers' teaching modes,skills and methods have been improved after receiving teachers' training.
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ABSTRACT:Objective To detect the expressions of thioredoxin (TRX1)and c-jun-activation-domain binding protein-1 (JAB1)in patients with acute myelogenous leukemia (AML)and healthy controls,and measure the TRX1 level in AML patients at different stages for evaluating its clinical significance.Methods The expressions of TRX1 and JAB1 in leukemia samples were analyzed by RT-PCR and Western blot at mRNA and protein levels, respectively.The correlation between TRX1 and JAB1,and the relationship between the gene expression and peripheral blood leukocytes count were also analyzed.Furthermore,serum TRX1 was measured by ELISA.Results TRX1 and JAB1 expressions at both mRNA and protein levels were obviously upregulated in leukemia patients (P<0.05). TRX1 was positively related to JAB1 in both newly diagnosed and recurrent AML patients.And high levels of TRX1 and JAB1 expressions were associated with white blood cell (WBC)counts in AML patients (P<0.05).Moreover, abundance of TRX1 in serum was significantly greater in AML patients,especially in the patients with recurrent AML,than in healthy donors (P<0.05).Conclusion There is a positive correlation between the expressions of TRX1 and JAB1 ,which is closely related to the occurrence and progression of AML.
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Objective To make the chromosome karyotype analysis of 130 patients with leukemia by using the improved chromosome short-term culture method.Methods We optimized the main factors with a single factor gradient experiment in short-term culture of bone marrow chromosome, including colchicines concentration, duration of action of colchicines,and hypotonic time.On this basis,we conducted the three-factors and three-level orthogonal experiment to achieve improved bone marrow chromosome preparation system,which was later applied in 130 patients with leukemia in our hospital.Results The orthogonal experiment results showed that the optimum conditions were colchicines concentration of 0.07 μg/mL,colchicines action time of 80 min,and hypotonic time of 35 min during the preparation of the bone marrow chromosome.Using this method,the chromosome preparation success rate reached 97.69% and the detection rate of abnormal karyotype reached 82.3% in the chromosome karyotype analysis.Conclusion Bone marrow chromosome preparation system with colchicines concentration of 0.07 μg/mL and colchicines action time of 80 min,and hypotonic time of 35 min is worthy of clinical promotion.
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<p><b>OBJECTIVE</b>To evaluate the efficacies of different treatments for recurrent cervical lymph nodes and the factors contributing to prognosis in patients with nasopharyngeal carcinoma after radiotherapy.</p><p><b>METHODS</b>Clinical data of 79 patients with nasopharyngeal carcinoma after radiotherapy were retrospectively analyzed, and all cases were diagnosed as having recurrent cervical lymph nodes by pathological examination. The factors including sex, age, the interval between completion of radiotherapy and recurrence, rN stage, treatment methods, and the location relationship between recurrent lesion and primary tumor in the neck were analyzed for prognosis. Kaplan-Meier curves, Log-rank test and Cox's proportional hazards regression mode were used in the statistical analysis.</p><p><b>RESULTS</b>The median recurrence time was 26 months, and the 1- , 3- and 5-year overall survival rates were 77.9%, 53.4% and 39.7%. Cox's proportional hazards regression mode analysis indicated that age, rN stage, treatment methods, and the location relationship between recurrent lesion and primary tumor were significantly prognostic factors.</p><p><b>CONCLUSIONS</b>Neck dissection is superior to re-radiotherapy in treatment of recurrent cervical lymph nodes in nasopharyngeal carcinoma after radiotherapy. The patients younger than 45 years old, in early rN stage and for recurrence in the center region of primary tumor have a better prognosis.</p>
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Humans , Carcinoma , Kaplan-Meier Estimate , Lymph Nodes , Pathology , Nasopharyngeal Neoplasms , Radiotherapy , Neck , Neck Dissection , Neoplasm Recurrence, Local , General Surgery , Prognosis , Proportional Hazards Models , Retrospective Studies , Survival Rate , Treatment OutcomeABSTRACT
Objective To study the mechanism of oxidative stress involved in the pathogenesis and relapse of acute monocytic leukemia (M5 ).Methods We detected reactive oxide species (ROS)levels,conducted plasma analysis obtained from 76 M5 patients at diagnosis and at relapse,and observed the ultrastructure of mitochondria of mononuclear cells in peripheral blood by transmission electron microscope.Results Compared with that in the control group,the average fluorescence intensity of intracellular ROS was significantly increased in M5 groups, especially in the relapse patients (P < 0.05 ).Low total antioxidative capacity (T-AOC)and antioxidant enzyme activity were characteristic of M5 at both diagnosis and relapse. However, lactate dehydrogenase (LDH ), malondialdehyde (MDA)and 8-hydroxy-2’-deoxyguanine (8-OHdG)increased significantly at both diagnosis and relapse (P < 0.05 ).Prominent ultrastructural abnormalities (mitochondrial swelling,outer membrane blebs,and aberrant cristae disorder)were present in patients with primary M5,and they were obviously abnormal in relapsing M5 patients.Conclusion Oxidative stress is the initiating factor of M5.Mitochondria are the main intracellular location for ROS generation.To maintain the dynamic balance between ROS and antioxidant defence may be the critical factor for preventing relapse.
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Objective To observe any change in the laterality index (LI) in the active volume of the hand motor cortex during rehabilitation after acute cerebral infarction and to analyze the mechanisms involved in the rehabilitation of motor function.Methods Sixteen patients with acute cerebral infarcts were administered standard but individualized rehabilitation training.Blood oxygenation-dependent functional magnetic resonance imaging (BOLD-fMRI) was used to evaluate the active volume of their hand sensorimotor cortex (SMC) and the LI,at admission and after 14 days of rehabilitation.The Fugl-Meyer motor assessment for the hand (FMA) was used to evaluate hand function.Ten healthy volunteers were recruited as a control group and subjected to a single BOLD-fMRI examination to confirm the location and the volume of the active area when performing the same rehabilitation exercises.Results The baseline LI of affected hand SMC activation was significantly smaller than that of the unaffected hand [(0.010 ±0.808) versus (0.789 ± 0.157)],but no significant difference was observed between the affected and the unaffected hands after treatment.Rehabilitation therapy significantly increased the SMC LI of affected hand activation when compared with the baseline,but no such effect was observed with the unaffected hand.In 12 patients with dysfunction of the right hand as evaluated by the FMA,the baseline LI of the affected hand was smaller than that of the unaffected hand and that of the healthy volunteers.Conclusion Rehabilitation after acute infarction can promote functional recovery.The LI of the affected hand reflects cerebral plasticity during rehabilitation after acute cerebral infarction.
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OBJECTIVE@#To investigate the clinical value that surgical treatment with comprehensive treatment in treating early stage nasopharyngeal carcinoma.@*METHOD@#Based on the case selection criteria, patients with early nasopharyngeal carcinoma were divided into surgery group and the conventional group according to patients' wishes. Surgery group were treated with surgery plus Radiochemotherapy as a comprehensive treatment while conventional group were treated with Radiochemotherapy. Outcome indices: (1) 5-year survival rate and 5-year disease-free survival rate; (2) Radiation dose to the nasopharynx; (3) Incidence of xerostomia.@*RESULT@#(1) The overall 5-year follow-up rate was 97.12%; 1 patient was lost to follow-up in surgical group, the 5-year follow-up rate was 96.77%; 2 patients were lost in conventional Group with 5-year rate of 97.26%. (2) The 5-year survival rate of 104 patients was 83.65% (87/104). (3) The 5-year survival rate and 5-year tumor-free survival rate were 96.77% (30/31) and 93.55% (29/31) in surgical group, 78.08% (57/73) and 73.97% (54/73) in conventional group. There were significant differences between the two groups (P < 0.05). (4) The radiation dose to the nasopharynx in surgery group and conventional group were (63.90 +/- 5.56) Gy and (71.48 +/- 4.18)Gy, respectively; the dose in surgical group was significantly less than the conventional group, there were statistical significance between the two groups. (5) The incidence of xerostomia was significantly less in surgical group (22.58%) than conventional group (65.75%), the difference was statistically significant.@*CONCLUSION@#The surgery combined with concurrent chemoradiotherapy is a effective comprehensive therapeutic interchange program for early stage nasopharyngeal carcinoma. These program can increase the long-term survival rate, but also reduce the radiation dose to the nasopharynx and the occurrence of radiation complications. A further aspect is worth consideration.
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Aged , Humans , Carcinoma , Chemoradiotherapy , Combined Modality Therapy , Methods , Disease-Free Survival , Follow-Up Studies , Incidence , Nasopharyngeal Carcinoma , Nasopharyngeal Neoplasms , Mortality , Pathology , General Surgery , Therapeutics , Nasopharynx , Radiation Effects , Neoplasm Staging , Prospective Studies , Radiotherapy Dosage , Survival Rate , Xerostomia , EpidemiologyABSTRACT
Objective To identify the neural substrates of three motor tasks (repetitive and sequential fin-get-to-thumb opposition movements in turn, making fates, fingers passive flexion-extension movements in turn) of dominant and subdominant hands by using the whole-brain functional magnetic resonance imaging. Methods Ten right-handed healthy volunteers were scanned while they were performing the movement tasks with their right and left fingers. The motor cortex active volume and intensity was recorded. Quantitive analysis of motor cortex was conducted with paired t test. Results Under the three hand motor tasks, activation volumes in SMC during movements of the subdominant hand were significantly larger than those during movements of the dominant hand (P < 0. 05). Activation volumes during finger-to-thumb opposition movements and passive bendlng-extending fingers movements were significantly larger than those during movements of making fasts (P < 0.05). Activation intensity during passive ben-ding-extending fingers movements was significantly larger than those during movements of making fasts (P < 0.05). Conclusion The representation of the Motor Cortex is related to the complexity of the hand motor exercises. Quantitive criterion as volume and intensity approves the dissymmetry of cortex activation by dominant and subdominant fingers'movements. It is practicable and credible to adopt invariable fingers passive flexion-extension movements in turn in the study on BOLD-fMRI.
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Objective To observe any change in the active volume of the hand motor cortex during rehabilitation therapy after acute cerebral infarction and analyze the mechanisms involved in motor function rehabilitation.Metbods Of 16 patients with acute brain infarction,8 were administered routine intemal medicine treatment only,while and the other 8 received rehabilitation therapy in addition.Before treatment and after 14 days,the patients were assessed with functional magnetic resonance imaging(fMRI)and the Fugl-Meyer assessment of motor function (FMA).The active volume of the motor cortex was compared between the two groups of patients.Ten healthy volunteers were examined with fMRI to confirm the location and the volume ofthe active area when performing the sanle exercises.Results After treatment,all the 16 patients showed increased motor cortex active volume,and their FMA scores also increased.Those receiving rehabilitation therapy improved tO a significantly greater extent than those treated with internal medicine treatment alone.Conclusion Rehabilitation of patients with acute infarction Can activate a greater volume of the motor cortex and promote functional recovery.