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Objective:To evaluate the effects of comprehensive reform of clinical education on cultivating the clinical thinking ability of medical students in internal medicine.Methods:A total of 44 clinical interns on medicine rotation were included in this study and divided into experimental group and control group, and a series of measures for clinical teaching reform, which included undergraduate tutorial system, team-based learning (TBL) mode, combination of electronic medical record and handwritten medical record, as well as formative assessment, were applied to fully promote clinical thinking ability of medical students. SPSS 17.0 software was used to compare the scores of final academic tests of rotation and competition of medical record writing between the control and the experiment groups. Self-designed questionnaires on undergraduate tutors and clinical interns were applied to comprehensively evaluate the effects of this education reform.Results:Independent-sample t tests showed there were statistically significant difference ( P<0.01) in the scores of final academic tests of rotation and competition of medical record writing between the two groups, and the mean score of the experiment group was higher than that of the control group. Questionnaire survey showed that tutors and clinical interns both fully affirmed the positive effects of the education reform on cultivating clinical thinking ability of medical students in internal medicine. Conclusion:Application of comprehensive education reform in clinical teaching of internal medicine, which based on introduction of undergraduate tutorial system and TBL mode, could effectively promote the clinical thinking ability of medical students and the teaching quality.
ABSTRACT
Objective To investigate the effect of remote ischemic preconditioning on nuclear factor erythroid-2 related factor 2 (Nrf2) signaling in the liver of aged rats after warm ischemia reperfusion injury.Methods A 70％ hepatic warm ischemia-reperfusion model was established in aged rats (15-16 months old) (1 hour after ischemia and 2 hours after reperfusion).12 male Sprague-Dawley rats were divided into two groups:pretreatment group and control group.The level of serum alanine aminotransferase (ALT) was detected after operation and the liver tissues were harvested for the determination of malondialdehyde (MDA) content and the activity of antioxidant enzyme-superoxide dismutase (SOD).The pathological changes of liver were observed.The change of Nrf2 protein expression in liver tissue was examined by Western blot.Results Serum ALT and MDA in the pretreatment group were significantly lower than those in the control group.The liver pathological damage of pretreatment group rats were lighter than the control group (P ＜ 0.05).Compared with the control group,the Nrf2 protein expression and the activity of SOD increased in the liver of pretreatment group (P ＜ 0.05).Conclusions Remote ischemic preconditioning can reduce 70％ hepatic ischemia-reperfusion injury in aged rats,and its mechanism may be related to its activation of Nrf2 signaling pathway.