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Mastery learning is a competency-based mixed education method, which divides complex medical education contents into several teaching units according to the degree of difficulty and sets minimum passing standard for each teaching unit. Formative assessment was used to evaluate whether the learners had reached the mastery standard and finally mastered the knowledge through pass-continue or fail-repeat approach. The learners who had reached the mastery standard were usually able to use their knowledge more freely in clinical practice, and were able to accomplish more complex tasks through their own judgment with less supervision.
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Objective To investigate the immediate oral feedback after objective structure clinical examination (OSCE) for postgraduate year 1 & 2 surgery residents (PGY1 & 2).Methods 37 PGY1 and 38 PGY2 wereevaluated.The examination was composed of 6 stationsand limited to15 minutes per station.Each station was evaluated by centesimal system score.Immediate oral feedback was given in the last2 minutes.A questionnaire was given to each resident and examiner at the end of OSCE.All data analyses were conducted using SPSS version 22.0,repeated measures ANOVA and LSD test were used,and correlations were tested by the Pearson correlation test.Results The average scores for PGY1 & 2 were (68.97 ± 5.40) and (68.35 ± 5.00),the between-and inter-round differences in average score were not statistically significant.There was no significant correlation about theevaluation of the residents' performance during OSCE between the examiners and the residents.The necessity and effectiveness of immediate oral feedback were confirmed by both the examiners and the residents.Conclusions Immediate oral feedback isfeasible with limited impact on OSCE score,but the plan should be furtherrefined.Follow-up study isnecessary to identify the long-term effect on the clinical competency.
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Objective To investigate the effectiveness and rationality of objective structured clinical examination (OSCE) used as achievement assessment for Postgraduate Year 1 surgery residents.Then the form and content of training and examination can be improved according to test results.Methods 31 Postgraduate Year 1 surgery residents were involved in the examination.The examination was composed of 5 stations,which were case analysis,wound dressing change,plaster fixation,laparoscopic simulator basic skills and irregular wound debridement suture.Each station was evaluated by centesimal system score and limited in 15 minutes.A questionnaire on their opinion and perception of the examination was given to each resident at the end of examination.A total number of 31 questionnaires were issued and recycled.The difficulty,discrimination and reliability of each station were calculated,and the correlation between each station was analyzed.Results The average OSCE score was (74.66 ± 4.39).The difficulty of total stations was 0.747.The distinction was 0.578 and the reliability was 0.402.The second station was lowest difficulty,and the fifth station was most difficult.Every station's discrimination was larger than 0.400.The reliability of the second and the fourth station was low.There was moderate correlation between the first station and the second station,as well as the first station and the fourth station.But there was no significant correlation between other stations.Residents' questionnaire survey showed that the fourth and the fifth stations were considered as the most difficult,and the second station was the simplest.They thought the fourth was most helpful for clinic.They performed best at the second station and worst at the fifth station.Conclusions OSCE can effectively evaluate the efficacy of the resident training.The residents' practical competency skills can be assessed better by examination simulating complex clinical scenario.Besides,after examination,we need to objectively evaluate the assessment efficiency,and dynamically adjust the training content and examination form according to residents' subjective opinions.
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Background and purpose:Breast cancer is one of the most common malignant diseases in women and its malignant proliferation is the major cause of death. To investigate the effects of N-myc downstream regulated gene 2 (NDRG2) on proliferation of breast cancer cells by using two parallel cell lines (MCF-7 and LM-MCF-7) with different metastatic abilities.Methods:The expression level of NDRG2 in breast cancer cells was detected by Western blot. The effects of overexpressing (or down-regulating) NDRG2 on proliferation of breast cancer cells were investigat-ed by lfow cytometry. The expression and location of β-catenin were detected by Western blot and immunolfuorescence respectively. NDRG2 blocking the transcription activity of β-catenin was investigated via co-transfecting MCF-7 cells with NDRG2 siRNA and pCMV-Tcfδ (lacking the portion responsible for the protein binding to DNA).Results:The expression level of NDRG2 was negatively related to the proliferation ability of breast cancer cells. Over-expressing NDRG2 (or down-regulating) via transfecting LM-MCF-7 (or MCF-7) cells with pCMV-NDRG2 (or NDRG2 siRNA) could inhibit (or promote) cell proliferation. Interestingly, the results of Western blot, immunolfuorescence and lfow cytometry revealed that down-regulation of NDRG2 resulted from the down-regulation of β-catenin and blocking its nuclear translocation, which led to losing control of the proliferation of breast cancer cells.Conclusion:NDRG2 inhibit the proliferation of breast cancer cells via down-regulating the expression of β-catenin and blocking its nuclear translo-cation, which is signiifcant for exploring the molecular mechanism of proliferation of breast cancer cells.
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The article summarized the workflow of instructional design by using ADDIE model.The model is a recirculation of assessment,design,development,implementation and evaluation,by which the quality of education can be improved continuously.After the initial assessment it was found that the model can basically reach the general goal for training the junior doctors.For the problem of residents' irregular study and great difference of individual clinical skills,some suggestions for improvement were made.It included adjusting the time and content of training,individualized teaching,reforming examination form and increasing objective measurement to assess the effectiveness of training.All of them can effectively improve the effectiveness of basic surgical training in surgical school.
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Objective To explore the significance on expression of mdr-1, P-gp and DNA heteroploidy in invasive bladder carcinoma. Methods The expressions of mdr-1 and P-gp were detected by RT-PCR and immunohistochemistry(SP) method, and DNA ploidy by flow cytometry method in 26 cases of invasive bladder carcinoma tissues, which were compared with those in 10 normal bladder tissues. At the same time, the flow cytometry was used to determine DNA heteroploidy. Results A of mdr-1 in the neoadjuvant chemotherapy CR, PR, non-respond and control group were (0.61±0.75), (0.71±0.11), (1.68±0.28) and (0.745±0.13),respectively (P＜0.05). Positive rates of P-gp had significant differences between CR, PR and non-respondgroup and control group (P ＜0.05). Positive rates of DNA heteroploid in the above groups were 50 %, 45 %,69 % and 10 %, respectively (P ＜0.05). Conclusion The detections of mdr-1, P-gp and of DNA heteroploid contribute to evaluate neo-adjuvant chemotherapy effects of invasive bladder carcinoma.
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Objective To evaluate the roles of high-resolution computer tomography (HRCT) and bron- choalveolar lavage (BALF) in the diagnosis of connective tissue diseases associated with interstitial lung disease (CTD-ILD). Methods Clinical data of chest HRCT and BALF of patients with CTD-ILD from January 1997 to December 2007 in in-patient department of Peking University First Hospital, were retrospectively analyzed. Results ①Among 46 cases with the picture of chest HRCT, 19 (41.3%)showed usual interstitial pneumonia(UIP) -like pattern and 18 (39.1%) showed lobular and interlobular septa thickening. 8 (8/17) of ANCA vasculitis (AASV) and 5 (5/9) of rheumatoid arthritis (RA) manifested as UIP-like patterns respectively. In polymyositis/dermatomyositis(PM/DM) and Sjogren's syndrome (KS) patients, the organizing pneumonia(OP)-like pattern and lymphocytic interstitial pneumonia(LIP)-like pattern were 2/4 and 2/4 respectively. ②Among 32 cases undergoing BAL, 10/10 patients with AASV-ILD all showed that neutrophils were dominant in BALF, while, the other 22 patients showed that the ratio of neutrophils elevation (14/22, 63.6%) and the ratio of lymphocytes elevation (18/22, 81.8%) were comparable, and there were 12/22(54.5%)patients with both types of cell elevation. Among 13 cases with iymphocytes elevation in BALF who performed analysis of sub-type lymphocytes, 10/13 cases showed decreased CD4/CD8 ratio, 3/13 cases showed increased CD4/CD8 ratio which were all related with SS. ③Among 15 patients undertaken HRCT and BALF detection together, 7/7 UIP-like cases showed the ratio of neutrephils elevation in BALK While in non-UIP-like cases, 5/8 showed the ratio of lymphocytes elevation. Conclusion ①UIP-like patterns and patterns of lobular and interlobular septa thickening are the most common imaging features of HRCT in CTD-ILD, the former are mostly seen in AASV and RA. OP-like patterns and LIP-like patterns are commonly seen in PM/DM and SS respectively. ②Tbe increased neutrophil percentage is dominant in BAL fluid of patients with AASV-ILD, while the others show that the ratio of neutrophil and lymphocyte elevation are comparable, lymphocytes subtype analysis shows decreased CD4/CD8 ratio is dominant in CTD-ILD patients with lymphocytes increased. There is a significant relationship between increased CD4/CD8 ratio and SS-LIP. ③All of the cases with UIP-like patterns show the ratio of neutrophils elevation in BALF. While the ratio of lymphocytes elevation is dominant in non-UIP-like cases.
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Objective To investigate the relationship beween bladder relaxation characters and 3-adrenergic receptor level in DM rats. Methods The studying subjects consist of induced diabetes and normal control rats,30 rats in each group,to detect bladder relaxation charaters in 2 groups and its relationship with 3-adrenergic receptor,cAMP contents.Western blot was performed to probe 3-adrenergic receptor.cAMP products of bladder was studied with radioimmunoassay. Results Bladder relaxation in response to isoproterenal stimulation was observed. Bladder pressure of streptozotocin induced diabetes rats at week 2,4,12 were (11.8?2.3),(11.9?2.2),(11.5?3.0)cm H_2O respectively,and (32.8?7.6),(33.9? 5.2 ),(34.7?2.7)cm H_2O in control group.3-adrenergic receptor level in diabetes group were (104?7),(105?11),(126?14)?m at week 2,4,12,and in control group (151?11),(151?10),(152?13)?m.cAMP products were detected at the same time points,namely,(0.195?0.026),(0.198?0.030),( 0.109? 0.031)pmol/L in diabetes group,and (0.349?0.051),(0.350?0.052),(0.353?0.051)pmol/L in control group. Conclusions Relaxation abilities is impaired in diabetes bladder.Though 3-adrenergic receptor level was up-regulated,cAMP products is donw-regulated,which is responsible for detrusor relaxation.3-adrenergic receptor pathway is impaired via donw-regulating cAMP products in diabetes cystopathy.
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Objective:To describe the clinical,radiological and pathological characteristics of idiopa-thic pulmonary haemosiderosis(IPH) in adults and to evaluate the methods of diagnosis and treatment.Methods:Two patients were successfully diagnosed and treated in our hospital and the literature on the subject was reviewed.Results:Two adult patients(19 and 34 years old) diagnosed in our hospital had 5 and 10 years of history of hemoptysis respectively,and chest CT showed bilateral diffuse alveolar opacities over mid and lower zones.Tests of antinuclear antibodies(ANAs),rheumatoid factor(RF),antineutrophilic cytopasmic antibodies(ANCA) and Anti-glomerular basement membrane(anti-GBM) antibody were negative.Haemosiderin-laden macrophages were found in bronchoalveolar lavage fluid(BALF) whose color was yellow.Microscopic examination of the lung tissue specimens obtained by transbronchial lung biopsy(TBLB) revealed hemorrhage and numerous hemosiderin-laden macrophages in the alveoli and no vasculitis or capillaritis were seen.These findings were consistent with a diagnosis of IPH.Steroid therapy had good effects.Conclusion:IPH is a diagnosis of exclusion of other causes of diffuse alveolar hemorrhage(DAH).IPH adults have relatively good drug responses and relatively good prognoses.
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To describe the clinical,radiological and pathological characteristics of idiopathic pulmonary alveolar proteinosis(I-PAP)and to evaluate the methods of diagnosis and treatment.Three patients were successfully diagnosed and treated in our hospital and the literature on the subject was reviewed.Three patients,two males and one female(mean age 46 years),were diagnosed averagely in 4 months.Two severe patients presented with progressive dyspnea and type I respiratory failure,and one mild patient only with dry cough and hypoxemia.Chest X-ray radiographs all showed perihilar "butterfly" shadow and chest CT scans showed diffused ground-glass opacities(GGO),typically with "map" changes and "crazy paving" patterns.All the patients underwent bronchoscope,branchoalveolar lavage fluid(BALF)had grossly opaque and/or milky appearance and its sediment was periodic acid-Schiff stain positive.Transbronchoscopic lung biopsy(TBLB)specimens were obtained and under light microscopy alveoli and some of the small bronchioles were filled with eosinophilic proteinaceous material with needle-like clefts.By electron microscopy numerous cellular debris and extracellular multilamellated bodies were found.Two severe patients were successfully treated with sequential whole-lung lavage and one required repeated lavages.I-PAP is rare and prone to be misdiagnosed.The radiological features may indicate the diagnosis and examinations of TBLB and BALF can make the accurate diagnosis.Whole-lung lavage is the most effective therapy by now and granulocyte-macrophage colony-stimulating factor(GM-CSF)may be beneficial in some patients.
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OBJECTIVE:To summarize the clinical effect of compound glycyrrhizin(CG)on SARS.METHODS:The clin?ical data of73patients with clinically diagnosed SARS(37cases were treated by CG)were prospectively analysed.RESULTS:After CG treatment,the symptoms of dry cough,chest distress and dyspnea improved quickly and the elevated serum level of aminotransferase decreased.The maximal dosages of corticosteroids used in CG group and control group were(354.3?219.8)mg/d and(430?262.6)mg/d,respectively.The average time to occurrence of antibody,duration for reduction of corticosteroid dosage and duration of hospital stay were shorter in CG group than those in control group.There was no significant difference in titer value of antibody between two groups.CG had little effects on WBC,blood sugar and electrolytes.CONCLUSION:CG may be a promising drug against SARS with less side effect.
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B-ultrasonic manifestations of 65 cases of cryptorchlchsms including location and size as well as internal structure of tests are analysed.Among these seventy-four per cent cases Were con-firmed by operations.It is Considered that B-ultrasonic imaging has important diagnostic value for cryptorchidism.
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Objective To observe the changes in the level of serum cystatin C and the expression of matrix metalloproteinase-9 (MMP-9) in the kidney after the development of diabetic nephropathy in streptozotocin (STZ) induced diabetic rats, and to study their correlation. Methods Sixteen female Wistar rats were used to reproduce diabetes by interperitoneal injection of STZ (60mg/kg). Immunohistochemical staining was employed to detect the expressions of MMP-9 in kidneys with image analysis system, and ELISA was used to determine serum cystatin C after 4 or 8 weeks. The correlation between MMP-9 and cystatin C was analyzed by SPSS 10.0. Results The expressions of MMP-9 in diabetic kidneys both at the 4th and the 8th week (8.180?0.905 and 3.948?0.623, respectively) were significantly lower than that of normal control rats (15.620?3.444 and 16.185?3.120, respectively. P