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Objective:To explore the teaching reform of internal medicine graduate students based on the concept of outcomes-based education (OBE).Methods:A total of 86 graduate students who studied in the Teaching and Research Section of Internal Medicine in the First Affiliated Hospital of Xinjiang Medical University from January 2019 to August 2020 were randomly divided into control group ( n=43) and observation group ( n=43). The control group adopted traditional teaching, and the observation group adopted the teaching based on the OBE concept. The evaluation of the academic performance of the two groups of graduate students and the recognition of the teaching mode by the graduate students were compared, and the improvement of the personal ability of the graduate students was evaluated. Meanwhile, the effect of teaching satisfaction and the improvement of learning ability of the graduate students was evaluated. SPSS 22.0 was used for t-test and Chi-square test. Results:The theoretical scores, general head and neck test scores, heart test scores, lung test scores, abdominal test scores, spinal and limb nervous system test scores, operation scores and total scores of graduate students in the observation group were higher than those in the control group ( P<0.05); students in the observation group believed that the teaching could improve their learning interest, improve the self-learning ability, improve communication and expression ability, improve teamwork ability, improve understanding and memory ability, improve internal medicine thinking ability, improve generalization ability, and improve clinical practice ability. All the above aspects were higher in observation group than control group ( P<0.05); the students in the observation group had 97.67% (42/43) recognition of teaching, which was higher than 83.72% (36/43) in the control group. Conclusion:Internal medicine teaching based on the concept of OBE can improve the academic performance and enhance the personal ability of graduate students, and the students are more satisfied with this teaching method.
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Compared with normal tissue, interstitial extracellular pH of tumor cells is acidic. The reverse transmembrane pH gradient around tumor cells is closely related to its uncontrolled progression, angiogenesis and metastasis. Changes in urinary pH have an impact on the occurrence, progression and treatment of bladder cancer by regulating the microenvironment of bladder cancer cells. Relevant studies have shown that urinary pH value is an important factor in predicting the final clinical efficacy of bladder cancer patients combined with alkalization agents, which helps to reflect the acid-base balance and immune defense system in the body. Continuous monitoring of urinary pH can provide guidance and decision-making for the prognosis of bladder cancer patients.
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Objective:To analyze the value of the Padua prediction score and the bleeding risk score in the risk assessment of venous thromboembolism(VTE)and hemorrhage in elderly patients with choledocholithiasis during endoscopic retrograde cholangiopancreatography(ERCP).Methods:Clinical data of 171 elderly patients with choledocholithiasis treated with ERCP at the Affiliated Hospital of Xinjiang Medical University from September 2017 to September 2019 were retrospectively analyzed.The Padua prediction score and bleeding risk score were used to evaluate the occurrence of VTE and hemorrhage risk stratification.Results:Of all patients treated with the procedure, 18 of them had complications after surgery, including postoperative pancreatitis(9 cases), biliary infections(4 cases), hemorrhage(3 cases)and VTE events(2 cases). In addition, complications occurred in elderly patients in different age groups, with no significant difference in incidence(all P>0.05). Evaluation models showed that 32.7%(56/171)were at high risk for VTE, and 15.2%(26/171)were at high risk for hemorrhage.Furthermore, 2 VTE events occurred in the high-risk group and, of 3 hemorrhage events, 2 were occurred in the low-risk group and 1 in the high-risk group.There was no significant difference in the incidence of complications between the high-risk group and the low-risk group( χ2=0.000, 2.867, P=1.000, 0.090). Logistic regression analysis results showed that scores of the two assessment models were not influencing factors for VTE/hemorrhage(Padua prediction score: OR=8.383, 95% CI: 0.926-75.869, P=0.059; bleeding risk score: OR=2.860, 95% CI: 0.250-32.740, P=0.398). Conclusions:For elderly choledocholithiasis patients treated with ERCP, the Padua prediction score and the bleeding risk score have limited ability for risk assessment.More attention needs to be paid to the two VTE risk factors, i.e., malignant tumors and previous VTE history, in addition to previous bleeding risk for antithrombotic therapy.
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To investigate the relationship between salt-inducible kinase 2 (SIK2) and lymph node metastasis in colorectal cancer patients complicated with chronic schistosomiasis. Tissue specimens were collected from 363 patients who were diagnosed as colorectal cancer by clinical and pathological examination in Wuhu Second People's Hospital from June 2015 to June 2020. Fifty-six patients were colorectal cancer complicated with schistosomiasis (CRC-S) and 307 patients were colorectal cancer not complicated with schistosomiasis (CRC-NS). The clinical and pathological data of the patients were analyzed to explore the relationship between chronic schistosomiasis and colorectal cancer. Immunohistochemistry and Western blotting were used to detect the distribution and expression of SIK2 in colorectal cancer specimens. The relationship between SIK2 and lymph node metastasis of CRC-S was analyzed. The rate of lymph node metastasis in CRC-S group was significantly higher than that in CRC-NS group (62.5% vs. 47.2%, <0.05). In CRC-S patients with lymph node metastasis, schistosome eggs were distributed mainly in tumor tissues (25/35, 71.4%), while in patients with CRC-S without lymph node metastasis, schistosome eggs were distributed mainly in paracancerous tissues (17/21, 81.0%) (14.243, <0.01). The SIK2 was mainly located in cytosol, and its expression in tumor tissues was higher than that in paracancerous tissues. Compared with CRC-NS patients, the expression of SIK2 in CRC-S patients was significantly increased; the expression of SIK2 in patients with lymph node metastasis was higher than that in patients without lymph node metastasis; and the expression of SIK2 in patients with schistosome eggs in cancer tissues was higher than that in patients with schistosome eggs in paracancerous tissues (all <0.01). Lymph node metastasis is more likely to be occurred in colorectal cancer patients with schistosomiasis, especially in those with schistosome eggs in tumor tissues. The expression of SIK2 may be correlated with chronic schistosomiasis, egg distribution and lymphatic metastasis.
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Humans , Biomarkers, Tumor , Colorectal Neoplasms/complications , Immunohistochemistry , Lymphatic Metastasis , Neoplasm Staging , Prognosis , Schistosomiasis/complicationsABSTRACT
Background: The prevalence of ulcerative colitis (UC) in China has significantly increased in recent years,and Toll-like receptor 4 (TLR4) may be closely related to the development of UC.Aims: To study the effect of vitamin D3 on expression of TLR4 in the intestinal mucosa in colitis model in rats.Methods: Thirty Sprague-Dawley rats were randomly divided into normal control group,model group and vitamin D3 group.Rats in model group and vitamin D3 group were given trinitro-benzene-sulfonic acid (TNBS) to induce colitis model.Rats in vitamin D3 group were given vitamin D3.HE staining was performed,and disease activity index (DAI) and colon histopathological score were evaluated,the expression of TLR4 was measured by immunohistochemistry.Results: Compared with normal control group,DAI and histopathological score in model group were significantly increased (P＜0.05),and expression of TLR4 was significantly increased (P＜0.05).After giving vitamin D3,DAI and histopathological score were significantly decreased (P＜0.05),and expression of TLR4 was significantly decreased (P＜0.05).Conclusions: The expression of TLR4 is increased in colon tissue in colitis model in rats,which may be involved in the pathogenesis of UC.Vitamin D3 can alleviate intestinal inflammation via inhibiting expression of TLR4,thereby playing a role in the adjunctive therapy of UC.
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Objectives To analyze the clinical and pathological characteristics of gastric submucosal tumors (GSMTs), and evaluate the safety and efficacy of endoscopic treatment for GSMTs. Methods 61 patients with GSMTs were selected from June 2014 to September 2012 by endoscopy and ultrasonography;they were all treated by endoscopic therapy; pathological examination was took in all removed tumors, the tumors which could be the gastric stromal tumor were furtherly examined by molecular biology technique of immunohistochemistry. Result In 61 cas-es, 39 cases are female patients, accounting for 63.93%;the tumors located at the stomach fund accounted for 52.46%(32/61), at the gastric corpus for 21.31%(13/61), at the gastric antrum for 11.48 %(7/61), at cardia for 14.75%(9/61); 10 cases were treated by Endoscopic submucosal dissection, 21 by endoscopic submucosal excavation, 27 by Endoscopic full-thickness resection, 3 by Submucosal tunnelling endoscopic resection; in all 61 cases, 2 were changed to laparoscopic treatment because one tumor was too big and broke the Serous and another was located at mucus Lake of gastric fund, 1 occurred postoperative bleeding and was treated by laparoscopy successfully, 1 oc-curred postoperative perforation and was treated by endoscopy successfully; after pathological and immunohisto-chemical analysis, 34 tumors were identified as gastric stromal tumor and all of them in risk classification were at very low risk, 11 were leiomyoma, 5 were lipoma, 3 were heterotopic pancreas, 5 were calcifying fibrous pseudotu-mor, 2 were inflammatory fibroid polyps, and 1 was angiomatous proliferation; gastric stromal tumor at gastric fundus account for 73.53 % (25/34), at gastric corpus for 11.76 % (4/34), at gastric antrum for 5.88 % (2/34) and at cardia for 8.82 %(3/34). Conclusion Most GSMTs are found in female and commonly lack of specific clinical symptoms;GMSTs are commonly located at gastric fund and most of them are gastric stromal tumors, vast majority of gastric stromal tumors in the risk classification are at very low risk;the endoscopic resection is a mini-invasive, safe and ef-fective treatment for GSMTs.
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Objective To explore the correlation between delirium and dementia in elderly patients undergoing hip fracture surgery.Methods A prospective study was conducted on 118 elderly patients with hip fracture who were free from prefracture dementia.Caregivers or the relatives described the patients' prefracture cognition by the Informant Questionnaire on Cognitive Decline in the Elderly-short form (IQCODE SF).Delirium was assessed by the Confusion Assessment Method (CAM).After 6 months,cognition was reassessed by using 5 cognitive tests,taking DSM-Ⅳ as the diagnostic criteria.Results Among 32 cases (27％) suffered from delirium in the acute phase,12 cases (38％) reached to the diagnostic criteria of dementia after 6 months follow up,while there were 6 cases (7％) reached to the diagnostic criteria of dementia after 6 months follow-up in the group without delirium in the acute phase (x2 =16.81,P＜0.001).IQCODE-SF score had no statistically significant difference in the prediction of dementia.Conclusions In elderly patients without the history of dementia,delirium after hip fracture surgery is the major predictor of dementia within half years.
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<p><b>OBJECTIVE</b>To explore the variation and association of intestinal epithelial tight junctions, E.coli, and expression of Toll-like receptor-4 (TLR-4) and tumor necrosis factor-alpha (TNFα) in a rabbit model of non-alcoholic fatty liver disease (NAFLD).</p><p><b>METHODS</b>Fourteen male New Zealand rabbits were randomly divided into two groups. The control group was given a normal diet, while the NAFLD group was given a high-fat diet. After 12 weeks, the two groups were sacrificed. Both length and width of the tight junctions of ileum epithelial cells were measured by electron microscopy. Enzyme-linked immunosorbent assay was used to detect the concentration of TNFα in venous blood serum. Location and expression of TLR-4 were observed by immunohistochemical staining. Copies of E.coli genes were measured by RT-PCR. The relationship between TNFα and tight junctions, TLR-4, and E.coli were respectively analyzed by stepwise multiple linear regression.</p><p><b>RESULTS</b>Compared with the control group, the NAFLD group has significantly shortened ileum epithelial fight junctions (t=5.031, P<0.01), increased copies of E. coli genes (t=-3.492, P<0.01), and increased ileal expression of TLR-4 (t=-44.089, P<0.01). A significant increase of TNFα was also observed in the NAFLD group (t=-17.768, P<0.01). Regression analysis showed that E.coli and intestinal epithelial tight junctions were correlated (standardized beta=-0.385), and showed a positive correlation between E. coli and TLR-4 (standardized beta=0.332 and 0.427).</p><p><b>CONCLUSION</b>Damage to the intestine as a physical barrier, biological barrier and immune barrier is closely related to TNFα expression, and the relation between the immune barrier and TNFα is more significant.</p>
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Animals , Male , Rabbits , Epithelial Cells , Escherichia coli , Intestinal Mucosa , Non-alcoholic Fatty Liver Disease , Tight Junctions , Toll-Like Receptor 4 , Tumor Necrosis Factor-alphaABSTRACT
Rhizobium leguminosarum biov.trifolii H954 has been fermented for eight days on the GMS medium.Culture supernatant is extracted by ethanol precipitation,sample is purified by Sephadex G\|50,Sephadex G\|10 and DEAE\|Cellulose chromatoraphy.Gas chromatography(GC), 13 C nuclear magnetic resonance spectroscopy(NMR)and mass spectrometry(MS) analysis indicated that the sample is cyclic,neutral glucan,and composes of glucose linked solely by 1→2 glucosidic bonds.Cyclic glucan has degrees of polymerization ranging form 17 to 22,with a degree of ploymerization of 19 as the major glucan cycles.