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Objective:To investigate the effect of narrative medicine teaching on the academic performance and empathy ability of clinical interns in department of thoracic surgery.Methods:A total of 74 interns in the department of thoracic surgery, with the "5+3" integration major of clinical medicine in Chongqing Medical University, were divided into observation group and control group, with 37 interns in each group. The interns in the control group received traditional teaching, and those in the observation group received narrative medicine teaching in addition to traditional teaching. The two groups were compared in terms of department examination score, level of humanistic concern, empathy level, ability to handle doctor-patient relationship, degree of satisfaction with teaching, discipline interest, and job intention after graduation. SPSS 21.0 was used to perform the t-test and chi-square test. Results:Compared with the control group, the observation group had significantly better theoretical score [(85.16±10.04) vs. (79.73±8.27)], operational skill score [(85.32±8.77) vs. (79.70±7.56)], level of humanistic concern [(3.78±0.95) vs. (3.24±1.04)], empathy scale score [(104.89±12.90) vs. (96.57±11.00)], results of the questionnaire on doctor-patient communication skills, confidence in professional practice, and doctor-patient orientation [(52.59±10.15) vs. (72.59±5.86)], degree of satisfaction with teaching (89.2% vs. 64.8% in the control group), discipline interest [(3.86±1.08) vs. (3.05±1.12)], and job intention after graduation (29.7% vs. 8.1%).Conclusion:Narrative medicine introduced into clinical practice teaching can improve the effectiveness of teaching, the empathy ability of students, and the degree of satisfaction with teaching.
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Objective:To investigate the application effect of case-based learning (CBL) in clinical practice teaching of cardiothoracic surgery.Methods:A total of 86 interns who rotated in our department from February to November 2019 were randomized into observation group ( n = 43) and control group ( n = 43) by drawing lots. The control group used traditional teaching method, and the observation group used CBL teaching method. The differences between the two groups in professional theoretical performance, clinical skill achievement and teaching satisfaction were compared. Results:The professional theoretical scores, clinical skills scores, and teaching satisfaction of the observation group were better than those of the control group, with statistical differences ( P < 0.05). Conclusion:The CBL teaching method can effectively help interns master professional theoretical knowledge and clinical practice skills of cardiothoracic surgery, which has obtained satisfactory teaching results and is worthy of promotion.
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A new method was proposed for analysis of the organic compounds in cigarette smoke by high resolution Orbitrap mass spectrometry based on polyacrylonitrile-silica (PAN-SiO2) nanofiber membrane extraction and methanol elution.Hydrophobic PAN-SiO2 nanofiber membrane which was used to enrich small molecular organic compounds in cigarette smoke was prepared by the technology of electrospinning.Several parameters including the concentrations of PAN and SiO2 nanopartical,elecrospining voltage,needle aperture and flow rate of spinning solution were optimized.Under the optimal conditions,a PAN-SiO2 nanofiber membrane with good adsorption performance and great physical strength was obtained.A total of 21 compounds including acetone,styrene,acrolein,isoprene,and acrylonitrile were identified by analyzing the cigarette smoke with Orbitrap MS spectrometry in the positive ion mode.Six organic acids including salicylic acid,malic acid and lactic acid were detected in negative ion mode.The limits of detection and quantification for nicotine were 0.071 ng/L and 0.236 ng/L,respectively.
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Phospholipids and their metabolites play an important role in a variety of cellular processes including cell-cell adhesion, cell growth and differentiation, apoptosis, phagocytosis as well as storage of energy. In this study, the phospholipid composition of cancer tissue and adjacent normal tissue from humans and animals were analyzed by internal extractive electrospray ionization mass spectrometry ( iEESI-MS ) . Extractive solvent at high voltage (+5. 5 kV) was injected into tissue samples using a fused silica capillary at a flow rate of 0. 5-1 μL/min, producing fine charged droplets containing analytes of tissue samples at the tip of the sample. Charged droplets were directly sampled to the atmospheric inlet of a mass spectrometer. Out of 21 different ratios of CH3 OH ∶H2 O solvent mixture, the ratio CH3 OH ∶ H2 O=30∶70 ( V/V ) showed the optimal phospholipids extraction and visibility in MS. A large number of phospholipids from different tissue samples ( such as cancer tissue and adjacent normal tissue of lung cancer, esophageal cancer tissue, pork, beef, porcine heart and porcine lung) were obtained simultaneously by iEESI-MS analysis. The experimental results demonstrated that iEESI-MS was characterized by minimal sample pretreatment, low sample consumption, and rapid analysis ( the analysis time per sample was less than 1 min) , and the selectivity and sensitivity of iEESI-MS could be improved by choosing proper solvent. Importantly, the experimental results provided new information for further studies of phospholipids in biological tissues.
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A rapid resolution liquid chromatography quadruple time-of-flight mass spectrometric ( RRLC-Q-TOF/MS) method combined with multivariate statistical analysis was applied to investigate the changes of endogenous metabolites in murine urine before and after ultraviolet B ( UVB ) irradiation for the purpose of discussing the physiological mechanism of acute injury caused by UVB radiation. A narrow-band UVB ( NB-UVB) (TL-01, peak value 312nm) was used to establish the acute light damage model. The urine samples were centrifuged before four times dilution treatment, subsequently the diluted urine samples were separated on a Supelco Ascentis Express C18 column using water (0. 1% formic acid) and acetonitrile as mobile phase by gradient elution. The differences metabolites with major contribution for grouping were found out based on the metabolic profiling analysis of principal component analysis ( PCA) and cluster analysis ( CA) , which could illustrate their possible mechanism of actions by means of relevant pathways. A prediction model was built to investigate the forecasting ability of the acute photo damage induced by UVB irradiation through the partial least square discriminant analysis ( PLS-DA ) . The results of multivariate statistical analysis showed that the blank control group was separated from UVB model group quite well, 11 endogenous metabolites were identified as the potential biomarkers through comparison with the database, tandem mass spectrum data and standard substance, which indicated the UVB radiation may affect the sphingolipid metabolism, nucleic acid metabolism, linoleic acid metabolism and amino acid metabolism pathways. These different metabolites could be helpful for diagnosing the light damage induced by UVB radiation
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Liquid-assisted surface desorption atmospheric pressure chemical ionization mass spectrometry (LA-DAPCI-MS)was used directly for the analysis of healthy rat liver (normal control group);acute alcoholic injury rat liver(alcohol model group)and Zhizi Dahuang decoction-treated rat liver (ZZDHD group)sections with the mass spectrometry images obtained simultaneously.Principal component analysis (PCA)was employed for the differentiation of livers of the groups;and 3 phospholipids;PC (34 ∶2);PC(36 ∶4)and PC(38 ∶4);were found to be the main factors.LA-DAPCI mass spectrometry images showed that the 3 phospholipids were evenly distrib-uted in liver under the spatial resolution of 0.01 mm2.Contents of 3 PCs in the model group were decreased in alcohol model group compared to the normal control group and the ZZDHD group;which revealed the relationship between acute alcoholic liver injury and intrahepatic phospholipid variation.The results showed that ZZDHD had protective effect on acute alcoholic liver injury-induced intrahepatic phospholipid variations at the molecular level.
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Theapplicationofinternalextractiveelectrosprayionizationmassspectrometry(iEESI-MS)was extended to direct molecular analysis of garlic tissues. By obviating time-consuming sample preparations, fragile active garlic substances such as organosulfur compounds ( e. g. , alliin, allicin ) were successfully detected and identified via collision-induced dissociation ( CID) , together with amino acids ( e. g. , arginine) and saccharides ( glucose, polysaccharides) . Mass spectral fingerprints of different kinds of garlic cloves, as well as various post-treatment ones, were further processed via principal component analysis ( PCA) to better visualize the differences. Our experimental results indicated that iEESI-MS allowed rapid recognition of metabolic changes in the garlic tissue subject to various external stimuli. The merits included simplicity of analysis, high speed ( less than 2 min per sample ) , good specificity, and minimal disturbance to the bioactivity of analytes.
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Objective:This study was aimed to investigate the safety and feasibility of applying duodenal feeding tube in thoracoscopy-and laparcoscopy-guided esophagectomy for esophageal carcinoma. Methods:Clinical data of 73 esophageal carcinoma patients who underwent esophagectomy and received a duodenal feeding tube by thoracoscopy and laparoscopy from March 2011 to September 2012 were analyzed retrospectively. Modes of operation included the separation of the esophagus by thoracoscopy, separation of the stomach by laparoscopy, reconstruction of the digestive tract, and so on. Results:A duodenal feeding tube was carefully placed at the site of esopha-gectomy of the patient. Operation time lasted from 180 min to 410 min, with an average of 273 min. The duodenal feeding tube was placed at 27 min into the operation. Intra-operative blood loss ranged from 50 mL to 450 mL, with an average of 120 mL. No post-operative death was encountered among the cases. After surgery, anastomotic fistula and gastrointestinal discomfort occurred in 2 and 5 of the 73 cases, respectively. Conclusion:Placement of a duodenal feeding tube at the site of esophagectomy through thoracoscopy and laparoscopy is completely safe and feasible.
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Objective To evaluate the short-term efficacy of lamivudine versus entecavir for patients with HBeAg-negative acute-on-chronic liver failure (ACLF) with different pretreatment liver failure degrees.MethodsA total of patients with HBeAg-negative ACLF were enrolled into this retrospective study.Seventy-two cases were treated with lamivudine 100 mg daily,while 93 cases were treated with entecavir 0.5 mg daily.Biochemical items,model for end-stage liver disease (MELD)score,hepatitis B virus (HBV) DNA level and mortality were observed.The efficacies of the two drugs were analyzed in patients with different degrees of liver failure.The comparison of rates was done using chi-square test and the measurement data were compared by t test.ResultsAmong the patients with pretreatment MELD scores above 30,the post-treatment HBV DNA levels in lamivudine group and entecavir group were (3.6 ± 1.1) lg copy/mL and (3.7 ± 1.4) lg copy/mL,respectively (t=0.181,P=0.859) and the mortalities were 92.0％ and 91.8％,respectively (χ2 =0.002,P=0.680).For the patients with pretreatment MELD scores from 23 to 30,the post-treatment HBV DNA levels in two groups were (3.2± 1.1) lg copy/mL and (3.2±2.3) lg copy/mL,respectively (t=0.760,P=0.455) and the mortalities were 42.9％,54.1％,respectively (χ2 =0.799,P=0.455).In patients with pretreatment MELD scores below 23,the post-treatment HBV DNA levels in two groups were (3.1±1.0) lg copy/mL and (2.8±1.5) lg copy/mL,respectively (t=-0.740,P=0.464) and the mortalities were 3/19 and 6.3％,respectively (χ2=1.227,P=0.455).In lamivudine group,the mortalities were significantly different among patients with three different ranges of pretreatment MELD scores (χ2 =26.967,P =0.000).The similar differences were also found in entecavir group (χ2 =41.260,P=0.000).ConclusionsAmong treatment na?ve patients with HBeAg-negative ACLF,the short-term efficacy of lamivudine versus entecavir is equal if the degree of pretreatment liver failure is similar.Meanwhile,the degrees of pretreatment liver failure significantly affects the outcome of the treatment.
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Objective Recent.studies have found a strong association of insulin resistance, which might occur during ischemia reperfusion in vitro in the experimental dogs, with disturbed function of cardiomyocytes. Obvious acute insulin resistance, along with glucose dysmetabolism in the reperfused cardiomyocytes, was furher observed in the study performed with ischemia-reperfused ventric- ular myocytes of rats. We tried to investigate preliminarily the molecular mechanisms of insulin resistance in the cardiomyocytes after ischemia reperfusion. Methods An experimental model of insulin-stimulated ischemia reperfusion (SI/R) was created by isolating cardiomyocytes from adult rats. Glucose uptake of the cardiomyoctyes was evaluated with isotope-labeling technique. Glucose trans- porter 4 (GLUT4) translocation induced by insulin was investigated with Western blot analysis, and the intracellular level of free Ca2+ ([Ca2+]I) was measured quantitatively with Ca2+ indicator Fura-2. Results Insulin can stimulated glucose uptake by cardiomyo- cytes, indicating that these cells were insulin-sensitive. Cardiomyocytes were demonstrated notable acute insulin resistmce during reperfusion. Insulin-stimulated GLUT4 translocation in the cardiomyocytes 15 minutes after reperfusion was 72.2% of that in the con- trol group(P<0.05), in which the GLUT4 content in plasma membrane remained unchanged. The finding suggested that a disturbed GLUT4 translocation might happen in the cardiomyocytes during insulin-stimulated ischemia-reperfusion. Calcium overload was identi- fied in the cardiomyocytes with ischemia reperfusion. At 15 minutes of reperfusion, [Ca2+]I was significantly higher in the reperfused cardiomyocytes than that in the control cardiomyocytes[(318.66±23.06)vs(130.70±0.82) nmol/L, P<0.05], and kept at a higher level [(177.79±17.46) nmol/L] at 60 minutes of reperfusion (P<0.05, vs control). Partial correlation analysis revealed a negative correlation of[Ca2+]I with insulin-induced ghcose uptake in the cardiomyoctyes (r = -0.557,P=0.006). Conclusion Disturbed GLUT4 translocation and decreased intrinsic activity may be important molecular mechanisms for the development of insulin resistance in the cardiomyocytes of rat during insulin-simulated ischemia reperfusion,. [Ca2+]I overload may account for the de- creased intrinsic activity d GLUT4.
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To investigate the feasibility of making up bovine pericardium into scaffolds for tissue engineering valve, it was decellularized by 0.5% trypsin incubation for three hours. The rats were divided into fresh bovine group, acellular pericardium group and control group, and OD value of rat anti-bovine IgG was measured. Serum levels of IgG showed no difference among the three groups on the 7th day postoperatively (P > 0.05). The OD values of IgG at other time-points displayed distinct difference among the three groups (P < 0.05). Fresh bovine pericardium group produced more IgG than acellular bovine pericardium group did at the same time-point. The IgG level of fresh bovine pericardium group reached the peak postoperatively, but in acellular bovine pericardium group its peak value appeared on the 30th day postoperatively. Histological examination demonstrated that the bovine pericardium was thoroughly decellularized, the fibrous structure was slightly loose, but remained essentially intact. These results indicate that the acellularization procedure can result in a complete removal of cells and decrease of immunogenicity.
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Animals , Cattle , Rats , Antibodies, Anti-Idiotypic , Allergy and Immunology , Bioprosthesis , Cell Separation , Methods , Immunoglobulin G , Allergy and Immunology , Implants, Experimental , Pericardium , Cell Biology , Allergy and Immunology , Rats, Sprague-Dawley , Tissue Engineering , Methods , Trypsin , PharmacologyABSTRACT
Objective:To Evaluation in Patients with Different Gastric Tube Reconstruction after esophagectomy With thoracoscopy and laparoscopyfor esophageal carcinoma.Methods Fromjune 2009 toDecember 2009,35 esophageal cancer patients underwent esophagectomy With thoracoscopy and laparoscopy for esophageal carcinoma.There were 20 patients in the retrosternal group and 15 in the prevertebral group Evaluation indicators include the amount of surgical bleeding,operative time,number of lymph nodes removed,Postoperative gastric juice volume,perioperative complications,postoperative hospital stay.Results Amount of bleeding,operative time,number of lymph nodes removed,postoperative hospital stay between the two groups surgery was no statistical difference.postoperative pulmonary complications and gastric juice volume in the retrosternal group were significantly lower than that of the prevertebral group.Anastomotic leakage occurred more frequently in retrosternal group than in preyertebral group.Conclusion:In esophagectomy With thoracoscopy and laparoscopy for esophageal carcinoma,different path has their own advantages and disadvantages.Determining the path to use should be in according with the patients,condition
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0.05).Resting [Ca2+]i in normal cardiac muscle cells was (117?22.41) nmol/L,while for the cells of experimental groups 1 and 2,it was significantly higher than normal cells,but there was no significant difference between them after 1 hour’s treatment of 0.5 ?mol/L ionomycin [(260.00?33.06) and (278?23.46) nmol/L respectively].The [Ca2+]i in experimental groups 3 and 4 was (391.00?20.01),and (379.00?23.92) nmol/L respectively,which were significantly higher than those of experimental groups 1 and 2,and control group (P
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Objectiove To explore the teaching effectiveness of PBL teaching methods the teaching of cardiothoracic surgery.Methods Random clinical medical intern students 2008-2009 in our department were divided into 2 groups,with PBL teaching methods used in experimental group,and traditional teaching methods in the control group.Results The excellent and failure rates of the exam scores of the students in the experimental group were 75% and 4% respectively.while in the control group were 43% and 18% respectively.After statistical treatment,compared with the excellent and failure rates in the experimental group and in the control group,the difference is of high significance.Conclusion PBL teaching method in cardiothoracic surgery in the teaching effectiveness of teaching is better,worthy of promotion.
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Objective:To explore the Clinical feasibility of single-working pore in VATS for treatment pulmonary peripheral,isolated lesion.Methods:From june 2008 to December 2009,22 patients with Pulmonary Peripheral,isolated lesion performed operation in VATS.Diseases include Pulmonary benign tumour,lung cancer(need wedge pulmonary resections).The incision for operation was 1.5～3.0 cm at lateral position of the fourth rib of anterior axillary line,while the incision for observation located at lateral position of the seventh rib of middle axillary line.Results none of patients need converse to transit-assisted small incision in chest.operative time was 30 ～ 100 min,an average of 55min.Intraoperative blood loss 10 ml ～ 200 ml,an average of 50ml.5-7 days for hospitalization,an average of 5.5 days.Conclusion:In accordance with the way of single-working pore in VATS for treatment pulmonary peripheral,isolated lesion.We minimize the trauma and ensure safety of operation.