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ObjectiveTo preliminarily predict the targets and signaling pathways of indole-3-methanol in the treatment of obesity based on molecular docking technology and network pharmacology， and then verify the prediction results by the experiment in vitro. MethodThe pharmacological targets of indole-3-methanol were obtained from SwissTargetPrediction and literature review. Obesity-related targets were obtained from Online Mendelian Inheritance in Man （OMIM）， GeneCards， and Comparative Toxicogenomics Database （CTD）. The protein-protein interaction network of the targets of indole-3-methanol and obesity was built by STRING. Cytoscape 3.8.2 was used for target screening. Gene ontology （GO） functional annotation and Kyoto Encyclopedia of Genes and Genomes （KEGG） pathway enrichment were performed for the common targets shared by obesity and indole-3-methanol in DAVID 6.8. AutoDock Vina 1.1.2 was employed to perform the molecular docking between indole-3-methanol and disease targets. Finally， the in vitro experiment was carried out to verify the anti-obesity effect of indole-3-methanol. ResultIndole-3-methanol and obesity shared 80 common targets， which included matrix metalloproteinase （MMP）-9， Janus kinase （JAK） 2， etc. KEGG enrichment predicted that indole-3-methanol mainly acted on tumor necrosis factor （TNF）， vascular endothelial growth factor （VEGF）， tyrosine kinase receptor 2 （ErbB2）， and epidermal growth factor receptor （EGFR） signaling pathways in the treatment of obesity. Molecular docking showed that indole-3-methanol had good binding activity with fat mass and obesity-associated protein （FTO）. The results of Western blot， MTT assay， and oil-red O staining showed that indole-3-methanol down-regulated the expression of FTO in 3T3-L1 cells （P<0.05）. ConclusionIndole-3-methanol may treat obesity by down-regulating the expression of FTO protein and further inhibiting adipocyte proliferation. This study provides an experimental basis for deciphering the anti-obesity mechanism of indole-3-methanol.
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Adjacent segment disease (ASDis) is a common complication of posterior lumbar spine fusion and often requires surgical treatment. In the treatment of ASDis, percutaneous spinal endoscopy can be used for simple decompression without removal of the original internal fixation, or for posterior fixation and fusion under the scope or in combination with other access fixation and fusion techniques, with the advantages of less surgical trauma, less bleeding, and faster postoperative recovery. Traditional trajectory screw technique is one of the risk factors for adjacent segment degeneration because of its tendency to cause damage to the adjacent synovial joint during surgery. In contrast, the cortical tone trajectory (CBT) screw placement technique not only reduces the damage to the articular joint during the screw placement process, but also preserves the original internal fixation in the treatment of ASDis, which significantly reduces the surgical trauma. Secondly, the implantation of CBT screws with the aid of digital technologies such as three-dimentinal printed guides, CT navigation, and robotics allows for more precise "double nailing" of ASDis patients to complete the fusion of adjacent segments, and is a minimally invasive procedure to be considered for patients who meet the clinical indications for fusion. This article reviews the literature on the use of percutaneous spinal endoscopy and CBT in the surgical management of ASDis.
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SUMMARY OBJECTIVE: To reduce surgical exposure and improve accuracy, this study evaluated the anatomical distance parameter D (including D1, D2, and D3) of the lumbar isthmus for cortical bone screw insertion. METHODS: A total of 25 structurally complete lumbar dry specimens were used for lumbar anatomy measurements. The six cadaver specimens were divided into upper and lower parts on the plane of the T11-T12 vertebrae, and we use the lower parts. Therefore, six lumbar wet specimens and another four complete lumbar dry specimens were selected. The lumbar isthmus tangent point was considered a coordinate origin, and the insertion point was determined through translating the distance of D1 value to the midline of the vertebral body horizontally and then vertically moved toward inferior board of the transverse process with the distance of D3 value. RESULTS: In four dry and six wet intact lumbar specimens, cortical bone screws were placed according to the average value of the isthmus parameter D. A total of 100 trajectories were verified in specimens by X-ray and computed topography scan to evaluate the safety, accuracy, and feasibility of the surgical use of isthmus parameter D. Using this parameter, the rates of excellent screw placement were 95% (38/40) in four dry specimens and 88.7% (53/60) in six wet specimens. CONCLUSION: The isthmus parameter D is easier to use by the operator, which can improve surgical accuracy and reduce operation time. LEVEL OF EVIDENCE: Level IV, prospective study.
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Objective To study mechanical properties of traditional trajectory (TT) and modified cortical bone trajectory (MCBT) on osteoporotic vertebrae through finite element analysis. Methods The three-dimensional model of L4 segment was established, and pedicle screw (PS) (diameter 6.0 mm, length 45 mm) and MCBT screw (diameter 4.5 mm, length 40 mm) were placed on both sides of the lumbar spine. The pull-out strength and the load-displacement ratio of screws in two different screw trajectories under up, down, left, right working conditions were analyzed, and the stability between the screw and vertebral body under osteoporotic conditions was evaluated. Results Compared with TT, the pull-out strength of MCBT screw was increased by 13.1%. Compared with PS, the load-displacement ratio of MCBT screw under up, down and left working conditions was increased by 57.2%, 32.4%, and 31.6%. Under right working condition, although the load-displacement ratio of MCBT screw was higher than that of PS, no statistical difference was found. The load-displacement ratio of vertebral body in MCBT group under lateral bending and axial rotation was significantly higher than that in TT group. The load-displacement ratio of vertebral body in MCBT group under flexion was lower than that in TT group. Although the load-displacement ratio of vertebral body in MCBT group under extension was higher that that in TT group, no statistical difference was found. Conclusions MCBT is superior to TT in pull-out strength, screw stability and vertebral body stability under lateral bending and axial rotation, but its vertebral body stability under flexion and extension was weaker than that of TT. The research findings demonstrate the superiority of MCBT under osteoporotic conditions and lay the foundation for clinical application of MCBT.
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OBJECTIVE：To optimize the extractio n technology of Fritillaria pallidiflora polysaccharides（FPSP），and to study its structure. METHODS ：Using the yield of FPSP as response value ，Box-Behnken design-response surface methodology was adopted to optimize solid-liquid ratio ，extraction temperature and extraction time of FPSP extraction technology. Structural properties of FPSP was characterized by UV spectrum ，FTIR，GC-MS，Congo red staining ，SEM，XRD and thermogravimetric analysis. RESULTS：The optimal technology parameters of FPSP were solid-liquid ratio of 1∶28（g/mL），extraction temperature of 94 ℃， extraction time of 2.5 h；the yield of FPSP was 16.25％（n＝3），the error of which to theoretical yield （16.58％）was 0.33％. FPSP contained xylose ，glucose and galactose with a molar ratio of 1∶58.02∶0.73，and trace amount of mannose ；there was a weak absorption peak near the wavelength of 280 nm；belonged to α-configuration pyranopolysaccharide. FPSP was in triple-helical structure. The surface of FPSP was a network structure formed by irregular particles. FPSP had both crystalline and amorphous structures. FPSP had good thermostability. CONCLUSIONS ：The optimized extraction technology of FPSP is reasonable ，and has high extraction yield. The research might provide reference for the further development and utilization of F. pallidiflora .
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Purpose@#Osteosarcoma (OS) is the most common primary bone tumor, with high morbidity in infants and adolescents. Long noncodingRNA LINC00313 has been found to modulate papillary thyroid cancer tumorigenesis and to be dysregulate in lung cancer.However, the role of LINC00313 in OS has not yet been addressed. @*Materials and Methods@#We evaluated mRNA and protein expression using real-time quantitative PCR and Western blotting. Cellproliferation was evaluated using MTT; apoptosis and autophagy were assessed with flow cytometry, Western blotting, and/orGFP-LC3 assay. Transwell assay was conducted to measure cell migration and invasion. Potential target sites for LINC00313 andmiR-342-3p were predicted with starBase v.2.0 and TargetScan Human, and verified using luciferase reporter assay, RNA immunoprecipitation,and RNA pull-down assay. In vivo, xenogeneic tumors were induced with U2OS and MG-63 cells, separately. @*Results@#LINC00313 was upregulated and miR-342-3p was downregulated in OS tissues and cells. High expression of LINC00313was associated with shorter overall survival. FOSL2 downregulation and miR-342-3p overexpression suppressed cell proliferationand migratory and invasive abilities while promoting apoptosis and autophagy, all of which were consistent with the effects ofLINC00313 knockdown. miR-342-3p, sponged by LINC00313, inversely modulated FOSL2 by targeting MG-63 cells, and FOSL2expression was positively controlled by LINC00313. LINC00313 knockdown suppressed tumor growth in vivo. @*Conclusion@#LINC00313 is upregulated in OS, and LINC00313 knockdown plays a vital anti-tumor role in OS cell progressionthrough a miR-342-3p/FOSL2 axis. Our study suggests that LINC00313 may be a novel, promising biomarker for diagnosis andprognosis of OS.
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SUMMARY A background of Pulmonary Hypertension (PH) indicates a progressive elevation of pulmonary vascular resistance, leading to overfilling, elevation of venous pressure, congestion in various organs, and edema in the venous system. This study aimed to investigate whether PH is a risk factor for deep vein thrombosis (DVT) of the lower extremities after hip and knee replacement surgery. METHODS A total of 238 patients who received joint replacement of lower extremities in our department of orthopedics from January 2009 to January 2012 were examined by echocardiography and Color Doppler flow imaging (CDFI) of the lower extremities. Based on pulmonary artery pressure (PAP), the patients were divided into a normal PAP group (n=214) and PH group (n=24). All the patients were re-examined by CDFI during post-operative care. RESULTS Among the 238 patients, 18 had DVT in the lower extremities after the operation. DVT total incidence rate was 7.56% (18/238). In the PH group, 11 patients had DVT (45.83%, 11/24), but in the normal PAP group, only 7 had DVT (3.27%, 7/214). The incidence of DVT was significantly lower in the normal PAP group than in the PH group (P<0.01). In addition, there was a positive correlation between PAP and the incidence of DVT. CONCLUSION PH could be a high-risk factor for the occurrence of DVT in patient's lower extremities after joint replacement surgeries.
RESUMO OBJETIVO A hipertensão pulmonar (HP) indica elevação progressiva da resistência vascular pulmonar, levando ao excesso de enchimento, elevação da pressão venosa, congestão em vários órgãos e edema no sistema venoso. Este estudo teve como objetivo investigar se a HP é um fator de risco para trombose venosa profunda (TVP) das extremidades inferiores após cirurgia de prótese de quadril e joelho. MÉTODOS Um total de 238 pacientes que receberam a substituição da articulação das extremidades inferiores em nosso departamento de ortopedia de janeiro de 2009 a junho de 2012 foi examinado por ecocardiograma e fluxo de imagem Doppler colorido (CDFI) dos membros inferiores. De acordo com a pressão arterial pulmonar (PAP), os pacientes foram divididos em grupo PAP normal (n=214) e grupo PH (n=24). Todos os pacientes foram reexaminados por CDFI durante os cuidados pós-operatórios. RESULTADOS Entre os 238 pacientes, 18 pacientes tiveram TVP nas extremidades inferiores após a operação. A taxa de incidência total de TVP foi de 7,56% (18/238). No grupo PH, 11 pacientes tiveram TVP (45,83%, 11/24), mas no grupo PAP normal, apenas sete pacientes tiveram TVP (3,27%, 7/214). A incidência de TVP foi significativamente menor no grupo PAP normal do que no grupo PH (P<0,01). Além disso, houve uma correlação positiva entre a PAP e a incidência de TVP. CONCLUSÃO A HP poderia ser um fator de alto risco para a ocorrência de TVP nas extremidades inferiores do paciente após cirurgias de substituição articular.
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Humans , Male , Female , Aged , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Knee/adverse effects , Venous Thrombosis/etiology , Hypertension, Pulmonary/complications , Postoperative Complications/etiology , Reference Values , Echocardiography, Doppler , Retrospective Studies , Risk Factors , Venous Thrombosis/diagnostic imaging , Preoperative Period , Hip/blood supply , Hypertension, Pulmonary/diagnostic imaging , Knee/blood supplyABSTRACT
Objective@#To establish the experimental model of rabbit mandibular anterior implant repair and evaluate the effects of transforming growth factor (TGF)-β3 and dental pulp stem cells (DPSC) in promoting the bone integration of implant.@*Methods@#The New Zealand rabbits were randomly divided into experimental group, control group and blank group (6 rabbits for each group) . In the experimental group, the implant area was filled with the mixture of TGF-β3, DPSC and Bio-oss powder. In the control group, the implant area was filled with the mixture of DPSC and Bio-oss powder. In the blank group, the implant area was filled with the mixture of phosphate buffer solution and Bio-oss powder. Eighteen New Zealand rabbits were sacrificed in 2 weeks after procedure. The treated alveolar bone tissue was observed. The bone tissue around the implant were estimated by HE staining, immunocytochemical staining and real-time quantitative PCR.@*Results@#The implants were no shedding nor loose. HE staining shows the blank group had a sparse trabecular bone and a small amount of blood vessel around the implant and no obvious new bone formation. The control group showed that the bone trabecula around the implant was sparse and slender, the osteoblasts were arranged linearly around the trabecular bone, a small amount of new bone formation was found around the implant. In the experimental group, there were more thick and dense trabecular bone around the implant, the surrounding osteoblasts were arranged in clusters. The osteoblasts were active and many new bone formed. Typical bone lacunae, bone cells and a large number of new blood vessels can be observed. Immunohistochemistry showed that the proportion of average positive area in the experimental group, control group, blank group were (24.6±5.3) %, (11.3±2.8) % and (7.6±3.8) % respectively. The expression of bone sialoprotein in experimental group were significantly higher than the other 2 groups(P=0.000). Real-time quantitative PCR results showed that the expression level of Runt-related transcription factor 2 (RUNX2), type Ⅰcollagen (COL-Ⅰ), alkaline phosphatase in the experimental group was higher than in the blank group. The expression level of RUNX2 and COL-Ⅰ in the experimental group was higher than that of the control group (P=0.023).@*Conclusions@#TGF-β3 has potential to promote the transformation of DPSC into osteoblasts, which can promote the integration of bone around the implant.
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To establish the experimental model of rabbit mandibular anterior implant repair and evaluate the effects of transforming growth factor (TGF)-β3 and dental pulp stem cells (DPSC) in promoting the bone integration of implant. The New Zealand rabbits were randomly divided into experimental group, control group and blank group (6 rabbits for each group) . In the experimental group, the implant area was filled with the mixture of TGF-β3, DPSC and Bio-oss powder. In the control group, the implant area was filled with the mixture of DPSC and Bio-oss powder. In the blank group, the implant area was filled with the mixture of phosphate buffer solution and Bio-oss powder. Eighteen New Zealand rabbits were sacrificed in 2 weeks after procedure. The treated alveolar bone tissue was observed. The bone tissue around the implant were estimated by HE staining, immunocytochemical staining and real-time quantitative PCR. The implants were no shedding nor loose. HE staining shows the blank group had a sparse trabecular bone and a small amount of blood vessel around the implant and no obvious new bone formation. The control group showed that the bone trabecula around the implant was sparse and slender, the osteoblasts were arranged linearly around the trabecular bone, a small amount of new bone formation was found around the implant. In the experimental group, there were more thick and dense trabecular bone around the implant, the surrounding osteoblasts were arranged in clusters. The osteoblasts were active and many new bone formed. Typical bone lacunae, bone cells and a large number of new blood vessels can be observed. Immunohistochemistry showed that the proportion of average positive area in the experimental group, control group, blank group were (24.6±5.3) %, (11.3±2.8) % and (7.6±3.8) % respectively. The expression of bone sialoprotein in experimental group were significantly higher than the other 2 groups(0.000). Real-time quantitative PCR results showed that the expression level of Runt-related transcription factor 2 (RUNX2), type Ⅰcollagen (COL-Ⅰ), alkaline phosphatase in the experimental group was higher than in the blank group. The expression level of RUNX2 and COL-Ⅰ in the experimental group was higher than that of the control group (0.023). TGF-β3 has potential to promote the transformation of DPSC into osteoblasts, which can promote the integration of bone around the implant.
Subject(s)
Animals , Rabbits , Bone Substitutes , Therapeutic Uses , Core Binding Factor Alpha 1 Subunit , Dental Implantation, Endosseous , Dental Pulp , Cell Biology , Integrin-Binding Sialoprotein , Metabolism , Mandible , Minerals , Therapeutic Uses , Osseointegration , Osteoblasts , Cell Biology , Random Allocation , Stem Cell Transplantation , Transforming Growth Factor beta , Transforming Growth Factor beta3 , Therapeutic UsesABSTRACT
<p><b>OBJECTIVE</b>To evaluate the biocompatibility and viability of nonionic triblock copolymer Pluronic F-127 as a cell scaffold for osteogenic differentiation of dental pulp stem cells(DPSC).</p><p><b>METHODS</b>DPSC were obtained via enzymatic digestion method and purified bylimited dilution method. The freeze dried hydrogel of 20% Pluronic F-127 was prepared and itsstructurewas observed usingscanning electron microscopy(SEM). After the encapsulation of cells of passage 3 in Pluronic F-127, the effects of hydrogel on the proliferations of DPSC were assessed with methyl thiazolyl terazolium(MTT) after one day and 3, 5, 7 days of incubations, respectively. On day 14, osteogenic abilities of DPSC encapsulated in the hydrogel were estimated by means of alizarin red S, immunocytochemical staining and real-time quantitative PCR(RT-qPCR).</p><p><b>RESULTS</b>DPSC were isolated and cultured successfully in the present study. SEM observations showed that porous structures which might be suitable for cell culture. A570 values of MTT were then normalized. A570 values of the cells in 2D cultures were 0.30±0.06, 0.30±0.17, 0.35±0.04 and 0.25±0.06 and A570 values of DPSC in 3D cultures were 0.36±0.06, 0.54±0.18, 0.70±0.10 and 0.32±0.10 on day 1, 3, 5 and 7, respectively. A570 value peaks were found on day 5 in both groups. The proliferation of 3D cultured DPSC was higher than that of 2D cultured cells(P<0.05). After 14 days of osteogenic induction, there were no calcium nodules observed in the control group and the numbers of calcium nodulesin the 2D and 3D groups had no significant difference(P>0.05). Inmmunocytochemical staining demonstrated strong expression of osteoblast marker Runt-related transcription factor 2(RUNX2), type Ⅰ collagen(Col-Ⅰ) and relatively low expression of osteocalcin(OCN). Moreover, RT-qPCR showed no differences between the relative expression of ALP, RUNX-2, OCN in the 2D and 3D groups (P>0.05), but a higher relative expression of Col-Ⅰ was observed in the 3D group(P=0.023).</p><p><b>CONCLUSIONS</b>Pluronic F-127 is a promising cell scaffold or cell carrier for the osteobalst differentiation of dental pulp stem cells.</p>
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Humans , Cell Culture Techniques , Cell Differentiation , Cells, Cultured , Collagen Type I , Metabolism , Core Binding Factor Alpha 1 Subunit , Metabolism , Dental Pulp , Cell Biology , Hydrogel, Polyethylene Glycol Dimethacrylate , Osteoblasts , Metabolism , Osteocalcin , Metabolism , Osteogenesis , Poloxamer , Stem Cells , Cell Biology , Tissue ScaffoldsABSTRACT
Objective To access the effectiveness of modified early warning score (MEWS) and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) in predicting the degree of injury and outcome for emergently admitted polytrauma patients.Methods In this single-center prospective study,266 polytrauma patients hospitalized from June 2012 to January 2013 were enrolled.MEWS and APACHE Ⅱ score were collected and compared for the rate of ICU admission,high dependency unit admission,outpatient therapy,death,and discharge within 30 days.Diagnostic and predictive performance of MEWS and APACHE Ⅱ were assessed by the receiver operating characteristic curve (ROC).Results A higher values in MEWS and APACHE Ⅱ were linked to much severe injury,increased likelihood of admission to the ICU or high dependency unit and high mortality.Patients with MEWS value ≥5 had increased risk of death as compared with those with MEWS value ＜ 5 (x2 =90.749,P ＜0.01).MEWS =5,for injury severity evaluation,showed a sensitivity of 85.7％ and specificity of 84.8％.MEWS value≥5 predicted ICU admission with a sensitivity of 80.0％ and specificity of 91.1％ and high dependency unit admission with a sensitivity of 67.9％ and specificity of 79.9％.APACHE Ⅱ score ≥ 21 was associated with increased rate of death,with significant difference from that among patients with APACHE Ⅱ score ＜ 21 (x2 =73.518,P ＜ 0.01).APACHE Ⅱ score =21,for injury severity evaluation,showed a sensitivity of 90.5％ and specificity of 79.5％.APACHE Ⅱ score ≥ 21 predicted ICU admission with a sensitivity of 95.0％ and specificity of 73.6％ and high dependency unit admission with a sensitivity of 88.2％ and specificity of 72.8％.In prediction of prognosis,ICU admission and high dependency unit admission,area under the ROC curve with 95％ CI for NEWS was 0.889 (0.830-0.948),0.937 (0.900-0.975) and 0.946 (0.916-0.977) respectively and for APACHE Ⅱ was 0.939 (0.898-0.979),0.761 (0.677-0.845) and 0.832 (0.782-0.883) respectively.MEWS and APACHE Ⅱ score in death group were (6.4 ± 2.7) points and (29.9 ± 6.4) points,but lowered to (3.0 ± 1.5) points and (16.8 ± 5.7) points respectively in survival group (P ＜ 0.01).Conclusions Both APACHE Ⅱ and MEWS have the ability to discriminate the severity of polytrauma patients and identify the potential of seriously ill patients.MEWS is more suitable for early identification of critically ill trauma patient due to its easy and quick operation as well as low cost,while APACHE Ⅱ is more suitable for evaluation of emergency observing patients and ICU patients.
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Objective To observe the effects of using problem-based learning (PBL) and lecture-based learning (LBL) in clinical teaching in emergency intensive care unit (EICU).Methods Three hundred and twelve 5-year clinical medicine undergraduates from Xinjiang Medical University including 108 students in 2007 class and 204 students in 2008 class were enrolled. The students in each class were randomly divided into two groups, 54 students in each group in 2007 class and 102 students in each group in 2008 class. Randomized controlled trial was conducted; in the first half of a semester, the students in the two groups of each class were taught by PBL method and LBL method respectively. At the middle of the semester, written examination (WES), objective structure clinical examinations (OSCE) and self assessment questionnaire test were carried out to evaluate students' learning effect. In the second half of the semester, the teaching method in the two groups of each class was exchanged, and at the end of the semester, the same examinations were carried out, and the examination and questionnaire scores in the two groups of each class were compared.Results The results of comparisons of the WES and OSCE scores between two modes in each class showed that the scores of WES and OSCE of the PBL mode were obviously higher than those in the LBL mode (the first half of semester in 2007 class: WES: 23.20±3.33 vs. 22.78±4.41, OSCE: 27.60±6.44 vs. 25.45±6.35, in 2008 class: WES: 24.45±2.65 vs. 23.02±3.67, OSCE: 29.53±4.67 vs. 27.57±6.83, in the second half of the semester in 2007 class: WES: 24.60±3.67 vs. 23.46±2.57, OSCE: 28.50±4.78 vs. 28.01±5.78, in 2008 class: WES: 23.54±3.56 vs. 22.56±6.89, OSCE: 28.08±2.15 vs. 27.43±7.23,P < 0.05 orP < 0.01). The score results of self assessment questionnaires of students in two groups of 2007 class and 2008 class showed that the self learning ability, initiative, linking theory with practice, team power and attentiveness were significantly higher in the PBL teaching mode than those in the LBL teaching mode [the first half of the semester in 2007 class: self learning ability (score): 4.20±0.67 vs. 3.32±0.71, the initiative (score): 4.15±0.98 vs. 2.01±0.81, linking theory with practice (score): 4.09±0.65 vs. 3.52±0.89, team power (score): 4.43±0.56 vs. 3.08±0.43, attentiveness (score): 4.25±0.77 vs. 2.98±0.67; the second half of the semester in 2007 class: self learning ability (score): 4.23±0.77 vs. 2.11±0.98, the initiative (score): 4.59±0.85 vs. 3.20±0.73, linking theory with practice (score): 4.23±0.71 vs. 2.88±0.87, team power (score): 4.66±0.63 vs. 2.21±0.64, attentiveness (score): 4.21±0.73 vs. 2.28±0.43; the first half of the semester in 2008 class: self learning ability (score): 7.60±0.64 vs. 5.62±0.41, the initiative (score): 7.23±0.47 vs. 5.07±0.51, linking theory with practice (score): 7.04±0.67 vs. 4.56±0.59, team power (score): 7.33±0.55 vs. 5.06±0.47, attentiveness (score): 6.21±0.87 vs. 4.88±0.37; the second half of the semester in 2008 class: self learning ability (score): 7.03±0.71 vs. 5.11±0.48, the initiative (score): 7.89±0.57 vs. 5.20±0.33, linking theory with practice (score): 7.63±0.25 vs. 4.88±0.57, team power (score): 7.64±0.33 vs. 5.21±0.67, attentiveness (score): 7.01±0.89 vs. 6.01±0.90].Conclusion PBL method of teaching is worthwhile to be explored and spread extensively, especially in medicine, a scientific course involving much attention on practice, it embodies more importance.
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60 kg) was given to all the patients 1-3 days after their operation.The pacing threshold and the amplitude of P and R waves on cardiograph were measured before injection and at 10,30,90,180 minutes afterwards.Results No significant changes were oburved in pacing threshold and the amplitade of P and R waves before and after the injection of metoprolol in patients with either newly implanted or replacement of permanent pacemakers.Conclusion Metoprolol tartrate has no effect on atrial and ventricular pacing threshold and the amplitude of P and R waves in patients with permanent pacemakers implantation.