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Chronic obstructive pulmonary disease （COPD） is characterized by long treatment course and poor prognosis. The pathogenesis has not been fully elucidated but is mostly related to the non-specific inflammation of the airway and surrounding tissues. T helper 1 （Th1） and T helper 2 （Th2） are generated by CD4+ T cell differentiation， and are in a dynamic equilibrium when the body is in normal state. The balance between pro-inflammatory cytokines and anti-inflammatory cytokines regulated by Th1/Th2 is vital for maintaining the immune homeostasis in respiratory tract. Chronic inflammatory state changes the level of inflammatory cells in the body， and there is immune disorder in T lymphocytes in the onset stage of COPD. Th1 cells are predominantly expressed in the stable stage of COPD， while Th2 cells are predominantly expressed in the acute exacerbations of COPD （AECOPD）. Th1/Th2 immune imbalance aggravates the inflammatory reaction， and thus restoring the immune balance between them and inhibiting the inflammatory reaction are critical for the treatment of COPD. At present， there has been no satisfactory treatment plan for COPD. Chinese medicine has a long history of preventing and treating COPD， with remarkable curative effect and few adverse reactions. A large number of animal experiments and clinical studies on Chinese medicine intervention of Th1/Th2 immune balance in COPD have indicated that Th1/Th2 immune balance is an important potential target for treating COPD by Chinese medicine， which can correct chronic inflammatory state by regulating the immune disorder of the body. It has also been found that Th1/Th2 balance plays an important immunoregulatory role in inflammatory response， but little is known about its specific mechanism in the pathogenesis of COPD. On this basis， this paper summarized and analyzed the biological characteristics of Th1/Th2 and their mechanism in the pathogenesis of COPD， as well as the intervention effect of single Chinese medicine or its effective components and Chinese medicine compound on Th1/Th2 immune balance in COPD. It further explored the pathogenesis of COPD and the potential therapeutic targets of Chinese medicine in interfering with Th1/Th2 immune balance in COPD， providing reference for further study on prevention and treatment of COPD with Chinese medicine.
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Objective:To evaluate the effect of ladder teaching of problem-based learning (PBL) after theoretical lecture in the standardized training of ophthalmology.Methods:This study collected the data of the resident trainees in the ophthalmology standardized training base of the PLA General Hospital from September 2015 to June 2020. According to the accepted teaching methods, they were divided into the ladder teaching method group (ladder group) and the pure PBL teaching method group (PBL group). The exam results of the first and second stages of the trainees, the pass rate of the first stage exam (ophthalmology theory), the pass rate of the second stage exam (clinical application), and the overall pass rate of the first and second stages were recorded for statistical analysis. Quantitative evaluation on the teaching effect of the "ladder teaching method of theory teaching followed by PBL" in the standardized training of ophthalmology in this training base was made. SPSS 24.0 was used to conduct t-test, rank-sum test and Chi-square test. Results:The results of the first stage examination (ophthalmology theory) in the ladder group were higher than those in the PBL group [(87.22±8.45) vs. (74.47±10.68)], with a statistically significant difference ( P < 0.01); the pass rate of the first stage examination (ophthalmology theory) in the ladder group was higher than that in the PBL group (95.83% vs. 85.00%), with no significant difference ( P = 0.213). The pass rate of the second stage examination (clinical application) in the ladder group was higher than that in the PBL group (95.65% vs. 76.47%), with no significant difference ( P = 0.070); the overall pass rate of routine training (first and second stages) in the ladder group was higher than that in the PBL group (91.67% vs. 65.00%), with a statistically significant difference ( P = 0.029). Conclusion:The ladder teaching of PBL after the theory teaching has a satisfactory effect in the standardized training of ophthalmology. This teaching method is easier to help the students to successfully complete the standardized training and pass the standardized training examination.
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Objective:This paper introduces the concepts of " patient-centered cell therapy research management model", to provide reference for domestic medical institutions which conduct cell therapy clinical trials.Methods:We reviewed and summarized the experiences of conducting cell therapy at Peking University Shenzhen Hospital, including challenges and response plans regarding to the technology assessment, ethical evaluation risks and regulatory compliance. According to which, this paper aims to explore the reflections and practical experience of establishing a patient-centered, multi-stakeholder shared decision-making research management system.Results:The " patient-centered cell therapy research management model" ensures the reliability of research results through multi-stakeholder engagement in decision-making and management, adequate technical evaluation, effective ethical review and harmonized scientific research management, which not only meets the urgent health needs of the patient, but also promotes the standardized development of emerging technologies.Conclusions:The " patient-centered cell therapy research management model" is tailored for the cell therapy research, it is important to promote its further assessment and applications.
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Objective:To explore the level of tibial growth plate chondrocyte mitophagy in young rats with chronic renal failure (CRF) and its effect on chondrocyte apoptosis.Methods:Male 4-week-old Sprague-Dawley rats were randomly divided into two groups according to random number table method: normal control group ( n=20, intragastric administration with distilled water) and CRF group ( n=20, given adenine suspension 150 mg·kg -1·d -1). All the young rats were sacrificed after continuous gavage for 6 weeks. The length of tibia was measured on X ray film, the width of tibia growth plate was measured and compared on histological section, and the apoptosis rate of chondrocytes in growth plate was detected by terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) assay. The growth plate chondrocytes of two groups were isolated and cultured to the third generation in vitro, and the apoptosis rate of chondrocytes was detected by TUNEL assay. The co-localization of mitochondria and autophagy lysosomes in chondrocytes was observed by double fluorescence staining. Western blotting was used to detect the level of mitochondrial marker protein translocate of the outer mitochondrial membrane-20 (Tom-20) and autophagy marker light chain-3 protein (LC-3). The mitophagy of growth plate chondrocytes was observed by transmission electron microscope. Results:Compared with the normal control group, the tibia length of CRF group was shorter [(27.32±5.81) mm vs (35.43±3.61) mm, t=5.226, P<0.001], and the relative width of growth plate in histological section was narrower (0.56±0.19 vs 1.00±0.21, t=6.744, P<0.001). The apoptosis rate of chondrocytes in growth plate in CRF group was higher than that in the normal control group (17.2%±4.8% vs 5.1%±3.4%, t=6.505, P<0.001). The apoptosis rate of chondrocytes cultured in vitro in CRF group was higher than that in the normal control group (11.8%±6.2% vs 3.1%±1.2%, t=4.357, P<0.001). The result of double influorescence staining showed that there was co-localization between mitochondria and autophagy lysosomes in CRF group. Western blotting results showed that the levels of LC-3 protein ( t=8.944, P<0.001) and Tom-20 protein ( t=6.708, P<0.001) in CRF group were lower than those in the normal control group. Conclusion:The level of tibial growth plate chondrocyte mitophagy in young rats with CRF increases, which will lead to a decrease in the number of mitochondria, an increase in the apoptosis and a decrease in the number of chondrocytes, and eventually lead to dysplasia of tibia.
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Objective:To explore the effect of mini-clinical evaluation exercise (Mini-CEX) combined with simulation teaching + case-based learning (CBL) in pediatric clinical teaching.Methods:A total of 60 medical students who practiced in Department of Pediatrics, Affiliated Hospital of Jining Medical College from August 2019 to August 2020 were selected as the research objects. According to different teaching methods, they were divided into control group ( n=30) and observation group ( n=30). The control group received traditional teaching, and the observation group received Mini-CEX combined with simulated teaching + CBL. The assessment results, comprehensive ability of medical interview, critical thinking ability and teaching satisfaction of the two groups were compared. SPSS 20.0 was performed for t-test and Chi-square test. Results:The test scores and total scores of the observation group were significantly higher than those of the control group ( P<0.05). After teaching, the Mini-CEX scores, the CTDI-CV (critical thinking disposition inventory Chinese version) scores and the total scores of the two groups increased significantly, and the above scores were significantly higher in the observation group than the control group ( P<0.05). The scores of the teaching program satisfaction questionnaire in the observation group were significantly higher than those in the control group ( P<0.05). Conclusion:The application of Mini-CEX combined with simulation teaching + CBL in pediatric clinical teaching can help to cultivate the medical interview ability, clinical practice ability and critical thinking ability of interns, improve the examination results, and improve the teaching satisfaction.
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Sepsis is caused by the imbalance of the host body's response to infection, which causes life-threatening organ dysfunction. Disorders of blood coagulation play a very important role in the development of sepsis. In sepsis, the body's coagulation system is activated, leading to hypercoagulability, while the anticoagulation mechanism is significantly inhibited, causing a large number of microthrombi to form, and disseminated intravascular coagulation (DIC) may occur. Although there are obvious controversies about the anticoagulation treatment of sepsis at home and abroad, we cannot deny the significance of anticoagulation treatment in sepsis. Only appropriate anticoagulation can effectively reduce the mortality in septic DIC, septic shock and high-risk population, and ultimately effectively reduce the occurrence of multiple organ dysfunction syndrome. The sepsis-induced coagulation dysfunction (SIC) score is currently used internationally to guide anticoagulation. SIC score is optimized based on the International Society on Thrombosis and Haemostasis (ISTH) overt DIC score and Sepsis-3, including platelet, international normalized ratio (INR) and sequential organ failure assessment (SOFA). The SIC score can sensitively monitor sepsis-induced coagulation dysfunction. When the SIC score is≥4, it is the best timing to initiate anticoagulation therapy. At present, the internationally recommended anticoagulant drugs include antithrombin (AT), thrombomodulin (TM), tissue factor pathway inhibitor (TFPI), heparin, etc., while the domestically recommended anticoagulant drugs are only unfractionated heparin and low molecular weight heparin. Before using anticoagulant drugs, it is necessary to evaluate the possibility of bleeding and thrombosis in the patients. At the same time, it is necessary to pay attention to the patient's primary disease. Try to adopt the treatment strategy of transitioning from unfractionated heparin to low molecular weight heparin without obvious anticoagulation contraindications.
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Objective:To identify the association of sex hormone and sex hormone-binding globulin (SHBG) levels in patients with Graves′ disease.Methods:Between December 2017 and July 2019, 152 patients with Graves′ disease were enrolled in the Department of Endocrinology and Metabolism of Zhongshan Hospital, Fudan University. Parameters such as height, weight, thyroid function, sex hormone, fasting blood glucose, insulin, C-peptide, glycosylated albumin, HbA 1C, and liver function were collected. The associations between SHBG and bioclinical characteristics were analyzed. Results:The glycosylated albumin level was negatively associated with SHBG in all subjects ( β=-0.308, P<0.01), while this association was not significant after the adjustment for thyroid hormones. Male patients had significantly lower SHBG level than female patients ( P<0.01). In male patients, SHBG was associated with luteinizing hormone ( r=0.465, P<0.01), estradiol ( r=0.629, P<0.01), testosterone ( r=0.786, P<0.01). While in female patients, SHBG was also associated with testosterone ( r=0.191, P<0.05). In multivariate linear regression analysis, estradiol was independently associated with SHBG ( β=0.329, P<0.01) in male subjects. Conclusion:The hypogonadism and infertility in Graves′ disease patients could partially be attributed to the association between SHBG and Graves′ disease.
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Objective To study the changes of serum NO, TGF-β1, IL-10 and IL-17 Levels and study of the efficacy of Bismuth - containing quadruple and standard triple therapy for patients with Hp positive peptic ulcer. Methods 109 cases of peptic ulcer treated in our hospital were retrospectively selected, and Hp test was positive. According to different dosing regimen, the patients were divided into two groups. There were 54 patients in the control group, using standard triple therapy, and the regimen was lansoprazole, amoxicillin, and metronidazole. 55 patients in the study group were treated with bismuth-based western therapy with bismuth potassium citrate, rabeprazole, amoxicillin, and furazolidone. Two weeks after treatment were regarded as the observation period, and the levels of serum NO, TGF-β1, IL-10 and IL-17 in the two groups were compared before and after treatment. The effective rate of ulcer healing, Hp clearance rate and incidence of adverse reactions were compared. Results The level of serum NO, TGF-β1, IL-10 and IL-17 was significantly lower than that in the control group (P <0.05). The effective rates of ulcer healing and Hp clearance in the study group were significantly higher than those in the control group (P <0.05). There was no significant differences between the study group and the control group in the incidence of adverse reactions. Conclusion Western medicine with bismuth in the treatment of Hp peptic ulcer patients, the serum NO, TGF-β1, IL-10 and IL-17 levels of indicators have significantly improved, and has obvious advantages in clinical treatment, and it is a reasonable dosing regimen of high efficiency and low recurrence.
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Objective To explore the insertion of the teaching contents of nursing in rural doctors'higher education,so as to increase their understanding of medical knowledge and improve their medical skills.Method 90 rural doctors of Grade 2014 were chosen as the research object,and according to their willingness to participate,they were divided into control group and observation group.The students in the control group were mainly taught by the relevant knowledge of clinical medicine,while nursing teaching content was inserted in the teaching of observation group.In the teaching process,firstly,the teaching contents of nursing were reorganized,and then the teaching content of clinical medicine was taken as the main line,according to the development of teaching content,flexibly inserting nursing teaching part.The results of the final examination of the internal medicine of the two groups were compared and the specific learning experience of rural doctors was investigated.SPSS 20.0 was used to analyze the data,the count data was expressed as percentage,and chi square test was performed.Results The number of students in the control group and the observation group whose subjective score was more than 40 was 17.65％ and 48.72％ respectively.The number of students scoring ＜30 points accounted for 23.53％ and 5.13％ of the total number of students,and there was a statistically significant difference between the two groups(P＜0.05).The observation group had a better learning experience,and had little influence on the learning of clinical medical knowledge.Conclusion In the stage of education for rural doctors,inserting the teaching contents of nursing can improve the teaching effect.
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Professor, who studied from professor, is a famous acupuncturist in Quanzhou of Southern Fujian. The publications authored by professorwere collected in this study to summarize his academic characteristics of acupuncture and moxibustion. The result indicated he highly valued the regulation of, and established the theory of "developingto nourish", which proposes to developto achieve the effect of culturing; he summarized eight methods to regulate the governor vessel and conception vessel, which can condition the body'sand; he paid attention to moxibustion therapy and its dosage, and made the best of direct moxibustion. In addition, he focused on meridian theory with effective application of meridian syndrome differentiation; in clinical treatment, he regulated the hand-meridian to treat diseases by nourishing, generatingand regulating.
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OBJECTIVE@#To survey the prevalence of obstructive sleep apnea-hypopnea syndrome(OSAHS) in adults aged over 60 years in Dongying city,and analyze the risk factors and the extent of damage to the quality of life for the elderly to provide the basis for prevention and treatment of OSAHS people.@*METHOD@#One thousand subjects were derived from a random cluster sampling in seven districts of Dongying city:they were asked to answer the questions from questionnaires. According to the questionnaire scoring, 100 subjects in high-risk group were selected randomly to make polysomnography monitoring for a whole night,so that the prevalence of the disease was calculated and the related risk factors were analyzed; elderly patients diagnosed with OSAHS were asked to assess the quality of life assessment questionnaire by face to face to understand the quality of life dimensions injury.@*RESULT@#The actual number of completed surveys was 934, and the efficiency was 93.4%. The estimated prevalence of OSARS in elder people defined by apnea-hypopnea index (AHI ≥ 5) was 32.5%; Multivariate analysis revealed that age smoking, family snoring,neck circumference, waist circumference, and abnormality of the upper airway were respectively independent risk factors of OSAHS,and the abnormalities of the upper airway had the most obvious impact on AHI. The damage caused by OSAHS to the quality of life for elderly people followed their daily work life, social relationships, symptoms, alertness, emotional, general health, symptoms.@*CONCLUSION@#The estimated prevalences of OSAHS in elder people were high. Actively promoting good habits to older people, weight loss, early detection and correct upper airway abnormalities may reduce the estimated prevalence of OSAHS. In the treatment process, the patient's physician should pay attention to their emotional and groom their psychological problems to improve the quality of life in elder people.
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Aged , Humans , China , Epidemiology , Polysomnography , Prevalence , Quality of Life , Risk Factors , Sleep Apnea, Obstructive , Epidemiology , Snoring , Surveys and QuestionnairesABSTRACT
The number of projects and the amount of sponsoring funds have been increasing during the past years.Conventional research branches are respiratory tumor and digestive tumor.Emerging research branches are lung transplantation and lung preservation.Underdeveloped research branches are acute lung injury and acute respiratory distress syndrome and thymic tumor.The position and academic impact of domestic thoracic surgery has been more valuable with the increasing number,quality and achievements of SCI papers.Therefore,international cooperation and megamergers should be encouraged and more attention should be paid to the censorship,implementation and achievements to optimize the value of projects.The aim of this article is providing important information on projects sponsored by National Nature Science Foundation of China(NSFC) in the field of general thoracic surgery,promoting the development of thoracic surgery of China.
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Online teaching has recently become a new way in medical education, to which great importance has been attached by domestic educational circles. The design principles, overall framework and functional structure of the online course platform in Peking Medical College were thus described with its implementation and characteristics summarized in the hope of providing certain reference for its building in domestic medical colleges and universities.
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Objective To investigate MRI appearances of aquaporin(AQP) and its effect in different brain regions of patients with Parkinson's disease(PD).Methods A prospective study was carried out in 33 PD patients(PD group) and 23 gender-and age-matched healthy controls (control group).Clinical data of PD patients were collected.The aquaporin imaging of diffusion-weighted magnetic resonance imaging (MRDWI) with multiple b-values in different brain regions were performed to detect the apparent diffusion coefficient(AQP-ADC) values of aquaporin.The PD patients were assessed and graded by modified Hoehn-Yahr grading,then the AQP-ADC values of control group,mild PD group,moderate and severe PD group were analyzed using one-way analysis of variance.The correlation analysis was carried out to detect the relationship between AQP-ADC values in different brain regions and Hoehn-Yahr grading of PD patients.Results Compared with control group,mild PD group had significantly higher AQP-ADC values in red nucleus(RN) and globus pallidus(GP) ((0.24±0.04) vs (0.21±0.04),(0.21±0.04) vs (0.16±0.04);both P＜0.05);while the AQP-ADC values in RN and GP of moderate and severe PD group were significantly lower than that of mild PD group((0.21±0.02) vs (0.24±0.04),(0.18±0.03) vs (0.21±0.04);both P＜0.05);but there was no significant difference between moderate and severe PD group and control group(P＞0.05);and there was also no significant difference in substantianigra (SN),putamen (Pu) and thalamus (THA) among control group,mild PD group and moderate and severe PD group(P＞0.05).The correlation analysis showed that there were negative correlations between the AQP-ADC values in RN and GP and Hoehn-Yahr grading(r=-0.479 and-0.395,P＜ 0.05),while there was no correlation in SN,Pu and THA (P＞ 0.05).Conclusion The AQPADC values are increased in RN and GP of mild PD patients,and decreased in moderate and severe PD patients,while there is no significant change in SN,Pu and THA of the two groups,suggesting that the expression of AQP in different brain regions may be related to the severity and pathological stage of PD.
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With literature of professor CHEN Yinglong such as Medical Notes of Doctor CHEN Yinglongfor Taiwan Compatriots,the'experience of doctor CHEN Yinglong treating common diseases in Fujian and Tai-wan is summarized. The diseases in the paper are constipation, retention of urine, asthma, vec6rdia, bi syndromeinsomnia, thoracic obstruction, pediatric obesity and freckle of face, etc. It is discovered that professor CHENYinglong treated diseases with combination of acupuncture and medication and accurate acupoints according to thefeature of climate in Fujian and Taiwan.
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Humans , Acupuncture Points , Acupuncture Therapy , History , Asthma , Therapeutics , Constipation , Therapeutics , History, 20th Century , TaiwanABSTRACT
The development, present situation, educational institution and association, legislation and application of acupuncture therapy in the Netherlands are introduced. Acupuncture was introduced into the Netherlands about 400 years ago. At present, being one of the complementary and alternative medicine, acupuncture has not passed the national legislation yet. The nongovernmental source is given priority to the development of acupuncture and the educational institution is private. Even though acupuncture has not been listed in the basic medical insurance in the Netherlands, it becomes one of the additional items of the insurance company and its expenditure is reimbursed partially. The field of TCM in the Netherlands now is facing to the issues to be solved, including constructing the official medical institution, educating high-quality acupuncturists, promoting national legislation and adopting acupuncture into the basic medical insurance.
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Based on the historical documents regarding professor, his educational philosophy of acupuncture and moxibustion was summarized. As a result, the following characteristics were found. He focused on the education of acupuncture and moxibustion, which combined the classroom teaching with apprentice teaching; he compiled teaching materials and committed himself to education reform; he started the first acupuncture undergraduate majors in Fujian province; he valued the academic inheritance and practice of acupuncture; he authored publications and proposed arguments to inherit experience. In addition, he valued medical ethics and focused on patients.
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This study was aimed to compare the effects of acupuncture stimulation on different acupoints, which included LR14-Qimen, ST25-Tianshu, GB34-Yanglingquanand CO11-pancreas and gallbladder (auricular vagus nerve intensively distributed areas) on gallbladder pressure and Oddi sphincter function of guinea pig, in order to discuss acupuncture effect on different acupoints in the regulation of motor function of extrahepatic biliary system. A total of 20 adult guinea pigs of both sexes were randomly divided into two groups, with 10 in each group. The detection was made on changes of Oddi sphincter electromyography and gallbladder pressure before and after acupuncture. A double-hook electrode was implanted into the Oddi sphincter for the detection of Oddi sphincter electromyography. And one small artificial balloon was put into the gallbladder to measure the intrabiliary pressure. After the guinea pig was anesthetized, changes of gallbladder pressure as well as the electromyography frequency and amplitude index of Oddi sphincter of the normal guinea pig were recorded. When the guinea pig was stabilized, acupuncture was given on LR14, ST25, GB34 and CO11 for 1 min. Observations were made on acupuncture effects of gallbladder pressure and Oddi sphincter function of guinea pig. The results showed that after acupuncture on LR14 and ST25, the electromyography frequency of Oddi sphincter was obviously increased compared with before acupuncture (frequency:P < 0.01, amplitude:P < 0.05); the gallbladder pressure was obviously decreased (P < 0.05). After acupuncture on CO11 and GB34, the electromyography frequency and amplitude index of Oddi sphincter were obviously decreased compared with before acupuncture (P < 0.05); the gallbladder pressure was obviously increased (P < 0.01). It was concluded that acupuncture on LR14 and ST25 can obviously inhibit the movement of gallbladder and promote the myoelectricity release of Oddi sphincter. Acupuncturing on CO11 and GB34 can apparently promote the shrinking movement of gallbladder and inhibit the myoelectricity release of Oddi sphincter.
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Objective To evaluate quantitative coronary angiography (QCA) measurement of culprit vessel fixed stenosis in acute ST segment elevation myocardial infarction (STEMI) emergency interventional thrombus aspiration.Methods One hundred and sixty-fore cases of STEMI patients accepting emergency interventional operation and thrombus aspiration treatment were choosed from September 2012 to October 2013 in the First Affiliated Hospital of Wenzhou Medical University.Thrombus Aspiration measuring vessel was carried after criminals using fixed stenosis rate QCA methods.Results The vascular stenosis rate was more than 50％ in 69.5％ of the male patients,vascular stenosis rate was more than 70％ in 40.2％ of the female patients,the anterior descending branch of the rami anterior descendens(LAD) (54.75％ ± 29.72％,n=76),Left circumflex artery (LCX) (55.25％ ± 32.23％,n =20),arteriae coronaria dextra (RCA) (56.40％ ± 29.76％,n =68).There was no difference between LAD,LCX and RCA (F=6.036,0.955,0.055;P＞0.05).Conclusion The most majority of serious vascular stenosis patients have acute STEMI.
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Objective To explore the effect of applying the management model of educating diabetics in health knowledge and filinging relevant data .Methods 1 000 patients with type 2 diabetes in hospital were randomly assigned into the experimental group and the control group ,and all of them received health education .In addition ,relevant data were filed in the experimental group ,then the compliance behavior ,general metabolic indicators and occurrences of complications were compared before and after the education in 1 ,3 and 6 months between these two groups .Results The general metabolic indicators in experimental group were better than the control group(P<0 .05);and the compliance behavior of the experimental group patients were improved obviously (P<0 .05);and the cases of the patients with complications from random visit were also obviously lower in the experimental group (P<0 .05) . After 1 month or 6 months ,the two groups of patients′qualities of life were significantly increased ,but the experimental group′was improved more obviously(P<0 .05) .After 6 months ,the degree of satisfaction of the experimental group was 91 .6% (458/500) , the control group′was 68 .2% (341/500) .The satisfaction of experimental group was significantly higher than the control group (P<0 .05) .Conclusion The management model to patients with type 2 diabetes could effectively improve patients′metabolic level and reduces the occurrences of complications and improves the therapeutic effect .