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Objective:To explore application of blended learning mode in the teaching of the general theory of surgery.Methods:Clinical undergraduates from Batch 2015 and Batch 2016 of Medical College of Hunan University of Medicine were taken as participants. One teaching class of Batch 2015 was selected as control group ( n=117), and the traditional teaching method was adopted; one teaching class from Batch 2016 was selected as experimental group ( n=115), and the blended learning model was adopted. The results of two groups' process assessment and final assessment were compared. A questionnaire was conducted among the clinical undergraduates of Batch 2016 who practiced blended learning to evaluate their satisfaction with this learning mode. SPSS 22.0 was used for t test. Results:The experimental group was significantly better than the control group in process assessment and final assessment results [(93.65±3.71) vs. (91.46±5.63); (68.36±8.14) vs. (64.94±8.98)]. The analysis of the questionnaire survey showed that students had a high satisfaction with the blended learning mode, and their approval rate reached over 90%.Conclusion:In the teaching process of clinical course of general theory of surgery, blended learning mode is highly recognized by students, which can significantly improve students' independent learning ability and interest, simultaneously increase students' classroom participation and teacher-student interaction, and finally improve students' professional overall qualities and critical thinking.
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OBJECTIVE： To systematically evaluate the difference of therapeutic efficacy of Xianling gubao capsules combined with routine therapy for postmenopausal osteoporosis （PMOP）. METHODS： Retrieved from Cochrane Library， PubMed， Embase， ClinicalTrials， CNKI， VIP， Wanfang database and CBM， clinical randomized controlled trials （RCTs） about Xianling gubao capsules combined with placebo and routine treatment （trial group） versus placebo and routine treatment or Xianling gubao capsules （control group） alone in the treatment of PMOP were collected. After literature screening and data extraction， the quality of included literatures were evaluated with Cochrane system evaluator manual 5.3 recommend bias risk evaluation tool. Bayesian Network Meta-analysis was performed with Stata 14.0 software and Bayesian Markov Chain Monte Carlo. RESULTS： A total of 16 RCTs were included， involving a total of 1 360 patients and 3 intervention measures as Xianling gubao capsules alone， Xianling gubao capsules combined with routine treatment， routine treatment. Results of Meta-analysis showed that in respect of improving total response rate， compared with routine treatment， Xianling gubao capsules combined with routine treatment [OR＝0.28，95％CI（0.12， 0.64），P＜0.05]could significantly improve total response rate； network Meta-analysis ranking showed that Xianling gubao capsules combined with routine treatment＞Xianling gubao capsules alone＞routine treatment. In terms of increasing bone mineral density （BMD）， compared with routine treatment， Xianling gubao capsules combined with routine treatment [OR＝0.45，95％CI（0.24， 0.84），P＜0.05] and Xianling gubao capsules alone [OR＝0.78， 95％CI（0.32， 0.84），P＜0.05] could significantly improve BMD； network Meta-analysis ranking showed that Xianling gubao capsules combined with routine treatment＞Xianling gubao capsules alone＞routine treatment. In the term of improving serum calcium level， compared with Xianling gubao capsules alone [OR＝4.76，95％CI（2.14， 10.59），P＜0.05] and routine treatment [OR＝0.45， 95％CI（0.21， 0.99），P＜0.05]， Xianling gubao capsules combined with routine treatment could significantly improve serum calcium level； network Meta-analysis ranking showed that Xianling gubao capsules combined with routine treatment＞routine treatment＞Xianling gubao capsules alone. In the term of improving serum phosphorus level， compared with Xianling gubao capsules alone， Xianling gubao capsules combined with routine treatment [OR＝2.85，95％CI（1.81， 4.48），P＜0.05] and routine treatment [OR＝2.93，95％CI（1.76， 4.86），P＜0.05] could significantly improve serum phosphorus level； network Meta-analysis ranking showed that routine treatment＞Xianling gubao capsules combined with routine treatment＞Xianling gubao capsules alone. CONCLUSIONS： Xianling gubao capsules combined with routine treatment can significantly improve therapeutic efficacy of PP patients， increase BMD and serum calcium level after treatment， but routine treatment is the best in improving serum phosphorous level.
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Objective To explore the status of intracranial aneurysms screened by CTA among the population with family history of stroke.Methods 200 patients including 108 men and 92 women in our hospital were involved,who had a family history of stroke.Head CTA examination,physical examination and laboratory tests were performed.Results 200 male and female had no statistical significance in demographic characteristics,past medical history and physical testing (P＞0.05);in lifestyle,smoking and drinking prevalence among male were higher than female (P＜0.05),and drug-usage rate of female were higher than male (P＜0.05).27 cases (13.5 ￥)had intracranial aneurysms,including 13 male cases (12.03 ％) and 14 females cases(15.22 ％),and there was one occurred aneurysm rupture and subarachnoid hemorrhage,the prevalence rate of aneurysm rupture was 87％.The 27 intracranial aneurysms cases had 29 CPC aneurysms,with 2 cases had two aneurysms.The number of aneurysm diameter ＜3 mm were 7 (24.14％),3 7 mm diameter were 12 (41.38％),and ＞7 mm were 10 (34.48％).Classified by the morphology,there were 7 (24.14％) fusiform aneurysm,22 (75.86％) cystic,3 (10.34％) small drops of blood sample.Conclusion CTA is a noninvasive and effective method for intracranial aneurysm,can provide additional valuable diagnostic information particularly for emergency of aneurysm screening.
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Objective To evaluate the clinical characteristics,diagnosis and surgical repair methods of double aortic arch (DAA) associated with complex cardiac anomalies.Methods Retrospectively analyzed the clinical data of the 5 DAA associated with complex cardiac anomalies patients,4 males and 1 female,age from 41 days to 19 years old,weight 4.3-56.0 kg.Accompanied cardiac malformites including 2 cases with TOF,2 cases with DORV,and 1 case with d-TGA.4 cases were diagnosed DAA via MSCT and were surgical treated combined with cardiac malformations at same stage.1 case of DAA associated with d-TGA experienced stubborn pulmonary infection with increased airway resistance and could not tolerate ventilator weaning after aterial switch operation.Then he was diagnosed DAA with left arch atresia through MSCT.So,the patient underwent another surgery to excise the left aortic arch.Results One case worsened postoperatively by the cause of vomiting and aspiration and then died.The other four were survival and discharged with no DAA repair relating complication.Conclusion Double aortic arch can be cured by surgical repair and DAA with cardiac defects can be operated in one stage via median sternotomy.Congenital vascular ring should be considered in patients with stubborn and unexplained respiratory symptoms,who should receive timely imaging examinations for accurate diagnosis and surgical treatment at the early stage.
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Objective To investigate the efficacy and safety of transthoracic minimally invasive occlusion operation guided by transesophageal echocardiography for the treatment of congenital atrial or/and ventricular septal defects (ASD/VSD).Methods The clinical data of a total of 44 patients who underwent surgical occlusion operation from September 2013 to June 2015 were summarized.The whole course of occlusion procedure were dynamically monitored and guided by transesophageal echocardiography.All the patients were followed up regularly by electrocardiogram and echocardiograph.Results Among the 44 patients,43 patients(28 VSDs and 16 ASDs,including one patient suffered with VSD and ASD simultaneously)were occluded successfully,and the other patient with VSD who failed in the surgery was converted to open heart repair.The occlusion operations were finished within 22 to 48 min.The length of incision spaned from 2 to 4.5 cm.The ventilator was used for 1 to 5 hours.The total drainge volumes were recorded each patient from 0 to 50 mL.The postoperative hospitalization stay was 2 to 6 days,and all patients survived and were discharged.During the follow-up of 1 to 12 months, there was no cases with A-V conduction block,valve incompetent,cardiac arrhythmia and residual shunt of heart septel defect.Conclusion Transthoraic mini-invasive surgical occlusion of atrial and ventricular septal defects is a therapeutic method with less trauma,higher safety and feasiblity,faster recovery,and the short-term therapeutic effect is satisfying.
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Designed experiment in medical functional experiment has become an important way to promote creative thinking and innovation of medical students.We applied different modes of designed experiment in undergraduates of clinical medicine and basic medicine in capital medical university,including classroom designed experiments,proposition designed experiments and free proposition designed experiments.After above reforming implements,creative thinking and innovation ability of medical students were enhanced.It also provided new ideas in future teaching reform in functional experiment.
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BACKGROUND:Calcium metaphosphate has excel ent biocompatibility, degradability, and cel affinity. Human bone marrow mesenchymal stem cel s can grow and proliferate in the pores of the porous calcium metaphosphate, but less is known about calcium metaphosphate nanoparticles. OBJECTIVE:To prepare calcium metaphosphate nanoparticles, and to analyze the effect of calcium metaphosphate nanoparticles at different concentrations on apoptosis of human bone marrow mesenchymal stem cel s by flow cytometry. METHODS:The calcium metaphosphate nanoparticles were prepared by wet bal mil ing. Scanning electron microscopy and transmission electron microscopy were used to observe the morphology of the calcium metaphosphate nanoparticles, and the crystal structure of nanoparticles was analyzed by X-ray diffraction. Calcium metaphosphate nanoparticles were mixed in the CYAGON Oricel TM basal medium, and the concentrations of calcium metaphosphate nanoparticles in the medium were 10, 1, 0.1 mg/L. Human bone marrow mesenchymal stem cel s were cultured for 7 days in the above-mentioned media, and apoptosis of human bone marrow mesenchymal stem cel s was analyzed by flow cytometry. RESULTS AND CONCLUSION:Calcium metaphosphate nanoparticles were successful y prepared by wet bal mil ing, irregular in shape, and the mean diameter was 10-30 nm. X-ray diffraction results showed the crystal structure of nonaparticles was mainlyβ-Ca(PO3)2. The cel ratio of G0/G1 phase and G2/M phase in 10 mg/L group was obviously higher than that in 1, 0.1 mg/L groups (P<0.01). The cel apoptosis rates during the early, middle, late stages in 10 mg/L group were obviously higher than those in 1, 0.1 mg/L groups (P<0.01), and the total cel apoptosis was also significantly increased in 10 mg/L group (P<0.01). These findings indicate that human bone marrow mesenchymal stem cel s proliferation can be inhibited by calcium metaphosphate nanoparticles, and apoptosis rate is increased significantly when the concentration of calcium metaphosphate nanoparticles increases from 1 mg/L to 10 mg/L.
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Objective To investigate if atorvastatin is effective in reducing carotid intima media thickness (CA-IMT) in normocholesterolaemic patients with transient ischemic attack (TIA). Methods Forty-two patients with TIA were recruited. Patients were randomised to receive atorvastatin(5-10 mg/d) or placebo daily. Serum concentration of cholesterol and CA-IMT were measured before randomisation and at 6-and 18-month intervals. Results CA-IMT was significantly lower in atorvastatin group than that in placebo group at 18-month (P
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Objective To evaluate the efficacy of ventricle septal defect(VSD) occluder through lower ministernotomy for patients with perimembranous VSD. Methods From January 2007 to August 2008,41 patients with perimembranous VSD(14 male,27 female,weighed 9.0 to 71 kg with a mean of 46.3?16.1) underwent a closure of perimembranous VSD through lower ministernotomy using Amplatzer occluder.Before the operation,all the cases had been confirmed as having a 3-to 8.5-cm perimembranous VSD by transthoracic echocardiography(TTE).Under general anaesthesia,a small incision was made at the lower sternum to expose the right ventricle,and then occluder was placed in the right ventricle.TEE,electrocardiography and chest X-ray were performed before discharge and 1 month after the operation.Results The procedure was completed successfully in all the patients with a mean operation time of(6.2?3.3) hours(ranged from 2.5 to 17 hours).The ICU stay was(15.1?4.3) in average(8-21 hours).The mean drainage volume after the surgery was(80?33) ml(35-210 ml).Follow-up was available in all the cases for(7.9?4.1) months(range,3-15 months).During the period,no A-V block,new AI,occluder displacement,embolization,tricuspid incompetence or residual occurred. Conclusions VSD occluder is feasible and safe for closure of perimembranous ventricular septal defects through lower ministernotomy.
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Objective To improve intracardiac operation skil ls on bea-ting-heart with mild hypothermic cardiopulmonary bypass (On pump beating-heart technique), and to review the clinical experience in 1 032 c ases. Methods A total of 1 032 cases of intracardiac operatio ns on pump beating-heart from November 1997 to September 2000 were reviewed. Of them, 714 cases were congenital heart diseases (CHD), and 318 cases were valvul ar heart diseases (VHD). The technique was improved by establishing simultaneous left atrium and ventricle suction and integrating sequential de-airing procedu re. Results The operative mortality was 2.33% (24/1 032), the m ortality was 2.7% (19/714) in cases with CHD, and 1.6% (5/318) in those with VHD. There was no pati ent complicated with systemic air embolism or permanent atrioventricular conduct ion block. Conclusion Results suggested that intracardiac procedures on pump beating-heart with mild hypothermic cardiopnlmonary bypass is safe and available in patients with CHD or VHD. It might extenuate the heart and lung injury by hypothermia and ischemia-reperfusion during cardiopulmonary bypass. Cardiac conducting block might be prevented during operation.
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Objective To compare the clinical efficiency of intracardiac procedures on traditional cardioplegic arrested-heart and on-pu mp beating-heart for congenital heart disease (CHD) with severe pulmonary hyper tension. Methods Among all 153 cases, 95 cases underwent operat ions on cardioplegic arrested-heart, while 58 on-pump beating-heart. In arres ted-heart group, 79 cases with ventricular septal defect (VSD), 13 with atria l septal defect (ASD) and 3 with patent ductus arteriosus (PDA) were examined whi le in beating-heart group, 43 cases with VSD, 10 with ASD, and 5 with PDA were examined. Results There were 12 cases of operative death (12.6%) and 8 of tracheotomy (8.4%) in heart arrested group. No operative death and tracheotomy in beating-heart group. 141 patients were followed up for 3 months to 10 year s with good recovery. There were 2 cases of right heart function failure six yea rs later in arrested-heart group. Conclusion Results sugges t that on-pump beating-heart technique is superior to traditional cardiopl egic arrested-heart for CHD with severe pulmonary hypertesion. The cause might be t hat on-pump beating-heart intracardiac operation is more effective in cardio pulmon ary protection.
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Objective To introduce the technique of mitral v alve replacements in beating heart, and review the clinical experience in 234 ca ses of operation. Methods A total of 234 patients of mitral val ve replacement in beating heart with mild hypothermic extracorporeal circulation (30～32 ℃) were reviewed. Results The procedures underwe nt fluently and only 2(0.85%) died early postoperatively. No low cardiac output , arrhythmia and cer ebral embolism complications was found. Conclusion Results sugg ested that mitral valve replacement in beating heart is a safe and available method and is good in extenuating myocardial and pulmonary i njury from ischemia-reperfusion and deep hypothermia.
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AIM: In order to study the relationship of the activation of ERK and delayed cardioprotection of 11,12-EET.METHODS: A rat ischemia/reperfusion(I/R) model was replicated by ligating left anterior descending coronary artery 30 min followed by 60 min.The expression of ERK was detected with Western blotting,and the change of heart function during reperfusion was observed.RESULTS: The difference of myocardial function was prominent at (24 h) in I/R group compared with sham group,EET+I/R and EET+PD098059+I/R group.The activity of ERK at(24 h) in EET+I/R group was higher than sham group, and the activity of ERK in EET+PD098059+I/R group was lower than that in EET+(I/R) group;the expression of phosphorylated ERK1/ERK2 at(24 h) in EET+I/R group was more than that in I/R group,and the expression of phosphorylated ERK1/ERK2 in EET+PD098059+I/R group was less than EET+I/R group.CONCLUSION: 11,12-EET has a delayed cardioprotection effect,and this protection effect is involved in the activity of ERK and expression of phosphorylated ERK1/ERK2.
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AIM: To examine the effect of pretreatment with low-concentration of 11, 12-epoxyeicosatrienoic acid(EET) on myocardial ischemia/reperfusion injury in rats. METHODS: After tracheotomy, myocardial ischemia/reperfusion was produced by occlusion and release of the left anterior descending artery(LAD) of the rats. Ischemic preconditioning(IP) was made by two times of ischemia (5 min)/reperfusion (5 min). The experiment was conducted in three groups: control,IP and pretreatment with 11,12-EET(6.24?10 -8 mol/L), and each group was subdivided into two subgroups:A,the rats were subjected to ischemia (10 min)/reperfusion (10 min) and arrhythmias during the whole periods were monitored; The rats in B were subjected to ischemia (60 min)/reperfusion (30 min) and arrhythmias, cardiac funtion and myocardial infarction size were documented. RESULTS: Both IP and pretreatment with 11,12-EET could protect the heart against arrhythmias, cardiac disfunction and myocardial infarction. CONCLUSION: Pretreatment with 11,12-EET had protective effect on myocardium in case of ischemia/reperfusion, which was similar to ischemic preconditioning.
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AIM: In order to study the relationship between the ERK and p38 MAPK activation and the protection of 11, 12-epoxyeicosatrienoic acid (11, 12-EET) and ischemia preconditioning (IP), the effects of 11, 12-EET and ischemic preconditioning on phosphorylated ERK and p38 MAPK during ischemia and reperfusion in rat myocardium were examined. METHODS: The rat heart was subjected to ischemia for 5 min by ligating the left anterior descending coronary artery followed by reperfusion for 5 min (two times) to undergo ischemia preconditioning. The rats were divided into 5 groups: (1) control; (2) sham group; (3) ischemia/reperfusion (I/R) group, in which the rat heart suffered from 60 min ischemia followed by 30 min reperfusion; (4) IP plus I/R group; (5) EET plus I/R group, in which 6.28?10 -8 mol/L 11, 12-EET was injected intravenously 20 min before I/R. The heart function was examined, and phosphorylated ERK and p38 MAPK were detected by Western blot. RESULTS: At 30 min reperfusion, +dp/dt max ,-dp/dt max and LVDP decreased significantly in I/R group compared with sham group, IP plus I/R group and EET plus I/R group; Phosphorylated ERK1/2 level was higher in I/R group than sham group, but was lower in I/R group than IP plus I/R group and EET plus I/R group; Phosphorylated p38 MAPK level was lower in control, sham, IP plus I/R and EET plus I/R group than I/R group. CONCLUSION: 11,12-EET protects rat heart against ischemia/reperfusion injury, the mechanism may be related to activation of ERK1/2 and inhibition of p38 MAPK. [
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Epoxyeicosatrienoic acids(EETs)are the metabolic products of arachidonic acid(AA). They have the function of stimulating cell division, inhibiting platelet aggregation and regulating the transfer of cell calcium. In recent years, more and more people paid their attention to the effects of EETs on heart. This article will give a review about EETs and the relationship between EETs and heart.
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Cytochrome P450 monoxygenase converts arachionic acid to four epoxyeicosatrienoic acid regiosomes: 5,6-EET(epoxyeicosatrienoic acid);8,9-EET; 11,12-EET and 14,15-EET.Recent studies show that EETs are involved in signal transduction. EETs open Ca 2+ -sensitive K + channel and inhibit Na + channel,Ca 2+ -sensitive Cl - channel and so on. What is more ,EETs have been demonstrated to activate PP60 c-src and initiate a tyrosine kinase cascade that mediates mitogenic effects.
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Aim To investigate the expression of phosphorylated JNK1/JNK2 and the protection of 11,12-EET in ischemic and reperfusion rat heart.Method The expression of JNK1/JNK2 was detected with western blot method and the changing of heart function during ischemia/reperfusion process was observed in different groups. Results The cardiac function (+dp/dt_(max)%,-dp/dt_(max)% and LVDP)of reperfusion periods(30 min) apparently decreased in ischemia/reperfusion (I/R) group contrasted with Sham group, short ischemia(SI)+I/R group and EET+I/R group,and the expression of phosphorylated JNK1/JNK2 increased in I/R group contrasted with nromal group,Sham group and EET+I/R group.Conclusion The myocardial protection of 11,12-EET ( 6.24?10~(-8) mol?L~(-1)) is able to inhibit the expression of phosphorylated JNK1/JNK2.
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AIM: To test the effect of ERK1/2 on ischemic preconditioning (IPC) in diabetic rat hearts. METHODS: The diabetic rat model was made with alloxan. After eight weeks, 24 rats were divided into 4 groups: non-diabetic IPC rats (group A); non-diabetic non-IPC rats (group B); diabetic IPC rats (group C); diabetic non-IPC rats (group D). ECGⅡ lead, left ventricular development pressure (LVDP), and first derivative of LVDP ~(?dp/dt_~max ) were recorded. Myocardial phosphorylation of extracellular signal regulated kinases1/2 (ERK1/2) was detected by Western-blotting. RESULTS: (1) The ventricular arrythmia score was significantly lower in group A than that in group C (P