Exploration on integrated medical education reform in comprehensive universities / 中华医学教育探索杂志

After years of exploration, Central South University has comprehensively reformed and upgraded the curriculum in both horizontal and vertical integration, including optimizing and constructing a basic clinical core curriculum system with organ system integration as the main line, utilizing the advantages of comprehensive universities to further advance the cross-teaching reform of science, engineering, arts and medicine, strengthening pre-medical education with the goal of early exposure to medicine, promoting the reform of early contact clinical integrated teaching according to the concept of "early, multiple and repeated clinical practice", and accelerating the integration of clinical skills training courses with the support of clinical skills simulation teaching. After the integration, the faculty team has gradually matured and the teaching quality has been significantly improved, which has strengthened the students' medical thinking and overall literacy.

Efficacy comparison between clavicular hook plate combined with coracoclavicular figment reconstruction and simple hook plate for acute acromioclavicular joint dislocation / 中华创伤杂志

Objective To compare the efficacy between hook plate combined with coracoclavicular ligament functional reconstruction by conjoined tendon transfer and single hook plate surgery in the treatment of Rockwood type Ⅲ and type Ⅴ acute acromioclavicular joint dislocations.Methods A prospective cohort study was conducted to analyze the clinical data of 37 patients with Rockwood type Ⅲ and Ⅴ acute acromioclavicular dislocations admitted to Jiangning Hospital Affiliated to Nanjing Medical University from October 2011 to April 2016.According to the random number method,the patients were divided into combined tendon and ligament reconstruction group (ligament reconstruction group,19 patients) and clavicular hook plate group (single plate group,18 patients).In the ligament reconstruction group,there were 14 males and five females,aged (47.0 ± 11.4) years,and there were 10 patients with type Ⅲ and nine with type Ⅴ.In the simple plate group,there were 12 males and six females,aged (45.0 ± 11.2)years,and there were 11 patients with type Ⅲ and seven with type Ⅴ.In the ligament reconstruction group,the acromioclavicular joint was reduced by clavicular hook plate,and the oblique ligament and the conical ligament were reconstructed by lateral half-inversion of the short head tendon of biceps brachii combined with tendon.The double-bundle functional reconstruction of coracoclavicular ligament was performed.In single plate group,hook plate was used to reduce acromioclavicular joint.The intraoperative blood loss,incision length,operation time,and visual analogue score (VAS) before operation and after 1 year follow-up were compared.Constant-Murley score and Karlsson score were used to evaluate the effect of operation.X-ray films were taken regularly to observe the reduction and maintenance of acromioclavicular joint dislocation.The complications were recorded.Results All patients were followed up for 17-24 months [(20.0 ± 1.7) months].There was no significant difference in intraoperative blood loss between the two groups (P ＞ 0.05).In the ligament reconstruction group and single plate group,the incision length was (13.4 ± 0.8) cm and (6.6 ± 0.7) cm (P ＜ 0.05);the operation time was (88.7 ± 8.3) minutes and (54.1 ± 7.3) minutes (P ＜ 0.05);the preoperative VAS score was (7.5 ± 0.9) points and (7.3 ± 0.7) points (P ＞ 0.05);the VAS at 1 year after operation was (2.1 ± 0.9) points and (3.8 ± 1.4) points (P ＜ 0.05).X-ray showed good reduction of acromioclavicular joint in ligament reconstruction group,with no loss of reduction occurred after removal of hook plate.In the simple plate group,loss of reduction,resorption of distal clavicle bone and bone fusion occurred after removal of hook plate.The Constant-Murley scores in the ligament reconstruction group and the single plate group were (89.5 ± 2.9) points and (79.6 ± 5.0) points respectively;the excellent and good rates of Karlsson score were 89.5％ (17/19) and 61.1％ (11/18) (both P ＜ 0.05),respectively.In the ligament reconstruction group,one patient complained of pain and swelling at the tendon.In the single plate group,loss of reduction occurred in three patients after removal of internal fixator;obvious subacromial osteolysis was seen in seven patients at 1 year after operation;and impingement sign was positive in nine patients at 1 year after operation.Conclusion The overall surgical effect of hook plate combined with coracoclavicular ligament functional reconstruction by conjoined tendon transfer is superior to single hook plate surgery in the treatment of type Rockwood Ⅲ and Rockwood Ⅴ acute acromioclavicular joint dislocations,though with longer operation time and bigger incision.

Non-weight-bearing area osteotomy of lateral tibial condyle in treating posterior-lateral condyle fracture of tibial plateau / 重庆医学

Objective To explore the clinical curative effects of non-weight-bearing area osteotomy of anterior lateral tibial condyle in treating posterior-lateral condyle fracture of tibial plateau.Methods A retrospective analysis was carried out on 24 cases of posterior-lateral condyle fracture of tibial plateau treated by osteotomy of anterior lateral tibial condyle in this hospital from December 2012 to December 2015,including 15 males and 9 females,aged 26-59 years old with an average age of 42.2 years old.Fracture Schatker classification:type Ⅱ in 16 cases,type Ⅴ in 3 cases and type Ⅵ in 5 cases.All 24 cases adopted surgical treatment via the approach of anterior lateral tibial condyle.During operation,the non-bearing area of lateral tibial condyle was cut to expose and reset the posterior-lateral fractured condyle and fix it with lateral raft steel plate.At the time of last follow-up,the recovery of the knee joint function was evaluated according to the knee scoring system of Hospital for Special Surgery (HSS) in USA.Results Twenty-four patients were postoperatively followed up for 12-24 months,with an average of 13.1 months.The Rasmussen score for the postoperative immediate fracture reduction quality averaged (17.3 ± 0.8)points;there were 19 cases of excellent results and 5 cases of good results,with the excellent and good rate of 100 ％.Twenty-four cases had no incision infection,no internal fixation loosening or breakage.The X ray film showed that the fracture got healing,and the average healing time was (13.1 ± 1.1) weeks(12-15 weeks).No surgery related complications including blood vessel and nerve damage occurred;2 cases appeared small area of superficial necrosis at the edge of the posterior incision,which was healed after dressing.At the last follow-up,the HSS knee score was(93.0±6.4) points,excellent in 19 cases,good in 4 cases,and fair in 1 case,with the excellent and good rate of 95.8％.Conclusion For the patients with posterior-lateral condyle fracture of tibial platform,non-weight-bearing area osteotomy approach of lateral tibial condyle allows enough space to directly expose the fracture area and carry out operation;combined with lateral raft locking steel plate fixation is more reliableto fixthe fractured bone,with convenient operation positioning,good postoperative functional recovery,fewer complications,and satisfied curative effects.

An Exploration of the development of medical simulation teaching center / 中华医学教育探索杂志

Medical simulation teaching is an emerging and developing teaching method in our coun-try. At present, the simulation teaching centers are developing rapidly in higher education institutions, but how to improve the effectiveness in the operation of the centers is still a subject that needs to be discussed. Based on our own experience, this paper analyzes the related factors in developing medical simulation teach-ing centers, making summary and demonstrations from aspects of team building, teacher training, docking needs, staffing and so on, so as to provide references and suggestions for the construction of medical simu-lation center higher education institutions.

Comparative analysis of eight year clinical medical professionals training —a case study of Xiangya School of Medicine, Central South University / 中华医学教育探索杂志

As one of the first pilot eight-year clinical medicine education institutions, Xiangya School of Medicine has already put it into practice for almost 12 years. After years exploring and reforming, its cultivating plan has already been built up. This paper will make a brief comparative analysis between 2004 version and 2012 version in cultivating objectives, model and characteristics, demonstrated the development and reform of its eight-year program education, shown its features such as strengthening the basic knowledge, emphasizing the clinical skills, cultivating the capabilities, and broadening the international perspectives, and attempt to contact the residency and research training, in order to provide the reference for the eight-year program education reform.

Reference significance of proximal fibula fractures for selecting surgical procedures for complex tibial plateau fractures involving posterior lateral spine / 重庆医学

Objective To compare the effects of two surgical procedures via comparison on tibial fractures with/without proximal fibula fractures ,and to explore the reference importance of proximal fibula fractures in surgery for complex tibial plateau fracturesinvolvingposterior and lateral spine .Methods Totally 69 cases of patients with complex tibial plateau fracturesinvolving‐posterior and lateral spine (Schatzker Ⅴ and Ⅵ) were selected ,who accepted treatment between January 2008 and October 2012 . The patients were screed according to the quality of fracture reduction immediately after operation .39 cases were screened whose scores were excellent and the general condition was similar .The patients were divided into group A1 ,A2 and B1 and B2 according to the whether there was proximal fibula fractures and whether accepted posterior lateral support steel plate:group A1 (n=10):without proximal fibula fractures but with posterior lateral support steel plate;group A2 (n=11):without proximal fibula fractures and without posterior lateral support steel plate;group B1 (n=9):with proximal fibula fractures and with posterior lateral support steel plate;group B2 (n=9):with proximal fibula fractures but without posterior lateral support steel plate .According to the knee scoring system of American Hospital for Special Surgery (HSS) ,a total of 39 cases of patients were followed up for 12-14 months (average 12 .8 months) to evaluate the recovery condition of knee function .And correlations between the scores of the 4 groups were compared .Results There were statistically significant differences between group B1 and group B2 on HSS scores (P0 .05) .Conclusion For patients with complex tibial plateau fracturesin‐volvingposterior and lateral spine and with proximal fibula fractures ,posterior lateral support steel plate can achieve more satisfac‐tory rehabilitation function .

Association between obesity-related plasma hemodilution and the concentration of prostate specific antigen / 南方医科大学学报

<p><b>OBJECTIVE</b>To determine the effect of obesity on prostate specific antigen (PSA) in men with benign prostatic hyperplasia (BPH) and develop a PSA-related parameter that can eliminate the effect of obesity.</p><p><b>METHODS</b>We reviewed the clinical data of 706 patients with BPH. Two PSA-related parameters, namely PSA mass (total circulating PSA protein) and PSA mass ratio (total circulation PSA protein per prostate volume), were calculated for all the patients and the association of BMI with PSA, PSA mass, and PSA mass ratio was assessed.</p><p><b>RESULTS</b>A higher BMI was significantly associated with a greater plasma volume and prostate volume (P<0.05). Linear regression analysis revealed a greater adjusted R2 of BMI versus plasma volume than of BMI PSA (0.569 vs 0.027). PSA was positively associated with the prostate volume and negatively with BMI and plasma volume (P<0.05). PSA mass was positively associated with prostate volume (P<0.05) but was not associated with BMI or plasma volume (P>0.05). PSA mass ratio was not associated with prostate volume (P>0.05) but negatively associated with BMI and plasma volume. Plasma volume and prostate volume, PSA, and PSA mass ratio (P<0.05), but not PSA mass (P>0.05), differed significantly among normal-weight, overweight, and obese patients.</p><p><b>CONCLUSION</b>A higher BMI is associated with a greater plasma volume in BPH patients. In obese patients with BPH, a lower PSA concentration may result from hemodilution caused by a greater plasma volume, and PSA mass can eliminate the effect of obesity on PSA.</p>

Analysis of the effect of azithromycin combined with the glucocorticoid for the mycoplasma pneumonia in children / 中国基层医药

Objective To investigate the clinical effects of azithromycin combined with glucocorticoid for the mycoplasma pneumonia in children.Methods 124 children with mycoplasma pneumonia were randomly divided into the study group and the control group with 62 cases in each group.On the basis of the routine symptomatic treatment,the control group was given azithromycin(10mg · kg-1 · d-1) and the study group was treated with azithromycin and hydrocortisone sodium succinate (0.2mg/kg) in the first five days,then stop giving hydrocortisone sodium succinate.The total course was two weeks.Results The study group of children with cough,fever and pulmonary rales disappeared significantly shorter than the control group.Comparison of clinical efficacy,the study group effective rate was 95.2％,the control group was 83.9％,the difference was statistically significant (P ＜ 0.05).Study group had 9 cases of adverse reactions,the control group had 14 cases of adverse reactions,the difference was statistically significant (P ＜ 0.05).Conclusion Glucocorticoid combined with azithromycin is used to treat children with mycoplasma pneumoniae pneumonia,which can improve the therapeutic efficacy and shorten treatment time.It is a better choice of clinical treatment for mycoplasma pneumoniae pneumonia in children.

Application and establishment of two-dimensional gel electrophoresis from proteome analysis of human osteosarcoma / 吉林大学学报(医学版)

Objective To establish analysis methods of two-dimensional(2-DE)gel electrophoresis for human osteosarcoma.Methods A series of methods,including Immobilized pH gradient were used as ID.Some applications,such as sample preparation used as choice of IPG gel,were improved.Coomassie brilliant blue staining,ImageMaster 2D Elite 3.01 analysis software,MALDI-TOF/ TOF MS and SWISS-PROT database serching were used to separate and indentify the proteins of human osteosarcoma.Results The good use pattern including repetitive experiments showed that in three experiments,the amount of protein spots of the same team sample deviates from the relative standard as following,the average of variation coefficient(%) : 23.00?10.11 and 20.33?9.90;and the range of variation coefficient(%) were:3.80-6.89 and 2.706.89 from osteosarcoma and normal group respectively.The isoelectric point and molecular weigh of the same protein spots in three experiments deviated from relative standard as following:(8.93%?1.17)%,(10.16?2.02)%,(10.87?3.86)%,respectively.Therefore,better resolution and repetitive 2-DE atlas were obtained.The proteins from 11 pairs of sample were analysed by mass spectrometry,9 identified proteins(transthyretin precursor, Triosephosphate isomerase,slow skeletal muscle,cardiac muscle Troponin T,Cofilin-1,Myosin light chain 1,Calgranulin B,Heat-shock protein,Annexin A5, Fanconi anemia group D2 proteins) were more abundant in osteosarcoma tisstues and 2 proteins manganese SOD and carbonic dehydratase appeared down-regulation in osteosarcoma tisstues.Conclusion This optimized 2-DE map is an important tool for further study on osteosarcoma,and these identified proteins were related-proteins with osteosarcoma.It is suggested that the changes of the proteome are involved in the pathology processe of osteosarcoma.