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Objective:To explore the effects of practice teaching based on Gagne's teaching theory combined with scene teaching method on core competency of nursing students in department of respiratory and critical care medicine.Methods:A total of 42 nursing students from the Respiratory and Critical Care Medicine Department of Beijing Jishuitan Hospital were enrolled and divided into observation group (21 cases) and control group (21 cases) using a random number table. Traditional teaching method was used in the control group, while Gagne's teaching theory combined with scene teaching method was used for teaching the observation group. After teaching, theoretical knowledge and actual operation ability of nursing students were assessed. The core competency of nursing students was evaluated by core competency assessment scale. The independent learning ability of nursing students was evaluated using an assessment tool. The self-evaluation of teaching effect in the two groups was compared. The t test or chi-square test was performed in SPSS 22.0. Results:The scores of theoretical knowledge and actual operation ability in the observation group were (88.10±7.52) and (90.81±4.88), respectively. These scores were significantly higher than those in the control group [(83.62±6.58) and (72.57±8.94), t=2.06, 8.21, P<0.05]. The scores of core competency and independent learning ability were significantly higher in the observation group than in the control group [(185.53±20.19) and (129.09±16.14) vs. (170.52±20.32) and (105.86±12.23), t=2.40, 5.10, P<0.05]. The score of self-evaluation on teaching effect was significantly higher in the observation group than in the control group [28 (25, 29) vs. 21 (20, 22), Z=5.39, P<0.05]. Conclusion:Gagne's teaching theory combined with scene teaching method in practice teaching of nursing students in the department of respiratory and critical care medicine should be promoted because this combined method improves the mastery of theoretical knowledge and actual operation skills, the independent learning ability and core competency of nursing students, and the effect of nursing teaching.
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One-carbon compounds such as methanol and methane are cheap and readily available feedstocks for biomanufacturing. Oxidation of methanol to formaldehyde catalyzed by methanol dehydrogenase (MDH) is a key step of microbial one-carbon metabolism. A variety of MDHs that depend on different co-factors and possess different enzymatic properties have been discovered from native methylotrophs. Nicotinamide adenine dinucleotide (NAD)-dependent MDHs are widely used in constructing synthetic methylotrophs, whereas this type of MDH usually suffers from low methanol oxidation activity and low affinity to methanol. Consequently, methanol oxidation is considered as a rate-limiting step of methanol metabolism in synthetic methylotrophs. To accelerate methanol oxidation, thereby improving the methanol utilization efficiency of synthetic methylotrophs, massive researches have focused on discovery and engineering of MDHs. In this review, we summarize the ongoing efforts to discover, characterize, and engineer various types of MDHs as well as the applications of MDHs in synthetic methylotrophs. Directed evolution of MDH and construction of multi-enzyme complexes are described in detail. In the future prospective part, we discuss the potential strategies of growth-coupled protein evolution and rational protein design for acquisition of superior MDHs.
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Oxidorreductasas de Alcohol/genética , Carbono , Metano , MetanolRESUMEN
Objective: To analyze the clinical pathological features of one patient with accessory breast cancer (ABC), and to explore the diagnosis, treatment, operation methods and prognosis of ABC patient. Methods: The patient received right axillary tumor resection, right axillary accessory breast resection and axillary lymph node dissection, didn't receive resection of breast in the affected side. According to the intraoperative frozen pathological diagnosis, the clinical diagnosis was ABC. After operation, the patient was treated with 8 cycles of AC-T regimen adjuvant chemotherapy (The first four cycles were given pirarubicin 60 mg · m-2, cyclophosphamide 600 mg · m-2 per cycle; the last four cycles were given docetaxel 100 mg · m-2 per cycle; every three weeks was a cycle of treatment), radiation therapy (The radiation dose was 50 Gy/25 f in the upper and lower part of the right collarbone and the tumor bed area, and after retract the tumor bed area was increased to 60 Gy) and endocrine therapy (Tamoxifen was administered at 20 mg per day). Results: The patient's breast color ultrasound and mammogram examination indicated that the right axillary mass of the patient was more likely to be malignant. The clinical diagnosis was right axillary ABC. According to the NCCN guide, the patient was treated with the standardized comprehensive treatment based on surgical treatment. 16 months after operation, the patient recovered well and had a normal life. There was no upper limb dysfunction and no lateral upper limb lymphedema, and there were no recurrence or metastasis Conclusion: ABC is extremely rarely seen in clinical practice. The clinical pathological features and treatment of ABC are similar to breast cancer. If there is no lesion in the mammary gland, it is not necessary to remove the mammary gland in the affected side.
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Objective:To analyze the clinical pathological features of one patient with accessory breast cancer (ABC),and to explore the diagnosis,treatment,operation methods and prognosis of ABC patient.Methods:The patient received right axillary tumor resection,right axillary accessory breast resection and axillary lymph node dissection,didn't receive resection of breast in the affected side.According to the intraoperative frozen pathological diagnosis,the clinical diagnosis was ABC.After operation,the patient was treated with 8 cycles of AC-T regimen adjuvant chemotherapy(The first four cycles were given pirarubicin 60 mg·m-2,cyclophosphamide 600 mg·m-2 per cycle;the last four cycles were given docetaxel 100 mg·m-2per cycle;every three weeks was a cycle of treatment),radiation therapy(The radiation dose was 50 Gy/25 f in the upper and lower part of the right collarbone and the tumor bed area,and after retract the tumor bed area was increased to 60 Gy)and endocrine therapy(Tamoxifen was administered at 20 mg per day).Results:The patient's breast color ultrasound and mammogram examination indicated that the right axillary mass of the patient was more likely to be malignant.The clinical diagnosis was right axillary ABC.According to the NCCN guide,the patient was treated with the standardized comprehensive treatment based on surgical treatment.16 months after operation,the patient recovered well and had a normal life.There was no upper limb dysfunction and no lateral upper limb lymphedema,and there were no recurrence or metastasis.Conclusion:ABC is extremely rarely seen in clinical practice.The clinical pathological features and treatment of ABC are similar to breast cancer.If there is no lesion in the mammary gland, it is not necessary to remove the mammary gland in the affected side.
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Objective:To investigate the prognostic factors and survival of patients with combined small cell lung cancer (C-SCLC) after they underwent complete resection. Methods:The clinical records of C-SCLC patients who were subjected to complete resection and systematic nodal dissection in one institution between January 2010 and December 2014 were retrospectively reviewed. Results:Sev-enty-eight patients with histologically diagnosed C-SCLC were identified. The most common combined component was large cell neuro-endocrine carcinoma (LCNEC) (n=42), followed by squamous cell carcinoma (SCC) (n=18), adenocarcinoma (AC) (n=10), and adenosqua-mous carcinoma (ASC) (n=8). The overall survival (OS) rate of the entire cohort was 39.1%. Multivariate analyses using Cox's propor-tional hazard models revealed that size [3 cm;hazard ratio (HR)=0.406;95%confidence interval (CI)=0.202-0.816;P=0.011], performance status (2;HR=0.113;95%CI=0.202-0.631;P=0.013), combined non-small cell lung cancer (NSCLC) components (LCNEC vs. non-LCNEC, HR=3.00;95%CI=0.096-0.483;P<0.001), stage Ⅲ A vs.Ⅰ;HR=0.195, 95%CI:0.063-0.602;P=0.004) and adju-vant therapy (yes vs. no, HR=0.402;95%CI=0.195-0.831;P=0.014) were significant prognostic factors of OS. Conclusion:The mixed NSCLC components within C-SCLC significantly influence survival. Adjuvant therapy is beneficial for patients with complete resection of C-SCLC.
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Objective:To investigate the efficacy of postoperative chemotherapy in patients with early-stage pulmonary large cell neu-roendocrine carcinoma (LCNEC) after resection. Methods:A cohort of 50 patients who underwent resection and systematic nodal dissection for LCNEC between January 2008 and December 2014 in our institution was retrospectively reviewed. The patients were divided into adjuvant chemotherapy group (32 cases) and non-chemotherapy group (18 cases). Follow-up information was investigated. Results:The median survival and the 5-year survival rate were 48 months and 72.5%for the adjuvant chemotherapy group whereas 29 months and 35.6%for the non-adjuvant chemotherapy group, respectively. Univariate and multivariate analyses using Cox's proportional hazard models showed that postoperative chemotherapy was a signifi cant prognostic factor for OS (P=0.005;hazard ratio=0.281, P=0.008, respectively). Conclusion:Postoperative chemotherapy is beneficial to patients with early-stage pulmonary LCNEC after complete resection.
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Objective:To investigate the efficacy of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) in adenosqua-mous carcinoma (ASC) of the lung after resection. Methods:Clinical data of patients suffering from ASC and receiving EGFR-TKI treat-ment at one institution between January 2006 and December 2014 were retrospectively reviewed. Results:A total of 27 EGFR muta-tion-positive patients with ASC subjected to EGFR-TKI therapy were enrolled in this study. EGFR mutations included deletion in exon 19 in 15 cases and point mutation at codon 858 in exon 21 in 12 cases. Of the 27 ASC patients who received EGFR-TKI treatment, 9 exhibit-ed a partial response and 11 manifested a stable disease, and these patients accounted for a disease control rate of 74.1%(20/27). The median overall survival (OS), median progression-free survival, and median relapse OS of the EGFR mutation-positive patients who underwent TKI therapy were 39 months [95%confidence interval (CI)=25.6-52.4], 15 months (95%CI=12.9-17.1), and 19 months (95%CI=0.9-37.1), respectively. The 3-and 5-year survival rates of these patients after operation were 51.9%and 15.3%, respectively. Con-clusion:The survival of EGFR mutation-positive ASC patients treated with EGFR-TKIs was satisfactory. EGFR testing was recommended for ASCs and EGFR-TKI treatment was suitable for ASCs with EGFR-sensitizing mutation.