RÉSUMÉ
Based on the teaching concept of constructivism, this study aims to promote independent inquiry-based learning and clinical thinking among students and establish the guiding ideology of "full participation, process control, in-depth discussion, and expansion of thinking". A blending learning model was adopted with offline inquiry-based group learning and in-class defense and comment, as well as online teacher-student interaction and supervision to promote learning. Case-problem-based learning (CPBL) of pathophysiology was carried out among the medical students in the class of 2017, and process management was strengthened to effectively manage the two key links of data retrieval and group discussion. The analysis of 176 teaching evaluations collected at the end of the semester show that in terms of the overall evaluation of CPBL teaching, 162 students (92.05%) had high evaluation on teaching objectives, organization, cases, and personal gains and held a very or relatively favorable attitude. There were more negative feedbacks on "appropriate time allocation"; 21 students (11.93%) held a relatively or very disapproving attitude, and 149 students (84.66%) "felt very tired". In terms of teaching effect evaluation, 150 students (85.23%) strongly or relatively agreed that CPBL teaching may help to understand professional knowledge, stimulate learning enthusiasm and initiative, improve problem solving ability, emphasize clinical practice to cultivate clinical thinking, supervise and promote learning, and enhance team cooperation and teacher-student communication. In terms of the evaluation of teachers, 167 students (94.89%) thought that teachers were rigorous, responsible, and enthusiastic in teaching, attached importance to process management, and did well in effective guidance and thinking inspiration (strongly or relatively agree). The above results suggest that the CPBL teaching reform of pathophysiology based on process management can effectively promote in-depth inquiry-based independent learning and the cultivation of clinical thinking and improve teaching effectiveness, but further improvement is needed for teaching arrangement and time allocation.
RÉSUMÉ
Objective To observe the effect of treadmill exercise on the expression of transforming growth factor-β1 (TGF-β1) and its receptor Smad3 protein as well as on cell apoptosis in the ischemic boundary zone,so as to explore how exercise promotes the recovery of neurological function after cerebral ischemia.Methods Thirty adult male Sprague-Dawley rats were randomly divided into a sham group (n=6),a model group (n=12) and an exercise group (n=12).A modified Longa's method was used to establish an animal model of cerebral ischemia by occluding the right middle cerebral artery in the rats of the model and exercise groups.Those of the sham group were subjected to the same surgical procedure except that no thread was inserted.After 24h the exercise group began treadmill training,while the other two groups were left on the treadmill without training.Modified neurological severity scores (mNSSs) were used to quantify the rats' neurological functioning on the 3rd,7th and 14th day after the surgery.The ischemic boundary zone tissue was then dissected to detect the expression of TGF-31 and Smad3 protein using western blotting.Cell apoptosis was detected by TUNEL staining.Results The average mNSS scores of the exercise group on the 7th and the 14th day were significantly lower than those of the model group at the same time points.The average expression level of TGF-β1 and Smad3 protein in the exercise group was significantly higher than in the model group.The number of TUNEL-positive cells in the exercise group was significantly lower than in the model group on the 14th day.Conclusions Treadmill exercise can improve the recovery of neurological function after cerebral ischemia.It may be partly due to upregulating the expression of TGF-β1 and Smad3 protein,which inhibit cell apoptosis in the ischemic boundary zone.