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Objective The study explored the feasibility of PBL teaching approach and mini-CEX scores evaluation method in hematology probation teaching practice. Methods 54 medical students of eight-year program were selected in the study and they were in hematology department of Sun Yat-sen Memorial Hospital for clinical probation. The study compared PBL teaching approach with traditional training method, and used mini-CEX to evaluate the students' clinical competence. Results The performance of PBL teaching group is better than traditional teaching group in the aspect of inquiry skill, clinical diagnosis, therapy plan and humanistic care (P<0.05). There is no significant difference of basic knowledge, physical examination skill and clinical operational skills between these two groups. More than 85％of the students in PBL group are satisfied with the teacher in the aspect of participation, feedback, guidance, correction and assistance. Conclusion Through this teaching practice, the study provides new methods for improving the teaching of pre-internal clinical practice in hematology department.
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[Objective] To explore the risk factors for mortality of bloodstream infections in the patients with hematologic diseases,so as to provide evidence for reasonable and effective application of treatments.[Methods] The clinical data of 242 cases of bloodstream infections who were hospitalized from Jan 2012 to Jun 2016 were analyzed retrospectively,then the analysis was performed for risk factors.The statistical analysis was processed by SPSS 19.0.[Results] A total of 266 strains of pathogens were isolated,including 99 strains of gram-positive bacteria,accounting for 37.2％,and 164 strains of gram-negative bacteria,accounting for 61.7％.Multivariate analysis showed that the significant independent risk factors for mortality were active states of hematologic diseases (P =0.007,OR =5.622,95％ CI 1.586 ～ 19.924),presentation with septic shock(P =0.007,OR =4.978,95％ CI 1.560 ～15.884),cardiac insufficiency (P =0.001,OR =11.878,95％ CI 2.760 ～ 51.120),level of albumin less than 35 g/L (P =0.036,OR =3.468,95％ CI 1.087 ～ 11.066),polymicrobial infection (P =0.010,OR =6.024,95％ CI 1.540 ～ 23.563),and Staphylococcus haemolyticus (P =0.001,OR =19.308,95％ CI 3.392 ～ 109.888)/Enterococcus (P =0.002,OR =15.266,95％ CI 2.817 ～82.728) infection.The survival curves show that the inappropriate initial antimicrobial therapy group or presentation with any one of the independent risk factors had a lower probability of survival than the control group.[Conclusions] Bloodstream infections in patients may cause high mortality rate,so it is necessary that we use antibiotic reasonably and spare no effort to reduce the mortality rate by appropriate application of antimicrobial therapy and effective intervention of the risk factors.
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Objective To investigate the association among cerebral lesions, mild cognitive impairment and artery stenosis.Methods In 685 cases which seek medical care in our hospital in recent years, we studied the cortical infarction lesions in this study, analysis of subcortical infarction in patients with cognitive impairment as well as the composition of the artery stenosis conditions were conducted .Results in this study, subcortical infarct patients with mild disturbance of consciousness accounted for 9.20%, while blood supply stenosis cases accounted for 49.34%.Elder than 70 years, long course of subcortical infarction, family history of alcohol consumption and dementia were associated with cortical (P <0.05), the incidence of subcortical infarct and mild cognitive disturbance were 2.138 times for infarct and mild disturbance of consciousness patients.Multivariate regression analysis showed that family history of hypertension and cerebrovascular disease were also risk factors.In addition, mild cognitive impairment can increase the risk of subcortical infarct and the incidence of vascular stenosis, OR was 2.077;elder than 70 years of age, subcortical infarct length, hypertension and family history of cerebrovascular disease were risk factors for subcortical infarction and stenosis of blood supply.In multivariate regression analysis, mild cognitive impairment, long duration of subcortical infarct, overweight and obesity, and hypertension showed to be risk factors of subcortical infarct and blood supply stenosis.Conclusion The artery stenosis and subcortical infarction with mild cognitive impairment show a positive correlation, while the presence of mild cognitive impairment and subcortical infarction and artery stenosis and an increased risk of an association, are related to each while age, duration and associated subcortical infarcts family history and other factors also affect the potential relationship between them .
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Objective To find out the cerebral blood flow velocity and its relationship with attention and execu?tion function in patients with major depressive episode. Methods A total of 70 patients with major depressive episode and 65 healthy controls were included. The 24 items Hamilton depression scale (HAMD-24) was adopted for patients' depressive symptoms assessment. The Cancellation Test (CT) and Wisconsin Card Sorting Test (WCST) were adopted for cognitive function assessment. And the blood flow velocity of cerebral arteries were detected by transcranial Doppler ul?trasonography (TCD). Results Compared with the controls, the patients showed significantly slower average blood flow ve?locity in basilar artery, left middle cerebral artery, right middle cerebral artery, left anterior cerebral artery and right ante?rior cerebral artery (P<0.05). Compared with those in the controls, the net score of each stage and the total net score of CT were significantly lower in the patients, while the total number of responses, response errors, perseverative errors and the necessary response number to complete the first category of WCST were significantly higher (P<0.01). The blood flow velocity in the cerebral basilar artery (r=0.25), left middle cerebral artery (r=0.46), right middle cerebral artery (r=0.25) and right posterior cerebral artery (r=0.26) showed positive correlations with total net score of CT (P<0.05), and the cere?bral artery average blood flow velocity showed negative correlations with the total number of responses, response errors and perseverative errors of WCST in the patients (P<0.05). Conclusions Compared with healthy controls, patients with major depressive episode suffer from lower average cerebral artery blood flow velocity, bad attention and executive func?tion. The change of average cerebral artery blood flow velocity may be responsible for impaired cognitive function in epi?sode major depression patients.
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Objective To analyze the present situation of the dental instrument cleaning and disinfection in Hainan province and to explore the management mode of dental instrument cleaning and disinfection which is suitable for the provincial situation .Meth-ods By adopting the stratified random sampling method according to the hospital grades ,24 hospitals in Hainan province were per-formed the questionnaire survey on the cleaning mode of oral instruments ,layout of cleaning and disinfection room ,cleaning method and facilities ,protection measures and training of cleaning staff .Results 14 hospitals (58 .33% ) had the sterilization and supply center for conducting the centralized processing on the dental instruments .The tertiary hospitals and the second-grade hospitals had the independent cleaning and disinfection rooms with the rational layout and professional cleaning staff ;the safeguard facilities had the application in place ,the training of the related cleaning and disinfection work and the cleaning process conformed the require-ment of the standards .Among 10 first-grade and below hospitals ,only 1 hospital(10 .00% ) had the rational layout of cleaning and disinfection rooms ;3 hospitals(30 .00% ) had the professional cleaning staff ;the related training of the cleaning staff was not basi-cally carried out and the safeguard was not in place ,most of the cleaning and disinfection instruments and the cleaning process were not in accordance with the requirements .The qualification rates of instruments cleaning and disinfection in different grades of hospi-tals by the ATP bioluminescence assay were 100 .00% ,90 .00% and 80 .00% .Conclusion The existing problems are general and prominent in the hospitals of the first-grade and below .It is suggested that the regionalized disinfection and supply management mode is implemented for maximally realizing the optimized resource configuration in the disinfection and supply center .
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Objective To investigate the service requirements and health and safety problems in home care among senile cerebrovascular disease patients above 65 years old and provide the direction and basis for the home care.Methods 78 cases of elderly patients with cerebrovascular sequela 2 years after discharge were selected as the research objects.One-on-one interviews with patients and their families,the self-made questionnaire were sent out,the patients' service item requirements and the main health and safety problems were reorganized,then the corresponding nursing intervention was implemented.One year later,patients were revisited and investigated again.Results In elderly patients,there were many health and safety issues in home care,their nursing service demand was high.After giving corresponding nursing intervention of health guidance,the incidence of aspiration,fall,falling out of bed,bedsore,sleep disorders,urinary tract infection was effectively reduced.Conclusions The mode of family care should be established on the basis of demand of home care by elderly cerebrovascular disease patients,which conforms to the ac-tual situation of our country,in order to improve patients' self-care ability and life quality.
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Objective Our preliminary study demonstrates that quercetin can inhibit the proliferation of HL-60 cells. This sudy aimed to find some drugs which could have synergistic effects with quercetin on apoptosis of HL-60 cells. Methods HL-60 cells were cultured with bortezomib at different concentrations (1, 2, 4, 8, 16, and 32μmol/L) alone or combined with quercetin at different concentrations for 48 h. HL-60 cells were cultured with lenalidomide at different concentrations (5, 10, 20, 40, 80, 160, and 320 μmol/L) alone or in combination with quercetin at different concentrations for 48 h. The CCK-8 assay was used to determine the effects on proliferation of HL-60 cells. Results Bortezomib significantly inhibited the proliferation of HL-60 cells (P 0.05). The results of cell viability of HL-60 cells treated by lenalidomide at higher concentrations (160 and 320μmol/L) were lower than those of the control group (P<0.05). IC50 of quercetin after cells treated by quercetin combined with bortezomib was not different from that treated by quercetin alone. Isobolographic analysis revealed the two drugs had no synergistic effect. Conclusions Bortezomib can inhibit the proliferation of HL-60 cells and it has a synergistic effect with quercetin on HL-60 cells. Lenalidomide has a weaker role in inhibition of the proliferation of HL-60 cells, and it has no synergistic effect with quercetin on HL-60 cells.
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Objective To investigate the effect of membrane-bound prostaglandin E2 synthase 1 (mPGES-1) inhibitor MK886 on cell cycle of the human acute myeloid leukemia HL-60/A cells.Methods Flow cytometry,Western blot and ELISA were used to measure the difference of cell cycle,expression of cyclin D1, mPGES-1 among HL-60/A cells,MNC and HL-60 cells.The effect of MK886 on cell cycle,cyclin D1,mPGES-1,PGE2,P-Akt and c-myc of HL-60/A cells were observed.Results Compared with MNC and HL-60 cells,the expression of cyclin D1 and mPGES-1 were higher in HL-60/A cells,the percentage of G0-G1 phase was decreased [MNC (62.63±6.58) ％,HL-60 (38.86±2.25) ％,HL-60/A (30.53±2.15) ％]and S phase increased[MNC (12.18±4.43) ％,HL-60 (47.70±1.88）％,HL-60/A (57.56±1.54) ％](all P＜ 0.05).After treated with MK886,cell cycle was arrested in G0-G1 phase.The expression of mPGES-1,cyclin D1,P-Akt and c-myc and synthesis of PGE2 were decreased.Conclusion MK886 can arrest HL-60/A cell cycles in G0-G1 phase,which possibly through down-regulation of mPGES-1/PGE2,reduction cyclin D1,P-Akt and c-myc expression.
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Objectiye To investigate the effect of selective COX-2 inhibitor, nimesulide, on inhibiting proliferation of the human acute myeloid leukemia HL-60 cells. Methods HL-60 cells were treated with different concentration of nimesulide. HL-60 cell proliferation was examined by CCK-8 method. Flow cytometry, Western blotting and ELISA were used to measure the effect of nimesulide on apoptosis, cell cycle,COX-2, PGE2, bax, bcl-2 and c-myc. Results Nimesulide inhibited HL-60 cells proliferation in a dose and time dependence manner. Nimesulide induced cell apoptosis and arrested cell cycle in G0-G1 phase. The expression of COX-2 protein declined after treated with nimesulide 48 h, the total apoptosis in 100, 200,400 μmol/L nimesulide-treated group and control group were (24.97 ± 6.36) %, (34.22 ± 5.76) %, (44.59 ±6.69) % and (4.11 ± 1.26) %, there were significant differences (P ＜ 0.05). Nimesulide inhibited the synthesis of PGE2, the expressions of bcl-2 and c-myc protein and upregulated the expression of bax protein simultaneity.Conclusion Nimesulide significantly inhibited the proliferation of HL-60 cells and induced cell apoptosis,which may be associated with the downregulation of COX-2 expression, reduction of PGE2 synthesis, arrest of cell cycle and regulation bcl-2, c-myc and bax protein expression.
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Objective To detect the expression of VEGF in NHL and analyze the relation of the expression levels with malignant aggressiveness,treatment response,and prognosis.Methods The expression of VEGF in lymph nodes taken from 39 NHL patients Wag measured by immunohistochemical-staining method.9 patients with benign lymphadenopathy were acted as control.Results The expression of VEGF in NHL(79.5%)was higher than that in the contrel(44.4%)(P=0.048＜0.05).In NHL,the VEGF level was higher in aggressive lympboma than that in indolent lymphoma(x2=5.284,P=0.044＜0.05).The patients had the higher-level expression as the Ann Arbor stage Wag higher,and the patients who had the higher-level expression of VEGF had higher serum LDH level,lower chemotherapy remission,unfavorable prognosis and lower 3-year survival (P＜0.05).Conclusion The expression of VEGF in NHL was increased.It was correlated with histopathological grade,Ann Arbor stage,chemotherapy response and prognosis.
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Objective To explore the correlation of atheroselerosis progression and the expression of platelet derived endothelial nitric oxide synthase (eNOS) in rabbits. Methods A total of 24 male New Zealand white rabbits were used in this study. Six of the animals were fed with normal food (control group). Eighteen rabbits were fed with cholesterol-rich food (1 g/d) for 12 weeks to establish the atherosclerosis model. Among 18 models, 6 rabbits were executed immediately and their aorta and platelet samples were collected for further analysis (model group), 6 rabbits were orally administered with pravastatin (10 rag/d) for additional 12 weeks (treated group), and the remaining 6 rabbits were left untreated until the end of the study (untreated group). The control, treated and untreated animals were then killed, and the aorta and platelet samples were collected for eNOS expression analysis (RT-PCR). Results The aorta samples in model and untreated group exhibited rough intima and a lot of longitudinal fatty streaks, which indicated that atherosclerosis models were established successfully. While in treated group, the degree of atherosclerosis was decreased. The average percent of thickness of fatty streaks or atheroselerotic plaques relative to the whole thickness of vessel walls was 0. 04±0. 02, 0. 82±0. 16, 0. 33±0. 18,0. 77±0. 14 in control, model, treated and untreated group, respectively. The thickness of fatty streaks or atherosclerotic plaques was significantly increased in the model and untreated groups and decreased in treated group compared with the control group (both P<0. 05). The expressions of platelet derived eNOS/mRNA were 1. 02± 0. 28, 0. 41± 0. 27, 1.00 ± 0. 77, 0. 40±0. 29 in control, model, treated and untreated group, respectively. The expression of eNOS/mRNA was markedly decreased in model group and untreated group compared with the control group, but was increased in treated group compared with untreated and model groups (F=3. 544, P = 0. 024). Conclusions There is a negative correlation between eNOS expression and atherosclerosis development, which suggests that the reversal effect of pravastatin on atheroselerosis progression and plaque formation may relate to the expression of platelet derived eNOS.
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Objective To investigate the clinical significance of the changes of electrocardiogram (ECG) and cardiac markers for myocardial damage after on-pump coronary artery bypass grafting (CABG) and off-pump coronary artery bypass grafting (OPCABG). Method Monitoring 25 patients of OPCABG (OPCABG group) and 25 patients of CABG (CABG group) R wave amplitude of V4 and V5 on antorior electrocardiographic lead and simultaneously determining cardiac markers for myocardial damage creatine phosphokinase isoenzyme MB (CPK-MB), tropenin I (cTnI) and heat-shock protein 70 (HSPT0) on different lime. Results R wave amplitude of V4 and V5 on anterior electrocardiographic lead had no significant changes on 0, 6, 18 and 24 hours after OPCABG. On the contrary, R wave amplitude of V4 and V5 on anterior electrocardiographic lead decreased significantly on 0, 6 and 18 hours after CABG (P<0.01), and came back to preoperative values 24 hours after operation. The levels of CPK-MB and cTnI reached its peak and higher significantly for CABG than those for OPCABG on 24 hours after operation, 29.29 μg/L vs 5.98 μg/L and 6.74 μg/L vs 1.91 μg/L respectively. HSP70 increased significantly on 6 hours after operation in two groups, but median of HSP70 was higher significantly in CABG group (11044.5 pmol/L vs1702.0 pmol/L). In the first day after operation the HSP70 peak was correlated significantly with the level of CPK-MB(r=0.370, P<0.01) and cTnI (r=0.458,P<0.01). Conclusions Myocardial damage is significantly alleviated for patients of OPCABG comparing with those of CABG. The HSF70 in circulation may indicate the degree of myocardial damage.
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For medical student, diagnostic practice is the first step of clinical study. To penetrate the humanities education in diagnostic teaching,the combination with practice from the following steps as physical examination, laboratory examination and interrogation, would cultivate medical students' humane quality imperceptibly and play an important role in creating noble medical ethics of them.