Practical research of diversified laboratory open training to improve clinical skills of medical students / 中华医学教育探索杂志

Objective:To improve the clinical skills of medical students, and explore the implementation plan and effect of diversified laboratory open training.Methods:A total of 808 undergraduate students of clinical medicine in Batch 2015 were selected for diversified laboratory open training in the 5th, 6th and 7th semesters. Multiple reservation methods were adopted including: personal independent network reservation, written reservation, "registered" network reservation; diversified open model: students practice independently, "workshop" special operation training, team make-up lessons; diversified practice modules: basic skills, specialist skills, and comprehensive skills. The results of the questionnaire survey on the two stages of students' diversified laboratory open training and the end of the internship were analyzed; and the Batch 2015 and Batch 2014 graduation skills test scores were compared. SPSS 20.0 software was used for t-test. Results:After the opening of the diversified laboratory: 92.61% (664/717) of the students were satisfied with the open model; 93.58% (671/717) of the students were satisfied with the reservation method; 94.42% (677/717) of the students thought that it could promote learning motivation; 97.35% (698/717) of the students thought that it could stimulate learning interest; 96.51% (692/717) of the students thought that it could help knowledge and skills grasp. After the internship and the return to the school, the questionnaire showed that 98.02% (741/756) of the students thought it could improve clinical skills; 92.33% (698/756) of the students thought it could cultivate clinical thinking; 95.63% (723/756) of the students thought it could enhance self-confidence in the internship; 94.18% (712/756) of the students thought it could increase a sense of professional belonging. The students' graduation skills (90.33±5.59) and single skill exam scores of Batch 2015 were better than Batch 2014 (82.22±7.19), with a statistically significant difference ( P<0.001). Conclusion:The opening of diversified laboratory could stimulate the interest and motivation of learning, help to improve clinical skills and clinical thinking, and enhance confidence in internship and sense of professional belonging.

Application of "post competence"-oriented mixed teaching in teaching of pediatric clinical skills / 中华医学教育探索杂志

Objective:To explore the application effect of the of multiple teaching methods in the teaching of pediatric clinical skills under the guidance of "post competence".Methods:Thirty students of Pediatrics grade 2016 were selected as the experimental group in Hubei Medical University, and they were taught through multiple teaching methods, including PBL, CBL, simulation teaching, virtual simulation teaching, and TBL. Thirty-one students of Pediatrics grade 2015 were collected as the control group, who were taught with traditional teaching mode. The scores of pediatric skills examination and questionnaire survey during school and clinical internship were compared between the two groups. SPSS 20.0 was used to perform the t test and chi-square test.Results:The experimental group scores were higher than those of the control group during school ( P<0.05). The questionnaire survey showed that the experimental group was superior to the control group in terms of satisfaction with teaching results, mastery of skill operations, improvement of learning interest and self-learning ability ( P<0.05). Examination scores of after-department skills in the experimental group was higher than that in the control group in pediatric clinical practice stage ( P<0.05), and the clinical teachers' evaluation of clinical thinking, doctor-patient communication, teamwork, professional quality, and work adaptability of the experimental group were higher than those of the control group ( P<0.05). Conclusion:"Post competence" orientated multiple teaching methods were applied to the teaching of pediatric clinical skills, which can stimulate medical students' interest in learning, improve their self-learning ability, contribute to their mastery of pediatric clinical skills and the improvement of post competence, and it can be promoted and applied in the teaching of pediatric clinical skills.

Prevention and treatment of perioperative pulmonary hypertensive crisis in patients with serious pulmonary arterial hypertension relevant with ventricular septal defect / 中国实用护理杂志

Objective To discuss key points of prevention and treatment of perioperative pulmonary hypertensive crisis in patients with serious pulmonary arterial hypertension associated with ventricular septal defect. Methods Retrospectively analyzed the nursing experience of perioperative pulmonary hypertensive crisis on 31 patients with serious pulmonary arterial hypertension associated with ventricular septal defect from March to December during 2016.Among these patients,7 patients occurred pulmonary hypertensive crisis.The prevention contained avoiding oxygen lack,keeping pH alkaloid in the body, application of pulmonary vasodilator, deep sedation. Results A total of 30 cases survived the perioperative period, and were discharged from the hospital, one died. Conclusions The patients with serious pulmonary arterial hypertension had more risks during the perioperative period,the main cause of death was pulmonary hypertensive crisis during this time.So prevention of pulmonary hypertension crisis is the key point of postoperative nursing.

Evaluation of left ventricular systolic synchrony in patients with dilated cardiomyopathy by tissuemotion mitral annular displacement / 中华医学超声杂志（电子版）

Objective To investigate the value of tissue motion mitral annular displacement (TMAD) in assessment of left ventricular systolic synchrony in patients with dilated cardiomyopathy (DCM).Methods Thirty-eight DCM patients and 30 healthy subjects were enrolled in this study.The left ventricular end diastolic volume (LVEDV),left ventricular end systolic volume (LVESV),and left ventricular ejection fraction (LVEF) in two groups were investigated using conventional echocardiographyexamination.The time of systolic mitral annular peak displacement (TP) in two groups were measured by the technique of TMAD at six sites (anteroseptal,posteroseptal,anterior,lateral,posterior and inferior).The standard deviation of TP (TP-SD) and the maximal difference of TP (TP-DIF) were calculated.And the correlation between TP-SD and LVEF as well as TP-DIF and LVEF in the DCM group were analyzed.The standard deviation and maximal difference of the time to point with minimal systolic volume of 16 segments (Tmsv16-SD,Tmsv16-DIF) of the DCM group were measured by the technique of real-time three-dimensional echocardiography (RT-3D).And the correlation between Tmsv-16SD and TP-SD as well as Tmsv16-DIF and TP-DIF were analyzed.Results Compared with the healthy subjects,LVESV and LVEDV increased (t=14.023,16.643,P ＜ 0.01) and the LVEF decreased significantly (t=26.112,P ＜ 0.01) in the DCM group.TP,TP-SD and TP-DIF in the DCM group obviously increased (t=7.628,6.869,7.507,6.616,5.631,4.738,7.368,5.777,6.781,P ＜ 0.01).TP-SD and TP-DIF were negatively correlated with LVEF (r=-0.645,-0.513,P ＜ 0.05),while TP-SD and Tmsv1 6-SD,TP-Dif and Tmsv1 6-Dif were positively correlated(r=0.643,P ＜ 0.01;r=0.563,P ＜ 0.05).Conclusions In this study,the TMAD technique was used to measure the time of peak displacement of mitral annulus to evaluate the synchrony of left ventricle movement.It is expected to be a new method in evaluation of the synchrony of left ventricle,which is simple,feasible approach without angle dependence.

The long term effectiveness of tonsillotomy vs.tonsillectomy by hypercator in treatment of obstructive sleep apnea hypopnea syndrome in children / 实用医学杂志

Objective To compare the long term effectiveness of tonsillotomy(TT)vs. tonsillectomy (TE)by hypercator in treatment of obstructive sleep apnea hypopnea syndrome(OSAHS)in children. Methods 119 children with tonsil hypertrophy were diagnosed with OSAHS and included in the study. Among them,57 children underwent TT by hypercator and 62 TE only after preoperative laboratory polysomnography(PSG). All participants were interviewed 5 years after operation to assess the satisfaction of their caregivers,investigate the frequency of respiratory infections,the rate of tonsil regrowth and evaluate their quality of life by Obstructive Sleep Apnea-18(OSA-18). Results Some of them received postoperative PSG. All parents reported alleviation of breathing obstruction,but the postoperative satisfaction in TT group was higher than TE group mainly because of the shorter time return to normal diet. The rate of the respiratory tract infections was not increased in all cases after surgery. Four cases of children were observed with tonsillar regrowth,but no surgery was needed for further treatment. The rate of the dry throat symptoms in TT group was lower than TE group. Conclusions Tonsillotomy by hypercator can effectively eliminate the obstruction symptoms in children with OSAHS,superior to TE for its shorter recovery period and smaller oral mucosal injury and lower rate of tonsils regrowth and it is worth to clinical promotion.

Effect of Arm Spasticity Inhibitor on Upper Extremities Spasticity with Shoulder Subluxation after Stroke / 中国康复理论与实践

@#Objective To observe the effect of Arm Spasticity Inhibitor worn in rehabilitation training on patients with upper extremities spasticity and shoulder subluxation after stroke. Methods 80 stroke patients with flexor spasm in upper extremities complicated with subluxation of shoulder were divided into treatment group and control group equally. Both groups accepted routine medicine and rehabilitation, and the treatment group wore the Arm Spasticity Inhibitor developed ourselves during the rehabilitation training. Their acromio-humeral interval (AHI) was measured with the X- ray; and they were assessed with modified Ashworth Scale (MAS), range of motion of shoulder (ROM) and elbow before and 2 months after treatment. Results It improved more in the AHI, score of MAS and ROM in the treatment group than in the control group after treatment (P<0.001). Conclusion Wearing Arm Spasticity Inhibitor during rehabilitation training may release the spasticity of upper extremities and shoulder subluxation, and improve shoulder function in patients after stroke.

Effect of Arm Spasticity Inhibitor on Upper Extremities Spasticity with Shoulder Subluxation after Stroke / 中国康复理论与实践

Objective To observe the effect of Arm Spasticity Inhibitor worn in rehabilitation training on patients with upper extremities spasticity and shoulder subluxation after stroke. Methods 80 stroke patients with flexor spasm in upper extremities complicated with sublux-ation of shoulder were divided into treatment group and control group equally. Both groups accepted routine medicine and rehabilitation, and the treatment group wore the Arm Spasticity Inhibitor developed ourselves during the rehabilitation training. Their acromio-humeral in-terval (AHI) was measured with the X-ray; and they were assessed with modified Ashworth Scale (MAS), range of motion of shoulder (ROM) and elbow before and 2 months after treatment. Results It improved more in the AHI, score of MAS and ROM in the treatment group than in the control group after treatment (P<0.001). Conclusion Wearing Arm Spasticity Inhibitor during rehabilitation training may release the spasticity of upper extremities and shoulder subluxation, and improve shoulder function in patients after stroke.

Genetic structure and diversity of T cell receptor alpha chain genes in Hezuo minipig / 中国实验动物学报

Objective To analyze the complexity of molecular structure in porcine T cell receptor gene and its similarity compared to humans.Method Based on the gene of porcine T cell receptor alpha chain ( TCRα) from the Gen-Bank database, 93 swine T cell receptor alpha chain genes ( STA) were cloned by reverse transcription-polymerase chain reaction (RT-PCR) from porcine peripheral blood lymphocytes, lymph nodes and spleen.Result Sequence analysis showed that STA genes all contain a domain of variable signal peptide and V, hypervariable J and conservative C.Howev-er, nucleotide sequence of STA was not completely identical with only 68.4%to 98.7%homology among genes, and had extremely sophisticated polymorphism and diversity.This was accord with the genetic structure of TCRαchain.Molecular structure, genetic evolution and classification of these genes were carried out according to the homology of TCRαgene, which all have several sites and zones of mutation on the domain of signal peptide, FR1 and CDR1, FR2 and CDR2, FR3 and CDR3.Analysis of similarity and classification of TCRαV domain(STAV)and J domain (STAJ) of Hezuo minipig u-sing IMGT/V-QUEST tools compared with those of humans found the genetic evolution relationship that was closer, and each of TRAV and TRAJ also found to have a corresponding fragment of humans, ever in 92% of similarity of TRAV be-tween swine and humans.Conclusion Our results indicate that inbred Hezuo minipig possesses genetic diversity against complicated environment of microbes in healthy status, and Hezuo minipig is suitable as an animal model for research on human immunology and diseases.

Isolating culture of human bone marrow-derived mesenchymal stem cells and the differentiation into blood vessel endothelial-like cells in vitro / 中国免疫学杂志

Objective:To study of isolating culture and differentiation of human bone marrow-derived mesenchymal stem eeUs into blood vessel endothelial-like cells in a specialized micro-environment in vitro,SO as to provide an experimental foundation for psoriasis.Methods:The hMSCs were isolated by density gradient centrifugation,amplificated and identificated in vitro.Vascular endothelial growth factor (VEGF)and basic fibroblast growth factor(bFGF)within endothelial cell growth medium(DMEM)were used to induce hMSCs differentiation into vascular endothelial-like cells.The induced hMSCs were detected by flow cytometry to find whether they had endothelial cell phenotypes.The Dil-ac-LDL ingestion assay Was used to apprmses the blood vessel endothelial-like cell function.Results:In cell morphology,the induced hMSCs transformed into endothelial-like cells.These cells expressed specific surface markers of,Vascular endothelial-like cells such as CD34,CDl06,HLA-DR,CD54,VWF,CD31,KDR and CD5 comparing to those in the control group(P＜0.01).The induced endothelial-like eeHs had the ability of ingesting Dil-ac-LDL.Conclusion:Combination of Density gradient eentrifugation and adherent methods can obtain pure MSCs.hMSCs Can obtain endothelial cell phenotypes after induced by VEGF and bFGF in vitro.Human hnSCs have potential to differemiate into vascular endothelial-like cells.The induced endothelial-like cells have completely mature endothelial cell functional properties.

Effects of prolonged oxygen exposure at different concentrations on expressions of vascular endothelial growth factor and its receptors mRNA in pulmonary tissues of neonatal rat / 中华围产医学杂志

Objective To study the effects of prolonged oxygen exposure at different concentrations on expressions of vascular endothelial growth factor (VEGF) and its receptors (VEGF receptor-1 ,VEGFR1 and VEGF receptor-2, VEGFR2)mRNA in lungs of neonatal rat. Methods Thirty-two SD rat pups were randomly divided into control and experimental group. Rats in the experimental group were further divided into three subgroups: 30% O2, 50% O2 and 75% O2 group. Each group had 8 rats. The rats were ,sacrificed at postnatal day 21 and their right lower lobes were collected. Expressions of VEGF, VEGFR1 and VEGFR2 mRNA were detected by RT-PCR. Results There was no effect on VEGF, VEGFR1 or VEGFR2 mRNA expression in 30% O2 group. The expressions of VEGF mRNA in the 75% O2 group was 0. 48 times of the control (P<0. 05). The expressions of VEGFR1 mRNA(P<0.01) and VEGFR2 mRNA (P<0.01) in 50% O2 and 75% O2 group were lower than those of control. Condusions Prolonged exposure to moderate or high oxygen concentration may reduce the expression of VEGF and its receptors' mRNA in the lung tissues of neonatal rats.

Drug Resistance of Pathogens Isolated from Urinary Tract / 中华医院感染学杂志

OBJECTIVE To approach the distribution characteristic and drug resistance status in pathogens from infected urinary tract in Jingshan County and offer the scientific evidence for clinically reasonable use of antibiotics.METHODS Totally 218 strains of pathogens isolated from urinary tract were identified by routine methods according to the National Clinical Laboratory Operation Rules.Drug susceptibility testing was performed by K-B methods recommended by CLSI.RESULTS Among 218 strains of pathogens from infected urinary tract,Escherichia coli accounted for 61.0%,ranking the first and enterococci ranked the second,accounted for 11.5%.Except for 100% sensitivity to vancomycin and teicoplanin in Gram-positive bacteria and to imipenem and meropenem in Gram-negative bacteria,the pathogens from infected urinary tract had been resistant to commonly used antibiotics in some degrees.The detection rate of extended-spectrum beta-lactamases(ESBLs) producers was 32.9%.CONCLUSIONS The drug resistance in pathogens from infected urinary tract is on the rise.We should strengthen monitoring and controlling of it.

Correlation between symptomatic, radiological and etiological classification in acute ischemic stroke / 临床神经病学杂志

Objective To study the correlation between symptomatic, radiological and etiological classification in acute ischemic stroke. Methods One hundred and twenty five patients with ischemic stroke within 48 hour of onset were prospectively studied with three step diagnosis: (1) symptomatic classification based on the Oxfordshire Community Stroke Project criteria (OCSP), (2) radiological classification(CT or MRI) and (3) etiological classification based on the Lausanne Stroke Registry criteria.Results Most of the patients with symptoms of total anterior circulation infarcts (TACI), partial anterior circulation infarcts (PACI) and posterior circulation infarcts (POCI) according to OCSP classification had corresponding lesions on CT or MRI, while only 67.3% of lacunar infarcts (LACI) patients had small subcortical infarction (SSI). More than 60% of patients with TACI were classified into cardioembolism (CE) in the third diagnosis, while the etiology of PACI was either CE or large artery atherosclerosis (LAA) in equal numbers. Only 57.7% of LACI patients were classified into small artery disease (SAD) and 28.8% of them into LAA, of which 80% patients had lesions other than SSI. The positive predictive value of SAD in the combination of LACI and SSI was 0.78. The etiology of POCI was variable.Conclusion Except for LACI, the symptomatic classification by OCSP corresponds well to the radiological classification. The etiological classification can be predicted in TACI and PACI, but it is hard to make in POCI, a number of LACI are due to LAA.