Application of active learning mode based on mind mapping in the teaching of major disaster rescue and medical service support / 中华医学教育探索杂志

Objective:To explore the effect and value of the active learning mode based on mind mapping in the teaching of medical service support for major disasters.Methods:A total of 90 undergraduate students of 2016 Clinical Medicine of Naval Medical University were randomly selected as research objects, and they were randomly divided into observation group and control group. The 45 students in the control group used the traditional teaching mode, and the 45 students in the observation group used the mind mapping-based active learning mode for major disaster rescue and medical survice. The teaching time of the two groups was 12 h. The theoretical examination of knowledge and practical skills of the two groups of students were compared after teaching, and the students' satisfaction with the application of mind mapping-based teaching model in the teaching of medical service support for major disaster rescue was investigated. EmpowerStats and R softwares were used for t test and Chi-square test. Results:There were 24 males and 21 females in the observation group, with an average age of (21.40±0.69) years old. There were 22 males and 23 females, with an average age of (21.71±0.55) years old. The theoretical performance of the observation group (91.38±4.37) was significantly higher than that of the control group (84.91±3.98) ( P<0.001), and the practical skill performance of the observation group (92.98±3.24) was significantly higher than that of the control group (87.38±3.80) ( P<0.001). At the same time, the students' satisfaction with teaching effect in the observation group was 82.2% (37/45), which was significantly higher than that in the control group (37.8%, 17/45). Conclusion:The active learning mode based on mind mapping focuses on cultivating students' independent learning, interactive exploration and clinical thinking ability, and has a broad application prospect in the teaching of medical service support for major disasters.

Mechanism of Talibin-1 regulating vascular remodeling of aortic dissection in mice / 中华普通外科杂志

Objective:To explore the role and mechanism of Talin-1 in mouse aortic dissection.Methods:Sixty male FVB mice were evenly divided into groups of blank, model, Talin-1 up-regulation, Talin-1 up-regulation control, Talin-1 down-regulation, and Talin-1 down-regulation control. Except mice in the blank group, mice were treated with β-aminopropionitrile (BAPN) combined with angiotensin to construct a mouse aortic dissection model. Hematoxylin-eosin and vascular elastic fiber staining (EVG) were used to observe the aorta and elastic fiber morphology and structure. Western blot was used to detect the phosphorylation levels of FAK and ERK1 / 2 in mouse aortic tissue.Results:The success rate of aortic dissection in model mice was 70%, and there was no aortic dissection appeared in the blank group.No mice died during the experiment. The incidence of aortic dissection in the Talin-1 down-regulated group was 100%, which was significantly higher than that in the Talin-1 down-regulated control group( P<0.05). The incidence of aortic dissection in the Talin-1 up-regulated group was 20%, significantly lower than that in the Talin-1 up-regulated control group. The wall thickness of the aorta of mice in the Talin-1 down-regulated group was accompanied by hematoma or pseudocavity formation. The median elastic fiber content was higher than that in the Talin-1 downregulation control group( P<0.05). The content of elastic fibers in the blood vessel wall of mice in the Talin-1 up-regulation group was significantly higher than that in the Talin-1 up-regulation control group.The down-regulation of Talin-1 significantly inhibited FAK phosphorylation, and instead promoted ERK1/2 phosphorylation( P<0.05). Conclusions:Down-regulation of Talin-1 may reduce the elastic fiber content in the aorta of mice by activating the ERK1/2 signaling pathway, leading to vascular remodeling of the aortic wall and promoting the occurrence of aortic dissection.

Outcomes of surgical treatment for carotid body tumor without preoperative embolization: a single-center retrospective study / 中华普通外科杂志

Objective:To investigate the outcomes of surgical treatment for carotid body tumor(CBT) without preoperative embolization at our institution.Methods:101 patients undergoing surgical treatment for CBT without preoperative embolization from 2011 to 2016 were followed-up for 2 years.Results:Complete resection of the CBT was achieved in all 101 cases(100%). Post-operative adverse events(AEs) mostly observed during hospitalization were as tongue bias(Ⅰ: 4, 36.4%; Ⅱ: 8, 19.5%; Ⅲ: 13, 26.5%), hoarseness(Ⅰ: 1, 9.1%; Ⅱ: 4, 9.8%; Ⅲ: 7, 14.3%), dysphagia (Ⅰ: 0; Ⅱ: 2, 4.9%; Ⅲ: 7, 14.3%) and local hematoma(Ⅰ: 0; Ⅱ: 0; Ⅲ: 1, 2.0%). No other serious AEs were observed. The total incidence of AEs was 5(45.5%) in type Ⅰ patients, 14(34.1%) in type Ⅱ, and 28(57.1%) in type Ⅲ. At the end of 2 years of follow-up, there was no AEs in type Ⅰ patients. The number of patients with adverse events in type Ⅲ was greater than that in type Ⅱ ( P>0.05). Three most frequently injured cranial nerves were hypoglossal nerve(21.9%), vagus nerve(20.3%), and recurrent laryngeal nerve(18.8%). Conclusion:Surgical management without preoperative embolization for CBT patients does not increase the risk of complications nor is it related to prognosis.

Progress on clinical application of orthodontic-implant combined therapy / 浙江大学学报·医学版

For complex implant cases, simple implantation could not achieve the desired therapeutic effect, and a multidisciplinary approach has become a general trend. Orthodontic treatment before implantation creates favorable conditions for subsequent implantation by increasing restoring three-dimensional space, improving occlusion of patients. It also stimulates the increase of autologous soft and hard tissue while biological potential of periodontal ligament is fully developed. The choice of operation time is vital to keep the level of soft and hard tissue at the implantation site, which improves the curative effect of implantation in terms of function and aesthetics. In this article, the orthodontic-implant combined therapy is briefly reviewed focusing on the three-dimensional space optimization, implant site enhancement by orthodontic extrusion and delayed orthodontic space opening.

Correlation between maximum thickness of carotid plaque and postoperative complications of CAS in patients with severe carotid stenosis / 中华普通外科杂志

Objective To investigate the relationship between the maximum thickness of carotid atherosclerotic plaque and the incidence of complications after carotid stenting in patients with severe carotid stenosis.Methods The clinical data of 85 patients with severe carotid stenosis undergoing CAS were analyzed.The maximum thickness of carotid plaque was evaluated according to ultrasound imaging data.Patients were divided into two groups according to the optimal threshold value:0.435 mm,which calculated in the ROC curve of plaque thickness.The incidence of complications within two years after CAS was analyzed.Results 85 patients were followed up for 2 years:restenosis occurred in 12 cases,the incidence rate was 14.1％,which was significantly correlated with the maximum thickness of atherosclerotic plaque(P =0.002).Postoperative restenosis occurred in 2 cases (3.70％) in group A and 10 cases (32.26％) in group B(P ＜ 0.001);Three cases (9.68％) suffered from relapsing cerebral infarction in group B compared to none in group A (P =0.020).Conclusion With the carotid plaque growing thicker,the incidence of restenosis after CAS in patients with carotid stenosis increases.Especially in patients whose maximum plaque thickness is more than 0.435 mm,the incidence of restenosis postoperative increases remarkably.

Dexmedetomidine hydrochloride up-regulates expression of hypoxia inducible factor-1α to alleviate renal ischemiareperfusion injury in diabetic rats / 南方医科大学学报

OBJECTIVE@#To verify whether dexmedetomidine hydrochloride (Dex) alleviates renal ischemia-reperfusion (IR) injury in diabetic rats by increasing the expression of hypoxia inducible factor-1 (HIF-1).@*METHODS@#A rat model of type 2 diabetes mellitus was established by high-fat diet and streptozotocin injection. The rats were subjected to daily intragastric administration of 0.05 mg/kg digoxin for 7 consecutive days and intraperitoneal injection of Dex 2 h before renal IR injury induced by ligation of the bilateral renal arteries for 60 min followed by reperfusion for 120 min. After reperfusion, blood samples were taken for detection of serum creatinine (Scr) and urea nitrogen (BUN) levels. Western blotting was used to detect the expression of HIF-1, cleaved caspase-3, Bcl-2, and Bax in the renal tissues; the expression of the HIF-1, p-eNOS, and eNOS were detected using ELISA. The percentage of apoptotic glomerular cells was assessed using TUNEL assay.@*RESULTS@#The levels of Scr, BUN, HIF-1, p-eNOS, and eNOS and the percentage of apoptotic cells in both normal and diabetic rats increased significantly after renal IR injury ( < 0.05). The expressions of Scr, BUN, p-eNOS, and eNOS decreased while HIF-1 expression increased significantly in Dex-treated rats with renal IR injury ( < 0.05). Compared with the non-diabetic rats, the diabetic rats showed more obvious increase in the expressions of Scr, BUN, p-eNOS, and eNOS following renal IR injury. In the diabetic rats with renal IR injury, Dex treatment prior to the injury significantly lowered the expressions of Scr, BUN, p-eNOS, eNOS, cleaved caspase-3, and Bax, decreased the percentage of apoptotic cells, and increased the levels of HIF-1a and Bcl-2 ( < 0.05). Digoxin treatment significantly antagonized the effects of Dex in the diabetic rats with renal IR injury by increasing the expressions of cleaved caspase-3 and Bax, promoting glomerular cell apoptosis, and decreasing renal expressions of HIF-1 and Bcl-2 ( < 0.05).@*CONCLUSIONS@#Dex alleviates renal IR injury in diabetic rats probably by inhibiting renal expression of HIF-1 and glomerular cell apoptosis.

Correlation between maximum thickness of carotid plaque and postoperative complications of CAS in patients with severe carotid stenosis / 中华普通外科杂志

Objective@#To investigate the relationship between the maximum thickness of carotid atherosclerotic plaque and the incidence of complications after carotid stenting in patients with severe carotid stenosis.@*Methods@#The clinical data of 85 patients with severe carotid stenosis undergoing CAS were analyzed. The maximum thickness of carotid plaque was evaluated according to ultrasound imaging data.Patients were divided into two groups according to the optimal threshold value: 0.435 mm, which calculated in the ROC curve of plaque thickness. The incidence of complications within two years after CAS was analyzed.@*Results@#85 patients were followed up for 2 years: restenosis occurred in 12 cases, the incidence rate was 14.1%, which was significantly correlated with the maximum thickness of atherosclerotic plaque(P=0.002). Postoperative restenosis occurred in 2 cases (3.70%) in group A and 10 cases (32.26%) in group B(P<0.001); Three cases (9.68%) suffered from relapsing cerebral infarction in group B compared to none in group A(P=0.020).@*Conclusion@#With the carotid plaque growing thicker, the incidence of restenosis after CAS in patients with carotid stenosis increases. Especially in patients whose maximum plaque thickness is more than 0.435 mm, the incidence of restenosis postoperative increases remarkably.

Preparation, transfer property and biocompatibility of the hollow fiber dialysis membrane / 中国组织工程研究

BACKGROUND:Polysulfone membrane holds good anti-biodegradation ability, but how to use it to prepare hol ow fiber dialysis membrane and its blood compatibility have not been ful y understood. OBJECTIVE:To study the preparation, transfer property and biocompatibility of hol ow fiber dialysis membrane. METHODS:With polysulfone as the film material, diethylene glycol as the porogen, polyvinyl pyrrolidone as the modifier, N, N-dimethylacetamide as the solvent, and the hol ow fiber dialysis membrane was prepared using nonsolvent-induced phase separation. The performance was measured using scanning electron microscopy, ultra-depth three-dimensional microscope imaging and porosity test;the transfer parameters including reject rate and water flux were detected by ultrafiltration device;the blood compatibility was determined through hemolysis test, dynamic clotting time test and platelet adhesion test. Type II medical polyurethane material served as negative control. RESULTS AND CONCLUSION:The section of hol ow fiber dialysis membrane was asymmetric. 17%dialysis membrane showed a porous middle layer, while 19%, 21%and 23%membrane showed a sponge-like middle layer. Under the same membrane area, the density of fiber dialysis membrane was significantly lower than that of the negative control material, and the porosity of fiber dialysis membrane was significantly higher than that of the negative control material (P<0.05). The water volume and water flux of the hol ow fiber dialysis membrane were significantly higher than those of the negative control material (P<0.05). Results from three hemolytic tests showed that the average absorbance values and hemolysis rate of the hol ow fiber dialysis membrane were significantly higher than those of the negative control material (P<0.05). The dynamic clotting time test and the platelet adhesion test revealed that the dynamic clotting time of hol ow fiber dialysis membrane at 20, 40 and 70 minutes was significantly shorter than that of the negative control material (P<0.05). These results suggest that polysiloxane can be used as the membrane material to prepare hol ow fiber dialysis membrane using nonsolvent-induced phase separation, and holds a good biocompatibility, blood compatibility and transfer efficiency.

A research of the application of evidence-based nursing in the patients with cerebrospinal fluid leakage after vertebrae surgery / 中国实用护理杂志

Objective To investigate the application of evidence-based nursing in the patients with cerebrospinal fluid leakage (CSFL) after vertebrae surgery.Methods 60 cases of patients were randomly divided into the observation group and the control group (30 cases in each),the control group was given conventional nursing,the observation group used evidence-based nursing,which was established by referring to some data and literatures according to a series of related nursing problems,getting direct and indirect evidence,and through analysis and summarizing to set up the nursing project for implementation.The incidence of intracranial hypotension headache,hyponatremia,wound healing disorders,infection of intervertebral space were compared.Results In the observation group,incidence of postoperative intracranial hypotension symptoms,postoperative hyponatremia,the incidence of wound healing disorders was statistically different from that of the control group.The incidence of infection in two groups showed no significant difference.Conclusions Using evidence-based nursing can reduce a series of complications in patients with CSFL after cervical surgery,control infection effectively,improve patients' comfort and improve the quality of nursing.

Decreased number and impaired function of endothelial progenitor cells in gld.apoE-/-C57BL/6 mice / 中华风湿病学杂志

Objective To detect the changes of number and function of endothelial progenitor cells (EPCs) in gld.apoE-/-C57BL/6 mice,and to investigate whether premature atherosclerosis of gld.apoE-/-C57BL/6 mice was mediated by the dysfunction of these EPCs.Methods EPCs were isolated from peripheral blood and bone marrow of four types of C57BL/6 female mice:gld+/+apoE+/+,gld,apoE-/-and gld.apoE-/-.The percentage of EPCs was analyzed by FACS as CD11b-Sca-1+CD309+ cells.The attached cells were stained with DiI labeled acetylated low-density lipoprotein (DiI-ac-LDL) and FITC-labeled Ulex Europaeus agglutinin 1 (FITC-UEA-1) double staining to determine their phagocytic function.The adherent function of EPCs was determined by calculating the number of re-cultured EPCs.The capacity of EPCs to form the cavity structure was detected by calculating the number of the formed vascular-like structure.Results The percentage of circulating EPCs was significantly decreased in the gld.apoE-/-group (0.012±0.002)％ compared to the gld+/+ apoE+/+ group [(0.039±0.005)％,P＜0.01],the gld group [(0.025±0.001)％,P＜0.05],and the apoE-/-group [(0.028±0.002)％,P＜0.01].The percentage of bone marrow derived EPCs was decreased in the gld.apoE-/-group (0.12±0.01)％ compared to the gld+/+apoE+/+ group [(0.42±0.05)％,P＜0.05].The percentage of DiI-acLDL and FITC-UEA-1 double positive cells was decreased in the gld.apoE-/-group [(59.2±2.1)％] compared to the gld+/+apoE+/+ group [(87.5±3.0)％,P＜0.01],and the gld group [(84.2±6.0)％,P＜0.01] ; the adherent function of EPCs was impaired in the gld.apoE-/-group [(50.0±5.3)％] compared to the gld+/+ apoE+/+ group [(86.0±7.3)％,P＜0.01],the gld group [(73.0±1.0)％,P＜0.01],and the apoE-/-group [(65.0±4.0)％,P＜0.05] respectively.The capacity of EPCs to form the cavity structure was decreased in the gld.apoE-/-group (4.0±0.3) compared to the gld+/+apoE+/+ group (12.0±1.4,P＜0.01).Conclusion The number of EPCs is decreased in the gld apoE-/-C57BL/6 mice,the adhesion,phagocytosis and angiogenic function of EPCs in the bone marrow are impaired,which may be one of the causes of lupus with atherosclerosis.

Value of Dezocine combining Fentanyl used for postoperative PCIA in breast cancer patients / 国际外科学杂志

Objective To investigate the significance of Dezocine combining Fentanyl used for postoperative PCIA in breast cancer patients.Methods One hundred and twenty six patients with ASA Ⅰ-Ⅲ entered the study.All patients were scheduled for breast cancer operation under intravenous analgesia with tube insertion and treated with PCIA after the operation.They were randomly divided into Fentanyl group (n =63) and Dezocine combining Fentanyl group(n =63).VAS,Ramsay,BCS in two groups were compared al 12 h,24 h,48 h after operation.Side effect was also detected.The changes of T cell subset and IL-2 were analyzed in the patients respectively at the first day before operation,at the first day after operation,at the seventh day after operation.Results At every time point,VAS in research group was significantly lower than that in control group(P ＜ 0.05).However,Ramsay in research group was obviously higher than that in control group(P ＜0,05).There were no significant differences in BCS between two groups (P ＞ 0.05).And no difference was found in the incidence of side effect between two groups (P ＞ 0.05).Compared with control group,the changes of T cell subset,IL-2 had no significant differences in research group at the first day after operation and at the first day before operation (P ＞ 0.05).At the seventh day after operation,the levels of CD4 +,CD4 +/CD8 +,IL-2 in research group were obviously higher than those in control group (P ＜ 0.05).However,the percentage of CD8 + T cells in research group was significantly lower than that in control group (P ＜ 0.05).Conclusions Dezocine combining Fentanyl in PCIA can increase analgesia effect with less side effect.It is positive to improve immunologic function for breast carcinoma patients after operation.

Treatment and prevention of central venous catheter-related bloodstream infections / 国际外科学杂志

Objective Focusing on the diagnosis, treatment and prevention of central venous catheter (CVC)-related bloodstream infections(CRBSI) in clinical practice, to provide clinical evidences for reducing the incidence of central venous catheter-related bloodstream infections Methods The related articles within the latest 5 years were reviewed, and the related monitoring data of the hospital were analyzed. Results ( 1 )The pathogens of CRBSI invaded bloodstream through the puncture point/hub, and the pathogens of the secondary CRBSI came from the infections in other sites, invading bloodstream and adhering the catheter tip. (2)Highlights on the diagnosis of CRBSI: For the patients with CVC, the possibility of the CRBSI should be considered when severe fever not due to non-infectious causes occurred. Infection occurring time and pathogen are different between the general catheters and the anti-infective catheters. The effect of antiinfection of the anti-infective catheters are limited. To pull out the catheters is the most effective treatment measures. Routine puncture point culture should be rejected. ( 3 ) Prevention of CRBSI: The indications of CVC intubation should be undisputed. Silicone catheter should be used. The catheter should not be indwelled more than 5 days. Conclusions Invasive operation, the lasting time of catheterization and using a lot of antibiotics are the susceptible factors for CRBSI. Hospital should establish suite intervention methods and operation procedures,strengthen education of the medical staff and proceed with targeted monitor for decreasing the rate of infectious.

Prognostic indicators for systemic lupus erythematosus analyzed by Cox proportional hazards model / 中华风湿病学杂志

Objective To analyze the prognostic factors and causes of death of patients with systemic lupus erythematosus (SLE).Methods A database with 319 patients were developed.They were newly diagnosed SLE in the Department of Rheumatology and Immunology,Affiliated Drum Tower Hospital of Nanjing University Medical School from 1999 to 2009.Normal distribution of measurement data was presented using mean±standard deviation.The skewed distribution of data was described by median(interquartile range).Using the rate or proportions,the character of classification data was also stated.Survival rate of SLE patients over time was studied by the Kaplan-Meier method,and prognostic factors were analyzed by COX proportional hazards model.Results The 5 year and 10-year survival rates was 96.2%, 88.7%, respectively Prognostic factors affecting survival included duration from onset to diagnosis, anemia, white blood cells in urine, low serum albumin,low C4 level,abnormal ECG and ultrasound echocardiography, pulmonary arterial hypertension (PAH) and systemic lupus erythematosus disease activity index (SLEDAI). However, PAH,duration from onset to diagnosis, low serum albumin were the independent poor prognostic factors and the relative risk and 95% confidence interval were 2.419 (1.052-5.564), 1.162 (1.043-1.294), 0.924 (0.873-0.978), respectively. Renal failure, pulmonary hypertension and infection were the main causes of death,followed by multiple organ failure and lupus encephalopathy. Conclusion PAH, duration from onset to diagnosis, low serum albumin are the important factors predicting poor prognosis. Early diagnosis, timely treatment of SLE organ damages and preventing complications are the key factors to improve the prognosis of patients with SLE.

Biotransformation of daidzein by resting cell system of bacterial strain isolated from bovine rumen gastric juice / 生物工程学报

In previous study we isolated a gram-positive bacterial strain, designated Niu-O16, from bovine rumen gastric juice. The growing cells of bacterial strain Niu-O16 is capable of biotransforming isoflavone daidzein into dihydrodaidzein efficiently under anaerobic conditions. In this study we investigated the optimal bioconversion conditions for the resting cells of bacterial strain Niu-O16 to convert daidzein into dihydrodaidzein. Single factor test showed that the optimal conditions for the initial pH of phosphate buffer, the concentration of the resting cell and the concentration of the substrate daidzein were 6.0-8.0, 32-64 mg/mL (wet weight) and 0.8-1.2 mmol/L, respectively. Orthogonal experiments were used to determine the optimal combination of the resting cell concentration, substrate concentration and biotransformation time. The results showed that the optimal combination included resting cell concentration 32 mg/mL, substrate concentration 0.8 mmol/L and the biotransformation time 24 h. Furthermore, the biotransformation kinetics under optimal conditions were studied, under which conditions the highest bioconversion rate was 63.9% in the resting cell system. The results might provide information for resting cell biotransforming of anaerobes as well as its industrial application.