Practice of online clinical clerkship teaching mode based on "3P" model / 中华医学教育探索杂志

In order to construct the online teaching mode of clinical clerkship course and improve the online clerkship teaching system of clinical medicine in China, based on the "3P" model, a complete set of online clinical clerkship mode has been constructed from three links of teaching, pre-class preparation, classroom teaching and after-class evaluation, and applied to clinical teaching practice of Internal Medicine. The practice suggests that students are highly satisfied and the teaching effect is good, which provides a new idea for the reform of online clerkship teaching of clinical medicine.

Practice of online clinical clerkship teaching mode based on "3P" model / 中华医学教育探索杂志

Objective:To construct the online teaching model of clinical clerkship teaching and improve the online teaching system of clinical medicine in China.Methods:Based on "3P" teaching model, a complete online clinical clerkship teaching model was constructed from three links: pre-class preparation, classroom teaching and after class evaluation. It was applied to practical teaching in 101 students in 2017 batch of clinical medicine "5+3" class, 2017 batch of five-year pediatrics class and 2017 batch of basic medicine class. After practice, all students were surveyed and the results were analyzed.Results:Through the analysis of questionnaire, 89.5% of the students were satisfied with the online course design, 81.61% of the students thought that the online design was scientific and reasonable, 86.6% of the students thought that the clerkship teaching process was attractive and could stimulate students' interest in learning, and 90.72% of the students thought that the goal of clerkship teaching was clear and the key problems and difficulties were clear.Conclusion:The online teaching mode of clinical clerkship has high student satisfaction and good teaching effect, which provides a new way for online clerkship model.

Application of PDCA cycle combined with project management method in the assessment and management of special skills training in clinical skills center / 中华医学教育探索杂志

Objective:To explore the application of PDCA cycle combined with project management method in the assessment and management of special skills training in clinical skills center.Methods:From January to December in 2018, the PDCA cycle combined with project management method was used to manage the special skills training project team. The utilization rate of special skills simulation equipment before and after management was compared. A questionnaire survey was conducted to investigate the satisfaction with the management model among the students involved in the special skills training in 2018.The data was analyzed by SPSS 13.0.Results:The utilization rate of special skills simulation equipment was significantly improved, and the students were highly satisfied with the management model.Conclusion:Using PDCA cycle combined with project management method, this paper explores a management model of special skills training and assessment in clinical skills center, which improves the quality of special skills training and assessment management in clinical skills center, and is worthy of further exploration and practice.

Role and mechanism of vitamin D in sepsis / 中华危重病急救医学

Sepsis is a life-threatening organ dysfunction caused by the host's imbalance in response to infection, which is still the leading cause of death in critically ill patients. In recent years, studies have found that vitamin D deficiency or insufficiency is common in critically ill patients, especially sepsis. The relationship between vitamin D and sepsis has attracted more and more attention. The mechanism of vitamin D in sepsis is described from the aspects of immune regulation, inflammation regulation, endothelial cell protection, carbon monoxide regulation, and receptor gene polymorphism, by analyzing the related literatures of vitamin D and sepsis in recent years in order to provide new ideas for clinical diagnosis and treatment of sepsis.

Role and mechanism of vitamin D in sepsis / 中华危重病急救医学

Sepsis is a life-threatening organ dysfunction caused by the host's imbalance in response to infection, which is still the leading cause of death in critically ill patients. In recent years, studies have found that vitamin D deficiency or insufficiency is common in critically ill patients, especially sepsis. The relationship between vitamin D and sepsis has attracted more and more attention. The mechanism of vitamin D in sepsis is described from the aspects of immune regulation, inflammation regulation, endothelial cell protection, carbon monoxide regulation, and receptor gene polymorphism, by analyzing the related literatures of vitamin D and sepsis in recent years in order to provide new ideas for clinical diagnosis and treatment of sepsis.

Effect of sarcopenia on the efficiency of the treatment of femoral neck fracture in elderly patients / 中华老年医学杂志

Objective To investigate the effect of sarcopenia on the efficiency of the treatment of femoral neck fracture in elderly patients.Methods A total of 65 elderly patients aged ≥65 years with femoral neck fractures meeting the inclusion and exclusion criteria were investigated in our hospital from February 2014 to February 2016.The muscle cross-sectional area(cm2) at the thoracic 12 pedicle level was measured by chest CT.The skeletal muscle index(SMI)is calculated by the formula that the muscle cross-sectional area(cm2)at T12 pedicle level was divided by m2 of the patient's body height(meter).SMI cutoff values of 42.6 cm2/m2 (males)and 30.6 cm2/m2 (females)were used to diagnose sarcopenia.Linear regression analysis was used to analyze the relationship of SMI with the length of hospital stay,blood transfusion during hospitalization and Harris score one month after surgery.The difference between the patients with and without sarcopenia in the length of hospital stay,the volume of blood transfusion,incidence rate of complications,Harris score,the mortality rate of perioperative period and on.year mortality rate were analyzed by ttest.Results Among 65 elderly patients,28 cases were diagnosed as sarcopenia.Their mean SMI was(30.3 ± 5.2)cm2/m2 in the sarcopenia group and (43.0±6.5)cm2/m2 in the non-sarcopenia group,the difference was statistically significant (t =-8.448,P ＜ 0.001).There were significant differences between the sarcopenia group and the non sarcopenia group in the mean hospital stay[(14.7 ± 5.8)d vs.(13.2±4.5)d,t =1.225,P =0.225],the transfusion volume during hospitalization[(1.7 ± 1.4) units vs.(0.92±1.0)units,t=2.621,P=0.011],Harris scores[(81.1±4.4) vs.(88.7±2.3),t=-8.219,P ＜0.001)],the incidence of complications(57.1 ％ vs.16.2 ％,x2 =11.923,P =0.001),the mortality of perioperative period(7.1％ vs.2.7％,P=0.573)and the one-year mortality(35.7％ vs.10.8％,x2 =4.468,P =0.035).Conclusions Sarcopenia can delay postoperative rehabilitation in elderly patients with femoral neck fracture and increase the incidence of complications and late mortality rate.

Application of Standardized Patient in Medical International Students' Graduation Practice Assessment / 中国医学伦理学

Objective:To determine the effect of standardized patients in medical international students' graduation practice assessment.Methods:The students were divided into two groups ofstandardized patient assessment and traditional assessment,the theoretical and professional performance was compared and analyzed after the assessments.All the students were investigated using questionnaire.Result:The students assessed using standardized patients reported higher skill scores than those with traditional assessments,and the difference was statistically significant.However,no difference was observed in theoretical scores.Gorcltusion:The introduction of standardized patient to medical international students' graduation practice assessment alleviates the status that emphasizes theory but ignores practice due to the lack of clinical resources,eliminates the obstacles in the communication between students and patients,and is conducive to the cultivation of humanistic quality and adaptability of the students.It is worthy popularizing in international students' graduation practice assessment.

Evaluation on the position competency of residents in the first year in a third grade hospital / 中华医学教育探索杂志

Objective To investigate the position competency of residents in the first year and to search for the standardizing training which aims at advancing position competencies. Method Twenty residents of the first year and 40 of superior doctors were taken as research targets. Question-naires including 8 aspects (basic ability, occupational spirit, communication skills, medical knowl-edge, team work, public health, information and management, and academic research) were con-ducted and were scored namelessly. The scores of items in one kind of ability were summed up to serve as the total score of this ability. The mean score of one kind of ability and the mean score of 8 kinds of abilities of residents and superior doctors was calculated. SPSS 17.0 was adopted to make statistical analysis. t-test was adopted to test the difference between the score from residents and superior doctors with P<0.05 representing statistics significance. Results The scores of 8 kinds of abilities were much lower than full scores. The scores of basic ability, occupational spirit, and team work from residents (78.5, 87.4, 41.9) were higher than those from superior doctors (72.6, 80.5, 39.5), with statistical significances (P=0.020, 0.013, 0.045). Conclusions Residents are lack of position competency and awareness, which demonstrates the gap between the training model and the demand of work. It is sug-gested that we should design the training system and evaluation methods based on doctors' compe-tences, add training for comprehensive ability and evaluate abilities of all aspects. An excellent hu-manity education should be built and quality cultivation should be taken attention to. Objective and measurable indices should be developed to increase residents' knowledge.

Prokaryotic expression and polyclonal antibody preparation of human platelet glycoprotein Ⅵ extracellular domain / 中华检验医学杂志

Objective To express and purify recombinant human platelet glycoprotein Ⅵ extracellular domain and prepare the polyclonal antibody against it.Methods Human platelet glycoprotein Ⅵ extracellular domain fragment (123~268 residues) was amplified by polymerase chain reaction and cloned into the prokaryotic expression vector pGEX-3x.The recombinant plasmid was constructed and expressed in E.coli after induction with isopropyl-?-D-thiogalactopyranoside (IPTG).The fusion protein was identified by Western blot analysis after purification by affinity chromatography.Rabbits were immunized with the purified fusion protein, and the collected rabbit antiserum was evaluated by sandwich ELISA, Western blot and flow cytometry.Results The coding sequence of GPVI extracellular domain was successfully inserted into pGEX-3x.Sequencing result showed that the cloned gene was identical as reported.After induction, a Mr 42kd fusion protein was expressed and confirmed by Western blot, which was identical to that expected.The titers of the antisera were up to 1∶[KG-*2]128. Sandwich ELISA result demonstrated that the prepared antibody recognized GPVI in human platelet. Western blot and flow cytometry revealed that the prepared antibody reacted with GPVI of platelet lysate and the native GPVI on human platelet surface.Conclusions Using purified prokaryotic expressed the fusion protein as antigen, the specific antibody was elicited in the immunized animals. The prepared polyclonal antibodies react specially with GPVI on human platelet surface and can be used for further studies of GPVI.

Application of continuous veno-venous hemofiltration to the treatment of multiple organ failure in senile patients / 医学研究生学报

Objective: To evaluate the effect and safety of continuous veno-venous hemofiltration(CVVH) in the treatment of multiple organ failure(MOF) in senile patients.Methods: Sixteen patients with multiple organ failure,aged over 80 years,were divided into a survival group,who lived more than 20 days,and a non-survival group,less than 20 days after CVVH,and observed for such clinical indexes as of renal function,K+and blood gas analysis,APACHEⅡ scores and complications.Results: After CVVH,eleven of the patients survived for over 20 days,with 1 case up to 3 years.CVVH effected a significant improvement in BUN,Scr,K+and blood gas as well as a marked reduction in complications.APACHE Ⅱ scores decreased significantly after CVVH in the survival group though not in the non-survival group,as compared with those before CVVH,which were significantly lower in the former than in the latter.Conclusion: CVVH is a safe,effective and well-tolerated method for the treatment of MOF in senile patients.Patients with higher APACHEⅡscores have a poor prognosis.

Construction of a recombinant adenovirus vector of the rat Lys184del mutant cardiac troponin I gene / 医学研究生学报

Objective: To construct a recombinant adenovirus expression vector of the SD rat Lys184del mutant cardiac troponin I gene(cTnI Lys184del).Methods: The Lys184del mutant cardiac troponin I gene of SD rat was induced by PCR-based site-directed mutagenesis,the amplified fragment containing the mutation was then inserted into the cloning vector pMD18-T.After the addition of a sequence encoding a 6?His tag at the C-terminus by PCR,the coding region of cTnI Lys184del was subcloned into Adeno-X viral DNA to form a recombinant adenoviral plasmid,which was packed into infectious recombinant adenoviral particles(Ad-cTnI Lys184del) by transfecting HEK293 cells.Results: The DNA sequence of Ad-cTnI Lys184del was proved to be correct by PCR and sequencing,and its expression was identified by Western blot analysis.Conclusion: The successfully constructed recombinant adenovirus Ad-cTnI Lys184del has provided valuable data for further researches on its functional characteristics.

The present situation in the study of atrial fibrillation in the elderly / 医学研究生学报

Atrial fibrillation is one of the commonest cardiac arrhythmia in the elderly, the incidence increased with increasing ages. Atrial fibrillation can induce severe cardiac insufficiency and thromboembolism, stroke is also a very important complication with high morbidity and mortality. Thus it is very necessary to pay special attention to the study of atrial fibrillation in the field of geriatric cardiovascular diseases.

Detection of E-cadherin gene promoter hypermethylation in plasma of breast cancer patients / 中国普通外科杂志

Objective To evaluate the feasibility in early diagnosis, predicting therapeutic effect, recurrence monitoring by examining promoter hypermethylation for cancer-associated genes E-cadherin in cancer tissue and peripheral blood of breast cancer patients. Methods The tumor tissue, paracancer- tissue and the paired plasma were examined for aberrant methylation of E-cadherin gene by methylation-specific PCR in 42 cases of breast cancer and 10 cases of breast benign diseases. Results The incidence of promoter hypermethylation of E-cadherin in tumor tissues was 52.4% and the paired plasma were 33.3%. E-cadherin hypermethylation in plasma samples and tumor samples significantly correlated with each other ( P

The Cytotoxic Effects on Gastric Cancer Mediated by Bi-specific Antibodies / 中国肿瘤生物治疗杂志

Bi-specific antibodies (BsAb) P210/MMC, P210/TNP and P40/CD3 were prepared with different approaches. Among 11 fusions, 7, 484 wells were planted, and 223 dual positive wells were obtained from 1, 111 growth wells, only five hybrid-hybridomas secreting BsAb were obtained, showing the difficulties to prepare BsAb. It was shown that bridge assay is very important for identification of the BsAb. Among 12 triomas secreting y and ? chains, only two had BsAb. Therefore, the frequency for y and ? to combine to BsAb was 16.7(2/12). BsAb(P210/TNP) with versatile adaptor could mediate cytotoxic effects on target cells of different cytotoxic agents conjugated with TNP.Moreover, BsAb(P40/CD3) could mediate cytotoxic effects of peripheral blood lymphocytes (PBLs) on target cells. With local injection, four times treatments could abolish the tumor xenografts in nude mice.