The effectiveness of problem-based learning and case-based learning teaching methods in clinical practical teaching in TACE treatment for hepatocellular carcinoma in China: a bayesian network meta-analysis.

PURPOSE: To investigate the effectiveness of problem-based learning (PBL) and case-based learning (CBL) teaching methods in clinical practical teaching in transarterial chemoembolization (TACE) treatment in China. MATERIALS AND METHODS: A comprehensive search of PubMed, the Chinese National Knowledge Infrastructure (CNKI) database, the Weipu database and the Wanfang database up to June 2023 was performed to collect studies that evaluate the effectiveness of problem-based learning and case-based learning teaching methods in clinical practical teaching in TACE treatment in China. Statistical analysis was performed by R software (4.2.1) calling JAGS software (4.3.1) in a Bayesian framework using the Markov chain-Monte Carlo method for direct and indirect comparisons. The R packages "gemtc", "rjags", "openxlsx", and "ggplot2" were used for statistical analysis and data output. RESULTS: Finally, 7 studies (five RCTs and two observational studies) were included in the meta-analysis. The combination of PBL and CBL showed more effectiveness in clinical thinking capacity, clinical practice capacity, knowledge understanding degree, literature reading ability, method satisfaction degree, learning efficiency, learning interest, practical skills examination scores and theoretical knowledge examination scores. CONCLUSIONS: Network meta-analysis revealed that the application of PBL combined with the CBL teaching mode in the teaching of liver cancer intervention therapy significantly improves the teaching effect and significantly improves the theoretical and surgical operations, meeting the requirements of clinical education.

Gelation behavior and mechanism of low methoxyl pectin in the presence of erythritol and sucrose: The role of co-solutes.

Co-solutes such as sucrose and sugar alcohol play a significant part in low methoxyl pectin (LMP) gelation. To explore their gelation mechanism, we investigated the gelation behavior of LMP in the presence of erythritol and sucrose with Ca2+. Results revealed that the introduction of erythritol and sucrose improved the hardness of the gels, fixed more free water, accelerated the rate of gel structuring, and enhanced the gel strength. FT-IR confirmed the reinforced hydrogen bonding and hydrophobic forces between the pectin chains after introducing co-solutes. And it could be observed clearly by SEM that the cross-linking density of gel network enhanced with co-solutes. Furthermore, gel disruption experiments suggested the presence of ionic interaction, hydrogen bonding, and hydrophobic forces in LMP gels. Finally, we concluded that the egg-box regions cross-linked only by LMP and Ca2+ were too weak to form a stable gel network structure. Adding co-solutes could increase the amount of cross-linking between pectin chains and enlarge the cross-linking zones, which favored the formation of a dense gel network by more hydrogen bonding and hydrophobic forces. Sucrose gels had superior physicochemical properties and microstructure than erythritol gels due to sucrose's excellent hydration capacity and chemical structure characteristics.

Effect of enzymatic de-esterification and RG-I degradation of high methoxyl pectin (HMP) on sugar-acid gel properties.

The influence of RG-I domains on high methoxyl pectin (HMP) sugar-acid gel properties has rarely been reported. In our work, HMP was modified by enzymatic de-esterification and degradation of RG-I domains to compare and analyze the relationship between the structure and final sugar-acid gel properties. The results showed that the degree of esterification (DE) of REP (pectin degraded by rhamnosidase) and GEP (pectin debranched by galactosidase) was the same as that of untreated HMP, whereas the DE of PMEP (pectin de-esterified by pectin methyl esterase) decreased from 59.63 % to 54.69 %. The monosaccharide composition suggested no significant changes in the HG and RG-I structural domains of PMEP. In contrast, the percentage of RG-I structural domains of REP and GEP dropped from 37 % to about 28 %, accompanied by a reduction in the proportion of the RG-I backbones and side chains. The rheological characterization of sugar-acid gels demonstrated an enhanced gel grade for PMEP and a weakened one for REP and GEP. Moreover, we constructed a correlation relationship between the fine structure of pectin and the properties of the sugar-acid gels, confirming the critical contribution of the RG-I region (especially the neutral sugar side chains) to the HMP sugar-acid gels.

Effect of ciprofol on swallowing function in patients undergoing painless gastrointestinal endoscopy.

BACKGROUND: Gastroscopy is one of the most commonly used diagnostic modalities for upper gastrointestinal disorders. This study compared the effect of ciprofol and propofol on swallowing function during painless gastroenteroscopy. METHODS: This was a single-center, placebo-controlled randomized trial. Three hundred sixty-eight patients undergoing painless gastroscopy were included in this study and randomly divided into 2 groups: the propofol group (PRO group, n = 183) and the ciprofol group (CIP group, n = 185). Sufentanil, ciprofol, and propofol are used to anesthetize the patients, and the effects of different solutions on these patients are compared and analyzed. The patient's general condition, vocal cord adduction reflex, dysphagia severity score, penetration and aspiration scale score, vital signs at different times, complications, recovery time (minutes), residence time in the resuscitation room (minutes), and adverse reactions were recorded. RESULTS: During the examination, the incidence of severe swallowing dysfunction in CIP group was lower than that in PRO group (P < .05). The BP in CIP group was higher than that in PRO Group (P < .05). The HR of CIP group was lower than that of PRO Group (P < .05). SpO2 in CIP group was higher than that in PRO Group (P < .05). The recovery time of CIP group was longer than that of PRO Group, and the postanesthesia care unit stay time of PRO group was longer than that of CIP group(P < .05). The incidence of respiratory depression, hypotension and cough in CIP group was lower than that in PRO Group (P < .05). The incidence of injection pain in CIP group was lower than that in PRO Group (P < .05). CONCLUSION: Compared with propofol, ciprofol has less inhibition on swallowing function, less impact on hemodynamics, less respiratory depression, and less injection pain, which is more suitable for painless gastroscopy.

Pectin gels based on H+/(NH4)2SO4 and its potential in sustained release of NH4.

A gelling strategy for HP was proposed in this study, ammonium sulfate (AS) as a co-solute could induce the gelling of HP in acidic environment. The solubility and Zeta potential of HP dramatically decreased in AS solution, which indicated AS could promote the aggregation of HP. The rheological results confirmed the gelling of HP (G' > G″) with AS: 25-30 wt% and pH ≤ 3.0, and the gel strength is mainly depended on HP rather than AS concentration. Smaller AS crystals (SEM) and reduced T2 values (LF-NMR) were observed in HP gels, suggested the gel network of HP could limit the migration of AS and water. Finally, it was found that the release process of NH4+ in HP + AS gel was lagged behind that of pure AS, which verified the potential of HP + AS gel in the field of sustained-release fertilizers.

Physicochemical characteristics and functional properties of high methoxyl pectin with different degree of esterification.

Moderate alkali de-esterification can change the physicochemical characteristics and thus the functional properties of high methoxyl pectin (HMP). The results revealed that de-esterification could increase negative charges (Zeta potential from -21 to -31 mV), decrease molecular weight (from 448 to 136 kDa) and apparent viscosity of HMP. Homogalacturonan (HG) content decreased (from 62% to 49%) while rhamnogalacturonan Ⅰ (RG-Ⅰ) content increased (from 32% to 46%) after de-esterification. The group characteristics of HMP with different degree of esterification (DE) were similar and no obvious impact was made on degree of crystallinity by alkali de-esterification. A conformation transition of HMP molecule implied by Congo red test were occurred as the DE decreased. With the decrease of DE, the molecular structure of HMP became shorter and smaller, and the entanglement was weaker. The de-esterification caused slight decrease of thermal stability. Alkali de-esterification would weaken the gel property and the emulsifying ability of HMP.

Citrus fiber for the stabilization of O/W emulsion through combination of Pickering effect and fiber-based network.

In this study, oil-in-water emulsions stabilized by citrus fiber were prepared and characterized. We found that citrus fiber can produce stable gel-like, surfactant-free O/W emulsions with microscale droplet sizes at fiber concentrations upon 2% (W/V) using 25% (V/V) oil. The interfacial framework, citrus fiber partition between the continuous phase and state of the droplets of emulsions were visualized by confocal laser scanning microscopy (CLSM), confirming that in addition to Pickering stabilization, the citrus fiber-based network also contributed to stabilization of the emulsions. The citrus fiber-stabilized emulsion is typical non-Newtonian fluid and its interfacial viscosity is not influenced obviously by changing pH from 2 to 10, ionic strength of NaCl from 0.00 to 1.00 mol/L or temperature from -20 to 70 °C. The acquired findings in this study show that citrus fiber can fabricate Pickering emulsions with excellent stability and solve the problem of resource waste during the pectin produce process.

Structural characterization of pectin-bismuth complexes and their aggregation in acidic conditions.

Bismuth-contained therapies are effective in treating gastric ulcer and eliminating Helicobacter pylori (Hp). Anion polysaccharides ligand could reduce the intake of bismuth, and enhance drug efficacy of bismuth compounds. In this study, pectin-bismuth (PB) was prepared and the changes of PB structure in acidic environment were reported for the first time. The structure of PB was characterized by FT-IR, XRD, and TGA, which suggested that combined with bismuth could alter the crystal structure of pectin. XPS confirmed the ionic binding of Bi3+ with carboxyl groups of pectin. The aggregating of PB with different pH level were also investigated, and the influence of pH on PB structure were observed by SEM. Results showed that PB has much larger volume of flocculation in acidic environment compared with bismuth nitrate. Additionally, apparent shear stress (τa) of PB suspension was evaluated. These results revealed the structural characteristics and acid-induced aggregation of pectin-bismuth, and bismuth could aggregate in acidic solution with the gelation of pectin.

Effective removal of nitrate by denitrification re-enforced with a two-stage anoxic/oxic (A/O) process from a digested piggery wastewater with a low C/N ratio.

The combined process of a long-term biogas digester and double anoxic/oxic tanks is very commonly used in piggery wastewater treatment in South China, but the effluent does not meet the discharge standard of total nitrogen (TN) and chemical oxygen demand (CODCr) due to a low C/N ratio and insufficient organic carbon in digested piggery wastewater. Thus, a typical two-stage anoxic/oxic (A1/O1/A2/O2) process, which is widely used to treat digested piggery wastewater in the engineering application, was selected for study on a laboratory scale. Finally, the average removal efficiency of ammonia nitrogen in the two-stage AO process was 98.7%; at the same time, the content of nitrate increased to 180-190 mg/L. To further eliminate nitrogen, an anaerobic tank (S1), which was equipped the sludge that was acclimated in our laboratory by a high nitrogen loading slurry, was employed to treat the effluent from the two-stage AO process and contributed more than 70% removal efficiency. Further analysis showed that ammonia-oxidizing bacteria (AOB) and nitrite oxidizing bacteria (NOB) in the O1 and O2 tanks together contributed to the conversion of ammonia nitrogen to nitrate, but the process of heterotrophic denitrification was inhibited in the A1 and A2 tanks because of insufficient carbon sources. In addition, most of the nitrate concentration was reduced under conditions with insufficient carbon sources, while Thauera-dominated the bacterial population in the sludge sample of the S1 tank.