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Objective:To explore the application and practice of "flipped classroom" in the teaching of general surgery interns.Methods:A total of 20 internship groups (3 to 5 people in each group) were randomly selected from the general surgery practice group in the Department of General Surgery of the Second Clinical Medical College of North Sichuan Medical College. They were randomly divided into the flipped group (45 people) and the traditional group (40 people), with 10 subgroups in each group. The flipped group adopted the flipped classroom teaching mode (students' self-study by handing out materials before class, students and teachers' discussion in class, and students and teachers' evaluation after class), while the control group adopted the current conventional teaching mode (students' preview before class, teachers' explanation in class, and teachers' question answering after class). At the end of the teaching, a questionnaire was used to evaluate the participation and completion of each student. The teaching effect was evaluated by medical history collection and case analysis. The participation, completion, and teaching effect between the two groups were compared and analyzed. SPSS 23.0 software was used for t-test and Chi-square test. Results:The participation of the flipped group was better than that of the traditional group [(17.45±1.83) vs. (15.57±1.52)], and the difference was statistically significant ( P < 0.05). There was no statistically significant difference between the flipped group and the traditional group. There was no significant difference in medical history collection scores between the two groups. The case analysis of the flipped group was better than that of the traditional group [(87.30±6.06) vs. (81.50±5.88), P < 0.05]. The questionnaire shows that about 90% of the students think that flipped classroom can improve their interest in learning [96% (43/45)], improve their autonomous learning ability [89% (40/45)], and have better learning effect. At the same time, 78% (35/45) of students think that learning time is too long. Conclusion:The flipped classroom teaching model can improve the teaching participation of general surgery students, improve students' interest in learning, improve their self-learning ability, and improve students' thinking ability of medical record analysis.
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Background: Dysregulation of intestinal flora is a key risk factor for colorectal cancer (CRC). In recent years, traditional Chinese medicine preparations and probiotics have been increasingly applied in the prevention of CRC. Aims: To investigate the preventive effect of Panax notoginseng saponins (PNS) combined with Bacillus subtilis on CRC. Methods: Thirty female BALB/c mice were randomly divided into normal control group (NC group), model group, PNS group, Bacillus subtilis group and PNS combined with Bacillus subtilis group (PaB group). CRC mice model was constructed by azoxymethane (AOM)/dextran sulfate sodium (DSS) method. During the experiment, the mice were weighed, and disease activity index (DAI) score was evaluated. The length of colorectum and tumor number were measured. Serum interleukin (IL) - 6 and IL - 10 contents were determined by ELISA. 16S rRNA sequencing was used to analyze the composition of intestinal flora. Results: Compared with model group, DAI score was significantly decreased (P<0.001), colorectal length was significantly increased (P<0.001), number of tumor was significantly decreased (P<0.001), tumor volume was significantly decreased (P<0.01), serum IL-6 content was significantly decreased (P<0.000 1), and serum IL-10 content was significantly increased in PaB group (P<0.000 1). The results of intestinal flora sequencing showed that Simpson index was significantly decreased in PaB group than in model group (P<0.05), Shannon index and Chao index were significantly increased (P<0.05), abundance of Bacteroidota was significantly increased (P<0.01), abundances of Firmicutes, Helicobacter and Oscillibacter were significantly decreased (P all <0.05), abundance of Lactococcus was significantly increased (P<0.05). Conclusions: The combination of PNS and Bacillus subtilis can effectively alleviate the occurrence of CRC caused by AOM/DSS, and its mechanism may be related to the improvement of composition of intestinal microbial community.
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Voluntary service spirit is highly coupled with medical humanistic spirit. Participating in voluntary service is an important channel for medical students to grow up. There are deficiencies in medical students' voluntary service at the social, school and personal levels. It is of great significance to strengthen the top-level design of all staff, whole process and all-round volunteer service, build a volunteer service platform with distinctive characteristics, normal development and multi benefits, create a "school local co construction" volunteer service brand, select advanced figures in voluntary service for medical students, and establish and improve long-term mechanisms for the operation, incentive and guarantee of voluntary services, thus improving the medical students' awareness of voluntary service, protecting their legitimate rights and interests in the service process, expanding the influence of voluntary service and enhancing the effectiveness of voluntary service.
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Objective:To construct a scientific and objective evaluation system for the in-service training of "double-qualified" clinical nursing teachers.Methods:From August 2020 to March 2021, the framework was preliminarily constructed through literature analysis, and the evaluation system was constructed by Delphi method and analytic hierarchy process.Results:The authority coefficients of the two rounds of expert consultation are 0.82 and 0.81 respectively, and the overall coordination coefficients are 0.24 and 0.21 respectively. As a result, we construct the evaluation system for the in-service training of "double-qualified" clinical nursing teachers, included 8 first-level indicators, 39 second-level indicators and 39 groups of grading rules.Conclusions:The evaluation index system for the on-the-job training of "dual-teacher" clinical nursing teachers constructed in this study can provide a reference for the reform of the current "dual-teacher" clinical nursing teachers′ on-the-job training, and improve the quality of teacher training, and guarantee the quality of nursing teaching.
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Based on the characteristics of medical specialty, this research group has developed the virtual simulation experiment teaching project of Chinese revolutionary morality (red medicine spirit). This project uses 3D simulation technology and OpenGL technology to build a virtual experimental learning environment based on WebGL, learn general Fu Lianzhang's glorious deeds and immersive experience of the inheritance and development of the spirit of red medicine by contemporary "heroes in harms way" in the fight against the COVID-19 epidemic in the form of 3D animation interaction. Through research, it is found that virtual simulation teaching is conducive to promoting students' understanding and mastery of medical humanities and improving students' satisfaction with teaching, with good popularization value.
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Ankylosing spondylitis (AS) is a chronic inflammatory disease with early onset of reduced bone mineral density,which can lead to spinal deformity and even fracture,affecting patients′ quality of life seriously. To improve the compliance and long-term quality of life for AS patients, it is neccessary to enhance the awareness and knowledge of this disease among community primary health care providers.
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Objective:To develop the evaluation index system for clinical teaching quality supervision of nursing undergraduates.Methods:Based on the theory of Donabedian's structure-process-outcome quality model, literature review, semi-structured interviews, Delphi method and Analytic Hierarchy Process were adopted to determine the teaching quality supervision index system for clinical nursing interns.Results:After two rounds of expert consultation, questionnaire response rates were 92.86%(26/28), 100.00%(26/26); expert authority coefficients were 0.871, 0.887 and the two rounds of expert consultation authority coefficient was 0.879; coefficients of variation ranged from 0.00 to 0.15 and 0.04 to 0.12; coordination coefficients ranged from 0.256 to 0.667 and 0.402 to 0.804 ( χ2 values were 60.276-427.571, P<0.01). The final index system consisted of 3 first-level indicators, 9 second-level indicators, and 36 third-level indicators. The analytic hierarchy process was used to determine the weights of all indexes, and the consistency test (CR<0.1) was performed. Conclusions:The construction of the index system for clinical teaching quality supervision of nursing undergraduates is scientific with reasonable weight. It can provide reference for the improvement and reform of clinical nursing teaching work.
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Objective To investigate the value of combination of A2DS2 score,procalcitonin(PCT) and C-reactive protein (CRP) predicting stroke-associated pneumonia (SAP) in patients with acute ischemic stroke.Methods Patients with acute ischemic stroke admitted to the Department of Neurology,Suqian People's Hospital of Nanjing Drum Tower Hospital Group from March 2015 to March 2019 were enrolled retrospectively.Multivariate logistic regression analysis was used to determine the independent correlation of A2DS2 scores as well as PCT and CRP levels with SAP.Receiver operating characteristic (ROC) curves were used to assess the individual and combined predictive values of A2DS2 scores,PCT and CRP levels for SAP.Results A total of 332 patients with acute ischemic stroke were enrolled,and 58 of them developed SAP (17.5％).After adjusting for age,smoking,and hyperlipidemia,the A2DS2 score (odds ratio [OR] 1.613,95％ confidence interval [CI] 1.092-2.389),PCT (OR 8.047,95％ CI 3.012-16.138) and CRP (OR 1.409,95％ CI 1.064-2.672) were the independent predictors of SAP occurrence.ROC curve analysis showed that the area under the curve of A2DS2 score,PCT and CRP alone,and the combination of the three for predicting SAP were 0.811,0.825,0.804 and 0.910,respectively.When the three are jointly used to predict SAP,the area under the curve is significantly higher than the individual prediction (all P ＜ 0.001).Conclusions The combination of A2DS2 score,PCT and CRP can improve the ability to predict SAP.
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Objective@#To investigate the value of combination of A2DS2 score, procalcitonin (PCT) and C-reactive protein (CRP) predicting stroke-associated pneumonia (SAP) in patients with acute ischemic stroke.@*Methods@#Patients with acute ischemic stroke admitted to the Department of Neurology, Suqian People's Hospital of Nanjing Drum Tower Hospital Group from March 2015 to March 2019 were enrolled retrospectively. Multivariate logistic regression analysis was used to determine the independent correlation of A2DS2 scores as well as PCT and CRP levels with SAP. Receiver operating characteristic (ROC) curves were used to assess the individual and combined predictive values of A2DS2 scores, PCT and CRP levels for SAP.@*Results@#A total of 332 patients with acute ischemic stroke were enrolled, and 58 of them developed SAP (17.5%). After adjusting for age, smoking, and hyperlipidemia, the A2DS2 score (odds ratio [OR] 1.613, 95% confidence interval [CI] 1.092-2.389), PCT (OR 8.047, 95% CI 3.012-16.138) and CRP (OR 1.409, 95% CI 1.064-2.672) were the independent predictors of SAP occurrence. ROC curve analysis showed that the area under the curve of A2DS2 score, PCT and CRP alone, and the combination of the three for predicting SAP were 0.811, 0.825, 0.804 and 0.910, respectively. When the three are jointly used to predict SAP, the area under the curve is significantly higher than the individual prediction (all P<0.001).@*Conclusions@#The combination of A2DS2 score, PCT and CRP can improve the ability to predict SAP.
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Objective To compare the safety and efficacy of directly thrombectomy and bridging therapy in patients with acute large vessel occlusion stroke within 4.5 h of onset.Methods From April 2014 to September 2017, patients with acute large vessel occlusion stroke treated with emergency mechanical thrombectomy in Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School were collected. The patients who were eligible for intravenous thrombolysis and whose onset time was ≤4.5 h were selected. The propensity score matching analysis and McNemar test were used to compare the safety and efficacy of direct mechanical thrombectomy and bridging therapy. Results A total of 41 patients with acute large vessel occlusion stroke were enrolled.The final propensity score matching was 12 pairs.In the direct thrombectomy group, the time from door to femoral artery sheath placement was significantly reduced (P=0.03), but there was no significant difference in the good functional outcome rate, mortality rate, and incidence of symptomatic intracranial hemorrhage between the two groups of patients at 90 d(P>0.05).Conclusion It is safe and effective to start direct mechanical thrombectomy within 4.5 h of onset in patients with acute large vessel occlusion stroke and can significantly shorten the time of vascular recanalization.
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Objective To investigate MRI features of cystic oligodendrocytoma.Methods MRI features of 10 patients with oligodendroglial tumors proved with operation and pathology were analyzed retrospectively.Results Among 10 patients,lesionslocated on the supratentorium in 8 patients,while on the cerebellar vermis in 2 patients.Solitary lesion was found in 9 cases,and multiple lesions were found in 1 case.Complete cystic lesions were observed in 4 cases,large cystic lesions with solid nodules were found in 3 cases,and multi-cystic lesions were found in 3 cases.Smooth cyst wall of lesions were found in 7 cases,locally depressed and rough wall were found in 3 cases.Calcifications were found in 3 cases.Mild peritumoral edema was found in 9 cases,moderate to severe edema was found in 1 case.The lesions significantly enhanced in 3 cases,ring enhanced in 3 cases,and locally enhanced in 1 case.Conclusion COD is difficult to diagnose,but has certain MRI characteristics.COD should be considered when supratentorial complete cystic lesion or large cystic lesion with septum and/or solid nodule was found with MRI.
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OBJECTIVE:To establish a method for the determination of related substances in Methylphenidate hydrochloride for injection. METHODS:HPLC method was adopted. The determination was performed on Waters symmetry C18 column with mo-bile phase consisted of methanol-0.01 mol/L potassium dihydrogen phosphate solution(60:40,V/V)at the flow rate of 1.0 mL/min. The detection wavelength was set at 210 nm,the column temperature was 35 ℃ and sample size was 10 μL. RESULTS:The linear range of impurity A and B were 0.02-3.0 μg/mL(r=0.9998). The limits of quantitation were 0.2,0.6 ng,and the limits of detec-tion were 0.06,0.2 ng,respectively. RSDs of precision,stability and reproducibility were all lower than 2.0%;recoveries were 98.2%-100.0%(RSD=0.56%,n=9),98.0%-100.3%(RSD=0.70%,n=9),respectively. CONCLUSIONS:The method is sim-ple,accurate and suitable for the determination of related substance in Methylphenidate hydrochloride for injection.
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The core values of traditional Chinese medicine culture greatly correlate with the ideological and political education of medical students and they can be integrated.Based on the discussion of the relationship between traditional Chinese medicine culture and medical students' ideological and political education,this paper analyzed the significance of integrating traditional Chinese medicine culture into medical students' ideological and political education:it could help to cultivate college students' patriotic sentiments,sense of honesty,and professional ethics.In addition,it put forward concrete implementation paths:exerting regional advantages and creating characteristic brand of ideological and political education,enriching classroom teaching and innovating the ways of ideological and political education,strengthening cultural construction and strengthening the perceptual cognition of ideological and political education,highlighting typical demonstration and enlarging the positive influence of ideological and political education.
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Objective To investigate the value of CT spectral imaging in differential diagnosis of atypical pheochromocytoma and adrenal adenoma.Methods The energy spectrum CT data of 13 cases of atypical pheochromocytoma and 15 cases of adrenal cortical adenoma confirmed by surgery pathology were retrospectively analyzed.All images processed by spectrum software.The CT value of different energy levels (40-140 keV) in arterial,venous and delayed phase,energy spectrum curve and spectrum curve type,base material of concentration (water-iodine,grease-iodine,blood-iodine) were obtained,and the CT value of different energy were standardize in the same period.Data were compared with samples t test.Results For arterial phase,the standardization CT values of pheochromocytoma on monochromatic images of 40 keV,70 keV to 140 keV had statistical difference with those of adenoma (all P＜0.05).For venous phase,the standardization CT values of pheochromocytoma on monochromatic images of 70 keV to 140 keV had statistical difference with those of adenoma (all P＜0.05).For delayed phase,the standardization CT values of the two tumors on monochromatic image of 40 keV to 140 keV had significant difference (all P＜0.05).Both the energy spectrum of the three periods of type curve was falling,pheochromocytoma always located above compared with adenoma.The standardization concentration of base materials including water (iodine),fat (iodine) and blood (iodine) of pheochromocytoma were higher than those of adenoma in three phases (all P＜0.001).The standardization concentration of base materials including iodine (water),iodine (fat) and iodine (blood) had no significant difference in three phases between pheochromocytoma and adenoma (all P＞ 0.05).Conclusion Atypical pheochromocytoma and adrenal adenoma have different spectral curve and spectrum characteristics of the material content.Spectral CT imaging provides a method of multiple parameters to identify atypical adrenal pheochromocytoma and adenoma.
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Objective To investigate the predictive value of serum glycated hemoglobin A1c (HbA1c)level and early neurological deterioration (END)in patients with acute cerebral infarction. Methods From June 2014 to January 2016,the consecutive patients with acute ischemic stroke (interval time from onset to admission < 3 days)admitted to the Department of Neurology,Suqian People′s Hospital were enrolled retrospectively. The neurological deficits of all patients were evaluated on the day of admission with the National Institutes of Health Stroke Scale (NIHSS). The symptoms of neurological deficits in patients were evaluated repeatedly for all patients within 7 days after admission. Any score increased ≥2 compared with before admission was defined as END. The 226 patients met the inclusion and exclusion criteria were enrolled,and they were divided into either an END group (n = 50,22. 1%)or a non-END group (n = 176,77. 9%)according to whether END occurred after acute cerebral infarction. Univariate analysis was used to analyze the differences between the 2 groups. Multivariable Logistic regression analysis was used to analyze the correlation between the HbA1c level and END. Results Compared with the non-END group,there were significant differences in the age,prevalence of diabetes,NIHSS score,hypersensitive C-reactive protein level,rate of ASPECT score 0-7,and serum HbAlc level in the patients of the END group (all P < 0. 05). The results of logistic regression analysis showed that the elevated hypersensitive C-reaction protein and serum HbA1c levels were the independent risk factors for END of acute cerebral infarction (OR,1. 048 and 1. 809 respectively,95% CI 1. 008 -1. 089 and 1. 429 -2. 292 respectively;P = 0. 018 and 0. 002 respectively). Conclusion The increased serum HbA1c level is an independent risk factor for END of acute cerebral infarction. It has certain predictive value for END.
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Objective To evaluate the value of spectral CT in risk classification of gastrointestinal stromal tumor (GIST).Methods Forty-one patients with GIST were collected,including 1 3 in high risk,1 2 in medium risk,1 1 in low risk and 5 in very low risk. All of the patients underwent plain and triple phases contrast enhanced CT with spectral CT scanning mode.CT value of 70 keV monochromatic images,the slope of spectral curve and normalized iodine concentration (NIC)were measured and calculated.Then, data was correlated with the risk of GIST.Results ①The CT value of 70 keV monochromatic images was negative correlation in the arterial phase (r=-0.173),positive correlation in delayed phase (r=0.552),and no correlation in venous phase with the risk of GIST.②The slopes of spectral curves in delayed phase were significantly different in GISTs with the different risk (χ2= 6.641,P= 0.036).③The NIC values of GISTs with different risk were significantly different in the triple phases (F=3.646,χ2=6.046,F=57.233,P=0.035, P=0.049,P<0.001),and correlated with the risk of GIST (r=-0.564)in the delayed phase.Conclusion Quantitative paremeters of spectral CT imaging such as the CT value of 70 keV,the slopes of spectral curves and iodine concentration are valuable for the risk classification of GIST,and can be used as a preoperative reference.
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Objective To establish a gas chromatography ( GC) method for determination of aniline,2-aminophenol and 4-aminophenol in mesalamine sustained release granules. Methods An HP-5 (10 m×0.53 mm,2.65 μm) capillary GC column was adopted. The carrier gas was high purity nitrogen at a flow rate of 15 mL.min-1 . The inlet temperature was controlled at 280 ℃ and the FID detector temperature was 300℃. The oven temperature was initially held at 70℃ for 2 min and was then programmed to 150 ℃ at 10℃.min-1 and held for 6 min. Results A good resolution was obtained between the peaks of the 3 impurities at chromatographic conditions above. The recoveries of aniline, 2-aminophenol and 4-aminophenol were among 98.04% to 103.00%. The precision and linearity equations were good. Conclusion The method can be adopted for the quality control of mesalazine sustained release granules.
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Objective To investigate the atypical CT ,MRI findings of pancreatic neuroendocrine tumors (PanNETs) ,in order to improve diagnosis .Methods The clinical ,imaging and pathological data of 6 patients with PanNETs confirmed by pathology were analyzed retrospectively .Results In all 6 cases ,2 lesions were located in the pancreatic head ,3 lesions in the pancreatic body ,and 1 lesion in the pancreatic tail .There were 2 functional PanNETs with an average size of 2 .1 cm × 2 .6 cm ,which showed homogeneous density or signal .There were 4 nonfunctional PanNETs with an average size of 2 .7 cm × 4 .3 cm ,one of which had calcification ,and two of which had obviously cystic change ,including intracapsular bleeding in one case .Contrast‐enhanced examinations showed that all 6 lesions had mild or moderate enhancement .Three lesions were manifested as relatively intense enhancement in the arterial and portal venous phase ,but decreased enhancement in the delayed phase ,including annular envelope enhancement in one case .Two le‐sions were manifested as progressive enhancement .The last case was manifested as inwardly filled enhancement .Three lesions had unclear boundaries ,while one lesion had splenic vein invasion .Two cases accompanied with mild expansion of the common bile duct or pancreatic duct .Conclusion PanNETs can be ma+nifested as atypical findings such as obviously cystic changes ,and(or) mild to moderate enhancement .It is suggested that the atypical imaging findings of PanNETs should be recognized well to improve the diag‐nostic accuracy .
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Objective To investigate the correlation between ankle-brachial index (ABI) and early neurological deterioration (END) in patients with acute ischemic stroke. Methods Consecutive patients with acute ischemic stroke admitted to hospital within 7 d after onset from January 2014 to December 2014 were enroled. Bidirectional Doppler flow detector was used to detect ABI. END was defined as the increased National Institutes of Health Stroke Scale score ≥2 or the increased motor score ≥1. The demographic characteristics, vascular risk factors, laboratory parameters, and the incidence of END were identified and analyzed. Results A total of 210 patients with acute ischemic stroke were enroled, including 51 had END and 159 did not have END. Univariate analysis showed that the proportion of patient with ABI ≤0. 9 of the END group was significantly higher than that of the non-END group (43. 1% vs. 22. 0% ; χ2 = 8. 714, P =0. 003). Multivariable logistic regression analysis showed that ABI ≤0. 9 (odds ratio 2. 688, 95% confidence interval 1. 265 - 5. 052; P = 0. 009) was independently associated with END in patients with ischemic stroke after adjusting for the confounding factors, such as age, sex, baseline systolic blood pressure, and ischemic heart disease. Conclusion The low ABI was associated with the occurrence of END in patients with acute ischemic stroke.
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BACKGROUND:There are less reports on the evaluation of plantar pressure distribution in knee osteoarthritis patients using modern gait analysis, and moreover, the database of characteristic plantar pressure has not been established in patients with osteoarthritis. OBJECTIVE: To evaluate the therapeutic effect of Chinese massage and functional exercise on knee osteoarthritis. METHODS:Forty patients with left knee osteoarthritis who were eligible for the inclusive criteria were randomized into two groups, with 20 in each group. Control group was given conventional treatment, and treatment group was given Chinese massage combined with functional exercise. Japanese Orthopaedic Association score and gait parameters were measured and compared between two groups before and at 3 months after treatment. RESULTS AND CONCLUSION:After treatment, the two groups both had evident efficacy in pain relief during walking, and there was no statisticaly difference between the two groups. There was a significant difference in the knee range of motion in the patients in the treatment group when going upstairs and downstairs as wel as during joint flexion before and after treatment, but no changes occurred in the control group. After treatment, the range of motion during joint flexion was better in the treatment group than the control group, but there was no difference in the sweling reduction between the two groups. In addition, the treatment group had a higher Japanese Orthopaedic Association score after treatment than before treatment (P < 0.05), and there was no statistical difference in the control group. Gait analysis showed that there were improvements in the percentage of contact time, parameters during stance phase and peak plantar pressure in the two groups, but there was no significant difference before and after treatment. Foot axis angle in the treatment group was improved significantly, which was significantly better than that in the control group. Al the indexes in the treatment group were improved a lot, but did not reach the normal.
