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Objective:To investigate the demand and practical utility of simulation operations specialists (SOS) in simulation teaching modules during the standardized residency training.Methods:Based on the feedback for stimulated courses of standardized residency training, subjective evaluation of all residents, teachers and SOS who participated in simulation courses in 2017-2018 academic year were investigated and studied via the mobile phone online investigation. At the same time, the design data of teaching concept map of relevant curriculum were also included. The SPSS 13.0 was used to conduct the t test and chi-square test. Results:At present, only 26.3% of the preset functions were used in the medical simulation courses based on high-tech medical simulator. Tutors commanded less than 30% functions, while SOS participated in the whole process of the course preparation and commanded 63.6% of the course operations, which was higher than the requirement of teaching concept map (45.5%). Among them, ECG monitoring regulation, venous management and special effects makeup were in greatest needs and were items with the biggest gap between ideality and reality. Resident physicians required SOS to replace the tutors to operate teaching facilities, so as to reduce interruption (37.0%), implications (31.3%) during courses, and improvement of experience sense during the course (32.3%). Furthermore, specialists with clinical background needed more assistance from SOS than those without clinical background ( tQ3=3.204, tQ4=2.573, tQ5=2.660; P<0.05). Differences were found between the actual work content of SOS and their job requirement ( χ2=12.632, P<0.01). Conclusion:SOS plays a significant role in the simulation course of standardized residency training, especially in the course of clinical professional physicians. Auxiliary functions of simulated courses, such as teaching aids management, special effects makeup, course designing, qualified SP and others are the main necessities for SOS at present. Participation of tutors and SOS together is essential to ensure a good development and performance of medical simulation courses for standardized residency training.
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Objective To study on the application value of flipped classroom and PBL in the teaching process of sanitary chemistry experiment. Methods 112 students studied in School of Public Health in Nanchang University were considered as research subjects, including Preventive Medicine grade 2014 class 1 (observation group, n=57) and class 2 (control group, n=55). The students were taught with flipped classroom model in the control group , while flipped classroom combined with PBL was applied in the observation group. The learning effect of the two groups was evaluated by using the form of "Richter score scale"in the self-made form. The data was input using Epidata 3.0 and processed by SPSS 18.0, and it was analyzed by t test and 2 test. Results The evaluation index scores (learning attitude, ability improvement, learning cooperation, professional quality improvement) in the observation group were significantly higher than that of thecontrol group (P<0.05). Besides, the final test scores were also significantly higher in the observation group than those in control group [(83.56 ±10.81) vs. (69.37 ±10.45), t=7.059, P=0.000]. Conclusion Combining flipped classroom with PBL in the teaching process of sanitary chemistry experiment for the students majored in Preventive Medicine not only improves students' exam results, but also helps students improve their learning attitude, learning ability, professional quality and so on. Therefore, the teaching method is worthy of wider application.
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Objective To evaluate the educational effectiveness of feedback debriefing in clinical training.Methods Forty medical students and fifteen teachers were enrolled in the 2015 after-internship clinical training,which was newly designed to obtain the debriefing part.The test scores and single technical practices were collected and analyzed,before and after the training.DASH scoring system was used to evaluate the effect of debriefing in the team simulation.Results were statistically analyzed by SAS 9.2(SAS institute Inc).Quantitative data were described by x ± s,while qualitative data were described by number and/or constituent ratio.Student's t test and Wilcoxon rank sum test were applied as needed.A P-value ＜ 0.05 was considered to be significant.Results The scores of the students before and after the assessment were (41.88 ± 8.54) vs.(65.06 ± 13.83),and the difference was statistically significant(P=0.000).Individual skills before and after the course had a different degree of improvement.The average DASH-scores evaluated by the students,teachers and supervisors were (39.3 ± 2.12) (very good),(35.1 ± 4.18) (good) and (37.2 ± 3.03)(very good),separately.Conclusions Potent debriefing helps to improve the effectiveness of simulationbased clinical training.
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A 63-year-old man presented with non-pruritic urticaria for 14 months,fever of unknown origin for nearly 12 months,and arthralgias of both lower limbs for 10 months.The fever,which was unrelated to the occurrence of skin lesions,appeared once a week on average,and might be as high as 39 ℃.Physical examination revealed irregular fever and lymphadenopathy in both inguinal and axillary regions.Skin lesions,consisting of rosecolored,slightly elevated plaques and papules,affected the trunk,both upper extremities and thighs.Skin biopsy showed perivascular infiltration of neutrophils and lymphocytes in the superficial dermal layer.Laboratory examination exhibited leukocytosis,elevated erythrocyte sedimentation rate and increased C-reactive protein level.Serum protein electrophoresis revealed an IgM-κ component in the γ-globulin zone.Radiographic examination suggested slight hepatosplenomegaly and hepatic cysts.Positron emission tomography/computed tomography (PET-CT) revealed bilateral knee joint effusion,degeneration of cervical vertebrae and lumbar vertebrae,as well as lymphadenectasis in both axillary,inguinal and popliteal regions as well as around external iliac vessels.Wholebody bone scan showed abnormalities of bilateral shoulder joints,elbow joints and knee joints,which were suggestive of arthritis.A diagnosis of Schnitzler syndrome was made.The patient was given prednisone 30 mg per day,and body temperature returned to normal with the improvement of condition on the second day.Subsequently,glucoside tripterygium total 20 mg thrice daily was additionally given,and the dose of prednisone was gradually decreased to 15 mg per day,with a satisfactory control of condition,disappearance of fever,skin eruptions or other discomfort,and marked relief of ostalgia and arthralgia.
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<p><b>OBJECTIVE</b>To assess the association of TNF-α and IL-1RA SNPs with the risk of silicosis in Chinese workers exposed to silica particles.</p><p><b>METHODS</b>Case-control study design was used to enroll 68 silicotic patients induced by silica particles and 68 healthy workers matched for length of silica particle exposure as controls. Both cases and controls were from the same company in southwest China, and each of them was requested to complete a questionnaire. Blood samples were drawn for genomic DNA extraction from each participant. The genotyping of TNF-α (-238 and -308) and IL-1RA (+2018) was performed using polymerase chain reaction-based restriction fragment length polymorphism (PCR-RFLP) and SYBR green-based quantitative polymerase chain reaction (qPCR), respectively. Unconditional logistic regression model was used to estimate odds ratios (ORs) and their 95% confidential intervals (CI) for SNPs.</p><p><b>RESULTS</b>No significant differences were found between cases and controls in particles exposure length, body mass index (BMI), and status of smoking and alcohol consumption except for age (P=0.001) and blood type (P=0.042). The frequencies of TNF-α (-238) and IL-1RA (+2018) genotypes in cases were significantly different from those in controls, (P=0.001 and P=0.002, respectively), while a borderline significant difference was found in the frequencies of TNF-α (-308) between cases and controls (P=0.063). The variants of three SNPs increased the risk of silicosis in the Chinese workers exposed to silica particles. The adjusted ORs of TNF-α (-308), TNF-α (-238) and IL-1RA (+2018) were 2.8 (95% CI: 1.1-7.5), 20.9 (95% CI: 1.8-236.4) and 4.0 (95% CI: 1.6-10.1), respectively.</p><p><b>CONCLUSION</b>It is suggested that cytokine polymorphisms of TNF-α (-238, -308) and IL-1RA (+2018) are associated with the risk of silicosis in the Chinese workers exposed to silica particles. Further independent studies on the interaction between SNPs and exposure to silica particles with a larger sample size are therefore warranted.</p>
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Adult , Humans , Male , Middle Aged , Asian People , Case-Control Studies , Genetic Predisposition to Disease , Genotype , Interleukin 1 Receptor Antagonist Protein , Genetics , Metabolism , Logistic Models , Odds Ratio , Polymorphism, Genetic , Silicon Dioxide , Toxicity , Silicosis , Genetics , Tumor Necrosis Factor-alpha , Genetics , MetabolismABSTRACT
ObjectiveTo investigate the etiology, clinical characteristics, diagnosis and treatment of regional portal hypertension caused by left upper abdominal malignant tumors.MethodsFrom January 2006 to December 2009, a total of 8 patients presenting regional portal hypertension were treated at our hospital, whose clinical data were analyzed retrospectively. ResultsPancreatic tumors (5/8) and retroperitoneal tumors(3/8)were the primary etiology,andthe main symptoms included upper gastrointestinal bleeding and irregular left upper abdominal pain.Isolated gastric varices were the most distinct clinical features. All patients underwent multi-visceral resection including pancreatic body and tail and spleen. Tumor involved stomach, left kidney, left adrenal and splenic flexure of colon were also removed en bloc. During the follow-up period there was no recurrent upper gastrointestinal bleeding, one patient died and two patients developed metastasis or tumor local recurrence.ConclusionRegional portal hypertension caused by malignant tumor was relatively rare,aggressive resection of multi-viscera combined with devascularization was an effective therapy.
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With the development of cell separation technique, hepatocyte transplantation becomes a hot topic; however, the application is limited by donor deficiency and immunological rejection. Microencapsulated hepatocytes contribute to the promotion and application for liver cell transplantation, for which provide a large amount of high activity and good function of liver cells, in this paper, liver cell microencapsulation technology and its progress in applications were reviewed, providing prospective way for large-scale and high-active culture in vitro and long-term cryopreservation.
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Objective To discuss the diagnostic methods and management of ruptured abdominal aortic (aneurysm)(AAA) and to analyse the main factors that influence prognosis.Methods The clinical data of 15 cases of ruptured infrarenal AAA treated in our hospital from 1998~2004 were retrospectively analysed. The main clinical manifestations were abdominal pain and/or back pain,low blood pressure or shock, and (pulsating) abdominal mass. 8 cases were diagnosed by DSA and/or sCTA; Doppler ultrasonic examination (suggested) rupture of abdominal aortic aneurysm in 2 cases; 2 cases had known history of AAA prior to (rupture); and 3 cases were diagnosed during operation. All of the patients underwent surgical operation. (Successful) clamping of the abdominal aorta above the neck of AAA was accomplished in 13 cases. Of these, the aorta was occluded below the diaphragm in 4 cases, and below the renal arteries in 9 cases.Results Seven cases(46.6%) died in the perioperative period. 2 died of blood loss from aneurysm that ruptured into the free abdominal cavity, 1died of myocardial infarction 5 days postoperatively, 2 died of respiratory failure 3 days and 7 days postoperatively, and 2 died of renal failure 4 days and 8 days after operation. Severe (complications) did not develop in the remaining patients.Conclusions Patients who present with the trilogy of abdominal pain and/or back pain, low blood pressure or shock and pulsating abdominal mass can be (diagnosed) easily. CT and Doppler ultrasonic examination are indicated for patients with questionable diagnosis and have stable vital signs. Operation is effective treatment for ruptured AAA. The crux of the operation is to mack an aortic occlusion proximal to the site of rupture of aorta to effectively control bleeding. Patients with rupture of AAA into the free peritoneal cavity or those with acute myocardial infarction, acute renal failure or respiratory complications had poor prognosis.