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Objective:To explore the application effect of problem-based learning (PBL) combined with mind mapping and situational teaching in cardiology teaching of rural doctors.Methods:Twenty rural doctors of Batch 2017 and 24 rural doctors of Batch 2018 were selected as study subjects, and they were divided into the experimental group (Batch 2018) taught by PBL combined with mind mapping and situational teaching and the control group (Batch 2017) taught by traditional teaching. Classroom tests and questionnaires were used to compare the students' mastery of the teaching content, and the teaching effect and student feedback were evaluated. SPSS 18.0 was performed for t test, rank-sum test and χ2 test. Results:The theoretical results of the experimental group were significantly higher than those of the control group ( P<0.05). The scores of learning interest and initiative ( Z=-3.606, P<0.001), classroom attraction ( Z=-3.455, P=0.001), understanding ( Z=-3.757, P<0.001) and mastering ( Z=-4.259, P<0.001) in the study effect evaluation of the experimental group were significantly higher than those of the control group. The satisfaction to teachers about active classroom atmosphere ( χ2=4.556, P<0.05), flexible methods ( χ2=12.813, P<0.05), satisfaction ( P<0.05), theory with practice ( P<0.05), and thinking inspiration ( χ2=21.042, P<0.05) of the experimental group were significantly greater than those of the control group. Conclusion:PBL combined with mind mapping and situational teaching has a good effect on the teaching of cardiology of rural doctors, and it is worthy of promotion in the grassroots.
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Objective:To preliminarily observe the clinical efficacy of microwave hyperthermia combined with intensity-modulated radiotherapy (IMRT) and chemotherapy for patients with locally advanced gastric cancer.Methods:Forty patients who could not been operated or refused operation were enrolled in this clinical trial, who were confirmed as locally advanced proximal or distal gastric cancer by gastroscopy pathology and imaging. Radiotherapy was delivered by IMRT technology for 5 times per week with a total dose of 46 to 56 Gy (median dose of 50 Gy) in 25 to 28 fractions. Synchronous hyperthermia was given at 42 to 44℃ twice a week, 45 min/time. S-1 or capecitabine-based synchronous chemotherapy was performed, d1-14/3 weeks. The symptom remission rate, adverse reactions, objective remission rate (complete and partial remission) and survival were observed.Results:A total of 40 patients, aged between 56 and 83 years (median age of 71 years), were enrolled in this study. The male-to-female ratio was 7: 1. Among them, 38 cases (95%) showed symptom remission. The most common adverse reactions were grade 1-2 gastrointestinal reactions and leukopenia. The objective remission rate was 87.5%, the 2-year progression-free survival and overall survival rates were 68.6% and 70.5%, respectively.Conclusion:Preliminary findings demonstrate that microwave hyperthermia combined with chemoradiotherapy achieve satisfactory outcomes and yield tolerable toxicity in patients with locally advanced gastric cancer.
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PURPOSE: To study the efficacy of capecitabine or S-1 plus oxaliplatin (CAPOX or SOX) for treating thymidine phosphorylase (TP)- or dihydropyrimidine dehydrogenase (DPD)-positive advanced gastric cancer.MATERIALS AND METHODS: Eighty-six patients with stage IIIC to IV gastric cancer were assessed for TP and DPD expression by immunohistochemistry. The association between CAPOX or SOX efficacy and TP/DPD expression was retrospectively analyzed.RESULTS: There were no significant differences in the objective remission rate (ORR, 52.27% vs. 47.62%; P>0.05), disease control rate (72.73% vs. 73.81%, P>0.05), progression-free survival (hazard ratio [HR], 1.119; 95% confidence interval [CI], 0.739–1.741; P=0.586), and overall survival (OS; HR, 0.855; 95% CI, 0.481–1.511; P=0.588) between CAPOX and SOX. A higher number of stage IV patients showed TP positivity, while DPD-positive patients predominantly showed intestinal type of gastric cancer. In TP-positive patients, the ORRs associated with CAPOX and SOX treatments were 57.14% and 38.10%, respectively; OS was better with CAPOX than with SOX (HR, 0.447; 95% CI, 0.179–0.978; P=0.046). Among DPD-positive patients, the SOX treatment-associated ORR (60.87%) was significantly higher than the CAPOX treatment-associated ORR (43.48%). Furthermore, SOX treatment resulted in better OS than did CAPOX treatment (HR, 2.020; 95% CI, 1.019–4.837; P=0.049).CONCLUSIONS: No significant difference in clinical efficacy was found between CAPOX and SOX. TP-positive patients might respond better to CAPOX while DPD-positive patients may respond better to SOX. Our findings might serve as a guide for personalized chemotherapy for gastric cancer.
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Humans , Capecitabine , Dihydrouracil Dehydrogenase (NADP) , Disease-Free Survival , Drug Therapy , Immunohistochemistry , Retrospective Studies , Stomach Neoplasms , Thymidine Phosphorylase , Thymidine , Treatment OutcomeABSTRACT
Objective To investigate the relationship between mineral and bone metabolic disorders and prognosis in patients with chronic renal disease (CKD).Methods 200 patients with CKD admitted to our hospital from October 2015 to October 2017 were included.The prognosis of the patients was analyzed and grouped according to their prognosis.The follow-up was 6 months.They were divided into good prognosis group (no event survival) and poor prognosis group (complication and death).The clinical characteristics of the two groups were compared,and ROC curves were drawn to analyze the predictive value of mineral and bone metabolic indexes for poor prognosis,including serum calcium (Ca),phosphorus (P),calcium × phosphorus (Ca × P),bone alkaline phosphatase (BSALP),25 hydroxyvitamin D3 [25 (OH) D3],osteocalcin (OC),total parathyroid hormone (iPTH).Logistic regression analysis was used to determine the independent risk factors of poor prognosis in patients with chronic kidney disease.Results Of the 200 patients,164 (82％) had a good prognosis,and 36 (18％) had poor prognosis.The ratio of CKD4,CKD5,poor blood glucose control and poor blood pressure control in the poor prognosis group were 27.78％,16.67％,47.22％,41.67％,respectively,better than the prognosis group (4.27％,1.22％,18.29％,15.85％).The levels of Ca × P,BSALP and OC in the poor prognosis group were (3.46 ±0.21) mmol2/ L2,(98.64 ± 12.67) U/L,(71.19 ±58.73) μg/L,higher than the good prognosis group [(3.34 ±0.28) mmol2/L2,(85.43 ± 15.58) U/L,(36.57 ± 23.65) μg/L];The 25 (OH) D3 level in the poor prognosis group was (11.39 ±6.56) μg/L,which was lower than that in the good prognosis group (19.64 ±8.65) μg/L;with statistically significant difference (P ＜0.05).The area under the curve of Ca × P,BSALP,25 (OH) D3 and OC was 0.782,0.806,0.815 and 0.857,respectively,to predict the poor prognosis of CKD.The logistic regression analysis showed that CKD stage (stage 4-5),poor glycemic control,poor control of blood pressure,Ca × P≥3.393 mmol2/L2,BSAL≥92.932 U/L,25 (OH) D3 ≤ 14.016 μg/L,OC ≥86.339 μg/L were independent risk factors of poor prognosis of CKD (P ＜ 0.05).Conclusions Serum Ca × P,BSALP,25 (OH) D3 and OC levels have certain predictive value for the poor prognosis of CKD.The more serious the mineral and bone metabolism disorders are,the greater the risk of poor prognosis.
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Objective To compare the clinical efficacy of clopidogrel and clopidogrel in the treatment of myocardial ischemia in patients with coronary heart disease (CHD).Methods86 patients with myocardial ischemia of coronary heart disease from January 2016 to January 2017 in our hospital, were randomly divided into group A (n=43) and group B (n=43), group A was treated with ticagrelor treatment, group B was treated with clopidogrel treatment, clinical curative effect were compared between the two groups.ResultsThe total effective rate in group A was 86.04% was significantly higher than 72.09% in group B, the difference was statistically significant (P<0.05);The number of ST segment descent in group A was (36.17±4.22) times,ST segment continuous decline time (120.29 ±13.53) s ST continued to decline time (120.29±13.53) s, heart rate (65.27±3.18) times/min, systolic blood pressure (105.44±2.17) mmHg, diastolic blood pressure (63.11±3.14) mmHg were significantly lower than the control group (P<0.05);group A patients with triglyceride,total cholesterol,plasma viscosity trimming rate, whole blood viscosity at low shear rate, and whole blood high shear rate were significantly lower than those in group B (P<0.05).ConclusionCompared with clopidogrel, Grillo can effectively improve the blood microcirculation of myocardial ischemia in patients with coronary heart disease, coronary heart disease,relieve myocardial ischemia caused by coronary heart disease The clinical efficacy is remarkable, and it has the value of popularization and Application.
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Objective To explore frequency distribution of vitamin D receptor (VDR) genotype and the correlations between polymorphism of VDR gene Bsm Ⅰ sites and bone mineral density in the patients undergoing maintenance peritoneal dialysis.Methods A case-control study was conducted based on 82 patients with maintenance peritoneal dialysis and 80 healthy people.The frequency distribution of VDR genotype in two groups was detected and analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP).Serum biochemistry and bone mineral density of the patients undergoing maintenance peritoneal dialysis were detected by dual energy X-ray absorption (DEXA) and automatic biochemical analyzer,respectively.All data was analyzed with SPSS 19.0 software.Results The frequency distribution of VDR genotype between case group and control group had no significant difference (P ＞ 0.05).The serum biochemical index such as Ca,P,alkaline phosphatase (ALP) and parathyroid hormone (PTH)] of patients with maintenance peritoneal dialysis had no significant difference among three VDR genotypes(P ＞0.05).Compared to VDR bb genotype,the serum Ca was significantly higher in VDR BB genotype (P ＜0.05).The bone mineral density (BMD) and T-Score of patients with VDR BB genotype were the lowest,the BB genotype was the highest,and the difference was statistically significant among three genotypes (P ＜0.05).Conclusions The frequency distribution of VDR genotype between case group and control group had no significant difference.However,there is a correlation between VDR gene BsmⅠ sites and bone mineral density of maintenance peritoneal dialysis patients.
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Objective To investigate clinical characteristics and related factors of ulcerative colitis (UC).Methods One hundred and thirty-seven newly diagnosed patients with UC from 2006 to 2009 in the People's Hospital of Xinjiang Uygur Autonomous Region were selected as our subjects.The clinical data were recorded and the patients were followed up for 3 years.Results Of 137 patients,complete remission rate was 38.69％ (53/137),and partial response rate was 61.31％ (84/137).The overall effective rate was 100％ (137/137).The 1-year cumulative relapse rate was 26.28％ (36/137),and 2-year cumulative relapse rate was 49.64％ (68/137),59.85％ (82/137) for 3-year cumulative relapse rate.The occasion rate (≤ 1 time/year)was 27.01％ (37/137),and frequency (≥2 times/year) was 32.85％ (45/137).Fifty-five patients (40.15％ (55/137)) were no recurrence within 3 years.Relapse rate were not relate to gender (P ＞0.05).The relapse rate of patients less than 50 years was 68.09％ (64/94) substantially higher than that over 50 age group (41.86％ (18/43),x2 =8.444,P ＜ 0.05).The relapse rate of Uygur patients (70.42％,50/71) was substantially higher than the Han (48.48 ％ (32/66),x2 =6.851,P ＜ 0.05).The relapse rate of left colon and extensive colon were 71.64％ (48/67) and 71.88％ (23/32),higher than that of rectum(28.94％,11/38) (P＜ 0.05).The relapse rate of severe group (82.61％,19/23) was higher than that of the mild (52.38％,33/63)and moderate groups (58.82％,30/51) (P ＜ 0.05).In maintenance of mitigation group,52.73％ patients (29/55) were received maintenance treatment and relapse of those patients were significantly higher than recurrence group (31.71％,26/82,P ＜ 0.05).Mental stress may be the top one risk factor,which lead to recurrence of UC (64.63％,53/82),followed by imbalance diet (56.10％,46/82) and overwork (39.02％,32/82).Conclusion Relapse rate of the Uygnr UC patients was higher than that of the Han,and young adults has the higher recurrence rates than the elder.The factors of lesion extent,severity,ability to maintain treatment are related to recurrence of UC.Stress,imbalance diet and overwork are risk factors of recurrence of UC.
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Objective To evaluate the prognestic effect of thrombus aspiration combined tirofiban in patients of acute myocardial infarction. Methods 372 patients with acute ST segment elevation myocardial infarction were randomly divided into the observation group (n=183) and the control group (n=189). Patients in the observation group received thrombus aspiration combined tirofiban additional to conventional treatment, and cases in the control group received routine treatment. The curative effect, postoperative complications and adverse reactions were compared between the 2 groups. Results The postoperative TIMI classⅢperfusion was achieved in 152 cases (83.1%) in the observation group and 140 cases (74.1%) in the control group (P 0.05). MACE reorded within 30 d post operation was 10 cases(5.5%) in the observation group and 22 cases (11.6%) in the control group (P < 0.05). No thrombocytopenia recorded in both groups. Conclusions Thrombus aspiration combined tirofiban for patients with acute myocardial infarction during PCI can improve the postoperative coronary artery perfusion, left ventricular ejection function and reduce the incidence of MACE within 30 days.
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Objective To evaluate the role of the sodium removal and explore the relationship of sodium balance and blood pressure in patients with traditional hemodialysis.Methods Fourteen patients with maintenance hemodialysis were randomly enrolled in this study.Serum sodium concentration was measured at the pre-dialysis and post-dialysis.At the beginning of dialysis and every half hour,20 ml waste dialysates were collected,10 ml were drown from total 180 ml waste dialysates that had being mingled for measuring total NaCl removal and the removal caused by ultrafiltration.The Fisher's Exact Test was used to analyze the difference in incidence of hypertension(≥ 150/90 mmHg group or ＜ 150/90 mmHg) between the different NaCl removal groups.Results The total NaCl removal in single hemodialysis session was (29 ±14.9)g,A average of (18 ± 6.9)g sodium was removed by ultrafiltation (83 ± 58.6)％.The patients whose sodium removal in a hemodialysis session were less than 29 g,which were vulnerable to hypertension (≥ 150/90 mmHg group) (P =0.023).Conclusions The factors that effected sodium removal in hemodialysis session were complicated; most of sodium was removed by ultrafiltration of plasma water.These results demonstrated that adequate ultrafiltration volume in triple times a week rather than restriction of fluid intake was the principal factor that controls blood pressure in patients with traditional hemodialysis.
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Objective To assess the relationships among the autologous serum-induced skin wheal-andflare reaction,ex vivo serum-induced basophil histamine release, and serum levels of IgG anti-FcεRI autoantibodies in patients with chronic idiopathic urticaria (CIU).Methods Sixty patients with CIU collected from the Renmin Hospital of Wuhan University were recruited for this study.Sera were obtained from the subjects,and ASST was performed in all of the subjects.The results of ASST were determined according to a recommended criterion described by Sabroe et al,and the positive results were further subclassified into wheal plus flare (W+F) pattern and wheal-only (W) pattern,negative results into flare-only (F) pattern and no response pattern.Enzyme linked immunosorbent assay was used to quantify the content of histamine released by autologous serum-induced basophils and serum levels of IgG anti-FcεRI autoantibodies.Results Of the 60 patients,19 (31.7％)were positive for ASST,including 16 (84.2％) presenting W+F pattern and 3 presenting W pattern; 41 were negative for ASST,including 3 (7.3％) giving F pattern and 38 giving no response pattern.The histamine release rate was significantly higher in ASST-positive patients than in ASST-negative patients (33.38％ ± 9.83％ vs.4.06％ ±1.44％,t =5.13,P＜ 0.01),and was nearly twice as high as that in basophils induced by 10 μmol/L formylmethionyleucylphenylalanine (Fmlp).The serum levels of IgG anti-FcεRI autoantibodies were high in only patients giving (W+F) pattern (757.64 ± 168.99 ng/L),but low in the normal human controls (43.25 ± 16.63 ng/L).Conclusions The positive ASST result of wheal plus flare pattern is associated with high serum levels of IgG anti-FcεRI autoantibodies,and is suggestive of a clinical diagnosis of autoimmune chronic urticaria (ACU).
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Objective To compare the impacts of subtotal nephrectomy and ischemiareperfusion injury on renal stem cells and progenitor cells of rats,and to explore the significance of renal stem cells and progenitor cells for renal repair and the possible mechanisms of prognosis in rats with acute renal failure (ARF) or chronic renal failure (CRF).Methods Rats of CRF or ARF model underwent 5/6 nephrectomy or renal artery ligation and repedusion respectively,and rars in control group underwent sham operation.Scr,BUN and 24 hour urine protein were regularly measured.Kidney specimens were obtained at the set time for HE staining and fluorescence staining.Expressions of CD24,CD133 and podocin were detected by immunofluorescence.RT-PCR was performed to quantify the expression of transforming growth factor β1 (TGF-β1),Notch2,hepatocyte growth factor (HGF),bone morphogenetic protein 7 (BMP7) and Pax-2 mRNA in renal tissue and the expression of podocin mRNA in renal cortex.Correlation among the expressions of Pax-2 mRNA,podocin mRNA and glomemlosclerosis index were analyzed.Results The rats of two models presented typical ARF or CRF in renal pathology and function.Glomerulosclerosis index in CRF group increased gradually with time,which were (2.34±0.28)％,(25.12±5.67)％,(89.42±12.28)％ and (171.23±32.28)％ at day 14,day 30,day 60 and day 90 respectively.Compared with sham group,the CD24+CD133+ cells of the ARF rats showed no significant change in quantity and distribution,while the CRF rats showed gradual reduction of CD24 +CD133+ cells.The expression of podocin in glomerulus decreased temporarily and recovered finally after ischemiareperfusion injury,but decreased gradually after 5/6 nephrectomy.Compared with sham group,expression of TGF-β1,Notch2 mRNA in renal tissue was increased in CRF group,while the expression of HGF,BMP7 mRNA in renal tissue of ARF group were increased.Between the expression of Pax-2 mRNA in renal tissue and the expression of podocin mRNA in renal cortex,there was positive correlation in CRF group,while they both were negatively correlated with glomerulosclerosis index.Conclusions Ischemia-reperfusion injury makes no obvious impairment to renal progenitor cells.Having progressively injured the living environment of renal progenitor cells,subtotal nephrectomy reduces renal progenitor cells,and causes podocytes to repairing incompetently,which may be the main pathogenesis of CRF with poor prognosis.
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Objective To study the relationship between cardiovascular diseases (CVD)and 24-h peritoneal protein losses (PPL) in continuous ambulatory peritoneal dialysis (CAPD)patients. Methods One hundred and seventy-eight CAPD patients in our department were enrolled in this study. Their 24-h PPL was measured and other clinical data were recorded at the beginning. Meanwhile, Doppler ultrasound examination was performed. They were then followed-up prospectively for the development of CVD. Results The average of 24-h PPL was (5.0±1.8) g.Patients with diabetic status or preexisting CVD or carotid arteries arteriosclerosis had higher 24-h PPL than those without (t=2.082, P=0.039; t=2.601, P=0.010; t=2.217, P=0.029). 24-h PPL was positively correlated with left ventricular end-diastolic diameter (LVDd), interventricular septal thickness (IVSTd), posterior wall diameter of left ventricle at end-diastolic (LVPWd) and left ventricular mass index (LVMI) (r=0.222, P=0.040; r=0.217, P=0.043; r=0.339, P=0.002; r=0.305, P=0.007). It was negatively correlated with ejection fraction of left ventricle (r=0.221, P=0.040). One hundred and fourteen CAPD patients were prospectively followed-up for at least twelve months. Patients developing CVD were 40.4% and 19.3% for high and low PPL groups respectively (x2=6.035, P=0.014). In the multivariable logistic regression analysis, the 24-h PPL was one of the independent factors for developing CVD. Conclusions There is a significant and independent relationship between 24-h PPL and new cardiovascular events. 24-h PPL may be an important predictor of cardiovascular disease.
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OBJECTIVE@#To characterize the hemodynamic changes of chronic congestive heart failure(CHF) model induced by rapid right ventricular pacing after myocardial infarction in awake Beagle dogs.@*METHODS@#Five healthy adult male Beagle dogs were prepared for surgery. After the probes for measurement and the pacing leads were implanted, the left anterior descending artery was ligated during the surgery to induce myocardial infarction in the anterior wall of the left ventricle close to the apex. Six weeks after the surgery, rapid right ventricular pacing was initiated at the rate of 220 to 260 beats per minute for 4 weeks to induce CHF. Echocardiography was performed before the surgery. Both echocardiography and hemodynamic measurement were carried out before the rapid pacing and 4 weeks after the rapid pacing when the Beagle dogs were awake.@*RESULTS@#There was no significant difference in left ventricle end diastolic diameter (LVEDD), left ventricle ejective fraction (LVEF), and fractional shortening (FS) between pre-operation and pre-pacing. LVEDD [(44.71+/-3.35) vs. (38.01+/-1.54) mm] and left ventricle end diastolic pressure (LVEDP) [(25.63+/-1.86) vs. (10.58+/-1.23) mmHg] at 4 weeks after pacing significantly increased compared with the pre-pacing data(P<0.05). LVEF, FS, and LV dp/dt max were significantly declined (P<0.01).@*CONCLUSION@#Left ventricle remodeling and hemodynamic changes in the Beagle dog CHF models produced by rapid right ventricular pacing after myocardial infarction are similar to the changes observed in CHF of human beings.
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Animals , Dogs , Male , Disease Models, Animal , Heart Failure , Hemodynamics , PhysiologyABSTRACT
0. 05]. After sublingual glycerytrinitrate administration,the diameter of the brachial artery dilated significantly [(4.26?0.54) mm vs (4.73?0.43) mm, P 0.05]. Sublingual glycerytrinitrate administration dilated the brachial artery significantly [(4. 37? 0.77) mm vs (4. 82?0. 60) mm, P
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Objective To study the characteristics of mutations of gene COL4A5 encoding type Ⅳ collagen ? 5 chain in one chinese pedigree with X-linked dominant inherited nephritis (Alport's syndrome,AS). Methods Genomic DNA was extracted from 35 members of the pedigree of Alport's syndrome. All of 51 exons of COL4A5 gene were amplified by PCR with the primers synthesized according to the published intron sequences of COL4A5. The PCR products were further analyzed by agarose gel electrophoresis and single strand conformation polymorphism (SSCP). The PCR products showing polymorphism were directly sequenced. Results PCR-SSCP analysis showed that 17 PCR products had abnormal mobility of single strand DNA. DNA sequencing analysis revealed 9 suspicious mutations. But these suspicious mutations were not be confirmed by inverse sequencing analysis. Conclusion The exon mutation of COL4A5 gene of this pedigree did not be found, and the mutations of COL4A5 gene may locate in the its introns.