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Objective:To explore the practical effect of multi-disciplinary treatment learning (MDT-L) combined with PBL+CBL teaching on the clinical clerkship of neurosurgery.Methods:In the study, 30 neurosurgery clinical interns accepted by Wuhan Third Hospital from January 2019 to December 2019 were set as the control group, and 30 neurosurgery clinical interns from January 2020 to December 2020 were set as the research group. The control group implemented conventional teaching, and the research group used MDT-L combined with PBL+CBL teaching. After the clerkship, the two groups' clinical clerkship results, changes of comprehensive abilities before and after clerkship, professional quality after clerkship, and satisfaction with teaching methods were compared. SPSS 26.0 was used for t test and chi-square test. Results:After the clerkship, the theoretical knowledge and operational skills assessment scores of the research group were significantly higher than those of the control group ( P<0.05). There was no statistically significant difference in the scores of the two groups in learning interest, analytical ability, communication skills, innovation ability and file management ability before the clerkship ( P>0.05). While, after the clerkship, the comprehensive ability scores of the above dimensions of the two groups increased, and the comprehensive ability scores of the study group were all higher than those of the control group ( P<0.05). After the clerkship, the scores of professional ability, problem analysis and solving ability, mastery of diagnosis and treatment procedures, scoring of medical documents writing and total scoring of professional quality in the study group were all higher than those in the control group ( P<0.05). The satisfaction scores of the study group on the attractiveness, effectiveness and practicality of the teaching method were higher than those of the control group ( P<0.05). Conclusion:The application of MDT-L combined with PBL+CBL teaching in neurosurgery clinical clerkship can not only improve the performance of internship, but also enhance the comprehensive ability of interns and improve their professional quality and satisfaction.
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Objective:To explore the correlation of serum neurogenic exosome MicroRNA-211-5p(miR-211-5p)levels and brain derived neurotrophic factor(BDNF)levels with cognitive impairment in patients with Parkinson's disease and their diagnostic value.Methods:A total of 80 patients with Parkinson's disease(PD)admitted to the Second Hospital of Jiaxing City from January 2017 to April 2018 were enrolled.According to the Montreal cognitive assessment scale, patients were divided into the cognitive impairment group(n=36)and the non-cognitive impairment group(n=44). Meanwhile, 30 healthy people who took health check-ups during the same period were selected as the control group.Exosomes were extracted from peripheral blood of subjects by using the ExoQuick kit, and the neurogenic exosomes were separated by an L1 cell adhesion molecule(L1CAM)biotinylated antibody.BDNF levels in the exosomes were measured with an enzyme-linked immunosorbent assay(ELISA), and the expression level of miR-211-5p in the exosome was determined by real-time fluorescence quantitative PCR(RT-QPCR).Results:There was a correlation between BDNF and miR-211-5p( r=-0.805, P<0.001)in serum neurogenic exosomes( r=-0.805, P<0.001). BDNF was correlated with miR-211-5p in both the PD and control groups( r=-0.785 and-0.867, P=0.002 and 0.001). The miR-211-5p level was higher and the BDNF level was lower in the PD group than in the control group(0.30±0.08 vs. 0.17±0.04, 0.55±0.06 mg/L vs. 0.75±0.06 mg/L, t=7.125 and 6.368, P=0.000 and 0.000). The BDNF level was lower(0.45±0.07 mg/L vs.0.63±0.07 6.368 and 0.75±0.08 mg/L, t=8.999 and 7.608, P=0.000 and 0.000)and the MiR-211-5p level was higher(0.36±0.07 vs. 0.24±0.05 and 0.17±0.04, t=10.923 and 7.520, P=0.000 and 0.000)in the cognitive impairment group than in the non-cognitive impairment and control groups.The receiver-operating characteristics(ROC)curve showed that the area under the curve of miR-211-5p as a measure for cognitive impairment in Parkinson's disease was 0.860(95% CI: 0.770-0.950)with a threshold of 0.32.The area under the curve of BDNF as a measure for cognitive impairment in Parkinson's disease was 0.891(95% CI: 0.822-0.961)with a threshold of 0.67.BDNF seemed to be the target gene of miR-211-5p, since the latter could inhibit BDNF expression by reducing BDNF mRNA levels. Conclusions:Human serum neurogenic exosome miR-211-5p is highly expressed in PD patients with cognitive impairment and has the potential to be used as one of diagnostic parameters for cognitive impairment in PD patients.The high expression of serum neurogenic exosome miR-211-5p may be related to the inhibition of BDNF by reducing its mRNA levels.
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Objective To investigate the effects of disulfiram combined with copper (DSF /Cu) on proliferation and migration of brain metastases from lung cancer. Methods The cell were divided into blank control group, valproate group (1.0 mmol·L-1 of valproate) , DSF /Cu (1,2,3,4,5 mg /0.17 mg) . Brain metastases from lung adenocarcinoma were incubated 72 hours.The changes of proliferative ability of cancer cells were detected by CCK-8 method, the effect of DSF /Cu on the migration ability of cancer cells was detected by Transwell chamber, and the degree of apoptosis of cancer cells was detected by Annexus V-PI double staining method. Results The ability of proliferation was significantly inhibited, the ability of migration was significantly reduced,and the rate of cell apoptosis was significantly increased in each dose group of brain metastases from lung adenocarcinoma compared with the blank control group. With the increase of DSF /Cu dose, its ability to inhibit the proliferation and migration of metastases cancer cells and induce apoptosis of metastases cancer cells has increased gradually. Conclusion DSF /Cu can inhibit the proliferation and migration of brain metastases from lung adenocarcinoma and induce apoptosis. DSF is expected to be a new method of the combined treatment of brain metastases cancer.
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Objective@#To explore the effects of the combination of butylphthalide and clopidogrel on the blood viscosity and parameters of transcranial Doppler in patients with cerebral infarction.@*Methods@#Ninety patients with cerebral infarction were selected, and they were divided into control group and observation group according to the digital table, with 45 cases in each group.The control group was orally given clopidogrel, the observation group was given clopidogrel combined with butylphthalide.The clinical curative effect, blood viscosity changes and transcranial Doppler changes were compared between the two groups.@*Results@#The total effective rate of the observation group was 93.33%, which was significantly higher than 73.33% of the control group (χ2=5.67, P<0.05). After treatment, the HSV and PSV of the two groups were lower than those before treatment(t=4.34, 4.56, 7.89, 7.23, all P<0.05), and the decrease of HSV and PSV in the observation group was more significant than those in the control group after treatment(t=6.55, 6.67, all P<0.05). Compared with those before treatment, the Vm of ACA and MCA in the two groups after treatment significantly increased(t=4.34, 4.90, 7.33, 6.92, all P<0.05), the PI of ACA and MCA significantly decreased(t=4.77, 4.66, 7.12, 7.29, all P<0.05), and the above indicators in the observation group after treatment improved more significantly compared with those in the control group(t=6.31, 5.50, 6.54, 6.28, all P<0.05).@*Conclusion@#The effect of the early combination of butylphthalide and clopidogrel in the treatment of patients with cerebral infarction is significant, and it can effectively improve the change of blood viscosity.
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OBJECTIVE: To explore the effects of Xingnaojing injection combined with modified large bone flap decompression on postoperative intracranial pressure (ICP) and serum inflammatory factors in patients with severe traumatic brain injury (STBI).METHODS: In retrospective analysis, STBI patients were selected from Wuhan Municipal Third Hospital during May 2014-Nov. 2016, and then divided into control group and observation group according to therapy plan, with 32 cases in each group. Control group received modified large bone flap decompression and rountine postoperative infection. Observation group was given Xingnaojing injection 30 mL, once a day, after modified large bone flap decompression, for consecutive 30 d. ICP levels and GCS score were compared between 2 groups 3, 5, 7 d after surgery. The levels of serum inflammatory factors (hs-CRP, TNF-α, IL-2, IL-6) were compared before surgery and 7 d after surgery. SF-36 score were observed before surgery and one month after surgery. GOS grading and the incidence of complication were observed one month after surgery. RESULTS: There was no statistical significance in baseline information between 2 groups (P>0. 05). Before surgery, there was no statistical significance in GCS score, serum inflammatory factor level or SF-36 score between 2 groups (P>0. 05). GOS grading of observation group was better than that of control group after surgery (P<0. 05). Compared with control group, the levels of ICP in observation group were decreased significantly 3, 5, 7 d after surgery (P<0. 05), while GCS score was increased significantly (P<0. 05); 7 d after surgery, the levels of serum inflammation factors were decreased significantly (P<0. 05). SF-36 score was increased significantly one month after surgery (P<0. 05), and the incidence of incisional hernia and acute encephalocele were decreased significantly (P<0. 05); there was no statistical significance in the incidence of delayed hematoma, hydrocephalus or interstitial brain edema (P>0. 05). CONCLUSIONS: Prognosis effect of Xingnaojing injection combined with modified large bone flap decompression may be better than modified large bone flap decompression alone in the treatment of STBI, and there is difference between them.
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Objective To explore the relationship between different blood glucose levels and prognosis in patients with acute severe craniocerebral injury.Methods Clinical data of 120 patients with acute severe craniocerebral injury from Jun.2014 to Jun.2017 in Department of Neurosurgery,Tongren Hospital of Wuhan University were analyzed retrospectively.The patients were divided into the group of acute severe craniocerebral injury and the group of acute extra-severe craniocerebral injury according to the Glasgow coma score (GCS).Blood glucose levels were detected at the time of admission,the 1st day,the 3rd day,the 7th day and the 14th day after operation.According to the blood glucose levels on admission,the patients were divided into the normal blood glucose group,the blood glucose value of 6.1-10.0 mmol/L group,the blood glucose value ＞ 10.0 mmol/L group.The prognosis was evaluated by Glasgow Outcome Score (GOS) 3 months after discharge.The relationship between the blood glucose levels and GOS score in different groups was analyzed.Results The blood glucose levels in the group of acute extra-severe craniocerebral injury were higher than those in the group of acute severe craniocerebral injury,and the difference was statistically significant (P＜0.05).Of the patients with acute severe craniocerebral injury,54 had good prognosis,and 16 had poor prognosis.Of the patients with acute extra-severe craniocerebral injury,28 had good prognosis,and 22 had poor prognosis.The rate of good prognosis were 77.1％ and 56％ respectively,and the difference had statistical significance (P=0.014,x2=6.025).The good prognosis of patients with normal blood glucose group was 23 and the poor prognosis was 4,with a good prognosis rate of 85.2％ (23/27).Among patients with blood glucose of 6.1-10.0 mmol/L,30 had good prognosis and 8 had poor prognosis,with a good prognosis rate of 78.9％(30/38).Among patients with blood glucose ＞10.0 mmol/L,31 had good prognosis and 24 had poor prognosis,with a good prognosis rate of 56.4％ (31/55).With the increase of blood glucose,the good prognosis rate gradually decreased and the poor prognosis rate gradually increased,and the difference was statistically significant(P=0.010,x2=9.283).Conclusion Blood glucose level has influence on the prognosis of patients with acute severe craniocerebral injury,and the good prognosis of patients with acute severe craniocerebral injury is severely affected by hyperglycemia.
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Objective To evaluate the safety and efficiency of combined finasteride and metformin on benign prostatic hyperplasia (BPH) with type 2 diabetes mellitus(T2DM).Methods Totally 106 patients with BPH plus T2DM received finasteride and metformin treatment for over 12months.Before and after treatment,the side effects and following parameters were measured:prostatic volume (PV),prostate-specific antigen(PSA),international prostate symptom score (IPSS),quality of life (QOL),the maximum flow rate of urinary (Qmax),residual urine(RU),body mass index (BMI),cholesterol (TG).Results There were obvious changes in the following:PV decreased from (56.40±18.75)ml to(42.40± 19.68) ml,PSA decreased from(3.65± 1.08) μg/L to (1.76±0.66)μg/L,IPSS decreased from(22.58±9.45)to(16.67±7.56),QOL decreased from(4.22± ±0.87) to (2.36 ± 0.74),Qmax increased from(8.32±2.42)ml/s to(15.48±3.61)ml/s,RU decreased form(68.36±19.25)ml to(36.42±13.91)ml,BMI decreased from(28.52±3.73)kg/m2 to (19.76± 1.88)kg/m2,TG decreased from (2.52 ± 0.43) mmol/L to (1.38 ± 0.52) mmol/L.The changes of PV,PSA,IPSS,QOL,Qmax,RU,BMI and TG were statistically significant (all P＜0.05).Conclusions Long term combined finasteride and metformin treatment for BPH plus T2DM is effective and safe.And the two drugs may be improve the efficacy each other.
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ObjectiveTo investigate the effect of finasteride on hemorrhage in peri-operation of transurethral plasmakinetic enucleation of prostate (TUPKEP).Methods150 patients with benign prostatic hyperplasia (BPH) were randomly divided into 3 groups:control group without finasteride (n= 50),treatment groupl 1 with finasteride 5 mg daily for 7 days(n= 50) and treatment group 2 with finasteride 10 mg daily for 7 days(n= 50) before and after operation.All patients received TUPKEP and the data were recorded,including total blood loss,operation time,amount of washing fluid during operation,blood loss of per gram tissue,blood loss per minute,washing time after operation,amount of washing fluid after operation,and rebleeding rate within 3 months after operation.ResultsThe 150 patients successfully received TUPKEP.The total blood loss,amount of washing fluid during operation,operation time,blood loss per gram tissue,amount of washing fluid after operation,washing time after operation and rebleeding rate within 3 months after operation in treatment group 1 and 2 significantly reduced as compared with control group (P＜0.05).The blood loss per minute were (1.77±0.89) ml/min,(1.71±0.82) ml/min and (1.70±0.81) ml/min in 3 groups,respectively,and there were no significant differences among groups (P＞ 0.05).There were no significant differences between treatment group 1 and 2 in the total blood loss,operation time,amount of washing fluid during operation,blood loss of per gram tissue,blood loss per minute,washing time and amount of washing fluid after operation (P＞0.05).The rebleeding rate within 3 months after operation in treatment group 1 (8/35) and treatment group 2 (3/26) decreased as compared with control group (17/39) (x2= 3.544 and 7.523,P=0.016 and 0.025)and it was lower in treatment group 2 than in treatment group 1 (x2 = 1.293,P = 0.044).Conclusions The application of finasteride in peri-operation of TUPKEP can reduce hemorrhage.
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BACKGROUND:It is accepted that the best method for spermatogonial stem cells separation is using artificial cryptorchism model combined with surface makers.OBJECTIVE:To explore the feasibility of separation spermatogonial stem cells with ?6-integrin and c-kit as specific surface markers.DESIGN,TIME AND SETTING:The randomized control experiment was performed at the Renmin Hospital of Wuhan University from May to December 2006.MATERIALS:Forty adult,white Kunming mice with 6 weeks old were randomly divided into cryptorchidism and control groups,with 20 animals in each group.METHODS:Artificial cryptorchidism model was prepared by made an incision at the median of abdomen,and testis was pulled into abdominal cavity,which was fixed at the each side of lateral abdominal wall.There was no treatment in the control group.The single cell suspension of seminiferous epithelium was obtained by traditional two step enzyme digestion at 2-3 months after operation.FITC-conjugated anti-?6-intergrin antibody and PE-conjugated anti-c-kit antibodies were added.Then the cells with low side scatter light-scattering properties were sorted and positively stained for ?6-intergrin and negative c-kit expression.Meanwhile,the viability of the isolated cells was assessed by trypan blue staining.MAIN OUTCOME MEASURES:The morphological changes of cryptorchidism,and the sorting results of spermatogonial stem cells.RESULTS:Cell distribution in seminiferous tubule was disorder with reduced numbers.The layer and lumens were disappeared,and cell division phase could be seen in the center of tubules.Compared to the control group,the testicular cells in the cryptorchidism group were increased in the side scatterlow,Forward scatterhi areas,with figure left-upward displacement.The distribution of ?6-integrin+ and c-kit cells were deviated each other,it named that most ?6-integrin+ cell were not spermatogonial stem cells,so do the c-kit-cells.Only 2.8% of testicular cells exhibited side scatterlow,?6-integrin+,and c-kit-,which were spermatogonial stem cells in the cryptorchidism group.And trypan blue staining showed that over 95% of them were viable.CONCLUSION:Using the two surface markers to sort spermatogonial stem cells can advance the purity of the spermatogonial stem cells in cell suspension,but the specificity is insufficient.