ObjectiveTo explore the present national status of diagnostic teaching as well as to investigate the opinions on teaching operation such as overall course planning, so as to provide references for the formulation of national diagnostic teaching standard in the future.MethodsSelf-made questionnaires were adopted to carry out an anonymous survey among the teachers from 50 different medical colleges and universities who worked on diagnostic teaching throughout the country from October 2016 to September 2017.ResultsA total of 100 teachers were investigated. The diagnostic teaching departments where 59 respondents worked in were formed by a few fixed teachers plus teachers in rotation. The requirement of rotation time as well as the setting up of lecture-internship ratio in each school were quite various. Forty-seven respondents agreed that the ideal lecture-internship ratio should be internship more than lecture. As for the instruments of clinical skill room, only 40% of the respondents agreed that their diagnostic departments were equipped with a steady standardized patient (SP) team, which was also the reason why SP teaching was the least utilized teaching method during internship (47%). The respondents had various opinions on whether the final exam should weigh more than 50% in the subject score. Above these, the planning and expectations of the respondents on diagnostic course were mostly in consensus.ConclusionsThe development of diagnostic course including teaching staff, teaching content and teaching condition, etc. among each medical colleges and universities was not balanced. It’s quite necessary to formulate a unified and reasonable standard to normalize the teaching staff constitution, teaching planning and set-up as well as teaching condition so as to guarantee the teaching quality.
【摘要】 目的 探討活動期感染性心內膜炎（infectiue endocarditis，IE）患者心臟手術的最佳時期。 方法 回顧分析1999年9月-2009年9月行外科治療的92例IE患者的臨床資料。IE診斷標準為修訂的Duke標準。采用SPSS 12.0軟件包，分析了年齡、性別、是否是院內感染IE、合并癥（糖尿病、慢性阻塞性腫疾病、癌癥）、病原菌、手術時間等因素與手術并發癥及6個月病死率的關系。 結果 56例患者在確診為IE后7 d內手術，36例患者在確診7 d后，并抗生素治療完成后手術。葡萄球菌為主要感染菌株，與栓塞、膿腫及感染性休克顯著相關。最常見的手術指征是重度的瓣膜關閉不全合并心功能不全。6個月的病死率為12%。早期手術與晚期手術比較，病死率增高。單因素分析顯示，與6個月病死率相關的因素包括葡萄球菌感染和感染性休克。多因素分析顯示感染性休克為6個月內死亡的預測因子。感染性休克的患者盡管行了早期手術，病死率仍為67%。嚴重瓣膜關閉不全的患者，若未出現心衰，無手術（早期或晚期）死亡。 結論 手術患者的預后由是否發生過感染性休克決定。晚期手術組患者結果好于早期手術組，但結果的差異可能并不是手術的時期不同，而是感染性心內膜炎的嚴重程度不同造成的。對于有重度瓣膜返流但無心衰的患者，早期手術可能在縮短住院時間，預防心衰發生上有幫助。【Abstract】 Objective To discuss the optimal time of cardiac operations in patients with infective endocarditis (IE). Methods We analyzed the clinical data of 92 patients with IE diagnosed by the modified Duke criteria between September 1999 and September 2009. SPSS 12.0 was used to analyze predictors of 6-month mortality, including age, sex, nosocomial origin of infection, comorbid conditions (diabetes, chromic obstructive pulmonary disease, cancer), the causative microorganisms, the timing of cardiac operation, and the complications. Results Fifty-six patients underwent operation within the first 7 days after diagnosis of infective endocarditis, and 36 received operation at the completion of antibiotic treatment 7 days after the diagnosis. Staphylococci predominated and were significantly associated with embolism, abscess, and septic shock. The most frequent indication for operation was severe regurgitation with heart failure. The 6-month mortality was 12%. Early operation showed an increased mortality compared with late operation. Univariate analysis showed that factors associated with 6-month mortality included staphylococci infection and septic shock. Multivariate analysis revealed that septic shock was a predictor of 6-month mortality. Despite early operation for patients with septic shock, 67% of them died. No death occurred to patients with severe regurgitation but without heart failure after undergoing (early or late) operations. Conclusions The prognosis for surgically treated patients is determined by the occurrence of septic shock. The outcome in patients undergoing late operations is favorable compared with patients undergoing early operations. This difference is probably not due to the timing of the surgical intervention but to the severity of infective endocarditis. In patients with severe regurgitation without heart failure, early operation may offer benefits in shortening the length of hospitalization and preventing development of heart failure.
Objective To investigate the effect of cleft palate on the development of the mid-part of the face so as to provide an optimum animal model for the fetal cleft repair. Methods Twenty female Boer hybrid goats were selected, aging from 8 to 12 months and weighing from 35 to 55 kg. The mating day was identified as 0 day of pregnancy. The goats werediagnosed with pregnancy by the B-ultrasound examination at 30 days, and were allocated into experimental group (n=14) and control group (n=6). In experimental group, uterine cavitory operation was performed at 65 days of pregnancy to form cleft palate which was a fissure between oral and nasal cavity; no treatment was given as the control group. At 120 days of pregnancy, and after 1 month and 3 months of birth, the gross observation and 3-dimensional skull CT reconstruction were performed; and the maxillary bone width named as PPMM and the maxillary bone length named as APMM were measured. Results After operation, 2 goats died of infection, miscarriage occurred in 3 goats; 9 goats were included into the experiment. The operation success rate was 64.3%. In experimental group, maxillary dysplasia occurred in all the fetal goats at 120 days of pregnancy, and more obvious maxillary dysplasia was observed at 1 month and 3 months after birth; no maxillary dysplasia occurred in control group. There were significant differences in PPMM and APMM between 2 groups at different time points (P lt; 0.05). In experimental group, the lambs had poor chewing function, and died of pulmonary infection after aspiration at 1-4 months after birth. Conclusion The surgical procedure for partial ablation of secondary primitive palate in the midl ine could make the model of cleft palate.
目的 總結68例二尖瓣成形術的臨床經驗，評估其術后臨床效果。 方法 回顧分析2001年12月－2011年12月進行二尖瓣成形術治療的68例二尖瓣關閉不全患者的臨床資料。成形術的方法為：人工瓣環植入、雙孔成形、后瓣矩形切除、贅生物切除及心包補片修復、腱索轉移等。術中采用注水實驗和經食管超聲心動圖檢查評估成形效果。 結果 68例患者中手術死亡2例，二次開胸止血1例，肺部感染3例。全部患者術中注水實驗和食管超聲心動圖檢查顯示成形效果滿意。存活66例患者隨訪6個月，術后10 d、6個月彩色多普勒超聲心動圖檢查：左心房內徑、左心室舒張末內徑縮小。術后6個月彩色多普勒超聲心動圖檢查：無或微量反流33例，輕度反流27例，輕～中度反流5例，中度反流1例。 結論 根據二尖瓣關閉不全的特征，選擇相應的二尖瓣成形技術，可以取的較好的臨床效果。
【摘要】 目的 探討主動脈竇瘤破裂（RSVA）的臨床特點、診斷及外科治療方法。 方法 2004年1月-2009年12月對28例RSVA患者在體外循環下行RSVA修補術，同期行室間隔缺損修補術18例，房間隔缺損修補術4例，主動脈瓣成形術2例，主動脈瓣置換術4例。術后隨訪3個月～6年，平均32.4個月。 結果 28例患者均無手術死亡和殘余分流。失訪4例。心功能Ⅰ級20例，Ⅱ級4例；復查心臟彩色超聲心動圖無主動脈竇瘤復發或殘余分流，主動脈瓣輕-中度反流2例。 結論 外科手術是RSVA的最有效治療方法，竇瘤破口直徑gt;0.5 cm者宜用補片修補。伴有中或重度主動脈瓣關閉不全時需根據主動脈瓣病變程度以及手術者經驗決定，必要時需放寬換瓣指征。【Abstract】 Objective To evaluate the clinical characteristics, diagnosis, and surgical treatment of ruptured sinus of Valsalva aneurysm (RSVA). Methods Twenty-eight patients with RSVA were treated surgically in extracorporeal circulation. Repair of RSVA with patch were taken in all patients while closure of ventricular septal defect (VSD) in 18 patients, closure of atrial septal defect (ASD) in four patients, aortic angioplasty (AA) in two patiens and replacement of aortic valve in four patients. Results There was no death and no residue leak after operation. The patients were followed-up for 24 patients, ranged from three months to six years, with the average 32.4 months. The cardiac function of 20 patients was found to be of NYHA classⅠand four patients of classⅡ. Review the heart colour echocardiography, there was no residual tumor or sinus and aortic regurgitation light-moderate in two patients. Conclusions Surgery is the most effective treatment for RSVA, the breaches of sinus tumor in diametergt;0.5 cm is used to repair. When the patients with moderate or severe aortic regurgitation, whether it is necessary to relax in disc indications depends on the degree of aortic disease and performer’s experience.
ObjectiveTo systematically evaluate the changes in placental protein expressions in gestational diabetes mellitus (GDM) and their correlations with maternal insulin resistance (IR). Methods PubMed, Cochrane Library, Scopus, Web of Science, Embase, China National Knowledge Infrastructure, VIP database, Wanfang Database and CBMdisc were searched for case-control studies published from January 2009 to November 2021, which reported the placental protein expressions in GDM and their correlations with IR. Two researchers independently reviewed the literature, extracted data and evaluated the literature quality. RevMan 5.4 software was used for meta-analysis, and descriptive analysis was performed on data that cannot be combined. ResultsA total of 19 studies were included, comprising 2 012 patients. The results of meta-analysis showed that: the expression level of retinol binding protein 4 (RBP4) [standard mean difference=2.11, 95% confidence interval (CI) (1.64, 2.58), P<0.000 01] and the positive rate of protein tyrosine phosphatase-1B (PTP1B) [relative risk (RR)=1.56, 95%CI (1.29, 1.88), P<0.000 01] were up-regulated, and the positive rate of insulin receptor substrate 1 (IRS-1) [RR=0.69, 95%CI (0.60, 0.78), P<0.000 01] was down-regulated. The protein expression levels of RBP4 (P<0.000 01) and PTP1B (P<0.000 01) were positively correlated with homeostasis model assessment of insulin resistance (HOMA-IR), while the protein expression levels of IRS-1 (P<0.000 01) and APN (P=0.002) were negatively correlated with HOMA-IR, and glucose transporter 4 (GLUT 4) was not correlated with HOMA-IR (P=0.79). Descriptive analysis found that the expression levels or positive rates of adipocytokines (leptin, resistin), oxidative stress markers (xanthione oxidase, malondialdehyde, 8-isoprostaglandin),inflammatory factors (tumor necrosis factor α, Toll-like receptor 4, Galectin-3, Galectin-2, migration inhibitory factor),fetuin-A, forkhead box transcription factor 1, forkhead box transcription factor 3a and estrogen receptor α in GDM placenta were up-regulated and all were positively correlated with HOMA-IR. The expression levels or positive rates of insulin signaling pathway proteins [phosphoinositide 3-kinase (PI3K), protein kinases B (AKT), phospho-protein kinases B (p-AKT), GLUT 4] were down-regulated, PI3K and AKT were negatively correlatedwith HOMA-IR, while p-Akt had no correlation with HOMA-IR. ConclusionsThe dysregulation of placental protein expressions may mediate maternal IR exacerbation, thus promote the occurrence and development of GDM and other pregnancy complications. The causal relationship and regulatory mechanism are still unclear, which need to be further studied.
Scientific research innovation capability represents a core competence for postgraduate students, with curriculum-based teaching laying the theoretical and technical foundation for their scientific endeavors. However, existing postgraduate courses on scientific research innovation often suffer from issues such as excessive redundancy and overlapping content. Addressing these challenges, the West China School of Medicine, Sichuan University, has innovatively developed a curriculum system tailored for clinical medicine master's students. Guided by the innovation chains of clinical and basic scientific research, and grounded in students' practical research needs, the system centers on two flagship courses: clinical research design and statistical analysis, and biomedical research strategies and experimental technical ability. This initiative has proven effective in enhancing students' scientific thinking and innovative capacities.
ObjectiveTo investigate the network structure of comorbid depression and anxiety symptoms among medical staff and analyze differences across institutional types. MethodsA convenience sampling method was used to select medical staff from medical institutions at various levels in Guang'an City as participants between August 10 and 15, 2024. General demographic questionnaires, the Chinese version of the Patient Health Questionnaire (PHQ-9) for depression screening, and the Chinese version of the Generalized Anxiety Disorder Scale (GAD-7) were used to survey them. The study aimed to analyze the influencing factors of anxiety and depression and construct a network model. Predictability, bridging strength, and node strength were used to assess the network structure. The non-parametric bootstrap method was employed to evaluate the accuracy and stability of the network, and finally, a Network Comparison Test (NCT) was used to examine the impact of different levels of healthcare institutions on the network model. ResultsA total of 889 participants were included in the study. The analysis showed that the incidence of depressive symptoms (PHQ-9≥5) among healthcare workers was 44.88%, while the incidence of anxiety symptoms (GAD-7≥5) was 43.98%, with a comorbidity rate of 36.67%. Network analysis revealed that the top three symptoms with the highest node strength were difficulty relaxing (A4), excessive worry (A3), and fatigue (D4). The top three symptoms with the highest bridging strength were irritability/anger (A6), fatigue (D4), and worrying about terrible things happening (A7). The different levels of healthcare institutions did not have a significant impact on the network model. ConclusionThe central symptoms (such as difficulty relaxing, excessive worry, and fatigue) and key bridging symptoms (such as irritability/anger, fatigue, and worrying about terrible things happening) in the anxiety and depression symptom network can serve as potential intervention targets for healthcare workers at risk of depressive and anxiety symptoms.