Objective:To explore the application of self-teaching model based on PBL teaching combined with flipped classroom in standardized residency training of orthopedics.Methods:There were 102 cases of residents who received standardized residency training from March 2017 to February 2018 in orthopedics department of Yueyang Hospital of Traditional Chinese and Western Medicine, among whom 55 were randomized into the observation group and 47 were divided into the control group. Traditional teaching was applied in the control group and self-teaching model was applied additionally in the observation group. At the end of the month, the teaching effect was evaluated by the department graduation examinations and questionnaire survey. SPSS 19.0 was used for t test. Results:The ability of history inquiry, diagnosis and physical examination of the residents in the observation group were higher than those in the control group. The self-study and data access ability, confidence in presenting, and satisfaction with teaching in the observation group were better than those in the control group.Conclusion:The self-teaching mode can arouse the learning initiative of residents, and increase residents' literature retrieval ability and their learning satisfaction.

Objective To assess the safety and efficacy of domestic sirolimus-eluting stent(SES)compared with bare metal stent(BMS)in the primary percutaneous coronary intervention(PCI)for patients with ST-segment elevation AMI in a real-world scenario.Method From January 2005 to March 2006,a total of 143 patient with ST-segment elevation AMI were enrolled in this study,and all of them underwent primary percutaneous coronary intervention(PCI).Among the 143 patients,74 were treated with domestic SESs(Firebird stent)and 69 with BMSs.The incidence of major adverse cardiovascular events(MACE:death,reinfarction,and target vessel revascularization[TVR])was evaluated at 30 days and 180 days.Continuous variables were compared using Student's unpaired t test.Categorical variables were compared using Fisher's test.Cox proportional hazard survival models were used to assess risk reduction of adverse events.P value

Objective To investigate the effects of echocardiography-guided pacemaker parameters optimization in order to enhance the efficacy of cardiac resynchronization therapy(CRT).Methods Seventeen patients with chronic heart failure received biventricular resynchronous pacing therapy.A-V delay and V-V delay was optimized under the guiding of spectral Doppler echocardiography and tissue Doppler imaging.Results The indices of heart function in all patients were significantly improved after the treatment.The NYHA class of the patients was improved from class Ⅲ～Ⅳ to class Ⅱ～Ⅲ.Since PAV/SAV was optimized to 130-180/100-150 ms,left ventricular filling time(LVFT) was increased from (354±147)ms to (420±112)ms,mitral reflux (MR) was decreased from (8.41±4.55)cm2 to (5.36±4.71)cm2.After VV delay was optimized to 4-40ms,standard deviation of time to regional peak systolic velocity (Ts-SD-12) was decreased from (48.4±17.9)ms to (30.2±18.6)ms,left ventricular outflow tract velocity time integral(VTI LVOT) was increased from (20.6±9.0)cm/s to (26.1±3.1)cm/s.Conclusions Echocardiography-guided optimization of the pacemaker parameters is necessary in order to enhance the efficacy of CRT.

Objective To evaluate the validity and reliability of the Chinese version of Alcohol Withdrawal Scale (AWS). Methods Totally 175 patients diagnosed as alcohol dependence according to the criteria of ICD-10 were studied. Intraclass correlation coefficient (ICC) analysis was applied for examining interrater consistency and Cronbach' s α for internal consistency. Factor analysis was used to examine the construct validity. Correlation analysis between AWS and CGI,Revised Clinic Institute Alcohol Withdrawal Syndrome Scale(CIWA-Ar) were conducted to evaluate the criterion validity. Based on clinical criteria,ROC curve was calculated so as to test the discriminative ability and establish the cut-off point of the scale. Results ( 1 ) Reliability: ICC value was 0.93,and Cronbach's α was 0.83,which indicated good interrater and internal consistency. (2) Validity:the correlation coefficients of the two subscale with the total scale score were 0.78,0.83 respectively. The correlation coefficients between the subscale were 0. 81 and factor analysis revealed that each item of the scale had relatively high load on the primary factor (0.409 ～0.926). At the time of admission,the total score of the AWS was positively correlated with that of CGI ( r = 0.71, P < 0.05 ). The total score of the AWS also was positively correlated with that of CIWA-Ar ( r = 0. 86, P<0. 05). As treatment went on,total score of the AWS showed a downward trend,at the end of the first week,the total score of the AWS was positively correlated with that of CGI ( r = 0.62, P<0.05). (3)The cut-off point of AWS for mild alcohol withdrawal state was determined as ≥3. With this cut-off point,AWS had both high sensitivity (92.1% ) and specificity (73.5% ) ,and the area under curve (AUC) was 0. 91. The cut-off point of AWS for moderate withdrawal state was determined as ≥7, and the sensitivity and specificity of AWS were 94.3 % and 89.7 % respectively, with the AUC of 0.94. The cut-off point of AWS for severe withdrawal state was determined as ≥ 10. With this cut-off point AWS had both high sensitivity (94. 9% ) and high specificity (92.6% ) .with the AUC of 0.93. Conclusion AWS has good reliability and validity and can reflect the change of the disease and the efficacy of treatment.

Objective To investigate the expression of matrix metalloproteinases 1 (TIMP-1)products inhibitor on smooth muscle cell (SMC) proliferation in rat autologous vein graft.Methods Autogenous vein transplantation model was established in 30 Wistar rats. The vein grafts were harvested at different time after grafting. The change of TIMP-1 was detected by using hematoxylin and eosin, immunohistochemistry and in situ hybridization (ISH). Results 1. Changes of histopathology in vein grafts: Intimal hyperplasia (IH) could be seen in 7 - 14 days, the peak at 2 ~ 4 weeks after operation.2. ISH results: TIMP-1mRNA positive cells appeared at 24 hours, increased significantly in 72 hours and reached the peak at 1 ~ 2 week after operation. There was significant difference between day 1 and 2 week.TIMP-I expression was not detected in normal vessels (P <0. 01). 3. Immunohistochemistry results: There was trace TIMP-I expression in normal vessels. The expression of TIMP-1 appeared at 72 hours after vein graft, increased mostly in 1 week, reached the peek at 2 week and reduced later. There was significant difference between day 1 and 2 week (P < 0. 01). Conclusions 1. The activation of TIMP-1 exists in autogenous vein grafts. 2. The intima experienced hyperplasia in spite of increased secretion of endogenous TIMP-1 after autogenous vein grafts.

Rheumatoid arthritis (RA) is a chronic inflammatory disease. Joint deformity and dysfunction can occur in the late stage of the disease,which is seriously harmful to human health. Anti-inflammatory factors (AIC), as a protective factor, together with pro-inflammatory factors (PIC) play important roles in the pathogenesis and progression of RA. It is widely accepted by the majority of scholars that the decrease of AIC and the increase of PIC in RA can aggravate the systemic and local inflammatory reactions and accelerate the articular cartilage and subchondral bone destruction, resulting in further progress of RA. A new generation of biological therapy for RA targeting at AIC is in the ascendant. Therefore ,it is important to understand the role of AIC in the pathogenesis of RA. From the perspective of the relationship between AIC and RA and the mechanism, this article reviews the research progress in this field, which provides new concepts for the diagnosis and treatment of RA.

OBJECTIVE To investigate the risk factors,clinical characteristics and resistance of Staphylococcus aureus nosocomial infections so as to guide the treatment of S.aureus infection.METHODS To collect clinical materials of S.aureus nosocomial infection and analyze risk factors and clinical characteristics and detect sensitivity of isolated strains to antibacterial agents.RESULTS Severe underlying diseases existed among 73 cases of S.aureus nosocomial infections,82.19 percent of patients had received invasive interventions.Lower respiratory tract was the most common infective site.Seventy-nine strains of S.aureus were isolated,including 66 meticillin-resistant S.aureus(MRSA) and 13 meticillin-sensitive S.aureus(MSSA).S.aureus showed general resistance to many kinds of antibiotic drugs.The resistant rates of MRSA were much higher than those of MSSA(P

Objective To study the effect of radon exhalation on the external dose model for building material,so as to provide the scientific and precise assessment of external radiation exposure hazard.Methods The mechanism of exhalation of radon from building material was analyzed,mathematical model of correction factor for the effect of radon exhalation was derived and resolved by Matlab program and the relationship between correction factor and diffusion length,surface emanation coefficient and thickness of building material was discussed.The absorbed dose rate induced by several classical building materials was calculated and compared.Results The radon exhalation correction factor was independent of diffusion length and thickness of building material in most cases.Negative correlation was found between radon exhalation correction factor and radon surface emanation coefficient.Radon exhalation correction factor numerically equals to '1-radon surface emanation coefficient'.The relative percentage deviation between absorbed dose rate induced by several classical building materials was in the range of 2.23％-10.02％,for both corrected and uncorrected radon exhalation effects.Conclusions Radon exhalation from building material has a certain effect on external dose model for building material,which should attract attention.It is important to conduct the correction for external dose model by introducing ‘1 -radon surface emanation coefficient’ as the radon exhalation correction factor,in order for the scientific assessment and control of external radiation exposure hazards from building materials.

OBJECTIVETo observe the change of PTEN/PI3K/AKT pathway hypoxia-inducible factor (HIF-1α), vascular endothelial growth factor (VEGF) in rats with adjuvant arthritis and to explore the mechanism of neovasculization in rheumatoid arthritis.

METHODSThirty rats were randomly divided into normal control group and model control group. The model control group were established the model of adjuvant arthritis using Freund's complete adjuvant. At 19 days after modeling, the expression of microvascular density (MVD), HIF-1α, VEGF were detected by ELISA assay and PTEN, PI3K, AKT were detected by Werstern Blotting.

RESULTSCompared with the normal control group, paw swelling, arthritic index were increased, and the expression of MVD, VEGF, HIF-1α of serum, PI3K, AKT of synovial tissue were significantly increased, PTEN was significantly decreased in model control group. PI3K, HIF-1α were positively correlated with MVD; VEGF, AKT were positively correlated with paw swelling; PTEN was negatively correlated with the arthritis index; HIF-1α was positively correlated with VEGF; PI3K was positively correlated with AKT, PTEN was negatively correlated with PI3K, AKT, VEGF.

CONCLUSIONImbalance of PTEN/PI3K/AKT pathway in rats with adjuvant arthritis is one of the mechanisms of synovial neovasculization.

Animals ; Arthritis, Experimental ; physiopathology ; Hypoxia-Inducible Factor 1, alpha Subunit ; physiology ; Neovascularization, Pathologic ; etiology ; PTEN Phosphohydrolase ; physiology ; Phosphatidylinositol 3-Kinases ; physiology ; Proto-Oncogene Proteins c-akt ; physiology ; Rats ; Rats, Sprague-Dawley ; Signal Transduction ; physiology

BACKGROUNDIncomplete stent apposition (ISA) has been demonstrated to be more common after drug-eluting stent (DES) implantation than after bare metal stent (BMS) implantation. Clinical outcomes of ISA remain controversial and the predictive accuracy of previous studies was limited by the short follow-up period of only 12-18 months. In the present study, we present the outcomes of a more than 2-year follow-up in patients with ISA after DES implantation.

METHODSFrom the clinical and core intravascular ultrasound (IVUS) database of the hospital, we identified 76 patients who had undergone DES implantation in de novo lesions between January 2004 and June 2005 and had received IVUS examination at a scheduled 6-month follow-up. A total of 13 (17.1%) patients had documented ISA at the follow-up by IVUS. Clinical follow-up was available up to 41 months after DES implantation and up to 33 months after identification of ISA.

RESULTSOver a mean follow-up of (34+/-5) months (range 24-41 months), 3 of the 13 patients (23.1%) suffered from ST elevated myocardial infarction with one death. Angiography confirmed the very late stent thrombosis (ST) in the area with ISA. All the 3 patients were implanted with sirolimus eluting stents in left anterior descending artery (LAD) and the very late ST occurred at 29, 31 and 32 months after DES implantation, and separately at 20, 23 and 23 months after the identification of ISA. All of the 3 patients had antiplatelet therapy continued before suffering from ST, and had been apparently stable on antiplatelet monotherapy with aspirin for a long period following dual antiplatelet therapy with aspirin and clopidogrel for more than 12 months.

CONCLUSIONISA of DES may be associated with a high incidence of very late stent thrombosis, even in clinically stable patients with dual antiplatelet therapy of at least 12 months after the procedure.

Aged ; Angioplasty, Balloon, Coronary ; adverse effects ; Drug-Eluting Stents ; adverse effects ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Thrombosis ; etiology ; Ultrasonography, Interventional