Objective To evaluate the effect of progressive problem-based learning (PBL) in teach-ing of neurology and study its impact factors. Methods A total of 110 5-year undergraduate students were randomly divided into LBL and progressive PBL groups, with 55 students in each group. Both groups ac-cepted basic knowledge, clinical skills, case analysis and document retrieval teaching. Progressive PBL were given by three steps including introduction phase, transition phase and PBL stage. At the end of the internship, theoretical knowledg,practical skill scores and questionnaires were used to evaluate the effects of different teaching methods. Pearsonχ2 test was used to analyze the effects of gender, urban-rural character, mastery of relevant based knowledge and intra-group contribution on examination results of progressive PBL. Results Theoretical knowledge score of progressive PBL group was significantly lower than LBL group [(78.49 ±3.15) vs. (81.94 ±5.37), t=-4.11, P=0.000], while clinical skill score [(86.34 ±9.16) vs. (80.96±7.85), t=1.63, P=0.003] and clinical analysis score [(82.25±5.17) vs. (70.54±3.85), t=13.47, P=
0.000] of progressive PBL group were significantly higher than LBL group. Teaching satisfaction scales of learning interest ( χ2=7.21, P=0.007), self-learning ability ( χ2=6.70, P=0.010), knowledge use ability ( χ2=7.92, P=0.005), analytical thinking ability (χ2=4.36, P=0.037) and expression ability (χ2=9.17, P=0.003) in progressive PBL group were significantly higher than LBL group. Gender( χ2=0.0109,P=0.917) and urban-rural character (χ2=0.045, P=0.831) showed no significant impact on examination results of progressive PBL. While relevant based knowledge (χ2=6.82, P=0.009) and intra-group contribution (χ2=4.91, P=0.027) showed significant impact on examination results of progressive PBL. Conclusion Progressive PBL can improve the clinical skill and case analysis ability of students. Relevant based knowledge and intra-group contribution have significant impact on the effect of progressive PBL.

Reform was made on traditional education mode based on the criterion of undergraduate medical education at home and aboard.The reform includes the changes in teaching content,teaching methods and assessment methods in an aim to establish independent learning mode,cultivate students' self-study ability,initiative spirit and innovation ability.

Objective To investigate the effect of acupuncture at point Neiguan on mouse myocardial hypertrophy.Methods Thirty-sixty healthy C57BL6 mice were randomized into blank, model and treatment groups, 12 rats each. In the treatment group, an acupuncture needle was inserted into point Neiguan and retained for 15 min, once daily. After nine days of treatment, the ratios of cardiac weight/tibial length were compared between the groups. Left ventricular myocardial tissues were processed by Masson trichrome staining in every group of mice. The differences in myocardial fiber arrangement and collagen fiber distribution between the groups were observed under the ordinary optical microscope in 100 times of field of vision. Sarcomere structure, myofibril arrangement, collagen fibers and mitochondria in injured myocardial tissues were observed by transmission electron microscopy. Results Heart rate increased significantly in the model group and decreased significantly in the acupuncture group compared with the blank group. Cardiac weight and the ratios of cardiac weight/tibial length increased significantly in the model and acupuncture groups compared with the blank group (P<0.01) and decreased significantly in the acupuncture group compared with the model group (P<0.01). In the model group, myocardial tissues had compensatory hypertrophy with incontinuous status, and myocardial transverse striations had severe disorder/disruption, karyopyknosis appeared and cytoplasmic eosinophilic change became obvious in few of the rats. The results were better in the acupuncture group than in the model group. In the model group, part of myofibrils had focal fusion, interstitial collagen fibers proliferated and mitochondria had swelling and compensatory increase. The results were also better in the acupuncture group than in the model group.Conclusions Acupuncture at point Neiguan can reduce the production of collagen fibers and mitochondria, improve the arrangement of sarcomere structure and delay the progression of myocardial hypertrophy.

ObjectiveTo investigate the efficacy of along-meridian distal point selection in treating post-cerebral infarction shoulder-hand syndrome.MethodSixty patients with post-cerebral infarction shoulder-hand syndrome were randomly allocated to treatment and control groups, 30 cases each. The control group was treated by routine neurological medical treatment, conventional acupuncture for stroke-attack on meridians and rehabilitation training and the treatment group, by along-meridian distal point selection in addition. The therapeutic effects were evaluated in both groups after four courses of treatment. The VAS scores, affected-side hand swelling scores and upper limb FMA scores were compared between the two groups before and after treatment. ResultThe VAS score, affected-side hand swelling score and upper limb FMA score were significantly better in both groups after treatment than before (P<0.01). Post-treatment VAS score, affected-side hand swelling score and upper limb FMA score were significantly better in the treatment group than in the control group; there were statistically significant differences (P<0.01,P<0.05). ConclusionAlong-meridian distal point selection has clinically a better improving effect on the pain, affected-side hand swelling and upper limb function in patients with post-cerebral infarction shoulder-hand syndrome.

Objective To study the mechanism of RING finger protein 34 ( RNF34 ) involved in innate immunity . Methods Recombinant PCR was used and transient expression of the plasmid was achieved in HEK 293T cells.The cells were stimulated with Sendai virus ( SeV) or N-RIG-Ⅰfor the indicated time while luciferase activity was observed using the dual-luciferase reporter assay kit .Results We constructed the plasmid pcDNA 3-Flag-RNF34 and its three mutations .The study found that when stimulated by SeV , RNF34 could inhibit the activity of NF-κB and IFN-βmore significantly than RNF34-ΔFYVE, RNF34-ΔCID and RNF34-ΔRING.We also found that RNF 34 and its three mutants had similar inhibitory effect when the activation of NF-κB and IFN-βwas stimulated by the N-RIG-Ⅰ.Conclusion RNF34 negatively regulates innate immunity by acting on the RIG-Ⅰ-MAVS signaling pathway .

Objective To investigate the morphological differences of proximal femoral medullary cavity in elderly patients with intertrochanteric fracture and its effect on the treatment efficacy of proximal femoral nail antirotation (PFNA). Methods A retrospective case series study was conducted on the clinical data of 112 elderly patients with intertrochanteric fracture of the femur from December 2012 to January 2017, including the preoperative and postoperative hip joints orthotopic X ray (including the proximal femur), lateral X ray, and pelvic orthotopic X ray films. The proximal femoral canal flare index (CFI) and the metaphyseal canal flare index (MCFI) were measured. The proportion of patients with different types of medullary cavity and the gender difference were analyzed according to Dorr typing. The fractures were classified according to the modified Evans classification. Operation time, fracture reduction quality, tip apex distance (TAD), incidence of intraoperative split fracture around the rotors, postoperative fracture reduction loss rate, weight bearing time, and fracture healing time were recorded. Results The proximal femoral canal flare index (CFI) was significantly correlated with the intramedullary diameter above the lesser trochanter, the inner diameter of the affected side medullary cavity isthmus, and metaphyseal canal flare index (MCFI) (P ＜0.01). There was clear difference in gender in terms of the medullary cavity diameter 20 mm above the middle point of lesser trochanter, medullary isthmus internal diameter, the medullary cavity diameter 20 mm below the middle point of lesser trochanter, CFI, and MCFI. Thereinto, there was significant difference in the medullary cavity diameter 20 mm above the middle point of lesser trochanter [male (52.6 ± 6.4) mm, female: (49.9 ± 5.4) mm], the medullary cavity diameter 20 mm below the middle point of lesser trochanter [male: (26.5 ± 3.7) mm, female: (23.1 ±2.8)mm], and MCFI (male:2.0 ±0.3, female:2.2 ±0.2). No significant difference between the medullary isthmus internal diameter and CFI was found (P＞0.05). In this group, the medullary cavity of proximal femur was classified by Dorr: the proportion of funnel type, normal type, and chimney type was 5.4％ (6/112), 73.2％ (82/112), and 21.4％ (24/112), respectively. There was no significant difference in the modified Evans fracture stability among different morphological types of the proximal femoral medullary cavity. The difference of weight bearing time between normal group and chimney group was statistically significant [normal type: (21.4±16.9)d, chimney type: (45.5 ± 11.2)d] (P ＜ 0.05), but there were no significant differences in operation time, reduction quality, TAD, intraoperative incidence of cleavage fracture incidence, reduction loss rate, and healing time between the two groups (P＞0.05). Conclusions The occurrence and development of osteoporosis can cause significant changes in the morphology of proximal femoral medullary cavity, mainly manifesting as the gradual increase of the proportion of chimney type. The efficacy of PFNA in treatment of the intertrochanteric fracture is satisfactory. However, the risk of intraoperative cleavage fracture and postoperative reduction loss should be taken seriously.

Objective:To figure out variety of the plasma level of Alpha-1-Antitrypsin(α1-AT) in patients who undergo AKI following cardiopulmonary bypass(CPB), and whether this biomarker serve as a competent predictor.Methods:We recruited 75 patients undergoing cardiac surgery with CPB from January 2018 to January 2019. Patients were categorized into two groups according to the development of AKI. The relationship between plasma concentration of α1-AT and renal injury in two groups was analyzed.Results:27 patients in the AKI group were aged (54.3±12.2)years old, including 15 males and 12 females, the time of cardiopulmonary bypass was(133.5±34.7)min. In the non-AKI group, 48 cases were aged(47.7±11.3)years old, including 26 males and 22 females, and the time of cardiopulmonary bypass was(133.5±34.7)min. α1-AT was significantly decreased in AKI group at 1 h after operation[(0.53±0.53)g/L vs. (1.46±0.91)g/L, P<0.05]compared with the non-AKI group. The sensitivity and specificity of α1-antitrypsin level at 1h after operation was the highest when α1-AT was 0.675 g/L. CPB time ( OR=5.890, 95% CI: 1.078-32.173) and age ( OR=4.427, 95% CI: 1.113-17.614) were independent risk factors for AKI after surgery, and α1-AT at 1h after CPB ( OR=0.084, 95% CI: 0.021-0.333) were protective factors after operation. Conclusion:Increased concentration of α1-AT after cardiopulmonary bypass at early time is a protective factor for AKI and the concentration of α1-AT in plasma could be used as an early biomarker of AKI after CPB.

Objective:To explore the pain points of outpatient service in hospital from the patient′s perspective, and to provide new ideas for optimizing management of service quality.Methods:Ten top hospitals in China were selected to collect the poor evaluation texts of outpatient services published by patients on the Dianping.com from January 1, 2017 to December 31, 2019. The user′ pain-point analysis model was introduced, the pain-point index word collection was constructed according to the word frequency, the pain-point index was quantitatively analyzed combined with the sentimental value, and the content of the index words was analyzed through conceptual annotation.Results:The analysis of 1 259 poor evaluation texts showed that patients′ poor evaluation of outpatient service quality mainly focused on four aspects: interpersonal interaction, process factors, human-computer interaction and environmental factors. The poor attitude of medical staff in interpersonal interaction and the long queuing time and short treatment time in process factors were the most prominent.Conclusions:Online patient comment analysis is suitable for the identification and perception of pain points in outpatient service, and is helpful for the hospital to choose the direction and items of service improvement.

Objective To investigate the protective effect of high-pressure carbon monoxide for preservation of ex vivo rabbit heart graft in comparison with the conventional HTK cardioplegic solution preservation. Methods Heart grafts isolated from 85 New Zealand rabbits were randomly divided into Naive group (n=5), HTK group (n=40) and CO group (n=40). The grafts underwent no preservation procedures in Naive group, preserved at 4 ℃ in HTK cardioplegic solution in HTK group, and preserved at 4℃in a high-pressure tank (PO2:PCO=3200 hPa:800 hPa) in CO group with Krebs-Henseleit solution perfusion but without cardioplegic solution. After preservation for 2, 4, 6, 8, 10, 14, 18, and 24 h, 5 grafts from the two preservation groups were perfused for 30 min with a modified Langendorff apparatus and examined for left ventricular systolic pressure (LVSP), left ventricular diastolic pressure (LVDP), arrhythmia score (AS), myocardial ultrestructure, and cardiac enzyme profiles. Results After preservation for 6 to 24 h, the cardiac enzyme profiles and systolic and diastolic functions were significantly better in CO group than in HTK group, but these differences were not obvious between the two groups after graft preservation for 2 to 4 h. Significant changes in the myocardial ultrastructures occurred in the isolated hearts after a 24-h preservation in both CO and HTK groups, but the myocardial damages were milder in CO group. Conclusion Preservation using high-pressure carbon monoxide can better protect isolated rabbit heart graft than the conventional HTK preservation approach especially for prolonged graft preservation.

Objective To investigate the protective effect of high-pressure carbon monoxide for preservation of ex vivo rabbit heart graft in comparison with the conventional HTK cardioplegic solution preservation. Methods Heart grafts isolated from 85 New Zealand rabbits were randomly divided into Naive group (n=5), HTK group (n=40) and CO group (n=40). The grafts underwent no preservation procedures in Naive group, preserved at 4 ℃ in HTK cardioplegic solution in HTK group, and preserved at 4℃in a high-pressure tank (PO2:PCO=3200 hPa:800 hPa) in CO group with Krebs-Henseleit solution perfusion but without cardioplegic solution. After preservation for 2, 4, 6, 8, 10, 14, 18, and 24 h, 5 grafts from the two preservation groups were perfused for 30 min with a modified Langendorff apparatus and examined for left ventricular systolic pressure (LVSP), left ventricular diastolic pressure (LVDP), arrhythmia score (AS), myocardial ultrestructure, and cardiac enzyme profiles. Results After preservation for 6 to 24 h, the cardiac enzyme profiles and systolic and diastolic functions were significantly better in CO group than in HTK group, but these differences were not obvious between the two groups after graft preservation for 2 to 4 h. Significant changes in the myocardial ultrastructures occurred in the isolated hearts after a 24-h preservation in both CO and HTK groups, but the myocardial damages were milder in CO group. Conclusion Preservation using high-pressure carbon monoxide can better protect isolated rabbit heart graft than the conventional HTK preservation approach especially for prolonged graft preservation.