How is it possible to bring about a harmonious development of science-tech education and humanity education in a way in medical education?One key to this issue is to map out a sound curriculum plan of humanity education.There is an analysis of curriculum plan in several foreign countries, such as America,Britain,France and Japan, in respect of training objectives, curriculum assignments,teaching contents and the methods are to be used for learning, teaching and evaluation.Finally,the comparison may shed light on the reform of our countrys curriculum plan.

This study evaluated the efficacy and safety of "J"-shaped uterine incision for caesarean section for patients diagnosed with placenta previa. A total of 55 consecutive cases of placenta previa treated in Union Hospital were retrospectively analyzed over a period of two years and 10 months. The subjects were divided into two groups with respect to the uterine incision. Twenty-four pregnant women with placenta previa who were indicated for caesarean section underwent the procedure using a new "J"-shaped uterine incision and 31 pregnant women with placenta previa received caesarean section that used the traditional transverse incision. The two groups were compared in terms of operation time, estimated blood loss, infant expulsion time, exhaust time and postoperative recovery. Meanwhile, comparison was also made in neonatal clinical data between the two groups. Compared with the "J"-shaped incision group, the traditional incision group had a lower Apgar scores (P<0.05). However, there existed no statistically significant differences in the overall time of operation and postoperative period of breaking wind (P>0.05). It is concluded that, with caesarean section for placenta previa patients, the "J"-shaped uterine incision significantly decreases intraoperative blood loss and facilitates the fetal delivery.

Objective To evaluate the clinical efficacy of early enteral nutrition combined with additional parenteral nutrition (EEN + PN) versus TPN (total parenteral nutrition) in patients after conventional pancreaticoduodenectomy (PD).Methods From January 2009 to January 2013, 340 consecutive patients who underwent conventional PD with Child's reconstruction at the First Affiliated Hospital of Xi'an Jiaotong University were enrolled into this single-center retrospective comparative study.There were 87 patients in the EEN + PN group and 253 patients in the TPN group.The preoperative baseline characteristics,histopathological types, intraoperative parameters and postoperative outcomes were recorded and compared between the two groups.Results There were no significant differences in the preoperative general characteristics data, pathological patterns, and intraoperative details.There were significantly higher rates in delayed gastric emptying (DGE), morbidity (15.9％ vs 6.7％, P ＜ 0.05), and pneumonia (10.3％ vs 3.6％, P ＜ 0.05);significantly prolonged nasogastric tube removal time (5.6 ± 0.2 days vs 3.9 ± 0.1 days, P＜0.05), and increase in hospitalization expenses (65 397.0 ± 861.2) Yuan vs (50 663.9 ± 239.2) Yuan, P ＜ 0.05) in the EEN + PN group when compared with the TPN group.Conclusions EEN + PN after conventional PD was associated with increased rates of DGE and pneumonia, prolonged nasogastric tube removal time, longer EN duration and increase in hospitalization expenses.Hence, EEN should only be performed prudently and selectively.

BACKGROUND:Cel co-culture can maximize the simulation ofin vivomicroenvironment. Cel scratch test and interleukin-1β can destroy the balance between matrix metaloproteinases (MMPs) and matrix metaloproteinase inhibitors (TIMPs), resulting in extracelular matrix degradation of the articular cartilage, functional disorders of chondrocytes and articular cartilage degeneration. OBJECTIVE:To study the effect of interleukin-1β on migration, MMP and TIMP expression of chondrocytes co-cultured with osteoblast supernatantin vitro. METHODS:There were three groups: chondrocyte monoculture group, osteoblast+chondrocyte group (co-culture group), osteoblast+chondrocyte+interleukin-1β group (interleukin-1β group). Cel scratch test was conducted to observe the migration of chondrocytes within 24 hours. Semi-quantitative PCR test was used to detect the changes in expressions of MMP-1, MMP-2, MMP-3, MMP-9, TIMP-1, TIMP-2, TIMP-3, TIMP-9 in chondrocytes within 24 hours. RESULTS AND CONCLUSION:Compared with the monoculture group, cel migration rate of the other two groups were increased significantly (P< 0.01). Compared with the monoculture group, the gene expressions of MMP-1, MMP-2, MMP-3 and MMP-9 were increased significantly in the coculture group (P < 0. 05); the gene expressions of MMP-1, MMP-3, MMP-9 were increased significantly in the interleukin-1β group (P< 0. 01). Compared with monoculture group, the gene expression of TIMP-1 was increased significantly (P < 0. 01), but the gene expressions of TIMP-3 and TIMP-4 were declined significantly (P < 0. 05) in the other two groups. These findings indicate that co-culture of chondrocytes with osteoblasts can promote chondrocytes migration, enhance gene expression of chondrocytes MMP-1, MMP-2, MMP-3, MMP-9 and regulate gene expression of TIMPs family. Interleukin-1β inhibitsthe migration of chondrocytes co-cultured with osteoblasts and gene expression of TIMPs family.

BACKGROUND:The correlation between blood stasis syndrome and non-blood stasis syndrome of lumbar intervertebral disc protrusion remains unclear.
OBJECTIVE:To construct serum protein pattern model for diagnosing blood stasis syndrome of lumbar intervertebral disc protrusion.
METHODS:A total of 180 cases were included in this study and divided into treatment group (120 patients with lumbar intervertebral disc protrusion) and control group (60 healthy cases from physical examination). Furthermore treatment group was equal y assigned into blood stasis syndrome subgroup and non-blood stasis syndrome subgroup, with 60 cases in each subgroup. The involved cases were wel matched in nations, genders and ages. Serum samples of peripheral blood from the 180 cases were col ected. Surface-enhanced laser desorption/inionation time of flight mass spectrometry and ProteinChip technology were employed to detect and plot protein mass spectrum. The protein peak values were identified using Biomarker Wizard software. Then serum diagnosis model of blood stasis syndrome of lumbar intervertebral disc protrusion was established. The obtained models were verified through double blind method. The differential proteins were searched by ExPASy data.
RESULTS AND CONCLUSION:We detected that peak values of eleven proteins had statistical significance (P<0.05) from the involved 180 cases. Among them, two proteins were highly expressed while the other nine proteins were lowly expressed. Serum protein pattern model for diagnosing blood stasis syndrome of lumbar intervertebral disc protrusion was established through Biomarker Patterns software, and the sensibility was 86.667%, the specificity was 94.167%, the positive predictive value was 88.136%. There are a variety of abnormal y expressed proteins in the serum of the patients with blood stasis syndrome of lumbar intervertebral disc protrusion. The serum protein pattern model involved eleven different proteins can be used to diagnose blood stasis syndrome of lumbar intervertebral disc protrusion.

Objective Purpose of this research is to biomechanically compare the screw-fixed and plate-fixed posterior malleolus fracture in osteoporosis patients with fatigue loading system and space motion system in simulation gait cycle,and to give a theory evidence on how to choose an internal fixation in osteoporosis patients with posterior malleolus fracture.Methods 72 osteoporotic cadaveric lower limbs were prepared to simulate Haraguchi Ⅰ posterior malleolus fracture and randomized into 2 groups with 36 each.Screw group were fixed with 2 paralleled 4.0 mm titanium partial thread cancellous screws from posterior to anterior.Plate group were fixed with plate.Based on the ratio of fracture area on sagittal plane to distal tibial articular surface (S),the two groups were subdivided into three subgroups,named as screw group A,plate group A,screw group B,plate group B,screw group C,plate group C.S (screw group A,plate group A)=l/4;S (screw group B,plate group B)=1/3;S (screw group C,plate group C)=1/2.According to the height of fracture fragments,these 6 subgroups were further divided into subgroup "a" with height 19.3mm and subgroup "b" with height 39 mm.Furthermore,4 different conditions of gait cycle were simulated as follows:1) specimen was loaded with 3.2 body weight (BW) at dorsiflexion angle of 12°;2) Start-up phase:dorsiflexion angle of 5°,3 BW;3) neutral position,3.6 BW;4) maximum plantar flexion,angle of 12°,4.5 BW.At the end of repeated loading,the displacement of fracture fragment was measured with space motion system.Results At dorsiflexion 12° and plantar flexion 15°,there was a significant difference of displacement between screw and plate group with a larger displacement in screw group,whatever S or H was.When ankle was at dorsiflexion of 5°,the displacement showed significant difference between screw group Aa and plate group Aa,screw group Ba and plate group Ba,screw group Bb and plate group Bb,screw group Cb and plate group Cb,with a larger displacement in screw group.In neutral position,the differences were significant with a larger displacement in screw group,except between screw group Bb and plate group Bb.Conclusion Plate can provide stronger fixation for osteoporosis patients with posterior malleolus fracture in most situations,but both of the two methods cannot provide stable fixation when posterior malleolus fragment was in a too big area or height.

This study evaluated the efficacy and safety of"J"-shaped uterine incision for caesarean section for patients diagnosed with placenta previa.A total of 55 consecutive cases of placenta previa treated in Union Hospital were retrospectively analyzed over a period of two years and 10 months.The subjects were divided into two groups with respect to the uterine incision.Twenty-four pregnant women with placenta previa who were indicated for caesarean.section underwent the procedure using a new"J"-shaped uterine incision and 31 pregnant women with placenta previa received caesarean section that used the traditional transverse incision.The two groups were compared in terms of operation time,estimated blood loss,infant expulsion time,exhaust time and postoperative recovery.Meanwhile,comparison was also made in neonatal clinical data between the two groups.Compared with the"J"-shaped incision group,the traditional incision group had a lower Apgar scores(P<0.05).However,there existed no statistically significant differences in the overall time of operation and postoperative period of breaking wind(P>0.05).It is concluded that,with caesarean section for placenta previa patients,the"J"-shaped uterine incision significantly decreases intraoperative blood loss and facilitates the fetal delivery.

Diarrhea ; epidemiology ; microbiology ; Humans ; Infant ; Salmonella Infections ; epidemiology ; microbiology ; Salmonella typhimurium

Objective To explore the efficacy and safety of uterine lower posterior wall breakwater-like suture technique in controlling the intraoperative bleeding of placenta previa. Methods From June 2016 to June 2017,47 patients were diagnosed placenta previa in Union Hospital,Tongji Medical College of Huazhong University of Science and Technology.Posterior wall breakwater-like suture technique was used preferentially,as for cases with poor myometrium layer,lower anterior wall stitch suture was used at the same time.Bilateral descending branches of uterine artery ligation and Cook balloon compression of uterine lower segment was conducted when necessary. The clinic data of the 47 cases were analyzed. Results Thirty cases(63.8, 30/47)were diagnosed placenta inccreta or percreta by ultrasound or MRI preoperatively.Senventeen cases were diagnosed as placenta accreta(36.2%,17/47).Thirty-four cases had the previous history of cesarean section.The average cervical canal length of 47 patients was(2.8±0.9)cm. There were 19 cases(40.4%,19/47)with 1 time posterior wall breakwater-like sutured and 16 cases (34.0%,16/47)with 2 or 3 times posterior wall breakwater-like sutured; 12 cases(25.5%,12/47)were treated with anterior wall stitch suture simultaneously.Ten cases(21.3%, 10/47)underwent uterine artery ligation, 17 cases(36.2%, 17/47)underwent COOK balloon compression on the staxis surface of lower segment. None of them had postpartum hemorrhage or performed internal iliac artery embolization. The median blood loss in the operation was 700 ml,the percentiles 25 was 500 ml,and the percentiles 75 was 1 200 ml.The blood loss≥1 000 ml in 18(38.3%,18/47)patients,and the most serious one was 2 500 ml. The median blood transfusion volume(including allogenetic transfusion and autotransfusion)was 450 ml, the percentiles 25 was 228 ml,and the percentiles 75 was 675 ml.The average vaginal bleeding volume was (150 ± 63)ml first day after operation. The mean hospitalization time was(4.7 ± 1.0)days. The mean gestational weeks of pregnancy termination was(36.1±1.5)weeks,and the mean birth weight of newborns was(2 817±492)g.Apgar score:1-minute 7.8±1.1,5-minute 8.9±0.8.No neonatal death, 16 cases were transferred to neonatal ICU(34.0%, 16/47)mainly for premature delivery and low birth weight. No complication was found in 6 months post-operation. Conclusions Uterine posterior wall breakwater-like suture technique is a simple,safe and effective way in controlling intraoperative bleeding of placental previa. Lower anterior wall stitch suture could effectively stop bleeding and restore the normal uterine shape. Combined application of various methods could significantly reduce the incidence of postpartum hemorrhage and hysterectomy,and improve maternal and fetal prognosis.

Objective To investigate effects of polyphylin Ⅰ on the proliferation and apoptosis of human melanoma cell line A375,and to explore their mechanisms.Methods Normal human melanocytes isolated from healthy human foreskin were divided into 6 groups to be treated with 0,1.5,3.0,6.0,9.0,12.0 mg/L polyphyllin Ⅰ respectively.A375 melanoma cells were divided into 4 groups,i.e.,control group,1.5-,3.0-,6.0-mg/L polyphyllin Ⅰ groups,to be treated with 0,1.5,3.0,6.0 mg/L polyphyllin Ⅰ,respectively.Cell counting kit-8 (CCK8) assay was performed to evaluate the effect of polyphyllin Ⅰ on the proliferation of normal human melanocytes and A375 cells.Hoechst 33258 fluorescent staining was conducted to observe the morphology of apoptotic cells,flow cytometry to estimate cell cycle phase distribution and apoptosis rate,dichloro-dihydro-fluorescein diacetate (DCFH-DA) fluorescent probe assay to detect the level of reactive oxygen species (ROS),rhodamine-123 staining to evaluate changes of mitochondrial membrane potential,spectrophotography to detect the level of ATP in A375 cells,as well as levels of lactic acid and glucose in the culture supernatant of A375 cells,and Western blot analysis to determine the protein expression of Bcl-2,Bcl-2-related X protein (Bax),cleaved-caspase-3,cyclin D1 and pyruvate kinase isozyme type M2 (PKM2).Statistical analysis was carried out by using one-way analysis of variance (ANOVA) for comparisons among groups and Student-Newman-Keuls-q (SNK-q) test for multiple comparisons.Results CCK8 assay showed that the treatment with polyphyllin Ⅰ at concentrations of 1.5,3.0,6.0 mg/L for 48 hours had no effects on the proliferation of normal human melanocytes,but significantly inhibited the proliferation of A375 cells.The survival rate of A375 cells was significantly lower in the 1.5-,3.0-,6.0-mg/L polyphyllin Ⅰ groups than in the control group (P ＜ 0.01).After the treatment with polyphyllin Ⅰ,distinct apoptotic morphology of A375 cells was observed under fluorescence microscope.Additionally,along with the increase of polyphyllin Ⅰ concentrations (0,1.5,3.0,6.0 mg/L),there were gradual increasing trends in the apoptosis rate of A375 cells (4.25％ ± 1.27％,10.03％ ± 1.49％,36.62％ ± 1.97％,44.11％ ± 2.47％ respectively,F =665.7,P ＜ 0.01),the percentage of A375 cells at G0/G1 phase (54.13％ ± 2.57％,67.35％ ± 3.79％,74.39％ ± 3.29％,82.29％ ± 3.99％ respectively,F =71.81,P ＜ 0.01),the level of ROS in A375 cells (P ＜ 0.01),the level of glucose in the culture supernatant (P ＜ 0.01),and the protein expression of Bax and cleaved-caspase-3 (both P ＜ 0.01),while gradual decreasing trends were found in the levels of mitochondrial membrane potential and ATP in A375 cells (both P ＜ 0.01),the level of lactic acid in the culture supernatant (P ＜ 0.01),and the protein expression of Cyclin D1,Bcl-2 and PKM2 (all P ＜ 0.01).Conclusion Polyphyllin Ⅰ can effectively induce A375 cell apoptosis by promoting the production of ROS in A375 cells and decreasing the mitochondrial membrane potential,and arrest A375 cells at G0/G1 phase by inhibiting the expression of PKM2 and Cyclin D1.