Objective: To prepare a simple, practical fiberoptic bronchoscope (FB) training simulator, and to evaluate its training efficacy. Methods: A box apparatus was designed for basic and advanced FB training; the box consisted of five boards with holes in it. The holes were aligned according to the entries of bronchus to pass the FB. Assistant materials could be placed in the box to simulate foreign bodies due to diseases, which was aimed to help the training of sophisticated skills including tracheal tube intubation, biopsy, brushing and bronchoalveolar lavage. To testify the training efficacy, forty volunteer residents who had never manipulated a FB were randomly assigned into two groups: one group was trained using the prepared training box (Group TB, n = 20) and the other group was trained using video-based technique (Group C, n = 20). The trainees of the two groups received an intubation examination using an advanced patient simulator, and the periods of intubation was compared between the two groups. Results: Flexible fiberoptic bronchoscope could smoothly pass through the holes in the box; the photos of the holes under bronchoscopy well simulated the normal images. All residents completed the training and examination. The mean duration of intubation was (55. 7 ± 10. 2) s in Group TB and (69. 3 ± 8. 9) s in Group C (P<0. 001). Conclusion: The present training box is simple and practical, and it can be used for advanced training of FB, with obvious training efficacy.

Objective: To screen for an optimized siRNA sequence targeting rat Toll-like receptor 4 (TLR4) in vitro. Methods: The full length gene of rat TLR4 was cloned and inserted into pEGFP-C1 plasmid to construct pEGFP-rTLR4. Three pairs of siRNAs targeting rTLR4 were chemically synthesized and were co-transfected with pEGFP-rTLR4 into HEK-293 cells via Lipofectamine2000. Cells were also co-transfected with siRNA targeting EGFP and negative control siRNA. The expression of EGFP was observed under inverted fluorescene microscope and flow cytometry. Results: Compared with the negative control group, 3 pairs of siRNAs targeting TLR4 and one pair of siRNA targeting EGFP significantly suppressed the EGFP expression (P<0.05); the inhibitory effect of siRNA2 (gene sequence: 5′-GTC TCA GAT ATC TAG ATC T-3′, 19 bp, 1 352-1 370) was the strongest one, with an interference efficiency over 75%. Conclusion: We have successfully obtained the siRNA sequence targeting TLR4 mRNA, which can efficiently suppress the expression of rat TLR4 mRNA in vitro.

Objective To examine the changes in the expression of voltage-gated sodium channel?subunit mRNA in the dorsal root ganglion(DRG)and the role it plays in the neuropathie pain.Methods Thirty- two male SD rats weighing 250-400g were randomly divided into 2 groups:groupⅠneuropathic pain(SNL,n= 20)and groupⅡsham operation(n=12).Neuropathic pain was produced by ligation of right sciatic nerve according to Seltzer.Paw withdrawal latency to noxious thermal(PWHL)and mechanical(PWML)stimulation were measured before(baseline)and 1,2,3,5,8,11,14,28 day after sciatic nerve ligation(SNL).DRG at L_(4,5) was isolated on the 14th day after SNL in 8 SNL and 4 sham-operated animals for determination of sodium channel?subunit mRNA expression(by in-situ hybridization).Results PWHL and PWML were significantly decreased on the 2nd-28th day after SNL as compared to the baseline in SNL group.There was no significant difference in?_1 subunit mRNA expression between the 2 groups.The?_2 subunit mRNA expression in DRG was hardly detectable.The?_3 subunit mRNA expression in DRG on the operated side was significantly higher in SNL group than in sham-operation group.Conclusion The up-regulation of sodium channel?_3 subunit mRNA expression in DRG may play an important role in neuropathic pain.

Objective In problem-based learning, students are often found difficult to con-struct medical knowledge systematically and transfer knowledge to solve new problems. In face of this challenge, this study aims to investigate the effect of visualization tool-supported online problem-based learning on medical students' clinical diagnostic expertise development. Methods A controlled study was conducted and 52 medical students were randomly assigned into experimental group (using visual-ization tool-supported online PBL environment for learning) and control group (using online PBL envi-ronment for learning without visualization tool support). Participants were asked to complete the diag-nostic analysis of three kidney problems according to the requirements of the learning environments and to provide feedback of online learning experience afterwards. Paired-sample t test and one-way analysis of vonriance were used to analyze both group's case 1 and case 3 on line learing scores. Results The results revealed that the experimental group had significant improvement in online learning performance [case 1: (1.47 ±0.54), case 3: (2.14 ±0.55), P=0.015], while the control group had no significant improvement [case 1:(1.57±0.67), case 3:(1.66±0.49), P=0.234]. Early performance of online learning and group factor had interative effects (F=7.266, P=0.013). Conclusions The findings suggest that visualization tool-supported online PBL environment can facilitate medical student clinical diagnostic expertise development effectively.

OBJECTIVETo observe clinical therapeutic effect of acupuncture on poststroke deglutition disorders.

METHODSSixty-eight inpatients of moderate and severe deglutition disorders were treated by the activating brain function to cause resuscitation needling method.

RESULTSTwenty-six cases were cured, 24 were remarkedly effective, 16 were effective, with a total effective rate of 97.06%.

CONCLUSIONThis needling method has a markedly therapeutic effect on poststroke moderate and severe deglutition disorders.

Acupuncture Points ; Acupuncture Therapy ; Brain ; Deglutition Disorders ; therapy ; Humans ; Resuscitation ; Stroke

OBJECTIVETo study the combined damage-effects of low-intensity 2,450 MHz microwave (MW) with three chemical mutagens on human lymphocyte DNA.

METHODSDNA damage of lymphocytes exposed to microwave and(or) with chemical mutagens were observed at different incubation time (0 h or 21 h) with comet assay in vitro. Three combination-exposure ways of MW with chemicals were used: MW irradiation before chemical exposures, simultaneously exposed to MW and chemicals and MW irradiation after chemical exposures. The three chemical mutagens were mitomycin C (MMC, DNA crosslinker), bleomycin (BLM, radiometric agent), methyl methanesulfonate (MMS, alkylating agent). The exposure time of MW and chemical mutagens were 2 h and 3 h respectively.

RESULTSThe differences of comet tail length between MW group and control group were not significant when lymphocytes were incubated for 0 h or 21 h (P > 0.05). However, when lymphocytes were incubated for 21 h with 30.00 micro mol/L of MMC, the comet tail lengths of MW + MMC group, MW-MMC group and MMC + MW group were (18.00 +/- 5.96), (21.79 +/- 11.47) and (22.32 +/- 8.10) micro m respectively; while with 3.00 micro mol/L of MMC, the comet tail lengths were (8.99 +/- 3.75), (12.40 +/- 5.35) and (14.00 +/- 5.38) micro m respectively, which were significantly higher than those of corresponding MMC groups [(9.42 +/- 3.34) and (6.50 +/- 2.89) micro m, P < 0.01 or P < 0.05]. The DNA damage of MW plus BLM groups and MW plus MMS groups were not significantly different from the corresponding BLM and MMS groups (P < 0.05).

CONCLUSION2 450 MHz MW (5 mW/cm(2)) did not induce DNA damage directly, but could enhance the DNA damage effects induced by MMC. The synergistic effects of 2 450 MHz MW with BLM and MMS were not obvious.

Bleomycin ; pharmacology ; Comet Assay ; DNA ; drug effects ; genetics ; radiation effects ; DNA Damage ; Humans ; Lymphocytes ; drug effects ; metabolism ; radiation effects ; Methyl Methanesulfonate ; pharmacology ; Microwaves ; adverse effects ; Mitomycin ; pharmacology ; Mutagens ; pharmacology ; Time Factors

Objective: To evaluate the efficacy and safety of catheter-directed interventional therapy in patients with acute pulmonary embolism(PE). Methods: PE was diagnosed by CT pulmonary angiography(CTPA). After risk stratification, a total of 79 PE patients (age (58.9±14.9) years old)were treated with catheter-directed interventional therapy via pulmonary vessels. The changes of pulmonary hemodynamics were compared before and after treatment. The risk of complications and side effects were observed. Results: The pulmonary artery pressure was changed followed by interventional therapy. The interventional therapy significantly decreased mean pulmonary arterial pressure (mPAP) from (35.3±11.2)mmHg (1 mmHg=0.133 kPa) to (30.0±10.6)mmHg (t=8.803,P<0.05) and the echocardiographic derived right ventricular dimension to left ventricular dimension (RV/LV) ratio from 0.93±0.16 to 0.83±0.15 (t=6.868,P<0.05). The arterial partial pressure of oxygen was increased from (69.0±8.6)mmHg to (75.1±9.9)mmHg (t=8.561,P<0.05) . The oxygen saturation was also increased from (93.9±2.9)% to (95.1±1.9)% at 24 h after the treatment (t=2.621,P<0.05) . Patients were further grouped as high-risk group (n=28) and intermediate risk group (n=51). mPAP and RV/LV ratio were significantly reduced in the two subgroups (all P<0.05) and the range of reduction was more significant in the high-risk group. Five patients experienced minor bleeding complication, 3 patients suffered worsened dispone post procedure and were treated with mechanical ventilation, 1 patient died, and 1 patient developed recurrent PE. Conclusion The catheter-directed interventional therapy improves pulmonary hemodynamics and reduces load of right ventricle both in high-risk or intermediate risk PE patients, this therapy strategy is safe and effective for patients with PE.

Aged ; Atrial Fibrillation ; surgery ; Catheter Ablation ; adverse effects ; Humans ; Male ; Pulmonary Veno-Occlusive Disease ; etiology ; therapy

OBJECTIVETo probe into long-term therapeutic effect and safety of Xingnao Kaiqiao acupuncture for treatment of cerebral infarction in restoration stage.

METHODSTwo hundred and thirty-four cases of cerebral infarction in restoration stage were randomly assigned to a Xingnao group and a routine group. The Xingnao group (n=116) were treated by Xingnao Kaiqiao acupuncture (once each day, for 4 weeks) and routine treatment of western medicine, and the routine group (n=118) were treated with routine acupuncture and the routine treatment of western medicine. They were followed-up for 6 months. The main indexes living, treatment and recurrence at the end of the following survey and the secondary indexes assessment of nervous functions at the end of the following survey, and the incidence rate of bad events in acupuncture were observed.

RESULTSThe death rate was 0.86% and the continuing treatment rate was 36.21% in the Xingnao group, and 1.69% and 36.44% in the routine group, with no significant difference between the two groups (both P>0.05) at the following-up of 6 months; the Xingnao group in decreasing recurrent rate and improving nervous function was better than the routine group (P<0.01); no severe adverse response was found in the 2 groups.

CONCLUSIONXingnao Kaiqiao acupuncture is safe and it is superior to routine acupuncture in long-term therapeutic effect, decreasing recurrence rate, improving nervous function.

Acupuncture Therapy ; adverse effects ; methods ; Adult ; Aged ; Cerebral Infarction ; therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Recurrence

BACKGROUND AND PURPOSE: Large cohort studies on relationship between family history of stroke (FHS) and stroke risk are lacking in Asians. We aimed to systematically evaluate the association of FHS with stroke risk in a cohort study of 0.5 million Chinese adults. METHODS: Information about FHS was self-reported. The median follow-up time was 7.16 years and the end-point of follow-up was incident stroke, which was entered directly into the China Kadoorie Biobank system. Multivariate analyses were performed with Cox proportional hazards model, and interaction analyses were carried using likelihood-ratio tests. RESULTS: Compared with participants without FHS, the hazard ratio (HR) (95% confidence interval, CI) of stroke for participants with FHS was 1.50 (1.46-1.55). The HRs increased with the number of first degree relatives with stroke (HRs=1.41, 1.98 and 2.47 for 1, 2 and ≥3 relatives, respectively, P(trend) <0.001). The HRs were 1.57 (95% CI: 1.50-1.66) and 1.49 (95% CI: 1.45-1.54) for sibling history and parental history, respectively. Similar associations with offspring stroke risk were observed between paternal history (HR=1.48, 95% CI: 1.43-1.54) and maternal history (HR=1.49, 95% CI: 1.43-1.55). Moreover, significant interactions were detected between FHS and health-risk behaviors (tobacco smoking and alcohol drinking). CONCLUSIONS: FHS is an independent risk factor for stroke in Chinese. The more first degree relatives are affected by stroke, the higher are individuals’ risk of suffering from stroke. The management of the health-risk behaviors for reducing stroke should be highlighted, especially for the individuals with FHS.
Adult ; Asian Continental Ancestry Group ; China* ; Cohort Studies* ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Parents ; Proportional Hazards Models ; Risk Factors ; Siblings ; Smoke ; Smoking ; Stroke*