Computer laboratory teaching is the most important method to train the computer operating skills of medical students.Therefore,we have attempted the student-centered open-laboratory teaching model.This teaching model can train the computer operating skills and creative ability of students in medical college.

Objective To review the current research and application of root cause analysis (RCA) method in China's hospital management.Methods A retrospective analysis in six aspects was made by means of formulating a retrieval strategy and inclusion criteria, retrieval of databases, and literature review.Results The number of Chinese RCA researches was increasing year by year, mostly from researcher of the eastern coastal areas.These studies focused on the effects of RCA application outcomes and nursing safety.Tools in use were mainly fishbone diagram, brainstorming and 3-why method.72.24% of the root causes as found in literature were system factors, and 27.76% were human factors.Most of the researches made positive comments on RCA.Conclusions RCA is being warmly embraced by China's hospital management as it can positively change the accountability culture towards adverse events.Yet RCA has not been satisfactorily applied, and its future research and application in China's hospital management need more in-depth study and critical analysis.

OBJECTIVETo study the expression of NFkappaB p65 and its target genes in intestinal metaplasia (IM), dysplasia (Dys), gastric cancer (GC) infected with Helicobacter pylori (Hp) and explore the mechanism of infection by cytotoxin-associated antigen A expressing Hp (CagA(+)Hp) in the development of gastric cancer.

METHODSCagA antibody in blood sample of 289 patients was determined by ELISA. Hp was detected by rapid urease test and Warthin starry staining. Expression of NFkappaB p65 and its target genes in IM, Dys and GC was examined by immunohistochemistry.

RESULTSIn IMI approximately II, IMIII, DysI, DysII approximately III and GC, the expression of NFkappaB p65 was significantly higher in patients with CagA(+)Hp infection than those without CagA Hp infection. In IMIII and DysII approximately III, the expression of NFkappaB p65, c-myc, CyclinD(1) and bcl-xl was significantly higher in patients with CagA Hp infection than those without CagA Hp infection. In gastric cancer infected with CagA(+)Hp, the expression of NFkappaB p65, c-myc, CyclinD(1) and bcl-xl was significantly higher in intestinal type than in diffuse type.

CONCLUSIONThere are different mechanisms in intestinal type and diffuse type in the development of gastric cancer. The occurrence of intestinal type gastric cancer is associated with CagA(+)Hp infection which by NFkappaB p65 upregulating the expression of c-myc, CyclinD(1),bcl-xl in patients with IMIII, DysII approximately III. It may be an effective method to prevent gastric cancer by inhibiting NFkappaB p65.

Adult ; Aged ; Antigens, Bacterial ; analysis ; Bacterial Proteins ; analysis ; Cyclin D1 ; metabolism ; Female ; Helicobacter Infections ; complications ; metabolism ; microbiology ; Helicobacter pylori ; Humans ; Male ; Middle Aged ; Precancerous Conditions ; metabolism ; microbiology ; pathology ; Proto-Oncogene Proteins c-myc ; metabolism ; Stomach Neoplasms ; metabolism ; microbiology ; pathology ; Transcription Factor RelA ; genetics ; metabolism ; bcl-X Protein ; metabolism

OBJECTIVEThis study was focused on the clinical effects of topical steroid for chronic rhinosinusitis (CRS) in Chinese adults.

METHODSThe CRS patients were randomly selected in the department of otorhinolaryngology, first affiliated hospital of Sun Yat-sen university between november 2010 and December 2011. Thirty-four CRS patients with polyps (CRSwNP) or CRS without polyps (CRSsNP), no prior surgeries were included. These patients were prescribed to use budesonide nasal spay for three months. Evaluation included visual analog score (VAS), sino-nasal outcome test-20(SNOT-20), CT scan (Lund-Mackay score). SPSS 16.0 software was used to analyze the data.

RESULTSFour patients were lost to follow up, while the other 30 patients finished the 3-months' follow up. Except for smelling disturbance which was not statistically changed (t = 0.902, P > 0.05), VAS for nasal blockage (baseline: 4.84 ± 3.15, after treatment: 2.26 ± 2.27), rhinorrhea (baseline: 6.03 ± 2.93, after treatment: 1.96 ± 2.23), headache (baseline: 1.68 ± 2.66, after treatment: 0.42 ± 0.95), facial pressure (baseline: 2.04 ± 2.97, after treatment: 0.58 ± 1.42) and general symptom (baseline: 6.00 ± 2.75, after treatment: 2.71 ± 1.90) were statistically decreased (t value was 4.386, 6.740, 2.445, 2.980, 6.989, respectively, all P < 0.05). VAS of nasal blockage, rhinorrhea and general symptom were statistically decreased after one-month's treatment (all P < 0.05), but no statistical improvements were observed between first, second and the third month (all P > 0.05). SNOT-20 was significantly decreased after treatment (t = 3.687, P < 0.01). 22.2% patients were cured on CT scan.

CONCLUSIONSTopical steroid improves objective symptoms and quality of life in CRS patients. Some of the patients can be cured in CT scores. The symptoms improvements begin from the first month, but do not change during the latter two months.

Administration, Intranasal ; Adolescent ; Adult ; Aged ; Chronic Disease ; Female ; Humans ; Male ; Middle Aged ; Sinusitis ; drug therapy ; Steroids ; administration & dosage ; adverse effects ; therapeutic use ; Treatment Outcome ; Young Adult

OBJECTIVETo explore the feasibility of endoscopic modified agger nasi approach for the surgical treatment of frontal sinus diseases.

METHODSThe data of patients undergoing modified agger nasi approach for frontal diseases were prospectively collected since January 2009, including demographic data, findings at surgery, presence of postoperative symptoms, endoscopic appearance of the frontal recess and sinus, and complications.

RESULTSNineteen patients were enrolled from January 2009 to August 2010. Seventeen patients had chronic rhinosinusitis, in which 13 patients (76.5%) completely healed, 3 patients (17.6%) improved and 1 patient (5.9%) failed. Two patients had frontal sinus and anterior ethmoid sinus inverted papilloma, with no recurrence. The patients were followed up from 6 to 24 months, medium 16 months. No severe complication occurred. No frontal recess adhesion was found. Four sides of frontal recess showed stenosis caused by tissue hypertrophy.

CONCLUSIONThe modified agger nasi approach provides excellent access to frontal recess and frontal sinus, with good effect for preventing re-stenosis after surgery.

Adult ; Endoscopy ; Female ; Frontal Sinus ; surgery ; Frontal Sinusitis ; surgery ; Humans ; Male ; Middle Aged ; Nose ; surgery ; Otorhinolaryngologic Surgical Procedures ; methods ; Prospective Studies ; Young Adult

OBJECTIVETo investigate the relationship between point mutation of penicillin-binding protein gene (pbp) and amoxicillin resistance (AMOgamma) of Helicobacter pylori (H. pylori) as well as to compare the protein profiles under proteomic technology to get the candidate resistance-related proteins.

METHODS(1) AMOgamma strains were selected from the sensitive H. pylori strain 26695 by serial passage technique in vitro. (2) Point mutations of five putative resistance genes (HP0597, HP1565, HP1542, HP1556, and HP0160) were analyzed by denaturing high-performance liquid chromatography (DHPLC) and DNA sequencing. (3) Proteins samples were separated by two-dimensional electrophoresis (2-DE). Protein profiles were compared between the AMOgamma strain obtained in vitro and its sensitive parent strain 26695. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) was performed to identify the proteins of interest. The proteins were searched by software MASCOT and identified by peptide fingerprint map using the program MS-FIT of Protein Prospect.

RESULTS(1) An AMOgamma strain (MIC 8 microg/ml) was obtained. Complete loss of the resistant phenotype was observed after cultivation in the absence of AMO or storage at - 80 degrees C. (2) DHPLC and Sequencing result showed no point mutations in five pbp genes in the AMOgamma strain when compared with the corresponding PCR products from its parent strain 26695. (3) Protein profiling showed that eleven protein spots were differently expressed between 26695 and the AMOgamma strain. Of these protein spots in the AMOgamma strain, two new spots (Spot 1 and Spot 2) were observed with one (Spot 3) was up-regulated three-fold and the remained ones (Spot 4-11) were down-regulated.

CONCLUSIONAMO resistance of H. pylori might be resulted from, unstable phenotype change rather than point mutations of pbp genes. These differentially regulated proteins in AMOgamma strain might play a role in development of resistance to AMO in H. pylori.

Amoxicillin ; pharmacology ; Anti-Bacterial Agents ; pharmacology ; Bacterial Proteins ; genetics ; metabolism ; Chromatography, High Pressure Liquid ; Drug Resistance, Bacterial ; genetics ; Electrophoresis, Gel, Two-Dimensional ; Helicobacter pylori ; drug effects ; genetics ; metabolism ; Point Mutation ; genetics ; physiology ; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization

Objective: To explore the performances of HbA1c when identifying elevated blood glucose among pre pubertal children, and to provide scientific basis for early screening biomarkers of abnormal blood glucose in children. Methods: A total of 1 208 prepubertal children aged 7 to 10 years old in Xiamen were sampled with the cluster sampling method. Fasting venous blood was drawn to measure the level of HbA1c and FPG. According to American Diabetes Association (ADA) criteria, participants were divided into normal group, HbA1c abnormal group, FPG abnormal group and combined abnormal group. Partial correlation analysis was used to analyze the correlation between HbA1c and FPG. The cutoffs of HbA1c were calculated when FPG was 5.6 mmol/L. Receiver operating curve (ROC) was used to judge the performances of HbA1c while screening abnormal blood glucose. Results: With HbA1c, FPG and the combined indicators as the screening criteria, the prevalence of high blood glucose were 2.2%, 4.0%, and 5.8%, respectively. The partial correlation coefficient of FPG and HbA1c was 0.15( P <0.01), and the correlation coefficient in girls( r =0.22) and non overweight group( r =0.16) were higher. The cutoff of HbA1c was 5.15% if FPG was 5.6 mmol/L. Taking the combined indicator as the reference standard, the AUC of FPG was 0.84 (95% CI =0.79-0.90) and the AUC of HbA1c was 0.69 (95% CI =0.63-0.74). Conclusion There is a low correlation between HbA1c and FPG in pre pubertal children. The performance of HbA1c is different from FPG when used as the indicator to screen children with abnormal blood glucose. It is recommended to use the combined indicator of HbA1c and FPG to screen abnormal blood glucose in prepubertal children.

OBJECTIVETo evaluate the value of the Centerpiece plate in the cervical single open-door laminoplasty and compared its advantages with conventional suture fixation methods.

METHODSFrom December 2009 to August 2011,32 patients with cervical spondylotic myelopathy were treated with operation. Of them, 15 cases underwent cervical single open-door laminoplasty and Centerpiece plate fixation (group A),there were 8 males and 7 females,aged from 51 to 65 years old with an average of 60.5 years and ranged in course of disease from 2 to 15 months; 17 cases underwent cervical single open-door laminoplasty and silk suture fixation (group B), there were 9 males and 8 females, aged from 49 to 66 years old with an average of 61.5 years and ranged in course of disease from 1 to 14 months. All the patients with unsteady gait symptom before operation and cervical MR imaging showed spinal cord compression and denaturation. According to standard of Japanese Orthopaedics Association (JOA) to evaluate the spinal nervers function before operation and at 6 months after operation;according to CT scan to determine the sagittal diameter (AP) of upper vertebral canal and cervical activity (ROM).

RESULTSAll the patients were followed up from 8 to 20 months with an average of 13 months. All the incisions healed well and no complications such as internal fixation loosening and breakage,spinal cord injury, reclose-door were found. Postoperative symptoms relieved obviously and MRI and CT showed vertebral canal volume expanded significantly. Operative time and blood loss in group A were respectively (155.0+/-12.3) min, (407.0+/-11.8) ml and in group B were respectively (148.0+/-14.4) min, (398.0+/-15.4) ml. There was no significantly differenc, between two groups (P>0.05). JOA score in group A improved from preoperative 9.1+/-2.6 to postoperative 15.5+/-1.8 and in group B improved from preoperative 9.3 +/- 2.1 to postoperative 13.1 +/- 2.5 (P<0.05). CT sagittal diameter (AP) in group A increased from preoperative (10.7+/-2.4) mm to postoperative (17.6+/-3.2) mm and in group B increased from preoperative (11.6+/-1.7) mm to postoperative (15.9+/-2.0) mm (P<0.05). Cervical activity (ROM) in group A be- fore and after operation were respectively (51.0+/-2.6) degrees, (45.0+/-3.5) degrees and in group B were respectively (52.0+/-1.8) and (42.0+/-2.4). There was no significantly difference before operation between two groups (P>0.05) and there was significantly difference after operation between two groups (P<0.05).

CONCLUSIONTreatment of cervical spondylotic myelopathy with posterior single open-door laminoplasty and Centerpiece plate fixation can enlarge spinal canal volume,keep original cervical activity, improve postoperative JOA score. The method has obviously advantages compared with traditional suture fixation methods.

Aged ; Bone Plates ; Cervical Vertebrae ; surgery ; Female ; Humans ; Laminectomy ; methods ; Male ; Middle Aged ; Spinal Canal ; surgery ; Spondylosis ; etiology ; surgery

Objective To investigate the effect of 1.94 μm thulium laser enucleation of benign prostatic hyperplasia (BPH) with volume >80 ml by morcellator. Methods From September 2014 to June 2016, there were 95 BPH patients with prostate volume over 80 ml treated by thulium laser were divided into two groups according to the surgical procedure: 45 cases in group A, prostate tissue were washed out of bladder after vapoenucleation by 1.94 μm thulium laser; 50 cases in group B, the enucleated prostate tissue were extracted by morcellator. The operation time, the decreasing level of hemoglobin on the first day after surgery, the hospitalization time, the gland tissue weight, catheterization duration, short-term incidence of complications, and the IPSS, PVP, Qmax, QOL in 3 months after surgeon of the two groups were observed and recorded. Results There was significant difference in operation time and gland tissue weight between the two groups. The group B have significantly short operation time compared with group A (P < 0.05), and obtained gland tissue remarkably exceed the group A (P < 0.05). No significant difference was found in hemoglobin level, hospitalization time, catheterization duration, and short-term complication between the two groups (P > 0.05). The IPSS, PVR, Qmax and QOL of 3 month, after operation were significantly improved but without any significant difference between the two groups (P < 0.05). Conclusion Vaporization cutting tissue or morcellating tissue after 1.94 μm thulium laser enucleation has high safety, good curative effect and low complication, while extraction prostate tissue by morcellator can shorten the operation time and get more tissues.

OBJECTIVETo investigate the pathogenic mechanisms of airway inflammation and recurrent wheezing induced by recurrent respiratory virus infection after respiratory syncytial virus (RSV) infection.

METHODSSixty-four female BALB/c mice (aged 6-8 weeks) were randomly divided into four groups: control, RSV, Poly(I:C), and RSV+Poly(I:C) (n=16 each). The bronchoalveolar lavage fluid (BALF) was collected on the 3rd day after Poly(I:C) administration, and the total cell number and differential counts in BALF were determined. Hematoxylin-eosin staining was used to observe pulmonary pathological changes. The airway responsiveness was detected. ELISA was used to measure the levels of interferon-γ (IFN-γ), interleukin-4 (IL-4), interleukin-13 (IL-13), matrix metallopeptidase-9 (MMP-9), and tissue inhibitor of metalloproteinase-1 (TIMP-1) in BALF.

RESULTSCompared with the other three groups, the RSV+Poly(I:C) group had significant increases in the total number of inflammatory infiltrating cells in the airway, airway responsiveness, and MMP-9 level in BALF (P<0.05). The RSV+Poly(I:C) group showed more severe pulmonary tissue injuries compared with the control and RSV groups (P<0.01). Compared with the RSV group, the RSV+Poly(I:C) group showed significant reductions in the levels of IL-4 and TIMP-1 in BALF (P<0.01).

CONCLUSIONSViral re-infection in the late stage of RSV infection may cause an imbalance of MMP-9/TIMP-1 expression and thus contribute to aggravated airway inflammation.

Animals ; Asthma ; etiology ; Bronchoalveolar Lavage Fluid ; chemistry ; Female ; Lung ; pathology ; Matrix Metalloproteinase 9 ; analysis ; Mice ; Mice, Inbred BALB C ; Poly I-C ; pharmacology ; Respiratory Syncytial Virus Infections ; complications ; Tissue Inhibitor of Metalloproteinase-1 ; analysis