Objective To explore the value of practicing PBL which was guided by MDT in teaching diagnoses and treatments of war wound and trauma caused by compound agents.Methods An emulational war wound case caused by compound factors was designed and a multi-disciplinary team been organized,then totally 45 interns who would graduate in 2017 were divide into two groups randomly,experimental group which had 23 cases received PBL model combined with MDT followed six step procedure which included case preparation by teachers,independent analysis and group discussion by interns,problem extraction by teachers and division of solution by interns before class,then answering and debating problems by interns in class,conclusion and reporting after class in the end,while the control group which had 22 cases received traditional teaching model in accordance with common case discussion in class including characteristics of patient,diagnosis and diagnostic basis,examinations needed to carry out,first aid measures and professional treatments.The effect of new teaching model was evaluated by assessment in class and questionnaire after class.The data was analyzed through Chi-square test by SPSS 22.0.Results Class assessment showed 18 (78.3％) interns in experimental group displayed good abilities of proposing,analyzing and resolving medical problem,as well as good presentation and speech skills.Questionnaire survey showed that not only clinical teaching of war wound and trauma could meet the demands of talent training in battle-field rescue,but also displayed new model,which could help interns to enhance abilities of first-aid and treatment of war wound on future war field,reinforce the consciousness of military medical support and service.In addition,it could clear confusion more professionally and strengthen teamwork and overall importance.Conclusion Applying PBL combined with MDT in teaching diagnoses and treatments of war wound and trauma can not only help interns to review and retain important knowledge of related subjects,but also improve the abilities of interns in clinical diagnoses and treatments,and moreover,it merges the medical knowledge and war wound cure together organically.In short,the new model is well worth applying in clinical teaching and military medical education because of its excellent effects.

Objective To explore the effects of willed movement on neurological performance and the extracellular signal-regulated kinase (ERK) and cAMP response element binding protein (CREB) pathway in rats following focal cerebral ischemia.Methods Reversible middle cerebral artery occlusion was induced in 144 male SpragueDawley rats using intraluminal sutures,and they were randomly divided into a control group,a swimming exercise group,an environment modification group,and a willed movement group.The observation time points were at 7,15 and 30 days after reperfusion.A behavioral test was performed to evaluate any neurological deficiency.Reverse transcription PCR (RT-PCR) and immunofluorescence were used to detect the ERK and CREB responses in terms of mRNA and phosphorylated ERK (pERK) and phosphorylated CREB (pCREB) protein in the peri-ischemic brain tissue.Results The climbing frequency of the willed movement group was significantly higher than that of the environment modification group.Three days after reperfusion the neurological deficit scores of all groups began to decrease,and that of the willed movement group had decreased significantly more than in the other three groups at all time points.ERK/CREB mRNA and pERK and pCREB protein expression were dramatically up-regulated in the willed movement group at 7,15 and 30 days after reperfusion,significantly more than in the other three groups.Conclusions Willed movement may promote motor recovery by up-regulating and activating the ERK/CREB pathway following focal cerebral ischemia.

Objective To study the uncertainty and traceability of HBV DNA assays and discuss the comparability of results among different detection systems. Methods Different detecting systems were used to detect HBV DNA using the national standard substance as "quality control substance". The uncertainty of the results was evaluated referring "Guidelines for estimating and reporting measurement uncerTAinty of chemical test results" of NATA The results were traced back to the national standard substance. According to the CLSI document EP9-A2, the results were analyzed and subjected to bias estimation with the t(0.05sv) √u2b1+ u2b2 as the criterion clinically accepted to investigate the comparability of different detecting systems. Results The means (-y) measured by 3 HBV DNA assay systems were 6.15,5.88,and 6.31 lg(kIU/L) respectively. Except system A,both the biases of system B and C had statistical significance (all P ＜ 0. 05) and expanded uncertainty of three detection systems was varied, but the difference was within the maximum acceptable range (± 0. 5) of the external quality assessment by National Center for Clinical Laboratory. Being traceable to national standard substance, the results of HBV DNA of the three detecting systems were (5.45 ± 1.23), (5.55 ± 1.32) and (5.42 ± 1.25) lg(kIU/L), respectively.There was significant difference among three systems (F = 5.63, P ＜ 0. 05). Comparing system A and B,there was significant difference in statistic (q = 5. 12, P ＜ 0. 05) and the difference between system B and C also had statistically significant (q = 6. 85, P ＜ 0. 05), but the results between system A and C had no statistical difference (q = 1.85,P ＞ 0. 05). Among these three systems, the difference of any two detection systems had no statistical significance (all P ＞ 0. 05). It showed that system bias was acceptable in clinical application and the results between different systems were comparable. Conclusions It is necessary to estimate the uncertainty and traceability when comparing the HBV DNA assay among the different labs. It also needs to estimate the bias of different systems and evaluate the clinical acceptability to ensure the accuracy and comparability of the results.

OBJECTIVETo explore whether the dental restoration of nickel-chromium (Ni-Cr) based alloys will lead to extra excretions of urinary Ni and Cr.

METHODSUrinary Ni and Cr were repeatedly measured in 33 patients before and 2 months after the dental restoration of Ni-Cr alloys. The associations between alloy restoration and urinary Ni or Cr were analyzed by paired t test and general linear model of repeated measures.

RESULTSA slightly higher urinary Ni was found in patients after 2 month of the alloy restoration, but the difference was not statistically significant (before: 46.4 microg x mol(-1) crea; after: 67.6 microg x mol(-1) crea; P=0.063). This difference was only in female subjects (before: 44.8 microg x mol(-1) crea; after: 73.7 microg x mol(-1) crea; P=0.068). A significant higher urinary Cr was found in patients after 2 month of the alloy restoration (before: 57.0 microg x mol(-1) crea; after: 99.4 microg x mol(-1) crea; P=0.024). This significant difference was only in female subjects (before: 59.8 microg x mol(-1) crea; after: 124.4 microg x mol(-1) crea; P=0.023). General linear models of repeated measurements showed that urinary excretions of Ni and Cr were associated with the number of restoration and the area of metal basis uncovered with porcelain.

CONCLUSIONDental restoration of Ni-Cr alloy might lead to the enhanced excretions of urinary Ni and Cr.

Chromium ; Chromium Alloys ; Dental Porcelain ; Female ; Follow-Up Studies ; Humans ; Male ; Nickel ; Prospective Studies

Objective:To investigate the progress and prognosis of cervical high-grade squamous epithelial lesion (HSIL) in pregnancy and its effects on pregnancy outcome.Methods:Eighty-five pregnant women who were complicated by cervical HSIL and accepted prenatal care and delivered in Shanghai First Maternity and Infant Hospital from January 2013 to December 2017 were retrospectively recruited as case group. Another 85 pregnant women without cervical lesions were recruited as control. The progress and outcome of cervical HSIL in the case group and the association with delivery mode were analyzed. The pregnancy outcomes were compared between the two groups by two independent sample t-test, Chi-square test or Fisher's exact test. Results:In the case group, the regression rate of cervical HSIL was 29% (25/85) with 10 cases regressing to low-grade squamous epithelial lesion or atypical squamous epithelial cells of undetermined significance and 15 to chronic cervical inflammation; the persistence rate was 64%(54/85); and the progression rate was 7%(6/85). All six progressed patients gave birth to alive babies and one case progressed to invasive cervical cancer and five to HSIL with micro-invasive cervical cancer after delivery. There was no significant difference in the progression rate [7%(4/60) vs 8%(2/25)], regression rate [32%(19/60) vs 24%(6/25)] or persistence rate [62%(37/60) vs 68%(17/25)] between vaginal delivery and cesarean delivery women ( χ2=0.509, P=0.775). The incidence of premature birth of the HSIL group was higher than that of the control group [9%(8/85) vs 1%(1/85), Fisher's exact test, P=0.017], while there were no significant differences in the incidence of other complications or adverse pregnancy outcomes such as intrauterine fetal death, preterm premature rupture of membranes, low-lying placenta, amniotic fluid contamination of Ⅱ-Ⅲ degree, placental abruption, oligohydramnios and fetal distress between the two groups (all P>0.05). Conclusions:The progression rate of HSIL during pregnancy is low. Thus, a close follow-up could be conducted if invasive carcinoma is ruled out and the postpartum treatment should base on pathological results. HSIL during pregnancy could increase the risk of preterm labor, but is not an indication of cesarean section.

Objective To investigate the association of silent information regulator 1 (SIRT1) polymorphisms with intracerebral hemorrhage (ICH) susceptibility.Methods From September 1,2013 to May 30,2017,Han ethnic 201 ICH patients and 203 controls from South China were enrolled in this study.Genotyping and sequencing ofSIRT1 polymorphisms (rs7069102,rs2273773 and rs7895833) were performed by PCR-restriction fragment length polymorphism (PCR-RFLP).The correlation of SIRT1 polymorphisms with ICH was analyzed.Results (1) The rs7895833 A allele frequency distribution was significantly higher and the rs7895833 GG+AG gene frequency distribution was significantly lower in the ICH group than those in the control group (P＜0.05);the rs7069102 C allele frequency distribution was lower and the GG+CG gene frequency distribution was higher in the ICH group than those in the control group,without significant differences (P＞0.05).(2) Logistic regression analysis indicated rs7895833 AA genotype carriers had increased risk for ICH (OR:1.57,95％CI:1.14-2.18,P=0.006).(3) As compared with patients with rs2273773 TT genotype,patients with CC and CT genotypes had significantly higher high-density lipoprotein cholesterol level (P＜0.05);there were no associations between rs2273773/rs7069102 and ICH.Conclusion SIRT1 rs7895833 is significantly associated with ICH susceptibility;rs2273773 genotypes affect plasma high-density lipoprotein cholesterol level in the Chinese Han ethnic population.