Objective To investigate effects of problem-based learning (PBL) and traditional learning (TL) on students' long-term memory and clinical practice ability. Methods Totally 79 5-year-program undergraduates of 2006, 2007, 2008 grade in school of clinical medicine of our hospital were randomly divided into PBL group (n=38) and TL group (n=41). The teaching effects were evaluated by two exams as well as teachers' subjective impression. SPSS 17.0 statistical analysis software was used;exam results were expressed as x±s; t test and rank sum test were used to analyze the exam results and subjective impression. α=0.05 was set as inspection level. Results In the second exam after 6 months, the mean exam scores were (76.66 ±5.94) and (73.59 ±5.74) in PBL group and TL group, without significant differences between the two groups (t=1.85, P=0.068). However, at clinical intern-ship stage, PBL group outperformed TL group based on the subjective evaluation (P=0.065, 0.277). Conclusion PBL can culture students' ability of problem-solving, but it is limited in culturing long-term memory.

OBJECTIVETo observe the association between angiotensin-converting enzyme (ACE) gene polymorphism and endothelial nitric oxide synthase (eNOS) gene polymorphism and risk of coronary artery disease (CAD) in Han Chinese.

METHODSThe polymorphism in the ACE and eNOS gene were detected by using polymerase chain reaction-restriction fragment length polymorphism analysis, blood pressure (BP), blood lipids, blood glucose (BS), body mass index (BMI) and left ventricle eject fraction (LVEF) were determined 236 patients with CAD and 190 healthy individuals.

RESULTSThe frequencies of DD genotype of ACE were higher and the II genotype were lower in CAD patients than in controls (P < 0.05). CAD patients with DD genotypes were related with higher serum TG, lower HDL-C, higher BS levels, higher BWI and lower LVEF compared to CAD patients with II and ID genotypes of ACE (all P < 0.05), while SBP, DBP, TC and LDL-C levels were similar among CAD patients and controls with different genotypes of ACE (P > 0.05). The genotype distributions of ACE and eNOS were also similar among CAD patients with or without diabetes mellitus/ACS, with single or multiple vessel diseases (P > 0.05). The frequency of GT genotype of eNOS was higher in CAD patients than in controls (P < 0.01) while the frequency of GG genotype in CAD patients and controls was similar (P > 0.05) and eNOS genotypes were not related to TC, TG, HDL-C, LDL-C, BS, BMI, SBP, DBP and LVEF levels among CAD patients and controls (P > 0.05). The risk of suffering from CAD in population with ACE DD genotype is 1.74 times higher than that with II genotype (P < 0.01) and 1.73 times higher in population with eNOS GT genotype than that with GT genotype (P < 0.05). The risk of suffering from CAD is 37.9% with II and GG genotypes and 77.8% with DD and GT genotypes.

CONCLUSIONThe ACE and eNOS genotype polymorphisms were associated with risk of CAD and persons with DD and GT genotypes take higher risk of suffering from CAD.

Aged ; Case-Control Studies ; Coronary Artery Disease ; genetics ; Female ; Gene Frequency ; Genotype ; Humans ; Male ; Middle Aged ; Nitric Oxide Synthase Type III ; genetics ; Peptidyl-Dipeptidase A ; genetics ; Polymorphism, Single Nucleotide

Objective To explore the effect of hypertension on the life quality in elderly.Methods A cohort of 1847 elderly in community in Beijing was recruited.Blood pressur,body structural and mental heath,cognition, activity and life satisfaction were evaluated by physical examination,CES-D scale,MMSE,and ADL,IADL scale.Results The life quality of the elderly hypertension was worse than those of normotensive;the morbidi- ties of chronic disease related to hypertension were higher and the cognitive ability worse with the duration of hy- pertension.The prevalence of depression was higher and the vitality was decreased as the rising of blood pres- sure.Conclusion Prevention and control hypertension improve life quality in elderly hypertension.

Objective To explore the depression status of hypertension and analyze the associated factors in the elderly population in a community of Beijing.Methods This cohort of 1064 elderly people in the community were screened with Centerfor Epidemiology Scale(CES-D). Results Those who lived in rural(21.6% vs city 7.3%),illiterate(19.9% vs literate 11.2%),mateless(19.7% vs mate 12.4%),lower income(21.9% vs high in- come 9.8%),life accidents(23.2% vs without life accidents 8.6%),sleep disorder(31.0% vs sleep good 8.7%) and lower living abilities(26.7% vs high living ability 9.0%)had higher incidence of depression(all P

Objective To investigate the learning curve of transesophageal echocardiography (TEE) applied in mechanically ventilated patients in intensive care unit (ICU).Methods A prospective observation study was conducted. A total of 60 consecutive patients necessary for mechanical ventilation and TEE examination admitted to the Department of Surgical ICU of the First Affiliated Hospital of Sun Yat-Sen University from December 2016 to June 2017 were enrolled. The TEE examination was performed by the same ICU physician who was skilled in transthoracic echocardiography (TTE). The TEE probe intubation (trial numbers of TEE intubation, the duration for a successful intubation at the first attempt, the total time for successful intubation), TEE examination (the scores of TEE examination, the duration of TEE examination), and the complication during examination were observed, with learning curve established. According to the date of examination, a statistical analysis was carried out for each group of 12 cases. Through the learning curve, that TEE examinations in how many cases should be performed by the ICU physician to master the skill was observed.Results With the increase of TEE examinations performed by the physician, the duration for a successful intubation at the first attempt and the total time for successful intubation were gradually reduced; the scores of TEE examination were gradually increased, and the duration of TEE examination gradually reduced. ① TEE intubation: there was no statistical significant difference among the 60 patients in the number of intubation attempts (F = 0.258,P = 0.904). After the SICU doctor completed TEE intubations in 12 cases, the duration for a successful intubation at the first attempt was significantly reduced (seconds: 22.24±18.37 vs. 34.88±1.65,P < 0.05) and then tended to stabilize in the 16 - 23 seconds. The learning curve indicated that the physician could basically master the intubation skills after performing TEE intubations in 24 cases. ② TEE examination: after the physician completed TEE intubations in 24 cases, the TEE examination scores were increased significantly (40.08±7.27 vs. 23.67±9.70,P < 0.05), and then tended to stabilize in the 40 - 47 scores; after TEE intubations were performed in 24 cases, the examination duration was significantly shortened (minutes: 39.97±6.67 vs. 58.22±14.19,P < 0.05), and after 36 cases were completed, the duration could be further shortened (minutes:31.04±7.84 vs. 39.97±6.67,P < 0.05). The learning curve indicated that the ICU physician could basically master the examination skills when TEE examinations were completed in 36 cases. In addition, no serious complications occurred during the TEE examination.Conclusions A SICU physician with skilled TTE experience can basically master the TEE technology through 36 times of examinations, and reach full mastery after 48 times, the duration for a successful intubation at the first attempt could be stabilized at 20 seconds, and the examination duration could be stabilized at 30 minutes.

ObjectiveTo assess the value of passive leg raising (PLR) test in predicting fluid responsiveness in patients with sepsis-induced cardiac dysfunction.Methods A prospective observational cohort study was conducted. Thirty-eight patients under mechanical ventilation suffering from sepsis-induced cardiac dysfunction admitted to Department of Surgical Intensive Care Unit of First Affiliated Hospital of Sun Yat-Sen University from September 2013 to July 2014 were enrolled. The patients were studied in four phases: before PLR (semi-recumbent position with the trunk in 45°), PLR (the lower limbs were raised to a 45° angle while the trunk was in a supine position), before volume expansion (VE, return to the semi-recumbent position), and VE with infusing of 250 mL 5% albumin within 30 minutes. Hemodynamic parameters were recorded in every phase. The patients were classified into two groups according to their response to VE: responders (at least a 15% increase in stroke volume,ΔSVVE≥15%), and non-responders. The correlations among all changes in hemodynamic parameters were analyzed by linear correlation analysis, and the receiver operating characteristic curve (ROC) was plotted to assess the value of hemodynamic parameters before and after PLR in predicting fluid responsiveness.Results Of 38 patients, 25 patients were responders, and 13 non-responders. There was no significant difference in the baseline and hemodynamic parameters at semi-recumbent position between the two groups. The changes in SV and cardiac output (CO) after PLR (ΔSVPLR andΔCOPLR) were significantly higher in responders than those of non-responders [ΔSVPLR: (14.7±5.7)%vs. (6.4±5.3)%,t = 4.304,P = 0.000;ΔCOPLR: (11.2±7.5)% vs. (3.4±2.3)%,t = 3.454,P = 0.001], but there was no significant difference in the changes in systolic blood pressure, mean arterial pressure, pulse pressure, and heart rate after PLR (ΔSBPPLR,ΔMAPPLR,ΔPPPLR andΔHRPLR) between two groups.ΔSVVE in responders was significantly higher than that of the non-responders [(20.8±5.5) % vs. (5.0±3.7) %,t = 8.347,P = 0.000]. It was shown by correlation analysis thatΔSVPLR was positively correlated withΔSVVE (r = 0.593,P = 0.000),ΔCOPLR was positively correlated withΔSVVE (r = 0.494,P = 0.002). The area under ROC curve (AUC) ofΔSVPLR≥8.1% for predicting fluid responsiveness was 0.860±0.062 (P = 0.000), with sensitivity of 92.0% and specificity of 70.0%; the AUC ofΔCOPLR≥5.6% for predicting fluid responsiveness was 0.840±0.070 (P = 0.000), with sensitivity of 84.0%and specificity of 76.9%; the AUC ofΔMAPPLR≥6.9% for predicting fluid responsiveness was 0.662±0.089, with sensitivity of 68.0% and specificity of 76.9%; the AUC ofΔSBPPLR≥6.4% for predicting fluid responsiveness was 0.628±0.098, with sensitivity of 76.0% and specificity of 61.5%; the AUC ofΔPPPLR≥6.2% for predicting fluid responsiveness was 0.502±0.094, with sensitivity of 56.0% and specificity of 53.8%; the AUC ofΔHRPLR≥-1.7%for predicting fluid responsiveness was 0.457±0.100, with sensitivity of 56.0% and specificity of 46.2%.Conclusion In patients with sepsis-induced cardiac dysfunction, changes in SV and CO induced by PLR are accurate indices for predicting fluid responsiveness, but the changes in HR, MAP, SBP and PP cannot predict the fluid responsiveness.

OBJECTIVETo investigate the association of the 4G/5G polymorphism located in the promoter region of plasminogen activator inhibitor-1(PAI-1) gene with prognosis of coronary artery disease (CAD) in Chinese Hans.

METHODSOne hundred and fifty five patients with CAD and 190 unrelated healthy control individuals were included in the study. The 4G/5G polymorphism was detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. A follow-up survey of major adverse cardiovascular event (MACE) and analysis of the relationship between the severity of coronary vessels and PAI-1 gene polymorphism were carried out.

RESULTS(1) The frequency of 4G/4G genotype of PAI-1 gene was higher in CAD patients than in controls (58/155, 37.42% vs 52/190, 27.37%, P< 0.01). (2) The frequency of 4G/4G genotype of PAI-1 in patients with MACE was higher than that in patients without MACE (40/81, 49.38% vs 18/74, 23.42%; P< 0.01). (3) The frequency of 4G/4G genotype in patients with multivessel disease was higher than that in patients with single-vessel disease (30/47, 44.77% vs 9/37, 24.32%; P< 0.05).

CONCLUSIONThe 4G/5G polymorphism located in the promoter region of PAI-1 gene was associated with prognosis of CAD patients, and may be regarded as a biomarker of the severity of the involved vessels.

Coronary Artery Disease ; genetics ; Female ; Gene Frequency ; Genetic Predisposition to Disease ; genetics ; Genotype ; Humans ; Male ; Plasminogen Activator Inhibitor 1 ; genetics ; Polymorphism, Genetic ; genetics

BACKGROUND AND OBJECTIVEAccumulating data indicate that docetaxel plus cisplatin and 5-fluorouracil has certain effect on advanced gastric or gastro-oesophageal junction adenocarcinoma. This study was to evaluate the efficacy and toxicity of docetaxel plus nedaplatin and 5-fluorouracil (DNF regimen) in treating advanced esophageal carcinoma.

METHODSForty-three patients with pathologically confirmed advanced esophageal carcinoma treated by DNF regimen: intravenous infusion of docetaxel (75 mg/m(2)) over 1 h, intravenous infusion of nedaplatin (100 mg/m(2)) over 3 h, intravenous infusion of leucovorin (CF, 200 mg/m(2)) over 2 h, intravenous injection of 5-fluorouracil (375 mg/m(2)) over 10 min, followed by a 46-hour infusion of 5-fluorouracil (2.6 g/m(2)). The cycle was repeated every three weeks. Treatment efficacy was evaluated every two weeks according to the WHO standards. All patients received at least two cycles of chemotherapy.

RESULTSPatients received a total of 144 cycles of treatment, and all were evaluable for efficacy and toxicity. Of the 43 patients, 2 (4.65%) achieved complete response (CR), 25 (58.14%) achieved partial response (PR), 9 (20.93%) had stable disease (SD), and 7 (16.28%) had progressive disease (PD). The overall response rate was 62.8%. The median time-to-progression (TTP) was 201 days and the median survival time (MST) was 310 days. Grade III/IV adverse events mainly included neutropenia (20.93%), febrile neutropenia (4.65%), thrombocytopenia (6.98%) and vomiting (9.30%). One patient died of grade IV thrombocytopenia.

CONCLUSIONDNF regimen is effective for and well tolerated by patients with advanced esophageal carcinoma.

Adenocarcinoma ; drug therapy ; pathology ; secondary ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Carcinoma, Squamous Cell ; drug therapy ; pathology ; secondary ; Esophageal Neoplasms ; drug therapy ; pathology ; Female ; Fluorouracil ; administration & dosage ; adverse effects ; Humans ; Liver Neoplasms ; drug therapy ; secondary ; Lung Neoplasms ; drug therapy ; secondary ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Neutropenia ; chemically induced ; Organoplatinum Compounds ; administration & dosage ; adverse effects ; Remission Induction ; Survival Rate ; Taxoids ; administration & dosage ; adverse effects ; Thrombocytopenia ; chemically induced

Objective: This study was designed to investigate the prognostic value of serum β2-micorglobulin(β2-MG) level in non-Hodgkin s lymphoma(NHL) patients and its correlation with Ann Arber staging system and the pathological type. Method: Serum β2-MG levels in 75 de novo NHL patients were measured by radioimmunoassay. Results: The β2-MG level in 75 NHL patients was higher than that in nomal control level in 52％ of the patients and correlated with the Ann Arber stage. There was significant difference between two groups (P<0.01). The international prognostic index (IPI) and the response rate to chemotherapy were also correlated with the β2-MG level in serum. The response rate, the complete response, and partial response were 87.2%, 61.5%, and 25.6% in normal serum β2-MG group, while in the high β2-MG group they were only 75.0%, 50.0%, and 25.0%, respectively, which were significantly different between the two groups (P<0.05). The difference of 5-year survival between the two groups was significant (64.1% vs 27.8%, P<0.05) and favorable in normal β2-MG group. Conclusion: β2-MG level in serum is an independen prognostic factor in de novo NHL, and the patients with abnormal β2-MG level in serum have a unfavorable prognosis.

Objective To explore the application of the involvement of micro-guide wire in the peripherally inserted central catheter (PICC) ectopic reset.Methods Totals of 74 patients with PICC ectopic were divided into experimental group and control group,and each group included 37 cases.The experimental group reset ectopie PICC through placing micro-guide wire under the guidance of digital subtraction angiography,while control group adjusted patient position and sent catheter according to conventional methods.The success rate of a reset,the operating time,the incidence of mechanical phlebitis were observed.Results The success rate of a reset in experimental group and control group were 100％ and 83.88％,respectively.The operation time during reset procedure were 4 min and 5 min in experimental and control group,respectively.Regarding the incidence of mechanical phlebitis due to reset,2.7％ in experimental group and 21.62％ in control group,there were statistical differences in three observational indexes( x2 =6.529,7.400,respectively;Z =-1.989;P ＜ 0.05 or P ＜0.01 ).Conclusions The involvement of micro-guide wire in the PICC ectopic adjustment can reduce the incidence of mechanical phlebitis and have a high reduction ratio.