PBL (Problem-based learning) is a kind of teaching method, which is helpful for guiding students to solve practical and complex problems. The compiling of PBL teaching plans is the key to the implementation of PBL teaching. According to the teaching outline of internal medicine, we set the PBL teaching plan, formulated the teaching goal, collected the clinical real cases, finished the compiling of PBL cases of student version and teacher version, and preceded teaching practice accord-ing to the PBL cases. Improving and constructing the compiling framework of internal medicine PBL teaching plan laid the theoretical foundation for carrying out internal medicine PBL teaching.

AIM:To explose the possible existing pathway of intracellular signaling transduction in hypertensive induced by insulin in rat vascular smooth muscle cells proliferation which involved mitogen-activated protein kinase. METHODS:Male spontaneously hypertensive rat (SHR) aorta and WKY(6 weeks old) were isolated and then cultured to make the purified vascular smooth muscle cells.6-8th generation of VSMC were interfered with insulin in vitro . MAPK activity was determined by myelin basic protein method and its volume was measured with Western Blot. And [ 3 H]-TdR was used to measure DNA synthesis in VSMC proliferation. RESULTS: After the interfered with insulin the DNA synthesis was increased obviously in SHR group. MAPK activity and its contains in SHR were increased more than the control group. Protein kinase C inhibitor decreased MAPK activity induced by insulin. CONCLUSION:Proliferation of SHR VSMC in vitro was correlated with increased activity of MAPK. Insulin can affect MAPK induced activity. So an insulin-PKC-MAPK axis may exist in hypertensive VSMC.

Objective To explore the relationship of the polymorphism of E-selectin gene A561C and essential hypertension (EH) among Chinese people. Methods Genotypes of E-selectin were analyzed in 95 EH patients with age ≤70 and 101 normal controls people matched in age and gender by polymerase chain reaction-restriction fragment length polymorphism ( PCR-RFLP). Serum levels of lipid, glucose, urea and creatinine were measured by biochemical techniques. Plasma soluble E-selectin were measured by enzyme-linked immunosorbent assay(ELISA). Results The frequency of E-selection genotypes AA, AC and CC in EH group were significantly higher than normal group (P

Objective To explore the risk factors of complicating urogenic sepsis after percutaneous nephrolithotripsy(PCNL)and construct a nomogram prediction model.Methods The data of 291 patients with stage 1 PCNL in 940 Hospital of Joint Logistics Support Force from October 2016 to October 2021 were retrospectively analyzed.The patients were divided into the sepsis group and non-sepsis group according to whether complicating urogenic sepsis after operation.The general data,stone-related data,operation-related data and laboratory detection related data were included.The independent risk factors were screened by the univariate and multivariate logistic regression analysis,and the nomogram prediction model was constructed.Results The results of univariate and multivariate logistic regression analysis showed that age≥60 years old(OR=6.438,95％CI:1.548-26.769),urinary leukocyte 3+(OR=5.651,95％CI:1.614-31.766),urinary nitrite positive(OR=7.117,95％CI:1.190-42.561),operation time≥90 min(OR=4.626,95％CI:1.137-18.817)and perfusion volume 30 L(OR=3.312,95％CI:1.090-10.061)were the independent risk factors of postoperative complicating urogenic sepsis.C-index of the constructed nomogram prediction model in the modeling samples was 0.937,the calibrated C-index was 0.914,and the model predictive efficien-cy was good.Conclusion Age ≥60 years old,urinary leukocyte 3+,urinary nitrite positive,operation time 90 min and perfusion volume ≥30 L are the independent risk factors for complicating urogenic sepsis after PCNL;the constructed nomogram prediction model has a good predictive efficiency for the occurrence of post-operative urogenic sepsis.

Objective:To compare the application effects of high-definition two-dimensional (HD-2D) and glasses-free three-dimensional (GF-3D) display systems in thoracoscopy teaching.Methods:A total of 40 clinical medicine interns with no surgical experience from The First Affiliated Hospital of Guangzhou Medical University were recruited and were required to participate in a 1-week training course of endoscopy. They were then randomly allocated to the HD-2D group and GF-3D group and asked to perform three tasks: peg transfer, circular cutting, and suture knotting. Their performance was measured with a system that scored speed and precision. SPSS 25.0 was used to conduct t-test, Pearson Chi-square test and Fisher exact test for the comparison. Results:The mean time for the peg transfer test in GF-3D group was shorter than that in HD-2D group, without statistically significant difference [(63.20±21.11) s vs. (71.15± 17.26) s, P = 0.212]. The mean time for the circular cutting test in GF-3D group was shorter than that in HD-2D group, without statistically significant difference [(112.50±16.67) s vs. (118.15±24.43) s, P=0.410]. The mean time for the suture knotting test in GF-3D group was shorter than that in HD-2D group, with statistically significant difference [(301.50±32.77) s vs. (341.75±57.23) s, P=0.019]. The total score in GF-3D group was higher than that in HD-2D group, with statistically significant difference [(78.33±5.88) points vs. (72.08±6.83) points, P=0.005]. Conclusion:The GF-3D display system is clearly superior to the HD-2D system because it reduces the surgical learning curve, and is therefore suitable for basic teaching and skills training.

Objective:To explore the changes and clinical significance of inflammatory indices of urogenic sepsis with different severity.Methods:A retrospective case-control study was used to analyze the clinical data of 71 patients with urogenic sepsis admitted to 940th Hospital of PLA Joint Logistics Support Force from January 2010 to April 2018, including 34 males and 37 females, aged 39-96 years [(63.1±18.3)years]. The patients were divided into three groups according to the clinical diagnostic criteria for septic shock and sepsis according to the 2014 edition of the Chinese Urology Surgical Guidelines for Diagnosis and Treatment: 21 cases in sepsis group [sequential organ failure assessment (SOFA) score of 3.0 (2.0, 3.0)points], 21 cases in severe sepsis group [SOFA score of 9.0 (6.0, 11.0)points], and 29 cases in septic shock group [SOFA score of 15.0 (14.0, 16.0)points]. Spearman correlation analysis was used to analyze the correlation of inflammatory indicators with SOFA, including white blood cell count, percentage of neutrophils, C-reactive protein, interleukin-6, procalcitonin, fibrinogen, D-dimer, and platelet. Multiple linear regression analysis and stepwise regression weighted analysis were performed to analyze the relation between inflammatory indicators and sepsis severity. Levels of each inflammatory indicator was detected and compared among the groups.Results:① Spearman correlation analysis: percentage of neutrophils, D-dimer, interleukin-6, procalcitonin and SOFA scores were significantly positively correlated, with the r s value of 0.738, 0.712, 0.31, 0.795, respectively ( P<0.01); platelet and SOFA scores were significantly negatively correlated, with the r s value of -0.661 ( P<0.01). ② Multiple linear regression analysis: percentage of neutrophils, platelet, D-dimer, procalcitonin and SOFA score were significantly correlated ( P<0.01); Stepwise regression weighted analysis suggested that the model linear relationship and fit was good. ③ Inflammatory index comparison: percentage of neutrophils in sepsis group, severe sepsis group and septic shock group was 82.30 (76.25, 88.45), 90.50 (86.55, 93.85), 95.10 (92.05, 97.95), respectively; level of platelet was 183.01 (144.50, 246.50)×10 9/L, 149.11 (81.04, 207.00)×10 9/L, 81.26 (50.01, 93.50)×10 9/L, respectively; level of D-dimer was 0.98 (0.71, 1.74)mg/L, 3.45 (1.79, 5.56)mg/L, 7.19 (4.26, 11.63)mg/L, respectively; level of procalcitonin was 0.55 (0.21, 1.09)ng/ml, 5.45 (3.74, 11.80)ng/ml, 17.68 (13.97, 26.75)ng/ml, respectively. There were significant differences in above indicators among the groups ( P<0.05). Conclusions:The serum levels of procalcitonin, percentage of neutrophils, D-dimer and platelet are positively correlated with the severity of urogenic sepsis. While combined detection of those indicators can better predict the severity of the sepsis.

OBJECTIVE: To explore the safety and effectiveness of one-stage posterior eggshell osteotomy and long-segment pedicle screw fixation in the treatment of ankylosing spondylitis kyphosis combined with acute thoracolumbar vertebral fracture. METHODS: A clinical data of 20 patients with ankylosing spondylitis kyphosis combined with acute thoracolumbar spine fracture, who were treated with one-stage posterior eggshell osteotomy and long-segment pedicle screw fixation between April 2016 and January 2022, was retrospectively analyzed. Among them, 16 cases were male and 4 cases were female; their ages ranged from 32 to 68 years, with an average of 45.9 years. The causes of injury included 10 cases of sprain, 8 cases of fall, and 2 cases of falling from height. The time from injury to operation ranged from 1 to 12 days, with an average of 7.1 days. The injured segment was T ₁₁ in 2 cases, T ₁₂ in 2 cases, L ₁ in 6 cases, and L ₂ in 10 cases. X-ray film and CT showed that the patients had characteristic imaging manifestations of ankylosing spondylitis, and the fracture lines were involved in the anterior, middle, and posterior columns and accompanied by different degrees of kyphosis and vertebral compression; and MRI showed that 12 patients had different degrees of nerve injuries. The operation time, intraoperative bleeding, intra- and post-operative complications were recorded. The visual analogue scale (VAS) score and Oswestry disability index (ODI) were used to evaluate the low back pain and quality of life, and the American spinal cord injury association (ASIA) classification was used to evaluate the neurological function. X-ray films were taken, and local Cobb angle (LCA) and sagittal vertical axis (SVA) were measured to evaluate the correction of the kyphosis. RESULTS: All operations were successfully completed and the operation time ranged from 127 to 254 minutes (mean, 176.3 minutes). The amount of intraoperative bleeding ranged from 400 to 950 mL (mean, 722.5 mL). One case of dural sac tear occurred during operation, and no cerebrospinal fluid leakage occurred after repair, and the rest of the patients did not suffer from neurological and vascular injuries, cerebrospinal fluid leakage, and other related complications during operation. All incisions healed by first intention without infection or fat liquefaction. All patients were followed up 8-16 months (mean, 12.5 months). The VAS score, ODI, LCA, and SVA at 3 days after operation and last follow-up significantly improved when compared with those before operation ( P<0.05), and the difference between 3 days after operation and last follow-up was not significant ( P>0.05). The ASIA grading of neurological function at last follow-up also significantly improved when compared with that before operation ( P<0.05), including 17 cases of grade E and 3 cases of grade D. At last follow-up, all bone grafts achieved bone fusion, and no complications such as loosening, breaking of internal fixation, and pseudoarthrosis occurred. CONCLUSION One-stage posterior eggshell osteotomy and long-segment pedicle screw fixation is an effective surgical procedure for ankylosing spondylitis kyphosis combined with acute thoracolumbar vertebral fracture. It can significantly relieve patients' clinical symptoms and to some extent, alleviate the local kyphotic deformity.
Humans ; Male ; Female ; Animals ; Adult ; Middle Aged ; Aged ; Spinal Fractures/surgery* ; Pedicle Screws ; Spondylitis, Ankylosing/surgery* ; Quality of Life ; Retrospective Studies ; Egg Shell/injuries* ; Thoracic Vertebrae/injuries* ; Lumbar Vertebrae/injuries* ; Kyphosis/surgery* ; Osteotomy ; Fracture Fixation, Internal/methods* ; Fractures, Compression/surgery* ; Treatment Outcome