We set up the characteristic medical psychology teaching mode based on the talent training objectives for three-year clinical medical majors and the requirements of the course qualification exam.The mode includes the basic psychological and clinical psychological teaching content system based on cases and tasks.Case-based teaching and Problem-based learning were used and research report and net exam were employed as main assessment methods.Online teaching resources were explored through establishing excellent course website,medlical psychology website and psychological test web

Objective To evaluate the diagnostic value of velocity parameters of Tardus-Parvus for the detection of renal artery stenosis ( RAS) ( diameter reduction ≥50%) and to determine the useful cutoffs for these parameters .Methods A study group was composed of 221 renal arteries that were detected Tardus-Parvus by color Doppler flow imaging and were referred to abdomino-aorto-re-nal arteriography afterwards .Five Doppler parameters including the peak systolic velocity ( PSV ) , end-diastolic minimum velocity (EDV), resistance index (RI), acceleration time (AT), and accelerated velocity (AC) from each location including renal aorta ( MRA) , segmental artery ( SRA) , interlobar artery ( IRA) , and arcuate artery ( ARA) were archived and compared among the differ-ent groups .Renal artery angiography showed arterial canon reduced 50% or higher RAS .Arteries were considered stenosed on renal arteriography if there was a diameter reduction of greater than 50%.Statistical analysis to determine the best parameter for predicting a RAS was performed with the receiver operating characteristic ( ROC) curves.The sensitivity, specificity, and negative and positive predicting values at various cutoffs were calculated .Results Renal artery stenosis degree was less than 50% in 16 cases, 50%~99%in 197 cases, completely occluded in 2 cases, and no stenosis in 6 case by renal arteriography .For RAS with inner diameter re-duction of 50%or more, the ROC curve analysis showed renal artery flow velocity had a good sensitivity and specificity , 50%~99%of the RAS had optimal threshold value in PSV 20 cm/s, EDV 10 cm/s, RI 0.50, AT 0.09 s, and AC 1.5 m/s2.Conclusions Tardus-Parvus had high specificity and sensitivity for diagnosis of stenosis rate in more than 50% of the RAS, low sensitivity for the narrow degree in 0~49%, and no clinical value for the renal artery occlusion .

OBJECTIVETo explore the clinical effects of transforaminal endoscopic spine system in surgical revision of lumbar vertebrae.

METHODSFrom January 2012 to October 2013,14 patients who needed reoperations of lumbar vertebrae were treated using transforaminal endoscopic spine system (TESSYS). There were 8 males and 6 males, aged from 27 to 84 years old with an average of (50.4 ± 18.9) years. Visual analogue scale (VAS) and Japanese Orthopaedic Association Scores (JOA) were compared before and after surgical revision. Macnab standard was used to assess the clinical effect.

RESULTSAll the patients were followed up from 6 to 27 months with the mean of 18 months. Preoperative VAS score was 6.79 ± 1.31, and in a week,3 months and 6 months after operation were 2.50 ± 1.29, 2.21 ± 1.53, 1.64 ± 1.08, respectively, which were all much lower (P < 0.01) than preoperative score. Preoperative JOA score was 12.43 ± 1.95, and the above corresponding postoperative JOA scores were 21.50 ± 3.78, 21.93 ± 4.55, 23.36 ± 4.33, respectively, which were all much higher than preoperative score (P < 0.01). According to the modified Macnab criteria, 5 patients got an excellent results, 7 good, 1 fair and 1 poor. The nerve root injury of L5 occurred in 1 case during paracentesis and no other complications were found.

CONCLUSIONSelecting the appropriate indications using TESSYS in surgical revision of lumbar vertebrae can successfully avoid the operation scar, reduce the surgical complications and obtain satisfactory clinical outcomes.

Adult ; Aged ; Aged, 80 and over ; Endoscopy ; methods ; Female ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Reoperation ; Spinal Fusion ; methods

OBJECTIVETo explore the clinical effects of PLIF surgery for elderly patients with lumbar degenerative disease.

METHODSFrom March 2010 to May 2013, 28 patients with lumbar degenerative disease, aged more than 80 years were treated with PLIF surgery. There were 10 males and 18 females, aged from 80 to 93 years old with an average of (85.44±3.66) years. Course of disease was from 3 to 20 years. The operation time, intra-operative blood loss, operation complications were recorded and JOA scores and Macnab criteria were used to evaluate the clinical outcomes.

RESULTSAll patients were followed up from 12 to 40 months with an average of 26.5 months. The average operation time was (150.00±26.42) min and the average intra-operative blood loss was (373.33±99.88) ml. The pre-operative JOA score was 12.30±2.43, and the corresponding postoperative JOA score at the final follow-up was 24.81±2.09 which was much higher than the preoperative one (P<0.01). According to the modified Macnab criteria to evaluate at the final follow-up, 16 patients got an excellent result, 10 good, 2 fair. In the weeks postoperatively, injuries of nerve root happened in 3 cases, superficial wound infection with delayed healing in 3 cases, and tear of the dural sac accompanied with cerebrospinal fluid leakage in 1 case. After long term follow-up, adjacent segment degeneration and the corresponding spinal canal stenosis occurred in 1 case at 34 months after operation. All cases got successful fusion without any displacement of internal fixation and pseudoarthrosis formation.

CONCLUSIONWith proper cases, fully preoperative preparation, perfect intra-operative manipulation and active treatment after operation, even advanced ages older than 80 years with lumbar degenerative disease could get satisfactory outcomes after PLIF surgery.

Aged ; Aged, 80 and over ; Female ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Operative Time ; Spinal Diseases ; surgery ; Spinal Fusion ; methods

OBJECTIVETo seek the special plasma molecule in unstable angina (UA) patients of qi deficiency and blood stasis syndrome (QDBS) and method for explore the proteomic specificity of the disease.

METHODSLC-MS(E) analysis was performed in UA patients of QDBS or non-QDBS and in healthy persons after the 6 proteins with optimal abundance in plasma being removed by polyclonal antibody affinity column (product of Agilent Co. USA).

RESULTSActin were found only expressed, and FN, ApoH and ANXA6 were found highly expressed in plasma of patients with UA-QDBS, suggesting they might be the special molecules for the disease. Moreover, as compared with health persons, SAA, CP, MYH11 and C6 showed high expression, and the 6 proteins, e.g. A1BG, ApoA4, GSN, HBB, HBD and TF, showed low expression in the plasma of UA-QDBS patients.

CONCLUSIONUA-QDBS might belong to a kind inflammatory reaction. There are simultaneous existence of myocardial injury, blood coagulation factor abnormality, lipid metabolic disorder and oxygen transport obstacle in patients of UA-QDBS, they influence and interact mutually. The newly discovered differential proteins might provide clues for studying or discovering new protein targets of angina relieving drugs. The new technique of label free quantitative proteomics is an efficient method for bio-marker research of diseases and syndromes.

Actins ; blood ; Aged ; Angina, Unstable ; blood ; diagnosis ; Biomarkers ; Chromatography, Liquid ; methods ; Diagnosis, Differential ; Female ; Fibronectins ; blood ; Gene Expression Profiling ; Humans ; Male ; Mass Spectrometry ; methods ; Medicine, Chinese Traditional ; Middle Aged ; Proteome ; metabolism ; Qi

To observe the influence of the placental apoptosis on the expression of Bax,Bcl-2, Fas, FasLand TNF-α during the second trimester of pregnancy, mice of experimental group were intraperitoneal injected with 100 purified Toxoplasma gondii tachyzoites added in 0.2mL of PBS, while those of the control group were injected with 0.2 mL of sterile PBS (0.01 mol/L, pH 7.4) in the 8-th day of pregnancy. During the 12, 14, 16 and 18-th days of pregnancy, 5 mice both in experimental and control group were randomly killed and the expression levels of the apoptosis-related proteins Bax, Bcl-2, Fas, FasL and TNF-α in the placental tissues were determined by means of immunohistochemical methods. It was showed that the apoptosis-related protein expressed both in villus and decidua of the placenta, most of which were expressed in syneytiotrophoblast (ST). The positive cells with expression of Bax, Fas, FasL and TNF-α increased along with the increase of the pregnant days in both the experimental group and the control group, and the positive cells with expression of Bcl-2 decreased along with the increase of the pregnant days. It was also demonstrated that the positive cells with expression of Bax, Fas, FasL and TNF-α of the experimental group showed a higher percentage of expression than that of the control group on the same pregnant days, but the positive cells with Bcl-2 expression of the experimental group were fewer than that of the control group. It is concluded that the expression of apoptosis-related protein Bax, Bcl-2, Fas, FasL and TNF-α in the placenta were altered when the pregnant mice were infected with Toxoplasma gondii during the second trimester, which may induce the apoptosis through the endogenic and ectogenic pathway.

Acupuncture Therapy ; Adolescent ; Adult ; Aged ; Anxiety Disorders ; therapy ; Female ; Humans ; Male ; Middle Aged ; Qi ; Young Adult

Animals ; Apoptosis ; physiology ; Brain Ischemia ; metabolism ; physiopathology ; Down-Regulation ; drug effects ; Ischemic Postconditioning ; methods ; Male ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; metabolism ; prevention & control ; p38 Mitogen-Activated Protein Kinases ; metabolism

Objective To investigate the causes of arterial reocclusion in diabetic feet patients after endovascular treatment and its remedial measures.Methods From January 2009 to October 2013,clinical data of 371 arterial reocclusion of diabetic feet patients after endovascular treatment in Tianjin First Central Hospital were reviewed retrospectively.We summarized the causes of reocclusion,treatment methods and the short term results.Results According to the Trans-Alantic Inter-Society Consensus (TASC) Ⅱ grading standards,the first time when the endovascular treatment started there were 37 cases of grade A,85 cases of grade B,143 cases of grade C,106 cases of grade D.Arterial re-occlusion developed from one day to 36 months,averaging at (21 ± 8) months.Causes of re-occlusion included intimal hyperplasia in 263 cases (70.9％),thrombosis in 65 cases (17.5％),dissection in 19 cases (5.1％),stent fracture in 17 cases (4.6％),vascular rupture in 7 cases (1.9％).Remedial therapy adopted for arterial reocclusion was repeated endovascular treatment in 327 cases (88.1％),arterial bypass surgery in 23 cases (6.2％),conservative treatment in 13 cases (3.5％),amputation (cut toe) in 4 cases (1.1％),4 cases (1.1％) died perioperatively.275 cases were followed up for 1 to 36 months,the average was (13 ± 8) months.patency rate was 82.9％,71.3％ and 63.0％ at 6 months,1 year and 2 years.Amputation rate was 1.1％,1.8％ and 2.5％ at 6 months,1 year and 2 years.Conclusions Intimal hyperplasia is to blame for arterial reocclusion after endovascular treatment of diabetic foot.In this case most patients still can benefit from second time endovascular treatment,with a satisfactory short term patency rate.

Objective To verify the accuracy of the mathematical model of gastrointestinal decompression after esophagectomy of esophageal cancer and explore predictive value of the mathematical model in the postoperative complications.Methods The retrospective case-control study was conducted.The clinicopatholo gical data of 192 patients with esophageal cancer who underwent esophagectomy in the Beijing Chaoyang Hospital of Capital Medical University between October 2013 and October 2016 were collected.Among 192 patients,160 didn't have postoperative complications and 32 had postoperative complications (7 with postoperative anastomotic leakage,9 with pulmonary infection and 16 with dysfunction of gastralintestinal tract).Patients selected the appropriate surgical procedures according to individual conditions,and then volume of gastrointestinal decompression was recorded daily.According to the regression equation of influencing factors of volume of postoperative gastrointestinal decompression:average daily drainage volume within 5 days (mL)=262.287 + 132.873 × tubular stomach-72.160 × smoking history-27.904 × pathological type of tumor-36.368 × age,predictive value of postoperative gastrointestinal decompression was calculated and compared with real volume of gastrointestinal decompression.Observation indicators:(1) comparison between predictive value and real volume of postoperative gastrointestinal decompression in patients without complications;(2) comparison between predictive value and real volume of postoperative gastrointestinal decompression in patients with complications.Measurement data with normal distribution were represented as (x)±s and comparison was analyzed using the pairedsamples t test.Measurement data with skewed distribution were described as M (range),and comparison was analyzed using the Wilcoxon signed rank tests.Results (1) Comparison between predictive value and real volume of postoperative gastrointestinal decompression in patients without complications:predictive value and real volume of postoperative gastrointestinal decompression in 160 patients without complications were respectively 187 mL (range,58-392 mL) and 207 mL (range,20-570 mL),with no statistically significant difference (Z=-1.106,P＞0.05).(2) Comparison between predictive value and real volume of postoperative gastrointestinal decompression in patients with complications:7 patients had postoperative anastomotic leakage,including 1 with cervical anastomotic leakage and 6 with chest anastomotic leakage.The predictive value and real volume of postoperative gastrointestinal decompression in 7 patients with anastomotic leakage were respectively (215±58)mL and (338± 106)mL,with a statistically significant difference (t=-3.139,P＜0.05).The predictive value and real volume of postoperative gastrointestinal decompression in 9 patients with postoperative pulmonary infection were respectively (176±61) mL and (239± 111) mL,with no statistically significant difference (t =-1.805,P＞0.05).The predictive value and real volume of postoperative gastrointestinal decompression in 16 patients with dysfunction of gastralintestinal tract were respectively (236 ± 60) mL and (357 ± 107) mL,with a statistically significant difference (t =-4.716,P＜ 0.05).Conclusions The mathematical model of gastrointestinal decompression after esophagectomy of esophageal cancer is correct and feasible.There is a predictive value for patients with postoperative anastomotic leakage and dysfunction of gastralintestinal tract.