China ; Digestive System Surgical Procedures ; Humans ; Physicians ; Science

Adolescent ; Adult ; Aged ; Agranulocytosis ; chemically induced ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Cisplatin ; administration & dosage ; adverse effects ; Cyclophosphamide ; administration & dosage ; adverse effects ; Doxorubicin ; administration & dosage ; adverse effects ; Etoposide ; administration & dosage ; adverse effects ; Female ; Follow-Up Studies ; Humans ; Lymphoma, T-Cell, Peripheral ; drug therapy ; Male ; Middle Aged ; Nausea ; chemically induced ; Prednisone ; administration & dosage ; adverse effects ; Remission Induction ; Vincristine ; administration & dosage ; adverse effects ; Young Adult

University of Manchester who first introduced Problem based learning(PBL)to the UK medical education,and adopted this new curriculum in 1994.Notably,Cambridge and Oxford have always had a high proportion of student-centred and self-directed learning,and have therefore not introduced PBL.Other medical schools have followed the example of Manchester,now PBL has become the mainstream curriculum in British medical edacation.First,this article is going to introduce how PBL curriculum is structured at Manchester medical school,and then reflect and give some thoughts on its current practice.

BACKGROUND:Many internal fixations,such as dynamic hip screw,Gamma screw,proximal femoral nail,angle steel plate,as well as locking proximac femoral plate,are utilized in treating intertrochanteric fractures,especially the dynamic hip screw However,the failure rate is gradually increased.OBJECTIVE:To explore the application and clinical efficacy of total hip replacement for the treatment of elderly intertrochanteric fracture fixation after failure of dynamic hip screw.METHODS:A total of four cases with intertrochanteric fractures were treated by total hip replacement after failure of dynamic hip screw fixation was selected.According to Evans typing,one case were type Ⅱ,two cases were type Ⅲ A,and one case was typeⅢB.Internal fixation displacement could be found at half to 1 year after dynamic hip screw fixation.Because of bone disunion,coxa adducta and pain,the patients could not walk.Sequentially,total hip replacement was performed with 45°abduct angle and10°-15°anteversion angle The clinical efficacy was evaluated by Harris scoring criteria.RESULTS AND CONCLUSION:All the cases were operated smoothly,with 1.5-2 hour operation duration and 400-600 mL blood loss.No case appeared allergic response to bone cement.By 3-12 months follow-up,4 successful operative cases do not appear prosthesis loosening,subsidence and are satisfied with well hip function.The average Harris score were 81 points.The results revealed that application of total hip replacement after the failure of DHS in elderly intertrochanteric fracture fixation,which shortened the time patients stay in bed to reduce complications and improved the hip joint function.

The distributioa of Se in Hb and the effects of Se intake and its chemical forms oil the distribution were studied. The results showed that Se in human Hb was all located in globin and divided equally in a and ? chains. However, a part of Se could fall from Hb during the process of isolation when more Se as SeMet was taken and "excess" Se appeared in Hb. It was implicated that there were at least two kinds of linkage between Se and Hb --tight and loose.Regarding the components of amino acid in ? and ? chains, we assumed that a tight linkage between Se and Hb was in the form of SeMet, which was incorporated into Hb by dietary Se during the synthesis of Hb; the loose linkage was formed by a part of "excess" Se and CyS, especially No.93 CyS in ? chain, being unstable sclcnotrisulf ide or selenopersulfide, which broke easily by reduction during isolation. They might be utilized first by human body when Se was required.

The paper probed into corporate governance and the feasibility of introducing corporate governance into China' s public hospitals based on the principal-agent theory and successful experiences of overseas hospitals.It also described the incentive and restriction mechanism of such governance.The authors proposed such key factors as evolution in property right/shareholding relationship,organization structure of introducing corporate governance,appropriate supervision,sufficient competition,and perfecting corporate governance mechanism.

Aim: To prepare novel aqueous polymer dispersions with high flexibility for sustained-release coating and investigate their properties. Methods: The aqueous polymer dispersions were synthesized by the emulsion polymerization. The physico-chemical properties and film-forming potential of the dispersions were investigated while the mechanical properties of the formed film and the drug release behavior when atenolol pellets were coated with the aqueous polymer dispersions were evaluated. Results: The prepared aqueous polymer dispersions (methyl methacrylate/ethyl acrylate, 1:2) were found to have proper physico-chemical properties, excellent film-forming capability and satisfying mechanical properties. It could form free film with high flexibility and low viscosity in low temperature even in absence of the plasticizer. Sustained release of atenolol pellets was achieved when the pellets were coated the polymer dispersions. 4-h and 8-h cumulative releases were more than 50% and 80%, respectively. There was no significant difference in release between pellets prior to and post compression of the coated pellets. Conclusion: The resulting aqueous polymer dispersions could be used as sustained-release coating material with high flexibility suitable for tableting.

Objective:To investigate the short-term effect of thoracoscopic and laparoscopic surgery in the treatment of esophageal cancer and its impact on stress response and inflammatory response.Methods:The clinical data of 124 patients with esophageal cancer admitted to Huai′an Cancer Hospital from March 2018 to March 2020 were analyzed. The patients in observation group (62 cases) were treated with thoracoscopic esophagectomy and the patients in control group (62 cases) were treated with traditional open esophagectomy. The changes of perioperative indexes, postoperative complications, stress response, inflammatory response indexes before and 3 d after operation, and pulmonary function before and 1 month after operation were compared between the two groups.Results:The intraoperative blood loss in the observation group was less than that in the control group: (189.52 ± 37.28) ml vs. (258.94 ± 32.14) ml; the operation time in the observation group was longer than that in the control group: (271.92 ± 25.43) min vs. (231.09 ± 23.16) min, and the differences were statistically significant ( t = 11.105, 9.347, P<0.05). But there was no significant difference in the total number of lymph node dissection between the two groups ( t = 1.295, P>0.05). The postoperative complications in the observation group was less than that in the control group: 9.68%(6/62) vs. 24.19%(15/62), χ2 = 4.644, P<0.05. The serum levels of cortisol and norepinephrine at 3 d after operation in the observation group were lower than those in the control group: (145.32 ± 12.39) μg/L vs. (197.56 ± 18.78) μg/L, (84.54 ± 5.98) μg/L vs. (98.93 ± 7.26) μg/L, and the differences were statistically significant ( t = 18.283, 12.047, P<0.05). The serum levels of interleukin 6, C-reactive protein and tumor necrosis factoralpha at 3 d after operation in the observation group were lower than those in the control group: (101.31 ± 6.56) μg/L vs. (149.09 ± 12.31) μg/L, (18.94 ± 4.53) mg/L vs. (29.95 ± 4.16) mg/L, (84.52 ± 5.89) ng/L vs. (109.32 ± 8.64) ng/L, and the differences were statistically significant ( t = 26.972, 14.096, 18.675, P<0.05). The levels of the first second forced expiratory volume (FEV 1) as a percentage of the estimated value and the ratio of FEV 1 and forced vital capacity at 1 month after operation in the observation group were higher than those in the control group: (8.79 ± 4.50)% vs. (72.16 ± 3.64)%, (67.84 ± 3.24)% vs. (60.39 ± 4.15)%, and the differences were statistically significant ( t = 9.020, 11.142, P<0.05). Conclusions:The short-term effect of thoracoscopic and laparoscopic surgery in the treatment of esophageal cancer is obvious, and the stress response, inflammatory response and lung function are less affected.

Objective: To investigate the effects of the link between overweight/obesity and type 2 diabetes mellitus (T2DM) on leptin and visfatin levels. Methods: Males without T2DM and male patients with T2DM hospitalized in Lishui Municipal Central Hospital from January to June, 2017 were enrolled. Subjects' age and medical history of diseases were collected. The height and body weight were measured, and the body mass index (BMI) was estimated. The leptin and visfatin levels were determined, and compared between patients with and without T2DM, and between patients with and without overweight/obesity. The effect of the link between overweight/obesity and T2DM on leptin and visfatin levels was examined using a generalized linear regression model. Results: There were 66 patients with T2DM, with a mean age of (49.70±9.45) years and a mean diabetes duration of (4.99±4.46) years, and there were 64 patients without T2DM, with a mean age of (43.89±0.20) years. The leptin [ (3.17±0.36) vs. (3.03±0.30) ng/mL; t=2.387, P=0.018] and visfatin levels [ (29.14±3.16) vs. (21.81±3.32) ng/mL; t=12.900, P<0.001] were significantly greater in T2DM patients than in patients without T2DM. The leptin level was significantly greater in patients with overweight/obesity than in those without overweight/obesity [ (3.27±0.32) vs. (2.92±0.26) ng/mL; t=6.634, P<0.001], and the visfatin level was significantly lower in patients with overweight/obesity than in those without overweight/obesity [(24.38±5.14) vs. (26.71±4.36) ng/mL; t=2.780, P=0.006]. Generalized linear regression analysis showed interacting effects of overweight/obesity and T2DM on leptin (β=0.286, P=0.003) and visfatin levels (β=2.709, P=0.008). Conclusion The interaction between overweight/obesity and T2DM affects leptin and visfatin levels.

Objective To discuss the protective effect of doxofylline on radical surgery for esophageal cancer.Methods Under elective general anesthesia, 60 cases, 35 males and 25 females, aged 45-70 years, BMI 20-30 kg/m2, ASA physical status Ⅰ or Ⅱ, FEV1%>50%, underwent radical surgery for esophageal cancer at middle and distal parts.Random number table was employed to divide these patients into two groups: doxofylline group (group D) and control group (group C) with 30 cases in each.After a routing intravenous induction in the two groups, mechanical ventilation was conducted after bronchial intubation with double channel catheter on the right side.The intravenous injection of doxofylline 4 mg/kg in group D was administrated 30 min after bronchial intubation with double channel catheter.Equal normal saline was instilled to the patients in group C.Blood samples were taken from radial artery to detect the levels of TNF-α, IL-6, IL-10, MDA and SOD at four time points: 10 min (T0) before the one-lung ventilation, 60 min after OLV (T1), after two-lung ventilation (T2) and the end of the operation (T3).Meanwhile, the blood and breath at these time points were tested.The occurrence of OLV, blood loss volumes, fluid input quantities, urine volumes, postoperative hyoxemia and pulmonary inflammation were observed.Results Compared with T0, the activity of SOD in serum and PaO2 in the two groups at T1-T3 decreased (P＜0.05).The concentrations of TNF-α, IL-6, IL-10 and MDA increased significantly (P＜0.05).Compared with group C, the activity of SOD activities and PaO2 in group D at T1-T3 increased while concentrations of TNF-α, IL-6, IL-10 and MDA decreased significantly (P＜0.05).The occurrence rates of postoperative hyoxemia and pulmonary inflammation in group D were obviously lower than those in group C (P＜0.05).Conclusion Doxofylline can suppress patients' inflammatory response and oxidative stress response after OLV and reduce the incidence rates of postoperative hyoxemia and pulmonary inflammation as well as alleviate lung injury triggered by radical surgery for esophageal cancer.