Continuing medical education refers to the completion of basic medical education for inservice education,which is to guarantee the sustainable development of physicians in clinical and scientific research ability,and is the essential means to safeguard and improve the level of medical treatment.Traditional continuing medical education is given priority to the form of regularly organize workshops,so it has some limitations to oral and maxillofacial surgery.MOOC teaching is a kind of large-scale open new online teaching mode.This study provides an overview of the MOOC development,characteristics and development situation in the medical teaching.The necessity and feasibility of MOOC based teaching protocol in oral and maxillofacial surgery continuing medical education has been discussed.And curriculum transformation,construction of education model and possible challenges have also been analyzed and discussed in this paper.

OBJECTIVETo evaluate the feasibility of using polyporus silk fibroin as a kind of novel material for facial nerve regeneration.

METHODSThe porous silk fibroin conduit was used in the reconstruction of a 5 mm facial nerve gap of SD rat. Chitosan conduit was taken as control group. General observation, electrophysiological study, histological study and image analysis were performed 2, 4, 6 and 8 weeks postoperatively.

RESULTSThe facial nerve of SD rat regenerated successfully as time passed through. Mean CAP percentage of regenerated nerve in SF conduit was 24.94% +/- 5.73% 8 weeks postoperatively, which had no statistical significance with that of chitosan conduit group (P = 1.125). And the average number of myelinated myelinated nerve fibers in SF conduit was 62. 5 +/- 6. 3, which had statistical significance with that in chitosan conduit group (P = 0.016).

CONCLUSIONSThe porous silk fibroin conduit could effectively repair facial nerve defect and improve peripheral nerve functional recovery.

Animals ; Facial Nerve Injuries ; surgery ; Female ; Fibroins ; pharmacology ; therapeutic use ; Materials Testing ; Nerve Regeneration ; drug effects ; Rats ; Rats, Sprague-Dawley ; Wound Healing

OBJECTIVETo determine the clinical characteristics and outcomes of redo CABG.

METHODSThe outcomes of 42 consecutive patients who underwent redo CABG from January 2002 to December 2010 was analyzed. There were 29 males and 13 females, aging from 46 to 78 years old with a mean of (61.2 ± 2.1) years. Off-pump CABG was applied for 31 patients and on-pump CABG for 11 patients. There were 1 patient underwent concomitant aortic valve replacement and 1 patient underwent aortic root and right aortic arch replacement respectively.

RESULTSThree patients died of right ventricle rupture, heart failure and multiple system organ failure respectively and the perioperative mortality rate was 4.8%. The post-operatively mechanical ventilation time varied from 9 to 27 h with a mean of (17 ± 7) h. There was no residual angina and perioperative myocardial infarction in the remaining patients who were all discharged uneventfully. Intraoperative 6 patients had accepted intraaortic balloon counterpulsation. During the follow-up from 6 months to 4.5 years for 38 patients, which showed no evidence of recurrent angina and postoperative coronary CT angiography in 12 patients showed the patency of grafts is good.

CONCLUSIONSatisfactory outcome of redo coronary artery bypass grafting can be achieved if proper indication were choose and reasonable management were performed.

Aged ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; Coronary Restenosis ; surgery ; Female ; Humans ; Male ; Middle Aged ; Reoperation ; Treatment Outcome

OBJECTIVETo investigate the dynamic variation and action mechanism of sICAM-1 and p38 mitogen-activated protein kinases (MAPK) signal transduction in human severe trauma and resuscitation, as well as the effect of lactated Ringer's solution(LR), 7.5% sodium chloride solution(HS) and 20% albumin injection(ALB) on the incidence and mortality of multiple organ dysfunction syndrome (MODS).

METHODSSeventy-two severe trauma patients (ISS score 16-43) were divided into ISS < or = 25 and ISS > 25 groups (each group was subdivided into LR, HS and ALB groups). ELISA was used to measure the concentration of sICAM-1. Western blot was used to measure the expression of p38 MAPK.

RESULTSCompared with LR group, the transfusion volume needed for maintaining systolic blood pressure > or = 90 mm Hg was significantly decreased in HS and ALB groups (P < 0.05). Compared with the control group, the concentration of blood sICAM-1 and the expression of p38 MAPK was elevated from 4 to 48 hours after trauma in all experimental groups (P < 0.05-0.01). At 4, 12, and 24 hours, there was significant correlation between the expression of p38 MAPK and sICAM-1 (P < 0.01). Compared with LR group, sICAM-1 and p38 MAPK in HS and ALB groups were decreased (P < 0.05). sICAM-1 and p38 MAPK were significantly higher in the group of ISS > 25 than that of ISS < or = 25 (P < 0.05). MODS incidence and mortality were significantly higher in the group of ISS > 25 than that of ISS < or = 25 (P < 0.05). MODS incidence and mortality were lower in HS and ALB groups than LR group (P < 0.05).

CONCLUSIONSThe up-regulation of polymorphonuclear neutrophil-endotheliocytes (PMN-EC) adhesion may be due to the increased sICAM-1 expression during severe trauma. The up-regulation of sICAM-1 expression is correlated with the activation of p38 MAPK. During severe trauma, the levels of sICAM-1 and p38 MAPK, as well as the incidence and mortality of MODS are lower when HS and ALB are used than single lactated LR solution is used.

Adult ; Albumins ; therapeutic use ; Cell Adhesion ; Female ; Fluid Therapy ; methods ; Humans ; Intercellular Adhesion Molecule-1 ; blood ; physiology ; Isotonic Solutions ; therapeutic use ; Male ; Middle Aged ; Multiple Organ Failure ; epidemiology ; mortality ; Resuscitation ; Saline Solution, Hypertonic ; therapeutic use ; Systole ; Wounds and Injuries ; blood ; physiopathology ; therapy ; p38 Mitogen-Activated Protein Kinases ; blood ; physiology

BCMA is one of the transmembrane receptors belonging to BAFF and APRIL. In order to identify the feasibility of sBCMA as decoy receptor and obtain active sBCMA for its structural and functional research, full length of hBCMA was amplified with total RNA from Raji cell line by RT-PCR, and the cDNA encoding the extracelluar soluble domain of hBCMA was inserted into pET43.1a(+) vector. The recombinant vector pET43.1a(+)-sBCMA was transformed into E. coli Origami B(DE3) pLyS which is helpful for disulfide bond construction of expression proteins. After IPTG induction, the recombinant protein was expressed as soluble fusion protein, sBCMA-NusA-His6, and identified by western blotting. Then the target protein was purified by Ni(+)-chelating Sepharose Fast Flow. The binding activity between recombinant sBCMA and BAFF was detected by ELISA. Also, Recombinant sBCMA inhibited proliferation of mouse B cell stimulating by rhsBAFF. It was proved that recombinant sBCMA has good bioactivity and the method to express those proteins rich in disulfide bond is feasible and effectual.
B-Cell Activating Factor ; chemistry ; B-Cell Maturation Antigen ; biosynthesis ; genetics ; Cloning, Molecular ; DNA, Complementary ; genetics ; Disulfides ; chemistry ; Escherichia coli ; genetics ; metabolism ; Humans ; Recombinant Fusion Proteins ; biosynthesis ; genetics ; Solubility ; Tumor Necrosis Factor Ligand Superfamily Member 13 ; chemistry

Objective To investigate antimicrobial resistance among gram-positive cocci in China in 2008.Methods From June 2008 to December 2008,1171 consecutive and non-repetitive gram-positive cocci were collected from 12 teaching hospitals.The MICs of antibacterial agents was determined by agar dilution method.Results The prevalence of MRSA and methicillin-resistant coagulase-negative Staphylococci(MRSCoN) was 49.9%(232/465) and 74.0%(179/242),respectively.The MRSA prevalence ranged from 33.3% to 65% in different regions.About 71.1%(108/152) of Staphylococcus aureus from respiratory tract specimens,48.3%(28/58) of Staphylococcus aureus from blood samples,and 36%(68/189) of Staphylococcus aureus from the pus,wound and sterile body fluid samples were resistant to methicillin.The susceptible rates of MRSA to trimethoprim/sulfamethoxazole(SXT) and chloramphenicol were 81.5%(183/232) and 89.7%(208/232).Susceptibility to gentamicin, erythromycin, clindamycin, tetracyclines,rifampicin,and quinolones were from 3.9% to 35.0%.All Staphylococci isolates were susceptible to vancomycin,teicoplanin,and linezolid.Three vacomycin-resistant Enterococcus faecium strains were found in this study.About 96.2%(101/105) of Enterococcus faecalis and 97%(130/134) of Enterococcus faecium were susceptible to linezoild.Fifty-one out of 105 of Enterococcus faecalis(48.6%)and 101 out of 134 Enterococcus faecium(75.4%)were resistant to high concentration gentaroicin.The susceptibility of Enterococcus faecalis to all the antibiotics except for chloramphenicol and tetracycline was higher than that of Enterococcus faecium.Enterococcus faecium isolates showed a high resistant prevalence to most of antibiotics except glycopeptides and linezolid.The prevalence of PISP among 225 isolates was was 36.6%(15/41),and the prevalence of PNSSP from the other patients ranged from 15.4% to 26.6%.The susceptible rates of PSSP to cefprozil,cefuroxime and cefaclor were 67.5%(114/169),66.3%(112/169) and 61.5%(104/169),respectively.All the PISP isolates were resistant to the above three antibiotics.Teicoplanin,vancomycin and linezolid were the most active agents against Staphylococcus pneumoniae(susceptible rate,100%).About 96.9%,97.8% and 98.2% Staphylococcus pneumoniae isolates were susceptible to gatifloxacin,levofloxacin,and moxifloxacin,respectively.The susceptible rates of Staphylococcus pneumoniae to ceftriaxone,chloramphenicol and amoxicillin/clavulanic acid were 81.3%,77.3%,and 68.0%,respectively.The susceptibility of Staphylococci pneumoniae to macrolides,SXT and tetracycline ranged from 11.6% to 23.6%.Conclusions The prevalence of VRE is low in China.However,methicillin-resistance among Staphylococci isolates was high.The prevalence of PNNSP isolated from (≤)3 years children is higher than in the other age population.Teicoplanin,vancomycin,and linezolid remain high activity against Staphylococci,Enterococcus faecalis,Enterococcus faecium,and Staphylococcus pneumoniae.

OBJECTIVETo Compare the curative effects between titanium mesh coated with or without silk fibroin and in the treatment of larger trachea circumferential defects. To explore the merits of titanium mesh coated with silk fibroin in promoting mucous healing and decreasing related complications.

METHODSTwenty-five New Zealand white rabbits were chosen , divided randomly as follows: group one: titanium mesh coated with silk fibroin (n = 12), group two: pure titanium mesh without silk fibroin (n = 12); Titanium mesh coated with silk fibroin and those titanium without silk fibroin were embedded in the anterior of 7-12th tracheal rings respectively, in 2 weeks we removed the anterior and lateral wall of 7-12th tracheal rings about 8 mm x 6mm (more than half ring) and used the two different materials to reconstruct tracheal defects. All these rabbits were euthanized in 4, 8 and 12 weeks and tracheal CT scan, tracheal endoscopy, histopathological examination and scanning electron microscopic examinations were performed. All complications such as death, local inflammation, tracheal stenosis were documented. Group three, leave one normal rabbit as controlled study , removed the anterior and lateral wall of 7-12th tracheal rings, and histopathological examination, scanning electron microscopy were performed as controlled study.

RESULTSThe CT scan, tracheal endoscopy of those with silk fibroin showed there was no apparent tracheal stenosis. Histopathological examination showed there was no obvious granulation tissue and scar. The mucous membrane and cilia grow normally. The silk fibroin was not entirely absorbed and the remains showed good biocompatibility. The scanning electron microscopy showed that the cilia grew better and more orderly than that of group two, and in 12 weeks, the cilia became normal. In group two, there were 5 rabbits died in succession from suffocation in 4, 5, 7, 17, 60 days after surgery. All rabbits had local or general subcutaneous emphysema. The CT scan, tracheal endoscopy and pathological examination showed that there were apparent granulation tissue, scar hypertrophy, and tracheal stenosis. The mortality of group two (41.7%) for suffocation compare to that of group one (0), the incidence rate of subcutaneous emphysema in group two (100%) to that of group one (25.0%) and the average cross section stenosis area in group two (18.15 +/- 7.85) mm2 to that of group one (3.15 +/- 1.58) mm2, there are significant statistically differences in these postoperative complications (P <0.05) and stenosis degree (P <0.05) between the two groups. In addition, there was one rabbit died of diarrhea in each group except group three.

CONCLUSIONSSilk fibroin and titanium mesh coated with silk fibroin showed good biocompatibility. Titanium mesh coated with silk fibroin used in tracheal reconstruction of rabbits can promote agglutination of mucous membrane and decrease postoperative complications, such as subcutaneous emphysema, tracheostenosis. It may be a prospective biomaterial which can be used in clinical circumferential trachea defect reconstruction.

Animals ; Biocompatible Materials ; Fibroins ; chemistry ; Male ; Rabbits ; Reconstructive Surgical Procedures ; methods ; Surgical Mesh ; Titanium ; chemistry ; Trachea ; surgery ; Tracheal Stenosis ; surgery ; Wound Healing

OBJECTIVETo evaluate the feasibility and safety of laparoscopic and endoscopic cooperative surgery for treating gastric gastrointestinal stromal tumors(GIST).

METHODSRetrospective analysis was performed on the clinical data of 46 patients with gastric GIST undergoing laparoscopic and endoscopic cooperative surgery between June 2009 and June 2011 at the Renji Hospital of Shanghai Jiaotong University School of Medicine.

RESULTSThere were 27 males and 19 females with the mean age of 58.5 years. Thirty-three patients received endoscopy-assisted wedge resection, and 13 cases received laparoscopy-assisted endoscopic resection. All the operations were successful. The mean operative time was (85.5±29.3) min, the mean blood loss was (31.4±12.2) ml, the mean post-operative gastrointestinal functional recovery time was (31.6±14.9) h, and the mean post-operative hospital stay was (5.1±2.9) d. No post-operative complication occurred. NIH risk assessment showed that 34 cases were very low risk and 12 low risk. No recurrence or metastasis was found during the follow-up ranging from 2 to 26 months(median, 12.6 months).

CONCLUSIONLaparoscopic and endoscopic cooperative surgery for gastric GIST is both feasible and safe with minimal invasiveness, fast recovery and satisfactory short-term outcomes.

Adult ; Aged ; Female ; Follow-Up Studies ; Gastrointestinal Stromal Tumors ; surgery ; Gastroscopy ; Humans ; Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Stomach Neoplasms ; surgery ; Treatment Outcome

OBJECTIVETo investigate the immunotherapy efficacy of both helper T lymphocytes (Th) and cytotoxic T lymphocytes (CTL) epitopes augmented dendritic cells (DCs) tumor vaccine on gastric cancer.

METHODSNaïve spleen T cells were stimulated by mixed peptides (a mixture of Th epitope MAGE-3 (22-36)) primed DCs per week in vitro. After 4 cycles of restimulation, peptide specific T cells were harvested and subgroups of which were determined with flow cytometry. Cytokines secreting profiles by CD4+ T cells and cytotoxicities of CD8+ T cells on tumor cells were assessed. The protective immunity by referred DCs tumor vaccines was also monitored.

RESULTSBoth Th and CTL epitopes primed DCs could elicit both CD4+ T cells and CD8+ T cells in vitro,of which CD4+ T cells released high amount of Th1 type cytokines (IFN-gamma, IL-2) on recognizing specific antigen, as well as CD8+ T cells exhibited efficient tumor-killing capacity. The effects induced by DCs pulsed with single epitope (Th or CTL epitope) in vivo were less effective than those induced by DCs pulsed with mixture epitopes.

CONCLUSIONSBoth Th and CTL epitopes augmented DCs tumor vaccine can induce CD4+ Th1 and CD8+ CTL mediated immune responses to eradicate gastric cancer cells.

Animals ; Cancer Vaccines ; immunology ; therapeutic use ; Cell Line ; Cell Line, Tumor ; Dendritic Cells ; immunology ; Epitopes, T-Lymphocyte ; immunology ; Immunotherapy ; Melanoma, Experimental ; Mice ; Peptides ; immunology ; Stomach Neoplasms ; therapy ; T-Lymphocytes, Cytotoxic ; immunology ; T-Lymphocytes, Helper-Inducer ; immunology

OBJECTIVETo assess the quality of life in cured patients with severe acute respiratory syndrome (SARS).

METHODSOne hundred and nineteen SARS outpatients, including 64 men and 55 women, with mean age (34.1 +/- 11.4) years and average days of discharge from hospital (28.0 +/- 12.8) days, were assessed by the St George's respiratory questionnaire (SGRQ), and 72 patients with spirometry test.

RESULTSThe patients had a moderately degree physiological impairment and increased SGRQ score. Scores of all four part of SGRQ correlated significantly with diffuse capacity of the lung for carbon monoxide/pre (DLco%). The correlation coefficients between the activation, impaction, total score, and diffuse capacity of the lung for carbon monoxide/alveolar ventilation/pre (DLco/Va%) were resembled (r = 0.47-0.54, P < 0.01). There was a significant relationship between the score of SGRQ and patients age, and gender. The time leaving hospital only had a significant relationship with the symptom score of SGRQ.

CONCLUSIONSSGRQ is a sensitive tool for assessing quality of life in cured SARS patients. The cured SARS patients' quality of life decrease moderately.

Adolescent ; Adult ; Age Factors ; Aged ; Convalescence ; Female ; Health Status ; Humans ; Lung ; physiopathology ; Male ; Middle Aged ; Quality of Life ; Respiratory Function Tests ; Sensitivity and Specificity ; Severe Acute Respiratory Syndrome ; physiopathology ; Sex Factors ; Surveys and Questionnaires