The learning theory of constructivism, formed by the development of cognitive psychology, shaped well thecognitive structure of medical students. It paid attention to the curriculum configuration and integration, and also thoughtmuch of the situated instruction. The theory embodied the main ideology of regarding medical students as the instruc-tional central and the principle of independent study. It offered the theoretical basis and a new view for the setting ofclinical integrate curriculum.

Objective To investigate the operative procedure and the clinical result of the modified rectangle cross-finger flap based on the dorsal branches in the middle phalange to repair degloved avulsion of fingertip.Methods From January 2006 to March 2010,26 patients with the avulsions of fingertip were treated by the modified rectangle cross-finger flap based on the dorsal branch in the middle phalange of adjacent finger.There were 21 men and 5 women,with an average age of 31.6 years(range,17-56 years).Fourteen cases were crushed by machine,8 cases were pressed and 4 cases were tied.There were 8 index fingers,9 long fingers,4 ring fingers and 5 little fingers.The length of the avulsion was 1.1-2.6 cm.The flap was harvested from the dorsal of contiguous digital of their middle and proximal segment.The both dorsal branches of the both proper palmar digital nerves were cut off and were anatomized with the nerve end of the injured digit.The area of flaps ranged from 3.6 cm×2.3 cm-6.5 cm×3.2 cm.The donors were closed by skin graft.Results The pedicels were cut when 13-23 d after operation.Twenty-five patients were followed up for 6-28 months(mean,16.3 months).All flaps survived with satisfactory appearance,sensation and function.All flaps and donors were primary healing.Two point discrimination was 6-9 mm with an average of 7.8 mm.The postoperative outcomes were evaluated by the total active movement.The results were excellent in 17fingers,good in 7,and fair in 1.The rate of excellent and good was 96%.Conclusion The treatment of degloved avulsion of fingertip with the modified rectangle cross-finger flap based on the dorsal branch in the middle phalange is recommendable.The operative procedure of harvesting the flap is simple.There is enough blood to supply the flap and the surviving rate is high.The postoperative function of the injured hand can be recovered satisfactorily.The figure of flap is well and the sense of flap is sensitive.The technique can be operated in the last 4 fingers without thumb.

Objective To observe the clinical efficacy of acupuncture in treating subjective tinnitus.Method Seventy subjective tinnitus patients were randomized into a treatment group and a control group, 35 cases in each group. The control group was intervened by conventional medication, while the treatment group was by acupuncture in addition to the medication given to the control. The serum zinc level, copper level, and pure-tone hearing threshold were observed before and after intervention, and the clinical efficacies were compared.Result After intervention, the serum zinc and copper levels, and pure-tone hearing threshold were significantly changed in both groups (P<0.05). The serum zinc and copper levels, and pure-tone hearing threshold of the treatment group were significantly different from that of the control group after intervention (P<0.05). The total effective rate was 93.8% in the treatment group versus 87.9% in the control group, and there was a significant difference between the two groups (P<0.05).Conclusion Acupuncture plus medication is an effective way in treating subjective tinnitus.

Objective To investigate the clinical efficacy and safety of brinzolamide combined with travoprost in the treatment of primary open-angle glaucoma.Methods 112 cases(140 eyes)of open-angle glaucoma patients from March 2015 to March 2016 were selected and randomly divided into the group A and the group B 56 cases(70 eyes)in each group.The group A was treated with travoprost therapy,while the group B was given travoprost combined with brinzolamide treatment,the adverse reactions and clinical curative effects in the two groups were observed and compared during treatment.Results After two weeks,one months,three months and six months in the two groups intraocular pressure were significantly lower than those before treatment,the difference was statistically significant(P<0.05),but in two weeks,one months,three months and six months in the group B the intraocular pressure was significantly lower than that in the group A,the difference was statistically significant(P<0.05).After treatment,two groups of BUT and ST were decreased significantly lower than before treatment,the difference was statistically significant(P<0.05),but there was no significant difference between BUT and ST after treatment,two groups of corneal fluorescein staining and ocular; Bengal staining scores were all significantly higher than before treatment,the difference was statistically significant(P<0.05),however,there was no significant difference in corneal fluorescein staining and ocular surface of rose bengal staining between the two groups.There was no significant difference in the incidence of adverse reactions between the two groups.Conclusion Brinzolamide combined with travoprost can reduce the intraocular pressure of patients with primary open-angle glaucoma,but can reduce tear film stability,damage the cornea,conjunctiva,reduce tear secretion,there is some damage to the conjunctiva,cornea,similar with travoprost.

Alzheimer's disease is a common disease among the elderly.It seriously affects the quality of life of patients.There is still no effective treatment.The existence of blood-brain barrier further limits the efficacy of therapeutic drugs.As a highly safe nano-carrier,liposomes can not only carry drugs into the brain,but also have the advantages of reducing toxicity and side effects.Therefore,liposomes are promising in the treatment of Alzheimer's disease.This paper summarized the application of different types and functions of liposomes in various therapeutic drugs for Alzheimer's disease,aiming to provide an effective delivery strategy for the treatment of Alzheimer's disease.

Objective: To investigate the breakfast consumption of middle school students and to analyze its relationship with physical fitness, so as to provide reference for improving physical fitness of middle school students. Methods: A total of 2 732 middle school students from Shangrao City were selected in September 2021 by random cluster stratified sampling. The breakfast consumption behaviors of middle school students were investigated by questionnaire, and the general information, family information and other lifestyle behaviors were collected. The physical fitness test includes grip strength, standing long jump, 1 minute sit up, sit forward bend, 50 m run and 20 m shuttle run test (20 m SRT) to evaluate the strength, flexibility, speed and endurance of middle school students. χ 2 tests were used to compare the correlation between different demographic characteristics, breakfast behavior and physical fitness,and Logistic regression analysis was used to infer the correlation strength between breakfast behavior and physical fitness. Results: The detection rate of physical fitness failure among middle school students was 21.5%. There were statistically significant differences between breakfast frequency and grip strength and 20 m SRT( χ 2=8.27, 13.90, P < 0.05 ). Logistic regression analysis results showed that 20 m SRT was positively correlated with breakfast frequency (sometimes eat breakfast, OR =1.51, skip or occasionally eat breakfast OR =2.08, P <0.05). Conclusion The low frequency of breakfast consumption of middle school students is associated with low performance on 20 m SRT. Schools and families should pay attention to the breakfast consumption of middle school students to ensure adequate daily nutrition intake.

OBJECTIVETo examine the effects of Panax notoginseng on the expression of cytochrome P450 (CYP) genes and glutathione S-transferase (GST) genes in lung tissues of male SD rats.

METHODRats were administered P. notoginseng 2 or 4 g X kg(-1) bw/d by gavage daily for 15 days. The levels of gene expression of CYP1A1, CYP1A2, CYP1B1, CYP2B1, CYP2E1, CYP3A1, CYP4A1 and glutathione S-transferase ml (GST-ml) and glutathione S-transferase pi (GST-pi) were examined by quantitative real-time reverse-transcription polymerase chain reaction (quantitative real time-RT-PCR) assays.

RESULTThe expression of CYP2E1, CYP1A2 and GST-pi genes was not changed by P. notoginseng treatment, however, 2 g * kg-1 dose of P. notoginseng gave a 4.00-fold (P < 0.05) induction of CYP3A1 mRNA. P. notoginseng significantly increased mRNA expressions of GSTml (1.64-fold, P <0. 05 and 1.53-fold, P > 0.05) and CYP1A1 (3.44-fold, P > 0.05 and 6.05-fold, P < 0.05) in the 2 g x kg(-1) and 4 g x kg(-1) bw/d treatment groups, respectively, but P. notoginseng had a inhibitory tendency on mRNA expressions of CYP1B1 (0.81-fold, P > 0.05 and 0.38-fold, P > 0.05) and significantly inhibited the expressions of CYP2B1 (0.47-fold, P < 0.05 and 0.50-fold, P < 0.05) and CYP4A1 (0.54-fold, P < 0.05 and 0. 72-fold, P < 0.05) genes in the two groups.

CONCLUSIONA specific effect of P. notoginseng on the expression of different cytochrome P-450 genes or glutathione S-transferase genes in the lung tissues of rats was observed in this investigation. These findings would be very important and helpful for studying the mechanism of action of P. notoginseng and its reasonable use in clinic.

Animals ; Cytochrome P-450 Enzyme System ; genetics ; metabolism ; Drugs, Chinese Herbal ; chemistry ; pharmacology ; Gene Expression ; drug effects ; Glutathione Transferase ; genetics ; metabolism ; Lung ; drug effects ; enzymology ; Male ; Panax notoginseng ; chemistry ; Random Allocation ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo examine the effects of Panax notoginseng on the expression of cytochrome P450 (CYP) genes and glutathione S-trans-ferase (GST) genes in liver tissues of male SD rats.

METHODRats were administered P. notoginseng 2 or 4 g x kg(-1) bw/d by gavage daily for 14 days. The levels of gene expression of CYP1A1, CYP1A2, CYP2B1, CYP2E1, CYP3A1, CYP4A1, and GSTml, GST-pi were examined by quantitative real-time reverse-transcription polymerase chain reaction (quantitative real time-RT-PCR) assays.

RESULTThe expression of CYP1A1, CYP1A2, CYP2E1, CYP3A1, GSTml and GST-pi genes was not changed by 2 or 4 g x kg(-1) P. notoginseng treatment, But P. notoginseng significantly inhibited mRNA expressions of CYP2B1 (0.48-fold, P < 0.05, and 0.61-fold, P < 0.05, respectively) and CYP 4A1 (0.69-fold, and 0. 51-fold, respectively).

CONCLUSIONP. notoginseng had a special inhibitory selectivity on the expression of CYP2B1 and CYP4A1 genes in liver tissues of rats, which indicated it may be one of the mechanisms of actions of P. notoginseng. P. notoginseng had no effects on the expressions of CYP1A1, CYP1A2, CYP2E1 and CYP3A1 genes, which suggested when P. notoginseng co-administrated with those drugs metabolized by the above major metabolizing enzymes in liver, metabolic herb-drug interactions would not be happened.

Animals ; Cytochrome P-450 Enzyme System ; genetics ; metabolism ; Drugs, Chinese Herbal ; pharmacology ; Gene Expression ; drug effects ; Glutathione Transferase ; genetics ; metabolism ; Liver ; drug effects ; enzymology ; Male ; Panax notoginseng ; chemistry ; Random Allocation ; Rats ; Rats, Sprague-Dawley

Objective:To investigate the efficiency and safety of traditional growing rod in the treatment of early onset dystrophic scoliosis secondary to type 1 neurofibromatosis (NF1-DS) with intraspinal rib head in children.Methods:From September 2006 to May 2020, this study recruited 20 children with intraspinal rib head with early onset NF1-DS who had received traditional growing rods. There were 13 boys and 7 girls and the age of the initial operation was 7.0±1.6 years (range, 4.1-9.8 years). There were 7 cases of simple left chest bend, 9 cases of simple right chest bend, and 4 cases of double chest bend; 13 patients had varying degrees of kyphosis deformity. Two children had neurological symptoms before surgery, American Spinal Injury Association Impairment Scale (AIS) were grade D. The proportion of the intraspinal rib head (IRP), the Cobb angle of the main chest bend, apical vertebra rotation (AVR), apical vertebral translation (AVT), trunk shift (TS) and sagittal TK, lumbar lordosis (LL), sagittal balance and T 1-S 1 height were measured before and after first time internal fixation and at last follow-up, and the complications were also evaluated. Results:All 20 patients were followed up and the average follow-up time was 41.6±23.8 months (range, 24-99 months). A total of 85 operations was conducted including 63 protrude operations. After operation, the IRP was significantly lower than that before operation (preoperative 33.1%±17.5% vs. postoperative 22.2%±11.3%, P<0.001) and no significant correction loss was found at last follow-up 23.7%±12.4% ( P>0.05). The mean Cobb angle decreased from 75.9°±26.7° preoperatively to 45.0°±18.5° postoperatively ( P<0.001) and there was still significant improvement at the last follow-up (41.0°±17.2°) compared with postoperatively ( P<0.05). The AVR was significantly reduced after surgery compared with preoperatively (33.0°±10.1° vs. 39.3°±13.3°, P<0.001), and the last follow-up (40.1°±11.4°) was significantly improved compared with postoperative ( P=0.005). The T 1-S 1 height increased from 259.8±70.7 mm preoperatively to 296.9±78.4 mm postoperatively ( P=0.001), and at the last follow-up 296.9±78.4 mm was still significantly higher than after operation ( P<0.001), with an average annual increase of 12.4±3.2 mm. Significant correction of AVT, TK, LL and sagittal balance were noted after initial surgery ( P<0.05), and no significant correction loss was found at last follow-up ( P>0.05). There were 10 complications in 7 cases. There were 5 complications of pedicle screw loosening, 1 complication of bolt droping, 2 complications of broken rod, 1 complication of distal junctional kyphosis and 1 complication of adding-on phenomenon. 2 cases with nerve injury were recover after operation (AIS grading E). None of the children had new neurological complications during growth rod insertion and multiple stretching during follow-up. Conclusion:For children with early onset NF1-DS with intraspinal rib head, if the preoperative AIS grade is D or E, traditional growing rod technique is relatively safe and effective and can make the intraspinal rib head remove from the spinal canal partly.