Objective:To explore the effectiveness of applying the learning group teaching method based on primary care guidelines for diagnosis and treatment of common diseases in the standardized training of general practice residents (referred to as "general practice resident training").Methods:This study was a randomized controlled trial. A total of 48 trainees enrolled in the general practice residency program at the Affiliated Huai′an No.1 People′s Hospital of Nanjing Medical University from September 2023 to August 2024 were included. They were divided into the observation group and the control group using a random number table method, with 24 trainees in each group. At baseline, general information such as age, sex, and education level of the trainees was collected, and their relevant theoretical knowledge was assessed. The control group trainees were intervened using the traditional teaching method, while the observation group trainees were intervened using the learning group teaching method based on the diagnosis and treatment guidelines for common diseases at primary care level. The teaching activities lasted for 1 year, with sessions held once a month, for a total of 12 sessions. At the end of the intervention, all trainees were assessed on theoretical knowledge, case analysis, and clinical skills. In addition, questionnaires were used separately to survey the trainees′ satisfaction in both groups, as well as the teaching satisfaction of instructors in the observation group.Results:The observation group included 18 females (75%), with a median age of 25 (24, 26) years, while the control group had 16 females (67%), with a median age of 25 (24, 26) years. There was no statistically significant difference in the age, proportion of female trainees, proportion of rural order oriented free medical students, proportion of undergraduate students, proportion of first-year trainees, and theoretical knowledge test scores before the implementation of intervention measures between the two groups of trainees (all P>0.05). At the end of the intervention, the theoretical knowledge, case analysis, and clinical skill test scores of the observation group were higher than those of the control group (all P<0.05). All 48 trainees participated in the survey. The observation group trainees were found to be more satisfied than the control group with the teaching methods, knowledge mastery, clinical diagnosis and treatment thinking, stimulation of learning interest, self-learning ability, teaching interest, interpersonal communication ability, teamwork ability, and community problem-solving ability (all P<0.05). Of the four teachers in the observation group who participated in the satisfaction survey, all expressed satisfaction with the teaching method and its content. They all believed that the teaching method helped them to broaden their teaching ideas and improve their teaching abilities and skills. Conclusions:The learning group teaching method, which is based on the diagnosis and treatment guidelines for common diseases at primary care level, can effectively enhance the theoretical knowledge, case analysis ability, and clinical skills of the trainees. This teaching method is highly effective, with both trainees and teachers expressing great satisfaction.

Objective:To explore the effectiveness of applying the learning group teaching method based on primary care guidelines for diagnosis and treatment of common diseases in the standardized training of general practice residents (referred to as "general practice resident training").Methods:This study was a randomized controlled trial. A total of 48 trainees enrolled in the general practice residency program at the Affiliated Huai′an No.1 People′s Hospital of Nanjing Medical University from September 2023 to August 2024 were included. They were divided into the observation group and the control group using a random number table method, with 24 trainees in each group. At baseline, general information such as age, sex, and education level of the trainees was collected, and their relevant theoretical knowledge was assessed. The control group trainees were intervened using the traditional teaching method, while the observation group trainees were intervened using the learning group teaching method based on the diagnosis and treatment guidelines for common diseases at primary care level. The teaching activities lasted for 1 year, with sessions held once a month, for a total of 12 sessions. At the end of the intervention, all trainees were assessed on theoretical knowledge, case analysis, and clinical skills. In addition, questionnaires were used separately to survey the trainees′ satisfaction in both groups, as well as the teaching satisfaction of instructors in the observation group.Results:The observation group included 18 females (75%), with a median age of 25 (24, 26) years, while the control group had 16 females (67%), with a median age of 25 (24, 26) years. There was no statistically significant difference in the age, proportion of female trainees, proportion of rural order oriented free medical students, proportion of undergraduate students, proportion of first-year trainees, and theoretical knowledge test scores before the implementation of intervention measures between the two groups of trainees (all P>0.05). At the end of the intervention, the theoretical knowledge, case analysis, and clinical skill test scores of the observation group were higher than those of the control group (all P<0.05). All 48 trainees participated in the survey. The observation group trainees were found to be more satisfied than the control group with the teaching methods, knowledge mastery, clinical diagnosis and treatment thinking, stimulation of learning interest, self-learning ability, teaching interest, interpersonal communication ability, teamwork ability, and community problem-solving ability (all P<0.05). Of the four teachers in the observation group who participated in the satisfaction survey, all expressed satisfaction with the teaching method and its content. They all believed that the teaching method helped them to broaden their teaching ideas and improve their teaching abilities and skills. Conclusions:The learning group teaching method, which is based on the diagnosis and treatment guidelines for common diseases at primary care level, can effectively enhance the theoretical knowledge, case analysis ability, and clinical skills of the trainees. This teaching method is highly effective, with both trainees and teachers expressing great satisfaction.

【Objective】 To evaluate the significance of Mayo adhesive probability (MAP) in predicting surgical difficulty and postoperative recovery in patients with renal cell carcinoma (RCC) undergoing laparoscopic radical nephrectomy (LRN). 【Methods】 The clinical data of 168 RCC patients who received transabdominal LRN during Jan.2017 and Dec.2020 were retrospectively analyzed. According to MAP, the patients were divided into low MAP group (n=100) and high MAP group (n=68). The differences in perioperative clinical data were compared between the two groups. 【Results】 Compared with low MAP group, the high MAP group had longer operation time (P<0.001), more intraoperative blood loss (P<0.001), higher Clavien-Dindo grade complications (P=0.008), longer hospital stay (P=0.003), higher levels of c-reactive protein (P=0.030) and IL-6 (P=0.009), lower levels of albumin (P<0.001) and prealbumin (P=0.020). 【Conclusion】 MAP can assess the risk of prolonged operation time, increased bleeding during transabdominal LRN, and postoperative recovery, thus guiding the preoperative planning.

Forty trainees who underwent position-transition training for general practitioner in the Affiliated Huai′an First People′s Hospital of Nanjing Medical University from August 2021 to July 2022 were randomly divided into the control group and the trial group with 20 in each group. The traditional teaching methods were applied in control group and the problem-based learning/case-based learning (PBL/CBL) combined scenario simulation teaching method were applied in trial group. The effect of the two teaching methods was evaluated by the examination results and the teaching satisfaction was assessed by the questionnaire survey. The exam scores of general practice thinking, comprehensiveness of inquiry content, integrity of preliminary diagnosis, comprehensiveness of preliminary treatment, ability to deal with critical and severe cases, ability of chronic disease management and concept of holistic care in trial group were significantly higher than those in control group( t=-15.79,-15.74,-16.67,-13.66,-18.57,-18.55,-19.74,all P<0.05). The satisfaction of trainees in the trial group was also significantly higher than that in the control group in terms of teaching methods, stimulating learning interest; and improvement of independent learning ability, general practice clinical thinking, doctor-patient communication ability, teamwork ability and community problem-solving ability( χ2=12.10,10.03,12.22,10.03,8.18,10.03,8.18,all P<0.05). The study shows that PBL/CBL combined scenario simulation teaching method can improve the learning effect and satisfaction of the trainees in position-transition training for general practitioner.

Objective:To evaluate the effect of uncoupling protein 1 (UCP1) expression of perirenal fat on the prognosis of clear cell renal cell carcinoma (ccRCC) .Methods:From Feb. 2013 to Oct. 2013 and Mar. 2015 to Oct. 2015, 98 patients with ccRCC who underwent retroperitoneal laparoscopic radical nephrectomy were analyzed. UCP1 mRNA of perirenal fat around tumor was detected by RT-qPCR. Preoperative Computed tomography (CT) images were used to evaluate the thickness and adhesiveness of perirenal fat. According to the UCP1 mRNA value, the patients were divided into high UCP1 group (42 cases) and low UCP1 group (56 cases) . The general clinical data, perirenal fat thickness and adhesiveness were compared, and Kaplan Meier curve was used to evaluate the difference of progression free survival (PFS) between the two groups. Univariate and multivariate Cox analysis were used to determine the potential independent prognostic factors of PFS.Results:In the high UCP1 group, the renal fat thickness, the ratio of fat adhesion, the ratio of Ⅲ to Ⅳ in Fuhrman grade and the ratio of >T2 in T stage were higher than those in the low UCP1 group[ (13.84±2.41) vs (10.75±1.99) , 42.86% vs 16.07%, 28.57% vs 8.93%, 21.43% vs. 5.36%; P=0.000, P=0.003, P=0.011, P= 0.037]. During the follow-up period (median, 62.0 months) , 15 cases (12 cases of high UCP1 group, 3 case of low UCP1 group) developed tumor progression. Kaplan Meier curve showed that PFS of high UCP1 group was worse than that of low UCP1 group (71.43% vs 94.64%, P=0.001) . Cox regression analysis showed that high UCP1 expression and high T stage were significantly correlated with low PFS ( β=1.334, RR=3.796, 95% CI=1.009-14.280, P= 0.048; β=2.886, RR=17.930, 95% CI=5.538-58.047, P=0.000) . Conclusions:The increased UCP1 expression of perirenal fat may be an independent risk factor of tumor progression in ccRCC. Combined with the assessment of browning of perirenal adipose tissue may be helpful for risk stratification of ccRCC patients after surgery.

A method was established for simultaneous determination of 21 active constituents including flavanols, isoflavones, flavonols, dihydroflavones, dihydroflavonols, chalcones, pterocarpan, anthocyanidins and phenolic acids in Spatholobi Caulis by ultra fast liquid chromatography with triple quadrupole linear ion trap mass spectrometry(UFLC-QTRAP-MS/MS). Then, it was employed to analyze and evaluate the dynamic accumulation of multiple bioactive constituents in Spatholobi Caulis. The chromatographic separation was performed on a XBridge®C_(18)(4.6 mm×100 mm, 3.5 μm) at 30 ℃ with a gradient elution of 0.3% formic acid aqueous solution-methanol, and the flow rate was 0.8 mL·min~(-1), using multiple-reaction monitoring(MRM) mode. A comprehensive evaluation of the multiple bioactive constituents was carried out by gray correlation analysis(GRA). The 21 target components showed good linearity(r>0.999 0) in the range of the tested concentrations. The average recovery rates of the 21 components were from 97.46% to 103.6% with relative standard deviations less than 5.0%. There were differences in the contents of 21 components in Spatholobi Caulis at diffe-rent harvest periods. Spatholobi Caulis had high quality from early November to early December, which is consistent with the local tradi-tional harvest period. This study reveals the rule of the dynamic accumulation of 21 components in Spatholobi Caulis and provides basic information for the suitable harvest time. At the same time, it provides a new method reference for the comprehensive evaluation of the internal quality of Spatholobi Caulis.
Chromatography, High Pressure Liquid ; Fabaceae/chemistry* ; Phytochemicals/isolation & purification* ; Plant Stems/chemistry* ; Plants, Medicinal/chemistry* ; Tandem Mass Spectrometry

Objective: To determine the change of gene expressions in human perirenal adipose tissue (PAT) and oblique abdomen subcutaneous adipose tissue (SAT) of overweight and obese subjects. Methods: Ninety-seven patients, including 35 overweight/obese patients and 62 non-obese patients, who underwent renal surgery were included. The clinical data and various gene expressions in PAT and SAT of two groups were analyzed. Results: Body mass index, waist circumference, systolic blood pressure, resting heart rate, fasting blood glucose, and serum creatinine were significantly higher in overweight/obese patients than those in non-obese patients(P<0.05 or P<0.01). Compared with non-obese patients, PAT adipocytes showed bigger, and the expressions of uncoupling protein-1 (UCP1) mRNA and protein were markedly lower in overweight/obese patients. The mRNA expressions of CIDEA and adiponectin in PAT of overweight/obese patients were significantly lower, while leptin, monocyte chemotactic protein 1, interleukin (IL)-6, and IL-10 mRNA expressions were significantly higher. There were no significant differences in the related gene expressions of SAT between the two groups. Conclusions Different parts of adipose tissue reveal various characteristics, and play different roles in the occurrence and development of obesity. UCP1 expression is decreased in PAT of overweight/obese patients, with the changes of adipocytokine expressions. (Chin J Endocrinol Metab, 2018, 34: 567-572)

As a new technology, three-dimensional printing possesses the characteristics of high precision and strong controllability, which has become a new technology and can be used in tissue engineering. Currently, using three-dimensional printing to build artificial skin has made certain achievement, and experiments in vitro have confirmed that the three-dimensional printing has the possibilities to build artificial skin whose structure and function are close to those of nature skin. However, the technology is not yet very mature and there are still some problems need to be solved, such as the recreation of the cutaneous appendages and the degradation and absorption of the extracellular matrix.

Objective To explore the size of access channel that may influence the intrarenal pelvic pressure during percutaneous nephrolithotomy.Methods From April 2014 to July 2015,83 patiens with unilateral renal calculus,ranged from 20 to 40mam were divided into 2 group randomly.40 cases underwent F24 channel PCNL and 43 cases underwent F16 channel PCNL.There was no statistically significant difference between the groups in preoperative variables,such as age,gender,preoperative status of infection,status of hydrpnephrosis,size and location of stone (P ＞ 0.05).We used a 6Fr ureteral catheter positioned into the renal pelvic,and the intrarenal pelvic pressure was measured by anesthesia monitor IBP channel during PCNL in different stages (entrance into the collecting system,calculi fragmentation,and termination)for all patients.Removing calculus time,postoperative hemoglobin changing,fever rate,procalcitonin abnormal rate,white blood cell counts and calculi clearance rate were recorded and compared.Results The intrarenal pelvic pressure in different stages on F24 channel and F16 channel were (7.5 ± 1.3)、(22.5± 4.3)、(14.0 ± 2.7) mmHg and (10.3 ± 1.1)、(34.6 ± 4.1)、(23.0 ± 3.6) mmHg,respectively.There was statistically significant difference between 2 groups (P ＜ 0.05).Compared with F16 channel,F24 channel had significant differences in removing calculus time [(12.8 ± 3.7) min vs.(23.3 ± 3.6) min],fever rate [17.5％ (7/40) vs.39.5％ (17/43)],procalcitonin abnormal rate [15.0％ (6/40) vs.34.9％(15/43)] and white blood cell counts abnormal rate [10.0％ (4/40) vs.27.9％ (12/43)] (P ＜ 0.05).However,no significant difference in postoperative hemoglobin changing [(11.8 ± 4.4)g/L vs.(13.7 ±4.7)g/L] and calculi clearance rate [87.5％ (35/40) vs.81.4％ (35/43)] (P ＞0.05).Conclusions Compared with F16 channel,the F24 channel PCNL maintains lower renal pelvic pressure,which is less than reflux limit,during calculi fragmentation,It might be contributed to reduce the postoperative fever rate.It can short time for removing calculi and achieve the better effect.

As a new industrial technology with characteristics of high precision and accuracy,the application of three-dimensional bioprinting technology is increasingly wide in the field of medical research.Collagen is one of the most common ingredients in tissue,and it has good biological material properties.There are many reports of using collagen as main composition of " ink" of three-dimensional bioprinting technology.However,the applied collagen is mainly from heterogeneous sources,which may cause some problems in application.Recombinant human source collagen can be obtained from microorganism fermentation by transgenic technology,but more research should be done to confirm its property.This article reviews the advances in the research of collagen and its biological application in three-dimensional bioprinting.