Objective:To investigate the promoting effect of individualized instruction combined with a blended learning model (IIBLM) in continuing training of neurology.Methods:A total of 93 trainees who received continuing training in Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, from August 2022 to December 2024 were enrolled as subjects. The 50 trainees registered since January 2024 were enrolled as observation group and received IIBLM teaching, including sub-specialty modular training, a cycle-adaptive cultivation system, a "mutual-selection" mentorship program, an on/off-line dual-track curriculum system, a dynamic course allocation mechanism based on "mutual selection", and a competency growth evaluation system, while the 43 trainees registered before January 2024 were enrolled as control group and received traditional teaching. A questionnaire survey and comprehensive competency assessments were performed to evaluate the effect of teaching, and the t-test, the chi-square test, and the qualitative analysis were used for statistical analysis. Results:Compared with the control group, the experimental group showed systematic improvements in clinical contents, theoretical curriculum, faculty competency, and workflow arrangement during continuing training, with a significant difference in the score of workflow arrangement between the two groups [(9.58±0.67) vs. (9.07±1.44), t=-2.13, P=0.037]. The observation group had a score of (97.70±1.30) for dynamic course allocation, an overall satisfaction rate of 97.15%, and a course benefit rate of 97.55%. The qualitative analysis showed that the trainees in the control group mainly complained of course monotony, while those in the observation group expected to enhance interdisciplinary integration and the cultivation of scientific research abilities. In addition, the results of competency assessment showed a continuous improvement in teaching effect after reform, with no significant difference. Conclusions:IIBLM teaching effectively enhances professional qualities, clinical competency, and the degree of satisfaction with courses among the trainees receiving continuing training, and it also revealed the necessity of interdisciplinary collaborative teaching and the integration of research and clinical practice.

Objective:To investigate the promoting effect of individualized instruction combined with a blended learning model (IIBLM) in continuing training of neurology.Methods:A total of 93 trainees who received continuing training in Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, from August 2022 to December 2024 were enrolled as subjects. The 50 trainees registered since January 2024 were enrolled as observation group and received IIBLM teaching, including sub-specialty modular training, a cycle-adaptive cultivation system, a "mutual-selection" mentorship program, an on/off-line dual-track curriculum system, a dynamic course allocation mechanism based on "mutual selection", and a competency growth evaluation system, while the 43 trainees registered before January 2024 were enrolled as control group and received traditional teaching. A questionnaire survey and comprehensive competency assessments were performed to evaluate the effect of teaching, and the t-test, the chi-square test, and the qualitative analysis were used for statistical analysis. Results:Compared with the control group, the experimental group showed systematic improvements in clinical contents, theoretical curriculum, faculty competency, and workflow arrangement during continuing training, with a significant difference in the score of workflow arrangement between the two groups [(9.58±0.67) vs. (9.07±1.44), t=-2.13, P=0.037]. The observation group had a score of (97.70±1.30) for dynamic course allocation, an overall satisfaction rate of 97.15%, and a course benefit rate of 97.55%. The qualitative analysis showed that the trainees in the control group mainly complained of course monotony, while those in the observation group expected to enhance interdisciplinary integration and the cultivation of scientific research abilities. In addition, the results of competency assessment showed a continuous improvement in teaching effect after reform, with no significant difference. Conclusions:IIBLM teaching effectively enhances professional qualities, clinical competency, and the degree of satisfaction with courses among the trainees receiving continuing training, and it also revealed the necessity of interdisciplinary collaborative teaching and the integration of research and clinical practice.

Objective:To investigate the predictive value of the product of first plasmacolchicine concentration and poisoning time for the prognosis of colchicine poisoning patients, and to provide a basis for early prognosis assessment.Methods:October 2021, patients with colchicine poisoning admitted in the First Affiliated Hospitol of Wenzhou Medical University from January 2017 to September 2021 were collected, including general information such as patient gender, age, oral colchicine dose, poisoning time, the first laboratory test index andplasma colchicine concentration after admission. The patients were divided into survival group and death group according to their prognosis. The differences in clinical indicators such as admission plasma colchicine concentration, blood routine, blood biochemistry, coagulation function, and blood gas analysis were compared between the two groups, and their predictive value for the prognosis of patients were analyzed.Results:A total of 23 patients with colchicine poisoning, aged 20-85 years, were included in this study, of which 15 cases (65.22%) survived and 8 cases (34.78%) died. The first plasma colchicine concentration at admision were 0.42-53.61 ng/ml. The plasma colchicine concentration and the concentration-time product were 10.08-2147.04 h·ng/ml.Compared with the survival group, the plasma colchicine concentration and the concentration-time product in the death group were significantly increased, and the differences were statistically significant ( P<0.05). Univariate logistic regression analysis showed that first plasma concentration and poisoning time>132.48 h·ng/ml, high C-reactive protein, high D-dimer, high absolute value of BE were the risk factors for the prognosis of patients with colchicine poisoning ( OR=12.000, 95% CI: 1.1181-128.836; OR=1.053, 95% CI: 1.009-1.098; OR=1.219, 95% CI: 1.039-1.429; OR=1.360, 95% CI: 1.1.044-1.773; P<0.05). High prothrombin time activity was protective factor affecting the prognosis of colchicine poisoning patients ( OR=0.941, 95% CI: 0.892~0.993; P<0.05). ROC curve analysis showed that the areas under the curves of first plasma concentration and poisoning time, C-reactive protein, absolute value of BE, D-dimer for predicting the prognosis of patients with colchicine poisoning were 0.918, 0.888, 0.867, 0.837, respectively, and the areas under the curves of prothrombin time activityfor predicting the prognosis of patients with colchicine poisoning was 0.788 ( P<0.05) . Conclusion:The product of the first plasma colchicine concentration at admission and poisoning time is closely related to the prognosis of patients with colchicine poisoning, it can be used as a predictor for early evaluation of the prognosis of poisoned patients.

Objective:To investigate the predictive value of the product of first plasmacolchicine concentration and poisoning time for the prognosis of colchicine poisoning patients, and to provide a basis for early prognosis assessment.Methods:October 2021, patients with colchicine poisoning admitted in the First Affiliated Hospitol of Wenzhou Medical University from January 2017 to September 2021 were collected, including general information such as patient gender, age, oral colchicine dose, poisoning time, the first laboratory test index andplasma colchicine concentration after admission. The patients were divided into survival group and death group according to their prognosis. The differences in clinical indicators such as admission plasma colchicine concentration, blood routine, blood biochemistry, coagulation function, and blood gas analysis were compared between the two groups, and their predictive value for the prognosis of patients were analyzed.Results:A total of 23 patients with colchicine poisoning, aged 20-85 years, were included in this study, of which 15 cases (65.22%) survived and 8 cases (34.78%) died. The first plasma colchicine concentration at admision were 0.42-53.61 ng/ml. The plasma colchicine concentration and the concentration-time product were 10.08-2147.04 h·ng/ml.Compared with the survival group, the plasma colchicine concentration and the concentration-time product in the death group were significantly increased, and the differences were statistically significant ( P<0.05). Univariate logistic regression analysis showed that first plasma concentration and poisoning time>132.48 h·ng/ml, high C-reactive protein, high D-dimer, high absolute value of BE were the risk factors for the prognosis of patients with colchicine poisoning ( OR=12.000, 95% CI: 1.1181-128.836; OR=1.053, 95% CI: 1.009-1.098; OR=1.219, 95% CI: 1.039-1.429; OR=1.360, 95% CI: 1.1.044-1.773; P<0.05). High prothrombin time activity was protective factor affecting the prognosis of colchicine poisoning patients ( OR=0.941, 95% CI: 0.892~0.993; P<0.05). ROC curve analysis showed that the areas under the curves of first plasma concentration and poisoning time, C-reactive protein, absolute value of BE, D-dimer for predicting the prognosis of patients with colchicine poisoning were 0.918, 0.888, 0.867, 0.837, respectively, and the areas under the curves of prothrombin time activityfor predicting the prognosis of patients with colchicine poisoning was 0.788 ( P<0.05) . Conclusion:The product of the first plasma colchicine concentration at admission and poisoning time is closely related to the prognosis of patients with colchicine poisoning, it can be used as a predictor for early evaluation of the prognosis of poisoned patients.

Objective:To evaluate the effect of general anesthesia on microelectrode recording (MER) during deep brain stimulation (DBS) of subthalamic nucleus (STN) in the patients with primary Parkinson′s disease (PD).Methods:Forty-four patients of both sexes with primary PD (duration of disease ≥ 5 yr and/or obvious symptom fluctuation), undergoing bilateral STN DBS from March 2008 to March 2018, aged<80 yr, were selected and divided into 2 groups by a random number table method: awake group ( n=26) and general anesthesia group ( n=18). In awake group, 0.5% ropivacaine was used for incision infiltration at skin incision.Patients in GA group received propofol and remifentanil by target-controlled infusion with Narcotrend to monitor the depth of anesthesia, and 0.5% ropivacaine was used for incision infiltration at skin incision.The total number of trajectories and length of STN were recorded during MER.Movement disorders were evaluated at 1 week before surgery and 6 months after surgery, and the improvement rate of dyskinesia was calculated.The postoperative anesthesia-, hardware- and stimulation-related complications were recorded. Results:There were no significant differences between the two groups in the total number of trajectories, length of STN and improvement rate of postoperative movement disorders ( P>0.05). Conclusion:General anesthesia does not affect the MER during STN DBS in the patients with primary PD.

Objective To study the expression and significance of apoptosis-related genes caspase-3,caspase-9,Bax and Bcl-2 in oral normal mucosa,oral simple hyperplasia,oral epithelial dysplasia and oral squamous cell carcinomas (OSCC) in Chinese hamsters.Methods The expressions of mRNA and protein of caspase-3,caspase-9,Bax and Bcl-2 in the oral normal mucosa,oral simple hyperplasia,oral epithelial dysplasia and OSCC tissues in Chinese hamsters were examined by immunohistochemistry and RT-PCR.Results During the process of oral carcinogenesis,the expression of Bcl-2 protein was significantly higher in OSCC than in oral normal mucosa,oral simple hyperplasia,and oral epithelial dysplasia (P<0.05).In dysplastic epithelia,the protein expressions of caspase-3,caspase-9 and Bax were more than that of normal epithelia,and along with the increased dysplasis,the expression level was decreased.Further analysis showed that expression of Bcl-2 was negatively related with the expressions of Bax,caspase-3 and caspase-9 (P<0.05).The result of RT-PCR showed that Bcl-2 was significantly increased in OSCC compared with normal mucosa,while the expressions of caspase-3,caspase-9 and Bax were decreased (P<0.05).Conclusions In the Chinese hamster squamous carcinoma,the expressions of caspase-3,caspase-9 and Bax are reduced and the Bcl-2 expression are increased,indicating that the expressions of caspase-3,caspase-9,Bax and Bcl-2 are closely related with the occurrence and development of oral squamous cell cancinoma.This study can offer some clues for gene therapy of OSCC,or can provide a reference for evaluating the biological characteristics and prognosis of OSCC.

Objective To study the expression and significance of EGFR, PDCD4, TGF-β1, Smad3, Smad7 in oral normal mucosa, oral simple hyperplasia, oral epithelial dysplasia and oral squamous cell carcinomas(OSCC).Methods Serum levels of EGFR, PDCD4 were measeured with ELISA in Chinese hamster during the oral mucosa carcinogenesis;The expressions of TGF-β1, Smad3, Smad7 in oral normal mucosa, oral simple hyperplasia, oral epithelial dysplasia and OSCC tissues were examined by immunohistochemistry.Results In the process of oral carcinogenesis,the expression level of EGFR increased significantly,while the expression of PDCD4 was decreased, the negatively correlation was evident between expression of these two proteins in ED and SCC.The expression of TGF-β1, Smad7 was higher in OSCC than in oral normal mucosa, oral simple hyperplasia, oral epithelial dysplasia(P < 0.05), while the expression of Smad3 was decreased.Further analysis showed the expression of TGF-β1 was correlated with the expression of Smad7.Conclusions The expressions of EGFR, PDCD4, TGF-β1, Smad3, Smad7 are closely related with the biological behaviors of oral squamous cell cancinoma.This experiment provides a theoretical basis for the study of oral squamous cell carcinomas mechanism research.So it has important significance for the development and prognosis of oral squamous carcinomaare.

Objective : To investigate the changes of vaspin and TNF-α levels in gingival crevicular fluid (GCF) of type 2 diabetic (T2DM) patients with chronic periodontitis (CP) after non-surgical periodontal treatment. Methods: 60 subjects were divided into 4 groups: DM-CP group (patients with both T2DM and CP, n=15); CP group (CP patients without T2DM, n=15); DM group (T2DM patients without CP, n=15), and CTRL group (systemically and periodontally healthy individuals, n=15). The clinical parameters of periodontal tissue and GCF were measured before and 8 weeks after non-surgical periodontal treatment. Results: The levels of vaspin and TNF-α were measured by ELISA. The levels of vaspin and TNF-α in CP group were significantly higher than those in CTRL group (P < 0.05), while the levels of vaspin and TNF-α in CP group were significantly decreased after treatment (P < 0.05). There was a statistically significant positive correlation between the total amount of vaspin and the total amount of TNF-α, the level of HbA1c, gingival index (GI) and probing depth (PD) (P < 0.05). Conclusion The results shows that vaspin and TNF-α are greatly decreased in periodontitis after non-surgical periodontal treatment. It suggests that vaspin and TNF-α in GCF may serve as inflammatory markers for the diagnosis and prognosis of diabetes and periodontitis.

PurposePrimary chest wall rhabdomyosarcoma (RMS) is very rare with limited imaging characteristic studies in the literature. This paper analyzes the CT imaging features of chest wall RMS in children to improve the diagnostic accuracy.Materials and MethodsThe imaging data of contrast enhanced CT scan of pathology conifrmed chest wall RMS in ifve children were analyzed.ResultsThe lesion was located in the anterior chest wall in one case, in the posterior chest wall in two cases, and the lateral chest wall in two cases (axillary). The tumors were round or spindle in shape with shallow spiculation. Plain CT showed heterogeneous density with patchy low-density necrotic area in two cases, and homogeneous attenuation in three patients. In all ifve cases there was no calciifcation or fatty tissue. The tumor involvement of adjacent spinal canal was seen in one case. Visceral compression was evident including lung parenchyma in one case, heart and liver in one case. Tumor blood vessel growth was seen in two cases. All ifve lesions were adjacent to the ribs, humerus, scapula and the spine with bone destruction in one case. On contrast enhanced scan, all ifve cases demonstrated heterogeneous mild to moderate enhancement, more prominent in the periphery. There were enlarged feeding arteries. Necrotic areas did not enhance. In two cases there were pulmonary metastases. Pleural effusion and ascites were identiifed in one case. There was lymph node metastasis in one case.ConclusionThe CT manifestation of children's chest wall RMS for chest wall include large soft tissue mass, heterogeneous density, no calciifcation or fatty tissue, partial necrosis, adjacent tissue compression, lymph node or distant metastasis. Combining with clinical manifestations, comprehensive analysis of contrast enhanced CT imaging can improve diagnostic accuracy.

Objective To study the expressions of P53,vascular endothelial growth factor (VEGF) and proliferating cell nuclear antigen (PCNA) in astrocytomas and their relationships with prognosis of these patients.Methods Immunohistochemical SP method was employed to detect the P53,VEGF and PCNA expression in 126 cases of human brain astrocytomas of different grades,collected in our hospital from May 2002 to May 2010; their correlations and their significance in the prognosis in these patients were analyzed.Results P53,VEGF,and PCNA expressed differently in astrocytomas of different grades,enjoying a positive relation with grades (P＜0.05); positive correlations of between P53 expression and both VEGF and PCNA expressions (r=0.608,P=0.000; r=0.432,P=0.001).In patients with the same grade of astrocytoma,those having positive P53 expression enjoyed poorer prognosis and lower survival rate with significant difference (P＜0.05); while VEGF and PCNA expressions had no correlation with the progonosis.Conclusion The expressions of PCNA,VEGF and P53 are closely associated with grade of the astrocytomas,and only P53 expression is an indicator of poor prognosis.