Mise en place et évaluation d’un apprentissage par simulation des examens gynécologiques

ObjectivesTo report the setting-up of a new educational program in the teaching of female pelvic and breast examinations and to investigate and compare the views and experience of undergraduate medical students and teachers on the program.Patients and methodsProspective evaluation of the teaching program through completion of a satisfaction questionnaire including items related to the educational value of the session by the students and the teachers.ResultsThe educational program included an online preparation for the session, 3 workshops on training models (breast examination, pelvic examination, cervical snear procedure) and a video clip. In total, 419 (80.6%) of 520 second study year students (and 15 [50%] of 30 teachers [13 doctors and 17 midwifes] responded to the questionnaire). The students and the teachers were either very satisfied (56.6% and 13.4%, respectively) or satisfied (43.2% and 86.6%, respectively). On average, 89.7% of students wanted more lessons of this type and all teachers felt these useful or very useful training for students.Discussion and conclusionTeaching sessions for pelvic and breast examination, which make combined use of videos and training models, are associated with a high degree of satisfaction from teachers and students in their second student's year.     

阿萨希毛孢子菌胞外分泌酶水平的比较

目的探索阿萨希毛孢子菌细胞外分泌酶的种类与活性。方法采用卵黄琼脂培养基、BSA-琼脂培养基和AIP-ZYM试剂盒，观察11株阿萨希毛孢子菌细胞外分泌酶的种类及酶活性。结果11株阿萨希毛孢子菌中9株磷脂酶活性较强，2株酶活性弱；均未测得酸性蛋白酶分泌。AIP—ZYM试剂盒显示11株菌有共性分泌酶，也有部分菌株有特异性分泌酶。结论阿萨希毛孢子菌细胞外分泌酶种类多样，不同来源菌株产酶种类及酶活性亦不相同。     

Directing exocrine secretory vesicles to the apical membrane by actin cables generated by the formin mDia1

The final stage in exocrine secretion involves translocation of vesicles from their storage areas to the apical membrane. We show that actin-coated secretory vesicles of the exocrine pancreas travel this distance over bundles of specialized actin cables emanating from the apical plasma membrane. These bundles are stable structures that require constant G-actin incorporation and are distinct from the actin web that surrounds the exocrine lumen. The murine mammalian Diaphanous-related formin 1 (mDia1) was identified as a generator of these cables. The active form of mDia1 localized to the apical membrane, and introduction of an active form of mDia1 led to a marked increase in bundle density along the lumen perimeter. Compromising formation of the cables does not prevent secretion, but results in disorganized trafficking and fusion between secretory vesicles. Similar apical secretory tracks were also found in the submandibular salivary glands. Together with previous results that identified a role for Diaphanous in apical secretion in tubular organs of Drosophila, the role of Diaphanous formins at the final stages of secretion appears to be highly conserved.     

Overcoming the spatial barriers of the stimulus secretion cascade in pancreatic β-cells

The ability of the pancreatic β-cells to adapt the rate of insulin release in accordance to changes in circulating glucose levels is essential for glucose homeostasis. Two spatial barriers imposed by the plasma membrane and inner mitochondrial membrane need to be overcome in order to achieve stringent coupling between the different steps in the stimulus-secretion cascade.

The first spatial barrier is overcome by the presence of a glucose transporter (GLUT) in the plasma membrane, whereas a low affinity hexokinase IV (glucokinase, GK) in the cytosol conveys glucose availability into a metabolic flux that triggers and accelerates insulin release. The mitochondrial inner membrane comprises a second spatial barrier that compartmentalizes glucose metabolism into glycolysis (cytosol) and tricarboxylate (TCA) cycle (mitochondrial matrix).

The exchange of metabolites between cytosol and mitochondrial matrix is mediated via a set of mitochondrial carriers, including the aspartate-glutamate carrier (aralar1), α- ketoglutarate carrier (OGC), ATP/ADP carrier (AAC), glutamate carrier (GC1), dicarboxylate carrier (DIC) and citrate/isocitrate carrier (CIC). The scope of this review is to provide an overview of the role these carriers play in stimulus-secretion coupling and discuss the importance of these findings in the context of the exquisite glucose responsive state of the pancreatic β-cell.     

蛇床子汤外阴阴道冲洗联合硝酸咪康唑栓治疗湿热下注型霉菌性阴道炎随机平行对照研究

[目的]观察蛇床子汤外阴阴道冲洗配合硝酸咪康唑栓治疗湿热下注型霉菌性阴道炎疗效。[方法]使用随机平行对照方法,将128例门诊患者按就诊顺序编号分为两组。对照组60例硝酸咪康唑1枚/次,1次/d,阴道用药;治疗组68例蛇床子汤洗剂(蛇床子、苦参、百部、黄柏、白鲜皮、明矾、荆芥、川椒),250mL/次,1次/d,外阴阴道冲洗;硝酸咪康唑栓治疗同对照组。两组均连续治疗7d为1疗程。观测临床症状、阴道分泌物、不良反应。治疗1疗程,判定疗效。[结果]治疗组显效50例,有效15例,无效3例,总有效率95.59%。对照组显效25例,有效24例,无效11例,总有效率81.67%。治疗组疗效优于对照组(P0.05)。[结论]蛇床子汤外阴阴道冲洗联合硝酸咪康唑栓治疗湿热下注型霉菌性阴道炎效果显著,值得推广。     

Lethal consequences of home cot modification

Sleeping accidents are a particular risk for infants and young children as they lack an understanding of potentially dangerous situations and are unable to self-extricate. These situations may result in deaths from asphyxia. While safety campaigns have focused on the faulty design of cots that are available for sale, modification of cots at home represents another potential problem area. A 17-month-old girl was found dead with her head wedged between the top side rail of her cot and a broomstick, which had been attached in an attempt to raise the height of the cot side. Death was due to neck compression from head entrapment. This case demonstrates that infant and toddler safe sleeping programmes should alert carers to the potential dangers of structurally altering cots or beds. Home modifications may create dangerous gaps that could result in entrapment with lethal neck compression; such alterations should be carefully assessed and documented by forensic death scene investigators.