沉浸式PBL模式在血液净化血管通路教学中的效果

目的评价沉浸式基于问题的学习(PBL)模式在血液净化血管通路教学中的效果。 方法研究对象为2019年9月至2021年9月贵州省各地医院参加血液净化血管通路培训的各级专科医生,前4期学员采取传统教学模式为对照组,后4期学员采用沉浸式PBL教学模式为研究组。培训结束后从理论知识、技能、满意度、评判性思维能力和带教老师自评方面进行考核。 结果与对照组相比,研究组的理论知识分数、临床操作技能分数,对培训的形式、规模、带教老师知识储备、培训效果的满意度,以及在寻求真相、求知欲、认知成熟度、系统化能力、分析能力及评判性思维能力方面的总分均增高(P<0.05)。此外,研究组的教师在培训场景、适时提问和讨论、操作规范性、有效考核评估以及突击应变能力方面的自评分数亦显著高于对照组(P<0.05)。 结论沉浸式PBL教学模式可以使血液净化血管通路培训的学员及带教老师在专业知识及实践操作能力方面得到进一步提升,值得推广。     

Gout-associated uric acid crystals induce tophi ulcerations and impair wound healing in a novel gouty ulcer model

This study aimed to establish a novel gouty ulcer rat model induced by monosodium urate (MSU) deposition and preliminarily explored how MSU crystals affected wound healing. MSU crystals were subcutaneously injected into the back of rats to simulate tophi formation and ulceration. Ultrasound was used to detect the formation of gouty tophi. MSU crystal deposition and histopathological changes were analysed by haematoxylin–eosin staining. After the skin over the tophi became broken in the model group, a full-thickness tissue defect of the same area was made on the backs of the phosphate buffered saline (PBS) controls. On Days 3, 7, and 14 after wounding, the infiltration of neutrophils and macrophages and the expression of inflammatory markers, including interleukin-1β (IL-1β), tumour necrosis factor-α (TNF-α), and Nod-like receptor protein 3 (NLRP3), were examined by immunohistochemical staining and Western blotting, respectively. After the first subcutaneous injection in rats, local tissues showed redness and swelling, indicating inflammation on approximately Day 14. Tophi-like manifestations appeared on approximately Day 18. Tophi appeared heterogeneously hyperechoic by ultrasound. Swelling and redness in injured tissue areas increased on approximately Day 22, skin tissue necrosis was seen in a small area on approximately Day 26, and skin necrosis was enlarged and the tophi were ulcerated on approximately Day 32, accompanied by yellowish-white, chalky secretions. Haematoxylin and eosin staining showed dermal deposition of needle-like crystals with surrounding granulomatous inflammation. On Days 3, 7, and 14 after wounding, immunohistochemical staining showed the infiltration of neutrophils and macrophages, and the expression of inflammation-related proteins (IL-1β, TNF-α, and NLRP3) were upregulated in gouty ulcers compared with those of PBS controls. The gouty ulcers were not completely healed by Day 14 compared with those in the PBS controls. In this study, a novel gouty ulcer rat model was constructed, which also revealed the existence of persistent chronic inflammation.     

Future of targeted therapy for gastrointestinal cancer: Claudin 18.2

The treatment of gastrointestinal cancer has always been a crucial research area, and targeted therapy has been receiving increasing attention. At present, the effect of targeted therapy is unsatisfactory for gastric cancer. Thus, the discovery of new targets is crucial. Claudin 18.2 (CLDN18.2), a member of the claudin family, belongs to the tight junction protein family that controls the flow of molecules between cell layers. CLDN18.2 expression has been discussed in many studies. In recent years, there have been many studies on targeted therapy with CLDN18.2-ideal monoclonal antibody 362. Furthermore, CLDN18.2-specific chimeric antigen receptor T therapy has been used for CLDN18.2-positive tumors, such as gastric and pancreatic cancers. Considerable research has been focused on CLDN18.2. CLDN18.2, a newly discovered marker for precise targeted therapy of gastric cancer, could offer new hope for the treatment of gastric cancer.     

Predictive Value of p62 Protein in the Recurrence of Oral Squamous Cell Carcinoma

Background: Tumor recurrence is one of the major problems that affect the postoperative efficacy of oral squamous cell carcinoma (OSCC) treatment. Autophagy is known to have a dual-sided effect on tumors. However, studies on autophagy and prognosis are limited. The purpose of this study is to analyze the relationship between autophagy and OSCC recurrence. Materials and methods: 72 patients with OSCC were followed for 5 years after curative surgery. Tissue specimens from each patient were divided into tumor, normal, and marginal groups. Autophagy protein expression was assessed by western blotting and immunofluorescence. Statistical significance was evaluated using the chi-square test. The Kaplan-Meier method was employed to construct a survival curve, and the log-rank test was used to compare survival rates. Cox regression was utilized to describe independent prognostic risk factors. ROC analysis was performed to evaluate the utility of p62 and LC3II expression in assessing OSCC recurrence. Results: Correlations were observed between survival rates and T stage (p = 0.00439), lymph node metastasis (p < 0.001), tumor differentiation (p = 0.00423), and changes in p62 expression (p < 0.001). Multivariate analysis showed lower p62 protein expression in the tumor group compared to the normal group with a higher risk of recurrence (RR = 3.713), and lower p62 protein expression was found in the marginal group compared to the tumor group, with a lower risk of recurrence (RR = 0.170). Conclusion: Expression of p62 protein is one of the important factors influencing relapse in OSCC patients and can be used as an early predictor of OSCC relapse.     

Screening for Aortic Aneurysm After Treatment of Coarctation

Isolated coarctation of the aorta (CoA) occurs in 6–8 % of patients with congenital heart disease. After successful relief of obstruction, patients remain at risk for aortic aneurysm formation at the site of the repair. We sought to determine the diagnostic utility of echocardiography compared with advanced arch imaging (AAI) in diagnosing aortic aneurysms in pediatric patients after CoA repair. The Congenital Heart Databases from 1996 and 2009 were reviewed. All patients treated for CoA who had AAI defined by cardiac magnetic resonance imaging (MRI), computed tomography (CT), or catheterization were identified. Data collected included the following: type, timing, and number of interventions, presence and time to aneurysm diagnosis, and mortality. Patients were subdivided into surgical and catheterization groups for analysis. Seven hundred and fifty-nine patients underwent treatment for CoA during the study period. Three hundred and ninety-nine patients had at least one AAI. Aneurysms were diagnosed by AAI in 28 of 399 patients at a mean of 10 ± 8.4 years after treatment. Echocardiography reports were available for 380 of 399 patients with AAI. The sensitivity of echocardiography for detecting aneurysms was 24 %. The prevalence of aneurysms was significantly greater in the catheterization group (p < 0.05) compared with the surgery group. Aneurysm was also diagnosed earlier in the catheterization group compared with the surgery group (p = 0.02). Multivariate analysis showed a significantly increased risk of aneurysm diagnosis in patients in the catheterization subgroup and in patients requiring more than three procedures. Aortic aneurysms continue to be an important complication after CoA repair. Although serial echocardiograms are the test of choice for following-up most congenital cardiac lesions in pediatrics, our data show that echocardiography is inadequate for the detection of aneurysms after CoA repair. Because the time to aneurysm diagnosis was shorter and the risk greater in the catheterization group (particularly for patients requiring more than one procedure), surveillance with cardiac MRI or CT should begin earlier in these patients.