To explore the optimization and effectiveness of emergency medicine course teaching for international students in China.
Methods
The data of regular performance, final examination papers and total evaluation scores of the emergency medicine course for international students majoring in clinical medicine at the School of Medicine of Zhejiang University from 2014 to 2024 were collected. The differences in the total evaluation scores of international students in different genders and places of origin were analyzed.
Results
The total evaluation scores of female students were better than those of male students [87.00 (82.00,91.00) vs. 86.00 (80.00, 90.00), Z=2.072, P=0.038]. There was a statistically significant difference in the total evaluation scores among different continents (H = 9.498,P = 0.049). Moreover, the total evaluation scores of Asian international students were much better than those of African students [87.00 (82.00, 91.00) vs. 84.00 (79.00, 90.00), P < 0.05].
Conclusions
The teaching of emergency medicine course for international students in China needs to be optimized. Differences in students' gender and places of origin have certain influences on academic performance.
To investigate the application effect of the goal-oriented advanced teaching method in emergency endotracheal intubation skills training.
Methods
A total of 64 standardized training residents who trained in the Department of Emergency Medicine, Zhongda Hospital, Southeast University from March 2023 to March 2024 were recruited as the research objects. Participants were randomly assigned to a control group (32 cases) and an advanced group (32 cases) based on the random number table method. Participants in the control group and advanced group received traditional clinical training and goal-oriented advanced training for tracheal intubation, respectively. After the training, all of resident doctors were assessed by theoretical test and clinical skill operations, while feedback on the teaching process was obtained through questionnaires. Besides, the training effect of resident doctors of emergency, critical care and anesthesiology in clinical practice was evaluated after 6-mouth follow-up.
Results
After the training, the total assessment scores of both the advanced group[(90.8±3.6) vs. (76.8±8.7), t=8.371, P<0.001] and the control group [(87.6 ±5.3) vs. (77.1 ±10.9),t = 4.891,P = 0.007] were significantly improved compared to those before the training.Moreover, the total assessment scores [(90.8 ± 3.6) vs. (87.6 ± 5.3),t = 2.889,P = 0.006], skill assessment scores [(55.7 ± 2.8) vs. (53.6 ± 3.7),t = 2.559,P = 0.013], and clinical thinking assessment scores [(17.8±1.6) vs. (16.1±2.0),t=3.815, P<0.001] of the advanced group after the training were all higher than those of the control group. The questionnaire survey showed that the advanced group had significantly improved scores in knowledge acceptance [(9.1 ± 0.8)vs. (7.7±1.1), t=5.719, P < 0.001], learning initiative [(8.9 ± 0.9) vs. (7.7 ± 1.4),t = 4.221, P <0.001], clinical thinking ability [(8.5 ± 1.2) vs. (7.0 ± 1.2) ,t = 5.172, P < 0.001], emergency response ability [(9.1 ± 1.0) vs. (7.2 ± 1.3),t = 6.309, P < 0.001], and training satisfaction [(9.1 ±0.9) vs. (7.7 ± 1.3),t = 5.111, P < 0.001] as compared with the control group. In clinical practice, there was no statistically significant difference in the success rate of the first tracheal intubation of residents of emergency, critical care, and anesthesiology between the advanced group and the control groups (10 / 11 vs. 6 / 9, χ2= 1.727,P = 0.189).
Conclusion
The goaloriented advanced teaching could enhance the efficacy of endotracheal intubation training for emergency resident physicians, by establishing explicit stage-specific objectives.
To investigate the metabolic alterations of human placental mesenchymal stem cell (hPMSC) therapy on Crohn's disease model mice based on fecal metabolomics, and to screen biomarkers related to efficacy evaluation.
Methods
A total of 25 SAMP1 / Yit mice with spontaneous chronic ileitis were used as Crohn's disease models and divided into a treatment group (n= 15) and a disease group (n = 10). Additionally, 10 AKR /J mice were used as healthy controls. Mice in the treatment group were injected intraperitoneally with hPMSC, and mice in the disease group and the healthy control group were injected intraperitoneally with an equal volume of phosphate buffered saline at the same time points. On the 0th, 3rd, 7th, and 14th days after treatment, fecal samples of mice in the three groups were obtained, and chemical isotope labeling liquid chromatography-mass spectrometry (CIL LC-MS) was used for metabolomic analysis.
Results
The fecal metabolomic analysis based on CIL LC-MS detected 3 504 mass spectral peak pairs, of which 77.77% could be positively or putatively identified. Partial least squares-discriminant analysis (PLS-DA) was performed according to the mass spectrometry data of the metabolites, and it was found that the metabolic disorders of Crohn's disease mice were restored to a certain extent after treatment. Statistical analysis of the metabolite abundance of mice in each group found that a total of 35 metabolites had significant changes between the disease group and the healthy control group, and between the treatment group and the disease group (P < 0.05, fold change > 1.2). Through stepwise optimization of biomarker combinations, five biomarkers with the best classification performance and biological significance were finally determined by the orthogonal partial least squares-discriminant analysis(OPLS-DA) and machine learning model based on logistic regression algorithm, namely 5-Hydroxyindolepyruvate, p-Synephrine, Isomer 1 of 4-(2-Aminophenyl)-2,4-dioxobutanoic acid, LMetanephrine, and Threonylproline. The combination of these biomarkers achieved an area under the receiver operating characteristic curve of 0.920 with an accuracy of 87.0%.
Conclusion
Five metabolites identified through CIL LC-MS-based fecal metabolomic analysis can serve as a biomarker panel to assess the efficacy of hPMSC in the treatment of Crohn's disease with high accuracy.
To investigate the influence of the expression level of sphingosine-1-phosphate receptor 1 (S1PR1) on the prognosis of breast cancer patients and its relationship with immune cell infiltration.
Methods
The GEPIA, TIMER, UALCAN, Kaplan-Meier Plotter,GENT2, cBioportal databases and the academic tool DAVID were used to analyze the influence of S1PR1 expression level on the prognosis of breast cancer patients, and the functional enrichment analysis on S1PR1-related genes was conducted. Meanwhile, the correlation between S1PR1 and infiltration abundance of six immune cells (B cells, CD8 +T cells, CD4 +T cells, macrophages,neutrophils and dendritic cells) in the overall breast cancer and different molecular subtypes[including basal-like, human epidermal growth factor receptor 2 (HER2) positive type and luminal breast cancers] was evaluated. The influence of infiltration abundance of various immune cells on the prognosis of breast cancer patients was analyzed by the Kaplan-Meier survival curve.
Results
The expression level of S1PR1 in breast cancer tissue was much lower than that in normal breast tissue, and there were statistically significant differences in S1PR1 expression levels among different clinical stages, lymph node metastasis status, molecular subtypes and tumor histological types (all P<0.05). Compared with normal breast tissue, the methylation level of S1PR1 promoter in primary breast cancer tissue was significantly higher (P < 0.05), and the methylation levels varied in different subtypes. Survival analysis indicated that the overall survival period and recurrence-free survival period of patients in the S1PR1 high-expression group were significantly better than those in the low-expression group (both P < 0.05). Gene function analysis indicated that the S1PR1-related genes were associated with immune deficiency.In the overall breast cancer samples, the expression level of S1PR1 was positively correlated with the infiltration abundance of CD8+T cells (r=0.461, P<0.001), CD4+T cells (r=0.391, P<0.001), macrophages (r=0.293, P<0.001), neutrophils (r=0.256, P<0.001) and dendritic cells(r=0.260, P<0.001). The survival curves of B cell high infiltration abundance in patients with overall breast cancer and HER2-positive breast cancer were much better than those of low infiltration abundance (P = 0.046, 0.017).
Conclusion
The expression of S1PR1 is associated with the prognosis of breast cancer patients and is involved in regulating the function of immune cells.
To analyze the influence of respiratory rate-oxygenation (ROX) index combined with chest CT on respiratory treatment decisions in patients with acute hypoxic respiratory failure (AHRF) related to corona virus disease 2019 infection (COVID-19).
Methods
A total of 62 adult patients with COVID-19-related AHRF who initiated high-flow nasal cannula oxygen therapy (HFNC) after the failure of conventional oxygen therapy in the Minda Hospital of Hubei Minzu University were retrospectively included from March 2020 to March 2024. The indications for mechanical ventilation (MV) were judged by attending physicians of the patients.All patients underwent CT examinations immediately after admission. The proportion of lung infiltration volume (LIV) was calculated through chest CT image analysis using 3D Slicer software. The clinical characteristics of all patients were recorded and the ROX index was calculated approximately 6 hours after admission. Multivariate logistic regression analysis was used to evaluate risk factors for the need of MV in patients with COVID-19-related AHRF. The area under the curve (AUC) and cutoff value of the ROX index and/or LIV for predicting the MV required by patients were analyzed using a receiver operating characteristic (ROC) curve.
Results
According to whether they received MV or not, 62 patients with COVID-19-related AHRF were divided into a HFNC group (35 cases) and a MV group (27 cases). At admission,the hemoglobin, creatinine, lactic dehydrogenase and LIV of patients in the MV group were significantly higher than those in the HFNC group, while the ROX index was significantly lower,and the time from the onset of the disease to admission and the time from the onset of the disease to the initiation of HFNC were significantly shorter (all P ＜0.05). Multivariate logistic regression analysis showed that the ROX index ≤6.55 [odds ratio (OR)=0.141, 95% confidence interval (CI) (0.023, 0.885),P = 0.037] and LIV ＞ 33.45% [OR = 40.012, 95%CI (4.833,331.273), P=0.001] were independent risk factors for MV treatment in patients with COVID-19-related AHRF. ROC curve analysis showed that the combination of ROX index and LIV had ideal efficacy in predicting the need for MV treatment in patients with COVID-19-related AHRF(AUC: 0.939; sensitivity: 92.59%; specificity: 82.86%). According to the prognosis at 28 days,62 patients with COVID-19-related AHRF were divided into a death group (6 cases) and a survival group (56 cases). After analysis, the ROX index of AHRF patients in the death group was significantly lower than that in the survival group [3.80 (3.00, 4.70) vs. 7.05 (5.40, 8.65),Z=3.549, P ＜0.001], while LIV was significantly higher [46.75% (44.20, 65.90)% vs. 32.90%(25.20, 37.45)%, Z=3.786, P ＜0.001].
Conclusion
The LIV combined with ROX index shown by chest CT can provide support and guidance for physicians in the decision-making of respiratory management (HFNC or MV) in patients with COVID-19-related AHRF.
