ABSTRACT In order to enhance the quality and mechanical properties of 3D printing carbon fiber reinforced composite (CFRP) workpiece, this paper prepares 3D printing CFRP laminates by proposing a layered coherent composite scanning path, and carries out orthogonal tests and single factor tests to disclose the effects of different process parameters (i.e., layer thickness, first layer thickness, nozzle temperature and printing speed) on the mechanical performance of the CFRP workpieces. Moreover, The grey relation analysis method is used to analyze the multi-objective parameters of the orthogonal tests results and the process parameters of 3D printing CFRP are optimized based on the tests results. The research results show that the process parameters of 3D printed CFRP can be ranked as delamination thickness, nozzle temperature, first layer thickness and printing speed, in descending order of the impact on the mechanical property of the CFRP laminates. the optimal process parameters for 3D printing include a layer thickness of 0.25 mm, a first layer thickness e of 0.2 mm, a nozzle temperature of 180°C, and printing speed of 45 mm/s. Under this parameter combination, the tensile strength, bending strength, and the interlaminar shear strength (ILSS) of the samples are 52.77 MPa, 276.63 MPa and 38.56 Mpa respectively, and the grey correlation degree increased to 0.845. D (CFRP workpiece path i.e., ie i (i.e. workpieces Moreover multiobjective multi objective 025 0 25 mm 02 2 0. 180C C 180 180°C 4 mms s mm/s combination ILSS (ILSS 5277 52 77 52.7 27663 276 63 276.6 3856 38 56 38.5 respectively 0845 845 0.845 i.e. (i.e 18 527 5 7 52. 2766 27 6 276. 385 3 38. 084 84 0.84 i.e 1 08 8 0.8

Abstract In China, Scutellaria is used for treating inflammatory-related diseases. Baicalin is the main active component of Scutellaria and has protective effects on acute pancreatitis. However, the mechanism of Baicalin is still unclear. In this study, the protective effects of baicalin on acute pancreatitis induced by taurocholate and its mechanism are investigated. In this study, mice were randomly divided into three groups: sham operation, model, and treatment groups. Acute pancreatitis in mice was induced by intraperitoneal injection of taurocholate (35 mg/kg). The treatment group was given baicalin (100 mg/kg) 2 h before acute pancreatitis induction. The mRNA expression levels of miR-429, nuclear factor kappa B65(NF-kB65), toll-like receptor 4(TLR4), TNF receptor associated factor6 (TRAF6), NF-kappa-B inhibitor(IkB), Follistatin-like 1 (FSTL1), and interleukin-1 receptor-associated kinase (IRAK) in the liver tissues 24 h after intraperitoneal injection were detected by RT-PCR. Then, the expression levels of NF-kB65, p-NF-κB65, TLR4, TRAF6, IkB, FSTL1, IRAK, p- IRAK, and p- IkB-а proteins were detected by Western blot. IL-6, TNF-α and IL-1 β in plasma were measured by ELISA, and histopathological changes in the pancreases of the mice were observed. The results showed that after baicalin treatment, miR-429 expression in the pancreatic tissues and the expression levels of NF-kB65, TLR4, TRAF6, p-IkB-а, FSTL1, and p-IRAK decreased. Similarly, pancreatic myeloperoxidase (MPO) activity and the plasma levels of IL-6, TNF-а, IL-12, IL-1β1, endotoxin, serum amylase, and lipase were reduced. Thus, the pancreatic injury induced by taurocholate was alleviated. The present study indicates that pretreatment with Baicalin can alleviate acute pancreatic injury induced by taurocholate in mice. The mechanism may be associated with the decreased miR-429 expression, reduced FSTL1 signaling pathway activity, TLR4 and TLR4/MyD88 signaling pathway inhibition, and reduced pancreatic inflammation. FSTL1 is the regulatory target for miR-429.

Abstract Sixty Ca-deficient male Wistar rats were divided into six groups to investigate the effect of a calcium-binding bonito hydrolysate (PBH-Ca) on calcium bioavailability in rats, including the normal group, the control groups (PBH + CaCO3 group and the CaCO3 group), and three PBH-Ca groups with doses of 2,000 (PBH-Ca-H group), 1,000 (PBH-Ca-M group), and 500 (PBH-Ca-L group) mg/kg body wt/day. Each group was given the corresponding drug by intragastric administration for 4 weeks. The indices measured included the rate of increase in body weight and body length, apparent calcium absorption rate, serum calcium, serum phosphorus, alkaline phosphatase (ALP) activity, bone volume fraction (BV/TV), bone mineral density (BMD), and trabecular microstructure of the rats scanned by micro-computed tomography. The results showed that PBH-Ca promoted the growth of rats, significantly increased the apparent calcium absorption rate and the number of bone trabeculae, stabilized serum calcium and serum phosphorus content in serum, significantly inhibited ALP activity, decreased the separation of bone trabeculae, accelerated bone growth of rats, and raised the BV/TV and femoral BMD in the rats. These results illustrate that PBH-Ca has promising potential in a high-quality calcium diet.

RESUMO Antecedentes: Entre pacientes com acidente vascular cerebral isquêmico (AVCI) agudo com divergência entre gravidade do déficit e volume do infarto, a trombectomia em 6 a 24 horas tem eficácia e segurança semelhantes ao tratamento em até 6 horas. Entretanto, a viabilidade da imagem ponderada em T2 com difusão (DWI) da ressonância magnética necessita validação. Objetivo: Investigar o prognóstico de pacientes com AVCI que recebem tratamento endovascular (EVT) em até 6 horas e de 6-24 horas usando tomografia computadorizada sem contraste (NCCT) e DWI. Métodos: Duzentos e nove pacientes com AVCI de circulação anterior submetidos a EVT foram divididos em ≤ 6 horas e 6-24 horas. Pacientes com sintomas até 6 horas foram tratados se NIHSS ≥ 7 e ASPECTS ≥ 5; aqueles com AVCI ao despertar (WUS) ou com sintomas entre 6-24 horas da última vez em que foram vistos bem (WUS/AVC de fase tardia, LPS) foram tratados se NIHSS ≥ 7 e ASPECTS ≥ 5. Resultados: As porcentagens de pacientes submetidos a implante de stent intracraniano e angioplastia intracraniana sem stent diferiram entre os dois grupos (p <0,001). As taxas de recanalização 0, 1, 2a e 2b não diferiram entre 6 horas e 6-24 horas (p> 0,05). A taxa de recanalização de grau 3 no grupo 6 horas foi menor do que 6-24 horas (p = 0,043). Pontuação na Escala Rankin (3 meses) não foi diferente (p = 0,629). Conclusões: EVT é um tratamento seguro e eficaz para pacientes com WUS e LPS selecionados por meio de imagens baseadas em NCCT e DWI.

ABSTRACT Background: Among patients with acute ischemic stroke with a mismatch between deficit severity and infarct volume, thrombectomy performed within a 6-24 hours time window has efficacy and safety similar to treatment within 6 hours. However, whether magnetic resonance imaging with T2 diffusion-weighted imaging (DWI) is feasible remains to be validated. Objective: To investigate prognosis among stroke patients receiving endovascular treatment (EVT) within 6 hours and 6-24 hours using non-contrasted computed tomography (NCCT) and DWI. Methods: Overall, 209 anterior-circulation ischemic stroke patients with large-vessel occlusion who underwent EVT were divided into ≤ 6 hours and 6-24 hours groups. Patients presenting symptoms within 6 hours were treated if their NIHSS score was ≥ 7 and ASPECTS score was ≥ 5, whereas those with wake-up stroke (WUS) or presenting symptoms 6-24 hours after last seen well (WUS/late-presenting stroke, LPS) were managed if their NIHSS score was ≥ 7 and ASPECTS score was ≥ 5. Results: The percentages of patients undergoing intracranial stenting and intracranial ballooning without stenting significantly differed between two groups (p < 0.001). Grades 0, 1, 2a and 2b recanalization rates did not differ between the 6 hours and 6-24 hours groups (all p > 0.05). Grade 3 recanalization rate in the 6 hours group was significantly lower than in the 6-24 hours group (p = 0.043). The 3-month Rankin Scale score did not significantly differ between the two groups (p = 0.629). Conclusions: EVT is a safe and effective treatment for patients with WUS and LPS selected through NCCT and DWI-based simple imaging.

Abstract Rock materials are often subjected to cyclic loads during construction. A full understanding of the deformation behavior of rock under cyclic loads is of great significance in engineering. In this study, by using the endochronic constitutive model proposed by Valanis, the reinforcement function form and constitutive parameters of the endochronic model are improved. An endochronic plasticity constitutive program for rock based on the finite element method is used to study the mechanical properties of rock under different cyclic loading conditions (of maximum loading stress, amplitude, and confining pressure), and through the use of red sandstone, marble, and basalt, experimental and simulation results are compared to verify the model. The results show that the theory can better simulate the hysteresis loop width and cumulative plastic strain of rock under cyclic loading and, under different loading conditions, the numerical simulation results are consistent with the actual rock experimental law. Therefore, the endochronic plasticity constitutive model in this study can be applied to investigate the influence of cyclic loading on the dynamic deformation behavior of rock.

The aim of this study was to elucidate the concise effects of a traditional herb pair, Curcumae rhizoma-Sparganii rhizoma (CRSR), on uterine leiomyoma (UL) by analyzing transcriptional profiling. The UL rat model was made by intramuscular injection of progesterone and gavage administration of diethylstilbestrol. From 11 weeks of the establishment of the model, rats of the UL+CRSR group were gavaged daily with CRSR (6.67 g/kg). The serum concentrations of progesterone (P) and estradiol (E2) were determined by radioimmunoassay, the uterine index was measured by caliper measurement, and the pathological status was observed by hematoxylin and eosin stain. Gene expression profiling was checked by NimbleGen Rat Gene Expression Microarrays. The results indicated that the uterine mass of UL+CRSR rats was significantly shrunk and serum P and E2 levels significantly reduced compared to UL animals and nearly to the level of normal rats. Results of microarrays displayed the extensive inhibition of CRSR upon the expression of proliferation and deposition of extracellular matrix (ECM)-related genes, and significantly regulated a wide range of metabolism disorders. Furthermore, CRSR extensively regulated key pathways of the UL process, such as MAPK, PPAR, Notch, and TGF-β/Smad. Regulation of the crucial pathways for the UL process and ECM metabolism may be the underlying mechanisms of CRSR treatment. Further studies will provide clear clues for effectively treating UL with CRSR.

Abstract Background: Cervical cancer (CC) ranks third in the morbidity and mortality of female cancer around the world. Derlin1 has been found to be overexpressed in several human cancers. However, it is still unclear about its roles in CC. The research aims to explore the relationship between Derlin1 and CC. Methods: We purchased a human CC tissues microarray, which contained CC tissues and corresponding para-cancerous tissues from 93 patients with primary cervical squamous cell carcinoma. Immunohistochemical staining was used to confirm the expression of Derlin1 in these tissues. And we detected the differential expression of Derlin1 in cervical cancer cell lines and normal cervical epithelial cells (H8). Further, the cervical cancer cell lines SiHa and C33A were used as an in vitro model, which was down-regulated the expression of Derlin1 using siRNA interference technology. The effects of Derlin1 down-regulating in CC cell lines on cell proliferation and migration were detected by CCK8 assay and transwell assay, respectively. The effect of Derlin1 down-regulating on apoptosis was analyzed by flow cytometry, and apoptosis-related proteins were detected using western blotting. In-depth mechanisms were studied using western blotting. In addition, the effects of Derlin1 up-regulating in normal cervical epithelial cells also were exposed. Results: Derlin1 was significantly elevated in CC tissues (81.7%, 76/93), and the expression of Derlin 1 was positively correlated with the tumor size, pathological grade, and lymph node metastasis in CC patients. And Derlin 1 was high expressed in cervical cancer cell lines compared to H8 cells. Knockdown of Derlin 1 in cervical cancer cell lines inhibited cell proliferation and migration. Moreover, knockdown of Derlin 1 induced apoptosis and affected the expression of apoptosis-related proteins, including Bcl-2, Bax, Bim, caspase3 and caspase9. Further experiments showed that AKT/mTOR signal pathway might be involve in this processes that knockdown of Derlin 1 inhibited the expression of p-AKT and p-mTOR. Over-expression of Derlin 1 in H8 cells promoted cell proliferation and migration via up-regulated the expression of p-AKT and p-mTOR. Conclusion: Derlin 1 is an oncogene in CC via AKT/mTOR pathway. It might be a potential therapeutic target for CC.

ABSTRACT Objective To present our experience in minimally invasive management of urinary tract stones in patients with urinary diversion. Materials and Methods We retrospectively reviewed 26 patients with urinary tract stones after cystectomy and urinary diversion. The types of urinary diversion were ileal conduit, colon conduit, ileal orthotopic neobladder in 19, 4, and 3 patients, respectively. At postoperative days 2, a plain KUB and urinary ultrasonography were performed in order to assess stone fragmentation or hydronephrosis. According to postoperative imaging, stone free rate (SFR) was defined as complete absence of fragments or residual stones less than 4mm. Results 19 patients were treated with minimally invasive percutaneous lithotripsy (MPCNL) and 2 patients required second-look MPCNL. Anterograde flexible ureteroscopy was performed in 2 patients, while in 2 patients a combined anterograde and retrograde approach was required. Three reservoir stones were treated by transurethral neo-bladder lithotripsy. Postoperative significant complications occurred in 2 patients (7.7%). The highest percentage of stone composition was struvite, as a result of chronic urinary tract infection (UTI). SFR was 88.5% (23 of 26). Conclusions Our experience showed that MPCNL is a safe and effective treatment modality with little morbidity for renal and upper ureteral stones in patients with urinary diversion. For middle and lower ureteral stones, an anterograde approach could be also considered as a first line treatment, but a combined anterograde and retrograde approach was required when the anterograde access alone cannot provide acceptable results.

Abstract: Winer's dilated pore is an infrequent appendageal tumor characterized by a giant comedone on the face, neck, and upper trunk in adults. We report a 57-year-old woman who developed multiple asymptomatic black papules on both labia majora. Histopathology showed grouped dilated follicles lined by keratinizing squamous epithelium in the superficial dermis. The superficial lining epithelium and interfollicular epidermis were atrophic, while the deep epithelium showed mild proliferation and melanin pigmentation with a few short projections extending into the surrounding dermis. We diagnosed multiple Winer's dilated pores based on late-onset lesions and pathological features. This patient may represent the first case of multiple vulvar Winer's dilated pores. We suggest that electrocautery may be effective for treating this type of superficial entity.

ABSTRACT Purpose: In a previous study the vaccine was effective against bladder cancer in a mouse model. However, a small portion of tumors regrew because the vaccine could not eliminate bladder cancer stem cells (CSCs). In this study, we showed a modified method for the isolation of bladder CSCs using a combination of differential adhesion method and serum-free culture medium (SFM) method. Materials and Methods: Trypsin-resistant cells and trypsin-sensitive cells were isolated from MB49, EJ and 5637 cells by a combination of differential adhesion method and SFM method. The CSCs characterizations of trypsin-resistant cells were verified by the flow cytometry, the western blotting, the quantitative polymerase chain reaction, the resistance to chemotherapy assay, the transwell assay, and the tumor xenograft formation assay. Results: Trypsin-resistant cells were isolated and identified in CSCs characters, with high expression of CSCs markers, higher resistance to chemotherapy, greater migration in vitro, and stronger tumorigenicity in vivo. Conclusion: Trypsin-resistant cells displayed specific CSCs properties. Our study showed trypsin-resistant cells were isolated successfully with a modified method using a combination of differential adhesion method and SFM method.

Tetrametilpirazina (TMP), o principal componente do extrato de Ligusticum wallichi Franchat (erva chinesa), apresenta propriedades neuroprotetoras na isquemia. Nesse estudo, avaliamos seus efeitos protetores nas células de Schwann (SC), cultivando-as na presença de condições de depleção de oxigênio da glicose (OGD) e medindo a sobrevivência dos nervos de ratos isquêmicos pelo resfriamento. No modelo de lesão isquêmica em SC induzida por OGD, demonstramos que o tratamento com TMP não somente reduziu as perdas de viabilidade celular induzida por OGD, a morte celular, a apoptose de SC dose-dependente e inibiu a liberação de LDH, mas, também, suprimiu a infra-regulação do Vcl-2 e a supra-regulação de Bax e caspase-3, e inibiu a consequente ativação da caspase-3. No modelo de nervo isquêmico por resfriamento, observamos que a exposição prolongada ao resfriamento por quatro semanas estava, marcadamente, associada com a ausência de SC, com o decréscimo da viabilidade celular e a apoptose em segmentos de nervo incubados na solução da Universidade de Wisconsin apenas. Entretanto, a TMP atenuou o dano no segmento do nervo preservando SC e antagonizando a diminuição da viabilidade da fibra nervosa e o aumento das células TUNEL-positiva de modo dose-dependente. De forma conjunta, nossos resultados indicam que o TMP não só fornece efeitos protetores em um modelo de dano semelhante à isquemia de SC de ratos cultivados pela regulação de BCl-2, Bax e caspase 3, mas, também, aumenta a sobrevivência celular e suprime a apoptose no modelo de isquemia por resfriamento por exposição prolongada por quatro semanas. Então, TMP pode ser uma estratégia terapêutica eficaz para prevenir doenças isquêmicas do sistema nervoso periférico e melhora a armazenagem do nervo periférico.

Tetramethylpyrazine (TMP), a major active ingredient of Ligusticum wallichi Franchat extract (a Chinese herb), exhibits neuroprotective properties in ischemia. In this study, we assessed its protective effects on Schwann cells (SCs) by culturing them in the presence of oxygen glucose deprivation (OGD) conditions and measuring cell survival in cold ischemic rat nerves. In the OGD-induced ischemic injury model of SCs, we demonstrated that TMP treatment not only reduced OGD-induced cell viability losses, cell death, and apoptosis of SCs in a dose-dependent manner, and inhibited LDH release, but also suppressed OGD-induced downregulation of Bcl-2 and upregulation of Bax and caspase-3, as well as inhibited the consequent activation of caspase-3. In the cold ischemic nerve model, we found that prolonged cold ischemic exposure for four weeks was markedly associated with the absence of SCs, a decrease in cell viability, and apoptosis in preserved nerve segments incubated in University of Wisconsin solution (UWS) alone. However, TMP attenuated nerve segment damage by preserving SCs and antagonizing the decrease in nerve fiber viability and increase in TUNEL-positive cells in a dose-dependent manner. Collectively, our results indicate that TMP not only provides protective effects in an ischemia-like injury model of cultured rat SCs by regulating Bcl-2, Bax, and caspase-3, but also increases cell survival and suppresses apoptosis in the cold ischemic nerve model after prolonged ischemic exposure for four weeks. Therefore, TMP may be a novel and effective therapeutic strategy for preventing peripheral nervous system ischemic diseases and improving peripheral nerve storage.

Objective: The aim of the study is to examine the distribution of integrated covariate and its association with blood pressure (BP) among children in Anhui province, China, and assess the predictive value of integrated covariate to children hypertension. Methods: A total of 2,828 subjects (1,588 male and 1,240 female) aged 7-17 years participated in this study. Height, weight, waistline, hipline and BP of all subjects were measured, obesity and overweight were defined by an international standard, specifying the measurement, the reference population, and the age and sex specific cut off points. High BP status was defined as systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) > 95th percentile for age and gender. Results: Our results revealed that the prevalence of children hypertension was 11.03%, the SBP and DBP of obesity group were significantly higher than that of normal group. Anthropometric obesity indices such as body mass index (BMI) were positively correlated with SBP and DBP. Integrated covariate had a better performance than the single covariate in the receiver-operating characteristic (ROC) curve, the cut-off value; the sensitivity and the specificity of the integrated covariate were 0.112, 0.577, 0.683, respectively. Conclusion: Integrated covariate is a simple and effective anthropometric index to identify childhood hypertension.

Objetivo: El objetivo del estudio es examinar la distribución de las covariables integrado y su asociación con la presión arterial (PA) entre los niños en la provincia de Anhui, China, y evaluar el valor predictivo de covariables integrado a los niños la hipertensión. Métodos: Un total de 2.828 sujetos (1.588 macho y 1.240 hembra) de 7 a 17 años participaron en este estudio. Altura, peso, cintura, hipline y BP de todos los sujetos fueron medidos, la obesidad y el sobrepeso se han definido por una norma internacional, especificando la medición, la población de referencia, y la edad y sexo los puntos de corte. La condición de alta presión se define como la presión arterial sistólica (PAS) y/o presión arterial diastólica (PAD) > percentil para edad y sexo. Resultados: Nuestros resultados revelan que la prevalencia de niños la hipertensión fue 11,03%, el SBP y DBP de obesidad grupo fueron significativamente más alta que la de grupo normal. Los índices de obesidad, tales como el índice de masa corporal (IMC) se correlacionaron positivamente con SBP y DBP. Integrated covariable tuvo un mejor rendimiento que la covariable en la curva de características operativas del receptor (ROC), el valor de corte, la sensibilidad y la especificidad de las covariables fueron integrados 0,112, 0,577,0,683, respectivamente. Conclusión: Integrado covariable es un simple y eficaz para identificar a la niñez índice antropométrico hipertensión.

PURPOSE: To construct a new biomaterial-small intestinal submucosa coated with gelatin hydrogel incorporating basic fibroblast growth factor, and to evaluate the new biomaterials for the reconstruction of abdominal wall defects.METHODS: Thirty six Sprague-Dawley rats were used in the animal experiments and randomly divided into three groups. The new biomaterial was constructed by combining small intestinal submucosa with gelatin hydrogel for basic fibroblast growth factor release. Abdominal wall defects were created in rats, and repaired using the new biomaterials (group B), compared with small intestinal submucosa (group S) and ULTRAPROTM mesh (group P). Six rats in each group were sacrificed at three and eight weeks postoperatively to examine the gross effects, inflammatory responses, collagen deposition and neovascularization.RESULTS: After implantation, mild adhesion was caused in groups B and S. Group B promoted more neovascularization than group S at three weeks after implantation, and induced significantly more amount of collagen deposition and better collagen organization than groups S and P at eight weeks after implantation.CONCLUSION: Small intestinal submucosa coated with gelatin hydrogel incorporating basic fibroblast growth factor could promote better regeneration and remodeling of host tissues for the reconstruction of abdominal wall defects.

OBJETIVO: comparar o conhecimento e percepção em terapia nutricional (TN) de residentes de cirurgia e cirurgiões. MÉTODOS: foram aplicados dois questionários padronizados sobre conhecimentos, atitudes e condutas em TN de 50 médicos (35 residentes e 15 cirurgiões) de 12 áreas cirúrgicas distintas. Utilizando-se o teste exato de Fisher, com significância de 5% com p<0,05, foi comparada a proporção de acertos, de acordo com a percepção a respeito do assunto de cada grupo. RESULTADOS: mais de 80% não se sentiram seguros frente à TN e 46% negaram conhecimento de equipe multiprofissional de TN (EMTN). Houve maior percentual de acertos, dentre os residentes, nos itens: trauma operatório e sua influência nutricional no paciente (p=0,047); IMC normal (p=0,036); e TN no pré-operatório (p=0,007) e indicação da TN pré-cirúrgico no grupo que diz que interagem com EMTN (p=0,02). Dentre os cirurgiões: complicações da TN e TN em pacientes previamente desnutridos (p=0,044); e Métodos de avaliação nutricional no pré-operatório no grupo que diz que interagem com EMTN (p=0,01). CONCLUSÃO: há falhas na educação médica. Apenas 13,3% estavam seguros quanto à TN, sendo que os seus conhecimentos não justificaram tal confiança. Não houve diferenças entre os acertos dos confiantes e não confiantes em TN na maioria dos assuntos. Destacaram-se melhores resultados no grupo que afirmou ser assistido por alguma EMTN. Baseando-se nos resultados, a indicação de melhores programas médicos educacionais deve ser objetivo para esta universidade.

OBJECTIVE: To compare the knowledge of nutritional therapy (NT) of surgery residents and surgeons. METHODS: We applied two standardized questionnaires on knowledge, attitude and behavior regarding NT to 50 physicians (35 residents and 15 surgeons) of 12 different surgical areas. We compared the proportions of hits according to the perception on the subject of each group using the Fisher exact test, with 5% significance and p < 0.05. RESULTS: More than 80% did not feel safe regarding NT and 46% denied knowledge of the NT multidisciplinary team (NTMT). There was a higher percentage of correct answers among residents in the items: surgical trauma and its nutritional influence on the patient (p = 0.047); normal BMI (p = 0.036); preoperative NT (p = 0.007); and indication of preoperative NT in the group that referred that to interact with the NTMT (p = 0.02). Among surgeons: complications of NT and NT in previously malnourished patients (p = 0.044); and methods for assessing preoperative nutritional status in the group that referred to interact with the NTMT (p =0.01). CONCLUSION: there are gaps in medical education. Only 13.3% were confident about NT, and their knowledge did not justify such confidence. There were no differences between the successes of confident and non-confident about NT in most subjects. The best results came from the group that claimed to be assisted by any NTMT. Better medical educational programs should be goal for this university.