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Objective:To explore the effect and significance of clinical pathway (CP) teaching method in the standardized residency training of gynecology.Methods:The study included in 60 residents having standardized residency training of gynecology from June 2016 to June 2019 as research subjects, and they were randomized into control group and experimental group. The traditional teaching method was applied in the control group ( n=30), while CP teaching method were used in the experimental group ( n=30). All residents in the two groups were tested for the basic theory, case analysis and clinical skill after training. At the same time, they all had a teaching satisfaction survey, and the effectiveness of CP teaching was investigated among residents of the experimental group. Descriptive statistics, t test and chi-square analysis were performed by SPSS 23.0 software. Results:The results of examination about the basic theory [(86.30±7.04) vs. (75.30±5.27)], case analysis [(84.97±6.49) vs. (78.60±4.78)] and clinical skill [(83.90±6.32) vs. (77.40±8.29)] in the experimental group were higher than those in the control group, with statistical differences ( P<0.05). And residents in the experimental group believed that CP teaching was helpful to improve their self-learning ability, clinical thinking ability, operation ability, communication ability and scientific research ability, and they supported the continuous promotion of CP teaching. Conclusion:CP teaching is beneficial to improve the quality of standardized residency training of gynecology, and it is expected to be further promoted and applied in the standardized residency training of gynecology.
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Objective:To explore the effectiveness of clinical pathway (CP) and team-based learning (TBL) teaching method in standardized residency training of gynecology.Methods:The research included 40 residents as objects who took standardized training in gynecological rotation in Luohe Central Hospital from July 2017 to July 2019, and they were randomized into experimental group and control group. The combination of CP and TBL teaching method was used in the experimental group ( n=20), while the traditional teaching method was applied in the control group ( n=20). All residents were tested for the professional theory and clinical skill after training. After the training, a survey about the teaching satisfaction and the effectiveness of teaching methods was conducted for both groups. Statistical analysis was performed by SPSS 23.0 software. Results:The average scores of professional theory and clinical practice skills in the experimental group were (85.55±5.96) points and (89.90±6.40) points respectively, which were better than the average scores of the control group [(76.36±6.68) points and (75.50±4.81) points, respectively], and there were significant differences between two groups ( P<0.05). The results of the questionnaire survey showed that the experimental group residents had a higher degree of satisfaction and a higher evaluation of the teaching method than the control group. Conclusion:CP and TBL teaching is beneficial to improve the quality of standardized residency training of gynecology, and it is suggested to make wide popularization and application in the training.
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AIM: To observe the analgesic effect of esketamine in patients with thoracoscopic lobectomy. METHODS: Sixty patients scheduled with thoracoscopic lobectomy were randomly divided into group esketamine (ESK, n =30) and group saline (SAL, n = 30). Esketamine in ESK group was given 0.2 mg/kg at induction and 0.12 mg • kg
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OBJECTIVE：To study the reversal effect of quercetin on human cervical squamous carcinoma cisplatin-resistant cell line SiHa/DDP. METHODS ：The drug resistance index of cisplatin to SiHa/DDP cells ，and the reversal resistance multiple of quercetin to SiHa/DDP cells were determined. The effects of quercetin （0.005 μg/mL），cisplatin（2.5 μg/mL），cisplatin combined with quercetin （2.5 μg/mL cisplatin+0.005 μg/mL quercetin），quercetin combined with pathway inhibitor（0.005 μg/mL quercetin+ 20 nmol/L rapamycin ）on the apoptotic rate of SiHa/DDP cells were investigated ，as well as its effects on the expression of phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt）/mammalian rapamycin target protein （mTOR） signaling pathway related proteins （PI3K，Akt，mTOR，P-gp，p70S6K）. RESULTS ：The resistance index of cisplatin to SiHa/DDP cells was 5.19， and reversal resistance multiple of quercetin to SiHa/DDP cells was 4.00. Compared with cisplatin alone and quercetin alone ， cisplatin combined with quercetin ，quercetin combined with rapamycin could significantly increase the apoptotic rate of SiHa/DDP cells（P＜0.05），while decreased the phosphorylation of Akt ，mTOR and p 70S6K protein as well as the expression of P-gp protein （P＜0.05）. CONCLUSIONS ：Quercetin can effectively reverse drug resistance of SiHa/DDP cells to cisplatin ，which may be associated with inhibiting the expression of the protein related to PI 3K/Akt/mTOR signaling pathway.
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Objective To compare the diagnostic accuracy of white light endoscopy ( WLE ) and magnifying endoscopy combined with narrow-band imaging ( ME-NBI) for intestinal-type gastric adenoma in benign lesions. Methods Data of patients with suspected early gastric neoplastic lesions diagnosed with WLE were collected from Shanghai Renji Hospital from January 2016 to December 2017. Patients with suspected early gastric neoplastic lesions by WLE were examined with WLE, ME-NBI and targeted biopsy again within 2 weeks. The results of WLE, ME-NBI and biopsy were recorded. Using pathological diagnosis as the golden standard, diagnostic efficacy of WLE and ME-NBI for intestinal-type gastric adenoma and other non-adenoma lesions was evaluated. Results A total of 232 patients ( 232 lesions) were included, i. e. , 124 intestinal-type gastric adenoma and 108 other non-adenoma lesions such as atrophy, ulcers, hyperplasia, low-grade intraepithelial neoplasia, etc. . The sensitivity, negative predictive value and accuracy of ME-NBI in intestinal-type gastric adenoma were higher than those of WLE ( 92. 7％ VS 71. 8％, 91. 6％ VS 73. 7％, 91. 8％ VS 80. 6％, all P <0. 01 ) . The specificity was consistent ( both 90. 7％) . There was no significant difference in the positive predictive value between WLE and ME-NBI ( 92. 0％ VS 89. 9％, P>0. 05 ) . Conclusion Diagnostic efficacy of ME-NBI in intestinal-type gastric adenoma from other non-adenoma lesions is significantly higher than that of WLE.
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Objective To study the diagnostic value of Japan narrow band imaging expert team ( JNET) classification for differentiating pathological type of colorectal lesions. Methods A total of 418 colorectal lesions were retrospectively diagnosed by magnifying endoscopy with narrow band imaging ( ME-NBI) using JNET classification by two inexperienced doctors after a short time of training in JNET classification. Then lesions were diagnosed with Sano classification by the two doctors. Diagnostic results were compared with histologic findings as a golden standard. Results The sensitivity, specificity, and accuracy of JNET classification and Sano classification for neoplastic lesion differentiation were 98. 2％ VS 98. 5％, 77. 8％ VS 66. 7％, and 96. 9％ VS 96. 4％, respectively ( all P>0. 05 ) . These indicators for diagnosing cancerous lesions, including high grade intraepithelial neoplasia, intramucosal carcinoma and submucosal carcinoma, were 66. 7％ VS 80. 2％ ( P=0. 023) , 87. 6％ VS 79. 5％ ( P=0. 006) , and 82. 1％ VS 79. 7％( P=0. 379 ) , respectively, and those for predicting submucosal deep invasive cancers were 34. 8％ VS 39. 1％, 100. 0％ VS 99. 0％, and 96. 4％ VS 96. 3％, respectively ( all P>0. 05) . The diagnostic accuracy of JNET classification for differentiating neoplastic lesions were 95. 2％ in those with diameter <10 mm, 97. 0％ in 10～<20 mm, and 97. 8％ in ≥20 mm (P=0. 483), this finding were 95. 2％, 85. 1％ and 72. 1％ for cancer, respectively ( P<0. 0001 ) , and 100％, 96. 3％, and 94. 4％ for submucosal deep invasive cancer, respectively (P=0. 026). Shape and location of colorectal lesions showed no significant effect on the diagnostic efficacy of JNET classification. Conclusion JNET classification is valuable for doctors without experience of ME-NBI in diagnosing colorectal lesions and the efficiency is slightly superior to Sano classification. However, the accuracy of diagnosis for cancer with diameter ≥20 mm need to be improved.
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Objective@#To study the risk factors of recurrent and metachronous cancer of early gastric cancer (EGC) after endoscopic resection.@*Methods@#A retrospectively study was performed on the data of 309 patients (318 lesions) who underwent endoscopic mucosal resection or endoscopic submucosal dissection and were pathologically confirmed as EGC (including high-grade intraepithelial neoplasia) in the digestive endoscopy center of Shanghai Renji Hospital from October 2008 to December 2016. The risk factors of recurrent and metachronous cancer were analyzed using univariate and multivariate Cox regression analysis.@*Results@#The follow-up time ranged from 6 to 80 months, with median time of 26.6 months. Thirteen patients (4.2%, 13/309) had recurrence, and 8 (2.6%, 8/309) occurred metachronous cancer, and the total incidence rate of recurrent and metachronous cancer was 6.8% (21/309). The multivariate regression analysis showed that non-curative resection (P<0.01, HR=5.73, 95%CI: 1.75-18.74) was the independent risk factor of recurrence, and moderate to severe mucosa atrophy around the lesions before resection (P=0.04, HR=4.87, 95%CI: 1.10-21.50) was the independent risk factor of metachronous cancer of differentiated EGC after endoscopic resection.@*Conclusion@#Recurrent and metachronous cancer of EGC after endoscopic resection are rare but cannot be ignored. Patients with non-curative resection should be alert to postoperative recurrence, and differentiated EGC patients with moderate to severe mucosa atrophy around the lesions before resection should pay more attention to metachronous cancer.
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Objective To assess the potential risk factors of canceration for intestinal?type gastric adenoma. Methods A retrospective study were performed on the data of 142 intestinal?type gastric adenoma patients who underwent endoscopic resection and was confirmed by postoperative histopathology at Digestive Endoscopy Centre, Shanghai Renji Hospital from May 2012 to December 2016. Potential risk factors for canceration of intestinal?type gastric adenoma were analyzed using univariate and multivariate Logistic analysis. Results A total of 142 intestinal?type gastric adenomas from 142 patients were collected in the study,comprised of 124 noncancerous lesions(low grade intraepithelial neoplasia)and 18 cancerous lesions (high grade intraepithelial neoplasia or carcinoma). Age 65 and older(P=0.03, OR=3.37, 95%CI:1.10?10.29),size equal or greater than 2 cm(P= 0.04, OR= 3.93, 95%CI: 1.07?14.49), and Helicobacter Pylori infection(P=0.04,OR=3.60,95%CI:1.07?12.14)were significantly associated with canceration in the univariate Logistic regression analysis. In the multivariate regression analysis,age 65 and older(P=0.03,OR=4.36,95%CI:1.17?16.24),size equal or greater than 2 cm(P=0.02,OR=5.79, 95%CI:1.28?26.12),and Helicobacter Pylori infection(P=0.03,OR=3.89,95%CI:1.15?13.59)were independent risk factors of canceration. Conclusion Intestinal?type gastric adenoma has varying degrees of intraepithelial neoplasia. Patient who is 65 years or older, or with Helicobacter Pylori infection, and lesion diameter of more than 2 cm are the potential risk factors of carceration.
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Background:Esophageal cancer is a digestive system malignant tumor with high incidence in China. Early diagnosis and treatment are the keys to increase the survival rate of patients with esophageal cancer. Now,applying magnifying endoscopy combined with narrow-band imaging(ME-NBI)for diagnosis of early esophageal cancer has become the hot research spot. Aims:To evaluate the diagnostic value of ME-NBI for early esophageal cancer and its invasive depth. Methods:Consecutive patients with early esophageal cancer or precancerous lesion undergoing conventional white light endoscopy with biopsy and ME-NBI from June 2013 to November 2015 at the Ren Ji Hospital,School of Medicine, Shanghai Jiao Tong University were collected retrospectively. The findings of ME-NBI and biopsy pathology of conventional white light endoscopy were comparatively analyzed. The accuracy of ME-NBI in diagnosis of invasive depth of early esophageal cancer was evaluated. Results:A total of 49 patients were enrolled. The overall agreement of ME-NBI findings with endoscopic surgical pathology(gold standard)as well as the sensitivity and negative predictive value of ME-NBI for differentiating early esophageal cancer and precancerous lesion were significantly higher than those of biopsy pathology under conventional white light endoscopy[91. 8%(45 / 49)vs. 24. 5%(12 / 49);100%(45 / 45)vs. 17. 8%(8 / 45);100%(3 / 3)vs. 9. 8%(4 / 41),P all < 0. 05]. Total accuracy of ME-NBI for diagnosing the invasive depth of early esophageal cancer was 77. 8%(35 / 45). Conclusions:ME-NBI has good diagnostic value for early esophageal cancer and its depth of invasion. It can be used as an effective modality for clinical diagnosis of early esophageal cancer.
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OBJECTIVE:To compare the efficacy and safety of methotrexate with different methods of administrations com-bined with hysteroscopy in the treatment of scar pregnancy(CSP). METHODS:Data of 56 CSP patients were retrospectively ana-lyzed and divided into group A(26 cases)and group B(30 cases)by different methods of administrations. The fluid in group A was injected methotrexate 50 mg/m2 into the capsule,once a week. After 1 week,if the β-HCG was decreased less than or equal to 50%,the patient was additionally injected methotrexate;and if the β-HCG was decreased more than 50%,no more methotrexate was given,the lesion electrosurgical excision was conducted under hysteroscopy when β-HCG0.05). After treatment,the β-HCG in 2 groups was significantly lower than before,14 d<10 d<7 d<4 d,and group A was lower than group B,the differences were statistically significant(P<0.05). The incidence of adverse reactions in group A was significantly lower than group B,the difference was statis-tically significant(P<0.05). CONCLUSIONS:Methotrexate with different methods of administrations combined with hysteroscopy has good efficacy in the treatment of CSP,however,the safety of intracapsular injection is better than intramuscular injection.
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Objective To explore the practicality and feasibility and evaluation of the team based learning method (TBL) combined with the clinical pathway leaning method (CP) in clinical teaching of department of gynecology and obstetrics. Methods Toltally 40 clinical specialist interns selected for the study were randomly divided into two groups (each 20) respectively, using TBL com-bined with CP teaching method and traditional teaching method, and to make analysis and comparisons on the above two teaching methods. Differences were compared with t testing. Meanwhile, a question-naire survey was carried out among students of TBL combined with CP teaching group for qualitative analysis of the implementation effect of TBL combined with CP pedagogy. (Qualitative analysis is the medical students' evaluation of teaching effect, without further statistical processing). Results The professional test results of TBL combined with CP teaching team were superior to the traditional teach-ing group [(83.95 ±7.63) vs. (72.00 ±5.26)] and the difference was significant by paired t tests and analysis (t=5.063,P<0.05). The knowledge contest results of TBL combined with CP teaching team were superior to the traditional teaching group(90 vs. 85,95 vs. 75,85 vs. 70). TBL combined with CP method has been recognized by 90% medical students and they think that most of their quality has been further improved. Conclusions TBL combined with CP method for the clinical teaching of de-partment of gynecology and obstetrics is practical and feasible, and should be widely applied.
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Objective To explore the clinical effect of the open and laparoscopic surgery in the treatment of ectopic pregnancy to retain the clinical efficacy of reproductive function analysis. Methods Four hundred and fifty-six patients with ectopic pregnancy were selected as our subjects. Two hundred and eleven cases were served as laparotomy group( open),and 245 cases were laparoscopic group( laparoscopic). The data of intraoperative blood loss,operative time,postoperative anal exhaust time,average hospital stay,tubal patency rate,intrauterine pregnancy rate and again repeat ectopic pregnancy rate were recorded. Results Patients in two groups were successfully completed surgery. The operative time,intraoperative blood loss,postoperative anal exhaust time,average hospitalization time were(55. 1 ± 13. 5)min,(63. 5 ± 18. 3)ml,(25. 7 ± 5. 6)h,(6. 1 ± 2. 0)d respectively in laparotomy group,and(41. 3 ± 15. 5)min,(41. 1 ± 13. 3)ml,(13. 5 ± 5. 1)h,(3. 6 ± 1. 4)d respectively in laparoscopic group,and the differences were significant( t =2. 045,2. 263,3. 131, 3. 152,P﹤0. 05). The tubal patency rate,intrauterine pregnancy,ectopic pregnancy rate in laparotomy group were 81. 0%( 171/211 ),59. 7%( 126/211 ) and 26. 5%( 56/211 ) respectively,and 75. 5%( 185/245 ), 53. 5%( 131/245 ) and 22. 9%( 56/245 ) respectively in laparoscopic group,and the differences were not significant(χ2 =2. 254,2. 130,1. 242;P ﹥0. 05 ). Conclusion Laparoscopic surgery in the treatment of ectopic pregnancy is superior to laparotomy in terms of small trauma,less bleeding,faster recovery,shorter hospitalization time,and postoperative tubal patency rate.
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Objective To evaluate the effects of applying clinical pathway (CP) in clinical teaching of gynecology and obstetrics. Methods Totally 200 clinical specialist interns selected for the study were randomly divided into two groups (each 100), respectively, using CP teaching and tradi-tional teaching. After the internship, professional assessment (clinical skills assessment, theory test, the respondent)were conducted to two groups of students and their professional examination scores were compared, while questionnaires were conducted in the CP teaching group. All date were analyzed by SPSS 17.0 software. Chi-square test was used for enumeration date while t test was used for mea-surement data. Results CP teaching team of professional test results [(80.01 ± 9.34) vs. (72.37 ± 10.79)], the passing rate(96%vs. 87%) were superior to the traditional teaching group(P=0.000 and 0.022). The questionnaire showed that: applying CP in clinical teaching of obstetrics and gynecology can improve interns' learning enthusiasm and initiative, improve their comprehensive analysis ability, clinical thinking ability, practical ability and many other capabilities and it got about 90% of interns' recognition. Conclusions The application of the CP in clinical teaching of obstetrics and gynecology can help enhance the teaching effectiveness, standardize the teaching process, and improve the qual-ity of teachers teaching gynecology and obstetrics.
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Clinical data of 6 children with retrocaval ureter were retrospectively analyzed.Diagnoses were mainly based on ultrasound-guided high-dose venous urography,computed tomography(CT)or renal dynamic imaging(single photon emission computed tomography).Surgical operation was the optimal treatment of choice,resulting in different improvement in hydronephrosis but no anastomotic stenosis.
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Objective To establish an HPLC method for determination of triptoquinone B in Radix Folium Seu Flos Tripterygii Wilfordii(RFFTW) and its tablets.Methods An external method with HiQ siL KYA-C_(18)(250 mm?4.6 mm,5 ?m) column as fixed phase and methanol-1% acetic acid solution((66∶)34) as mobile phase was adopted.The detective wave length was 254 nm and the flow rate was 1.0 mL/min.Results The linearity range was 6.62—105.9 ?g/mL(r=0.999 9),the average recovery of T.wilfordii from Hunan Province was 97.78%,RSD was 1.09%(n=9),and the average recovery of tablet of T.hypoglaucum was 99.83%,RSD was 1.76%(n=9).Conclusion The method is accurate and sensitive.It is adoptable for quantitative analysis of triptoquinone B in RFFTW and its tablets.