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Objective structured clinical examination (OSCE) is an important assessment method for examining clinical thinking and clinical skills of medical students. OSCE has been applied in the quarterly phase examination in our department. According to the characteristics of otolaryngology, three stations of common items and five stations for personalized tests were set in the assessment. According to the different training that residents received during their stay in the previous department, different contents were assessed in the station for personalized examination. During the OSCE, residents took turns entering into each examine station and teachers gave scores according to the marking criteria of different station. After the examinations, two-way assessment and feedback were conducted between students and teachers. Through the practice in standardized training of residents in recent years, we found that OSCE was more comprehensive and flexible than others, which gained good application effects.
ABSTRACT
Objective structured clinical examination (OSCE) is an important assessment method for examining clinical thinking and clinical skills of medical students. OSCE has been applied in the quarterly phase examination in our department. According to the characteristics of otolaryngology, three stations of common items and five stations for personalized tests were set in the assessment. According to the different training that residents received during their stay in the previous department , different contents were assessed in the station for personalized examination. During the OSCE, residents took turns entering into each examine station and teachers gave scores according to the marking criteria of different station. After the examinations, two-way assessment and feedback were conducted between students and teachers. Through the practice in standardized training of residents in recent years, we found that OSCE was more comprehensive and flexible than others, which gained good application effects.
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Objective To explore the independent risk factors of the prolonged time of retention ICU after type A aortic dissection operation,to establish a corresponding perioperative risk assessment system.Methods A total of 509 consecutive patients with type A aortic dissection were enrolled in the study from September 2011 to May 2016,among which,418 patients received emergency operation.The prolonged retention time of ICU was considered as endpoint event.A perioperative assessment system was established through the analysis of related risk factors of the most common complications after type A aortic dissection operation.The possible risk factors of prolonged retention time of ICU were introduced into a single factor analysis.The meaningful variables in the single factor analysis were introduced into logistic regression analysis.The independent risk factors which were obtained from logistic regression analysis were used to establish risk prediction modeL,and the ROC curve and Hosmer-Lemeshow goodness of fit test were used to evaluate the model.Results The perioperative mortality rate was 8.64％,the prolonged retention time of ICU was 5.06 days,and 98 cases exceeded 7 days.The results of logistic regression analysis showed that age,the history of stroke,obesity,emergency operation,cardiopulmonary bypass time,deep hypothermic circulatory arrest time,renal inadequacy,massive transfusion,hypoxemia,and pulmonary infection were the independent risk factors for prolonged retention time of ICU.Accordingly,a mathematical model was established.The area under ROC cure for prediction model(AUC) =0.761,Hosmer-Lemeshow goodness of fit test P =0.512.Conclusion The logistic model estabhshed in this study can successfully predict ICU retention time after type A aortic dissection operation,and the efficacy was predicted satisfactorily.
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Organ transplantation is an ideal treatment for certain late-stage diseases. With the report of a penile transplantation in Tygerberg Hospital, South Africa, this topic has, once again, aroused exploration in the field. At present, two penile transplantation operations have been performed and gained some positive results. Patients can gain void standing, erectile function and better cosmetic appearance. However, debates and potential risks still exist. Here, we briefly review the progress of studies in this filed and discusses the potential risks and debates in penile transplantation
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Objective To investigate the expression levels and significance of interferon-γ(IFN-γ),interleukin (IL)-10 mRNA in peritoneal fluid mononuclear cells (PFMC) in patients with endometriosis (EM).Methods A total of 55 patients with EM diagnosed histopathologically after operation were enrolled as EM group,and 52 patients without EM were enrolled as control group.The PFMC were isolated,and the expression levels of IFN-γ and IL-10 mRNA were determined by TaqMan real-time reverse transcriptase-polymerase chain reaction (RT-PCR).Results It was found that IFN-γ mRNA expression level was significantly decreased in EM group compared with that in control group (P＜0.05),while IL-10 mRNA expression level was significantly increased in EM group compared with that in control group (P＜0.05).The ratio of IFN-γ/ IL-10 was significantly lower in EM group than that in control group (P＜0.05).The ratio of IFN-γIL-10 was significantly higher in patients with stage Ⅰ-Ⅱ than that in patients with stage Ⅲ-Ⅳ (P＜0.05).Conclusion The imbalance of IFN-γ/ IL-10 in PFMC is associated with the pathogenesis of EM.
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Objective To explore the effects of multidisciplinary comprehensive pulmonary rehabilitation on aged patients with pneumo-coniosis. Methods From January, 2012 to January, 2015, 85 old stable inpatients with pneumoconiosis were divided into control group (n=40) and rehabilitation group (n=45). Both groups accepted routine medicine, while the rehabilitation group received multidisciplinary com-prehensive pulmonary rehabilitation for twelve weeks. They were assessed with cardiopulmonary exercise test, BODE index and quality of life before and after treatment. Results The maximum work, maximal oxygen uptake, 6-minute walk distance, scores of modified Version of the British Medical Researsh Council Respiratory Questionnaire, BODE index, activities of daily living, social activities, depression and anx-iety improved in the rehabilitation group after treatment (t>3.379, P2.201, P0.05). Conclusion Multidisciplinary comprehensive pulmonary rehabilitation can effectively improve exercise tolerance and quality of life in aged patients with pneumoconiosis.
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Objective To investigate the change of CNP (C-natriuretic peptides) in patients with PCOS (polycystic ovary syndrome) undergoing in vitro fertilization-embryo transfer (IVF-ET) with GnRH-α longprotocol for controll ovarian hyper-stimulation(COH).Methods From March 2012 to September 2014,22cases patients with PCOS undergoing IVF-ET in the Reproductive Medical Center of the Center Hospital of JiangMen were selected as study group(Group 1),and 32 cases patients with normal ovarian reserve,the age younger than 35,and the number of oocytes retrieved more than 6 at the same period were selected as control group(Group 2).The level of serum CNP and estradiol(E2) on the day of human chorionic gonadotropin (HCG) and retrieving oocytes,the level of CNP and E2 in follicular fluid were analyzed.In additional,the levels of CNP and E2 in follicular fluid of different fertility and embryo quality were compared.Results (1) CNP and E2 on the day of HCG were significantly higher than that on the day of retrieving oocytes (CNPof Group 1:(107.21±78.55) μg/L vs.(73.01±55.99) μg/L,CNP of Group 2:(69.16±32.39) μg/L vs.(44.11±27.23) μg/L;E2 of group 1:(5231.38±1489.00) ng/L vs.(1985.52±662.54) ng/L,E2 of Group 2:(3678.45±969.57) ng/L vs.(1567.71±493.93) ng/L;t =2.968,2.752,8.147,14.567;P＜0.05).CNP and E2 on the day of retrieving oocytes and E2 on the day of HCG of Group 1 were higher than that of Group 2(t=2.866,2.227,2.173;P＜0.05).CNP in follicular fluid in Group 1 was higher than that in Group 2,but E2 of in follicular fluid in Group 1 was lower than that in Group 2 (t =2.244,-2.650;P＜0.05).(2) In Group 1,CNP and E2 in follicular fluid of normal fertility were lower than that of unnormal fertility,and E2 in follicular fluid of unnormal fertility were higher than that of no-fertility,and there were significant differences(t =-6.117,-2.374,2.760;P＜0.05).(3) In Group 2,only E2 in follicular fluid of unnormal fertility were higher than that of no-fertility,and there was significant difference(t=2.658,P＜0.05).(4) In 2 groups,CNP in follicular fluid of high-quality embryo were lower than that of non-high-quality embryo,and there was significant difference (t =-2.910,-2.029;P＜0.05).CNP in follicular fluid of non-high-quality embryo in Group 1 were higher than that in Group 2,but E2 in follicular fluid of non-high-quality embryo in Group 2 were higher than that in Group 1,and there were significant differences (t =2.141,-2.009;P ＜ 0.05).Conclusion There are differences in the change of CNP in the patients with PCOS and non-PCOS,and there are some deficiencies of the first meiosis in the patients with PCOS.
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PurposeAlteration of the regional cerebral flow and cerebrovascular reserve (CVR) caused by cerebral artery stenosis or occlusion is an essential risk factor for ischemic stroke. This study aims to assess the CVR in patients with severe middle cerebral artery (MCA) stenosis or occlusion by using MR perfusion-weighted imaging (PWI) with CO2 inhalation stress test. Materials and MethodsPWI were performed before and after CO2 inhalation stress on 28 patients with severe middle cerebral artery stenosis or occlusion and 10 healthy volunteers. The regions of interest (ROI) were put on the affected hemisphere of the MCA blood supply area and the contralateral side in both groups. The relative cerebral blood volume (rCBV), relative mean transit time (rMTT), relative cerebral blood flow (rCBF) and CVR were measured.Results① The rCBV, rCBF and rMTT of the affected side were 149.16±33.01, 18.04±5.24, 8.65±1.81 before CO2 inhalation stress, and 156.23±21.60, 23.77±8.77, 8.72±3.01 after CO2 inhalation stress. The rCBV, rCBF and rMTT were signiifcantly increased (t=1.238, 2.561 and 2.647, P<0.05) after CO2 inhalation stress. The rCBV, rCBF and rMTT of the contralateral side were 176.22±40.12, 22.43±5.74, 8.10±3.71 before CO2 inhalation stress, and 198.54±39.87, 27.64±7.22, 8.03±2.97 after CO2 inhalation. The rCBV, rCBF was significantly increased (t=1.780 and 1.665,P<0.05) while rMTT was signiifcantly decreased (t=2.871,P<0.05) after CO2 inhalation.②The CVR of the affected side, contralateral side and control group were 18.9%, 26.8%, and 39.1%, respectively. There were significantly differences (t=1.604, 2.321 and 1.874,P<0.05) between the affected and contralateral side, the affected side and control group, the contralateral side and control group.ConclusionPWI with CO2 inhalation stress test is valuable in assessing the cerebrovascular reserve in patients with severe middle cerebral artery stenosis or occlusion.
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Objective To analyse long-term follow-up outcome of cryoballoon ablation (CBA) for atrial ifbrillation (AF) in a single center and to investigate the clinical relative factors which affecting the effect. Methods The inpatient, operating and outpatient data of patients, who were treated by CBA for AF in our center from January 2009 to April 2013, were retrospectively analyzed. Left atrium diameter (LAD) was measured by transthoracic echocardiography. Failure-treatment of CBA was defined by episode of AF, atrial lfutter, atrial tachycardia lasted for 30 seconds after 3 months. Results A total of 199 patients were enrolled. The rates of phrenic nerve paralysis, pericardial effusion, transient ischemic attack were 1.5%(n=3), 0.5%(n=1), 0.5%(n=1),respectively. All complications were resolved spontaneously.152 patients had completed follow-up data after ifrst-time CBA during a long-term follow-up of mean 23±14 months, 65 patients (42.8%) treated success. 75 patients with failure-treated were (86.2%) experienced the atrial arrhythmia recurrence in ifrst 12 month. The characteristics of failure-treated patients included with older age[(62±7) years vs. (52±10) years, P=0.0379]and larger LAD[(48±6)mm vs. (43±6) mm, P<0.0001]. The Logistic analysis showed that LAD[OR=0.896(0.842,0.953), P=0.005]and age[OR=1.037 (1.000,1.076), P=0.0488]could individually predict the treat-failure after ifrst CBA, and only LAD[OR=0.876 (0.822,0.935), P < 0.0001]could individually predict the total CBA. Conclusions CBA procedure for AF is safe and effective, and the result of long-term follow-up is preferable. Most atrial arrhythmia are recurred during ifrst 12 month after CBA. LAD can individually predict the failure in treatment of CBA.
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Objective To investigate the effects of troglitazone on cholesterol homeostasis and secretion of 3T3-L1 cells by sirolimus and the underlying mechanisms. Methods In vitro cultured 3T3-L1 cells were divided into control group,sirolimus (100 nmol/L) group,sirolimus(100nmol/L)+ troglitazone (10 μmol/L) group and troglitazone (10 μmol/L) group.High performance liquid chromatography (HPLC) was used to measure intracellular cholesterol accumulation.ELISA was used to measure leptin excretion.Quantitative real-time PCR and Western blotting were used to examine mRNA and protein expression of PPARγ. Results Free cholesterol of sirolimus +troglitazone group was 1.19 times of sirolimus group (P＜0.05).The leptin secretion levels of control group,sirolimus group,sirolimus+troglitazone group and troglitazone group were (19.02±0.52) μg/L,(15.62±0.47) μg/L,(16.45±0.51) μg/L,(18.07±0.66) μg/L,respectively.And the leptin secretion level of sirolimus+ troglitazone group was 1.05 times of sirolimus group (P＜0.05).The PPARγmRNA expressions of sirolinus group,sirolimus + troglitazone group and troglitazone group were 0.60±0.14,1.12±0.27,1.30±:0.14 folds of control,and the PPARγ mRNA expression of sirolimus + troglitazone group was higher than that of sirolimus group (P＜0.05).PPARγ protein expression had the same tendency. Conclusion Troglitazone reduces the inhibitory effect of sirolimus on PPARγ transactivation and the inhibitory effect of sirolimus on 3T3-L1 cells differentiation and adipogenesis.
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Objective To investigate the relationship between the urinary albumin excretion (UAE) and serum uric acid in general population. Methods The study participants were derived from the epidemiological study on the association of metabolic syndrome and chronic kidney disease (CKD) in Pinggu district, Beijing. A total of 992 participants (463 men and 529 women) aged from 30 to 75 years were enrolled in this study. For each participant, UAE, serum uric acid, serum creatinine, and serum lipids were detected and other potential risk factors for CKD were surveyed. Results ( 1 ) The frequencies of microalbuminuria, macroalbuminuria and hyperuricemia were 12.9% , 1.8% and 4.3% respectively. The persons with hyperuricemia had significantly higher frequency of albuminuria than those without hyperuricemia (37. 2% vs 13. 7% , P ＜0. 01). (2) The participants were divided according to the quartiles (25% , 50% , 75% ) of serum uric acid level, and the frequencies of albuminuria in males were 13. 2% , 13. 9% , 17. 2% and 25.4% , while those in females were 8. 4% , 6. 2% , 9. 6% and 24. 8%. ( 3 ) Multivariate logistic regression analysis showed, hyperuricemia was significantly associated with albuminuria in females (OR =2. 31, 95% CI 1. 15-4. 68; P=0.02), but not in males. If the persons with reduced renal function were excluded, similar result still could be gained. Conclusions The prevalence of albuminuria increases gradually with uric acid elevation. Serum uric acid is an independent risk factor of elevated UAE, especially in females.
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Objective To investigate the discriminator value of Han Chinese first morning urine albumin creatinine ratio (ACR) for determining the microalbuminuria. Methods A total of 1056 participants (494 males and 562 females) were selected from epidemiologic study of the metabolic syndrome and chronic kidney disease in Pinggu district, Beijing. Eight-hour overnight urinary albumin excretion (UAE) was regarded as the gold standard for defining the albuminuria,and the ROC curve analysis was used to determine the ACR discriminator value for microalbuminuria. Results (1)Microalbuminuria was found in 12.5% of participants,macroalbuminuria in 1.7%. (2)The ACR discriminator value for microalbuminuria by ROC curve analysis was 1.95 g/mol (sensitivity 97.6% and specitivity 88.6%) for men, 3.62 g/mol(sensitivity 83.8% and specitivity 89.1%) for women, 2.78 g/mol (sensitivity 88.7% and specitivity 85.9%)for overall. The upper boundary of microalbuminuria by ROC curve analysis was 22.59 g/mol (sensitivity 100.0% and specitivity 98.8%) . (3)The inter-rater agreement of the result in this study showed that sensitivity was 91.3% and specitivity was 88.2%, positive likelihood ratio was 7.56 and negative likelihood ratio was 0.10, positive predictive value was 56.9% and negative predictive value was 98.4%. Conclusions The ACR discriminator value for determining microalbuminuria is obviously higher in women than that in men, and is higher than recommendation of international guidelines. The result by ROC curve analysis has better sensitivity and specitivity.
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Objective To observe plasma resistin levels in patients with essential hypertension (HT) of Xinjiang Kazakans and Han nationalities, and explore its association with insulin resistance (IR), blood glucose, blood lipids, blood pressure and obesity. Methods Total 127 Kazakan cases and 131 Han cases were selected as the subjects. According to their blood pressure, they were divided into HT group of Kazakans, control group of Kazakans, HT group of Hans and control group of Hans. Blood pressure, height, weight, waist circum-ference (WC) and hip were measured. Plasma resistin, fasting insulin(FINS), fasting plasma glucose (FPG), total cholesterol (TC), tri-glyceride (TG), high-density lipoprotein cholesterol ( HDL-C), low-density lipoprotein cholesterol ( LDL-C), apoprotein-A1( Apo-A1)and apoprotein-B(Apo-B) were determined. Body mass index (BMI), waist-hip ratio ( WHR), body fat percentage ( BF% )and homeostasis model assessment of insulin resistance index ( HOMA-IR) were calculated. Results Plasma resistin levels in the HT groups of Kazakans and Hans were significantly higher than those in their control groups ( P<0.01 ). There were no significant difference in the comparison of plasma resistin levels in HT groups or control groups between Kazakans and Hans ( P>0.05). Plasma resistin was posi-tively and significandy correlated with age, systolic blood pressure (SBP), WC, BMI, WHR, BF%, FlaG, FINS, HOMA-IR, TG in HT groups of Kazakans and Hans ( HT group of Kazakans, r=0.492,0.296,0.281,0.648,0.263,0.515,0.742,0.759,0.797,0.595; HT group of Hans, r=0.417,0.275,0.391,0.483,0.278,0.318,0.453,0.560,0.641,0.310; P<0.05). After the influential factors such as age, blood glucose, blood lipids and obesity were adjusted, plasma resistin level in four groups were still positively and significantly corre-lated with FINS and HOMA-IR ( HT group of Kazakans, r=0.432,0.410 ; control group of Kazakans, r=0.327,0.305 ; HT group of Hans, r=0.426,0.425 ; control group of Hans, r=0.377,0.392 ; P<0.05), but not correlated with SBP or DBP( P>0.05 ). HOMA-IR, FPG and BMI were independent factors for plasma resistin level in HT group of Kazakans, while HOMA-IR, FlaG and BF% were inde-pendent factors for plasma resistin level in HT group of Hans. Conclusion Plasma resistin level was increased in patients with HT of Kaza-karts and Hans. Close correlations between resistin and obesity, blood glucose and IR were found, and there may be indirect correlation be-tween resistin and blood pressure.