Prevalence of Burnout and Its Associated Factors among Medical Students in a Public University in Selangor, Malaysia: a CrossSectional Study

@#Introduction: Burnout is a growing trend among medical students worldwide. The aim of this study was to determine the prevalence and factors associated with burnout among medical students at a public university in Malaysia. Methods: A cross-sectional study was conducted among 1st through 5th year medical students at a public university using a simple random sampling method in recruiting participants. In this study, The Maslach Burnout Inventory-General Survey for Student (MBI-SS) was used and burnout is defined as severely emotionally exhausted and severely depersonalised. Results: A total of 328 medical students were recruited with a with response rate of 88.6%. The burnout prevalence was 10.1%. Based on multivariate logistic regression, presence of smartphone addiction with adjusted (odds ratio (OR) 7.37, 95% confidence interval (CI) = 1.67, 32.49), course choice not based on personal interest or due to family pressure (OR 2.72, 95% CI = 1.08, 6.85) and the presence of family relationship problems (OR = 3.58, 95% CI = 1.27, 10.04) are more likely to be associated with burnout among the medical students. Conclusion: Our study has shown that every tenth medical students suffers from burnout. Medical students who are addicted to smartphone, have chosen medical course against individual interest or because of family pressure and have family relationship problems are at risk of getting burnout. Intervention is required to address this issue for the future well-being of medical students.

Anxiety, Depression and Stress Among Medical Students in Malaysia During COVID-19: A Cross-Sectional Study

@#Introduction: This study aimed to determine the prevalence and factors associated with psychological distress following the COVID-19 pandemic among medical students at one of the public universities in Malaysia. Method: From August to October 2020, a web-based cross-sectional study was conducted among undergraduate medical students at a public university. DASS-21, Brief Resilience Scale and WHOQOL-Bref questionnaires were used in this study. Results: The prevalence of depression was 40.5%, anxiety 46.0% and stress 30.9%. Based on multivariate logistic regression, a higher quality of life score is associated with a lower likelihood of depression (AOR=0.583, p<0.001), anxiety (AOR=0.726, p<0.001), and stress, (AOR=0.702, p<0.001) respectively. Likewise, a higher resilience score is less likely to be associated with depression (AOR=0.880, p=0.002), anxiety (AOR=0.880, p=0.002), and stress (AOR=0.850, p<0.001). Older age (OR=0.700, p=0.020) was associated with less stress and being on campus (OR=3.436, p=0.021) was at risk of stress during the COVID-19 pandemic. Conclusion: Our results suggest that medical students with higher quality of life and resilience scores had less depression, anxiety and stress. Older age was associated with less stress, and during the COVID-19 pandemic, being on campus was at risk of stress. Various stakeholders need to keep these findings in mind and identify those who are at risk for developing depression, anxiety, and stress in order to take further action to improve their quality of life and resilience

Multiple portions enteral nutrition and chyme reinfusion of a blunt bowel injury patient with hyperbilirubinemia undergoing open abdomen: A case report / 中华创伤杂志(英文版)

Blunt bowel injury (BBI) is relatively rare but life-threatening when delayed in surgical repair or anastomosis. Providing enteral nutrition (EN) in BBI patients with open abdomen after damage control surgery is challenging, especially for those with discontinuity of the bowel. Here, we report a 47-year-old male driver who was involved in a motor vehicle collision and developed ascites on post-trauma day 3. Emergency exploratory laparotomy at a local hospital revealed a complete rupture of the jejunum and then primary anastomosis was performed. Postoperatively, the patient was transferred to our trauma center for septic shock and hyperbilirubinemia. Following salvage resuscitation, damage control laparotomy with open abdomen was performed for abdominal sepsis, and a temporary double enterostomy (TDE) was created where the anastomosis was ruptured. Given the TDE and high risk of malnutrition, multiple portions EN were performed, including a proximal portion EN support through a nasogastric tube and a distal portion EN via a jejunal feeding tube. Besides, chyme delivered from the proximal portion of TDE was injected into the distal portion of TDE via a jejunal feeding tube. Hyperbilirubinemia was alleviated with the increase in chyme reinfusion. After 6 months of home EN and chyme reinfusion, the patient finally underwent TDE reversal and abdominal wall reconstruction and was discharged with a regular diet. For BBI patients with postoperative hyperbilirubinemia who underwent open abdomen, the combination of multiple portions EN and chyme reinfusion may be a feasible and safe option.

Fear of Covid-19 and Burnout Among Healthcare Providers in Malaysia: Is Resilience a Missing Link?

@#Introduction: During the COVID-19 pandemic, healthcare providers have been in great fear due to the high risk of contracting COVID-19 infection at any time. This study aimed to determine the mediating role of resilience on the relationship between fear of COVID-19 and burnout in primary care healthcare providers in Malaysia. Methods: This was an online cross-sectional study involving 1280 healthcare providers aged 18 years and older from 30 government primary care clinics in Malaysia. We used the COVID-19 Fear Scale, the Copenhagen Burnout Inventory Scale, and the Short Brief Resilience Scale to collect data from the respondents. Smart-PLS was used to perform mediation analysis. Results: The mean age of the respondents was 36 years old and mean duration of working experience was 11 years. The majority of the respondents were female (82.4%) and Malays (82.3%). The study population consisted of nurses (47.4%), doctors (26%), medical assistants (11.9), healthcare assistant (7.1%), medical laboratory technicians (6.4%) and drivers(1.3).The results show that fear of COVID-19 positively predicts burnout. According to the results, resilience mediates the relationship between fear of COVID-19 and all the three burnout domains, namely personal burnout (β=0.175,p<0.001), work-related burnout (β=0.175,p<0.001) and client-related burnout (β=0.172,p<0.001). Additionally, resilience reduces the impact of COVID-19 fear on the three domains of burnout. Conclusion: Our study has reported a mediating effect of resilience on the relationship between fear of COVID-19 and burnout.

Risk Perception and Emergency Preparedness Against Flood Affected Participants From the Primary Health Care Centre, Malaysia: A Comparison Between Genders

@#Introduction: Flooding has become a major natural disaster in Malaysia in recent decades. There may be a gender difference in many aspects related to flood response and practice. This study aimed to examine the gender gap in knowledge, attitudes, and practice of flood preparedness in Malaysia. Method: This cross-sectional study was conducted among patients attending the primary care clinic at Universiti Sains Malaysia health campus, Kelantan. A validated questionnaire was used for data collection. Results: 328 subjects were recruited, 56.1% of them were females. The female respondents were younger than the males (36 vs. 41 years old). However, females have better knowledge, and practice on flood preparedness compared to male respondents. Among those, women were more aware of the local emergency plan than males (p=0.01). More female respondents kept their vaccination and personal medical records in a waterproof container or sealed plastic bag during past and future flood preparations (3-5 day supply of non-perishable food) than male respondents (p<0.05). In addition, with the practice of keeping a one-week supply of medication, and having their medical records in a waterproof container along with a first-aid kit (p=0.001). For future flood preparation, more women would filter the cloudy water through clean clothes for boiling (p=0.035). The determinants of good preparedness for future floods for female were older-age (p=0.001), blue-collar (p=0.043); whereas male were lower household income (p=0.014), being blue collar (0.014) and white collar (0.039) compared with student/retiree based on multivariate logistic regression. Conclusion: Our study reported that the determinants of good preparedness for future floods were older-age, blue-collar and having a lower-household income.

Tendon-regulating and bone-setting manipulation plus endurance resistance exercises for female with chronic neck pain / 针灸推拿医学（英文版）

Objective: To observe the clinical efficacy of tendon-regulating and bone-setting manipulation combined with endurance resistance exercises in treating female with chronic neck pain, and explore the mechanism. Methods: A total of 57 female patients with chronic neck pain who met the inclusion criteria were randomly divided into a manipulation group (29 cases) and a medium-frequency electrotherapy group (28 cases). Patients in both groups received the same endurance exercise therapy, while those in the manipulation group received additional tendon-regulating and bone-setting manipulation, and those in the medium-frequency electrotherapy group received additional medium-frequency electrotherapy. Both groups were treated for 5 weeks. Before and after treatment, the neck function of patients was evaluated by visual analog scale (VAS), Analgesy-Meter, Northwick Park questionnaire (NPQ), root mean square (RMS) and median frequency (MF) of surface electromyography of sternocleidomastoid muscle and posterior cervical extensor muscle, and the patients were followed up at a month after treatment. Results: All patients completed the treatment and were followed up. Compared with the same group before treatment, the VAS scores of both groups decreased, the tenderness values increased, the RMS and MF values increased, and the NPQ scores decreased after treatment (all P<0.05). The improvement of manipulation group was more notable than that of medium-frequency electrotherapy group (all P<0.05). At one-month follow-up, the VAS and NPQ scores of the manipulation group were lower than those before and after treatment, and the VAS and NPQ scores of the medium-frequency electrotherapy group were only lower than those before treatment; the two scores of the manipulation group were lower than those of the medium-frequency electrotherapy group (both P<0.05). Conclusion: Tendon-regulating and bone-setting manipulation combined with endurance resistance exercises can relieve neck pain and cervical dysfunction in female patients with chronic neck pain. The efficacy of this method is more durable and better than that of medium-frequency electrotherapy combined with endurance exercises.

Coronavirus Disease-2019: Knowledge and Practices Behaviour of Healthcare Workers at a University Teaching Hospital in Malaysia

@#Introduction: Coronavirus disease-2019 (COVID-19) was declared a global pandemic in March 2020, with 15 million people have been infected worldwide, and this number is increasing. Our study sought to assess the knowledge and practice of healthcare workers (HCWs) in a teaching hospital in Malaysia. Methods: This cross-sectional study was undertaken using online Google form links among HCWs. Knowledge and practice were assessed using a validated questionnaire. The analysis was performed with SPSS version 26. Factors associated with poor knowledge were analysed using multivariate analysis. Results: A total of 193 HCW responded to our online survey. Majority of our HCWs were female (74.1%) with a mean age of 32.5 years. We found 53 (27.5%) and 134 (69.4%) of our HCWs had good knowledge and good practice on COVID-19, respectively. Knowledge gap was identified in the symptomatology, investigation methods and management. Based on multiple logistic regression, determinants of poor knowledge scores were those work as medical attendants (aOR = 3.626; 95% CI = 1.489, 8.834) and nurses (aOR = 4.107; 95% CI = 1.175, 14.358). Conclusion: Around one-third and 70% of our HCWs have good knowledge and practice of COVID-19 infection respectively. Continuous, specifically targeted and updated medical education, need to be carried out to improve the knowledge and practice among our HCWs in order to keep abreast of the fast-moving pace of COVID-19 knowledge development.

Multi-center randomized double-blind controlled study on children's anorexia (spleen-stomach disharmony) treated with Child Compound Endothelium Corneum / 中国中药杂志

Child Compound Endothelium Corneum(CCEC)has the effects in invigorating the spleen and appetizing the appetite, and dissolving the accumulation of food. The recent studies have proved that it could improve gastrointestinal motility, restore physiological gastrointestinal peristalsis, increase gastrointestinal digestive motility, and enhance appetite. This trial aimed to evaluate its clinical efficacy and safety in the treatment of children's anorexia(spleen-stomach disharmony). A total of 240 children with anorexia in line with the inclusion and exclusion criteria were selected and randomly divided into experimental group and control group, with 120 in each group. Patients in the experimental group took CCEC and Erpixing Granules simulant. Patients in the control group took Erpi-xing Granules and CCEC simulant. After 21 days of treatment, there was no statistical difference in the recovery rate of anorexia, reduced food intake, eating time, weight change, traditional Chinese medicine syndrome effect, single symptom effect, and trace element Zn recovery rate between the two groups. Based on the non-inferiority test, the experimental group was not inferior to the control group in efficacy. How-ever, the effect of CCEC in reducing appetite in children with anorexia was better than that of control drugs(P<0.05). There was no statistical difference in the incidence of adverse events and adverse reactions between the two groups during the trial. This experiment confirmed the efficacy and safety of CCEC in the treatment of children's anorexia(spleen-stomach disharmony), with a safety and re-liability in clinical application. In addition, it was a better choice for children with anorexia who were mainly manifested by reduced appetite. Meanwhile, compared with granule, chewable tablets were more convenient to take in clinic. Therefore, the efficacy and safety of CCEC for the treatment of children's anorexia(spleen-stomach disharmony) were not inferior to those of Erpixing Granules, with a safety and reliability in clnic. However, due to the small sample size of this trial, the efficacy results only show a trend. It is suggested to further carry out a large-sample-size clinical study to define the clinical advantages of CCEC.

Comparison of pulmonary circulation hemodynamics and respiratory mechanics induced by drowning with equal volume of freshwater and seawater in sheep: a randomized controlled study / 中华危重病急救医学

Objective:To compare the effects of freshwater and seawater drowning on sheep's pulmonary circulation hemodynamics and respiratory mechanics.Methods:According to the random number table method, healthy crossbred sheep were divided into freshwater drowning group ( n = 12) and seawater drowning group ( n = 12). 30 mL/kg of freshwater or seawater was infused respectively through trachea for approximately 5 minutes. Before the drowning, immediately after drowning, and 30, 60, 120 minutes after drowning, the systemic circulation hemodynamic parameters [heart rate (HR), mean arterial pressure (MAP), cardiac output (CO)] were monitored by pulse indicator continuous cardiac output (PiCCO); the respiratory parameters were obtained through the ventilator, including tidal volume (VT), lung compliance (Cdyn), oxygenation index (PaO 2/FiO 2), peak airway pressure (Ppeak)]; PiCCO and the right heart floating catheter (Swan-Ganz catheter) was used to measure pulmonary hemodynamic parameters [pulmonary systolic pressure (PAS), pulmonary diastolic pressure (PAD), pulmonary artery wedge pressure (PAWP), and extravascular lung water (EVLW)]. The animals were sacrificed at the end of the experiment, and the amount of residual water in the respiratory tract was measured; the pathological changes in the lung tissue were observed by hematoxylin-eosin (HE) staining. Results:① Systemic circulation hemodynamics: compared with the values before drowning, HR, MAP, and CO at the time of immediately after drowning in both freshwater and seawater were significantly increased and peaked. In addition, all indicators in the freshwater drowning group were significantly higher than those in the seawater drowning group [HR (bpm): 170.75±1.87 vs. 168.67±2.27, MAP (mmHg, 1 mmHg = 0.133 kPa): 172.92±1.62 vs. 159.42±3.18, CO (L/min): 13.27±0.71 vs. 10.33±0.73, all P < 0.05].② Respiratory parameters: compared with values before drowning, PaO 2/FiO 2, VT, and Cdyn decreased immediately in both freshwater and seawater drowning groups, Ppeak was significantly increased; in addition, the values in the seawater drowning group were decreased or increased more significantly than freshwater drowning group [PaO 2/FiO 2 (mmHg): 37.83±1.99 vs. 60.42±5.23, VT (mL): 86.25±7.66 vs. 278.75±9.67, Cdyn (mL/cmH 2O): 8.86±0.33 vs. 23.02±0.69, Ppeak (cmH 2O, 1 cmH 2O = 0.098 kPa): 42.17±2.69 vs. 17.67±1.15, all P < 0.01]. In addition, PaO 2/FiO 2 in the freshwater drowning group was gradually increased over time, while the seawater group continued to decline.③ Pulmonary circulation hemodynamic parameters: PAS, PAD, PAWP at the time of immediately after drowning in both freshwater and seawater groups were significantly higher than before drowning; in addition, the freshwater drowning group was significantly higher than the seawater drowning group [PAS (mmHg): 34.58±2.87 vs. 26.75±1.66, PAD (mmHg): 27.25±1.22 vs. 16.75±0.87, PAWP (mmHg): 27.83±1.85 vs. 11.75±1.82, all P < 0.01]. Thereafter, PAS and PAD in the freshwater drowning group gradually decreased, while the parameters in the seawater drown group continued to increase. PAWP gradually decreased after freshwater or seawater drowning, and recovered to pre-drowning levels 120 minutes after drowning and 30 minutes after drowning, respectively. EVLW continued to increase after freshwater drowning, reaching a peak at 30 minutes, and then decreased, until 120 minutes after drowning was still significantly higher than that before drowning (mL/kg: 10.73±1.27 vs. 7.67±0.69, P < 0.01); EVLW could not be measured.④ Residual water in the respiratory tract: residual water in the freshwater drowning group was significantly less than that in the seawater drowning group (mL: 164.33±25.21 vs. 557.33±45.23, P < 0.01).⑤ HE staining: partial alveolar atrophied in the freshwater drowning group, some alveolar spaces were broken, alveolar spaces and alveolar cavity showed a little powdery substance deposition; it was noted that alveolar expanded in the seawater drowning group, alveolar spaces were broken and bleeding and edema were obvious in the interstitial space. Conclusion:The effect of seawater drowning on the respiratory mechanics and pulmonary circulation of animals is more obvious than that of freshwater drowned animals, and the amount of residual water in the respiratory tract is also significantly more than that of freshwater drowned animals.

Current situation of undergraduate anesthesiology teaching and thoughts on improvement of curriculum structure / 中华医学教育探索杂志

After more than 30 years of exploration and development, undergraduate anesthesiology teaching in China has formed a relatively large teaching scale in the whole country. However, the teaching mode and cultivation mechanism are not yet fully mature, which still has room for improving relevant curriculum structures. This study has investigated the current situation of undergraduate anesthesiology teaching in 38 medical colleges, summarized characteristics of teaching programs and curriculum design, and proposed relevant improvement suggestions.

The Malay version of smartphone addiction scale: Development, factor structure and validation of a short form for Malaysian adolescents

@#Introduction: This study aimed to validate the Malay version of the short form Smartphone Addiction Scale (SAS-M-SF) and to examine its psychometric properties in a cohort of pre-university adolescents. Methods: We obtained the validity and reliability evidence for the SAS-M-SF using a group of 307 pre-university students in Universiti Putra Malaysia (UPM), Serdang, Selangor, Malaysia with a mean age of 18.4±0.2 years (70.4% female and 29.6% male). A questionnaire containing the Malay version of Smartphone Addiction Scale (SAS-M), the Malay version of the short form Smartphone Addiction Scale (SAS-M-SF), and the Malay version of the Internet Addiction Test (IAT-M) was administered on the adolescents. Results: The SAS-M-SF displayed good internal consistency (Cronbach’s α=0.80). Using principle component analysis, we identified a 4-factor SAS-M-SF model. A significant correlation between the SAS-M-SF and the IAT-M was found, lending support for concurrent validity. The prevalence of smartphone addiction was 54.5% based on cut-off score of ≥36 with a sensitivity of 70.2% and a specificity of 72.5%. Conclusions: The 10-item SAS-M-SF is a valid and reliable screening tool for smartphone addiction among adolescents. The scale can help clinicians or educators design appropriate intervention and prevention programs targeting smartphone addiction in adolescents at clinical or school settings.

Clinical observation on prevention of chemotherapy infection in gastric cancer by moxa-stick moxibustion plus rhG-CSF and its effect on immune function / 针灸推拿医学（英文版）

Objective: To observe the effect of moxa-stick moxibustion plus recombinant human granulocyte-colony stimulating factor (rhG-CSF) in preventing chemotherapy infection in gastric cancer and its effect on immune function. Methods: A total of 70 patients with gastric cancer treated by chemotherapy were randomly divided into an observation group and a control group, with 35 cases in each group. The control group was given rhG-CSF, and the observation group was given additional moxa-stick moxibustion on the basis of rhG-CSF. Both groups were treated for 2 chemotherapy cycles, totally 6 weeks. The number of patients with infection, the duration of infection and the duration of continuous use of antibiotics were observed. The leukocytes and granulocytes counts, the levels of tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ) were measured before and after treatment, and the levels of CD4, CD8 and natural killer (NK) cells were analyzed. Results: The infection rate of the observation group was significantly lower than that of the control group (P<0.05), and the duration of infection and the duration of continuous use of antibiotics were also shorter (P<0.05). After treatment, the leukocytes and granulocytes counts in the two groups were higher than those before treatment (all P<0.05). After treatment, the levels of TNF-α and IFN-γ of the patients in the two groups were improved (all P<0.05), and there were significant differences between the observation group and the control group (P<0.05). After treatment, the numbers of CD4, CD8, and NK cells in the observation group increased significantly (all P<0.05), but the changes in the control group were not significant (P>0.05). Conclusion: Moxa-stick moxibustion plus rhG-CSF can significantly reduce the incidence and severity of chemotherapy infection in gastric cancer, increase the leukocytes and granulocytes counts, and regulate the levels of inflammatory factors, which may be related to the improvement of the immune function of the patients.

Clinical study on Jin's three-needle therapy for post-stroke cognitive impairment / 针灸推拿医学（英文版）

Objective: To observe the clinical efficacy of Jin's three-needle therapy on post-stroke cognitive impairment (PSCI) and the effect on neuroelectrophysiology (event-related potentials). Methods: A total of 60 PSCI patients were selected and divided into a treatment group and a control group according to the method of random number table, with 30 cases in each group. The patients in the control group received routine treatment while the patients in the treatment group received additional Jin's three-needle therapy. The treatment for both groups lasted four weeks. Mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) scores as well as amplitude and latency of potential 300 (P300) were adopted to compare the between-group results before and after treatment. Results: Before treatment, there were no significant differences (all P>0.05) in MMSE and MoCA scores, P300 latency and P300 amplitude between the two groups. After 4 weeks of treatment, the MMSE and MoCA scores and P300 amplitudes were improved in both groups, and the P300 latencies became shorter. The results showed significant intra-group and between-group differences (all P<0.05). Conclusion: Based on the routine treatment, Jin's three-needle therapy is effective for PSCI. The mechanism is probably through its regulation on the patients' neuroelectrophysiology.

Neurophobia among family medicine specialist trainees in Malaysia

@#Background: Neurophobia is defined as the fear of neural sciences and clinical neurology. Our study aims to determine the prevalence and factors associated with neurophobia among family medicine specialist trainees in Malaysia. Methods: A cross-sectional study was conducted among family medicine specialist trainees. Multiple logistic regression analysis was used to determine the factors associated with neurophobia. Results: A total of 415 subjects were enrolled into this study. The prevalence of neurophobia was 66% (n=274/415). In multivariate logistic regression analysis, having poor knowledge in neurology (odds ratio [OR] 3.85, 95% confidence interval [CI] 1.87-7.94), those with self-declared phobia toward neurology or neuroscience subject (OR 2.56 95% CI 1.30-5.03); those whose practice were in government sector (OR 1.78, 95% CI 1.09-2.88); those who perceived basic neuroscience (OR 1.95, 95% CI 1.03-3.67) and the complex clinical examination were important (OR 2.10, 95% CI 1.19-3.72); and those who perceived textbooks were not a useful method of learning (OR 1.78, 95% CI 1.05-3.02) were more prone to have neurophobia. Conclusion: Two-thirds of family medicine specialist trainees in Malaysia found neurology a difficult subject. Among the factors associated with neurophobia were those with poor knowledge in neurology, and those who self-declared to have phobia toward neurology or neuroscience subject.

Relationship between Toxoplasma gondii infection and dysfunctional diseases of the hippocampus / 西安交通大学学报(医学版)

The hippocampus, a crucial structure for neuronal plastic response, participates in various aspects of higher function of the brain. Toxoplasma gondii is prevalent in humans and seropositivity of toxoplasma is estimated to be more than 30% in the world. This review summarizes the recent findings on the role of toxoplasma infection in hippocampus-dysfunctional diseases with an emphasis on the underlying mechanisms. Those hippocampus-dysfunctional diseases include epilepsy, schizophrenia, cognitive disorder, and depression. Also, this review discusses the potential problems or limitations of previous studies on this subject, and at the same time raises novel strategies for treating hippocampus-dysfunctional diseases, especially cryptogenic or treatment-resistant diseases.

Study on the relationship between career anchor and career orientation of doctors in Sir Run Run Shaw Hospital / 中华医院管理杂志

Objective@#To use the career anchor scale to understand the career development route preference of doctors, so as to provide a reference for their individual career planning and positioning, encourage them to realize their personal value, and provide scientific decision-making basis for hospital human resource management.@*Methods@#The career anchor scale was used and a career orientation scale was established. In June 2017, a group sampling survey was conducted among doctors at a university affiliated hospital in Zhejiang province, and 790 valid questionnaires were collected. The questionnaire covered 40 items, with the self-report 6 subscale and the χ2 test used for comparison of rates.@*Results@#Eight types of career anchors were commonly distributed among doctors, among which the technical/functional anchor was the main career anchor, scoring 24.45±5.11 points. There was a correlation between doctors′ career anchors and their career orientations, among which the managerial career anchors scored the highest, with a correlation coefficient of 0.228.@*Conclusions@#The career anchor theory can be used to guide the career development of employees and establish a multi-career development ladder for doctors.

Effect of minimally invasive techniques for removing impacted wisdom teeth on local inflammatory response and pain / 局解手术学杂志

Objective To explore the effect of minimally invasive techniques for removing impacted wisdom teeth on local inflammation and pain. Methods A total of 110 patients with impacted wisdom teeth removed in our department from June 2016 to February 2018 were divided into observation group(55 cases,minimally invasive removal) and control group (55 cases, traditional chisel) according to the surgical method. The operative status, the inflammatory mediators and pain mediators in the gingival sulcus before and after the treatment, and the therapeutic effects of the two groups were compared. Results The operative time of the observation group was shorter than that of the control group,the intraoperative blood loss was less than that in the control group, the differences were significant(P ＜ 0. 05). The levels of PTX3, cells in the gingival sulcus adhesion of cytokine 1 (ICAM1),peroxidase (MPO),prostaglandin E2 (PGE2) levels,pain mediator 5-hydroxytryptamine(5-HT), calcitonin gene-related peptide(CGRP), substance P(SP), galanin(Gla) and adenosine triphosphate(ATP) in the observation group after treatment was lower than those in the control group, the differences were significant(P ＜ 0. 05); The degree of mouth opening restriction, facial swelling and visual analog scale score(VAS) in the observation group were lower than those in the control group, the differences were significant(P ＜ 0. 05). Conclusion Compared with traditional chisel in extraction of impacted wisdom teeth, the minimally invasive wisdom tooth extraction can relieve the inflammatory response and pain sensation of patients,and the clinical treatment effect is significant.

Controlled ovarian stimulation protocols in endometriosis patients: with antagonist or agonist? / 浙江大学学报·医学版

OBJECTIVE@#To compare laboratory and clinical outcomes of fertilization-embryo transfer (IVF-ET) in patients with endometriosis using antagonist protocol, long agonist protocol or prolonged agonist protocol.@*METHODS@#Totally 313 patients with endometriosis were recruited in Reproductive Centers of the Second Affiliated Hospital of Zhejiang University School of Medicine,Jiaxing Women and Children's Hospital,and Ningbo Women and Children's Hospital from April 2017 to October 2018, including 81 patients treated with antagonist protocol (antagonist group), 148 treated with long agonist protocol (long agonist group) and 84 treated with prolonged agonist protocol (prolonged agonist group). The clinical and laboratory data of the patients were retrospectively analyzed to investigate the effect of ovarian stimulation protocols on the IVF-ET outcomes of patients with endometriosis.@*RESULTS@#The average age in the antagonist group patients was significantly higher than those in the other two groups (all 0.05). Fertilization rate and available embryo rate were comparable among the three groups (all >0.05). Considering analysis per cycle with embryo transfer, the human chorionic gonadotrophin (HCG) positive rate, clinical pregnancy rate and total implantation rate showed no significant difference among the three groups (all >0.05). The implantation rate after fresh embryo transfer in the antagonist group was lower than that in the long agonist group (0.05). While the implantation rate of freeze-thaw embryo transfer showed a higher trend in the antagonist group, but there was no significant difference (>0.05). The patients were further divided into diminished and normal ovarian reserve subgroups, the per cycle with embryo transfer, the HCG positive rate, clinical pregnancy rate and total implantation rate still showed no significant difference between two subgroups (all >0.05), no matter in which ovarian stimulation protocol groups. Besides, in women with diminished ovarian reserve, the available embryo rate in antagonist group was significantly higher than that in the long agonist group (<0.05). The amount and duration of Gn application in antagonist group were significantly lower than those in long and prolonged agonist groups (all <0.05).@*CONCLUSIONS@#Patients with endometriosis who used the antagonist protocol in IVF procedure could reduce the cost and time of Gn treatment, when combined with frozen-embryo transfer strategy the antagonist protocol has comparable clinical pregnancy outcome with long or prolonged agonist protocol, especially in those with diminished ovarian reserve, the higher available embryo rate can be achieved.

Rational use of medications and risk assessment during lactation / 中华围产医学杂志

Pregnant and breastfeeding women are perhaps "the last true therapeutic orphans". Due to dearth of adequate research on certain medications and healthcare providers' poor knowledge of lactational pharmacology, nursing mothers are often ill-advised to give up breastfeeding or unlikely to receive appropriate treatment. Accumulating evidence-based data have shown that most medications are safe for nursing mothers. Besides safety concerns, infant's condition and maternal attitude should also be considered when making treatment decisions. Clear understanding of lactational pharmacology and risk assessment tools in breastfed infants would be beneficial to meet the medical needs of nursing mothers and promote breastfeeding.

Systemic pathologic physiology parameters changes in sheep drowning: a control study in freshwater and seawater / 中华危重病急救医学

Objective To compare the systemic pathologic physiology parameter changes in sheep drowning in freshwater and seawater. Methods The experimental animals were healthy crossbred sheep. According to the envelope method, 24 sheep were randomly divided into two groups, with 12 animals in each group. The animals in both groups were subjected to mechanical ventilation and analgesia and sedation, the drowning models were reproduced by injecting 10-25 mL/kg of seawater or freshwater into the endotracheal tube of animals. The changes in hemodynamics before drowning, immediately after drowning (immediately after water injection) and 30, 60, and 120 minutes after drowning in both groups were recorded. The urine color changes after drowning and occurrence time were recorded. The animals were sacrificed at 120 minutes after drowning, and heart, kidney, liver, spleen and intestine were harvested for pathological observation under light microscope using hematoxylin and eosin (HE) staining. Results ① The changes in systemic hemodynamic: there was no significant difference in hemodynamics before drowning between the two groups.Compared with before drowning, heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), left ventricular maximum systolic force index (dPmax), and pulmonary wedge pressure (PAWP) immediately after drowning in both seawater and freshwater groups were significantly increased, which showed a decrease tendency with drowning time prolongation. Compared with drowning immediately, dPmax at 30 minutes after freshwater drowning was significantly decreased (mmHg/s: 919.83±14.51 vs. 2 628.42±59.75, P < 0.01), which was below the level before drowning till 120 minutes. CO at 30 minutes after freshwater drowning was retreated as compared with drowning immediately, but it was still higher than that before drowning (L/min: 8.25±0.66 vs. 5.75±0.73, P < 0.01). Global end-diastolic volume (GEDV) and PAWP at 120 minutes after freshwater drowning were decreased to the level before drowning [GEDV (mL): 642.92±7.29 vs. 638.25±7.00, PAWP (mmHg, 1 mmHg = 0.133 kPa): 5.83±1.19 vs. 5.42±1.08, both P > 0.05]. Compared with immediately after drowning, MAP, CO and PAWP at 30 minutes after seawater drowning were significantly lowered [MAP (mmHg): 90.50±3.58 vs. 159.42±3.18, CO (L/min): 2.37±0.45 vs. 10.33±0.73, PAWP (mmHg): 4.17±0.72 vs. 11.75±1.82, all P < 0.01], which were lower than those before drowning till 120 minutes. After drowning for 30 minutes, MAP, CO and PAWP in seawater group were significantly lower than those in freshwater group [MAP (mmHg): 90.50±3.58 vs. 117.42±1.78, CO (L/min): 2.37±0.45 vs. 8.25±0.66, PAWP (mmHg): 4.17±0.72 vs. 24.83±1.27], dPmax was significantly increased (mmHg/s: 1 251.42±62.50 vs. 919.83±14.51, all P < 0.01), and the tendency continued till 120 minutes. There was no significant difference in HR at all the time points between the two groups. ② The changes in urine: after freshwater drowning, the animals had hemoglobinuria and lasted until the end of the experiment, and the time of hemoglobinuria occurrence was at 20-35 minutes after drowning with an average of (25.30±5.15) minutes. After seawater drowning, the change in urine was not found until the end of the experiment.③ The variations of each organ tissue in pathology and hematology at 120 minutes after drowning: after freshwater drowning, the systemic tissue edema was found in organs such as heart, kidney, liver, spleen, and small intestine. After seawater drowning, there were different degrees of edema in the systemic organs, and some of them shrank. Conclusions After freshwater drowning, the animals showed decreased dPmax, increased CO and blood volume, edema and hemolysis of the tissue cells. After seawater drowning, CO and blood volume decreased, and some tissue cells were in atrophy.