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Objective To investigate the effectiveness and rationality of objective structured clinical examination (OSCE) used as achievement assessment for Postgraduate Year 1 surgery residents.Then the form and content of training and examination can be improved according to test results.Methods 31 Postgraduate Year 1 surgery residents were involved in the examination.The examination was composed of 5 stations,which were case analysis,wound dressing change,plaster fixation,laparoscopic simulator basic skills and irregular wound debridement suture.Each station was evaluated by centesimal system score and limited in 15 minutes.A questionnaire on their opinion and perception of the examination was given to each resident at the end of examination.A total number of 31 questionnaires were issued and recycled.The difficulty,discrimination and reliability of each station were calculated,and the correlation between each station was analyzed.Results The average OSCE score was (74.66 ± 4.39).The difficulty of total stations was 0.747.The distinction was 0.578 and the reliability was 0.402.The second station was lowest difficulty,and the fifth station was most difficult.Every station's discrimination was larger than 0.400.The reliability of the second and the fourth station was low.There was moderate correlation between the first station and the second station,as well as the first station and the fourth station.But there was no significant correlation between other stations.Residents' questionnaire survey showed that the fourth and the fifth stations were considered as the most difficult,and the second station was the simplest.They thought the fourth was most helpful for clinic.They performed best at the second station and worst at the fifth station.Conclusions OSCE can effectively evaluate the efficacy of the resident training.The residents' practical competency skills can be assessed better by examination simulating complex clinical scenario.Besides,after examination,we need to objectively evaluate the assessment efficiency,and dynamically adjust the training content and examination form according to residents' subjective opinions.
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The article summarized the workflow of instructional design by using ADDIE model.The model is a recirculation of assessment,design,development,implementation and evaluation,by which the quality of education can be improved continuously.After the initial assessment it was found that the model can basically reach the general goal for training the junior doctors.For the problem of residents' irregular study and great difference of individual clinical skills,some suggestions for improvement were made.It included adjusting the time and content of training,individualized teaching,reforming examination form and increasing objective measurement to assess the effectiveness of training.All of them can effectively improve the effectiveness of basic surgical training in surgical school.
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Objective To explore the association between perioperative glycemic control and the post-operative complications of patients undergoing pancreatic surgery. Method The clinical data of 412 patients who underwent pancreatoduodenectomy between January 1995 and April 2010 were retrospectively analyzed. Results The average fasting glycemic level was significantly higher than normal postoperatively, and the post-operative application of insulin effectively controlled glycemic levels. The rates of postoperative mortality, pancreatic fistula,hemorrhage, and infections among patients with glucose level > 8. 3 mmol/L (7.0% , 23.7% , 9.7% , and 15. 1 % ) were significantly higher than those with glucose level ≤8. 3 mmol/L (2. 7% , 11. 9% , 4. 0% , and 6.6%) (P=0.037, P=0.002, P = 0.020, and P=0.005). On the contrary, the rates of postoperative mortality and hemorrhage among patients with glucose level≤6. 1 mmol/L (6. 2% and 8. 6% ) were significantly higher than those with glucose level between 6. 1 and 8. 3 mmol/L (0. 7% and 1.4% ) (P = 0. 023 and P = 0. 011).The rate of hypoglycemia was significantly higher in patients with glucose level ≤6. 1 mmol/L (7. 4% vs. 0. 7% ,P = 0. 009). Conclusions Postoperative glucose level can be stably controlled by continuous intravenous glucose infusion plus regular insulin therapy. A target perioperative glucose level between 6. 1 and 8. 3 mmol/L can effectively and safely reduce postoperative mortality and complications.
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Objective To investigate the expression and regulation of FGFR1 protein and mRNA in human pancreatic cancer cell lines.Methods The expressions of FGFR1 protein and mRNA in pancreatic cancer cells were tested by Western blot,Northern blot and RT-PCR.The effects of exogenous growth factors and tyrosine kinase inhibitors on expression of FGFR1 protein and mRNA was observed.Results FGFR1 protein and mRNA expressed in 7 pancreatic cancer cell lines in different levels.After stimulation of several exogenous growth factors,we found that IGF-1,EGF and FGF2 up-regulated the expression of FGFR1 in Mia PaCa-2 significantly;EGF and FGF2 up-regulated the expression of FGFR1 in PANC-1 significantly (P＜0.05).The effect of FGF2 on the expression of FGFR1 was in time-dependent manner.ERK1/2 special inhibitor UO126 and p38 MAPK special inhibitor SB203580 down-regulated the expression of FGFR1.Conclusion Expression of FGFR1 is up-regulated by growth factors and may be modulated through ERK1/2 and p38 MAPK signal transduction pathway.
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Objective To assess the long-term survival and prognosfie factors in a series of patients with distal bile duet carcinoma. Methods A retrospective clinical analysis was made on 76 cases of distal bile duct cancer who were admitted into our hospital from January 1996 to December 2006. Clinicopathologic factors with possible prognostic significanees were selected and analyzed. Survival was calculated with the Kaplan-Meier method. A multivariate analysis of these individuals was performed using the Cox proportional Hazards Model. Results There were 46 males and 30 females. The age ranged from 21 to 88 years with a mean of 65.21 patients received palliative surgery including, bypass procedure, intraoperative biliary stenting, or percutaneous transhepatie biliary drainage. Radical resection was performed on 42 cases and the 1-, 3- and 5-yeur survival rates were 88.0%, 41.3% and 29.2% respectively. 38 cases died of liver metastasis or recurrence. In multivariate analysis, surgical procedure (P = 0.006) and liver metastasis (P = 0.008), but not sex, age, invasion of pancreas, invasion of duodenum, diameter or differentiation of tumor, were significant independent prognostic factors. Conclusions Radical resection is only curative treatment modality. Prevention on postoperative liver metastasis is essential for improving survival.
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Objective To study the role of Ⅲb isoform of human fibroblast growth factor receptor 1 (FGFR1-Ⅲb) in PANC-1 pancreatic cancer cells. Methods The plasmid of human full-length FGFR1-Ⅲb isoform，pSVK4/FGFR1-Ⅲb, was stable transfected into cultured PNAC-1 pancreatic cancer cell lines facilitated by lipofectamine. The function of FGFR1-Ⅲb in transfected pancreatic cancer cells were examined by MTT assay, soft agar assay, cell migration assay, single cell movement assay, In vivo tumorigenicity assay. Results The basal anchorage-dependent and -independent cell growth was significantly inhibited. Additionally, FGFR1-Ⅲb expression inhibited single cell movement and in vitro invasion as determined by time-lapse microscopy and boyden chamber assay as well as in vivo tumor formation and growth in nude mice. Microscopic analysis of the xenograft tumors revealed a reduced Ki-67 labelling, lower amount of tumor necrosis and higher grade of differentiation in FGFR1-Ⅲb expressing tumors. Conclusion We identified a functional human FGFR mRNA splice variant that inhibits the transforming potential of pancreatic cancer cells.
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Objective To test the expression of cyclooxygenase 2 (COX 2) gene in colorectal adenomas, cancers in contrast to that of normal mucosa.[WT5”HZ] Methods [WT5”BZ] With reference to the expression of ? actin gene, the expression of COX 2 mRNA was examined in colorectal adenomas from 10 patients, cancerous tissues and adjacent noncancerous mucosa from 30 patients by reverse transcription polymerase chain reaction (RT PCR). Quantitation of relative band densities was performed using densitometry scanning techniques.[WT5”HZ] Result [WT5”BZ] Strong expression of COX 2 mRNA was detected in ninety percent of cancers with range of 0 02～0 85 (median 0 5). The difference of expression of COX 2 mRNA between cancers and normal mucosa or adenomas was significant (rank sum test, P
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Objective To investigate the correlation between VEGF-C and COX-2 expression in human rectal cancers and its significance in cancer metastasis. Methods VEGF-C expression was detected with Western blot in LOVO cells treated with NS-398 or PGE2. VEGF-C and COX-2 expression in 45 rectal adenocarcinomas was tested with immunohistochemistry. Results NS-398 inhibited the VEGF-C expression, and PGE2 up-regulated the expression of VEGF-C in a dosage-dependent way in LOVO cells. VEGF-C expression was significantly higher in adenocarcinomas with lymph node metastasis, and was related with the expression of COX-2 in 45 rectal adenocarcinomas. Conclusion COX-2 up-regulates VEGF-C and VEGF-C plays an important role in lymphatic metastasis of rectal cancers.