Application of mixed assessment of competence of general practitioners in Shanghai suburban communities / 中华全科医师杂志

A pilot mixed assessment method was used to evaluate the clinical and teaching ability of general practitioners (GPs) in a suburban district of Shanghai. In December 2018, 29 GPs from 20 community health centers in a suburban district of Shanghai were assessed by a mixed method consisting of 3 domains and 8 stations for one day. The average age of GPs was (37.8±4.7) years and 22 were females (75.9%). In 3 domains, the average score (66.8±9.7) and qualified rate (75.9%) of clinical thinking abilities were the lowest. In 8 stations, the average score [(53.8+13.4) points] and qualified rate (34.5%) of adult SOAP medical record writing station were the lowest. The average score of pediatric outpatients consult station of GPs with<15 years of community work experience was higher than that of GPs with >15 years of work experience [(68.6+10.2) vs. (58.5+9.4), t=2.787, P<0.05]. There was no significant difference in the scores among GPs with different teaching years and titles. The average scores of clinical thinking ability domain ( t=2.115) and adult outpatient consult station ( t=3.410); in the clinical operation ability domain the ophthalmoscopy and readings ( t=3.816) and otoscopy and reporting station ( t=2.286); clinical teaching abilities ( t=2.618) and simulated educational situation station ( t=2.452) and mini lectures station ( t=2.802) of GPs in the community teaching base were higher than those in non-community teaching base (all P<0.05). Mixed assessment method can be used as one of the important means for GPs′ ability assessment. The community teaching bases have effectively improved the clinical and teaching abilities of GPs in suburban areas, however, the clinical thinking abilities of them are still weak.

Teaching clinic for training of general practitioners in suburban of a Shanghai community / 中华全科医师杂志

In order to improve the quality of clinical teaching, Xidu Community Health Service Center of Shanghai Fengxian District established a teaching clinic for training of general practitioners in 2015. The clinic served as a suburban teaching station of Department of General Practice of Zhongshan Hospital, a tertiary university hospital. This article introduces the implementation methods, achievements, practical experiences and work prospects of the clinic. The issues of system evaluation and the generalization of this teaching model for training of general practitioners are also discussed in the article.

Teaching clinic for training of general practitioners in suburban of a Shanghai community / 中华全科医师杂志

In order to improve the quality of clinical teaching, Xidu Community Health Service Center of Shanghai Fengxian District established a teaching clinic for training of general practitioners in 2015. The clinic served as a suburban teaching station of Department of General Practice of Zhongshan Hospital, a tertiary university hospital. This article introduces the implementation methods, achievements, practical experiences and work prospects of the clinic. The issues of system evaluation and the generalization of this teaching model for training of general practitioners are also discussed in the article.

Application of OSTE in teaching competence assessment for general practice preceptors in community training bases / 中华全科医师杂志

Objective To apply objective structured teaching evaluation (OSTE) in teaching competence assessment for general practice preceptors in community training bases.Methods The teaching competency was assessed with OSTE for 28 general practice preceptors in Fengxian District of Shanghai in December 2017.The application of OSTE was evaluated with questionnaire among preceptors,examiners and standardized students(SS).Results Among 28 preceptors there were 23 females (82.1％),with an average age of (37.3±4.2) years.The average teaching duration was (2.8±2.1) years.In the five OSTE station,the highest total score was (88.1 ±2.7) points in the first station self-presentation,while the lowest was (70.8± 14.5) points of the second part physical examination feedback of the third station ambulatory care teaching.The total score in the fifth station (doctor-patient communication teaching) of participants with＜ 15 years of community practice was higher than those ≥15 years of community practice [(80.1±8.5) vs.(71.6± 7.1),t=2.092,P=0.007].Except"being able to adapt to this form of evaluation",the proportions of choosing "very good"were all more than 50％ in other 4 aspects.The overall willingness of "recommending OSTE as the main method to evaluate the teaching competence of GP trainers" was higher in examiners and SS than that inpreceptors (Z=2.836,P=0.005).Conclusion The innovative approach of OSTE has been widely recognized,but the professional capability,the cognition of general practice,the teaching competence and the willingness to use OSTE need to be strengthened for general practice receptors in community bases.

Application value of totally laparoscopic transabdominal-hiatal approach in the radical resection of Siewert type Ⅱ adenocarcinoma of esophagogastric junction / 中华消化外科杂志

Objective To investigate the safety and feasibility of totally laparoscopic transabdominalhiatal approach in the treatment of Siewert type Ⅱ adenocarcinoma of esophagogastric junction (AEG).Methods The retrospective and descriptive study was conducted.The clinicopathological data of 11 patients with Siewert type Ⅱ AEG who were admitted to Affiliated Hangzhou First People's Hospital of Zhejiang University School of Medicine from May 2017 to July 2018 were collected.There were 8 males and 3 females,aged 56-72 years,with an average age of 63 years.Patients underwent radical resection of AEG by totally laparoscopic transabdominalhiatal approach.Observation indicators:(1) surgical situations and postoperative recovery;(2) postoperative pathological examination;(3) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative adjuvant chemotherapy,complications,food intake,anastomosis patency,tumor recurrence and metastasis,and survival up to December 2018.Measurement data with normal distribution were presented as Mean±SD,measurement data with skewed distribution were presented as M (range),and count data were represented as absolute number or percentage.Results (1) Surgical situations and postoperative recovery:all the patients underwent totally laparoscopic radical resection of Siewert type Ⅱ AEG by transabdominal-hiatal approach,without conversion to open surgery or perioperative death.Of the 11 patients,8 underwent total gastrectony including 3 combined with splenic hilar lymph node dissection and 3 underwent proximal gastrectomy with double-tract reconstruction.Operation time,time of superior overlap esophagojejunostomy,volume of intraoperative blood loss,time for initial out-of-bed activities,time to first flatus,time to initial liquid diet intake,time of drainage tube removal were respectively (245± 39)minutes,(60± 12) minutes,(75±23) mL,(24± 8) hours,(2.4± 0.5) days,(3.5 ± 0.8) days,(8.2 ± 1.3) days respectively.There was no serious complication including postoperative hemorrhage,anatomotic fistula or death.Three patients had left pleural effusion,and were cured after thoracic drainage.The duration of postoperative hospital stay was (11.0±3.0) days.(2) Postoperative pathological examination:all the 11 patients had negative upper surgical margin.The length of proximal margin,tumor diameter,total number of lymph lodes harvested,and number of lower mediastinal lymph lodes harvested were (2.1 ±0.2) cm,(2.6±0.9) cm,(36.0±4.0)/case and (2.3± 0.8)/case.Pathological examination showed adenocarcinoma in all the 11 patients.pTNM staging:2 cases were in stage Ⅰ B,4 cases in stage Ⅱ A,3 cases in stage Ⅱ B and 2 cases in stage Ⅲ A.(3) Follow-up and survival situations:11 patients were follow-up for 6-19 months,with a median time of 9 months.Chemotherapy regimeus were formulated according to the pathological examination.Nine patients received postoperative adjuvant chemotherapy,and 2 in stage Ⅱ B received no postoperative adjuvant chemotherapy.During the follow-up,11 patients had no obvious reflux symptom or choking feeling,and the anastomosis was patent as evaluated by oral contrast agent and gastroscopy.There was no tumor recurrence and metastasis or death in the 11 patients.Conclusion Totally laparoscopic transabdominal-hiatal approach applied in the radical resection is safe and feasible for the treatment of Siewert type Ⅱ AEG,with good short-term outcomes.

Application value of duodenum double lumen cannula suction in the duodenal rupture repair / 中国基层医药

Objective To investigate the clinical value of the duodenum double lumen cannula suction in duodenal rupture repair.Methods According to the operation methods,60 patients with duodenal rupture undergoing duodenal repair were divided into the surgical drainage alone group(26 cases)and double sets attract tube group (34 cases).The surgery effect and complications were observed.Results The difference of traffic flow 7 days after the operation between the two groups was statistically significant(t =7.564,P <0.05).The length of stay and hospital costs of the surgical drainage alone group were more than those of the double sets attract tube group,the differences were statistically significant(t =3.567,4.123,all P <0.05).The fistula,intra -abdominal infections,wound infec-tions,pulmonary infection rates of the surgical drainage alone group were 30.77%,42.31%,46.15%,26.92%, which were higher than 2.94%,11.76%,8.82%,2.94%,5.88% of the double sets attract tube group,the differ-ences were statistically significant(χ2 =8.949,7.330,10.950,2.986,5.116,all P <0.05).Conclusion Applica-tion of the double lumen cannula duodenal suction in duodenal rupture repair can significantly reduce the incidence of postoperative complications,has certain security,it is recommended in clinical practice.

Hypertension intervention program organized by tertiary hospitals with community health centers / 中华全科医师杂志

Five hundred and nineteen patients with essential hypertension from 6 community health centers in Baoshan Distract of Shanghai were enrolled in the program,all patients received direct or indirect comprehensive interventions.These interventions were conducted by doctors from tertiary hospitals and community health serwice centers.Among these hyperpietic,462 patients were followed-up for 1 year.After interventions,the awareness rate of hypertension was significantly increased,unhealthy life styles were changed; blood pressure control rate and risk factors control rate were also increased; carotid-femoral artery pulse wave velocity and carotid-radial artery pulse wave velocity were decreased (P ＜ 0.01 or P ＜ 0.05).The results indicate that comprehensive interventions organized by tertiary hospitals with community health centers are effectivc in managcmcnt of hypcrtension.

Study on femoral 3D reconstruction and computer aid low-temperature deposition manufacturing / 生物医学工程学杂志

Serious femoral damages are a common human bone disease. Rebuilding the femur and studying its mechanical properties are a continuous medical research topic, but traditional femoral prosthesis often cause some problems such as prosthesis loosening. In this work, we selected a healthy male, took his femur scanning by CT, and rebuilt high-precision femur prototypes by Mimics10.0 software, then chose the material having good biocompatibility and biodegradable, utilizing low-temperature deposition manufacturing (LDM) technology for the femoral manufacturing. This approach, fabricating the femur via LDM technology, laid a foundation for the later research on the femoral implantation in the human body.

Study on computer-aided deposition manufacturing of vascular tissue engineering scaffolds at low temperature / 生物医学工程学杂志

Since there is a clinical need for the tissue-engineered vascular graft (TEVG), fabricating the vascular scaffold individually appears to be necessary. In this work, we have developed the traditional tubular scaffold and branch vascular scaffold utilizing low-temperature deposition manufacturing (LDM) technology. Then different tubular scaffolds were fabricated by changing the processing parameters, and the morphological properties of the scaffolds were assessed. The scaffolds reproduced the structure of 3D vascular model accurately. Wall thickness of the scaffold increased with the increase of velocity ratio (V(L)/V(s)) and nozzle temperature, and both the micropore size and wall roughness were positively correlated with the nozzle temperature. However, the porosity was barely affected by the nozzle temperature. This approach, fabricating vascular scaffold with special structure and appearance features via LDM technology, is potential for the individual fabrication of vascular scaffold.

Design of a three-dimensionally controlled multi-cell-assembly system based on the control of a mixer nozzle / 生物医学工程学杂志

Three-dimensionally controlled cell-assembly technique makes fabricating tissues and organs in vitro to be possible. However, for real tissues and organs with complex structure and various cells, fabricating tissues and organs in vitro need a technique that could assemble and locate multi cells and materials precisely in the space. Facing the needs of multi-cell assembly, we designed a mixer nozzle and the matching pulse switching circuit which based on the single-nozzle cell assembly system, and developed a multi-cell-assembly system. We also carried out some assembly experiments with this system using materials that were similar to the multi-component extracellular matrix materials. The results demonstrated that the system could assemble various cells and materials into three-dimensional inhomogeneous structures precisely.

Baicalin protects thymus of rats with severe acute pancreatitis.

To study the protective role of Baicalin on rats thymus with severe acute pancreatitis (SAP). The SAP rats were randomly assigned to the model control, Baicalin treated and Octreotide treated groups. Normal rats were assigned to the sham-operated group. The rat survival rates, pathological changes of thymus, apoptotic indexes and expression levels of NF-kappaB, Bax, Bcl-2, Caspase-3 and P-selectin of all groups were observed and recorded at 3, 6 and 12 h after operation, respectively. Rat survival rates were significantly higher in both Baicalin- and Octreotide-treated groups than those in the model control group at 12 h (P < 0.05). The thymus pathological score was significantly lower in Baicalin treated group than in control group at 3 and 12 h (P < 0.05). The expression of NF-kappaB, Bax and Bcl-2 in thymus tissue was negative in all groups. At 3 h after operation, the staining intensity, positive staining rate and intensity of Caspase-3 protein in the thymuses of the Baicalin treated group were significantly higher than those in the model control group (P < 0.01). At different time points after operation, no marked difference was observed in the staining intensity of P-selectin protein between the Baicalin treated group and the model control group (P > 0.05). At 6 h after operation, the positive staining rate and intensity of P-selectin protein in the Baicalin treated group was significantly lower than those in the model control group (P < 0.05). The apoptotic indexes were significantly higher in treated group than in model control group at 6 h (P < 0.05). Baicalin has a protective role on the thymus of SAP rats, and its effect of decreasing inflammatory mediators level in blood, inhibiting P-selectin expression and inducing apoptosis of thymocytes may involve in the mechanism of its protective role.

Effects of Salvia miltiorrhizae on ICAM-1, TLR4, NF-kappaB and Bax proteins expression in multiple organs of rats with severe acute pancreatitis or obstructive jaundice.

To observe the protective effects of Salvia miltiorrhizae injection on multiple organs of rats with SAP or OJ. Two hundred eighty-eight rats were used for SAP-associated experiments and OJ-associated experiments. The rats were randomly divided into sham-operated, model control and treated group. According to the different time points after operation, the SAP rats in each group were subdivided into 3, 6 and 12 h groups while the OJ rats were divided into 7, 14, 21 and 28 days groups. The mortality rates, pathological changes and ICAM-1 (only in lung), TLR4 (only in liver), Bax and NF-kappaB proteins expression in multiple organs (liver, kidney, lung, intestinal mucosa, spleen, thymus and lymph nodes) were observed, respectively. The mortality rates of treated groups decreased in both SAP and OJ experiments. Compared to model control group, the pathological changes can be seen in treated groups including; (1) the pathological changes of multiple organs in SAP and OJ experiments were improved, the pathological severity scores of kidney (at 6 h), intestinal mucosa (at 12 h), spleen (at 6 and 12 h), thymus (at 3 and 6 h) and lymph nodes (at 3 and 6 h) in SAP experiment and of liver (on 21 and 28 days), lung (21 days), intestinal mucosa (on 21 and 28 days) and spleen (on 21 and 28 days) in OJ experiment significantly declined (P < 0.05 or P < 0.01); (2) the positive rate of Bax protein in pancreas (at 3 h) and liver (on 6 and 12 h) in SAP experiment and in liver (on 28 days), kidney (on 21 days), and thymus (on 28 days) in OJ experiment were significantly lower (P < 0.05 or P < 0.01); (3) the positive rate of NF-kappaB in liver (at 12 h) and kidney (at 6 h) in SAP experiment and in liver (on 21 days), kidney (on 28 days), intestinal mucosa (on 28 days) and thymus (on 14 days) in OJ experiment significantly decreased (P < 0.05). (4) the positive rate of ICAM-1 in lungs (at 12 h) in SAP experiment was significantly less (P < 0.05). Salvia miltiorrhizae injection can protect multiple organs of SAP or OJ rats and inhibit the expression of ICAM-1, TLR4, NF-kappaB and regulate Bax proteins. Salvia miltiorrhizae may relieve the inflammation response and enhance the immunity function of SAP and OJ rats.