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Objective:To explore the application value of objective structured radiology examination (OSRE) in clinical skills assessment of medical imaging technology, and evaluate the repeatability of the assessment tool.Methods:A total of 55 interns majoring in medical imaging technology were randomly divided into 11 groups (5 in each group), and 9 different cases of OSRE were designed. Each student had to complete 3 cases of OSRE. Five senior attending doctors or deputy chief physicians independently evaluated each case of OSRE. Two months after the internship, three cases of OSRE were randomly selected for scoring to evaluate the internal consistency between raters and the repeatability of the evaluation method. SPSS 16.0 was used for statistical analysis, and multiple linear regression was used to analyze the correlation between academic qualifications and OSRE scores.Results:The OSRE average score of all the students was (12.0±4.9), and the average ICC range between evaluators was 0.36 to 0.80 ( P < 0.001). The consistency of 6 cases was good, that of case 3 was poor, and that of cases 6 and 7 was moderate. After 2 months, the ICC of 4 raters was equal to or greater than 0.8 (excellent consistency), and the ICC of rater 3 was 0.68, and the average original score difference ranged from -1 to 0.8. In multiple linear regression, the OR value of education was 0.90 (95% confidence interval 0.30-1.50, P = 0.01), and education was positively correlated with OSRE score. Conclusion:The OSRE aims to assess clinical skills and knowledge in a standardized clinical environment through the use of pre-set standard scoring scales, so that clinical knowledge can be evaluated in a high-level and repeatable manner.
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Objective:To summarize the experience of Bacillus Calmette-Guerin(BCG) in the treatment of bladder cancer secondary to renal transplantation.Methods:The clinical data of 5 patients who underwent BCG bladder irrigation after secondary bladder cancer after kidney transplantation in Tianjin First Central Hospital from January 2015 to December 2019 were analyzed. There were 1 male and 4 female cases. During the period of immunosuppression after transplantation, 1 case developed secondary high-level non-muscular invasive bladder cancer (NMIBC), 3 cases developed secondary low-grade NMIBC, and 1 case developed secondary glandular cystitis (4 cases). The mean age of the 5 patients with secondary bladder cancer was 59.7±4.0 years. Case one with high level NMIBC was treated with transurethral resection of bladder tumor (TURBT) and postoperative irrigation of epirubicin. Case 3 and 5 with low-level NMIBC accepted regular postoperative irrigation of gemcitabine. No irrigative therapy was performed in case 2. Bladder cancer recurred in case 1, 2, 3 and 5 after 20.1±9.7 months. TURBT was observed in all the 4 patients, among which 3 were of high grade NMIBC and 1 was of low grade NMIBC. Four patients were irrigated with BCG 2 weeks after operation. Postoperative pathology indicated low-level NMIBC in case 4, and BCG was irrigated 2 weeks after the operation. During perfusion therapy, immunosuppressive agents were continued.Results:During BCG perfusion, 4 of the 5 cases showed BCG related local inflammation, among which 2 cases presented symptoms of bladder irritation, 1 case presented hematuria, and 1 case presented hematuria with low fever. Patients with frequent urination, pain in urine, hematuria and other symptoms improved after drinking plenty of water, taking bed rest and taking levofloxacin (0.5g/ day ×7 days). Patients with low fever were treated with antipyretic treatment. No antituberculous agents were used prophylactically during BCG perfusion. There were no symptoms of tuberculosis infection or sepsis. The function of transplantated kidney was normal and no tendency of rejection. The 5 patients were followed up for 7-24 months, 1 patient was lost to follow-up after 7 months of BCG bladder perfusion, and no tumor recurrence or metastasis was found in 5 patients during the follow-up.Conclusions:The use of immunosuppressive agents does not reduce the biological activity of BCG, and BCG does not increase the risk of systemic toxicity or affect the function of transplanted kidneys in immunocompromised patients. BCG is a treatment option for bladder cancer secondary to renal transplantation.
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Objective:To evaluate the effect of film reading of the case based on flipped classroom in the teaching of medical imaging interns.Methods:Forty undergraduates majoring in medical imaging technology in Kangda College of Nanjing Medical University were selected as the research objects, and they were randomly divided into group A (experimental group) and group B (control group). The flipped classroom teaching of imaging performance of "basic chest lesions" was conducted respectively in the two groups, and group A conducted film reading of the case on the flipped classroom. The scores of written test and film reading of the two groups were compared, and the differences of students' subjective feelings were analyzed by questionnaires. SPSS 20.0 was used for chi-square test and t test. Results:The scores of written test and film reading in group A [(87.32±8.11) points and (85.54±5.23) points] were higher than those in group B [(81.20±9.76) points and (79.03±6.01) points], with statistical significance ( P<0.05). The seven subjective evaluations of group A were higher than those of group B, with statistical significance ( P<0.05). Conclusion:Film reading of the case based on flipped classroom can stimulate students' interest in learning and cultivate their clinical practice ability and critical thinking, which is an effective teaching mode.
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Objective:To evaluate the value of controlled low central venous pressure (CLCVP) in laparoscopic hepatectomy within an enhanced recovery after surgery (ERAS) programme.Methods:Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, of liver function Child-Pugh grade A, with New York Heart Association classⅠor Ⅱ, scheduled for elective laparoscopic hepatectomy with an expected surgery time 3-5 h, were divided into 2 groups ( n=30 each) using a random number table method: CLCVP-ERAS group (group CE) and routine ERAS group (group E). In group CE, the central venous pressure was maintained less than 5 cmH 2O through using restricted fluid replacement, adjusting the position, giving the vasodilator and etc.In group E, the central venous pressure was maintained at 5-12 cmH 2O.Arterial blood samples were then collected before operation and at 1 and 4 days after operation for determination of parameters of hepatic and renal functions.The volume of fluid infused before and after liver resection, total volume of intraoperative fluid infused, blood loss, blood transfusion, duration of surgery, postoperative time to first flatus, off-bed time, length of hospitalization and total cost of hospitalization were recorded. Results:Compared with group E, the volume of fluid infused before liver resection, total volume of intraoperative fluid infused, blood loss, and blood transfusion were significantly decreased, the volume of fluid infused after liver resection was increased, the duration of surgery, time to first flatus after operation, off-bed time and length of hospitalization were shortened, and the total cost of hospitalization was reduced ( P<0.05), and no significant change was found in the parameters of hepatic and renal functions in group CE ( P>0.05). Conclusion:CLCVP is helpful for the rapid recovery of patients without obvious adverse reactions when used for laparoscopic hepatectomy within an ERAS programme.
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Objective@#To investigate effect of the contact surface between the bridge and the adjacent teeth on the stress distribution of the implant and bone tissue and the displacement of the prosthesis in the cantilever fixed implant bridge restoring missing mandibular central incisors.@*Methods@#Two-dimensional images of the mandible and dentition in healthy adults were obtained using CT data. A three-dimensional finite element model of cantilever fixed bridge supported by implants with mandibular central incisor was established by computer reconstruction technique.The contact surface between the bridge and the adjacent natural tooth was designed as "oval" and "trapezoid". The "trapezoid" has a slightly smaller median diameter on the labial side and a slightly larger medial diameter on the lingual side. Loading of 120 N was applied on the tangential margin of the middle line of the long axis of the bridge 41. The direction was set at 0°, which was parallel to the long axis of the tooth and downward. The buccal to lingual and downward angles were 30°, 45° and 60°, respectively, perpendicular to the long axis of the tooth and 90° to the lingual side.The stress distribution of the implant and surrounding bone tissue and the displacement of the prosthesis were compared between the two models.@*Results@#Under axial and buccolingual loading, the maximum equivalent stress peak in the implant and surrounding bone tissue in the cantilever with trapezoidal contact surface design and the maximum displacement of the prosthesis were lower. Moreover, the distribution of stress was more balanced and the concentration range of stress was smaller. With the loading angle increasing, this trend was more obvious. When loading angle increased to 90°, the maximum equivalent stress and the maximum displacement of the elliptic contact surface model implant and surrounding bone tissue were 196 and 101 MPa and 0.196 mm, respectively, while the trapezoidal contact surface model were 157 and 72 MPa and 0.164 mm, respectively.@*Conclusions@#The trapezoidal contact surface of the bridge and the adjacent teeth in the cantilever fixed bridge supported by implants with mandibular central incisor is beneficial to reduce the impact of the leverage on the implant and surrounding bone tissue.
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With the rapid development of high-throughput sequencing ( NGS) technique, intestinal microbiome could be studied more deeply. Intestinal contents and fecal samples have the characteristics of con-venient sampling and strong representation, so they are often used as the main research objects in the study of intestinal microbiota. The method of collecting and storage of samples are very important to affect the internal flora structure and diversity, which determines the accuracy of subsequent sequencing analysis. This review summarizes the sampling and storage methods of fecal samples in the study of intestinal microbiome.
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OBJECTIVE@#To investigate the effect of acupuncture on TGF-β1/Smads signaling pathway in the lung tissue of mice with airway remodeling.@*METHODS@#Thirty specific pathogen-free mice were randomly divided into blank group, model group and acupuncture group (=10). Mouse models of asthma were established in the model group and the acupuncture group, and the mice in the latter group received 7 acupuncture therapies (at bilateral Fei Shu, Da Zhui and Zu Sanli, 20 min each time) every other day, starting on the 10th day after the modeling. At 24 h after the last acupuncture, the mice were subjected to inhalation of 1% OVA for 3 days, and 24 h after the last challenge, the mice were given methacholine chloride (Mch) inhalation at different concentrations for measurement of lung resistance using a noninvasive stroke volume meter. HE staining was used to observe the pathological changes in the lung tissues, and TGF-β1 levels in the the bronchoalveolar lavage fluid (BALF) and serum were detected using ELISA; Western blotting was used to detect the differential protein expressions in the airway smooth muscles between the two groups. The airway smooth muscle cells were isolated from the mice in the acupuncture group and treated with a TGF- β1 inhibitor (LY2157299), and the relative expressions of type-Ⅰ and Smads proteins were detected using Western blotting.@*RESULTS@#The mice in the model showed obvious tracheal fistula with airway pathologies including lumen narrowing, bronchial mucosa thickening, dissociation of the epithelial cells, and thickening of the alveolar septum and airway smooth muscles. These pathological changes were obviously milder in the acupuncture group. The asthmatic mice exhibited significantly increased lung resistance in positive correlation with Mch concentration. Serum TGF-β1 level was significantly elevated in asthmatic mice ( < 0.05); TGF-β1 levels in the serum and BALF were significantly lower in the acupuncture group than in the model group ( < 0.05). In the model group, the expressions of -SMA, TGF-β1 and Smads in the airway smooth muscles were significantly higher than those in the other two groups (both < 0.05). In cultured airway smooth muscle cells, the expressions of type-Ⅰ and Smads were significantly higher in cells treated with LY2157299 than in the control cells (>0.05).@*CONCLUSIONS@#Acupuncture can inhibit airway remodeling by inhibiting the expression of airway TGF-β1 and down-regulating the expression of Smads and -SMA to reduce airway inflammatory response. Airway expressions of type-Ⅰ and Smads proteins remain high after inhibiting TGF-β1. Acupuncture may control asthma progression through the TGF-β1/Smads pathway.
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Animals , Mice , Acupuncture Points , Acupuncture Therapy , Airway Remodeling , Airway Resistance , Asthma , Metabolism , Pathology , Therapeutics , Bronchi , Pathology , Disease Progression , Lung , Metabolism , Muscle, Smooth , Random Allocation , Smad Proteins , Metabolism , Transforming Growth Factor beta1 , MetabolismABSTRACT
Objective To investigate the clinical efficacy of aprepitant in the treatment of cisplatin based chemotherapy in-duced nausea and vomiting.Methods The tumor patients treated with cisplatin(80 mg/m2)chemotherapeutic regimen in Affiliated Shantou Hospital of Sun Yat-Sen University from December 1,2014 to December 1,2016 were selected,61 cases still had vomiting after using granisetron and dexamethasone for routinely stopping vomiting,the patients with aprepitant and dexamethasone for fur-ther stopping vomiting served as the aprepitant group,while the patients with granisetron and dexamethasone as the granisetron group.Then the complete response(CR)rates within 24,24-72,>72-144 h were observed in the two groups.Results The CR rates within 24 h in the aprepitant group and granisetron group were 66.67% and 51.61% respectively,the difference was not sta-tistically significant(P=0.232),which at 24-72 h were 80.00% and 54.84% respectively,the aprepitant group was significantly better than the granisetron group(P=0.036),which at >72-144 h were 86.67% and 64.52% respectively,the aprepitant group was better than the granisetron group(P=0.045).The comparison of adverse reactions between the two antiemetic drugs found that constipation,diarrhea,urticaria,fatigue and anxiety had no significant difference(P>0.05),the occurrence rate of total adverse reactions in the aprepitant group was 23.33%,which in the granisetron group was 25.81%,the difference between the two groups was not statistically significant(P>0.05).Conclusion Aprepitant combined with dexamethasone has better effect for treating hy-peremetic chemotherapy drug cisplatin chemotherapy caused nausea and vomiting with good tolerance.
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Docetaxel (DXT)is a member of the taxane drug class,which is used to treat breast cancer,lung cancer,gastric cancer,prostate cancer and so on.Docetaxel can be used as a single agent or in combination with other chemotherapeutic drugs.Many side effects of docetaxel have been reported in recent years.New dosage forms are developed to reduce toxicity and increase efficacy.An overview of these novel formulations of docetaxel and clinical progress will be discussed by consulting 43 literatures.
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<p><b>OBJECTIVE</b>To explore the value of computed tomography colonography with low radiation dose combined with the enhanced scanning in the diagnosis of colorectal carcinoma.</p><p><b>METHODS</b>A total of 120 patients with clinical suspected colorectal carcinoma undergoing CT colonography and enhanced scanning were randomly divided into routine dose group and low dose group. Conventional colonoscopy and/or surgical pathology were used as the gold standard. Sensitivity, specificity and Youden's index of colorectal cancer TNM staging accuracy were calculated in two groups. The radiation dose of two groups was compared.</p><p><b>RESULTS</b>For conventional dose and low dose group, in the diagnosis of colorectal cancer (including cancer and adenoma), the sensitivity was 100% (45/45 and 44/44), specificity was 93.3%(14/15) and 87.5%(14/16), the Youden's index was 0.93 and 0.88. There were no significant differences between two groups in T, N and M staging accuracy preoperatively (P>0.05). The effective radiation dose of low dose group was significantly lower than that of conventional dose group [(15.9 ± 4.3) mSv vs. (21.4 ± 5.5) mSv, P<0.01].</p><p><b>CONCLUSION</b>Low dose CTC combined with enhanced scanning not only reduces the radiation dose of patients, but can possesses similar value of conventional dose CTC in the early diagnosis and preoperative pathological staging of colorectal cancer.</p>
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Humans , Colonography, Computed Tomographic , Colonoscopy , Colorectal Neoplasms , Diagnostic Imaging , Radiation DosageABSTRACT
Objective To investigate the clinical application of iodine-enhanced image of dual-source computed tomography (DSCT) in distinguishing benign and malignant thyroid nodules.Methods Thirty patients with thyroid nodules underwent DSCT imaging with dual-source computed tomography.All thyroid nodules were confirmed by operation or biopsy.Iodine concentration in the thyroid nodule and normal thyroid tissue were calculated and not enhanced.A receiver operator characteristic curve in SPSS software was utilized to select critical value of optimum sensitivity and specificity.The data were retrospectively analyzed.Results There were 30 patients with 40 thyroid nodules (17 malignant nodules,23 benign nodules).The range of iodine concentration in malignant nodules was -2.4-0.9 mg/ml(median-0.5 mg/ml),and that in normal thyroid tissue was-0.9-2.2 mg/ml (median 0.7 mg/ml).The range of iodine concentration in benign nodules was 1.5-4.4 mg/ml(median 2.4 mg/ml),and that in normal thyroid tissue was 1.5-4.3 mg/ml (median 2.6 mg/ml).Among them,the iodine concentration in the solid part of benign nodules was significantly higher than that in malignant nodules,the difference was statistically significant(Z=-3.23,P=0.21).When critical value was 0.15 mg/ml,sensitivity was 82.40％,specificity was 81.00％.Conclusion Iodine-enhanced images with DSCT in non-enhanced weighted images may be an implement tool for differential diagnosis of benign and malignant nodules of the thyroid gland.
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<p><b>OBJECTIVE</b>To investigate the correlation between arterial partial pressure of CO2 (PaCO2) and end expiratory tidal partial pressure of CO2 (Pet-CO2) in morbidly obese patients during anesthesia for laparoscopic gastric bypass surgery.</p><p><b>METHODS</b>Forty morbidly obese patients with a body mass index (BMI) between 35 and 50 kg/m(2) underwent laparoscopic gastric bypass surgery under general anesthesia. PaCO2 and Pet-CO2 were measured after intubation and before induction of pneumoperitoneum (T0), at 30 min (T1), 60 min (T2), and 120 min (T3) during pneumoperitoneum, and at 30 min (T4) and 60 min (T5) after deflation.</p><p><b>RESULTS</b>At each time point of measurement, Pet-CO2 was lower than PaCO2 in all the patients. PaCO2 and Pet-CO2 were positively correlated before, during, and after pneumoperitoneum (P<0.05). At a moderate pressure of CO2 pneumoperitoneum (16 mmHg), the level of correlation between PaCO2 and Pet-CO2 at T1, T2, and T3 differed from that before and after post-pneumoperitoneum.</p><p><b>CONCLUSIONS</b>PaCO2 and Pet-CO2 are closely correlated during a moderate CO2 pneumoperitoneum in morbidly obese patients undergoing laparoscopic gastric bypass surgery.</p>
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Adult , Female , Humans , Male , Middle Aged , Anesthesia , Arterial Pressure , Blood Gas Analysis , Carbon Dioxide , Blood , Gastric Bypass , Laparoscopy , Obesity, Morbid , Blood , General Surgery , Pneumoperitoneum, ArtificialABSTRACT
BACKGROUND: The polarity and the layer-by-layer coating method which are utilized to improve the membrane surface of optical glasses is a new focus for researching in the world. OBJECTIVE: To prepare a stable hydrophilic anti-fogging coating by surface modification. METHODS: Hydrophilic anti-fogging coatings of complexes of polyacrylic acid (PAA), cationic polyacrylamide (CPAM) and sodium silicate were fabricated by layer-by-layer coating method. Subsequently, the stable multilayer films were obtained by thermal torrefaction. Then the transmittance, hydrophlicity, and hardness were tested. RESULTS AND CONCLUSION: In the wavelength coverage of 200 nm, the transmittance of the anti-fogging coatings was above 92.9%. In the wavelength coverage of 700-800 nm, the transmittance reached 98.1%, suggesting that the membrane had the good transmittance. Water drop dispersed completely after 230 ms when it contacted with the surface of the multilayer films, suggesting that it had the good hydrophilicity. The hardness of stable films structure was 4 H. The layer-by-layer coating method was simple and favorable for preparing the anti-fogging coatings with good product properties including good stability, anti-fogging function and the improved transmittance.
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Objective To analyze the MRI characters of hemodialysis-related osteoarthropathy in long-term dialysis recipients, and to evaluate the diagnostic value of X-ray, CT, and MRI on hemodialysis-related osteoarthropathy. Methods The shoulders, hips, wrists and lumbar vertebraes of 32 patients underwent X-ray and CT examinations. Twenty-six of them received MRI examinations. Results In X-ray of 32 patients, 28 appeared osteoporosis, 11 showed bone resorption, 6 had cystic lesions, 11 had bone sclerosis, 1 had joint swelling, and 19 had soft tissue calcification. In CT of 32 patients, 32 appeared osteoporosis, 9 showed bone resorption, 12 had cystic lesions, 11 had bone sclerosis, 3 had joint swelling, and 19 had soft tissue calcification. In MRI of 26 patients, 6 appeared osteoporosis, 2 showed bone resorption, 14 showed cystic lesions, 5 had bone sclerosis, 15 had joint swelling, and 1 showed soft tissue calcification. Conclusions X-rays plain film is the first choice for the diagnosis of hemadialysis-related osteopathy, and MRI is the first choice for the diagnosis of hemedialysis-related arthropathy. CT and MRI is pretty useful in the diagnosis of hemodialysis-related osteoarthropathy.
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Objective To summarize the X-ray and CT manifestations of dialysis- related osteoarthropathy. Methods The study consisted of 20 cases with long-term dialysis patients. The X-ray and CT scanning of their shoulder, knee, hip, wrist and cervical vertebrae were performed respectively. The X-ray and CT manifestations of dialysis- related osteoarthropathy were observed. Results The roentgenographic and CT features included:universal osteoporosis(n=20), bone resorption(n=17), bone sclerosis(n=15), calcification(n=19) . Conclusion X-ray and CT are of significance in diagnosing bone resorption and calcification.