ABSTRACT
Objective To establish a simple scoring system for the diagnosis of liver fibrosis in chronic hepatitis B (CHB), and to observe its sensitivity and specificity. Methods Two hundred and thirty-three patients diagnosed as CHB by liver biopsy were divided into model group (N = 154) and validation group (N = 79). The general information, biochemical parameters and imaging data of all patients were observed. With hepatic fibrosis being obvious or not as the end point of primary study in the model group, we established a simple scoring system for the diagnosis. The cut-off, sensitivity and specificity of the system were tested in the model group by ROC curve, and its diagnostic efficacy was tested in the validation group. Results(1) A simple scoring system for the diagnosis of liver fibrosis called MDFS was established in the model group, and the dimensions of the system included sex, HBV-DNA, Fibroscan (FS) value and splenomegaly. In MDFS, male, HBV-DNA≥ 107 U/mL,FS value≥7.3 kPa, and splenomegaly were assigned 1 point, -2 points, 3 points, and 2 points respectively. (2) The best cut-off value in MDFS was 2 points.(3) ROC curve of the model group indicated that the specificity and sensitivity were 92.86% and 54.76% respectively, the area under curve(AUC) was 0.790, and the Youden index was 0.4762. In the validation group, the diagnostic cut-off value was over 2 points, and the sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 52.17%, 82.35%, 2.96, and 0.58 respectively. (4) The scoring results of MDFS for different traditional Chinese medical syndromes of CHB showed that the scores of blood stasis blocking collaterals > damp-heat accumulation > deficiency of spleen and kidney yang> liver depression and spleen deficiency = stagnation of liver Qi. Conclusion The MDFS diagnostic scoring system has medium efficiency. The specificity of MDFS is relatively high and MDFs has a relatively low misdiagnosis rate for the diagnosis of obvious hepatic fibrosis in CHB. The MDFS is expected to be a noninvasive and simple diagnosing way for hepatic fibrosis in CHB.
ABSTRACT
General/family medicine is a newly established major in medical education to meet the demands in general/family doctors. It is a new educational reform subject for medical schools to enhance the teaching for students in general medicine. Pathophysiology is a bridging course for foun-dational medical courses to be connected to clinical courses, and it is also a required course for med-ical students in cultivating students' critical thinking abilities. In military medical schools, there are certain features in the students. It is quite common to find these students have less desired academic foundation, and they come from different areas in the military units and will go back to certain units upon graduation. In the teaching of the course of pathophysiology, it has been proved that the following methods can help promoting the quality of teaching and learning. These methods include adjusting the teaching contents to emphasize the key points, selecting teaching methods to enhance interactions, and utilizing the advantages of internet and multi-media facilities in case discussions. However, there is still a long way to go to find out better ways in adjusting the course contents to the needs of general medicine education and sequencing the foundational courses in the medical courses.