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A survey on mental health status was conducted during October 2021 to January 2022 among grade 2017—2021 medical students majored in general practice who received 3+2-year education integrated undergraduate study and residency training for assistant physicians in a medical school in Jiangsu province. The SCL-90 and the self-made scale were used to investigate the mental health status and the results were compared with the national norm, the norm of national physicians, and the norm of medical students in Jiangsu province. A total of 125 valid questionnaires were recovered, and the positive detection rate of SCL-90 scale was 17.6%. Compared with the national norm in 2015, the scores of forcing ( t=-2.47), the interpersonal sensitivity ( t=-2.00), the hostile ( t=-2.65), the paranoid( t=-3.14) and the psychiatric factor( t=-2.45) of the study group were significantly lower than those of the norm ( P<0.05). Compared with the norm of national physicians and the norm of medical students in Jiangsu province, the scores of all the items except the fear factor were lower than those of the norms ( P<0.05). In the study group there were no significant differences in the total score and all factors among students with different genders, different training stages, and different background. The total score of SCL-90 scale was negatively associated with the study performance and clinical skill mastery ( r=-0.18) and the sense of achievement ( r=-0.23, P<0.05). The study shows that the mental health status of this group of students is generally better than that of the several norms.
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Objective To investigate the value of SpyGlass single-operator choledochoscopy system in the diagnosis and treatment of patients with unexplained biliary stricture, complex bile duct stones, or other biliary tract diseases. Methods A retrospective analysis was performed for the clinical data of the patients with biliary tract diseases who were diagnosed and treated with SpyGlass in The Second Affiliated Hospital of Nanjing Medical University from December 2017 to June 2020. For the patients with biliary stricture, the biliary lesions were fully visualized under the guidance of SpyGlass, and SpyBite biopsy was performed if necessary; the patients with bile duct stones were treated with SpyGlass-guided direct-view laser lithotripsy; for the patients with gallbladder disease, the cystic duct was superselected with the assistance of SpyGlass. The SpyGlass system was analyzed in terms of its sensitivity, specificity, and accuracy rate in diagnosis and treatment, lithotripsy success rate, stone clearance rate, procedure success rate, and incidence rate of complications. Results A total of 58 patients underwent SpyGlass procedure. SpyGlass was used to evaluate biliary stricture of unknown nature in 44 (76%) patients; SpyGlass visual impression had a diagnostic sensitivity of 92% (24/26), a specificity of 94% (17/18), and an accuracy of 93% (41/44), and SpyBite biopsy had a diagnostic sensitivity of 71% (15/21), a specificity of 92% (11/12), and an accuracy of 79% (26/33). SpyGlass was used for the treatment of bile duct stones in 8 patients (14%), with a lithotripsy success rate of 83% (5/6) and a stone clearance rate of 88% (7/8). A guide wire under the SpyGlass system was to superselect the cystic duct in 5 patients (9%), with a procedure success rate of 80% (4/5). In one patient (1%), SpyGlass was used to assist the removal of common bile duct stones after liver transplantation and the treatment of bile duct anastomotic stricture. A total of 5 patients (9%) experienced complications after surgery. Conclusion The SpyGlass choledochoscopy system is accurate, safe, and effective in the diagnosis and treatment of unexplained biliary stricture, complex bile duct stones, and other biliary tract diseases.
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Objective To investigate the value of SpyGlass single-operator choledochoscopy system in the diagnosis and treatment of patients with unexplained biliary stricture, complex bile duct stones, or other biliary tract diseases. Methods A retrospective analysis was performed for the clinical data of the patients with biliary tract diseases who were diagnosed and treated with SpyGlass in The Second Affiliated Hospital of Nanjing Medical University from December 2017 to June 2020. For the patients with biliary stricture, the biliary lesions were fully visualized under the guidance of SpyGlass, and SpyBite biopsy was performed if necessary; the patients with bile duct stones were treated with SpyGlass-guided direct-view laser lithotripsy; for the patients with gallbladder disease, the cystic duct was superselected with the assistance of SpyGlass. The SpyGlass system was analyzed in terms of its sensitivity, specificity, and accuracy rate in diagnosis and treatment, lithotripsy success rate, stone clearance rate, procedure success rate, and incidence rate of complications. Results A total of 58 patients underwent SpyGlass procedure. SpyGlass was used to evaluate biliary stricture of unknown nature in 44 (76%) patients; SpyGlass visual impression had a diagnostic sensitivity of 92% (24/26), a specificity of 94% (17/18), and an accuracy of 93% (41/44), and SpyBite biopsy had a diagnostic sensitivity of 71% (15/21), a specificity of 92% (11/12), and an accuracy of 79% (26/33). SpyGlass was used for the treatment of bile duct stones in 8 patients (14%), with a lithotripsy success rate of 83% (5/6) and a stone clearance rate of 88% (7/8). A guide wire under the SpyGlass system was to superselect the cystic duct in 5 patients (9%), with a procedure success rate of 80% (4/5). In one patient (1%), SpyGlass was used to assist the removal of common bile duct stones after liver transplantation and the treatment of bile duct anastomotic stricture. A total of 5 patients (9%) experienced complications after surgery. Conclusion The SpyGlass choledochoscopy system is accurate, safe, and effective in the diagnosis and treatment of unexplained biliary stricture, complex bile duct stones, and other biliary tract diseases.
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Objective@#To evaluate the methodology, safety and clinical applications of colonic transendoscopic enteral tubing (TET) as a new method of fecal microbiota transplantation (FMT) and colonic administration.@*Methods@#This prospective study included patients who underwent colonic TET for FMT and(or) colonic administration in the Second Affiliated Hospital of Nanjing Medical University from October 2014 to December 2018. The TET procedure time, success rate, retention time of TET tube, factors influencing TET tube retention, adverse events and satisfaction degree were evaluated.@*Results@#A total of 257 patients underwent TET, among whom 130 patients (50.6%) for microbiota tronsplantation, 8 patients (3.1%) for colon-drip medication, 118 patients (45.9%) for FMT and colon-drip medication, and 1 patient (0.4%) without treatment after TET. The TET procedure time was 10.0±2.8 min. The number of endoscopic clips used was 3.5±1.0. The success rate of the TET procedure was 100.0% (257/257). The retention time of TET tube for 160 patients maintaining the tube for treatment was 9.3±3.8 days. Multivariate analysis indicated that endoscopic clip type (P=0.001) was an independent influencing factor for the retention time of the tube. A total of 9 patients (3.5%) reported adverse events of mild anus discomfort, 4 patients (1.6%) of mobile inconvenience, 3 (1.2%) of anal pain, 2 (0.8%) of mild abdominal pain, 2 (0.8%) of mild bloating, and 1 (0.4%) of mild anal bleeding. No severe adverse events were observed in this study. The total satisfaction degree on colonic TET was 97.3% (250/257) in all patients.@*Conclusion@#The colonic TET, a safe and easy-operating endoscopic interventional technology with a high degree of patients satisfaction, can be used for colonic delivering of FMT and medications for various diseases.
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Objective:To evaluate the methodology, safety and clinical applications of colonic transendoscopic enteral tubing (TET) as a new method of fecal microbiota transplantation (FMT) and colonic administration.Methods:This prospective study included patients who underwent colonic TET for FMT and(or) colonic administration in the Second Affiliated Hospital of Nanjing Medical University from October 2014 to December 2018. The TET procedure time, success rate, retention time of TET tube, factors influencing TET tube retention, adverse events and satisfaction degree were evaluated.Results:A total of 257 patients underwent TET, among whom 130 patients (50.6%) for microbiota tronsplantation, 8 patients (3.1%) for colon-drip medication, 118 patients (45.9%) for FMT and colon-drip medication, and 1 patient (0.4%) without treatment after TET. The TET procedure time was 10.0±2.8 min. The number of endoscopic clips used was 3.5±1.0. The success rate of the TET procedure was 100.0% (257/257). The retention time of TET tube for 160 patients maintaining the tube for treatment was 9.3±3.8 days. Multivariate analysis indicated that endoscopic clip type ( P=0.001) was an independent influencing factor for the retention time of the tube. A total of 9 patients (3.5%) reported adverse events of mild anus discomfort, 4 patients (1.6%) of mobile inconvenience, 3 (1.2%) of anal pain, 2 (0.8%) of mild abdominal pain, 2 (0.8%) of mild bloating, and 1 (0.4%) of mild anal bleeding. No severe adverse events were observed in this study. The total satisfaction degree on colonic TET was 97.3% (250/257) in all patients. Conclusion:The colonic TET, a safe and easy-operating endoscopic interventional technology with a high degree of patients satisfaction, can be used for colonic delivering of FMT and medications for various diseases.
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Objective@#To survey the resident participation in community health management service and its influencing factors.@*Methods@#A survey on the resident participation in community health management service with self-designed questionnaire was conducted during January to March 2018 among residents in one of the subdistricts in Nanjing Gulou district. The questionnaire includes basic information of residents, understanding health management service, and the participation in the health management.@*Results@#Total 500 questionnaire were distributed, 449 copies were retrieved and 402 were valid. The rates of engagement in health archives, management of blood pressure, blood glucose and blood lipids, attending health education, regular health check-up, health follow-ups, and equipping family medicine kits were 62.2% (250/402), 71.0% (286/402), 49.5% (199/402), 59.9% (241/402), 72.6% (292/402), 66.9% (269/402), respectively. The rates of engagement of health archives, attending health education, regular health check-up and equipping family medicine kits for healthy residents were higher than those with chronic diseases (χ2=6.31, 4.09, 10.83, 10.83; P<0.05). The logistic regression analysis suggested that age, income, and understanding health management services were independent influence factors for resident active participation in health management.@*Conclusion@#The survey indicates that the young, high-income and healthy residents are more likely to participate in health management service, and the overall resident participation needs to be further improved.
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Objective To survey the resident participation in community health management service and its influencing factors.Methods A survey on the resident participation in community health management service with self-designed questionnaire was conducted during January to March 2018 among residents in one of the subdistricts in Nanjing Gulou district.The questionnaire includes basic information of residents,understanding health management service,and the participation in the health management.Results Total 500 questionnaire were distributed,449 copies were retrieved and 402 were valid.The rates of engagement in health archives,management of blood pressure,blood glucose and blood lipids,attending health education,regular health check-up,health follow-ups,and equipping family medicine kits were 62.2％ (250/402),71.0％ (286/402),49.5％ (199/402),59.9％ (241/402),72.6％ (292/402),66.9％ (269/402),respectively.The rates of engagement of health archives,attending health education,regular health check-up and equipping family medicine kits for healthy residents were higher than those with chronic diseases (x2=6.31,4.09,10.83,10.83;P＜0.05).The logistic regression analysis suggested that age,income,and understanding health management services were independent influence factors for resident active participation in health management.Conclusion The survey indicates that the young,high-income and healthy residents are more likely to participate in health management service,and the overall resident participation needs to be further improved.
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Objective To investigate the demands and needs of patients contracting for family doctor service in Nanjing Gulou district. Methods A questionnaire survey was conducted between July and December 2017 among residents in Nanjing Gulou district. The questionnaire included basic information of residents, willingness to sign service contract with family doctors, annual outpatient needs, demands of service mode, expectation for family doctor service, and willingness to pay. Results A total of 420 questionnaires were distributed and 415 questionnaires were valid. Multivariate analysis of variance suggested that age, income, and understanding of signing family doctor service were independent factors influencing signing intention (P<0.05).The variance analysis trend test indicated that the healthy people had highest willingness of signing, followed by the patients and the pregnant women (F=6.82, P<0.01). The number of annual outpatient service needs for healthy population, hypertensive patients, diabetic patients and pregnant women was(2.64±3.48),(7.02±4.80),(9.98±5.37)and(11.20±4.33)respectively (F=77.94, P<0.01). The average need of outpatient visit for health males was higher than that for females (P<0.01). There were significant differences in outpatient needs between patients with non-complicated hypertensionand complicated hypertension (P<0.01). The most anticipated services for healthy people were health records (74.26％,101/136), medical appointments (56.62％,77/136), and physical check-up (56.62％,77/136);those were management of blood glucose, blood pressure and body weight (70.13％, 108/154), regular testing (66.88％,103/154), follow-up supervision (66.23％,102/154) for chronic patients;those were regular physical examination (80.26％, 61/76), follow-up supervision (50.00％, 38/76) and health records (46.05％, 35/76) for pregnant women. The most popular health communication channel is WeChat, accounting for 44.10％(183/415), followed by outpatient clinic, telephone and internet services, accounting for 37.11％(154/415), 31.57％(131/415)and 11.08％(46/415)respectively. Among those who chose WeChat, 81.4％(149/183) were under 45 years old. And 86.27％(358/415)of people were willing to pay for corresponding signing fees. Conclusion Age, income, and understanding of general practice will affect residents′ willingness to sign the service contract with family doctors. Gender, disease spectrum and number of illnesses affect residents′outpatient service needs. Individualized family doctor service should be provided for people with different health needs.
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Objective To learn the relationship and operating mechanism between medical staff's loyalty and patient satisfaction.Methods Medical staff and inpatients of a tertiary hospital in Nanjing were sampled at a 1:2 ratio for study,with 840 questionnaires released and 269 valid questionnaires recovered;medical staff service quality as perceived by inpatients served as the intermediate variable,with Mplus7.0 used to build a structural formula model for an empirical study of the relationship between staff loyalty and patient satisfaction.Results Staff loyalty exerts certain positive influence on patient satisfaction and staff service quality ( P direct effect value 0.143).Conclusions Structural formula model can reveal the relationship and extent of the influence of staff loyalty on patient satisfaction.This indicates that hospitals should enhance the loyalty,medical competence and communication skills of their medical staff for higher patient satisfaction.
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ObjectiveTo investigate the application value of transpancreatic septotomy with pancreatic duct stent or guide wire in difficult endoscopic retrograde cholangiopancreatography (ERCP). MethodsA total of 309 patients who underwent difficult ERCP in Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University from June 2012 to May 2014 were selected; 228 patients among them received placement of pancreatic duct guide wire/plastic stent or conventional precut papillotomy, and achieved successful bile duct cannulation; the other 81 patients received transpancreatic septotomy with placement of guide wire (guide wire group, 37 patients) or pancreatic duct stent (stent group, 44 patients). The success rate and incidence of complications were compared between these two methods for cannulation. ResultsOf the 81 patients who underwent transpancreatic septotomy, 77 achieved successful bile duct cannulation, and the success rate did not differ significantly between the guide wire group and stent group (91.89% (34/37) vs 97.73% (43/44); P＞0.05). Seventeen patients experienced complications, with 8 cases of acute pancreatitis, 3 cases of hemorrhage, and 1 case of biliary tract infection in the guide wire group, and 3 cases of acute pancreatitis, 1 case of hemorrhage, 1 case of biliary tract infection in the stent group; compared with the guide wire group, the stent group had a significantly lower incidence of complications (11.36% vs 32.43%; χ2=3.75, P＜0.05) and a significantly lower incidence of acute pancreatitis (6.82% vs 21.62%;χ2=2.25, P＜0.05). ConclusionTranspancreatic septotomy can further improve the success rate of bile duct cannulation with ERCP. The stent group has a higher success rate and a lower incidence of pancreatitis after ERCP than the guide wire group, and thus the application of stent is safer in clinical practice.
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Gastrointestinal benign stricture is one of common diseases in clinics , endoscopic dilation is its preferred treatment . However , for the dilation ineffective refractory strictures , it represents a difficult management problem given the limited therapeutic in-terventions available .Mitomycin-C is an antibiotic which has the dual role of anti-tumor and anti-proliferation.As an anti-proliferative drug, it was first applied in the field of ophthalmology .Local auxiliary application of MMC can be a feasible and safe measurement to improve the efficacy of refractory esophageal strictures .The aim of this study is to perform a systematic review which employs mitomycin C in the treatment of refractory esophageal strictures caused by corrosion , endoscopic submucosal dissection , esophageal atresia repara-tion and radiotherapy .
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Objective To investigate the clinical situation of inflammatory bowel disease (IBD).Methods The clinical features and treatment features of 122 patients with IBD were investigated.Results In 122 IBD patients,54 cases had ulcerative colitis (UC),the lesion was in colon,hospital number visited was median 3,the ratios of using amino salicylic acid salts,hormones,immunosuppressive agents,biological agents and antibiotics was 100.0％ (54/54),55.6％ (30/54),24.1％ (13/54),7.4％ (4/54) and 75.9％ (41/54); 68 cases had Crohn disease (CD),the lesion was in the ileocolic,hospital number visited was median 4,the ratios of using amino salicylic acid salts,hormones,immunosuppressive agents,biological agents and antibiotics was 95.6％ (65/68),58.8％ (40/68),47.1％ (32/68),11.8％ (8/68) and 79.4％ (54/68).The uses of CD in patients with immunosuppression,quinolone antibiotics in patients of CD were higher than those of patients with UC,the use of herbal medicine in patients of CD was lower than that in patients of UC,the difference was statistically significant (P ＜ 0.05).Conclusion The main drugs currently used to treat IBD are amino salicylic acid preparation,corticosteroids,immunosuppressive agents,biological agents.
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Body mass index [BMI] has been demonstrated to be associated with serum uric acid [SUA] level in many developed countries, however, there is still a lack of large sample study in Jiangsu Province, one of the most economically developed regions in China, where fat-rich diet is common. Through retrospective analysis in healthy subjects, we determined the association of BMI with hyperuricemia risk. Data of 39,736 participants from January 2011 to June 2013 in China were analyzed for parameters including physical examinations and biochemical blood analysis. On univariate analysis, SUA was positively correlated with age, SBP, DBP, BMI, FPG, red blood cell count, hemoglobin, white blood cell count, platelet, cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol, ALT, AST, bilirubin, albumin, BUN and creatinine. SUA was significantly elevated in a linear fashion as BMI increased, and SUA in obesity was significantly higher than underweight. The prevalence of hyperuricemia remained approximately 2.98 times greater among individuals with overweight, and 5.96 times greater among obesity, compared to individuals with underweight. There is a positive relationship between BMI and SUA among healthy subjects in Jiangsu province, China
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Humans , Male , Female , Body Mass Index , Cross-Sectional Studies , Retrospective StudiesABSTRACT
Enhancing medical humanitarian activities in clinical teaching is demanded by modern medicine and education.It contains the modern values of constructing a harmonious doctor-patientrelationship and adjusting to medical education and modern medical model development.We put forward several countermeasures such as establishing concept of respect for people,improving teachers'humanistic caring ability,strengthening management to enhance students' sense of responsibility,enhancing students' doctor-patient communication skills,and abiding by relevant laws and regulations in the current situation which lacks humanistic care,doctor-patient communication and legal concept.
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BACKGROUND/AIMS: Pyogenic liver abscess (PLA) is a serious, life threatening condition with a high mortality rate that represents a diagnostic and therapeutic challenge. The aim of this study was to collect demographic data and clinical, laboratory and microbiological characteristics of PLA patients treated between 2000 and 2010. We also aimed to collect information regarding our management experience of these cases. METHODS: As a retrospective review, 47 patients with PLA in a tertiary referral center were examined to determine their demographic characteristics, clinical features, and laboratory, imaging, and microbiologic findings as well as the treatment outcome. RESULTS: Cryptogenic PLA was the most frequently identified type of PLA, while benign biliary tract disease was the most frequently identifiable cause of PLA (18/47 patients; 38.3%). Leukocytosis and elevated alanine transaminase were common laboratory findings and were observed in 35 (74.5%) and 22 (46.8%) patients, respectively. Increased fibrinogen was also detected in 11 of 15 investigated cases (73.3%). Notably, infection-induced thrombocytopenia occurred in 8 patients (17%). Diabetes mellitus was associated with the occurrence of infection induced shock when compared to the non-diabetic group (p<0.05). Patients with two or more comorbid diseases had longer hospitalizations when compared to patients with one comorbid disease or those without comorbidities (p<0.001). The number of days needed to establish diagnosis was correlated with the length of hospitalization (p<0.001). The overall hospital mortality rate was 2.1% (1/47). CONCLUSIONS: Characteristics of PLA patients from the past 10 years are presented. The number of days needed to establish a PLA diagnosis was correlated with the length of the hospital stay. The hospital stay of PLA patients can be further improved by early diagnosis and effective treatments during the early stages of PLA progression.
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Humans , Alanine Transaminase , Asian People , Biliary Tract Diseases , Clinical Audit , Comorbidity , Diabetes Mellitus , Early Diagnosis , Fibrinogen , Hospital Mortality , Hospitalization , Length of Stay , Leukocytosis , Liver Abscess, Pyogenic , Retrospective Studies , Shock , Tertiary Care Centers , Thrombocytopenia , Treatment OutcomeABSTRACT
Objective:To construct and identify the small hairpin RNA(shRNA) expression vector for Smad 4/DPC 4 gene. Methods:Three shRNA sequences targeting Smad 4 were designed by software and cloned into the expression vector pGCsi-H1/Neo/GFP.DNA sequencing was used to confirm that the plasmids were constructed correctly.The constructed plasmids with different shRNA and the control plasmid were transiently transfected into the 293 cell line cells.Fluorescene quantitative PCR was used to detect the efficiency of RNA interference against Smad 4. Results:Double enzyme(HindⅢ and BamHⅠ) digestion(analysis) and DNA sequencing confirmed that Samd 4 specific shRNA expression vectors were constructed successfully.Fluorescene quantitative PCR showed that the inhibition rates of Smad 4 mRNA expression in cells transfected with shRNA expression vector psiSmad 4-1,psiSmad 4-2 and psiSmad 4-3 were 39.00%,8.80% and 73.80%,respectively,which indicated Smad 4 mRNA expression was specifically inhibited. Conclusion:Smad 4 pGCsi-H1/Neo/GFP/shRNA plasmid was constructed successfully,which may provide a novel applicable strategy for gene therapy and study of its role in carcinogenesis.
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The transforming growth factor-?(TGF-?)-Smad signaling pathway has an important role in carcinogenesis. In recent years, some investigations have revealed the functions of TGF-? super-family ligands, receptors, Smads protein, up stream and down stream regulators and cross-talk among many signaling pathways in gastrointestinal cancers, lung cancer and other cancers. This review attempts to collate and integrate the extensive body of in vivo and in vitro studies about TGF-?-Smad signaling pathway and Smad4 in cancers.
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Cancers of the digestive system account for a large portion of malignant tumors in humans,and the trend is on the rise.The formation of neovascularization is the dominant factor in the metastasis of tumors.The vascular endothelial growth factor(VEGF) is well documented as the most potent inducer of angiogenesis.It promotes the formation of new blood vessels in several aspects,such as proliferation of endothelial cells,endothelial cell migration and increased vascular permeability.So VEGF is regarded as an important factor in the development of digestive system tumors.The purpose of this review is to investigate the relationship between VEGF and digestive system tumors.
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Objective To evaluate the short-term effects and complications of transoral endoscopic suturing in the treatment of gastroesophageal reflux diseases (GERD). Methods Sixteen patients with GERD, confirmed by gastroscopy, upper gastrointestinal barium meal examination, and esophageal pH value examination, received gastroesophageal suturing by using an endoscopic suturing device (manufactured by Bard Co.). The site of suturing was 1cm below the dentation line, with a suture interval of 1.5cm and a knot interval of 2.0cm. Symptom severity scoring, esophageal 24-hour pH monitoring and the degree of esophagitis before and 1 month after the operation were compared respectively. Results A total of 42 sutures and 21 knots were made in the 16 cases. The mean operation time was 30 min. The sum of heartburn scores and regurgitation scores before the treatment were 39 (mean, 2.44) and 32 (mean, 2.0), and those after the treatment were 11 (mean, 0.68) and 10 (mean, 0.63), respectively, with statistical significances between preoperation and postoperation ( ? 2 =19.5 and 16.33; P
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Objective To explore the mechanisms of TGF-? 1?TGF-? 1RⅡ and NF-?B on the angiogenesis in patients with hepatocellular carcinoma.Methods The expression of TGF-? 1 ?TGF-? RⅡ and NF-?B protein in 36 cases of HCC and surrounding HCC tissue was separately detected using immunohistochemistry technique.To observe the relationship of TGF-? 1 protein and MVD, TGF-? 1RⅡ protein and MVD, NF-?B and TGF-? 1 protein, using CD34 labelling vessel endothelial cell. Results The expression of TGF-? 1 and MVD in HCC tissue was higher than that in surrounding HCC tissue (P