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Objective:To explore the criteria of general practice doctoral supervisors.Methods:The expert consultation questionnaire was formed by literature analysis. Experts in the field of general medicine from universities and tertiary hospitals in Shanghai were invited to participate in two rounds of Delphi consultation. The consultation content included the basic requirements and the importance evaluation of the selection criteria for general practice doctoral supervisors. Descriptive analysis and Analytic Hierarchy Process (AHP) were used to analyze the results of the study.Results:A total of 29 experts participated in the consultation, all with senior professional titles and doctoral degrees. The positive coefficient and expert authority coefficient of the two rounds of expert consultation were 1.0 and 0.925, respectively. The Kendall coordination coefficient of indicator importance evaluation were 0.436 and 0.397, respectively. The ethics, age, professional title, educational background and academic degree and diploma were considered to be included in the basic qualifications. The optimal standards for supervisor selection included teaching ability, scientific research ability, student training and team promotion ability that subdivided into 13 evaluation indexes.Conclusion:The basic qualifications and optimal standards for general practice doctoral supervisors have been preliminarily developed, which provides reference for selection of qualified general practice doctoral supervisors.
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Objective:To investigate the clinical effect of hysteroscopic scar excision for cesarean scar pregnancy(CSP) and its effect on serum β-human chorionic gonadotropin(β-HCG).Methods:From January 2017 to January 2019, 83 patients with endogenous CSP admitted to the People's Hospital of Wenzhou were divided into observation group(43 cases) and control group(40 cases) according to different surgical methods.The observation group underwent hysteroscopic scar lesion resection, while the control group underwent uterine artery embolization.The success rate, intraoperative bleeding volume, vaginal bleeding time and hospitalization time, postoperative complications and the recovery time of blood β-HCG were compared between the two groups.Results:The success rate of operation in the observation group was 97.67%(42/43), which was higher than that in the control group[82.50%(33/40)](χ 2=3.875, P<0.05). The amount of bleeding in the observation group[(43.28±10.28)mL] was less than that in the control group[(74.32±15.48)mL], the time of vaginal bleeding in the observation group[(5.79±1.45)d] was shorter than that in the control group[(8.54±1.89)d], and the time of hospitalization in the observation group[(7.32±1.48)d]was shorter than that in the control group[(10.80±1.97)d], the differences were statistically significant( t=10.832, 7.468, 9.140, all P<0.05). There was no statistically significant difference in postoperative complications between the two groups( P>0.05). The recovery time of blood β-HCG in the observation group[(19.54±3.52)d]was shorter than that in the control group[(28.73±6.57)d]( t=8.020, P<0.05). The total satisfaction rate of the observation group was 97.67%(42/43), which was higher than 77.50%(31/40) of the control group(χ 2=6.170, P<0.05). Conclusion:Hysteroscopy-assisted scar excision is effective in the treatment of CSP, and can shorten the recovery time of blood β-HCG.
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Objective:To explore the necessity of supplementary operation after primary cervical conization for cervical lesions and the choosing method of reoperation, so as to provide clinical data for further stratification treatment after primary conization.Methods:A prospective study was performed in 116 patients with complete data due to cervical biopsy diagnosis of cervical lesions who first received cervical conization, and received supplementary surgeries within 6 months at Wenzhou People Hospital from March 2016 to March 2018, and 17 cases who received radical resection diagnosed grade Ⅰa1 with vascular infiltration or above were excluded. The patients were divided into residual and non-residual according to residual disease of supplementary surgical specimens. The residual rates of clinical and pathological factors (including incision margin, gland involvement, curettage of cervical canal) were analyzed by univariate analysis. The factors of P ≤ 0.10 were further analyzed by progressive Logistic regression. The clinical and pathological data of 41 patients undergoing repeated conization were analyzed. The follow-up data were analyzed and summarized. Results:Univariate analysis showed that the residual rate of disease in the patients with positive margin, endocervical cone margin involvement and other positive margin was 55.36% (31/56), 63.64% (14/22) and 50.00% (17/34), respectively, higher than that of the patients with negative margin 30.00% (18/60) with statistical significance ( P<0.05). There was no significant difference in pregnancy (≥ 3), parity (≥ 2), symptomatic cases between the two groups, but all P < 0.10. Multivariate analysis showed that both endocervical cone margin involvement and vaginal incision margin were independent risk factors for residual disease, and OR was 4.083 (95% CI 1.459 to 11.430, P = 0.007) and 2.333 (95% CI 0.978 to 5.569, P = 0.056); 19 cases (46.34%) of cervical lesions and 11 cases (26.83%) of high-grade cervical lesions were found in 41 cases after repeated conization. 2 cases (4.88%) of positive margin of incision were supplemented with total hysterectomy; the incidence of intraoperative massive bleeding was 4.88% (2/41). The incidence of massive hemorrhage after operation was 2.43% (1/41). Conclusions:Margin involvement and vaginal incision margin might predict the occurrence of residual disease. Additional surgery should be considered in these cases. Repeat conization can remove residual cervical lesions with minimal trauma and can be used as the preferred treatment.
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Psoriasis (Ps) is an inflammatory skin disease caused by genetic and environmental factors. Previous studies on DNA methylation (DNAm) found genetic markers that are closely associated with Ps, and evidence has shown that DNAm mediates genetic risk in Ps. In this study, Consensus Clustering was used to analyze DNAm data, and 114 Ps patients were divided into three subclassifications. Investigation of the clinical characteristics and copy number variations (CNVs) of DEFB4, IL22, and LCE3C in the three subclassifications revealed no significant differences in gender ratio and in Ps area and severity index (PASI) score. The proportion of late-onset ( ≥ 40 years) Ps patients was significantly higher in type I than in types II and III (P = 0.035). Type III contained the smallest proportion of smokers and the largest proportion of non-smoking Ps patients (P = 0.086). The CNVs of DEFB4 and LCE3C showed no significant differences but the CNV of IL22 significantly differed among the three subclassifications (P = 0.044). This study is the first to profile Ps subclassifications based on DNAm data in the Chinese Han population. These results are useful in the treatment and management of Ps from the molecular and genetic perspectives.
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Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , Asian People , Genetics , Case-Control Studies , China , Cornified Envelope Proline-Rich Proteins , Genetics , DNA Copy Number Variations , DNA Methylation , Genetic Predisposition to Disease , Interleukins , Genetics , Psoriasis , Classification , Genetics , Risk Factors , beta-Defensins , GeneticsABSTRACT
Objective To explore the clinical effects of modified pedicled pectoralis major myocutaneous flaps(PMMFs) in repairing postoperative defects following head and neck malignant tumor radical operation.Methods Twenty-eight patients with surgical defects after head and neck malignant tumor operation in this hospital from September 2013 to January 2017 were selected and performed the repairing reconstruction by modified PMMFs,then observed and followed up for the survival of the flaps.Results All 28 cases were followed-up for 3-36 months,all modified PMMFs survived.Using modified PMMFs to repair surgical defects following head and neck malignant tumor operation had the advantages of high survival rate and less trauma;meanwhile the swallow and language function could obtain the maximal recovery.Conclusion Using modified PMMFs to repair surgical defects following head and neck malignant tumor operation has good clinical curative effect and is worth clinical application.
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Objective To explore the clinical effect of dorsal digital artery reverse island flap in the repair of distal finger skin defect.Methods From January,2011 to January,2015,60 fingers of 60 cases with dorsal branch of the digital artery were used to repair the defect of the distal finger skin.The 30 refers to the index finger,middle finger 15 fingers,10 ring fingers and 5 little fingers.Harvested area of 1.2 cm ×1.7 cm to 3.2 cm × 3.6 cm,the wrist or distal medial arm full thickness skin graft donor site.Evaluation of sensory recovery by the British Medical Research Association.Results All flaps survived.Twelve finger flap tension blisters,and the flaps survived after the stitches.Follow-up of 60 cases of 60 to hand function according to the Chinese medicine will hand surgery society of upper extremity function evaluation standard trial Tam method to evaluate the:50 excellent,10 fingers good,the excellent and good rate was 100％;48 fingers flap sensation recovery to S4 class,and 12 refers to the recovery to S3.The two-point discrimination perception of 5 to 8 mm,average 6.5 mm;patients far,nearly interphalangeal joint average activity recovery was good.Skin flap skin ruddy,soft texture,no fat,no pigmentation,fearless cold performance.No scar hypertrophy and contracture,skin pain no allergy and reoperation.Conclusion The flap for repair of distal finger skin defect is a simple,no damage to the main artery and nerve and good sensory recovery,less postoperative complications,and excellent method of flap survival.It is worth promotion in primary hospitals.
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Objective To investigate the association between serum ferritin(SF) level at early and mid trimester of pregnancy and gestational diabetes mellitus (GDM) and insulin resistance (IR).Methods A total of 192 cases of women who were accepted antenatal examination from the first trimester of pregnancy at Yueqing People Hospital from July,2012 to October,2013 was prospectively analyzed and followed up.All cases were divided into two groups:96 cases of GDM pregnant women who were diagnosed as GDM at mid trimester of pregnancy as GDM group,and 96 cases of pregnant women with normal glucose tolerance at the same time as the control,normal glucose tolerance (NGT group).The differences in clinical data were compared between two groups.The relationship between SF level and fasting plasma glucose (FPG),fasting insulin (FINS),homeostasis model assessment insulin resistance (HOMA-IR),and C-peptide was investigated with Spearman rank correlation analysis.The predictive values of SF and relative variables to GDM were calculated by receiver operating characteristic curve (ROC) or Logistic regression analysis.Results (1) There was statistically significant difference in body weight and body mass index (BMI) at prepregnancy and mid trimester of pregnancy,Hb,FPG,FINS,SF,and C-peptide at the first trimester of pregnancy,SF level and FPG and HOMA-IR and C-peptide at mid trimester of pregnancy between two groups (P ＜ 0.01 or P ＜ 0.05).(2) As showed by Spearman rank correlation analysis,there was statistical correlation between SF at mid trimester of pregnancy,and FPG,FINS,HOMA-IR and C-peptide (P ＜0.01 or P ＜ 0.05);while no statistical correlation was found between SF at the first trimester of pregnancy and the same factors above (P ＞ 0.05).(3) The area under the ROC curve of SF at mid trimester of pregnancy for GDM was 0.653.The sensitivity and specificity were 68.8％ and 59.4％ in predicting GDM at the cut-off value of 16.61 ng/ml.As showed by Logistic regression analysis,high level of SF at mid trimester of pregnancy was a independent risk factor for GDM.Odds ratio (OR) was 1.032 (95％ CI:1.008 ～ 1.058,P ＜ 0.01).Conclusions The relationship between SF at different trimester of pregnancy and GDM is variant.There is relationship between high level SF of mid trimester of pregnancy in GDM pregnant women and IR.The level of SF might predict the occurrence of GDM.
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Objective: To discuss the significance of neoadjuvant chemotherapy followed by surgery in the treatment of local advanced esophageal cancer. Methods:A total of 272 cases of local advanced esophageal cancer were studied in retrospect. Out of the 272 cases, 112 were treated with neoadjuvant chemotherapy followed by surgery (CT-S), whereas the remaining 160 cases underwent surgical treatment (S) only. Complications and survival state after surgery were compared. Results: The rate of complications after surgery was as follows: CT-S: 34.8% (39/112); S: 29.4% (47/160), P=0.50. The five-year survival rate was 35.7% and 29.4%, respectively, P<0.05. The CT-S patients were divided into partial remission (PR) and stable disease (SD)/progressive disease (PD) groups according to the effect of the chemotherapy. The five-year survival rate was 38.5% and 30.1%, respectively, P<0.01. Conclusion: Neoadjuvant chemotherapy is available for local advanced esophageal cancer. Postoperative complications are not increased by chemotherapy, and the survival rate for local advanced esophageal cancer is improved by neoadjuvant chemotherapy. PR has better prognosis compared with SD/PD.
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The synthetic biology matures to promote the heterologous biosynthesis of the well-known drug paclitaxel that is one of the most important and active chemotherapeutic agents for the first-line clinical treatment of cancer. This review focuses on the construction and regulation of the biosynthetic pathway of paclitaxel intermediates in both Escherichia coli and Saccharomyces cerevisiae. In particular, the review also features the early efforts to design and overproduce taxadiene and the bottleneck of scale fermentation for producing the intermediates.
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Objective To explore the cosmetic effect of oncoplastic volume displacement in breastconserving surgery.Methods 43 cases of breast cancer in stages I and Ⅱ with pathological diagnosis by core needle biopsy were operated by extended resection of tumor combined with axillary lymph nodes dissection.Among the patients,wound cavity was repaired by direct skin suture without suture of mammary gland deletion in 22 cases,and another 21 cases were repaired by oncoplastic volume displacement technique in which skin suture followed by freeing remaining breast tissue flap and translocation to repair the mammary defect.All of them were treated with three-dimension conformal radiotherapy,standard chemotherapy and endocrine therapy after operation.3 years after partial removal of breast,a retrospective historical control study had been fulfilled to analyze breast cosmetic results between two groups.Results In direct suture group,the cosmetology score was 4.3 points and fine rate was 40.9% (9/22).In breast reconstruction group.the score was 4.8 points and fine rate was 71.4% (15/21).The breast cosmetic effect in breast reconstruction group was significantly better than that in direct suture group (P<0.01).Conclusion It will get better breast cosmetic results after operation to utilize oncoplastic volume displacement suture technique in breast-conserving surgery.
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Influenza A/H1N1 virus-encoded nonstructural, or NS1, protein inhibits the 3'-end processing of cellular pre-mRNAs by binding the cellular protein: the 30-kDa subunit of CPSF (cleavage and polyadenylation specificity factor, CPSF30). CPSF30 binding site of the NS1 protein is a potential target for the development of drugs against influenza A/H1N1 virus. A yeast two-hybrid screening system was constructed and used for screening Chinese medicines that inhibit the interaction of the A/H1N1 flu NS1 protein and human CPSF30 protein. The NS1 gene of A/H1N1 virus was amplified by consecutive polymerase chain reaction (PCR), and the human CPSF30 gene of HeLa cell cloned by reverse transcriptase-polymerase chain reaction (RT-PCR). Then the two gene fragments confirmed by sequencing were subcloned into the yeast expression vectors pGBKT7 and pGADT7, respectively. The two constructs, bait vector pGBKNS1 and prey vector pGADCPSF, were co-transformed into yeast AH109. The eight individual yeast colonies were picked and subjected to verification by PCR/gel electrophoresis. The inhibition of the NS1-CPSF30 interaction was allowed the identification of selective inhibitors. The four of more than thirty identified Chinese medicines, including 'Shuanghuanglian oral liquid', showed the strong inhibition of the NS1-CPSF30 interaction.
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Objective To analyze and solve problems in spreading out the power supply system in mobile field hospital during the earthquake relief.Methods According to the layout of the mobile field hospital and the need of electrical power,the sketch map of electric circuit was drawn out and spread with load as less as possible.Results Current supply and its safety in mobile field hospital are guaranteed.Conclusion This kind of power supply system meets the requirement of the mobile field hospital in emergent rescue tasks.
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According to the actual situation of taking part in the earthquake relief mission followed by the mobile field hospital,the characteristics of medical support mission and the main problems in the use of medical equipment of the mobile field hospital are summarized.Aimed at the problems,equipments are suggested to be added especially used for surgery,first aid,blood transfusion and some special subjects,and improvement should be made on the equipment of ultrasonic diagnosis,inspection and X-ray examination.Finally,the necessary sorts and quantity of the medical equipments needed in the mission are listed.
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Objective To analyze and solve the difficulties in rapidly expanding the mobile field hospital in earthquake relief mission.Methods Aimed at the difficulties in the speed,advance men were sent out before the expansion.Then the personnel were regrouped in the proceeding of the expansion,and the vehicles entered the district according to the predefined area and order.Results The expanding speed was raised.Conclusion The scheme meets the requirements of the first aid in the mobile field hospital.
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By the application of modularization combination principle,a new type of field medical point operation instrument set is designed.It not only innovates the organization mode of the traditional field operation instrument case,meets the requirement of intensivization,portability and standardization but also improves the support efficiency of medical service.
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This article is to discuss the ethical principles in the diagnosis and treatment of oral disease in elderly patients.The patient-oriented concept should not be neglected.Doctors′ moral responsibility must be strengthened during examination,diagnosing and curing process.Medical skills should be well mastered and improved.Characteristic of senile patients should be attached to and right oral health education is obligatory for patients.
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Objective To discuss the use management of both war and peace time for medical equipment in field clinics. Methods Medical equipment was sent to different departments which are personal management. Results The usage management can improve the capacity of using and maintaining of medical equipments. Conclusion The management method improves field medical treatment ability of field clinics and adapts the usage management of medical equipments in field clinics.
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This paper discusses issues involved in the deployment of the shelters of campaign-grade rapid medical support system in such aspects as entering of the vehicles,unloading of the shelters and grouping of the staffs. It suggests that the vehicles should rapidly move in at their positions and be butted bidirectional. As the system is deployed,such things should all be fixed as the position of the vehicles & equipments as well as the deployment motions and sequence. The system is positioned at hard surface,the shelters should be pushed towards the immobilized vehicles,but for the system located at soft surface,it is quite the contrary. With the above-mentioned measures implemented,the duration for shelters of campaign-grade rapid medical support system can be reduced largely.
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The module of surgical instruments modularization based on the theory research are applied to the medical rescue of earthquake relief effort by the application of methods on practical demonstration,which solves the defects and inadequacies of the traditional surgical instruments box group field and validates the feasibility of practical application in the combination of modular design of surgical instruments,these can provide practical basis for new modules of field surgical instruments.
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Hypoxic pulmonary hypertension(HPH) is a common disease featured by acute hypoxic pulmonary vasoconstriction(HPV) and chronic hypoxic pulmonary vascular remolding(HPVR) leading to the sustained increasing of pulmonary artery pressure.There are many mediators involved in the HPH but none can illustrate it successfully.Primary work has found 15-lipoxygenase(15-LO) and its catalyzed production 15-hydroxyeicosatetraenoic acid(15-HETE)(from arachidonic acid) are up-regulated in pulmonary vascular when exprosed to hypoxia.And it has been found 15-LO/15-HETE involved in many processes of both the HPV and HPVR,indicating 15-LO/15-HETE may be an important mediator of HPH.Advances research on 15-LO/15-HETE may illustrate the mechanism of HPH,and will give some message in looking for a potential clinical target of HPH.