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Since 2016, Binzhou Medical University began to carry out the blended learning reform in the organ-systems based curriculum (OSBC) of the experimental class of clinical medicine. Based on the traditional face-to-face teaching method, the blended learning mode of the integrated course of endocrine system under OSBC has been carried out by using the small private online course (SPOC) of MOOC platform of China universities. Many teaching methods have been adopted and formed, including case-based learning (CBL), problem-based learning (PBL), professional bilingual teaching, scientific research teaching and virtual simulation experiment teaching. The evaluation system for the combination of formative and summary assessment has been also adopted in the whole process to assess the students' academic achievement, and the teaching effect as well. The blended learning mode of the integrated course of the endocrine system under OSBC is still in the exploratory stage. There are some limitations, such as too high requirements for teachers' quality, long preparation time for teaching, and great difficulty in supervising online learning. However, the practice of teaching reform that has been carried out shows that it is effective, feasible, and worth popularizing.
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Purpose@#This study was performed to investigate the association of Glasgow prognostic score (GPS), combined positive score (CPS), and clinicopathological characteristics of locally advanced rectal cancer. @*Methods@#Between February 2012 and February 2018, 103 patients with locally advanced rectal cancer treated by neoadjuvant chemoradiotherapy and total mesorectal excision (TME) were retrospectively evaluated. @*Results@#According to the classification of the GPS, 85 (82.5%), 13 (12.6%), and 5 patients (4.9%) were classified as a score of 0, 1, and 2, respectively. Patients were classified into the GPS-low group (GPS of 0, n = 85) and GPS-high group (GPS of 1 or 2, n = 18) with an area under the curve of 0.582 for overall survival (OS). The mean programmed death-ligand 1 (PD-L1) CPS of the whole group was 2.24 (range, 0–70). The PD-L1 CPS of the GPS-high group was higher than the GPS-low group (P < 0.001). Multivariate analysis by Cox proportional hazards model indicated that GPS was associated with OS and diseasefree survival (DFS). Furthermore, PD-L1 CPS was associated with DFS (hazard ratio, 1.050; 95% confidence interval, 1.017– 1.083; P = 0.003). @*Conclusion@#Elevated GPS was related to the PD-L1 CPS. GPS and PD-L1 CPS were associated with the prognosis of locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy followed by TME.
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Objective To evaluate whether any association exists between peripheral blood cell-based inflammatory biomarkers obtained before adjuvant chemoradiotherapy and adverse events ( AEs) and survival of patients with pathological stage Ⅱ/Ⅲ rectal cancer treated by adjuvant chemoradiotherapy. Methods A total of 109 rectal cancer patients were included. The prognostic abilities of neutrophil to lymphocyte ratio ( NLR) , platelet to lymphocyte ratio ( PLR) , lymphocyte to monocyte ratio ( LMR) and neutrophil to albumin ratio ( NAR ) for overall survival ( OS ) were calculated by the receiver operating characteristic ( ROC) curves. Results NAR was associated with the occurrence of grade ≥2 leukopenia (OR=4. 442, 95％ CI:1. 216-16. 221, P<0. 05). The 5-year OS rates of patients with NAR ≥ 0. 055 and patients with NAR<0. 055 were 68. 2％ and 83. 9％, respectively ( P>0. 05) . The 5-year disease-free survival ( DFS) rates of patients with NAR ≥ 0. 055 and patients with NAR<0. 055 were 59. 1％ and 76. 8％, respectively (χ2 =3. 887, P<0. 05 ) . Multivariate analysis by Cox proportional-hazards model showed that NAR was significantly associated with OS (HR=3. 035, 95％ CI:1. 021-9. 019, P<0. 05). Conclusions These results suggest that NAR obtained before adjuvant chemoradiotherapy might serve as an independent biomarker for predicting AEs and prognosis in rectal cancer treated with adjuvant chemoradiotherapy.
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Objective@#To evaluate whether any association exists between peripheral blood cell-based inflammatory biomarkers obtained before adjuvant chemoradiotherapy and adverse events (AEs) and survival of patients with pathological stage Ⅱ/Ⅲ rectal cancer treated by adjuvant chemoradiotherapy.@*Methods@#A total of 109 rectal cancer patients were included. The prognostic abilities of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR) and neutrophil to albumin ratio (NAR) for overall survival (OS) were calculated by the receiver operating characteristic (ROC) curves.@*Results@#NAR was associated with the occurrence of grade ≥2 leukopenia (OR=4.442, 95% CI: 1.216-16.221, P<0.05). The 5-year OS rates of patients with NAR ≥ 0.055 and patients with NAR<0.055 were 68.2% and 83.9%, respectively (P>0.05). The 5-year disease-free survival (DFS) rates of patients with NAR ≥ 0.055 and patients with NAR<0.055 were 59.1% and 76.8%, respectively (χ2=3.887, P<0.05). Multivariate analysis by Cox proportional-hazards model showed that NAR was significantly associated with OS (HR=3.035, 95% CI: 1.021-9.019, P<0.05).@*Conclusions@#These results suggest that NAR obtained before adjuvant chemoradiotherapy might serve as an independent biomarker for predicting AEs and prognosis in rectal cancer treated with adjuvant chemoradiotherapy.
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Objective@#To choose the corresponding teaching methods according to different teaching stage in the teaching of pathology for five-year clinical students, and to analyze the difference of teaching effects between staged-teaching and traditional teaching.@*Methods@#Students were randomly divided into two groups, with 112 in the experimental group and 118 in the control group. Considering that the teaching content in the experimental group contained the general introduction and different sections and students might experience stages such as "knowledge memorizing", "pathology-clinical connection" and "knowledge application", so presentation, assimilation and discussion class (PAD class), blending teaching and flipped classroom were adopted respectively. Examination scores and questionnaire survey were used to evaluate the difference between two teaching ways. SPSS 19.0 was used for data analysis, and t-test and chi-square test were used for inter-group comparison.@*Results@#The pathological average score of students in the experimental group was (78.56±7.172), which was higher than (72.53±8.539) in the control group, with statistically significant difference (t=5.809, P=0.000). According to the questionnaire survey, the teaching effects using different teaching methods in different stages in the experimental group was superior than that in the control group, with statistically significant difference (P<0.01).@*Conclusion@#Using different teaching methods in different stages is beneficial to guide students for truly comprehending the knowledge, applicating appropriate learning methods, and gradually forming their self-learning ability.
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Objective@#To analyze the pathological features and their influence on the clinical outcome of non-nasopharyngeal EBV-associated carcinomas.@*Methods@#One hundred and twenty cases of non-nasopharyngeal EBV-associated carcinoma confirmed by in situ hybridization were identified at Zhejiang Cancer Hospital from January 1, 2006 to May 1, 2018, and the clinicopathological data were collected and analyzed using Kaplan-Meier survival analysis, Cox univariate and multivariate analysis.@*Results@#One hundred and twenty cases were involved in the study; the male to female ratio was 1∶1; patients′ age range was 24 to 89 years (median 50 years). The primary sites were large parotid glands (62 cases), lung(26 cases), stomach(15 cases), and others (oral, oropharynx, larynx, cervix, liver; totally 17cases). Non-nasopharyngeal EBV-associated cancer could be divided into two histological types according to the amount of interstitial lymphocytes: type Ⅰ was "lymphoepithelial-like carcinoma" and rich in stromal lymphocytes; type Ⅱ lacked lymphocytic infiltration. Ninety-eight primary tumor samples could be classified morphologically: 43 cases were as type Ⅰ and 55 cases as typeⅡ; the distribution of type Ⅰ was 57.4% (27/47) in large parotid glands, 20.8% (5/24) in lung, 4/13 in stomach, and 7/14 in other sites. Complete treatment and survival data were obtained for 114 patients. According to the TNM staging criteria of WHO, 52 patients were at early stages (Ⅰ-Ⅱ) and 62 were at advanced stages (Ⅲ-Ⅳ); 102 patients underwent surgery. Seventy-four patients received adjuvant chemotherapy before or after surgery, and 52 patients received local radiotherapy. Kaplan-Meier survival analysis showed that patients with type Ⅱ EBV-associated carcinoma had a worse prognosis than patients with type Ⅰtumors (P=0.010 2). In addition, vascular invasion(P=0.021 8),neural recidivism(P=0.000 1),advanced stage(P=0.017 1),lymph node metastasis (P=0.005 0) and chemotherapy (P=0.013 2) were poor prognostic factors; female patients had better survival than male (P=0.028 4). Cox multivariate regression analysis found that lymph node metastasis (95%CI: 1.489-13.830, P=0.007 6) and neural recidivism (95%CI: 1.228-6.544, P=0.014 7) were independent adverse prognostic factors. Cox multivariate regression analysis after stratification by site revealed that radiotherapy was a preferable prognostic factor for EBV-associated carcinoma of the large salivary glands (95%CI: 0.003-0.569, P=0.016 8).@*Conclusion@#EBV associated carcinoma can be divided into two types, for which type Ⅰ was with abundant interstitial lymphocytes and type Ⅱ was lack of interstitial lymphocytes. TypeⅡ EBV-associated carcinoma has a worse prognosis than type Ⅰ. Radiation therapy can prolong the survival time of patients with primary EBV-associated carcinoma of large salivary glands.
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Objective To choose the corresponding teaching methods according to different teaching stage in the teaching of pathology for five-year clinical students,and to analyze the difference of teaching effects between staged-teaching and traditional teaching.Methods Students were randomly divided into two groups,with 112 in the experimental group and 118 in the control group.Considering that the teaching content in the experimental group contained the general introduction and different sections and students might experience stages such as "knowledge memorizing","pathology-clinical connection" and "knowledge application",so presentation,assimilation and discussion class (PAD class),blending teaching and flipped classroom were adopted respectively.Examination scores and questionnaire survey were used to evaluate the difference between two teaching ways.SPSS 19.0 was used for data analysis,and t-test and chi-square test were used for inter-group comparison.Results The pathological average score of students in the experimental group was (78.56 ± 7.172),which was higher than (72.53 ± 8.539) in the control group,with statistically significant difference (t=5.809,P=0.000).According to the questionnaire survey,the teaching effects using different teaching methods in different stages in the experimental group was superior than that in the control group,with statistically significant difference (P＜ 0.01).Conclusion Using different teaching methods in different stages is beneficial to guide students for truly comprehending the knowledge,applicating appropriate learning methods,and gradually forming their self-learning ability.
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Binzhou Medical University began to launch an experimental class of the clinical medical science in 2012 aimed at the undergraduates only.In this class,the ‘centered on the subject’ teaching mode was transformed into the ‘ organ-systems based curriculum’ or ‘ OSBC’ for short.Under the OSBC,the morphology combined the following three subjects:anatomy,hyphology and pathematology into an organic unity.This new subject pays more attention to the relationship among the morphology' s characters,the functional situation and the change of the pathogenesis.A variety of forms such as combining theories with experiments,the case-oriented teaching,translocation type teaching and bilingual teaching are used.To evaluate the students' performance more comprehensively,and to judge the teaching quality more objectively,the formative and summative assessments are used together.The morphology under this new mode is still on its exploration stage.Though with the shortage of corresponding teaching materials and the qualified teachers,it bears fruit and is feasible.
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Objective To observe the clinical effects of radiotherapy and/or chemotherapy in the treatment of nasal and Waldeyer ring natural killer (NK)/T cell lymphoma and to analyze the prognostic factors.Methods Between January 20,2000 and December 21,2010,109 patients with nasal NK/T cell lymphoma and 21 patients with Waldeyer ring NK/T cell lymphoma were admitted to our hospital; the diagnosis was confirmed by immunohistochemistry.According to the Ann Arbor staging system,116 patients were classified as stage Ⅰ E,and 14 as stage Ⅱ E.Thirty patients received radiotherapy alone;2 patients received chemotherapy alone; 98 patients received radiochemotherapy.Results The follow-up rate was 100％.Seventy-eight patients were followed up for at least 5 years.The complete remission (CR) rate was 89.2％ in all patients.The CR rates of stage Ⅰ E patients and stage Ⅱ E patients were 88.8％ and 92.9％,respectively (x2 =0.02,P =0.837).The CR rates of patients receiving radiotherapy alone and patients receiving radiochemotherapy were 86％ and 96％,respectively (x2 =1.44,P =0.230).The five-year overall survival (OS) rate and disease-free survival (DFS) rate of all patients were 58.0％ and 57.2％,respectively.The five-year OS rates of stage Ⅰ E patients and stage Ⅱ E patients were 60.6％ and 36.3％,respectively (x2 =0.25,P =0.615) ;the five-year DFS rates of stage Ⅰ E patients and stage Ⅱ E patients were 59.7％ and 36.3％,respectively (x2 =0.21,P =0.648).The five-year OS rates of patients receiving radiotherapy alone and patients receiving radiochemotherapy were 70.0％ and 48.4％,respectively (x2 =0.01,P =0.933) ; the five-year DFS rates of patients receiving radiotherapy alone and patients receiving radiochemotherapy were 65.6％ and 48.4％,respectively (x2 =0.09,P =0.764).The grade 3-4 toxicity rates of radiotherapy alone and radiochemotherapy were 6.7％ and 54.1％,respectively (x2 =41.38,P=0.002).The radiation dose to the primary lesion and Eastern Cooperative Oncology Group (ECOG) score were correlated with OS (x2 =3.1 8,P =0.005 ; x2 =2.97,P =0.008).Conclusions The clinical effect of radiochemotherapy is similar to that of radiotherapy alone in the patients with stage ⅠE and ⅡE nasal and Waldeyer ring NK/T cell lymphoma,but radiochemotherapy has higher toxicity than radiotherapy alone.The radiation dose to the primary lesion and ECOG score are the influential factors for OS.
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The local recurrence rote is high after operation without chemotherapy or radiotherapy for lo-cally advanced rectal cancer. Recent random-control clinical phase Ⅲ studies suggest that the neoadjuvant ther-apy for locally advanced rectal cancer can improve local control rate obviously and ameliorate survival rate for pathologically complete response patients. In Europe and America, the neoadjuvant therapy has been regarded as the standard treatment for locally advanced rectal cancer. However the choice of chemotherapy agents, the application of hyperthermia and so on will be still requested further clinical trails.
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Objective To study the expression and the significance of phosphorylated P38(p-P38) and uPA in breast cancer tissues.Methods Immunohistochemistry(S-P) was used to test the protein expression of p-P38 and uPA in 60 specimens from 50 patients with breast cancer.Western blotting was adopted to detect the protein expression of p-P38 and uPA in breast cancer cells and uPA protein expression after incubation with SB203580,an specific inhibitor of P38 MAPK blocked P38 MAPK signaling pathway.Results The positive rates of p-P38 protein and uPA protein in breast cancer tissues were 56.7%and 60.0% respectively.The protein expression level of p-P38 and uPA in breast cancer tissues was significantly higher than that in adjacent normal tissues(P
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Purpose:To investigate the comprehensive treatment value on the malignant Tumor of lung transference.Methods:From January, 1993 to January, 1999, our hospital accepted 75 cases malignant tumor of lung transference in all. It was proved that the primary foci were lungs transference. There are 34 male cases and 41 female cases in the group. The average age is 47 years old the ages(between 27 to 71).Single primary foci reach 12 cases, and multiprimary foci reach 63 cases. Pure operation removals are 4 cases; operation with chemotherapy are 2 cases, and 6 cases are treated with plan radiotherapy before operation with chemotherapy after operation; 17 cases, radio and chemotherapy; 10 cases, only radiotherapy; 36 cases, only chemotherapy. 59 cases in 75 take additional traditional Chinese drugs.Results:The effective rate of nasopharyngeal carcinoma in lung transferring tumor (CR+PR) is 71.4% (20/28) MST is 9.5 month; the effective rate of lung cancer (CR+PR) is 53.3% (8/15) MST 8.5 month; breast cancer, 68.7% (22/32) MST 21 month. The total effective rate of this group (CR+PR) is 66.7% (50/75), CR rate is 36.04%, PR rate is 30.7%, NC rate is 25.3%, PD rate is 8%.Total MST is 13.5 month. Traditional Chinese medicine (TCM) can help the radiotherapy and chemotherapy in the function.Conclusions:The group of cases are for retrospect investigation, there are many disease type, but not many in each type, the analysis of the result shows that they are sensitive to radiotherapy and chemotherapy, the radiotherapy and chemotherapy is a kind of supplementary treatment to low degree malignant tumor of lung transference, it has definite clinical meaning if assisting with traditional Chinese medicine. [
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Purpose: To evaluate the efficacy and the side effects of 3 D-conformal radiotherapy for malignant thoracic tumor. Methods: Between September 1999 and August 2002, 36 patients with malignant thoracic tumor were treated with 3D-conformal radiotherapy. Twenty-two patients had primary lung cancer, 12 patients had metastatic lung cancer, and 2 patients had malignant mediastinal tumor. All 36 patients were pathologically confirmed. Squamous cell carcinoma 16 cases, adenocarcinoma 15 cases, small cell carcinoma 2 cases, embryonal carcinoma 1 case, malignant thymoma 1 case and sarcoma 1 case. For the primary tumor, conventional radiotherapy was first used to 50Gy/25F/5W, followed by 3D-conformal radiotherapy 16-20Gy(4Gy per fraction, 3 fractions per week) with MLC or cone from 5 ~6 non coplanar or coplanar static ports. For metastatic tumor, using arc therapy to only 28-40Gy(4Gy per fraction, 3 fractions per week, 7-10 fractions) with cone from 1 ~ 4 arcs. Tumor volumes from 1. 85 cm3 to 104. 61 cm3 with a median of 24. 96 cm3 in 3D-CRT. Results: To evaluate the effects, thoracic CT scan was taken two months after completion of 3D-conformal radiotherapy. In 34 evaluated patients, 13 cases obtained CR, 14 PR, 5 NC, and 2PD. The overall 1 and 2-year survival rates were 74. 1% and 38.4%. Toxicity consisted of grade 1 acute radiation pneumonitis in 17 patients, grade 2 in 10 patients, grade 3 in 1 patients, and 2 patients dead of radiation pneumonitis ( with non coplanar technique), late complication was radiation pulmonary fibrosis, grade 1 in 20 cases, grade 2 in 8 cases. Conclusions: 3D-conformal radiotherapy as complement of conventional external beam radiotherapy for malignant thoracic tumor can obtain better short-term effects, although the survival is yet to be investigated. But attention must be given to the irradiation technique, the irradiation volume should not be too large and beams angles appropriately adjusted to avoid excessive irradiated volume in normal lung.