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Objective To explore the clinical characteristics and related factors of Helicobacter pylori (Hp) infection in gastric stump lesion.Methods Eighty-nine patients with subtotal gastrectomy gastrointestinal symptoms underwent gastroscope,the clinical data were retrospectively analyzed.The relationship between gastric Hp infection and different operation reasons,different operation,different degree of inflammation,postoperative time,the existence of bile reflux was assessed.Results There were 29 cases of gastric Hp infection,the positive rate of Hp was 32.6％ (29/89).There were no significant difference between different preoperative disease such as duodenal ulcer (bleeding/perforation),gastric ulcer (bleeding/perforation),gastric cancer,leiomyosarcoma and HP infection (P ＞0.05).There was no significant different positive rate of Hp infection between Billroth Ⅰ and Billroth Ⅱ after operation (P ＞0.05).The rate of Hp infection increased with the degree of inflammation (moderate to severe) in gastric stump and anastomotic inflammation.There were significant difference [gastritis severity of inflammation:27.3％ (12/44) vs.57.1％ (16/28),anastomotic inflammation:25 ％ (10/40) vs.50％ (18/36),P ＜ 0.05] ;there was significant difference between two groups of more than 10 years [43.9％ (18/41)] and less than 10 years [22.9％ (11/48)] of Hp infection rate (x2 =4.433,P =0.035) ; the positive rate of Hp infection in group of no bile reflux under gastroscopy were higher than the group of bile reflux,there was significant difference [22.2％ (10/45) vs.43.2％ (19/44),x2 =4.449,P =0.035).Multivariate Logistic regression analysis showed that,the degree of inflammation (severe) and bile reflux was associated with gastric Hp infection,inflammation (severe) was the dominant risk factor [OR =1.24,95％ CI:1.22-1.56,P =0.01],with bile reflux were protective factors [OR =0.76,95％CI:0.58-0.99,P =0.04].Conclusions Hp infection can promote and aggravate the gastric remnant mucosa inflammation,Hp infection and bile reflux can lead to gastric mucosa pathological changes,there can be independence pathogenic factors,also can cause at the same time,regulate the eradication of residual gastric Hp infection is very important,also deal with the residual stomach regular line of gastroscope and Hp,histologic examination.
RESUMEN
Objective To evaluate the efficacy of applying problem based learning (PBL) combined with traditional teaching in clinical internship in department of gastroenterology.Methods Totally 60 full-time medical undergraduates of clinical medicine in clinical internship in department of gastroenterology of the Second Hospital of Baoding were randomly divided into PBL group (n=30) and traditional group (n=30).Practical effect of the different modes was evaluated by questionnaire and examination resuits.Data were analyzed by SPSS 15.0.Enumeration data were compared between groups using x2 test and measurement data were manifested (x-) ± s with P ＜ 0.05 signifying significant difference.Results PBL group was superior to traditional group in comprehensive analysis capabilities,motivation to learn and learning outcomes with statistically significant differences between the two groups (P values were 0.001,0.007 and 0.005).Concerning stimulating students' interest and satisfaction of the teaching mode,the difference between the two groups was not statistically significant (P ＞ 0.05).PBL group was superior to traditional group in the pre-class preparation,full and accurate expression of views in classroom and clinical logic,with statistically significant differences between the two groups (P values were 0.002,0.000 and 0.002).There was no difference in communicative abilities with patients between the two groups (P=0.118).PBL group had higher scores than traditional group in the quiz,case analysis and overall performance,with statistically significant differences between the two groups (P values were 0.005,0.045 and 0.013).Concerning score of glossary and multiple-choice questions,differences between two group were not statistically significant (P＞0.05).Conclusions PBL combined with traditional teaching method is suitable for internship teaching in the department of gastroenterology for full-time undergraduates of clinical medicine.PBL can improve students' clinical comprehensive analysis capabilities and helps to develop the ability to take the initiative to solve practical problems.