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Sixty general practitioners of in-service training undertaking rotation in gastroenterology department of Qingdao Municipal Hospital from July 2017 to July 2019 were randomized assigned in trial group ( n=30) and control group ( n=30). The problem-oriented mode was applied in trial group and conventional mode was applied in control group for teaching of two typical digestive diseases (upper gastrointestinal bleeding and acute pancreatitis). The formative evaluation and questionnaire survey were used to compare the teaching effects and the results of evaluation were compared with χ 2 test by SPSS 17.0 between two groups. The excellent and good rates of evaluation for the clinical psychological quality, clinical reasoning ability, doctor-patient communication ability and practice-based learning and improvement ability in trial group were significantly higher than those in the control group(χ2=7.38, P=0.03; χ2=12.96, P<0.01; χ2=23.33, P<0.01; χ2=16.14, P<0.01). Questionnaire survey showed more satisfaction towards teaching method in trial group was higher than that in control group(χ2=12.86, P<0.01); and the clinical reasoning ability, learning initiative and self-confidence in trial group were improved more markedly than those in control group(χ2=8.26, P=0.02; χ2=19.48, P<0.01; χ2=21.46, P<0.01). The problem-oriented clinical thinking teaching model demonstrates good effects on clinical comprehensive ability for general practitioners of in-service training during gastroenterology rotation, which is worth further promotion.
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Objective To investigate the expression level of serum miR-486-5p in patients with pancreatic cancer and the value of serum miR-486-5p combined with carbohydrate antigen 19-9 (CA19-9) in predicting the resectability of pancreatic cancer. Methods A total of 60 patients who were diagnosed with pancreatic cancer in Qingdao Municipal Hospital from September 2018 to December 2020 were enrolled, among whom 32 patients had resectable or borderline resectable pancreatic cancer (operable group) and 28 had unresectable pancreatic cancer (non-operable group), and a benign pancreatic disease group with 30 patients and a healthy control group with 44 individuals were also established. Quantitative real-time PCR was used to measure the serum level of miR-486-5p in each group, and the relative expression level of miR-486-5p was calculated to analyze its association with the clinical features of pancreatic cancer, including age, sex, tumor location, tumor size, TNM stage, lymphatic metastasis, and distant metastasis. The Mann-Whitney U test was used for comparison of non-normally distributed continuous variables between two groups, and the chi-square test was used for comparison of categorical variables. The receiver operating characteristic (ROC) curve was plotted, and a binary logistic regression analysis was used to calculate the combined predictive value and then investigate the value of serum miR-486-5p combined with CA19-9 in predicting the resectability of pancreatic cancer. Results The relative expression level of serum miR-486-5p in the operable group [2.16 (1.38~3.30)] and the non-operable group [4.65 (2.80~9.90)] was significantly higher than that in the benign pancreatic disease group [1.01 (0.52~1.53)] and the healthy control group [0.99 (0.24~1.01)] (all P < 0.001). There were significant differences in the number of patients with low or high expression of miR-486-5p between the patients with different TNM stages, presence or absence of lymphatic metastasis, and presence or absence of distant metastasis ( χ 2 =13.765, 5.157, and 6.638, all P < 0.05). Compared with CA19-9 alone, miR-486-5p+CA19-9 had a significantly better value in distinguishing the operable group from the benign pancreatic disease group (area under the ROC curve [AUC]=0.87, 95% confidence interval [ CI ]: 0.760-0.942; with a sensitivity of 81.3% and a specificity of 83.3%), distinguishing the operable group from the healthy control group (AUC=0.92, 95% CI : 0.836-0.970; with a sensitivity of 90.6% and a specificity of 86.4%), and distinguishing the operable group from the non-operable group (AUC=0.94, 95% CI : 0.884-0.998; with a sensitivity of 85.7% and a specificity of 93.7%) ( Z =2.841, 2.510, and 2.387, all P < 0.05), and the optimal cut-off values were 3.12, 3.21, and 6.63, respectively. Conclusion MiR-486-5p can be used as a serum biomarker for the diagnosis of pancreatic cancer, and miR-486-5p combined with CA19-9 has a better clinical value than CA19-9 alone in predicting the resectability of pancreatic cancer in the patients with benign pancreatic diseases and the healthy population.
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Objective To investigate the expression level of serum miR-486-5p in patients with pancreatic cancer and the value of serum miR-486-5p combined with carbohydrate antigen 19-9 (CA19-9) in predicting the resectability of pancreatic cancer. Methods A total of 60 patients who were diagnosed with pancreatic cancer in Qingdao Municipal Hospital from September 2018 to December 2020 were enrolled, among whom 32 patients had resectable or borderline resectable pancreatic cancer (operable group) and 28 had unresectable pancreatic cancer (non-operable group), and a benign pancreatic disease group with 30 patients and a healthy control group with 44 individuals were also established. Quantitative real-time PCR was used to measure the serum level of miR-486-5p in each group, and the relative expression level of miR-486-5p was calculated to analyze its association with the clinical features of pancreatic cancer, including age, sex, tumor location, tumor size, TNM stage, lymphatic metastasis, and distant metastasis. The Mann-Whitney U test was used for comparison of non-normally distributed continuous variables between two groups, and the chi-square test was used for comparison of categorical variables. The receiver operating characteristic (ROC) curve was plotted, and a binary logistic regression analysis was used to calculate the combined predictive value and then investigate the value of serum miR-486-5p combined with CA19-9 in predicting the resectability of pancreatic cancer. Results The relative expression level of serum miR-486-5p in the operable group [2.16 (1.38~3.30)] and the non-operable group [4.65 (2.80~9.90)] was significantly higher than that in the benign pancreatic disease group [1.01 (0.52~1.53)] and the healthy control group [0.99 (0.24~1.01)] (all P < 0.001). There were significant differences in the number of patients with low or high expression of miR-486-5p between the patients with different TNM stages, presence or absence of lymphatic metastasis, and presence or absence of distant metastasis ( χ 2 =13.765, 5.157, and 6.638, all P < 0.05). Compared with CA19-9 alone, miR-486-5p+CA19-9 had a significantly better value in distinguishing the operable group from the benign pancreatic disease group (area under the ROC curve [AUC]=0.87, 95% confidence interval [ CI ]: 0.760-0.942; with a sensitivity of 81.3% and a specificity of 83.3%), distinguishing the operable group from the healthy control group (AUC=0.92, 95% CI : 0.836-0.970; with a sensitivity of 90.6% and a specificity of 86.4%), and distinguishing the operable group from the non-operable group (AUC=0.94, 95% CI : 0.884-0.998; with a sensitivity of 85.7% and a specificity of 93.7%) ( Z =2.841, 2.510, and 2.387, all P < 0.05), and the optimal cut-off values were 3.12, 3.21, and 6.63, respectively. Conclusion MiR-486-5p can be used as a serum biomarker for the diagnosis of pancreatic cancer, and miR-486-5p combined with CA19-9 has a better clinical value than CA19-9 alone in predicting the resectability of pancreatic cancer in the patients with benign pancreatic diseases and the healthy population.
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Objective:To explore the expression of serum miR-224-5p in PDAC and its significance for early clinical diagnosis.Methods:From August 2018 to April 2020, 40 patients with PDAC (11 patients with early PDAC, 29 patients with advanced PDAC), 21 patients with chronic pancreatitis and 40 healthy volunteer controls admitted in Qingdao Municipal Hospital were enrolled. The level of serum miR-224-5p in each group was detected by qRT-PCR method, and the correlation with clinicopathological parameters was analyzed. The receiver-operating characteristic (ROC) curve of miR-224-5p, CA19-9 and miR-224-5p combined with CA19-9 were drawn, and the sensitivity and specificity of the diagnosis were calculated.Results:The serum miR-224-5p levels in early PDAC group, middle and late PDAC group, chronic pancreatitis group and healthy control group were 3.21(2.01, 4.60), 4.70(3.50, 8.26), 1.72(1.02, 2.78) and 1.38(0.89, 2.11), respectively; and the level of serum miR-224-5p in the middle and late PDAC group was significantly higher than that in the early PDAC group, and that in the early PDAC group was significantly higher than that in the chronic pancreatitis group and the healthy control group, and all the differences were statistically significant ( P<0.05). The sensitivity of serum miR-224-5p combined with CA19-9, miR-224-5p, and CA19-9 in the diagnosis of overall PDAC was 95.0%, 85.0% and 67.5%, respectively; and the specificity was 70.0%, 82.5% and 87.5%, respectively. The sensitivity for early PDAC was 90.9%, 72.7% and 63.6%, and the specificity was 85.0%, 72.5% and 87.5%, respectively. MiR-224-5p combined with CA19-9 has the highest specificity in the diagnosis of PDAC. The level of serum miR-224-5p in patients with PDAC was correlated with TNM stage, lymph node metastasis and distant metastasis (all P values <0.05). Conclusions:The expression of serum miR-224-5p was significantly up-regulated in patients with early PDAC, and The level of serum miR-224-5p in patients with PDAC was correlated with TNM stage, lymph node metastasis and distant metastasis. The sensitity of serum miR-224-5p and miR-224-5p combined with CA19-9 for early PDAC diagnosis were superior to CA19-9 alone, which can be used as a potential sensitive biological marker for early screening of PDAC.
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Objective:To evaluate the application of digital memory in abdominal physical examination teaching in cultivating gastroenterology professional postgraduates during the course of clinical rotations.Methods:Sixty clinical specialty postgraduates from Qingdao Municipal Hospital practicing in gastroenterology department from September, 2016 to September, 2018 were selected as subjects, and were randomized into experimental group ( n=30) and control group ( n=30). They were respectively received digital memory mode and traditional mode for clinical practice. The teaching effect was evaluated by comparing the scores of theory examination, skill results and clinical assessment at the end of training stage. Statistical analysis was performed using t test and chi-square test by SPSS 17.0. Results:There was no significant difference in the scores of theory examination and skill operation results between the experimental group and the control group, however, the number of excellent postgraduates and the average scores in clinical assessment were significantly higher than those in control group ( χ2=9.14, P=0.01). Questionnaire survey showed good evaluation of digital memory model in the experimental group. The recognition rate of learning interest and initiative, theoretical knowledge, systematic memory, clinical thinking ability as well as operational skills are 56.67%, 63.33%, 66.67%, 63.33% respectively. Conclusion:The digital memory mode in abdominal physical examination teaching demonstrates good effects on cultivating professional postgraduates' clinical comprehensive ability during the course of rotation in gastroenterology department, which worth further popularization.
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Objective To investigate the significance of "merge" model versus "traditional" model in rotation training for professional clinical postgraduate students in department of gastroenterology. Methods The professional clinical postgraduate students who underwent rotation training in Qingdao Municipal Hospital from July 2012 to July 2016 were enrolled as subjects and were trained with the"merge" model and the "traditional" model, respectively. The two groups of subjects were compared in terms of clinical knowledge , skills , and core competencies . Results The postgraduates trained by the"merge" model had a significantly higher total score of clinical examinations than those trained by the"traditional" model [(92.60±2.52) vs. (83.80±3.14), t=10.93, P<0.01], while there were no significant differences in professional quality and doctor-patient communication between the two groups. Compared with those trained with the"traditional"model, the postgraduates trained by the"merge"model had significantly better understanding of clinical knowledge and clinical thinking ability, diagnosis and treatment skills, and psychological quality (χ2=27.00, 10.23, and 12.21, all P<0.01);however, there was no significant difference in clinical research ability between the two groups (χ2=1.39, P=0.24). Conclusion The model of professional clinical postgraduate training combined with standardized training of residents is superior to the traditional training model, and compared with the "traditional" model, the "merge" model is more beneficial to the training of comprehensive clinical practice abilities and thus holds promise for further application.
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Objective To evaluate the efficacy of confocal laser endomicroscopy(CLE)for the assessment of the grading of gastric intestinal metaplasia(GIM)in vivo.Methods Patients with known GIM underwent CLE(Pentax EC-3870K).The presence of GIM was indentified immediately by the endoscopist during the procedure.The updated Sydney Classifycation System as reference,GIM was subdivided as mild,moderate and severe according to the area of intestinal metaplasia glands and the number of goblet cells.The histological evaluation remained the gold standard for the final diagnosis of GIM.The presence of the dysplasia and the expression of the Ki67 were examined.Results A total of 151 GIM positive areas were found in 58 patients with mild in 92,moderate in 34.and severe in 25 by CLE. One hundred and forty-six GIM areas were examined histopathologically with positive rate of 96.7%(mild in 82,moderate in 36 and severe in 28).The sensitivity and specificity of CLE were 90.2%and 73.9%in diagnosis of mild GIM,69.4 oA and 92.2%in moderate GIM,71.4% and 95.9%in severe GIM.The kappa coefficient of CLE criteria and the histopathological grading for mild,moderate and severe GIM were 0.65,0.63 and 0.70,respectively.The more severe the GIM,the higher the ratio of incomplete GIM,the ratio of dysplasia and the stronger expression of Ki67.Conclusions CLE may offer an instant and reliable diagnosis for GIM with high accuracy.It is helpful in grading of GIM.