On construction of learning guidance model for undergraduates in medical schools—an empirical analysis based on PLS-SEM model / 中华医学教育探索杂志

Objective:To explore the learning guidance model and its influencing factors of undergraduates in medical schools.Methods:Based on the developmental learning guidance theory, 1 117 undergraduates from two undergraduate medical universities were selected as the research objects, through questionnaire surveys to collect their knowledge learning, curriculum learning and other core variables, and balanced guidance, compound guidance and other outcome variables, using Smart PLS 3.0 to test the validity of the samples.Results:There were statistical significance in the path relationship affecting the core variables and the outcome variables of the learning guidance model, P<0.05, indicating that the influencing factors of the learning guidance model had a significantly positive effect on the learning guidance model construction. Conclusion:Constructing a "balanced-compound-special" learning guidance model suitable for undergraduates' learning activities in medical universities provides a reference for the application and promotion of learning guidance model in medical undergraduate stage.

Clinical analysis of 31 cases of 2019 novel coronavirus infection in children from six provinces (autonomous region) of northern China / 中华儿科杂志

Objective@#To analyze the epidemiological history, clinical manifestations, treatment and the short-term prognosis of 31 cases of 2019 novel coronavirus(2019-nCoV) infection in children from six provinces (autonomous region) in northern China.@*Methods@#A retrospective analysis of the epidemiological history, clinical symptoms, signs, laboratory examinations, chest imaging, treatment and the short-term prognosis of 31 cases of 2019-nCoV was conducted. The patients were diagnosed between January 25th, 2020 and February 21st, 2020 in 21 hospitals in 17 cities of six provinces(autonomous region) of Shaanxi, Gansu, Ningxia, Hebei, Henan and Shandong.@*Results@#The age of the 31 children with 2019-nCoV infection was 7 years and 1 month (6 months -17 years). Nine cases (29%) were imported cases. Other 21 cases (68%) had contact with confirmed infected adults. One case (3%) had contact with asymptomatic returnees from Wuhan. Among the 31 children, 28 patients (90%) were family cluster cases. The clinical types were asymptomatic type in 4 cases (13%), mild type in 13 cases (42%), and common type in 14 cases (45%). No severe or critical type existed. The most common symptom was fever (n=20, 65%), including 1 case of high fever, 9 cases of moderate fever, 10 cases of low fever. Fever lasted from 1 day to 9 days. The fever of fifteen cases lasted for ≤3 d, while in other 5 cases lasted > 3 d. Other symptoms included cough (n=14, 45%), fatigue (n=3, 10%) and diarrhea (n=3, 9%). Pharyngalgia, runny nose, dizziness, headache and vomiting were rare. In the early stage, the total leukocytes count in peripheral blood decreased in 2 cases (6%), the lymphocytes count decreased in 2 cases (6%), and the platelet count increased in 2 cases (6%).Elevation of C-reactive protein (10%, 3/30), erythrocyte sedimentation rate(19%,4/21), procalcitonin(4%,1/28), liver enzyme(22%, 6/27) and muscle enzyme (15%, 4/27) occurred in different proportions. Renal function and blood glucose were normal. There were abnormal chest CT changes in 14 cases, including 9 cases with patchy ground glass opacities and nodules, mostly located in the lower lobe of both lungs near the pleural area. After receiving supportive treatment, the viral nucleic acid turned negative in 25 cases within 7-23 days. Among them, 24 children (77%) recovered and were discharged from hospital. No death occurred.@*Conclusions@#In this case series, 2019-nCoV infections in children from six provinces (autonomous region) in northern China are mainly caused by close family contact. Clinical types are asymptomatic, mild and common types. Clinical manifestations and laboratory examination results are nonspecific. Close contact history of epidemiology, nucleic acid detection and chest imaging are important bases for diagnosis. After general treatment, the short-term prognosis is good.

Effect of previous intestinal resection on postoperative anastomotic fistula in Crohn′s disease with intestinal resection and anastomosis / 中华普通外科杂志

Objective:To explore the effect of previous intestinal resection on anastomotic fistula within 30 days after surgery in Crohn′s disease.Methods:The clinical data from 92 Crohn′s disease patients who underwent intestinal resection and anastomosis at the Department of General Surgery in Shanghai Ninth People′s Hospital, Shanghai Jiaotong University School of Medicine from Jan 2016 to Sep 2019. Patients were divided into no previous intestinal resection group ( n=45) and previous intestinal resection group ( n=47). The relationship between previous intestinal resection and postoperative anastomotic leak in Crohn′s disease patients with intestinal resection and anastomosis was analyzed. Results:A total of 11 cases (12% leak rate) underwent postoperative anastomotic leak. There were 2 leaks in patients with no previous history of intestinal resection, while 9 leaks in patients with previous bowel resection (χ 2 =4.722, P=0.03). The OR of the postoperative anastomotic leak in Crohn′s disease patients with previous intestinal resection compared with no previous intestinal resection group was 5.092 (95% CI: 1.035-25.048). Patients with 1 previous resection (24 cases) had a leak rate of 13%, whereas patients with >1 previous resection episodes (23 cases) had a leak rate of 26%. The number of previous resection episodes correlated with an increasing risk for clinical anastomotic leak (correlation coefficien r=0.995). Conclusions:Previous intestinal resection is an independent risk factor for ensuing postoperative anastomotic leak in Crohn′s disease patients with intestinal resection and anastomosis.

The time-dependent evolution spectrum of acute care surgery patients: a real world study based on 23 795 electronic admission medical records / 中华急诊医学杂志

Objective One of the major challenges to emergency department is to provide high quality and time sensitive service under limitation of human/material resources,along with patients population with extremely complex conditions.We presented a study that based on a big data got from real world and used wavelet transform technique to analyze time-dependent diseases spectrum patterns and evolution patterns,which will provide solid methodological support for optimizing resources configuration for acute care surgery service.Methods Record data of patients admitted to acute care surgery from 2007-2014 were collected by using data management tool (Avaintec,Helsinki,Finland).The data were cleansed and were transformed to continuing spectrum according to time series of admission time points (per 9 hours).Matlab was used for wavelet transform,and applied five levels of wavelet decomposition and calculated the best decomposition levels by K-mean algorithm for each level.Then we used aprori algorithm for data mining (frequent patterns mining).Results A total of 23 795 cases were enrolled and acute abdomens were made up biggest proportion of admission.Meanwhile,it is found that the spectrum of acute care surgery admission frequency was a complex rising sequence.After wavelet decomposition,signal wave A reflexed trends evolution in a given time scale,and noise wave D reflexed minutia at relevant time scale.In another words,a principal wave A1 represented fluctuation at a cycle of 16 days.Noise wave D1 reflected intensity level in this 16 days' cycle.For example,the 5 · 12 episodes of massive earthquake in 2008 were included in the study,it is found that a significant noise wave at D3 level that indicated a 4 days' cycle.Clinically,it indicated explosive admissions to acute care surgery in 4 days.Conclusions The admission spectrum to acute care surgery is a phenomenon of multi-scale.Based on wavelet decomposing,we can easily analyze the rule of admission spectrum from electronic records of patients and can be used for optimization the emergency medicine resources.

Management of huge defects following extensive abdominal wall neoplasm resection: classification and immediate reconstruction / 中华普通外科杂志

Objective To evaluate the effect of extensive resection and immediate reconstruction based on classification of abdominal wall defects for patients with abdominal wall neoplasms.Methods From Jan 1999 to May 2016,112 patients with abdominal wall neoplasms were treated with extensive resection,including Type Ⅰ (n =20),Type Ⅱ (n =45) and Type Ⅲ (n =47).Immediate abdominal wall reconstruction comprised primary sutures or free skin graft for Type I defects,component separation (CST) with or without a prosthetic or biological mesh reinforcement for Type Ⅱ defects and pedicled or vascularized myocutaneous flap with or without a prosthetic or biological mesh or prosthetic + biological mesh with or without CST for Type Ⅲ defects.Results The average follow up was 76.86 ± 21.22 months,3 patients developed flap necrosis,9 patients suffered from wound infection.Local recurrence was observed in 20 patients,35 patients developed distant metastasis.Conclusions The optimal strategy based on the abdominal wall defect classification for immediate reconstruction of huge abdominal wall defects is safe and effective after resection of abdominal wall neoplasms.

Risk factors of gas-related complications in peroral endoscopic myotomy for achalasia / 中华消化内镜杂志

Objective To investigate the risk factors and incidence of gas-related complications in peroral endoscopic myotomy for easophageal achalasia.Methods Clinical data of 216 patients with achalasia treated by peroral endoscopic myotomy from August 2011 to November 2013 were collected.Potential risk factors for gas-related complications were analyzed by univariate and multivariate analysis.Results The incidence of gas-related complications was 10.2％ (22/216).Univariate analysis showed risk factors for complications were Sigmoid type esophagus,simple longitudinal incision for tunnel entry,tunnel width ≤3 cm,degree of myotomy,and operation time (P ＜ 0.05),while multivariate analysis showed the risk factors were Sigmoid type esophagus,simple longitudinal incision for tunnel entry,and tunnel width ≤3 cm(P ＜ 0.05).Conclusion Simple longitudinal incision for tunnel entry,tunnel width≤3 cm and sigmoid type esophagus are risk factors of gas-related complications in POEM,while myotomy depth is not.

Clinical efficacy of submucosal tunnel endoscopic resection for upper gastrointestinal muscularis propria submucosal tumors / 中华消化外科杂志

Objective To evaluate the clinical efficacy of submucosal tunnel endoscopic resection (STER) for upper gastrointestinal muscularis propria submucosal tumors (SMTs) with diameter ≥3.5 cm.Methods The clinical data of 14 patients with SMTs≥3.5 cm who were admitted to the Second Xiangya Hospital of Central South University between October 2011 and July 2014 were retrospectively analyzed, including 13 patients with tumor at esophagus and 1 patient with tumor at cardia.All patients underwent STER and the observed indexes included operation tine, tumor location and diameter, results of pathological examination and occurrence of postoperative complications.All patients were followed up regularly at the out-patient department including reexamination of gastroscopy, endoscopic ultrasonography (EUS) and computed tomography (CT) till August 2014.Measurement data with normal distribution were presented as average (range).Results All the 14 patients underwent STER successfully with mean operation time of 83 minutes (range, 60-160 minutes).Fourteen tumors were exited, with 13 located at esophagus and 1 at gastric cardia.En bloc resection was achieved in 13 patients and the tumors were extracted through the tunnel.The tumor in the remaining 1 patient was large with a diameter of 5.3 cm and close to trachea, it was extracted by 2 pieces.The average diameter of 14 tumors extracted was 4.1 cm and postoperative pathological examination confirmed the tumors as leiomyomas.Three patients had postoperative complications, subcutaneous emphysema occurred in 1 patient and retrosternal pain in 1 patient.One patient suffered mucosal laceration and recovered after a metal stent was inserted for 2 weeks.The average duration of postoperative hospital stay was 6.4 days (range, 4.0-8.0 days).All patients were followed up for a median time of 11.5 months (range, 1.0-24.0 months) with no recurrence.Conclusion STER is a safe and effective method for SMTs with diameter≥3.5 cm.

Peroral endoscopic full-thickness myotomy for severe esophageal achalasia / 中华消化内镜杂志

Objective To evaluate the efficacy and safety of peroral endoscopic full-thickness myotomy for patients with severe esophageal achalasia.Methods A total of 64 patients with severe achalasia,whose Eckardt's score ≥6,esophageal diameter ≥6 cm or with S-type esophagus,were treated by peroral endoscopic full-thickness myotomy.Data of Eckardt's score,complications,recurrence,gastroscopy and esophageal barium radiography were collected before and during periodical follow-up.Results All the 64 patients underwent peroral endoscopic myotomy (POEM) successfully,mean operation time was 55 minutes,average length of tunnel and myotomy were 14.1 cm and 10.6 cm respectively,and full-thickness myotomy was performed beyond 6 cm near esophagogastric junction.Symptoms remitted in all patients.Eckardt's score decreased significantly [pre-treatment VS post-treatment,(7.4 ± 1.5) VS (0.6 ± 0.8),P ＜ 0.001],the diameter of esophageal lumen reduced[pre-treatment VS post-treatment,(59.7 ± 13.0) mm VS (31.4 ±3.3) mm,P ＜ 0.001),and the diameter of cardia increased [pre-treatment VS post-treatment,(15.6 ± 10.1) mm VS (33.4 ± 8.9) mm,P ＜ 0.001].Complications occurred in 9.4％ (6/64) of the cases,gas-related complications was 6.3％ (4/64).Treatment success was achieved in 98.4％ cases (63/64) with a follow-up of 6 ～20 months (median 12.3 months),with no recurrence cases.Conclusion Peroral endoscopic full-thickness myotomy is an effective and safe method for severe achalasia.Long-term efficacy and complications need further assessment.

Peroral Endoscopic Myotomy for Esophageal Achalasia:Analysis of 216 Cases / 胃肠病学

Background:There have been several studies about peroral endoscopic myotomy( POEM)for treating esophageal achalasia( EA). Although the feasibility,safety and effectiveness of POEM have been demonstrated,comparative studies of full-thickness and circular muscle myotomy were rare. Aims:To evaluate the efficacy and safety of POEM for treating patients with EA. Methods:A total of 216 patients with EA admitted from Aug. 2011 to Nov. 2013 at the Second Xiangya Hospital of Central South University were treated with POEM,of whom 133 received full-thickness myotomy and 83 received circular muscle myotomy. Data about Eckardt ’s score, diameter of esophageal lumen, intra- and post-operative complications and recurrence before and/or during periodical follow-up were collected,and the efficacy of full-thickness and circular muscle myotomy was compared. Results:All the 216 patients successfully underwent POEM with an average operation time of 59. 1 minutes. Average length of tunnel and myotomy were 13. 3 cm and 10. 1 cm,respectively. Symptoms remitted in all of the 216 patients,Eckardt’s score decreased significantly,diameter of esophageal lumen was reduced(pre-treatment vs. 6 months after treatment,53. 7 mm vs. 30. 8 mm,P0. 05). Conclusions:POEM is an effective and safe method for treating EA. Full-thickness myotomy did not increase the operation time and procedure-related complications, however,its long-term efficacy and complications need to be further assessed.

Advances of treatment for angioimmunoblastic T-cell lymphoma / 白血病·淋巴瘤

Angioimmunoblastic T-cell lymphoma (AITL) is a rare subtype of peripheral T-cell lymphoma (PTCL) with aggressive behaviour and poor prognosis.Due to the rarity of the disease,few prospective controlled randomized clinical trials were conducted,and the standard therapeutic option for AITL has not been established.Although conventional anthracycline-based chemotherapy achieves response rates of up to 50 ％,most of the patients relapse,the median survival time and overall survival rate are unsatisfactory.Recent studies have demonstrated that hematopietic stem cell transplantation and cyclosporine show promising efficacy in the treatment of AITL.This current review mainly focused on the advance of treatment for AITL.

Clinical significance of TGF-β1 and VEGF expression in tissues of nasal inverted papilloma / 中国基层医药

ObjectiveTo investigate the clinical significance of transforming growth factor β1 (TGF-β1)and vascular endothelial growth factor (VEGF) expression in tissues of nasal inverted papilloma (NIP).MethodsThe clinical data of patients with NIP underwent surgical resection were retrospectively analyzed.The TGF-β1 and VEGF expression in NIP tissues and nasal polyps tissues were detected by immunohistochemistry method.100 patients with NIP were divided into benign lesions,atypical hyperplasia and malignant group according to result of pathological diagnosis,the nasal polyps was used as the control group.ResultsThe positive expression rate of TGF-β1 and VEGF in the NIP group were 46.0％ and 32.0％,compared with the control group the differences were significant(all P ＜ 0.05 ).In different pathological groups,the results of TGF-β1 and VEGF expression were malignant group ＞ atypical hyperplasia ＞ benign lesions.The positive expression rate of TGF-β1 and VEGF in the NIP group had significantly positive correlation(P ＜ 0.05).ConclusionThe TGF-β1 and VEGF expression were closely related to the the occurrence,development and malignant of NIP.TGF-β1 was highly expressed in the NIP tissues,and could increase the expression of VEGF and promote the formation of neovascularization of NIP.

Safety and efficacy of carbon dioxide insufflation during colonoscopy / 中南大学学报(医学版)

OBJECTIVE@#To assess the safety and efficacy of carbon dioxide (CO(2)) in colonoscopy examination.@*METHODS@#We randomized 349 patients to undergo colonoscopy with insufflation of air (n=175) or CO(2) (n=174). At colonoscopy, p (ET CO(2)) was observed at 4 time points: before the exam, arrived caecum, back rectum, and after the exam. Patient's experience of pain in the end and after the examination at 1, 3, 6, and 24 h was registered using a visual analog scale (VAS). Sedation was not used routinely.@*RESULTS@#The groups were similar in age, sex, inspection time, and caecal intubation rate (all P>0.05). There were no significant differences in p (ET CO(2)) values between the 2 groups before and after the procedure (all P>0.05). VAS scores in the CO(2) group at various time points after the examination were significantly lower than those in the air group (all P<0.05). The percent of VAS scores of 0 in the CO(2) group after 1, 3, 6, and 24 h was significantly higher than that in the air group (all P<0.01).@*CONCLUSION@#Injection of CO(2) for colonoscopy will not cause CO(2) retention, and it may significantly reduce the pain, which is safe and effective.

Endoscopic band ligation versus endoscopic hemoclip placement for bleeding due to Dieulafoy lesions in the upper gastrointestinal tract / 中南大学学报(医学版)

OBJECTIVE@#To compare the hemostatic efficacy and safety of endoscopic band ligation(EBL) and endoscopic hemoclip placement(EHP) for bleeding due to Dieulafoy lesions in the upper gastrointestinal tract.@*METHODS@#Between February 2004 and October 2006, 34 patients with Dieulafoy lesions in the upper gastrointestinal tract were prospectively enrolled,including 22 cases of lesions in the stomach,10 in gastrointestinal stoma,and 2 in duodenal, who were randomly assigned to undergo EBL (n=16) or EHP (n=18). The therapeutic results of these 2 groups were compared.@*RESULTS@#The median number of O-ring or hemoclip required in the EBL group and the EHP group was similar. The rate of primary haemostasis,recurrent bleeding,transfer into surgery, complications, and average stay and blood transfusion requirements did not significantly differ in the 2 groups (P>0.05).@*CONCLUSION@#In this study, no significant differences are detected in the efficacy and the safety of EBL vs. EHP for bleeding due to Dieulafoy lesions in the upper gastrointestinal tract.