Exploration and application of "internet + mobile medicine" in the process management of standardized residency training of obstetrics and gynecology / 中华医学教育探索杂志

Objective:To assess the application effect of "internet + mobile medicine" on the process management of standardized residency training of obstetrics and gynecology.Methods:A total of 43 teachers including 14 administrators and 29 instructors who were not directly responsible for management, and 41 residents who participated in the standardized training in our base were enrolled as research objects. The data of process management were sorted by internet technology, and combined with personal wishes and casting lots, the residents were divided into two groups: the control group ( n=21) adopted traditional way while the observation group ( n=20) used mobile medicine for process management. By conducting multi-dimensional questionnaire and data comparison, we analyzed the evaluation of teachers and residents, the scores of different stage of residents, and the satisfaction of cervical cancer postoperative patients to medical care under different process management mode. SPSS 22.0 software was used for t test and chi-square test. Results:The application of "internet + mobile medicine" in standardized residency training obtained positive evaluation both by teachers and residents, and the ratio of considering "necessary" to reform the traditional residency training management mode in residents [95.1%(39/41)] and administrators [92.9%(13/14)] were both higher than that in instructors [62.1%(18/29)]. And 78.6%(11/14) of the administrators believed that cloud data management took less time. After 6 months of process management by different modes, the clinical diagnosis and treatment ability and skill operation ability scores of observation group were higher than those of control group [(93.6±5.6) vs. (89.4±5.7); (89.6±8.8) vs. (84.0±8.7)]. The "overall medical satisfaction rate" of cervical cancer patients was relatively high in both groups [100%(30/30) vs. 93.3%(28/30)], and the "very satisfied rate" of patients in the mobile medical group was higher than that in the traditional group [86.7%(26/30) vs. 63.3%(19/30)].Conclusion:The application of "internet + mobile medicine" is conducive to strengthening the process management and optimizing the quality of standardized residency training management of obstetrics and gynecology.

Adjuvant chemotherapy versus adjuvant concurrent chemoradiotherapy after radical surgery for early-stage cervical cancer: a randomized, non-inferiority, multicenter trial / 医学前沿

We conducted a prospective study to assess the non-inferiority of adjuvant chemotherapy alone versus adjuvant concurrent chemoradiotherapy (CCRT) as an alternative strategy for patients with early-stage (FIGO 2009 stage IB-IIA) cervical cancer having risk factors after surgery. The condition was assessed in terms of prognosis, adverse effects, and quality of life. This randomized trial involved nine centers across China. Eligible patients were randomized to receive adjuvant chemotherapy or CCRT after surgery. The primary end-point was progression-free survival (PFS). From December 2012 to December 2014, 337 patients were subjected to randomization. Final analysis included 329 patients, including 165 in the adjuvant chemotherapy group and 164 in the adjuvant CCRT group. The median follow-up was 72.1 months. The three-year PFS rates were both 91.9%, and the five-year OS was 90.6% versus 90.0% in adjuvant chemotherapy and CCRT groups, respectively. No significant differences were observed in the PFS or OS between groups. The adjusted HR for PFS was 0.854 (95% confidence interval 0.415-1.757; P = 0.667) favoring adjuvant chemotherapy, excluding the predefined non-inferiority boundary of 1.9. The chemotherapy group showed a tendency toward good quality of life. In comparison with post-operative adjuvant CCRT, adjuvant chemotherapy treatment showed non-inferior efficacy in patients with early-stage cervical cancer having pathological risk factors. Adjuvant chemotherapy alone is a favorable alternative post-operative treatment.

Recommendations on management of gynecological malignancies during the COVID-19 pandemic: perspectives from Chinese gynecological oncologists / 부인종양

The outbreak of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 has rapidly spread globally. Cancer patients are at a higher risk of being infected with the coronavirus and are more likely to develop severe complications, as compared to the general population. The increasing spread of COVID-19 presents challenges for the clinical care of patients with gynecological malignancies. Concerted efforts should be put into managing gynecological malignancies in an orderly manner by strictly implementing the measures that are specifically developed for controlling the spread of COVID-19. We have drafted Recommendations on Management of Gynecological Malignancies during the COVID-19 Pandemic based on our experience on controlling COVID-19 pandemic in China. We recommend that patients with gynecological malignancies should be managed in hierarchical and individualized manners in combination with local conditions related to COVID-19. Medical care decision should be balanced between controlling COVID-19 pandemic spread and timely diagnosis and treatment for gynecologic oncology patients.

A multicenter, randomized, open and positive parallel controlled clinical study of clotrimazole vaginal expansion suppository and vaginal tablet in the treatment of mild and moderate vulvovaginal candidiasis / 中华妇产科杂志

Objective:Using clotrimazole vaginal tablet as a positive control, to evaluate the results of clotrimazole vaginal expansion suppository in the treatment of mild and moderate vulvovaginal candidiasis in terms of efficacy, patient satisfaction, side effects, and recurrence rate.Methods:This study was jointly conducted by 5 hospitals from August 2017 to October 2018, patients with mild and moderate vulvovaginal candidiasis confirmed by fungal culture and symptoms scores were selected. They were randomized to experimental group and control group as 1∶1 ratio. In the experimental group ( n=105), the subjects applied clotrimazole vaginal expansion suppository (150 mg) daily at night for 7 days. In the control group ( n=106), the subjects used a single dose of clotrimazole vaginal tablet (500 mg). Follow-ups were performed at (8±3) and (30±5) days after the discontinuation of the drugs, respectively. The difference in clinical symptoms and signs scores was used to evaluate the improvement of clinical symptoms, and the patient′s satisfaction and side effects were recorded. Results:At the first follow-up, the experimental group and control group were followed up by fungal culture on the cure rate [66.7% (70/105) versus 63.2% (67/106), P>0.05] and total effective rate [98.1% (103/105) versus 99.1% (105/106), P>0.05], the differences were not statistically significant. At the second follow-up, the recurrence rates of the experimental group and the control group were 5.7% (4/70) and 14.9% (10/67), respectively, with no significant difference ( P>0.05). In the evaluation of patient satisfaction, the leakage of the drug in the experimental group was significantly better than that in the control group ( P<0.01). The side effects mainly included vaginal stimulation, itching and burning sensation, and there was no statistical difference between the two groups ( χ2=1.070, P=0.586). Conclusions:In the treatment of mild and moderate vulvovaginal candidiasis, clotrimazole vaginal expansion suppository is no less effective than clotrimazole vaginal tablet, and there is no significant difference in the recurrence rate between the two. In terms of patient satisfaction, clotrimazole vaginal expansion suppository is superior to clotrimazole vaginal tablet.

Recommendations on management of gynecological malignancies during the COVID-19 pandemic: perspectives from Chinese gynecological oncologists / 부인종양

The outbreak of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 has rapidly spread globally. Cancer patients are at a higher risk of being infected with the coronavirus and are more likely to develop severe complications, as compared to the general population. The increasing spread of COVID-19 presents challenges for the clinical care of patients with gynecological malignancies. Concerted efforts should be put into managing gynecological malignancies in an orderly manner by strictly implementing the measures that are specifically developed for controlling the spread of COVID-19. We have drafted Recommendations on Management of Gynecological Malignancies during the COVID-19 Pandemic based on our experience on controlling COVID-19 pandemic in China. We recommend that patients with gynecological malignancies should be managed in hierarchical and individualized manners in combination with local conditions related to COVID-19. Medical care decision should be balanced between controlling COVID-19 pandemic spread and timely diagnosis and treatment for gynecologic oncology patients.

Gestational trophoblastic disease and the second-birth pregnancy / 西安交通大学学报(医学版)

With the overall implementation of the two-child policy,scar of the uterus and elderly mothers bring a lot of gynecological and obstetric problems.Therefore,we are paying attention and making responses to obstetric challenges.At the same time,we should also attach importance to the gynecological problems caused by the secondbirth pregnancy.Currently,the hot spots include increased incidence of hydatidiform mole,which may lead to gestational trophoblastic tumor,and the second-birth pregnancy of gestational trophoblastic tumor patients after treatment.This paper discusses the issues of gcstational trophoblastic disease and the second-birth pregnancy from the following aspects:relationship between age and development of gestational trophoblastic disease,effect of chemotherapy on ovarian function in gestational trophoblastic tumor patients,protection of ovarian function during chemotherapy,and appropriate time and prognosis of next pregnancy after treatment.

Application of three-dimensional power Doppler in diagnosing and treating gestational trophoblastic disease / 西安交通大学学报(医学版)

Objective To clarify the reliability of three-dimensional power Doppler as a quantitative method in detecting gestational trophoblastic disease (GTD ) and assessing its therapeutic effect. Methods We prospectively collected a database of 52 patients with GTD diagnosed at the First Affiliated Hospital of Xi’an Jiaotong University from December 201 1 to October 2013 and 30 healthy women as controls.Sonography was performed using a Voluson E8. Resistance index (RI ), vascularization index (VI ), flow index (FI ) and vascularization-flow index (VFI)of the region of interest were collected for further analysis.Results Of the 52 GTD datasets,variation from the mean value was RI 0.47±0.1 7;VI (81.46 ±20.54)%;FI 67.28 ±20.21;and VFI 58.12±25.53.Three-dimensional power Doppler examination indicated that there were significant differences in RI,VI,FI and VFI values between healthy individuals and patients in each subgroup (P <0.01).Further,after combining invasive hydatidiform mole and choriocarcinoma groups,it also showed a significant difference between hydatidiform mole group and the combined malignant group (P <0.01).And the abnormal sonographic and power Doppler findings in GTD were resolved when chemotherapy was given successfully.Conclusion RI,VI,FI and VFI values were more related to the information of tumor blood flow,and more intuitive to manifest the status of the disease.They could be new methods in diagnosing and assessing treatment of GTD for their real-time nature.

The expressions of hypoxia-inducible factor 1αand carbonic anhydrase IX in gestational trophoblastic disease / 西安交通大学学报(医学版)

Objective To explore the role of hypoxia-inducible factor 1α(HIF-1α)and carbonic anhydrase IX (CAIX)in oncogenesis and development of gestational trophoblastic disease (GTD).Methods The expressions of HIF-αand CAIX were determined immunohistochemically by specific antibodies on formalin-fixed paraffin sections of normal pregnancy villi (32 cases),hydatidiform moles (33 cases),and invasive hydatidiform moles (26 cases). Results The positive rate of HIF-1α in normal pregnancy villi (NP),hydatidiform moles (HM)and invasive hydatidiform moles (IM) was 28.1% (9/32 ), 45.5% (1 5/33 ) and 73.1% (1 9/26 ), respectively. It was significantly higher in IM than in HM and NP(P 0.05).The positive rate of CAIX in NP,HM and IM was 31.2 (10/32),3.0(1/33)and 57.7%(1 5/26),respectively.It was significantly higher in IM than in HM and NP (P 0.05).Conclusion The expressions of HIF-1αand CAIX were both higher in gestational trophoblastic neoplasia than in normal pregnancy and hydatidiform moles, which indicates that HIF-1αand CAIX may play a role in oncogenesis and development of malignant transformation of trophoblastic cells.

Real-time detection of survivin mRNA expression in cervical cancer cell lines using molecular beacon imaging / 西安交通大学学报·英文版

Objective: To detect the expression of survivin mRNA in cervical cancer cell lines using molecular beacon imaging technology. Methods: Human cervical cancer cells (HeLa and SiHa) and human fetal lung fibroblast HFL-I were cultured in vitro. After adding 100 nmol/L survivin mRNA molecular beacon, the fluorescent signals were observed under fluorescent microscope. The expressions of survivin in cervical cancer cells and HFL-I cell were examined by immunocytochemical streptravidin-biothin peroxidase (SP) assay at the same time. Results: Two kinds of survivin mRNA molecular beacon, with different color fluorescence, had strong fluorescent signal in cervical cancer cell lines, and the signal in SiHa cell line was stronger, but these signals were not found in HFL-I; Immunocytochemical staining of positive survivin was located in the cytoplasm of cervical cancer cell lines HeLa and SiHa, whereas, no expression of survivin was detected in HFL-I cell line. Conclusion: The technology of molecular beacon imaging can be used to detect the expression of survivin mRNA in viable cells successfully, and may provide a new approach to the diagnosis of early stage cervical cancer and the following-up in the clinic.

REAL-TIME DETECTION OF SURVIVIN mRNA EXPRESSION IN CERVICAL CANCER CELL LINES USING MOLECULAR BEACON IMAGING / 药物分析学报

Objective To detect the expression of survivin mRNA in cervical cancer cell lines using molecular beacon imaging technology. Methods Human cervical cancer cells (HeLa and SiHa) and human fetal lung fibroblast HFL-I were cultured in vitro. After adding 100 nmol/L survivin mRNA molecular beacon, the fluorescent signals were observed under fluorescent microscope. The expressions of survivin in cervical cancer cells and HFL-I cell were examined by immunocytochemical streptravidin-biothin peroxidase (SP) assay at the same time. Results Two kinds of survivin mRNA molecular beacon, with different color fluorescence, had strong fluorescent signal in cervical cancer cell lines, and the signal in SiHa cell line was stronger, but these signals were not found in HFL-I ; Immunocytochemical staining of positive survivin was located in the cytoplasm of cervical cancer cell lines HeLa and SiHa, whereas, no expression of survivin was detected in HFL-I cell line. Conclusion The technology of molecular beacon imaging can be used to detect the expression of survivin mRNA in viable cells successfully, and may provide a new approach to the diagnosis of early stage cervical cancer and the following-up in the clinic.

Proliferation of Mel-CAM defined IT in first-trimester villi and hydatidiform mole / 西安交通大学学报(医学版)

Objective To explore the relationship between Mel-CAM and adherence and invasion of trophoblastic cells and proliferation of Mel-CAM defined intermediate trophoblast.Methods Double immunohistochemical staining technique was used to detect the expression of Ki-67 in Mel-CAM defined intermediate trophoblast in human villi during the first trimester and hydatidiform mole.Results In this study there was a significantly stronger expression of Mel-CAM in hydatidiform mole than that in first-trimester villi (P

Relationship between the prognosis and expression of estrogen receptor and progesterone receptor in gestational trophoblastic tumor / 西安交通大学学报(医学版)

Objective To explore the expression of estrogen receptor(ER) and progesterone receptor(PR) in gestational trophoblastic tumor(GTT) and their significance.Methods The expression of ER and PR in 34 cases of GTT was detected by immunohistochemical method;20 cases of normal villi and 30 cases of hydatiform mole served as controls.Results The positive expression rate of ER in normal villi,hydatiform mole and GTT was 85.00%,83.33% and 44.12%,respectively,and had positive correlation with the malignance degree of GTT.The positive expression rate of PR in normal villi,hydatiform mole and GTT was little.The expression of ER was closely related to these clinicopathological features of GTT(P