The Effect of Uncertainty Training on the Improvement of Diagnostic Ability in Chinese Medical Students.

Objective: To evaluate the effect of the uncertainty training on improvement of students' diagnostic ability. Methods: Data were collected on 70 fifth-year medical students enrolled in the Case Discussion courses on Obstetrics and Gynecology in the spring of 2020. Of these students, 36 were in the uncertainty training group and 34 in the control group. The effect of training was evaluated by cognitively diagnostic assessment which mapped exam questions to 4 attributes assessing clinical reasoning and basic science knowledge. Results: Uncertainty training was able to improve students' ability to use basic science concepts for inference and problem solving, and the ability to integrate complex clinical information to arrive at a diagnosis. But it could not improve students' ability on the basic recall of foundational concepts and the ability to use basic science concepts in clinical reasoning. Medical students could do well in integrating complex clinical information although they didn't recall basic science knowledge well. Conclusion: Uncertainty training could be used as an effective teaching method in Case Discussion course on Obstetrics and Gynecology. However, students still need to improve their basic knowledge besides the training.

[Diagnosis of placenta previa accreta by two dimensional ultrasonography and color doppler in patients with cesarean section].

OBJECTIVE: To determine the accuracy of two dismensional sonography and color doppler in diagnosing placenta previa accreta in patients with previous cesarean section. METHODS: Forty-one patients with previous cesarean sections were confirmed to have partial or total placenta previa in the current pregnancy and were given ultrasound examinations after the 28th week of gestation. Specific ultrasound features of the placenta and its interphase with the uterus and the bladder for placenta accreta were checked by two-dimensional ultrasonography and color Doppler. All the patients were traced until delivery. The golden standard in diagnosis was the intraoperative finding and the pathologic exam. RESULTS: Twenty-two patients had ultrasonographic evidence of placenta previa, 20 of which were later confirmed placenta previa accreta intraoperatively. Nineteen patients had no ultrasound evidence of placenta previa, and 1 of which was later confirmed placenta previa accreta. The sensitivity and specificity of antenatal ultrasound diagnosis of placenta previa accreta were 95.24% and 94.74% respectively. The most prominent feature to suggest placenta accreta in twodismensional sonography was the presence of multiple lakes that represented dilated vessels extending from the placenta through the myometrium. The most prominent color Doppler feature was the presence of interphase hypervascularity with abnormal vessels linking the placenta to the bladder, and the rate was 95.24%. CONCLUSION: Placenta previa accreta can be diagnosed made with a thorough two dimensional ultrasonographic and color Doppler examination in patients with previous cesarean scar and placenta previa.

[DRD2/ANKK1 Taq IA polymorphism and early infant temperament].

OBJECTIVE: To investigate whether there is an association between DRD2/ANKK1 Taq IA polymorphism and early infant temperament. METHODS: DRD2/ANKK1 Taq IA polymorphism (rs1800497) was determined using polymerase chain reaction-ligase detection reaction (PCR-LDR) techniques in 149 Chinese Han infants from Changsha City. Their mothers were asked to complete the Early Infant Temperament Questionnaires (EITQ) when the infants were 1 to 4 months old (mean: 2.75 months). There were three genotypes found in these infants: C/C, T/T and C/T. The subjects were subdivided into T-carrier (CT, TT) and non-T-carrier (CC) groups for statistical analysis. RESULTS: There were no differences in the temperament style distribution between the T-carrier and non-T carrier groups. There were also no statistically significant differences between the two groups in the score of the nine temperament dimensions. CONCLUSIONS: DRD2/ANKK1 Taq IA polymorphism is not associated with early infant temperament.

[Relationship between the levels of estradiol and monoamine neurotransmitters and postpartum depression].

OBJECTIVE: To explore the relationship of estradiol (E(2)), monoamine neurotransmitters 5-hydroxytryptamine (5-HT), dopamine (DA) and postpartum depression. METHODS: Totally 342 women within 42 days after childbirth were assessed with Edinburgh postnatal depression scale (EPDS), Beck depression inventory (BDI), and general health questionnaire (GHQ). Above or equal to 13 of overall score of EPDS was the diagnosis standard of postpartum depression, and the women tested were divided into depression group and normal group accordingly, using the reagent box of radio immunoassay to test estradiol and 5-HT and DA level in the serum. RESULTS: (1) Incidence: the incidence of postpartum depression was 16.7% (57/342). The highest incidence occurred in patients above 35 (22.2%); the incidence among women under 23 years old was lowest (12.5%), with a significant difference between them (P < 0.01); the incidence in persons with a bachelor degree and above (21.3%) was higher than that of persons with a lower degree of education (7.9%), with a significant difference between the two groups. (2) Biological indicator: the levels of E(2), and 5-HT in depression group (64.39 +/- 0.22) pmol/L, (1.09 +/- 0.21) micromol/L were significantly lower than those in the normal group (126.18 +/- 0.47) pmol/L, (2.67 +/- 0.36) micromol/L (P < 0.01); whereas the level of DA in depression group (5.21 +/- 0.54) micromol/L was significantly higher than that in the normal group (3.16 +/- 0.98) micromol/L (P < 0.01). (3) The levels of E(2) and 5-HT were negatively correlated with the score of EPDS, BDI, GHQ (P < 0.05); but the level of DA was positively related to the scores of EPDS and BDI (P < 0.05), while it had no relationship with GHQ (P > 0.05). CONCLUSIONS: Evaluation scales such as EPDS, BDI, and GHQ should be used to screen for postpartum depression. The measurement of estradiol and monoamine neurotransmitter (5-HT, DA) level can be used as biological objective indicators for prevention and treatment of postpartum depression.

[Meconium-stained amniotic fluid and intra-amniotic infection].

OBJECTIVE: To explore the relationship between meconium-stained amniotic fluid and Fifty-six women of cesarean section with intact membrane and intra-amniotic infection. METHODS: without parturient were divided into 3 groups according to the property of amniotic fluid (no meconium, I to approximately II degree meconium stainedness, and III degree mecomium stainedness). The content of interleukin-6 in amniotic fluid was measured with ELISA. The infiltration of inflammatory cells in the placenta and its membrane was determined by the pathological diagnosis. The neonatal Apgar score and puerperial infection after the surgery were analyzed. RESULTS: There were no significant differences in the content of IL-6 in amniotic fluid and in the infiltration of inflammatory cells among the 3 groups. But the rate of neonatal asphyxia in the meconium-stained cases was significantly higher than that without meconium. CONCLUSION: Meconium-stained amniotic fluid is a marker of fetal distress, but it is not related to intra-amniotic infection.