RESUMO
Objective:To summarize the prognosis of medullary thyroid carcinoma (MTC) patients with biochemical recurrence (the increase of postoperative calcitonin and no abnormal imaging) and to investigate the optimal cut-off value of calcitonin for postoperative structural recurrence (with imaging abnormality).Methods:Literature retrieval was conducted for PubMed, CNKI, EMbase, Web of Science, Cochrane and other databases, and literatures related to the increase of calcitonin after MTC surgery were included. Review Manager 5.4 software was used for Meta-analysis of the recurrence and death. SPSS 23.0 software was used and receiving operating characteristic (ROC) curve was used to analyze the rising folds of postoperative calcitonin level in comparison with the maximum value of experiment detection, and to predict the outcome of biochemical recurrence transforming to structural recurrence, and then the optimal cut-off value could be worked out.Results:A total of 7 studies including 1 005 MTC patients (276 cases of biochemical recurrence and 542 cases of biochemical cure). Meta-analysis showed that structural recurrence rate in postoperative biochemical recurrence group [40.6% (112/276) vs. 2.2% (12/542); OR = 27.99, 95% CI 14.57-53.78, P < 0.001] and mortality [10.0% (19/190) vs. 0.96% (3/312); OR = 7.26, 95% CI 2.42-21.84, P < 0.001] were higher than those in the biochemical cure group (normal postoperative calcitonin level and no disease state). The data of 89 MTC patients with biochemical recurrence were collected in another 4 studies. ROC curve analysis showed that area under the curve of the rising folds of postoperative calcitonin level in predicting structural recurrence was 0.825; according to the cut-off value at all sections, the optimal cut-off value of the increased postoperative calcitonin was 50 times, the sensitivity was 66. 7%, the specificity was 88.6%. Conclusions:MTC patients with postoperative biochemical recurrence have higher structural recurrence rate and mortality compared with patients with normal postoperative calcitonin. The postoperative elevation of calcitonin more than 50 times the maximum value of the laboratory detection can be taken as the critical diagnostic value, when more than 50 times is prone to structural recurrence.
RESUMO
Objective:To investigate the efficacy and safety of the modified gasless unilateral axillary approach (MGUAA) endoscopic thyroid surgery in treatment of papillary thyroid microcarcinoma (PTMC) .Methods:From Jan. 2019 to Dec. 2019, 90 patients receiving PTMC (cT1N0M0, cI stage, 8th, 2017 AJCC) therapy by modified gasless unilateral axillary approach endoscopic thyroid surgery (MGUAA group, n=41) , and conventional open thyroid surgery (OS group, n=49) were retrospectively analyzed. Ninety patients were enrolled in the study, including 14 males and 76 females,with the mean age (42.1±12.0) years.The effectiveness of central lymph node dissection (CLND) , the operation time, the types of operation, the amount of drainage, the duration of hospital stay, the related complications, the postoperative pain of neck and axillary and the cosmetic satisfaction were compared between the two groups.SPSS 25.0 statistical software was used for statistical analysis, the measurement data was expressed by ±s, paired t test was used to compare the measurement data between groups, and Chi-square test was used to campare the count date between groups. Results:The mean age (35.0±8.6) years and the amount of surgical bleeding (12.3±7.3) ml in the MGUAA group were significantly lower than those (48.1±11.1) years and (16.1±4.3) ml in the OS group ( P<0.01) , while the mean operation time (99.1±19.5) min, the mean amount of drainage (221.4±67.9) ml and the postoperative drainage tube placement time (5.0±0.8) days were significantly higher than those of (70.6±17.8) min, (98.3±63.7) ml and (3.8±1.0) days in the MGUAA ( P<0.01) . There was no significant difference in the number of lymph nodes of CLND or the duration of hospital stay between the two groups ( P>0.05) . In terms of surgical complications, the transient recurrent laryngeal nerve injury, the postoperative hematoma, the postoperative infection, and the lymphatic leakage had no significant difference between the two groups ( P>0.05) . The MGUAA group had significant advantages in avoiding the postoperative dysphagia in front of neck, the postoperative pain of neck, and cosmetic satisfaction over the OS group [ (0.0% vs 28.6%) , (14.6% vs 71.4%) , (1.1±0.3) score vs (2.4±0.5) score ( P<0.01) ]. Whereas in axillary area pain on the surgical side, the MGUAA group was inferior to the OS group ( P<0.01) . Conclusion:The modified gasless unilateral axillary approach endoscopic thyroid surgery is a feasible, safe and cosmetically operation for PTMC (cT1N0M0, cI stage, 8th, 2017 AJCC) .
RESUMO
Objective To understand the cognitive level of chronic obstructive pulmonary disease (COPD) disease management and pulmonary rehabilitation among medical staff in the respiratory departments and community of public health institutions in Panyu of Guangzhou, in order to assess the status of prevention and treatment of COPD in this area. Methods From March to October 2017, a questionnaire survey was conducted among 339 medical staff in Panyu, including respiratory doctors, nurses and therapists of four tertiary hospitals, five secondary hospitals, and three first-level hospitals, GPs, nurses and therapists at 16 community health service centres, among them, there are 147 respiratory and general practitioners (hereinafter referred to as doctors), 171 respiratory and general nurses (hereinafter collectively referred to as nurses), and 22 rehabilitation therapists (hereinafter collectively referred to as therapists). Using Epidata software to create questionnaire database entry data. Results The awareness rate of COPD airflow limitation severity of nurses was only 19.9％, which was lower than that of doctors (39.7％) and therapists (22.7％). Doctors, nurses, and therapists are familiar with the low percentage of the GOLD guidelines, which are respectively only 12.3％, 7.6％, and 4.5％. Nurses were diagnosed with pulmonary function as a basis for COPD, and the awareness rate was only 60.2％ lower than that of doctors (82.9％) and therapists (81.8％). In alleviating COPD patients′shortness of breath, only 31.8％therapists chose short-acting beta-agonists, lower than doctors (61％) and nurses (45％). There is disagreement about the long-term use of inhaled corticosteroids in COPD. Medical staff have the highest awareness of lip-reducing and abdominal breathing, followed by Taiji and Ba Duan Jin exercises, and low awareness of modern rehabilitation programs such as elastic bands, upper and lower limb exercises. The effective pulmonary rehabilitation program should last at least 8 weeks, and the awareness rate of this therapy practice was 40.9％, higher than doctors (13.7％) and nurses (18.1％). Medical staff believe that the main factors affecting patient compliance are the cost of the drug and the patient′s lack of understanding of the benefits of the treatment. Additionally, 40.4％ of doctors, 51.5％ of nurses, and 54.5％of therapists believe that community health services cannot manage COPD. The reasons that affect community management of COPD, doctors believe that patient compliance and lack of man power, nurses believe that the main shortage of manpower and equipment, the therapist believes that the lack of medical awareness and poor patient compliance. Conclusion Doctors, nurses, and therapists have inconsistent understandings of COPD disease management and pulmonary rehabilitation, and each has its own focus. It is necessary to strengthen learning exchanges for each weak knowledge point. The awareness rate of modern rehabilitation exercise for pulmonary rehabilitation is not as high as that of traditional Chinese medicine. It is necessary to pay attention to the promotion of the benefits and significance of COPD pulmonary rehabilitation treatment and improve compliance.
RESUMO
According to the course character and training objective, we analyzed the necessity of the experiment teaching reform of microbiology examination . The modules of employable Skills (MES) was applied to the experiment teaching of microbiology examination tentatively. On the basis of the needs of microbiology laboratory jobs, the contents of experimental course were integrated and optimized to skills module , comprehensive training module and application module , which include fourteen study units such as basic techniques of identification of bacteria,the separation and identifi-cation of pathogenic bacteria, microbiology examination of clinical specimen etc. Intensive teaching and multiplex teaching methods were applied to each module according to the module's characteristic, teaching objectives and cognitive rules of students. This teaching reform has achieved initial results.
RESUMO
In order to adapt to the requirements of the modern clinical laboratory to medical laboratory technology personnel operation ability,our hospital has modified professional microbiology experiment course to modular teaching from the traditional teaching mode.In the process of teaching experiment,the experiment course and clinical practice class are arranged,and the experiment course of microbiology is divided into five modules:basic skills,application,comprehensive training,extension,and clinical practice module.Basic skills module focuses on the foundation that students learn to observe the microbial morphology and master the basic operation technology,at the same time,cultivates the students' sterile ideas and biological safety;Application module pays attention to the detection of various types of bacteria,lets the student have as many times of trying as possible,battle-hardened;Comprehensive training module emphasizes students' ability of analyzing and resolving problems;Extension module guides students actively to make diffusing thinking and comprehensive analysis of problems;The final clinical practice module that combines theory and practice,further consolidates the basic operation skills,cultivates students' comprehensive ability,improves students' the independent working ability and professional thinking and habits.Five modules link up with each other closely and have progressive layers of the process.In sum,modular teaching motivates the students' interest in learning,solves the problem of students' insufficient operating ability,improves the teaching effect and provides a reform method for improving the quality of microbiological test experiment.
RESUMO
OBJECTIVE:To establish a new semi-automatic drug dispensing mode,with proper cost,which falls in between full-automatic drug dispensing mode and manual drug dispensing mode,good work efficiency,standard and simple operation meth-od and meets national laws and regulations. METHODS:A semi-automatic drug dispensing system was designed,in which the in-formation in the drug dispensing sheet could be automatically printed on the drug bag,and automatic bagging,packaging and deliv-ery of drugs were realized. Such drug dispensing system included hardware(mechanical structures such as drug turntable and drug funnel,transmission device,etc.)and software control systems(the program of interface with hospital information system,micro control unit software,computer software,etc.). Through commissioning,formal operation and statistics,based on 18 oral drug dis-pensing sheets with the same contents,calculated the time of drug dispensing and the number of drug dispensing errors by 3 phar-macists respectively in manual drug bag dispensing mode and semi-automatic drug dispensing mode,to evaluate the effect of the semi-automatic drug dispensing system. RESULTS:From commissioning in May 2012 to formal operation in September 2012,the system operated normally and utility model patents were obtained. In the two modes,the total time of drug dispensing was 481 and 397 min (t=6.82,P<0.001),the numbers of drug dispensing errors were 25 and 7 (χ2=9.353 8,P=0.002 2),respectively. There was statistical significance. CONCLUSIONS:The semi-automatic drug dispensing system has higher efficiency and less num-ber of drug dispensing errors compared with manual drug bag dispensing mode and lower cost compared to full-automatic drug dis-pensing system. It deserves promotion.
RESUMO
As an anchoring protein,receptor for activated C kinase 1 ( RACK1 ) can combine together with many kinds of intracellular signaling molecules and participate in many signal conduction in cells.Researchers have paid close attention to the role of RACK1 in signal transduction molecule network of tumor cells.Abundant studies reveal that RACK1 can regulate signal transduction by regulating tumorigenesis and immune escape in tumor cells,and then play important roles.
RESUMO
Objective To observe the curative effect of modified Yiweitang on anorexia of the Spleen and Stomach Yin deficient type. Methods90 patients with anorexia belonging to spleen yin deficiency type were randomized in to 2 groups, by 1: 1 ratio. According to the age of children, appropriate dose of modified Yiwei decoction (treatment group) and Erbao Granule (control group), 3 times/d, for 4 weeks were given to the children. Clinical efficacy of the treatment group was observed before and after the treatment and compared with the control group. Results(①) symptom scores: Vomiting (0.061±0.024), sweating (0.140±0.004), stool (0.024±0.011), urine (0.026±0.010) in treatment group after treatment, showing statistical significance (P＜0.05) with the control group. ② disease treatment: The total effective rate was 93.3％ and 91.1％ in the treatment group and the control group, the difference was not statistically significant (X2=0.886, P＞0.05). ③symptoms treatment: The total effective rate was 95.6％ and 66.7％ in the treatment group and the control group respectively, the difference was statistically significant (x2=0.625, P＜0.05). Conclusion The treatment of modified Yiweitang was better than Erbao Granule in treating children with anorexia belonging to stomach yin deficiency.
RESUMO
Objective To study of the imaging diagnosis and differential diagnosis of cystitis glandularis. Methods The clinical data and imaging findings of 8 cases with cystitis glandularis proved by pathology were retrospectively analyzed with literaures re-view. Results The lesions on images appeared as nodular mass in 4 cases, diffuse in 2 cases and mixed type in 2 cases,1 case with cystic degeneration. The lesions in 2 cases obviously reduced in size after treatment. The CT value of the lesions post contrast-en-hanced scan averagely increased up to 15.8 HU compared with that of plain scan. The lesions were localized in 6 cases and diffuse in 2 cases. Conclusion cystitis galandularis has some imaging characteristics, but the final diagnosis is depended on pathology.
RESUMO
Objective To explore the effect of chronic compound stress on serum adiponectin level and AdipoR2 expression in rats.Methods Forty male Sprague-Dawley rats were randomly divided into two groups:the stress group underwent chronic compound stress and the control group was fed normally.After 8 weeks of stress or feeding,the serum adiponectin,blood glucose ,insulin resistance and HbA1 C,HDL-C,LDL-C,triglyceride and total cholesterol were measured.Results ①After 8 weeks of stress,the score of open-field behaviors and 24-h urocortisol were significantly different between the stress and control groups (32.0 ± 8.6 vs.52.0 ± 12.7,5.8 ± 0.4 vs.(5.3 ±0.1 ) ng/L,repectively; P ＜0.05 or 0.01 ) ;②After 8 weeks of stress,the adiponectin,total cholesterol ,triglyceride,HDL-C,InIR and HbA1 C were significantly different between the two groups (P ＜ 0.05 or 0.01 ) ;③After 8 weeks of stress,there were significant difference on the expression of AdipoR2mRNA and protein between the two groups (P ＜0.01 ) ,with the expression of AdipoR2mRNA of 0.67 ±0.04 and 1.00 ±0.11 and the expression of protein of 0.73±0.02 and 1.00 ± 0.04 in the stress and control group,respectively.Adiponectin was negatively related with HbA1 C,LDL-C and IR ( r = - 0.26,- 0.88 and - 0.37,P ＜ 0.05 or 0.01 ),and positively related with HDL-C ( r =0.78 ,P ＜0.01 ).Conclusions In rats,chronic compound stress decreases the level of serum adiponectin and the expression of AdipoR2 in liver.
RESUMO
OBJECTIVE: To investigate the situation and future trend of use of drugs in this hospital after medical re- form.METHODS:Using the principle of sequencing analysis of DUD system of drug,we analysed the data of drug consumption in our hospital during the period 1999-2000.RESULTS: The policy of medical reform has affected the component ratio of drugs used, the consumption of peroral drugs being increased.The incidence of cardiovascular diseases was high in this re- gion.CONCLUSION:Most of the drugs used after medical reform were those assigned in medical insurance,which will improve the rationality and effectiveness of medication.
