Introduction: Malignant lymph nodes (LN) in esophageal cancer (EC) necessitate neoadjuvant chemo- and/or radiotherapy for curative surgery. However, cytological diagnosis is often impossible due to inability to perform LN EUS-FNA beyond non-traversable stenosis with linear echoendoscopes (ø 11.8mm). Aim: To study the ability of the linear echobronchovideoscope (CEBUS) to visualize the celiac axis (CA) and passage through stenotic EC for CEBUS-guided FNA of LN. Method: Consecutive patients with no surgical history who underwent EUS for non-EC indications were recruited for the CA study (Group A); patients with stenotic EC for the EUS-FNA study (Group B). (1) CEBUS (ø 6.2mm) was inserted transorally up to 50cm to visualize CA. (2) For patients with stenotic EC, a pediatric gastroscope was first used to place a 0.035“ guidewire. A 5F Teflon catheter was inserted through the working channel of CEBUS to enable retrograde insertion of guidewire through CEBUS. After the guidewire appeared, CEBUS was then carefully advanced over the guidewire through the stenosis. (3) EUS-FNA was performed on LN beyond the stenosis using TBNA needle. Results: 17 patients were recruited for the CA study (12M:5F; median age 62.7 years, range 43.6–86.6) (A). Two patients had EC, both with non-traversable stenosis (B). In Group A, CA was visualized in 15/17 (88.2%) patients. No difficulty in intubation was encountered. The median length of the scope was 48cm (range 41–50) upon CA visualization. In Group B, CEBUS was passed through the stenosis with EUS-FNA of LN successfully performed in the 2 patients. There was no complication. Conclusion: CEBUS was able to visualize CA in the majority of patients. CEBUS and CEBUS-guided FNA were feasible in patients with stenotic EC without the need for predilation. Despite the floppy shaft of CEBUS, narrow viewing angle and less echo-penetration, FNA of LN was feasible.
Objective
To explore the application effects of PBL, CBL and LBL teaching methods on clinical internship of higher midwife nurses.
Methods
Higher midwife nurses′ clinical internship in our department in 2015 and 2016 were chosen as objects of study. 32 of them in 2016 were taken as experiment group, which were applied teaching methods of PBL+CBL+LBL, while 33 nurses in 2015 were chosen as control group, which were applied conventional teaching methods. Nurses in both groups were investigated with questionnaire about comprehensive skills and the results were compared for the effects of teaching methods.
Results
The higher midwife nurses in experiment group were the scores of (3.78±0.32) and (2.82±0.26) in control group with statistical significance between two groups (t=8.173, P<0.01) .
Conclusions
The teaching methods of PBL, CBL and LBL can improve clinical internship effects in higher midwife nurses effectively and improve clinical teaching quality.
Key words:
Midwifery; Education, nurse; Student, nurse; Problem Based Learning; Case Based Learning; Lecture Based Learning; Clinical teaching
The causes and pathogenesis of colorectal cancer metastasis in TCM,clinical and experimental study of TCM in treating colorectal cancer were expounded through summing up and analyzing related study in recent years,which is aiming to guide clinical study and treatment.
Abstract Background An increasing number of COVID‐19 patients worldwide will probably need tracheostomy in an emergency or at the recovering stage of COVID‐19. We explored the safe and effective management of tracheostomy in COVID‐19 patients, to benefit patients and protect health care workers at the same time. Methods We retrospectively analyzed 11 hospitalized COVID‐19 patients undergoing tracheostomy. Clinical features of patients, ventilator withdrawal after tracheostomy, surgical complications, and nosocomial infection of the health care workers associated with the tracheostomy were analyzed. Results The tracheostomy of all the 11 cases (100%) was performed successfully, including percutaneous tracheostomy of 6 cases (54.5%) and conventional open tracheostomy of 5 cases (45.5%). No severe postoperative complications occurred, and no health care workers associated with the tracheostomy are confirmed to be infected by SARS‐CoV‐2. Conclusion Comprehensive evaluation before tracheostomy, optimized procedures during tracheostomy, and special care after tracheostomy can make the tracheostomy safe and beneficial in COVID‐19 patients.
To evaluate the therapeutic effect of Liang's anti-rheumatism and rheumatoid granule (LARG) in treating patients with rheumatoid arthritis (RA) at the active stage.Fifty patients were administered orally with LARG in the treated group, 30 patients were treated with Wangbi granule in the control group. Symptoms, physical signs and relevant laboratory indexes in the 2 groups were observed and compared before treatment and after being treated for 2 months.The total effective rate and curative-markedly effective rate in the treated groups were superior to those in the control group (P <0.01). The improvement in aspects of integral scoring of symptom and physical signs, including arthragia, tumefaction, dysfunction indexes, morning stiffness and 15m walking time, and laboratory indexes, including blood sedimentation rate, rheumatoid factor, C creative protein, immunoglobin, as well as hemorheology relevant indexes in the treated group after treatment were significantly different to those before treatment and those in the control group (P <0.05 or P <0.01).LARG has obvious therapeutic effect on RA at the active stage.
Background The death-associated protein kinase (DAPK) is a tumor suppressor gene, which is a mediator of cell death of INF-γ–induced apoptosis. Aberrant methylation of DAPK promoter has been reported in patients with head and neck squamous cell carcinoma (HNSCC). However, the results of these studies are inconsistent. Hence, the present study aimed to evaluate the association between the promoter methylation of DAPK gene and HNSCC. Methods Relevant studies were systematically searched in PubMed, Web of Science, Ovid, and Embase. The association between DAPK promoter methylation and HNSCC was assessed by odds ratio (ORs) and 95% confidence intervals (CI). To evaluate the potential sources of heterogeneity, we conducted the meta-regression analysis and subgroup analysis. Results Eighteen studies were finally included in the meta-analysis. The frequency of DAPK promoter methylation in patients with HNSCC was 4.09-fold higher than the non-cancerous controls (OR = 3.96, 95%CI = 2.26–6.95). A significant association between DAPK promoter methylation and HNSCC was found among the Asian region and the Non-Asia region (Asian region, OR = 4.43, 95% CI = 2.29–8.58; Non-Asia region, OR = 3.39, 95% CI = 1.18–9.78). In the control source, the significant association between DAPK promoter methylation and HNSCC was seen among the autologous group and the heterogeneous group (autologous group, OR = 2.71, 95% CI = 1.49–4.93; heterogeneous group, OR = 9.50, 95% CI = 2.98–30.27). DAPK promoter methylation was significantly correlated with alcohol status (OR = 1.85, 95% CI = 1.07–3.21). Conclusion The results of this meta-analysis suggested that aberrant methylation of DAPK promoter was associated with HNSCC.
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