Objective
To investigate the effect of involvement in clinical in improving comprehensive abilities of medical students and strengthening their occupational cognition.
Methods
The students in the 5-year class of 2014 of pediatrics in our university were enrolled as subjects, among whom 78 students who received involvement in clinical and teaching were enrolled as experimental group and 81 students who did not receive such teaching were enrolled as control group. A questionnaire survey was performed for the students participating in the teaching, including basic information, pre-training quality evaluation, development of personal knowledge and abilities, and comments or suggestions. The two groups were compared in terms of the score of the theoretical course of pediatric surgery, so as to explore whether early involvement in clinical practice could improve the theoretical study of students. Finally, the performance of students in clinical was evaluated and compared between the two groups to assess the role of early involvement in clinical practice in improving comprehensive abilities and occupational cognition.
Results
More than 90% of the students were satisfied with involvement in clinical and they thought this activity helped them to improve clinical thinking, strengthen occupational cognition, enhance learning interests, improve communication skills, and promote the combination of basic and clinical knowledge. In addition, the follow-up analysis found that compared with the control group, the experimental group had a significantly higher average score [(74.59±0.50) vs. (68.89±0.67)] and a significantly higher proportion of students with a score of >70, and no students failed. As for the score of clinical practice, the experimental group had significantly better clinical work proficiency, clinical thinking, operational ability, and doctor-patient communication ability than the control group.
Conclusion
Early involvement in clinical among medical students can improve their comprehensive abilities and help to cultivate clinical thinking and doctor-patient communication skills and strengthen their occupational cognition, which lays a good foundation for cultivating high-quality talents through medical education.
Key words:
Early involvement in clinical practice; Medical student; Comprehensive ability; Occupational cognition
Abstract Background NR2F6 is an orphan nuclear receptor with dual tumorigenic activity in the immune system and tumor cells, playing an essential role in tumor differentiation and immunity. This study aimed to investigate the expression level of NR2F6 in various tumors and its effect on neuroblastoma. Methods We evaluated the role of NR2F6 in the genesis and development of 34 different tumors through multiple databases. In addition, we investigated the effects of NR2F6 expression levels on neuroblastoma risk factors and prognosis using pathology sections and clinical data from primary retroperitoneal neuroblastoma in children. The effects on cell proliferation, invasion, and migration were explored by knocking down NR2F6 expression in SK-N-BE(2). Results The findings showed that NR2F6 was significantly correlated with the prognosis of neuroblastoma and was an important indicator suggesting disease regression. In addition, NR2F6 knockdown slowed down neuroblastoma cells' proliferation, invasion, and migration ability in vitro. Impact: In conclusion, our results suggest that NR2F6 plays a crucial role in tumor-promoting effects and can be used as a potential prognostic marker for neuroblastoma.
Objective To evaluate the short-term results of discectomy combined with Isobar non-fusion internal fixation.Methods Between May 2006 and May 2008,65 cases of single segment lumbar disc protrusion were random surgically treated by discectomy combined with Isobar non-fusion internal fixation(34 cases,group A) and single discectomy(31 cases,group B),respectively.In group A,there were 18 males and 16 females with an average age of 38.8 years(range,23-51 years);the involved segments were L2,3(1 case),L3,4(4 cases),L4,5(20 cases),and L5,S1(9 cases),including 11 cases of protrusion type,16 cases of prolapsed-type,and 7 cases of sequestered type;and the mean disease duration was 7.2 months(range,1-66 months).In group B,there were 19 males and 12 females with an average age of 39.2 years(range,21-49 years);the involved segments were L3,4(2 cases),L4,5(24 cases),and L5,S1(5 cases),including 13 cases of protrusion type,15 cases of prolapsed-type,and 3 cases of sequestered type;and the mean disease duration was 6.5 months(range,3 weeks to 72 months).There was no significant difference in the general data between 2 groups(P 0.05).The surgical results were assessed by visual analogue scale(VAS) for back/leg pain and the Oswestry disability index(ODI).The height of involved intervertebral space was measured dynamically after operation.Results The patients of two groups were followed up 32 months on average(range,24-49 months).All clinical symptoms of the patients were notably improved in 2 groups.One patient in group B experienced postoperative cerebral fluid leakage,and was cured after extubation,changing posture,and other measures.There was no implant failure,such as pedicle fracture,screw loosening,or screw malposition during the follow-up.The ODI and VAS were significantly improved after operation.The back and leg pain VAS scores at each time point were decreased significantly when compared with those before operation(P 0.05) in 2 groups.There were significant differences in back pain VAS(P 0.05) between groups A and B at 1 and 2 years after operation.There was significant difference in the ODI score(P 0.05) at 2 years when compared with that before operation in 2 groups,but there was no significant difference between 2 groups(P 0.05).After operation,the mean height of involved intervertebral space was increased significantly(P 0.05) when compared with preoperative value in group A,while the height had a gradual decline at 3 weeks and 3 months(P 0.05),and had a significant decline at 6 months,1 year,and 2 years(P 0.05) when compared with preoperative value in group B.There were significant differences in the height of involved intervertebral space between groups A and B at each time point after operation(P 0.05).Conclusion Discectomy combined with Isobar non-fusion internal fixation presents with satisfactory short-term results;moreover,it can better relieve back pain in comparison with single discectomy,which possibly related to the preservation of responsible intervertebral spaces.
Background Nutritional problem after surgery for Hirschprung’s disease (HSCR) was not optimistic. This study aimed to analyze the risk factors of postoperative undernutrition for patients with HSCR and establish a scoring system for predicting postoperative undernutrition. Methods Retrospective review of 341 patients with HSCR who received Laparoscopic-assisted pull-through surgery in a tertiary-level pediatric hospital was conducted with assessments of clinical data. Univariate/multivariate Logistic regression analysis was used to identify independent factors of postoperative undernutrition, and establish a scoring system for predicting postoperative nutritional status based on the sum of adjusted odds ratios (ORs). Results The postoperative undernutrition of 341 patients with HSCR was 29.9%. Multivariate Logistic regression analysis showed that non-breast feeding (mixed: OR = 6.116, artificial: OR = 12.00), preoperative undernutrition (risk of malnutrition: OR = 7.951, malnutrition: OR = 8.985), non-parental caregivers (OR = 3.164), long-segment HSCR (OR = 12.820), postoperative complications within 30 days (grade 1 ~ 2: OR = 2.924, Grade 3 ~ 4: OR = 6.249), and surgery for other systemic malformation (OR = 5.503) were risk factors for postoperative undernutrition (all p < 0.05), and scoring system was developed based on these determinants. The area under the receiver operator characteristic curve of the derivation sample was 0.887 (95% confidence interval [CI]: 0.839–0.934) and that of the validation sample was 0.846 (95% CI: 0.772 ~ 0.920) with the optimal cut-off value of 12; calibration curves of the derivation sample showed considerable predictive performance for postoperative undernutrition. Conclusion Risk factors identified affecting postoperative undernutrition should be taken seriously in patients with HSCR. We successfully developed a desirable scoring system to predict postoperative nutritional status, which might be helpful for clinical practice.
We made the third party medical disputes mediation organization dispose medical disputes more quickly and effectively by analyzing its theoretical knowledge,running mode,economic framework,administrative agency and personnel disposition,which provided institutional insurance for the establishment of harmonious relationship between doctors and patients in our country.
Key words:
Medical dispute; Mediation organization; Relationship between doctors and patients
Purpose: This study aimed to compare clinical manifestations, physical examination findings, laboratory, and radiographic dates in pediatric patients with different pathological diagnoses of acute scrotum as well as to accurately establish the true incidence of various pathological diagnoses of acute scrotum. Methods: The records of children hospitalized for acute scrotum from 1990 to 2008 were reviewed. Results: A total of 1228 cases were included in the study (103 with testicular torsion, 918 with torsion of the testicular appendix, 72 with tunica vaginalis inflammation, 46 with epididymitis and 89 with other pathological diagnoses). Duration of pain less than 6 hours, fever, vomiting, history of trauma or activities, absence of cremasteric reflex, and abnormal testicle direction were significantly associated with testicular torsion. Blue dot sign and tender nodule were found significantly associated with torsion of the testicular appendix. Ultrasound showed decreased or absent blood flow in 91.3% testicular torsion patients; enlarged epididymis was found in 91.1% and 91.3% patients with torsion of the testicular appendix and epididymitis, respectively; and scrotal wall edema and hydrocele were found significantly associated with tunica vaginalis inflammation. Our salvageability rate in testicular torsion was 30.1%. Conclusions: Overlap existed between testicular torsion and other acute scrotum. The clinical manifestations, physical examination findings, laboratory, and radiographic data were helpful in distinguishing acute scrotum. Doppler ultrasound is an indispensable imaging modality for the clinical assessment of patients with acute scrotum; in the presence of a clinical suspicion of testicular torsion, even with an apparently normal-color Doppler ultrasound, surgical exploration is still indicated.
Abstract Background: The presence of urinary tract infection (UTI) due to Extended-Spectrum Beta-Lactamase (ESBL)-producing bacteria is reported increased. Aim to study the most frequent uropathogens and the antibiotic susceptibility patterns of them in children and identify whether urodynamic change, underlying neurologic disorders and undernourishment were independent risk factors for ESBL positive UTI which is unclear. Methods: We retrospectively reviewed microbial etiologies and antimicrobial resistance among patients experiencing UTI events in the urology ward of Chongqing Medical University Afflicated Chlidren's Hospital from January 1994 and December 2019. All strains were cultured and identified by the Clinical Microbiology Laboratory. Results: A total of 854 patients with UTI over a 26-years period were evaluated and Escherichia coli was the most common pathogen. During the study period, the proportion of UTI cases attributed to Enterococci increased significantly. Susceptibilities to carbapenems and amikacin decreased significantly, indicating increased antibiotic resistance of pathogens associated with UTI. Interestingly, the susceptibilities to piperacillin/tazobactam have increased. 72.64% were caused by ESBL bacteria and ESBL-producing bacteria increased significantly. ESBL (+) and ESBL (-) UTI were compared and there were no significant differences in the clinical presentation between gender, side of the lesion and urodynamic results. Significant potential risk factors of ESBL-UTI were presence of congenital urological abnormalities, vesicoureteral reflux, neurologic disorder, age <12months, fever and previous use of antibiotics in the last 3 months. On logistic regression analysis, underlying neurologic disorder (OR =8, CI 1.845-34.695) and history of previous antibiotics administration in the last 3 months (OR =4.764, CI 3.114-7.289) were identified as an independent significant risk factor for ESBL- UTI. The nomogram generated was well calibrated for all predictions of ESBL+ probability, and the accuracy of the model nomogram measured by Harrell’s C statistic (C-index) was 0.741. Conclusions: The current situation of multiple bacterial antibiotic resistance has become a worrisome issue in UTI, and urologist should act timely. Our data will greatly assist physicians recognizing the risk factors of ESBL-UTI and optimising antibiotic use.
Objective
To explore the feasibility and safety of laparoscopic adrenalectomy (LA) for adrenal neurogenic tumors in children.
Methods
From May 2006 to May 2016, the clinical data were analyzed retrospectively for 15 surgical cases undergoing abdominal laparoscopic tumor resection. The pathological type were defined as adrenal ganglioneuromas, ganglioneuroblastoma and neuroblastomas. During the same period, the data of the matched-pair group of another 13 patients undergoing open adrenalectomy (OA) were included. Two groups were compared in terms of age, gender, resection type, tumor size, tumor location, clinical stage and tumor pathological type. Statistical analysis was performed for matched-pair group.
Results
Statistical differences existed in mean tumor bed drainage volume. LA group had less drainage as compared to OA group(40 vs 78 ml, P=0.028), mean operative duration was similar for two groups(140 vs 80 min, P=0.064), blood loss volume(20 vs 30 ml, P=0.059), duration of indwelling drainage tube (3 vs 4 days, P=0.903), time of food intake (24 vs 23 h, P=0.410) and average postoperative stay (7 vs 7 days, P=0.893). The differences had no statistical significance (P>0.05). In LA group, one case of electrolyte imbalance was promptly relieved by supplement of electrolyte. And another case of lymphatic fistula was managed successfully by keeping a longer drainage time. After a median follow-up period of 36 months, 3-year disease-free survivals were 76.2% and 69.9% in LA and matched-pair groups while 5-year overall survival rates 85.7% and 80.0% respectively. There was no statistical significance.
Conclusions
Laparoscopic adrenalectomy for adrenal neurogenic tumor is both safe and mini-invasive with comparable outcomes as open surgery in children.
Key words:
Therapeutic laparoscopy; Neuroblastoma; Ganglioneuroma
Multimedia is a widely-used teaching means in contemporary medical education.Establishing and improving the multimedia teaching material library is a strong guarantee for the smooth implementation of multimedia.The causes,significance and methods for establishment of pediatric surgery teaching multimedia material library according to the characteristics of pediatric surgery teaching are described in this article,with a view to provide a reference to other relevant professional institutions.
Key words:
Multimedia; Pediatric surgery medicine; Clinical teaching
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