Objective To analyze the proportions of interhospital and intrahospital consultation cases of chief residents in the Department of Endocrinology and Metabolism in West China Hospital of Sichuan University, and summarize the distribution characteristics of endocrine and metabolic diseases in other specialized departments, in order to promote the routine work optimization and the cultivation of specialists in endocrinology and metabolism. Methods A total of 1 299 cases were completed by the chief residents in the Department of Endocrinology and Metabolism between July 2012 and June 2013. Distribution of departments, composition and distribution of consultation cases were analyzed retrospectively. The characteristics of endocrine and metabolic diseases were summarized, and the difference of endocrine and metabolic consultation demand was compared among different departments . Results Among the 1 299 consultation patients, there were 612 males (47.11%) and 687 females (52.89%) aged between 14 and 96 years averaging at 56.3. There were 747 (57.51%) interhospital consultation cases and 552 (42.49%) intrahospital consultation cases. The most common reason for emergency consultation was stress hyperglycemia in diabetic patients after surgery or trauma, followed by thyroid diseases and electrolyte disturbances. Most consultation applications were from the Emergency Department, and the consultation purpose was mainly blood glucose control. The main consultation purpose of surgical and gynecologic departments was perioperative assessment and treatment adjustment in patients combined with endocrine diseases such as diabetes and thyroid diseases. Meanwhile,the purpose of obstetric consultation was mainly treatment for patients with hyperthyroidism complicated with pregnancy, gestational diabetes treatment and perioperative blood glucose control. Conclusions Clinical consultation work is challenging, which also provides an excellent chance for chief residents to study and review professional knowledge and accumulate clinical experiences. Chief residents should have the knowledge of the proportions and distribution of consultation cases in order to optimize daily work. They should also summarize consultation experiences so as to promote their knowledge of diagnosis and treatment.
Orlistat, which has a new mechanism of action, is currently the only approved weight-loss drug in China. In addition to controlling body weight, orlistat can significantly improve blood glucose, blood pressure, dyslipidemia, adiponectin, insulin concentration and other obesity-related biochemical indicators in patients with overweight/obese. Recently, orlistat was approved for weight management in patients with polycystic ovary syndrome. Although there are clinical trials supporting the good weight loss efficacy of orlistat, its long-term safety and effectiveness in obesity-related diseases still need to be further determined. This article provides a brief review of the new progress in the clinical efficacy and safety of orlistat, aiming to provide a reference for the more rational drug application.
Pituitary Society released an international consensus statement on the diagnosis and management of prolactin-secreting adenoma (PRLoma) on September 5, 2023, providing recommendations based on the latest evidence-based approach for the screening, diagnosis, treatment and management of PRLoma. This consensus statement not only updated the clinical epidemiology, pathogenesis, clinical symptoms, complications, diagnostic criteria, and treatment progress of pituitary PRLoma, but also focused on special populations such as pregnant women, postmenopausal women, children/adolescents, transgender patients, as well as the treatment of special types such as cystic and invasive pituitary PRLoma. This article aims to help neurosurgeons, endocrinologists, and related healthcare professionals standardize the diagnosis and treatment of PRLoma by interpreting the updated section of the consensus.
Objective To analyze the glucolipotoxicity effects of glucose combined with free fatty acid (FFA) on ketone production and ultrastructure of skeletal muscle, by exogenous elevating circulating glucose and FFA concentration. Methods Fifty Wistar rats were divided into high-fat-feed induced obesity group (OB group, n=40) and ordinary feed as normal control group (NC group, n=10). Circulating glucose and FFA levels were increased by infusion in high-fat-fed obese rats. The levels of serum lipid, plasma FFA and beta-hydroxybutyric acid were detected by the horizontal colorimetry, and the microstructure of skeletal muscle was observed by transmission electron microscopy, especially the changes of the mitochondrial structure. Euglycemic-hyperinsulinemic clamp with tracer infusion was performed to assess peripheral insulin sensitivity. Results The average weight and body fat ratio in the OB group was higher than that in the NC group (P<0.05). Insulin clamp test to assess peripheral insulin sensitivity showed that the steady-state glucose Infusion rate in the OB group during clamp test was significantly lower than that in the NC group [OB: (19.26±1.84) mg/(kg·min)vs. NC: (28.82±1.69) mg/(kg·min), P<0.05]. The mitochondrial denaturation of skeletal muscle in the OB group of rats was observed, and the swelling and crest permutation, the accumulation of lipid droplets and cavitation were formed, and hypertrophy of mitochondria were also seen after intralipid and glucose infusion, which was obvious in the combined infusion group. Conclusions By exogenous elevating circulating glucose and FFA concentration, the products of ketone body increases. The mitochondrial damage of skeletal muscle suggests that mitochondrial may be the potential target of glucoxicity and lipotocicity.
Objective To explore the application value of standardized patient (SP)-based teaching method in the teaching of medical history taking for international students. Methods During the autumn semester of 2017, 96 international medical students were randomly divided into two groups, with 48 students in the SP-based teaching group and 48 students in the conventional teaching group. The test scores of medical history taking in English in internal medical practice of the two groups were compared. The teaching feedback from the international students was collected and evaluated by online questionnaire survey. Results The scores of medical history taking examination in internal medical practice of the students using SP-based teaching method were higher than those of the students using conventional teaching method (86.5±9.7 vs.78.2±10.6), and the difference was statistically significant (t=3.983, P<0.001). According to the questionnaire analysis, in terms of whether the current teaching method could enhance learning interest, improve communication ability, promote clinical skills, train clinical thinking, and highlight humanistic care, students with positive views in the SP-based teaching group accounted for 92.86%, 97.62%, 85.71%, 90.48%, and 95.24%, respectively, while students with positive views in the conventional teaching group accounted for 90.00%, 87.50%, 82.50%, 77.50%, and 97.50%, respectively, and the differences were not statistically significant (P>0.05). Conclusions Well-trained SP has a good application value in clinical practice of internal medicine and diagnostics teaching for international students. SP-based teaching method has been accepted and supported by the majority of international medical students who have experienced it.
Multi-disciplinary team (MDT) is increasingly applied in oncology and refractory diseases. In recent years, MDT has also been applied in diagnosis and treatment of pituitary adenoma and related diseases. This review summarizes the advantages and characteristics of the MDT diagnosis and treatment mode, and analyzes the application and effect of the MDT diagnosis and treatment mode in the Center of Pituitary Adenoma and Related Diseases, West China Hospital, Sichuan University. So far, it has shown that MDT has advantages such as it is professional, full of collaborative interaction, and efficient and optimized. It is a platform of multi-disciplinary cooperation and resources in the diagnosis and treatment of difficult diseases. Case discussion in MDT mode is conducive to timely selection of the best treatment options for patients with pituitary adenoma and related diseases, providing a good learning platform for doctors with different professional backgrounds, and promoting the improvement of professional diagnosis and treatment level of doctors in related departments. The development of MDT will help us to use limited medical resources efficiently, promote the medical team to be more specialized, optimize the diagnosis and treatment process, and improve the effectiveness of the treatment, for benefiting more patients with pituitary adenomas and related diseases.
With the promoting of “the Belt and Road Initiative”, medical assistance to Xinjiang is one ofthe important tasks of public hospitals in China. West China Hospital of Sichuan University actively explores the“Huaxi-Karamay” model of multi-disciplinary group assistance and scientific and technological assistance to Xinjiang, and leverages the technical leadership and leading role of medical experts to improve the medical and health service capabilities of Karamay, especially in chronic diseases management. This article takes the People’s Hospital ofKaramay City in Xinjiang province as an example to discuss the exploration and practice of the new chronic diseasemanagement model of the endocrinology and metabolism center with medical assistance from West China Hospital ofSichuan University, aiming to provide a certain reference for the in-depth development of medical aid to Xinjiang in thefuture.