【Abstract】ObjectiveTo introduce the clinical appliance of liver transplantation (LT) in the therapy of alveolar hydatid disease (AHD).MethodsThe related literatures were collected and reviewed.ResultsThe 5year survival rate of AHD was 71% after LT. Removing the liver and preventing the recurrence are the two major difficulties in the treatment.ConclusionAs the only feasible and effective therapy for advanced AHD, LT should be studied further.
Objective To explore the short term and long term effectiveness of the problem-based learning (PBL) in clinical skill training. Methods A total of 162 clinical medicine undergraduates in Grade 2003 (7-years study) and 2004 (5-year study) who were supposed to intern in the internal medicine departments were randomly divided into the PBL group (n=75) and the control group with traditional training (n=87) for having their clinical skills training. Then t test was applied to compare the two groups about the scores of intern rotation examination and graduate OSCE as well. Results About the baseline: the students in the two groups got similar scores in their internal medicine exam before clinical intern rotation (84.04±7.40 vs. 82.63±8.77, P=0.287). About the short term effectiveness: compared to the control group, the students in the PBL group got higher subjective evaluation from their supervised clinicians (P=0.006). In writing examination, the students of those two group got similar scores in knowledge part (54.17±9.26 vs. 51.67±9.56, P=0.92), while the PBL group won in case reasoning question (20.39±5.27 vs. 16.51±4.90, Plt;0.001). About the long term effectiveness: in the graduate OSCE, the two groups got similar scores in skills operation such as punctures and lab results analyses (P=0.567 and P=0.741), while the students in the PBL group had better performance at the case reasoning and standard patients treating (75.59±9.85 vs. 71.11±12.01, P=0.027). Conclusion With the great short term and long term effectiveness, the PBL applied in the clinical skill training improves the students’ ability of both synthesized analyses and the integrated clinical skills such as clinical thinking and interpersonal communication, but doesn’t aim at the basic knowledge and operation skills.
Alveolar hydatid disease，Orthotopic liver transplantation，Therapy
Objective To analyze retrospectively the 1861 wounded inpatients and deaths in West China Hospital of Sichuan University after the Wenchuan earthquake, so as to provide reference for the improvement of emergency plans for the disaster of earthquake and the establishment of state-level regional medical centers. Methods The analysis was based on the data provided by the Department of Information of the Hospital up until July 23. The software of Microsoft EXCEL was used for data input, and SPSS 11.5 was used for statistical analysis. Results Up to July 23, 2728 cases from the disaster area have been treated in the hospital, of whom 872 were admitted into the emergency department and 1856 into the inpatient department (974 men, median age 43 years; 882 women, median age 46 years). Most patients were sent to the hospital within the first 2 weeks after the quake (82.4%), and the number of inpatients reached its peak on Day 8 after the quake (976 cases). The majority of the inpatients were discharged on Day 9 to Day 18 after the quake (60.2%). The wounded were mainly from Deyang, Aba Prefecture and Dujiangyan. The admission diagnoses were mainly fracture (54.84%), craniocerebral injury (9.81%) and thoracoabdominal injury (7.54%). There were totally 33 deaths, including 5 pre-hospital deaths, 1 emergency death and 27 inpatient deaths. Conclusion The development of an emergency plan for the medical rescue after an earthquake disaster is an essential step to enhance the emergent response capability, improve the scientific process of field triage, transport and transfer, and ensure the rational allocation and application of healthcare resources after any unexpected big disasters in the future.
ObjectiveTo analyze a new classification of the left apicoposterior segmental bronchus and summarize its clinical significance. Methods We accessed the computed tomography imaging data of the inpatients treated in the Department of Thoracic Surgery, Henan Provincial People's Hospital between January and November 2021. We observed and classified the branching pattern of the left apicoposterior segmental bronchus (B1+2) using three-dimensional computed tomography bronchography and angiography (3D-CTBA) technique. And we filtered out the patients who underwent thoracoscopic left apicoposterior segmentectomy and analyzed their clinical data retrospectively to summarize the instructing significance of different bronchial classification in the accurate and safe operation of left apicoposterior segmentectomy. Results Finally 240 patients were collected, including 131 males and 109 females with a median age of 51.0 (19.0-77.0) years. The anatomical pattern of the left apicoposterior segmental bronchus was divided into four main types based on the branching pattern of the outer subsegmental bronchi (B1+2c): type Ⅰ 10% (24 patients), type Ⅱ 54% (130 patients) , type Ⅲ 17% (40 patients) , type Ⅳ 18% (43 patients) and other variations 1% (3 patients). Thirty-two patients smoothly underwent thoracoscopic left apicoposterior segmentectomy, including 23 patients of type Ⅰ and type Ⅱ receiving LS1+2 resection, the other 9 patients of type Ⅲ and type Ⅳ receiving LS1+2 resection (3 patients), LS1+2c resection (4 patients) and LS1+2(a+b) resection (2 patients). Conclusion This new classification systematically and concisely elucidates the branching characteristics of the left apicoposterior bronchus. Different branching types are instructive to the left apicoposterior segmentectomy.
ObjectiveTo compare the clinical therapeutic efficacy of radiofrequency ablation (RFA) and external beam radiation (XRT) in the treatment of early hepatocellular carcinoma (HCC). MethodsThe early HCC patients were collected in the SEER (Surveillance, Epidemiology, and End Results) database, from 2010 to 2015, according to the established inclusion and exclusion criteria. The patients were assigned into an XRT group and a RFA group according to according treatment plans. The propensity score matching (PSM) was performed at a ratio of 1∶4 based on age, gender, race, alpha-fetoprotein (AFP), cirrhosis, and tumor diameter. The overall survival of the patients of the two groups was compared, and the risk factors affecting the long-term prognosis for the early HCC patients were analyzed. ResultsA total of 2 861 early HCC patients were collected, including 2 513 in the RAF group and 348 in the XRT group. After PSM, a total of 1 582 patients were enrolled, including 343 in the XRT group and 1 239 in the RFA group. After PSM, the proportion of tumor with larger diameter (>5 cm) in the XRT group was still higher than that in the RAF group (P<0.001), but there were no statistically significant differences in the other clinical pathological characteristics between them (P>0.05). The Kaplan-Meier survival curves of the RFA group was better than that of the XRT group (HR=1.65, P<0.001); The stratified analysis based on the tumor diameter revealed that the survival curves of the RFA group were superior to those of the XRT group in the HCC patients with tumor diameters <3 cm, 3–5 cm, and >5 cm (<3 cm: HR=1.79, P<0.001; 3–5 cm: HR=1.50, P<0.001; >5 cm: HR=1.67, P=0.003). The results of the multivariate Cox regression model analysis showed that the older age (≥65 years), higher AFP level (≥400 μg/L), larger tumor diameter (≥3 cm), and later AJCC stage (stage Ⅱ) were the risk factors for overall survival in the early HCC patients (RR>1, P<0.05), while XRT treatment was a risk factor for shortening overall survival in the HCC patients (HR(95%CI)=1.62(1.41, 1.86)=1.61, P<0.001). ConclusionThe data analysis results from the SEER database suggest that the long-term overall survival of RFA treatment is superior to XRT treatment for patients with AJCC stage Ⅰ or Ⅱ.