目的 探讨贵州地区进行宫颈癌机会性筛查的价值。 方法 回顾性分析2010年11月－2011年10月贵州省人民医院妇科门诊及住院进行宫颈癌机会性筛查的1 842例患者资料，筛查方法包括液基细胞学技术、宫颈刮片、人乳头瘤病毒（HPV）分型检测、HPV第2代捕获杂交法检测、阴道镜检查，以病理确诊宫颈癌前病变及宫颈癌。 结果 贵州地区女性人群的HPV平均感染率为21.87%。共检出宫颈癌前病变39例（2.12%），宫颈癌2例（0.11%）。 结论 医院内就诊女性宫颈病变检出率高，应高度重视其机会性筛查，有助于早期干预治疗。
Objective To analyze the value of serum microRNAs (miR-218, miR-329, and miR-567) in predicting the clinical efficacy of programmed death-1 (PD-1) inhibitor combined with synchronous chemotherapy in patients with non-small cell lung cancer (NSCLC). Methods A total of 160 patients with NSCLC treated with PD-1 inhibitor combined with synchronous chemotherapy in Taiyuan Hospital, Peking University First Hospital between January 2021 and January 2023 were prospectively selected as the study objects by convenience sampling, and the serum levels of miR-218, miR-329, and miR-567 and the clinical efficacy of the patients were collected. According to the clinical efficacy, the patients were divided into remission group (partial remission and complete remission) and non-remission group (stable disease and disease progression). Receiver operating characteristic (ROC) curve was used to analyze the predictive value of serum miR-218, miR-329 and miR-567 levels in the clinical efficacy of PD-1 inhibitor combined with synchronous chemotherapy in patients with NSCLC. Results Of the 160 patients, 34 (21.2%) had disease progression, 85 (53.1%) had stable disease, 39 (24.4%) had partial remission, and 2 (1.2%) had complete remission. They were divided into remission group (41 cases) and non-remission group (119 cases). Multiple logistic regression analysis showed that high levels of serum miR-218, miR-329, and miR-567 could promote the clinical efficacy of PD-1 inhibitor combined with synchronous chemotherapy in patients with NSCLC (all P<0.05). ROC curve analysis showed that, for predicting the clinical efficacy of PD-1 inhibitor combined with synchronous chemotherapy in patients with NSCLC according to the cut-off value of the joint prediction probability of serum miR-218, miR-329, and miR-567, the area under the ROC curve was 0.938 [95% confidence interval (0.855, 0.964)], and the sensitivity, specificity, positive predictive value, and negative predictive value were 82.9%, 92.4%, 79.1%, and 94.0%, respectively. Conclusion The combined detection of serum miR-218, miR-329 and miR-567 levels has a high predictive value for the therapeutic effect of PD-1 inhibitor combined with synchronous chemotherapy in patients with NSCLC.
Objective To explore the effects of lecture-based learning (LBL), problem-based learning (PBL) or combination of both on the cardiovascular system anatomy teaching. Methods Nine classes majoring in clinical medicine of Grade 2009 were randomly divided into the LBL class, the PBL class and the PBL combined with LBL class. The examination scores and questionnaire were used to evaluate the teaching effect. Results The students of LBL class did well in the objective questions test, but badly in case analysis. On the contrary, the students of PBL class did well in case analysis, but were weak in objective questions test. However, the students of PBL combined with LBL class could get good grades in both of them. Questionnaire showed that the PBL teaching method, PBL and LBL combined method could improve their communicative ability, learning motivation, comprehensive analysis ability, language skills and so on. Conclusion Combination of PBL and LBL not only enhances students’ memories about the anatomic knowledge, but also helps students practice efficiently what they learned to analyze clinical cases. Furthermore, the method of PBL combined with LBL improves, to a certain extent, students’ comprehensive quality.
Objective To investigate the surgical technique and effectiveness of anatomical posterolateral complex (PLC) reconstruction in treating severe posterolateral knee instability using Y-shaped allogeneic Achilles tendon. Methods The clinical data of 12 patients with Fanelli type C chronic PLC injury with severe posterolateral knee instability who met the selection criteria between June 2013 and August 2017 were retrospectively analyzed. There were 9 males and 3 females, with a median age of 34.5 years (range, 18-57 years). The average time from injury to surgery was 10.5 months (range, 3-24 months). All of them were multi-ligament injuries and were treated with anatomical reconstruction of Y-shaped allogeneic Achilles tendon. The posterior and varus stress X-ray films were used to measure and calculate the difference of posterior displacement of tibia and difference of lateral joint opening distance between bilateral knees to evaluate the backward stability of LCL and knee joint; the knee flexion 30° tibial external rotation test was used to calculate the difference of tibial external rotation angle between bilateral knees to evaluate the stability of knee external rotation. The knee function was evaluated by the International Knee Documentation Committee (IKDC) 2000 subjective and objective scores. ResultsThe operation successfully completed in 12 patients, and there was no vascular and nerve injury during operation. The operation time was 2.5-3.5 hours, with an average of 2.7 hours; the intraoperative blood loss was 20-100 mL, with an average of 55 mL. All patients were followed up 13-41 months, with an average of 28.1 months. At last follow-up, the difference of posterior displacement of tibia, the difference of lateral joint opening, the difference of tibial external rotation angle between bilateral knees, and the IKDC2000 subjective score, the objective scores of tibial external rotation and knee varus significantly improved when compared with those before operation (P<0.05). The knee joint of 1 patient with anterior cruciate ligament, posterior cruciate ligament, and PLC reconstruction was stiff at 15 months after operation, and the range of motion of the knee joint was 10°-80°. After arthroscopic release, the range of motion of the knee joint was 5°-120°, the reconstructed ligament was stable. In the other patients, the knee flexion angle was normal in 2 cases; 9 cases had knee flexion limitation of 5°-10°, with an average of 6.4°; no knee extension was limited. ConclusionAnatomical PLC reconstruction using Y-shaped allogeneic Achilles tendon can effectively treat Fanelli type C chronic PLC injury with severe posterolateral knee instability and improve the knee joint stability.