Clinical practice was an important part in the medical education.To improve the clinical education quality of obstetrics and gynecology,several methods were chosen to settle the problems such as setting up and perfecting the management mechanism,strengthening the construction of teachers and the cultivation of students’overall quality.

Objective To discuss effects of thoracoscopic lobectomy on early-stage non-small cell lung cancer . Methods 60 patients with non-small cell lung cancer patients were randomly divided into two groups of 30 cases in each group using thoracoscopic lobectomy (VATS) treatment,as the VATS group,another group using traditional open surgery(TOS) therapy,TOS as a group.(1) Operative time,blood loss,postoperative drainage time,drainage, postoperative pain,postoperative bed days,after several days of hospitalization were compared between the two groups . (2) 1,3 and 5 days after surgery,serum C-reactive protein(CRP) and interleukin-6(IL-6)levels were compared. Results (1)were operative time,postoperative drainage time,pain time,bed time and hospitalization time in VATS group were (69.50 ±15.33)min,(60.23 ±9.75)h,(46.75 ±7.36)h,(3.54 ±1.58)d,(9.50 ±2.50)d,com-pared with TOS group (86.77 ±19.56)min,(66.50 ±10.50)h,(58.36 ±9.58)h,(5.50 ±1.55)d,(13.55 ± 3.18)d short d observed group blood loss ,drainage volume(161.55 ±25.54)mL,(155.75 ±23.18)mL,compared with TOS group(186.58 ±25.35)mL,(169.65 ±26.87)mL less,the difference was statistically significant (t =39.14,28.19,54.11,6.03,7.24,98.36,76.34,all P<0.05).(2) VATS group after 1,3 and 5 days CRP serum and were(79.58 ±22.15) mg/L,(97.23 ±28.16) mg/L,(98.44 ±27.19) mg/L,IL-6,respectively (69.36 ± 17.32) ng/L, ( 96.33 ±25.67 ) ng/L, ( 103.16 ±28.89 ) ng/L, were higher than the TOS group ( 97.84 ± 25.37)mg/L,(119.17 ±31.77)mg/L,(130.81 ±33.29)mg/L,(76.83 ±21.97)ng/L,(121.15 ±32.64)ng/L, (122.08 ±30.74)ng/L,the difference was statistically significant (t=70.12,58.33,69.17,64.34,79.58,92.17,all P<0.05).Conclusion VATS lobectomy for non-small cell lung cancer has better effects and safety .

Objective: To analyze the correlations between cholecystolithiasis or cholecystectomy and the risk of colorectal cancer, and make a brief summary combining with the present study. Methods: Qualified studies about the correlations between cholecystolithiasis or cholecystectomy and the risk of colorectal cancer published in English and Chinese before April 2018 were retrieved from PubMed, Cochrane Library, China National Knowledge Infrastructure(CNKI), Wan Fang Data, and VIP. Case-control and cohort studies were selected according to the inclusion and exclusion criteria and assessed by the Newcastle-Ottowa Scale, then we chose the high-quality literature to extract the data and analyze those data by RevMan 5.3 software. Publication bias was analyzed by Stata 12.1 software. Results: A total of 28 articles were finally included in the systematic review, including 23 case-control studies and 5 cohort studies. The results showed that there is a significant relationship between cholecystolithiasis and the risk of colorectal cancer(OR=1.70, 95%CI: 1.39~2.08, P<0.05)、colon cancer(OR=1.74, 95%CI: 1.36~2.23, P<0.05)、rectal cancer (OR=1.35, 95%CI: 1.02~1.80, P<0.05). The results showed a risk of colorectal cancer(OR=1.31, 95%CI: 1.14~1.51, P<0.05) and colon cancer (OR=1.20, 95%CI: 1.05~1.36, P<0.05) after cholecystectomy, but the risk is significantly less than the risk in patients with gallstone. And there is no relevance between cholecystectomy and the risk of rectal cancer(OR=0.89, 95%CI: 0.73~1.08, P>0.05). Conclusion There is a positive association between cholecystolithiasis and colorectal cancer, but cholecystectomy itself may be not the risk of rectal cancer.

Background: The use of molecular categorisation is shifting paradigm towards the use of molecular information to refine risk stratification in endometrial cancer (EC). To date, evidence to support molecular-guided therapies is limited to retrospective studies and secondary molecular analyses of patients receiving standard treatment. The PROBEAT study is the first randomized phase III trial to evaluate tailored adjuvant treatment based on WHO-endorsed molecular classification in Chinese EC patients. It is expected to provide a clinical decision-making tool for adjuvant treatment of patients with high-intermediate risk (HIR) or intermediate risk (IR) EC to better optimise and personalise patient care and increase relapse-free survival. Methods The PROBEAT trial is a prospective, multicentre study led by Women’s Hospital of Zhejiang University Gynaecologic Oncology Group. Recruitment started on January 24, 2022, and 590 patients with HIR or IR endometrioid EC are expected to be recruited from 13 clinical centres in China. All tumor tissues will be classified into four molecular subtypes (POLEmut, MMRd, p53abn, or NSMP) based on WHO-endorsed molecular classification. Patients will be randomly assigned at a 2:1 ratio to either experimental arm and will receive molecular profile-based adjuvant treatment (observation in the POLEmut subgroup, vaginal brachytherapy in the MMRd or NSMP subgroup, or chemoradiotherapy in the p53abn subgroup) or to standard arm and will receive preferred adjuvant radiotherapy as recommended by the recent National Comprehensive Cancer Network guidelines version 1 (2022). The primary outcome is 3-year rates of recurrence. Secondary outcomes are relapse-free survival, overall survival, adverse events and health-related cancer-specific quality of life.

Objective By analyzing the cases of cryptorchidism owing to dysplasia in children to explore how to apply orchidectomy in the treatment of children with cryptorchidism. Methods Two hundred and seven cryptorchi-dism patients with dysplasia who underwent surgical treatment were collected in the Department of Urology,Anhui Province Children′s Hospital Affiliated to Anhui Medical University from July 2005 to May 2016. All the patients were true cryptorchidism,aged from 0. 6 to 11. 4 years [(4. 7 ± 1. 2)years]. There were 78 cases of left cryptorchidism,104 cases of right cryptorchidism and 25 cases of bilateral cryptorchidism. All cases underwent ultrasound examination be-fore surgery,showing that there were no testis in 53 cases,testicular atrophy or dysplasia in 154 cases. All cases under-went surgical treatment,including 149 cases of inguinal incision alone,groin incision combined with laparoscopic explo-ration in 47 cases and simple laparoscopic surgery in 11 cases. Communication with the parents of all the children was conducted during operation. One hundred and sixty - seven cases of mild and moderate testicular dysplasia underwent testicular descending fixation. Forty cases of severe dysplasia or testicular atrophy,including 16 cases of intrahepatic unilateral cryptorchidism and 22 cases of unilateral cryptorchidism outside the abdomen which underwent testicular resection,while 2 cases of bilateral cryptorchidism with severe dysplasia underwent bilateral testicular descent fixation after communication with the parents of the children during operation. All the specimens were sent for pathological examination after the operation. One hundred eighty - six cases were followed up from 1 to 128 months [(53 ± 8) months],and 21 cases were lost. Ultrasound examination was performed from 3 to 6 months after the operation to observe the development of bilateral testis and whether testicular dysplasia or testicular atrophy existed. Results All the children successfully underwent the operation and discharged from hospital. The group who underwent testicular had confirmed slim blood vessels in spermatic cord and poor testicular development through operation,while another group in postoperative follow up ultrasound showed that there was no obvious testicular - like structure in 6 cases,complete atrophy in 12 cases and partial atrophy in 48 cases and no atrophy in 93 cases. No patients had testicular resection again and no canceration after the operation. The healthy sides of the testicular resection in another group all had normal development. Conclusions Mild and moderate testicular dysplasia in children can choose testicular descending fixation,while severe dysplasia or testicular atrophy should select a reasonable surgical approach after communication with families.

Objective:To evaluate the risk of HBV recurrence after liver transplantation in patients with end-stage hepatitis B related liver disease, and to explore the indications for antiviral therapy withdrawal.Methods:The data of HBV DNA, cccDNA in liver puncture tissues and peripheral blood in 31 patients after liver transplantation was retrospectively analyzed.Results:Among the 31 patients, 15 (48%) had detectable and quantified HBV DNA in liver biopsy tissue, while their HBV related serological indicators were negative, suggesting an occult HBV infection in some patients. The study found 15 out of 19 cases who were taking Entecavir were cccDNA negative (78.9%), compared to 5 out of 12 cases (41.6%) in Lamivudine regiment ( P=0.03). Conclusions:Hidden HBV infection can be detected by amplifying cccDNA and HBV DNA in liver puncture tissue by using ddPCR. Entecavir is superior to lamivudine in the clearance of cccDNA.

Objective To investigate the value of the preoperative Child-Pugh score and albuminbilirubin (ALBI) score predicting posthepatectomy liver failure (PHLF) and prognosis of patients with hepatocellular carcinona (HCC).Methods The retrospective cohort study was conducted.The clinical data of 226 HCC patients who were admitted into the People's Hospital of Peking University between January 2010 and October 2014 were collected.After preoperative related examinations,feasibility and extent of liver resection were discussed according to patients' conditions by muhidisciplinary team,and then surgery was performed.Observation indicators:(1) surgical situations;(2) factors analysis affecting PHLF of HCC patients;(3) receiver operating characteristic (ROC) curve analysis of Child-Pugh and ALBI scores predicting PHLF;(4) follow-up and survival situations;(5) prognosis analysis of HCC patients after hepatectomy.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival up to August 2016.Measurement data with normal distribution were represented as-±s.Measurement data with skewed distribution were described as M (P25,P75).The survival curve was drawn by the Kaplan-Meier method,and the Log-rank test was used for survival analysis.The influencing factors of PHLF were analyzed using the logistic regression model.The prognostic factors were analyzed by the COX regression model.ROC analysis was used for predictive value of Child-Pugh and ALBI scores.Results (1) Surgical situations:226 patients underwent successful surgery,including 171 receiving localized liver resection (＜ 3 Couinaud hepatic segments resection) and 55 receiving extensive liver resection (≥ 3 Couinaud hepatic segments resection).Volume of intraoperative blood loss of 226 patients was 1-22 550 mL,with a median of 800 mL.Of 226 patients,89,9,4,4,3 and 1 were complicated with liver failure,pulmonary infection,bile leakage,gastrointestinal henorrhage,incision infection and infectious shock,respectively,they were cured and discharged from hospital by life-sustaining treatment and symptomatic treatment.Duration of hospital stay was 2-49 days,with a median of 12 days.(2) Factors analysis affecting PHLF of HCC patients:results of univariate analysis showed that gender,total bilirubin (TBil),albumin (Alb),prothrombin time (PT),international normalized ratio (INR),platelet (PLT),peritoneal effusion,volume of intraoperative blood loss,Child-Pugh score and ALBI score were related factors affecting PHLF of HCC patients [Odds ratio (OR) =O.490,1.077,0.763,1.613,26.342,0.990,2.458,5.052,2.875,34.570,95％ confidence interval (CI):0.248-0.971,1.030-1.127,0.699-0.833,1.248-2.087,2.722-254.936,0.985-0.995,1.386-4.361,2.467-10.347,1.807-4.576,11.674-102.376,P＜0.05].Child-Pugh score and ALBI score in the multivariate analysis were respectively analyzed using the logistic regression model for avoiding multicollinearity.Excluding TBil,Alb,PT and peritoneal effusion,logistic regression model of Child-Pugh score showed that PLT,volume of intraoperative blood loss and Child-Pugh score were independent factors affecting PHLF of HCC patients (OR=0.991,4.462,2.412,95％CI:0.986-0.996,2.090-9.527,1.479-3.934,P＜0.05).Excluding TBil and Alb,Logistic regression model of ALBI score showed that PLT,volume of intraoperative blood loss and ALBI score were independent factors affecting PHLF of HCC patients (OR=O.990,4.867,42.947,95％CI:O.984-0.995,2.088-11.346,12.409-148.637,P＜ 0.05).(3) ROC analysis of Child-Pugh and ALBI scores predicting PHLF:area under the ROC was respectively 0.652 (95％CI:0.577-0.727) in the Child-Pugh score and 0.801 (95％CI:0.741-0.861) in the ALBI score,with a statistically significant difference (Z=3.590,P＜0.05).The best critical value,sensitivity and specificity of PHLF that were predicted by ALBI score were-2.58,68.5％ and 86.9％,respectively.Further analysis showed that area under the ROC was respectively 0.642 (95％CI:0.554-0.731) in Child-Pugh score and 0.813 (95％CI:0.744-0.882) in ALBI score,excluding factors of extensive liver resection affecting PHLF,with a statistically significant difference (Z=3.407,P＜0.05).(4)Follow-up and survival situations:of 226 patients,217 were followed up for 1.3-79.5 months,with a median time of 29.5 months.During the follow-up,134 patients had survival and 92 died.(5) Prognosis analysis of HCC patients after hepatectomy:results of univariate analysis showed that Alb,PLT,alpha-fetoprotein (AFP),peritoneal effusion,tumor diameter,extent of resection,combined portal vein tumor thrombus (PVTT),combined vascular tumor thrombus and Child-Pugh score were related factors affecting prognosis of HCC patients [Hazard Ratio (HR)=0.954,1.003,2.958,1.698,1.155,1.785,2.326,3.001,1.324,95％CI:0.911-0.999,1.000-1.005,1.955-4.476,1.115-2.585,1.103-1.209,1.138-2.802,1.310-4.130,1.983-4.546,1.037-1.690,P ＜ 0.05].Excluding Alb and peritoneal effusion for avoiding multicollinearity,results of multivariate analysis showed that AFP,tumor diameter,combined vascular tumor thrombus and Child-Pugh score were independent factors affecting prognosis of HCC patients (HR =2.237,1.080,2.122,1.309,95％ CI:1.439-3.476,1.028-1.134,1.362-3.305,1.010-1.697,P＜0.05).Further analysis of Kaplan-Meier curve showed that median survival time in patients with grade A and B of Child-Pugh score were respectively 30.6 months and 25.2 months,with a statistically significant difference in survival (x2 =4.491,P＜0.05).The median survival time in patients with grade 1 and 2 of ALBI score were respectively 29.6 months and 31.0 months,with no statistically significant difference in survival (x2 =0.539,P＞0.05).Conclusion Preoperative ALBI score in predicting PHLF is superior to that of Child-Pugh score,but ALB1 score is not independent factor affecting prognosis of HCC patients.

We conducted a prospective study to assess the non-inferiority of adjuvant chemotherapy alone versus adjuvant concurrent chemoradiotherapy (CCRT) as an alternative strategy for patients with early-stage (FIGO 2009 stage IB-IIA) cervical cancer having risk factors after surgery. The condition was assessed in terms of prognosis, adverse effects, and quality of life. This randomized trial involved nine centers across China. Eligible patients were randomized to receive adjuvant chemotherapy or CCRT after surgery. The primary end-point was progression-free survival (PFS). From December 2012 to December 2014, 337 patients were subjected to randomization. Final analysis included 329 patients, including 165 in the adjuvant chemotherapy group and 164 in the adjuvant CCRT group. The median follow-up was 72.1 months. The three-year PFS rates were both 91.9%, and the five-year OS was 90.6% versus 90.0% in adjuvant chemotherapy and CCRT groups, respectively. No significant differences were observed in the PFS or OS between groups. The adjusted HR for PFS was 0.854 (95% confidence interval 0.415-1.757; P = 0.667) favoring adjuvant chemotherapy, excluding the predefined non-inferiority boundary of 1.9. The chemotherapy group showed a tendency toward good quality of life. In comparison with post-operative adjuvant CCRT, adjuvant chemotherapy treatment showed non-inferior efficacy in patients with early-stage cervical cancer having pathological risk factors. Adjuvant chemotherapy alone is a favorable alternative post-operative treatment.
Female ; Humans ; Uterine Cervical Neoplasms/drug therapy* ; Prospective Studies ; Quality of Life ; Neoplasm Staging ; Chemoradiotherapy ; Chemotherapy, Adjuvant/adverse effects* ; Adjuvants, Immunologic ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Retrospective Studies